Case Title: IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF BUCKLIN

Citation: 

Docket Number: 

State: wyoming

Court: Wyoming Supreme Court

Date: 2001-10-19T00:00:00Z

Document:
IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF BUCKLIN2001 WY 10133 P.3d 440Case Number: 00-325Decided: 10/19/2001

OCTOBER TERM, A.D. 2001

                                                                                                
  

IN THE 
MATTER OF THE WORKER'S

COMPENSATION 
CLAIM OF EMILY

ANN 
BUCKLIN, AN EMPLOYEE OF

BIG HORN 
COUNTY SHERIFF'S

DEPARTMENT:

EMILY ANN BUCKLIN,

Appellant(Petitioner),

v.

                                                                                                

STATE OF 
WYOMING, ex rel.,

WYOMING 
WORKERS' SAFETY

AND COMPENSATION DIVISION,

Appellee(Respondent) 
.

Appeal 
from the District Court of Big Horn County

The 
Honorable Hunter Patrick, Judge

Representing 
Appellant:

            
George Santini of Ross, Ross & Santini, Cheyenne, WY.

Representing 
Appellee:

Gay 
Woodhouse, Attorney General; John W. Renneisen, Deputy Attorney General; and 
David L. Delicath, Assistant Attorney General.

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

            
HILL, Justice.

[¶1]      Appellant, Emily 
Ann Bucklin (Bucklin), appeals from an order of the district court that affirmed 
a determination of the Medical Commission (Commission), which denied most of the 
worker's compensation benefits Bucklin sought.  It is not disputed that Bucklin was 
injured while at work when a top-heavy file cabinet fell onto her shoulder and 
arm while she was in a sitting position.  
As a result of that occurrence, Bucklin sought medical attention.  In the course of her treatment, it 
became evident that there existed a fracture or cancerous lesion in her cervical 
spine (neck).  Because Bucklin had 
been treated for breast cancer in 1984, the treating physicians considered 
metastases a possible diagnosis prior to the surgical procedures necessitated by 
her condition.  However, Bucklin 
needed immediate surgical intervention to stabilize her spine, and it was not 
until the surgery was completed and a biopsy performed that the presence of 
cancer was confirmed.  The treating 
physicians testified that they could not definitively sort out the interaction 
of the work-related injury and the metastases, but their testimony was clear 
that the source of Bucklin's pain and the event that made the surgery an 
immediate requirement was the on-the-job injury.  That is, Bucklin's injury at work, 
combined with a weakness in her neck, produced a condition that required the 
treatment provided by Bucklin's physicians.  The ultimate conclusion reached by the 
Commission was that Bucklin had failed to show, by a preponderance of the 
evidence, that the treatment and surgery of her neck and shoulder injury 
stemming from her work injury were not related to a preexisting 
cancer and were related to her work injury.  The district court entertained Bucklin's 
petition for review of agency action pursuant to W.R.A.P. 12, and it concluded 
that the Commission's determination was based on substantial 
evidence.

[¶2]      We will reverse 
and remand to the district court for further remand to the Commission, with 
direction that Bucklin's just claims be paid by the Workers' Compensation 
Division (Division).

[¶3]      Bucklin poses 
these issues:

1.  Did the Medical Commission err as a 
matter of law in denying Bucklin's claims for treatment of her work related neck 
and shoulder injuries?

2.  Did Bucklin's employment activities 
aggravate, accelerate or combine with her pre-existing undiagnosed condition of 
cancer to result in a compensible injury?

3.  Can the Medical Commission make a 
factual finding regarding causation which is directly contrary to the 
uncontroverted medical testimony before it?

The 
Division states a single issue:

Did the 
Medical Commission correctly conclude that Appellant's surgery was not 
necessitated by her accident at work?

