Case Title: IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF CALVIN D. PHILLIPS V. TIC--THE INDUSTRIAL COMPANY OF WYOMING, INC.,

Citation: 

Docket Number: 

State: wyoming

Court: Wyoming Supreme Court

Date: 2005-04-08T00:00:00Z

Document:
IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF CALVIN D. PHILLIPS V. TIC--THE INDUSTRIAL COMPANY OF WYOMING, INC.,2005 WY 40109 P.3d 520Case Number: 04-58Decided: 04/08/2005
 
 
APRIL 
TERM, A.D. 2005

 
 
                                                                                                                                   

 
 
IN THE 
MATTER OF THE WORKER'S

COMPENSATION 
CLAIM OF:

 
 
CALVIN 
D. PHILLIPS,

Appellant

(Petitioner),

 
 
v.

 
 
TIC--THE 
INDUSTRIAL COMPANY

OF 
WYOMING, INC.,

 
 
Appellee

(Respondent).

 
 

 
 

Representing 
Appellant:

 
 
            
David M. Gosar, Jackson, Wyoming.

 
 

Representing 
Appellee:

 
 
            
Timothy M. Stubson of Brown, Drew & Massey, LLP, Casper, Wyoming.

 
 
Before 
HILL, C.J., and GOLDEN, KITE, and VOIGT, JJ., and KAUTZ, 
D.J.

 
 
VOIGT, 
Justice, delivered the opinion of the Court; KITE, Justice, filed a dissenting 
opinion.

 
 
 
 
  
VOIGT, 
Justice.

 
 
[¶1]      On June 14, 2001, 
Calvin D. Phillips (the appellant) injured his back in the course of his 
employment with The Industrial Company of Wyoming, Inc. (the appellee).  The Wyoming Workers' Safety and 
Compensation Division (the Division) awarded the appellant temporary total 
disability benefits in October 2001.  
The appellee objected to this award and a contested case hearing 
ensued.  The hearing examiner 
decided that the appellant's temporary total disability benefits should cease as 
of April 1, 2002, because the appellant had reached maximum medical improvement 
(which term may be used interchangeably with the term "ascertainable 
loss").  The appellant appeals from 
that determination.  We 
affirm.

 
 

 
 
[¶2]      We find the 
dispositive issue in this appeal to be whether the record contains substantial 
evidence to support the hearing examiner's finding that the appellant had an 
ascertainable loss by April 1, 2002.

 
 

 
 
[¶3]      In May 2001, the 
appellant, age sixty, began working for the appellee near Lysite as a 
"millwright helper" and maintenance worker.1  On June 14, 2001, the appellant injured 
his lower back at work while emptying twenty-five gallons of fluid from a 
fifty-five gallon drum.  The 
appellant continued to work after the injury, with some restrictions,2 until he was "laid off" on August 
24, 2001.

 
 
[¶4]      The appellant 
ultimately sought medical attention for back pain and left leg pain (extending 
downward to the knee).3  He was prescribed a conservative 
treatment regimen including anti-inflammatory medication, pain medication, two 
steroid injections,4 and physical therapy.5  According to Dr. Clayton Turner, the 
appellant's treating orthopedic surgeon, the appellant did not progress 
satisfactorily in this treatment regimen.  
A July 11, 2001, MRI revealed that the appellant had a "small left 
paracentral disc herniation arising from the L4/L5 disc, impinging upon the 
origin of the left L5 nerve root."  
On October 29, 2001, Dr. Turner performed a "surgical decompression . . . 
partial discectomy at L4-5" to remove a portion of the disc and relieve the 
pressure on the nerve.

 
 
[¶5]      According to the 
literature Dr. Turner provides his patients regarding surgery of this 
nature:

 
 
            
A lumbar discectomy is an operation to remove pressure on a nerve in your 
spine.  . . . Removing the fragment 
of herniated disc material pressing on the nerve root subsequently eliminates 
the pressure on the nerve.

 
 
            
The general purpose of considering this approach is to relieve the leg 
pain due to an irritated nerve, usually due to a herniated disc . . ..  It is critical that patients understand 
that any patient with the above-mentioned herniated disc . . . actually has two 
underlying spinal problems.  The 
first problem is a tear in the disc . . . causing back pain.  The second problem is the pressure on a 
nerve in your spine, which causes leg pain.

 
 
            
The discectomy . . . allows removal of the pressure on the nerve, which 
nicely relieves leg pain.  However, 
the other problem is not treated and any back pain present before the operation 
is likely to continue after the operation.

 
 
            
Most patients complain of both back and leg pain.  Discectomy is a reasonable approach if 
the patient's primary complaint is leg pain and the patient feels that the back 
pain present before surgery is tolerable.  
If back pain itself is substantial and not tolerable then a fusion may 
need to be considered.  The primary 
reason to consider a discectomy alone (to relieve leg pain only and tolerate 
back pain) and avoid a fusion is that the recovery from a spinal fusion is quite 
prolonged.  Any spinal fusion 
requires six to nine months of recovery with considerable activity restriction, 
whereas recovery from a discectomy takes only four to six 
weeks.

 
 
. . 
.

 
 
            
Post-Laminectomy Syndrome:  
One possible complication is worsening of the back pain present before 
surgery, which is known as Post-Laminectomy Syndrome.  This occurs in approximately 5-10% of 
patients who undergo lumbar discectomy.  
If worsening of back pain is substantial then a fusion operation may be 
necessary in the future.

 
 
. . 
.

 
 
            
Patients routinely experience a dramatic, remarkable reduction in their 
leg pain.  . . 
.

 
 
            
. . . As stated in the introduction, persistence of the back pain present 
before the operation is expected.  
Increased pain with prolonged sitting and driving is expected as 
well.  As per the other activities 
described above, slowly increase your exposure to these activities and expect 
decreased discomfort with time.

 
 
LONG-TERM 
RESTRICTIONS

 
 
            
There are no long-term restrictions with regards to recreational 
athletics.  In general, I recommend 
that you develop the habit of bending at the knees and not the spine to preserve 
spinal function and avoid additional spinal injury at the same or another level 
in the years ahead.  For heavy 
laborers, specific complex rehabilitation may be necessary and work return is 
variable.  Return to physically 
demanding work that involves regular heavy lifting, bending and twisting is not 
recommended.

 
 
"Fusion" 
is defined in this literature as "growing together of the two bones surrounding 
an injured disc so that painful motion is stopped."

 
 
[¶6]      The appellant 
reported that his left leg pain almost instantly disappeared following the 
discectomy.  His medical records 
indicate that on November 7, 2001, he was "doing very well" and had "active full 
range of motion of his lower extremities . . .."  The appellant was advised to avoid 
lifting more than twenty to thirty pounds, to avoid repetitive stooping, 
bending, twisting or lifting for the next four weeks, to increase his daily 
activities as tolerated, and to walk as much as he would like; if the appellant 
had minimal to no back pain six weeks after the surgery, he could resume 
vigorous physical activities and do whatever was within his comfort level.6

 
 
[¶7]      The appellant 
stated that he felt "[g]ood, but not all the way right" after the 
discectomy.  On December 4, 2001, 
medical records indicate that the appellant was "doing very well" but complained 
of "some increased pain in his back and across his left hip."  The appellant exhibited guarded active 
range of motion of his back and his back was "bothersome" when he engaged in 
"repetitive stooping, bending, twisting to include cleaning around the house or 
yard."  According to Dr. Turner, it 
is "not uncommon after discectomy type procedures that patients will experience 
back pain."  The appellant was 
placed on medication and instructed to avoid repetitive stooping, bending, 
twisting or lifting for four weeks.  
The appellant reported that the medication did not help and that his pain 
had increased as of December 12, 2001.

