ADJ16435725 — California WCAB decision

What the panel ordered

Petition for reconsideration granted; WCJ's Finding and Order rescinded; case remanded for further proceedings.

Applicant sought reconsideration of the WCJ's Finding and Order issued on December 22, 2025, which denied increased permanent disability for psyche and erectile dysfunction claims. The WCJ's decision was rescinded and the matter was returned for further proceedings.

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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.

AOE/COERemandedbrain/head · psyche · erectile dysfunction

The WCJ's conclusion that the injury was not a violent act or catastrophic injury was found to be inadequately supported, with concerns about disregarding some medical evidence and insufficient findings on the psychiatric injury causation and catastrophic injury factors. The Appeals Board granted reconsideration and remanded for further development of the record.

From the decision · page 1Applicant seeks reconsideration of the Finding and Order (F&O) issued by the workers' compensation administrative law judge (WCJ) on December 22, 2025, wherein the WCJ found that applicant's April 4, 2022 injury "did not constitute or result from a violent act and was not a catastrophic injury pursuant to Labor Code section 4660.1 and 3208.31 which would entitle applicant to increased permanent disability for the psyche aspect or erectile dysfunction, as set forth in the attached Opinion on Decision."

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

The WCJ disregarded some medical evidence including MRI findings and other reports indicating severity of injury.

Favours Applicant prevailed

This led to an inadequate basis for denying catastrophic injury status.

From the decision · page 17(Ibid.) As explained above, to the extent that applicant's sequalae are a result of the physical injury to his brain, meaning that factor number 4 may apply, they also may be included in the determination of whether applicant's injury was catastrophic, including their effect on applicant's ADLs under factor 3. Here, the WCJ concluded that applicant's physical injury was not catastrophic on the grounds that it was not a "severe, mangling injury" like in the Guerro case; that there was "minimal PD and restrictions" recommended in the reporting of Drs. Verpukhovskiy, Longacre and Jasper; that applicant returned to work after the injury and only reported the headaches, blurred vision and psyche issues later; that he was not in a "catastrophic state" on the day of the injury or the first few days afterwards; and that this was not a severe brain injury, spinal cord injury with paralysis, limb amputation or severe burn as described in section 4660.1(c)(2)(B). (Report, at pp. 5-9; Opinion at pp. 4-8.) We have several concerns regarding the grounds cited by the WCJ in reaching the conclusion that the injury here was not catastrophic. First, the WCJ discussed the medical reporting of Drs. Verpukhovskiy, Longacre and Jasper, and appeared to disregard the other medical evidence, including the MRI findings and other medical reports. (Opinion, at pp. 5-6.)

Applicant's head injury symptoms took days to manifest and treatment was ongoing, including at Casa Colina for traumatic brain injury effects.

Favours Applicant prevailed

Indicates seriousness and ongoing nature of injury relevant to catastrophic injury determination.

From the decision · page 18Our next concern is that the WCJ emphasized that applicant's condition in the days after his injury did not appear to be serious or catastrophic, noting that he was sent back to work on the day of injury, and that he "did not mention his head" on the day of injury, and was not in a "catastrophic state" at the time of injury or immediately thereafter. (Opinion, at p. 6.) These observations are relevant, but the inquiry cannot stop there. The medical evidence as a whole must be considered, and the determination of whether the injury was catastrophic must include an evaluation, by the WCJ, of the first Wilson factor: the "intensity and seriousness of treatment received by the employee that was reasonably required to cure or relieve from the effects of the injury." (Wilson, supra, at pp. 414-415.) Here, the evidence indicates that it took a few days for applicant's head injury to reveal itself, and a few weeks or longer, for applicant to receive the diagnoses of post-concussion syndrome, traumatic brain injury, and the MRI finding of hemorrhagic contusion. Moreover, his treatment for his head and psyche injuries is ongoing. Even the IMR physician approved applicant's treatment at Casa Colina for "the effects of his traumatic brain injury."

Medical record lacks clear evidence on what percentage of psychiatric and erectile dysfunction injuries were directly caused by the industrial accident versus compensable consequences.

Favours neutral

Necessitates further development of the record to determine compensability and increased impairment rating eligibility.