[¶4]      On March 24, 
1984, Bucklin was diagnosed with breast cancer.  She underwent a modified radical 
mastectomy in March of 1984, and that was followed by two years of 
chemotherapy.  Over the succeeding 
years, Bucklin did routine semi-annual, and then annual, follow-up visits to her 
oncologist, Neel Hammond, M.D. (and for the years 1993-1996 to another 
physician), and all check-ups were negative through and including October or 
November of 1997.

[¶5]      On August 18, 
1998, while employed as a dispatcher for the Big Horn County Sheriff, Bucklin 
was injured when a three-drawer file cabinet toppled onto her left arm and 
shoulder.  Bucklin was seated in a 
rolling desk chair at the time.  She 
felt immediate pain and assumed that she had pulled a muscle "or something of 
that nature."  Bucklin was able to 
complete the remaining three and one-half hours of her work shift, but her pain 
worsened over the following days.   
On August 24, 1998, Bucklin consulted with R.C. Wecker, M.D., an 
orthopedic surgeon.  Dr. Wecker's 
notes indicate that Bucklin complained of pain in her shoulder and "in her neck, 
posterior shoulder, arm and shoulder area".  He concluded that Bucklin may have 
suffered two injuries, one to the shoulder and one to the neck.  Therefore, he sent Bucklin to get an MRI 
of her cervical spine and asked that she return on September 1, 1998, which she 
did.

[¶6]      The MRI report 
contained these "Impressions:"  
"1.  Abnormal marrow signal 
C7 as well as the transverse process of T1 on the left.  Neoplastic process such as metastatic 
disease is considered.  There is, 
however, no evidence of neural impingement.  2.  
Mild cervical spondylosis  
C5-6."  Dr. Wecker's notes of 
Bucklin's September 1, 1998 appointment were as follows:

Patient 
returns today for follow up on injury to her neck and left shoulder.  The MRI of the left shoulder was 
negative for any rotator cuff tear or obvious abnormality, other than slight 
hypertrophy of the acromioclavicular joint, which is probably not a new 
finding.

TEST 
RESULTS:

The MRI 
of her neck however, demonstrated an increased uptake, or abnormal signal 
intensity, in the body of the C7 vertebrae of the cervical spine, which could 
represent a fracture vs. some type of bone lesion such as a tumor infiltration, 
etc.  As the patient does have a 
prior history of carcinoma of the breast with mastectomy performed in 1984 I 
recommended today that we proceed with a bone scan to evaluate not only her 
cervical spine, but the total body for a possibility of metastasis vs. fracture 
of her cervical spine, which may have occurred from this injury.  The patient was referred down to the 
Radiology Dept. where she was injected and a bone scan will be performed yet 
today so that we can get this evaluated promptly.

The 
patient had the bone scan performed here in the Thermopolis Hospital today which 
revealed a localized area of marked increased uptake in the body of the C7 
vertebral body, but no other areas of increased uptake were noted on the entire 
total body bone scan survey, suggesting no other metastatic lesions or the fact 
that the C7 vertebrae may indeed be a fracture rather [than] a metastatic 
lesion.  Based on this finding, the 
radiologist suggested that we perform a limited CT scan of the area of C6, 7 and 
T1, which was performed today to evaluate the possibility of fracture and it 
appears that the patient has a lytic lesion, or replacement type lesion, of the 
body and a portion of the pedicle and extending out into the transverse process 
and posterior lamina of C7, more on the left side, which is consistent with her 
referred pain being more into the left shoulder area and left posterior 
neck.  The appearance of the CT scan 
suggests that this was more of a metastatic or evasive type lesion than a 
fracture, although I suspect that the patient's recent trauma was probably 
enough to cause a pathological fracture through the previously weakened area of 
the C7 vertebral body and was therefore the cause of her sudden increased pain 
as she had been totally asymptomatic prior to that accident of the file cabinet 
falling on her.

