IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Ryan L. Ford Contractor and :

Flagship City Insurance Company, :

Petitioners :

:

v. : No. 703 C.D. 2017

: Submitted: November 9, 2017

Workers’ Compensation Appeal :

Board (Petersen), :

Respondent :

BEFORE: HONORABLE P. KEVIN BROBSON, Judge

HONORABLE PATRICIA A. McCULLOUGH, Judge

HONORABLE BONNIE BRIGANCE LEADBETTER, Senior Judge

OPINION NOT REPORTED

MEMORANDUM OPINION

BY JUDGE BROBSON FILED: June 4, 2018

Petitioners Ryan L. Ford Contractor and Flagship City Insurance 

Company (collectively, Employer) petition for review of an order of the Workers’ 

Compensation Appeal Board (Board), dated May 5, 2017. The Board affirmed the 

decision of a Workers’ Compensation Judge (WCJ), granting the claim and review 

petitions filed by Steen Petersen (Claimant). For the reasons set forth herein, we 

affirm. 

Claimant worked for Employer as a skilled craftsman, performing a 

variety of construction-related tasks, including carpentry, plumbing, and flooring. 

On October 16, 2014, Claimant sustained a work-related injury in the nature of a 

right knee laceration and infection. Employer accepted liability for Claimant’s 
2

work-related injury pursuant to a medical-only Notice of Temporary Compensation 

Payable, which was subsequently converted to a Notice of Compensation Payable. 

On March 23, 2015, Claimant filed: (1) a claim petition, asserting that he had 

sustained a right knee laceration, a right knee infection, avascular necrosis in the 

medial femoral condyle of his right knee, and an oblique tear of the posterior horn 

of the medial meniscus in his right knee, while working for Employer on 

October 16, 2014, and that he is disabled as of December 5, 2014; and (2) a petition 

to review, seeking to amend Claimant’s injury description to include right knee 

avascular necrosis in the medial femoral condyle and a right knee oblique tear of the 

posterior horn of the medial meniscus.1

Claimant testified before the WCJ at the hearing held on May 19, 2015. 

At that time, Claimant explained that on October 16, 2014, he was using a 

reciprocating saw, also known as a sawzall, with a six-inch blade to cut out a floor 

joist that had fire damage. (Reproduced Record (R.R.) at 26a-28a, 47a.) Claimant 

explained further that as he was cutting the floor joist, the sawzall’s blade pinched, 

jumped up, and entered his right knee. (Id. at 28a-29a.) After the sawzall’s blade 

exited his knee, Claimant laid the sawzall down and noticed that his pants were torn 

and his knee was bleeding. (Id. at 29a.) Claimant stated that he stopped the bleeding

using a first-aid kit provided by Employer, went back into the building and collected 

his tools, and then returned to the shop. (Id. at 29a-30a, 48a.) After he arrived at 

the shop, Claimant reported the incident to Employer and went home. 

 

1 On March 25, 2015, Claimant also filed a penalty petition, alleging that Employer had 

violated Section 406.1 of the Workers’ Compensation Act, Act of June 2, 1915, P.L. 736, added 

by the Act of February 8, 1972, P.L. 25, as amended, 77 P.S. § 717.1. The WCJ determined that 

no penalty was warranted, and Claimant did not appeal the WCJ’s determination. As such, the 

WCJ’s decision denying Claimant’s penalty petition is not an issue in this case, and, therefore, the 

penalty petition will not be addressed in any further detail. 
3

(Id. at 30a-31a.) Approximately two hours after he had arrived at home, Claimant 

could not walk and was experiencing pain, swelling, and stiffness in his right knee. 

(Id. at 31a.) As a result, Claimant sought treatment from Lewistown Hospital, where 

he underwent an x-ray, had his right knee “washed out” with a machine and 

immobilized, and was released. (Id. at 31a-32a.) Claimant explained that the day 

after the incident, he was in excruciating pain, so he returned to Lewistown Hospital. 

(Id. at 32a.) At the hospital, Claimant was admitted and treated by Paul R. Sensiba,

M.D., who performed surgery on Claimant’s right knee. (Id. at 32a-33a.) 

Claimant testified that a couple days after the surgery, he returned to 

work with Employer in a light-duty capacity, performing odd jobs such as pulling 

numbers for a job, repairing a sink drain, and installing laminate flooring. 

(Id. at 33a-35a.) Claimant explained that the kneeling and up and down movement 

required to perform some of these jobs caused him to experience pain in his right 

knee. (Id. at 35a.) On November 26, 2014, Dr. Sensiba released Claimant to return 

to work without restrictions. (Id. at 34a, 50a.) Claimant stated that upon his return 

to full-duty work with Employer, he was required to perform a job at the Northwest 

Bank Building in Lewistown. (Id. at 39a.) When asked whether the job had any 

effect on his symptoms, Claimant explained: “[I]t took me three days to do a 

day-and-a-half job, and by the time I got done carrying those two five gallon buckets 

of tar across the room that night was excruciating. I just couldn’t do it.” (Id. at 40a.) 

