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IN THE COMMONWEALTH COURT OF PENNSYLVANIA Diane Miller, Petitioner v. Workers' Compensation Appeal Board (County of Washington), Respondent BEFORE: : : : : : : : :

No. 2298 C.D. 2011 Submitted: May 18, 2012

HONORABLE BERNARD L. McGINLEY, Judge HONORABLE MARY HANNAH LEAVITT, Judge HONORABLE ANNE E. COVEY, Judge

OPINION NOT REPORTED MEMORANDUM OPINION BY JUDGE LEAVITT FILED: December 14, 2012

Diane Miller (Claimant) petitions for review of an adjudication of the Workers' Compensation Appeal Board (Board) that denied her claim for compensation for a right knee injury, which she allegedly sustained when she collapsed at work. The Workers' Compensation Judge (WCJ) found that Claimant's injury was not work-related because she failed to prove that she lost consciousness for work-related reasons. The Board affirmed the WCJ on other grounds, holding that the real problem with Claimant's evidence was that it did not prove whether the torn meniscus in her knee was caused by her fall at work or by another fall she suffered outside of work in the same time frame. Discerning no error, we affirm the Board. Claimant worked as a certified nurse assistant for Washington County (Employer) at the Washington County Health Center. While working for

Employer, Claimant was involved in two separate incidents that gave rise to this proceeding. The first incident occurred on May 29, 2008, when Claimant was involved in a motor vehicle accident that took place in the Center's driveway. Employer issued two notices of temporary compensation payable providing both medical and disability benefits for bruising to her right knee. Employer issued a notice stopping benefits as of July 23, 2008, and Claimant responded with a claim petition, which asserted a right knee injury along with several other injuries. Claimant, who had been off work since the May incident, returned to work on October 7, 2008. After working for a few hours, she collapsed to the floor. This prompted Claimant's second claim petition, in which she asserted that the October fall had either aggravated her pre-existing knee injury or caused her to sustain a new knee injury. Employer timely denied the allegations in both petitions, and the matter was referred to a WCJ for hearing. Claimant testified live before the WCJ about the two incidents at work that prompted her two claim petitions. The WCJ received evidence from a number of witnesses, proffered by Claimant and Employer, and also did a site view of the Center and of the vehicle involved in the first incident.1 Claimant testified that on May 29, 2008, she was accompanying a patient at the Center to an off-site doctor's visit in the Center van when the accident occurred. The wheelchair lift on the Center's van, which had not been properly stowed, hit a vehicle that was parked in the Center driveway. Claimant estimated that the van was moving at a speed of 20 mph at the time of the accident. Claimant testified that although she was wearing her seat belt, the impact caused
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Although many witnesses testified in this case, we summarize only the evidence most relevant to this appeal.

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her to fly over the partition separating the passenger compartment from the driver's compartment, causing injuries to her knee, ribs, teeth and elbow. She thought that the van had travelled 20 feet or 20 yards before the accident. After a short delay, the trip resumed, and Claimant accompanied the patient to her cardiologist appointment. When Claimant returned to the Center, she contacted her supervisor and reported that she was in pain and needed medical attention. She left work without finishing her shift. She returned to work for her next scheduled shift two days later but left because of pain. In June and July, Claimant sought a variety of medical treatments and physical therapy. On August 14, 2008, she received a notice that she could return to light-duty work, but Employer did not have a job for her. Claimant also testified about other episodes involving her right knee. On approximately September 16, 2008, Claimant's knee "gave out" while she was at her sister's house. Notes of Testimony, October 20, 2008, at 60 (N.T. ___).2 On September 22, 2008, Claimant's knee gave out again while she was walking down the stairs at another sister's house, causing her to fall; her sister took her to the hospital emergency room on the 22nd. Claimant then testified about another work incident that took place on October 7, 2008, her first day back on the job after leaving in May. She returned to work reluctantly because her knee was swollen and painful. In fact, she was undergoing physical therapy for her knee and wearing a leg brace. She testified that she was limping at work and that she complained to co-workers that her knee
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Claimant submitted a reproduced record but did not include all of the hearing transcripts. Therefore, we cite to the certified record where necessary.

