Title: IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF: MARIA ALVAREZ V. STATE OF WYOMING ex rel. WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION

State: wyoming

Issuer: Wyoming Supreme Court

Document:

IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF: MARIA ALVAREZ V. STATE OF WYOMING ex rel. WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2007 WY 126164 P.3d 548Case Number: 06-139Decided: 08/06/2007
APRIL TERM, A.D. 2007

 
 
IN THE 
MATTER OF THE WORKER'S COMPENSATION CLAIM OF:

 
 
MARIA 
ALVAREZ,

 
 
Appellant

(Respondent),

 
 
v.

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

 
 
Appellee

(Petitioner).

 
 
Appeal 
from the DistrictCourtofSweetwaterCounty

 
 

Representing 
Appellant:

David M. 
Gosar, Jackson, Wyoming.

 
 

Representing 
Appellee:

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

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

 
 
KITE, 
J., delivers the opinion of the Court; GOLDEN, J., files a dissenting opinion in 
which VOIGT, C.J., joins.

 
 

KITE, 
Justice.

 
 
[¶1]      After injuring 
her left rotator cuff at work, Maria Alvarez filed for and received worker's 
compensation benefits.  Two months 
later, she fell and re-injured her rotator cuff.  The Wyoming Workers' Safety and 
Compensation Division (the Division) denied her claim for benefits for the 
re-injury on the ground it was caused by the fall and was not work-related.  Ms. Alvarez requested a hearing and the 
Division referred the matter to the Medical Commission.  After the hearing, the Medical 
Commission awarded Ms. Alvarez benefits.  
The Division filed a petition for review in district court, which 
reversed the Medical Commission's decision.  Ms. Alvarez appealed to this Court and we 
reverse the district court's order.

 
 
ISSUES

 
 
[¶2]      Ms. Alvarez 
presents the following issue:

 
 
Should 
this Court overrule Bruhn v. State ex 
rel. Wyo. Workers' Safety and Compensation Division, 951 P.2d 373 (Wyo. 
1997) and extend benefits to workers who sustain additional injuries while 
traveling to or from receiving medical care for work-related injuries?  In the alternative, should this Court 
clarify or modify Bruhn to extend 
coverage to workers who, like Mrs. Alvarez, reinjure their original workplace 
injuries while traveling to or from obtaining medical care for these 
injuries[?]

 
 
The 
Division phrases the issues as:

 
 
I.          
Whether the Medical Commission Hearing Panel's order awarding benefits to 
Appellant constitutes an error of law because Appellant was injured while 
outside the course and scope of employment, specifically, while traveling from a 
medical appointment?

 
 
II.         
Whether the Medical Commission Hearing Panel's order awarding benefits to 
Appellant constitutes an error of law because the Medical Commission misapplied 
the "second compensable injury theory?"

 
 
FACTS

 
 
[¶3]      In June of 2003, 
Ms. Alvarez suffered a torn left rotator cuff as a result of a work-related 
incident.  She filed a report of 
injury with the Division.  The 
Division determined her injury was compensable and paid benefits.  In September of 2003, her doctor 
performed surgery to repair the torn supraspinatus tendon involved in her 
rotator cuff injury.  

 
 
[¶4]  In November of 2003, while she was still 
recovering from the surgery, Ms. Alvarez fell on two separate occasionsonce 
when she was leaving her physical therapist's office and once at home.  After the falls, Ms. Alvarez experienced 
increased pain in her shoulder.  
When the pain persisted, her doctor ordered an MRI which revealed a 
re-tear of the supraspinatus tendon he had previously repaired in the September 
surgery.  He performed a second 
surgery to repair the re-torn tendon.

 
 
[¶5]      Ms. Alvarez filed 
a claim for worker's compensation benefits for the re-torn tendon.  The Division denied her claim, 
maintaining that she had suffered a new injury unrelated to the original work 
injury.  Ms. Alvarez objected to the 
Division's determination and requested a hearing.  The Division referred the case to the 
Medical Commission.

