Court Opinion

ID: 9948535
Source: CourtListenerOpinion
Date Created: 2024-03-07 16:05:17.172282+00
Date Added: 2024-06-11T14:30:28.479327
License: Public Domain

IN THE SUPERIOR COURT OF THE STATE OF DELAWARE

STACY MCDANIEL-WESCHE,             :
     Claimant Below-Appellant,     : C. A. No. S23A-03-002 CAK
     v.                            :
SUN BEHAVIORAL HEALTH,             :
     Employer Below-Appellee.      :

                        Submitted: February 15, 2024
                           Decided: March 6, 2024

                  On Appeal from Industrial Accident Board

                                 AFFIRMED

                MEMORANDUM OPINION AND ORDER

Jonathan B. O’Neill, Esquire, Kimmel, Carter, Roman, Peltz & O’Neill, P.A., 56
West Main Street, Suite 400, Plaza 273, Christiana, DE 19702, Attorney for
Claimant/Appellant.

Nicholas E. Bittner, Esquire, Heckler & Frabizzio, 800 Delaware Avenue,
Wilmington, DE 19899-0128, Attorney for Employer/Appellee.

KARSNITZ, R.J.
                       PROCEDURAL BACKGROUND

     On August 23, 2022, Stacy McDaniel-Wesche ( “Claimant”) filed a Petition to

Determine Additional Compensation Due (the “Petition”) with the Delaware

Industrial Accident Board (the “Board”), seeking payment of medical expenses and

permanent impairment to the neck and right upper extremity resulting from a work

accident.

     On February 7, 2023, the Board held a hearing. Claimant testified on her own

behalf, while also submitting deposition transcripts of Dr. Ganesh Balu and Dr.

Jonathan     Kates. Sun Behavioral Health, Inc. (“Employer”) submitted a

deposition transcript of Dr. Lawrence Piccioni. The Board issued its decision on

February 14, 2023, finding Claimant sustained a soft tissue injury to the neck,

with treatment through November 9, 2021 being compensable. Benefits for the

treatment of any other body parts were denied.

     On March 9, 2023, Claimant filed a notice of appeal of the Board’s decision to

this Court, challenging the Board’s decision as to the denial of benefits. Claimant

filed her Opening Brief on October 9, 2023. Employer filed its Answering Brief on

October 26, 2023. Claimant filed her Reply Brief on November 13, 2023. I held oral

argument on February 15, 2024. This is my decision.

                                     FACTS

       On December 13, 2020, Claimant, a registered nurse, was involved in an

                                         2
incident at work where she intervened in an assault and was grabbed and struck by a

patient. Claimant initially felt pain in her neck, and over the following week noticed

pain in other body parts. Claimant subsequently saw video footage of the incident,

but that video has since been recorded over in the normal course of business.

      Following the incident, Claimant went to the emergency room, where she

declined X-rays. Indeed, Claimant did not want to seek treatment at all, but her

husband insisted. The records identify only abrasions and the only body parts treated

were the face and neck.

      Before the work incident, Claimant had treated with a chiropractor for upkeep

on various other body parts.

      After the work incident, Claimant was involved in a motor vehicle accident

on January 18, 2021. She initially did not recall whether she sought treatment for

that accident, although later she testified that she did not seek treatment.

      Claimant began treatment with Dr. Balu on February 9, 2021. Dr. Balu’s

records do not show evidence of radiculopathy. Dr. Balu performed an injection into

the AC joint and the biceps tendon, even though the biceps tendon was shown to be

normal on the MRI. Although Dr. Balu gave a diagnosis of partial rotator cuff tear

and impingement, he never administered an injection into the rotator cuff. Because

the shoulder is compartmentalized, the other injections would not have reached the

subacromial space or the rotator cuff. The injections did not provide significant

                                          3
relief. At a visit with Dr. Balu on July 20, 2021, Claimant was instructed to return in

four weeks, but she did not.

      Instead, Claimant treated with a chiropractor for fifteen visits over a three-

month period. When she stopped treating with the chiropractor in October 2021, she

was doing fairly well.

      Claimant returned to Dr. Balu on February 9, 2022, at which time her physical

examination findings were essentially the same as they had been at the July 2021

visit. However, despite Claimant identifying right shoulder complaints, Dr. Balu

did not perform a right shoulder examination. By November 9, 2022, Claimant’s

pain scores were higher than they had previously been.

