Court Opinion

ID: 9374853
Source: CourtListenerOpinion
Date Created: 2023-02-24 15:05:40.294654+00
Date Added: 2024-06-11T17:16:53.644197
License: Public Domain

RENDERED: FEBRUARY 17, 2023; 10:00 A.M.
                      NOT TO BE PUBLISHED

               Commonwealth of Kentucky
                        Court of Appeals

                           NO. 2021-CA-0797-WC

KENNETH TURNER                                                  APPELLANT

                 PETITION FOR REVIEW OF A DECISION
v.             OF THE WORKERS' COMPENSATION BOARD
                       ACTION NO. WC-15-94425

COMMONWEALTH OF KENTUCKY-
DEPARTMENT OF CORRECTIONS;
HONORABLE JONATHAN ROBERT
WEATHERBY, JR.,
ADMINISTRATIVE LAW JUDGE;
AND WORKERS’ COMPENSATION
BOARD                                                            APPELLEES

                                 OPINION
                                AFFIRMING

                                ** ** ** ** **

BEFORE: ACREE, EASTON, AND JONES, JUDGES.

JONES, JUDGE: The Appellant, Kenneth Turner, seeks review of the June 18,

2021, opinion of the Workers’ Compensation Board (“Board”), wherein the Board
affirmed the Administrative Law Judge’s (“ALJ”) order on remand. Having

reviewed the record and being otherwise sufficiently advised, we affirm the Board.

                                  I. BACKGROUND

             In 2015, Turner was 58 years old and employed by the Department of

Corrections as a full-time maintenance employee. He performed most of his duties

at the Kentucky State Penitentiary in Eddyville, Kentucky, taking care of

plumbing, electrical, and air conditioning issues. Turner’s job duties required him

to lift and carry heavy items and climb ladders.

             Turner worked the night shift at the penitentiary on February 15,

2015, and some overtime the following the day. Sometime between 2:00 p.m. and

3:00 p.m. on February 16, 2015, Turner was sent to return a key to the yard office

after which he planned to clock out and go home. After returning his key, Turner

attempted to walk along a sidewalk within the penitentiary. It had been snowing

the night before, and there was snow and ice on the walkway. Turner slipped and

fell on the icy sidewalk. As part of this claim, Turner alleges that he injured his

hip, ribs, right shoulder, and neck when he fell. Only Turner’s alleged neck injury

remains at issue.

             The following week, on February 23, 2015, Turner visited his family

practitioner, Holly McCormick, APRN, with complaints of headaches, right

shoulder pain, and right-sided chest pain; it does not appear that Turner

                                         -2-
complained of any neck pain at that time. Turner described his fall to Nurse

McCormick. She ordered x-rays and a CT scan. The x-rays revealed a shoulder

abnormality of the clavicle and in the AC joint and broken ribs. Nurse McCormick

referred Turner to an orthopedic surgeon for his shoulder condition. Turner

returned to Nurse McCormick on March 4, 2015, with continued complaints of

pain in his right shoulder and ribs. He did not make complaints of neck pain at this

time either. Nurse McCormick referred Turner to the Trigg County Hospital

Rehabilitation Department (“Trigg County”) for physical therapy.

              Turner complained of right upper extremity radicular pain during his

first physical therapy appointment on March 24, 2015. At a March 31, 2015, visit,

Turner again complained of right upper extremity pain with headaches, and the

office notes indicate cervical pathology was suspected.

             Turner returned to Nurse McCormick again on April 6, 2015, because

of his neck pain, which he reported was gradually worsening since his fall. Nurse

McCormick noted that Turner reported to her that he had been having issues with

neck pain since his work accident, and that it had been coming on gradually after

the work accident. Turner continued his complaints on April 13, 2015. According

to office notes, Turner had a positive Spurling’s test for cervical radiculitis and

demonstrated limited cervical range of motion.

                                          -3-
             Nurse McCormick referred Turner to Dr. Chang after an MRI

revealed pathology within Turner’s shoulder, and Dr. Chang recommended Turner

visit a cervical specialist. On May 7, 2015, Nurse McCormick noted that Turner

was still having difficulties with his neck and was awaiting a referral to an

orthopedic specialist for the condition. On July 16, 2015, Nurse McCormick

observed that the MRI of Turner’s neck was abnormal and wrote that “[t]his all

stems from a worker’s comp claim when he fell and hit his neck, head, and

shoulder area.”

