Court Opinion

ID: 9840667
Source: CourtListenerOpinion
Date Created: 2023-09-19 18:12:42.527694+00
Date Added: 2024-06-11T08:10:39.995307
License: Public Domain

FILED
                                                                         September 19, 2023
                                                                           EDYTHE NASH GAISER, CLERK
                                                                           SUPREME COURT OF APPEALS
                                                                               OF WEST VIRGINIA
                            STATE OF WEST VIRGINIA
                          SUPREME COURT OF APPEALS

Steven Gration,
Claimant Below, Petitioner

vs.)   No. 21-0949    (BOR Appeal No. 2056661)
                       (Claim No. 2019010976)

Contura Energy, Inc.,
Employer Below, Respondent

                              MEMORANDUM DECISION

        Petitioner Steven Gration appeals the decision of the West Virginia Workers’
Compensation Board of Review (“Board of Review”). Contura Energy, Inc., filed a timely
response. 1 The issues on appeal are medical benefits, additional compensable conditions, and
temporary total disability benefits. The claims administrator denied a request for authorization of
a right L5-S1 transforaminal epidural steroid injection on December 18, 2019. On July 15, 2020,
the claims administrator denied a request for the addition of lumbosacral intervertebral disc
displacement, lumbar intervertebral disc displacement, and sacroiliac joint sprain to the claim.
Finally, on July 16, 2020, the claims administrator denied a request to reinstate temporary total
disability benefits. The Workers’ Compensation Office of Judges (“Office of Judges”) affirmed
the decisions in its April 21, 2021, Order. The Order was affirmed by the Board of Review on
October 22, 2021. Upon our review, we determine 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. Gration, an electrician, was injured on November 10, 2018, when he stepped in a hole,
twisted, and fell. He was treated at Beckley Area Regional Hospital that day and stated that he
stepped in a hole, twisted his knee, and heard a pop. The claim was held compensable for lumbar
sprain, right knee sprain, and left elbow contusion on November 15, 2018.

        On December 5, 2018, Mr. Gration was treated by Rajesh Patel, M.D., for lower back and
right knee pain. Dr. Patel diagnosed right L5 radiculitis, lumbar sprain, lumbago, lumbar facet,
pain, right knee pain, and possible lumbar disc herniation. Mr. Gration underwent a lumbar MRI
on January 4, 2019, which revealed desiccation of the L4-L5 disc with mild disc space narrowing
at L5-S1; atrophy of the right paraspinous muscles and the lower lumbar level; and stable L4-5
and L5-S1 disc bulges. On March 11, 2019, Dr. Thymius administered a right sacroiliac joint

       1
        Petitioner, Steven Gration, is represented by Reginald D. Henry, and respondent, Contura
Energy, Inc., is represented by H. Dill Battle III.
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steroid injection. Mr. Gration presented for a follow-up appointment on March 20, 2019, and
reported that the injection provided some relief but then wore off. Dr. Patel diagnosed right
sacroiliac joint pain, right L5 radiculitis, lumbar sprain, right sacroiliac joint sprain, lumbago, and
knee pain.

        Mr. Gration underwent a sacroiliac joint injection on May 1, 2019, for the diagnosis of
sacroilitis. In a May 15, 2019, follow-up, Dr. Patel stated that sacroiliac joint injections had not
provided much pain relief for Mr. Gration. His diagnoses were L5-S1 lumbar disc bulging, L4-5
lumbar disc bulging, possible sacroiliac pain, and facet sprain. On June 12, 2019, the claims
administrator granted authorization of a right L5-S1 transforaminal epidural steroid injection,
which was administered on June 17, 2019. On June 29, 2019, Mr. Gration was seen by Melissa
Lilly, PA-C, for follow-up and reported that the injection provided 70% pain relief for four days,
then his pain returned. PA-C Lilly assessed lumbosacral intervertebral disc displacement and
sacroilitis. She recommended a series of three injections and then referral back to Dr. Patel for
surgical options if the injections did not work. On July 30, 2019, the claims administrator
authorized right L5-S1 transforaminal epidural steroid injections. Mr. Gration underwent a
transforaminal epidural steroid injection on September 17, 2019.

