Jerry D. Alford
Otis
R. Mann, Jr.
Alum Creek, West Virginia
Charleston,
West Virginia
Attorney for Appellant
Attorney
for Appellant
Harvey Lambert
Billy
Payne, Jr.
James M. Robinson
Darrell
V. McGraw, Jr., Attorney General
Robinson & Rice, L.C.
Sandra
L. Evans, Assistant Attorney General
Huntington, West Virginia
Employment
Programs Litigation Unit
Attorney for Appellant
Charleston,
West Virginia
Columbus Baisden
Attorneys
for Appellee,
CHIEF JUSTICE DAVIS delivered the Opinion of the Court.
JUSTICE MAYNARD concurs and reserves the right to file a concurring opinion.
1. A compensable injury
which does not initially or of itself produce a permanent total disability
may become progressively worse over time or combine with prior impairments
under the second injury statute, W. Va. Code, 23-3-1, so as to result
in a permanent total disability. . . . . Syllabus, in
part, Miracle v. Workers' Compensation Commissioner, 181 W. Va.
443, 383 S.E.2d 75 (1989).
2. Where there are
multiple reports from various experts which establish that the claimant has
currently reached permanent total disability status, the Workers' Compensation
Commissioner has a reasonable discretion in selecting the beginning date for
the award and payment of permanent total disability benefits. The selection
should be based on the dates upon which the experts found the claimant to
have been permanently and totally disabled. Syllabus point 2, Young
v. Workers' Compensation Commissioner, 181 W. Va. 440, 383 S.E.2d
72 (1989).
3. The Workers' Compensation
Division, in exercising its reasonable discretion, pursuant to Young v.
Workers' Compensation Commissioner, 181 W. Va. 440, 383 S.E.2d 72
(1989), to select the date of disability from which a permanent
total disability award will be calculated and paid within the meaning of W. Va.
Code § 23-4-18 (2001) (Supp. 2001), should scrutinize all the evidence included in the
record and, in evaluating this evidence, should consider such factors as:
(1) whether the claimant has ever been medically released to return to work;
(2) whether such a release, if given, was contradicted; (3) whether there
have been any periods of temporary improvement following a debilitating injury
or treatment; and (4) reliable testimony offered by the claimant. In ascertaining
the reliability of a claimant's testimony, consideration may be given to his
or her cooperation, or lack thereof, during examinations performed to evaluate
his or her level of impairment. To the extent our prior ruling in the Syllabus
of Miracle v. Workers' Compensation Commissioner, 181 W. Va. 443,
383 S.E.2d 75 (1989), is inconsistent with this holding, it is hereby modified.
4. The fact that a workers'
compensation claimant has been awarded social security disability benefits
is persuasive evidence that the claimant is permanently and totally disabled
for workers' compensation purposes, and where social security disability is
founded on work-related medical conditions that are substantially similar
to those being asserted in connection with a workers' compensation claim for
permanent total disability, the social security disability award should be
given considerable weight.
5. When an employee,
who has been injured in the course of and as a result of his/her employment,
applies for workers' compensation benefits in the form of a permanent total disability (PTD) award, the employee's application for such
compensation is governed by the statutory, regulatory, and common law as it
existed on the date of the employee's injury or last exposure when there is
no definite expression of legislative intent defining the law by which the
employee's application should be governed. Syllabus point 8, State
ex rel. ACF Industries, Inc. v. Vieweg, 204 W. Va. 525, 514 S.E.2d
176 (1999).
6. The 'date of injury,'
as it refers to an application for workers' compensation benefits arising
from an occupational injury, is the date upon which the employee sustained
the occupational injury which renders him/her eligible for the compensation
award for which he/she has applied. Syllabus point 9, State ex rel.
ACF Industries, Inc. v. Vieweg, 204 W. Va. 525, 514 S.E.2d 176 (1999).
Davis, Chief Justice:
In two
(See footnote 1) workers' compensation cases,
which have been consolidated for purposes of this Court's review, claimants
who have been awarded permanent total disability challenge the date determined
to be the onset of their total disability. In each case the date of onset of
total disability was set by the date of an examination report that concluded
the claimant was permanently and totally disabled. Each of the claimants argues
that the onset date of his total disability should have been established by
an earlier event. In one instance the claimant argues that the onset date should
be the date he underwent a below the knee amputation. In the remaining case,
the claimant argues that the onset date should coincide with the date he was
awarded social security disability benefits. We conclude that certain criteria
should be considered in evaluating the evidence to determine the onset date
of permanent total disability, and that a social security disability award is
persuasive evidence of the onset of permanent total disability. More specifically,
we find that a social security disability award should be given considerable
weight when it has been granted for a condition substantially similar to that
for which a permanent total disability award is sought.
