Cleveland Cliffs, Inc. v. Billy Cecil

IN THE INTERMEDIATE COURT OF APPEALS OF WEST VIRGINIA

FILED
CLEVELAND CLIFFS, INC., May 23, 2024
Employer Below, Petitioner ASHLEY N. DEEM, DEPUTY CLERK
INTERMEDIATE COURT OF APPEALS
OF WEST VIRGINIA
v.) No. 24-ICA-51 (JCN: 2022010927)

BILLY CECIL,
Claimant Below, Respondent

MEMORANDUM DECISION

Petitioner Cleveland Cliffs, Inc., (“Cleveland”) appeals the January 3, 2024,
decision of the Workers’ Compensation Board of Review (“Board”). Respondent Billy
Cecil timely filed a response.1 Cleveland did not file a reply. The issue on appeal is whether
the Board erred in reversing the March 28, 2023, decision of the claim administrator, and
granting Mr. Cecil’s request for a left medial meniscus repair and possible revision
reconstruction of the ACL.

This Court has jurisdiction over this appeal pursuant to West Virginia Code § 51-
11-4 (2022). After considering the parties’ arguments, the record on appeal, and the
applicable law, this Court finds no substantial question of law and no prejudicial error. For
these reasons, a memorandum decision affirming the Board’s order is appropriate under
Rule 21 of the Rules of Appellate Procedure.

Prior to the compensable injury in this case, Mr. Cecil had filed a claim for a left
knee injury that occurred on August 12, 2019. In his completed Employees’ and
Physician’s Report of Occupational Injury or Disease for that claim, Mr. Cecil indicated
that he sustained a left knee injury while dismounting from a bulldozer. Mr. Cecil sought
treatment at Welch Community Hospital Urgent Care on the date of the injury. The
diagnosis was left knee pain and left knee sprain. An x-ray taken on August 12, 2019,
showed tricompartmental osteoarthritis with no fracture, deformity, or large joint effusion.

Robert Kropac, M.D., performed an orthopedic examination of Mr. Cecil on August
28, 2019. Dr. Kropac diagnosed a left knee strain and ordered an MRI to rule out internal
derangement with torn lateral meniscus. A left knee MRI performed on September 23,
2019, revealed small joint effusion, mild chondromalacia patella changes, a tear of the
posterior horn medial meniscus, intrameniscal degenerative changes of the anterior horn,

1
Cleveland is represented by Jeffrey B. Brannon, Esq. Mr. Cecil is represented by
William B. Gerwig, III, Esq.

1
lateral meniscus intact, mild intrameniscal degenerative changes, and torn and swollen
ACL.

Mr. Cecil returned to Dr. Kropac on September 27, 2019, to follow-up regarding the
MRI. Mr. Cecil complained of knee pain when walking and standing. He stated that the
pain was significantly worse when he tried to go up and down stairs. Dr. Kropac reviewed
the MRI report and diagnosed a torn medial meniscus in the left knee, and an ACL rupture
in the left knee. Dr. Kropac opined that these conditions were secondary to the
compensable injury of August 12, 2019. Dr. Kropac requested authorization for Mr. Cecil
to see Phillip Branson, M.D., for surgery on his left knee.

Mr. Cecil visited Dr. Branson on October 28, 2019. Dr. Branson’s assessment was
left knee ACL tear, medial meniscus tear, and early osteoarthritis. Dr. Branson
recommended ACL reconstruction surgery on Mr. Cecil’s left knee. On February 7, 2020,
Dr. Branson performed a left knee arthroscopic ACL reconstruction and a left knee medial
meniscal repair. The pre- and post-operative diagnoses were left knee medial meniscus tear
and ACL tear.

The injury currently at issue in this case occurred on December 21, 2020. Mr. Cecil
completed an Employees’ and Physicians’ Report of Occupational Injury on February 8,
2021, in which he stated that he sustained a left knee injury when his left knee gave out
and popped as he hopped off an excavator. Dr. Branson, who completed the physician’s
portion of the application, diagnosed a left knee injury.

On January 4, 2021, Mr. Cecil followed-up with Dr. Branson. Dr. Branson noted
pain in the left knee with full extension, negative effusion, and tenderness over the
quadricep. A left knee x-ray revealed arthritis: Kelligren Larsen Grade II mild to
moderate/varus; involving the medial and patellofemoral compartments, and
patellofemoral arthritis.

