IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Solid Waste Services, Inc., d/b/a :

J.P. Mascaro & Sons, :

Petitioner :

 :

v. : No. 441 C.D. 2020

 : Submitted: September 18, 2020

Workers’ Compensation Appeal :

Board (Boos), :

Respondent :

BEFORE: HONORABLE RENÉE COHN JUBELIRER, Judge

HONORABLE MICHAEL H. WOJCIK, Judge

HONORABLE ELLEN CEISLER, Judge

OPINION NOT REPORTED

MEMORANDUM OPINION BY

JUDGE COHN JUBELIRER FILED: March 31, 2021

Solid Waste Services, Inc., d/b/a J.P. Mascaro & Sons (Employer) petitions 

for review of the Order of the Workers’ Compensation Appeal Board (Board) that 

affirmed the Decision of a Workers’ Compensation Judge (WCJ) granting Mark 

Boos’s (Claimant) Claim Petition. On appeal, Employer argues that the Board erred 

in affirming because: (1) the WCJ’s finding that Claimant’s work-related laceration 

became infected was not supported by substantial evidence; (2) Claimant’s medical 

expert’s causative testimony was equivocal and, therefore, legally incompetent; and 

(3) the award of ongoing disability benefits was impermissibly based on the mere 

possibility that Claimant’s symptoms will recur in the future. Upon review, we 

affirm because substantial evidence supported the WCJ’s findings, Claimant’s 

medical expert’s testimony was not equivocal, and the award of ongoing benefits 
2

was not based on the potential that Claimant might have future symptoms, but on a 

finding that Claimant’s symptoms are ongoing. 

I. Background

A. Claim Petition

On October 10, 2017, Claimant filed the Claim Petition alleging that, on 

March 21, 2017, he was knocked off of a truck at a landfill and sustained a workrelated injury in the nature of a laceration to his lower left leg that resulted in

Claimant developing an autoimmune disease. (WCJ Decision, Finding of Fact 

(FOF) ¶ 1; see Claim Petition, Reproduced Record (R.R.) at 8a.) Claimant sought

total disability benefits ongoing from March 21, 2017. Employer filed an answer 

denying the Claim Petition’s material allegations. 

The matter was assigned to the WCJ, who held two hearings. At the first 

hearing, on November 3, 2017, the WCJ held a preliminary discussion with counsel, 

and at the second, on April 11, 2018, Claimant testified live before the WCJ and 

offered photographic and documentary evidence, as well as the trial deposition 

testimony of Sean McCall, D.O., a board-certified internist (Claimant’s Expert). 

Employer presented the trial deposition testimony of Samuel Valenti, M.D., also a 

board-certified internist (Employer’s Expert).

B. Claimant’s Evidence 

In support of his Claim Petition, Claimant testified as follows.1 Claimant 

worked for Employer as a tractor-trailer driver, hauling garbage from New Jersey to 

Keystone Landfill in Dunmore. On March 21, 2017, while maneuvering his truck 

on to a tipper machine at Keystone Landfill, Claimant fell out of his truck and into 

1 Claimant’s testimony is summarized in Findings of Fact 3-7, and the transcript of that 

testimony is found at pages 97a-139a of the reproduced record.
3

the garbage pit, cutting his left leg on a piece of metal. Claimant immediately called 

his supervisor and explained what happened. He washed the laceration with saline

solution and, two hours later, went to Employer’s office, where he was instructed to 

seek treatment at Northeast Rehabilitation in Scranton. At Northeast Rehabilitation, 

Claimant saw Employer’s Expert, who cleaned the laceration and prescribed 

Claimant antibiotics. Thereafter, Claimant returned to work in a limited capacity, 

seeing Employer’s Expert on several more occasions. On one of those “visit[s,]

[C]laimant recalled expressing concern to [Employer’s Expert] that he still had pus[]

coming out of the wound.” (FOF ¶ 5.) Employer’s Expert “cleaned the wound and 

released [C]laimant to full[-]duty work.” (Id.)

After resuming work driving the tractor-trailer, Claimant recalled an incident, 

which he testified occurred approximately one month after his accident, in which his 

left foot became swollen and he had to cut his boot off. While Claimant took 

approximately two days off from work, the swelling eventually subsided, and he 

returned to work for approximately two to three weeks. A second swelling episode

occurred in June 2017, this time in Claimant’s hands, which prevented him from 

driving, and so Employer assigned him office duties. It is at this point that Claimant 

saw Claimant’s Expert, who prescribed Prednisone and referred Claimant to David 

M. Pugliese, D.O., a rheumatologist.

Dr. Pugliese examined Claimant and authored a note in August 2017 

explaining that Claimant was under his care for inflammatory arthritis, which 

interfered with Claimant’s ability to safely work, and suggesting that Claimant be 

given two to four weeks off from work. (Id.) Dr. Pugliese referred Claimant to an 

immunologist, Yoon Kim, D.O., who saw Claimant twice, ordered bloodwork, and 

adjusted Claimant’s medications. Claimant testified that swelling like that which 
4

occurred in his feet and hands occurred elsewhere, including his tongue, mouth, 

esophagus, and throat. As a result, Claimant carries an Epinephrine pen and 

Prednisone. “Claimant has not returned to work in any capacity since August 30, 

2017.” (Id.) Claimant identified various photographs of his body, including one 

showing the injury to his leg “approximately two weeks after the [laceration] 

occurred,” (R.R. at 105a; R.R. at 149a), and others showing swelling in various parts 

of Claimant’s body, (id.at 117a-25a).

Claimant’s Expert testified by deposition as follows.2 Claimant has been his

patient since approximately 2014, and, with respect to Claimant’s work accident, 

Claimant’s Expert first saw Claimant on June 15, 2017, at which time Claimant

complained of severe swelling in both hands. Claimant reported having a work 

injury that resulted in a leg wound, which ultimately became infected. Claimant’s 

Expert stated: “I do believe he did have an infection based upon [Employer’s 

Expert’s] description o[f] the laceration and the fact that [Employer’s Expert] started 

him on dual antibiotic therapy . . . .” (FOF ¶ 10 (quoting Claimant’s Expert’s 

Deposition (Dep.) at 12, R.R. at 182a).) After a second visit on July 5, 2017, at 

which Claimant complained of tongue swelling, shortness of breath, and difficulty 

swallowing, Claimant’s Expert diagnosed Claimant with angioedema “presumably 

due to an adverse reaction to [the medication] Plaquenil.” (Id. ¶ 11 (quoting 

Claimant’s Expert’s Dep. at 13, R.R. at 183a).) Though the diagnosis of angioedema 

remained unchanged, “the [etiology] has not inasmuch as [C]laimant has been off 

Plaquenil ever since and the angioedema has persisted.” (Id.) Claimant saw 

Claimant’s Expert two more times – on September 29, 2017, and March 13, 2018 –

and was examined by several specialists, including Dr. Pugliese, Dr. Kim, and Amit

2 Claimant’s Expert’s deposition testimony is summarized in Findings of Fact 8-17, and 

the transcript of that deposition testimony is found at pages 172a-221a of the reproduced record.
5

Sharma, M.D., an infectious disease doctor, whose office notes Claimant’s Expert 

reviewed.3

Claimant’s Expert expressed his opinion “that [C]laimant has angioedema 

with no causative bacteria or [etiology], apparently, according to the immunologist.” 

