IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Catherine Fox, :

Petitioner :

:

v. : No. 409 C.D. 2020

: Submitted: September 4, 2020

Workers’ Compensation Appeal :

Board (Chestnut Hill Healthcare :

Center), :

Respondent :

BEFORE: HONORABLE P. KEVIN BROBSON, Judge1

HONORABLE ANNE E. COVEY, Judge

HONORABLE J. ANDREW CROMPTON, Judge

OPINION NOT REPORTED

MEMORANDUM OPINION

BY JUDGE BROBSON FILED: January 27, 2021

Catherine Fox (Claimant) petitions for review of an order of the Workers’

Compensation Appeal Board (Board), dated April 1, 2020. The Board affirmed an 

order of a Workers’ Compensation Judge (WCJ), which denied Claimant’s claim 

petition against Chestnut Hill Healthcare Center (Employer). We now affirm.

I. BACKGROUND

Beginning in February or March 2016, Claimant worked for Employer as its 

chief executive officer and nursing home administrator. (Reproduced Record (R.R.)

at 65a.) On or about November 15, 2016, Claimant began experiencing pain in her 

1 This case was assigned to the opinion writer prior to January 4, 2021, when Judge Brobson 

became President Judge.
2

upper back while using her computer at her desk at work, and, over the next few 

days, she developed pain, stiffness, and reduced range of motion in her neck. 

(Id. at 73a-74a.) On November 21, 2016, Claimant informed Employer that she was 

unable to work and sought medical treatment for her symptoms. (Id. at 75a-76a.) 

On December 19, 2016, Claimant filed a claim petition, seeking full disability 

benefits beginning November 21, 2016, and ongoing, and alleging that the symptoms 

she experienced beginning in mid-November 2016 constituted a work-related 

injury.2 (Id. at 1a-4a.) Specifically, Claimant alleged that the subject injury is a 

work-related aggravation of head, neck, shoulder, and arm injuries she sustained 

prior to her work for Employer. (Id. at 2a.) Employer filed an answer denying all 

allegations in the claim petition. (Id. at 15a-18a.) The matter was assigned to a

WCJ, who conducted a hearing.

At the hearing, Claimant testified that, beginning in 1995, many years prior to 

her employment with Employer, Claimant experienced persistent head and neck pain 

and restricted range of motion for which she received a treatment of regular Botox 

injections for approximately six years, from 1995 to 2001. (Id. at 67a-69a.) 

Claimant initially testified that she experienced no neck pain, restricted motion, or 

other neck problems from 2001 until 2016. (Id. at 69a.) On April 11, 2016, a few 

months after she began working for Employer, Claimant was injured in a

non-work-related automobile accident. (Id. at 69a-71a, 227a.) She testified that the 

accident immediately caused “excruciating” pain in her neck and head, for which 

she sought and received emergency medical care. (Id. at 71a-72a.) Claimant stated 

2 Claimant also filed a penalty petition, which the WCJ denied at the same time she denied 

the claim petition. (R.R. at 8a-11a; WCJ’s Decision at 12.) Claimant has not challenged the denial 

of her penalty petition on appeal, and, therefore, we do not address it in this opinion.
3

that she did not experience any neck pain after her emergency care, but she sought 

treatment from her primary care physician, Neil Mermelstein, D.O., before returning 

to work several days after the accident with no restrictions and no neck pain or 

problems. (Id. at 72a.)

Claimant further testified that she continued to perform her job duties without 

pain until on or about November 15, 2016, when she began to experience discomfort 

while working at her computer. (Id.) She explained that the discomfort began when 

she would turn her head to look at a document on her right side, next to the computer 

screen, which was on her left. (Id. at 73a.) The discomfort grew into “a sharp pain 

. . . [in] the upper left part of [Claimant’s] back.” (Id.) Over the next two or three 

days, Claimant experienced intermittent episodes of similar pain while at work and 

developed stiffness in the left side of her neck. (Id. at 73a-74a.) Claimant testified 

that this pain differed from the pain she experienced from 1995 to 2001 and the pain 

following the April 2016 accident. (Id. at 77a, 164a-68a.)

Claimant stated that, on Friday, November 18, 2016, she informed 

Employer’s director of human resources, Tina Klein, of the pain and problems she 

was experiencing. (Id. at 74a.) Claimant recounted that, during their conversation, 

she experienced neck pain traveling down her left arm into her left hand and that 

Ms. Klein observed Claimant’s head shaking when she turned her head to the left. 

(Id. at 74a-75a.) Claimant further testified that, upon hearing Claimant’s description 

of her symptoms, Ms. Klein said she “should go home.” (Id. at 75a.) Claimant 

stated that Ms. Klein expressed her belief that Claimant’s symptoms were related to 

the setup of her desk and chair and that Ms. Klein contacted other human resources 

personnel of Employer about Claimant’s injuries. (Id. at 83a.) Claimant also 

asserted that she had previously complained to her supervisor, Carol Pritchard, on 
4

several occasions that her office chair did not fit her properly and was causing 

discomfort in her back. (Id. at 76a, 82a.) Claimant stated that on the following 

Monday, November 21, 2016, she made an appointment with Dr. Mermelstein and 

informed Ms. Klein and Ms. Pritchard that she would not report to work that day. 

(Id. at 75a-76a.)

