Hutchings v. Labor Commission

2016 UT App 160
THE UTAH COURT OF APPEALS
K AYLA H UTCHINGS,
Petitioner,
v.
LABOR C OMMISSION AND WASHINGTON
C OUNTY S CHOOL DISTRICT,
Respondents.
Opinion
No. 20150429-CA
Filed July 29, 2016
Original Proceeding in this Court
Robert M. Jensen and Virginius Dabney, Attorneys
for Petitioner
Bret A. Gardner and Kristy L. Bertelsen, Attorneys
for Respondent Washington County School District
JUDGE S TEPHEN L. R OTH authored this Opinion, in which J UDGE
GREGORY K. O RME concurred. S ENIOR JUDGE R USSELL W. BENCH
concurred in the result.1
ROTH, Judge:
¶1 	Kayla Hutchings seeks review of the Labor Commission’s
(the Commission) decision to deny her claim for permanent total
disability. We decline to disturb the Commission’s decision.
1. Senior Judge Russell W. Bench sat by special assignment as
authorized by law. See generally Utah R. Jud. Admin. 11-201(6).

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BACKGROUND
¶2 	In 	August 	2008, 	Hutchings 	was 	employed 	by 	the
Washington County School District as a cafeteria worker. One
day in late August, she and a coworker were loading boxes of
food into the school’s walk-in freezer. After continuously lifting
and loading boxes that weighed up to forty pounds for about
half an hour, Hutchings and her coworker had to lift a box that
weighed 	approximately 	eighty 	pounds 	onto 	a 	shelf 	in 	the
freezer. When Hutchings pushed the box onto the shelf, she
experienced a sudden pain in her back and immediately felt sick
to her stomach. Subsequently, Hutchings refrained from tasks
that required her to bend and lift.
¶3 	Hutchings, however, did not miss any work due to the
incident, and she did not immediately seek medical attention for
pain that may have resulted from it. Nor did she mention the
incident or any back or leg pain during a November 2008
appointment with Dr. Britt, a WorkMed physician, regarding
another accident she also suffered while at work—a steam burn
on her arm. Instead, Hutchings first reported to a medical
professional that she was suffering from low back or radicular
leg pain in December 2008 during the course of an annual visit to
her primary care physician, Dr. Staheli. Dr. Staheli ordered an
MRI of her lumbar spine, which showed that Hutchings suffered
from degenerative disc disease on multiple spinal levels as well
as other degenerative phenomena in her lower back.
¶4 	Shortly 	after 	the 	MRI 	was 	completed, 	the 	school’s
principal referred Hutchings to WorkMed for her low back and
leg pain. At this second WorkMed appointment, Dr. Britt noted
that Hutchings reported “[n]o specific trauma” but indicated
that at the first of the school year there was always heavy lifting
required; he also noted that Hutchings’s pain began around that
time and that her pain had “to be work related.” He indicated
that the pain had worsened within the four weeks preceding the
appointment and that she had had no medical treatment for the

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problem 	until 	her 	December 	appointment 	with 	Dr. 	Staheli.
Dr. Britt diagnosed Hutchings with lower back pain and a disc
extrusion. He referred Hutchings to Dr. Snook, a neurosurgeon,
but he otherwise released her back to work with modified duty.
¶5 	Dr. Snook diagnosed Hutchings with degenerative disc
disease as well as nerve-root compression from a cyst in her
lower 	back. 	In 	February 	2009, 	he 	performed 	surgery 	to
decompress the affected nerve root. He noted that while there
had been “some suggestion” prior to surgery that a herniated
disc in Hutchings’s lower back was also compressing the nerve
root, during surgery he found the disc at issue to be “flat,” with
no sign that it was compressing on the nerve root. Consequently,
he performed no disc surgery.
¶6 	While the surgery initially alleviated Hutchings’s pain,
by June 2009, Hutchings had again seen both Dr. Staheli and
Dr. Snook, complaining that her leg and back pain had returned.
From this point forward, Hutchings continued to experience
lower 	back 	and 	radicular 	leg 	pain 	and 	she 	tried 	many
treatments, including epidural shots and electrotherapy. In May
2012, she sought another opinion by Dr. Major, who diagnosed
her with a degenerative vertebral condition and joint disease in
her lower back, though he was uncertain regarding the exact
source of her pain. He opined that Hutchings needed a “2-level
spinal fusion” to relieve her symptoms.
¶7 	In January 2012, Hutchings filed an application for a
hearing with the Commission to determine whether she was
entitled to disability compensation due to the accident that
occurred 	at 	the 	end 	of 	August 	2008. 	After 	an 	evidentiary
hearing, the administrative law judge (the ALJ) determined in an
August 2013 decision that at the time of her accident, Hutchings
had 	been 	suffering 	from 	a 	preexisting 	degenerative 	back
condition. 	The 	ALJ 	noted 	that 	because 	of 	the 	preexisting
condition, Hutchings was required to show not just that the
injury “ar[ose] out of and in the course of [her] employment,”

