DAVIS, Justice.
[¶ 1] Appellant Don Birch sought reimbursement for travel expenses related to chiropractic treatment he received at the Utah Spine and Disc Clinic in Murray, Utah from the Wyoming Division of Workers' Compensation (Division). Mr. Birch lived in Daniel, Wyoming. The Division denied his request for reimbursement because traditional types of chiropractic care, manipulation and traction could have been obtained at a location in
[¶ 2] We will attempt to clarify the three issues Mr. Birch presents by restating them as follows:
[¶ 3] The uncontested background of Mr. Birch's case is succinctly set out in the hearing examiner's "Findings of Fact, Conclusions of Law, and Order":
Mr. Birch also received more common forms of chiropractic treatment, including adjustment and traction, in Utah.
[¶ 4] Mr. Birch testified at the ensuing telephonic administrative hearing, and he submitted over two hundred pages of documents, including the deposition of Dr. Brett Luddington, the chiropractor who supervised his treatment at the Utah clinic. Among other documents which will be addressed in more detail below were promotional materials generated by the treatment provider and the manufacturer of the device used on Birch, both of which not surprisingly extolled the treatment benefits of Class IV cold lasers. He also submitted articles that addressed chiropractors' increased use of therapeutic cold lasers and reports of studies on their efficacy.
[¶ 5] Birch attempted to establish the following in the OAH hearing: 1) that therapeutic lasers produce beneficial effects by directing light in the infrared range through the body to targeted tissues, thereby stimulating light sensitive cellular chemicals' to initiate a series of salutary chemical reactions;
[¶ 6] Dr. Luddington's deposition testimony concerning laser therapy generally parroted his employer's and the manufacturer's promotional material, with few references to the details of the scientific studies he claimed found it to be effective. The manufacturer's claims and Dr. Luddington's testimony were at odds with other exhibits that Birch submitted, however. For example, both asserted that therapeutic lasers reduce pain by using the light itself to induce a series of chemical reactions in the cells of targeted tissues, not by generating heat in the tissue with the laser. On the other hand, Birch's Exhibit 10 characterized that theory as hypothetical and in need of further experimental studies to demonstrate its efficacy.
[¶ 7] The remaining scientific articles submitted by Birch also did little to advance his cause. Exhibit 7, for instance, noted that the medical research community remains skeptical and unable to reach firm conclusions about the "mechanism of action and effectiveness" of therapeutic lasers due to insufficient data or conflicting findings. It then recounted the authors' statistical analysis of sixteen clinical studies involving a total of 820 patients who were treated with Class III lasers and placebo "lasers" for non-specific neck pain of unknown etiology. In some cases, that treatment was supplemented by exercise therapy and analgesic drugs. The study concluded there was only moderate statistical evidence for the short and medium term effectiveness of laser treatment for neck pain, and conceded that the mechanism by which a laser may reduce pain remains unknown.
[¶ 8] Exhibit 8 summarized a small study in which twenty-one patients with lower back pain were treated with chiropractic manipulation and exercise therapy, and twenty-four patients with similar complaints received Class IV laser therapy in addition to manipulation and exercise. The second group self-reported greater pain reduction than the first, but no placebo laser control was used in the study, and it did not attempt to isolate the effect of laser therapy when used with other treatment modalities. Consequently, the author conceded that further study was required to validate his provisional findings.
[¶ 9] The Division relied primarily on the deposition testimony of Dr. Daniel Staight. Dr. Staight is a chiropractor with some specialized chiropractic training in orthopedics. He served on the Division's chiropractic review panel for nine years, and he also chaired a number of committees of the American Chiropractic Association. He concluded, as had the review panel, that the use of therapeutic lasers was an experimental or investigatory procedure which should not be compensable under Wyoming's workers' compensation statutes or the Division's rules. He observed that laser treatment is also regarded as experimental by Medicare, Utah's workers' compensation program, Cigna, Aetna, and Blue Cross/Blue Shield of Utah.
[¶ 11] The hearing examiner ultimately found the Division's evidence more persuasive and upheld its determination to deny Birch reimbursement for his travel expenses for his Utah treatment because he could have obtained comparable chiropractic treatment in Wyoming, and because chiropractic use of cold lasers is experimental and investigatory. The district court affirmed.
Leavitt v. State ex rel. Wyo. Workers' Safety & Comp. Div., 2013 WY 95, ¶¶ 17-19, 307 P.3d 835, 840 (Wyo.2013).
[¶ 13] Mr. Birch challenges the hearing examiner's determinations that cold laser
Leavitt, ¶ 29, 307 P.3d at 842.
