Title: IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF: THOMAS ANASTOS V. GENERAL CHEMICAL SODA ASH and STATE OF WYOMING, ex rel. WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION

State: wyoming

Issuer: Wyoming Supreme Court

Document:

IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF: THOMAS ANASTOS V. GENERAL CHEMICAL SODA ASH and STATE OF WYOMING, ex rel. WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2005 WY 122120 P.3d 658Case Number: 04-211Decided: 09/27/2005
APRIL 
TERM, A.D. 2005

 
 
IN THE 
MATTER OF THE WORKER'S

COMPENSATION 
CLAIM OF:

 
 
THOMAS 
ANASTOS,

 
 
Appellant

(Petitioner/Employee-Claimant),

 
 
v.

 
 
GENERAL 
CHEMICAL SODA ASH

 
 
Appellee

(Employer/Respondent),

 
 
and

 
 
STATE OF 
WYOMING, ex rel., WYOMING

WORKERS' 
SAFETY AND COMPENSATION

DIVISION,

 
 
Appellee

(Objector/Respondent).

 
 
Appeal 
from the DistrictCourtofSweetwaterCounty

The 
Honorable Nena James, Judge

 
 
Representing 
Appellant:

 
 

            
Sean W. 
Scoggin of Tiedeken & Scoggin, P.C., Cheyenne, Wyoming.

 
 
Representing 
Appellee General Chemical Soda Ash:

 
 

            
Stephen 
H. Kline of Kline Law Office, P.C., Cheyenne, Wyoming.

 
 

Representing 
AppelleeState of Wyoming, ex 
rel., Wyoming 
Workers' Safety and Compensation Division:

 
 
            
Patrick J. Crank, Attorney General; John W. Renneisen, Deputy Attorney 
General; Steven R. Czoschke, Senior Assistant Attorney General; and Kristi M. 
Radosevich, Assistant Attorney General, Cheyenne, 
Wyoming.

 
 
Before 
HILL, C.J., and GOLDEN, KITE, VOIGT, and BURKE, 
JJ.

 
 
 
 
  
            
VOIGT, Justice.

 
 
[¶1]      Thomas Anastos 
was injured while working for General Chemical Soda Ash.  The Wyoming Workers' Compensation and 
Safety Division awarded Anastos temporary total disability1 benefits for diagnosis and 
treatment of a back injury it deemed to be work-related.  Anastos' doctor released him to return 
to work and the Division awarded an eight percent permanent partial impairment 
rating,2 thereby terminating Anastos' 
temporary total disability benefits.  
Anastos objected to the eight percent permanent partial impairment 
rating, because he claimed that he continued to suffer from headaches and vision 
problems resulting from the work injury.  
The matter was referred to the Medical Commission, which held a contested 
case hearing.  The Medical 
Commission determined that Anastos failed to prove his headaches were caused by 
his work-related injury and that he was not, therefore, entitled to temporary 
total disability benefits after November 9, 2001.  This appeal is from the district court's 
affirmance of the Medical Commission's determinations.

 
 
ISSUES

 
 
1.         
Whether the Medical Commission's denial of worker's compensation benefits 
for Anastos' headaches was supported by substantial 
evidence?

 
 
2.         
Whether the Medical Commission's denial of temporary total disability 
benefits after November 9, 2001, was supported by substantial 
evidence?

 
 
FACTS

 
 
[¶2]      On April 28, 
2001, Anastos was injured while working as a mine hoist operator for General 
Chemical.  Anastos met with Dr. Lee 
Balka, the company physician, on May 1, 2001.  Dr. Balka diagnosed Anastos with a 
rhomboid muscle strain, prescribed an anti-inflammatory, and allowed him to 
return to work with orders to contact the doctor if the strain did not resolve 
itself within ten days.  Anastos 
claims that he also reported headaches to Dr. Balka, but the doctor's records 
contain no mention of such headaches.  Following his visit with Dr. Balka, 
Anastos returned to work and continued working in his capacity as a hoist 
operator until June 7, 2001.

 
 
[¶3]      On May 30, 2001, 
Anastos called the Division to report the injury.  The report described Anastos' injury as 
"picking up weight felt pain in back."  On June 12, 2001, Anastos signed the 
employee's report of injury and added to the description of the injury, "neck, 
shoulders, legs, knees, feet, hip and head."  General Chemical's report of the injury 
referred to Dr. Balka's notes and described Anastos' injury as a rhomboid muscle 
strain and indicated that it believed the injury was work-related.  Treatment for Anastos' back injury was 
not contested by either the Division or General Chemical, and the Division 
issued a Final Determination finding that Anastos' back injury was 
compensable.

