Case Title: McMasters v. State ex rel. Workers' Safety & Comp. Div.

Citation: 

Docket Number: S-11-0107

State: wyoming

Court: Wyoming Supreme Court

Date: 2012-03-02T00:00:00Z

Document:
IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF:JIMMIE McMASTERS v. STATE OF WYOMING ex rel. WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2012 WY 32Case Number: S-11-0107Decided: 03/02/2012NOTICE: 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. 2011
 
IN 
THE MATTER OF THE WORKER’S COMPENSATION CLAIM OF:JIMMIE 
McMASTERS,Appellant (Petitioner),v.STATE OF WYOMING ex rel. 
WYOMING WORKERS’ SAFETY AND COMPENSATION DIVISION,Appellee 
(Respondent).
 
Appeal 
from the District Court of Natrona County
The 
Honorable David B. Park, Judge 
 
Representing 
Appellant:
Robert 
Nicholas of Nicholas & Crank, P.C., Cheyenne, Wyoming
 
Representing 
Appellee:
Gregory 
A. Phillips, Wyoming Attorney General; John W. Renneisen, Deputy Attorney 
General; James Michael Causey, Senior Assistant Attorney General; Kelly 
Roseberry, Assistant Attorney General
 
Before 
KITE, C.J., and GOLDEN, HILL, VOIGT, and BURKE, 
JJ.
 
GOLDEN, 
Justice.
[¶1]      In 2003, Jimmie 
McMasters (McMasters) was working as a heating, ventilation and air conditioning 
(HVAC) journeyman when he fell nine feet from a beam to a concrete floor and 
suffered a compression fracture to his L1 vertebrae.  In 2008, McMasters applied for permanent 
total disability benefits claiming a total disability under the “odd lot” 
doctrine.  The Wyoming Workers’ 
Safety and Compensation Division (Division) denied the 
application.
 
[¶2]      The Division did 
not dispute that McMasters could not return to work as an HVAC journeyman but 
instead contended that his failure to obtain alternative employment was due to a 
preexisting psychological condition and a poor effort to find work.  The Medical Commission agreed and upheld 
the denial of benefits.  On appeal, 
the district court found the Commission’s decision to be supported by 
substantial evidence and affirmed.
 
[¶3]      We reverse.  McMasters established a prima facie case under the odd lot 
doctrine when he showed he could not return to his former employment and the 
combination of his psychological and physical conditions precluded alternative 
employment.  The burden thereafter 
shifted to the Division to show that light work of a special nature, which 
McMasters could perform, was available.  The Division did not meet its 
burden.
 
ISSUE
 
[¶4]      McMasters 
presents the following issue on appeal:
 
Did 
the Panel err, as a matter of law, in concluding that Mr. McMasters failed to 
meet his burden in establishing that he is Permanently Totally 
Disabled?
 
FACTS
 
[¶5]      In the eleven 
years before his work injury, McMasters worked primarily in construction.  Four of those years were as an HVAC 
apprentice.  After he completed his 
apprenticeship, he worked two years as an HVAC journeyman, which is the position 
he held when he suffered his work injury.  

 
[¶6]      On April 17, 
2003, McMasters was working for the Casper Tin Shop, installing duct work 
through a vaulted ceiling at the Childhood Development Center in Casper, 
Wyoming.  The task required 
McMasters to stand and move about on two-inch wide trusses.  He lost his footing and fell 
approximately nine feet to the concrete floor below, landing on his 
tailbone.  McMasters was unable to 
get up and was taken by ambulance to the Wyoming Medical Center.  What followed were years of treatment 
and evaluation by numerous medical providers and specialists, and ultimately 
McMasters’ application for permanent total disability 
benefits.
 
2003
 
[¶7]      Dr. Joseph Sramek 
treated McMasters at the hospital and recorded the following assessment of 
McMasters’ injury and treatment:
 
The 
patient had a fall on the job with an L[1] compression fracture.  He has no canal compromise from 
this.  It is a 20% compression 
fracture.  I believe this one can be 
treated conservatively in a brace with close followup and imaging studies.  In all likelihood, he will be out of 
work at least for 6 to 8 weeks while he wears this brace, unless they can find 
sedentary work for him.  Hank 
Osborne from High Plains Orthoprosthetics has been consulted to fit him for a 
Jewett brace.  If he gets this in 
the morning, we can start to have him ambulate with physical therapy to see if 
he tolerates it.  In the meantime, 
we will provide adequate pain control and he can be discharged tomorrow if he is 
able to ambulate well with the brace.  
We will set up additional followup for him on an outpatient 
basis.
 
[¶8]      On May 5, 2003, 
McMasters had his first follow-up appointment with Dr. Sramek’s office.  The notes from that visit included the 
following assessment and plan:
 
Overall, 
it appears the patient’s low back pain has improved considerably since his 
hospital discharge.  No evidence of 
fracture progression is seen on radiographic studies and his neurologic 
examination remains intact.
 
At 
this time, we have recommended that he will continue the utilization of the 
Jewett bracing system for an additional 2 months.  He will return in approximately 6-8 
weeks for a follow-up visit to include repeat AP/lateral thoracolumbar x-rays 
centered at L1.
 
For 
pain control he will continue his current dosing of Lortab 7.5 mg to be dosed as 
1-2 PO Q 6 hrs. PRN pain.
 
I 
have completed a work restriction form, which limits his return to work 
activities until 07/01/2003.
 
[¶9]      McMasters had a 
second follow-up appointment with Dr. Sramek’s office on June 11, 2003.  McMasters reported an increase in low 
back pain and low back spasm, which Robert Griffin, Dr. Sramek’s PA, attributed 
to immobilization, “as well as a change in both the static and dynamic positions 
of the spine.”  McMasters was 
instructed to wear his Jewett brace for another four to six weeks and was 
advised that when the brace was removed, he would be enrolled in physical 
therapy.  
 
¶10]    On July 10, 2003, McMasters 
had a third follow-up examination with Dr. Sramek’s office.  The entries from that visit indicate 
that McMasters was improving and reported a decrease in back pain from his last 
visit.  McMasters was instructed to 
stop wearing the Jewett brace and to begin an eight-week physical therapy 
program.  He was again restricted 
from working during that period.  

 
[¶11]   On September 8, 2003, McMasters 
again saw PA Robert Griffin.  During 
that examination, McMasters reported significant improvement in his lower back 
pain as well as in his lumbar spine range of motion.  Griffin made the following entry in the 
chart for a plan going forward:
 
Prior 
to returning the patient to work activities, I would like to have him undergo a 
physical capacity evaluation and possible disability rating with Dr. 
Zondag.  This will be scheduled 
sometime in the next 3-4 weeks.  At 
this time we have restricted the patient’s return to work status until 
10/15/2003.  Dr. Zondag may wish to 
amend our current return to work plan based on his 
evaluation.
 
[¶12]   On October 6, 2003, Robert Griffin 
reviewed additional films that had been taken of McMasters’ spine.  He made the following 
observation:
 
Comparison 
is made to previous studies on 05/05/2003.  
Evidence of L1 compression fracture is again seen.  Anterior wedging is approximately 
25-30%.  This appears to have 
slightly increased when compared with the previous study.  More sclerosis is noted about the 
fracture margins, suggesting adequate healing.  No additional abnormalities are 
seen.
 
[¶13]   On November 3, 2003, at the request 
of the Division, Dr. Tuenis D. Zondag examined McMasters for the purpose of 
providing an Independent Medical Evaluation (IME) and impairment rating.  Dr. Zondag diagnosed a compression 
fracture at L1 with 30-40% compression.  
He noted that McMasters’ “subjective complaints are consistent with the 
objective findings,” and “[s]ymptom magnification behavior was not evident.” Dr. 
Zondag found McMasters had reached maximum medical improvement and calculated a 
5% whole body permanent impairment.  
Dr. Zondag also found that McMasters could return to work in a heavy work 
occupation.  
 
2004
 
[¶14]   In early 2004, McMasters attempted 
to return to work for his employer, Casper Tin Shop, but his employer had not 
held his position.  McMasters then 
went to work for Sheet Metal Specialties, another Casper company.  On his first day back to work, McMasters 
aggravated his back injury carrying tools up a ladder.  McMasters worked for two weeks before 
quitting due to back pain. 
 
[¶15]   On April 2, 2004, McMasters saw Dr. 
Sramek for his back pain.  Dr. 
Sramek made the following entries in McMasters’ chart:
 
ASSESSMENT:
Patient 
has axial back pain at the level of his fracture.  I suspect the fracture is still playing 
a role.
 
