Case Title: CHRISTINA CAMILLERI v. STATE OF WYOMING, ex rel. WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION

Citation: 

Docket Number: S-09-0242

State: wyoming

Court: Wyoming Supreme Court

Date: 2010-12-02T00:00:00Z

Document:
CHRISTINA CAMILLERI v. STATE OF WYOMING, ex rel. WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2010 WY 156Case Number: No. S-09-0242Decided: 12/02/2010NOTICE: This opinion is subject to formal revision before publication in Pacific Reporter Third. Readers are requested to notify the Clerk of the Supreme Court, Supreme Court Building, Cheyenne, Wyoming 82002, of any typographical or other formal errors so correction may be made before final publication in the permanent volume.
OCTOBER 
TERM, A.D. 2010

 
 

CHRISTINA 
CAMILLERI,Appellant (Petitioner),v.STATE OF WYOMING, ex 
rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION,Appellee 
(Respondent).

 
 
Appeal 
from the District Court of Washakie County

 
 

Representing 
Appellant:

Donna 
D. Domonkos, Cheyenne, Wyoming.

 
 

Representing 
Appellee:

Bruce 
A. Salzburg, Wyoming Attorney General; John W. Renneisen, Deputy Attorney 
General; James Michael Causey, Senior Assistant Attorney General; and Kristen J. 
Hanna, Senior Assistant Attorney General.

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

 
 
*Chief 
Justice at time of expedited conference.

 
 

HILL, 
J., 
delivers the opinion of the Court; BURKE, J., files a special concurrence, 
with whom VOIGT, J., 
joins.

 
 

HILL, 
Justice.

 
 
[¶1]      Appellant, 
Christina Camilleri (Camilleri), seeks review of the district court's order 
affirming the "Findings of Fact, Conclusions of Law and Order" issued by a 
Medical Commission Hearing Panel (Commission).  The Commission determined that Camilleri 
was not entitled to further benefits (after June 22, 2005), that she was at an 
ascertainable loss as of June 22, 2005, that her attorney was relieved from any 
obligation to further represent her, and that the matter was remanded to the 
Workers' Compensation Division (Division) to carry out the mandates of the 
Commission's decision.  We will 
affirm.

 
 
ISSUES

 
 
[¶2]      Camilleri states 
this issue:

 
 
Whether 
there is substantial evidence to support the Commission's decision to reject 
[Camilleri's] evidence.

 
 
The 
Division rephrases what it perceives as the issues in greater 
detail:

 
 
I.  Was 
the Hearing Panel's decision denying ongoing medical treatment to [Camilleri] 
and determination that [she] was at ascertainable loss or maximum medical 
improvement on June 22, 2005, supported by substantial 
evidence?

 
 
II.  Was 
the Hearing Panel's decision denying ongoing medical treatment to [Camilleri] 
and determination that [she] was at ascertainable loss or maximum medical 
improvement on June 22, 2005, arbitrary capricious, or otherwise not in 
accordance with Wyoming law?

 
 
Prefatory 
Matter

 
 
[¶3]      We will begin our 
discussion by explaining to the Division and the Medical Commission, as well as 
our readership in general, that petitions for review of agency decisions are 
governed by W.R.A.P. 12.  The most 
important part of this review process is the record that is created at the 
agency level, because both the district court sitting as an intermediate court 
of appeals, and this Court as the court of last resort, rely almost entirely on 
the content of that record in resolving the issues raised by the petition for 
review of agency action.  Rule 12.07 
provides:

 
 
(a)  Within 
60 days after the service of the petition, or within the time allowed by the 
reviewing court, the agency shall transmit to the reviewing court the original 
or a certified copy of the entire record of the proceedings under review and a 
separate letter of transmittal marked for the personal attention of the judge or 
judges of the reviewing court.  The record papers transmitted to the 
appellate court by the agency shall be securely fastened, in an orderly manner, 
in one or more volumes consisting of no more than 250 pages per volume, with 
pages numbered and with a cover page bearing the title of the case and 
containing the designation 'Transmitted Record,' followed by a complete index of 
all papers.  The agency shall 
provide copies of the index to the reviewing court and to the 
parties.  Concurrently with 
transmitting the record, the agency shall serve notice of the transmittal on all 
parties.

            
(b)  The record in a contested case shall consist of the matter 
required by W.S. 16-3-107(o), Wyoming Administrative Procedures Act.  To the extent any matter required was 
not preserved by the agency and there is no record, the court may take evidence 
on that matter.  The record in all 
other cases shall consist of the appropriate agency documents reflecting the 
agency action and its basis.  By 
stipulation of all parties to the review proceedings, the record may be 
shortened.  Any party unreasonably 
refusing to stipulate to limit the record may be disciplined in accordance with 
Rule 1.03.  The reviewing court may 
require or permit subsequent additions or corrections to the record.  A record remanded by a court to an 
agency for any reason or purpose may be recalled by the remanding court, as 
necessary, upon its own motion.  
[Emphasis added.]

 
 
Also 
see Wyo. Stat. Ann. § 16-3-107(o) through (r) (LexisNexis 
2009).

 
 
[¶4]      In this case, 
Volume I of the record on appeal consisted of the proceedings in the district 
court (intermediate court of appeals), and it was in the form required by the 
governing rule.  The record from the 
agency consisted of two volumes (Volumes II and III in this Court).  Volume II contained 535 pages, and they 
were not securely fastened (the 
initial pages and the ending pages were falling out of the volumes).  Moreover, although we rely primarily 
upon common sense for this advice, a part of "securely fastened" includes a 
cover page made of something sturdier than ordinary typing paper.  For so long as this Court can remember, 
this has entailed the use of "red backs," but any sturdy cover will do.  Those preparing records should also take 
note that the rule requires that each volume contain "no more" than 250 pages.  More often than not, breaking a volume 
at page 250 exactly may separate a document or documents in a way that does not 
make sense, in which case the volume break might well come before page 250 (not 
more than 250 pages).  The record 
must have an index that is as complete as possible.  In this case, each of the parties' 
disclosure statements contained numerous exhibits.  Instead of the index showing where each 
exhibit began in the index, the index simply lumped them altogether so that 
Camilleri's exhibits are spread over 256 pages (they might well have been 
contained in a single, separate volume and as a courtesy to the courts each 
exhibit should have been tabbed  exceeding the not to exceed 250 pages by 6 
pages would have been an acceptable adherence to the general rule).  Almost always, the transcript should be 
a separate volume.  Here, the 
transcript was found at pages 774-947 of Volume III (Volume III ran from page 
536-947).

 
 
[¶5]      The findings in 
this case demonstrate that the Medical Commission has taken to heart our 
requirement that findings be complete and detailed; however, references to the 
contents of the record on appeal were not made to pages of the record, but to 
documents that were not indexed, and the agency record was not paginated as it 
accumulated.  In the future we would 
expect that both the clerks of the district courts and the clerk of this Court, 
to decline to accept the record on appeal until it is assembled in accordance 
with the governing rule.  It is 
incumbent upon the agencies, in the first instance, to submit a proper record, 
but the parties also have a responsibility to look at the record once filed and 
see that it is in an acceptable form.