 
 
[¶4]      On June 1, 2001, 
Anastos went to see Dr. John Whipp, an orthopedic surgeon.  Dr. Whipp's notes indicate that Anastos 
was suffering from pain in the right shoulder and lower back.  Although Anastos claims that he 
complained of headaches to Dr. Whipp at this time, Dr. Whipp's records reflect 
no such complaint.  Dr. Whipp saw 
Anastos again on June 15, 2001.  Once again, Dr. Whipp's records contain 
no mention of headaches; however, he testified that he thought headaches would 
have been one of the symptoms prompting a neurological referral.  Dr. Whipp described Anastos' complaints 
as "bizarre" and referred Anastos to Dr. Peter Crane, a 
neurologist.

 
 
[¶5]      Dr. Crane 
examined Anastos on July 18, 2001.  A follow-up letter from Dr. Crane to Dr. 
Whipp represents the first documented report of Anastos' headaches.  Although Dr. Crane found it "difficult 
to get a good history from [Anastos]," he described Anastos' symptoms as 
follows:

 
 
[t]he 
headache radiates from the back of his head over the top of his head, can be 
more on one side than the other, settles in the frontal areas and occasionally 
the temporal areas, and when severe, the headaches are associated with blurred 
vision, more in the right eye than the left.

 
 
Dr. 
Crane also noted that Anastos claimed to have been experiencing these headaches 
since the injury at work, but that they were not quite as severe as initially. 
 Dr. Crane's impression was that 
Anastos suffered a "[s]udden onset of generalized headache with persistence 
since 5/28/01 of uncertain etiology."  He ordered a cranial MRI and MRA, and a 
cervical MRI.  The results of the 
cranial tests were normal.  The 
cervical MRI revealed a slight dislocation of a cervical vertebra (C5/6); 
however, Dr. Crane informed Anastos that this was not causing the headaches. 
 Dr. Crane concluded that he thought 
the headaches may be related to stretching of ligaments and muscles and that 
they could be treated.  However, Dr. 
Crane's records indicate that Anastos did not feel comfortable with Dr. Crane's 
opinion and proposed treatment, and that Dr. Crane advised Anastos that he could 
seek a second opinion if he so wished.

 
 
[¶6]      Dr. Crane 
referred Anastos back to Dr. Whipp, who recommended physical therapy.  Anastos attended physical therapy for 
approximately a month and a half, and then on September 21, 2001, Dr. Whipp made 
the following notation:

 
 
I 
have reviewed his situation and basically right now there is not much that 
Physical Therapy thinks they can do for him.  In my opinion, I do not believe that he 
has anything which can be treated surgically, and evidently Dr. Crane does not 
feel that he has anything that warrants aggressive treatment.  . . .  So my recommendation is for him to try a 
different job if he can make these arrangements with the company or at least 
modify his current job, but I do think that one either needs to return him back 
to work or he needs to think about other career choices.

 
 
During 
this time, Anastos reported to Dr. Whipp that his headaches had 
improved.

 
 
[¶7]      On October 5, 
2001, Dr. Ann MacGuire performed an independent medical examination of Anastos 
to determine whether his current problems were related to his original work 
injury.  Dr. MacGuire diagnosed 
Anastos with "1) Upper body/neck strain. 2) Low-level depression, most likely 
pre-existing."  She concluded that 
Anastos had reached maximum medical improvement, gave him a five percent 
impairment rating of the whole person, and stated that he could return to his 
previous job with a fifty pound lifting restriction.

 
 
[¶8]      On November 2, 
2001, Dr. Whipp's notes indicate that he had reviewed Dr. MacGuire's report. 
 He stated that he agreed with Dr. 
MacGuire's conclusion that Anastos had reached maximum medical improvement and 
that it was time to ascertain a physical impairment rating.  Dr. Whipp also stated that Anastos had 
told him that he did not wish to return to his previous employment with General 
Chemical and was going to try for early retirement.  Nonetheless, with the recommendation of 
Drs. MacGuire and Whipp, Anastos returned to work at General Chemical on 
November 9, 2001, working in a light duty job as a janitor.  Anastos worked in that capacity for 
approximately one month and then left work and never 
returned.

