Case Title: Beall v. Sky Blue Enters., Inc.

Citation: 

Docket Number: S-11-0162

State: wyoming

Court: Wyoming Supreme Court

Date: 2012-03-14T00:00:00Z

Document:
IN THE MATTER OF THE WYOMING WORKER'S COMPENSATION CLAIM OF: MICHAEL BEALL #2 v. SKY BLUE ENTERPRISES, INC.2012 WY 38Case Number: S-11-0162Decided: 03/14/2012This 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 that correction may be made before final publication in the permanent volume.  
OCTOBER 
TERM, A.D. 2011
IN THE MATTER OF THE 
WYOMING WORKER’S COMPENSATION CLAIM OF:
 
MICHAEL BEALL 
#2,
 
Appellant 
(Employee/Claimant),
 
v.
 
SKY BLUE ENTERPRISES, 
INC.,
 
Appellee 
(Employer/Objector).
 
 
Appeal 
from the District Court of Carbon County
The 
Honorable Wade E. Waldrip, Judge
 
Representing 
Appellant:
Donna D. Domonkos, 
Domonkos Law Office, Cheyenne, Wyoming.
 
Representing 
Appellee:
Bradley T. Cave, 
Maryt L. Fredrickson, and Isaac N. Sutphin, Holland & Hart, LLP, Cheyenne, 
Wyoming.
 
 
Before KITE, C.J., 
and GOLDEN, HILL, VOIGT, and BURKE, JJ.
 
BURKE, 
Justice.
 
[¶1]        
Appellant, 
Michael Beall, received preauthorization from the Wyoming Workers’ Safety and 
Compensation Division for an orchiectomy, a procedure to remove his left 
testicle, which he claimed was related to a workplace injury.  Mr. Beall’s employer, Sky Blue 
Enterprises, Inc., objected to the preauthorization and the matter was referred 
to the Medical Commission Hearing Panel for a contested case hearing. Mr. Beall 
elected to undergo the surgery prior to the scheduled hearing.  The Commission denied Mr. Beall’s claim 
for reimbursement of medical expenses on the basis that the surgery was not 
reasonable or necessary medical care resulting from his workplace injury.  Mr. Beall appealed to the district 
court, which affirmed the Commission’s order.  He challenges that decision in this 
appeal.  We 
affirm.
 
ISSUES
 
[¶2]      
Mr. Beall presents 
the following issues: 
 
1.    
Whether the Medical 
Commission’s decision is arbitrary, capricious, or otherwise not in accordance 
with the law as a result of the fact that Mr. Beall was required to bear the 
burden of proving his claim for reimbursement of medical 
expenses.
 
2.    
Whether the Medical 
Commission’s decision is supported by substantial 
evidence.
 
Appellee, Sky Blue, 
states the issues as follows: 
 
1.    
Whether placing the 
burden of proof on the claimant Mr. Beall was in accordance with 
well-settled law and not arbitrary or capricious.
 
2.    
Whether the Medical 
Commission’s decision that Mr. Beall’s orchiectomy and associated medical 
treatment was not reasonable, necessary, nor causally related to his workplace 
accident of October 13, 2008, and thus was a noncompensable injury, is supported 
by substantial evidence.
 
FACTS
 
[¶3]        
Mr. Beall was injured 
on October 13, 2008 when, in the course of connecting a water valve for his 
employer, Sky Blue, he fell on the valve and struck his groin.  The fall was not witnessed by any of his 
coworkers.  Immediately after the 
incident, Sky Blue’s safety coordinator drove Mr. Beall to a doctor’s office in 
Rock Springs.  Mr. Beall was 
examined by a physician’s assistant, who noted that Mr. Beall had no swelling or 
bruising and instructed Mr. Beall to take ibuprofen for the pain.  Although Mr. Beall was released to “work 
as directed,” his safety coordinator drove Mr. Beall to his home in 
Rawlins.
 
[¶4]        
When Mr. Beall 
returned to work on October 15, expecting to be assigned light duty, he was 
instead assigned to an activity involving heavy lifting, which he refused.  After leaving work that day, Mr. Beall 
sought treatment from Dr. Wayne Couch, his primary care provider.  A physician’s assistant at Dr. Couch’s 
office adjusted Mr. Beall’s pain medications and referred him to Central Wyoming 
Urological Associates in Casper.  On 
October 16, Chad Sundquist, a physician’s assistant at the urology clinic, 
examined Mr. Beall and noted that there were no abnormalities of Mr. Beall’s 
scrotum, testes, or groin area.  Mr. 
Beall complained of discomfort upon palpation, but no swelling, bruising, or 
bleeding was indicated.  An 
ultrasound and CT scan were administered on October 22.  Results from the ultrasound revealed 
that 
 
The testes were 
homogeneous in echotexture without evidence of testicular laceration or hematoma 
in this patient status post trauma.  
Color Doppler flow demonstrated in both the right and left testes.  The epididymis was within normal limits 
bilaterally.
 
. . 
.
 
The patient has 
bilateral hydroceles without evidence of testicular laceration or hematoma.1 
 
Similarly, the CT 
scan indicated that 
 
There is no evidence 
of pelvic fracture or hematoma in this patient who has sustained a “straddle” 
type injury.  There does appear to 
be a small amount of increased attenuation in the ischiorectal fossa fat which 
may be secondary to edema from the patient’s trauma.  There is no focal hematoma 
present.
 
At a follow-up visit 
at the urology clinic on November 10, Mr. Beall was again examined by Mr. 
Sundquist.  In the report from the 
second examination, Mr. Sundquist reported Mr. Beall’s “status” as follows: 

 
Improved.  I am not able to identify any structural 
urologic abnormalities and [Mr. Beall’s] pain is consistent with a body wall 
strain/connective tissue trauma.  I 
recommend anti-inflammatories, and ice/heat [as needed] and will have patient 
follow [up] with his [primary care provider] for further 
consideration/evaluation and treatment.  
The patient sought my recommendations for how long he should be out of 
work, [and requested that I] fill out paperwork for short-term total 
disability.  I advised him again 
that I cannot identify any urologic pathology, which is what I am authorized to 
see and treat. 
 
[¶5]        
Mr. Beall continued 
to treat with Dr. Couch, who subsequently referred him to Dr. Gary 
Chizever, a gastroenterologist in Rawlins.  
Dr. Chizever examined Mr. Beall on January 8, 2009, and noted that “The 
patient demonstrated marked evidence of tenderness even on approach to the 
scrotal exam, even before any physical contact actually made.  He demonstrated this behavior during 
examination of left groin area as well.”  
With regard to his review of the CT scan from the Casper urology clinic, 
Dr. Chizever noted the following: “Question of small abnormality in the soft 
tissue in ischiorectal fossa. No obvious gross lesions to my review.”  Dr. Chizever ordered a repeat CT scan in 
order to “follow up on the question raised of an ischiorectal soft tissue 
abnormality from patient’s previous CT.”  After reviewing the results of the repeat 
CT scan, Dr. Chizever noted that the “previously identified possible abnormality 
in the ischiorectal fossa found on CT now appears resolved on follow up study.” 
 Dr. Chizever advised Mr. Beall that 
it was “his and Dr. Couch’s option whether a repeat visit to [a] urologist would 
be of benefit.”  Dr. Chizever 
subsequently notified the Division that he felt Mr. Beall could return to 
work.
 
