What the panel ordered
Petition for Reconsideration granted; Findings and Award of December 29, 2025 rescinded; matter returned to trial level for further proceedings.
Applicant seeks reconsideration of the Findings and Award issued on December 29, 2025, which found injury AOE/COE only to the right shoulder and permanent disability of 9%. The WCJ's decision was rescinded and the matter returned for further proceedings.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.
Dr. Welborn's medical opinions were found speculative and not substantial evidence to deny injury AOE/COE to the left shoulder and right upper extremity body parts; the Appeals Board granted reconsideration and remanded for further proceedings.
From the decision · page 8It 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 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].) 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. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc).) "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].)
The issue of permanent disability to the right shoulder was not decided on reconsideration as the matter was remanded for further development of the medical record.
From the decision · page 11Since we are rescinding the decision and returning the matter for further development of the record so that further medical reporting can be obtained, we do not consider the issue of whether Dr. Welborn's reporting was substantial evidence on the issue of permanent impairment to applicant's right shoulder. We observe that Dr. Welborn's opinion as to whether applicant has the need for further medical treatment to her right shoulder is at best speculative, and is based on an incorrect understanding of the law regarding defendant's obligation to provide reasonable and necessary medical treatment to cure or relieve applicant from the effects of her industrial injury. (See Lab. Code, § 4600(a).)
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Dr. Welborn's medical opinions were speculative and conclusory, lacking substantial evidence to deny injury to left shoulder and right upper extremity.
Favours Applicant prevailed
The Appeals Board found Dr. Welborn's opinions insufficient to support denial of injury AOE/COE to the left shoulder and right upper extremity, leading to granting reconsideration and remand.
From the decision · page 9Lastly, applicant has objective factors of left shoulder injury, but Dr. Welborn has offered no left shoulder diagnosis to date. Dr. Welborn understands that applicant was using her left upper extremity more after her right shoulder surgeries and he is not aware of any specific injury to the applicant's left shoulder in October 2023. Nonetheless, Dr. Welborn does not believe applicant's left shoulder injury is industrial in nature because her symptoms began about one year after her last right shoulder surgery in October 2023. Hence, without confirmed diagnoses for the right upper extremity elbow, wrist, hand, and left shoulder, Dr. Welborn determined all related conditions are non-industrial. Dr. Welborn's reporting is simultaneously speculative and conclusory in nature.
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 right shoulder injury as industrial; diagnosed right elbow tendonitis, carpal tunnel syndrome (later retracted), medial and lateral epicondylitis, rotator cuff tear; opined left shoulder and right upper extremity injuries non-industrial; opinions found speculative and not substantial evidence.
Medical opinions were speculative, conclusory, and lacked substantial evidence to support denial of injury to left shoulder and right upper extremity.
From the decision · page 1Applicant contends that the reporting of panel Qualified Medical Evaluator (PQME), John Welborn, M.D., is not substantial evidence as to causation of injury to the left shoulder, right upper extremity, right elbow and right wrist, and as to the impairment to the right shoulder.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298, 302
The employee bears the burden of proving injury AOE/COE by a preponderance of the evidence.
The Appeals Board found that the medical evidence presented by Dr. Welborn was not substantial evidence to deny injury to the left shoulder and right upper extremity.
From the decision · page 7The employee bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298, 302 [80 Cal.Comp.Cases 489]; Lab. Code, § 3600(a), 3202.5.) The Supreme Court of California has long held that an employee need only show that the "proof of industrial causation is reasonably probable, although not certain or `convincing.'" (McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 413 [33 Cal.Comp.Cases 660].) "That burden manifestly does
What proof carried it
The evidence the panel weighed, by kind.
Dr. Welborn's medical opinions were speculative and conclusory, lacking substantial evidence to deny injury to left shoulder and right upper extremity.
From the decision · page 9Lastly, applicant has objective factors of left shoulder injury, but Dr. Welborn has offered no left shoulder diagnosis to date. Dr. Welborn understands that applicant was using her left upper extremity more after her right shoulder surgeries and he is not aware of any specific injury to the applicant's left shoulder in October 2023. Nonetheless, Dr. Welborn does not believe applicant's left shoulder injury is industrial in nature because her symptoms began about one year after her last right shoulder surgery in October 2023. Hence, without confirmed diagnoses for the right upper extremity elbow, wrist, hand, and left shoulder, Dr. Welborn determined all related conditions are non-industrial. Dr. Welborn's reporting is simultaneously speculative and conclusory in nature.
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About this page
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