Appeal No. 2051975 (Claim No. 2012039770)
Ralph Staton, by Patrick K. Maroney, his attorney, appeals
the decision of the West Virginia Workers' Compensation
Board of Review. The City of Charleston, by James W. Heslep,
its attorney, filed a timely response.
issue on appeal in this case is the denial of Mr.
Staton's request for the authorization for a magnetic
resonance imaging (MRI) of his lumbar region. The claims
administrator denied his request in an Order dated August 17,
2016. In its April 21, 2017, Order, the Workers'
Compensation Office of Judges affirmed the claims
administrator's decision to deny Mr. Staton's
request. This appeal arises from the Board of Review's
Final Order dated October 4, 2017, in which the Board
affirmed the April 21, 2017, 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
Staton, a firefighter/paramedic, injured his low back on June
20, 2012, while lifting a high-rise pack into the side
compartment of an emergency vehicle. The claims administrator
held the claim compensable for low back strain and right knee
strain on June 28, 2012. Mr. Staton received conservative
treatment following his injury.
October 15, 2012, an independent medical evaluation performed
by Bill Hennessey, M.D., listed allowed conditions in the
claim to be low back strain and right knee sprain. Dr.
Hennessey reported that an MRI of the lumbar spine conducted
on August 2, 2012, was normal, and revealed typical
age-related degenerative change at the lowest two levels, no
disc herniation, no nerve root encroachment, and no
post-traumatic findings. Dr. Hennessey concluded that Mr.
Staton had reached his maximum medical improvement. Using the
American Medical Association's Guides to the
Evaluation of Permanent Impairment, (4th ed.
1993) and West Virginia Code of State Rules § 85-20
(2006), Dr. Hennessey could not provide a rating for
impairment because Mr. Staton's condition was temporary,
and not permanent. Dr. Hennessey concluded that there is no
objective evidence of any residual physical impairment in the
claim. Dr. Hennessey found no physical restrictions which
would limit Mr. Staton's ability to participate in either
vocational or avocational activities of his choice, including
those of his pre-injury job duties as a firefighter.
City of Charleston submitted a March 25, 2013, independent
medical evaluation from Joseph Grady, M.D. Dr. Grady's
assessment of Mr. Staton was listed as being resolved lumbar
sprain and resolved knee sprain. Dr. Grady did not find signs
of radiculopathy, and he concluded that Mr. Staton had
reached his maximum degree of medical improvement. Dr. Grady
did not find ratable impairment for Mr. Staton's right
knee injury. Using the American Medical Association's
Guides, Dr. Grady found 0% whole person impairment
for the lumbar sprain.
Staton suffered several subsequent injuries after his
compensable injury of June 20, 2012. During the course of his
treatment, Mr. Staton sought treatment for his occupational
back injuries at Primary Care Nitro. He submitted numerous
records and treatment notes regarding his ongoing care and
treatment for low back pain. In June of 2015, Mr. Staton
sought treatment at Primary Care Nitro for low back pain. He
attributed his symptoms to lifting a 500-pound patient. On
September 22, 2015, Mr. Staton once again reported to Primary
Care Nitro with an onset of pain he attributed to lifting
tires while participating in a Cross Fit program. On November
26, 2015, Mr. Staton injured his shoulder, neck, and back
while lifting a 300-pound patient. His assessment following
the injury was unspecified injury of muscles and tendons of
the rotator cuff of the right shoulder. On June 22, 2016,
Primary Care Nitro requested authorization for a lumbar MRI
due to Mr. Staton's continued back pain.
Order dated August 17, 2016, the claims administrator denied
Mr. Staton's request for a lumbar MRI. The claims
administrator noted Dr. Hennessey's October 15, 2012,
independent medical evaluation report that advised that no
further treatment was necessary to address Mr. Staton's
compensable conditions. The claims administrator also stated
that a September 20, 2013, Office of Judges Order, in a
separate claim, indicated that Mr. Staton's doctor was
requesting additional treatment for what appeared to be a
more serious non-compensable spine diagnosis related to
pre-existing severe degenerative changes. Mr. Staton
protested the decision of the claims administrator.
Staton was deposed on November 15, 2016. He testified that he
injured his back while working for the City of Charleston as
a firefighter and paramedic. He stated that he continued to
have problems for over four years after the injury, which has
been made worse by a shoulder and low back injury that he
received on Thanksgiving of 2015. Before the November 26,
2015, injury, Mr. Staton testified that he had a dull ache in
his back that was manageable with Percocet and rest. After
the 2015 injury, Mr. Staton reported that his pain
dramatically changed his low back condition. He stated that
he does not enjoy a great quality of life following the 2015
injury because his pain is not well controlled. He also
experiences radiating pain down the right side of his leg. He
had surgery to repair his shoulder, and MRIs of his back and
neck have been recommended to assess his condition. Mr.
Staton testified that his health insurance will not pay for
the requested MRIs because his health insurance believes that
his injuries are related to his workers' compensation
Office of Judges found that the claims administrator did not
err in denying the requested treatment based on the report of
Dr. Hennessey, who advised no further treatment was
necessary. The Office of Judges concluded that the requested
treatment for a lumbar MRI is not medically related and
reasonably necessary to treat the compensable injuries in
this claim. The Office of Judges took judicial notice of a
prior Office of Judges Order dated September 20, 2013, which
concluded that Mr. Staton's physician was requesting
additional treatment for what appeared to be a more serious
non-compensable spine diagnosis which was related to
preexisting severe degenerative changes. The Office of Judges
affirmed the claims administrator's August 17, 2016,
Order denying Mr. Staton's request for a lumbar MRI.
Board of Review adopted the conclusions of the Office of
Judges and affirmed its decision in an Order dated October 4,
2017. We agree with the decision of the Board of Review.
Although Mr. Staton argues that he suffered an aggravation of
his compensable condition, the evidence submitted suggests
his current symptoms are related to an incident that occurred
on June 9, 2015. The Board of Review correctly affirmed the
April 21, 2017, Order of the Office of Judges.
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 ...