Title: MICHELLE KENYON v. STATE OF WYOMING, ex rel. WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION

State: wyoming

Issuer: Wyoming Supreme Court

Document:

MICHELLE KENYON v. STATE OF WYOMING, ex rel. WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2011 WY 14Case Number: No. S-10-0091Decided: 02/02/2011NOTICE: This opinion is subject to formal revision before publication in Pacific Reporter Third. Readers are requested to notify the Clerk of the Supreme Court, Supreme Court Building, Cheyenne, Wyoming 82002, of any typographical or other formal errors so correction may be made before final publication in the permanent volume.
OCTOBER 
TERM, A.D. 2010

 
 

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

 
 
 
 

Appeal 
from the District Court of Sweetwater County

The 
Honorable Nena R. James, Judge

 
 
Representing 
Appellant:

Donna 
D. Domonkos, Cheyenne, Wyoming.

 
 
Representing 
Appellee:

Bruce 
A. Salzburg, Wyoming Attorney General; John W. Renneisen, Deputy Attorney 
General; James Michael Causey, Senior Assistant Attorney 
General.

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

 
 
KITE, 
Chief Justice.            

 
 
[¶1]  Michelle Kenyon sought worker's 
compensation benefits for arthroscopic right knee surgery necessitated by a 
work-related injury and for a subsequent total knee replacement.  After a contested case hearing, the 
Office of Administrative Hearings (OAH) awarded benefits for the arthroscopic 
surgery and related treatment but denied benefits for the total knee 
replacement, ruling that she did not satisfy her burden of proving that her work 
related injury necessitated that procedure.  Ms. Kenyon petitioned for judicial 
review and the district court affirmed the OAH decision.  Ms. Kenyon appealed to this Court 
claiming the OAH failed to apply the second compensable injury rule and its 
associated burden of proof, improperly found the Wyoming Worker's Compensation 
Division's (Division) expert was more persuasive than her treating physician and 
improperly determined that she was not credible.  We affirm.     

 
 
 
 
ISSUE

 
 
[¶2]      Ms. Kenyon 
presents the following issue for this Court's 
consideration:

 
 
            
Whether the Office of Administrative Hearing's Findings of Fact and 
Conclusions of Law are in accordance with the law.

 
 
 
 
FACTS

 
 

[¶3]    Ms. Kenyon has a long 
history of right knee problems.  
After she injured her right knee in a non-work related accident, Dr. 
Peter Rork, M.D., performed surgery in 1999, which included anterior 
cruciate ligament (ACL) reconstruction, 
partial lateral meniscectomy and debridement of loose cartilage.  Because she continued to experience 
pain, Dr. Rork performed a second surgery in 2000.  X-rays taken in the summer of 2000 
showed osteoarthritic changes in the right knee, and Dr. Rork instructed her to 
use a brace.    

 
 
[¶4]      On March 19, 
2006, Ms. Kenyon injured her right knee while working for Franks Westates near 
Pinedale, Wyoming.  She was working 
in the oilfield on a casing crew when she caught her foot under a vent.  In the process of trying to free her 
foot, she twisted her right knee.  
She again sought medical treatment from Dr. Rork, and he operated on her 
knee on March 29, 2006.  This time, 
he performed a partial lateral meniscectomy, debridement of loose cartilage, and 
three compartment synovectomy.   
Tests conducted at that time also showed osteoarthritic degenerative 
changes.    

 
 
[¶5]      Ms. Kenyon saw 
Dr. Rork for follow up treatment through May 2, 2006.  His notes from that appointment 
indicated that she had good days and bad days but continued to improve.  He instructed her to continue physical 
therapy and remain off work.  
Although he expected to see her for more follow up appointments, she did 
not return for approximately eighteen months.      

 
 
[¶6]      Ms. Kenyon filed 
a report of injury on April 20, 2006.  
She indicated in her report that she had previously injured and undergone 
surgery on her right knee.  On May 
16, 2006, the Division issued a final determination, denying benefits because 
her report of injury had not been filed in a timely fashion and the Division had 
not received copies of the medical records from her preexisting injury.  Ms. Kenyon objected to the final 
determination and requested a hearing.1   

 
 
[¶7]      When Ms. Kenyon 
finally saw Dr. Rork again in November 2007, she reported that she was 
experiencing increasing discomfort in her right knee.  The radiological evaluations showed 
"significant osteoarthritic changes" in Ms. Kenyon's knee.  Dr. Rork stated in his notes that he 
believed Ms. Kenyon would eventually need a total knee arthroplasty (total knee 
replacement).  With regard to the 
cause of the potential total knee replacement, Dr. Rork stated:  

 
 
She 
had knee arthroscopy and debridement on March 29 and never really bounced back 
from that.  I believe that I am not 
able to say with confidence that she would have ended up at this point without 
the work-related injury, but I am able to say with confidence that she is here 
because of the work-related injury.  
She will need a total knee arthroplasty.  She has a hearing with worker's 
compensation and we will contact her attorney at her request concerning the 
same.  

