ADJ16581671 · August 10, 2026

The WCAB denied the request for an additional orthopedic panel, finding chiropractic specialty appropriate and that an orthopedist consultation is sufficient; granted the request for an additional general vascular panel due to the venous condition issue being deferred.

From the decision · page 108, § 31.5(a)(10).) Either party may appeal the Medical Director's decision regarding the appropriateness of the panel specialty to a WCJ as provided in AD Rule 31.1(b). (Cal. Code Regs., tit. 8, § 31.1(b).) Defendant makes no showing that chiropractic is the inappropriate specialty to opine in this claim. To the extent that defendant’s Petition alleges that Dr. Poli’s reporting is not substantial and he should be replaced pursuant to McDuffie v. Los Angeles County Metropolitan Transit Authority (2001) 67 Cal.Comp.Cases 138 (Appeals Board en banc), we likewise deny that request outright. We do not disturb the order for an additional panel in the specialty of general vascular as Dr. Poli clearly indicated that he is not able to opine on the venous condition and declined to do so.

The WCAB found the QME and PTP medical opinions to be substantial evidence supporting injury to multiple body parts, rejecting defendant's challenge to the medical evidence and causation findings.

From the decision · page 11FINDINGS OF FACT 1. the applicant, while employed during the period from March 13, 2015 through July 21, 2022 as an electrician/electrician helper at various jobsites in California, by T Boyer Company, whose workers’ compensation insurance carrier was Compwest Insurance Company, sustained injury arising out of and occurring in the course of employment to his bilateral knees, bilateral feet, bilateral shoulders, bilateral hands, lumbar spine, circulatory system/blood pressure and psyche.

The WCAB rescinded the temporary disability period awarded by the WCJ due to lack of MMI finding and deferred the issue pending further development of the venous condition record.

From the decision · page 9that an orthopedist should evaluate applicant’s knees with the possible need for surgery. This would indicate that applicant is not at maximum medical improvement at either the time of the report or at the time of the PTP report. Further, though the psyche QME did not conclude that applicant was temporary totally disabled, she also did not find him at MMI. The psyche treater did opine that applicant was temporarily disabled at least through September 2024. Finally, the issue of injury in the form of the venous condition is deferred. Until there is a finding as to the compensability of that condition, the end date for temporary disability is not supported. As such, we will rescind the finding of the period of temporary disability so that the WCJ can make a finding of maximum medical improvement and develop the record for the venous condition.

QME Poli’s detailed medical findings and causation opinions based on examination and diagnostic tests.

Favours Applicant prevailed

Supported injury findings to multiple body parts and rejection of defendant’s challenge to medical evidence.

From the decision · page 7it is well-established that the relevant and considered opinion of one physician may constitute substantial evidence, even if inconsistent with other medical opinions in the record. (Place v. Workmen’s Comp. Appeals Bd. (1970) 3 Cal.3d 372, 378-379 [35 Cal.Comp.Cases 525].) Additionally, in Dr. Poli’s supplemental report and following review of diagnostics, applicant’s condition showed objective orthopedic findings including multilevel intervertebral disc protrusions lumbar spine; bilateral facet joint arthropathy, lumbar; osteoarthritis of both knees; arthritic changes in the right foot; tendinosis, tear of anterior glenoid labrum right, and impingement of the right shoulder; tendinosis left shoulder, osteoarthritis right hand; osteoarthritis left hand. (Applicant’s Exhibit 17.) Dr. Poli does not qualify any of these findings as contingent on knowledge of whether there is a venous condition.

Lack of maximum medical improvement finding and deferred venous condition issue.

Favours Defendant prevailed

Led to rescission of temporary disability period and deferral of that issue.

From the decision · page 9that an orthopedist should evaluate applicant’s knees with the possible need for surgery. This would indicate that applicant is not at maximum medical improvement at either the time of the report or at the time of the PTP report. Further, though the psyche QME did not conclude that applicant was temporary totally disabled, she also did not find him at MMI. The psyche treater did opine that applicant was temporarily disabled at least through September 2024. Finally, the issue of injury in the form of the venous condition is deferred. Until there is a finding as to the compensability of that condition, the end date for temporary disability is not supported. As such, we will rescind the finding of the period of temporary disability so that the WCJ can make a finding of maximum medical improvement and develop the record for the venous condition.

