Background
Deborah Bolen, a school employee for Raleigh County Board of Education, sustained a work injury on September 15, 2023, while lifting a stroller containing two autistic children over a metal threshold while propping open a door with her body. She felt a popping sensation in her mid-back and reported burning pain radiating to her left buttock and hip. Bolen had a significant medical history including prior work-related back injuries on March 9, 2015, and February 1, 2018, for which she received ongoing chiropractic care.
Following the 2023 injury, imaging studies revealed a shallow posterior central disc protrusion at T7-T8 in the thoracic spine and a left foraminal and extraforaminal protrusion of the L3-L4 disc in the lumbar spine. Bolen sought to add intervertebral disc prolapse as a compensable diagnosis and requested authorization for a thoracic MRI, physical therapy referral, and orthopedic spine surgeon referral. The claim administrator and the Workers’ Compensation Board of Review denied these requests, finding that Bolen had not established causation between the disc prolapse and the compensable injury.
The Board emphasized that Bolen’s treating chiropractor’s records documented mid-back symptoms prior to September 15, 2023, and that medical experts disagreed on whether the condition was newly caused by the work injury or merely exacerbated pre-existing pathology. Bolen appealed to the Intermediate Court of Appeals.
The Court’s Holding
The Intermediate Court of Appeals affirmed the Board’s decision, holding that Bolen failed to establish that thoracic intervertebral disc prolapse was causally related to the compensable September 15, 2023, injury. The court found that because Bolen’s thoracic spine was symptomatic before the injury, she was not entitled to a presumption that her thoracic impairment resulted from the work injury under West Virginia precedent. The court noted that the Board properly discredited certain medical opinions—particularly those from treating provider PA Miller and Dr. Guberman—because they either acknowledged uncertainty about causation or relied on factually inaccurate assumptions that Bolen had no prior thoracic symptoms.
The court gave substantial weight to the opinions of Drs. Preusen and Cervantes, who opined that the thoracic imaging findings were chronic in nature and that the intervertebral disc prolapse was not causally related to the work injury. The court applied the deferential “clearly wrong” standard of review and concluded that the Board’s findings were supported by substantial evidence. Because Bolen did not establish that the disc prolapse was a compensable condition resulting from the work injury, the requested medical treatments (MRI, physical therapy, and spine surgeon consultation) were properly denied as not reasonably related to a compensable diagnosis.
Key Takeaways
- Pre-existing symptoms documented before a work injury can defeat a claimant’s presumption that post-injury imaging abnormalities resulted from the workplace incident.
- Medical opinions that acknowledge uncertainty about causation or rely on incomplete factual records may be deemed unreliable and discredited by the Workers’ Compensation Board.
- Authorization for medical treatment depends on first establishing that the underlying diagnosis is causally related to the compensable injury; absent such nexus, treatment requests may be denied.
- Courts apply highly deferential review to Workers’ Compensation Board decisions, requiring only that findings be supported by substantial evidence or a rational basis.
Why It Matters
This decision reinforces a significant burden for workers’ compensation claimants with pre-existing spinal conditions who seek to attribute new imaging findings or symptom exacerbations to workplace injuries. The court’s analysis demonstrates that when medical records establish prior symptomatic disease, claimants must present compelling evidence that the work injury, not the pre-existing condition, caused the new or worsened impairment. The opinion also illustrates that even where treating providers support causation, if their medical opinions rest on incomplete or inaccurate factual premises, those opinions can be rejected in favor of opinions from reviewing physicians.
For employers and insurers, the decision provides guidance that prior medical records and symptom histories are critical to defending against requests to add diagnoses as compensable conditions. The deferential standard of review also means that Board decisions on causation are difficult to overturn absent clear error, making the administrative phase of workers’ compensation claims particularly important for establishing the factual record about pre-injury symptomatology.