Davies v. West Virginia Office of the Insurance Commissioner
Docket: No. 35550
Court: West Virginia Supreme Court; April 1, 2011; West Virginia; State Supreme Court
Timothy E. Davies, the appellant, challenges a 2% permanent partial disability (PPD) award for carpal tunnel syndrome granted by the Workers’ Compensation Board of Review, arguing he is entitled to a 6% award based on a proper interpretation of W. Va.C.S.R. 85-20-64.5. The court finds this regulation invalid in his case and reverses the 2% award, reinstating the 6% award previously granted by the Workers’ Compensation Office of Judges (OOJ).
Mr. Davies, employed as a millwright by Alcan Rolled Products, developed carpal tunnel syndrome due to his work and had his claim ruled compensable in June 2007. After undergoing surgery and rehabilitation, he returned to work in November 2007. A PPD evaluation by Dr. Paul Bachwitt concluded that he reached maximum medical improvement, assessing a 6% whole-person impairment using the AMA Guides Fourth. However, Dr. Bachwitt then applied W. Va.C.S.R. 85-20-64.5, which limits PPD awards for carpal tunnel syndrome based on severity, and recommended a 2% award, determining Mr. Davies' condition was mild.
The OOJ later found that Dr. Bachwitt’s interpretation of the regulation was unfounded and awarded Mr. Davies the full 6% based on his prior assessment of impairment. The Board of Review subsequently reversed this decision, leading to Mr. Davies’ current appeal. The court’s ruling reinstates the 6% award, aligning with the OOJ's assessment.
The standard of review for the Supreme Court of Appeals regarding decisions by the Board of Review is defined by West Virginia Code § 23-5-15(b) and (d). The court must consider the record from the Board, giving deference to its findings and conclusions. If the Board's decision reverses a prior ruling from the commission or Office of Judges on the same issue, it can only be reversed or modified if it clearly violates constitutional or statutory provisions, results from erroneous legal conclusions, or is unsupported by the evidentiary record. A de novo review applies to interpretations of statutes or administrative rules, with the court not re-evaluating evidence but focusing on legal questions.
In the case at hand, Mr. Davies claims the Board erred in reversing the Office of Judges’ (OOJ) decision awarding him a 6% permanent partial disability (PPD) award, arguing that the OOJ correctly interpreted the relevant rules. In contrast, Alcan supports the Board’s decision to reduce the PPD award to 2%, based on Dr. Bachwitt's calculations. The resolution hinges on the application of W. Va.C.S.R. 85-20-64.1 and 64.5, which outline the assessment criteria and ranges for permanent partial disability, specifically noting that carpal tunnel syndrome awards range from 0% to 6% per affected hand.
The review identifies ambiguity in the application of rules regarding carpal tunnel syndrome within the relevant legal framework. This ambiguity necessitates a construction of the rules to align with legislative intent, as articulated in precedents such as Simpson v. West Virginia Office of Ins. Comm’r and others. Specifically, W. Va.C.S.R. 85-20-64.5 establishes a standardized range for permanent partial disability (PPD) awards for carpal tunnel syndrome, but these parameters must remain reasonable and compatible with impairment assessments based on the AMA Guides Fourth.
The parties involved in the appeal propose differing interpretations of W. Va.C.S.R. 85-20-64.5. Mr. Davies advocates for an interpretation aligned with the Office of Judges (OOJ), which suggests that after determining a claimant's impairment using the AMA Guides, the impairment should be compared to the PPD range of 0% to 6% in W. Va.C.S.R. 85-20-64.5. According to this view, if the impairment exceeds 6%, it should be reduced to 6%, while impairments of 6% or less require no adjustment. Mr. Davies' rating of 6% would necessitate no reduction. However, this interpretation raises concerns about its applicability across various cases of carpal tunnel syndrome, particularly when analyzed against Table 16 of the AMA Guides Fourth, which suggests whole-person impairment ratings of 0, 6, 12, and 24, indicating potential unjust outcomes when applied uniformly.
