IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Amazon.com Services LLC, : American Zurich Insurance Company : and Sedgwick Claims Management : Services, :

Petitioners :

:

v. :

: Engel L. Then Roman (Workers’ : Compensation Appeal Board)

, : No. 185 C.D. 202 2

Respondent : Submitted: August 5 , 2022

BEFORE: HONORABLE RENÉE COHN JUBELIRER , President Judge

HONORABLE ANNE E. COVEY, Judge HONORABLE LORI A. DUMAS , Judge

OPINION NOT REPORTED

MEMORANDUM OPINION BY JUDGE COVEY FILED: December 1, 2022

Amazon.com Services LLC, American Zurich Insurance Company

, and
Sedgwick Claims Management Services (collectively, Employer) petition this Court
for review of the Workers’ Compens ation (WC) Appeal Board’s (Board) February
8, 2022 order affirming WC Judge Brian Hemak ’s (WCJ Hemak) decision that
denied Employer’s Petition to Terminate Compensation Benefits (Termination
Petition), granted Engel L. Then Roman ’s ( Claimant ) Petition to R eview
Compensation Benefits (Review Petition), and directed Employer to pay Claimant’s
counsel fees. Employer presents four issues for this C ourt’s review: (1) whether
WCJ Hemak erred by relying on the equivocal and legally incompetent testimony of
Claimant’s medical expert; (2) whether WCJ Hemak capriciously disregard ed
substantial competent evidence in finding that Claimant met her burden of proof to2

establish a change to the work

- injury description ; (3) whether WCJ Hemak failed to

render a reasoned decision ; and (4) whether WCJ Hemak err ed by denying
Employer ’ s Termination Petition

. 1 After review, this Court affirms.

On August 22, 2019, Claimant sustained a n injury to her right leg
during the course and scope of her employment with Employer. On October 3, 2019

, Employer issued a Notice of Temporary Compensation Payable (NTCP)
acknowledging Claimant’s injury, which was described as “work[

- ]related right leg
pain.” Certified Record (C.R.) Item 10 at 3. Thereafter, the NTCP converted to a
Notice of Compensation Payable (NCP)

. On September 29, 2020, Employer filed

the Termination Petition

, alleging therein that Claimant had fully recovered from her
injury as of September 8, 2020. On October 14, 2020, Claimant filed the Review
Petition alleging that the injury description was incorrect and that her condition had

worsened.

On October 19, 2020, WCJ Joseph Grady conducted a hearing. The

matter was subsequently reassigned to WC J Hemak who held hearings on January
22 and February 25, 2021. On June 3, 2021, WCJ Hemak denied Employer’s
Termination Petition and granted Claimant’s Review Petition, thereby amending

Claimant’s work

- related injury descripti on to include lumbar radiculitis and disc

herniations at L4

- 5 and L5

- S1. Employer appealed to the Board . On February 8,

2022, the Board affirmed WCJ Hemak’s decision

. Employer appealed to this Court

. 2

1 The order of Employer’s issues is consistent with the order Employer argued them in its brief, as opposed to the order Employer set forth in its Statement of the Questions Involved.

2 “Our review is limited to determining whether the WCJ’s findings of fac t were supported by substantial evidence, whether an error of law was committed, or whether constitutional rights were violated.” Pierson v. Workers’ Comp. Appeal Bd. (Consol Pa. Coal Co. LLC) , 252 A.3d 1169, 1172 n.3 (Pa. Cmwlth.), appeal denied , 261 A. 3d 378 (Pa. 2021).3 Initially,

[w] hen, as here, a claimant is seeki ng to amend an NCP pursuant to [S] ection 413(a) of the [WC] Act [(Act)]

, [ 3 ] [s] he has the burden to prove that h [er] disability has increased and that the original work

- related injury caused the amending disability

. Accordingly, Claimant has the burden of establishing the causal relationship between h [er] work

- related [] injury and h [er] [additional injuries] by unequivocal medical testimony.

Huddy v. Workers’ Comp. Appeal Bd. (U.S. Air) , 905 A.2d 589, 592

- 93 (Pa. Cmwlth.

2006) (footnote and citation omi tted).

