Title: IRENE HICKS V. STATE OF WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION

State: wyoming

Issuer: Wyoming Supreme Court

Document:

IRENE HICKS V. STATE OF WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2005 WY 11105 P.3d 462Case Number:  04-2Decided: 02/04/2005
 
 
OCTOBER 
TERM, A.D. 2004

 
 
                                                                                                
   

 
 
IRENE 
HICKS,

 
 
Appellant

(Employee/Petitioner) 
,

 
 
v.

 
 
STATE OF 
WYOMING, ex rel., WYOMING

WORKERS' 
SAFETY AND COMPENSATION

DIVISION,

 
 
Appellee

(Objector/Respondent) 

 
 

Appeal 
from the DistrictCourtofNatronaCounty

The 
Honorable W. Thomas Sullins, Judge

 
 
Representing 
Appellant:

Donald 
Lee Tolin, Law Offices of Donald Tolin, Casper, Wyoming.

 
 

Representing 
Appellee:

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

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

 
 

HILL, 
Chief Justice.

 
 
[¶1]      Irene Hicks 
(Hicks) appeals from an order of the Workers' Compensation Medical Commission 
(the Medical Commission) denying her request for worker's compensation benefits 
for a September 2001 spinal fusion surgery that, she claimed, was the product of 
a work-related injury she suffered in July 1998.  The Medical Commission concluded that 
Hicks was not a credible witness, and that she had failed in her burden of 
proving causation, as substantial evidence showed that Hicks' work-related 
injury had resolved before her surgery.  
We affirm.

 
 

[¶2]      Hicks presents 
three issues in her brief:

1.  Did the District Court 
err in denying [Hicks] benefits under the Workers' Compensation Act including 
the costs for her September 17, 2001 fusion surgery that her doctors determined 
was necessary and causally connected to her of her [sic] July 1, 1998 work 
related injury?

 
 
2.  Did 
the District Court err in upholding the decision of the Medical Commission which 
acted in an arbitrary, capricious, and in an abuse of discretion, otherwise not 
in accordance with the law, manner by totally disregarding the totality of the 
circumstances including the overwhelming evidence at the contested case hearing 
in support of [Hicks], by misconstruing and misapplying the evidence to attack 
[her] credibility, by willfully discounting substantial credible evidence from 
[her] treating doctors, by not allowing certain testimony in, and by 
inappropriately relying upon mere speculation and conjecture from the Division's 
"hired gun" who did only a fifty (50) minute paper document review without ever 
doing an independent medical examination of [Hicks]?

 
 
3.  Has 
[Hicks'] constitutional and due process rights been violated by the District 
Court in upholding the decision of the Medical Commission which overlooked the 
Division's inconsistent determination that [she] sustained a compensable work 
related injury on July 1, 1998, but denied her benefits under the Act for her 
necessary treatment including her September 17, 2001 surgery, even though she 
met her burden of proof before the Medical Commission?

 
 
The 
Wyoming Workers' Safety and Compensation Division (the Division) significantly 
restates the issues:

 
 
I.   A 
claimant applying for workers' compensation benefits must prove that each 
additional claim is related to her employment injury.  The Medical Commission Hearing Panel 
determined that Ms. Hicks' medical complaints subsequent to August 29, 2001, 
were not related to a compensable injury, but rather, due to her preexisting 
condition.  Is the Medical 
Commission Hearing Panel's decision denying benefits supported by substantial 
evidence?

 
 
II.  Ms. Hicks claims the 
Medical Commission Hearing Panel acted arbitrarily and capriciously by 
determining witness credibility, weighing the evidence and by discounting 
certain conflicting medical opinions.  
Is a challenge to these factual determinations more appropriately 
reviewed under the substantial evidence test since both parties presented 
evidence at the contested case hearing?

 
 
III. Ms. 
Hicks alleges the Medical Commission Hearing Panel violated her constitutional 
due process rights, however, she fails to present a proper constitutional claim. 
Should this Court refuse to consider the alleged constitutional error because it 
is not supported with appropriate constitutional analysis or 
authority?

