Case Title: Jaqua v. State ex rel. Wyoming Workers' Compensation Div

Citation: 

Docket Number: 

State: wyoming

Court: Wyoming Supreme Court

Date: 1994-05-03T00:00:00Z

Document:
Jaqua v. State ex rel. Wyoming Workers' Compensation Div1994 WY 51873 P.2d 1219Case Number: 93-167Decided: 05/03/1994Supreme Court of Wyoming
Donald 
T. JAQUA,

Appellant 
(Petitioner),

v.

STATE 
of Wyoming, ex rel., WYOMING WORKERS' COMPENSATION 
DIVISION,

Appellee 
(Respondent).

 

Appeal 
from the District Court, Natrona County, Dan Spangler, 
J.

 

Representing 
Appellant:

Donald 
L. Painter, Casper

Representing 
Appellee:.

Joseph 
B. Meyer, Atty. Gen., John W. Renneisen, Deputy Atty. Gen., Kenneth E. Spurrier, 
Asst. Atty. Gen., W. Thomas Sullins, II, Sp. Asst. Atty. 
Gen.

Before 
MACY, C.J., and THOMAS, CARDINE, GOLDEN and TAYLOR, 
JJ.

THOMAS, 
Justice.

[¶1]      The sole issue 
presented in this appeal is whether substantial evidence exists to support a 
denial of benefits under the Wyoming Worker's Compensation Act (WYO. STAT. §§ 
27-14-101 to -805 (1991 & Supp. 1993)). Donald T. Jaqua (Jaqua), in a 
creative manner, attempts to couch the question as one of law; but we are 
satisfied the determination by the hearing examiner is supported by substantial 
evidence, and the question truly is one of fact. Jaqua asserted an entitlement 
to benefits because of a back injury he sustained as a result of a fall on 
stairs while working as an employee of the Wyoming Highway Department. The 
Worker's Compensation Division (State) asserts that Jaqua is not entitled to 
benefits because the medical expenses and any disability were attributable to a 
preexisting condition. We hold Jaqua did not satisfy his burden of proof to 
establish his injury was related to his work. We affirm the Order on Appeal 
entered in the district court affirming the decision of the hearing 
examiner.

[¶2]      In his 
Appellant's Brief, Jaqua states this issue:

1. 
Whether Defendant's "injury" was, as a matter of law, a new injury or a 
recurrence of an old injury.

In 
the Brief of Appellee, the issue is asserted to be factual and is stated 
as:

I. 
Whether substantial evidence exists to support the hearing examiner's denial of 
employee-claimant's claim for worker's compensation 
benefits.

[¶3]      Jaqua was 
employed by the Wyoming State Highway Department (Department) in 1984. More than 
twenty years earlier, he sustained an injury to his back while serving in the 
Navy in 1961. Jaqua testified he had experienced back discomfort on numerous 
occasions during the twenty-three year period between the injury when he was in 
the Navy and his employment at the Department. He treated this back discomfort 
with non-prescription medication. Later, he experienced occasional discomfort in 
his surveying work for the Department when he was doing extensive walking and 
carrying equipment.

[¶4]      In 1988, Jaqua 
had nonwork-related surgery on his back involving a decompression laminectomy 
and the removal of a herniated disc. His medical records show he suffered an 
injury, which was not compensable, from a fall in November of 1989. On July 18, 
1990, a Magnetic Resonance Imaging (MRI) diagnosis was accomplished due to 
bilateral hip pain and right side back pain, apparently induced by the 1989 
fall. Again, on April 6, 1992, Jaqua sought treatment for his back condition. 
The report of the physician advises, "He [Jaqua] has progressive increasing 
symptoms over the past few years. He complains of pain in his back which 
radiates into his buttocks, notes feeling of numbness in both legs." The 
physician prescribed a back rehabilitation program.

[¶5]      Three weeks 
later, on April 27, 1992, according to Jaqua's report, he lost his footing, fell 
down a few stairs, landed in a sitting position, and injured his arm and 
buttocks while at work. He sought treatment from a physician in Phoenix, Arizona 
whose medical history record noted the failure of conservative treatment of 
rest, time, therapy, and past surgery, and also noted a continuing disk problem 
that had troubled Jaqua for a prolonged period. The Arizona physician performed 
back surgery on July 14, 1992.

[¶6]      Jaqua filed an 
Employee's Report of Injury, Occupational Illness or Disease related to the 
April 27, 1992 fall. The State issued an Initial Review - Due to Pre-Existing 
Condition and denied benefits because the medical reports reflected Jaqua's back 
condition was preexisting. Subsequently, the State furnished a Determination of 
Disputed Claim in which benefits again were denied because no medical evidence 
established Jaqua's back condition was the result of the accident while at work. 
Jaqua objected to the determination by the State, and a contested case hearing 
was scheduled. The hearing was continued on two occasions, due to the hearing 
examiner's request for additional discovery, and culminated on the third 
occasion when the Order Denying Benefits was issued. The critical findings in 
that Order Denying Benefits are:

1. 
That Employee-Claimant has failed to meet his burden of proof with respect to 
the benefits claimed, and the objections of the Objector-Defendant, State of 
Wyoming, ex rel., Wyoming Workers' Compensation Division to the award of the 
benefits claimed is sustained.

