SCOTT WASTE SERVICE V. JOSHUA EATON, ET AL. — MEMORANDUM OPINION OF THE COURT AFFIRMING

IMPORTANT NOTICE “NOT TO BE PUBLISHED OPINION” THIS OPINION IS DESIGNATED “NOT TO BE PUBLISHED” PURSUANT TO RULE OF APPELLATE PROCEDURE (RAP) 40(D). THIS OPINION SHALL NOT BE CITED AS BINDING PRECEDENT IN ANY OTHER CASE IN ANY COURT OF THIS STATE. UNDER RAP 41, UNPUBLISHED OPINIONS OF KENTUCKY APPELLATE COURTS RENDERED AFTER JANUARY 1, 2003, THAT ARE FINAL UNDER RAP 40(G), MAY BE CITED BY A PARTY FOR CONSIDERATION BY A COURT IF THERE IS NO PUBLISHED OPINION THAT ADEQUATELY ADDRESSES THE POINT OF LAW BEING ARGUED BY A PARTY. IF AN UNPUBLISHED OPINION IS CITED FOR CONSIDERATION BY A COURT THE OPINION SHALL BE SET OUT AS AN UNPUBLISHED OPINION IN THE DOCUMENT IN WHICH THE UNPUBLISHED OPINION IS CITED.

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RENDERED: OCTOBER 22, 2026 NOT TO BE PUBLISHED Supreme Court of Kentucky 2026-SC-0078-WC SCOTT WASTE SERVICE APPELLANT V. ON APPEAL FROM COURT OF APPEALS NO. 2024-CA-0970 WORKERS' COMPENSATION NO. WC-22-86941 JOSHUA EATON; HONORABLE TONYA M. CLEMONS, ADMISTRATIVE LAW JUDGE; AND WORKERS’ COMPENSATION BOARD OF KENTUCKY APPELLEES MEMORANDUM OPINION OF THE COURT AFFIRMING Joshua Eaton filed a workers’ compensation claim alleging that a January 20, 2022, workplace fall caused an injury to his right hip and thigh and a subsequent infection. After considering the medical evidence, the ALJ determined that Eaton’s condition was work-related and found Dr. Fadel’s causation opinion persuasive over the contrary opinions of Dr. Cancian and Dr. Wolens. Scott Waste Service (Scott) appealed the ALJ’s decision to the Workers’ Compensation Board (the Board), arguing that Dr. Fadel’s opinion did not constitute substantial evidence under Cepero v. Fabricated Metals Corp., 132 S.W.3d 839 (Ky. 2004) because it failed to account for Eaton’s prior medical history. On July 12, 2024, the Board affirmed the ALJ’s decision and

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2 rejected Scott’s argument concerning the sufficiency of Dr. Fadel’s opinion. Scott then appealed to the Court of Appeals for review of the Board’s opinion. Scott’s sole argument was that Dr. Fadel’s opinion was not substantial evidence under Cepero. The Court of Appeals concluded that Dr. Fadel had been sufficiently furnished with Eaton’s relevant medical history and that the ALJ was entitled to find his opinion persuasive. Accordingly, the Court of Appeals affirmed the Board’s July 12, 2024, opinion. Scott now appeals to this Court. Based on the specific facts of this case, we affirm the Court of Appeals’ judgment, and we decline to hold that Dr. Fadel’s November 22, 2022, and November 30, 2023, reports do not constitute substantial evidence of causation under Cepero. I. Facts and Procedural History Eaton has a high school diploma and an active CDL. He began working as a garbage truck driver for Scott in 2019, and on January 20, 2022, he suffered a fall at work. Eaton, then forty-one, has insulin-dependent diabetes. Relevant past medical history was that Eaton was treated for an abscess on his left buttock, and the abscess was drained. In November 2013, Eaton was again treated for an abscess on his right buttock, and the abscess was drained. Subsequently, in July 2020, Eaton was treated for diabetic ulcers on his left foot. These conditions resolved. On January 20, 2022, Eaton was sitting in the Scott employee parking lot in his personal vehicle waiting for his garbage truck to heat up. When

