Title: IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF: SHEILA MAE BOYCE V. STATE OF WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION

State: wyoming

Issuer: Wyoming Supreme Court

Document:

IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF: SHEILA  MAE BOYCE V. STATE OF WYOMING, ex rel.,  WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2005 WY 9105 P.3d 451Case Number: 04-54Decided: 02/01/2005
 
OCTOBER 
TERM, A.D. 2004

 
 
                                                                                                            

 
 
IN THE 
MATTER OF THE WORKER'S

COMPENSATION 
CLAIM OF:

 
 
SHEILA  MAE BOYCE,

 
 
Appellant

(Petitioner),

 
 
v.

 
 
STATE OF 
WYOMING, ex rel., WYOMING

WORKERS' 
SAFETY AND COMPENSATION

DIVISION,

 
 
Appellee

(Respondent).

 
 
 
 

Appeal 
from the DistrictCourtofSubletteCounty

The 
Honorable Nancy Guthrie, Judge

 
 

Representing 
Appellant:

            
David M. Gosar of Gosar Law Office, Jackson, Wyoming. 

 
 

Representing 
Appellee:

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

 
 
 
 
Before 
HILL, C.J., and GOLDEN, KITE and VOIGT, JJ., and KAUTZ, 
DJ.

 
 
 
 
 
 
KITE, 
Justice.

 
 
[¶1]      Claiming that her 
work activities materially aggravated a preexisting condition in her foot, 
Sheila M. Boyce filed a claim for workers' compensation benefits.  The Wyoming Workers' Compensation 
Division (the Division) denied her claim, she objected and, after a hearing, the 
Office of Administrative Hearings (OAH) also denied her claim, finding that Ms. 
Boyce did not meet her burden of proving her work activities substantially or 
materially aggravated her preexisting condition.  Ms. Boyce appealed to the district 
court, which affirmed the denial of benefits, and she now appeals to this 
court.  We 
reverse.

 
 
 
 

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

 
 
The 
decision denying Workers' Compensation coverage is based on an incorrect 
interpretation and application of Wyoming law.  It is not necessary for the 
employee/claimant's physicians to testify using the words, "material," 
"substantial," or some other equivalent term, in regard to whether the 
employee/claimant's pre-existing condition was materially or substantially 
aggravated by work conditions, but rather, medical and other evidence must be 
sufficient to prove material aggravation.

 
 
The 
Division phrases the issues as follows:

 
 
I.          
The Workers' Compensation Act excludes preexisting conditions from the 
definition of compensable injuries.  
However, a claimant may be eligible for workers' compensation benefits if 
a preexisting condition is materially aggravated by an accident during 
employment and the claimant proves this fact by a preponderance of the 
evidence.  The hearing examiner 
determined Ms. Boyce failed to meet this burden of proof.  Was the hearing examiner's decision in 
accordance with Wyoming workers' compensation 
law?

 
 
II.          
The hearing examiner determined that Ms. Boyce's medical problems were 
not due to a material aggravation of her preexisting condition during her 
employment   with  Gibralter  Holdings,  LLC.    Is  the 

            
hearing examiner's decision denying benefits supported by substantial 
evidence?

 
 
 
 

[¶3]      In February 2001, 
Ms. Boyce received a cortisone injection in her right foot for treatment of bone 
spurs and heel pain.  Four to five 
months later, in July 2001, she began employment with Gibralter Holdings, LLC, 
which was building a new Super 8 Motel in Pinedale, Wyoming.  
Until the motel opened for business in late September 2001, Ms. Boyce 
worked out of her home hiring employees and ordering supplies.  In August and September of 2001, while 
she was working out of her home, Ms. Boyce sought further treatment for her heel 
condition.  When the motel 
subsequently opened, Ms. Boyce worked at the motel as the head of 
housekeeping.  Her duties included 
inspecting guestrooms, doing laundry, supervising the cleaning staff and 
maintaining the breakfast room.  
During the time she was performing these duties, the condition of her 
foot grew progressively worse. 

