Case Title: Mitcheson v. Wyoming

Citation: 

Docket Number: S-11-0236

State: wyoming

Court: Wyoming Supreme Court

Date: 2012-05-25T00:00:00Z

Document:
IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF: GARY A. MITCHESON  v. STATE OF WYOMING, ex. rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2012 WY 74Case Number: S-11-0236Decided: 05/25/2012This opinion is subject to formal revision before publication in Pacific Reporter Third.  Readers are requested to notify the Clerk of the Supreme Court, Supreme Court Building, Cheyenne, Wyoming 82002, of any typographical or other formal errors so that correction may be made before final publication in the permanent volume.  
APRIL 
TERM, A.D. 2012
IN THE MATTER OF THE 
WORKER’S COMPENSATION CLAIM OF:
 
GARY A. 
MITCHESON,
 
Appellant
(Petitioner),
 
v.
 
STATE OF WYOMING, ex 
rel., WYOMING WORKERS’ SAFETY AND COMPENSATION DIVISION,
 
Appellee
(Respondent).
 
Appeal 
from the District Court of Converse County
The 
Honorable John C. Brooks, Judge
 
Representing 
Appellant:
 
Robert 
A. Nicholas, Nicholas & Crank, PC, Cheyenne, Wyoming.
 
Representing 
Appellee:
 
Gregory 
A. Phillips, Attorney General; John D. Rossetti, Deputy Attorney General; 
Michael J. Finn, Senior Assistant Attorney General; Kelly Roseberry, Assistant 
Attorney General.
 
Before 
KITE, C.J., and GOLDEN, HILL, VOIGT, and BURKE, JJ.
 
BURKE, 
Justice.
 
[¶1]        
The 
Wyoming Workers’ Safety and Compensation Division awarded benefits to Appellant, 
Gary Mitcheson, after he fell at work and injured his tailbone in July of 2007. 
Approximately two years later, the Division issued a final determination denying 
payment for medical care that Mr. Mitcheson claimed was related to his workplace 
injury.  Mr. Mitcheson requested a 
contested case hearing, and the Office of Administrative Hearings (OAH) upheld 
the Division’s determination.  Mr. 
Mitcheson appealed to the district court, which upheld the OAH’s order.  He challenges the district court’s 
decision in this appeal.  We 
affirm.
 
ISSUES
 
[¶2]      
Appellant presents 
the following issues:
 
1.    
Is the OAH Order 
arbitrary and unsupported by substantial evidence?
 
2.    
Is the OAH Order 
denying payment for treatment of Mr. Mitcheson’s tailbone injury 
arbitrary?
 
3.    
Is [the] OAH Order 
denying payment for medical care contrary to the “Rule Out” Rule and therefore 
contrary to law? 
 
The Division phrases 
the issues as follows:
 
1.    
In making its 
determination, the OAH utilized the medical records submitted into evidence, but 
gave very little weight to the testimony of Mitcheson and his physician because 
the OAH found their testimonies to be incredible.  Does the evidence that the OAH deemed 
credible constitute substantial evidence to support the OAH’s determination that 
Mitcheson failed to prove a causal connection between his 2007 work injury and 
his 2009 medical treatment?
 
2.    
Was the OAH’s 
decision denying benefits to Mitcheson arbitrary, capricious, or otherwise not 
in accordance with Wyoming law?
 
FACTS
 
[¶3]        
Mr. Mitcheson fell 
and fractured his tailbone on July 8, 2007, as he was finishing work on a water 
well for his employer, Douglas Exploration.  According to Mr. Mitcheson, he fell 
backwards off of a raised deck, striking his tailbone on a piece of angle iron 
on his way down, and then fell approximately four more feet, landing on the edge 
of a metal, box-shaped mud pit, which was situated eighteen inches above the 
ground.  Mr. Mitcheson was unable to 
go to work the next day because he was too sore.  Suspecting that he had broken his 
tailbone, Mr. Mitcheson rested in his motel room for a few days and then 
drove to his home in Utah.  
 
