IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Transcription

1 IN THE COMMONWEALTH COURT OF PENNSYLVANIA Cheryl Nanni, : Petitioner : : v. : No. 795 C.D : Submitted: October 10, 2014 Workers Compensation Appeal : Board (Brunner, MD), : Respondent : BEFORE: HONORABLE RENÉE COHN JUBELIRER, Judge HONORABLE P. KEVIN BROBSON, Judge HONORABLE ROCHELLE S. FRIEDMAN, Senior Judge OPINION NOT REPORTED MEMORANDUM OPINION BY JUDGE BROBSON FILED: January 30, 2015 Petitioner Cheryl Nanni (Claimant) petitions for review of an order of the Workers Compensation Appeal Board (Board). The Board affirmed a decision of a Workers Compensation Judge (WCJ), denying Claimant s Petition to Review Compensation Benefits, through which Claimant sought to add depression to Claimant s identified work-related injuries. We affirm the Board s order. In an earlier decision dated September 23, 2009 (2009 WCJ Decision), WCJ Sarah C. Makin addressed a claim petition Claimant filed relating to a work injury Claimant sustained on April 2, WCJ Makin noted that the parties had submitted a stipulation of facts, which WCJ Makin incorporated into her decision. According to the incorporated factual findings, Claimant alleged that she sustained a disabling respiratory condition in the course of her employment with Douglas J. Brunner, M.D., (Employer) as a result of repetitive exposure to

2 airborne irritants at work through April 2, (2009 WCJ Decision, Finding of Fact (F.F.) no. 4.) Employer and his insurer accepted the claim as compensable and, pursuant to an examination and diagnosis by Employer s physician, identified Claimant s work-related injury as chronic sinusitis. WCJ Makin determined that Claimant was disabled beginning on April 3, 2008, as a consequence of her work-related injury and was entitled to weekly compensation of $ Claimant filed a review petition on November 1, The review petition, while noting that Claimant was seeking to add an injury to the identified chronic sinusitis, did not state what specific injury or injuries Claimant sought to add to her identified work-related injury. The WCJ conducted a hearing on December 15, During that hearing, Claimant testified regarding difficulty she was having with her vision and about her mental condition. Specifically, Claimant briefly testified regarding her treatment with a psychiatrist and a psychologist, the latter of which predated the on-set of her work-related chronic sinusitis. Claimant s testimony can be summarized as indicating that she believed she needed to see those mental health specialists, in part because she was experiencing mental health problems as a result of her work-related sinusitis injury. Claimant did not testify that she was suffering specifically from depression as a result of her work injury. Claimant s counsel, however, stated that from a psychological perspective, it s depression. (Reproduced Record (R.R.) at 24.) Claimant submitted medical reports and/or letters from various physicians, including (1) Joseph R. Spiegel, M.D, an apparent specialist in the field of Otolaryngology, who performed endoscopic sinus surgery on Claimant in March 2008; (2) Frances E. Marchant, M.D., whose letterhead indicates he is associated with an ENT practice; (3) Laurence D. Fine, M.D., whose letterhead 2

3 indicates he is a neurologist; (4) Jeffrey J. Dekret, M.D., Claimant s psychiatrist; and (5) Edward J. Murphy, Psy.D. Claimant also submitted a memorandum from Jeffrey E. Celebre, Ph.D., Claimant s psychologist. 3 In response, Employer presented the deposition testimony of Gladys Fenichel, M.D., who testified as an expert in the field of psychiatry, and a medical report by James N. Palmer, M.D., the Director of Rhinology in the Department of Otorhinolaryngology at the University of Pennsylvania. The WCJ denied Claimant s review petition. She reasoned that although Claimant established that she suffers from depression, Claimant failed to prove that her work injury caused her depression. On appeal to the Board, Claimant raised several challenges. Claimant challenged the WCJ s finding of fact number 3, relating to the credibility of Dr. Celebre and Dr. Fenichel, arguing: The reasons for the [WCJ s] credibility determinations are unsupported by the evidentiary record when considered in its entirety. The record was summarized in a manner to support the WCJ s desired conclusion, leading to an erroneous perception that the credibility determinations are supported by the evidence. Although a WCJ is not required to itemize every line of testimony of documentary evidence, relevant omissions from the evidence presented adversely effected the basis of the credibility determinations. (Claimant s Appeal to the Board, Addendum to Appeal.) Claimant also challenged the WCJ s findings of fact numbers 4-32, based upon her assertion that [a]lthough the WCJ sets forth a detailed, and largely accurate description of the evidence, relevant omissions to the evidence adversely impact the credibility determinations. (Id.) Finally, Claimant challenged the WCJ s conclusion of law number 3, in which the WCJ concluded that Claimant failed to satisfy her burden to prove that her depression is related to her work-related injury. Claimant