 
 
[¶8]      On December 20, 
2001, the appellant still had a "deep" backache, frequent discomfort in the 
lower back with radiation in the left buttock, and was advised to pursue 
physical therapy and resume anti-inflammatory medication.  Physical therapy records indicate that 
as of December 24, 2001, the appellant was experiencing lower back pain 
associated with his initial injury and all lumbar spine movements were "rachet 
like & non-fluid."  The 
therapist noted decreased lumbopelvic dynamic stability, decreased lumbar spine 
range of motion, decreased pain with activity, increased swelling in the lumbar 
spine, and that Dr. Turner was "contemplating fusion" if physical therapy was 
not successful.  The appellant was 
to continue physical therapy three times per week for six weeks.7

 
 
[¶9]      On January 17, 
2002, the appellant reported that he had "good" days and "bad" days, ongoing 
mechanical back pain, and the ratcheting effect continued.  His medical records state that this was 
most likely "discogenic" in nature and that he was to continue the conservative 
treatment regimen for another month.8  The appellant's January 29 medical 
records note persistent back pain and intermittent right hip and thigh 
pain.  On February 21, 2002, the 
appellant reported mechanical back pain and "ratcheting sensation . . . 
when getting up" and the medical records attribute this to "ongoing discogenic 
back pain."  The appellant was 
advised to continue with physical therapy and medication for another two months, 
although the record only reflects that the appellant attended physical therapy 
until March 4, 2002.9

 
 
[¶10]   The appellant testified that his 
physical activity to this point varied.  
For the first four months or so after the discectomy, the appellant 
engaged in very little activity aside from walking and physical therapy.  At some point, the appellant attempted 
housework such as the dishes, vacuuming, and cleaning.  These activities apparently "caused a 
problem" and the appellant stated that his doctor told him "not to do 
that."  He also tried to lift a bale 
of hay and "found that that was not the thing to do."  The appellant's wife, Cathy Phillips, 
stated that the appellant was "in too much pain to do most things.  And any of the outdoors chores, I always 
did them"; most things "required bending or lifting something, and it couldn't 
be done."  She added that after the 
discectomy, the appellant used pain medication and she did not "know that . . . 
he was ever going to get better.  It 
didn't seem like it."

 
 
[¶11]   In March 2002, TIC hired a private 
investigator to surveil the appellant.  
The investigator summarized her observations as 
follows:

 
 
During a 
three-day surveillance of [the appellant] conducted 04/01/02-04/03/02 at his 
residence in Riverton, WY, investigator established that he is actively engaged 
in the care and light exercise of ten horses, a flock of chickens and turkeys, 
and two dogs.  He is assisted in 
this by an unidentified female, presumably his wife Kathy.

 
 
            
Investigator observed the [appellant] bending, pulling, pushing, reaching 
above his head, walking, drivingincluding entering and exiting his vehicle, 
lunging a horse, and performing tasks related to the rudimentary care and 
feeding of farm animals.  The 
[appellant] appeared to perform all activities without signs of obvious pain or 
discomfort.  He appeared to move 
with a normal gait and in a manner consistent with his age.  He does not have a noticeable limp, 
although it is possible that he does favor his right side in a small 
way.

 
 
            
Over this three day period, the [appellant] was active each morning from 
about 09.00 am until noon or 1.00 pm.  
He then retired to his house and reappeared when the unidentified female 
returned at about 05.00 pm.  They 
then spent half an hour doing the evening chores.

 
 
[¶12]   In her report, the investigator 
provided more specifics regarding the appellant's activities, which activities 
(according to the investigator) the appellant performed with "no trouble," no 
"signs of pain or discomfort," and no "grasping of his back."  Additionally, the investigator 
videotaped the appellant performing various activities.

 
 
1.         
The appellant raked around the henhouse entrance and reached "up to 
remove a block from the chicken door";

 
 
2.         
Hooked up a horse trailer to a truck and later unhooked the trailer 
("bending down from the waist to unfasten the two safety 
chains");

 
 
3.         
Opened the truck's hood when it broke down;

 
 
4.         
Walked one-half mile up a "slight rise";

 
 
5.         
Filled the stock tanks with a hosepipe and placed a heater into the 
tanks;

 
 
6.         
Pushed a Jeep forward several inches into the garage and walked back to 
the house "seemingly with no obvious signs of pain or 
discomfort";

 
 
7.         
Led a horse to the corral, lunged it on the left leg (held "lunge rein in 
his left hand and carrie[d] a lunge whip . . . in his right" and "crack[ed] the 
lunge whip" behind the horse), and worked with the horse for another twenty 
minutes; and

 
 
8.         
Pulled a Mormon cart to a haystack, carried one-third bale of hay "as a 
waiter would carry a tray of drinks," threw hay into pen, entered pen, and 
distributed the hay, pulled another bale down from head height, lifted it up, 
and loaded it onto cart.10

 
 
[¶13]   The appellant testified that by 
this time (approximately six months after the discectomy), his condition had 
improved "considerably"; he was feeling "pretty well," was "frisky" and 
relatively free from pain.  The 
appellant claimed that at some point thereafter, his back pain started "getting 
bad" and "going bad again.  And 
that's why the second surgery."  
Yet, the appellant also testified that he still experienced pain (some 
"days a great deal, some days not""there's good days, and then there's bad 
days") and while the pain had "diminished" at one point, it "was there all the 
time" and "just never went away."11  The appellant's wife echoed this 
testimony in that the appellant was feeling better "most of the time" but not 
all of the time; she did not feel that the appellant's condition "worsened," it 
"just never got better."

 
 
[¶14]   The appellant further explained 
that his physical activity had increased and he "got to doing more and more 
things."  The appellant acknowledged 
that he tried to feed his horses "once,"12 (April 1, 2002) but when he was 
distributing the hay, his back began "hurting pretty bad" and he "quit."  The appellant claimed to have been very 
sore and spent most of the next day "on the couch."  He also admitted that he lunged the 
horse and that he experienced no discomfort or physical restrictions that 
interfered with his ability to do so.  
Cathy Phillips testified that she did not think the appellant was 
successful in being more active because he was still hurting a lot and it was 
hard for him to bend.  There is 
obviously some contrast between this testimony and what the investigator 
observed and recorded.

 
 
[¶15]   On May 2, 2002, Dr. Turner noted 
that the appellant was "not doing well" and was still "complaining of ongoing 
back pain as well as a ratcheting type sensation.  . . .  We have previously discussed various 
treatment options available including possible additional surgery such as a 
fusion.  So far he has failed to 
improve with physical therapy."  The 
appellant's range of motion was restricted secondary to discomfort, Dr. Turner 
suspected post-discectomy syndrome, and the appellant was "going to need to 
consider a fusion at the L4-5 level . . .."

 
 
[¶16]   The appellant underwent fusion 
surgery June 26, 2002:

 
 
[Appellant:]     Why did I think about 
the second surgery?

 
 
[Appellant's 
counsel:]            
Yes.

