Case Title: In re Helm

Citation: 

Docket Number: 

State: wyoming

Court: Wyoming Supreme Court

Date: 1999-06-16T00:00:00Z

Document:
In re Helm1999 WY 82982 P.2d 1236Case Number: 97-326Decided: 06/16/1999Supreme Court of Wyoming

IN THE 
MATTER OF THE WORKER'S COMPENSATION CLAIM OF LINDA K. HELM, AN

 

EMPLOYEE OF FLYING J OIL COMPANY: LINDA K. HELM, 
Appellant

(Petitioner/Claimant),

 

v.

 

STATE OF WYOMING, ex rel., WYOMING 
WORKERS'

SAFETY AND COMPENSATION DIVISION; and FLYING J. OIL 
CO., Appellees   
(Respondents).

 

                                

Certification from the District 
Court of Laramie County The

Honorable Edward L. Grant, 
Judge

 

 

Representing Appellant:

Bill G. Hibbler, Cheyenne, 
Wyoming.

 

 Representing Appellee State ex rel. 
Wyoming Workers' § Safety and Compensation Division:

William U. Hill, Attorney 
General; John W. Renneisen, Deputy Attorney General; Gerald W. Laska, Senior 
Assistant Attorney General; and Bernard P. Haggerty, Assistant Attorney General, 
Cheyenne, Wyoming.

 

     Before LEHMAN, 
C.J., and THOMAS, MACY, GOLDEN, and TAYLOR,* JJ.

    * 
Chief Justice at time of expedited conference; retired November 2, 
1998.

 

     THOMAS, 
Justice.

    
[¶1]     The dispositive issue in this case is 
whether Linda K. Helm (Helm) failed to meet the burden of proof assigned to her 
under Pederson v. State ex rel. Wyoming Workers' Compensation Div., 939 P.2d 740, 742 (Wyo. 1997). Specifically, the hearing examiner decided that Helm 
failed to demonstrate that carpal tunnel syndrome, claimed as a subsequent 
injury, was causally related to an original, covered injury to her knee. The 
failure of proof is subject to the rule on review testing whether the decision 
was arbitrary, capricious, an abuse of discretion, or contrary to law. Helm 
phrases the problem in alternative ways, but the determination that she failed 
to prove the causal connection between the two medical conditions structures the 
issue. The record in this case captures conflicting expert opinions on the issue 
of causation. Causal connection is a question of fact, and the function of 
determining the credibility of the witnesses and weighing the evidence is 
assigned to the hearing examiner. In a case such as this, the decision of the 
hearing examiner will be overturned only if it is clearly contrary to the great 
weight of the evidence. It is not. The Order Denying Benefits, premised on the 
failure of Helm to carry her burden of proof, is affirmed.

 

   [¶2]     In the Brief of Appellant, the issues 
that are raised are:

 

I. Whether a subsequent injury sustained by a 
claimant, which is causally related to an existing compensable injury, should 
also be compensated by the Wyoming Workers' Safety and Compensation Division?

 

II. Whether the hearing examiner's decision denying 
benefits to appellant, Linda K. Helm, is arbitrary, capricious, contrary to law 
or supported by substantial evidence?

 

This Statement of the Issues 
is found in the Brief of Appellee, State of Wyoming, ex rel., Wyoming Workers' 
Safety and Compensation Division (Division):

 

The Employee injured her left knee at work, she 
suffered more that fifty intervening falls, and more than a year later she 
injured her right wrist in a fall on the stairs in her 
house.

 

A. 
Was the denial of benefits for carpal tunnel syndrome supported by substantial 
evidence, within the Hearing Examiner's discretion, and in accordance with 
law.

 

   [¶3]     On September 6, 1995, Helm, who then 
worked as a waitress in a Cheyenne truck stop, slipped on a wet floor at work, 
causing an injury to her left knee. The course of treatment of that injury was 
premised upon an MRI obtained on October 10, 1995, which apparently indicated, 
among other things, that her anterior cruciate ligament (ACL) was intact. Her 
treating physician attempted rehabilitation and conservative treatment, but Helm 
continued to have problems with her knee.  
Almost a year later, another MRI was conducted on September 11, 1996, 
which disclosed a complete tear of the ACL. Helm's physician concluded that this 
tear was causally related to the fall she had sustained at 
work.