 
 
Dr. 
Rork performed a total knee replacement on July 9, 2008.  Ms. Kenyon requested workers' 
compensation benefits for that procedure as well as for the March 2006 surgery, 
and the Division maintained she was not entitled to benefits for either 
procedure.    

 
 
[¶8]      At the contested 
case hearing held on December 3, 2008, Ms. Kenyon testified and presented the 
deposition testimony of Dr. Rork.  
The Division submitted a report prepared by Paul Ruttle, M.D., who had 
performed an orthopedic medical evaluation of Ms. Kenyon and reviewed her 
medical records.  The OAH left the 
evidence open at the conclusion of the hearing because Dr. Ruttle was scheduled 
to be deposed later.  The hearing 
was reconvened on February 11, 2009, at which time Dr. Ruttle's deposition 
transcript and Dr. Rork's written response to Dr. Ruttle's testimony were 
admitted into evidence.     

 
 
[¶9]      The OAH issued a 
decision in which it awarded benefits for the "acute" injury and associated 
surgery in March 2006, but denied benefits for the total knee replacement in 
July 2008, concluding that procedure was not related to the work injury.  Ms. Kenyon petitioned the district court 
for review, and it affirmed the OAH decision.  She then appealed to this Court.       

 
 
STANDARD 
OF REVIEW

 
 
[¶10]   On appeal from a district court's 
review of an administrative agency's decision, we review the case as if it had 
come directly from the agency and do not give any deference to the district 
court's decision.  Dutcher v. State ex rel. Wyo. Workers' 
Safety & Comp. Div., 2010 WY 10, ¶ 9, 223 P.3d 559, 561 (Wyo. 2010); 
Dale v. S & S Builders, LLC, 2008 WY 84, ¶ 8, 188 P.3d 554, 557 (Wyo. 
2008).  Our review is governed by 
Wyo. Stat. Ann. § 16-3-114(c) (LexisNexis 2009):

 
 
(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.

 
 
            

[¶11]   In accordance with § 16-3-114(c), 
we review the agency's findings of fact by applying the substantial evidence 
standard.  Dale, ¶ 22, 188 P.3d  at 561.  Substantial evidence means "such relevant evidence 
as a reasonable mind might accept as adequate to support a conclusion."  Bush v. State ex rel. Wyo. Workers' 
Comp. Div., 2005 WY 120, ¶ 5, 120 P.3d 176, 179 (Wyo. 2005) (citations 
omitted).  "Findings of fact are 
supported by substantial evidence if, from the evidence 
preserved in the record, we can discern a rational premise for those findings." 
 Id.    

 
 
[¶12]   With regard to an agency 
determination that the claimant did not satisfy her burden of proof, we have 
said:

 
 
If 
the hearing examiner determines that the burdened party failed to meet his 
burden of proof, we will decide whether there is substantial evidence to support 
the agency's decision to reject the evidence offered by the burdened party by 
considering whether that conclusion was contrary to the overwhelming weight of 
the evidence in the record as a whole. If, in the course of its decision making 
process, the agency disregards certain evidence and explains its reasons for 
doing so based upon determinations of credibility or other factors contained in 
the record, its decision will be sustainable under the substantial evidence 
test.  Importantly, our review of 
any particular decision turns not on whether we agree with the outcome, but on 
whether the agency could reasonably conclude as it did, based on all the 
evidence before it.

 

Dale, 
¶ 
22, 188 P.3d  at 561 (citations omitted).  

 
 

[¶13]   "We review an agency's conclusions 
of law de novo, and will affirm only if the 
agency's conclusions are in accordance with the law."  Moss v. State ex rel. Wyo. Workers' Comp. 
Div., 2010 WY 66, ¶ 11, 232 P.3d 1, 4 (Wyo. 2010); Dale, ¶ 26, 188 P.3d  at 
561-62.

 
 
 
 
DISCUSSION

 
 
[¶14]   Although Ms. Kenyon's stated issue 
is general, her appellate brief includes several arguments that the OAH decision 
was erroneous, including: the hearing examiner failed to identify and apply the 
second compensable injury rule and its associated burden of proof; the hearing 
examiner incorrectly accepted the Division's expert's medical opinion instead of 
her treating physician's opinion; and the hearing examiner improperly concluded 
that she was not a credible witness.

