State News : West Virginia

The Following are summaries of 2019 West Virginia cases dealing with the issues of pre-existing conditions and mental health exposure claims.

1.         Comorbidities and the Dreaded Pre-Existing Condition

 In Bowles v. WV Office of the Insurance Commissioner and Pine Ridge Coal Co., LLC, No. 18-0797, 2019 WL4165292 (W. Va. Sept. 3, 2019), the Supreme Court of Appeals of West Virginia found that a claimant had not established that his carpal tunnel syndrome was work related and affirmed an order denying compensation. The claimant, Mr. Bowles, worked as a coal miner for many years and was eventually diagnosed with carpal tunnel syndrome which he alleged was the result of repetitive wrist motions required by his job.Id. at *1. An independent medical evaluation revealed that Mr. Bowles suffered from two non-occupational risk factors, diabetes mellitus and obesity, which could cause carpal tunnel.Id. Additionally, the independent examiner opined that Mr. Bowles' work activities were not of the type to cause carpal tunnel and emphasized the fact that Bowels had quit working in 2012 and was not diagnosed with carpal tunnel until three years later.Id. at *2. Ultimately, Bowles' pre-existing conditions were a significant factor in denying his request for workers' compensation benefits. The Court found the only opinion as to causation was the IME doctor, who opined that the carpal tunnel syndrome was not causally related to Mr. Bowles's occupational activities. Instead, the IME doctor found Mr. Bowles has two important and significant nonoccupational risk factors for the development of carpal tunnel syndrome, diabetes mellitus and obesity. The fact that Mr. Bowles ceased work in 2012 and experienced increased symptoms for three to four years before filing for benefits is consistent with the doctor's opinion.Id., at *2.

 In contrast, the court in Arcelormittal Weirton, LLC v. Prentice, No. 18-0723, 2019 WL 1828005 (W. Va. Apr. 25, 2019), held that a claim for carpal tunnel and ulnar neuropathy was compensable despite the fact that the claimant suffered from pre-existing conditions, including diabetes and obesity. In that case, Mr. Prentice, the claimant, alleged that he developed carpal tunnel as a result of carrying tools while working as a crane repairman.Id. at *1.

An EMG performed on July 27, 2016, showed bilateral ulnar sensory and motor neuropathies, severe on the right and moderate to severe on the left. Mr. Prentice reported to his treating physician on August 26, 2016, tingling in both of his ring and small fingers. The treating doctor reviewed the EMG and noted that carpal tunnel syndrome was not diagnosed. On examination, Mr. Prentice had positive Tinel's and Phalen's signs over the median nerves of the wrists and positive Tinel's sign over the ulnar nerves in the elbows. The treating doctor noted Prentice's history of rheumatoid arthritis, bilateral ulnar nerve neuropathy at the elbow, and an exam suggestive of carpal tunnel syndrome. He recommended a repeat EMG. The treating physician diagnosed rheumatoid arthritis, bilateral post-traumatic osteoarthritis, bilateral ulnar neuropathy, and bilateral carpal tunnel syndrome. A repeat EMG was performed on September 2, 2016, and showed marked bilateral ulnar neuropathy.Id., at *1. Prentice's doctor performed carpal tunnel release surgery on October 5, 2016, and his claim was rejected thereafter on October 25, 2016.Id. In a subsequent record review, a different doctor noted Prentice's diabetes and obesity and opined that there was no evidence of carpal tunnel.Id. at *2. Despite the record review findings and the pre-existing conditions, the court found no error in awarding Prentice compensation.Id. at *2-3. The court stated that it was acceptable to find Prentice's practicing physician more persuasive than a doctor performing a record review. Prentice also presented evidence that his job required repetitive heavy manual lifting, which pursuant to West Virginia Code of State Rules § 85-20-41.5, has been shown to contribute to the development of carpal tunnel syndrome.Id. at *2.

These two cases document the Court's view the causation determination for CTS is fact-specific. When evaluating allegations of CTS, it is imperative to investigate the preexisting medical conditions of each claimant and determine the impact on the claimant's medical condition. Additionally, a precise examination of the job duties and functions of a claimant is also important to analyze the compensability under the parameters of West Virginia Code of State Rules § 85-20-41.5.

2.         Mental Health Exposure Claims

In D'Amour v. Combined Ins Co. of Am. AT, No. 18-0677, 2019 WL 2404586 (W. Va. May 30, 2019), the West Virginia Supreme Court held that adjustment disorder with anxious mood and post-concussion syndrome were compensable claims, in part overturning a decision by the Board of Review. The claimant, D'Amour, sought to add compensable conditions to his claims including Post-concussion syndrome and post-traumatic brain injury.Id. at *1. D'Amour was a door-to-door salesman and was injured when he knocked on a door and was attacked by four dogs.Id. D'Amour reported a bite on the wrist and head injury after he fell back and struck the sidewalk, but an initial CT scan revealed no abnormalities.Id.

D'Amour stated that his head was not bothering him at the emergency room, but he was perplexed when it took him three hours to drive home despite the fact that he lives only thirty minutes away from the hospital.Id. D'Amour developed headaches and light sensitivity and reported problems with short term memory, focusing, and concentration.Id. Subsequent brain scans continued to show no abnormalities and D'Amour was diagnosed with post-concussive syndrome.Id. at *1-*2. Several months later, D'Amour's symptoms worsened and he began suffering from depression as a result of his inability to work.Id. at *2. D'Amour was eventually diagnosed with major depression and adjustment disorder with depressed mood.Id. at *2-3. In denying D'Amour's request to add post-concussion syndrome to his compensable claims, the Board of Review relied upon one physician who believed that D'Amour was not a valid reporter of his symptoms even though four other physicians had concluded that it was the proper diagnosis. Id. at *3-4. The West Virginia Supreme Court decided that such a finding was clearly wrong based upon the evidentiary record and determined that post-concussion syndrome and concussion were compensable.Id. at *4.

In Riley v. All. Coal, LLC, No. 18-0586, 2019 WL 2406701 (W. Va. May 30, 2019), a coal miner appealed a Board of Review decision denying the addition of post-traumatic stress disorder to his claim. Mr. Riley was injured on the job when rocks fell from the veiling and struck his helmeted head. Id. at *1. The claim was initially held compensable for concussion and bilateral upper extremity numbness.Id. Subsequently, Riley reported problems with behavior, sleep, memory, and anxiety and was found to have met the criteria for PTSD.Id. Riley was evaluated by three doctors and his PTSD was confirmed by two. The third doctor determined that Riley had reached maximum medical improvement, but deferred an opinion on Riley's psychological stated because he was not qualified in that area.Id. at *3. The West Virginia Supreme Court held that there was sufficient evidence linking Riley's PTSD to his compensable injury. However, the employer did not get an opportunity to evaluate Riley with their own physician so the court remanded the case for further evidence. Id. at *3-4.

By: Joe Unger and Dill Battle