Court Opinion

ID: 9919088
Source: CourtListenerOpinion
Date Created: 2024-01-17 15:09:40.100468+00
Date Added: 2024-06-11T08:04:01.467872
License: Public Domain

IN THE COMMONWEALTH COURT OF PENNSYLVANIA

TA Operating LLC,                              :
                             Petitioner        :
                                               :
               v.                              :   No. 320 C.D. 2022
                                               :   SUBMITTED: December 4, 2023
Leonard Maurer (Workers’                       :
Compensation Appeal Board),                    :
                      Respondent               :

BEFORE:       HONORABLE PATRICIA A. McCULLOUGH, Judge
              HONORABLE LORI A. DUMAS, Judge
              HONORABLE BONNIE BRIGANCE LEADBETTER, Senior Judge

OPINION NOT REPORTED

MEMORANDUM OPINION BY
SENIOR JUDGE LEADBETTER                                       FILED: January 17, 2024

              TA Operating LLC (Employer) petitions for review of an order of the
Workers’ Compensation Appeal Board, which affirmed the decision of the Workers’
Compensation Judge (WCJ) granting Claimant Debra Maurer’s1 fatal claim petition
based on the death of her husband, Leonard Maurer (Decedent). Upon review, we
affirm.
              Decedent collapsed while at work on Saturday, July 14, 2018, and
passed away shortly thereafter. Claimant filed the fatal claim petition seeking
widow benefits on January 24, 2020, alleging Decedent’s death resulted from a
cardiac arrest while in the course and scope of his employment with Employer.
Reproduced Record (R.R.) at 5a. Employer filed an answer denying that the cardiac

       1
          While the record contains different spellings for Claimant’s first name, her testimony
reflects that the correct spelling is Debra. Reproduced Record (R.R.) at 40a.
arrest was work related, and hearings were held before the WCJ over several days.
R.R. at 10a-11a.
             Claimant testified that she had been married to Decedent since 1986
and their only child together was no longer a dependent when Decedent passed away.
Decedent was 53 years old, 6 feet 1 inch tall, and weighed approximately 220 to 225
pounds at the time of his death. He had never treated with a doctor or taken any
medication for heart problems, but had been taking medication for high blood
pressure for approximately two years. Decedent smoked cigarettes for as long as
Claimant knew him and smoked about a pack a day. He did not exercise and his
hobbies were playing pool and shuffle board. He never complained of shortness of
breath or chest pains, did not drink alcohol, and was not an anxious person. Claimant
was not aware of any heart issues in Decedent’s family and was under the impression
that his father died of cancer. R.R. at 30a-34a, 37a, 42a-45a, 260a-61a.
             Decedent worked full time as a heavy-duty diesel mechanic for
Employer for five years, sometimes in excess of 40 hours per week. Claimant
testified that Decedent performed road calls on tractor trailers including changing
tires and alternators, performing electrical work, and other services along those lines.
She later clarified that Decedent performed work both alongside the road for
disabled vehicles as well as in Employer’s shop, and he was on a road call when he
suffered his fatal heart attack. R.R. at 32a-33a, 48a, 260a.
             Claimant saw Decedent before he left for work at around 5:30 a.m. and
described it as a normal day, with no issues or fighting; however, she noted that it
was very hot with temperatures in the 90s. Claimant received a telephone call from
Decedent’s supervisor around 2:45 p.m. stating only that something had happened

                                           2
to Decedent and Claimant needed to call the police. No autopsy was performed.
R.R. at 31a-32a, 34a-35a, 41a, 45a, 260a-61a.
             Claimant also presented the testimony of Jermaine Lahr who worked as
a diesel technician performing emergency road service for Employer from 2010 to
2017. Lahr worked with Decedent for several years and testified that they held the
same job with the same duties. These duties included diagnosing and repairing all
forms of commercial vehicles, performing oil changes, and replacing parts such as
tires, rims, brakes, and drums. Lahr stated that Employer’s shop was open 24/7, 365
days a year. Lahr worked both in the shop and alongside the road, noting that calls
for roadside service to fix a flat tire were very common. R.R. at 181a-83a, 261a.
             Lahr explained that when responding to a roadside call for Employer, a
technician would have to set up a safety zone and then jack the tractor trailer up
using a 20-ton jack weighing around 50 pounds and a jack stand weighing another
30 pounds. A tractor trailer tire with a rim weighs between 100 and 125 pounds,
depending on the size, and a technician had to carry all of this equipment from the
work vehicle to the disabled tractor trailer. After the vehicle was jacked up, a
technician had to remove the lug nuts with an air impact gun, which weighed about
30 pounds, and then remove the tire and rim assembly. Lahr testified that sometimes
the tires would slide right off, but other times a technician had to pry them off using
force. Technicians had to change the tire and rim by hand since Employer did not
have machines to accomplish that. All told, it would normally take a technician 30
to 45 minutes to remove a tire from a tractor trailer. R.R. at 183a-85a, 192a, 261a.
             Lahr stated that it is a very strenuous job to change a tractor trailer tire,
either alongside the road or in the shop, given the weight of the parts and equipment
used. Changing a tire roadside in the warmer months adds to the strain because the