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pain was "thumping" and was "killing" her. N.T., February 3, 2009, at 44, 56; N.T., July 6, 2009, at 47, 53, 55, 58. Then, while in a patient's room, she lost consciousness and fell to the floor. The next thing Claimant remembered was waking up in the hospital, where she spent two days. Claimant underwent knee surgery in January 2009 and returned to full-duty work in June 2009. Claimant and Employer both presented the testimony of co-workers Debra Richey and Kathy Gonzalez, who were present in the room when Claimant collapsed. Richey and Gonzalez testified that Claimant complained of feeling dizzy, passed out and fell face-first onto the floor. Claimant presented the deposition testimony of her treating physician, board certified orthopedic surgeon Michael J. Scheel, M.D. Dr. Scheel first

examined Claimant on June 11, 2008, and diagnosed her with a right knee bruise, sprain and exacerbation of pre-existing arthritis, all attributable to the May 2008 motor vehicle accident. Dr. Scheel had Claimant undergo an MRI on August 11, 2008, after she complained of worsening knee pain. The MRI showed arthritic changes and muscle strain but no meniscus or ligament tears. Dr. Scheel examined Claimant on August 14th and ordered a series of injections for knee pain, which were administered by a nurse practitioner. Dr. Scheel reviewed the medical records to determine what occurred with Claimant in September, because he did not see her that month. The records noted that Claimant came to the office for an injection on September 29, 2008. Claimant reported that she had fallen a week earlier. Dr. Scheel did not know anything specific about the fall and did not know whether Claimant was treated for it. Dr. Scheel's partner, Dr. McCulloch, examined Claimant's knee and saw an abrasion and swelling but felt that the knee ligaments were stable enough to 4

proceed with the injection. Dr. McCulloch did not comment on the condition of the meniscus. He did, however, give Claimant a knee brace to wear. Claimant received her last injection on October 6, 2008, and told the nurse practitioner that her symptoms were improving. This led Dr. Scheel to release Claimant to lightduty work. Dr. Scheel next saw Claimant on October 29, 2008. Claimant told Dr. Scheel that she had lost consciousness and fallen at work, causing her to twist and reinjure her right knee and to be hospitalized. Dr. Scheel had no idea what Claimant told hospital staff about her knee. Claimant complained to Dr. Scheel of increased knee pain, would not allow Dr. Scheel to complete a meniscal examination, and had more knee swelling than she had in August. However, Dr. Scheel did not see "any signs of obvious new trauma." Reproduced Record at 330a (R.R. ___). Claimant underwent an MRI on November 3rd which confirmed Dr. Scheel's suspicion that Claimant had sustained a medial meniscal tear. Because Claimant did not have a tear at the time of the August 11, 2008, MRI but had one at the time of the November 3, 2008, MRI, and because her knee symptoms were different between Dr. Scheel's visit with Claimant on August 14, 2008, and his next visit with her on October 29, 2008, Dr. Scheel opined that Claimant sustained the medial meniscal tear when she fell at work on October 7 th. Dr. Scheel admitted that he was forced to rely on Claimant telling him where she got hurt because that was really "the only thing [he] had to go by." R.R. 324a. Dr. Scheel surgically repaired the torn meniscus in January 2009, and released Claimant to return to work without restrictions at the end of May 2009. Claimant submitted into evidence her hospital records from Washington Hospital dated September 22, 2008. Claimant reported to hospital 5

staff that she had fallen at her sister's house and was complaining of pain in her right knee and leg as well as in her mouth. Claimant also submitted her hospital records from Washington Hospital relating to her admission on October 7, 2008, after she collapsed at work. The records noted that Claimant was wearing a knee brace but did not document any knee complaints or injury, instead reporting that even though Claimant collapsed and landed face-first, "[s]he did not suffer any injuries" and "did not have any injuries from this episode." Certified Record, Claimant's Exhibit 30 at 7, 9. Hospital personnel ran diagnostic tests to ascertain why she lost consciousness, but could not find a reason. Employer presented the deposition testimony of Michael W. Weiss, M.D., a board certified orthopedic surgeon who performed independent medical examinations (IME) of Claimant on two occasions: July 8, 2008, and July 7, 2009. At the first IME, Claimant told Dr. Weiss that she had injured her right knee in the May 2008 automobile accident. Based on a review of medical records and an objectively normal physical examination, Dr. Weiss opined that Claimant fully recovered from any soft tissue injuries or bruises she sustained in that incident. At the second IME in July 2009, Claimant told Dr. Weiss that she had undergone knee surgery and returned to work. Dr. Weiss viewed both the August 2008 and November 2008 MRI films of Claimant's right knee. Dr. Weiss agreed with Dr. Scheel that there was no meniscus tear on the August MRI and a definite medial meniscal tear on the November MRI. Thus, Claimant injured her meniscus sometime between August and November. Dr. Weiss testified, however, that it was not possible to determine whether the tear was caused by Claimant's fall at her sister's house in late September or the fall at work in early October. The only way 6

