Marstiller v. W. Va. United Health Sys., 14-1244
| Decision Date | 24 March 2016 |
| Docket Number | No. 14-1244,No. 15-0464,No. 15-0303,14-1244,15-0303,15-0464 |
| Parties | BARBARA J. MARSTILLER, Claimant Below, Petitioner v. WEST VIRGINIA UNITED HEALTH SYSTEMS, Employer Below, Respondent |
| Court | West Virginia Supreme Court |
(BOR Appeal Nos. 2049540, 2049754 & 2050022)
Petitioner Barbara J. Marstiller, by M. Jane Glauser, her attorney, appeals the decision of the West Virginia Workers' Compensation Board of Review. West Virginia United Health Systems, by T. Jonathan Cook, its attorney, filed a timely response.
This appeal arises from the Board of Review's Final Orders dated November 5, 2014; March 9, 2015; and April 22, 2015. In the November 5, 2014, Order, the Board of Review affirmed, in part, and reversed, in part, a May 30, 2014, Order of the Workers' Compensation Office of Judges. The Board of Review reversed the Office of Judges' insofar as it added the conditions of right labral tear and chondromalacia of the superior acetabular weight bearing dome. The Board of Review affirmed all the other findings of the Office of Judges. In its Order, the Office of Judges reversed the claims administrator's January 2, 2013, decision which denied the request to add the diagnoses sprain of the lumbar region and pain in joint, pelvic region and thigh to the claim. The Office of Judges reversed the claims administrator's January 14, 2013, decision which denied the request for a diagnosis update to include hip pain. The Office of Judges reversed, in part, and affirmed, in part, the claims administrator's January 14, 2013, decision which denied the request for a diagnosis update to include right hip pain, lumbar radiculitis, and lumbar facet arthritis. The Office of Judges included right hip pain but denied lumbar radiculitis, and lumbar facet arthritis. The Office of Judges reversed, in part, and affirmed, in part, the claims administrator's January 23, 2013, decision denying disorder of hip joint, right hip pain, depression, and sciatica to the claim. The Office of Judges affirmed the claims administrator's decision regarding the denial of disorder of hip joint and sciatica. The Office of Judges also concluded that the depression ruling was premature. The Office of Judges reversed the claims administrator's January 23, 2013, decisions that denied the request to add a right labral tear and chondromalacia of superior acetabular weight bearing dome to the claim and found the conditions compensable. Finally, the Office of Judges affirmed, in part, and reversed, in part, the January 23, 2013, decision of the claims administrator which corrected the January 14, 2013, decision of the claims administrator. The decision of January 23, 2015, found that right hip pain, lumbar radiculitis, and facet arthrosis all were not compensable conditions. The Office of Judges found that right hip pain was compensable. However, it held that the lumbar radiculitis and facet arthrosis were not compensable conditions.
In its March 9, 2015, decision, the Board of Review affirmed an August 13, 2014, Order of the Workers' Compensation Office of Judges. In its Order, the Office of Judges affirmed the claims administrator's May 11, 2012, decision denying authorization for Oxycodone and Valium. The Office of Judges affirmed the claims administrator's May 31, 2012, decision denying authorization for transforaminal epidural injections. It affirmed the claims administrator's June 15, 2012, decision denying authorization for right knee treatment. It affirmed the claims administrator's June 15, 2012, decision denying authorization for Oxycodone. It affirmed the claims administrator's June 28, 2012, decision denying reimbursement for a bill from Carolina Health Specialist for $267.30. It affirmed the claims administrator's July 3, 2012, decision denying reimbursement for a bill from Carolina Health Specialist for $267.30 and Grand Strand Regional for $100.00. It affirmed the claims administrator's July 3, 2012, decision denying authorization for Cymbalta. It reversed the claims administrator's September 6, 2012, decision denying authorization for a total hip replacement and remanded with instructions that authorization be granted. It affirmed, in part, and reversed, in part, the claims administrator's November 13, 2012, decision denying authorization for Cymbalta, Klonopin, and Robaxin. The decision was affirmed in regard to the denial of Klonopin and reversed in regard to the denial of Cymbalta and Robaxin. The Office of Judges reversed the claims administrator's January 2, 2013, decision denying authorization for total hip replacement. It affirmed the claims administrator's January 2, 2013, decision denying authorization for counseling for chronic pain. It reversed the claims administrator's January 2, 2013, decision denying authorization for Cymbalta and Neurontin. It affirmed, in part, and reversed, in part, the claims administrator's January 23, 2013, decision denying authorization for Valium, physical