ADJ9589869 · June 20, 2024

The record lacks evidence to establish the direct cause of the bacterial infection as industrial injury; the case is remanded for further development to determine if applicant's occupational duties increased risk of infection.

From the decision · page 8The alleged injury in this matter is a bacterial infection. The parties have litigated this case as if they were litigating a direct occupational disease. A direct occupational disease occurs where the injured worker's point of infection can be established through evidence. Here, no such evidence is in the record, and it does not appear that such evidence exists. As neither party can establish the direct cause of the bacterial infection, the appropriate legal standard in this case is whether the infection meets the causation threshold for nonoccupational disease per Latourette. (Ibid.) Where it is impossible to pinpoint the direct cause of an infection, we must determine whether applicant's occupational duties exposed applicant to an increased risk of acquiring the infection to that of the general public. (Ibid.) This question was not presented to any of the doctors. Accordingly, the record requires development.

No direct evidence exists in the record establishing the point of infection for the bacterial infection.

Favours Defendant prevailed

Without direct evidence of the point of infection, the case cannot be decided on industrial injury causation and requires further development.

From the decision · page 8The alleged injury in this matter is a bacterial infection. The parties have litigated this case as if they were litigating a direct occupational disease. A direct occupational disease occurs where the injured worker's point of infection can be established through evidence. Here, no such evidence is in the record, and it does not appear that such evidence exists. As neither party can establish the direct cause of the bacterial infection, the appropriate legal standard in this case is whether the infection meets the causation threshold for nonoccupational disease per Latourette. (Ibid.) Where it is impossible to pinpoint the direct cause of an infection, we must determine whether applicant's occupational duties exposed applicant to an increased risk of acquiring the infection to that of the general public. (Ibid.) This question was not presented to any of the doctors. Accordingly, the record requires development.

Applicant's occupational duties involved frequent exposure to rose bushes causing scratches and pokes, which could be entry points for infection.

Favours Applicant prevailed

This fact supports the possibility of industrial injury but was not sufficiently developed in the record, leading to remand for further proceedings.

From the decision · page 4The dispute then turns to when and where streptococcus viridans entered applicant's body. Applicant stated scratches and pokes would

Diagnosed post streptococcus viridans bacteremia with infected left toe necrosis; opined infection likely entered through skin puncture or breakdown on left foot, possibly from stepping on a thorn or rosebush; concluded streptococcus viridans caused foot infection and amputation.

The QME provided detailed medical opinions on the mechanism of injury and causation linking the infection to possible industrial exposure, but the record lacks direct evidence to establish causation conclusively, requiring further development.

From the decision · page 4In this case, it is undisputed that applicant contracted streptococcus viridans bacteremia according to the final diagnoses when applicant was discharged from the hospital after his surgeries. (Def. Exh. C, Parkview records, p. 1.) On October 3, 2017, applicant was evaluated by panel qualified medical evaluator ("PQME") Ramesh Karody, M.D. (Joint Exh. X, Joint Panel Qualified Medical Examination report, October 3, 2017.) Dr. Karody also diagnosed applicant with post streptococcus viridans bacteremia with infected left toe necrosis. (Id., p. 18.)

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 be speculative, be based on pertinent facts and an adequate examination and history, and set forth reasoning in support of its conclusions.

The panel applied this standard to evaluate the sufficiency of medical evidence regarding causation.

From the decision · page 6To constitute substantial evidence "... a medical opinion must be framed in terms of

Labor Code §§ 3202.5, 3600(a)

Applicant must prove by a preponderance of the evidence that an injury occurred AOE/COE.

The panel cited these statutes as the legal basis for proving industrial injury causation.

From the decision · page 7must prove by a preponderance of the evidence that an injury occurred AOE/COE. (Lab. Code

Latourette v. Workers' Comp. Appeals Bd. (1998) 17 Cal.4th 644

Where it is impossible to pinpoint the direct cause of an infection, the appropriate legal standard is whether the applicant's occupational duties exposed them to an increased risk of acquiring the infection compared to the general public.

The panel applied this standard to remand the case for further development on increased risk of infection due to occupational duties.

From the decision · page 8The alleged injury in this matter is a bacterial infection. The parties have litigated this case as if they were litigating a direct occupational disease. A direct occupational disease occurs where the injured worker's point of infection can be established through evidence. Here, no such evidence is in the record, and it does not appear that such evidence exists. As neither party can establish the direct cause of the bacterial infection, the appropriate legal standard in this case is whether the infection meets the causation threshold for nonoccupational disease per Latourette. (Ibid.) Where it is impossible to pinpoint the direct cause of an infection, we must determine whether applicant's occupational duties exposed applicant to an increased risk of acquiring the infection to that of the general public. (Ibid.) This question was not presented to any of the doctors. Accordingly, the record requires development.

Applicant's testimony about frequent scratches and pokes from rose bushes at work, which were not reported as injuries because they were considered normal work occurrences.

From the decision · page 4The dispute then turns to when and where streptococcus viridans entered applicant's body. Applicant stated scratches and pokes would

Testimony from employer's office manager and coworker confirming that injuries from thorns such as scrapes, cuts, and scratches were common and frequent in the workplace.