Title: IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF KATHLEEN HORN-DALTON, AN EMPLOYEE OF SOUTHWEST WYOMING REHABILITATION CENTER: KATHLEEN E. HORN-DALTON V. 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 KATHLEEN HORN-DALTON, AN EMPLOYEE OF SOUTHWEST WYOMING REHABILITATION CENTER: KATHLEEN E. HORN-DALTON V. STATE OF WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2009 WY 14200 P.3d 810Case Number: S-07-0276Decided: 02/05/2009
OCTOBER 
TERM, A.D. 2008

 
 
IN 
THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF KATHLEEN HORN-DALTON, AN 
EMPLOYEE OF SOUTHWEST WYOMING REHABILITATION CENTER: KATHLEEN E. 
HORN-DALTON,

 
 
Appellant

(Petitioner),

 
 
v.

 
 
STATE 
OF WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION 
DIVISION,

 
 
Appellee

(Respondent).

 
 
Appeal 
from the District Court of Sweetwater County

The 
Honorable Jere A. Ryckman, Judge

 
 

Representing 
Appellant:

Lynn 
Boak of Cheyenne, Wyoming.

 
 

Representing 
Appellee:

Bruce 
A. Salzburg, Attorney General; John W. Renneisen, Deputy Attorney General; James 
Michael Causey, Senior Assistant Attorney General; Brandon W. Snyder, Special 
Assistant Attorney General, MacPherson, Kelly & Thompson, 
LLC.

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

 
 
VOIGT, 
Chief Justice.

 
 
[¶1]      Appellant, 
Kathleen Horn-Dalton, claims that the district court erred when it upheld an 
Office of Administrative Hearings' (OAH) decision in favor of the Workers' 
Safety and Compensation Division (Division), which determined that Appellant was 
not eligible for benefits.  The 
district court upheld the OAH's dismissal of Appellant's claim because it found 
that Appellant did not timely file her claim and that Appellant was not eligible 
for benefits because she did not prove that her illness was work related.  We affirm.

 
 
ISSUES

 
 
[¶2]     1.     Was the OAH's finding 
that Appellant's claim was untimely supported by substantial 
evidence?

 
 
2.    Was the OAH's conclusion that 
Appellant failed to prove that her untimely filing did not prejudice her 
employer or the division against the great weight of the evidence, and did the 
OAH properly apply the statutory presumption to deny Appellant's 
claim?

 
 
3.    Was the OAH's finding that 
Appellant failed to prove that her injury was work related against the great 
weight of the evidence? 

 
 
FACTS

 
 
[¶3]      Appellant began 
work for the Southwest Wyoming Rehabilitation Center (SWRC) in August of 
1975.  Appellant served as Executive 
Director and later President of the organization.  In 1999, relations between Appellant and 
the Board of Directors of SWRC began to deteriorate.  There were several unpleasant 
confrontations and the Board attempted to fire Appellant while she was out of 
town.  The Wyoming Attorney 
General's office intervened in 2000 because the Board was not operating 
according to its own corporate requirements and the Board was reorganized.  However, relations between Appellant and 
the Board continued to deteriorate.  
The tension came to a head at a Board meeting in September of 2003, in 
which two Board members accused Appellant of a number of improprieties related 
to her position.  Appellant became 
physically ill after the meeting and vomited several times.  Several Board members resigned after the 
meeting, including those who had been most aggressive toward Appellant.  In June of 2004, the Board requested 
Appellant's resignation.

 
 
[¶4]      Appellant 
testified that, although she had been experiencing "pain and physical problems" 
for some time, she experienced increasing exhaustion and body aches after the 
September 30 meeting.  Appellant 
left for a vacation shortly after the meeting.  During her vacation, she fell and 
injured her knee in a grocery store.  
After the fall, Appellant experienced severe and increasing pain in her 
neck, back and hips.  She sought 
relief from a series of orthopedic physicians, believing her symptoms to be a 
result of the fall.  In March of 
2004, Appellant visited a nurse practitioner for a regular checkup.  The nurse practitioner informed 
Appellant that her symptoms were consistent with a diagnosis of fibromyalgia, 
and referred Appellant to a specialist.  
Appellant's nurse practitioner also provided Appellant with several 
prescriptions to manage her symptoms.

