Case Title: ELSIE SANCHEZ V. STATE OF WYOMING, el rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION

Citation: 

Docket Number: 

State: wyoming

Court: Wyoming Supreme Court

Date: 2006-05-26T00:00:00Z

Document:
ELSIE SANCHEZ V. STATE OF WYOMING, el rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2006 WY 64134 P.3d 1255Case Number: 05-204Decided: 05/26/2006
APRIL 
TERM, A.D. 2006

 
 
ELSIE 
SANCHEZ,

 
 
Appellant

(Petitioner),

 
 
v.

 
 
STATE OF 
WYOMING, ex rel., WYOMING WORKERS' SAFETY 
AND COMPENSATION DIVISION,

 
 
Appellee

(Respondent).

 
 
Appeal 
from the DistrictCourtofCarbonCounty

 
 

Representing 
Appellant:

Michael 
H. Schilling of Schilling & Winn, P.C., Laramie, Wyoming.

 
 

Representing 
Appellee:

Patrick 
J. Crank, Wyoming Attorney General; John W. Renneisen, Deputy Attorney General; 
Steven R. Czoschke, Senior Assistant Attorney General; and Kristi M. Radosevich, 
Assistant Attorney General.

 
 
Before 
HILL, C.J., and GOLDEN, KITE, VOIGT, and BURKE, 
JJ.

 
 

VOIGT, Justice.

 
 
[¶1]      Elsie Sanchez 
(the claimant) sought workers' compensation benefits alleging that she developed 
thoracic outlet syndrome (TOS) during her employment with Carbon County School 
District #1 (the employer).  The 
Wyoming Workers' Safety and Compensation Division (the Division) denied benefits 
and, after a contested case hearing, the Medical Commission (the Commission) 
determined that the claimant's symptoms were not compensable.  On appeal, the district court affirmed 
the Commission's decision.  We will 
affirm the denial of benefits.

 
 

ISSUES

 
 
[¶2]     1.   Is the Commission's finding that 
the claimant's symptoms were not causally related to her employment supported by 
substantial evidence?

 
 
           
2.   Are the Commission's 
actions arbitrary and capricious?

 
 

FACTS

 
 
[¶3]      The claimant 
started working for the employer as a custodian in 1989, and continued this 
employment until January 30, 2002.  
In October 2001, the claimant began waking up at night with numbness in 
her arms and fingers and noted increasing neck pain, headaches, nausea, and 
general weakness; however, she did not suffer any discrete injury at work that 
triggered these symptoms.  She filed 
a Report of Injury with the Division on December 3, 2001.  The Division determined that the injury 
was work-related and provided workers' compensation benefits through July 11, 
2003.

 
 
[¶4]      On April 10, 
2002, the claimant underwent a discectomy and spinal fusion for "cervical 
spondylotic radiculopathy" and was assigned a 28% whole person impairment 
rating.  She initially reported an 
improvement in her condition, though she continued to have intermittent numbness 
in her hands.  Eventually, the 
claimant saw Dr. Richard Sanders, a TOS specialist, when her headaches and neck 
pain returned and the numbness in her hands increased.  Dr. Sanders came to the conclusion that, 
"[t]o a reasonable degree of medical certainty, [the claimant's] symptoms are 
due to repetitive-stress injury at work."  
He performed an operation to treat the TOS symptoms on the claimant's 
right side on May 29, 2003, and another operation to treat her left side on 
August 19, 2003.

 
 
[¶5]      The claimant 
requested workers' compensation benefits for her TOS treatment, but the Division 
denied the claim because the TOS was "unrelated to the workers compensation 
injury of October 24, 2001 . . . and is not compensable."  After a hearing, the Commission agreed 
with the Division that her symptoms were not causally related to her employment 
and denied the claim.  She appealed 
that decision to the district court, which affirmed the Commission.  This appeal 
followed.

 
 
STANDARD 
OF REVIEW

 
 
[¶6]      When reviewing 
administrative action, we conduct our review as if the appeal had come directly 
from the administrative agency.  Hicks v. State ex rel. Wyo. Workers' Safety 
& Comp. Div., 2005 WY 11, ¶ 16, 105 P.3d 462, 469 (Wyo. 2005).  Our review is limited by Wyo. Stat. Ann. 
§ 16-3-114(c) (LexisNexis 2005), which provides, in pertinent 
part:

 
 
(c)    . . .  The reviewing court 
shall:

. . . 
.

