IN THE COMMONWEALTH COURT OF PENNSYLVANIA

TA Operating LLC, :

Petitioner :

:

 v. : No. 320 C.D. 2022

: SUBMITTED: December 4, 2023

Leonard Maurer (Workers’ :

Compensation Appeal Board), :

Respondent :

BEFORE: HONORABLE PATRICIA A. McCULLOUGH, Judge

HONORABLE LORI A. DUMAS, Judge

HONORABLE BONNIE BRIGANCE LEADBETTER, Senior Judge

OPINION NOT REPORTED

MEMORANDUM OPINION BY

SENIOR JUDGE LEADBETTER FILED: January 17, 2024

TA Operating LLC (Employer) petitions for review of an order of the 

Workers’ Compensation Appeal Board, which affirmed the decision of the Workers’ 

Compensation Judge (WCJ) granting Claimant Debra Maurer’s1fatal claim petition 

based on the death of her husband, Leonard Maurer (Decedent). Upon review, we 

affirm. 

Decedent collapsed while at work on Saturday, July 14, 2018, and 

passed away shortly thereafter. Claimant filed the fatal claim petition seeking 

widow benefits on January 24, 2020, alleging Decedent’s death resulted from a 

cardiac arrest while in the course and scope of his employment with Employer. 

Reproduced Record (R.R.) at 5a. Employer filed an answer denying that the cardiac 

1 While the record contains different spellings for Claimant’s first name, her testimony 

reflects that the correct spelling is Debra. Reproduced Record (R.R.) at 40a. 
2

arrest was work related, and hearings were held before the WCJ over several days. 

R.R. at 10a-11a. 

Claimant testified that she had been married to Decedent since 1986 

and their only child together was no longer a dependent when Decedent passed away. 

Decedent was 53 years old, 6 feet 1 inch tall, and weighed approximately 220 to 225 

pounds at the time of his death. He had never treated with a doctor or taken any 

medication for heart problems, but had been taking medication for high blood 

pressure for approximately two years. Decedent smoked cigarettes for as long as 

Claimant knew him and smoked about a pack a day. He did not exercise and his 

hobbies were playing pool and shuffle board. He never complained of shortness of 

breath or chest pains, did not drink alcohol, and was not an anxious person. Claimant 

was not aware of any heart issues in Decedent’s family and was under the impression 

that his father died of cancer. R.R. at 30a-34a, 37a, 42a-45a, 260a-61a. 

Decedent worked full time as a heavy-duty diesel mechanic for 

Employer for five years, sometimes in excess of 40 hours per week. Claimant 

testified that Decedent performed road calls on tractor trailers including changing 

tires and alternators, performing electrical work, and other services along those lines. 

She later clarified that Decedent performed work both alongside the road for 

disabled vehicles as well as in Employer’s shop, and he was on a road call when he 

suffered his fatal heart attack. R.R. at 32a-33a, 48a, 260a.

Claimant saw Decedent before he left for work at around 5:30 a.m. and 

described it as a normal day, with no issues or fighting; however, she noted that it 

was very hot with temperatures in the 90s. Claimant received a telephone call from 

Decedent’s supervisor around 2:45 p.m. stating only that something had happened 
3

to Decedent and Claimant needed to call the police. No autopsy was performed. 

R.R. at 31a-32a, 34a-35a, 41a, 45a, 260a-61a.

Claimant also presented the testimony of Jermaine Lahr who worked as 

a diesel technician performing emergency road service for Employer from 2010 to 

2017. Lahr worked with Decedent for several years and testified that they held the 

same job with the same duties. These duties included diagnosing and repairing all 

forms of commercial vehicles, performing oil changes, and replacing parts such as 

tires, rims, brakes, and drums. Lahr stated that Employer’s shop was open 24/7, 365 

days a year. Lahr worked both in the shop and alongside the road, noting that calls 

for roadside service to fix a flat tire were very common. R.R. at 181a-83a, 261a. 

Lahr explained that when responding to a roadside call for Employer, a 

technician would have to set up a safety zone and then jack the tractor trailer up 

using a 20-ton jack weighing around 50 pounds and a jack stand weighing another 

30 pounds. A tractor trailer tire with a rim weighs between 100 and 125 pounds, 

depending on the size, and a technician had to carry all of this equipment from the 

work vehicle to the disabled tractor trailer. After the vehicle was jacked up, a 

technician had to remove the lug nuts with an air impact gun, which weighed about 

30 pounds, and then remove the tire and rim assembly. Lahr testified that sometimes 

the tires would slide right off, but other times a technician had to pry them off using 

force. Technicians had to change the tire and rim by hand since Employer did not 

have machines to accomplish that. All told, it would normally take a technician 30 

to 45 minutes to remove a tire from a tractor trailer. R.R. at 183a-85a, 192a, 261a. 