4 contended that conclusion of law number 3 is erroneous to the extent [it is] based upon erroneous credibility determinations. (Id.) The Board rejected what it characterized as Claimant s assertion that the WCJ s decision was not reasoned under Section 422(a) of the Workers Compensation Act (Act). 1 The Board reviewed the medical reports and/or letters Claimant submitted and determined that the WCJ did not overlook or fail to consider the opinions expressed therein. The Board also rejected Claimant s assertion that the testimony of Employer s expert, Dr. Fenichel, is not competent. The Board concluded also that the explanations the WCJ provided for not accepting as credible the statements of Claimant s medical experts were sufficient. Claimant raises the following issues in this appeal: 2 (1) whether the testimony of Employer s medical expert was equivocal; (2) whether the WCJ failed to render a reasoned decision in accordance with Section 422(a) of the Act; and (3) if the testimony of Employer s medical expert was equivocal, and, thus, not competent, whether the WCJ s decision is based upon an improper capricious disregard of competent evidence. The ultimate issue in this matter, however, 1 Act of June 2, 1915, P.L. 736, as amended, 77 P.S This Court s review is limited to considering whether necessary facts are supported by substantial evidence, and whether any errors of law or violations of constitutional rights were committed. 2 Pa. C.S Substantial evidence is relevant evidence that a reasonable mind might accept as adequate to support a finding. Mrs. Smith s Frozen Foods Co. v. Workmen s Comp. Appeal Bd. (Clouser), 539 A.2d 11, 14 (Pa. Cmwlth. 1988). Additionally, in accordance with our Supreme Court s decision in Leon E. Wintermyer, Inc. v. Workers Compensation Appeal Board (Marlowe), 812 A.2d 478 (Pa. 2002), we may also review a WCJ s decision for capricious disregard of material, competent evidence as a component of our appellate review when a party has properly presented such an issue to the Court. Wintermyer, 812 A.2d at

5 concerns the question of whether Claimant established that there is a causal connection between her work injury and her depression. When a claimant seeks to add injuries to those previously accepted in a notice of compensation payable, the claimant bears the burden to prove that there is a material mistake i.e., that the accepted injury fails to include all of the injuries that the claimant suffered in the work incident. Cinram Mfg. Inc. v. Workers Comp. Appeal Bd. (Hill), 932 A.2d 346, 349 (Pa. Cmwlth. 2007), affirmed, 975 A.2d 577 (Pa. 2009). Additionally, when the causal connection between the work incident and the alleged injury is not obvious, a claimant also bears the burden to establish causation and can do so only by offering unequivocal medical evidence. Namani v. Workers Comp. Appeal Bd. (A. Duie Pyle), 32 A.3d 850, 856 n.4 (Pa. Cmwlth. 2011), appeal denied, 47 A.3d 849 (Pa. 2012). In this matter, there is no dispute regarding the fact that Claimant has depression. The key question, as noted above, is whether Claimant satisfied her burden to prove a causal connection between her work injury and her depression. Our review of the medical statements of Claimant s experts, except Dr. Celebre, indicates that none of them provided an unequivocal medical opinion that Claimant s depression is related to her work-related sinusitis or treatment of her sinusitis. Dr. Marchant did comment in a letter to a referring physician that, at the time she examined Claimant on December 6, 2010, Claimant had an array of complaints, including some depression, some bad dreams associated with the use of Singulair. (R.R. at 60.) Dr. Marchant also noted in the impressions section of her letter that there were [p]ossible significant psychological effects from Singulair and even Astepro. (R.R. at 61.) The WCJ specifically mentioned this aspect of Dr. Marchant s statement in finding of fact number 19. Although these 5