 
 
[¶6]  In her Disclosure Statement, Ms. Alvarez 
claimed that she was entitled to benefits because the re-tear was a "compensable 
consequence" of the original work injury.  
The Division claimed the re-tear was caused by a non-work-related fall 
and was not compensable.  Prior to 
the hearing, the parties agreed that the question for determination was whether 
Ms. Alvarez's current medical treatment and additional temporary total 
disability benefits (TTD) were related to her work injury or due instead to an 
intervening event.  To support her 
claim, Ms. Alvarez presented her doctor's deposition testimony.  When asked whether the re-tear was 
related to the work injury, he testified that in his opinion the re-tear was a 
continuum in treatment of, and related to, the initial work injury. 

 
 
[¶7]  In his closing argument before the 
Medical Commission, counsel for Ms. Alvarez argued the re-tear was a compensable 
consequence of the work injury because it resulted from a fall that occurred as 
she was leaving a physical therapy appointment she was required to attend as a 
result of the work injury.  He 
stated:  "It is that connection 
between the treatment of the work-related injury, and this fall and the 
additional injury, that is the compensable consequence . . . ."  In response, the Division's attorney 
cited State ex rel. Wyo. Workers' Safety 
and Comp. Div. v. Bruhn,  951 P.2d 373 (Wyo. 1997) for the 
principle that an injury sustained while going to or from a medical appointment 
occasioned by a work injury is not work related and is, therefore, not 
compensable.

 
 
[¶8]  The Medical Commission concluded Ms. 
Alvarez had met her burden of proving the re-tear and subsequent treatment were 
compensable.  In its findings of 
fact, the Medical Commission found that the re-tear was caused by the more 
significant of the two falls, the fall in the parking lot at the physical 
therapy facility.  The Medical 
Commission further found that "the re-tear was occasioned by Ms. Alvarez's 
attendance at physical therapy," which was part of her overall care and 
treatment for her work injury.  In 
its conclusions of law, the Medical Commission concluded:  "But for the original work-related 
injury, Ms. Alvarez would not have been receiving the post-surgery physical 
therapy at the time of her fall in the parking lot."  Citing Bruhn, the Medical Commission further 
concluded:  "Ms. Alvarez was at a 
place where she was directed to be by her treating physician, and was following 
her physician's specific orders regarding physical therapy, and the fall in the 
parking lot was the sole and direct causative factor in the re-injury of her 
left shoulder, which required an additional surgery."  On that basis, the Medical Commission 
concluded Ms. Alvarez was entitled to benefits for the care and treatment of her 
left shoulder and continuing TTD benefits.

 
 
[¶9]  The Division filed a petition for review 
in district court, which reversed the Medical Commission's order awarding 
benefits.  In its order, the 
district court stated:

 
 
Although 
substantial evidence supports the [M]edical [C]ommission's conclusion that the 
fall on the icy parking lot of the physical therapist caused the re-tear of 
claimant's rotator cuff, there is not substantial evidence supporting the 
[M]edical [C]ommission's decision under the second compensable injury rule, the 
premises rule or any other legal theory alluded to in the Commission's 
decision.

 
 
            
Causation is the common denominator in both the second compensable injury 
rule and the premises rule and, in both instances, the record is devoid of any 
evidence causally linking the first compensable work injury to the injury 
sustained by Claimant in the parking lot of her physical therapist.  Specifically, there is no testimony 
establishing the first compensable injury as a cause of the 
re-tear.

 
 
Ms. 
Alvarez appeals from the district court's order.

