Johnson v. Christiana School District

majority opinion

IN THE SUPERIOR COURT OF THE STATE OF DELAWARE

ANGELINA JOHNSON )

)

Appellant, )

)

v. )

) C.A. No. N25A-05-005 KMM

CHRISTIANA SCHOOL DISTRICT, )

)

Appellee. )

Submitted: April 20, 2026

Decided: July 16, 2026

Upon appeal of Industrial Accident Board Decision – Affirmed

MEMORANDUM OPINION

Cynthia Pruitt, Esquire., DOROSHOW PASQUALE KRAWITZ & BHAYA, Wilmington,

Delaware, Attorney for Appellant.

William R. Baker, Esquire., TYBOUT REDFEARN & PELL, Wilmington, Delaware,

Attorney for Appellee.

Miller, J.

I. Introduction

Claimant Angela Johnson (“Johnson”) was employed by Christiana School

District (“Employer”) as a third-grade teacher when she suffered a spinal stroke

while at school on January 6, 2022, which left her a paraplegic. Johnson filed a

Petition to Determine Compensation Due with the Industrial Accident Board (the

“Board”). The Board held an evidentiary hearing (the “Hearing”) on Johnson’s

petition, during which it heard testimony from Johnson, Employer, and two

competing medical experts. The central issue was causation.

The Board issued its April 24, 2025 decision (the “Decision”) denying

Johnson’s petition. Because there was no identifiable industrial accident, the Board

applied the Duvall v. Charles Connell Roofing “substantial cause” standard. The

Board accepted Employer’s expert’s opinions over the opinions offered by Johnson’s

expert and ruled that Johnson’s job-related stress was not a substantial cause of the

stroke.

Johnson filed an appeal making two arguments. First, an identifiable

industrial accident occurred and therefore, the Board erred by applying an incorrect

legal standard. Instead of the “substantial cause” standard in Duvall, the Board

should have applied the “but for” standard expressed in Reese v. Home Budget.

Second, accepting Employer’s medical expert’s opinions on causation was not

supported by substantial evidence in the record.

Employer counters that the Board applied the correct legal standard because

there was no identifiable accident and, further substantial evidence supports the

Board’s decision to accept Employer’s expert’s opinions over Johnson’s expert.

There is no evidence in the record that Johnson suffered an identifiable

industrial accident. Therefore, the Board did not err in applying the Duvall standard.

Further, the Board’s findings are supported by substantial evidence. Accordingly,

the Decision is AFFIRMED.

II. Factual Background

A. Johnson’s Evaluation

After years as a paraprofessional,1 Johnson obtained a teaching certificate

from Wilmington University. 2 In 2020, she was hired by Employer as a Special

Education teacher at Bancroft Elementary School.3 In 2021, Johnson was elevated

to a Team Leader for the third-grade teachers.4 Employer conducts teacher

performance evaluations twice a year: one is an advanced-scheduled classroom

observation and the other is an unannounced classroom observation, for which the

teacher is provided 24-hours’ notice.5 An evaluation will result in either an

Industrial Accident Board Hearing February 24, 2025 transcript (“Hearing Tr.”), at 8-9. 2

Id. at 14-15.

Id. at 15.

Id. at 17.

Id. at 17, 46-47; see also Johnson Ex. 2 (previous performance reviews). Although the testimony is unclear exactly how much notice is given for the announced observation compared to the

“effective” or “ineffective” rating.6 An “ineffective” rating over multiple

evaluations will result in the teacher being placed on an improvement plan. 7 If the

teacher fails to improve, the teacher could then be “written up” and eventually fired.8

The improvement plan is “a three-year process.” 9

On January 5, 2022, Johnson was informed that principal Rella Reynolds

(“Reynolds”) would perform a classroom evaluation the next day. 10 Reynolds

conducted Johnson’s previous evaluations.11 Johnson was nervous because

Reynolds “was very hard and very critical of [Johnson] and [her] work in [the]

classroom”12 and never gave her a really good evaluation,13 despite Johnson

believing she deserved a higher rating.14 As a result, the evaluations with Reynolds

were “very strenuous” for Johnson.15 Johnson worried that if she received multiple

unannounced observation, Johnson explained in her brief that “one [is] announced ahead of time, and one announced the day before.” Johnson’s Opening Brief (“OB”), at 4 (D.I. 19). 6

Hearing Tr., at 73.

Id. at 74.

Id. at 38-39.

Id. at 74.

Id. at 22-23, 37.

Id. at 21; see also Johnson Ex. 2.

Hearing Tr., at 21. Johnson believed Reynolds wanted to fire her. See id. at 21-22, 37, 41, 49. 13

Id. at 22.

