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

Citation: 

Docket Number: 

State: wyoming

Court: Wyoming Supreme Court

Date: 2003-01-15T00:00:00Z

Document:
IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF: HIMES2003 WY 561 P.3d 393Case Number: 01-65Decided: 01/15/2003
OCTOBER TERM, A.D. 2002

 

                                                                                                            

 

IN 
THE MATTER OF THE WORKER'S

COMPENSATION 
CLAIM OF:

 

PENNY 
HIMES,

 

Appellant(Employee-Claimant),

 

v.

 

PETRO 
ENGINEERING & CONSTRUCTION,

 

Appellee(Employer-Objector),

                                                                                                

and

 

STATE 
OF WYOMING ex rel. WYOMING

WORKERS' 
COMPENSATION DIVISION,

 

                             Appellee(Objector-Defendant).

 

 

 

W.R.A.P. 
12.09 Certification from the District Court of Laramie 
County

The 
Honorable Edward L. Grant, Judge 

 

 

 

Representing 
Appellant:

James 
W. Gusea, Cheyenne, Wyoming

Representing 
Appellee State of Wyoming ex rel. Wyoming Workers' Compensation 
Division:

Hoke 
MacMillan, Wyoming Attorney General; John W. Renneisen, Deputy Attorney General; 
Gerald L. Laska, Senior Assistant Attorney General; David L. Delicath, Assistant 
Attorney General.  Argument by Mr. 
Delicath.

 

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

*Chief 
Justice at time of oral argument

 

 

GOLDEN, 
Justice.

 

[¶1]           
Worker's 
compensation claimant appeals from a determination from the Medical Commission 
Hearing Panel that she is not entitled to a permanent partial impairment rating 
above the fifteen percent she has already received from the Division.  Finding no error, we 
affirm.

 

 

ISSUES

 

[¶2]           
Appellant 
presents two issues:

 

I.  Was the decision of the Medical 
Commission contrary to Penny Himes' constitutional right to due process; and was 
the decision of the Medical Commission without observance of procedure required 
by law in that the decision purported to determine issues that had not been 
raised?

 

II.  Was the decision to uphold the permanent 
impairment rating of only 5% unsupported by substantial evidence in that both of 
the physicians hired by the Division reported the employee/claimant was unable 
to work at the time of their examinations?

 

Appellee 
simplifies the issues thus:

 

I.  Did the Medical Commission determine 
issues that were not properly before it in violation of Appellant's right to due 
process?

 

II.  Did substantial evidence support the 
Medical Commission's determination that Appellant is not entitled to an 
increased permanent impairment rating?

 

 

FACTS

 

[¶3]           
In 
1990, Penny Himes was involved in a non-work related automobile accident in 
which she sustained whiplash type injuries.  She testified that these injuries were 
resolved by 1992.  On November 17, 
1992, Himes was involved in a work related accident while handling 
scaffolding.  She currently alleges 
she suffered neck, back and shoulder injuries as a direct result of the work 
related accident.  She visited the 
hospital emergency room on November 18, 1992, and the nurse's report from that 
visit indicates that Himes complained of pain in the right lower lumbar region 
and numbness in both legs, burning up to the shoulders, and migraine 
headache.  There was also an 
indication of left thoracic pain.  
The diagnosis was lumbar strain.  

 

[¶4]           
The 
Workers' Compensation Division (the "Division") initially awarded Himes 
temporary total disability.  She was 
evaluated in December 1993 by Dr. Meade Davis.  Dr. Davis opined that "the on-the 
job-injury of November 17, 1992, substantially aggravated a prior existing 
injury to her neck and back from a car accident in September 1990."  He stated that he believed she could 
benefit from appropriate physical therapy but, if given a current physical 
impairment rating, he would rate her at 4% whole body impairment.  In May 1994, the Division and Himes 
stipulated and agreed to a 4% whole body permanent physical impairment rating. 

