Title: DARRELL-ANN WALTON V. STATE OF WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION

State: wyoming

Issuer: Wyoming Supreme Court

Document:

DARRELL-ANN WALTON V. STATE OF WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2007 WY 46153 P.3d 932Case Number: 05-289Decided: 03/16/2007
OCTOBER TERM, A.D. 2006

 
 
DARRELL-ANN 
WALTON,

 
 
Appellant

(Petitioner/Employee-Claimant),

 
 
v.

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

 
 
Appellee

(Respondent/Objector-Defendant).

 
 
Appeal from the 
DistrictCourtofCarbonCounty

 
 

Representing 
Appellant:

Gregory L. Winn of Schilling & 
Winn, P.C., Laramie, 
Wyoming

 
 

Representing 
Appellee:

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

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

 
 

GOLDEN, Justice. 

 
 
[¶1]      Darrell-Ann 
Walton was injured in a work-related accident in 2002.  She claims she injured primarily her low 
back, left shoulder and neck in the accident.  The Wyoming Workers' Compensation 
Division (Division) denied all claims submitted by Walton for injuries to her 
left shoulder and neck, determining that such injuries were not causally related 
to her work accident.  Walton also 
submitted a claim for medication for migraine headaches, which was denied on the 
basis that her migraines were not causally related to the work accident.  The Division paid claims relating to 
Walton's low back injury until October 2004.  The Division denied further claims, 
determining that Walton's physical condition with regard to her low back had 
reached pre-injury status.  

 
 
[¶2]      Upon Walton's 
request for a hearing on the denial of her various claims, the Division referred 
the case to the Medical Commission.  
After a contested case hearing, the Medical Commission Hearing Panel 
upheld the Division's denial of benefits in all respects.  Walton sought review from the district 
court, arguing the decision denying benefits was not supported by substantial 
evidence and was arbitrary and capricious.  
The district court affirmed the Medical Commission's final order in all 
respects.  Walton presents the same 
arguments on appeal.  We affirm the 
final decision denying benefits for her injuries to her neck and left shoulder 
as well as the denial of payment for medication for migraine headaches.  We reverse the denial of benefits for 
injuries to Walton's low back.

 
 
ISSUES

 
 
[¶3]      Walton presents 
two issues for our review:

 
 
1.         
Whether the conclusion of the Medical Commission Hearing Panel that the 
Appellant failed to meet her burden of proof establishing that the injuries to 
her neck, shoulder, lower back, and her headaches were directly and causally the 
result of her employment related accident at Memorial Hospital of Carbon County 
on October 2, 2002 [is] supported by substantial evidence.

 
 
2.         
Whether the conclusion of the Medical Commission Hearing Panel that 
Appellant's injuries to her neck, shoulder, lower back, and her headaches were 
directly and causally the result of her employment related accident at Memorial 
Hospital of Carbon County on October 2, 2002 [is] arbitrary and capricious as 
that standard is applied as a "safety net" under Newman.

 
 
The Division restates the issues, 
adding a bit more context:

 
 
1.         
The Medical Commission Hearing Panel determined that Ms. Walton's low 
back injury resolved by October 12, 2004, following her October 2, 2002 work 
injury.  Further, the Medical 
Commission determined Ms. Walton failed to prove the relatedness between her 
work injury and complaints regarding her neck, left shoulder and headaches.  Does substantial evidence support the 
Medical Commission Hearing Panel's decision denying 
benefits?

 
 
2.         
Whether the Medical Commission's decision denying benefits is arbitrary 
or capricious?

 
 
FACTS

 
 
[¶4]      On October 2, 
2002, Walton was working as an emergency room admissions clerk at Memorial 
Hospital of Carbon County when she slipped and fell in a hallway of the 
hospital.  In her initial injury 
report, completed by Walton the same day, she stated that she had twisted her 
back and had suffered injury to her right ankle, right knee, right elbow, left 
buttock and left hip.   
Immediately after the fall she was taken to the hospital's emergency 
room.  The emergency room notes 
reflect the same complaints, namely stiffness and soreness in her right leg, 
knee and ankle, but her major complaint of pain in the emergency room was 
regarding her left hip area.  