Claimant explained further that when he returned to work on December 5, 2014, the 

Monday after he had completed the Northwest Bank Building job, Employer laid 

him off. (Id. at 40a, 44a.) 

Claimant testified further that following his lay-off, he continued to 

treat with Dr. Sensiba. (Id. at 40a-41a.) Claimant explained that Dr. Sensiba 
4

restricted him to sedentary duty as of January 7, 2015. (Id. at 41a.) Thereafter, on 

January 10, 2015, Claimant underwent an MRI of his right knee. (Id. at 42a.) 

Claimant explained that he continues to experience stiffness in his right knee, he has 

to use a cane to walk, and when he walks too far, his right knee aches and he has to 

sit down. (Id. at 43a.) He stated that he does not believe that he is capable of

returning to a job in construction. (Id. at 44a.) 

Claimant also testified that prior to the October 16, 2014 work-related 

incident, he did not have any physical difficulties, problems, or issues with his right 

or left knee. (Id. at 26a, 47a.) Claimant explained that he also did not seek any 

treatment for his knees at any time prior to the October 16, 2014 work-related 

incident. (Id. at 47a.) Claimant explained further that he had not sustained any 

injuries working as a self-employed carpenter in the ten years prior to working for 

Employer. (Id. at 46a.) Claimant testified that in late December 2014 or early 

January 2015, he was walking in the rain at home, slipped on some mud, and fell 

down. (Id. at 51a.) Claimant initially testified that he did not injure himself in the 

fall, but he later indicated that he did hurt his knee. (Id. at 51a, 56a.) Claimant stated 

further that he did not seek any treatment in connection with the slip and fall incident. 

(Id. at 51a.) Claimant also indicated that he was involved in a motor vehicle accident 

on October 23, 2014, and sustained injuries to his neck and back as a result thereof.2 

(Id. at 53a-54a.) 

 

2 Claimant again testified before the WCJ at the hearing held on November 17, 2015. At 

that time, Claimant indicated that he had not worked in any capacity since the May 19, 2015 

hearing. (R.R. at 88a-89a.) Following Claimant’s testimony at the November 17, 2015 hearing, 

the parties stipulated that Claimant had performed a flooring job on November 3, 2015, as 

referenced in a surveillance report prepared by Gittings Investigations and Security and the 

deposition testimony of William Stevens. (Id. at 175a.)
5

Claimant presented the deposition testimony of Dr. Sensiba, who is 

board certified in orthopedic surgery. (Id. at 96a.) Dr. Sensiba testified that he first 

treated Claimant on October 17, 2014, at Lewistown Hospital. (Id. at 97a.) 

Dr. Sensiba stated that medical professionals evaluated Claimant in the emergency 

room the evening before, at which time such medical professionals washed out

Claimant’s knee, treated Claimant with IV antibiotics, and sent Claimant home. (Id.) 

Dr. Sensiba stated further that Claimant returned to Lewistown Hospital because his 

symptoms—i.e., pain and swelling in his right knee—had not improved. (Id.) 

Dr. Sensiba performed a physical examination, which revealed a laceration on 

Claimant’s right leg, swelling in Claimant’s right knee, and pain with range of 

motion and upon palpation. (Id.) Due to the amount of swelling in Claimant’s knee, 

Dr. Sensiba aspirated Claimant’s knee so that the fluid could be analyzed to rule out 

an infection. (Id.) Dr. Sensiba explained that the fluid that he removed from 

Claimant’s right knee was mostly blood, which indicated that there was something 

traumatic going on inside the knee. (Id.) Dr. Sensiba explained that “you don’t get 

as much blood as I pulled out of [Claimant’s] knee without some sort of 

intra-articular injury happening.” (Id. at 98a.) Dr. Sensiba explained further that 

even though the blade may not have penetrated all the way into the knee, something 

happened intra-articularly from the force of the sawzall coming down onto 

Claimant’s knee. (Id. at 98a, 101a.)

Dr. Sensiba testified further that he performed surgery on Claimant’s 

right knee because he was concerned about debris getting inside the knee joint and 

causing infection. (Id. at 97a-98a.) Even though Claimant’s knee was not red or 

hot, Dr. Sensiba was concerned about infection, because Claimant was not 

responding to IV antibiotics and his knee continued to be painful and swollen.
6

(Id. at 98a.) Dr. Sensiba also indicated that Claimant’s pain and swelling was out of 

proportion to what he would expect for a superficial laceration. (Id.) During the 

surgery, Dr. Sensiba explored and cleaned the laceration, repaired the tendon fascia, 

and performed an arthroscopy. (Id. at 99a.) Dr. Sensiba explained that the laceration 

went through the quadriceps fascia, but not the tendon or the knee joint. 

