ADJ11167605 · July 20, 2026

The WCJ found substantial medical evidence supporting the permanent disability rating based on the QME Dr. Feinberg's reports, including the justification for adding impairments rather than combining them, consistent with the en banc Vigil decision. The defendant's challenges to the impairment ratings and vocational evidence were rejected due to lack of substantial evidence.

From the decision · page 14In this case I found Dr. Feinberg’s reporting to be substantial medical evidence on impairments and adopted his finding of 60 percent WPI for the right upper extremity, and 20 percent WPI for the left upper extremity. Dr. Feinberg’s opinion was based on Table 13-22 on page 343 of the AMA Guides[.]… In this case I find that there was sufficient support in the reporting of Dr. Feinberg to justify his opinions on WPI. The applicant has consistently reported that she cannot use her dominant right upper extremity for self-care or daily activities. Therefore, she meets the stated criteria of a Class 4 impairment for the right upper extremity, which was what Dr. Feinberg assigned. The applicant also has consistently reported that she has difficulty with self-care activities with her non-dominant left upper extremity, thus meeting the criteria for a Class 3 impairment of the left upper extremity per Table 13-22. Dr. Feinberg’s physical examination of the applicant supported the applicant’s complaints in his observation of her bilateral upper extremities. He found reduced range of motions, positive tests, and obvious deformity.

Dr. Feinberg's November 11, 2024 report justifies adding impairments for bilateral upper extremities rather than combining them, supporting a 60% WPI for right and 20% WPI for left upper extremity.

Favours Applicant prevailed

This medical opinion was relied upon by the WCJ as substantial evidence to support the permanent disability rating and permanent total disability finding.

From the decision · page 8In an August 4, 2021 supplemental report, Dr. Feinberg clarified that his opinion regarding the applicant’s ability to engage in the open labor market was a medical opinion. (Joint Ex. 101, p. 1.) He further stated that the issue of applicant’s ability to compete in the open labor market needed to be opined upon by a vocational expert. (Ibid.) Joint Exhibit 109: Report of QME Steven Feinberg, M.D., dated November 11, 2024. The applicant was re-examined on November 11, 2024, with Dr. Feinberg having been provided updated medical records as well as the surveillance video previously summarized in the 8/9/2023 Opinion on pages 7-8. At the time of the re-evaluation the applicant had complaints of pain to the bilateral upper extremities with the right worse than the left. (Joint Ex. 109, pp. 18-19.) She was unable to move the fingers of her right hand, and her hand was stuck in the open position. (Id. at p. 18.) Although having constant left hand pain, she was able to use that hand normally, including opening and closing her hand, but the hand became tired and weak quickly. (Id.

Applicant consistently reported inability to use dominant right upper extremity for self-care and difficulty with non-dominant left upper extremity, supported by physical examination findings.

Favours Applicant prevailed

Supports the impairment ratings and the finding of permanent total disability.

From the decision · page 14In this case I found Dr. Feinberg’s reporting to be substantial medical evidence on impairments and adopted his finding of 60 percent WPI for the right upper extremity, and 20 percent WPI for the left upper extremity. Dr. Feinberg’s opinion was based on Table 13-22 on page 343 of the AMA Guides[.]… In this case I find that there was sufficient support in the reporting of Dr. Feinberg to justify his opinions on WPI. The applicant has consistently reported that she cannot use her dominant right upper extremity for self-care or daily activities. Therefore, she meets the stated criteria of a Class 4 impairment for the right upper extremity, which was what Dr. Feinberg assigned. The applicant also has consistently reported that she has difficulty with self-care activities with her non-dominant left upper extremity, thus meeting the criteria for a Class 3 impairment of the left upper extremity per Table 13-22. Dr. Feinberg’s physical examination of the applicant supported the applicant’s complaints in his observation of her bilateral upper extremities. He found reduced range of motions, positive tests, and obvious deformity.

Defendant did not provide substantial medical evidence to rebut Dr. Feinberg's impairment opinions or challenge the change in WPI rating.