                                           3
technician has to deal with the heat coming off the asphalt, which adds around 20
degrees Fahrenheit (° F). Lahr experienced mild bouts of heat illness while working
for Employer. In addition, when changing a tire alongside a road, a technician
always has to worry about being hit by a passing vehicle and Lahr had lost friends
to this type of incident. Lahr stated that this added to the stress level of the job. R.R.
at 184a-87a, 192a, 261a-62a.
             Lahr understood that on the day in question, Decedent initially
responded to a roadside call for one flat tire. Decedent then realized that a second
tire needed to be replaced because it did not match up with the new tire, so he
returned to Employer’s shop for another tire and a brake drum. Lahr explained that
Decedent must have taken both tires off before he collapsed because both tires must
be removed to be able to see the brake drum. R.R. at 191a-94a, 262a.
             On cross-examination, Lahr admitted that he is engaged to Decedent’s
daughter, with whom he has two children. Lahr had known her for nine years and
knew Decedent for seven years. Lahr further admitted that Employer’s work
vehicles had air conditioning and that Decedent would have been in his air-
conditioned work vehicle that day to travel between Employer’s shop and the
roadside service call. R.R. at 187a-89a, 262a.
             Claimant submitted weather data for July 14, 2018, indicating a high
temperature of 91° F. R.R. at 226a. She also submitted work orders from Employer
documenting the three service calls Decedent worked on that day. R.R. at 205a-12a.
The technician comments section of the last work order corroborates Lahr’s
testimony regarding Decedent removing two tires, observing a cracked brake drum,
returning to Employer’s shop, and then going back to the roadside call. R.R. at 210a-
11a. Also admitted into evidence were the emergency medical services (EMS)

                                            4
records, emergency room records, and documentation of funeral expenses. Notably,
the EMS report states that the truck driver at the scene reported Decedent was
working on the driver’s tractor trailer when Decedent complained of shortness of
breath, went back to his service truck, and was then found slumped over in the
driver’s seat. R.R. at 233a.
             Claimant presented the deposition testimony of Jeffrey S. Fierstein,
M.D., who is board certified in internal medicine and cardiology. Dr. Fierstein is a
non-invasive cardiologist who has been in practice continually since 1983, with his
areas of expertise being the diagnosis and treatment of cardiovascular disease as well
as preventive cardiology. Dr. Fierstein explained that in a case like this, the items
he considers particularly relevant are the patient’s background, history, risk factors
for cardiovascular disease, whether or not he/she has had prior events, and the
circumstances under which the event occurred. R.R. at 63a-64a, 71a-72a, 262a.
             Based upon his review of medical records, Dr. Fierstein testified that
Decedent had a history of hypertension and smoking, was overweight, and had a
family history of cardiovascular disease. He believed that coronary artery disease
could be presumed in Decedent’s case. Dr. Fierstein explained coronary artery
disease as the development of cholesterol plaque within the arteries resulting in some
degree of narrowing of those arteries. R.R. at 68a, 262a.
             Dr. Fierstein understood that the day in question was particularly hot,
about 90° F, when Decedent was called to help change a tire on a disabled tractor
trailer. Decedent complained to a bystander that he was short of breath and went to
his truck to sit down. He was later found collapsed in his truck and 911 was called.
When EMS arrived, Decedent was in cardiac arrest and pulseless. They performed
cardiopulmonary resuscitation (CPR), used a defibrillator and intubated Decedent,