PLAN:
I 
am going to get a MRI with stir sequences.  
In addition I am going to get some plain x-rays of his back including 
flexion/extension and I am going to also try to reopen his case with Workers’ 
Compensation as I think the fracture is impairing him from returning to his 
previous line of work.  I will have 
him follow-up with me after the studies.
 
I 
have also given him some samples of Celebrex and a prescription for Skelaxin 800 
mg QHS.  I think he should stay off 
work for now until we get his pain issues further 
resolved.
 
[¶16]   On April 19, 2004, Dr. Sramek 
reviewed an MRI of McMasters’ lumbar spine.  He observed possible edema at the 
fracture site and a disc herniation at the L5-S1 level.  He noted none of McMasters’ symptoms 
related to the L5-S1 herniation.  
Dr. Sramek referred McMasters for a vertebroplasty, a procedure in which 
bone cement is injected into the problematic disc to solidify the 
vertebrae.  McMasters underwent the 
vertebroplasty procedure on May 20, 2004.  
He reported temporary relief from the procedure but then his pain 
worsened.  
 
[¶17]   On August 3, 2004, on referral from 
Dr. Sramek, McMasters saw Dr. Zondag for an occupational medicine and vocational 
rehabilitation consultation.  Dr. 
Zondag noted that “persistent changes in the MRI prompted Dr. Sramek to 
encourage Mr. McMasters to consider an alternate job or retraining.”  Dr. Zondag 
concluded:
 
I 
indicated to Jimmy that given his history and the requirement for vertebroplasty 
that he is not capable of returning to full HVAC work.
 
I 
feel that in an alternate job he will have to stay away from being in a bent 
position for long periods of time and stay away from twisting.  His lift capacity is best within the 
light to light medium type of physical work capacity based upon Department of 
Labor Standards.
 
He 
reports now that he can tolerate sitting well, but has reduced tolerance for 
standing and prolonged walking as well as reduced tolerance for working in the 
bent position for prolonged times or repetitively.
 
I 
feel that the patient should be considered for alternate job placement within 
work that is compatible with his restrictions and/or 
retraining.
 
[¶18]   On September 21, 2004, McMasters, 
on referral from the Division of Vocational Rehabilitation (DVR), saw Dr. Jack 
Herter for a psychological evaluation.  
The purpose of the DVR referral was “eligibility determination and 
vocational services planning.”  Dr. 
Herter’s report contained a disclaimer that “[t]his evaluation is not a 
Psychological Pain Evaluation or Pre-surgical Psychological Pain 
Evaluation, nor is it intended for Workers Compensation Case 
Management.”  (Emphasis in 
original.)  
 
[¶19]   In preparing his evaluation, Dr. 
Herter considered McMasters’ history and behavioral presentation, and he 
administered tests to determine McMasters’ intellectual functioning and 
personality functioning.  Dr. Herter 
reported that McMasters’ employment history was notable for reasonable periods 
of stability.  With respect to 
McMasters’ intellectual functioning, Dr. Herter noted that McMasters had 
attended school through the eighth grade and then obtained his GED.  He reported 
further:
 
Intellectually 
and academically, Mr. McMasters would be capable of handling 
vocational-technical level coursework as well as coursework at the community 
college level; however his Mathematics disorder would require special 
accommodations.  If special 
accommodations and tutorial assistance fail, he may need a math waiver.  Also, personality variables will need to 
be addressed in your vocational planning.
 
[¶20]   With respect to McMasters’ 
personality functioning, Dr. Herter made the following 
findings:
 
Mr. 
McMasters’s history suggests a work ethic and potential for maintaining 
employment stability up to four years.
 
Mr. 
McMasters’s test data supported high levels of anxiety, depression and worry as 
well as elevated levels of somatization.  
All three variables are known to impede the rehabilitation process and to 
prolong suffering in patients with chronic pain.
 
Mr. 
McMasters’s data suggest low self-esteem, self-doubt, social introversion and 
social maladjustment.
 
Mr. 
McMasters was the product of an unstable, rejecting and abusing family 
environment, which left him Axis-II issues.  Personality Disorders (DSM-IV Axis-II 
Psychopathology) are enduring patterns of maladaptive and self-defeating 
behaviors, beliefs and attitudes, which are pervasive and inflexible over time, 
have onset in adolescence or early adulthood, and lead to distress or impairment 
in social, personal or other important areas of functioning.  Personality Disorders are viewed as 
being “traits,” which are stable characteristics of the individual’s 
personality, as opposed to “states,” which tend to be transient and variable 
personality and emotional fluctuations. Personality Disorders are generally 
resistant to psychotherapeutic interventions.  
 
Elevations 
occurred on measures of Avoidant, Antisocial and Paranoid traits.  Avoidant traits facilitated the 
development of a Panic Disorder with Agoraphobia.
 
[¶21]   Dr. Herter completed his report 
with a recommendation that McMasters be referred to a psychiatrist to assess 
whether he might benefit from being placed on an antidepressant.  He further recommended that any 
vocational rehabilitation include pain management psychotherapy and cognitive 
behavioral therapy.  

 
2005
 
[¶22]   In January 2005, DVR referred 
McMasters to the Community Health Center of Central Wyoming for psychiatric 
evaluation by Dr. Larry Plemmons.  
Dr. Plemmons noted problems with sleeping due to pain, decreased 
motivation, and problems with concentration and memory.  He diagnosed McMasters with a “major 
depressive disorder,” and prescribed an antidepressant.  
 
[¶23]   During 2005, McMasters continued to 
see Dr. Sramek for back pain.  On 
June 8, 2005, McMasters saw Dr. Paul Ruttle for a new impairment rating.  Dr. Ruttle assigned an 11% whole person 
impairment rating.  He recommended 
restrictions on McMasters’ standing, walking, lifting and bending, and he agreed 
with Dr. Sramek that McMasters was a poor surgical candidate at that time due to 
his obesity.  
 
[¶24]   On December 6, 2005, McMasters was 
referred to Wind City Physical Therapy for occupational therapy in the chronic 
pain program.  McMasters was 
discharged on January 24, 2006, with the following report from his occupational 
therapist:
 
Jim 
presents with negative thoughts and expresses negative behaviors (at home) 
during therapy requiring maximal verbal cuing to attempt at positive thoughts 
and behaviors.  He continues with 
negative verbalizations such as “I don’t like people telling me to change or 
that I need to change.”  “I will get 
better once these lawsuits I have pending are over, rather [sic] I win or 
lose.”  “No one believes me I hurt, 
I went to one of my lawyers Friday (Hampton Young), and he acted like I was not 
really in pain.”  “My back will not 
get better, the doctors keep telling me I am getting worse and my back is 
broke.”  “My pain is physical not 
mental, this pain program seems like it is telling me my pain is in my 
head.”  Jim states he feels that he 
has adapted the best way he can in dealing with the pain.  Jim is difficult to work with secondary 
to the negative thoughts and this therapist discussed with Jim the benefits of 
Cognitive Behavior Therapy for pain and the importance of him being in a stage 
of his life in which he is willing to make the necessary lifestyle changes in 
order to increase his quality of life.  
After much discussion with Jim, it was decided to discharge him from 
therapy secondary to stating he is not willing to change, “I am a negative 
person and I will stay that way, no one is going to change me into a positive 
person, I had a difficult childhood.”
 
2006
 
[¶25]   On January 27, 2006, Dr. Sramek 
sent a letter to the Division requesting a referral to Dr. Michael Kaplan, a 
specialist in spinal diagnostics and pain intervention.  Dr. Kaplan saw McMasters on May 11, 
2006, and recommended facet injections, which Dr. Kaplan performed on May 25, 
2006.  This procedure gave McMasters 
temporary relief from his pain while at rest.  
 
[¶26]   On June 1, 2006, Dr. Sramek 
recommended McMasters be administered a steroid injection, and that procedure 
was performed at the Wyoming Medical Center on June 12, 2006.  McMasters reported no benefit from the 
procedure.  
 
[¶27]   In that same month, June 2006, the 
Division referred McMasters to Dr. Herter for evaluation.  The stated purpose of the evaluation was 
“to identify psychological, psychosocial, and cognitive-behavioral factors, 
apparent and/or suggested, in the examinee’s assessment data, self-reported 
history, medical records, and behavioral presentation, which could potentially 
impede adaptation to pain and/or potentially pose as threats to medical 
treatment outcome.”  