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3 Eaton got out of his personal vehicle to go to his garbage truck, he slipped on ice, fell, and landed on his right side. Other employees witnessed Eaton fall. Eaton immediately reported the fall to his supervisor; however, he did not fill out an incident report because his supervisor was busy. Eaton believed he had only bruised his hip. However, Eaton’s condition eventually worsened, and he sought medical attention for the injury. On February 13, 2022, Eaton visited the emergency room at The Medical Center at Franklin because of right hip pain and difficulty with any weightbearing. According to the medical report, “there has been no injury but definite pain in the right hip area.” Eaton had a CT scan, and he was diagnosed with right hip bursitis. On February 15, 2022, Eaton again visited the same emergency room because of right hip pain. Eaton received an MRI, “which was significant for a partial tearing of the gluteus medius and hematoma on the right hip area.” At this time, the MRI history form noted that Eaton had right hip pain for six days that was worsening with “zero trauma.” On February 28, 2022, Eaton visited the Scottsville Rural Health Center because of difficulty walking due to pain. It was noted that there was swelling in the right hip. Eaton’s intake forms state that he “fell [at] work at [the] end of January on ice[.]” He was diagnosed with a right hip hematoma, uncontrolled type two diabetes, type two diabetes with hyperglycemia, and other injuries. On March 1, 2022, Eaton was admitted to The Medical Center at Bowling Green after complaints of right lower extremity pain. In the medical report, it was documented that the “[p]ain initially began around 3 weeks ago after he

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4 fell off his work truck and landed on his right hip.” On March 10, 2022, Eaton was transported by EMS to the University of Kentucky Hospital due to an infection in his leg attributed to the fall he sustained while at work. Eaton was admitted to the hospital, and he was diagnosed with an abscess of the right thigh, type two diabetes mellitus with hyperglycemia without long-term current use of insulin, cellulitis of the right lower extremity, and type two diabetes mellitus with other skin complications without long-term current use of insulin. Eaton was then transferred to The Medical Center at Scottsville, and later referred back to The Medical Center at Bowling Green. Eaton received further treatment for the discussed injuries to his right thigh. The medical records referenced both his January 20 fall and his uncontrolled type two diabetes. He was also diagnosed with transient foot drop. In August 2022, Eaton was hospitalized at the University of Louisville Hospital, and his right pinky toe was amputated. After Eaton’s work injury in January 2022, he returned to work for Scott in April 2022. He worked until August 2022 but went on medical leave due to his foot condition. He returned in January 2023, but went on medical leave again in November 2024 due to a right foot abscess. In connection with Eaton’s workers’ compensation claim, he was examined by two doctors: Dr. Fadel and Dr. Cancian. Furthermore, Dr. Wolens performed a record review.

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5 Eaton was first evaluated by Dr. Fadel on November 22, 2022. After evaluating Eaton and summarizing his medical records from after the January 2022 fall, Dr. Fadel concluded: It is also my medical opinion that the fall at work caused the bleeding around the hip and thigh region, which then became infected. The infection more likely than not originated from compromised skin that was generated by the fall. The right foot infection had nothing to do with the work injury. The infectious process there was secondary to what happens to most diabetics, which is small vessel disease in the foot region. He assessed a sixteen percent whole body permanent partial impairment due to the specific injury sustained to the right lower extremity while at work in January 2022. Subsequently, Eaton was evaluated by Dr. Cancian on February 10, 2023. After evaluating Eaton and summarizing his medical records from after the January 2022 fall, Dr. Cancian concluded that “Mr. Eaton ha[d] sustained permanent functional impairment causally related to the January 20, 2022 work incident.” He assessed ten percent whole person impairment due to the workplace injury sustained on January 20, 2022. Lastly, Dr. Wolens performed a records review on May 16, 2023. Dr. Wolens reviewed Eaton’s medical history from both before and after the January 20, 2022, workplace injury. Dr. Wolens concluded that “there is no evidence of a work caused injury.” He found that Eaton’s injuries were not related to the January 2022 work incident. He opined: There are two factors that raise into significant question the alleged fall to the hip. The first is that the ER record of 2/13/2022, ER record of 2/15/2022, and radiology technician history of 2/15/2022 all report Mr. Eaton as having provided a

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6 history of having experienced no trauma. Had there been trauma sufficient to cause a hematoma, one would not expect this to have been forgotten. Secondly, and more importantly, is that three weeks post fall, a CT scan was performed on 2/13/2022, of which the radiologist specifically reported that there was no hematoma. Two days later, however, an MRI was performed on 2/15/2022, where there was a sizable hematoma reported in the gluteus medius muscle. Hematomas occur after injury acutely. For a hematoma to develop, a soft tissue contusion must result in disruption of a blood vessel or blood vessels. These blood vessels then bleed into the soft tissues acutely. That is, hematomas, if they are to form, do so acutely. During the acute stage, they usually reach their peak within several days. At that point, the blood vessels coagulate and no further bleeding into the tissue occurs. Hence it becomes critical to understand that the 2/13/2022 CT scan, which was performed three weeks after injury, showed no evidence of a hematoma. Therefore, for there to have been a hematoma in the gluteus medius two days thereafter on the MRI imaging dated 2/15/2022 raises serious questions as to etiology. It also raises the question regarding whether the MRI radiological interpretation is correct and that what was read as a hematoma was a not a hematoma but instead an early abscess. It is here that Mr. Eaton's preinjury history becomes important. Mr. Eaton has already developed in the past spontaneous abscesses to the left and right buttock secondary to diabetes. He has also developed spontaneous infections of the right and left foot necessitating a transmetatarsal amputation of the 5th digit on the right. These were all secondary to uncontrolled diabetes. Therefore, there is a high probability that what developed in the right buttock and hip was that of a spontaneous infection secondary to uncontrolled diabetes. There is otherwise little, if any, explanation for why there would be no hematoma on the 2/13/2022 CT and for a hematoma to then be present two days later on the 2/15/2022 MRI. Furthermore, although these two studies utilize different imaging methods, CT imaging is usually the study of choice for the identification of a hematoma. Therefore, the fact that the hematoma was diagnosed on the MRI and not the CT is of no significance. After Dr. Wolens performed a records review, Dr. Cancian submitted an addendum report on September 27, 2023. Dr. Cancian reviewed Eaton’s medical records from before the January 2022 workplace incident. His report stated:

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7 In my original report, I opined that the claimant’s condition was causally related to the reported January 20, 2022 fall onto the right hip. In light of the medical records now available for my review, I have changed my opinion. When forming my previous opinions, I was not privy to the claimant’s extensive history with spontaneous abscesses, dating back to 2013. Within 1 week that year, the claimant had both right and left perineal abscess operantly treated. Similarly in September of that year, he had a repeat right abscess overlying the gluteus maximus. In November that year, he again had a right sided abscess irrigation debridement. These were all reported as being unprovoked abscesses. These newly provided records also paint the picture of the claimant as an extremely uncontrolled diabetic, with blood sugars been in the 300–400s dating back almost a decade at this point. I also revisited the initial documentation in the medical records regarding the claimant’s right hip in association with the alleged work injury. During his first presentation to the emergency department on February 13, 2022, the claimant denied any history of injury. Even on subsequent follow-up on February 17, 2022, he reported that he did not have any pain initially to the right hip. A trauma which would have been significant enough to cause this level of abscess would have been memorable, and would have left the claimant having immediate difficulty weightbearing. Upon further examining the claimant’s medical records, he has a significant history of bilateral foot diabetic ulcers status post operative debridement procedures, which could certainly have spread hematogenously. The causal link between the claimant’s employment and his right hip symptoms was tenuous at the time of my initial report, and given the new information and upon further reflection on this case, it is now my medical opinion that there does not exist a reasonable degree of medical probability that the claimant’s right hip/thigh diagnoses are causally related to the claimant’s employment or the alleged workplace incident in question. The more likely scenario that I have now concluded is that these were spontaneous diabetic abscesses which the claimant retroactively assumed to be due to a minor, unrelated workplace incident. Subsequently, Dr. Fadel also filed an addendum report on November 30, 2023, which stated:

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8 Thank you for the additional medical records involving Mr. Eaton’s medical history for review. In addition, I have also received an Independent Medical Examination [IME] completed by John Cancian, M.D., which took place on February 10, 2023. In addition, he created an addendum to that report that was also reviewed by me dated September 27, 2023. The initial IME that was completed by Dr. Cancian was a thorough report, but I must respectfully disagree with a small portion of it. Specifically, the apportionment of Mr. Eaton’s neurological impairment, which involved his peroneal nerve with foot drop that was sustained shortly after this January 20, 2022 work injury. Nowhere in the medical records that I possess and have reviewed state that Mr. Eaton had any motor deficit whatsoever involving the right peroneal nerve just prior to his January 20, 2022 work injury. Therefore, there would be no ratable impairment for apportionment in this specific case. The medical records reviewed that begin on March 7, 2013 at the Sumner Regional Medical Center Emergency Room initiated some pertinent information. At that time, there was extensive information involving right and left peroneal and buttock abscesses that formed, which required surgical treatment on a number of occasions through that year. These findings would suggest that Mr. Eaton in fact did have pre- existing disease in a dormant, which was probably localized bacterium already in place prior to his fall at work on January 20, 2022. However, it is my medical opinion that after his fall, he developed a hematoma that acted as a culture medium for the initial quiescent status of the bacterium into a full and ongoing infection, which required treatment outlined in my November 22, 2022 report. If it were not for the fall and development of the hematoma, the severity of the pre-existing dormant condition may have stayed quiet for a number of years, since it had already stayed quiet for nine years. The remaining conclusions within that initial report generated by me on November 22, 2022 have not changed, even after reviewing the medical records given to me. Finally, the opinions expressed within this addendum report are all within a reasonable degree of medial probability.