 

   [¶4]     The Division arranged for an independent 
medical evaluation by another physician. The physician employed by the Division 
also opined that the tear of the ACL was related causally to the original 
injury:

 

As to whether the original injury of September, 1995 
resulted in the problems she is experiencing, due to the fact the patient has 
had no other specific injury over the course and is continually symptomatic, I 
would conclude the ACL tear is due to her original injury. As to why the MRI 
scan of 1995 was normal, MRI's are not entirely sensitive for cruciate ligament 
injuries. She may have had either a partial tear or the MRI missed the tear of 
the ACL, which may have been present since her initial injury. At any 
rate, due to the lack of another 
significant injury, I think the ACL tear was present after the initial injury. 
Therefore, the problems she is experiencing are directly related to her original 
injury to her left knee.

 

Following this examination, 
the Division agreed to pay for corrective surgery and treatment of the torn 
ACL.

 

   [¶5]     On either November 24 or 25 of 1996, 
Helm sustained a fall while descending the stairs in her home. When she saw her 
treating physician a few days later, she also complained of intermittent 
numbness in her right arm. The numbness persisted, and her physician diagnosed 
the condition as Carpal Tunnel Syndrome (CTS). The physician concluded that 
Helm's problem with her ACL had caused her to fall at home and that fall, in 
turn, resulted in her suffering from CTS. When this information was presented to 
the Division, it sent Helm's file to still another physician for a chart review. 
Based upon his review of the chart, the third physician concluded that Helm's 
CTS was not work related.  Following 
that assessment, the Division denied the claim for benefits for CTS submitted by 
Helm.

 

   [¶6]     Helm requested a hearing on the final 
determination relating to her claim for CTS. On July 2, 1997, that hearing 
occurred before a hearing examiner of the Office of Administrative Hearings. 
Helm testified on her own behalf, and she also called her daughter as a witness. 
She also offered six exhibits: (1) the deposition of her treating physician; (2) 
a letter from the Division to the second physician requesting an evaluation of 
Helm; (3) the independent medical evaluation by the second physician; (4) the 
final determination letter dated September 27, 1995; (5) the final determination 
letter dated November 15, 1996; and (6) the final determination letter dated 
March 3, 1997. All of Helm's exhibits were received into evidence by the hearing 
examiner.

 

[¶7]      The Division 
called no witnesses at the hearing.  
Instead, counsel for the Division conducted cross-examinations of Helm 
and her daughter, and the Division introduced five exhibits of its own: (a) the 
emergency room report dated September 6, 1995; (b) the chart review by the third 
physician; (c) the treatment record from Helm's treating physician; (d) the 
progress report from the Platte County Memorial Hospital dated January 7, 1997; 
and (e) the report of Cheyenne Radiology and MRI dated September 11, 1996. Like 
Helm's exhibits, the Division's exhibits were received into 
evidence.

 

   [¶8]     The evidence most favorable to the 
Division's determination to deny benefits is the review of the medical records 
made by the third physician. In the course of that review, the third physician 
was asked, [c]ould a fall cause carpal 
tunnel syndrome? " His response was:

 

Carpal tunnel is generally considered a repetitive 
use type of syndrome. It is my opinion that it could not occur with just one 
fall. Therefore, I cannot relate the carpal tunnel to the workrelated injury in 
September of 1995.

 

In addition to the testimony 
of the third physician, the Division established by crossexamination of Helm's 
daughter that Helm engaged in craft hobbies, including crocheting, which could 
involve repetitive hand and wrist motions.

 

   [¶9]     At the hearing, most of the Division's 
evidence and its argument focused on a demonstration of the proposition that 
Helm's ACL tear was not related to the fall she sustained at work. The natural 
extension of that theory is that the fall on the stairs at home was not work 
related, and, even if the CTS was a product of the fall on the stairs, it did not result from her 
injury at work. The Division supported this position with the treatment records 
of the treating physician, which indicated that Helm's cruciate ligament was 
intact on her initial visit. The treating physician also testified in his 
deposition that although he believed the ACL tear was a product of the work 
injury, he could not actually prove that fact.

