Case Title: IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF: SWEETS

Citation: 

Docket Number: 01-75

State: wyoming

Court: Wyoming Supreme Court

Date: 2002-03-12T00:00:00Z

Document:
IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF: SWEETS2002 WY 3742 P.3d 461Case Number: 01-75Decided: 03/12/2002

OCTOBER TERM, A.D. 2001

                                                                                                
   

IN THE 
MATTER OF THE WORKER'S

COMPENSATION 
CLAIM OF:

IVAN L. 
SWEETS, 

Appellant(Employee-Claimant),

v.

STATE OF 
WYOMING, ex rel.,

WYOMING 
WORKERS' SAFETY

AND 
COMPENSATION DIVISION, 

Appellee(Objector-Defendant).

W.R.A.P. 
12.09(b) Certification from the District Court of Sweetwater 
County

The 
Honorable Jere Ryckman, Judge

Representing 
Appellant: 

Jody L. 
James of James and Scott, P.C., Rock Springs, Wyoming.

Representing 
Appellee: 

Hoke 
MacMillan, Attorney General; John W. Renneisen, Deputy Attorney General; Gerald 
L. Laska, Senior Assistant Attorney General; and David L. Delicath, Assistant 
Attorney General.

Before 
LEHMAN, C.J., and GOLDEN, HILL, and VOIGT, JJ., and Keith G. Kautz, 
D.J.

  

            
HILL, Justice. 

[¶1]      On April 9, 1997, 
Appellant, Ivan L. Sweets (Sweets), was injured while at work in the laundry at 
the Wyoming State Penitentiary (WSP).1  It is his claim that the 1997 injury 
eventually necessitated a knee surgery and other medical care for which he 
sought worker's compensation benefits.  
The Appellee, Division of Wyoming Workers' Safety and Compensation 
Division (Division), contends that Sweets's medical problem was the result of a 
19852 injury he suffered while playing 
basketball at the WSP and, thus, the medical expenses submitted to the Division 
for compensation benefits were properly denied.  Sweets sought review in the district 
court under W.R.A.P. 12.  The 
district court certified the matter here for our review.  We will reverse and remand with 
directions.

[¶2]      Sweets poses 
these issues:

1.  Was the Hearing Examiner's finding that 
[Sweets] did not suffer a 1997 left knee anterior cruciate ligament injury 
supported by substantial evidence?

2.  Was the Hearing Examiner's finding that 
the most complete and in depth medical review was performed by Dr. Rheim Jones 
an abuse of discretion?

3.  Was the Hearing Examiner's finding that 
[Sweets] suffered an April 9, 1997 left knee sprain/strain injury that resolved 
itself by no later than July 28, 1998 arbitrary and 
capricious?

The 
Division rephrases those issues thus:

I.          
Does substantial evidence support the Hearing Examiner's finding that 
[Sweets] failed to prove that he injured his anterior cruciate ligament on April 
9, 1997?

II.          
Does substantial evidence support the Hearing Examiner's finding that the 
most complete and in depth review of [Sweets's] condition was the one performed 
by Dr. Rheim Jones?

III.         
Does substantial evidence support the Hearing Examiner's finding that 
[Sweets] sprained or strained his left knee on April 9, 1997 and that injury 
resolved itself by July 28, 1998?

[¶3]      This case began 
when Sweets filed a report of an occupational injury on April 9, 1997.  In that document, Sweets reported that 
he was cleaning a drain in the laundry room at the WSP and his "knee went out 
while bending."  The report 
indicated that Sweets injured his left knee.3  At the time of the injury, Sweets was 
seen in the infirmary at the WSP, and these notations appear in his medical 
file:

Mr. 
Sweets comes to the clinic this morning.  
He miss stepped [sic], his left knee popped.  There may be a slight affusion; this 
happened just a short time ago.  I 
have seen him in the past for his knee.