[¶4]        
Five days after his 
fall, Mr. Mitcheson was examined by a nurse practitioner at the Emery Medical 
Center in Castle Dale, Utah.  The 
initial report of injury submitted to the Division indicated that Mr. Mitcheson 
had reported pain in his tailbone and left side.  The report also stated that Mr. Mitcheson 
had a “resolving large bruise to lower back,” as well as bruising on his 
tailbone and left flank.  Mr. 
Mitcheson was diagnosed with a tailbone fracture and a left lumbar hematoma, and 
was treated with non-narcotic pain medication and a plastic donut.  The Wyoming Workers’ Safety and 
Compensation Division issued a final determination opening Mr. Mitcheson’s case, 
which noted that the body parts to be covered were his “tailbone (coccyx), 
kidney, mid back (thoracic), and low back (lumbar).”
 
[¶5]        
Although Mr. 
Mitcheson was released to work on the day after his visit to the Emery Medical 
Center, he did not work again until seven months later, in February of 2008.1  In October of 2008, Mr. Mitcheson found a 
job driving a truck for Target Trucking, which required a commercial driver’s 
license (CDL).  In order to maintain 
his CDL, Mr. Mitcheson was required to pass a physical examination administered 
by a Utah Department of Transportation medical examiner.  Due to a high diastolic blood pressure 
reading on his first two medical exams, however, Mr. Mitcheson did not qualify 
for a one-year medical certificate until his third exam, in January of 2009. 
 On the “health history” portion of 
each of his medical examinations, Mr. Mitcheson reported that he had no 
history of spinal injury or disease, and that he had no history of chronic low 
back pain.
 
[¶6]        
In March of 2009, 
approximately twenty months after his workplace injury, and approximately five 
months after he began working as a truck driver, Mr. Mitcheson returned to the 
Emery Medical Center and reported that he had been having pain in his lower back 
since the accident in July of 2007.  At this visit, Mr. Mitcheson complained 
of low back pain and vertebral tenderness.  Mr. Mitcheson was referred to Dr. Robert 
Bourne, who noted in July of 2009 that Mr. Mitcheson complained of back pain and 
numbness in his left foot, and that Mr. Mitcheson’s complaints stemmed “from an 
accident two years ago when he was working on a drill rig.”  Dr. Bourne ordered an x-ray that 
revealed “a mild to moderate sized bone spur at L4 with minimal degeneration at 
that level.”  Dr. Bourne submitted a 
bill to the Division and requested authorization for an MRI.  The Division denied payment, finding 
that “Current treatment to the back is not related to the original July 8, 2007 
work injury to the coccyx and is not considered reasonable and necessary medical 
care pursuant to Wyoming Statute 27-14-102(a)(xii).”  Mr. Mitcheson objected to the Division’s 
final determination, and the matter was set for a contested case hearing before 
the OAH.
 
[¶7]        
Prior to the 
contested case hearing, Mr. Mitcheson saw Dr. Larry Copeland at Western 
Orthopedics & Sports Medicine in June of 2010, approximately eleven months 
after his visit to Dr. Bourne.  Mr. 
Mitcheson complained of intermittent pain in his low back and numbness in his 
left foot.  An x-ray of Mr. 
Mitcheson’s back revealed “marginal spurring of the lower lumbar area with 
slight increased sclerosis in the facets at L4-5 and L5-S1” and “narrowing of 
the L5-S1 disc space.”  Dr. Copeland 
noted the following impressions: “1: Mild to moderate degenerative L5-S1 disc 
disease. 2: Mild lumbar spondylosis.”  
Dr. Copeland stated, in deposition testimony introduced at the hearing, 
that it was his opinion that Mr. Mitcheson’s back problems were the result of 
his workplace accident in July of 2007.  
He acknowledged, however, that his opinion was premised on Mr. 
Mitcheson’s report that he had experienced “chronic” pain since the accident, 
and further, that his opinion would change “somewhat” if Mr. Mitcheson’s 
pain was not chronic.
 