 
 
[¶9]      On November 28, 
2001, Anastos visited Dr. Crane again and reported continued headaches, 
dizziness, blurred vision, double vision, sensitivity to light, sensitivity to 
noises, and frequent vomiting.  Finding these symptoms difficult to 
explain, Dr. Crane referred Anastos to Dr. Kathleen Digre, a neuro-opthamologist 
at the University 
of Utah.  Dr. Digre saw Anastos on January 10, 
2002.  In a letter to Anastos' 
attorney, Dr. Digre stated:

 
 
His 
headache has been peculiar in that when he lies down he does better and when he 
is upright he has more pain indicating that he has positional headaches that 
seem to come on with exertion.  . . 
.  It was my impression [when I 
examined Anastos] that his headache had some migraine features.  However it did seem to start after he 
had lifted these weights in part of his job.  I wondered whether at some point he 
could have a low pressure headache syndrome which then [led] to more migraine 
related headaches.  His headaches at 
the present time now are really exertional headache[s].

 
 

Therefore 
I would suggest at least by the patient[']s history that his symptoms are linked 
to the work related event of April of 2001.  He may have started out with a low 
pressure headache but the headache he is having now is more migrainous and 
certainly exertion valsalva maneuvers[3] 
can make migraines occur.

 
 
Dr. 
Digre also concluded that Anastos' vision problems were not related to his work, 
but rather were genetically inherited abnormalities.  Later, in her deposition testimony, Dr. 
Digre described Anastos' reported history with his headaches as "unusual" and 
"striking . . .."  She went on 
to list a number of potential causes for Anastos' headaches, but concluded that 
no objective evidence existed supporting any of the possible diagnoses.  Dr. Digre testified that she did not 
expect the headaches to persist.

 
 
[¶10]   On December 12, 2001, Dr. MacGuire 
submitted her report to the Division assessing Anastos a five percent whole 
person impairment rating.  Anastos 
requested a second opinion, and Dr. Whipp increased the impairment rating to 
eight percent, with the additional three percent to account for pain.  Neither General Chemical nor the Division 
contested the additional three percent.

 
 
[¶11]   The Division issued a Final 
Determination on January 10, 2002, stating that Anastos was not eligible to 
receive temporary total disability benefits after November 9, 2001, because that 
was the day he was released to return to work.  On June 26, 2002, the Division issued 
another Final Determination of Permanent Partial Impairment Benefit accepting 
Dr. Whipp's eight percent whole body impairment rating.  Also, the Division issued final 
determinations denying all of Anastos' claims relating to his headaches and 
vision problems.

 
 
[¶12]   Anastos objected to these final 
determinations and requested a contested case hearing before the Medical 
Commission.  The Medical Commission 
heard Anastos' case on September 13, 2002, and entered its Findings of Fact, 
Conclusions of Law and Order of Medical Commission Hearing Panel on November 5, 
2002.  With respect to Anastos' 
claimed headaches and vision problems, the Medical Commission 
stated:

 
 
            
8.         
With regard to medical treatment and diagnostic testing for Mr. Anastos' 
headaches and eyes, the Panel FINDS Mr. Anastos has not met his burden of 
proof.  It is undisputed that Mr. 
Anastos['] eye problems in part stem from non-work related conditions and the 
remainder of his vision problems relate to his headaches.  As to the headaches, the medical records 
from Drs. Balka and Whipp are clear  there was no mention made of headaches to 
either doctor two months following the work accident.  Had his headaches been causally related 
to Mr. Anastos' work injury such would have been apparent shortly after the 
injury.  The Panel does not find it 
credible to believe that two physicians would fail to record complaints of 
debilitating headaches with associated vision changes.

 
 
            
9.         
Furthermore, the Panel FINDS that the doctors who examined Mr. Anastos 
are unclear as to the cause of these headaches.  At best the various doctors speculate 
that Mr. Anastos' headaches may be migraines, muscle-tension, low pressure, 
cervical, positional or exertional.  
Migraines are certainly not work-related.  A low pressure headache from a spinal 
fluid leak would have likely resolved by the present time.  The remaining causes may or may not be 
work-related, but the late onset of such headaches in relation to the date of 
injury weighs heavily against finding that they are work related.  Finally, the Panel has serious concerns 
about pre-existing issues which may be having an effect on [Anastos] as 
reflected in Dr. MacGuire's report.