      Claimant saw Dr. Kates on February 2, 2022 for the purpose of evaluating

permanent impairment, and not for treatment. Claimant’s intervening motor vehicle

accident was not identified in Dr. Kates’ report, and Claimant never told Dr. Kates

about it. Dr. Kates did not have any records since July 2021, nor did he have

the EMG report. The physical examination findings were not consistent with a

partial rotator cuff tear. There was no atrophy noted, notwithstanding the significant

time elapsed since the work incident. Dr. Kates found no permanent impairment to

the lower back or right hip. He did find 11% permanent impairment to the neck, as

well as 11% permanent impairment to the right shoulder. His opinions were based

on Claimant’s history and subjective complaints and were subject to change if those

                                          4
were not accurate. Claimant saw Dr. Kates again on October 24, 2022, at which time

he still had not seen updated medical records or the EMG. He did not provide her

with a full physical examination at that time.

      Claimant visited Dr. Piccioni on November 9, 2021, after she had

discontinued chiropractic care and during the gap between visits with Dr. Balu. There

were no objective signs on physical examination. Her subjective symptoms did not

match prior EMG or MRI findings to support radiculopathy. At a second examination

with Dr. Piccioni on June 10, 2022, Claimant informed Dr. Piccioni that she had

returned to Dr. Balu. On examination, there were still no objective findings.

                            THE BOARD HEARING

      The Board conducted a hearing on February 7, 2023.                     Claimant

acknowledged she did not identify her pre-accident treatment with a chiropractor.

She acknowledged prior low back and ACL issues. She did not identify the

intervening motor vehicle accident. Claimant testified that she told Dr. Balu about

the accident. However, Dr. Balu testified that she did not tell him about the accident,

and that he did not document the motor vehicle accident and, if Claimant had

reported it, he would have documented it.

      Claimant acknowledged she did not voluntarily seek out treatment, and did

not stop working because of a doctor’s note. Claimant acknowledged her first

appointment with Dr. Balu was almost two months after the work incident, and she

                                          5
only went when she felt it was necessary to do so, and that it had not been necessary

previously. As of the hearing date, she had not seen an orthopedic surgeon.

      Dr. Piccioni testified on behalf of Employer, explaining the first 48 -72 hours

after an injury are the most painful, yet Claimant went back to work, did not receive

much care, and had no initial diagnostic studies. He confirmed that the important

diagnostic studies were performed after the intervening accident; therefore, it is

impossible to distinguish what was caused by the work accident and what was caused

by the car accident. Both Dr. Piccioni and Dr. Kates agreed the MRI findings for

Claimant predated the work accident, and the work accident did not cause any

structural changes. Dr. Balu was the only physician to document spasm, which was

the only objective finding.

      Dr. Piccioni also discussed his concerns with Dr. Balu’s performing all

medical services in-house, generating a bill of almost $63,000 in less than two years

(including a large gap in treatment), without any referral to an orthopedic specialist.

He questioned Dr. Balu’s findings and Claimant’s lack of improvement from

treatment. Dr. Piccioni also questioned the lack of a medical basis for administering

platelet-rich plasma (“PRP”) injections to Claimant.

      Dr. Piccioni testified the work-related injury to the neck was a sprain,

superimposed on chronic degenerative changes, with no evidence of radiculopathy.

It is reasonable and appropriate to conclude the neck injury resolved during the gap

                                          6
in treatment in 2021, after she discontinued chiropractic care and before she returned

to Dr. Balu. Dr. Piccioni did not attribute any right shoulder injury to the work

incident, citing no early complaints or diagnoses, non-acute MRI findings,

inconsistencies between examination findings and diagnoses, and the lack of an

injection to the diagnosed rotator cuff. He also did not attribute any low back or

right hip injuries to the work incident.

      According to Dr. Piccioni, treatment up through October 2021 was

reasonable and necessary, and treatment thereafter was unreasonable regardless

of causation. Dr. Piccioni opined that his examination date of November 9, 2021

was a fair cutoff date for reasonable and necessary treatment. He also believed that

the PRP injections and the right shoulder treatment were neither reasonable nor

necessary. Based solely on Claimant’s subjective complaints, Dr. Piccioni found a

3% permanent impairment to the neck; and if those subjective complaints are not

believed, 0%. Of the 3% rating, it is not possible to distinguish whether it was

caused by the work accident versus the intervening motor vehicle accident.