 
 
[¶4]      In January and 
February 2002, Ms. Boyce again sought treatment for her heel problems.  By this time, her heel condition had 
worsened to the degree that she frequently was unable to perform room 
inspections.  In February, doctors 
placed her foot in a cast and she was told she would need surgery.  She was terminated from her employment 
on February 26, 2002.  Shortly 
thereafter, she filed her claim for benefits, which the hearing officer denied 
resulting ultimately in her appeal to this Court.    

 
 
 
 

[¶5]      Ms. Boyce asserts 
that the hearing examiner incorrectly interpreted and applied Wyoming law when he 
denied her claim for benefits and, accordingly, the following standards 
apply:

 
 
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.  

 
 

Ludwig 
v. State ex rel. Wyoming Workers' Safety and Compensation Div., 2004 
WY 34, ¶7, 86 P.3d 875, ¶7 (Wyo. 2004) (citations omitted).  The Division contends the issue raised 
more appropriately presents a substantial evidence question and the following 
standards apply:

 
 
We afford respect and deference to a 
hearing examiner's findings of fact if they are supported by substantial 
evidence.  Our task is to examine 
the entire record to determine whether substantial evidence supported the 
hearing examiner's findings.  We 
will not substitute our judgment for that of the hearing examiner when 
substantial evidence supports his decision. 

 
 

Salas v. 
General Chemical, 2003 
WY 79, ¶9, 71 P.3d 708, ¶9 (Wyo. 2003) (citations omitted). 

 
 
[¶6]      We conclude the 
substantial evidence standard does not apply.  Rather, because the hearing examiner 
concluded Ms. Boyce did not meet her burden of proof, our review is governed by 
the arbitrary and capricious standard.  
When the party charged with the burden of proof has failed to meet that 
burden, we review the case under the arbitrary, capricious, abuse-of-discretion, 
or otherwise-not-in-accordance-with-law standard.  Brees v. Gulley Enterprises, 
Inc., 6 P.3d 128, 132 (Wyo. 2000); Keck v. State ex rel. Wyoming Workers' 
Safety & Compensation Div., 985 P.2d 430, 432 (Wyo. 
1999).

 
 
Under 
the arbitrary, capricious and abuse of discretion standard, we are charged with 
examining the entire record. In our examination and review of a hearing 
examiner's determination, we defer to the hearing examiner's findings of fact. 
We will examine conflicting and contradictory evidence to see if the hearing 
examiner reasonably could have made its findings based on all the evidence 
before it. The findings of fact may include determinations of witness 
credibility, as the hearing examiner is charged with determining the credibility 
of the witnesses.  In our review, we 
will not overturn the hearing examiner's determinations regarding witness 
credibility unless they are clearly contrary to the overwhelming weight of the 
evidence.  

                                                                                                         

Brees, 6 P.3d  
at 132 (citations omitted).  To the 
extent the hearing examiner misapplied Wyoming law in reaching its conclusion, Ms. 
Boyce is correct that the issue before us is one of law over which our review is 
plenary and we afford no deference to the hearing examiner's conclusion. 
Ludwig, ¶7.

 
 
 

 
 
[¶7]      In her only 
issue, Ms. Boyce claims the hearing examiner misapplied the law by requiring 
medical testimony that her work conditions "materially or substantially" 
aggravated her preexisting condition.  
She contends she was not required to present medical testimony using the 
precise words "material" or "substantial," as long as she met her burden of 
proving by a preponderance of the evidence that her work contributed to 
aggravation of her heel problems.  
She points to testimony from her physicians, Dr. Boyle and Dr. Jost, both 
of whom testified that her work aggravated her heel condition.  Although the physicians did not use the 
terms materially or substantially, she asserts their testimony combined with the 
other evidence demonstrated that her work activity materially aggravated her 
preexisting heel condition.

 
 
[¶8]      The Division 
asserts the hearing examiner did not misapply the law and Ms. Boyce simply 
failed to prove by a preponderance of the evidence that her work materially or 
substantially aggravated her preexisting condition.  The Division claims the evidence showed 
her condition worsened before she began working at the motel and that she was 
not on her feet as much as she reported to her physicians.  The Division asserts the hearing 
examiner properly weighed the conflicting evidence and, in light of other 
evidence, discounted or disregarded the doctors' testimony. 

