Summary
The West Virginia Supreme Court of Appeals affirmed the Board of Review’s decision in a workers’ compensation claim involving Michael Keller’s shoulder injury. The court held that chronic right shoulder pain, right upper-extremity radiculitis, and a history of failed rotator cuff repair were causally related to the compensable injury, and that a pain-management evaluation was medically necessary and reasonably required. The court issued the decision as a memorandum decision under Rule 21 of the West Virginia Rules of Appellate Procedure.
Topics
Practice areas
Questions Presented
- Whether the Board of Review erred in finding that right-shoulder chronic pain, right-upper-extremity radiculitis, and a history of failed rotator-cuff repair were causally related to Keller's compensable employment injury.
- Whether a pain-management evaluation was medically necessary and reasonably required treatment for Keller's compensable injury.
- Whether the requests were properly denied because they were submitted by a consulting physician rather than the authorized treating physician.
Holdings
- The Board of Review did not err in finding that right-shoulder chronic pain, right-upper-extremity radiculitis, and a history of failed rotator-cuff repair were causally related to Keller's compensable injury.
- The Board of Review did not err in finding that a pain-management evaluation was medically necessary and reasonably required in the course of treatment for Keller's compensable injury.
- The fact that the diagnosis-update and pain-management requests were made by a consulting physician rather than the authorized treating physician did not, on this record, provide sufficient cause to deny the requests.
Key quotations
“based upon the claimant’s history, medical records, and in light of the preponderance of the evidence standard set forth in West Virginia Code 23-4-1g (2018), the Board concludes that right shoulder chronic pain, right upper extremity radiculitis, and history of failed rotator cuff repair are causally related to Mr. Keller’s compensable injury in this claim. These conditions were sustained in the course of and resulting from Mr. Keller’s employment. Additionally, the evidence establishes that a pain management evaluation is medically necessary and reasonably required in the course of treatment for the compensable injury.” (at 2-3)
“For the foregoing reasons, we find that the decision of the Board 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 so clearly wrong based upon the evidentiary record that even when all inferences are resolved in favor of the Board’s findings, reasoning and conclusions, there is insufficient support to sustain the decision.” (at 4)
Factual background
Michael Keller, a coal miner, injured his back and right shoulder while pulling hoses at work on June 3, 2015. His claim was held compensable for thoracic strain and shoulder strain, and he underwent two shoulder surgeries but continued to experience chronic right-shoulder pain, limited range of motion, and weakness. A consulting orthopedic surgeon diagnosed chronic right-shoulder pain, right-upper-extremity radiculitis, and a history of failed rotator-cuff repair, and recommended a pain-management evaluation before further surgery. The treating physician did not add the proposed diagnoses to the claim, and the claims administrator denied the requests.
Procedural history
The claims administrator denied authorization for a diagnosis update and pain-management referral. The Office of Judges affirmed those denials in orders dated December 4, 2017, and January 22, 2018. The Board of Review reversed both orders, finding the requested conditions causally related to the compensable injury and the pain-management evaluation medically necessary and reasonably required. The Supreme Court of Appeals of West Virginia affirmed the Board.