Id. at 37 (“My work is exemplary”). While the evaluator’s only options were to rate a teacher “effective” or “ineffective” (Id. at 73), Johnson testified she was “not used to getting [an] effective” rating because her “work is exemplary” and she’s “better than effective.” Id. at 37. It appears that Johnson may have been referring to the ratings she received as a paraprofessional, which used a different scale. Hearing Tr., at 10-13, 38; see also Johnson Ex. 2.

Hearing Tr., at 21. Johnson was “intimidated by” Reynolds, who Johnson felt was not “supportive.” Id. at 22, 41.

bad evaluations from Reynolds, Johnson would get “blackballed” among the other

principals. 16

Johnson never received an “ineffective” rating. Indeed, in her last evaluation,

Johnson received an “effective” rating in every category. 17 And Reynolds included

the comment that “Ms. Johnson has shown consistent effective performance

throughout the formative cycle.”18 Accordingly, Johnson was not on probation or an

improvement plan at the time of her injury.19 Thus, as of January 5, 2022, Johnson

was not in danger of losing her job. 20

B. Johnson suffers a stroke.

Johnson worked late on January 5 to ensure she was ready for the evaluation

the next day.21 That evening, Johnson attended a Boy Scout meeting where she had

trouble focusing because she was dwelling on the upcoming review.22 While at the

meeting, Johnson began experiencing back spasms, for which she took an over-thecounter pain medication.23 The following morning, Johnson’s “leg felt a little

funny,” she “felt nauseated,” and her “hands started hurting and just shaking.”24

Id.. at 22.

Id. at 20-21, 37.

Id. at 37; Johnson Ex. 2, at 36.

Hearing Tr., at 36, 39-40.

Id. at 75.

Id. at 23.

Id. at 24.

Id.

Because she had a headache, she checked her blood pressure, which was 187/95.25

Johnson then proceeded to school.

At school, in preparation for the evaluation, Johnson was making copies in

the lounge when she suddenly could not feel her legs, they “just went out” from

under her, and she collapsed.26 Johnson experienced “excruciating pain” in her back,

hips, legs, and feet. 27 She could not move. Johnson was transported to Christiana

Care by ambulance. 28 The hospital records indicate that Johnson reported to the

neurologist that she was not feeling stressed. 29

Johnson was diagnosed with having suffered a spinal stroke, which left her a

paraplegic.30 The blockage, or occlusion, occurred where the artery enters the spine

between T12 and T9.31

C. Johnson’s pre-existing medical conditions

Johnson has a history of high blood pressure (hypertension), 32 high blood

sugar,33 and anxiety.34 As to the hypertension, Johnson admitted that multiple times

Id.

Id. at 25.

Id.

Id. at 26.

Id. at 28.

Johnson Ex. 3, January 23, 2025 deposition transcript of Michael Dogali, M.D. (“Dogali Tr.”), at 24; Employer Ex. 1, February 20, 2025 deposition transcript of John B. Townsend, III, M.D. (“Townsend Tr.”), at 39.

Dogali Tr., at 21-22.

Hearing Tr., at 24, 29.

Id. at 30-31.

Id. at 31-33.

over the two years prior to the injury, her blood pressure readings were considered

critically high.35 Johnson’s medical records indicated, and she agreed, that there

would be periods when she did not take blood pressure medications, despite having

a prescription. 36 As to her high blood sugar, Johnson recalled having A1C and blood

sugar levels over the recommended levels for years prior to the injury. 37 Johnson

testified that she had taken Lexapro, Xanax, and Prozac over the years for anxiety.38

D. The Medical Experts

1. Dr. Dogali

Johnson offered the expert testimony of Michael Dogali, M.D., a Florida

neurosurgeon.39 Dr. Dogali has treated hundreds of stroke patients and researched

the relationship between stress and strokes, developing a special interest in

hemorrhagic strokes. 40 Dr. Dogali did not examine Johnson but conducted an

interview with her.41 Dr. Dogali noted Johnson’s severe diabetes, hypertension, high

cholesterol, hyperlipidemia, anxiety, and migraine headaches. 42 Dr. Dogali did not

Id. at 29. As recently as four months prior to the injury, medical records indicate that Johnson’s blood pressured reached readings of 157/103 and 161/111. Townsend Tr., at 32-33. 36

Hearing Tr., at 29.

Id. at 31. As recently as four months prior to the injury, medical records indicate that Johnson’s A1C levels reached 9.8. Townsend Tr., at 33. Her highest recorded levels reached 11.9. Townsend Tr., at 54.

Hearing Tr., at 31.

Dogali Tr., at 4-5.

Id. at 6.

Id. at 13. Because Johnson was two years post-stroke and prior medical records, which included the results of an American Spinal Cord Injury Association exam, were available, Dr. Dogali testified that a physician exam was not necessary. Id. at 13-14.