 
 
[¶9]      Based upon a 
thorough review of the entire record and applying the applicable standards of 
review, we hold the hearing examiner misapplied the law to the extent he 
concluded expert medical testimony using the words "material or substantial" was 
required.  We also hold the hearing 
examiner's conclusion that Ms. Boyce did not meet her burden of proof because 
her medical experts did not include the word "material" in their opinion was 
arbitrary, capricious, an abuse of discretion and not in accordance with the 
law.

 
 
[¶10]   "Injury," as the term is defined in 
Wyo. Stat. Ann. 27-14-102 (a)(xi) (LexisNexis 2003) of the Wyoming Worker's 
Compensation Act, does not include any injury or condition preexisting at the 
time employment begins with the employer against whom a claim is made.  However, "in Wyoming an employer takes 
the employee as he finds him."  
Lindbloom v. Teton International, 684 P.2d 1388, 1389 (Wyo. 1984).  If an employee suffers from a 
preexisting condition, that employee may still recover if his employment 
substantially or materially aggravates that condition.  Id.   In Lindbloom, we cited with 
approval the widely accepted treatise, Larson's Workmen's Compensation Law, for 
the proposition that:

 
 
"Preexisting 
disease or infirmity of the employee does not disqualify a claim under the 
arising out of employment' requirement if the employment aggravated, 
accelerated, or combined with the disease or infirmity to produce the death or 
disability for which compensation is sought."

     

1 
Larson's Workmen's Compensation Law, § 12.20, p. 273-276.  Larson goes on to 
say:

 
 
"Since the rule of law stated at the 
beginning of this section is so widely accepted, in practice most of the 
problems in this area are medical rather than legal. * * * *  It will be found, then, that denials of 
compensation in this category are almost entirely the result of holdings that 
the evidence did not support a finding that the employment contributed to the 
final result.  Whether the 
employment aggravated, accelerated, or combined with the internal weakness or 
disease to produce the disability is a question of fact, not law, and a finding 
of fact on this point * * * * based on any medical testimony * * * * will not be 
disturbed on appeal."

 
 
Id., § 12.20, p. 313-16.

                                                                                                         

[¶11]   To prove aggravation of a 
preexisting injury, a claimant must demonstrate by a preponderance of the 
evidence that the work contributed to a material degree to the aggravation of 
the preexisting condition.  
Salas, ¶10; Jim's Water Service v. Eayrs, 590 P.2d 1346, 
1349 (Wyo. 1979); Claim of 
Vondra, 448 P.2d 313 (Wyo. 1968).  The causal connection between the work 
and the condition is satisfied if the medical expert testifies it is more 
probable than not that the work contributed in a material fashion to the 
aggravation of the injury.  
Id.  Expert medical testimony to the effect 
that the work "contributed to" the injury or that the injury "most likely" or 
"probably" is the product of the workplace suffices.  Id.   We can find no authority for the 
proposition that the medical expert must state with specificity that the work 
conditions "materially or substantially" aggravated the preexisting 
condition.  Nor can we find 
authority requiring the medical expert to apportion the aggravation between work 
conditions and other possible contributing factors.  In fact, Larson opines, except by 
exceptional statute in a few states, of which Wyoming is not one,  "the relative contribution of the 
accident and the prior disease is not weighed . . . ." Larson, supra, at 
§ 9.02[6].

 
 
[¶12]   Applying these principles in 
Salas, we upheld a hearing officer's finding that the employee's work 
accident aggravated a preexisting degenerative condition in his knee.1 Salas experienced knee problems 
prior to his work accident. He presented evidence, however, primarily through 
his own testimony and that of his treating physician, that the accident 
aggravated his preexisting condition.  
His treating physician testified that in his opinion to a reasonable 
degree of medical probability while the accident did not cause or appear to 
accelerate the preexisting degenerative changes in Salas's knee, it did cause an 
"exacerbation" or "aggravation of his preexisting condition."  We held this evidence together with 
Salas's own testimony, supported "the hearing examiner's conclusions that the 
work efforts on behalf of the employer contributed to a material degree to the 
precipitation, aggravation or acceleration of his preexisting condition to the 
point that surgery could no longer be avoided."  Salas, ¶22.  We reached this result despite the 
Division's presentation of expert medical testimony that the claimant's 
condition was not related to the accident but was more probably related to his 
preexisting condition. 