             Turner was eventually referred to Dr. Gregory Lanford, who saw

Turner for an independent medical examination (“IME”) and a neurological

evaluation on September 17, 2015. Dr. Lanford diagnosed right C6 radiculopathy,

weakness in the right biceps, and absent right biceps jerk consistent with foraminal

stenosis at C5-6 on the right. Dr. Lanford observed that Turner did not experience

any of his current symptoms prior to the work injury. Dr. Lanford noted that

Turner had failed conservative treatment and recommended a cervical fusion at

C4-6. Dr. Lanford concluded that, without surgery, Turner would be at maximum

medical improvement.

             Dr. Paul Phillips, Jr., analyzed Dr. Lanford’s surgical

recommendation through a utilization review on September 29, 2015. Dr. Phillips

found the requested anterior cervical fusion at C4-6 was not medically necessary

                                         -4-
and appropriate as the records did not include significant findings of recent

electrodiagnostic studies confirming negative cervical radiculopathy. Dr. Phillips

indicated that the surgery was not pre-certified, because Turner had not undergone

selective nerve root blocks.

             Dr. Berkman, a neurosurgeon, also saw Turner at the request of the

carrier. Dr. Berkman stated that the February 16, 2015, work-related injury caused

a right shoulder injury, cervical sprain, and exasperation of pre-existing cervical

spondylosis with a right C5 radiculopathy. Dr. Berkman recommended epidural

steroid injections at the C4-5 on the right and additional physical therapy for the

cervical spine problems.

             The workers’ compensation carrier ultimately denied the proposed

cervical fusion, at which time there was a lapse in Turner’s treatment. By July 6,

2016, however, Turner obtained private insurance coverage and began treating

with Dr. John Yezerski for his shoulder and neck. Dr. Yezerski diagnosed a right

rotator cuff tear and adhesive capsulitis of the right shoulder. Dr. Yezerski initially

treated the condition conservatively with injections, but those measures failed and,

on August 1, 2016, Dr. Yezerski performed a total shoulder replacement, which

returned Turner to a functional range of motion and increased his strength. Dr.

Yezerski opined that following the surgery Turner had a 14% impairment to the

body as a whole.

                                          -5-
             Dr. Yezerski provided Turner with a number of restrictions, including

prohibiting him from reaching overhead with his right arm. Since Turner had to

climb ladders to perform his maintenance job at the penitentiary, this precluded

Turner from returning to the type of work he was performing at the time of his

injury. Dr. Yezerski indicated that Turner reached maximum medical

improvement on September 13, 2017.

             After the shoulder surgery, Turner again sought treatment for his neck

pain. Because his insurance would not permit a return to Dr. Lanford, Turner

visited Dr. Thomas Gruber on November 8, 2016, for neck pain and numbness.

Dr. Gruber noted that Turner’s issues were complicated insomuch as the cervical

spine problems and right shoulder problems made it hard to differentiate the cause

of pain. An MRI revealed degenerative disc disease with right foraminal stenosis

at the C4-5 and C5-6 levels along with disc herniation at both levels. Dr. Gruber

agreed with Dr. Lanford that a two-level fusion surgery was the appropriate

treatment.

             Dr. Gruber performed the fusion surgery on February 6, 2017. Turner

indicated that his cervical condition improved after the surgery but he continued to

experience some cervical stiffness. Dr. Gruber recommended trigger point

injections to improve the stiffness. Following a July 11, 2017 visit, Dr. Gruber

concluded Turner had reached maximum medical improvement for his neck

                                        -6-
condition and could return to work. In an August 15, 2017, report, Dr. Gruber

indicated that Turner’s work injury exacerbated the pre-existing dormant, non-

disabling degenerative conditions in Turner’s cervical spine and concluded Turner

had no active impairment rating prior to the injury. He assigned Turner a 25%

impairment rating and gave him several restrictions regarding lifting loads over

twenty pounds and turning his head.

             On August 12, 2015, Dr. Gregory Gleis performed an IME.

According to Dr. Gleis, a May 12, 2015 cervical spine x-ray and a June 25, 2015

cervical MRI revealed pre-existing degenerative changes. Dr. Gleis believed that

while Turner’s left shoulder condition was consistent with pain from the cervical

spine and his initial right shoulder symptoms were consistent with an AC joint

separation, Turner’s symptoms were now suggestive of referred cervical pain.

