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

State: wyoming

Issuer: Wyoming Supreme Court

Document:

IN THE MATTER OF THE WORKER'S COMPENSATION CLAIM OF: HALL2001 WY 13637 P.3d 373Case Number: 01-1Decided: 12/28/2001
 OCTOBER TERM, A.D. 2001

 

                                                                                                            

 

IN THE 
MATTER OF THE WORKER'S

COMPENSATION 
CLAIM OF:

 

DENISE 
HALL, 

Appellant(Petitioner),

 

v.

                                                                                                

STATE OF 
WYOMING ex rel.

WYOMNG 
WORKERS' COMPENSATION

DIVISION, 

Appellee(Respondent).

 

 

W.R.A.P. 
12.09(b) Certification from the District Court of Teton 
County

The 
Honorable D. Terry Rogers, Judge 

 

Representing 
Appellant:

David M. 
Gosar, Jackson, Wyoming.

 Representing 
Appellee:

Gay 
Woodhouse, Wyoming Attorney General; John W. Renneisen, Deputy Attorney General; 
Gerald L. Laska, Senior Assistant Attorney General; David L. Delicath, Assistant 
Attorney General.

   

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

  

GOLDEN, 
Justice. 

[¶1]           
This 
appeal presents the issue of whether Appellant Denise Hall, who was seeking 
worker's compensation benefits, failed in her burden of proving causation when 
two of her treating physicians testified that her lower back pain symptoms were 
caused by a 1997 uncontested work-related accident.  After Hall established that a type of 
spinal fracture known as a pars defect was causing her back pain, the Wyoming 
Workers' Compensation Division relied on evidence that a pars defect as well as 
other lower back injuries had existed since Hall was injured in a 1995 non-work 
related automobile accident.  The 
hearing examiner denied worker's compensation benefits for failure of 
proof.  

 

[¶2]           
Our 
review of the entire record does not show that Hall provided sufficient evidence 
establishing causation, and we affirm the order denying 
benefits.

 

 

ISSUES

 

[¶3]           
Hall 
presents this statement of the issues:

 

I. Did 
the hearing examiner err as a matter of law when, contrary to this Court's 
decision in Pino v. State, 996 P.2d 679 (Wyo. 2000), which provides that 
an employee/claimant's physicians only need testify that a workplace accident 
"contributed to," "probably," or "most likely" caused an injury, he disregarded 
the testimony of two physicians--who undisputedly satisfied this 
standard--because they did not testify to a "high degree of 
surety?"

 

II. Is 
the order denying benefits supported by substantial evidence when, on the one 
hand, employee/claimant's testimony and the testimony of two physicians 
supported her claim while, on the other, no physician testified for the 
Division, but instead, it relied on speculation and inferences drawn from 
ambiguous medical records?

 

The 
Division contends that the sole issue for our review is:

 

1.      
Did the 
hearing examiner correctly determine that Appellant failed to prove every 
element of her claim?

 

 

FACTS

 

[¶4]           
Hall was injured 
in a work-related accident on December 3, 1997.  She sought medical treatment from Dr. 
Franklin Rivers on the same day of the accident, and typed notes from that visit 
stated that she complained of "pain in the neck, primarily the right side and 
multiple contusions and abrasions obvious over the right side of her torso and 
right leg."  The doctor's notes also 
referred her for three chiropractic treatments in the next week.  Dr. Rivers ordered x-rays of Hall's 
cervical spine but none were taken of her lower back.  Dr. John Zendler, a chiropractor, also 
examined Hall on December 3, 1997, and documented "lower back complaints as well 
as upper back and neck complaints."  
Dr. Zendler continued to treat Hall through January of 1999.  Dr. Ron Gooder testified that on Hall's 
several visits to him between June and November of 1997, he did not treat Hall 
for back pain.  He did not treat her 
after her work-related accident; however Dr. Gooder did treat Hall for back pain 
on July 28, 1998, and his notes indicated that Hall was suffering from chronic 
muscle back pain at least partly aggravated by work. 

 

[¶5]           
Hall 
filed for benefits and, initially, the Division paid them.  Benefit payments are not in the record 
on appeal; however, the Division asserts that it paid thousands of dollars in 
uncontested medical benefits until April 21, 1999, when it denied a $400.00 
claim and Hall's request for temporary total disability benefits.  Hall objected to these denials, and a 
hearing followed. 

 

[¶6]           
Hall 
presented medical reports and the testimony of Drs. Zendler and Gooder.  The evidence showed that after her 1997 
work-related accident, Hall received a number of treatments for lower back 
pain.  On September 22, 1998, Hall 
sought medical treatment for lower back pain after a softball game and again on 
October 18, 1998, after a semi-trailer truck door struck her.  An x-ray taken after the latter incident 
indicated that she had suffered a bilateral pars defect1 at the L-5 vertebrae.  Dr. Zendler testified that Hall had not 
reported having suffered any previous lower back complaints before her 
work-related injury in 1997, and, based on this absence of lower back pain, he 
concluded that the bilateral fracture was sustained during the 1997 work-related 
accident.  Dr. Zendler did not 
believe that the bilateral pars defect was caused by the truck door striking 
Hall because mild degeneration associated with it indicated an older 
injury.

