SAMUEL A. ROBINSON, Claimant Below, Petitioner
WEST VIRGINIA OFFICE OF INSURANCE COMMISSIONER, Commissioner Below, Respondent and EASTERN ASSOCIATED COAL, LLC, Employer/Claimant Below, Respondent
Appeal No. 2051190 (Claim No. 2000045824)
Samuel A. Robinson, by Patrick K. Maroney, his attorney,
appeals the decision of the West Virginia Workers'
Compensation Board of Review. West Virginia Office of the
Insurance Commissioner by Henry C. Bowen, its attorney, filed
a timely response.
issue on appeal is whether bilateral sacroiliac joint
injections should be authorized. The claims administrator
denied the request for bilateral sacroiliac joint injections
on February 11, 2015. The Office of Judges affirmed the
claims administrator's decision on March 3, 2016. The
Board of Review affirmed the Order of the Office of Judges on
August 24, 2016. 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
Robinson, a brakeman for Eastern Associated Coal, LLC, hurt
his lower back while lifting an object at work on March 5,
2000. Mr. Robinson was treated by Dr. Weisman who diagnosed a
lumbar sprain, overextension, and strenuous repetitive
movements. He was advised to be off work for a week and to
follow up with another physician. The report stated that his
injury aggravated a pre-existing back injury. On April 11,
2000, the claims administrator held the claim compensable for
a lumbar sprain. On August 28, 2000, the claim was held
compensable for reaction to spinal or lumbar puncture, a
lumbosacral sprain, and a lumbar sprain.
Orphanos, M.D., performed an independent medical evaluation
August 15, 2001. In Dr. Orphanos's opinion, Mr. Robinson
sustained a musculoligamentous type injury involving the
lumbar spine as a result of the work-related injury
superimposed on pre-existing spondylolysis at L5 level with
no evidence of spondylolisthesis. Dr. Orphanos noted that Mr.
Robinson had preexisting spondylolysis at the L5 level and
also noted degenerative bulging discs at L4-5 and L5-S1. Mr.
Robinson was found to be at maximum medical improvement and
was found to have 12% whole person impairment.
January 25, 2006, the claims administrator held that the
approved diagnoses were depressive disorder, major depressive
disorder, lumbosacral sprain, lumbar sprain, reaction to
spinal/lumbar puncture, unspecified neuralgia
neuritis/radiculitis, other/unspecified disc disorder of
lumbar region, and lumbosacral neuritis or radiculitis. The
thoracic spine was not a compensable diagnosis in the claim.
29, 2009, report authored by Rajesh Patel, M.D., stated that
Mr. Robinson would benefit from decompression at L4-5 but not
a fusion. John Schmidt, M.D., examined Mr. Robinson on
December 7, 2009, and suggested a modification to his spinal
cord stimulator for the pain. He suggested a removal of the
spinal cord stimulator followed by replacement with a paddle
type electrode and generator. Dr. Schmidt noted there was an
approximately 80% chance of meaningful improvement in Mr.
Robinson's pain with a dorsal column paddle type spinal
cord stimulator electrode and generator. Dr. Schmidt then
requested authorization for a dorsal laminectomy for
placement of a spinal cord stimulator.
February 28, 2011, letter from Wassim Saikali, M.D., stated
that the nerve test showed mild left L5/S1 radiculopathy and
mild right L5/S1 radiculopathy. There was no evidence of
severe polyneuropathy and medications were suggested. Timothy
Deer, M.D., completed a report on November 26, 2012, stating
that a new CT scan was needed of the lumbar spine as Mr.
Robinson was having progressive left leg weakness with
increased lower back pain. Dr. Deer opined that this was
attributable to the compensable work injury. He requested a
new CT scan of the lumbar spine and referral to Neurological
Associates for a second opinion.
Klein, M.D., issued a report on February 12, 2013, stating
that an independent medical evaluation showed that Mr.
Robinson was at maximum medical improvement. The evaluation
did not recommend additional treatment to include physical
therapy, injections, or medications. The report also stated
that the most recent September 19, 2012, physical examination
of Mr. Robinson did not medically support the requested
lumbar spine CT scan as there was no documented change in
neurological status. The requested sacroiliac joint
injections was also not medically supported because the
diagnostic tests, including Gaenslen's and Patrick's
tests, were negative.
February 12, 2013, Mr. Robinson's request for a CT and
two sacroiliac joint injections was denied. The denial was
based upon a physician review Dr. Klein's physician
review. On August 9, 2013, Prasadarao Mukkamala, M.D.,
performed an independent medical evaluation. Dr. Mukkamala
noted that Mr. Robinson complained mostly of pain in the legs
and feet. He suggested that the low back pain was very well
controlled with the spinal cord stimulator. He found Mr.
Robinson to be at maximum medical improvement and opined that
all he requires is a home exercise program. The claims
administrator denied sacroiliac joint injections on September
6, 2013. A nerve conduction study report completed on October
28, 2013, stated that it was an abnormal study. There was
electrophysiological evidence for an active S1 radiculopathy
on the left. There was no electrophysiological evidence for
separate litigation in this claim from this appeal, the
Office of Judges issued a decision on October 9, 2014,
affirming, among other things, the claims administrator's
denial of payment for sacroiliac joint injections.
November 14, 2014, Mr. Robinson testified that after the
accident he had severe pain in his lower back down both legs
as well as burning pain in both of his feet. He stated that
he had none of these problems prior to this injury. He
testified that he has a spinal cord stimulator which helps
with the back pain, but does not help with the leg and feet
pain. Mr. Robinson testified that he was prescribed Lyrica
for the burning in his feet, and he was unable to function
without it. Mr. Robinson testified regarding his medical
providers and indicated that he was checked for neuropathy
which was negative. He stated that Dr. Deer would like for
him to have surgery to install a larger implant or paddle
January 2, 2015, Mr. Robinson was seen by Dr. Deer.
Sacroiliac joint inflammation was suspected due to antalgic
gait and authorization was requested for bilateral sacroiliac
joint injections. The claims administrator denied the request
on February 11, 2015. On May 17, 2015, Dr. Deer completed a
statement that bilateral sacroiliac joint injections should