 
 
STANDARD 
OF REVIEW

 
 
[¶10]  In an appeal from a district court's 
decision on a petition for review of administrative action, we afford no 
deference to the district court's decision and, instead, review the case as if 
it came directly from the agency.  
Bonsell v. State ex rel. Wyo. 
Workers' Safety and Comp. Div., 2006 WY 114, ¶ 7, 142 P.3d 686, 688 (Wyo. 
2006).  Judicial review of agency 
decisions is limited to those considerations specified in Wyo. Stat. Ann. § 
16-3-114(c) (LexisNexis 2005), which provides in pertinent 
part:

 
 
            
(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;

 
 
            
. . . .

 
 
     (E) Unsupported by 
substantial evidence in a case reviewed on the record of an agency hearing 
provided by statute.

 
 
Additionally, 
we have said:

 
 
            
The substantial evidence test is the appropriate standard of review in 
appeals from contested case proceedings when factual findings are involved and 
both parties submit evidence.  
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.  Even if the factual 
findings are found to be supported by substantial evidence, the ultimate agency 
decision may still be found to be arbitrary or capricious for other 
reasons.  An appellate court does 
not examine the record only to determine if there is substantial evidence to 
support the agency's decision, but it also must examine the conflicting evidence 
to determine if the hearing examiner could have reasonably made its finding and 
order upon all of the evidence before it.  

 
 
            
We do not defer to the agency's determination on issues of law; instead, 
we will correct any error made by the agency in either interpreting or applying 
the law.  

 
 

Bonsell, ¶ 8, 
142 P.3d  at 688-89 (citations omitted).

 
 
DISCUSSION

 
 
[¶11]  Given the emphasis placed on Bruhn by both the Division and the 
Medical Commission, Ms. Alvarez frames the issue for our determination as being 
dependent on the meaning of this Court's holding in that case.  She asserts that this Court should 
overrule Bruhn and extend benefits to 
employees injured while traveling to or from medical treatment for work-related 
injuries or, alternatively, clarify Bruhn to allow benefits when an employee 
re-injures a work injury while traveling to or from medical treatment for the 
work injury.  The Division argues in 
essence that Bruhn does not allow 
benefits under Ms. Alvarez's circumstances and the Medical Commission erred when 
it awarded her benefits.  The 
Division also contends the Medical Commission incorrectly applied the second 
compensable injury rule to award Ms. Alvarez benefits because her work injury 
was not the sole and direct cause of her subsequent injury.  We conclude that Bruhn does not govern the outcome of 
this case; rather, the second compensable injury rule applies.  Before addressing that issue, however, 
we mention one other matter.   
  

 
 
[¶12]  Neither party claims nor has claimed 
that the Medical Commission was without authority to decide this case.  However, we find it appropriate to 
emphasize that the case was properly decided by the Medical Commission because 
it was a medically contested case in which the primary issue required the 
application of medical judgment to complex medical facts.  McIntosh v. State ex rel.   Wyo. Med. Comm'n, 
2007 WY 108, ___ P.3d ___, (Wyo. 2007).  

 
 
[¶13]  When the Division referred this case to 
the Medical Commission, the parties agreed the primary issue was whether Ms. 
Alvarez's current medical treatment and additional TTD were related to her work 
injury, or due to the intervening falls.  
In her disclosure statement, the claimant asserted the re-tear was a 
"compensable consequence" of the original work injury.  The Division claimed the re-tear was 
caused by a fall that was not work-related but rather was a new non-compensable 
injury.  To support her claim, Ms. 
Alvarez presented the testimony of her doctor.  In response to the question of whether 
the re-tear was related to the work injury, he testified that in his opinion the 
re-tear and subsequent surgery was a continuum in treatment of, and related to, 
the initial work injury.  The 
Medical Commission awarded the claimant benefits, finding she had met her burden 
of proving the re-tear was compensable.

 
 
 [¶14]  The primary issue for determination by 
the Medical Commission required the application of medical judgment to complex 
medical facts.  The panel was 
required to decide based upon the evidence presented whether the re-tear was 
related to the initial work injury, making it compensable.  The evidence presented consisted 
primarily of the claimant's testimony, her medical records and her treating 
physician's deposition testimony.  
The Medical Commission's decision was based on medical records and 
opinion concerning the medically contested issue presented for determination at 
the contested case hearing.  Thus, 
the Medical Commission had authority to decide the case.