[¶6]        
Mr. Beall returned to 
Dr. Couch and reported that “there is no way I can do my job.”  Dr. Couch referred Mr. Beall for 
follow-up urology and neurology consults in Casper.  On February 17, Dr. Couch notified the 
Division that Mr. Beall had been released to return to work.  The following day, Mr. Beall’s workers’ 
compensation claims representative noted that she received a message from Mr. 
Beall indicating that he had fired Dr. Couch and had found another doctor. 

 
[¶7]        
On February 17, Mr. 
Beall saw Dr. David R. Cesko in Rawlins.  With regard to his examination of Mr. 
Beall, Dr. Cesko noted as follows:
 
At this point, his 
exam is actually relatively benign.  
When I just barely touch his inguinal area on the left, he screams out in 
pain, which I think is somewhat overreacted.  I do not think the amount of pain is 
consistent with the exam.  Both of 
his testicles [] are equal.  No 
masses were palpated.  No hernia was 
palpated.
 
Dr. Cesko referred 
Mr. Beall to Dr. William D. Flock, a urologist in Laramie.  Dr. Flock noted that Mr. Beall’s left 
testicle was extremely tender but that he was “unable to palpate” the problem. 
 In his notes, Dr. Flock indicated 
the following treatment plan options: “1. Neurology consult[,] 2. Urodynamic[,] 
3. ? left orchiectomy.”  Dr. Cesko 
subsequently referred Mr. Beall to Dr. Reed Shafer, a neurologist, who conducted 
a physical examination and provided a complete neurologic study of Mr. Beall. 
 Dr. Shafer determined that there 
“seems to be no anatomical abnormality demonstrated in terms of the genitalia,” 
and reported that an electrodiagnostic study of Mr. Beall’s left lower extremity 
was a “normal study.”
 
[¶8]        
Mr. Beall then went 
to see Dr. Richard R. Augspurger, a urologist in Denver, pursuant to a referral 
by Dr. Flock.  Mr. Beall reported 
that his symptoms were left testicular pain, urinary frequency, and erectile 
dysfunction.  After conducting a 
physical examination and urodynamic testing, Dr. Augspurger detected no 
neurologic cause for any of Mr. Beall’s symptoms.  With regard to Mr. Beall’s left 
testicular pain, Dr. Augspurger noted that “the remaining option would be 
to do a left orchiectomy as it appears that all conservative methods have been 
tried.” 
 
[¶9]        
In July of 2009, Mr. 
Beall contacted Dr. Augspurger and indicated that he wanted to proceed with an 
orchiectomy.  Dr. Augspurger 
subsequently requested preauthorization for the procedure from the Wyoming 
Workers’ Compensation Division, and the Division requested peer reviews from Dr. 
Jeffrey Balison and Dr. James White.  
Dr. White stated that “it would be nice to see some abnormalities on the 
imaging studies, but this is a sensory and a subjective symptom and even though 
there are no significant findings on imaging studies, the symptoms that this 
patient is experiencing certainly warrant this approach.”  The preauthorization report from Dr. 
Balison, in turn, provided as follows:

            
There seems little doubt that Mr. Beal[l] sustained a left groin injury 
while at work on 10/13/08.  He 
sought medical care the day of injury and several times immediately 
thereafter.  Of note, there has not 
been any reliable physical evidence of injury other than his self-reported pain 
which has seemingly become even worse with time, although he has not worked 
much, if at all, since injury and has relied on narcotic medication for pain 
management.
 
            
The only evident description that is counter to normal physical findings 
is contained in a letter to the division by Dr. Cesko written 04/02/09 that 
claims the left testis is spongy and non-functional.  This is at odds with three urologists, a 
general surgeon, and about three other primary care providers.  It is thereby discarded as being 
inaccurate. 
 
            
More problematic is the linkage of erectile dysfunction to the accident. 
. . . Coupled with a normal neurological exam, essentially normal urodynamics 
and neuromuscular testing as well as ultrasounds and CT scans that are 
urologically unremarkable, secondary gain and somatization become problematic 
considerations.  Psychological 
evaluation is advised, particularly since erectile dysfunction may constitute a 
future potential claim.
 
            
Although this patient has had very detailed and generally quite adequate 
evaluations, I would suggest consideration of the following before 
orchiectomy.
 
1.            
[Testing to rule out 
diabetes.]
 
2.            
[Testing to rule out 
sarcoidosis.]
 
3.            
Request Dr. 
Augspurger block the inguinal spermatic cord with short-acting local anesthetic 
(Lidocaine) as well as a concurrent long-acting local (Marcaine).  If the patient gets substantial relief, 
he may be suffering from Chronic Regional Pain Syndrome (CRPS) Type II from a 
traumatic injury to the genital branch of the left genitofemoral nerve or 
similarly to the il[i]oinguinal nerve nearby.  A simple sensory neurectomy could 
potentially yield substantial, if not complete, relief and can be completed as 
an outpatient under local and minimal sedation.
 
            
If all the above fails, orchiectomy is the remaining logical choice.  Testicular prosthetic implantation would 
be up to the patient.
 
            
. . . 
 
[¶10]     
Based on the reports 
provided by Drs. Balison and White, the Division issued preauthorization 
approval for the surgery on August 31, 2009.  The approval noted as 
follows:
 
Either the injured 
worker or the employer may object to this determination and request a 
hearing.  Affected parties have a 
right to a hearing before a hearing examiner as provided by the Wyoming Worker’s 
Compensation Act and to legal representation.  The Division must receive a written 
request for a hearing on or before September 15, 2009.  If a timely written request for hearing 
is not filed with the Division, the final determination by the Division pursuant 
to W.S. § 27-14-601(k) shall not be subject to further administrative or 
judicial review.
 
On September 15, Sky 
Blue objected to the Division’s determination, claiming that (1) Mr. Beall’s 
condition did not meet the definition of “injury” under Wyo. Stat. Ann. § 
27-14-102(a)(xi); (2) that there was no evidence that Mr. Beall sustained an 
injury in the course of his employment with Sky Blue; and (3) that the medical 
procedures proposed to treat Mr. Beall’s condition were not “medically 
reasonable, necessary or appropriate under the circumstances.”  The matter was referred to the Medical 
Commission to determine whether the procedure was “medically reasonable and 
necessary” as a result of the October 2008 workplace injury.  Approximately two weeks after Sky Blue 
objected to the Division’s determination, and one week after the matter was 
referred to the Medical Commission, Mr. Beall proceeded with the 
orchiectomy.  A post-operative 
pathology report of the testicle revealed “no grossly evident mass lesions” and 
indicated that the testicle was functional.
 
[¶11]     
The contested case 
hearing was held on July 22, 2010.  The Commission heard testimony from Mr. 
Beall and was presented with extensive medical records from each of his 
treatment providers, as well as deposition testimony from Dr. Augspurger.  After considering all of the evidence, 
the Commission concluded that “the 
orchiectomy procedure was not reasonable and necessary medical care as related 
to the October 13, 2008, work injury.”  The Commission also determined 
that 
 
Mr. Beall has not 
established a causal connection between the orchiectomy procedure and the work 
injury of October 13, 2008, and benefits related thereto are therefore found to 
be non-compensable.  Mr. Beall, at 
most, sustained a minor injury to his ischiorectal/scrotal area, which was fully 
resolved by the time he saw Dr. Chizever on February 11, 
2009.
 
