Title: Willey v. State ex rel. Wyo. Workers' Safety & Comp. Div.

State: wyoming

Issuer: Wyoming Supreme Court

Document:

IN THE MATTER OF WORKER'S COMPENSATION CLAIM OF: MICHAEL WILLEY v. STATE OF WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2012 WY 144Case Number: S-12-0081Decided: 11/14/2012This opinion is subject to formal revision before publication in Pacific Reporter Third. Readers are requeseted to notify the Clerk of the Supreme Court, Supreme Court Building, Cheyenne, Wyoming 82002 of any typographical or other formal errors so that correction may be made before final publication in the permanent volume. 
OCTOBER TERM, A.D. 
2012 
 
IN 
THE MATTER OF THE WORKER’S COMPENSATION CLAIM OF:
 
MICHAEL 
WILLEY,
 
Appellant
(Petitioner),
 
v.
 
STATE OF WYOMING, ex 
rel., WYOMING WORKERS’ SAFETY AND COMPENSATION DIVISION,
 
Appellee
(Respondent).
 
Appeal from the 
District Court of Campbell County
The Honorable John R. 
Perry, Judge
 
 
Representing 
Appellant:
Donna D. 
Domonkos, Domonkos Law Office, Cheyenne, Wyoming.
 
Representing 
Appellee:
Gregory A. Phillips, 
Attorney General; John D. Rossetti, Deputy Attorney General; Michael J. Finn, 
Senior Assistant Attorney General; Claudia Lair, Legal Intern.
 
Before KITE, 
C.J., and GOLDEN,* HILL, VOIGT, and BURKE, JJ.
 
*Justice Golden 
retired effective September 30, 2012.
 
BURKE, 
Justice.
 
[¶1]        
The Wyoming Workers’ 
Safety and Compensation Division issued a final determination awarding 
Appellant, Michael Willey, a 2% permanent partial impairment benefit after Mr. 
Willey was injured in a work-related accident.  Mr. Willey 
challenges the district court’s order affirming the Medical Commission’s 
decision to uphold the Division’s final determination.  We 
affirm.
 
ISSUE
 
[¶2]      
Appellant presents 
the following issue for our consideration:
 
Whether the Medical 
Commission’s decision is supported by substantial evidence.
 
FACTS
 
[¶3]        
In May, 2009, Mr. 
Willey was injured in the course of his employment with Precision Well Service, 
Inc.  He was injured while working under a vehicle that was 
suspended a few feet off the ground by a backhoe.  The vehicle 
slipped from its support and landed on Mr. Willey, pinning him beneath the 
vehicle.  He was taken to the emergency room, where 
x-rays suggested a “[n]ondisplaced fracture” in one of his ribs. 
 Mr. Willey was treated and released.
 
[¶4]        
Two days after the 
accident, Mr. Willey saw Dr. Joseph Allegretto, an orthopedist, who treated Mr. 
Willey for pain symptoms.  Dr. Allegretto ordered an MRI, 
which revealed “[m]ild disc protrusion” in Mr. Willey’s cervical spine, 
and “[m]inimal broad based protrusion” in Mr. Willey’s cervical and 
thoracic spine, which was “not impinging on the [spinal] cord.”  
During the next few months, Mr. Willey was treated with spinal steroid 
injections and pain medication.  In September, 2009, a “large 
inferior scapular hematoma” that had developed as a result of Mr. Willey’s 
accident was surgically removed from his shoulder.  Mr. 
Willey was subsequently referred to Dr. Tuenis Zondag, a pain 
management physician, for additional spinal steroid injections.  
After examining Mr. Willey in January, 2010, 
Dr. Zondag reported that Mr. Willey had normal range of motion in 
his shoulder and that the steroid injections had alleviated his neck and 
shoulder pain.
 
[¶5]        
Mr. Willey, however, 
continued to experience back pain and was referred to Dr. Thomas 
Kopitnik, a neurosurgeon, for further treatment.  
Dr. Kopitnik diagnosed Mr. Willey with “mild diffuse 
disc bulging” in the cervical and thoracic spinal regions.  In 
February, 2010, Dr. Kopitnik noted that “[Mr. Willey’s] last 
injection did help to relieve all of his pain complaints.  He 
no longer complains of any pain to the cervical spine or into the upper 
extremities.  He does have some pain upon occasion between the 
shoulder blades. . . . He states he would like to return to work 
full-duty.  He denies any difficulty with weakness or 
paraesthesias.”  Dr. Kopitnik also noted 
that Mr. Willey’s “[m]otor strength is 5/5 throughout bilateral upper 
extremities.”  On February 28, 2010, it was determined that 
Mr. Willey had reached maximum medical improvement.
 