[¶ 14] With respect to whether substantial evidence supports those findings, we have observed that
Leavitt, ¶ 32, 307 P.3d at 842. Moreover,
Leavitt, ¶ 21, 307 P.3d at 841.
[¶ 15] The Division has limited statutory authority to reimburse claimants for travel expenses related to medical care. The pertinent provisions of Wyo. Stat. Ann. § 27-14-401(d) provide:
Wyo. Stat. Ann. § 27-14-401(d) (LexisNexis 2013). This statute is one of the bases upon which the Division denied Mr. Birch's request for reimbursement of his travel expenses
[¶ 16] The hearing examiner found based upon Birch's testimony that some degree of standard chiropractic care could have been obtained in Pinedale, Jackson, Rock Springs, Green River, and Evanston, and that he could have received Class III laser therapy in Rock Springs. All of these cities are closer to Birch's home in Daniel than Murray, Utah. Birch provided this information to the hearing examiner through his Exhibit 5, a letter from a Rock Springs chiropractic clinic. The hearing examiner held that Birch had not carried his burden of persuading him that Class IV lasers are so different from Class III lasers that Birch could not have received laser therapy in Rock Springs that was substantially equivalent to what he received at Utah Spine and Disc Clinic, presumably assuming that such treatment might not be experimental.
[¶ 17] Birch's testimony and his Exhibit 5 can reasonably be viewed as conceding that standard forms of chiropractic care could be obtained in western Wyoming, particularly in Jackson and Rock Springs, and that Class III laser therapy was available at a chiropractic clinic in Rock Springs. He never disputed the Division's contention that manual chiropractic manipulation or mechanical traction, which he received in Utah along with laser therapy, was available at those Wyoming facilities. The record as a whole therefore reasonably supports the hearing examiner's conclusion that standard modes of chiropractic care were available in Wyoming in cities closer to Daniel than Murray, Utah.
[¶ 18] As we noted above, the exhibits Birch submitted drew little distinction between the relative efficacy of Class III and Class IV lasers. Only the manufacturer of the laser used on Birch claimed that the light beam of the latter penetrated more deeply than that of the former, but that distinction rested on what appears to be a largely untested hypothesis that therapeutic lasers of all classes create a photo-chemical reaction in tissue. Because that effect remains unproven and hypothetical, the therapeutic value of both classes of lasers is equally experimental at this point. As we also observed above, both Class III and Class IV lasers can also can be viewed as topically heating the body's surface, in turn conducting that heat to underlying tissue, which is what commonly available infrared heat lamps do. There is nothing in the record to suggest that Class IV lasers are more effective than heat lamps.
[¶ 19] We conclude that the findings are sufficient to permit us to evaluate whether relevant evidence reasonably supports them. We also conclude that the hearing examiner's decision with respect to this issue is not contrary to the overwhelming weight of the evidence as a whole. We therefore agree that Birch did not carry his burden to demonstrate that he could not have received laser therapy that was substantially equivalent to what he received at Utah Spine and Disc Clinic in Rock Springs.
[¶ 20] As noted above in footnote 5, the Division is statutorily prohibited from paying for experimental medical procedures and, by extension, from reimbursing travel expenses incurred to obtain experimental treatment. § 27-14-102(a)(xii). However,
Wyo. Dep't of Workforce Services, Rules, Regulations & Fee Schedules, Workers' Comp. Div., ch. 10, § 10. In Tarraferro v, State ex rel. Wyoming Medical Commission, 2005 WY 155, 123 P.3d 912 (Wyo.2005), this Court also attempted to provide some context for understanding the term by quoting from 1A Lawyers' Medical Cyclopedia of Personal Injuries and Allied Specialties § 2.53 (2001):
Tarraferro, ¶ 17, 123 P.3d at 919-20.
[¶ 21] The word "experimental" and similar phrases are terms of art describing a medical procedure or service that has not been adequately tested or shown to be useful for a particular treatment purpose. That is, the regularity of the benefits a practitioner hopes to achieve with the procedure in question has not yet been subjected to sufficiently rigorous trials to make it an accepted form of treatment among healers practicing in a relevant specialty. See Tarraferro, ¶ 18, 123 P.3d at 920. See also 12 Steven Plitt et al., Couch on Insurance § 181:4 (3d ed. updated 2013) (an experimental or investigative procedure is one whose effectiveness with respect to a specific condition has not been commonly accepted as proven by the medical profession, or one that is still in the trial stage).
