HILL, Justice.
[¶ 1] Vernon Bailey challenges a Medical Commission order denying him further benefits for a cervical spine injury. Mr. Bailey argues on appeal that the Medical Commission's findings and conclusions were not supported by substantial evidence. We will affirm.
[¶ 2] Mr. Bailey phrases the single issue as follows:
[¶ 3] On February 7, 2011 Vernon Bailey slipped and fell during his shift as a custodial supervisor at the Holiday Inn in Riverton. He injured his knees, right wrist, head, neck,
[¶ 4] On March 4, 2011 the Wyoming Workers' Compensation Division (Division) awarded benefits to Mr. Bailey. Dr. Narotzky referred Mr. Bailey to Dr. Todd Hammond, an anesthesiologist, who administered a steroid injection. Dr. Hammond gave Mr. Bailey a pain log and recommended that he follow up with Dr. Thomas Kopitnik, another neurosurgeon, if his symptoms did not improve. Dr. Narotzky recommended, and Mr. Bailey underwent, an MRI of his cervical spine, which showed minimal to mild foraminal narrowing in C3-4, C4-5, and C5-6.
[¶ 5] Six weeks after his MRI Mr. Bailey received a CT C-spine post-myelogram. The CT scan showed "[m]ultilevel degenerative changes of the cervical spine." After reviewing Mr. Bailey's scans Dr. Kopitnik recommended that Mr. Bailey "undergo a C5-6 and C6-7 anterior cervical discectomy and fusion because of neck pain." Dr. Kopitnik submitted a request to the Division for preauthorization for the recommended discectomy and fusion. However, the Division denied the request, to which Mr. Bailey objected. Mr. Bailey requested a hearing, which was referred to the Medical Commission.
[¶ 6] Before the Medical Commission hearing Dr. Kopitnik submitted to a deposition. He testified that Mr. Bailey previously reported back pain to Dr. Narotzky in 2009, a full year and a half before his work fall. Dr. Kopitnik testified that, in his opinion, Mr. Bailey's work fall did not cause his cervical spine injury. This was contrary to his earlier statement that he expressed when he submitted the preauthorization request for Mr. Bailey's surgery in 2011. Dr. Kopitnik stated, "[Mr. Bailey] had a myelogram of his neck February 16, 2010. And this new myelogram, April 18, 2011, to me, does not look that different."
[¶ 7] In March of 2012 Mr. Bailey was referred to yet another doctor, Dr. Eric Schubert, a neurologist, who reviewed the MRI and CT scan of Mr. Bailey's cervical spine. Dr. Schubert reported that the MRI showed "moderate degenerative disk disease at C4-5, C5-6, and C6-7." Dr. Schubert recommended surgery to alleviate Mr. Bailey's pain. Dr. Schubert was also deposed in preparation for the Medical Commission hearing and again testified that he recommended a three-level discectomy and fusion for Mr. Bailey. However, when asked if the 2011 workplace fall caused the need for recommended surgery, Dr. Schubert responded "that would be conjecture on my part." Dr. Schubert also admitted that Mr. Bailey's medical records reflected a recommendation of neck surgery
[¶ 8] Along with the testimony of Drs. Kopitnik and Schubert, Dr. John F. Ritterbusch, an orthopedic surgeon, conducted an independent medical examination. After examining Mr. Bailey and his medical records Dr. Ritterbusch found no evidence of acute injury after the accident of February 7, 2011 on the CT scans, x-rays, and myelogram. Dr. Ritterbusch said it was his opinion that the documentation failed to establish an acute injury or an aggravation or exacerbation to the cervical spine after the accident. The doctor also stated that "[i]t is a mystery to me after reviewing this chart why this surgical procedure was ever considered."
[¶ 9] After the hearing the Medical Commission upheld the Division's denial of benefits for Bailey's cervical spine issues. In its findings of fact the Medical Commission relied upon Dr. Kopitnik's testimony and discounted Dr. Schubert's testimony. In response, Mr. Bailey filed a Petition for Review of Administrative Action in district court. The district court affirmed the Medical Commission and this appeal followed.
[¶ 10] When considering an appeal from a district court's review of an administrative agency's decision, we treat the case as if it had come directly from the administrative agency, without giving any deference to the district court's decision. Kenyon v. State ex rel. Wyo. Workers' Safety & Comp. Div., 2011 WY 14, ¶ 10, 247 P.3d 845, 848 (Wyo. 2011); Dale v. S & S Builders, LLC, 2008 WY 84, ¶ 8, 188 P.3d 554, 557 (Wyo.2008). Our review is governed by Wyo. Stat. Ann. § 16-3-114(c) (LexisNexis 2013):
Under § 16-3-114(c) we review the agency's findings of fact by applying the substantial evidence standard. Dale, ¶ 21, 188 P.3d at 561. Substantial evidence means "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Bush v. State ex rel. Workers' Comp. Div., 2005 WY 120, ¶ 5, 120 P.3d 176, 179 (Wyo. 2005) (citation omitted). "`Findings of fact are supported by substantial evidence if, from the evidence preserved in the record, we can discern a rational premise for those findings.'" Kenyon, ¶ 11, 247 P.3d at 849, quoting Bush, ¶ 5, 120 P.3d at 179.