 
 
[¶5]      Walton visited 
her family physician, Dr. Charles Young, regarding her injuries for the first 
time on November 14, 2002.  On this 
first visit Dr. Young's notes reflect that Walton complained of injury to her 
back, left hip, right elbow and right arm.  
Walton regularly returned to Dr. Young with complaints of low back pain 
from November 2002 onward.  Upon 
submission of the claim, the Division determined that medical payments for 
injuries to Walton's "left back, right arm  elbow, right foot, feet, toe(s), or 
ankle(s), right leg  knee, and left hip" were compensable.  Walton received extensive treatment on 
her low back from several different physicians.  In October 2004, the Division ceased 
paying benefits for treatment to Walton's low back, determining that Walton's 
low back had reached pre-injury status.

 
 
[¶6]      Dr. Young first 
noted complaints of pain by Walton in her left shoulder on November 25, 
2003.  The first notation concerning 
complaints of pain in her neck and migraine headaches appears in March 
2004.  Upon submission of the new 
claim in March 2004, the Division denied benefits for medical treatment to 
Walton's neck and left shoulder on the basis that there was no compelling 
evidence directly relating the treatment to injuries sustained in the work 
accident.  The Division also denied 
a claim for payment for migraine headache prescription medication, again finding 
no causal relationship between the migraine headaches and the original work 
accident.    

 
 
[¶7]      Walton requested 
a contested case hearing on all denials.  
The case was referred to the Medical Commission.  After a full hearing, the Medical 
Commission Hearing Panel agreed with the Division's contentions and upheld the 
denial of benefits in all respects.  
Walton sought review from the district court, which affirmed the Medical 
Panel's decision.  This appeal 
ensued.

 
 
DISCUSSION

 
 
Standard of 
Review

 
 
[¶8]      When reviewing an 
administrative agency order, we review the case as if it came directly from the 
administrative agency, affording no deference to the district court's 
decision.  Hicks v. State ex rel. Wyoming Workers' 
Safety and Comp. Div., 2005 WY 11, ¶ 16, 105 P.3d 462, 469 (Wyo. 2005).  The scope of our review is governed by 
Wyo. Stat.  Ann. § 16-3-114(c) 
(LexisNexis 2005), which provides:

 
 
(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.

 
 
[¶9]      In appeals where 
both parties to a contested case submit evidence, appellate review of the 
evidence is limited to application of the substantial evidence test.  Berg v. State ex rel. Wyoming Workers' 
Safety and Comp. Div., 2005 WY 23, ¶ 7, 106 P.3d 867, 870 (Wyo. 2005) 
(citing Newman v. State ex rel. Wyoming 
Workers' Safety and Comp. Div., 2002 WY 91, ¶ 22, 49 P.3d 163, 171 (Wyo. 
2002)).  We review the entire record 
and apply the substantial evidence test as follows:

 
 
In reviewing findings of fact, we 
examine the entire record to determine whether there is substantial evidence to 
support an agency's findings.  If 
the agency's decision is supported by substantial evidence, we cannot properly 
substitute our judgment for that of the agency and must uphold the findings on 
appeal.  Substantial evidence is 
relevant evidence which a reasonable mind might accept in support of the 
agency's conclusions.  It is more 
than a scintilla of evidence.  

 
 

Cramer v. State ex rel. Wyoming 
Workers' Safety and Comp. Div., 2005 WY 124, ¶ 10, 120 P.3d 668, 
671 (Wyo. 2005).

