ADJ10522919 · July 9, 2026

The Appeals Board found the sexual dysfunction impairment was directly caused by the industrial injury, not barred by Labor Code section 4660.1(c)(1), and that applicant is entitled to 100% permanent disability without apportionment based on medical and vocational evidence.

Vocational expert Frank Diaz opined applicant is 100% permanently disabled without apportionment due to severe work restrictions and unemployability.

Favours Applicant prevailed

Supported 100% permanent disability award without apportionment.

Applicant sustained industrial injury to lumbar spine and right shoulder on November 27, 2013, causing permanent disability.

Favours Applicant prevailed

Established basis for permanent disability award.

PQME Dr. Kuyt provided neuroanatomical evidence linking sexual dysfunction directly to lumbar spine injury, overcoming statutory bar.

Favours Applicant prevailed

Supported finding that sexual dysfunction impairment is directly caused by industrial injury, allowing rating increase.

From the decision · page 13In evaluating the clinical reality of this case, the WCJ incorrectly determined that section 4660.1(c)(1) disqualified applicant’s permanent impairment related to sexual dysfunction under the legal premise that the condition was a compensable consequence of the lumbar spine pathology. PQME Dr. Kuyt provided the necessary neuroanatomical evidence linking applicant’s genitourinary impairment directly to neurologic trauma. He diagnosed upper motor neuron bladder disease with detrusor instability resulting from a documented corticospinal tract lesion at L4-S1, which disrupted modulation of the S2-S4 lower motor neuron reflex arc. The critical factor establishing direct neurologic injury is the shared neuroanatomy of the sacral nerve roots. The bladder, pelvic floor, and erectile mechanisms all rely on the same S2-S4 sacral circuitry. Because the parasympathetic fibers controlling erectile function originate from these segments, the lumbar corticospinal tract lesion provides objective evidence that the sexual dysfunction is a primary neurogenic impairment. Furthermore, PQME Dr. Kuyt detailed a distinct anatomical complication resulting from the surgical intervention itself. The anterior lumbar interbody fusion at L5-S1 inherently risks disrupting the sympathetic nerve plexus over the disc space, which coordinates the ejaculatory

Applicant suffered catastrophic decline after lumbar fusion surgery with physical limitations and pain precluding sedentary work; assessed 28% whole person impairment for lumbar spine without apportionment.

Directly related to industrial injury and post-surgical complications causing permanent disability.

From the decision · page 4acknowledging applicant would not continue with the functional restoration program. (App. Ex. 17, p. 1.) In his report dated March 2, 2016, Dr. Mallavaram deemed applicant permanent and stationary and assessed 28% whole person impairment (WPI) without apportionment for the lumbar spine based on DRE Category V (AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Table 15-3, p. 384.) Dr. Mallavaram’s opinion relied on a complete loss of motion at the L5-S1 level following an unsuccessful surgical arthrodesis attempt. Furthermore, he documented significant left lower extremity impairment characterized by pain and sensory changes with anatomic distribution at the L5-S1 level as well as EMG findings and potential complex regional pain syndrome (CRPS). (App. Ex. 12, p. 3.) During his deposition on April 30, 2018, Dr.

Found urinary dribbling and sexual dysfunction industrial; recommended urologic evaluation; extreme physical restrictions limiting work ability; no apportionment to preexisting factors for lumbar spine and right shoulder.

Provided comprehensive evaluation supporting industrial causation and no apportionment.

From the decision · page 4Mallavaram confirmed that the inability to work and the broader work restrictions stemmed directly from the physical limitations, sensory deficits, and persistent pain following the unsuccessful lumbar fusion surgery. (Id. at pp. 11:4-25 to 12:1-20.) Dr. Mallavaram opined that applicant developed symptoms supporting a diagnosis of CRPS including swelling, discoloration, and hair loss on the left leg. (Id. at pp. 15:21-25 to 16:1:1-22.) In his report dated July 20, 2016, PQME Dr. Klassen, after evaluating applicant in the field of orthopedic surgery, took a history that he reported urinary dribbling and a lack of sexual function since his surgery. (Def. Ex. D, pp. 2, 4, 6, 12.) PQME Dr. Klassen found these conditions to be industrial and recommended a urologic evaluation. (Id. at pp. 12, 15.) He observed applicant utilized a cane and exhibited an antalgic gait, concluding he possessed extreme physical restrictions that limited his ability to work. (Id. at pp. 4, 10, 14-15.) Specifically, PQME Dr. Klassen restricted applicant from repetitive bending or stooping, standing or sitting for more than five minutes in one position, and lifting, pushing, pulling, or carrying more than three pounds. (Id. at pp. 14-15.)

