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

State: wyoming

Issuer: Wyoming Supreme Court

Document:

Gonzales v. State ex rel. Wyoming Workers' Compensation Div.1998 WY 170970 P.2d 865Case Number: 98-159Decided: 12/30/1998Supreme Court of Wyoming
 
In 
the Matter of the Worker's Compensation Claim of Margie Marie GONZALES,

 Appellant 
(Employee-Petitioner),

v.

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

Appellee 
(Objector-Respondent).

 

Appeal from the District 
Court, Fremont County, Nancy J. Guthrie, J.

 

Robert A. 
Nicholas of Nicholas Law Office, LLC, Riverton, Wyoming, representing 
Appellant.

John W. 
Renneisen, Deputy Attorney General; Gerald W. Laska, Senior Assistant Attorney 
General; and Bernard P. Haggerty, Assistant Attorney General, representing 
Appellee.

Before 
LEHMAN, C.J., and THOMAS, MACY, GOLDEN and TAYLOR,* 
JJ.

* Retired November 2, 
1998.

MACY, 
Justice.

[¶1]      Appellant Margie 
Marie Gonzales (the employee) appeals from the district court's order affirming 
the Office of Administrative Hearings' denial of worker's compensation 
benefits.

[¶2]      We 
affirm.

ISSUES

[¶3]      The employee 
presents the following issues for our review:

1. Is Ms. 
Gonzales' thoracic condition directly related to her 1993 work 
injury?

2. Was the 
decision of the Hearing Examiner arbitrary, capricious, an abuse of discretion, 
or unsupported by substantial evidence?

3. Does the 
Hearing Examiner's decision fail to address the ultimate issue raised by the 
objection [to] the Final Determination?

4. Does the 
Hearing Examiner's Order set out sufficient findings of fact and conclusions of 
law?

5. Was the 
decision unsupported by substantial evidence?

FACTS

[¶4]      The employee was 
injured on October 18, 1993, while she was working as a certified nurse's 
assistant at the Wind River Healthcare and Rehabilitation Center. She was moving 
a patient when she felt a sharp pain in her neck, a burning sensation in her 
right shoulder, and numbness and tingling down her right arm. She filed an 
injury report claiming that she injured her "[r]ight upper back." She received 
benefits from the Division of Workers' Safety and Compensation (the division) 
for pain related to her neck.

[¶5]      The employee 
consulted with Michael Pryor, M.D. in January of 1994, to whom she reported pain 
in her cervical spine and shoulder. He reviewed her cervical spine films, which 
were normal. He was unable to identify a neurologic deficit and diagnosed 
fibromyalgia.1 She was seen by Peter Crane, M.D., 
a neurologist, on October 13, 1994. He found that the cause of her right 
shoulder and arm pain was uncertain.

[¶6]      Michael J. Ford, 
M.D., an orthopedic surgeon, first saw the employee on November 27, 1995, for an 
independent medical examination and impairment rating. He reported that the 
x-ray of the thoracic spine and chest was normal and requested an MRI, which 
also came back normal. Dr. Ford gave the employee a four percent whole person 
impairment rating for her cervical spine injury but concluded that she was not 
entitled to a thoracic spine impairment rating because she had no limitation of 
her range of motion in that part of her back.

[¶7]      The employee 
first visited Kenneth A. Pettine, M.D., an orthopedic surgeon, in January of 
1996. In his deposition, Dr. Pettine stated that her examination showed no 
evidence of neurologic findings and that her neck appeared to be normal. He 
noted that she had pain and decreased range of motion in her thoracic area. 
After ordering a discogram, Dr. Pettine diagnosed a disk tear in her thoracic 
spine, specifically at T9-T10. The employee told Dr. Pettine that her pain 
stemmed from her 1993 work-related injury, and he concluded that her chronic, 
incapacitating back pain in the thoracic region was directly related to her 
work-related injury.