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see Utah Code Ann. § 34A-2-410 (LexisNexis 2015), but “that the
work 	exertion 	at 	the time 	of 	the 	accident 	was unusual 	or
extraordinary as compared to the exertions of nonemployment
life,” see Allen v. Industrial Comm’n, 729 P.2d 15, 26 (Utah 1986)
(“[W]here the claimant suffers from a preexisting condition
which contributes to the injury, an unusual or extraordinary
exertion is required to prove legal causation.”). The ALJ then
concluded that Hutchings’s exertion was not unusual under the
circumstances, and as a result, Hutchings had failed to establish
legal causation.
¶8 	Hutchings sought review by the Commission of the ALJ’s
order denying her benefits. The Commission determined that
“[w]hile there is evidence of pre-existing degenerative changes
in Ms. Hutchings’s lumbar spine, the record does not clearly
show 	that 	she 	suffered 	from 	a 	pre-existing 	condition 	that
contributed to her work injury.” It therefore concluded that,
contrary 	to 	the 	ALJ’s 	determination, 	“the 	more 	stringent
standard of legal causation does not apply to Ms. Hutchings’s
claim.” Instead, the Commission determined that under the less
stringent 	standard, 	legal 	causation 	was 	established 	by 	the
evidence before the ALJ. The Commission then decided that
there was a conflict in the medical opinions over whether her
work accident was the medical cause of her “current low-back
condition” and that the issue of medical causation should be
referred to a medical panel. Accordingly, the Commission set
aside the ALJ’s order and remanded the case “for consideration
of 	the 	medical 	cause 	of 	Ms. 	Hutchings’s 	current 	low-back
problems with the participation of an impartial medical panel
qualified to assess her condition.”
¶9 	The ALJ then instructed the medical panel that it was to
answer three related questions:
Is 	there 	any 	medically 	demonstrable 	causal
connection 	between 	[Hutchings’s] 	low 	back

Hutchings v. Labor Commission
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condition 	and 	the 	industrial 	accident 	which
occurred in August 2008?
Please 	state 	the 	percentage 	of 	whole 	person
impairment, if any, sustained by [Hutchings] as a
result 	of 	the 	medical 	problem 	caused 	by 	the
industrial accident.
Please identify any medical or functional capacity
limitations 	which 	apply 	to 	[Hutchings] 	and
specifically indicate[] whether the limitation is a
result 	of 	injury 	sustained 	in 	the 	August 	2008
industrial accident.
The 	medical 	panel 	ultimately 	concluded 	that 	there 	was no
medically demonstrable causal connection between the August
2008 accident and Hutchings’s low back condition, and as a
consequence, the accident itself did not result in any impairment
or cause any “functional capacity limitations.”
¶10 	The panel reasoned that Hutchings’s history of “four
medical encounters for low back pain . . . beginning 20 months
before the alleged injury,” with the last one “only 20 days prior”
to the event itself, indicated “significant lumbar degenerative
pathology.” Thus, it concluded that, when this chronological
history was combined with the results of the December 2008
MRI (which showed significant degenerative conditions “at four
levels” of the spine), “it is clear that Mrs. Hutchings’[s] low back
condition antedated” the August 2008 industrial accident.
¶11 	The 	panel 	then 	explained 	that 	“[o]ther 	historical
information” 	post-dating 	the 	August 	2008 	accident 	also
supported its conclusion. For example, the panel noted, (1) in
November 	2008, 	about 	three 	months 	after 	the 	accident,
Hutchings “was examined and treated by Dr. Britt at WorkMed”
for 	an 	unrelated 	workplace 	injury, 	but 	there 	was 	“no
information relative to [low back or leg pain] recorded during

Hutchings v. Labor Commission
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that visit,” and she was “released . . . to regular duty” less than a
week later; (2) Hutchings “missed work due to headache[s] since
the start of the school year but never from [low back pain] or leg
pain”; (3) there was no mention of the August 2008 accident in
Dr. 	Staheli’s 	report 	of 	Hutchings’s 	December 	2008 	annual
physical, despite the fact that she complained of low back pain
and Dr. Staheli ordered an MRI; and (4) while Dr. Britt recorded
in his report of her December 16, 2008, visit to WorkMed that
Hutchings 	“had 	noted 	[low 	back]/leg 	pain 	since 	restarting
school,” Dr. Britt also recorded that “there was ‘no specific
trauma’” that explained her symptoms but instead only “a lot of
heavy lifting at the ‘first of the year.’” The medical panel noted
that it found Dr. Snook’s surgical findings to be “of interest”
where Dr. Snook performed “[n]o disc surgery” because he
found 	a 	“flat 	(not 	bulging) 	. 	. 	. 	disc with 	no 	evidence 	of
encroachment” on the nerve root in Hutchings’s lower back that
he had earlier diagnosed as compressed and where he did not
see the cyst that he considered to be the cause of the nerve-root
compression.
¶12 	The 	panel 	ultimately 	concluded 	that 	“[t]he 	[medical
record] information cited in this comment does not allow the
medical 	panel 	to 	find 	any 	reasonable 	demonstrable 	causal
connection between Mrs. Hutchings[’s] low back condition and
the industrial accident which occurred in August 2008.” As a
result, the panel also determined that there was no whole-person
impairment 	attributable 	to 	the 	accident 	and 	that, 	although
Hutchings 	had 	capacity 	limitations 	of 	“Sedentary 	Physical
Demand Characteristic of Work Level,” “this is not related to the
August 2008 industrial accident.”
¶13 	Hutchings objected to the medical panel report, but the
ALJ found “no basis to require a hearing or disallow the medical
panel report” and admitted it into the record. The ALJ then
found that the “medical panel opinion [was] persuasive given
the 	[medical 	panel’s] 	expertise, 	independence 	and 	sound
analysis” and that she had “reviewed the medical record and

Hutchings v. Labor Commission
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[found] the panel’s analysis consistent with the record and
supported by the opinion of Dr. Knoebel.”2 The ALJ determined
that “[t]he weight of the evidence presented does not support
the Petitioner’s position” and concluded that Hutchings had
“failed 	to 	meet 	her 	burden 	of 	proof 	regarding 	medical
causation.”
¶14 	The Commission affirmed the ALJ’s decision and denied
Hutchings’s request for reconsideration. Hutchings seeks review
of these orders.
ISSUES ON APPEAL
¶15 	This case concerns medical causation. Hutchings’s central
claim on appeal is that the Commission’s medical causation
determination was erroneous. She contends that it was error for
the Commission to adopt the medical panel report because the
medical panel did not properly apply the medical causation test.
In particular, Hutchings asserts that the medical panel failed to
consider whether the accident medically caused or aggravated
her preexisting low back condition. Instead, she contends, the
medical panel “considered only preexisting conditions” as a
medical 	cause 	and 	then 	“stopped” 	the 	analysis 	without
considering “the accident as a cause.” She also contends that the
evidence 	does 	not 	support 	the 	medical 	panel’s 	and 	the
Commission’s determination that the accident did not cause or
aggravate her low back condition.
2. Dr. Knoebel was the independent medical evaluator who
examined 	Hutchings 	in 	May 	2012, 	after 	she 	had 	filed 	her
application for a hearing for disability benefits. He ultimately
concluded that her low back condition was degenerative and
“[n]on-industrial.”

