Case Title: JAMES A. HERRERA V. STATE OF WYOMING, ex rel., WYOMING WORKERS SAFETY AND COMPENSATION DIVISION

Citation: 

Docket Number: S-09-0191

State: wyoming

Court: Wyoming Supreme Court

Date: 2010-07-28T00:00:00Z

Document:
JAMES A. HERRERA V. STATE OF WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2010 WY 103236 P.3d 277Case Number: S-09-0191Decided: 07/28/2010
APRIL 
TERM, A.D. 2010

 
 

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

 
 
Appeal 
from the District Court of Sweetwater County

The 
Honorable Jere A. Ryckman, Judge

 
 
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; 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.

 
 
KITE, 
Chief Justice.

 
 
[¶1]  After sustaining a work related injury 
ultimately requiring amputation of his right index finger, James A. Herrera 
began taking an anti-depressant medication.  The Wyoming Workers' Safety and 
Compensation Division (Division) paid for the medication for two years and then 
denied further payment.  Mr. Herrera 
objected and, after a contested case hearing, the Office of Administrative 
Hearings (OAH) awarded him benefits.  
The Division sought review in district court and the district court 
reversed the award.  We reverse the 
district court's ruling.  

 
 
ISSUES

 
 
[¶2]  Mr. Herrera presents two issues for this 
Court's consideration:

 
 
            
1.         
Whether the OAH's findings and conclusions were supported by substantial 
evidence.

 
 
            
2.         
Whether the OAH's findings and conclusions are in accordance with the 
law.

 
 
FACTS

 
 
[¶3] 
On October 1, 2002, Mr. Herrera was working for Groathouse Construction as a 
cement finisher.  He and a co-worker 
were setting up cement forms and the co-worker was using a 10-pound sledge 
hammer to pound in a stake to hold the forms.  He swung the sledge hammer, missed the 
stake and struck Mr. Herrera's right hand.  
The blow crushed Mr. Herrera's right hand and index finger.  Mr. Herrera filed a report of injury and 
the Division awarded him benefits. 

 
 
[¶4]  Between the date of injury and 2006, Mr. 
Herrera underwent multiple surgeries on his right hand.  In June of 2006, Mr. Herrera's physician 
prescribed the drug Lexapro to help relieve anxiety Mr. Herrera was experiencing 
as a result of his injury.  After 
the surgeries proved unsuccessful in relieving Mr. Herrera's pain and other 
symptoms, his right index finger was amputated in March of 2008.  

 
 
[¶5]  The Division paid medical and other 
benefits for the treatment of Mr. Herrera's hand, including the Lexapro 
prescription.  In June of 2008, 
however, the Division issued a final determination in which it denied further 
payment for the Lexapro.1  As grounds for the denial, the Division 
asserted that Lexapro, commonly used as an anti-depressant, was used to treat a 
mental injury and, pursuant to Wyo. Stat. Ann. § 27-14-102(a)(xi)(J) (LexisNexis 
2007), "medications used to treat mental health conditions cannot be paid six 
months after the claimant reaches maximum medical improvement."2  Mr. Herrera objected to the 
determination and the OAH scheduled a contested case 
hearing.

 
 
[¶6]  Following the hearing in October of 
2008, the OAH awarded benefits.  In 
its ruling, the OAH stated:

 
 
26.  [T]his case involved a medication which 
appears to be prescribed for multiple reasons and not just for treatment of 
depression or anxiety.  Herrera was 
a very credible witness and his unchallenged testimony was that the Lexapro was 
prescribed to treat his pain and elevated blood pressure, in addition to his 
anxiety.  Herrera credibly explained 
that when the doctor attempted to discontinue the Lexapro prescription, 
Herrera's hand pain increased significantly and due to the severe hand pain his 
blood pressure became dangerously high.  
Once Herrera restarted the prescription, his hand pain decreased and his 
blood pressure returned to a safe level.

 
 
27.  Based on the unchallenged testimony and 
proof of the results of the Lexapro prescription, this Office finds the Lexapro 
is being prescribed to treat not only Herrera's anxiety, but also his physical 
injury.  As the Lexapro is being 
used as a pain control for Herrera's significant injury, this Office finds it is 
not subject to the limits of Wyo. Stat. Ann. § 27-14-102(a)(xi)(J), (LEXIS 
2002).  Therefore, Herrera has 
proven, by a preponderance of the evidence, all of the essential elements of his 
claim.  Specifically, Herrera proved 
he suffered a significant right hand injury while in the course and scope of his 
duties for Groathouse, Herrera is still being treated for his injuries, and 
Herrera's Lexapro prescription is for the treatment of Herrera's work related 
physical injury.

