A. Nichols v. WCAB (S.D. of Philadelphia) ( 2022 )


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  •          IN THE COMMONWEALTH COURT OF PENNSYLVANIA
    Angela Nichols,                      :
    :
    Petitioner :
    :
    v.                    : No. 777 C.D. 2020
    : Submitted: February 19, 2021
    Workers’ Compensation Appeal         :
    Board (School District of            :
    Philadelphia),                       :
    :
    Respondent :
    BEFORE:     HONORABLE MICHAEL H. WOJCIK, Judge
    HONORABLE CHRISTINE FIZZANO CANNON, Judge
    HONORABLE BONNIE BRIGANCE LEADBETTER, Senior Judge
    OPINION NOT REPORTED
    MEMORANDUM OPINION
    BY JUDGE WOJCIK                                    FILED: February 9, 2022
    Angela Nichols (Claimant), pro se, petitions for review of an order of
    the Workers’ Compensation Appeal Board (Board), which affirmed a decision of a
    Workers’ Compensation Judge (WCJ) denying her Claim Petition filed against the
    School District of Philadelphia (Employer) because she did not meet her burden of
    proving that she sustained a disabling work-related injury. On appeal, Claimant
    contends that she did meet her burden of proof, and that Employer’s medical expert
    was not qualified to render an opinion regarding her injuries. For the following
    reasons, we affirm the Board’s order.
    On December 6, 2017, Claimant filed a Claim Petition, seeking
    compensation under the Workers’ Compensation Act (Act),1 and asserting that she
    sustained injuries to her lower back, upper back, neck, and right leg on September
    25, 2017, while she was working for Employer as a special education classroom
    assistant, earning $372.00 per week. Certified Record (C.R.) Item No. 2, at 2-3.2
    She claimed that her injuries were caused by “REPETITIVE JOB ACTIVITIES
    INCLUDING LIFTING, BENDING, [and] TRANSFERRING OF STUDENTS.”
    Id. at 2. Claimant sought total disability benefits from September 25, 2017, and
    ongoing. Id. at 4. Employer filed an Answer to the Claim Petition, denying all
    material allegations, and the matter was assigned to a WCJ for disposition. C.R.
    Item Nos. 3-4.
    Claimant testified at two hearings held before the WCJ on January 3,
    2018, and November 19, 2018. C.R. Item Nos. 10, 12. At the first hearing, Claimant
    testified that she began working for Employer on September 15, 2016.3 C.R. Item
    No. 10, 1/3/2018 Hearing Transcript (Hr’g Tr.) at 4-5. She explained that her duties
    as a classroom assistant for special needs students, who are physically and mentally
    handicapped, primarily involved “help[ing] with their personal care needs[.]” Id. at
    5. For example, she assisted the students in the bathroom, pushed their wheelchairs,
    changed their clothes, and helped them eat. Id. at 5-6. Claimant explained that many
    of the students had limited mobility, so she had to manually lift and turn them. She
    1
    Act of June 2, 1915, P.L. 736, as amended, 77 P.S. §§1-1041; 2501-2710.
    2
    On August 27, 2020, this Court granted Claimant leave to proceed in forma pauperis.
    Claimant elected not to file a reproduced record. See Pa. R.A.P. 2151(b) (“If leave to proceed in
    forma pauperis has been granted to a party, such party shall not be required to reproduce the
    record.”).
    3
    Claimant was represented by counsel before the WCJ and the Board.
    2
    estimated the students’ average weight to be 75 pounds. Id. at 7. Claimant further
    stated that she had to stand and walk most of the day. Id. at 6.
    Claimant testified that she developed pain in her back beginning in
    March of 2017. 1/3/2018 Hr’g Tr. at 10. She explained that it became difficult for
    her to bend, lift the students, and push the students in wheelchairs. Id. at 10. Over
    time, her pain worsened, and on one occasion near the end of March of 2017, she
    took three days off of work due to the pain. Id. at 10, 21. However, she managed to
    work through June of 2017, when the school year ended and she had the summer
    off. Id. at 10-11.
    Claimant testified that she returned to work on August 28, 2017, for the
    new school year, but she continued to have pain while performing her job duties and
    also “noticed that the symptoms were getting worse and that the job was getting
    more difficult to perform.” 1/3/2018 Hr’g Tr. at 11-12. Then, on September 25,
    2017, Claimant explained that while she was lifting a student from a wheelchair to
    a bed, she experienced severe pain in her lower back, as well as in her legs and feet.