Favours Applicant prevailed

Lack of rebuttal evidence led to acceptance of Dr. Feinberg's impairment ratings and permanent disability finding.

From the decision · page 15and are based on reasonable medical probability. I therefore found that Dr. Feinberg’s opinions on impairment are substantial medical evidence. Defendant argues that Dr. Feinberg’s rating of 60% WPI for the right upper extremity should not be used because he failed to justify the change from 50% WPI in his earlier reporting. (Def. Trial Brief, filed 1/20/206, p.7, line 10 - p. 9, line 8; 5/16/2016 Petition, p. 11, line 29 – p. 12, line 4.) Defendant had suggested that the change was based on the applicant’s unreliable subjective complaints. (Def. Trial Brief, filed 1/20/206, p. 9, lines 2-5.) This disregards that Dr. Feinberg also reviewed additional medical records, and the surveillance footage. I believe that Dr. Feinberg is only obligated to justify and support his current impairment rating, and I continue to find that he has done that. I do not believe that Dr. Feinberg is required to justify a change from a prior impairment when the change is not challenged by defendant in a deposition or through a request for a supplemental report. The defendant did not undertake those efforts and presented no substantial medical evidence to rebut Dr. Feinberg’s impairment opinion. Besides not questioning the change in WPI from prior reporting, the defendant also failed to depose Dr. Feinberg to challenge his opinion of 60% WPI. I continue to be persuaded by Dr.

Dr. Feinberg opined that the bilateral upper extremity impairments should be added rather than combined, justifying a 60% WPI for the right upper extremity and 20% WPI for the left upper extremity, with causation industrial and need for future medical care.

Supported by physical examination, applicant's complaints, and consistent with Vigil en banc decision on adding impairments.

From the decision · page 8In an August 4, 2021 supplemental report, Dr. Feinberg clarified that his opinion regarding the applicant’s ability to engage in the open labor market was a medical opinion. (Joint Ex. 101, p. 1.) He further stated that the issue of applicant’s ability to compete in the open labor market needed to be opined upon by a vocational expert. (Ibid.) Joint Exhibit 109: Report of QME Steven Feinberg, M.D., dated November 11, 2024. The applicant was re-examined on November 11, 2024, with Dr. Feinberg having been provided updated medical records as well as the surveillance video previously summarized in the 8/9/2023 Opinion on pages 7-8. At the time of the re-evaluation the applicant had complaints of pain to the bilateral upper extremities with the right worse than the left. (Joint Ex. 109, pp. 18-19.) She was unable to move the fingers of her right hand, and her hand was stuck in the open position. (Id. at p. 18.) Although having constant left hand pain, she was able to use that hand normally, including opening and closing her hand, but the hand became tired and weak quickly. (Id.

Dr. Rakkar agreed with Dr. Feinberg's opinions on impairment but did not review the latest QME report.

Agreement with Dr. Feinberg's impairment opinions supports the permanent disability rating.

From the decision · page 10Dr. Feinberg opined that causation of the upper extremity injury was industrial. (Joint Ex. 109, p. 27.) Dr. Feinberg opined that apportionment for the bilateral upper extremities is 100% to the medical treatment and the resulting CRPS. (Id. at p. 27.) It is not explicitly stated that the medical treatment was for the industrial injury. Dr. Feinberg additionally stated that there is a need for future medical care. (Id. at p. 27.) Applicant’s Exhibit 7: Report of George Rakkar, M.D., dated November 3, 2025. Dr. Rakkar is the applicant’s primary treating physician. (Minutes of Hearing and Summary of Evidence (MOH/SOE), March 2, 2023, p, 2, line 26.) In a telemedicine treatment report of November 3, 2025, the applicant indicated to Dr. Rakkar that there were no significant changes in her condition. (Applicant’s Ex. 7, p. 2.) It did not appear that Dr. Rakkar reviewed the November 11, 2024 report of Dr. Feinberg because he references the older June 29, 2021 report. (Id. at p. 2.) Dr. Rakkar states that he was entirely in agreement with the opinions of Dr. Feinberg. (Id. at p.