       On October 29, 2019, Prasadarao Mukkamala, M.D., performed an independent medical
evaluation in which he found that Mr. Gration had reached maximum medical improvement and
required no further treatment. On October 30, 2019, Mr. Gration returned to PA-C Lilly for follow-
up after his injection. He reported 60-70% pain relief for less than two weeks. PA-C Lilly
recommended he proceed with the third injection.

        Rebecca Thaxton, M.D., opined in a November 18, 2019, physician review that right L5-
S1 transforaminal epidural steroid injections should not be authorized. She noted that the
compensable condition in the claim is low back strain and that a January 7, 2019, MRI showed
disc desiccation, narrowing, atrophy of the muscles, and bulges at L4-5 and L5-S1. Dr. Thaxton
noted that Dr. Mukkamala found Mr. Gration to be at maximum medical improvement with no
motor sensory deficit or signs of radiculopathy. Dr. Thaxton opined that while degenerative
changes may prolong recovery, Mr. Gration did not require the requested transforaminal epidural
steroid injections for the compensable injury. On December 18, 2019, the claims administrator
denied authorization of transforaminal epidural steroid injections.

        In a June 22, 2020, physician review, Syam Stoll, M.D., recommended that Lumbar sprain,
L5-S1 disc bulge, L4-5 disc bulge, and sacroiliac sprain not be added to the claim. He opined that
the mechanism of injury did not support a causal connection between the conditions and the
compensable injury. Dr. Stoll noted that Mr. Gration sustained a lumbar sprain as a result of the
compensable injury and that he reached maximum medical improvement for the condition. He
opined that Mr. Gration’s ongoing complaints of lumbar pain are unrelated to the compensable
injury. On July 15, 2020, the claims administrator denied a request by Dr. Patel for the addition of
lumbosacral intervertebral disc displacement, lumbar intervertebral disc displacement, and
sacroiliac sprain to the claim. The claims administrator closed the claim for temporary total
disability benefits on July 16, 2020.

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        On October 14, 2020, Dr. Patel stated that Mr. Gration was not at maximum medical
improvement. He opined that a spinal cord stimulator should be considered and if that failed, then
Mr. Gration would be at maximum medical improvement. In an October 26, 2020, addendum to
his report, Dr. Patel opined that sacroiliac joint sprain and lumbar sprain are the direct result of the
compensable injury. He stated that the L4-5 and L5-S1 disc protrusions could have resulted from
the compensable injury but also could have been preexisting. Regardless, Dr. Patel asserted that
the disc protrusions became symptomatic as a result of the compensable injury and treatment for
such should be authorized.

        On November 25, 2020, Kenneth Fortgang, M.D., performed an age of injury analysis of
Mr. Gration’s lumbar CT scan in which he determined that there were no acute findings. Dr.
Fortgang also analyzed the lumbar MRI and concluded that the findings noted were all chronic in
nature.

        The Office of Judges affirmed the claims administrator’s denial of authorization of a right
L5-S1 transforaminal epidural steroid injection; denial of a request for the addition of lumbosacral
intervertebral disc displacement, lumbar intervertebral disc displacement, and sacroiliac joint
sprain to the claim; and denial of a request to reinstate temporary total disability benefits. The
Office of Judges found that the evidence did not support the addition of the requested conditions
to the claim. It relied on Dr. Fortgang’s opinion that the MRIs showed chronic findings and no
acute injuries. Dr. Stoll opined that Mr. Gration’s mechanism of injury does not support the
addition of the requested conditions to the claim.

        Regarding the requested transforaminal epidural steroid injections, the Office of Judges
concluded that the treatment was not reasonable or necessary for a compensable condition. Further,
Mr. Gration already underwent two injections, neither of which provided lasting pain relief. The
Office of Judges also found that additional temporary total disability benefits were not necessary.
Dr. Mukkamala found Mr. Gration had reached maximum medical improvement. The Board of
Review adopted the findings of fact and conclusions of law of the Office of Judges and affirmed
its order on October 22, 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. 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. Pursuant to Syllabus Point 5 of Moore v. ICG Tygart Valley, Inc., 247 W. Va.
292, 879 S.E.2d 799 (2022),

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       [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.