    Id. at 12-13. Claimant stated that she nevertheless completed her workday, but again
    experienced extreme pain later that evening. Id. at 13. She claimed that her lifting
    of the student impacted her back, neck, legs, feet, and hands. Id.
    Within two days of the incident, Claimant stated that she contacted
    Kathy Leonard, an administrator in the special education department, via telephone
    to notify her of Claimant’s symptoms. 1/3/2018 Hr’g Tr. at 14. Leonard referred
    Claimant to Worknet for medical treatment, and Worknet referred her to Michelle
    Hirsch, M.D., Claimant’s family doctor. Id. at 14-15. Dr. Hirsch then referred
    Claimant to an orthopedist, whom she saw twice. Id. at 15-16. The orthopedist told
    Claimant that she could return to work but could not lift anything over 25 pounds.
    3
    Id. at 27. Claimant stated that she then attended 11 physical therapy sessions, but
    her pain continued. Id. at 16. Claimant also testified that, at the time of the hearing,
    she was treating with Jason Lazaroff, D.C., and attending physical therapy three days
    a week. Id. at 17.
    Claimant further testified that she was first treated for back and neck
    pain about five years ago, due to a car accident. Id. at 17-18. She stated, however,
    that she recovered from that accident and did not have any back or neck issues at the
    time she began working for Employer. Id. at 18. Claimant testified that she has not
    returned to work for Employer, or anywhere else, since September 25, 2017. Id. at
    16-17.
    Claimant testified before the WCJ a second time on November 19,
    2018. C.R. Item No. 12, 11/19/2018 Hr’g Tr. at 1. Since her prior testimony, she
    was evaluated by Matthew J. Tormenti, M.D., a neurosurgeon at Princeton Brain,
    Spine & Sports Medicine. Id. at 7-8. Dr. Tormenti referred Claimant to one of his
    colleagues, Mark McLaughlin, M.D., also a neurosurgeon, who recommended
    surgery due to the severe condition discovered on a cervical magnetic resonance
    imaging (MRI) scan of Claimant. Id. at 8-9. Claimant, however, could not get the
    surgery because Dr. McLaughlin’s practice does not accept her medical insurance.
    Id. at 9. Additionally, Claimant stated that she treats at ProHealth, where she
    receives physical therapy, chiropractic services, acupuncture, and massage, which
    provides temporary relief. Id. at 11-12.
    Claimant stated that she has severe, continuous pain, which worsens
    with physical activity. 11/19/2018 Hr’g Tr. at 13-14. If she stands for a long period
    of time or walks more than three blocks, it is very painful; she feels a burn from her
    low back to her feet. Id. at 14-15. It takes her two to three hours to shower and dress
    4
    due to the pain, and household cleaning takes all day because she needs to take many
    breaks. Id. at 15. Claimant testified that she cannot return to work because she
    cannot lift students, push wheelchairs, or stand for long periods of time. Id. at 16.
    On cross-examination, Claimant was asked about her prior
    consultations with Dr. Hirsch. Claimant admitted to telling Dr. Hirsch on September
    21, 2017, that she “had a history of chronic mid and low back pain beginning around
    2000 after a motor vehicle accident[]” and that the pain “had been worsening over
    the past few months with no new injury.” 11/19/2018 Hr’g Tr. at 19. Claimant also
    reported to Dr. Hirsch that she had numbness in her feet and swelling in her legs. Id.
    at 19-20. Additionally, in December of 2017, Claimant informed staff at ProHealth
    that she had prior back pain as a result of the motor vehicle accident. Id. at 20.
    In support of her Claim Petition, Claimant presented the August 1, 2018
    deposition testimony of Dr. Tormenti, who first treated Claimant on January 9, 2018.
    C.R. Item No. 15, at 7. At that time, Claimant reported a prior motor vehicle accident
    that caused back pain but claimed that she had been asymptomatic until the work
    injury of September 25, 2017, which caused back pain with radiation into her legs
    and arms. Id. at 7-8.