  

1.    
Second 
Compensable Injury/Burden of Proof

 
 
[¶15]   Ms. Kenyon asserts that the OAH 
erred as a matter of law by failing to apply the second compensable injury rule 
and its associated burden of proof, which she claims is more lenient than the 
preponderance of the evidence burden applied by the agency.2  The second compensable injury rule was 
recently described by this Court in State 
ex rel. Wyo. Workers' Safety & Comp. Div. v. Kaczmarek, 2009 WY 110, ¶ 
9, 215 P.3d 277, 281 (Wyo. 2009):

 
 
            
Wyoming law has long recognized that a single incident at work can give 
rise to more than one compensable injury. See Baldwin v. Scullion, 50 
Wyo. 508, 62 P.2d 531, 539 (1936). This principle, referred to as the second 
compensable injury rule, applies when "an initial compensable injury ripens into 
a condition requiring additional medical intervention." Yenne-Tully v. State 
ex rel. Wyo. Workers' Safety & Comp. Div., 12 P.3d 170, 172 (Wyo. 
2000).

 
 
[¶16]   The issues considered by the OAH in 
this case were whether the acute injury and resulting surgery in March 2006 and 
the subsequent total knee replacement in 2008 were the result of Ms. Kenyon's 
work injury on March 19, 2006, or the result of a preexisting knee 
condition.  The OAH ruled that the 
2006 injury and treatment were related to the work accident and therefore 
compensable, but the 2008 total knee replacement was related to her preexisting 
condition and not compensable.

 
 
[¶17]   Preexisting conditions are excluded 
from the definition of compensable injury:

 
 
            
(xi)       
"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. 
"Injury" does not include:

            
. . . .

                        
(F) Any injury or condition preexisting at the time of employment with 
the employer against whom a claim is made[.]

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

 
 
[¶18]   However, an employee who has a pre-existing condition may still 
recover if her "employment aggravated, accelerated, or combined with the disease 
or infirmity to produce the death or disability for which compensation is 
sought."  Dutcher, ¶ 14, 223 P.3d  at 562, citing 
Lindbloom v. Teton Int'l, 684 P.2d 1388, 1389 (Wyo. 1984) and Larson's Workmen's Compensation Law.  "To prove 
aggravation of a preexisting 
condition, a claimant must demonstrate by a preponderance of the evidence that 
the work contributed to a material degree to the aggravation of the condition. 
 State ex rel. Wyo. Workers' 
Safety & Comp. Div. v. Slaymaker, 2007 WY 65, ¶ 14, 156 P.3d 977, 981-82 
(Wyo. 2007)."  Dutcher, ¶ 15, 223 P.3d  at 
562.

 
 
[¶19]   The OAH made the following relevant 
conclusions regarding Ms. Kenyon's preexisting knee condition and her March 19, 
2006, injury: 

 
 
            
67.       
The undisputed evidence at [the] hearing proved Kenyon suffered from a 
significant preexisting right knee condition prior to the March 19, 2006 
incident.  Kenyon had undergone two 
surgeries and been instructed to wear a knee brace to alleviate [her] right knee 
pain.

            
68.       The evidence is equally 
clear that Kenyon had returned to her normal activities and had been performing 
very physical employment for the years prior to her March 19, 2006 
incident.

. 
. . .

            
71.       
[T]his Office finds the only evidence at [the] hearing proved Kenyon 
suffered an[] acute exacerbation of her pre-existing right knee condition during 
the March 19, 2006 incident.  Both 
Dr. Rork and Dr. Ruttle opined Kenyon had suffered a right knee injury while in 
the course and scope of her [work] duties . . . . 

            
72.       
On March 29, 2006, Dr. Rork performed minor arthroscopic surgery to 
repair Kenyon's acute injury, and also addressed problems associated with 
Kenyon's chronic osteoarthritis which was most likely caused by Kenyon's 
original 1998 right knee injury.  

 
 
            
73.  Kenyon underwent a short 
course of physical therapy and was seen by Dr. Rork on three follow-up 
visits.  Kenyon discontinued her 
treatment with Dr. Rork as of May 2, 2006.  

            
74.       
Kenyon was able to golf and fish and hike after the May 2, 2006 
examination.  This Office finds, as 
Dr. Ruttle opined and the evidence indicated, Kenyon had recovered from her 
March 19, 2006 minor acute injury as of May 2, 2006 when she ceased treatment 
with Dr. Rork.  

 
 
As 
to the treatment associated with the total knee replacement, the OAH 
concluded:

 
 
            
76.       
The undisputed evidence provided Kenyon sought no right knee medical 
treatment from May 2, 2006 until November 6, 2007 when she returned to Dr. Rork 
complaining of continued right knee pain.  
During the November 6, 2007 examination, Dr. Rork noted Kenyon was 
suffering from significant osteoarthritis and that Kenyon had never recovered 
from her March 29, 2006 surgery.   

            
77.       
Kenyon admitted she sought no right knee treatment for eighteen months, 
but testified she suffered continued pain throughout the period.  As explained above, Kenyon's testimony 
regarding her continued pain after May 2, 2006 was not credible.  It must also be noted, Kenyon returned 
to her every day activities such as frequent golfing and taking care of her 
horses without needing additional treatment.  