From Turner’s examination and medical records, Dr. Gleis found sufficient

correlation between the neck and right arm symptoms to conclude that the head

contusion from the February 16, 2015, incident could have caused Turner’s neck

injury. He determined that Turner was not yet at maximum medical improvement

for the cervical spine.

             On April 3, 2018, Dr. Thomas O’Brien also conducted an IME. He

diagnosed minor bruises/contusions to the shoulder, ribs, and hip as a result of the

work incident. Dr. O’Brien concluded Turner did not sustain a permanent injury in

                                         -7-
the fall; rather, Turner’s rib and hip contusions resolved a few days after the

incident and his shoulder pain improved. Dr. O’Brien, who did not review

Turner’s physical therapy records, emphasized that Turner did not complain of

neck pain until almost two months after the work accident and relied upon his

interpretation of the June 23, 2015, MRI scan of Turner’s cervical spine. Dr.

O’Brien concluded:

             Mr. Turner has a non-work-related, multilevel, cervical
             degenerative disc disease. The work activities of
             February 16, 2015, did not cause an injury to the cervical
             spine nor cause any type of temporary or permanent
             aggravation, acceleration or precipitation of this
             degenerative cervical condition above and beyond the
             natural history of progression of this condition in a
             middle-aged man. The two-month hiatus where there are
             no symptoms of neck pain or cervical radiculopathy
             effectively rules out a causal association with Mr.
             Turner’s neck symptoms and the ultimate surgical
             procedure that was carried out by Dr. Gruber in the form
             of a C4-C5, C5-C6 anterior cervical decompression and
             fusion procedure on February 6, 2017. Further support
             for my causation opinion comes from the objective
             imaging studies including the cervical MRI scan. The
             cervical MRI scan dated June 23, 2015 depicts
             longstanding, mild, degenerative disc changes at C4-C5
             and C5-C6 with no acute objective findings that can in
             any way be causally associated with an acute injury to
             the cervical spine resulting from the work incident of
             February 16, 2015.

(Record (R.) at 322) (emphasis added). Dr. O’Brien assessed a 0% impairment for

the neck and opined Turner could have returned to unrestricted work by May 12,

2015.

                                         -8-
             Turner filed a Form 101 on November 11, 2018, seeking both

temporary and permanent wage and medical benefits for his work-related injuries.

In his Form 101, Turner alleged he sustained multiple injuries to multiple body

parts when he slipped and fell at work on February 16, 2015. Following a final

hearing, at which Turner testified, the ALJ rendered his initial decision on July 23,

2018. The ALJ relied heavily upon Dr. O’Brien’s opinions and determined that

Turner sustained only temporary injuries to the shoulder, ribs, and hip due to his

work accident. The ALJ awarded Turner temporary benefits from the date of the

accident until May 12, 2015, when he determined Turner had reached maximum

improvement. Turner appealed to the Board.

             On January 11, 2019, the Board issued an opinion vacating the ALJ’s

opinion and remanding the claim to the ALJ for a review of the evidence with

particular regard to Dr. O’Brien’s opinion. The Board acknowledged that Dr.

O’Brien’s opinion on causation was based in part on a partially incomplete medical

history insomuch as it did not contain Turner’s physical therapy records. The

Board directed the ALJ to review Dr. O’Brien’s opinion in the context of those

records and provide additional findings related thereto.

             On March 18, 2019, the ALJ issued his first decision on remand,

again finding that Turner had sustained only temporary injuries. Despite the

Board’s directions on remand, the ALJ did not reference the physical therapy

                                         -9-
records or explain whether he considered how Dr. O’Brien’s failure to review

those records as part of his IME might affect the reliability of Dr. O’Brien’s final

opinion.

              Turner appealed, and on August 2, 2019, the Board rendered its

second opinion vacating and remanding the ALJ’s judgment. Although the Board

had directed the ALJ to provide a summary of the Trigg County records, the ALJ

failed to include the fact that Turner was experiencing cervical spine pain at his

appointments and did not reference the March 24 and 31 physical therapy records

in his summary. The Board noted that the ALJ’s only reference to the physical

therapy records was: “[w]hile there was some reference to neck symptoms made at

a physical therapy visit on March 24, 2015, as well as a complaint to a nurse on

April 6, 2015, the point made by Dr. O’Brien regarding the late onset of symptoms

is still persuasive.” (R. at 1056.) On remand, the Board refused to direct the ALJ

to issue an opinion without considering Dr. O’Brien’s medical opinions altogether

as Turner requested; instead, it directed the ALJ to address all the records before

him as they pertained to Turner’s cervical condition and to explain that Dr.

