ADJ11545203 — California WCAB decision

What the panel ordered

The WCAB panel affirmed the WCJ's Findings, Award and Orders issued on September 25, 2019, finding that applicant sustained injury arising out of and in the course of employment to his left knee on July 25, 2018.

Defendant sought reconsideration of the Findings, Award and Orders issued by the WCJ on September 25, 2019, which found injury AOE/COE to applicant's left knee but not left leg on July 25, 2018. The WCJ issued a Report and Recommendation to deny the petition for reconsideration. The WCAB panel affirmed the WCJ's decision on January 19, 2022.

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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.

AOE/COEApplicant prevailedleft knee

The WCAB found substantial evidence in the medical reports and applicant's testimony supporting injury AOE/COE to the left knee, rejecting defendant's argument about inconsistencies and video evidence authentication issues.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

Applicant testified consistently about the injury mechanism, supporting causation.

Favours Applicant prevailed

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.

PTPRelied upon

Dr. Gray's medical assessment found a complex tear of the medial meniscus of the left knee and noted the injury was not consistent with the video depiction but supported industrial injury to the left knee.

Dr. Gray's report was considered substantial evidence supporting injury AOE/COE despite doubts about the video evidence.

From the decision · page 2On examination by defense counsel, the video taken on the day of injury [July 25, 2018] was shown. An individual wearing a hard hat (purported to be the applicant) is seen walking into a large work area at the time of the alleged work injury, and is observed to be walking with an uneven gait prior to the incident. At the time of the incident he is seen removing a barricade from the back of a work truck, and in the process of bringing it down is seen to fall to the ground, first on the right knee and then bringing his left knee to rest, although is not seen to fall backwards as previously represented by the applicant in his deposition. (Defendant represented this to be the same video seen by Dr. Gray of U.S. Healthworks and commented upon in her report [September 10, 2018] [Applicant's Exhibit "3"].

PTPRelied upon

Dr. Miles' report described injury from unloading materials with a pop to the left knee and immediate pain, constituting substantial medical evidence of industrial injury.

Dr. Miles' report was found to be substantial evidence based on medical history, examination, and job duty description.

From the decision · page 6(Deposition of the applicant, dated June 17, 2019, 31:11-19.).) When questioned about which part of his body hit the floor first, his buttocks or his back, applicant responded: "I'm not 100 percent sure if it was my butt or if it was at the same time. I wouldn't be able to tell you. What I can tell you was I was on the floor." (Id at 32:13-16.) Based on our review of the applicant's testimony, we find no evidence supporting defendant's argument that applicant's testimony failed to support the mechanism of injury discussed in the medical reports. Dr. Gray's medical assessment dated September 10, 2018, provides "[applicant] states he was standing removing a sign from a truck when he fell he did not land on knee but states [that he] twisted and developed medial knee pain." (Applicant's Exhibit 3, US Health Works Chronology of Medical Records by Kathleen Gray, M.D., (Exhibit 3) p. 3.) The medical report of Andrew Miles, D.C., includes a description that applicant suffered injury when "he was unloading materials from his vehicle when he experienced a pop to his left knee. He states that he fell back and he immediately experienced pain in his left knee." (Applicant's Exhibit 1, Primary Treating Physician's Initial Comprehensive Evaluation Report an Authorization of Treatment by Andrew Miles, D.C., dated October 11, 2018, (Exhibit 1) p.

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Lab. Code, 3600(a)

An employer is liable for injury arising out of and in the course of employment under Labor Code section 3600(a).

The panel applied this standard to determine compensability of the injury.

From the decision · page 4Next, we address defendant's contention that the WCJ erred in finding that applicant sustained industrial injury. Here we observe the fundamental principal that an employer is liable in the workers' compensation system for an injury to an employee, "...arising out of and in the course of the employment..." (Lab. Code, § 3600(a);1 Maher v. Workers' comp. Appeals Bd. (1983) 33 Cal.3d 729, 732§ 733 [48 Cal.Comp.Cases 326] (Maher).) The concept of "in the course of the employment" generally, "...refers to the time, place, and circumstances under which the injury occurs." (Maher, supra, 33 Cal.3d at 733.) "Arising out of" employment generally refers to the causal connection between the employment and the injury. (Id.) In other words, the employee must be exposed to the "danger from which the injury results" as a result of his "particular employment." (Maher, supra, 33 Cal.3d at 734 n.3 (citing Industrial Indem. Co. v. Ind. Acc. Com. (1950) 95 Cal.App.2d 804, 809).)

Maher v. Workers' comp. Appeals Bd. (1983) 33 Cal.3d 729

The concept of 'in the course of employment' refers to the time, place, and circumstances of the injury; 'arising out of' refers to causal connection to employment.

The panel cited this case to explain the legal standard for injury causation.

From the decision · page 4Next, we address defendant's contention that the WCJ erred in finding that applicant sustained industrial injury. Here we observe the fundamental principal that an employer is liable in the workers' compensation system for an injury to an employee, "...arising out of and in the course of the employment..." (Lab. Code, § 3600(a);1 Maher v. Workers' comp. Appeals Bd. (1983) 33 Cal.3d 729, 732§ 733 [48 Cal.Comp.Cases 326] (Maher).) The concept of "in the course of the employment" generally, "...refers to the time, place, and circumstances under which the injury occurs." (Maher, supra, 33 Cal.3d at 733.) "Arising out of" employment generally refers to the causal connection between the employment and the injury. (Id.) In other words, the employee must be exposed to the "danger from which the injury results" as a result of his "particular employment." (Maher, supra, 33 Cal.3d at 734 n.3 (citing Industrial Indem. Co. v. Ind. Acc. Com. (1950) 95 Cal.App.2d 804, 809).)

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

Employment need only be a contributing cause of the injury; causation must be reasonably probable.

The panel applied this standard to assess causation probability.

From the decision · page 4The employment need only be a contributing cause of the injury. (South Coast Framing, Inc., et al. v. Workers' Comp. Appeals Board (Clark) (2015) 61 Cal.4th 291, 297§ 299 [80 Cal.Comp.Cases 849]; Wickham v. North American Rockwell Corp. (1970) 8 Cal.App.3d 467, 473 [35 Cal.Comp.Cases 751] (citing Madin v. Industrial Acc. Com. (1956) 46 Cal.2d 90, 92§ 93).) Moreover, "...industrial causation itself need not be certain, but only `reasonably probable.'" (McAllister v. Workmen's Comp. Appeals Board (1968) 69 Cal.2d 408, 417 [33 Cal.Comp.Cases 660] (McAllister).)

Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604

A medical opinion must be framed in terms of reasonable medical probability, not speculative, based on pertinent facts and adequate examination, with reasoning support.

The panel used this standard to evaluate the medical evidence's substantiality.

From the decision · page 62.)) We find no inconsistencies between applicant's testimony and the injury described in applicant's medical reports. Defendant also argues that the reporting of Dr. Miles is not substantial evidence. Defendant's argument fails to cite any evidence that Dr. Miles' report relies upon incorrect facts, history, conjecture, or is otherwise defective. (Place v. Workmen's Comp. Appeals. Bd., supra, 35 Cal.Comp.Cases 525.) 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).) On the record before us, we are persuaded that Dr. Miles' report constitutes substantial medical evidence. Dr. Miles obtained a medical history from applicant, conducted a physical examination, and received a detailed description of applicant's job duties. (Exhibit 1, pp. 2-5.) Next, defendant argues that the reporting of Dr. Gray contains doubts regarding the mechanism of injury. (Petition, 7:10-16.) Upon review of the record, we do not agree that Dr.

ADJ11545203 · January 19, 2022

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