Court Opinion

ID: 9892321
Source: CourtListenerOpinion
Date Created: 2023-10-23 16:15:19.901852+00
Date Added: 2024-06-11T08:03:59.493993
License: Public Domain

FILED
                                                                              October 23, 2023
                            STATE OF WEST VIRGINIA                             EDYTHE NASH GAISER, CLERK
                                                                               SUPREME COURT OF APPEALS
                          SUPREME COURT OF APPEALS                                 OF WEST VIRGINIA

James P. May,
Claimant Below, Petitioner

vs.)   No. 22-0121    (BOR Appeal No. 2057182)
                       (JCN: 2021006223)

B E T, LTD,
Employer Below, Respondent

                              MEMORANDUM DECISION

        Petitioner James P. May appeals the decision of the West Virginia Workers’ Compensation
Board of Review (“Board of Review”). B E T, LTD, filed a timely response. 1 The issues on appeal
are compensability and medical benefits. The claims administrator rejected the claim on October
21, 2020. On November 6, 2020, the claims administrator denied authorization of a request for
lower back physical therapy. The Workers’ Compensation Office of Judges (“Office of Judges”)
affirmed the decisions in its July 7, 2021, order. The order was affirmed by the Board of Review
on January 20, 2022. Upon our review, we determine that oral argument is unnecessary and that
this case satisfies the “limited circumstances” requirement of Rule 21(d) of the Rules of Appellate
Procedure and is appropriate for a memorandum decision rather than an opinion. See W. Va. R.
App. P. 21.

        Mr. May, a parts manager, alleges that he injured his lower back in the course of his
employment on September 18, 2020. Mr. May was previously treated for lower back issues by
Nicholas Bremer, M.D., on May 7, 2019. Dr. Bremer noted that Mr. May was evaluated for chronic
low back pain that was present for approximately six months and had progressively worsened. Mr.
May stated that the lower back pain radiated into his hips and both legs to his knees. Dr. Bremer
diagnosed sacroilitis, lumbosacral spondylosis without myelopathy or radiculopathy, lumbar
radiculopathy, and chronic pain syndrome. Mr. May was seen by Ashley Comer, APRN NP-C, on
June 11, 2019, for low back and bilateral hip pain and follow-up after bilateral sacroiliac joint
injections. The assessments were sacroilitis and chronic pain syndrome. On September 4, 2019,
Mr. May reported to Kelley Whoolery, PA-C, that he hurt his back three years prior and was taking
Baclofen. Mr. May was again seen on March 3, 2020, and September 14, 2020. PA-C Whoolery
recommended physical therapy.

       1
        Petitioner, James P. May, is represented by Patrick K. Maroney, and respondent, B E T,
LTD, is represented by James W. Heslep.
                                                1
        On September 23, 2020, Mr. May sought treatment from PA-C Whoolery for a low back
injury that occurred four days prior while Mr. May was pulling on a jack at work. It was noted that
Mr. May had a history of back pain that radiated to the left leg and that he had previously
undergone injections. Following the alleged injury at issue, Mr. May reported low back pain that
radiated down his left leg to his foot. PA-C Whoolery diagnosed backache, unspecified dorsalgia,
and lumbar radiculopathy. 2

        A September 29, 2020, treatment note from Boone Memorial Hospital (“BMH”) indicates
Mr. May presented to the emergency room for increased back pain after an injury at work a week
and a half prior. Mr. May reported that he was pulling a pallet of ammunition when he felt a sudden
onset of severe low back pain. A CT scan showed mild degenerative changes in the lumbar spine
with no evidence of acute injury. L. Lucas, D.O., completed the report of injury on September 29,
2020, stating that Mr. May injured his back because the pallet jack was too heavy. It was indicated
Mr. May had a lumbar sprain as a result of an occupational injury. However, the diagnoses were
listed as acute low back pain and back muscle spasms.

       On October 6, 2020, Richard Knapp, M.D., with BMH, noted that Mr. May injured his
back and was using a cane to walk. Mr. May had undergone two weeks of physical therapy. An x-
ray was performed that day and showed degenerative changes and no evidence of acute injury. Dr.
Knapp referred Mr. May for an MRI. Mr. May returned to Dr. Knapp on October 13, 2020, and
was advised to continue physical therapy. The claims administrator rejected the claim on October
21, 2020. On November 6, 2020, the claims administrator denied a request from BMH for lower
back physical therapy.