      There was discussion at the hearing about the video of the incident,

suggesting that the video may have helped prove causation as to certain areas of the

body. Claimant’s attorney asked the Board to draw an adverse inference from the

absence of the video. Employer’s attorney argued in response that the adverse

inference issue should have been raised as a pre-hearing matter.

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      Following a comprehensive review of the evidence, the Board found the neck

injury and treatment through November 9, 2021 to be compensable. The Board

specifically found Dr. Piccioni’s testimony to be persuasive, while Claimant and

Dr. Balu gave inconsistent and insufficient testimony to support any further

benefits. Claimant did not disclose information about the intervening car accident

either to her own medical experts or to the Board, which impacted her credibility.

Claimant was also inconsistent by testifying she could no longer work as a bedside

nurse or engage in activities of daily living, and yet she waited almost two months

to seek further medical treatment, while never pursuing orthopedic treatment.

Claimant only stopped working and sought treatment after the intervening car

accident. Even once treatment started, Claimant again had a lengthy gap in treatment,

which undermined her alleged ongoing symptoms.

      The Board was persuaded by Dr. Piccioni’s comprehensive review of the

records, which supported the exclusion of all injuries but the neck. The Board

accepted his testimony on the imaging and EMG studies, noting they could be

related to either the work accident or the motor vehicle accident, with no way to

distinguish between them, aside from noting the actual MRI findings predated both

accidents. This was buttressed by the gap in treatment, which ended with Claimant

discontinuing chiropractic treatment because she was doing well, supporting the

lack of need for further treatment. The Board spent multiple paragraphs

                                         8
    summarizing Dr. Piccioni’s relevant testimony, noting they found his conclusions

    convincing.

          The Board accepted treatment through November 9, 2021, excluding any PRP

    injections, with the neck injury resolving at that point. The Board found insufficient

    evidence to find right shoulder, hip, or back injuries related to the work accident.

    Given the finding of resolution of the neck and denial of the other body parts, the

    Board accepted Dr. Piccioni’s testimony that there was no permanent impairment

    attributable to the work accident.

                               STANDARD OF REVIEW

         The appeal before me is on the record of the proceedings before the Board.1

M y review is limited. I review the decision of the Board solely to determine whether

there is substantial competent evidence in the record to support the Board's findings

and whether its decision is free from legal error.2

         I do not determine questions of credibility, or make my own factual findings.3

I view the facts in the light most favorable to the Board.4 A ruling of the Board will

not be disturbed on appeal unless it is based clearly on unreasonable or capricious

grounds. The "Court gives significant weight to the [Board] regarding its application

1
   29 Del. C. §10142.
2
   Johnson v. Chrysler Corp., 213 A.2d 64, 66 (Del. 1965); General Motors Corp. v.
Freeman,164 A.2d 686, 688 (Del. 1960); General Motors Corp. v. Jarrell, 493 A.2d 978, 980
(Del. Super 1985).
3
  Id.
4
  Chudnofsky v. Edwards, 208 A.2d 516,518 (Del. 1965).
                                             9
of legal principles in the specialized context of our state's workers' compensation

scheme, because the [Board] has the occasion to give life to that scheme on a weekly

basis in the many cases that come before it."5

                                    ANALYSIS

      There are two issues on appeal: (1) whether the Board’s decision limiting the

compensable injury to Claimant’s neck through November 9, 2021 is supported by

substantial evidence and free of legal error; and (2) whether the Board acted properly

in not applying an adverse inference from the absence of a video of the work accident

(spoliation).

      Substantial Evidence Free from Legal Error

      Claimant argues that the Board's acceptance of Dr. Piccioni’s medical expert

opinion that Claimant had a 0% - 3% impairment to the neck, and no injury to the

low back or right hip, attributable to the work accident is legally flawed. However,

“[t]he Board is free to accept or reject in whole or in part testimony offered before

it and to fix its verdict upon testimony accepted."6 The Board is free to accept one

expert's opinion over another and may accept or reject an expert's testimony

entirely.7 The Board acted within its legal authority when accepting the expert

5
  Berry v. MIRTA QSR KNE LLC, 2021 WL 626944 (Del. Super. Feb. 16, 2021) citing
Christiana Care Health Services v. Davis, 127 A.3d 391, 395 (Del. 2015).
6
  Collins v. Giant Food, Inc., 1999 WL 1442024, at *3 (Del. Super. Oct. 13, 1999).
7
  Torres v. Reybold Homes, Inc., 1999 WL 144024 (Del. Super. Apr. 24, 2014).
                                         10
testimony of Dr. Piccioni over that of Dr. Balu. The Board's acceptance of expert

testimony, even when contradicted by other expert testimony, qualifies as substantial

evidence for purposes of appeal.8 Substantial evidence is "such relevant evidence as

a reasonable mind might accept as adequate to support a conclusion."9 In my

opinion, the Board's decision to accept Dr. Piccioni’s medical expert opinion as to

the extent of Claimant’s injuries from the work accident was supported by substantial

evidence and within the Board's purview as trier of fact.

      Beyond the Board’s broad discretion in choice of medical experts, it also

enjoys discretion in its findings of credibility. “Often, as in this case, this factual

finding depends in large measure on the Board's assessment of the credibility of the

witnesses who testify before it. It is the exclusive function of the Board to evaluate

the credibility of witnesses.”10 Our Supreme Court has upheld the Board’s

prerogative to find a delay in seeking treatment to harm the claimant’s credibility.11

      Claimant argues the lack of diagnostic testing after the work accident simply

means that she preferred to go back to work. Claimant also failed to seek diagnostic

testing after her work shift ended. In my view, however, this undercuts her claim of

significant injury. Claimant continued to work her regular job as a nurse until she

8
 DiSabatino Bros. Inc. v. Wortman, 453 A.2d 102, 106 (Del. 1988).
9
 Histed v. E.J DuPont de Nemours & Co., 621 A2.d 340, 342 (Del. 1993).
10
   Powell v. OTAC, Inc., 223 A.3d 864, 871 (Del. 2019).
11
   Id., at 872.
                                            11
voluntarily quit. She was never given work restrictions prior to quitting. Claimant

went to her primary care physician, who did refer her to an orthopedic specialist or

to obtain CT or MRI studies of any body part, and only obtained X-rays of the neck.

Nothing else was apparently significant enough to concern the physician. Indeed, she

did not obtain anything more than a cervical X-ray after the intervening vehicle

accident. The Board accepted her cervical injury, after her eventual pursuit of a

cervical X-ray and treatment for her neck. However, even on a subsequent visit to

her primary care physician, she did not complain about her right shoulder or low

back. Moreover, did not even allege low back and right hip injuries as part of her

Petition. The Board refused to accept Claimant’s claims, as is their prerogative.

       Claimant states that the Board claimed the emergency room records do not

document right shoulder, low back, or right hip pain, and then counters that Dr.

Piccioni identified right hip and low back complaints. However, Dr. Piccioni was

referring to her primary care physician’s records, not the emergency room records.

       Claimant must prove that she suffered an injury sustained during an accident

related to her employment.12 Identifying a symptom does not constitute proving an

injury. There was essentially no treatment for the right hip and lower back, and by

the time of Dr. Piccioni’s first examination, Claimant no longer had complaints to

12
  Lewicki v. New Castle County, 913 A.2d 570, 2006 WL 3307436, at *2 (Del. Super. Nov. 15,
2006) (Table).
                                             12
either body part. Dr. Balu provided no meaningful explanation as to why he would

relate the low back and right hip to the work accident, nor did he address the lack of

such complaints documented in the emergency room records.

      Claimant did not provide the name of her chiropractor. Thus, no physician

was able to review her pre-accident chiropractic records, although Claimant

acknowledged receiving chiropractic adjustments before the accident. This could be

evidence of a preexisting low back and right hip condition. However, because

Claimant was not forthcoming with the chiropractic records, neither her physicians

nor Employer’s physician could review them to determine if her subsequent

symptoms and complaints preexisted the work accident, This affects decision making

as to the issue of causation.

      With respect to the gaps in treatment, Claimant disputed not seeking

additional treatment for two months after the work accident, and stated she treated

consistently with Dr. Balu except for a three-month gap. While Claimant did go to

her primary care physician three weeks after the work accident, there was no

specialist treatment until two months later, and no orthopedic treatment at all.

Claimant’s gap in treatment with Dr. Balu stretched from July 2021 to February 2022

-- a span of seven months. Claimant discontinued treatment with Dr. Balu, having

only a handful of chiropractic sessions resulting in reported improvement in

symptoms, and then a gap with no treatment at all until it was time to be rated for

                                         13
permanent injury by Dr. Piccioni. Only then did Claimant return to Dr. Balu. All

these events point to minor medical problems and damaged Claimant’s credibility.

