In Miracle v. Workers' Compensation Commissioner, 181 W. Va. 443, 383 S.E.2d 75 (1989), the 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). 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. The Miracle Court also discussed Dunlap v. State Compensation Director, 149 W. Va. 266, 140 S.E.2d 448 (1965), but concluded that the case was not helpful as it focused on whether a PTD award should be offset by any Temporary Total Disability benefits received. In Miracle, the Court accepted the date of the medical report as the date of PTD onset. However, there were only four days between the report and the examination it described. In accepting the date of the report as the onset of PTD, we specifically acknowledged that "the Commissioner chose the date of Dr. Fordham's report, which was January 20, 1987. While technically the more correct date would be January 16, 1987, the date of the examination, we do not consider this to be a significant difference." Miracle, 181 W. Va. at 446, 383 S.E.2d at 78. The claimant in Miracle sought a ruling that his PTD had commenced approximately fourteen years earlier.