O’Brien did not review Turner’s physical therapy records in the course of his

evaluation.

              On October 22, 2019, the ALJ rendered his second opinion on

remand. The ALJ addressed the Trigg County physical therapy records briefly,

                                         -10-
mentioning that Turner was seen on April 13, 2015, and referenced notes of

shoulder impingement, cervical complaints, apparent range of motion

measurements, and a possible Spurling’s test. However, the ALJ ultimately found

these records to be “illegible” and therefore of little evidentiary value. The ALJ

again failed to discuss the March 2015 physical therapy records and reiterated his

reliance upon Dr. O’Brien’s opinions without accounting for the fact that Dr.

O’Brien rendered his opinion without the benefit of having reviewed all the

physical therapy records. The ALJ also noted the objective findings supporting Dr.

O’Brien’s opinions, including his review of the June 23, 2015, MRI.

             Turner again appealed to the Board, arguing that the ALJ had once

again failed to explain how he could rely on Dr. O’Brien’s conclusion with respect

to the cervical injury when it appeared that opinion incorrectly relied on the fact

that Turner had not complained of cervical pain to any of his providers in the

immediate aftermath of his fall. On February 7, 2020, the Board once again

vacated and remanded the ALJ’s judgment. The Board wrote:

             We note the ALJ has had multiple opportunities to
             provide an accurate review of the evidence but has failed
             to do so. In his latest decision, the ALJ only made a
             passing statement that the records from the Trigg County
             Hospital Rehabilitation Department are “illegible,” and
             did not reference the physical therapy records. We must
             therefore, again vacate the ALJ’s determinations, and
             remand for a complete review of the records, and those
             from the Trigg County Hospital Rehabilitation
             Department. The ALJ must then discuss the impact of

                                         -11-
            the information contained in those records upon Dr.
            O’Brien’s opinion. After reviewing the evidence and the
            impact, the ALJ may make any determination supported
            by the evidence. We do not direct any particular result;
            however, any decision must be based upon an accurate
            review of the evidence and its impact.

(R. at 1146) (emphasis added).

            This time, Turner did not wait for the ALJ to render another opinion.

Instead, Turner petitioned our Court for review of the Board’s opinion. Before us,

Turner argued the Board abused its discretion insomuch as it should have: (1) held

that Dr. O’Brien’s opinion cannot constitute substantial evidence supporting the

ALJ’s opinion; (2) and remanded the claim to the ALJ for new findings and

conclusions in conformity with that holding and without reference to or reliance

upon Dr. O’Brien’s IME.

            Following an extensive review of the record and case law, we

affirmed the Board, holding that Dr. O’Brien’s failure to review the physical

therapy records did not require exclusion of his report. We explained:

                   We are not convinced that the facts before us are
            analogous to those of Cepero [v. Fabricated Metals
            Corp., 132 S.W.3d 839 (Ky. 2004)] or Eddie’s Service
            Center [v. Thomas, 503 S.W.3d 881 (Ky. 2016)]. Rather,
            we are persuaded that the facts before us most closely
            resemble those of GSI Commerce [v. Thompson, 409
            S.W.3d 361, 365 (Ky. App. 2012)]. Turner accurately
            points out that Dr. O’Brien did not have the opportunity
            to review his full medical history, while the other doctors
            did. However, Dr. O’Brien did not arrive at his medical
            determination solely on the basis of the partially flawed

                                       -12-
medical history before him. Dr. O’Brien’s premise for
concluding that Turner’s injuries were not causally
related to his work injury was not entirely based upon his
somewhat incomplete medical history – it was also based
upon his interpretation of objective medical data:
Turner’s June 23, 2015, MRI. Dr. O’Brien opined that
the MRI “depicts longstanding, mild, degenerative disc
changes at C4-C5 and C5-C6 with no acute objective
findings that can in any way be causally associated with
an acute injury to the cervical spine resulting from the
work incident of February 16, 2015.” R. at 322.

