BURKE, Justice.
[¶ 1] Appellant, Michael Beall, received preauthorization from the Wyoming Workers' Safety and Compensation Division for an orchiectomy, a procedure to remove his left testicle, which he claimed was related to a workplace injury. Mr. Beall's employer, Sky Blue Enterprises, Inc., objected to the preauthorization and the matter was referred to the Medical Commission Hearing Panel for a contested case hearing. Mr. Beall elected to undergo the surgery prior to the scheduled hearing. The Commission denied Mr. Beall's claim for reimbursement of medical expenses on the basis that the surgery was not reasonable or necessary medical care resulting from his workplace injury. Mr. Beall appealed to the district court, which affirmed the Commission's order. He challenges that decision in this appeal. We affirm.
[¶ 2] Mr. Beall presents the following issues:
Appellee, Sky Blue, states the issues as follows:
[¶ 3] Mr. Beall was injured on October 13, 2008 when, in the course of connecting a water valve for his employer, Sky Blue, he fell on the valve and struck his groin. The fall was not witnessed by any of his coworkers. Immediately after the incident, Sky Blue's safety coordinator drove Mr. Beall to a doctor's office in Rock Springs. Mr. Beall was examined by a physician's assistant, who noted that Mr. Beall had no swelling or bruising and instructed Mr. Beall to take ibuprofen for the pain. Although Mr. Beall was released to "work as directed," his safety coordinator drove Mr. Beall to his home in Rawlins.
[¶ 4] When Mr. Beall returned to work on October 15, expecting to be assigned light duty, he was instead assigned to an activity involving heavy lifting, which he refused. After leaving work that day, Mr. Beall sought treatment from Dr. Wayne Couch, his primary care provider. A physician's assistant at Dr. Couch's office adjusted Mr. Beall's pain medications and referred him to Central Wyoming Urological Associates in Casper. On October 16, Chad Sundquist, a physician's assistant at the urology clinic, examined Mr. Beall and noted that there were no abnormalities of Mr. Beall's scrotum, testes, or groin area. Mr. Beall complained of discomfort upon palpation, but no swelling, bruising, or bleeding was indicated. An ultrasound and CT scan were administered on October 22. Results from the ultrasound revealed that
Similarly, the CT scan indicated that
At a follow-up visit at the urology clinic on November 10, Mr. Beall was again examined by Mr. Sundquist. In the report from the second examination, Mr. Sundquist reported Mr. Beall's "status" as follows:
[¶ 5] Mr. Beall continued to treat with Dr. Couch, who subsequently referred him to Dr.
[¶ 6] Mr. Beall returned to Dr. Couch and reported that "there is no way I can do my job." Dr. Couch referred Mr. Beall for follow-up urology and neurology consults in Casper. On February 17, Dr. Couch notified the Division that Mr. Beall had been released to return to work. The following day, Mr. Beall's workers' compensation claims representative noted that she received a message from Mr. Beall indicating that he had fired Dr. Couch and had found another doctor.
[¶ 7] On February 17, Mr. Beall saw Dr. David R. Cesko in Rawlins. With regard to his examination of Mr. Beall, Dr. Cesko noted as follows:
Dr. Cesko referred Mr. Beall to Dr. William D. Flock, a urologist in Laramie. Dr. Flock noted that Mr. Beall's left testicle was extremely tender but that he was "unable to palpate" the problem. In his notes, Dr. Flock indicated the following treatment plan options: "1. Neurology consult[,] 2. Urodynamic[,] 3. ? left orchiectomy." Dr. Cesko subsequently referred Mr. Beall to Dr. Reed Shafer, a neurologist, who conducted a physical examination and provided a complete neurologic study of Mr. Beall. Dr. Shafer determined that there "seems to be no anatomical abnormality demonstrated in terms of the genitalia," and reported that an electrodiagnostic study of Mr. Beall's left lower extremity was a "normal study."
