ADJ19575878 — California WCAB decision

What the panel ordered

The Appeals Board granted defendant's Petition for Reconsideration, rescinded the September 9, 2025 Findings and Award, and returned the case to the trial level for further proceedings consistent with the opinion.

Defendant filed a Petition for Reconsideration of the Findings and Award issued on September 9, 2025; the WCJ's Report recommended denial of the Petition; the Appeals Board granted reconsideration, rescinded the Findings and Award, and returned the case to the WCJ for further proceedings.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.

Cumulative traumaRemandedleft shoulder

The Appeals Board found the medical evidence insufficient and not substantial to support the WCJ's findings on cumulative injury and date of injury, requiring further development of the record and updated expert medical opinion.

From the decision · page 1Defendant filed a Petition for Reconsideration (Petition) of the Findings and Award (F&A) issued on September 9, 2025, wherein the workers' compensation administrative law judge (WCJ) found in pertinent part that applicant, while employed by defendant during the cumulative period ending July 2024, sustained injury arising out of and in the course of his employment to the left shoulder and deferred findings as to additional body parts; that the date of injury pursuant to Labor Code section 5412 was the date of the agreed medical evaluator (AME)'s report; and that the left shoulder injury resulted in temporary disability.1

The facts that decided it

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

AME Dr. Aval's opinions were based on speculation and missing medical records, making them insufficient to support injury causation and date of injury findings.

Favours Defendant prevailed

The Board rejected the AME's opinions as not substantial evidence, leading to the remand for further development.

From the decision · page 9AME Dr. Aval stated "the job duties the patient describes having performed... since 2010 are considered a viable mechanism of cumulative trauma injury to result in injury to [applicant's shoulders]," and that the doctor needed to review "additional medical records, including all records related to the treatment the patient required at the times of the respective industrial injuries." (Joint Exhibit 102, page 36, emphasis added.) In his supplemental report, Dr. Aval confirmed none "of the old records have been provided." (Joint Exhibit 101, page 6.)

Applicant's treating physician Dr. Lee's reports did not discuss causation or explain how the injury occurred, thus not substantial evidence for injury causation.

Favours Defendant prevailed

The lack of causation discussion in Dr. Lee's reports contributed to the rejection of evidence supporting injury causation.

From the decision · page 9Although the treating physicians maintain that applicant was temporarily totally disabled based on a July 1, 2024 date of injury, none of the reports discuss causation nor explain how the injury occurred and are therefore not substantial evidence on the issue. (Exhibits 1 through 4, and 6 through 10.)

Applicant testified about physically taxing work activities causing pain and strain to the left shoulder, supporting the claim of injury.

Favours Applicant prevailed

Applicant's testimony supported the claim of injury but was not a substitute for expert medical opinion.

From the decision · page 5Applicant testified he last worked at defendant CarMax on July 1, 2024, when someone from human resources called and said his disability could not be accommodated. Probably the most difficult thing for his left shoulder was putting on the wheels and taking them off. It was very heavy, put a strain, and was somewhat painful. His left shoulder surgery was approved in April 2025. (MOH, July 22, 2025, page 5, lines 9-12, 15-17, and 21-22.) He started working at CarMax on March 23, 2010. He had the same job duties through when he stopped working there. When he last worked in July 2024, he had been back to work in the last week of June and worked for five days that week. He was off consistently from February 28, 2023, for a right shoulder injury. He also had a prior left shoulder injury on April 11, 2018. (MOH, July 22, 2025, page 6, lines 11-14 and 18-22.) When applicant last worked, he was doing his regular activities. He feels that the work he was doing aggravated his left shoulder condition. (MOH, July 22, 2025, page 7, lines 6-8.)

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.

AMERejected · orthopedic

Dr. Aval opined that the job duties since 2010 were a viable mechanism for cumulative trauma injury to multiple body parts including shoulders, but he needed additional medical records to address apportionment and causation more definitively. His opinions were found to be based on speculation due to missing records and thus not substantial evidence.

The Appeals Board found Dr. Aval's opinions speculative and lacking necessary medical history, making them insufficient to support findings on injury causation and date of injury.

