CHARLESTON — The West Virginia Supreme Court of Appeals ruled that a workers' compensation claims manager rightfully denied the addition of two diagnoses to a work injury claim.
Jerry Nibert appealed the decision made by the West Virginia Workers' Compensation Board of Review where it affirmed the decision by the Office of Judges to deny the addition of lumbar spondylosis without myelopathy and lumbar radiculopathy to his claim, according to the memorandum decision of the court.
Nibert was a welder for Globe Specialty Metals and was pushing a stationary welder when he was injured and sought treatment for back pain and injury at Montgomery General Hospital. He was diagnosed with sciatica and Dr. Jonathan Hess diagnosed lumbosacral strain with radiculopathy and indicated in an injury report that the injury aggravated a prior injury, according to the decision.
The claims administrator held the claim compensable for lower back sprain/strain on Dec. 30, 2015, and Nibert sought treatment in early 2016 with Dr. Matthew Walker, who diagnosed lumbar spinal stenosis, lumbar disc degeneration and lumbosacral spondylosis. He also saw Dr. Timothy Deer in May 2016, who diagnosed lumbar disc degeneration, lumbar spondylosis without myelopathy and lumbar radiculopathy.
The claims administrator denied the addition of lumbar spondylosis without myelopathy and lumbar radiculopathy to the claim on April 17, 2017, the Office of Judges affirmed the claims administrator’s denial of the addition of the diagnoses on Aug. 20, 2018, order.
"The Office of Judges concluded that even if Mr. Nibert has lumbar radiculopathy, it is not related to the compensable injury," the decision stated. "The Office of Judges held that a preponderance of the evidence indicates lumbar radiculopathy should not be added to the claim."
The Board of Review adopted the findings of fact and conclusions of law of the Office of Judges and affirmed its order on Aug. 20, 2018.
"After review, we agree with the reasoning and conclusions of the Office of Judges as affirmed by the Board of Review," the decision states. "A preponderance of the evidence shows that even if Mr. Nibert does suffer from lumbar radiculopathy, it is not related to the compensable injury. Further, lumbar spondylosis is a degenerative condition, and the evidence indicates that it is preexisting and unrelated to the compensable injury."
The court found that the decision of the Board of Review was 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, which was why it affirmed the decision.
West Virginia Supreme Court of Appeals Case number: 18-0805
