Background
On August 5, 2020, Bobby Snelson, a painter employed by Bobby Snelson Bob’s Painting, fell approximately fifteen feet off a metal roof, fracturing his right wrist and right knee. His workers’ compensation claim was accepted as compensable for right arm fracture and right distal radius fracture, and he underwent surgery for those injuries. Shortly after surgery, Snelson began experiencing significant right shoulder pain. MRIs revealed rotator cuff tendinosis with partial-thickness tears of the supraspinatus and subscapularis tendons, a SLAP tear, and arthritic changes. He sought to add right shoulder rotator cuff tear and right shoulder SLAP tear as compensable components of his claim and to obtain authorization for arthroscopic rotator cuff repair, labral debridement, and possible biceps tenodesis.
Snelson’s treating orthopedic surgeon, Dr. Nick Zervos, opined with “100% certainty” that the shoulder injuries were caused by the workplace fall, noting that Snelson had no shoulder symptoms prior to the accident and had performed overhead painting work without limitation. The Independent Medical Examiner, Dr. Joseph Grady, acknowledged he could not exclude the possibility that the fall caused the shoulder injury, given that Snelson sustained a significant impact to the right upper extremity. Nonetheless, the claim administrator denied compensability of the shoulder conditions and denied authorization for the requested surgery. The Board of Review affirmed, and the Intermediate Court of Appeals (“ICA”) affirmed the Board in an October 24, 2025 memorandum decision.
Snelson appealed to the Supreme Court of Appeals of West Virginia, arguing that the ICA erred in its affirmance and that the causation presumption established in Moore v. ICG Tygart Valley, LLC, 247 W. Va. 292, 879 S.E.2d 779 (2022), required a finding of compensability given that his shoulder was asymptomatic before the injury and symptoms arose and continuously manifested thereafter.
The Court’s Holding
A three-justice majority summarily affirmed the ICA’s decision without extended analysis, finding no reversible error on the record. The court declined to hold oral argument, disposing of the appeal under West Virginia Rule of Appellate Procedure 21(c). The majority applied a deferential standard to the Board of Review’s factual findings, reversing only if clearly wrong, while reviewing questions of law de novo under Duff v. Kanawha County Commission, 250 W. Va. 510, 905 S.E.2d 528 (2024). The right shoulder rotator cuff tear, SLAP tear, and related surgical procedures thus remain non-compensable components of the claim.
Two justices dissented. Writing for himself and Justice Wooton, Justice Trump argued that the majority’s affirmance was inconsistent with the Moore presumption. Under Moore, a claimant’s disability is presumed to result from a compensable injury when the preexisting condition was asymptomatic before the injury and symptoms continuously manifested afterward — a rebuttable presumption the employer failed to overcome here. The dissenters emphasized that Snelson had no prior shoulder symptoms despite existing arthritis, that his treating surgeon opined with certainty as to causation, and that even the IME physician could not exclude the fall as the cause. The dissenters would have reversed and authorized the requested surgery.
Key Takeaways
- The West Virginia Supreme Court of Appeals affirmed, 3-2, that a worker’s right shoulder injuries were not compensable components of a claim arising from a roof-fall, despite the worker’s treating surgeon opining with “100% certainty” that the fall caused the shoulder damage.
- The majority applied deferential review to the Board of Review’s factual findings and summarily affirmed without oral argument, leaving the detailed evidentiary weighing undisturbed.
- The dissent argued that the Moore v. ICG Tygart Valley presumption of causation — triggered when a preexisting condition was asymptomatic before a compensable injury and continuously symptomatic after — should have compelled a finding of compensability, particularly where the employer’s own IME physician could not rule out causation.
- The case illustrates the significance of the causation standard in West Virginia workers’ compensation: IME opinions that merely decline to “exclude” a causal link, without affirmatively establishing it, may be insufficient to overcome a claim administrator’s denial even when treating physicians opine to certainty.
Why It Matters
This decision is a practical reminder for West Virginia workers’ compensation practitioners that a treating physician’s strong causation opinion — even one expressed with certainty — may not prevail over a claim administrator’s denial when the Board of Review credits conflicting or equivocal medical evidence. The majority’s summary affirmance offers little doctrinal guidance, but the outcome signals that the Moore presumption does not operate automatically and that factfinders retain considerable discretion in weighing competing medical opinions on causation.
The sharp 3-2 split, with the dissent methodically applying Moore to the facts, suggests that the boundary of the causation presumption in multi-site traumatic injury cases remains unsettled. Attorneys representing injured workers in similar circumstances — where a single traumatic event affects multiple body parts but only some are initially accepted — should carefully develop the evidentiary record to demonstrate pre-injury asymptomaticity and continuous post-injury manifestation, and should be prepared for the possibility that even compelling treating-physician testimony may be insufficient without corroborating objective findings squarely attributing causation to the work event.