 
 
[¶15]  Returning to the express issue 
presented, we conclude based upon our review of the record, that resolution of 
Ms. Alvarez's case does not require that Bruhn be overruled.  In Bruhn, this Court reversed an award of 
benefits made under Wyo. Stat. Ann. § 27-14-403(e) (Michie 1997) to the 
survivors of a woman who was killed in a car accident while driving home from a 
doctor's appointment necessitated by a work injury.  This Court held the woman's death was 
not compensable because it did not "arise out of her employment" in the sense 
required by Wyoming's worker's compensation statutes.  That is, a causal connection did not 
exist between the woman's death in the car accident and the conditions under 
which her work was required to be performed.  In order to be compensable under § 
27-14-403(e), the Bruhn court said, 
the initial injury must have been the direct cause of the employee's death.  Because the car accident, and not the 
initial injury, caused the death, the Court held the death was not 
compensable.

 
 
[¶16]  Upon first reading, Bruhn would seem to govern Ms. Alvarez's 
claim.  A careful review of the 
case, however, reveals important differences.  The most important difference for 
purposes of this discussion is that there was no suggestion in Bruhn that the initial work injury, by 
its nature, directly caused or somehow contributed to the car accident or the 
employee's death.  The employee had 
injured her back at work and no claim was made that her back injury contributed 
to or predisposed her to losing control of her car on the ice and being killed 
when she was ejected and the car rolled over her.  The only factor linking the work injury and 
the death was that the employee was traveling from a doctor's appointment for 
treatment of the work injury when she lost control of her vehicle and was 
killed.  

 
 
[¶17] In 
contrast, in Ms. Alvarez's case the fact that she fell as she was leaving a 
physical therapy appointment for treatment of her work injury was not the only 
factor linking the work injury and the subsequent injury for which she sought 
benefits.  Ms. Alvarez initially 
tore the supraspinatus tendon of her left rotator cuff at work when she was 
attempting to assist a patient.  
Surgery was performed to repair the torn tendon.  Two months later, with her arm still in 
a sling, Ms. Alvarez fell twice, the first time as she was leaving her physical 
therapy appointment, and tore the same tendon that had been previously 
repaired.  Another surgery was 
performed to repair the second tear.  
Ms. Alvarez's doctor testified that the re-tear was related to the 
original work injury.  Thus, unlike 
the situation in Bruhn where the only 
factor linking the death and the work injury was that the death occurred when 
the employee was traveling from a doctor's appointment necessitated by the work 
injury, Ms. Alvarez presented medical testimony from which she could argue a 
direct causal connection between the original tear and the re-tear, i.e. her 
rotator cuff would not have been torn and required a second surgery after she 
fell if she had not previously torn it at work predisposing her to a re-tear. 

 
 
[¶18]  Given this distinction, Bruhn does not control the outcome of 
Ms. Alvarez's case.  Instead, the 
outcome is controlled by our cases involving the second compensable injury 
rule.  The second compensable injury 
rule applies when an initial compensable injury ripens into a condition 
requiring additional medical intervention.  Yenne-Tulley v. Workers' Safety & Comp. 
Div., 12 P.3d 170, 172 (Wyo. 2000).  
Under the rule, a subsequent injury is compensable if it is causally 
related to the initial compensable work injury.  Id.