 
 
[¶7]  The Division sought review in district 
court.  After considering the 
parties' arguments, the district court concluded substantial evidence did not 
support the OAH ruling and reversed the award of benefits.  The district court 
stated:

 
 
The 
finding that [Mr. Herrera]'s physical injury was treated with Lexapro is 
contrary to the overwhelming weight of the evidence.  Instead, document evidence emphasizes 
[Mr. Herrera]'s "depression," "situational depression," "depressive anxieties," 
"acute stress reaction," and helpfulness to his mood.  It is noteworthy that no physician 
testified and no medical evidence was presented connecting the physical injury 
and [Mr. Herrera]'s use of Lexapro.  
Substantial evidence does not support the finding that [Mr. Herrera] was 
being treated with Lexapro for a physical injury.

 
 
Mr. 
Herrera appealed to this Court from the district court's ruling. 

 
 
STANDARD 
OF REVIEW

 
 
[¶8]  In considering an appeal from a district 
court's review of an administrative agency's decision, we give no special 
deference to the district court's decision.  Dale v. S & S Builders, LLC, 2008 WY 
84, ¶ 8, 188 P.3d 554, 557 (Wyo. 2008).  
Instead, we review the case as if it had come directly to us from the 
administrative agency.  Id.  Our review is governed by Wyo. 
Stat.  Ann. § 16-3-114(c) 
(LexisNexis 2009), which states:

 
 
            
(c) To the extent necessary to make a decision and when presented, the 
reviewing court shall decide all relevant questions of law, interpret 
constitutional and statutory provisions, and determine the meaning or 
applicability of the terms of an agency action.  In making the following determinations, 
the court shall review the whole record or those parts of it cited by a party 
and due account shall be taken of the rule of prejudicial error.  The reviewing court 
shall:

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

(ii) 
Hold unlawful and set aside agency action, findings and conclusions found to 
be:

(A) 
Arbitrary, capricious, an abuse of discretion or otherwise not in accordance 
with law;

 (B)   Contrary to constitutional right, 
power, privilege or immunity;

(C) 
In excess of statutory jurisdiction, authority or limitations or lacking 
statutory right;

(D) 
Without observance of procedure required by law; or

(E) 
 Unsupported by substantial evidence 
in a case reviewed on the record of an agency hearing provided by statute.  

 
 
[¶9]  When the burdened party prevailed before 
the agency, we determine if substantial evidence exists to support the agency's 
decision by considering whether there is relevant evidence in the entire record 
which a reasonable mind might accept in support of the agency's ruling.  Dale, ¶ 22, 188 P.3d  at 561.  Findings of fact are supported by 
substantial evidence if, from the evidence preserved in the record, we can 
discern a rational premise for those findings.   Bush v. State ex rel. Wyoming Workers' 
Comp. Div., 2005 WY 120, ¶ 5, 120 P.3d 176, 179 (Wyo. 2005) (citations 
omitted).  

 
 
[¶10]  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.  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.  Id.  We review an agency's conclusions of law 
de novo, and will affirm only if the 
agency's conclusions are in accordance with the law.  Id., ¶ 26, 188 P.3d  at 561-62.  

 
 
DISCUSSION

 
 
[¶11]  Mr. Herrera contends the OAH's 
determination that he was entitled to benefits was supported by substantial 
evidence and must be affirmed.  He 
points to his testimony that his physician prescribed Lexapro for pain, numbness 
and depression.  He also points to 
his testimony that when he stopped taking Lexapro his pain increased, which 
caused his blood pressure to rise, and when he resumed taking Lexapro those 
physical symptoms subsided.  Because 
the Division did not present evidence disputing his testimony, he contends, 
substantial evidence supported the OAH ruling.