Id. at 14.

review Johnson’s past blood pressure readings43 or take a family history.44 He was

unaware of whether Johnson was taking her blood pressure medication in the days

leading up to the incident.45 Dr. Dogali’s record-review was limited to the Christiana

Care records from 2022 onward.46

During the interview, Johnson recounted the onset of her symptoms and

reported great stress stemming from the upcoming evaluation,47 believing she may

be fired.48

Dr. Dogali explained that with heightened stress, essentially in “fight or flight”

reaction,49 the body’s immunological system becomes very active, releasing

adrenaline and norepinephrine, which raises blood pressure very quickly. 50 He

testified that studies have shown approximately 30-40% of cerebral stroke victims

experienced a severe anxiety attack within an hour preceding the event.51 Similar

results are found in cardiac patients.52 Dr. Dogali recognized that while this

Id. at 49-50.

Id. at 42-43.

Id. at 52.

Id. at 38-40.

Id. at 16.

Id. at 16, 19-20.

Id. at 17.

Id. at 17-18.

Id. at 6-7, 18-19.

Id. at 18.

correlation “hasn’t been as widely accepted for stroke[s], … it is becoming now

recognized both in the literature and in practice.”53

In Dr. Dogali’s view, the back pain and spasms Johnson suffered the night

before was a “prodromal event.”54 He opined that Johnson actually suffered two

strokes the morning of January 6: an initial vascular infarction followed by a

hemorrhagic infarction. 55 While making copies, Johnson experienced a blockage of

the artery, which cutoff the blood flow, causing the spinal cord to stop functioning

and the cells begin to die, and eventually the hemorrhagic stroke occurred when the

blood vessel burst.56 Dr. Dogali opined that Johnson’s stress associated with the

upcoming evaluation “contributed to” the spinal strokes.57

Dr. Dogali acknowledged Johnson’s emergency room statement that she was

not stressed and Johnson’s denial that she would ever make such a statement because

she was highly stressed leading up to the incident. 58 Dr. Dogali explained that this

discrepancy was likely due to the pain medications she was given that day, including

morphine. 59

Id. at 6-7.

A prodromal event is an early sign or a precursor.

Dogali Tr., at 23-24.

Id. at 21-24.

Id. at 27, 36. Dr. Dogali also referred to Johnson’s stress as a trigger. Id. at 36. 58

Hearing Tr., at 28-29.

Dogali Tr., at 47.

Dr. Dogali also acknowledged Johnson’s numerous pre-existing health

conditions and that she was obese,60 all of which are risk factors for a stroke. 61 He

believed that her high blood pressure and diabetes “would have caused [a stroke or

heart attack]” in the future.62

2. Dr. Townsend

John Townsend III, M.D., a board-certified neurologist, testified for

Employer.63 Dr. Townsend treated stroke patients in the emergency room for

approximately 20 years, early in his career.64 Most strokes are cerebral, with spinal

strokes accounting for only 1% of all strokes. 65 He testified that there are two types

of spinal strokes: (1) ischemic strokes, where a blood clot blocks a blood vessel in

the spinal cord; and (2) hemorrhagic strokes, which occur when the spinal cord

breaks or tears.66 The majority of spinal strokes are ischemic. 67 Dr. Townsend

testified that the “biggest of the risk factors” for spinal strokes is atherosclerosis

vascular disease (a buildup of plaque in an artery).68 Other high risk factors include

Id. at 43.

Id. at 41.

Id. at 36.

Townsend Tr., at 4.

In 2008, hospitals hired in-house stroke neurologists, so emergency doctors no longer provided initial treatment for stroke patients. Id. at 6.

Id. at 5.

Id. at 9.

Id.

Id. at 11-12, 14-15.

“high cholesterol, hypertension, [and] diabetes.”69 He further testified that the

cerebral stroke literature supports a finding that patients with variable blood pressure

are at six-times a greater risk of an ischemic event compared to those who had well

controlled blood pressure. 70

Dr. Townsend performed a physical and neurological exam of Johnson, 71 and

reviewed medical records from Christiana Care, primary care providers and other

medical providers, dating back to 2013.72 The records revealed that Johnson

suffered from chronic anxiety,73 “poorly controlled diabetes,” 74 “poorly controlled

hypertension,”75 high cholesterol, and weight issues. 76 At times, she was

noncompliant with the blood pressure medication recommendation 77 and monitoring

her blood sugar levels. 78 Additionally, Johnson suffered from diabetic retinopathy

and hypertensive retinopathy, conditions caused by prolonged exposure to diabetes

and high blood pressure, respectively.79

Id. at 11-12. Dr. Townsend also recognized obesity to be a high-risk factor of strokes in general, not spinal strokes specifically. Id. at 14.

Id. at 16-17, 53.

Id. at 37.

Id. at 7. Dr. Townsend reviewed the records of Dr. Biasotto, MedExpress, Christiana Care, Crozer-Chester Medical Center, Brandywine Urology, Global Neuroscience Institute, Mid Atlantic Retina, Jefferson, Moss-Magee Rehab Hospital, Crestview Medical Center, Saint Francis Family Practice. Id. at 7.

