PEARCE, Judge:
{1 Sandra Gail Fogleman seeks judicial review of the denial of her application for permanent total disability compensation. We conclude that the Utah Labor Commission's Appeals Board (the Board) did not err in affirming an administrative. law judge's denial of Fogleman's claim for permanent total disability compensation. We also conclude that the Board did not err by declining to award Fogleman compensation for the treatment of conditions it found to be medically unrelated to her industrial accident. Accordingly, we decline to disturb the Board's decision,
BACKGROUND
~ T2 Kolob Care and Rehabilitation Centers (Kolob) is a medical care facility.
Fogleman worked as Kolob's receptionist, Her duties included greeting visitors, answering the telephone, filing paperwork and interacting: with vendors. - Additionally, Fogleman handled Kolob's mail, which required her to visit an on-site mailbox by walking through a parking lot and up a "slight incline across some stepping stones."
13 While delivering mail to the mailbox one day, Fogleman fell and landed on her hands and knees (the Work Accident), Fo-gleman believes that an unstable stepping stone " 'flipped' causing her to fall." Because Fogleman was carrying the mail in her left hand, "[slhe felt most of the force of the fall on her right knee, hip and hand."
T4 After a coworker cleaned her wounds, Fogleman finished her work shift, Later that day, Fogleman visited an urgent care provider. The clinic assessed Fogleman with "contusions and abrasions" on her hands and knees. Fogleman's hands eventually healed, but her knee and hip pain continued.
T5 At a doctor's appointment roughly six months after the Work Accident, Fogleman complained of "pain and numbness in her right leg extending to the foot," in addition to her ongoing knee and hip pain. A lumbar magnetic resonance imaging (MRI) revealed "multilevel degenerative disc disease" in Fo-gleman's spine. | - |
16 Fogleman received diagnoses for her allments from a number of other physicians. One doctor concluded that Fogleman was "probably 100%" impaired from the Work Accident. Another found that the "original complaints were reasonably caused by [the Work Accident] but that current presentation no longer correlates with ... the original condition," That physician also concluded, "The current clinical findings are atypical of the original medical condition and cannot reasonably be causally associated."
T7 Fogleman applied for workers compensation benefits, and as part of the proceedings, the parties submitted Fogleman's medical history. Due to the divergent medical
conclusions in Fogleman's medical records, the administrative law judge (the ALJ) assigned a medical panel to examine Fogleman and opine on her condition. -
¶ 8 The panel examined Fogleman and reviewed her medical records. | The panel issued a report, finding, | _. ‘
[Fogleman's] hands have significantly improved and are no longer painful. She has occasional numbness when using the hands in certain ways. The contusions suffered to the hands at the time of injury have healed. The [pain in her] knees contin-uels] to be a problem . ... There is pain in the anterior aspect of the knee, patellar crepitus,; and a mild limp. Although MRI examinations have failed to show injury to the joint surfaces of the knees, medications and physical therapy have been administered without a pain relieving effect, the right knee continues to be painful, It has been given the diagnosis of traumatic chondrosis and chondromalacia.... This has not been demonstrated on the MRI examinations.
Since the injury, she has also developed right hip pain.... This hip pain was not noted on the initial examination, but, [in later examinations] it had become. notable.... It continues to be a painful problem.
In response to a specific questlon posed by the ALJ, the medical panel concluded that there was "a causal connection between the injuries to the knees, hands, and right hip and [the Work Accident]," but that there was "no connection betwéen the back pain and sciatica and [the Work Accident]."
T9 The medical panel also responded to other specific questions. The medical panel opined that; (1) Fogleman had suffered a two percent whole-person impairment as a result of the Work Accident; (2) "[the majority of patients, after such an injury, would have returned to full function some weeks after [the Work Accident]"; and (8) Fogle-man's "depression and anxiety compound her current concerns.". The panel also stated that "[nlo objective test[s] have shown clear injury.... [But] Fogleman has not been able to return to work function." The panel ree-ommended maximum restrictions on any work Fogleman might perform of. "no deep knee bends, no lifting greater than 80 pounds except on an occasional basis, and no excessive stair climbing (more than 3 times per four hour shift)."