 
 
The 
Medical Commission also found:

 
 
            
6.         
With regard to temporary total disability benefits after November 9, 
2001, it is undisputed that Mr. Anastos was at maximum medical improvement by 
this period of time.  Furthermore, 
by this period of time he was released to return to work although with 
restrictions.  See W.S. 
§27-14-404.  The Panel FINDS Mr. 
Anastos is not entitled to additional temporary total disability after November 
9, 2001.

 
 
[¶13]   On December 4, 2002, Anastos filed 
a Petition for Judicial Review of Agency Action with the district court 
challenging the Medical Commission's decision.  On February 25, 2004, the district court 
filed a detailed decision letter affirming the Medical Commission's decision. 
 Anastos then filed a timely Notice 
of Appeal with this Court.

 
 
STANDARD 
OF REVIEW

 
 
[¶14]               
We recently held that the substantial evidence test is the appropriate 
standard of review in appeals 
from Wyoming Administrative Procedures 
Act contested case proceedings when factual findings are involved and 
both parties submit evidence.  Newman v. Wyoming Workers' 
Safety and Comp. Div., 2002 WY 91, ¶ 22, 49 P.3d 163, ¶ 22 (Wyo.2002).  . . .  Because both parties presented 
cases-in-chief, we apply the substantial evidence standard.  We afford respect and deference to a 
hearing examiner's findings of fact if they are supported by substantial 
evidence.  Haagensen v. State ex 
rel. Workers' Comp. Div., 949 P.2d 865, 867 (Wyo.1997).  Our task is to examine the entire record 
to determine whether substantial evidence supported the hearing examiner's 
findings.  State ex rel. 
Wyo. 
Workers' Comp. Div. v. Waggener, 946 P.2d 808, 814 (Wyo.1997).  We will not substitute our judgment for 
that of the hearing examiner when substantial evidence supports his decision. 
 Id.  Substantial evidence is relevant 
evidence which a reasonable mind might accept in support of the agency's 
conclusions.  Id.  A hearing examiner's conclusions of law 
are afforded no special deference and will be affirmed only if truly in accord 
with law.  State ex rel. 
Wyo. Workers' 
Comp. Div. v. Barker, 978 P.2d 1156, 1159 (Wyo.1999).

 
 

Hermosillo 
v. State ex rel. Wyoming Workers' Safety and Compensation Div., 
2002 WY 175, ¶ 6, 58 P.3d 924, 926 (Wyo. 
2002).

 
 

When 
the party charged with the burden of proof has failed to meet that burden, we 
review the case under the arbitrary, capricious, abuse-of-discretion, or 
otherwise-not-in-accordance-with-law standard.  Brees v. Gulley 
Enterprises, Inc., 6 P.3d 128, 132 
(Wyo.2000); Keck v. State ex rel. Wyoming Workers' Safety and Compensation 
Div., 985 P.2d 430, 432 
(Wyo.1999).

 
 
"Under 
the arbitrary, capricious and abuse of discretion standard, we are charged with 
examining the entire record.  In our 
examination and review of a hearing examiner's determination, we defer to the 
hearing examiner's findings of fact.  We will examine conflicting and 
contradictory evidence to see if the hearing examiner reasonably could have made 
its findings based on all the evidence before it.  The findings of fact may include 
determinations of witness credibility, as the hearing examiner is charged with 
determining the credibility of the witnesses.  In our review, we will not overturn the 
hearing examiner's determinations regarding witness credibility unless they are 
clearly contrary to the overwhelming weight of the 
evidence."

 
 
Brees, 6 P.3d  at 132 . . ..

 
 

In 
re Boyce, 2005 WY 9, ¶ 6, 105 P.3d 451, 454 
(Wyo. 2005).

 
 
DISCUSSION

 
 
[¶15]   On appeal, Anastos makes two 
arguments: he first asserts that the Medical Commission's decision denying 
payment for treatment of his headaches was not supported by substantial 
evidence; second, he claims that the Medical Commission's decision denying 
payment for temporary total disability benefits after November 9, 2001, was not 
supported by substantial evidence.