Hutchings v. Labor Commission
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ANALYSIS
I. Applicable Law
¶16 	Under 	our 	Workers’ 	Compensation 	Act, 	industrial
accidents that aggravate or “light up” a preexisting condition are
compensable. See, e.g., Nyrehn v. Industrial Comm’n, 800 P.2d 330,
335 (Utah Ct. App. 1990). In order to qualify for compensation,
the claimant must demonstrate (1) that the injury occurred “by
accident”3 and (2) that the conditions and activities of the job
were the cause of the injury. See Allen v. Industrial Comm’n, 729
P.2d 15, 18 (Utah 1986); see also Utah Code Ann. § 34A-2-401
(LexisNexis 2015). The key causation question is “whether, given
this body and this exertion, the exertion in fact contributed to the
injury.” Allen, 729 P.2d at 24. The answer to this question has
two components. The claimant must show that the work exertion
was both the legal cause and the medical cause of the injury or
disability. See id. at 25–27.
¶17 	The purpose of legal causation is to determine “what kind
of exertion satisfies the test of ‘arising out of the employment’”
by examining the work-related exertion that led to the injury in
relation to any “‘personal causal contribution’” of the claimant—
usually an existing physical condition. Id. at 25–26 (emphasis
added) (citations omitted). The employer bears the burden of
demonstrating the existence of a preexisting condition and that
the condition contributed to the injury. Nyrehn, 800 P.2d at 334. If
the employer does so, “a claimant with a preexisting condition
must 	show 	that 	the 	employment 	contributed 	something
substantial to increase the risk he already faced in everyday life
because of his condition.” Allen, 729 P.2d at 26. Thus, “where the
claimant suffers from a preexisting condition which contributes
to the injury, an unusual or extraordinary exertion is required to
3. Neither party contests that Hutchings’s injury occurred “by
accident.”

Hutchings v. Labor Commission
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prove legal causation,” with the “extra exertion serv[ing] to
offset the preexisting condition of the employee as a likely cause
of the injury.” Id. at 25–26. In contrast, “[w]here there is no
preexisting condition, a usual or ordinary exertion is sufficient
[to establish legal causation].” Id. at 26.
¶18 	The determination of medical causation may also take
into account the role of a preexisting condition in the claimed
disability. See, e.g., Giesbrecht v. Board of Review, 828 P.2d 544, 547
(Utah Ct. App. 1992) (upholding the Industrial Commission’s
denial of benefits when the preexisting condition (cancer) was
not aggravated by the injury claimed in the case (a bone fracture
in the claimant’s leg)); Virgin v. Board of Review, 803 P.2d 1284,
1287–90 	(Utah 	Ct. 	App. 	1990) 	(upholding 	the 	Industrial
Commission’s decision to deny benefits where the claimant’s
preexisting condition was the “sole [medical] cause” of the
claimant’s disability); Olsen v. Industrial Comm’n, 776 P.2d 937,
939–40 (Utah Ct. App. 1989) (declining to disturb the Industrial
Commission’s adoption of the medical panel’s conclusion that
claimant’s condition was caused by preexisting heart disease),
aff’d, 797 P.2d 1098 (Utah 1990); Large v. Industrial Comm’n, 758
P.2d 954, 957 (Utah Ct. App. 1988) (declining to disturb the
Industrial 	Commission’s 	causation 	determination 	where
substantial 	evidence 	supporting 	the 	determination 	that
preexisting 	conditions, 	not 	the 	claimant’s 	injury, 	was 	“the
medical 	cause 	of 	[the 	claimant’s] 	permanent 	total 	disability
status”). The purpose of the medical causation requirement “is to
ensure 	that 	there 	is 	a 	medically 	demonstrable 	causal 	link
between the [legally sufficient] work-related exertions and the
unexpected injuries that resulted from those strains.” Allen, 729
P.2d at 27; see also Nyrehn, 800 P.2d at 334 (“Under the legal
[causation] test, the law must define what kind of exertion
satisfies the test of ‘arising out of the employment’ . . . [then] the
doctors must say whether the exertion (having been held legally
sufficient to support compensation) in fact caused this [injury].”
(omission and second and third alterations in original) (citation

Hutchings v. Labor Commission
20150429-CA 	10 	2016 UT App 160
and additional internal quotation marks omitted)). To meet the
medical causation requirement, the claimant must “prove the
disability is medically the result of an exertion or injury that
occurred during a work-related activity” by showing through
“evidence, 	opinion, 	or 	otherwise 	that 	the 	stress, 	strain, 	or
exertion required by his or her occupation led to the resulting
injury or disability.” Allen, 729 P.2d at 27; accord Cook v. Labor
Comm’n, 2013 UT App 286, ¶ 12, 317 P.3d 464. In this regard, a
claimant attempting to show that the work-related exertion
aggravated a preexisting condition “must prove the subsequent
disability is medically the result of an exertion or injury that
occurred during a work-related activity, and not solely the result
of a pre-existing condition.” Virgin, 803 P.2d at 1288 (citation and
internal quotation marks omitted). If the claimant cannot do so,
then “compensation should be denied.” Allen, 729 P.2d at 27.
Furthermore, 	because 	medical 	causation 	is 	often 	dependent
upon interpretation of relevant medical records and specialized
examination of the claimant, our supreme court has observed
that “[i]t is through the expertise of the medical panel that the
[Industrial] 	Commission 	should 	be 	able 	to 	make 	the
determination of whether the injury sustained by a claimant is
causally 	connected 	or 	contributed 	to 	by 	the 	claimant’s
employment.” 	Id. 	(citation 	and 	internal 	quotation 	marks
omitted).
¶19 	In Virgin v. Board of Review, 803 P.2d 1284 (Utah Ct. App.
1990), the claimant suffered an industrial accident where he was
hit by a piece of equipment on his left hip and knocked down. Id.
at 1285. Three days after the accident, he was examined by a
physician’s assistant who only “found bruising and tenderness
in the left hip area, but no fractures.” Id. The claimant “made no
claim for compensation at that time and did not miss any work
as a result of” the accident. Id. About twenty months later, the
claimant underwent a total hip replacement and submitted a
claim for medical expenses and disability related to the surgery,
“claiming his hip replacement surgery was caused in part by his