Claimant explained that she has continued to experience the symptoms that 

began in mid-November 2016, including pain, stiffness, and muscle spasms in her 

back and neck and numbness in both hands. (Id. at 78a.) She has not returned to 

work since November 21, 2016. (Id. at 80a.) Claimant testified that, because of 

these symptoms, she is in constant, sometimes disabling pain and is often unable to 

sleep. (Id. at 158a-59a, 167a.) Concerning whether she is able to drive in her present 

condition, Claimant stated:

A. Well I do drive but I’m - they would like me to not drive. 

So when I tell you I’m driving, that means I’m with 

another person that I go to my appointments - who takes 

me with [sic] to my appointments. So sometimes I will 

drive, but if I feel it’s going really bad, I don’t, because 

[my head] goes to the left and I can’t see then.

Q. Okay. Did you drive here today?

A. That’s the only time I would drive. No, my husband 

brought me.

(Id. at 170a.)

On cross-examination, Claimant sought to add to her earlier testimony, 

explaining other symptoms she had noticed on Friday, November 18, 2016, while at 

work. (Id. at 85a-87a.) She explained the nature and location of the pain and 

immobility she experienced beginning in 1995 and how it differed from the 

symptoms she experienced in November 2016. (Id. at 87a-92a.) Claimant had 

initially testified that her 1995 symptoms were the result of a viral infection, but, on 
5

cross-examination, she stated that she was not sure what caused the pain, only that 

she and several of her acquaintances were ill with similar symptoms and believed 

they had contracted a virus. (Id. at 67a-68a, 95a-96a.) Claimant testified that her 

treating physician in 1995—Howard Hurtig, M.D.—diagnosed her with cervical 

dystonia. (Id. at 96a.) She stated that the pain resulting from the April 2016 accident 

resolved within one week and that she was not receiving further treatment for the 

accident at the time she ceased working in November 2016. (Id. at 96a-97a, 231a.) 

Claimant initially admitted that she had experienced neck problems, including her 

head shaking when turning to the left, continuously from 1995 until November 2016. 

(Id. at 98a.) When asked whether she believed she “always had” cervical dystonia 

and the associated neck problems, Claimant said that she was not sure her symptoms 

were caused by cervical dystonia but stated that she has experienced shaking in her 

neck continuously since 1995 and that the nature of her neck pain changed over time. 

(Id. at 98a-99a.) She then stated that she has “not had an issue with [her] neck since 

[she] stopped seeing Dr. Hurtig in 2001 or 2000.” (Id. at 99a.) Throughout her 

testimony on cross-examination, however, Claimant admitted that she has taken the 

drug Klonopin for “movement disorders” continuously from 1995 to the present, as

prescribed by Dr. Hurtig and Dr. Mermelstein.3 (Id. at 97a, 99a-100a.) She also 

admitted that she recently began receiving the same type of injection treatment she 

had received for her neck problems from 1995 to 2001, although the injections are 

not administered in precisely the same locations or muscles as before. 

(Id. at 179a-81a.) Claimant also stated that, in addition to the pain, shaking, and 

range-of-motion issues she described on direct examination, she has recently 

3 Although Claimant initially testified that she has been taking Klonopin since 1995, in 

subsequent direct testimony she stated that she has been taking it since 1999. (R.R. at 219a-20a.)
6

complained to doctors that she experiences headaches, ringing in her ears, and a 

spinning sensation in her head and eyes. (Id. at 103a-04a.)

Claimant further admitted on cross-examination that she never personally 

completed a written report of her alleged work injury. (Id. at 174a-75a.) She 

emphasized that she expected Ms. Klein to complete the report and that Ms. Klein

had expressed her belief that Claimant’s injury was work related. (Id. at 175a.) 

Claimant recalled that Dr. Mermelstein wrote her a note excusing her from work, 

but she could not recall whether the note described Claimant’s symptoms as a work 

injury or an underlying medical condition. (Id. at 176a.) Claimant admitted that she 

never told Dr. Mermelstein she believed her injury to be work related.4 (Id. at 177a.)

In support of the claim petition, Claimant presented the testimony of 

Ms. Klein, who testified that she began working for Employer as human resources 

director on April 17 or 18, 2016—just a few days after Claimant’s accident. 

(Id. at 132a.) Ms. Klein stated that, to her knowledge, Claimant missed only one 

week of work following the vehicle accident and made no complaints about 

4 This admission by Claimant is consistent with the records of Dr. Mermelstein concerning 

his treatment of Claimant, which Claimant introduced in support of the claim petition and which 

do not indicate that Claimant ever asserted to Dr. Mermelstein that her injuries are work related. 

(See R.R. at 405a-08a.) Dr. Mermelstein’s records indicate that Claimant sought treatment from 

him on May 2, 2016, complaining of pain in her neck, back, arms, and fingers, that Dr. Mermelstein 

diagnosed Claimant with injuries from an “accident,” and that he prescribed various treatments 

including pain medication, physical therapy, x-rays, and a referral for orthopedic care. 

(Id. at 405a-06a.) When asked about the May 2, 2016 note, which appears to contradict Claimant’s 

assertion that she saw Dr. Mermelstein only once approximately five days after the 

April 11, 2016 accident, Claimant stated that she “[didn’t] remember” seeing him on May 2nd and 

appeared to deny that he issued the prescriptions indicated in the note. (Id. at 229a-30a.) 