(ii)     Hold unlawful and set 
aside agency action, findings and conclusions found to be:

(A)     Arbitrary, capricious, 
an abuse of discretion or otherwise not in accordance with 
law;

. . .; 
or

(E)     Unsupported by 
substantial evidence in a case reviewed on the record of an agency hearing 
provided by statute.

 
 
[¶7]      The claimant in a 
workers' compensation case bears the burden of proving the elements of the claim 
by a preponderance of the evidence.  
Decker v. State ex rel. Wyo. Med. Comm'n, 
2005 WY 160, ¶ 21, 124 P.3d 686, 693 (Wyo. 2005).  When both parties present evidence, we 
apply the substantial evidence test.  
Id., ¶ 23, 124 P.3d  at 694.  Under the substantial 
evidence test, 

 
 
"we 
examine the entire record to determine whether there is substantial evidence to 
support an agency's findings.  If 
the agency's decision is supported by substantial evidence, we cannot properly 
substitute our judgment for that of the agency and must uphold the findings on 
appeal.  Substantial evidence is 
relevant evidence which a reasonable mind might accept in support of the 
agency's conclusions.  It is more 
than a scintilla of evidence."

 
 

Cramer 
v. State ex rel. Wyo. Workers' Safety & Comp. Div., 2005 
WY 124, ¶ 10, 120 P.3d 668, 671 (Wyo. 2005) (quoting Newman v. State ex rel. Wyo. Workers' Safety 
& Comp. Div., 2002 WY 91, ¶ 12, 49 P.3d 163, 168 (Wyo. 
2002)).

 
 
[¶8]      Even if 
substantial evidence supports an administrative decision, it may still be 
arbitrary and capricious.  Decker, ¶ 24, 124 P.3d  at 694.  "Under the umbrella of arbitrary and 
capricious actions would fall potential mistakes such as inconsistent or 
incomplete findings of fact or any violation of due process."  Padilla v. State ex rel. Wyo. Workers' 
Safety & Comp. Div., 2004 WY 10, ¶ 6, 84 P.3d 960, 962 (Wyo. 2004).  Finally, we review conclusions of law de novo.  Blommel v. State ex rel. Wyo. Dep't of 
Empl., Div. of Workers' Safety & Comp., 2005 WY 128, ¶ 9, 120 P.3d 1013, 
1015 (Wyo. 2005).

 
 

DISCUSSION

 
 
Substantial 
Evidence

 
 
[¶9]      The claimant 
argues that the Commission's decision to deny benefits was not supported by 
substantial evidence.  The 
Commission concluded that "the purported TOS condition treated by Dr. Sanders 
has not been shown to be related to or caused by her employment . . . ."  This conclusion was based on a finding 
that Dr. Sanders did not fully understand the nature of the claimant's 
occupational requirements or her out-of-work activities when he diagnosed her 
with work-related TOS.  The 
Commission further determined that the claimant's job duties did not include 
repetitive motions that trigger TOS.  
The claimant contends that Dr. Sanders' conclusions were based on 
competent evidence, were corroborated by other evidence in the record, and that 
the other evidence in the record did not support the Commission's 
decision.

 
 
[¶10]   When an injury1 arises over time, a claimant's 
burden of proof is enhanced by Wyo. Stat. Ann. § 27-14-603(a) (LexisNexis 
2005).2  Yenne-Tully v. Workers' Safety & Comp. 
Div., Dept. of Empl., 12 P.3d 170, 172 (Wyo. 2000).  In pertinent part, that statute 
reads:

 
 
(a)     The burden of proof in 
contested cases involving injuries which occur over a substantial period of time 
is on the employee to prove by competent medical authority that his claim arose 
out of and in the course of his employment and to prove by a preponderance of 
the evidence that:

(i)      There is a direct 
causal connection between the condition or circumstances under which the work is 
performed and the injury;

(ii)     The injury can be seen 
to have followed as a natural incident of the work as a result of the 
employment;

(iii)    The injury can fairly be 
traced to the employment as a proximate cause;

(iv)     The injury does not 
come from a hazard to which employees would have been equally exposed outside of 
the employment; and

(v)      The injury is 
incidental to the character of the business and not independent of the relation 
of employer and employee.

