Appeal No. 2051109 (Claim No. 2014022721)
Ronnie Combs, by John H. Skaggs, his attorney, appeals the
decision of the West Virginia Workers' Compensation Board
of Review. Enerfab, by Maureen Kowalski, its attorney, filed
a timely response.
issue on appeal is whether Mr. Combs is entitled to medical
treatment. On July 1, 2015, the claims administrator denied a
request for medical treatment with Challie Minton, M.D., or
any other medical provider. The Office of Judges affirmed the
decision in its February 9, 2016, Order. The Order was
affirmed by the Board of Review on June 3, 2016. 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
Combs, an electrician, was injured on December 19, 2013, when
he was on a ladder cutting cables off of a pole and fell to
the ground after cutting the last cable. The claims
administrator denied compensability of the claim on April 9,
2014. The Office of Judges reversed the claims
administrator's decision on March 11, 2015, and held the
claim compensable for injuries to the left elbow, left
shoulder, and low back. After entering decisions holding the
claim compensable and closing the claim for permanent partial
disability benefits on March 25, 2015, the claims
administrator entered a decision on July 1, 2015, denying
authorization for treatment with Dr. Minton, or any other
doctors. This is the decision at issue in the instant appeal.
Combs treated with Dr. Minton for the first time on April 23,
2015. Mr. Combs complained of intermittent bilateral tinnitus
and chronic neck pain due to a fall at work in December of
2013. Mr. Combs came to Dr. Minton seeking a referral to an
orthopedist for a workers compensation claim for his neck.
Dr. Minton noted Mr. Combs had full range of motion, was
moving his neck without difficulty, and appeared to be in no
pain. Dr. Minton diagnosed neck pain, referred Mr. Combs to
an orthopedist, and provided him a handout on arthritis.
Combs testified via deposition on September 28, 2015. He
stated his worst pain was in his shoulder, neck, and in
between his shoulder blades. He wanted his neck and middle
back to be included as compensable conditions. He wanted Dr.
Minton's treatment to be authorized so he could receive
treatment for his head, left shoulder, neck, middle back, and
low back. He acknowledged that the cervical spine was not a
compensable condition in the claim.
to seeking treatment with Dr. Minton on April 23, 2015, Mr.
Combs's medical treatment included visits with a
chiropractor, a cervical spine MRI, and a lumbar spine
MRI.Mr. Combs also had independent
medical evaluations performed by Paul Bachwitt, M.D., and
Bruce Guberman, M.D. Neither Dr. Bachwitt nor Dr. Guberman
diagnosed a cervical spine condition as the result of the
December 19, 2013, work injury.
Office of Judges affirmed the claims administrator's July
1, 2015, decision denying authorization for treatment with
Dr. Minton or any other doctors on February 9, 2016. It found
the claims administrator's decision was defective because
it failed to list grounds for the denial of the treatment.
However, the Office of Judges then found the decision had to
be affirmed because there was no record of Mr. Combs having
requested any treatment. The Office of Judges also determined
that Mr. Combs had submitted evidence that he had been seen
by doctors and had MRI's taken of his cervical spine and
thoracic spine following the December 19, 2013, injury. Yet,
Mr. Combs failed to submit evidence showing he needed medical
treatment for a compensable condition connected to the
injury. Additionally, there was no evidence that a doctor
requested treatment for one of the compensable conditions,
which were left elbow, left shoulder, and low back.
Board of Review adopted the findings of fact and conclusions
of law of the Office of Judges and affirmed its Order on June
3, 2016. After review, we agree with the Board of Review.
Although compensability of the claim was originally denied,
when Mr. Combs treated with Dr. Minton for the first time on
April 23, 2015, Dr. Minton noted he was being treated for
complaints of bilateral tinnitus and chronic neck pain. Dr.
Minton also noted Mr. Combs was seeking a referral to an
orthopedist for a workers' compensation claim for his
neck. The cervical spine is not a compensable condition. The
medical records do not show that Dr. Minton was treating Mr.
Combs for a compensable diagnosis. Therefore, the claims
administrator properly determined that treatment with Dr.
Minton should not be authorized.
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. ...