ADJ13738554 · May 30, 2024

The WCAB found that the record was undeveloped on whether the applicant sustained injury arising out of and in the course of employment to the left shoulder and knee, as the QME report did not address whether the April 20, 2019 accident aggravated preexisting conditions; thus, the matter was remanded for further development.

From the decision · page 5Here, the record reveals that QME Dr. Rapoff reviewed diagnostic studies, including an MRI, that showed that applicant has "a bona fide left shoulder and left knee condition... [i.e.,] pre-existing, degenerative changes in the left shoulder and left knee which can cause pain." (Ex. B, Report of QME Dr. Rapoff, April 13, 2023, p. 58.) Notwithstanding this record, QME Dr. Rapoff's reporting offers no opinion as to whether applicant's April 20, 2019 accident lit up her preexisting left shoulder and left knee conditions and caused her to sustain industrial injury. Nor does the reporting offer an explanation or rationale for failing to address the issue. Notably, QME Dr. Rapoff's conclusion that applicant's descriptions of the extent of her claimed injury lack credibility does not negate the question of whether applicant in fact sustained injury in the first instance. We therefore conclude that the record should be further developed on the issue of whether applicant sustained injury to the left shoulder and knee.

Since the record on orthopedic injury was remanded for further development, the WCAB also remanded the record on claimed dental, sleep, and psyche injuries for further development as appropriate.

From the decision · page 6Additionally, we note the WCJ's statement in the Report that dental QME Dr. Hatami opined that applicant had myofascial pain, bruxism, xerostomia, and periodontitis that were aggravated or exacerbated by her orthopedic injuries and that the extent of the aggravation or exacerbation could be determined once applicant became permanent and stationary. (Report, pp. 3-4.) However, the WCJ concluded that development of the record as to the extent of applicant's claimed dental injury was unwarranted because applicant did not sustain orthopedic injury. But since we have concluded that the record as to the claimed orthopedic injury should be developed, we likewise conclude that the record as to the claimed dental, sleep, and psyche injuries should be developed, as appropriate.

QME Dr. Rapoff's report did not address whether the April 20, 2019 accident aggravated preexisting left shoulder and knee conditions.

Favours Applicant prevailed

This omission left the record undeveloped on causation, necessitating remand for further proceedings.

From the decision · page 5Here, the record reveals that QME Dr. Rapoff reviewed diagnostic studies, including an MRI, that showed that applicant has "a bona fide left shoulder and left knee condition... [i.e.,] pre-existing, degenerative changes in the left shoulder and left knee which can cause pain." (Ex. B, Report of QME Dr. Rapoff, April 13, 2023, p. 58.) Notwithstanding this record, QME Dr. Rapoff's reporting offers no opinion as to whether applicant's April 20, 2019 accident lit up her preexisting left shoulder and left knee conditions and caused her to sustain industrial injury. Nor does the reporting offer an explanation or rationale for failing to address the issue. Notably, QME Dr. Rapoff's conclusion that applicant's descriptions of the extent of her claimed injury lack credibility does not negate the question of whether applicant in fact sustained injury in the first instance. We therefore conclude that the record should be further developed on the issue of whether applicant sustained injury to the left shoulder and knee.

Did not find that applicant sustained specific industrial injuries to neck, left shoulder, low back, or left knee; noted preexisting degenerative changes in left shoulder and knee but did not address whether the April 20, 2019 accident aggravated these conditions.

The report was found to be substantial medical evidence but incomplete on causation regarding aggravation of preexisting conditions, leading to remand for further development.

From the decision · page 3Discoid lateral meniscus with superimposed myxoid degeneration. Distal quadriceps and proximal patellar tendinosis.... 10/28/2020 Bahan DC, - Harbor Chiropractic, Inc. - Doctors First Report of Occupational Injury or Illness: History: the applicant... "who reports having been involved in a specific injury during the course of performing her usual and customary work duties as a General Laborer for her employer, Angel's Janitorial Solutions incorporated. (SI - 04/20/2019 back left shoulder, left knee, dental as well as symptoms of psyche and sleep disorder). She was never provided any medical care, nor did she seek any medical care on her own.... The patient states she had another fall in 10/2019 where she aggravated her pain symptoms. She was finally provided medical care on 06/2020 at the company's clinic where she was examined, underwent diagnostic studies, and informed she needed to undergo surgery for her left knee and needed therapy for her back.