       Additionally, we note that Dr. O’Brien states in his
report that he based his opinion, at least partially, on the
lack of reference to any neck pain for two months. Two
months is approximately eight weeks. Turner fell on
February 16, 2015. The first mention of neck pain in the
physical therapy records is around March 24, 2015, a
period of five weeks and one day, less than two months
but greater than one month. It is entirely possible the
ALJ could have determined that the physical therapy
records would not have totally contradicted Dr.
O’Brien’s statements insomuch as Turner did not report
neck pain to any medical provider in the days, weeks, or
even first month following his fall. Turner also testified
that his neck pain was not immediate, beginning a few
weeks after his fall.

       Based on our review of the records, we agree with
the Board. Dr. O’Brien’s opinion, although based in part
on an incomplete review of all the medical records, is not
so “substantially inaccurate or largely incomplete” that it
could not be considered substantial evidence by the ALJ.
See Cepero, 132 S.W.3d at 842. As such, we cannot
disagree with the Board’s decision refusing to direct the
ALJ to reconsider the award without consideration of or
reliance on Dr. O’Brien’s opinion.

      In this circumstance, evaluating the credibility and
proper weight of Dr. O’Brien’s report falls on the ALJ.

                            -13-
            Paramount Foods, Inc. [v. Burkhardt, 695 S.W.2d 418,
            419 (Ky. 1985)]. The ALJ may determine whom and
            what to believe when there is conflicting evidence.
            Pruitt v. Bugg Brothers, 547 S.W.2d 123, 124 (Ky.
            1977). The Board is charged with making sure the ALJ’s
            opinion is based on an accurate understanding of the facts
            and evidence. To date, the ALJ’s opinions have not
            demonstrated a sufficient understanding of the record to
            allow the Board to confidently conclude that the ALJ
            considered the scope of the issues before deciding that
            Dr. O’Brien’s report was the most credible and reliable
            report before him. The Board cannot affirm the ALJ
            unless his determinations are based upon an accurate
            review of the evidence and its impact. The ALJ must
            provide a sufficient basis for his determination as the
            Board has directed. Kentland Elkhorn Coal Corp. v.
            Yates, 743 S.W.2d 47, 49 (Ky. App. 1988).

Turner v. Department of Corrections, No. 2020-CA-0330-WC, 2020 WL 6114559,

at *8 (Ky. App. Oct. 16, 2020).

            Hoping to put an end to the impasse between the ALJ and the Board,

we attempted to articulate how the ALJ might go about demonstrating to the Board

that he had an adequate understanding of the record. To this end, on remand, we

urged the ALJ to:

            separately discuss each of the following in as much detail
            as possible to provide the assurances the Board requires
            with respect to the record: (1) provide a summary and
            analysis of the March and April records at issue
            highlighting any complaints or references to
            cervical/neck pain or treatment; (2) summarize and
            explain his understanding of Dr. O’Brien’s opinions
            regarding Turner’s neck injury and the rationale
            underpinning those opinions, if any; (3) provide some
            explanation of whether Dr. O’Brien’s failure to review

                                       -14-
              the records at issue affected the ALJ’s assessment of the
              credibility and reliability of Dr. O’Brien’s report, and the
              explanation for such determination; and (4) in light of
              any such determination explain how the ALJ considered
              Dr. O’Brien’s opinion in comparison to the other
              opinions of record.

Id.

              Finally, we reminded the Board that if the ALJ did so, “the Board

must then accept the ALJ’s ultimate findings so long as they are legally sufficient,

as the Board ha[d] plainly determined that Dr. O’Brien’s opinion is capable of

serving as substantial evidence if supporting analysis is provided by the ALJ.” Id.

              On January 26, 2021, the ALJ rendered a remand opinion and order.

In relevant part, it states:

                     This matter is before the ALJ upon Remand from
              the Workers’ Compensation Board with direction to
              provide additional findings in light of [Turner’s] physical
              therapy records that indicate complaints of cervical pain
              that [Turner] related to the work injury as well as the
              suspicion referenced by Holly McCormick to the
              suspected cervical pathology. The prior findings and
              evidence summaries, specifically including the references
              to the physical therapist’s conclusions and APRN Holly
              McCormick’s notes as listed in the Opinion, Award and
              Order issued on July 23, 2018, are specifically
              incorporated herein by reference.