 
 
FACTS 
AND PROCEEDINGS

 
 
[¶6]      On September 1, 
2004, Camilleri first telephonically reported an on-the-job injury to her 
supervisor.  According to Camilleri, 
the injury occurred on that date at about noon, at her place of employment, the 
Worland Senior Center (Center).  A 
written report, prepared on September 16, 2004, was submitted to the Workers' 
Safety and Compensation Division (Division) by Camilleri and her supervisor on 
September 16, 2004, and it was received there on September 20, 
2004.

 
 
[¶7]      Camilleri was 
employed at the Center as a licensed practical nurse, and her co-employee Benita 
Bauer (Bauer), was the cook there.  
In a nutshell, Camilleri claimed that Bauer ran into her, perhaps 
deliberately, left-shoulder to left-shoulder, in a narrow hallway at their 
workplace.  Although Camilleri had 
some predisposing bodily infirmities, she asserted the shoulder blow delivered 
by Bauer was forceful enough to cause the immediate onset of pain to her left 
shoulder and her neck.  Her 
pre-existing health problems did not include any problem with her left 
shoulder.  The problems with 
Camilleri's neck had resolved by the time of hearing and were not an issue at 
the hearing into this matter and any injury that may have occurred to her neck 
is not an issue in this appeal.  
However, her shoulder continued to cause her great pain, and so far as 
the record shows, that continues.

 
 
[¶8]      At the hearing, 
Camilleri's claims were that she was entitled to temporary total disability 
payments for the period from June 22, 2005 through July of 2006, during which 
time she was unable to work because of the continued problems she had with her 
shoulder.  In early July of 2006, 
Camilleri found suitable employment that was within her physical capabilities at 
the Wyoming Boys School near Worland.  
She also claimed she was entitled to benefits for surgical treatment that 
had been recommended by her attending physician, James Randolph, M.D, an 
orthopedic surgeon.

 
 
[¶9]      Throughout the 
early months of her treatment, Camilleri's medical care providers were unable to 
ascertain the cause of the pain in her shoulder and most of them perceived that 
Camilleri displayed a sense of pain that was not consistent with her claimed 
injury.  Eventually she was referred 
to Dr. Randolph, who was still treating her as of the date of the hearing.  She opted for conservative, non-invasive 
treatment, and Dr. Randolph respected her concerns and decisions in that regard, 
especially because early on Dr. Randolph warned that invasive treatment could 
worsen, not lessen, her pain.

 
 
[¶10]   Camilleri received benefits from 
the date of injury until June 22, 2005.  
By letter dated June 22, 2005, the Division informed Camilleri that it 
would not approve payment of benefits after June 22, 2005.  By letter dated June 29, 2005, 
Camilleri's attorney asked to be appointed to handle her client's petition for 
review of that decision.  Apparently 
that appointment was made, and Camilleri has continued to be represented by 
counsel throughout this process.  In 
that request, Camilleri indicated that the matter should be assigned to the 
Medical Commission.

 
 
[¶11]   In a letter dated July 13, 2005, a 
claims analyst for the Division referred this case to the Office of 
Administrative Hearings (OAH) pursuant to Wyo. Stat. Ann. § 27-14-601(k)(v) 
(LexisNexis 2009) which provides:

 
 
§ 
27-14-601. Payment or denial of claim by division; notice; objections; review 
and settlement of claims; filing fee; preauthorization of hospitalization or 
surgery.

 
 
            
(a)  Upon receipt, the division shall review the initial injury 
reports to determine if the injury or death resulting from injury is compensable 
and within the jurisdiction of this act.  
No subsequent claim for compensation under this act shall be approved if 
the division determines the injury or death is not compensable and under the 
jurisdiction of this act or if the employer states on his injury report that the 
injury is not compensable, until a determination is rendered by the 
division.  The division shall 
provide notice of its determination to the employee, employer and the 
claimant.

.

            
(d)  Upon receipt of a claim for impairment, disability or 
death benefits filed under W.S. 27-14-403(g) or 27-14-501(e) and (f) and if the 
initial injury or death resulting from injury is determined compensable and 
within the jurisdiction of this act, the division shall determine if the injured 
employee or his dependents are eligible for benefits and shall approve or deny 
the claim in accordance with this act.  
If a claim is approved, the division shall determine the amount of the 
award for compensation in accordance with W.S. 27-14-403 through 27-14-406 and 
27-14-408, if applicable.  The 
division shall provide notice of any determination under this subsection to the 
employer, employee and the claimant.

            
(e)  In accordance with this act, the division shall by rule 
and regulation establish necessary procedures for the review and settlement of 
the compensability of an injury or death resulting from injury and of claims 
filed under this act through interviews with employees, employers and health 
care personnel or through review of written reports.  Nothing in this act shall prohibit the 
employer or division from reaching a settlement of up to two thousand five 
hundred dollars ($2,500.00) under this subsection in any one (1) case without an 
admission of compensability or that the injury was work 
related.

.

            
(g)  No claim for benefits under this act shall be denied based 
solely on the failure of the employer to have complied with the requirements of 
this act.

.

            
(k)  Determinations by the division pursuant to this section 
and W.S. 27-14-605 shall be in accordance with the 
following:

                        
(i)  The initial review of entitlement to benefits pursuant to 
subsections (a) and (e) of this section shall be made by the division within 
fifteen (15) days after the date the injury report or claim is filed.  Following initial review, the division 
shall issue a final determination or if a final determination cannot be made 
based upon available information at that time, the division may issue a request 
for additional information as necessary;

                        
(ii)  Following issuance of a request for additional 
information under paragraph (k)(i) of this section, the division shall 
investigate the matter and issue its final determination within forty-five (45) 
days after issuing the request;

                        
(iii)  Notice of a final determination issued by the division 
under this subsection shall include a statement of reasons and notice of the 
right to a hearing;

                        
(iv)  Any interested party may request a hearing before a 
hearing examiner on the final determination of the division by filing a written 
request for hearing with the division within fifteen (15) days after the date 
the notice of the final determination was mailed by the division.  If the division has not rendered a final 
determination within sixty (60) days following the date the claim was filed, any 
interested party may request a hearing before a hearing examiner in the manner 
prescribed by this paragraph.  If 
the written request for hearing is sent to the division by certified or 
registered mail, postage prepaid, return receipt requested, proof of such 
mailing within the time provided by this subsection with a receipt signed by an 
agent of the state of Wyoming shall be presumed to be timely filing of the 
request with the division;

                        
(v)  Upon receipt of 
a request for hearing, the division shall immediately provide notice of the 
request to the appropriate hearing authority as determined pursuant to W.S. 
27-14-616;

                        
(vi)  If timely written request for hearing is not filed, the 
final determination by the division pursuant to this subsection shall not be 
subject to further administrative or judicial review, provided however that, in 
its own discretion, the division may, whenever benefits have been denied to a 
worker, make a redetermination within one (1) year after the date of an original 
determination regardless of whether or not a party has filed a timely appeal 
pursuant to paragraph (iv) of this subsection. [Emphasis 
added.]

 
 
[¶12]   Wyo. Stat. Ann § 27-14-616 
(LexisNexis 2009) provides:

 
 
§ 
27-14-616. Medical commission; hearing panels; creation; membership; duties; 
rulemaking.