Lahr stated that it is a very strenuous job to change a tractor trailer tire, 

either alongside the road or in the shop, given the weight of the parts and equipment 

used. Changing a tire roadside in the warmer months adds to the strain because the 
4

technician has to deal with the heat coming off the asphalt, which adds around 20 

degrees Fahrenheit (° F). Lahr experienced mild bouts of heat illness while working 

for Employer. In addition, when changing a tire alongside a road, a technician 

always has to worry about being hit by a passing vehicle and Lahr had lost friends 

to this type of incident. Lahr stated that this added to the stress level of the job. R.R. 

at 184a-87a, 192a, 261a-62a. 

Lahr understood that on the day in question, Decedent initially 

responded to a roadside call for one flat tire. Decedent then realized that a second 

tire needed to be replaced because it did not match up with the new tire, so he 

returned to Employer’s shop for another tire and a brake drum. Lahr explained that 

Decedent must have taken both tires off before he collapsed because both tires must 

be removed to be able to see the brake drum. R.R. at 191a-94a, 262a. 

On cross-examination, Lahr admitted that he is engaged to Decedent’s 

daughter, with whom he has two children. Lahr had known her for nine years and 

knew Decedent for seven years. Lahr further admitted that Employer’s work 

vehicles had air conditioning and that Decedent would have been in his airconditioned work vehicle that day to travel between Employer’s shop and the 

roadside service call. R.R. at 187a-89a, 262a. 

Claimant submitted weather data for July 14, 2018, indicating a high 

temperature of 91° F. R.R. at 226a. She also submitted work orders from Employer 

documenting the three service calls Decedent worked on that day. R.R. at 205a-12a. 

The technician comments section of the last work order corroborates Lahr’s 

testimony regarding Decedent removing two tires, observing a cracked brake drum, 

returning to Employer’s shop, and then going back to the roadside call. R.R. at 210a11a. Also admitted into evidence were the emergency medical services (EMS)
5

records, emergency room records, and documentation of funeral expenses. Notably, 

the EMS report states that the truck driver at the scene reported Decedent was 

working on the driver’s tractor trailer when Decedent complained of shortness of 

breath, went back to his service truck, and was then found slumped over in the 

driver’s seat. R.R. at 233a. 

Claimant presented the deposition testimony of Jeffrey S. Fierstein, 

M.D., who is board certified in internal medicine and cardiology. Dr. Fierstein is a 

non-invasive cardiologist who has been in practice continually since 1983, with his 

areas of expertise being the diagnosis and treatment of cardiovascular disease as well 

as preventive cardiology. Dr. Fierstein explained that in a case like this, the items 

he considers particularly relevant are the patient’s background, history, risk factors 

for cardiovascular disease, whether or not he/she has had prior events, and the 

circumstances under which the event occurred. R.R. at 63a-64a, 71a-72a, 262a. 

Based upon his review of medical records, Dr. Fierstein testified that 

Decedent had a history of hypertension and smoking, was overweight, and had a 

family history of cardiovascular disease. He believed that coronary artery disease 

could be presumed in Decedent’s case. Dr. Fierstein explained coronary artery 

disease as the development of cholesterol plaque within the arteries resulting in some 

degree of narrowing of those arteries. R.R. at 68a, 262a. 

Dr. Fierstein understood that the day in question was particularly hot, 

about 90° F, when Decedent was called to help change a tire on a disabled tractor 

trailer. Decedent complained to a bystander that he was short of breath and went to 

his truck to sit down. He was later found collapsed in his truck and 911 was called. 

When EMS arrived, Decedent was in cardiac arrest and pulseless. They performed 

cardiopulmonary resuscitation (CPR), used a defibrillator and intubated Decedent, 
6

and then transported him to the hospital. At the hospital, CPR was continued and 

Decedent received epinephrine due to the possibility of a pulmonary embolism. 

Decedent never recovered circulation or a pulse and was subsequently pronounced 

dead at 3:17 p.m. R.R. at 69a-71a, 262a. 