Diagnosed upper motor neuron bladder disease and neurogenic sexual dysfunction directly linked to lumbar spine injury; explained shared sacral nerve root neuroanatomy.

Provided neuroanatomical evidence linking sexual dysfunction directly to industrial injury, overcoming statutory bar.

From the decision · page 6epidurals, and was already considered a surgical candidate before the industrial injury pushed him over the edge to require surgery. (Id. at pp. 26:15-25 to 27:1-10.) Regarding sexual dysfunction, PQME Dr. Klassen noted medical records from 2006 indicating applicant experienced sexual side effects from psychotropic medications including Paxil taken prior to his November 27, 2013 injury. (Id. at p. 38:7-11.) In his report dated June 26, 2017, PQME Dr. Kuyt evaluated applicant in urology and reviewed his medical history, including an anterior and posterior lumbar fusion at L5-S1 on October 7, 2014. (Def. Ex. F, p. 3.) PQME Dr. Kuyt reported applicant suffered a 50% loss of pre-injury voiding function and a 70% loss of pre-injury sexual function. (Id. at p. 20.) PQME Dr. Kuyt diagnosed applicant with “upper motor neuron bladder disease,” which clinically presents as detrusor instability. The L4–S1 corticospinal tract lesion disrupts upper motor neuron modulation of S2-S4 lower motor neuron impulses, producing hyperactivity of the lower urinary tract, manifesting as urgency, daytime urge incontinence, and nocturia. (Id. at p. 17.) Addressing concurrent sexual dysfunction, PQME Dr. Kuyt identified a shared neurologic mechanism. He noted that the bladder, pelvic floor, and erectile function all rely on common sacral nerve circuitry derived from the S2-S4 sacral nerve roots.

California Labor Code

Labor Code section 4660.1(c)(1)

Bar against increases in impairment ratings for sexual dysfunction unless directly caused by industrial injury.

LeBoeuf, 34 Cal.3d 234

LeBoeuf standard for permanent disability rating reflecting labor market reality

Permanent disability rating must reflect diminished ability to compete in open labor market, including vocational rehabilitation feasibility.

From the decision · page 10P.D. LEXIS 322, *20–23.].) 3 In LeBoeuf, the Supreme Court applied a standard of labor market reality stating that, “A permanent disability rating should reflect as accurately as possible an injured employee’s diminished ability to compete in the open labor market. The fact that a worker has been precluded from vocational retraining is a significant factor to be taken into account in evaluating his or her potential employability.” (LeBouef, supra, 34 Cal.3d at pp. 245-246.) The Court concluded, “This is to ensure that the permanent disability rating upon which an award is based accurately reflects both the permanent medical and vocational disabilities.” (Id. at p. 243.) Accordingly, to rebut the PDRS and establish permanent total disability, applicant must prove the following: 1) Applicant has received a work restriction(s), which requires substantial medical evidence. 2) The work restriction(s) precludes applicant from rehabilitation into another career field, which requires vocational expert evidence. 3) The work restriction(s) precludes applicant from competing on the open labor market,

Applicant's testimony about injury and work history

Medical records and expert reports showing direct neurogenic cause of sexual dysfunction

From the decision · page 13In evaluating the clinical reality of this case, the WCJ incorrectly determined that section 4660.1(c)(1) disqualified applicant’s permanent impairment related to sexual dysfunction under the legal premise that the condition was a compensable consequence of the lumbar spine pathology. PQME Dr. Kuyt provided the necessary neuroanatomical evidence linking applicant’s genitourinary impairment directly to neurologic trauma. He diagnosed upper motor neuron bladder disease with detrusor instability resulting from a documented corticospinal tract lesion at L4-S1, which disrupted modulation of the S2-S4 lower motor neuron reflex arc. The critical factor establishing direct neurologic injury is the shared neuroanatomy of the sacral nerve roots. The bladder, pelvic floor, and erectile mechanisms all rely on the same S2-S4 sacral circuitry. Because the parasympathetic fibers controlling erectile function originate from these segments, the lumbar corticospinal tract lesion provides objective evidence that the sexual dysfunction is a primary neurogenic impairment. Furthermore, PQME Dr. Kuyt detailed a distinct anatomical complication resulting from the surgical intervention itself. The anterior lumbar interbody fusion at L5-S1 inherently risks disrupting the sympathetic nerve plexus over the disc space, which coordinates the ejaculatory

Vocational expert Frank Diaz's opinion of 100% permanent disability without apportionment