(Id. ¶ 14.) Specifically, Claimant’s Expert testified:

Something is flaring it up, and we have a suspicion and a reasonable 

certainty that, from the timeline that I have been taking care of 

[Claimant], I believe his issues started shortly after his leg injury, and 

have never totally resolved, and have flared-up off and on since that 

time. 

(Id. (quoting Claimant’s Expert’s Dep. at 21, R.R. at 191a).) He stated that Claimant 

had none of these problems before March 21, 2017. On direct examination, 

Claimant’s Expert testified as follows:

Q. As a result of your treatment of [Claimant], your understanding 

of his injury, also the review of [Employer’s Expert’s] records, and, by 

the way, the review of that photograph [showing the laceration], do you 

have an opinion within a reasonable degree of medical certainty as to 

whether or not the injury which caused the laceration also resulted in 

an infection?

A. It’s my opinion that that injury did relate, did cause an infection 

to [Claimant].

Q. And, Doctor, the next opinion based on your treatment and 

treatment of referral physicians within your medical group, and your 

occasion to review their opinions, and also your occasion to continue 

to treat [Claimant], do you have an opinion within a reasonable degree 

of medical certainty as to, number one, the diagnosis, which I believe 

you already stated, but you can state it again.

A. Angioedema.

3 On the day of his deposition, Claimant’s Expert reviewed for the first time the office notes 

of Employer’s Expert. (FOF ¶ 9.) 
6

Q. And, Doctor, based on the history, the medical background as 

you understood [Claimant’s] condition to be prior to March 21, 2017, 

up until today’s date, whether or not there’s a connection between his 

injury, the laceration, infection, and the angioedema?

A. I believe there is a connection between the infection and the 

angioedema, as it never was present before, and it surfaced fairly soon 

after his injury.

Q. Is that opinion based within a reasonable degree of medical 

certainty?

A. Yes, it is.

(R.R. at 192a-93a.) While acknowledging that angioedema can result from a variety 

of causes, Claimant’s Expert believed causes other than the infection had been ruled 

out by the specialists to which Claimant was referred. (FOF ¶ 15; R.R. at 194a.)

4

 In 

response to the question of whether Claimant is “disabled for driving tractor-trailer,” 

Claimant’s Expert responded:

I would consider him disabled, because when he has these flare-ups, 

they are potentially life-threatening, as the tongue can swell, he can get 

short of breath, his hands can swell substantially to the point where it 

does inhibit safe control of steering wheels and reaction times and 

things like that, in my opinion.

(R.R. at 194a.) 

On cross-examination, Claimant’s Expert testified that, while he reviewed a 

photograph of the laceration of Claimant’s leg, he had not seen other photographs 

showing Claimant’s swollen feet, lips, tongue, and the rashes on his body. 

4 On redirect examination, Claimant’s Expert was questioned whether causative factors 

other than infection had been ruled out, to which he answered: “The factors that I would have 

thought of as an internist? Yes. I would have deferred to the immunologist to make sure all the 

other causes would have been ruled out.” (R.R. at 209a.)
7

Claimant’s Expert was presented with a September 8, 2017 note written by Dr. 

Pugliese, which Claimant’s Expert read into the record:

[Claimant] has an inflammatory arthritis and has asked if it could be 

related to an injury and infection that he obtained at work. I’ve

explained to him that there are many theories about the development of 

autoimmune disease. While one of them does suggest that a genetically 

predisposed person could have expression of his or her autoimmunity 

triggered by infection/trauma or another in[citing] event, there’s no way 

to prove cause and effect. The temporal profile in this case does fit the 

pattern, but, [] again, there’s no way to prove causality. 

(FOF ¶ 16 (quoting Claimant’s Expert’s Dep. at 38-39, R.R. at 208a-09a).) On 

redirect examination, when asked whether an infection is an accepted cause of 

angioedema, Claimant’s Expert stated that “[i]t could be one, yes.” (R.R. at 209a.) 

In addition, Claimant’s Expert was presented with another note from Dr. Pugliese, 

dated January 3, 2018, which he read into the record:

[Claimant] has developed severe angioedema that is related to an 

infection that he got at work. The angioedema has been persistent and 

has interfered with his ability to at times swallow and even breath[e]. 

In addition to the angioedema[,] there has been pain and fatigue and 

rash. He is currently unable to work as a result of this. He is being 

referred to multiple specialists, including immunology and infectious 

disease in addition to my care in rheumatology. He’s on multiple 

medications to help manage this, but to date we have not been able to 

control the disease.

It is my opinion that[,] within a certain degree of medical certainty[,] 

[Claimant’s] decline is a direct result of the infection that he got in 

March.

(FOF ¶ 17 (quoting Claimant’s Expert’s Dep. at 42-43, R.R. at 212a-13a).) 
8

C. Employer’s Evidence

Employer’s Expert examined Claimant on four occasions in March and April 

of 2017 and testified by deposition as follows.5 On March 21, 2017, the date of 

Claimant’s injury, Employer’s Expert described Claimant’s laceration as superficial 

in that the skin was together, it was not bleeding, and “there was no significant 

manifestation of an infective process.” (Id. ¶ 18.) Employer’s Expert cleaned the 

laceration with Betadine and peroxide, dressed the wound with a bandage, and 

prescribed Claimant antibiotics out of concern for “the potential of infection” given 

where Claimant fell. (R.R. at 294a-95a.) In an unscheduled visit 48 hours later, 

Claimant presented with increased pain and concern about drainage from the wound. 

Employer’s Expert noticed “no significant manifestation of an infection.” (Id. at 

296a.) At Claimant’s third visit to Employer’s Expert, Claimant reported that the 

drainage was improving but the discomfort in his leg persisted. Employer’s Expert 

directed Claimant to finish his antibiotics and return in a week. At Claimant’s final 

visit on April 3, 2017, Employer’s Expert noted good scab formation, minimal 

scarring, and found no evidence of an infective process. “[H]is impression . . . was 

that the laceration healed nicely”; he found no need for further treatment. (FOF 

¶ 21.) 