Dr. Mermelstein’s note from Claimant’s November 22, 2016 appointment states that Claimant was 

suffering “persistent neck pain following her [motor vehicle accident]” and mentions no 

work-related cause of her injuries. (Id. at 408a.) When Employer’s counsel asked Claimant about 

this apparent discrepancy on cross-examination, Claimant responded that she “[didn’t] know why 

[Dr. Mermelstein] would put that in [the note].” (Id. at 230a-31a.)
7

problems with her neck, back, or head until mid-November 2016. (Id. at 134a-35a.) 

She confirmed that Claimant’s desk setup required her to turn her head to the left 

frequently. (Id. at 135a-36a.) Ms. Klein explained that Claimant had complained of 

pain in her neck, upper back and shoulders during the workday, was often physically 

uncomfortable, and would experience shaking of her head on occasion. (Id.) 

Ms. Klein explained that she contacted Employer’s human resources management 

company and insurance carrier about filing a workers’ compensation report or claim 

after Claimant reported her symptoms in mid-November 2016. (Id. at 140a-42a.) 

She acknowledged, however, that she “didn’t know” if Claimant’s injuries were 

work related, never filed a report of a work-related injury for Claimant, and never 

saw evidence that anyone else had filed such a report. (Id. at 140a-42a, 151a.) 

On cross-examination, Ms. Klein stated that Claimant never described a single

accident or other traumatic event that occurred at work and that Claimant’s

symptoms arose gradually as she performed her typical work. (Id. at 150a-51a.) 

Ms. Klein also admitted that she was responsible for filing work injury reports for 

Employer. (Id. at 151a.)

Claimant also presented the deposition testimony of Nirav Shah, M.D., who 

is a board-certified neurological surgeon. (Id. at 244a, 246a.) Dr. Shah testified that 

he first examined Claimant on January 20, 2017, when Claimant complained of what 

she characterized as a work-related repetitive motion injury to her neck. 

(Id. at 248a-49a.) Upon first treating Claimant, Dr. Shah noted her history and 

earlier diagnosis of cervical dystonia and her April 2016 accident. (Id. at 249a.) 

Dr. Shah explained that cervical dystonia is a musculoskeletal disorder that causes 

muscle tightening, which can result in stiffness, pain, and limited range of motion in 

the neck. (Id. at 251a.) He explained that the disease is most often (though not 
8

always) idiopathic (i.e., lacking an external cause) and congenital. (Id. at 252a.) 

He opined that Claimant made a full recovery prior to mid-November 2016, 

including from her cervical dystonia and any injury caused by the April 2016 

accident. (Id. at 249a.) Upon examining Claimant in January 2017, he found 

objective evidence of cervical nerve injury and cervical trauma, including palpable 

spasms, arm weakness, and decreased sensation, which were confirmed by the 

magnetic resonance imaging (MRI) results he reviewed, showing aggravation in 

Claimant’s neck and a protrusion between the C6-7 vertebrae. (Id. at 253a, 256a.) 

He did not, however, observe any shaking in Claimant’s head or neck. (Id. at 265a.) 

These findings, he opined, are more consistent with cervical nerve damage caused 

by trauma than with cervical dystonia, which affects only the muscles. (Id. at 254a.) 

Regarding the specific cause of Claimant’s injuries, Dr. Shah opined that Claimant’s 

repetitive twisting of her neck to view her computer screen at work was a “viable” 

cause, and he believed that aspect of Claimant’s work had aggravated her preexisting 

dystonia, resulting in her present symptoms. (Id. at 254a-56a.)

Dr. Shah further testified that he advised Claimant not to return to her position 

with Employer because doing so would likely worsen her condition, that he 

continued to treat her, and that he referred her to Jed Shapiro, M.D., for pain 

management. (Id. at 257a-58a.) He stated that, when he performed a second 

examination of Claimant on May 19, 2017, Claimant’s symptoms and objective 

findings, as well as his causal opinion and medical advice, were unchanged. 

(Id. at 260a-62a.) Dr. Shah disagreed with the medical opinions offered by 

Employer’s witnesses that Claimant did not suffer a work-related injury. 

(Id. at 263a-68a.) He specifically opined that dystonia can often be “set off” by 
9

repetitive activities and that Claimant exhibits radiculopathy that is distinct from her 

dystonia. (Id. at 267a.)

On cross-examination, Dr. Shah agreed that no single, traumatic event at work 

caused Claimant’s injuries. (Id. at 272a.) Instead, he opined, multiple repetitive 

actions (such as turning to look to the left) aggravated her preexisting dystonia over 

time. (Id. at 272a-73a.) Dr. Shah was aware that Claimant continually took 

Klonopin before and after the alleged work injury to treat and prevent dystonia. 

(Id. at 271a, 274a, 297a-99a.) He explained that it is not surprising that Claimant’s 

condition has not improved since she stopped working, because aggravation injuries 

often do not return to the baseline level of the preexisting injury and because 

Claimant has not yet completed all treatment options. (Id. at 276a-79a.) Dr. Shah 

admitted that cervical dystonia can worsen without any external or traumatic cause, 

but he reaffirmed his opinion that Claimant’s injuries are most likely work related

given Claimant’s explanation of her repetitive motions at work. (Id. at 281a.) He 

admitted that Claimant suffered from post-concussive syndrome after she sustained 

a head injury in the April 2016 accident, which likely caused some of the symptoms 

Claimant reported, such as dizziness and ringing in her ears. (Id. at 290a-91a.) 

He explained that those symptoms would not be caused by dystonia or 

radiculopathy. (Id. at 291a.) He further opined that Claimant’s current neck pain 

and motion problems are related to her work injury, not her traumatic head injury. 

(Id.)