 
 
[¶10]   Even if sufficient evidence 
supports the administrative decision under the substantial evidence test, Newman requires that this Court apply 
the arbitrary-and-capricious standard as a "safety net" to catch other agency 
action that may have violated the Wyoming Administrative Procedures Act.  Loomer v. State ex rel. Wyoming Workers' 
Safety and Comp. Div., 2004 WY 47, ¶ 15, 88 P.3d 1036, 1041 (Wyo. 
2004).  "Under the umbrella of 
arbitrary and capricious actions would fall potential mistakes such as 
inconsistent or incomplete findings of fact or any violation of due 
process."  Rodgers v. State ex rel. Wyoming Workers' 
Safety and Comp. Div., 2006 WY 65, ¶ 19, 135 P.3d 568, 575 (Wyo. 2006); Padilla v. State ex rel. Wyoming Workers' 
Safety and Comp. Div., 2004 WY 10, ¶ 6, 84 P.3d 960, 962 (Wyo. 
2004).

 
 
Payment for Migraine 
Medication

 
 
[¶11]   On appeal Walton makes no specific 
argument supporting the compensability of the treatment for her migraine 
headaches.  We therefore decline to 
review the matter.  The decision of 
the Medical Commission denying payment for Walton's medication for migraine 
headaches is summarily affirmed.

 
 
Low 
Back

 
 
[¶12]   The Division initially found the 
injury to Walton's low back compensable and paid benefits for treatment to her 
low back for approximately two years.  
The Division then decided that Walton's low back had reached pre-injury 
status and denied further benefits.  
In upholding the denial of benefits, the Medical Commission simply stated 
that Walton had "likely sustained a soft tissue injury to her low back" but that 
her condition had resolved to baseline "as reflected in the various medical 
records and reports."  The Medical 
Commission provides no further information specifying exactly what medical 
records or reports it is relying upon in reaching this conclusion.  There is no indication from the Medical 
Commission as to what it believes Walton's pre-injury status was, why it 
believes Walton's injury was only a soft-tissue injury, or when it believes 
Walton's condition returned to pre-injury status.  In other words, there are no basic 
findings of fact supporting the ultimate finding.  Given the content of the Medical 
Commission's order, this Court is unable to adequately review the ultimate 
conclusion of the Medical Commission.  

 
 
[¶13]   Although we would normally remand 
the case to the Medical Commission Review Panel for further findings, the record 
is clear that no evidence supports a finding that Walton's low back reached 
pre-injury status at any time before the hearing.  The Medical Commission's conclusion to 
the contrary is arbitrary and capricious.  

 
 
[¶14]   It was initially Walton's burden to 
prove that her low back condition never returned to baseline and consequently 
her current complaints are related to her work accident.  Walton testified that, before the 
accident, her low back was pain free.  
Dr. Young corroborated this information.  Walton testified that she has 
experienced low back pain consistently since the accident.  The medical records amply demonstrate 
continuous treatment for complaints of low back pain.  No treating physician ever has indicated 
that Walton's low back had returned to pre-injury status.  We fail to find any evidence that 
Walton's low back was pain free for any significant period from the time of the 
accident to the time of the hearing.

 
 
[¶15]   In its brief, the Division points 
out what it characterizes as a gap in treatment for low back pain at the 
beginning of 2003 and argues the gap suggests Walton's low back pain resolved 
towards the end of January 2003.  
This conclusion seems to have been initially suggested by Dr. Terry Allen 
Brown in February 2004.  The 
Division had requested an opinion from Dr. Brown as to whether Walton's neck and 
shoulder injuries were attributable to the work accident.  Dr. Brown conducted a record review of 
Walton's medical records in formulating his opinion.  He never examined Walton personally. 

 
 
[¶16]   Dr. Brown did not testify at the 
hearing.  Instead, the Division 
introduced into evidence a letter written by Dr. Brown addressed to the Division 
outlining his opinion.  Despite only 
being asked about the causation of Walton's neck and shoulder injuries, Dr. 
Brown suggested that Walton's low back pain resolved in a timely fashion.  His only comments supporting this 
opinion were:

 
 
What is somewhat disturbing on 
review of this case is the duration of the complaints.  It is noted that there is note by the 
chiropractor on 1/30/03 that she "was feeling pretty good" that day.  This would coincide with the last 
physical therapy note of 1/27/03 at which point she was 0 on the 0-10 pain scale 
and discharged from care.  