         Of course, the initial delay is also complicated by the intervening vehicle

accident. Claimant minimizes this because she testified that she had no injuries and

sought no treatment related to that accident. Before the vehicle accident, there was

no indication the work accident aggravated any preexisting conditions, and all her

symptoms were consistent with a neck strain/sprain. The vehicle accident could

cause new injuries aggravating her preexisting conditions. It is impossible to state to

a reasonable degree of medical probability that the vehicle accident had no impact

on Claimant’s physical condition. Dr. Piccioni testified about the complication the

intervening vehicle accident raises in assessing causation and the extent of injuries related

to the work accident, and the Board accepted his testimony. In a similar case, where

Dr. Picconi also testified, an MRI finding giving rise to surgery was only visualized

after intervening incidents, which could have caused additional injury to the

claimant’s lumbar spine. The Board accepted the doctor’s testimony and found that

claimant failed to meet the burden of proof, and this Court affirmed: “By accepting

Dr. Piccioni's opinion, the Board made a permissible credibility determination in

order to reconcile competing medical theories of causation.”13

         With respect to the intervening vehicle accident, Claimant is an intelligent and

13
     Hamilton v. Independent Disposal Service, 2017 WL 631770 (Del. Super. Feb. 15, 2017).
                                               14
educated medical professional, and she knows or should know that vehicle accidents

are considered significant events, which should be disclosed to medical providers. In

fact, her testimony of telling Dr. Balu about the accident demonstrates its relevance.

      The evidence about the intervening vehicle accident and treatment therefor is

conflicting and contradictory. Dr. Piccioni testified that Claimant could not recall

whether she received treatment following the vehicle accident. Claimant’s attorney

testified there was an emergency room visit after the vehicle accident. Claimant testified

there was no medical treatment following the accident. Claimant also testified she

told Dr. Balu about the accident, but Dr. Balu denied this. indicated she did not, or

he would have documented it. The Board was well within its rights to find this

harmful to Claimant’s credibility.

      Next, Claimant argues that the Board rejected the necessity of PRP injections

without explanation. However, the Board reviewed Dr. Piccioni’s reasoning for

rejecting them and explicitly agreed with such reasoning. Whether the Board has

previously awarded PRP injections in other cases is irrelevant. The prior Board

decision cited by Claimant involved injections to the left ankle. Dr. Piccioni

discussed the anatomy where PRP injections could be considered, noting none of

that applied in this case. Further, it appears from the record the first PRP injection

was performed on February 21, 2022, which is after the cutoff date due to

resolution, and thus it is irrelevant whether the Board specifically considered it,

                                           15
because the Board found all treatment after the cutoff to be non-compensable due to

resolution.

      Next, Claimant argues that the Board placed too much weight on Dr.

Piccioni’s testimony on the degree of permanency of the neck injury from the work

accident. With respect to her right shoulder, Claimant stresses Dr. Piccioni’s statement

that there was an impact to Claimant’s right side by a chair during the work accident.

As stated above, however, contact of a body part may constitute an accident, but it

does not automatically mean that there is an injury.

       Claimant suggests Dr. Piccioni’s testimony is speculative, and yet her own

medical experts do not address causation or the interplay with the intervening vehicle

accident. Dr. Kates stated that all MRI findings predate the work accident, and show

no acute, traumatic rotator cuff injury. His entire explanation for causation of the

right shoulder was because Claimant was asymptomatic before the work accident.

However, according to the emergency room and primary care physician records,

Claimant’s right shoulder was also asymptomatic after the work accident. The only

complaints arose after the intervening vehicle accident.         which, as discussed

previously, is fatal to establishing causation linked to her employment. Even the

diagnosis of a rotator cuff tear is questionable, as Dr. Balu never treated the rotator

cuff; he injected areas of the shoulder completely unrelated to the rotator cuff.

      Claimant has also failed to carry her burden of proof on the issue of

                                          16
permanency of the injury. Claimant must prove the loss of a body part or a loss of

use of a body part resulting from the work accident.14 Evidence showing a lack of

work-related symptoms goes to the core of the loss of use standard, even if the Board

does not plainly state that it is addressing loss of use.15 “Without some physical

manifestation of the injury, the Board correctly assert[s] that the Claimant suffered

no loss of use.”16 If there are no medical findings attributable to a work injury, then

there cannot be a loss of use, as loss of use must be demonstrable through the

manifestations of the injury.17

       The only physician to document objective findings in the neck (spasm) was

Dr. Balu. The two physicians who assessed permanent impairment did not find any

spasm or other objective findings. As explained by Dr. Piccioni, objective findings

in this situation would include atrophy, loss of reflex, paralysis, spasm, swelling,

bruising, and lacerations; none of those were found by Dr. Kates or Dr. Piccioni.