On February 18, 2021, Mr. Cecil underwent an MRI arthrogram of his left knee,
which revealed an ACL prosthesis in place and intact. The PCL appeared intact. There was
an irregularity of the medial meniscus, consistent with a complex tear with irregular radial
and horizontal oblique components, posteriomedially. A small vertical circumferential tear
in the mid portion of the lateral meniscus was noted. Further, there were irregular marrow
edematous findings in the proximal tibia, as well as the medial and lateral distal femur.
Mild patellar cartilage irregularity/chondromalacia, and mild joint effusion were also
noted.

On April 23, 2021, Dr. Branson performed a left knee arthroscopy minor partial
medial and lateral meniscectomy and debridement of joint. The preoperative diagnosis was
left knee medial and lateral meniscus tears, and the postoperative diagnosis was left knee

2
medial and lateral meniscus tears, medial meniscus status post repair, repair intact, and
ACL intact.

Mr. Cecil began treatment with Dana Lycans, M.D., on November 1, 2021. Dr.
Lycans’ assessment was left knee pain with quadriceps weakness, suspected plica
syndrome versus recurrent medial meniscus tear. On November 22, 2021, Mr. Cecil
underwent an MRI of his left knee, which revealed a complex tear in the posterior-to-
posterior junctional medial meniscus. On March 22, 2022, Dr. Lycans performed a left
knee arthroscopy with medial meniscus repair and partial lateral meniscectomy. The pre-
operative and post-operative diagnoses were left medial and lateral meniscus tear.

Mr. Cecil followed-up with Dr. Lycans on September 28, 2022. Mr. Cecil stated
that he had been walking with a shopping cart when he turned and felt a pop in his knee.
He complained of pain and buckling in the left knee following this incident. His pain was
mostly lateral and did not radiate. Dr. Lycans’ assessment was left knee pain and suspected
lateral meniscus tear, and he recommended an additional MRI of the left knee. On October
20, 2022, Mr. Cecil underwent a left knee MRI, which revealed a complex tear of the
medial meniscus and nonspecific edema of the lateral femoral condyle. Mr. Cecil followed-
up with Dr. Lycans on October 26, 2022. Dr. Lycans recommended a second opinion from
Chad Lavender, M.D., at Marshall Orthopedics.

Mr. Cecil began treatment with Dr. Lavender on December 12, 2022. Dr.
Lavender’s assessment was left knee pain and left knee patellofemoral arthritis with medial
meniscus tear. Dr. Lavender opined that the ACL appeared intact and did not require
surgical treatment. With regard to the medial meniscus tear, Dr. Lavender stated that he
would defer to Dr. Lycans, as he stated that he was unsure whether Mr. Cecil had a new
tear or a postsurgical change. Dr. Lavender further stated that if Dr. Lycans felt that this
was a new tear, then he would recommend another surgery.

Mr. Cecil followed-up with Dr. Lycans on December 14, 2022. He reported
continued pain and instability in the left knee on the medial joint line, and that his knee
was buckling frequently. Dr. Lycans’ assessment was left knee pain with medial meniscus
tear. He opined that he was unsure whether Mr. Cecil’s instability was caused by the knee
pain and meniscus tear or whether his ACL was incompetent. Dr. Lycans recommended a
left medial meniscus repair, and stated that if Mr. Cecil’s ACL was incompetent, a revision
reconstruction might be necessary.

On March 20, 2023, Prasadarao Mukkamala, M.D., performed an independent
medical evaluation (“IME”). Dr. Mukkamala stated that Mr. Cecil was injured in 2020
while at work when he hopped down from equipment and his left knee buckled. Further,
Dr. Mukkamala noted that Mr. Cecil had surgery for a prior compensable injury in 2019
and that he had returned to work for three weeks before he was again injured in December
2020. Mr. Cecil reported pain in the left knee and weakness in the left leg. However, Dr.

3
Mukkamala opined that Mr. Cecil did not need any further treatment, and that he had
reached maximum medical improvement (“MMI”) for the compensable injury. In
particular, Dr. Mukkamala disagreed with Dr. Lycans’ recommendation for surgery.
Although Dr. Mukkamala noted that Mr. Cecil continued to be symptomatic, he opined
that surgery was unlikely to improve his symptoms. Dr. Mukkamala stated that Mr. Cecil
had a left knee arthritic condition with degenerative arthrosis. Dr. Mukkamala noted that
Mr. Cecil had decided to go to college and change careers. Dr. Mukkamala assessed 4%
whole person impairment for both the compensable injuries of August 2019 and December
2020.