            
78.       
Kenyon sought no further treatment from Dr. Rork until February 1, 2008 
when she returned complaining of right knee pain aggravated by activity but 
relieved by rest.   

            
79.       
In May, 2008, Kenyon subsequently sought right knee treatment in Utah 
which was reportedly caused by Kenyon golfing.  In late June 2008, Kenyon suffered yet 
another right knee injury stepping into a boat while on a fly fishing 
outing.  Dr. Rork was not aware of 
Kenyon's intervening incidents and based his opinion solely on Kenyon's limited 
history.

 
 
[¶20]   Under the second compensable injury 
rule, Ms. Kenyon would be entitled to benefits for the total knee replacement if 
the injury incurred at work on March 19, 2006, ripened into the condition 
requiring total knee replacement.   
It is clear that the hearing examiner considered whether the total knee 
replacement was caused by her 2006 injury (thus, a second compensable injury) or 
her preexisting condition.  
Regardless of whether the issue was phrased in terms of a second 
compensable injury ruling or not, the OAH considered the proper question in this 
case.  

 
 
[¶21]   Ms. Kenyon also argues that the OAH 
erred by applying the preponderance of the evidence burden of proof.  She claims that Pino v. State ex rel. Wyo. Workers' Safety 
& Comp. Div., 996 P.2d 679, 685 (Wyo. 2000) and Kaczmarek, ¶ 11, 215 P.3d  at 282-83, 
indicate that the second compensable injury rule imposes a more lenient burden 
of proof, i.e., the claimant must demonstrate it is "more probable than not" 
that the first and second injury are causally related.      

 
 
[¶22]   As the OAH recognized, a claimant 
generally has the burden of proving each of the essential elements of her claim 
by a preponderance of the evidence.  Dale, ¶ 35, 188 P.3d  at 563; Sherwin-Williams Co. v. Borchert, 994 P.2d 959, 963 
(Wyo. 2000). "As a part of that burden, the claimant must prove a causal 
connection exists between a work-related injury and the injury for which 
worker's compensation benefits are being sought."  Id.  
The definition of "preponderance of the evidence" is 
"proof which leads the trier of fact to find that the 
existence of the contested fact is more probable than its non-existence."  Judd v. State ex rel. Wyo. Workers' Safety 
& Comp. Div., 2010 WY 85, ¶ 
31, 233 P.3d 956, 968 (Wyo. 2010), quoting Anastos v. General Chemical Soda 
Ash, 2005 WY 122, ¶ 20, 120 P.3d 658, 665-66 (Wyo. 2005).  We recognized that "preponderance of the 
evidence" is the same as "more probable than not" in Kaczmarek, ¶ 11, 215 P.3d  at 282-83 when 
we referred to the burden of proof for a second compensable injury using both 
phrases.  Thus, the burden of 
proof for a second compensable injury is no different than the burden applied to 
all claimants to show the causal connection between their injuries and their 
work.  

 
 
[¶23]   Ms. Kenyon may have gotten the idea 
that the second compensable injury burden of proof is more lenient from Kaczmarek and Yenne-Tully v. Workers' Safety & Comp. 
Div., 12 P.3d 170 (Wyo. 2000).  
In Kaczmarek, ¶ 11, 215 P.3d  
at 282, we distinguished between the preponderance of the evidence burden of 
proof which applies to second compensable injuries and the more onerous burden 
of proof for modification of benefits under Wyo. Stat. Ann. § 27-14-605 
(LexisNexis 2009).  Under § 
27-14-605, the claimant must prove "to a reasonable degree of medical 
certainty' that the increase or decrease in capacity is due solely to the 
injury.'"  Id., quoting Wyo. Stat. Ann. § 
27-14-605(a) & (c)(ii).  See also, Casper Oil Co. v. Evenson, 
888 P.2d 221, 225 (Wyo. 1995).  
In Yenne-Tully, 12 P.3d  at 
172, we distinguished between the second compensable injury burden and higher 
standard of proof for an injury which occurs over a substantial period of time 
under Wyo. Stat. Ann. § 27-14-603.    

 
 
[¶24]   The hearing examiner in this case 
repeatedly stated that Ms. Kenyon was obligated to prove the causal connection 
between her injury and the employment "by a preponderance of the evidence."  Therefore, we conclude the OAH applied 
the correct burden of proof.  

 
 

2.    
 Substantial Evidence Review of OAH 
Factual Findings

 
 
[¶25]   We turn now to the OAH's factual 
findings.  Ms. Kenyon claims the 
hearing examiner's decision to accept Dr. Ruttle's opinion over her treating 
physician, Dr. Rork's, opinion is not supported by substantial evidence. When conflicting medical opinions are presented at the 
contested case hearing, the agency has the

 
 
responsibility, 
as the trier of fact, to determine relevancy, assign probative value, and 
ascribe the relevant weight given to the evidence presented. Clark v. State 
ex rel. Wyoming Workers' Safety & Compensation Div., 934 P.2d 1269, 1271 
(Wyo. 1997). The [agency] is in the best position to judge and weigh medical 
evidence and may disregard an expert opinion if it finds the opinion 
unreasonable or not adequately supported by the facts upon which the opinion is 
based. Id.; Matter of Goddard, 914 P.2d 1233, 1238 (Wyo. 
1996).

