Court Opinion

ID: 9840018
Source: CourtListenerOpinion
Date Created: 2023-09-14 21:11:50.974508+00
Date Added: 2024-06-11T09:43:01.001153
License: Public Domain

FILED
                                                                          September 14, 2023
                                                                            EDYTHE NASH GAISER, CLERK
                                                                            SUPREME COURT OF APPEALS
                                                                                OF WEST VIRGINIA

                             STATE OF WEST VIRGINIA
                           SUPREME COURT OF APPEALS

Darrell E. McDaniel,
Claimant Below, Petitioner

vs.)   No. 21-1006     (BOR Appeal No. 2056900)
                        (Claim No. 2019025078)

ANR, Inc.,
Employer Below, Respondent

                              MEMORANDUM DECISION

        Petitioner Darrell E. McDaniel appeals the decision of the West Virginia Workers’
Compensation Board of Review dated November 19, 2021, in which the Board determined that
Mr. McDaniel has not met the whole person impairment threshold for pursuing permanent total
disability benefits. Respondent ANR, Inc., filed a timely response. 1 The Board of Review affirmed
the June 4, 2021, decision of the Workers’ Compensation Office of Judges (“Office of Judges”),
which affirmed the denial of the request for a permanent total disability award by the claims
administrator on July 9, 2020. Upon our review, we determine that oral argument is unnecessary
and that a memorandum decision affirming the Board of Review’s decision is appropriate. See W.
Va. R. App. P. 21.

        Mr. McDaniel sustained multiple work-related injuries during his forty-one years of
employment in the coal mines. On May 31, 2019, Mr. McDaniel filed a permanent total disability
application indicating that he had been awarded 63.37% in permanent partial disability benefits
from his various occupational injuries and diseases. On July 23, 2019, the claims administrator
found that he met the minimum requirements for further consideration of a permanent total
disability award. 2 In accordance with West Virginia Code § 23-4-6(n)(1), Mr. McDaniel’s claim

       1
        Darrell E. McDaniel is represented by Reginald D. Henry, and ANR, Inc., is represented
by H. Dill Battle III.
       2
          Pursuant to West Virginia Code § 23-4-6(n)(1), a claimant must first meet the eligibility
threshold by demonstrating that he or she has been awarded the sum of 50% in permanent partial
disability award, or 35% in statutory disability awards. Most often the eligibility threshold is
determined by simply adding the claimant’s prior permanent partial disability awards. Once the
eligibility threshold has been satisfied, the claimant will be reevaluated for a determination as to
whether he or she meets the whole-person medical impairment threshold by being assessed with
at least 50% whole-person impairment from all compensable injuries/diseases, or a 35% statutory
award. Id.
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was referred to the Permanent Total Disability Review Board (“PTD Review Board”) to be
reevaluated for a determination as to whether he meets the whole person medical impairment
threshold by being assessed with at least 50% whole person impairment from all compensable
injuries/diseases.

       The PTD Review Board referred Mr. McDaniel to Joseph Grady, M.D., who prepared a
report dated February 12, 2020, concluding that Mr. McDaniel was at maximum medial
improvement with regard to all orthopedic injuries. In his report, Dr. Grady opined that Mr.
McDaniel had a total of 29% whole person impairment. Dr. Grady found 9% for the right
extremity, 8% for the left upper extremity, 8% for the cervical spine, and 8% for the lumbar spine.
Dr. Grady concluded that Mr. McDaniel’s impairment ratings included the bilateral upper
extremities, as well as the cervical and lumbar spine injuries. However, Dr. Grady’s impairment
recommendation excluded Mr. McDaniel’s occupational pneumoconiosis and occupational
hearing loss ratings.