[¶7]      Dr. Wecker 
recommended that Bucklin further consult with her oncologist and a neurosurgeon 
in Billings, Montana.  She saw Fred 
McMurry, M.D., a neurosurgeon, as well as one of his associates in the practice 
of neurosurgery, on September 3, 1998.  
It is evident from Dr. McMurry's deposition testimony, which was 
presented to the Commission in the form of a transcript, that he was anxious to 
get to the heart of the matter:

            
She [Bucklin] had a cancer and I assume what we're meeting here about 
today is the relevance of any work related event.

            
She had developed a pain and that was why she was seen.  The pain came on actually while she 
rolled a chair while carrying out some office work and there was quite a bit of 
severe pain after that moment of injury.

            
And in the course of the evaluation, then, this, basically, will 
summarize the case.  There really 
was a problem and it turned out that there was an abnormal area that contained a 
malignant cancer that had migrated from another location in her 
body.

            
But the moment of onset of symptoms came on when she was, when she 
twisted at work.  I think the 
mechanical change that occurred there that pinched the nerve I'm sure did happen 
while she was at work.

            
It turns out, you know, that underlying this area there was another 
abnormal area, you know, perhaps the tissues were weakened by the cancer.  But at the time she developed symptoms 
she had a work related injury and so that's really what this is all 
about.

[¶8]      Counsel for the 
Division spent the next 12 pages of the deposition trying to get Dr. McMurry to 
change that simple and straightforward analysis, but he did not budge from 
it.  Rather, Dr. McMurry's testimony 
remained consistent that the on-the-job injury was the immediate cause of the 
need for her surgery.  For example, 
when asked if anyone treated Bucklin for a "fracture," McMurry 
replied:

Now when 
we use the term fracture, the entire bone was disrupted and, basically, replaced 
by a very abnormal tissue and it was the kind of bone that was vulnerable to 
injury.

If we 
would describe this in comparison to someone who might say fall off a motorcycle 
and have a contusion to the neck with a fracture, the actual findings would look 
quite different.

But the 
mechanism of injury or the mechanism of pain, I guess, what caused the pain, 
involved a compression of this abnormal tissue that really was softer than 
normal bone and portions of disc and bone material had pushed up against a 
nerve.

Now her 
problem was a pinched nerve in lay terms and it was, certainly happened at the 
moment, I don't think there's any question it happened at the moment we just 
discussed [the toppling file cabinet injury].

But your 
question having to do with the fracture, you know, we're dealing with a very 
different appearance on these images because there's actually destruction of 
bone in this area.  So it's a 
different kind of finding on the images.

In one 
case, you'd have a cracked through normal bone and in another case you've got a 
normal bone that's been replaced by a growing tissue that's actually destroying 
the bone and the disruption of that tissue.

            
. . . .

            
And, you know, when you're starting out with a weakened structure and 
undoubtedly that was developing and, I'm sure, at the time of injury there was a 
sudden change in the structure there because of the 
injury.

[¶9]      Bucklin saw Dr. 
Hammond on September 4, 1998.  
Bucklin had previously consulted with Dr.  Hammond as her treating oncologist from 
1984-92 and then again in 1997.  He 
confirmed that the treating physicians suspected there was cancer present, but 
only surgery could confirm that suspicion (a needle biopsy was not a safe 
procedure to perform at C6-C7).  The 
surgery was necessary to stabilize Bucklin's spine but also had the added 
benefit of producing a diagnostic function (to remove tissue and test it for 
malignancy).  Hammond's role, 
pre-surgically, was to insure that there were no breast cancer problems other 
than the one suspected at C7.  Dr. 
Hammond was able to agree with the Division's position that Bucklin's work did 
not cause her cancer, but in virtually all respects, within the range of his 
expertise (which was oncology and not neurosurgery, radiology, or orthopedics), 
Dr. Hammond buttressed the testimony of Drs. McMurry and Wecker that Bucklin's 
problem arose because she suffered an injury at work and, further, that she was 
more susceptible to such an injury because of the condition of the bone in her 
spine at C7, i.e., the bone likely would not fracture without the cancer 
being present, but also, bone that would not fracture unless there was some 
trauma.