Employer first argues that WCJ Hemak erred by rel ying on the
equivocal and legally incompetent testimony of Claimant ’ s medical expert

, who
could only testify to possible causation for the erroneous finding s of disc herniations

and lumbar radiculiti s, or aggravation thereto, without full medical testing, and
review of medical records and diagnostic studies which could not rule out

, inter alia

, underlying systemic causes for Claimant ’ s complaints. Specifically, Employer

contends that Claimant’s treat ing physician Joseph Chun, D.O. ’s (Dr. Chun) 4

testimony was equivocal and incompetent because Dr. Chun did not have a complete
understanding of Claimant’s underlying systemic condition and diabetes, which he

never ruled out. Employer further asserts that Dr. Chun only testified to possible
causes for the disc bulges or herniations

.

Claimant rejoins that Dr. Chun testified that it was his opinion, within
a reasonable degree of medical certainty, that Claimant sustained an aggravation of
her p reexisting disc degeneration and disc bulges, and that it was also possible that

the small disc herniations of the bottom two discs L4

- 5 and L5

- S1 were the result of

the August 22, 2019 trauma and work injury. Claimant further retorts that Dr. Chun

3 Act of June 2, 1915, P.L. 736, as amended , 77 P.S. § 772.

4 Dr. Chun is board

- certified in pain management and physical medicine and rehabilitation

.4

relate d that it was his opinion, within a reasonable degree of medical certainty, that

Claimant ’ s August 22, 2019 work injury caused the lumbosacral pain with the
radiating lower extremity pain, i.e.

, lumbar radiculitis

.

Medical testimony will be found unequivocal if the medical expert, after providing a foundation, testifies that in his professional opinion that he believes a certain fact or condition exists. Medical testimony is equivocal if, after a review of a medical expert ’ s entire testimony, it is found to be merely based on possibilities. Medical testimony will be deemed incompetent if it is equivocal. Whether medical testimony is equivocal is a question of law subject to plenary review.

PetSmart, Inc. Through Indem

. Ins

. Co

. of N

. Am

. v. Workers’ Comp

. Appeal B d.

(Sauter)

, 219 A.3d 703 , 706 (Pa. Cmwlth. 2019) (quoting Campbell v. Workers ’
Comp. Appeal Bd. (Pittsburgh Post Gazette) , 954 A.2d 726, 730 (Pa. Cmwlth. 2008)

(citations omitted) )

.

Here, Dr. Chun testified on direct examination:

Q. Did you come to any and conclusion or diagnosis that

- - - assuming that the history that she gave you, that she incurred an injury on August 22 nd , 2019, and also that there w as no report or history of any minor back problems before , were you able

- - - were you able to come to a medical conclusion or a diagnosis or a tentative diagnosis at that point in time as to what her condition was?

A. Yes. My impression was she had a work injury on August 22 nd , 2019, which caused the lumbosac ral pain with the radiating lower extremity pain. And my diagnosis was lumbar radiculitis related t o stenosis , disc bulges [,] and disc protrusions. And as I mentioned before, she did not report any prior history of low back pain or radiating lower extrem ity pain or any imaging studies that would show any of the abnormalities that were discussed before.

Reproduced Record (R.R.) at 39a

- 40a.5 Dr. Chun further related:

Q. So what effect did that injury, in your opinion, have on that

- - - well, let me ask you this. What you saw on the [magnetic resonance imaging (] MRI [)] scan, and maybe I ’ m getting ahead because I understand there was a subsequent MRI, but what did the MRI scan show you a s far as any pre [] existing pathology and how the work i n jury

- - - as to the diagnosis, how she has symptoms ?

A. Yes. She had unde rlying mild degenerative changes,
so at

- - - mild disc degeneration at L3

- 4 level, L4

- 5 level, L5

- S1 level, with some middle disc bulges. That was her preexisting MRI, as well as maybe the s mall disc herniations at the bottom two disc levels. There were small central and right

- - - there was a small central right paracentral disc herniation at the L4

- 5 level and small central disc herniation at the L5

- S1 level. So at the very least

, this w as an aggravation o f her preexisting disc degeneration and disc bulges

.
And it ’ s also possible that at the disc herniations , the small disc herniations of the bottom two disc s were the result of this trauma and work injury and her symptoms caused

- - - her symptoms are consistent with this.

