ADJ8427517 · July 15, 2026

The WCJ found applicant was not entitled to an additional or replacement QME in internal medicine, but the Appeals Board rescinded that decision and returned the matter for further proceedings because the issue was not properly analyzed and further development of the record was warranted.

From the decision · page 1We previously granted applicant’s Petition for Reconsideration of the “Findings of Fact, Orders, and Opinion on Decision” (F&O) issued on March 3, 2023, by the workers’ compensation administrative law judge (WCJ), in order to further study the factual and legal issues. This is our Opinion and Decision After Reconsideration. The WCJ found, in pertinent part, that applicant, in pro per, was not entitled to an additional and/or replacement panel qualified medical evaluator (QME) in the specialty of internal medicine. Applicant contends that the WCJ erred because the reporting of the agreed medical evaluator (AME) does not constitute substantial evidence and that further development of the record with the current AME is not warranted. We have received an answer from defendant. The WCJ filed a Report and Recommendation on Petition for Reconsideration (Report) recommending that we deny reconsideration. We have considered the allegations of the Petition for Reconsideration, the Answer, and the contents of the WCJ’s Report. Based on our review of the record and for the reasons discussed below, as our Decision After Reconsideration we will rescind the March 3, 2023 F&O and return this matter to the trial level for further proceedings.

Applicant was initially represented by counsel who agreed to use Dr. Norman Panting as an internal AME.

Favours Defendant prevailed

This fact supports that the AME agreement was validly made while applicant was represented, affecting the issue of entitlement to a replacement QME.

From the decision · page 2Applicant worked as a contract administrator when she sustained an admitted cumulative injury through March 30, 2012, to her neck, right shoulder, and right elbow. (Minutes of Hearing and Summary of Evidence, December 7, 2022, p. 2, lines 9-14.) Applicant claims further injury to her upper extremities, left shoulder, left elbow, fingers, arms, back, and to the adrenal gland in the form of Addison’s Disease. (Ibid.) While applicant is presently in pro per, she was initially represented by counsel who agreed to use Dr. Norman Panting as an internal AME. (Id. at p. 2, lines 23-25.) Applicant claims to have sustained injury to her adrenal gland as a consequence of epidural injections of glucocorticoid. (Petition for Additional QME in Internal Medicine, August 19, 2022, p. 2.) Dr. Panting took a history of applicant undergoing epidural steroid injections in 2015 to her shoulder.

Dr. Panting opined that applicant's adrenal insufficiency was due to an auto-immune disorder and not caused by steroid injections, but did not adequately explain the negative adrenal autoantibody test or why injections would not exacerbate the condition.

Favours Applicant prevailed

The incomplete explanation led the Board to find the medical opinion deficient and warrant further development of the record.

From the decision · page 2(Defendant’s Exhibit A, Report of Norman Panting, M.D., June 21, 2018, p. 2.) In 2016, applicant consulted with an endocrinologist who diagnosed adrenal insufficiency. (Ibid.) According to Dr. Panting, applicant’s treating physician did not diagnose applicant as having Addison’s disease from use of injected glucocorticoids, but instead applicant suffered from primary adrenal failure as a result of an auto-immune disorder. (Id. at pp. 18-19.) Dr. Panting did not find that applicant’s internal complaints industrial. (Id. at p.

Dr. Panting opined that applicant's adrenal insufficiency was due to an auto-immune disorder (primary adrenal failure) and not industrially caused by steroid injections; he did not adequately explain why the adrenal autoantibody test was negative or why the injections would not exacerbate the condition.

The opinion was found incomplete and warranted further development of the record.

From the decision · page 2(Defendant’s Exhibit A, Report of Norman Panting, M.D., June 21, 2018, p. 2.) In 2016, applicant consulted with an endocrinologist who diagnosed adrenal insufficiency. (Ibid.) According to Dr. Panting, applicant’s treating physician did not diagnose applicant as having Addison’s disease from use of injected glucocorticoids, but instead applicant suffered from primary adrenal failure as a result of an auto-immune disorder. (Id. at pp. 18-19.) Dr. Panting did not find that applicant’s internal complaints industrial. (Id. at p.

South Coast Framing v. Workers’ Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291

Applicant must prove by a preponderance of the evidence that an injury occurred AOE/COE (Lab. Code §§ 3202.5; 3600(a)).

