What the panel ordered
The Appeals Board granted reconsideration, rescinded the July 25, 2024 Findings and Award, and substituted new findings awarding 72 percent permanent disability with no valid apportionment, entitlement to future medical care for cervical, thoracic, lumbar spine, right shoulder, and head, and deferred attorney fees and weekly rate determination to the WCJ.
Applicant sought reconsideration of the July 25, 2024 Findings and Award, which the WCJ had issued, contesting permanent disability apportionment and future medical care entitlement. The WCJ recommended denial of reconsideration, but the Appeals Board granted reconsideration, rescinded the prior Findings and Award, and issued new findings.
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
The Board concluded that the applicant's right to future medical care was not abrogated and granted entitlement to future medical care for the cervical spine, thoracic spine, lumbar spine, right shoulder, and head.
From the decision · page 1Applicant seeks reconsideration of the July 25, 2024 Findings and Award (F&A), wherein the workers' compensation administrative law judge (WCJ) found that applicant, while employed as an aide/substitute teacher on June 15, 2016, sustained industrial injury to her cervical spine, thoracic spine, lumbar spine, right shoulder, and in the form of headaches. The WCJ found in relevant part that applicant sustained permanent disability subject to nonindustrial apportionment, and that applicant was entitled to future medical care to the head/headaches, but not to the thoracic spine or bilateral knees.
The Appeals Board found that the apportionment opinions of the QME and regular physician were not substantial evidence under legal standards, thus no valid apportionment was supported. The Board awarded 72 percent permanent disability without apportionment.
From the decision · page 10reasonable medical opinion. As such, the apportionment described by the QME does not constitute substantial evidence. Insofar as the QME applies 30 percent nonindustrial apportionment to the cervical spine, the analysis is also conclusory and lacks even a rudimentary discussion of why the motor vehicle accident now contributes to applicant's permanent disability in the cervical spine and right upper extremity.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
The QME and regular physician's apportionment opinions lacked detailed explanation and did not meet legal standards for substantial evidence under Labor Code section 4663 and Escobedo.
Favours Applicant prevailed
This led the Board to reject apportionment and award 72 percent permanent disability without apportionment.
From the decision · page 10reasonable medical opinion. As such, the apportionment described by the QME does not constitute substantial evidence. Insofar as the QME applies 30 percent nonindustrial apportionment to the cervical spine, the analysis is also conclusory and lacks even a rudimentary discussion of why the motor vehicle accident now contributes to applicant's permanent disability in the cervical spine and right upper extremity.
The QME diagnosed a thoracic spine sprain/strain and recommended future medical care including physical therapy for cervical, thoracic, lumbar spine and right shoulder.
Favours Applicant prevailed
This supported the Board's grant of future medical care entitlement including the thoracic spine.
From the decision · page 7However, the January 16, 2017 report of QME Dr. Gwalani includes a diagnosis of a sprain/strain injury to the thoracic spine, albeit not resulting in whole person impairment. (Ex. 3, Report of Tulsidas Gwalani, M.D., dated January 16, 2017, at p. 16.) In the report's discussion of future medical treatment, the QME opines that applicant will need to undertake a home exercise program including range of motion, stretching, and strengthening of the cervical, thoracic and lumbar spine regions and the right shoulder. (Id. at p. 20.) The QME further indicates applicant will require 12 sessions of annual physical therapy to the neck, mid-back and low back and right upper extremity to maintain optimum functional levels and to avoid deconditioning. (Ibid.) Thus, the record provides evidence of the need for future medical care, including the thoracic spine. We will grant reconsideration to amend Findings of Fact No. 9 to list all of the body parts for which applicant is entitled to future medical care, including those stipulated by the defendant, and also the thoracic spine as reflected in the QME reporting.
What the panel did with the medical opinions
The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
Dr. Weinmann apportioned 15 percent of applicant's headache disability to pre-existing neurocysticercosis but the Board found this apportionment insubstantial and invalid under legal standards.
The Board found Dr. Weinmann's apportionment opinion conclusory and lacking explanation as required by Labor Code section 4663 and Escobedo.
From the decision · page 10reasonable medical opinion. As such, the apportionment described by the QME does not constitute substantial evidence. Insofar as the QME applies 30 percent nonindustrial apportionment to the cervical spine, the analysis is also conclusory and lacks even a rudimentary discussion of why the motor vehicle accident now contributes to applicant's permanent disability in the cervical spine and right upper extremity.
Dr. Gwalani diagnosed a thoracic spine sprain/strain and opined 30 percent apportionment to prior motor vehicle accident and degenerative changes, but the Board found this apportionment legally invalid.
The Board concluded Dr. Gwalani's apportionment lacked the required detailed explanation and was not substantial evidence under Labor Code section 4663 and Escobedo.
From the decision · page 10reasonable medical opinion. As such, the apportionment described by the QME does not constitute substantial evidence. Insofar as the QME applies 30 percent nonindustrial apportionment to the cervical spine, the analysis is also conclusory and lacks even a rudimentary discussion of why the motor vehicle accident now contributes to applicant's permanent disability in the cervical spine and right upper extremity.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code section 4663; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604
A physician's report must include an apportionment determination with explanation of the approximate percentage of permanent disability caused by industrial injury and other factors, as required by Labor Code section 4663 and Escobedo.
The Board found the apportionment opinions of the QME and regular physician did not meet this standard and were not substantial evidence.
From the decision · page 10reasonable medical opinion. As such, the apportionment described by the QME does not constitute substantial evidence. Insofar as the QME applies 30 percent nonindustrial apportionment to the cervical spine, the analysis is also conclusory and lacks even a rudimentary discussion of why the motor vehicle accident now contributes to applicant's permanent disability in the cervical spine and right upper extremity.
Labor Code section 4600
Applicant is entitled to future medical care pursuant to Labor Code section 4600.
The Board concluded applicant's right to future medical care was not abrogated and granted entitlement for all injured body parts.
From the decision · page 1Applicant seeks reconsideration of the July 25, 2024 Findings and Award (F&A), wherein the workers' compensation administrative law judge (WCJ) found that applicant, while employed as an aide/substitute teacher on June 15, 2016, sustained industrial injury to her cervical spine, thoracic spine, lumbar spine, right shoulder, and in the form of headaches. The WCJ found in relevant part that applicant sustained permanent disability subject to nonindustrial apportionment, and that applicant was entitled to future medical care to the head/headaches, but not to the thoracic spine or bilateral knees.
What proof carried it
The evidence the panel weighed, by kind.
Applicant's testimony and medical reports including QME and regular physician reports.
From the decision · page 2On April 4, 2018, the parties proceeded to trial, framing issues of, in relevant part, injury to the head, thoracic spine and bilateral knees, permanent disability, and apportionment. The WCJ heard testimony from the applicant and ordered the matter continued.
The same issues, filtered across the whole corpus — or paste your own facts and let the search rank by factor match.
About this page
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