Employer’s Expert “[did not] believe that any autoimmune phenomenon [is] 

[] related to [Claimant’s] work injury . . . .” (Id. ¶ 23 (quoting Employer’s Expert’s 

Dep. at 26, R.R. at 307a).) Employer’s Expert explained that, in order to trigger the 

expression of autoimmunity, “the trauma needs to be significant enough or the 

medical process [must] be [] severe enough for the body to recognize itself as foreign 

and develop a significant immune or autoimmune response to itself.” (Id. (quoting 

5 Employer’s Expert’s deposition testimony is summarized in Findings of Fact 18-25, and 

the transcript of that deposition testimony is found at pages 282a-343a of the reproduced record.
9

Employer’s Expert’s Dep. at 27, R.R. at 308a).) Here, Employer’s Expert opined 

that the trauma Claimant experienced was “not significant enough to create a[n 

autoimmune] response.” (R.R. at 309a.)

When asked on cross-examination whether Claimant had an infection, 

Employer’s Expert responded: “I don’t believe he did.” (FOF ¶ 25 (quoting 

Employer’s Expert’s Dep. at 40-41, R.R. at 321a-22a).) According to Employer’s 

Expert’s notes pertaining to his physical examination of Claimant, there was good 

healing, no drainage, no erythema, and no induration. Based on Employer’s Expert’s 

interpretation of Claimant’s treatment records, while “there was a concern of an 

autoimmune disease, as well as inflammatory arthritide, [] the actual diagnosis . . . 

was [not] stated.” (Id. (quoting Employer’s Expert’s Dep. at 45, R.R. at 326a).) 

 

D. WCJ Decision

The WCJ summarized the parties’ relevant evidence as follows. Claimant cut 

his leg while on the job, (id. ¶ 26a), and thereafter experienced bouts of swelling, 

(id. ¶¶ 26d-26f), which he did not experience prior to his work injury, (id. ¶ 26g). 

Based on that history, and Claimant having been prescribed antibiotics and reseen 

by Employer’s Expert, Claimant’s Expert “gathered [C]laimant had an infection.” 

(Id. ¶ 26h.) Claimant’s Expert opined that “there is a connection between the 

infection and [Claimant’s diagnosis of] angioedema as it was never present before 

and surfaced soon after his injury.” (Id. ¶ 26j.) The symptoms Claimant experiences 

are “potentially life threatening” and Claimant is thus “disabled from returning to 

work . . . .” (Id. ¶ 26k.) Employer’s Expert saw Claimant four times following his 

injury, at the first visit characterizing Claimant’s laceration as “superficial,” (id. ¶ 

26p), and at the second visit noting drainage from Claimant’s leg, which Claimant 

and Employer’s Expert had some concern about, (id. ¶ 26q). Claimant experienced 
10

continued discomfort, but at Claimant’s final visit, Employer’s Expert observed that 

Claimant’s laceration “healed nicely and scab formation was strong.” (Id. ¶ 26s.) 

Employer’s Expert “does not believe [C]laimant’s autoimmune phenomenon is 

related to [C]laimant’s work injury” because the inciting trauma must be severe, and 

here “[C]laimant’s trauma was mild in nature.” (Id. ¶ 26t.)

After considering the evidence, the WCJ “accepted as most credible and 

convincing the testimony of [C]laimant . . . as well as [Claimant’s Expert].” (Id. 

¶ 27.) The WCJ attached significant weight to the fact that Claimant’s Expert, 

having seen Claimant as far back as 2014, “was clearly in a position to offer credible 

testimony that [C]laimant did not have any of the types of problems or symptoms 

that [Claimant’s Expert] found [C]laimant to have prior to March 21, 2017.” (Id. 

¶ 28.) Unlike Employer’s Expert, Claimant’s Expert examined Claimant and 

tracked his symptoms in the months following Claimant’s injury when he began 

experiencing swelling. Moreover, the WCJ found credible Claimant’s Expert’s 

statement that “something is flaring up, and we have a suspicion and reasonable 

certainty that . . . [Claimant’s] issues started shortly after his leg injury and have 

never totally resolved . . . .” (Id. (quoting Claimant’s Expert’s Dep. at 21, R.R. at 

191a).) The WCJ acknowledged the seemingly inconsistent nature of Dr. Pugliese’s 

opinions – in his September 8, 2017 letter he stated there is no way to prove causality 

between an infection and the expression of autoimmunity, while in his January 3, 

2018 letter he stated that Claimant’s angioedema was caused by the infection 

resulting from Claimant’s work-related injury. (Id.) The WCJ concluded:

The challenge by [] [Employer] herein as to the sufficiency of causality 

was correctly argued. While there is, of course, no specific evidence of 

what substance entered [] [C]laimant’s system resultant from having a 

laceration on his left lower leg with a piece of metal at a landfill, this 

Judge thinks [] [C]laimant’s [Expert], . . . and ultimately Dr. Pugliese 
11

eventually within his January 3, 2018 report[,] gave consideration to 

the same and were still able to unequivocally opine that [C]laimant 

developed severe angioedema that was related to the infection he got at 

work . . . . 

(Id.) 

The WCJ “rejected as not credible” Employer’s Expert’s opinions. (Id. ¶ 27.) 

In particular, the WCJ found Employer’s Expert’s opinion that Claimant’s injury 

was not significant enough to cause an autoimmune response unsupported by the 

record because Employer’s Expert “has nothing to identify or establish the 

precipitating agent or trauma at a landfill that entered [] [C]laimant’s system through 

a piece of metal.” (Id.) The WCJ noted that Employer’s Expert examined Claimant

on only four occasions over a period of less than two weeks and, though Employer’s 

Expert reviewed Claimant’s medical records prior to his deposition, a full year had 

elapsed since Employer’s Expert saw Claimant, during which time Claimant had 

many treatments. It was disingenuous, according to the WCJ, for Employer’s Expert 

to state, based upon reviewing Claimant’s treatment records between April 3, 2017,

and his deposition on May 3, 2018, that no one had a “firm grasp on establishing a 

working diagnosis for [] [C]laimant.” (Id. ¶ 28.) 

Based on his credibility determinations and factual findings, the WCJ 

concluded that Claimant had met his burden of proving a causal connection between 

the March 21, 2017 work incident, a laceration that became infected resulting in 

angioedema, which caused his ongoing disability. (WCJ Decision, Conclusion of 

Law ¶ 2.) Therefore, the WCJ granted the Claim Petition. Employer appealed to 

the Board.
12

E. Board Opinion

In its appeal, Employer argued the WCJ’s Decision was not supported by 

substantial evidence and was based on equivocal opinions. Employer maintained in 

its appeal that Claimant’s burden of proof on causation was assumed, shifting the 

burden on Employer to disprove causation. The WCJ also erred, according to 

Employer, by granting Claimant ongoing disability due to the “implied theory” of 

“possible recurrence.” (Employer’s Appeal, R.R. at 50a.)

The Board affirmed the WCJ’s Decision. The Board held that the WCJ did 

not err by crediting Claimant’s Expert’s opinions over the contrary opinions of 

Employer’s Expert and that Claimant was able to meet his burden of proof based on 

the testimony of Claimant’s Expert and Dr. Pugliese’s 2018 note, which “tied 

Claimant’s development of angioedema to his infection from the work incident.” 