 
 
[¶5]      Appellant was not 
able to get an appointment with a fibromyalgia specialist for several 
months.  Appellant testified that 
she mentioned that she had fibromyalgia in a phone call with the corporate 
attorney for SWRC before she was asked to resign, and believed she had informed 
the human resource director of her condition in a conversation about her work 
schedule.  Appellant filled out a 
Report of Injury dated July 15, 2004, claiming that her hostile work environment 
had caused stress-related illness, including fibromyalgia, depression, panic 
attacks, and anxiety disorder.1  In late 2004, a specialist confirmed the 
diagnosis of fibromyalgia.

 
 
STANDARD 
OF REVIEW

 
 
[¶6]      The standards of 
review for administrative decisions are set forth in Wyo. Stat. Ann. § 
16-3-114(c) (LexisNexis 2007) as follows:

 
 
(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.  

 
 
[¶7]      We set forth in 
detail the proper application of these standards in Dale v. S & S Builders, LLC, 2008 WY 
84, ¶¶ 20-26, 188 P.3d 554, 561-62 (Wyo. 2008).  "The finder of fact is charged with 
determining the time and cause of a compensable injury; however, whether an 
employee's claim is to be barred for failure to timely file notice or a claim is 
a mixed question of fact and law."  Iverson v. Frost Constr., 2003 WY 162, ¶ 
16, 81 P.3d 190, 195 (Wyo. 2003).  
We will review de novo the 
question of law, whether the OAH correctly applied the statutory presumption of 
denial for untimely filing.  Dale, 2008 WY 84, ¶ 26, 188 P.3d  at 
561-62.  We will determine if the 
findings of fact underlying that legal conclusion are supported by substantial 
evidence.  Id. at ¶ 25, 188 P.3d  at 561.  We will review the OAH's finding that 
Appellant did not meet her burden of proof to determine 
"whether that conclusion was contrary to the overwhelming weight of the evidence 
in the record as a whole."  Id. at ¶ 22, 188 P.3d  at 561. 
 "Importantly, our review of any particular decision turns not 
on whether we agree with the outcome, but on whether the agency could reasonably 
conclude as it did, based on all the evidence before it."  Id.

 
 
DISCUSSION

 
 
[¶8]      The hearing 
examiner found that Appellant failed timely to report her injury as required by 
statute.  He also found that 
Appellant's claim was presumptively denied because she failed to show that her 
employer and the division were not prejudiced as a result of her untimely 
claim.  However, the hearing 
examiner addressed the merits of Appellant's claim and found that she had failed 
to prove that she had a compensable work-related injury.

 
 

Timeliness

 
 
[¶9]                  
(a)    As soon as is 
practical but not later than seventy-two (72) hours after the general nature of 
the injury became apparent, an injured employee shall, in writing or by other 
means approved by the department, report the occurrence and general nature of 
the accident or injury to the employer.  
In addition, the injured employee shall within ten (10) days after the 
injury became apparent, file an injury report with the employer and the division 
in a manner and containing information prescribed by division rule and 
regulation. . . . 

 
 
. 
. . .

 
 
(c)    Failure of the injured 
employee, any dependent or personal representative to report the accident or 
injury to the employer and to file the injury report in accordance with 
subsection (a) of this section is a presumption that the claim shall be 
denied.  The presumption may be 
rebutted if the employee establishes by clear and convincing evidence a lack of 
prejudice to the employer or division in investigating the injury and in 
monitoring medical treatment.  

 
 
Wyo. 
Stat. Ann. § 27-14-502 (LexisNexis 2007).

 
 
[¶10]                           
Our law on determining the date of a compensable injury is 
well-established.  We have 
consistently held that when a correct diagnosis or prognosis of present or 
likely future disability is communicated to the claimant, the injury is 
discovered, it is compensable, and the statute of limitations begins to 
run.  When determining the time a 
particular injury became compensable, it should be asked: When would a 
reasonable person, under the circumstances, have understood the full extent and 
nature of the injury and that the injury was related to his or her 
employment?