Following his leg injury, Mr. Lambert developed chronic
osteomyelitis
(See footnote 4) in the leg and, over a period of about fifteen
years, he endured approximately twenty-eight surgical procedures attempting
to save the leg. These procedures included debridement, a bone graft using part
of his hip bone, a muscle graft using muscle from his left shoulder, and various
skin grafts. Ultimately, on December 18, 1996, Mr. Lambert required a below-the-knee
amputation of his right leg. Shortly after the amputation, he developed deep
vein (See footnote
5) thrombophlebitis
(See footnote 6) in his left leg requiring the
placement of a vena cava
(See footnote 7) filter. He also developed pulmonary emboli
(See footnote 8)
in his left lung. In the years following the amputation, Mr. Lambert has
suffered phantom pain in the right leg and soreness at the stump. He has also
experienced pain in his hip and shoulder that is associated with his prior surgeries,
and pain associated with changes in his gait resulting from the amputation.
In addition to his chronic pain, Mr. Lambert also suffers from major depression. He apparently takes
numerous medications for his various symptoms. He has been awarded a total
of 59% permanent partial disability (hereinafter PPD) in connection
with this injury, including 10% for the psychiatric residual of his major
depression. According to the record in this case, Mr. Lambert completed his
formal education only through the eighth grade. His history of employment
has been in jobs requiring moderate to heavy exertion.
Mr. Lambert apparently applied for Permanent Total
Disability (hereinafter PTD) on more than one occasion prior to
his amputation, but his requests were consistently denied. On May 26, 1999,
he once again applied for PTD. In support of his application, he submitted
the report of an examination performed by Dr. Bruce A. Guberman, a disability
evaluating physician and certified independent medical examiner. In his report
dated June 15, 1998, Dr. Guberman concluded that [c]onsidering the patient's
age, education, work experience and the objective evidence of his impairment
related to the October 21, 1981 injury, I do not believe that the patient
is able to sustain gainful employment on a full time basis. . . .
I believe that Mr. Lambert is permanently disabled from his prior type of
employment. Mr. Lambert also tendered the report of a vocational consultant,
Mr. Anthony Michael, Jr., dated May 5, 1999. Mr. Michael similarly concluded
When considering this claimant's vocational profile;
an individual approaching advanced age (51) with a limited education (8th
grade), no transferable work skills, severe physical limitations, moderate
mental limitations and chronic pain it is this consultant's opinion that there would be no jobs that this
individual could perform and the claimant's inability to work is directly
related to limitations which have resulted from his work-related injury.
In a subsequent deposition, Mr. Michael was asked to speculate when Mr. Lambert
actually became totally disabled. Mr. Michael explained that he had reviewed
numerous medical reports regarding Mr. Lambert's condition and, after expressing
the difficulty of estimating a disability at some earlier point in time, he
stated the best I can determine, it looks like sometime in the years
1991, '92 would be my best estimate. In addition, Mr. Michael qualified
his estimation by stating that he did not have any contact with Mr. Lambert
in the early 1990's. Finally, upon further questioning, Mr. Michael stated,
based upon his review of Mr. Lambert's medical records, that there did not
appear to be any period of time following his amputation that Mr. Lambert
would have been able to return to full time employment.
Dr. Bernard Nolan, an orthopedic surgeon, examined
Mr. Lambert on behalf of the Division. In his report dated March 19, 1998,
he stated [i]n my opinion Mr. Lambert has reached maximum medical improvement.
He is not working and, in my opinion, he is not capable of returning to gainful
employment.
A rehabilitation assessment was performed in June
1999, and it was determined that vocational rehabilitation services would
not be useful to Mr. Lambert due to the residuals of his injury. The evaluator, Mr. John W. McCue, opined that Mr.
Lambert's age and limited education, along with suitable gainful employment
opportunities would hinder any attempt at feasible vocation rehabilitation
opportunities.
On August 13, 1999, Mr. Lambert was awarded Permanent
Total Disability by the Workers' Compensation Division. The Division determined
the onset date of Mr. Lambert's total disability was May 5, 1999, the date
of Mr. Michael's vocational evaluation report. In this regard, the Division
stated that Mr. Michael's report was the first evidence received by
the Division that states claimant is permanently and totally disabled from
a vocational, as well as medical and psychiatric, standpoint. Mr. Lambert
appealed the Division's determination of the onset date of his disability.