              1. [Turner] in this matter alleged a work-related injury
              occurring on February 16, 2015. He presented to Trigg
              County Hospital and the medical records reference
              shoulder impingement, cervical complaints and a positive
              Spurling’s test.

                                          -15-
2. The medical records of Holly McCormick, APRN
indicate that [Turner] presented on February 23, 2015, a
week after the fall at work, but did not complain of neck
pain or issues. [Turner] was referred to physical therapy
and began to complain about radicular pain in the right
upper extremity on March 24, 2015, and again on March
31, 2015. On April 6, 2015, [Turner] reported having
had some issues with neck pain since the work accident.
His physical therapist believed that his shoulder pain
could have been work-related and cervical pathology was
suspected per the office note of the same date.

...

5. The ALJ has repeatedly found that the opinion of Dr.
O’Brien is the most persuasive and convincing in this
matter. The ALJ acknowledges that the report of Dr.
O’Brien includes a review of the records of Holly
McCormick, APRN, but does not include a reference to
[Turner’s] cervical spine complaints or the much-
discussed physical therapy records which include a
reference to [Turner’s] initial cervical spine complaints.
While this omission is unexplained, the poor image
quality of the documents cannot be overlooked.

6. The ALJ finds that these omissions by Dr. O’Brien do
not diminish the substantial credibility of his opinions
regarding [Turner’s] condition. The ALJ also notes that
while Dr. O’Brien referenced a two-month delay in the
reporting of symptoms by [Turner], the records
referenced herein clearly limit that delay to
approximately five weeks. The ALJ also finds that this
discrepancy has no effect on the credibility of the
opinions offered by Dr. O’Brien.

...

8. The ALJ finds that the failure by Dr. O’Brien to
acknowledge that [Turner] complained about work-
related cervical symptoms a few weeks earlier than he

                           -16-
            previously believed, or that a nurse practitioner suspected
            cervical pathology, do not rise to the level articulated in
            Cepero that would constitute a medical history so
            inaccurate as to nullify his otherwise credible opinion.

            9. The ALJ therefore finds that while Dr. O’Brien
            included a summary of the records of Holly McCormick
            but omitted any reference to cervical complaints or
            suspected pathology resulting therefrom, his
            understanding of [Turner’s] medical history is not so
            inaccurate that it serves to diminish his ultimate
            conclusions. The ALJ therefore finds that his opinions
            are credible and convincing.

            10. The ALJ continues to find that the report of Dr.
            O’Brien in this matter is the most comprehensive,
            thorough, and persuasive and further finds that ample
            substantial evidence as referenced hereinbefore supports
            his conclusions.

            11. Dr. O’Brien assessed a 0% impairment for cervical
            spine and found that [Turner] reached maximum medical
            improvement and could return to work unrestricted on
            May 12, 2015. The opinions of Dr. O’Brien have
            convinced the ALJ and the ALJ thus finds that [Turner]
            sustained only temporary injuries that resolved as of May
            12, 2015.

(R. 1555-58.)

            Once again, Turner appealed to the Board. Turner argued to the

Board that the ALJ failed to comply with this Court’s directives. He requested the

Board vacate the ALJ’s remand opinion and send the case back down with

directions that it be assigned to a different ALJ and that the new ALJ should

reassess the evidence without consideration of Dr. O’Brien’s IME report. This

                                        -17-
time, however, the Board affirmed the ALJ concluding that his decision on remand

contained the sufficient analysis required by the law of the case. Specifically, the

Board stated:

                    The Board previously remanded this claim on
             three occasions to insure the ALJ accurately summarized
             and understood the evidence, and performed a sufficient
             analysis in light of Dr. O’Brien’s inaccurate statement
             that Turner had no cervical complaints until two months
             after the alleged February 16, 2015 injury.

             ...

                    On appeal, Turner argues the ALJ erred by failing
             to comply with the dictates of the Board and the Court of
             Appeals. Turner argues the ALJ did not provide a
             summary and analysis of the March and April 2015
             records at issue highlighting any complaints and
             references to cervical/neck pain or treatment. Turner
             contends the ALJ’s summary on remand remains
             insufficient, as the ALJ failed to discuss the limited range
             of motion and positive Spurling’s test found in the
             physical therapy records from March 24, 2015 and April
             13, 2015. Turner contends the ALJ did not adequately
             summarize and explain his understanding of Dr.
             O’Brien’s opinions regarding the neck injury and the
             rationale underpinning those opinions. Turner contends
             the ALJ shows he did not review the evidence again, and
             he is confused about Dr. O’Brien’s opinion regarding
             when the cervical pathology started. Finally, Turner
             notes the Court of Appeals directed the ALJ to explain
             how he considered Dr. O’Brien’s opinion in comparison
             to the other opinions of record. Turner observes the ALJ
             made no reference on remand to the fact that six other
             medical experts indicated the cervical spine complaints
             were work-related.