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9 On March 18, 2024, the ALJ entered her Opinion, Award, and Order. Ultimately, the ALJ found that Eaton met his burden to prove that he suffered a work-related injury to his right lower extremity due to the work incident in January 2022. In doing so, the ALJ acknowledged the differing opinions between Dr. Fadel, Dr. Cancian, and Dr. Wolens. In the ALJ’s Analysis, Findings of Fact, and Conclusions of Law, she noted: The ALJ acknowledges pre-injury treatment records documenting Eaton’s uncontrolled diabetes along with treatment for spontaneous abscesses in 2013 as well as left foot diabetic ulcers in 2020. These records are not, however, indicative of an ongoing problem with spontaneous abscesses within nine years prior to the January 2022 work incident. Additionally, the ALJ acknowledges the initial ER records from Franklin Medical Center include a narrative history of non- traumatic right thigh symptoms for only six days prior to his visit. Eaton, however, plausibility testified he was not the individual who provided the medical history to the medical providers. Instead, he explained his spouse discussed his history with treating providers as he was given narcotic medication, including morphine, to deal with his ongoing pain symptoms and did not provide a history to the treating medical staff. See 01.16.24 Hearing Tx, at p. 23–25. The ALJ further acknowledges it does not appear from their detailed outlines of records reviewed, Drs. Wolens or Cancian had the opportunity to review the testimony of Eaton or any of the other witnesses in this matter. Thus, it does not appear they were aware of the description of the incident as well as Eaton’s explanation for any inaccuracies in the history taken during his initial ER visits. Moreover, while Drs. Wolens and Cancian opinions on a lack of causation appear to be based, in part, on Eaton’s uncontrolled diabetes and his 2013 history of spontaneous abscesses, they provide no explanation of a lack of evidence of pre-existing, ongoing actively symptomatic spontaneous abscesses for nine years prior to the January 2022 work incident. Further, while Drs. Wolens and Cancian opine Eaton did not suffer a hematoma due to the work incident based upon diagnostic

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10 studies, the ALJ notes the treatment records interchangeably refer to the lesion on Eaton’s right thigh as a hematoma and abscess. Thus, the medical records and diagnostic studies appear to confirm some intramuscular abnormality for which Eaton underwent an extensive course of treatment, which Dr. Fadel relates to the work incident of January 20, 2022. While the ALJ respects the competence of Drs. Cancian and Wolens, their opinions as to the cause of Eaton’s right lower extremity conditions in his right thigh and the right footdrop are not persuasive in light of the opinions of Dr. Fadel. Dr. Fadel thoroughly and succinctly describes the causal relationship between the work incident of January 20, 2022, and the infected hematoma of the right thigh and peroneal nerve neuritis with resultant foot drop of the right lower extremity. Further, he acknowledges Eaton’s pre-existing, dormant condition which he opines was brought into reality by the work fall on January 20, 2022. The ALJ awarded temporary total disability (TTD) benefits, permanent partial disability (PPD) based upon a sixteen percent impairment rating enhanced by the two-multiplier contained in KRS1 342.720(1)(c)2, and medical benefits. The ALJ dismissed Eaton’s claims for injuries associated with a right foot diabetic ulcer and right fifth toe amputation, which were not attributed to his fall. On April 11, 2024, the ALJ denied Scott’s petition for reconsideration. Subsequently, Scott appealed the ALJ’s opinion to the Board. The Board noted that [t]he sole issue on appeal [was] whether the ALJ erred in relying on Dr. Jeffrey Fadel’s medical opinions regarding causation because, as Scott argue[d] they were based on a substantially “incomplete” medical history and the finding of a work-related injury should be reversed upon the holding in Cepero v. Fabricated Metal Corp., 132 S.W.3d 839 (Ky. 2004). 1 Kentucky Revised Statutes.

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11 The Board affirmed the ALJ’s Opinion, Award, and Order. In its opinion, it stated: This claim presents conflicting medical opinions as to the cause and degree of Eaton’s injuries. Where there are conflicting medical opinions, the ALJ as fact-finder has wide discretion to pick and choose whom and what to believe. Copar, Inc. v. Rogers, 127 S.W.3d 554, 561 (Ky. 2003). . . . The Board held that Dr. Fadel’s opinions “constitute[d] substantial evidence upon which the ALJ could in rely in making her determinations.” Accordingly, the Board held that Scott’s reliance on Cepero was misplaced. The Board noted that in Cepero, this Court held that a “medical opinion predicated upon such erroneous or deficient information that is completely unsupported by any other credible evidence can never, in our view, be reasonably probable.” 132 S.W.3d at 842. The Board found that the facts in Cepero were “unusual” because it involved “not only a complete failure to disclose, but also affirmative efforts by the employee to cover up a significant injury to the left knee two and a half years prior to the alleged work-related injury to the same knee.” The Board reasoned that Eaton’s case differed from Cepero because “Dr. Fadel was not provided a history so inaccurate or incomplete as to render his opinion lacking in probative value.” To support its holding, the Board stated that Dr. Fadel received an expansive list of medical records, and he referenced Eaton’s prior medical records. “In fact, he referenced the records and prior abscesses in his reports and explained they suggested Eaton did have a pre-existing disease which was dormant and probably localized bacterium prior to the fall.”