 
 
She was not seen by the chiropractor 
again until 4/2/03 complaining of low back pain and pain in the left hip with no 
explanation as to why there was such a gap of time or why she was apparently 
much better previously and now was worse, again given the fact that she had a 
sedentary occupation.   

 
 
[¶17]   We do not feel this opinion 
justifies a finding that Walton's low back had returned to its baseline at the 
end of January 2003.  First, the 
opinion was unsolicited.  Dr. 
Brown's focus was on other complaints.  
Even the Division seems not to have paid too much attention to the 
impromptu remarks since it did not deny claims associated with Walton's low back 
injury until October 2004, after Walton's IME.  Second, the opinion was based solely 
upon a record review.  No valid 
conclusion can be drawn by the absence in medical records of a reason why Walton 
did not visit her chiropractor for approximately two months or what severity of 
pain she may have been experiencing in the interim.  It is pure speculation to impute any 
pertinent information from the absence of notations in the various medical 
records.  

 
 
[¶18]   Further, the opinion to some extent 
misstates the record evidence.  For 
instance, the January 2003 physical therapy discharge note indicates that Walton 
was pain free when standing.  The 
note also indicates, however, that Walton suffered pain with forward 
flexion.  Although she was released 
from official physical therapy sessions, she was to continue to do physical 
therapy exercises at home and continue to use a TENS machine.  

 
 
[¶19]   Finally, and most critically, 
Walton saw Dr. Young on March 5, 2003.  
During this early March visit, Dr. Young noted that Walton was still 
doing physical therapy and using the TENS unit.  Dr. Young's medical records reflect that 
Dr. Young prescribed pain medications and muscle relaxants for Walton on this 
occasion.  Dr. Brown seems to have 
discounted this visit and focused solely on the chiropractic treatment sessions 
in arriving at his opinion that there was a gap in treatment.  

 
 
[¶20]   Dr. Young expanded on his notes 
from the March 5 visit in a deposition taken several months after Dr. Brown 
conducted his paper review.  Dr. 
Young testified that Walton was experiencing discomfort when she visited him in 
early March 2003.  At that visit Dr. 
Young continued her on the pain and muscle relaxant medications he had 
previously prescribed and supplemented those medications with a prescription for 
darvocet, an additional pain medication.  

 
 
[¶21]   Given the state of the record, 
substantial evidence does not support a finding that Walton's low back was pain 
free for any significant period of time, if indeed at all, at the end of January 
or through February 2003.  Our 
review of the rest of the record reveals no significant gap in complaints or 
treatment that would support a finding that Walton's low back returned to 
pre-injury status.

 
 
[¶22]   The only other evidence in the 
record the Division seemed to rely upon in denying further claims by Walton for 
her low back injury is the IME report from Dr. Moress.  Dr. Moress' report, however, does not 
support the denial of Walton's claim.  
Indeed, Dr. Moress verified that Walton does have a medical condition 
that merits continued benefits.

 
 
[¶23]   In his report, Dr. Moress 
opined:

 
 
Ms. Walton is a very emotionally 
disturbed individual who has pain over her entire body, excluding her left 
ear.  She is extremely depressed and 
on the verge of suicide and certainly meets the criteria for a somatoform pain 
disorder.  It would take the wisdom 
of Solomon to ferret out one specific area of her totality of body complaints 
and then state this is what the industrial accident caused.  Because [of] the somatoform pain 
disorder, I am unable to state that she has either neck or low back pain related 
to the original industrial injury.   

 
 
Dr. Moress' treatment 
recommendations included:

 
 
Ms. Walton needs psychological 
professional counseling and ongoing medication for her depression.  Whether this is a liability of the 
industrial accident is unknown.  A 
psychological evaluation should be a liability of the industrial accident and 
would help to determine the psychosocial dynamics of her total body pain 
presentation, treatment, and any relationship to the industrial accident. 

