Implied Addition of Compensable Conditions and the Moore Presumption in West Virginia Workers’ Compensation Law: Commentary on Comas v. Bass Pro Group, LLC

I. Introduction

The Supreme Court of Appeals of West Virginia’s memorandum decision in Charles E. Comas v. Bass Pro Group, LLC (Nov. 12, 2025) sits at the intersection of three significant themes in workers’ compensation law:

How to treat preexisting degenerative conditions that become symptomatic after a workplace injury;
Whether a request for medical treatment can operate as an implied request to add a new compensable condition to a claim; and
How far courts and agencies must go to avoid letting procedural technicalities defeat meritorious claims, especially for self‑represented claimants.

The case arises from a retail worker’s slip‑and‑fall on a wet loading dock, followed by persistent knee pain, an MRI revealing a degenerative medial meniscal tear, and a dispute over authorization of arthroscopic surgery. The claim was originally held compensable only for a “left knee sprain”.

When the claimant’s orthopedist requested arthroscopic surgery to address a medial meniscus tear and the claim administrator denied authorization, the Workers’ Compensation Board of Review (“BOR”) and the Intermediate Court of Appeals (“ICA”) affirmed the denial on the simple ground that the only compensable condition was a sprain and surgery is “inappropriate treatment” for a sprain under the medical treatment guidelines.

The Supreme Court reversed, holding that under Moore v. ICG Tygart Valley, LLC and the legislative policy against “form over substance,” the BOR erred in refusing to treat the meniscal tear as a compensable component and in ignoring unrefuted evidence that a preexisting degenerative condition was asymptomatic until the work injury. The Court remanded with instructions to proceed in accordance with Moore.

A vigorous dissent by Justice Ewing, joined by Justice Bunn, criticizes the majority for overstepping the statutory standard of review and for undermining the regulatory requirement that new diagnoses be added through formal update procedures.

Although issued as a memorandum decision under Rule 21 of the Rules of Appellate Procedure, Comas meaningfully develops West Virginia workers’ compensation doctrine in three ways:

It reinforces and operationalizes the Moore presumption for asymptomatic preexisting conditions, in the specific context of degenerative meniscal tears.
It recognizes that, in appropriate circumstances, a treatment request can function as an “informal” request to add a compensable diagnosis when the claim administrator itself treats the condition as being at issue.
It reemphasizes that procedural formalities cannot be used to defeat a claim on a technicality, especially where the claimant is self‑represented and the record itself puts the additional condition squarely in play.

II. Factual and Procedural Background

A. The workplace injury and early treatment

On September 5, 2022, Charles Comas slipped and fell on a wet concrete loading dock while working for Bass Pro Group. He immediately experienced:

"a sharp, burning pain inside the knee," that he had never "felt . . . before in [his] life."

He promptly reported the incident to his supervisor. Five days later, he presented to the emergency department at Wheeling Hospital reporting that the pain had persisted without relief. X‑rays revealed:

Mild degenerative joint disease (DJD) of the left knee; and
No fracture.

Importantly, Mr. Comas denied any prior history of left knee injury or symptoms.

He then came under the care of Nurse Practitioner Ross Tennant in Occupational Medicine. At a September 15, 2022 visit, Tennant:

Recorded that he suspected a medial meniscus tear; and
Specifically noted that the claimant denied any prior difficulty with the left knee.

Tennant prescribed conservative care:

Elevation and ice;
Physical therapy; and
Light‑duty work restrictions.

B. Persistent symptoms, MRI, and orthopedic consultation

At a September 29, 2022 follow‑up, Tennant noted that physical therapy had begun but that the claimant still had:

"significant discomfort to the medial aspect of his left knee;" and
complaints that the knee felt "unstable at times."

In light of persistent symptoms, Tennant requested authorization for a diagnostic MRI. A subsequent visit on October 13, 2022, recorded:

"there has been no improvement [in] pain discomfort to the medial aspect of [petitioner's] left knee with treatment from physical therapy. . . . [Petitioner] reports increased pain whenever he twists or turns suddenly."

The claim administrator approved the MRI, which was performed on October 20, 2022, and interpreted as showing:

"[d]egenerative tearing of the posterior horn of medial meniscus with associated mild cartilage loss and osseous edema."

Tennant then sought authorization for an orthopedic consultation.

On October 26, 2022, the claim administrator issued two important orders:

It held the claim compensable for a “left knee sprain”; and
It authorized an orthopedic consultation with orthopedic surgeon Dr. Jeffrey Abbott.

