ADJ18042476 · August 10, 2026

The WCJ's original permanent disability rating and occupational group number were rescinded due to insufficient explanation for the Almaraz/Guzman rating and incomplete evidence on occupational group; the matter was returned for further development of the record.

From the decision · page 12He estimates that he lifted consistently all day, especially while working in the warehouse.” (MOH, p. 5, lines 23-25.) Accordingly, we will grant applicant’s Petition, rescind the May 14, 2026 F&A and substitute a new F&A that defers the issues of permanent disability and occupational group number and return the matter for further proceedings consistent with this opinion. For the foregoing reasons, IT IS ORDERED that applicant’s Petition for Reconsideration of the Findings of Fact and Award issued by the WCJ on May 14, 2026 is GRANTED. IT IS FURTHER ORDERED as the Decision After Reconsideration of the Workers’ Compensation Appeals Board that the May 14, 2026 Findings of Fact and Award is RESCINDED and the following is SUBSTITUTED therefor:

The QME's explanation for using the Almaraz/Guzman rating was insufficient to meet the standard for substantial medical evidence.

Favours Applicant prevailed

This led to deferral of the permanent disability rating issue and further development of the record.

From the decision · page 11Dr. Smolins’ conclusion that the deficits in activities of daily living were not fairly represented by an 8 percent whole person impairment, and that they more accurately corresponded with a 15 percent impairment. The QME’s supplemental report of November 23, 2025 examined activities of daily living for the purpose of establishing overlap and amplification to justify adding disabilities instead of combining them on the combined values chart in the PDRS, but the report did not provide any additional information to explain why using the hernia table to assess 15 percent whole person impairment is more accurate than using the lumbar spine diagnosis-related estimate of 8 percent. (Joint Exhibit 6, pp. 1-2.) Unfortunately, the deposition of the QME added very little to answer these questions. Dr. Smolins noted that his worksheet listing activities of daily living included limitations on lifting and carrying, and Class 2 of Table 6-9 prescribes a range of impairment for “frequent discomfort, precluding heavy lifting, but not hindering some activities of daily living.” (Joint Exhibit 1, p. 7, lines 14-17.) The QME also agreed with a leading question that those ADL deficits are not accounted for or captured in the lumbar diagnosis-related estimate (DRE) category II, but he did not explain why. (Id. p.

The evidence on the occupational group number was incomplete and inconsistent, requiring further development.

Favours Applicant prevailed

This led to deferral of the occupational group number issue and further proceedings.

From the decision · page 12This development of the record will also afford the WCJ the opportunity to consider further the issue of applicant’s occupational group number. The group number selected by the WCJ, 360, appears to be a compromise between the number requested by defendant, 214, and the number requested by applicant, 470. While group number 360 may indeed be the best reflection of applicant’s actual job duties, the WCJ may want to take this opportunity to develop the record to address deficits in the evidence that was offered by both sides on this issue, as noted in her Report. Defendant’s list of job duties is not comprehensive, offering a list of just “some” of the essential job functions for all personnel. Applicant’s trial testimony is likewise problematic, based on an imperfect recollection. We note that applicant’s testimony at trial does provide some guidance as to the weight associated with lifting while working in the warehouse, because he testified that he “lifted boxes weighing between 25 to 75 pounds every day.

Assessed permanent impairment of lumbar spine and shoulders using AMA Guides; proposed an 8% whole person impairment under DRE Lumbar Category II and an alternative 15% impairment using Almaraz/Guzman rating based on activities of daily living limitations; recommended adding impairments for back and shoulders due to overlap and amplification of effects on ADLs.

The QME's opinion on the Almaraz/Guzman rating was central to the dispute over the permanent disability rating and occupational group number, but the WCJ found the explanation insufficient, leading to deferral and further development.