                                                                                                                                          

[¶19]  A review of the cases in which we have 
applied the second compensable injury rule is instructive.  In Casper Oil Co. v. Evenson, 888 P.2d 221 
(Wyo. 1995), 
an employee injured his back at work in 1989 resulting in surgery three months 
later.  The Division awarded him 
benefits for that injury.  
Approximately nine months after the work injury, and after the initial 
surgery, the employee slipped and fell at home.  He reported the fall to his doctor, 
stating that it had aggravated his work injury.  There was no contention the fall was 
work related.  Three years later, 
when his back problems persisted, his doctor performed a spinal fusion.  The employee filed a report of injury 
and, after a contested case hearing, the Office of Administrative Hearings (OAH) 
awarded him benefits for the subsequent back injury.  The employer appealed, claiming there was 
insufficient evidence to support the hearing examiner's determination that the 
1993 spinal fusion was related to the 1989 work injury. We affirmed the award of 
benefits on the basis that the spinal fusion was a second compensable injury 
causally related to the work injury.

 
 
[¶20]  We reached the same result in Pino v. State ex rel. Wyo. Workers' Safety 
& Comp. Div., 996 P.2d 679 (Wyo. 2000), where the employee injured his 
back at work and received benefits as a result.  Over a year and a half later, he coughed 
as he was getting out of the shower, heard a pop and experienced pain.  His doctor diagnosed a herniated 
disc.  The employee applied for 
benefits and the Division denied his claim.  The hearing examiner 
concluded:

 
 
6.  Pino has failed to meet his burden.  The evidence does establish that in 1995 
Pino suffered a work-related injury which may have resulted in a disc 
bulge.  From 1995 through May 1997, 
Pino worked but had periodic flare-ups of his low back pain radiating into his 
legs.  He sought medical treatment 
and these treatments were paid for by the Division.  In May 1997, while at home, Pino 
coughed, felt a pop, and experienced immediate pain in his low back.  An MRI in 1997 revealed a herniated 
disc.  It is the opinion of the 
doctors that the work injury in 1995 weakened Pino's disc and predisposed him to 
a disc herniation.  There is no 
question that the cough in 1997 caused the disc herniation and caused Pino's 
current back condition.

 
 
            
7.  The medical evidence 
establishes that the injury in 1995 predisposed Pino to the possibility of a 
disc herniation.  However, doing 
mundane things at home such as lifting, bending, twisting or coughing can cause 
a herniated disc.  In this case, 
Pino was at home when he coughed.  
Pino has failed to establish that his herniated disc was caused by an 
injury received at work.

 
 

Id. at 
682.  This Court reversed, holding 
the second compensable injury rule applied and the employee had met his burden 
of proving the herniated disc was causally related to the work injury.  The Court said:

 
 
The 
thrust of the hearing examiner's disposition is clear; he ruled that the cause 
of the herniation was a cough that occurred at home not the work place.  Yet, there is nothing in the second 
compensable injury rule that attributes any significance to the place where the 
worker happened to be when the injury manifested itself nor is any triggering 
event required.  Other cases simply 
report the increasing severity of the injury over time that ultimately required 
surgery.  In Evenson, the triggering event was a slip 
and fall at home.

 
 

Id. at 
685.       
 

 
 
[¶21]  In two more recent cases, we reversed 
and remanded benefit denials because the hearing examiner did not consider the 
facts in light of the second compensable injury rule.  Carabajal v. State ex rel. Wyo. Workers' 
Safety and Comp. Div., 2005 WY 119, 119 P.3d 947 (Wyo. 2005); Yenne-Tully, 12 P.3d  at 170.  In Yenne-Tully, the employee suffered a 
work related back injury for which he received medical treatment and worker's 
compensation benefits.  A subsequent 
CT scan revealed a bulging disc at L3-L4 and "some significant irregularity, 
primarily at the L5-S1, more minor at the L4-L5 level."  Id. at 171.  
 Eight years later, he awoke 
one morning unable to move because of extreme pain.  An MRI revealed a herniated disc at 
L4-L5.  After surgery was performed 
to repair the disc, the employee sought benefits.  The OAH denied the claim for 
benefits.  Finding that the second 
compensable injury rule applied but had not been considered by the OAH, we 
reversed and remanded the case to the OAH for application of the rule.  On remand, the OAH concluded the employee 
failed to meet his burden of proving a second compensable injury because the 
only medical opinion presented concluded his injury was primarily attributable 
to non-work-related causes.  We 
affirmed.  Yenne-Tully v. 
State ex rel. Wyo. Workers' Safety & Comp. Div., 2002 WY 90, 48 P.3d 1057 (Wyo. 2002).    

