Title: JAMES L. BALL V. STATE OF WYOMING, EX REL., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION

State: wyoming

Issuer: Wyoming Supreme Court

Document:

Cite as: 2010 WY 128, 239 P.3d 621

APRIL 
TERM, A.D. 2010

                                                                                                
            

JAMES 
L. BALL,Appellant(Respondent),v.STATE OF WYOMING, ex 
rel., WYOMING WORKERS' SAFETY AND COMPENSATION 
DIVISION,Appellee(Petitioner).

 

Appeal 
from the District Court of Laramie County

The 
Honorable Edward L. Grant, Judge 

 
 

Representing 
Appellant:

George 
Santini of Ross, Ross & Santini, LLC, Cheyenne, 
Wyoming

 
 

Representing 
Appellee:

Bruce 
A. Salzburg, Wyoming Attorney General; John W. Renneisen, Deputy Attorney 
General; James M. Causey, Senior Assistant Attorney General; Cara Boyle 
Chambers, Assistant Attorney General.  
Argument by Ms. Chambers.

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

 
 
* Chief Justice at 
time of oral argument

 
 

GOLDEN, 
Justice.

 
 
[¶1]      James L. Ball 
(Ball) appeals the district court decision reversing an Office of Administrative 
Hearings order awarding benefits for medical treatments Ball received for a 
hernia.  Ball suffered the hernia 
when a spinal cord stimulator, implanted to treat chronic back pain from an 
earlier compensable work-related injury, malfunctioned and shocked him, causing 
him to stand rapidly and then fall.  
The question we must answer is whether the hernia occurred "in the course 
of the employment" as that term appears in Wyo. Stat. Ann. § 27-14-603(c)(iii) 
(LexisNexis 2009). We hold that Ball's hernia occurred "in the course of the 
employment" and reverse the district court's decision. 

 
 
ISSUES

 
 
[¶2]      Ball presents 
these issues:

 
 
            
1.         
Was the decision of the Hearing Officer that James Ball's hernia was 
compensable under the "second injury doctrine" correct?

 
 
            
2.         
Did the District Court err by concluding as a matter of law that James 
Ball's hernia did not occur within the "course of employment" as required under 
§ 27-14-603(c)(iii) (LexisNexis 2009)?

 
 
            
3.         
Should Wyoming recognize that injuries occurring from complications of 
medical treatment of work-related injuries are themselves 
compensable?

 
 
The 
Wyoming Workers' Safety and Compensation Division (Division) states a single 
issue:

 
 
Did 
the Hearing Examiner commit an error of law by analyzing Appellant's injury 
under the second compensatory injury doctrine and by failing to properly apply 
the requirements of Wyo. Stat. Ann. § 27-14-603(c)?

 
 
FACTS

 
 
[¶3]      In June 1993, 
while at work, Ball slipped on a drain cover as he was walking into a walk-in 
refrigerator to get some milk, and injured his shoulder, neck, back, and right 
leg.  He was awarded permanent total 
disability benefits and has received ongoing benefits for treatment of chronic 
pain, including narcotic pain medications and implantation of a spinal cord 
stimulator. 

 
 
[¶4]      Ball originally 
had a spinal cord stimulator implanted for treatment of his chronic pain in 
2000.  By May of 2006, the original 
stimulator was no longer operable and a new stimulator was implanted.  Unfortunately, with the new stimulator, 
Ball developed painful side effects that he described as "good jolts" or "a 
shocking sensation," and which occurred without warning while he was lying down 
or moved in a certain way.  At the 
time of the hearing in this matter, Ball was working with his physicians to 
resolve these problems.  

 
 
[¶5]      In mid-July of 
2007, Ball was at home lying in bed when he experienced a shocking sensation 
that caused him to attempt to stand up "real fast."  Ball described it as having his right 
leg feel as though it was all muscle cramps or a big "charley horse."  As Ball stood, he fell.  He did not know whether he passed out or 
not, but when he attempted to get up, he experienced a pain in his left groin 
that he had never experienced before.  
Ball attempted to call his physician as he feared he had broken a wire on 
the stimulator.  He initially 
thought that he had perhaps pulled a muscle, but the pain in his left groin 
worsened over time to the point that he sought medical attention.  

 
 
[¶6]      A few days after 
falling, Ball saw Dr. Deborah Young, M.D., a board certified psychologist and 
neurologist who had treated Ball for some time for his chronic pain.  Dr. Young, who had seen Ball on June 28, 
2007, and recertified his total disability, met with Ball on July 26, 2007.  Dr. Young stated the following 
concerning that visit:

 
 
In 
the interval since our last appointment, somewhere around 7/15/07, Mr. Ball 
experienced severe shock-like pains on his right flank and right leg, which he 
attributed to his spinal stimulator.  
The pain was so intense that he jumped out of bed and either secondary to 
the pain or the postural hypotension I mentioned in my last letter, or a 
combination of both, he fell to the floor.  
Since that time he has had severe left groin pain, which Dr. 
Wailes' office has plans to evaluate.  
At our appointment, it was clear that Mr. Ball was in more pain; it was 
difficult for him to handle sitting in the chair and he asked to stand for part 
of the meeting. 