 
 

[¶3]      Hicks has 
suffered two work-related back injuries.  
In 1997 Hicks was working at a motel when she fell off a chair and hit 
her back on a table.  Hicks suffered 
a mild anterior compression fracture. The injury was successfully resolved 
through chiropractic treatment.  
While Hicks was being treated for this injury, an examination revealed a 
congenital spinal defect  spondylolysis with a pars defect in her right side at 
L5.

 
 
[¶4]      On July 1, 1998, 
Hicks was working as a certified nursing assistant when she hurt her back while 
lifting a patient.  Conservative 
handling of the injury was attempted, beginning with medication and chiropractic 
treatment.  After that course of 
treatment was unsuccessful, Hicks was referred to physical therapy in January of 
1999.  Hicks' initial commitment to 
physical therapy was called into question when she was discharged from physical 
therapy on February 4, 1999, for noncompliance with her doctor's prescribed 
orders after she missed six of eleven scheduled appointments during the first 
month of treatment.  Nevertheless, 
Hicks was quickly readmitted to physical therapy and she participated, though 
with continued periodic absences, until early April of 1999 when she completely 
ceased attending and was again discharged.

 
 
[¶5]      Dr. Anne MacGuire 
evaluated Hicks for an impairment rating in May of 1999.  Hicks was assigned a zero percent 
impairment rating for her July 1998 back injury.  She sought a second opinion from Dr. 
Terry Brown, who assigned a five percent impairment rating.  As a result of the July 1998 injury, 
Hicks received temporary total disability benefits for the period of July 16, 
1998, to April 30, 1999, and permanent partial impairment benefits in October 
and November of 1999.

 
 
[¶6]      From Hicks' last 
physical therapy session in early April of 1999 until March 1, 2000, there is no 
record of any medical treatment for Hicks' back injury.  Hicks endured several other unrelated 
medical difficulties during that period, including thyroid problems, 
complications from morbid obesity, and cysts that at one point necessitated 
emergency surgery.  Then, on March 
1, 2000, Hicks visited Dr. Jason Hayes complaining of back pain.  Hicks was sent to physical therapy but 
her attendance was desultory, and she was referred to Dr. Robert Narotzky in May 
of 2000.  Hicks was informed that 
physical therapy might help but there was no guarantee and that if surgical 
treatment was to be considered, she needed to lose weight  at that time, Hicks, 
who was about 5'4" tall, weighed approximately 296 pounds  and until she did 
so, the only other recourse was medication.  In March 2001 Hicks underwent gastric 
bypass surgery.  The surgery was a 
success and by July of 2002, Hicks had lost over 180 pounds.  The surgery did not, however, lessen 
Hicks' pain.  Dr. Narotzky gave 
Hicks pars injections in July and August of 2001 but these, too, were 
ineffective.  On September 17, 2001, 
Dr. Narotzky performed a one-level fusion of Hicks' lumbar region at L5-S1.  The surgery successfully relieved Hicks' 
back pain.

 
 
[¶7]      In a Final 
Determination issued on October 2, 2001, the Division denied medical benefits 
for the fusion surgery stating that the definition of injury does not 
include:  "Any injury or condition 
preexisting at the time of employment with the employer against whom a claim is 
made. (Wyoming Statute 27-14-102(a)(xi)(F))."  Hicks objected to the Final 
Determination, and a contested case hearing was held before a Medical Commission 
panel on June 6, 2002, and continuing on July 11, 2002.

 
 
[¶8]      Hicks called 
three witnesses during the hearing:  
Dr. Narotzky, Dr. Tuenis Dow Zondag, and herself.  Dr. Narotzky opined that the July 1998 
injury necessitated the fusion surgery.  
He testified that the July 1998 injury aggravated Hicks' preexisting 
spondylolysis:

 
 
Q:  Okay.  And on the 27th of March [2002], you indicated in a letter 
written, addressed to me [Hicks' counsel]  are you familiar with that, it's 
marked as Exhibit A?

 
 
A:  Yes, 
I am.

