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.
QMERejected
Opined 28% whole person impairment (WPI) based on DRE Lumbar Category V, later increased to 40% WPI based on gait derangement rating; assigned 80% industrial causation and 20% preexisting degenerative factors for apportionment but failed to provide legally sufficient reasoning for apportionment.
His apportionment opinion was found speculative and legally insufficient due to lack of detailed 'how and why' reasoning and failure to frame in terms of reasonable medical probability.
From the decision · page 3With respect to permanent disability, PQME Dr. Anderson opined that applicant has
28% whole person impairment (WPI) based on DRE Lumbar Category V under Table 15-3 on
page 384 of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides).
She underwent a lumbar fusion, resulting in loss of motion segment integrity that places her in
DRE Lumbar Category IV, and developed recurrent radiculopathy with motor weakness supported
by MRI findings, placing her in DRE Lumbar Category III. Because both Categories III and IV
are present, the AMA Guides directly place her in DRE Lumbar Category V, which allows up to
28% WPI based on limitations in activities of daily living (ADLs). (Id. at p. 48.)
vocational_expertRelied upon
Concluded applicant sustained 100% permanent disability due to lack of amenability to vocational rehabilitation and inability to compete in the open labor market due to physical limitations and chronic pain.
His vocational opinion was credited as substantial evidence supporting 100% permanent disability.
From the decision · page 1Applicant contends that the WCJ erred in rejecting the opinion of Vocational Expert (VE)
Frank Diaz, CDMS, who concluded that applicant sustained 100% permanent disability due to
lack of amenability to vocational rehabilitation. In addition, applicant contends that the
apportionment finding was legally erroneous because defendant failed to carry its burden of proof,
as the opinion of Panel Qualified Medical Evaluator (PQME) Wayne E. Anderson, D.O., was not
substantial medical evidence.
vocational_expertRejected
Concluded applicant effectively retired and did not meet legal criteria to rebut scheduled disability rating; opinion found speculative and legally insufficient due to lack of grounded factual basis and improper substitution of medical judgments.
Her vocational opinion was rejected as speculative and legally insufficient.