    Dr. Tormenti examined Claimant’s medical records, including two
    MRI scans. He opined that Claimant “had a Type 1 Chiari malformation with a
    syrinx or a big fluid-filled cavity in the middle of her spinal cord that was expanding
    out of her spinal cord.” C.R. Item No. 15, at 16. He explained that “[a] Chiari
    malformation is when the cerebellum or the back part of the brain actually herniates
    out through the bottom of the skull and into the spinal canal.” Id. Dr. Tormenti
    further explained that Claimant’s malformation was cutting off some of her spinal
    5
    fluid flow, and was causing a syrinx in the middle of her spinal cord. Id. at 17. Dr.
    Tormenti stated that this condition can cause pain, numbness, and tingling. Id.
    Dr. Tormenti stated that no one knows the exact cause of a Chiari
    malformation; some people are born with it, and it has been seen in children. C.R.
    Item No. 15, at 17. Other people can develop it later in life. Id. Dr. Tormenti
    explained that it is not a condition that he regularly treats. Id. However, he has
    treated it in the past and understands the surgery, but the surgery required is
    relatively involved. Id. He stated that his partner, Dr. McLaughlin, has more
    expertise with the condition and surgery.       Id. at 17-18.    Dr. Tormenti thus
    recommended Claimant to Dr. McLaughlin, who examined her and recommended
    surgery. Id. at 17-18, 20-21.
    When asked for his opinion in the case based on his review of the
    history that he obtained from Claimant, his examinations of Claimant, and
    Claimant’s other medical records and the diagnostic studies reviewed, Dr. Tormenti
    opined that Claimant sustained a sprain and strain to her neck and low back on
    September 25, 2017, and had disc bulging in her lumbar spine and cervical spine,
    and the Chiari malformation. C.R. Item No. 15, at 24-25. Dr. Tormenti further
    opined that Claimant’s Chiari malformation probably predated her work injury, “but
    that she was asymptomatic until th[e work] event . . . [and] the [work] event did lead
    to it acutely becoming a problem.” Id. at 25. Therefore, Claimant’s condition was
    work related.    Id.   Dr. Tormenti also noted that because Claimant became
    symptomatic as a result of the September 25, 2017 work event, surgical treatment is
    necessary to correct the Chiari malformation, which “can be made significantly
    worse by exertion, . . . even heavy coughing”; thus, he opined that Claimant’s
    6
    injuries have rendered her unable to perform her job since September 25, 2017, or
    any physical job. Id. at 25-27.
    Dr. Tormenti noted that Claimant’s cervical MRI also showed some
    degeneration and disc bulging, which may contribute to the pain in her neck. C.R.
    Item No. 15, at 15, 18. However, he did not focus on it because the Chiari
    malformation was his primary concern. Id. at 18. Dr. Tormenti explained that the
    Chiari malformation needs to be addressed because it can cause progressive
    neurologic problems that may become irreversible if not treated. Id. at 18-19.
    Employer presented the October 10, 2018 deposition testimony of John
    Nolan, M.D., who is an orthopedic surgeon.4 C.R. Item No. 19. Dr. Nolan
    conducted an independent medical examination (IME) of Claimant on February 28,
    2018. Id. at 8. He reviewed Claimant’s medical records, but not her MRIs, and she
    recounted her medical history. Id. Based on his examination, Dr. Nolan determined
    that Claimant had no objective signs of impairment. Id. at 13. To the degree she
    sustained any injury on September 25, 2017, however, he concluded that it was a
    strain of her cervical or lumbar spine, from which she had fully recovered. Id.
    Several months after the IME, Dr. Nolan had the opportunity to review
    additional medical records, including Claimant’s x-rays and MRIs, based on which
    he determined that Claimant had changes to her lumbar and cervical spine, which
    were degenerative and not work related. C.R. Item No. 19, at 14-15. He observed
    that Claimant’s October 30, 2017 MRI did show fluid inside her spinal cord, i.e., the
    syrinx. Id. at 15. Dr. Nolan did not believe that the syrinx was work related,
    however, because “[s]ome people feel that [it] can be caused by trauma,” and there
    4
    During his deposition, Dr. Tormenti was asked whether orthopedic surgeons are qualified
    to treat a Chiari malformation, to which he responded that only neurosurgeons are so qualified.
    C.R. Item No. 15, at 27.
