Appeal No. 2050862, Claim No. 2013013411
Eddie Jinnis, by Patrick Maroney, his attorney, appeals the
decision of the West Virginia Workers' Compensation Board
of Review. Summit Environmental Services, LLC, by Alyssa
Sloan, its attorney, filed a timely response.
appeal arises from the Board of Review's Final Order
dated March 3, 2016, in which the Board affirmed a September
22, 2015, Order of the Workers' Compensation Office of
Judges. In its Order, the Office of Judges affirmed the
claims administrator's November 7, 2014, decision denying
a request for authorization of a lumbar spine MRI. The Court
has carefully reviewed the records, written arguments, and
appendices contained in the briefs, and the case is mature
Court has considered the parties' briefs and the record
on appeal. The facts and legal arguments are adequately
presented, and the decisional process would not be
significantly aided by oral argument. Upon consideration of
the standard of review, the briefs, and the record presented,
the Court finds no substantial question of law and no
prejudicial error. For these reasons, a memorandum decision
is appropriate under Rule 21 of the Rules of Appellate
August 6, 2012, Mr. Jinnis injured himself while attempting
to escape a furnace fire. He initially sought treatment in
the emergency department of Norton Community Hospital where
he was diagnosed with second degree burns, a right wrist
sprain, and a left knee injury. His claim for workers'
compensation benefits was held compensable for
overexertion/sudden strenuous movement, second degree burns
of the wrist, an unspecified lower leg injury, and an
unspecified sprain of the wrist. While in the emergency
department, Mr. Jinnis completed a Report of Injury in which
he indicated that he sustained injuries to his knee and
wrist, as well as burn injuries. Following his visit to the
emergency department, Mr. Jinnis was treated at Woodland
Urgent Care for general complaints of pain, including back
pain, chest pain, and knee pain.
Jinnis sought follow-up care with Jiab Suleiman, D.O., who
initially noted that Mr. Jinnis complained of left knee pain.
During an office visit that occurred on November 5, 2012, Dr.
Suleiman opined that Mr. Jinnis has fully healed and is not
experiencing any further problems. However, on June 9, 2014,
Mr. Jinnis sought treatment with Dr. Suleiman for lower back
pain with radiation into his legs, which Mr. Jinnis
attributed to the August 6, 2012, injury. Dr. Suleiman
diagnosed Mr. Jinnis with lumbago and recommended that Mr.
Jinnis undergo a lumbar spine MRI.
24, 2014, William Gonte, M.D., performed an independent
medical evaluation. Dr. Gonte noted that Mr. Jinnis
complained of lower back pain. However, Dr. Gonte determined
that Mr. Jinnis had full range of motion in his lower back
during the evaluation. On September 12, 2014, Syam Stoll,
M.D., performed a records review and recommended denying Dr.
Suleiman's request for authorization of a lumbar spine
MRI. Dr. Stoll noted that in early 2013, there was a four
month gap during which Mr. Jinnis did not receive any medical
treatment before returning to Dr. Suleiman for an evaluation
of chronic left knee pain on March 14, 2013. He further noted
that Mr. Jinnis followed up with Dr. Suleiman on June 9,
2014, with complaints of radiating lower back pain. Dr. Stoll
then opined that the medical evidence of record demonstrates
that Mr. Jinnis's current complaints of lower back pain
are unrelated to the compensable August 6, 2012, injury.
November 4, 2014, the StreetSelect Grievance Board issued a
decision following the claims administrator's initial
denial of the request for authorization of a lumbar spine
MRI. The Grievance Board found that Mr. Jinnis's
complaints of lower back pain did not begin until
approximately two years after the compensable injury. It then
determined that the medical evidence available for review
does not support a finding that there is a relationship
between the compensable injury and Mr. Jinnis's
complaints of lower back pain. On November 7, 2014, the
claims administrator denied Dr. Suleiman's request for
authorization of a lumbar spine MRI based upon Dr.
Stoll's records review. In its Order affirming the
November 7, 2014, claims administrator's decision, the
Office of Judges held that the requested lumbar spine MRI is
not medically related or reasonably required for the
treatment of the compensable August 6, 2012, injury. The
Board of Review affirmed the reasoning and conclusions of the
Office of Judges in its decision dated March 3, 2016. On
appeal, Mr. Jinnis asserts that the evidence of record
clearly demonstrated that the requested lumbar spine MRI is
medically necessary and reasonably required for the treatment
of the compensable injury.
Office of Judges noted that Mr. Jinnis did not list his lower
back as an injured body part when completing the Report of
Injury. Although the Office of Judges noted that Mr. Jinnis
complained of lower back pain on August 14, 2012, when
seeking treatment at Woodland Urgent Care, it found that he
did not receive any treatment for his lower back or make any
other complaints regarding his lower back until
2014. The Office of Judges then took note of Dr.
Stoll's report following his records review in which he
opined that the request for authorization of a lumbar spine
MRI should be denied. Finally, the Office of Judges concluded
that Mr. Jinnis has failed to demonstrate that the requested
lumbar spine MRI is necessary for the treatment of the
compensable August 6, 2012, injury. We agree with the
reasoning and conclusions of the Office of Judges, as
affirmed by the Board of Review.
the foregoing reasons, we find that the decision of the Board
of Review is not in clear violation of any constitutional or
statutory provision, nor is it clearly the result of
erroneous conclusions of law, nor is it based upon a material
misstatement or mischaracterization of the evidentiary
record. Therefore, the decision of the Board of Review is
CONCURRED IN BY: Chief Justice Allen H. Loughry II, Justice
Robin J. Davis, Justice Margaret L. Workman, Justice Menis E.
Ketchum, Justice Elizabeth D. Walker