[¶8]      Anne M. MacGuire, 
M.D., a rheumatologist, saw the employee on March 12, 1996, to give an opinion 
concerning the employee's current medical condition, a diagnosis, a recommended 
treatment plan, and an opinion as to whether her problems were related to her 
October 1993 injury. The doctor examined the employee and 
reported:

Her complaints of 
discomfort are truly in the thoracic spine, not her neck. When examined, she had 
an extremely positive withdrawal reaction. When one would just touch her skin, 
she would flinch, flex her back and jerk away very suddenly. This type of 
reaction would be unusual in someone who truly had a significant disc injury as 
they would not want to move this fast, and, typically, just touching the skin 
does not evoke any significant pain responses in a truly serious disc 
injury.

Dr. MacGuire 
found that the employee's symptoms were inconsistent with a thoracic spine 
injury but, nevertheless, gave the employee a five percent whole person 
impairment rating.

[¶9]      Dr. Ford saw the 
employee again on February 3, 1997. At that point in time, he reported that 
"this patient's symptoms seem to be way out of proportion to any objective 
findings" and "there seems to be a lot of functional overlay."2 He was unable to say that her 
condition was work related.

[¶10]   The division had Robert G. Weiner, 
M.D., an orthopedic surgeon, conduct an independent medical examination on May 
25, 1996. In his medical report, Dr. Weiner concluded that the thoracic 
condition the employee was complaining about was not related to the October 18, 
1993, injury:

Any pathology from the 
annular tear of T9-T10 can in no way explain all of the examinee's symptoms or 
clinical findings. Ruptured thoracic disks are extremely rare, and certainly 
could not be explained by the mechanism of injury that the examinee describes as 
occurring on 10/18/93. The description of the injury being the turning of the 
examinee, resulting in a stabbing pain in the right side of her neck with a 
burning sensation in the right shoulder and right arm, can in no way be 
explained by pathology at the T9-T10 level.

. . . 
.

. . . I do not feel that 
she suffered a tear of the annulus at T9-T10 on 10/18/93, and I do not feel that 
the pathology demonstrated at that level by Dr. Pettine is Workers Compensation 
in nature.

The division 
issued a final determination on June 5, 1996, which discontinued benefits for 
the employee's thoracic back condition.3

[¶11]   The employee objected to the 
division's final determination and requested a hearing. A hearing was held 
before the Office of Administrative Hearings on February 6, 1997. At the 
hearing, the employee testified that the pain had not "moved" from her neck to 
her back but had gotten gradually more intense. When confronted with her early 
medical records that described only neck pain, however, she conceded that she 
had not immediately reported her back pain to her doctors because she did not 
want to have to quit working.

[¶12]   Dr. Weiner, the only examining 
physician to testify at the hearing, stated that the T9-T10 problem was a 
degenerative condition, which probably had been asymptomatic for many years. He 
opined that, on the basis of a reasonable medical probability, the work incident 
did not cause a thoracic spine injury. He testified that, had the employee 
suffered a thoracic injury, she would have experienced immediate stabbing pain 
in the mid-thoracic area followed by a dull persistent aching pain that was 
fairly unresponsive to any activity or change of position. He believed that her 
condition was due more to an emotional problem rather than to organic pathology. 
In response to a question from the hearing examiner on this point, Dr. Weiner 
gave the following analogy:

If you go out and you see 
that overnight your rear tire of your car has become flat, you would not also 
expect your headlights to have failed, your windshield to be broken, and your 
seats to no longer move back and forth. You would expect to find, when you 
examine a patient, the subjective and objective findings to be consistent with 
the organic pathology, if such organic pathology is found.

With a thoracic disk, you 
expect certain symptoms to exist to a certain degree. They may vary from patient 
to patient, but they are within a certain parameter. When somebody's symptoms 
are well outside that parameter, you begin to question whether what you're 
dealing with is true pathology or whether it's going to explain all of the 
patient's symptoms. No more than a flat tire can explain why your headlights 
don't work, a patient's thoracic disk will not explain neck pain, and pain 
radiating into the patient's hand and arm.

Secondly, thoracic disk 
pathology will not cause hypersensitivity to light touch of the thoracic spine. 
That finding is inconsistent or is not part of the symptomatic thoracic disk 
symptomatology syndrome.

He also 
explained why he did not think that the employee was entitled to an impairment 
rating for chronic pain:

Q Was there anything that 
you felt that you saw in this patient that either suggested to you she should 
not have an impairment rating under Chapter 15 or she should have a pain 
impairment rating?