                                          5
and then transported him to the hospital. At the hospital, CPR was continued and
Decedent received epinephrine due to the possibility of a pulmonary embolism.
Decedent never recovered circulation or a pulse and was subsequently pronounced
dead at 3:17 p.m. R.R. at 69a-71a, 262a.
             In short, Dr. Fierstein opined, within a reasonable degree of medical
certainty, that Decedent’s cause of death was performing significant physical work
in a hot environment, that created a condition of myocardial ischemia resulting in a
fatal arrhythmia, i.e. cardiac arrest. See R.R. at 82a, 263a. While Dr. Fierstein
acknowledged that coronary artery disease probably contributed to Decedent’s
death, he stressed that Decedent’s cardiac arrest and death could have happened in
the absence of coronary artery disease and “that the immediate cause, the proximate
cause of the event was precipitated by the work he was doing in that hot
environment.” R.R. at 95a, 263a.
             More specifically, Dr. Fierstein explained that Decedent had a sudden
cardiac arrhythmia which was fatal and most likely precipitated by cardiac ischemia,
which is insufficient blood flow to his heart muscle. This could have been caused
by either an acute myocardial infarction, meaning an occlusion of a blood vessel that
immediately deprived a portion of his heart muscle from the appropriate oxygen and
blood, or a severe narrowing of the coronary artery which, when coupled with the
increased workload of his activity and the heat, placed stress on Decedent’s
cardiovascular system creating ischemia. R.R. at 72a-73a, 262a-63a. In layman’s
terms, Dr. Fierstein explained,

             [s]o my conclusion was that the stress of the work that he
             did in that -- in that environment, the hot environment, the
             90-degree weather, so a combination of the extreme
             workload of changing the tire, which was a strenuous
             activity, and the hot weather was sufficient to create the

                                           6
             arrhythmia that he died from, and that that activity and that
             hot environment was a substantial contributing factor to
             his death.

R.R. at 73a (emphasis added).
             Dr. Fierstein further testified that the heart muscle is very dependent on
getting an adequate supply of oxygen and there is no surplus or stored oxygen that
can be called upon to meet increased demands in real time. Heat is a significant
stressor on the heart even in the absence of exercise because the heart needs to
increase the blood flow to the skin quite a bit in order to cool the body. If you then
impose work such as physical labor on top of that hot environment, not only do you
have to increase blood flow to the skin, you also have to increase it to the muscles
doing the work. R.R. at 73a-75a, 262a-63a. Dr. Fierstein stated that doing heavy
work such as changing a tire in a hot environment is

             what you would call a double whammy. You clearly
             impose a significant workload stress and demand on the
             heart muscle to increase blood flow to the skin, increase
             blood flow to the muscle, and at some point, you can
             exceed the body and the heart’s capacity to do that, and it
             would be a subsequent, you know, failure of the
             cardiovascular system to occur.

R.R. at 77a-78a. Dr. Fierstein indicated that an autopsy would have been helpful in
several respects, including whether Decedent had underlying coronary artery
disease, an arrhythmia, or unrecognized cardiomyopathy, and whether he
experienced a sudden occlusion precipitated by the physical stress of changing the
tire in the heat. R.R. at 81a-82a, 263a.
             On cross-examination, Dr. Fierstein acknowledged that while Decedent
smoked one pack of cigarettes a day at the time of his death, there was a period of
time where he smoked two to three packs a day and that long-term cigarette use is a

                                           7
substantial risk factor for the development of coronary artery disease. R.R. at 84a-
85a, 263a. In addition, Dr. Fierstein conceded that Decedent was at the lower end
of the obese definition and obesity is a stressor for the heart. R.R. at 85a-86a, 263a.
Decedent also had a family history of cardiac issues as his father had coronary artery
disease at the age of 59. R.R. at 86a-87a, 263a.
             Employer’s sole witness was its medical expert, Joseph C. Kraynak,
M.D. Similar to Dr. Fierstein, Dr. Kraynak is board certified in internal medicine
and cardiovascular diseases, and has been practicing as a non-invasive cardiologist
since 1983. Dr. Kraynak testified that while no autopsy was performed, he was
almost certain Decedent had coronary artery disease based on his risk factors
including family history, high blood pressure, and history of smoking for more than
30 years. See R.R. at 133a, 138a, 264a. He further noted that Decedent was obese
and led a sedentary lifestyle. Given all of the above, Dr. Kraynak opined, to a
reasonable degree of medical certainty, that the substantial contributing factor for
Decedent’s cardiac arrest was his underlying coronary artery disease, the most
common cause of sudden cardiac death. R.R. at 140a-41a, 143a, 264a. Dr. Kraynak
did not find Decedent’s work to be a substantial contributing factor because the
weather or “environmental conditions that day were really unremarkable for that part
of the country[,]” and the workload was not unnatural or uncommon for Decedent.
R.R. at 142a; see also R.R. at 264a. However, like Dr. Fierstein, he conceded that
he did not know exactly how much physical labor Decedent performed on the day
he died. R.R. at 131a, 142a, 264a.
             On cross-examination, Dr. Kraynak admitted that physical exertion can
elevate the risk of cardiac arrest. R.R. at 147a, 264a. While he agreed that extreme
heat can also contribute to cardiac arrest, he maintained that the temperature on the