 
 
[¶7]      On August 1, 
2007, Ball was examined by Dr. James Shaw, M.D., an associate of Dr. Wailes with 
Pacific Pain Medicine Consultants.  
At that time, Dr. Shaw noted:

 
 
The 
patient presents for an early follow up after a fall from bed.  He ha[d] an electrical sensation 
discharge from what he believes was the SCS and a "charlie's horse" and passed 
out.  He immediately felt a pull and 
burn in his groin on the left that has been present ever since.  When he lays down he is fine, but when 
he gets up and walks around he feels the pain and it bulges.  Valsalva increases the pain.  It does not radiate to the testes or 
down the thigh.  There is no history 
of previous herniorrhaphy.  He still 
has stimulation in the low back but more stimulation in the legs but to the 
point of discomfort.  No obvious 
significant movement of the leads on his last xray last week.  The location of the pain is in the lower 
back neck and thoracic spine, but now has severe groin pain.  The pain radiates down bilateral lower 
extremities and down bilateral upper extremities.  The pain is described as sharp, burning, 
aching and stabbing.  The severity 
of the pain is usually severe.  The 
timing of the pain is constant.   
Associated symptoms are numbness and weakness on the right side.  Pain clinic treatments have included 
medication management and spinal cord stimulation.  Overall the patient is frustrated with 
ongoing pain and anxious to pursue other options.   As part of this patient's exam, I 
have reviewed the notes of Dr. Young.  
The worst area of pain is located in the groin. 

 
 
In 
that same report, Dr. Shaw noted the following in his treatment 
plan:

 
 
He 
is complaining of classic hernia complaints after this fall from his electrical 
feeling in his legs.  I would 
consider this a work related problem based off the origin of the fall.  I will order an ultrasound to r/o hernia 
as based on his complaints.  In the 
meantime, no heavy lifting or repetitive bending in the meantime. Pain is so 
significant he couldn't tolerate the SCS adjustment we had scheduled for him so 
he has rescheduled.  

 
 
[¶8]      Following an 
abdominal CT scan, which revealed an inguinal hernia containing a large bowel, 
Ball underwent surgery on August 16, 2007.  
At the time of the operation, the surgeon noted that "[t]here was a lot 
of scarring either this hernia had been quite chronic or it may be related to 
previous surgery.  I think the 
patient may have had a vasectomy on that side."  Ball had in fact had a vasectomy more 
than twenty years earlier.  

 
 
[¶9]      Ball saw Dr. 
Young again on December 6, 2007, after having undergone hernia surgery.  In a letter concerning that visit, Dr. 
Young summarized the history Ball had previously provided concerning his hernia, 
that he had jumped out of bed and fallen to the floor after experiencing an 
electrical sensation in his right leg.  
Dr. Young concluded, "[I]t would appear that the hernia developed as a 
consequence of the neurological sequelae of Mr. Ball's work-related 
injury."  

 
 
[¶10]   The Division issued a final 
determination denying payment for treatment of Ball's hernia on the basis that 
it was not related to Ball's original 1993 injury to his back.  Ball objected to the Division's 
determination, and the matter was referred for a contested case hearing.  During the contested case hearing, Ball 
contended that he was entitled to benefits to cover the costs related to his 
hernia because the development of his hernia was causally related to his 
original work-related injury.  
Specifically, Ball claimed that his fall was caused by a malfunction in 
his electrical stimulator, which was prescribed and implanted to treat his 
chronic low back pain.  Ball 
contended that the hernia statute, Wyo. Stat. Ann. § 27-14-603(c), should not 
apply, but if it were applicable, he had proven the statute's elements.  

 
 
[¶11]   The Division contended at the 
contested case hearing that Ball had not filed an injury report for his hernia 
and thus neither the Division nor the hearing examiner had jurisdiction to award 
benefits.  The Division further 
contended that § 27-14-603(c) was controlling and that Ball could not meet his 
burden of proof under that statute, because "how, why, when, or where the 
Claimant's hernia occurred is a matter of significant speculation or 
conjecture."  The Division also 
contended that one of the facilities that had provided care for Ball's hernia 
had failed to file timely reports of certain treatments or procedures and such 
applications for payment were thus barred.  

 
 
[¶12]   At the contested case hearing, the 
only witness to testify was Ball.  
No deposition testimony was presented, and the Division did not present 
an independent medical evaluation.  
Following the contested case hearing, the hearing examiner entered his 
findings, conclusions and order on February 7, 2008.  The hearing examiner concluded the 
employee was not required to submit a new injury report because his hernia was a 
compensable second injury.  The 
hearing examiner agreed with the Division, however, that certain of the costs 
for Ball's treatment were not reimbursable because the facility that had 
provided the treatment had not timely submitted the reports of its 
treatment.  

 
 
[¶13]   The hearing examiner also agreed 
with the Division that the hernia statute, § 27-14-603(c), was applicable.  The hearing examiner found, however, 
that Ball had proved all of the statutorily required elements and Ball's hernia 
was therefore a compensable injury.  
Specifically, the hearing examiner made the following relevant findings 
of fact:

 
 
            
(i)         
Was the Hernia of Recent Origin?

 
 
            
51.       
This Office finds and concludes that Ball clearly proved his July 2007 
hernia was of recent origin.  Ball 
testified his left groin pain started after his fall and was a new pain.  Ball also indicated he has never before 
had a hernia or groin pain, although he did have a vasectomy five years 
ago.  In addition, there is no 
indication of any groin pain or hernia in the medical records, which were 
submitted in this case, prior to July 2007.  Although Dr. Deemer's operative report 
suggests that Ball's hernia could have been chronic, Ball's symptoms, related to 
his hernia, did not arise until his fall which was caused by a shock from the 
spinal stimulator. . . .  
Furthermore, this Office gave little weight to Dr. Deemer's unsolicited 
comment in his operative report because the statement was speculative as to the 
reason for the scar tissue.

 
 
            
(ii)        Was 
the Hernia's Appearance Accompanied by Pain?