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12 Furthermore, the Board mentioned that Dr. Fadel’s report also mentioned Dr. Cancian’s report and addendum. Scott then appealed to the Court of Appeals. Again, “Scott’s sole argument on appeal [was] that Dr. Fadel’s report, which the ALJ relied on in determining causation, does not constitute substantial evidence of causation.” Scott Waste Serv. v. Eaton, No. 2024-CA-0970-WC, 2026 WL 118814, at *5 (Ky. App. Jan. 16, 2026). Scott argued that the ALJ and Board failed to properly apply Cepero. Ultimately, the Court of Appeals disagreed with Scott and affirmed the Board. Id. Scott took issue with the fact that Dr. Fadel did not specifically reference Eaton’s 2020 injuries because the 2020 injuries were relevant in that they were “no different than the abscess that developed in 2022.” Id. The Court of Appeals noted that Scott cited a passage in Cepero that stated: “In the absence of proof, we will not assume that any competent medical examiner would be aware of but fail to mention a history of a prior injury to the exact same part of the body for which compensation is sought.” Id. *3 (quoting Cepero, 132 S.W.3d at 843). The Court of Appeals first noted that “a left foot is not a right hip or thigh.” Id. at *4. Furthermore, the Court of Appeals rejected Scott’s argument that Dr. Fadel’s opinion was invalid merely because he did not expressly discuss every aspect of Eaton’s medical history. Id. It held that Cepero does not require a physician to recite every prior medical condition in his report. Id. Rather,

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13 [i]n the passage cited by Scott, the court was not setting forth a mandate, but merely explaining why it would not infer knowledge of a party’s medical history when a doctor’s report is silent and there is an “absence of proof” the doctor was furnished with the party’s “true medical history.” Id. The Court of Appeals concluded that Dr. Fadel had been sufficiently informed of Eaton’s medical history. Id. Dr. Fadel reviewed Dr. Cancian’s addendum, which discussed Eaton’s prior abscesses and diabetic ulcers, and indicated that he reviewed medical records dating back to 2013. Id. Thus, unlike in Cepero, this was not a case where the physician had a complete failure to consider relevant medical history. Id. The Court of Appeals further rejected Scott’s argument that Dr. Fadel’s statement that Eaton’s condition had remained dormant for nine years was necessarily inaccurate because Eaton suffered a diabetic foot ulcer in 2020. Id. at *4–5. The court reasoned that whether the 2020 foot ulcer was medically related to the 2013 abscesses was a medical question rather than a factual matter for the court to resolve. Id. Scott therefore could not establish that Dr. Fadel’s medical opinion was erroneous simply because the opinion differed from that of Dr. Cancian. Id. Thus, the Court of Appeals held because Dr. Fadel had been provided with sufficient information, the ALJ was entitled to determine the persuasiveness of each physician’s opinion. Id. Scott now appeals to this Court.

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14 II. Analysis Scott asks this Court to reverse the Court of Appeals’ opinion after it rejected its argument that Dr. Fadel’s report does not constitute substantial evidence of causation under Cepero. “[T]he ALJ as fact finder has the sole authority to judge the weight, credibility, substance, and inferences to be drawn from the evidence.” Oufafa v. Taxi, LLC, 664 S.W.3d 592, 597 (Ky. 2023) (quoting Apple Valley Sanitation, Inc. v. Stambaugh, 645 S.W.3d 434, 438 (Ky. 2022)) (internal quotations omitted). The ALJ “may reject any testimony and believe or disbelieve various parts of the evidence, regardless of whether it came from the same witness or the same adversary party’s total proof[.]” Whittaker v. Rowland, 998 S.W.2d 479, 481 (Ky. 1999) (citing Paramount Foods, Inc. v. Burkhardt, 695 S.W.2d 418 (Ky. 1985)). “[W]here the party with the burden of proof was successful before the ALJ, the issue on appeal is whether the substantial evidence supported the ALJ’s conclusion.” Id. (citing Special Fund v. Francis, 708 S.W.2d 641 (Ky. 1986)). “Substantial evidence has been defined as some evidence of substance and relevant consequence, having the fitness to induce conviction in the minds of reasonable men.” Id. (citing Smyzer v. B.F. Goodrich Chem. Co., 474 S.W.2d 367 (Ky. 1971)). “Although a party may note evidence which would have supported a conclusion contrary to the ALJ’s decision, such evidence is not an adequate basis for reversal on appeal.” Id. (citing McCloud v. Beth-Elkhorn Corp., 514 S.W.2d 46 (Ky. 1974)).