 
 
[¶12]  The Division asserts the district court 
properly held substantial evidence did not support the OAH ruling that Lexapro 
was prescribed to reduce Mr. Herrera's pain, numbness and high blood 
pressure.  The Division contends the 
evidence showed Lexapro was prescribed to treat Mr. Herrera's agitation, stress, 
anxiety and depression, that is, mental injuries.  Citing § 27-14-102(a)(xi)(J), the 
Division asserts mental injuries are compensable only when there is evidence, 
which did not exist in Mr. Herrera's case, that a licensed psychiatrist or 
clinical psychologist diagnosed such injuries.  In the absence of a mental health 
diagnosis, the Division contends Mr. Herrera had the burden of proving Lexapro 
was for treatment of physical injuries which, the Division asserts, he failed to 
do because he did not present medical evidence supporting his testimony.   

 
 
[¶13]  Section 27-14-102(a)(xi)(J) excludes 
from coverage any mental injury unless it is caused by a compensable physical 
injury, it occurs subsequent or simultaneously with the physical injury and it 
is established by clear and convincing evidence.  We addressed this exclusion in Brierley v. State ex rel. Wyoming Workers' 
Safety and Comp. Div., 2002 WY 121, ¶ 17, 52 P.3d 564, 571 (Wyo. 2002) 
(holding clear and convincing evidence established that the claimant's attempted 
suicide was the result of a mental injury suffered subsequent to a compensable 
injury); Sechrist v. State ex rel. 
Wyoming Workers' Safety and Comp. Div., 2001 WY 45, ¶ 12, 23 P.3d 1138, 1141 
(Wyo. 2001) (holding the claimant established by clear and convincing evidence 
that her depression was caused by her compensable physical injury); State ex rel. Wyoming Workers' Safety and 
Comp. Div. v. Summers, 987 P.2d 153, 155-56 (Wyo. 1999) (holding the OAH 
erroneously applied the exclusion to a diagnosis given in 1993 before the 
exclusion was enacted); and Frantz v. 
Campbell County Memorial Hosp., 932 P.2d 750, 754 (Wyo. 1997) (holding the 
exclusion did not violate the equal protection clause of the Wyoming 
Constitution or the Fourteenth Amendment to the United States Constitution), 
overruled on other grounds in Torres v. 
State ex rel. Wyoming Workers' Safety and Comp. Div., 2004 WY 92, 95 P.3d 794 (Wyo. 2004).  None of these 
cases required us to consider the question presented here:  whether substantial evidence supported 
the OAH's findings and conclusions that medication prescribed for a mental 
injury was also prescribed to treat a claimant's physical injury, making § 
27-14-102(a)(xi)(J) inapplicable.             

 
 
[¶14]  As reflected in paragraph 6 above, the 
OAH found that Mr. Herrera's physicians prescribed Lexapro not only to treat Mr. 
Herrera's depression and anxiety but also for treatment of his physical 
injury.  Because it was prescribed 
to treat his physical injury, the OAH concluded it did not fall within the 
purview of § 27-14-102(a)(xi)(J), which applies only to mental injuries.  The OAH made this finding on the basis 
of Mr. Herrera's unchallenged testimony that his physician prescribed Lexapro 
for pain and numbness as well as anxiety, when she discontinued the 
prescription, Mr. Herrera's pain increased significantly causing his blood 
pressure to rise, and when she restarted the prescription these physical 
symptoms lessened.  The OAH found 
Mr. Herrera's unchallenged testimony concerning the reason for the prescription 
and the effects of discontinuing it to be "very credible" evidence that Lexapro 
was prescribed for treatment of his physical injury.  

 
 
[¶15]  The duty to weigh the evidence and 
determine the credibility of the witnesses and evidence belongs to the OAH as 
the fact-finder.  Stewart v. State ex rel. Wyoming Workers' 
Safety and Comp. Div., 2007 WY 58, ¶ 14, 155 P.3d 198, 203 (Wyo. 2007); Olivas v. State ex rel. Wyoming Workers' 
Safety and Comp. Div., 2006 WY 29, ¶ 17, 130 P.3d 476, 485 (Wyo. 2006).  The OAH has the opportunity to observe 
the witnesses and hear their testimony and is, therefore, in the best position 
to judge the witnesses' demeanor, truthfulness and veracity and decide which 
evidence is most dependable.  Id.  For this reason, we defer to the 
fact-finder on credibility findings.  
Stewart, ¶ 14, 155 P.3d  at 
203.  We do not re-weigh the 
evidence or second-guess the agency's determinations as to witness 
credibility.  Id.  Our task is to review the record to 
determine whether substantial evidence supports the hearing examiner's 
decision.  Id.  