Examination 
reveals the joint to be stable.  
Range of motion is normal.  I 
am going to put a neoprine [sic] sleeve on.  He is to wear it during the day for a 
couple of weeks.  He believes he can 
continue with his job as a laundry supervisor.  Mr. Sweets is to return to see me in two 
weeks.  I have prescribed IBU 800 mg 
tid.

[¶4]      It is apparent 
from the record that the Division asked Sweets to send it a more detailed 
description of the circumstances surrounding his injury.  Sweets wrote to the Division on April 29, 
1997, and his explanation in that letter adds nothing to what has been recited 
above, although Sweets did provide the Division more information about the 
injury which occurred in 1984.  It 
is in this letter that Sweets stated that the previous injury was in 1985, and 
from that point forward most persons involved in treating or evaluating Sweets 
continued to use 1985 as the relevant date.

[¶5]      Sweets testified 
that his left knee has continued to give him problems since the time of the 1997 
injury, though he received no treatment for it until 1998-99, after he was 
released from the WSP.  On July 28, 
1998, Sweets paid a visit to a physician in Kemmerer, and that physician noted 
no instability in his left knee but suggested that an MRI be done and that 
Sweets return for a recheck in three weeks.  Sweets did not return to Kemmerer for a 
recheck, but an MRI was performed on August 7, 1998, at the hospital in Rock 
Springs and that MRI revealed:  
"Complete disruption of the anterior cruciate ligament, probably 
chronic."  Sweets asserted that he 
was unable to afford to go back to Kemmerer to pursue treatment, and his next 
treatment began with Joseph Oliver, M.D., an orthopedic surgeon from Rock 
Springs, on October 5, 1999.  Dr. 
Oliver's final conclusion was that Sweets suffered a new injury on April 9, 
1997, but an additional factor was a material aggravation of a 1984 injury 
wherein Sweets suffered a medial meniscal tear in his left knee.  Dr. Oliver recommended surgery to 
correct the anterior cruciate ligament problem, and that surgery was 
performed.  The costs of that 
surgery and its associated hospitalization make up the lion's share of the 
claims submitted by Sweets to the Division, which the Division declined to pay 
on the basis that the treatment was not related to, nor necessitated by, the 
April 9, 1997 injury.  At this 
juncture, we also take note that on May 15, 1997, the Division sent Sweets a 
letter containing the following information:

The 
Workers' Compensation Division has reviewed your accident report(s) and all 
other documents in our file. We have determined that the injury to your right 
[sic] knee is covered by the Wyoming Workers'4 Compensation Act and claims for 
medical and/or disability benefits will be reviewed and paid if 
compensable.

The 
evidence, including both your own statements in a letter as well as the medical 
records from the prison infirmary, indicate this condition is a pre-existing 
one.  As there has never been a 
workers' compensation claim filed on this injury, we must assume the 
pre-existing injury and it is not work related.  Our compensability on this case is 
therefore limited to an acute exacerbation of the pre-existing condition.  We will not accept any previous primary 
injury as compensable and if you do have any previous injury such as a torn 
medial meniscus, we would not pay for the surgical repair of this 
condition.

(Emphasis 
in original.)

[¶6]      On June 3, 1997, 
the Division sent Sweets a letter correcting its reference to his right knee and 
changing it to his left knee.  The 
Division said the error came about because the report of injury did not specify 
which knee was involved, although that too is not correct.  The letter went on to 
say:

As the 
records do indicate your left knee injury is an aggravation of a pre-existing 
condition, and there was never a workers' compensation [sic] filed on 
your left knee the Division's compensability is limited to an acute exacerbation 
of the pre-existing condition.  We 
will not accept any previous injuries as compensable and if you 
have any previous injury such as a torn medial meniscus, we would 
not pay for the surgical repair of these conditions.  If the records, however, clearly 
indicate a condition attributable to the injury of April 9th, 1997, we will consider payment for repair of 
the condition.

(Emphasis 
in original.)