[¶6]        
The following month, 
at the request of the Division, Dr. Allegretto examined Mr. Willey for the 
purpose of providing an independent medical evaluation (IME) and 
impairment rating.  Dr. Allegretto concluded that Mr. Willey 
was entitled to a whole body impairment rating of 25%.  His 
rating was based in large part on his classification of Mr. Willey’s impairment 
as an “alteration of motion segment integrity,” or AOMSI. 
 The Division requested a second opinion from Dr. Craig 
Uejo, who determined that Mr. Willey should receive a 2% whole body 
impairment rating.  In light of the discrepancy between the 
two ratings, the Division requested a third opinion from Dr. Franklin Shih. 
 Dr. Shih also provided a 2% whole body impairment rating. 
 Neither Dr. Uejo nor Dr. Shih classified Mr. 
Willey’s injury as an AOMSI.  Based on the findings of 
Drs. Shih and Uejo, the Division issued a final determination awarding 
Mr. Willey a 2% permanent partial impairment benefit.
 
[¶7]        
Mr. Willey challenged 
the Division’s final determination, and the matter was referred to the Medical 
Commission Hearing Panel.  A hearing was held on June 23, 
2011.  During the hearing, the Medical Commission heard 
testimony from Mr. Willey and was presented with relevant medical records, as 
well as Dr. Uejo’s evaluation report and the deposition testimony of 
Dr. Shih and Dr. Allegretto.  The Commission concluded that 
Mr. Willey’s injuries should not be classified as an AOMSI, and 
determined that the “medical records are strongly corroborative of the 2% whole 
body physical impairment award.”  The Commission ultimately 
determined that “Mr. Willey has failed to meet his burden of proof that he is 
entitled to a physical impairment rating beyond the 2% whole body rating 
provided by the Division as a result of his work injury of May 21, 2009.” 
 The district court affirmed the Medical Commission’s 
decision.  Mr. Willey timely appealed the district court’s 
order. 
 
STANDARD OF 
REVIEW
 
[¶8]        
Review of an 
administrative agency’s action is governed by the Wyoming Administrative 
Procedure Act, which provides that:
 
(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:
 
. . 
.
 
(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.          

 
Wyo. Stat. Ann. § 
16-3-114(c) (LexisNexis 2009).  
 
[¶9]        
Under this statute, 
we review an administrative agency’s findings of fact pursuant to the 
substantial evidence test.  Dale v. S & S 
Builders, LLC, 2008 WY 84, ¶ 22, 
188 P.3d 554, 561 (Wyo. 2008).  Substantial 
evidence is relevant evidence which a reasonable mind might accept in support of 
the agency’s conclusions.  Id., ¶ 11, 
188 P.3d  at 558.  Findings of fact are supported 
by substantial evidence if, from the evidence in the record, this Court can 
discern a rational premise for the agency’s 
findings.  Middlemass 
v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 2011 WY 
118, ¶ 11, 259 P.3d 1161, 1164 (Wyo. 2011).     

DISCUSSION
 
[¶10]     
A claimant in a 
workers’ compensation case has the burden to prove all the elements of the claim 
by a preponderance of the evidence.  Kenyon v. State 
ex rel. Wyo. Workers’ Safety & Comp. Div., 2011 WY 14, ¶ 
22, 247 P.3d 845, 851 (Wyo. 2011).  A 
preponderance of the evidence is “proof which leads the trier of 
fact to find that the existence of the contested fact is more probable than its 
non-existence.”  Id.  The 
Division concedes that Mr. Willey experienced a work-related injury, for which 
he was entitled to workers’ compensation benefits.  The 
dispute in this case focuses on the extent of Mr. Willey’s injury and, more 
specifically, the proper impairment rating for the injury. 
 