 
[¶28]   Dr. Herter met with McMasters on 
June 13th, 19th, and 27th.  He made 
several specific findings based on his testing and examination of 
McMasters.  These findings included 
high to extreme levels of depression, and moderately high to extreme levels of 
anxiety.  Dr. Herter also found that 
McMasters presented with high to very high levels of somatization, which he 
explained “is not a conscious process,” but is a “process whereby bodily 
complaints are exaggerated and/or exacerbated by stress and/or by strong 
emotional states.”  Among other 
additional findings was a finding of very high levels of Global Psychological 
Distress (GPD).  Dr. Herter 
explained:
 
[GPD] 
is frequently observed in the pain patient population.  GPD is an extreme emotional response to 
a catastrophic event or to an event perceived as being a catastrophic 
threat.  For a poorly educated 
worker, who has relied exclusively on his/her nonverbal and physical abilities 
to survive, an injury that potentially prevents him/her from using his/her 
physical abilities to work can be perceived as a catastrophic threat to his/her 
survival.
 
[¶29]   Dr. Herter reported the following 
conclusions to the Division:
 
Mr. 
McMasters presented with multiple psychological/ psychosocial risk factors, 
which were discussed in detail in the body of this report.  These risk factors have been associated 
with impaired adaptation to pain, poor pain coping, prolonged disability, low 
rates of RTW, impaired or problematic compliance with treatment and 
rehabilitation regimens and less than satisfactory responses to medical 
treatment interventions, including invasive procedures.
 
Mr. 
McMasters’s current psychosocial risk factors could be expected to impede RTW 
issues as much as they negatively detract from his probability of having 
successful medical treatment outcomes.
 
Mr. 
McMasters’s data was apparent for high levels of Perceived Disability.  Mr. McMasters believes that he is 
disabled.  If Mr. McMasters is 
unable or unwilling to make significant behavioral changes; remains angry; fails 
to learn effective pain management techniques; remains physically inactive; I 
would suggest that his probability of returning to any form of gainful 
employment would be poor.
 
* 
* * *
 
Treating 
Mr. McMasters successfully and effectively will be a challenge.  He presents with multiple issues of 
significant complexity.  He has a 
chronic pain disorder associated with both psychological factors (depression, 
anxiety, somatization and anger) and a medical condition.  Though his depression is reactive and 
part of his pain diagnosis, the level of his depression warranted a diagnosis of 
major depressive disorder. In light of the level and severity of Mr. McMasters’s 
depression, I would recommend a psychiatric referral for psychoactive medication 
assessment and management.
 
Mr. 
McMasters’s anxiety is reactive and part of his pain diagnosis. Anxiety is 
associated with decreased comprehension of information presented by health care 
providers.  Highly anxious patients 
become incapacitated with fear and embarrassment, which would appear to be 
consistent with [what] Mr. McMasters reported.  His anxiety evolved into a Panic 
Disorder with Agoraphobia.  Studies 
indicate that approximately 24% of chronic pain patients experience panic 
disorders.  Panic-afflicted patients 
tend to avoid certain rehabilitation situations and sometimes become too 
overwhelmed to leave their homes, which would be consistent with what Mr. 
McMasters reported.  Successful 
treatment of Panic Disorder with Agoraphobia typically requires a specific 
Cognitive-Behavioral treatment protocol.  
Some psychoactive medications can be effective for symptom management, 
but anti-anxiety agents impede Cognitive-Behavioral treatment.  I would recommend a referral to a 
clinical psychologist specializing in the Cognitive-Behavioral treatment of 
Panic Disorder.
 
[¶30]   Because McMasters’ condition failed 
to improve, Dr. Sramek ordered a repeat MRI scan of his spine, which revealed 
degenerative disc disease at the L5-S1 level of the spine.  Dr. Sramek referred McMasters to Dr. 
Brian Weider, a neurosurgeon.  Dr. 
Weider noted the degenerative disc disease at L5-S1 and also reported that 
McMasters “has had diskography, which demonstrates partially concordant disk 
pain at L1-L2 as well as L5-S1 with nonconcordant pain T12 L1.” 

 
2007
 
[¶31]   In January 2007, Dr. Weider 
performed an L5-S1 lumbar decompressive laminectomy and fusion surgery on 
McMasters.  On Dr. Weider’s 
referral, McMasters began physical therapy in April 2007.  McMasters’ July 2007 physical therapy 
records indicate that McMasters “continues to work very hard with his 
exercises,” and that McMasters reported “feeling a little bit better 
particularly across his low back.”
 
[¶32]   On July 12, 2007, Dr. Weider 
reported to the Division that McMasters had reached maximum medical 
improvement.  Dr. Weider recommended 
an occupational medicine evaluation to determine work capacity and noted that it 
“is reasonable to not expect him to return to a position that requires 
repetitive heavy bending, lifting, and twisting.”  
 
[¶33]   On August 15, 2007, the Division 
referred McMasters to Dr. Kaplan for a permanent partial impairment rating.  Dr. Kaplan performed a medical record 
review and a physical examination of McMasters, and on August 30, 2007, he 
issued his rating.  Dr. Kaplan 
awarded McMasters a 23% whole body permanent impairment rating. He also 
found:
 
The 
patient cannot return to work in construction given his current status.  He is likely going to do better in a 
sedentary to light duty position.  
He will likely be more comfortable changing positions during the day 
without a constant sitting exposure throughout his shift.
 
2008
 
[¶34]   On January 17, 2008, McMasters saw 
Dr. Kenneth Pettine, a Colorado surgeon, in an attempt to address his continuing 
pain.  Dr. Pettine examined 
McMasters and reviewed his records and MRI films.  He concluded:
 
At 
this point, I think his current situation is permanent.  I do not know that there is anything 
such as chiropractics or physical therapy which is going to change his current 
symptoms.  I think his options are 
more or less to live with his symptoms and possibly consider pain 
management.
 
[¶35]   Throughout his treatments, 
McMasters was continuing to be seen at the Community Health Center in Casper for 
issues relating to pain, sleeplessness and depression.  On July 10, 2008, John Noffsinger, a PA 
at the Community Health Center, referred McMasters to Dr. Bradley Vilims of the 
Wyoming Brain and Spine Institute for pain management.  
 
[¶36]   McMasters saw Dr. Vilims on August 
12, 2008.  Dr. Vilims examined 
McMasters and made a “referral to Dr. Jack Herter of pain psychology to deal 
with and stabilize some of his depression and anxiety issues.”  
 
[¶37]   Dr. Herter saw McMasters on three 
occasions between October 20, 2008, and December 2, 2008, on referral from Dr. 
Vilims for a psychological consultation to “determine whether the patient would 
be stable enough psychologically to pursue a provocation lumbar 
discography.”  Dr. Herter expressed 
the following conclusions:
 
Progress 
in attempting to treat the patient’s panic disorder and pain disorder has been 
minimal and extremely slow.  While I 
am willing to persist in trying to help the patient to move forward, my 
experience with these types of patients has been that attitudinal and 
characterological issues (personality disorders) greatly limit the degree of and 
the potential for significant behavioral change.
 
In 
the absence of medical necessity, Mr. McMasters does not appear to be stable 
enough psychologically, at this time, to pursue a provocation lumbar discography 
from the standpoint that he would have a strong probability of having a panic 
attack at some point during the procedure.  
One possibility might be to consider placing him on a potent anxiolytic 
during the procedure in an attempt to prevent the occurrence of a panic 
attack.
 
[¶38]   In this same timeframe, Dr. Herter 
wrote a letter to Social Security Disability Determination Services concerning 
McMasters’ employability.  He 
reported:
 
By 
virtue of his Panic Disorder and Agoraphobia, Mr. McMasters would not be capable 
of handling full-time, low stress, low demand competitive employment of any kind 
on a sustained basis; nor could he be expected to relate appropriately to 
supervisors and co-workers on a sustained basis; nor could he be expected to 
handle routine work stress and change.
 
Mr. 
McMasters’ Chronic Pain Disorder prevents him from being able to handle low 
stress, low demand competitive employment of any kind on a sustained basis.  His Pain Disorder would prevent him from 
being able to relate appropriately to supervisors and to fellow workers on a 
sustained basis (e.g., pain causes Mr. McMasters to be extremely impatient, 
irritable and short-tempered).  His 
Pain Disorder prevents him from being able to handle routine work stress and 
change on a sustained basis.  

 
Mr. 
McMasters’ Avoidant Personality Disorder and Paranoid Personality Disorder would 
prevent him from being able to relate appropriately to supervisors and 
co-workers on a sustained basis.
 
Mr. 
McMasters’ Major Depressive Disorder would prevent him from being able to handle 
low stress/low demand competitive employment of any kind on a sustained basis, 
and would also prevent him from being able to relate appropriately to 
supervisors and co-workers on a sustained basis, and would further prevent him 
from being able to handle routine work stress and change on a sustained 
basis.
 
Alone 
or in combination, Mr. McMasters’ Panic Disorder, Pain Disorder and Major 
Depressive Disorder impede concentration, attention and short-term memory in a 
manner that would prevent him from being able to sustain simple, low stress, 
repetitive employment of any kind.
 