 

[¶7]           
The 
Division established that Hall had suffered a lower back injury in a car 
accident in 1995.  It presented MRI 
films taken of Hall's lower back in 1995 showing a pars defect at L-5, and 
medical records indicating a number of treatments for lower back pain and a 
diagnosis of spondylolisthesis.   

 

[¶8]           
The hearing 
examiner issued an order finding that Hall was injured while within the scope of 
her employment on December 3, 1997, and treated for neck pain and contusions 
over the right side of her torso and right leg as a result of her injury.  She had x-rays taken of the cervical 
area of her spine, and the treating doctor prescribed chiropractic treatment and 
released her from work.  It found 
that Hall was requesting medical benefits for lower back pain; she had been 
treated for low back pain prior to December 3, 1997, and diagnosed with 
spondylolisthesis at L5-S1 and disc protrusion at L4-L5 as early as 1995.  The order further found "[t]he treating 
doctor of Employee/Claimant cannot say with a high degree of surety that [h]er 
low back pain and current treatment is related to her injury in December, 
1997."  The order found that Hall 
"argues her symptoms had all resolved prior to her injury in December, 1997, and 
that her present condition stems from the December, 1997 injury."  The order stated that "Employee/Claimant 
has a history of back problems which have required medical treatment on numerous 
occasions both prior to December 1997, and subsequently.  She has not established by a 
preponderance of the evidence that the treatment she is requesting is directly 
related to the one injury that occurred in December, 1997."  

 

[¶9]           
In its 
conclusion of law, the hearing examiner stated that Hall had not met her burden 
of proof "establishing a medical condition she currently has is related to the 
injury of December 3, 1997," and denied the claim for medical benefits and 
temporary total disability.  The 
district court certified the case to this Court pursuant to W.R.A.P. 
12.09.

 

 

DISCUSSION

 

Standard of 
Review

 

[¶10]       
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.  Keck v. State ex rel. Wyo. Workers' 
Safety and Comp. Div., 985 P.2d 430, 432 (Wyo. 1999); City of 
Casper v. Utech, 895 P.2d 449, 452 (Wyo. 1995).  Under the arbitrary, capricious and 
abuse-of-discretion standard, we are charged with examining the entire 
record.  Wyo. Stat. Ann. § 
16-3-114(c) (LexisNexis 2001); Utech, 895 P.2d  at 452.   

 

[¶11]       
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. Hurley v. PDQ 
Transport, Inc. 6 P.3d 134, 137 (Wyo. 2000).  

 

[¶12]       
When we 
review mixed questions of law and fact, our standard has been stated this 
way:

 

            
When an agency's determinations contain elements of law and fact, we will 
not treat them as findings of fact.  
We extend deference only to agency findings of "basic fact."   When reviewing a finding of 
"ultimate fact," we divide the factual and legal aspects of the finding to 
determine whether the correct rule of law has been properly applied to the 
facts.  If the correct rule of law 
has not been properly applied, we do not defer to the agency's finding but 
correct the agency's error in either stating or applying the law.  

 

Union 
Pacific R.R. Co. v. State Bd. of Equalization, 802 P.2d 856, 860-61 (Wyo. 1990).

 

[¶13]       
We 
review an administrative agency's findings of fact by applying the substantial 
evidence standard.  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.  Substantial evidence is relevant 
evidence which a reasonable mind might accept in support of the agency's 
conclusions.  Frontier Refining, 
Inc. v. Payne, 2001 WY 49, ¶6, 23 P.3d 38, ¶6 (Wyo. 2001).  Accordingly, "we examine only the 
evidence which favors the prevailing party, allowing every favorable inference, 
while omitting consideration of any conflicting evidence."  Id.  

 

 

Burden 
of Proof 

 

[¶14]       
The 
Division's uncontested award of benefits is not a final adjudication that 
precludes the Division from challenging future benefits.  Tenorio v. State ex rel. Wyoming 
Workers' Compensation Div., 931 P.2d 234, 239 (Wyo. 1997).  The statutory language of the Wyoming 
Workers' Compensation Act confers finality on the benefits paid to the employee 
through uncontested determinations, subject to the exceptions found in Wyo. 
Stat. Ann. § 27-14-605.  
Id.   The 
statutory language, however, does not guarantee a claimant future benefits on 
the basis of a prior award nor does public policy favor the payment of an 
unjustified worker's compensation claim.  
Id.  Therefore, an 
employee/claimant must prove that he was entitled to receive benefits for all 
outstanding claims despite previous awards for the same injury.  Id.  The doctrines of res judicata and 
collateral estoppel apply in workers' compensation claims when adjudicated 
before the Office of Administrative Hearings. Id.; Matter of Workers' 
Compensation Claim of Hemme, 914 P.2d 824, 827 (Wyo. 1996); Stockdale v. 
Transystems Services, Inc., 908 P.2d 981, 983 (Wyo. 1995); Matter of 
Swasso, 751 P.2d 887, 890-91 (Wyo. 1988).  Subject to the provisions of Wyo. Stat. 
Ann. § 27-14-605(a), the Division is estopped from redetermining the 
compensability of an injury as it relates to claims which have been approved or 
paid.  Tenorio, at 239; 
Martinez v. State ex rel. Wyo. Workers' Comp. Div., 917 P.2d 619, 622 (Wyo. 
1996); Herring v. Welltech, Inc., 660 P.2d 361, 366 (Wyo. 
1983).

