IN THE COMMONWEALTH COURT OF PENNSYLVANIA

US Airways, Inc., through its insurer :

New Hampshire Insurance Company :

and Sedgwick Claims Management :

Services, :

Petitioners :

:

v. : No. 1476 C.D. 2017

: Submitted: March 16, 2018

Workers’ Compensation Appeal :

Board (Uram), :

Respondent :

BEFORE: HONORABLE MARY HANNAH LEAVITT, President Judge

HONORABLE MICHAEL H. WOJCIK, Judge

HONORABLE DAN PELLEGRINI, Senior Judge

OPINION NOT REPORTED

MEMORANDUM OPINION BY

SENIOR JUDGE PELLEGRINI FILED: April 9, 2018

American Airlines, Inc., previously U.S. Airways, Inc., (Employer) 

petitions for review of the Workers’ Compensation Appeal Board’s (Board)

decision affirming a workers’ compensation judge’s (WCJ) order granting Michael 

Uram’s (Claimant) Review Petition to amend his work injury to include an 

aggravation of avascular necrosis and degenerative joint disease1 as well as

 

1 Avascular necrosis is the pathologic death of a portion of tissue due to deficient blood 

supply, resulting in irreversible damage. Stedman’s Medical Dictionary, 25th Edition, Williams 

& Wilkins (1990), pp. 1026 - 1027.
2

affirming the denial of Employer’s Termination and Suspension Petition. For the 

following reasons, we affirm.

I.

Claimant began employment with Employer in 1979 as a ramp 

agent/baggage handler. In December 2014, Claimant suffered a work injury and 

was unable to work from January 19, 2015, to June 22, 2015. A Notice of

Temporary Compensation Payable was issued describing the injury as a “right 

groin sprain/strain.” (Reproduced Record (R.R.) at 1a.) Following Claimant’s

return to work, the Department of Labor & Industry (Department) issued a

Notification of Suspension. Claimant then filed an Employee Challenge to the 

Notification of Suspension.

On September 18, 2015, Employer filed a Termination and 

Suspension Petition alleging that Claimant was fully recovered and capable of 

returning to work without restriction. On November 2, 2015, the parties entered

into a Supplemental Agreement providing that Claimant was restricted by his 

treating physician to working 40 hours per week without overtime. Claimant was 

to receive weekly partial disability benefits in the amount of $512.63 to 

compensate him for the loss of overtime wages. The Supplemental Agreement 

only resolved the Employee Challenge and did not address Employer’s 

Termination and Suspension Petition.

On December 11, 2015, Claimant filed a Petition to Review seeking

to amend the description of his work injury to include an aggravation of underlying 
3

avascular necrosis and early degenerative joint disease of the right hip. Employer 

filed an answer denying all material averments.

Before the WCJ, Claimant testified that he was working in the area 

where the bags came down from the ticket counter onto a carousel. When he lifted 

a bag off the carousel to put it on the top shelf of a baggage cart, he twisted and felt 

a pull in his hip. He went on to testify that he still experiences jabbing and 

shooting pains down his leg, back and buttocks and that it increases with activity.

To support the notion that the injury was work-related, Claimant’s 

treating physician, Michael R. Pagnotto, M.D. (Dr. Pagnotto), a board certified 

orthopedic surgeon who specializes in the treatment of hip and knee arthritis, 

testified that Claimant’s right hip injury was caused by avascular necrosis, opining:

Yes, I felt that this was a right hip avascular necrosis 

with a small area of femoral head collapse.

At that time, I felt that this avascular necrosis was 

aggravated by his work-related injury, which caused the 

small fracture of the femoral head, which is – you know 

we use the word fracture here, but really when you have 

avascular necrosis, you have bone that has lost its blood 

supply and so what you are really looking at is collapse. 

When the bone loses its blood supply, the bone can start 

to crumble. So most people, when they hear fracture, 

they think you know that you broke a bone in a car 

accident or you know fell and twisted, but this is more of 

what I was referring to in my note, that he had this small 

area of, small quote fracture in the femoral head.