    7
    was no work-related neck injury reported here, and because it generally would take
    a fair amount of time to develop. Id. at 17. Dr. Nolan stated that he was familiar
    with Chiari malformation, but he does not treat it and is “not an expert in it”; if he
    had a patient with Chiari malformation, he would refer her to a neurosurgeon. Id. at
    6-8, 17.
    Dr. Nolan reviewed the transcript of Dr. Tormenti’s deposition
    testimony and stated that the history Dr. Tormenti obtained from Claimant differed
    from the history she reported to Dr. Nolan and the history contained in her medical
    records. C.R. Item No. 19, at 18. For example, Claimant told Dr. Tormenti that she
    was asymptomatic for several years prior to September 25, 2017; however, her
    medical records showed that she reported back pain to her family doctor on
    September 21, 2017, four days prior to the alleged work incident. Id. Further, Dr.
    Nolan disagreed that Claimant sustained sprains and disc bulging on September 25,
    2017, that would make her Chiari malformation symptomatic. Id. at 18-19. He also
    noted that Claimant’s MRIs showed that disc degeneration was already present and
    symptomatic prior to the work event. Id. Moreover, her physical examination was
    benign. Id. at 19. Therefore, Dr. Nolan found no objective reason why Claimant
    could not perform her job duties. Id.
    In a decision circulated on May 8, 2019, the WCJ determined that
    Claimant failed to meet her burden of proving that she sustained a disabling work-
    related injury on September 25, 2017. C.R. Item No. 5, WCJ Decision, Findings of
    Fact No. 8. In doing so, the WCJ found Claimant not credible based on her demeanor
    while testifying and because “[h]er testimony [was] internally inconsistent and
    inconsistent with the various histories that she provided to her treating physicians.”
    Id., Findings of Fact No. 6. The WCJ further found that Dr. Nolan’s testimony was
    8
    more credible and persuasive than Dr. Tormenti’s, because Dr. Tormenti’s opinions
    were “based almost entirely on the history provided by Claimant, who [the WCJ
    found] not credible.” Id., Findings of Fact No. 7(a). The WCJ explained that Dr.
    Nolan’s opinions were “reasonably and logically explained” and “consistent with
    his objectively normal examination [of Claimant,] as well as the objectively normal
    examinations of Dr. Tormenti.” Id., Findings of Fact No. 7(b)-(c). Accordingly, the
    WCJ denied and dismissed Claimant’s Claim Petition. Id., Conclusions of Law No.
    2.
    Claimant appealed to the Board. She first argued that substantial
    evidence did not support the WCJ’s determination that she did not sustain a disabling
    work injury on September 25, 2017. C.R. Item No. 6, at 2. Claimant further argued
    that the WCJ erred in finding that her testimony was inconsistent, and in rejecting
    Dr. Tormenti’s testimony in favor of Dr. Nolan’s testimony, when Dr. Nolan
    acknowledged that, as an orthopedic surgeon, he does not treat Chiari malformation
    with syrinx, while Dr. Tormenti, a neurosurgeon, does treat patients with that
    condition. Id. Claimant asserted that the WCJ’s credibility findings are in error and
    not supported by substantial evidence. Id.
    The Board disagreed with Claimant and affirmed the WCJ’s decision
    in an Opinion and Order issued on June 2, 2020. C.R. Item No. 8, at 3. In doing so,
    the Board pointed out the various inconsistencies in Claimant’s testimony before the
    WCJ, noting that Claimant first testified that her back pain began in March of 2017,
    while bending, lifting, and twisting at work, and that it progressively worsened up
    until September 25, 2017, when she was lifting a student to transfer the student from
    a wheelchair to a bed and felt severe low back pain, which spread to her legs and
    feet and worsened later that evening to the point she could not get up. Id. at 2-3.
    9
    The Board also noted Claimant’s acknowledgment that she injured her back
    previously in a motor vehicle accident, but was treated and the pain went away. Id.
    at 3. The Board next reviewed Claimant’s testimony from the November 19, 2018
    hearing, stating that she informed Dr. Hirsch on September 21, 2017, of a history of
    back pain from 2000 onward, due to a motor vehicle accident, and that the pain had
    been worsening with no new injury. However, the Board noted, Claimant told Dr.