[¶ 22] With these definitions in mind, we examine the sufficiency of the hearing examiner's findings relating to the experimental nature of therapeutic lasers (to the extent they are alleged to provide benefits greater than that achieved by the use of heat lamps
[¶ 23] The hearing examiner first explored Dr. Luddington's testimony concerning the mechanism by which the laser might treat pain. He claimed the laser did not heat the targeted tissue like an ultrasound machine would, but that the light generated by the cold laser produced a chemical change in the cells of the targeted tissue, thus relieving pain. The hearing examiner also considered Dr. Luddington's position that FDA approval of the laser with which he treated Mr. Birch meant that it should no longer be considered experimental, when the record in fact showed that FDA approval was based on its finding that the laser was similar to a heat lamp.
[¶ 24] Moreover, as noted above, the literature Birch submitted tended to show that therapeutic lasers are in fact still experimental, contrary to Dr. Luddington's deposition testimony. For example, the author of Exhibit 10, relating to the treatment of facial nerves of rats with lasers, formulated a theory that the light generated by the laser changes nerve cell chemistry, but admitted that this theory is hypothetical and in need of further study. Exhibit 7, a statistical analysis of sixteen clinical studies using lasers to treat neck pain, noted that the medical research community remains skeptical and unable to make firm conclusions about the "mechanism of action and effectiveness" of therapeutic lasers due to insufficient data or conflicting findings. Exhibit 8 was a small study in which some patients with lower back pain were treated with chiropractic manipulation and exercise therapy, and others with similar complaints received Class IV laser therapy in addition to manipulation and exercise. The second group self-reported greater pain reduction than the first, but the author conceded that further study was required to validate those provisional results.
[¶ 25] On the other hand, Dr. Staight testified by deposition that a number of insurers and the Division's chiropractic advisory panel consider the use of Class IV lasers still to be experimental. He also concluded, after reviewing relevant literature and research, that the laser therapy offered by Utah Spine and Disc Clinic was experimental under the definition found in the Division's rules. Dr. Staight also testified — and provided an article supporting that testimony — that FDA approval of the laser used on Birch meant only that it was safe, not that it was effective.
[¶ 26] The hearing examiner ultimately found Dr. Staight to be a more credible and reliable witness than Dr. Luddington. While the former's testimony was straightforward, logical, and focused, the latter was confusing and reflected no clear understanding of how or why the laser would promote healing. Although Dr. Luddington's explanation relied heavily on promotional materials provided by the manufacturer of the laser, those materials were inconsistent with the manufacturer's claims to the FDA that the device was simply used to provide topical heating. Furthermore, Dr. Luddington's assertion that the sort of laser treatment provided to Mr. Birch was not experimental was at odds with his admission that Utah Spine and Disc would not bill insurance companies or workers' compensation authorities for such treatment because those entities consider it to be experimental. In addition, none of the literature
[¶ 27] We conclude that the hearing examiner's order sets out adequate findings of fact, and that they sufficiently direct us to evidence from which we can discern whether there is a reasonable basis for them. The hearing examiner's decision regarding the experimental nature of cold laser therapy was therefore supported by substantial evidence and not contrary to law, as he correctly, and consistently with Tarraferro, interpreted the term "experimental" as it applies to cold laser therapy.
[¶ 28] Mr. Birch concedes that he asked for reimbursement of what he spent traveling to Utah, where he received manual chiropractic manipulation and mechanical traction for back pain, and likewise concedes that similar services were available in Rock Springs. He now invokes de novo review by this Court, alleging that § 27-14-401(d), which is quoted in ¶ 15, requires the hearing examiner to reimburse him for the portion of his Utah travel expenses that he would have paid if he had instead gone to Rock Springs for treatment.
[¶ 29] In interpreting statutes, this Court first looks to see if the legislature's intent can be ascertained in the ordinary and obvious meaning of the words employed when read together as a whole, giving full consideration to their arrangement and connection, and giving effect to every word, clause, and sentence. We need go no further if the statute is unambiguous; that is, if reasonable persons are able to agree to its meaning consistently and predictably. Bourke v. Grey Wolf Drilling Co., LP, 2013 WY 93, ¶ 19, 305 P.3d 1164, 1168-69 (Wyo. 2013).
[¶ 30] The statute expresses a preference that medical care be obtained in Wyoming and/or at an appropriate facility closest to an employee's home. Reimbursement for travel expenses is permitted only to the extent that one actually travels to such a site and receives treatment. Birch's interpretation would read the expressed preference and its corollary effect on travel reimbursement out of the statute. In effect, he would have the Division pay for a trip he did not make to a place where he received no treatment. The unambiguous language of the legislature was not intended to countenance, much less to require, such a result.
[¶ 31] The hearing examiner did not err in his interpretation of the applicable Wyoming statutes. His decision contained adequate findings of fact, and those findings were supported by substantial record evidence. We therefore affirm the district court's order upholding the OAH decision.