 
 
A.        Well, 
the first one having done so well, but I knew it wasn't right because I wasn't 
yet back to where I was prior to the injury.  So my thoughts were  and we had talked 
about this with Dr. Turner, he and I, that down the road this second one may be 
necessary.

 
 
And then 
I thought if the first one did so well, the second one  and that's still my 
hope  will eliminate the problem altogether and then I'll be back to being  
I'm a worker.  I like to work.  I want to go back to work.  And so I thought, okay, I'll do the 
second one and then I'll be okay.

 
 
. . 
.

 
 
Q.        How 
have you felt since that surgery?

 
 
A.        On 
again, off again.  I'm never  not 
in constant real hurtful pain but a reminder that it's there.  But some days okay, some  like today, I 
feel good today.

 
 
. . 
.

 
 
Q.        How 
do you feel now as compared to  and I mean in general, not necessarily today  
as compared to how you felt before your surgery, your second 
surgery?

 
 
A.        
Before the second surgery, how do I feel now.  Better, after the second 
one.

 
 
Q.        Okay, 
how so?  Can you explain a little 
bit?

 
 
A.        Well, 
I haven't tested myself at this point in time to see what my mobility and 
everything is going to be, but I feel better in here, that  that in the end, 
this will take care of it.  I 
haven't started physical therapy, so I don't know my limits. 

 
 
[¶17]   According to Cathy Phillips, the 
appellant considered the fusion surgery "because he wanted the pain gone because 
it hurt prior to surgery a lot.  And 
he had a lot of confidence that this was going to fix things and he would be 
able to go back to work, which is what he was wanting to do."  She added:

 
 
[Appellant's 
counsel:]            
What about the second surgery, has that seemed to have helped 
him?

 
 
A.        I 
guess it's hard to say because it was a more serious surgery and it's still real 
soon.  I think he tries real hard to 
get around.  Some days he's got less 
pain, you know, some days it still hurts like crazy.

 
 
Q.        Do 
you know if he's using as much medication as he did prior to the 
surgery?

 
 
A.        As 
far as I know he is, yeah.

 
 
Q.        Does 
he seem to be improving?

 
 
A.        I 
think in getting around maybe.  I 
don't know if it hurts less.  I know 
a lot of times you can tell it hurts a lot.  He doesn't say it hurts, he doesn't 
express that, but just I can tell the way he gets up or when he groans or 
something that it's got to be hurting.  
I think it's probably getting better overall, but it's also too 
soon.

 
 
[¶18]   Dr. Turner was deposed in this 
matter on May 31, 2002.  As of that 
date, Dr. Turner testified that:  
(1) the discectomy essentially relieved the appellant's localized left 
leg pain; (2) the appellant's subsequent back pain was related to his original 
disc injury and originated at the same level of the back; (3) Dr. Turner's 
"impression at this point [was] that [the appellant] basically [had] an 
incompetent disk, [and was] structurally not able to maintain stability at that 
level of his spine and causes his back pain"; (4) after a discectomy, "the disk 
is not normal and will never return to being a normal disk" and "after this type 
of surgery, [most patients] are going to have a problem disk at that level of 
their spine"; and (5) the appellant had a "fairly poor prognosis."  One could expect nine to twelve months 
of recovery from fusion surgery and Dr. Turner was "doubtful" that the appellant 
would be able to return to a physically demanding job after the fusion.  Dr. Turner 
elaborated:

 
 
[Appellant's 
counsel:]            
Has Mr. Phillips reached, in your opinion, his maximum medical 
improvement yet?

 
 
[Dr. 
Turner:]    In my opinion, 
no.

 
 
Q.        Is a 
fusion surgery necessary for him to reach maximum medical 
improvement?

 
 
A.        I 
wouldn't say it's necessary.  If he 
is unwilling to consider a fusion, then I believe he has reached maximum medical 
improvement.

 
 
Q.        If he 
is willing to consider a fusion, is there a possibility that he could improve 
further from his present condition?

 
 
A.        
Yes.

 
 
. . 
.

 
 
[Appellee's 
counsel:]            
Was there particular reason why a discectomy was done and not a 
discectomy and fusion during your first surgery?

 
 
A.        There 
really aren't indications for doing a discectomy and a fusion as the initial 
procedure in something [such] as a herniated disk.  That was done about 30 years ago.  Commonly shown it didn't lead to 
improved results in most patients.

 
 
Q.        So in 
someone that has a herniated disk like this, your typical procedure is to go in 
and do the discectomy, and that's it?

 
 
A.        
Yes.

 
 
Dr. 
Turner apparently did not review the surveillance videos and was not asked for 
any opinions, hypothetical or otherwise, in that 
regard.

 
 
[¶19]   Dr. Paul Ruttle, an orthopedic 
surgeon retained by the appellee, was deposed in this matter on August 7, 
2002.  Dr. Ruttle examined the 
appellant on June 11, 2002, and reviewed the appellant's medical records and 
other materials.  During his 
physical examination of the appellant, Dr. Ruttle noted "normal" strength in the 
appellant's lower extremities, that the appellant's range of motion was 
"somewhat restricted," and that the appellant experienced "pain in his lower 
back when he forward flexed and when he extended his spine."  According to Dr. Ruttle, his physical 
examination of the appellant was inconsistent with what he observed in the 
aforementioned surveillance videos:

 
 
A.        Well, 
during the physical exam, Mr. Phillips was  noted difficulty bending forward to 
even 40 degrees, which is a little  which is a little less than half of what a 
patient should be able to forward flex, which is normally 85-90  80 to 90 
degrees and he did  when he did that during [the] physical exam [he] 
experienced pain.

 
 
            
During the Sub-rosa videos dated April 1st and 2nd, 
2002, he was seen forward flexing while feeding chickens.  He was able to bend with bales of hay 
and do all sorts of other activities on the range there.

 
 
[Appellee's 
counsel:]            
What particular activities that you saw in those videos were inconsistent 
with what he displayed during his physical examination?

 
 
A.        Well, 
not only could he forward flex easily while performing activities such as 
feeding chickens, he was able to forward flex on a repetitive basis, move 
forward, bend forward, straighten up, move forward, bend, straighten up on 
multiple occasions followed one right after another without a single evidence of 
pain.

 
 
. . 
.

 
 
Q.        In 
your review of these videos and Mr. Phillips' activities, did you see motion or 
any other evidence of pain in reviewing his activities?

 
 
A.        
No.

 
 
Q.        In 
speaking with Mr. Phillips, did he make any representations to you about his 
lifting abilities?

 
 
A.        
Yes.

 
 
Q.        And 
what were those representations?

 
 
A.        
Stated that he was able to lift only approximately 20 
pounds.

 
 
Q.        
Okay.  And, again, is that 
consistent with what he demonstrated on the video that was taken a couple of 
months before you saw him?

 
 
A.        
No.[13]

 
 
Q.        In 
your discussions with Mr. Phillips, did he talk to you at all about the course 
of his back pain, whether it had improved steadily or whether it had gotten 
worse or stayed the same?

 
 
A.        He 
stated that the back pain and buttock pain on the left along with proximal side 
pain had continued since the operation.

 
 
Q.        In 
those videos that you were able to see, did you see Mr. Phillips handling 
horses, lunging horses?

 
 
A.        Yes, 
I did.

 
 
Q.        Could 
you give us a little bit of description on what kind of demands that sort of 
activity has on the lower back?