The Workers' Compensation Office of Judges affirmed the Division's determination
by order entered July 10, 2000, similarly concluding that Mr. Michael's report
was the first piece of reliable evidence received by the Division to
show that, from a vocational standpoint, the claimant was permanently totally
disabled. Mr. Lambert then appealed to the Workers' Compensation Appeal
Board, where the disposition of his case was again affirmed, by order entered
April 30, 2001, which order is presently before this Court for review.
On July 20, 1990, Mr. Payne filed a petition seeking
PTD. However, PTD benefits were denied by a decision of the OOJ dated December
9, 1993. In his order denying PTD benefits, the administrative law judge noted
one evaluator's opinion that Mr. Payne was poorly motivated to return to work.
In addition, another examiner, who watched Mr. Payne depart from his office
building after an evaluation, observed an inconsistency between Mr. Payne's evaluation and his normal behavior. The order also detailed that
intellectual functioning evaluations of Mr. Payne rendered varied results.
The lowest score he received indicated a full scale IQ of 78, while a later
test suggested a full scale IQ of 91. The OOJ decision denying PTD benefits
was ultimately affirmed by the WCAB on October 11, 1994. This Court refused
to hear the case on appeal.
Thereafter, Mr. Payne was awarded Social Security
Disability benefits on November 19, 1996. It appears that the evidence relied
upon by the Social Security Administration was essentially the same evidence
that had been submitted to the Division in connection with Mr. Payne's first
petition for PTD benefits, which petition had been denied. Nevertheless, the
Social Security Administration ALJ found that, for Social Security Disability
purposes, Mr. Payne's total disability commenced on February 17, 1988. Mr.
Payne then filed, on April 7, 1998, a second petition seeking PTD benefits
from the Workers' Compensation Division. Mr. Payne was referred by the Division
for psychiatric, functional capacity, rehabilitation, and orthopedic evaluations.
The psychiatric evaluation was conducted by Dr.
Ahmed D. Faheem. In his report dated February 10, 1999, Dr. Faheem found that
Mr. Payne's psychiatric problems, in and of themselves, were neither disabling
nor progressive. A functional capacity evaluation was conducted by Lisa Muckleroy.
By letter dated January 27, 1999, Ms. Muckleroy reported that Mr. Payne exhibited Symptom Exaggeration and
Inappropriate Illness Behavior and he failed 76% of his Validity Criteria
giving him an Invalid Validity Profile, indicating submaximal effort.
As a result of Mr. Payne's conduct during the evaluation, the results obtained
therefrom were considered invalid by Ms. Muckleroy. A rehabilitation evaluation
was performed by Mr. Olen J. Dodd. Mr. Dodd, whose report was dated May 7,
1999, determined that Mr. Payne could function only in sedentary or light
ranges of unskilled jobs,
(See footnote 12) and concluded that Mr. Payne
would not require rehabilitation services. Finally, Mr. Payne received an
orthopedic evaluation by Dr. George Orphanos, an orthopedic surgeon, who,
by report dated April 5, 1999, opined that Mr. Payne was permanently and totally
disabled.
Based upon the foregoing evidence, Mr. Payne was
ultimately granted PTD benefits by order entered on September 16, 1999. In
its order granting PTD to Mr. Payne, the Division stated
[s]pecial attention has been
given to the decision dated November 19, 1996, from the social security administration
granting the claimant's application for social security disability benefits
based upon the same condition as is before the Workers' Compensation Division
at this time. The granting of social security disability benefits is persuasive
upon the issue of permanent total disability since the social security disability
definition is more restrictive than that of the applicable workers' compensation standard. See Cardwell v. SWCC, 301 S.E.2d 790,
at 793 n.3 (W. Va. 1983).
The onset date of Mr. Payne's PTD was determined to be April 5, 1999, the
date of Dr. Orphanos' report.
Mr. Payne appealed the Division's determination
of the onset date of his disability, arguing that he was entitled to an onset
date that coincided with his award of social security disability benefits.
In support of his appeal, Mr. Payne submitted the deposition testimony of
Dr. Orphanos. In his deposition, Dr. Orphanos expressed his belief that, at
the time of his evaluation of Mr. Payne, Mr. Payne's back condition was the
same with regard to his inability to work as it was on the date when Mr. Payne
was granted social security disability benefits.
(See footnote 13) By decision entered August
3, 2000, the Workers' Compensation OOJ affirmed the onset date established
by the Division. The WCAB similarly affirmed, by order entered April 30, 2001.
It is from this order of the WCAB that Mr. Payne appeals.
Conley v. Workers' Comp. Div., 199 W. Va. 196, 199, 483 S.E.2d
542, 545 (1997). In addition, we are asked to evaluate the actual onset dates
assigned by the Division in the cases underlying this appeal. The date of
onset of PTD is a factual question that will not be reversed unless it is
plainly wrong.
