Court Opinion

ID: 9874577
Source: CourtListenerOpinion
Date Created: 2023-09-26 22:12:03.051982+00
Date Added: 2024-06-11T12:05:17.780891
License: Public Domain

IN THE INTERMEDIATE COURT OF APPEALS OF WEST VIRGINIA

                                                                            FILED
CITY OF HUNTINGTON,
                                                                      September 26, 2023
Employer Below, Petitioner
                                                                         EDYTHE NASH GAISER, CLERK
                                                                       INTERMEDIATE COURT OF APPEALS
vs.) No. 23-ICA-202         (JCN: 2022019151)                                OF WEST VIRGINIA

STEVEN STREETS,
Claimant Below, Respondent

                             MEMORANDUM DECISION

        Petitioner City of Huntington (“City”) appeals the April 20, 2023, order of the
Workers’ Compensation Board of Review (“Board”). Respondent Steven K. Streets filed
a response. 1 City filed a reply. The issue on appeal is whether the Board erred in reversing
the claim administrator’s order and holding the claim compensable for a left shoulder
rotator cuff tear and whether the Board erred in granting Mr. Streets’ motion to untimely
file his protest.

       This Court has jurisdiction over this appeal pursuant to West Virginia Code § 51-
11-4 (2022). After considering the parties’ arguments, the record on appeal, and the
applicable law, this Court finds no substantial question of law and no prejudicial error. For
these reasons, a memorandum decision affirming the Board’s order is appropriate under
Rule 21 of the Rules of Appellate Procedure.

       On March 24, 2022, Mr. Streets presented to Jessica Carmichael, M.D., reporting
that he had been raking gravel while at work the day before when he felt a pop in his
shoulder. Mr. Streets stated that, since the incident, he had pain in his left shoulder that
radiated into his shoulder blade and neck. Dr. Carmichael diagnosed a left shoulder strain.

       On March 25, 2022, Mr. Streets was treated by Allen Young, M.D., at St. Mary’s
Occupational Medicine. Mr. Streets again reported feeling a pop in his left shoulder while
he was raking gravel at work and that he had experienced pain thereafter. Dr. Young noted
no prior history of significant issues with the left shoulder and diagnosed Mr. Streets with
a neck sprain and a left shoulder sprain. Dr. Young assisted Mr. Streets in completing an
Employees’ and Physicians’ Report of Occupational Injury form, and the physician’s
section contained a diagnosis of neck and left shoulder sprain/strain.

       1
        City is represented by Scott K. Sheets, Esq. Mr. Streets is represented by Edwin
H. Pancake, Esq.

                                             1
       Mr. Streets returned to see Dr. Young on March 30, 2022, with complaints of
worsening pain and decreased range of motion. Dr. Young suspected a rotator cuff issue
and requested an MRI of the left shoulder, a referral to an orthopedist, and physical therapy.
On April 11, 2022, Mr. Streets followed up with Dr. Young, who noted that his
recommendations for an MRI, physical therapy, and a referral to an orthopedist had not yet
been approved. Dr. Young reiterated these recommendations, stating that he suspected a
rotator cuff tear. Dr. Young continued Mr. Streets on modified work duties. The same
recommendations were made at an appointment on April 25, 2022, as well.

       By order dated May 3, 2022, the claim administrator denied the claim. On June 22,
2022, Mr. Streets underwent an MRI of the left shoulder, which revealed full thickness
tears involving the supraspinatus and infraspinatus tendons. The imaging report noted
remarkable atrophy within the infraspinatus and mild atrophy and subtle increased signal
within the supraspinatus with prominent retraction of both tendons.

        Thomas J. O’Brien, M.D., an orthopedic surgery specialist, performed a utilization
review of Mr. Streets’ claim. In his report, Dr. O’Brien referenced several medical records
dated prior to the work-related injury, including two that indicated injuries to Mr. Streets’
left shoulder. First, records from December of 2020 indicated that Mr. Streets fell over a
concrete wall while at work and injured his left shoulder and upper back. Second, a record
from December of 2021 indicated that Mr. Streets presented to the emergency room (“ER”)
with complaints of left shoulder pain after falling on his arm. According to Dr. O’Brien’s
report, these records indicated that ER staff stated that Mr. Streets “may have torn his
rotator cuff.” Dr. O’Brien also referenced a medical record from February of 2022, wherein
Mr. Streets indicated that he had no pain in his left shoulder, that his symptoms had
resolved, and that he had full passive range of motion.