[¶8]        
In addition to Dr. 
Copeland’s deposition testimony, the hearing examiner received testimony from 
Mr. Mitcheson and his wife, as well as documentary evidence of 
Mr. Mitcheson’s medical records.  
After considering all of the evidence, the hearing examiner found that 
Mr. Mitcheson had failed to meet his burden of proof:
 
Although there is no 
dispute that Mitcheson suffered a significant fall and fractured his tailbone in 
July 2007, Mitcheson failed to meet his burden of proof because much of his 
case, including Dr. Copeland’s opinion, depended upon the credibility of 
Mitcheson’s testimony and reported medical history, which were significantly 
undermined by his admitted lack of candor regarding his DOT physicals.  Further, the eighteen month period of no 
medical care was not consistent with Mitcheson’s position that he had chronic, 
unimproved and worsening low back symptoms since his 
injury.
 
As a result, the 
hearing examiner upheld the Division’s final determination.  The district court affirmed the hearing 
examiner’s decision, and Mr. Mitcheson timely filed this 
appeal.
 
STANDARD OF 
REVIEW
 
[¶9]        
Review of an 
administrative agency’s action is governed by the Wyoming Administrative 
Procedure Act, which provides that:
 
(c) 
To the extent necessary to make a decision and when presented, the reviewing 
court shall decide all relevant questions of law, interpret constitutional and 
statutory provisions, and determine the meaning or applicability of the terms of 
an agency action. In making the following determinations, the court shall review 
the whole record or those parts of it cited by a party and due account shall be 
taken of the rule of prejudicial error. 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;          
(B) Contrary 
to constitutional right, power, privilege or immunity;      (C) In excess of statutory 
jurisdiction, authority or limitations or lacking statutory right;           
(D) Without 
observance of procedure required by law; or(E) Unsupported by substantial 
evidence in a case reviewed on the record of an agency hearing provided by 
statute.          

 
Wyo. Stat. Ann. § 
16-3-114(c) (LexisNexis 2009).  We review an 
administrative agency’s findings of fact pursuant to the substantial evidence 
test.  Dale v. S & S 
Builders, LLC, 2008 WY 84, ¶ 22, 188 P.3d 554, 561 (Wyo. 2008).  Substantial evidence is relevant 
evidence which a reasonable mind might accept in support of the agency’s 
conclusions.  Id., ¶ 11, 188 P.3d  at 558.  Findings of fact are supported by 
substantial evidence if, from the evidence in the record, this Court can discern 
a rational premise for the agency’s findings.  Middlemass v. State ex rel. 
Wyo. 
Workers’ Safety & Comp. Div., 
2011 WY 118, ¶ 11, 259 P.3d 1161, 1164 (Wyo. 
2011).  When 
the hearing examiner determines that the burdened party failed to meet his 
burden of proof, we will decide whether there is substantial evidence to support 
the agency’s decision to reject the evidence offered by the burdened party by considering 
whether that conclusion was contrary to the overwhelming weight of the evidence 
in the record as a whole.  Dale, ¶ 22, 188 P.3d  at 
561.
 
[¶10]     
The arbitrary and 
capricious standard of review is used as a “safety net” to catch agency action 
which prejudices a party’s substantial rights or which may be contrary to the 
other review standards under the Administrative Procedure Act, yet is not easily 
categorized or fit to any one particular standard.  Id., ¶ 23, 188 P.3d  at 561.  The arbitrary and capricious standard 
applies if the agency failed to admit testimony or other evidence that was 
clearly admissible, or failed to provide appropriate findings of fact or 
conclusions of law.  Id.  We review an agency’s conclusions of law de novo.  Id., ¶ 26, 188 P.3d  at 
561-62.
 