[¶ 8] Mr. Beall then went to see Dr. Richard R. Augspurger, a urologist in Denver, pursuant to a referral by Dr. Flock. Mr. Beall reported that his symptoms were left testicular pain, urinary frequency, and erectile dysfunction. After conducting a physical examination and urodynamic testing, Dr. Augspurger detected no neurologic cause for any of Mr. Beall's symptoms. With regard to Mr. Beall's left testicular pain, Dr. Augspurger noted that "the remaining option would be to do a left orchiectomy as it appears that all conservative methods have been tried."
[¶ 9] In July of 2009, Mr. Beall contacted Dr. Augspurger and indicated that he wanted to proceed with an orchiectomy. Dr. Augspurger subsequently requested preauthorization for the procedure from the Wyoming Workers' Compensation Division, and the Division requested peer reviews from Dr. Jeffrey Balison and Dr. James White. Dr. White stated that "it would be nice to see some abnormalities on the imaging studies, but this is a sensory and a subjective symptom and even though there are no significant findings on imaging studies, the symptoms that this patient is experiencing certainly warrant this approach." The preauthorization report from Dr. Balison, in turn, provided as follows:
[¶ 10] Based on the reports provided by Drs. Balison and White, the Division issued preauthorization approval for the surgery on August 31, 2009. The approval noted as follows:
On September 15, Sky Blue objected to the Division's determination, claiming that (1) Mr. Beall's condition did not meet the definition of "injury" under Wyo. Stat. Ann. § 27-14-102(a)(xi); (2) that there was no evidence that Mr. Beall sustained an injury in the course of his employment with Sky Blue; and (3) that the medical procedures proposed to treat Mr. Beall's condition were not "medically reasonable, necessary or appropriate under the circumstances." The matter was referred to the Medical Commission to determine whether the procedure was "medically reasonable and necessary" as a result of the October 2008 workplace injury. Approximately two weeks after Sky Blue objected to the Division's determination, and one week after the matter was referred to the Medical Commission, Mr. Beall proceeded with the orchiectomy. A post-operative pathology report of the testicle revealed "no grossly evident mass lesions" and indicated that the testicle was functional.
[¶ 11] The contested case hearing was held on July 22, 2010. The Commission heard testimony from Mr. Beall and was presented with extensive medical records from each of his treatment providers, as well as deposition testimony from Dr. Augspurger. After considering all of the evidence, the Commission concluded that "the orchiectomy procedure was not reasonable and necessary medical care as related to the October
The district court affirmed the Medical Commission's decision. Mr. Beall appealed the district court's decision to this Court.
[¶ 12] Review of an administrative agency's action is governed by the Wyoming Administrative Procedure Act, which provides that:
Wyo. Stat. Ann. § 16-3-114(c) (LexisNexis 2009). We review an administrative agency's findings of fact pursuant to the substantial evidence test. Dale v. S & S Builders, LLC, 2008 WY 84, ¶ 22, 188 P.3d 554, 561 (Wyo. 2008). Substantial evidence is relevant evidence which a reasonable mind might accept in support of the agency's conclusions. Id., ¶ 11, 188 P.3d at 558. Findings of fact are supported by substantial evidence if, from the evidence in the record, this Court can discern a rational premise for the agency's findings. Middlemass v. State ex rel. Wyo. Workers' Safety & Comp. Div., 2011 WY 118, ¶ 11, 259 P.3d 1161, 1164 (Wyo.2011).
[¶ 13] The arbitrary and capricious standard of review is used as a "safety net" to catch agency action which prejudices a party's substantial rights or which may be contrary to the other review standards under the Administrative Procedure Act, yet is not easily categorized or fit to any one particular standard. Dale, ¶ 23, 188 P.3d at 561. The arbitrary and capricious standard applies if the agency failed to admit testimony or other evidence that was clearly admissible, or failed to provide appropriate findings of fact or conclusions of law. Id. We review an agency's conclusions of law de novo. Id., ¶ 26, 188 P.3d at 561-62.