From the decision · page 2On April 28, 2026, the parties proceeded to trial. Issues submitted for decision included permanent disability, apportionment, and occupational group number, with applicant claiming that the occupational group number is 470, and the employer claiming the group number is 214. (Minutes of Hearing and Summary of Evidence, April 28, 2026 (MOH) p. 2, lines 21-25.) The parties stipulated that applicant sustained an industrial injury to the low back and shoulders on April 14, 2023. (Id. at p. 2, lines 5-7.) The parties both relied upon the medical expert opinions of Qualified Medical Evaluator (QME) David Smolins, M.D. (Joint Exhibits 1- 6). In his report dated September 26, 2025, the QME found that applicant had reached maximal medical improvement. Dr. Smolins assessed percentages of permanent impairment for the low back and shoulders using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides, or Guides). His assessment of impairment of the lumbar spine is as follows: Utilizing the AMA Guides 2001, Fifth Edition, chapter 15, page 384, table 15-3, he falls into DRE Lumbar Category II with an 8% whole person impairment… …As per the Almaraz-Guzman decision, one may analogize to a separate corner of the Guides. the applicant is found to have an 8% whole person impairment for the lumbar spine as per the strict rating.

Almaraz/Guzman (2010) 187 Cal.App.4th 808

An employee's impairment may be determined by reference to any applicable portion of the AMA Guides, including discretionary use to achieve a more accurate assessment (Almaraz/Guzman).

The QME was permitted to use Table 6-9 of the AMA Guides as an alternative method to assess impairment, but the explanation must be substantial evidence.

From the decision · page 9Applicant contends that the WCJ erred by not using the QME’s “Almaraz/Guzman” rating. Applicant further contends that the WCJ incorrectly found that his occupational group number in the PDRS is 360, and not 470. An “Almaraz/Guzman” rating refers to a rating fashioned by a physician using material found within the AMA Guides in a discretionary manner that deviates from its exact instructions in order to achieve a more accurate assessment of impairment. (Almaraz/Guzman, supra, 187 Cal.App.4th 808.) The court held that (1) an employee's impairment may be determined by reference to any applicable portion of the AMA Guides, and (2) this determination may be used to rebut the rating of permanent disability established by the PDRS. The court reasoned that the language of section 4660 permits reliance on the entire AMA Guides in deriving an impairment rating in a particular case, and Chapters 1 and 2 of the AMA Guides provide instructions that permit a physician to use clinical judgment in deciding how to apply the remaining chapters. (Id. at p.

Labor Code §§ 5903, 5952(d)

All decisions must be supported by substantial evidence; medical opinions must provide reasoning, not just conclusions.

The QME's opinion lacked sufficient explanation to constitute substantial evidence, requiring further development of the record.

From the decision · page 10All decisions of the Workers’ Compensation 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) 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].) We have previously held en banc that “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.” (Escobedo v. Marshalls (2007) 70 Cal.Comp.Cases 604, 620, citing Hegglin v. Workmen’s Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93]; Place v. Workmen’s Comp. Appeals Bd. (1970) 3 Cal.3d 372, 378-379 [35 Cal.Comp.Cases 525]; Zemke v. Workmen’s Comp. Appeals Bd.

Applicant's limitations in activities of daily living were noted but not fully accounted for in the strict AMA Guides lumbar spine impairment rating.

From the decision · page 11Dr. Smolins’ conclusion that the deficits in activities of daily living were not fairly represented by an 8 percent whole person impairment, and that they more accurately corresponded with a 15 percent impairment. The QME’s supplemental report of November 23, 2025 examined activities of daily living for the purpose of establishing overlap and amplification to justify adding disabilities instead of combining them on the combined values chart in the PDRS, but the report did not provide any additional information to explain why using the hernia table to assess 15 percent whole person impairment is more accurate than using the lumbar spine diagnosis-related estimate of 8 percent. (Joint Exhibit 6, pp. 1-2.) Unfortunately, the deposition of the QME added very little to answer these questions. Dr. Smolins noted that his worksheet listing activities of daily living included limitations on lifting and carrying, and Class 2 of Table 6-9 prescribes a range of impairment for “frequent discomfort, precluding heavy lifting, but not hindering some activities of daily living.” (Joint Exhibit 1, p. 7, lines 14-17.) The QME also agreed with a leading question that those ADL deficits are not accounted for or captured in the lumbar diagnosis-related estimate (DRE) category II, but he did not explain why. (Id. p.