 
 
            
52.       
This Office finds and concludes that Ball clearly proved his July 2007 
hernia was accompanied by pain.  
Ball testified he immediately experienced left groin pain after his fall 
in July 2007.  Ball's testimony is 
further supported by Dr. Young's July 26, 2007, letter to Ball's claim's analyst 
which indicated Ball had severe left groin pain after his fall, and Ball was in 
pain at his appointment with Dr. Young.  
Furthermore, the medical records from each of the physicians indicated 
that Ball consistently reported how and when his left groin pain 
started.

 
 
            
(iii)       Was the 
Hernia immediately preceded by some accidental strain suffered in the Course of 
Ball's Employment?

 
 
            
53.       
The appearance of Ball's hernia or hernia related symptoms was 
immediately preceded by an accidental strain.  Ball testified, and repeatedly and 
consistently reported to his medical providers, that he fell when his leg gave 
out after a shock from his spinal stimulator caused him to have a "charley 
horse."

 
 
            
54.       
In addition, this Office finds and concludes that Ball's accidental 
strain  the "charley horse" and subsequent fall  was suffered in the course of 
his employment because the spinal stimulator was the initial cause of the 
unbroken chain of events leading to Ball's accidental strain.  The spinal stimulator adequately 
connected or related Ball's fall/accidental strain to his work because the 
spinal stimulator was implanted into Ball to treat his low back and leg pain 
which directly resulted from his work related injury in 1993.  Moreover, the medical records from 
Pacific unequivocally established that Ball's spinal stimulator provided 
significant relief of Ball's work related pain.  In other words, as required by the quote 
cited above from In re Hardison, Ball 
clearly proved his July 2007 hernia was related to his employment through the 
implanted spinal stimulator. 

 
 
            
(iv)      Did Ball's Hernia 
Exist Prior to the Date of His Fall? 

 
 
            
55.       
This Office finds and concludes that Ball clearly proved his hernia did 
not exist prior to his fall in July 2007.  
Other than Dr. Deemer's statement in his operative report, "either this 
hernia had been quite chronic or it may be related to previous surgery," there 
is no evidence which suggested Ball had the hernia before his fall in July 
2007.  The medical records from Dr. 
Shaw and Dr. Young do not mention a hernia or groin pain prior to July 2007 and 
Dr. Shaw's August 1, 2007, medical notes expressly stated Ball has no history of 
a hernia.

 
 
            
56.       
Accordingly, Ball has met his burden under Wyo. Stat. Ann. § 27-14-603(c) 
(LEXIS 2007).  Prior to the July 
2007 work related fall, there is no evidence Ball ever had a hernia or suffered 
symptoms related to a hernia.  The 
work related fall resulted in a strain accompanied by immediate pain and the 
appearance of an inguinal hernia on Ball.  
Ball is therefore awarded medical benefits for his hernia. 

 
 
[¶14]   The Division appealed the hearing 
examiner's order to the district court.  
On appeal to the district court, the Division submitted only one issue, 
whether the hearing examiner had misapplied the elements of the hernia statute 
to the evidence in the case.  In 
arguing its position, the Division contended a hernia is not compensable as a 
second injury unless the original injury was itself a hernia.    

 
 
[¶15]   On July 27, 2009, the district 
court entered its Order Reversing and Remanding Award of Benefits.  In so ordering, the district court 
expressly deferred to the hearing examiner's findings of fact and found those 
were supported by substantial evidence.  
The district court concluded, however, that under the hernia statute, a 
hernia is a compensable injury only when it is the original injury.  That is, the district court rejected 
even the Division's proposed compromise interpretation and concluded, as a 
matter of law, a hernia can never be compensable as a second injury. 

 

[¶16]   Ball timely filed his notice of 
appeal.  On appeal, Ball again 
contends the hernia statute does not apply, but also argues alternatively that 
if the Court were to find the statute does apply, his hernia injury meets the 
statute's requirements for compensability.  
The Division has again limited its statement of the issue on appeal and 
has adopted the district court's reasoning.   It agrees there is no evidentiary 
dispute for this Court to address and instead contends, as a matter of law, a 
hernia is never compensable as a second compensable 
injury.

 
 
DISCUSSION

 
 
Standard 
of Review

 
 
[¶17]   We review administrative decisions 
based on the factors set forth in the Wyoming Administrative Procedure Act, 
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.

 
 
Wyo. Stat. Ann. § 
16-3-114(c) (LexisNexis 2009).

 
 
[¶18]   In regard to the interpretation and 
application of law, we have further stated:

 
 
The 
interpretation and correct application of the provisions of the Wyoming Worker's 
Compensation Act are questions of law over which our review authority is 
plenary. Conclusions of law made by an administrative agency are affirmed only 
if they are in accord with the law. We do not afford any deference to the 
agency's determination, and we will correct any error made by the agency in 
either interpreting or applying the law.

 
 

Wyoming 
Workers' Safety & Comp. Div. v. Faulkner, 
2007 WY 31, ¶ 10, 152 P.3d 394, 396 (Wyo. 2007) 
(quoting Bailey v. State ex rel. Wyo. 
Workers' Safety & Comp. Div., 2002 WY 145, ¶ 9, 55 P.3d 23, 26 (Wyo. 
2002) 
(citations omitted)).  