 
 
[¶16]   
With regard to his first argument, Anastos claims that statements 
made by his physicians provide substantial evidence to demonstrate that he 
should have been awarded benefits for his headaches.  He first identifies a statement made by 
Dr. Digre during her deposition where, when asked to give her opinion as to what 
was causing the headaches, she stated the following:

 
 
Well, 
from talking with [Anastos] and, you know, and the records that I have available 
and just listening to his story, because I don't have anything else but his 
story, and the studies that I was able to review, by history at least it seems 
like his headache seemed to start after heavy lifting or pulling from his hoist 
job.

 
 
Anastos 
asserts that the above statement provides substantial evidence of a causal 
connection between his headaches and his work-related 
injury.

 
 
[¶17]   Next, Anastos claims that he 
reported the headaches to both Dr. Balka and Dr. Whipp.  He references the following testimony 
from Dr. Whipp in an attempt to show that he did report the headaches to Dr. 
Whipp, even though Dr. Whipp did not record such a report.

 
 
            
Q         
Okay.  When did you next see 
Mr. Anastos?

 
 
            
A         
It was 6/15.

 
 
            
Q         
Okay.  I note that you 
indicated you visited with [Anastos] at length and then the second sentence of 
your note says, "I want to have him seen by a neurologist."  What was your rationale for 
that?

 
 
            
A         
Well, there's some pain syndromes that we can kind of classify right away 
and put our finger on it and have a pretty good idea of what's going on.  [Anastos'] was a bit more vague and a 
little bit bizarre, and I wasn't certain what was causing his problems.  It seems like at that time, and we get 
busy and don't dictate a very extensive note, but it seems as if at that time he 
was starting to talk about more head problems.  And when they do that and I'm not 
certain of what's happening and the neurological picture is a bit strange, I 
usually refer folks to a neurologist at that interval.

 
 
            
Q         
So between the time you saw him on 6/1 of 2001 and 6/15 of 2001 did he 
make complaints of headache known to you?

 
 
            
A         
I believe so.  My note 
actually doesn't say that he was complaining of headaches, but I'm pretty sure 
that was one of the symptoms that he described to me that caused the 
neurological referral.

 
 
            
Q         
Okay.  Dr. Whipp, you 
referenced before your dictation was somewhat limited.  That dictation doesn't reflect 
everything that went on but is just a summary of your 
visit?

 
 
            
A         
Well, unfortunately these days we sometimes will see 20 or 30 folks and 
then go back and just dictate a little bit of a note that says why they were 
there and it does not entail the whole visit at all, 
unfortunately.

 
 
            
Q         
Okay.  So as of 6/15 of 2001, 
you referred Mr. Anastos to the neurologist.  Was that Dr. 
Crane?

 
 
            
A         
I believe so, sir.

 
 
            
Q         
Now what was your diagnosis on your initial visit?

 
 
            
A         
Well, I thought he had some sort of cervical strain or perhaps an early 
disc herniation, I wasn't certain which, but all of which you treat the same so 
it didn't make a lot of difference.  
And we didn't really try to pin anything down, we were treating mostly 
his symptom pattern initially.

 
 
            
Q         
With cervical strains and herniated cervical discs, are one of the 
symptoms headaches?

 
 
            
A         
Yes.

 
 
[¶18]   Finally, Anastos alleges that Dr. 
Crane testified "it was his opinion to a reasonable degree of medical 
probability, that the exertional headaches of Anastos were related to the 
exertion and injury Anastos suffered on April 2[8], 2001 . . .."  The opinion to which Anastos refers was 
expressed by Dr. Crane during a deposition.  In that deposition, Anastos' attorney 
referenced a letter Dr. Crane wrote on behalf of Anastos and the questioning 
proceeded as follows:

 
 
            
Q         
And what does that letter say?

 
 
            
A         
"To Whom it May Concern: Tom Anastos suffered injury at work on 
4/28/01.  Among other things he 
developed severe headaches, which have persisted since that time.  I feel that these headaches are 
temporally related to the injury he sustained."

 
 

            
Q         
Was that your opinion on November 13th 
of 2001?

 
 
            
A         
Yes.

 
 
            
Q         
Okay.  Is that still your 
opinion today?

 
 
            
A         
Well, all it means is that his headaches began when he had the injury and 
yes, that's correct, that's still my opinion.

 
 
            
Q         
Doctor, do you have an opinion, based upon a reasonable degree of medical 
probability, of whether this exertion that Mr. Anastos described to you of 
4/28/01 was the cause of his headaches?