 
 

Spletzer 
v. State ex rel. Wyo. Workers' Safety & Comp. Div., 
2005 WY 90, ¶ 21, 116 P.3d 1103, 1112 (Wyo. 2005). We do not re-weigh the 
evidence, but defer to the agency's decision so long as it is based on relevant 
evidence that a reasonable mind might accept as supporting that decision. 
Id., ¶ 22, 116 P.3d  at 1112.

 
 
 
 

Chavez 
v. State ex rel. Wyo. Workers' Safety & Comp. Div., 2009 
WY 46, ¶ 18, 204 P.3d 967, 971 (Wyo. 2009).   

 
 
[¶26]   The OAH recognized that the 
determining factor on the issue of whether or not Ms. Kenyon's total knee 
replacement was related to her work injury was the physicians' opinions.  With regard to those opinions, the 
hearing examiner concluded:

 
 
            
80.       
This Office must weigh the opinions offered by Dr. Rork and Dr. Ruttle 
under the Baxter3 standards.  This Office finds that all the 
physicians are highly qualified and well trained professionals.  This Office also finds that each 
physician's opinion is equally unequivocal.  Thus, this Office must weigh the history 
and reasoning behind the opinions.  

            
81.       
Dr. Rork admitted that Kenyon's need for treatment in November 2007 and 
subsequent July 9, 2008, total [knee replacement] was caused by Kenyon's 
osteoarthritis which had been present prior to Kenyon's March 19, 2006 work 
injury; however, Dr. Rork believe[d] that Kenyon's March 19, 2006 work injury 
was an aggravating factor in Kenyon's ultimate need for total knee 
replacement.  Dr. Rork did not 
adequately explain how he determined that Kenyon's March 19, 2006 acute right 
knee injury caused the extensive osteoarthritis, which was noted as early as 
July 2000, and which led to the July 8, 2008 arthroplasty, but just blankly 
asserted it was . . . "probably what tipped her over the edge."  

            
82.       
Dr. Rork did not have a good history as to how Kenyon was injured on 
March 19, 2006 and in fact admitted he had no understanding of what Kenyon was 
doing at the time of the alleged work injury.  Dr. Rork further did not explain why he 
stated Kenyon had never recovered after the March 29, 2006 surgery, when there 
was a break in treatment for eighteen months.  Further, Dr. Rork did not know of 
Kenyon's May 2008 golfing incident or Kenyon's June 2008 boating incident.  Reviewing the record, Dr. Rork had 
almost no information regarding Kenyon's recovery and activities between May 
2006 and the July 2008 arthroplasty, but rather Dr. Rork based his entire 
opinion on Kenyon's unsubstantiated statement she never healed after the March 
29, 2006 surgery.

            
83.       
Dr. Ruttle, on the other hand, had a more complete understanding of 
Kenyon's history.  Dr. Ruttle 
summarized pages of Kenyon's medical records, performed an examination focused 
on the cause of Kenyon's need for treatment and obtained a very detailed history 
from Kenyon.  Dr. Ruttle noted that 
Kenyon's 1999 surgery was more extensive and required a second surgery followed 
by months of knee pain, whereas? Kenyon's March 29, 2006 surgery was rather 
minor and after six weeks Kenyon discontinued all treatment.  Dr. Ruttle knew of Kenyon's intervening 
injuries and also used the objective evidence in arriving at his conclusion that 
Kenyon had recovered from her March 19, 2006 acute injury as of May 2, 2006 and 
that Kenyon's treatment from November 6, 2007 forward was not related to the 
March 19, 2006 incident.  Dr. Ruttle 
thoroughly explained the basis for his opinion and did not rely totally on 
Kenyon's unsubstantiated and less than credible history.  Additionally, Dr. Ruttle based his 
opinion on published and accepted medical research covering the cause of 
osteoarthritis in knees.

            
84.       
Using the Baxter factors, this 
Office finds the opinion of Dr. Ruttle more persuasive than the opinion of Dr. 
Rork.  Dr. Ruttle had a more 
thorough history and had a complete understanding of Kenyon's March 19, 2006 
injury.  Further, Dr. Ruttle 
thoroughly explained his opinion and supported his findings with established and 
accepted medical journals.  

            
85.       
Accordingly, this Office finds Kenyon failed to prove that her November 
6, 2007 treatment and subsequent July 9, 2008 right knee arthroplasty was caused 
by or related to her March 19, 2006 acute knee injury.  