[¶7]      A disclosure 
statement filed by the Division with the Office of Administrative Hearings on 
March 22, 2000, indicated that the Division took the position that the problems 
with Sweets's left knee were pre-existing, that the problems with his left knee 
did not occur in the course and scope of his employment, and that Sweets had the 
burden of proving each and every element of his claims for medical and temporary 
total disability benefits by a preponderance of the 
evidence.

[¶8]      At the request of 
the Division, Sweets was sent to Rheim B. Jones, M.D., an orthopedic surgeon in 
Idaho Falls, Idaho,5 for the purpose of undergoing an 
independent medical examination.  We 
will discuss that evaluation more fully later, but for the time being, we note 
that Dr. Jones determined that:

Mr. 
Sweets sustained a basketball injury to his left knee in 1985, while 
incarcerated in the Wyoming State Penitentiary.  Dr. Kirsch diagnosed a medial meniscal 
tear.  It is my opinion, based on 
the medical record, Mr. Sweet's [sic] testimony6 [sic], chronology of his 
symptoms, and x-ray findings, that Mr. Sweets sustained an anterior cruciate 
ligament injury in 1985.  It went 
undiagnosed.  The unstable knee and 
torn medial meniscus caused the degenerative arthritis.

The 
injury of 04/09/97 did not cause the anterior cruciate ligament tear and the 
resulting arthritis.  The incident 
of 04/09/97 represented an episode of instability from the pre-existing torn 
anterior cruciate ligament and medial meniscal tear.

[¶9]      Dr. Jones also 
indicated:  "Since 1985, Mr. Sweets 
has been unable to play basketball, football, fish, and do his climbing 
activities."  This conclusion is at 
odds with Sweets's testimony as well as the reports filed by all other health 
care providers.  According to 
Sweets, and there is no other evidence to contradict it, he was able to do all 
of his activities, including work, until after the April 9, 1997 
injury.

[¶10]    The Division also sent Sweets 
to Michael Kaplan, M.D., at Gem City Bone & Joint in Laramie for an independent 
medical evaluation.  Dr. Kaplan 
specifically challenged Dr. Jones's statement that Sweets was unable to play 
sports, etc., and indicates the opposite was true.  In addition, Dr. Kaplan 
opined:

Dr. 
Jones's opinion in the IME is that 100% of the patient's problems should be 
apportioned to the accident in 1985.  
However, with a severe anterior cruciate deficiency, I would have 
expected the patient to have had problems with instability and with all of the 
activity that he claims he participated in.  Additionally, it seems that he may have 
been denied appropriate serial assessments and diagnostics following the 
Workers' Compensation injury in 1997, delayed care until 
1999.

[¶11]   Dr. Oliver, Sweets's treating 
physician, also commented on Dr. Jones's evaluation:

I have 
read Dr. Jones' evaluation and I feel that the injury that Mr. Sweets sustained 
in 1985 was a probable meniscal tear.  
He gave no history of problems up until his injury in 1997.  After that injury he had significant 
problems with his knee with instability and giving out.  It is my feeling that he did have injury 
in 1985, which was probably a meniscal tear, but he was able to function up 
until 1997 with this, which is not unusual to have people function with a torn 
meniscus for some period of time without being symptomatic.  I have a number of patients in my 
practice that this has happened to.  
As far as him having significant problems after his injury of 1997, I 
feel that his cruciate deficiency developing from that injury and his 
instability after that time was a result of that second injury of 
1997.

I do not 
agree that 100 per cent of Mr. Sweets[s] problems are related to his injury of 
1985.  Again as related to me by Mr. 
Sweets, he had minimal problems with his knee up until his injury of 1997 when 
his knee got progressively worse.  I 
feel that the tearing of his anterior cruciate ligament at the time of this 
injury caused his symptoms to get worse and progress, as far as 
instability.  His knee became 
unstable to the point that he was more symptomatic after the anterior cruciate 
ligament injury in 1997.