Because the Board did not find Claimant to be credible, it was entitled to discount her

subjective complaints. The lack of objective medical findings means that there is no

loss of use, and no loss of use means that there is no permanent impairment. Even

if the Board had accepted Claimant’s subjective complaints, it was her burden to

14
    Miller v. Delaware Psychiatric Ctr., 2013 WL 1281850, at *11 (Del. Super. Mar. 28, 2013).
15
   See Cruz v. Ryder Public Transp., 2003 WL 1563719, at *6 (Del. Super. Mar. 20, 2003).
16
   Young v. Food Lion, Inc., 2002 WL 499890, at *2 (Del. Super. Jan. 28, 2002).
17
    Id.
                                               17
prove they related to the work accident, and she failed to do so.

      Claimant suggests the finding of a soft tissue injury to the neck is inconsistent

with the MRI imaging showing herniated discs. This ignores Dr. Kates’ own

acknowledgment that such MRI findings predated the work accident. Dr. Picconi

agreed with Dr. Kates’ statement on the MRI findings predating the accident.

Claimant’s argument is contradictory: the herniated discs are proof of more than a

soft tissue injury resulting from the work accident, but her own expert testified that

the herniations predated the work accident. In any event, the Board’s specifically

found that the MRI studies showed no acute findings. Even if the studies did show

acute findings, they occurred after the intervening vehicle accident.

      The controlling point is that the Board’s decision was supported by substantial

competent evidence.

      Spoliation

      Claimant argues that the Board should have drawn an adverse inference from

the spoliation of the video of the work accident. I have three reasons for rejecting

this argument.

       First, Claimant never directly asked for an adverse inference finding at the

 Board hearing. During closing arguments, counsel for Claimant discussed the video

 and said that there should be an adverse inference with respect to the video. Counsel

 did not ask for a ruling on an adverse inference; he simply asked the Board to act

                                          18
 as if there were an adverse inference. But “[a]dministrative cases cannot be

 ‘reversed and remanded’ on appeal based on a change in strategy and evidence that

 parties chose not to present to the administrative board.”18 “[W]hen the Court acts

 in its appellate capacity on an appeal from an administrative agency, it is limited to

 the record, and will not consider issues not raised before that agency.”19

        Second, Claimant did not follow the Delaware process for obtaining an

 adverse inference. There must be a preliminary finding of intentional or reckless

 destruction of evidence,20 but Claimant never requested such a finding by the

 Board. Even if Claimant had followed the appropriate procedure, there is no

 evidence on the record of intentional or reckless conduct. Claimant’s testimony

 was t h a t the video was not saved and had been recorded over, not deleted. No

 other evidence was presented about the video. Claimant never requested that a copy

 of the video be saved. The claim itself had been accepted, and there was no dispute

 that the incident had occurred. The complaints about the right shoulder began two

 months later, so there was no reason at the time Claimant saw the video to believe

 that there would be a dispute as to which body parts were injured in the work

 accident.

18
    Gatewood v. Salga Products, Inc., 1996 WL 944878, at *5 (Del. Super. Aug. 5, 1996).
19
    Potts Welding & Boiler Repair Co., Inc. v. Zakrewski, 2002 WL 144273, at *4
(Del. Super. Jan. 11, 2002).
20
   Sears, Roebuck and Co. v. Midcap, 893 A.2d 542, 550 (Del. 2006).
                                              19
       Third, there is no reason to believe an adverse inference would have changed

 the outcome. The Board’s decision focused heavily on gaps and delays in

 treatment and complaints, coupled with the issue of the intervening accident.

 Claimant testified as to precisely what the video allegedly showed, and the Board

 was free to accept or reject her testimony. Even if the video corroborated

 Claimant’s testimony, she failed to identify any right shoulder complaints for two

 months after the work accident. That delay in onset -- a critical issue for the Board

 -- had nothing to do with the video.

                                  CONCLUSION

      For the foregoing reasons, Claimant’s appeal is denied, and the decision of

the Board is AFFIRMED.

      IT IS SO ORDERED.

                                               /s/ Craig A. Karsnitz
                                               Craig A. Karsnitz

cc:   Prothonotary

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