 
 

Iverson, 
2003 WY 162, ¶ 15, 81 P.3d  at 195 (citations and quotation marks 
omitted).

 
 
[¶11]   Appellant's nurse practitioner 
informed her on March 22, 2004, that her symptoms were consistent with a 
diagnosis of fibromyalgia.  
Appellant indicated during the hearing that she associated her symptoms 
with job-related stress from that date.  
It was not unreasonable for the hearing examiner to conclude that 
Appellant knew she had a compensable, work-related injury on March 22, 
2004.

 
 
[¶12]   Appellant filled out and submitted 
a Report of Injury on July 15, 2004.  
She admits that she did not report her injury to her employer in 
writing.  Appellant claims that she 
mentioned her illness in a conference call in April of 2004, although she cannot 
recall the date or details of that conversation.  Even if it occurred, that verbal 
"report" would have been outside the seventy-two hour reporting period set forth 
in Wyo. Stat. Ann. § 27-14-502(a) for initial notice to an employer.  Therefore, it was not unreasonable for 
the hearing examiner to conclude that Appellant failed to comply with the 
requirements of Wyo. Stat. Ann. § 27-14-502(a) by failing to report her injury 
to her employer within seventy-two hours and by failing to file a written injury 
report within ten days.  See Wesaw v. Quality Maintenance, 2001 
WY 17, ¶ 14, 19 P.3d 500, 506 (Wyo. 2001).  
The hearing examiner was correct in presuming that the claim should be 
denied unless Appellant could show that neither the Division nor her employer 
was prejudiced by Appellant's failure timely to report her 
injury.

 
 
Prejudice

 
 
[¶13]   Appellant claims that her failure 
to report the injury in a timely manner did not prejudice the Division's or her 
employer's ability to investigate the injury and monitor Appellant's medical 
treatment.  Neither the Division nor 
the employer has made any claim that it was unable to investigate the factual 
circumstances underlying Appellant's claim.  We have found prejudice where the 
Division or the employer is denied access to medical records because of a 
claimant's failure timely to report an injury and where early monitoring of a 
claimant's treatment could have affected the amount of a claim.  See Beitel v. State ex rel. Wyo. Workers' 
Comp. Div., 991 P.2d 1242, 1247-48 (Wyo. 1999).  We have generally found no prejudice 
where there was no range of treatment available and where the ability to impose 
work restrictions and monitor treatment would not have benefited the employer or 
the Division.  See In re Worker's Compensation Claim of 
Payne, 993 P.2d 313, 318 (Wyo. 1999); State ex rel. Workers' Safety & Comp. 
Div. v. Garl, 2001 WY 59, ¶¶ 17-18, 26 P.3d 1029, 1034 (Wyo. 2001).  

 
 
[¶14]   Appellant presented evidence that 
the treatment for fibromyalgia consists largely of pain management and that she 
has not had any aggressive or surgical treatments related to the illness.  There is no indication in the record 
that any other, let alone any less aggressive, treatment options were 
available.  There is also no 
indication that work restrictions could have affected Appellant's condition in 
any way once she was diagnosed with fibromyalgia and had acute onset of 
symptoms.  There was no evidence in 
the record that the division or the employer was prejudiced by Appellant's 
failure timely to file her injury report.  
Under those circumstances, it was not reasonable for the hearing examiner 
to conclude that Appellant did not meet her burden of showing by clear and 
convincing evidence that the failure timely to report her injury did not 
prejudice her employer or the division.  

 
 

Work-Related 
Injury

 
 
[¶15]   "An employee-claimant in a worker's 
compensation case has the burden of proving all the statutory elements which 
comprise a compensable injury.  This 
burden includes establishing the cause of the condition for which compensation 
is claimed and proving that the injury arose out of and in the course of 
employment."  Hanks v. City of Casper, 2001 WY 4, ¶ 6, 
16 P.3d 710, 711 (Wyo. 2001) (citations omitted).  Appellant claims that the stress of her 
employment, specifically the September 2003 meeting where several Board members 
became extremely abusive, triggered her fibromyalgia syndrome.  