Hutchings v. Labor Commission
20150429-CA 	11 	2016 UT App 160
. . . industrial accident.” Id. at 1286. The medical panel explained
that “perhaps the surgery happened sooner than it would have
without the industrial accident,” but it ultimately concluded that
the claimant’s need for hip surgery and subsequent disability
“were not caused by the industrial injury.” Id. at 1289. We
upheld the Industrial Commission’s decision to deny benefits
because the medical evidence permitted only speculation that
the 	accident 	hastened 	the 	surgery 	and 	there 	was no 	other
evidence that the claimed impairment was attributable to the
industrial accident. Id. at 1289–90. Rather, there was substantial
evidence supporting the Industrial Commission’s determination
that a medical condition that both predated and had no relation
to the accident necessitated the hip replacement. Id. Thus, the
disability for which the claimant sought compensation—his hip
replacement—was 	not 	the 	medical 	result 	of 	the 	workplace
accident because the claimant “would have needed the surgery
in any event” due to his preexisting condition. Id. Accordingly,
the claimant failed to demonstrate that his hip replacement was
attributable to the industrial accident. Id.
¶20 	In 	sum, 	the 	role 	of 	a 	preexisting 	condition 	in 	the
determination of legal causation is different from the role such a
condition plays in the determination of medical causation. Once
a preexisting condition is identified, the legal causation question
depends on whether the work-related exertion was no more than
the 	physical 	stresses 	encountered 	in 	ordinary 	life. 	Medical
causation, then, depends on whether a preexisting condition
actually caused or aggravated the specific injury or disability for
which compensation is sought.
¶21 	Here, Hutchings sought compensation for the economic
consequences of her current low back condition. To be entitled to
compensation, she was therefore required to demonstrate by a
preponderance of the evidence that the conditions and activities
she experienced at work in August 2008 were both the legal and
the 	medical 	cause 	of 	her 	current 	low 	back 	condition. 	The
Commission determined that she met the test for legal causation

Hutchings v. Labor Commission
20150429-CA 	12 	2016 UT App 160
because 	the 	accident 	was 	of 	a 	kind 	that 	could 	result 	in
compensable injury for her back problems even in the face of a
potentially related preexisting condition, and Hutchings does
not challenge that determination on appeal. Thus, Hutchings
must now demonstrate that the Commission’s conclusion that
she had not established medical causation—that the accident
caused or aggravated the specific disability for which she seeks
compensation 	(her 	low 	back 	condition)—was 	based 	on 	an
incorrect 	legal 	premise 	or 	that 	it 	was 	not 	supported 	by
substantial evidence in the record. See Oliver v. Labor Comm’n,
2015 UT App 225, ¶ 8, 359 P.3d 684 (explaining that we review
“the Commission’s application and interpretation of law for
correctness” and that “we will not disturb factual findings unless
[the petitioner] demonstrates that a finding is not supported by
substantial evidence”), cert. granted, 366 P.3d 1213 (Utah Oct. 27,
2015) (No. 20150889). Hutchings has effectively conceded that
she was suffering from a degenerative spinal condition at the
time of her accident by arguing that the accident aggravated this
condition. Thus, in order to demonstrate medical causation, she
must 	show 	that 	the 	Commission 	erred 	in 	concluding 	that
preexisting degenerative changes were the sole medical cause of
her current low back condition. See Virgin, 803 P.2d at 1288.
II. The Determination of Medical Causation in the Present Case
¶22 	Hutchings 	argues 	that 	the 	medical 	panel 	failed 	to
properly analyze medical causation and that the Commission’s
subsequent adoption of the report perpetuated the error. She
contends that it is clear the medical panel considered only her
preexisting condition as a medical cause of her disability and did
not consider whether the accident aggravated or contributed to
the conditions for which she seeks compensation. As proof, she
points to the instructions given to the medical panel, the medical
panel’s reasoning, and certain medical evidence.
¶23 	Medical 	causation 	is 	fundamentally 	a 	factual
determination. See Chase v. Industrial Comm’n, 872 P.2d 475, 479