    Tormenti that she was symptom free for some time before September 25, 2017. Id.
    at 4. Upon review of the above testimony, the Board determined that the WCJ did
    not err in denying Claimant’s Claim Petition, as she bore the burden of proving all
    of the elements necessary to support an award, but failed to do so because the WCJ
    rejected her testimony as incredible. Moreover, because the WCJ found Claimant
    not credible, the Board concluded that it did not need to address her claim regarding
    the WCJ crediting Dr. Nolan’s testimony over Dr. Tormenti’s testimony. Id. at 4
    n.2.
    Claimant now petitions for review to this Court, raising two issues.5
    First, she claims that the Board erred by concluding that she did not meet her burden
    of establishing that a disabling work injury occurred on September 25, 2017.
    Second, she claims that Dr. Nolan is not a neurosurgeon and, thus, is not qualified
    to render an opinion on Chiari malformation with syrinx.6
    In her brief, Claimant argues that she met her burden of proving that
    she sustained a disabling work injury on September 25, 2017, and that the WCJ’s
    5
    Our standard of review is limited to a determination of whether necessary findings of fact
    are supported by substantial evidence, whether constitutional rights were violated, or whether an
    error of law was committed. Morey v. Workmen’s Compensation Appeal Board (Bethenergy
    Mines, Inc.), 
    684 A.2d 673
    , 676 n.6 (Pa. Cmwlth. 1996).
    6
    In her brief, Claimant argues these two issues as one. For ease of discussion, we address
    them separately.
    10
    finding to the contrary is not supported by substantial evidence. Claimant’s Brief at
    19. Specifically, she claims that after experiencing back and neck pain beginning in
    March of 2017, her pain progressively worsened and ultimately culminated in her
    suffering a disabling work injury on September 25, 2017, when she experienced a
    severe onset of pain in her neck, back, and extremities while lifting a nearly 75-
    pound student. Id. at 5, 10, 19. Her medical expert, Dr. Tormenti, opined that her
    severe onset of pain was the result of a preexisting Chiari malformation that became
    acutely symptomatic due to her work-related physical activities. Thus, she asserts
    that her Claim Petition should have been granted.
    Employer responds that the WCJ rejected Claimant’s testimony as not
    credible based upon her demeanor while testifying and because her testimony
    regarding the onset of her injuries was inconsistent. Employer additionally notes
    that because Dr. Tormenti’s medical opinions were based almost exclusively on the
    history provided to him by Claimant, his testimony was also rejected. Therefore,
    Employer claims that Claimant failed to meet her burden of proving a disabling work
    injury based on the WCJ’s credibility determinations.
    In a claim petition proceeding, the burden of proving all necessary
    elements to support an award rests with the claimant. Inglis House v. Workmen’s
    Compensation Appeal Board (Reedy), 
    634 A.2d 592
    , 595 (Pa. 1993). The claimant
    must establish that her injury was sustained in the course and scope of her
    employment and is causally related thereto, and that the injury resulted in a
    disability.   McCabe v. Workers’ Compensation Appeal Board (Department of
    Revenue), 
    806 A.2d 512
    , 515-16 (Pa. Cmwlth. 2002).7 The claimant must also
    establish that the disability continues through the pendency of the claim petition
    7
    In this context, disability is synonymous with a loss of earning power. McCabe, 
    806 A.2d at 515-16
    .
    11
    proceedings.       Soja v. Workers’ Compensation Appeal Board (Hillis-Carnes
    Engineering Associates), 
    33 A.3d 702
    , 707 (Pa. Cmwlth. 2011). Where the causal
    relationship between the work incident and the injury is not obvious,8 unequivocal
    medical evidence is necessary to establish that relationship. Roundtree v. Workers’
    Compensation Appeal Board (City of Philadelphia), 
    116 A.3d 140
    , 145 (Pa.
    Cmwlth. 2015).
    In reviewing a substantial evidence9 challenge, we “consider the
    evidence as a whole, view the evidence in a light most favorable to the party [that]
    prevailed before the WCJ, and draw all reasonable inferences which are deducible
    from the evidence in” that party’s favor. Frog, Switch & Manufacturing Co. v.
    Workers’ Compensation Appeal Board (Johnson), 
    106 A.3d 202
    , 206 (Pa. Cmwlth.