would be if the same physician had seen Claimant three separate times: before the fall at her sister's house; after the fall at her sister's house but before the fall at work; and after the fall at work, and could compare those medical records. That was not done by Dr. Scheel or by any other physician. For that reason, Dr. Weiss disagreed with Dr. Scheel's attribution of the meniscus tear to the fall at work. Dr. Weiss felt it was more likely that the tear happened during the fall at her sister's house because the medical records following that incident document that Claimant had struck and cut her knee, while the medical records following the fall at work do not indicate that Claimant struck her knee or sustained a new knee injury. The WCJ rejected Claimant's testimony as not credible.3 Although the WCJ believed that Claimant had some knee problems after May 2008, he completely discredited Claimant's description of the May 29, 2008, motor vehicle accident as a violent collision that caused her to fly over the partition and left her looking at the floor of the driver compartment. Her testimony that the van was traveling at 20 mph was discredited by other witnesses that the van was traveling at 2 mph, and that it caused only a small dent in the parked car's taillight, as was verified on the WCJ's inspection. The WCJ also found Claimant's exaggeration of her symptoms to diminish her credibility. With respect to the October 7, 2008, incident, the WCJ found that "[t]here is nothing that credibly establishes in the evidence that [C]laimant's work, and particularly knee pain caused by work caused [C]laimant to pass out." WCJ Decision at 43, Finding of Fact 36(b). The WCJ credited Richey and Gonzalez on

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The WCJ has complete authority over questions of credibility, conflicting medical evidence and evidentiary weight. Sherrod v. Workmen's Compensation Appeal Board (Thoroughgood, Inc.), 666 A.2d 383, 385 (Pa. Cmwlth. 1995).

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that issue, finding that their testimony was consistent while Claimant's was not. The WCJ also rejected Claimant's testimony that "all of her problems occurred as a result of an October 7, 2008 alleged injury." Id. The WCJ further rejected Claimant's medical evidence because it was based on her discredited version of events, finding that "Claimant's entire version of events of what occurred on October 7, 2008 are not supported other than she felt dizzy and then passed out. However, the evidence does not persuasively establish an injury caused, substantially contributed to, or aggravated by [C]laimant's work activities." WCJ Decision at 44, Finding of Fact 36(c). The WCJ agreed with Dr. Weiss that it was impossible to know whether the meniscus tear was caused by the fall at Claimant's sister's house or her fall at work. Based on his findings, the WCJ denied both claim petitions,

concluding that Claimant failed to prove that she sustained a work-related injury on either May 29, 2008, or October 7, 2008. Claimant appealed. The Board affirmed the WCJ's denial of the claim for a May 2008 injury purely on credibility determinations. With regard to the claim for an October 7, 2008, knee injury, the Board concluded that the WCJ "improperly focused on whether or not Claimant's collapse on October 7, 2008 was caused by her previous knee injury allegedly caused by the motor vehicle accident." Board Adjudication at 16. The Board affirmed the denial of the claim petition because, regardless of the reason for Claimant's collapse, she failed to prove through credible medical evidence that her fall at work resulted in a knee injury. Claimant then petitioned for this Court's review.4
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This Court's review of an order of the Board is limited to determining whether the necessary findings of fact are supported by substantial evidence, whether Board procedures were violated,

