Title: Romero v. Davy McKee Corp.

State: wyoming

Issuer: Wyoming Supreme Court

Document:

Romero v. Davy McKee Corp.1993 WY 77854 P.2d 59Case Number: 92-265Decided: 06/07/1993Supreme Court of Wyoming
Timothy T. 
ROMERO,

 Appellant 
(Petitioner/Employee-Claimant),

v.

DAVY McKEE CORPORATION, 

Appellee 
(Respondent-Employer).

 

George Santini 
of Graves, Santini & Villemez, P.C., Cheyenne, for 
appellant.

Michael 
Rosenthal and Rebecca L. Hellbaum of Hathaway, Speight, Kunz, Trautwein & 
Barrett, Cheyenne, for appellee.

Before MACY, 
C.J., and THOMAS, CARDINE, GOLDEN and TAYLOR, JJ.

MACY, Chief 
Justice.

[¶1]      This is an appeal 
from the district court's order affirming an independent hearing examiner's 
decision that Appellant Timothy T. Romero's employment with Appellee Davy McKee 
Corporation did not materially contribute to, aggravate, or accelerate the 
continued loosening of Mr. Romero's wrist implant.

[¶2]      We 
affirm.

[¶3]      Mr. Romero 
provides this statement of the issues:

   1. Did the hearing officer err in 
ruling that employee-claimant's wrist injury was not compensable where the 
medical evidence established that the injury arose as a result of his continuing 
work efforts as a pipefitter including those with Davy McKee 
Corporation?

   2. Did the hearing officer and 
district court apply the wrong legal standard for the determination of whether 
an aggravation of a pre-existing injury results in a compensable 
injury?

   3. Did the hearing officer err as 
a matter of law in failing to apply the provisions of § 27-14-603(e), W.S. 1977 
(1991 Repl.)[1] where the employee-claimant's 
injury was directly related to his continuing work efforts as a 
pipefitter?

[¶4]      On August 12, 
1991, Mr. Romero filed a worker's compensation report of injury in which he 
related that he was injured on June 27, 1991, during the course and scope of his 
employment. He described his injury as follows:

     I was pulling two 
pieces of 8" pipe together with a wire come-a-long. The bolt holding the gear 
came out when there was extreme press[ure] as I was pulling[,] releasing all the 
press[ure] to my hand & wrist.

On the day he 
was injured, Mr. Romero received treatment for a laceration to his thumb, and he 
returned to work. He did not complain specifically of an injury to his wrist at 
that time. Davy McKee Corporation objected to Mr. Romero's claim for worker's 
compensation benefits. By a letter dated September 13, 1991, the Workers' 
Compensation Division concluded that Mr. Romero had a preexisting condition and 
that the injury was an exacerbation of that condition. Mr. Romero requested a 
hearing.

[¶5]      A hearing was 
held on May 8, 1992. At the conclusion of the proceedings, the hearing examiner 
issued these findings:

2. Employee-Claimant 
Timothy T. Romero, Sr. claimed an injury to his left wrist, stemming from a 
work-related accident which occurred on June 27, 1991, while at work for 
Employer Davy McKee Corporation at a construction site located in Laramie 
County, Wyoming.

3. Employee-Claimant 
Timothy T. Romero, Sr. had suffered a previous work-related injury to his left 
wrist in the State of Montana which required seven prior surgeries, including 
the implantation of a prosthetic device in the wrist and for which he received 
workers' compensation benefits in the State of Montana.

4. There was no factual 
dispute concerning the previous injuries sustained by Mr. Romero to his left 
wrist, nor the medical treatment provided prior to July 1990.

5. Having reviewed the 
extensive medical testimony provided in this matter through the depositions of 
Drs. R.N. Hans[e]n and Patrick McDonald, the Office finds that Employee-Claimant 
Timothy T. Romero, Sr.'s current condition did not arise out of or in the course 
of employment while at work for Employer Davy McKee Corporation.

6. As such, 
Employee-Claimant Timothy T. Romero, Sr. has not met the required burden of 
proof set out in Wyoming Statutes § 27-14-603(a) or 
27-14-102(a)(xi).

     7. The Office finds 
that where, as here, the medical conditions involved are complex, the testimony 
of the medical experts is important and helpful.