    2014) (internal quotation marks omitted). Where both parties present evidence, it
    does not matter if there is evidence that supports a contrary finding; the only question
    is whether there is evidence that supports the findings that were made. McCabe, 
    806 A.2d at 515
    . This Court must accept the WCJ’s findings if, upon consideration of
    the evidence as a whole, the findings are supported by competent evidence of record.
    Inglis House, 634 A.2d at 595. “The WCJ is the ultimate fact finder and has
    complete authority for making all credibility” and evidentiary weight
    determinations. Rife v. Workers’ Compensation Appeal Board (Whitetail Ski Co.),
    8
    “An obvious relationship exists where the claimant’s injuries immediately and directly or
    naturally and probably result from a work incident; in such cases, the fact finder is not required to
    depend alone, or at all, upon medical testimony to find the causal connection.” Metelo v.
    Workmen’s Compensation Appeal Board (Old Original Bookbinders Restaurant), 
    642 A.2d 653
    ,
    655 (Pa. Cmwlth. 1994).
    9
    “Substantial evidence is such relevant evidence as a reasonable mind might accept as
    adequate to support a conclusion.” City of Philadelphia v. Workers’ Compensation Appeal Board
    (Kriebel), 
    29 A.3d 762
    , 769 (Pa. 2011).
    12
    
    812 A.2d 750
    , 755 (Pa. Cmwlth. 2002). It is well settled that a “WCJ may reject the
    testimony of any witness in whole or in part, even if that testimony is
    uncontradicted.”    Hoffmaster v. Workers’ Compensation Appeal Board (Senco
    Products, Inc.), 
    721 A.2d 1152
    , 1156 (Pa. Cmwlth. 1998). In the rare instances
    where we review a credibility determination, “[w]e must view the reasoning as a
    whole and overturn the credibility determination only if it is arbitrary and capricious
    or so fundamentally dependent on a misapprehension of material facts, or so
    otherwise flawed, as to render it irrational.” Casne v. Workers’ Compensation
    Appeal Board (STAT Couriers, Inc.), 
    962 A.2d 14
    , 19 (Pa. Cmwlth. 2008).
    In her brief, Claimant contends that she met her burden of proof because
    her testimony established that a disabling work injury occurred on September 25,
    2017, when she suffered pain after lifting a student, and her medical expert, Dr.
    Tormenti opined that the pain was a result of a Chiari malformation revealed on her
    MRI that became symptomatic due to the physical nature of her job. As such, she
    asserts that she presented sufficient evidence of her claim. However, as noted above,
    it does not matter that there is evidence in the record which supports a factual finding
    contrary to that made by the WCJ; rather, the pertinent inquiry is whether there is
    any evidence in the record that supports the WCJ’s factual finding. McCabe, 
    806 A.2d at 515
    . Moreover, here, the WCJ did not find that Claimant presented
    insufficient evidence to support her claim; rather, the WCJ found that the evidence
    Claimant presented was simply not credible.
    Claimant testified before the WCJ on two occasions. When a witness
    testifies live before a WCJ, the WCJ’s observation of the witness’s demeanor alone
    is sufficient reason to support his determination of credibility. Casne, 
    962 A.2d at
    18 (citing Daniels v. Workers’ Compensation Appeal Board (Tristate Transport),
    13
    
    828 A.2d 1043
     (Pa. 2003)).        Here, the WCJ stated that “[h]aving observed
    Claimant’s comportment and demeanor during [her] testimony and having reviewed
    the evidence of record in its entirety, this [WCJ] rejects Claimant’s testimony as not
    credible.” C.R. Item No. 5, WCJ Decision, Findings of Fact No. 6. This finding
    alone is sufficient to support the WCJ’s rejection of Claimant’s testimony.
    Additionally, the WCJ found Claimant not credible because “[h]er
    testimony [was] internally inconsistent and inconsistent with the various histories
    that she provided to her treating physicians.” C.R. Item No. 5, WCJ Decision,
    Findings of Fact No. 6. Before this Court, Claimant does not challenge the WCJ’s,
    and thus the Board’s, finding that her testimony was inconsistent. Instead, in her
    brief, she attempts to counter her inconsistencies by offering explanations for the
    inconsistencies that were not presented to the WCJ or the Board. For example,
    Claimant now claims on appeal to this Court that she informed Dr. Tormenti that she
    was asymptomatic for back pain for several years before September 25, 2017,
    because the pain that developed that day was more severe than her prior pain.