 

[¶5]           
According 
to Himes, she continued to receive treatments from Jonathan Singer, D.O., 
between 1993 and 1996 for back and neck pain with some mention of shoulder 
pain.  Himes testified that she saw 
him on a diminishing basis, eventually as infrequently as once every six 
months.  Himes testified that her 
condition deteriorated during that time.  
In 1996 Himes discontinued treatment with Dr. Singer and went instead to 
a chiropractor who referred her to Dr. Ken Pettine, an orthopedic surgeon.  Dr. Pettine first saw Himes in May 
1996.  In January 1997, Dr. Pettine 
performed surgery on Himes including fusion at C6-C7 and at L6-S1.  After this surgery Himes was evaluated 
by Dr. Bruce Lockwood.  Dr. Lockwood 
concluded that Himes had sustained an ascertainable loss and gave her a 5% 
impairment rating for her lumbar spine and a 5% impairment rating for her 
cervical spine, for a total 10% whole body impairment rating.  Dr. Lockwood suggested that, although he 
did not have sufficient information to ascertain an acceptable apportionment, it 
would be appropriate to apportion the impairment between the injuries caused by 
the automobile accident and the injuries caused by the work accident.  Despite Dr. Lockwood's suggestion of 
apportionment, the Division awarded Himes a 10% permanent partial impairment 
rating.  On April 9, 1998, the 
Division and Himes further stipulated and agreed to an increase in the permanent 
physical impairment rating to 15% whole body impairment. 

 

[¶6]           
Shortly 
after this stipulation and agreement was accepted, Himes underwent surgery on 
her right shoulder and then surgery on her thoracic spine.  The Division paid for both 
procedures.  In 1999 Himes underwent 
another surgery to her cervical spine that was directly related to her 1997 
fusion surgery.  The Division again 
paid for this cervical spine surgery.  
Although the record is silent as to what next transpired, it appears that 
Himes then applied for yet another increase in her permanent partial impairment 
rating.  The Division requested 
Himes be evaluated by Dr. Michael Kaplan.  
The Division requested that Dr. Kaplan assess only the impairment to the 
cervical spine.  Dr. Kaplan rated 
her at 5% whole body impairment with regard to the cervical spine only. 

 

[¶7]           
While 
the record before this Court is devoid of any objection from Himes, in her brief 
and in her argument before the Commission she suggests that she objected to the 
rating at least in part because of its limited scope.  She wanted a rating for her thoracic 
spine and shoulder impairments as well as her cervical and lumbar spine.  Seemingly in response to this objection 
to the first rating, the Division sent Himes to Dr. Mark Rangitsch for a second 
evaluation.  The Division, however, 
maintained that the scope of the rating was for the cervical spine only.  Dr. Rangitsch also rated Himes at 5% 
impairment with regard to the cervical spine only.  Dr. Rangitsch also mentioned that the 
lack of medical intervention between 1993 and May 1996 led him to question if 
the cervical spine impairment was attributable to the work accident. 

 

[¶8]           
Since 
neither impairment rating was above the 5% rating received earlier by Dr. 
Lockwood for her cervical spine, the Division denied Himes' application for an 
increase in her permanent partial impairment rating.  Himes requested a contested case 
hearing.  The Division referred the 
matter to the Office of the Medical Commission.  At the hearing, Himes argued that she 
should not be subject to a permanent impairment rating because she had not yet 
attained a level of ascertainable loss.  
Himes wanted a reinstatement of her temporary total disability 
benefits.  In the alternative, since 
both Dr. Kaplan and Dr. Rangitsch also stated she was not capable of working 
yet, she argued that her impairment rating obviously must be much higher, and it 
would be if all her medical impairments were rated, not just her cervical spine 
impairment.

 

[¶9]           
The 
Commission found that Himes had reached a level of ascertainable loss and that 
she was not entitled to a greater impairment rating than the 15% she already had 
been awarded.  The Commission 
specifically found that Himes failed to carry her burden of proof that any of 
her current medical impairments are related to her 1992 work accident.  The Division then contacted her health 
care providers and informed them that it would no longer pay for any medical 
treatment for Himes.  Himes timely 
appealed the decision of the Commission to the district court, which certified 
the appeal to this Court pursuant to W.R.A.P. 12.09.

 

 

STANDARD 
OF REVIEW

 

[¶10]      
We 
review appeals certified to us pursuant to W.R.A.P. 12.09 applying the appellate 
standards that are applicable to a reviewing court of the first instance.  Weaver v. Cost Cutters, 953 P.2d 851, 854 (Wyo. 1998).  W.R.A.P. 
12.09(a) limits judicial review of administrative decisions to a determination 
of those matters that are specified in Wyo. Stat. Ann. § 16-3-114(c) (LexisNexis 
2001):

 

(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:

 

(i) 
Compel agency action unlawfully withheld or unreasonably delayed; 
and

(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. 