The district court 
affirmed the Medical Commission’s decision.  Mr. Beall appealed the district court’s 
decision to this Court.
 
STANDARD OF 
REVIEW
 
[¶12]     
Review of an 
administrative agency’s action is governed by the Wyoming Administrative 
Procedure Act, which provides that:
 
(c) 
To the extent necessary to make a decision and when presented, the reviewing 
court shall decide all relevant questions of law, interpret constitutional and 
statutory provisions, and determine the meaning or applicability of the terms of 
an agency action. In making the following determinations, the court shall review 
the whole record or those parts of it cited by a party and due account shall be 
taken of the rule of prejudicial error. The reviewing court 
shall:
 
. 
. .
 
(ii) Hold unlawful 
and set aside agency action, findings and conclusions found to 
be:
(A) Arbitrary, capricious, an 
abuse of discretion or otherwise not in accordance with law;          
(B) Contrary 
to constitutional right, power, privilege or immunity;      (C) In excess of statutory 
jurisdiction, authority or limitations or lacking statutory right;           
(D) Without 
observance of procedure required by law; or(E) Unsupported by substantial 
evidence in a case reviewed on the record of an agency hearing provided by 
statute.          

 
Wyo. Stat. Ann. § 
16-3-114(c) (LexisNexis 2009).  We review an 
administrative agency’s findings of fact pursuant to the substantial evidence 
test.  Dale v. S & S 
Builders, LLC, 2008 WY 84, ¶ 22, 188 P.3d 554, 
561 (Wyo. 2008).  Substantial 
evidence is relevant evidence which a reasonable mind might accept in support of 
the agency’s conclusions.  Id., ¶ 11, 188 P.3d  at 558.  Findings of fact are supported by 
substantial evidence if, from the evidence in the record, this Court can discern 
a rational premise for the agency’s findings.  Middlemass v. State ex rel. Wyo. Workers’ 
Safety & Comp. Div., 
2011 WY 118, ¶ 11, 259 P.3d 1161, 1164 (Wyo. 2011).  
 
[¶13]     
The arbitrary and 
capricious standard of review is used as a “safety net” to catch agency action 
which prejudices a party’s substantial rights or which may be contrary to the 
other review standards under the Administrative Procedure Act, yet is not easily 
categorized or fit to any one particular standard.  Dale, ¶ 23, 188 P.3d  at 561.  The arbitrary and capricious standard 
applies if the agency failed to admit testimony or other evidence that was 
clearly admissible, or failed to provide appropriate findings of fact or 
conclusions of law.  Id.  We review an agency’s conclusions of law de novo.  Id., ¶ 26, 188 P.3d  at 561-62.  
 
DISCUSSION
 
Burden of 
Proof
 
[¶14]     
A 
claimant in a workers’ compensation case generally has the burden of proving 
each of the essential elements of the claim by a preponderance of the 
evidence.  Kenyon v. State ex rel. Wyo. Workers’ Safety 
& Comp. Div., 2011 WY 14, ¶ 22, 247 P.3d 845, 851 (Wyo. 2011).  In this case, however, Mr. Beall 
contends that the Medical Commission improperly assigned to him the burden of 
proving his claim for reimbursement of medical expenses.  Citing our recent decision in Lane-Walter v. State ex rel. Wyo. Workers’ 
Safety & Comp. Div., 2011 WY 52, 250 P.3d 513 (Wyo. 2011), Mr. Beall 
claims that the Division’s preauthorization for the orchiectomy established a 
presumption that he was entitled to reimbursement for his medical expenses, and 
that the burden shifted to his employer to prove that the procedure was not 
reasonable or necessary treatment related to his workplace injury.  He further contends that placing the 
burden of proof on his employer “is also consistent with the law of placing the 
burden on the party who asserts the affirmative of any 
issue.”
 
[¶15]     
We 
note initially that, at the contested case hearing, Mr. Beall did not claim that 
the Commission improperly allocated the burden of proof.  Rather, Mr. Beall’s counsel expressly 
acknowledged that Mr. Beall had the burden of proving that he was entitled to 
reimbursement for his medical expenses:

            
We believe the evidence will also show that the surgery Mr. Beall 
submitted to was appropriate and necessary.  We believe the evidence will meet Mr. 
Beall’s burden of proof.  And at the 
end of the testimony, we will respectfully ask the Medical Commission to find 
that Mr. Beall has met his burden and that preauthorization for the surgery 
was appropriate and that the resulting surgery and medical care was necessary 
and appropriate.
 
Generally, 
we do not consider issues on appeal that have not been raised in an 
administrative action.  Watkins v. State ex rel. Wyo. Workers’ Safety & 
Comp. Div., 2011 WY 49, ¶ 22, 250 P.3d 1082, 1089 (Wyo. 2011).  
 
We 
have recognized in more than a few decisions . . . that orderly procedure and 
good administration require that objections to the proceedings of an 
administrative agency be made while it has opportunity for correction in order 
to raise issues reviewable by the courts.
 
Id. 
(quoting Wyoming Bancorporation v. 
Bonham, 527 P.2d 432, 439 (Wyo. 1974)).  In Mr. Beall’s case, however, he was 
prompted to raise an issue as to proper allocation of the burden of proof by our 
decision in Lane-Walter, which was 
issued after the Commission’s order denying benefits but before Mr. Beall’s 
appeal reached this Court.2  In Lane-Walter, although the claimant had 
not previously raised the issue, we indicated that, under the unusual 
circumstances of that case, the Division should have the burden of proving the 
claimant’s treatment was not reasonable or necessary.  In order to dispel any notion that Mr. 
Beall was merely a victim of timing, we will proceed to evaluate the merits of 
Mr. Beall’s assertion that he should not have the burden of proving his claim 
for reimbursement of medical expenses. 
 
[¶16]     
The 
Division’s decision to preauthorize medical care is governed by Wyo. Stat. Ann. 
§ 27-14-601(o), which provides as follows:
 
(o) The 
division pursuant to its rules and regulations may issue a determination of 
preauthorization for an injured worker’s nonemergency hospitalization, surgery 
or other specific medical care, subject to the following:
(i) The 
division’s determination that the worker suffered a compensable injury is final 
and not currently subject to contested case or judicial review;     (ii) A 
claim for preauthorization is filed by a health care provider on behalf of the 
injured worker;          
(iii) The 
division’s determination pursuant to this subsection is issued in accordance 
with the procedures provided in subsection (k) of this section;  (iv) Following a final 
determination to preauthorize, the necessity of the hospitalization, surgery or 
specific medical care shall not be subject to further review and providers’ 
bills shall be reviewed only for relatedness to the preauthorized care and 
reasonableness in accord with the division’s fee 
schedules.
 
(Emphasis 
added.)  Subsection (k), in turn, 
provides in relevant part that
 
(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;     
. 
. .       
(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. 
 
. 
. .       
(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.)  In providing that 
preauthorization for an injured worker’s medical care is subject to the 
procedures in subsection (k), the statute preserves the ability of an employer 
or other interested party to request a hearing on the preauthorization decision, 
as occurred in the present case. 
 
