ADJ13057169 · March 12, 2026

The WCJ's adoption of Dr. Burt's Almaraz-Guzman rating was supported by substantial medical evidence, including a thorough explanation of the alternative rating method and the synergistic effect of multiple injuries, consistent with Almaraz-Guzman II and Vigil standards.

From the decision · page 8Defendant contends that the WCJ's adoption of Dr. Burt's Almaraz-Guzman rating was an "improper deviation from the permanent disability rating schedule." (Petition, p. 10.)

Dr. Burt provided a detailed explanation and alternative rating using the Almaraz-Guzman method, supported by AMA Guides and clinical judgment.

Favours Applicant prevailed

This constituted substantial medical evidence supporting the applicant's permanent disability rating and rebutting the standard rating schedule.

From the decision · page 8Here, in his December 13, 2022 report, Dr. Burt provided strict AMA Guides ratings for applicant's right knee, right lower extremity CRPS, and lumbar spine. Dr. Burt also invoked Almaraz Guzman II, and provided the following explanation with respect to his alternate ratings:

Dr. Burt testified that the synergistic effect of injuries to the knee, CRPS, and lumbar spine increased the applicant's impairment beyond the combined values chart rating.

Favours Applicant prevailed

This testimony satisfied the Vigil standard and justified the use of the addition method for rating impairments.

From the decision · page 10Here, in addition to the explanation provided in his December 13, 2022 report, Dr. Burt testified as follows with respect to use of the addition versus CVC method for rating impairments:

Dr. Jones and Dr. Xeller's opinions were found less persuasive due to lack of reevaluation, absence of lumbar spine analysis, and reliance on outdated or incomplete methodology.

Favours Applicant prevailed

This supported the WCJ's decision to rely on Dr. Burt's opinion as substantial medical evidence.

From the decision · page 11IV. Lastly, defendant contends that the reporting of Dr. Burt lacks substantial medical evidence because his findings on CRPS are based upon "obsolete methodology" and "speculative reasoning." (Petition, p. 1.) We remind the parties that during his March 29, 2024 deposition, Dr. Burt specifically testified that even if applicant had no CRPS and "no signs or symptoms of CRPS," his Almaraz- Guzman analysis would remain unchanged due to applicant's loss of lifting capacity and alteration of station and gait. (Exhibit 109, pp. 26:21-28:25.) Notwithstanding the above, we note also that the existence of the "Budapest Criteria" does not close the door on other avenues for diagnoses. In his April 19, 2024 report, Dr. Jones states that the criteria are "generally" used for diagnosis, but he does not allege that they supersede the AMA Guides. (Exhibit 113.) Further, his own opinion is lacking in that he readily admits to reliance on past reporting given applicant's reluctance to a reevaluation. (Ibid.) Dr.

Diagnosed CRPS and provided alternative permanent disability ratings using Almaraz-Guzman method, explaining synergistic effects of injuries on ADLs and supporting additive rating over combined values chart.

Dr. Burt provided detailed AMA Guides ratings and explained why the alternative Almaraz-Guzman rating more accurately reflected the applicant's disability, including synergistic effects of multiple injuries.

From the decision · page 2Applicant sought treatment with primary treating physician (PTP), Jeff Jones, M.D. Thereafter, the parties agreed to use Dr. Burt as the AME. Dr. Burt evaluated applicant on two occasions and issued reports dated September 29, 2021, December 27, 2021, January 18, 2022, March 30, 2022, December 13, 2022, February 19, 2024, June 27, 2025, and July 21, 2025. In his September 29, 2021 report, Dr. Burt diagnosed applicant with low back pain, radiculopathy, post-surgical lesions, and right lower extremity CRPS involving the infrapatellar branch of the saphenous nerve and common femoral nerve at the fibular head. (Exhibit 101, p. 7.) In his January 18, 2022 supplemental report, Dr. Burt stated that, in accordance with page 553 of AMA Guides, "CRPS is currently believed to occur in the central nervous system, so the evaluator should use the station and gait impairment criteria in Table 13-15 to rate lower extremity impairments due to lesions in the central nervous system." (Exhibit 103, p.

Did not diagnose CRPS, noted reliance on past reports and use of Budapest criteria for clinical diagnosis.

Dr. Jones's opinion was found less persuasive due to reliance on outdated reports and lack of reevaluation, and absence of superseding AMA Guides.

From the decision · page 5inquiry from the defense attorney. Dr. Jones indicated that applicant did not have CRPS, but admitted that the findings were not "more definitive" because he was forced to rely upon past

Provided impairment rating excluding lumbar spine analysis, lacking consideration of synergistic effects of multiple injuries.

Dr. Xeller's reports lacked lumbar spine analysis and did not address synergistic effects, making them less persuasive than Dr. Burt's opinion.

From the decision · page 6Thereafter, Charles Xeller, M.D. was retained as the Independent Medical Evaluator (IME). Dr. Xeller evaluated applicant on at least one occasion and issued reports dated March 21, 2025, April 15, 2025, and June 13, 2025.

Almaraz v. Environmental Recovery Services/Guzman v. Milpitas Unified School Dist. (2009) 74 Cal.Comp.Cases 1084 (Appeals Bd. en banc)

Almaraz-Guzman II standard for rebutting the permanent disability rating schedule by providing an alternative rating within the AMA Guides.

The WCJ applied this standard to find Dr. Burt's alternative rating method as substantial medical evidence supporting the applicant's permanent disability rating.

From the decision · page 8It is well established that while the PDRS is prima facie evidence of an employee's permanent disability, it is rebuttable. (Lab. Code, § 4660.1; Almaraz v. Environmental Recovery Services/Guzman v. Milpitas Unified School Dist. (Almaraz-Guzman II) (2009) 74 Cal.Comp.Cases 1084, 1106 (Appeals Bd. en banc); see Blackledge v. Bank of America (2010) 75 Cal.Comp.Cases 613 (Appeals Bd. en banc); City of Sacramento v. Workers' Comp. Appeals Bd. (Cannon) (2013) 222 Cal.App.4th 1360.) In Almaraz-Guzman II, we held that a "scheduled permanent disability rating may be rebutted by successfully challenging the component element of that rating relating to the employee's WPI under the AMA Guides....by establishing that another chapter, table, or method within the four corners of the Guides most accurately reflects the injured employee's impairment." (Almaraz II, supra, at pp. 1095-1096.) In Milpitas Unified School District v. Workers' Comp. Appeals Bd. (Guzman) (2010) 187 Cal.App.4th 808 [75 Cal.Comp.Cases 837], the Court of Appeal affirmed our decision in Almaraz II and noted that the end goal in rating impairments is ultimately accuracy.

Vigil v. County of Kern (2024) 89 Cal.Comp.Cases 686 (Appeals Bd. en banc)

Vigil standard requiring proof of impact on ADLs and overlap or amplification of overlapping ADLs to rebut the combined values chart method.

The WCJ found Dr. Burt's testimony satisfied the Vigil requirements for using the addition method over the combined values chart for rating impairments.

From the decision · page 10Subsequent to Kite, the Appeals Board issued the en banc case of Vigil wherein it was determined that if an applicant seeks to rebut the CVC and add rather than combine impairments, the applicant must establish 1) The ADLs impacted by each impairment, and 2) That the ADLs either do not overlap, or overlap in such a way that it increases or amplifies the impact of the overlapping ADLs. (Vigil, supra, at pp. 688-689.)

Applicant's subjective complaints, history, physical findings, and medical records supported Dr. Burt's synergistic effect opinion.

From the decision · page 10Q: So your findings of synergistic effect, I'm sorry, is that based upon his subjective complaints to you?