(Id. at 98a-99a, 103a.) Dr. Sensiba also evacuated a hematoma in the knee joint, 

cauterized active bleeding in the suprapatellar pouch, repaired tearing in the medial 

and lateral menisci, and performed chondroplasty on the patella. (Id. at 99a.) Dr. 

Sensiba opined that the medial and lateral meniscus tears were likely preexisting, 

but that they had been aggravated by the October 16, 2014 work injury. (Id.) Dr. 

Sensiba also indicated that chondromalacia of the patella can be aggravated by acute 

trauma. (Id.) Dr. Sensiba stated that following the surgery, Claimant improved, but 

he continued to have pain in his knee. (Id. at 99a-100a.) Thereafter, 

in December 2014, following a period of sedentary duty and light duty work, 

Dr. Sensiba released Claimant to return to work full duty without restrictions. 

(Id. at 99a-100a.) Dr. Sensiba explained that even though Claimant continued to 

experience pain, Claimant wanted to return to his pre-injury job. (Id. at 100a.) 

Dr. Sensiba stated that he treated Claimant again on January 7, 2015.

(Id.) At that time, Claimant reported that his condition had worsened and that he 

was experiencing more pain in his knee. (Id.) Dr. Sensiba ordered an MRI of 

Claimant’s knee, which revealed changes in the medial meniscus and avascular 

necrosis in the medial femoral condyle. (Id.) Dr. Sensiba explained that avascular 

necrosis essentially means that part of Claimant’s knee had died because it did not 

have the proper blood flow. (Id.) When asked whether the avascular necrosis was 

consistent with Claimant’s October 16, 2014 work-related injury, Dr. Sensiba stated: 
7

“[H]e had some traumatic injury to his knee that caused him to have fairly large 

bloody effusion and hemarthrosis in his knee, so I think it is, yes.” (Id.) Based upon 

his visit with Claimant on January 7, 2015, Dr. Sensiba returned Claimant to 

sedentary duty restrictions. (Id.)

Dr. Sensiba opined within a reasonable degree of medical certainty that 

Claimant’s right knee problems are related to the October 16, 2014 work injury. (Id.) 

Dr. Sensiba opined further that all of the work restrictions that he has imposed upon 

Claimant are also related to the October 16, 2014 work-related incident. (Id.) 

Dr. Sensiba indicated that Claimant has not fully recovered from his 

October 16, 2014 work injury, and he did not have any plans to release Claimant 

from his care in the immediate future. (Id.) When asked about his opinion regarding

the conclusions of Barry A. Ruht, M.D., Employer’s expert, that any extra-articular 

injury was caused by Claimant’s subsequent slip in the mud and not the 

October 16, 2014 work-related injury, Dr. Sensiba indicated that he believed that 

Claimant’s subsequent slip and fall occurred after he had obtained the MRI of 

Claimant’s right knee in January 2015. (Id.) Dr. Sensiba further indicated that, even 

though the sawzall blade did not go all the way into the knee joint, the degree of 

bleeding inside the knee was evidence of trauma that extended into the intra-articular 

space. (Id.)

On cross-examination, Dr. Sensiba admitted that Claimant had fully 

recovered from and does not need any further treatment with respect to the right knee 

laceration. (Id. at 104a.) Dr. Sensiba also admitted that, during surgery, he did not 

discover any objective evidence of trauma to the meniscus or medial lateral gutters, 

an acute anterior cruciate ligament (ACL) rupture, or loose bodies.3 (Id.) When 

 

 

3 Although asked about medial lateral gutters, Claimant’s ACL, and loose bodies, those 

structures do not appear to be at issue in this matter.
8

questioned about the cause of the trauma to Claimant’s right knee, if it was not the 

saw blade, Dr. Sensiba said he could speculate but did not know for sure. (Id.) Dr. 

Sensiba indicated that he did not specifically know when the subsequent slip and fall 

incident had occurred, but he would not disagree with Claimant’s statements 

regarding the timing thereof. (Id.) Dr. Sensiba admitted that a slip and fall with a 

representation that the knee was hurt could have caused further injury to the knee. 

(Id. at 105a.) Dr. Sensiba also confirmed that he first diagnosed Claimant with 

avascular necrosis in January 2015, after he released Claimant to return to full duty 

work without restrictions in December 2014. (Id.) Dr. Sensiba indicated that when 

he released Claimant to return to full duty work in December 2014, Claimant 

continued to experience pain and swelling in his right knee. (Id.) Dr. Sensiba, 

admitted, however, that Claimant’s pain and swelling had improved postoperatively. 

(Id.) 

Employer presented the deposition testimony of Dr. Ruht, a board 

certified orthopedic surgeon. (Id. at 112a.) Dr. Ruht performed an independent 

medical examination of Claimant on June 2, 2015. (Id. at 114a.) As part of his 

independent medical examination, Dr. Ruht reviewed Claimant’s medical records, 

obtained a history, and performed a physical examination. (Id. at 115a-29a.) Dr. 