C. Orthopedic diagnosis, competing expert opinion, and denial of surgery

On November 11, 2022, Dr. Abbott evaluated the claimant and obtained additional X‑rays, which again showed mild degenerative changes. Based on the MRI and clinical findings, Dr. Abbott diagnosed:

Acute medial meniscus tear of the left knee, and
Osteoarthritis of the left knee.

Consistent with the workers’ compensation knee‑injury treatment guidelines, Dr. Abbott requested authorization for left knee arthroscopy.

The claim administrator then sought an independent records review from orthopedic surgeon Dr. David Soulsby, asking specifically:

"[w]hether there is a reasonable probability that degenerative osteoarthritis has caused a pre-existing tear of the medial meniscus."

In a December 23, 2022 report, Dr. Soulsby opined that:

The osteoarthritis preexisted the work injury;
There was a "reasonable medical probability" that the claimant also had a preexisting degenerative medial meniscus tear; and
These conditions were not related to the work incident, though the incident “may have caused temporary exacerbation.”

He further stated:

"Because of pre-existing osteoarthritis and degenerative meniscal tearing, there is a reasonable certainty that [petitioner] would have developed symptoms at some point in the near future regardless of the work incident."

While he conceded the proposed surgery was "reasonable and necessary for the stated diagnosis," he concluded it was not work‑related.

Relying on this report, the claim administrator issued a December 28, 2022 order denying authorization for the arthroscopic surgery.

(Separately, the claimant re‑injured his left knee at work on January 8, 2023, but the Court’s analysis focuses on the original September 2022 injury.)

D. Protest, Board of Review, and ICA decisions

On January 11, 2023, acting pro se, the claimant protested the denial of surgery. He asserted:

That the meniscal tear occurred during the work accident;
That the DJD finding was "secondary to the meniscal tear"; and
That arthroscopic surgery was needed to alleviate pain from the tear.

He submitted the MRI report in support. In a May 18, 2023 deposition, he testified that before the September 5, 2022 incident he had never had any "problems," "symptoms," or "pain" in his left knee, but since then had experienced constant pain and swelling.

On September 28, 2023, the BOR affirmed the claim administrator’s denial of surgery. Critically, the BOR did not address:

Whether the meniscal tear was related to the work injury; or
The claimant’s unrefuted testimony that his knee was asymptomatic before the injury.

Instead, the BOR reasoned simply that:

"the compensable condition of the claim is left knee sprain and per W. Va. C.S.R. § 85-20-43b, surgery is an inappropriate treatment for knee sprain. It is determined that the requested treatment is not medically related and reasonably required for the compensable injury of left knee sprain."

The ICA, in turn, affirmed the BOR’s decision in a March 25, 2024 memorandum decision.

III. Summary of the Supreme Court’s Decision

The Supreme Court reversed the ICA and the BOR and remanded with instructions. Its core conclusions can be summarized as follows:

Application of Moore’s presumption.
The Court held that syllabus point 5 of Moore v. ICG Tygart Valley, LLC applies: when a claimant has a preexisting condition that was asymptomatic before the work injury and becomes symptomatic afterwards with continuous symptoms, the resulting disability is presumed to be caused by the compensable injury. Here, even assuming the meniscal tear was degenerative and preexisting, the unrefuted evidence was that it was asymptomatic pre‑injury and continuously symptomatic post‑injury. Under Moore, the meniscal tear should be treated as a compensable component.
Treatment request as an implied request to add a compensable condition.
The Court concluded that the claim administrator, by seeking Dr. Soulsby’s opinion about whether the medial meniscus tear was caused by degenerative osteoarthritis or by the workplace incident, had “clearly treated” the request for arthroscopy as a request to add the medial meniscal tear as a compensable condition. If the claim administrator were viewing the case as solely a knee‑sprain claim, there would have been no need to seek a causation opinion about a meniscal tear; it could simply have denied surgery as “inappropriate” for a sprain under the guidelines.
BOR error in relying exclusively on the “sprain” diagnosis and the sprain guidelines.
The BOR erred by:
- Ignoring the claim administrator’s implicit treatment of the tear as a compensable component;
- Failing to apply Moore despite unrefuted evidence that the tear was asymptomatic before the injury and symptomatic afterwards; and
- Denying surgery solely on the ground that it is “inappropriate” for a sprain, without engaging the meniscal‑tear diagnosis.
Rejection of “form over substance” in the workers’ compensation process.
The Court held that it would be improper to deny treatment based solely on the claimant’s failure (while self‑represented) to formally file a request to add the meniscal tear as a compensable condition, when the record as a whole showed that the issue was squarely before the claim administrator. Relying on Moore, Best Buy v. Parrish, Martin v. Workers’ Compensation Division, and West Virginia Code § 23‑1‑1(b), the Court emphasized that workers’ compensation cases must be decided on their merits, and deserving workers must not be thwarted by technicalities.
Disposition.
The Court reversed the ICA’s decision and remanded to the BOR with directions to proceed in accordance with Moore. Practically, this means the BOR must:
- Treat the medial meniscal tear as being at issue as a potential compensable component; and
- Apply the Moore presumption and evaluate whether the employer has successfully rebutted it.

