ADJ8136297 · August 13, 2026

The WCAB deferred the issue of the occupational group code for further proceedings due to its integral role in calculating permanent disability.

The WCAB deferred the issue of permanent disability for further proceedings consistent with the reconsideration opinion.

The WCAB found that the medical evidence for psychiatric and sleep impairments was not substantial due to incomplete medical history review and lack of incorporation by the primary treating physician, and thus denied compensability for these injuries.

From the decision · page 113. applicant, while employed during the period of April 3, 2011 to December 11, 2011, at Santa Fe Springs, California, by Superior Grocer, whose workers’ compensation carrier was CIGA by its servicing facility Sedgwick for Ullico, now in liquidation, sustained injury to his bilateral hands and wrists. 4. Applicant has not sustained the burden of establishing injury to the psychiatric, sleep, or internal systems.

Applicant's medical history was incomplete and not fully disclosed to evaluating physicians.

Favours Defendant prevailed

This undermined the credibility and substantiality of medical evidence for psychiatric and sleep impairments, leading to denial of these injury claims.

From the decision · page 10additional medical records to the reporting physicians over the course of more than a decade of litigation, and that applicant’s trial testimony lacked credibility. Based on her review of the entire evidentiary record, the reports in evidence, and her assessment of witness credibility, the WCJ has concluded that development is neither appropriate nor necessary. When the WCJ’s findings are supported by solid, credible evidence, they are to be accorded great weight by the Board, and we should only reject them on the basis of contrary evidence of considerable substantiality. (Lamb v. Workers’ Comp. Appeals Bd. (1974) 11 Cal.3d 274 [39 Cal.Comp.Cases 310]; Bracken v. Workers’ Comp. Appeals Bd. (1989) 214 Cal.App.3d 246 [54 Cal.Comp.Cases 349].) We have reviewed the entire evidentiary record including applicant’s testimony over multiple days of trial, the reporting of the QME and applicant’s treating physicians, and the parties’ pleadings.

The medical reports of Drs. Nogales and Navab lacked review of relevant medical records and were not incorporated by the primary treating physician.

Favours Defendant prevailed

This led to the rejection of their reports as substantial evidence for psychiatric and sleep injuries.

From the decision · page 6Unfortunately, Dr. Nogales did not review any of Applicant’s medical records aside from the reports from Peter Hong D.C. From the evidence presented, it appears Applicant treated with Peter Hong D.C. as the Primary Treating Physician only for six months from February 13, 2012 to August 29, 2012 (Applicant’s Exhibit 19). At the bottom of page 11 from Dr. Nogale’s P&S report dated October 15, 2014, she stated:

Evaluated applicant's orthopedic injuries and provided substantial evidence supporting injury arising out of and in the course of employment, leading to awards of temporary and permanent partial disability.

The WCJ and WCAB relied on Dr. Saheb's orthopedic evaluations as substantial evidence for injury and disability.

From the decision · page 10additional medical records to the reporting physicians over the course of more than a decade of litigation, and that applicant’s trial testimony lacked credibility. Based on her review of the entire evidentiary record, the reports in evidence, and her assessment of witness credibility, the WCJ has concluded that development is neither appropriate nor necessary. When the WCJ’s findings are supported by solid, credible evidence, they are to be accorded great weight by the Board, and we should only reject them on the basis of contrary evidence of considerable substantiality. (Lamb v. Workers’ Comp. Appeals Bd. (1974) 11 Cal.3d 274 [39 Cal.Comp.Cases 310]; Bracken v. Workers’ Comp. Appeals Bd. (1989) 214 Cal.App.3d 246 [54 Cal.Comp.Cases 349].) We have reviewed the entire evidentiary record including applicant’s testimony over multiple days of trial, the reporting of the QME and applicant’s treating physicians, and the parties’ pleadings.

Provided reports on psychiatric injury and whole person impairment, but reports were not reviewed with complete medical history and were discounted as not substantial evidence.

Reports lacked review of relevant medical records and were not incorporated by the primary treating physician, leading to rejection of their evidentiary value.

From the decision · page 6Unfortunately, Dr. Nogales did not review any of Applicant’s medical records aside from the reports from Peter Hong D.C. From the evidence presented, it appears Applicant treated with Peter Hong D.C. as the Primary Treating Physician only for six months from February 13, 2012 to August 29, 2012 (Applicant’s Exhibit 19). At the bottom of page 11 from Dr. Nogale’s P&S report dated October 15, 2014, she stated:

Provided reports on sleep impairment but had inaccurate medical history and reports were not incorporated by primary treating physician or PQME, leading to rejection of credibility and evidentiary value.