        The evidence of record indicates Mr. Gration had preexisting lumbar spine issues;
however, it also indicates that he had no treatment between 2013 and when the compensable injury
occurred on November 10, 2018. Following the compensable injury, Mr. Gration suffered from
continuous low back symptoms. Dr. Patel opined that the disc protrusions became symptomatic as
a result of the compensable injury. In accordance with our holding in Moore, the case is reversed
and remanded with instructions to authorize a right L5-S1 transforaminal epidural steroid
injection; add lumbosacral intervertebral disc displacement, lumbar intervertebral disc
displacement, and sacroiliac joint sprain to the claim; and grant the request to reinstate temporary
total disability benefits as supported by the evidence of record.

                                                                          Reversed and Remanded.
ISSUED: September 19, 2023

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

CONCURRING, IN PART, AND DISSENTING, IN PART:

Justice C. Haley Bunn

DISSENTING:

Justice Tim Armstead

Bunn, Justice, concurring, in part, and dissenting, in part:

         I concur with the majority’s decision to reverse and remand the Board of Review’s order
in this case and the majority’s conclusion that Mr. Gration 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), because there is some indication that the alleged aggravation of his preexisting,
degenerative condition that the workers’ compensation tribunals found to be noncompensable

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might be related to his workplace injury and thus could be compensable under Moore. See Syl. pt.
5, id. (“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.”).

        However, I disagree with the majority’s decision to conduct this analysis, itself, and to
remand with directions to find Mr. Gration’s condition compensable in accordance with the Moore
factors. Instead, this case should have been remanded to permit the tribunals who are tasked with
determining compensability in the first instance to consider Mr. Gration’s preexisting condition in
accordance with Moore and to decide whether the alleged aggravation of this condition is related
to his compensable injury. The workers’ compensation tribunals are responsible for determining
the facts in workers’ compensation cases, and our review of their decisions is limited to considering
whether there is error in the tribunals’ findings of fact or their legal conclusions. See, e.g., W. Va.
Code § 23-5-15(d) (“If the decision of the board represents an affirmation of a prior ruling by both
the commission and the Office of Judges that was entered on the same issue in the same claim, the
decision of the board may be reversed or modified by the Supreme Court of Appeals only if the
decision is in clear violation of constitutional or statutory provision, is clearly the result of
erroneous conclusions of law, or is based upon the board’s material misstatement or
mischaracterization of particular components of the evidentiary record. The court may not conduct
a de novo reweighing of the evidentiary record. If the court reverses or modifies a decision of the
board pursuant to this subsection, it shall state with specificity the basis for the reversal or
modification and the manner in which the decision of the board clearly violated constitutional or
statutory provisions, resulted from erroneous conclusions of law, or was based upon the board’s
material misstatement or mischaracterization of particular components of the evidentiary record.”
(emphasis added)). If this Court determines the lower tribunals have erred in rendering their
rulings, the governing standard of review prohibits this Court from reweighing the record evidence
and issuing a new decision applying the law to the facts of the case as we found them. Rather, this
Court must exercise restraint and remand the case for the workers’ compensation tribunals to
undertake this factual inquiry.

        Because I feel the majority has overstepped its role by reweighing the evidentiary record
in this case instead of permitting the tribunals charged with this task to perform their prescribed
function, I dissent from the majority’s decision to the extent that it determined that Mr. Gration’s
injuries were compensable under Moore, and reversed and remanded for entry of an order of
compensability, rather than reversing the finding of noncompensability and remanding the case to
the workers’ compensation tribunals to conduct the Moore analysis themselves. Accordingly, I
respectfully concur, in part, and dissent, in part, from the majority’s decision in this case.

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Armstead, Justice, dissenting:

       I dissent to the majority’s resolution of this case. I would have set this case for oral
argument to thoroughly address the error alleged in this appeal. Having reviewed the parties’ briefs
and the issues raised therein, I believe a formal opinion of this Court was warranted, not a
memorandum decision. Accordingly, I respectfully dissent.

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