Hutchings v. Labor Commission
20150429-CA 	13 	2016 UT App 160
(Utah Ct. App. 1994). “We will not disturb the Commission’s
factual 	findings 	unless 	the 	party 	challenging 	the 	findings
demonstrates that a finding is not supported by substantial
evidence.” Swift Transp. v. Labor Comm’n, 2014 UT App 104, ¶ 8,
326 P.3d 678. The Commission is the ultimate finder of fact, even
if “a medical panel is convened.” Danny’s Drywall v. Labor
Comm’n, 2014 UT App 277, ¶ 14, 339 P.3d 624 (explaining that
“[t]he role of the Medical Panel is to evaluat[e] medical evidence
and advis[e] an administrative law judge with respect to the
administrative law judge’s ultimate fact-finding responsibility”
but that the Commission “is always the ultimate fact finder” and
“is not bound by the panel’s report” (alterations in original)
(citations 	and 	internal 	quotation 	marks 	omitted)). 	The
Commission is neither bound to adopt the medical panel’s
report, nor is it obligated to base its findings and decisions on
the report. Id. And while “[i]t is not unusual for . . . the
Commission to adopt the findings of a medical panel,” the
Commission’s “prerogative and duty . . . [is] to consider not only
the report of the medical panel, but also all of the other evidence
and to draw whatever inferences and deductions fairly and
reasonably could be derived therefrom.” Id. (first alteration in
original) 	(citations 	and 	internal 	quotation 	marks 	omitted).
Indeed, the Utah Supreme Court has stated that the medical
panel’s “proper purpose is limited to medical examination and
diagnosis, the evidence of which is to be considered by the
[Industrial] Commission in arriving at its decision.” Jensen v.
United States Fuel Co., 424 P.2d 440, 442 (Utah 1967).
¶24 	However, 	whether 	the 	Commission 	has 	applied 	the
correct legal standard in reaching its medical causation finding is
a legal question, which we review for correctness. See Provo City
v. Labor Comm’n, 2015 UT 32, ¶ 17, 345 P.3d 1242 (stating that
“[f]or appeals from administrative decisions,” “we review the
law applied to [the] facts for correctness”). As discussed below,
we conclude that both the medical panel and the Commission

Hutchings v. Labor Commission
20150429-CA 	14 	2016 UT App 160
properly considered whether the industrial accident aggravated
Hutchings’s preexisting condition.
A. 	The ALJ’s Instructions to the Medical Panel
¶25 	Hutchings claims that the medical panel was improperly
instructed 	regarding 	the 	medical 	causation 	test, 	and, 	in
particular, that the Commission failed to ensure that the medical
panel was aware of and applied the aggravation rule. Medical
panel 	instructions 	generally 	do 	not 	provide 	a 	basis 	for 	an
appellate 	court 	to 	disturb 	the 	Commission’s 	findings. 	See
Johnston v. Labor Comm’n, 2013 UT App 179, ¶¶ 23–25, 307 P.3d
615. In Johnston, the claimant argued the same legal error that
Hutchings argues here—that the medical panel was not aware of
the aggravation rule and instead “employed some other method
for determining medical causation.” Id. ¶ 24. However, we
concluded in Johnston that the medical panel’s “understanding of
the 	aggravation 	rule 	is 	not 	binding 	on 	the 	[Commission]”
because the Commission, not the medical panel, makes the
ultimate medical causation determination. Id. We observed that
“medical panels [are] comprised of individuals without legal
training” and that the “medical panel . . . is not the finder of fact
and does not make a final and binding [legal] determination.” Id.
Rather, the Commission is the ultimate fact finder, and it is “not
bound by the opinions contained in the medical panel’s report.”
Id. ¶ 23. As a result, we reasoned that even if the medical panel
was unaware of the legal rules related to medical causation or
“employed 	some 	other 	method 	for 	determining 	medical
causation,” that would not provide a basis for convening a
hearing regarding the medical panel report or for disturbing the
Commission’s factual findings. See id. ¶¶ 23–25. It was therefore
not an error for the Commission to decline the petitioner’s
request to hold a hearing to inquire into the medical panel’s
understanding of the aggravation rule. Id. ¶ 25. Likewise, even
assuming that Hutchings is correct that the medical panel was
incorrectly instructed regarding the medical causation test, “the
medical panel’s possible misunderstanding of the aggravation

Hutchings v. Labor Commission
20150429-CA 	15 	2016 UT App 160
rule” is not a basis on which we will disturb the Commission’s
medical causation determination, absent a showing that the
Commission embraced the same misunderstanding. See id. ¶ 24.
¶26 	Here, we conclude that the questions the ALJ gave the
panel neither distorted the medical causation test nor neglected
the concept of aggravation; rather, the questions required the
panel 	to 	consider 	whether 	the 	accident 	contributed 	to
Hutchings’s current low back condition in any degree. The first
question posed to the panel was nearly verbatim the medical
causation test articulated in Allen v. Industrial Commission, 729
P.2d 15 (Utah 1986). See id. at 27 (“The purpose of the medical
cause test is to ensure that there is a medically demonstrable
causal 	link 	between 	the 	work-related 	exertions 	and 	the
unexpected injuries that result from those strains.”). And the
second 	and 	third 	questions 	required 	the 	panel 	to 	consider
whether 	any 	“percentage 	of 	[Hutchings’s] 	whole 	person
impairment” or “medical or functional capacity limitations” was
caused by the accident. These questions directed the panel to
consider whether the accident caused any portion of the low
back condition for which Hutchings sought compensation. As a
result, we cannot agree with Hutchings’s assertion that the
medical panel was incorrectly instructed regarding the medical
causation test.
B. 	The 	Medical 	Panel’s 	and 	the 	Commission’s 	Medical
Causation Analyses
¶27 	We 	also 	conclude 	that 	the 	Commission’s 	medical
causation determination was based on an appropriate analysis of
the facts and applicable law. Hutchings contends that neither the
medical panel nor the Commission considered the accident as a
medical cause of her low back condition. But it is clear from the
record 	that 	both 	the 	medical 	panel 	and 	the 	Commission
determined that Hutchings’s low back condition was the sole
medical 	result 	of 	a 	preexisting 	condition 	by 	appropriately
considering the entire medical history in relation to the accident.