(Board’s Opinion at 3, 5.) According to the Board, “the substantial, competent 

evidence of record supports the fact Claimant sustained a work-related injury that 

resulted in a disability.” (Id. at 6.) Moreover, the Board held that Claimant’s 

Expert’s testimony was not equivocal, and the WCJ did not err in relying upon it 

because, while Employer “ma[de] arguments taking various parts of [Claimant’s 

Expert’s] testimony out of context, review of it as a whole clearly shows [Claimant’s 

Expert’s] unequivocal opinion that Claimant’s angioedema was caused by his workrelated injury.” (Id. at 7.) Employer now petitions this Court for review.6

6 This Court’s “review is limited to determining whether constitutional rights were violated, 

whether the adjudication is in accordance with the law[,] or whether necessary findings of fact are 

supported by substantial evidence.” City of Philadelphia v. Workers’ Comp. Appeal Bd. 

(Sherlock), 934 A.2d 156, 159 n.5 (Pa. Cmwlth. 2007).
13

II. Appeal to this Court

Employer raises three issues on appeal. Employer contends that the WCJ’s 

finding that Claimant’s laceration became infected is not supported by substantial 

evidence. Employer also argues that Claimant’s Expert’s opinion that the infected 

laceration caused Claimant’s angioedema is equivocal and thus incompetent. 

Employer last maintains that the Board erred by affirming the WCJ’s Decision 

granting ongoing disability benefits under the premise of “possible recurrence.” 

(Employer’s Brief (Br.) at 32.) 

This being a claim petition proceeding, Claimant bears the burden of 

establishing all of the elements necessary to support an award of workers’ 

compensation benefits, including the existence of an injury and disability, and a 

causal relationship between the disability and the work incident. Giant Eagle, Inc. 

v. Workers’ Comp. Appeal Bd. (Thomas), 725 A.2d 873, 876 (Pa. Cmwlth. 1999). 

Disability is the loss of earnings or earning power that is caused by a work-related 

injury. Sch. Dist. of Phila. v. Workers’ Comp. Appeal Bd. (Lanier), 727 A.2d 1171, 

1172 (Pa. Cmwlth. 1999). Where the causal relationship between the work incident 

and the injury is not obvious, unequivocal medical evidence is necessary to establish 

that relationship. Roundtree v. Workers’ Comp. Appeal Bd. (City of Philadelphia), 

116 A.3d 140, 145 (Pa. Cmwlth. 2015) (citations omitted). We now address 

Employer’s arguments as to why Claimant did not meet his burden of proof. 

A. Substantial Evidence

1. Parties’ Arguments

Employer argues that the Board improperly credited Claimant’s Expert’s 

opinion that Claimant’s laceration became infected because the opinion relied on 
14

“insufficient evidence.” (Employer’s Br. at 27.) Employer focuses on the following 

exchange from Claimant’s Expert’s deposition:

Q. As a result of your treatment of [Claimant], your understanding 

of his injury, also the review of [Employer’s Expert’s] records, 

and, by the way, the review of th[e] photograph [showing 

Claimant’s laceration],[] do you have an opinion within a 

reasonable degree of medical certainty as to whether or not the 

injury which caused the laceration also resulted in an infection?

A. It’s my opinion that that injury did relate, did cause an infection

to [Claimant].

(Id. at 23-24 (quoting Claimant’s Expert’s Dep. at 22, R.R. at 192a) (footnote 

omitted).) According to Employer, this exchange illustrates that Claimant’s Expert’s 

opinion was based on: (1) Claimant’s “lay opinion that his leg became infected[;]”

(2) Claimant’s Expert’s treatment of Claimant; (3) Claimant’s Expert’s review of 

Employer’s Expert’s records; and (4) Claimant’s Expert’s review of a photograph 

showing Claimant’s laceration. (Id. at 22-26.)

Employer argues that an opinion regarding the presence of an infection may 

only be given by an expert witness, and because Claimant’s Expert relied on 

Claimant’s “lay opinion” as to the issue of infection, the WCJ should not have 

credited Claimant’s Expert’s opinion that Claimant’s leg was infected. (Id. at 22-

23.) Moreover, Employer submits that, to the extent Claimant’s Expert’s opinion 

was based on his treatment of Claimant, the opinion should not be credited because 

Claimant’s Expert did not treat Claimant until three months after the work-related 

injury, and, by that time, the laceration had healed. (Id. at 24.) And, according to 

Employer, Claimant’s Expert could not have formed his opinion by reviewing 

Employer’s Expert’s records “because those records flatly refute the existence of an 
15

infection.” (Id.) Further, Claimant’s Expert’s testimony regarding the photograph 

of Claimant’s laceration is unclear:

Q. And, Doctor, upon the review of that photograph, does that sort 

of buttress your opinion regarding the severity of the laceration 

and/or infection?

A. Yes, it does.

(Id. at 26 (quoting Claimant’s Expert’s Dep. at 11-12, R.R. at 181a-82a).) According 

to Employer, Claimant’s Expert’s answer was unclear – to which question was his 

answer addressed? 

In summary, Employer claims that the “only evidence upon which the [WCJ] 

credited Claimant’s Expert’s opinion that [Claimant’s] laceration became infected 

was [Claimant’s] self-serving lay opinion that he had an infection and the affirmative 

response of [Claimant’s Expert] to a compound, unclear question.” (Id. at 26-27.) 

That evidence, Employer contends, does not “rise up to the threshold of being 

substantial evidence.” (Id. at 27.) 

Claimant responds that the WCJ’s finding that Claimant’s leg wound became 

infected is supported by substantial evidence. The finding was based on Claimant’s 

Expert’s opinion, and “it was the WCJ’s prerogative to credit [Claimant’s Expert’s] 

opinion over that of [Employer’s Expert’s], which [the WCJ] did.” (Claimant’s Br. 

at 15.) According to Claimant, “a reasonable mind would find this evidence 

([Claimant’s Expert’s] opinion as to causality and ongoing disability) adequate to 

support the WCJ’s findings and conclusions . . . .” (Id.)7

7 Claimant argues that Employer waived its argument that the WCJ did not issue a 

“reasoned decision.” (Claimant’s Br. at 9.) However, nowhere in Employer’s brief is such an 

argument advanced. Accordingly, we need not consider Claimant’s waiver argument. In addition, 

Claimant spends considerable time in his brief defending the WCJ’s credibility determinations. 

However, in its reply brief, Employer is clear that it is not contesting those determinations. “The 
16

2. Analysis

In reviewing a substantial evidence8 challenge, we “consider the evidence as 

a whole, view the evidence in the light most favorable to the party [that] prevailed 

before the WCJ, and draw all reasonable inferences which are deducible from the 

evidence in” that party’s favor. Frog, Switch & Mfg. Co. v. Workers’ Comp. Appeal 

Bd. (Johnson), 106 A.3d 202, 206 (Pa. Cmwlth. 2014) (quotation omitted). 