[¶17]     
Additionally, Wyo. 
Stat. Ann. § 27-14-606 provides that no determinations are final under the 
Worker’s Compensation Act without notice and an opportunity for a hearing: 

 
Each determination or 
award within the meaning of this act is an administrative determination of the 
rights of the employer, the employee and the disposition of money within the 
worker’s compensation account as to all matters involved. No determination shall 
be final without notice and opportunity for hearing as required by this act. 

 
In Martinez v. State ex rel. Wyoming Workers’ 
Comp. Div., 917 P.2d 619 
(Wyo. 1996), we analyzed this statute in the context of a dispute involving an 
employer’s claim for reimbursement of benefits received by an injured worker, as 
well as that worker’s claims for further benefits relating to the same 
injury.  The hearing examiner 
concluded that the employer did not meet its burden of proving that the 
employee’s benefits should be terminated and, as a result, awarded benefits to 
the employee on his outstanding claims and denied the employer’s request for a 
modification of the benefits which had already been paid.  Id., 917 P.2d  at 620.  On appeal, the district court reversed 
the hearing examiner’s decision with respect to the employee’s outstanding 
claims, reasoning that the employee had the burden of proving that he was 
entitled to receive compensation for those claims.  Id., 917 P.2d  at 620-21.  In upholding the district court’s 
decision, we cited Wyo. Stat. Ann. § 27-14-606, and, quoting from a prior 
decision, noted that “the employer is entitled to dispute any award or claim on 
the basis that it is unreasonable or improper, and certainly can raise the 
question as to whether the award or claim is causally related to the industrial 
accident which occurred or whether it may be attributable to some other 
event.”  Id., 917 P.2d  at 621 (quoting Herring v. Welltech, Inc., 660 P.2d 361, 
366 (Wyo. 1983)).  We concluded as 
follows:
 
From 
the clear language of § 27-14-606 and this Court’s decisions which have 
interpreted the statute, it is obvious that the normal process for an employer’s 
objection applied to the employee’s outstanding claims. It follows, then, that 
the employee bore the usual burden of proving that he was entitled to receive 
benefits for his outstanding claims. To place the burden of proof on the 
employer to dispute an employee’s right to receive benefits on any further 
claims after the employee’s first claim has been approved would effectively 
nullify the provisions of § 27-14-606.       
Martinez, 917 P.2d  at 
621.  See also Johnson v. State ex rel. Wyo. Workers’ 
Safety & Comp. Div., 2010 WY 166, 244 P.3d 491 (Wyo. 2010).
 
[¶18]     
Although Martinez is distinguishable based on the 
fact that there was no decision to preauthorize medical treatment in that case, 
we find that the statutes mandate the same result.  Wyo. Stat. Ann. § 27-14-601(k)(iv) and 
Wyo. Stat. Ann. § 27-14-606 each preserve an employer’s ability to object to a 
determination to preauthorize treatment.  
Further, Wyo. Stat. Ann. § 27-14-601 does not set forth any evidentiary 
presumptions arising from preauthorization that would support an injured 
worker’s claim for benefits or shift the burden of proof.  Accordingly, there is no indication in 
the statute that the burden shifts to the party objecting to preauthorization to 
disprove any elements of an injured worker’s claim.  Despite the Division’s grant of 
preauthorization for Mr. Beall’s orchiectomy, the burden remained with Mr. Beall 
to prove that he was entitled to reimbursement for his medical 
expenses.
 
[¶19]     
Our 
decision in Lane-Walter does not 
require a different result.  In that 
case, the claimant entered into a settlement agreement with the Workers’ Safety 
and Compensation Division in 1997 requiring the Division to pay for medical 
expenses related to the claimant’s back injury.  Lane-Walter, ¶ 5, 250 P.3d  at 515.  In 2007, the claimant sought 
preauthorization for a surgical procedure but was informed by the Division that 
no preauthorization for the procedure was required.  Id., ¶¶ 8-9, 250 P.3d  at 516.  The claimant proceeded with the surgery 
without objection from the Division or the claimant’s employer.  Id.  After the surgery, the Division denied 
benefits on the basis that the procedure was not reasonable or necessary.  Id., ¶ 1, 250 P.3d  at 514.  The matter was referred to the Medical 
Commission, which upheld the Division’s denial of benefits.  Id.  In reversing the district court’s 
decision upholding the Medical Commission’s denial of benefits, we indicated 
that under the unusual circumstances presented, the burden should have shifted 
to the Division to prove that the claimant’s procedure was not reasonable and 
not medically necessary.  Id., ¶ 18, 250 P.3d  at 519.  Ultimately, however, we reversed the 
Medical Commission’s decision because it was not supported by substantial 
evidence.  We concluded that 

            
To the extent that Lane-Walter had a burden of proof in this case, we 
hold: There is not substantial evidence to support the agency’s decision to 
reject the evidence offered by Lane-Walter. We reach that decision by 
considering whether the Medical Commission’s conclusions were contrary to the 
overwhelming weight of the evidence in the record as a whole. 
The 
Medical Commission’s determinations that both Dr. Horne and Lane-Walter were not 
credible witnesses are not supported by substantial evidence, i.e., there is not 
relevant evidence in the record which a reasonable mind might accept in support 
of the Medical Commission’s conclusions. The order of the district court 
affirming the Medical Commission is reversed.
 
Id., ¶ 22, 250 P.3d  at 
520.
 
[¶20]     
The 
present case is distinguishable from Lane-Walter.  In this case, the Division never gave 
any indication to Mr. Beall that preauthorization for the orchiectomy was not 
required, but rather followed the relevant statutory procedures by providing 
notice of preauthorization to Mr. Beall’s employer.  Mr. Beall’s employer objected to the 
preauthorization within the period set by Wyo. Stat. Ann. § 27-14-601(k).  Further, there was no settlement 
agreement in this case stipulating that Mr. Beall experienced a workplace injury 
or that his employer would pay for medical treatments related to that 
injury.  In light of these facts, we 
find that our decision in Lane-Walter 
does not require shifting of the burden of proof in this case.  The burden remained with Mr. Beall to 
prove all elements of his claim.  See, e.g., 
Kenyon, 
¶ 22, 247 P.3d  at 851.
 
Substantial 
Evidence
 
[¶21]     
The 
Wyoming Worker’s Compensation Act provides benefits for work-related 
injuries.  An “injury” is defined by 
the Act as follows:
 
“Injury” 
means any harmful change in the human organism other than normal aging and 
includes damage to or loss of any artificial replacement and death, arising out 
of and in the course of employment while at work in or about the premises 
occupied, used or controlled by the employer and incurred while at work in 
places where the employer’s business requires an employee’s presence and which 
subjects the employee to extrahazardous duties incident to the 
business.
 
Wyo. 
Stat. Ann. § 27-14-102(a)(xi).  Consistent with the phrase “arising out 
of and in the course of employment,” we have explained that there must be “a 
causal nexus between the injury and some condition, activity, environment or 
requirement of the employment.”  Shelest v. State ex rel. Wyo. Workers’ 
Safety & Comp. Div., 2010 WY 3, ¶ 8, 222 P.3d 167, 170 (Wyo. 2010) 
(emphasis omitted).
 