        Mr. McDaniel was then referred to Dominic Gaziano, M.D., for evaluation of his
occupational pneumoconiosis claims on February 13, 2020. In his report dated February 17, 2020,
Dr. Gaziano opined that Mr. McDaniel has chronic obstructive pulmonary disease with significant
reversibility of a minor degree. Based upon the significant reversibility of the bronchitis condition,
Dr. Gazino found that the pulmonary function impairment of 15%, recommended by the
Occupational Pneumoconiosis Board, is a valid measurement of Mr. McDaniel’s pulmonary
functional impairment.

       For his history of occupational noise-induced hearing loss, Mr. McDaniel was evaluated
by David Phillips, M.D., on March 2, 2020. Dr. Phillips reviewed an audiogram conducted by A.
James Paine, M.D., with the Ear, Nose, and Throat Associates of Charleston, in 2019 and
determined that the audiogram was the most accurate indicator of impairment at the time of Mr.
McDaniel’s retirement. Dr. Phillip’s agreed with Dr. Paine that Mr. McDaniel’s rating of whole
person impairment should be 1.366% whole person impairment due to noise-induced hearing loss.

         The impairment recommendations of Drs. Grady, Gaziano, and Phillips were referred to
Randall Short, M.D., to determine Mr. McDaniel’s combined whole person impairment. In his
report dated March 30, 2020, Dr. Short utilized the Combined Values Chart on page 322 of the
American Medical Association’s Guides to the Evaluation of Permanent Impairment (4th ed. 1993)
(“AMA Guides”) and found that Mr. McDaniel has a total of 41% whole person impairment for
all of his compensable conditions.

        On April 8, 2020, the PTD Review Board issued its initial recommendations. It was found
that Mr. McDaniel had a 41% whole person impairment for all of his compensable injuries based
upon Dr. Grady’s recommendation of 29%, 15% for occupational pneumoconiosis, and 1.366%
for hearing loss. The PTD Review Board determined that Mr. McDaniel had not met the minimum
requirements for further consideration for an award of permanent total disability of either 50%
resulting from compensable injuries or of 35% statutory disability under West Virginia Code § 23-
4-6(f). The PTD Review Board issued its final decision on July 9, 2020, finding that Mr. McDaniel

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did not satisfy the 50% whole body medical impairment threshold. Mr. McDaniel filed a protest,
and the Office of Judges assumed jurisdiction over the issue.

        In support of his protest, Mr. McDaniel submitted the Evaluation for PTD report of Robert
B. Walker, M.D., dated September 17, 2020. Dr. Walker reviewed the claimant’s medical history
and conducted a physical examination, while noting that Mr. McDaniel suffers from chronic pain
in the neck and lower back, along with significant trauma in both upper extremities that interferes
with “handling, lifting, and carrying.” After his examination, Dr. Walker concluded that Mr.
McDaniel’s impairment ratings would include bilateral upper extremities, cervical and lumbar
spine injuries, occupational hearing loss, and occupational pneumoconiosis. Dr. Walker opined
that Mr. McDaniel has 55% whole person impairment under the AMA Guides. The 55% whole
person impairment was based upon a finding of 14% for the right upper extremity; 13% for the
left upper extremity; 15% for the cervical spine; 15% for the lumbar spine; 15% for occupational
pneumoconiosis; and 1% for occupational hearing loss.

         ANR, Inc., requested a record review of the independent medical evaluation reports of Drs.
Grady and Walker by Marsha L. Bailey, M.D. In her report dated February 1, 2021, Dr. Bailey
opined that Dr. Grady’s impairment recommendations were easy to follow and supported by his
physical examination findings. Dr. Bailey agreed with the opinions and impairment ratings given
by Dr. Grady in his February 12, 2020, report. However, Dr. Bailey found numerous errors in Dr.
Walker’s September 17, 2020, impairment recommendations. Dr. Bailey noted that Dr. Walker
failed to follow the General Measurement Principles under the Range of Motion Model for the
examination of Mr. McDaniel’s spine. Dr. Walker provided only two measurements for each
cervical and lumbar spine range of motion where the AMA Guides direct examiners to select at
least three consecutive spine range of motion measurements. Dr. Bailey also found that Dr. Walker
failed to apply the validity test for spine range of motion measurements as set forth by the General
Measurements Principles. Dr. Bailey opined that Dr. Walker failed to apply the State of West
Virginia validity tests as instructed on the Low Back Examination form. Dr. Walker also did not
provide straight leg measurements when Mr. McDaniel was seated, and, therefore, he could not
compare those measurements for validity or symptom amplification. Dr. Bailey questioned Dr.
Walker’s application of the Table ratings for Mr. McDaniel’s cervical and lumbar spine
recommendations, as well as the impairment rating for right carpal tunnel syndrome. Using Dr.
Walker’s physical examination findings and measurements, Dr. Bailey found a combined total of
47% whole person impairment.