                                          8
day in question was not extreme. R.R. at 150a, 264a. Dr. Kraynak further explained,
“I do believe that a normal activity can trigger death in a patient with heart
disease[,]” R.R. at 151a-52a, and “I think that what really contributed to his death
was coronary artery disease and that basically any activity, including a normal
activity at home, could have triggered death.” R.R. at 152a; see also R.R. at 264a.
             On May 5, 2021, the WCJ issued a decision and order granting the fatal
claim petition. The WCJ found the testimony of Claimant and Lahr to be credible,
and specifically credited the testimony of Dr. Fierstein over the testimony of Dr.
Kraynak. The WCJ explained that while Lahr had a personal relationship with
Decedent’s daughter for years, his testimony was uncontradicted by Employer and
was confirmed in part by the work orders. The WCJ also noted that Lahr’s admission
that Decedent would have been riding in an air conditioned work vehicle to and from
the roadside call demonstrated that Lahr’s testimony was not false or exaggerated
due to his personal relationships. R.R. at 265a.
             As for the medical experts, the WCJ explained that much of their
testimony was similar as they both believed Decedent had underlying coronary
artery disease based upon his smoking, high blood pressure, and family history.
Both doctors also recognized that while obesity is not an independent risk factor for
coronary artery disease it could have come into play. The main difference in their
testimony had to do with the ultimate issue here, whether the work Decedent
performed that day had any role in his sudden cardiac arrest and death. The WCJ
credited Dr. Fierstein’s opinion on this issue because his understanding that
Decedent had to change a tractor trailer tire alongside the road was confirmed
through the work orders as well as the testimony of Lahr regarding the considerable
weight of the equipment involved to do so. Dr. Fierstein also acknowledged the

                                         9
significance of the temperature that day coupled with the stress of the work being
performed. The WCJ rejected Dr. Kraynak’s testimony on this issue because, while
he testified that normal activity could trigger death in a patient with coronary artery
disease, he did not believe Decedent’s work on the day he died was a factor in his
death because it was not abnormal. R.R. at 265a-66a. Given the above, the WCJ
determined that Claimant met her burden of proving that the work Decedent
performed for Employer on the day he died was the substantial contributing factor
in his sudden cardiac arrest and death and she was therefore entitled to benefits.
Employer then appealed to the Board, which affirmed.
             On appeal to this Court, Employer argues that the Board erred in
affirming the WCJ’s decision because Dr. Fierstein’s expert opinion regarding the
cause of Decedent’s cardiac arrest is premised on facts not contained in the
evidentiary record and, therefore, is incompetent as a matter of law. Specifically,
Employer complains that the record fails to contain evidence regarding the work
Decedent was allegedly performing immediately preceding his cardiac arrest. We
disagree.
             With a claim petition generally, “a claimant bears the burden of proving
all the necessary elements for an award of workers’ compensation benefits.” Holy
Redeemer Health Sys. v. Workers’ Comp. Appeal Bd. (Lux), 163 A.3d 498, 503 (Pa.
Cmwlth. 2017). In the specific context of a fatal claim petition, the surviving family
member must demonstrate, by substantial evidence, the elements necessary to merit
an award. City of Phila. v. Workers’ Comp. Appeal Bd. (Kriebel), 29 A.3d 762, 769
(Pa. 2011). These elements are “establishment of a work-related injury,” “impact
on the earning capacity of the employee,” and that the injury “was a substantial

                                          10
contributing cause in bringing about the death of that employee.” Id. (quotation
omitted).
             As this Court has further explained,

             [j]ust as with any other type of injury, in order for a
             decedent’s fatal heart attack to be compensable, the
             claimant must establish that the heart attack was causally
             related to the decedent’s employment.          Yantos v.
             Workmen’s Comp[.] Appeal B[d.] (Vulcan Mold & Iron
             Co[.]), [] 563 A.2d 232, 236 ([Pa. Cmwlth. ]1989). If the
             causal connection is not obvious, the connection must be
             established by unequivocal medical testimony.
             Lamoreaux v. Workmen’s Comp[.] Appeal B[d.] (Celotex
             Corp[.]), [] 497 A.2d 1388, 1390 ([Pa. Cmwlth. ]1985).