 

   [¶10]  The third physician, from a review of 
the record, presented a contrary conclusion to those of the treating physician 
and the physician who examined Helm on behalf of the Division. The doctor 
explained his conclusion at some length:

 

There was really no instability to the knee noted 
until quite some time after the September 1995 injury. The instability was not 
noted until the slip and fall which occurred almost one year after the original 
work-related injury. If she did have a partial tear and the MRI was not 
sensitive to it, there certainly should have been an effusion accompanying that, 
and this goes against the initial MRI report. It suggests that there could have 
been an internal derangement of the knee. With the lack of effusion, which would 
have signified some injury, even if there was a partial injury, it is my opinion 
that some level of effusion should have been present. It is very hard to believe 
that she may have had a partial tear with a normal ligamentous examination that 
progressed to a complete tear on an MRI a year later. Therefore, I would have a 
hard time conceptualizing and believing that the second MRI showed a complete 
anterior cruciate ligament deficient 
knee and an unstable knee which was giving way and that it would be related to 
her September 6, 1995 injury. In my opinion, the only plausible explanation is 
that there was another intervening injury and that injury caused the knee to be 
completely unstable and caused an anterior cruciate ligament to be torn 
across.

 

It is also my opinion that the fact that she now has 
an anterior cruciate ligament that is completely torn * * * does not appear to 
be compatible or consistent with the examinations that have been rendered to 
her. The initial MRI report showed no effusion, normal findings, and is now 
compared to what is now later being identified as a completely torn anterior 
cruciate ligament and unstable knee. Therefore, it is my opinion that another 
injury must have occurred and her current condition is not related to her work 
injury of September 6, 1995.

 

   [¶11]  After the hearing, the hearing examiner 
ruled in favor of the Division. In the conclusions of law, the hearing examiner 
stated:

 

7. Helm has failed to meet her burden in that she has 
failed to establish a causal nexus between the knee injury in 1995 and the [CTS] 
condition in 1996. From the time of her original knee injury to the November 
1996 fall, Helm fell at least 50 times.  
None of these were at work with Flying J Oil Company and the fall in 
November was in Helm's house. Helm worked as a waitress and this work requires 
extensive repetitive motion. This Office is not persuaded that the work injury 
in 1995 caused Helm's knee to go out and that when she fell in November 1996 it 
caused her [CTS] condition. Too much time has passed between the two injuries, 
there are two different body parts involved and Helm's work as a waitress is 
more likely the cause of the [CTS] than a single fall.

 

Helm sought review of the 
Order Denying Benefits in the district court, and the case was certified to this 
Court in accordance with W.R.A.P. 12.09.

 

   [¶12] Helm suggests that this 
Court should re-evaluate the evidence included in the record of the 
administrative hearing and substitute our judgment for that of the hearing 
examiner. We do not apply our substantial evidence rule in that way because the 
rule limits this Court to analyzing the record to determine if there is evidence 
from which a reasonable person could find the fact or facts as found by the 
hearing examiner. The relationship between the substantial evidence rule as it 
pertains in administrative proceedings and the rule that is used when the agency 
concludes that there has been a failure of proof has produced some 
consternation. These rules are not mutually exclusive. The substantial evidence 
rule is invoked to determine the validity of the factual findings by the agency. 
The failure of a factual finding on a material issue to be supported by 
substantial evidence leads to a conclusion that error is present in the 
proceedings. Assuming, as we determine is true here, that the findings of fact 
are supported by substantial evidence, we then test whether the agency 
determination that a claimant failed to meet the burden of proof assigned to her 
is arbitrary, capricious, an abuse of discretion, or otherwise not supported by 
law.

 

   [¶13]  In a worker's compensation matter, we 
said recently:

 

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.  Martinez v. 
State ex rel. Wyoming Workers' Compensation Div., 917 P.2d 619, 621 (Wyo. 1996). 
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 the law" 
language of Wyo.Stat. § 16-3-114(c)(ii) (1990). City of Casper v. Utech, 895 P.2d 449, 452 (Wyo. 1995). On appeal the complainant * * * has the burden of 
proving arbitrary administrative action. Knight v. Environmental Quality Council 
of State of Wyo., 805 P.2d 268 (Wyo. 1991); Wyoming Bancorporation v. Bonham, 
527 P.2d 432, 439 (Wyo. 1974); Marathon Oil Co. v. Welch, 379 P.2d 832, 836 
(Wyo. 1963); Whitesides v. Council of City of Cheyenne, 78 Wyo. 80, 319 P.2d 520, 526 (1957). The agency, as the trier of fact, is charged with weighing the 
evidence and determining the credibility of witnesses. Utech, 895 P.2d  at 451, 
and cases there cited. 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.  Wyoming Steel & Fab, 
Inc. v. Robles, 882 P.2d 873, 875 (Wyo. 1994).