[¶22]     
One 
of the benefits provided by the Worker’s Compensation Act is payment of medical 
expenses for work-related injuries.  “The expense of medical and hospital care 
of an injured employee shall be paid from the date of the compensable injury . . 
. .”  Wyo. Stat. Ann. § 
27-14-401(a).  As indicated in the 
definition of “medical and hospital care,” however, medical care must be 
reasonable and necessary in order for an expense to be covered by the 
Act: 
“'Medical 
and hospital care’ when provided by a health care provider means any reasonable 
and necessary first aid, medical, surgical or hospital service . . . .”  Wyo. Stat. Ann. § 
27-14-102(a)(xii).  The Rules and 
Regulations of the Workers’ Compensation Division provide further guidance as to 
the meaning of the phrase “medically necessary”:  “'Medically necessary treatment’ means 
those health services for a compensable injury that are reasonable and necessary 
for the diagnosis and cure or significant relief of a condition consistent with 
any applicable treatment parameter.” 
Rules, 
Regulations and Fee Schedules of the Wyoming Workers’ Safety and Compensation 
Division, Ch. 1, § 4(al). 
 
[¶23]     
In 
this case, Mr. Beall was required to establish that the orchiectomy was 
reasonable and necessary medical treatment related to his workplace injury.  The Medical Commission, in its Findings 
of Fact, Conclusions of Law, and Order, determined that Mr. Beall’s 
orchiectomy was not reasonable and necessary:
 
This 
Panel finds and concludes that the orchiectomy procedure was not reasonable and 
necessary medical care as related to the October 13, 2008, work injury.  If Mr. Beall suffered an injury by 
slipping and falling at work on October 13, 2008, it was a minor injury to his 
groin, as revealed by slightly enlarged hydroceles and a small amount of, “. . . 
increased attenuation in the ischiorectal fossa fat which may be related to this 
patient’s trauma and a small amount of edema in the region . . . .” (CAT scan of 
October 22, 2008), as indicated in his initial urologic workup. 
(Employer/Objector Exhibit 3-5). There are absolutely no objective medical 
findings of injury to the testicle indicated in examinations that occurred 
shortly after the incident. . . . Mr. Beall may have suffered a slight 
trauma to the scrotal area, as indicated by hydroceles and the slight swelling 
of the ischiorectal fossa fat, but that condition had fully resolved by the time 
he saw Dr. Chizever on February 11, 2009, at which time Dr. Chizever noted that 
the “. . . previously identified possible abnormality in the ischiorectal fossa 
found on CT now appears resolved on follow up study.” (Employer/Objector Exhibit 
5-3).
 
In 
accordance with the finding that Mr. Beall’s injury had fully resolved by the 
time he saw Dr. Chizever on February 11, 2009, the Medical Commission concluded 
that “all care and treatment after that date, including the orchiectomy surgery, 
is not related to the work injury of October 13, 2008, and is therefore found to 
be non-compensable.”
 
[¶24]     
Mr. 
Beall claims that the Commission’s determination that the orchiectomy was not 
related to his work injury is not supported by substantial evidence.  He contends, first, that because he was 
the only witness to the accident, his testimony alone is sufficient to prove 
that he sustained a workplace injury.  
Second, he asserts that his pain was inherently subjective and that he 
was the only person who could testify about the pain he experienced as a result 
of his injury.  With respect to this 
argument, Mr. Beall ascribes great evidentiary significance to the fact that he 
voluntarily chose to undergo the orchiectomy, suggesting that his election to 
proceed with the removal of his testicle leads inexorably to the conclusion that 
the procedure was medically necessary.  
Third, Mr. Beall claims that the Commission’s adverse credibility 
determinations were based on an incorrect and biased examination of the 
evidence.
 
[¶25]     
To 
a large extent, Mr. Beall’s first two claims do not address the question 
presented under our standard of review.  
The assertions that Mr. Beall’s testimony was sufficient to prove his 
injury and that the subjective nature of his pain established that the 
orchiectomy was reasonable and necessary do not constitute direct challenges to 
the evidentiary grounds for the Commission’s decision.  Mr. Beall essentially asks this Court to 
reweigh the evidence and suggests that we ignore evidence supporting the 
Commission’s findings.  As we have 
previously noted, however, our task “is not to re-weigh the evidence presented 
to the Commission but only to determine if substantial evidence exists to 
support its conclusion.”  Watkins, ¶ 25, 250 P.3d  at 1091.  When we consider Mr. Beall’s claims in 
accordance with the parameters of the substantial evidence test, we must 
conclude that the Commission’s finding that Mr. Beall’s orchiectomy was not 
related to his workplace injury is supported by substantial 
evidence.
 
[¶26]     
The 
key finding of the Commission in this case was that Mr. Beall’s workplace injury 
had resolved by the time of his visit to Dr. Chizever, over seven months prior 
to the orchiectomy.  This conclusion 
finds ample support in the record.  
Dr. Chizever’s notes from Mr. Beall’s January 8, 2009 appointment 
indicate no abnormalities relating to Mr. Beall’s testicles: “Urologic exam is 
normal . . . . Testes descended bilaterally.  No gross evidence of hydrocele nor 
scrotal masses (see ultrasound report).”  
Dr. Chizever noted only the possibility of an abnormality with respect to 
Mr. Beall’s ischiorectal fossa based on the CT scan at Central Wyoming 
Urological Associates on October 22: “Scrotal Ultrasound done October 22, report 
reviews suggesting bilateral small hydroceles.  No ischemia.  No masses.  CT of the pelvis from October 22 films 
and report reviewed.  Question of 
small abnormality in the soft tissue in ischiorectal fossa.  No obvious gross lesions to my review.” 
 On February 11, 2009, after a 
follow-up CT scan, Dr. Chizever noted that the possible abnormality in the 
ischiorectal fossa appeared to be resolved.  No abnormalities regarding Mr. Beall’s 
testicles were noted.  After Mr. 
Beall’s examination, Dr. Chizever and Dr. Couch each notified the Division that 
Mr. Beall had been released to return to work.
 
[¶27]     
Further, 
the treatment providers who examined Mr. Beall during the hours and days 
immediately following his injury also could not identify any abnormalities in 
Mr. Beall’s testicles.  The 
physician’s assistant who examined Mr. Beall in Rock Springs immediately after 
the incident found no objective indications of injury: “no swelling[,] no 
bruising[,] no mass[,] has some point tenderness to the inguinal and cord.”  Likewise, notes from the examination at 
Rawlins Urgent Care two days after the incident reveal only that there was “no 
blood in [Mr. Beall’s] urine.”  Subsequent reports from Mr. Beall’s 
physical examinations at Central Wyoming Urological Associates, and the results 
from his ultrasound and CT scan, also did not reveal objective signs of 
testicular trauma.  In Mr. 
Sundquist’s report of the physical examination conducted on Mr. Beall’s first 
visit to Central Wyoming Urological Associates, he noted the following: 

 
SCROTUM: 
Scrotum is normal in appearance with no cysts, rashes, abnormal pigmentations, 
or lesions.  No ecchymoses. Normal 
exam, but significant patient discomfort to palpation of the scrotum, scrotal 
contents and inguinal areas (L>R). 
 
TESTES: 
Testes are palpable in the scrotum and normal in size, symmetry and 
texture.
 