Q. Is this opinion within a reasonable degree of medical certainty?

A. Yes.

R.R. at 40a

- 42a (emphasis added)

. Based on Dr. Chun’s testimony, WCJ Hemak
opined: “This [WCJ] also specifically finds that Claimant’s work[

- ]related injury

should be amended to include lumbar radiculitis and disc herniations at L4

- 5 and

L5

- S1.” R.R. at 172a.

On c ross

- examination, Dr. Ch un acknowledged :

Q. Now, you had reviewed the same MRI from January 8, 2020

. Is that correct?

A. I reviewed the report of that

- - - Q. Okay.6 A.

- - - particular MRI.

Q. Okay.

And you would agree the MRI showed degenerative changes in the lumbar spine [?] Correct?

A. Yes.

Q. And the small focal herniations, those could be degenerative

- type herniations

. Correct?

A. Y es. It could be degenerative or part of it could also be traum atic

. Q. And there’s

- - - there ’ s no way for you to tell

. Is that correct?

A. That is correct , without a prior MRI.

R.R. at 57a

- 58a (emphasis added)

.

Dr. Chun also recognized:

Q. [Dr. Samuel Valenti (Dr. Valenti) 5 ] [] states or recommends, and I’m quot ing this, I would potentially consider checking [thyroid stimulating hormone (] TSH [)]

, [creatine phosphokinase (] CPK [)] and perhaps checking lab values that would be consistent with potential systematic flammatory process as the symptomology appears to be significantly diffuse, involving the lower extremities more than the upper extremities. She is not exhibiting any issu es with core weakness. She got up from her chair and table without any difficulty. No history of falls or significant weakness. Is that correct?

A. Yes.

Q. Was there any checking of her TSH

, CPK or the la b values for a systemic inflammatory process ?

A. I do not know

. In my opinion

, I do not think it ’ s a systemic process

. Q. Has that been ruled out?

5 Dr. Valenti referred Claimant to Dr. Chun. See R.R. at 34a.7 A. I do not know.

R.R. at 62a

- 63a (emphasis added). “ These selections from the testimony of Dr.

[Chun] in no measure render, as a matter of law, his testimo ny incompetent .” Am.
Contracting Enters., Inc. v. Workers’ Comp. Appeal Bd. (Hurley) , 789 A.2d 391,

396 (Pa. Cmwlth. 2001).

I n Liveringhouse v. Workers’ Compensation Appeal Board (Adecco)

, 970 A.2d 508 (Pa. Cmwlth. 2009), this Court addressed whether a claimant’s
doctor’s (Doctor) testimony was equivocal and incompetent based on his testimony

that the claimant’s work duties caused or aggravated the claimant’s injury . Therein,
this Court explained:

[The Doctor’s] testimony viewed as a whole unequivocally indicates that [the c] laimant ’ s carpal tunnel syndrome was caused by her job duties. He testified that when he belatedly received the actual [ electromyography

or ] EMG numbers from [another doctor] , the result was conclusive for severe carpal tunnel on the right and moderate to severe carpal tunnel on the left. The WCJ chose to emphasize [the Doctor’s] opinion that [ the

c ] l aimant ’ s job duties would “ likely ” cause carpal tunnel

, but he also opined that even if she had some
pre [] existing condition that was not symptomatic [

, ] her job duties would aggravate it to the extent that it would become symptomatic. A doctor ’ s testimony should be considered as a whole

, and a determination of whether it is unequivocal should not rest upon a few words taken out of context

.

Id

. at 515 (emphasis added) . “ In essence, [this Court’s] decision in Liveringhouse
strongly suggests that an expert ’ s opinion will not be deemed incompetent simply
because an expert testifies that a claimant ’ s work [injury] either caused an injury or aggravated a preexisting injury. ” Exec

. Offs

. v. Workers’ Comp. Appeal Bd.8

(Rothwell) (Pa. Cmwlth. No. 546 C.D. 2020 , filed Apr

. 21, 2021), slip op. at 15
(emphasis added)

. 6

Further, in rejecting a claimant’s argument that an employer’s doctor
did not have a full understanding of her medical history, this Court held:

[A] medical expert ’ s opinion is not rendered incompetent unless it is based solely on inaccurate information. Am. Cont racting Enters., Inc.