Id. at 22.

Id. at 39.

Id.

Id. at 45.

Id. at 23-24, 27-28, 53-54.

Id. at 24, 26-27, 53-54.

Id. at 29-30.

Dating back to 2014, 80 the records reflected Johnson’s blood pressure was not

controlled: in a 2020 visit, her blood pressure was 170/100, which was so high that

Dr. Townsend would “be thinking about sending that person to the emergency room

for acute treatment.”81 In the months leading up to the January 6 event, Johnson’s

readings were 157/103 and 161/111, again, very high. 82 Similarly, her diabetes was

not under control two months prior to the incident, as she had an A1C reading of

9.8.83

Dr. Townsend opined Johnson suffered an ischemic spinal stroke followed by

a hemorrhagic transformation.84 While he agreed with Dr. Dogali that the “onset of

the stroke” likely presented itself as the back pain the previous night, 85 Dr. Townsend

disagreed with Dr. Dogali’s opinion that Johnson experienced a hemorrhagic

infarction and that she suffered two strokes.86 Rather, Dr. Townsend opined that

Johnson experienced a hemorrhagic transformation, where there is some leakage of

the blood vessels due to damage to the brain barrier, 87 which is a “common

consequence of [an] ischemic stroke.”88 He further opined that Johnson’s spinal

Id. at 23.

Id. at 52.

Id. at 32-33.

Id. at 33. Johnson’s A1C levels reached as high as 11.5 and 11.9. Id. at 54. A reading of 6 is recognized as the onset of diabetes. Id. at 27.

Id. at 11, 36, 39, 59.

Id. at 40-41.

Id. at 42-43, 56-57.

Id.. at 43.

Id.

stroke “was more likely related to her history of hypertension and likely

atherosclerosis as that has an increased risk with diabetes.” 89 Dr. Townsend reached

his conclusions based on Johnson’s numerous chronic comorbidities for a stroke

(including “high cholesterol, hypertension, hyperlipidemia,” obesity, varied blood

pressure, and high A1C levels)90 and that Johnson’s stress was unlikely to cause such

a reaction that could produce the type of blood pressure increase suggested by Dr.

Dogali.91

Dr. Townsend explained that no literature directly links stress to spinal

strokes92 and that none of the reports Dr. Dogali relied upon dealt with spinal

strokes.93 For example, one report “outline[d] or compare[d] the characteristics of

cerebral” strokes to those of spinal strokes94 and found that conditions such as heart

disease, high blood pressure, and diabetes are similarly high-risk factors for each of

the types of stroke, but it made no mention of stress being a causal contributor.95

Additionally, according to the cerebral stroke articles, stress was considered only a

Townsend Tr., at 40, 41-42. Dr. Townsend believed she was at risk of having a stroke prior to the spinal stroke on January 6, 2022. Id. at 72.

Id. at 45.

Id. at 75.

Id. at 10, 47-48, 78.

Id. at 12-13.

Id. at 11.

Id. at 11-12, 78-79. Dr. Townsend also noted that while “some of the risk factors are similar” for spinal strokes and cerebral strokes, “some of them are different.” Id. at 78-79.

“moderate risk factor” 96 that increased the risk of a stroke by only 1.3 times.97

Further, Dr. Townsend was unaware of any literature supporting Dr. Dogali’s

conclusion that 30-40% of strokes are preceded by an acute stress incident.98

E. The Decision

The Decision reflects a factual predicate leading up the incident on January 6,

2022 that is consistent with Johnson’s version of events. To those facts, the Board

applied the Duvall standard to determine whether her injuries were compensable,

which Johnson bore the burden of proving.99

“The Board accept[ed] the opinions of Dr. Townsend over the opinions of Dr.

Dogali” 100 on two grounds. First, Dr. Dogali’s opinions were not supported by the

literature. He relied on two articles discussing the connection between stress and

cerebral strokes, but neither addressed spinal strokes.101 Further, the articles

characterized stress as a moderate risk factor (not high-risk), 102 and as Dr. Dogali

acknowledged, the acute anxiety correlating to a stroke theory is not widely

Id. at 13-14.

Id. at 14.

Id. at 46.

Angelina Johnson v. Christiana School District, IAB Hearing No. 142375, 27 (Apr. 24, 2025) (Decision) at 23.

100

Id.

101

Id.

102

Id.

accepted for strokes but is becoming now recognized “for cerebral strokes both in

the literature and in the practice.” 103

In contrast, Dr. Townsend relied on articles addressing spinal strokes and he

testified that there was no literature linking stress to spinal strokes. 104

Second, Dr. Dogali did not have a sufficient understanding of Johnson’s

medical history. He did not physically examine Johnson, he was not aware of the

extent of her history of high blood pressure, how long she had a high BMI, whether

she took medication for her anxiety, and had not reviewed any medical records prior

to January 6, 2022.105 Contrary to the medical records, the Board found that Dr.