 
 
[¶27]   Taking aim at specific aspects of 
the hearing examiner's decision, Ms. Kenyon claims the hearing examiner should 
not have accepted Dr. Ruttle's reasoning that she had recovered from her March 
2006 work related injury on the grounds that she did not seek treatment for her 
injury for a year and a half.  She 
claims Dr. Ruttle did not take into account that she was incarcerated for five 
of those months.  Besides the 
obvious problem with this argumenta five month period of incarceration does not 
explain the eighteen month lapse in treatment, there is nothing in the record 
indicating that Ms. Kenyon could not have sought treatment for her knee if she 
needed it while she was incarcerated.  

 
 
[¶28]   Furthermore, there were other 
reasons Dr. Ruttle believed that Ms. Kenyon had recovered from her work injury 
by the time she needed the total knee replacement.  He described the relatively minor nature 
of the 2006 injury and surgery and how that compared with the more serious 
injury and surgeries in 1999 and 2000.  
He emphasized that, with the earlier injury, she sought medical treatment 
when the knee continued to bother her after the surgery.  He contrasted that to the fact that she 
did not seek medical treatment for pain after she recovered from the 2006 
surgery.  Dr. Ruttle also noted that 
she lived a fairly active lifestyle after the 2006 surgery, including playing 
golf on a regular basis.  Dr. 
Ruttle's opinion that Ms. Kenyon had recovered 
from her 2006 work related injury was reasonable and 
adequately supported by the facts in the record.  See Chavez, ¶ 18, 204 P.3d  at 971.  As such, there is substantial 
evidence to support the OAH adoption of his opinion in that regard.  

 
 
[¶29]   Next, Ms. Kenyon faults the OAH for 
accepting Dr. Ruttle's opinion because it was "based on published and accepted 
medical research covering the cause of osteoarthritis in the knee."  Dr. Ruttle's report included the 
following statement:  

 
 
Recent 
work in orthopedic literature has also suggested that despite successful, 
stabilizing[] anterior cruciate reconstruction, patients with reconstructed 
anterior cruciate ligament[s] may develop arthritis within the involved 
knee.   

 
 
Dr. 
Ruttle testified about the literature at his deposition.  He referenced several articles 
indicating that patients who had ACL reconstruction and meniscetomy have a 
higher incidence of osteoarthritis than patients who did not.    

 
 
[¶30]   Initially, we observe that, 
although the hearing examiner mentioned Dr. Ruttle's statements about the 
literature in a couple of instances, he did so only briefly and that did not 
appear to be his primary consideration in accepting Dr. Ruttle's opinion over 
Dr. Rork's.  Instead, it was simply 
another fact to support Dr. Ruttle's opinion that Ms. Kenyon's osteoarthritis 
which necessitated the total knee replacement was the result of her earlier 
injury rather than the 2006 work related injury.  Dr. Rork's report also included an 
extensive rendition of Ms. Kenyon's medical history and medical records and the 
results of his physical examination of her.  The record, therefore, contains relevant evidence that a reasonable mind might accept as 
adequate to support a conclusion.  
Dale, ¶ 22, 188 P.3d  at 
561.

 
 
[¶31]   Ms. Kenyon also criticizes the OAH 
finding that Dr. Ruttle's opinion was more persuasive because he was aware that 
Ms. Kenyon had suffered some intervening injuries between the 2006 surgery and 
the 2008 total knee replacement, while Dr. Rork's testimony did not indicate 
that he was aware of those incidents.  
This argument is referring to Dr. Ruttle's remark that Ms. Kenyon 
experienced pain and swelling in May 2008 after playing golf and in June 2008 
when she stepped into a boat while fishing.   She maintains it was not appropriate to 
discount Dr. Rork's opinion on the basis that he did not know about the 
incidents because they occurred after he was deposed in February 2008.  However, the OAH allowed Dr. Rork to 
provide a response to Dr. Ruttle's deposition testimony and report after the 
contested case hearing.  Although 
Dr. Rork provided an e-mail response, which was admitted into evidence, he did 
not address the intervening injuries.  
Thus, the OAH did not err by considering the fact that Dr. Ruttle took 
the intervening injuries into account in rendering his opinion and Dr. Rork did 
not.  

 
 
[¶32]   Ms. Kenyon maintains that her 
situation is comparable to that presented in Judd, 2010 WY 85, 233 P.3d 956.  Ms. Judd suffered from preexisting 
degenerative arthritis in her knee, but was working full time as a physical 
therapy aide until she tripped and fell at work, injuring her knee.  She had arthroscopic surgery, which the 
division covered.  However, she 
never recovered her ability to put weight on the knee and eventually underwent 
total knee replacement.  Id., ¶¶ 4-7, 34, 233 P.3d  at 959, 
969.  The Medical Commission denied 
benefits, reasoning that the preexisting condition, rather than the fall, 
necessitated the total knee replacement.  
Id., ¶ 23, 233 P.3d  at 
966-67.  In making that 
determination, the commission relied on the medical opinions of two independent 
evaluators instead of Ms. Judd's treating physician.  The independent evaluators had concluded 
that "because the fall did not change the underlying knee pathology, that is 
physically alter the degenerative arthritis, and because Judd's total knee 
replacement surgery was inevitable, there was no material aggravation of the 
preexisting condition."  Id., ¶ 35, 233 P.3d  at 970.    