 
 
[¶16]  Our review of the record reveals that 
Mr. Herrera was the only witness who testified at the hearing.  He testified that his surgeon, Dr. Heidi 
E. Jost, explained to him that she was prescribing Lexapro for the pain, 
numbness, depression and anxiety he was experiencing as a result of his 
injury.  He testified that Dr. Jost 
told him that Lexapro would help him deal with the pain and other symptoms he 
was having and get on with his everyday life.  Mr. Herrera also testified that his 
physician, Dr. Ann Thedieck, took him off Lexapro, but started him back on it 
when his pain level and blood pressure increased.  Back on Lexapro, his blood pressure and 
pain level decreased and Dr. Thedieck advised him to continue taking it.           
  

 
 
[¶17]  In addition to Mr. Herrera's testimony, 
the record contains medical records reflecting that Mr. Herrera had "pain, 
numbness and depression related to inability to return to his prior profession 
with huge financial implications" and "now takes Lexapro."  The records also reflect that Mr. 
Herrera saw a mental health counselor twice after undergoing surgery to amputate 
his finger; however, the counselor noted after the second visit that Mr. Herrera 
was coping well and there were no plans for follow-up.     

 
 
[¶18]   Although the medical records 
contained evidence that Lexapro was prescribed for depression and anxiety, the 
evidence presented showed that it also had the effect of treating Mr. Herrera's 
pain and blood pressure.  The OAH 
found Mr. Herrera to be "very credible" and particularly found credible his 
testimony as to the physical effects of discontinuing, and then re-starting, the 
Lexapro prescription.  Mr. Herrera's 
testimony in this regard was unchallenged.  
Despite references in the medical records to Mr. Herrera's depression, he 
was seen only twice for mental health counseling, was reported to be coping well 
mentally and was not seen again.  
The counseling records make no reference to Lexapro as a treatment option 
for his mental health issues.  

 
 
[¶19]  From the entire record and giving due 
regard to the OAH's duty to weigh the evidence and opportunity to observe Mr. 
Herrera, hear his testimony and assess his demeanor, truthfulness and veracity, 
we conclude the record contains such relevant evidence as a reasonable mind 
might accept as adequate to support the finding that Lexapro treated Mr. 
Herrera's physical injury.  Dale, ¶ 22, 188 P.3d  at 561.  Substantial evidence supported the OAH'S 
findings that § 27-14-102(a)(xi)(J) did not apply.  

 
 
[¶20]  In reaching the contrary result, the 
district court relied on references in the medical records to Mr. Herrera's 
"situational depression," "depressive anxieties," and "acute stress 
reaction."  There is no doubt from 
the records that Mr. Herrera's physician and surgeon believed his physical 
injury had mental health consequences.  
Absent Mr. Herrera`s testimony, we likely would uphold the district 
court's ruling.  However, the task 
of reviewing courts is not to re-weigh the evidence but to decide whether the 
evidence was such as a reasonable mind might accept as adequate to support the 
finding.  In the present case, the 
OAH assessed Mr. Herrera as a very credible witness whose unchallenged testimony 
concerning the effects of Lexapro on his physical injuries was very believable. 
We are not in a position to second guess that assessment.     

 
 
[¶21]  Our conclusion that Wyoming's mental 
injury exclusion did not apply under the circumstances of Mr. Herrera's case 
gains support from a decision of a Louisiana Court of Appeals construing a 
similar statute.  In Harris v. Christus St. Patrick Hospital, 
857 So. 2d 1278 (La. App. Ct. 2003), the claimant sustained a serious work 
related hand injury requiring multiple surgical procedures.  Her hand remained functionally useless 
and she ultimately was referred to a pain management specialist who prescribed 
anti-depressant medication in addition to pain medication.  After a worker's compensation judge 
ordered payment of the anti-depression medication, the employer appealed 
claiming error on the grounds that La.R.S. 23:1021(7)(c) and (d) provided that 
mental injuries must be proven by clear and convincing evidence and were not 
compensable unless diagnosed by a licensed psychiatrist or psychologist and the 
diagnosis met the criteria established in the most current Diagnostic and 
Statistical Manual of Mental Disorders. 