DISCUSSION
 
[¶11]     
A claimant in a 
workers’ compensation case has the burden to prove all the elements of the claim 
by a preponderance of the evidence.  Kenyon v. State ex rel. Wyo. Workers’ 
Safety & Comp. Div., 2011 WY 14, ¶ 22, 247 P.3d 845, 851 (Wyo. 2011).  A preponderance of the evidence is 
“proof which leads the trier of fact to find that the existence of the contested 
fact is more probable than its non-existence.”  Id.  To prove entitlement to an award of 
benefits, a claimant must demonstrate that he sustained an “injury,” as defined 
in Wyo. Stat. Ann. § 27-14-102(a)(xi):
 
“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.
 
Further, 
the claimant must prove a causal connection exists between a work-related injury 
and the injury for which workers’ compensation benefits are sought.  Kenyon, ¶ 22, 247 P.3d  at 
851.
 
[¶12]     
In determining that 
Mr. Mitcheson did not meet his burden of proving his lower back symptoms were 
related to his workplace injury, the hearing examiner found that 
Mr. Mitcheson’s credibility was “significantly undermined” by the fact that 
he did not seek treatment for his symptoms until March of 2009, and by 
inconsistencies in Mr. Mitcheson’s account of the history of his lower back 
symptoms.  The hearing examiner’s 
credibility findings were explained as follows:
 
For a number of 
reasons, this Office finds and concludes Mitcheson did not prove, by a 
preponderance of the evidence, his low back injury and symptoms treated by Dr. 
Bourne and Dr. Copeland, were caused by or related [to] his July 8, 2007, work 
related accident.
 
            
52.    First, even 
though Mitcheson knew the Division opened a case and provided coverage for 
Mitcheson’s July 8, 2007, low back and tailbone injuries, Mitcheson did not seek 
medical care or treatment for his low back injury and symptoms from July 13, 
2007 until March 20, 2009.  
According to Dr. Copeland’s June 1, 2010 examination notes, Mitcheson 
stated “that his pain has not improved at all since the injury, making it very 
difficult for him to work.”  It was 
very difficult for this Office to believe Mitcheson had the described ongoing 
pain and symptoms yet did not seek any medical care for approximately eighteen 
months.  In other words, it was not 
believable that Mitcheson’s low back pain and symptoms which began with his fall 
on July 8, 2007, continued unabated and worsened yet he did not seek any 
treatment or care for eighteen months, he continued to work driving heavy 
equipment, he did not report his symptoms to the DOT medical examiner and the 
DOT medical examiner did not find any symptoms or pain on 
examination.
 
            
53.    Second, 
Mitcheson’s explanations for not seeking medical care and for not reporting his 
injury to the DOT medical examiner were not reasonable.  There was no credible evidence 
suggesting Mitcheson would lose his CDL if he revealed his 2007 back 
injury.  To the contrary, the 
evidence demonstrated he revealed his high blood pressure but kept his CDL and 
the actual Medical Examination Report indicated “[t]he presence of a certain 
condition may not necessarily disqualify a driver, particularly if the condition 
is controlled adequately, is not likely to worsen or is readily amenable to 
treatment.”  In addition, although 
it was reasonable for Mitcheson to believe he would continue to have some pain 
after he fractured his pelvis for a period of time, it was not reasonable for 
him to assert he had eighteen months of unabated and worsening pain yet just 
lived with it.
 
            
54.    Third, 
Mitcheson’s case and proof of the essential causal connection between his March 
2009 low back injury and symptoms depended upon his testimony and reported 
history of his pain and symptoms, which, as discussed previously, this Office 
found questionable.  In order to 
conclude that Mitcheson’s March 2009 low back injury and symptoms are related to 
his July 2007 [injury], this Office had to believe Mitcheson’s testimony and 
reported history that he had ongoing pain and symptoms from July 8, 2007 through 
March 20, 2009, and that he had no other accidents or injuries.  Due to his demonstrated willingness to 
not reveal material information about his lower back to DOT and because having 
continuing and worsening pain at the same time he is operating heavy equipment 
is inconsistent with a history of eighteen months of no medical care, this 
Office could not rely on Mitcheson’s testimony and 
history.
 
