MICHELLE D. MASTERS, Claimant Below, Petitioner
GREENBRIER HOTEL CORPORATION, Employer Below, Respondent
Appeal No. 2050894) (Claim No. 2013024698)
Michelle D. Masters, by Patrick K. Maroney, her attorney,
appeals the decision of the West Virginia Workers'
Compensation Board of Review. Greenbrier Hotel Corporation,
by James W. Heslep, 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 an October
20, 2015, Order of the Workers' Compensation Office of
Judges. In its Order, the Office of Judges affirmed the
claims administrator's January 14, 2015, decision to deny
medical authorization for a repeat cervical MRI and ten
occupational therapy sessions over an eight month period. The
Court has carefully reviewed the records, written arguments,
and appendices contained in the briefs, and the case is
mature for consideration.
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
Masters, a culinary instructor for Greenbrier Hotel
Corporation, injured her neck and shoulder on July 11, 2012,
while lifting a mini fridge onto a countertop. The claims
administrator held the claim compensable on July 18, 2012,
for a sprain of the shoulder/arm and neck as well as
overexertion and strenuous movement. An MRI performed the
same day revealed a left lateral C5-C6 disc protrusion
creating nerve root encroachment, a small posterior central
and left paramidline C6-C7 disc protrusion creating no nerve
root displacement, and a small focal posterior central T1-T2
disc protrusion creating no cord compression.
Thompson, M.D., of the Greenbrier Clinic, examined Ms.
Masters on July 20, 2012, and stated that she suffered from
cervical disease. He suggested physical therapy and advised
Ms. Masters to remain off work until further evaluation.
Bruce Guberman, M.D., completed an independent medical
evaluation on October 18, 2012, in which he opined that her
treatment up to this point had been medically necessary and
appropriate. Dr. Guberman believed that Ms. Masters was not
at her maximum degree of medical improvement in relation to
her cervical spine and would benefit from follow-ups with her
treating physician and a nerve conduction study. Dr. Guberman
believed Ms. Masters's shoulders were doing well and were
not the source of her problems. He found her to be at maximum
medical improvement in relation to her shoulders and opined
that she did not suffer any whole person impairment related
23, 2013, Joseph Grady, M.D., performed an independent
medical evaluation and noted that Ms. Masters has already
completed forty-four physical therapy sessions up to this
point with reports that they provided some relief. She has
also been treated with oral steroids and returned to work
after a few weeks on a part-time basis. He concluded that it
would be reasonable for her to consider having injections in
her neck in light of her structural abnormalities. Dr. Grady
opined that she did not wish to pursue those, or if they
cannot be performed, Ms. Masters would likely then be at
maximum medical improvement. He believed the use of a
nonsteroidal anti-inflammatory medication, such as Naproxen,
Dauphin, M.D., performed a physician's review for the
purpose of determining whether the request for occupational
therapy sessions and occipital nerve blocks is reasonable. He
recommended the nerve block but found that the occupational
therapy sessions should be denied. He stated that Ms. Masters
has had forty-five physical medicine treatments in this claim
and has reached maximum medical improvement, with the
exception of her neck. Dr. Dauphin stated that Ms. Masters
should continue to receive epidural injections in her neck,
and upon completion of the injections, Dr. Grady should be
asked to issue an addendum report providing an impairment
rating. He stated the occupational therapy sessions exceeded
treatment guidelines set forth in West Virginia Code of State
Rules § 85-20 (2006).
Masters underwent cervical epidural injections on January 14,
2014. On May 12, 2014, A.E. Landis, M.D., performed an
independent medical evaluation. Dr. Landis opined that Ms.
Masters was at her maximum degree of medical improvement in
relation to all her injuries. However, he opined that Ms.
Masters would require some ongoing treatment to maintain her
maximum degree of medical improvement. Dr. Landis recommended
the regular use of a home cervical traction device.
Thaxton, M.D., performed a physician's review on November
16, 2014, which addressed the reasonableness of the requested
repeat cervical MRI, cervical nerve block, and occupational
therapy sessions. Dr. Thaxton did not recommend payment for
the repeat cervical MRI and osteopathic manipulation. She did
recommend payment of the repeat cervical nerve block. Dr.
Thaxton opined that the physical therapy in this claim has
been excessive and exceeds the guidelines set forth in West
Virginia Code of State Rules § 85-20. She concluded that
occupational therapy sessions are no longer reasonable or
within the treatment guidelines. Dr. Thaxton stated that an
MRI performed now would not be reflective of the acute injury
from 2012, and therefore should not be approved.
December 18, 2014, the claims administrator initially denied
the request for a repeat cervical MRI and ten occupational
therapy sessions over an eight month period. On January 13,
2015, the StreetSelect Grievance Board determined that a
repeat MRI would not reveal anything pertinent to the 2012
injury. Further, the Board found that ten occupational
therapy sessions over an eight month period were also not
reasonably required. Based upon the StreetSelect Grievance
Board's determination, the claims administrator denied
medical authorization for a repeat cervical MRI and ten
occupational therapy sessions over an eight month period on
January 14, 2015.
August 20, 2015, Ms. Masters was deposed. She testified about
her injury and the treatment she has received thus far. She
was originally treated at the Greenbrier Clinic and then she
had vocational rehabilitation. She returned to work in a
modified form in October of 2012 and started full duty
sometime thereafter. Around January of 2015, her workload
increased which she stated put more strain on her neck.
October 20, 2015, the Office of Judges determined that the
medical evidence did not support the authorization of the
additional treatment of a repeat cervical MRI or ten
occupational therapy sessions over an eight month period for
the treatment of the compensable sprain. The Office of Judges
noted that under West Virginia Code of State Rules §
85-20-35.5 (2006), the expected recovery period for a sprain
is not to exceed eight weeks. The Office of Judges noted that
the request for a repeat MRI and occupational therapy was
completed two years after the injury. Furthermore, Ms.
Masters was determined to be at maximum medical improvement
on May 12, 2014. The Office of Judges determined that the
treatment received to date was excessive pursuant to the
treatment guidelines contained in West Virginia Code of State
Rules § 85-20. The Board of Review adopted the findings
of the Office of Judges and affirmed its Order on March 3,
review, we agree with the consistent decisions of the Office
of Judges and Board of Review. The evidence of record
supports the conclusion that any further treatment would be
outside of the guidelines contained in West Virginia Code of
State Rules § 85-20 without sufficient justification.
Furthermore, there is evidence that Ms. Masters has reached
maximum medical improvement. As a ...