Court Opinion

ID: 9881043
Source: CourtListenerOpinion
Date Created: 2023-09-29 15:12:52.205765+00
Date Added: 2024-06-11T13:58:57.675058
License: Public Domain

IN THE SUPREME COURT, STATE OF WYOMING

                                        2023 WY 94

                                                                APRIL TERM, A.D. 2023

                                                                     September 29, 2023

 JON BRESSLER,

 Appellant
 (Petitioner),

 v.
                                                            S-23-0064
 STATE OF WYOMING, ex rel.
 DEPARTMENT OF WORKFORCE
 SERVICES, WORKERS' COMPENSATION
 DIVISION,

 Appellee
 (Respondent).

                    Appeal from the District Court of Fremont County
                        The Honorable Jason M. Conder, Judge

Representing Appellant:
      Larry B. Jones, Burg, Simpson Eldredge Hersh and Jardine, P.C., Cody, Wyoming.

Representing Appellee:
      Bridget L. Hill, Attorney General; Mark Klaassen, Deputy Attorney General; Holli
      J. Welch, Senior Assistant Attorney General.

Before FOX, C.J., and KAUTZ, BOOMGAARDEN, GRAY, and FENN JJ.

NOTICE: This opinion is subject to formal revision before publication in Pacific Reporter Third.
Readers are requested to notify the Clerk of the Supreme Court, Supreme Court Building, Cheyenne,
Wyoming 82002, of any typographical or other formal errors so that correction may be made before
final publication in the permanent volume.
BOOMGAARDEN, Justice.

[¶1] Jon Bressler suffered a work-related injury to his right arm in 2016. As part of his
treatment, he routinely received physical therapy. In 2020, the Department of Workforce
Services, Workers’ Compensation Division (the Division) denied compensating Mr.
Bressler for three physical therapy sessions. The Medical Commission (the Commission)
upheld the denials after a contested case hearing, finding Mr. Bressler’s continued physical
therapy was no longer reasonable and necessary medical care for his work-related injury.
The district court affirmed. We also affirm.

                                              ISSUE

[¶2]   Mr. Bressler raises one issue, which we phrase as:

               Whether the Medical Commission’s conclusion that Mr.
               Bressler’s continued physical therapy was not reasonable and
               necessary medical care for his work-related injury is supported
               by substantial evidence.

                                              FACTS

[¶3] In January 2016, Mr. Bressler was a special education teacher at Fremont County
School District # 2. During a school-shooter training, he was physically securing a door
when a purported intruder opened it with force, crushing Mr. Bressler’s right arm. After
he submitted a report of injury, the Division determined Mr. Bressler had sustained a
compensable work-related injury to his lower right arm. Mr. Bressler soon after began
physical therapy as part of his medical care. One year later, Mr. Bressler’s injury caused
him to develop complex regional pain syndrome (CRPS). 1

[¶4] Between 2017 and 2020, the Division requested independent medical evaluations
(IME) to determine whether Mr. Bressler had reached maximum medical improvement and
should be rated for permanent benefits. The Division received four IME reports from Scott
Johnston, M.D., Ricardo Neives, M.D., Jed Shay, M.D., and Gary Walker, M.D, a majority
of whom agreed Mr. Bressler had reached maximum medical improvement. Dr. Johnston
and Dr. Walker confirmed Mr. Bressler’s diagnosis of CRPS and determined him to have
36% permanent partial impairment. Mr. Bressler subsequently applied for and received
permanent total disability benefits.

1
  “Complex regional pain syndrome (CRPS) is a condition resulting in intense burning pain, stiffness,
swelling, and discoloration that most often affects the hand.” Complex Regional Pain Syndrome (Reflex
Sympathetic         Dystrophy),       American       Academy         of      Orthopaedic     Surgeons,
https://orthoinfo.aaos.org/en/diseases--conditions/complex-regional-pain-syndrome-reflex-sympathetic-
dystrophy/ (Last visited September 12, 2023).

                                                  1
[¶5] In 2019, Mr. Bressler’s treating physician, Dr. Heidi Jost, wrote a letter
recommending Mr. Bressler receive physical therapy twice weekly, indefinitely, to help
treat his CRPS and other medical issues. Nonetheless, the Division requested three
Physical Therapy Panel reviews to determine whether Mr. Bressler’s continued physical
therapy remained reasonable and necessary to treat his work-related injury or was
maintenance care not covered under the Division’s rehabilitation guidelines.

