ADJ10630370 — California WCAB decision

What the panel ordered

Petition for reconsideration granted; Findings and Award of September 13, 2023 rescinded; matter returned to WCJ for further proceedings.

Applicant sought reconsideration of the Findings and Award issued by the WCJ on September 13, 2023, which found no injury AOE/COE to brain, psych, or nervous system from stroke; the WCAB granted reconsideration, rescinded the F&A, and returned the matter to the WCJ for further proceedings.

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What was disputed, and how it came out

Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.

AOE/COERemandedbrain · psych · nervous system

The WCAB found that the AME Dr. Sanossian's opinion that workplace stress was less than 1% cause of the stroke was based on assumptions and lacked objective evidence, thus not substantial evidence. The WCAB granted reconsideration to further develop the record on causation.

From the decision · page 4DISCUSSION We first note, it has long been the law that once reconsideration has been granted, the Appeals Board has the authority to address issues all issues, including those not specifically raised by the Petition. (Lab. Code, § 5906; (Great Western Power Co. v. Industrial Acc. Com. (Savercool) (1923) 191 Cal. 724, 729 [10 I.A.C. 322]); (State Comp. Ins. Fund v. Industrial Acc. Com. (George) (1954) 125 Cal.App.2d 201, 203 [19 Cal.Comp.Cases 98]; Pasquotto v. Hayward Lumber (2006) 71 Cal.Comp.Cases 223, 229 - 230, fn. 7 (Appeals Board en banc).) In this matter, the Finding that applicant did not sustain injury AOE/COE was based on the reporting and deposition testimony of AME Dr. Sanossian. (See Opinion on Decision, p. 6.) Any award, order, or decision of the Appeals Board must be supported by substantial evidence. (Lab. Code, § 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274, 281 [39 Cal.Comp.Cases 310]; Garza v.

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc)

Substantial evidence must be based on reasonable medical probability, not speculation or assumptions.

The WCAB found Dr. Sanossian's opinion speculative and lacking objective evidence, thus not substantial evidence.

From the decision · page 5sufficient if the work is a contributing cause of the injury. (South Coast Framing, Inc. v. Workers' Comp. Appeals Bd. (2015) 61 Cal.4th 291 [80 Cal.Comp.Cases 489]; Nash v. Workers' Comp. Appeals Bd. (1994) 24 Cal.App.4th 1793 [59 Cal.Comp.Cases 324].) Clearly, if an injured worker's employment was a contributing factor to the cause of the injury (whether less than 1%, or more than 1%) the causation requirement in a workers' compensation injury claim is satisfied.. (South Coast Framing, Inc. v. Workers' Comp. Appeals Bd., supra.) However, to be substantial evidence a medical opinion must be framed in terms of reasonable medical probability, it must not be speculative, it must be based on pertinent facts and on an adequate examination and history, and it must set forth reasoning in support of its conclusions. (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc).) A medical opinion is not substantial evidence if it is based on facts no longer germane, on inadequate medical histories or examinations, on incorrect legal theories, or on surmise, speculation, conjecture, or guess. (Place v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 372 [35 Cal.Comp.Cases 525]; Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162 [36 Cal.Comp.Cases 93]; Escobedo v. Marshalls, supra.)

South Coast Framing, Inc. v. Workers' Comp. Appeals Bd. (2015) 61 Cal.4th 291

For causation in workers' compensation, work need only be a contributing cause, even less than 1%.

The WCAB noted that even less than 1% contribution from work satisfies causation if supported by substantial evidence.

From the decision · page 5sufficient if the work is a contributing cause of the injury. (South Coast Framing, Inc. v. Workers' Comp. Appeals Bd. (2015) 61 Cal.4th 291 [80 Cal.Comp.Cases 489]; Nash v. Workers' Comp. Appeals Bd. (1994) 24 Cal.App.4th 1793 [59 Cal.Comp.Cases 324].) Clearly, if an injured worker's employment was a contributing factor to the cause of the injury (whether less than 1%, or more than 1%) the causation requirement in a workers' compensation injury claim is satisfied.. (South Coast Framing, Inc. v. Workers' Comp. Appeals Bd., supra.) However, to be substantial evidence a medical opinion must be framed in terms of reasonable medical probability, it must not be speculative, it must be based on pertinent facts and on an adequate examination and history, and it must set forth reasoning in support of its conclusions. (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc).) A medical opinion is not substantial evidence if it is based on facts no longer germane, on inadequate medical histories or examinations, on incorrect legal theories, or on surmise, speculation, conjecture, or guess. (Place v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 372 [35 Cal.Comp.Cases 525]; Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162 [36 Cal.Comp.Cases 93]; Escobedo v. Marshalls, supra.)

ADJ10630370 · December 7, 2023

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