Claimant also presented the deposition testimony of Dr. Shapiro, who is board 

certified in anesthesiology. (Id. at 342a.) He testified that Claimant was 

experiencing significant, continuous pain when he began treating her for pain relief 

on January 31, 2017. (Id. at 346a, 349a.) At that time, Dr. Shapiro diagnosed 
10

Claimant with cervicalgia (generalized neck pain), cervical sprain and strain, and 

cervical radiculopathy. (Id. at 352a-53a.) He also diagnosed Claimant with a 

sprain/strain and internal derangement of both shoulders, caused by pathology or 

trauma, which, he opined, caused the pain and weakness he observed in her 

shoulders upon examination. (Id.) He did not impose specific work restrictions, 

but he recommended that Claimant avoid repetitive bending and heavy lifting. 

(Id. at 354a.) As to the cause of Claimant’s injuries, Dr. Shapiro first observed that 

cervical dystonia often has no known cause, but then he gave his medical opinion 

that Claimant’s injuries were caused by her work activities. (Id. at 356a, 365a.) 

He further opined that Claimant had fully recovered from any preexisting 

neurological injuries before mid-November 2016, and he disagreed with the medical 

testimony to the contrary offered by Employer. (Id. at 366a-70a.)

On cross-examination, Dr. Shapiro acknowledged that he has no record of

Claimant telling him that her injuries were caused by repetitive actions at work. 

(Id. at 372a.) He also admitted that, according to his records, Claimant has not 

undergone physical therapy as he recommended. (Id. at 376a.) He acknowledged

that his records sometimes differ from Claimant’s testimony as to the efficacy of the 

pain-relieving injections he administered. (Id. at 377a-79a.) Finally, he stated that 

Claimant continues to drive, at least occasionally, despite her injuries. (Id. at 380a.)

In opposition to the claim petition, Employer presented the deposition 

testimony of Richard H. Bennett, M.D., who is board certified in neurology and 

electromyography. (Id. at 415a, 417a.) Dr. Bennett performed an independent 

medical examination (IME) of Claimant on May 22, 2017. (Id. at 418a.) He took 

Claimant’s medical history, including her description of the April 2016 accident and 

her report of a work-related aggravation of the symptoms in her neck, which 
11

occurred in mid-November 2016. (Id. at 419a.) Upon physical examination, 

Dr. Bennett found Claimant to have normal strength, sensation, and neurological 

function. (Id. at 422a.) He noted tightness and spasms in Claimant’s neck muscles

and intermittent, involuntary shaking of her head, but he was unable to relate those 

symptoms to any particular trauma-related issue, given that he found her 

neurological function to be objectively normal. (Id. at 422a-23a.) Dr. Bennett

opined that Claimant’s MRI results, which he reviewed during the IME, showed 

age-related arthritis, osteoarthritis, and impingement, which he characterized as 

“normal finding[s].” (Id. at 425a.) Based on the IME, Dr. Bennett opined that

Claimant did not suffer a work-related injury and that her injuries are fully explained 

by her preexisting, incurable cervical dystonia, which expectedly comes and goes 

over time and is entirely unrelated to her work. (Id. at 426a, 428a, 436a.) He added 

that he does not believe work restrictions are appropriate for Claimant to prevent 

injury and that any difficulty she suffers due to movement at work is due to her 

preexisting cervical dystonia, not a work injury. (Id. at 426a-27a, 448a.) Contrary 

to the medical testimony offered by Claimant’s witnesses, Dr. Bennett opined that 

Claimant does not have any symptoms of cervical radiculopathy and that the 

cervicalgia with which she was diagnosed was merely a general description of neck 

pain, not a specific condition or injury. (Id. at 427a-28a.)

On cross-examination, Dr. Bennett admitted that, when opining on Claimant’s 

fitness to return to work, he had no knowledge of her working conditions or job 

duties. (Id. at 432a.) He clarified his earlier testimony, however, by stating that she 

could return to work at a sedentary office job similar to the one she performed for 

Employer. (Id.) He also explained that, in his opinion, Claimant’s cervical dystonia 

was present since birth, was likely caused by a genetic predisposition, and was 
12

certainly not caused by a viral infection, as Claimant testified. (Id. at 434a-35a.) 

Dr. Bennett acknowledged that Claimant told him she last received treatment for 

cervical dystonia in 2000, but he emphasized that he could not verify that 

independently. (Id. at 432a-33a.) He reaffirmed his opinion that Claimant’s cervical 

dystonia is a congenital condition that will wax and wane on its own, regardless of 

whether Claimant receives injections or takes Klonopin and that the worsening of 

her symptoms in November 2016 had “nothing to do with her work activities.” 

(Id. at 433a-34a, 436a.)

Employer also presented the deposition testimony of David L. Glaser, M.D., 

a board-certified orthopedic surgeon, who performed an IME of Claimant on 

April 12, 2017. (Id. at 452a-54a.) During the IME, Dr. Glaser observed intermittent 

head shaking but normal strength, range of motion, and neurological findings in 

Claimant’s neck and shoulders. (Id. at 455a.) He observed no spasms or other 

objective findings of illness in Claimant. (Id.) Dr. Glaser opined that the diagnoses

other physicians made of Claimant’s condition (including cervicalgia and cervical 

dystonia) were nonspecific and not based on an accurate medical history of 

Claimant, and he opined that she did not suffer any injury related to her work in 

mid-November 2016. (Id. at 456a-57a, 459a.) He based this opinion on Claimant’s 

MRI and objective IME findings, which he characterized as “normal” and 

“not consistent with a work-related problem[,]” and on Claimant’s medical history. 