Place v. Workers' Comp. Appeals Bd. (1970) 3 Cal.3d 372

A medical opinion is not substantial evidence when based on incorrect facts, history, examination or legal theory, or surmise, speculation, conjecture or guess.

The WCAB reviewed whether the QME report was substantial medical evidence given the absence of outpatient notes in the medical history.

From the decision · page 4DISCUSSION Applicant contends that the WCJ erroneously found that the report from QME Dr. Rapoff constitutes substantial medical evidence on the grounds that QME Dr. Rapoff did not review the outpatient notes from LAC/USC Primary Care showing that applicant sought medical treatment on May 3, 2019 for injuries related to her April 20, 2019 accident herein. We observe decisions of the WCAB must be supported by substantial evidence such as medical opinion. (Labor Code § 5903, 5952; Garza v. Workmen's Comp. App. Bd. (Garza) (1970) 3 Cal.3d 312, 317-319 [33 Cal.Comp.Cases 500].) A medical opinion is not substantial evidence when based on incorrect facts, history, examination or legal theory, or surmise, speculation, conjecture or guess. (Place v. Workers' Comp. Appeals Bd. (Place) (1970) 3 Cal.3d 372, 378 [90 Cal. Rptr. 424, 475 P.2d 656, 35 Cal.Comp.Cases 525].) A medical opinion should be based on reasonable medical probability and logical and persuasive reasoning, which is consistent with the record. (McAllister v. Workmen's Comp. Appeals Bd. (McAllister) (1968) 69 Cal.2d 408, 413, 416-417 [33 Cal.Comp.Cases 660]; Escobedo v.

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

For causation in workers' compensation, it is sufficient if the work is a contributing cause of the injury; acceleration or aggravation of a preexisting condition is compensable.

The WCAB noted the legal standard for causation requiring development of the record on whether the accident aggravated preexisting conditions.

From the decision · page 5Coast Framing, Inc. v. Workers' Comp. Appeals Bd. (2015) 61 Cal.4th 291 [80 Cal.Comp.Cases 489].) "[T]he proximate cause requirement of Labor Code section 3600 has been interpreted as merely elaborating on the general requirement that the injury arise out of the employment. The danger from which the employee's injury results must be one to which he or she was exposed in the employment." (Id., at pp. 297 - 298 [citations omitted].) The acceleration, aggravation or `lighting up' of a preexisting condition "is an injury in the occupation causing the same." (Id., at p. 301, quoting Tanenbaum v. Industrial Acc. Com. (1935) 4 Cal.2d 615, 617; see also Zemke v. Workers' Comp. Appeals Bd. (1968) 68 Cal.2d 794 [33 Cal.Comp.Cases 358]; Reynolds Electrical & Engineering Co. v. Workers' Comp. Appeals Bd. (Buckner) (1966) 65 Cal.2d 438 [31 Cal.Comp.Cases 421].)

QME Dr. Rapoff's report did not address whether the April 20, 2019 accident aggravated preexisting left shoulder and knee conditions.

From the decision · page 5Here, the record reveals that QME Dr. Rapoff reviewed diagnostic studies, including an MRI, that showed that applicant has "a bona fide left shoulder and left knee condition... [i.e.,] pre-existing, degenerative changes in the left shoulder and left knee which can cause pain." (Ex. B, Report of QME Dr. Rapoff, April 13, 2023, p. 58.) Notwithstanding this record, QME Dr. Rapoff's reporting offers no opinion as to whether applicant's April 20, 2019 accident lit up her preexisting left shoulder and left knee conditions and caused her to sustain industrial injury. Nor does the reporting offer an explanation or rationale for failing to address the issue. Notably, QME Dr. Rapoff's conclusion that applicant's descriptions of the extent of her claimed injury lack credibility does not negate the question of whether applicant in fact sustained injury in the first instance. We therefore conclude that the record should be further developed on the issue of whether applicant sustained injury to the left shoulder and knee.