6 statements of Dr. Marchant suggest that Claimant may have suffered some psychological effect from medication Claimant was taking to treat her work-related injury, Dr. Marchant s statement is insufficient to support an alleged causal connection between Claimant s depression and her work injury. Dr. Marchant only referred generally to the relationship between the treatment for Claimant s work-related sinusitis and her depression. Dr. Marchant did not express an unequivocal medical opinion that either the treatment for Claimant s work injury or the work injury itself caused Claimant s depression. Thus, Dr. Marchant s statement would not be sufficient to support the causal connection Claimant was required to establish. Claimant also submitted a letter dated August 24, 2010, that her treating psychiatrist, Dr. Dekret, sent to Maria Melli, M.D., Claimant s primary care physician. (R.R. at 69.) In that letter, Dr. Dekret stated that he had been treating Claimant for approximately one year, and he treated her depression with Cymbalta 30 mg daily. (Id.) Dr. Dekret stated that Claimant s core symptoms of depression responded to lower doses of Cymbalta. (Id.) Dr. Dekret stated that Claimant s problems of tiredness and poor concentration seemed to him to be more related to her sinusitis. (Id.) Dr. Dekret did not indicate that those particular symptoms were related to Claimant s depression. Dr. Dekret did not specifically state that Claimant s work-related injury caused her to suffer from depression. Consequently, this statement does not constitute an unequivocal medical opinion establishing a causal connection between Claimant s work injury and her depression. Claimant also submitted a neuropsychological evaluation conducted and reported by Dr. Murphy. (Id. at 70.) Dr. Murphy indicated in his report that 6

7 on the Beck Depression Inventory II, [Claimant] presents with severe symptoms of depression. (Id. at 74.) Although Dr. Murphy noted that Claimant related her depressive symptoms to her work-related injury, in his diagnostic paragraph he opined, in pertinent part, that Dr. Celebre would be best able to comment in terms of perceived emotional changes which developed pursuant to her exposure incident in October (Id. at 75.) Thus, Dr. Murphy s opinion reflected Claimant s own non-medical opinion, but he refused to express his own professional opinion regarding a possible link between Claimant s work injury and her depression. Thus, Dr. Murphy s statement does not constitute an unequivocal medical opinion supporting Claimant s position. Claimant also submitted the report of Dr. Fine, a neurologist. Dr. Fine s report includes no opinion regarding the cause of Claimant s depression. Other than evaluating Claimant s physical condition, Dr. Fine s only possible reference to Claimant s psychological condition was his statement that if [Claimant s] cognitive concerns dominate, you may want to consider referring her to Bryn Mawr Rehab Hospital to Dr. Murphy for neuropsychological testing. (R.R. at 59.) This statement does not constitute unequivocal medical evidence relating Claimant s work injury to her depression. Because none of the above medical statements or reports constitute the type of unequivocal medical evidence necessary to support a causal connection between Claimant s work injury (or her treatment for her work injury) and her depression, any errors Claimant alleges regarding the WCJ s evaluation of the evidence, as stated in her factual findings, would be harmless error. Accordingly, we reject all claims of errors Claimant raises regarding the medical evidence discussed above. 7