IV. Precedents and Authorities Cited

A. Moore v. ICG Tygart Valley, LLC

The linchpin of the majority’s analysis is syllabus point 5 of Moore:

"A claimant's disability will be presumed to have resulted from the compensable injury if: (1) before the injury, the claimant's preexisting disease or condition was asymptomatic, and (2) following the injury, the symptoms of the disabling disease or condition appeared and continuously manifested themselves afterwards. There still must be sufficient medical evidence to show a causal relationship between the compensable injury and the disability, or the nature of the accident, combined with the other facts of the case, raises a natural inference of causation. This presumption is not conclusive; it may be rebutted by the employer."

Two aspects of this rule are crucial in Comas:

The presumption applies even to preexisting degenerative conditions, so long as they were asymptomatic before the compensable injury.
The presumption can rest not only on explicit medical testimony of causation, but also on the "nature of the accident" combined with the facts of the case that raise a “natural inference” of causation.

In Moore itself, the Court also criticized an “overly technical” approach to a claim‑update form. There, the Office of Judges refused to add a diagnosis of cervical radiculopathy because the update form explicitly mentioned only “C5‑6 spondylosis and C6 radiculopathy (M47.22)” but referenced office notes that themselves listed cervical radiculopathy under a different code. The Court held that the administrative tribunal erred in refusing to consider what was, in substance, a request to add radiculopathy as a compensable condition, emphasizing that workers’ compensation adjudication must not elevate form over substance.

Comas extends that anti‑formalistic strand of Moore to the context of treatment requests and degenerative conditions.

B. Duff v. Kanawha County Commission

The Court cited syllabus point 3 of Duff, which applies the standard of review mandated by West Virginia Code § 23‑5‑12a(b):

Questions of law are reviewed de novo; and
Findings of fact by the BOR are accorded deference unless clearly wrong.

The majority’s treatment of the BOR’s decision—as an error of law in failing to apply Moore and in improperly limiting the scope of the compensable condition—contrasts sharply with the dissent’s view that the BOR’s decision fell squarely within its fact‑finding authority and thus merited deference.

C. Best Buy v. Parrish (memorandum decision)

In Best Buy v. Parrish, the Court affirmed the addition of complex regional pain syndrome (CRPS) as a compensable condition where:

"The claim administrator treated complex regional pain syndrome as a compensable condition as evidenced by the authorization and payment for medical treatment related to the condition, even though it does not appear that a formal request to add the condition as compensable was ever made."

Best Buy thus stands for the proposition that an actual practice of authorizing or paying for treatment related to a diagnosis may demonstrate that the condition has effectively been treated as compensable, even absent formal amendment.

The Comas majority invokes this principle by analogy: the claim administrator’s act of soliciting a causation opinion specifically about the meniscal tear showed that it was treating the tear as a potential compensable component, such that it was improper for the BOR to act as if only a sprain was in play.

D. Martin v. Workers’ Compensation Division

The Court cites Martin for the caution that:

"Although the rules and regulations governing the workers' compensation system in this state are necessarily detailed and complex, we must be careful to prevent those deserving of compensation from being thwarted by technicalities or procedural niceties[.]"

This theme—protecting claimants from being defeated by procedural missteps—is heavily emphasized in Comas, especially because the claimant initially proceeded without counsel.

E. Lucas v. Blue Creek Mining, LLC (memorandum decision, cited in dissent)

Justice Ewing’s dissent cites Lucas as a counterpoint. In that case, the claimant:

Had a claim compensable only for a right knee sprain; and
Underwent surgery for a medial meniscus tear.

The Court held the claimant was not entitled to permanent partial disability impairment for the surgery because:

The meniscal tear was not a compensable condition; and
Surgery is not an appropriate treatment for a sprain under the guidelines.