I said given that his mechanism, that it didn’t make sense 

that he would truly have an acute fracture as much as 

avascular necrosis with a little bit of collapse.
4

(R.R. at 109a-110a.) He went on to testify that it was not a groin sprain or strain 

because the MRI did not show any evidence of an injury to Claimant’s muscles,

but it did show evidence of an injury to his femoral head, which was an 

aggravation of his underlying avascular necrosis.

Regarding Dr. Pagnotto’s recommendation that Claimant be restricted 

to working no more than 40 hours per week, the doctor testified that two MRIs

showed significant hip pathology and that working more than 40 hours per week 

would aggravate Claimant’s hip and cause him pain.

In opposition, Employer offered the testimony of William D. 

Abraham, M.D. (Dr. Abraham), also a board certified orthopedic surgeon. Based 

on his examination, Dr. Abraham disagreed with Dr. Pagnotto’s diagnosis that 

Claimant’s condition was the result of his avascular necrosis having been

aggravated at work. He did not deny that Claimant had both degenerative joint 

disease and avascular necrosis, but opined that both conditions were pre-existing 

and that there was no evidence that the work injury aggravated or substantially 

changed the prognosis of those pre-existing conditions. Dr. Abraham opined that 

the injury could best be described as a groin sprain or strain. He then explained 

how he arrived at the conclusion that the work injury did not affect the avascular 

necrosis or the underlying degenerative joint disease.

[I]t’s my opinion, so we can all accept that it’s an 

opinion, and to look at that and sort of make a 

conclusion, but I think it would make sense, and here’s 

my rationale, one was that I don’t think there’s any 

denying that these particular conditions were pre-existing 

this date. There’s certainly nothing about lifting bags on 
5

that particular day that caused arthritis, we can all accept 

that that’s a process that’s been ongoing for a long period 

of time. And similarly, the avascular necrosis is not a 

process that would be created as a result of lifting a fiftyor sixty-pound bag. So I think that to me those are 

givens. So then the real question is what happened on 

that particular day and was there anything to suggest that 

he had anything more than a groin strain? And I arrived 

at that diagnosis based really on sort of a generic 

sense that this gentleman had lifted, he had what I 

would describe as a soft-tissue injury, that’s the strain 

in the groin, that’s where he had his pain, and that 

injury, as I said, went on to satisfactory recovery.

(R.R. at 181a-182a) (emphasis added).

The WCJ denied Employer’s Termination and Suspension Petition

and granted Claimant’s Petition to Review. In so doing, the WCJ accepted the 

testimony of Dr. Pagnotto to be more credible than Dr. Abraham’s testimony. The 

WCJ rejected Dr. Abraham’s testimony where it conflicted with Dr. Pagnotto. In 

finding Dr. Abraham to be less credible, the WCJ noted that Dr. Abraham only 

examined Claimant once and diagnosed him with a groin strain even though the 

diagnostic studies did not support this opinion. The WCJ also noted that Dr. 

Abraham repeatedly discussed how the condition of avascular necrosis was not 

caused by the work injury even though that was not at issue, the true issue being 

whether Claimant’s pre-existing injury was aggravated by the work injury.
6

Employer appealed the WCJ’s decision and the Board affirmed. This 

petition for review followed.2

II.

A.

Employer argues that the WCJ erred by capriciously disregarding the 

substantial competent evidence presented by Employer’s expert, Dr. Abraham, and 

instead relied upon the equivocal and legally incompetent opinions of Claimant’s 

expert, Dr. Pagnotto, in finding that Claimant had met his burden of proof.

What Employer’s argument ignores is that it is not within our scope of 

review to judge the probative value of testimony even if, on the same record, we 

might reach a different result. American Chain & Cable Co. v. Workmen’s 

Compensation Appeal Board, 391 A.2d 50 (Pa. Cmwlth. 1978). As we have held 

repeatedly, it is up to the WCJ to determine the credibility and weight of the 

evidence presented. Container Corporation of America v. Workmen’s 

Compensation Appeal Board, 429 A.2d 1264, 1267 (Pa. Cmwlth. 1981). In so 

doing, the WCJ may accept or reject the testimony of any witness in whole or in 

part, including the testimony of medical witnesses. Id.