In short, Dr. Fierstein opined, within a reasonable degree of medical 

certainty, that Decedent’s cause of death was performing significant physical work 

in a hot environment, that created a condition of myocardial ischemia resulting in a 

fatal arrhythmia, i.e. cardiac arrest. See R.R. at 82a, 263a. While Dr. Fierstein 

acknowledged that coronary artery disease probably contributed to Decedent’s 

death, he stressed that Decedent’s cardiac arrest and death could have happened in 

the absence of coronary artery disease and “that the immediate cause, the proximate 

cause of the event was precipitated by the work he was doing in that hot 

environment.” R.R. at 95a, 263a. 

More specifically, Dr. Fierstein explained that Decedent had a sudden 

cardiac arrhythmia which was fatal and most likely precipitated by cardiac ischemia, 

which is insufficient blood flow to his heart muscle. This could have been caused 

by either an acute myocardial infarction, meaning an occlusion of a blood vessel that 

immediately deprived a portion of his heart muscle from the appropriate oxygen and 

blood, or a severe narrowing of the coronary artery which, when coupled with the 

increased workload of his activity and the heat, placed stress on Decedent’s 

cardiovascular system creating ischemia. R.R. at 72a-73a, 262a-63a. In layman’s 

terms, Dr. Fierstein explained, 

[s]o my conclusion was that the stress of the work that he 

did in that -- in that environment, the hot environment, the 

90-degree weather, so a combination of the extreme 

workload of changing the tire, which was a strenuous 

activity, and the hot weather was sufficient to create the 
7

arrhythmia that he died from, and that that activity and that 

hot environment was a substantial contributing factor to 

his death. 

R.R. at 73a (emphasis added). 

Dr. Fierstein further testified that the heart muscle is very dependent on 

getting an adequate supply of oxygen and there is no surplus or stored oxygen that 

can be called upon to meet increased demands in real time. Heat is a significant 

stressor on the heart even in the absence of exercise because the heart needs to 

increase the blood flow to the skin quite a bit in order to cool the body. If you then 

impose work such as physical labor on top of that hot environment, not only do you 

have to increase blood flow to the skin, you also have to increase it to the muscles 

doing the work. R.R. at 73a-75a, 262a-63a. Dr. Fierstein stated that doing heavy 

work such as changing a tire in a hot environment is 

what you would call a double whammy. You clearly 

impose a significant workload stress and demand on the 

heart muscle to increase blood flow to the skin, increase 

blood flow to the muscle, and at some point, you can 

exceed the body and the heart’s capacity to do that, and it 

would be a subsequent, you know, failure of the 

cardiovascular system to occur. 

R.R. at 77a-78a. Dr. Fierstein indicated that an autopsy would have been helpful in 

several respects, including whether Decedent had underlying coronary artery 

disease, an arrhythmia, or unrecognized cardiomyopathy, and whether he 

experienced a sudden occlusion precipitated by the physical stress of changing the 

tire in the heat. R.R. at 81a-82a, 263a. 

On cross-examination, Dr. Fierstein acknowledged that while Decedent 

smoked one pack of cigarettes a day at the time of his death, there was a period of 

time where he smoked two to three packs a day and that long-term cigarette use is a 
8

substantial risk factor for the development of coronary artery disease. R.R. at 84a85a, 263a. In addition, Dr. Fierstein conceded that Decedent was at the lower end 

of the obese definition and obesity is a stressor for the heart. R.R. at 85a-86a, 263a. 

Decedent also had a family history of cardiac issues as his father had coronary artery 

disease at the age of 59. R.R. at 86a-87a, 263a. 

Employer’s sole witness was its medical expert, Joseph C. Kraynak, 

M.D. Similar to Dr. Fierstein, Dr. Kraynak is board certified in internal medicine 

and cardiovascular diseases, and has been practicing as a non-invasive cardiologist 

since 1983. Dr. Kraynak testified that while no autopsy was performed, he was 

almost certain Decedent had coronary artery disease based on his risk factors 

including family history, high blood pressure, and history of smoking for more than 

30 years. See R.R. at 133a, 138a, 264a. He further noted that Decedent was obese 

and led a sedentary lifestyle. Given all of the above, Dr. Kraynak opined, to a 

reasonable degree of medical certainty, that the substantial contributing factor for 

Decedent’s cardiac arrest was his underlying coronary artery disease, the most 

common cause of sudden cardiac death. R.R. at 140a-41a, 143a, 264a. Dr. Kraynak 

did not find Decedent’s work to be a substantial contributing factor because the 

weather or “environmental conditions that day were really unremarkable for that part 

of the country[,]” and the workload was not unnatural or uncommon for Decedent. 

R.R. at 142a; see also R.R. at 264a. However, like Dr. Fierstein, he conceded that 

he did not know exactly how much physical labor Decedent performed on the day 

he died. R.R. at 131a, 142a, 264a. 