 
 
[¶13]   In Brees, a case more 
directly on point, we held the employee failed to meet her burden of proof to 
establish her work materially aggravated her preexisting condition.  Brees claimed to have sustained a back 
injury at work.  On appeal, she did 
not dispute that she had a preexisting back condition, but argued that her 
doctor's testimony established that her work injury materially aggravated the 
preexisting condition.  We concluded 
presentation of the physician's testimony was not sufficient to meet the 
claimant's burden of proof because the physician was never directly asked 
whether her surgery resulted from the preexisting condition or from work 
conditions.  Without such testimony, 
we concluded, the claimant did not establish a compensable injury.  Brees, 6 P.3d  at 
130.

 
 
[¶14]   In State ex rel. Wyoming Worker's Compensation Div. v. Roggenbuck, 938 P.2d 851 (Wyo. 
1997), another substantial evidence case, we upheld an award of benefits to a 
claimant for aggravation of a preexisting condition.  Despite the claimant's extensive history 
of back problems, two previous back surgeries, and the fact that he filed a 
report of injury only nine days into his new employment, we concluded he 
presented substantial evidence that his work contributed to a material degree to 
the precipitation, aggravation or acceleration of his preexisting 
condition.  Unlike the evidence in 
Brees, the testimony presented in Roggenbuck squarely addressed 
the issue of whether the last injury was a material aggravation of the 
pre-existing condition.   Id. at 133

 
 
[¶15]   In Hoff v. State ex rel. Wyoming 
Workers' Safety and Compensation Div., 2002 WY 129, 53 P.3d 107 (Wyo. 
2002), we affirmed a denial of benefits based upon the conclusion that Hoff's 
condition related to an underlying chronic problem rather than a work 
injury.  We reached this result from 
a record containing conflicting evidence, including testimony by the claimant 
that her symptoms after the work injury were different than her symptoms before 
the injury and expert medical opinion that the work injury caused the 
preexisting condition to become symptomatic necessitating treatment.   Id., ¶25.  

 
 
[¶16]   These cases make clear that our 
case law requiring a claimant to show his or her employment "materially or 
substantially aggravated" the preexisting injury does not require expert medical 
testimony specifically using the words "substantial or material."  Rather, what our cases require is that 
the claimant show that work activities, rather than the natural progression of 
the condition, factors associated with ordinary daily living or some other 
non-work related factor, significantly aggravated the preexisting 
condition.  The nexus between work 
activities and the aggravation ordinarily will be shown through expert opinion 
testimony.  That is, expert medical 
testimony ordinarily will be required to establish the link between the 
worsening of the medical condition and the claimant's work activities, rather 
than some other factor.  The 
materiality of the nexus ordinarily will be shown through evidence of the facts 
and circumstances surrounding the employment. Stated simply, the claimant is 
required to prove by a preponderance of all of the evidence that the work 
activities were a significant factor in the worsening of the preexisting 
condition.

 
 