Ruht explained that Dr. Sensiba, in his operative report, indicated that there did not 

appear to be any traumatic or acute injury in the region of the medial femoral 

condyle, which is the area that Dr. Sensiba later diagnosed to have avascular 

necrosis. (Id. at 119a, 135a-36a.) Dr. Ruht explained further that he would describe 

Claimant’s October 16, 2014 work-related injury as a small, superficial laceration 

that was debrided and repaired, with bruising to the blood vessels within the knee 

that had caused some bleeding. (Id. at 120a.) Dr. Ruht also explained that 
9

Dr. Sensiba’s treatment notes from October 29, 2014, and November 26, 2014, 

evidenced normal examinations despite Claimant’s subjective complaints of pain. 

(Id. at 122a-23a.) Dr. Ruht testified further that following a physical examination 

of Claimant on January 7, 2015, Dr. Sensiba ordered an MRI of Claimant’s right 

knee. (Id. at 123a.) The MRI, which was performed on January 10, 2015, revealed, 

inter alia, avascular necrosis in the medial femoral condyle and an oblique tear of 

the posterior horn of the medial meniscus. (Id. at 124a-25a.) Dr. Ruht also stated 

that Claimant’s physical therapy note from January 9, 2015, indicated that Claimant 

had slipped and fell in the mud at home on an unknown date. (Id. at 123a-24a.) 

Dr. Ruht confirmed, however, that based on the timeline, he believed that Claimant’s

slip and fall incident had occurred sometime prior to the MRI. (Id. at 124a.) 

Based on his review of Claimant’s medical records, the history he 

obtained from Claimant, and his physical examination of Claimant, Dr. Ruht opined

that Claimant had sustained a laceration to his right thigh as a result of the 

October 16, 2014 work-related incident. (Id. at 129a.) Dr. Ruht opined further that 

Claimant had fully recovered from the laceration and would have no restrictions 

based upon the October 16, 2014 work-related injury. (Id. at 129a, 132a, 137a.) 

Dr. Ruht opined further that the avascular necrosis in Claimant’s right knee was 

unrelated to Claimant’s October 16, 2014 work-related injury. (Id. at 129a-30a, 

132a-33a.) Dr. Ruht attributed the avascular necrosis to the slip and fall incident 

that occurred prior to January 10, 2015. (Id. at 125a, 130a, 134a.) Dr. Ruht 

explained that this conclusion was based upon: (1) the x-ray of Claimant’s right 

knee performed on October 16, 2014, which showed no evidence of avascular 

necrosis; (2) the lack of fatty globules or droplets contained within the fluid obtained 

from the two aspirations of Claimant’s right knee performed on October 17, 2014; 
10

and (3) Dr. Sensiba’s indication in his operative report that there did not appear to 

be any traumatic injury in the region of the medial femoral condyle. (Id. at 118a, 

120a-21a, 133a-34a.) Dr. Ruht also opined that Claimant did not sustain an 

aggravation of any preexisting problem as a result of the October 16, 2014 

work-related incident. (Id. at 134a-35a.) 

On cross-examination, Dr. Ruht admitted that Claimant’s medical 

records indicated that both an emergency room doctor and Dr. Sensiba aspirated a 

significant amount of bloody fluid from Claimant’s right knee following the 

October 16, 2014 work-related injury. (Id. at 139a-41a.) Dr. Ruht also admitted that 

Dr. Sensiba’s operative report indicated the presence of a hematoma and active 

bleeding in the suprapatellar pouch that required cauterization. (Id. at 140a, 

142a-43a.) Dr. Ruht confirmed that the October 16, 2014 work-related injury caused 

the hematoma, the bleeding in the suprapatellar pouch, and the need for the 

aspiration of blood. (Id. at 143a-44a.) Dr. Ruht also confirmed that each of these 

conditions are examples of an interruption of blood flow to the area of the laceration. 

(Id. at 143a-44a.) Dr. Ruht confirmed further that other than the physical therapy 

note, he did not see any medical records attributing any injury to Claimant’s slip and 

fall incident. (Id. at 145a.) Dr. Ruht agreed that he had no knowledge of the body 

part on which Claimant fell or the mechanism of injury relative to Claimant’s slip 

and fall incident. (Id. at 146a.) Dr. Ruht also acknowledged that any conclusions 

that he made regarding the slip and fall incident were based on his supposition of 

what had occurred.

4

 (Id.) On redirect, Dr. Ruht clarified that the part of Claimant’s 

 

4 Employer also presented the testimony of Ryan Ford, Employer’s owner, who testified 

regarding, inter alia, the particulars of Claimant’s employment with Employer, Claimant’s return 

to work under light-duty restrictions following his October 16, 2014 work-related injury, 

Claimant’s return to full-duty work thereafter, and the particulars of Claimant’s layoff from 

employment with Employer. (R.R. at 64a-77a.) 
11

right knee where there had been an interruption in blood flow does not provide the 

blood supply to the medial femoral condyle. (Id. at 147a.) Dr. Ruht also clarified 

that Dr. Sensiba’s operative report indicated that there was no damage to the blood 

supply of the medial femoral condyle as of the date of surgery. (Id. at 147a-48a.)