 
 
A.        Well, 
it has a number  there is a number of problems with that activity, first of 
all, standing, and then, if you recall on the Sub-rosa videos, twisting while 
he's maneuvering the horse.  He's 
also holding his arms out in front of him, which tends to shift a significant 
amount of force sort of anteriorly to the front of the spine, and that can have 
in a significantly compromised spine a painful effect.

 
 
Q.        Would 
you expect somebody with the type of back injury that Mr. Phillips described to 
you in your examination to be able to do that kind of 
activity?

 
 
A.        Yeah, 
they might be able to do that activity but they would certainly have a lot more 
pain or would represent to have a lot more pain.  But he seems to be doing it quite 
comfortably.

 
 
Q.        Given 
your experience with patients that have undergone the same kind of treatment as 
Mr. Phillips and your physical examination of him as well as the review of 
medical records and the videos, do you have an opinion regarding when Mr. 
Phillips would have been able to return to light duty following the surgery he 
underwent in October of 2001?

 
 
A.        
Assuming surgery  well, the surgery, we'll say  roughly say November 
1st.  He should have been 
able to go back to some light duty January 1st.

 
 
Q.        
Okay.  And what about 
returning to work in some sort of  in a full-duty capacity, the kind of work 
that he had been involved in prior to his workplace 
injury?

 
 
A.        I 
would say certainly after reviewing the Sub-rosa video that he should have been 
able to do that by  by April 1st, 2002.

 
 
[¶20]   With respect to the appellant's 
fusion surgery, Dr. Ruttle testified as follows:

 
 
[Appellant's 
counsel:]            
All right.  Am I correct that in your report, Doctor, you express the opinion that 
Mr. Phillips may not be helped by a spinal fusion?  Is that correct?

 
 
A.        Well, I  
I  at this point after reviewing that video, I  I can't see how a spinal 
fusion is going to help a patient with that degree of activity.

 
 
Q.        All 
right.  Would 
your opinion be affected at all by the knowledge that Mr. Phillips did, in fact, 
undergo a spinal fusion on the 26Th of June and 
since that time his symptoms have greatly declined or possibly ceased 
altogether?

 
 
A.        I have no 
independent knowledge of that. 

 
 
Q.        All 
right.  And 
hypothetically, how would that affect would that knowledge affect your 
opinion?

 
 
A.        I don't 
know.  I would 
have to look at the patient.  I really  I really can't answer that 
hypothetical.

 
 
[¶21]   Several applications for temporary total 
disability benefits appear in the record:

 
 
1.         On 
September 14, 2001, Dr. Turner certified that the appellant was able to return 
to modified duty and to avoid repetitive stooping, bending and twisting, that 
surgery was not indicated, and in his professional medical opinion the appellant 
would be temporarily totally disabled from August 25, 2001 to September 30, 
2001.  Dr. 
Turner additionally testified that if the appellant had not had light duty work 
available in June 2001, Dr. Turner would have certified the appellant for 
temporary total disability. 

 
 
2.         On 
October 24, 2001, Dr. Turner certified that the appellant was able to return to 
modified duty according to unspecified attached documentation and "no light duty 
after surgery," surgery was indicated on October 29, 2001, the appellant had not 
reached the point of ascertainable loss, and in his professional medical opinion 
the appellant would be temporarily totally disabled from October 1, 2001 to 
December 31, 2001.

 
 
3.         On 
January 23, 2002, Dr. Turner certified that the appellant was not able to return 
to modified duty, surgery was not indicated, the appellant had not reached the 
point of ascertainable loss, and that in his professional medical opinion the 
appellant would be temporarily totally disabled from January 1, 2002 to February 
28, 2002.

 
 
4.         On 
February 27, 2002, Dr. Turner certified that the appellant was not able to 
return to modified duty, surgery was not indicated, and in his professional 
medical opinion the appellant would be temporarily totally disabled from March 
1, 2002, to May 31, 2002.  Dr. Turner did not answer the question as to 
whether the appellant had reached the point of ascertainable loss, and obviously 
this certification was prior to the aforementioned surveillance videos.

 
 
[¶22]   Dr. Turner testified that given the 
appellant's physical condition on May 31, 2002, the appellant was not safely 
able to return to work in a physically demanding position.  Dr. Turner 
apparently had never released the appellant to return to work since October 
2001.

 
 
[¶23]   The Division issued a final 
determination approving the appellant's application for temporary total 
disability payments in October 2001.  The appellee objected to the Division's final 
determination and the case was referred to the Office of Administrative Hearings 
for a contested case hearing.  A contested case hearing was initially set for 
April 25, 2002.  
The Division notified the hearing examiner on March 20, 2002, that it did 
not intend to appear for the hearing.  A contested case hearing was ultimately held 
on September 9, 2002.14  The hearing examiner found, in pertinent part, 
as follows:

 
 
1.         The 
appellant was "temporarily totally disabled from August 25, 2001, until his 
surgery on October 29, 2001, and from October 30, 2001 during his recuperation 
from surgery."

 
 
2.         A 
"video tape shows [the appellant] to be active and moving comfortably on April 
1, 2002."

 
 
3.         The 
appellant had "reached maximum medical improvement by April 1, 2002, unless he 
chose to undergo further surgery.  Dr. Turner and Dr. Ruttle agreed that [the 
appellant] had reached maximum medical improvement by this date."

 
 
4.         
Temporary total disability benefits shall cease if the appellant has "an 
ascertainable loss or has reached a point of stability or recovery."

 
 
5.         It 
was "clear the [appellant] had reached a point of stability and his temporary 
total disability benefits should be terminated.  Dr. Turner agreed that [the appellant] had 
reached maximum medical improvement until he should elect to undergo a fusion at 
the L4-L5 level of his spine."

 
 
6.         The 
appellant should "receive temporary total disability benefits for the period of 
time he was disabled, specifically August 25, 2001, through April 1, 2002."

 
 
[¶24]   In November 2002, the appellant 
petitioned the district court to review the hearing examiner's findings.  In February 2004, 
the district court affirmed the hearing examiner.  The appellant now appeals from the district 
court's decision.

 
 

 
 
[¶25]                           
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.  In Re Worker's Comp. 
Claim of Johnson, 2001 WY 
48, ¶ 7, 23 P.3d 32, ¶ 7 
(Wyo.2001).  We 
recently held that the substantial evidence test is the appropriate standard of 
review in appeals from Wyoming Administrative Procedures Act contested case 
proceedings when factual findings are involved and both parties submit 
evidence.  Newman v. Wyoming Workers' Safety and Comp. 
Div., 2002 WY 91, ¶ 22, 49 P.3d 163, ¶ 22 
(Wyo.2002).  . . 
. Because both parties presented cases-in-chief, we apply the substantial 
evidence standard.  
We afford respect and deference to a hearing examiner's findings of fact 
if they are supported by substantial evidence.  Haagensen v. State ex 
rel. Workers' Comp. Div., 949 P.2d 865, 867 (Wyo.1997).  Our task is to examine the entire record to 
determine whether substantial evidence supported the hearing examiner's 
findings.  State ex rel. Wyo. Workers' Comp. Div. v. 
Waggener, 946 P.2d 808, 814 
(Wyo.1997).  We 
will not substitute our judgment for that of the hearing examiner when 
substantial evidence supports his decision.  Id.  Substantial evidence 
is relevant evidence which a reasonable mind might accept in support of the 
agency's conclusions.  
Id.  A hearing examiner's 
conclusions of law are afforded no special deference and will be affirmed only 
if truly in accord with law.  State ex rel. 
Wyo. Workers' Comp. Div. v. 
Barker, 978 P.2d 1156, 1159 
(Wyo.1999).