        Dr. O’Brien opined that Mr. Streets did not sustain a traumatic rotator cuff tear as a
result of his work activities and that, rather, the tear was attributable to chronic preexisting
degenerative arthritis. According to Dr. O’Brien, the MRI reports showed chronic
degenerative arthritis of the acromioclavicular joint and a chronic-appearing retracted
rotator cuff tear with fatty atrophy of the rotator cuff muscles. Dr. O’Brien opined these
findings indicate that the rotator cuff tear predated the alleged injury by years. 2

       2
          Also submitted before the Board was a document by Darlene Burns, RN. The
Board included a distinct finding of fact related to or based on Ms. Burns’ correspondence,
noting that she opined that Mr. Streets had not sustained a traumatic rotator cuff tear.
However, upon close inspection, it appears that Ms. Burns’ correspondence is simply a
letter forwarding Dr. O’Brien’s report. Ms. Burns’ letter appears to contain a verbatim
recitation of Dr. O’Brien’s report and, in fact, states at the beginning of her letter that “Our
Review Physician, Thomas J. O’Brien, M.D., . . . has reviewed this case. His letter is
attached for your review.” As such, it appears that Ms. Burns’ letter is not a distinct,
additional letter providing an opinion as to the causality of Mr. Streets’ diagnosis.
                                               2
       On June 30, 2022, Jarrod Smith, M.D., authored a letter indicating that he had seen
Mr. Streets for a visit in February of 2022, and that Mr. Streets had been doing well at that
time. Dr. Smith stated it was his professional opinion that Mr. Streets’ work-related injury
“caused significant dysfunction of his left shoulder.” Dr. Smith opined that, if the rotator
cuff tear had been chronic, the MRI would have shown “much more atrophy” and that the
MRI findings were consistent with an acute work-related injury.

       On August 16, 2022, counsel for Mr. Streets filed a motion before the Board
requesting permission to untimely file a protest of the claim administrator’s order. Counsel
noted that he was newly retained and had not received a copy of the claim file from the
claim administrator. By order dated September 9, 2022, the Board granted the motion to
allow the late filing.

        Mr. Sheets testified via deposition in January of 2023. Mr. Sheets described his
actions and mechanism of injury on the date of the alleged injury. Mr. Sheets admitted that
he had previously fallen in December of 2021 due to a diabetic episode and strained his
left shoulder. Mr. Streets explained that he was in the hospital for six days following that
fall and then subsequently contracted COVID-19, which forced him to rest at home. As a
result of these periods of rest, Mr. Streets regained full mobility without pain in his left
shoulder. Mr. Streets stated that, otherwise, he had no problems with his left shoulder prior
to his work-related injury.

        By order dated April 20, 2023, the Board reversed the claim administrator’s order
and held the claim compensable for a left shoulder rotator cuff tear. Citing to Gill v. City
of Charleston, 236 W. Va. 737, 783 S.E.2d 857 (2016) and Moore v. ICG Tygart Valley,
LLC, 247 W. Va. 292, 879 S.E.2d 779 (2022), the Board found that the evidence failed to
establish that Mr. Streets’ left shoulder rotator cuff tear preexisted the work-related injury.
The Board noted that, though Mr. Streets stated he previously injured his left shoulder in
December of 2021, he subsequently regained full mobility and had no pain by February of
2022. The Board also noted that Mr. Streets continued his regular work duties until he felt
a pop in his left shoulder while raking gravel at his job. Further, Dr. Smith opined that the
MRI and exam findings were consistent with an acute work-related injury, and he had the
advantage of examining Mr. Streets both before and after the work-related injury. In
contrast, the Board noted, Dr. O’Brien had not examined Mr. Streets. As such, the Board
concluded that the evidence did not establish that Mr. Streets had a preexisting diagnosis
of a left rotator cuff tear and held the claim compensable. 3 City now appeals.