The dissent in Comas argues that this case is controlled by the same logic as Lucas: absent a formal addition of a meniscal tear as a compensable diagnosis, the only proper conclusion is that surgery is inappropriate as treatment for a sprain. The majority distinguishes the situation implicitly by finding that here, unlike in Lucas, the record demonstrates that the claim administrator brought the tear into the claim and that Moore’s presumption applies.

F. Statutes, Rules, and Regulations

1. West Virginia Code § 23‑1‑1(b)

Section 23‑1‑1(b) expresses the overarching legislative intent for the workers’ compensation system:

To assure the quick and efficient delivery of indemnity and medical benefits to injured workers at a reasonable cost to employers; and
That workers’ compensation cases shall be decided on their merits.

The majority uses this policy statement to condemn decisions that elevate form over substance and to justify treating the claimant’s treatment request as an effective request to recognize the meniscal tear as compensable.

2. West Virginia Code § 23‑5‑12a(b)

This statute prescribes the standard of review for appeals from the BOR. As incorporated in Duff, courts must:

Review legal questions de novo; and
Defer to the BOR’s factual findings unless clearly wrong.

The dissent accuses the majority of ignoring this standard and “assum[ing] the role of factfinder” by concluding that the claim administrator must have treated the arthroscopy request as an informal request to add the meniscal tear.

3. West Virginia Code of State Rules, Series 85‑20 (Medical Management Guidelines)

Several sections of the Medical Management Guidelines for workers’ compensation play a central role.

§ 85‑20‑42.1 – General guidelines for knee injuries.
Recognizes that:
"[t]he vast majority of knee injuries result from direct trauma to the joint or are caused by torsional or angulatory forces"
and that they vary in severity. The rule is designed to guide a logical diagnostic and treatment sequence, and it provides that:
- A failure of a presumed knee sprain to show progressive resolution within three weeks warrants orthopedic referral (§ 85‑20‑42.1.a); and
- A presumed diagnosis of a meniscal injury likewise warrants orthopedic consultation (§ 85‑20‑42.1.f).
§ 85‑20‑43 – Knee sprains.
This rule outlines conservative treatment for sprains, including ice, temporary partial weight‑bearing restrictions, and rehabilitative procedures. It also designates surgery as an “inappropriate” treatment for knee sprains (BOR cited § 85‑20‑43b or § 85‑20‑43.2.b.1).
§ 85‑20‑44.1 and § 85‑20‑44.3.b.1 – Meniscal injuries.
Section 44.1 explains that the mechanism of meniscal injury is similar to that of sprains, but with persistent symptoms such as pain, swelling, sensations of “catching or giving way,” and possible locking.
Section 44.3.b.1 states that the appropriate treatment for meniscal injuries includes outpatient arthroscopic meniscectomy or meniscal repair.
§ 85‑20‑44.2.c – Diagnostic testing for meniscal injuries.
Specifies MRI as an appropriate diagnostic test for suspected meniscal tears.
§ 85‑20‑6 – Updating diagnoses (cited in dissent).
Provides that the initial diagnosis often requires updating, and that:
"Changes, additions, and revisions of the injured worker's condition must be reported using the applicable . . . private carrier . . . form[.]"
The dissent relies heavily on this provision to argue that absent such a formal update, the BOR correctly treated the only compensable condition as a sprain.

4. West Virginia Rule of Appellate Procedure 21

Rule 21 authorizes the Supreme Court to dispose of some cases through memorandum decisions, rather than full opinions with syllabus points. Here, the Court expressly found that a Rule 21 memorandum decision reversing the ICA was appropriate. Even so, the decision provides substantive guidance on how Moore and the medical guidelines must be applied.

V. The Court’s Legal Reasoning

A. Recognizing the medial meniscus tear as effectively part of the claim

A threshold question was whether the medial meniscus tear was properly “in the case” at all. Formally, the claim had been held compensable only for a left knee sprain, and the claimant never filed a specific form requesting that “medial meniscus tear (left knee)” be added.

The BOR and ICA, taking a narrow view, treated the claim as only involving a sprain. The majority, however, scrutinized how the claim administrator handled the treatment request.

The Court observed that, from the outset:

Tennant suspected a medial meniscus tear and documented this in his notes;
Conservative treatment for a sprain failed to resolve symptoms;
An MRI—an appropriate diagnostic test for meniscal injury—was authorized and performed, revealing a medial meniscal tear; and
An orthopedic consultation was authorized, at which Dr. Abbott diagnosed an acute medial meniscus tear and recommended arthroscopic surgery.