(Id. at 457a.) He noted that, in his view, nothing in Claimant’s own account of her 

medical history or in her medical records suggests a work-related mechanism that 

could cause her current symptoms, and she is able to return to full-duty work without 

restrictions. (Id.) He also opined that the head shaking he observed in Claimant was 

“volitional[,]” or an instance where Claimant was intentionally magnifying her 
13

symptoms. (Id.) He specifically disagreed with Dr. Shapiro’s opinion that the 

shaking was beyond Claimant’s control, opining that no known type of involuntary 

muscle contraction can cause that exact movement. (Id. at 458a.) Finally, upon 

reviewing Dr. Mermelstein’s records, Dr. Glaser observed that the medical history 

Claimant gave him was inconsistent with those records. (Id.) Specifically, he 

observed that the records indicate Claimant sought treatment after the 

April 2016 accident for an extended period of time thereafter, rather than only 

initially, as she had reported to him. (Id.) He also noted that Dr. Mermelstein’s 

records described Claimant’s symptoms in mid-November as resulting from the 

accident, and they do not mention any relation between Claimant’s work and her 

injuries. (Id.) Based on these observations, Dr. Glaser concluded that the medical 

history Claimant gave him was not accurate. (Id.)

On cross-examination, Dr. Glaser testified that Claimant never articulated to 

him a belief that her injuries arose from repetitive activities at work, although he 

admitted that Claimant did briefly mention turning her head while at work. 

(Id. at 462a.) He emphasized that the medical expert testimony presented by 

Claimant is based on the medical history she provided, which, in his opinion, is 

inaccurate and conflicts with Dr. Mermelstein’s records. (Id.) To clarify his earlier 

testimony suggesting Claimant magnified her symptoms, Dr. Glaser testified that, 

to the extent Claimant does have genuine residual symptoms from the 2016 accident 

or some other cause, Claimant’s work activities did not aggravate those preexisting 

injuries. (Id. at 464a.)

By decision and order dated February 1, 2019, the WCJ denied Claimant’s 

claim petition. In so doing, the WCJ made the following relevant credibility 

determinations and factual findings:
14

7. The undersigned . . . finds [Claimant’s] testimony entirely not 

credible. The undersigned had three opportunities to observe 

Claimant as she testified and her demeanor and responses belie her 

allegations of a work[-]related injury. Claimant’s answers were 

consistently rambling, often off topic, and regularly lacking in 

complete sentences. This signals . . . an effort to search for what 

one would think were appropriate answers, rather than a situation 

where an individual relays a factual scenario that happened to that 

person. In addition, her histories to medical professionals have 

varied significantly, her recovery from the motor vehicle accident 

is questionable, particularly in light of Dr. Mermelstein’s records, 

and her asserted recovery from cervical dystonia as of 2000[] is 

belied by her daily use of Klonopin to control that condition.

The fact that Claimant continued to drive, and with medical 

approval, for so long when she asserted that her head would get 

stuck and she would not be able to see, belies the severity of her 

complaints. Claimant contradicted herself at times during her 

testimony. Finally, the alleged mechanism of injury does not

support her plethora of complaints.

8. The undersigned . . . finds [Ms. Klein’s] testimony not relevant as 

Claimant never reported a work[-]related injury to Ms. Klein.

9. The undersigned . . . finds the testimony of Dr. Bennett and 

Dr. Glaser more competent and credible than the testimony of 

Dr. Shah and Dr. Shapiro. Claimant’s medical professionals relied 

on Claimant’s history, which is not credible. Dr. Shapiro and 

Claimant offered different accounts of how his injections worked.

Dr. Shapiro related all Claimant’s complaints to the alleged 

work[-]related injury, while Dr. Shah relates some to ongoing 

concussion symptoms from the motor vehicle accident, from which 

Claimant asserts she fully recovered. Initially, Dr. Shapiro found a 

distinct shoulder injury, but indicated that upon reflection and 

further discussion with Claimant this was not the case. . . .

10. Claimant did not sustain a November 21, 2016 work[-]related 

injury.

(WCJ’s Decision at 10.) Based on these credibility determinations and findings, 

the WCJ concluded that “Claimant . . . failed to meet her burden to prove that she 

sustained a November 21, 2016 work[-]related injury.” (Id. at 11.) Claimant 
15

appealed the WCJ’s decision to the Board, and the Board affirmed. Claimant now 

petitions this Court for review.

II. ARGUMENTS

On appeal,5 Claimant argues that the Board erred in affirming the WCJ’s

decision denying Claimant’s claim petition because: (1) there is not substantial 

evidence of record to support the WCJ’s finding that Claimant did not sustain a 

work-related injury on November 21, 2016; (2) the WCJ capriciously disregarded 

Ms. Klein’s testimony; and (3) the WCJ erred in failing to give a sufficient 

explanation for her decision not to credit Claimant’s testimony.6

III. DISCUSSION

A. Substantial Evidence

Generally, in much of her brief, Claimant presents far-ranging arguments that 

the testimony she presented adequately supports the claim petition. Concerning 

substantial evidence for the WCJ’s decision, Claimant asserts that Dr. Bennett’s 

testimony, which the WCJ credited, undermines the WCJ’s decision and is not 

substantial evidence. Specifically, she first claims that her continuous use of 

Klonopin from 2000 to 2016 is evidence of her recovery during that time (not of her 

continued illness), because Dr. Bennett admitted that new episodes of cervical 

dystonia might occur regardless of her use of Klonopin. Second, Claimant 

emphasizes Dr. Bennett’s admission that there is no record of Claimant receiving 

5 This Court’s review is limited to a determination of whether an error of law was 

committed, whether findings of fact are supported by substantial evidence, or whether 

constitutional rights were violated. Section 704 of the Administrative Agency Law, 2 Pa. C.S. 