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15 Scott’s first argument to this Court is that the Board and the Court of Appeals erroneously limited the application of Cepero. In Cepero, the claimant sought workers’ compensation benefits for a knee injury that he attributed to a workplace accident. 132 S.W.3d at 841–42. Physicians offered opinions regarding the cause of his condition, but the medical history that the physicians provided did not accurately reflect a significant preexisting knee injury. Id. This Court concluded that the physicians’ opinions attributing the claimant’s condition to the workplace accident were not substantial evidence because they were based on a substantially inaccurate or incomplete medical history. Id. at 842–43. Specifically, this Court held: [I]n cases such as this, where it is irrefutable that a physician's history regarding work-related causation is corrupt due to it being substantially inaccurate or largely incomplete, any opinion generated by that physician on the issue of causation cannot constitute substantial evidence. Medical opinion predicated upon such erroneous or deficient information that is completely unsupported by any other credible evidence can never, in our view, be reasonably probable. Furthermore, to permit a ruling of law to stand based upon such evidence that is not reliable, probative and material would be fundamentally unjust. We therefore conclude the opinions of Dr. Changaris and, to a limited degree, the earliest opinions of Dr. Ballard on causation, do not measure up as substantial evidence, and it was error for the ALJ to blindly elect to adopt their flawed conclusions to support any ruling of law. Id. at 842–43. In this case, Scott contends that the Board incorrectly stated that there must be an “egregious” omission under Cepero. The Board’s opinion stated: Scott’s reliance on Cepero v. Fabricated Metals Corp. . . . is misplaced. This claim is distinguishable from Cepero, which was an unusual case involving not only a complete failure to disclose, but also affirmative efforts by the employee to cover up a

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16 significant injury to the same knee. The prior, non-work-related injury left Cepero confined to a wheelchair for more than a month. The physician upon which the ALJ relied on was not informed of his prior history by the employee and had no other apparent means of becoming so informed. Every physician who was adequately informed of this prior history opined Cepero’s left knee impairment was not work-related but, instead, was attributable to the non-work-related injury two and a half years previous. In Cepero, the Supreme Court found a medical opinion erroneously premised on the claimant’s egregious omission of a directly relevant past medical history was sufficient to mandate reversal based on an insufficient history received by the medical expert. The Court held a “medical opinion predicated upon such erroneous or deficient information that is completely unsupported by any other credible evidence can never, in our view, be reasonably probable.”. . . . After reviewing the evidence and the ALJ’s decision, we conclude that Dr. Fadel was not provided a history so inaccurate or incomplete as to render his opinion lacking in probative value. Dr. Fadel provided an expansive list of all the medical records he reviewed, including those from Summer Regional Medical Center in which Scott argues compels a contrary determination. However, a review of Dr. Fadel’s reports does not reveal any inaccuracy in his understanding of Eaton’s complete medical history and prior abscesses. In fact, he referenced the records and prior abscesses in his reports and explained they suggested Eaton did have a preexisting disease which was dormant and probably localized bacterium prior the fall. He also referenced the report and addendum from Dr. Cancian. The ALJ specifically referenced this in her summary of Dr. Fadel’s medical evidence as a basis for her findings. Therefore, we find the holding in Cepero v. Fabricated Metals Corp. . . . is inapplicable. Furthermore, Scott contends that the Court of Appeals erroneously stated that the omission must be “obvious even to a layperson” under Cepero. The Court of Appeals noted: Considering the frequency with which Cepero is cited to challenge medical opinions as in this case, we read the case as hinging upon the worker’s failure to adequately disclose his own medical history—evidence not only medically relevant, but necessary to the expert opinion regarding his injury, the medical relevance of which

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17 was obvious even to layperson. Our workers’ compensation tribunals in both the Executive and Judicial Branches are as capable as laypersons of surmising that a past left knee injury is medically relevant to a present left knee issue. But they would be ill-advised to jump to a conclusion, independently of expert opinion, that finds a past foot ulcer relevant to a present thigh infection. Our courts should therefore be wary of striking medical opinions pursuant to Cepero, unless omitted or inaccurate medical history is obviously relevant to a party’s condition, even to a layperson. Cepero should not be understood as invalidating medical opinions upon any and every instance of omission or inaccuracy. Disposition of these matters often comes down to a duel of experts, with attendant accusations of omission and inaccuracy, which may turn out to be substantial, or which may turn out to be carps and quibbles. Unless the relevance of medical-history omissions or inaccuracies are obvious even to a layperson, the expert duel must play out, as it did here, because medical professionals are in the better position to impeach contrasting medical opinions as they did here. Scott Waste Serv., No. 2024-CA-0970-WC, 2026 WL 118814, at *5. To support its argument, Scott cited three cases where this Court has referenced the Cepero holding. First, in Eddie’s Service Center v. Thomas, this Court stated that “[w]hen a physician’s opinion is based on a history that is ‘substantially inaccurate or largely incomplete,’ that opinion ‘cannot constitute substantial evidence.’” 503 S.W.3d 881, 887 (Ky. 2016) (quoting Cepero, 132 S.W.3d at 842) (“Dr. Roseman’s opinion that Eddie’s death was not work- related is based, in large part, on his conclusion that Eddie’s activity before his death required only minimal non-strenuous exertion. Dr. Roseman reached this conclusion based on his belief that Eddie walked up and down a hill several times and was able to converse in a normal tone after doing so. However, as noted above, Eddie did not “walk” up and down a hill, he climbed