 
 
[¶19]   In an appeal from a district 
court's appellate review of an administrative decision, we review the case as if 
it came directly from the hearing examiner, affording no deference to the 
district court's decision.  State ex rel. Wyoming Workers' Safety & 
Comp. Div. v. Kaczmarek, 2009 WY 
110, ¶ 7, 215 P.3d 277, 280 (Wyo. 2009).1  

 
 
[¶20]   Because Ball and the Division agree 
that Ball suffered a hernia injury, the sufficiency of the evidence 
substantiating that injury is not at issue.  Likewise, the Division does not in this 
appeal challenge the hearing examiner's findings regarding three of the four 
required elements of the hernia statute, namely, the hernia was of recent 
origin, the appearance of the hernia was accompanied by pain, and the hernia did 
not exist before the date of the injury.  
See § 27-14-603(c)(i), (ii), 
and (iv).  Where the parties diverge 
is on the third requirement of the hernia statute, § 27-14-603(c)(iii), that the 
hernia was sustained "in the course of the employment."  There is again no factual dispute as to 
the circumstances of Ball's hernia injury.  
Instead, the parties dispute questions of law, specifically the meaning 
of the phrase "in the course of the employment" in the hernia statute, and the 
applicability of the second compensable injury rule to a hernia 
injury.

 
 
Second 
Compensable Injury Rule

 
 
[¶21]   At the outset of our discussion, we 
believe it is a useful starting point to address what the second compensable 
injury rule is and what it is not.  
In its brief, the Division has pointed out that where a common law remedy 
conflicts with a statutory remedy, the statutory remedy is controlling, citing 
Schlattman v. Stone, 511 P.2d 959, 961-62 (Wyo. 
1973)).  Applying this principle, 
the Division contends the second compensable injury rule is a common law remedy 
that conflicts with the hernia statute and thus cannot be applied to a hernia 
injury.  We do not take issue with 
the Division's statement of the relationship between statutory and common law 
remedies, but we do disagree with the Division's contention that the second 
compensable injury rule is a "common law remedy."

 
 
[¶22]   The Workers' Compensation Act 
defines the term "injury" for purposes of compensability under the Act.  "Injury" means

 
 
any 
harmful change in the human organism other than normal aging and includes damage 
to or loss of any artificial replacement and death, arising out of and in the 
course of employment while at work in or about the premises occupied, used or 
controlled by the employer and incurred while at work in places where the 
employer's business requires an employee's presence and which subjects the 
employee to extrahazardous duties incident to the 
business.

 
 
Wyo. 
Stat. Ann. § 27-14-102(a)(xi) (LexisNexis 2009).  

 
 
[¶23]   We have discussed the causal nexus 
this provision requires between an injury and the injured employee's 
work:

 
 
The 
provision acknowledges that injuries may occur on or off the premises of 
the employer. In either case, the injury is compensable if it arises out of and 
in the course of employment. This requirement emphasizes the need for a causal 
connection between the injury and the employment. Such a causal connection is 
supplied when there is a nexus between the injury and some condition, activity, 
environment or requirement of the employment. It is this requirement, and 
only this requirement, which is envisioned by the language contained in § 
[27-14-102(a)(xi)].

 
 

Corean 
v. State ex rel. Workers' Comp. Div., 
723 P.2d 58, 60 (Wyo. 1986); see also Haagensen v. State ex rel. Wyoming Workers' 
Comp. Div., 949 P.2d 865, 
867-68 (Wyo. 1997).  We have also 
stated that an "injury is not compensable if it cannot fairly be traced to the 
employment as a contributing cause and if it comes from a hazard that the 
employee would have been equally exposed to outside of the employment."  Finley v. State ex rel. Wyoming Workers' 
Safety & Comp. Div., 2006 WY 
46, ¶ 8, 132 P.3d 185, 188 
(Wyo. 2006) (quoting State ex rel. 
Wyoming Workers' Safety & Comp. Div. v. Bruhn, 951 P.2d 373, 377 (Wyo. 
1997)).

 
 
[¶24]   The above-quoted passages are this 
Court's interpretations of the statutorily required causal link between an 
injury and the injured employee's work.  
The same is true of the second compensable injury rule.  When a condition or injury is found 
compensable under the second compensable injury rule, it merely means that an 
initial compensable injury has resulted in an injury or condition that requires 
additional medical intervention.  
That is, under the second compensable injury rule, a subsequent injury or 
condition is compensable if it is causally linked to the initial compensable 
work injury.  Alvarez v. State ex rel. Wyoming Workers' 
Safety & Comp. Div., 2007 WY 
126, ¶ 18, 164 P.3d 548, 552 
(Wyo. 2007); Yenne-Tully v. Workers' 
Safety & Comp. Div., 12 P.3d 170, 172 (Wyo. 2000).  We 
recently explained the second compensable injury rule and its required 
causation:  

 
 
We 
have used a number of terms to describe the required causal connection between 
the first and second injuries including: "direct cause" (Pino v. State ex rel. Wyo. Workers' Safety 
& Comp. Div., 996 P.2d 679, 684 (Wyo. 2000); Taylor v. State 
ex rel. Wyo. Workers' Safety & Comp. Div., 2003 WY 83, ¶ 12, 72 P.3d 799, 803 (Wyo. 2003)); 
"caused by" (Casper Oil Co. v. 
Evenson, 888 P.2d 221, 226 (Wyo. 1995)); "causally related to" (Chavez v. State ex rel. Wyo. Workers' Safety 
& Comp. Div., 2009 WY 
46, ¶¶ 26-27, 204 P.3d 967, 
973-74 (Wyo. 2009); Walsh v. Holly Sugar 
Corp., 931 P.2d 241, 243 
(Wyo. 1997)); "direct causal connection" (Alvarez v. State ex rel. Wyo. Workers' 
Safety & Comp. Div., 2007 WY 
126, ¶ 17, 164 P.3d 548, 552 
(Wyo. 2007)); "direct and natural result" (Stewart v. State ex rel. Wyo. Workers' 
Safety & Comp. Div., 2007 WY 
58, ¶ 12, 155 P.3d 198, 203 (Wyo. 2007) (quoting 1 Arthur Larson & Lex 
K. Larson, Larson's Workers' Compensation Law § 10.10, at 10-2 (2006))); 
"significant causal connection" and "predominant cause" (Yenne-Tully v. State ex rel. Wyo. Workers' 
Safety & Comp. Div., 2002 WY 
90, ¶ 11, 48 P.3d 1057, 1062 
(Wyo. 2002)); "fairly be traced to" and "a contributing cause" (State ex rel. Wyo. Workers' Safety & 
Comp. Div. v. Bruhn, 951 P.2d 373, 377 (Wyo. 1997)). Regardless of the terminology used to describe the 
causal connection, the burden remains the same: the claimant must show, by a 
preponderance of the evidence, that it is more probable than not that the second 
injury was caused by the first.

