What the panel ordered
The Appeals Board dismissed applicant's petition for reconsideration, granted defendant's petition for reconsideration, rescinded the WCJ's decision of May 1, 2024, and returned the matter to the WCJ for further proceedings.
Defendant sought reconsideration of the Findings and Award dated April 22, 2024, issued May 1, 2024; the WCJ issued a Report recommending granting defendant's petition; the Appeals Board granted defendant's petition, rescinded the Findings and Award, and returned the matter to the WCJ for further proceedings.
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.
The Appeals Board found that the WCJ's Findings and Award lacked substantial evidence due to incomplete vocational expert report review by QMEs, requiring further development of the record consistent with recent en banc decisions.
From the decision · page 1Defendant seeks reconsideration of the Findings and Award (F&A) dated April 22, 2024, and issued on May 1, 2024, wherein the workers' compensation judge (WCJ) found in relevant part that applicant has permanent disability as found by qualified medical evaluator (QME) Dr. Deshmukh for the cervical spine, and by QME Dr. Bhatia for the left upper extremity, with a combined rating of 59% after adjustment for age and occupation; and applicant has "further permanent disability determined by Paul Stanford... resulting in a 100% permanent disability" and the reports were determined to be substantial evidence; and that the reports of Scott Simon were determined not to be substantial evidence.1
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Vocational expert reports were not submitted to QMEs for review as required by Nunes I and II.
Favours Defendant prevailed
This procedural deficiency undermined the substantial evidence basis of the Findings and Award, necessitating remand for further proceedings.
From the decision · page 2Defendant contends that the reports of applicant's vocational expert were not substantial evidence as only the first reports, and not the subsequent reports, were submitted to the QMEs for review.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604
A report must set forth reasoning in support of its conclusions to constitute substantial evidence.
Applied to evaluate the sufficiency of vocational expert reports and medical opinions.
From the decision · page 2To constitute substantial evidence, among other things, a report "must set forth reasoning in support of its conclusions." (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc).) It is well established that in order to constitute substantial evidence, a medical opinion must be predicated on reasonable medical probability. (McAllister v. Workmen's Comp. App. Bd. (1968) 69 Cal.2d 408, 413, 416-417, 419 [33 Cal.Comp.Cases 660].) Also, a medical report is not substantial evidence unless it sets forth the reasoning behind the expert's opinion, not merely the conclusions. (Granado v. Workmen's Comp. App. Bd. (1968) 69 Cal.2d 399, 407 [33 Cal.Comp.Cases 647].) "Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories. Medical opinion also fails to support the Board's findings if it is based on surmise, speculation, conjecture or guess." (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93].)
McAllister v. Workmen's Comp. App. Bd. (1968) 69 Cal.2d 408
A medical opinion must be predicated on reasonable medical probability to constitute substantial evidence.
Applied to assess the validity of medical opinions in the Findings and Award.
From the decision · page 2To constitute substantial evidence, among other things, a report "must set forth reasoning in support of its conclusions." (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc).) It is well established that in order to constitute substantial evidence, a medical opinion must be predicated on reasonable medical probability. (McAllister v. Workmen's Comp. App. Bd. (1968) 69 Cal.2d 408, 413, 416-417, 419 [33 Cal.Comp.Cases 660].) Also, a medical report is not substantial evidence unless it sets forth the reasoning behind the expert's opinion, not merely the conclusions. (Granado v. Workmen's Comp. App. Bd. (1968) 69 Cal.2d 399, 407 [33 Cal.Comp.Cases 647].) "Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories. Medical opinion also fails to support the Board's findings if it is based on surmise, speculation, conjecture or guess." (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93].)
Granado v. Workmen's Comp. App. Bd. (1968) 69 Cal.2d 399
Medical reports must set forth reasoning, not just conclusions, to be substantial evidence.
Applied to determine the evidentiary value of medical reports in the case.
From the decision · page 2To constitute substantial evidence, among other things, a report "must set forth reasoning in support of its conclusions." (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc).) It is well established that in order to constitute substantial evidence, a medical opinion must be predicated on reasonable medical probability. (McAllister v. Workmen's Comp. App. Bd. (1968) 69 Cal.2d 408, 413, 416-417, 419 [33 Cal.Comp.Cases 660].) Also, a medical report is not substantial evidence unless it sets forth the reasoning behind the expert's opinion, not merely the conclusions. (Granado v. Workmen's Comp. App. Bd. (1968) 69 Cal.2d 399, 407 [33 Cal.Comp.Cases 647].) "Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories. Medical opinion also fails to support the Board's findings if it is based on surmise, speculation, conjecture or guess." (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93].)
Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162
Medical opinions based on surmise, speculation, conjecture or guess are not substantial evidence.
Applied to reject medical opinions lacking a proper evidentiary basis.
From the decision · page 2To constitute substantial evidence, among other things, a report "must set forth reasoning in support of its conclusions." (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc).) It is well established that in order to constitute substantial evidence, a medical opinion must be predicated on reasonable medical probability. (McAllister v. Workmen's Comp. App. Bd. (1968) 69 Cal.2d 408, 413, 416-417, 419 [33 Cal.Comp.Cases 660].) Also, a medical report is not substantial evidence unless it sets forth the reasoning behind the expert's opinion, not merely the conclusions. (Granado v. Workmen's Comp. App. Bd. (1968) 69 Cal.2d 399, 407 [33 Cal.Comp.Cases 647].) "Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories. Medical opinion also fails to support the Board's findings if it is based on surmise, speculation, conjecture or guess." (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93].)
Labor Code section 5313
Labor Code section 5313 requires a WCJ to state reasons or grounds for determinations.
Applied to require clear articulation of decision bases in the WCJ's opinion on decision.
From the decision · page 3Labor Code section 5313 requires a WCJ to state the "reasons or grounds upon which the determination was made." The WCJ's opinion on decision "enables the parties, and the Board if reconsideration is sought, to ascertain the basis for the decision, and makes the right of seeking reconsideration more meaningful." (Hamilton v. Lockheed Corporation (Hamilton) (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Board en banc), citing Evans v. Workmen's Comp. Appeals Bd. (1968) 68 Cal.2d 753, 755 [33 Cal.Comp.Cases 350, 351].) A decision "must be based on admitted evidence in the record" (Hamilton, supra, at p. 478), and must be supported by substantial evidence. (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 [35 Cal.Comp.Cases 16].) As required by section 5313 and explained in Hamilton, "the WCJ is
Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473
A decision must be based on admitted evidence and supported by substantial evidence.
Applied to ensure the WCJ's decision was supported by the record evidence.
From the decision · page 3Labor Code section 5313 requires a WCJ to state the "reasons or grounds upon which the determination was made." The WCJ's opinion on decision "enables the parties, and the Board if reconsideration is sought, to ascertain the basis for the decision, and makes the right of seeking reconsideration more meaningful." (Hamilton v. Lockheed Corporation (Hamilton) (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Board en banc), citing Evans v. Workmen's Comp. Appeals Bd. (1968) 68 Cal.2d 753, 755 [33 Cal.Comp.Cases 350, 351].) A decision "must be based on admitted evidence in the record" (Hamilton, supra, at p. 478), and must be supported by substantial evidence. (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 [35 Cal.Comp.Cases 16].) As required by section 5313 and explained in Hamilton, "the WCJ is
Vocational evidence must be submitted to the physician for consideration and cannot substitute for medical apportionment.
Applied to clarify the role of vocational evidence in apportionment determinations.
From the decision · page 2In the en banc decision in Nunes v. State of California, Dept. of Motor Vehicles (June 22, 2023) 2023 Cal. Wrk. Comp. LEXIS 30 [88 Cal.Comp.Cases 741] ("Nunes I"), the Appeals Board held that Labor Code section 4663 requires a reporting physician to make an apportionment determination and prescribes the standard for apportionment, and that the Labor Code makes no
Kuykendall v. Workers' Comp. Appeals Bd. (2000) 79 Cal.App.4th 396
The Appeals Board has a constitutional mandate to ensure substantial justice and may require further evidence development.
Applied to justify remanding the case for further proceedings and evidence development.
What proof carried it
The evidence the panel weighed, by kind.
Vocational expert reports were not submitted to QMEs for review, undermining substantial evidence status.
From the decision · page 2Defendant contends that the reports of applicant's vocational expert were not substantial evidence as only the first reports, and not the subsequent reports, were submitted to the QMEs for review.
The same issues, filtered across the whole corpus — or paste your own facts and let the search rank by factor match.
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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