IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Thomasina Owens, :

Petitioner :

:

v. : No. 125 C.D. 2018

: Submitted: June 8, 2018

Workers’ Compensation Appeal Board :

(Elwood Staffing Services Inc.), :

Respondent :

BEFORE: HONORABLE PATRICIA A. McCULLOUGH, Judge

HONORABLE CHRISTINE FIZZANO CANNON, Judge

HONORABLE DAN PELLEGRINI, Senior Judge

OPINION NOT REPORTED

MEMORANDUM OPINION BY

SENIOR JUDGE PELLEGRINI FILED: July 17, 2018

Thomasina Owens (Claimant) petitions for review of the order of the 

Workers’ Compensation Appeal Board (Board) affirming the Workers’ 

Compensation Judge’s (WCJ) decision denying her claim petition because she 

failed to meet her burden of establishing that she sustained a carpal tunnel injury or 

was disabled as a result of her July 19, 2015 work injury, as well as granting the 

termination petition of Elwood Staffing Services Inc. (Employer) because she had 

fully recovered from her burns incurred at work. For the reasons that follow, we 

affirm.
2

I.

On February 2, 2015, Claimant was assigned by Employer to work at 

Oberthur Technologies as a machine operator where her duties required her to 

load, stamp and adjust 25,000 to 35,000 credit cards per day. On July 19, 2015, 

while at work, Claimant suffered burns when she picked up a coffee pot in the 

break room and coffee and grounds fell on her left arm and hand. On August 5, 

2015, Employer issued a medical only Notice of Compensation Payable (NCP)

listing a left arm burn as Claimant’s accepted injury.

After being burned, Claimant performed light-duty work inspecting 

credit cards until January 2016 when her light-duty job changed to putting credit 

cards into a metal box and squeezing them with her right hand to make sure they 

were not cracked, allegedly causing pain going up her arm, knots in her right wrist 

and right thumb pain. On February 25, 2016, Claimant stopped working due to her 

bilateral hand and arm pain.

On March 21, 2016, Claimant filed a claim petition alleging that her 

July 19, 2015 work injury should be amended to include a “left arm and wrist,

burn, carpal tunnel.” (Record (R.) Item No. 2, Claim Petition at 1.) Employer 

filed an answer denying the allegations in the claim petition and asserting, inter 

alia, that Claimant’s carpal tunnel was not causally related to her work injury or, in 

the alternative, that she was only partially disabled and work was available to her 

within her restrictions. Employer then filed a termination petition alleging that 

Claimant had fully recovered from her work-related injury as of April 20, 2016. 

Claimant filed an answer and the two petitions were consolidated.
3

II.

In support of her claim petition, Claimant testified1that on July 19, 

2015, she was pulling out a coffee pot at work when the coffee and grounds fell on 

her dominant left arm and hand. Claimant testified that over the next two days, she 

developed blisters, pain and heaviness in her left hand. She sought treatment at 

Einstein Hospital’s emergency room where she was diagnosed with second-degree 

burns, given a carpal tunnel splint and pain medication, and was referred to the 

burn center. Claimant testified that she continued to work but experienced 

burning, heaviness, pain in her wrist and tingling in her fingers. She did not see 

any other physicians or seek any additional treatment until October 2015 when she 

was seen at WorkNet, an occupational medical office designed by Employer for 

the treatment of its employees for work-related injuries. There she was prescribed 

a splint, burn cream, physical therapy and work restrictions. She was then 

assigned a light-duty position where she would sit and inspect credit cards.

Claimant testified that in January 2016, her light-duty job was 

changed where she was required to use a tool to check each credit card and then

put the credit card in a metal container and squeeze it with her right hand to make 

sure it did not crack. Claimant testified that due to this light-duty position, she 

began experiencing pain in her right thumb, burning in her hand, and numbness in 

her fingers that became sufficiently severe that she left her employment on 

February 25, 2016, and she has not looked for other work since that time. She 

 

1 Claimant testified at a hearing before the WCJ on May 11, 2016, and by deposition 

conducted on July 20, 2016.
4

testified that she then sought additional treatment with Morton L. Silverman, M.D.

(Dr. Silverman) who started her on physical therapy.

As to her condition, Claimant testified that her condition has 

improved and admitted that at some point, WorkNet released her to return to work 

with no restrictions, but she felt she was unable to return to regular-duty work 

because she was still having pain, tingling and numbness in her fingers and wrists,

and pain up her arms. Claimant testified that she is able to return to work with 

restrictions but she has not contacted Employer to see if it would be able to 

accommodate her.