 
 
Q:  And 
in that letter, you indicated that you had reviewed Mrs. Hicks  Ms. Hicks' 
medical record and her treatment to date. ["]It would be my opinion to a 
reasonable degree of medical probability that her July 1st, 1998 injury while employed by 
Interim Health Care as a CNA was the source of her back pain and subsequent need 
for treatment, including surgery done on 9-17-2001.  Although the work injury probably did 
not cause the L5 spondylolisthesis, it certainly, from the review of all the 
medical records, did cause her to become much more 
symptomatic.["]

 
 
And is 
that your professional medical opinion in this particular 
case?

 
 
A:  Yes, 
it is.

 
 
Dr. 
Narotzky's opinion was based solely upon Hicks' representations of continuous 
back pain from inception of the injury until the fusion 
surgery:

 
 
Q:  You 
have given an opinion in writing regarding the causative relationship between 
the July 1998 accident and the surgery that you ultimately performed last 
fall.  Here you're being asked to 
testify regarding causation.  Is 
there anything about the physical exam, your physical exams of Ms. Hicks, that 
would allow you to identify the causative event?

 
 
A:  No.

 
 
Q:  Now, 
you actually performed the surgery.  
Is there anything about observations during the surgery that would 
provide information to you regarding the causative event?

 
 
A:  No.

 
 
Q:  Now 
you have had a chance to review at least some of the radiological studies, I 
believe, that Ms. Hicks has had over the last, oh, five years or so.  Is there anything about looking at the 
x-rays themselves or the MRI scans that allows you to identify the causative 
event?

 
 
A:  No, 
there is not.

 
 
.

 
 
Q:  And, 
in fact, your opinions regarding causation are in large part, if not entirely, 
based upon the history provided by your patient, correct?

 
 
A:  Correct.

 
 
.

 
 
Q:  Okay. 
So is your opinion in part based upon the fact that you believe that she had 
constant low back pain from the 1998 injury until you first saw 
her?

 
 
A:  Basically 
that she continued to have symptoms from her injury until the time that I saw 
her and until the time that she underwent surgery.

 
 
When 
asked about the extent to which Hicks had accurately related her medical 
history, Dr. Narotzky responded that he did not recall any disclosure by Hicks 
of her 1997 injury.  However, Dr. 
Narotzky testified that his opinion was not affected by the failure to disclose 
because the 1997 injury had completely resolved by the time of the injury in 
July 1998.

 
 
[¶9]      The second 
witness called by Hicks was Dr. Zondag, an employee in Dr. Narotzky's 
practice.  Dr. Zondag's opinion 
paralleled Dr. Narotzky's:

 
 
My 
opinion is that Irene [Hicks] had a preexisting spondylosis at both the right 
and the left side at L5 and that this became symptomatic with the injury that 
she sustained in July of 1998.  This 
symptomatic irritation of the spondylolisthesis never resolved and because it 
failed conservative care and it seemed to be the origin of pain based upon pars 
injections and relief and not responding to others, that it was indication for 
surgical correction so that she could return to a more functional life and 
return to a more productive one.

 
 
It is my opinion that the episode as 
she described it to me that happened in the nursing home was the material 
contributing cause as to why the spondylosis became symptomatic, remained 
symptomatic and failed conservative treatment and then required a fusion 
operation.

 
 
Dr. 
Zondag also based his opinion upon Hicks' description of chronic back pain 
existing from the date of injury until the fusion surgery.  Dr. Zondag acknowledged that Hicks did 
not advise him that she had experienced a work-related back injury in 1997.  After considering the medical records 
relating to the 1997 injury in Hicks' file, Dr. Zondag stood by his opinion that 
the surgery was related to the July 1998 injury.

 
 
[¶10]   In her testimony, Hicks maintained 
that she suffered back pain continually from July 1998 until she underwent 
fusion surgery in September of 2001.  
Hicks testified that from the time physical therapy ended in April of 
1999, until she saw Dr. Hayes in March of 2000, she experienced severe medical 
problems unrelated to her back injury.  
Explaining the absence of medical records regarding back treatment during 
this time period, Hicks implied that the issue of her back pain was still raised 
during her doctor's appointments but the more immediate concern was her other 
medical problems.  Regarding her 
medical history, Hicks emphatically stated that she had advised and discussed 
with Dr. Narotzky the details of her 1997 injury.