Dogali presumed Johnson had “relatively normal blood pressure” but started

showing signs of hypertension only more recently. 106

Johnson had a long history of health issues. The Board made factual findings

that Johnson had a history of uncontrolled blood pressure for six or seven years and

uncontrolled diabetes since 2014. 107 She had not taken blood pressure medication

in the three weeks leading up to the January 6 incident. 108 Johnson also suffered

from a history of uncontrolled anxiety and stress, both at home and at work.109

103

Id. at 8.

104

Id. at 24.

105

Id. at 8, 11.

106

Id. at 11.

107

Id. at 14-16.

108

Id. at 14.

109

Id. at 15.

Ultimately, the Board found that “Dr. Townsend presented more credibly than

Dr. Dogali” and it accepted Dr. Townsend’s opinion that Johnson suffered one stroke

followed by a transformation.110 “Considering the number and extent of [Johnson’s]

comorbidities that ha[d] been recognized as risk factors, the Board f[ound] that

[Johnson’s] spinal stroke had been in the process and occurred unrelated to work.”111

The Board recognized that Johnson was “highly stressed because of her

upcoming performance evaluation” and this stress was heightened by her poor

relationship with the evaluator.112 Johnson had “not previously received a poor

performance evaluation,” “she was not on probation,” nor “she was … under an

improvement plan.”113 And had she received a poor performance evaluation on

January 6, she would not be immediately fired 114 because the administrative process

would have taken at least a few years.115 Thus, the objective evidence did not

suggest that Johnson was at risk of losing her job. Yet, she was quite anxious about

the review.

The Board did not attempt to quantify the impact of Johnson’s stress, stating

“[n]o one but [Johnson] knows how stressed [she] was about the performance

110

Id. at 25.

111

Id.

112

Id.

113

Decision, at 25.

114

Id. at 25-26.

115

Id. at 26.

evaluation compared to her other stressors.” 116 But while Johnson “might believe

she suffered a spinal stroke because of her heightened stress related to her

performance evaluation[,] the medical evidence did not support her belief.”117

Because that belief was not “[]supported by the medical evidence,” the Board found

no evidence that stress “is a contributing factor to a spinal stroke.” 118 Accordingly,

Johnson did not sustain her burden of proof and the Board found her injury was not

compensable.

III. The Parties’ Contentions

Johnson raises two issues on appeal: (1) the Board erred in applying the

Duvall v. Charles Connell Roofing standard as opposed to the standard expressed in

Reese v. Home Budget because there was an identifiable industrial accident; and (2)

the Board’s decision to accept Dr. Townsend’s medical opinion was not supported

by substantial evidence.

On the first ground, Johnson argues that the annual evaluation is an

identifiable event, which caused heightened anxiety, “trigger[ing]” a spinal stroke.

As such, the Board should have applied the Reese standard and examined whether

the heightened stress was “a cause” rather than “a substantial cause” of the stroke.

116

Id.

117

Id.

118

Id.

On the second ground, Johnson asserts that the Board’s acceptance of Dr.

Townsend’s medical opinion over Dr. Dogali’s is not supported by the substantial

evidence because the Board found the following: (i) a spinal stroke is a rare

condition; (ii) there are not many studies or much literature on spinal strokes; (iii)

significantly heightened stress is a contributing factor for cerebral strokes; (iv) there

is no evidence that significantly heightened stress is a contributing factor for spinal

strokes; and (v) it will not make a finding that is unsupported by medical evidence.

In essence, Johnson contends that because there was no medical evidence submitted

showing a spinal stroke is different than a cerebral stroke, the Decision lacks

substantial evidence.

Employer responds that the Board correctly applied the Duvall standard as

there was no identifiable industrial accident. Further, the Board’s conclusions

regarding the cause of a spinal stroke are supported by substantial evidence in the

record, as explained by Dr. Townsend.

IV. Standard of Review

This court’s review of the Decision is limited to an examination of the record

for errors of law and a finding of whether substantial evidence exists to support the

Board’s findings. Substantial evidence (more than a scintilla and less than a

preponderance) is relevant evidence that a reasonable mind would be willing to

accept as adequate in supporting a conclusion.119 “Under this standard of review,

this Court is required to ‘search the entire record to determine whether, on the basis

of all the testimony and exhibits before the agency, it could fairly and reasonably

reach the conclusion it did.’”120 Thus, in the absence of an error of law and where

substantial evidence supports the Board’s findings, its decision must be affirmed.121

It is solely within the Board’s purview to weigh the evidence, assess the

credibility of witnesses, resolve conflicts in the evidence, and make factual

findings. 122 The Board resolves conflicts in medical testimony as the finder of fact

and the reviewing court takes “due account” of the Board’s expertise.123 Thus, the

Board is free to accept one expert’s testimony over another’s. 124 Where the Board

does so, “the opinion adopted by the Board constitutes substantial evidence for

purposes of appellate review.”125 The court construes the record “in the light most

favorable to the party prevailing below, resolving all doubts in its favor.” 126

119

Powell v. OTAC, Inc., 223 A.3d 864, 871 (Del. 2019); Munyan v. Daimler Chrysler Corp., 909 A.2d 133, 136 (Del. 2006).

