Case Title: IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF ROBERT NAGLE, JR.: ROBERT NAGLE, JR. V. STATE OF WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION

Citation: 

Docket Number: S-07-0222

State: wyoming

Court: Wyoming Supreme Court

Date: 2008-05-19T00:00:00Z

Document:
IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF ROBERT NAGLE, JR.: ROBERT NAGLE, JR. V. STATE OF WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2008 WY 99190 P.3d 159Case Number: S-07-0222Decided: 05/19/2008
APRIL 
TERM, A.D. 2008

 
 
IN 
THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF ROBERT NAGLE, JR.: ROBERT 
NAGLE, JR.Appellant,(Employee/Claimant),v.STATE OF 
WYOMING, ex rel., WYOMING WORKERS' SAFETY 
AND COMPENSATION 
DIVISION,Appellee(Respondent).

 
 
Appeal 
from the DistrictCourtofCampbellCounty

The 
Honorable Michael N. Deegan, Judge

 
 

Representing 
Appellant:

Sean 
W. Scoggin of Tiedeken & Scoggin, P.C., Cheyenne, Wyoming.

 
 

Representing 
Appellee:

Bruce 
A. Salzburg, Wyoming Attorney General; John W. Renneisen, Deputy Attorney 
General; Steven R. Czoschke, Senior Assistant Attorney General; and Kristi M. 
Radosevich, Senior Assistant Attorney General.

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

 
 

HILL, 
Justice.

 
 
[¶1]      On January 5, 
1987, Appellant, Robert Nagle, Jr. (Nagle), suffered an open fracture, 
dislocation and crush injury to the first, second, and fourth metatarsals of his 
left foot.  Since then, he has 
continued to experience worsening medical complications, which he claims can be 
traced to that injury.  Over the 
course of the intervening years, Nagle received worker's compensation benefits 
for the treatment associated with these ongoing problems.  In 2003, he sought an award of permanent 
total disability benefits.  By 
letter dated April 22, 2003, the Wyoming Workers' Safety and Compensation 
Division (Division) denied his claim for permanent total disability 
benefits.  Nagle also sought 
benefits for a "second compensable injury" that occurred when he fell in a 
parking lot and injured his wrist and hip.  
His claim is that his left foot and leg "gave out," causing him to 
fall.  The Division denied that 
claim as well.  Nagle objected to 
both determinations and requested a hearing.

 
 
[¶2]      A hearing 
concerning both issues was held before the Medical Commission on February 8, 
2006, and it denied relief to Nagle in an order dated May 22, 2006.  On June 8, 2006, Nagle filed a petition 
for review in the district court.  
In a decision letter filed of record on August 3, 2007, the district 
court affirmed the Medical Commission.  
Nagle timely filed his notice of appeal to this Court on September 4, 
2007.  After briefing and assignment 
to the Court's expedited docket, the case was taken under advisement by this 
Court on February 5, 2008.

 
 
[¶3]      In this appeal, 
Nagle contends that the Medical Commission's decision was arbitrary, capricious, 
and not supported by standing case law, or by substantial evidence presented at 
the hearing.  Because there is not 
substantial evidence to sustain the Medical Commission's determination, we will 
reverse the district court's order affirming the Medical Commission and remand 
this matter to the district court with directions that it further remand the 
case to the Medical Commission with directions that it award permanent total 
disability benefits to Nagle.  In 
addition, it shall direct the Medical Commission to order that Nagle be paid 
benefits for the injuries he suffered to his wrist and hip when he fell in 2001, 
which were caused by the gait/walking instability associated with his mutilated 
left foot.

 
 
ISSUES

 
 
[¶4]      Nagle raises 
these issues:

 
 
I.          
Whether the Medical Commission's decision that Mr. Nagle was not entitled 
to permanent total disability benefits was arbitrary and capricious and not 
supported by the standing case law.

 
 
II.         
Whether the Medical Commission's decision that Mr. Nagle's medical 
treatment for his wrist and hip was arbitrary and capricious and not supported 
by the substantial evidence presented at the hearing.

 
 
The 
Division responded:

 
 
I.          
Whether the Medical Commission Hearing Panel's determination, that Mr. 
Nagle failed to prove his entitlement to permanent total disability benefits, 
was arbitrary or capricious?

 
 
II.         
Whether the Medical Commission Hearing Panel's determination, that Mr. 
Nagle failed to prove the relatedness between his 1987 left foot injury and his 
recent wrist and hip injuries, was arbitrary or 
capricious?

 
 
FACTS 
AND PROCEEDINGS

 
 
[¶5]      We noted above 
that Nagle injured his left foot on January 5, 1987.  Treatment of the injury required five 
surgical procedures that took place between January 7, 1987, and February 12, 
1993.  He continues to receive 
treatment for that injury until this day, and that treatment is paid for by the 
Division.  Nagle received temporary 
total disability benefits for approximately a year after the injury.  He was able to return to light duty work 
and was employed intermittently from 1988 until 2001.  He was on sick leave for a year after 
that and in 2002, he retired on Medicare/Social Security disability and has not 
returned to employment since that time.

 
 
[¶6]      Wyo. Stat. Ann. § 
27-14-102(a)(xvi) (LexisNexis 2007) defines "permanent total disability:"  "Permanent total disability' means the 
loss of use of the body as a whole or any permanent injury certified under W.S. 
27-14-406, which permanently incapacitates the employee from performing work at 
any gainful occupation for which he is reasonably suited by experience or 
training[.]"  Wyo. Stat. Ann. § 
27-14-406 (LexisNexis 2007) provides:

 
 
(a)  Subject 
to W.S. 27-14-602, upon certification by a physician licensed to practice 
surgery or medicine that an injury results in permanent total disability as 
defined under W.S. 27-14-102(a)(xvi), an injured employee shall receive for 
eighty (80) months a monthly payment as provided by W.S. 27-14-403(c) less any 
previous awards under W.S. 27-14-405 which were involved in the determination of 
permanent total disability, and dependent children shall receive an award as 
provided by W.S. 27-14-403(b).  The 
monthly payment amount computed under W.S. 27-14-403(c) and any amount awarded 
under W.S. 27-14-408 shall constitute the exclusive benefit for both the 
physical impairment and the economic loss resulting from an injury, including 
loss of earnings, extra expenses associated with the injury and vocational 
rehabilitation.  An employee shall 
not receive benefits under this section if receiving benefits under W.S. 
27-14-404 or 27-14-405.

