ADJ11122058 · December 12, 2025

The Board found substantial medical evidence supporting the addition method for aggregating orthopedic and internal disabilities, as explained by AME Dr. Simpkins, which showed independent impacts on activities of daily living (ADLs) and a synergistic effect, thus rebutting the combined values chart (CVC) method used by the WCJ.

From the decision · page 1Applicant seeks reconsideration of the Findings and Award (F&A) issued on April 11, 2022, by the workers' compensation administrative law judge (WCJ). The WCJ found in pertinent part that while employed as a building maintenance superintendent for the County of Riverside, applicant sustained injury arising out of and in the course of his employment during the period of January 1, 2001 to November 27, 2017 to both wrists, both shoulders, left elbow, both knees, cervical spine, lumbar spine, hypertension, and lymphoma; and that the injury caused 94% permanent disability.

AME Dr. Simpkins' medical opinion that orthopedic and hematopoietic disabilities affect different body systems with independent impacts on activities of daily living and have a synergistic effect.

Favours Applicant prevailed

This opinion provided substantial medical evidence to rebut the Combined Values Chart method and supported the use of addition for permanent disability rating, leading to the 100% award.

From the decision · page 6In his second deposition dated December 6, 2021, AME Dr. Simpkins expanded on his opinion of lack of overlap between the body systems testifying that disability to the hematopoietic system limits applicant's physical activities due to his lack of endurance from diminished oxygen capabilities and anemia. (Joint Ex. 9 at p. 53:7-11.) This was separate and distinct from applicant's orthopedic disability due to derangement or dysfunction of muscles and tendons. (Id. at p. 53:12- 14.) He testified "[t]hey are two separate systems that function somewhat in a parallel universe as opposed to an inner or overlapping universe" (Id. at p. 53:14-16) resulting in a synergistic effect (id. at pp. 57:23-25 to 58:1-16) to compete in the open labor market (Id. at p. 59:22-23) requiring aggregation of the internal and orthopedic disabilities by addition (Id. at pp. 60:18-25 to 61:1-3). This is "because of the different disease processes that are acting on the applicant's hematopoietic systems and musculoskeletal systems" (Id. at p. 61:4-6) resulting in differing impacts on ADLs from both applicant's orthopedic injury and from his chemotherapy due to his lymphoma injury (Id. at pp. 85:11-25 to 86:1-9; 91:7-17; 92:18-25 to 93:1; 98:11-20).

Diagnosed lymphoma and other conditions; opined lymphoma arose from benzene exposure causing 40% whole person impairment.

Provided medical basis for internal impairment rating relevant to aggregation method dispute.

From the decision · page 4Here, AME Dr. Majcher, in his initial report dated October 18, 2019, diagnosed applicant with gastroesophageal reflux disease, a sleep disorder, erectile dysfunction and lymphoma. (Joint Ex. 1, p. 7.) In AME Dr. Majcher's supplemental report dated March 12, 2020, he opined that applicant's lymphoma arose from his exposure to benzene resulting in whole person impairment of 40% based on Table 9-3, Class 3 on page 200 of the AMA Guides of Impairment (AMA Guides). (Joint Ex. 2 at pp.2-3.)

Diagnosed multiple orthopedic impairments; opined that orthopedic and hematopoietic disabilities should be added due to separate systems and synergistic effect on ADLs, supporting addition over CVC.

Thoroughly explained the medical basis for addition method, which the Board found substantial and persuasive.

From the decision · page 6In his second deposition dated December 6, 2021, AME Dr. Simpkins expanded on his opinion of lack of overlap between the body systems testifying that disability to the hematopoietic system limits applicant's physical activities due to his lack of endurance from diminished oxygen capabilities and anemia. (Joint Ex. 9 at p. 53:7-11.) This was separate and distinct from applicant's orthopedic disability due to derangement or dysfunction of muscles and tendons. (Id. at p. 53:12- 14.) He testified "[t]hey are two separate systems that function somewhat in a parallel universe as opposed to an inner or overlapping universe" (Id. at p. 53:14-16) resulting in a synergistic effect (id. at pp. 57:23-25 to 58:1-16) to compete in the open labor market (Id. at p. 59:22-23) requiring aggregation of the internal and orthopedic disabilities by addition (Id. at pp. 60:18-25 to 61:1-3). This is "because of the different disease processes that are acting on the applicant's hematopoietic systems and musculoskeletal systems" (Id. at p. 61:4-6) resulting in differing impacts on ADLs from both applicant's orthopedic injury and from his chemotherapy due to his lymphoma injury (Id. at pp. 85:11-25 to 86:1-9; 91:7-17; 92:18-25 to 93:1; 98:11-20).

