What the panel ordered
The Appeals Board panel denied defendant's Petition for Reconsideration, affirming the WCJ's finding that applicant has a chronic lung disease entitling her to up to 240 weeks of temporary total disability benefits under Labor Code section 4656(c)(3)(I).
Defendant sought reconsideration of the Findings and Award issued by the WCJ on August 14, 2025, which found applicant has chronic lung disease entitling her to up to 240 weeks of total temporary disability indemnity under Labor Code section 4656(c)(3)(I). The WCJ issued a Report and Recommendation to deny the petition, which the Appeals Board panel adopted and incorporated.
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 substantial medical evidence supports that applicant has a chronic lung disease industrially related to COVID-19, entitling her to up to 240 weeks of temporary total disability benefits, rejecting defendant's argument that the medical reports must use the exact phrase 'chronic lung disease'.
From the decision · page 1Defendant seeks reconsideration of the Findings and Award (F&A), issued by the workers' compensation administrative law judge (WCJ) on August 14, 2025, wherein the WCJ found in pertinent part that applicant has "chronic lung disease" for purposes of Labor Code section 4656(c)(3)(I)1, which entitles her to receive up to an aggregate of 240 weeks of total temporary disability indemnity pursuant to section 4656(c)(3).
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant has been treating for serious post COVID-19 respiratory issues since June 2020, with documented hospitalizations and ongoing treatment.
Favours Applicant prevailed
This established the chronic nature of the lung disease qualifying for extended temporary total disability benefits.
From the decision · page 4Here, it is undisputed that applicant sustained injury arising out of and in the course of employment (AOE/COE) to her respiratory system/COVID-19. The medical evidence establishes that applicant has been treating for serious post COVID-19 respiratory issues since June of 2020, when she was first diagnosed with the virus. It is well documented that applicant has been totally temporarily disabled for the better part of the last five years. Dr. Miller has consistently diagnosed applicant with post-COVID-19 pneumonia/long-hauler syndrome and Dr. Ellis's diagnoses include "Long COVID Syndrome which is industrially related." We will not disturb the WCJ's findings merely because the medical reporting does not contain certain terms of art.
Medical opinions from Dr. Ellis, Dr. Lineback, and Dr. Fortanansce consistently support the diagnosis of chronic lung disease industrially related to COVID-19.
Favours Applicant prevailed
Their well-reasoned and detailed medical opinions provided substantial evidence to uphold the WCJ's findings.
From the decision · page 3(1999) 75 Cal.App.4th 1315, 1328 [64 Cal.Comp.Cases 1231].) This is particularly troubling where, as the WCJ notes, "lung disease" is not a medical diagnosis, but rather a broad general term for a category of conditions that prevent the lungs from working properly. To be substantial evidence, a medical opinion must be well-reasoned, based on an adequate history and examination, and it must disclose a solid underlying basis for the opinion. (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Bd. en banc); see also E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687].) Jonathan C. Ellis, M.D., QME in internal medicine issued reports dated January 25, 2022 (Exhibit 2) and October 30, 2023 (Exhibit 3). Dr. Ellis reviewed at least 2,152 pages of records (Exhibit 2: QME report of Dr. Ellis, M.D., dated January 25, 2022, pp. 4, 6-58) and took a detailed history (Id. pp. 68-71, 75-79.) Dr. Ellis explained the basis of his conclusions. (Id. pp. 76-82.) Dr. Ellis's diagnoses include "Long COVID Syndrome which is industrially related." (Id. p. 82.) Dr. Ellis provided a detailed analysis, his opinions are well-reasoned, based on an adequate history
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.
Diagnosed Long COVID Syndrome industrially related; provided detailed, well-reasoned opinions based on extensive record review and history; opined applicant unable to return to work until respiratory condition resolved.
His reports provided substantial medical evidence supporting chronic lung disease diagnosis and industrial causation.