{10 The ALJ deemed "the opinion of the medical panel to be the persuasive evidence to resolve the conflicts in medical conclusions between various physicians in the case." Based on the medical panel report, the ALJ found that as a result of the Work Accident, Fogleman suffered an injury to her hands, right hip, and knees; that the injury to her hands had completely healed; and that her hip and knees had "reached a point of medical stability." The ALJ concluded that Fo-gleman suffered a two percent whole-person impairment as a result of the Work Accident. The ALJ also adopted the medical panel's finding with regard to Fogleman's maximum work restrictions.
111 The ALJ granted Fogleman temporary total dlsablhty compensation from the date of the Work Accident to the date of the Work Accident impairments' medical stabilization. The ALJ also awarded permanent partial disability compensation for Fogle-man's Work Accident impairments and awarded compensation for medical treatment related to Fogleman's hand and hip injuries.
¶ 12 However, the ALJ denied Fogleman's permanent total disability claim, The ALJ concluded that Fogleman had not established any of the three elements a claimant is required. to prove to qualify for permanent total disability compensation, See Utah Code Ann...§ 34A-2-418(1)(b) (LexisNexis Supp. 2015)
The ALJ ruled that Fogleman had not established that she had sustained a significant impairment or combination of impairments as a result of the Work Accident,
the first element of a permanent total disability compensation claim. See id. § 34A-2-413(1)(b)(i). The ALJ found that the injury to Fogleman's hands, knees, and hip had stabilized and only created "minimal [physi-call restrictions" for Fogleman, The ALJ did not include Fogleman's back injury in the significant impairment analysis because it was not "medically caused by [the Work Accident]."
{13 The ALJ also held that Fogleman had not established a permanent total disability or that the Work Accident was, the. "direct cause" of a permanent total disability, the second and third elements of a permanent total disability compensation claim. See id. § §4A-2-418(1)(b)(if)-(iii). Rather, the ALJ concluded that Fogleman's back injury, which the ALJ found to be unrelated to the Work Accident, was the cause of the "mobility and pain problems that are responsible for the disability that keeps [Fogleman] from finding employment." .
1 14 Fogleman sought the Board's review of the ALJ's order. The Board affirmed the ALJ's ruling,. It concluded, among other things, that Fogleman did not sustain a significant impairment or combination of impairments from the Work Accident. The Board focused on the Work Accident impairments and their effect on Fogleman's ability to perform her prior work activities.
- T15 The Board, like the ALJ, did not. cons1der conditions that were not found to be a result of the Work Accident. It then concluded that the Work Accident impairments "do not significantly impair [Fogleman's] ability to do the type of office work she has mainly performed since 1991." And, because the Work Accident caused Fogleman only "minor injuries" that did not affect her ability to engage in her prior work activities, it held that Fogleman's two percent whole-person impairment did not constitute a significant impairment under Utah Code section B4A-2-418(1)(b)(i). Accordingly, the Board affirmed the ALJ's denial of Fogleman's claim for permanent total disability compensation. Fogleman now seeks review of the Board's decision.
ANALYSIS
I. The Board's Denial of Fogleman's Claim for Permanent Total Disability Compensation
A. - Utah's Permanent Total Disability Compensation Statute
116 Before turning to Fogleman's arguments, we review the statutory framework governing claims for permanent total disability compensation. To qualify for permanent total disability benefits, an employee must prove three statutory elements by a preponderance of the evidence.. Utah Code Ann. § §4A-2418(1)(b) (LexisNexis Supp. 2015). The employee must establish that:
(i) the employee sustained a significant impairment or combination of impairments as a result of the industrial accident ... that gives rise to the permanent total disability entitlement;
(if) the employee has a permanent, total disability; and
() the industrial accident ... is the direct cause of the employee's permanent total disability.
Id. To establish the second 'element-a permanent, total disability-the employee must also demonstrate, by a preponderance of the evidence, that:
(i) the employee is not gainfully employed;
(i) the emplbyee has an impairment or combination of impairments that limit the employee's ability to do basic work activities;
(i) the industrial or occupatlonally caused impairment or combination of impairments prevent the employee from performing the essential functions of the work activities for which the employee has been qualified until the time of the industrial accident ... that is the basis for the employee's permanent total disability claim; and
(iv) the employee cannot perform other work reasonably available, taking into consideration the employee's [age, ed
ucation, past work experience, medical capacity, and residual functional capacity.]
