Title: Price v. State ex rel. Wyo. Workers' Safety & Comp. Div.

State: wyoming

Issuer: Wyoming Supreme Court

Document:

IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF: VALARIE D. PRICE v. STATE OF WYOMING, ex rel., WYOMING WORKER'S SAFETY AND COMPENSATION DIVISION2011 WY 160Case Number: No. S-11-0117Decided: 12/08/2011NOTICE: The 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 that correction may be made before final publication in the permanent volume.
OCTOBER 
TERM, A.D. 2011
 
IN 
THE MATTER OF THE WORKER’S COMPENSATION CLAIM OF:VALERIE D. 
PRICE,Appellant (Petitioner),v.STATE OF WYOMING, ex rel., 
WYOMING WORKERS’ SAFETY AND COMPENSATION DIVISION,Appellee 
(Respondent).
 
 
Appeal 
from the District Court of Fremont County
The 
Honorable Norman E. Young, Judge
 
Representing 
Appellant:
Sky 
D Phifer, Phifer Law Office, Lander, Wyoming.
 
Representing 
Appellee:
Gregory 
A. Phillips, Wyoming Attorney General; John D. Rossetti, Deputy Attorney 
General; James M. Causey, Senior Assistant Attorney 
General.
 
Before 
KITE, C.J., and GOLDEN, HILL, VOIGT, and BURKE, 
JJ.
 
VOIGT, 
Justice.
 
[¶1]      The Office of 
Administrative Hearings (OAH) upheld the decision of the Wyoming Worker’s Safety 
and Compensation Division (Division) denying the appellant, Valerie Price, 
reimbursement of medical expenses for an injury suffered following a 
work-related accident on the basis that the subsequent injury was not work 
related.  This Court upholds that 
determination.
 
ISSUE
 
[¶2]      Does substantial 
evidence support the hearing examiner’s decision upholding the Division’s denial 
of payment for medical services relating to the appellant’s cervical 
spine?
 
FACTS
 
[¶3]      The appellant 
slipped and fell on December 25, 2004, while taking out garbage for her 
employer.  She was diagnosed with 
injuries to her right hip, shoulder, and elbow and received Wyoming workers’ 
compensation benefits for her shoulder injury and an umbilical hernia.  Throughout the beginning of 2005, the 
appellant was treated by Dr. John Harp at the Lander Medical Clinic.  Dr. Harp ordered x-rays but no bone 
injury was apparent.  He also 
prescribed a course of physical therapy to strengthen the appellant’s arm and 
improve her range of motion.  In 
February 2005, Dr. Harp ordered an MRI of the appellant’s right shoulder which 
showed a clavicle fracture, although the doctor noted that the MRI did not 
reveal injury commensurate with the appellant’s complaints.  Because the appellant continued to 
experience pain in her shoulder after three months of physical therapy, Dr. Harp 
scheduled the appellant for surgery to repair her clavicle.  Dr. Harp also noted that there was a 
risk that the shoulder would not improve following surgery.  After the surgery, the appellant was 
again placed on a course of physical therapy.  The doctor noted that the appellant was 
“slowly, but surely improving” and he expected her to make “a full recovery 
without permanent impairment.”  In 
May 2005, Dr. Harp allowed the appellant to return to work without 
restriction.  After a follow-up 
visit in August of 2005, another doctor at the Lander clinic indicated that 
although the appellant was still experiencing pain in her shoulder, he was 
“unsure how this relates to her initial injury.”  Dr. Harp referred the appellant to Dr. 
Bienz at Gem City Bone and Joint.
 
[¶4]      Dr. Bienz saw the 
appellant in September 2005, and was unable to determine the source of her 
continuing shoulder pain and, again, the appellant was prescribed a course of 
physical therapy.  After five weeks, 
the appellant reported to Dr. Bienz that her shoulder pain had not 
diminished.  The doctor’s notes 
indicate that “her pain seems well out of proportion to [his] objective 
findings.”  Dr. Bienz scheduled the 
appellant for an MRI, the results of which were normal and indicated no sign of 
injury to the appellant’s shoulder.  
Once again the appellant was prescribed physical therapy, but the doctor 
suggested that success would not be likely.  Four weeks later, in December of 2005, 
Dr. Bienz’s notes show an increased range of motion in the appellant’s shoulder, 
despite continuing numbness and burning sensations in her fingers.  These symptoms, he suggested, are likely 
a result of the shoulder manipulation performed during the appellant’s physical 
therapy sessions.
 
[¶5]      Following a 
referral, Dr. Behrens examined the appellant on February 7, 2006, and ordered an 
MRI of the patient’s cervical spine.  
The findings of the radiologist were as follows:
 
The 
cervical vertebral bodies show slight loss of the normal cervical lordotic 
curvature.  This is most pronounced 
at the C4-5 level.  The cerebellar 
tonsils are normotopic in position.  
The cervical cord is of normal caliber and shows normal signal 
intensity.  There is no evidence of 
spinal canal stenosis.  The cervical 
discs show normal hydration.  There 
is minor bulging of the annulus at the C5-6 level.  This does not result in any canal or 
foraminal stenosis however.  No 
additional abnormalities are note [sic].
 