 
 

Wyo. Stat. 
Ann. § 27-14-603.  Although the 
statute specifically enumerates five elements, "they are closely related because 
each contributes to indicate whether the employment environment caused the 
injury.  Therefore, the same 
evidence will often offer support to several of the elements."  Sinclair Trucking v. Bailey, 848 P.2d 1349, 1353 (Wyo. 1993), overruled on 
other grounds by Newman v. State ex rel. Wyo. Workers' Safety & Comp. 
Div., 2002 WY 91, ¶ 24, 49 P.3d 163, 172 (Wyo. 2002).  See also Baxter v. Sinclair Oil Corp., 2004 WY 
138, ¶ 14, 100 P.3d 427, 432 (Wyo. 2004) (reaffirming the Sinclair Trucking analysis of § 
27-14-603).  The test under § 
27-14-603(a) is whether a claimant has shown "a causal connection between the 
injury and the employment."  Sinclair Trucking, 848 P.2d  at 
1352.  A "causal connection exists 
when there is a nexus between the injury and some condition, activity, 
environment or requirement of the employment." Id.  The Commission held that no such 
connection was proven by the claimant and, therefore, determined that her TOS 
was not compensable.  That decision 
is supported by substantial evidence.  

 
 
[¶11]   The claimant presented Dr. Sanders' 
testimony and argued that the Commission should take guidance from Colorado's rules when 
evaluating a TOS claim.  Under the 
Colorado rules 
that were submitted by the claimant, TOS

 
 
is felt 
to be a neurovascular disorder affecting the upper extremity which, on rare 
occasions, is caused by workplace factors, such as jobs that require repetitive 
activities of the upper extremities.  
It should be emphasized that occupational TOS is a relatively uncommon 
disorder and other disorders with similar symptomatology need to be ruled 
out.

 
 
. . . . 

 
 
The 
majority of occupations resulting in TOS are probably related to tasks requiring 
repetitive activities and awkward postures.  Although little published literature 
exists regarding TOS as an occupational disorder, at-risk occupations include 
workers on assembly lines with repetitive head motions and keyboard work (e.g. 
typewriter, computer, adding machine).  
A common factor in the development of TOS in these occupations is that 
the workers' hands are fixed to a keyboard or machine.  When attempting to talk to others in the 
work area or talk on the telephone, or when looking from copy to monitor to 
keyboard, in a suboptimal ergonomic worksite.  The worker must extend his/her neck in 
various directions in order to keep the hands in a fixed position.  When working on an assembly line, the 
worker must look up or down for the next item.  The result probably is small neck 
traumata which eventually lead to scalene muscle stretching, fibrosis, and nerve 
compression, since the nerves of the brachial plexus are normally in contact 
with these muscle fibers.

 
 
Dr. 
Sanders testified that he had been involved in creating the Colorado rules and that 
he was experienced in diagnosing and treating TOS.  He stated that TOS generally developed 
in one of three ways: (1) a patient could experience a "whiplash" type of 
injury, often from automobile accidents; (2) a patient could fall, or otherwise 
strain his/her body "where the neck gets jerked or a person lands on their 
shoulder"; and (3) "repetitive stress" can cause TOS without any sudden injury, 
as when a worker is "doing data entry all day long."  Dr. Sanders ultimately concluded that 
"[t]o a reasonable degree of medical certainty, [the claimant's] symptoms are 
due to repetition stress injury at work" and her symptoms arose from strain to 
her neck caused by "moving chairs, tables, garbage cans, dumping garbage cans"  
activities that could involve lifting between 50 and 70 pounds.  The Commission found that Dr. Sanders' 
conclusion could not be relied upon because he had not inquired sufficiently 
into the claimant's job duties, the frequency of heavy lifting, or into her 
non-work-related leisure activities that could have caused her symptoms.  Instead, the Commission found the 
testimony of Dr. Marc Treihaft to be credible, which testimony indicated that 
the claimant's physical infirmities were not work-related.

 
 
[¶12]   When faced with deciding between 
the conclusions of two medical experts, the fact-finder must consider: (1) the 
opinion given; (2) the reasons for the opinion; (3) the strength of the opinion; 
and (4) the qualifications and credibility of the individual giving it.  Thornberg v. State ex rel. Wyo. Workers' 
Comp. Div., 913 P.2d 863, 868 (Wyo. 1996), as modified on denial of reh'g (Apr. 29, 
1996).  We generally defer to the 
fact-finder's determinations of credibility and the weight to be given to 
conflicting evidence.  Id. at 
869.

 
 
[¶13]   Dr. Sanders testified that in 90% 
of his cases, TOS is caused by either a "whiplash" injury, a fall, or other 
distinct injury "where the neck gets jerked or a person lands on their 
shoulder."  In the instant case, the 
claimant has never alleged that she suffered such a workplace injury; instead, 
Dr. Sanders stated that the claimant's TOS fell into the third category  
workers with "repetitive stress" injuries.  

 
 
[¶14]   Dr. Sanders examined the claimant 
one time before he diagnosed her injury as work-related and recommended surgery 
to treat her TOS.  According to Dr. 
Sanders, the claimant developed TOS from repetitive stress because she was 
"lifting barrels of 50 pounds and sometimes up to 70 pounds, you tend to throw 
your neck back to give you a little aid in lifting, and this was probably the 
mechanism . . . ."  However, he 
admitted that, while examining the claimant, he did not inquire into any of her 
non-occupational pursuits that may have caused TOS, even though such an inquiry 
was required under the Colorado rules that he assisted in 
drafting.  Regarding the claimant's 
job duties, Dr. Sanders gave the following answers to questions posed by counsel 
for the Division:

 
 
Q.   And how many times per day was [the 
claimant] lifting 50 to 70 pounds?

A.   I didn't ask her specifically how 
many times, but I gathered it was several times when she would come in to clean 
up and empty the various gallons into a dumpster.

Q.   Okay.  How did you gather that?  What specifically did she tell you that 
led you to believe that?

A.   She told me that she worked for a 
few hours doing this.

Q.   Worked for a few hours doing 
what?

A.   Cleaning, 
lifting.

Q.   I'm - -

A.   I don't have specific details to 
tell you how many times she was doing this a day.

Q.   Okay.  And that's, I guess, my question.  You say this was from repetitive 
lifting.  I'm wondering what 
information you have to suggest she lifted these things more than once per shift 
or once per week.

A.   Well, she told me [she] was 
cleaning up a lunchroom.  And I 
didn't ask her how many tables or chairs there were in the lunchroom.  But if she's cleaning up a lunchroom in 
a school, I imagine that she was lifting several chairs, several tables, and had 
certainly more than one or two garbage barrels to empty. 

Q.   Okay.  Would you agree that that's speculation 
on your part, because you haven't seen the lunchroom?

A.   I would 
agree.

Q.   Okay.  And specifically you didn't question her 
further about the repetitiveness of this type of work; you just took it that a 
janitor did this type of work and it must have been repetitive.  Is that a fair 
statement?

A.   Yes.

 
 
Based on 
this evidence, the Commission could properly conclude that Dr. Sanders lacked 
vital information to support his opinion and, therefore, the reasons for the 
opinion and the strength of the opinion were lacking in 
foundation.

 
 
[¶15]   In contrast, Dr. Treihaft, another 
physician who assisted in developing Colorado's TOS rules, reviewed the 
claimant's records and came to the conclusion that

 
 
[t]he 
patient's initial symptoms of severe neck pain and headaches do not appear to be 
work-related.  There was no obvious 
injury and these symptoms are not attributable to repetitive motion.  The numbness in her hands may have been 
related to a carpal tunnel syndrome undetected by the electrophysiologic 
studies.  The work-relatedness of 
her hand numbness is also subject to question as the job description does not 
support repetitive motion.

 
 
Addressing 
the question of [TOS], the syndrome may be divided into three groups, vascular 
(arterial and venous), neurogenic, and non-specific or disputed.  Ms. Sanchez' presentation and evaluation 
are inconsistent with the vascular or the true neurogenic 
[TOS].

 
 
. . . 
  I find no convincing evidence 
of [TOS] requiring surgery in this case.

 
 
[¶16]   The Commission did not clearly err 
in agreeing with Dr. Treihaft and determining that Dr. Sanders did not have 
enough information to conclude that the claimant's TOS was work-related.  Dr. Sanders' opinion lacked foundation 
as to the frequency of the claimant's heavy-duty employment obligations and her 
non-work-related activities.3  We also note that the Colorado rules that Drs. 
Sanders and Treihaft assisted in drafting emphasized "that occupational TOS is a 
relatively uncommon disorder and other disorders with similar symptomatology 
need to be ruled out."  It does not 
appear that Dr. Sanders attempted to rule out similar conditions before 
recommending the claimant for TOS surgery.

 
 
[¶17]   Dr. Treihaft, on the other hand, 
based his opinion on a review of the claimant's entire medical file and 
determined that her symptoms were not indicative of TOS and they did not appear 
to be work-related.  The critical 
distinction between the two experts was that, while Dr. Sanders concluded that 
the claimant's TOS was work-related but lacked the appropriate evidence, Dr. 
Treihaft determined, based on the claimant's entire medical history, that 
evidence did not exist to support a finding of occupational TOS.  While the Commission could have come to 
other conclusions based on the evidence presented, our standard of review 
requires us to accept its conclusions if they are supported by substantial 
evidence.  In this case, it appears 
that a reasonable mind could accept Dr. Treihaft's conclusions and we must, 
therefore, affirm the Commission's findings.  