Crucially, when Dr. Abbott requested surgery, the claim administrator did not deny it purely on the basis that surgery is an inappropriate treatment for a sprain under § 85‑20‑43. Instead, it:

Sought an expert opinion from Dr. Soulsby specifically addressing whether the medial meniscus tear was preexisting and degenerative or causally related to the work incident; and
Denied surgery based on Soulsby’s conclusion that the tear was not work‑related.

From this, the Court drew a strong inference:

"By requesting that Dr. Soulsby opine as to 'whether there is a reasonable probability that degenerative osteoarthritis has caused a pre-existing tear of the medial meniscus,' and then denying left knee arthroscopy based upon Dr. Soulsby's report, the claim administrator clearly treated Dr. Abbott's request for authorization of left knee arthroscopy as a request to add medial meniscus tear of the left knee as a compensable component of petitioner's claim."

In other words, if the administrator truly believed the only compensable condition was a sprain and that no meniscal tear was in play, it could have simply cited § 85‑20‑43’s rule that surgery is “inappropriate” for sprains. There would have been no need to obtain a causation opinion about whether a tear was preexisting or work‑related.

The majority therefore held that the administrator had, in substance, treated the surgery request as an “informal” request to add the meniscal tear as a compensable diagnosis. Given that posture, the BOR was obligated to address whether the tear was compensable—including by applying Moore.

This reasoning is reinforced by the Court’s reliance on Best Buy v. Parrish and Martin, both of which caution against denying claims simply because a particular procedural formality was not followed when the facts and the administrator’s own actions show that a condition is effectively being treated as part of the claim.

B. Applying the Moore presumption to a degenerative meniscal tear

Even if the medial meniscal tear was structurally present before the injury, the critical question under Moore is whether a preexisting, asymptomatic condition became symptomatic and disabling only after the work injury.

The claimant conceded that he had degenerative joint disease, and the MRI described the tear as “degenerative.” For purposes of legal analysis, the petitioner was willing to assume that the tear preexisted the work injury in a structural sense.

The Court focused instead on the symptom timeline:

Before the September 5, 2022 incident, the claimant affirmatively testified he had no left knee “problems,” “symptoms,” or “pain.”
Immediately after twisting and falling, he experienced sharp, burning pain unlike anything before.
The pain and swelling persisted despite conservative measures.
There was no evidence contradicting his claim of pre‑injury asymptomatic status.

This evidence was, in the Court’s view, unrefuted. Further, the mechanism of injury—slipping on a wet surface and twisting the knee—is a classic torsional injury mechanism for a meniscal tear, as recognized by § 85‑20‑42.1.

Thus, even accepting that the tear was “degenerative” and preexisting in historical terms, the Court concluded:

"[T]he unrefuted evidence shows that the meniscus tear was asymptomatic until he fell and twisted his knee at work and since then, he has experienced continuous pain and swelling despite undergoing conservative treatments . . . . [H]is medial meniscus tear of the left knee should be included as a compensable component of his claim, as dictated by Moore."

This is a significant doctrinal clarification:

Simply labeling a condition “degenerative” does not defeat compensability.
If the condition was asymptomatic before the injury and becomes symptomatic only afterwards, it falls squarely within Moore’s presumption.
The presumption may be supported not only by explicit medical testimony but also by the “nature of the accident” and the continuous symptom history.

Although Dr. Soulsby opined that the tear was degenerative and that symptoms would have developed anyway “in the near future,” that opinion does not negate the fact that the symptoms actually did develop immediately after the workplace incident and persisted thereafter. Under Moore, such a sequence raises at least a strong presumption of work‑related causation— one the BOR must confront directly on remand.

C. Using the knee‑injury guidelines as a logical sequence, not a rigid label

The Medical Management Guidelines for knee injuries do not treat “sprain” and “meniscal tear” as watertight compartments. Section 85‑20‑42.1 expressly contemplates that a case may begin as a “presumed sprain” but, if symptoms fail to resolve or if a meniscal injury is suspected, must proceed to orthopedics, advanced imaging, and ultimately more invasive treatment.

In this case:

The injury mechanism—slip and twist—was consistent with both a sprain and a meniscal tear.
The claimant was initially treated under the sprain protocol (ice, restricted weight‑bearing, physical therapy).
When conservative care failed and instability was reported, he was referred for an MRI and orthopedic consultation.
The MRI showed a medial meniscal tear; the orthopedist diagnosed an acute tear and recommended arthroscopic treatment in line with § 85‑20‑44.3.b.1.

The BOR, however, effectively stopped the analysis at step (1), treating the case as a pure “sprain” claim and invoking the guideline that surgery is “inappropriate” for sprains.

