Noah Fleenor v. Alpha Metallurgical Resources, Inc.

1
IN THE INTERMEDIATE COURT OF APPEALS OF WEST VIRGINIA
NOAH FLEENOR,
Claimant Below, Petitioner
v.) No. 25-ICA-76 (JCN: 2024007247)
ALPHA METALLURGICAL RESOURCES, INC.,
Employer Below, Respondent
MEMORANDUM DECISION
Petitioner Noah Fleenor appeals the January 29, 2025, order of the Workers’
Compensation Board of Review (“Board”), which affirmed the claim administrator’s order
and found Mr. Fleenor failed to show he developed bilateral carpal tunnel syndrome
(“CTS”) in the course of and resulting from his employment. Alpha Metallurgical
Resources, Inc. (“Alpha”) filed a response.1 Mr. Fleenor did not file a reply.
This Court has jurisdiction over this appeal pursuant to West Virginia Code § 51-
11-4 (2024). After considering the parties’ arguments, the record on appeal, and the
applicable law, this Court finds that there is error in the Board’s decision but no substantial
question of law. This case satisfies the “limited circumstances” requirement of Rule 21(d)
of the Rules of Appellate Procedure for reversal in a memorandum decision. For the
reasons set forth below, the Board’s decision is vacated and remanded for further
proceedings consistent with this decision.
Mr. Fleenor began working in the coal mining industry around 2005 and was
previously employed by Brooks Run Mining Company Inc. as an electrician, Delta
Contracting Inc. as an equipment operator, Beckley Water Company as a general laborer,
and Lightning Contract Services Inc. as an electrician. In December of 2017, he began
work as an electrician for Marfork Coal Company, LLC, which is operated by Alpha, and
he is still currently employed in this position. Mr. Fleenor’s symptoms include constant
pain and tingling, reduced grip strength, and numbness in both hands. In his deposition
testimony, Mr. Fleenor stated that his symptoms began gradually approximately ten years
ago and progressed over the last four to five years. Mr. Fleenor has been diagnosed with
carpal tunnel syndrome, and he provided an opinion that it was caused by his occupation
as an electrician in a coal mine.
1 Mr. Fleenor is represented by Reginald D. Henry, Esq. Alpha is represented by
Sean Harter, Esq.
FILED
September 30, 2025
ASHLEY N. DEEM, CHIEF DEPUTY CLERK
INTERMEDIATE COURT OF APPEALS
OF WEST VIRGINIA

2
Mr. Fleenor first sought medical attention for his symptoms on August 17, 2022,
when he presented to Juli Brehm, D.O., to establish care. Mr. Fleenor told Dr. Brehm that
he had numbness in both hands, and that sometimes his thumbs would draw. Dr. Brehm
ordered an EMG study, which was performed by B.K. Vaught, M.D. Dr. Vaught’s October
19, 2022, EMG study showed abnormalities and indicated moderately severe CTS on the
right and mild CTS on the left. On May 1, 2023, Mr. Fleenor underwent wrist x-rays at
Plateau Medical Center, which were interpreted as showing degenerative changes of the
bilateral wrists and arthritic changes near both thumbs at the first carpometacarpal joints.
On May 4, 2023, Mr. Fleenor was seen by Stephen B. Whitfield, M.D., who
diagnosed bilateral CTS that was more severe on the right and prescribed a wrist splint. Dr.
Whitfield explained that Mr. Fleenor’s “drawing up” of his bilateral thumbs was related to
CMC arthritis rather than CTS. Dr. Whitfield indicated that it was his understanding that
Mr. Fleenor was an electrician in the coal industry, that his symptoms began while working
in the mines, and that his symptoms had been present for over a year.
On December 15, 2023, Mr. Fleenor submitted an Employees' and Physicians'
Report of Occupational Injury or Disease completed by Dr. Whitfield, who diagnosed Mr.
Fleenor with an occupational disease of CTS.2 On January 30, 2024, Mr. Fleenor
completed a SmartCasualty CTS form (“CTS form”) which provides his work history;
indicates he was right-hand dominant; and states that he worked in a job involving bending
and rotation with his wrists, grasping objects with his hands, twisting, screwing and turning
tools, pressing and pushing with the palm or surface of his hands, rotating his wrists, and
pounding for a period of over seventeen years.
On March 6, 2024, Mr. Fleenor underwent an independent medical evaluation
performed by Prasadarao B. Mukkamala, M.D., at the request of the claim administrator.
Dr. Mukkamala confirmed the diagnosis of bilateral CTS, which was mild on the right and
borderline on the left side. Dr. Mukkamala believed that Mr. Fleenor’s CTS was unrelated
to his occupational activities. Dr. Mukkamala noted that Mr. Fleenor had experienced
symptoms prior to his employment at Alpha, and he did not believe that Mr. Fleenor's
occupational activities at Alpha worsened the condition. Thus, Dr. Mukkamala found it
was unlikely that Mr. Fleenor’s condition was caused by his work activities, concluding
that there was no clear-cut occupational risk factor for the development of CTS. He further
noted that Mr. Fleenor was overweight, had degenerative changes at the wrist, and
indicated that Mr. Fleenor’s increased body mass index was a non-occupational risk factor
for the development of CTS. Dr. Mukkamala also believed that Mr. Fleenor's
carpometacarpal joint arthritis increased his risk factor for the development of CTS.
2 The Employee’s Claim Information section of the Report of Occupational Injury
or Disease is blank.