Claimant also admitted that approximately 30 years ago, she 

developed carpal tunnel syndrome due to the repetitive nature of her job duties on 

an assembly line at Ford Electronics. At that time, she underwent surgery on her

left hand, and she testified that she had no problems with the carpal tunnel up until

her work injury in July 2015. Claimant also admitted that she was diagnosed with 

chronic left thumb tendonitis while working at Ford Electronics.

In support of her carpal tunnel claim, Claimant also offered Dr. 

Silverman’s deposition testimony. He testified that he evaluated Claimant on 

November 30, 2015, and that his physical examination demonstrated a positive 

Tinel’s sign at her left wrist, mild decreased pain sensation in the left arm and 

hand, weak left hand grip, and some skin discoloration at the base of her left thumb 

and wrist. Based on those results, Dr. Silverman testified that he diagnosed 

Claimant with left carpal tunnel syndrome and healed burns of the left hand and 
5

wrist, both of which he attributed to her July 2015 work injury. He testified that he 

started Claimant on physical therapy to reduce the pain in her hand and improve 

her motion.

Dr. Silverman testified that when he saw Claimant on February 22, 

2016, she had increased pain and pain in her right wrist. He attributed her 

symptoms in her right wrist to overuse of that hand because of the repetitive work 

she was performing on light-duty. Dr. Silverman prescribed Claimant Naprosyn 

and advised her not to work for the next several weeks. When he saw Claimant on 

March 14, 2016, she reported that both hands continued to hurt, that there was a 

positive Tinel’s sign in both wrists, and a moderately decreased left hand grip. At 

her final examination on July 18, 2016, there was a positive Tinel’s sign at both of 

Claimant’s wrists as well as her left elbow and right shoulder, marked decrease in 

left hand grip strength, and tenderness at her right elbow and left thumb.

Dr. Silverman reviewed the EMG study performed by Dr. Scott Fried 

(Dr. Fried) on April 13, 2016, which showed, inter alia, significant carpal tunnel 

syndrome on the right and moderate carpal tunnel on the left. He testified that he 

also reviewed Claimant’s March 31, 2016 functional capacity evaluation (FCE), 

wherein Claimant demonstrated that she was able to perform 56.6% of the physical 

demands of her pre-injury job as a machine operator.

Dr. Silverman opined that Claimant had second-degree burns to the 

left forearm and wrist, from which she had fully recovered, as well as left carpal 

tunnel syndrome and bilateral radial tunnel syndrome. Also, due to the repetitive 
6

use of her right hand during her light-duty work, Claimant had developed right 

carpal tunnel syndrome. He further testified that as of February 25, 2016,

Claimant was unable to perform either her pre-injury job or her light-duty job due

to her work-related injury. Dr. Silverman testified that “it is known that burn 

injuries do cause cases of carpal tunnel.” (R. Item No. 18, C-3 Transcript of Dr. 

Morton Silverman, at 26.) He referred to medical literature, specifically the Annals 

of Burns and Fire Disasters, which indicates that carpal tunnel can be caused by 

burns, particularly thermal burns, and that the symptoms may take 4 to 14 months 

to fully develop. Dr. Silverman testified that he disagreed with the opinion of 

Employer’s expert witness, Sidney M. Jacoby, M.D. (Dr. Jacoby), that Claimant’s 

carpal tunnel was not related to her burn injury because Claimant had been 

diagnosed with carpal tunnel at her initial emergency room visit.

On cross-examination, Dr. Silverman agreed that none of Claimant’s

WorkNet records indicated that she had carpal tunnel syndrome or that she 

complained of any carpal tunnel symptoms in her left wrist. While Claimant 

treated with WorkNet from July 2015, the first noted problems with her left wrist 

or any carpal tunnel symptoms did not come until October 2015. Dr. Silverman 

also admitted that Claimant had shown some improvement and, at the time of his 

deposition, she was capable of some form of light-duty work.

Dr. Silverman stated that he referred Claimant to David Zelouf, M.D.

(Dr. Zelouf), a hand surgeon with the Philadelphia Hand Center, who saw her on 

January 11, 2016. Dr. Zelouf reported a benign examination with no obvious 

pathology, and noted that Claimant had produced an obvious lack of effort in all 
7

five of her grip test findings; therefore, he released her back to unrestricted work 

duties. However, Dr. Silverman testified that Dr. Zelouf did not perform a Tinel’s 

sign and was unable to review Claimant’s EMG and MRI studies. Dr. Silverman 

attempted to follow up with Dr. Zelouf several times but was unable to reach him; 

therefore, he referred Claimant to Dr. Fried.