 
 
            
(b)  This section specifies the length of time amounts computed 
pursuant to W.S. 27-14-403(c) are to be awarded and except for amounts awarded 
under W.S. 27-14-408, shall not be construed to allow awards in excess of the 
amounts computed pursuant to W.S. 27-14-403(c).

 
 
            
(c)  Any objection to a final determination pursuant to this 
section shall be referred to the medical commission for hearing by a medical 
hearing panel acting as hearing examiner pursuant to W.S. 
27-14-616.

 
 
[¶7]      The only person 
who testified at the hearing on this matter was Mr. Nagle.  In this regard, we must keep in mind our 
rule that the testimony of an injured worker alone is sufficient to prove an 
accident if there is nothing to impeach or discredit the worker's testimony, and 
the worker's statements are corroborated by surrounding circumstances.  Moreover, the occurrence of injuries 
resulting from accidents to which there are no eye-witnesses does not prevent 
fair inferences from being drawn and findings of facts from being made.  Ikenberry v. State ex rel. Wyoming Workers' 
Compensation Division, 5 P.3d 799, 803 (Wyo. 2000).  This most directly applies to Nagle's 
contention that it was the disabled condition of his left foot and leg that 
caused him to stumble and fall, injuring his wrist and hip, but it also applies 
to his permanent total disability claim.  
In this regard, we are also called upon to consider Nagle's fall in light 
of the second compensable injury rule.  
Alvarez v. State ex rel. Workers' 
Safety and Compensation Division, 2007 WY 126, ¶¶ 18-28, 164 P.3d 548, 
552-55 (Wyo. 2007).

 
 
[¶8]      Mr. Nagle was 50 
years of age in 2006, and his educational attainment was a high school diploma 
(and a few college courses before 1974).  
In 2003 he took a pre-English class because he was not very good in 
English, but had not done anything since to follow up on that.  Nagle also took some courses (six or 
eight classes) after his injury, through a junior college, to try to develop 
"something to fall back on."  Nagle 
lived in Newcastle until age 12, graduated from a 
New Mexico high school in 1974, and returned to 
live in Wyoming in 1977.  He has lived and worked in or around 
Newcastle since 
then.  In 1978 he began working in a 
coal mine and continued that work for 24 years, until he was no longer able to 
do the tasks required of him in his line of work because of his 
injury.

 
 
[¶9]      Nagle related the 
extent of his injuries and the course of treatment over the years 1987-2002, in 
detail, but we will not include that material here because it does not affect 
any of the issues raised in the appeal.  
Suffice it to say that the gist of Nagle's testimony was that by 2002, he 
was totally disabled.  Nagle drove 
from Newcastle to Cheyenne for the hearing in this case, but was 
not driving back home that same day. Mr. Nagle lives alone.  In 2002, he went on Social Security 
disability.  In addition to the 
disabling injury to his foot, Nagle has a "flutter" in his heart for which he 
takes medication, but that condition imposes no restrictions on his ability to 
function on a day-to-day basis.

 
 
[¶10]   Although the record is not clear as 
to the exact date when the event occurred, Nagle fell in the parking lot of a 
Wal-Mart store when "his leg gave out" because he had walked too much (probably 
just before Christmas in 2001).  He 
injured himself generally in the fall, but most specifically, he broke his wrist 
which eventually required surgical treatment.  He sought treatment in Newcastle at that time, 
but no perceptible injury was diagnosed.  
However, when he continued to experience pain in his wrist and hip, he 
sought treatment from John Barrasso, M.D., a Casper orthopedic surgeon.  Dr. Barrasso provided treatment for 
Nagle beginning immediately following his 1987 injury and until the time of the 
hearing on this matter.  Nagle 
reported that he had no problems with his wrist prior to that 
fall.

 
 
DISCUSSION

 
 
Permanent 
Total Disability under the Odd Lot Doctrine

 
 
[¶11]   This case involves issues which we 
have considered with some frequency in recent years.  We will apply our recently revised 
standard of review in order that the result in this case may be conformed to the 
governing statutes, the relevant facts, and the applicable case law.  Dale v. S&S Builders, LLC, 2008 WY 
84, ¶¶ 8-27, 188 P.3d 554, 557-562 (Wyo. 2008).  In addition, we are called upon to 
review this case in light of the odd lot doctrine:

 
 
 This 
court has long recognized the odd lot doctrine with respect to permanent total 
disability determinations made within the purview of the Wyoming Worker's 
Compensation Act.  In the case of Schepanovich v. United States Steel 
Corp., 669 P.2d 522, 525 (Wyo.1983) this court stated:

 
 
      In our opinion in 
Cardin v. Morrison-Knudsen, 
Wyo., 603 P.2d 862 (1979), this court adopted a 
definition of the "odd-lot doctrine" as 
follows:

 
 
"... 
The odd-lot doctrine' is described in 2 Larson, Law of Workmen's Compensation, 
§ 57.51 at p. 10-109 (1976), as providing that permanent total disability 'may 
be found in the case of workers who, while not altogether incapacitated for 
work, are so handicapped that they will not be employed regularly in any well 
known branch of the labor market.' "  
603 P.2d  at 863-864.