 
 
[¶16]   Appellant's doctor testified by 
deposition as an expert on fibromyalgia.  
The doctor testified that she believed that the stress2 from Appellant's job was a 
significant triggering factor in her fibromyalgia.  However, she also testified that 
fibromyalgia is an immensely complex and little understood syndrome and that the 
causes of the illness are not clear.  
Appellant had a number of other underlying conditions that her doctor 
considered contributing factors to her fibromyalgia.  Appellant's doctor also did not believe 
that Appellant's fibromyalgia was directly triggered by the Board meeting, but 
instead testified that the condition would have emerged over the course of 
years.  This testimony supports the 
conclusion that Appellant's injury occurred over a substantial period of time 
and is subject to the heightened burden of proof of Wyo. Stat. Ann.§ 
27-14-603(a) (LexisNexis 2007), which states as follows:

 
 
(a)       The burden 
of proof in contested cases involving injuries which occur over a substantial 
period of time is on the employee to prove by competent medical authority that 
his claim arose out of and in the course of his employment and to prove by a 
preponderance of the evidence that:

(i)        There 
is a direct causal connection between the condition or circumstances under which 
the work is performed and the injury;

(ii)       The injury 
can be seen to have followed as a natural incident of the work as a result of 
the employment;

(iii)      The injury can 
fairly be traced to the employment as a proximate cause;

(iv)      The injury does 
not come from a hazard to which employees would have been equally exposed 
outside of the employment; and

(v)       The injury 
is incidental to the character of the business and not independent of the 
relation of employer and employee.

 
 
[¶17]   Another doctor reviewed Appellant's 
files and pointed out that there are no studies that conclusively explain the 
causes of fibromyalgia or how it relates to stress.  That doctor pointed to several chronic 
conditions from which Appellant suffered that made Appellant susceptible to 
fibromyalgia.  The record shows that 
Appellant suffered considerable stress outside the office at various times, 
including several stressful incidents close to the onset of her symptoms.  

 
 
[¶18]   In Hanks v. City of Casper, 2001 WY 4, 16 P.3d 710 (Wyo. 2001), we upheld a determination similar to that of the hearing 
examiner in this case.  The claimant 
in Hanks presented medical testimony 
that a work-related incident triggered her fibromyalgia.  Id. at ¶ 8, 16 P.3d  at 711.  However, we upheld the OAH's 
determination that the claimant had not met her burden of proof because the 
doctor's testimony was equivocal and because the doctor testified that a 
triggering event does not cause fibromyalgia.  Id. at ¶ 9, 16 P.3d  at 711.  Given the heightened burden of proof 
that Appellant faced, and the inconclusive medical testimony, we find that the 
hearing examiner could reasonably have concluded that Appellant failed to meet 
her burden of proving that her injury was directly related to her 
employment.  

 
 
CONCLUSION

 
 
[¶19]   
The OAH reasonably determined that Appellant's claim was not timely 
filed.  However, the OAH erred when 
it applied the statutory presumption to deny Appellant's claim because its 
conclusion that Appellant failed to prove that neither her employer nor the 
Division was prejudiced by the delay was against the great weight of the 
evidence.  The OAH's determination 
that Appellant failed to meet her burden of proof on the issue of whether her 
injury resulted from her employment was not against the great weight of the 
evidence.  The OAH's order is 
affirmed. 

 
 

FOOTNOTES

 
 

1Appellant 
also filed a separate claim for De Quervain's tenosynovitis, which claim was 
denied.  Appellant has not contested 
that denial in this appeal.  

 
 

2We 
do not decide whether a physical ailment caused by job-related stress is 
compensable under the worker's compensation statutes.  The parties did not brief this issue 
sufficiently for us to decide such an important question of law and we need not 
reach the question because Appellant has failed to prove another essential 
element of her claim.