Mr. Davies' interpretation of W. Va.C.S.R. 85-20-64.5 would result in all individuals with carpal tunnel syndrome receiving a uniform 6% Permanent Partial Disability (PPD) award, irrespective of the severity of their impairment. This means that even a claimant with the lowest level of impairment (6) would receive a 6% award, while a claimant with the highest level (24) would also be capped at 6%. Such a uniform application is deemed absurd, unjust, and unreasonable, contradicting the Court's duty to avoid interpretations that lead to such results, as established in Peters v. Rivers Edge Mining Inc. and other cited cases.
Consequently, the Court rejects Mr. Davies' interpretation and considers an alternative proposed by Alcan, which suggests categorizing impairments as mild, moderate, or severe with corresponding PPD awards based on ratings from Table 16. Under this classification, a 6% impairment would be categorized as mild, potentially qualifying for a 1% or 2% award; a 12% impairment would be moderate, qualifying for a 3% or 4% award; and a 24% impairment would be severe, qualifying for a 5% or 6% award. However, Alcan's approach lacks clarity on how to differentiate between awards within each classification, as claimants with identical ratings would not have a clear basis for distinguishing between the lower and higher percentage awards.
Moreover, the Court emphasizes that the language of W. Va.C.S.R. 85-20-64.5 does not support Alcan's proposed categorization. The Court asserts that statutes and administrative rules cannot be amended or rewritten under the guise of interpretation, aligning with precedent that prohibits the addition of terms that the Legislature intentionally omitted.
The Court determined that it lacks the authority to alter existing regulations to favor Alcan's position. After examining the interpretation of W. Va. C.S.R. 85-20-64.5 regarding carpal tunnel syndrome impairment, the Court found that this regulation conflicts with Table 16 of the AMA Guides Fourth Edition. Consequently, W. Va. C.S.R. 85-20-64.5 (2004) is deemed invalid for assessing impairment ratings for carpal tunnel syndrome using the AMA Guides. As a result, it cannot be applied to Mr. Davies’ permanent partial disability (PPD) claim, which was evaluated using Table 16, and the only credible evidence of Mr. Davies’ impairment is a 6% whole-person impairment rating from Dr. Bachwitt before the application of the conflicting regulation. The Court reversed the Workers’ Compensation Appeal Board's decision, which awarded Mr. Davies a 2% PPD, and reinstated the Office of Judges' earlier ruling granting him a 6% PPD award for his condition.
The September 2, 2009, order of the Board of Review is reversed, and the January 29, 2009, order of the Office of Judges (OOJ) is reinstated. The Workers’ Compensation rules mandate that permanent partial disability (PPD) assessments be based on the range of motion models found in the AMA Guides Fourth. Specifically, Table 16, which details "Upper Extremity Impairment Due to Entrapment Neuropathy," is relevant for assessing carpal tunnel syndrome. The OOJ's order noted two methods for evaluating impairment from carpal tunnel syndrome: one using detailed measurements of sensory loss and motor deficit (Table 15), and the other using Table 16 based on the severity of nerve involvement. The analysis focuses on Table 16 since Table 15 was not applied in Mr. Davies' case.
W. Va.C.S.R. 85-20-64 outlines ranges of PPD awards for various injuries, including carpal tunnel syndrome, indicating that assessments exceeding set ranges will be reduced to fit within those limits. Specifically, workers with a valid claim for carpal tunnel syndrome can receive a PPD award ranging from 0% to 6% for each affected hand. The document also addresses the absence of ambiguity in statutory interpretation despite differing opinions, emphasizing that the OOJ noted issues with the regulation's language, particularly regarding the inappropriate application of range of motion assessment methods for carpal tunnel evaluations. Ultimately, the ruling is confined to assessments using Table 16 of the AMA Guides Fourth, in accordance with W. Va.C.S.R. 85-20-64.1 and W. Va.C.S.R. 85-20-3.8.