            
55.    Fourth, 
Mitcheson’s 2009 symptoms and diagnoses were different than his 2007 diagnoses 
and symptoms.  In [2007] he was 
diagnosed with a contused lower back and a fractured coccyx, but in 2009 he was 
diagnosed with a herniated disc at L4, and the steroid injection confirmed L4 to 
be the source of his pain.  
Moreover, in 2007, Mitcheson’s pain was located at his tailbone and he 
had no associated symptoms but in March 2009 his pain was located in the center 
of his lumbar spine above the tailbone and he reported urinary problems and foot 
numbness.  In addition, Dr. Copeland 
acknowledged Mitcheson’s 2009 L4 diagnosis was above his 
coccyx.
 
The hearing examiner 
also discounted Dr. Copeland’s opinions as a consequence of his findings 
regarding Mr. Mitcheson’s credibility:
 
            
46.    This Office 
concluded Dr. Copeland’s opinion testimony was not persuasive or helpful because 
Dr. Copeland’s opinion was dependent upon the accuracy of the history 
provided to him by Mitcheson, which this Office found questionable.  Dr. Copeland readily agreed his opinion 
assumed Mitcheson had chronic low back pain ever since his work related fall and 
his opinion would change if Mitcheson had not been having chronic low back pain 
and symptoms since his injury.
 
Based on these 
findings, the hearing examiner concluded that Mr. Mitcheson “did not 
establish his need for treatment to his lumbar spine for low back pain and 
symptoms in March 2009 was caused by his July 8, 2007, injury at 
work.”
 
[¶13]     
In Mr. Mitcheson’s 
first issue, he contends that the hearing examiner, in determining that his low 
back symptoms were not caused by or related to his workplace injury, made 
inaccurate factual findings and disregarded uncontested facts.  He challenges several of the hearing 
examiner’s credibility findings, asserting that they were arbitrary and 
unsupported by the evidence.  He 
claims there was no evidence to support the hearing examiner’s finding that the 
lapse between the time of his injury and the time of treatment was unreasonable 
and inconsistent with his reports of unabated pain.  Mr. Mitcheson further claims that 
“The only evidence submitted by the Division to rebut the evidence presented by 
Mr. Mitcheson regarding his back condition is Mr. Mitcheson’s 
re-application for his CDL where he did not check the appropriate boxes 
regarding previous back injuries.”  
(Emphasis omitted.)  With 
regard to this evidence, Mr. Mitcheson asserts that the hearing examiner 
arbitrarily and unreasonably rejected his testimony that he would not be able to 
retain his CDL if he revealed his back pain to the department of transportation 
medical examiner.
 
[¶14]     
Our evaluation of the 
hearing examiner’s decision is directed by well-established standards for 
reviewing administrative agency action.  
As we have stated on many occasions since our decision in Dale, 188 P.3d 554,
 
If, in the course of 
its decision making process, the agency disregards certain evidence and explains 
its reasons for doing so based upon determinations of credibility or other 
factors contained in the record, its decision will be sustainable under the 
substantial evidence test. Importantly, our review of any particular decision 
turns not on whether we agree with the outcome, but on whether the agency could 
reasonably conclude as it did, based on all the evidence before it.   
Davenport 
v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 
2012 WY 6, ¶ 12, 268 P.3d 1038, 1042 (Wyo. 
2012).  Further, we give substantial 
deference to a hearing examiner’s credibility findings: “Credibility 
determinations are the unique province of the hearing examiner, and we eschew 
re-weighing those conclusions. We defer to the agency’s determination of witness 
credibility unless it is clearly contrary to the overwhelming weight of the 
evidence.”  Beall v. Sky Blue Enters. (In re Beall), 
2012 WY 38, ¶ 28, 271 P.3d 1022, 1034 (Wyo. 2012) 
(citation omitted).
 
