BOR
Appeal No. 2051604 (Claim No. 2015031660)
MEMORANDUM DECISION
Mr.
Williams seeks to have his workers' compensation claim
held compensable, and seeks reasonable medical treatment for
his injuries allegedly sustained on March 11, 2015, but not
reported until April 15, 2015, after he had been disciplined
for tardiness. The claims administrator denied the the claim
on May 26, 2015. The claims administrator also issued two
additional Orders, denying requests for physical therapy and
a lumbar MRI.
On
October 5, 2016, the Worker's Compensation Office of
Judges affirmed all three of the claims administrator's
Orders. This appeal arises from the Board of Review's
Final Order dated February 17, 2017, which affirmed the
Office of Judges Orders denying the claim and denying
treatment. The Court has carefully reviewed the records,
written arguments, and appendices contained in the briefs,
and the case is mature for consideration. 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, we affirm the decision of the Board of
Review.
Mr.
Williams, a roof bolter, filed a Report of Injury stating
that he sustained an injury on March 11, 2015, when he
slipped and fell at work. Although Mr. Williams alleged his
injury occurred on March 11, 2015, he did not report the
incident until April 15, 2015, the day he sought treatment at
Bradshaw Medical Clinic with Cherie Vance, FNP-BC. During
physical examination, he reported that his back pain
developed acutely and had been present for one month. His
physical examination showed no swelling, redness, or
palpitation. The assessment for the alleged injury was acute
low back pain and lumbago. Mr. Williams was prescribed pain
medication, and he was referred to an orthopedic surgeon for
a consultation. A work excuse note was provided to him for
work from April 15, 2015, through April 21, 2015.
A
treatment note establishes that Mr. Williams was seen for
care at the Bradshaw Medical Clinic on April 9, 2015, six
days before he first reported his alleged injury on April 15,
2015. He sought treatment for complaints of cough and sinus
pain. The office note makes no mention of any complaints of
back pain or the possibility of a work-related injury. Mr.
Williams was diagnosed with acute sinusitis, unspecified and
unspecified infective otitis externa. He was treated with
Q-Tussin for cough.
On May
11, 2015, Mr. Williams was evaluated by Robert Kropac, M.D.,
for an orthopedic consultation. Mr. Williams reported an
increased amount of low back pain, with right lower extremity
radiating pain and numbness. Dr. Kropac opined that Mr.
Williams presented with subjective complaints, and clinical
findings on physical examination were consistent with a
diagnosis of lumbosacral musculoligamentous strain, and
lumbar disc herniation with right lower extremity
radiculopathy secondary to the injury on March 11, 2015. Dr.
Kropac recommended physical therapy, and requested an MRI of
the lumbosacral spine for diagnostic purposes. A prescription
was provided for physical therapy three times a week for four
weeks. A work excuse was provided stating Mr. Williams could
not return to work until June 9, 2015.
On June
8, 2015, Mr. Williams returned to Dr. Kropac for an
orthopedic re-examination. He reported that he was not able
to participate in physical therapy. He also reported that he
was unable to have an MRI. After re-evaluation, the diagnoses
remained to be lumbosacral musculoligamentous strain, and
lumbar disc herniation with right lower extremity
radiculopathy secondary to the compensable injury. Dr. Kropac
also provided work excuses that kept Mr. Williams off work
through, at least, July 23, 2015.
On May
26, 2015, the claims administrator issued an Order denying
the application for benefits. The application was denied
because the claims administrator did not believe the evidence
provided showed that Mr. Williams sustained an injury in the
course of and resulting from his employment. The claims
administrator further stated that the decision was also based
upon the Report of Injury form that was completed two months
after the date of injury, and it was not completed by the
original treating physician. Following the Order rejecting
the claim, the claims administrator issued two additional
Orders on May 26, 2015. The claims administrator issued an
Order denying the request from Dr. Kropac for a lumbar spine
MRI. The claims administrator also issued an Order denying
Dr. Kropac's request for physical therapy three times a
week for four weeks. Both additional Orders were denied
because the claim was rejected. Mr. Williams protested all
three Orders.
Mr.
Williams finally underwent a lumbar MRI on July 9, 2015.