        On December 22, 2020, Mr. May answered interrogatories in which he asserted that he had
no prior injuries, conditions, or other problems with the body part at issue. Mr. May testified in a
March 15, 2021, deposition that on September 18, 2020, a coworker swung a pallet of ammunition
around and when Mr. May attempted to help his coworker steady the pallet, his back gave out. Mr.
May felt immediate pain in his back and left leg. He alleged that he reported his injury to a
coworker, Ross Dillard, but Mr. Dillard claimed to have no knowledge of the injury. Mr. May also
asserted that he reported the injury to his supervisor Kelley Goodpaster.

        Mr. May testified that he left work the day of the alleged injury and sought treatment from
Family Health Associates. He was referred for physical therapy. Mr. May stated that physical
therapy greatly improved his symptoms, and he had not seen a physician since finishing the
treatment. Mr. May testified that no physician prescribed a cane for walking, but he was unable to
walk without one since the September 18, 2020, injury. Mr. May stated that he was off of work
for four weeks following the alleged injury and was then laid off from employment. Mr. May
stated that he had never experienced symptoms like the ones that resulted from the alleged injury.
He admitted that he had previously experienced aches and pains but nothing that prevented him
from working or doing his normal daily activities.

       2
        The note stated “NOT WORKER’S COMP” but it is unclear if Mr. May made that
statement.
                                       2
        The Office of Judges affirmed the claims administrator’s decisions rejecting the claim and
denying authorization of lower back physical therapy. It found that there was confusion in the
record regarding the exact date of injury. Mr. May testified that he was injured on September 18,
2020, but medical records indicate he reported the date as September 21, 2020. Mr. May stated in
interrogatories that he was injured on September 21, 2020. The Office of Judges ultimately found
that the correct date of the alleged injury was September 18, 2020.

        The Office of Judges noted that Mr. May had a history of low back pain. PA-C Whoolery
noted in a September 23, 2020, treatment note that Mr. May previously saw Dr. Bremer for chronic
back pain. PA-C Whoolery noted that Mr. May reported low back pain that radiated into his left
leg following the alleged injury, but the symptoms were the same that Mr. May was treated for
prior to the alleged injury. Further, PA-C Whoolery noted that Mr. May’s complaints on September
23, 2020, were not related to workers’ compensation. The Office of Judges found that when Mr.
May was seen at BMH Emergency Department on September 29, 2020, he was diagnosed with
acute low back pain and back muscle spasms.

        The Office of Judges found that in his answers to interrogatories, Mr. May failed to mention
his previous treatment by Dr. Bremer and denied any prior injuries or issues with his lower back.
The Office of Judges noted that the medical records clearly show Mr. May was diagnosed with
sacroilitis, lumbosacral spondylosis, lumbar radiculopathy, and chronic pain syndrome prior to the
alleged injury. The Office of Judges further found that Mr. May testified in his deposition that his
prior back issues were not as severe as the symptoms that arose following the alleged injury
because his prior symptoms did not prevent him from working or doing his normal daily activities.
The Office of Judges determined that Mr. May was previously treated several times for lower back
pain with medications and injections, and physical therapy was recommended. The Office of
Judges concluded that pursuant to Gill v. City of Charleston, 236 W. Va. 737, 783 S.E.2d 857
(2016) 3, Mr. May did not sustain a discrete new injury on September 18, 2020. The Board of
Review adopted the findings of fact and conclusions of law of the Office of Judges and affirmed
its order on January 20, 2022.

        This Court may not reweigh the evidentiary record, but must give deference to the findings,
reasoning, and conclusions of the Board of Review, and when the Board’s decision affirms prior
rulings by both the Workers’ Compensation Commission and the Office of Judges, we may reverse
or modify that decision only if it is in clear violation of constitutional or statutory provisions, is
clearly the result of erroneous conclusions of law, or is based upon a material misstatement or

       3
        In Syllabus Point 3 of Gill v. City of Charleston, 236 W. Va. 737, 783 S.E.2d 857 (2016),
this Court created a general rule that:

               A noncompensable preexisting injury may not be added as a compensable
       component of a claim for workers’ compensation medical benefits merely because
       it may have been aggravated by a compensable injury. To the extent that the
       aggravation of a noncompensable preexisting injury results in a [discrete] new
       injury, that new injury may be found compensable.