[¶15]     
We find that the 
hearing examiner’s findings are supported by substantial evidence.  As indicated in the findings set forth 
above, the hearing examiner’s primary concerns focused on (1) the amount of time 
that elapsed between Mr. Mitcheson’s injury in July, 2007 and his visit to the 
Emery Medical Center in March, 2009; (2) the variations in Mr. Mitcheson’s 
symptoms as reported when he was injured in 2007 and when he sought treatment in 
2009; and (3) the inconsistencies in Mr. Mitcheson’s stated reasons for delaying 
treatment until 2009 and for failing to report his back symptoms on his 
department of transportation medical exams.
 
[¶16]     
First, in 
disregarding Mr. Mitcheson’s testimony that he had experienced constant and 
unrelenting pain since his workplace injury, the hearing examiner could 
reasonably conclude that Mr. Mitcheson’s account was inconsistent with the 
failure to report his back symptoms until March of 2009, over twenty months 
after his injury.  During the time 
that elapsed between his injury and his visit to the Emery Medical Center, 
Mr. Mitcheson went back to work for Douglas Exploration as a driller’s 
helper, and then worked for Moab Salt, LLC as a laborer and equipment 
operator.  In addition, during the 
five months immediately preceding his visit to the Emery Medical Center in March 
of 2009, Mr. Mitcheson worked as a truck driver for Target Trucking.  Considering the significant lapse 
between the time of Mr. Mitcheson’s injury and time at which he sought treatment 
for his back problems, his varied work history subsequent to the 2007 injury, 
and the lack of any evidence to corroborate his testimony of continuous back 
pain during this period, the hearing examiner’s determination that Mr. 
Mitcheson’s reports of constant back pain were not credible is supported by the 
record.
 
[¶17]     
Second, the hearing 
examiner’s finding that Mr. Mitcheson’s testimony was not consistent with the 
symptoms documented in his medical history also finds support in the 
record.  As noted by the hearing 
examiner, Mr. Mitcheson was diagnosed with a broken tailbone and lumbar hematoma 
after his injury in 2007, but was found to have “[m]ild to moderate degenerative 
L5–S1 disc disease” and “[m]ild lumbar spondylosis” upon his examination by Dr. 
Copeland in June of 2010.  Further, 
although Mr. Mitcheson testified that he experienced back pain “ever since day 
one. . . . From the day that I was injured” that had “gotten worse,” and had 
“never gotten better,” he reported during his visit with Dr. Bourne in July of 
2009 that he had “intermittent back pain” and “intermittent numbness” in his 
left foot.  Accordingly, the fact 
that Mr. Mitcheson’s representations of his symptoms at the hearing did not 
align with the symptoms documented in his medical records provides further 
support for the hearing examiner’s conclusion that Mr. Mitcheson was not a 
credible witness. 
 
[¶18]     
Finally, the hearing 
examiner could reasonably determine that Mr. Mitcheson’s explanations for his 
failure to report his back symptoms for nearly two years, as well as his failure 
to report his symptoms on his department of transportation medical exams, 
reflected poorly on his credibility.  
Mr. Mitcheson stated that he did not seek treatment for his back pain 
because he could not afford to see a doctor.  However, on cross-examination, Mr. 
Mitcheson acknowledged that he knew the Division would pay for medical treatment 
relating to his injury, and that he had received a letter from the Division 
instructing him to submit invoices from his treatment providers to the 
Division.  With regard to the lack 
of any indication of his back pain on the department of transportation medical 
exams, Mr. Mitcheson initially stated that “at the time [I] was on high blood 
pressure pills [and] was trying to get my high blood pressure down.  I wasn’t thinking.  And another thing is that when you put 
down a back injury, nobody wants to hear you.”  Mr. Mitcheson subsequently testified that 
“if I didn’t pass any of [the medical exams], I would be out of work.”  This testimony, however, was 
contradicted by the fact that Mr. Mitcheson received, initially, a 
three-month extension, and later, a one-year extension of his medical 
certificate, despite having high blood pressure.  Further, Mr. Mitcheson acknowledged 
that the medical examination form expressly stated that the presence of a 
certain condition would not necessarily disqualify a driver from receiving a 
medical certificate.  