2009
 
[¶39]   In July 2009, the Division referred 
McMasters to Dr. Meade Davis, III, a board-certified orthopedic surgeon in 
Cheyenne, for an IME to determine whether McMasters was permanently totally 
disabled.  On July 23, 2009, Dr. 
Davis spent four hours examining McMasters, reviewing records, and preparing his 
report.  The records he reviewed 
included the following:
 
1.         
Wyoming Employer Report of Injury
2.         
IME Report from Tuenis Zondag, MD: 11-3-03
3.         
IME – Michael Kaplan, MD: 8-30-07
4.         
IME – Paul Ruttle, MD: 6-16-05
5.         
Miscellaneous communication from Wyoming             
Worker’s Safety & Compensation Division
6.         
Emergency Report from Wyoming Medical Center: 4- 17-03
7.         
CT scan, lumbar spine Report: 4-17-03
8.         
Report from Central Wyoming Neurosurgery: 5-5-03
9.         
Miscellaneous other x-ray reports
10.       Office 
visit Mountain View Clinic: 6-11-03
11.       
Miscellaneous North Platte physical therapy notes
12.       Multiple 
office visits from Central Wyoming       
Neurosurgery
13.       
Occupational therapy notes
14.       Operative 
notes
15.       Hospital 
records
16.       Psychology 
reports
17.       Report from 
Wyoming Brain and Spine Associates:     11-1-06 and 
12-12-06
18.       
Miscellaneous lab tests
19.       Other 
miscellaneous hospital, therapy and office visit             
notes
 
[¶40]   On physical examination, Dr. Davis 
found decreased range of motion in the lumbar spine and pain with attempted 
motion in flexion, extension, rotation and sidebending.  Dr. Davis provided the following 
diagnosis:
 
My 
diagnosis is status post compression fracture at L1, vertebroplasty of L1, 
lumbar fusion at L4, L5 with autograph.  
Mr. McMasters suffers from persistent pain in the lumbar area.  There is also aggravating and 
compounding psychological issues plus weight issues involved in Mr. McMasters[’] 
current condition.
 
[¶41]   Dr. Davis reported the following 
conclusions in response to the Division’s questions:
 
In 
response to your specific questions and letter dated July 1st, 2009.  The question asked, Is the claimant 
permanently totally disabled as a result of the injury sustained to the low back 
in the work injury of April 2003?  I 
feel at this time Mr. McMasters is permanently totally disabled from his 
injuries sustained at work in April 2003.  

 
* 
* * *
 
In 
summary Mr. McMasters suffered a back injury, underwent back surgery and has 
chronic disabling pain in the back and left hip area.  He cannot sit for more than about 30 
minutes, he can’t do much lifting or participate in motion of his spine because 
of pain.  He has a complex 
psychological disorder.  The 
combination of problems in this gentleman make him probably unsuitable for any 
employment.
 
[¶42]   On August 3, 2009, the Division 
sent a follow-up letter to Dr. Davis.  
The Division requested that Dr. Davis clarify the connection he drew 
between McMasters’ hip pain and his lumbar injury and clarify whether he 
believes McMasters’ lumbar injury alone, without consideration of his 
psychological or weight issues, is the cause of his permanent total 
disability.  
 
[¶43]   On August 6, 2009, Dr. Davis 
responded to the Division with the following additional 
information:
 
The 
question as to whether his lumbar injury alone causes him to be permanently 
totally disabled, is perhaps not entirely relevant as we take patient’s [sic] as 
we find them.  If they have 
depression and other complicating problems and then you superimpose another 
injury, i.e. a back injury on top of that they may perfectly well become 
unemployable, which is what I feel is occurring in this case.  This gentleman is probably on the low 
scale of motivation to work in the first place.  We could argue that one gains weight 
when one is inactive because of pain problems such as low back pain.  In our IME report we felt that the left 
hip discomfort was not related to any graft harvesting.  We felt the pain was probably related to 
his injury as a referral type of pain from the low back and does not reflect hip 
pathology.  It is obviously 
difficult to find objective evidence when a patient complains of referred 
pain.
 
[¶44]   On August 7, 2009, McMasters was 
evaluated by Dr. Timothy Blaney, a licensed psychologist in Buffalo.  The Division referred McMasters to Dr. 
Blaney for the purpose of determining his suitability, from a psychological 
standpoint, for trial implantation of a spinal cord stimulator.  After Dr. Blaney evaluated McMasters, 
but before he issued his report, the Division submitted additional questions 
concerning the cause of McMasters’ psychological conditions and the impact of 
those conditions on his ability to return to work.  
 
[¶45]   Dr. Blaney reported that McMasters 
suffers from, among other conditions, failed back syndrome, chronic pain, and a 
pain disorder “with Both Psychological Factors and a General Medical 
Condition.”  Dr. Blaney observed 
that based on McMasters’ clinical profile, he could be expected to “behave 
erratically with healthcare providers, alternately distancing and engaging, and 
often blaming,” and he “may actually be too upset to understand or follow 
medical advice.”  Dr. Blaney also 
cautioned that McMasters “is likely to have a much slower recovery, to generate 
greater expenses, and to have more unanticipated complications to medical 
procedures due to his emotional condition.”  He reported the following treatment 
prognosis:
 
Because 
of his psychological profile, Mr. McMasters is at risk for an exaggerated 
negative reaction to either relatively benign or invasive medical 
procedures.  He may show increasing 
lethargy, fatigue, and hopelessness that suggest to him that treatments are a 
failure.  Such a pattern of negative 
self-fulfillment makes true engagement in lifestyle changes and healing 
unlikely.
 
[¶46]   Dr. Blaney reported to the Division 
that he believed McMasters was at high risk of a negative outcome from further 
medical procedures, including the spinal cord stimulator implantation.  He explained:
 
[McMasters’] 
negativity and hopelessness represent both acute depressive symptoms as a 
consequence of pain, as well as enduring personality variables.  The latter has been extensively 
discussed by Dr. Herter over the course of numerous consultations, evaluations, 
and treatment sessions. Based on experiences during childhood, Mr. McMasters has 
established a rather inflexible and dysfunctional approach to viewing the world. 
 He is negativistic and 
guarded.  His injury, pain, and 
associated conditions have exacerbated these underlying tendencies for 
maladjustment.
 
Mr. 
McMasters seems [sic] himself as the victim of circumstances and feels incapable 
of affecting his own fate toward a more positive outcome.  He continues to blame others, including 
physicians, other healthcare providers, Workers[’] Compensation staff, and the 
DVR Counselor for his continued distress, despite his own inactivity and 
disengagement from needed lifestyle changes.  At present, he is extremely discouraged, 
emotionally fragile, and preoccupied with worry.  His perceptions and recollections of his 
treatment history are quite inconsistent with the medical records.  Aside from facet joint injections 
undertaken in 2006 and 2008, Mr. McMasters has in fact benefitted from 
previous procedures, including the vertebroplasty and the laminectomy/fusion 
surgery.  There is no evidence to 
support his claim of the bone graft from his hip having been a failure, for 
example.  His allegation of having 
gained 100 pounds since his injury also appears to be unfounded.  Yet, he persists in blaming his 
self-consciousness, social avoidance, and panic attacks on his weight gain.  Rather, the opposite appears more 
likely.  He has gained some weight 
due to inactivity, but his increasing despondency, social isolation, depression, 
and anxiety underlie his overeating, smoking, and other negative health habits. 
[Emphasis in original.]
 
[¶47]   In response to the Division’s 
follow-up questions, Dr. Blaney opined that McMasters’ personality disorders and 
psychological conditions were caused by social and environmental factors 
unrelated to his work injury.  Dr. 
Blaney further explained:
 
It 
is estimated that his premorbid adjustment and functioning was likely 
tenuous.  When injured at work, Mr. 
McMasters was unable to cope effectively with his physical pain, decreased 
functioning, and unemployment.  
Resulting stressors were exacerbated by preexisting coping deficits and 
maladaptive patterns, in addition to developing symptoms of anxiety and 
depressive disorders.  Now 
unemployed for several years, Mr. McMasters appears to have become wedded to the 
idea of his own disability, which further impedes his taking necessary steps for 
self-improvement.  So pervasive are 
his convictions and so entrenched is his negativity, that without addressing 
underlying psychological features, no medical solutions are likely to 
prove efficacious in the long-term. [Emphasis in 
original.]
 