“[W]here both parties present evidence, it does not matter that there is evidence in 

the record [that] supports a” contrary finding; the only question is whether there is 

evidence that supports the findings that were made. McCabe v. Workers’ Comp. 

Appeal Bd. (Dep’t of Revenue), 806 A.2d 512, 515 (Pa. Cmwlth. 2002). “The WCJ 

is the ultimate fact finder and has complete authority for making all credibility” and 

evidentiary weight determinations. Rife v. Workers’ Comp. Appeal Bd. (Whitetail 

Ski Co.), 812 A.2d 750, 755 (Pa. Cmwlth. 2002). It is well-settled that a “WCJ may 

reject the testimony of any witness in whole or in part, even if that testimony is 

uncontradicted.” Hoffmaster v. Workers’ Comp. Appeal Bd. (Senco Prods., Inc.),

721 A.2d 1152, 1156 (Pa. Cmwlth. 1998).

Although Employer argues there is insufficient evidence to support the WCJ’s 

finding that Claimant’s laceration became infected, we disagree. Claimant’s Expert 

opined that Claimant’s laceration became infected based on: (1) Claimant’s report 

about his work-related injury and subsequent infection; (2) Employer’s Expert’s use 

of dual antibiotic therapy to treat Claimant; and (3) a photograph showing 

[WCJ’s] credibility determinations are not a question before this Court, and as a result, should not 

be considered in deciding the instant matter.” (Employer’s Reply Br. at 1.) Accordingly, we need 

not evaluate the WCJ’s credibility determinations. 

8

“Substantial evidence is such relevant evidence as a reasonable mind might accept as 

adequate to support a conclusion.” City of Philadelphia v. Workers’ Comp. Appeal Bd. (Kriebel), 

29 A.3d 762, 769 (Pa. 2011).
17

Claimant’s laceration. Employer contends that this evidence is either insufficient to 

support that opinion or flatly refutes that opinion and, therefore, the WCJ’s finding 

is unsupported.

Employer first argues that an opinion regarding the presence of an infection 

may only be given by an expert witness, and because Claimant’s Expert relied on 

Claimant’s “lay opinion” as to the issue of infection, the WCJ should not have 

credited Claimant’s Expert’s opinion that Claimant’s leg was infected. (Employer’s 

Br. at 22-23.) Contrary to Employer’s argument, it was not necessary for Claimant 

to be a medical expert to report to Claimant’s Expert that his work-related laceration

became infected, and it was not improper for Claimant’s Expert to have relied on 

Claimant’s report in rendering his ultimate opinion. Claimant’s Expert’s medical 

opinion was based on multiple factors, including Claimant’s factual report that he 

had “pus [] flowing out of his leg for a day or two [after the injury], . . . had to be reseen [by Employer’s Expert], and . . . was on antibiotics.” (R.R. at 181a.) From this 

information, which is corroborated by Employer’s Expert’s testimony, Claimant’s 

Expert “gathered [Claimant] had an infection.” (Id.) In addition, Claimant’s 

Expert’s review of a photograph showing Claimant’s laceration approximately two 

weeks after the incident, (id. at 149a), to which no objection was lodged, buttressed 

Claimant’s Expert’s opinion that Claimant’s leg was infected, (id. at 181a-82a.) 

Thus, Employer’s focus on “[Claimant’s] subjective lay opinion of infection” and 

the purported “parameters of th[e] legal standard” applicable thereto, (Employer’s 

Br. at 22), misses the mark because Claimant’s Expert did not base his opinion 

merely on Claimant’s opinion as to whether he had had an infection.

Moreover, Employer’s argument that “[Claimant’s Expert’s] review of 

[Employer’s Expert’s] records could not be the basis for finding that [Claimant] had 
18

an infection because those records flatly refute the existence of an infection”

misconstrues the evidence. (Id. at 24.) While Employer points out language in 

Employer’s Expert’s records tending to suggest an infection was not present, (id. at 

25), there is also language indicating the contrary, including Employer’s Expert’s 

prescribing of Augmentin and Doxycycline Monohydrate, (R.R. at 272a-73a), 

noting that, after Claimant’s second visit on March 23, 2017, there was no 

“significant evidence of an infective process” and no “outward signs of significant

infection,” (id. at 275a-76a) (emphasis added)), and that, as of April 3, 2017, “the 

infection is resolved and [Claimant] does not require any further treatment,” (id. at 

280a (emphasis added)). Thus, when considered as a whole, Employer’s Expert’s 

records do not “flatly refute the existence of an infection,” (Employer’s Br. at 24),

but rather are, at most, ambiguous on that issue, and, as the ultimate fact finder, the 

WCJ had “complete authority for making all credibility” and evidentiary weight 

determinations. Rife, 812 A.2d at 755.

Further, Employer’s challenge to Claimant’s Expert’s testimony regarding the 

photograph showing Claimant’s laceration is not persuasive. At his deposition, 

Claimant’s Expert was asked to review Claimant’s exhibit 3, the photograph 

Claimant took of the laceration two weeks after the work incident and, having done 

so, testified:

Q. And, Doctor, do you know whether or not he had an infectious 

process going on or can you tell that by your exam?

A. Subjectively what he had described to me . . . is that he was 

injured at work. He told me that he presented to the work doctor, it was 

cleaned out, and he indicated pus was flowing out of his leg for a day 

or two later. He had to be re-seen, and [] he was on antibiotics. From 

that I gathered he had an infection.
19

Q. And, Doctor, upon review of that photograph, does that sort of 

buttress your opinion regarding the severity of the laceration and/or 

infection?

A. Yes, it does.

Q. And in review [of Employer’s Expert’s] note, do you have any 

cause to believe that [Claimant] did not have an infection?

A. No, I do not. I’m sorry. I do believe he did have an infection 

based on [Employer’s Expert’s] description of the laceration and the 

fact that [Employer’s Expert] started [Claimant] on dual antibiotic 

therapy or Augmentin and Doxycyline.

(R.R. at 180a-82a.) Employer isolates the part of this exchange wherein Claimant’s 

Expert is asked whether the photograph “buttress[es] [his] opinion regarding the 

severity of the laceration and/or infection,” and Claimant’s Expert answers “[y]es, it 

does.” (Employer’s Br. at 26.) In so doing, Employer argues that Claimant’s Expert 

“did not provide any explanation; he merely gave an affirmative response to an 

unclear compound question . . . .” (Id.) However, when this passage is considered 

in context with the questioning and testimony that occurred before and after it, which 

was concerned solely with whether an infection was present, it was reasonable for 

the WCJ to infer that Claimant’s Expert’s answer addressed the infection portion of 

the question.