[¶10]   On September 22, 1998, surgery was 
performed to remove that portion of Bucklin's cervical spine that was causing 
her problems, a bone graft was used to stabilize her spine, and a tumor was 
removed from that area.  The thrust 
of the Division's objection to Bucklin's claim is found in this exchange during 
Dr. Hammond's deposition:

Q.        [by 
counsel for the Division] Okay.

And 
here's where we are.  Of course, I 
represent the Workers' Compensation Division.

She had 
this accident at work which caused a pinched nerve, and the Division's 
[sic] received bills from health care providers which total over $35,000 
and, you know, a [sic] typically a pinched nerve repair doesn't cost 
anywhere near that much.

And 
maybe this is beyond your abilities, Doctor, but is it likely or possible that 
much of the treatment or some of the treatment was for the preexisting condition 
and ought to be paid by someone else?

A.  That's 

MR. 
BANCROFT:     Is that 
George laughing?

THE 
WITNESS [Dr. Hammond]:  No, that's 
me laughing.

[¶11]   The record both before the 
Commission and the district court is clear that the benefits at issue were only 
for the diagnostic and treatment services provided prior to the neck surgery and 
the neck surgery itself.  Bucklin 
did not seek benefits for any services related to cancer treatments that 
preceded or followed the surgery.

[¶12]   The Division presented no medical 
testimony that contradicted that of Bucklin's treating 
physicians.

[¶13]   Our standard of review in a case 
such as this is well established.  A 
claimant for worker's compensation benefits has the burden of proving all the 
essential elements of the claim by a preponderance of the evidence in the 
contested case hearing.  When an 
agency decides that the party charged with the burden of proof has failed to 
meet that burden, the case is reviewed under the "[a]rbitrary, capricious, an 
abuse of discretion or otherwise not in accordance with law" language of Wyo. 
Stat. Ann. § 16-3-114(c)(ii)(A) (LexisNexis 2001).  On appeal, the complainant has the 
burden of proving arbitrary administrative action.  The agency, as the trier of fact, is 
charged with weighing the evidence and determining the credibility of 
witnesses.  The deference normally 
accorded to the findings of fact by a trial court is extended to the 
administrative agency, and the agency's decision as to the facts will not be 
overturned unless it is clearly contrary to the overwhelming weight of the 
evidence.  Demonstrating evidentiary 
contradictions in the record does not establish the irrationality of the ruling, 
but we do examine conflicting evidence to determine if the agency reasonably 
could have made its finding and order based upon all of the evidence before 
it.  Lunde v. State ex rel. 
Wyoming Workers' Compensation Division, 6 P.3d 1256, 1258-59 (Wyo. 
2000).  In this case, the hearing 
was before the Commission, but our standard of review is no different than it 
would be where the hearing is conducted before a hearing officer.  Wyo. Stat. Ann. § 27-14-616(b)(iv) 
(LexisNexis 2001).

[¶14]   The evidence adduced before the 
Commission compels us to eliminate the topic of a preexisting condition as 
determinative in the resolution of this case.  The presence of a preexisting condition, 
or at least the failure of Bucklin to prove that a preexisting condition was not 
the source of her problems was, of course, the basis for the Commission's denial 
of benefits.  In a case where a 
worker suffered a hemorrhage to his eye during the performance of strenuous 
work, we held that an infirmity in the worker's blood vessels did not preclude 
an award of benefits.  In re 
Scrogham, 52 Wyo. 232, 73 P.2d 300, 307 (1937):

The 
testimony is clear that respondent had never noticed any red color when looking 
at a light previous to the happening on December 27, 1935; that on that day when 
he had lifted the heavy sack of beans to the top of the pile he for the first 
time noticed that condition.  
Medical experts who testified on the trial all say that he would notice 
red color when looking at a light immediately upon a hemorrhage taking place and 
that the strain of lifting could produce the rupture of the blood vessels of the 
eye in their then condition.  The 
inference is irresistible, as we view the evidence, that the workman suffered a 
compensable injury.  That this 
personal injury was an accident, that it arose out of his employment, and that 
it made no difference that the blood vessels in the workman's eye were 
abnormally weak, whether this came by disease or existed from birth, so far as 
the right to compensation is concerned, is abundantly established through the 
reasoning of the decisions above considered.