EPIDIDYMIDES: 
Bilateral epididymides are palpable, posterolateral in position, of normal size 
and symmetry.  No palpable 
mass.
 
VAS 
DEFERENS: Left and right are normal.
 
Consistent 
with these notations, the findings from the scrotal ultrasound ordered by 
Central Wyoming Urological Associates indicated that “The testes were 
homogeneous in echotexture without evidence of testicular laceration or hematoma 
in this patient status post trauma.  
Color Doppler flow demonstrated in both the right and left testes.3  The epididymis was within normal limits 
bilaterally.”  Similarly, the 
findings from the pelvic CT scan indicated no abnormalities in Mr. Beall’s 
pelvic region aside from the “small amount of increased attenuation in the 
ischiorectal fossa fat,” which was resolved in a follow-up study as noted 
above.  This evidence provides 
substantial support for the Commission’s findings.
 
[¶28]     
We 
are also not persuaded by Mr. Beall’s challenges to the Commission’s findings 
with respect to his credibility.  As 
we recently reiterated, the fact finder is entitled to make assessments as to 
witness credibility and we are reluctant to overturn those judgments on appeal: 

 
“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). “We defer to the agency’s determination of witness 
credibility unless it is clearly contrary to the overwhelming weight of the 
evidence.” Glaze v. State ex rel. Wyo. 
Workers’ Safety & Comp. Div., 2009 WY 102, ¶ 29, 214 P.3d 228, 235 (Wyo. 
2009). “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, 2008 WY 84, ¶ 22, 188 P.3d  at 561; 
see also Chavez v. State ex rel. Wyo. 
Workers’ Safety & Comp. Div., 2009 WY 46, ¶ 18, 204 P.3d 967, 971 (Wyo. 
2009).  
Watkins, ¶ 23, 250 P.3d  at 1090.  We note that, in this case, Mr. Beall’s 
credibility was essential to his claim for reimbursement of his medical expenses 
given the lack of objective medical findings with respect to his injury, and the 
fact that he received treatment based solely on his subjective reports of 
pain.
 
[¶29]     
Mr. 
Beall attacks three specific findings of the Commission which he asserts are not 
supported by the evidence.  First, 
based on the following paragraph from the Commission’s findings of fact, Mr. 
Beall claims that the Commission incorrectly concluded that statements made in 
his injury report, which indicated that he was told to go back to work after the 
incident, were inconsistent with his testimony at the contested case 
hearing:

            
The fall itself was apparently not witnessed by any other party, and Mr. 
Beall testified at the Evidentiary Hearing and in spite of the injury report, in 
which Mr. Beall indicated that he was, “ . . . told to go back to work . . .”, 
[] that [his foreman] told him to see [the safety coordinator].  Mr. Beall testified that [the safety 
coordinator] gave him some ibuprofen and a big bag of ice to put on his crotch 
area and then drove him to the doctor in Rock Springs, Wyoming, which is about 
one hour from the work site where the injury occurred.  
 
Mr. 
Beall asserts that there is no inconsistency between his injury report and his 
testimony at the evidentiary hearing because he had been told to go back to work 
by the time he completed the injury report, several days after he was 
injured.  In light of this 
explanation of the evidence, Mr. Beall concludes that “the Commission appears to 
be, once again, viewing the evidence in a light most likely to result in a 
denial of benefits.”
 
[¶30]     
Second, 
Mr. Beall claims that the Commission improperly translated Dr. Augspurger’s 
testimony that a person “may” see swelling after traumatic injury to the 
testicle into the statement that a person would “expect” to see swelling.  He points to the following findings of 
fact: 
 
Dr. 
Augspurger also confirmed that Mr. Beall’s testicle pain could be caused by a 
variety of conditions, and many of his patients, “. . . have testicular pain and 
we never find the exact etiology.” (Employer/Objector’s Exhibit 15-8, Augspurger 
Deposition Transcript page 8). Dr. Augspurger also indicated that if there was 
trauma to the testicle causing pain, one would expect to see, “. . . swelling of 
the testicle.  Their scrotum may 
have changed colors, become black and blue from bleeding into the scrotum.” 
(Employer/Objector’s Exhibit 15-9, Augspurger Deposition Transcript page 
9).
 
Dr. 
Augspurger’s testimony, as it appears in the deposition transcript, stated as 
follows:
 
Q:  Okay.  So what would you look for in a patient 
who you believe has suffered trauma resulting [in] testicular pain?  What sort of objective findings would 
you expect to see in a patient like that?
 
A:  If you saw them acutely [within the 
first week or so after the injury], they may have an injury to the testicle with 
swelling of the testicle.  Their 
scrotum may have changed colors, become black and blue from bleeding into the 
scrotum.
 
[¶31]     
Third, 
Mr. Beall claims that the Commission improperly discredited his testimony that 
he was screaming and vomiting after the incident because none of his coworkers 
observed him do these things and because the physician’s assistant who examined 
him in Rock Springs did not indicate that he had been vomiting.  Mr. Beall contends that the Medical 
Commission could not properly rely on his coworkers’ statements because they 
were not subject to cross-examination.  
He asserts that “While these types of hearsay statements are admissible 
as evidence in an administrative hearing, the lack of information in these 
incident reports is not conclusive evidence that an event did not occur.”  He also claims that any inconsistencies 
in his testimony “were not of the nature or magnitude” to overcome the 
conclusion that his surgery was medically necessary.
 
[¶32]     
We 
find no merit in Mr. Beall’s assertions.  
Even if we accepted his claims without qualification, we could not 
conclude that the Commission’s credibility findings are not supported by 
substantial evidence.  The findings 
identified by Mr. Beall, to the extent that they actually reflect the 
Commission’s doubts about Mr. Beall’s credibility, constitute a negligible 
portion of the Commission’s credibility findings, and are extraneous to the 
central issues identified by the Commission.  Mr. Beall does not squarely contest the 
Medical Commission’s principle credibility determinations, which were focused 
primarily on three distinct areas of concern: (1) Mr. Beall’s failure to provide 
accurate or complete medical information relating to his injury to a succession 
of doctors and physicians’ assistants; (2) Mr. Beall’s failure to provide any of 
his treatment providers with information relating to a prior groin injury from 
which he experienced similar symptoms; and (3) Mr. Beall’s demeanor and 
testimony at the contested case hearing.
 
[¶33]     
The 
Commission found that Mr. Beall’s credibility was undermined by his failure to 
provide accurate or complete medical histories regarding his treatment to a 
series of health care providers.  
The Commission noted that Mr. Beall had provided incomplete medical 
information to Dr. Flock (“[T]here is no indication that any medical records 
from the prior medical consults had been provided to Dr. Flock for his review, 
including the prior urologic workup in Casper.”), Dr. Cesko (“Mr. Beall failed 
to advise Dr. Cesko that he had already been through a full urological workup 
with Central Wyoming Urological Associates, P.C., and that [their] findings upon 
examination, were unremarkable.”), and Dr. Shafer (“This Panel notes that Dr. 
Shafer was not provided the medical records of Dr. Couch, Dr. Cesko, or Dr. 
Flock, and relied exclusively on the subjective reporting of Mr. Beall, which 
was inaccurate and incomplete.”).  
The Commission also found that Mr. Beall had provided misleading 
information to Dr. Augspurger.  It 
noted that Dr. Augspurger’s initial report from his examination of Mr. 
Beall stated that Mr. Beall had “significant swelling of his left testicle” at 
the time of injury, and that “[t]he testicle got a large size and now that has 
slowly resolved.”  The Commission 
found, however, that there was no indication that Mr. Beall experienced any 
swelling relating to his injury:  

            
This Panel notes that the initial workups that were provided by the 
Hunter Family Medical Clinic in Rock Springs, Wyoming, Rawlins Urgent Care in 
Rawlins, Wyoming, and Central Wyoming Urological Associates, P.C., in Casper, 
Wyoming, did not indicate a swollen testicle in any of their medical records 
regarding Mr. Beall’s examinations.
 