 

[¶11]      
The 
interpretation and correct application of the provisions of the Wyoming Worker's 
Compensation Act are questions of law over which we exercise plenary 
review.  We afford no deference to 
an agency's conclusions of law and will affirm the same only if they are in 
accord with the law.  Weaver, 
953 P.2d  at 855 ("When an agency has not invoked and correctly applied the 
correct rule of law, we correct the agency's errors.") 

 

[¶12]      
When 
both parties submit evidence in a contested case in which factual issues are 
involved, we review the case under the substantial evidence test.  Newman v. Wyo. Workers' Comp. 
Div., 2002 WY 91, ¶22, 49 P.3d 163, ¶22 (Wyo. 2002).  In determining whether substantial 
evidence supports an agency decision, we examine the entire record.  If substantial evidence exists to 
support an agency decision, we will not substitute our judgment for the judgment 
of the agency and will affirm the agency decision.  Id. at ¶24.

 

 

DISCUSSION

 

[¶13]      
Himes' 
issues are best resolved by first looking at the contested case hearing 
procedure.  Himes requested a 
modification of her benefits.  A 
modification can only be granted pursuant to the terms of Wyo. Stat. Ann. § 
27-14-605(a) (LexisNexis 2001) that allows, in pertinent part, "for a 
modification of the amount of benefits on the ground of increase . . . of 
incapacity due solely to the injury."  
Himes argued she was entitled to an increase in her permanent physical 
impairment (PPI) rating because she had suffered an increase in incapacity due 
to numerous physical impairments that had arisen as the result of her work 
accident.

 

[¶14]      
The 
fact that the Division had paid medical benefits for Himes' various medical 
conditions in the past did not preclude the Division from challenging Himes' 
request for a higher PPI rating.  
Hall v. State ex rel. Wyoming Workers' Comp. Div., 2001 WY 136, 
¶14, 37 P.3d 373, ¶14 (Wyo. 2001) ("The Division's uncontested award of benefits 
is not a final adjudication that precludes the Division from challenging future 
benefits."); see also Tenorio v. State ex rel. Wyoming Workers' Comp. 
Div., 931 P.2d 234, 239 (Wyo. 1997).  
Once Himes requested an increase in her PPI rating, it became her burden 
to prove all essential elements of her claim by a preponderance of the 
evidence:

 

A 
claimant is not guaranteed future benefits on the basis of a prior award.  Further, it is not the burden of the 
employer or the Division to prove that a claimant is not entitled to a 
continuation of . . . benefits.  
Rather, the claimant has the burden of showing that he is entitled to a 
continuance of benefits.  With 
respect to outstanding claims for worker's compensation benefits, the claimant 
bears the burden of proving all essential elements of his claim by a 
preponderance of the evidence.

 

Snyder 
v. State ex rel. Wyo. Workers' Comp. Div., 
957 P.2d 289, 293 (Wyo. 1998) (citations omitted).  One essential element was relating all 
the physical ailments of which Himes was complaining to the work accident.  Another essential element was providing 
medical evidence of a statutorily acceptable PPI rating for all such physical 
ailments.  

 

[¶15]      
At 
the hearing then, Himes had an affirmative duty to present evidence that she was 
entitled to a higher PPI rating due to injuries related to her work 
accident.  A thorough review of the 
record reveals that, at the hearing, Himes only argued that the doctors who 
provided an impairment rating should not have limited their ratings to her 
cervical spine condition.  She did 
not present any credible evidence that her other physical impairments such as 
her thoracic or shoulder conditions were related to her work accident.  Further, Himes presented absolutely no 
evidence on the issue of her PPI rating.  
She did not present any medical evidence that her cervical spine 
condition was improperly rated.  She 
did not present any medical evidence regarding a proper rating for any of her 
other medical conditions.  Himes 
simply failed to offer any evidentiary basis to support a higher PPI rating than 
the 15% she had already been awarded.  
Given the state of the evidence, the Commission would have erred had it 
awarded a higher PPI rating.  

 

[¶16]      
Himes' 
arguments on appeal confuse the burden of proof.  In her second issue, Himes alleges the 
Commission committed error by upholding the PPI rating of 5% to her cervical 
spine.  She argues the 5% was not 
supported by substantial evidence.1  This argument fails to recognize that it 
is not the Division's burden to substantiate its PPI rating; it is her burden to 
prove she is entitled to a higher PPI rating.