 

[¶15]       
In this 
case, the Division cannot contest the compensability of Hall's original claim or 
retract any payments already made to her.  
Because the Division contests the present claim for $400.00 and temporary 
total disability benefits, however, Hall must prove that these claims are the 
result of her work-related injury.  
The Division is entitled to present evidence that Hall's present symptoms 
were caused or partially caused by her car accident, or to assert that Hall has 
suffered a new injury that is not compensable.

[¶16]       
Hall's medical 
evidence established that her lower back pain is caused by a bilateral pars 
defect.  Dr. Zendler testified that 
the bilateral pars defect occurred during her 1997 work-related accident.  The Division developed evidence that a 
pars defect existed in 1995, two years before her work-related accident occurred 
in 1997.  In cross-examination, Dr. 
Gooder did not believe that the 1995 pars defect had any relationship to Hall's 
present pain symptoms.  Dr. Zendler 
testified that the 1995 films did not indicate a bilateral pars fracture, and he 
stated that he could not be sure if it was the cause of Hall's later lower back 
pain complaints.  He reiterated his 
opinion that because Hall had no history of lower back pain until after the 
work-place injury, that accident caused a bilateral pars fracture due to trauma 
and continued to cause Hall pain symptoms.  
The Division asked Dr. Zendler whether his opinion would remain unchanged 
if he were to become aware of prior complaints of pain before December 3, 1997, 
and Dr. Zendler responded noncommittally that it would depend on the time and 
cause of those back problems.  From 
this evidence, the hearing examiner found that the physician's evidence did not 
provide a "high degree of surety" that Hall's present symptoms were caused by 
her work-related accident.

 

[T]he 
causal connection between an accident or condition at the workplace is satisfied 
if the medical expert testifies that it is more probable than not that the work 
contributed in a material fashion to the precipitation, aggravation or 
acceleration of the injury.  We do 
not invoke a standard of reasonable medical certainty with respect to such 
causal connection. Testimony by the medical expert to the effect that the injury 
"most likely," "contributed to," or "probably" is the product of the workplace 
suffices under our established standard. . . . 

 

[U]nder 
either the "reasonable medical probability" or "more probable than not" 
standard, [a claimant succeeds] in demonstrating the causal connection by a 
preponderance of the evidence. 

 

Pino v. 
State ex rel. Wyo. Workers' Safety & Comp. Div., 996 P.2d 679, 685 (Wyo. 2000).   
Although Hall is correct that the applicable standard is not a "high 
degree of surety," the issue presented is whether the hearing examiner was 
entitled to find Hall's medical evidence not credible.  

 

[¶17]       
Reviewing 
the entire record, the evidence before the hearing examiner showed that a pars 
defect was causing Hall's pain symptoms, that Hall had a preexisting pars defect 
and disk protrusions, that one doctor testifying on Hall's behalf had found the 
preexisting pars defect irrelevant without reason, and that another doctor had 
testified that he was unaware of previous lower back pain injuries or 
symptoms.  On this record, the 
hearing examiner was entitled to determine that Hall's medical evidence was not 
credible.  Having made that basic 
finding, the hearing examiner properly concluded that Hall had not established 
causation between her work-related accident and her present pain symptoms, thus 
failing in her burden to prove every essential element of her claim. 

 

[¶18]       
Addressing 
the Division's alternate claim, the Division bore the burden of proving that 
Hall's present pain symptoms were caused by a new injury.  Dan's Supermarket v. Pate, 2001 
WY 104, ¶¶19, 20, 33 P.3d 1121, ¶¶91, 20 (Wyo. 2001).  The evidence established that Hall had 
suffered subsequent incidents that required medical attention, and after the 
truck door struck her, an x-ray indicated that Hall had suffered a bilateral 
pars defect at some point.  Dr. 
Zendler testified that the bilateral pars defect that first showed after Hall 
was struck by the truck door was actually suffered two years earlier.  The Division did not present any 
evidence refuting this or showing that the bilateral pars defect was caused by 
the subsequent incident, thus failing in its burden of proving a new 
injury.  Nevertheless, we can affirm 
the hearing examiner's order denying benefits on the basis earlier discussed, 
that Hall failed to establish causation and the evidence supports the hearing 
examiner's conclusion that Hall failed in her burden of 
proof.

FOOTNOTES

1Dr. Zendler testified that a pars defect 
is a fracture of the pars intra-articularis, two small pieces of bone arising 
from the vertebrae.  It was unclear 
from his testimony whether more than one injury can occur from a pars 
defect.