     8. Having carefully 
reviewed the transcripts of the medical experts presented by the parties prior 
to the hearing, the Office finds that the testimony of Employer's expert, Dr. 
Patrick McDonald, [is] the more persuasive medical view as to what took place 
and adopts his view that Employee-Claimant's wrist condition was the result of a 
degenerative process which occurred over a long period of time.

     9. As such, the Office 
finds that nothing in Employee-Claimant Timothy T. Romero Sr.'s employment with 
Davy McKee Corporation materially contributed to, aggravated or accelerated the 
pre-existing conditions in Employee-Claimant Romero's left wrist and that the 
loosening process which affected Employee-Claimant's left wrist prosthesis began 
prior to his employment with Davy McKee Corporation and continued during that 
time. It was not materially aggravated by the scope and course of employment 
with Davy McKee Corporation.

The hearing 
examiner disallowed Mr. Romero's claim but did not require reimbursement of 
previously awarded interim temporary total disability benefits. The Workers' 
Compensation Division alerted Mr. Romero and his health care providers that his 
claims could be submitted in Montana under his previous claim there.

[¶6]      On June 15, 1992, 
Mr. Romero filed a petition for review in the district court. The Workers' 
Compensation Division was joined in the review proceedings as a respondent. On 
October 9, 1992, the district court issued an order affirming the hearing 
examiner's decision:

Petitioner [Romero] 
argues that the relevant inquiry in this matter is whether the loosening was 
causally connected to his employment as a pipefitter[;] if so, he is entitled to 
benefits. Petitioner relies upon W.S. § 27-14-603(a)(i):

(a) The burden of proof 
in contested cases involving injuries which occur over a substantial period of 
time is on the employee to prove by competent medical authority that his claim 
arose out of and in the course of his employment and to prove by a preponderance 
of evidence that:

(i) There is a direct 
causal connection between the condition or circumstances under which the work is 
performed and the injury; . . .

This provision must be 
read in pari materia with the definition of "injury" at W.S. § 
27-14-102(a)(xi) which provides that "injury" does not include "[a]ny injury or 
condition preexisting at the time of employment with the employer against whom a 
claim is made."

A preexisting injury may 
present a compensable claim "[`]if the employment aggravated, accelerated, or 
combined with the disease or infirmity to produce the . . . disability for which 
compensation is sought. . . .['] 1 Larson's Workmen's Compensation Law, § 12.20, 
p. 3-276." Lindbloom v. Teton International, 684 P.2d 1388, 1390 (Wyo. 1984). A 
claim for aggravation of a preexisting injury requires proof that the "work 
effort contributed to a material degree to the precipitation, aggravation 
or acceleration of the existing condition of the employee. [Citation omitted.]" 
(Emphasis added.) Lindbloom, supra at 1389-90. This is the analysis, or rather 
standard, used by the hearing examiner.

The hearing examiner 
found that nothing in Romero's employment with McKee "materially contributed to, 
aggravated or accelerated the pre-existing conditions in [his] left wrist . . ." 
This finding is supported by substantial evidence in the testimony of Dr. 
McDonald. He viewed the loosening as a degeneration over a period of time, and 
not the result of any incident while in the employ of McKee. The record supports 
the proposition that while the loosening continued to occur during the 
employment with McKee, the work effort did not materially contribute, aggravate, 
or accelerate this condition.

This Court cannot 
substitute its discretion for that of the hearing examiner as to factual 
disputes. The inquiry at this level of review commences with a search in the 
record for substantial evidence to support the findings. If such evidence is 
found in the record, the inquiry comes to an end. Lindbloom, supra at 
1389.

[¶7]      Our task is to 
examine the entire record to determine if substantial evidence exists to support 
the hearing examiner's findings. We will not substitute our judgment for that of 
the hearing examiner if his decision is supported by substantial evidence. 
Substantial evidence is relevant evidence which a reasonable mind might accept 
in support of the agency's conclusions. Farman v. State ex rel. Wyoming Workers' 
Compensation Division, 841 P.2d 99, 102 (Wyo. 1992).