A It is my feeling that 
Chapter 15, basing a patient's impairment on pain, is when that pain has a 
proven objective etiology. Because then you cannot - and the book requires you, 
as much as possible, to use that objective finding to give the rating, rather 
than base it on pain, because pain is so subjective.

There are certain 
syndromes, one is a thalamic infarct in the brain which will give a person 
intractable pain, which pathology being fairly minimal, sometimes difficult to 
prove, but the symptoms are fairly classical. When the patient demonstrates 
findings on physical examination, that I consider incompatible with any proven 
or known pathology, then it is my feeling that I cannot base any impairment 
rating on the subjective complaint of pain. And, therefore, I will not use 
Chapter - that chapter, in giving an impairment based on the 
pain.

[¶13]   The hearing examiner denied the 
claim for medical benefits for treatment of the employee's T9-T10 thoracic disk 
and denied her claim for a permanent partial impairment benefits rating under 
Chapter 15 of the AMA GUIDE TO THE EVALUATION OF PERMANENT IMPAIRMENT (4th ed.). 
The employee sought review of the hearing examiner's order in the district 
court. After briefing and an untranscribed oral argument, the district court 
affirmed the hearing examiner's decision. The employee appeals to this 
Court.

STANDARD OF 
REVIEW

[¶14]   When we review a decision in a 
worker's compensation case, we do not accord deference to the district court's 
decision. Cabral v. Caspar Building Systems, Inc., 920 P.2d 268, 269 (Wyo. 
1996). Instead, we review the case as if it had come directly to this Court from 
the agency. Id. Judicial review of an agency's action is governed by WYO. STAT. 
ANN. § 16-3-114(c) (Michie 1997). W.R.A.P. 12.09(a).

[¶15]   Whether or not an employee's injury 
occurred in the course of his employment is a question of fact. DeWall v. State 
ex rel. Wyoming Workers' Safety and Compensation Division, 960 P.2d 502, 503 
(Wyo. 1998). We review an administrative agency's findings of fact by applying 
the substantial evidence standard. Id. The burden to demonstrate that the 
agency's findings and conclusions are not supported by substantial evidence is 
on the appellant. Mekss v. Wyoming Girls' School, 813 P.2d 185, 201 (Wyo. 1991), 
cert. denied, 502 U.S. 1032, 112 S. Ct. 872, 116 L. Ed. 2d 777 (1992). Our task is 
to examine the entire record to determine whether substantial evidence supported 
the hearing examiner's findings. DeWall, 960 P.2d  at 503. We will not substitute 
our judgment for that of the hearing examiner when substantial evidence supports 
his decision. Id. Substantial evidence is relevant evidence that a reasonable 
mind may accept in support of the agency's conclusions. 
Id.

DISCUSSION

A. Substantial 
Evidence

[¶16]   The employee complains that the 
hearing examiner's decision to deny benefits for her thoracic condition was 
arbitrary, capricious, an abuse of discretion, or unsupported by substantial 
evidence. Weighing the evidence and assessing the credibility of the witnesses 
are tasks performed by the hearing examiner, not by an appellate 
court:

The testimony in this 
record may be subject to varying interpretations, but we will not usurp the 
function of the [trier of fact] in making factual findings with respect to this 
case. It is the duty of the trier of fact to weigh and evaluate the testimony of 
the witnesses, including that given by experts. . . . "The [trier of fact] . . . 
was the sole judge of the credibility of the witnesses and was entitled to 
interpret the evidence."

Creek v. Town of 
Hulett, 657 P.2d 353, 357 (Wyo. 1983) (quoting Ward v. Yoder, 355 P.2d 371, 374 
(Wyo. 1960)). See also Goddard v. Colonel Bozeman's Restaurant, 914 P.2d 1233, 
1237-38 (Wyo. 1996). We will not disturb the hearing examiner's decision unless 
it is "clearly contrary to the overwhelming weight of the evidence on record." 
Nellis v. Wyoming Department of Transportation, 932 P.2d 741, 743 (Wyo. 
1997).