Accordingly, because Claimant’s Expert’s opinion was not based on an

improper lay opinion and was otherwise supported, the WCJ’s crediting of that

opinion was not “arbitrary and capricious or so fundamentally dependent on a 

misapprehension of material facts, or so otherwise flawed, as to render it irrational.” 

Casne v. Workers’ Comp. Appeal Bd. (STAT Couriers, Inc.), 962 A.2d 14, 19 (Pa. 

Cmwlth. 2008). And, because “a reasonable mind might accept” Claimant’s 

Expert’s opinion “as adequate” to support the finding that Claimant’s laceration 
20

became infected, the challenged finding of fact is supported by substantial evidence. 

City of Philadelphia v. Workers’ Comp. Appeal Bd. (Kriebel), 29 A.3d 762, 769 (Pa. 

2011). 

B. Equivocation

1. Parties’ Arguments

Employer contends that Claimant has not met his burden of proving a causal 

connection between his disabling injury – angioedema – and his work-related 

laceration because the expert testimony Claimant offered to establish that connection 

is equivocal. Employer posits four reasons why Claimant’s Expert’s testimony is 

equivocal. 

First, in response to the question of whether an infection is an accepted cause 

of angioedema, Claimant’s Expert stated that “[i]t could be one, yes.” (Employer’s 

Br. at 28 (quoting R.R. at 209a).) This testimony, according to Employer, is 

equivocal as a matter of law because “[s]uch [an] expert opinion that it is conceivable 

that a substance could cause or may have caused an effect does not constitute 

unequivocal medical testimony and is not competent evidence to support a finding 

that any such effect occurred.” (Id. (quoting BJ’s Wholesale Club v. Workers’ Comp. 

Appeal Bd. (Pearson), 43 A.3d 559, 565 (Pa. Cmwlth. 2012) (emphasis in 

original)).)

Second, Claimant’s Expert relied on the medical opinion of Dr. Pugliese, who 

expressed “absolutely equivocal opinions,” (Employer’s Br. at 30), by opining in 

one note that “there’s no way to prove causality” between an infection and the 

expression of autoimmunity, (id. at 29 (quoting R.R. at 208a-09a)), and, in a second, 

later note, stating that “[Claimant] has developed severe angioedema that is related 

to an infection that he got at work[,]” (id. at 29-30 (quoting R.R. at 212a)). Thus, 
21

argues Employer, “any opinion provided by Dr. Pugliese that [Claimant’s Expert] 

would have relied upon would have been equivocal as a matter of law.” (Id. at 30.)

Third, Claimant’s Expert’s opinion regarding causation is equivocal. 

Employer cites Claimant’s Expert testimony as follows:

Q. Okay. And at that point in time were you able to come to a 

medical diagnosis regarding what was going on with [Claimant]?

A. We have a working diagnosis of angioedema with no causative 

bacteria or etiology . . . .

(Id. at 30 (quoting Claimant’s Expert’s Dep. at 21, R.R. at 191a) (emphasis in 

original).) Employer argues that “[t]he fact that [Claimant’s Expert] later opines to 

within a reasonable degree of medical certainty that an infection had caused the 

angioedema, totally contradicts [t]his statement.” (Id.)

Last, Claimant’s Expert’s testimony is equivocal because, Employer argues, 

“it is based on nothing more than the proximity of the injury and onset of 

angioedema.” (Id. at 31.) In support of this assertion, Employer cites the following 

testimony:

Q. And, Doctor, based on the history, the medical background as 

you understood [Claimant’s] condition to be prior to March 21, 2017, 

up until today’s date, whether or not there’s a connection between his 

injury, the laceration, infection, and the angioedema?

A. I believe there is a connection between the infection and the 

angioedema, as it never was present before, and it surfaced fairly soon 

after his injury.

(Id. (quoting R.R. at 193a).) Employer contends that “[t]estimony is equivocal when 

the medical expert merely assumes that an injury is work-related based upon 

temporal proximity to a work event.” (Id. at 31-32 (quoting Moyer v. Workers’ 
22

Comp. Appeal Bd. (Pocono Mountain Sch. Dist.), 976 A.2d 597, 599 (Pa. Cmwlth. 

2009)) (alteration in original).)

Claimant responds that Claimant’s Expert testified unequivocally that 

Claimant’s work-related laceration became infected and that infection caused 

Claimant’s disabling injury – angioedema. Claimant contends that ample caselaw 

supports this position because Claimant’s Expert testified that it was his 

“professional opinion within a reasonable degree of medical certainty that the workrelated laceration that Claimant sustained . . . resulted in an infection and, later, 

angioedema . . . .” (Claimant’s Br. at 4.) Acknowledging that Claimant’s Expert 

explained that infection is not the only cause of angioedema, Claimant points out 

that Claimant’s Expert nonetheless “opined within a reasonable degree of medical 

certainty that it was his professional opinion that the angioedema Claimant was 

experiencing was causally related to [his] infection . . . .” (Id. at 6.) 

2. Analysis

When unequivocal medical evidence is necessary, “the medical witness must 

testify, not that the injury or condition might have or possibly came from the 

assigned cause, but that in [the witness’s] professional opinion the result in question 

did come from the assigned cause.” Berks Cnty. Intermediate Unit v. Workmen’s 

Comp. Appeal Bd. (Rucker), 631 A.2d 801, 804 (Pa. Cmwlth. 1993). In determining 

whether testimony is equivocal, “we examine the testimony of a witness as a whole 

and do not take words or phrases out of context.” Bemis v. Workers’ Comp. Appeal 

Bd. (Perkiomen Grille Corp.), 35 A.3d 69, 72 (Pa. Cmwlth. 2011). Medical 

evidence that is less than positive or is based on possibilities is equivocal and is not 

legally competent evidence that establishes the necessary causal relationship. Potere 

v. Workers’ Comp. Appeal Bd. (Kemcorp), 21 A.3d 684, 690-91 (Pa. Cmwlth. 2011). 
23

“However, the law does not require every utterance which escapes the lips of a

medical witness on a medical subject to be certain, positive, and without reservation 

or exception.” Bemis, 35 A.3d at 72. A medical opinion is not considered equivocal 

simply because the witness “use[s] [] words such as ‘probably,’ ‘likely,’ and 

‘somewhat’ . . . so long as the testimony, read in its entirety, is unequivocal and the 

witness does not recant the opinion or belief first expressed.” Id. “Whether an 

expert’s opinion is competent is a question of law subject to plenary review.” 

Kriebel, 29 A.3d at 769.

Applying these principles to Claimant’s Expert’s testimony in its entirety, his 

testimony that Claimant’s work-related laceration became infected and that this 

infection caused Claimant’s angioedema is unequivocal and, therefore, competent to 

support the WCJ’s findings. On direct examination, Claimant’s Expert testified as 

follows:

Q. As a result of your treatment of [Claimant], your understanding 

of his injury, also the review of [Employer’s Expert’s] records, and, by 

the way, the review of that photograph [showing the laceration], do you 

have an opinion within a reasonable degree of medical certainty as to 

whether or not the injury which caused the laceration also resulted in 

an infection?