In support of its termination petition, Employer offered the deposition 

testimony of Dr. Jacoby, a board certified orthopedic surgeon. He testified that he 

performed an independent medical examination (IME) of Claimant on April 20, 

2016, at which time he obtained a history, reviewed medical records and diagnostic 

studies, and conducted a physical examination. In recounting Claimant’s history, 

Dr. Jacoby noted that when she returned to WorkNet in November 2015, her burn 

injury had resolved but she complained of numbness and tingling. The physician’s 

assistant recommended that Claimant report a new incident as he felt it was 

unrelated to her July 2015 work injury, and Claimant was released to full duty.

Dr. Jacoby testified that on physical examination, Claimant had 

symmetric cervical, shoulder and elbow range of motion, and he did not find any 

scars, scar contracture or evidence of the prior left arm burn. Claimant had a 

benign upper extremity examination, despite her subjective complaints and 

inconsistencies with regard to her passive and active ranges of motion. Dr. Jacoby 

testified that Claimant’s median and ulnar nerves were objectively found to be 

within normal limits, and that the median nerve is involved in carpal tunnel 

syndrome. Dr. Jacoby performed a grip strength test and found that Claimant had 

physiologic grip strength on a bell curve on the right, and a flat line on the left. He 
8

testified that Claimant displayed a lack of effort with grip testing, particularly with 

her left hand and wrist. Dr. Jacoby did not find any signs of dystrophy or 

contractures, which would indicate a higher level of injury.

Dr. Jacoby reviewed Claimant’s November 3, 2015 EMG report and 

raw data, noting that only her left side had been evaluated. Dr. Jacoby noted a 

subtle delay across the left carpal tunnel, with an essentially normal sensory 

evaluation, no neurogenic changes, and no evidence of left ulnar or motor changes. 

Dr. Jacoby also reviewed Claimant’s April 13, 2016 EMG report which showed 

that multiple nerves had subtle delays in function. However, Dr. Jacoby noted that 

these findings were not surprising in someone of Claimant’s age and given her 

previous carpal tunnel surgery. Dr. Jacoby testified that this second EMG report 

did not change his overall opinion.

Dr. Jacoby diagnosed Claimant with status post second-degree burns 

to the left forearm and left arm pain, which he stated was a catch-all to describe her 

subjective residual complaints. He opined that Claimant’s left forearm burn had 

healed with an excellent prognosis as there was barely any residual scarring or 

burn-related sensitivity. He further opined that while her residual complaints of 

left upper extremity weakness, pain, numbness and tingling may exist, they were 

not causally related to her work-injury as the mechanism of injury was inconsistent 

with the complaints noted. In addition, any discomfort would be due to age-related 

changes or additional nonorganic factors.
9

Dr. Jacoby reviewed Dr. Silverman’s testimony and August 1, 2016 

report. He testified that he agreed with Dr. Silverman’s opinion of a healed burn, 

but disagreed with the opinion that Claimant’s right hand and wrist problems were 

related to her work injury or light-duty job duties because Claimant’s burn had 

healed, and she had excellent skin integrity with no evidence of contracture. In 

addition, Claimant demonstrated multiple inconsistencies, including her breakaway pain and her passive and active ranges of motion. Dr. Jacoby testified that he 

reviewed the article Dr. Silverman relied upon and it described individuals with 

high degree burns involving a significant total body surface area, which was 

incompatible with Claimant’s superficial burn of limited surface area. Dr. Jacoby 

opined that Claimant could return to work without any restriction and he did not 

recommend any additional treatment with regard to her work injury.

The WCJ found Claimant’s testimony to be credible regarding the 

occurrence of her July 19, 2015 work injury and subsequent medical treatment. 

However, he did not find her to be credible regarding the onset of carpal tunnel 

syndrome and its relationship to her work injury since she had prior carpal tunnel 

surgery and did not complain of carpal tunnel symptoms until three months after 

the work injury. The WCJ also found the testimony of Dr. Jacoby to be more 

credible than that of Dr. Silverman. He found credible Dr. Jacoby’s opinion that 

Claimant’s symptoms were not related to her work injury because Claimant’s 

medical history showed she was released to full-duty work in August 2015, and 

was diagnosed as having a benign examination with multiple inconsistencies by 

Dr. Zelouf in January 2016. Moreover, the WCJ noted Dr. Jacoby credibly 

explained that Claimant’s EMG findings were related to her past carpal tunnel 
10

surgery, and the medical literature Dr. Silverman relied upon pertained to 

individuals with high degree burns that were not present in Claimant’s case.