'This Court will
not reverse a finding of fact made by the Workmen's Compensation Appeal Board
unless it appears from the proof upon which the appeal board acted that the
finding is plainly wrong. Syl. pt. 2, Jordan v. State Workmen's Compensation
Commissioner, 156 W. Va. 159, 191 S.E.2d 497 (1972), quoting, Syllabus,
Dunlap v. State Workmen's Compensation Commissioner, 152 W. Va.
359, 163 S.E.2d 605 (1968).' Syllabus, Rushman v. Lewis, 173 W. Va.
149, 313 S.E.2d 426 (1984). Syl. pt. 1, Conley.
Rhodes v. Workers' Comp. Div., 209 W. Va. 8, 12, 543 S.E.2d 289,
293 (2000). We have also explained that
[T]he plainly wrong standard of review is a deferential
one, which presumes an administrative tribunal's actions are valid as long
as the decision is supported by substantial evidence. Syl. pt[.] 3, In
re: Queen, 196 W. Va. 442, 473 S.E.2d 483 (1996); Frymier-Halloran
v. Paige, 193 W. Va. 687, 695, 458 S.E.2d 780, 788 (1995).
Conley, 199 W. Va. at 199, 483 S.E.2d at 545.
In Miracle v. Workers' Compensation Commissioner, 181 W. Va. 443, 383 S.E.2d 75 (1989), this Court was asked to resolve the very issue herein raised. In Miracle, the Workers' Compensation claimant had received a PTD award with an onset date that coincided with the date of a report in which a medical doctor opined that all of the various impairments the claimant had accumulated from multiple injuries combined to render him permanently and totally disabled. In affirming this disposition of the case, the Miracle Court first reviewed the scant precedent then available on this issue, which consisted of only two helpful cases. See Anderson v. State Workers' Comp. Comm'r, 174 W. Va. 406, 327 S.E.2d 385 (1985), and Burgess v. State Comp. Comm'r, 121 W. Va. 571, 5 S.E.2d 804 (1939). (See footnote 15) The Court then acknowledged the difficulties associated with determining the onset date of permanent total disability, particularly when the disability arises from multiple injuries or the progression of an injury.
Our cases illustrate some
of the obvious, inherent difficulties in determining the date upon which an
injured worker becomes permanently and totally disabled. Medical evidence
and expert opinion are frequently conflicting, since estimates of permanent
disability are often nothing more than that--estimates. As we recognized in
Griffith v. State Workmen's Compensation Comm'r, 157 W. Va. 837,
843, 205 S.E.2d 157, 161 (1974), [t]he rating of disabilities, regardless
of legislative precision or medical expertise, remains an inexact science.
See Posey v. State Workmen's Compensation Comm'r, 157 W. Va.
285, 290-92, 201 S.E.2d 102, 105-06 (1973); Miles v. State Compensation
Comm'r, 136 W. Va. 183, 190-91, 67 S.E.2d 34, 38-39 (1951); Syllabus,
Stone v. Compensation Appeal Bd., 106 W. Va. 572, 146 S.E. 372
(1929). The issue can be complicated where, as here, the original injury was
not initially sufficiently severe to result in permanent total disability,
but has subsequently progressed or become aggravated, resulting in several
reopenings and additional PPD awards.
The second injury statute,
which permits prior impairments to be considered in the permanent disability
calculus, adds another dimension. In this area, further problems arise because
physicians frequently evaluate only the second injury and ignore the residual
disability from prior injuries. Moreover, medical reports often do not assess
the individual's ability to work, which, under Posey and related cases, sets the standard
for permanent total disability. This type of evaluation is often left to experts
in the field of vocational rehabilitation.
Miracle, 181 W. Va. at 446, 383 S.E.2d at 78 (footnote omitted).
Acknowledging that [t]he determination of the degree of disability is
based on the reports of the various physicians and other experts who have
examined the claimant, Id. (citing Stewart v. State Workmen's
Comp. Comm'r, 155 W. Va. 633, 186 S.E.2d 700 (1972), and McGeary
v. State Comp. Dir., 148 W. Va. 436, 135 S.E.2d 345 (1964)), the
Court held:
A compensable injury which
does not initially or of itself produce a permanent total disability may become
progressively worse over time or combine with prior impairments under the
second injury statute, W. Va. Code, 23-3-1, so as to result in a permanent
total disability. In such circumstances, the date of disability,
from which a permanent total disability award will be calculated and paid
within the meaning of W. Va. Code, 23-4-18, is the first date on which
medical or other expert evidence indicated that such permanent total disability
existed.