 
[¶19]     
In light of the 
inconsistencies between Mr. Mitcheson’s testimony at the contested case hearing 
and his documented medical history, and the contradictions in 
Mr. Mitcheson’s explanations for his extensive delay in seeking treatment 
and his failure to report his back symptoms on his department of transportation 
medical exams, we cannot find that the hearing examiner’s credibility 
determination is clearly contrary to the overwhelming weight of the evidence. 
Additionally, the hearing examiner properly determined that Mr. Mitcheson’s lack 
of credibility provided reason to discount the medical opinions of Dr. 
Copeland.  As we have previously 
stated, “a hearing examiner is entitled 
to disregard an expert opinion if he finds the opinion unreasonable, not 
adequately supported by the facts upon which the opinion is based, or based upon 
an incomplete and inaccurate medical history provided by the claimant.”  Taylor v. State ex rel. Wyo. Workers’ Safety 
& Comp. Div., 2005 WY 
148, ¶ 15, 123 P.3d 143, 148 
(Wyo. 2005).  Because the causal 
link between Mr. Mitcheson’s 2007 workplace injury and his treatment in 2009 
depended entirely on the testimony of Mr. Mitcheson, and the opinion of Dr. 
Copeland, we find substantial evidence to support the hearing examiner’s 
conclusion that Mr. Mitcheson did not meet his burden of establishing that his 
back treatment was related to his workplace injury.
 
[¶20]     
In his second issue, 
Mr. Mitcheson claims that his treatment was also related to his tailbone pain, 
and that the hearing examiner erred in failing to provide factual findings on 
this issue.  In support of this 
claim, Mr. Mitcheson asserts that he “frequently discussed his tailbone pain 
with his doctors and healthcare providers.”  He requests that we remand this matter 
back to the OAH with instructions to make specific findings regarding the 
treatment of his tailbone, or enter an order directing the Division to pay for 
treatment of his tailbone. We are unable to find merit in Mr. Mitcheson’s 
claim.
 
[¶21]     
First, we note that 
the record does not indicate that Mr. Mitcheson received treatment for his 
tailbone pain after his initial visit to the Emery Medical Center in July of 
2007.  There is no indication that 
Mr. Mitcheson complained of pain in his tailbone during his visit to Dr. Bourne 
in July of 2009, which was the treatment subject to the Division’s final 
determination in this case.  
Further, after his consultation with Dr. Copeland in June of 2010, 
Dr. Copeland recommended, and Mr. Mitcheson received, an L4 epidural injection 
to treat the pain in his back.  Although Mr. Mitcheson’s tailbone pain 
was noted during his visit to Dr. Copeland, there is no indication in the record 
that he received any treatment other than the steroid injection.  More importantly, however, this issue has 
not been raised until this appeal.  
The contested decision in this case was the Division’s determination that 
the “Current treatment [with Dr. Bourne] to [Mr. Mitcheson’s] back is not related to the original July 
8, 2007 work injury to the coccyx and is not considered reasonable and necessary 
medical care.” (Emphasis added.)  At 
the contested case hearing, counsel for Mr. Mitcheson acknowledged that the 
issue was “whether Mr. Mitcheson can prove his July 2009 . . . low-back pain is causally connected to 
his July 8, 2007, work injury.”  (Emphasis added.)  Indeed, counsel for Mr. Mitcheson 
began his opening statement by declaring that “this hearing is about Gary 
Mitcheson and whether or not his injury that he sustained while working over in 
Riverton on a rig July 8 of 2007 is related to his ongoing back problems that he is having today.” 
(Emphasis added.)  At no point 
during the hearing did counsel suggest that Mr. Mitcheson’s treatment was 
related to his tailbone.  Because 
the issue was not raised below, we decline to consider it on appeal.  See In re Beall, ¶ 15, 271 P.3d  at 
1029.
 