 
[¶11]     
Under the Wyoming 
Worker’s Compensation Act, a licensed physician must rate an employee’s physical 
impairment using the most recent edition of the American Medical Association’s 
Guides to the Evaluation of Permanent Impairment (AMA Guides).1  Wyo. 
Stat. Ann. § 27-14-405(g).  The Act provides that if the 
percentage of physical impairment is disputed, the Division must obtain a second 
opinion.  Wyo. Stat. Ann. § 27-14-405(m).  
Any objection to the Division’s final determination is then referred to 
the Medical Commission for a hearing.  Id. 
 
[¶12]     
Mr. Willey contends 
that the Medical Commission’s decision is not supported by substantial 
evidence.  He asserts that the Commission’s decision to reject 
Dr. Allegretto’s impairment rating was “clearly contrary to the overwhelming 
weight of the evidence” because Dr. Allegretto’s rating was based on his history 
of treating Mr. Willey, and was made after a thorough physical examination and 
review of Mr. Willey’s medical records. In contrast, he points out that 
Dr. Uejo performed only a review of Mr. Willey’s medical records, 
and that Dr. Shih conducted only a brief physical examination before arriving at 
a 2% impairment rating.  Mr. Willey also takes issue with the 
Commission’s finding that he was not a credible witness because he exaggerated 
the extent of his injury and symptoms.
 
[¶13]     
The Division contends 
that the Commission’s decision should be upheld because it is supported by the 
opinions of Dr. Shih and Dr. Uejo, and that the Medical Commission could 
properly rely on Dr. Shih’s and Dr. Uejo’s application of the AMA 
Guides in determining Mr. Willey’s impairment rating.  The 
Division also claims that the Commission’s determination with respect to Mr. 
Willey’s credibility is supported by the evidence.  The 
Division concludes that “[Mr. Willey’s] medical records, the Division’s expert 
assessments as well as the expert testimony provided by the Division[’]s 
physicians, all provide substantial evidence to allow the Commission to 
reasonably conclude that the proper rating is 2%.”  We agree 
with the Division.
 
[¶14]     
At the contested case 
hearing, counsel for Mr. Willey framed the issue before the Medical Commission 
as follows:  “Basically[,] this case relies on the technical 
application of the [AMA Guides].  And as an attorney, 
or as a layperson, we don’t know a lot [about] how to do that.” 
 On appeal, Mr. Willey argues that Dr. Allegretto correctly 
applied the AMA Guides in classifying his impairment as an AOMSI, 
and places emphasis on the following excerpt from Dr. Allegretto’s deposition 
testimony: 
 
            
The mechanism of injury is consistent with what I saw on physical exam 
and consistent with what I saw on the imaging studies, the MRI scan.  
So because those two things showed damage to the discs of the thoracic 
spine, as well as affiliated injuries of the musculature, I said that this was 
an alteration of several mobile segments – that’s the MS – and that was 
basically thrown out by both of the other raters as being likely.
 
            
The difficulty with the thoracic spine as opposed to the cervical spine 
and the lumbar spine is that there’s no good way to test the neurologic elements 
like there is in the cervical or lumbar spine.
 
            
And you know, I’ve gone through this book several times, and it talks 
about loss of reflexes, motor strength loss, sensory loss, as documentation of 
nerve injury.  And that’s all true.  
However, in the thoracic spine, the nerves have significant overlap from 
one to the other, they individually will innervate the muscles of the trunk, 
okay? So you can’t pinpoint one nerve goes to one muscle, it’s all the nerves go 
to all the muscles.
 
            
And so if you have deficits of the nerves, the muscles will still 
function because of the remaining nerves that go to the remaining healthy nerves 
that go to the muscle, so you can’t use musculature deficits.  
There are no reflexes in the thoracic spine, and really what you’re left 
with is sensory aberration.  And the pain drawing that I had 
[Mr. Willey] fill out at the time of his examination for his IME, show 
exactly that, sensory distribution abnormalities in the thoracic spine on the 
right side, and that’s consistent with where his thoracic spine MR 
was abnormal. So that’s why I did that.
 
            
And if I can, I’ll read you the specific diagnostic criteria there, that 
may be helpful.  For the thoracic spine – and I’m reading from 
the Sixth Edition [of the AMA Guides], page 567 – a Class 
4, invertebral disc herniation or AOMSI at 
multiple levels with medically documented injury with or without 
surgery.  And he clearly met all three of those.
 