 
 
[¶11]   The Division called one witness, 
Dr. James Ruttle.  Dr. Ruttle 
reviewed Hicks' medical files and reached an opinion on causation contrary to 
that expressed by Drs. Narotzky and Zondag.  He concurred that Hicks' underlying 
congenital defect was rendered symptomatic by the July 1998 injury.  He concluded, however, that the injury 
responded to treatment and was resolved by the time Hicks completely ceased 
physical therapy in April 1999.  
According to Dr. Ruttle, Hicks' congenital spondylolysis, coupled with 
her morbid obesity, were the cause of her renewed back pain in March of 2000 and 
subsequent need for fusion surgery.  
Dr. Ruttle cited the reports filed by Hicks' physical therapists with her 
treating physician.  Those reports 
noted a positive progression in Hicks' injury.  For example:

 
 

·        
2/16/99 
 Hicks quoted as saying, "I'm feeling really, really good today."  Noted that patient did well with all 
exercises.

·        
2/19/99 
 Hicks: "I'm doing much better overall and I really feel like I have a ton of 
energy."  Noted that patient did 
very well with new exercises and was showing improvements in back strength and 
endurance.

·        
2/24/99 
 Hicks: "I'm doing really pretty good today. I'm still getting the muscle 
cramps in my calfs [sic] but other than that I'm doing 
great."

·        
3/4/99  
Noted that patient was a little sore and that her back was 
hurting.

·        
3/10/99 
 Hicks reported that she was a little sore in her quads but felt good. Noted 
that she did very well with all exercises.

·        
3/15/99 
 Hicks stated she was tired on Saturday but felt great on Sunday and on 
today.  Physical therapist reported 
that Hicks "tolerated increases in weight very well, needs to do one leg at a 
time on leg curls. [Hicks] asked to do more [exercises], did stepups  left 
feeling good."

·        
3/25/99 
 It was noted that Hicks was very motivated and that she felt good.  Hicks worked "very hard, looked good" 
and "she was very motivated wanted to do more."

·        
4/2/99  
Hicks again reported that she was doing good. The physical therapist commended 
her on her work habits and good attitude.

·        
4/5/99  
Hicks: "My back has been feeling good.  
It feels good now."

·        
4/9/99  
Hicks reported that she went dancing and her back felt good although she did 
suffer knee pain afterward.  It was 
again noted that Hicks did very well in workout. This was the last physical 
therapy session Hicks attended.

 
 
Dr. 
Ruttle concluded from these notes that physical therapy was working for Hicks, 
and that her injury had demonstrated a discernable improvement over the course 
of treatment as evidenced by her own statements and the physical therapists' 
descriptions of her sessions.

 
 
[¶12]   Dr. Ruttle went on to note that 
after Hicks ceased attending physical therapy in April of 1999, there is no 
record of her having sought medical treatment for back pain for almost a full 
year.  When Hicks did seek medical 
attention for back pain in March of 2000, Dr. Ruttle noted that the progress 
notes from that examination state that Hicks did physical therapy for her back 
"about a year ago," and the pain was improving but that in the "last 3 weeks 
back has been hurting and numbness" had appeared.  There is an insertion under the "3 
weeks" notation that appears to say, "a week ago fell off step." However, the 
progress note goes on to state that there was "no new trauma" although Hicks had 
been doing "lots of riding in trucks."  
Dr. Ruttle believed that the record supported a conclusion that physical 
therapy had resolved the July 1998 injury, and that Hicks' underlying congenital 
defect had become symptomatic again by March of 2000, possibly triggered by her 
morbid obesity.  Thus, he concluded 
that the back pain for which Hicks sought treatment, and which ultimately 
required surgery, was not related to her work injury.

 
 
[¶13]   The Medical Commission concluded 
that Hicks' failure to inform her treating physicians of her 1997 injury, 
coupled with her sporadic compliance with physical therapy and other medical 
orders, called her credibility into question.  The Medical Commission agreed with Dr. 
Ruttle's opinion that Hicks' July 1998 injury had resolved through treatment in 
the spring of 1999.  Accordingly, 
they concluded that Hicks had failed to meet her burden of establishing a causal 
connection between her work-related injury of July 1998 and her back surgery in 
September of 2001.

