ADJ10630370 · December 7, 2023

The WCAB found that the AME Dr. Sanossian's opinion that workplace stress was less than 1% cause of the stroke was based on assumptions and lacked objective evidence, thus not substantial evidence. The WCAB granted reconsideration to further develop the record on causation.

From the decision · page 4DISCUSSION We first note, it has long been the law that once reconsideration has been granted, the Appeals Board has the authority to address issues all issues, including those not specifically raised by the Petition. (Lab. Code, § 5906; (Great Western Power Co. v. Industrial Acc. Com. (Savercool) (1923) 191 Cal. 724, 729 [10 I.A.C. 322]); (State Comp. Ins. Fund v. Industrial Acc. Com. (George) (1954) 125 Cal.App.2d 201, 203 [19 Cal.Comp.Cases 98]; Pasquotto v. Hayward Lumber (2006) 71 Cal.Comp.Cases 223, 229 - 230, fn. 7 (Appeals Board en banc).) In this matter, the Finding that applicant did not sustain injury AOE/COE was based on the reporting and deposition testimony of AME Dr. Sanossian. (See Opinion on Decision, p. 6.) Any award, order, or decision of the Appeals Board must be supported by substantial evidence. (Lab. Code, § 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274, 281 [39 Cal.Comp.Cases 310]; Garza v.

Dr. Sanossian's opinion that workplace stress was less than 1% cause of stroke was based on assumptions without objective evidence.

Favours Applicant prevailed

This undermined the credibility and substantiality of the medical evidence on causation, leading to reconsideration and remand for further development.

From the decision · page 5Here, Dr. Sanossian explained that he "made the assumption of workplace stress and the assumption of an elevated blood pressure secondary to that. But, there is no objective evidence whatsoever of that." (Joint Exh. K, p. 25.) He had previously stated, "We don't have any such readings. However, I did make the assumption that chronic stress would cause that elevation." (Joint Exh. K, p.17; see also p. 19.) Thus, there is no factual basis for disputing our conclusion that Dr. Sanossian's opinions are based on surmise, speculation, conjecture, or guess. Based thereon, his opinions are not substantial evidenced and cannot be the basis for determining the issue of injury AOE/COE.

Stated that applicant's neuropsychological impairment was caused by her October 11, 2015 stroke.

From the decision · page 1Applicant contends that the report from neuropsychology qualified medical examiner (QME) James H. Jennison, Ph.D., is evidence that her neuropsychological impairment was caused by her October 11, 2015 stroke, and that defendant did not issue a timely denial so the section 5402 injury presumption applies to her injury claim.

Stated that workplace stress was less than 1% cause of applicant's stroke and that his opinion was based on assumptions without objective evidence, thus not substantial evidence for injury causation.

Opinion based on assumptions and lack of objective evidence, not substantial evidence for causation.

From the decision · page 5Here, Dr. Sanossian explained that he "made the assumption of workplace stress and the assumption of an elevated blood pressure secondary to that. But, there is no objective evidence whatsoever of that." (Joint Exh. K, p. 25.) He had previously stated, "We don't have any such readings. However, I did make the assumption that chronic stress would cause that elevation." (Joint Exh. K, p.17; see also p. 19.) Thus, there is no factual basis for disputing our conclusion that Dr. Sanossian's opinions are based on surmise, speculation, conjecture, or guess. Based thereon, his opinions are not substantial evidenced and cannot be the basis for determining the issue of injury AOE/COE.

Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc)

Substantial evidence must be based on reasonable medical probability, not speculation or assumptions.

The WCAB found Dr. Sanossian's opinion speculative and lacking objective evidence, thus not substantial evidence.

From the decision · page 5sufficient if the work is a contributing cause of the injury. (South Coast Framing, Inc. v. Workers' Comp. Appeals Bd. (2015) 61 Cal.4th 291 [80 Cal.Comp.Cases 489]; Nash v. Workers' Comp. Appeals Bd. (1994) 24 Cal.App.4th 1793 [59 Cal.Comp.Cases 324].) Clearly, if an injured worker's employment was a contributing factor to the cause of the injury (whether less than 1%, or more than 1%) the causation requirement in a workers' compensation injury claim is satisfied.. (South Coast Framing, Inc. v. Workers' Comp. Appeals Bd., supra.) However, to be substantial evidence a medical opinion must be framed in terms of reasonable medical probability, it must not be speculative, it must be based on pertinent facts and on an adequate examination and history, and it must set forth reasoning in support of its conclusions. (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc).) A medical opinion is not substantial evidence if it is based on facts no longer germane, on inadequate medical histories or examinations, on incorrect legal theories, or on surmise, speculation, conjecture, or guess. (Place v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 372 [35 Cal.Comp.Cases 525]; Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162 [36 Cal.Comp.Cases 93]; Escobedo v. Marshalls, supra.)

South Coast Framing, Inc. v. Workers' Comp. Appeals Bd. (2015) 61 Cal.4th 291

For causation in workers' compensation, work need only be a contributing cause, even less than 1%.

The WCAB noted that even less than 1% contribution from work satisfies causation if supported by substantial evidence.

From the decision · page 5sufficient if the work is a contributing cause of the injury. (South Coast Framing, Inc. v. Workers' Comp. Appeals Bd. (2015) 61 Cal.4th 291 [80 Cal.Comp.Cases 489]; Nash v. Workers' Comp. Appeals Bd. (1994) 24 Cal.App.4th 1793 [59 Cal.Comp.Cases 324].) Clearly, if an injured worker's employment was a contributing factor to the cause of the injury (whether less than 1%, or more than 1%) the causation requirement in a workers' compensation injury claim is satisfied.. (South Coast Framing, Inc. v. Workers' Comp. Appeals Bd., supra.) However, to be substantial evidence a medical opinion must be framed in terms of reasonable medical probability, it must not be speculative, it must be based on pertinent facts and on an adequate examination and history, and it must set forth reasoning in support of its conclusions. (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc).) A medical opinion is not substantial evidence if it is based on facts no longer germane, on inadequate medical histories or examinations, on incorrect legal theories, or on surmise, speculation, conjecture, or guess. (Place v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 372 [35 Cal.Comp.Cases 525]; Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162 [36 Cal.Comp.Cases 93]; Escobedo v. Marshalls, supra.)

Dr. Sanossian's opinion was based on assumptions and lacked objective evidence, undermining its credibility.

From the decision · page 5Here, Dr. Sanossian explained that he "made the assumption of workplace stress and the assumption of an elevated blood pressure secondary to that. But, there is no objective evidence whatsoever of that." (Joint Exh. K, p. 25.) He had previously stated, "We don't have any such readings. However, I did make the assumption that chronic stress would cause that elevation." (Joint Exh. K, p.17; see also p. 19.) Thus, there is no factual basis for disputing our conclusion that Dr. Sanossian's opinions are based on surmise, speculation, conjecture, or guess. Based thereon, his opinions are not substantial evidenced and cannot be the basis for determining the issue of injury AOE/COE.