2. 
That Employee-Claimant has failed to meet his burden of proof to establish an 
"injury" pursuant to W.S. 1977, § 27-14-102(a)(xi).

3. 
That the evidence presented reflects that Employee-Claimant had a pre-existing 
injury or condition, and therefore the claims for benefits herein are precluded 
pursuant to W.S. 1977, § 27-14-102(a)(xi)(F).

4. 
That as a result of the inconsistencies in the Employee-Claimant's testimony and 
asserted positions with the notes, records, and testimony of the medical care 
providers herein, the Employee-Claimant has failed to meet his burden to 
establish a work related injury herein.

This 
Order Denying Benefits was affirmed by the district court of the Seventh 
Judicial District after judicial review was sought. Jaqua has appealed the order 
of the district court.

[¶7]      Our standard of 
review with respect to factual determinations by administrative agencies, 
particularly in Worker's Compensation cases, is well 
known:

Our 
standard for reviewing findings of fact made in an administrative worker's 
compensation hearing is well settled. If, after examining the entire record, we 
find substantial evidence to support the agency's finding, we will not 
substitute our own judgment for that of the agency. Instead, we will uphold the 
agency's finding. Substantial evidence is relevant evidence which a reasonable 
person might accept as supporting the agency finding. Aanenson v. State of 
Wyoming ex rel. Wyoming Worker's Compensation Division, 842 P.2d 1077, 1079 
(Wyo. 1992).

Sinclair 
Trucking v. Bailey, 
848 P.2d 1349, 1351 (Wyo. 1993).

[¶8]      The party who 
appeals from an administrative determination has the burden of proving the lack 
of substantial evidence to sustain the ruling of the agency. Application of 
Campbell County, 731 P.2d 1174 (Wyo. 1987). In order to prevail before the 
hearing examiner, Jaqua was charged with demonstrating an injury, arising from 
his employment, while at work. That definition of injury is found in the Wyoming 
Worker's Compensation Act as follows:

(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:

* 
* *

(F) 
Any injury or condition preexisting at the time of employment with the employer 
against whom a claim is made.

WYO. 
STAT. § 27-14-102(a) (Supp. 1993).

We 
emphasize the exclusion found in this statute.

[¶9]      At the hearing, 
Jaqua's evidence consisted primarily of his testimony, much of which supports 
the determination of a preexisting condition. He advised he experienced very 
uncomfortable backaches in 1961, although they were not debilitating. He claimed 
the Navy had diagnosed his problem as a prostate ailment. He conceded he was 
uncomfortable on numerous occasions because of his back ailment between the time 
of his release from the Navy and before he became an employee of the Department. 
At one point in his testimony, Jaqua stated he did not seek any medical 
treatment for his back discomfort during this period, but he later testified he 
had received the benefit of an MRI diagnostic procedure in Denver through the 
Veterans Administration and, in California, X-rays had been taken relating to 
his back problems.

[¶10]   Jaqua testified that, prior to 
April 27, 1992, the only work he had missed due to his back ailment occurred in 
1988 when he was off work for approximately two months because of back surgery 
for a nonwork-related injury. He received a full release from his surgeon and 
returned to his work at the Department. He said that, for a period of four or 
five months prior to the fall on April 27, 1992, he had experienced aching in 
his middle and upper back, and he had sought medical relief on April 6, 1992. He 
described the critical accident as a slip and fall on a stairway that caused 
extreme discomfort in his lower back. No one else was present at the 
time.

[¶11]   In subsequent testimony, Jaqua 
stated MRI diagnostic procedures prior to and after this fall demonstrated 
changes in the condition of his back. This statement was supported, however, 
with only equivocal medical records and testimony of a physician. The physician 
in Arizona who had performed the most recent surgery testified he "thought it 
[the disk] was larger" after this accident. In his deposition, he did point out 
that the symptoms described to him by Jaqua were solely of the left anterior 
thigh whereas the symptoms described to the treating physician in Laramie 
included pain in his back radiating into his buttocks and no feeling in both 
legs.

[¶12]   With respect to the treating 
physician's report in the medical record, Jaqua disavowed the statement that he 
had injured his back over thirty years earlier; declared the medical records of 
the doctor were not accurate; and contended the doctor's report was wrong when 
it described tenderness in the lower back, lumbosacral junction. He also 
asserted the State was not supposed to have those medical records. Jaqua denied 
he had told the Phoenix physician he had experienced the back injury on April 
27, 1992 when he fell into a two-foot hole. On his accident report filed April 
30, 1992, Jaqua stated he had never suffered an injury to his back prior to the 
accident. 