             ...

                                        -18-
        Since the first decision of the Board, we have
noted that Dr. O’Brien’s opinion on causation was not
based solely on a mistaken belief that Turner had no
cervical complaints for two months following the injury
. . . Dr. O’Brien also formed his opinion based upon MRI
studies that he stated revealed longstanding mild
degenerative disc changes with no acute objective
findings that can be associated with an acute injury
resulting from the work incident. Dr. O’Brien stated the
work injury did not cause any temporary or permanent
aggravation, acceleration or precipitation of the
degenerative cervical condition above the natural
profession of this condition. Turner initially voiced no
complaints of neck or radicular pain to Nurse
McCormick when she saw him on week following the
accident. He first reported neck complaints to her on
Apri16, 2015, or seven weeks following the work
incident. Turner voiced no complaint of neck problems
to Dr. Chang until May 12, 2015, approximately three
months following the incident and two months after
beginning treatment with Dr. Chang.

       We have repeatedly indicated we directed no
particular finding regarding the weight to be given Dr.
O’Brien’s opinions. . . . [T]he Court of Appeals
concluded it could not disagree with the Board’s decision
refusing to direct the ALJ to reconsider the award
without consideration of, or reliance on, Dr. O’Brien’s
opinion. The Court further noted the evaluation of the
credibility and proper weight to be given to Dr.
O’Brien’s opinion falls on the ALJ.

       The Board’s function is to determine whether the
ALJ’s decision is based upon an accurate understanding
of the facts and evidence. Here, the ALJ found Dr.
O’Brien’s failure to acknowledge Turner complained
about work-related cervical symptoms a few weeks
earlier than he previously believed, or that a nurse
practitioner suspected cervical pathology did not rise to
the level of the inaccuracy articulated in Cepero

                           -19-
                constituting a medical history so inaccurate as to nullify
                Dr. O’Brien’s otherwise credible opinions. . . . Again we
                note, Dr. O’Brien also based his opinion on the type of
                changes reflected in the MRI. Based upon this evidence,
                the ALJ could reasonably believe the difference between
                a five-week delay and an eight-week delay would not
                significantly alter Dr. O’Brien’s causation opinion.

                ...

                       In this instance, we determine the ALJ sufficiently
                provided the basis for his decision, supported by the
                evidence, and a contrary result is not compelled. While
                Turner has identified evidence supporting a different
                conclusion, there was substantial evidence presented to
                the contrary. As such the ALJ acted within his discretion
                to determine which evidence to rely upon, and it cannot
                be said the ALJ’s conclusions are so unreasonable to
                compel a different result.

(R. at 1622-1633.) This appeal followed.

                                 II. STANDARD OF REVIEW

                Pursuant to KRS1 342.285, the ALJ is the sole finder of fact in

workers’ compensation claims. Our courts have construed this authority to mean

the ALJ has the sole discretion to determine the quality, character, weight,

credibility, and substance of the evidence and to draw reasonable inferences from

that evidence. Paramount Foods, Inc., 695 S.W.2d at 419; McCloud v. Beth-

Elkhorn Corp., 514 S.W.2d 46, 47 (Ky. 1974). Moreover, an ALJ has sole

discretion to decide whom and what to believe and may reject any testimony and

1
    Kentucky Revised Statutes.

                                           -20-
believe or disbelieve various parts of the evidence, regardless of whether it comes

from the same witness or the same adversary party’s total proof. Caudill v.

Maloney’s Discount Stores, 560 S.W.2d 15, 16 (Ky. 1977). On review, neither the

Board nor the appellate court can substitute its judgment for that of the ALJ as to

the weight of evidence on questions of fact. Shields v. Pittsburgh & Midway Coal

Mining Co., 634 S.W.2d 440, 441 (Ky. App. 1982).