[¶ 14] A claimant in a workers' compensation case generally has the burden of proving each of the essential elements of the claim by a preponderance of the evidence. Kenyon v. State ex rel. Wyo. Workers' Safety & Comp. Div., 2011 WY 14, ¶ 22, 247 P.3d 845, 851 (Wyo.2011). In this case, however, Mr. Beall contends that the Medical Commission improperly assigned to him the burden of proving his claim for reimbursement of medical expenses. Citing our recent decision in Lane-Walter v. State ex rel. Wyo. Workers' Safety & Comp. Div., 2011 WY 52, 250 P.3d 513 (Wyo.2011), Mr. Beall claims that the Division's preauthorization for the orchiectomy established a presumption that he was entitled to reimbursement for his medical expenses, and that the burden shifted to his employer to prove that the procedure was
[¶ 15] We note initially that, at the contested case hearing, Mr. Beall did not claim that the Commission improperly allocated the burden of proof. Rather, Mr. Beall's counsel expressly acknowledged that Mr. Beall had the burden of proving that he was entitled to reimbursement for his medical expenses:
Generally, we do not consider issues on appeal that have not been raised in an administrative action. Watkins v. State ex rel. Wyo. Workers' Safety & Comp. Div., 2011 WY 49, ¶ 22, 250 P.3d 1082, 1089 (Wyo.2011).
Id. (quoting Wyoming Bancorporation v. Bonham, 527 P.2d 432, 439 (Wyo.1974)). In Mr. Beall's case, however, he was prompted to raise an issue as to proper allocation of the burden of proof by our decision in Lane-Walter, which was issued after the Commission's order denying benefits but before Mr. Beall's appeal reached this Court.
[¶ 16] The Division's decision to preauthorize medical care is governed by Wyo. Stat. Ann. § 27-14-601(o), which provides as follows:
(Emphasis added.) Subsection (k), in turn, provides in relevant part that
(Emphasis added.) In providing that preauthorization for an injured worker's medical care is subject to the procedures in subsection (k), the statute preserves the ability of an employer or other interested party to request a hearing on the preauthorization decision, as occurred in the present case.
[¶ 17] Additionally, Wyo. Stat. Ann. § 27-14-606 provides that no determinations are final under the Worker's Compensation Act without notice and an opportunity for a hearing:
In Martinez v. State ex rel. Wyoming Workers' Comp. Div., 917 P.2d 619 (Wyo.1996), we analyzed this statute in the context of a dispute involving an employer's claim for reimbursement of benefits received by an injured worker, as well as that worker's claims for further benefits relating to the same injury. The hearing examiner concluded that the employer did not meet its burden of proving that the employee's benefits should be terminated and, as a result, awarded benefits to the employee on his outstanding claims and denied the employer's request for a modification of the benefits which had already been paid. Id., 917 P.2d at 620. On appeal, the district court reversed the hearing examiner's decision with respect to the employee's outstanding claims, reasoning that the employee had the burden of proving that he was entitled to receive compensation for those claims. Id., 917 P.2d at 620-21. In upholding the district court's decision, we cited Wyo. Stat. Ann. § 27-14-606, and, quoting from a prior decision, noted that "the employer is entitled to dispute any award or claim on the basis that it is unreasonable or improper, and certainly can raise the question as to whether the award or claim is causally related to the industrial accident which occurred or whether it may be attributable to some other event." Id., 917 P.2d at 621 (quoting Herring v. Welltech, Inc., 660 P.2d 361, 366 (Wyo.1983)). We concluded as follows:
Martinez, 917 P.2d at 621. See also Johnson v. State ex rel. Wyo. Workers' Safety & Comp. Div., 2010 WY 166, 244 P.3d 491 (Wyo.2010).