§ 704.

6 We have reordered Claimant’s arguments on appeal for purposes of discussion and 

disposition.
16

other treatment between 2000 and November 2016, which further undermines the 

WCJ’s conclusion that she did not recover before 2016. Third, Claimant argues that 

Dr. Bennett did not explain why Claimant’s symptoms worsened in November 2016

or why he suggested work restrictions, if her injuries were not related to her job 

duties. In addition to her arguments concerning Dr. Bennett’s testimony, Claimant 

challenges the WCJ’s finding that she did not recover from the April 2016 accident, 

because, she alleges, she was only out of work for one week after the accident and 

there is no evidence of her seeking other treatment between April and November 

2016. Finally, Claimant argues that the WCJ’s finding that she continues to drive is 

not supported by substantial evidence.

In response, Employer argues that the record contains substantial evidence 

that Claimant received treatment for cervical dystonia before November 2016. 

Employer emphasizes that all four testifying physicians concluded that Claimant’s 

preexisting cervical dystonia is a congenital condition, not caused by trauma, which

is expected to wax and wane over time. Employer points out that Claimant does not 

acknowledge or specifically challenge the WCJ’s decision to credit the medical 

testimony offered by Employer (i.e., that the worsening of Claimant’s symptoms 

was not work related), and not to credit the testimony of Dr. Shah and Dr. Shapiro—

a decision that was within the WCJ’s discretion. Employer also points out that 

Claimant does not challenge the testimony and opinion of Dr. Glaser, who, unlike 

Dr. Shah and Dr. Shapiro, reviewed Dr. Mermelstein’s records showing that 

Claimant received treatment for the April 2016 accident over an extended period. 

Thus, Employer asserts, whether the testimony offered by Claimant supports a 

contrary result is not relevant because the WCJ’s decision is supported by substantial 

evidence credited by the WCJ.
17

In workers’ compensation proceedings, it is well settled that the WCJ is the 

ultimate finder of fact. Williams v. Workers’ Comp. Appeal Bd. (USX Corp.-Fairless 

Works), 862 A.2d 137, 143 (Pa. Cmwlth. 2004). As factfinder, matters of credibility, 

conflicting medical evidence, and evidentiary weight are within the WCJ’s exclusive 

province. Id. If the WCJ’s findings are supported by substantial evidence, they are 

binding on appeal. Agresta v. Workers’ Comp. Appeal Bd. (Borough of 

Mechanicsburg), 850 A.2d 890, 893 (Pa. Cmwlth. 2004). Substantial evidence is 

relevant evidence that a reasonable mind might accept as adequate to support a 

finding. Mrs. Smith’s Frozen Foods Co. v. Workmen’s Comp. Appeal Bd. (Clouser), 

539 A.2d 11, 14 (Pa. Cmwlth. 1988). 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 in the record to support 

a contrary finding; if substantial evidence supports the WCJ’s necessary findings, 

we may not disturb those findings on appeal. Williams, 862 A.2d at 143-44.

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 (Act),

7

an employee’s injuries are compensable if they “(1) arise[] in the course of 

employment and (2) [are] causally related thereto.” ICT Grp. v. Workers’ Comp. 

Appeal Bd. (Churchray-Woytunick), 995 A.2d 927, 930 (Pa. Cmwlth. 2010). 

7 Act of June 2, 1915, P.L. 736, as amended, 77 P.S. § 411(1).
18

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

causally related to the work incident.” City of Pittsburgh v. Workers’ Comp. Appeal 

Bd. (Wilson), 11 A.3d 1071, 1075 (Pa. Cmwlth. 2011).

Here, much of Claimant’s argument on appeal simply asserts that the 

testimony she offered supports the claim petition. The WCJ, however, declined to 

credit that testimony and denied the claim petition. We may not revisit the WCJ’s 

credibility determinations on appeal, and it is irrelevant whether evidence in the 

record might support a finding or conclusion contrary to those that the WCJ 

actually made. Williams, 862 A.2d at 143-44. Instead, we focus on the portions of 

Claimant’s argument concerning support for the WCJ’s findings and conclusions.

Claimant initially contends that Dr. Bennett’s testimony is not substantial 

evidence because it contains statements or admissions directly contradicting the 

WCJ’s findings. We disagree. Dr. Bennett’s opinion concerning Klonopin, 

when viewed in context, merely stated that Claimant’s use of Klonopin would not 

increase her risk of cervical dystonia—he did not state that Claimant’s use of 

Klonopin was unrelated to her preexisting dystonia. (R.R. at 433a-34a.) To the 

contrary, he admitted that it was “certainly possible” that Claimant was taking 

Klonopin to treat her preexisting cervical dystonia, and he never stated or suggested 

that Claimant’s use of Klonopin shows that she recovered from any injury, as 

Claimant appears to assert. (Id. at 433a.) Dr. Bennett also discussed Claimant’s 

treatment history before 2016, but, contrary to Claimant’s view, he never directly 

opined whether Claimant actually received treatment for dystonia between 2000 and 

2016. Instead, he stated that, based only on “what [Claimant] said” to him about her 

history, she had most recently been treated for dystonia in 2000. (Id. at 432a-33a.) 