Based on all of the above, the WCJ found that “Claimant’s current 

complaints including bilateral carpal tunnel syndrome are not related to the July 

19, 2015 work injury” (WCJ’s January 6, 2017 Decision, Finding of Fact Number 

9), and that she was not disabled as a result of her July 19, 2015 work injury. The 

WCJ also found that Employer met its burden of proving that Claimant had fully 

recovered from her work injury in the nature of a left arm burn as of April 20, 

2016. Therefore, the WCJ denied Claimant’s claim petition and granted 

Employer’s termination petition.

III.

Claimant appealed to the Board arguing that the WCJ’s decision was 

not based on substantial competent evidence and was not well reasoned. Claimant 

also argued that the WCJ failed to consider whether she suffered an aggravation of 

her preexisting carpal tunnel syndrome due to her work injury.

The Board affirmed the WCJ’s decision that Claimant failed to meet 

her burden because the WCJ rejected her testimony as well as that of Dr. 

Silverman that her work injury caused her carpal tunnel syndrome or that it caused 

any disability. Instead, the WCJ accepted Dr. Jacoby’s testimony that Claimant’s 

work injury in the nature of a left arm burn had fully resolved. The Board noted 

that the WCJ did not directly address whether Claimant’s repetitive job duties 

related to her carpal tunnel syndrome. However, the Board found that there was no 
11

credited substantial, competent evidence to support this claim because the WCJ 

accepted Dr. Jacoby’s testimony that Claimant’s carpal tunnel was not related in 

any way to her work injury and rejected Dr. Silverman’s conflicting opinion. This 

appeal followed.2

IV.

Claimant’s main argument on appeal is that the WCJ erred in denying 

her claim petition and granting Employer’s termination petition by failing to 

address her argument that she suffered an aggravation of her preexisting carpal 

tunnel syndrome. Claimant argues that her light-duty job duties were admittedly 

repetitive in nature, and that the WCJ failed to consider whether such repetitive 

work duties aggravated her underlying bilateral carpal tunnel syndrome.

It is well established that a claimant in a workers’ compensation case 

bears the burden of proving all of the elements necessary to support an award. 

Inglis House v. Workmen’s Compensation Appeal Board (Reedy), 634 A.2d 592 

(Pa. 1993). This includes proving that the claimant sustained an injury during the 

course and scope of employment, causation and the length or duration of the 

 

2

In a workers’ compensation proceeding, this Court’s scope of review is limited to 

determining whether errors of law were committed, whether constitutional rights were violated, 

and whether necessary findings of fact are supported by substantial evidence. Roundtree v. 

Workers’ Compensation Appeal Board (City of Philadelphia), 116 A.3d 140, 143 n.4 (Pa. 

Cmwlth. 2015). Substantial evidence has been defined as “such relevant evidence as a 

reasonable person might accept as adequate to support a conclusion. . . . In performing a 

substantial evidence analysis, this [C]ourt must view the evidence in a light most favorable to the 

party who prevailed before the factfinder.” Waldemeer Park, Inc. v. Workers’ Compensation 

Appeal Board (Morrison), 819 A.2d 164, 168 (Pa. Cmwlth. 2003) (citation omitted).
12

claimant’s disability. Coyne v. Workers’ Compensation Appeal Board (Villanova 

University and PMA Group), 942 A.2d 939, 945 (Pa. Cmwlth. 2008). Specifically, 

to establish a work-related aggravation of a preexisting condition, a claimant must 

show a causal connection between the work injury and the aggravation. Chick-FilA v. Workers’ Compensation Appeal Board (Mollick), 792 A.2d 678 (Pa. Cmwlth. 

2002). “Where the causal connection is not obvious, unequivocal medical 

testimony is required to establish the causal connections between the work incident 

and the disability.” Southwest Airlines/Cambridge Integrated Service v. Workers’ 

Compensation Appeal Board (King), 985 A.2d 280, 286 (Pa. Cmwlth. 2009) 

(citation omitted).

Claimant has not met this burden as there is no credible evidence that 

she is disabled. First, the WCJ did not find Claimant’s testimony to be credible 

regarding the onset of her carpal tunnel syndrome and its relationship to her work 

injury. Specifically, the WCJ noted that while Claimant treated with WorkNet 

from July 2015 to October 2015, she did not report any problems or carpal tunnel 

symptoms with her left wrist until the end of October 2015. Moreover, Claimant 

did not establish that there was a causal connection between her left arm burn and 

her purported bilateral carpal tunnel syndrome because the WCJ found Dr. 