From the decision · page 19of applicant's psychiatric injuries were directly caused by the April 4, 2022 incident, and what percentage of his psyche injury was a compensable consequences of his physical injury, as required. (Wilson, supra, 84 Cal.Comp.Cases at 414.) The record also contains inadequate medical evidence explaining specifically how the accident either directly or indirectly resulted in applicant's psyche injury. In addition, the WCJ made no findings on these issues, as required. Consequently, we are unable to determine the preliminary issue of whether section 4660.1 applies, and thus cannot reach the issue of whether applicant may be entitled to an increased impairment rating under section 4660.1 because his injury resulted from him being a victim of a violent act or was a catastrophic injury. In order to determine what portion of applicant's injury was actually a physical injury to his brain, what percentage of applicant's psychiatric injury was directly caused by the 2022 accident and what percentage was a compensable consequence of the injury sustained that day, we conclude that the record should be developed.

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.

secondary_treaterRelied upon · psychology

Found erectile dysfunction industrial and due to traumatic brain injury but did not address causation percentage.

Relevant to the erectile dysfunction claim and its compensability.

From the decision · page 19Regarding applicant's erectile disfunction claim, although applicant was diagnosed with this condition by both Dr. Ponton and Dr. Wachs, and Dr. Ponton found the injury to be industrial and due to his traumatic brain injury, neither doctor addressed the question of what percentage of applicant's injury was directly caused by the April 4, 2022 accident and what percentage was a compensable consequence. (Applicant's Exh. 8, at p. 37; Applicant's Exh. 10, at pp. 7-9.) Applicant did not testify about his erectile disfunction, and there is no clear evidence in the medical record to determine whether the injury was caused by the physical injury to his brain, so additional medical evidence may be required.

QMERelied upon · psychiatry

Diagnosed major depressive disorder related to traumatic brain injury and found with reasonable medical probability that employment events were the predominant cause of psychiatric injury.

The opinion was considered in evaluating whether the psychiatric injury was compensable and related to the industrial injury.

From the decision · page 7A QME evaluation in psychiatry was subsequently conducted by Kyle Jasper, M.D, QME, on April 22, 2025, with a report dated May 19, 2025. (Joint Exh. 1.) After reviewing extensive medical records and diagnostic studies, conducting testing, and interviewing applicant, Dr. Jasper diagnosed applicant with "Major Depressive Disorder, single episode, current episode moderate, without psychotic features," history of traumatic brain injury, and a provisional diagnosis of unspecified neurocognitive disorder, with a GAF rating of 55, indicating moderate symptoms or moderate difficult with social/occupational functioning. (Id. at pp. 61-62.) Regarding causation, Dr. Jasper found that applicant's psychiatric injury is related to his traumatic brain injury, and concluded, "With reasonable medical probability (>51%) the actual events of employment were the predominant cause to have produced a psychiatric injury." (Id. at p. 64.) Applicant is not yet permanent and stationary. (Ibid.)

secondary_treaterRelied upon · neurology

Diagnosed head trauma with cerebral contusion and post-concussion syndrome.

Medical evidence of physical injury severity was relevant to the catastrophic injury determination.

From the decision · page 2The mechanism of injury was described as "The patient fell harnessed 15 feet down from 4th floor to 3rd floor, He swing [sic] like a pendulum and hit a metal column." He was diagnosed with a cerebral concussion and contusions on his left ankle and thigh. (Applicant's Exh. 16, at p. 1.) On April 22, 2022, Dr. Saquib referred him to a neurologist for evaluation and treatment, and for a brain MRI, noting that "The patient is still manifesting cortical function deficit such as forgetfulness, slow speech, struggling to find correct words etc." (Applicant's Exh. 16, at p. 2.) On May 3, 2022, applicant had a brain MRI, which showed hemorrhagic contusion. (Applicant's Exh. 5, at p. 1; Joint Exh. 11.) On August 9, 2022, a neurological evaluation was performed by David L. Edelman, M.D. (Applicant's Exh. 14.) By way of history, applicant reported that: He was working as an apprentice doing construction when he fell from the fourth floor of a building to the third floor. He hit his head as well as injuring his left ankle and left hip and low back. He is unaware if he sustained a loss consciousness....