A. It’s my opinion that that injury did relate, did cause an infection 

to [Claimant]. 

Q. And, Doctor, the next opinion based on your treatment and 

treatment of referral physicians within your medical group, and your 

occasion to review their opinions, and also your occasion to continue 

to treat [Claimant], do you have an opinion within a reasonable degree 

of medical certainty as to, number one, the diagnosis, which I believe 

you already stated, but you can state it again.

A. Angioedema.
24

Q. And, Doctor, based on the history, the medical background as 

you understood [Claimant’s] condition to be prior to March 21, 2017, 

up until today’s date, whether or not there’s a connection between his 

injury, the laceration, infection, and the angioedema?

A. I believe there is a connection between the infection and the 

angioedema, as it never was present before, and it surfaced fairly soon 

after his injury.

Q. Is that opinion based within a reasonable degree of medical 

certainty?

A. Yes, it is.

(R.R. at 192a-93a.) This exchange is a clear expression of “[Claimant’s Expert’s] 

professional opinion [that] the result in question[, angioedema,] did come from the 

assigned cause,” Berks County Intermediate Unit, 631 A.2d at 804, and it is 

sufficient to establish a causal relationship between the injury and the work incident, 

Giant Eagle, Inc., 725 A.2d at 876. See also Phila. Coll. of Osteopathic Med. v. 

Workmen’s Comp. Appeal Bd. (Lucas), 465 A.2d 132, 135 (Pa. Cmwlth. 1983) 

(“[A]s to the facts which a claimant must prove by medical evidence, it is sufficient 

that [the claimant’s] medical expert, after providing a foundation, testify that in [the 

expert’s] professional opinion or that [the expert] believes or that [the expert] thinks 

the facts exist.”). 

Employer’s arguments would have us enforce an equivocality standard that 

permits no room for expressions of doubt, but that is not the law. “[T]he law does 

not require every utterance which escapes the lips of a medical witness on a medical 

subject to be certain, positive, and without reservation or exception.” Bemis, 35 

A.3d at 72; see also Phila. Coll. of Osteopathic Med., 465 A.2d at 134-35 (“Certainly 

it is not the law . . . that every utterance which escapes the lips of a medical witness 

on a medical subject, must be certain, positive, and without reservation, exception, 
25

or peradventure of a doubt.”). Thus, a medical opinion is not considered equivocal 

simply because the witness uses words such as “probably,” “likely,” and 

“somewhat,” “so long as the testimony, read in its entirety, is unequivocal and the 

witness does not recant the opinion or belief first expressed.” Bemis, 35 A.3d at 72.

For this reason, we reject Employer’s argument, relying on BJ’s Wholesale

Club, that Claimant’s Expert’s statement that an infection “could be” a cause of 

angioedema rendered Claimant’s Expert’s entire opinion “equivocal as a matter of 

law, even if [Claimant’s Expert] had earlier said the ‘magic words’[] that the 

infection led to [Claimant’s] development of angioedema.” (Employer’s Br. at 28

(footnote omitted).) In BJ’s Wholesale Club, we held that an expert’s testimony was 

equivocal because it was based entirely on possibilities – the expert’s testimony

regarding causation was replete with words such as “can,” “conceivable,” and 

“could.” 43 A.3d at 565-66. Here, in contrast, Claimant’s Expert’s testimony, read 

in its entirety, is positive on the issues of whether Claimant’s laceration caused an 

infection which in turn led to him developing angioedema, and Claimant’s Expert’s 

single expression of mere possibility is insufficient to render his entire opinion 

equivocal. 

Furthermore, Claimant’s Expert’s medical opinion is not equivocal simply 

because he considered the medical opinions of other physicians whose opinions were 

arguably inconsistent or differed from his. Employer contends that Dr. Pugliese, 

whose opinions Claimant’s Expert relied upon, expressed “absolutely equivocal 

opinions,” (Employer’s Br. at 30), as illustrated in Dr. Pugliese’s notes dated 

September 18, 2017, and January 3, 2018. However, the seemingly contradictory9

9

It is unclear from the record if something changed Dr. Pugliese’s opinion in the months 

between September 2017 and January 2018, particularly given the number of specialists Claimant 

had been seeing. 
26

nature of Dr. Pugliese’s opinions has no bearing on the equivocality of Claimant’s 

Expert’s own testimony regarding causation. Claimant’s Expert did not testify that 

he shared the exact same views as Dr. Pugliese along the same timeline that Dr. 

Pugliese held them. Instead, Claimant’s Expert testified that, within a reasonable 

degree of medical certainty, “there is a connection between the infection and the 

angioedema,” (R.R. at 193a), and other causes – hereditary, cold air induced causes, 

insect borne, and medication – had been ruled out. 

Finally, Employer points out Claimant’s Expert’s own “equivocal” deposition 

testimony, which Employer cites in the following manner:

Q. Okay. And at that point in time were you able to come to a 

medical diagnosis regarding what was going on with [Claimant]?

A. We have a working diagnosis of angioedema with no causative 

bacteria or etiology . . . .

(Employer’s Br. at 30 (quoting R.R. at 191a) (emphasis in original).) Employer 

argues that “[t]he fact that [Claimant’s Expert] later opines [] within a reasonable 

degree of medical certainty that an infection had caused the angioedema, totally 

contradicts his statement.” (Id.) Employer doubles down in its reply brief, arguing 

that these “two statements sat next to each other are jaw-droppingly contradictory 

and undoubt[edly] 100% equivocal as a matter of law.” (Employer’s Reply Br. at 

2.) However, Employer fails to cite the full deposition testimony, in which 

Claimant’s Expert expressed his opinion that Claimant has angioedema “with no 

causative bacteria or etiology, apparently, according to the immunologist.” (R.R. 

at 191a (emphasis added).) In addition, immediately after this answer, Claimant’s 

Expert testified: 
27

Something is flaring it up, and we have a suspicion and a reasonable 

certainty that, from the timeline that I have been taking care of 

[Claimant], I believe his issues started shortly after his leg injury, and 

have never totally resolved, and have flared-up off and on since that 

time. 

(Id.) Read in its entirety, this portion of the deposition testimony does not reveal, as 

Employer submits, Claimant’s Expert’s opinion that Claimant’s angioedema was not 

caused by a bacterial infection. (See Employer’s Reply Br. at 2.) Instead, it shows 

Claimant’s Expert’s understanding of the immunologist’s opinion and Claimant’s 

Expert’s “reasonable certainty” that Claimant’s autoimmune issues began shortly 

after his injury. Whether or not the immunologist believed that a bacterial infection 

was the cause of Claimant’s angioedema has no bearing on the equivocality of 

Claimant’s Expert’s own testimony regarding causation.