 
 
            
A         
Well, it's really hard to say a hundred percent, but, you know, they 
began at about the same time so it's kind of hard to say that it's not 
related.

 
 
[¶19]   In sum, Anastos argues that the 
above-quoted statements clearly provide substantial evidence supporting his 
position that: (1) his headaches began concurrently with his work-related 
injury, (2) he reported the headaches to Dr. Balka and Dr. Crane when he first 
visited with them, even though neither doctor's records reflect such a complaint 
of headaches, and (3) there is a causal connection between the work injury and 
his headaches.

 
 

[¶20]   In order to be eligible to receive 
worker's compensation benefits, a claimant must have sustained an "injury" as 
defined by Wyo. Stat. Ann. § 27-14-102(a)(xi) (LexisNexis 2001).  "Injury' means any harmful change in 
the human organism other than normal aging . . . arising out of and in the 
course of employment while at work . . .."  
To demonstrate that an injury arose out of the course of employment, the 
claimant must establish a causal  
connection between the work-related incident and the injury.  Hanks v. City of Casper, 2001 WY 4, ¶ 
6, 16 P.3d 710, 711 (Wyo. 2001).  The claimant bears the burden of proving 
this causal connection by a preponderance of the evidence.  Clark v. State ex rel. Wyoming Workers' 
Safety and Compensation Div., 2001 WY 132, ¶ 19, 36 P.3d 1145, 1150 (Wyo. 
2001).  "A preponderance of the 
evidence' is defined as proof which leads the trier of fact to find that 
the existence of the contested fact is more probable than its non-existence.'" 
 Matter of Worker's Compensation Claim of 
Thornberg, 913 P.2d 863, 866 (Wyo. 1996) (quoting Scherling 
v. Kilgore, 
599 P.2d 1352, 1359 (Wyo. 1979)).

 
 
"[T]he 
causal connection between an accident or condition at the workplace is satisfied 
if the medical expert testifies that it is more probable than not that the work 
contributed in a material fashion to the precipitation, aggravation or 
acceleration of the injury.  We do 
not invoke a standard of reasonable medical certainty with respect to such 
causal connection.  
Testimony by the medical expert to the effect that the injury most 
likely,' contributed to,' or probably' is the product of the 
workplace suffices under our established standard . . 
..

 
 
            
[U]nder either the reasonable medical probability' or more probable 
than not' standard, [a claimant succeeds] in demonstrating the causal connection 
by a preponderance of the evidence."

 
 

Hall v. State ex rel. Wyoming 
Workers' Compensation Div., 2001 WY 136, ¶ 
16, 37 P.3d 373, 378 (Wyo. 2001) (quoting In re Pino, 996 P.2d 679, 685 (Wyo. 
2000)).  We have said 
that

 
 
[t]he 
finder of fact is not necessarily bound by the expert medical testimony . . .. 
 Forni [v. PathFinder Mines], 834 P.2d 
[688] 693 [(Wyo.1992)].  It is the 
hearing examiner's responsibility, as the trier of fact, to determine relevancy, 
assign probative value and ascribe the relevant weight given to medical 
testimony.  Clark [v. State ex rel. Wyoming 
Workers' Safety and Compensation Div.], 
934 P.2d [1269] 1271 [(Wyo.1997)] (citing Matter of Worker's Compensation 
Claim of Thornberg, 913 P.2d [863] 867 
[(Wyo.1996))].  "The 
hearing examiner [is] also in the best position to judge the weight to be given 
to the medical evidence."  Matter of Goddard, 914 P.2d [1233] 1237 [(Wyo.1996)]; Latimer [v. Rissler & McMurry 
Co.], 902 P.2d [706] 711 
[(Wyo.1995)].  "The trier 
of fact may disregard an expert opinion if he finds the opinion unreasonable or 
not adequately supported by the facts upon which the opinion is based."  Clark, 934 P.2d  at 1271.

 
 

Morgan 
v. Olsten Temporary Services, 975 P.2d 12, 16 (Wyo. 1999).  "In weighing the medical opinion 
testimony, the fact finder considers: (1) the opinion; (2) the reasons, if any, 
given for it; (3) the strength of it; and (4) the qualifications and credibility 
of the witness or witnesses expressing it."  Bando v. Clure Bros. 
Furniture, 980 P.2d 323, 329-30 (Wyo. 
1999) (quoting Matter of Worker's Compensation Claim of 
Thornberg, 913 P.2d at 
868). 
 "Demonstrating evidentiary 
contradictions in the record does not establish the ruling was irrational, 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."  Bando, 980 P.2d  at 331.

