ADJ8450336 · July 15, 2026

The Board found industrial injury to multiple body systems including heart and sleep disorder, and awarded permanent disability percentages of 43% and 100% in the two cases, with no apportionment to nonindustrial factors for certain injuries.

From the decision · page 1We previously granted reconsideration to allow us time to further study the factual and legal issues in this case. This is our Opinion and Decision After Reconsideration. 1 Applicant seeks reconsideration of the Joint Findings & Award (F&A) issued on June 14, 2022, by the workers’ compensation administrative law judge (WCJ). The WCJ found in pertinent part that, in ADJ8450336, applicant sustained an industrial injury on July 20, 2010, while employed as a registered nurse, to her low back, both shoulders, both wrists, gastrointestinal system in the form of gastroesophageal reflux disease (GERD), and a sleep disorder, which resulted in 40% permanent disability, commencing February 25, 2014. The WCJ further found in pertinent part that, in ADJ8720647, applicant sustained an industrial injury during the period from March 5, 2007 to January 11, 2013, to her neck, low back, left wrist, left hip, left ankle, and gastrointestinal system in the form of GERD, which resulted in 26% permanent disability, commencing November 12, 2014. In both cases, the WCJ found that applicant did not sustain an industrial injury to her heart or cardiovascular system in the form of hypertensive cardiac disease, and that, while the presumption of compensability pursuant to Labor Code section 3212.2 2 applied, defendant successfully rebutted it.

Applicant sustained industrial injury to heart and cardiovascular system in the form of hypertensive cardiac disease within statutory time limits.

Favours Applicant prevailed

This fact triggered the presumption of compensability under Labor Code section 3212.2, which defendant failed to rebut, leading to a finding of industrial causation.

PQME Dr. Mahmoudi confirmed LVH developed progressively overlapping with employment periods.

Favours Applicant prevailed

Supported the finding that the heart condition was industrially caused and not rebutted by defendant.

Applicant's testimony about stressful work environment and duties involving exposure to riots and injuries.

Favours Applicant prevailed

Supported the credibility of industrial injury claims and the impact on applicant's health.

From the decision · page 3Her responsibilities also included performing dressing changes, cleaning ears, and examining eyes for foreign objects. (MOH/SOE, 01/27/2022, 9:11-15.) She treated infected wounds and administered medications or vaccines by injection when ordered by a physician. In cases of significant infection, a doctor might order an antibiotic injection, such as tetracycline, or a tetanus vaccine, which she administered only pursuant to a physician’s order. On average, such injections occurred four to five times per month. Injections were also sometimes required for cuts, bruises, or abrasions. She provided care to inmates on a one-on-one basis and then escorted them, unaccompanied, back to their housing units or holding cells. This occurred daily. (MOH/SOE, 01/27/2022, 9:16-20.) She testified that her work was stressful and that the stress persisted throughout her entire career. The stress arose from the constant need to remain aware of her surroundings, including who was nearby, who might be following her, and who appeared dangerous or ill. She also encountered riots in which inmates fought one another, requiring her to treat injuries such as

Found applicant's LVH developed during employment and did not find impairment for weight gain; apportioned GERD impairment between two injury dates; supported adding separate internal WPIs with orthopedic WPIs due to distinct body systems affected.

His opinion supported finding industrial causation for heart and sleep disorder and combining impairments for permanent disability rating.

From the decision · page 53.) In addition, given that her medical records did not show either consistently high blood pressure reading or an increase in the number or dosage of her medications, her employment neither caused nor worsened her hypertension. (Ibid.) However, because her LVH developed gradually, it was reasonably probable that it occurred during the course of her employment. (Ibid.) PQME Dr. Mahmoudi found applicant reached MMI for her LVH and insomnia on November 12, 2014, and, for her GERD on September 21, 2016. (Ibid.) With respect to permanent disability, PQME Dr.

Rated cervical spine, shoulders, and carpal tunnel syndrome impairments with specific percentages and apportioned 100% of permanent disability to respective injury dates; opinion adopted by the Board.

His opinion was adopted for orthopedic claims and WPI additions, influencing the permanent disability rating.

