United Exposition Service Co. v. State Indus. Ins. System

• Decision Date: 27 April 1993
• Docket Number: No. 23151,23151
• Parties: UNITED EXPOSITION SERVICE CO., Appellant, v. STATE INDUSTRIAL INSURANCE SYSTEM, an Agency of the State of Nevada, and Robert Keating, Respondents.
• Court: Nevada Supreme Court

Page 423

851 P.2d 423

109 Nev. 421

UNITED EXPOSITION SERVICE CO., Appellant, v. STATE INDUSTRIAL INSURANCE SYSTEM, an Agency of the State of

Nevada, and Robert Keating, Respondents.

No. 23151.

Supreme Court of Nevada.

April 27, 1993.

J. Michael McGroarty, Las Vegas, for appellant.

R. Scott Young, Gen. Counsel and William Zeigler, Associate Gen. Counsel, Carson City, for respondent State Indus. Ins. System.

Jay W. Brewer & Associates and John P. Lavery, Las Vegas, for respondent Keating.

OPINION

PER CURIAM:

FACTS

Respondent Robert Keating (Keating), a truck driver employed by appellant United Exposition Service Co. (United), suffered chest contusions after striking his chest on the door of his truck in the course and scope of employment. Approximately two weeks later, Keating underwent cardiac catheterization which depicted severe heart disease. He then received a four-vessel coronary artery bypass. Respondent State Industrial Insurance System (SIIS) notified Keating that it would accept liability for the chest contusions and abrasions but denied liability for the cardiac catheterization and bypass surgery. Keating appealed the initial decision to a hearing officer, using as support a letter from his treating physician, Dr. Miller, that stated Keating's need for heart surgery possibly could have been precipitated by the chest injury. The hearing officer reversed the SIIS decision, determining that Keating's condition, and subsequent need for bypass surgery, was industrially-related. An appeals officer affirmed the decision of the hearing officer. United then filed a petition for judicial review with the district court, which affirmed the decision of the appeals officer.

DISCUSSION

This court's role in reviewing an administrative decision is identical to that of the district court: 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. Titanium Metals Corp. v. Clark County, 99 Nev. 397, 399, 663 P.2d 355, 357 (1983). This standard of review is codified in NRS 233B.135. ¹

It is well recognized that this court, in reviewing an administrative agency decision, will not substitute its judgment of the evidence for that of the administrative agency. State, Dep't of Mtr. Vehicles v. Becksted, 107 Nev. 456, 458, 813 P.2d 995, 996 (1991). This court is limited to the record below and to the determination of whether the administrative body acted arbitrarily or capriciously. State, Emp. Sec. Dep't v. Weber, 100 Nev. 121, 124, 676 P.2d 1318, 1320 (1984). The central inquiry is whether substantial evidence supports the agency's decision. Desert Inn Casino & Hotel v. Moran, 106 Nev. 334, 336, 792 P.2d 400, 401 (1990). 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).

United argues that the decision of the appeals officer was not supported by substantial evidence and was clearly erroneous under NRS 233B.135. United further asserts that Keating failed to meet his burden of proof as to medical causation. We agree. 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 was not merely the result of the natural progression of a preexisting disease or condition. State Industrial Insurance System v. Kelly, 99 Nev. 774, 775-76, 671 P.2d 29, 30 (1986). Although the industrially-related accident need not be the sole cause of the disability, it must be a cause. Id. 99 Nev. at 776, 671 P.2d at 30. The claimant must show a causal nexus between the final condition and the industrial injury before worker's compensation benefits may be recovered. Warpinski v. SIIS, 103 Nev. 567, 569, 747 P.2d 227, 229 (1987). ² A careful review of the record reveals that Keating did not show that his need for heart surgery was caused or contributed to by his industrial injury.

In support of his claim, Keating relied on the medical opinion of Dr. Miller, his treating physician. By letter dated August 9, 1990, Dr. Miller stated, "It is my belief that the accident (work-related) possibly could have been the precipitating factor in Mr. Robert Keating's illness." An award of compensation cannot be based solely upon possibilities and speculative testimony. A testifying physician must state to a degree of reasonable medical probability that the condition in question was caused by the industrial injury, or sufficient facts must be shown so that the trier of fact can make the reasonable conclusion that the condition was caused by the industrial injury. See generally Warpinski, 103 Nev. at 570, 747 P.2d at 229-230; SIIS v. Porter, 103 Nev. 170, 734 P.2d 729 (1987); Harbor Insurance Company v. Industrial Commission, 545 P.2d 458, 459 (Ariz.1976). We conclude that Keating presented neither sufficient medical testimony nor sufficient facts to support a determination that there was a causal connection between his chest injury and his subsequent need for heart surgery.

The speculative nature of Dr. Miller's opinion, that the chest injury "possibly could have been" a precipitating factor, does not support the appeals...