 
 
[¶21]   While none of the doctors who 
examined and treated Anastos were able definitively to diagnose the cause of his 
headaches, Drs. Digre, Crane, and Whipp all acknowledged that based on 
information provided by Anastos, there seemed to be a temporal relationship 
between the reported headaches and his injury.  However, the Medical Commission 
concluded that 

 
 
the 
doctors who examined Mr. Anastos are unclear as to the cause of these 
headaches.  At best the various 
doctors speculate that Mr. Anastos' headaches may be migraines, muscle-tension, 
low pressure, cervical, positional or exertional.

 
 

We 
have held that speculative medical testimony is insufficient to satisfy a 
claimant's burden of proof.  Frazier v. State ex rel. Wyoming Workers' Safety 
and Compensation Div., 997 P.2d 487, 490 (Wyo. 2000).  None of the tests Anastos underwent 
revealed any physiological problem causing his headaches, and no doctor ever 
definitively diagnosed a cause or proper treatment.  Without objective evidence, the doctors 
were forced to rely solely on information Anastos provided and to speculate as 
to the cause of his headaches.

 
 
[¶22]   The Medical Commission questioned 
the credibility of Anastos' testimony when it stated:  

 
 
Had 
his headaches been causally related to Mr. Anastos' work injury such would have 
been apparent shortly after the injury.  
The Panel does not find it credible to believe that two physicians would 
fail to record complaints of debilitating headaches with associated vision 
changes. 

 
 

We 
have said that medical opinions based solely on information provided by a 
claimant whose credibility is in question are suspect and of little value.  Newman v. State ex rel. Wyoming Workers' 
Safety and Compensation Div., 2002 WY 91, ¶ 31, 49 P.3d 163, 175 (Wyo. 
2002).  
In Newman, the claimant suffered a back injury 
while working at a restaurant.  Id., 2002 WY 91, ¶ 3, 49 P.3d  at 165.  Over a year after the initial injury 
occurred, the claimant began complaining of intermittent headaches and double 
vision.  Id., 2002 WY 91, ¶ 4, 49 P.3d  at 165.  One of the claimant's doctors filed a 
report relating the claimant's headaches to her original injury.  Id.  
However, the claimant's doctor noted that because he was not able to 
examine the claimant at the time of her accident, he could only make inferences 
based on the information provided by the claimant.  Id.  
The hearing examiner denied the claimant headache-related benefits 
and concluded that the claimant's testimony lacked credibility.  Id., 2002 WY 91, ¶ 31, 49 P.3d  at 175.  We affirmed the denial of benefits based 
on the hearing examiner's conclusion that the doctor's "opinions were based on 
information provided by [the claimant] as to how the injury occurred and, 
because [the claimant]'s testimony lacked credibility, those opinions were of 
little value."  Id.

 
 

[¶23]   A similar result was reached in Matter of Krause, 803 P.2d 81 (Wyo. 
1990).  There, the claimant injured his hand in 
1979 and was awarded worker's compensation benefits.  Id. at 82.  In 1987, the claimant experienced 
problems in the same hand while operating a hammer drill.  Id.  The problem persisted and he sought 
treatment with Dr. Madden, a specialist in hand surgery.  Id.  
Dr. Madden diagnosed claimant's condition as "an unstable 
scaphotrapezial trapezoidal joint in his wrist," and testified "that the 
probabilities" were that the claimant's current injury was a direct result of 
his original injury.  Id.  
The claimant's worker's compensation claim requesting benefits for 
his wrist injury was denied.  Id.  
On appeal, we noted that the claimant's case rested solely on the 
validity of Dr. Madden's testimony linking the current wrist injury to the 
claimant's original injury.  Id. at 83.  In affirming the denial of benefits, we 
noted a number of inconsistencies between the claimant's testimony and what he 
reported to Dr. Madden.  Id. at 83-85.  With regard to Dr. Madden's testimony, 
we stated:

 
 
            
"Where the testimony of a disinterested witness is not directly 
contradicted but there are circumstances which controvert the testimony or 
explain it away, or if such testimony is clouded with uncertainty and 
improbability, or otherwise appears to be unreliable or unworthy of belief, the 
trier of fact is not bound to accept it."

