Guerrero v. State ex rel. Dep't of Workforce Servs., Workers' Comp. Div.

• Decision Date: 19 June 2015
• Docket Number: No. S–14–0271.,S–14–0271.
• Citation: 352 P.3d 262,2015 WY 88
• Parties: In the Matter of the Worker's Compensation Claim of Jaime GUERRERO, Appellant (Petitioner), v. STATE of Wyoming, ex rel., DEPARTMENT OF WORKFORCE SERVICES, WORKERS' COMPENSATION DIVISION, Appellee (Respondent).
• Court: Wyoming Supreme Court

352 P.3d 262

2015 WY 88

In the Matter of the Worker's Compensation Claim of Jaime GUERRERO, Appellant (Petitioner)

v.STATE of Wyoming, ex rel., DEPARTMENT OF WORKFORCE SERVICES, WORKERS' COMPENSATION DIVISION, Appellee (Respondent).

No. S–14–0271.

Supreme Court of Wyoming.

June 19, 2015.

Representing Appellant: Matthew R. Sorenson of Daly, Davidson & Sorenson, LLC, Gillette, Wyoming.

Representing Appellee: Peter K. Michael, Wyoming Attorney General; John D. Rossetti, Deputy Attorney General; Michael J. Finn, Senior Assistant Attorney General; Kristin M. Nuss, Senior Assistant Attorney General.

Before BURKE, C.J., and HILL, KITE, DAVIS, and FOX, JJ.

Opinion

KITE, Justice.

[¶ 1] The Office of Administrative Hearings (OAH) denied Jaime Guerrero's worker's compensation claim on the grounds he failed to prove a causal relationship between his lower back problems and a work-related accident on June 8, 2011. The district court upheld the OAH decision.

[¶ 2] We affirm.

ISSUES

[¶ 3] The issues for review in this case are:

1. Whether the OAH decision that Mr. Guerrero did not meet his burden of establishing the causal relationship between his back problems and his work-related accident is supported by substantial evidence.

2. Whether the OAH properly applied the second compensable injury rule.

FACTS

[¶ 4] On June 8, 2011, Mr. Guerrero, who was a welder for Ironarc Welding, LLC, suffered a work-related injury. He welded a drain-off valve on a pipe at an oil well pumping station and was watching while the system was restarted, when a thirteen pound blow-out valve broke loose from the pipe and hit him on the lower left side of the front of his body. Mr. Guerrero went to the emergency room where he was treated for “blunt abdominal trauma with a contusion, hematoma

and abrasions to the left suprapubic region.” He underwent surgery a few days later to drain the hemotoma.

[¶ 5] The Department of Workforce Services, Workers' Compensation Division (the Division) approved benefits for the injury to Mr. Guerrero's left groin, abdomen, upper leg, and knee. He was unable to work for approximately three months and received temporary total disability benefits during that time. While he was convalescing, he took prescription pain medication. Because of continued numbness and pain in his leg, his treating physician, Sara Hartsaw, M.D., referred him to a neurologist for further evaluation. He saw neurologist Robert Finley, M.D., on September 8, 2011, who diagnosed him as suffering from “weakness involving the left lower extremity and sensory alteration noted in what appears to be likely the distribution of the left lateral femoral cutaneous nerve consistent with ‘meralgia paresthetica

.’ ”¹ Mr. Guerrero did not complain to Dr. Finley of back pain at that time, and his notes indicate that Mr. Guerrero told him he did not have any significant back pain while in the hospital after the accident.

[¶ 6] Mr. Guerrero participated in a work hardening

program with a physical therapist to ready him to return to work. He testified that he had some pain in his lower back while at therapy but he thought it was from “sitting around those three months and not really being interactive with anybody.” Dr. Hartsaw released Mr. Guerrero to return to work without restrictions starting September 19, 2011, and he went back to work as a welder.

[¶ 7] On October 18, 2011, Mr. Guerrero saw Dr. Hartsaw for continued problems with his left leg and, this time, he also complained of back pain. She referred him to neurologist and pain management specialist Romer Mosquera, M.D., who addressed Mr. Guerrero's back pain even though the written referral was only for the problems with his leg. Mr. Guerrero saw Dr. Finley and Dr. Mosquera on November 23, 2011, and complained to both about his back pain.

[¶ 8] Dr. Mosquera ordered an MRI of Mr. Guerrero's lumbar spine. The MRI revealed:

Lumbar degenerative change at L3–L4 through L5–S1, with findings suggesting disc tear at each of those levels, some central narrowing at L4–L5, and disc protrusion to the right at L5–S1 compromising the right S1 root.

The medical records from Mr. Guerrero's December 20, 2011, appointment with Dr. Mosquera indicate that Mr. Guerrero stated his back pain had started acutely “several months ago;” was severe and radiated down both of his thighs; and was aggravated by lifting, exercising, carrying heavy objects, and driving, sitting or standing for long periods. The doctor discussed Mr. Guerrero's MRI results with him and recommended a lumbar epidural steroid injection

. Mr. Guerrero had the epidural injection on January 5, 2012, and it relieved a great deal of his pain. He did not, however, return to Dr. Mosquera for a follow-up appointment.

[¶ 9] The Division denied Mr. Guerrero's claim for worker's compensation benefits for the evaluation and treatment of his back pain, finding “[t]his case is not open for the lumbar spine” and noting he was referred to Dr. Mosquera “for left lower extremity pain only, not low back pain.” More specifically, the Division determined that the lumbar spine evaluation and treatment were not related to his original work injury. Mr. Guerrero objected, and the Division referred the matter to the OAH.²

[¶ 10] The OAH held a contested case hearing on March 4, 2013. Transcripts of the depositions of Dr. Hartsaw and Dr. Mosquera were admitted into evidence, as were the relevant medical records. Mr. Guerrero was the only witness who testified at the contested case hearing. The OAH ruled that Mr. Guerrero did not satisfy his burden of proving his back pain was caused by the work accident and denied his request for worker's compensation benefits. Mr. Guerrero petitioned the district court for review, and that court affirmed the OAH decision. Mr. Guerrero then appealed to this Court.

STANDARD OF REVIEW

[¶ 11] When an appeal is taken from a district court's review of an administrative agency's decision, we examine the case as if it had come directly from the agency without giving any deference to the district court's decision. Dutcher v. State ex rel. Wyo. Workers' Safety & Comp. Div., 2010 WY 10, ¶ 9, 223 P.3d 559, 561 (Wyo.2010) ; Dale v. S & S Builders, LLC, 2008 WY 84, ¶ 8, 188 P.3d 554, 557 (Wyo.2008). Our review is governed by Wyo. Stat. Ann. § 16–3–114(c) (LexisNexis 2013):

(c) To the extent necessary to make a decision and when presented, the reviewing court shall decide all relevant questions of law, interpret constitutional and statutory provisions, and determine the meaning or applicability of the terms of an agency action. In making the following determinations, the court shall review the whole record or those parts of it cited by a party and due account shall be taken of the rule of prejudicial error. The reviewing court shall:

(i) Compel agency action unlawfully withheld or unreasonably delayed; and

(ii) Hold unlawful and set agency action, findings and conclusions found to be:

(A) Arbitrary, capricious, an abuse of discretion or otherwise not in accordance with law;

(B) Contrary to constitutional right, power, privilege or immunity;

(C) In excess of statutory jurisdiction, authority or limitations or lacking statutory right;

(D) Without observance of procedure required by law; or

(E) Unsupported by substantial evidence in a case reviewed on the record of an agency hearing provided by statute.

[¶ 12] Under § 16–3–114(c), we review the agency's findings of fact by applying the substantial evidence standard. Dale, ¶ 22, 188 P.3d at 561. Substantial evidence means “such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Bush v. State ex rel. Wyo. Workers' Comp. Div., 2005 WY 120, ¶ 5, 120 P.3d 176, 179 (Wyo.2005) (citation omitted). See also Kenyon v. State ex rel. Wyo. Workers' Safety & Comp. Div., 2011 WY 14, ¶ 11, 247 P.3d 845, 849 (Wyo.2011). “Findings of fact are supported by substantial evidence if, from the evidence preserved in the record, we can discern a rational premise for those findings.” Id., ¶ 11, 247 P.3d at 849 (citation omitted).

[¶ 13] When an agency rules that the claimant did not satisfy his burden of proof, we apply the following standard:

If the hearing examiner determines that the burdened party failed to meet his burden of proof, we will decide whether there is substantial evidence to support the agency's decision to reject the evidence offered by the burdened party 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 agency 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 agency could reasonably conclude as it did, based on all the evidence before it.

Dale, ¶ 22, 188 P.3d at 561 (citations omitted).

[¶ 14] “We review an agency's conclusions of law de novo, and will affirm only if the agency's conclusions are in accordance with the law.” Middlemass v. State ex rel. Wyo. Workers' Safety & Comp. Div., 2011 WY 118, ¶ 13, 259 P.3d 1161, 1164 (Wyo.2011), quoting Kenyon, ¶ 13, 247 P.3d at 849, which quoted Moss v. State ex rel. Wyo. Workers' Comp. Div., 2010 WY 66, ¶ 11, 232 P.3d 1, 4 (Wyo.2010).

DISCUSSION

1. Direct Causation

[¶ 15] “A worker's compensation claimant has the burden of proving all of the essential elements of his claim by a preponderance of the evidence.” State ex. rel. Wyo. Workers' Safety & Comp. Div. v. Slaymaker, 2007 WY 65, ¶ 13, 156 P.3d 977, 981 (Wyo.2007) ; Sanchez v. State ex rel. Wyo. Workers' Safety & Comp. Div., 2006 WY 64, ¶ 7, 134 P.3d 1255, 1257 (Wyo.2006). In order to qualify for worker's compensation benefits, an employee must demonstrate he suffered a compensable injury, as defined in Wyo. Stat. Ann. §...