 
 
            
(a)  The medical commission is created to consist of eleven 
(11) health care providers appointed by the governor as 
follows:

                        
(i)  Seven (7) licensed physicians appointed from a list of not 
less than fourteen (14) nominees submitted by the Wyoming Medical 
Society;

                        
(ii)  Four (4) health care providers appointed from a list of 
not less than eight (8) nominees developed and submitted by appropriate health 
care provider groups selected by the director.

            
(b)  One (1) member shall be elected by commission members as 
chairman and one (1) as vice-chairman.  
The division shall designate an employee to serve as executive secretary 
of the commission or contract with an individual to provide executive secretary 
services to the commission.  The 
governor may appoint no more than eleven (11) additional health care providers 
as associate members of the commission whose function is limited to serving as 
members of individual medical hearing panels.  Except for initial members, the terms of 
commission members and associate members shall be three (3) years.  Three (3) members of the initial 
commission and three (3) initial associate members shall be appointed to a one 
(1) year term and four (4) initial commission members and four (4) initial 
associate members shall be appointed to a two (2) year term.  The duties of the commission shall 
be:

                        
(i)  To promulgate rules and regulations, with the approval of 
the director of the department, declaring particular medical, hospital or other 
health care procedures either acceptable or not necessary in the treatment of 
injuries or particular classes of injuries and therefore either compensable or 
not compensable under this act or expanding or limiting the compensability of 
such procedures under this act;

                        
(ii)  To promulgate rules and regulations, with the approval of 
the director of the department, establishing criteria for certification of 
temporary total disability by health care providers and setting forth the types 
of injuries for which particular health care providers may certify temporary 
total disability pursuant to W.S. 27-14-404(g);

                        
(iii)  To advise the division, upon request, on the usefulness 
of medical cost containment measures; and

                        
(iv)  To furnish three (3) members of the commission to serve 
as a medical hearing panel to hear cases referred for hearing.  The division shall refer medically 
contested cases to the commission for hearing by a medical hearing panel.  The decision to refer a contested case 
to the office of administrative hearings or a medical hearing panel established 
under this section shall not be subject to further administrative review.  Following referral by the division, the 
hearing examiner or medical hearing panel shall have jurisdiction to hear and 
decide all issues related to the written notice of objection filed pursuant to 
W.S. 27-14-601(k).  
Different medical hearing panels with different membership may be 
selected to hear different cases, but a panel may hear more than one (1) 
case.  Individual medical hearing 
panels shall be selected by the executive secretary under the supervision and 
guidance of the chairman of the medical commission.  At least one (1) member of each panel 
shall be a physician.  One (1) 
member shall be designated by the executive secretary to serve as chairman of 
the panel.  When hearing a medically 
contested case, the 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.  For cases referred to the medical 
commission as small claims hearings under W.S. 27-14-602(b), the medical hearing 
panel may consist of one (1) physician who 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.

            
(c)  The members of the commission and of medical hearing 
panels when serving shall be immune from liability and shall be defended by the 
attorney general if sued and indemnified against loss from legal action in the 
same manner as state employees.

            
(d)  The division shall establish a fee schedule for the 
compensation of members of the medical commission and medical hearing panels for 
their professional services to be paid from the worker's compensation 
account.

            
(e)  Upon agreement 
of all parties to a case, the hearing examiner in a contested case under this 
chapter may transfer a medically contested case to a medical hearing panel or 
may seek the advice of the medical commission on specified medical issues in the 
contested case.  The advice shall be 
in writing and shall become part of the record of the case.  [Emphasis 
added.]

 
 
[¶13]   In an order entered on September 
19, 2005, the OAH assigned this matter to the Medical Commission in accordance 
with Wyo. Stat. Ann. § 27-14-405(m) (LexisNexis 2009) which 
provides:

 
 
§ 
27-14-405. Permanent partial disability; benefits; schedule; permanent 
disfigurement; disputed ratings.

.

            
(m)  If the percentage of physical impairment is disputed, the 
division shall obtain a second opinion and if the ratings conflict, shall 
determine the physical impairment award upon consideration of the initial and 
second opinion.  Any objection to a 
final determination pursuant to this subsection shall be referred to the medical 
commission for hearing by a medical hearing panel acting as hearing examiner 
pursuant to W.S. 27-14-616.

 
 
DISCUSSION

 
 
Standard 
of Review

 
 
[¶14]   The applicable standard of review 
is that set out in Dale v. S & S 
Builders, LLC, 2008 WY 84, ¶¶ 22-25, 188 P.3d 554, 561 (Wyo. 2008), and 
we set it out verbatim below:

 
 
Thus, 
in the interests of simplifying the process of identifying the correct standard 
of review and bringing our approach closer to the original use of the two 
standards, we hold that henceforth the substantial evidence standard will be 
applied any time we review an evidentiary ruling.  When the burdened party prevailed before 
the agency, we will determine if substantial evidence exists to support the 
finding for that party by considering whether there is relevant evidence in the 
entire record which a reasonable mind might accept in support of the agency's 
conclusions.  If the hearing 
examiner determines that the burdened party failed to meet his burden of proof, 
we will decide whether there is substantial evidence to support the agency's 
decision to reject the evidence offered by the burdened party by considering 
whether that conclusion was contrary to the overwhelming weight of the evidence 
in the record as a whole.  See, Wyo. Consumer Group v. Public Serv. Comm'n 
of Wyo., 882 P.2d 858, 860-61 (Wyo.1994); Spiegel, 549 P.2d  at 1178 (discussing 
the definition of substantial evidence as "contrary to the overwhelming weight 
of the evidence").  If, in the 
course of its decision making process, the agency disregards certain evidence 
and explains its reasons for doing so based upon determinations of credibility 
or other factors contained in the record, its decision will be sustainable under 
the substantial evidence test.  
Importantly, our review of any particular decision turns not on whether 
we agree with the outcome, but on whether the agency could reasonably conclude 
as it did, based on all the evidence before it.

 
 
            
The arbitrary and capricious standard remains a " safety net' to 
catch agency action which prejudices a party's substantial rights or which may 
be contrary to the other W.A.P.A. review standards yet is not easily categorized 
or fit to any one particular standard."  
Newman, ¶ 23, 49 P.3d  at 
172.   Although we explained 
the "safety net" application of the arbitrary and capricious standard in Newman, we will refine it slightly here 
to more carefully delineate that it is not meant to apply to true evidentiary 
questions.  Instead, the arbitrary 
and capricious standard will apply if the hearing examiner refused to admit 
testimony or documentary exhibits that were clearly admissible or failed to 
provide appropriate findings of fact or conclusions of law.  This listing is demonstrative and not 
intended as an inclusive catalog of all possible circumstances.  Id.

 
 
            
There will be times when the arbitrary and capricious standard appears to 
overlap with some of the other standards.  
For example, a decision against the great weight of the evidence might 
properly be called arbitrary or capricious in everyday language.  However, the words "arbitrary" and 
"capricious" must be understood in context as terms of art under the 
administrative review statute and should not be employed in areas where the more 
specifically defined standards provide sufficient relief.

 
 
            
In summary, while we believe Newman was analytically correct and 
supported by relevant authorities, application of the different standards of 
review to evidentiary matters proved confusing and led to arguably inconsistent 
decisions.  Thus, we take this 
opportunity to diverge somewhat from Newman in order to simplify the process 
of determining the proper standard of review for both litigants and courts.  In the future, we will apply the 
substantial evidence standard anytime we are reviewing an evidentiary 
issue.