 
 

Id. 
at 
83 (quoting 30 Am.Jur.2d Evidence § 
1083 (1967)).  We concluded that "[b]ecause of the 
inconsistencies in the testimony and deficient medical and work history with 
respect to [the claimant], the hearing officer did not abuse his discretion in 
rejecting Dr. Madden's testimony and opinion."  Matter of Krause, 803 P.2d  at 
85.

 
 

[¶24]   Because 
of their speculative nature, the Medical Commission was not bound to accept the 
expert medical opinions in the instant case.  The Medical Commission concluded that 
Anastos' testimony regarding the cause of his headaches lacked credibility; 
therefore, the doctors' medical opinions, which opinions relied on the veracity 
of the information Anastos provided, were insufficient to demonstrate that the 
headaches were causally connected to Anastos' work-related injury.  Consequently, we affirm the Medical 
Commission's conclusion that Anastos failed to meet his burden of proof.

 
 

[¶25]   Anastos' 
second appellate issuewhether the Medical Commission's denial of payments for 
temporary total disability benefits after November 9, 2001, was supported by 
substantial evidenceis also resolved by our determination of the first 
issue.  Anastos admits as much in 
his brief:

 
 
            
[The second] argument follows the outcome of the determination of the 
first argument of this brief as the basis for the temporary total disability 
benefits to continue after November 9, 2001 is that Anastos continued to suffer 
from the headaches and was unable to return to work with this 
pain.

 
 
It 
is undisputed that Anastos recovered from the muscle strainthe injury which was 
initially diagnosed by Dr. Balka and for which Anastos was receiving the 
temporary total disability benefits.  
Because we conclude that Anastos did not demonstrate that his headaches 
were related to his original injury, we affirm the Medical Commission's 
determination that Anastos was not entitled to additional temporary total 
disability benefits after November 9, 2001.

 
 
CONCLUSION

 
 
[¶26]   The Medical Commission determined 
that Anastos' headaches were not related to his original work injury and that he 
was not entitled to temporary total disability benefits after November 9, 
2001.  We have reviewed the entire 
record and are satisfied that the Medical Commission's determinations are 
supported by substantial evidence.  
Affirmed.

 
 
 
 

FOOTNOTES

1

Wyoming defines 
"temporary total disability" as 
"that period of time an employee is temporarily and totally incapacitated from 
performing employment at any gainful employment or occupation for which he is 
reasonably suited by experience or training.  The period of temporary total disability terminates 
at the time the employee completely recovers or qualifies for benefits 
under W.S. 27-14-405 or 
27-14-406[.]"  Wyo. Stat. Ann. § 
27-14-102(a)(xviii) (LexisNexis 
2001).  The purpose of temporary total disability benefits is 
"to provide income for an employee during the time of healing from his injury 
and until his condition has stabilized."  Pacific Power and Light v. 
Parsons, 692 P.2d 226, 228 (Wyo. 1984).

 
 

Phillips 
v. TIC-The Indus. Co. of Wyoming, Inc., 2005 
WY 40, ¶ 27, 109 P.3d 520, 532 (Wyo. 2005).

 
 

2With 
regard to permanent partial impairment, Phillips, 2005 WY 40, ¶ 37 n.21, 109 P.3d  at 535-36 
n.21, 
explains:

 
 

            
The Division's 
rules state that an initial application for permanent partial impairment benefits 
may be filed when a worker "has suffered an ascertainable loss as defined in 
W.S. § 27-14-102(a)(ii)" and the worker may thereafter apply for permanent 
partial, or permanent total, disability awards pursuant to Wyo. Stat. Ann. §§ 
27-14-405 or 17-14-406 based "upon the rating given by the physician . . .." 
 3 Weil's Code of Wyoming Rules, 
supra, at ch. 5, § 4(d)(i) and (ii), 025 220 001-17.  Similarly, to collect temporary total 
disability benefits beyond the maximum period allowed by statute, one must show, 
among other things, that he "does not have an ascertainable loss which would 
qualify for benefits under W.S. § 27-14-405 or 406[.]"  3 Weil's Code of Wyoming Rules, 
supra, at ch. 7, § 2(b)(i)(D), 025 220 
001-20.

 
 

3A 
"valsalva maneuver" is the "inflation of the middle ear by closing the mouth and 
nostrils and blowing so as to puff out the cheeks."  Webster's Third New International 
Dictionary, 2530 (1993).