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Angelina Johnson, a third-grade teacher, filed a workers' compensation petition seeking benefits for a spinal stroke she suffered on January 6, 2022, while at school preparing for a scheduled performance evaluation. The Industrial Accident Board denied her claim, finding that her work-related stress was not a substantial cause of the stroke. Johnson appealed to the Delaware Superior Court,  On January 6, 2022, Johnson was at school making copies in preparation for a scheduled annual performance evaluation when she suffered a spinal stroke. Johnson had multiple poorly controlled pre-existing medical conditions, including hypertension with readings reaching 187/95 and 170/100, and diabetes with A1C levels between 9.8 and 11.9.  Medical records dating to 2013 documented chronic uncontrolled hypertension and diabetes. Johnson was frequently non-compliant with her blood pressure medication, including during the three weeks before her stroke. With regard to her performance, Johnson had never received an "ineffective" rating and was not on probation or any performance improvement plan. The scheduled evaluation was a routine annual employment activity required of all teachers. The central issue on appeal was whether the Industrial Accident Board correctly applied Delaware's workers' compensation causation standards. Specifically, the court addressed two questions: (1) whether the Board properly applied the "substantial cause" standard from Duvall v. Charles Connell Roofing rather than the "but for" standard from Reese v. Home Budget Center, and (2) whether substantial evidence supported the Board's determination that Johnson's work stress was not a substantial cause of her spinal stroke.   The Superior Court affirmed the Industrial Accident Board's decision, holding that the "substantial cause" standard applied because Johnson's scheduled annual teacher evaluation, though stressful, was not an identifiable industrial accident—it was a routine employment activity, not a physical or unexpected event. The court further held that substantial evidence supported the Board's acceptance of the employer's medical expert testimony over Johnson's expert because the employer's expert reviewed a more complete medical history and relied on literature specific to spinal strokes.   The Superior Court held that the Board correctly applied the Duvall "substantial cause" standard rather than the Reese "but for" standard. The court reasoned that Johnson's scheduled annual performance evaluation was a routine employment activity, not an unexpected physical accident. The court next addressed whether substantial evidence supported the Board's finding that Johnson's work stress was not a substantial cause of her stroke.  The court found substantial evidence supporting the Board's decision to accept Dr. Townsend's testimony over Dr. Dogali's.  Dr. Townsend reviewed Johnson's medical records dating back to 2013, which documented a decade-long history of chronic uncontrolled hypertension and diabetes.  He relied on medical literature specific to spinal strokes. In contrast, Dr. Dogali reviewed only post-2022 medical records, relied on studies concerning cerebral strokes rather than spinal strokes, and incorrectly assumed that Johnson's medical conditions were recent developments.