ADJ10790437 · May 8, 2026

The WCAB found substantial medical evidence supporting that applicant sustained a dental injury arising out of and in the course of employment based on the medical reports of Dr. Mayer Schames and the repeated requests for dental specialist authorization by PTP Dr. Stokes. The lien claimant met its burden to show services were reasonable and necessary. The WCAB deferred the amount owed for medical treatment to trial level for further determination.

From the decision · page 1Defendant seeks reconsideration of the February 9, 2026 Opinion and Decision After Reconsideration (ODAR), wherein the Workers' Compensation Appeals Board (WCAB) found in pertinent part, that: 1) the applicant, while employed during the period from November 1, 2011 through September 20, 2016 as a Charge Nurse, by Parkview Community Hospital sustained injury to her cervical spine and a dental injury arising out of and in the course of employment as a Charge Nurse; 2) lien claimant The Dental Trauma Center met its burden pursuant to Labor Code1 section 4620(a) to show that a contested claim existed when applicant was evaluated by Dr. Schames beginning on January 9, 2018; 3) lien claimant The Dental Trauma Center met its burden under section 4621 to show its services were reasonable and necessary at the time they were provided beginning on January 9, 2018; 4) lien claimant The Dental Trauma Center is entitled to payment under section 4622 for services it provided beginning on January 9, 2018, and deferred the amount owed. The WCAB also deferred the issue of whether lien claimant is entitled to payment for medical treatment provided to applicant.

Applicant sustained dental injury arising out of and in the course of employment based on substantial medical evidence including Dr. Schames' report.

Favours Applicant prevailed

This fact supported the WCAB's finding of compensability for dental injury and entitlement to lien payment.

From the decision · page 7Dr. Schames examined applicant on January 9, 2018, and summarized the history of her injury. He stated that: "With reasonable medical probability, the myofascial pain of the facial musculature was caused and/or contributed to by the applicant's bruxism in response to her industrial pain and/or emotional stressors", and concluded that: "It is my opinion that, with reasonable medical probability, this patient's presenting complaints and clinical symptoms in my area of expertise were caused or aggravated on an industrial basis." (Exhibit 11, 1/9/18, pp. 14- 15.) We find no basis upon which to disturb that finding.

PTP Dr. Stokes repeatedly requested authorization for dental specialist due to teeth grinding, supporting dental injury claim.

Favours Applicant prevailed

Supported the finding of dental injury causation despite defendant's argument about lack of incorporation of Dr. Schames' reports.

From the decision · page 8Additionally, Dr. Stokes' initial report states, "I am requesting authorization for dental specialist due to teeth grinding." (Exhibit 3, 11/17/2016, p. 12.) Dr. Stokes made the same request for a dental specialist four more times. (Exhibits 4, 5, 6, and 7, 12/29/2016, 3/9/2017, 5/4/2017, 10/19/2017 at p. 7.) The fact that PTP Dr. Stokes fails to incorporate Dr. Schames' reporting does not, as asserted by defendant render the record as lacking in substantial medical evidence.

With reasonable medical probability, the myofascial pain of the facial musculature was caused and/or contributed to by applicant's bruxism in response to her industrial pain and/or emotional stressors. Applicant's presenting complaints and clinical symptoms were caused or aggravated on an industrial basis.

The WCAB relied on Dr. Schames' medical report as substantial evidence supporting the finding of dental injury causation and entitlement to lien payment.

From the decision · page 7Dr. Schames examined applicant on January 9, 2018, and summarized the history of her injury. He stated that: "With reasonable medical probability, the myofascial pain of the facial musculature was caused and/or contributed to by the applicant's bruxism in response to her industrial pain and/or emotional stressors", and concluded that: "It is my opinion that, with reasonable medical probability, this patient's presenting complaints and clinical symptoms in my area of expertise were caused or aggravated on an industrial basis." (Exhibit 11, 1/9/18, pp. 14- 15.) We find no basis upon which to disturb that finding.

Requested authorization for dental specialist due to teeth grinding multiple times, supporting the dental injury claim.

The WCAB found Dr. Stokes' repeated requests for dental specialist authorization supported the finding of dental injury causation despite not incorporating Dr. Schames' reports.