[¶17]   WYO. STAT. ANN. § 27-14-102(a)(xi) 
(Michie Supp. 1998) defines a compensable injury:

(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.

(Emphasis 
added.) An injury is received "in the course of employment" when it occurs while 
the employee is performing the duties for which she was hired. State ex rel. 
Wyoming Workers' Safety and Compensation Division v. Bruhn, 951 P.2d 373, 376 
(Wyo. 1997). An injury "aris[es] out of" the employment when a causal connection 
exists between the injury and the conditions under which the work is required to 
be performed. 951 P.2d  at 376-77.

[¶18]   The evidence in this case indicated 
that a thoracic disk injury would cause certain symptoms to exist within a 
certain parameter. Such an injury would cause a person to feel immediate pain in 
the mid-thoracic area followed by a dull persistent aching pain. It would not 
explain the symptoms that the employee claims she suffers from such as 
hypersensitivity to light touch. The hearing examiner agreed with the physicians 
who felt that the employee's symptoms came from an emotional condition rather 
than from a work-related physical injury because her symptoms were totally 
inconsistent with a thoracic spine injury. We hold that substantial evidence 
supported the hearing examiner's decision.

B. Findings of 
Fact and Conclusions of Law

[¶19]   The employee asserts that the 
hearing examiner's findings of fact were cryptic, incomplete, and incorrect. Our 
law requires the findings of fact and conclusions of law made by an agency to be 
done with a degree of detail. Mekss, 813 P.2d  at 201. "A record of material and 
substantial evidence must be created so that a reviewing court can determine 
whether such factual development occurred or whether, instead, the agency's 
actions were based on unwarranted or undeclared assumptions." Jackson v. State 
ex rel. Wyoming Workers' Compensation Division, 786 P.2d 874, 877 (Wyo. 
1990).

[¶20]   The hearing examiner's order 
included sufficient detail to enable us to determine that he relied upon the 
following information in making his decision: the employee suffered a 
work-related neck injury on October 18, 1993; eventually, she began complaining 
of back pain; Dr. Ford's opinion was given great weight; and, under the AMA 
GUIDE TO THE EVALUATION OF PERMANENT IMPAIRMENT, the employee was not entitled 
to a chronic pain impairment rating because she could not produce objective 
findings to explain her complaints of pain and she could not establish that the 
pain was related to her original injury.4 We hold that the hearing examiner's 
findings and conclusions were sufficiently specific to enable us to conduct a 
meaningful review of the final order in accordance with the provisions of § 
16-3-114(c).

C. All Issues 
Were Resolved

[¶21]   The employee complains that the 
hearing examiner failed to address whether her "underlying thoracic condition" 
was compensable. She maintains that, because the order denied only her claim for 
medical benefits for the treatment of her T9-T10 thoracic disk, her claim for 
benefits for her underlying thoracic condition is 
unresolved.

[¶22]   The record in this case is 
difficult to work with as it is incomplete and disorganized. It is, therefore, 
hard to determine with any degree of precision what the exact issues before the 
hearing examiner were. Nevertheless, it appears to us that the opinions of the 
physicians regarding the tear at T9-T10 and the employee's complaints of pain 
pertained to the overall thoracic condition. The majority of the physicians did 
not believe that the tear could create the employee's current symptoms nor could 
they find anything objective to explain her thoracic pain or to show that she 
suffered a thoracic injury at all on October 18, 1993. We conclude that the 
issues that the hearing examiner resolved disposed of the entire thoracic 
condition issue.

[¶23]   Affirmed.

Footnotes

1 
Fibromyalgia syndrome is a widespread musculoskeletal pain and fatigue 
disorder.

2 Robert G. 
Weiner, M.D. testified that the term functional overlay means that subjective 
complaints seem to be more exacerbated or not compatible with what one would 
find purely objective.

3 It is 
difficult to determine when and why benefits for the thoracic condition were 
given, but apparently they were awarded sometime after the benefits for her neck 
injury were awarded.

4 The hearing 
examiner did misstate that Dr. MacGuire had expressed a strong opinion about the 
work relatedness of this injury. We conclude that this was an oversight on the 
part of the hearing examiner and that it did not significantly impact his 
ultimate determination.