 
 
We 
review an agency's conclusions of law de novo, and we will affirm such legal 
conclusions only if they are in accordance with law.  Dale, ¶ 26, 188 P.3d  at 
561-62.

 
 
[¶15]   In this case, we are called upon to 
apply two of the standards set out in Dale.  First, the Commission made many 
credibility determinations in its analysis of the evidence and in that regard we 
will apply this aspect of the Dale 
standard:

 
 
If, 
in the course of its decision making process, the agency disregards certain 
evidence and explains its reasons for doing so based upon determinations of 
credibility or other factors contained in the record, its decision will be 
sustainable under the substantial evidence test.

 
 

Dale, ¶ 22, 188 P.3d  at 561.  "Substantial evidence" consists of the 
relevant evidence in the entire record which a reasonable mind might accept in 
support of the agency's conclusions.  
Id.

 
 
[¶16]   Second, after having examined the 
Commission's credibility determinations, and because the panel determined that 
Camilleri failed to meet her burden of proof, we must then decide whether there 
is substantial evidence to support the agency's decision to reject the evidence 
offered by the burdened party, by considering whether that conclusion was 
contrary to the overwhelming weight of the evidence in the record as a 
whole.

 
 
[¶17]   Although mention is made of the 
"arbitrary and capricious" standard in the Division's brief, Camilleri did not 
rely on that aspect of the Dale 
standard of review, and we discern no reason to call it into 
play.

 
 
[¶18]   It is not clear why this case was 
reassigned from the OAH to the Medical Commission.  Camilleri requested that her case be 
assigned to the Medical Commission, but it was the Division's initial decision 
to assign it to OAH.  The 
justification for the change was based upon there being a dispute about 
Camilleri's physical impairment rating, but the record does not bear out that 
any such conflict existed.  So far 
as the record shows, none of Camilleri's treating physicians had evaluated her 
for an impairment rating.  
Nonetheless, without objection from Camilleri, the Division sent her to 
see Paul E. Ruttle, M.D.  He 
performed an independent medical evaluation (Orthopedic Medical Evaluation) at 
the Division's request and that report was received by the Division on June 20, 
2005.  In the report Dr. Ruttle 
noted that Camilleri's impairment rating is 3%, that she had reached maximum 
medical improvement, and he recommended that Camilleri "undergo psychiatric 
evaluation on a nonindustrial injury basis."  Dr. Ruttle spent 45 minutes reviewing 
Camilleri's voluminous medical records, 45 minutes in a face-to-face evaluation 
of the patient, and 30 minutes in report preparation.  Michael J. Ford, M.D., was also asked to 
do an IME on Camilleri.  His report 
was received by the Division on September 2, 2005.  He spent one hour reviewing medical 
records, 20 minutes with Camilleri, and 40 minutes to prepare the written 
evaluation.  Dr. Ford concluded that 
her impairment rating was zero.

 
 
[¶19]   Camilleri's primary orthopedic 
physician, Dr. Randolph did not provide, nor was he asked to provide, an 
impairment rating.  As noted above, 
on June 22, 2005, Camilleri was informed that her further claims would be 
denied.

 
 
[¶20]   All of the medical records 
summarized above are contained in the record on appeal.  In addition, a video-conference hearing 
was held on May 16, 2007, at which Camilleri's primary physician testified, as 
did Camilleri, Camilleri's husband, and Benita Bauer, the co-worker who was 
alleged to have impacted her shoulder, against that of Camilleri, at their 
workplace, so as to injure her left shoulder.

 
 
[¶21]   The Commission issued a lengthy 
decision letter on July 30, 2007.  
Camilleri filed a petition for review in the district court and by 
decision letter issued on June 24, 2009, the district court affirmed the 
decision of the Commission.  While 
we always utilize and appreciate the district court's appellate decision, we 
afford no deference to the district court's decision.  Instead, we review the agency's decision 
as if it came directly from the agency.  Dale, ¶ 8, 188 P.3d 557.

 
 
Credibility 
of Witnesses

 
 
[¶22]   Camilleri's challenge to the 
Commission's decision is two-pronged.  
It is her contention that its decision is contrary to the overwhelming 
weight of the evidence in the record before us.  Of great importance to that argument, is 
her contention that the Commission credited the testimony of all witnesses for 
the Division, but found that Camilleri's witnesses were pretty much across the 
board not credible.  In analyzing 
such credibility determinations we apply the "substantial evidence" test, i.e., 
is there relevant evidence in the entire record which a reasonable mind might 
accept in support of the credibility determinations made.

 
 
[¶23]   We will address the Commission's 
credibility findings in the same order as they were memorialized in the 
Commission's findings.  We begin by 
noting that the Commission considered on-going treatment of Camilleri's cervical 
spine as an issue in dispute at the hearing, and that it included her shoulder 
only parenthetically as an issue (as shown in this sentence):  "Whether the  Claimant's ongoing 
treatment for her cervical spine [and shoulder] is related to her work 
injury."  At the outset of the 
hearing, Camilleri conceded that the issues with her cervical spine had been 
resolved, and it was only the condition of her shoulder that was at issue 
at the hearing.  The second issue in 
dispute is whether the percentage of Camilleri's physical impairment was 
disputed.  If it was disputed, the 
Division was to obtain a second opinion and if that rating conflicted with the 
one provided by Camilleri's physician, then it was the Commission's purpose to 
determine the physical impairment award upon consideration of the initial and 
second opinion.  Wyo. Stat. Ann. § 
27-14-405(m) (LexisNexis 2009).  In 
this case, Camilleri's treating physician did not provide, nor was he asked to 
provide, an impairment rating for his patient.  Indeed, the Division obtained two 
"second-opinions" and wholly disregarded Dr. Randolph's testimony and all of the 
medical records provided by him to the Division.  Both "second-opinions" conflicted with 
Dr. Randolph's assessment of his patient.

 
 
[¶24]   In the Commission's findings it is 
noted that the Division also sought a forfeiture of benefits paid on Camilleri's 
behalf because she declined surgery.  
However, the Division did not file the necessary petition, so that claim 
was not considered by the Commission.  
See Wyo. Stat. Ann § 27-14-407 (LexisNexis 2009).

 
 
[¶25]   The Commission noted in its 
findings that the report filled in (it is a fill-in-the blanks form) by 
Camilleri's supervisor stated only that:  
"Another employee walked into this employee, hitting her [left] 
shoulder."  In a report written by 
Camilleri herself, she reported the incident in these words:  "Bert Bauer walked towards me and 
slammed her [left] shoulder and [left side] of body into my [left] shoulder and 
shoved me."  After reviewing 
Camilleri's "injury report and other documents," on October 22, 2004, the 
Division issued a "Final Determination Opening Case" and Camilleri received 
benefits until late June of 2005 as noted more fully above.  The Division continued to inquire about 
Camilleri's progress in physical therapy after June 22, 
2005.