Syllabus, Miracle. The Court noted that this holding is consistent
with the conclusions of other jurisdictions where there is no specific language
in the workers' compensation statute setting the date for the award and payment
of PTD benefits. Id., 181 W. Va. at 446, 383 S.E.2d at 78.
On the same day that the Miracle opinion
was handed down, the Court also rendered its decision in a similar case styled
Young v. Workers' Compensation Commissioner, 181 W. Va. 440, 383
S.E.2d 72 (1989). The claimant in Young had sustained numerous injuries to his back and sought a second injury life award. Mr.
Young was granted the award, but he challenged the date his award was to become
effective. Although numerous reports had been submitted on the issue of his
total disability, it was determined that his PTD commenced on March 26, 1986,
the date of a report by an orthopedist who had concluded that Mr. Young was
permanently and totally disabled. The Young Court affirmed the Division's
decision with respect to the onset of Mr. Young's disability, and held:
Where there are multiple reports
from various experts which establish that the claimant has currently reached
permanent total disability status, the Workers' Compensation Commissioner
has a reasonable discretion in selecting the beginning date for the award
and payment of permanent total disability benefits. The selection should be
based on the dates upon which the experts found the claimant to have been
permanently and totally disabled.
Syl. pt. 2, Young.
Most recently, this Court addressed the issue of the onset date for a PTD award in Wingrove v. Workers' Compensation Division, 208 W. Va. 80, 538 S.E.2d 378 (2000), overruled, in part, on other grounds by Martin v. Workers' Comp. Div., 210 W. Va. 270, 557 S.E.2d 324 (2001). In Wingrove, the claimant suffered an injury that got progressively worse over time. 208 W. Va. at 86, 538 S.E.2d at 384. He was initially awarded PTD by the Division with an onset date of February 13, 1987, the last date he worked. (See footnote 16) Id. at 83, 538
S.E.2d 381. The employer protested and the Workers' Compensation Office
of Judges modified the ruling by changing the onset date to October 16, 1992,
the date of a medical report concluding that the claimant was permanently
and totally disabled. Id. The Workers' Compensation Appeal Board subsequently
reversed the PTD award, concluding that Mr. Wingrove had been fully compensated
by a ten percent PPD award he had received. Id. Before this Court,
the claimant sought reinstatement of his PTD award and a determination that
his disability commenced on February 13, 1987. Id. Applying Miracle
and Young, we concluded that the proper onset date for the claimant's
PTD was October 16, 1992. In reaching this conclusion, we explained that,
although there were findings that the claimant was permanently and totally
disabled as early as 1987, only one expert considered all of the claimant's
potential in determining that [he] was permanently and totally disabled. Dr.
J.P. Griffith, Jr., who evaluated the claimant on October 16, 1992 . . . .
Id. at 86, 538 S.E.2d at 384.
In the instant case, we have considered the parties
arguments and the case law discussed above and we are persuaded that our prior
holdings in Miracle and Young should be revisited and further
refined. As we acknowledged in Miracle, the task of determining the date upon which an injured worker has become permanently and totally