        In a decision dated June 4, 2021, the Office of Judges found that Mr. McDaniel has not
established by a preponderance of the evidence that he has whole person impairment of 50% or
more from his compensable injuries. Dr. Walker’s recommendations for the cervical and lumbar
spine were found to be unreliable. The Office of Judges determined that the only reliable rating
for Mr. McDaniel’s cervical and lumbar spine was from Dr. Grady, who opined 8% whole person
impairment. The Office of Judges stated, “[e]ven if one were to combine the 8% for the cervical
and the 8% for the lumbar spine with the remaining highest impairment ratings for the remaining
injuries regardless of reliability, the claimant would not meet or exceed the 50% WPI threshold
requirement. . . per the Combined Values Chart of the AMA Guides” The Office of Judges
concluded that the claims administrator was not in error in finding that Mr. McDaniel does not
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suffer from a whole body medical impairment of 50% or more resulting from either a single
occupational injury or occupational disease, or a combination of such injuries or disease. The
Board of Review adopted the findings of fact and conclusions of law of the Office of Judges and
affirmed the June 4, 2021, decision in an order dated November 19, 2021.

        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
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. V. Off. Ins. Comm’n., 230 W. Va.
80, 83, 736 S.E.2d 80, 83 (2012).

        This case is before this Court to determine whether or not Mr. McDaniel has met the second
threshold to entitle him to further consideration for a permanent total disability award. It is Mr.
McDaniel’s position that the Board of Review’s decision is clearly wrong and should be reversed
because a preponderance of the evidence of record establishes that he has a total of 63.37%
permanent impairment from his various occupationally related injuries and diseases. As such, he
maintains that he has met the whole person impairment threshold for further consideration of a
permanent total disability award. ANR, Inc., argues that Mr. McDaniel has not demonstrated with
reliable and credible evidence that the Office of Judges was clearly wrong in affirming the July 9,
2020, order denying his application for permanent total disability benefits because he did not suffer
50% or more whole body medical impairment, as required under West Virginia Code § 23-4-
6(n)(1).

        After review, we agree with the conclusions of the Office of Judges as affirmed by the
Board of Review. In this claim, the PTD Review Board determined that Mr. McDaniel has 41%
whole person impairment, and he does not have whole person impairment of at least 50%. Mr.
McDaniel contends that he has met the statutory threshold based upon his prior awards and the
assessment of Dr. Walker. However, the record indicates that Dr. Walker’s impairment assessment
was unreliable because he failed to correctly apply the AMA Guides, and he did not correctly apply
the Tables of West Virginia Code of State Rules § 85-20 for cervical and lumbar spine impairment
recommendations. Because Mr. McDaniel’s argument and recalculation of impairment relies upon
the recommendation of Dr. Walker, he has not submitted sufficient evidence to support a finding
that the PTD Review Board was clearly wrong. Thus, Mr. McDaniel is not eligible for further
consideration for a permanent total disability award. The evidentiary record supports the Board of
Review’s decision, and the order dated November 19, 2021, is affirmed.

                                                                                           Affirmed.

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ISSUED: September 14, 2023

CONCURRED IN BY:

Chief Justice Elizabeth D. Walker
Justice Tim Armstead
Justice John A. Hutchison
Justice William R. Wooton
Justice C. Haley Bunn

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