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18 up and down a steep embankment and climbed under the truck several times to position and reposition the tow chain. Bailey, the only person to testify regarding the amount of exertion required, stated that the activity was strenuous—testimony that Dr. Roseman largely ignored.”). Second, in Currens v. RJ Insulation, this Court stated: The core of Currens’ argument may be boiled down to an immaterial factual distinction she identifies between her own case and Cepero’s. Dr. Wunder received all of Currens’ relevant medical records, whereas Dr. Changaris, the relevant physician in Cepero, had conflicting or missing information upon which he based his diagnoses. However, Cepero’s central conclusion was that a physician’s medical determinations must be based on accurate information to become “substantial evidence.” Dr. Wunder’s access to Currens’ medical history, including her recent treatment for cervical radiculopathy, was immaterial because his report was quite simply factually inaccurate. Dr. Wunder stated that Currens had not sought treatment for cervical radiculopathy since 2010 despite Dr. Barczewski’s records clearly indicating that she sought treatment for the same condition days before her injury. Given these facts, the ALJ properly rejected Dr. Wunder’s report under Cepero. No. 2020-SC-0298-WC, 2021 WL 1679567, at *2 (Ky. Apr. 29, 2021). Third, in Lexington Fayette Urban County Government v. Gosper, we noted: Specifically, Cepero may best be understood to establish that any opinion generated by a physician on the issue of causation cannot constitute substantial evidence where the physician’s medical history pertaining to the claimant’s injury is irrefutably corrupt due to it being substantially inaccurate or largely incomplete. More generally, however, Cepero decrees that no medical opinion can be reasonably probable when predicated upon erroneous or deficient information which is completely unsupported by any other credible evidence. 671 S.W.3d 184, 206 (Ky. 2023).

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19 We agree with Scott and hold that, based on the language of Cepero and this Court’s subsequent interpretation of Cepero, the doctrine does not require an egregious omission. As for the Court of Appeals’ opinion, the strict language of Cepero does not require the omission to be so obvious that it would be apparent to a layperson. Therefore, we acknowledge that the Board’s and Court of Appeals’ discussion of Cepero may have erroneously expanded its application. That conclusion, however, does not render the Board’s or Court of Appeals’ opinion incorrect. The facts in Cepero did involve egregious omissions, and the Board could reasonably distinguish those facts from the circumstances presented herein. Moreover, the Board did not rely on the presence of egregious omissions in Cepero as the basis for concluding that Cepero did not apply. Rather, the Board determined that Dr. Fadel had received Eaton’s prior medical history and had accounted for that history in his addendum. Dr. Fadel also addressed the contrary opinion of Dr. Cancian. Accordingly, the ALJ considered Eaton’s prior medical history, as well as Dr. Fadel’s and Dr. Cancian’s addenda addressing that history. Based on the specific facts of Eaton’s case, the Board determined that Cepero was not applicable. As for the Court of Appeals, it was confronted with a difficult issue arising from Cepero: when may a court determine that a medical opinion is not credible based on the physician’s failure to consider a claimant’s medical history?

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20 Appellate courts are not in the position to reject a medical opinion as lacking credibility unless the basis for doing so can be identified without making a medical determination. For example, in Cepero, the physician’s opinion was clearly based on an inaccurate or substantially incomplete medical history because the employee had sustained extensive prior injuries to the same knee for which he sought workers’ compensation benefits. Cepero, 132 S.W.3d at 842–43. Likewise, in Eddie’s Service Center, this Court could determine from the factual record that Dr. Roseman had largely ignored the only testimony concerning the amount of exertion required to perform the employee’s job. 503 S.W.3d at 887. In Currens, this Court held that the ALJ rejected a doctor’s report because “Dr. Wunder’s access to Currens’ medical history, including her recent treatment for cervical radiculopathy, was immaterial because his report was quite simply factually inaccurate. Dr. Wunder stated that Currens had not sought treatment for the same condition days before her injury.” Currens, No. 2020-SC-0298-WC, 2021 WL 1679567, at *2. In these cases, the deficiency in the physician’s consideration of the relevant history or evidence was apparent from the record and did not require this Court to resolve a disputed medical question. However, this case differs. Here, the Court of Appeals was confronted with the fact that Dr. Fadel reviewed Eaton’s medical history and prepared an addendum specifically addressing that prior history. Dr. Fadel clearly stated that he reviewed Dr. Cancian’s report from September 27, 2023, which stated Dr. Cancian’s reasoning for finding “that there does not exist a reasonable

