Charles G. Delbert v. Murray American Energy, Inc.

Citation: Not availableDocket: 17-0380

Court: West Virginia Supreme Court; December 6, 2017; West Virginia; State Supreme Court

Original Court Document: View Document

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Mr. Delbert seeks approval for lumbar surgery and the inclusion of spinal stenosis with neurogenic claudication as secondary diagnoses in his workers’ compensation claim. The claims administrator denied both requests on January 12, 2016, and March 17, 2016, citing insufficient justification for adding the secondary condition. These decisions were upheld by the Workers’ Compensation Office of Judges and subsequently affirmed by the Board of Review on March 21, 2017. 

Mr. Delbert suffered a low back injury while working at McElroy Mine on October 3, 1996, which led to an initial diagnosis of acute lumbar strain and later a compensable claim for lumbar sprain. An MRI from October 1996 revealed moderate spinal stenosis and herniated discs, prompting lumbar discectomies in January 1997. After reaching maximum medical improvement, he returned to work and received an 11% permanent partial disability award in March 1998.

Subsequent MRIs in 2007 and 2015 indicated worsening spinal stenosis and degenerative changes. A neurosurgeon reviewed the 2015 MRI findings, which showed severe stenosis at critical lumbar levels. Following a thorough review of the records and briefs, the Court affirmed the Board of Review's decisions, concluding that the case did not warrant oral argument.

Dr. Hargraves assessed that the spinal canal had critically narrowed at the L4-L5 level, concluding that therapy would be ineffective and recommending immediate surgery. On December 8, 2015, Dr. Aniruddha Logan requested authorization for lumbar decompression surgery due to stenosis. Dr. Ronald Fadel reviewed Mr. Delbert's medical history on January 8, 2016, noting that stenosis had been documented since a 1996 MRI, with its progression evident in subsequent MRIs, including one from September 20, 2015. Dr. Fadel stated that Mr. Delbert's stenosis predated his compensable injury and was not traumatic, attributing it to age-related factors and obesity rather than the work injury or previous surgeries. Consequently, he recommended denying the surgery authorization. The claims administrator denied the surgery on January 12, 2016, based on Dr. Fadel's opinion. Dr. Logan later submitted a Medical Statement on February 8, 2016, asserting that Mr. Delbert's condition warranted surgical intervention and was exacerbated by the work-related injury. Dr. Hargraves requested spinal stenosis be added as a compensable condition on February 3, 2016, citing clinical findings from earlier visits. However, the claims administrator denied this request on March 17, 2016, and again on March 30, 2016, relying on Dr. Fadel's assessment each time.

Mr. Delbert contested the decisions of the claims administrator regarding his surgery request, which was denied on January 12, 2016, due to the diagnosis of spinal stenosis being non-compensable. The Office of Judges upheld this denial on May 9, 2016, noting that his claim included only lumbar sprain and intervertebral disc displacement. An earlier denial of spinal stenosis as a secondary condition was also affirmed. The Office of Judges found Dr. Fadel's report convincing, stating that Mr. Delbert's stenosis was likely due to a degenerative process unrelated to his work injury from October 3, 1996. Subsequent appeals to the Workers’ Compensation Board of Review resulted in reaffirmation of the previous decisions. The Board concluded that the evidence indicated Mr. Delbert’s spinal stenosis pre-existed his injury and thus, the surgery authorization was rightfully denied. Mr. Delbert's appeal argued for a reversal, but the Board, supported by Dr. Fadel's opinion, maintained that the stenosis was unrelated to the compensable injury. The Board's decisions were affirmed, concluding that they did not violate legal standards or mischaracterize evidence. The ruling was officially issued on December 7, 2017, with concurrence from the Chief Justice and Justices involved.