Dietz v. Workers’ Comp. Appeal Bd. (Lower Bucks Cnty. Mun. Auth.), 126 A.3d
1025, 1030 (Pa. Cmwlth. 2015). “Medical evidence is considered unequivocal if the
medical expert, after providing a foundation, testifies that in his medical opinion, he
thinks the facts exist.” Craftsmen v. Workers’ Comp. Appeal Bd. (Krouchick), 809
A.2d 434, 439 (Pa. Cmwlth. 2002). Of particular importance in this matter, “[a]n
expert witness is permitted to base an opinion upon facts of which he has no personal
knowledge, so long as those facts are supported by evidence in the record.” Dietz,
126 A.3d at 1031 (citing Yantos, 563 A.2d at 235).
             Here, Dr. Fierstein based his testimony upon his understanding that
Decedent was working in 90-degree weather changing a tractor trailer tire alongside
a road when he reported feeling short of breath and subsequently collapsed in his
work vehicle. These are uncontradicted facts of record, found in the credible
testimony of Claimant and Lahr, and corroborated by the weather report, the EMS
records, and Employer’s own work orders. While Dr. Fierstein admitted that he did
not know specifically how far into the tire change Decedent got before he collapsed,

                                          11
this is of no moment and does not render his opinion equivocal. Our courts have
repeatedly rejected the argument in cardiac arrest cases that a claimant needs to
prove exactly what the decedent was doing prior to the event.

              Our Supreme Court has explained that “where a decedent
              was performing his or her usual job assignment at the time
              of the fatal heart attack, and the connection between the
              work and the heart attack was supported by competent
              medical testimony, decedent’s claimant was entitled to
              compensation.” [Workmen’s Comp. Appeal Bd. v.]
              Bernard S. Pincus Co., 388 A.2d [659,] 663 [(Pa. 1978)]
              (emphasis added). Where exertion leads to a fatal heart
              attack, there is no need to pinpoint the exact work duty
              which caused the exertion. Plumbers Contractors, Inc. v.
              Workmen’s Comp[.] Appeal B[d.] (Lewellyn), [] 402 A.2d
              555, 557 ([Pa. Cmwlth. ]1979). In other words, “[i]t is not
              necessary to prove and identify the precise work details
              which caused a heart death that resulted from decedent’s
              exceptional work activity.” P[a.] State Oral Sch[.] v.
              Workmen’s Comp[.] Appeal B[d.] (Gerek), [] 475 A.2d
              175, 178 ([Pa. Cmwlth. ]1984).

Dietz, 126 A.3d at 1031.
              Just as in Dietz, “[i]t is undisputed that Decedent had a very physical
job[,]” and that “[h]is daily job [duties] involved strenuous physical activity.” 126
A.3d at 1032. It is further undisputed that Decedent was responding to a roadside
service call for a flat tire on a tractor trailer at the time of his death, and that this type
of call was within his usual job duties. Dr. Fierstein unambiguously opined that the
immediate cause of Decedent’s cardiac arrest and death was performing this
significant physical work in a hot environment. The WCJ specifically credited Dr.
Fierstein’s testimony and opinion in this regard over Employer’s expert. As the
ultimate factfinder with “exclusive province over questions of credibility and
evidentiary weight[,]” the WCJ “is free to accept or reject, in whole or in part, the

                                             12
testimony of any witness, including medical [experts].” Kimberly Clark Corp. v.
Workers’ Comp. Appeal Bd. (Bromley), 161 A.3d 446, 461 (Pa. Cmwlth. 2017)
(quotations omitted).
            In sum, evidence of how much and what type of activity Decedent was
performing that day is not a prerequisite to compensation. Dietz; Lewellyn; Bernard
S. Pincus. Decedent was performing his usual job assignment at the time of his
cardiac arrest and the connection between his work and his death is supported by Dr.
Fierstein’s competent medical testimony. Accordingly, we affirm.

                                      _____________________________________
                                      BONNIE BRIGANCE LEADBETTER,
                                      President Judge Emerita

                                        13
       IN THE COMMONWEALTH COURT OF PENNSYLVANIA

TA Operating LLC,                     :
                      Petitioner      :
                                      :
           v.                         :   No. 320 C.D. 2022
                                      :
Leonard Maurer (Workers’              :
Compensation Appeal Board),           :
                      Respondent      :

                                   ORDER

          AND NOW, this 17th day of January, 2024, the Order of the Workers’
Compensation Appeal Board is AFFIRMED.

                                    _____________________________________
                                    BONNIE BRIGANCE LEADBETTER,
                                    President Judge Emerita