 
 
[¶14]   Hicks filed a Petition for Review 
of the Medical Commission's Order with the district court, which affirmed.  This appeal 
followed.

 
 

[¶15]   The question before us is whether 
or not Hicks met her burden of proof and established that the injury corrected 
through surgery in September of 2001 was causally connected with her July 1998 
work-related injury.  The standards 
we will apply in our review were recently set out in Salas v. General 
Chemical, 2003 WY 79, ¶¶9-11, 71 P.3d 708, ¶¶9-11 (Wyo. 
2003):

 
 
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.  In Re 
Worker's Comp. Claim of Johnson, 2001 WY 48, ¶7, 23 P.3d 32, ¶7 (Wyo. 
2001).  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. 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).

 
 
An 
"injury" does not include a "condition preexisting at the time of employment 
with the employer against whom a claim is made[.]" Wyo. Stat. Ann. § 
27-14-102(a)(xi)(F) (Michie 1997).  
The

 
 
burden 
is upon the claimant to prove that his work accident, not his preexisting 
condition, caused the necessity for the surgery.  Matter of Corman, 909 P.2d 966, 
970 (Wyo. 1996); Matter of Claim of 
Fortier, 910 P.2d 1356, 1358 (Wyo. 1996).  While aggravation of a preexisting 
condition is a compensable injury, Matter of Injury to Carpenter, 736 P.2d 311, 312 (Wyo. 1987), claimant must prove that his employment aggravated, 
accelerated, or combined with the disease or infirmity to produce the disability 
for which compensation is sought.  
Romero v. Davy McKee Corp., 854 P.2d 59, 61 (Wyo. 1993); Lindbloom v. Teton Int'l, 684 P.2d 1388, 1390 (Wyo. 1984).

 
 

State ex 
rel. Wyoming Workers' Compensation Div. v. 
Roggenbuck, 938 P.2d 851, 853 (Wyo. 1997).  "To prove aggravation of a preexisting 
injury, the claimant must demonstrate that the work effort contributed to a 
material degree to theaggravationof the existing condition of the 
employee.'"  Frazier v. State ex 
rel. Wyoming Workers' Safety and Compensation Div., 997 P.2d 487, 490 (Wyo. 
2000) (quoting Lindbloom v. Teton Intern., 684 P.2d 1388, 1389-90 
(Wyo. 1984)) 
(emphasis omitted).

  
 
 
"[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aggravation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)).

 
 
Whether 
the employment "aggravated, accelerated, or combined with the internal weakness 
or disease to produce the disability is a question of fact.'"  Brees v. Gulley Enterprises, 
Inc., 6 P.3d 128, 131 (Wyo. 2000) (quoting Lindbloom, 684 P.2d at 
1390).

 
 
[¶16]   We accord no deference to the 
district court's conclusions.  Our 
review is conducted as if the appeal had come directly to this Court from the 
administrative agency.  Robbins 
v. State ex rel. Wyoming Workers' Safety and Compensation Division, 2003 WY 
29, ¶15, 64 P.3d 729, ¶15 (Wyo. 2003).

 
 

 
 
[¶17]   Hicks complains that several of the 
Medical Commission's findings were contrary to the record.  Initially, Hicks takes issue with the 
Medical Commission's determination that she was not a credible witness.  The Medical Commission cited Hicks' 
failure to inform Drs. Narotzky and Zondag of her prior back injury in 1997, 
along with her noncompliance with the physical therapy requirements, as the 
basis for its determination.  Hicks 
insists that she informed her treating physicians of all relevant details 
related to her injury and provided them with all pertinent medical records, 
including those pertaining to her 1997 injury.  She dismisses the Medical Commission's 
reliance on this finding by pointing out that both Drs. Narotzky and Zondag 
testified that the presence of the 1997 injury did not affect their medical 
opinion that the surgery was causally connected to the 1998 work-related 
injury.  On the issue of her 
attendance at physical therapy sessions, Hicks asserts that the Medical 
Commission ignored evidence of legitimate reasons for her absences, including 
the illness of a family member, conflicting appointments for her children, and 
car trouble.  Particularly, Hicks 
stresses her testimony that the physical therapy caused her pain and 
discomfort.  She also claims that 
the Medical Commission misstated the number of times she was actually absent 
from physical therapy.  Accordingly, 
Hicks concludes that the Medical Commission's findings are simply not relevant 
to her credibility.

