Braewood Convalescent Hosp. v. Workers' Comp. Appeals Bd. (Bolton) (1983) 34 Cal.3d 159, 164; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc)
Decisions by the Appeals Board must be supported by substantial evidence, which means evidence that is reasonable, credible, and of solid value, framed in terms of reasonable medical probability, not speculative, based on pertinent facts and adequate examination, and with reasoning supporting conclusions.
The WCJ found Dr. Gwartz's opinion did not meet the substantial evidence standard due to being self-contradictory and lacking explanation.
From the decision · page 4III.
We highlight the following legal principles that may be relevant to our review of this
matter:
It is well established that decisions by the Appeals Board 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, supra; LeVesque v. Workmen's Comp. Appeals Bd. (1970)
1 Cal.3d 627 [35 Cal. Comp. Cases 16].) "The term `substantial evidence' means evidence which,
if true, has probative force on the issues. It is more than a mere scintilla, and means such relevant
evidence as a reasonable mind might accept as adequate to support a conclusion... It must be
reasonable in nature, credible, and of solid value." (Braewood Convalescent Hosp. v. Workers'
Comp. Appeals Bd. (Bolton) (1983) 34 Cal.3d 159, 164 [48 Cal.Comp.Cases 566], emphasis
removed and citations omitted.) To constitute substantial evidence "... a medical opinion must be
framed in terms of reasonable medical probability, it must not be speculative, it must be based on
pertinent facts and on an adequate examination and history, and it must set forth reasoning in
support of its conclusions." (Escobedo v.
Lab. Code, 5705; Pullman Kellogg v. Workers Comp. Appeals Bd. (Normand) (1980) 26 Cal.3d 450, 456; Kopping v. Workers' Comp. Appeals Bd. (Kopping) (2006) 142 Cal.App.4th 1099, 1115; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 613; Gay v. Workers' Comp. Appeals Bd. (Gay) (1979) 96 Cal.App.3d 555, 564
The defendant has the burden of proof on apportionment and must demonstrate a legal basis for apportionment based on reasonable medical probability.
The WCJ found the defendant did not meet the burden of proof for apportionment due to insufficient substantial medical evidence.
From the decision · page 4Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals
Board en banc).)
The defendant has the burden of proof on apportionment. (Lab. Code, § 5705; Pullman
Kellogg v. Workers Comp. Appeals Bd. (Normand) (1980) 26 Cal.3d 450, 456 [45 Cal.Comp.Cases
170]; Kopping v. Workers' Comp. Appeals Bd. (Kopping) (2006) 142 Cal.App.4th 1099, 1115 [71
Cal.Comp.Cases 1229]; Escobedo v. Marshalls (Escobedo) (2005) 70 Cal.Comp.Cases 604, 613
(Appeals Board en banc).) To meet this burden, the defendant "must demonstrate that, based upon
reasonable medical probability, there is a legal basis for apportionment." (Gay v. Workers' Comp.
Appeals Bd. (Gay) (1979) 96 Cal.App.3d 555, 564 [44 Cal.Comp.Cases 817]; see also Escobedo,
supra, at p. 620.) Here, it is unclear from our preliminary review that there is substantial medical
evidence to support the WCJ's decision without additional development of the record.