West Virginia Record

Tuesday, January 28, 2020

Justices affirm decision to add hand therapy to employee’s disability benefits

By Kyla Asbury | Jan 27, 2018

Wvschero

CHARLESTON – The West Virginia Supreme Court of Appeals affirmed the decision of adding hand therapy and orthopedic evaluation with a hand specialist to a Murray American Energy employee’s disability benefits.

The issue on appeal is whether the left hand should be added as a compensable component of the claim, payment for medical treatment and temporary total disability benefits, according to a Dec. 19 memorandum decision.

On Feb. 15, 2016, the claims administrator denied a request for hand therapy and for an orthopedic evaluation with a hand specialist and closed the claim for TTD benefits on March 28, 2016.

On April 6, 2016, the claims administrator denied a request to add post-operative left hand edema as a compensable condition and, on April 19, 2016, the claims administrator denied a request for hand therapy.

On April 20, 2016, the claims administrator denied a request to add intrinsic muscle tightness in the left hand along with capsular tightness as compensable conditions and also denied a request to reopen the claim for temporary total disability benefits two days later.

 The Office of Judges reversed the claims administrator’s decisions in its Dec. 7, 2016, Order, with the exception of the April 22, 2016, decision, which was found moot based on its reversal of the March 28, 2016, decision.

The order was affirmed by the Board of Review on May 19.

Howard Steffik, a rock duster, was injured on June 6, 2015, while working for Murray American Energy when a three-inch hose he was using to clear rock dust exploded, striking him multiple times.

Steffik was treated in the emergency room at Wheeling Hospital where he was diagnosed with acute bilateral corneal foreign bodies, acute left corneal abrasion, acute facial contusion and acute left shoulder contusion.

Steffik was able to return to work, but due to increased pain and discomfort in his left shoulder he was treated by Corporate Health on June 16, 2015, and, upon examination, a nurse practitioner, Ross Tennant noted Steffik had difficulty performing over hand movement although he had full range of motion of the left shoulder.

Tennant also noted subjective complaints of discomfort with any flexion and abduction and recommended a left shoulder MRI, which revealed a full thickness tear of the distal supraspinatus tendon, mild degenerative changes of the glenohumeral joint and a tear of the posterior and inferior labrum.

Dr. Dante Marra, an orthopedic surgeon, diagnosed left shoulder rotator cuff tear, impingement syndrome and acromioclavicular degenerative joint disease and recommended a left shoulder arthroscopy. Marra performed surgery on July 30, 2015.

Steffik returned to see Marra for his first post-operative visit on July 30, 2015, when it was noted that he was doing well. Marra recommended he continue to limit his activities and admonished him to wear his sling and avoid any use of the left upper extremity.

On Aug. 17, 2015, another doctor, known as Dr. Mitlon, saw Steffik and he noted that Steffik was not wearing the prescribed sling and block, but was wearing a simple sling.

Steffik told Milton he had been non-compliant and had worsening discomfort when not wearing the prescribed sling. On Sept. 15, 2015, Steffik complained to Milton about shoulder discomfort and swelling in his left hand. Milton noted little or no edema, with no redness to the skin and no suggestion of a vascular abnormality. He recommended icing the shoulder and starting the physical therapy.

Steffik continued treatment with Milton for both his left shoulder and his left hand.

Dr. Joseph Grady performed an independent medical evaluation on Steffik on Feb. 4, 2016, for the compensable conditions of non-traumatic rupture of long head of biceps tendon, complete rotator cuff tear, other affections of shoulder region and contusion of the shoulder region.

Steffik reported pain, stiffness and edema of the left hand and Grady diagnosed status post left shoulder arthroscopic subacromial decompression, distal clavicular resection, rotator cuff repair, open biceps tenodesis and resolved left upper extremity contusions. He found Steffik had reached maximum medical improvement in relation to the left shoulder.

Grady believed Steffik should see a hand specialist for a more definitive workup regarding the left hand condition and to provide direction for treatment.

On Feb. 15, 2016, the claims administrator denied Milton’s request for hand therapy and for an orthopedic evaluation with a hand specialist because the hand was not a compensable diagnosis in the claim. On Feb. 16, 2016, the claims administrator suspended temporary total disability benefits based on  Grady’s opinion that Steffik had reached maximum medical improvement from the injury.

On April 6, 2016, the claims administrator acknowledged Milton’s request to include post-operative left hand edema as a compensable diagnosis. The claims administrator did not specifically authorize or deny the request, but noted the Feb. 15, 2016, denial of authorization of Milton’s previous request for treatment and that the claim was in litigation on that issue.

On Dec. 7, 2016, the Office of Judges reversed all of the decisions of the claims administrator. It noted that Steffik relied on the medical opinions of Drs. Marra, Milton, Lese, and Grady in his request to reverse the decisions of the claims administrator, while Murray American Energy argued that the opinions of these physicians should be discounted, in part, because of Steffik’s non-compliance with the their orders by failing to wear his sling as recommended.

“However, the Office of Judges found there was no record of any problems with Mr. Steffik’s left hand prior to his work injury,” the decision states. “His non-compliance in wearing the sling did not invalidate the opinions of the physicians that the left hand condition was work-related. All of the physicians that treated or evaluated Mr. Steffik agreed that the left hand condition was work-related.”

The Office of Judges found these physicians were in a better position to express an opinion regarding the work-relatedness of the condition than a physician who had never examined Steffik.

The Office of Judges also found that Milton’s medical records showed he noted that Steffik had slight swelling of the left hand on Sep. 17, 2015. 

“The Office of Judges found that a preponderance of the evidence demonstrated that left hand edema and intrinsic muscle tightness of the left hand along with capsular tightness were compensable conditions,” the decision states. “It also determined that a preponderance of the evidence demonstrated that hand therapy and an orthopedic evaluation with a hand therapist were medically related and reasonably necessary to treat the subject injury.”

The Office of Judges also found that the initial closure on March 28, 2016, based upon Grady’s opinion was premature due to the addition of the compensable components. Therefore, it found that Steffik’s temporary total disability benefits should be reinstated and benefits paid as substantiated by proper medical evidence.

The Board of Review adopted the findings of fact and conclusions of law of the Office of Judges and affirmed its order on May 19.

“After review, we agree with the Office of Judges as affirmed by the Board of Review,” the decision states. “Mr. Steffik sustained an injury that led to the need for arthroscopic surgery of the left shoulder. The surgery was performed approximately six weeks after the injury.”

Steffik began to experience left hand swelling about six weeks after the surgery and the treating physician’s repeated requests for a referral to a hand specialist were not without merit.

“For the 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 evidentiary record,” the decision states. “Therefore, the decision of the Board of Review is affirmed.”

W.Va. Supreme Court of Appeals case number: 17-0533

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West Virginia Supreme Court of Appeals