Vigil (Sammy) v. County of Kern, (2024) 89 Cal. Comp. Cases 686, 694 (Appeals Board en banc)

The Combined Values Chart (CVC) in the Permanent Disability Ratings Schedule (PDRS) may be rebutted and impairments may be added where an applicant establishes the impact of each impairment on the activities of daily living (ADLs) and that either: (a) there is no overlap between the effects on ADLs as between the body parts rated; or (b) there is overlap, but the overlap increases or amplifies the impact on the overlapping ADLs.

Applied to justify adding impairments rather than combining them for permanent disability rating.

From the decision · page 13denied), the Appeals Board held that while impairments are generally to be combined, alternative methods of rating impairment may be utilized. (Id. at page 216.) The scheduled impairment rating is rebuttable, and simple addition of impairments, rather than combining impairments, may be used where justified. (Id. at page 216.) Further clarification on adding impairments was provided in the en banc decision in Vigil (Sammy) v. County of Kern, (2024) 89 Cal. Comp. Cases 686. That decision held that: “The Combined Values Chart (CVC) in the Permanent Disability Ratings Schedule (PDRS) may be rebutted and impairments may be added where an applicant establishes the impact of each impairment on the activities of daily living (ADLs) and that either: (a) there is no overlap between the effects on ADLs as between the body parts rated; or (b) there is overlap, but the overlap increases or amplifies the impact on the overlapping ADLs.” (Vigil (Sammy) v. County of Kern, (2024) 89 Cal. Comp. Cases 686, 694 (Appeals Board en banc).)

Applicant's consistent reports of inability to use dominant right upper extremity for self-care and difficulty with non-dominant left upper extremity

From the decision · page 14In this case I found Dr. Feinberg’s reporting to be substantial medical evidence on impairments and adopted his finding of 60 percent WPI for the right upper extremity, and 20 percent WPI for the left upper extremity. Dr. Feinberg’s opinion was based on Table 13-22 on page 343 of the AMA Guides[.]… In this case I find that there was sufficient support in the reporting of Dr. Feinberg to justify his opinions on WPI. The applicant has consistently reported that she cannot use her dominant right upper extremity for self-care or daily activities. Therefore, she meets the stated criteria of a Class 4 impairment for the right upper extremity, which was what Dr. Feinberg assigned. The applicant also has consistently reported that she has difficulty with self-care activities with her non-dominant left upper extremity, thus meeting the criteria for a Class 3 impairment of the left upper extremity per Table 13-22. Dr. Feinberg’s physical examination of the applicant supported the applicant’s complaints in his observation of her bilateral upper extremities. He found reduced range of motions, positive tests, and obvious deformity.

Dr. Feinberg's physical examination findings of reduced range of motion, positive tests, and obvious deformity in bilateral upper extremities

From the decision · page 14In this case I found Dr. Feinberg’s reporting to be substantial medical evidence on impairments and adopted his finding of 60 percent WPI for the right upper extremity, and 20 percent WPI for the left upper extremity. Dr. Feinberg’s opinion was based on Table 13-22 on page 343 of the AMA Guides[.]… In this case I find that there was sufficient support in the reporting of Dr. Feinberg to justify his opinions on WPI. The applicant has consistently reported that she cannot use her dominant right upper extremity for self-care or daily activities. Therefore, she meets the stated criteria of a Class 4 impairment for the right upper extremity, which was what Dr. Feinberg assigned. The applicant also has consistently reported that she has difficulty with self-care activities with her non-dominant left upper extremity, thus meeting the criteria for a Class 3 impairment of the left upper extremity per Table 13-22. Dr. Feinberg’s physical examination of the applicant supported the applicant’s complaints in his observation of her bilateral upper extremities. He found reduced range of motions, positive tests, and obvious deformity.