In the Matter of the Worker's Compensation Claim Of: Richard J. Delacastro v. State of Wyoming, Ex Rel., Wyoming Workers' Safety and Compensation Division, 321 P.3d 327

In June 2007 Delacastro injured his right hip at work carrying boxes; treated for a right hip strain and lateral femoral cutaneous nerve irritation and improved with therapy.
He stopped care, then in 2009 returned with back, bilateral thigh pain and foot numbness; his treating physicians (Drs. Roberts and Pettine) suspected lumbar pathology (possible L2-3 annular tear) and recommended diagnostic testing including discography.
The Division denied coverage for the 2009 back-related testing/treatment as unrelated to the 2007 hip injury; Delacastro appealed to the Office of Administrative Hearings (OAH).
OAH approved payment for diagnostic work up through a discography on a “rule out” basis and ordered the Division to pay outstanding bills up to that test.
The discography was negative (no pain reproduction); OAH denied payment for further lumbar testing/treatment and left open that future hip-related treatment remains compensable if administratively shown related to the original hip injury.
The district court affirmed OAH; the Wyoming Supreme Court affirmed as modified, concluding substantial evidence supported OAH’s denial of further back treatment but clarified that future hip treatment may be administratively reviewed.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether OAH’s denial of all future medical benefits (including for the hip) was supported by substantial evidence	Delacastro: OAH erred by denying all future benefits; his ongoing symptoms are from the original injury	Division: The 2007 event was a compensable hip injury; 2009 back treatment is a new, unrelated condition	Held: OAH recognized the 2007 hip injury; future hip treatment may be pursued separately; order modified to permit administrative review of future hip care
Whether OAH properly denied additional diagnostic testing/treatment for the lumbar spine after a negative discography	Delacastro: He injured his lumbar spine in 2007; discography was inconclusive for all causes and further testing (e.g., nerve root block) is needed	Division: The 2009 lumbar complaints are not shown to be causally related to the 2007 workplace hip injury; discography was negative so further lumbar care is not compensable	Held: Substantial evidence supports OAH’s denial of further lumbar testing/treatment after negative discography; the “rule out” discography was compensable but a negative result meant Delacastro failed to prove causation

Dale v. S & S Builders, LLC, 188 P.3d 554 (Wyo. 2008) (substantial evidence standard for agency factfinding)
Bush v. State ex rel. Wyo. Workers’ Comp. Div., 120 P.3d 176 (Wyo. 2005) (definition and review of substantial evidence)
Kenyon v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 247 P.3d 845 (Wyo. 2011) (claimant bears burden to prove causation by preponderance)
Snyder v. State ex rel. Wyo. Workers’ Comp. Div., 957 P.2d 289 (Wyo. 1998) (diagnostic tests may be compensable on a “rule out” basis)
Mitcheson v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 277 P.3d 725 (Wyo. 2012) (requirement of objective indication to support rule-out diagnostics)
Watkins v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 250 P.3d 1082 (Wyo. 2011) (agency may discount expert opinions if unsupported)
Taylor v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 123 P.3d 143 (Wyo. 2005) (limits on reliance where medical history is incomplete)
Moss v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 232 P.3d 1 (Wyo. 2010) (de novo review of agency conclusions of law)