On October 21, 2016,5the WCJ issued a decision, granting Claimant’s 

claim and review petitions. In so doing, the WCJ summarized the witnesses’ 

testimony and made the following relevant credibility determinations: 

9. Based upon a thorough review of the evidence and 

testimony of record, this Judge finds Claimant to be 

credible to establish the history of the incident, and 

the presence of knee pain and difficulties with 

performing the duties of his employment whether 

they were light-duty or full-duty. I base this 

assessment of Claimant’s credibility in large part on 

my observation of his demeanor. I acknowledge 

that Claimant is not credible with regard to his work 

capacity near the close of the record because he 

clearly was able to work in some capacity and did 

so. However, I find no error in Claimant attempting 

to return to work. There was no evidence of a job 

offer after Claimant was laid off in December 2014.

10. Based upon a thorough review of the evidence and 

testimony of record, this Judge finds the testimony 

of Dr. Sensiba to be credible in large part. In so 

holding, I rely on the fact that Dr. Sensiba was 

sufficiently qualified to render an opinion regarding 

a knee condition, and he has been acting as a 

treating physician which, in this Judge’s 

assessment, puts him in a slightly better position to 

assess Claimant’s condition rather than Dr. Ruht, 

who saw the Claimant on only one occasion. The 

testimony of Dr. Sensiba is credible to establish that 

Claimant sustained a laceration to his knee, as well 

as an aggravation of his pre-existing lateral and 

 

5 While the WCJ’s order is dated October 20, 2016, the decision was not circulated until 

October 21, 2016. 
12

medial meniscus tears. Dr. Sensiba provided a clear 

explanation of his opinions in this regard. Further, 

I find it credible that Claimant has not recovered 

from his injury, based upon the testimony of 

Dr. Sensiba, who rendered an opinion within a 

reasonable degree of medical certainty and 

adequately explained his opinion. I further note that 

Dr. Sensiba’s opinion regarding the existence of an 

aggravation of the meniscal tears was not directly 

addressed by the testimony of Dr. Ruht. Rather, he 

seemed to focus specifically on the avascular 

necrosis. 

I do not accept any testimony as credible or 

sufficient that Claimant sustained an aggravation of 

any pre-existing chondromalacia of the patella. 

Dr. Sensiba opined that this is something that “can” 

be aggravated by trauma. He did not specifically 

state that the patella findings were aggravated by the 

incident. Also, Dr. Sensiba has not testified or 

credibly established that any alleged new tear of the 

posterior horn of the medial meniscus is related to 

the October 16, 2014 injury. 

Finally, with respect to the avascular necrosis, while 

it is a difficult issue, this Judge feels compelled to 

find that the avascular necrosis in the medial 

condyle arose as a result of the work injury as 

testified to by Dr. Sensiba. While it is true that the 

incident involving Claimant’s slip and fall may 

have occurred before January 9, 2015, and before 

the January 10, 2015 MRI, it is unclear exactly 

when it occurred. Further, reliance on this slip and 

fall by Dr. Ruht to establish that the avascular 

necrosis occurred as a result of same seems to be 

quite a stretch. There is no evidence of medical 

treatment for this slip and fall. There is no evidence 

regarding the mechanism of injury for this slip and 

fall. There is ample evidence of a knee injury of 

significance causing both swelling and bleeding on 

October 16, 2014. As a result, I feel compelled to 

find Dr. Sensiba credible to establish that the 

Claimant’s avascular necrosis arose as a result of 

this work injury. Claimant has no prior knee 
13

problems and Dr. Sensiba explained that there was 

a sufficient blow to the knee under the 

circumstances. 

11. Based upon a thorough review of the evidence and 

testimony of record, this Judge finds the testimony 

of Dr. Ruht not credible to the extent it contradicts 

that of Dr. Sensiba. Dr. Ruht saw the Claimant on 

only one occasion and was not in as good a position 

to assess Claimant’s condition as Dr. Sensiba. 

Further, the testimony of Dr. Ruht relied heavily on 

Dr. Sensiba’s operative report, but failed to accept 

the opinions given by Dr. Sensiba under oath. It 

seems that he chose to be selective as to which 

opinions, testimony, or findings of Dr. Sensiba he 

would rely on. In addition, this Judge notes that 

Dr. Ruht did not directly address the issue regarding 

Claimant’s lateral and medial meniscus tears. He 

found Claimant recovered from the laceration, 

which I can accept based upon the testimony of both 

witnesses, but did not address the meniscal tears 

that were repaired. He further did not adequately 

explain his reliance on the January 9, 2015 physical 

therapy note, which failed to explain any 

mechanism of injury or the significance of any 

impact. I cannot accept his opinions regarding 

Claimant’s condition except for the status of the 

laceration itself. 

