What the panel ordered
Petition for reconsideration granted in part; Findings affirmed except issue of injury AOE/COE deferred; matter remanded to WCJ for further proceedings.
Defendant sought reconsideration of the WCJ's Findings issued December 12, 2023, which found applicant's stroke injury arose out of and in the course of employment; the WCJ recommended denial of reconsideration; the WCAB granted reconsideration and remanded the issue of injury AOE/COE for further proceedings.
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.
The issue of whether the stroke injury was industrial was deferred because the medical opinions from QMEs Mahmoudi and Rutchik were not substantial evidence as they deferred causation to a cardiologist, and the record lacked substantial evidence on this threshold issue.
From the decision · page 1Defendant seeks reconsideration of the Findings issued by the workers' compensation administrative law judge (WCJ) on December 12, 2023, wherein the WCJ found in pertinent part that applicant's injury to his brain and nervous system, in the form of a stroke, arose out of and occurred in the course of his employment with defendant.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Both QMEs Mahmoudi and Rutchik deferred the causation of the stroke to a cardiologist, resulting in the medical opinions not constituting substantial evidence on causation.
Favours Defendant prevailed
This lack of substantial evidence on causation required deferral of the injury AOE/COE issue and remand for further proceedings.
From the decision · page 1Defendant contends that the reports from internal medicine qualified medical examiner (QME) Massoud Mahmoudi D.O., and neurology QME Jonathan S. Rutchik, M.D., are not substantial evidence that applicant's stroke was cardiac based, so applicant did not meet his burden of proof.
What the panel did with the medical opinions
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.
Believed applicant's cardiac, brain, and GI conditions were industrial; deferred causation of stroke to a neurologist; stated no cardiac source of emboli found; testified that if neurological causes ruled out, cardiovascular system would be the remaining plausible cause.
The opinion was ultimately not considered substantial evidence because the doctor deferred causation to a neurologist and did not provide a definitive causation opinion on the stroke.
From the decision · page 2BACKGROUND Applicant claimed injury to his heart/cardiovascular system, to his gastrointestinal system, and to his brain/nervous system in the form of a stroke, while employed by defendant as a correctional officer during the period from October 20, 2015, through October 20, 2016. The following is a brief summary of the numerous reports from Dr. Mahmoudi and Dr. Rutchik, and their deposition testimony, relevant to the issues addressed herein: Internal medicine QME Dr. Mahmoudi evaluated applicant on November 29, 2017. Dr. Mahmoudi examined applicant, took a history, and reviewed the medical record he was provided. The diagnoses included cerebrovascular accident, hypertension, and ventricular hypertrophy. (Joint Exh. AA, Massoud Mahmoudi D.O., December 18, 2017, p. 19.) The doctor stated, "I believe, within reasonable medical probability that the claimant's cardiac, brain, and the GI condition are industrial" and he requested that he be provided Veteran's Administration (VA) and "pre-injury" medical records. (Joint Exh. AA, p.
Diagnosed stroke due to embolism related to vertebral artery; opined cardiac issues (ventricular hypertrophy, atrial flutter, hypertension) were significant contributors; deferred cardiovascular causation to specialists; testimony showed deference to cardiology for final causation determination.
The opinion was ultimately not considered substantial evidence because the doctor deferred causation to a cardiologist and did not provide a definitive causation opinion on the stroke.
From the decision · page 3Neurology QME Dr. Rutchik evaluated applicant on September 23, 2020. After examining applicant, taking a history, and reviewing the medical record, Dr. Rutchik diagnosed applicant as having: "Cerebrovascular accident (CVA) - Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery [...] Hypertension [and] Ventricular hypertrophy." (Joint Exh. MM, Jonathan S. Rutchik, M.D., September 23, 2020, p. 12.) Dr. Rutchik's deposition was taken on April 28, 2023. At the deposition the doctor testified that:
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, 5952(d)
An award, order, or decision of the Appeals Board must be supported by substantial evidence.
The medical opinions must be substantial evidence, not based on speculation or conjecture, and must set forth reasoning behind the opinion.
From the decision · page 4DISCUSSION It is well established that 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. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312, 317 [35 Cal.Comp.Cases 500]; LeVesque v. Workmen's Comp. Appeals Bd. (1970) 1 Cal.3d 627, 635 [35 Cal.Comp.Cases 16]; Universal City Studios, Inc. v. Workers' Compensation Appeals Bd. (Lewis) (1979) 99 Cal.App.3d 647 [44 Cal.Comp.Cases 1133].) 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, and to be substantial evidence the medical opinion must set forth the reasoning behind the physician's opinion, not merely his or her conclusions; a mere legal conclusion does not furnish a basis for a finding. (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]; Granado v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 399 [33 Cal.Comp.Cases 647]; Bracken v. Workers' Comp. Appeals Bd. (1989) 214 Cal. App.
What proof carried it
The evidence the panel weighed, by kind.
The medical opinions of QMEs Mahmoudi and Rutchik deferred causation of stroke to a cardiologist, resulting in lack of substantial evidence on causation.
From the decision · page 1Defendant contends that the reports from internal medicine qualified medical examiner (QME) Massoud Mahmoudi D.O., and neurology QME Jonathan S. Rutchik, M.D., are not substantial evidence that applicant's stroke was cardiac based, so applicant did not meet his burden of proof.
The same issues, filtered across the whole corpus — or paste your own facts and let the search rank by factor match.
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