Opinion ID: 1125088
Heading Depth: 1
Heading Rank: 3

Heading: error on the part of the appeals officer

Text: We have reviewed several irregularities in the manner that this claim was handled by Bally's administrator and by the hearing officer, and have come to the conclusion that these irregularities are sufficient in themselves to warrant the remand to the administrator ordered by the district court. This appeal, however, is from the district court's order setting aside the decision of the appeals officer. NRS 233B.135 governs judicial review of the final decision of an administrative agency, in this case represented by the decision of the appeals officer. Under this statute, the supreme court is authorized to correct errors of law and to review the evidence presented to the agency in order to determine whether the agency's decision was arbitrary or capricious and was thus an abuse of the agency's discretion. Clements v. Airport Authority, 111 Nev. 717, 721, 896 P.2d 458, 460 (1995). Further, the decision of an administrative agency will be affirmed only if there is substantial evidence to support the decision. SIIS v. Swinney, 103 Nev. 17, 20, 731 P.2d 359, 361 (1987). Substantial evidence is that which `a reasonable mind might accept as adequate to support a conclusion.' State Emp. Security v. Hilton Hotels, 102 Nev. 606, 608, 729 P.2d 497, 498 (1986) (quoting Richardson v. Perales, 402 U.S. 389, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971)). We conclude that the district court was quite correct in its decision to set aside the appeal officer's ruling on the ground that the record was without substantial evidence to support the decision of the appeals officer. From our discussion relating to the hearing officer's decision in this case, no substantial evidence exists that is adequate for a reasonable mind to accept the conclusion that the non-industrial accident was the sole cause of Ms. Reeves' present injuries and complaints. We therefore affirm the district court's judgment in this regard. Additionally, the appeals officer made an erroneous conclusion of law when she concluded that the objective medical evidence does not establish a change in Claimant's condition between the first serious automobile accident and the second minor accident and that objective medical evidence did not support a finding of a medical condition causally related to the September 25, accident. The appeals officer made an error of law by requiring objective medical evidence to support a claim for the kind of soft tissue injury suffered by Ms. Reeves by reason of a typical cervical sprain/strain. Such injuries rarely manifest themselves in objective terms, confirmable by x-ray or other physical means of establishing objective physical harm. If we were to accept the appeals officer's conclusion of law and declare that soft tissue injuries must, in industrial accident claims cases, be established by objective evidence, we would work a great mischief indeed to workers' compensation law. The kinds of injuries sustained by Ms. Reeves can be reliably established by any reasonable and probable medical testimony, independent of objective evidence of the injury. The hearing officer, by ruling that Ms. Reeves' problems owe their etiology to a previous accident, appears to have accepted a determination made by the insurer's medical advisor that the claimant had a pre-existing condition which was not exacerbated by the most recent incident. The appeals officer affirmed this ruling of the hearing officer. As discussed above, Ms. Reeves was not required to establish her injuries by objective medical evidence. Additionally, at the time that Ms. Reeves' industrial claim arose, we had recognized that `preexisting illness normally will not bar a claim if the employment aggravates, accelerates or combines with the disease to trigger disability or death.' State Industrial Insurance System v. Kelly, 99 Nev. 774, 775, 671 P.2d 29, 29-30 (1983) (quoting Spencer v. Harrah's, Inc., 98 Nev. 99, 101, 641 P.2d 481, 482 (1982)). In Kelly, we adopted the rule that the claimant has the burden of showing that the claimed disability or condition was in fact caused or triggered or contributed to by the industrial injury and not merely the result of the natural progression of the preexisting disease or condition. Id. at 775-76, 671 P.2d at 30 (citing Arellano v. Industrial Commission, 25 Ariz.App. 598, 545 P.2d 446, 452 (1976). We further recognized in Kelly that [t]he fact that industrial aggravation may have been but one of several causes producing the symptomatic condition is of no moment. `An industrially related accident does not have to be the cause of injury or death, but merely a cause. If the job is said to precipitate or accelerate the condition, a causal connection with the work can be found.' Id. at 776, 671 P.2d at 30 (quoting Harbor Insurance Company v. Industrial Commission, 25 Ariz.App. 610, 545 P.2d 458, 461 (1976)). This was the standard in effect at the time that Ms. Reeves' industrial claim arose. [9] The medical records in this case indicate that Ms. Reeves claims to suffer from both new injuries and aggravating injuries. With respect to those injuries thought by competent medical authority to have been an aggravation of a preexisting condition, the claims administrator, the hearing officer and the appeals officer should have determined whether Ms. Reeves' industrial accident was a cause of the aggravation. For all of the reasons discussed herein, the judgment of the district court is affirmed; and the matter will, in accordance with the order of the district court, be remanded for reconsideration by Bally's self-insured administrator. SHEARING, C.J., and ROSE, YOUNG and MAUPIN, JJ., concur.