Arch Coal, Inc. v. Jimmie Lemon

Citation: 814 S.E.2d 667Docket: 17-0152

Court: West Virginia Supreme Court; May 30, 2018; West Virginia; State Supreme Court

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The Supreme Court of Appeals of West Virginia addressed the workers' compensation claim of Jimmie Lemon against Arch Coal, Inc. Lemon asserted that he sustained a low back injury during his employment, specifically a herniated disc at L4-5. Initially, the Office of Judges found the claim compensable, which was upheld by the Workers’ Compensation Board of Review. However, in December 2017, the Court reversed this decision, ruling that Lemon's injury was not work-related. Following a rehearing on May 15, 2018, the Court reconsidered the evidence and determined that Lemon’s injury was indeed work-related, thus upholding the prior administrative findings. The December 2017 decision was withdrawn, and the Board of Review's ruling was affirmed, leading to the reinstatement of the compensable claim for the herniated disc.

Lemon’s injury occurred on April 6, 2016, while operating a shuttle car in a rough underground area, where he experienced a jarring impact. Prior to this incident, Lemon had a history of back issues documented in earlier workers' compensation claims, including an MRI from 2009 that showed mild bulging discs but no herniation. Following the April incident, Lemon visited a chiropractor, who diagnosed a lumbar disc protrusion with nerve root compression. This case emphasizes that a claimant must prove their claim by a preponderance of the evidence, and that aggravation of a noncompensable preexisting injury does not automatically render it compensable unless it results in a new injury.

Lemon was instructed by Price not to work underground and to return after his medical examination. An MRI on April 13, 2016, revealed a right lateral disc herniation and bulge at L4-5, causing nerve root impingement, and degenerative disc disease at L5-S1. Upon reporting back, Lemon expressed a desire to file an accident report, attributing his back issue to long-term wear and tear, and he could not pinpoint when the injury occurred. Price noted Lemon's significant pain while operating a shuttle car, leading to an early exit from work. Additionally, Crum’s statement indicated Lemon attributed his back issue to a prior injury and had not reported a work-related injury on April 1, 2016.

On April 20, 2016, Lemon completed an injury report stating the incident occurred on April 6, 2016, when his vehicle hit rough terrain. Dr. Kominsky, who assessed Lemon, labeled the injury as occupational, noting the MRI indicated a new injury at L4-5. However, the Claim Administrator denied the claim on April 29, 2016, citing a lack of work-related causation. Further medical evaluations followed, including a discectomy performed by Dr. Orphanos on June 24, 2016. Dr. Soulsby concluded that Lemon’s condition was due to pre-existing degenerative disc disease rather than a specific traumatic incident. Comparative analysis by Dr. Luchs indicated that Lemon's condition resulted from progressive degenerative changes rather than an acute injury. 

Ultimately, after an evidentiary hearing, the Administrative Law Judge reversed the Claim Administrator's decision on August 18, 2016, ruling the claim compensable based on Lemon’s herniated disc at L4-5. The Judge acknowledged conflicting opinions among physicians regarding the injury's origin, with Dr. Luchs suggesting the disc herniation likely predated the April 6 incident and lacked signs of an acute injury.

Lemon's disc herniation, although not present in a prior examination, predates his April 6, 2016, injury. He testified that he had never been diagnosed with a ruptured disc or herniation before the incident. The Administrative Law Judge (ALJ) noted that an MRI taken shortly after the injury revealed a right lateral disc herniation at L4-5, contributing to nerve root impingement, which could explain his severe low back pain. On January 20, 2017, the Workers’ Compensation Board of Review upheld the ALJ's findings, rejecting Arch Coal's motion for reconsideration. Arch Coal appealed this decision. 

On December 19, 2017, this Court issued a Memorandum Decision concluding that Lemon did not sustain a work-related injury on the date in question and reinstated the Claim Administrator's rejection of his claim. The Court highlighted Lemon's history of back issues, including a prior disc bulge observed in 2009, and noted that the April 2016 MRI indicated the disc had herniated. Expert opinions from Dr. Soulsby and Dr. Luchs suggested that Lemon's symptoms were attributable to preexisting conditions rather than a new injury. Lemon contested the decision, claiming that the Court did not adequately respect the ALJ's and Board of Review's findings. In March 2018, the Court granted a rehearing. The standard of review mandates deference to the Board of Review's findings, with the Supreme Court of Appeals able to reverse only if there are clear violations of law or insufficient support for the decision based on the evidentiary record.

The court is restricted from conducting a de novo re-weighing of the evidentiary record according to W.Va. Code, 23-5-15. If the court reverses or modifies a board decision, it must specify the reasons, demonstrating a clear violation of constitutional or statutory provisions, erroneous legal conclusions, or a lack of sufficient support for the board’s decision. The case involves workers’ compensation benefits under W.Va. Code, 23-4-1(a), which mandates compensation for employees with personal injuries from covered employment, and the claimant must prove their case by a preponderance of the evidence (W.Va. Code, 23-4-1g(a)). The Administrative Law Judge's finding of compensability relied on this standard, but the Memorandum Decision incorrectly framed the issue as whether Lemon's low back injury was non-compensable, rather than whether the Board of Review's decision should be upheld or modified. For a claim to be compensable, it must demonstrate a personal injury occurring in the course of employment. The court must defer to the Board’s findings unless it can provide specific reasons for any reversal. The Memorandum Decision lacked the necessary analysis and inappropriately re-weighed evidence, focusing on discussions of degenerative disc disease without addressing significant medical evidence indicating a new injury related to the April 6, 2016, incident. This evidence suggested that Lemon had not experienced a herniated disc prior to that date, and the court failed to recognize the expertise of Dr. Orphanos, a neurosurgeon who directly observed the damaged disc during surgery.

Dr. Orphanos did not contest the traumatic origin of Lemon's herniation. The Administrative Law Judge (ALJ) and the Board of Review determined that Lemon experienced a new, work-related injury at L4-5, in addition to his existing degenerative joint disease and prior workers’ compensation claims, which did not involve a herniated disc. Citing the precedent set in *Gill v. City of Charleston*, the court ruled that a noncompensable preexisting injury cannot be included in a workers’ compensation claim solely due to aggravation from a compensable injury, unless it results in a distinct new injury that may be compensable.

The ALJ and Board of Review evaluated various factors indicative of compensability. Despite initial uncertainty from Lemon about the injury's occurrence, he sought medical attention the day after the incident on April 6, 2017, and reported to work with a noticeable limp and severe back pain. He recalled that while operating a shuttle car, he experienced excruciating pain, leading him to leave work early. The ALJ highlighted that there was no contradictory evidence regarding Lemon leaving work approximately two hours early on the date of the alleged injury.

The court affirmed the Board of Review's decision, which upheld the ALJ's conclusion that the evidence supported Lemon's claim for a compensable injury—a herniated disc at L4-5. The previously filed Memorandum Decision was withdrawn, and the case was remanded to reinstate the January 20, 2017, decision from the Board of Review confirming the compensability of Lemon's claim. The court noted that determining whether employment contributed to the injury is a factual question, and the Board's findings would not be disturbed unless clearly erroneous.