 
 

Hermosillo v. State ex rel. Wyoming Workers' Safety and 
Compensation Div., 2002 WY 175, ¶ 6, 58 P.3d 924, 926 (Wyo. 
2002).  
However,

 
 
[w]hen the party charged with the burden of proof has failed 
to meet that burden, we review the case under the arbitrary, capricious, 
abuse-of-discretion, or otherwise-not-in-accordance-with-law standard.  Brees v. Gulley Enterprises, Inc., 6 P.3d 128, 132 
(Wyo.2000); Keck v. State ex rel. Wyoming Workers' Safety and 
Compensation Div., 985 P.2d 430, 432 (Wyo.1999).

 
 
"Under the arbitrary, capricious and abuse of discretion 
standard, we are charged with examining the entire record.  In our examination 
and review of a hearing examiner's determination, we defer to the hearing 
examiner's findings of fact.  We will examine conflicting and contradictory 
evidence to see if the hearing examiner reasonably could have made its findings 
based on all the evidence before it.  The findings of fact may include 
determinations of witness credibility, as the hearing examiner is charged with 
determining the credibility of the witnesses.  In our review, we will not overturn the 
hearing examiner's determinations regarding witness credibility unless they are 
clearly contrary to the overwhelming weight of the evidence."

 
 

Brees, 6 P.3d  at 132.

 
 

In re Boyce, 2005 WY 9, ¶ 6, 106 P.3d 451, 454 (Wyo. 2005).

 
 
The hearing examiner, as the trier of fact, is charged with 
weighing the evidence and determining the credibility of witnesses. . . . "When 
presented with medical opinion testimony, the hearing examiner, as the trier of 
fact, is responsible for determining relevancy, assigning probative value, and 
ascribing the relevant weight to be given to the testimony."  Bando v. Clure Bros. Furniture, 980 P.2d 323, 329 
(Wyo.1999).  "In 
weighing the medical opinion testimony, the fact finder considers:  (1) the opinion; (2) 
the reasons, if any, given for it; (3) the strength of it; and (4) the 
qualifications and credibility of the witness or witnesses expressing it."  Id. at 329-30.  "Demonstrating 
evidentiary contradictions in the record does not establish the ruling was 
irrational, 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."  
Id. at 
331.

 
 

Baxter v. Sinclair Oil Corp., 2004 WY 138, ¶ 9, 100 P.3d 427, 430-31 (Wyo. 
2004).

 
 

 
 

 
 
[¶26]   Wyo. Stat. Ann. § 27-14-403(a) 
(LexisNexis 2001) provided, in pertinent part:

 
 
(a)       In addition to 
payment of medical and hospital care[15] . . ., an 
injured employee and his dependents may be entitled to one (1) or more awards 
for:

 
 
(i)         
Temporary total disability;

 
 
(ii)        Permanent 
partial impairment;

 
 
(iii)       Permanent 
partial disability or vocational rehabilitation as provided under W.S. 
27-14-408;

 
 
(iv)       Permanent total 
disability; or

 
 
(v)        Death.

 
 

[¶27]   The resolution of this appeal involves 
several interrelated statutes encompassing temporary total disability benefits, 
permanent partial impairment benefits, permanent partial disability benefits, 
and permanent total disability benefits.  Wyoming defines "temporary total 
disability" as "that period of time an employee is temporarily and totally 
incapacitated from performing employment at any gainful employment or occupation 
for which he is reasonably suited by experience or training.  The period of 
temporary total disability terminates at the time the employee completely 
recovers or qualifies for benefits under W.S. 27-14-405 or 27-14-406[.]"  Wyo. Stat. Ann. § 
27-14-102(a)(xviii) (LexisNexis 2001). The purpose of temporary total disability 
benefits is "to provide income for an employee during the time of healing from 
his injury and until his condition has stabilized."  Pacific Power and Light v. Parsons, 692 P.2d 226, 228 
(Wyo. 1984).

 
 
[¶28]   In that regard, Wyo. Stat. Ann. § 
27-14-404 (LexisNexis 2003) further provides, in pertinent part:

 
 
(a)       If after a 
compensable injury is sustained and as a result of the injury the employee is 
subject to temporary total disability as defined under W.S. 27-14-102(a)(xviii), 
the injured employee is entitled to receive a temporary total disability award 
for the period of temporary total disability as provided by W.S. 
27-14-403(c).  
The period for receiving a temporary total disability award under this 
section for injuries resulting from any one (1) incident or accident shall not 
exceed a cumulative period of twenty-four (24) months, except that the division 
pursuant to its rules and regulations and in its discretion may in the event of 
extraordinary circumstances award additional temporary total disability 
benefits.  The 
division's decision to grant such additional benefits shall be reviewable by a 
hearing examiner only for an abuse of discretion by the division.

 
 
(b)       Any employee 
awarded benefits under W.S. 27-14-405 or 27-14-406 is not eligible for benefits 
under subsection (a) of this section unless the employee has returned to gainful 
employment and following employment, undergoes additional surgery not reasonably 
contemplated before the award for permanent impairment or disability and then 
only for a reasonable period of recuperation, confinement for medical care 
during the actual period of confinement or unless application is made and an 
award is granted under W.S. 27-14-605.

 
 
(c)        Payment 
under subsection (a) of this section shall cease prior to expiration of the 
twenty-four (24) month maximum period specified under subsection (a) of this 
section if:

 
 
(i)         
Recovery is complete to the extent that the earning power of the employee 
at a gainful occupation for which he is reasonably suited by experience or 
training is substantially restored; or

 
 
(ii)        The 
employee has an ascertainable loss and qualifies for benefits under W.S. 
27-14-405 or 27-14-406.

 
 
[¶29]   "Permanent partial disability" is 
defined as "the economic loss to an injured employee, measured as provided under 
W.S. 27-14-405(j), resulting from a permanent physical impairment[.]"  Wyo. Stat. Ann. § 
27-14-102(a)(xv).  
In that regard, Wyo. Stat. Ann. § 27-14-405 (LexisNexis 2003) provides, 
in pertinent part:

 
 
(f)         An 
injured employee suffering an ascertainable loss may apply for a permanent 
partial impairment award as provided in this section.

 
 
(g)       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.  
The award shall be paid as provided by W.S. 27-14-403 for the number of 
months determined by multiplying the percentage of impairment by forty-four (44) 
months.

 
 
(h)        An injured 
employee awarded permanent partial impairment benefits may apply for a permanent 
disability award subject to the following terms and conditions:

            

(i)         The 
injured employee is because of the injury, unable to return to employment at a 
wage that is at least ninety-five percent (95%) of the monthly gross earnings 
the employee was earning at the time of injury;

 
 
(ii)        An 
application for permanent partial disability is filed not before three (3) 
months after the date of ascertainable loss or three (3) months before the last 
scheduled impairment payment, whichever occurs later, but in no event later than 
one (1) year following the later date; and

 
 
(iii)       The employee has 
actively sought suitable work, considering the employee's health, education, 
training, and experience.