 
 
[¶24]   As can be seen, Dr. Moress never 
suggests that Walton's low back had ever returned to baseline.  Indeed, far from being pain free, Walton 
was in extreme discomfort when Dr. Moress examined her.  Given her then current condition, Dr. 
Moress could not discern whether the neck and low back pain Walton was suffering 
was related to the work accident.  
In other words, Dr. Moress noted that Walton was suffering from low back 
pain, but had no opinion as to the causation of such pain.

 
 
[¶25]   Dr. Moress' diagnosis was 
somatoform pain disorder.  This 
diagnosis does not necessarily mean that there is nothing physically wrong with 
Walton. "Somatoform disorder is a relatively new term for what many people used 
to refer to as psychosomatic disorder."  
Mark H. Beers et al., Merck Manual 
of Medical Information 601 (2d Home ed. 2003). 

 
 
  When people have persistent pain with 
evidence of psychologic disturbances and without evidence of a disorder that 
could cause the pain, the pain may be described as psychogenic. Pain that is 
purely psychogenic is rare. More commonly, the pain has a physical cause, but 
the doctor's assessment indicates that the degree of pain and the disability 
experienced are out of proportion to what most people with a similar disorder 
experience. Sometimes this type of pain is described as a chronic pain syndrome. 
Psychologic factors often contribute to disability and to an exaggeration of 
pain complaints. Any kind of pain can be complicated by psychologic factors. 
Even when pain is suspected to be psychogenic, doctors still investigate whether 
a physical disorder is contributing to the pain.

 

 
The fact that the pain is caused or 
worsened by psychologic factors does not mean that it is not real. Most people 
who report pain are really experiencing it, even if a physical cause cannot be 
identified. Pain complicated by psychologic factors still requires treatment, 
often by a team that includes a psychologist or psychiatrist. 

 
 

Id., at 449-50.

 
 
[¶26]   Dr. Moress expressed that the way 
to find out what was happening was for Walton to undergo a psychological 
evaluation.  Dr. Moress specifically 
states that the Division should be responsible for paying for the 
evaluation.  Dr. Moress' opinion 
thus is that, at least for the time being, Walton continues to have a legitimate 
claim.  He simply suggested a new 
course of action to better determine the nature and extent of Walton's physical 
injuries and whether her current symptoms are related to the work accident.  In sum, Dr. Moress' opinion is relevant 
with regard to the continuing care and treatment of Walton.  It does not support an immediate denial 
of benefits for Walton's low back pain.

 
 
Neck and Left 
Shoulder

 
 
[¶27]   The Medical Commission found 
Walton's injuries to her neck and left shoulder to be unrelated to her work 
accident:

 
 
It is clear to the Panel that 
following the work related fall Ms. Walton did not make any reports of any 
injury to her head, neck, upper back, either shoulder, or her left arm, for 
months following the accident.  Had 
she sustained any injury it would be reasonable and expected that she would have 
made some report to one of the many doctors she saw in the first several months 
following the accident.  Upon 
initially seeing Dr. Young, she expressed no such complaints and in fact no 
x-rays of her neck or shoulder were requested for over a year.  Several of the notes reflect a problem 
with the right elbow as opposed to the left.  Physical therapy records reflect no 
complaints with her head, neck, upper back, shoulders or arms.  In short, there is nothing to indicate 
there was ever any injury to her shoulders, neck, left arm or head as a result 
of the fall.

 
 
Although we would prefer clearer 
findings of basic fact, these findings generally are supported by substantial 
record evidence.

 
 
[¶28]   The Medical Commission was 
incorrect in its final statement: "there is nothing to indicate there was ever 
any injury to her shoulders, neck, left arm or head as a result of the 
fall."  Walton, of course, put on 
evidence supporting her position that she injured her left shoulder, neck and 
head in the fall.  Indeed, on this 
issue Walton essentially faults the Medical Commission for not accepting her 
version of events.  Generally, 
Walton claims she fell on her left side, jamming her left shoulder, hitting her 
head, and momentarily losing consciousness.  Though she quickly regained 
consciousness, she doesn't remember filling out the injury report or being 
examined in the emergency room.  She 
testified that she remembers telling every doctor she saw thereafter about neck 
and left shoulder pain as well as low back pain.  She cannot explain why they did not 
write those complaints down, but she theorizes that she and the doctors 
considered the pain mainly a symptom caused by muscle spasms in her low back and 
therefore the sole focus was on injury to her low back.  

