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.
QMERelied upon · orthopedic surgeon
Consistently found one cumulative injury through last date of work July 28, 2013, with detailed explanation of injury progression and causation related to employment.
Dr. Hughes' opinion was found to be substantial evidence and not based on speculation, unlike other QMEs who had inconsistent opinions.
From the decision · page 6It is well established that the relevant and considered opinion of one physician, though
inconsistent with other medical opinions, may constitute substantial evidence and the Appeals
Board may rely on the medical opinion of a single physician unless it is "based on surmise,
speculation, conjecture, or guess." (Place v. Workmen's Comp. App. Bd. (1970) 3 Cal.3d 372, 378
[35 Cal.Comp.Cases 525]; Market Basket v. Workers' Comp. Appeals Bd. (1978) 86 Cal.App.3d
137 [46 Cal.Comp.Cases 913.) Having reviewed the medical reporting, unlike Drs. Clarke and
Ryan, Dr. Hughes' medical opinion is not the result of surmise, speculation, conjecture, or guess.
Further, Dr. Hughes' consistent and recent QME reports contain substantial evidence of applicant
experiencing one cumulative injury. (Ex. DD, QME Report by Dr. Hughes, dated 9/19/19, p. 10;
Ex. EE, QME Report by Dr. Hughes, dated 11/21/19, p. 2; Ex. FF, QME Report by Dr. Hughes,
dated 3/8/21, p. 2; Ex. GG, QME Evaluation Report by Dr. Hughes, dated 8/9/21, pp. 7-8; Ex. HH,
QME Supplemental Report by Dr. Hughes, dated 1/25/22, p. 1; Ex. II, Deposition of Dr. Hughes,
dated 3/8/21, pp. 34-35.) Therefore, based on the substantial evidence of Dr. Hughes' reporting,
applicant sustained one cumulative trauma with her last date of injurious exposure as her last day
of work, July 28, 2013.
QMERejected · physical medicine rehabilitation and pain medicine
Found two periods of cumulative trauma in 2008 and 2013 but noted difficulty discerning periods of disability.
From the decision · page 3The initial Qualified Medical Evaluator (QME) with specialties in physical medicine
rehabilitation and pain medicine, Dr. Aidan Clarke, found in her reports of October 2014 and July
2017, that applicant's injury was AOE/COE and that she had two periods of cumulative trauma,
in 2008 and 2013 based on her conclusion that applicant had improved after the 2008 surgery.
(Ex. A, QME Report by Dr. Clarke dated 10/20/14, pp. 14-16; Ex. B, QME Report by Dr. Clarke
dated 7/9/17, pp.48-49.) However, Dr. Clarke also stated that the periods of disability were
"difficult to discern." (Ex. B, p. 48.)
QMERejected · physical medicine, rehabilitation, and pain medicine
Repeatedly changed opinion on whether there was one or two cumulative injuries, ultimately inconsistent.
From the decision · page 3The next QME with specialties in physical medicine, rehabilitation, and pain medicine, Dr.
Manijeh Ryan, found that the injury was AOE/COE but repeatedly changed her mind on whether
there was one cumulative trauma injury or two cumulative injuries. (Ex. JJ, QME Report by Dr.
Ryan, dated 7/9/17, p. 18.) She first found one injury ending on August 12, 2013 (Ex. JJ, p. 18);
then two injuries ending in December 10, 2008, and August 12, 2013 (Ex. KK, QME Report of
Dr. Ryan, dated 1/22/18); then one injury again (Ex. PP, Deposition of Dr. Ryan, dated 11/14/19,
p. 33); and she again found two cumulative injuries in her later reports and deposition. (Ex. LL,
QME 1st Follow Up Report by Dr. Ryan, dated 6/18/20, p. 83; Ex. MM, 2nd Follow up Report by
Dr. Ryan, dated 2/19/21, p. 38; Ex. NN, QME Testing Report by Dr. Ryan, dated 2/26/21, p. 1;
Ex. OO, QME Supplemental Report by Dr. Ryan, dated 7/27/21, p. 10; Ex. QQ, Deposition of Dr.
Ryan, dated 10/29/20, pp. 86-87, 90.)