disabled is a difficult endeavor. Unless an injury is so severe as to obviously
render a worker permanently and totally disabled at the time it is sustained,
there rarely is a precisely discernable moment in time at which permanent
disability arises. There may even be circumstances in which an injury, seemingly
superficial at the outset, is later is found to have resulted in substantial
or even total impairment. As we have said, '[t]he rating of disabilities,
regardless of legislative precision or medical expertise, remains an inexact
science.' Miracle, 181 W. Va. at 446, 383 S.E.2d at 78 (quoting
Griffith v. State Workmen's Comp. Comm'r, 157 W. Va. 837, 843,
205 S.E.2d 157, 161 (1974)).
In an effort to establish a fair and manageable solution to this problem, we have counseled that the onset of PTD should be ascertained from the first date on which medical or other expert evidence indicated that such permanent total disability existed. Syl., Miracle. In practical application, this holding seems to have resulted in the Division searching medical, psychiatric, and vocational reports for a magical phrase stating the claimant is permanently and totally disabled from future employment, or some similar express declaration, so that the date of that report, or the date of the underlying examination, may become the genesis of PTD benefits. (See footnote 17) If the magical words have not been included, the content of the report appears to often be disregarded. This is particularly problematic where a claimant's disabilities span two or more specialities. PTD frequently arises from a combination of physical or of physical and psychiatric impairments. However, specialists may not be qualified to evaluate impairments outside their given specialty. For example, an orthopedic physician is not qualified to evaluate psychiatric impairment, and, conversely, a psychiatrist should not attempt to ascertain the level of impairment arising from physical injuries. Commonly, it is the functional capacity or vocational report that ultimately puts a claimant's various impairments together to ascertain the cumulative total thereof. Out of necessity, however, functional capacity and vocational evaluations may be performed only after a long series of medical and psychiatric examinations on behalf of all the interested parties. Thus, the date of that evaluation or report is often quite removed from the point of actual disability. While it may be necessary to obtain a vocational evaluation to rule out the possibility of rehabilitation prior to awarding PTD benefits, it does not seem appropriate to use the date of such a report to establish the onset of total disability when there is earlier reliable evidence supporting a finding of PTD. (See footnote 18)
The solution to this dilemma, we believe, is to require
deeper scrutiny on the part of the Division in finding PTD, and to expand the
scope of the relevant evidence that may be considered in deciding upon the associated
onset date for the award. As one court has observed, [t]he question of
permanent total disability is an issue of fact and all relevant evidence
bearing upon the issue should be considered. Revere Copper &
Brass, Inc. v. Birdsong, 267 Ark. 922, 926, 593 S.W.2d 54, 56 (1979) (emphasis
added).
To this end, we specifically discourage complete
reliance on buzzwords contained in medical evaluations. Instead, the Division
should look at the record as a whole and give due consideration to the actual
content of medical reports to determine whether they support a finding of
PTD and may, thus, indicate the onset thereof. In examining the content of
these reports, we believe certain factors should be considered as indicative
of PTD status. For example, the absence of a medical release permitting the
claimant to return to work, either from the time of his or her initial injury
or from the time of some significant aspect of treatment such as surgery,
signals that this person may indeed have been rendered unable to engage
in substantial gainful activity requiring skills or abilities comparable to
those of any gainful activity in which he or she has previously engaged with
some regularity and over a substantial period of time. W. Va. Code § 23-4-6(n) (2)
(1999) (Supp. 2001).
(See footnote 19) Where such a release is present in the
record, however, contemplation should be given to whether the release was
contradicted, such as by evidence the claimant was unable to engage in substantial
gainful activity, and the reliability of the evidence supporting the challenge.
In addition, evidence that the claimant has experienced periods of temporary
improvement following a debilitating injury or treatment may suggest that
the claimant had not yet reached his or her maximum medical improvement and,
thus, was not PTD during that period of time. Finally, we believe that testimony
offered by a claimant should also be considered, so long as there is nothing
in the record demonstrating that the claimant's testimony is unreliable. In
ascertaining the reliability of a claimant's testimony, consideration may
be given to his or her cooperation, or lack thereof, during the evaluation
process.
Accordingly, we hold that the Workers' Compensation
Division, in exercising its reasonable discretion, pursuant to Young v.
Workers' Compensation Commissioner, 181 W. Va. 440, 383 S.E.2d 72
(1989), to select the date of disability from which a permanent
total disability award will be calculated and paid within the meaning of W. Va.
Code § 23-4-18 (2001) (Supp. 2001), should scrutinize all the evidence
included in the record and, in evaluating this evidence, should consider such
factors as: (1) whether the claimant has ever been medically released to return to work; (2) whether such a release,
if given, was contradicted; (3) whether there have been any periods of temporary
improvement following a debilitating injury or treatment; and (4) reliable
testimony offered by the claimant. In ascertaining the reliability of a claimant's
testimony, consideration may be given to his or her cooperation, or lack thereof,
during examinations performed to evaluate his or her level of impairment.
To the extent our prior ruling in the Syllabus of Miracle v. Workers' Compensation
Commissioner, 181 W. Va. 443, 383 S.E.2d 75 (1989), is inconsistent
with this holding, it is hereby modified.
Additionally,
we note that Mr. Payne has argued that a disability award from the Social
Security Administration should be conclusive evidence of Workers' Compensation
PTD. Citing Cardwell v. State Workmen's
Compensation Commissioner, 171 W. Va. 700, 704 n.3, 301 S.E.2d 790,
793 n.3 (1983),
Mr. Payne asserts that the Social
Security Administration definition of disability is more restrictive than that
of the Division and, therefore, a Social Security Disability award should be
determinative in finding PTD for Workers' Compensation Purposes. We disagree.
First, the language relied upon by Mr. Payne is
mere dicta. Furthermore, he has misinterpreted that language. While it may
be true that the definition of disability applied by the Social Security Administration
is in some respects more restrictive than the definition utilized by this State's workers' compensation scheme, it must be remembered
that these two programs are intended to serve slightly different purposes.
(See footnote 20)
As the Division notes, any medical impairment may be considered for social security
disability, while only work-related impairments may be considered in connection
with a workers' compensation claim.
