What the panel ordered
Petition for Reconsideration denied; original Findings, Award, and Orders affirmed.
Defendant sought reconsideration of the April 11, 2025 Findings, Award, and Orders; WCJ prepared a Report and Recommendation to deny the petition; the Appeals Board timely acted on the petition on June 30, 2025.
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 WCJ found Dr. Simpkins's apportionment opinion conclusory and lacking detailed reasoning as required by Escobedo and Yeager, thus not substantial evidence; the Appeals Board denied reconsideration affirming this finding.
From the decision · page 5In the instant matter, Dr. Simpkins indicated that for the cervical spine, he would apportion "25% of the current level of impairment to the presence of age-related degeneration, 20% of the current level of impairment to preexisting injury, and 55% of the current level of impairment to the direct result of the injuries arising out of and occurring in the course of her employment on a continuous trauma basis." (Exhibit 1, p. 20.) Dr. Simpkins explained that "available diagnostic studies reveal[ed] moderate to severe spondylosis" and that "at least two MVAs" resulted in "injury to the cervical spine[.]" (Ibid.) Reference to the specific dates and findings of the alleged studies were not indicated. Specifics regarding the dates of the MVAs and corresponding injuries and diagnoses were also not provided.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Dr. Simpkins's apportionment opinion did not include specific references to medical records or detailed reasoning supporting the apportionment percentages.
Favours Defendant prevailed
This lack of detailed reasoning and specific references led the WCJ and Appeals Board to find the opinion conclusory and not substantial evidence, resulting in denial of the petition for reconsideration.
From the decision · page 5In the instant matter, Dr. Simpkins indicated that for the cervical spine, he would apportion "25% of the current level of impairment to the presence of age-related degeneration, 20% of the current level of impairment to preexisting injury, and 55% of the current level of impairment to the direct result of the injuries arising out of and occurring in the course of her employment on a continuous trauma basis." (Exhibit 1, p. 20.) Dr. Simpkins explained that "available diagnostic studies reveal[ed] moderate to severe spondylosis" and that "at least two MVAs" resulted in "injury to the cervical spine[.]" (Ibid.) Reference to the specific dates and findings of the alleged studies were not indicated. Specifics regarding the dates of the MVAs and corresponding injuries and diagnoses were also not provided.
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.
Found 25% whole person impairment to cervical spine and 8% to lumbar spine with 45% apportionment to age-related degeneration and preexisting injury for cervical spine; recommended future medical for cervical and lumbar spine; did not find injury AOE/COE for right shoulder or left foot.
From the decision · page 2The parties retained Dr. Albert Simpkins as the orthopedic PQME. In a report dated June 11, 2024, Dr. Simpkins found 25% whole person impairment to the cervical spine and 8% whole person impairment to the lumbar spine with 45% apportionment to age related degeneration and preexisting injury for the cervical spine. (Joint Exhibit 1, pp. 16-18, 20.) Future medical was recommended for both the cervical and lumbar spine. (Id. at p. 19.) Dr. Simpkins did not find injury AOE/COE for the right shoulder or left foot.
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; E.L. Yeager v. Workers' Comp. Appeals Bd. (2006) 145 Cal.App.4th 922
Apportionment must be based on reasonable medical probability and supported by detailed reasoning and pertinent facts as outlined in Escobedo and Yeager.
The WCJ applied these standards to find Dr. Simpkins's apportionment opinion conclusory and lacking substantial evidence.
From the decision · page 5Pursuant to E.L. Yeager v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687], "[a] medical opinion is not substantial evidence if it is based on facts no longer germane, on inadequate medical histories or examinations, on incorrect legal theories, or on surmise, speculation, conjecture, or guess. (citations.) Further, a medical report is not substantial evidence unless it sets forth the reasoning behind the physician's opinion, not merely his or her conclusions. (citation.)" "A medical report which lacks a relevant factual basis cannot rise to a higher level than its own inadequate premises. Such reports do not constitute substantial evidence to support a denial of benefits. (citation.)" (Kyle v. Workers' Comp. Appeals Bd (City and County of San Francisco) (1987) 195 Cal.App.3d 614, 621.)
What proof carried it
The evidence the panel weighed, by kind.
Dr. Simpkins's apportionment opinion lacked detailed reasoning and specific references to medical records, rendering it conclusory and not substantial evidence.
From the decision · page 5In the instant matter, Dr. Simpkins indicated that for the cervical spine, he would apportion "25% of the current level of impairment to the presence of age-related degeneration, 20% of the current level of impairment to preexisting injury, and 55% of the current level of impairment to the direct result of the injuries arising out of and occurring in the course of her employment on a continuous trauma basis." (Exhibit 1, p. 20.) Dr. Simpkins explained that "available diagnostic studies reveal[ed] moderate to severe spondylosis" and that "at least two MVAs" resulted in "injury to the cervical spine[.]" (Ibid.) Reference to the specific dates and findings of the alleged studies were not indicated. Specifics regarding the dates of the MVAs and corresponding injuries and diagnoses were also not provided.
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About this page
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