[¶ 18] Although Martinez is distinguishable based on the fact that there was no
[¶ 19] Our decision in Lane-Walter does not require a different result. In that case, the claimant entered into a settlement agreement with the Workers' Safety and Compensation Division in 1997 requiring the Division to pay for medical expenses related to the claimant's back injury. Lane-Walter, ¶ 5, 250 P.3d at 515. In 2007, the claimant sought preauthorization for a surgical procedure but was informed by the Division that no preauthorization for the procedure was required. Id., ¶¶ 8-9, 250 P.3d at 516. The claimant proceeded with the surgery without objection from the Division or the claimant's employer. Id. After the surgery, the Division denied benefits on the basis that the procedure was not reasonable or necessary. Id., ¶ 1, 250 P.3d at 514. The matter was referred to the Medical Commission, which upheld the Division's denial of benefits. Id. In reversing the district court's decision upholding the Medical Commission's denial of benefits, we indicated that under the unusual circumstances presented, the burden should have shifted to the Division to prove that the claimant's procedure was not reasonable and not medically necessary. Id., ¶ 18, 250 P.3d at 519. Ultimately, however, we reversed the Medical Commission's decision because it was not supported by substantial evidence. We concluded that
Id., ¶ 22, 250 P.3d at 520.
[¶ 20] The present case is distinguishable from Lane-Walter. In this case, the Division never gave any indication to Mr. Beall that preauthorization for the orchiectomy was not required, but rather followed the relevant statutory procedures by providing notice of preauthorization to Mr. Beall's employer. Mr. Beall's employer objected to the preauthorization within the period set by Wyo. Stat. Ann. § 27-14-601(k). Further, there was no settlement agreement in this case stipulating that Mr. Beall experienced a workplace injury or that his employer would pay for medical treatments related to that injury. In light of these facts, we find that our decision in Lane-Walter does not require shifting of the burden of proof in this case. The burden remained with Mr. Beall to prove all elements of his claim. See, e.g., Kenyon, ¶ 22, 247 P.3d at 851.
[¶ 21] The Wyoming Worker's Compensation Act provides benefits for work-related injuries. An "injury" is defined by the Act as follows:
Wyo. Stat. Ann. § 27-14-102(a)(xi). Consistent with the phrase "arising out of and in the course of employment," we have explained that there must be "a causal nexus between the injury and some condition, activity, environment or requirement of the employment." Shelest v. State ex rel. Wyo. Workers' Safety & Comp. Div., 2010 WY 3, ¶ 8, 222 P.3d 167, 170 (Wyo.2010) (emphasis omitted).
[¶ 22] One of the benefits provided by the Worker's Compensation Act is payment of medical expenses for work-related injuries. "The expense of medical and hospital care of an injured employee shall be paid from the date of the compensable injury. . . ." Wyo. Stat. Ann. § 27-14-401(a). As indicated in the definition of "medical and hospital care," however, medical care must be reasonable and necessary in order for an expense to be covered by the Act: "`Medical and hospital care' when provided by a health care provider means any reasonable and necessary first aid, medical, surgical or hospital service. . . ." Wyo. Stat. Ann. § 27-14-102(a)(xii). The Rules and Regulations of the Workers' Compensation Division provide further guidance as to the meaning of the phrase "medically necessary": "`Medically necessary treatment' means those health services for a compensable injury that are reasonable and necessary for the diagnosis and cure or significant relief of a condition consistent with any applicable treatment parameter." Rules, Regulations and Fee Schedules of the Wyoming Workers' Safety and Compensation Division, Ch. 1, § 4(al).
[¶ 23] In this case, Mr. Beall was required to establish that the orchiectomy was reasonable and necessary medical treatment related to his workplace injury. The Medical Commission, in its Findings of Fact, Conclusions of Law, and Order, determined that Mr. Beall's orchiectomy was not reasonable and necessary:
In accordance with the finding that Mr. Beall's injury had fully resolved by the time he saw Dr. Chizever on February 11, 2009, the Medical Commission concluded that "all care and treatment after that date, including the orchiectomy surgery, is not related to the work injury of October 13, 2008, and is therefore found to be non-compensable."
