ADJ12129817 — California WCAB decision

What the panel ordered

Findings of Fact of February 4, 2021 affirmed except Sixth Finding of Fact amended to grant applicant entitlement to further medical treatment; matter returned to trial level for further proceedings

Petition for reconsideration granted to study factual and legal issues; decision after reconsideration issued

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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.

Medical treatment / UR / IMRApplicant prevailedright inguinal hernia · left inguinal region

Preponderance of evidence including applicant's testimony and Dr. Swartz's report supports entitlement to further medical treatment to cure or relieve effects of industrial injury.

From the decision · page 3With the foregoing testimony in mind, we find that Dr. Swartz's report of October 11, 2019 acquires additional persuasive value on the question of further medical care. At the end of his report, Dr. Swartz remarked in conclusory fashion that no further treatment or diagnostic testing was indicated. However, this conclusion is contradicted by the doctor's narrative assessment of applicant's hernia symptoms. On page seven of his October 11, 2019 report, Dr. Swartz stated that "I do not see where he was examined for a left inguinal hernia at the different times he had been evaluated for his right inguinal hernia, in retrospect which would be a precautionary measure to see if there was a bilateral inguinal hernia occurring." In reference to applicant's complaints of a left inguinal hernia, Dr. Swartz further stated that "it would be reasonable that he does return to his surgeon, Dr. Lesher, for a reevaluation and particularly for his complaint of pain in the left inguinal region." We construe Dr.

The facts that decided it

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

Applicant testified he still has painful symptoms from right inguinal hernia repair and desires further medical treatment

Favours Applicant prevailed

Supports finding of entitlement to further medical treatment

From the decision · page 2Nevertheless, we conclude that the WCJ's denial of further medical treatment is inconsistent with the preponderance of evidence in this case. The last treatment record is that of the treating surgeon, Dr. Lesher, who surgically repaired applicant's right inguinal hernia on March 29, 2019 and issued a post-operation report dated April 4, 2019. (Exhibit B.) The report is silent on the issue of follow-up medical treatment. Applicant testified at trial on November 30, 2020 that he saw Dr. Lesher about 10 to 14 days after the surgery, the apparent purpose of which was applicant's release from further surgical care. Otherwise, the record again is silent as to what further treatment may have been recommended by Dr. Lesher when he last saw applicant in April 2019. Although applicant testified he has not thought about scheduling a follow-up appointment

Dr. Swartz's medical report recommends reevaluation of right inguinal hernia and initial evaluation of left inguinal complaints

Favours Applicant prevailed

Supports entitlement to further medical treatment despite doctor's conclusion of no further treatment

From the decision · page 3With the foregoing testimony in mind, we find that Dr. Swartz's report of October 11, 2019 acquires additional persuasive value on the question of further medical care. At the end of his report, Dr. Swartz remarked in conclusory fashion that no further treatment or diagnostic testing was indicated. However, this conclusion is contradicted by the doctor's narrative assessment of applicant's hernia symptoms. On page seven of his October 11, 2019 report, Dr. Swartz stated that "I do not see where he was examined for a left inguinal hernia at the different times he had been evaluated for his right inguinal hernia, in retrospect which would be a precautionary measure to see if there was a bilateral inguinal hernia occurring." In reference to applicant's complaints of a left inguinal hernia, Dr. Swartz further stated that "it would be reasonable that he does return to his surgeon, Dr. Lesher, for a reevaluation and particularly for his complaint of pain in the left inguinal region." We construe Dr.

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.

QMERelied upon

Dr. Swartz's October 11, 2019 report supports further medical treatment including reevaluation of right inguinal hernia and initial evaluation of left inguinal complaints despite concluding no further treatment was indicated.

Report admitted without objection; narrative assessment supports further treatment contrary to conclusory statement; consistent with applicant's symptoms and testimony.