            
And, documented signs of bilateral or multiple 
level radiculopathy at the clinically appropriate levels present at 
the time of examination.
 
            
So he clearly meets that based on his pain drawing and based on my 
physical exam.  They chose to use the Class 0, or a different 
class all together, like nonspecific chronic recurrent thoracic pain, I believe 
[Dr. Uejo] did, which is a Class 1, and that’s why his rating was two 
percent because he went to this one up here – if you don’t mind me pointing – 
and he failed to put the correlative physical examination points that I had on 
my exam.
 
            
As I read through his impairment rating, he did not look at my 
examination findings at all.  And because of that, he would 
miss these findings over here.  How can he miss that these are 
disc herniations?  I don’t know.  
It’s clearly stated in the radiographic report.  If he 
didn’t review the scan itself, he would have no appreciation for 
that.  The only reason that I can come up [with] is he 
discounted it as preexisting, and I suspect that’s an argument, but this is a 
gentleman who was asymptomatic before, so I have to go with that 
philosophy.
 
            
So this is the crux of the difference is because I choose this one, which 
he meets all of these, those criteria, and also the shoulder was rated as zero 
percent by the other raters, and because I did a range of motion that showed 
deficits, he ended up with seven percent based on the deficits of his range of 
motion.
 
[¶15]     
Dr. Shih, however, 
testified in his deposition that classification of Mr. Willey’s impairment as 
an AOMSI was not supported by the medical records, and that 
Dr. Allegretto had misapplied the Guides:
 
So now if we get to 
this specific definition of an altered motion segment, at the very end of the 
table for the cervical spine, it indicates, Note: Alteration of motion segment 
integrity indicates AOMSI.  It is defined using 
flexion/extension x-rays, (figure 17-5 and 17-6).  
 
            
In the cervical spine, a diagnosis of AOMSI by translation 
method requires greater than 20 percent anterior, or greater than 20 percent 
posterior relative translation of one vertebrae on another on flexion or 
extension radiographs, [respectively]; or angular motion of more than 11 degrees 
greater than each of these adjacent levels. 
 
            
Alternatively, there may be complete or near complete loss of motion of a 
motion segment due to developmental fusion or successful or unsuccessful 
[attempts at] surgical arthrodesis, includ[ing] [dynamic 
stabilization, or] preserved motion with [disk] arthroplasty. 
 
            
In the cervical spine, these specific parameters apply to motion segments 
from C3 to C7.
 
            
So the bottom line is Mr. Willey didn’t fit into the [AOMSI] 
category, so the discrepancy between Dr. Allegretto and myself is Dr. Allegretto 
put Mr. Willey into a diagnostic category that the medical records do not 
confirm.
 
. . .
 
            
The simplest way for you to understand it is if the x-rays show abnormal 
degrees of motion in terms of instability, then you can qualify this as [an 
AOMSI]; and the other way you can qualify it as an [AOMSI] is if 
we have done surgically something to the spine; so, for example, doing a fusion 
alters a motion segment; doing a disk replacement surgery alters the motion 
segment.  And so it can either be radiographically 
proven instability of the spine, or we did something that we know inherently 
what we did to it, being a fusion or a disk replacement, changed the motion 
segment.
 
. . . 
 
            
Dr. Allegretto misapplied the Sixth Edition, so there are no diagnostic 
criteria that allow[] him to call this an [AOMSI].  So 
again, the reason I read all the stuff that I read to you is that the Sixth 
Edition is actually very specific; that you have to have this, or this, or this 
to qualify as an [AOMSI].  And so the reason Dr. 
Allegretto was able to come up with a different class was he called it an 
[AOMSI]; but unfortunately, the pathology doesn’t meet the criterion for 
an [AOMSI].  And that’s not an 
interpretation.  If you read the Sixth Edition definition of 
an [AOMSI], there’s no documentation of any of the conditions that 
qualify him for an [AOMSI].
 
