ADJ2937484 — California WCAB decision

What the panel ordered

Petition for Reconsideration granted; matter set for status conference; final decision after reconsideration deferredp. 10

Applicant petitioned for reconsideration and/or removal of WCJ's Findings of Fact and Award issued September 11, 2023

Read the official decision →

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.

Reconsideration / removalApplicant prevailed

Preliminary review indicates possible need for further development of the record regarding medical causation and permanent disability rating

From the decision · page 10IT IS ORDERED that applicant’s Petition for Reconsideration of the Findings of Fact and Award issued on September 11, 2023 by a workers’ compensation administrative law judge is GRANTED.

The facts that decided it

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

WCJ's decision found industrial injuries to multiple body parts but applicant contends additional QME evaluations are needed for proper permanent disability rating

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.

AMENot reached · pulmonary

Changed opinion from non-industrial to industrial causation of liver injury between 2008 and 2021 reports; recommended additional QME evaluations in rheumatology, otolaryngology, and gastroenterology

Opinion referenced in petition for reconsideration

From the decision · page 2In support of his assertions, petitioner notes that “as recently as 2021” Agreed Medical Examiner (AME) Edward O’Neill opined that the applicant should be evaluated by both a QME in Rheumatology, Otolaryngologist, and Gastroenterologist.

PTPNot reached

Determined applicant to be totally permanently disabled

Opinion referenced in petition for reconsideration

From the decision · page 11. Applicant has been determined to be totally Permanently Disabled by his Primary Treating Physician, Dr. Robert Franco.

AMENot reached · pulmonary

Opined it was medically improbable that applicant has occupationally related liver disease

Opinion referenced in panel's preliminary review

From the decision · page 3With respect to the issue of causation of applicant’s liver disease, the Agreed Medical Examiner for applicant’s pulmonary issues, Gerald Levine, M.D., opined in his May 2, 2011 reporting, that it was “medically improbable that he has occupationally related liver disease”. (Ex. A, Report of Gerald Levine, M.D., May 2, 2011, p. 22).

QMENot reached · rheumatology

Found industrial causation for applicant's rheumatological system and nasal system

Opinion referenced in petition for reconsideration

From the decision · page 3Further, QME Andrew Berman finds applicant’s nasal condition industrial (Ex. 37, Report of Andrew Berman, March 17, 2023, p. 2).

otherNot reached

Would defer to a cardiology QME on the issue of injury to the heart

Opinion stated in deposition testimony

From the decision · page 3Dr. Renee Rinaldi, in her deposition taken on January 17, 2023, indicated that she would defer to a cardiology Qualified Medical Evaluator (QME) on the issue of injury to the heart. (Ex. 8, Deposition of Renee Rinaldi, M.D. January 17, 2023, pg. 8, lines 6-9).

The rules the panel named

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

Lab. Code, § 5903, 5952(d); Lamb v. Workmen’s Comp. Appeals Bd. (1974) 11 Cal.3d 274

Decisions by the Appeals Board must be supported by substantial evidence

Applied to determine whether existing record is sufficient to support WCJ's decision

From the decision · page 5It is well established that decisions by the 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) 3 Cal.3d 312 [35 Cal.Comp.Cases 500]; LeVesque v. Workmen’s Comp. Appeals Bd.

E.L. Yeager Construction v. Workers’ Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604

Medical opinion must be framed in terms of reasonable medical probability, based on adequate examination and history, not speculative, and must set forth reasoning

Applied to evaluate adequacy of medical evidence in the record

From the decision · page 6Medical evidence is required if there is an issue regarding the compensability of the claim. (Lab. Code, § 4060(c)(d), 4061(i), 4062.3(l).) A medical opinion must be framed in terms of reasonable medical probability, it must be based on an adequate examination and history, it must not be speculative, and it must set forth reasoning to support the

Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473

Decisions must be based on admitted evidence in the record; adequate and complete record is necessary

Applied to assess whether record is sufficient for decision

From the decision · page 6Further, decisions of the Appeals Board “must be based on admitted evidence in the record.” ( Hamilton v. Lockheed Corporation ( Hamilton ) (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Board en banc).) An adequate and complete record is necessary to understand the basis for the WCJ’s decision. (Lab. Code, § 5313; see also Cal. Code Regs., tit.

ADJ2937484 · November 27, 2023

What the panel ordered

What was disputed, and how it came out

The facts that decided it

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What the panel did with the medical opinions

The rules the panel named

What proof carried it

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