 
 
Arbitrary 
and Capricious

 
 
[¶18]   The claimant next argues that the 
Commission's decision was otherwise arbitrary and capricious because "there is 
an absence of promulgated legislation, rules, and regulations for determination 
of whether or not [TOS] exists and whether or not it is work related in 
Wyoming."  The claimant further argues 
that

 
 
            
[t]here has been no adoption by Wyoming 
of the Colorado definition of TOS occupations or any 
other definition of TOS occupations.  
There is no definition of repetitive motion anywhere to be found in the 
statutory or administrative provisions of the Wyoming Workers' Compensation 
scheme.  The medical panel creates 
out of whole cloth an extremely narrow concept that in order for an injury to be 
the result of repetitive activities, only occupations with "classic repetitive 
motion" can qualify.  Without any 
objective criteria establishing what constitutes repetitive motion in work, or 
which occupations may be defined as repetitive, the medical panel concludes that 
[the claimant] was not employed in a position that had repetitive motion 
components.

 
 
[¶19]   We have recognized a variety of 
ways in which an agency's actions can be arbitrary and capricious.  See Padilla, ¶ 6, 84 P.3d  at 962 
("inconsistent or incomplete findings of fact or any violation of due 
process");  Hoff v. State ex rel. Wyo. Workers' Safety 
& Comp. Div., 2002 WY 129, ¶ 8, 53 P.3d 107, 110 (Wyo. 2002) ("agency 
action which prejudiced a party's substantial right to the administrative 
proceeding or which might be contrary to the other WAPA review standards"); and 
Newman, ¶ 23, 49 P.3d  at 172 ("the 
agency may have willfully discounted credible evidence, refused to admit certain 
testimony or documentary exhibits, or failed to provide findings of fact or 
conclusions of law").  While we have 
never created an exclusive list of arbitrary and capricious actions, the 
claimant has not attempted to analogize the actions of the Commission or the 
Division to any of our previous case law, and has further failed to demonstrate 
how the absence of "legislation, rules, and regulations" specifically dealing 
with TOS is otherwise arbitrary and capricious.  Because the claimant's argument is not 
supported by citation to pertinent authority and merely references the 
claimant's closing argument, but not factual evidence contained in the record, 
it must fail.  Hicks, ¶ 25, 105 P.3d  at 472.  

 
 

CONCLUSION

 
 
[¶20]   The Commission's conclusion that 
the claimant's TOS was not causally related to her employment is supported by 
substantial evidence.  Further, the 
claimant has not demonstrated that the Commission's decision was otherwise 
arbitrary and capricious.

 
 
[¶21]   Affirmed.

 
 
FOOTNOTES

 
 

1The 
Worker's Compensation Act defines "injury" as: 

 
 
"Injury" 
means any harmful change in the human organism other than normal aging and 
includes damage to or loss of any artificial replacement and death, arising out 
of and in the course of employment while at work in or about the premises 
occupied, used or controlled by the employer and incurred while at work in 
places where the employer's business requires an employee's presence and which 
subjects the employee to extrahazardous duties incident to the business.  "Injury" does not 
include:

. . . 
.

(F) Any 
injury or condition preexisting at the time of employment with the employer 
against whom a claim is made;

(G) Any 
injury resulting primarily from the natural aging process or from the normal 
activities of day-to-day living, as established by medical evidence supported by 
objective findings[.]

 
 
Wyo. 
Stat. Ann. § 27-14-102(a)(xi) (LexisNexis 2005).

 
 

2In her 
brief, the claimant initially argues that her TOS "is factually a second 
compensable injury.'  As such, the 
enhanced burden of proof under W.S. § 27-14-603(a) should not have been applied 
to the Appellant by the medical panel."  
The claimant, however, concludes this argument by stating that she "does 
not appeal the non-application of the second compensable injury rule."  The remainder of the claimant's 
appellate argument analyzes her claim under Wyo. Stat. Ann. § 27-14-603(a).  Consequently, we will also restrict our 
review to that analysis.

 
 

3The 
claimant correctly points out that she presented testimony regarding the amount 
and frequency of lifting she did during the course of her employment and also 
regarding her lack of high-risk leisure activities.  However, when weighing the opinions of 
the experts in this case, the Commission could still discount Dr. Sanders' 
opinion because it lacked foundation when Dr. Sanders examined the claimant and 
scheduled her for surgery.