 
 
      An injured 
workman who comes within the "odd-lot doctrine" need not show that he is totally 
incapable of doing any work at all in order to be entitled to an award for 
permanent total disability.  E.R. Moore Co. v. Industrial Commission, 
71 Ill. 2d 353, 17 Ill.Dec. 207, 376 N.E.2d 206 (1978); Wilson v. Weyerhaeuser Company, 30 Or.App. 
403, 567 P.2d 567 (1977); and 2 Larson, Workmen's Compensation Law, § 57.51, at 
10-164.21 (1982).  This court has 
stated the proposition in this fashion:

 
 
            
"... The theory of counsel for the employer appears to be that the 
workman must go further than to show that he cannot do any hard work; that he 
must also show that he cannot do light work.  Of course, it would almost be 
impossible, in many instances, for a man educated only to do hard work, to show 
that at some time or other some good Samaritan might not turn up and offer him 
some light work which he might be able to do.  The law does not require 
impossibilities.  It is stated in 71 
C.J. 1071 that where it is found that the employee is permanently and totally 
disabled so far as hard or manual work is concerned, but that he might do light 
work of a special nature not generally available, the burden is on the employer 
to show that such special work is available to the employee.' ..." In re Iles, 56 Wyo. 443, 452, 110 P.2d 826 (1941).

 
 
            
This court went on further to enunciate in Schepanovich, at 
528:

 
 
The 
burden of proof initially is assigned to the injured workman who is seeking to 
qualify as permanently totally disabled under the "odd-lot doctrine" to 
demonstrate that he is incapacitated "from performing any work at any gainful 
occupation for which he is reasonably suited by experience and training."   Section 27-12-405(a), W.S.1977; Cardin v. Morrison-Knudsen, supra.   The test to be invoked is whether 
the workman is so disabled that the services which he is reasonably equipped to 
perform by his experience and training are not marketable in a well-known branch 
of the labor market in the community so as to provide a steady and continuous 
source of income rather than sporadic or intermittent employment.  See 2 Larson, Workmen's Compensation 
Law, § 57.51 (1982).  If that 
showing is made, the burden of proof is then shifted to the employer to show 
that light work of a special nature which the employee could perform but which 
is not generally available in fact is available to the employee.  In re Iles, supra; Cardin v. Morrison Knudsen, 
supra.

 
 
            
Finally, this court adopted the following rule formulated in 2 Larson, Workmen's Compensation Law, § 57.61, at 
10-164.95 to 1-164.114 (1982) through its opinion in Schepanovich, at 
528-29:

 
 
"... 
If the evidence of degree of obvious physical impairment, coupled with other 
facts such as the claimant's mental capacity, education, training, or age, 
places claimant prima facie in the odd-lot category, the burden should be on the 
employer to show that some kind of suitable work is regularly and continuously 
available to the claimant.  
Certainly in such a case it should not be enough to show that claimant is 
physically capable of performing light work, and then round out the case for 
noncompensability by adding a presumption that light work is 
available....

 
 
            
"The corollary of the general-purpose principle just stated would be 
this:  If the claimant's medical 
impairment is so limited or specialized in nature that he is not obviously 
unemployable or relegated to the odd-lot category, it is not unreasonable to 
place the burden of proof on him to establish unavailability of work to a person 
in his circumstances, which normally would require a showing that he has made 
reasonable efforts to secure suitable employment...."

 
 
Other 
jurisdictions in this context have held that an employee in circumstances 
similar to those of the appellant must show that reasonable efforts have been 
made to obtain suitable employment in order to meet their burden of proof and 
shift the burden of proof to the employer.  
Wiedmaier v. Industrial 
Commission, 121 Ariz. 127, 589 P.2d 1 
(1978); Oliver v. Wyandotte Industries 
Corporation, Me., 360 A.2d 144 (1976); Marez v. Kerr-McGee Nuclear Corporation, 
93 N.M. 9, 597 P.2d 1178 (1978) (Sutin, J., specially concurring); Haines v. State Accident Insurance Fund, 
27 Or.App. 793, 558 P.2d 367 (1976);  
Shealy v. Algernon Blair, 
Inc., 250 S.C. 106, 156 S.E.2d 646 (1967).  See also cases cited in 2 Larson, Workmen's Compensation Law, § 57.61 at 
10-164.114, n. 29 (1982).

 
 
. 
. . .

 
 
            
In § 27-14-102(a)(xvi) (Lexis 1999) there appears a definition of 
permanent total disability, which reads as follows:

 
 
(a) 
"Permanent total disability" means the loss of use of the body as a whole or any 
permanent injury certified under W.S. 27-14-406, which permanently incapacitates 
the employee from performing work at any gainful occupation for which he is 
reasonably suited by experience or training.  

 
 
The 
claim of Vaughan 
that he is totally disabled is presented under the phrase relating to a 
condition which "permanently incapacitates the employee from performing work at 
any gainful occupation for which he is reasonably suited by experience or 
training."  It is of significance 
that the legislature specifically used the words "gainful occupation" in this 
definition which suggests its concurrence with those policy considerations 
utilized previously by this court in support of the adoption of the odd lot 
doctrine.  In fact, this court has 
previously recognized the statutory definition for permanent total disability is 
consistent with the odd lot doctrine.  
Gilstrap v. State ex rel. Workers' 
Compensation Div., 875 P.2d 1272, 1274 (Wyo.1994) (citing City of Casper v. Bowdish, 713 P.2d 763, 
765 (Wyo.1986) and Cardin v. 
Morrison-Knudsen, 603 P.2d 862, 863-64 (Wyo.1979)).

 
 

Vaughn 
v. State ex rel. Workers' Compensation Division, 2002 WY 131, ¶¶ 8-12, 53 P.3d 559, 
562-63 (Wyo. 2002).