 

   
Pederson, 939 P.2d  at 742.

 

   [¶14]  Applying the Pederson standard, we do 
not disturb the decision of the hearing examiner unless a claimant, in this 
instance Helm, can demonstrate that it was arbitrary, capricious, an abuse of 
discretion, or otherwise not in accordance with law. This rule affords the 
petitioner the opportunity to show that the findings of fact1 were contrary to the overwhelming 
weight of the evidence. When an agency's action or decision is Abased on a 
consideration of relevant factors and is rational," we will not rule that the 
action or decision is arbitrary or capricious.  Mortgage Guaranty Ins. Corp. v. Langdon, 
634 P.2d 509, 520 (Wyo. 1981).

 

 [¶15]  Helm, as a claimant of worker's 
compensation benefits, was charged with the burden of establishing each element 
of her claim. Shassetz v. State ex rel. Wyoming Workers' Safety and Compensation 
Div., 920 P.2d 1246, 1248 (Wyo. 1996) (quoting Padilla v. Lovern's, Inc., 883 P.2d 351, 354 (Wyo. 1994)). Even though Helm asserts that the burden shifted to 
the Division after she made a prima facie case, the burden of proof does not 
shift to the Division.  Shassetz, 
920 P.2d  at 1250; Johnson v. State ex rel. Wyoming Workers' Compensation Div., 
911 P.2d 1054, 1061-62 (Wyo. 1996); Casper Iron & Metal, Inc. v. 
Unemployment Ins. Com'n of Dept. of Employment of State of Wyo., 845 P.2d 387, 
393 (Wyo. 1993). Properly assigning the burden of proof to Helm, the hearing 
examiner ruled that she had failed to meet that burden and had failed to prove a 
causal relationship between her fall at work and her CTS. That determination is 
exclusively within the province of the hearing examiner, and we defer to his 
judgment. Pederson, 939 P.2d  at 742. The evidence in this case provided a rational basis for the hearing 
examiner to conclude that Helm had failed to establish that causal connection by 
a preponderance of the evidence. This decision was neither arbitrary nor 
capricious. It did not manifest an abuse of discretion, nor can it be said that 
it was otherwise not in accordance with law. It is not contrary to the 
overwhelming weight of the evidence. In such an instance, this Court does not 
re-weigh the evidence because that function is exclusively the province of the 
hearing examiner. Pederson, 939 P.2d  at 742-43.

 

   [¶16]  The Order Denying Benefits entered by 
the Office of Administrative Hearings is affirmed.

    

     GOLDEN, 
Justice, dissenting.

    
[¶17]  Because I believe the 
majority opinion's decision is an erroneous one resulting from its application 
of an incorrect standard of review, I respectfully dissent. The sole issue 
before the hearing examiner was Helm's claim that her wrist injury was causally 
related to a compensable work injury.  
The state of the evidence before the hearing examiner clearly settled 
that her claim was not mere assertion. She established a prima facie case, and 
we must, therefore, examine the hearing examiner's conclusion of law that she 
has failed to meet her burden" as 
legally concluding that her prima facie showing has been satisfactorily rebutted 
by the Division's countervailing evidence. Pan American Petroleum Corp. v. 
Wyoming  Oil & Gas Conservation 
Comm'n, 446 P.2d 550, 557 (Wyo. 1968). In City of Casper v, Utech, 895 P.2d 449, 
452 (Wyo. 1995), we found that when a 
hearing examiner decides that a party has not met its burden of proving its case 
as a whole, Pan American will still apply. Utech then determined, in what the 
majority opinion calls the Pederson standard, that when a claimant fails in her 
burden of proof" to establish a prima facie case, it will apply the arbitrary, 
capricious, . . . not in accordance with law" standard of review. 
Id.