 
 
[¶26]   In a sworn statement given to the 
Worland Police Department on September 28, 2004, Camilleri elaborated on the 
event of September 1, 2004, and described a pattern of harassment on the part of 
Bauer toward her.  Through her 
attorney, Camilleri also sought to press a claim with the Compliance Officer, 
Department of Employment, Labor Standards, over the incident at issue here, as 
well as the fact that her employment with the Center was terminated at the end 
of September 2004.  On March 10, 
2005, the new Executive Director of the Center forwarded some additional 
informal information from other employees of the Center, to the Division, which 
tended to discredit Camilleri's story that her back was injured on September 1, 
2004.  Of course, it is of some 
significance to note that Camilleri never made complaints about her back.  It is also important to note that the 
record as a whole reveals that there were no "eye-witnesses" to the event 
Camilleri described, and the report referred to immediately above has very 
little evidentiary value, given that this case turned largely on depositions, 
sworn testimony, affidavits, and other documents that can be said to have some 
self-authenticating value (e.g., 
doctor's notes, MRI's, medical tests, etc.).  Camilleri said that Bauer did butt her 
with her shoulder, and Bauer denied it, but no one else purported to have seen 
the actual event in question.

 
 
[¶27]   The record appears to bear out that 
Camilleri's job at the Senior Center was eliminated because of the expiration of 
a grant that funded her position.  
However, we note at this juncture that both Camilleri and the Executive 
Director who was serving at the time of the incident at issue here, described 
the work environment of the Senior Center as dysfunctional, and this was 
especially true with respect to Bauer.  
Camilleri did not dispute the evidence brought forward by the Division 
that she had been treated in the past for a variety of on-the-jobs 
injuries/conditions, although none of these were associated with her left 
shoulder.  Camilleri did not dispute 
that she suffered from anxiety/depression.  
It is also undisputed that Camilleri underwent a variety of medical 
procedures and saw several doctors in the months after September 1, 2004, and 
prior to the hearing on May 16, 2007.  
It was not until Camilleri saw Dr. Randolph that the source of her pain 
was diagnosed by means of an MRI, although the accuracy of that diagnosis is 
also a critical point in this case.  
A radiologist identified a labrum tear in Camilleri's shoulder and Dr. 
Randolph concurred with the radiologist's reading of the 
MRI.

 
 
[¶28]   The record reveals that Camilleri 
reported an incident wherein Bauer intentionally, or at least without pausing to 
acknowledge that she had done so, hit Camilleri with her left shoulder.  Bauer self-reported that she is 5'9" 
tall and weighs 230 pounds, although she was described by both Camilleri and 
Wallingford as being somewhat larger than that.  Camilleri was of about the same height 
and weighed approximately 170-80 pounds.  
As noted above, there were no "eye-witnesses to the event (i.e., no one 
reported seeing the incident that Camilleri described).  Bauer reported that no such incident 
occurred and if there was such an encounter at all, it occurred the day before 
Camilleri reports it as occurring, and that she did no more than brush elbows 
with Camilleri at that time.  
Wallingford described Bauer as an "angry" and difficult employee and that 
she and Camilleri did not get along at all.  The animosity Wallingford reported was 
based on the fact that Bauer did not like to have employees in her kitchen and 
most employees were prohibited from being there during the lunch hour, except 
for Camilleri and one other employee who had to go through the kitchen to get to 
their offices.

 
 
[¶29]   The Commission paid especially 
close attention to Wallingford's testimony and set it out in detail.  In one of several findings as to 
credibility, the Commission described Wallingford's testimony as "wanting."  We construe that as a finding by the 
Commission that they did not believe Wallingford's testimony.  The basis for that finding is that 
Wallingford chose to believe Camilleri (over Bauer), even though no one else 
witnessed the injury-causing incident, simply because Wallingford and Camilleri 
were friends.  We note in this 
regard that our precedents do not require there to be "eye witnesses" to 
workplace injuries and that the testimony of an employee will suffice to 
establish that an injury occurred.  
This credibility determination appears to have been based on nothing more 
than idle speculation that Wallingford was motivated to lie because she was a 
"friend" of Camilleri.  We can find 
no hint in the record that Wallingford did anything other than honestly and 
forthrightly describe the difficulties she had with Bauer; that Camilleri was 
not a difficult employee; and that Camilleri reported what Bauer had done and 
she believed Camilleri's report.  We 
conclude that this credibility determination is not supported by any substantial 
evidence.

 

[¶30]   The Commission goes on to find that 
Camilleri was not a credible witness either.  Although the Commission's findings with 
respect to Camilleri's reporting of the injurious incident itself, as well as 
her subjective reports of the medical problems that followed, are somewhat 
tenuous, some of the documentary evidence does support a finding that 
significant portions of her testimony and reports of injury/pain were not 
credible.  Her reports to 
authorities/agencies, as well as to examining physicians, were notable, in part, 
because they varied greatly from report to report and from time to time.  Although there was a significant body of 
evidence to support the basic finding that Camilleri's testimony and reports 
lacked a sufficient level of credibility, we also note that the Commission 
undermined its own credibility when it decided to rely on what the Commission 
declared to be false reports of neck pain, when at the hearing Camilleri 
conceded that her neck pain problems had resolved and were no longer at 
issue.  However, in the final 
balance, we conclude that the Commission's finding that much of Camilleri's 
testimony was not credible is supported by substantial 
evidence.

 
 
[¶31]   A close examination of Dr. 
Randolph's testimony reveals several things of great significance in this 
case.  First, he is the only 
physician who spent a meaningful amount of time with Camilleri.  Second, he was the only physician who 
carefully examined the objective medical evidence (MRI's, etc.).  Third, he is the only physician who 
listened diligently to Camilleri's subjective complaints.  His testimony at the hearing was 
guarded.  He acknowledged that 
Camilleri's condition could not be accurately diagnosed with clinical 
observations in the examination room, nor could it be diagnosed with certainty 
even with the latest and most advanced external diagnostic procedures.  He conceded that he would not be able to 
state with certainty that she had suffered a shoulder injury until an invasive 
procedure was completed (one which Camilleri finally agreed to undergo quite 
reluctantly, because she wanted to avoid invasive procedures if possible).  He also conceded that Camilleri's 
reports of pain appeared to be out of proportion to the injury she appeared to 
have suffered to her shoulder, although Dr. Randolph did diagnose a rare, but 
widely recognized pain syndrome that may have contributed to Camilleri's 
condition.  However, we are unable 
to credit, even in the slightest degree, the Commission's findings about Dr. 
Randolph's credibility.  The 
Commission concluded that Dr. Randolph had not credited the opinions of other 
physicians who examined Camilleri (Drs. Ruttle and Ford) and reached this 
conclusion:  "Dr. Randolph may also 
have a financial stake in the outcome of this case given the extensive treatment 
performed after June of 2005 and for which he may not be paid."  There is not so much as a scintilla of 
evidence to support such a finding and that this Commission would give voice to 
such a libelous accusation causes us great concern about the credibility of the 
Commission.  See, e.g., Judd v. State ex rel. Wyo. Workers' 
Safety& Comp. Div. (Medical Commission), 2010 WY 85, ¶¶ 36-40, 233 P.3d 956, 970-71 (Wyo. 2010); In re 
Worker's Comp. Claim of Glaze v. State ex rel. Wyo. Workers' Safety & Comp. 
Div., 2009 WY 102, ¶¶ 27-30, 214 P.3d 228, 235 (Wyo. 2009); In re Worker's Comp. Claim v. State ex rel. 
Wyo. Workers' Safety & Comp. Div., 2009 WY 66, ¶¶ 16-18, 208 P.3d 41, 48 (Wyo. 2009); Decker v. State ex 
rel. Wyo. Med. Comm'n, 2008 WY 100, ¶¶ 30-36, 191 P.3d 105, 121-22 
(Wyo. 2008); Nagle v. State ex rel. Wyo. 
Worker's Safety & Comp. Div. (In re Worker's Comp. Claim of Nagle), 2008 
WY 99, ¶¶ 13-39, 190 P.3d 159, 166-74 (Wyo. 2008); Walton v. State ex rel. Wyo. Workers' Safety 
& Comp. Div. (Medical Commission), 2007 WY 46, ¶ 39, 153 P.3d 932, 941 (Wyo. 2007); Rodgers v. State ex rel. 
Wyo. Workers' Safety & Comp. Div. (Medical Commission), 2006 WY 65, 
¶ 53, 135 P.3d 568, 585 (Wyo. 2006); Decker v. State ex rel. Wyo. Med. 
Comm'n, 2005 WY 160, 124 P.3d 686, ¶¶ 38-42, 124 P.3d 686, 698-99 (Wyo. 
2005); Tarraferro v. State ex rel. Wyo. 
Med. Comm'n, 2005 WY 155, ¶¶ 18-21, 123 P.3d 912, 920 (Wyo. 2005); Vaughan v. State ex rel. Wyo. Workers' Comp. 
Div. (Medical Commission), 2002 WY 131, ¶¶ 33-36, 53 P.3d 559, 567 
(Wyo. 2002); Keck v. State ex rel. 
Workers' Safety & Comp. Div., 985 P.2d 430, 433 (Wyo. 
1999).