Dr. 
Behrens, however, never reviewed the results of the MRI after the Division 
refused to pay for his services.
 
[¶6]      The appellant was 
sent to Dr. Ruttle in March 2006 for an independent medical examination.  The doctor concluded that the appellant 
exhibited no evidence of cervical spine injury following an examination.  The appellant was also sent to Dr. Ford 
who, following a review of the 2006 MRI of the appellant’s cervical spine, 
determined that the results showed “some loss of cervical lordosis and a mild 
C5-6 disk bulge not causing any nerve root impingement and probably not 
clinically important considering her age.”
 
[¶7]      In 2009, the 
appellant was referred to Dr. Jenkins who ordered a second MRI1 of her cervical spine.  The results of the MRI suggested that 
the appellant was suffering from mild cervical spondylosis, mild foraminal 
stenosis of the C3-4 disc, and a paracentral bulge of C5-6.  The doctor indicated that the bulge in 
the C5-6 disc should not be giving her the pain she experienced in her right 
shoulder.  In a letter to the 
Division, Dr. Jenkins suggested that the impingement of the C3-4 disc could 
affect a nerve leading to the trapezius muscle.  He added that “it is just difficult to 
tell at this time whether any significant pain is coming from her neck.  We do know that an EMG was done on [sic] 
2006 showed no evidence of cervical radiculopathy.”  Under Dr. Jenkins’ care, the appellant 
continued with physical therapy and the doctor noted improvement in her range of 
motion and a decrease in pain in her arms.  
The doctor later suggested that “[t]he fact that her shoulder workup is 
now completely negative and she continues to have pain certainly suggests that 
the pain may be coming from another source and the most logical source is her 
cervical spine.”
 
[¶8]      The Division 
issued four Final Determinations objecting to the payments amounting to 
$2,097.00 for x-rays and an MRI of the appellant’s cervical spine on the grounds 
that injuries to the cervical spine were not the result of a work-related 
injury.  After the appellant 
requested a hearing, the OAH denied coverage for these tests, finding that the 
appellant had not met her burden of establishing that, although the condition of 
her cervical spine may now be causing shoulder pain, any damage to the cervical 
spine was not a result of her slip and fall.  Following an appeal, the district court 
affirmed the findings of the OAH.  The appellant now appeals to this 
Court.
 
STANDARD 
OF REVIEW
 
[¶9]      The substantial 
evidence standard will be applied when this Court reviews evidentiary 
issues.  Dale v. S & S Builders, 2008 WY 84, 
¶ 25, 188 P.3d 554, 561 (Wyo. 2008).  
“Substantial evidence is relevant evidence which a reasonable mind might 
accept in support of the agency’s conclusions.  It is more than a scintilla of 
evidence.”  Id. at ¶ 11, at 558 (internal 
citations and quotations omitted).  
Such a review requires that we determine whether there was substantial 
evidence to support the agency’s findings.  
Id.
 
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. 
 
Id. 
at ¶ 22, at 561.  “This Court will 
not re-weigh the evidence nor substitute its judgment for that of the Hearing 
Examiner.”  Thomas v. Star Aggregates, Inc., 982 P.2d 714, 716 (Wyo. 1999), citing Snyder 
v. State ex rel. Wyo. Worker’s Comp. Div., 957 P.2d 289, 292-93 (Wyo. 
1998).
 
DISCUSSION
 
[¶10]   The appellant must establish by a 
preponderance of the evidence that she is entitled to receive workers’ 
compensation benefits.  Snyder, 957 P.2d  at 293.  For the appellant to meet that burden 
here, she must show not only that her shoulder pain resulted from an injury to 
her cervical spine, but also that such injury to her spine resulted from the 
December 25, 2004, accident.  Wyo. 
Stat. Ann. § 27-14-102(a)(xi) (LexisNexis 2011) (A compensable injury must 
“aris[e] out of and in the course of employment.”).  For the injury to have occurred “in the 
course of employment,” there must be “a nexus between the injury and some 
condition, activity, environment or requirement of the employment.  Existence of such a nexus depends upon a 
reasonable relationship between the project being performed and the claimant’s 
job.”  State ex rel. Wyo. Workers’ Comp. Div. v. Espinoza, 
924 P.2d 979, 981 (Wyo. 1996) (internal citations and quotations omitted).  As stated above, the determination of 
the OAH will be upheld provided that substantial evidence supports the decision. 
 See supra 
¶ 9.
 
[¶11]   The appellant argues that since her 
shoulder pain has yet to subside, she is entitled to reimbursement for 
diagnostic measures that may determine the source of her affliction.  In making this argument the appellant 
relies upon Snyder v. State ex rel. Wyo. 
Worker’s Comp. Div., 957 P.2d 289 (Wyo. 1998).  In Snyder, the appellant fell at work which 
resulted in an injury to his back and pain in his shoulder.  After the back injury resolved, the 
appellant still experienced pain and tingling in his right shoulder and arm, and 
x-rays were ordered to determine the source of his symptoms.  Id. at 294-95.  This Court reversed the hearing 
examiner’s denial of reimbursement for the cost of those x-rays, holding that 
“[a]n appropriate diagnostic measure is not non-compensable merely because it 
fails to reveal an injury which is causally connected to an on-the-job 
injury.”  Id. at 295.  This decision was partly based on the 
fact that “[n]o evidence was presented to undermine or contradict this course of 
action.”  Id.  
 
[¶12]   Snyder is distinguishable from this 
case.  While we acknowledge that 
procedures to rule out the source of an injury are not necessarily 
non-compensable simply because the test may show that the injury is not in fact 
related to a workplace accident, we cannot extend that logic to say that all 
diagnostic tests ought to be compensable.  
Reimbursement is disputed with regard to the 2009 MRI of the appellant’s 
cervical spine.  Dr. Jenkins ordered 
this exam to determine whether the appellant’s shoulder pain and arm numbness 
were derived from some damage to her cervical spine.  The Snyder court, in ruling for the patient, 
relied upon the fact that the diagnostic examination at issue had not been 
“undermined” by other evidence.  
That is not the case here.  
Although the 2006 MRI had not been reviewed by any of the appellant’s 
physicians, the radiologist’s report as well as Dr. Ford’s analysis of the MRI 
could reasonably have been interpreted by the Hearing Examiner to indicate 
nothing more than mild degeneration of the appellant’s cervical spine with no 
suggestion that any minor abnormalities were the result of recent trauma rather 
than age related wear and tear.  
Additionally, a subsequent MRI of the cervical spine would not have been 
necessary to determine whether the appellant’s shoulder pain was the result of 
some damage to her cervical spine, and, if such damage existed, whether or not 
it was caused by the appellant’s slip and fall.  The 2006 MRI was still available for 
review by Dr. Jenkins.  If the 
cervical spine had been injured in the appellant’s late 2004 slip and fall, it 
certainly was reasonable to assume that indication of such damage would have 
appeared on the 2006 MRI, and that any future MRIs of the appellant’s cervical 
spine would not have shown evidence of a work-related injury that was not 
apparent in the earlier MRI, regardless of whether the cervical spine appeared 
to be damaged.
 
[¶13]   The appellant also argues that the 
Hearing Examiner’s reliance on the evaluations by Dr. Ruttle and Dr. Ford was 
misplaced.  The appellant indicates 
that Dr. Ruttle did not have access to the 2006 or 2009 MRIs, the records of 
chiropractor Dr. Park showing improvement to the appellant’s shoulder following 
cervical manipulation, the records of the appellant’s 2009 physical therapist 
showing improvement following neck physical therapy, or Dr. Jenkins’ records 
suggesting that the appellant’s pain may be the result of impingement of the C4 
nerve.  The appellant claims that 
“Dr. Ford does not support the position of the Hearing Examiner” because Dr. 
Ford only noted that the appellant benefited from massage therapy and 
manipulation.  While the appellant 
is correct that the reports from the independent medical examinations of Dr. 
Ruttle and Dr. Ford do not conclusively establish that the appellant’s injuries 
were not related to her cervical spine, these reports also do not show the 
contrary—that the appellant’s arm pain is derived from her cervical spine, which 
was injured in her fall at work.  In 
addition, Dr. Ford did, in fact, review the 2006 MRI and his conclusions are 
more revealing than the appellant suggests.  See supra ¶ 6.
 
[¶14]   The appellant emphasizes the fact 
that she has felt pain in her shoulder since her injury in December 2004.  It is clear from the record that the 
appellant fractured her clavicle and underwent surgery to repair her 
shoulder.  There is sufficient 
evidence in the record, however, to support the conclusion of the Hearing 
Examiner that the appellant did not meet her burden of proving the necessary 
connection between the work-related injury to the appellant’s hip, shoulder, and 
elbow and subsequent diagnostic treatment of her cervical spine.  
 
CONCLUSION
 
[¶15]   To meet her burden of proof, the 
appellant needed to produce substantial evidence not just that her shoulder pain 
is emanating from her cervical spine, but also that any damage to her cervical 
spine is a direct result of her slip and fall.  While it is true that the appellant has 
been experiencing pain in her shoulder area since shortly after her slip and 
fall, the record contains substantial evidence showing that this pain was not 
necessarily related to the accident.  
Although a number of physicians suggested that perhaps the pain was 
emanating from the cervical spine, nerve tests, x-rays, and an MRI did not 
establish this and, more importantly, such examinations did not show, nor did 
any doctor suggest, that any imperfections in the appellant’s cervical spine 
were caused by her fall.  It was 
reasonable for the Hearing Examiner to conclude, based upon substantial evidence 
in the record, that the appellant did not meet her burden of establishing that 
her shoulder pain was the result of her workplace slip and fall, and therefore 
we affirm.
 
FOOTNOTES
 
1It 
is the cost of this 2009 MRI that is disputed by the 
appellant.