. . . . “[ T ]he fact that a medical expert does not have all of a claimant ’ s medical records goes to the weight given the expert ’ s testimony, not its competency.” Marriott Corp. v. Workers ’ Comp. Appeal Bd. (Knechtel)

, 837 A.2d 623, 631 n.10 (Pa. Cmwlth. 2003).

Pryor v. Workers ’ Comp

. Appeal Bd

. (Colin Serv

. Sys

. )

, 923 A.2d 1197 , 1203 (Pa.

Cmwlth. 2006)

. “ Moreover, it is well established that the opinion of a medical expert

must be viewed a s a whole

, and that inaccurate information will not defeat that
opinion unless it is dependent on those inaccuracies. ” Am

. Contracting Enter s. , Inc.

, 789 A.2d at 396.

Based on its thorough review, this Court conclude s that Dr. Chun’s
testimony was competent as a matter of law. First, Dr. Chun’s opinion was
“sufficiently definite and unequivocal to render it admissible.” Cerro Metal Prod s.

Co. v. Workers ’ Comp

. Appeal Bd

. (Plewa) , 855 A.2d 932, 937 (Pa. Cmwlth. 2004)
(quoting Cramer v. Workmen’s Comp. Appeal Bd. (Uni

- Mart s) , 627 A.2d 231, 233

(Pa. Cmwlth. 1993))

. Dr. Chun testified that Claimant ’ s work injury caused

Claimant’s aggravated disc herniations and lumbar radiculitis, or aggravation

thereto , and that Claimant did not report any prior history of low back pain or

6 This Court’s unreported memorandum opinions may be cited “for [their] persuasive value, but not as a binding precedent.” Section 414(a) of the Commonwealth Court’s Internal Operating Procedur es, 210 Pa. Code § 69.414(a). Executive Offices is cited for its persuasive
value.9

radiating lower extremity pain or any imaging studies that would show any of the

abnormalities that were discussed

. See R.R. at 39a

- 40a. On cross

- examination, Dr.

Chun did not waiver in his opinion that the work inj ury caused Claimant ’ s most

recent issues with her lower back and legs

. Accordingly, Dr. Chun’s testimony was
sufficiently unequivocal.

Employer next argues that WCJ Hemak capriciously disregarded
substantial competent evidence in finding that Claimant me t her burden of pro ving,

relative to the Review Petition

, a change to her work injury that include d lumbar disc
herniations and lumbar radiculitis, or aggravation thereto, when the substantial
competent evidence established Claimant ’ s issues were preexisting and related to
underlying systemic conditions unrelated to the work injury. Specifically, Employer

contends that the substantial

, competent record evidence established that Claimant ’ s complaints could be due to underlying systemic issues, name ly

, diabetes, which the
referring doctor suspected before referring Claimant to Dr. Chun. Employer further

asserts that the substantial

, competent record evidence established that Claimant ’ s disc bulges or herniations were preexisting and part of the unde rlying degenerative

condition in Claimant ’ s low back, rather than acute, based on Dr. Chun’s

concessions. Employer submits that Claimant ’ s complaints changed with respect to
her lower extremities, which were clearly affected by the diabetes for which she was prescribed a boot and a cane. 7 Claimant rejoins that

, g iven the accepted testimony

and the WCJ’s credibility determinations

, which were neither arbitrarily nor
capriciously made

, the substantial

, competent evidence did support the WCJ
granting Claimant ’ s Review Petition.

7 Claimant testified: “Q. Who prescribed the cane and the boot? Do you know the name of the doctor? A. Dr. Rashid, Seleena Rashid [Claimant’s family doctor], in Geisinger.” R.R. at 155a. However, there was no testimony that diabetes was the reason for s aid prescription.10 A capricious disregard only occurs when the WCJ deliberately ignores relevant, competent evidence. Capasso v. Workers’ Comp. Appeal Bd. (RACS Assocs., Inc.) , 851 A.2d 997, 999 (Pa. Cmwlth. 2004). Capricious disregard of evidence “is a deliberate and baseless disregard of apparently trustworthy evidence.” Williams v. Workers’ Comp. Appeal Bd. (USX Corp.

