Pain as Symptom, Not Compensable Condition: Delsignore v. Timberline Logging Enterprises Precedent

Introduction

In John J. Delsignore v. Timberline Logging Enterprises, LLC, the Supreme Court of Appeals of West Virginia clarified two critical points in the context of workers’ compensation claims:

1. “Pain” standing alone is a symptom, not an independent compensable condition.
2. Agreement on treatment modalities does not necessarily equate to concurrence on specific diagnoses.

The case arose from a 2021 industrial accident in which Mr. Delsignore, while employed as a tree feller, suffered a displaced trimalleolar fracture and related injuries. After initial surgery and compensable findings for the fracture and pelvic contusion, Mr. Delsignore sought to expand his claim to include post-traumatic subtalar joint arthritis of the right ankle, left hip joint pain, and low back pain with left-sided sciatica. The claim administrator, the West Virginia Workers’ Compensation Board of Review (“Board”), and the Intermediate Court of Appeals (“ICA”) all denied those additions. On May 2, 2025, the Supreme Court affirmed, producing a memorandum decision under Rule 21 of the Rules of Appellate Procedure.

Summary of the Judgment

The Supreme Court held 5–0 that:

• There was insufficient medical evidence to support post-traumatic arthritis of the right ankle as a diagnosable, compensable condition;
• Pain-based labels—“left hip joint pain” and “low back pain with left-sided sciatica”—cannot be added to a workers’ compensation claim because “pain is a symptom, not a diagnosis”;
• Concurrence on a treatment recommendation (e.g., orthotic brace) does not create an implicit agreement on every underlying diagnosis;
• No statutory presumption aided Mr. Delsignore’s request, as causation was not genuinely disputed and the evidence weighed against finding new compensable conditions.

Accordingly, the ICA’s and Board’s decisions were affirmed.

Analysis

Precedents Cited

• Harpold v. City of Charleston, No. 18-0730 (W. Va. Apr. 25, 2019): reaffirmed that “pain is a symptom, not a diagnosis.”
• Whitt v. US Trinity Energy Servs., LLC, No. 20-0732 (W. Va. Feb. 25, 2022): similarly excluded pain-based conditions as non-diagnoses.
• Pripich v. State Compensation Commissioner, 112 W. Va. 540, 166 S.E. 4 (1932): established the presumption favoring employees when causation is in conflict.
• Moore v. ICG Tygart Valley, LLC, 247 W. Va. 292, 879 S.E.2d 779 (2022): set out factors for presuming causation from asymptomatic pre-existing disease to post-injury symptom onset.
• Numerous memorandum decisions (e.g., Miller, Mills, Williams, Radford) have consistently held that symptom-only labels (myalgia, dorsalgia, arthralgia) cannot form compensable conditions.

Legal Reasoning

The Court applied the following principles:

1. De Novo Review of Law; Clear Error for Facts. Under W. Va. Code § 23-5-12a(b) and Duff v. Kanawha Cnty. Comm’n, legal questions are reviewed de novo, factual findings only for clear error.
2. Preponderance Standard. The Board weighed medical and lay evidence under the “preponderance of the evidence” standard and found it favored denial of the requested diagnoses.
3. Symptom vs. Diagnosis Distinction. Citing Harpold and Whitt, the Court reiterated that labeling “pain” by location (hip, sciatica) does not convert it into a discrete injury or disease.
4. Medical Evidence Requirements. For post-traumatic arthritis, the absence of radiographic confirmation and expert opinion rejecting early-onset arthritis (Dr. Martin) proved dispositive.
5. Statutory Presumptions Inapposite. Neither W. Va. Code § 23-4-1g(a) (tie-breaker presumption in claimant’s favor) nor the causation presumption from Pripich/Moore applied because there was no genuine conflict on causation and the record simply lacked a valid diagnosis.

Impact

This decision consolidates and clarifies several strands of West Virginia workers’ compensation jurisprudence:

• It reaffirms that claim amendments must be supported by objective findings—e.g., radiographs or unequivocal surgical/clinical diagnosis—rather than subjective symptoms alone.
• It warns practitioners and claimants that treatment agreement (e.g., use of braces or orthotics) cannot be stretched to imply agreement on every possible diagnosis that might warrant that treatment.
• It confines the application of statutory presumptions to their intended circumstances—where causation or diagnosis is genuinely in dispute—not to cases where the claimant simply lacks evidence to establish a new compensable condition.
• It will guide lower tribunals to carefully differentiate between “symptoms” (which may support a diagnosis) and “diagnoses” (which alone can form the basis for compensability).

Complex Concepts Simplified

• Compensable Condition: A medically recognized injury or disease that arises from and during employment, eligible for benefits.
• Symptom vs. Diagnosis: A symptom (e.g., “pain,” “weakness”) is what the patient experiences; a diagnosis (e.g., “post-traumatic arthritis”) is the medically identified disorder causing those symptoms.
• Independent Medical Evaluation (IME): An examination by a physician not previously involved in the claimant’s care, used to obtain an unbiased assessment.
• Maximum Medical Improvement (MMI): The point at which a patient’s condition is expected to stabilize, with no further significant functional recovery anticipated.
• Preponderance of the Evidence: The standard of proof meaning “more likely than not” (>50% probability).

Conclusion

Delsignore v. Timberline Logging Enterprises cements the principle that “pain” alone cannot constitute a compensable workers’ compensation condition in West Virginia. It underscores the necessity of objective medical findings to substantiate each claimed diagnosis. Additionally, it clarifies that concurrence on treatment modalities does not amount to wholesale agreement on underlying diagnoses. Going forward, claimants and employers alike must ensure that any expansion of compensable conditions be grounded in clear diagnostic criteria—radiographic evidence, specialist opinions, or analogous medical proof—rather than mere symptomatic complaints.