 
 
[¶30]   "Permanent total disability" means the 
"loss of use of the body as a whole or any permanent injury certified under W.S. 
27-14-406, which permanently incapacitates the employee from performing work at 
any gainful occupation for which he is reasonably suited by experience or 
training[.]"  
Wyo. Stat. Ann. § 27-14-102(a)(xvi).  In that regard, Wyo. Stat. Ann. § 27-14-406 
(LexisNexis 2003) provides, in pertinent part:

 
 
(a)       Subject to W.S. 
27-14-602, upon certification by a physician licensed to practice surgery or 
medicine that an injury results in permanent total disability as defined under 
W.S. 27-14-102(a)(xvi), an injured employee shall receive for eighty (80) months 
a monthly payment as provided by W.S. 27-14-403(c) less any previous awards 
under W.S. 27-14-405 which were involved in the determination of permanent total 
disability, and dependent children shall receive an award as provided by W.S. 
27-14-403(b).  . 
. .  An employee 
shall not receive benefits under this section if receiving benefits under W.S. 
27-14-404 or 27-14-405.

 
 

 
 
[¶31]   The appellant argues that the hearing 
examiner's decision to terminate temporary total disability payments as of April 
1, 2002, was premature because the appellant's fusion surgery was "imminent" and 
the appellant's condition would "likely change if he had back fusion 
surgery."  
Accordingly, the fact that the appellant underwent a subsequent fusion 
surgery precluded the determination of any "final" ascertainable loss (as 
opposed to an "interim" period of stability between surgeries) and a permanent 
impairment rating was therefore "impossible" (and in fact had never been 
formally assigned).  
The appellant contends that the record did not contain substantial 
evidence that the appellant had an ascertainable loss by April 1, 2002, and that 
the hearing examiner misapplied Wyo. Stat. Ann. § 27-14-404(c)(ii) in denying 
the appellant temporary total disability benefits.

 
 
[¶32]   The parties focus their appellate 
arguments on the applicability of Wyo. Stat. Ann. § 27-14-404(c)(ii), which 
subsection provides that temporary total disability benefits "shall cease" prior 
to the statutory maximum period if "[t]he employee has an ascertainable loss and 
qualifies for benefits under W.S. 27-14-405 or 27-14-406."  The key issue for 
purposes of that subsection is whether the particular record in the instant case 
contains sufficient evidence16 that the appellant had an ascertainable loss by 
April 1, 2002.  
An ascertainable loss is "that point in time in which it is apparent that 
permanent physical impairment has resulted from a compensable injury, the extent 
of the physical impairment due to the injury can be determined and the physical 
impairment will not substantially improve or deteriorate because of the 
injury[.]"  Wyo. 
Stat. Ann. § 27-14-102(a)(ii).

 
 

[¶33]   An "ascertainable loss" is "commonly 
measured at the point of maximum medical improvement.'"  State ex. rel. Wyoming Workers' Compensation Div. v. 
Gerdes, 951 P.2d 1170, 1174 n.1 
(Wyo. 1997).17  Generally, the

 
 
commonest question is when does the "healing period" end and 
"stabilization" occur?  
The answer to this questionwhich is sometimes phrased as "when has 
maximum medical improvement (MMI) been reached?" or "when has the condition 
become stationary?"determines in most states when temporary benefits cease and 
when the extent of permanent disability can be appraised, for purposes of making 
either a permanent partial or a permanent total award.

 
 
. . .

 
 
The issue may be a purely medical one.  Thus, there may be 
medical evidence that the period of recuperation is not yet over, that further 
healing and strengthening may be anticipated, and that it is still too early to 
appraise claimant's permanent disability.  Conversely, there may be medical testimony 
that the claimant has recovered as much as he or she ever will, and that any 
lingering disability is permanent.  The fact that some treatment is still 
necessary, such as physical therapy or drugs, does not necessarily rule out a 
finding that the condition has become stabilized, if the underlying condition 
causing the disability has become stable and if nothing further in the way of 
treatment will improve that condition.  But, if treatment was given in the hope of 
improving the condition, the later discovery that no improvement resulted does 
not bar a finding that the healing period persisted throughout the process of 
treatment.  The 
persistence of pain may not of itself prevent a finding that the healing period 
is over, even if the intensity of the pain fluctuates from time to time, 
provided again that the underlying condition is stable.

 
 
. . .

 
 
The determination whether the period of temporary total 
disability has ended may also involve nonmedical facts touching claimant's 
employment situation.

 
 
4 Larson's Workers' Compensation Law § 80.03[2], [3], and 
[4] (2004) (footnotes omitted).  We have said that 
in

 
 
the usual case, temporary total disability will be awarded 
for a single initial period of recovery and stabilization.  See Pacific Power and Light v. Parsons, Wyo., 692 P.2d 226, 228 
(1984).  Once 
stabilization occurs, the extent of permanent disability, whether partial or 
total, should be determined and the employee should receive an appropriate 
award.

 
 

Parnell v. State ex rel. Wyoming Worker's Compensation 
Div., 735 P.2d 1367, 1368 (Wyo. 1987).

 
 
[¶34]   We find that the record in the instant 
case contains substantial evidence that the appellant had an ascertainable loss 
by April 1, 2002.  
It is undisputed that, in the absence of the appellant's fusion surgery, 
the appellant had already reached the point of ascertainable loss and/or maximum 
medical improvement.  
The only remaining consideration was whether the appellant's physical 
impairment would thereafter "substantially improve or deteriorate because of the 
injury," and the hearing examiner apparently felt that it would not.

 
 
[¶35]   The fact that the appellant underwent a 
subsequent fusion surgery, alone, is not necessarily determinative, as both 
parties elicited medical testimony on the issue.  The state of the record is as follows:

 
 
1.         Dr. 
Ruttle, who physically examined the appellant, reviewed the appellant's medical 
records and other materials, and reviewed the surveillance videotapes, testified 
that he could "not see how a spinal fusion [was] going to help a patient with 
that degree of activity."

 
 
2.         Dr. 
Turner testified that following a discectomy, the disc is not normal and will 
never return to being a normal disc.  His literature indicates that a return "to 
physically demanding work that involves regular heaving lifting, bending and 
twisting is not recommended."  In May 2002, Dr. Turner testified that the 
appellant had a "fairly poor prognosis" and could not safely return to a 
physically demanding position.

 
 
3.         Dr. 
Turner testified that the appellant had reached maximum medical improvement 
unless he was willing to consider fusion surgery.  However, Dr. Turner also testified that a 
fusion was not "necessary" for the appellant to reach maximum medical 
improvement, that there was merely a "possibility" that the fusion would allow 
the appellant to improve further, and that he was "doubtful" that the appellant 
would return to a physically demanding job after the fusion.