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21 degree of medical probability that the claimant’s right hip/thigh diagnoses are causally related to the claimant’s employment or the alleged workplace incident in question.” Accordingly, Dr. Fadel acknowledged “[t]he medical records reviewed that begin on March 7, 2013.” Dr. Fadel concluded that Eaton had a dormant condition that “may have stayed quiet for a number of years, since it had already stayed quiet for nine years.” He then concluded that “[t]he remaining conclusions within that initial report generated by me on November 22, 2022 have not changed, even after reviewing the medical records given to me.” In finding that Eaton’s case differed from Cepero, Court of Appeals specifically reasoned: Through Dr. Cancian's addendum, Dr. Fadel was sufficiently furnished with Eaton's history of abscesses and foot ulcers. In addition, Dr. Fadel stated his addendum was also based on “medical records reviewed that begin on March 7, 2013 at the Sumner Regional Medical Center Emergency Room.” (R. 4926). While not conclusive, this tends to indicate Dr. Fadel was, in fact, furnished with Eaton's medical records dating back to 2013, which would have included medical records relating to his 2013 abscesses and 2020 left foot ulcer. Further, in his addendum, Dr. Fadel specifically referenced Eaton's 2013 abscesses. (R. 4926). And in his initial report, Dr. Fadel diagnosed Eaton with a right foot ulcer, which he concluded was unrelated to Eaton's fall at work, explaining, “The right foot infection had nothing to do with the work injury. The infectious process there was secondary to what happens to most diabetics.” (R. 38). Dr. Fadel was not only furnished with information but demonstrated awareness of Eaton's issues with abscesses and foot ulcers. There was no “complete failure to consider relevant medical events.” Gosper, 671 S.W.3d at 206 (emphasis added).

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22 Scott Waste Serv., No. 2024-CA-0970-WC, 2026 WL 118814, at *4. Scott argues that the Court of Appeals erred when it explained “why Dr. Fadel likely reviewed the medical records at issue” because “there is absolutely no evidence that Dr. Fadel reviewed these records.” We disagree. The record supports the Court of Appeals’ conclusion that Dr. Fadel was furnished with Eaton’s relevant medical history. We further reject Scott’s argument that Dr. Fadel’s opinion that “the pre- existing dormant condition may have stayed quiet for a number of years, since it had already stayed quiet for nine years”—as it relates to Eaton’s right and left peroneal and buttock abscesses—is evidence that Dr. Fadel did not review Eaton’s medical records from 2020. In order for this Court to conclude this, it would be required to determine that Dr. Fadel’s opinion was nevertheless based on an inaccurate or incomplete history by determining whether Eaton’s 2020 diabetic foot ulcer was the same injury as the abscess that developed in 2022. A hematoma that served as a culture medium for former buttock abscesses is not readily connected to a diabetic foot ulcer, and this Court is in no position to determine which medical opinion is accurate. The ALJ had the sole authority to judge the credibility of both Dr. Fadel’s and Dr. Cancian’s reports. We therefore defer to the ALJ’s findings on this matter. Because Dr. Fadel filed an addendum report and specifically stated that “[t]he remaining conclusions within that initial report generated by me on November 22, 2022 have not changed, even after reviewing the medical records given to me[,]” we decline to hold that Dr. Fadel’s November 22, 2022, and

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23 November 30, 2023, reports do not constitute substantial evidence of causation under Cepero. Although we decline to expand Cepero, we do not disturb the ultimate result reached by the Board and the Court of Appeals. Both relied on the specific facts of the case—including Dr. Fadel’s addendum addressing Eaton’s prior medical history and Dr. Cancian’s addendum report—rather than resting their conclusions on an expansive interpretation of Cepero. III. Conclusion For the reasons stated herein, we affirm the holding of the Court of Appeals. All sitting. All concur. COUNSEL FOR APPELLANT: Rodney J. Mayer John H. McCracken U’Sellis Mayer & Associates COUNSEL FOR APPELLEE: Scott C. Justice Justice Law Office COUNSEL FOR HON. TONYA M. CLEMENS: Pro Se COUNSEL FOR WORKERS’ COMPENSATION BOARD OF KENTUCKY: Michael Wayne Alvey, Chairman

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