 
 
Overwhelming 
Weight of Evidence

 
 
[¶32]   Having determined that some of the 
Commission's credibility determinations are not supported by substantial 
evidence, it is now incumbent upon this Court to credit that testimony in 
determining the next part of the standard of review.  In this regard we apply this 
standard:  "whether there is 
substantial evidence to support the agency's decision to reject the evidence 
offered by the burdened party by considering whether that conclusion was 
contrary to the overwhelming weight of the evidence in the record as a 
whole."  Dale, ¶ 22, 188 P.3d  at 
561.

 
 
[¶33]   We conclude that Wallingford's 
testimony was credible.  Her 
decision to file a "Wyoming Report of Injury Form" was a duty, not some sort of 
option that turned on whether or not she believed Camilleri, at the time 
Camilleri made her report.  In her 
deposition, she testified under oath and answered the questions asked of 
her.  Her perceptions of the climate 
in the workplace at the Center may have differed from that of others who worked 
there, but the only questioning by the Division of any substance was whether or 
not she was still friends with Camilleri.

 
 
[¶34]   We conclude that Dr. Randolph's 
testimony was credible.  He appeared 
to be the only medical professional who had a complete grasp of Camilleri's 
medical picture.  He was forthright 
in testifying that no medical expert could say that Camilleri did, or did not, 
have a serious injury to her shoulder, and that the final diagnosis would only 
come to light after surgery.  He 
testified that the workplace incident described by Camilleri could have caused 
the injury, although he did not "decide" one way or the other whether it 
actually did happen exactly as Camilleri described.  In this regard, the Commission did not 
appear to take into account that Dr. Randolph's duty as a physician is to treat 
patients who present with injuries that are treatable, whether or not he finds 
the details of "their history" credible or not.  If Camilleri had a treatable shoulder 
injury, then it appeared to be his goal to do his best by her.  To some extent, the other physicians who 
figure in the evidentiary "picture" of this case looked at her history of 
depression and anxiety and dismissed her as a "psychiatric" case.  Camilleri never denied that she suffered 
from what may be categorized as "psychiatric" problems 
(anxiety/depression).

 
 
[¶35]   Our criticisms of the Commission's 
credibility findings raise significant difficulties in crediting its ultimate 
conclusions.  However, we have 
carefully reviewed all of the evidence contained in the record in reaching our 
ultimate holding.  After that 
careful review, we hold that the record contains substantial evidence to support 
the Commission's decision to reject much of the testimony/evidence offered by 
Camilleri herself, as well as that the Commission's decision was not contrary to 
the overwhelming weight of the evidence in the record as a whole.  Thus, while we are greatly concerned 
that the Commission's analysis of the testimonial and documentary evidence was 
seriously flawed we conclude that the Commission's decision should be 
affirmed.

 
 
CONCLUSION

 
 
[¶36]   The decision of the district court 
to affirm the Medical Commission is also affirmed by this 
Court.

  

BURKE, 
Justice, 
specially concurring, 
with 
whom VOIGT, Justice, joins.

 
 
[¶37]   I concur in the result reached by 
the majority but write separately for two reasons.  First, I would commend, rather than 
criticize, the Medical Commission for its thoroughness and detailed explanations 
of its credibility determinations.  
Second, in light of those explanations, it is not the function of this 
Court to reweigh the Commission's credibility determinations. 

 
 
[¶38]   It is difficult to imagine a more 
comprehensive written decision than the Medical Commission's "Findings of Fact, 
Conclusions of Law and Order of Medical Commission Hearing Panel" issued in this 
case.  The document is 40 pages in 
length.  As demonstrated by the 
excerpts set forth below, the evidence before the Commission is presented in 
exhaustive detail.  Most 
significantly, the Commission fully explained how it weighed that evidence.  Where conflict in the testimony exists, 
the Commission explained how it resolved that conflict.  Where evidence is disregarded based upon 
credibility concerns, the Commission provided a full explanation.  "If, in the course of its decision 
making process, the agency disregards certain evidence and explains its reasons 
for doing so based upon determinations of credibility or other factors contained 
in the record, its decision will be sustainable under the substantial evidence 
test."  Dale v. S & S Builders, LLC, 2008 WY 
84, ¶ 22, 188 P.3d 554, 561 (Wyo. 2008).  
See also Chavez v. State ex rel. Wyo. Workers' Safety 
& Comp. Div., 2009 WY 46, ¶ 18, 204 P.3d 967, 971 (Wyo. 2009).  Based upon my review of the record, I 
would conclude that the Commission's credibility determinations were supported 
by substantial evidence.  

 
 

[¶39]   We have previously emphasized that 
a Medical Commission, in rendering its decision, should make specific 
credibility determinations.  Walton v. State ex rel. Wyo. Workers' Safety 
& Comp. Div., 2007 WY 46, ¶ 31, 153 P.3d 932, 939 (Wyo. 2007).  On occasion, we have found it necessary 
to remand a case because the hearing examiner failed to provide specific 
findings of credibility, making appellate review of the decision 
impossible.  E.g., Olivas v. State ex rel. Wyo. Workers' Comp. 
Div., 2006 WY 29, ¶ 17, 130 P.3d 476, 486 
(Wyo. 2006) ("When 
the resolution of a claim for benefits rests largely, if not exclusively, on an 
assessment of a claimant's credibility, a hearing examiner's failure to make 
findings regarding the claimant's credibility on the record renders an effective 
review of the order denying benefits impossible.").  This is not such a case, and the 
majority does not suggest otherwise.  
Instead, the majority engages in its own credibility determinations.  That is not the proper function of this 
Court and is directly at odds with our precedent.  "Credibility 
determinations 
are the unique province of the hearing examiner, and we eschew re-weighing those 
conclusions."  Hamilton v. State ex rel. Wyo. Workers' 
Safety & Comp. Div., 2001 WY 20, ¶ 11, 18 P.3d 637, 640 (Wyo. 
2001).  See 
Huntington v. State ex rel. Wyo. Workers' 
Comp. Div., 2007 WY 124, ¶ 11, 163 P.3d 839, 842 (Wyo. 2007); 
Olivas, ¶ 
17, 130 P.3d  at 485-86.  
This 
Court is not in a position to make determinations regarding the credibility of 
witnesses.  The determination of the 
weight and credibility of the evidence is assigned by law to the administrative 
agency as the trier of fact, and it is not within this Court's prerogative to 
perform that duty.  Leavitt v. 
State ex rel. Wyo. Workers' Safety & Comp. Div., 980 P.2d 332, 335 (Wyo. 1999). 

