ADJ14647678 · July 21, 2023

The QME Dr. Nakashima's reports and deposition testimony were found not to be substantial evidence due to discrepancies, inadequate examination, and failure to address subsequent medical conditions; the record requires further development with updated medical records and re-evaluation by the QME.

From the decision · page 5Having reviewed Dr. Nakashima's reports and deposition testimony, there appear to be discrepancies and/or issues that need clarification. For example, Dr. Nakashima stated that, "The subsequent medical conditions of persistent diarrhea, dehydration, heart palpitations, anxiety, and sleep disturbance, were derivatives of the 6/17/19 injury." (App. Exh. 2, p. 3.) But he later stated, "Because the patient recovered from her Salmonella enteritidis, no permanent disability exists and whole person impairment is a moot issue." (App. Exh. 3, pp. 21 § 22.) Although the doctor said applicant had recovered from the Salmonella enteritidis, he did not address the subsequent medical conditions.

Dr. Nakashima's reports and deposition testimony contained discrepancies and did not adequately address subsequent medical conditions after Salmonella infection.

Favours Applicant prevailed

This undermined the substantiality of the medical evidence supporting no permanent disability, leading to the decision to remand for further evaluation.

From the decision · page 5Having reviewed Dr. Nakashima's reports and deposition testimony, there appear to be discrepancies and/or issues that need clarification. For example, Dr. Nakashima stated that, "The subsequent medical conditions of persistent diarrhea, dehydration, heart palpitations, anxiety, and sleep disturbance, were derivatives of the 6/17/19 injury." (App. Exh. 2, p. 3.) But he later stated, "Because the patient recovered from her Salmonella enteritidis, no permanent disability exists and whole person impairment is a moot issue." (App. Exh. 3, pp. 21 § 22.) Although the doctor said applicant had recovered from the Salmonella enteritidis, he did not address the subsequent medical conditions.

Dr. Nakashima acknowledged the November 18, 2021 remote evaluation was inadequate and expressed willingness to re-evaluate with new medical records.

Favours Applicant prevailed

This indicated the need for further medical evaluation to determine permanent disability and treatment needs.

From the decision · page 5At his deposition, Dr. Nakashima testified that the evaluation he did in 2021, was virtual, and "... unfortunately it prevented me from checking a complete motor exam and sort of seeing whether or not she still had any restrictions." (App. Exh. 4, p. 17.) He later testified that, "Now, there may have been a change since 2021 when I interviewed the applicant... so if there is new medical information, if there is new medical records, then I would be happy to re-evaluate that... I would be happy to re-eval that, but this letter itself is not accurate." (App. Exh. 4, p. 34.) Dr. Nakashima's testimony indicates that the November 18, 2021 was not an "adequate" examination, and that due to changes in applicant's condition since that examination, it would be appropriate to re-evaluate applicant.

Concluded applicant's Salmonella enteritidis and related symptoms were industrially related; found no permanent disability as applicant recovered; acknowledged limitations of remote evaluation and willingness to re-evaluate with new records; disagreed with treating physician's assertions of worsening conditions without new records.

The board found discrepancies and inadequacies in Dr. Nakashima's reports and deposition, leading to the conclusion that his opinions were not substantial evidence and that further evaluation was needed.

From the decision · page 2BACKGROUND Applicant claimed injury to her gastrointestinal system in the form of sepsis (the body's overactive/extreme reaction to an infection), and in the form of urticaria (skin rash) as a consequence of Salmonella enteritidis (bacterial infection) while employed by defendant as a landscape architect on June 17, 2019. On September 20, 2019, QME Dr. Nakashima evaluated applicant. Dr. Nakashima examined applicant, took a history, and reviewed the medical record. He concluded that applicant's Salmonella enteritidis, dehydration, heart palpitations, anxiety, and sleep pattern alteration were industrially related; and that her iron deficiency anemia and SIBO (Small Intestine Bacterial Overgrowth) were pre-existing and not industrially related. (App. Exh. 1, Philip Nakashima, M.D., September 20, 2019, p. 16.) Dr. Nakashima then stated:

Reported worsening of pre-existing conditions and new medical conditions after Salmonella sepsis injury, including SIBO, GI distress, migraines, tachycardia, chronic urticaria, and hypogammaglobulinemia.

Her report was considered by Dr. Nakashima and the board but was found not supported by new medical records and not fully addressed by the QME, leading to further development ordered.

From the decision · page 3Dr. Nakashima was shown a recent medical report from treating physician Kimberly

Lab. Code, § 5952(d)

Substantial evidence must support any decision of the Appeals Board.

The board found Dr. Nakashima's reports and deposition testimony were not substantial evidence due to discrepancies and inadequacies, requiring further development of the record.

From the decision · page 4DISCUSSION It has long been established that any decision of the Appeals Board must be supported by

Discrepancies in Dr. Nakashima's reports regarding permanent disability and subsequent medical conditions

From the decision · page 5Having reviewed Dr. Nakashima's reports and deposition testimony, there appear to be discrepancies and/or issues that need clarification. For example, Dr. Nakashima stated that, "The subsequent medical conditions of persistent diarrhea, dehydration, heart palpitations, anxiety, and sleep disturbance, were derivatives of the 6/17/19 injury." (App. Exh. 2, p. 3.) But he later stated, "Because the patient recovered from her Salmonella enteritidis, no permanent disability exists and whole person impairment is a moot issue." (App. Exh. 3, pp. 21 § 22.) Although the doctor said applicant had recovered from the Salmonella enteritidis, he did not address the subsequent medical conditions.

Dr. Nakashima's deposition testimony revealed inadequacies in the remote evaluation and willingness to re-evaluate with new medical records

From the decision · page 5At his deposition, Dr. Nakashima testified that the evaluation he did in 2021, was virtual, and "... unfortunately it prevented me from checking a complete motor exam and sort of seeing whether or not she still had any restrictions." (App. Exh. 4, p. 17.) He later testified that, "Now, there may have been a change since 2021 when I interviewed the applicant... so if there is new medical information, if there is new medical records, then I would be happy to re-evaluate that... I would be happy to re-eval that, but this letter itself is not accurate." (App. Exh. 4, p. 34.) Dr. Nakashima's testimony indicates that the November 18, 2021 was not an "adequate" examination, and that due to changes in applicant's condition since that examination, it would be appropriate to re-evaluate applicant.