 

The 
burden is assigned to the claimant . . . to establish every essential element of 
his claim by a preponderance of the evidence.  Deroche v. R.L. Manning Company, 
Wyo., 737 P.2d 332 (1987); McCarty v. Bear Creek Uranium Company, Wyo., 
694 P.2d 93 (1985); Alco of Wyoming v. Baker, Wyo., 651 P.2d 266 
(1982).  The Wyoming rule is in 
accord with the general rule requiring that the party asserting a change of 
condition (increase or decrease of incapacity) must assume the burden of proof 
whether the party be claimant or employer.  
3 A. Larson, Workmen's Compensation Law § 81.22(c) (1983).  In invoking § 27-12-606, W.S.1977 
[precursor to § 27-14-605(a)], [the claimant] assumed the burden of 
demonstrating "increase of incapacity due solely to the 
injury."

 

Lehman 
v. State ex rel. Wyoming Workers' Comp. Div., 
752 P.2d 422, 425 (Wyo. 1988).

 

[¶17]      
Instead 
of putting on affirmative proof of the essential elements of her claim, she 
simply argued that the Division incorrectly limited the scope of the impairment 
rating.  The primary argument 
advanced in her brief is that the "matter should be remanded to the Division for 
an appropriate rating with regard to all of the problems previously treated 
operatively, including her shoulder, thoracic and lumbar spine." The purpose of 
the contested case hearing was for her to prove the nature and extent of her 
permanent physical impairments and that such impairments were directly related 
to her work accident.  She failed to 
do so.  The Commission correctly 
refused to grant Himes a PPI rating above the 15% she has already been awarded 
because she failed to carry her burden of proving all essential elements of her 
claim to a higher PPI rating.  

 

[¶18]      
Himes' 
first issue also fails to recognize her burden of proof and required 
administrative hearing procedures.  
The Commission included in its order specific findings that Himes did not 
meet her burden of proving that her current physical complaints are related to 
her work injury.  Himes argues that 
the Commission should not have made specific findings regarding causation of her 
current medical complaints.  Her 
primary contention in this regard is that causation was at issue only as a 
defense to her claim, "not as an ultimate issue to be decided by the Medical 
Commission."  

 

[¶19]      
Causally 
relating her current medical complaints to her work accident was, of course, an 
essential element of her claim and thus directly at issue.  The Commission made specific findings in 
its order that she did not meet her burden proving that any of her current 
medical complaints were related to her work accident.  These findings by the Commission are not 
only appropriate, but also required.  
Pursuant to the Wyoming Administrative Procedure Act (W.A.P.A.) the 
Commission is charged with including in its final decision "findings of fact and 
conclusions of law separately stated.  
Findings of fact, if set forth in statutory language, shall be 
accompanied by a concise and explicit statement of the underlying facts 
supporting the findings."  Wyo. 
Stat. Ann. § 16-3-110 (LexisNexis 2001).  
We have interpreted this statutory requirement rather 
extensively:

Our 
rule is that this statutory provision demands findings of basic facts upon all 
material issues in the proceeding and upon which the ultimate findings of fact 
or conclusions are based.  FMC v. 
Lane, 773 P.2d 163 (Wyo. 1989).  
In Cook v. Zoning Board of Adjustment for the City of Laramie, 776 P.2d 181, 185 (Wyo. 1989), we stated:

 

"It 
is insufficient for an administrative agency to state only an ultimate fact or 
conclusion, but each ultimate fact or conclusion must be thoroughly explained in 
order for a court to determine upon what basis each ultimate fact or conclusion 
was reached.  The court must know 
the why."  Geraud v. 
Schrader, 531 P.2d 872, 879 (Wyo.), cert. denied sub nom. Wind 
River Indian Education Association, Inc. v. Ward, 423 U.S. 904, 96 S. Ct. 205, 46 L. Ed. 2d 134 (1975).

 

Mekss 
v. Wyoming Girls' School, State of Wyo., 
813 P.2d 185, 201-02 (Wyo. 1991), cert. denied, 502 U.S. 1032 
(1992).  Given the requirement of 
strict compliance with § 16-3-110, the Commission was obligated to include in 
its order the findings upon which it based its denial of an increased PPI 
rating.  This included findings 
regarding the issue of causation with regard to each medical condition Himes put 
at issue.  

