Background
Freda J. Lee, a cashier at Little General Stores, filed a workers’ compensation claim alleging she sustained a lumbar spine injury on May 15, 2024, while lifting and carrying cases of beverages to a cooler at work. Her treating physician diagnosed a lumbar disc herniation and referred her for physical therapy. The claim administrator rejected the claim on August 7, 2024, finding that Lee failed to establish a compensable work-related injury. The Workers’ Compensation Board of Review affirmed the rejection on July 2, 2025.
Lee’s medical history revealed extensive prior treatment for chronic low back pain dating from January 2017 through April 2024. Medical records documented multiple diagnoses including lumbar intervertebral disc displacement, sciatica, and fibromyalgia. A 2019 lumbar MRI showed a herniated nucleus pulposus. Notably, just three weeks before the alleged May 2024 workplace incident, on April 23, 2024, Lee sought treatment for increased low back pain related to her employment.
At her deposition, Lee testified regarding the incident and acknowledged some inconsistency about whether the injury occurred on May 15 or May 16, 2024. She stated she had healed from a 2018–2019 spine compression fracture and denied prior treatment for lower back issues—contradicted by the extensive medical records presented.
The Court’s Holding
The Intermediate Court of Appeals affirmed the Board’s rejection of Lee’s claim. To qualify for workers’ compensation benefits, a claimant must prove three elements: (1) a personal injury, (2) received in the course of employment, and (3) resulting from that employment. Lee bore the burden of proving her claim by proper and satisfactory proof.
Applying West Virginia Supreme Court precedent in Gill v. City of Charleston (2016) and Moore v. ICG Tygart Valley, LLC (2022), the court found Lee failed to establish entitlement to the presumption of causation under Moore. Although Moore creates a presumption when a preexisting condition was asymptomatic before the injury and symptoms appeared afterward, that presumption requires sufficient medical evidence of causation and may be rebutted by the employer. The Board found Lee’s symptoms were not preceded by an asymptomatic period: she had received extensive, continuous treatment for identical lumbar symptoms from 2017 through April 2024. Pursuant to Gill, a preexisting noncompensable injury cannot be added as a compensable component merely because it was aggravated by a workplace incident.
The court concluded the Board was not clearly wrong in finding that Lee’s pre-injury medical history—showing ongoing, symptomatic lumbar pathology virtually identical to post-injury symptoms—defeated her causation claim. The ample evidence of continuous treatment dating back seven years, culminating just weeks before the alleged injury, supported rejection of her claim.
Key Takeaways
- Preexisting medical conditions present a substantial barrier to workers’ compensation recovery; aggrieved claimants must prove a distinct new injury, not merely aggravation of prior disease.
- Symptom continuity before and after the alleged work incident weighs heavily against establishing causation, particularly when supported by contemporaneous medical records.
- Claimant testimony inconsistent with documented medical history undermines credibility and burden-of-proof satisfaction in workers’ compensation appeals.
- West Virginia applies a deferential standard of review to Workers’ Compensation Board determinations, upholding them if supported by substantial evidence or rational basis.
Why It Matters
This decision reinforces West Virginia’s stringent causation standard for workers’ compensation claims involving preexisting conditions. Claimants cannot leverage workplace incidents to convert noncompensable prior injuries into compensable ones through simple aggravation. The court’s emphasis on symptom continuity and timeline demonstrates that medical causation requires more than temporal proximity; it demands evidence that a genuinely new injury occurred distinct from the preexisting disease. For employers and insurers, the decision validates aggressive use of pre-incident medical records to rebut presumptions of causation.
For claimants and their counsel, the ruling illustrates the critical importance of establishing asymptomatic periods or discontinuity in treatment history to trigger Moore’s presumption. The case also highlights how inconsistent testimony by claimants—particularly denying prior treatment contradicted by medical records—damages credibility and weakens even facially colorable injury claims at appellate review.