The Board applied the standard to assess causation and compensability of the claimed injury.

From the decision · page 3When applicant claims a physical injury, applicant has the initial burden of proving industrial causation by showing the employment was a contributing cause. (South Coast Framing v. Workers’ Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298, 302; § 5705.) Applicant must prove by a preponderance of the evidence that an injury occurred AOE/COE. (Lab. Code 1 §§ 3202.5; 3600(a).) The requirement of Labor Code section 3600 is twofold. On the one hand, the injury must occur in the course of the employment. This concept ordinarily refers to the time, place, and circumstances under which the injury occurs. On the other hand, the statute requires that an injury arise out of the employment. It has long been settled that for an injury to arise out of the employment it must occur by reason of a condition or incident of the employment.

Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604

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

The Board reviewed the adequacy of the AME's medical opinion under this standard.

From the decision · page 3To 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

McDuffie v. Los Angeles County Metropolitan Transit Authority (2001) 67 Cal.Comp.Cases 138 (Appeals Board en banc)

Before directing augmentation of the medical record, the WCJ or Board must establish that specific medical opinions are deficient (inaccurate, inconsistent, or incomplete).

The Board emphasized the threshold for ordering further medical development.

From the decision · page 4Los Angeles County Metropolitan Transit Authority (2001) 67 Cal.Comp.Cases 138 (Appeals Board en banc), we stated that “[s]ections 5701 and 5906 authorize the WCJ and the Board to obtain additional evidence, including medical evidence, at any time during the proceedings (citations) [but] [b]efore directing augmentation of the medical record... the WCJ or the Board must establish as a threshold matter that specific medical opinions are deficient, for example, that they are inaccurate, inconsistent or incomplete.” (McDuffie, supra, at 141.) The preferred procedure is to allow supplementation of the medical record by the physicians who have already reported in the case. (Ibid.) “Only if the supplemental opinions of the previously reporting physicians do not or cannot cure the need for development of the medical record, should other physicians be considered.” (Id.

Labor Code section 4062.1(a)

If an employee is not represented by an attorney, the employer shall not seek agreement on an agreed medical evaluator, nor shall an agreed medical evaluator prepare the formal medical evaluation on any issues in dispute (Lab. Code § 4062.1(a)).

The Board noted the legal requirement regarding AME agreements when the employee is unrepresented.

From the decision · page 4at 142.) It appears that the parties and the court may have incorrectly framed the issue in this matter. The primary issue in this case is whether applicant may be relieved of the AME agreement, which was made while applicant was represented. Per section 4062.1(a): “If an employee is not represented by an attorney, the employer shall not seek agreement with the employee on an agreed medical evaluator, nor shall an agreed medical evaluator prepare the formal medical evaluation on any issues in dispute.” All of the reporting obtained from AME Dr. Panting was obtained while applicant was represented, and thus, there does not appear to be any issue raised in the current briefing that would warrant a rejection of the prior AME agreement. However, and out of an abundance of caution, we will rescind the F&O and return this matter to the trial level as the issue raised was not the issue analyzed by the trial judge. If applicant has a legal argument to make as to rescinding the AME agreement, that issue is preserved at the trial level. The opinion on decision, in essence, is based on whether the current reporting of the AME is substantial evidence; however, this is not an issue raised on the Minutes of Hearing. To be clear,

Dr. Panting's opinion did not adequately explain why the adrenal autoantibody test was negative or why steroid injections would not exacerbate the adrenal condition after temporary improvement.

From the decision · page 5(Defendant’s Exhibit A, Report of Norman Panting, M.D., June 21, 2018, p. 2, (emphasis added).) Here, Dr. Panting does not appear to have adequately explained the how or why such injections would not have caused exacerbation or aggravation of the adrenal gland deficiency after any temporary palliative effect wore off. Dr. Panting was directly asked to address aggravation and/or exacerbation, but instead answered that it did not cause primary adrenal insufficiency. That was not the question asked of him, and it would appear that his opinion warrants further development of the record. Furthermore, Dr. Panting found applicant’s condition to be the result of an auto-immune disorder, but does not explain why applicant’s adrenal autoantibody test result was negative. This would appear to require additional explanation. Accordingly, as our Decision After Reconsideration we rescind the March 3, 2023 F&O and return this matter to the trial level for further proceedings.