therapy for the right hip, physical therapy for the lower back, and an orthopedic evaluation of the right knee. The Office of Judges affirmed the denial of Valium, physical therapy for the lower back, and an orthopedic right knee evaluation but reversed the denial of physical therapy for the right hip. It affirmed, in part, and reversed, in part, the claims administrator's January 29, 2013, decision denying authorization for Cymbalta, Valium, Neurontin, physical therapy and a follow-up visit. The Office of Judges affirmed the denial of Valium but reversed the denial of Cymbalta, Neurontin, physical therapy, and a follow-up visit. It affirmed the claims administrator's February 12, 2013, decision denying authorization for an office visit regarding radiculitis. It affirmed the claims administrator's March 21, 2013, decision denying authorization for an epidural steroid injection. It affirmed, in part, and reversed, in part, the claims administrator's May 17, 2013, decision denying authorization for a lumbar MRI, referral to a pain clinic, physical therapy, and Baclofen. The Office of Judges affirmed the decision denying the lumbar MRI, referral to the pain clinic, and Baclofen. The denial of physical therapy was reversed. It affirmed the claims administrator's October 7, 2013, decisiondenying authorization for payment of services rendered on September 16, 2013, for pain in the joint, pelvic region, and thigh. It also affirmed the claims administrator's February 28, 2014, decision denying authorization for Ultram and Hydrocodone.
In its April 22, 2015, decision, the Board of Review affirmed a November 6, 2014, Order of the Workers' Compensation Office of Judges. In its Order, the Office of Judges affirmed the claims administrator's January 29, 2014, decision to deny the request for payment of a bill from West Virginia University Medical Corporation for the service date of November 25, 2013. The Court has carefully reviewed the records, written arguments, and appendices contained in the briefs, and the case is mature for consideration.
This Court has considered the parties' briefs and the record on appeal. The facts and legal arguments are adequately presented, and the decisional process would not be significantly aided by oral argument. Upon consideration of the standard of review, the briefs, and the record presented, the Court finds no substantial question of law. For these reasons, a memorandum decision is appropriate under Rule 21 of the Rules of Appellate Procedure.
Ms. Marstiller, an employee of West Virginia United Health Systems, injured her hip and back on March 30, 2010, when she hopped down from a tall chair. An MRI of the lumbosacral spine conducted the next day revealed very small disc bulges with no evidence of nerve root impingement or canal stenosis. From April 14, 2010, through July 7, 2010, Ms. Marstiller underwent conservative treatment including physical therapy. Ms. Marstiller was progressing and tolerated the activity with mild complaints of pain and difficulty. However, she began experiencing burning pain in her hips. She received treatment for this complaint from Joseph Voelker, M.D., who diagnosed her with lumbosacral spondylosis and degenerative changes of the low back as well as left leg pain. Dr. Voelker interpreted the March 31, 2010, MRI as showing mild degenerative disc disease with a L4-5 disc bulge without nerve root compression. He recommended that Ms. Marstiller continue conservative treatment with physical therapy.
On May 28, 2010, the claims administrator approved the application for benefits. The accepted diagnosis was low back strain/sprain. An internal provider letter by Matthew Lively, D.O., on July 22, 2010, indicated Ms. Marstiller has low back pain and right lateral hip pain. At that time she occasionally had symptoms that radiated down the posterior part of her leg to her knee. This sensation continued through her many visits to doctors throughout her appeal. An August 18, 2010, MRI of the right hip revealed mild greater trochanteric bursitis and a small focal tear or separation of the chondrolabral junction at the anterior-superior acetabular labrum.
On November 3, 2010, an independent medical evaluation from William Mills, M.D., was completed. Dr. Mills diagnosed chronic and non-radicular low back pain. He found Ms. Marstiller to be at her maximum degree of medical improvement with regard to her back. Dr. Mills opined that he could not state whether Ms. Marstiller had reached her maximum degree of medical improvement in regards to her hip. He recommended that she see a hip specialist. From November 11, 2010, through April 18, 2012, Ms. Marstiller received treatment from Scott Sauer, M.D., an orthopedic surgeon, for lumbar facet arthropathy, bursitis of the bilateral hips, bilateral hip pain, and lumbar radiculitis.
On November 29, 2010, the claims administrator added the diagnosis of hip pain. On December 27, 2010, Ms. Marstiller underwent a contrast MRI of the right hip. It...
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