from the District Court of Laramie County The Honorable
Catherine R. Rogers, Judge
Representing Appellant: Peter K. Michael, Wyoming Attorney
General; Daniel E. White, Deputy Attorney General; J.C.
DeMers, Senior Assistant Attorney General
Representing Appellee: Brian J. Hanify, Hanify Law Office,
P.C., Cheyenne, Wyoming
DAVIS, C.J., and BURKE [*] , FOX, KAUTZ, and BOOMGAARDEN, JJ.
John Lysne sought worker's compensation coverage for knee
replacement surgery, which the Medical Commission (the
Commission) approved. The Workers' Compensation Division
(the Division) appeals, contending that Mr. Lysne did not
provide adequate proof that his need for the surgery is
causally related to his work injury. We affirm.
The Division asserts one issue, which we rephrase as:
Was the Commission's finding that Mr. Lysne's work
injury caused his need for knee replacement surgery supported
by substantial evidence and not contrary to law?
On July 22, 2013, Mr. Lysne, a roofer employed by Inman
Roofing, injured his left knee while carrying shingles up a
ladder and onto a roof. As he stepped onto the roof with his
left foot, his leg "gave out," causing him pain.
When his knee did not heal after a month, he visited his
doctor, who prescribed pain medication and told him to treat
the knee with rest, ice and elevation. Mr. Lysne's knee
did not improve, and when he sought the renewal of his pain
medication prescription, his doctor indicated that he would
need an MRI. Mr. Lysne then filed a worker's compensation
claim and received an MRI.
After reviewing the MRI, Mr. Lysne's doctor referred him
to Dr. Bruce Smith, an orthopedic surgeon in Cheyenne. Dr.
Smith examined Mr. Lysne on January 21, 2014, noted that he
continued to experience pain, and diagnosed him with
chondromalacia of the left knee, medial meniscus tear,
patellar malalignment syndrome, and plica syndrome of the
knee. Based upon his findings, on February 6, 2014, Dr. Smith
operated on Mr. Lysne's knee, performing an arthroscopic
excision of the medial meniscus tear, arthroscopic chondral
shaving of the patella, femoral groove, the medial femoral
condyle and the lateral tibial plateau, and an arthroscopic
excision of the medial plica in the knee.
Post-surgery, Mr. Lysne began physical therapy. Initially,
his knee did well, but as his therapy progressed, Mr. Lysne
was unable to "work past the pain." Consequently,
in May of 2014, Dr. Smith recommended continued physical
therapy and encouraged him to seek a second opinion. In June
of 2014, Mr. Lysne saw Dr. Mark McKenna, another orthopedic
surgeon, who ordered a second MRI. That MRI revealed
"meniscal fraying and irritation" and
"swelling within the soft tissue and some cartilage
damage." On July 31, 2014, Dr. McKenna performed a
second arthroscopic procedure and found "a tear of the
posteromedial meniscus in the posterior horn[, ] . . . loose
fragments within the joint[, ] . . . and synovitis and scar
tissue formation over the anterior aspect of the joint."
In October of 2014, Mr. Lysne again saw Dr. McKenna and
reported continued and worsening pain in the knee. Dr.
McKenna gave him an intraarticular injection of pain
medications in his knee to relieve his pain and suggested
that Mr. Lysne undergo an MRI of his back to determine
whether it was contributing to his knee problems. Based upon
his review of the results of the second MRI, Dr. McKenna
recommended that Mr. Lysne see a neurologist or neurosurgeon
and did not think that a knee replacement would help him at
that point. Accordingly, Mr. Lysne met with a neurosurgeon
who ruled out his back as a cause of his knee pain.