(Quotation marks 
omitted.)  Dr. Shih concluded that a 2% impairment rating was 
appropriate under the 6th Edition of the AMA 
Guides:
 
At this point the 
ratable areas appear to be cervical and thoracic spine.  
Rating in this case is somewhat difficult given Mr. Willey’s rather 
non-physiologic presentation.  If I were to base Mr. Willey’s 
impairment rating on today’s evaluation alone, his impairment rating would be 
zero percent given his rather inconsistent and non-physiologic 
presentation.  Given, however, the review of the overall 
medical records and some consistency in physical findings, I felt it was 
appropriate to go ahead with an impairment rating.  Mr. Willey 
would qualify for cervical and thoracic spine impairment.  He 
would fall in the class diagnosis level 1 for each area.  He 
does not have radiographic findings that are significant nor does he have 
physical exam findings that are significant.  I do not find 
Mr. Willey’s functional history to be credible and so [I am] not applying 
that as a modifier.  Mr. Willey would have an adjustment grade 
of -2 for the cervical and thoracic regions, which would then result in a one 
percent whole person impairment for the cervical spine and one percent whole 
person impairment for the thoracic spine.  His overall 
impairment would be a two percent whole person.
 
[¶16]     
Similarly, 
Dr. Uejo concluded in his report that no records supported the 
existence of a verifiable thoracic or cervical radiculopathy, or an 
AOMSI.  With regard to Mr. Willey’s thoracic 
spinal area, Dr. Uejo stated as follows:
 
            
The Guides approach to the evaluation of impairment due to 
thoracic strain is based on Section 17.2, Diagnosis-Based Impairment 
(DBI) (6th ed., 560) and Section 17.2b, Thoracic Spine 
(6th ed., 563).  The most applicable diagnosis 
would appear to be Thoracic Spondylitis disease as outlined in 
Dr. Zondag’s January 14, 2010 report.  Although 
epidural injections were performed, no records support the existence of a 
verifiable thoracic radiculopathy or Alteration of Motion Segment 
Integrity (AOMSI).  A “possible” compression fracture 
of the T3 thoracic vertebral body is described by 
Dr. Zondag, yet not confirmed in radiological reports provided or 
other physician’s opinions as an injury found or related to the work 
injury.
 
Dr. Uejo 
made similar findings with regard to Mr. Willey’s cervical spine:
 
            
The Guides approach to the evaluation of impairment due to 
cervical strain is based on Section 17.2, Diagnosis-Based Impairment 
(6th ed., 560), and Section 17.2a, Cervical Spine 
(6th ed., 563).  The most applicable diagnosis for 
the cervical spine would be similar to the thoracic spine with 
Cervical Spondylitis disease.  Although epidural 
injections were performed, no records support the existence of a verifiable 
cervical radiculopathy, or Alteration of Motion Segment Integrity 
(AOMSI).
 
In 
Dr. Uejo’s “Final Impairment Rating Summary,” he concluded 
that
 
            
Due to the specific injury on May 21, 2009, the examinee sustained injury 
to his cervical, thoracic spine and right shoulder.  The 
medical history and clinical findings were thoroughly reviewed for supported 
impairment.  At maximum medical improvement, the medical 
condition of the examinee supported 1% WPI [whole person impairment] 
in the cervical spine, 1% WPI in the thoracic spine and 
0% WPI for the right shoulder.
 
Dr. Uejo’s 
report notes that he is an Associate Editor of The Guides Casebook, a 
reviewer of the 6th Edition of the AMA 
Guides, and an Associate Editor for the AMA Guides 
Newsletter.
 
[¶17]     
The Medical 
Commission considered Dr. Allegretto’s testimony, but was ultimately persuaded 
by the opinions of Dr. Shih and Dr. Uejo, who both concluded 
that  Mr. Willey was entitled to a 2% impairment 
rating:
 
            
In reviewing the physical impairment ratings, we note the extreme 
discrepancy between Dr. Shih and Dr. Uejo’s 2%, and Dr. Allegretto’s 
25% whole body rating.  The primary discrepancy between the 
two revolves around the thoracic spine regional grid classification, set forth 
in the AMA Guides, Sixth Edition, on Page 567, Table 17-3.  
Dr. Allegretto immediately placed Mr. Willey in the Class 4 
category, (most serious) which requires the inclusion of certain medical 
criteria, including “documented signs of a residual bilateral or 
multiple-level radiculopathy at the clinically appropriate levels 
present at the time of examination.” (AMA Guides, Sixth Edition, Table 17-3, 
Class 4).
 
. . .
 