 
 
[¶33]   We reversed, concluding that Ms. 
Judd had satisfied her burden of proving a work related material aggravation of 
her preexisting condition had led to the total knee replacement.  We stated that the commission erred by 
relying on the independent evaluators' opinions because there is no requirement 
in Wyoming law that the underlying pathology must change in order to find a 
material aggravation of a preexisting condition.  It was significant, in our view, that 
her physical condition and abilities changed dramatically after her fall and she 
did not recover until after the knee replacement surgery was performed.  Id., ¶¶ 34-38, 233 P.3d  at 969-71.  See also, Slaymaker, 2007 WY 65, 156 P.3d 977.   

 
 
[¶34]   
Judd is readily distinguishable from the case at bar because the 
evidence clearly showed that Ms. Judd had not recovered from her work related 
injury when she underwent the total knee replacement.  In fact, she was unable to put weight on 
the knee until after the knee replacement surgery.  Here, it reasonably can be concluded 
that Ms. Kenyon recovered after her 2006 injury and surgery and it was clear she 
went for eighteen months without medical treatment before returning to Dr. Rork 
for her total knee replacement.    

 
 
[¶35]   The present case is very similar to 
Chavez.  Mr. Chavez injured his back at work 
in 1989.  He had surgery on his back 
in 1991, and the division paid for that treatment.  Mr. Chavez had a second surgery in 2006, 
but the division denied benefits for that surgery, reasoning that it was not 
related to his 1989 work injury.  Id., ¶¶ 3-4, 204 P.3d  at 968-69.  The hearing examiner considered the 
testimony of Mr. Chavez's treating physician, who testified the 2006 surgery was 
related to the 1989 work injury, and Dr. Ruttle, who testified the surgery was 
not related to the work injury but was instead "due to the recurrence of what 
was a chronic, preexisting problem."  
Id., ¶¶ 13-16, 204 P.2d  at 
970-71.  The Medical Commission 
accepted Dr. Ruttle's opinion over the treating physician's, and we concluded 
there was substantial evidence in the record to support that choice.  Id., ¶ 19, 204 P.3d  at 971-72.  In affirming the Medical Commission, we 
recognized that, in its decision, it had "noted several reasons for affording 
more weight" to Dr. Ruttle's opinion than to Mr. Chavez's treating physician's 
and those reasons were supported by the medical evidence.  In particular, the record established 
that Mr. Chavez had "recovered" and "got better" after his 1989 injury and he 
told his treating physician that his back pain was long standing and did not 
identify the 1989 incident as the cause of his pain.  Id., ¶¶ 17-19, 204 P.3d  at 971-72.           

 
 
[¶36]   As in Chavez, the OAH's decision included a 
detailed review of Dr. Rork's and Dr. Ruttle's medical opinions and a careful 
explanation of why it accepted Dr. Ruttle's opinion instead of Dr Rork's.  The underlying facts, including the 
lapse in medical treatment, Ms. Kenyon's active lifestyle after the 2006 
surgery, and the medical evidence showing that she had significant preexisting 
osteoarthritis supported Dr. Ruttle's opinion that her preexisting condition, 
rather than the 2006 injury, led to her total knee replacement.  The OAH decision to accept Dr. Ruttle's 
opinion over Dr. Rork's was "based on relevant 
evidence that a reasonable mind might accept as supporting that decision."  Id., ¶ 18,  204 P.3d  at 971, citing  Spletzer,  ¶ 22, 116 P.3d  
at 1112.  

 
 
[¶37]   Finally, Ms. Kenyon challenges the 
OAH determination that she was not entirely credible.  The hearing examiner made the following 
factual findings:

 
 
            
19.       At [the] hearing, 
Kenyon was very evasive in answering questions about her treatment after the 
March 29, 2006 right knee surgery, but eventually admitted she only had three 
follow-up visits with Dr. Rork.  
Kenyon claimed that although she quit receiving medical treatment, her 
knee never recovered.

            
20.       
Kenyon alleged she was in constant pain, but was performing physical 
therapy at home because [of] her continued knee pain.

            
21.       
Kenyon testified that she had been active all her life . . . .  Kenyon alleged she was never able to 
return to her normal life activities after the March 29, 2006, surgery but could 
not explain why she had completely ceased treatment if she was still suffering 
significant pain.