            
As already intimated, we are quite well satisfied that their logic is 
sound and may safely be followed.  
They harmonize with the liberal construction of the Workmen's 
Compensation Law, which we have repeatedly said would always be applied to 
problems of this character.  It may 
not be amiss to note also that unusually heavy sacks of beans were lifted by the 
workman when no scales were under the hopper, and there appeared to have been 
none on December 27, 1935, when the accident happened to Scrogham.  So he would clearly have been subject to 
some extra strain at least in his work on that day.  However, we do not think this fact 
controlling.  Compensation is not 
made to rest under our law upon the condition of health of the employee or upon 
his freedom from liability to injury through a constitutional weakness or latent 
tendency.  An award is made for an 
injury which is a hazard of the employment, and as said by the Supreme Court of 
Massachusetts in the case of In re Madden, 222 Mass. 487, 111 N.E. 379, 382, 
L.R.A.1916D, 1000, "it is the hazard of the employment acting upon the 
particular employ© in his condition of health and not what that hazard would be 
if acting upon a healthy employ© or upon the average employ©.  The act makes no distinction between 
wise or foolish, skilled or inexperienced, healthy or diseased employ©s.  All who rightly are describable as 
employ©s come within the act."

[¶15]   The governing principle enunciated 
in that decision is mirrored by the legal encyclopedias:

            
A denial of compensation is not warranted merely by the existence at the 
time of the accident of a latent or pre-existing defect or disease which is 
aggravated, accelerated, or lighted up thereby, or of an impaired body 
structure, notwithstanding, except for such disease or impaired condition, the 
injury would not have occurred, for the condition is deemed not the cause of the 
injury but merely a condition which enabled the cause to become operative.  The fact that the employee's disability 
did not result from the injury, but through the disease which the injury 
aggravated, accelerated, or lighted up, does not prevent liability, for the 
claim is not based on the disease but on what the injury did to the 
disease.

99 
C.J.S. Workers' Compensation § 328 (2000).

            
Every worker brings with him to his employment certain infirmities.  For purposes of workers' compensation an 
employer takes an employee as he finds him at the time of his employment, and 
assumes the risk of having a weakened condition, such as alcoholism or cancer, 
aggravated by some injury which might not hurt or bother a perfectly normal 
healthy person.

82 
Am.Jur. 2d Workers' Compensation § 317 (1992).

[¶16]   We hold that the district court 
erred in affirming the Commission's determination that Bucklin "failed to show, 
by a preponderance of the evidence, that treatment and surgery of her neck and 
shoulder injury were not related to a preexisting cancer and are related to her 
work injury of August 18, 1998."  
The expert medical testimony adduced before the Commission established, 
without a doubt, that there was a preexisting cancer.  However, according to that same expert 
medical testimony, its only role under the circumstances of this case was to 
predispose Bucklin to the sort of injury that she suffered while at work.  Bucklin's treating physicians were 
unanimous in opining that the cause of the problem which necessitated surgery 
was the accident that occurred while she was at work, and there is no evidence 
in the record to contradict those opinions.1

[¶17]   The order of the district court 
affirming the Commission's determination is reversed, and this matter is 
remanded to the district court with directions that the Commission's 
determination be reversed and the Division be directed to pay the benefits at 
dispute in this matter.

FOOTNOTES

   
1See Devous v. 
Board of Medical Examiners, 845 P.2d 408, 418 (Wyo. 1993).  As we did in Devous, here, we 
also acknowledge and accept the expertise of the Commission.  However, "[I]f judicial review has any 
purpose, it must be exercised by objectively evaluating evidence in the 
record."  There is no way a 
reviewing court can reach the "subjective determinations" by individual 
Commission members.