Id. § 34A-2-418(1)(c).
T 17 An employee's failure to establish any one of the elements defeats her claim for permanent total disability compensation. See id, § 34A-2-418(1)(b)-(c); see also Prows v. Labor Comm'n, 2014 UT App 196, ¶¶ 12, 19, 333 P.3d 1261 (upholding the Utah Labor Commission's denial of permanent total disability compensation because the employee did not establish one element),
B. Fogleman's Challenges to the Board's Denial of Her Permanent Total Disability Compensation Claim
1. The Board's Interpretation of Utah Code Section 34A-2-418(1)(b)(i)
1 18 Fogleman challenges the Board's conclusion that she did not sustain a significant impairment. See Utah Code Ann. § 34A-2-418(1)(b)(i) (LexisNexis Supp. 2015). Fogle-man argues that the Board erred by not considering her "as an individual, taking all of her issues, including those sustained from [the Work Accident], into consideration." In essence, Fogleman contends the Board erred in interpreting the statute as requiring it to disregard impairments not causally related to the Work Accident in determining whether she had suffered a significant impairment. Whether the Board correctly interpreted Utah Code section 34A-2418(1)(b)@) is a matter of law that we review for correctness, "granting little or no deference to [the Board's] determination." Utah Chapter of the Sierra Club v. Board of Oil, Gas, & Mining, 2012 UT 73, ¶ 9, 289 P.3d 558 (citation and internal quotation marks omitted).
119 Fogleman asserts that the Board should have considered her back injury as well as her anxiety and depression to determine whether she had sustained a significant impairment. The Board recognized that Fo-gleman suffered from those conditions, but did not include them in its analysis because it concluded they were not causally related to the Work Accident.
120 For the purpose of determining whether Fogleman had suffered a significant impairment, the Board did not err by reading the statute as requiring it to disregard impairments it found to not be causally related to the Work Accident. Subsection requires the employee to establish that she "sustained a significant impairment or combination of impairments as a result of the industrial accident ... that gives rise to the permanent total disability entitlement." Utah Code Ann. § §4A-2-418(1)(b)G) (emphases added), By its plain language, then, the statute requires Fogle-man to show that her impairment or combination of impairments was sustained "as a result of" the Work Accident and that it "gives rise to the permanent total disability." See id.; see also Marion Energy, Inc. v. KFJ Ranch P'ship, 2011 UT 50, ¶ 14, 267 P.3d 863 ("[When faced with a question of statutory interpretation, our primary goal is to evince the true intent and purpose of the Legislature. The best evidence [of that] is the plain language of the statute itself." (citations and internal quotation marks omitted)).
121 Fogleman's argument does not address the plain language of the statute. Nor does she address cases in which this court has appeared to endorse the Board's reading of the statute. See, e.g., Clawson v. Labor Comm'n, 2013 UT App 123, ¶ 10 & n. 4, 302 P.3d 1247 (concluding that the Board did not err by disregarding an employee's preexisting medical conditions that were unrelated to the work accident in its permanent total disability analysis but setting aside the Board's decision on other grounds)
In the absence of an argument squarely addressing the statute's plain language and the cases that cut against her position, Fogleman cannot sus
tain her burden on appeal of demonstrating that the Board misinterpreted the statute.
€22 Therefore the Board did not err by considering only those impairments that were the result of the Work Accident in its significant impairment determination under Utah Code section 84A-2-418(1)(b)G).
2, The Board's S1gmficant—Impau'ment De termination
23 Fogleman also argues that the Board erred in concludmg that her two percent whole-person unpalrment did not constitute a significant impairment. ‘
a. - Standard of Review
124 Determining "whether. a particular impairment is 'significant' ... requires a equrt to evaluate the severity of the impairment and determine whether the level of impairment exceeds a minimum threshold." Provo City v. Labor Comm'n, 2015 UT 32, ¶ 16, 345 P.3d 1242, This question is a mixed question of law and fact that we review "ei ther deferential[ly] or de novo, depending on the nature of the particular mixed question." Id. 1174. The particular standard of review depends on three factors:
(1) the degree of variety and complemty in the facts to which the legal rule is to be applied; (2) the degree to which a trial court's application of the legal rule relies on facts observed by the trial judge, such as a witness's appearance and demeanor, relevant to the application of the law that cannot be adequately reflected in the ree-ord available to appellate courts; and (8) other policy reasons that weigh for or against granting [deference] to trial courts.