From the decision · page 8In his May 19, 2019 report, AME Dr. Anderson, after reevaluating applicant, opined that she has 5% WPI to the cervical spine based on DRE Category II under Table 15‑5 at page 392 of the AMA Guides, citing complaints of pain, loss of motion, and nonverifiable radiculopathy. (App. Ex. A-20 at p. 9.) He concluded that 100% of the permanent disability related to the March 5, 2007 to January 11, 2013 date of injury. (Ibid.) For the shoulders, he noted that a strict application of the AMA Guides, which requires subtracting the left shoulder’s range of motion from the right, yields a 3% Upper Extremity Impairment (UEI), equating to 2% WPI. However, he determined that rating the left shoulder’s loss of motion directly under Almaraz v. Environmental Recovery Services/Guzman v. Milpitas Unified School District (2009) Cal.Comp.Cases 1084 (Appeals Board en banc) provided the most accurate representation of applicant’s impairment when combined with her positive MRI study. Under this direct method, AME Dr. Anderson calculated 150° of flexion (2% UEI under Figure 16-40, page 476), 140° of abduction (2% UEI under Figure 16-43, page 477), and 40° of internal rotation (3% UEI under Figure 16-46, page 479). This totals 7% UEI, which converts to 4% WPI. Finally, he apportioned 100% of the permanent disability for both shoulder injuries related to the July 20, 2010 specific date of injury.

Labor Code section 3212.2

Presumption of compensability for heart trouble under Labor Code section 3212.2 applies to correctional officers performing incidental custodial duties.

Defendant failed to rebut the presumption; LVH developed during employment within statutory time limits.

From the decision · page 9Section 3212.2 establishes that heart trouble developing or manifesting during a correctional officer’s employment presumptively arises out of and in the course of employment. (Lab. Code, § 3212(c).) The statute extends this rebuttable presumption after termination for three calendar months per full year of qualifying service, up to a maximum of 60 months from the last date worked. (Ibid.) The application of the presumption is not limited to those whose primary or principal duties were custodial, but rather applies to employees who had any duties incidentally custodial. (Cal. Dep’t of Corr. & Rehab. v. Workers’ Comp. Appeals Bd. (Alviso) (2016) Cal.Comp.Cases 608, 609 (writ denied); Reeves v. Workers’ Comp. Appeals Bd. (2000) Cal.App.4th 22, 28 [65 Cal.Comp.Cases 359].) In defining “heart trouble,” in Muznik v. Workers’ Comp. Appeals Bd. (1975) 51 Cal.App.3d 622 [40 Cal.Comp.Cases 578], the Court wrote as follows: [T]he phrase “heart trouble” assumes a rather expansive meaning.

Labor Code section 5412

Date of injury for heart and cardiovascular system hypertensive cardiac disease is the date applicant first acquired knowledge of the industrial nature of the condition under Labor Code section 5412.

Date of injury set as March 9, 2018 based on PQME Dr. Mahmoudi's report.

From the decision · page 11not rebut the section 3212.2 presumption of compensability for either the July 20, 2010 specific injury or the cumulative trauma period from March 5, 2007, to January 11, 2013. Because we find industrial causation, we must determine the date of injury pursuant to section 5412. The record establishes that no physician informed applicant that her hypertension related to her employment or provided her any work restrictions. Applicant first acquired knowledge of the industrial nature of her cardiac condition upon the issuance of PQME Dr. Mahmoudi’s March 9, 2018 supplemental report. In that report, PQME Dr. Mahmoudi identified the LVH and concluded it reasonably occurred during the course of her employment. Therefore, we concur with applicant’s contention and find the date of injury pursuant to section 5412 is March 9, 2018.

Applicant's testimony about stressful work environment and duties involving exposure to riots and injuries.

From the decision · page 3Her responsibilities also included performing dressing changes, cleaning ears, and examining eyes for foreign objects. (MOH/SOE, 01/27/2022, 9:11-15.) She treated infected wounds and administered medications or vaccines by injection when ordered by a physician. In cases of significant infection, a doctor might order an antibiotic injection, such as tetracycline, or a tetanus vaccine, which she administered only pursuant to a physician’s order. On average, such injections occurred four to five times per month. Injections were also sometimes required for cuts, bruises, or abrasions. She provided care to inmates on a one-on-one basis and then escorted them, unaccompanied, back to their housing units or holding cells. This occurred daily. (MOH/SOE, 01/27/2022, 9:16-20.) She testified that her work was stressful and that the stress persisted throughout her entire career. The stress arose from the constant need to remain aware of her surroundings, including who was nearby, who might be following her, and who appeared dangerous or ill. She also encountered riots in which inmates fought one another, requiring her to treat injuries such as

Medical records showing no consistent high blood pressure or increased medication dosage, but LVH developed gradually during employment.

From the decision · page 53.) In addition, given that her medical records did not show either consistently high blood pressure reading or an increase in the number or dosage of her medications, her employment neither caused nor worsened her hypertension. (Ibid.) However, because her LVH developed gradually, it was reasonably probable that it occurred during the course of her employment. (Ibid.) PQME Dr. Mahmoudi found applicant reached MMI for her LVH and insomnia on November 12, 2014, and, for her GERD on September 21, 2016. (Ibid.) With respect to permanent disability, PQME Dr.