8 Claimant s remaining pertinent medical evidence consists solely of a letter written by Claimant s psychologist, Dr. Celebre. (R.R. at 67.) In that letter Dr. Celebre commented that in 2007 Claimant had symptoms of social anxiety and moderate levels of depression. (Id.) Dr. Celebre noted that Claimant began to complain of coughing, headaches, and nasal congestion, which she believed was associated with her office environment. (Id.) Dr. Celebre stated that Claimant had sinus surgery in March 2008, but that her anxiety and depression remained at the same clinically significant levels as before the surgery. (Id.) Dr. Celebre reported that Claimant refused to return to her office and that Employer ultimately fired her. (Id.) Dr. Celebre stated that Claimant told him that her medical symptoms became worse, and that she had begun to suffer from additional fatigue, concentration problems, and that she was becoming depressed that she was getting no relief from these symptoms. (Id.) After a second surgery, Claimant reported to Dr. Celebre, she had initial improvement, but the physical problems returned. (Id.) Dr. Celebre described the symptoms Claimant was experiencing at the time he wrote the letter in March 2010: Currently, this patient s reported level of functioning at home is at a compromised level. The level of fatigue, headaches and low levels of concentration has affected her ability to drive; she can only drive for 30 minutes at a time and not much more. She also reports that she can read, either from a book or the computer for no more than a half hour. She requires help from her two daughters to perform tasks she used to perform with ease such as writing checks and organizing data for taxes. (Id.) Dr. Celebre offered the following opinion regarding Claimant s condition: In my opinion, her depression and anxiety in the past three years is due to her sense of helplessness over her severe and chronic sinus congestion. Before 2007, she was active and very motivated in her work and had 8

9 attended interior design courses at a college of art in Philadelphia. Her current level of emotional distress would make it very difficult for her to work full time. My diagnosis is Major Depression Disorder, Single Episode, Moderate. There is no Axis II diagnosis. Axis III is Sinusitis. Axis IV is severe medical and financial stress. Axis V is 55 (Global Assessment of Functioning). (Id. at ) It is clear from Dr. Celebre s letter that he believes that Claimant s depression is related to her work-related sinus condition. Employer, on the other hand, offered the deposition testimony of Dr. Fenichel, a psychiatrist. Dr. Fenichel agreed with Dr. Celebre s opinion that Claimant suffers from depression. Dr. Fenichel provided a thorough description of the work-related history that culminated in the diagnosis of Claimant s work-related chronic sinusitis. Dr. Fenichel also testified regarding discrepancies between Claimant s recitation regarding her personal history predating her employment and admissions she made regarding her personal history in a document contained in Dr. Celebre s files that Dr. Fenichel reviewed. Dr. Fenichel explained that when she asked Claimant about her personal history, including her childhood and her previous mental state, her description was inconsistent with the history Claimant revealed to Dr. Celebre: She said she was not sickly as a child. She always had good health. And she denied any type of abuse, physical, sexual, or verbal. And what was significant about that was the additional records that were reviewed that included a form that she filled out for Dr. Celebre, which identified lots of problems in the family and problems that she clearly did not talk about with me during the evaluation.... And her own personal history in regard to her feelings about herself. She talked to me about she was always a positive person and busy person. And this was not how she described herself in the form that she had completed for Dr. Celebre.... In regard to identifying some disturbing events and possible events, 9

10 but most of these additional two papers identified all kinds of negative feelings that Mrs. Nanni has felt about herself. And these symptoms have nothing to do with the work injury. Example, she wanted to go to modeling school, they laughed at me and told me I wasn t pretty enough to be a model. Clearly this is a problem that has nothing to do with any kinds of depression symptoms that she relates to the exposure in her work situation. (R.R. at ) In explaining the importance of having an accurate personal history for the purpose of forming an opinion regarding a psychological condition, Dr. Fenichel explained: Clearly it is impossible to fully understand an individual with one appointment. With that having been said, there is a level of expectation that a person should provide reliable history about significant problems in her past. Problems in the past are just really facts, and if an individual clearly does not relate an accurate history regarding any type of abuse, physical, sexual, or verbal, then, she is presenting a history which is inaccurate. She s presenting a history that she acknowledged that she had problems related to her divorce, but she denied any other type of problem. And so, in regard to drawing conclusions, the conclusions from Mrs. Nanni, based on what she was just telling me, really were not compatible with what she had told her treating psychologist. She did tell me that she saw Dr. Celebre before her work accident, but she certainly did not relate the information that she completed in a self-report form for him. (R.R. at ) Thus, Dr. Fenichel summarized the records she reviewed concerning Claimant, including the self-report form Claimant completed for Dr. Celebre. Dr. Fenichel testified as follows regarding information contained in that form: Ms. Nanni completed the form for Dr. Celebre, that I talked about, refer [sic] to chronic problems from childhood related to anxiety. Her father threatened her to death. He threatened her mother and other members of 10

