LISA A. PECJAK, Claimant Below, Petitioner
WAL-MART ASSOCIATES, INC., Employer Below, Respondent
Appeal No. 2051262, Claim No. 2011018465
Lisa A. Pecjak, by Christopher J. Wallace her attorney,
appeals the decision of the West Virginia Workers'
Compensation Board of Review. Wal-Mart Associates, Inc., by
Karin L. Weingart its attorney, filed a timely response.
issue on appeal is whether temporomandibular joint
dysfunction ("TMJ") should be added as a
compensable component of the claim. This appeal originated
from the January 2, 2015, claims administrator's decision
denying the request to add cervicalgia and TMJ as
compensable secondary conditions to the claim. In its April
25, 2016, Order, the Workers' Compensation Office of
Judges affirmed the decision. The Board of Review's Final
Order dated October 24, 2016, affirmed the Order of the
Office of Judges. 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
Pecjak, a cashier, was injured in the course of her
employment on November 25, 2010, when she was struck in the
left side of her face with a role of labeling tape thrown by
a co-worker. Ms. Pecjak finished her shift and then proceeded
to the emergency room. The report noted that mild swelling
was present over the left lower jaw with no abrasions or
obvious bruising. A CT scan was performed and revealed no
evidence of acute fracture of the facial bones. The mandible
was intact, as well as the pterygoid plates and orbital
walls. According to the CT scan, no focal soft tissue
swelling of the face was apparent. Ms. Pecjak was diagnosed
with left facial contusion.
November 29, 2010, Ms. Pecjak sought treatment from Nathan
Duer, M.D., who assessed traumatic left TMJ and referred her
to an oral surgeon for further evaluation. Ms. Pecjak
subsequently presented to Steven Krakora, D.M.D., for
treatment. She informed Dr. Krakora that her facial pain had
started prior to the trauma but was more severe now. Dr.
Krakora diagnosed myofascial pain syndrome secondary to
bruxism (grinding of the teeth) and trauma, no evidence of
fracture, and contusion on the mandible. Ms. Pecjak continued
to seek treatment from Dr. Duer through January of 2011. At
that time, Dr. Duer stated that there was nothing more
medically he could do for her. His assessment remained TMJ.
February 17, 2011, Ms. Pecjak presented to West Virginia
University School of Dentistry with complaints of left jaw
pain resulting from trauma one year prior to the TMJ
diagnosis. Upon palpation, there was severe popping and
cracking on the left side for which no teeth appeared to be
the cause. The assessment indicated that a left disc appeared
to possibly be displaced. On May 3, 2011, Ms. Pecjak began
seeking treatment at Cornerstone Care. Ms. Pecjak reported
that she had recently undergone testing and was diagnosed
with trigeminal neuralgia. Shannon Scango, PA-C, evaluated
Ms. Pecjak and listed her assessment as trigeminal neuralgia
Pecjak presented to the emergency room on June 7, 2011. She
complained of pain from TMJ and associated pain in her left
ear, as well as numbness and tingling throughout her left
face. Ms. Pecjak also attributed a recent nose bleed to
"nerve damage" from the TMJ. She was evaluated by
Owen Lander, M.D., and Aladdin Timbayan, M.D., both of whom
assessed TMJ and trigeminal neuralgia. Ms. Pecjak was
instructed to contact her dentist.
September 11, 2011, Ms. Pecjak began presenting to Jefferson
Pain and Rehabilitation Center. On that day, Ms. Pecjak was
evaluated by Zheng Wang, M.D., Ph.D., and he reported that
Ms. Pecjak was making progress with conservative management
of physical therapy, a nerve block, and injection therapy
under the diagnoses of sprain/strain of the neck,
Teltze's disease, left TMJ, left facial trauma, and left
point during the course of her treatment, Ms. Pecjak
requested that the diagnoses of TMJ and cervicalgia be added
as compensable secondary conditions to the claim. Ms. Pecjak
has an extensive and significant history of dental issues
that began as early as April 6, 2005, when it was noted in a
medical report that she had six chipped teeth. In 2006, Ms.
Pecjak was treated for headaches and left facial pain. On
June 30, 2008, Ms. Pecjak presented to the emergency room
with complaints of dental pain. The report noted that Ms.
Pecjak had poor dentition.
Pecjak's history of poor dental hygiene continued after
the compensable injury. On July 25, 2012, Ms. Pecjak
presented to the emergency department for complaints of
dental pain. She stated that she had multiple dental
cavities. She was assessed with dental cavity and abscess,
prescribed antibiotics, and advised to follow-up with a
dentist as soon as possible. Ms. Pecjak returned to see Ms.
Scango at Cornerstone Care on October 23, 2012, for worsening
TMJ symptoms. Ms. Pecjak stated that she had recently seen a
dentist who encouraged her to have some teeth pulled. On
October 29, 2012, Ms. Pecjak presented to the emergency room
again and was diagnosed with dental abscess and widespread
dental decay. Ms. Pecjak then returned to Dr. Krakora on
October 31, 2012, and it was indicated that she had severe
decay and periodontal disease. Severe bone loss was also
noted. Dr. Krakora's plan was to extract all of the
remaining upper teeth. After surgical extraction, the
diagnosis was irreversible pulpitis and non-restorable,
severe periodontal disease.
effort to have TMJ added to the claim, Ms. Pecjak underwent
an independent medical evaluation performed by Charles
Werntz, III, D.O., on October 25, 2011. Dr. Werntz reported
that Ms. Pecjak's underlying injury occurred when she was
struck in the side of the head by a roll of labeling tape at
work. The diagnoses were left sided facial trauma with injury
to the musculature overlying the side of the left jaw and TMJ
on the left. Dr. Werntz reported that Ms. Pecjak's
symptoms were essentially untreated from the date of injury
until September of 2011. He opined that Ms. Pecjak's
current symptoms are related to the workplace injury as there
is no evidence suggesting another cause. Dr. Werntz opined
that Ms. Pecjak was not at maximum medical improvement and
that she should complete the course of pain treatment therapy
and physical therapy in order to reach maximum medical
Krakora, Ms. Pecjak's treating dentist, evaluated Ms.
Pecjak on March 26, 2013, and noted that she had experienced
facial pain for several years. He diagnosed myofascial pain
syndrome secondary to bruxism. Dr. Krakora recommended that
Ms. Pecjak see Thomas Braun, D.M.D., who specialized in TMJ.
Ms. Pecjak was seen by Dr. Braun on April 25, 2013. Dr. Braun
reported "an impression of traumatic osteoarthrosis,
left temporomandibular joint, awaiting confirmation".
His plan was to have MRIs taken before considering scheduling
arthroplasty of the left temporomandibular joint.
7, 2013, Ms. Pecjak presented to Jefferson Pain and
Rehabilitation Center and was evaluated by Joseph Phillips,
NP. The assessment was drug abuse, other mixed, or
unspecified nondependent drug use; cervical myofascial pain
syndrome; and TMJ. Mr. Phillips reported that Ms. Pecjak was
to stop taking pain medication. Ms. Pecjak's family
discarded all of her ...