We also reject Employer’s argument, relying on Moyer, that Claimant’s 

Expert’s opinion is equivocal because “it is based on nothing more than the 

proximity of the injury and onset of angioedema.” (Employer’s Br. at 31.) This 

Court in Moyerstated that “[t]estimony is equivocal when the medical expert merely 

assumes that an injury is work-related based on temporal proximity to a work 

event.” Moyer, 976 A.2d at 599 (emphasis added). However, Claimant’s Expert did 

not merely assume on the basis of timing that Claimant’s work-related injury caused 

the angioedema. Again, it is important to read Claimant’s Expert’s testimony in

context. Directly preceding the exchange that Employer relies on is the following:

Q. As a result of your treatment of [Claimant], your understanding 

of his injury, also the review of [Employer’s Expert’s] records, and, by 

the way, the review of that photograph [showing the laceration], do you 

have an opinion within a reasonable degree of medical certainty as to 

whether or not the injury which caused the laceration also resulted in 

an infection?
28

A. It’s my opinion that that injury did relate, did cause an infection 

to [Claimant]. 

Q. And, Doctor, the next opinion based on your treatment and 

treatment of referral physicians within your medical group, and your 

occasion to review their opinions, and also your occasion to continue 

to treat [Claimant], do you have an opinion within a reasonable degree 

of medical certainty as to, number one, the diagnosis, which I believe 

you already stated, but you can state it again.

A. Angioedema.

(R.R. at 192a-93a.) When this line of questioning is read together with the portions 

Employer isolated, it is clear that Claimant’s Expert concluded that Claimant’s 

infected laceration caused his angioedema based on Claimant’s Expert’s history of 

treating Claimant, his review of Employer’s Expert’s records, a review of a 

photograph showing the laceration, his review of the opinions of physicians to which 

Claimant was referred, and the timing of the injury and onset of the angioedema. 

Accordingly, because viewing Claimant’s Expert’s testimony in its entirety 

reveals that his opinions were not based on mere possibilities, the equivocal opinions 

of other physicians, or the mere temporal proximity between the work incident and 

Claimant developing angioedema, that testimony was not equivocal. Therefore, 

Claimant’s Expert’s opinion that, within a reasonable degree of medical certainty, 

Claimant’s leg became infected which, in turn, caused Claimant to develop 

angioedema, is competent testimony on the issue of causation.

C. WCJ’s Grant of Ongoing Disability Benefits

1. Parties’ Arguments

Employer last contends that the Board erred by affirming the WCJ’s Decision 

granting Claimant ongoing disability benefits under the premise of a “possible 

recurrence.” (Employer’s Br. at 32.) Employer explains that Claimant’s testimony 
29

shows that Claimant’s alleged disability comes and goes and therefore Claimant is 

not totally disabled. Employer claims it was error for the WCJ to award total 

disability to Claimant because “the mere ‘possibility of a future recurrence [of a 

condition] does not constitute a compensable disability.’” (Id. (quoting Swartz v. 

Workmen’s Comp. Appeal Bd. (Dutch Pantry Rest.), 543 A.2d 201, 204 (Pa. 

Cmwlth. 1988)) (alteration in original).) 

Claimant responds that the WCJ credited Claimant’s and Claimant’s Expert’s 

testimony regarding Claimant’s ongoing symptoms and the effect those symptoms 

had on Claimant’s ability to work, no objections were lodged regarding that 

testimony, and Employer’s Expert had no firsthand knowledge of Claimant’s 

condition after April 3, 2017. (Claimant’s Br. at 16-17.) According to Claimant, 

because the WCJ’s credibility determinations and findings “were based upon the 

substantial, competent evidence of record, the Board did not err in affirming the 

WCJ’s decision to grant Claimant’s Claim Petition and ongoing total disability 

benefits.” (Id. at 17.) 

2. Analysis

Claimants may be considered disabled by a work-related injury despite the 

resolution of their symptoms “if there is evidence that [the symptoms] are likely to 

recur once [they] return[] to work.” Schrader Bellows Pneumatics, Div. of ParkerHannifin Corp. v. Workers’ Comp. Appeal Bd. (Earle), 711 A.2d 578, 581 (Pa. 

Cmwlth. 1998). Where claimants “establish that they [are] unfit or unable to perform 

their duties when they return[ ] to work” by unequivocal medical testimony, ongoing 

disability can be established. Id. However, the mere possibility of a future 

recurrence is not a compensable injury. Swartz, 543 A.2d at 204. In Swartz, the 

claimant argued that she had not recovered from her work-related injury because it 
30

could possibly recur in the future. Id. The claimant’s medical expert testified that 

the claimant had recovered from her disabling injury, which was caused by exposure 

to a chemical solution, but opined that “future exposure to [the] allergic chemicals 

could precipitate further exacerbation” of her condition. Id. The Court rejected the 

claimant’s argument and held that “[t]he possibility of a future recurrence does not 

constitute a compensable disability.” Id. 

Based on the WCJ’s findings and credibility determinations, we agree with 

Claimant that there was no error in granting ongoing benefits. The WCJ “accepted 

as most credible and convincing the testimony of [C]laimant . . . as well as 

[Claimant’s Expert].” (FOF ¶ 27.) In response to the question of whether Claimant 

is “disabled for driving tractor-trailer,” Claimant’s Expert’s responded:

I would consider him disabled, because when he has these flare-ups, 

they are potentially life-threatening, as the tongue can swell, he can get 

short of breath, his hands can swell substantially to the point where it 

does inhibit safe control of steering wheels and reactions times and 

things like that, in my opinion.

(R.R. at 194a.) Given this testimony, the WCJ found Claimant disabled “from 

returning to work driving a tractor trailer beginning August 31, 2017[,] and 

continuing thereafter.” (FOF ¶ 27.) Here, in contrast to the situation in Swartz, the 

WCJ did not find that Claimant had recovered from his angioedema and merely 

could, upon some triggering event, experience future symptoms. Rather, the WCJ 

found that Claimant’s symptoms are ongoing and interfere with his ability to drive, 

and sometimes they are severe enough to be life-threatening. For this reason, 

Employer’s reliance on Swartz is misplaced.

 
31

III. Conclusion

For the foregoing reasons, Claimant satisfied his burden of proving that he 

sustained a compensable work injury which has resulted in ongoing disability, and, 

therefore, there was no error in the Board upholding the WCJ’s Decision granting

the Claim Petition. Accordingly, we affirm.

_____________________________________

RENÉE COHN JUBELIRER, Judge
IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Solid Waste Services, Inc., d/b/a :

J.P. Mascaro & Sons, :

Petitioner :

 :

v. : No. 441 C.D. 2020

 : 

Workers’ Compensation Appeal :

Board (Boos), :

Respondent :

O R D E R

NOW, March 31, 2021, the Order of the Workers’ Compensation Appeal 

Board, entered in the above-captioned matter, is AFFIRMED.

_____________________________________

RENÉE COHN JUBELIRER, Judge