11 the family, but he had not threatened her.... As a child she was shy, introverted, and with anxiety and shame. She felt ignored. She heard her father argue with her mother that she and her brother were mistakes. She always felt like a nuisance, even if she was quiet. (R.R. at ) Dr. Fenichel opined that while she believed that Claimant did suffer from depression, it was her opinion that the file included many factors in addition to the sinus complaints that contributed to her depression, including her developmental history and her marriage. (R.R. at 109.) Dr. Fenichel further testified that it was her opinion [t]hat the depression was not specifically related to the work injury, that Ms. Nanni had a diagnosis of chronic sinusitis that had caused a change in her regular activities. She was in treatment with Dr. Celebre and she had a history of treatment with Paxil. It was my opinion that the other factors that were noted in the self-report form... were important, again, related to the abuse from her father, feelings of poor self-worth, isolation and depression in childhood.... Her ongoing psychological treatment is related to significant underlying psychological problems. (R.R. at 110 (emphasis added).) Thus, Dr. Fenichel opined that, given the other potential causes of her depression, Claimant s depression was not related in particular to Claimant s work-related injury. Thus, with regard to the two key medical opinions in this matter, Dr. Fenichel s testimony reflects a thorough review of Claimant s psychological history, as revealed in a self-report Claimant provided to Dr. Celebre. Dr. Fenichel s testimony indicates that the history Claimant presented to Dr. Celebre encompasses psychological factors known to Dr. Celebre, which Dr. Celebre did not discuss in his statement. Dr. Fenichel opined that those other non-work related psychological factors contributed to Claimant s depression. 11

12 Based upon Dr. Fenichel s reference to and consideration of Claimant s complete psychological history, the WCJ made a finding that Dr. Fenichel s opinion was more credible than the medical opinion of Dr. Celebre. We will first consider Claimant s argument that the testimony of Employer s medical expert, Dr. Fenichel, was equivocal and, thus, incompetent to support the WCJ s necessary factual findings. The question of whether expert medical testimony is unequivocal and, thus, competent evidence to support factual determinations is a question of law subject to our review. Somerset Welding & Steel v. Workmen s Comp. Appeal Bd. (Lee), 650 A.2d 114, 117 (Pa. Cmwlth. 1994), appeal denied, 659 A.2d 990 (Pa. 1995). [M]edical testimony is unequivocal if a medical expert testifies, after providing foundation for the testimony, that, in his professional opinion, he believes or thinks a fact exists. O Neill v. Workers Comp. Appeal Bd. (News Corp., Ltd.), 29 A.3d 50, 58 (Pa. Cmwlth. 2011). Taking a medical expert s testimony as a whole, it will be found to be equivocal if it is based only upon possibilities, is vague, and leaves doubt. Kurtz v. Workers Comp. Appeal Bd. (Waynesburg College), 794 A.2d 443, 449 (Pa. Cmwlth. 2002). Additionally, as suggested above, in order to constitute competent medical opinion evidence, a medical expert s testimony must reflect an adequate understanding of the relevant facts in order to demonstrate that he or she has a proper foundation for his or her opinion. Sears, Roebuck & Co. v. Workmen s Comp. Appeal Bd., 409 A.2d 486, 490 (Pa. Cmwlth. 1979). In reviewing an expert s testimony on this basis, we must consider whether the expert had sufficient facts before him upon which to express his medical opinion. Id. An expert is permitted to express an opinion based upon facts of which he has no 12