On cross-examination, Dr. Kraynak admitted that physical exertion can 

elevate the risk of cardiac arrest. R.R. at 147a, 264a. While he agreed that extreme 

heat can also contribute to cardiac arrest, he maintained that the temperature on the 
9

day in question was not extreme. R.R. at 150a, 264a. Dr. Kraynak further explained, 

“I do believe that a normal activity can trigger death in a patient with heart 

disease[,]” R.R. at 151a-52a, and “I think that what really contributed to his death 

was coronary artery disease and that basically any activity, including a normal 

activity at home, could have triggered death.” R.R. at 152a; see also R.R. at 264a. 

On May 5, 2021, the WCJ issued a decision and order granting the fatal 

claim petition. The WCJ found the testimony of Claimant and Lahr to be credible, 

and specifically credited the testimony of Dr. Fierstein over the testimony of Dr. 

Kraynak. The WCJ explained that while Lahr had a personal relationship with 

Decedent’s daughter for years, his testimony was uncontradicted by Employer and 

was confirmed in part by the work orders. The WCJ also noted that Lahr’s admission 

that Decedent would have been riding in an air conditioned work vehicle to and from 

the roadside call demonstrated that Lahr’s testimony was not false or exaggerated 

due to his personal relationships. R.R. at 265a. 

As for the medical experts, the WCJ explained that much of their 

testimony was similar as they both believed Decedent had underlying coronary 

artery disease based upon his smoking, high blood pressure, and family history. 

Both doctors also recognized that while obesity is not an independent risk factor for 

coronary artery disease it could have come into play. The main difference in their 

testimony had to do with the ultimate issue here, whether the work Decedent 

performed that day had any role in his sudden cardiac arrest and death. The WCJ 

credited Dr. Fierstein’s opinion on this issue because his understanding that 

Decedent had to change a tractor trailer tire alongside the road was confirmed 

through the work orders as well as the testimony of Lahr regarding the considerable

weight of the equipment involved to do so. Dr. Fierstein also acknowledged the 
10

significance of the temperature that day coupled with the stress of the work being 

performed. The WCJ rejected Dr. Kraynak’s testimony on this issue because, while 

he testified that normal activity could trigger death in a patient with coronary artery 

disease, he did not believe Decedent’s work on the day he died was a factor in his 

death because it was not abnormal. R.R. at 265a-66a. Given the above, the WCJ 

determined that Claimant met her burden of proving that the work Decedent 

performed for Employer on the day he died was the substantial contributing factor 

in his sudden cardiac arrest and death and she was therefore entitled to benefits. 

Employer then appealed to the Board, which affirmed. 

On appeal to this Court, Employer argues that the Board erred in 

affirming the WCJ’s decision because Dr. Fierstein’s expert opinion regarding the 

cause of Decedent’s cardiac arrest is premised on facts not contained in the 

evidentiary record and, therefore, is incompetent as a matter of law. Specifically, 

Employer complains that the record fails to contain evidence regarding the work 

Decedent was allegedly performing immediately preceding his cardiac arrest. We 

disagree. 

With a claim petition generally, “a claimant bears the burden of proving 

all the necessary elements for an award of workers’ compensation benefits.” Holy 

Redeemer Health Sys. v. Workers’ Comp. Appeal Bd. (Lux), 163 A.3d 498, 503 (Pa. 

Cmwlth. 2017). In the specific context of a fatal claim petition, the surviving family 

member must demonstrate, by substantial evidence, the elements necessary to merit 

an award. City of Phila. v. Workers’ Comp. Appeal Bd. (Kriebel), 29 A.3d 762, 769 

(Pa. 2011). These elements are “establishment of a work-related injury,” “impact 

on the earning capacity of the employee,” and that the injury “was a substantial 
11

contributing cause in bringing about the death of that employee.” Id. (quotation 

omitted). 

As this Court has further explained, 

[j]ust as with any other type of injury, in order for a 

decedent’s fatal heart attack to be compensable, the 

claimant must establish that the heart attack was causally 

related to the decedent’s employment. Yantos v. 

Workmen’s Comp[.] Appeal B[d.] (Vulcan Mold & Iron 

Co[.]), [] 563 A.2d 232, 236 ([Pa. Cmwlth. ]1989). If the 

causal connection is not obvious, the connection must be 

established by unequivocal medical testimony. 

Lamoreaux v. Workmen’s Comp[.] Appeal B[d.] (Celotex 

Corp[.]), [] 497 A.2d 1388, 1390 ([Pa. Cmwlth. ]1985). 