 

2 Our scope of review is limited to determining whether constitutional rights were 

violated, whether an error of law was committed, or whether a necessary finding of fact was 

unsupported by substantial evidence. American Refrigerator Equipment Company v. Workmen’s

Compensation Appeal Board, 377 A.2d 1007 (Pa. Cmwlth. 1977).
7

Because we may not reweigh evidence and because it was fully within 

the WCJ’s power to make the credibility determinations she made as well as to 

assign the proper weight of the evidence presented based upon those 

determinations, we may not disturb a WCJ’s decision if substantial evidence 

supports those findings.

B.

Employer contends that there is not substantial evidence to support the

WCJ’s denial of its Termination and Suspension Petition because Dr. Pagnotto’s

testimony that Claimant has not fully recovered from his work-related injury is 

equivocal.3 Employer notes that it is undisputed that the MRIs and X-rays 

indicated that by April 2015, any sign of fracture or bone collapse attributed to the 

work injury had resolved itself and, therefore, the WCJ should have granted the

Termination and Suspension Petition.

Employer contends that the only reason its Termination and 

Suspension Petition was not granted was because the WCJ relied on Dr. Pagnotto’s

 

3 An employer seeking to terminate workers’ compensation benefits bears the burden of 

proving either that the employee’s disability has ceased or that any current disability arises from 

a cause unrelated to the employee’s work injury. Udvari v. Workmen’s Compensation Appeal 

Board (USAir, Inc.), 705 A.2d 1290, 1293 (Pa. 1997). The employer meets this burden when its

medical expert unequivocally testified that it is his opinion, within 

a reasonable degree of medical certainty, that the claimant is fully 

recovered, can return to work without restrictions and that there are 

no objective medical findings which either substantiate the claims 

of pain or connect them to the work injury.

Id.
8

equivocal testimony. For example, when asked if there was any evidence of 

fracture or collapse in Claimant’s hip, Dr. Pagnotto answered: “So, there was no 

evidence of ongoing fracture, yes. I would argue that he probably still had some 

degree of collapse because it’s pretty rare that someone who has a small area of 

collapse spontaneously heals that.” (R.R. at 139a.) Employer contends that 

testimony such as this, that Claimant “probably still had some degree of collapse,”

renders Dr. Pagnotto’s entire testimony equivocal because it is not sufficiently 

definitive and, therefore, it is incompetent.

Medical testimony is incompetent if it is equivocal. Kurtz v. Workers’

Compensation Appeal Board (Waynesburg College), 794 A.2d 443 (Pa. Cmwlth.

2002). A court will find medical testimony to be unequivocal and competent if the 

medical expert, after providing a foundation, testifies that in his professional 

opinion, he believes a certain fact or condition exists. Johnson v. Workers’

Compensation Appeal Board (Abington Memorial Hospital), 816 A.2d 1262, 1267

(Pa. Cmwlth. 2003). A court will consider medical testimony equivocal if it is 

found to be based upon mere possibilities. Signorini v. Workmen’s Compensation 

Appeal Board (United Parcel Service), 664 A.2d 672 (Pa. Cmwlth. 1995). In 

determining whether medical testimony is unequivocal, the medical witness’s 

entire testimony must be reviewed and taken as a whole. Indian Creek Supply v. 

Workers’ Compensation Appeal Board (Anderson), 729 A.2d 157, 160 (Pa.

Cmwlth. 1999). Whether medical testimony is unequivocal is a question of law 

fully reviewable on appeal. Johnson, 816 A.2d at 1267.
9

The use of terms such as “might have been,” “could have been,” or 

“probably” is an indicator that the offered opinion is equivocal. Lewis v.

Workmen’s Compensation Appeal Board (Pittsburgh Board of Education), 472 

A.2d 1176, 1178 (Pa. Cmwlth. 1984). However, there is no requirement that every 

utterance which escapes the lips of a medical witness on a medical subject must be 

certain, positive and without reservation, exception or peradventure of doubt. 

Heath v. Workmen’s Compensation Appeal Board (Agway, Inc.), 514 A.2d 1021, 

1023 (Pa. Cmwlth. 1986). The claimant has produced competent evidence to 

support an award even if the medical witness admits to uncertainty, reservation or 

lack of information with respect to specific details, so long as the expert does not 

recant the opinion or belief first expressed. Philadelphia College of Osteopathic 

Medicine v. Workmen’s Compensation Appeal Board (Lucas), 465 A.2d 132 (Pa.