13 personal knowledge so long as those facts are supported elsewhere in the record. Newcomer v. Workmen s Comp. Appeal Bd. (Ward Trucking Corp.), 692 A.2d 1062, 1066 (Pa. 1997). Unless a medical opinion is based upon such personal knowledge or record support, the opinion will be deemed to have no value. Lookout Volunteer Fire Co. v. Workmen s Comp. Appeal Bd. (Savercool), 418 A.2d 802, 805 (Pa. Cmwlth. 1980). A medical expert s opinion will be held to be incompetent only when the opinion is based solely on inaccurate or false information; when the record as a whole contains factual support for an expert s opinion, the evidence is not incompetent. Am. Contracting Enter., Inc. v. Workers Comp. Appeal Bd. (Hurley), 789 A.2d 391, 396 (Pa. Cmwlth. 2001). It is also well settled that in a workers compensation proceeding, answers given during cross-examination do not, as a matter of law, destroy the effectiveness of the previous opinions expressed by a physician. Hannigan v. Workmen s Comp. Appeal Bd. (Asplundh Tree Expert Co.), 616 A.2d 764, 767 (Pa. Cmwlth. 1992), appeal denied, 634 A.2d 1118 (Pa. 1993). Instead, such statements go to the weight, not the competency, of the expert s opinion. Corcoran v. Workers Comp. Appeal Bd. (Capital Cities/Times Leader), 725 A.2d 868, 872 (Pa. Cmwlth. 1999). Claimant points to testimony Dr. Fenichel provided on cross-examination that Claimant argues renders Dr. Fenichel s testimony equivocal. First, Claimant refers to Dr. Fenichel s testimony that it is impossible to fully understand an individual with one appointment, (R.R. at 103), and that [i]t takes time to develop trust before discussing personal, intimate details of one s life, (R.R. at 119). Claimant also relies upon Dr. Fenichel s testimony on cross-examination that she [did not know] what role the work injury and the 13

14 symptoms have in regard to the depression... I can t tell you the absolute role of these recent stressors in light of everything else that I know about this individual from the history that she s presented. (R.R. at 132.) What appears to be clear from Dr. Fenichel s testimony is that Claimant was not entirely candid with Dr. Fenichel when she was examined. Claimant failed to provide Dr. Fenichel with an accurate account of her personal history, but the information Dr. Fenichel gleaned from Dr. Celebre s records the self-report form provided Dr. Fenichel with reason to conclude that those other factors played a role in Claimant s depression. Dr. Fenichel could not eliminate those other factors as causes of Claimant s depression, and they prevented her from opining that the work injury was the cause of Claimant s depression. While Dr. Fenichel testified that she could not be sure of the role that Claimant s work injury played in her depression, she also testified that the history Claimant revealed to Dr. Celebre (but not to Dr. Fenichel) indicated that there were numerous contributory factors arising from Claimant s pre-work history that caused her depression. As we noted above, a medical expert s response to questions on cross-examination do not diminish the opinions expressed by such an expert on direct examination. Hannigan, 616 A.2d at 767. In this case, Claimant apparently was not candid with Dr. Fenichel with regard to her history. Based upon the information contained in Claimant s self-report form, Dr. Fenichel opined that, contrary to the information Claimant personally provided to her, Claimant had a history of psychological issues that she believed caused or contributed to her depression. Based upon the foregoing analysis, we conclude that Dr. Fenichel s 14