 
 
[¶18]   The Medical Commission, as the 
trier of fact, is assigned the task of determining the credibility of the 
witnesses and weighing the evidence.  
We will overturn its determinations only if they are contrary to the 
great weight of the evidence.  
Hurley v. PDQ Transport, Inc., 6 P.3d 134, 138 (Wyo. 2000) (citing 
Helm v. State ex rel. Wyoming Workers' 
Safety and Compensation Division, 982 P.2d 1236, 1237 (Wyo. 1999)).  The record does not support Hicks' 
arguments.  Dr. Narotzky and Dr. 
Zondag testified unequivocally that Hicks did not inform them of her 1997 
injury.  That this information was 
not considered material by the doctors in the formation of their opinions on 
causation is established only through hindsight.  Hicks had a duty to affirmatively 
disclose all relevant medical information related to her claim for benefits, 
including any prior or preexisting injuries.  We will not disturb the Medical 
Commission's determination that Hicks' failure to timely disclose pertinent 
medical information was relevant to an assessment of her credibility as a 
witness.

 
 
[¶19]   Similarly, we find no error in the 
Medical Commission's citation of Hicks' failure to comply with her treating 
physician's medical orders as a basis for doubting her credibility.  A letter from Hicks' physical therapist 
notifying her treating physician of her termination for noncompliance supports 
the Medical Commission's determination that Hicks missed over half of the 
sessions scheduled in January of 1999.  
The record also fails to support Hicks' claim that physical therapy was 
causing her pain.  The physical 
therapy notes only contain complaints from Hicks about general soreness and the 
aches and pains usually associated with the rehabilitation of an injury.  Indeed, the notes indicate that Hicks' 
back injury was "feeling good" and that she was progressing on her 
rehabilitation.  Simply put, the 
record does not support Hicks' arguments.  
Faced with a conflict between Hicks' testimony and the record, the 
Medical Commission made a determination that the independent, contemporaneous 
notes of the physical therapist were more credible.  We cannot say that the Medical 
Commission's determination was incorrect.

 
 
[¶20]   Nevertheless, Hicks argues that she 
showed by a preponderance of the evidence that there was a causal relationship 
between her work-related injury of July 1998 and the necessity for surgery in 
September of 2001.  Hicks' position 
is predicated on the opinions of Drs. Narotzky and Zondag.  She insists that their opinions are 
sufficient to meet her burden of proof.  
Hicks dismisses the Medical Commission's reliance upon Dr. Ruttle's 
opinion.  She points out that Dr. 
Ruttle's opinion was rendered after a fifty-minute review of her medical 
records.  That, she contends, is not 
an investigation sufficient to establish a reliable medical opinion, and the 
Medical Commission erred in relying upon it.

 
 
[¶21]   Hicks' injury presented complex 
medical issues related to causation that would normally signify a need for the 
trier of fact to rely on the technical medical knowledge of an expert.  A finder of fact is not necessarily 
bound by an expert's medical testimony. Morgan v. Olsten Temporary 
Services, 975 P.2d 12, 16 (Wyo. 1999) 
(citing 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 Workers' 
Compensation Claim of Thornberg, 913 P.2d [863] at 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, 975 P.2d  at 16.

 
 
[¶22]   Drs. Narotzky and Zondag's opinions 
on causation were not based upon any medical evidence; rather, they were derived 
exclusively from Hicks' representations that she had suffered from constant back 
pain from the inception of her injury in July of 1998 until her surgery in 
September of 2001.  Dr. Ruttle based 
his opinion that there was no causation on Hicks' medical records.  As noted above, Hicks' physical therapy 
notations describe improvement in her back pain, and that she was doing well 
with the exercises.  The record 
contains a gap from April of 1999 until March of 2000 with no evidence of any 
medical treatment for back pain.  
When Hicks did return to a doctor complaining of back pain in March of 
2000, the doctor's contemporaneous notes state that, in the prior three weeks, 
Hicks had experienced back pain and numbness.  The surgical fusion Hicks eventually 
underwent was at the same position that her congenital spinal defect was 
located.  From these facts, Dr. 
Ruttle concluded that Hicks' 1998 injury had probably been resolved through 
physical therapy and that the pain she began feeling again in 2000 was her 
congenital defect becoming symptomatic, probably because of her morbid obesity. 