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

An employee bears the burden of proving injury AOE/COE by a preponderance of the evidence.

Applied to assess compensability of psychiatric injury.

From the decision · page 10II. An 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.) Section 3208.3(b) provides: (1) In order to establish that a psychiatric injury is compensable, an employee shall demonstrate by a preponderance of the evidence that actual events of employment were predominant as to all causes combined of the psychiatric injury.

Labor Code section 3208.3(b)

To establish that a psychiatric injury is compensable, an employee must demonstrate that actual events of employment were predominant as to all causes combined of the psychiatric injury.

Applied to determine causation of psychiatric injury.

From the decision · page 10II. An 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.) Section 3208.3(b) provides: (1) In order to establish that a psychiatric injury is compensable, an employee shall demonstrate by a preponderance of the evidence that actual events of employment were predominant as to all causes combined of the psychiatric injury.

Wilson v. CA State Fire case (84 Cal.Comp.Cases 393; 2019 Cal. Wrk. Comp. LEXIS 29)

Definition of violent act as characterized by strong physical force, extreme or intense force, or vehemently or passionately threatening act.

Applied to evaluate whether injury mechanism constituted a violent act.

From the decision · page 14We observe that the Appeals Board has defined a violent act within the meaning of section 4660.1(c)(2) as an act characterized by either strong physical force, extreme or intense force, or an act that is vehemently or passionately threatening. (Wilson, supra, 84 Cal.Comp.Cases at p. 405.) The determination of whether a physical injury is the result of a violent act requires an evaluation of the mechanism of injury in light of the event causing the injury. This focus on the mechanism of injury comports with the statute's language, which emphasizes the event causing the injury, rather than the injury itself: the statute expressly refers to being a victim of or direct exposure to a violent "act." The word "injury" is not in this subsection. The focus in evaluating whether an injury qualifies for the exception in section 4660.1(c)(2)(A) is therefore on the mechanism of injury, not on the injury itself. (Wilson, supra, 84 Cal.Comp.Cases at p. 406 [Emphasis in original].)

What proof carried it

The evidence the panel weighed, by kind.

objective testingfavours Applicant prevailed

MRI findings of hemorrhagic contusion and medical reports indicating ongoing treatment for traumatic brain injury and psychiatric conditions

From the decision · page 2The mechanism of injury was described as "The patient fell harnessed 15 feet down from 4th floor to 3rd floor, He swing [sic] like a pendulum and hit a metal column." He was diagnosed with a cerebral concussion and contusions on his left ankle and thigh. (Applicant's Exh. 16, at p. 1.) On April 22, 2022, Dr. Saquib referred him to a neurologist for evaluation and treatment, and for a brain MRI, noting that "The patient is still manifesting cortical function deficit such as forgetfulness, slow speech, struggling to find correct words etc." (Applicant's Exh. 16, at p. 2.) On May 3, 2022, applicant had a brain MRI, which showed hemorrhagic contusion. (Applicant's Exh. 5, at p. 1; Joint Exh. 11.) On August 9, 2022, a neurological evaluation was performed by David L. Edelman, M.D. (Applicant's Exh. 14.) By way of history, applicant reported that: He was working as an apprentice doing construction when he fell from the fourth floor of a building to the third floor. He hit his head as well as injuring his left ankle and left hip and low back. He is unaware if he sustained a loss consciousness....

treatment coursefavours Applicant prevailed

Applicant's failure to respond to multiple antidepressant medication trials and ongoing psychiatric treatment

From the decision · page 7and insomnia and ongoing monitoring by a psychiatrist. (Ibid.) Dr. Musher provided ongoing treatment. (Joint Exhs. 4, 5.) In a follow-up evaluation conducted by Dr. Musher on June 12, 2025, he noted that applicant has failed to respond to five different antidepressant medication trials, and applicant reported suicidal and depressive thoughts. (Joint Exh. 7; Applicant's Exh. 10, at p. 2.) Dr. Musher diagnosed applicant with "Major Depressive Disorder Recurrent Episode, Severe - depressed, angry, irritable - will benefit from rTMS therapy for Treatment Resistant Depression," and referred applicant for a full course of TMS therapy. (Ibid.)

ADJ16435725 · March 30, 2026