15 testimony was not equivocal, and, therefore, was competent medical evidence for the WCJ to consider. We next address Claimant s assertion that the WCJ failed to render a reasoned decision as required by Section 422(a) of the Act. Section 422(a) of the Act provides, in relevant part: All parties to an adjudicatory proceeding are entitled to a reasoned decision containing findings of fact and conclusions of law based upon the evidence as a whole which clearly and concisely states and explains the rationale for the decisions so that all can determine why and how a particular result was reached. The [WCJ] shall specify the evidence upon which the [WCJ] relies and state the reasons for accepting it in conformity with this section. When faced with conflicting evidence, the [WCJ] must adequately explain the reasons for rejecting or discrediting competent evidence. Uncontroverted evidence may not be rejected for no reason or for an irrational reason; the [WCJ] must identify that evidence and explain adequately the reasons for its rejection. The adjudication shall provide the basis for meaningful appellate review. A decision is reasoned for purposes of Section 422(a) of the Act if it allows for adequate appellate review. Daniels v. Workers Comp. Appeal Bd. (Tristate Transp.), 828 A.2d 1043, 1052 (Pa. 2003). To meet this standard, a WCJ does not need to discuss all of the evidence presented. Dorsey v. Workers Comp. Appeal Bd. (Crossing Constr. Co.), 893 A.2d 191, 195 n.4 (Pa. Cmwlth. 2006), appeal denied, 916 A.2d 635 (Pa. 2007). Rather, [t]he WCJ is only required to make the findings necessary to resolve the issues raised by the evidence and relevant to the decision. Id. [T]he WCJ is the sole arbiter of the credibility and the weight of testimony and other evidence, and he or she is free to reject or accept the testimony of 15

16 any witness in whole or in part. O Donnell v. Workers Comp. Appeal Bd. (United Parcel Serv.), 831 A.2d 784, 789 (Pa. Cmwlth. 2003). The findings of the WCJ are conclusive on appeal so long as they are supported by substantial evidence. Id. Moreover, Section 422(a) [of the Act] does not permit a party to challenge or second-guess the WCJ s reasons for credibility determinations. 16 Unless made arbitrarily or capriciously, a WCJ s credibility determinations will be upheld on appeal. Dorsey, 893 A.2d at 195 (citation omitted). as follows: With regard to a WCJ s credibility determinations, this Court has stated Although our Supreme Court has held that a WCJ need not explain credibility determinations relating to a witness who testifies before the WCJ, Section 422(a) of the Act requires some explanation of credibility determinations by a WCJ with regard to conflicting deposition testimony in order to enable this Court to review a WCJ s decision. Under Section 422(a) of the Act, a WCJ must articulate the objective rationale underlying his credibility determinations where the testimony of such witnesses is conflicting. A WCJ may satisfy the reasoned decision requirement if he summarizes the witnesses testimony and adequately explains his credibility determinations. Thus, while summaries of testimony alone would be insufficient to satisfy the reasoned decision requirement, where a WCJ summarizes testimony and also objectively explains his credibility determinations, the decision will satisfy the requirement. Further, other evidence in the record may provide the objective support necessary under Section 422(a) of the Act for adequate credibility determinations. Amandeo v. Workers Comp. Appeal Bd. (Conagra Foods), 37 A.3d 72, 76 (Pa. Cmwlth. 2012) (citations omitted) (quoting Clear Channel Broad. v. Workers Comp. Appeal Bd. (Perry), 938 A.2d 1150, 1157 (Pa. Cmwlth. 2007), appeal denied, 951 A.2d 1167 (Pa. 2008)). Thus, [w]here the WCJ fails to provide an objective

17 basis for his credibility determinations, effective appellate review is precluded. Dorsey, 893 A.2d at 196. Claimant first claims that the WCJ fails to provide an adequate basis for her credibility determinations in finding of fact number 3, where the WCJ found in pertinent part that: Dr. Fenichel is more credible and persuasive than Dr. Celebre because[: (1)] the Claimant s treating physician, Dr. Dekret, didn t provide a causative link between the Claimant s psychiatric condition and work injury and thus provided support for Dr. Fenichel s opinion of the lack of the aforesaid relationship[; (2)] Dr. Celebre didn t provide an explanation of the mechanism or effect of the work injury on the Claimant s pre-existing psychological condition despite Dr. Celebre s treatment of the Claimant for over 4 years before the work injury [; (3)] Dr. Celebre didn t explain the impact, if any, of other factors, like the Claimant s developmental history and marriage, on the development and existence of the Claimant s depression in contrast to Dr. Fenichel s testimony [; (4)] because Dr. Fenichel reviewed several records and reports about Claimant for the bases of her opinions[; and (5)] because no evidence established Dr. Celebre s review of several records and reports about the Claimant and for the formulation of his opinions. (WCJ Decision, F.F. no. 3; internal breaks added.) We need look no further than the reasons the WCJ expressed in bracketed numbers (4) and (5) above, wherein the WCJ found Dr. Fenichel s opinion more credible than Dr. Celebre s based upon Dr. Fenichel s discussion and identification of Claimant s complete psychological background. This objective reason is sufficient to provide the Court with an understanding of the basis of the WCJ s determination that Dr. Fenichel s opinion is more credible than Dr. Celebre s opinion. Based upon this, we conclude that the reasons the WCJ offered in support of her credibility determination satisfy the requirements for a 17