[¶48]   In response to the Division’s 
question whether McMasters’ psychological conditions relate to non-industrial 
issues, Dr. Blaney agreed, but advised that “his injury, pain, and unemployment 
have exacerbated underlying conditions and contributed to his present 
status.”  In response to the 
Division’s question whether McMasters’ psychological conditions impact his 
ability to return to work, Dr. Blaney opined:
 
The 
most significant impediment to future gainful employment is Mr. McMasters’ 
insistence that he is disable[d] and unable to work.  This is his essential, unalterable 
reality, until he elects to change his mind.  Although his physicians have repeatedly 
encouraged less physical work, Mr. McMasters’ single attempt to return to work a 
few months post injury was in the same HVAC field.  He has not attempted to work since.  His experience with DVR was apparently 
also unproductive.  Should he choose 
to do so, Mr. McMasters would seem capable of performing well in a low 
physical-impact, low-stress job in an area of personal interest.  In order to maintain his employment, he 
would likely need to persist in managing his symptoms of anxiety and depression, 
both with continued medication and counseling.
 
2010
 
[¶49]   In March 2010, McMasters consulted 
Reg Gibbs, MS, a certified rehabilitation counselor from Billings, Montana.  Gibbs interviewed McMasters by telephone 
on four separate dates for a total of over three hours.  He also reviewed McMasters’ medical and 
psychological records, including physical therapy notes and the report and 
deposition of Dr. Davis, his worker’s compensation records, his DVR records, and 
his education and employment history.  

 
[¶50]   Gibbs completed his evaluation and 
report on May 10, 2010.  He 
concluded that McMasters is not able to work in any capacity in the labor market 
and explained:
 
In 
the course of completing this report, I have considered the opinions of Drs. 
Plemmons, Herter, and Blaney who have addressed the psychological components of 
Mr. McMasters’ disability, as well as those of Drs. Zondag, Wieder, and Davis, 
who have addressed the physical components.  After carefully analyzing their 
opinions, it is clear that Mr. McMasters cannot return to his pre-injury level 
of employment.  The question is, can 
Mr. McMasters perform work at “any gainful occupation for which he is reasonably 
suited by experience or training.”
 
Any 
employee who works in the labor market must have the physical and psychological 
capacity to meet the demands of the work tasks.  Of paramount importance is the fact that 
the employee must be able to safely perform the work tasks in such a way that 
he/she does not incur any injury or place fellow workers or others in harm’s 
way.  When considering Mr. 
McMasters[’] current level of physical and psychological functioning, it is 
apparent that he is significantly impaired in both the physical and 
psychological domains.  His ability 
to work safely in an occupation for which he is reasonable [sic] suited by 
experience or training, in consideration of himself and others, is not 
feasible.
 
If 
McMasters had only the psychological or the physical issues to overcome in 
consideration of employment for which he is reasonable [sic] suited, his chances 
of being successful in a job search would increase.  However, taken in tandem, the 
significance of impairment in both the physical and psychological domains 
preclude him from employment.  Even 
if one would ignore the psychological component of Mr. McMasters’ disability, 
Dr. Davis has made it abundantly clear that Mr. McMasters is physically 
incapable of performing work tasks without significant risk of further 
injury.  Thus, Mr. McMasters is not 
able to work in any capacity in the labor market.
 
[¶51]   In May 2010, the Division referred 
McMasters to Kelly White, MS, a vocational specialist from Dayton, Wyoming.  White interviewed McMasters in Casper, 
reviewed McMasters employment history, and under a section of her report titled 
“Medical Notes/Legal Notes” indicated “Mr. McMasters’ file was reviewed.”  In that section of her report, White 
referenced comments by Dr. Kaplan, Dr. Davis, DVR, and Dr. Herter.    
 
[¶52]   White concluded that McMasters 
could return to employment and identified potential positions.  The potential positions White specified 
as meeting McMasters’ transferable skills and physical capacity were: Assembler, 
Small Products; Order Clerk; Tutor; and Bill and Account Collector.  For each of these positions, White did 
not identify an available opening, but instead indicated “[t]here have been 
openings in the last six months and there are expected openings.”  Regarding these positions, White made 
the following observations:
 
The 
above jobs were identified based on Mr. McMasters[’] physical limitations.  There is some question as to his 
emotional state and how it is affecting his return to work.  However, Mr. McMasters has demonstrated 
an ability to return to one semester of college and according to his 
self-report, he passed all but one class.  
He would increase his vocational success if he:
 
1.         
Return [sic] to work with a therapist on depression, anxiety, 
somatization and anger (these conditions have been known to improve with 
treatment).  There was also 
reference to a personality disorder.  
This condition would have existed long before his injury and Mr. 
McMasters has demonstrated and [sic] ability to be in the work force with the 
affects [sic] of the personality disorder.  
Counseling support would be helpful.
 
2.         
Work [sic] with his doctors to ensure his pain medication is compatible 
with a work environment.  He will 
also need to ensure his pain medication is appropriate for some one [sic] with 
“a long term history of alcohol, amphetamine and cannabis abuse in full time 
remission” (from 8/30/2007 Dr. Kaplan’s impairment rating)
 
The 
job of newspaper delivery route driver was also researched but it did not 
demonstrate any availability[.]
 
[¶53]   White additionally identified the 
following potential positions specific to Casper, Wyoming: Call Center Sales; 
Collections Agent; and Gas Station Attendant.  Regarding these positions, White 
provided the following prefatory comment:
 
An 
Internet job search was performed for Casper Wyoming 5/13/2010.  The following jobs appear to meet his 
transferable skill level.  Physical 
demands of the jobs are not always delineated on the Internet sight [sic] and it 
is not known if these jobs would meet his limitations.  However, these are positions he may want 
to consider researching further[.]
 
[¶54]   Following McMasters’ application 
for Permanent Total Disability benefits, and the Division’s denial of those 
benefits, a hearing was held before the Commission on June 3, 2010.  On July 27, 2010, the Commission issued 
its decision upholding the Division’s denial of benefits based on its findings 
that McMasters’ inability to obtain gainful employment was due primarily to his 
psychological condition, which existed before his work injury, and his poor 
attempt at searching for work. On March 9, 2011, the district court entered its 
order affirming the Commission’s decision.  

 
 
 
 
STANDARD 
OF REVIEW
 
[¶55]   We review administrative decisions 
based on the factors set forth in the Wyoming Administrative Procedure Act, 
which provides:
 
(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.
 
Wyo. 
Stat. Ann. § 16-3-114(c) (LexisNexis 2011).
 
[¶56]   Under this statute, we review an 
agency’s findings of fact by applying the substantial evidence standard.  Dale 
v. S & S Builders, LLC, 
2008 WY 84, ¶ 22, 188 P.3d 554, 561 (Wyo. 2008). 
Substantial evidence means “such relevant evidence as a reasonable mind might 
accept as adequate to support a conclusion.” Bush 
v. State ex rel. Wyo. Workers’ Comp. Div., 
2005 WY 120, ¶ 5, 120 P.3d 176, 179 (Wyo. 2005). 
“'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.’”  Kenyon 
v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 
2011 WY 14, ¶ 11, 247 P.3d 845, 849 (Wyo. 2011) 
(quoting Bush, 
¶ 5, 120 P.3d at 179).
 
[¶57]   With regard to an agency’s 
determination that a claimant did not satisfy his burden of proof, this Court 
has said:
 
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. 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.
 
Kenyon, 
¶ 12, 247 P.3d  at 849 (quoting Dale, 
¶ 22, 188 P.3d at 561).
 
[¶58]   “'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.’” Kenyon, 
¶ 13, 247 P.3d  at 849 (quoting Moss 
v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 
2010 WY 66, ¶ 11, 232 P.3d 1, 4 (Wyo. 2010)).  In an appeal from a district court’s 
appellate review of an administrative decision, we review the case as if it came 
directly from the hearing examiner, affording no deference to the district 
court’s decision.  Deloge v. State ex rel. Wyo. Workers’ Safety 
& Comp. Div., 2011 WY 154, ¶ 5, 264 P.3d 28, 30 (Wyo. 2011); In re Kaczmarek, 2009 WY 110, ¶ 7, 215 P.3d 277, 280 (Wyo. 2009).
 
DISCUSSION
 
[¶59]   The Commission concluded that 
McMasters was not entitled to permanent total disability benefits, statutorily 
or under the odd lot doctrine.  The 
Commission summed up the basis for its decision in Paragraph 37 of its findings 
of fact and Paragraph 7 of its conclusions of law.  It stated:
 
            
37.       
Under the circumstances, and after reviewing all the evidence and 
testimony, this Panel finds that Mr. McMasters is not a credible witness; he has 
made only minimal efforts at returning to the work force, and has provided 
extremely inconsistent information to his medical providers regarding a variety 
of issues, particularly his personal limitations.  This panel further finds that the 
opinion of Dr. Davis that Mr. McMasters is Permanently Totally Disabled is not 
supported by the evidence, and that Dr. Davis relied excessively on the 
self-report of Mr. McMasters regarding his medical condition and incorrectly 
applied legal principals [sic] regarding the “Odd-lot Doctrine” and “taking 
employees as we find them”.  
Although Mr. McMasters advised Dr. Davis that he was only able to sit for 
thirty minutes, this Panel observed Mr. McMasters sitting during the Evidentiary 
Hearing for up to an hour and twenty minutes without any apparent distress.  In conclusion, this Hearing Panel finds 
and concludes that Mr. McMasters has not met his burden of proof in establishing 
that he is Permanently Totally Disabled.
 