Labor Code §§ 5903, 5952(d); Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604; Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162

Substantial evidence must support the Board's decisions, including medical opinions framed in reasonable medical probability and based on adequate examination and history.

The Board applied this standard to evaluate the medical opinions and found AME Dr. Simpkins' opinion substantial and persuasive.

From the decision · page 2It is axiomatic that substantial evidence must support the decisions by the Appeals Board. (Lab. Code, § 5903, 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274 [39 Cal.Comp.Cases 310]; Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312 [35 Cal.Comp.Cases 500]; LeVesque v. Workmen's Comp. Appeals Bd. (1970) 1 Cal.3d 627

Department of Corrections and Rehabilitation v. Workers' Comp. Appeals Bd. (Fitzpatrick) (2018) 27 Cal.App.5th 607; Almaraz-Guzman II (2009) 74 Cal.Comp.Cases 1084; Kite (2013) 78 Cal.Comp.Cases 213; Vigil (2024) 89 Cal.Comp.Cases 686

Permanent disability ratings are generally combined using the Combined Values Chart (CVC), but this is rebuttable by medical evidence showing a more accurate rating method.

The Board applied these precedents to determine that addition of impairments was appropriate based on medical evidence showing independent impacts on ADLs and a synergistic effect.

From the decision · page 3In Department of Corrections and Rehabilitation v. Workers' Comp. Appeals Bd. (Fitzpatrick) (2018) 27 Cal.App.5th 607 [83 Cal.Comp.Cases 1680], the Court of Appeal found that permanent disability "are generally combined" using the CVC though the "scheduled rating [under the CVC] is not absolute" and other methodologies may be used to calculate permanent disability. (Id., pp.613-614.) Thus, while the scheduled rating is prima facie evidence of an injured employee's permanent disability, the scheduled rating is rebuttable. (Almaraz v. Environmental Recovery Services/Guzman v. Milpitas Unified School Dist. (Almaraz-Guzman II) (2009) 74 Cal.Comp.Cases 1084, 1106 (Appeals Board en banc); see Blackledge v. Bank of America (2010) 75 Cal.Comp.Cases 613 (Appeals Board en banc); City of Sacramento v. Workers' Comp. Appeals Bd. (Cannon) (2013) 222 Cal.App.4th 1360 [79 Cal.Comp.Cases 1].) The overarching goal of rating permanent impairment is to achieve accuracy. (Milpitas Unified School Dist. v. Workers' Comp. Appeals Bd. (Almaraz-Guzman III) (2010) 187 Cal.App.4th 808, 822 [75 Cal.Comp.Cases 837].) (Almaraz-Guzman III, supra, at p. 822.)

AME Dr. Simpkins' detailed testimony explaining the lack of overlap and synergistic effect on ADLs between orthopedic and hematopoietic impairments

From the decision · page 6In his second deposition dated December 6, 2021, AME Dr. Simpkins expanded on his opinion of lack of overlap between the body systems testifying that disability to the hematopoietic system limits applicant's physical activities due to his lack of endurance from diminished oxygen capabilities and anemia. (Joint Ex. 9 at p. 53:7-11.) This was separate and distinct from applicant's orthopedic disability due to derangement or dysfunction of muscles and tendons. (Id. at p. 53:12- 14.) He testified "[t]hey are two separate systems that function somewhat in a parallel universe as opposed to an inner or overlapping universe" (Id. at p. 53:14-16) resulting in a synergistic effect (id. at pp. 57:23-25 to 58:1-16) to compete in the open labor market (Id. at p. 59:22-23) requiring aggregation of the internal and orthopedic disabilities by addition (Id. at pp. 60:18-25 to 61:1-3). This is "because of the different disease processes that are acting on the applicant's hematopoietic systems and musculoskeletal systems" (Id. at p. 61:4-6) resulting in differing impacts on ADLs from both applicant's orthopedic injury and from his chemotherapy due to his lymphoma injury (Id. at pp. 85:11-25 to 86:1-9; 91:7-17; 92:18-25 to 93:1; 98:11-20).