Dilip B. Patel, M.D., reviewed the findings and concluded
that Mr. Williams had a significant finding of a focally
protruding disc centrally at L3-L4, as well as an extruding
small disc herniation right posterior lateral inferiority at
the L4-L5 level. Degenerative disc disease was found at L3-4,
L4-5 and at the L5-S1 levels. The MRI did not show any
evidence of an acute to subacute compression fracture,
traumatic subluxation or bone contusion.
Mr.
Williams testified by deposition on February 4, 2016. He
testified that he was hauling a load of supplies on March 11,
2015. When the scoop started spinning, he got off to get a
bag of rock dust, and slipped and fell in the wet mud. Mr.
Williams stated that he twisted his back, and he thought he
might have pulled a muscle in his back. He stated that he
finished his shift and mentioned the injury to several
co-workers. Mr. Williams was able to return to work the next
day. As he continued to work for a few days, he began
experiencing pain and numbness in his legs and back. Mr.
Williams continued to work until April 15, 2015, when he
sought treatment at Bradshaw Medical Clinic. Mr. Williams
testified that prior to March 11, 2015, he had never had any
back problems, leg problems, or hip problems and that he had
no pain going down his leg.
Mr.
Williams was evaluated by Prasadarao Mukkamala, M.D., on May
5, 2016. Dr. Mukkamala did not believe there was objective,
credible medical evidence that Mr. Williams sustained a
compensable injury on March 11, 2015. Dr. Mukkamala made note
of the fact that Mr. Williams did not seek medical attention
for his alleged injury until five weeks after the incident on
March 11, 2015. Because the x-rays did not reveal a fracture,
Dr. Mukkamala was of the opinion that Mr. Williams most
likely would have suffered a lumbar sprain. The lumbar sprain
being a soft tissue injury, would hurt at whatever level it
hurts at the time, but then in the subsequent couple of
weeks, the pain would abate. Dr. Mukkamala stated that the
report of injury is not supported by the natural history for
an injury of this type. Dr. Mukkamala concluded that Mr.
Williams did not suffer a compensable injury on March 11,
2015. Because Mr. Williams worked for more than three weeks
following the alleged injury, Dr. Mukkamala opined that he
was never temporarily and totally disabled, and was not in
need of any additional medical treatment.
The
Office of Judges found that the preponderance of the evidence
fails to show that Mr. Williams sustained an injury in the
course of and as a result of his employment on March 11,
2015. Although Mr. Williams contends that he reported the
injury around the time of its occurrence, the Office of
Judges found it unsubstantiated. Mr. Williams did not seek
medical treatment until five weeks after the alleged incident
on March 11, 2015. Mr. Williams testified at deposition that
he informed several co-workers about his injury. He further
testified that he returned to work the next day and reported
the incident to his supervisor. Mr. Williams stated that
nothing was done and that he continued to work, but he could
hardly walk from the pain. The Office of Judges reasoned that
his contention that he reported the injury to his employer
would be more persuasive if one or more of those individuals
had verified Mr. Williams's version of the incident.
Immediately following the reporting of his alleged injury, he
sought treatment at Bradshaw Medical Clinic where a physical
examination showed no swelling or redness, and no localized
tenderness on palpation. The Office of Judges deemed the
opinion of Dr. Mukkamala to be the most persuasive medical
statement of record. Based upon the preponderance of the
evidence, the Office of Judges concluded that the claims
administrator Orders denying compensability and treatment
should be affirmed.
The
Board of Review adopted the findings of fact and conclusions
of law of the Office of Judges, and affirmed the conclusions
of the Office of Judges in a Final Order dated February 17,
2017. On appeal, Mr. Williams, by Gregory S. Prudich, his
attorney, argues that he has met his burden of proof and that
it is more likely than not that an injury occurred on March
11, 2015. T. Jonathan Cook, counsel for XMV, Inc., argues
that the record does not document that Mr. Williams had any
back pain until he reported his symptoms on April 15, 2015,
five weeks after his alleged date of injury. We agree with
the Board's decision. Dr. Mukkamala advised that Mr.
Williams would have had pain immediately following the
incident and pain would not have developed five weeks after
the incident. The evidence supports the Board of Review's
decision.
For the
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 ...