ADJ7172447 · October 1, 2026

The issue of additional permanent disability was deferred pending resolution of the combining or adding impairments issue.

From the decision · page 86. Applicant currently has permanent disability from this industrial injury of 76%. The issue of whether applicant’s injury caused additional permanent disability is deferred. ***

The WCAB deferred the issue of combining or adding impairments for further evidentiary development to address the impact on activities of daily living (ADLs) as required by Vigil. The current record was incomplete, particularly regarding AME Dr. Mehtani's analysis.

From the decision · page 7XIV, § 4 [The system of workers’ compensation “shall accomplish substantial justice in all cases expeditiously, inexpensively, and without incumbrance of any character; all of which matters are expressly declared to be the social public policy of this State.”].) Pursuant to sections 5701 and 5906, a WCJ or the Appeals Board may not leave undeveloped issues that, through the exercise of its specialized knowledge, recognizes as requiring further evidentiary development. (Kuykendall, supra, 79 Cal.App.4th at p. 404.) Following our independent review of the record, we believe that the medical-legal opinion of AME Dr. Mehtani mandating addition requires development to address our holdings in Vigil. AME Dr. Mehtani did not address how applicant’s permanent disabilities affected his ADLs and, if there is any overlap, does not discuss how they amplify the effect on the overlapping ADLs. 7

AME Dr. Mehtani opined that psychiatric and physical impairments do not significantly overlap and that adding impairments is more accurate than combining via CVC.

Favours Applicant prevailed

This opinion supports applicant's contention but was not fully developed regarding ADLs impact, leading to deferral for further development.

From the decision · page 5H), he diagnosed applicant with post-traumatic stress disorder with recurrent moderate anxiety (Id. at p. 40) with global assessment functioning at 55 or 23% whole person impairment with 3% added for chronic low grade persistent pain. (Id. at p. 56.) AME Dr. Mehtani found no basis for apportionment. (Id. at pp. 52-53.) This resulted in a permanent disability rating string as follows: PSYCHIATRIC – MENTAL AND BEHAVIORIAL 100% (14.01.00.00 - 26 - [8]36 - 490J - 48 - 44%) 44% (with 3% add-on for pain) With respect to aggregation of the permanent disabilities amongst the various body systems, AME Dr. Mehtani, in his report dated March 19, 2019, wrote that the 26% whole person impairment was “in addition to any degree of disability given to by the other specialists including internal medicine specialist, pulmonologist, ENT physician, and sleep specialist.” (Id. at p. 57.) However, in his supplemental report dated August 27, 2019, (Def. Ex. G), AME Dr. Mehtani wrote as follows: As you recall I stated in my deposition done in my office on July 17, 2019 that I would like to review the QME report from plastic and reconstructive surgery, Dr. Robert

The medical evidence did not address the impact of impairments on activities of daily living as required by the Vigil decision.

Favours neutral

Lack of this analysis led the Board to defer the issue of combining or adding impairments for further evidentiary development.

From the decision · page 7XIV, § 4 [The system of workers’ compensation “shall accomplish substantial justice in all cases expeditiously, inexpensively, and without incumbrance of any character; all of which matters are expressly declared to be the social public policy of this State.”].) Pursuant to sections 5701 and 5906, a WCJ or the Appeals Board may not leave undeveloped issues that, through the exercise of its specialized knowledge, recognizes as requiring further evidentiary development. (Kuykendall, supra, 79 Cal.App.4th at p. 404.) Following our independent review of the record, we believe that the medical-legal opinion of AME Dr. Mehtani mandating addition requires development to address our holdings in Vigil. AME Dr. Mehtani did not address how applicant’s permanent disabilities affected his ADLs and, if there is any overlap, does not discuss how they amplify the effect on the overlapping ADLs. 7

Diagnosed industrial postnasal drip with intermittent hoarseness; found 2% whole person impairment for speech impairment.

Provided impairment rating for voice/speech related to injury.

From the decision · page 5Applicant was evaluated by AME Dr. Schindler, an otolaryngologist, and, in his report dated December 1, 2011, he diagnosed applicant with industrially caused postnasal drip with intermittent hoarseness directly related to his injury and found 2% whole person impairment based on Table 11- 9, on page 265, based on a 5% impairment of speech. (App. Ex. 7; Def. Ex. P, at p. 8.) This resulted in a permanent disability rating string as follows: VOICE/SPEECH 100% (11.03.04.00 - 2 - [2]2 - 490I - 4 - 3%) 3% Applicant was evaluated by QME Dr. Harvey, a plastic surgeon, and, in his report dated November 19, 2019, he diagnosed applicant with burns requiring skin grafts resulting in pigment changes. (App. Ex. 5; Def. Ex. E, at p. 3.) QME Dr. Harvey found 15% whole person impairment based on Class II, Table 8-2, on page 178, (Id. at p. 8), due to the skin grafts and intermittent need for moisturizers. (Id. at p.

Diagnosed PTSD with moderate anxiety and 26% whole person impairment plus 3% for chronic pain; found no apportionment; opined adding impairments is more accurate than combining via CVC due to lack of significant overlap between psychiatric and physical impairments.

AME Dr. Mehtani provided detailed reasoning that psychiatric and physical impairments do not significantly overlap and that adding impairments better reflects overall disability, but did not address impact on ADLs as required by Vigil, leading to deferral for further development.

From the decision · page 5H), he diagnosed applicant with post-traumatic stress disorder with recurrent moderate anxiety (Id. at p. 40) with global assessment functioning at 55 or 23% whole person impairment with 3% added for chronic low grade persistent pain. (Id. at p. 56.) AME Dr. Mehtani found no basis for apportionment. (Id. at pp. 52-53.) This resulted in a permanent disability rating string as follows: PSYCHIATRIC – MENTAL AND BEHAVIORIAL 100% (14.01.00.00 - 26 - [8]36 - 490J - 48 - 44%) 44% (with 3% add-on for pain) With respect to aggregation of the permanent disabilities amongst the various body systems, AME Dr. Mehtani, in his report dated March 19, 2019, wrote that the 26% whole person impairment was “in addition to any degree of disability given to by the other specialists including internal medicine specialist, pulmonologist, ENT physician, and sleep specialist.” (Id. at p. 57.) However, in his supplemental report dated August 27, 2019, (Def. Ex. G), AME Dr. Mehtani wrote as follows: As you recall I stated in my deposition done in my office on July 17, 2019 that I would like to review the QME report from plastic and reconstructive surgery, Dr. Robert

Diagnosed industrially aggravated left ventricular hypertrophy and obstructive sleep apnea; found 30% whole person impairment for heart and 5% for sleep apnea with 80% apportionment for sleep apnea to non-industrial factors.

Provided impairment ratings and apportionment for heart and sleep apnea.

From the decision · page 4Our en banc decision in Vigil issued on June 10, 2024, after our Opinion and Order Granting Petition for Reconsideration dated February 11, 2022, and is mandatory authority on all WCJs and WCAB panels. (Cal. Code Regs., tit. 8, § 10325(a); City of Long Beach v. Workers’ Comp. Appeals Bd. (Garcia) (2005) 126 Cal.App.4th 298, 316, fn. 5 [70 Cal.Comp.Cases 109]; Gee v. Workers’ Comp. Appeals Board (2002) 96 Cal.App.4th 1418, 1424, fn. 6 [67 Cal.Comp.Cases 236]; see also Govt. Code, § 11425.60(b).) Here, applicant was evaluated by QME Dr. Bellinger, an internist, and, in his report dated February 27, 2021 (App. Ex. 6; Def. Ex. A), he diagnosed applicant with industrially aggravated left ventricular hypertrophy and obstructive sleep apena (Id. at p. 19), and found 30% whole person impairment for the heart based on Class III, Table 4-2, on page 66 of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) due to applicant being asymptomatic and on a current anti-hypertensive medical regimen. (Id.

Diagnosed burns requiring skin grafts with pigment changes; found 15% whole person impairment for scars and skin grafts; found no apportionment to non-industrial factors.

Provided impairment rating for burns and scars; report reviewed by AME Mehtani for combining or adding impairments issue.

From the decision · page 5Applicant was evaluated by AME Dr. Schindler, an otolaryngologist, and, in his report dated December 1, 2011, he diagnosed applicant with industrially caused postnasal drip with intermittent hoarseness directly related to his injury and found 2% whole person impairment based on Table 11- 9, on page 265, based on a 5% impairment of speech. (App. Ex. 7; Def. Ex. P, at p. 8.) This resulted in a permanent disability rating string as follows: VOICE/SPEECH 100% (11.03.04.00 - 2 - [2]2 - 490I - 4 - 3%) 3% Applicant was evaluated by QME Dr. Harvey, a plastic surgeon, and, in his report dated November 19, 2019, he diagnosed applicant with burns requiring skin grafts resulting in pigment changes. (App. Ex. 5; Def. Ex. E, at p. 3.) QME Dr. Harvey found 15% whole person impairment based on Class II, Table 8-2, on page 178, (Id. at p. 8), due to the skin grafts and intermittent need for moisturizers. (Id. at p.