 
 

Kaczmarek, 
¶ 11 n.3, 215 P.3d  at 282 n.3.          

 
 
[¶25]   That the second compensable rule is 
a causation analysis, and not a court-created benefit or remedy, is clear from 
the manner in which this Court has applied the rule.  See, e.g., Chavez v. State ex rel. Wyoming 
Workers' Safety & Comp. Div., 2009 WY 46, ¶¶ 26-27, 204 P.3d 967, 973-74 (Wyo. 2009) 
(recognizing rule that subsequent injury is compensable if it is causally 
related to initial compensable work injury and upholding Medical Commission's 
factual finding that the required causal link did not exist between original 
work-related injury and subsequent back surgery); Nagel v. State ex rel. Wyoming Workers' 
Safety & Comp. Div., 2008 WY 
99, ¶ 38, 190 P.3d 159, 173 
(Wyo. 2008) (applying second compensable injury rule to find causal link between 
original work injury to foot and wrist and hip injuries sustained fourteen years 
later in fall caused by disabled foot); Alvarez, ¶ 26, 164 P.3d  at 555 (applying 
second compensable injury rule in upholding Medical Commission finding that 
re-tear of rotator cuff and resulting surgery were related to original 
work-related rotator cuff tear); Carabajal v. State ex rel. Wyoming Workers' 
Safety & Comp. Div., 2005 WY 
119, ¶ 17, 119 P.3d 947, 953 
(Wyo. 2005) (reversing OAH denial of benefits and remanding for application of 
second compensable injury rule in consideration of causal relationship between 
surgery to treat herniated disc and work injury over twenty years earlier); Casper Oil Co. v. Evenson, 888 P.2d 221, 225 (Wyo. 1995) 
(upholding benefits under second compensable injury rule where injured employee 
received immediate medical attention for work-related back injury and proved a 
causal link to his subsequently developed need for surgery); Baldwin v. Scullion, 62 P.2d 531, 539 (Wyo. 1936) 
(upholding award of benefits where employee showed subsequent condition was 
gradually and ultimately produced by original work 
injury).

 
 
[¶26]   This Court's analysis in other 
cases involving the application of the second compensable injury rule proceeds 
in much this same vein.  It is thus 
clear that the second compensable injury rule is not a common law remedy.  It is simply an expression of this 
Court's interpretation of the causal link required between an employee's work 
and original work injury and any related and subsequently developed injury or 
condition.  

 
 
[¶27]   We therefore reject the Division's 
argument that the rule cannot be applied where there is a statute governing a 
particular injury or condition.  We 
now turn to the Division's remaining argument that the language of the hernia 
statute limits compensability of a hernia injury to those instances where the 
hernia is the original injury and the hernia occurred in the work 
place.

 
 
Hernia 
Statute

 
 
[¶28]   The Division and Ball disagree 
whether the hernia statute applies and, if it does apply, how it should be 
interpreted.  The hernia statute 
provides as follows:

 
 
If 
an employee suffers a hernia, he is entitled to compensation if he clearly 
proves that:

 
 
(i) 
The hernia is of recent origin;

 
 
(ii) 
Its appearance was accompanied by pain;

 
 
(iii) 
It was immediately preceded by some accidental strain suffered in the course of 
the employment; and

 
 
(iv) 
It did not exist prior to the date of the alleged injury.

 
 
Wyo. 
Stat. Ann. § 27-14-603(c) (LexisNexis 2009).       

 
 
[¶29]   In interpreting the hernia statute, 
to determine both its applicability and its meaning, we apply our usual rules of 
statutory interpretation.

 
 
In 
interpreting statutes, our primary consideration is to determine the 
legislature's intent. All statutes must be construed in pari materia and, in 
ascertaining the meaning of a given law, all statutes relating to the same 
subject or having the same general purpose must be considered and construed in 
harmony. Statutory construction is a question of law, so our standard of review 
is de novo. We endeavor to interpret statutes in accordance with the 
legislature's intent. We begin by making an inquiry respecting the ordinary and 
obvious meaning of the words employed according to their arrangement and 
connection. We construe the statute as a whole, giving effect to every word, 
clause, and sentence, and we construe all parts of the statute in pari materia. When a statute 
is sufficiently clear and unambiguous, we give effect to the plain and ordinary 
meaning of the words and do not resort to the rules of statutory construction. 
Wyoming Board of Outfitters and 
Professional Guides v. Clark, 2001 WY 78, ¶ 12, 30 P.3d 36, ¶ 12 (Wyo. 2001); Murphy v. State Canvassing Board, 12 P.3d 677, 679 (Wyo. 2000). 
Moreover, we must not give a statute a meaning that will nullify its operation 
if it is susceptible of another interpretation. Billis v. State, 800 P.2d 401, 413 (Wyo. 
1990) (citing McGuire v. McGuire, 608 P.2d 1278, 1283 (Wyo. 
1980)).