Found strain/sprain of lumbar spine, chondromalacia knees, plantar fasciitis, tendinosis shoulders, sleep disorder; injuries to multiple body parts caused by work; not at MMI; recommended additional panels in internal medicine and psychology; later confirmed injuries and causation with objective orthopedic findings; deferred opinion on venous condition; recommended orthopedist consultation for treatment.

Provided detailed medical findings and causation opinions based on examination and diagnostic tests; clarified role of orthopedist as treatment consultant, not additional panel.

From the decision · page 2Poli on December 13, 2022. (Applicant’s Exhibit 1.) He was diagnosed with strain/sprain of lumbar spine, chondromalacia right and left knees, bilateral plantar fasciitis, tendinosis right and left shoulders, and sleep disorder. (Id. at p. 8.) Dr. Poli concluded that the lower back and upper and lower extremities demonstrated signs of injury, while the cervical spine was normal. (Id. at p. 8.) He noted that the medical records he reviewed showed foot and knee complaints dating back to 2016 which were consistent with the type of work activities applicant was performing. The upper extremities and low back sustained a type of trauma that would be industrially related. (Id. at p. 9.) He concluded that applicant was not at maximum

Diagnosed hypertension related to medication use, stress, and chronic pain; not at MMI; no work restrictions needed on internal basis.

Provided medical opinion on internal medicine issues supporting injury findings; not at MMI.

From the decision · page 411.) He continued on to clarify that, “his injuries to the bilateral feet, bilateral knees, thoraco-lumbar spine, bilateral shoulders and bilateral hands were caused and arose as a result of his work at T Boyer Company with a preponderance of medical certainty.” (Id. at p. 12.) Dr. Poli adjusted the impairment ratings in accordance with the newly provided evidence and provided an analysis pursuant to the Kite case. Applicant was seen by Jonathan C. Ellis, M.D., on December 13, 2023 for an internal QME evaluation. (Applicant’s Exhibit 22.) Applicant was diagnosed with hypertension with noticeable increase after 2016, which Dr.

Found psychiatric injury due to physical injuries; not temporarily totally disabled from psychological perspective; not at MMI.

Psychological evaluation supported injury to psyche; no MMI found.

From the decision · page 411.) He continued on to clarify that, “his injuries to the bilateral feet, bilateral knees, thoraco-lumbar spine, bilateral shoulders and bilateral hands were caused and arose as a result of his work at T Boyer Company with a preponderance of medical certainty.” (Id. at p. 12.) Dr. Poli adjusted the impairment ratings in accordance with the newly provided evidence and provided an analysis pursuant to the Kite case. Applicant was seen by Jonathan C. Ellis, M.D., on December 13, 2023 for an internal QME evaluation. (Applicant’s Exhibit 22.) Applicant was diagnosed with hypertension with noticeable increase after 2016, which Dr.

E.L. Yeager Construction v. Workers’ Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922

Medical opinion must be based on reasonable medical probability, not speculative, and supported by pertinent facts and adequate examination.

WCAB found QME opinions met this standard and constituted substantial evidence.

From the decision · page 6Defendant contends that the record is incomplete without a determination as to whether applicant’s venous condition is industrially caused and whether the condition is causing the issues in the alleged body parts, particularly the lower extremities. For the reasons stated in the WCJ’s Report, we agree with the WCJ that the opinion of the QME is substantial medical evidence upon which the WCJ properly relied. To be considered substantial evidence, a medical opinion “must be predicated on reasonable medical probability.” (E.L. Yeager Construction v. Workers’ Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; McAllister v. Workmen’s Comp. Appeals Bd. (1968) 69 Cal.2d 408, 413, 416–17, 419 [33 Cal.Comp.Cases 660].) A physician’s report must also 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. (Gatten, supra, 145 Cal.App.4th at 928 [71 Cal.Comp.Cases 1687]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 612 (Appeals Board en banc).) We observe, moreover,

Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604

A physician’s report must set forth reasoning in support of conclusions to be substantial evidence.

WCAB relied on detailed medical findings and reasoning in QME reports.