Department of Corrections and Rehabilitation v. Workers’ Comp. Appeals Bd. (Fitzpatrick) (2018) 27 Cal.App.5th 607

Permanent disability impairments are generally combined using the Combined Values Chart (CVC) but may be added if supported by substantial medical evidence showing more accurate rating.

The Board applied this standard to evaluate whether to combine or add impairments.

From the decision · page 3Appeals Bd. (Fitzpatrick) (2018) 27 Cal.App.5th 607 [83 Cal.Comp.Cases 1680], the Court of Appeal found that permanent disability impairments “are generally combined” using the CVC though the “scheduled rating [under the CVC] is not absolute” and other methodologies may be used to calculate permanent disability. (Id. at pp. 613-614.) Thus, while the scheduled rating is prima facie evidence of an injured employee’s permanent disability, the scheduled rating is rebuttable. (Almaraz v. Environmental Recovery Services/Guzman v. Milpitas Unified School Dist. (Almaraz-Guzman II) (2009) 74 Cal.Comp.Cases 1084, 1106 (Appeals Board en banc); see Blackledge v. Bank of America (2010) 75 Cal.Comp.Cases 613 (Appeals Board en banc); City of Sacramento v. Workers’ Comp. Appeals Bd. (Cannon) (2013) 222 Cal.App.4th 1360 [79 Cal.Comp.Cases 1].) The overarching goal of rating permanent impairment is to achieve accuracy.

Vigil v. County of Kern (2024) 89 Cal.Comp.Cases 686 (Appeals Board en banc)

An injured employee can rebut the CVC and add impairments if they establish the impact on activities of daily living (ADLs) and show no overlap or amplifying overlap of impairments.

The Board deferred the issue pending further evidence addressing ADLs impact as required by Vigil.

From the decision · page 3(Milpitas Unified School Dist. v. Workers’ Comp. Appeals Bd. (Almaraz-Guzman III) (2010) 187 Cal.App.4th 808, 822 [75 Cal.Comp.Cases 837].) For example, in Athens Administrators v. Workers’ Comp. Appeals. Bd. (Kite) (2013) Cal.Comp.Cases 213 (writ denied) (Kite), the Appeals Board concluded that impairments resulting from cumulative injury to the bilateral hips may be added where substantial medical evidence supports a physician’s opinion that adding impairments will result in a more accurate rating of the level of disability than the rating that results from using the CVC. (See also De La Cerda v. Martin Selko & Co. (2017) 83 Cal.Comp.Cases 567 (writ denied) (requires following a physician’s opinion as to the most accurate rating method if they provide a reasonably articulated medical basis for doing so and does not require use of the term “synergistic”).) In Vigil v. County of Kern (2024) 89 Cal.Comp.Cases 686 (Appeals Board en banc) (Vigil), the Appeals Board held that an injured employee can rebut the CVC in the PDRS and add impairments where they can establish the impact of each impairment on the activities of daily living (ADLs). In addition, they must show either (a) there is no overlap between the effects on ADLs 3

Applicant's medical evidence did not address impact on activities of daily living (ADLs) as required by Vigil decision, leading to deferral of combining or adding impairments issue.

From the decision · page 7XIV, § 4 [The system of workers’ compensation “shall accomplish substantial justice in all cases expeditiously, inexpensively, and without incumbrance of any character; all of which matters are expressly declared to be the social public policy of this State.”].) Pursuant to sections 5701 and 5906, a WCJ or the Appeals Board may not leave undeveloped issues that, through the exercise of its specialized knowledge, recognizes as requiring further evidentiary development. (Kuykendall, supra, 79 Cal.App.4th at p. 404.) Following our independent review of the record, we believe that the medical-legal opinion of AME Dr. Mehtani mandating addition requires development to address our holdings in Vigil. AME Dr. Mehtani did not address how applicant’s permanent disabilities affected his ADLs and, if there is any overlap, does not discuss how they amplify the effect on the overlapping ADLs. 7