18 reasoned decision. Ace Wire Spring & Form Co. v. Workers Comp. Appeal Bd. (Walshesky), 93 A.3d 923, 935 (Pa. Cmwlth. 2014), appeal denied, A.3d (Pa., No. 318 WAL 2014, filed November 6, 2014). Thus, we reject Claimant s contention that the WCJ s decision is not reasoned based upon Claimant s assertion that the WCJ failed to provide an objective rationale to reject Claimant s medical expert s opinion. Claimant also argues that the WCJ s decision contains key inconsistencies, and, thus, the decision fails to satisfy the requirements of a reasoned decision under Section 422(a) of the Act. Claimant asserts: In rejecting Dr. Celebre s opinions, FF 3 is in direct conflict with FF 24 where the Judge did outline the doctor s opinion of causation; namely that claimant s physical symptoms combined with her inability to work is the current cause of claimant s depression. The WCJ s description of Dr. Fenichel s testimony is in direct conflict with Dr. Fenichel s actual testimony. Dr. Fenichel did NOT state that claimant s depression was not related to her work injury. Indeed she repeatedly had no idea, did not know the cause of claimant s depression.... The statement attributed to Dr. Fenichel simply does not exist anywhere in the record. What Dr. Fenichel did say, was that claimant s disability is due to her physical symptoms, and not the depression. She never addressed the contrary question whether the disability caused (or contributed to) her depression. (Claimant s Brief at ) As we noted above, however, in addressing the question of whether Dr. Fenichel s testimony was unequivocal, we quoted her testimony that the file included many factors in addition to the sinus complaints that contributed to her depression, including her developmental history and her marriage, (R.R. at 109), that the depression was not specifically related to the work injury, and that Dr. Fenichel believed that the other factors that were noted 18

19 in the self-report form... were important, again, related to the abuse from her father, feelings of poor self-worth, isolation and depression in childhood.... Her ongoing psychological treatment is related to significant underlying psychological problems. (R.R. at 110). Thus, Dr. Fenichel did testify that other factors played a role in Claimant s depression. In this matter, Claimant simply provided insufficient medical evidence connecting her work-related sinus condition to her depression. It is clear that her various experts recognized both her depression and her work-related injury, but with the exception of Dr. Celebre, whose opinion the WCJ afforded less weight than Dr. Fenichel s, none of those experts provided unequivocal evidence of such a connection. Based upon the foregoing, we conclude that the WCJ did not overlook or fail to address any evidence pertinent to Claimant s contention that her depression is related to her work injury. Rather, the WCJ explained adequately why she did not find the only clear evidence of a causal connection to Claimant s work injury the statements of Dr. Celebre sufficiently credible to support this necessary element of Claimant s review petition. Accordingly, we affirm the Board s order. 3 P. KEVIN BROBSON, Judge 3 Because we have concluded that the WCJ did not err in finding Dr. Fenichel s testimony competent, we need not address Claimant s argument that the WCJ capriciously disregarded medical evidence Claimant submitted in support of her review petition. 19

20 IN THE COMMONWEALTH COURT OF PENNSYLVANIA Cheryl Nanni, : Petitioner : : v. : No. 795 C.D : Workers Compensation Appeal : Board (Brunner, MD), : Respondent : O R D E R AND NOW, this 30th day of January, 2015, the order of the Workers Compensation Appeal Board is AFFIRMED. P. KEVIN BROBSON, Judge