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.
QMERelied upon · pain management
Found nominal limitations in activities of daily living; 100% of thoracic, bilateral upper extremity and chest wall disability and 90% of lumbar disability attributable to the May 11, 2018 incident.
From the decision · page 4The most recent rounds of evaluation began on February 24, 2023, resulting in the report
of pain management PQME Dr. Helm. "the applicant states he continues to work eight hours a week,
four hours twice a week, at his job as a window tinter. He states that the owner of his company is
using the employees who are "well," so that the applicant states that he is only given eight hours.
He also states that he is not able to work more than eight hours because of his injuries. He states
that he turned 62 approximately two months prior to this reevaluation and started receiving Social
Security benefits. He states that he continues to work to pay for his Kaiser insurance until he
receives Medicare at age 65." (Exhibit 101, PQME Standiford Helm, February 28, 2023, page 2.)
Dr. Helm found nominal limitations in activities of daily living (ADLs).
QMERejected · internal medicine
Found no industrial impairment related to chronic kidney disease or diabetes due to reduced medication use, but the Board rejected this opinion as based on inaccurate medical history regarding NSAID use.
Rejected as substantial evidence due to reliance on inaccurate medication history.
From the decision · page 6Use of NSAIDs was reported to the doctor as only being a couple times a month. Based on
this history the doctor found no industrial impairment related to the chronic kidney disease, which
has its causal nexus with diabetes mellitus and hypertensive vascular disease (Exhibit 104, page
4.) By contrast, applicant testified at trial that since he last saw Dr. Noriega, he takes a lot of the
Ibuprofen. (First MOH, page 12, lines 2-3.) It appears this NSAID comes in the form of Ibuprofen
800 milligrams. (Second MOH, page 2, lines 9-11.)
We are unable to rely on the medical reporting of Dr. Noriega as substantial medical
evidence when his opinions are based on facts no longer germane such as the inaccurate medical
QMERejected · psychology
Attributed 100% of psychiatric injury to employment events but found no permanent psychiatric disability; Board found his disability causation opinion unclear and requiring further development.
Opinion on disability causation unclear and contradictory; further development needed.
From the decision · page 7While on the surface the conclusion that psychiatric disability was caused by the fall seems
obvious, we are unable to determine the cause of psychiatric disability from Dr. Brown's reporting.
The record requires clarification on this point. While a lay opinion connecting psychiatric
disability to applicant's injury on May 11, 2018, is temporally attractive, such lay opinion does
not replace expert medical opinion. Physical pain as described by Dr. Brown "during the course
of employment," and physical pain from a specific injury, could conceivably lead to two separately
caused psychiatric disabilities. (See, Lab. Code § 5411, 5412.) For causation of injury, not
disability, Dr. Brown concludes "100% of the applicant's psychiatric injury resulted from real and/or
actual events of the applicant's employment." Without a separate informed and reasoned analysis of
the cause of disability, Dr. Brown's opinions regarding disability appear to be based on surmise,
speculation, conjecture or guess. (Hegglin, supra, at p. 169.)