Raymond T. Hatfield appeals the West Virginia Workers’ Compensation Board of Review's decision regarding medical and temporary total disability benefits after his claim was denied. The claims administrator initially denied six weeks of physical therapy on August 29, 2019, and subsequently closed the claim for temporary total disability benefits on October 1, 2019. A referral for total shoulder arthroplasty was also denied on November 11, 2019. The Office of Judges affirmed these decisions on November 12, 2020, and the Board of Review upheld this on March 30, 2021.
In reviewing the case, the court evaluated the record and found no substantial legal questions or prejudicial errors, affirming the appropriateness of a memorandum decision under Rule 21 of the Appellate Procedure. The court applies a standard of review that defers to the Board's findings unless there is a clear violation of law, erroneous conclusions, or mischaracterization of evidence. Hatfield, a steelworker, sustained a left shoulder injury on January 25, 2019, with a significant history of prior shoulder issues, including multiple MRIs revealing various injuries and degenerative changes.
Mr. Hatfield received treatment for a work-related injury to his left shoulder from Dr. Allen Young on January 25, 2019, who diagnosed a sprain and a possible labral injury after Mr. Hatfield reported an incident at work involving a prybar. Despite some improvement in range of motion, an MRI on February 13, 2019, revealed degenerative changes, a labral tear, and additional tendon issues. Following a reinjury on February 25, 2019, Dr. Stanley Tao diagnosed a superior glenoid labrum lesion and a biceps strain, leading to surgery on April 3, 2019, for a labral tear and associated conditions. Post-surgery, Mr. Hatfield experienced significant pain and was unable to work until May 15, 2019.
By June 25, 2019, he reported limited relief from injections, and Dr. Tao recommended vocational rehabilitation. An August 12, 2019, Independent Medical Evaluation by Dr. Prasadarao Mukkamala concluded that Mr. Hatfield had reached maximum medical improvement, requiring no further treatment, and permitted him to return to work with specific restrictions. Dr. Mukkamala assessed a 5% impairment, considering a previous 3% award.
On August 27, 2019, Dr. Tao disagreed with the maximum medical improvement assessment, noting ongoing pain and limited motion, and recommended continued therapy. The claims administrator denied authorization for further physical therapy on August 29, 2019, and closed the claim for temporary total disability benefits on October 1, 2019. Mr. Hatfield received a 1% permanent partial disability award on October 4, 2019, bringing his total to 4%. A referral for total shoulder arthroplasty was denied on November 11, 2019.
Mr. Hatfield's left shoulder x-ray on December 11, 2019, revealed reduced joint space, a small osteophyte on the humerus, and a subchondral cyst in the glenoid. He reported four prior work-related left shoulder injuries and began missing work due to the compensable injury on March 23, 2019. Following surgery on April 3, 2019, he had not been released to work. Dr. Tao, his treating physician, referred him to Dr. Jasko, who recommended a total shoulder replacement due to severe arthritis. Mr. Hatfield expressed significant limitations in using his left arm. A subsequent CT scan on February 27, 2020, confirmed osteoarthritis.
In a March 10, 2020, Independent Medical Evaluation, Dr. David Jenkinson concluded that Mr. Hatfield's condition did not exceed a sprain or strain from the compensable injury, attributing his symptoms to prior surgeries and degenerative changes rather than requiring a total shoulder replacement. He noted Mr. Hatfield had reached maximum medical improvement and could return to work without restrictions. Despite reviewing additional imaging, Dr. Jenkinson maintained that the findings did not justify a total joint replacement and disagreed with Dr. Jasko's diagnosis of end-stage arthritis.
The Office of Judges upheld the claims administrator’s decisions, denying six weeks of physical therapy, closing the claim for temporary total disability benefits, and denying a referral for evaluation for total shoulder arthroplasty in a November 12, 2020, Order. It determined that Mr. Hatfield had reached maximum medical improvement by August 12, 2019, based on Dr. Mukkamala's assessment, despite Dr. Tao's assertion regarding recovery from a labral tear. The labral tear was not considered compensable, leading to the claim's closure for temporary total disability benefits. The claim remained compensable only for a left shoulder strain.
Mr. Hatfield has reached maximum medical improvement regarding his injury, with Dr. Jenkinson finding no structural injury from the incident on January 25, 2019. Prior to this event, Mr. Hatfield had undergone multiple surgeries on his left shoulder and exhibited some deterioration in that area. The Office of Judges determined that the arthritic changes were not attributable to the compensable injury and denied a request for referral to Marshall Orthopedics for a total shoulder arthroplasty, as well as physical therapy, based on the finding that further treatment was unnecessary. This decision was upheld by the Board of Review on March 30, 2021. According to West Virginia Code § 23-4-7a, temporary total disability benefits are to cease once maximum medical improvement is reached, and evidence supports that Mr. Hatfield has reached this point. Furthermore, West Virginia Code § 23-4-3(a)(1) mandates that claims administrators cover necessary healthcare services, but the requested treatments were deemed unnecessary for his compensable left shoulder strain. The ruling was affirmed on September 19, 2022, with a dissent from Chief Justice Hutchison, who called for oral argument under Rule 19.