[¶ 24] Mr. Beall claims that the Commission's determination that the orchiectomy was not related to his work injury is not supported by substantial evidence. He contends, first, that because he was the only witness to the accident, his testimony alone is sufficient to prove that he sustained a workplace injury. Second, he asserts that his pain was inherently subjective and that he was the only person who could testify about the pain he experienced as a result of his injury. With respect to this argument, Mr. Beall ascribes great evidentiary significance to the fact that he voluntarily chose to undergo the orchiectomy, suggesting that his election to proceed with the removal of his testicle leads inexorably to the conclusion that the procedure was medically necessary. Third, Mr. Beall claims that the Commission's adverse
[¶ 25] To a large extent, Mr. Beall's first two claims do not address the question presented under our standard of review. The assertions that Mr. Beall's testimony was sufficient to prove his injury and that the subjective nature of his pain established that the orchiectomy was reasonable and necessary do not constitute direct challenges to the evidentiary grounds for the Commission's decision. Mr. Beall essentially asks this Court to reweigh the evidence and suggests that we ignore evidence supporting the Commission's findings. As we have previously noted, however, our task "is not to re-weigh the evidence presented to the Commission but only to determine if substantial evidence exists to support its conclusion." Watkins, ¶ 25, 250 P.3d at 1091. When we consider Mr. Beall's claims in accordance with the parameters of the substantial evidence test, we must conclude that the Commission's finding that Mr. Beall's orchiectomy was not related to his workplace injury is supported by substantial evidence.
[¶ 26] The key finding of the Commission in this case was that Mr. Beall's workplace injury had resolved by the time of his visit to Dr. Chizever, over seven months prior to the orchiectomy. This conclusion finds ample support in the record. Dr. Chizever's notes from Mr. Beall's January 8, 2009 appointment indicate no abnormalities relating to Mr. Beall's testicles: "Urologic exam is normal. . . . Testes descended bilaterally. No gross evidence of hydrocele nor scrotal masses (see ultrasound report)." Dr. Chizever noted only the possibility of an abnormality with respect to Mr. Beall's ischiorectal fossa based on the CT scan at Central Wyoming Urological Associates on October 22: "Scrotal Ultrasound done October 22, report reviews suggesting bilateral small hydroceles. No ischemia. No masses. CT of the pelvis from October 22 films and report reviewed. Question of small abnormality in the soft tissue in ischiorectal fossa. No obvious gross lesions to my review." On February 11, 2009, after a follow-up CT scan, Dr. Chizever noted that the possible abnormality in the ischiorectal fossa appeared to be resolved. No abnormalities regarding Mr. Beall's testicles were noted. After Mr. Beall's examination, Dr. Chizever and Dr. Couch each notified the Division that Mr. Beall had been released to return to work.
[¶ 27] Further, the treatment providers who examined Mr. Beall during the hours and days immediately following his injury also could not identify any abnormalities in Mr. Beall's testicles. The physician's assistant who examined Mr. Beall in Rock Springs immediately after the incident found no objective indications of injury: "no swelling[,] no bruising[,] no mass[,] has some point tenderness to the inguinal and cord." Likewise, notes from the examination at Rawlins Urgent Care two days after the incident reveal only that there was "no blood in [Mr. Beall's] urine." Subsequent reports from Mr. Beall's physical examinations at Central Wyoming Urological Associates, and the results from his ultrasound and CT scan, also did not reveal objective signs of testicular trauma. In Mr. Sundquist's report of the physical examination conducted on Mr. Beall's first visit to Central Wyoming Urological Associates, he noted the following:
Consistent with these notations, the findings from the scrotal ultrasound ordered by Central Wyoming Urological Associates indicated that "The testes were homogeneous in echotexture without evidence of testicular laceration or hematoma in this patient status post trauma. Color Doppler flow demonstrated in
[¶ 28] We are also not persuaded by Mr. Beall's challenges to the Commission's findings with respect to his credibility. As we recently reiterated, the fact finder is entitled to make assessments as to witness credibility and we are reluctant to overturn those judgments on appeal:
Watkins, ¶ 23, 250 P.3d at 1090. We note that, in this case, Mr. Beall's credibility was essential to his claim for reimbursement of his medical expenses given the lack of objective medical findings with respect to his injury, and the fact that he received treatment based solely on his subjective reports of pain.