 
 
[¶22]  The court upheld the order requiring 
payment of the anti-depressant medication, finding that there was no evidence 
the claimant had psychological problems unrelated to her work injury and that 
her claim was based upon her "physical disability rather than the depression she 
suffered as byproduct of her physical injury."  Id. at 1284.  The court stated:

 
 
Under 
these circumstances, we find that Ms. Harris' request for depression medication 
is not governed by the heightened burden of proof and diagnostic requirements of 
La.R.S. 23:1021(7)(c) and (d). We simply cannot conclude that the legislature 
intended to increase the cost and to extend the recovery time of each physical 
injury claim by requiring a psychiatric or psychological consultation whenever a 
physician in another specialty prescribes anti-depression medication in the 
course of treating that physical injury.  
Accordingly, we hold that La.R.S. 32:1021(7)(c) and (d) apply only when 
the claimant alleges to be disabled as the result of a mental injury or 
illness.

 
 
We 
find the Louisiana appeals court's reasoning to be 
persuasive.

 
 
[¶23]  The Division asserts the district court 
properly reversed the ruling because the OAH relied almost exclusively on Mr. 
Herrera's testimony, which was not supported by medical evidence.  We have said that "the testimony of an 
injured worker alone is sufficient to prove an accident if there is nothing to 
impeach or discredit the worker's testimony, and the worker's statements are 
corroborated by surrounding circumstances."  Nagle v. State ex rel. Wyoming Workers' 
Safety and Comp. Div., 2008 WY 99, ¶ 7, 190 P.3d 159, 163 (Wyo. 2008).  Here, the Division presented no evidence 
to impeach or discredit Mr. Herrera's testimony and his testimony was 
corroborated by medical records showing that he was treated with Lexapro for 
pain and numbness, as well as depression.  

 
 
[¶24]  Additionally, we have said that when a 
single incident is alleged to have caused an injury, medical testimony is not 
required if it is not essential to establish a causal connection between the 
occurrence and the injury.  Gray v. State ex rel. Wyoming Workers' 
Safety and Comp. Div., 2008 WY 115, ¶ 17, 193 P.3d 246, 252 (Wyo. 
2008).  Here, there was no dispute 
concerning the incident that caused Mr. Herrera's injury; therefore, medical 
testimony was not required to establish that causal connection.  The only question was whether Lexapro 
was prescribed solely to treat mental injuries or whether it was intended to 
treat Mr. Herrera's physical injury, specifically the pain and high blood 
pressure caused by the pain.  
Through his own testimony, Mr. Herrera sufficiently established that the 
Lexapro treated his physical injuries.  
Under the circumstances, he was not required to present medical 
testimony.

 
 
[¶25]  We reverse the district court's order 
and remand for reinstatement of the OAH's order awarding benefits.  

 
 
FOOTNOTES

 
 

1The Division also issued final determinations denying travel 
reimbursement on the grounds Mr. Herrera did not obtain treatment from the 
closest available health care provider; denying temporary total disability 
benefits after May 28, 2008, on the ground Mr. Herrera was released to return to 
light duty work; denying coverage for the prescription drug Lyrica on the ground 
it was not for treatment of his work injury; and denying coverage for two 
appointments with a mental health counselor on the ground they were not related 
to his work injury.  Prior to the 
contested case hearing, the parties reached a settlement agreement on these 
matters in which the Division agreed to withdraw its objections and pay the 
disputed amounts.  Thus, the only 
matter left for determination at the contested case hearing was whether the 
Division's final determination denying payment for Lexapro should be 
upheld.  

 

2Section 27-14-102(a)(xi) provides in relevant part:           

 
 
            
(xi) "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.  "Injury" does not 
include:

            
. . . .

            
            
(J) Any mental injury unless it is caused by a compensable physical 
injury, it occurs subsequent to or simultaneously with, the physical injury and 
it is established by clear and convincing evidence, which shall include a 
diagnosis by a licensed psychiatrist or licensed clinical psychologist meeting 
criteria established in the most recent edition of the diagnostic and 
statistical manual of mental disorders published by the American Psychiatric 
Association.  In no event shall 
benefits for a compensable mental injury be paid for more than six (6) months 
after an injured employee's physical injury has healed to the point that it is 
not reasonably expected to substantially 
improve.