RAYMOND K. FULLER, Claimant Below, Petitioner
HUNTINGTON ALLOYS CORPORATION, Employer Below, Respondent
Appeal No. 2051563) (Claim No. 2015031338)
Raymond K. Fuller, by Edwin Pancake, his attorney, appeals
the decision of the West Virginia Workers' Compensation
Board of Review. Huntington Alloys Corporation, by Jillian
Moore and Steven Wellman, its attorneys, filed a timely
issue presented in the instant appeal is Mr. Fuller's
request for authorization of an anterior cervical discectomy
and fusion. On September 29, 2015, the claims administrator
denied the request for authorization of the procedure. The
Office of Judges affirmed the claims administrator's
decision on September 12, 2016. This appeal arises from the
Board of Review's Final Order dated March 1, 2017, in
which the Board affirmed the Order of the Workers'
Compensation Office of Judges. The Court has carefully
reviewed the records, written arguments, and appendices
contained in the briefs, and the case is mature for
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 the Board of Review's decision is based
upon a misstatement or mischaracterization of the evidentiary
record. 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.
Fuller injured his neck and left shoulder on May 22, 2015,
while attempting to maneuver rods within a furnace during the
course of his employment with Huntington Alloys Corporation.
On the date of injury, Mr. Fuller sought medical treatment at
St. Mary's Urgent Care and was diagnosed with a left
shoulder sprain. He sought follow-up care with Allen Young,
M.D., Huntington Alloys Corporation's on-site physician,
on May 26, 2015. He complained of left shoulder pain and pain
in the area of his left trapezius, which radiated into the
left arm. On June 30, 2015, Mr. Fuller's claim for
workers' compensation benefits was held compensable for a
neck sprain and a sprain of an unspecified site of the
shoulder/arm. Additionally, the claims administrator
authorized a one-time consultation with neurosurgeon Matthew
30, 2015, Dr. Werthammer examined Mr. Fuller. Dr. Werthammer
noted that he previously treated Mr. Fuller in 2013 for
lumbar spondylosis. Mr. Fuller had experienced neck and
shoulder pain over the years, but never experienced pain
radiation into the left arm until the May 22, 2015, injury.
Dr. Werthammer then opined that a cervical spine MRI revealed
multilevel spondylosis and a left-sided disc herniation at
C6-7. Dr. Werthammer diagnosed Mr. Fuller
with a cervical disc herniation with radiculopathy and
recommended that he undergo an anterior cervical discectomy
and fusion at C6-7. Dr. Young re-examined Mr. Fuller on July
31, 2015, and concurred with Dr. Werthammer's
recommendation that Mr. Fuller undergo an anterior cervical
discectomy and fusion.
September 28, 2015, Christopher Chenault, M.D., performed a
records review in which he concluded that the medical
evidence did not support the finding that the request for
surgery was related to the compensable injury. Dr. Chenault
noted that Mr. Fuller did not complain of neck pain until
several days after the date of injury. Additionally, he
opined that the cervical spine MRI revealed only degenerative
changes, which are most prominent at C7-11. Further, Dr.
Chenault opined that the clinical findings contained in the
evidentiary record did not consistently present at C6-7,
which is the level at which Dr. Werthammer diagnosed a disc
herniation. Finally, he concluded that the mechanism of
injury described by Mr. Fuller was inconsistent with the
production of a disc herniation. Based upon Dr.
Chenault's record review, the claims administrator denied
Dr. Werthammer's request for authorization of a C6-7
anterior cervical discectomy and fusion on September 29,
Mukkamala, M.D., performed an independent medical evaluation
on October 27, 2015. Dr. Mukkamala opined that Mr. Fuller had
reached maximum medical improvement with respect to the
compensable injury and required no further treatment. He
noted that Mr. Fuller has an extensive history of
pre-existing neck and back complaints, and found that Mr.
Fuller has co-existing, non-compensable cervical spondylosis,
which has delayed his recovery. Finally, Dr. Mukkamala opined
that Mr. Fuller's current neck symptoms are not causally
related to the compensable injury, but rather are
pre-existing and degenerative in nature.
Lee Bailey, M.D., performed an independent medical evaluation
on June 2, 2016. Dr. Bailey also opined that Mr. Fuller had
reached maximum medical improvement with respect to the
compensable injury and required no further treatment. After
reviewing Mr. Fuller's medical record, she opined that
his current complaints were identical to the complaints he
expressed in 2009 after sustaining a left shoulder injury.
Additionally, she opined that the cervical spine MRI revealed
only degenerative changes that were the result of the normal
aging process. Finally, Dr. Bailey opined that the requested
anterior cervical discectomy and fusion was not medically
necessary or reasonably required for the treatment of the
Order affirming the September 29, 2015, claims
administrator's decision, the Office of Judges held that
the preponderance of the evidence failed to establish that
the requested anterior cervical discectomy and fusion was
medically necessary or reasonably required for the treatment
of the compensable injury. The Board of Review affirmed the
reasoning and conclusions of the Office of Judges in its
March 1, 2017, decision. On appeal, Mr. Fuller asserts that
the evidence of record demonstrates that he sustained a
herniated disc at C6-7 as a result of the compensable injury.
He further asserts that the requested anterior cervical
discectomy and fusion is medically necessary for the
treatment of the herniated disc at C6-7.
Office of Judges found persuasive Drs. Chenault's,
Mukkamala's, and Bailey's conclusions that the
requested anterior cervical discectomy and fusion were
unnecessary for and unrelated treatment for the compensable
injury. The Office of Judges then concluded that the claims
administrator properly denied the request for authorization
of an anterior cervical discectomy and fusion. We disagree.
Werthammer, a board certified neurosurgeon, evaluated Mr.
Fuller at the request of Dr. Young, the treating physician.
In Dr. Werthammer's opinion, the radicular features in
the left upper extremity corresponded to a C7 distribution,
which corresponded to the disc herniation at C6-C7 seen on
the cervical MRI. Dr. Chenault, a board certified orthopedic
surgeon, did not examine Mr. Fuller. Dr. Mukkamala, a
physical medicine and rehabilitation physician, and Dr.
Bailey, an occupational medicine physician, both opined that
the MRI findings were degenerative in nature. However, Dr.
Werthammer was the only neurosurgeon to evaluate Mr. Fuller.
As such, his opinion regarding the need for the surgery was
more reliable. Therefore, the Office of Judges and Board of
Review erred when they relied on the opinions of Drs.
Chenault, Mukkamala, and Bailey.
foregoing reasons, we find that the decision of the Board of
Review is based upon a misstatement or mischaracterization of
the evidentiary record. Therefore, the decision of the Board
of Review is reversed and remanded. The claims administrator
shall hold the claim ...