From the decision · page 3With the foregoing testimony in mind, we find that Dr. Swartz's report of October 11, 2019 acquires additional persuasive value on the question of further medical care. At the end of his report, Dr. Swartz remarked in conclusory fashion that no further treatment or diagnostic testing was indicated. However, this conclusion is contradicted by the doctor's narrative assessment of applicant's hernia symptoms. On page seven of his October 11, 2019 report, Dr. Swartz stated that "I do not see where he was examined for a left inguinal hernia at the different times he had been evaluated for his right inguinal hernia, in retrospect which would be a precautionary measure to see if there was a bilateral inguinal hernia occurring." In reference to applicant's complaints of a left inguinal hernia, Dr. Swartz further stated that "it would be reasonable that he does return to his surgeon, Dr. Lesher, for a reevaluation and particularly for his complaint of pain in the left inguinal region." We construe Dr.

PTPGiven great weight

Dr. Lesher surgically repaired right inguinal hernia on March 29, 2019; post-operation report silent on follow-up treatment; last seen applicant about 10-14 days post-surgery for release from surgical care.

Medical record and testimony show no clear follow-up treatment plan; applicant still has painful symptoms warranting further treatment.

From the decision · page 2Nevertheless, we conclude that the WCJ's denial of further medical treatment is inconsistent with the preponderance of evidence in this case. The last treatment record is that of the treating surgeon, Dr. Lesher, who surgically repaired applicant's right inguinal hernia on March 29, 2019 and issued a post-operation report dated April 4, 2019. (Exhibit B.) The report is silent on the issue of follow-up medical treatment. Applicant testified at trial on November 30, 2020 that he saw Dr. Lesher about 10 to 14 days after the surgery, the apparent purpose of which was applicant's release from further surgical care. Otherwise, the record again is silent as to what further treatment may have been recommended by Dr. Lesher when he last saw applicant in April 2019. Although applicant testified he has not thought about scheduling a follow-up appointment

What proof carried it

The evidence the panel weighed, by kind.

Testimony and credibilityfavours Applicant prevailed

Applicant's trial testimony about ongoing painful symptoms and desire for further treatment

From the decision · page 2Nevertheless, we conclude that the WCJ's denial of further medical treatment is inconsistent with the preponderance of evidence in this case. The last treatment record is that of the treating surgeon, Dr. Lesher, who surgically repaired applicant's right inguinal hernia on March 29, 2019 and issued a post-operation report dated April 4, 2019. (Exhibit B.) The report is silent on the issue of follow-up medical treatment. Applicant testified at trial on November 30, 2020 that he saw Dr. Lesher about 10 to 14 days after the surgery, the apparent purpose of which was applicant's release from further surgical care. Otherwise, the record again is silent as to what further treatment may have been recommended by Dr. Lesher when he last saw applicant in April 2019. Although applicant testified he has not thought about scheduling a follow-up appointment

Medical recordsfavours Applicant prevailed

Medical report of Dr. Swartz indicating need for reevaluation of right and left inguinal hernia symptoms

From the decision · page 3With the foregoing testimony in mind, we find that Dr. Swartz's report of October 11, 2019 acquires additional persuasive value on the question of further medical care. At the end of his report, Dr. Swartz remarked in conclusory fashion that no further treatment or diagnostic testing was indicated. However, this conclusion is contradicted by the doctor's narrative assessment of applicant's hernia symptoms. On page seven of his October 11, 2019 report, Dr. Swartz stated that "I do not see where he was examined for a left inguinal hernia at the different times he had been evaluated for his right inguinal hernia, in retrospect which would be a precautionary measure to see if there was a bilateral inguinal hernia occurring." In reference to applicant's complaints of a left inguinal hernia, Dr. Swartz further stated that "it would be reasonable that he does return to his surgeon, Dr. Lesher, for a reevaluation and particularly for his complaint of pain in the left inguinal region." We construe Dr.

ADJ12129817 · September 22, 2021

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