Appeal from the District Court of Fremont County The Honorable Norman E. Young, Judge
The opinion of the court was delivered by: Voigt, Justice.
Before KITE, C.J., and GOLDEN, HILL, VOIGT, and BURKE, 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.
[¶1] The Office of Administrative Hearings (OAH) upheld the decision of the Wyoming Worker's Safety and Compensation Division (Division) denying the appellant, Valerie Price, reimbursement of medical expenses for an injury suffered following a work-related accident on the basis that the subsequent injury was not work related. This Court upholds that determination.
[¶2] Does substantial evidence support the hearing examiner's decision upholding the Division's denial of payment for medical services relating to the appellant's cervical spine?
[¶3] The appellant slipped and fell on December 25, 2004, while taking out garbage for her employer. She was diagnosed with injuries to her right hip, shoulder, and elbow and received Wyoming workers' compensation benefits for her shoulder injury and an umbilical hernia. Throughout the beginning of 2005, the appellant was treated by Dr. John Harp at the Lander Medical Clinic. Dr. Harp ordered x-rays but no bone injury was apparent. He also prescribed a course of physical therapy to strengthen the appellant's arm and improve her range of motion. In February 2005, Dr. Harp ordered an MRI of the appellant's right shoulder which showed a clavicle fracture, although the doctor noted that the MRI did not reveal injury commensurate with the appellant's complaints. Because the appellant continued to experience pain in her shoulder after three months of physical therapy, Dr. Harp scheduled the appellant for surgery to repair her clavicle. Dr. Harp also noted that there was a risk that the shoulder would not improve following surgery. After the surgery, the appellant was again placed on a course of physical therapy. The doctor noted that the appellant was "slowly, but surely improving" and he expected her to make "a full recovery without permanent impairment." In May 2005, Dr. Harp allowed the appellant to return to work without restriction. After a follow-up visit in August of 2005, another doctor at the Lander clinic indicated that although the appellant was still experiencing pain in her shoulder, he was "unsure how this relates to her initial injury." Dr. Harp referred the appellant to Dr. Bienz at Gem City Bone and Joint.
[¶4] Dr. Bienz saw the appellant in September 2005, and was unable to determine the source of her continuing shoulder pain and, again, the appellant was prescribed a course of physical therapy. After five weeks, the appellant reported to Dr. Bienz that her shoulder pain had not diminished. The doctor's notes indicate that "her pain seems well out of proportion to [his] objective findings." Dr. Bienz scheduled the appellant for an MRI, the results of which were normal and indicated no sign of injury to the appellant's shoulder. Once again the appellant was prescribed physical therapy, but the doctor suggested that success would not be likely. Four weeks later, in December of 2005, Dr. Bienz's notes show an increased range of motion in the appellant's shoulder, despite continuing numbness and burning sensations in her fingers. These symptoms, he suggested, are likely a result of the shoulder manipulation performed during the appellant's physical therapy sessions.
[¶5] Following a referral, Dr. Behrens examined the appellant on February 7, 2006, and ordered an MRI of the patient's cervical spine. The findings of the radiologist were as follows:
The cervical vertebral bodies show slight loss of the normal cervical lordotic curvature. This is most pronounced at the C4-5 level. The cerebellar tonsils are normotopic in position. The cervical cord is of normal caliber and shows normal signal intensity. There is no evidence of spinal canal stenosis. The cervical discs show normal hydration. There is minor bulging of the annulus at the C5-6 level. This does not result in any canal or foraminal stenosis however. No additional abnormalities are note [sic].
Dr. Behrens, however, never reviewed the results of the MRI after the Division refused to pay for his services.
[¶6] The appellant was sent to Dr. Ruttle in March 2006 for an independent medical examination. The doctor concluded that the appellant exhibited no evidence of cervical spine injury following an examination. The appellant was also sent to Dr. Ford who, following a review of the 2006 MRI of the appellant's cervical spine, determined that the results showed "some loss of cervical lordosis and a mild C5-6 disk bulge not causing any nerve root impingement and probably not clinically important considering her age."
[¶7] In 2009, the appellant was referred to Dr. Jenkins who ordered a second MRI*fn1 of her cervical spine. The results of the MRI suggested that the appellant was suffering from mild cervical spondylosis, mild foraminal stenosis of the C3-4 disc, and a paracentral bulge of C5-6. The doctor indicated that the bulge in the C5-6 disc should not be giving her the pain she experienced in her right shoulder. In a letter to the Division, Dr. Jenkins suggested that the impingement of the C3-4 disc could affect a nerve leading to the trapezius muscle. He added that "it is just difficult to tell at this time whether any significant pain is coming from her neck. We do know that an EMG was done on [sic] 2006 showed no evidence of cervical radiculopathy." Under Dr. Jenkins' care, the appellant continued with physical therapy and the doctor noted improvement in her range of motion and a decrease in pain in her arms. The doctor ...