            
This Panel agrees with Dr. Shih and Dr. Uejo’s analysis 
regarding the AOMSI.  Dr. Allegretto rated 
Mr. Willey into the Class 4 Level, and the underlying medical records do 
not support that classification.  Dr. Allegretto, in essence, 
is saying that Mr. Willey has spine instability at multiple levels with 
documented signs of residual bilateral or multiple 
level radiculopathy at the clinically appropriate levels, but the 
medical records submitted do not support the classification, and Mr. Willey does 
not have documented radiculopathy at any level that would support 
such a finding.
 
            
In discussing what sort of objective evidence was missing in documenting 
any radiculopathy, Dr. Shih indicated the following:
 
            
A nerve conduction study would be a truly objective study.  
But Dr. Allegretto is correct in that it really can’t be utilized 
effectively in a thoracic spine.  You can get – actually back 
up on that.
 
            
You can get information from just inserting needles into the 
thoracic paraspinous musculature; so there actually is information 
that you can get from the needle component of the examination, just in the 
thoracic paraspinous musculature.
 
            
But as an electographer, we like to have multiple muscles showing 
abnormalities to confirm a diagnosis; and when we just look at 
the paraspinous musculature, that doesn’t allow us to show that we 
looked at multiple levels to confirm the diagnoses.
 
            
The other way to confirm radiculopathy would be through 
consistent clinical examination, so if you can, weakness in a L4 
distribution.  If you had a sensory loss in a L4 
distribution, and if you had reflex changes in L4 distribution, then 
I would feel pretty comfortable saying that was objective evidence of 
a L4 radiculopathy. 
 
            
If you want to bump it up a notch, if you had atrophy in a L4 
distribution, that would make it even better; and then if you want to bump it up 
another notch, if you had EMG (electromyelogram) findings 
consistent with the L4, that would nail it.
 
            
Q. [Counsel] And what you’re saying, from your review of these records, 
these objective findings were lacking?
 
            
A: (Dr. Shih) That’s correct. (Employee/Claimant’s Exhibit 14, Page 10, 
Shih Deposition, Pages 30-31).
 
            
This Panel agrees with the physical impairment ratings of Drs. Shih and 
Uejo, and we find that the submitted medical records are strongly 
corroborative of the 2% whole body physical impairment award.  
Dr. Allegretto made the jump into a Class 4 Category without supporting 
documentation.  Clearly, Mr. Willey does not suffer from spine 
joint instability, nor is there any medical documentation thereof.  
We reject Dr. Allegretto’s physical impairment rating for that reason, 
and find that the rating is not supported by the medical evidence.
 
[¶18]     
We conclude that the 
Medical Commission’s findings are supported by substantial evidence.  
As we have previously stated, “It is the obligation of 
the trier of fact to sort through and weigh the differences in 
evidence and testimony, including that obtained from medical 
experts.”  In re Worker’s Comp. Claim of David v. 
State ex rel. Wyo. Workers’ Safety and Comp. Div., 2007 WY 22, 
¶ 15, 151 P.3d 280, 290 (Wyo. 2007). Further, we have noted that 
“The Commission is in the best position to judge and weigh medical evidence and 
may disregard an expert opinion if it finds the opinion unreasonable or not 
adequately supported by the facts upon which the opinion is 
based.”  Spletzer v. Wyo. ex rel. Wyo. 
Workers’ Safety & Comp. Div., 2005 WY 90, ¶ 21, 116 P.3d 1103, 1112 (Wyo. 2005).  After reviewing conflicting testimony 
and reports of the medical experts, the Medical Commission found the opinions of 
Drs. Shih and Uejo to be more persuasive than Dr. Allegretto’s 
opinion, and explained its reasons for that finding in its order.  
While we recognize that Dr. Allegretto was a “treating physician,” and 
that Dr. Shih and Dr. Uejo do not fit into that category, the weight 
to be given to the opinions of those doctors is within the province of the 
Medical Commission.  In light of the expert opinions of Drs. 
Shih and Uejo, the criteria set forth in the AMA Guides, Mr. 
Willey’s medical records, and Mr. Willey’s symptoms at the time of the hearing, 
there was substantial evidence to support the Commission’s conclusion that Mr. 
Willey’s impairment did not involve an alteration of motion segment integrity, 
as determined by Dr. Allegretto, and that a 2% whole person impairment rating 
was consistent with Mr. Willey’s medical 
history.
 