(WCJ’s Decision at 7-9.) Based on these credibility determinations, the WCJ 

concluded that Claimant met his burden of proving that his October 16, 2014 

work-related injury caused him to sustain a right knee laceration, an aggravation of 

the pre-existing lateral and medial meniscus tears in his right knee, and the onset of 

avascular necrosis in his right knee and to be disabled beginning December 5, 2014, 

and continuing thereafter. Employer appealed to the Board, which affirmed the 

WCJ’s decision. Employer then petitioned this Court for review. 
14

On appeal,6 Employer argues that the Board committed an error of law 

by affirming the WCJ’s decision because the WCJ’s decision is not supported by 

substantial evidence.7 More specifically, Employer argues that Dr. Sensiba’s 

testimony was equivocal and incompetent because: (1) Dr. Sensiba’s opinion that 

Claimant sustained an aggravation of pre-existing lateral and medial meniscus tears8

and the onset of avascular necrosis in his right knee as a result of the 

October 16, 2014 work-related injury is based on a mechanism of injury—i.e., 

impact to Claimant’s knee from the sawzall itself—that is not supported by the 

evidentiary record; and (2) Dr. Sensiba admitted that he could only speculate and 

was not sure what had caused intra-articular trauma to Claimant’s right knee. 

Employer argues further that even assuming that Dr. Sensiba’s testimony is 

unequivocal and competent, the WCJ’s opinion is not supported by substantial 

evidence.

In response, Claimant argues that Employer is essentially asking this 

Court to reweigh the evidence and overturn the WCJ’s credibility determinations on 

 

6 This Court’s standard of review is limited to determining whether constitutional rights 

were violated, whether an error of law was committed, or whether necessary findings of fact are 

supported by substantial evidence. Section 704 of the Administrative Agency Law, 2 Pa. C.S. 

§ 704.

7

In its brief, Employer presented three issues for our consideration, all of which relate to 

whether the WCJ’s decision to expand Claimant’s injury description to include an aggravation of 

pre-existing lateral and medial meniscus tears and the onset of avascular necrosis in Claimant’s 

right knee is supported by substantial evidence. Because all of Employer’s arguments are 

interrelated, we will address them together. 

8 While Employer appears to challenge the WCJ’s determination with respect to the finding 

that Claimant had sustained an aggravation of preexisting tears to the lateral and medial menisci, 

Dr. Ruht’s testimony and Employer’s brief focus on whether there is substantial evidence of record 

to support the WCJ’s finding that Claimant sustained avascular necrosis in his right knee as a result 

of the October 16, 2014 work-related incident. For these reasons, the remainder of this opinion 

will only address the avascular necrosis injury.
15

appeal. More specifically, Claimant argues that Dr. Sensiba’s testimony as a whole 

“is clear and unequivocal in establishing causation between the work injury and 

Claimant’s ongoing disability[] and, therefore, is sufficient to support” the WCJ’s 

decision. (Claimant’s Br. at 14.) Claimant argues further that the trauma to 

Claimant’s right knee occurred when the “reciprocating saw blade punctured 

Claimant’s leg directly above his knee,” and, therefore, “Dr. Sensiba did not 

‘speculate’ an additional trauma to Claimant’s knee.” (Claimant’s Br. at 20-21.) 

Claimant also argues that even if Dr. Sensiba had expressed uncertainty regarding 

the trauma to Claimant’s right knee, his opinion was still unequivocal because he 

“maintained throughout his testimony that Claimant’s avascular necrosis is the result 

of the October 16, 2014 work injury [and a]ny expression of uncertainty regarding 

the medical details would go to the credibility of [his] opinion, not his competency.” 

(Claimant’s Br. at 22.) 

At the outset, we note that it is well settled that the WCJ is the sole 

arbiter of credibility and evidentiary weight. Womack v. Workers’ Comp. Appeal 

Bd. (Sch. Dist. of Phila.), 83 A.3d 1139, 1154 (Pa. Cmwlth.), appeal denied, 

94 A.3d 1011 (Pa. 2014). In determining whether the WCJ’s findings are supported

by substantial evidence, we may not reweigh the evidence or the credibility of the 

witnesses but must simply determine whether the WCJ’s findings have the requisite 

measure of support in the record as a whole. Elk Mountain Ski Resort, Inc. v. 

Workers’ Comp. Appeal Bd. (Tietz, deceased), 114 A.3d 27, 32 n.5 

(Pa. Cmwlth. 2015). It is irrelevant whether there is evidence to support a contrary 

finding; if substantial evidence supports the WCJ’s necessary findings, we may not 

disturb those findings on appeal. Williams v. Workers’ Comp. Appeal Bd. 

(USX Corp.-Fairless Works), 862 A.2d 137, 143-44 (Pa. Cmwlth. 2004).
16

It is also well settled that with respect to a claim petition, the claimant 

bears the burden of proving all elements necessary for an award. Inglis House v. 