Cmwlth. 1983).

Although Dr. Pagnotto’s statement that he “would argue [Claimant]

probably still had some degree of collapse” is equivocal, it is an isolated statement.

Throughout his testimony, Dr. Pagnotto consistently opined that Claimant’s work 

injury caused an aggravation of pre-existing avascular necrosis with secondary 

degenerative joint disease, which would render a 40 hour per week limitation a 

reasonable accommodation. Furthermore, Dr. Pagnotto never recanted his medical 

opinion. Therefore, Dr. Pagnotto’s testimony was unequivocal and competent.
10

C.

Employer also argues that the WCJ did not issue a reasoned decision

because she failed to address competent conflicting evidence and reconcile the 

material contradictions in the record.

When faced with conflicting evidence, the WCJ must adequately 

explain the reasons for rejecting or discrediting competent evidence. Daniels v. 

Workers’ Compensation Appeal Board (Tristate Transport), 828 A.2d 1043, 1047 

(Pa. 2003). A reasoned decision includes an explanation of why certain testimony 

is rejected and other testimony is accepted. See PEC Contracting Engineers v. 

Workers’ Compensation Appeal Board (Hutchison), 717 A.2d 1086, 1088 (Pa. 

Cmwlth. 1998) (holding that the decision was reasoned where the WCJ credited 

claimant’s medical expert because of his experience and familiarity with treating 

claimant, and rejected the testimony of employer’s medical expert because the 

expert only saw the claimant twice).

In this case, the WCJ clearly explained her reasons for finding 

Claimant’s expert more credible than Employer’s, including the fact that 

Claimant’s expert was his treating physician who had seen Claimant on many 

different occasions and Employer’s expert only saw him once. In doing so, the 

WCJ reasoned:

Dr. Pagnotto has had the benefit of evaluating and 

treating the Claimant on multiple occasions since 

February 19, 2015. I note that both doctors agreed that 

the Claimant’s avascular necrosis pre-existed the work 

injury and was not directly caused by the work injury. 

However, the Claimant was asymptomatic and unaware 
11

that he even had avascular necrosis prior to the work 

injury. Dr. Pagnotto credibly opined that the Claimant 

suffered an aggravation to his pre-existing avascular

necrosis as a result of the work injury that occurred on 

December 29, 2014, and that the aggravation of that 

condition continues. He credibly explained how the MRI 

findings support his opinion. In fact, he noticed a 

discrepancy between the reading of the MRI and that of 

the radiologist, who originally noted a fracture. Dr. 

Pagnotto credibly explained that Claimant did not 

actually have a fracture, in the traditional meaning, but 

rather a femoral head collapse which supports his opinion 

that there was aggravation of the avascular necrosis. Dr. 

Pagnotto credibly explained that although the mechanism 

of injury was a relatively low energy event, it was 

enough to cause the femoral head collapse that was 

evident on the MRIs, because the Claimant’s hip was 

already bad due to the underlying avascular necrosis and 

arthritis.

(R.R. at 236a.)

The WCJ also reasoned that both Dr. Pagnotto and Dr. Abraham 

agreed that Claimant suffered from avascular necrosis, but Dr. Abraham’s core 

argument – that the avascular necrosis was not caused by a work injury – was 

irrelevant in this matter as the question was whether the avascular necrosis was 

aggravated by the work injury.

Given that the WCJ adequately explained why she accepted 

Claimant’s expert as more credible than Employer’s expert, her opinion, without 

further elucidation, allows us to conduct adequate appellate review and, therefore, 

the decision is reasoned.
12

For the foregoing reasons, we affirm the Board’s decision.

________________________________

DAN PELLEGRINI, Senior Judge
IN THE COMMONWEALTH COURT OF PENNSYLVANIA

US Airways, Inc., through its insurer :

New Hampshire Insurance Company :

and Sedgwick Claims Management :

Services, :

Petitioners :

:

v. : No. 1476 C.D. 2017

:

Workers’ Compensation Appeal :

Board (Uram), :

Respondent :

O R D E R

AND NOW, this 9

th day of April, 2018, the Workers’ Compensation 

Appeal Board’s order dated September 22, 2017, is affirmed.

________________________________

DAN PELLEGRINI, Senior Judge