 
 
[¶23]   The problem with Hicks' argument is 
that she relies entirely upon her own testimony.  This calls into question the reliability 
of her expert witnesses' opinions on causation since those were based upon their 
belief in her assertions of uninterrupted back pain.  However, the Medical Commission did not 
find Hicks to be a credible witness, a finding we have not disturbed.  Hicks' testimony is not consistent with 
other parts of the record, as illustrated by the contradiction between the notes 
from her physical therapists and Hicks' assertions that the sessions caused her 
pain.

 
 
If the 
hearing record demonstrates ambiguities or inconsistencies that require weighing 
the evidence and assessing the credibility of witnesses, the trier of fact has 
the sole responsibility for those functions.  They are not the prerogative of the 
reviewing court.  * * *  In this regard, we have said, 
"[f]urthermore, [w]hen the inconsistencies in the evidence and the claimant's 
testimony make it impossible for the hearing examiner to determine whether the 
accident arose out of [and] in the course of his employment, the claimant has 
failed to sustain his burden.'"

 
 

Morgan, 975 P.2d  at 15 (citations omitted).  
Under these circumstances, there is substantial evidence to support the 
Medical Commission's conclusions.  
Hicks failed to prove by a preponderance of the evidence that her surgery 
was causally related to her work injury.  
In 
Boyce v. State ex rel. Workers' Safety and Compensation Division, 2005 WY 
9 _____P.3d _____ (Wyo. 2005), we held that when a "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."  Id., ¶6.  In this case, the Medical Commission 
found that Hicks had failed to meet her burden of proof but it also made the 
factual finding that her back injury was not caused by her work.  When the trier of fact's conclusion that 
the claimant has failed to meet his or her burden of proof is coupled with a 
factual finding that the injury was not work-related, we will apply the 
substantial evidence test.

 
 
[¶24]   Finally, Hicks contends that she 
was denied due process.  
Specifically, she claims that the Medical Commission refused to allow her 
to produce evidence showing that the Division had continued to pay her benefits 
for her July 1998 injury, after her back injury had allegedly resolved in the 
Spring of 1999.  Hicks argues that 
if her injury had, in fact, resolved itself or if the surgery was not related to 
the July 1998 injury, then the Division would not have continued to pay her 
benefits. 

 
 
[¶25]   We have consistently stated that an 
uncontested award of benefits is not a final adjudication that precludes the 
Division from challenging future benefits, and that, accordingly, a claimant 
must prove that she was entitled to receive benefits for all outstanding claims 
despite any previous awards for the same injury.  Newman v. State ex rel. Wyoming 
Workers' Safety and Compensation Division, 2002 WY 91, ¶27, 49 P.3d 163, ¶27 
(Wyo. 2002) (quoting Hall v. State ex rel. Wyoming Workers' Compensation 
Division, 2001 WY 136, ¶14, 37 P.3d 373, ¶ 14 (Wyo. 2001)); see also 
Tenorio v. State ex rel. Wyoming Workers' Compensation Division, 931 P.2d 234, 239 (Wyo. 1997).  In her brief, 
Hicks does not address how her argument was proper in light of this 
well-established principle.  Even if 
we assumed that the Medical Commission prohibited Hicks from presenting this 
evidence,1 it appears that Hicks' argument is 
not appropriate.  Hicks has failed 
to present us with a cogent argument supported by authoritative citation.  We do not consider such arguments.  Dobson v. Stahla, 2003 WY 6N, ¶5, 
63 P.3d 209, ¶5 (Wyo. 2003).

 
 
[¶26]   Affirmed.

 
 

FOOTNOTES

1Hicks 
neglects to mention in her brief that she inserted into the record an exhibit 
detailing all of the benefits paid by the Division arising out of her July 1998 
work-related injury.  There is 
nothing in the record indicating that Hicks attempted to make any argument 
before the Medical Commission based on this evidence.