 
 

[¶36]   It was reasonable for the hearing 
examiner to conclude from this evidence18 that substantial improvement would 
not have resulted from the fusion surgery.  See generally, for 
example, Myers v. F.C.A. Services, Inc., 592 N.W.2d 354, 358-59 (Iowa 
1999); Pitzer v. Rowley Interstate, 
507 N.W.2d 389, 391-92 (Iowa 1993); Briggs v. Consolidated 
Freightways, 234 Neb. 410, 451 N.W.2d 278, 282-83 (1990); Baca v. Bueno Foods, 108 N.M. 
98, 766 P.2d 1332, 1334-36 
(1988); Emery v. Adjustco, 82 Or.App. 
101, 727 P.2d 622, 625 (1986); Coburn v. Frank Dodge & 
Sons, 165 Vt. 529, 687 A.2d 465, 467-68 (1996); GTC Auto Parts v. Labor and 
Industry Review Com'n, 184 Wis.2d 450, 516 N.W.2d 393, 398 
(1994); and 82 Am.Jur.2d Workers' 
Compensation §§ 382-83 (2003).19

 
 

[¶37]   Once the appellant reached the point of 
ascertainable loss in the instant case,20 he essentially 
"qualified" for permanent partial impairment benefits.  Wyo. Stat. Ann. § 
24-14-405(f) provides that an "injured employee suffering an ascertainable loss 
may apply for a permanent partial impairment award as provided in this 
section."21  Should the appellant actually apply for such 
an award,22 the amount of the award would of course be 
computed based on the degree of his permanent impairment.  See Wyo. Stat. Ann § 
27-14-405(g).  
The testimony of both Dr. Ruttle and Dr. Turner indicated that the degree 
of the appellant's impairment was capable of determination and neither party has 
satisfactorily articulated why, for purposes of Wyo. Stat. Ann. § 27-14-404(c)(ii), 
the appellant would not have otherwise qualified for a permanent partial 
impairment award in the instant case.23  See generally also Higgins v. State ex rel. Wyoming Workers' 
Compensation Div., 739 P.2d 129, 132-33 (Wyo.), cert. denied, 484 U.S. 988 (1987) (termination of temporary total disability 
benefits under a prior version of the statute).

 
 
[¶38]   Upon being "awarded" permanent partial 
impairment benefits, the appellant could then, subject to certain other 
conditions, potentially seek lost earnings in the form of permanent partial 
disability benefits.24  See Wyo. Stat. Ann § 27-14-405(h).  Neither the record, 
nor the appellant, indicates that the appellant's impairment was such that he 
was permanently, totally disabled pursuant to Wyo. Stat. Ann. § 27-14-406.

 
 
[¶39]   The appellant could conceivably also 
seek total temporary disability benefits for the healing period following his 
fusion surgery pursuant to Wyo. Stat. Ann. § 27-14-605 (LexisNexis 2003):

 
 
(a)       If a 
determination is made in favor of or on behalf of an employee for any benefits 
under this act, an application may be made to the division by any party within 
four (4) years from the date of the last payment for additional benefits or for 
a modification of the amount of benefits on the ground of increase or decrease 
of incapacity due solely to the injury, or upon grounds of mistake or 
fraud.  The 
division may, upon the same grounds and within the same time period, apply for 
modification of medical and disability benefits to a hearing examiner or the 
medical commission, as appropriate.  

 
 
(b)       Any right to 
benefits shall be terminated and is no longer under the jurisdiction of this act 
if a claim for any benefit is not filed with the division within the four (4) 
year limitation prescribed under subsection (a) of this section.

 
 

See State ex rel. Wyoming Workers' Safety and Compensation 
Div. v. Henriksen, 2001 WY 42, ¶ 7, 21 P.3d 1185, 1186-87 
(Wyo. 2001); In re Osenbaugh, 10 P.3d 544, 549-50 (Wyo. 
2000); In re Hernandez, 8 P.3d 318, 322-23 (Wyo. 
2000); and Parnell, 735 P.2d  at 
1368-69.

 
 
[¶40]   We affirm.

  
KITE, Justice, dissenting.

 
 
[¶41]   I cannot agree with the majority's 
resolution of this case.  There is no dispute that the fusion resulted 
from Mr. Phillip's work injury.  The only way the hearing examiner could 
conclude otherwise was to find that the fusion was unnecessary.  Yet that finding 
does not appear in the hearing examiner's order. 

 
 
[¶42]   Moreover, the hearing examiner's 
findings of fact and conclusions of law are inconsistent in that they state that 
Mr. Phillips had an ascertainable loss "unless he chose to undergo future 
surgery."  He 
did choose to undergo future surgery.  Therefore, pursuant to the findings of fact, 
he did not have an ascertainable loss.

 
 
[¶43]  It may be that the videotape recording and 
some of the testimony convinced the hearing examiner that the surgery was 
unnecessary.  If 
so, a finding to that effect should appear in the order.  As we said in State ex rel. Dept. of Transportation v. Legarda, 2003 WY 130, ¶10, 77 P.3d 708, ¶10 (Wyo. 2003), to survive judicial review the record of a contested 
agency action must contain such factual findings as would permit a court to 
follow the agency's reasoning from the evidentiary facts on record to its 
eventual legal conclusions.  When an agency does not set forth sufficient 
findings to permit this Court to follow its reasoning, we cannot uphold its 
decision.  The 
hearing examiner's findings in Mr. Phillips' case do not support the conclusion 
that he had an ascertainable loss.  For this reason, I would reverse the hearing 
examiner's determination.

 
 

FOOTNOTES

  
1The appellant described the physical demands of 
his duties as a mixture of "light" and "heavy;" he estimated that about seventy 
percent of his duties were heavy and thirty percent of his duties were light or 
moderate.

  
2The appellant stated that he initially was 
released to return to light duties.  He apparently spent a few days in a tool 
trailer repairing tools and then continued with his usual employment (excluding 
heavy lifting) until August 24, 2001, without missing a day of work.

 
 
The medical releases contained in the record indicate that 
on June 28, 2001, and August 1, 2001, the appellant was released to return to 
full duty with "attention given to not aggravate the injury."  In order to clarify 
some apparent confusion regarding the appellant's work status pursuant to these 
releases, an October 3, 2001, letter states that the appellant "was able to 
return to work full time, but with the restrictions of no repetitive stooping, 
bending, twisting, reaching, climbing or overhead work and no lifting over 20 
pounds."

  
3Prior to the June 14, 2001, injury, the appellant 
never sought or received medical treatment for lower back pain.

  
4The appellant had steroid injections on August 8, 
2001, and September 7, 2001.  He stated that he experienced relief from the 
first injection, but the second injection had no effect.  According to the 
appellant, his symptoms then got "progressively" worse.

  
5Physical therapy records from this time period 
indicate that the appellant presented June 26, 2001, with lumbar spinal pain, 
decreased range of motion and increased pain with activity, a dysfunctional 
gait, and decreased lumbar spine stability.  On June 29, 2001, the appellant experienced no 
pain with activity (the pain had gradually decreased since June 26), the 
appellant participated in light duty work June 27-28, and participated in full 
duty work June 29 with no pain or difficulty.  According to the records:  the appellant 
ambulated and moved with ease and no pain substitutions, range of motion was 
pain free, spinal motion was smooth and symmetrical, the appellant understood 
the potential for re-injury, all patient goals had been met, the appellant was 
able to return to work full time with no symptoms, and the appellant was to 
return to the clinic upon experiencing any pain or discomfort in his lower back 
or if he wanted to continue with a lumbopelvic stability program.  Obviously, these 
records contain additional medical shorthand we are not able to interpret in the 
absence of expert assistance.

  
6Dr. Paul Ruttle, another orthopedic surgeon, 
testified that in his experience, recovery after surgery varied but most 
patients were capable of some degree of daily living activity within a month or 
two, were capable of light duty work within one to two months, were capable of 
full duty within four to six months, and fully recovered after about a year.