[¶ 29] Mr. Beall attacks three specific findings of the Commission which he asserts are not supported by the evidence. First, based on the following paragraph from the Commission's findings of fact, Mr. Beall claims that the Commission incorrectly concluded that statements made in his injury report, which indicated that he was told to go back to work after the incident, were inconsistent with his testimony at the contested case hearing:
Mr. Beall asserts that there is no inconsistency between his injury report and his testimony at the evidentiary hearing because he had been told to go back to work by the time he completed the injury report, several days after he was injured. In light of this explanation of the evidence, Mr. Beall concludes that "the Commission appears to be, once again, viewing the evidence in a light most likely to result in a denial of benefits."
[¶ 30] Second, Mr. Beall claims that the Commission improperly translated Dr. Augspurger's testimony that a person "may" see swelling after traumatic injury to the testicle into the statement that a person would "expect" to see swelling. He points to the following findings of fact:
Dr. Augspurger's testimony, as it appears in the deposition transcript, stated as follows:
[¶ 31] Third, Mr. Beall claims that the Commission improperly discredited his testimony that he was screaming and vomiting after the incident because none of his coworkers observed him do these things and because the physician's assistant who examined him in Rock Springs did not indicate that he had been vomiting. Mr. Beall contends that the Medical Commission could not properly rely on his coworkers' statements because they were not subject to cross-examination. He asserts that "While these types of hearsay statements are admissible as evidence in an administrative hearing, the lack of information in these incident reports is not conclusive evidence that an event did not occur." He also claims that any inconsistencies in his testimony "were not of the nature or magnitude" to overcome the conclusion that his surgery was medically necessary.
[¶ 32] We find no merit in Mr. Beall's assertions. Even if we accepted his claims without qualification, we could not conclude that the Commission's credibility findings are not supported by substantial evidence. The findings identified by Mr. Beall, to the extent that they actually reflect the Commission's doubts about Mr. Beall's credibility, constitute a negligible portion of the Commission's credibility findings, and are extraneous to the central issues identified by the Commission. Mr. Beall does not squarely contest the Medical Commission's principle credibility determinations, which were focused primarily on three distinct areas of concern: (1) Mr. Beall's failure to provide accurate or complete medical information relating to his injury to a succession of doctors and physicians' assistants; (2) Mr. Beall's failure to provide any of his treatment providers with information relating to a prior groin injury from which he experienced similar symptoms; and (3) Mr. Beall's demeanor and testimony at the contested case hearing.
[¶ 33] The Commission found that Mr. Beall's credibility was undermined by his failure to provide accurate or complete medical histories regarding his treatment to a series of health care providers. The Commission noted that Mr. Beall had provided incomplete medical information to Dr. Flock ("[T]here is no indication that any medical records from the prior medical consults had been provided to Dr. Flock for his review, including the prior urologic workup in Casper."), Dr. Cesko ("Mr. Beall failed to advise Dr. Cesko that he had already been through a full urological workup with Central Wyoming Urological Associates, P.C., and that [their] findings upon examination, were unremarkable."), and Dr. Shafer ("This Panel notes that Dr. Shafer was not provided the medical records of Dr. Couch, Dr. Cesko, or Dr. Flock, and relied exclusively on the subjective reporting of Mr. Beall, which was inaccurate and incomplete."). The Commission also found that Mr. Beall had provided misleading information to Dr. Augspurger. It noted that Dr. Augspurger's initial report from his examination of Mr. Beall stated that Mr. Beall had "significant swelling of his left testicle" at the time of injury, and that "[t]he testicle got a large size and now that has slowly resolved." The Commission found, however, that there was no indication that Mr. Beall experienced any swelling relating to his injury:
Importantly, the Commission ultimately concluded that the inaccurate and incomplete medical histories supplied to Mr. Beall's treatment providers, and the medical opinions generated from that misinformation, contributed to the decision to preauthorize the orchiectomy:
Mr. Beall does not challenge any of the Commission's findings that his treatment providers were supplied with incomplete and inaccurate information.