He immediately acknowledged, however, that he “d[idn’t] know” and “c[ouldn’t] 
19

verify that” independently. (Id. at 433a.) Contrary to Claimant’s assertion, 

Dr. Bennett clearly identified a cause of Claimant’s worsening symptoms that is 

unrelated to her work—i.e., preexisting cervical dystonia, which is expected to wax 

and wane over time without any external cause. (Id. at 436a.) Finally, Dr. Bennett 

was clear that he recommended a sedentary position for Claimant only “to allow 

[Claimant] to function at the maximal level” given her preexisting injuries and that 

“[o]ngoing complaints or work restrictions . . . do not appear to be directly related 

to a work injury.” (Id. at 448a.) Based on the foregoing observations, Dr. Bennett’s 

testimony, which the WCJ credited, provides substantial evidence for the WCJ’s 

findings that Claimant did not recover from cervical dystonia before November 2016 

and that her injuries are not work related.

Next, Claimant alleges that no evidence in the record supports the WCJ’s 

finding that Claimant did not recover from the April 2016 accident before 

mid-November 2016. Claimant insists that there is no evidence of her seeking 

treatment for injuries from the accident between April and November 2016. 

Again, we disagree. Dr. Mermelstein’s records, which Claimant submitted as 

evidence, note that Claimant sought treatment for injuries from an “accident” on 

May 2, 2016, and characterize Claimant’s symptoms on November 22, 2016, as 

“persistent neck pain following her [motor vehicle accident].” (Id. at 405a-06a, 

408a.) When offered the opportunity to testify about these records, Claimant offered 

no explanation, stating only that she disagreed with, or did not understand, the 

content of Dr. Mermelstein’s records. (Id. at 229a-31a.) Thus, we conclude that

Dr. Mermelstein’s records support the WCJ’s conclusion that Claimant continued to 

seek treatment for, and was not recovered from, the injuries she sustained in the 

April 2016 accident as of November 21, 2016.
20

Finally, Claimant essentially argues that the WCJ’s finding that she continues 

to drive is not supported by substantial evidence. On direct examination, 

Claimant offered equivocal testimony about her driving habits, first stating that 

she “do[es] drive,” but then, recognizing that she should not drive, she 

stated: “[w]hen I tell you I’m driving, that means I’m with another person . . . .” 

(Id. at 170a.) Ultimately, Claimant admitted that “sometimes [she] will drive[.]” 

(Id.) Both Dr. Shapiro and Dr. Bennett testified that Claimant continues to drive, 

at least occasionally, despite her injuries. (Id. at 380a, 421a, 446a.) Thus, the WCJ’s 

finding that Claimant continues to drive is supported by substantial evidence of 

record.

For the foregoing reasons, we cannot conclude that the WCJ’s decision was 

not supported by substantial evidence. This is true notwithstanding Claimant’s 

requests that we reweigh the evidence, find credited testimony unpersuasive, or 

credit the testimony she offered—decisions that are within the exclusive province of 

the WCJ as factfinder, not of this Court. See Williams, 862 A.2d at 143-44.

B. Capricious Disregard

Claimant next argues that the WCJ capriciously disregarded the testimony of 

Ms. Klein. Claimant asserts that Ms. Klein’s testimony is relevant because it 

corroborates Claimant’s testimony about the onset date of her injuries, and it shows 

that Ms. Klein understood Claimant’s injuries to be work related. Specifically, 

Claimant relies on Ms. Klein’s communications with Employer’s insurance and 

human resources personnel about Claimant’s injuries to establish that Claimant 

reported her injuries to Employer and, further, that the injuries were work related.

Although a WCJ is free to make credibility determinations, the WCJ cannot 

capriciously disregard competent, relevant evidence, and “[c]apricious disregard is 
21

found when the fact[]finder ignores relevant, competent evidence.” Armitage v. 

Workers’ Comp. Appeal Bd. (Gurtler Chems.), 842 A.2d 516, 519 n.4 (Pa.

Cmwlth. 2004). When determining whether testimony is relevant, we note that 

where the causal connection between a claimant’s injury and her work is not obvious

(such as in the instant matter), the claimant must demonstrate that connection by 

unequivocal medical testimony. City of Pittsburgh, 11 A.3d at 1075. Accordingly,

lay testimony about the medical cause of a claimant’s injury is not relevant to the 

WCJ’s findings regarding causation. Cromie v. Workmen’s Comp. Appeal Bd. 

(Anchor Hocking Corp.), 600 A.2d 677, 679 (Pa. Cmwlth. 1991); Acme Standex v. 

Workers’ Comp. Appeal Bd. (Gomez & Roma Aluminum Co.) (Pa. Cmwlth., 

No. 1397 C.D. 2017, filed Nov. 20, 2018), slip op. at 21.8

The WCJ initially noted (and did not ignore) the portions of Ms. Klein’s 

testimony concerning the symptoms Claimant reported to her. (See WCJ’s Decision 

at 5.) When determining whether Claimant’s injuries were work related, the WCJ 

properly disregarded Ms. Klein’s testimony because it was not medical testimony, 

and was, therefore, irrelevant to determining the cause of Claimant’s injuries.9 

See Cromie, 600 A.2d at 679; Acme, slip op. at 21. Accordingly, we conclude that 

the WCJ did not capriciously disregard Ms. Klein’s testimony, because the WCJ did 

not ignore the relevant portions of her testimony and properly disregarded the 

irrelevant portions thereof. See Armitage, 842 A.2d at 519 n.4.