[¶6] Dr. Dustin Martinson issued the first Physical Therapy Panel review opining Mr.
Bressler’s documents showed support for ongoing physical therapy, but such therapy
needed to be questioned and accompanied by further documentation. Dr. Martinson also
opined that Mr. Bressler’s current documentation did not demonstrate he benefitted from
physical therapy other than as maintenance care and Mr. Bressler should be transitioned to
a home exercise program. Dr. Tom Davis completed the second Panel review, stating Mr.
Bressler’s physical therapy treatment had not resulted in substantial improvement to his
overall functional ability and he should be discharged to a home exercise program.

[¶7] Dr. Heather Martinson completed the third Panel review. She opined Mr. Bressler’s
physical therapy treatment was not reasonable and necessary care for his work-related
injury as Mr. Bressler had not shown objectively measurable progress in the course of over
358 physical therapy sessions. She also opined that any current physical therapy treatment
would be classified as maintenance care and Mr. Bressler should be transitioned to a home
exercise program. Dr. Martinson was deposed in February 2021 during which she affirmed
the conclusions in her Panel review.

[¶8] The Division issued three final determinations between July and August 2020
stating that, based on the Physical Therapy Panel reviews, Mr. Bressler’s continued
physical therapy “would not be considered reasonable or necessary” medical care. The
Division thus denied Mr. Bressler compensation for three of his physical therapy treatments
and coverage for any future treatments. Mr. Bressler objected to the Division’s
determinations and the matter was referred to the Commission for a contested case hearing.
Mr. Bressler continued to receive physical therapy without the Division’s coverage at the
time of the hearing in May 2021.

[¶9] At the contested case hearing, Mr. Bressler and the Division agreed the main issue
before the Commission was the reasonableness of Mr. Bressler’s physical therapy
treatment from the end of June 2020 to the date of the hearing and beyond. The parties
submitted disclosure statements along with their exhibits to the Commission prior to the
hearing. Mr. Bressler did not call any medical experts to testify. Rather, Mr. Bressler was
the sole witness. He testified about incurring his work-related injury, his CRPS diagnosis,
and the pain he continues to feel in his right arm. He also testified he attends physical
therapy two times per week, which consists of a series of treatments and exercises. He
described the benefits he receives from physical therapy, including short-term pain relief,
an increased ability to grasp objects with his right hand, better sleep for a couple nights

                                            2
after sessions, and increased ability to try activities he had previously been able to perform.
Mr. Bressler further testified to performing a rigorous home exercise program for one hour
every morning which helped him loosen up, grasp objects, and reduce his pain level. He
confirmed he had not returned to work since his 2016 injury and is currently receiving
permanent total disability benefits. He did not dispute that he had received approximately
358 physical therapy sessions over three-and-a-half years as noted in Dr. H. Martinson’s
review. Mr. Bressler also stated he saw Dr. Jost once a year and each time she renewed
his physical therapy orders.

[¶10] The Commission issued its order the next month, concluding Mr. Bressler’s
continued physical therapy was not reasonable and necessary medical care for his work-
related injury. It thus upheld the Division’s three final determinations denying Mr. Bressler
physical therapy benefits. Mr. Bressler appealed the Commission’s decision to the district
court. The district court affirmed.

[¶11] Mr. Bressler timely appealed.

                                       DISCUSSION

[¶12] Mr. Bressler argues the Commission’s order denying him continued physical
therapy benefits is unsupported by substantial evidence. “We examine the case as if it
came directly from the Medical Commission and give no deference to the district court’s
decision affirming the agency decision.” Genner v. State ex rel. Dep’t of Workforce Servs.,
Workers’ Comp. Div., 2022 WY 123, ¶ 12, 517 P.3d 1138, 1142 (Wyo. 2022) (citing
Morris v. State ex rel. Dep't of Workforce Servs., Workers’ Comp. Div., 2017 WY 119, ¶
23, 403 P.3d 980, 986 (Wyo. 2017)).

[¶13] Our review is governed by the Wyoming Administrative Procedure Act, which
requires us to “[h]old unlawful and set aside agency action, findings and conclusions found
to be . . . [u]nsupported by substantial evidence in a case reviewed on the record of an
agency hearing provided by statute.” Wyo. Stat. Ann. § 16-3-114(c)(ii)(E) (LexisNexis
2023). Under the substantial evidence test, we examine the entire record for “relevant
evidence which a reasonable mind might accept in support of the agency’s conclusions.”
Rodriguez v. State ex rel. Dep’t of Workforce Servs., Workers’ Comp. Div., 2022 WY 166,
¶ 9, 522 P.3d 164, 168 (Wyo. 2022) (citation omitted). We review the agency’s
conclusions of law de novo. Id. ¶ 11, 522 P.3d at 168 (citation omitted).