Dietz v. Workers’ Comp. Appeal Bd. (Lower Bucks Cnty. Mun. Auth.), 126 A.3d 

1025, 1030 (Pa. Cmwlth. 2015). “Medical evidence is considered unequivocal if the 

medical expert, after providing a foundation, testifies that in his medical opinion, he 

thinks the facts exist.” Craftsmen v. Workers’ Comp. Appeal Bd. (Krouchick), 809 

A.2d 434, 439 (Pa. Cmwlth. 2002). Of particular importance in this matter, “[a]n 

expert witness is permitted to base an opinion upon facts of which he has no personal 

knowledge, so long as those facts are supported by evidence in the record.” Dietz, 

126 A.3d at 1031 (citing Yantos, 563 A.2d at 235). 

Here, Dr. Fierstein based his testimony upon his understanding that 

Decedent was working in 90-degree weather changing a tractor trailer tire alongside 

a road when he reported feeling short of breath and subsequently collapsed in his 

work vehicle. These are uncontradicted facts of record, found in the credible 

testimony of Claimant and Lahr, and corroborated by the weather report, the EMS 

records, and Employer’s own work orders. While Dr. Fierstein admitted that he did 

not know specifically how far into the tire change Decedent got before he collapsed, 
12

this is of no moment and does not render his opinion equivocal. Our courts have 

repeatedly rejected the argument in cardiac arrest cases that a claimant needs to 

prove exactly what the decedent was doing prior to the event. 

Our Supreme Court has explained that “where a decedent 

was performing his or her usual job assignment at the time 

of the fatal heart attack, and the connection between the 

work and the heart attack was supported by competent 

medical testimony, decedent’s claimant was entitled to 

compensation.” [Workmen’s Comp. Appeal Bd. v.] 

Bernard S. Pincus Co., 388 A.2d [659,] 663 [(Pa. 1978)] 

(emphasis added). Where exertion leads to a fatal heart 

attack, there is no need to pinpoint the exact work duty 

which caused the exertion. Plumbers Contractors, Inc. v. 

Workmen’s Comp[.] Appeal B[d.] (Lewellyn), [] 402 A.2d 

555, 557 ([Pa. Cmwlth. ]1979). In other words, “[i]t is not 

necessary to prove and identify the precise work details 

which caused a heart death that resulted from decedent’s 

exceptional work activity.” P[a.] State Oral Sch[.] v. 

Workmen’s Comp[.] Appeal B[d.] (Gerek), [] 475 A.2d 

175, 178 ([Pa. Cmwlth. ]1984). 

Dietz, 126 A.3d at 1031. 

Just as in Dietz, “[i]t is undisputed that Decedent had a very physical 

job[,]” and that “[h]is daily job [duties] involved strenuous physical activity.” 126 

A.3d at 1032. It is further undisputed that Decedent was responding to a roadside 

service call for a flat tire on a tractor trailer at the time of his death, and that this type 

of call was within his usual job duties. Dr. Fierstein unambiguously opined that the 

immediate cause of Decedent’s cardiac arrest and death was performing this 

significant physical work in a hot environment. The WCJ specifically credited Dr. 

Fierstein’s testimony and opinion in this regard over Employer’s expert. As the 

ultimate factfinder with “exclusive province over questions of credibility and 

evidentiary weight[,]” the WCJ “is free to accept or reject, in whole or in part, the 
13

testimony of any witness, including medical [experts].” Kimberly Clark Corp. v. 

Workers’ Comp. Appeal Bd. (Bromley), 161 A.3d 446, 461 (Pa. Cmwlth. 2017) 

(quotations omitted). 

In sum, evidence of how much and what type of activity Decedent was 

performing that day is not a prerequisite to compensation. Dietz; Lewellyn; Bernard 

S. Pincus. Decedent was performing his usual job assignment at the time of his 

cardiac arrest and the connection between his work and his death is supported by Dr. 

Fierstein’s competent medical testimony. Accordingly, we affirm. 

_____________________________________

BONNIE BRIGANCE LEADBETTER,

President Judge Emerita
IN THE COMMONWEALTH COURT OF PENNSYLVANIA

TA Operating LLC, :

Petitioner :

:

 v. : No. 320 C.D. 2022

:

Leonard Maurer (Workers’ :

Compensation Appeal Board), :

Respondent :

O R D E R

AND NOW, this 17th day of January, 2024, the Order of the Workers’ 

Compensation Appeal Board is AFFIRMED.

_____________________________________

BONNIE BRIGANCE LEADBETTER,

President Judge Emerita