NATHANIEL E. ELLIS, Claimant Below, Petitioner
SPARTAN MINING COMPANY, Employer Below, Respondent
Appeal No. 2052174) (Claim No. 2016027518)
Nathaniel Ellis, by, his attorney, Reginald Henry, appeals
the decision of the West Virginia Workers' Compensation
Board of Review. Spartan Mining Company, by Sean Harter, its
attorney, filed a timely response.
issues on appeal are temporary total disability benefits and
medical treatment. On January 4, 2017, the claims
administrator closed Mr. Ellis' claim for temporary total
disability benefits. On February 13, 2017, the claims
administrator denied a request from Dr. McCleary for a right
knee MRI. The Office of Judges reversed both of the decisions
in its August 3, 2017, Order. The Order was reversed and
vacated by the Board of Review on January 8, 2018. The Court
has carefully reviewed the records, written arguments, and
appendices contained in the briefs, and the case is mature
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
Ellis, a utility man, was injured when he tripped while
getting into a scoop and twisted his right knee on April 30,
2016. He was treated in the emergency room Logan General
Hospital for right knee pain. He was diagnosed with a right
knee sprain. On May 25, 2016, the claim was held compensable
for a right knee sprain.
3, 2016, right knee MRI revealed no evidence of internal
derangement. All of the ligaments, tendons, and menisci were
intact. Robert McCleary, D.O., performed a right knee
arthroscopic fat pad debridement on July 21, 2016. The
pre-operative diagnosis was sprain of the right knee. The
post-operative diagnosis was right knee anterior friction fat
pad syndrome. Mr. Ellis underwent a functional capacity
evaluation on September 28, 2016, which showed he was able to
work at a medium to heavy physical demand level and that he
may have significant difficulty or limitation if required to
walk or bend over for prolonged periods. The evaluation also
showed right quadriceps weakness; mildly antalgic gait
pattern; and decreased ability to climb stairs, perform bent
over walking as if in coal mines, and perform activities that
required him to bend his right knee. Work conditioning was
Bailey, M.D., performed an independent medical evaluation on
November 10, 2016. She noted that Mr. Ellis complained of
mild pain, right knee instability, and the inability to fully
extend his right knee due to pain. He reported that the
surgery resolved his original right knee pain, improved his
range of motion, and improved the frequency of his right knee
giving out. Mr. Ellis had been unable to return to his
pre-injury work duties, but believed he would be able to do
so after he completed the work hardening. On examination, Mr.
Ellis had no soft tissue swelling or effusion of the knee. He
was tender to palpation. Strength was symmetrical in both
knees. His right knee has 120 degrees of flexion and four
degrees of extension. His left knee had 120 degrees of
flexion and two degrees of extension. Dr. Bailey diagnosed
resolved right knee sprain and strain and opined that Mr.
Ellis had reached maximum medical improvement.
November 18, 2016, Dr. McCleary restricted Mr. Ellis from
working until December 19, 2016. The claims administrator
suspended Mr. Ellis's temporary total disability benefits
on December 1, 2016, based on the independent medical
evaluation of Dr. Bailey. On December 18, 2016, Mr. Ellis was
seen by Dr. McCleary for right knee pain over the medial
aspect of the knee. Dr. McCleary noted 120 degrees of knee
flexion and extension, good muscle strength, and tenderness
of the medial femoral condyle secondary to the friction pad
syndrome. In an attending physician's report dated
December 28, 2016, Dr. McCleary opined that Mr. Ellis had
reached maximum medical improvement. He also opined that Mr.
Ellis had been temporarily and totally disabled from July 21,
2016, through December 17, 2016. The claims administrator
closed the claim for temporary total disability benefits on
January 4, 2017.
Ellis returned to work on January 11, 2017. The next day he
was treated in the emergency room at Logan Regional Medical
Center for right knee and low back pain. Mr. Ellis's
right knee was swollen and tender. The range of motion was
limited due to pain. A right knee x-ray showed mild
osteoarthritis. He was diagnosed with back pain, knee
effusion, and knee pain. Mr. Ellis returned to see Dr.
McCleary on January 18, 2017. Dr. McCleary noted diffuse
swelling over the patellar tendon. Mr. Ellis said he was
working when he felt a pop in his knee and fell to the
ground. Dr. McCleary diagnosed right knee sprain; lumbar
sprain; and sprain of the right knee, unspecified ligament,
subsequent encounter. Dr. McCleary recommended a repeat MRI,
intra-articular injections into the right knee, and took Mr.
Ellis off work through March 18, 2017.
claims administrator denied Dr. McCleary's request for a
right knee MRI on February 13, 2017. Mr. Ellis had the MRI on
February 15, 2017. It showed no evidence of a cruciate or
collateral ligament tear and no meniscal injury. There was
mild signal irregularity near the quadriceps tendon insertion
on the patella, which was stable from the previous study. No
new abnormality was seen. On February 20, 2017, Dr. McCleary
noted persistent pain in the medial aspect of the knee as
well as mild paraspinal lumbar spasm. He took Mr. Ellis off
of work through April 20, 2017.
Ellis testified via deposition on May 16, 2017, that he
worked underground on the move crew putting structure in,
moving belts, and cleaning for day shift. On the day he was
injured, he was working in forty-two inches of coal. He was
getting in a scoop to move a piece of the belt when he
slipped and twisted his knee. After his surgery, the pain
went right back to where it was. He is unable to sit or walk
if he has to bend his knee. He had been unable to return to
work because of his knee. Mr. Ellis had not sought treatment
from Dr. McCleary since February of 2017 because he could not
pay for the visits.
31, 2017, Prasadarao Mukkamala, M.D., performed an
independent medical evaluation at which time Mr. Ellis's
chief complaint was right knee pain. He told Dr. Mukkamala he
was unable to go on stairs due to the pain. On examination,
Dr. Mukkamala noted normal range of motion of the right knee.
He also noted no deformity, crepitus, instability, or
swelling in the right knee. Dr. Mukkamala diagnosed sprained
right knee, status post arthroscopic debridement of the fat
pad. He opined that Mr. Ellis had reached maximum medical
improvement and found no indication for a follow-up MRI, or
any other medical treatment.
Office of Judges reversed the claims administrator's
suspension of temporary total disability benefits in its
August 3, 2017, Order and authorized the benefits through
April 20, 2017, and thereafter as substantiated by proper
medical evidence. It noted that the claim was closed for
temporary total disability benefits based on Dr. Bailey's
November 10, 2016, evaluation in which she opined Mr.
Ellis's right knee complaints had resolved. It determined
that a preponderance of the evidence indicated the injury
caused more than a knee sprain. The Office of Judges further
found that Dr. Bailey understated Mr. Ellis's ongoing
knee problems. Dr. McCleary continued to treat Mr. Ellis
after Dr. Bailey's examination and after his attempt to
return to work.
Office of Judges also reversed the claims administrator's
February 13, 2017, decision and granted authorization for the
right knee MRI. The Office of Judges found that a
preponderance of the evidence indicated that the right knee
MRI was reasonable medical treatment for the work injury. It
noted that physical therapy and surgery failed to improve Mr.
Ellis's right knee symptoms and the MRI was needed due to
the continued right knee complaints. Therefore, it was
reasonable for Dr. McCleary to request the repeat MRI to
address Mr. Ellis's ...