Hutchings v. Labor Commission
20150429-CA 	16 	2016 UT App 160
Cf. Resort Retainers v. Labor Comm’n, 2010 UT App 229, ¶ 29, 238
P.3d 1081 (concluding that the Commission properly adopted
the medical panel’s report, in part because the Commission
“considered the evidence, which included reports in conflict
with the medical panel’s recommendations, before it adopted the
findings of the medical panel” and that the medical panel
“similarly considered all of the evidence”).
¶28 	First, the medical panel made its causation findings after
examining Hutchings and conducting an extensive review of her
medical history. Indeed, six out of ten pages of the medical
panel’s report are an exhaustive recitation of the medical history
related 	to 	Hutchings’s 	low 	back 	condition, 	beginning 	in
December 2006 with her first low back pain appointment with
Dr. Staheli and ending with Dr. Major’s assessment in 2012.
Further, the medical panel analyzed Hutchings’s back condition
in the context of her medical history as a whole and based its
medical 	causation 	conclusions 	on 	specific 	evidence 	in 	the
medical record. For example, in response to the ALJ’s question of
whether there was a medically demonstrable causal connection
between Hutchings’s low back condition and her accident, the
medical panel referenced Hutchings’s reports of low back pain
before her accident, the MRI studies, Dr. Staheli’s and Dr. Britt’s
medical 	reports, 	the 	events 	between 	the 	accident 	and
Hutchings’s December 2008 appointment with Dr. Staheli in
which she first reported low back pain to a medical provider,
and Dr. Snook’s surgical findings. Based on this history, the
panel determined that “the [medical record] information . . .
does 	not 	allow 	the 	medical 	panel 	to 	find 	any 	reasonable
demonstrable causal connection between Mrs. Hutchings[’s] low
back condition and the industrial accident which occurred in
August 2008.”
¶29 	The ALJ then determined that Hutchings had “failed to
meet her burden of proof regarding medical causation” because
she had “reviewed the medical record and [found] the panel’s
analysis consistent with the record and supported by the opinion

Hutchings v. Labor Commission
20150429-CA 	17 	2016 UT App 160
of Dr. Knoebel.” The Commission’s own assessment of the
medical 	record 	also 	tracked 	the 	medical 	panel’s 	medical
causation 	opinion 	and 	appropriately 	adopted 	the 	medical
panel’s reasoning. See id. (determining that it was proper for the
Commission 	to 	adopt 	the 	medical 	panel 	report 	where 	the
Commission “considered all the evidence, as it is required to
do, and 	ultimately 	found 	that 	the 	medical 	panel’s 	opinions
were . 	. 	. 	persuasive” 	(footnote 	omitted)). 	The 	Commission
determined that “[a]fter reviewing the medical evidence and
the medical panel’s report,” Hutchings’s “low-back condition
was not medically caused by the work accident.” In making
this determination, 	the 	Commission 	extensively 	reviewed
Hutchings’s medical 	history as well as the medical 	panel’s
findings and analysis. In particular, it described the evidence it
found in the record to be supportive of the medical panel’s
conclusions. 	For 	example, 	the 	Commission 	noted 	that 	the
imaging studies the panel relied on “revealed longstanding
degenerative 	changes 	in 	[Hutchings’s] 	low 	back”; 	that 	the
panel’s reasoning was “supported by the findings of Dr. Snook,
who also assessed Ms. Hutchings with degeneration in her
lumbar spine and confirmed such degeneration postoperatively”;
that “Dr. Snook’s findings of only degenerative changes rather
than an acute injury appear to contradict Dr. Staheli’s [initial]
diagnosis of a ‘herniated lumbar disk’”; that Dr. Staheli later
assessed Hutchings with “degenerative disc disease, arthritis
and a lumbar-spine cyst”; and that “Dr. Knoebel opined that Ms.
Hutchings’s 	low-back 	problems 	are 	due 	to 	pre-existing
degeneration.” 	Based 	on 	this 	evidence, 	the 	Commission
concluded 	that 	the 	record 	supported 	the 	medical 	panel’s
determination that Hutchings’s low back condition was “due to
pre-existing degeneration” and that the panel had “appropriately
addressed the medical aspects of the claim including the central
issue 	of 	medical 	causation.” 	Under 	the 	circumstances, 	it 	is
apparent that both the medical 	panel 	and the Commission
assessed 	the 	medical 	evidence 	in 	the 	record 	to 	determine
whether the accident medically caused Hutchings’s current low

Hutchings v. Labor Commission
20150429-CA 	18 	2016 UT App 160
back 	condition. 	Accordingly, 	we 	are 	not 	persuaded 	by
Hutchings’s argument that the Commission improperly applied
or analyzed the medical causation test.
C. 	Substantial 	Evidence 	Supporting 	the 	Commission’s
Medical Causation Finding
¶30 	Hutchings 	next 	contends 	that 	the 	evidence 	does 	not
support 	the 	medical 	panel’s 	or 	the 	Commission’s 	medical
causation determinations. In particular, she contends that the
evidence supports her claim that the accident aggravated her
preexisting, asymptomatic low back condition. The Commission’s
medical causation finding is entitled to “substantial deference” so
long as it is supported by substantial evidence. See Danny’s
Drywall v. Labor Comm’n, 2014 UT App 277, ¶ 11, 339 P.3d 624.
“Substantial 	evidence 	is 	more 	than 	a 	mere 	scintilla 	of
evidence . . . though something less than the weight of the
evidence,” and the substantial evidence test is met “when a
reasonable 	mind 	might 	accept 	as 	adequate 	the 	evidence
supporting the decision.” See Cook v. Labor Comm’n, 2013 UT App
286, ¶ 14, 317 P.3d 464 (omission in original) (citations and
internal quotation marks omitted). We will not “reweigh the
evidence and independently choose which inferences we find to
be most reasonable”; rather, we defer to the Commission’s
findings “when reasonably conflicting views arise,” as it is the
Commission’s “province to draw the inferences and resolve
these 	conflicts.” 	Danny’s 	Drywall, 	2014 	UT 	App 	277, 	¶ 	11
(citations 	and 	internal 	quotation 	marks 	omitted). 	“In 	other
words, we will not overturn [the Commission’s] factual findings
if 	they 	are 	based 	on 	substantial 	evidence, 	even 	if 	another
conclusion from the evidence is permissible.” Allied Constr. &
Dev., Inc. v. Labor Comm’n Appeals Bd., 2013 UT App 224, ¶ 2, 310
P.3d 1230 (citation and internal quotation marks omitted). But
rather than demonstrate that there is no substantial evidence to
support 	the 	Commission’s 	decision, 	Hutchings 	focuses 	on
evidence in the record that she contends requires a different