[¶8]      Mr. Romero had 
worked as a pipefitter for more than ten years prior to the incident which gave 
rise to this appeal. In 1985, while working in Montana, Mr. Romero suffered an 
on-the-job injury which resulted in many surgeries being performed on both of 
his wrists. The injury was the subject of a worker's compensation claim filed in 
Montana, and that matter was settled for approximately $50,000. Mr. Romero's 
medical history, as it affects the issues raised in this appeal, is well 
summarized in a letter2 written by his primary physician, 
Jeffrey N. Hansen, M.D.:

I certainly know Tim 
quite well and have taken care of him for about 6 years. The problem that he has 
with his left wrist is an ongoing one and has presented great difficulty. The 
problem initially was wrist ligament instability that occur[r]ed on a traumatic 
basis working as a pipefitter. He also developed carpal tunnel 
syndrome.

Our initial procedure was 
a limited wrist fusion which failed to relieve his symptoms. We then went on to 
an attempted complete wrist fusion which we failed to achieve after two tries. 
Since he had a successful wrist fusion on the right side, we were disappointed 
with that because, even though having both wrists fused is not necessarily the 
best option, it is an option that is relatively permanent. However, after our 
attempts failed to get this wrist fused, we elected to use a bony ingrowth type 
of prosthesis that was developed, as you know, by Dr. Beckenbaugh at the Mayo 
Clinic. That prosthesis was originally designed for patients with rheumatoid 
arthritis and low demand, but a number of them have been used, to my 
understanding, in people who do construction work and more demanding work with 
the knowledge that there is really no way to be sure that the prosthesis will 
hold up. The whole point behind bony ingrowth prostheses is to allow more normal 
function than we could ever achieve with a cemented type of component in the 
wrist joint, or any other joint for that matter. The hope was that these types 
of bony ingrowth prostheses could end up being very strong and literally 
permanent and allowing close to normal activity, with the only potential problem 
being wear of the plastic surface on the joint. It turns out that the feeling 
continues to be that once these prostheses achieve good bony union they may well 
be permanent. That doesn't mean that some of them won't loosen. It may well be 
that the prostheses never really get full mechanical ingrowth to start with and 
then they gradually loosen from there. What that means is that, instead of a 
bony attachment, they get a fibrous or scar tissue attachment that gradually 
loosens with time.

With Mr. Romero, he was 
doing some work off and on for a period of a year or so and not having much 
problem. It might be added that the prosthesis that was currently in place was a 
custom prosthesis designed especially for him because he loosened his first one. 
He certainly is a person who demonstrated previous aseptic loosening and it is 
entirely possible that that had been developing even though his wrist was 
asymptomatic. Usually, when the component starts to loosen, symptoms occur which 
were not occurring in this gentleman at the time he was working. He states that 
the symptoms all developed after the alleged incident when he had a winch kick 
back on him. It is entirely possible that the prosthesis was loosening from the 
standpoint of lucency around the component radiographically, but that the 
fibrous attachment was still reasonably solid.

All I can do is believe 
the patient when he tells me it was comfortable before the injury. I think that 
he had a fibrous union that was torn loose when the come along kicked back on 
him. I think, for that reason, the incident, as described, had a significant 
contribution to the need for more surgery. I would certainly have to say, 
however, that this occurred in the setting of a pre-existing condition that may 
well have been gradual aseptic loosening and the event in question simply 
exacerbated the loosening and made it worse or brought it to the need for 
medical attention. You have to realize that this is really not a black or white 
question and does not represent a yes or no answer.

I believe what, with a 
reasonable degree of medical certainty, we can say that the patient had bony 
ingrowth wrist prosthesis which was reasonably comfortable and then got more 
symptomatic after the alleged incident. We cannot deny that the prosthesis may 
have been loosening before that, but the patient simply wasn't feeling it. I 
think more likely he had a stable fibrous ingrowth that got jerked loose, 
presenting a more mechanical type of instability. From the standpoint of cause 
and effect and responsibility, it would seem appropriate to me that this problem 
is 50% due to pre-existing situation and 50% due to the new injury.

