Appeal No. 2052954) (Claim No. 2015028989)
Jeffrey Meador, by Counsel Reginald D. Henry, appeals the
decision of the West Virginia Workers' Compensation Board
of Review ("Board of Review"). Southern
Conservation District, by Counsel Daniel G. Murdock, filed a
issues on appeal are temporary total disability benefits,
medical benefits, and an additional compensable condition.
The claims administrator closed the claim for temporary total
disability benefits on May 13, 2016. In two separate
decisions dated June 13, 2017, the claims administrator
denied a request for a spinal cord stimulator and denied a
request to add complex regional pain syndrome to the claim.
The Office of Judges affirmed the decision in its May 18,
2018, Order. The Order was affirmed by the Board of Review on
December 3, 2018.
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. 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.
Meador, a crew foreman, was injured in the course of his
employment on April 27, 2015. The Employees' and
Physicians' Report of Injury indicates he injured his
right leg when the chainsaw he was using kicked back and cut
him. The diagnosis was listed as complex right lower
extremity laceration with cortical tibia fracture. Mr. Meador
sought treatment from Charleston Area Medical Center that
day. The treatment note indicates Mr. Meador accidentally cut
his right lower leg with a chainsaw. He was diagnosed with
incomplete fracture of the right tibia and lacerations to the
leg. The claim was held compensable for closed fracture of
the right tibia and open wound of the right knee, leg, and
ankle on May 7, 2015.
14, 2015, treatment note from Orthopedic Trauma Group
indicates Mr. Meador was two weeks post-operative irrigation
and debridement of a chainsaw injury. He had no redness,
warmth, swelling, or discoloration in the area. He did have
pain at the laceration site and numbness and weakness in his
right foot. On June 4, 2015, Mr. Meador returned and
complained of decreased sensation in his right leg along the
peroneal nerve and limited range of motion in the right foot.
It was noted that he had swelling throughout the right leg.
On July 2, 2015, Mr. Meador returned with decreased sensation
along the peroneal nerve. X-rays showed a cortical defect
along the right tibia.
Grace, M.D., from the Center for Pain Relief, performed an
evaluation of Mr. Meador on September 22, 2015. Mr. Meador
reported constant burning pain, cold intolerance, changes in
skin color, abnormal skin temperature, and abnormal nail
growth in the right lower extremity. Dr. Grace diagnosed
complex regional pain syndrome of the right leg. He ordered a
lumbar sympathetic block, a right leg neuroma injection, and
physical therapy. Dr. Grace further stated that Mr. Meador
may be a spinal cord stimulator candidate.
notes from Orthopedic Trauma Group from December of 2015,
through February of 2016, indicate Mr. Meador saw no
improvement in his symptoms. He continued to have pain and a
burning sensation in his right leg and foot. Examination
showed decreased sensation in the peroneal nerve and swelling
throughout the right leg. Mr. Meador was unable to return to
notes by Dr. Grace from January of 2016, through April of
2016, indicate lumbar block injections had no effect on Mr.
Meador's symptoms. On examination, he had increased
response to pain, increased sensitivity, weakness, abnormal
color, temperature abnormalities, and abnormal nail growth in
the right lower extremity. Dr. Grace diagnosed complex
regional pain syndrome and requested authorization of a trial
spinal cord stimulator.
Meador was evaluated at the Orthopedic Trauma Group on April
21, 2016. It was noted that he had lost motor function of the
right leg due to an extensive laceration. Mr. Meador was
wearing a brace on the right leg. He reported a burning
sensation in the leg and foot. He had decreased sensation
along the peroneal nerve but there was no evidence of
cellulitic changes or abnormal coloring.
May 10, 2016, independent medical evaluation, Prasadarao
Mukkamala, M.D., noted that Mr. Meador underwent physical
therapy for a year, was unsuccessfully treated with lumbar
blocks, and currently requests a spinal cord stimulator.
Physical examination showed restricted range of motion in the
right ankle and foot as well as decreased sensation in the
right leg. Mr. Meador had normal temperature, skin color,
skin texture, and hair and nail growth in the right lower
extremity. Dr. Mukkamala opined that the diagnoses of
post-traumatic stress disorder and complex regional pain
syndrome were not causally related to the compensable injury.
Dr. Mukkamala saw no evidence of complex regional pain
syndrome and opined that Mr. Meador had reached maximum
medical improvement. Based on his evaluation, the claims
administrator closed the claim for temporary total disability
benefits on May 13, 2016.
Meador was evaluated at Orthopedic Trauma Group on May 19,
2016. He was receiving pain management with periodic
injections. Physical examination showed right foot drop but
no sign of discoloration. Treatment notes by Dr. Grace from
May of 2016, through January of 2017, indicate Mr. Meador
continued to report a burning sensation in his right leg.
Physical examination showed abnormal color, temperature, and
nail growth in the right lower extremity. Dr. Grace again
diagnosed complex regional pain syndrome. On August 16, 2016,
he requested that complex regional pain syndrome be added to
the claim. He stated that Mr. Meador had limited range of
motion, tenderness, decreased sensation, cold sensitivity,
weakness, abnormal coloring, abnormal temperature, and
mottled skin of the right lower extremity.
claims administrator denied the addition of chronic pain to
the claim on July 30, 2015. The Office of Judges reversed the
decision and added chronic pain as a compensable condition in
the claim on October 26, 2016. The claims administrator
denied a request to add complex regional pain syndrome to the
claim on June 13, 2017. In a separate decision that same day,
the claims administrator also denied a request for a spinal
Mukkamala performed a second independent medical evaluation
on January 12, 2018, in which he found weakness in the ankle.
Skin temperature of the right leg was the same as all other
limbs. Mr. Meador's right lower extremity showed normal
skin color, hair growth, texture, and nail growth. Dr.
Mukkamala noted right foot drop. Dr. Mukkamala found no
evidence of complex regional pain syndrome and stated that he