As 
stated above, I feel to have a meniscal tear does not necessarily mean that your 
knee is going to be unstable and the function can be relatively normal, which I 
feel Mr. Sweets was from his injury in 1985 to his injury in 1997 when he got 
progressively worse.

[¶12]   A hearing was held on November 17, 
2000.  The only evidence taken at 
that hearing was Sweets's testimony.  
The remainder of the record is made up of a deposition from Dr. Oliver, 
the various medical reports described above, and documents of an administrative 
nature.  The Hearing Officer 
generally denied Sweets's claim for worker's compensation 
benefits.

[¶13]   Our standard of review in a case 
such as this is well established:

            
A claimant for worker's compensation benefits has the burden of proving 
all the essential elements of the claim by a preponderance of the evidence in 
the contested case hearing.  
Martinez v. State ex rel. Wyoming Workers' Compensation Div., 917 P.2d 619, 621 (Wyo.1996).  When an 
agency decides that the party charged with the burden of proof has failed to 
meet that burden, the case is reviewed under the "[a]rbitrary, capricious, an 
abuse of discretion or otherwise not in accordance with law" language of Wyo. 
Stat.  § 16-3-114(c)(ii) 
(1990).  City of Casper v. 
Utech, 895 P.2d 449, 452 (Wyo.1995).  
On appeal the complainant, Pederson in this instance, has the burden of 
proving arbitrary administrative action.  
Knight v. Environmental Quality Council of State of Wyo., 805 P.2d 268 (Wyo.1991);  Wyoming 
Bancorporation v. Bonham, 527 P.2d 432, 439 (Wyo.1974);  Marathon Oil Co. v. Welch, 379 P.2d 832, 836 (Wyo.1963); Whitesides v. Council of City of Cheyenne, 78 
Wyo. 80, 319 P.2d 520, 526 (1957).  
The agency, as the trier of fact, is charged with weighing the evidence 
and determining the credibility of witnesses.  Utech, 895 P.2d  at 451, and cases 
there cited.  The deference normally 
accorded to the findings of fact by a trial court is extended to the 
administrative agency, and the agency's decision as to the facts will not be 
overturned unless it is clearly contrary to the overwhelming weight of the 
evidence.  Wyoming Steel & 
Fab, Inc. v. Robles, 882 P.2d 873, 875 (Wyo.1994).  Demonstrating evidentiary contradictions 
in the record does not establish the irrationality of the ruling, but we do 
examine conflicting evidence to determine if the agency reasonably could have 
made its finding and order based upon all of the evidence before it.  Matter of Corman, 909 P.2d 966, 
971 (Wyo.1996);  Knight, 805 P.2d  at 274; Ward v. Board of Trustees of Goshen County School Dist. No. 
1, 865 P.2d 618, 623 (Wyo.1993);  
State ex rel. Wyoming Workers' Compensation Div. v. Ramsey, 839 P.2d 936, 941 (Wyo.1992).  

Ikenberry 
v. State ex rel. Wyoming Workers' Compensation Division, 5 P.3d 799, 802 (Wyo. 2000) (citing Claim of Pederson, 939 P.2d 740, 742 
(Wyo.1997)).

[¶14]   Based upon the evidence in the 
record, the Hearing Examiner made the following determinations, which are of 
particular importance to the resolution of this matter.  We agree with Sweets that his findings 
are incorrect and/or inaccurate as asserted in Sweets's statement of the 
issues:

[¶15]   1.  The Hearing Examiner found that Sweets 
injured his knee in 1985 while playing basketball, and that the injury which 
occurred was a torn medial meniscus, but that problem was not treated until 
surgery in October of 1999.  Viewing 
the same materials, which were available to the Hearing Officer, we conclude 
that the injury occurred in 1984, and it was diagnosed as a medial meniscus 
tear.  However, that tear was not 
treated during the 1999 surgery, or at least no claim was made for repair of the 
medial meniscus.  The claim was for 
surgery to correct the anterior cruciate ligament 
deficiency.

