What the panel ordered
Findings of Fact rescinded; matter returned to WCJ for further proceedings and new decision.
Defendant petitioned for reconsideration of the WCJ's finding that applicant sustained industrial injury (leukemia); WCAB granted reconsideration to further study the issues.
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.
Dr. Miller's medical opinion was not substantial evidence because it relied on an inapplicable legal presumption and was speculative; record requires further development.
From the decision · page 7This testimony is inconsistent with all of his previous statements that since he was not provided any material safety data sheets, he used the presumption in reaching his conclusion regarding the cause of applicant's cancer. Dr. Miller's application of the Labor Code section 3212.1 firefighter/police officer presumption is clear evidence that his conclusion regarding injury AOE/COE is based on an incorrect legal theory.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Dr. Miller based his causation opinion on the firefighter/police officer presumption, which does not apply to applicant's occupation.
Favours Defendant prevailed
Reliance on an inapplicable legal presumption rendered the medical opinion not substantial evidence.
From the decision · page 7This testimony is inconsistent with all of his previous statements that since he was not provided any material safety data sheets, he used the presumption in reaching his conclusion regarding the cause of applicant's cancer. Dr. Miller's application of the Labor Code section 3212.1 firefighter/police officer presumption is clear evidence that his conclusion regarding injury AOE/COE is based on an incorrect legal theory.
Dr. Miller's causation opinion was speculative and not supported by substantial evidence.
Favours Defendant prevailed
Speculation and lack of substantial evidence required further development of the record.
From the decision · page 7Further, in his October 2, 2018 report, Dr. Miller explained that although there is "a hypothetical mode of action to explain how inhaled formaldehyde might induce leukemia" that theory is debated and several studies dispute and "do not support the hypothesis." (App. Exh. 1, p. 19.) He then concluded that applicant's exposure to chemicals "could have contributed to her acute myeloid malignancy and the preceding appearance of an ANCA-vasculitis, which was a paraneoplastic finding." (App. Exh. 1, p. 20.) Dr. Miller's conclusion that applicant's chemical exposure "could have" been a cause of her cancer appears to be based on speculation, conjecture, or guess.
Dr. Miller deferred to a hematologist for causation due to the complexity of the case and his lack of board certification in hematology.
Favours Defendant prevailed
Deference to another specialty indicated the need for further medical evaluation.
From the decision · page 8Finally, at the October 8, 2019 deposition, Dr. Miller stated that because he is not a Board Certified Hematologist, he would defer the issue of causation to a hematologist. (App. Exh. 3, p. 33.)
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.
Dr. Miller opined that applicant's workplace exposures could have contributed to her leukemia, but relied on a legal presumption inapplicable to applicant's occupation and acknowledged deferring to a hematologist for causation.
Opinion not substantial evidence due to reliance on inapplicable presumption and speculative causation.
From the decision · page 7This testimony is inconsistent with all of his previous statements that since he was not provided any material safety data sheets, he used the presumption in reaching his conclusion regarding the cause of applicant's cancer. Dr. Miller's application of the Labor Code section 3212.1 firefighter/police officer presumption is clear evidence that his conclusion regarding injury AOE/COE is based on an incorrect legal theory.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162; Granado v. Workers' Comp. Appeals Bd. (1970) 69 Cal.2d 399; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (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, and the medical opinion must set forth the reasoning behind the physician's opinion, not merely his or her conclusions; a mere legal conclusion does not furnish a basis for a finding.
Applied to reject Dr. Miller's opinion as not substantial evidence due to reliance on inapplicable presumption and speculation.
From the decision · page 6An award, order or decision by the Appeals Board must be supported by substantial evidence in light of the entire record. (Lab. Code § 5903, 5952; Garza v. Workmen's Comp. App. Bd. (1970) 3 Cal.3d 312, 317-319 [33 Cal.Comp.Cases 500]; LeVesque v. Workmen's Comp. Appeals Bd. (1970) 1 Cal.3d 627, 635-637 [35 Cal.Comp.Cases 16].) 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, and the medical opinion must set forth the reasoning behind the physician's opinion, not merely his or her conclusions; a mere legal conclusion does not furnish a basis for a finding. (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162 [36 Cal.Comp.Cases 93]; Granado v. Workers' Comp. Appeals Bd. (1970) 69 Cal.2d 399, [33 Cal.Comp.Cases 647]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc).)
What proof carried it
The evidence the panel weighed, by kind.
Dr. Miller's causation opinion relied on an inapplicable legal presumption and was speculative; he also deferred to a hematologist for causation due to case complexity.
From the decision · page 7This testimony is inconsistent with all of his previous statements that since he was not provided any material safety data sheets, he used the presumption in reaching his conclusion regarding the cause of applicant's cancer. Dr. Miller's application of the Labor Code section 3212.1 firefighter/police officer presumption is clear evidence that his conclusion regarding injury AOE/COE is based on an incorrect legal theory.
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
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