 
 
[¶12]   Nagle filed two separate claims, 
one for permanent total disability and a second for benefits associated with his 
second compensable injury (the fall in the Wal-Mart parking lot).  Eventually, both cases were referred to 
the Medical Commission.  The 
Division's rules specifically provide that cases involving whether a claimant is 
permanently totally disabled should be assigned to the Medical Commission (see 
Chapter 6, Section 1(a)(i)(B)), and the governing statute requires 
it.

 
 
[¶13]   A significant problem in this case 
is that the Medical Commission did not look at this case under the strictures of 
the odd lot doctrine as presented in the applicable case law.  Rather, it took a very narrow view of 
what constitutes "permanent total disability," and, for the most part, 
disregarded Nagle's evidence and the burden of proof that largely fell to the 
Division and the employer.

 
 
[¶14]   The record irrefutably established 
that the degree of Nagle's obvious impairment, coupled with his mental capacity, 
education, training, and age, placed him prima facie in the odd lot 
category.  That being the case, the 
burden of proof shifted to the employer to show that light work of a special 
nature which the employee could perform, but which is not generally available, 
in fact is available to the employee.  
It is the Division that failed in its burden of proof, not 
Nagle.

 
 
[¶15]   While the Medical Commission is 
presumed to have "special expertise" in parsing medical testimony, medical 
records, etc., it also has an obligation to apply its fact-finding expertise in 
a manner that conforms itself to the governing law.  The evidence presented by the Division 
at that hearing did not appear to have been developed in response to the issues 
that are at large in this case, but rather solely to the narrow definition of 
"permanent total disability" without taking into account the odd lot 
doctrine.  The evidence presented by 
Nagle established that he qualified to be considered for permanent total 
disability under the odd lot doctrine.  
The burden then shifted to the Division to present evidence that some 
special work of a light or sedentary nature was actually available to him.  Otherwise, he would qualify as a 
permanently disabled worker under the odd lot doctrine.  The Division failed to do this, and the 
record supports only a conclusion that Nagle is permanently incapacitated from 
performing any work at any gainful occupation for which he was reasonably suited 
by experience and training.

 
 
[¶16]   It was an uncontested underlying 
fact that Nagle received disability benefits from Social Security.  Nagle had worked at a sawmill, in the 
oil fields, and in a coal mine, doing such jobs as laborer, oiler, loader 
operator, panel operator, a lead man, and a blast hole driller.  Contrary to the Medical Commission's 
findings, he did look for work, albeit not in a way that the Commission approved 
of, but in a manner consistent with his experience as a laboring man, i.e., he 
called on employers in person to see if they had work available.  However, as noted above, that finding 
was not relevant to the requirements of the odd lot doctrine because  the burden was on the Division to show 
that there was work available that was suited to Nagle  Nagle did not have to 
demonstrate that he searched for work and could find none (although he did do 
that in his own way).

 
 
[¶17]   Earlier in our discussion, we noted 
that Nagle drove to Cheyenne for the hearing.  That information was elicited from Nagle 
by the attorney for the Division for the apparent purpose of demonstrating that 
Nagle was not permanently and totally disabled.  The Commission noted that fact in its 
findings.  However, we conclude that 
the notation is irrelevant because all we know is that Nagle drove to Cheyenne, 
not how long it took, or how many stops he made, or if he suffered great pain in 
making that drive.  The mere fact 
that he drove to Cheyenne is of no consequence to any issue at 
large in this case.

 
 
[¶18]   The Medical Commission made 
findings that Nagle was able to do sport hunting for the apparent purpose of 
concluding that, if he could hunt, then he was probably able to work.  That finding is not supported by the 
record, because Nagle's unrebutted testimony was that while he rode along with 
friends when they went hunting (those friends also took him for rides in their 
vehicles), he was not able to hunt except with considerable assistance.  In any event, the efforts Nagle made to 
go hunting do not serve to support any of the Medical Commission's ultimate 
conclusions.

 
 
[¶19]   The Division offered no live 
witnesses at the hearing but did provide the Medical Commission with seven 
exhibits.  Exhibit 1 was from an organization 
named "QuickLook" and was commissioned by the Division for the purposes of the 
hearing into Nagle's instant claims.  
It was entitled a "Functional Capacity Evaluation Summary Report."  It contained only bare conclusions with 
no supporting factual information.  
The only real purport of that document was that Nagle's subjective 
reports of pain were not reliable, and objective criteria should be consulted 
and considered more reliable.1  The objective criteria were not included 
with the report, nor did any person who conducted the testing appear at the 
hearing.  The report had a 
hand-written notation on it that looked like this:  "Robert, You have the testing FCE 
Rpt."  Also, the following document 
was attached to that report, apparently inadvertently:

 
 
Robert,

 
 
I 
reviewed all the medical records, briefly and found NOTHING about any bone 
scan.  I did review the FCE and 
attached only those things I wanted you to review.  I am sure you have the complete FCE in 
your files.  He did not put forth 
full effort and stated to the evaluator that his heart beat was slow because he 
had taken his HEART medication.  She 
also stated that he was NOT permanently disabled.  He has had back surgery and he is 50% at 
severe disability, however; this is not WC.  The Pain assessment questionnaire did 
state that he had inappropriate illness behavior by the Waddell's 
test.

 
 
I 
don't know how that will stand up in any hearing but I do know that another 
doctor stated that his foot problems are not coming from his back problems.  It does stand alone, however; the type 
of pain radiating into his buttocks and leg could be from that back pain/surgery 
he had.

 
 
This 
is just a little bit that I could find for you.  If you need additional help, please let 
me know.  I can be reached by email 
much better than by phone .

 
 
Thank 
you for your help,

Josie

 
 
[¶20]   In Paragraph 3 of its findings, the 
Medical Commission accurately notes that Nagle continued to work for his 
employer in occupations for which he was suited by experience or training, in a 
"light duty" capacity for 13 years, until such time as he was no longer able to 
do light duty work.  This is 
confirmed by Nagle's testimony, by the documentation from Dr. Barrasso, and from 
Dr. Barrasso's deposition.