 
 
[¶22] In 
Carabajal, the claimant injured his 
back at work, underwent surgery for a herniated disc at L5-S1 and received 
worker's compensation benefits for over two years.  Carabajal, ¶ 3, 119 P.3d  at 949.  He returned to work and had no further 
complaints until twenty-five years later, when he experienced back pain as he 
was walking.  He was not at work at 
the time or engaged in any work-related activity.  He sought medical treatment and an MRI 
revealed scar tissue and a herniated disc at the same level as before.  He underwent a microdiscectomy and, when 
problems persisted, a spinal fusion.  
His claim for benefits was denied and he requested a hearing.   The hearing officer denied his claim on 
the ground that he failed to prove he sustained a work related injury.  Id., ¶ 7, 119 P.3d  at 950. As in Yenne-Tully, we 
reversed and remanded the case for the OAH to apply the second compensable 
injury rule.  Id., ¶ 24, 119 P.3d  at 955.

 
 
[¶23] 
 In contrast to these cases, in Walsh v. Holly Sugar Corp., 931 P.2d 241 
(Wyo. 1997), 
we upheld a denial of benefits to an employee who sought to establish that he 
had suffered a second compensable injury.  
In Walsh, the employee 
suffered a back injury while employed by Holly Sugar and received worker's 
compensation benefits.  Four years 
later, after he had left his employment with Holly Sugar, he sought benefits for 
back pain he experienced while working at his farm baling hay.  The Division denied benefits, the OAH 
ruled the denial was proper and the district court affirmed.  We also affirmed, concluding the 
doctor's testimony could be summarized as saying "the current problem could be 
causally related to the 1989 injury and that it could just as well not be 
related to the 1989 injury."  
Additionally, on cross-examination the doctor testified he was 
speculating that the current problem was related to the 1989 work injury.  We held that the hearing examiner 
correctly determined the claimant failed to establish by a preponderance of the 
evidence that his 1993 symptoms were causally related to his 1989 work 
injury.  

 
 
[¶24]  With these cases and the second 
compensable injury rule in mind, we turn to consideration of the evidence Ms. 
Alvarez presented.  She testified 
that on June 22, 2003, she hurt her left arm while trying to assist a patient at 
work.  She received medical 
treatment and ultimately had surgery.  
Approximately two months after the surgery, she fell a couple of times, 
once on the ice in the parking lot as she was leaving her physical therapist's 
office after receiving treatment for her work injury and again the same week at 
home as she was walking through her living room.  In the fall on the ice in the parking 
lot, she fell directly on her left shoulder, causing her to cry with pain.  In the fall at home, she hit the 
fireplace with her right side and hip but did not strike her left shoulder.  After the falls, she had increased pain 
in her left shoulder and made an appointment with her doctor to let him know 
what had happened. 

 
 
[¶25] 
 Dr. Ludwig Kroner, the orthopedic 
surgeon who treated Ms. Alvarez, testified that she continued to have pain and 
stiffness after the first surgery and did not progress as he would have 
expected.  At her November 13, 2003, 
appointment, however, she seemed to be "over the hump," her passive motion was 
full and they planned to begin more aggressive physical therapy.  The next time he saw her, on December 2, 
2003, Ms. Alvarez reported having fallen, complained of stiffness in her left 
shoulder and experienced pain on examination.  On January 13, 2004, Dr. Kroner ordered 
an arthrogram MRI of her left rotator cuff, which showed a re-tear at what 
appeared to be the same place as the previous tear.  He performed surgery to repair the 
re-tear.  Based upon his 
observations during the surgery, he testified that she had re-torn her 
supraspinatus tendon in what appeared to be the same spot.  Dr. Kroner testified that he suspected 
the re-tear was caused by the fall "with the most energy" although there was a 
possibility that overaggressive physical therapy in October could have resulted 
in the re-tear.  Dr. Kroner also 
testified that in his opinion the second surgery to repair the re-tear was 
related to the initial work injury.  