After 
further noting that Dr. Augspurger’s deposition revealed that he had relied 
entirely on Mr. Beall’s report of a traumatic injury to his groin, the 
Commission concluded as follows:
 
            
As with the other physicians who provided treatment to Mr. Beall, Dr. 
Augspurger was provided an incorrect and incomplete medical history.  Significantly, several prior 
evaluations, including neurologic evaluations and ultrasounds, were not provided 
to Dr. Augspurger.  Mr. Beall has 
exhibited a pattern of repeatedly providing inaccurate, incomplete or pointedly 
misleading medical information to his treating physicians, including Dr. 
Augspurger.  Dr. Augspurger and 
the other physicians relied upon those inaccuracies in providing medical care to 
Mr. Beall, including the left testicle removal, which was pursuant to Mr. 
Beall’s request.  It is noteworthy 
that the pathology report of the removed testicle basically shows a normal 
testicle that was functional.
 
Importantly, 
the Commission ultimately concluded that the inaccurate and incomplete medical 
histories supplied to Mr. Beall’s treatment providers, and the medical opinions 
generated from that misinformation, contributed to the decision to preauthorize 
the orchiectomy:
 
The 
treating and Peer Review physicians were also misled and misinformed by Mr. 
Beall and the medical opinions that were generated from the inaccurate and 
misleading information cannot be considered credible in light of the magnitude 
of the misrepresentations made by Mr. Beall, although they provide a basis for 
understanding why Drs. Balison and White, and ultimately the Division, 
approved the surgical removal of Mr. Beall’s left testicle.  
 
Mr. 
Beall does not challenge any of the Commission’s findings that his treatment 
providers were supplied with incomplete and inaccurate 
information.
 
[¶34]     
The 
Medical Commission’s order further indicates that it was troubled by the fact 
that Mr. Beall had not informed his treatment providers that he had previously 
experienced problems very similar to those that he claimed arose from his 
injury.  The Commission stated that 

 
            
15.  Mr. Beall apparently had 
very similar problems in the past that resulted in a California Workers’ 
Compensation claim that allegedly took place on December 21, 1991, where he was 
evaluated at the Emergency Room of the Barstow Community Hospital in Barstow, 
California, with complaints of, “. . . pain in right lower quadrant into right 
testis . . .”, and later for, “. . . right groin pain, bladder dysfunction and 
sexual difficulties . . . .” (Employer/Objector Exhibits 13-1 and 13-3). In 
1992, Mr. Beall was provided a variety of evaluations, including a Doppler 
penile blood flow examination, and in 1993, the notes reflect that a Hearing was 
held that apparently resulted in a ruling that Mr. Beall did not sustain a 
compensable injury on December 21, 1991. (Employer/Objector’s Exhibit 13-3 and 
13-4).
 
            
In addition, submitted records indicate that in November of 2000, Mr. 
Beall apparently had additional problems with “dysuria and frequency . . . ” and 
a reference was made of a, “. . . right inguinal surgery in 1997 . . . .” 
(Employer/Objector’s Exhibit 13-7 and 13-8).  It is of note that Mr. Beall failed to 
advise any of his Wyoming health care 
providers of these prior problems and he indicated on page 1 of his Wyoming Report of Injury, 
(Employee/Claimant’s Exhibit 1-1), that the body part had not been injured 
previously.
 
            
Mr. Beall also failed to disclose that he had any prior urologic problems 
in written answers to interrogatory questions that had been submitted by the 
Employer/Objector.  In response to a 
question about whether he had ever had any care and treatment to his “. . . 
genitalia, your reproductive system, or your urologic system . . . ,” Mr. Beall 
indicated only that [he had been treated for two other unrelated medical 
conditions]. (Employer/Objector’s Exhibit 12-6).
 
(Emphasis 
in original.)  The Commission 
concluded that Mr. Beall’s subjective reports of his current injury were not 
credible based, in part, on the fact that “Mr. Beall failed to advise ANY of his 
treating physicians that he had prior testicular problems pursuant to a work 
injury in California, which also included components of urinary incontinence, 
erectile dysfunction, and objective pain and hernia.” 
 
[¶35]     
Mr. Beall does not 
challenge these findings.  Rather, 
noting that the previous injury was to his right testicle, he contends that 
“Whether the medical records before the accident were incomplete and whether the 
doctors had that information in determining the necessity of the surgery is not 
relevant.  This Court has to merely 
ask itself if ANY man would be willing to have his left testicle removed, if it 
were not medically necessary.”  
(Footnote omitted.)  We have 
previously noted, however, that “As the trier of fact, the Medical Commission 
[is] charged with determining relevancy, assigning probative values and weighing 
the evidence.”  McIntosh v. State ex rel. Wyo. Med. 
Comm’n, 2007 WY 108, ¶ 13, 
162 P.3d 483, 488-89 (Wyo. 2007).  The Commission concluded that Mr. 
Beall’s prior injuries to his groin were relevant to his October 13, 2008 injury 
and we do not second-guess that conclusion in this appeal.
 
[¶36]     
The 
Commission also determined that Mr. Beall was not a credible witness based on 
his testimony at the contested case hearing.  The Commission noted that although 
Mr. Beall’s medical records clearly indicated that he had undergone a 
physical examination at the Casper urology clinic on two separate occasions, Mr. 
Beall denied that such examinations had occurred:
 
            
Mr. Beall testified during the hearing that [physician’s assistant] 
Sundquist, “. . . did not have me open up my britches or anything . . .”, during 
the examination. (Beall Hearing Testimony).  However, page 2 of the medical report 
from Mr. Beall’s October 16, 2008, examination by [physician’s assistant] 
Sundquist indicates [visual and palpable observations relating to Mr. Beall’s 
phallus, meatus, scrotum, testes, epididymides, and vas deferens]. 
(Employer/Objector’s Exhibit 3-2 and 3-3).
 
. 
. . 
 
            
This Medical Panel finds that Mr. Beall’s statement that he was not 
physically examined by Central Wyoming Urological Associates, P.C., is not 
supported by the medical records, and is not credible.
 
. 
. .
 
            
8.  Mr. Beall returned for a 
follow-up visit with [physician’s assistant] Sundquist on November 10, 2008, 
where he advised [physician’s assistant] Sundquist that his, “. . . 
symptoms have not significantly changed . . . .” (Employer/Objector’s Exhibit 
3-6).  Once again, the records 
reflect that Mr. Beall was given a physical examination, which on this date 
included a rectal and prostate examination.  During his hearing testimony Mr. Beall 
again denied that he was given a physical examination and he indicated 
that:
 
[T]hey 
still didn’t pull down my britches or anything like that.  They didn’t do any type of examination 
to speak of. (Beall Hearing Testimony).
 