[¶19]     
As a final matter, we 
note that Mr. Willey also challenges the Medical Commission’s finding that he 
was not a credible witness.  The Commission found that Mr. 
Willey was “not an entirely credible witness,” in part because his account of 
his pain and other symptoms was not consistent with his medical 
records:  
 
            
The Medical Panel finds that Mr. Willey is not an entirely credible 
witness.  He tends to exaggerate the significance of the 
injury, particularly to his thoracic spine.  He indicated that 
he had nine broken ribs, but medical records indicate that he actually only 
fractured one rib.  Mr. Willey was worked up in a very 
thorough manner after the work injury and we note that Dr. Zondag 
found that he had almost [a] full range of motion in his shoulder and had 5/5 
motor strength in his bilateral upper extremities.  Mr. Willey 
also testified that he got very little relief from the injections that had been 
provided to him by Todd Hammond, M.D., of Casper, Wyoming, but the medical 
records submitted in Employee/Claimant’s Exhibit 9, Page 5, indicated that 
“Prior to the injections, the patient stated [his] pain was 8.5 out of a 
possible 10.  Afterwards, the patient stated [his] pain was 
5.5 out of a possible 10.”
 
. . .
 
            
We also further note that Mr. Willey seems to have a tendency to 
exaggerate or embellish the magnitude of his injury.  In Dr. 
Shih’s examination of Mr. Willey, he noted numerous non-physiologic complaints 
that did not conform with physical examination or medical records.  
We observed the same characteristics at Mr. Willey’s Evidentiary 
Hearing.  Mr. Willey is fully employed, with only a greater 
than 50 pound lifting limitation, he does not take pain medication for the work 
injury, has not had nor is he a likely candidate for surgery, and he is not 
receiving any sort of ongoing medical care for his work related 
condition.  We reject the 25% physical impairment rating 
conducted by Dr. Allegretto as unrealistic and inconsistent with the medical 
records.  Mr. Willey is entitled to a 2% whole body 
physical impairment award.
 
Mr. Willey contends 
that the Medical Commission, in making its credibility determination, 
mischaracterized his testimony relating to the number of ribs that he fractured 
at the time of injury, and misinterpreted his testimony regarding his need for 
pain medication.  He notes that his testimony was that his 
x-rays had showed “one fractured rib and one cracked rib,” rather than nine 
broken ribs.  He also notes that his testimony was that he did 
not continue to take pain medications because they made his life “more 
miserable.”
 
[¶20]     
We give substantial 
deference to a hearing examiner’s credibility findings: “Credibility 
determinations are the unique province of the hearing examiner, and we eschew 
re-weighing those conclusions.  We defer to the agency’s 
determination of witness credibility unless it is clearly contrary to the 
overwhelming weight of the 
evidence.”  Beall v. Sky Blue Enters. 
(In re Beall), 2012 WY 38, ¶ 28, 271 P.3d 1022, 1034 
(Wyo. 2012) (internal citation omitted).  Mr. 
Willey appears to be correct in his assertion that the Medical Commission 
mischaracterized his testimony relating to the number of ribs he fractured at 
the time of his accident.  However, he does not address the 
fact that there remains a discrepancy between his testimony at the hearing, 
where he claimed to have had “one fractured rib and one cracked rib,” and his 
medical records, which state that a “focal irregularity” was “suggestive of 
a nondisplaced fracture” in one of his ribs. 
 Beyond this specific quarrel with the Commission’s findings, 
however, Mr. Willey’s challenge to the Commission’s credibility 
determination lacks substance.  The evidence in the record 
supports the Commission’s finding that Mr. Willey tended to exaggerate the 
extent of his symptoms.  Ultimately, however, the Commission’s 
findings with respect to Mr. Willey’s credibility had little, if any, bearing on 
its decision to uphold the Division’s award of a 2% impairment 
benefit.  As set forth above, that decision was based on Mr. 
Willey’s medical records, the assessments of Mr. Willey’s impairment by Dr. Shih 
and Dr. Uejo, and the criteria set forth in the AMA Guides. 
 Accordingly, even if we found that the Medical Commission’s 
credibility findings were not supported by the record, substantial evidence 
would remain to support the Commission’s decision. 
 
[¶21]     
Affirmed.
 
FOOTNOTES
1The parties 
agree that the 6th Edition is the most recent 
edition of the AMA Guides.