[¶14] Wyo. Stat. Ann. § 27-14-102(a)(xii) (LexisNexis 2023) states, in part:

              “Medical and hospital care” when provided by a health care
              provider means any reasonable and necessary first aid,
              medical, surgical or hospital service, medical and surgical
              supplies, apparatus, essential and adequate artificial

                                              3
                replacement, body aid during impairment, disability or
                treatment of an employee pursuant to this act . . . and any other
                health services or products authorized by rules and regulations
                of the division.

The Division’s rules provide that “[w]orkers with injuries compensable under the
[Wyoming Worker’s Compensation Act] shall be provided reasonable and necessary health
care benefits as a result of such injuries.” Workers’ Comp. Div. Rules & Regulations, Ch.
7, § 3(a)(i) (2011). 2

[¶15] Further, the Division has established rules and regulations governing the
compensability of physical therapy claims, which state:

                (a) Chiropractors, physical therapists, physical therapists
                assistants, occupational therapists, and occupational therapist
                assistants may perform treatment modalities in the
                management of soft tissue injuries for the progressive
                development of strength and mobility, and to improve
                functional outcomes. An initial evaluation should document
                the diagnoses or clinical impression consistent with the
                presenting complaint(s) and the results of the examination and
                diagnostic procedures conducted. Subsequent visits performed
                require documentation of measured, objective, significant
                findings.

                (b) The Division shall pay physical therapy and occupational
                therapy services only if they are provided pursuant to a
                prescription from the injured employee’s primary treating
                health care provider, as defined in Chapter 1, Section 4(au) of
                these Rules.

                (c) The Division shall monitor claims for services and may
                require the provider to submit a formal written treatment plan
                or supplemental report detailing the medical necessity, specific
                goals, number of sessions and time frames for review and
                authorization to continue the service. If the injured worker is
                not responding within the recommended duration periods, per
                the assessment of the provider, other treatment interventions,
                further diagnostic studies or consultation may be considered.

2
  The Division has since updated the rules and regulations cited in this opinion; however, Mr. Bressler’s
injury occurred in 2016 and as such this Court applies the agency’s rules in effect at that time. See Wyo.
Stat. Ann. § 27-14-602(b).

                                                    4
              (i)    The Administrator adopts the Rehabilitation Therapy
                     Utilization Guidelines For The Care And Treatment
                     of Injured Workers and the Chiropractic Utilization
                     Guidelines For The Care And Treatment Of Injured
                     Workers, which will be used by the Division in its
                     evaluation and payment of physical therapy and
                     chiropractic claims. These guidelines are available
                     under separate cover through the Division.

Workers’ Comp. Div. Rules & Regulations, Ch. 10, § 21 (2011) (emphasis in original).

[¶16] The Division’s guidelines for rehabilitation therapy state in relevant part:
            ...

              Ethical Guidelines

              Once it has been determined that the injured worker will
              benefit from treatment provided by a physical, occupational, or
              speech therapist, certain ethical guidelines should be followed.
              The Division should only be billed for procedures which
              were provided and medically necessary to treat the injured
              worker’s compensable injury. Appropriate documentation
              shall always be provided. Once the injured worker has
              recovered from the injury or reached a level of ascertainable
              loss, he is to be released from care and a final bill should be
              sent to the Division. Any expenses/bills for further treatment
              may be the injured worker’s responsibility.

              ...

              D) Discharge

              • Injured workers who have undergone a course of care and
              are considered to be at either pre-injury status or MMI
              [maximum medical improvement] should be discharged
              from active care. An independent home program shall be
              completed, if needed, prior to discharge. Maintenance care is
              not eligible for compensation.
              • A re-injury or a new injury will require documentation to
              validate relatedness.
              • Injured workers who have responded to care and have
              reached an ascertainable loss, but have a permanent
              impairment rating and ongoing residuals may be eligible for

                                             5
               “as needed” care following the Ethical Guidelines on a case by
               case basis.