[¶17]   We turn to consideration of the 
record before us.  Ms. Boyce 
testified that her foot was fine after the cortisone shot in February 2001, 
until she began work at the motel in late September and was on her feet all the 
time.  Although she received a 
second cortisone shot in August 2001, and returned to the doctor again on 
September 21, 2001, she testified that her condition only really began to 
deteriorate after she began work at the motel.  After she began work at the motel, she 
testified that her job required her to perform daily quality assurance checks in 
each of the guest rooms, meaning she was on her feet for extended periods of 
time daily.   She testified she 
could not remember for sure but thought there were 65 guest rooms located on 
three stories of the motel.  She 
further testified the elevator did not work reliably, forcing her to go up and 
down the stairs several times a day. She testified that her work schedule 
varied; sometimes she worked seven days a week, sometimes six and sometimes 
five.  In her report of injury, Ms. 
Boyce reported her injury was caused by going up and down stairs several times a 
day and that she was on her feet seven to eight hours a day.  She testified that she did the quality 
assurance checks regularly until February 2002, when the pain in her foot made 
it impossible for her to do them.  
Thereafter, she worked mostly at her desk and assigned the quality 
assurance checks to other employees. On February 20, 2002, in order to 
immobilize her foot and prevent flexion and extension and further worsening of 
her condition, her doctor placed her foot in a cast. 

 
 
[¶18]   Dr. Heidi Michelson-Jost testified 
that absent some aggravating factor, the usual prescribed treatments of rest, 
physical therapy and anti-inflammatory medication resolve most cases of plantar 
fasciitis.  Dr. Jost testified that 
by the time she began treating Ms. Boyce in late February 2002, Ms. Boyce had an 
extreme case of plantar fasciitis.  
Dr. Jost and Dr. Judy Boyle testified unequivocally that in their opinion 
Ms. Boyce's condition was aggravated by her work 
activities.

 
 
[¶19]   In an effort to refute Ms. Boyce's 
evidence, the Division presented evidence that after the initial diagnosis and 
treatment in February 2001, Ms. Boyce consulted a doctor twice because of foot 
pain before she began work at the motel, there were only 43 not 65 guest rooms, 
not every room was checked every day, the elevator was out of order for only six 
days, there were days when Ms. Boyce worked only "an hour and a half, three 
hours," her hours really began to taper off in December 2001, she worked an 
average of six hours per day one week in January and three hours per day one 
week in February, she performed room checks only seven times in January and 
twice in February, during the last two months of her employment she assigned the 
quality assurance task to other employees, she did not file a report of injury 
claiming her foot condition was work related until after she was terminated, and 
she told the motel manager in the fall of 2001 that she had a recurring problem 
in her foot that flared up from time to time.  The Division presented no evidence 
refuting the physician testimony that Ms. Boyce's work activities aggravated her 
preexisting condition nor did it present any evidence of factors besides her 
work activities that may have caused her condition to deteriorate so 
significantly.

  

[¶20]   At the hearing, the Division argued 
the law required the doctors to opine that the work conditions "materially or 
substantially" aggravated her condition and, because they did not do so, Ms. 
Boyce failed to meet her burden of proof.  
At the Division's suggestion, the hearing examiner recessed the hearing 
to review the doctors' depositions to confirm the Division's claim. Having done 
so, the hearing examiner stated, "I agree with the Division on this one."  On this basis, he found in relevant 
part:

 
 
29.  . . . Neither of the physicians 
concluded that the Employee's condition, which was acknowledged to be 
preexisting, was materially or substantially aggravated by her employment. The 
physician's testifying said the Employee's condition was contributed to by her 
employment or that her employment aggravated her 
condition.

 
 
Based 
upon his findings, the hearing officer concluded in pertinent 
part:

 
 

6.                  
Conditions 
preexisting employment are not compensable unless a condition of employment 
materially or substantially exacerbates a preexisting condition suffered 
by an employee.  

 
 
. . 
.

 
 

8.                  
Medical 
evidence is necessary in workers' compensation claims to establish a causal 
connection in cases where a medical condition complained of is not "immediately 
and directly or naturally and probably" the result of a single incident.  

 
 

9.                  
Opinions 
expressed by medical experts in terms of "can", "could", or "possibly" are not 
sufficient to meet an employee's burden of proof. 

 
 

10.             
 The Office, when considering the weight 
to be given to expert opinions, must consider: (1) the opinion given; (2) the 
reasons for the opinion; (3) the strength of it; and (4) the qualification and 
credibility of the individual giving it.

 

11. The 
Office concludes the Employee suffered from a preexisting condition. The Office 
further concludes the Employee did not meet her burden of proof, by competent 
evidence and by a preponderance of the evidence, that her work conditions 
substantially or materially aggravated her preexisting 
condition.