Silverman’s testimony not to be credible. Rather, the WCJ accepted as credible 

Dr. Jacoby’s testimony and his opinion that Claimant’s symptoms were not related 

to her work injury. Claimant’s medical history showed she was released to fullduty work in August 2015, and Dr. Zelouf’s January 2016 report indicated a 

benign examination with multiple inconsistencies. Dr. Jacoby’s physical 

examination of Claimant revealed that both median nerves were within normal 
13

limits, she failed to put forth adequate effort in several grip tests, and he was not 

surprised by any changes in her studies given her age and prior carpal tunnel 

surgery. Finally, the WCJ found that Dr. Jacoby critically refuted the medical 

literature Dr. Silverman relied upon in rendering his opinions because it pertained 

to individuals with high degree burns that were not present in Claimant’s case.

Even ignoring that it was Claimant’s burden, which she did not 

sustain because the WCJ did not accept the proffered testimony in support of that 

claim, there is more than substantial, competent evidence to support the WCJ’s 

determination that Claimant failed to prove that she was disabled and that her 

current complaints were not related to her work injury. There was no need or 

reason for the WCJ to address Claimant’s argument that her light-duty job duties 

aggravated her preexisting carpal tunnel syndrome because the WCJ determined 

she was not disabled.3

Claimant also takes issue with the WCJ’s finding that she did not 

complain of carpal tunnel symptoms until three months after her work injury. 

Again, the WCJ specifically found Claimant’s testimony not to be credible with 

 

3

In a related argument, Claimant asserts that the WCJ’s decision is not reasoned because 

it did not address the argument that her light-duty job duties aggravated her preexisting carpal 

tunnel syndrome. Again, there was no reason for the WCJ to address this issue as he determined 

that Claimant failed to prove that she was disabled and there was not substantial, competent 

evidence to support Claimant’s argument. In addition, the WCJ’s decision is reasoned because it 

allows for adequate appellate review without further elucidation, Daniels v. Workers’ 

Compensation Appeal Board (Tristate Transport), 828 A.2d 1043, 1052 (Pa. 2003), and because 

the WCJ summarized the conflicting medical testimony and adequately explained his credibility 

determinations. Amandeo v. Workers’ Compensation Appeal Board (Conagra Foods), 37 A.3d 

72, 76 (Pa. Cmwlth. 2012).
14

respect to the timing or onset of her carpal tunnel syndrome. Essentially, Claimant 

asks this Court to accept the evidence she presented and to overturn the credibility 

determinations of the WCJ. As we have stated over and over again, “[t]he WCJ, as 

the ultimate fact-finder in workers’ compensation cases, ‘has exclusive province 

over questions of credibility and evidentiary weight.’” A & J Builders, Inc. v. 

Workers’ Compensation Appeal Board (Verdi), 78 A.3d 1233, 1238 (Pa. Cmwlth. 

2013) (quoting Anderson v. Workers’ Compensation Appeal Board (Penn Center 

for Rehab), 15 A.3d 944, 949 (Pa. Cmwlth. 2010)). We are bound by these 

credibility determinations and cannot overturn them on appeal. “Moreover, it is 

irrelevant whether the record contains evidence to support findings other than those 

made by the WCJ; the critical inquiry is whether there is evidence to support the 

findings actually made.” A & J Builders, Inc., 78 A.3d at 1238.4

Accordingly, the order of the Board is affirmed.

________________________________

DAN PELLEGRINI, Senior Judge

 

4 The only argument Claimant makes in support of her claim that the WCJ erred in 

granting Employer’s termination petition is that he did not address her argument that the work 

injury aggravated her preexisting carpal tunnel syndrome. This argument is without merit for the 

reasons stated above. In addition, we note that there is no dispute that Claimant has fully 

recovered from her initial accepted work injury of a left arm burn as even Claimant’s treating 

physician, Dr. Silverman, testified to this fact.
IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Thomasina Owens, :

Petitioner :

:

v. : No. 125 C.D. 2018

:

Workers’ Compensation Appeal Board :

(Elwood Staffing Services Inc.), :

Respondent :

O R D E R

AND NOW, this 17th day of July, 2018, the order of the Workers’ 

Compensation Appeal Board dated January 17, 2018, at No. A17-0022, is hereby 

affirmed.

________________________________

DAN PELLEGRINI, Senior Judge