[¶16]   2.  The Hearing Examiner determined that 
great weight should be given to Dr. Jones's findings because they were the most 
complete and in-depth review done.  
Again, based on our review of the record we note that, indeed, Dr. 
Jones's report is some 34 pages long, but unless we are to use the phrase, 
"weight of the evidence," literally, it should carry no more weight than any of 
the other medical evidence.  Only a 
few of the 34 pages pertain to the issue at hand.  Of special note is that Dr. Jones is the 
only health care provider to conclude that Sweets was unable to play sports or 
work after the 1985 injury.  The 
vast weight of the evidence compels a conclusion that that is patently incorrect 
and seriously detracts from Dr. Jones's overall 
conclusions.

[¶17]   3.  The Hearing Examiner concludes that 
Sweets did suffer a work-related injury on April 9, 1997, but that injury 
resolved itself no later than July 28, 1998.  Our review of the record reveals that 
there is no medical evidence to support this conclusion.  This is apparently based upon the fact 
that on July 28, 1998, a physician in Kemmerer saw Sweets, and she found no 
instability in the knee.  That same 
physician wanted to see an MRI.  An 
MRI was done about ten days later, and it revealed a complete anterior cruciate 
ligament deficiency.  If the Hearing 
Examiner's reasoning were to be followed, then it also would have to be 
concluded that the deficiency occurred during that ten-day time span, and there 
is no evidence in the record to support such a conclusion.  Moreover, because such a conclusion 
requires medical expertise, we view the Hearing Officer's findings in this 
regard to be beyond the scope of his role in this process.

[¶18]   The errors in the Hearing 
Examiner's findings so undermine the credibility and, hence validity, of the 
result reached in this case that the Order Finding and Limiting Compensable 
Injury cannot be affirmed.  
Therefore, we reverse that Order and remand to the district court with 
directions that the district court further remand to the Office of 
Administrative Hearings.  At a 
minimum, the Hearing Examiner shall amend his findings so as to conform them to 
the evidence in the record and issue a new order.  The Hearing Officer may also choose to 
remand the matter back to the Division for a hearing de novo before the 
Medical Commission, or to enter an order awarding benefits as claimed by Sweets, 
as there is substantial evidence in the record to support such an award of 
benefits.

FOOTNOTES

1Inmates working in the Correctional Industries 
Program, which includes the prison laundry, are covered by worker's 
compensation.  Wyo. Stat. Ann. §§ 
25-13-106(a) and 27-14-401(h) (LexisNexis 2001). 

2Sweets testified that the injury 
occurred in 1984, and the documentation related to that injury indicates that 
Sweets was treated at the hospital in Rawlins on April 9, 1984.  A left knee arthrogram revealed 
that:  "There was a horizontal 
linear defect noted in the posterior horn of the medial meniscus on the medial 
aspect consistent with a tear."  
Sweets did indicate that injury occurred in 1985, when he wrote to the 
Division in April of 1997.  In his 
findings, the Hearing Examiner describes this occurrence as the 1985 injury, and 
we will adopt that convention to avoid confusion.  In quoted material, any reference to a 
1984 injury should be construed to refer to the so-called "1985 
injury."

3This fact is of importance only because 
the Division originally identified the injury as being to Sweets's right knee, 
though the report of injury clearly indicated the left knee.  Other than the obvious "credibility" 
issues that arise when such a mistake is made, this fact is of no particular 
importance, as the Division promptly corrected the error when Sweets called it 
to the Division's attention.

4Although the Division calls itself the 
"Wyoming Workers' Compensation Division," the Act is actually entitled 
the "Wyoming Worker's Compensation Act."

   5Idaho Falls is 
approximately 350 miles from Rock Springs. 

6Sweets's testimony was not given until 
November 17, 2000.  We must assume 
that Dr. Jones means Sweets's report to him during the 
examination.