 
 
[¶21]   The primary flaw we see in these 
findings and conclusions is that our prior cases do not require medical 
testimony that a work injury or work conditions "substantially or materially" 
aggravated the preexisting condition.  
As noted above, we have held in the Jim's Water Service and 
Vondra line of cases that expert medical testimony to the effect that the 
work "contributed to" the injury or that the injury "most likely" or "probably" 
was the product of the workplace suffices.  
Although Ms. Boyce's physicians did not use the words "most likely" or 
"probably," they both testified unequivocally that in their opinion her work 
situation aggravated her preexisting condition.  Neither physician used the terms "can", 
"could", or "possibly" and so the hearing officer's reference in his conclusions 
of law to those words being insufficient to meet an employee's burden of proof 
is not pertinent.  The hearing 
officer's reliance on the finding in paragraph 29 demonstrates his 
misunderstanding of the standard when he states first that neither physician 
concluded Ms. Boyce's condition was materially or substantially aggravated by 
her employment but then states they testified her employment contributed to or 
aggravated her heel condition.  As 
we state above, medical testimony to the effect that work contributed to or 
aggravated the employee's condition is all that is required under Wyoming law to 
meet the employee's burden of proving a material or substantial aggravation of a 
preexisting condition.  To the 
extent the hearing officer concluded otherwise in paragraph 29, he misapplied 
the law.

 
 
[¶22]   The evidence showed Ms. Boyce's 
condition was satisfactory up until she began work at the motel requiring her to 
be on her feet a significant part of each work day.  Then, within just a few months, her 
condition had worsened to a point described as "extreme" and her foot was placed 
in a cast. The experts testified, without contradiction, that plantar fasciitis 
ordinarily resolves with the usual prescribed treatments unless the condition is 
aggravated by other factors.  The 
Division presented no evidence suggesting Ms. Boyce's plantar faciitis was 
beyond ordinary when first diagnosed.  
Yet, the evidence showed, by February 2002 her condition was 
extreme.  The only evidence 
presented explaining why that was so concerned her employment.  The Division made no showing that other 
factors caused her condition to deteriorate.  The only expert medical 
testimony presented was the unequivocal testimony of two doctors that Ms. 
Boyce's work aggravated her preexisting condition.  No expert testimony was presented 
refuting their testimony or suggesting some other cause for her deteriorating 
condition.  While the hearing 
officer correctly cited Thornberg v. State ex rel. Wyoming Workers' 
Compensation Div., 913 P.2d 863 (Wyo. 1996) for the principle that opinions 
expressed by medical experts in terms of "can," "could", or "possibly" are not 
sufficient to meet an employee's burden of proof, that principle is not 
applicable here where Ms. Boyce's experts used none of those limiting words, but 
testified unequivocally that in their opinion her work conditions aggravated her 
preexisting foot problems.  The 
Division offered no evidence contradicting the doctors' opinions, no explanation 
for why those opinions should be ignored, and no evidence regarding what else 
could have caused the aggravation of Ms. Boyce's condition. From our review of 
the entire record in accordance with the applicable standard of review, we 
conclude the hearing officer based his conclusion that Ms. Boyce did not meet 
her burden of proving her preexisting condition was aggravated by work 
conditions on his erroneous belief that the medical testimony was legally 
inadequate.  As a result, that 
conclusion was arbitrary and capricious, an abuse of discretion and not in 
accordance with Wyoming law. 

 

[¶23]   The hearing examiner's conclusion 
is reversed.  This case is remanded 
to the district court to reverse the order denying benefits and for entry of an 
order granting benefits. 

                                                                                                         

  

 
 

FOOTNOTES

1Unlike the present case in which we apply the 
arbitrary and capricious standard of review, many of our aggravation of 
preexisting injury cases, including Salas, required a determination of 
whether substantial evidence supported the hearing examiner's decision. While 
application of the different standard requires a different analysis, we discuss 
those cases to illustrate the fact dependent nature of the inquiry.