DEBRA L. CASTEEL-ELLISON, Claimant Below, Petitioner
NEW RIVER HEALTH ASSOCIATION, INC., Employer Below, Respondent
Appeal No. 2051257, Claim No. 2015009955
Debra L. Casteel-Ellison, pro-se, appeals the decision of the
West Virginia Workers' Compensation Board of Review. New
River Health Association, Inc., by Lisa Warner Hunter, its
attorney, filed a timely response.
issue on appeal is the compensability of the claim. On
October 3, 2014, the claims administrator denied
compensability of Ms. Casteel's claim for right carpal
tunnel syndrome. The Office of Judges reversed the claims
administrator's decision in its April 11, 2016, Order and
held the claim compensable for right carpal tunnel syndrome.
The Order was reversed by the Board of Review on September 1,
2016. The Board of Review vacated the Office of Judges'
Order and reinstated the claim administrator's rejection
of the claim. 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 that the Board of Review's decision is
not supported by a preponderance of the evidence. This case
satisfies the "limited circumstances" requirement
of Rule 21(d) of the Rules of Appellate Procedure and is
appropriate for a memorandum decision rather than an opinion.
Casteel-Ellison, who is employed in data entry for New River
Health Association, filed an application for workers'
compensation benefits arising from a diagnosis of right
carpal tunnel syndrome she sustained during the course of her
employment. On September 16, 2014, Ms. Casteel-Ellison was
seen by Whitney Boggs, M.D., for complaints of right hand
swelling and pain. She provided a history of working on a
computer, typing, and using a mouse. Dr. Boggs diagnosed
carpal tunnel syndrome and recommended she wear splints. She
saw Dr. Boggs again on September 25, 2014, when she reported
that she had been icing her wrist at least once a day and
that her hand first started hurting about six months ago. Dr.
Boggs recommended she undergo nerve conduction velocity
employee's and physician's report of occupational
injury form was completed by Ms. Casteel-Ellison and Dr.
Boggs on September 24, 2014. Ms. Casteel-Ellison alleged
right and left hand injuries due to computer work and data
entry. Dr. Boggs stated that he first treated Ms.
Casteel-Ellison on September 16, 2014, when he diagnosed
carpal tunnel syndrome and indicated both of her hands were
injured. On October 3, 2014, the claims administrator denied
compensability due to lack of testing to establish the
diagnosis of carpal tunnel syndrome.
Vaught, M.D., performed EMG/NCV testing on November 19, 2014.
The testing revealed electrophysiologic evidence for mild
right median mononeuropathy at the wrist consistent with
carpal tunnel syndrome. Ms. Casteel-Ellison was seen by
Matthew Nelson, M.D., on February 4, 2015, for moderate pain
and numbness in her right hand. She reported loss of grip
strength. Dr. Nelson diagnosed carpal tunnel syndrome and
recommended a right carpal tunnel release.
Casteel-Ellison testified at a hearing before the Office of
Judges on April 2, 2015. She stated she works as a
"comm" center representative, which is a clerical
position. Her job duties included adding information to
medical records by inputting information and transferring
faxes, mail, and e-mails into the medical record. She had
been working at this job for three years. She believes the
carpal tunnel syndrome was work-related because she spends
all day using a keyboard and mouse and moved her thumb and
finger constantly. She is five feet six inches tall and
weighs 223 pounds. She has high blood pressure for which she
takes medication. Dr. Boggs did grip strength testing and
some other testing and diagnosed her with carpal tunnel
syndrome. Dr. Boggs prescribed ibuprofen, an
anti-inflammatory, and wrist splints. She denied having any
hobbies that involved the use of her wrists.
Bailey, M.D., performed a medical records review and provided
a report dated July 1, 2015. Dr. Bailey opined that the
physical examinations by Dr. Boggs were nonspecific and not
supportive of median neuropathy or carpal tunnel syndrome.
The thenar atrophy documented by Dr. Boggs supported a
diagnosis of severe, long standing median nerve compression.
The muscle hypertrophy of the right hand, right hand edema,
and osteoarthritic joints of both hands were not consistent
with the diagnosis of carpal tunnel syndrome. Dr. Bailey
acknowledged that the information provided suggested Ms.
Casteel-Ellison had right carpal tunnel syndrome. However,
Dr. Bailey opined that the right carpal tunnel syndrome was
not work-related. Ms. Casteel-Ellison's clerical
activities did not show a relationship with causing carpal
tunnel syndrome. Her weight problem contributed to the carpal
tunnel syndrome. While Dr. Bailey found Ms. Casteel-Ellison
had no occupational risks associated with carpal tunnel
syndrome, there were personal risk factors including her
obesity and osteoarthritis of both hands.
Casteel-Ellison underwent the carpal tunnel release and was
healing well when she was seen by Nathan Doctry, M.D., on
June 28, 2016. He recommended occupational therapy on August
Office of Judges reversed the claims administrator's
October 3, 2014, decision and held the claim compensable for
right carpal tunnel syndrome on April 11, 2016. It noted the
claims adjuster originally denied the claim due to a lack of
testing to establish a diagnosis. However, that problem was
satisfied through the introduction of valid EMG/NCV testing.
The employer relied on the opinion of Dr. Bailey who did not
examine Ms. Casteel-Ellison, but instead provided a medical
records review. Dr. Bailey was hesitant to confirm the
diagnosis of carpal tunnel syndrome due to the findings of
muscle atrophy, edema, and osteoarthritic joints in Ms.
Casteel-Ellison's right hand. Dr. Bailey also opined that
the carpal tunnel syndrome was not work-related because Ms.
Casteel-Ellison did not have occupational responsibilities
that were highly repetitious, highly forceful, or extremely
awkward. Dr. Bailey opined the Ms. Casteel-Ellison's
weight and/or osteoarthritis could have been the cause of the
carpal tunnel syndrome.
Office of Judges also noted that Dr. Vaught, a neurologist,
and Dr. Nelson, an orthopedic surgeon who examined Ms.
Casteel-Ellison, had no hesitancy in diagnosing right carpal
tunnel syndrome. Additionally, while she may have had a
weight problem, her weight did not vary more than twenty
pounds over seven years. Additionally, Ms. Casteel-Ellison
had no documented symptoms of carpal tunnel syndrome prior to
working for the employer, even though her weight problem
existed for four years prior. The Office of Judges found the
employer was asking it to find that a medical report from a
physician who never examined the Ms. Casteel-Ellison
constituted a preponderance of the evidence. The Office of
Judges declined to do so and found the carpal tunnel syndrome
Board of Review reversed the Office of Judges and found that
its analysis and conclusions were clearly wrong in view of
the reliable, probative and substantial evidence of the whole
record. The Board of Review referred to West Virginia Code of
State Rules § 85-20-41(2006) regarding conditions that
can precipitate carpal tunnel syndrome, as well as the
occupational groups at high risk for carpal tunnel syndrome.
It found Ms. Casteel-Ellison's job duties were normal
clerical activities that did not fall into the high risk
categories. Additionally, she had increased body mass, which
was a non-occupational risk factor. It concluded that the
preponderance of the evidence failed to demonstrate Ms.
Casteel-Ellison's employment duties had any relationship
to her carpal tunnel syndrome.
review, we find the Board of Review erred in reversing the
Office of Judges' Order. Ms. Casteel-Ellison did not have
any problems with her right hand until she started using the
mouse in order to transfer medical information into the
charts every day, all day while she was at work. She has no
other conditions that contribute to the development of carpal