                                                  3
mischaracterization of the evidentiary record. See W. Va. Code §§ 23-5-15(c) & (d). We apply a
de novo standard of review to questions of law. See Justice v. W. Va. Off. Ins. Comm’n, 230 W. Va.
80, 83, 736 S.E.2d 80, 83 (2012).

       After review, we find that the Board of Review’s decision is the result of erroneous
conclusions of law. In Syllabus Point 5 of Moore v. ICG Tygart Valley, Inc., 247 W. Va. 292, 879
S.E.2d 779 (2022), this Court stated that:

               A claimant’s disability will be presumed to have resulted from the
       compensable injury if: (1) before the injury, the claimant’s preexisting disease or
       condition was asymptomatic, and (2) following the injury, the symptoms of the
       disabling disease or condition appeared and continuously manifested themselves
       afterwards. There still must be sufficient medical evidence to show a causal
       relationship between the compensable injury and the disability, or the nature of the
       accident, combined with the other facts of the case, raises a natural inference of
       causation. This presumption is not conclusive; it may be rebutted by the employer.

        In this case, Mr. May clearly had preexisting lower back issues for which he underwent
treatment. However, it is unclear from the record what, if any, symptoms he was experiencing
prior to the alleged injury at issue. Neither the Office of Judges nor the Board of Review had the
opportunity to perform the Moore analysis. We therefore reverse and remand the case to the Board
of Review for further development of the evidentiary record and analysis under Moore. 4

                                                                        Reversed and Remanded.

ISSUED: October 23, 2023

CONCURRED IN BY:
Chief Justice Elizabeth D. Walker
Justice John A. Hutchison
Justice William R. Wooton

DISSENTING:

Justice Tim Armstead
Justice C. Haley Bunn

BUNN, Justice, joined by Justice Armstead, dissenting:

       4
         Pursuant to West Virginia Code § 23-5-8a(a) the Office of Judges was terminated, and
its authority was transferred to the Board of Review.
                                                 4
        I dissent from the majority’s decision in this case because I would have affirmed the Board
of Review’s order. The majority has determined that Mr. May was entitled to an analysis of his
injury under our prior holding in Moore v. ICG Tygart Valley, LLC, 247 W. Va. 292, 879 S.E.2d
779 (2022), which provides that

                       [a] claimant’s disability will be presumed to have resulted
               from the compensable injury if: (1) before the injury, the claimant’s
               preexisting disease or condition was asymptomatic, and
               (2) following the injury, the symptoms of the disabling disease or
               condition appeared and continuously manifested themselves
               afterwards. There still must be sufficient medical evidence to show
               a causal relationship between the compensable injury and the
               disability, or the nature of the accident, combined with the other
               facts of the case, raises a natural inference of causation. This
               presumption is not conclusive; it may be rebutted by the employer.

Syl. pt. 5, id. (emphasis added). I disagree with the majority’s resolution of this case because Mr.
May has not satisfied the first prong of the Moore analysis which requires that his preexisting
condition was “asymptomatic” at the time he sustained his allegedly work-related injury. See id.
(emphasis added). On the contrary, the record evidence demonstrates that the medical provider
who first evaluated Mr. May for the allegedly work-related back injury at issue in this case noted
that, at the time of her examination, Mr. May was already taking two pain-relieving medications,
had received pain management injections and recent x-rays, and had declined referrals to physical
therapy all for a prior back injury that pre-dated his alleged injury at work. Therefore, it is clear
that Mr. May’s preexisting back condition was not “asymptomatic” at the time of his allegedly
work-related injury, and, as a result, he cannot meet the first prong of the Moore analysis. See id.
(emphasis added). Because Mr. May does not satisfy the first element of Moore, reversing the
Board of Review’s decision to the contrary and remanding the case with instructions to conduct
this analysis is not supported by the facts and is patently wrong. Accordingly, I dissent from the
majority’s decision in this case because the Board of Review did not err by affirming the lower
tribunals’ orders finding Mr. May’s allegedly work-related back injury was not compensable and
further denying his request for medical benefits. I am authorized to state that Justice Armstead
joins in this dissenting opinion.

                                                 5