 
 
            
Moreover, we will not enlarge, stretch, expand, or extend a statute to 
matters that do not fall within its express provisions. Gray v. Stratton Real Estate, 2001 WY 125, ¶ 5, 36 P.3d 1127, ¶ 5 (Wyo. 2001); Bowen v. State, Wyoming Real Estate 
Commission, 900 P.2d 1140, 
1143 (Wyo. 1995).

 
 

Loberg 
v. Wyo. Workers' Safety & Comp. Div., 
2004 WY 48, ¶ 5, 88 P.3d 1045, ¶ 5 (Wyo. 2004) 
(quoting Board of County Comm'rs of Teton 
County v. Crow, 2003 WY 40, 
¶¶ 40-41, 65 P.3d 720, ¶¶ 40-41 
(Wyo. 2003)). Only if we determine the language of a statute is ambiguous will 
we proceed to the next step, which involves applying general principles of 
statutory construction to the language of the statute in order to construe any 
ambiguous language to accurately reflect the intent of the legislature. If this 
Court determines that the language of the statute is not ambiguous, there is no 
room for further construction. We will apply the language of the statute using 
its ordinary and obvious meaning.

 
 

State 
v. Hanover Compression, LP, 
2008 WY 138, ¶ 8, 196 P.3d 781, 
784 (Wyo. 2008) (quoting BP Am. Prod. Co. 
v. Wyo. Dep't of Revenue, 2005 
WY 60, ¶ 15, 112 P.3d 596, 
604 (Wyo. 2005)).

 
 
[¶30]   The Division contends that the 
hernia statute applies anytime the injury at issue is a hernia.  Ball on the other hand contends that the 
statute applies only where the hernia at issue is the original work injury.  We agree with the Division and conclude, 
as the hearing examiner did, that the hernia statute unambiguously requires an 
employee's injury to satisfy all criteria in the statute to be compensable.  The statute does not create any 
exceptions to its application, and we would have to read terms into the statute 
to create an exception for hernias that are second compensable injuries, 
something we will not do.  See Parker v. Artery, 889 P.2d 520, 528 (Wyo. 1995) 
(legislature's omission of language from statute construed as 
intentional).

  

[¶31]   Having determined the statute is 
applicable, we turn then to the parties' contentions concerning its 
meaning.  The present dispute is 
centered on the meaning of the phrase "in the course of the employment," as it 
is used in the third element of the hernia statute.  See § 27-14-603(c)(iii).  Ball contends that "in the course of 
employment" means a hernia is compensable if it is found to be causally related 
to the employee's original work injury, assuming all of the other elements of 
the statute are met.  The Division 
on the other hand contends that the phrase means the hernia must have been the 
original injury and must have occurred in the workplace to be compensable.  We find Ball's position to be the more 
persuasive as it is in keeping with the plain language and context of the hernia 
statute, as well as the legislative intent.  

 
 
[¶32]   It is clear at the outset that the 
legislature did not expressly state, as it certainly could have, that a hernia 
must be suffered in the workplace, and be the original work injury, to be 
compensable.  We note with interest 
that in the same statute addressing a hernia, the legislature also addresses 
employment-related coronary conditions and has written "[t]he causative exertion 
occurs during the actual period of employment 
stress[.]"  Wyo. Stat. Ann. 
§ 27-14-603(b)(ii) (LexisNexis 2009) (emphasis added).  In the hernia section of this same 
statute, § 27-14-603(c)(iii), instead of writing that the hernia "was 
immediately preceded by some accidental strain in 
the course of the employment," the legislature easily could have written 
that the hernia "was immediately preceded by some accidental strain suffered during the actual period of employment 
stress," or that the hernia "was immediately preceded by some accidental 
strain suffered at the workplace" or "at 
work," but it did not.  

 
 
[¶33]   Plainly, if the legislature had 
meant to say "at the workplace" or "at work" in the hernia statute, it would 
have done so.  The language is not 
only shorter, but quite specific.  
We think such language would have come naturally to any draftsman, unless 
that draftsman really intended to say something different from "at the 
workplace" or "at work."  In keeping 
with our rules of statutory interpretation, we will not supply those terms or 
read them into the statute.  It 
follows then that the only way we may accept the Division's proposed 
interpretation of § 27-14-603(c)(iii) is to find those limitations on 
compensability within the plain meaning of the phrase "in the course of the 
employment."

 
 
[¶34]   The "in the course of employment" 
language is used elsewhere in the Act, and because our rules of interpretation 
mandate that we construe statutes in pari 
materia and must consider and construe in harmony all statutes relating to 
the same subject or having the same general purpose in ascertaining the meaning 
of a given law, the legislature's use of the language elsewhere in the Act will 
be our starting point for determining the meaning of the phrase as it is used in 
the hernia statute.   In 
particular, the Act defines an injury as one "arising out of and in 
the course of employment."  
§ 27-14-102(a)(xi) (emphasis added). 

 
 
[¶35]   As noted in our earlier discussion, 
this Court has addressed on numerous occasions the type of causal requirement 
that is created by the Act's use of the phrase "arising out of and in the course 
of employment."  With respect to the 
separate components of the phrase, we have held that there is no distinction to 
be drawn between "arising out of employment" and "in the course of 
employment."  Corean, 723 P.2d  at 60.  In Corean, we stated: 

 
 
Unlike 
the state courts discussed above, we have consistently refused to create a 
two-part analysis for the phrase "arising out of and in the course of 
employment." Instead, we have construed "arising out of" employment to mean the 
same thing as "in the course of employment."

 
 

Id. 
(emphasis 
added).2

 
 
[¶36]   In Corean, this Court not only adhered to 
its prior refusal to recognize a distinction between the phrases "arising out of 
employment" and "in the course of employment," it also rejected the suggestion 
that the place where an employee's injury occurred is a definitive factor in 
determining whether that injury arose out of or in the course of 
employment.  Our words bear 
repeating:

 
 
The 
provision acknowledges that injuries may occur on or off the premises of 
the employer. In either case, the injury is compensable if it arises out of and 
in the course of employment. This requirement emphasizes the need for a causal 
connection between the injury and the employment. Such a causal connection is 
supplied when there is a nexus between the injury and some condition, activity, 
environment or requirement of the employment. It is this requirement, and 
only this requirement, which is envisioned by the 
language[.]

 
 
Id. 

 
 
[¶37]   We see no reason to depart from our 
holding in Corean.  The phrases "arising out of" and "in the 
course of" employment, together or separately, mean the same thing.  Thus, the phrase "in the course of the 
employment" as used in the hernia statute means the same thing it means 
elsewhere in the Act.  A hernia, 
like any other injury, is compensable if there exists "a nexus between the 
injury and some condition, activity, environment or requirement of the 
employment."  See Corean, 723 P.2d  at 60.  And, a hernia, like any other injury, is 
compensable whether it occurs on or off the premises of the employer, 
as long as the required nexus exists between the employee's work and the 
hernia.  Id.; see also Alvarez, ¶ 27, 164 P.3d  at 555 ("[w]hat 
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"). 

 
 
[¶38]   The upshot of the legislature's use 
of the phrase "in the course of the employment" in the hernia statute is that a 
hernia is compensable for the same reason any other work injury is compensable  
there exists a causal relationship between the work and the injury.  It follows then that the second 
compensable injury rule applies in the same manner to a hernia as it would to 
any other work injury.  If a causal 
link exists between an employee's original work injury and his development of a 
hernia, the hernia arose "in the course of the employment" and is compensable as 
a second or subsequent compensable injury.  

 
 
[¶39]   This interpretation does not 
undermine the purpose to be achieved by the restrictions on the compensability 
of hernia injuries.  This Court has 
previously discussed the legislative purpose behind the statute limiting the 
compensability of hernia injuries: 

 

We 
have already quoted from Smith v. 
Cabarrus Creamery Company, a Tennessee case, a state which has a statute on 
hernia almost like ours, and have seen that the court in that case did not 
believe that within the contemplation of the statute, liberally construed, 
industry should be relieved from most cases of hernia, most of which, as stated 
by the court, "are produced (protrude) by the strain of lifting." The South 
Carolina Court, under a statute on hernia also very similar to ours, expressed 
the opinion in Rudd v. Fairforest 
Finishing Co., 189 S.C. 188, 200 S.E. 727, 729, that "in our opinion, the 
legislative purpose evident in our Act is to restrict compensation for hernia to 
those cases where there is a relative and reasonably close coincidence between 
the accidental injury and the hernia, and where it is clear that no other agency 
intervened, as to time, place, or action, to cause the injury." In Arduini v. General Ice Cream Company, 
123 Conn. 43, 46, 192 A. 314, 316, 114 A.L.R. 1333, the court stated that "the 
underlying reason for such special provisions [as to hernia] in this and other 
states is that owing to the nature of hernia and its onset, a lifting or 
straining, perhaps months before, may be assigned as the producing cause and the 
basis of a claim for compensation the merits of which, due to lapse of time and 
lack of notice to the employer, are extremely difficult of just determination, 
and the purpose is to restrict compensation to those cases where there is 
relative coincidence of accident and some significant manifestation of a hernia 
resulting therefrom, and thereby measurably alleviate that difficulty." . . . 
With the light which we have on the question before us, imperfect, perhaps, as 
that still is, we are unable to see how we can sustain the contention of 
appellant above discussed. It may not be amiss, in this connection, to quote 
from Dr. Kessler, from whom we have already quoted, and who wrote on page 418 as 
follows: "The specter of an army of fraudulent claims for hernia is not as 
menacing to these employers who have been progressive enough to institute 
physical examination of their employees, both at the time of hiring and at 
periodical intervals. The record of a preexisting hernia bars a claimant from 
compensation unless the existing hernia becomes strangulated. With a record of 
no hernia at the time of hiring and the occurrence of a hernia during the course 
of employment, the task of deciding the compensability becomes easier. The fact 
that no hernia existed prior to the alleged accident and there was a 
corroborated history of some strain or unusual effort are in my mind the two 
most important criteria of the responsibility for a hernia and payment of 
compensation by the employer."

 
 

Colorado 
Fuel & Iron Corp. v. Frihauf, 
58 Wyo. 479, 494-96, 135 P.2d 427, 432-433 (1943).

 
 
[¶40]   The primary goal of the hernia 
provision, as recognized by this Court in Frihauf, is to restrict compensation for 
hernia injuries to those hernias that are work related and are reported in a 
sufficiently timely manner that the Division and the employer have an adequate 
opportunity to evaluate the causal link between the hernia and the employee's 
work.  Given the meaning we have 
always given the phrase "in the course of employment," the Division is left in a 
position in which it may make the required determinations of whether the 
reported hernia injury was of recent origin, accompanied by pain, work related, 
and not preexisting.  The required 
determinations may be made without reading into the statute a bright line rule 
requiring that the hernia both occurred in the workplace and that it was the 
original injury.