(See footnote 21) Moreover, in order to receive
social security disability, one need only be impaired for a continuous period
of twelve months.
(See footnote 22) Conversely, to qualify for a Workers'
Compensation PTD award, one is expected to show a permanent impairment and
associated inability to engage in substantial gainful activity requiring
skills or abilities comparable to those of any gainful activity in which he
or she has previously engaged with some regularity and over a substantial
period of time. W. Va. Code § 23-4-6(n) (2). Accordingly,
while a social security disability award may be persuasive evidence of the onset of PTD, we decline to find such evidence conclusory. We do recognize,
however, that where work related medical conditions used to establish social
security disability are substantially similar to those resulting in Workers'
Compensation PTD, the social security disability award should be given considerable
weight. Based upon the foregoing analysis, we hold that
the fact that a workers' compensation claimant has been awarded social security
disability benefits is persuasive evidence that the claimant is permanently
and totally disabled for workers' compensation purposes, and where social
security disability is founded on work-related medical conditions that are
substantially similar to those being asserted in connection with a workers'
compensation claim for permanent total disability, the social security disability
award should be given considerable weight.
(See footnote 23)
Accordingly, the proper law to be applied in these cases
must be determined based upon the date each of the party claimants sustained
his respective injury. Mr. Lambert was injured on October 21, 1981; Mr. Payne
sustained his injury on September 20, 1983. Under the law in force at the time
of these injuries, 1. Harvey Lambert. Mr. Lambert argues
that the onset date for his PTD award should be December 18, 1996, the date
his leg was amputated. In support of his argument, Mr. Lambert asserts that
the vocational report used to establish the onset date of his PTD relied on
medical reports dating back to his amputation. In addition, the vocational
consultant testified that he observed no periods of temporary improvement following the amputation of Mr. Lambert's leg, and that there was no period
subsequent to the amputation during which Mr. Lambert could have returned
to full-time work. Our review of the record submitted on appeal supports Mr.
Lambert's contention that he should be awarded PTD as of December 18, 1996,
the date of his leg amputation. A review of the medical records following
that amputation reveals that Mr. Lambert has consistently and continuously
suffered from numerous debilitating complications associated with his left
leg injury and subsequent amputation. The record is devoid of evidence indicating
that Mr. Lambert was able to perform any remunerative work in a field
of work for which he is suited by experience or training at any time
after the amputation of his left leg. Following his amputation, he was apparently
never medically released to resume employment, never did resume employment,
and has never experienced a temporary period of improvement during which he
could have reasonably and fairly resumed employment. Under these circumstances,
we find that the Worker's Compensation Appeal Board was plainly wrong in affirming
the onset date established by the Division. Accordingly, we reverse this case
and remand it for entry of an order granting Mr. Lambert PTD benefits with
an onset date of December 18, 1996.
While both of the instant claimants have been determined
to be PTD, it is, nevertheless, necessary to consider the criteria for PTD in
determining when their respective conditions reached that stage. Consequently,
we pause briefly to identify the law applicable to their claims. In 1995, the
provisions of the West Virginia Code related to Workers' Compensation were significantly
amended by the West Virginia Legislature. As part of these amendments, the provisions
related to the requisites for a PTD award were dramatically changed.
(See footnote 24) Subsequent to those modifications,
we were asked to determine the appropriate law to be applied to determining
the eligibility of a claimant to PTD benefits where the claimant's date of
injury occurred prior to the enactment of the 1995 amendments, but where his
or her application for PTD benefits was filed after the effective date of
the amended statutes. See State ex rel. ACF Indus., Inc. v. Vieweg,
204 W. Va. 525, 514 S.E.2d 176 (1999). After thoroughly considering the
issue, we concluded that
[w]hen an employee, who has been injured in the course
of and as a result of his/her employment, applies for workers' compensation
benefits in the form of a permanent total disability (PTD) award, the employee's
application for such compensation is governed by the statutory, regulatory,
and common law as it existed on the date of the employee's injury or last
exposure when there is no definite expression of legislative intent defining
the law by which the employee's application should be governed.
Syl. pt. 8, ACF Indus. We further explained in syllabus point 9 of
ACF Industries that [t]he 'date of injury,' as it refers to an
application for workers' compensation benefits arising from an occupational
injury, is the date upon which the employee sustained the occupational injury
which renders him/her eligible for the compensation award for which he/she
has applied.
[a] claimant is permanently
and totally disabled under our workmen's compensation statute when he is unable
to perform any remunerative work in a field of work for which he is suited by
experience or training. Each case will be considered on the peculiar facts for
the reason that what may be totally disabling to one person would only be slightly
disabling to another of a different background and experience.