 
 
[¶40]   At its core, this case revolved 
around the credibility of Ms. Camilleri.  
The Commission found that she was not credible, and there is ample 
support in the record for that determination.  There is also support in the record for 
the Commission's conclusion that the testimony of her supervisor, Kathy 
Wallingford, was "wanting," and that the evidence presented by other medical 
experts was more persuasive than the testimony of Dr. Randolph, Ms. Camilleri's 
treating physician.

 
 
[¶41]   The majority concludes that the 
Commission did not believe Ms. Wallingford's testimony "simply because 
Wallingford and Camilleri were friends."  
That is not accurate.  Their 
friendship was a factor mentioned by the Commission in discussing 
Ms. Wallingford's testimony, but there were additional reasons.  Ms. Wallingford did not witness the 
accident.  Additionally, she 
investigated the incident and could not find one witness to corroborate Ms. 
Camilleri's story.  After describing 
Ms. Wallingford's testimony in detail, the Commission summed up its view of the 
testimony this way: 

 
 
46.       . . . The 
Panel notes that Ms. Wallingford is a friend of Ms. Camilleri's.  Despite the fact that she was not 
present on the day of the incident, and that she was unable to confirm that 
anything occurred on the day in question by interviewing kitchen staff, it 
appears that she is accepting 100% of the Employee/Claimant's version of the 
events.  Ms. Wallingford was 
terminated by the employer shortly after this incident by the board of 
directors.  On the whole, the Panel 
finds that the credibility of Ms. Wallingford is wanting.

 
 
[¶42]   That finding dovetails with the 
Commission's credibility determination regarding Ms. Bauer, the employee who 
allegedly caused the injury.  
According to the Commission:

 
 
49.       Overall, 
the testimony of Ms. Bauer was credible and it appears this was a very minor 
incident.  It is undisputed that 
numerous employees and volunteers [were] working in and near the kitchen when 
this event occurred.  This is a 
small area.  Had a significant event 
occurred in the doorway, it is probable that there would have been someone who 
saw something.  No witness was 
called to corroborate the Employee/Claimant's version of these events.  From her appearance before the Medical 
Commission, Ms. Bauer is in her late 50's or early 60's.  She is five feet nine inches tall and 
[at] the time of the accident weighed 230 pounds.  Ms. Camilleri is of similar height 
and weighed 170 pounds at the time of this incident.  It seems highly improbable that 
Ms. Bauer administered a "body check" to Ms. Camilleri that would rival 
that of a hockey player.  Ms. 
Wallingford conducted an investigation of this incident and none of the kitchen 
workers saw anything or were aware of any incident.  The Panel believes that 
this event was a very minor occurrence and that it is highly improbable that Ms. 
Camilleri sustained any injury.

 
 

[¶43]   The 
Commission's "body check" reference is, in large measure, a response to the 
escalating versions of the incident given by Ms. Camilleri to her physicians and 
others.  According to the 
Commission:  

 
 
48.       The record 
and testimony show[] that Ms. Camilleri was not credible in her reports to her 
doctors or to the Panel in this case.  
Her tone and demeanor during testimony and cross examination indicated 
she was not being forthcoming.  The 
story of this event as related by Ms. Camilleri has grown and been dramatically 
changed over time.  The report of 
injury filed with the Division noted that "another employee walked into this 
employee, hitting [left] shoulder."  
The report filed with her employer stated that Ms. Bauer slammed her left 
shoulder and upper body into Ms. Camilleri and shoved her.  The Division's injury report paints a 
picture of a minor incident.  The 
report to her employer presents an entirely different picture.  Ms. Camilleri then reports to the police 
department that she had been assaulted numerous times by Ms. Bauer.  However, no corroborating evidence of 
such was presented.  In fact, Ms. 
Camilleri testified in her deposition that there were no prior physical contacts 
with Ms. Bauer.  This report to 
the police corresponds to the time Ms. Camilleri lost her job.   However, when Ms. Camilleri saw 
Dr. Jessen on October 28, 2004, she did not say anything about the work incident 
in issue.  By the time she saw 
Dr. Biles she reported being deliberately slammed into or run into by a 
co-worker.  She then told Dr. 
Goodman she had been hit by a door opened by a co-employee and she felt a "pop 
in her neck" and pain into her left shoulder.  By the time she saw Dr. Randolph, Ms. 
Camilleri related that when she was struck by a co-worker she was knocked to the 
ground.  She told Dr. Ruttle that 
when she was hit she felt a "pop" in her neck and that she had to catch herself 
on a counter.  This was the first 
time since the injury that Ms. Camilleri related using her left arm to brace or 
catch herself.  Ms. Camilleri then 
told Dr. Bilbool, a Psychiatrist, that she was tackled by a co-worker who hit 
her in the chest and shoulder.  

 
 
(Internal 
citations omitted.)

 
 
[¶44]   Those conflicting "histories" 
served as a partial basis for the Commission's decision to provide less weight 
to the opinion of Dr. Randolph.  But 
the Commission also provided additional explanation: 

 
 
54.       The 
evidence is clear that Ms. Camilleri had a long history of neck and upper 
extremity issues.  She treated with 
her chiropractor the day before the incident in question and received treatment 
on her neck.  The incident involving 
Ms. Bauer was a minor or insignificant event.  The Panel does not believe Ms. Camilleri 
sustained a neck injury.  The Panel 
agrees with Dr. Goodman that, at worst, she sustained a minor exacerbation of 
her ongoing neck problems and this would have resolved within a short period of 
time.  This is confirmed by Drs. 
Ruttle and Ford as well.  Her neck 
was certainly at maximum medical improvement by June 22, 
2005.

 
 
To 
the extent Ms. Camilleri's doctors have opined to the contrary, they were 
related a history [by] the Employee/Claimant that some significant event 
occurred.  These doctors were not 
fully aware of the Employee/Claimant's significant pre-existing history.  They relied heavily on the subjective 
complaints of Ms. Camilleri.  Dr. 
Randolph bases much of his opinions on Ms. Camilleri's history that at the time 
of the injury she spun and had to catch herself on her outstretched left 
arm.  As discussed below, the Panel 
finds this did not occur.  They also 
do not appear to be fully cognizant of Ms. Camilleri's hostility toward her 
former employer and co-employee, or the psychological factors in this case.  None of these doctors, including Dr. 
Randolph, have adequately explained the cause of her pain.  Likewise, these doctors do not appear to 
be fully aware of the variable and contradictory findings by other doctors as 
discussed throughout these findings.  
No one has explained the claims of bilateral upper extremity 
problems.  There are reports of 
global pain, exaggerated pain, and pain behaviors that are not addressed.  There is little objective evidence of a 
work injury.  Dr. Randolph doggedly 
maintains that Ms. Camilleri has C.R.P.S. despite [the] fact that no criteria 
for this diagnosis exist as will be discussed below.  Dr. Randolph may also have a financial 
say in the outcome of this case given the extensive amount of treatment 
performed after June of 2005 and for which he may not be 
paid.