 
 
[¶21]   Exhibit 2, was not pertinent to any 
issue in the case.  Exhibit 3 was a Functional Capacity 
Evaluation prepared by Todd Gentzler, MPT.  
In his 7-page report he concluded:

 
 
The 
above results indicate that Mr. Nagle qualifies to work consistently at the heavy work category; however I do 
think that because of his past medical history, it would be more appropriate to 
keep him in more of the medium category.  I do think he would be able to work with 
modifications at work, such as sitting for some time and standing for some 
period of time and being able to move around in different positions.  The medium classification states that he 
should be able to occasionally lift 50 pound[s], frequently lift 20 pounds and 
constantly lift 10 pounds.  Clearly, 
he exceeded all of this testing while doing the FCE over 4 hours in the 
clinic.  [Emphasis 
added.]

 
 
[¶22]   
This particular exhibit is, of course, so at odds with Nagle's live 
testimony, the reports of his physician, Dr. Barrasso, who treated him over a 
period of 17 years, and all other physicians who examined him (with the 
exception of Dr. Kaplan), as to strain its credibility to the breaking 
point.  We conclude that the Medical 
Commission could give no weight to this report and it should not have relied on 
it in its finding in Paragraph 9.

 
 
[¶23]   Exhibit 4 was a Vocational 
Evaluation report that was prepared for the Division in September of 2004.  The report concluded that work had been 
available to Mr. Nagle over the past six months and that openings were expected 
in the next six months for several positions, including:  a person to market cell phone packages 
on the phone (apparently from home); a security guard/gate guard; and outside 
delivery (courier/messenger).  None 
of these positions were available in Newcastle, where Nagle lived and owned his 
home.  This item of evidence did not 
function to fulfill the Division's burden of proof and did not serve to support 
any of the Medical Commission's findings.

 
 
[¶24]   Exhibit 5 was an "Independent 
Medical Evaluation" prepared by Michael Kaplan, M.D., that was commissioned by 
the Division.  Dr. Kaplan looked at 
many of the papers in Nagle's file, but reached conclusions that were the 
opposite of Nagle's treating physician (and all other physicians).  He suggested that Nagle could work in 
the "medium capacity."  This was 
based upon Exhibit 1 and not on testing that Dr. Kaplan did himself.  The last paragraph of Dr. Kaplan's 
letter was a lengthy disclaimer stating that his opinion was basically only as 
good as the information provided to 
him.  Some of the materials he 
reviewed do not appear in the record that was created at the hearing and were 
not available to the Medical Commission, so far as the record shows.  Dr. Kaplan's description of Nagle's 
"Present Complaints" suggests that he did not review Dr. Barrasso's 
information with care, if he did so 
at all.  In "Functional History," 
Dr. Kaplan indicated that Nagle enjoyed "hunting, fishing, and hiking."  Such a conclusion is wholly implausible 
given the bulk of the medical and other records in this file.  Dr. Kaplan was unable to connect any of 
Nagle's complaints to his original injury, whereas Dr. Barrasso related all of 
Nagle's complaints to the original injury (as did all the other physicians)  
and he had personally observed Nagle's complex set of problems as they developed 
over a 17-year time span.  Dr. 
Kaplan's assessment may, in part, be explained by this excerpt from his 
report:

 
 
He 
also describes a bad right knee, which continues to bother him, as well as the 
left knee.  He was a very 
fast-speaking historian, somewhat difficult to follow, with a severe somatic 
focus.  He also would come directly 
into this examiner's space, touching the medical record and writing surface, and 
I informed him it was difficult for 
me to interview him under those circumstances.  He was constantly moving in the room, 
leaning on furniture.  Some of these 
physiologic behaviors have been observed by prior examiners including the 
occasion when the vocational evaluation report was completed and subsequently 
dictated.  I have reviewed that 
document today.

 
 
[¶25]   Exhibit 6 was a report of a 
state-wide "internet job search" done by Leslie Wolfe, MSW, LCSW, on September 
21, 2004.  It listed a number of 
jobs that the evaluator thought Mr. Nagle could perform (including some of those 
listed above).  However, only one of 
those jobs was in Newcastle, and that was working 
as a "hotel clerk," (there was "one current opening" in that field in Newcastle).  This exhibit does not serve to support 
the Medical Commission's ultimate conclusions.

 
 
[¶26]   Exhibit 7 was an "Adult Neurologic 
Evaluation" of Mr. Nagle, performed on April 11, 2005, by Black Hills 
Neurology.  It verifies much of Dr. 
Barrasso's documentation and testimony, but does not support the Medical 
Commission's ultimate conclusions in any way.

 
 
[¶27]   Although neither counsel for the 
parties, nor the Medical Commission, had much luck in getting "to the point" in 
light of the rigorous standards that apply to the odd lot doctrine, Dr. 
Barrasso's testimony was the most complete and credible information offered before the Commission.  Dr. Barrasso was asked if he ever felt 
Nagle was untruthful in his reporting, and Dr. Barrasso said "No."  He related the course of treatment in 
summary form.  His additional 
testimony was focused on Nagle's condition and circumstances at the time of the 
hearing.  He 
testified:

 
 
He's 
had ongoing pain problems with that leg [left], various hypersensitive nerves, 
which isn't unusual with a crush injury.  
But his pattern of walking has changed, which puts additional strain on 
his knee and his hip and then his lower back.

            
. . . .

            
Just kind of briefly looking at some of the surgery he's had, I see that 
in 1994, which would have been ten years ago, he had cartilage surgery on the 
left knee on that inside cartilage, which is the place that the cartilage is 
more likely to wear out.  And that 
was seven years after his injury.

            
. . . .