From the decision · page 6Defendant contends that the record is incomplete without a determination as to whether applicant’s venous condition is industrially caused and whether the condition is causing the issues in the alleged body parts, particularly the lower extremities. For the reasons stated in the WCJ’s Report, we agree with the WCJ that the opinion of the QME is substantial medical evidence upon which the WCJ properly relied. To be considered substantial evidence, a medical opinion “must be predicated on reasonable medical probability.” (E.L. Yeager Construction v. Workers’ Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; McAllister v. Workmen’s Comp. Appeals Bd. (1968) 69 Cal.2d 408, 413, 416–17, 419 [33 Cal.Comp.Cases 660].) A physician’s report must also 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. (Gatten, supra, 145 Cal.App.4th at 928 [71 Cal.Comp.Cases 1687]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 612 (Appeals Board en banc).) We observe, moreover,

Place v. Workmen’s Comp. Appeals Bd. (1970) 3 Cal.3d 372

Relevant and considered opinion of one physician may constitute substantial evidence even if inconsistent with others.

WCAB credited QME Poli’s opinion despite other medical opinions.

Additional panel in different specialty requires good cause under Cal. Code Regs., tit. 8, §31.7.

Denied additional orthopedic panel request; granted additional general vascular panel.

From the decision · page 10Here, the chiropractic specialty is an orthopedic specialty. Dr. Poli issued opinions for all disputed medical issues including causation, body parts injured, apportionment, impairment. Defendant points to Dr. Poli’s deposition as an indication that Dr. Poli is deferring to an orthopedist. However, Dr. Poli clarified that the only reason for an orthopedist to become involved in this matter is to provide an expert opinion as to medical treatment. This does not warrant an additional panel, but rather a consultation at best, or a secondary orthopedic treater at worst. Defendant has made it known that their preference is to replace Dr. Poli, and the additional panel in orthopedics is an attempt to backdoor a replacement panel in a different specialty. First, a prior request to replace Dr. Poli was denied following a trial on the matter in 2023. A party may submit a written request for a replacement QME panel in another specialty to the Medical Director on the basis that the chosen specialty "is medically or otherwise inappropriate for the disputed medical issue(s)" pursuant to AD Rule 31.5(a)(10). (Cal. Code Regs., tit.

Objective orthopedic findings including multilevel intervertebral disc protrusions, facet joint arthropathy, osteoarthritis, tendinosis, and labrum tear.

From the decision · page 7it is well-established that the relevant and considered opinion of one physician may constitute substantial evidence, even if inconsistent with other medical opinions in the record. (Place v. Workmen’s Comp. Appeals Bd. (1970) 3 Cal.3d 372, 378-379 [35 Cal.Comp.Cases 525].) Additionally, in Dr. Poli’s supplemental report and following review of diagnostics, applicant’s condition showed objective orthopedic findings including multilevel intervertebral disc protrusions lumbar spine; bilateral facet joint arthropathy, lumbar; osteoarthritis of both knees; arthritic changes in the right foot; tendinosis, tear of anterior glenoid labrum right, and impingement of the right shoulder; tendinosis left shoulder, osteoarthritis right hand; osteoarthritis left hand. (Applicant’s Exhibit 17.) Dr. Poli does not qualify any of these findings as contingent on knowledge of whether there is a venous condition.

Credibility of QME and PTP medical opinions as substantial evidence supporting injury findings.

From the decision · page 6Defendant contends that the record is incomplete without a determination as to whether applicant’s venous condition is industrially caused and whether the condition is causing the issues in the alleged body parts, particularly the lower extremities. For the reasons stated in the WCJ’s Report, we agree with the WCJ that the opinion of the QME is substantial medical evidence upon which the WCJ properly relied. To be considered substantial evidence, a medical opinion “must be predicated on reasonable medical probability.” (E.L. Yeager Construction v. Workers’ Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; McAllister v. Workmen’s Comp. Appeals Bd. (1968) 69 Cal.2d 408, 413, 416–17, 419 [33 Cal.Comp.Cases 660].) A physician’s report must also 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. (Gatten, supra, 145 Cal.App.4th at 928 [71 Cal.Comp.Cases 1687]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 612 (Appeals Board en banc).) We observe, moreover,