Wyo. Workers’ Comp. Div. Rehabilitation Therapy Guidelines for the Care and Treatment
of Injured Workers in Consultation with the Rehabilitation Therapy Panel, Dep’t of
Workforce Servs., at *2, 3–4 (2015) (emphasis added). 3

[¶17] Mr. Bressler had the burden of proving all the essential elements of his claims by a
preponderance of the evidence. Genner, ¶ 14, 517 P.3d at 1142 (citation omitted); see also
In re Worker’s Comp. Claim of David, 2007 WY 22, ¶ 9, 151 P.3d 280, 287 (Wyo. 2007)
(“Since each new claim or award involves a separate administrative determination under
[Wyo. Stat. Ann.] § 27–14–606, the claimant is required to prove that he or she is entitled
to receive benefits for all outstanding claims even if he or she has received previous awards
for the same injury.” (citations omitted)). Under the provisions quoted above, Mr. Bressler
had the burden of proving his continued physical therapy is reasonable and necessary
medical care for his work-related injury.

[¶18] The Commission found Mr. Bressler failed to meet his burden. As such:

               . . . we will decide whether there is substantial evidence to
               support the [Commission]’s decision to reject the evidence
               offered by [Mr. Bressler] by considering whether that
               conclusion was contrary to the overwhelming weight of the
               evidence in the record as a whole. If, in the course of its
               decision[-]making process, the [Commission] disregards
               certain evidence and explains its reasons for doing so based
               upon determinations of credibility or other factors contained in
               the record, its decision will be sustainable under the substantial
               evidence test. Importantly, our review of any particular
               decision turns not on whether we agree with the outcome, but
               on whether the [Commission] could reasonably conclude as it
               did, based on all the evidence before it.

McMillan v. State, 2020 WY 68, ¶ 8, 464 P.3d 1215, 1218 (Wyo. 2020) (quoting Boyce v.
State ex rel. Dep’t of Workforce Servs., Workers’ Comp. Div., 2017 WY 99, ¶ 21, 402 P.3d
393, 399–400 (Wyo. 2017)).

[¶19] Based on the evidence in the record, the Commission could reasonably conclude
Mr. Bressler failed to meet his burden to show continued physical therapy was reasonable

3
    The Division’s guidelines can be found on its website at: https://dws.wyo.gov/wp-
content/uploads/2023/03/Rehabilitation-Therapy-Utilization-Guidelines-2015.pdf (last visited September
12, 2023).

                                                  6
and necessary medical care for his work-related injury. The Commission’s order noted
that it reviewed eighty-two pages of physical therapy records, the three Physical Therapy
Panel reviews, the four IME reports, the deposition testimony of Dr. H. Martinson, and the
testimony of Mr. Bressler. The Commission’s decision relied primarily on Dr. Martinson’s
deposition testimony and the three Panel reviews.

[¶20] Mr. Bressler contends the Commission placed improper weight on Dr. Martinson’s
deposition testimony because her testimony demonstrated she was not an objective witness.
This Court does not reweigh the evidence presented to the Commission. See City of
Rawlins v. Schofield, 2022 WY 103, ¶ 50, 515 P.3d 1068, 1083 (Wyo. 2022) (citation
omitted). Rather, we defer to the Commission’s findings of fact and credibility
determinations when they are supported by a rational premise. Rodriguez, ¶ 28, 522 P.3d
at 171 (citing McMasters v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 2012 WY
32, ¶ 71, 271 P.3d 422, 439 (Wyo. 2012)); see also Hart v. State ex rel. Dep’t of Workforce
Servs., 2018 WY 105, ¶ 18, 442 P.3d 653, 659 (Wyo. 2018) (“Because the administrative
body ‘is the trier of fact and has the duty to weigh the evidence and determine the credibility
of witnesses,’ we will defer to the Medical Commission’s findings of fact unless they are
clearly contrary to the overwhelming weight of the evidence in the record.” (citation
omitted)).

[¶21] Dr. Martinson was deposed prior to the contested hearing and opined that even
considering the physical therapy Mr. Bressler received after the Division entered its denials
of benefits, physical therapy had not led to substantial improvements in Mr. Bressler’s
medical condition. She explained:

              Based on the documentation that I have received, I can say that
              he is reporting the same pain levels, the same treatments have
              been performed for him, and there is little to no progress with
              physical therapy for his condition.
              ...
              In physical therapy, patients need to be making progressive
              improvement for physical therapy to be benefiting. If the
              patient needs it to prevent backsliding, we call that
              maintenance care.

She also testified that Mr. Bressler’s “358 visits of rehabilitation is - - is unheard of in
physical therapy. Either somebody is going - - even if they’re in physical therapy, they’re
either going to make progress and improve and get better or they’re not going to make
progress and physical therapy is not the method of treatment for them.” She further opined
that continued physical therapy would only constitute maintenance care for Mr. Bressler.
Though Mr. Bressler contends Dr. Martinson’s statement that 358 sessions is “unheard of
in physical therapy” demonstrates an improper bias, he cites to no pertinent authority for
his position and the record clearly shows Dr. Martinson reviewed Mr. Bressler’s medical

                                              7
documents and stated an expert medical opinion based on those documents. See
McMillian, ¶ 17, 464 P.3d at 1220–21 (“When presented with expert medical testimony,
the Commission, ‘as the trier of fact, is responsible for determining relevancy, assigning
probative value, and ascribing the relevant weight to be given to the testimony.’” (citation
omitted)).

[¶22] Mr. Bressler also asserts the Commission’s reliance on Dr. H. Martinson’s
deposition testimony is contrary to the Physical Therapy Panel reviews of Dr. D. Martinson
and Dr. Davis, and Dr. Walker’s IME report, none of which opine Mr. Bressler’s physical
therapy should end. The record not only refutes Mr. Bressler’s contentions, but also
corroborates the Commission’s reliance on Dr. H. Martinson’s testimony. Dr. D.
Martinson acknowledged there was support for ongoing physical therapy, however he
questioned whether it should be continued and that “there is not current documentation that
supports the claimant benefiting from physical therapy.” He ultimately concluded Mr.
Bressler’s physical therapy is maintenance care and recommended Mr. Bressler should be
transitioned to a home exercise program. Dr. Davis likewise stated Mr. Bressler has gone
“without substantial improvement in his overall functional ability” after three years of
physical therapy and should be transitioned to a home exercise program. Dr. Walker’s
IME report noted that Mr. Bressler had been receiving physical therapy treatment for his
CRPS, however he also noted Mr. Bressler’s “prognosis at this point is very poor” and he
did “not expect any additional improvement over time without additional treatment.” Dr.
Walker did not offer any opinion as to the necessity of physical therapy but recommended
Mr. Bressler undergo alternative treatments such as a “spinal cord stimulator trial” or a
“stellate ganglion block.” 4

[¶23] After it reviewed the parties exhibits and testimony, the Commission found Dr. H.
Martinson’s deposition testimony was “uncontradicted and persuasive.”               This
determination was not contrary to the overwhelming weight of the evidence in the record,
as discussed above. McMillan, ¶ 8, 464 P.3d at 1218. Therefore, the Commission offered
a rational premise for finding Dr. H. Martinson’s deposition testimony to be credible.
Rodriguez, ¶ 28, 522 P.3d at 171 (citation omitted).

[¶24] Mr. Bressler lastly asserts the Commission’s reliance on the Physical Therapy Panel
reviews is unwarranted due to conflicting evidence from Dr. Johnston and Dr. Jost,
physicians who Mr. Bressler contends are in a better position to gauge the effectiveness of
any medical treatment than the members of the Panel. Dr. Johnston’s IME report noted
physical therapy as one option among many for treating CRPS but did not specifically

4
  Mr. Bressler also points to a 2019 letter from Dr. David Renner, a neurologist, affirming Mr. Bressler’s
diagnosis of CRPS and briefly stating “PT should be employed to provide assistance with non-self-
administered needs[.]” Though this letter appears contrary to the Panel reviews, it is only one
recommendation out of several offered to the Commission and does not address whether physical therapy
remained reasonable and necessary after June 30, 2020, the sole issue before the Commission. Additionally,
Dr. Renner did not testify at the hearing to contradict the deposition testimony offered by Dr. H. Martinson.

                                                     8
recommend physical therapy or otherwise contradict the Panel reviews. The Commission
acknowledged such evidence when it stated in its order that “[a]ll physicians reviewing this
case recommended alternative therapies” for Mr. Bressler, “yet none were pursued.”

[¶25] Dr. Jost submitted a letter “To Whom It May Concern” in February 2019
recommending Mr. Bressler receive physical therapy two times a week, indefinitely. The
Commission addressed Dr. Jost’s letter, finding it to be “the only evidence to refute the
reasonableness and necessity of continued physical therapy[.]” However, the Commission
found Dr. Jost’s letter was two years old by the time of the hearing and Dr. Jost was not
called to testify. The Commission thus articulated a rational premise to disregard the letter.
See McMillan, ¶ 8, 464 P.3d at 1218 (citation omitted).

                                      CONCLUSION

[¶26] The Commission’s conclusion that Mr. Bressler’s continued physical therapy is not
reasonable and necessary medical care for his work-related injury is supported by
substantial evidence. Therefore, its order upholding the Division’s three final
determinations denying Mr. Bressler physical therapy benefits is affirmed.

                                              9