 
 
[¶41]   As further evidence that our 
interpretation does not offend the legislative intent in using the phrase "in 
the course of employment," we note that this Court has for years interpreted the 
phrase in the manner discussed above.  
During that time, the legislature has not changed the definition or 
enhanced the hernia statute to limit compensability to injuries that occur in 
the workplace.  We thus conclude 
that the legislature has acquiesced in the interpretation we have given the 
phrase "in the course of employment," as that phrase is used throughout the Act, 
including in the hernia statute.  See In the Interest of ANO, 2006 WY 74, ¶ 14, 136 P.3d 797, 801 (Wyo. 
2006).

 
 
[¶42]   We find that if there is any 
disservice to the legislative intent, it is in the statutory interpretation 
urged by the Division.  The 
Division, in its brief on appeal and again during oral argument, agreed that 
there is no factual dispute concerning the events that led to Ball's 
hernia.  The Division further stated 
it does not take issue with the hearing examiner's finding that Ball's hernia 
was caused by Ball's original work injury.  
Instead, the Division contends the hernia statute makes this a unique 
case where that causal relationship is immaterial because the statute bars 
benefits for any hernia injury unless the injury is the original injury and 
occurred in the workplace.  The 
Division went so far as to argue that if the injury Ball suffered when his 
spinal stimulator malfunctioned had been something other than a hernia, a broken 
limb, for example, the injury would have been compensable.

 
 
[¶43]   The Division's interpretation 
produces an absurd result, and we have repeatedly held that we will reject 
statutory interpretations that lead to absurd results.  See Stutzman v. Office of Wyoming State 
Engineer, 2006 WY 30, ¶ 16, 
130 P.3d 470, 475 (Wyo. 2006); 
Allied-Signal, Inc. v. Wyoming State Bd. 
of Equalization, 813 P.2d 214, 226 (Wyo. 1991).  That the 
legislature did not intend such a result is further evidenced by the 
legislature's express statement that at least part of its intention in enacting 
the Act was to ensure benefit claims would be decided on their merits.  See Wyo. Stat. Ann. § 27-14-101(b) 
(LexisNexis 2009) ("[i]t is the specific intent of the legislature that benefit 
claims cases be decided on their merits").  
The Division's proposed bright line rule, that a hernia must occur in the 
workplace and be the original work injury, disregards the merits of an actual 
causal relationship between a hernia injury and the employee's work and thus 
achieves a result opposite of that intended by the legislature.  

 
 
Quasi-Employment 
Doctrine

 
 
[¶44]   As a final matter, we address the 
Division's contention that the hearing examiner's finding of compensability was 
an improper application of the "quasi-employment doctrine" that this Court 
rejected in Bruhn.  Again, we disagree.  In Bruhn, this Court rejected the 
"quasi-employment doctrine" because it was viewed as a doctrine that would allow 
compensation for an injury that could not be fairly traced to the employee's 
work and that the employee would have been equally exposed to outside of the 
employment.  Bruhn, 951 P.2d  at 377.  This is not a concern in the present 
case.

 
 
[¶45]   The hearing examiner applied the 
clear and convincing burden of proof required by the hernia statute and found 
Ball had met this elevated burden.  
He found Ball had presented clear and convincing proof of the causal link 
between the malfunction of his spinal stimulator, which was implanted to treat 
the original work injury, and his subsequent fall and hernia.  Because the Division does not contest 
this finding, it cannot suggest that the concern we expressed in Bruhn is at play in this case.  The harm to which Ball was exposed was 
one that occurred only because of the medical treatment he received for a work 
injury.  The medical treatment Ball 
received for his work injury caused his hernia, and the hernia was therefore a 
compensable second injury.  See Rodgers v. State ex rel. Wyoming Workers' 
Safety & Comp. Div., 2006 WY 
65, ¶ 53, 135 P.3d 568, 585 
(Wyo. 2006) (holding compensable subsequent gastrointestinal problems caused by 
pain medication taken for work-related back injury).

 
 
[¶46]   The hearing examiner did not rely 
on the quasi-employment doctrine in finding a causal connection between Ball's 
original work injury and his hernia.  
There was, therefore, no error related to that doctrine.  

 
 
CONCLUSION

 
 
[¶47]   The hearing examiner's finding that 
the authorized medical treatment for Ball's original work injury caused his 
subsequent hernia is uncontested, and the district court erred in holding that 
benefits were barred on the ground that the second compensable injury rule could 
not be applied.  We reverse and 
remand to the district court for a remand to the Office of Administrative 
Hearings for reinstatement of the hearing examiner's original order awarding 
benefits.  

 
 
FOOTNOTES

 
 

1The district court's decision in such cases is, however, always of help 
as an aid to our analysis and may reveal some factor not apparent to the parties 
but a subject of judicial discernment.  
Bd. of Cty. Comm'rs of Teton Cty. 
v. Teton Cty. Youth Servs., Inc., 652 P.2d 400, 421 (Wyo. 1982) 
(Raper, J., dissenting).

 
 

2We 
acknowledge the Division relied on our analysis in Corean to support its opposite 
suggestion that this Court has drawn a critical distinction between the phrases 
"arising out of" and "in the course" of employment and has held that the latter 
means during working hours and in the place of employment.  The Division's recounting of our holding 
in Corean was flawed because it 
relied on our recitation of the rulings in certain other states, without then 
considering the paragraph immediately following that recitation, quoted above in 
the text, wherein we expressly rejected that approach.  Thus, contrary to the Division's 
assertion, we have not interpreted the phrases "arising out of" and "in the 
course of" employment as having separate and distinct meanings, but have in fact 
reached the opposite conclusion.