120

Wilson v. New Castle Cty., 1997 WL 1048172, at *2 (Del. Super. Oct. 28, 1997) (citation omitted); Dudlek v. Jovie Childcare Reimagined, 2024 WL 4380153, at *3 (Del. Super. Oct. 3, 2024).

121

Zayas v. State, 273 A.3d 776, 785 (Del. 2022) (citing Olney v. Cooch, 425 A.2d 610 (Del. 1981)); Munyan, 909 A.2d at 136.

122

Zayas, 273 A.3d at 785 (citing Powell, 223 A.3d at 870).

123

Id. (citing Spellman v. Christiana Care Health Servs., 74 A.3d 619 (Del. 2013)). 124

Id.

125

Munyan, 909 A.2d at 136 (citing Reese v. Home Budget Center, 619 A.2d 907, 910 (Del. 1992)). 126

Dudlek, 2024 WL 4380153, at *3 (citation omitted).

While legal issues are reviewed de novo, 127 the court affords significant

deference to the Board’s fact and credibility determinations. 128 Absent errors of law,

the Board’s decision is reviewed for abuse of discretion. 129 Abuse of discretion

occurs when a tribunal has “exceeded the bounds of reason in view of the

circumstances and has ignored recognized rules of law or practice so as to produce

injustice.” 130

V. Discussion

A. The Board did not commit legal error in applying the Duvall

Standard.

1. Standards for determining a compensable injury.

Under Delaware’s Workers Compensation Act (the “Act”),131 with exceptions

that do not apply here, “every employer and employee” is bound to “pay and to

accept compensation for personal injury or death by accident arising out of and in

the course of employment, regardless of the question of negligence.”132 “Accident”

is not defined in the statute, but it is given its ordinary meaning: “‘An event that

127

Zayas, 273 A.3d at 785 (citing Oceanport Indus., Inc. v. Wilmington Stevedores, Inc., 636 A.2d 892 (Del. 1994)); Cline v. Nemours Found., 2023 WL 6622211 at *10 (Del. Super. Oct. 11, 2023). 128

Christiana Care Health Servs. v. Davis, 127 A.3d 391, 395 (Del. 2015) (citing Histed v. E.I. Du Pont de Nemours & Co., 621 A.2d 340 (Del. 1993)); Powell, 223 A.3d at 872. See also 29 Del. C. § 10142.

129

Glanden v. Land Prep, Inc., 918 A.2d 1098, 1100 (Del. 2007).

130

Harper v. State, 970 A.2d 199, 201 (Del. 2009).

131

19 Del. C. § 2301 et. seq.

132

19 Del. C. § 2304.

takes place without one’s foresight or expectation; an undesigned, sudden, and

unexpected event.’”133

“A preexisting disease or infirmity, whether overt or latent, does not disqualify

a claim for workers’ compensation if the employment aggravated, accelerated, or in

combination with the infirmary produced the disability.” 134 The “employer takes the

employee as he finds him.” 135 As the Delaware Supreme Court set out in Reese,136

applying a “but for” standard to preexisting conditions, an injury from an accident

is compensable even if not “the sole cause or even a substantial cause of the injury,”

as long as the accident “provides the ‘setting’ or ‘trigger,’ causation is satisfied.”137

When there is a specific identifiable accident, there is no need to quantify causation,

and the “but for” test applies, determining whether it was “a” cause.138

However, where there is no “specific link between regular job-related duties

and the aggravation of preexisting aliments,” under the “usual exertion” rule, a

claimant must show that the “ordinary stress and strain of employment” was a

“substantial cause” of the injury, as the Delaware Supreme Court expressed in

Duvall.139 “Substantial cause” is “limited to claims arising out of the ordinary stress

133

Duvall v. Charles Connell Roofing, 564 A.2d 1132, 1134 (Del. 1989) (quoting Webster’s New International Dictionary).

134

Reese v. Home Budget Ctr., 619 A.2d 907, 910 (Del. 1992).

135

Id.

136

Id.

137

Id.

138

Id. at 11.

139

Duvall, 564 A.2d at 1133.

and strain of employment, [but] has no application to causation relating to specific

and identifiable industrial accidents.”140 The substantial cause standard is used in

Delaware only in the absence of an identifiable industrial accident “‘because of the

difficulty of identifying a specific link between regular job related duties and the

aggravation of preexisting ailments.’”141

Thus, the determination of whether Duvall or Reese applies hinges on

whether there was an identifiable industrial accident.

2. The record supports that there was no identifiable industrial

accident.