Hutchings v. Labor Commission
20150429-CA 	19 	2016 UT App 160
conclusion—that the accident aggravated her preexisting low
back condition.
¶31 	According to Hutchings, the evidence shows that at the
time of the August 2008 accident she immediately suffered new
and unprecedented back pain and radicular pain; she then
experienced 	ongoing 	mobility 	limitations 	and 	needed 	staff
assistance to do her work; and she eventually underwent spinal
surgery 	and 	other 	treatment. 	This 	sequence 	of 	events, 	she
argues, conclusively establishes that the accident caused her
disability. She also directs us to medical reports that she claims
correctly 	considered 	the 	aggravation 	rule 	and, 	as 	a 	result,
concluded that the accident aggravated whatever preexisting
condition contributed to her pain and need for surgery. But this
evidence does not require a conclusion that the Commission’s
decision is unsustainable. Hutchings must do more than point us
to facts or pieces of evidence that she contends support her
arguments 	on 	appeal. 	See 	Carbon 	County 	v. 	Department 	of
Workforce Servs., 2012 UT App 4, ¶¶ 5, 8, 269 P.3d 969. Instead,
Hutchings must demonstrate that the Commission’s medical
causation finding itself is not supported by substantial evidence.
See Danny’s Drywall, 2014 UT App 277, ¶ 11. And there is
substantial evidence in the record that conflicts with Hutchings’s
view and from which the Commission could reasonably have
found that Hutchings’s low back condition resulted entirely
from degenerative changes and not from acute injury.
¶32 	To begin with, the medical panel’s report alone provides
substantial 	evidence 	to 	support 	the 	Commission’s 	medical
causation determination. See Cook, 2013 UT App 286, ¶¶ 14–20
(concluding that the medical panel report constituted substantial
evidence to support the Board’s finding that there was no
medical causation where the panel report was thorough and the
conclusion was explained by reference to the factual findings
from the evidentiary hearing, the claimant’s medical history, and
“relevant medical literature”). The ALJ and the Commission
noted that the medical panel in this case was comprised of two

Hutchings v. Labor Commission
20150429-CA 	20 	2016 UT App 160
doctors who were both orthopedic surgeons, diplomates of the
American Board of Orthopedic Surgery, and licensed to practice
medicine in Utah. Further, the medical panel report noted that
“[b]oth physicians met, interviewed, and examined” Hutchings
after which they conferred and reached unanimous conclusions
in their report. And, as discussed above, it is clear that the
medical panel reached its findings and conclusions only after
examining Hutchings and exhaustively reviewing her medical
history. 	Further, 	as 	discussed 	below, 	the 	medical 	panel’s
ultimate conclusion—that Hutchings’s low back condition is the
medical result of continuing degenerative changes that predated
her accident—is corroborated by the evidence it referenced. As a
result, 	the 	medical 	panel’s 	report 	constitutes 	substantial
evidence in its own right.
¶33 	Moreover, with respect to the medical record as a whole,
the Commission noted that there was evidence that undermined
Hutchings’s claim that the August 2008 accident caused or
aggravated her preexisting low back condition, a conclusion
implicit in the medical panel’s analysis. For example, the record
demonstrates that Hutchings did not miss work due to her low
back pain, that she had previously managed her low back pain
with medication, and that she did not mention her low back pain
to Dr. Britt during an evaluation for a different work injury in
November 2008. And when she was finally seen by Dr. Britt in
December 2008 for low back pain, he noted that there had been
no specific trauma—rather, he noted that the first of the school
year always involved heavy lifting—and that Hutchings’s pain
had only worsened in the prior few weeks.
¶34 	Indeed, 	multiple 	doctors 	diagnosed 	her 	low 	back
condition as degenerative. For example, Hutchings’s surgeon,
Dr. Snook, assessed her with spinal degeneration on multiple
vertebral 	levels 	and 	a 	degenerative 	cyst. 	Her 	primary 	care
physician, 	Dr. 	Staheli, 	later 	assessed 	her 	with 	degenerative
disc disease, arthritis, and a spinal cyst. Dr. Major diagnosed
her with a degenerative vertebral condition and joint disease.

Hutchings v. Labor Commission
20150429-CA 	21 	2016 UT App 160
Dr. Knoebel, 	after 	examining 	Hutchings 	and 	reviewing 	the
medical records, noted that the findings in the record indicated
that 	Hutchings 	suffered 	from 	a 	“degenerative 	low 	back
condition” 	that 	was 	not 	reasonably 	probable 	to 	have 	been
“secondary” to the “lifting incident.” And the medical panel,
also 	after 	examining 	Hutchings 	and 	reviewing 	her 	medical
history and the imaging studies, concluded that Hutchings was
suffering from multiple degenerative spinal conditions.
¶35 	Further, it does not appear that any medical report in the
record characterized any particular spinal condition from which
Hutchings was suffering—whether bulging discs or some other
condition—as evidence that Hutchings had suffered an acute
trauma 	or 	injury 	from 	her 	accident. 	While 	several 	medical
reports noted Hutchings’s accident as part of her history, no
report linked that accident with a specific spinal condition.
Indeed, the closest a report came to doing so was Dr. Britt’s
assessment in December 2008 that Hutchings had a “blown disc”
in her lower back that had “to be work related.” But even this
statement was qualified by other statements in the same report
that indicated that there was “[n]o specific trauma,” indicated
that the pain had only worsened in the preceding four weeks,
and attributed the blown disc to exertions during the “[first] of
the year [when Hutchings] always has to do a lot of heavy
lifting.” Thus, the medical record contains substantial evidence
that, whatever pain or injury Hutchings may have suffered from
the accident, the disability underlying her compensation claim
resulted from degenerative spinal conditions, not the accident
itself.
¶36 	To be sure, as Hutchings has pointed out, there is also
conflicting medical evidence that the accident aggravated or
medically affected her preexisting low back condition, not least
Hutchings’s own description of the accident and its aftermath.
But it is the Commission’s prerogative to resolve the conflicts in
the evidence, and it did so. See Cook v. Labor Comm’n, 2013 UT
App 286, ¶ 20, 317 P.3d 464. For example, Hutchings points to