* 
* * *
 
            
7.         
This Panel has analyzed this case under the “Odd-Lot Doctrine” as 
recognized in Wyoming, which provides that PTD may be awarded where a worker 
“who, while not all together incapacitated for work is so handicapped that they 
will not be employed regularly at any well known branch of the labor market.” * 
* * 
 
* 
* * *
 
            
Herein, Mr. McMasters was found to have the ability to pursue and 
complete college level classes, and Dr. Herter indicated that, “Intellectually 
and academically, Mr. McMasters would be capable of handling 
vocational-technical level coursework as well as coursework at the community 
college level. . . .  .”  In addition, his medical providers 
repeatedly found that he had the physical capacity to engage in light to 
sedentary work.
 
            
This Panel finds and concludes that Mr. McMasters’ primary reasons for 
not returning to work are his psychological problems, which predate and are not 
caused by the work injury.  He has 
not proved that he is physically incapable of suitable employment, in light of 
his limitations, including his mental capacity, education, training, and 
age.  Mr. McMasters is still 
considered quite young at age 39, and his prior work history provides him with 
transferable skills that could be applied to other jobs.  Dr. Kaplan noted that, after the final 
fusion surgery that he was trying to walk a mile four times a week, has a valid 
driver’s license, and would, “. . . likely do better in a sedentary, light duty 
position. . . .”  We further find 
that Mr. McMasters has not met his burden in establishing a prima facie 
“Odd-lot” case, and that he has residual physical abilities that would permit 
him to work in a sedentary or light duty job.  In addition, this Panel also notes that 
Mr. McMasters is currently receiving some sort of interventional psychotherapy 
with Dr. Naginey in Casper, Wyoming, and is being considered for a nerve 
ablation treatment by Dr. Vilims and that these treatments, if successful, could 
positively affect Mr. McMasters’ overall employability status.  With the ongoing treatment, his young 
age, his stable work history and transferrable skills, this Panel is reluctant 
to find Mr. McMasters as Permanently and Totally Disabled.
 
            
Although we do not feel this is an “Odd-lot” case, we have analyzed Mr. 
McMasters’ claim under that standard as well, and find that the Division has 
shown that there are gainful jobs available in the community that Mr. McMasters 
could perform on a regular basis in light of his 
limitations.
 
[¶60]   We conclude that the Commission’s 
findings of fact are unsupported by substantial evidence and that it has 
misapplied the law in its conclusion that McMasters is not entitled to permanent 
total disability benefits under the odd lot doctrine.
 
A.        
The Odd Lot Doctrine
 
[¶61]   The Wyoming Workers’ Compensation 
Act defines the term “permanent total disability” as “the loss of use of the body as a whole or any permanent 
injury certified under W.S. 
27-14-406, 
which permanently incapacitates the 
employee from performing work at any gainful occupation for which he is 
reasonably suited by experience or training.”  Wyo. 
Stat. Ann. § 27-14-102(a)(xvi) 
(LexisNexis 2011).  The statutory 
definition is consistent with the odd lot doctrine, which permits a finding of 
permanent disability “in the case of workers who, while not altogether 
incapacitated for work, are so handicapped that they will not be employed 
regularly in any well known branch of the labor market.”  Nagle 
v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 
2008 WY 99, ¶ 11, 190 P.3d 159, 164 (Wyo. 2008) 
(quoting Cardin 
v. Morrison-Knudsen, 
603 P.2d 862, 863-64 (Wyo. 1979)).  Under the odd 
lot doctrine, a claimant who is not actually permanently totally disabled is 
eligible for permanent total disability benefits because his disability and 
other factors make him de facto unemployable.  Moss, ¶ 13, 232 P.3d  at 5; 
State 
ex rel. Wyo. Workers’ Safety & Comp. Div. v. Pickens, 
2006 WY 54, ¶ 14, 134 P.3d 1231, 1236 (Wyo. 2006).
 
[¶62]   The odd lot doctrine shifts the 
traditional burden of proof in a worker’s compensation 
case.
 
The 
claimant is required to make a prima facie showing that (1) “he is no 
longer capable of working at the job in which he was employed at the time of his 
injury,” and (2) “the degree of obvious physical impairment, coupled with other 
facts, such as mental capacity, education, training, or age” qualify him for odd 
lot treatment. City 
of Casper v. Bowdish, 
713 P.2d 763, 765 (Wyo. 1986). 
Once a claimant has established his prima facie case, the burden shifts 
to the Division to show that light work of a special nature which the claimant 
could perform is available.  Id. at 766.
 
Pickens, 
¶ 14, 134 P.3d  at 1236.
 
[¶63]   To meet the second prong of his prima facie case, a claimant must demonstrate he made reasonable efforts to find work in his 
community after reaching maximum medical improvement or, alternatively, that he 
was so completely disabled by his work injury that any effort to find employment 
would have been futile.  Moss, ¶ 14, 232 P.3d  at 5; 
Anaya 
v. Holly Sugar Corp., 
928 P.2d 473, 475-76 (Wyo. 1996).
 
[¶64]   This Court has held that a claimant 
who fits within the odd lot doctrine need not show that he is totally incapable 
of doing any work at all to be entitled to permanent total disability 
benefits.  Pickens, ¶ 13, 134 P.3d  at 1235; Schepanovich v. United States Steel 
Corp., 669 P.2d 522, 525 (Wyo. 1983).  
We have explained:
 
“ 
. . . The theory of counsel for the employer appears to be that the workman must 
go further than to show that he cannot do any hard work; that he must also show 
that he cannot do light work. Of course, it would almost be impossible, in many 
instances, for a man educated only to do hard work, to show that at some time or 
other some good Samaritan might not turn up and offer him some light work which 
he might be able to do. The law does not require impossibilities. It is stated 
in 71 C.J. 1071 that 'where it is found that the employee is permanently and 
totally disabled so far as hard or manual work is concerned, but that he might 
do light work of a special nature not generally available, the burden is on the 
employer to show that such special work is available to the employee.’ . . .” In re Iles, 56 Wyo. 443, 452, 110 P.2d 826 (1941).
 
Schepanovich, 
669 P.2d  at 525.
 
[¶65]   Finally, this Court adopted the 
following rule stated in 2 Larson, Workmen’s Compensation Law, § 57.61, at 
10-164.95 to 1-164.114 (1982):
 
“ 
. . . If the evidence of degree of obvious physical impairment, coupled with 
other facts such as the claimant’s mental capacity, education, training, or age, 
places claimant prima facie in the 
odd-lot category, the burden should be on the employer to show that some kind of 
suitable work is regularly and continuously available to the claimant. Certainly 
in such a case it should not be enough to show that claimant is physically 
capable of performing light work, and then round out the case for 
noncompensability by adding a presumption that light work is available. . . 
.
 
“The 
corollary of the general-purpose principle just stated would be this: If the 
claimant’s medical impairment is so limited or specialized in nature that he is 
not obviously unemployable or relegated to the odd-lot category, it is not 
unreasonable to place the burden of proof on him to establish unavailability of 
work to a person in his circumstances, which normally would require a showing 
that he has made reasonable efforts to secure suitable employment. . . 
.”
 
Schepanovich, 
669 P.2d  at 528.
 
B.        
McMasters’ Prima Facie 
Case
 
[¶66]   The first prong of McMasters’ prima facie case, that he is no longer 
capable of working at the job in which he was employed at the time of his 
injury, is not in dispute.  All of 
the physicians who examined McMasters agreed that physically he was restricted 
to light or sedentary duty, and the Division acknowledged at page 31 in its 
brief that “McMasters made a showing that he can no longer work in the HVAC 
field.”  
 