- Fairless Works) , 862 A.2d 137, 144 (Pa. Cmwlth. 2004). Nonetheless, “where there is substantial evidence to support [a WCJ ’ s] factual findings, and those findings in turn support the conclusions, it should remain a rare instance in which an appellate court would disturb an adjudication based upon capricious disregard.” Leon E. Wintermyer, Inc. v. Workers’ Comp. Appeal Bd. (Marlowe)

, . . . 812 A.2d 478, 487 n.14 ( [Pa.] 2002).

Dep’t of Corr. SCI

- Chester v. Faison (Workers’ Comp. Appeal Bd.)

, 266 A.3d 714

, 736 (Pa. Cmwlth. 2021).

As this Court has often opined, the primary role of the WCJ is well settled:

The WCJ is the fa ct finder, and it is solely for the WCJ

. . . to assess credibility and to resolve conflicts in the evidence.

Neither the Board nor this Court may reweigh the evidence or the WCJ ’ s credibility determinations. In addition, it is solely for the WCJ, as the fact [] finder, to determine what weight to give to any evidence.

. . . As such, the WCJ may reject the testimony of any witness in whole or in part

, even if that testimony is uncontradicted

. Hawbaker v. Workers’ Comp. Appeal Bd. (Kriner ’ s Quality Roofing Servs. & Uninsured Emp. Guar. Fund)

, 159 A.3d 61, 69 (Pa. Cmwlth. 2017) (internal citations, quotations, and brackets omitted).

W. Penn Allegheny Health Sys., Inc. v. Workers’ Comp. Appeal Bd. (Cochenour)

, 251 A.3d 467, 475 (Pa. Cmwlth. 2021) (emphasis added)

.

Moreover, “substantial evidence” is such relevant evidence as a reasonable person might accept as adequate11 to support a conclusion. In performing a substantial evidence analysis, the evidence must be viewed in a light
most favorable to the party that prevailed before the WCJ. In a substantial evidence analysis where both parties present evidence

, it is immaterial that there is evidence in the record supporting a factual finding contrary to that made by the WCJ ; rather, the pertinent inquiry is whether there is any evidence which supports the WCJ ’ s factual finding.

Id

. ( emphasis added; citations omitted).

Here, WCJ Hemak considered and compared the expert medical
testimony of Employer’s expert

, Thomas DiBenedetto , M.D. (Dr. DiBenedetto )

, and
Dr. Chun at length and found the testimony of Dr. Chun to be more credible and
persuasive than the testimony of Dr. DiBenedetto. See R.R. at 172a. WCJ Hemak

further determined that, t o the extent Dr. DiBenedetto’s testimony conflict ed with
Dr. Chun’s testimony, Dr. Chun’s testimony wa s accepted and Dr. DiBenedetto’s
testimony was rejected. See id

. WCJ Hemak also specifically accepted Claimant’s
testimony , as it was supported by Dr. Chun’s testimony. See i d

. B ecause WCJ

He mak accepted Dr. Chun’s and Claim a nt’s testimony

, and rejected Dr.

DiBenedet t o’s testimony, which was within his province to do, WCJ Hemak did not
capriciously disregard substantial

, competent evidence in finding that Claimant met
her burden of proof under the Review Petition

.

Employer next argues that t he WCJ failed to render a reasoned decision

based on substantial

, competent record evidence by giving a cursory review of the
evidence and failing to reconcile clear ly contradictory evidence that Claimant
suffered from preexisting low back issues and underlying systemic

conditions/disease.

[A] WCJ ’ s decision must satisfy the reasoned decision requirements of Section 422(a) of the Act, 77 P.S. § 834. Section 422(a) [o f the Act] provides, in relevant part, that12 [a]ll parties to an adjudicatory proceeding are entitled to a reasoned decision containing findings of fact and conclusions of law based upon the evidence as a whole which clearly and concisely states and explain s the rationale for the decisions so that all can determine why and how a particular result was reached.