  
7Physical therapy records indicate that the 
appellant was sore December 25, but less sore during therapy December 26.  On December 28, the 
appellant had pain about the same intensity as December 26, and was to continue 
with the stability program as tolerated.  He reportedly was very sore on December 29 
through December 31, experienced less pain with medication, and only completed 
exercises that did not increase his pain.  On January 2, 2002, the appellant reported 
pain at the L4-S1 level, radiating left to right.  On January 4, he reported a significant 
decrease in pain.  
On January 7, the appellant was very sore after herding two cows that got 
out of the pasture.  
Prior to this, the appellant was "feeling okay."  On January 9, the 
appellant was still sore.  On January 11 and 16, the appellant reported 
less pain, and on January 18, the appellant was very sore but had not taken any 
pain medication.

  
8Physical therapy records indicate that on January 
21, 2002, the appellant reported he had "good days" and "bad days," with less 
pain than his previous visit, and was avoiding activities and positions that 
increased his pain.  
On February 1, the appellant noted a significant increase in back pain, 
and experienced another "bad day" February 4 with no change in his level of 
activity.  He 
had no new complaints on February 6, and on  February 8, the appellant felt "pretty good" 
with medication, tolerated exercise well, and felt better than he had in "a long 
time" (most likely, according to the records, due to increased medication).  On February 11, the 
appellant reported that he knew the pain was there but it was not "stabbing" 
pain.  He stated 
on February 13, that he experienced much less pain during the last week and was 
still on medication.  
On February 15, the appellant reported an increase in pain but no change 
in his activity.  
On February 20, he stated that the pain "[was] there," but much less so 
than in the previous two or three weeks.

  
9Physical therapy records indicate that on 
February 22, 2002, the appellant reported less pain in his lower back and he 
exhibited improvement in exercise tolerance.  On February 25, the appellant's lumbar spine 
musculature was less tender.  The appellant claimed that he was sore the 
evening of February 25 and that he experienced difficulty while standing up from 
the couch.  On 
March 1, the appellant did not take his pain medication and was "very 
sore."  On March 
4, the appellant reported that he had experienced less soreness each day since 
March 1.

  
10According to Cathy Phillips, she and the 
appellant fed their horses oat hay, which hay was "very dry," had been sitting 
all winter, and made for "pretty light" bales (not over thirty pounds).  The appellant 
testified that one of these hay bales weighed thirty-five pounds.

11At one point, the appellant theorized that his pain 
fluctuation was due to the weather because on a chilly day he was "pretty 
uncomfortable" and on a warm day, he experienced minimal pain.

  
12Cathy Phillips recalled that the appellant 
attempted to feed the horses in the springtime "when he was supposed to be 
trying to do some things."  He told his wife that he "shouldn't have tried 
that" and  she 
did not recall him trying to feed the horses again.

  
13The appellant later testified at the contested 
case hearing that he made this representation consistent with his doctor's 
recommendation, not in order to represent his actual lifting ability.

  
14Counsel for the appellee entered an appearance on 
April 2, 2002, and requested that the April 25th hearing date be 
continued because counsel was scheduled to appear for trial in another court 
that day.  The 
hearing was continued, and reset for July 11, 2002.  On July 8, 2002, 
counsel for both parties requested a continuance because they had not been able 
to schedule Dr. Ruttle's deposition prior to the hearing date.  The hearing was 
ultimately reset for September 9, 2002.

  
15Benefits for the appellant's medical and hospital 
care pursuant to Wyo. Stat. Ann. § 27-14-401 (LexisNexis 2003) are not at issue 
in this appeal.

  
16"The extent and duration of an employee's 
disability are questions of fact . . .."  Parsons, 692 P.2d  
at 229.

  
17The Division's rules and regulations currently 
define "maximum medical improvement" as a

condition or state that is well stabilized and unlikely to 
change substantially in the next year, with or without medical treatment.  Over time, there may 
be some change; however, further recovery or deterioration is not 
anticipated.  
This term may be used interchangeably with the term "ascertainable loss", 
defined in W.S. § 27-14-102(a)(ii).

 
 

3 Weil's Code of Wyoming Rules, Department of Employment, Workers' Compensation Commission, 
Workers' Compensation Rules, Regulations and Fee Schedules, ch. 1, § 4(t), 
025 220 001-4 (2004).

  
18While the medical testimony could perhaps have 
been more thoroughly developed, we note that it "is not the burden of the 
employer . . . to prove that a claimant is not entitled to a 
continuation of temporary total disability benefits"; rather, "the claimant has 
the burden of showing that he is entitled to a continuance of benefits."  Snyder v. State ex rel. Wyoming Worker's Compensation 
Div., 957 P.2d 289, 293 
(Wyo. 1998) (emphasis in 
original).  See also Shassetz v. State ex 
rel. Wyoming Workers' Safety and Compensation Div., 920 P.2d 1246, 1248-50 
(Wyo. 1996) and Higgins v. State ex rel. Wyoming Workers' 
Compensation Div., 739 P.2d 129, 131 (Wyo.), cert. denied, 484 U.S. 988 (1987).

  
19This does not mean that any period of stability 
between surgeries necessarily warrants a determination that a claimant has an 
ascertainable loss.  
That determination must rest on the particular circumstances and 
testimony in each case.

  
20This case is somewhat unique because the issue 
regarding whether the appellant had an ascertainable loss arose in the context 
of terminating the appellant's temporary total disability benefits, rather than 
a substantive claim for permanent benefits.  Several years have passed awaiting appellate 
resolution of the issue.

  
21The Division's rules state that an initial 
application for permanent partial impairment benefits may be filed when a worker 
"has suffered an ascertainable loss as defined in W.S. § 27-14-102(a)(ii)" and 
the worker may thereafter apply for permanent partial, or permanent total, 
disability awards pursuant to Wyo. Stat. Ann. §§ 27-14-405 or 17-14-406 based 
"upon the rating given by the physician . . .." 3 Weil's Code of Wyoming Rules, 
supra, at ch. 5, § 4(d)(i) and (ii), 025 220 
001-17.  
Similarly, to collect temporary total disability benefits beyond the 
maximum period allowed by statute, one must show, among other things, that he 
"does not have an ascertainable loss which would qualify for benefits under W.S. 
§ 27-14-405 or 406[.]"  
3 Weil's Code of Wyoming Rules, supra, at ch. 
7, § 2(b)(i)(D), 025 220 001-20.

  
22According to the Division's rules, a "person 
seeking an award of benefits under the Act must submit a written application for 
benefits to the Division, on a form provided by the Division."  3 Weil's Code of 
Wyoming Rules, supra, at ch. 5, § 4, 025 220 
001-16. See also Tenorio v. State ex rel. 
Wyoming Workers' Compensation Div., 931 P.2d 234, 238 
(Wyo. 1997).

  
23The appellee did not cross-appeal from the 
hearing examiner's decision and in its appellate brief, the appellee agreed that 
the appellant had an "ascertainable loss" by April 1, 2002.  The appellee further 
stated that "at the very least, Appellant qualified for benefits under Section 
405(f)," that Dr. Turner "specifically noted that the injury and resulting 
[discectomy] resulted in a permanent impairment to the Appellant that would not 
allow him to return to work in a physically demanding position," and that the 
appellant had not produced any evidence that he was "not qualified for benefits 
under that section . . .."

24As early as February 11, 2002, the appellant indicated in a 
pleading that "at such time as [the appellant] reached maximum medical 
improvement," he anticipated "seeking a loss of earning capacity and award 
pursuant to Wyo. Stat. § 27-14-405 (Lexis 2001) and/or a vocation award pursuant 
to Wyo. Stat. § 27-14-408 (Lexis 2001)" if appropriate.