3
Mr. Fleenor testified in a deposition on May 20, 2024. According to Mr. Fleenor,
be began working as a coal miner around 2005. He first started working at Kingston as a
scoop and buggy operator. Mr. Fleenor testified that these job duties required him to haul
coal, rock, and mine supplies. He next worked for Brooks Run Mining beginning in 2011
or 2012 as an electrician.3 Mr. Fleenor testified that he repaired equipment during the
midnight shift. He “spliced cables, took out pins, used hammers, hung panels, rewired a
lot of controls, compactors, just anything to do with the electrical part of it - - basically it
was just mechanic work and electrical work both.”
After Mr. Fleenor was laid off from Brooks Run, he ran heavy equipment at Delta
Contracting for several months, then he worked as a general laborer for a water company
for approximately four months. While at the water company, he fixed leaks and operated
a backhoe. Thereafter, Mr. Fleenor worked for Lightning Contract Services as an
electrician. Mr. Fleenor did not describe his job duties at Lightning Contract services.
However, he testified that the tip of his left little finger was amputated while changing the
head of a continuous miner.
Mr. Fleenor testified that he began working for Alpha on December 8, 2017, and
that he continues to work as a mine electrician. He works approximately ten-hour shifts,
five to six days a week. According to Mr. Fleenor’s testimony, he repairs equipment,
including “tires, change the bits on the miners, take out pins, we fire equipment up, chains,
we use hammers, we use - - I mean. Any kind of hand tools, we weld, we torch, and the
list goes on, but it’s - - basically, it is…the electrician part, which is the wires and changing
out the electrical components, and then you do the mechanical side of it . . ..” Mr. Fleenor
testified that he uses his wrists, “[y]ou have to bend them, you are squeezing something,
you are pulling, I mean, I use my hands more than anything else on my body, everything
an electrician does.” Mr. Fleenor also testified that he used “[q]uite a bit” of force while
working: “I mean, not everything goes easy in the mines. If you are going to drive a pin in
with a hammer, you are going to drive it in, you ain’t just going to tap it in.” Mr. Fleenor
also said that he was exposed to “a lot of vibration,” and that he used both hands nearly
equally: “there is nothing you can do one handed…Basically, you are going to swap hands
and use both hands to pick up stuff, swing a hammer with both hands…sometimes you can
use one, but most of the time, it is both.” According to Mr. Fleenor, the work is repetitive.
“I go in, I make splices, I mean, it’s the same thing, we do the same thing every night…it
is just on different equipment.”
Mr. Fleenor testified that he noticed slight symptoms in his hands nine or ten years
previously, but that within the past five years, the symptoms increased. He did not seek
medical attention until he began dropping objects and experiencing numbness in his hands,
3 According to Mr. Fleenor’s testimony, he worked at two mines owned by Brooks
Run.

4
“it is just something that over the years has just been worse than it was earlier….” Mr.
Fleenor also testified that his “thumbs draw.” Mr. Fleenor denied a history of rheumatoid
arthritis, hypothyroidism, hypertension, diabetes, or significant trauma to the wrists.
Finally, Mr. Fleenor testified that he stands 5’11’’ and weighs 215 pounds.
On March 19, 2024, the claim administrator denied Mr. Fleenor’s claim for CTS.
The claim administrator alleged that the medical evidence did not support a causal
connection between his medical condition and employment activities. Mr. Fleenor
protested to the Board.
Mr. Fleenor underwent a second independent medical evaluation on August 13,
2024, which was performed by Syam B. Stoll, M.D. Dr. Stoll indicated he reviewed the
medical and administrative documents in Mr. Fleenor’s case, including Mr. Fleenor’s
deposition testimony. He noted that Mr. Fleenor used impact wrenches, hammers, and
breaker bars. Dr. Stoll also described Mr. Fleenor’s symptoms. Dr. Stoll confirmed the
diagnosis of bilateral CTS, and he concurred with Dr. Mukkamala’s opinion that Mr.
Fleenor’s CTS was not caused by work activities. Dr. Stoll also believed that Mr. Fleenor's
symptoms pre-existed his employment with Alpha. According to Dr. Stoll’s report, he
based his opinion on Official Disability Guidelines, which indicates that high force with
repetitive activity is associated with higher levels of carpal tunnel syndrome and abnormal
nerve conduction studies. Dr. Stoll concluded that after reviewing Mr. Fleenor’s CTS
form, Mr. Fleenor’s work “lacks any frequency of specific activities to substantiate the
causality of CTS as being causally related to his job duties.”
On January 29, 2025, the Board affirmed the claim administrator’s order which
rejected the claim. It held that Mr. Fleenor’s job as a coal mine electrician was not one of
the occupational groups at risk for developing CTS as identified in West Virginia Code of
State Rules § 85-20-41.5 (2006) and held there was no evidence to establish a direct causal
relationship between the conditions of his work and his development of CTS. It is from
this order that Mr. Fleenor 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;