[¶67]   We turn then to the second prong 
and the requirement that McMasters show that his physical impairment, coupled 
with other facts, such as mental capacity, education, training, or age qualify 
him for treatment under the odd lot doctrine.  The evidence on this prong 
included:
 
-        
the 
report and testimony of Dr. Davis, the Division’s own expert, who opined that 
McMasters was permanently and totally disabled and “[t]he combination of 
problems in this gentleman make him probably unsuitable for any 
employment;”  
 
-        
the 
report and testimony of Reg Gibbs, an occupational therapist, that due to his 
combination of his physical impairment and his psychological concerns, McMasters 
“is not able to work in any capacity in the labor market;”  
 
-        
the 
evaluation and report of Dr. Herter, the psychologist who met with McMasters on 
numerous occasions, and concluded, “[a]lone or in combination, Mr. McMasters’ 
Panic Disorder, Pain Disorder and Major Depressive Disorder impede 
concentration, attention and short-term memory in a manner that would prevent 
him from being able to sustain simple, low stress, repetitive employment of any 
kind;” and
 
-        
the 
evaluation and report of Dr. Blaney, the Division-referred psychologist, who 
stated that McMaster could perform in a “low physical-impact, low-stress job in 
an area of personal interest,” if he were able to manage his anxiety and 
depression, which in a separate portion of his evaluation, he described as 
“unlikely,” given McMasters’ psychological profile.  
 
[¶68]   Consistent with the above evidence, 
McMasters testified that he takes pain medication three times daily, as 
prescribed by Dr. Vilims, and that he wears a TENS unit for pain.  Regarding his job search, McMasters 
confirmed that he had applied for thirty positions and stated that he is 
currently registered with Job Service.   He 
testified:
 
            
Q.        
Okay.  I will look at Exhibit 
1 from the Division, starting at page 6.  
Are these the places where you applied for work, Mr. 
McMasters?
 
            
A.        This 
is actually the paper that I filled out.  
This is my handwriting, yes.
 
            
Q.        
Okay.  And continuing on, did 
you apply to any places that you thought you might be able to get 
work?
 
            
A.        
Personally, I didn’t think I would be able to get work anywhere.  I applied to places that had 
advertisements looking for work.
 
            
Q.        
Okay.  And are these places 
that you actually applied at, the places on the list, did you actually apply 
there?
 
            
A.        
Yes.
 
            
Q.        All 
right.  There was some suggestion in 
one of the records I saw or something from the Division that said that you 
allege that you were applying at places where you knew you couldn’t get work 
anyway, like as an accountant or something like that.  Did you do that?
 
            
A.        I 
applied for one accountant job because there was – I had exhausted all other – 
the whole process to me is ridiculous.  
But I did my best to play along.  
I am very, very frustrated.  
And I am sorry, but this has been eight years.
 
[¶69]   Given the evidence above, we find 
there can be no question that McMasters met his burden of showing that the 
degree of his physical impairment combined with his mental capacity, education, 
training, and age make him eligible for permanent total disability 
benefits.  Four separate 
professionals evaluated McMasters and concluded that the combination of his 
physical restrictions, pain and psychological condition has rendered him 
unemployable.
 
[¶70]   The Commission concluded otherwise 
and rejected McMasters’ prima facie 
showing.  It reached its conclusion 
on essentially two grounds.  First, 
it found that McMasters was not credible.  
That finding had a domino effect in the Commission’s reasoning.  From that finding, the Commission 
concluded that the reports of Dr. Davis and Reg Gibbs were not credible – Dr. 
Davis’ report because he relied on the subjective complaints of McMasters, and 
the Gibbs report because he relied on Dr. Davis’ report.  The second ground for the Commission’s 
rejection of McMasters’ prima facie 
showing was its determination that McMasters’ psychological impairments were the 
primary reason he could not return to work and those predated and were unrelated 
to his work injury.  That is, the 
Commission found the opinions of Dr. Herter and Dr. Blaney credible and accepted 
them, but it nonetheless concluded that as a matter of law, McMasters was not 
entitled to permanent total disability benefits.
 
 
 
 
1.         
Commission’s Credibility Determinations
 
[¶71]   We consider first the Commission’s 
finding that McMasters lacked credibility.  
This Court will defer to a fact finder’s credibility determinations, but 
only where those determinations are supported by a rational premise.  Moss, ¶ 30, 232 P.3d  at 9.  In this case, we find that premise 
missing.
 
[¶72]   The Commission’s stated reasons for 
finding McMasters lacked credibility were: 1) he has made only minimal efforts 
at returning to the work force; 2) he has provided “extremely inconsistent 
information” to his medical providers regarding a variety of issues, 
particularly his limitations; and 3) although McMasters told Dr. Davis that he 
was only able to sit for thirty minutes at a time, the Commission panel  members observed him sitting for an hour 
and twenty minutes during the hearing without any apparent distress.  
 
[¶73]   We are at a loss to understand how 
McMasters’ alleged minimal efforts at returning to work could affect his 
credibility.  McMasters applied for 
work, and then he testified quite candidly that he was frustrated by the 
requirement because he felt it was a waste of time because of his 
disability.  Given the tone of 
McMasters’ testimony, it is clear that there was no deceit in his attempts to 
find work or in his testimony regarding the same.  He may have been disgruntled, but he was 
not dishonest.  Furthermore, to 
satisfy the second prong of his prima 
facie case, an employee must show he is unemployable, and applying for work 
is not the only way to do that.  In 
fact, this Court has held that an employee is not required to show that he 
searched for work and could find none to prove he is permanently and totally 
disabled under the odd lot doctrine.  
Nagle, ¶ 16, 190 P.3d  at 
166.  Given that McMasters’ 
lackluster attempt at finding alternate employment is not a basis to reject his 
odd lot claim, we cannot see how it could be viewed as a basis to find he lacks 
credibility or as a basis to ignore other evidence of his disability.  
 
[¶74]   The Commission’s next purported 
reason for finding that McMasters lacked credibility was that he provided 
“extremely inconsistent information” to his medical providers concerning his 
limitations.  We again cannot accept 
the Commission’s reasoning as a rational premise for finding McMasters lacked 
credibility.  It is certainly 
conceivable that in seeing multiple medical providers and specialists over a 
period of seven years, McMasters may have felt differently and may have 
described his symptoms and limitations differently on different occasions.  The Commission did not cite to specific 
examples of extreme inconsistencies that led to their finding, and in the 
absence of something more concrete, we cannot accept that the only or even a 
likely reason for variations in a patient’s reporting under these circumstances 
is deceit or dishonesty.  

 
[¶75]   We find it noteworthy on this 
question that none of the medical providers or specialists who examined or 
evaluated McMasters reported that they found McMasters’ complaints of pain to be 
lacking in credibility.  The only 
provider the Commission pointed to as allegedly agreeing with their assessment 
of McMasters’ credibility is psychologist Dr. Blaney.  In particular, the Commission, in 
Paragraph 28 of its findings of fact, stated that the panel agreed with Dr. 
Blaney that “McMasters’ representations about his physical condition are highly 
inconsistent with the medical records.”  
The Commission’s finding is a distortion of Dr. Blaney’s comments.  In his report, Dr. Blaney discussed how 
McMasters’ psychological and emotional issues impacted his perceptions and 
recollections concerning treatment and caused him to believe that treatments had 
been unsuccessful, when the medical records in fact showed certain of the 
procedures to be helpful.  Dr. 
Blaney did not suggest that McMasters was being dishonest about his pain or his 
disability.  In fact, Dr. Blaney 
referred to McMasters’ perception of his disability as “his essential, 
unalterable reality.”  

 
[¶76]   Dr. Davis testified similarly.  He testified that McMasters had an 
objectively verifiable physical injury and that the kind of pain McMasters was 
reporting was consistent with that injury.  
He also testified: 
 
            
Q.        And 
you answered some questions for Ms. Kempster about some of the pain that he 
reported was subjective.  In other 
words, just based on his report.  
Was there anything about your physical examination that led you to 
believe that Mr. McMasters was not being truthful with you about the pain he was 
experiencing when you were examining him?
 
            
A.        Let 
me think.  No. No, in his mind, he 
was being truthful.
 
            
Q.        And 
in your mind, did it appear to you that he was being truthful as well?  In other words, you didn’t pick up any 
sense of exaggeration or dishonesty in your evaluation of 
him?
 
            
A.        I 
picked up no evidence of dishonesty.  
I thought he was exaggerating, yes, and I think that has to do with his 
complex psychological problem that this is superimposed 
on.
 
[¶77]   The final basis the Commission 
offered as a reason to find McMasters lacked credibility was its observation 
that McMasters seemed to sit without apparent distress during the hearing, 
contrary to the limitations on sitting that he had reported to Dr. Davis.  This Court has on prior occasions 
cautioned the Commission against these types of impromptu medical diagnoses and 
reminded the Commission of its obligation to make its decision on the basis of 
the records and testimony entered into evidence.  Moss, ¶ 30, 232 P.3d  at 9; Nagle, ¶ 17, 190 P.3d at 166-67; Rodgers v. Wyo. Workers’ Safety & Comp. 
Div., 2006 WY 65, ¶ 41, 135 P.3d 568, 582 (Wyo. 2006); Decker v. Wyo. Workers’ Safety & Comp. 
Div., 2005 WY 160, ¶ 34, 124 P.3d 686, 697 (Wyo. 2005).  We find the Commission’s observations as 
unpersuasive in this case as we have in the other cited 
cases.
 