The majority held that this approach made the guidelines into a rigid label rather than a “logical sequence for the diagnostic evaluation and treatment of the more complex injuries” (quoting § 85‑20‑42.1). Once the clinical course moved the case out of the “simple sprain” box and into the “probable meniscus tear” pathway, it was improper to deny surgery simply by falling back on the generic sprain rule.

D. Rejecting procedural technicalities, especially for pro se claimants

The majority was plainly troubled by the prospect that the claimant—who was initially self‑represented— would lose access to medically indicated treatment simply because he did not file the correct form to add “medial meniscus tear” to the list of compensable conditions.

The Court saw the BOR’s reliance on this omission as an example of impermissible elevation of form over substance, in tension with:

West Virginia Code § 23‑1‑1(b) (cases to be decided on their merits);
Moore (rejecting hyper‑technical reading of update forms);
Best Buy v. Parrish (recognizing compensability where administrators de facto treated a condition as compensable); and
Martin (warning against denying deserving workers based on procedural niceties).

The Court expressly inferred that the BOR “refused to consider the issue under Moore because petitioner, who was then self‑represented, failed to formally request” addition of the meniscal tear, and declared that “this was error.”

By doing so, the Court sends a clear signal: where the record, the administrator’s conduct, and the medical evidence collectively put a condition in play, administrative tribunals may not avoid addressing it based solely on the absence of a particular form or procedural label, particularly when a claimant lacks counsel.

E. Scope of the remand and unresolved questions

The Court’s disposition is carefully phrased:

It reverses the ICA and remands to the BOR with directions to proceed in accordance with Moore;
At the outset, it also uses the phrase “with directions for entry of an order consistent with our ruling herein,” which strongly suggests that the meniscal tear is to be recognized as compensable.

What remains for the BOR on remand?

Formally addressing compensability of the medial meniscal tear.
Under the Court’s analysis, the BOR must treat the meniscal tear as properly raised and evaluate, under Moore, whether it is a compensable component. The unrefuted evidence of pre‑injury asymptomatic status and continuous post‑injury symptoms, together with the injury mechanism, strongly favors such a finding.
Evaluating whether the employer has rebutted the Moore presumption.
The employer can attempt to rebut the presumption with medical evidence and argument, particularly Dr. Soulsby’s opinion that symptoms would have arisen soon regardless. The BOR will need to decide whether that opinion is sufficient to overcome the presumption.
Reconsidering medical authorization.
If the meniscal tear is held compensable, the earlier rationale—that surgery is “inappropriate” for a sprain—falls away, and the BOR must instead determine whether arthroscopy is reasonable and necessary treatment for the compensable tear, under § 85‑20‑44.3.b.1.

While the majority’s reasoning strongly points toward a conclusion that the tear is compensable and that surgery should be authorized, it stops short of dictating the precise medical authorization decision, instead directing the BOR to apply the correct legal framework.

VI. The Dissent’s Perspective

Justice Ewing, joined by Justice Bunn, offers a sharply different view of the case. The dissent’s key points are:

Strict adherence to the compensable diagnosis of “sprain.”
The dissent emphasizes that:
- The claim was held compensable for left knee sprain;
- The claimant did not protest that initial order; and
- No formal request was ever made to add a medial meniscus tear.
Therefore, in the dissent’s view, the BOR properly applied § 85‑20‑43b to deny surgery as “inappropriate” for the only compensable condition—sprain.
Deference to the BOR under § 23‑5‑12a(b).
The dissent maintains that the BOR’s conclusion is neither clearly erroneous as a factual matter nor legally incorrect. Citing Duff, it argues that the majority effectively reweighs the evidence and supplants the BOR’s role as factfinder, contrary to the statutory standard of review.
Regulatory requirement of formal updates under § 85‑20‑6.
The dissent relies heavily on § 85‑20‑6, which requires that changes or additions to a claimant’s diagnosis “must be reported using the applicable form.” By treating a surgical request as an “informal” request to update the claim, the majority, in the dissent’s view, disregards this mandatory procedure and creates confusion for claim administrators, who are left to guess whether a request relates to an existing compensable condition or an unarticulated new diagnosis.
Narrow reading of Moore.
The dissent distinguishes Moore on two grounds:
- In Moore, the physician did submit an update form that, on its face, referenced treatment notes listing cervical radiculopathy; the problem was a technicality in how the diagnosis was coded. Here, by contrast, the claimant took no steps to request addition of the meniscal tear.
- In Moore, there was clear medical evidence tying the new condition to the work injury; in Comas, by contrast, the only explicit causation opinion on the meniscal tear (from Dr. Soulsby) is that it is not work‑related.
Accordingly, the dissent sees no basis to extend Moore to treat an unrequested diagnosis as compensable.
Reliance on Lucas v. Blue Creek Mining, LLC.
The dissent cites Lucas as confirming that a claimant cannot receive benefits for surgery addressing a meniscal tear when the only compensable condition is a sprain. It views the majority’s decision as inconsistent with this line of cases.