From the decision · page 3(1999) 75 Cal.App.4th 1315, 1328 [64 Cal.Comp.Cases 1231].) This is particularly troubling where, as the WCJ notes, "lung disease" is not a medical diagnosis, but rather a broad general term for a category of conditions that prevent the lungs from working properly. To be substantial evidence, a medical opinion must be well-reasoned, based on an adequate history and examination, and it must disclose a solid underlying basis for the opinion. (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Bd. en banc); see also E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687].) Jonathan C. Ellis, M.D., QME in internal medicine issued reports dated January 25, 2022 (Exhibit 2) and October 30, 2023 (Exhibit 3). Dr. Ellis reviewed at least 2,152 pages of records (Exhibit 2: QME report of Dr. Ellis, M.D., dated January 25, 2022, pp. 4, 6-58) and took a detailed history (Id. pp. 68-71, 75-79.) Dr. Ellis explained the basis of his conclusions. (Id. pp. 76-82.) Dr. Ellis's diagnoses include "Long COVID Syndrome which is industrially related." (Id. p. 82.) Dr. Ellis provided a detailed analysis, his opinions are well-reasoned, based on an adequate history
Diagnosed complex case with prolonged hospitalizations post-COVID; found applicant temporarily totally disabled; recommended further diagnostic testing and continued maintenance treatment.
His findings were persuasive and consistent with chronic lung disease diagnosis.
From the decision · page 7The internal pulmonology panel QME, Dr. James Lineback, in his report of November 5, 2024,6 indicates that her primary complaints are chest pain and shortness of breath. She uses a walker and supplemental oxygen. He diagnoses her with a history of COVID positivity and shortness of breath, use of home oxygen, history of lung nodules and obstructive sleep apnea. Dr. Lineback states that this is a "very complex case that involves two prolonged hospitalizations following COVID positivity." Dr. Lineback finds her to be temporarily totally disabled.
Diagnosed Post COVID-19 pneumonia, long COVID syndrome with chronic dyspnea; found applicant not at maximum medical improvement; recommended continued cardiopulmonary therapy; found applicant credible.
His opinion bolstered the finding of chronic lung disease and was credited by the court.
From the decision · page 10Further, PQMEs in the other specialties bolster the court's conclusion that there is a "chronic lung disease." Neurology PQME Dr. Fortanansce diagnoses Post COVID-19 pneumonia, long covid syndrome with chronic dyspnea. He finds she is not yet at maximum medical improvement and "cardiopulmonary therapy should definitely be continued."17 Dr. Fortanansce states, "I do not feel that she is exaggerating her symptomology. She is a nurse and appeared to be fairly straightforward in her history."18
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 (Appeals Bd. en banc)
Substantial medical evidence must be well-reasoned, based on adequate history and examination, and disclose a solid underlying basis for the opinion.
Applied to evaluate the medical opinions regarding chronic lung disease diagnosis.
Labor Code section 4616.2(d)(3)(B)
Definition of serious chronic condition as a medical condition that persists without full cure or worsens over time or requires ongoing treatment to maintain remission or prevent deterioration.
Used to define 'chronic' in the context of Labor Code section 4656(c)(3)(I).
From the decision · page 6In the present case, the injury or condition at issue is "chronic lung disease."1 Temporary disability is thus dependent on the existence both a "chronic" injury or condition and a "lung disease" to qualify for the exception to the two-year (104) week cap on temporary disability. These two conditions are discussed infra. CHRONIC CONDITION OR INJURY: Cal Lab Code section 4616.2(d)(3)(B) defines a serious chronic condition as "a medical condition due to a disease, illness, or other medical problem or medical disorder that is serious in nature and that persists without full cure or worsens over an extended period of time or requires ongoing treatment to maintain remission or prevent deterioration." The applicant originally tested positive for COVID in June of 2020 and was subsequently hospitalized twice for the condition. Applicant experienced well documented residual sequelae from her COVID infection with respect to her respiratory system. She has been evaluated by
What proof carried it
The evidence the panel weighed, by kind.
Applicant's medical reports and testimony regarding ongoing respiratory symptoms and treatment since June 2020.
From the decision · page 4Here, it is undisputed that applicant sustained injury arising out of and in the course of employment (AOE/COE) to her respiratory system/COVID-19. The medical evidence establishes that applicant has been treating for serious post COVID-19 respiratory issues since June of 2020, when she was first diagnosed with the virus. It is well documented that applicant has been totally temporarily disabled for the better part of the last five years. Dr. Miller has consistently diagnosed applicant with post-COVID-19 pneumonia/long-hauler syndrome and Dr. Ellis's diagnoses include "Long COVID Syndrome which is industrially related." We will not disturb the WCJ's findings merely because the medical reporting does not contain certain terms of art.
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