Reports were not credible or based on substantial medical evidence due to inaccurate history and lack of incorporation as required by Labor Code §4605.

From the decision · page 8Additionally, Dr. Navab’s reports had inaccurate medical history. For example, in Dr. Terrence’s Psychological QME report from January 25, 2006, he noted that the applicant reported problems initiating and maintaining sleep. (Defendant Exhibit E, p. 22). Here, Dr. Navab said Applicant did not have any pre-existing condition, disease, symptoms, or impairment as it relates to sleep prior to this industrial injury (Applicant’s Exhibit 21, p.12-13). Moreover, Dr. Navab’s reports were not reviewed or incorporated by the PTP or the PQME per the requirements of Labor Code §4605. Accordingly, we did not find his reports to be credible or based on substantial medical evidence.

Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc)

A medical opinion must be framed in terms of reasonable medical probability, not speculative, based on pertinent facts and adequate examination, and set forth reasoning to constitute substantial evidence.

The WCJ and WCAB applied this standard to evaluate the medical opinions of Drs. Nogales and Navab and found them lacking substantial evidence due to incomplete record review and lack of incorporation.

From the decision · page 9The WCJ’s Report appropriately acknowledges that decisions of the Appeals Board must be supported by substantial evidence. To constitute substantial evidence “a medical opinion must 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.” (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc).) Not all expert medical opinion constitutes substantial evidence. (Hegglin v. Workmen’s Comp. Appeals Bd. (1971) 4 Cal.3d 162 [36 Cal.Comp.Cases 93, 97]; Place v. Workmen’s Comp. Appeals Bd. (1970) 3 Cal.3d 372, 378-379 [35 Cal.Comp.Cases 525].) To constitute substantial evidence, a medical opinion must be predicated on reasonable medical probability. (Escobedo, supra, at p.

Labor Code §§ 5701, 5906; Tyler v. Workers’ Comp. Appeals Bd. (1997) 56 Cal.App.4th 389, 394 [62 Cal.Comp.Cases 924]

The WCAB has discretionary authority to develop the record when the existing record is inadequate to support a final determination or to provide due process.

The WCJ exercised discretion to decline further development of the record, finding the existing record adequate and noting the applicant's failure to submit requested medical records over a decade of litigation.

From the decision · page 9611.) Medical opinion also fails to support the Board’s findings if it is based on surmise, speculation, conjecture, or guess.” (Hegglin, supra, 4 Cal.3d 162.) Whether a physician’s opinion constitutes substantial evidence “must be determined by the material facts upon which his opinion was based and by the reasons given for his opinion.” (Ibid.) The Workers’ Compensation Appeals Board has the discretionary authority to develop the record when the record does not contain substantial evidence or when appropriate to provide due process or fully adjudicate the issues. (Lab. Code, §§ 5701, 5906; Tyler v. Workers’ Comp. Appeals Bd.

Applicant's medical history was incomplete and not fully disclosed to evaluating physicians, undermining credibility of psychiatric and sleep injury claims.

From the decision · page 10additional medical records to the reporting physicians over the course of more than a decade of litigation, and that applicant’s trial testimony lacked credibility. Based on her review of the entire evidentiary record, the reports in evidence, and her assessment of witness credibility, the WCJ has concluded that development is neither appropriate nor necessary. When the WCJ’s findings are supported by solid, credible evidence, they are to be accorded great weight by the Board, and we should only reject them on the basis of contrary evidence of considerable substantiality. (Lamb v. Workers’ Comp. Appeals Bd. (1974) 11 Cal.3d 274 [39 Cal.Comp.Cases 310]; Bracken v. Workers’ Comp. Appeals Bd. (1989) 214 Cal.App.3d 246 [54 Cal.Comp.Cases 349].) We have reviewed the entire evidentiary record including applicant’s testimony over multiple days of trial, the reporting of the QME and applicant’s treating physicians, and the parties’ pleadings.

Applicant's treating physicians in psychology and sleep medicine did not have complete medical records, leading to rejection of their reports as substantial evidence.

From the decision · page 6Unfortunately, Dr. Nogales did not review any of Applicant’s medical records aside from the reports from Peter Hong D.C. From the evidence presented, it appears Applicant treated with Peter Hong D.C. as the Primary Treating Physician only for six months from February 13, 2012 to August 29, 2012 (Applicant’s Exhibit 19). At the bottom of page 11 from Dr. Nogale’s P&S report dated October 15, 2014, she stated: