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

• Decision Date: 27 June 2022
• Docket Number: S-21-0256
• Parties: ANTHONY HART, Appellant (Petitioner), v. STATE OF WYOMING, ex rel. DEPARTMENT OF WORKFORCE SERVICES, WORKERS' COMPENSATION DIVISION, Appellee (Respondent).
• Court: Wyoming Supreme Court

2022 WY 81

ANTHONY HART, Appellant (Petitioner), v. STATE OF WYOMING, ex rel. DEPARTMENT OF WORKFORCE SERVICES, WORKERS' COMPENSATION DIVISION, Appellee (Respondent).

No. S-21-0256

Supreme Court of Wyoming

June 27, 2022

Appeal from the District Court of Campbell County The Honorable Stuart S. Healy III, Judge

Representing Appellant Corrie Lynn Lamb, Barney &Graham LLC, Gillette, Wyoming.

Representing Appellee Bridget Hill, Wyoming Attorney General Mark Klaassen, Deputy Attorney General; Peter F. Howard, Senior Assistant Attorney General; Holli J. Welch, Senior Assistant Attorney General.

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

KAUTZ Justice.

[¶1] After a contested case hearing, the Wyoming Medical Commission (Medical Commission) upheld the Wyoming Workers' Safety and Compensation Division's (Division) denial of coverage for Anthony Hart's thoracic spine treatment, and the district court affirmed. Mr. Hart claims the Medical Commission's decision was not supported by the hearing evidence. We affirm.

ISSUES

[¶2] The issues on appeal are:

1. Was the Medical Commission's decision that Mr. Hart did not prove his thoracic spine injury was caused by his work-related accident supported by substantial evidence?

2. Was the Medical Commission's decision that treatment for Mr. Hart's thoracic spine injury was not compensable under the "rule out doctrine" supported by substantial evidence?

FACTS

[¶3] Mr. Hart was employed by Peabody Powder River Services, LLC as a production technician at the North Antelope Rochelle coal mine near Wright. On September 17, 2017, he was driving a haul truck which, when fully loaded, weighed 350 tons. The roads at the mine were very rough, causing Mr. Hart to bounce "vigorous[ly]" as he drove. The truck seat was equipped with an air shock; however, the shock was "shot" and did not work properly. Mr. Hart injured his back when the seat "bottomed out" after hitting a bump.

[¶4] Mr. Hart filed a report of injury with the Division, stating he had injured his "back." He identified the location of his back injury as "L1," referring to the vertebrae at the top of the lumbar spine (low back). Mr. Hart sought medical treatment for "low back" pain on September 18, 2017. After examining Mr. Hart and reviewing x-rays, a physician assistant concluded Mr. Hart had a "lumbar strain" and recommended treatment with pain medication, a muscle relaxer, a home exercise program, and physical therapy. The Division issued a final determination which approved worker's compensation benefits for treatment of an injury to Mr. Hart's lumbar spine.

[¶5] Mr. Hart's lumbar spine injury initially improved, but in November 2017, his low back pain worsened and he ceased working. An MRI of his lumbar spine showed some mild abnormalities at the L5-S1 level, which is low on the lumbar spine, but "[e]very level above L5 in the lumber spine [was] normal." Mr. Hart remained off work and continued to be treated for his lumbar spine injury over the next several months, including by interventional pain management specialist Todd Hammond, M.D. In early April 2018, Mr. Hart was released to "full duty" work after he passed a "work status test" which measured his ability to perform all physical requirements necessary to return to work at his job. While Mr. Hart was being treated for his work-related lumbar spine injury from Fall 2017 through Spring 2018, the medical records do not contain any reports of pain in his thoracic spine (mid-back).

[¶6] A June 4, 2018, medical record from Dr. Hammond contains the first post-accident mention of Mr. Hart experiencing thoracic spine pain.^[1] Dr. Hammond treated Mr. Hart's thoracic spine injury with thoracic facet injections, a medial branch block, and eventually rhizotomy (cauterization) of the sensory nerves at the T10 through T12 vertebrae levels, which are "at the junction where the thoracic spine . . . turns into the lumbar spine." Mr. Hart's thoracic spine injury improved after the rhizotomy.

[¶7] The Division issued a final determination denying Mr. Hart worker's compensation coverage for his thoracic spine treatment because it was not "reasonable and necessary medical care to the 9/17/2017 worker's compensation injury to the lumbar spine." Mr. Hart objected to the final determination, stating "most of back was hurting[;] I fixed what hurt the most first." The Division referred Mr. Hart's case to the Medical Commission.

[¶8] After a contested case hearing, the Medical Commission upheld the Division's denial of coverage for Mr. Hart's thoracic spine injury. It concluded Mr. Hart had not proven 1) a causal relationship between "the treatment [he] received for injury to the thoracic spine" and the "approved workplace injury to the lower back" which occurred nine months earlier, or 2) the thoracic spine treatment was "compensable pursuant to the 'rule out' doctrine." The Medical Commission noted there was no mention in his medical records of any thoracic spine pain until June 4, 2018, and Dr. Hammond, Mr. Hart's treating physician and expert medical witness, could not say to a reasonable degree of medical probability that the thoracic spine injury originated from the September 2017 work-related accident. Mr. Hart filed a petition for judicial review of the Medical Commission's decision, and the district court affirmed. He appealed to this Court.

STANDARD OF REVIEW

[¶9] When an appeal is taken from a district court's decision on review of an administrative agency's ruling, we examine the case as if it came directly from the agency giving no special deference to the court's decision. In re Vinson, 2020 WY 126, ¶ 25, 473 P.3d 299, 308 (Wyo. 2020); Guerrero v. State ex rel. Dep't of Workforce Servs., Workers' Comp. Div., 2015 WY 88, ¶ 11, 352 P.3d 262, 265 (Wyo. 2015) (citing Dale v. S &S Builders, LLC, 2008 WY 84, ¶ 8, 188 P.3d 554, 557 (Wyo. 2008)) (other citations omitted). Wyo. Stat. Ann. § 16-3-114 (LexisNexis 2021) governs judicial review of administrative decisions:

(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 aside 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.

[¶10] In accordance with § 16-3-114(c)(ii)(E), we review an agency's findings of fact by applying the substantial evidence standard. Vinson, ¶ 26, 473 P.3d at 308. See also, Camacho v. State ex rel. Dep't of Workforce Servs., Workers' Comp. Div., 2019 WY 92, ¶ 23, 448 P.3d 834, 843 (Wyo. 2019) ("'[T]he substantial evidence test is the appropriate standard of review in appeals from [Wyoming Administrative Procedure Act] contested case proceedings when factual findings are involved and both parties submit evidence.'" (quoting Dale, ¶ 10, 188 P.3d at 558)).

"In reviewing findings of fact, we examine the entire record to determine whether there is substantial evidence to support an agency's findings. If the agency's decision is supported by substantial evidence, we cannot properly substitute our judgment for that of the agency and must uphold the findings on appeal. Substantial evidence is relevant evidence which a reasonable mind might accept in support of the agency's conclusions."

Id. (quoting Dale, ¶ 11, 188 P.3d at 558) (other citations omitted). See also, Kenyon v. State ex rel. Wyo. Workers' Safety &Comp. Div., 2011 WY 14, ¶ 11, 247 P.3d 845, 849 (Wyo. 2011) ("Substantial evidence means 'such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.'" (quoting Bush v. State ex rel. Wyo. Workers' Comp. Div., 2005 WY 120, ¶ 5, 120 P.3d 176, 179 (Wyo. 2005)) (other citations omitted)).

[¶11] When the Medical Commission determines "the burdened party failed to meet his burden of proof, [the reviewing court] 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." Mitcheson v. State ex rel. Wyo. Workers' Safety &Comp. Div., 2012 WY 74, ¶ 9, 277 P.3d 725, 730 (Wyo. 2012) (citing Dale, ¶ 22, 188 P.3d at 561). See also, Boyce v. State ex rel. Dep't of Workforce Servs., Workers' Comp. Div., 2017 WY 99, ¶ 21, 402 P.3d 393, 399-40 (Wyo. 2017) (when an administrative agency concludes a worker's compensation claimant fails to meet his burden of proof, we decide whether, upon review of the entire record, there is substantial evidence to support the agency's decision).

[¶12] Under § 16-3-114(c)(ii)(A), a court may set aside an agency decision found to be "[a]rbitrary, capricious, an abuse of discretion or otherwise not in accordance with law[.]" We do not use the arbitrary and capricious standard to review the sufficiency of the evidence to support an agency's decision following a contested case hearing. Dale, ¶ 22, 188 P.3d at 561....