            
22.       
During her cross-examination, Kenyon admitted that for a portion of time 
after she ceased medical treatment in May 2006 and before she returned for 
treatment in November 2007, Kenyon was incarcerated. 

            
23.       
When questioned as to the cause of her incarceration, Kenyon again was 
extremely evasive and had to be directed to answer the questions.  Kenyon claimed she was jailed for "a 
probation violation" but would not initially expound.

            
24.       
When ordered to thoroughly answer, Kenyon eventually admitted to having 
been convicted of theft in 2003, which is a crime of dishonesty.  Kenyon attempted to minimize her crime 
by claiming she was convicted "of stealing her own money back from an abusive 
ex-boyfriend."

            
25.       
Kenyon admitted that, at the time of the hearing, she was still on 
probation, even after serving five months in county jail for her prior probation 
revocation.  Throughout all the 
questioning regarding her conviction, Kenyon was evasive and provided incomplete 
and what appeared less than truthful answers.

            
26.       
Kenyon also admitted on cross examination, grudgingly, that she only 
sought additional right knee treatment after an incident where she fell out of a 
boat and when she realized golfing caused additional pain in her right 
knee.  Again, Kenyon attempted to 
minimize that any activities were the cause of her pain and added that all her 
pain she associates with the March 19, 2006 work injury.  

  

Based 
upon these findings, the hearing examiner concluded:

 
 
            
53.       
This Office must first address the credibility of Kenyon as a 
witness.  This Office found Kenyon 
to be a less than completely credible witness, but not so unbelievable that all 
of her testimony was rendered useless.  
Kenyon attempted to evade many questions and had to be instructed to 
answer the questions posed.  
Kenyon's demeanor and actions were more indicative of a witness 
attempting to mislead or not provide complete information.  Kenyon would stare down at the floor, 
look away from the hearing examiner, roll her eyes and otherwise appear less 
than honest.  

            
54.       
That being said, Kenyon's testimony in some manner was confirmed by the 
contemporaneously prepared medical records and therefore this Office was able to 
determine that at least some of Kenyon's testimony was credible; however, her 
testimony regarding her criminal history, her continued pain after the March 29, 
2006, surgery and her inability to return to normal activities was not 
believable.  

            
 

[¶38]   Ms. Kenyon argues that the hearing 
transcript does not indicate that she had to be instructed to answer questions 
more thoroughly.  After reviewing 
the transcript, we agree that Ms. Kenyon was not overtly ordered or instructed 
by the hearing examiner to answer the questions more thoroughly.  However, it does appear that her answers 
were, at times, evasive and not entirely forthcoming.  Moreover, the hearing examiner was in 
the room with Ms. Kenyon.  He had the opportunity to observe the witness and hear her 
testimony and was, therefore, "in the best position to judge [her] demeanor, 
truthfulness and veracity. . . .  
For this reason, we defer 
to the fact-finder on credibility findings."  Herrera v. State ex rel. Wyo. Workers' 
Safety & Comp. Div., 2010 WY 103, ¶ 15, 236 P.3d 277, 282 (Wyo. 2010). 
Under these circumstances, we defer to the hearing examiner's findings 
that Ms. Kenyon was not completely credible and conclude there was substantial 
evidence to support them. 

 
 
[¶39]   Affirmed.       

 
 
FOOTNOTES

 
 

1The administrative proceedings were delayed numerous times.  The record indicates that Ms. Kenyon's 
attorneys had a difficult time contacting her and, at some point, she was 
incarcerated for five months. 

 
 

2Ms. Kenyon did not raise the second compensable injury rule at the agency 
level.  We generally do not address 
arguments raised for the first time on appeal.  However, we recognized in Carabajal v. State ex rel. Wyo. Workers' 
Safety & Comp. Div., 2005 WY 119, ¶¶ 20-21, 119 P.3d 947, 954 (Wyo. 
2005), that the application of the correct burden of proof falls within an 
exception to the rule because it is fundamental in nature.  Thus, we addressed the legal issue of 
whether the second compensable injury rule should have been applied in Carabajal even though it was not 
specifically raised until appeal.  
Id.    

 
 

3The OAH was presumably referring to the following statements from Baxter v. Sinclair Oil Corp., 2004 WY 
138, ¶ 9, 100 P.3d 427, 431 (Wyo. 2004):

 
 
"When 
presented with medical opinion testimony, the hearing examiner, as the trier of 
fact, is responsible for determining relevancy, assigning probative value, and 
ascribing the relevant weight to be given to the testimony." Bando 
v. Clure Bros. Furniture, 
980 P.2d 323, 329 (Wyo. 1999). "In weighing the medical opinion testimony, the fact 
finder considers: (1) the opinion; (2) the reasons, if any, given for it; (3) 
the strength of it; and (4) the qualifications and credibility of the witness or 
witnesses expressing it." Id. 
at 329-30.