From the decision · page 9AME Dr. Aval stated "the job duties the patient describes having performed... since 2010 are considered a viable mechanism of cumulative trauma injury to result in injury to [applicant's shoulders]," and that the doctor needed to review "additional medical records, including all records related to the treatment the patient required at the times of the respective industrial injuries." (Joint Exhibit 102, page 36, emphasis added.) In his supplemental report, Dr. Aval confirmed none "of the old records have been provided." (Joint Exhibit 101, page 6.)

PTPNot substantial evidence · orthopedic

Dr. Lee found applicant temporarily totally disabled for the July 1, 2014 date of injury but did not discuss causation in his reports, which were not substantial evidence on injury causation.

Dr. Lee's reports did not discuss causation or explain how the injury occurred, thus not substantial evidence for injury causation.

From the decision · page 9Although the treating physicians maintain that applicant was temporarily totally disabled based on a July 1, 2024 date of injury, none of the reports discuss causation nor explain how the injury occurred and are therefore not substantial evidence on the issue. (Exhibits 1 through 4, and 6 through 10.)

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Labor Code sections 5903, 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274; Garza v. Workmen's Comp. Appeals Bd.

A decision must be based on admitted evidence in the record and must be supported by substantial evidence.

The Appeals Board emphasized the need for substantial evidence to support findings, particularly medical evidence for injury causation.

From the decision · page 8B. In the F&A, the WCJ found that applicant sustained injury to the left shoulder and referenced the parties' stipulation to injury that did not include a body part injured. The WCJ explained the applicant "testified in detail only as to injury of the left shoulder, describing tasks involving the removal and reinstallation of heavy wheels as the most physically taxing, with associated pain and strain." (Opinion on Decision, page 3.) A decision must be based on admitted evidence in the record and must be supported by substantial evidence. (Lab. Code, § 5903, 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274, 281 [39 Cal.Comp.Cases 310]; Garza v. Workmen's Comp. Appeals Bd.

McAllister v. Workers' Comp. Appeals Bd. (1968) 69 Cal.2d 408

Medical evidence that industrial injury was reasonably probable constitutes substantial evidence for finding injury AOE/COE.

The Board cited this case to explain the standard for medical evidence supporting injury causation.

From the decision · page 9Medical evidence that industrial injury was reasonably probable, although not certain, constitutes substantial evidence for finding injury AOE/COE. (McAllister v. Workers' Comp. Appeals Bd. (1968) 69 Cal.2d 408, 417 [33 Cal.Comp.Cases 660].) Although the factual issue of the occurrence of the alleged incident is a determination for the WCJ, the issue of injury is a medical determination, which requires expert medical opinion.

Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162

Medical reports and opinions are not substantial evidence if based on erroneous facts, inadequate histories, or incorrect legal theories.

The Board rejected medical opinions that were speculative or based on inadequate medical history.

From the decision · page 9"Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories. Medical opinion also fails to support the Board's findings if it is based on surmise, speculation, conjecture or guess." (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93].

McClune v. Workers' Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117

The WCJ and Appeals Board have a duty to further develop the record where there is insufficient evidence on an issue.

The Board ordered further development of the record due to insufficient evidence.

From the decision · page 11The WCJ and the Appeals Board have a duty to further develop the record where there is insufficient evidence on an issue. (McClune v. Workers' Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117, 1121-1122 [63 Cal.Comp.Cases 261].) The Appeals Board has a constitutional mandate to "ensure substantial justice in all cases." (Kuykendall v. Workers' Comp. Appeals Bd. (2000) 79 Cal.App.4th 396, 403 [65 Cal.Comp.Cases 264].) The Board may not leave matters undeveloped where it is clear that additional discovery is needed. (Id. at p. 404.) The preferred procedure is to allow supplementation of the medical record by the physicians who have already reported in the case. (McDuffie v. Los Angeles County Metropolitan Transit Authority (2003) 67 Cal.Comp.Cases 138, 142 (Appeals Board en banc).)

ADJ19575878 · December 16, 2025

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

What the panel did with the medical opinions

The rules the panel named

What proof carried it

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