            
Well, it had been about over a year since I had seen him.  And he had told me that  I asked him 
how things had gone in the last year.  
And he told me that during the past year, he had three separate episodes 
where he was walking at work, had increasing pain and problems on the foot.  Each time he had to modify his activity, 
change his weight-bearing pattern to try to throw his weight to the opposite 
side of the foot.  But he continued 
to work full time.  And it just 
seemed that the pattern was such that he was having more frequent problems with 
the foot.

            
Now, this was ten years after his injury, but it was continuing to really 
aggravate him at work.  And that's 
why after that discussion, I made that notation that he was going to have 
continued degeneration of his injured left foot, would continue to give him 
problems at work and ultimately shorten his full work  and maybe the words 
should have been "full-time work career," because he was really having a hard 
time doing this full time.

 
 
[¶28]   At this point in Nagle's treatment, 
personnel from his employer came to Dr. Barrasso's office and showed him a video 
of what the work of driving a truck would be like.  Dr. Barrasso then filled out a form 
allowing Nagle to return to work a week later.  As noted above, Nagle then continued to 
work from 1988 through 2001.  
However, beginning in 1999, Nagle reported more and more difficulties to 
Dr. Barrasso: 

 
 
Well, 
he's made a real effort to work, has been committed to working, but just has had 
more and more problems as the years went on, to the point where fifteen years 
after his work-related injury to his foot, he was having pain, cramping, 
problems with the entire left leg, left lower extremity.  It made it very difficult for him to 
continue.

. 
. . .

            
The final sentence says, he has always made every effort to work his full 
job responsibility But in spite of multiple surgeries, medication, injections, 
therapy and time, he is now at a point where it is my belief he is permanently 
disabled to function at his job.

            
. . . .

But 
I think the buttocks pain and the leg pain and spasms is all related to walking 
in an abnormal way for seventeen years or so from the time of his 
injury.

            
. . . .

[Dr. 
Barrasso characterized Nagle's condition as] A progression of his initial injury 
that changed his pattern of walking and changed the pattern of feedback to his 
brain from his foot because of the nerves that were injured and crushed.  And then over a longer period of time, 
that continues with abnormal stresses and strains on the other joints and are 
moving uphill from there, the ankle, the knee, the hip and the lower 
back.

            
. . . .

He 
was walking in an abnormal way because of his foot problems.  And it's almost as if you walk with one 
foot normal and put a stone in your  in the shoe on the other foot.  So [you] try to take the weight off of 
the stone, you'd turn your foot crooked or walk a little funny or change 
it.  If you do that for a five-mile 
hike, by the end of the hike, your knee is going to hurt, your hip is going to 
hurt, and your lower back is going to hurt.  But it's all because of a stone in your 
shoe.

And 
I think that's what's been going on with him.  He had a crush injury.  He had areas that were very sensitive, 
bones that were broken and crushed that healed but not in exactly the normal 
position.  And in spite of him 
trying to work hard and trying to get everything lined up, he continued for 
seventeen years walking kind of with a stone in his shoe.  And there was no way to take the stone 
out of his shoe, because it was within his foot itself.  And that resulted in ongoing pain and 
deterioration to the point where he really wasn't able to go back and do the 
kind of work he had done at the time of his injury.

 
 
[¶29]   In response to questioning from 
counsel for the Division suggesting that Dr. Barrasso did not spend that much 
time with Nagle, he responded:

 
 
When 
you say how long they took, usually if I see 20 patients in a morning and Bob is 
one of them, he is always the longest visit and may take the time of three or 
four other folks.  And it's usually 
a lengthy visit, because he lives in Newcastle, and it's a bit of a drive, and I 
always spend quite a bit of time with him.  
And he always shows me either his foot or his ankle or his hip or his 
knee.  And I don't know that I 
record all of those things.  But the 
visits seem to be extensive.

 
 
[¶30]   Dr. Barrasso conceded that he had 
not reviewed the Functional Capacity Evaluations noted above, but he did 
comment:

 
 
            
I don't know that I saw them.  
He told me about one, and it really disturbed him, because he said they 
had him down crawling around on the floor like a dog, and he felt he was being 
treated in almost a subhuman way.  
And I heard about that at great length.

 
 
[¶31]   The testimony given above followed 
after a letter Dr. Barrasso wrote to the Division on June 26, 2002, just before 
Nagle filed his claim for permanent total disability 
benefits:

 
 
I 
am the orthopaedic surgeon taking care of Robert Nagle for injuries sustained in 
a work-related accident that occurred in 1987.  He had a significant crushing injury to 
his foot and it has become a disabling situation for him.  He has had multiple operations with 
excision, reconstruction and osteotomies and he continues to have ongoing pain 
and problems with that leg now fifteen years from the time of his initial 
injury.

 
 
Mr. 
Nagle has continued to work as an equipment operator for 22 years, but he is 
having quite a bit of difficulty functioning as an equipment operator.  He can no longer sit for more than a 
couple of hours without his left leg cramping.  When he is fatigued, his left leg gives 
out on him and makes it difficult for him to use that leg to balance.  When the fatigue sets in he needs to 
rest the leg for a day or two to regain use of the leg.  As a result of the abnormalities that 
occurred to the foot, this has changed his pattern of walking and over the last 
fifteen years he has developed additional knee pain, hip pain and buttock pain, 
which results in muscle cramps in the back of his thigh.  He has pain with almost all activity and 
even at rest.  He is never pain 
free.  He is at a point where he can 
no longer stand for more than an hour without severe pain in his 
foot.

 
 
I 
have tried a number of different treatment modalities on Mr. Nagle including 
recent injections into the foot, which have given him some temporary 
relief.  He is wearing pads that put 
local anesthetic through the skin to help relieve some of the pain, but he has 
now reached the end of the line in his ability to perform his full duties as an 
equipment operator.  He feels that 
he can longer function as an equipment operator.  I have known him and seen him on scores 
of occasions over the last fifteen years and I believe him.  He has always made every effort to work 
his full job responsibility, but in spite of multiple surgeries, medication, 
injections, therapy and time, he is now at a point where it is my belief he is 
permanently disabled to function at his job.

 
 
[¶32]   It is our view that the Medical 
Commission has distorted this testimony to conclude that Nagle is not 
permanently disabled under the odd lot doctrine, but only disabled from doing 
what he once did.  However, when all 
of the evidence is considered in context, the only sustainable conclusion that 
can be reached based on the evidence available to the Commission, is that Nagle 
is permanently disabled from doing work at any gainful occupation for which he 
was reasonably suited by experience and training.

 
 
[¶33]   Other physicians commented on 
Nagle's condition.  Wayne Johnson, 
M.D., wrote in his report:

 
 
Lastly, 
I do not think the claimant can go back to his previous level of employment as a 
driller.  I think that he is capable 
of doing sedentary to light work only, something where he could sit down and use 
his upper extremities, his hands, i.e., like clerical work, answering phones or 
typing, something that does not require him to be on his feet because he has a 
diminished standing and walking tolerance of approximately 30 minutes and 
walking approximately two to three blocks.

 
 
[¶34]   Bryan D. Den Hartog, M.D. 
commented:

 
 
He 
has developed post traumatic arthritis of multiple joints of his foot and this 
has become a disabling condition to where it is difficult for him to bear weight 
for more than a few feet.  He no 
longer can function as an equipment operator.  It is my opinion that he is permanently 
disabled to function in his previous job.

 
 
[¶35]   Meade Davis III, M.D., 
commented:  "I feel that it is 
unlikely that he can return to his former work."

 
 
[¶36]   
Using this information, 
the Medical Commission concluded that Nagle was only unable to go back to his 
job as a driller or truck driver, but that he was not permanently disabled.  We have applied the substantial evidence 
test, and we conclude that when the great weight of the evidence is read fairly 
and in the context in which it was given, the evidence presented at the hearing 
does not support the Medial Commission's conclusions.  On the contrary, we conclude that the 
evidence will support only a conclusion that Nagle is permanently and totally 
disabled from further pursuing gainful employment as contemplated by the odd lot 
doctrine.

 
 
Nagle's 
Fall Injuries and the Second Compensable Injury Rule

 
 
[¶37]   The standard of review to be 
applied here is well-summarized in Alvarez v. State ex rel. Workers' Safety and 
Compensation Division, 2007 WY 126, ¶¶ 17-22, 164 P.3d 548, 552-54 
(Wyo. 2007):

 
 
In 
contrast, in Ms. Alvarez's case the fact that she fell as she was leaving a 
physical therapy appointment for treatment of her work injury was not the only 
factor linking the work injury and the subsequent injury for which she sought 
benefits.  Ms. Alvarez initially 
tore the supraspinatus tendon of her left rotator cuff at work when she was 
attempting to assist a patient.  
Surgery was performed to repair the torn tendon.  Two months later, with her arm still in 
a sling, Ms. Alvarez fell twice, the first time as she was leaving her physical 
therapy appointment, and tore the same tendon that had been previously 
repaired.  Another surgery was 
performed to repair the second tear.  
Ms. Alvarez's doctor testified that the re-tear was related to the 
original work injury.  Thus, unlike 
the situation in Bruhn where the only 
factor linking the death and the work injury was that the death occurred when 
the employee was traveling from a doctor's appointment necessitated by the work 
injury, Ms. Alvarez presented medical testimony from which she could argue a 
direct causal connection between the original tear and the re-tear, i.e. her 
rotator cuff would not have been torn and required a second surgery after she 
fell if she had not previously torn it at work predisposing her to a 
re-tear.

 
 
            
Given this distinction, Bruhn 
does not control the outcome of Ms. Alvarez's case.  Instead, the outcome is controlled by 
our cases involving the second compensable injury rule.  The second compensable injury rule 
applies when an initial compensable injury ripens into a condition requiring 
additional medical intervention.  Yenne-Tully v. Workers' Safety & Comp. 
Div., 12 P.3d 170, 172 (Wyo.2000).  
Under the rule, a subsequent injury is compensable if it is causally 
related to the initial compensable work injury.  Id.

 
 
            
A review of the cases in which we have applied the second compensable 
injury rule is instructive.  In Casper Oil Co. v. Evenson, 888 P.2d 221 
(Wyo.1995), an employee injured his back at work in 1989 resulting in surgery 
three months later.  The Division 
awarded him benefits for that injury.  
Approximately nine months after the work injury, and after the initial 
surgery, the employee slipped and fell at home.  He reported the fall to his doctor, 
stating that it had aggravated his work injury.  There was no contention the fall was 
work related.  Three years later, 
when his back problems persisted, his doctor performed a spinal fusion.  The employee filed a report of injury 
and, after a contested case hearing, the Office of Administrative Hearings (OAH) 
awarded him benefits for the subsequent back injury.  The employer appealed, claiming there 
was insufficient evidence to support the hearing examiner's determination that 
the 1993 spinal fusion was related to the 1989 work injury.  We affirmed the award of benefits on the 
basis that the spinal fusion was a second compensable injury causally related to 
the work injury.

 
 
            
We reached the same result in Pino 
v. State ex rel. Wyo. Workers' Safety & Comp. Div., 996 P.2d 679 
(Wyo.2000), where the employee injured his back at work and received benefits as 
a result.  Over a year and a half 
later, he coughed as he was getting out of the shower, heard a pop and 
experienced pain.  His doctor 
diagnosed a herniated disc.  The 
employee applied for benefits and the Division denied his claim.  The hearing examiner 
concluded:

 
 
      6.  Pino has failed to meet his burden.  The evidence does establish that in 1995 
Pino suffered a work-related injury which may have resulted in a disc 
bulge.  From 1995 through May 1997, 
Pino worked but had periodic flare-ups of his low back pain radiating into his 
legs.  He sought medical treatment 
and these treatments were paid for by the Division.  In May 1997, while at home, Pino 
coughed, felt a pop, and experienced immediate pain in his low back.  An MRI in 1997 revealed a herniated 
disc.  It is the opinion of the 
doctors that the work injury in 1995 weakened Pino's disc and predisposed him to 
a disc herniation.  There is no 
question that the cough in 1997 caused the disc herniation and caused Pino's 
current back condition.