[¶ 11] Regarding an agency determination that the employee/claimant did not satisfy his burden of proof, we have stated:
Dale, ¶ 22, 188 P.3d at 561 (citations omitted).
[¶ 12] Finally, "we review an agency's conclusions of law de novo, and will affirm only if the agency's conclusions are in accordance with the law." Kenyon, ¶ 13, 247 P.3d at 849, quoting Moss v. State, 2010 WY 66, ¶ 11, 232 P.3d 1, 4 (Wyo.2010). See also, Dale, ¶ 26, 188 P.3d at 561-62.
[¶ 13] Mr. Bailey argues on appeal that the Medical Commission's findings and conclusions were not supported by substantial evidence. Mr. Bailey contends that the Medical Commission erred when it gave greater weight to one expert over another. Based upon our review of the record, we conclude that the Medical Commission's decision was supported by substantial evidence.
[¶ 15] In applying this provision, we have said that an employer takes an employee as he finds him, and an employee who has a preexisting condition may still recover if his employment substantially or materially aggravated the condition. Lindbloom v. Teton Int'l, 684 P.2d 1388, 1389 (Wyo.1984). Furthermore, a "preexisting disease or infirmity of the employee does not disqualify a claim under the `arising out of employment' requirement if the employment aggravated, accelerated, or combined with the disease or infirmity to produce the death or disability for which compensation is sought." Dutcher v. State ex rel. Wyo. Workers' Safety & Comp. Div., 2010 WY 10, ¶ 14, 223 P.3d 559, 562 (Wyo.2010) (quoting Lindbloom, 684 P.2d at 1389; State ex rel. Wyo. Workers' Safety & Comp. Div. v. Faulkner, 2007 WY 31, ¶ 11, 152 P.3d 394, 397 (Wyo.2007)); State ex rel. Wyo. Workers' Comp. Div. v. Fisher (In re Fisher),, 914 P.2d 1224, 1227 (Wyo.1996).
[¶ 16] For a claimant to recover under the theory of material aggravation he must establish by a preponderance of the evidence his work "contributed to a material degree to the aggravation of the preexisting condition." Boyce v. State ex rel. Wyo. Workers' Safety & Comp. Div., 2005 WY 9, ¶ 11, 105 P.3d 451, 455 (Wyo.2005). We further explained the proof required to show a work-related aggravation of a preexisting condition:
Boyce, ¶ 16, 105 P.3d at 456. This Court has explained that "there are no `magic' words which must be uttered by the medical expert in order to justify a finding that the claimant suffered a material aggravation of a pre-existing condition." State ex rel. Wyo. Workers' Safety v. Slaymaker, 2007 WY, 65, ¶ 18, 156 P.3d 977 at 984 (Wyo.2007). However, the Medical Commission can disregard a medical expert's testimony if they find it "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.'" Watkins v. State ex rel. Wyo. Med. Comm'n, 2011 WY 49, ¶ 25, 250 P.3d 1082, 1091 (Wyo. 2011) (quoting Taylor v. State ex rel. Wyo. Workers' Safety & Comp. Div., 2005 WY 148, ¶ 15, 123 P.3d 143, 148 (Wyo.2005)).
[¶ 18] During the hearing, Dr. Kopitnik testified as follows:
[¶ 19] About Dr. Kopitnik's testimony, the Medical Commission said, "[t]he most persuasive opinion in this matter is that put forth by Dr. Kopitnik, who actually requested preapproval from the Division of the cervical procedure, but indicated upon questioning that Mr. Bailey's pre and post February 7, 2011 condition was not `appreciably different.'" The credibility of Dr. Kopitnik's testimony was bolstered by Dr. Ritterbusch, who said it was his opinion that the documentation failed to establish an acute injury or an aggravation or exacerbation to the cervical spine after the accident.
However, when Dr. Schubert was pressed about stating his opinion to a reasonable degree of medical probability, he stated for a third time: "... that would be conjecture on my part." Dr. Schubert also testified that he based his opinion on Mr. Bailey's assertions that he did not have any cervical spine symptoms before his workplace fall in 2011. However, the record clearly indicates that Mr. Bailey's cervical spine problems began prior to the accident.
[¶ 21] The Medical Commission summarized Dr. Schubert's testimony as follows:
The Medical Commission based its credibility determinations on the record and explained its reason as to why it accepted Dr. Kopitnik's testimony and rejected Dr. Schubert's testimony. If, in the course of its decision making process, the agency disregards certain evidence and explains its reasons for doing so based upon determinations of credibility or other factors contained in the record, its decision will be sustainable under the substantial evidence test. Along with Dr. Kopitnik's testimony, the medical records and independent medical examination supported the Medical Commission's decision to deny Mr. Bailey benefits for his cervical spine injury.
[¶ 22] Under these circumstances, we cannot say that the Medical Commission was wrong to discount the medical opinions proffered by Dr. Schubert. The Medical Commission's rejection of Mr. Bailey's evidence and its determination that Mr. Bailey failed to meet his burden of proving his preexisting cervical spine injury was materially aggravated by his fall at work on February 7, 2011 was not contrary to the great weight of the evidence. Consequently, substantial evidence existed to support the Medical Commission's decision.
[¶ 23] We affirm the district court's order affirming the Medical Commission's order denying Vernon Bailey further benefits for his cervical spine injury.