In sum, the dissent sees Comas as a departure from both the statutory standard of review and the regulatory scheme for updating diagnoses, and warns that it will create uncertainty and administrative burdens by encouraging implicit or informal requests for new compensable conditions.

VII. Simplifying Key Legal and Medical Concepts

A. “Compensable condition” vs. “treatment authorization”

In workers’ compensation:

A compensable condition is a specific injury or diagnosis that the administrator has officially recognized as being caused by a workplace incident.
Treatment authorization is the separate decision to approve or deny particular medical procedures or services for that condition.

Normally, treatment must be:

Medically necessary; and
Related to a compensable condition.

Problems arise when medical evidence reveals a different or additional diagnosis (e.g., a meniscal tear) beyond the original one (e.g., a sprain). Administrators typically require a formal request to add the new diagnosis as compensable before approving treatment for that diagnosis. Comas deals with the question: when can a treatment request and the administrator’s own actions suffice to bring the new diagnosis into the claim?

B. Preexisting vs. degenerative vs. work‑related

Many workers have degenerative conditions—wear‑and‑tear changes that develop with age—long before any accident. “Degenerative joint disease” or “degenerative meniscal tear” refers to such age‑related changes.

A condition may be:

Preexisting: it existed before the workplace incident;
Asymptomatic: the worker had no symptoms from it; and
“Lit up” or aggravated by an accident, resulting in symptoms and disability.

Under Moore (and long‑standing compensation principles), a worker can recover when a workplace injury activates or worsens a preexisting condition that was previously asymptomatic. The employer takes the worker as it finds him.

In Comas, the key point is that even if the tear was present before the fall, the fact that it was symptom‑free before the accident and symptomatic afterwards triggers a presumption that the work injury caused the disability.

C. What is a medial meniscus tear and arthroscopy?

The meniscus is a wedge‑shaped piece of cartilage in the knee that cushions and stabilizes the joint. Each knee has two menisci; the medial meniscus is on the inner side.

A medial meniscus tear can occur:

Traumatically (e.g., twisting while the foot is planted); or
Degeneratively (gradual fraying due to wear‑and‑tear).

Symptoms often include:

Pain localized to the inner knee;
Swelling;
Sensation of the knee catching, locking, or giving way.

Arthroscopy is a minimally invasive surgical procedure in which a surgeon inserts a small camera and instruments into the knee through tiny incisions to:

Trim off torn fragments (partial meniscectomy); or
Repair the tear (meniscal repair).

Under § 85‑20‑44.3.b.1, arthroscopic treatment is considered appropriate for certain meniscal injuries, especially when conservative treatment fails.

D. Structure of workers’ compensation adjudication in West Virginia

The pathway of this case illustrates the basic structure:

Claim administrator (private carrier or self‑insured employer):
- Initially decides compensability (which diagnoses are accepted); and
- Authorizes or denies treatment requests.
Workers’ Compensation Board of Review (BOR):
Hears protests to the administrator’s orders, takes evidence, and issues written decisions.
Intermediate Court of Appeals (ICA):
Reviews BOR decisions for legal error and clearly erroneous factual findings.
Supreme Court of Appeals of West Virginia:
Has final review authority; may issue full opinions or memorandum decisions under Rule 21.

E. “Appropriate” vs. “inappropriate” treatment under the guidelines

The medical guidelines distinguish:

“Appropriate” treatment – recommended for a given diagnosis (e.g., ice and physical therapy for sprains; arthroscopy for persistent meniscal tears); and
“Inappropriate” treatment – generally disfavored or not medically justified for that diagnosis.

The BOR’s error, in the majority’s view, was to treat the guidelines as if the diagnosis could never evolve: once “sprain” was stamped on the claim, all later treatment had to be measured solely against the sprain protocol, even when the clinical and diagnostic record demonstrated a meniscal tear. The guidelines, however, are written to allow for diagnostic evolution and escalation when symptoms persist.