    Claimant’s Brief at 12-13. Thus, the pain that began developing in March of 2017
    did not seem important to mention. 
    Id.
     This Court cannot consider “factual
    averments contained in a brief which were not part of the record before the
    administrative agency . . . .” Anam v. Workmen’s Compensation Appeal Board
    (Hahnemann), 
    537 A.2d 932
    , 934 (Pa. Cmwlth. 1988).              As such, we reject
    Claimant’s belated attempt to explain why her testimony was inconsistent.
    The Board held that the WCJ’s finding that Claimant was not credible
    negated her ability to sustain her burden of proof. The finding that Claimant was
    not credible also led the WCJ to find Dr. Tormenti’s testimony not credible because
    “his opinions [were] based almost entirely on the history provided by Claimant[.]”
    14
    C.R. Item No. 5, WCJ Decision, Findings of Fact No. 7(a). Claimant had the burden
    of proving that her Chiari malformation became symptomatic during her
    employment and was causally related to her employment. McCabe, 
    806 A.2d at 515-16
    . Because her testimony regarding the onset of her pain, and Dr. Tormenti’s
    testimony relating the Chiari malformation to her employment, were rejected by the
    WCJ, Claimant could not meet that burden.           As such, we reject Claimant’s
    contention that she sustained her burden of proving a disabling work injury.
    Claimant’s second claim is that the WCJ erred by accepting the
    testimony of Dr. Nolan over that of Dr. Tormenti because Dr. Nolan is not a
    neurosurgeon, has not treated patients with Chiari malformation with syrinx, and is
    not capable of performing the corrective surgery. Employer responds that Dr. Nolan
    is a medical doctor who sees patients with Chiari malformation with syrinx, is
    familiar with the condition, and is trained in the treatment of spine disorders. As
    such, according to Employer, Dr. Nolan was qualified to render an opinion.
    The Board did not discuss Dr. Nolan’s qualifications in its decision, but
    instead concluded that because the WCJ deemed Claimant and her medical expert
    not credible, it was irrelevant whether Dr. Nolan was qualified to render an opinion
    regarding her Chiari malformation with syrinx. We agree with the Board. A
    claimant has the burden at all stages of “a claim petition proceeding, [and] the burden
    never shifts to [the] employer to show that the disability has ceased or been reduced.”
    Soja, 
    33 A.3d at 707
    . Here, Claimant had the burden to establish that she sustained
    a disabling work injury. Specifically, she claimed that the pain caused by her Chiari
    malformation with syrinx was a result of her physical job duties. It is impossible for
    her to sustain her burden of proof, however, when the WCJ found that both she and
    her medical expert were not credible.
    15
    However, even if we reached the issue, Claimant would not prevail. In
    workers’ compensation cases, “[a]n expert medical witness . . . is qualified to testify
    outside of his medical specialty, and any objection to that testimony goes to the
    weight of the evidence, not its competency.” Williams v. Workers’ Compensation
    Appeal Board (USX Corporation-Fairless Works), 
    862 A.2d 137
    , 145 (Pa. Cmwlth.
    2004) (a claim that the WCJ could not credit an anesthesiologist over a psychologist
    with regard to the claimant’s psychological injuries was rejected by this Court). The
    WCJ, not this Court, determines the weight of the evidence. 
    Id.
    For the above reasons, Claimant has not established that the Board erred
    in determining that she failed to meet her burden of proving the elements of her
    Claim Petition. Accordingly, we affirm the Board’s order.
    MICHAEL H. WOJCIK, Judge
    16
    IN THE COMMONWEALTH COURT OF PENNSYLVANIA
    Angela Nichols,                      :
    :
    Petitioner :
    :
    v.                    : No. 777 C.D. 2020
    :
    Workers’ Compensation Appeal         :
    Board (School District of            :
    Philadelphia),                       :
    :
    Respondent :
    ORDER
    AND NOW, this 9th day of February, 2022, the order of the Workers’
    Compensation Appeal Board, dated June 2, 2020, is hereby AFFIRMED.
    __________________________________
    MICHAEL H. WOJCIK, Judge