[¶13]   The hearing examiner was clear in 
his statement that medical testimony was very important in Jaqua's case. He 
encouraged Jaqua to present any medical testimony from his treating physicians 
or from his records that would assist in substantiating his claim. A 
chronological examination of the evidence available to the hearing examiner 
demonstrates more than substantial evidence for the finding of fact that Jaqua's 
injury was not work related. These basic facts support the conclusions Jaqua had 
failed to meet his burden of proof to establish an injury pursuant to the 
statute and the condition was the product of a preexisting injury were 
justified. The State did offer substantial, competent medical evidence to 
support the order and deny benefits.

[¶14]   In April of 1988, a discharge 
summary by the physician who had accomplished Jaqua's back surgery 
states:

A 
long history of back and leg pain. He had a previous service injury with back 
and leg pain. MRI was done in April which showed disc herniation at the L2-3 
interspace of the right midline, and the L3-4 interspace centrally with some 
associated hypertrophic changes at these levels, and specific spinal stenosis at 
L3-4 level.

An 
evaluation of Jaqua was accomplished by a licensed physical therapist on May 17, 
1988 and that revealed that he was complaining of low back pain. The evaluation 
states:

Patient 
states that the original injury was in the Navy approx. 35 years ago and that it 
has been getting progressively worse. * * * Patient states he has had multiple 
old injuries, but otherwise than that considers himself in good medical 
health.

[¶15]   The report of the MRI diagnosis of 
Jaqua's lumbar spine on July 18, 1990 advised Jaqua had fallen in November, 1989 
and had bilateral hip pain with right side back pain since that time. In a 
Progress Note entered April 6, 1992, the initial treating physician for this 
claimed injury stated:

Donald 
[Jaqua] is a 53-year-old male who injured his back over 30 years ago. * * * He 
has progressive increasing symptoms over the past few years. He complains of 
pain in his back which radiates into his buttocks, notes feeling of numbness in 
both legs. * * * Patient reports increasing tenderness in the region of the 
lumbosacral junction.

This 
report was made prior to the injury for which benefits were 
sought.

[¶16]   On May 6, 1992, another MRI 
procedure was accomplished after the April 27, 1992 injury. It was compared with 
the report of the MRI diagnosis accomplished on July 18, 1990. The physician 
concluded, "[t]his does not appear to have shown any significant change when 
compared to the previous study. * * * Prominent central disk herniation, L-3 
level, unchanged when compared with the previous study." This is to be compared 
with the neurosurgical consultation accomplished by the Phoenix physician on 
July 7, 1992, which stated:

Back 
pain, left leg pain, numbness, weakness * * * white male states he had problems 
with his back for a prolonged period of time * * * was operated on in 1988. The 
patient did reasonably well, got back to work as a surveyor until April 27, 1992 
when he fell into a two foot hole and since that time could not work. * * 
* He had a previous MRI scan carried out in 1990, and it appears to me that the 
disc is somewhat larger at the present time, although it is difficult to be 
absolutely sure. (Emphasis added.)

[¶17]   After offering this equivocal 
testimony, Jaqua, through his counsel, asserted that, because the Department did 
not terminate him in 1988 following his nonwork-related back surgery, the 
Department must have in some way assumed the risk of further injury to his 
preexisting condition. We can find no basis in our law or statutes for that 
premise, and Jaqua does not provide one. It, therefore, is not applied in our 
resolution of this case. We have said with respect to the Wyoming Worker's 
Compensation Act:

In 
Abas v. State ex rel. Wyoming Worker's Compensation Division, Wyo., 701 P.2d 1153, 1156 (1985), we held that

"worker's 
compensation statues are to be liberally construed to effectuate their 
beneficent purpose. The purpose of such construction is to require the industry 
to bear the burden of industrial accidents, not the injured worker. But we 
cannot ignore clear statutory language and apply worker's compensation statutes 
to situations that do not reasonably fall within the intended ambit of such 
laws."

Woodman 
v. Grace Bomac Drilling, 
736 P.2d 313, 315 (Wyo. 1987).

[¶18]   It is unfortunate Jaqua has 
suffered from problems with his back for much of his life. He reported to the 
Phoenix physician that his life had become "absolutely miserable" due to the 
pain. In accordance with what we have said, however, we cannot ignore the clear 
mandate of the law and order compensation for a preexisting condition nor order 
compensation where the denial, premised upon the absence of a work-related 
injury, is supported by substantial evidence.

[¶19]   After examining the entire record, 
in accordance with our standards, we perceive substantial evidence to support 
the findings of the hearing examiner. The denial of worker's compensation 
benefits is affirmed.