Johnson argues that there was an identifiable event—the annual teacher

evaluation. Because this triggered her anxiety, according to Johnson, the Board

should have applied the “but for” test to determine whether stress was “a cause.”

Employer responds that the annual review is not an “accident” as this was a part of

140

Reese, 619 A.2d at 911; State v. Steen, 719 A.2d 930, 932 (Del. 1998) (“In cases where a claimant is injured by the aggravation of a pre-existing condition and there is no identifiable industrial accident, however, causation is governed by the usual exertion rule.”) (emphasis in original).

141

Steen, 719 A.2d at 933 (quoting Reese, 619 A.2d at 911).

Johnson’s normal employment activities and, therefore, the Board properly applied

the “substantial cause” standard.

As the cases below illustrate, an identifiable accident must be “specific and

identifiable,” 142 “physical,”143 and “unexpected.” 144 “[T]he claimant must

demonstrate that a work-accident occurred, establishing one with a definite referral

to time, place and circumstance.” 145

In State v. Steen, the Delaware Supreme Court affirmed the lower court’s

finding that “Steen did not experience an identifiable physical accident” when he

suffered a burst brain aneurism while responding to the scene of a car accident as the

deputy chief of a volunteer fire company.146 Mr. Steen was not assisting on the scene

in some physical way, but suffered the injury while he was “giving instructions to

fire department personnel.”147

In Tibbits v. United Parcel Service,148 a delivery driver was driving along his

route “when he experienced lower back pain ‘out of nowhere’ around 10:15 or 10:20

142

Reese, 619 A.2d at 911.

143

Steen, 719 A.2d at 933 (“Steen’s aneurysm was pre-existing and … Steen did not experience an identifiable physical accident.”); see also Tibbits v. United Parcel Serv., 2013 WL 1400864, at *4 (Del. Super. Mar. 28, 2013), aff’d in part and remanded sub nom. United Parcel Serv. v. Ryan Tibbits, 93 A.3d 655 (Del. 2014) (“Under this rule an injured claimant can recover workers’ compensation benefits when there is no specific identifiable physical industrial accident.”). 144

Duvall, 564 A.2d at 1134.

145

Powell, 223 A.3d at 871 (quoting Hardy v. E. Quality Vending, 2015 WL 2378903, at *6 (Del. Super. May 12, 2015)) (internal quotation marks omitted).

146

Steen, 719 A.2d at 933.

147

Id. at 931.

148

2013 WL 1400864 (Del. Super. Mar. 28, 2013).

a.m.” 149 “Because a specific and identifiable work activity could not be pinpointed,”

the Superior Court upheld the board’s decision that no industrial accident occurred

and continued its analysis under the “usual exertion rule,” which applies the

substantial cause test. 150

Here, Johnson presented no facts that would constitute an “accident.” As

noted, the Board accepted her factual version of events. The record reflects that she

began experiencing back spasms and pain the night of January 5 and had symptoms

of headache, nausea, and her leg feeling “funny” the next morning. While at the

school, she suffered a catastrophic event, but there was no work related specific and

identifiable, physical, and unexpected event. Indeed, Johnson did not pinpoint a

specific moment in time when she suffered an accident. Her version of events did

not include any physical activity and the evaluation was not unexpected. As in Steen

and Tibbits, Johnson failed to establish an “accident.”

Johnson relies on Page v. Hercules, Inc.151 to argue this that conclusion is

wrong because, in her view, Page requires the court to focus “in an unintended cause

or result, rather than a specific incident or unusual event’” to determine whether an

accident occurred.152 Johnson, however, misconstrues Page. The claimant in Page

149

Id. at *1.

150

Id. at *3-4.

151

Page v. Hercules, Inc., 637 A.2d 29 (Del. 1994).

152

Johnson Reply Brief, at 3 (D.I. 24) (emphasis in original).

sought benefits due to an injury arising from the “the ordinary stress and strain of

her job duties” and applied the “substantial cause” test. 153 The Page court, citing

Duvall, noted that the “by accident” language in Section 2304 of the Act, “focuses

on the unintended cause or result, rather than a specific incident or unusual event.”154

In this context, the Duvall court, noting that “accident” is not defined in the Act,

adopted a plain and ordinary meaning: “‘[a]n event that takes place without one’s

foresight or expectation; an undesigned, sudden, and unexpected event.’”155 Duvall

and Page were interpreting “by accident” in the implementing provision of the Act

for work related injuries, which of course, does not require a physical accident.156

Unlike here, the courts were not analyzing whether an identifiable accident had

occurred to determine whether the “but for” or “substantial cause” standard

applied. 157

Johnson also relies on language in Reese that “[i]f the accident provides the

‘setting’ or ‘trigger,’ causation is satisfied for purposes of compensability.”158 She

153

Page, 637 A.2d at 33.

154

Id.

155

Duvall, 564 A.2d at 1134.