77 P.S. § 834. To satisfy the reasoned decision requirements, a WCJ must set forth the rationale for the decision by specifying the evidence relied up on and

reasons for accepting it. Daniels [ v. Workers’ Comp. Appeal Bd. (Tristate Transp.) ] , 828 A.2d [ 1043, ] 10 47 [ ( Pa. 2003) ] ; Dorsey v. Workers’ Comp. Appeal Bd. (Crossing Constr. Co.) , 893 A.2d 191, 194 (Pa. Cmwlth. 2006). In the face of conflicting evidence, the WCJ “must adequately explain the reasons for rejecting or discrediting competent evidence.” 77 P.S. § 834. “Section 422(a) [of the Act] does not require the WCJ to discuss all of the evidence presented[]” but only “to make the findings necessary to resolve the issues raised by the evidence and relevant to the decision.” Dorsey , 893 A.2d at 194 n.4. “[T]he purpose of a reasoned decision is to spare the reviewing court from having to imagine why the WCJ believed one witness over another[]” and to “permit adequate appellate review.” Id

. at 194, 196.

Dep’t of Corr. SCI

- Chester , 266 A.3d at 736

- 37.
Here, WCJ Hemak described Claimant’s, s ee R.R. at 170a

- 171a

, Dr.

Chun’s

, s ee R.R. at 171a

- 172a, and Dr. Di Benedetto’s

, s ee R.R. at 17 1 a , testimony
in detail. Thereafter, WCJ Hemak explained:

This [WCJ] has considered and compared the expert medical testimony of Dr. DiBenedetto and Dr. Chun at length and finds the testimony of D r. Chun to be more credible and persuasive than the testimony of Dr. DiBenedetto. Dr. Chun demonstrated that he was more familiar with Claimant and Claimant’s condition, having benefited from examining Claimant on numerous occasions over the course of a y ear, whereas Dr. DiBenedetto examined Claimant on one isolated occasion. Furthermore, the testimony of Claimant and Dr. Chun were quite consistent and supportive of each other.13 Although Dr. DiBenedetto felt Claimant had recovered from her work

- related in

jury and related her complaints to

non

- work

- related problems, the record establishes that Claimant did not have any such complaints or difficulties until she sustained her work

- related injury and has been consistently symptomatic since that time. On the o ther hand, Dr. Chun correlated Claimant’s complaints to his physical examination and the results of the MRI studies. To the extent Dr. DiBenedetto’s testimony conflicts with Dr. Chun’s testimony, Dr. Chun’s testimony is accepted and Dr. DiBenedetto’s test imony is rejected. Furthermore, Claimant’s testimony is also specifically accepted, as it was supported by Dr. Chun’s testimony.

R.R. at 172a.

WCJ Hemak’s credibility determination s complied with the reasoned
decision requirement because they contained more than just a conclusory statement
regarding the experts ’ credibility. WCJ Hemak explained that Dr. C hun’s testimony
was more credible and persuasive than that of Dr. DiBenedett o because it was

consistent wit h Claimant ’ s credible testimony

, and because , as Claimant ’ s treating
physician, Dr. Chun was more familiar with Claimant ’ s experiences and symptoms.

WCJ Hemak explained that he reject ed Dr. DiBenedett o ’s testimony because Dr.

DiBenedett o examined Claimant on a single occasion

. Thus, WCJ Hemak
articulated an objective basis for the determination. Accordingly, WCJ Hemak

rendered a reasoned decision. 8

8 Employer also argues that WCJ Hemak erred by denying Employer’s Termination Petition. Specifically, Employer contends that if th is Court finds that the work injury description should have remained right leg pain, then the Termination Petition should have been granted based

on Dr. DiBenedetto ’s unequivocal testimony. Because this Court rules that Cl aimant met her burden of proving the amended work injury description, this issue is moot.14 For all of the above reasons, the Board’s order is affirmed.

___________________________ ______ ANNE E. COVEY, JudgeIN THE COMMONWEALTH COURT OF PENNSYLVANIA

Amazon.com Services LLC, : American Zurich Insurance Company : and Sedgwick Claims Management : Services, :

Petitioners :

:

v. :

: Engel L. Then Roman (Workers’ : Compensation Appeal Board), : No. 185 C.D. 2022

Respondent :

O R D E R

AND NOW, this 1 st day of December , 20 2 2

, the Workers’
Compensation Appeal Board’s February 8, 2022 order is affirmed.

___________________________ ______ ANNE E. COVEY, Judge