[¶22]     
Finally, in Mr. 
Mitcheson’s third issue, he claims that his visits to Dr. Bourne and Dr. 
Copeland are compensable “regardless of the relatedness of the complaints to the 
original work injury because both doctors were ruling out the possible causes of 
Mr. Mitcheson’s back pain.”  He 
states that this conclusion is compelled by our decision in Snyder v. State ex rel. Wyo. Worker’s Comp. 
Div., 957 P.2d 289 (Wyo. 
1998).  In Snyder, the employee-claimant fell at 
work and injured his shoulder and back. 
 Id. at 291.  The Division denied reimbursement of a 
bill for cervical x-rays and a portion of an office visit related to cervical 
complaints, as well as a bill for cervical traction therapy.  Id. at 292.  We upheld the hearing examiner’s 
decision denying benefits relating to the cervical traction therapy, noting that 
the treating physician “did not state that the treatments were necessary for 
proper attention to the work-related occurrence.”  Id. at 295.  However, we reversed the denial of 
compensation for the cervical x-rays and exam based on the treating physician’s 
determination that tingling in the claimant’s hands indicated that his neck was 
a possible source of his shoulder problems.  We described the treating physician’s 
actions as follows:
 
[The treating 
physician’s] notes reflect that [the claimant] reported the tingling began when 
his shoulder was retracted during physical therapy.  The tingling alerted [the treating 
physician] that a neck problem may have been the source of [the claimant’s] 
difficulties, including the shoulder pain.  
Consequently, he ordered neck x-rays because he believed x-rays were 
appropriate to investigate the claimant’s symptoms.
 
Id.  After noting that no evidence was 
presented to undermine or contradict the treating physician’s course of action, 
we stated that “An appropriate diagnostic measure is not non-compensable merely 
because it fails to reveal an injury which is causally connected to an 
on-the-job injury.”  Id.
 
[¶23]     
The 
present case is distinguishable from Snyder.  In this case, although Dr. Bourne 
requested authorization for an MRI to rule out the possibility of a disc 
herniation, there is no indication in Dr. Bourne’s notes that he believed a disc 
herniation was caused by the injury to Mr. Mitcheson’s tailbone.  As a result, the element critical to the 
holding in Snyder, which was the 
objective indication of a physiologic connection between the claimant’s injury 
and the diagnostic measure at issue, is absent in this case.  Given the lack of such a connection, we 
conclude that the treatment was not compensable as a diagnostic test.  This conclusion is consistent with our 
recent decision in Price v. State ex rel. 
Wyo. Workers’ Safety & Comp. Div., 2011 WY 160, ¶ 12, 266 P.3d 940, 943 (Wyo. 2011), 
where we stated that “While we acknowledge that procedures to rule out the 
source of an injury are not necessarily non-compensable simply because the test 
may show that the injury is not in fact related to a workplace accident, we 
cannot extend that logic to say that all diagnostic tests ought to be 
compensable.”  Finally, because 
there was no indication that any treatment received from Dr. Copeland was 
intended to “rule out” the possible causes of Mr. Mitcheson’s back pain, we find 
no basis for Mr. Mitcheson’s claim that treatment received from Dr. Copeland is 
compensable as a diagnostic measure.
[¶24]     
Affirmed.
 
FOOTNOTES
1Mr. Mitcheson’s job 
with Douglas Exploration apparently ended due to completion of the well he was 
working on when his injury occurred.