       3
         We note that the Board made a problematic finding in its order holding the claim
compensable for a left shoulder rotator cuff tear. Specifically, the Board found that “[e]ven
if the claimant had a preexisting left shoulder condition, it was asymptomatic at the time

                                                                     (continued . . .)
                                              3
        Our standard of review is set forth in West Virginia Code § 23-5-12a(b) (2022), in
part, as follows:

       The Intermediate Court of Appeals may affirm the order or decision of the
       Workers’ Compensation Board of Review or remand the case for further
       proceedings. It shall reverse, vacate, or modify the order or decision of the
       Workers’ Compensation Board of Review, if the substantial rights of the
       petitioner or petitioners have been prejudiced because the Board of Review’s
       findings are:
       (1) In violation of statutory provisions;
       (2) In excess of the statutory authority or jurisdiction of the Board of Review;
       (3) Made upon unlawful procedures;
       (4) Affected by other error of law;
       (5) Clearly wrong in view of the reliable, probative, and substantial evidence
       on the whole record; or
       (6) Arbitrary or capricious or characterized by abuse of discretion or clearly
       unwarranted exercise of discretion.

Duff v. Kanawha Cnty. Comm’n, 247 W. Va. 550, 555, 882 S.E.2d 916, 921 (Ct. App.
2022).

      On appeal, City first argues that the Board erred in permitting Mr. Streets to
untimely file his protest. According to City, Mr. Streets had sixty days to file his protest

of the March 23, 2022 work injury. Pursuant to the standards set forth in Gill and Moore,
the claim is compensable.” However, we note that this Court recently explained that a

       preexisting condition itself does not become compensable, only the discrete
       new injury. Moore reaffirmed and expanded on the holding in Gill and
       therefore the holdings in both cases must be considered together. When read
       in unison, Gill and Moore do not render preexisting injuries compensable.
       Compensability is limited only to discrete new injuries and disabilities that
       manifest following the compensable injury.

Blackhawk Mining, LLC v. Argabright, __ W. Va. __, __ S.E.2d __, 2023 WL 3167476
(2023). Accordingly, to the extent the Board suggested that a preexisting, but
asymptomatic, rotator cuff tear could be held compensable, we reiterate that a preexisting
condition cannot become compensable. Only discrete new injuries are able to be held
compensable. However, because this finding does not appear to form the basis of the
Board’s conclusions and because we find that the Board made sufficient findings to support
holding the claim compensable, as set forth more fully above, we conclude that this finding
is harmless error.

                                              4
pursuant to West Virginia Code § 23-5-6a (2022). City argues that Mr. Streets did not
attempt to file a protest until six weeks after the time frame had expired. Moreover, had
Mr. Streets demonstrated good cause for the untimely filing, he could have been permitted
120 days under the statute. However, City claims that Mr. Streets’ contention that his
counsel was recently retained was not sufficient to demonstrate good cause. City states that
there was no evidence that Mr. Streets had any difficulty securing counsel or that he ever
attempted to secure counsel within the time frame to file a protest. As such, City argues
that this Court should reverse the Board’s order on the basis that the untimely filed protest
should never have been permitted. We disagree.

       We find that the Board did not abuse its discretion in permitting Mr. Smith to
untimely file a protest to the claim administrator’s order rejecting the claim. As City
admits, the Board is afforded discretion in deciding whether to extend a deadline for filing.
Pursuant to West Virginia Code § 23-5-6 (2021), “the Workers’ Compensation Board of
Review or court,” as the case may be, shall consider whether the applicant was represented
by counsel and whether timely and proper notice was actually received by the applicant or
the applicant’s representative” in determining whether good cause or excusable neglect in
untimely filing a protest has been demonstrated. Here, Mr. Streets was not represented by
counsel at the time the claim administrator rejected the claim. It appears, though, that he
did attempt to work towards filing a protest, as his physician forwarded documents to the
Board on his behalf. The Board issued a letter to the physician, indicating that it could not
“acknowledge your protest” as the physician was not an authorized legal representative for
Mr. Streets. The Board further indicated that if Mr. Streets desired to protest the claim
administrator’s order, he would have to provide an explanation showing good cause or
excusable neglect for the late filing. Shortly thereafter, Mr. Streets retained counsel, who
sought to untimely file the protest. Given the foregoing, we conclude that the Board did
not abuse its discretion in permitting Mr. Streets to untimely file a protest, especially
considering that it appears he was attempting to file a protest through his physician.