On March 28, 2023, the claim administrator issued an order denying Dr. Lycans’
request for surgery based on Dr. Mukkamala’s IME. Mr. Cecil protested this order. By
order dated January 3, 2024, the Board reversed the decision of the claim administrator.
The Board concluded that a preponderance of the medical evidence established that the
requested left medial meniscus repair and possible revision reconstruction of the ACL are
medically necessary and reasonably required for treatment of the compensable injury. The
Board weighed the medical evidence and found the opinions of Dr. Lycans and Dr.
Lavender to be more credible than Dr. Mukkamala, on the basis that both are orthopedic
specialists. It is from this order that Cleveland now appeals.

Our standard of review is set forth in West Virginia Code § 23-5-12a(b) (2022), in
part, as follows:

The Intermediate Court of Appeals may affirm the order or decision of the
Workers’ Compensation Board of Review or remand the case for further
proceedings. It shall reverse, vacate, or modify the order or decision of the
Workers’ Compensation Board of Review, if the substantial rights of the
petitioner or petitioners have been prejudiced because the Board of Review’s
findings are:

(1) In violation of statutory provisions;
(2) In excess of the statutory authority or jurisdiction of the Board of Review;
(3) Made upon unlawful procedures.
(4) Affected by other error of law;
(5) Clearly wrong in view of the reliable, probative, and substantial evidence
on the whole record; or
(6) Arbitrary or capricious or characterized by abuse of discretion or clearly
unwarranted exercise of discretion.

On appeal, Cleveland asserts one assignment of error. Cleveland argues that the
Board’s reversal of the claim administrator’s order was clearly wrong in view of the
reliable, probative, and substantial evidence in the record. Cleveland contends that the
Board incorrectly discounted Dr. Mukkamala’s opinion simply because he is not an

4
orthopedist. While not raised as an assignment of error, Cleveland also argues that the
Board ignored evidence regarding an intervening injury, and that both Dr. Lycans and Dr.
Lavender failed to show how the surgery was reasonably related to the December 21, 2020,
injury. We disagree.

As the Supreme Court of Appeals of West Virginia has set forth, “[t]he ‘clearly
wrong’ and the ‘arbitrary and capricious’ standards of review are deferential ones which
presume an agency’s actions are valid as long as the decision is supported by substantial
evidence or by a rational basis.” Syl. Pt. 3, In re Queen, 196 W. Va. 442, 473 S.E.2d 483
(1996).

The claim administrator must provide a claimant with medically related and
reasonably necessary treatment for a compensable injury. See W. Va. Code § 23-4-3 (2005)
and W. Va. Code R. § 85-20-9.1 (2006).

Upon review of the record, we cannot conclude that the Board’s decision to reverse
the claim administrator’s order and grant authorization for a left medial meniscus repair
and possible revision reconstruction of the ACL was clearly wrong based on the evidence.
The Board found that the opinions of Dr. Lycans and Dr. Lavender, who are both
orthopedic surgeons, were more credible than the opinion of Dr. Mukkamala, who is not
an orthopedic specialist. Further, the medical evidence establishes that Dr. Mukkamala
examined Mr. Cecil only once, and that he was less familiar with his injury and his previous
surgeries than Drs. Lycans and Lavender. The Board found that the preponderance of the
evidence established that the left medial meniscus repair and possible ACL revision
reconstruction recommended by Dr. Lycans are medically necessary and reasonably
required for treatment of the compensable injury. With our deferential standard of review
in mind, we cannot conclude that the Board was clearly wrong.

Further, we find no merit in Cleveland’s argument that the Board ignored evidence
regarding an intervening injury. The medical evidence in the record does not support
Cleveland’s contention that the latest request for surgery is related to an intervening injury.
The record indicates that Mr. Cecil injured his left knee twice while at work, and that he
underwent multiple surgeries on his left knee. We note that Dr. Mukkamala, who reviewed
extensive medical records in the claim file, did not opine that the latest request for surgery
was unrelated to the injury in the claim. Instead, his recommendation against surgery was
premised on his belief that another surgery would not relieve Mr. Cecil’s symptoms. The
Board found that the requested left medial meniscus repair and possible revision
reconstruction of the ACL is medically necessary and reasonably required for treatment of
the compensable injury. We defer to the Board’s findings.

Accordingly, we affirm the Board’s January 3, 2024, decision.

Affirmed.

5
ISSUED: May 23, 2024

CONCURRED IN BY:

Chief Judge Thomas E. Scarr
Judge Charles O. Lorensen
Judge Daniel W. Greear

6