officer affirmed that decision, determining that Sloan had failed to 

establish that his condition arose out of and in the course of his 

employment. On administrative appeal from that determination, the 

appeals officer found that there was no medical opinion addressing any 

causal relationship between the ultimate diagnosis of a paraspinal abscess 

and the back injury that Sloan had sustained at work. The appeals officer 

thus determined that a medical question existed as to the medical 

probability that a back injury could result in the paraspinal abscess and 

directed the parties to provide additional medical reporting. Sloan was 

subsequently evaluated by two physicians. Dr. Steven Parker opined that 

the muscle strain in Sloan's back resulted in a localized hematoma, which 

provided "fertile soil" that became infected and developed into an abscess. 

Dr. Charles Krasner provided his opinion that Sloan's urinary tract 

infection had developed before his back strain and that, while a back 

strain in itself should not result in an epidural abscess, the injury had 

increased the risk of spinal infection and the urinary tract infection led to 

the development of the abscess. 

The appeals officer entered a decision and order reversing the 

hearing officer and ordering the acceptance of the claim, concluding that 

the medical reporting was credible and that the nonindustrial infection 

"accelerated" to the back "as a result of the hematoma" caused by the back 

injury at work. Bally Technologies filed a petition for judicial review, 

which the district court denied. This appeal followed. 

DISCUSSION 

This court reviews an appeals officer's decision in a workers' 

compensation matter for clear error or abuse of discretion. NRS 

233B.135(3); Vredenburg v. Sedgwick CMS, 124 Nev. 553, 557, 188 P.3d 

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1084, 1087 (2008). Judicial review is confined to the record before the 

appeals officer, and on issues of fact and fact-based conclusions of law, the 

appeals officer's decision will not be disturbed if it is supported by 

substantial evidence. Vredenburg, 124 Nev. at 557, 188 P.3d at 1087-88; 

Grover C. Dils Med. Ctr. v. Menditto, 121 Nev. 278, 283, 112 P.3d 1093, 

1097 (2005). An appeals officer's determinations on pure issues of law, 

however, are reviewed de novo. Roberts v. State Indus. Ins. Sys., 114 Nev. 

364, 367, 956 P.2d 790, 792 (1998). 

When an employee suffers an industrial injury that 

aggravates, precipitates, or accelerates a preexisting nonindustrial 

condition, the compensability of that employee's workers' compensation 

claim depends on the insurer's ability to prove that the work injury is not 

a substantial contributing cause of the employee's condition. See NRS 

616C.150; NRS 616C.175(1); see also Ross v. Reno Hilton, 113 Nev. 228, 

229, 931 P.2d 1366, 1367 (1997). Here, the appeals officer determined 

that Sloan's urinary tract infection was a preexisting condition that was 

accelerated by the back injury Sloan sustained while at work. This 

determination is supported by substantial evidence in the record, 

particularly by the reports of Drs. Parker and Krasner. See Vredenburg, 

124 Nev. at 557 n.4, 188 P.3d at 1087 n.4 ("Substantial evidence is 

evidence that a reasonable person could accept as adequately supporting a 

conclusion."); Langman v. Nev. Adm'rs, Inc., 114 Nev. 203, 209-10, 955 

P.2d 188, 192 (1998) (providing that this court will not substitute its 

judgment regarding the weight or credibility given to evidence). 

Appellants argue on appeal that there is no evidence that the paraspinal 

abscess and resulting surgery was a foreseeable consequence of the back 

strain injury or that the back strain was the "direct cause" of the abscess. 

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But they do not cogently argue that the back strain was not a substantial 

contributing cause of the paraspinal abscess, and it is not clear how the 

record would support such an argument. See NRS 616C.175(1) (explaining 

that when an industrial injury aggravates, precipitates, or accelerates a 

preexisting nonindustrial condition, the injury is compensable "unless the 

insurer can prove by a preponderance of the evidence that the [industrial] 

injury is not a substantial contributing cause of the resulting condition"). 

Thus, we conclude that the appeals officer did not abuse her discretion or 

commit an error of law when she determined that Sloan's claim should be 

accepted. 

Appellants further argue that the appeals officer improperly 

shifted the burden to them when she determined a medical question 

existed and directed the parties to provide additional medical reporting. 

But substantial evidence in the record supports the appeals officer's 

determination that Sloan suffered an injury to his back while at work, and 

that he later had surgery to remove a paraspinal abscess that significantly 

improved his back condition. Based on these factual findings, it was not a 

clear error or an abuse of discretion for the appeals officer to conclude that 

a medical question arose as to whether a causal relationship existed 

between the back injury and the paraspinal abscess. See NRS 

233B.135(3); Maxwell v. State Indus. Ins. Sys., 109 Nev. 327, 331, 849 P.2d 

267, 271 (1993) (explaining that this court may not substitute its 

judgment for that of the appeals officer as to the weight of the evidence on 

questions of fact). As the appeals officer has authority to order an 

independent medical examination, paid for by the insurer, if necessary to 

resolve a medical question regarding the injured employee's condition in a 

contested claim, see NRS 616C.330(3), we conclude that the appeals officer 

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had authority to direct the parties to provide additional medical evidence 

so as to resolve the medical question regarding Sloan's condition, and 

thus, did not abuse her discretion. Accordingly, we affirm the district 

court's order denying judicial review. 

It is so ORDERED. 

/- 

Hardesty 

Cherry 

cc: Second Judicial District Court Dept. 10 

Nicholas F. Frey, Settlement Judge 

Thorndal Armstrong Delk Balkenbush & Eisinger/Reno 

Arnold Brock, Jr. 

Washoe District Court Clerk 

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