[¶78]   The hearing was held via 
videoconference with panel members in Cheyenne and Sheridan, and McMasters and 
his attorney in Casper.  It is 
difficult to understand, given the lack of proximity, how the panel members 
could clearly ascertain McMasters’ distress or lack thereof.  Additionally, we know from McMasters’ 
testimony that he was using a TENS unit to alleviate pain during the hearing, 
which may be one reason he was able to sit for longer.  Or perhaps the stress of the hearing was 
overriding the stress of the pain, or maybe he was having a good day, or maybe 
McMasters took days to recover from the hearing.  We just do not know, and it is all of 
these unanswered questions that make these types of observations largely 
irrelevant.  They simply provide 
very little helpful information and are a particularly flimsy basis for 
rejecting credibility.   

 
[¶79]   Based on the foregoing, we reject 
the Commission’s finding that McMasters is not a credible witness.  We also reject any of the findings that 
grew from that flawed determination, such as the Commission’s findings that the 
reports of Dr. Davis and Reg Gibbs lacked credibility because they were based 
directly or indirectly on the subjective complaints of McMasters.  We also note that, with respect to the 
opinions of Dr. Davis and Reg Gibbs, the record is clear that they relied on far 
more than the subjective complaints of McMasters.
 
2.         
Commission’s Psychological Determination
 
[¶80]   We turn next to the Commission’s 
finding that the primary reason McMasters is unable to return to work is his 
psychological condition, and its conclusion of law that because the 
psychological condition predated McMasters’ work injury, he is not entitled to 
permanent total disability benefits.  
The Commission’s determination is not supported by substantial evidence 
and is not in accordance with law.
 
[¶81]   The law has long recognized that an 
employee’s right to worker’s compensation benefits does not depend on the 
employee’s condition or health or on his freedom from a susceptibility to injury 
due to constitutional weakness or latent tendency, but instead on the hazard of 
the employment acting on the particular employee in his then state of 
health.  Wright v. Wyo. State Training School, 71 
Wyo. 173, 189, 255 P.2d 211, 217-18 (1953); see also Straube v. State ex rel. Wyo. Workers’ 
Safety & Comp. Div., 2009 WY 66, ¶ 17, 208 P.3d 41, 48 (Wyo. 2009) 
(employer/Division takes employee as it finds him).  This Court has 
stated:
 
Compensation 
under our law is not to be denied because the injury would not have occurred 
except for the peculiar susceptibility of the individual worker. . . . [A]n award of compensation is not 
precluded because the risk is one which has not become generally recognized 
or because only employees unusually susceptible will suffer from [the disease]. 
 
Wright, 
71 Wyo. at 191, 255 P.2d  at 218 (citing 
Webb v. New Mexico Pub. Co., 141 P.2d 333 (N.M. 1943) (emphasis in original)).
 
[¶82]   The odd lot doctrine is consistent 
with this premise in its provision for benefits when a claimant’s work injury 
combined with some other factor, such as mental capacity, renders the claimant 
unemployable. The question in this case then is whether it is McMasters’ 
psychological condition alone that is disabling him or whether it is the 
combination of his work injury and the underlying psychological condition that 
is disabling him.  The record is 
clear that it is the combination of the two conditions that has permanently and 
totally disabled McMasters:
 
-        
Dr. 
Davis opined that it is the physical injury superimposed on the psychological 
condition that has made McMasters unsuitable for 
employment;
 
-        
Dr. 
Herter explained the debilitating effect the loss of McMasters’ ability to 
perform heavy physical work had on him given his limited education and 
psychological condition and opined that McMasters was not employable; and 

 
-        
Dr. 
Blaney reported that McMasters’ psychological condition predated his work 
injury, but “his injury, pain, and unemployment have exacerbated underlying 
conditions and contributed to his present status.”  
 
[¶83]   In addition to the professional 
opinions that it is the physical and psychological conditions acting in concert 
that have disabled McMasters, there is McMasters’ condition before his 2003 work 
injury.  We know from the record, 
and the Commission agreed, that McMasters had a stable employment history before 
his injury.  In the eleven years 
before his work injury, McMasters worked primarily in construction.  Four of those years were as an HVAC 
apprentice, with another two years as an HVAC journeyman.  Additionally, both McMasters and his 
wife testified that McMasters led an active and social life before his 
injury.  
 
[¶84]   The only conclusion that can be 
drawn from the record is that McMasters’ physical impairment from his work 
injury combined with his underlying psychological condition to render him 
permanently and totally disabled.  
We thus conclude that McMasters met his prima facie case.
 
C.        
Division’s Burden of Proof
 
[¶85]   Having established that McMasters 
made his prima facie case, we next 
consider whether the Division met its burden of showing that light work of a special nature that McMasters 
could perform was available.  The 
Commission found that the Division met its burden with the report of Vocational 
Specialist Kelly White.  We 
disagree.
 
[¶86]   Kelly White’s report identified 
potential positions for McMasters in Casper, Wyoming, subject to the caveat that 
the physical demands of the jobs were not known and “[t]here is some question as 
to [McMasters’] emotional state and how it is affecting his return to 
work.”  In other words, White’s 
report did not identify even a single available position that McMasters could 
perform.  The most the report did 
was identify positions that, as White phrased it, McMasters “may want to 
consider researching further.”  Of 
course, the Division did not meet its burden of proof with this offering, and 
again, we find no support for the Commission’s determination 
otherwise.
 
D.        
Final Concerns with Commission’s Decision
 
[¶87]   As a final matter, we address some 
of the additional grounds the Commission cited for rejecting McMasters’ 
disability claim.  Excerpting from 
the above-quoted conclusions of the Commission, it stated:
 
            
Herein, Mr. McMasters was found to have the ability to pursue and 
complete college level classes, and Dr. Herter indicated that, “Intellectually 
and academically, Mr. McMasters would be capable of handling 
vocational-technical level coursework as well as coursework at the community 
college level. . . .  .”  * * * *
 
* 
* * *
 
* 
* * Mr. McMasters is still considered quite young at age 39, and his prior work 
history provides him with transferable skills that could be applied to other 
jobs.  * * * In addition, this Panel 
also notes that Mr. McMasters is currently receiving some sort of interventional 
psychotherapy with Dr. Naginey in Casper, Wyoming, and is being considered for a 
nerve ablation treatment by Dr. Vilims and that these treatments, if successful, 
could positively affect Mr. McMasters’ overall employability status.  With the ongoing treatment, his young 
age, his stable work history and transferrable skills, this Panel is reluctant 
to find Mr. McMasters as Permanently and Totally Disabled.
 
[¶88]   The above findings do not change 
the result in this case.  With 
respect to the suggestion that McMasters return to school and obtain additional 
training, this Court has held that the odd lot doctrine “does not encompass any obligation on the part of the 
injured employee to enter into any training program in order to improve his 
chances of employment.”  Moss, ¶ 34, 232 P.3d  at 10.  The Commission’s reliance on such a 
requirement is contrary to law.  

 
[¶89]   With respect to McMasters’ age, 
there is no evidence in the record to suggest his age is a factor or that his 
condition is one he will outgrow.  
With respect to the interventional psychotherapy by Dr. Naginey, the only 
evidence in the record is McMasters’ testimony that he is seeing Dr. 
Naginey.  The record contains no 
reports or evidence of any type detailing the progress of that treatment or its 
prospects for success.  The 
Commission’s reliance on Dr. Naginey’s treatment to reject McMasters’ claim is 
pure speculation unsupported by evidence.  
With respect to the nerve ablation treatment, the same is true.  McMasters testified that Dr. Vilims was 
considering a procedure, “I don’t know what it’s called. It’s basically the 
destruction of the nerves that are constantly firing and giving me this 
pain.”  The record contains no other 
evidence concerning “nerve ablation” treatment, and in particular no evidence 
from Dr. Vilims concerning the likelihood the procedure will be performed or 
will be successful.  Again, the 
Commission’s reliance on the treatment is speculation unsupported by 
evidence.
 
CONCLUSION
 
[¶90]   McMasters met his prima facie burden of establishing that 
he is unable to return to his former employment and that his work injury has 
combined with his psychological condition to render him permanently totally 
disabled under the odd lot doctrine.  
The Division presented no evidence of available employment that McMasters 
could perform.  We reverse and 
remand to the district court for entry of an order remanding to the Commission 
for entry of an order awarding McMasters permanent total disability 
benefits.