8 Pursuant to Section 414(a) of this Court’s Internal Operating Procedures, 210 Pa. Code 

§ 69.414(a), an unreported panel decision issued by this Court after January 15, 2008, may be cited 

“for its persuasive value, but not as binding precedent.” 

9 Additionally, we note that Claimant appears to have mischaracterized Ms. Klein’s 

testimony concerning the cause of Claimant’s injuries. When Ms. Klein was finally permitted to 

answer after numerous objections to her testimony on grounds of relevance and competence, she 

simply stated: “I didn’t know if this [injury] was work[ ]related or not.” (R.R. at 142a.)
22

C. Explanation of Credibility Determination

Claimant argues that the WCJ erred by failing to explain in sufficient detail 

why the WCJ did not credit Claimant’s testimony. Claimant notes the WCJ’s 

statements that Claimant gave rambling, incomplete, or off-topic answers to 

questions or gave inconsistent medical history to providers. She asserts, however,

that the WCJ erred in failing to cite specific examples of these alleged shortcomings

in her testimony. In response, Employer argues that, because the WCJ was able to 

observe Claimant’s demeanor during her testimony on three occasions, the WCJ was 

free to accept or reject that testimony without the need to provide a detailed 

explanation for that decision. Employer also points out that the WCJ, although not 

legally required to do so, identified specific inconsistencies between Claimant’s 

testimony and the other evidence she offered, including Dr. Mermelstein’s records

and the testimony of her physicians about the medical history she provided to them.

Section 422(a) of the Act, 77 P.S. § 834, provides, in pertinent part, that all 

parties in a workers’ compensation case are “entitled to a reasoned decision[,]” and 

that “[w]hen faced with conflicting evidence, the [WCJ] must adequately explain the 

reasons for rejecting or discrediting competent evidence.” In interpreting this 

requirement, the Pennsylvania Supreme Court has held that “when the issue involves 

the credibility of contradictory witnesses who have actually testified before the WCJ, 

it is appropriate for the [WCJ] to base his or her determination upon the demeanor 

of the witnesses.” Daniels v. Workers’ Comp. Appeal Bd. (Tristate Transp.), 

828 A.2d 1043, 1052-53 (Pa. 2003). Because “[s]uch a credibility determination 

may involve nothing more than the fact[]finder’s on-the-spot, and oftentimes 

instinctive, determination that one witness is more [or less] credible[,]” a WCJ’s 
23

direct observation of a witness’s testimony, combined with the WCJ’s credibility 

conclusion, is often sufficient to render that credibility determination adequately 

reasoned. Id. at 1053. Our Supreme Court has stated that Section 422(a) does not 

require that WCJs “explain inherently subjective credibility decisions according to 

some formulaic rubric or detailed to the ‘nth degree.’” Id.

Here, as noted in her decision, the WCJ directly observed Claimant’s 

testimony at three separate hearings. The WCJ then summarized that testimony and 

concluded that it was not credible on the basis of Claimant’s demeanor, which 

suggested to the WCJ that Claimant was “search[ing] for . . . appropriate answers, 

rather than . . . relay[ing] a factual scenario that happened to” her. (WCJ’s Decision 

at 10.) Although this explanation might have been sufficient for a reasoned decision 

under Daniels because the WCJ directly observed Claimant’s testimony, the WCJ 

went further. She explained that she declined to credit Claimant’s testimony based 

on other, more credible evidence in the record, including inconsistent medical 

histories Claimant provided in the past, Dr. Mermelstein’s records (which contradict 

Claimant’s testimony regarding her recovery from the April 2016 accident), 

Claimant’s continued use of Klonopin, and testimony that Claimant continues to 

drive despite her condition. (Id.) The WCJ also noted that “Claimant contradicted 

herself at times during her testimony.” (Id.) We disagree with Claimant’s assertion 

that the WCJ was obligated to list detailed, specific examples to support the several 

objective rationales she articulated for declining to credit Claimant’s testimony. 

We find no such requirement in our decisions applying Section 422(a) of the Act, 

and, to the contrary, we note our Supreme Court’s statement that Section 422(a) 

allows a WCJ to determine witness credibility based on direct observation without 

wading into minute detail. Daniels, 828 A.2d at 1053. Based on the numerous 
24

objective rationales the WCJ articulated, which are supported by evidence in the 

record and may well go beyond the minimal explanation required for directly 

observed testimony under Daniels, her decision not to credit Claimant’s testimony

was adequately explained and “reasoned” as required by Section 422(a) of the Act.

IV. CONCLUSION

For the reasons set forth above, we conclude that there is substantial evidence 

of record to support the WCJ’s findings and her conclusion that Claimant failed to 

meet her burden of proving that she sustained a work-related injury on 

November 21, 2016. We further conclude that the WCJ did not capriciously 

disregard competent, relevant testimony or fail to explain her credibility 

determinations adequately. Accordingly, we affirm the Board’s order.

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

Catherine Fox, :

Petitioner :

:

v. : No. 409 C.D. 2020

:

Workers’ Compensation Appeal :

Board (Chestnut Hill Healthcare :

Center), :

Respondent :

O R D E R

AND NOW, this 27th day of January, 2021, the order of the Workers’

Compensation Appeal Board is AFFIRMED.

P. KEVIN BROBSON, Judge