            
Mr. Beall also indicated that no one read the x-rays, that had been 
taken, but they only looked at the narrative report on the 
front.
 
The 
Commission provided the following summary of Mr. Beall’s misstatements regarding 
the reports and opinions of his treatment providers:
 
            
26.  During his testimony at 
the Evidentiary Hearing, this Panel did not find Mr. Beall to be a credible 
witness.  Mr. Beall insisted 
that he was never physically examined at the urological examination in Casper, 
although the medical records very clearly indicate that a physical examination 
occurred.  We find it highly 
unlikely that a urologic workup would be conducted by these medical providers 
without a physical examination of Mr. Beall’s testicles and scrotum and the 
submitted records indicate an examination was provided.  He also indicated that Dr. Flock, the 
urologist in Laramie, said his testicle was “. . . really damaged . . .” and was 
a “. . . nonfunctional organ . . .”, although Dr. Flock’s records make no 
mention of a nonfunctioning organ.  
Mr. Beall further testified that Dr. Augspurger examined him and “. . . 
saw how squishy the testicle was . . .”, but Dr. Augspurger’s records do not 
reflect such a finding.
 
            
In addition, Mr. Beall testified that he never told Dr. Chizever 
that he had developed hematuria and had been prescribed a course of oral 
antibiotics for his condition, although Dr. Chizever’s records clearly reflect 
that he did.  Mr. Beall also again 
denied that he was physically examined at his initial visit with Dr. Chizever, 
although the chart note clearly indicates that a thorough physical examination, 
including examination of the scrotal area, was carried 
out.
 
In 
addition, the Commission noted that Mr. Beall’s demeanor at the contested case 
hearing also reflected poorly on his credibility: 
 
            
This Panel also notes that Mr. Beall was elusive and upon 
cross-examination, failed to answer direct questions with direct answers.  The following exchange is representative 
of Mr. Beall’s testimony:
 
Q: 
[Dr. Augspurger] didn’t say, gee, your testicle is mushy.  He didn’t say that, did 
he?
 
A: 
He didn’t say it, no he didn’t – I believe he said that, yeah.  I believe he said that it was mushy and 
kind of weird. (Beall Hearing Testimony).
 
            
Again, this Panel notes that Dr. Augspurger’s medical records make no 
mention of a testicle that is either “mushy” or “weird”.
 
Mr. 
Beall does not address the Commission’s findings with respect to his demeanor at 
the contested case hearing. 
 
[¶37]     
Finally, 
Mr. Beall does not address the Commission’s adverse credibility findings with 
respect to Dr. Cesko.  As we have 
previously noted, “a hearing examiner is entitled to disregard an expert opinion 
if he finds the opinion unreasonable, not adequately supported by the facts upon 
which the opinion is based, or based upon an incomplete and inaccurate medical 
history provided by the claimant.” Taylor 
v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 2005 WY 148, ¶ 15, 
123 P.3d 143, 148 (Wyo. 2005). After quoting a March 27, 2009 letter from Dr. 
Cesko to the Division which stated that Mr. Beall’s “left testicle has been 
turned into a spongy nonfunctional organ,” the Commission noted that Dr. Cesko’s 
conclusions were not supported by the evidence:
 
            
It is noteworthy that Dr. Cesko indicates that Mr. Beall’s left 
testicle has been turned into a, “. . . spongy nonfunctional organ . . 
.”, with “. . . pudendal nerve damage . . . .”  Clearly, none of the initial 
examinations, including the urological examinations in Casper, revealed a 
“spongy nonfunctional organ”.  Dr. 
Cesko stated in his deposition testimony that he believed he received that 
specific information from Dr. Flock, the Urologist in Laramie, Wyoming, who saw 
Mr. Beall at the Memorial Hospital of Carbon County on March 4, 2009.  However, a review of Dr. Flock’s 
records that were submitted clearly indicates that no such representation of a 
“spongy nonfunctional organ” was ever indicated by him.  Dr. Cesko also stated during his 
deposition that he had not reviewed any of the prior medical records from 
Central Wyoming Urological Associates, P.C., of Casper, Wyoming, nor had he seen 
the initial reports of treatment provided by Hunter Family Medical Clinic out of 
Rock Springs, Wyoming.
 
            
Dr. Cesko also makes a rather amazing representation 
that:
 
It 
is apparent that he did suffer pudendal nerve damage from the straddle injury. 
(Employer/Objector’s Exhibit 6-1).
 
            
A review of Dr. Cesko’s notes clearly indicate no objective findings of 
neurological damage, and a neurological workup that was provided by Reed Shafer, 
M.D., a Board Certified Neurologist, and Electrodiagnostic Physician with CMS 
(Cheyenne Medical Specialists, P.C.) in Cheyenne, Wyoming, on April 16, 2009, 
was found to be normal.  This Panel 
finds that Dr. Cesko’s indication of neurologic damage is totally unsupported by 
the evidence.
 
            
This Medical Hearing Panel finds that Dr. Cesko has provided incorrect, 
misleading, and unsupported representations to the Wyoming Workers’ Safety and 
Compensation Division about the nature and pathology of Mr. Beall’s 
injury.  Dr. Cesko also erroneously 
relied on the subjective, inaccurate, and incomplete history that had been 
provided to him by Mr. Beall without qualification or question.  Dr. Cesko’s letter to the Division was 
based on incorrect information that was not supported by any of the medical 
studies, and prompted a cascade of unwarranted and unnecessary medical care that 
ultimately resulted in the orchiectomy surgery.
 
(Emphasis 
in original.)  Mr. Beall fails to 
assert any grounds for rejecting these findings.
 
[¶38]     
We 
find no reason in the record to depart from the credibility findings of the 
Medical Commission or to conclude that they are clearly contrary to the 
overwhelming weight of the evidence.  Mr. Beall provides no response to the 
main credibility issues identified by the Commission.  Rather, as discussed above, he simply 
ignores the major part of the Commission’s thirty-one-page order, which focused 
on the misleading statements and incomplete medical histories Mr. Beall supplied 
to a succession of treatment providers, Mr. Beall’s evasive testimony at the 
contested case hearing, and the unsupported opinions of Dr. Cesko.  The Commission’s credibility 
determinations are corroborated by the record, and we find substantial evidence 
to support those determinations.
[¶39]     
The 
burden of proving that the orchiectomy was reasonable and necessary medical care 
as related to his October 13, 2008 workplace injury rested with Mr. Beall, and 
substantial evidence supports the Commission’s determination that Mr. Beall 
failed to meet this burden.
 
[¶40]     
Affirmed.
[¶41]     
FOOTNOTES
1A hydrocele is a 
fluid-filled sac surrounding a testicle that results in swelling of the 
scrotum.
 
2Two weeks after the 
district court issued its decision affirming the Medical Commission’s order, 
Mr. Beall, relying on the decision in Lane-Walter, filed a petition requesting 
the court to relieve him from the judgment.  The district court denied the 
petition.
3Dr. Augspurger stated 
in his deposition that the Doppler flow shown on the scrotal ultrasound 
indicated good blood flow to the testicles.
[¶42]