herniated disc in March 2008. 1In April 2008, MGM Mirage's insurer, 

appellant Chartis Insurance, accepted respondent's workers' compensation 

claim, and in so doing, it categorized respondent's injury as a "lumbar 

strain." 2 

After his claim for a lumbar strain had been accepted, 

respondent requested temporary total disability (TTD) benefits from 

Chartis. Respondent submitted a physician's progress report completed by 

his own neurosurgeon that certified respondent as TTD from the date of 

his initial January 2008 examination. Chartis denied respondent's 

request for TTD benefits, as did a hearing officer. 

Respondent then appealed the denial to an appeals officer. 

Before the appeals officer, appellants argued that respondent's herniated 

disc was not a compensable injury because it was a preexisting condition 

that was not aggravated by respondent's November 2007 fall. The appeals 

officer disagreed and awarded TTD benefits to respondent, as well as 

medical benefits. Appellants then filed a petition for judicial review, 

which the district court denied. This appeal followed. 

"This court, like the district court, reviews an appeals officer's 

decision for clear error or abuse of discretion." Dickinson v. Am. Med. 

Response, 124 Nev. 460, 465, 186 P.3d 878, 882 (2008); see also NRS 

233B.135(3) (setting forth the standard for judicial review of an agency's 

decision). Although we review issues of law de novo, "the appeals officer's 

'Respondent underwent a follow-up surgery roughly one year later. 

2We note that AIG, and not appellant Chartis, was actually the 

insurer responsible for the initial processing of respondent's claim. We 

refer to Chartis in this disposition for the sake of clarity. 

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fact-based legal conclusions are entitled to deference and will not be 

disturbed if they are supported by substantial evidence. Substantial 

evidence is evidence that a reasonable person could accept as adequately 

supporting a conclusion." Dickinson, 124 Nev. at 465-66, 186 P.3d at 882 

(footnotes omitted). Moreover, our review is limited to the record before 

the appeals officer. Id. at 466, 186 P.3d at 882; see NRS 233B.135(1)(b). 

Substantial evidence supports the appeals officer's finding that 

respondent's fall aggravated his preexisting condition 

Under NRS 616C.175, if an employee sustains a work-related 

injury that "aggravates, precipitates or accelerates" a nonwork-related 

preexisting condition, the employee is entitled to compensation "unless the 

insurer can prove by a preponderance of the evidence that the subsequent 

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

NRS 616C.175(1). Appellants argued before the appeals officer that there 

was no evidence to support respondent's contention that his fall 

aggravated, precipitated, or accelerated his preexisting condition. Rather, 

appellants contended that the pain respondent experienced following his 

fall was merely a recurrence of the pain associated with his alreadyherniated disc. The appeals officer disagreed and awarded TTD benefits 

to respondent. 

On appeal, appellants contend that it was clearly erroneous 

for the appeals officer to find that respondent's fall aggravated his 

herniated disc. We disagree, as substantial evidence supports the appeals 

officer's finding. First, respondent testified that immediately before his 

fall, he was able to discharge his occupational duties, whereas 

immediately after his fall and in the ensuing days, he struggled to stand 

under his own power. This is the epitome of an "aggravation." See Grover 

C. Dils Med. Ctr. v. Menditto, 121 Nev. 278, 286-87, 112 P.3d 1093, 1099 

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(2005) (indicating that an "aggravation" is "the result of a specific, 

intervening work-related trauma," whereas a "recurrence" is when 

"symptoms of an original injury persist and when no specific incident can 

independently explain the worsened condition"). Moreover, the physician 

who treated respondent after his fall referred him to a neurosurgeon, 

which is something that his pre-fall treating physicians never did. 

Finally, the doctor who conducted an independent review of respondent's 

medical records expressly opined that respondent's surgeries were "done 

as a direct result of the industrial accident." 

Thus, substantial evidence supports the appeals officer's 

finding that respondent's fall aggravated his herniated disc. NRS 

616C.175(1); Grover C. Dils Med. Ctr., 121 Nev. at 286-87, 112 P.3d at 

1099. As this was the only meaningful argument that appellants put forth 

before the appeals officer to support the denial of TTD benefits, the officer 

did not clearly err in awarding these benefits. 3 Dickinson, 124 Nev. at 

465-66, 186 P.3d at 882; NRS 233B.135(1)(b). 

3Appellants argued alternatively that TTD benefits were 

unwarranted because respondent moved out of state shortly after his fall, 

which, according to appellants, prevented them from offering respondent 

modified light-duty employment. See NRS 616C.475(5)(b) (relieving an 

employer of the obligation to pay TTD benefits if the employer offers the 

employee light-duty employment that complies with restrictions imposed 

by the employee's physician). Appellants presented no evidence to the 

appeals officer to suggest that they had a viable light-duty employment 

offer for respondent and were simply unable to communicate this offer to 

respondent or his attorney. Accordingly, the appeals officer did not clearly 

err in rejecting this argument. 

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Medical benefits were properly awarded once the appeals officer determined 

that respondent's herniated disc was a compensable injury 

Appellants contend that the appeals officer improperly 

awarded medical benefits for the treatment associated with respondent's 

herniated disc because appellants initially accepted respondent's claim for 

only a "lumbar strain" and respondent did not directly challenge the scope 

of his claim. We disagree. Because appellants' primary argument before 

the appeals officer was that respondent's herniated disc was not 

aggravated by his fall, the issue of whether his herniated disc was a 

compensable injury was squarely before the appeals officer. 4 See NRS 

616C.360(2) (indicating that an appeals officer must hear any matter 

raised before him or her on its merits). Thus, once the appeals officer 

determined that the herniated disc was a compensable injury, medical 

benefits were clearly part of the "compensation" to which respondent was 

entitled. See NRS 616A.090 (defining "compensation" to include "accident 

benefits"); NRS 616A.035(1) (defining "accident benefits" as "medical, 

surgical, hospital or other treatments"). 

In sum, the award of TTD benefits was not clearly erroneous 

because substantial evidence supported the appeals officer's finding that 

respondent's fall aggravated his herniated disc. Dickinson, 124 Nev. at 

465-66, 186 P.3d at 882; NRS 233B.135(1)(b). Additionally, the officer 

properly awarded medical benefits as part of the compensation to which 

4We note that the appeals officer's May 2009 interim order expressly 

stated as much: "[T]here remains an underlying medical issue in this 

appeal as to whether the claim includes the disc pathology and subsequent 

surgery or whether the claim is limited to a [lumbar] strain only with all 

other conditions denied." 

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respondent was entitled. NRS 616A.090; NRS 616A.035. Accordingly, we 

affirm the district court's denial of appellants' petition for judicial review. 5 

It is so ORDERED. 

cc: Chief Judge, The Eighth Judicial District Court 

Hon. Jack B. Ames, Senior Judge 

Janet Trost, Settlement Judge 

Lewis Brisbois Bisgaard & Smith, LLP/Las Vegas 

Michael Paul Wood 

Eighth District Court Clerk 

5Any concerns about respondent's TTD certification from his 

neurosurgeon that were not properly advanced as arguments to the 

appeals officer were not considered on appeal. See City of Las Vegas v. 

Lawson, 126 Nev. , n.2, 245 P.3d 1175, 1179 n.2 (2010) (indicating 

that a party is precluded from raising an argument on appeal that was not 

raised before the appeals officer); Edwards v. Emperor's Garden Rest., 122 

Nev. 317, 330 n.38, 130 P.3d 1280, 1288 n.38 (2006) (noting that this court 

need not consider an issue when a party fails to provide cogent argument 

supported by salient authority). 

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