 

[¶20]      
While 
there is no error in the Commission's making specific findings regarding 
causation and putting those findings in its order, we are told that the Division 
has used those findings to inform health care providers that it will not pay for 
any future medical treatments for Himes.  
It is important to note that the order of the Commission contains no 
language regarding future benefits.  
The separate actions of the Division are not properly before this Court 
on this appeal.  The Division, 
however, concedes in its brief that it should not have made any decisions 
regarding Himes' eligibility for future benefits.2  The Division states in its brief that 
Himes may submit additional claims for future benefits and will be entitled to a 
hearing if such are denied.  

 

[¶21]      
Himes 
is not satisfied with this concession, however, because, as long as the findings 
regarding causation are in the order, she faces a potential problem.  This potential problem is the result of 
the operation of the fundamental doctrines of law known as res judicata and 
collateral estoppel.  See 
Slavens v. Board of County Comm'rs for Uinta County, 854 P.2d 683, 685 
(Wyo. 1993) ("This court has held that both res judicata and collateral estoppel 
apply to final adjudicative determinations by administrative tribunals."3)  The effect of the doctrines of res 
judicata and collateral estoppel should be well known to all attorneys.  If certain conditions are met, the 
doctrines prevent claims and issues adjudicated in a prior contested proceeding 
from being relitigated between the same parties.  It is not for this Court to decide if 
the doctrine of res judicata or collateral estoppel will apply in a future 
proceeding.  We only note that they 
are available as potential defenses to the Division in a future proceeding for 
benefits, and it is this possibility to which Himes 
objects.

 

[¶22]      
Himes 
strongly urges this Court to view the issue in terms of a violation of due 
process.  She does not, however, 
present any legally supported constitutional argument in her brief.  Her due process argument is that she was 
never warned that she might lose future benefits as a result of findings made 
during the course of the instant proceeding.  Unfortunately for Himes, the potential 
availability of the defense of res judicata or collateral estoppel in a future 
proceeding simply does not present a due process violation.4  She phrases her argument in terms of the 
Division's determining issues that had not been raised, and thus she had no 
notice, but, as has been discussed already, she put causation directly at issue 
by bringing her claim.  No due 
process violation is presented by the Commission's findings that Himes failed to 
meet her burden of proving that her current medical conditions are related to 
her work accident.

 

 

CONCLUSION

 

[¶23]      
This 
case presents no due process violations.  
By requesting a modification in benefits, Himes put all elements of her 
claim at issue, including whether or not her current complaints regarding 
physical impairments are related to her work accident.  The Commission is required under the 
W.A.P.A. to make findings on these issues.   That there might be collateral 
consequences to this procedure does not implicate any constitutional due process 
issues.  The Division has confessed 
that the decision of the Commission should not have been used to directly cut 
off future benefits so hopefully that issue is resolved.

 

[¶24]      
The 
Commission's denial of Himes' request for a higher PPI rating is supported by 
the record.  Himes failed to present 
evidence supporting that she was entitled to a modification in her 
benefits.  

 

[¶25]      
Affirmed.

 

 

FOOTNOTES

1To the extent Himes references her ability to work in the phrasing of her 
issue, it is misleading.  The only 
issue before the Commission was Himes' PPI rating.  A PPI rating is strictly a medical 
question and is unrelated to the claimant's ability to work.  "An injured employee's impairment shall 
be rated by a licensed physician using the most recent edition of the American 
Medical Association's guide to the evaluation of permanent impairment."  Wyo. Stat. Ann. § 27-14-405(g) 
(LexisNexis 2001).

2These decisions should only be made once a request for benefits is 
submitted.  See In re 
Wright, 983 P.2d 1227, 1233 (Wyo. 1999) ("the Commission lack[s] subject 
matter jurisdiction over future claims").  

3The Commission clearly qualifies as an administrative tribunal pursuant 
to Wyo. Stat. Ann. § 27-14-616(b)(iv) (LexisNexis 2001):  "When hearing a medically contested 
case, the [Commission] panel shall serve as the hearing examiner and shall have 
exclusive jurisdiction to make the final administrative determination of the 
validity and amount of compensation payable under this act."  

4We note 
that, while the existence of the potential defense of res judicata or collateral 
estoppel does not raise due process concerns, the actual application of such 
defenses might.  "[E]xtreme 
applications of the doctrine of res judicata may be inconsistent with a federal 
right that is fundamental in character.'"  
Richards 
v. Jefferson County, Alabama, 
517 U.S. 793, 797, 116 S. Ct. 1761, 1765, 135 L. Ed. 2d 76 (1996).