Workmen’s Comp. Appeal Bd. (Reedy), 634 A.2d 592, 595 (Pa. 1993). Pursuant to 

Section 301(c)(1) of the Workers’ Compensation Act,

9

an employee’s injuries are 

compensable if they “(1) arise[] in the course of employment and (2) [are] causally 

related thereto.” ICT Group v. Workers’ Comp. Appeal Bd. (Churchray˗Woytunick), 

995 A.2d 927, 930 (Pa. Cmwlth. 2010). Further, an employee must demonstrate that 

he is disabled as a consequence of the work-related injury. Cromie v. Workmen’s 

Comp. Appeal Bd. (Anchor Hocking Corp.), 600 A.2d 677, 679 (Pa. Cmwlth. 1991). 

Unequivocal medical evidence is required where it is not obvious that an injury is 

causally related to the work incident. Id. “The question of whether expert medical 

testimony is unequivocal, and, thus, competent evidence to support factual 

determinations is a question of law subject to our review.” Amandeo v. Workers’ 

Comp. Appeal Bd. (Conagra Foods), 37 A.3d 72, 80 (Pa. Cmwlth. 2012). “In such 

cases, we review the testimony as a whole and may not base our analysis on a few 

words taken out of context.” Id. “Taking a medical expert’s testimony as a whole, 

it will be found to be equivocal if it is based only upon possibilities, is vague, and 

leaves doubt.” Kurtz v. Workers’ Comp. Appeal Bd. (Waynesburg College), 

794 A.2d 443, 449 (Pa. Cmwlth. 2002). “[M]edical testimony is unequivocal if a 

medical expert testifies, after providing a foundation for the testimony, that, in his 

professional opinion, he believes or thinks a fact exists.” O’Neill v. Workers’ Comp. 

Appeal Bd. (News Corp., Ltd.), 29 A.3d 50, 57 (Pa. Cmwlth. 2011).

In addition to this requirement that a medical expert’s testimony be 

unequivocal, the medical expert’s testimony also must reflect the expert’s adequate 

 

9 Act of June 2, 1915, P.L. 736, as amended, 77 P.S. § 411(1).
17

understanding of the facts to be competent. Sears, Roebuck & Co. v. Workmen’s 

Comp. Appeal Bd., 409 A.2d 486, 490 (Pa. Cmwlth. 1979). In reviewing an expert’s 

testimony on this basis, we must consider whether the expert “had sufficient facts 

before him upon which to express” his medical opinion. Id. A medical expert’s 

opinion will be held to be incompetent only when the opinion is based solely on 

inaccurate or false information; when the record as a whole contains factual support 

for an expert’s opinion, the opinion is not incompetent. Am. Contracting Enters., 

Inc. v. Workers’ Comp. Appeal Bd. (Hurley), 789 A.2d 391, 396 (Pa. Cmwlth. 2001). 

Furthermore, answers given during cross-examination in a workers’ compensation 

proceeding “do not, as a matter of law, destroy the effectiveness of [the] previous 

opinions expressed by a physician.” Hannigan v. Workmen’s Comp. Appeal Bd. 

(Asplundh Tree Expert Co.), 616 A.2d 764, 767 (Pa. Cmwlth. 1992), appeal denied, 

634 A.2d 1118 (Pa. 1993). Instead, such statements go to the weight, not the 

competency, of the expert’s opinion. Corcoran v. Workers’ Comp. Appeal Bd. 

(Capital Cities/Times Leader), 725 A.2d 868, 872 (Pa. Cmwlth. 1999).

Here, Employer contends that Dr. Sensiba’s opinion regarding the 

cause of the avascular necrosis in Claimant’s right knee is equivocal and 

incompetent, because the record does not contain any evidence of a specific blow or 

impact to Claimant’s right knee from the sawzall itself, other than the sawzall blade, 

and Dr. Sensiba admitted that he could only speculate and was not sure what had 

caused the trauma to Claimant’s right knee. We disagree. First, Dr. Sensiba’s 

opinion on causation is based on a traumatic injury to Claimant’s right knee, which 

is supported by the record. Dr. Sensiba testified that, even though the sawzall blade 

may not have penetrated all the way into the knee, the degree of bleeding inside the 

knee was evidence of intra-articular trauma from the force of the sawzall coming 
18

down onto Claimant’s knee. (R.R. at 98a, 100a-01a.) Employer’s suggestion that 

the penetration of the sawzall blade into Claimant’s knee was not of sufficient force 

to cause trauma to Claimant’s right knee is just that, a suggestion. Claimant testified 

that he was using a sawzall to cut out a fire-damaged floor joist, when the sawzall’s 

blade pinched, jumped up, and entered his right knee. (Id. at 26a-28a.) The sawzall 

blade had to have contacted Claimant’s knee with some measure of force for it to 

have penetrated into Claimant’s knee. Thus, Claimant’s description of the 

October 16, 2014 work injury provides the necessary factual support in the record 

for Dr. Sensiba’s opinion regarding the causal connection between the 

October 16, 2014 work-related incident and the avascular necrosis in Claimant’s 

right knee.