Syl. pt. 3, Posey v. State Workmen's Compensation Comm'r, 157 W. Va.
285, 201 S.E.2d 102 (1973).
(See footnote 25) Having reviewed the appropriate
law to be applied to the instant claims, we proceed to consider the arguments
raised by the individual claimants.
2.
Billy Payne, Jr. Mr. Payne seeks
an onset date that coincides with the date he was awarded Social Security
Disability benefits, November 19, 1996. In support of his proposed onset date,
Mr. Payne argues that Dr. Orphanos, in his deposition testimony, opined
that Mr. Payne's condition had not changed since the order granting social
security disability. We are unpersuaded by Mr. Payne's arguments. Although
his social security disability award should be given substantial weight, since
the condition for which he was granted the award is identical to that for
which he has been granted workers' compensation PTD, the social security disability
award in and of itself is not controlling. There is substantial evidence in
the record indicating that Mr. Payne's failure to cooperate with the professionals
attempting to evaluate his condition impaired their ability to ascertain his
true level of impairment and his ability to return to a job for which he is
suited. In its order granting PTD benefits to Mr. Payne, the Division expressly
stated that it gave [s]pecial attention to the decision of the
Social Security Administration granting him disability benefits. However,
the record, when considered as a whole, does not clearly establish that Mr.
Payne was PTD prior to April 5, 1999.
Under these circumstances, we simply cannot conclude that the decision finding
the onset date of Mr. Payne's PTD to be April 5, 1999, is plainly wrong. Consequently,
this case is affirmed.
For the reasons stated
in the body of this opinion, the April
30, 2001, order of Workers' Compensation Appeal Board, finding the onset date
for Mr. Lambert's PTD award was properly set at May 5,
1999, is reversed. Mr. Lambert's case is remanded for the entry of an order
granting him PTD benefits with an onset date of December 18, 1996. In addition,
we affirm the April 30, 2001, order of
the Workers' Compensation Appeal Board affirming
that the onset of Mr. Payne's PTD occurred on April 5, 1999.
With respect to social security disability and disability
awards under workers' compensation, there is a like commonality of purpose.
Eligibility for the two programs arises simultaneously and may often arise,
at least in part, from the same cause of injury in the workplace. Both social
security disability and workers' compensation contemplate payment for the
involuntary interruption of work. The requirement of eligibility for social
security disability insurance, that a recipient be unable to engage in substantial
gainful activity conceptually includes anyone permanently and totally
disabled for workers' compensation purposes.
(Footnote omitted) (Emphasis added). While eligibility for social security
disability insurance conceptually includes anyone PTD for workers' compensation
purposes, our discussion above demonstrates that the reverse is not necessarily
true.
(1) The term disability means --
(A) inability to engage in
any substantial gainful activity by reason of any medically determinable
physical or mental impairment which can be expected to result in death
or which has lasted or can be expected to last for a continuous period of
not less than 12 months; or
(B) in the case of an individual
who has attained the age of 55 and is blind . . ., inability by
reason of such blindness to engage in substantial gainful activity requiring
skills or abilities comparable to those of any gainful activity in which he
has previously engaged with some regularity and over a substantial period
of time.
(Emphasis added).
In determining whether to
extend full retroactivity, the following factors are to be considered: First,
the nature of the substantive issue overruled must be determined. If the issue
involves a traditionally settled area of law, such as contracts or property
as distinguished from torts, and the new rule was not clearly foreshadowed,
then retroactivity is less justified. Second, where the overruled decision
deals with procedural law rather than substantive, retroactivity ordinarily
will be more readily accorded. Third, common law decisions, when overruled, may result in the overruling decision being given retroactive
effect, since the substantive issue usually has a narrower impact and is likely
to involve fewer parties. Fourth, where, on the other hand, substantial public
issues are involved, arising from statutory or constitutional interpretations
that represent a clear departure from prior precedent, prospective application
will ordinarily be favored. Fifth, the more radically the new decision departs
from previous substantive law, the greater the need for limiting retroactivity.
Finally, this Court will also look to the precedent of other courts which
have determined the retroactive/prospective question in the same area of the
law in their overruling decisions.).
Syl. pt. 5, Bradley v. Appalachian Power Co., 163 W. Va. 332,
256 S.E.2d 879 (1979). Based upon our consideration of these factors, we conclude
the holdings of this case are applicable to any workers' compensation claim
currently in the appeal process, so long as the issue of the onset date for
a PTD award has been properly raised. Where the appeal period has expired
without the issue of PTD onset being raised, this opinion will have no effect.