ADJ10507939 · June 3, 2021

The WCJ's finding of no bilateral knee injury was reversed because the WCJ did not provide a complete factual and legal analysis of the statute of limitations defense and further development of the record was warranted due to evidence suggesting possible cumulative trauma injury to the knees.

From the decision · page 5If the true basis for the WCJ's finding of no bilateral knee injury is that applicant's claim was made beyond the Statute of Limitations (an affirmative defense), we cannot uphold it because the WCJ's Opinion on Decision did not provide a complete factual and legal analysis of the elements necessary to sustain the defense. (See Lab. Code, § 5313.) The Opinion on Decision enables the parties, and the Board if reconsideration is sought, to ascertain the actual basis for the decision, and makes the right of seeking reconsideration more meaningful. (Evans v. Workers' Comp. Appeals Bd. (1968) 68 Cal.2d 753 [33 Cal. Comp. Cases 350].)

Applicant testified he had knee problems over the years and thought the pain was work-related, but never missed work due to knee pain.

Favours Applicant prevailed

Supports the need for further inquiry and expert medical opinion on cumulative trauma injury claim.

From the decision · page 5In fact, the evidence of record suggests that applicant's claim of bilateral knee injury requires further inquiry. At trial on December 12, 2019, applicant testified that he had problems with his knees over the years, and that although he never missed any time from work because of knee pain, nothing happened to injure his knees after he stopped working. According to Dr. Ryan, who evaluated applicant's hernia injury, he was having right knee problems at the time of the doctor's report dated September 28, 2015, not too long after applicant stopped working in May 2015. (Joint Exhibit W.) In one exchange upon cross-examination, applicant testified that he first felt left knee pain around 2001, and that he thought it was caused by work, though no doctor had ever taken him off work for his knees. (See Summary of Evidence, 12/12/19, 8:6-9:39.)

Dr. Ryan's report noted right knee problems shortly after applicant stopped working in May 2015.

Favours Applicant prevailed

Indicates possible industrial injury requiring further development of the record.

From the decision · page 5In fact, the evidence of record suggests that applicant's claim of bilateral knee injury requires further inquiry. At trial on December 12, 2019, applicant testified that he had problems with his knees over the years, and that although he never missed any time from work because of knee pain, nothing happened to injure his knees after he stopped working. According to Dr. Ryan, who evaluated applicant's hernia injury, he was having right knee problems at the time of the doctor's report dated September 28, 2015, not too long after applicant stopped working in May 2015. (Joint Exhibit W.) In one exchange upon cross-examination, applicant testified that he first felt left knee pain around 2001, and that he thought it was caused by work, though no doctor had ever taken him off work for his knees. (See Summary of Evidence, 12/12/19, 8:6-9:39.)

Dr. Ryan evaluated applicant's hernia injury and noted right knee problems at the time of the report dated September 28, 2015, shortly after applicant stopped working in May 2015.

From the decision · page 5In fact, the evidence of record suggests that applicant's claim of bilateral knee injury requires further inquiry. At trial on December 12, 2019, applicant testified that he had problems with his knees over the years, and that although he never missed any time from work because of knee pain, nothing happened to injure his knees after he stopped working. According to Dr. Ryan, who evaluated applicant's hernia injury, he was having right knee problems at the time of the doctor's report dated September 28, 2015, not too long after applicant stopped working in May 2015. (Joint Exhibit W.) In one exchange upon cross-examination, applicant testified that he first felt left knee pain around 2001, and that he thought it was caused by work, though no doctor had ever taken him off work for his knees. (See Summary of Evidence, 12/12/19, 8:6-9:39.)

California Labor Code

Labor Code section 3202.5

Failure of proof standard for industrial injury claims.

From the decision · page 5WCJ's rejection of the claim is failure of proof under Labor Code section 3202.5. However, the WCJ goes on to state that even if applicant presented such proof, "his claim likely could have been barred by the Statute of Limitations." This latter statement suggests that the real reason for the WCJ's rejection of the claim is that it was filed beyond the Statute of Limitations. The same is true of the WCJ's Report, wherein section 3202.5 is quoted but the WCJ states that applicant "failed to claim injury to the knees in a timely manner."

California Labor Code

Labor Code section 5313

Requirement for complete factual and legal analysis of statute of limitations defense.

From the decision · page 5If the true basis for the WCJ's finding of no bilateral knee injury is that applicant's claim was made beyond the Statute of Limitations (an affirmative defense), we cannot uphold it because the WCJ's Opinion on Decision did not provide a complete factual and legal analysis of the elements necessary to sustain the defense. (See Lab. Code, § 5313.) The Opinion on Decision enables the parties, and the Board if reconsideration is sought, to ascertain the actual basis for the decision, and makes the right of seeking reconsideration more meaningful. (Evans v. Workers' Comp. Appeals Bd. (1968) 68 Cal.2d 753 [33 Cal. Comp. Cases 350].)

Applicant's testimony about knee problems over the years and belief that knee pain was work-related.

From the decision · page 5In fact, the evidence of record suggests that applicant's claim of bilateral knee injury requires further inquiry. At trial on December 12, 2019, applicant testified that he had problems with his knees over the years, and that although he never missed any time from work because of knee pain, nothing happened to injure his knees after he stopped working. According to Dr. Ryan, who evaluated applicant's hernia injury, he was having right knee problems at the time of the doctor's report dated September 28, 2015, not too long after applicant stopped working in May 2015. (Joint Exhibit W.) In one exchange upon cross-examination, applicant testified that he first felt left knee pain around 2001, and that he thought it was caused by work, though no doctor had ever taken him off work for his knees. (See Summary of Evidence, 12/12/19, 8:6-9:39.)

Medical records from Kaiser documenting treatment for bilateral knees with complaints of gradual onset of pain over several years, but no industrial cause noted.

From the decision · page 4The Kaiser records document treatment in 2018 and 2019 for bilateral knees with complaints of gradual onset of pain over the last "several years". (the applicant stopped working in 2015.) There is nothing in any of these records which would support a finding of industrial injury to the knees. The records note the industrial injury to the hernia but make no mention of any industrial cause or industrial aggravation of the applicant's knee complaints.