RONALD E. MILLS, Claimant Below, Petitioner
WEST VIRGINIA OFFICE OF INSURANCE COMMISSIONER, Commissioner Below, Respondent and ISLAND FORK CONSTRUCTION LTD, Employer Below, Respondent
Appeal No. 2051629) (Claim No. 2000051941)
workers' compensation law, a claimant is entitled to
medically related and reasonably required treatment as long
as the treatment is for an injury or disease sustained in the
course of and resulting from employment. Ronald E. Mills was
working for Island Fork Construction, LTD, when he injured
his lower back. We are asked to decide whether a lumbar MRI
without contrast should be authorized. After a thorough
review of the evidence, we find that the requested treatment
is neither medically related nor reasonably required for the
compensable injury. We also find, after consideration of the
parties' briefs and evidentiary record, that the
decisional process would not be significantly benefitted by
oral argument. We find no substantial question of law or
prejudicial error. Therefore, a memorandum decision is
appropriate under Rule 21 of the Rules of Appellate
Mills, a heavy equipment operator, was injured on March 24,
2000, in the course of his employment while lifting and
tugging on a structure. He was treated by Robert Kropac,
M.D., for the injury. On August 21, 2002, Mr. Mills was again
seen for lower back and left leg pain by Dr. Kropac who
recommended several medications for pain control. Dr. Kropac
also recommended a repeat MRI of the lumbosacral spine for
diagnostic purposes. A 2004 MRI showed disc degeneration and
residual disc bulging at L5-S1 but no evidence of disc
herniation or spinal stenosis. The claims administrator added
displaced lumbar intervertebral disc and lumbosacral
sprain/strain to the claim.
9, 2005, A.E. Landis, M.D., performed an independent medical
evaluation of Mr. Mills and opined that he suffered a soft
tissue sprain injury to his lower back in the work-related
incident. The injury was superimposed on preexisting
degenerative disc disease at L5-S1. Dr. Landis found that Mr.
Mills has had extensive treatment and has had persistent
symptoms related to his degenerative disc disease. Dr. Landis
concluded that he had reached maximum medical improvement and
assessed 5% impairment. The claims administrator thereafter
granted a 5% permanent partial disability award.
years after the initial injury, Dr. Kropac examined Mr. Mills
and diagnosed lumbar disc herniation with left lower
extremity radiculitis. He requested authorization for an MRI.
On the request, where it asks if the injury is related to an
accident, he marked "NO". Mr. Mills testified in a
deposition that prior to his compensable injury in 2002, he
had no back problems. Since the injury he has had ongoing
back problems. His main issue is the sciatic nerve going down
his leg. The pain is nearly constant and worsens with
activity. He stated that it had been a few years since his
latest MRI. Mr. Mills testified that he does home exercises
and takes medication to manage his symptoms. He said that his
job sometime irritates his back.
Kropac also testified in a deposition that he had treated Mr.
Mills for his compensable injury for many years. He stated
that Mr. Mills needs an MRI to evaluate his increasing back
pain and radicular symptoms to determine if there has been a
progression of his disc herniation or recurrent disc
herniation. Dr. Kropac asserted that the MRI is medically
necessary and that he would be unable to provide Mr. Mills
with a proper treatment plan without one. On
cross-examination, Dr. Kropac admitted that once a disc is
herniated, it is very easy to rupture it, even without
further injury. A cough or sneeze could cause a rupture. Dr.
Kropac disagreed with Dr. Landis's finding that Mr. Mills
had a soft tissue injury because he did have a disc
herniation due to the injury.
claims administrator denied the lumbar MRI without contrast.
And the Office of Judges affirmed the decision. It found that
Dr. Kropac examined Mr. Mills and diagnosed disc herniation
secondary to the compensable injury. The requested MRI at
issue was for diagnostic purposes. In his testimony, Dr.
Kropac asserted that he needed an MRI to evaluate Mr.
Mills's increasing pain with radiculopathy. Dr. Kropac
acknowledged that pain, including radicular pain, can be
caused by degenerative changes. He further said that once
someone has a disc herniation, it is very easy to rupture the
disc. The Office of Judges found that the claim has not been
held compensable for disc herniation although Dr. Kropac
stated it is part of the compensable injury and is the basis
of his treatment request. The Office of Judges noted that the
2004 lumbar MRI did not show a disc herniation; however, it
did show degeneration, which Dr. Kropac indicated could be
the cause of Mr. Mills's pain. The Office of Judges
therefore found that the requested MRI was neither medically
necessary nor reasonably required treatment for the
compensable injury. The Board of Review adopted the findings
of fact and conclusions of law of the Office of Judges and
affirmed its Order.
appeal before this Court, Mr. Mills argues that he has been
reporting increasing pain for the past few years. His
treating physician determined that an MRI is necessary to see
if his displaced disc progressed. He asserts that Dr.
Kropac's opinion is the only of record and the MRI should
therefore be authorized. The West Virginia Office of the
Insurance Commissioner argues that the preponderance of the
evidence does not show that the requested treatment is
reasonably required for the compensable injury. It asserts
that a disc herniation has not been held compensable in this
claim and an MRI to check for its progression was therefore
review, we agree with the reasoning and conclusions of the
Office of Judges as affirmed by the Board of Review. The
evidence shows that the claim has not been held compensable
for herniated lumbar disc. An MRI to evaluate that condition
was therefore properly denied.
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 Chief Justice Allen H. Loughry II Justice Robin J.
Davis Justice Margaret L. ...