 
 
[¶29]   Parts of Walton's story were 
corroborated by two separate witnesses.  
At the time of the accident Walton was walking with a co-worker who 
corroborated Walton's description of the fall.  The co-worker testified that Walton fell 
on her left side, hitting first her hip, then her left elbow and then her head. 
The co-worker believed that Walton temporarily lost consciousness because Walton 
hit her head hard enough for her to hear it hit the floor and immediately after 
the fall Walton's eyes were closed.  
When Walton opened her eyes Walton "seemed really out of it" and "didn't 
seem herself at all."  

 
 
[¶30]   In his deposition Dr. Young 
corroborates that he remembers Walton complaining of neck and shoulder pain at 
the first visit and consistently thereafter.  He testified that his failure to note 
the same was simply an oversight on his part because he was primarily focusing 
on the low back pain.  

[¶31]   The Medical Commission failed to 
make any explicit findings of credibility as to this particular testimony of 
Walton, the co-worker, and Dr. Young, which is normally mandatory.  The corroborating testimony, however, 
does not help Walton as much as it first appears.  While the co-worker agreed that Walton 
fell on her left side, the co-worker also testified that by the time Walton 
reached the emergency room after the fall she thought that Walton was no longer 
confused and instead "was really aware of what had happened."  Dr. Young's testimony is internally 
inconsistent.  Dr. Young's note from 
Walton's first visit states that Walton "hurt her back, left hip and right elbow 
and arm."  Thus, Dr. Young did note 
problems other than just the low back.  
Not included is any note of neck or left shoulder pain.  In fact, Dr. Young did not note a 
complaint of left shoulder pain until November 25, 2003.  He did not note a complaint of neck pain 
until March 4, 2004. 

 
 
[¶32]   Walton's testimony also is 
problematic.  Walton testified that 
she thinks she must have temporarily lost consciousness because she does not 
remember the fall and she had a horrible headache.  She remembers walking and then being on 
the floor, with her co-worker and one other hospital employee looking over 
her.  Walton does remember how she 
felt after the fall.  She did not 
want to get up or have anyone touch her immediately because of the severe pain 
she was experiencing.  According to 
her testimony: "I remember having severe pain in my left elbow and I felt like I 
had jammed my shoulder out of joint and was afraid I  that's why I didn't want 
to move.  I was afraid I had broken 
something."  

 
 
[¶33]   Inconsistent with this testimony is 
the fact that, despite being left-handed, she was able to hand-write the 
information on the initial injury report.  
She did not list a headache or left shoulder pain on the injury report, 
nor do the emergency room records contain any indication of a headache or left 
shoulder pain.  No imaging studies 
were done of her left shoulder or neck at the time of the accident, or indeed 
until over a year after the accident.  

 
 
[¶34]   Walton testified she cannot vouch 
for the accuracy of the injury report or the emergency room records because she 
did not remember participating in either.  
Her co-worker who walked her back to the emergency room, however, 
testified that Walton was alert and coherent by the time Walton filled out the 
injury report.  The emergency room 
records also note that Walton was alert.

 
 
 [¶35]  The Medical Commission should have 
expressly ruled on its credibility determinations and findings on the evidence 
Walton presented.  Even without 
this, however, there is substantial evidence to support the Commission's 
determination.  The record 
unambiguously reflects that neither the initial injury report nor the emergency 
room records indicate an injury to Walton's left shoulder or neck.  Dr. Young's notes reflect that Walton 
did not complain of left shoulder or neck pain until November 2003.  Although an X-ray and an MRI were 
conducted on Walton's low back in November 2002, no imaging studies were 
undertaken of Walton's left shoulder until December 2003 or her neck until July 
2004.  When Walton first began 
physical therapy in January 2003, the intake notes mentioned only low back 
pain.  There was no mention of any 
complaint of pain in the neck or left shoulder at any point throughout the 
initial physical therapy sessions (approximately eight sessions). 