VIII. Practical and Doctrinal Impact

A. Impact on claims involving degenerative conditions

Comas reinforces that:

Employers and carriers cannot defeat compensability merely by pointing to MRI language describing a condition as “degenerative.”
If a worker credibly testifies that the joint was asymptomatic before the injury and became symptomatic afterwards, and if the mechanism of injury is consistent with the condition, Moore’s presumption will generally apply.
Medical opinions that a worker “would have developed symptoms anyway” may not be sufficient to rebut the presumption, particularly if the symptoms in fact began immediately after the accident.

As a result, we can expect more successful claims in which a workplace incident “lights up” underlying degenerative pathologies, especially in knees, shoulders, and spines.

B. Impact on procedure: implied addition of compensable conditions

Comas also develops the law on how new diagnoses enter a claim. While regulators expect diagnoses to be updated via formal forms (§ 85‑20‑6), the Court makes clear that:

When the claim administrator itself solicits a causation opinion on a new diagnosis and bases its decisions on that diagnosis, it has effectively treated the diagnosis as part of the claim; and
In that situation, the BOR and courts may not ignore the diagnosis solely because a specific “add diagnosis” form was never filed.

For claimants and their counsel, the decision provides a foothold to argue that medical conditions are in play even without perfect paperwork—particularly where the administrator has ordered diagnostic testing or specialist consultations for the suspected condition.

For claim administrators and employers, the decision suggests a need for:

Clear documentation distinguishing between:
- authorizing diagnostic work “to rule out” conditions; and
- formally recognizing those conditions as compensable; and
Consistency between how conditions are treated in medical management and how they are framed in legal orders.

C. Guidance for the BOR and ICA

The decision conveys two strong messages to the BOR and ICA:

They must engage substantively with all diagnoses and theories of causation evident in the record, even if not perfectly labeled on forms, especially when the administrator has already commissioned opinions about those diagnoses.
They must faithfully apply Moore’s presumption wherever the evidence shows a preexisting, asymptomatic condition becoming symptomatic after a workplace injury.

Failure to do so may be characterized as an error of law rather than a mere factual dispute, limiting the deference normally accorded under § 23‑5‑12a(b).

D. Relationship to Lucas v. Blue Creek Mining

Although not expressly overruled, Lucas is effectively confined to circumstances in which:

No steps were taken—formally or informally—to bring the additional diagnosis into the claim; and
The claim administrator’s and physicians’ conduct do not show that the additional diagnosis was being treated as part of the compensable injury.

In cases like Comas, where the administrator solicited a causation opinion on the very diagnosis at issue, Lucas’s logic cannot be mechanically applied.

E. Policy: balancing anti‑formalism and administrative order

The tension between the majority and dissent reveals a broader policy debate:

Majority’s emphasis: Ensuring substantive justice and access to medically necessary care, especially for pro se claimants, at the cost of some procedural looseness.
Dissent’s emphasis: Maintaining clear procedural rules and deference to administrative fact‑finding, to avoid placing undue burdens and uncertainty on claim administrators.

Future cases may refine the boundary between these approaches: at what point does leniency for procedural imperfections give way to the need for predictable, rule‑based administration? Comas marks a significant step toward substantive fairness in close cases involving degenerative conditions and imperfect documentation.

IX. Conclusion

Comas v. Bass Pro Group, LLC is more than a routine reversal of a treatment denial. It:

Applies and strengthens the Moore presumption that a preexisting, asymptomatic condition which becomes symptomatic only after a compensable injury is presumed to be work‑related;
Recognizes that a request for treatment, combined with the claim administrator’s own actions (seeking causation opinions, authorizing diagnostic tests, etc.), can operate as an implied request to add a diagnosis as a compensable condition;
Reaffirms that workers’ compensation decisions must not be driven by procedural technicalities—especially for self‑represented claimants—but by the substance of the medical and factual record; and
Clarifies that the medical guidelines for knee injuries are to be used as a logical diagnostic and treatment sequence, not as rigid labels that prevent cases from evolving from “sprain” to “meniscal tear” when the evidence warrants.

The case will likely serve as a touchstone in West Virginia for:

Workers with degenerative but previously asymptomatic conditions who suffer traumatic injuries;
Attorneys seeking to expand the scope of compensable conditions beyond the original diagnosis; and
Administrative bodies tasked with balancing formal regulatory requirements against the Legislature’s directive that workers’ compensation cases be decided on their merits.

In that sense, Comas marks an important, if formally “memorandum,” step in the continuing evolution of West Virginia workers’ compensation law toward a system that more fully recognizes the realities of aging workers and the complex medical trajectories of seemingly simple injuries.