Murray v. Labor Comm'n, 2013 UT 38, ¶ 36, 308 P.3d 461 (alteration in original) (citation and internal quotation marks omitted). In Murray, the Utah Supreme Court analyzed the issues presented by a mixed question of law and fact and, to determine the particular standard of review, asked whether their resolution was "fact-like"-i.e., the administrative tribunal is in a superior position to decide the question-or "law-like"-i.e., the question lends "itself to consistent resolution by a uniform body of appellate precedent." Id. ¶ 37 (citation and internal quotation marks omitted).
125 In Provo City, the supreme court addressed an argument similar- to the one at issue here and determined that it was a fact-like question, reviewed deferentially under a substantial evidence standard. See 2015 UT 32, ¶¶ 18, 23-24, 345 P.3d 1242. There, the court reviewed the Board's significant-impairment determination, which was based on a six percent whole-person impairment, for substantial evidence, Id. ¶¶ 23-24. Because the question presented here does not differ materially from that in Provo City, we review Fogleman's challenge to the Board's decision under a substantial-evidence standard. See id. "A finding is supported by substantial evidence when a reasonable mind might accept as adequate the evidence supporting the decision," Bailey v. Retirement Bd., 2012 UT App 365, ¶ 2, 294 P.3d 577 (citation and internal quotation marks omitted).
b. The Board's Application of the Law to the Facts
€26 Fogleman argues that the Board erred in finding that her impairments did not constitute a significant impairment and by failing to "include all of [her] work limitations as found by the medical panel" in its significant-impairment determination.
€27 Fogleman relies on two Utah Supreme Court cases to argue that "a low percentage of physical impairment is not per se less than [a] permanent total disability" and to argue that the disability must be
evaluated "in terms of the specific individual who has suffered a work-related injury." See Hardman v. Salt Lake City Fleet Mgmt., 725 P.2d 1323 (Utah 1986); Kaiser Steel Corp. v. Industrial Comm'n, 709 P.2d 1168 (Utah 1985)
We readily agree. We can envision situations in which a low-percentage impairment or impairments could meet Utah Code section 84A-2-418(1)®b)(i)'s significant-impairment standard. But these considerations do not lead us to conclude, as Pogle-man argues, that the Board's determination here is not supported by substantial evidence.
128 Noting the disagreement between treating physicians, the ALJ convened a medical panel. That panel reviewed the medical records and examined Fogleman,. The Board found the medical panel report persuasive and expressly adopted it. In doing so, the Board found, among other things, that Fogleman suffered injuries to her hands, knees, and right hip, amounting to a two percent whole-person impairment, and that her physical restrictions did not prevent her from performing office work similar to her duties at Kolob.
129 The medical also determined that Fogleman's knee, hand, and right hip injuries were medically causally related to the Work Accident. It found that there were "no X-ray or surgical abnormalities documented that related to [Fogleman's] impairments." The panel also noted that Fogleman complained of continued pain in her hip and right knee, but found - that "[nlo objective test[s] have shown clear injury," and that a "normal range of motion returned in less than a month after the injury." In light of that, evidence, we cannot conclude the Board's determination-that Fogleman's two percent whole-person impairment does not constitute a significant impairment-lacks a substantial evidentiary basis.
930 While Fogleman continues to have pain in her right knee and hip, substantial evidence supports the Board's finding that those impairments maximum effect on her work abilities does not prevent her from carrying out her prior day-to-day work activities, Accordingly, we decline to disturb the Board's determination that Fogleman's impairments do not "exceed[ ] [the] minimum threshold," see Provo City v. Labor Comm'n, 2015 UT 32, ¶ 16, 345 P.3d 1242, and thus do not constitute a significant impairment under Utah Code section 84A-2-418(1)b)(G).
3. Fogleman's Remaining Challenges Regarding the Board's Denial of Her Claim for Permanent Total Disability Compen- - sation
'T31 Fogleman raises a number of other challenges to the Board's denial of her permanent total disability compensation claim. Because Fogleman has not carried her burden of demonstrating that the Board erred in concluding that the Work Accident impairments do not constitute a significant impairment-a required element of her claim-we need not address Fogleman's remaining arguments. See supra ¶¶ 16-17.