[¶ 34] The Medical Commission's order further indicates that it was troubled by the fact that Mr. Beall had not informed his treatment providers that he had previously experienced problems very similar to those that he claimed arose from his injury. The Commission stated that
(Emphasis in original.) The Commission concluded that Mr. Beall's subjective reports of his current injury were not credible based, in part, on the fact that "Mr. Beall failed to advise ANY of his treating physicians that he
[¶ 35] Mr. Beall does not challenge these findings. Rather, noting that the previous injury was to his right testicle, he contends that "Whether the medical records before the accident were incomplete and whether the doctors had that information in determining the necessity of the surgery is not relevant. This Court has to merely ask itself if ANY man would be willing to have his left testicle removed, if it were not medically necessary." (Footnote omitted.) We have previously noted, however, that "As the trier of fact, the Medical Commission [is] charged with determining relevancy, assigning probative values and weighing the evidence." McIntosh v. State ex rel. Wyo. Med. Comm'n, 2007 WY 108, ¶ 13, 162 P.3d 483, 488-89 (Wyo.2007). The Commission concluded that Mr. Beall's prior injuries to his groin were relevant to his October 13, 2008 injury and we do not second-guess that conclusion in this appeal.
[¶ 36] The Commission also determined that Mr. Beall was not a credible witness based on his testimony at the contested case hearing. The Commission noted that although Mr. Beall's medical records clearly indicated that he had undergone a physical examination at the Casper urology clinic on two separate occasions, Mr. Beall denied that such examinations had occurred:
The Commission provided the following summary of Mr. Beall's misstatements regarding the reports and opinions of his treatment providers:
In addition, the Commission noted that Mr. Beall's demeanor at the contested case hearing also reflected poorly on his credibility:
Mr. Beall does not address the Commission's findings with respect to his demeanor at the contested case hearing.
[¶ 37] Finally, Mr. Beall does not address the Commission's adverse credibility findings with respect to Dr. Cesko. As we have previously noted, "a hearing examiner is entitled to disregard an expert opinion if he finds the opinion unreasonable, not adequately supported by the facts upon which the opinion is based, or based upon an incomplete and inaccurate medical history provided by the claimant." Taylor v. State ex rel. Wyo. Workers' Safety & Comp. Div., 2005 WY 148, ¶ 15, 123 P.3d 143, 148 (Wyo.2005). After quoting a March 27, 2009 letter from Dr. Cesko to the Division which stated that Mr. Beall's "left testicle has been turned into a spongy nonfunctional organ," the Commission noted that Dr. Cesko's conclusions were not supported by the evidence:
(Emphasis in original.) Mr. Beall fails to assert any grounds for rejecting these findings.
[¶ 38] We find no reason in the record to depart from the credibility findings of the Medical Commission or to conclude that they are clearly contrary to the overwhelming weight of the evidence. Mr. Beall provides no response to the main credibility issues identified by the Commission. Rather, as discussed above, he simply ignores the major part of the Commission's thirty-one-page order, which focused on the misleading statements and incomplete medical histories Mr. Beall supplied to a succession of treatment providers, Mr. Beall's evasive testimony at the contested case hearing, and the unsupported opinions of Dr. Cesko. The Commission's credibility determinations are corroborated by the record, and we find substantial evidence to support those determinations.
[¶ 39] The burden of proving that the orchiectomy was reasonable and necessary medical care as related to his October 13, 2008 workplace injury rested with Mr. Beall, and substantial evidence supports the Commission's determination that Mr. Beall failed to meet this burden.
[¶ 40] Affirmed.