             If the fact finder finds in favor of the person having the burden of

proof, the burden on appeal is only to show that there was some substantial

evidence to support the decision. See Special Fund v. Francis, 708 S.W.2d 641,

643 (Ky. 1986). However, if the ALJ finds against the party having the burden of

proof, the appellant must “show that the ALJ misapplied the law or that the

evidence in [his] favor was so overwhelming that it compelled a favorable

finding.” Gray v. Trimmaster, 173 S.W.3d 236, 241 (Ky. 2005).

             On appeal, our role “is to correct the Board only where . . . the Board

has overlooked or misconstrued controlling statutes or precedent, or committed an

error in assessing the evidence so flagrant as to cause gross injustice.” ViWin Tech

Windows & Doors, Inc. v. Ivey, 621 S.W.3d 153, 157 (Ky. 2021) (quoting Western

Baptist Hosp. v. Kelly, 827 S.W.2d 685, 687-88 (Ky. 1992)).

                                        -21-
                                     III. ANALYSIS

             As he did before the Board, Turner argues to this Court that the ALJ’s

opinion on remand should be vacated and this matter remanded for a new

determination without any reference whatsoever to Dr. O’Brien’s medical

opinions. However, as the Board correctly noted, such a result would be

inconsistent with this Court’s prior opinion. The last time this case was before us,

we explicitly held that Dr. O’Brien’s opinion was not so faulty or so substantially

incomplete as to require its exclusion.2 Furthermore, we agreed with the Board

that the ALJ could rely on the opinion as long it was clear that he had a proper

understanding of what Dr. O’Brien did and did not rely on in reaching his opinion

and made a reasoned decision to rely on it notwithstanding its shortcomings.

             To this end, we urged the ALJ on remand to provide a more complete

analysis of his understanding of Dr. O’Brien’s report and the other evidence of

record. The ALJ’s remand opinion, which incorporated his prior opinions by

reference, substantially complies with our directives. The ALJ correctly observed

that Dr. O’Brien was off by a few weeks in his assessment of when Turner first

complained of neck pain and that Dr. O’Brien had not reviewed Turner’s physical

2
  We note that since our initial remand, the Kentucky Supreme Court has continued to apply
Cepero consistent with our prior analysis. See Yahagi America Molding, Inc. v. Craine, No.
2021-SC-0262-WC, 2022 WL 17726210, at *5 (Ky. Dec. 15, 2022); Papineau v. Trans Ash Inc.,
No. 2020-SC-0296-WC, 2021 WL 2617124, at *12 (Ky. Jun. 17, 2021); Packers Sanitation
Services v. Cabrera, No. 2020-SC-0215-WC, 2021 WL 1133613, at *3 (Ky. Mar. 25, 2021).

                                           -22-
therapy records. Nevertheless, the ALJ pointed out it is clear from the evidence of

record that Turner did not affirmatively complain of neck pain until several weeks

after his fall, which is consistent with Dr. O’Brien’s statements, even if those

statements are off by a week or two. The ALJ further noted that he was persuaded

by Dr. O’Brien’s opinion because it was based on subsequent imaging of Turner’s

cervical spine. The ALJ determined that the imaging and Dr. O’Brien’s

assessment that the cervical changes were degenerative overrode his minor

misstatement of the dates and his failure to reference having reviewed the physical

therapy records.

             We are cognizant that there are several other medical opinions in the

record that are at odds with Dr. O’Brien’s opinion; however, proof is not a

numbers game. The ALJ was not required to discount Dr. O’Brien’s report simply

because it was in the minority. The ALJ was free to pick and choose which

evidence he found most convincing.

             “No purpose is served by second-guessing such judgment calls, let

alone third-guessing them.” Western Baptist Hosp., 827 S.W.2d at 687. “[T]his

debatable issue has already been fully debated and reasonably resolved. It merits

no further consideration.” Id. at 688. The fact that the ALJ decided this case in a

way that differed from how this Court or even the Board might have decided the

case is not a basis for reversal.

                                         -23-
                              IV. CONCLUSION

           For the reasons set forth above, we affirm the Board’s June 18, 2021,

opinion.

           ALL CONCUR.

BRIEF FOR APPELLANT:                    BRIEF FOR APPELLEE
                                        COMMONWEALTH OF
Jeffery A. Roberts                      KENTUCKY, DEPARTMENT OF
Murray, Kentucky                        CORRECTIONS:

                                        Sara May
                                        Pikeville, Kentucky

                                     -24-