382 Accordingly, we conclude that the Board did not err by restricting its significant impairment analysis, under Utah Code section 34A-2-418(1)(b)G), to Fogleman's impairments resulting from the Work Accident. And the Board's determination that Fogle-man's impairments do not amount to a significant impairment is supported by substantial evidence. We decline to disturb the Board's denial of Fogleman's claim for permanent total disability compensatlon
IL The Board's Alleged Failure to Give Fogleman the "Benefit of the Doubt"
133 Fogleman also argues that we should overturn the Board's decision because the "Board failed to properly consider [the] longstanding rule of statutory construction applicable to all industrial claims"-that "her claim be liberally construed in favor of awarding benefits, and that any doubts raised from the evidence be resolved in favor of her claim." We are required to "look closely to assure ourselves that [the Board] has liberally construed and applied the [Workers' Compensation Act] to provide coverage and has resolved any doubt respecting the right to compensation in favor of an injured employee." Salt Lake City Corp. v. Labor Comm'n, 2007 UT 4, ¶ 16, 153 P.3d 179.
€ 34 Fogleman raised this argument before the Board. The Board rejected it, reasoning that giving Fogleman the benefit of the doubt and applying statutes liberally "does not mean ignoring the persuasive medical evidence that [the Work Accident] did not result in a significant impairment or render [Fogleman] . permanently and totally disabled."
135 We agree with the Board. It is true that the Workers' Compensation Act is "to be construed liberally, resolving any doubt as to an employee's right to compensation in favor of the employee." Murray v. Labor Comm'n, 2012 UT App 33, ¶ 6, 271 P.3d 192, aff'd on other grounds, 2018 UT 38, 308 P.3d 461. But, it is nevertheless the burden of the employee to establish all of the elements of a claim for permanent total disability compensation. See Utah Code Ann. § 34A-2-418(1)(b)-(c) - (LexisNexis - Supp. 2015). For us to hold otherwise would ignore the plain language of Utah Code section 34A-2-418(1), which requires the employee to establish each element by a preponderance of the evidence. See id.
36 The Utah Supreme Court has stated, The benefit of the doubt owing to workers' compensation claimants comes at the back end of the litigation-after the judge (or commission) makes a run at resolving disputed questions of fact, at clarifying gray areas of law, and at applying the law to the facts of the case at hand. In the rare case where that process yields genuine doubt-in a dead heat without an apparent winner-that doubt should be resolved in favor of coverage. But otherwise the judge (or commission) is oath-bound to rule in favor of the party whose case is strongest under the law as applied to the facts. Such a judgment cannot be abandoned on the mere presence of doubt about the matter. f
Jex v. Labor Comm'n, 2018 UT 40, ¶ 56, 306 P.3d 799. In other words, before the tie can go to the runner, there has to be a tie.
137 The Board did not err by concluding that Fogleman had not established an entitlement to permanent total disability compensation under Utah Code section 34A-2-418(1)(b)-(c). And because Fogleman did not establish the necessary elements of a permanent total disability claim, she is not entitled to a "benefit of the doubt."
IIl. Fogleman's Anxiety and Depression
€38 Fogleman next argues that the Board "erred by failing to specifically include an award of treatment for [her] industrially-compounded depression and anxiety." Essentially, she contends that this treatment should have been awarded because the medical panel found medical causation between the Work Accident and her anxiety and depression. Whether medical causation has been established is an issue of fact, which we review for substantial evidence. Cook v. Labor Comm'n, 2013 UT App 286, 10, 317 P.3d 464; see also Provo City v. Labor Comm'n, 2015 UT 32, ¶ 8, 345 P.3d 1242 ("[A] challenge to an administrative agency's finding of fact is reviewed for substantial evidence."). "To establish medical causation, a 'claimant must show by evidence, opinion, or otherwise that the stress, strain, or exertion required by his or her occupation led to the resulting injury or disability'" Cook, 2013 UT App 286, ¶ 12, 317 P.3d 464 (quoting Allen v. Industrial Comm'n, 729 P.2d 15, 27 (Utah 1986)). And an employee "can generally recover benefits when an industrial injury aggravates or 'light[s] up' a pre-existing condition and has a causal connection with the subsequent onset of symptoms." Johnston v. Labor Comm'n, 2013 UT App 179, ¶ 23, 307 P.3d 615 (alteration in original) (quoting Virgin v. Board of Review, 803 P.2d 1284, 1288 (Utah Ct.App.1990)).