Hutchings v. Labor Commission
20150429-CA 	22 	2016 UT App 160
the 	MRI 	studies 	as 	well 	as 	the 	reports 	of 	Dr. 	Major 	and
Dr. Staheli as evidence that the accident aggravated her low back
condition. But the Commission found that the “imaging studies
on Ms. Hutchings’s lumbar spine . . . revealed longstanding
degenerative changes in her low back rather than an acute
injury,” 	and 	the 	evidence 	supports 	this 	finding. 	While 	the
December 2008 MRI studies suggested that Hutchings’s pain
could have been due to a herniated disc that was compressing on
a nerve in her lower back, those studies also indicated that she
was suffering from degenerative disc disease on multiple levels
as well as several other spinal conditions that, as the medical
panel found, were unlikely products of her accident. Further, as
the Commission noted, the suggestion of a herniated disc in the
2008 MRI studies was directly refuted by Dr. Snook’s surgical
report in February 2009. Dr. Snook indicated that he did not
perform any disc surgery because during surgery he discovered
that, despite the suggestion in the MRI studies, the disc at issue
was not compressing a nerve root in Hutchings’s lower back.
Instead, his pre- and postoperative diagnosis was that Hutchings
was suffering from a degenerative spinal condition and a cyst
“encroaching on [a] nerve” in her lower back. His later reports
indicate that he explained to Hutchings that it was unlikely the
cyst was caused by her work.4
4. Hutchings 	characterizes 	Dr. 	Snook’s 	surgical 	report 	as
describing a flat disc only after he performed the surgery to
decompress her nerve, suggesting that it was the surgery itself
that 	flattened 	the 	disc. 	However, 	Dr. 	Snook’s 	report 	more
reasonably supports a conclusion that he did not perform any
disc-related procedures because he discovered after the surgery
began that the disc was already “flat.” He stated that “[t]here
was some suggestion” of a herniated disc in Hutchings’s lower
back but further noted that he “did not see any evidence of that
at the time of surgery.”

Hutchings v. Labor Commission
20150429-CA 	23 	2016 UT App 160
¶37 	In addition, Hutchings points out that Dr. Major indicated
that a definite percentage of Hutchings’s body impairment and
her low back condition were related to her work injury and that
Dr. Staheli opined that Hutchings’s “physical and/or mental
limitations were . . . in whole or in part caused, aggravated or
accelerated 	by 	and 	[were] 	a 	direct 	result 	of 	[Hutchings’s]
industrial injury.” But, even if there are medical reports in the
record that support a conclusion that Hutchings’s low back
condition was aggravated by her accident, we will not disturb
the 	Commission’s 	finding 	where 	there 	is 	other 	substantial
evidence 	in 	the 	record 	to 	support 	the 	Commission’s
determination that Hutchings’s low back condition is not the
medical 	result 	of 	her 	industrial 	accident. 	Id. 	(“It 	is 	the
[Commission’s] responsibility to resolve conflicts in the evidence
that come before it.”). It is also the Commission’s prerogative to
weigh the evidence and to rely on the evidence that it considers
most credible. See id. (“[The Commission] may choose to give
certain evidence more weight than other evidence.” (citation and
internal quotation marks omitted)). And here, the Commission
relied 	on 	the 	medical 	panel 	report 	and 	several 	individual
doctors’ 	reports, 	as 	well 	as 	Dr. 	Knoebel’s 	evaluation, 	to
ultimately determine that Hutchings’s low back condition was
not medically caused by her accident. Although the Commission
might have reached a different decision based on the evidence,
we will not disturb the Commission’s determination merely
because 	“another 	[determination] 	from 	the 	evidence 	is
permissible.” Green v. Labor Comm’n, 2013 UT App 165, ¶ 3, 306
P.3d 824 (citation and internal quotation marks omitted).
¶38 	Thus, we conclude that while the accident itself might
have been the legal cause of some harm or injury to Hutchings,
the Commission’s decision that the disability for which she has
claimed compensation was not medically caused by the accident
is 	supported 	by 	substantial 	evidence 	in 	the 	whole 	record,

Hutchings v. Labor Commission
20150429-CA 	24 	2016 UT App 160
including 	the 	medical 	panel’s 	assessment.5 Accordingly, 	we
decline 	to 	disturb 	the 	Commission’s 	medical 	causation
determination.
CONCLUSION
¶39 	Hutchings has failed to demonstrate that the Commission
incorrectly 	applied 	the 	medical 	causation 	test 	or 	that 	the
Commission’s 	medical 	causation 	determination 	was 	not
supported by substantial evidence. For these reasons, we decline
to disturb the Commission’s order.
5. Because we conclude that there was substantial evidence
supporting the Commission’s medical causation determination,
we decline to address Hutchings’s argument that there was not
sufficient 	evidence 	for 	the 	medical 	panel 	(and, 	later, 	the
Commission) to conclude that she was suffering from chronic
low back pain before her accident. Furthermore, nothing in the
Commission’s own medical causation determination suggests
that it primarily relied on a finding that Hutchings had suffered
from chronic low back pain at the time of her accident. Indeed,
the Commission specifically noted in its order affirming the
ALJ’s decision that even if Dr. Staheli’s multiple references to
low 	back 	pain 	before 	her 	accident 	were 	mistaken, 	those
references “are not the only evidence relied upon by the medical
panel.”