 

[¶26] 
 From our review of the record, we 
agree with the Medical Commission's conclusion that Ms. Alvarez met her burden 
of proving the re-tear and resulting surgery were compensable; however, we reach 
that conclusion not on the basis of Bruhn but by applying the second 
compensable injury rule.  There was 
no dispute that the initial rotator cuff tear was work-related and required 
surgical intervention. While she was still recovering from that surgery, Ms. 
Alvarez fell.  Her doctor recorded 
in his notes that he suspected the re-tear occurred when she fell.  He further testified that in his opinion 
the re-tear was related to the initial work related tear.            

     

[¶27]  As we have said, there is nothing in the 
second compensable injury rule that attributes any significance to where the 
worker was at the time the injury manifested itself nor is any triggering event 
required.  In Evenson, the triggering event was a fall 
at home.  In Pino, the triggering event was a cough 
as the employee stepped out of the shower at home.  Here, the triggering event was a fall on 
the ice in a parking lot.  What 
matters is not where the employee was or the nature of the triggering event, but 
whether the initial compensable injury ripened into a condition requiring 
additional medical intervention and whether the subsequent injury was causally 
related to the initial compensable injury.  Yenne-Tulley, 12 P.3d  at 172.  Dr. Kroner's testimony was undisputed 
that the re-tear and repair were a continuum in treatment of and related to the 
initial work injury.  The Division 
presented no evidence to the contrary.  
Given the undisputed medical testimony, the district court's conclusions 
that "the record is devoid of any evidence causally linking the first 
compensable work injury to the injury sustained by [Ms. Alvarez] in the parking 
lot of her physical therapist" and further that "there is no testimony 
establishing the first compensable injury as a cause of the re-tear" were 
incorrect.  We hold that Ms. Alvarez 
met her burden of proving the re-tear was a compensable consequence of her 
initial work injury and the Medical Commission's decision was supported by the 
second compensable injury rule. 

 
 
[¶28]  In reaching this result, we are 
cognizant of the fact that Ms. Alvarez did not expressly argue the second 
compensable injury rule in support of her claim for benefits but relied instead 
on the Bruhn premises rule.  The Medical Commission, however, was 
alerted to the theory as evidenced by its discussion of the rule in its 
conclusions of law.  Therefore, we 
are not foreclosed from considering this issue on appeal.  Carabajal, ¶ 21, 119 P.3d  at 954. 

   

[¶29]  The district court's order is reversed 
and the case is remanded for entry of an order affirming the Medical 
Commission's order on the basis of the second compensable injury 
rule.

 
 
  

GOLDEN, 
Justice, dissenting, in which VOIGT, 
Chief Justice, joins.

 
 
[¶30]   I respectfully dissent.  The Wyoming Workers' Safety and 
Compensation Division (the Division) denied Maria Alvarez's claim for 
benefits.  Upon Alvarez's request 
for a hearing, the Division referred the matter to the Medical Commission, which 
awarded benefits including medical and temporary total disability (TTD).  On review, the district court reversed 
the Medical Commission's decision on substantive grounds.  Alvarez now appeals the district court's 
decision denying her worker's compensation benefits.  I would hold that the Medical Commission 
lacked subject matter jurisdiction to decide Alvarez's case because it was not a 
"medically contested case" as required by Wyo. Stat. Ann. § 27-14-616(b)(iv) 
(LexisNexis 2007).  The order of the 
Medical Commission is therefore void.  
Accordingly, I would dismiss this appeal.

 
 
[¶31]   I am mindful that neither party has 
raised the issue of jurisdiction.  
Jurisdiction, however, can never be waived and this Court can, and indeed 
has an obligation to, confirm it has jurisdiction over an appeal.  Birkle v. Wyoming Workers' Safety and 
Compensation Div., 2007 WY 9, ¶ 2, 150 P.3d 187, 189 (Wyo. 2007); Granite Springs Retreat Ass'n v. 
Manning, 2006 WY 60, ¶ 5, 133 P.3d 1005, 1009-10 (Wyo. 
2006).

 
 
[¶32]   The basic facts of this case are 
not in dispute.  Alvarez suffered a 
torn left rotator cuff as a result of a work-related incident.  The Division determined that the injury 
was compensable and paid benefits. Alvarez successfully underwent surgery and 
was progressing well with her rehabilitation.  Although Alvarez was unable to work 
because of the injury, her treating physician anticipated that she would be able 
to return to work.  A few 
months  before her projected date of 
return, Alvarez fell on two separate occasions  once when she was leaving her 
physical therapist's office and once at home.  The ultimate result was a re-tear of the 
rotator cuff, although it is uncertain which fall actually caused the 
damage.  Alvarez was required to 
undergo a second surgery to repair the re-tear and her return to work was 
consequently delayed.  

 
 
[¶33]   The Division determined that it 
would not provide benefits associated with the re-tear of the rotator cuff, 
maintaining that under current Wyoming law the re-tear should be categorized 
as a new injury not related to the original work injury.  Alvarez objected to the Division's 
determination.  In her request for a 
hearing and in her Disclosure Statement, Alvarez claimed that she was entitled 
to benefits because the re-tear was a "compensable consequence" of the original 
work injury. At the hearing before the Medical Commission, Alvarez advanced 
multiple legal theories as to why the injury should be compensable.  There was no dispute regarding Alvarez's 
medical diagnosis or medical eligibility for TTD benefits.  The solitary medical testimony was from 
Ms. Alvarez's treating physician that Ms. Alvarez suffered a re-tear of a prior 
covered injury.  The case consisted 
of a factual question of where the new injury occurred. The issue presented to 
the Medical Commission was whether, under Wyoming law, benefits for Alvarez's re-tear of 
her rotator cuff were available.  As 
the Division attorney stated in his closing argument, "This is a legal 
case."  

 
 
[¶34]   My review of the record confirms 
that this case required no medical expertise for its resolution.  The primary issue in this case involved 
the legal issue of coverage.  As we 
have stated on several occasions, the Medical Commission has no legal authority 
to decide issues of law.  Birkle, ¶ 5, 150 P.3d at 189-90; Jacobs v. State ex rel.   Wyo. Med. Comm'n, 2005 WY 104, ¶¶ 10, 12, 118 P.3d 441, 444-45 (Wyo. 2005); French v. Amax 
Coal West, 960 P.2d 1023, 1028-30 (Wyo. 1998).  The Medical Commission should have 
dismissed the case and returned it to the Division.  Jacobs, ¶ 10, 118 P.3d at 444-45; French, 960 P.2d  at 
1030.

 
 
[¶35]   Once again, because of the 
inattentiveness of all participants in the proceedings below, the Medical 
Commission conducted proceedings which exceeded its statutory authority.  If every worker's compensation case, 
simply because medical records are involved, is construed to be a medically 
contested case, which surely cannot be the Legislature's intention, the Office 
of Administrative Hearings might as well close its doors.   Having no subject matter 
jurisdiction,  the Medical 
Commission's actions are void and this Court should dismiss this appeal for lack 
of jurisdiction.  See McIntosh, 2007 WY 108, ___ P.3d ___ (Wyo. 2007) (Golden, J., 
dissenting); Birkle, ¶ 8, 150 P.3d  at 
190; French, 960 P.2d  at 
1030.