5
(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.
Syl. Pt. 2, Duff v. Kanawha Cnty. Comm’n, 250 W. Va. 510, 905 S.E.2d 528 (2024).
On appeal, Mr. Fleenor asserts one assignment of error and argues the Board was
clearly wrong in finding his CTS was not sustained in the course of and resulted from his
employment. Pursuant to West Virginia Code § 23-4-1(f) (2024),
a disease is considered to have been incurred in the course of, or to have
resulted from, the employment only if it is apparent to the rational mind, upon
consideration of all circumstances: (1) That there is a direct causal
connection between the conditions under which work is performed and the
occupational disease; (2) that it can be seen to have followed as a natural
incident of the work as a result of the exposure occasioned by the nature of
the employment; (3) that it can be fairly traced to the employment as a
proximate cause; (4) that it does not come from a hazard to which workmen
would have been equally exposed outside of the employment; (5) that it is
incidental to the character of the business and not independent of the relation
of employer and employee; and (6) that it appears to have had its origin in a
risk connected with the employment and to have flowed from that source as
a natural consequence, though it need not have been foreseen or expected
before its contraction[.]
In this case, the Board applied West Virginia Code § 23-4-1(f) and concluded that
Mr. Fleenor’s CTS was not related to his work activities. The Board stated that “the
claimant’s employment as an electrician in the coal mining industry does not fall into any
of the occupational groups listed in C.S.R. §85-20-41.5. Moreover, the evidence, including
the claimant’s testimony, does not indicate that the claimant performed high force,
repetitive manual movement.”
A review of Mr. Fleenor’s deposition testimony suggests there is evidence that he
used his hands in a high force and repetitive manner. Mr. Fleenor testified that he worked
for Brooks Run beginning in 2011 or 2012 as an electrician. While at Brooks Run, he
spliced cables, removed pins, used hammers, hung panels, and rewired controls. Mr.
Fleenor next worked as a heavy equipment operator and general laborer for approximately
six to eight months, and then began working for Alpha on December 8, 2017, as an
electrician. While at Alpha, Mr. Fleenor worked ten-hour shifts, five to six days a week.
Mr. Fleenor spliced cables, repaired tires, changed bits on continuous miners, and used

6
hammers, welders and other hand tools. He used both hands frequently, had to bend his
wrists in different positions, squeeze and pull materials, his hands were exposed to
vibrations, and according to Mr. Fleenor’s testimony, he used “quite a bit of force” with
his hands. Mr. Fleenor testified that he used his hands “more than anything else on [his]
body,”
West Virginia C.S.R. §85-20-41.5 recognizes that certain work is high risk for the
development of carpal tunnel syndrome. A type of work listed in Rule 41.5 is “high force,
high repetitive manual movement.” The Board found that Mr. Fleenor did not submit
evidence of high force, repetitive work. However, our reading of Mr. Fleenor’s undisputed
deposition testimony shows that he did submit such evidence, and that the Board was
clearly wrong when it made its finding that there was no evidence of high force, repetitive
work.
The Board also relied on the opinions of Dr. Mukkamala and Dr. Stoll, when Dr.
Mukkamala did not have a full description of Mr. Fleenor’s work activities,4 and Dr. Stoll
based his conclusions primarily on Official Disability Guidelines, and he failed to
acknowledge that Mr. Fleenor provided a description of his job activities, which include
high force, repetitive work.5
In summary, the Board was clearly wrong when it concluded that Mr. Fleenor did
not provide evidence that he engaged in high force, repetitive work. Mr. Fleenor provided
evidence that he engaged in heavy work which involved repetitive, high force manipulation
of objects with both hands. Mr. Fleenor also provided an opinion from Dr. Whitfield that
his work activities caused carpal tunnel syndrome.6 Moreover, the Board abused its
discretion when it relied on Dr. Mukkamala’s report, even though he did not have all
information regarding Mr. Fleenor’s job duties, and when it relied on Dr. Stoll, even though
his conclusions are based primarily on disability guidelines and not Mr. Fleenor’s actual
work activities.
Accordingly, the Board’s order of January 29, 2025, is vacated, and this claim is
remanded to the Board for it to fully review the evidence submitted, including Mr.
4 Dr. Mukkamala’s evaluation was made before the claimant’s deposition.
5 Dr. Stoll’s report indicates that he reviewed Mr. Fleenor’s testimony. However,
his conclusions appear to be based primarily on Mr. Fleenor’s CTS form.
6 The employer argues that Dr. Whitfield’s opinion should be disregarded because
the claimant’s section of the Report of Occupational Injury or Disease is blank. We find
this argument unavailing. If the employer believed Mr. Fleenor’s application was faulty,
it should have rejected the claim based on an incomplete application.

7
Fleenor’s description of his job activities, and provide an order consistent with the
requirements of West Virginia Code § 23-4-1(f).
Vacated and Remanded.
ISSUED: September 30, 2025
CONCURRED IN BY:
Chief Judge Charles O. Lorensen
Judge Daniel W. Greear
Judge S. Ryan White