On January 19, 2015, Mr. Lysne saw Dr. Jean Basta, a third
orthopedic surgeon. Dr. Basta concluded that Mr. Lysne had a
left medial meniscus tear, a left chondromalacia patella, and
internal derangement in the left knee. Dr. Basta suspected
that "he is retearing the medial meniscus because it is
in a weakened state." Dr. Basta gave Mr. Lysne another
injection in his knee and ordered him to use crutches and
remain non-weight-bearing for six weeks, and, if the pain
persisted, she would perform a third arthroscopic surgery at
Four days after seeing Dr. Basta and at the direction of the
Division, Mr. Lysne saw Dr. Ricardo Nieves for an independent
medical evaluation and impairment rating evaluation (IME).
Despite the fact that Mr. Lysne was non-weight-bearing and
had just received an injection for continued pain in his left
knee, Dr. Nieves concluded that he was at maximum medical
improvement (MMI) and that he had sustained a 1% whole body
physical impairment. On March 4, 2015, the Division
determined that Mr. Lysne's workplace injury resulted in
a 1% impairment of his left knee and awarded him benefits in
the amount of $1, 509.68. Mr. Lysne objected to this
determination, arguing that the conclusion that he had
reached MMI was premature.
On March 10, 2015, at the suggestion of Dr. Edgrin, who saw
Mr. Lysne for reasons unrelated to his knee, Mr. Lysne saw
Dr. Charlie Yang, an orthopedic surgeon in Denver, Colorado.
Dr. Yang discussed treatment options with Mr. Lysne,
including a left total knee arthroplasty (replacement). Mr.
Lysne indicated that he would like to pursue the surgical
intervention upon obtaining worker's compensation
approval. In April, Dr. Ricardo Nieves supplemented his IME
evaluation, concluding that "[i]n my professional
opinion within a reasonable degree of medical probability a
left total knee replacement surgery is not causally related
to Mr. Lysne's work injury of 7/22/2013 in which the
resulting work injury was of a medial meniscus injury."
On April 16, 2015, the Division denied Mr. Lysne's
request for the preauthorization of his total knee
replacement surgery. Mr. Lysne again objected to that
The Division then referred Mr. Lysne to Dr. Mark Rangitsch, a
fifth orthopedic surgeon, for another IME. In his May 4, 2015
report, Dr. Rangitsch explained that "further treatment
options  could help" and suggested
"unicompartmental [partial] knee replacement."
Subsequently, the Division referred Mr. Lysne to Dr. Greg
Reichardt, a physical and rehabilitation medicine specialist,
for a third IME on June 23, 2015. Dr. Reichardt concluded
that a total knee replacement was not reasonable and
necessary medical care for his workplace injury. Two months
later, on August 17, 2015, Mr. Lysne saw a sixth orthopedic
surgeon, Dr. Rocci Trumper. Dr. Trumper examined Mr. Lysne
and recommended a total knee replacement.
After a contested case hearing on Mr. Lysne's objections
to the Division's determinations, the Commission reversed
the Division's March 4, 2015 and April 16, 2015
determinations. The Commission found that the physical
impairment rating of 1% whole body offered by the Division
was premature, that Mr. Lysne was not at a level of maximum
medical improvement when he was rated by Dr. Nieves, and that
he should be placed back on Temporary Total Disability
payments for an additional period of time, terminating in
June 2015 when he resumed gainful employment. With respect to
pre-authorization for total knee replacement surgery, the
The hearing panel further finds that the preauthorization
request for total knee replacement surgery is reasonable and
necessary under the circumstances and causally related to
[Mr. Lysne's] work injury and is fully compensable.
Division appealed, and the district court affirmed the
Commission's findings. The Division timely appeals.
We review an appeal from a district court's review of an
administrative agency's decision as if the case came
directly from the agency and give no deference to the
district court. Morris v. State ex rel. Dep't of
Workforce Servs., Workers' Comp. Div., 2017 WY 119,
¶ 23, 403 P.3d 980, 986 (Wyo. 2017) (citing Guerrero
v. State ex rel. Dep't of Workforce Servs., Workers'
Comp. Div., 2015 WY 88, ¶ 11, 352 P.3d 262, 265
(Wyo. 2015)). Wyo. Stat. Ann. § 16-3-114(c) (LexisNexis
2017) establishes the scope of our review:
(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
. . . .
(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 ...