From the decision · page 8Additionally, Dr. Stokes' initial report states, "I am requesting authorization for dental specialist due to teeth grinding." (Exhibit 3, 11/17/2016, p. 12.) Dr. Stokes made the same request for a dental specialist four more times. (Exhibits 4, 5, 6, and 7, 12/29/2016, 3/9/2017, 5/4/2017, 10/19/2017 at p. 7.) The fact that PTP Dr. Stokes fails to incorporate Dr. Schames' reporting does not, as asserted by defendant render the record as lacking in substantial medical evidence.

Performed medical-legal examination and mentioned referral to dental specialist Dr. Mayer Schames.

From the decision · page 4On February 6, 2018, panel qualified medical evaluator (PQME) Alex H. Etemad, M.D., performed a medical-legal examination of applicant. Dr. Etemad issued a report and mentions in his report that applicant was referred to to Dr. Mayer Schames, D.D.S for oral medical care.

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

Employee bears burden of proving injury AOE/COE by preponderance of evidence; proof of industrial causation must be reasonably probable, not certain.

Applied to assess causation of dental injury.

From the decision · page 7The employee bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298, 302 [80 Cal.Comp.Cases 489]; Lab. Code, § 3600(a) & 3202.5.) The Supreme Court of California has long held that an employee need only show that the "proof of industrial causation is reasonably probable, although not certain or `convincing.'" (McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 413 [33 Cal.Comp.Cases 660].) "That burden manifestly does not require the applicant to prove causation by scientific certainty." (Rosas v. Workers' Comp. Appeals Bd. (1993) 16 Cal.App.4th 1692, 1701 [58 Cal.Comp.Cases 313].)

Labor Code section 4600

Employer must provide medical treatment reasonably required to cure or relieve effects of injury; no apportionment of medical expenses if injury partially caused by industrial injury.

Applied to determine entitlement to medical treatment payment for dental injury.

From the decision · page 8the applicant's caused or aggravated Periodontal Disease has understandably appeared at a later time than the original industrial injury, given that these processes are derivative consequences of the applicant's injuries and the Ibuprofen and Aleve medications they were and are taking on an industrial basis. (Exhibit 11, 1/9/18, at p. 14.) An employer is required to provide medical treatment "that is reasonably required to cure or relieve the injured worker from the effects of his or her injury... " (Lab. Code, § 4600) There is no apportionment of the expenses of medical treatment. If the need for medical treatment is partially caused by applicant's industrial injury, the employer must pay all of the injured worker's

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

Substantial evidence requires a medical opinion framed in terms of reasonable medical probability, based on pertinent facts and adequate examination, and not speculative.

Applied to evaluate the medical evidence supporting dental injury causation.

From the decision · page 7Workmen's Comp. Appeals Bd. (1970) 1 Cal.3d 627 [35 Cal.Comp.Cases 16].) To constitute 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, 621 (Appeals Board en banc).) "Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories. Medical opinion also fails to support the Board's findings if it is based on surmise, speculation, conjecture or guess." (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93].)

Repeated requests for dental specialist authorization by PTP Dr. Stokes

From the decision · page 8Additionally, Dr. Stokes' initial report states, "I am requesting authorization for dental specialist due to teeth grinding." (Exhibit 3, 11/17/2016, p. 12.) Dr. Stokes made the same request for a dental specialist four more times. (Exhibits 4, 5, 6, and 7, 12/29/2016, 3/9/2017, 5/4/2017, 10/19/2017 at p. 7.) The fact that PTP Dr. Stokes fails to incorporate Dr. Schames' reporting does not, as asserted by defendant render the record as lacking in substantial medical evidence.

Medical reports of Dr. Mayer Schames supporting industrial causation of dental injury

From the decision · page 7Dr. Schames examined applicant on January 9, 2018, and summarized the history of her injury. He stated that: "With reasonable medical probability, the myofascial pain of the facial musculature was caused and/or contributed to by the applicant's bruxism in response to her industrial pain and/or emotional stressors", and concluded that: "It is my opinion that, with reasonable medical probability, this patient's presenting complaints and clinical symptoms in my area of expertise were caused or aggravated on an industrial basis." (Exhibit 11, 1/9/18, pp. 14- 15.) We find no basis upon which to disturb that finding.