 
 
55.       As to the 
shoulder, again this was a minor incident.  
Prior to July of 2005, no doctor was able to determine what, if anything, 
was the cause of her claimed shoulder pain.  No doctors were able to find laxity in 
the shoulder or confirm . . . popping or snapping in the shoulder.  In July of 2005 Ms. Camilleri 
reported an incident where her shoulder may have shifted in bed.  After this point her pain level appears 
to have increased.  Thereafter, a 
physical therapist noted in September 2005, that Ms. Camilleri may have some 
instability in her shoulder and the shoulder did show some sliding to the front 
of the glenoid.  She also had 
positive impingement testing.  Left 
shoulder instability was also noted at the pain clinic in Billings.  Following this July 2005 incident, a 
left shoulder arthrogram MRI was done that indicated a small tear of the glenoid 
labrum.  Dr. Randolph testified that 
the MRI is not 100% diagnostic and the only way to confirm a glenoid labrum tear 
is through surgery.  Dr. Ford 
did not believe the MRI showed a tear.  
Importantly, both Dr. Randolph and Dr. Ford both testified that such 
conditions are not caused by a direct blow to the shoulder.  Such conditions occur from falling or 
landing on an outstretched arm or repetitive throwing.

 
 
It 
was not until Ms. Camilleri saw Dr. Ruttle in July of 2005, that she ever 
reported using her left arm to catch herself on a counter.  The accident and injury reports, as well 
as history  to her many doctors, 
including Dr. Randolph, never said that the impact caused her to spin around 
requiring her to catch herself with her left arm.  This change in her story did not occur 
for many months.  Thus, the required 
mechanism for such an injury did not occur or exist  i.e., falling or landing 
on an outstretched arm.  Based on 
the testimony from Ms. Bauer, it is questionable if there was even a 
counter top in proximity to where this claimed event occurred.  The glenoid labrum tear, if it exists, 
is not related to the work injury in question.

 
 
Like 
her neck, the Panel finds that at worst, she would have sustained a minor bump 
on her left arm and shoulder which would have resolved in a short period of time 
and certainly by June of 2005.  
    

 
 
56.       The Panel 
does not believe Ms. Camilleri has C.R.P.S.  Drs. Ruttle and Ford opined that she 
does not have this condition.  By a 
lack of notation, it appears that Dr. Gee does not believe she has this 
condition nor did the pain clinic in Billings.  Dr. Randolph wrote and testified that 
her only symptom of this condition was exaggerated pain.  Ms. Camilleri's skin was warm and 
dry.  She does not have 
discoloration, swelling, abnormal sweating patterns, or vascular changes.  Dr. Randolph has never seen a case of 
C.R.P.S. develop from an impact to the shoulder such as alleged in this 
case.

 
 
The 
AMA Guides to the Evaluation of Permanent Impairment (5th Edition) at Table 16-16 at pg. 496 
provides objective diagnostic criteria 
for C.R.P.S.  An individual who 
meets eight or more of the criteria has probable C.R.P.S.  If an individual has less than eight of 
the findings it is unlikely they are suffering from this condition.  This table provides the 
following:

 
 

Local 
clinical signs:

 
 
Vasomotor 
changes:

·         
Skin 
color: mottled or cyanotic

·         
Skin 
temperature: cool

·         
Edema

 
 
Pseudomotor 
changes:

·         
Skin 
dry or overly moist

 
 
Trophic 
changes:

·         
Skin 
texture: smooth, nonelastic

·         
Soft 
tissue atrophy: especially in fingertips

·         
Joint 
stiffness and decreased passive motion

·         
Nail 
changes: blemished, curved, talon-like

·         
Hair 
growth changes: fall out, longer, finer

 
 
Radiographic 
signs:

·         
Radiographs: 
trophic bone changes osteoporosis

·         
Bone 
scan: findings consistent with C.R.P.S.

 
 
The 
only evidence that Ms. Camilleri has this condition is reported pain, which is 
subjective.  None of the other 
diagnostic criteria are present.  If 
Ms. Camilleri has some type of chronic pain, it is not from the work events in 
issue.

 
 
(Internal 
citations omitted; emphasis in original.)

 
 

[¶45]   It 
should also be noted that this was a medically contested case heard by a panel 
of the Medical Commission.  The 
panel members in this case included three physicians, two of whom were board 
certified.  "The role of the Medical 
Commission is to resolve medically contested issues through the professional 
expertise of [healthcare] providers.  
The Commission's role includes determining the weight to be given to 
medical opinion testimony, and will not be reweighed upon review."  Hurley v. PDQ Transport, Inc., 6 P.3d 134, 138 (Wyo. 2000) (citation omitted).  
The Medical Commission is not obligated to accept the findings of a 
medical expert if, in their expertise, the Commission determines that the 
factual basis for the medical opinion is not credible or reliable.  Id.  The findings of the Commission in this 
case demonstrate that it did not ignore Dr. Randolph's testimony.  It fully considered his testimony, but 
found his opinion was not credible.  
The Commission's findings were not clearly erroneous and were supported 
by substantial evidence.  

 
 

[¶46]   As 
a final note, I also take exception to the majority's harsh criticism of the 
Commission for mentioning Dr. Randolph's potential financial interest in the 
outcome as a credibility factor.  
Arguably, this finding is not supported by substantial evidence because 
Dr. Randolph was never specifically asked if his medical bills had been paid and 
the Claimant testified that she was seeking "reimbursement" for medical bills 
that she, or her insurance company, had paid.  It should be noted, however, that the 
financial interest of a witness in the outcome of a case is relevant to 
determining the bias of the witness.

 
 
Nor 
is it to be disputed that the court in its discretion may allow counsel to 
cross-examine an expert witness as to the amount he has received, is to receive, 
or expects to receive for treatment, examination or testifying, for such 
information has a possible bearing upon the witness's impartiality, credibility 
and interest in the result.  Grutski v. Kline, 352 Pa. 401, 43 A.2d 142; Commonwealth v. Simmons, 361 Pa. 
391, 65 A.2d 353; Duffy v. Griffith, 
134 Pa.Super. 447, 4 A.2d 170; 70 C.J. 1158, pages 954, 
955.

 
 

McNenar 
v. New York, C. & S. L. R. Co., 
20 F.R.D. 598, 600 (D. Pa. 1957).  
In any event, it is obvious that the Commission did not rely on this 
credibility factor to justify a total disregard of Dr. Randolph's 
testimony.  See, e.g., Glaze v. State ex rel. Wyo. Workers' Safety 
& Comp. Div., 2009 WY 102, ¶ 29, 214 P.3d 228, 235 (Wyo. 2009).