(Footnote continued on the next page . . .) 8

Claimant appeals only the denial of her claim for an October 7, 2008, work-related knee injury. Claimant argues that the WCJ erred in focusing on what caused her to fall, when that is immaterial. Instead, the WCJ should have

addressed the critical issue of whether the fall resulted in a torn meniscus, but he failed to do so. In a claim petition proceeding, the claimant has the burden of establishing all elements necessary for an award of benefits. Inglis House v. Workmen's Compensation Appeal Board (Reedy), 535 Pa. 135, 141, 634 A.2d 592, 595 (1993). The claimant must prove that she sustained an injury related to her employment. Good Shepherd Workshop v. Workmen's Compensation Appeal Board (Caffrey), 555 A.2d 1374, 1377 (Pa. Cmwlth. 1989) (quoting Workmen's Compensation Appeal Board v. United States Steel Corp., 376 A.2d 271, 273 (Pa. Cmwlth. 1977)). In McCarthy v. General Electric Co., 293 Pa. 448, 143 A. 116 (1928), our Supreme Court addressed a factual situation like the present one, where a claimant fell at work for unknown reasons. The Court held that if a claimant falls while working on the employer's premises, any resulting injury is compensable. The claimant has no burden to show an exact cause for why he or she fell. Id. at 452, 143 A. at 118. The Court found it not "material that the employee fell because he became dizzy or unconscious...[or because of] some disease with

(continued . . .)
whether constitutional rights were violated or an error of law was committed. City of Philadelphia v. Workers' Compensation Appeal Board (Brown), 830 A.2d 649, 653 n.2 (Pa. Cmwlth. 2003).

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which the employee was afflicted...[or] a lapse of the brain...[or] an unexplained cause[.]" Id.5 The Board properly concluded that the WCJ erred to the extent he focused on what might have caused Claimant to fall, because the cause is wholly irrelevant. It is undisputed that Claimant fell on Employer's premises while However, there is a critical additional element

performing her work duties.

Claimant had to prove in order to prevail on her claim petition. Regardless of the reason for a fall, the claimant must establish that the fall caused an injury. McCarthy, 293 Pa. at 452, 143 A. at 118. Where there is no obvious causal connection between an injury and the alleged cause, the claimant must prove the connection through medical evidence. Lewis v. Workmen's

Compensation Appeal Board (Pittsburgh Board of Education), 508 Pa. 360, 365, 498 A.2d 800, 802 (1985). A medical opinion must be both competent and credible to support an award of benefits. Campbell v. Workers' Compensation Appeal Board (Pittsburgh Post Gazette), 954 A.2d 726, 730 (Pa. Cmwlth. 2008). Claimant argues that the WCJ's only reason for denying the claim petition was the lack of a cause for the fall, and he erred by completely neglecting to address the critical issue of whether the fall resulted in a torn meniscus. Claimant also argues that because the WCJ misperceived what the critical issue was, he failed to provide an adequate explanation for rejecting Dr. Scheel's

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This Court has followed this precedent and held that a claimant can be entitled to benefits if a fall occurs on the employer's premises during work hours even if "the fall was caused by a preexisting physical condition of the employee totally unconnected with his employment." American Mutual Insurance Company v. Workmen's Compensation Appeal Board (Davenport and Natural Marble & Onyx Company), 530 A.2d 121, 126 (Pa. Cmwlth. 1987).

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opinion as to causation.6 For these reasons, Claimant contends that the Board erred in affirming the WCJ's decision, and requests a remand for the WCJ to address the cause of the meniscal tear. Employer responds that the WCJ made sufficient findings and Claimant did not meet her burden of proof because her evidence was not credible. We disagree with Claimant's assertion that the WCJ denied the claim solely because Claimant could not prove why she fell. Although the cause of the fall was ultimately irrelevant, the parties presented much conflicting testimony on why Claimant fell, with Employer suggesting it was dizziness and Claimant implying her knee pain from a prior work injury caused her to faint. The WCJ discussed and resolved the conflicts in this evidence because the parties presented it to him. However, the WCJ did not stop there. The WCJ discussed all of the evidence at length and made extensive credibility determinations. Of relevance here, the WCJ found, in pertinent part: Claimant again testified at the February 3, 2009 hearing. Her testimony based on hearing her testimony and observing her demeanor was not credible. She stated that all of her problems occurred as a result of an October 7, 2008 alleged injury. That testimony was not believable. WCJ Decision at 43, Finding of Fact 36(b) (emphasis added). The WCJ explained that he was "[n]ot crediting the medical evidence since it is based on [C]laimant's
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Pursuant to Section 422(a) of the Workers' Compensation Act, Act of June 2, 1915, P.L. 736, as amended, 77 P.S.

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