Second, when taken as a whole, Dr. Sensiba’s testimony on causation 

is not speculative. In an attempt to demonstrate the speculative nature of 

Dr. Sensiba’s opinion, Employer directs our attention to a single exchange between 

Employer’s counsel and Dr. Sensiba during cross-examination:

Q. And you believe there was some kind of 

trauma to his knee, but you’re not exactly sure what 

specifically caused that, if it wasn’t the blade, correct?

A. I can speculate. 

Q. But you’re not sure, right?

A. But I’m not sure.

(Id. at 104a.) This single exchange during cross-examination does not destroy the 

effectiveness of Dr. Sensiba’s overall opinion. See Hannigan, 616 A.2d at 767. If 

we were to conclude otherwise, we would be taking a few of Dr. Sensiba’s words 

out of context and not considering Dr. Sensiba’s testimony as a whole. See 

Amandeo, 37 A.3d at 80. In addition, Employer’s counsel’s question asks 

Dr. Sensiba to speculate as to a potential cause of the trauma to Claimant’s right 
19

knee “if it wasn’t the blade.” In other words, Employer’s counsel asked Dr. Sensiba 

to speculate not about the cause attributed by Dr. Sensiba—i.e., the force of the 

sawzall blade entering Claimant’s right knee—but rather, a potential alternative 

cause. For these reasons, Dr. Sensiba’s testimony is unequivocal and competent. 

Employer also contends that even assuming that Dr. Sensiba’s

testimony is unequivocal and competent, the WCJ’s decision that Claimant sustained 

avascular necrosis in his right knee as a result of the October 16, 2014 work-related 

incident is not supported by substantial evidence because: (1) Dr. Sensiba did not 

diagnose Claimant with the onset of avascular necrosis until after Claimant 

recovered from the right knee laceration, was released to return to full-duty work, 

was laid off by Employer, and slipped and fell and sustained a non-work related 

injury to his right knee; (2) the WCJ ignored the existence, timing, and significance 

of Claimant’s slip and fall injury to his right knee; (3) Claimant’s current symptoms 

and complaints are related to the onset of avascular necrosis, not the right knee 

laceration, and Claimant recovered from the right knee laceration and was released 

to return to full-duty work as of November 26, 2014; (4) Dr. Ruht provided the only 

credible and competent expert opinion in this matter; and (5) Claimant provided 

false testimony to the WCJ regarding work that he performed. In making this 

argument, Employer is essentially asking this Court to reweigh the evidence and 

reconsider the WCJ’s credibility determinations, which we will not do. 

Dr. Ruht opined that the avascular necrosis in Claimant’s right knee 

was unrelated to Claimant’s October 16, 2014 work-related injury. Dr. Ruht 

attributed the avascular necrosis to Claimant’s slip and fall incident. Dr. Sensiba, 

on the other hand, opined that the avascular necrosis in Claimant’s right knee is

related to and was caused by the October 16, 2014 work-related incident. The WCJ 
20

credited Dr. Sensiba’s testimony over Dr. Ruht’s testimony on the basis that 

Dr. Sensiba “was sufficiently qualified to render an opinion regarding a knee 

condition” and had been acting as Claimant’s treating physician, whereas Dr. Ruht 

had treated Claimant on only one occasion. (WCJ’s Decision at 8.) In addition, the 

WCJ found that Dr. Ruht’s reliance on the slip and fall incident as the cause of 

Claimant’s avascular necrosis was a stretch. The WCJ noted that even though the 

slip and fall incident may have occurred before the January 10, 2015 MRI of 

Claimant’s right knee, there was no evidence regarding the mechanism of injury for 

such slip and fall incident or that Claimant had sought medical treatment as a result 

of such slip and fall incident. (Id.) The WCJ, as the ultimate fact-finder, had the 

discretion to credit Dr. Sensiba’s testimony over Dr. Ruht’s testimony. As set forth 

more fully above, Dr. Sensiba’s testimony supports the WCJ’s determination that 

Claimant had sustained an aggravation of his preexisting lateral and medial meniscus 

tears and avascular necrosis in his right knee. 

For all of the above-stated reasons, the WCJ’s determination that the 

avascular necrosis in Claimant’s right knee was caused by the October 16, 2014 

work injury is supported by substantial evidence, and, therefore, the Board did not 

commit an error of law in affirming the WCJ’s decision. Accordingly, we affirm the 

Board’s order. 

P. KEVIN BROBSON, Judge
IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Ryan L. Ford Contractor and :

Flagship City Insurance Company, :

Petitioners :

:

v. : No. 703 C.D. 2017

:

Workers’ Compensation Appeal :

Board (Petersen), :

Respondent :

O R D E R

AND NOW, this 4

th day of June, 2018, the order of the Workers’ 

Compensation Appeal Board is hereby AFFIRMED. 

P. KEVIN BROBSON, Judge