 
 
      7. The medical 
evidence establishes that the injury in 1995 predisposed Pino to the possibility 
of a disc herniation.  However, 
doing mundane things at home such as lifting, bending, twisting or coughing can 
cause a herniated disc.  In this 
case, Pino was at home when he coughed.  
Pino has failed to establish that his herniated disc was caused by an 
injury received at work.

 
 

Id. 
at 682.   This Court reversed, 
holding the second compensable injury rule applied and the employee had met his 
burden of proving the herniated disc was causally related to the work 
injury.  The Court 
said:

 
 
The 
thrust of the hearing examiner's disposition is clear; he ruled that the cause 
of the herniation was a cough that occurred at home not the work place.  Yet, there is nothing in the second 
compensable injury rule that attributes any significance to the place where the 
worker happened to be when the injury manifested itself nor is any triggering 
event required.  Other cases simply 
report the increasing severity of the injury over time that ultimately required 
surgery.  In Evenson, the triggering event was a slip 
and fall at home.

 
 

Id. 
at 685.

 
 
            
In two more recent cases, we reversed and remanded benefit denials 
because the hearing examiner did not consider the facts in light of the second 
compensable injury rule.  Carabajal v. State ex rel. Wyo. Workers' 
Safety and Comp. Div., 2005 WY 119, 119 P.3d 947 (2005); Yenne-Tully, 12 P.3d  at 170.  In Yenne-Tully, the employee suffered a 
work related back injury for which he received medical treatment and worker's 
compensation benefits.  A subsequent 
CT scan revealed a bulging disc at L3-L4 and "some significant irregularity, 
primarily at the L5-S1, more minor at the L4-L5 level."  Id. 
at 171.   Eight years later, he 
awoke one morning unable to move because of extreme pain.  An MRI revealed a herniated disc at 
L4-L5. After surgery was performed to repair the disc, the employee sought 
benefits.  The OAH denied the claim 
for benefits.  Finding that the 
second compensable injury rule applied but had not been considered by the OAH, 
we reversed and remanded the case to the OAH for application of the rule.  On remand, the OAH concluded the 
employee failed to meet his burden of proving a second compensable injury 
because the only medical opinion presented concluded his injury was primarily 
attributable to non-work-related causes.  
We affirmed.  Yenne-Tully v. State ex rel. Wyo. Workers' 
Safety & Comp. Div., 2002 WY 90, 48 P.3d 1057 
(2002).

 
 
            
In Carabajal, the claimant 
injured his back at work, underwent surgery for a herniated disc at L5-S1 and 
received worker's compensation benefits for over two years.  Carabajal, ¶ 3, 119 P.3d  at 
949.  He returned to work and had no 
further complaints until twenty-five years later, when he experienced back pain 
as he was walking.  He was not at 
work at the time or engaged in any work-related activity.  He sought medical treatment and an MRI 
revealed scar tissue and a herniated disc at the same level as before.  He underwent a microdiscectomy and, when 
problems persisted, a spinal fusion.  
His claim for benefits was denied and he requested a hearing.  The hearing officer denied his claim on 
the ground that he failed to prove he sustained a work related injury.  Id., ¶ 7, 
119 P.3d  at 950.  As in Yenne-Tully, we reversed and remanded 
the case for the OAH to apply the second compensable injury rule.  Id., ¶ 24, 
119 P.3d  at 955.

 
 
[¶38]   With respect to the injuries that 
Nagle suffered in his late 2001 stumble and fall, we will be quite brief, as was 
the Medical Commission.  Nagle's 
report is plausible in every respect.  
There is no basis for disbelieving his testimony that his leg gave out on 
him, as it had many times in the past, and as he reported to Dr. Barrasso.  There is likewise no factual 
circumstance contained in the record that would disallow application of the 
second compensable injury rule.  
Indeed, it is a classic case of the application of that rule.  Thus, as was the case with Nagle's claim 
for permanent total disability, there is not substantial evidence in the record 
to support the Commission's conclusions to the contrary.

 
 
CONCLUSION

 
 
[¶39]   The order of the district court 
affirming the Medical Commission is reversed, and we remand this matter to the 
district court with directions that it further remand the case to the Medical 
Commission with directions that it award permanent total disability benefits to 
Nagle.  In addition, it shall direct 
the Medical Commission to order that Nagle be paid benefits for the injuries he 
suffered to his wrist and hip when he fell in 2001 because of his gait/walking 
instability associated with his 1987 injuries.

 
 
FOOTNOTES

 
 

1In this 
regard, we refer our readers to our opinion in Tarraferro v. State ex rel. Wyoming Medical 
Commission, 2005 WY 155, ¶ 5, 123 P.3d 912, 914, n.1 (Wyo. 2005) 
wherein we noted:

 
 
Of course, 
one of the limitations of medical science is that the body's five classic senses 
cannot provide any information to a 
diagnostician:  "The examiner cannot 
see the pain, hear the pain, touch the pain, taste the pain, or smell the 
pain.  Worse yet, though in an age 
of medical miracles, we cannot X-ray the pain, measure it like serum levels of 
hemoglobin or sodium, plot it on graph paper like an EEG, or cut it out like a 
tumor.  There are no measuring 
devices like voltmeters to tell us whether a patient is experiencing mild, 
moderate, or severe pain.  In short, 
there is no objective direct tangible physical evidence for pain itself."  6B Lawyers' Medical Cyclopedia of 
Personal Injuries and Allied Specialties, § 44 A. 1, at 251 (LEXIS Publishing 
2000).