156

See Boulden v. Delmarva Power and Light Co., 1994 WL 682867, at *3 (Del. Super. Oct. 31, 1994) (“When the usual work habits and duties are a substantial cause of the claimant’s disability, the claimant may recover.”).

157

See also Giofre v. G.C. Cap. Grp., 1995 WL 264585, at *4 (Del. Super. Apr. 17, 1995), aff’d sub nom. G & C Cap. v. Giofre, 670 A.2d 1338 (Del. 1995) (finding the de minimis body movement of the employee turning his head in response to a work-related question and the resulting neck injury satisfied the “accident” requirement in Section 2304). 158

Reese, 619 A.2d at 910 (emphasis added).

argues that the evaluation and the resulting stress were the “triggers” for her stroke

and thus, there was an identifiable event.159 Johnson’s argument, however,

misapplies Reese. There, the claimant suffered a back injury while delivering a

mattress in the course of his employment, which the court found to be a “specific

and identifiable industrial accident.”160 That accident triggered the claimant’s

mental health injury, which the court found to be compensable.161 Thus, the

“trigger” related to the injury resulting from the industrial accident, not the

determination of whether an industrial accident had occurred.

With substantial evidence in the record that Johnson did not suffer an

identifiable industrial accident, the Board correctly applied the Duvall standard to

Johnson’s petition.

B. The Board’s reliance on Dr. Townsend’s testimony is supported by

substantial evidence.

The Board accepted the testimony of Dr. Townsend over that of Dr. Dogali.

Johnson argues that the Board’s determination is not supported by substantial

evidence because of the Board’s finding that heightened stress is a contributing

factor to a cerebral stroke and there was no evidence that “a vascular cerebral stroke

was different from a vascular spinal stroke” or would have different causes.162 While

159

OB, at 26.

160

Reese, 619 A.2d at 911.

161

Id. at 910.

162

OB, at 29.

Johnson acknowledges that Dr. Townsend testified spinal strokes are rare, she argues

that he offered no evidence a spinal stroke was any different than a stroke occurring

in a different part of the body.163

Employer counters that it is within the Board’s purview to weigh credibility

of the witnesses and there is substantial evidence supporting the Board’s decision.164

Johnson does not challenge the Board’s authority to accept one expert over

another. She also does not take issue with the Board’s finding that Dr. Dogali’s

opinions on stress and spinal strokes were not supported by the literature.165 The

crux of Johnson’s argument is Dr. Townsend acknowledged that stress has some

impact on cerebral strokes, but he did not rule out that stress can be a cause of a

spinal stroke. But, Johnson, not Employer, bore the burden to prove her injury was

compensable. 166 Thus, it was not Employer’s obligation to disprove Johnson’s

unsupported stress theory. As the Board ruled, it would not make medical findings

without supporting evidence, which is what Johnson’s argument would require. On

this ground alone, Johnson’s argument fails.

Additionally, a review of the entire record below, and construing it in favor of

Employer as the Court must, shows that the Decision is supported by substantial

163

Id.

164

Employer’s Answering Brief (D.I. 20), at 17-18.

165

See Decision, at 24.

166

Lewis v. Scotti Muffler, 2001 WL 1752561, at *6 (Del. Super. Dec. 27, 2001); Hoffecker v. Lexus of Wilmington, 2012 WL 341714, at *3 (Del. 2012) (citing Strawbridge & Clothier v. Campbell, 492 A.2d 853, 854 (Del. 1985)).

evidence. First, Dr. Townsend had a more thorough understanding of Johnson’s prior

medical history, having reviewed records dating back almost 10 years before the

incident.167 Dr. Townsend testified to the serious and prolonged comorbidities from

which Johnson suffered and the correlated high risks for a stroke. 168 Dr. Dogali did

not take a family history or review past medical records, and assumed that Johnson’s

underlying medical conditions only recently became problematic. 169

Second, the medical literature Dr. Townsend relied on related to spinal strokes,

in contrast to Dr. Dogali, who relied solely on articles on cerebral strokes.170 And,

Dr. Townsend’s testimony on Johnson’s medical conditions increasing the risks of

ischemic events was supported by the literature. Further, the articles Dr. Dogali

relied on found stress was only a “moderate risk,” increasing the risk by only 1.3x.

This Court will not second guess the Board’s credibility determination. Accordingly,

the Board’s findings are supported by substantial evidence, and there has been no

abuse of discretion.

The Board’s Decision is AFFIRMED.

IT IS SO ORDERED.

/s/Kathleen M. Miller

Kathleen M. Miller, Judge

167

Townsend Tr., at 22-23, 69-70.

168

Id., at 22, 39, 45.

169

Dogali Tr., at 38-40, 42-43, 49-50; Decision, at 11.

170

Townsend Tr., at 12-13; see also Decision, at 24.

Johnson v. Christiana School District

Authorities cited

Opinion · public domain