 

   [¶18]  Despite Utech's limitation, the hearing 
examiner's use of the seemingly magic words failed to meet her burden" has 
caused the majority opinion to ignore the Pan American portion of the Utech 
standard of review. Where, as here, a claimant establishes a prima facie case 
and then is found to have failed in proof of the case as a whole, this Court is 
required to review the decision under Pan American and its progeny. Pan American 
requires that in his written decision, the hearing examiner must sufficiently 
set forth the basic facts prompting his ultimate conclusion on factual issues 
that the claimant's established prima facie case has been satisfactorily 
rebutted by the Division's countervailing evidence. Pan American, 446 P.2d  at 
557.

 

   [¶19]  In my judgment, this hearing examiner's 
written decision falls far short of the Pan American requirement. The relevant 
facts show that Helm was under the care of Dr. Gasser and saw him several times 
after she was initially injured on September 6, 1995. Dr. Gasser's deposition 
testimony plainly stated his expert opinion that the instability of her injured knee 
caused numerous falls, and Helm injured her wrist from one of these falls. In an 
evaluation arranged by the Division, Dr. Rangitsch also examined Helm and 
testified that the knee was grossly unstable. " Without personally examining 
Helm, Dr. Akmakjian reported that Helm's knee was completely unstable" but does 
not have a trick knee that caused the fall. " It is unclear of which fall he 
speaks. Dr. Akmakjian was not asked for his opinion as to whether Helm actually 
suffered from carpal tunnel syndrome, 
but he did reply to the question [c]ould a fall cause carpal tunnel syndrome" in 
this manner:

 

Carpal tunnel is generally considered a repetitive 
use type of syndrome. It is my opinion that it could not occur with just one 
fall. Therefore, I cannot relate the carpal tunnel to the workrelated injury in 
September of 1995.

 

   [¶20]  As a reviewing court, we have no idea 
why the hearing examiner accepted the speculative opinion of Dr. Akmakjian, who 
performed a paper review, " over the opinions of Dr. Gasser, the claimant's 
treating physician, and Dr. Rangitsch, who also saw the claimant upon the 
Division's request. Paragraph seven of the hearing examiner's conclusions of law 
is not explanatory and is actually baffling. The claimant fell at least fifty 
times between the date of her September, 1995, work-related fall, which the 
Division at all times agreed caused the original knee injury, and the date of 
her November, 1996, fall which injured her right wrist and arm for which she 
sought an award. It is irrelevant that those falls did not occur at work. A 
preponderance of the evidence shows that the September, 1995, work-related knee 
injury caused these falls, and Dr. Akmakjian's testimony does not refute it. In 
finding that Helm failed in her burden of proof, the hearing examiner concludes 
[t]oo much time has passed between the two injuries. " That is an irrelevant 
finding because no medical expert based an opinion on the passage of time. He 
also concludes there are two different body parts involved. " No kidding! That 
is also irrelevant in the face of the obvious connection between an injured knee 
that gives way, causing one to fall, and the injury of the wrist and arm in the 
fall. Finally, the hearing examiner interestingly concludes, without any 
findings of fact to support it, that the claimant's waitress work requires 
extensive repetitive motion" and that work is more likely the cause of the 
[carpal tunnel] than a single fall. " Dr. Akmakjian's report may have cast doubt 
on whether the wrist injury was properly labeled as carpal tunnel syndrome, but 
no evidence refuted that her wrist and arm were injured by the single fall and 
that injury is compensable. I have no confidence in a hearing examiner's 
decision which contains such deficient and baffling reasoning, and I must 
respectfully dissent.

 

         

FOOTNOTES

1 
Although the hearing examiner labeled his finding that Helm's CTS was not work 
related as a conclusion of law, it is more properly a finding of fact. In such 
cases, this Court will review findings in their proper category, regardless of 
how the hearing examiner has labeled them. Billings v. Wyoming State Bd. Of 
Outfitters and Professional Guides, 837 P.2d 84, 87 (Wyo. 1992).  See also Kilmer v. Dillingham City 
School Dist., 932 P.2d 757, 764 n.8 (Alaska 1997) and Battaglia Properties, Ltd. 
v. Florida Land and Water Adjudicatory Com'n, 629 So. 2d 161, 168 (Fla. App. 
1993). Lest there be any doubt, we reiterate that the question of whether an 
injury occurred in the course of employment is a question of fact. Cabral v. 
Caspar Bldg. Systems, Inc., 920 P.2d 268, 269 (Wyo. 1996).