[¶9]      Dr. Hansen's 
deposition testimony and written reports are equivocal about the "cause" of the 
loosening of Mr. Romero's wrist implant. When read in their entirety, they tend 
to support the proposition that the accident at issue here at least contributed 
to the loosening of the implant. In addition to the testimony offered by Dr. 
Hansen, Patrick McDonald, M.D. concluded that Mr. Romero's work for Davy McKee 
Corporation contributed to a continuum of loosening which began when Mr. Romero 
resumed working as a pipefitter in 1990 after recovering from his seventh 
surgery. Mr. Romero had worked as a pipefitter in both California and Washington 
before coming to work in Wyoming in June of 1991. Although Mr. Romero claimed to 
have greater and different pain after June 27, 1991, his testimony revealed that 
he suffered almost constant "arthritic"-type pain in his wrists.

[¶10]   In Lindbloom v. Teton 
International, 684 P.2d 1388 (Wyo. 1984), we held that, when the disability in 
question results solely from the "`natural and normal progress of the 
pre-existing condition,' it is not a disease `attributable to industry.'" 684 P.2d  at 1390 (quoting Tanenbaum v. Industrial Accident Commission, 4 Cal. 2d 615, 
52 P.2d 215, 216 (1935)). More importantly, when such circumstances are in 
question, we are confronted with a finding of fact which is usually derived from 
medical testimony. If substantial evidence is present in the record to support 
that finding of fact, we will not disturb it on appeal. Hohnholt v. Basin 
Electric Power Co-op, 784 P.2d 233, 234 (Wyo. 1989); Mountain States Telephone 
& Telegraph Company v. Carpenter, 736 P.2d 311, 313 (Wyo. 1987); Lindbloom, 
684 P.2d  at 1389. Though the cases involving factual circumstances like those 
presented here are not common, comparable rulings from other appellate courts 
assure us of the prudence of our holding. In Patterson v. Clarke County Motors, 
Inc., 551 So. 2d 412 (Ala. Civ. App. 1989), a determination that loosening of an 
implanted prosthetic hip was the result of an on-the-job injury was affirmed on 
the basis that substantial evidence supported that finding. In that case, the 
appellate court noted that the medical testimony supported these conclusions: 
The worker had not experienced prior problems with the prothesis; the worker 
required hospitalization immediately following the injury; and no evidence 
existed to indicate that the worker had engaged in activities which might have 
caused loosening of the prothesis. 551 So. 2d  at 415-16. None of those facts are 
present in Mr. Romero's case. In Bassett v. Civil Service Commission of City of 
Philadelphia, 100 Pa. Cmwlth. 356, 514 A.2d 984 (1986), the appellate court 
noted that, when a conflict occurs in the medical testimony as to whether the 
loosening of a prosthesis was caused by a particular on-the-job injury or was 
secondary to total hip failure, determinations of the credibility and weight to 
be accorded the evidence are vested in the fact finder. 

[¶11]   In this instance, conflicts exist 
in the medical testimony; however, substantial evidence is present to support 
the hearing examiner's determination. This is especially so in light of the 
requirement that he consider the weight and credibility to be given to the 
contradictory and, in many instances, internally inconsistent medical 
testimony.

[¶12]   Affirmed.

FOOTNOTES

1 Wyo. Stat. § 
27-14-603(e) (1991) provides:

(e) 
Notwithstanding W.S. 27-14-201, in those proceedings in which the entitlement of 
a worker to benefits for successive compensable injuries is established but no 
single employer can be determined to be chargeable for the injuries, the 
division shall distribute the benefit charge to employers within the general 
industrial classification in which the employee was engaged at the time his most 
recent claim arose.

This statutory provision 
has an effective date of July 1, 1991.

2 The letter was prepared 
about a week after Davy McKee Corporation took the physician's deposition, and 
Mr. Romero sought to have it introduced into evidence at the hearing. Davy McKee 
Corporation objected to the letter's introduction because it had no opportunity 
to cross-examine the doctor concerning its contents and because the letter was 
offered "at the last minute." The hearing examiner refused to admit the letter 
into evidence. Because the letter contains such a useful summary and captures 
Dr. Hansen's other testimony in a narrative form, we will use it here. However, 
we do not in any way question the hearing examiner's decision to refuse its 
admission which was grounded upon Mr. Romero's failure to timely offer the 
exhibit. The hearing examiner acted well within his discretion in refusing 
evidence developed at the "last minute" which could have been prepared within 
the time limits for submitting exhibits.