 
 
[¶36]   Further, two of the doctors 
treating Walton for her neck and left shoulder complaints both testified that if 
her diagnosed injuries were caused by the work accident they would expect 
symptoms to appear shortly thereafter.  
One doctor testified that he would expect Walton to experience pain 
within a couple of months.  The 
other doctor testified that he would expect Walton to experience pain and have 
trouble performing day-to-day activities immediately after the fall.  From this evidence, we find that the 
Medical Commission's upholding of the denial of the claims for neck and left 
shoulder injury is supported by substantial evidence and is not otherwise 
arbitrary or capricious.

 
 
[¶37]   We must note one additional 
matter.  During the course of the 
hearing, one of the doctors on the Medical Commission hearing panel conducted 
his own, brief "neurological examination" of Walton, explaining that he is "one 
who likes to get the information directly."  He had Walton move her neck and describe 
the resultant symptoms.  We cannot 
overemphasize the appropriate function of the Medical 
Commission:

 
 
            
As the hearing examiner in medically contested cases, the Medical 
Commission is tasked with weighing the medical and other evidence presented to 
it by the parties.  It 
is not tasked with providing the equivalent of an independent medical 
examination and opinion.

 
 

Decker v. State ex rel. Wyoming 
Medical Comm'n, 
2005 WY 160, ¶ 34, 124 P.3d 686, 697 (Wyo. 2005) (emphasis added).  Respect for this strictly defined role 
is vital:

 
 
If judicial review has any purpose, 
it must be exercised by objectively evaluating evidence in the record.  There is no way that a judicial review 
could reach the subjective determination of standards by individual members of 
the Board.  Consequently, in order 
to maintain the integrity of judicial review, we conclude it is necessary that, 
with respect to the violations that were asserted . . . , expert testimony in 
the record was required and, lacking such testimony, there is no substantial 
evidence to sustain those allegations.  

 
 

Devous v. Wyoming State Bd. of 
Medical Examiners, 
845 P.2d 408, 418 (Wyo. 1993); see also 
Rodgers, ¶ 41, 135 P.3d  at 582 (the Medical Commission hearing panel's 
findings of fact must be derived from the record, not personal knowledge or 
expertise).  To the extent the 
doctor on the panel at this hearing was attempting to diagnose Walton, the 
doctor's actions were improper.  
Because we see no indication that the hearing panel was influenced by 
this "neurological exam," under the specific circumstances of this case, the 
improper action did not result in reversible error.  We take this opportunity, however, to 
once again admonish the Medical Commission that it is to base its decisions on 
the evidence presented and not its personal medical 
opinions.

 
 
CONCLUSION

 
 
[¶38]   The Medical Commission failed to 
make required findings of basic facts on several critical issues.  The record and the Order are sufficient, 
however, to enable us to adequately review the final decision of the Medical 
Commission without overstepping our boundaries on review.  

 
 
[¶39]   The record is clear that the 
decision denying benefits for Walton's low back is arbitrary and 
capricious.  No evidence supports a 
finding that Walton's low back has returned to pre-injury status.  The denial of benefits for continued 
treatment for Walton's low back injury is reversed.  We want to make clear that we have no 
comment as to the nature of any future treatment.

 
 
[¶40]   The denial of benefits for injuries 
to Walton's neck and left shoulder is affirmed.  Substantial evidence exists to support 
the finding that any injury to Walton's neck and left shoulder are not causally 
related to the work accident.  The 
denial is not arbitrary or capricious.

 
 
[¶41]   Walton makes no argument in her 
appellate brief that her migraine headaches are causally related to the work 
accident.  The denial of benefits 
for the medication for such headaches is summarily 
affirmed.

 
 
[¶42]   The order of the district court is 
affirmed in part, reversed in part, and remanded for further proceedings 
consistent with this opinion.