       City next argues that the Board erred in reversing the claim administrator’s order
and holding the claim compensable for a left shoulder rotator cuff tear. According to City,
the Board erred in disregarding the opinion of Dr. O’Brien on the basis that he had not had
the opportunity to examine Mr. Streets in person. City avers that Dr. O’Brien was able to
review the MRI, which was an internal examination and revealed degenerative conditions
that one cannot possibly see by physically examining a patient. City contends that Dr.
O’Brien properly found that Mr. Streets’ rotator cuff tear preexisted the work-related
injury, noting prior medical records indicating that he twice fell and injured his shoulder.
Accordingly, City claims that the Board incorrectly found that Mr. Streets’ rotator cuff tear
did not preexist the claim simply because he was asymptomatic on the date of the alleged
injury. City argues that the Board ignored the medical evidence, including Dr. O’Brien’s
report, the MRI, and the medical records predating the claim, all of which indicated that
Mr. Streets’ rotator cuff tear was degenerative and preexisted the claim.

                                             5
        Upon review, we conclude that the Board was not clearly wrong in finding that Mr.
Streets’ left shoulder rotator cuff was compensable. The record indicates that Mr. Streets
notified his employer of an injury and nearly immediately sought treatment, which
eventually revealed a rotator cuff tear in his left shoulder. The evidence before the Board
came down to the reports of two physicians: Dr. O’Brien and Dr. Smith. Dr. O’Brien
opined that the MRI showed chronic, degenerative arthritis and atrophy of the tear, which
indicated that the tear was preexisting and due to degenerative changes rather than an acute
injury. In contrast, Dr. Smith opined that the tear was due to the work-related injury and
would have been more atrophied if it were chronic and degenerative in nature. Ultimately,
the Board found that Dr. Smith’s report was more persuasive given that he had the
opportunity to examine Mr. Streets both before and after the injury. Other than arguing that
the opportunity to examine Mr. Streets in person was irrelevant to the diagnosis here, City
fails to demonstrate that the Board was clearly wrong in finding Dr. Smith’s report to be
more persuasive. Instead, it simply asks us to reweigh the evidence in its favor. We decline
to do so, and we further note that credibility determinations are within the discretion of the
Board. See Martin v. Randolph Cnty Bd. of Educ., 195 W. Va. 297, 306, 465 S.E.2d 399,
408 (1995) (“We cannot overlook the role that credibility places in factual determinations,
a matter reserved exclusively for the trier of fact. We must defer to the ALJ’s credibility
determinations and inferences from the evidence . . . .”).

       Moreover, while City argues that the Board glossed over Mr. Streets’ history of
preexisting conditions, we conclude that the Board adequately considered the evidence
before it. Importantly, though City argues that Dr. O’Brien referenced medical records
from a few months before the work-related injury which allegedly indicate that Mr. Streets
“may” have torn his rotator cuff, those medical documents were never submitted before
the Board. Based on the evidence that was submitted before it, the Board found that, while
Mr. Streets had fallen and injured his shoulder prior to the work-related injury, he had full
mobility and no pain by the time he returned for a follow-up with Dr. Smith, and he was
able to return to work without restrictions. As such, the Board concluded that no diagnosis
of a preexisting left shoulder rotator cuff tear had been established. These findings by the
Board are sufficiently supported by the record such that we conclude that the Board was
not clearly wrong in holding Mr. Streets’ left shoulder rotator cuff tear compensable.

       Accordingly, based on the foregoing, we affirm the Board’s April 20, 2023, order.

                                                                                   Affirmed.

ISSUED: September 26, 2023

                                              6
CONCURRED IN BY:

Chief Judge Daniel W. Greear
Judge Thomas E. Scarr
Judge Charles O. Lorensen

                               7