1389 Fogleman first contends that the Board's order can be construed to grant her an award of future medical care for her anxiety and depression. She also argues that, at a minimum, the order's wording "is ambiguous" and therefore we should remand for further consideration.
T 40 The Board ordered that Fogleman is "entitled to the future medical care outlined by the medical panel for her work injuries." The Board expressly found, however, that "[whhile there is some evidence that [Fogle-man] has other limitations stemming from ... her emotional state, the medical panel's report shows that such conditions are not medically causally related to [the Work Accident]." Consequently, Fogleman's anxiety and depression were not included in the Board's grant of future medical care for her "work injuries." Because the Board specifically considered and denied Fogleman's request for an award of treatment for her anxiety and depression, we disagree with Fo-gleman's characterization of the Board's order.
141 Fogleman also appears to argue that the Board erred in concluding that the Work Accident did not cause or aggravate her anxiety and depression. Fogleman seeks support for her argument in the medical panel's statement that her anxiety and depression "compound her current concerns." There are two problems with Fogleman's argument.
$42 First, the Board expressly found that while "[Fogleman's] 'depression and anxiety hinder her ability to work," "the medical panel's report shows that such conditions are not medically causally related to [the Work Accident]." To successfully challenge the Board's factual findings, Fogleman must "demonstrate how [the record] evidence is inadequate to support the finding[s]." Swift Transp. v. Labor Comm'n, 2014 UT App 104, ¶ 8, 326 P.3d 678, Fogleman has failed to make this showing; she simply highlights a single statement in the medical panel report that arguably contradicts the Board's factual findings. Fogleman does not include any reference to the medical panel's determination that "medical problems caused by the industrial accident [had] stabilized" or its statement that she "had received the appropriate treatment for [her] problems." Nor
does she reference the panel's statement, "It was not expected that her problems would significantly change with further intervention." - Because Fogleman has not rebutted the evidence supporting the Board's ruling, she has failed to demonstrate how that evidence is inadequate to support the Board's ruling.
148 Second, even if Fogleman could shoulder her burden on appeal with a single comment from the medical panel report, the statement upon which she relies does not support her argument. As discussed above, an employee may recover costs for treatment of a pre-existing condition if the employee presents evidence that an industrial accident has aggravated or lit up a pre-existing condition and that there is a causal connection between the subsequent symptoms and the Work Accident. . See Johnston v. Labor Comm'n, 2013 UT App 179, ¶ 23, 307 P.3d 615. But Fogleman has failed to make this showing. The only evidence Fogleman raises to support her claim-the medical panel's statement regarding her anxiety and depres-ston-seems to reverse that causation, The panel stated that the anxiety and depression "compound" her other concerns, not that the Work Accident caused a flare up in her anxiety and depression. . .
T44 Accordingly, we reject Fogleman's contention that the Board's grant of costs for future medical care can be construed to include an award of costs related to the treatment of her anxiety and depression. Because the Board's order is not ambiguous regarding an award of future care for Fogle-man's anxiety and depression, we reject her request to remand for further clarification. We also reject Fogleman's argument that the Board erred by failing to award those costs.
CONCLUSION
¶45 We conclude that the Board did not err in denying Fogleman's petition for permanent total disability compensation under Utah Code section 34A-2-418(1)(b). - The Board did not err in restricting its significant-impairment analysis, under subsection 418(1)(b)G), to those of Fogleman's impairments that were found to be causally related to the Work Accident. The Board's conclusion that Fogleman's impairments did not constitute a significant impairment is supported by substantial evidence. We reject Fogleman's argument that the Board erred by failing to "liberally construe[ 1 [her claim] in favor of awarding benefits" The plain language of the statute requires Fogleman to prove the elements of her claim by a preponderance of the evidence and she has failed to do so. Finally, we conclude that the Board specifically considered and rejected Fogle-man's claim that she be granted an award of treatment for her anxiety and depression, and we conclude that its decision is supported by substantial evidence.
T46 We decline to disturb the Board's decision.