Appeal No. 2051839), (Claim No. 2015015785)
Rebecca Stiltner, by Gregory S. Prudich, her attorney,
appeals the decision of the West Virginia Workers'
Compensation Board of Review. Bluefield Regional Medical
Center, by Mark J. Grigoraci, its attorney, filed a timely
issue on appeal is Ms. Stiltner's entitlement to
permanent partial disability. The claims administrator
granted a 0% permanent partial disability award on March 30,
2015. The Office of Judges affirmed the decision in its
February 27, 2017, Order. The Order was affirmed by the Board
of Review on July 27, 2017. 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
Stiltner, a registered nurse, was injured in the course of
her employment on August 28, 2014, when she lost her balance
and put her right foot down hard to keep herself from
falling. A right foot x-ray taken on September 12, 2014,
showed a small planar calcaneal spur. There was no fracture
or dislocation. Ms. Stiltner was treated for the injury by
Mark Wilt, M.D., on September 12, 2014, at which point he
diagnosed right foot tendonitis. On November 9, 2014, Ms.
Stiltner reported that her right foot pain was worsening. Dr.
Wilt noted that she had sustained an injury to her right foot
in August that caused pain and swelling. On December 5, 2014,
Dr. Wilt recommended she remain off of work and continue to
use a walker. On January 23, 2015, Ms. Stiltner was weight
bearing with supportive shoes. She appeared to be improving
but she reported swelling in her noncompensable left foot.
Dr. Wilt put her in a walking boot for the left foot until an
MRI could be completed. On March 26, 2015, Ms. Stiltner
reported that her pain was gradually improving.
of the right foot showed a second metatarsal stress fracture
on November 10, 2014.Ms. Stiltner completed a report of
occupational injury on December 5, 2014, alleging that she
injured her right foot on August 28, 2014. Dr. Wilt completed
the physician's section and diagnosed a second metatarsal
fracture of the right foot. Ms. Stiltner was taken off of
work until January 18, 2015. The claim was held compensable
for second metatarsal fracture of the right foot on December
Kropac, M.D., performed an independent medical evaluation on
March 24, 2015, in which he found that Ms. Stiltner had
reached maximum medical improvement. He diagnosed healed
stress fracture of the second metatarsal of the right foot.
He concluded that the left foot and knee symptoms were not
related to the compensable right foot injury. Dr. Kropac
determined that Ms. Stiltner could return to full duty work
with no restrictions in regard to the right foot injury.
Using the American Medical Association's Guides to
the Evaluation of Permanent Impairment (4th ed. 1993),
he assessed 0% permanent partial disability. Based on his
report, the claims administrator granted Ms. Stiltner a 0%
permanent partial disability award on March 30, 2015.On June
14, 2015, Mohammed Ranavaya, M.D., reviewed Ms.
Stiltner's medical records and concurred with Dr.
Kropac's recommendation of 0% permanent partial
disability for the right foot.
Guberman, M.D., performed an independent medical evaluation
on December 16, 2015, in which he found that Ms. Stiltner had
reached maximum medical improvement. He diagnosed history of
stress fracture of the second right metatarsal, history of
stress fracture of the left foot, and chronic post-traumatic
left knee strain. Dr. Guberman concluded that the left foot
and left knee problems were related to stress and the
abnormal biodynamics attributable to the compensable right
foot injury; therefore, the left knee and foot problems are
related to the compensable injury. Using the American Medical
Association's Guides, he found 8% impairment for
range of motion abnormalities in the left ankle. For the
right foot he found 3% impairment for extension range of
motion abnormalities. His total assessment was 11% whole
person impairment for both feet.
Stiltner testified in a deposition on December 18, 2015, that
she was removing a shoe cover when she lost her balance. She
put her right foot down to keep from falling and felt a snap
followed by pain. Dr. Wilt diagnosed a stress fracture and
put her in a CAM boot. She was off of work from November 12,
2014, until the following August. She stated that Dr. Wilt
also subsequently diagnosed a stress fracture in her
noncompensable left foot. Ms. Stiltner was unaware of an
injury to her left foot. She stated that two weeks after she
was put in a CAM boot on her left foot, she began
experiencing intense pain and swelling in the left knee.
Kropac testified in a deposition on March 8, 2016, that he is
an orthopedic surgeon and had performed an evaluation of Ms.
Stiltner's right foot. He found the fracture was well
healed. He stated that he only evaluated the right foot but
speculated that the left foot and left knee injury was
unrelated to the compensable right foot fracture as no
mention was made of a left foot injury at that time. On
cross-examination, Dr. Kropac admitted that a stress fracture
would alter someone's gait but disagreed that it would
put greater stress on the opposite side of the body. He
explained that one only overuses one side of the body over
another if they are using a cane or similar device.
Guberman testified in a deposition on May 15, 2016, that Ms.
Stiltner's left knee problems developed due to the
difference in her gait as a result of the compensable injury.
He stated that wearing a CAM boot on the left foot for two
weeks could cause excruciating left knee pain. He agreed that
Ms. Stiltner did not sustain an acute left knee injury, but
he opined that her symptoms were related to accumulated
trauma due to gait abnormalities caused by the compensable
right foot stress fracture.
23, 2016, Prasadarao Mukkamala, M.D., performed an
independent medical evaluation in which he opined that the
left foot and left knee problems were not causally related to
the compensable injury. He determined that Ms. Stiltner had
reached maximum medical improvement. Using the American
Medical Association's Guides, he assessed 0%
Stiltner testified in a deposition on November 4, 2016, that
she had experienced problems with her left foot and left knee
following her compensable right foot fracture. She stated
that prolonged standing or walking caused right foot
tightness, swelling, aching, and pain. The symptoms were
aggravated by walking. She stated that she used to be active
but was now unable to exercise due to foot pain. She
testified that Dr. Guberman seemed to have given her a more
thorough examination as he took more measurements and asked
her questions about her use of ibuprofen for the right foot.
Ms. Stiltner asserted that Dr. Mukkamala did not take as many
measurements and did not inquire about her pain management.
She stated that she could not do the kind of nursing job that
requires being on her feet all day. She admitted that no
doctor had given her any work restrictions.
Office of Judges affirmed the claims administrator's
grant of a 0% permanent partial disability award on February
27, 2017. It first found that though Ms. Stiltner asserts
that her left lower extremity should also be included as part
of the compensable injury, no evidence has been introduced
indicating that the left lower extremity conditions have been
added to the claim. Therefore, only the right lower extremity
condition was addressed. The Office of Judges next determined
that the only evaluator of record to find impairment of the
right foot was Dr. Guberman who found 3% impairment based on
Table 42 of the American Medical Association's
Guides. The Office of Judges found that his range of
motion measurements were difficult to follow. Table 42 of the
American Medical Association's Guides refers to
plantar flexion, flexion contracture, and extension. Dr.
Guberman found thirty-five degrees plantar flexion with the
right knee fully extended and thirty-five degrees plantar
flexion with the knee flexed to forty-five degrees. He also
found eight degrees dorsiflexion with the knee fully
extended, five degrees dorsiflexion with the knee flexed to
forty-five degrees, thirty degrees inversion, and twenty
degrees eversion. The Office of Judges stated that the
significance of the flexion at thirty-five degrees with the
right knee flexed as opposed to fully extended was unknown;
however, Ms. Stiltner's flexion capability exceeded
twenty degrees either way. The Office of Judges then
determined that the range of motion studies done by Drs.
Kropac and Mukkamala do not corroborate Dr. Guberman's
findings that Ms. Stiltner had limited range of motion with