ADJ11428234 · October 17, 2025

The WCAB found the QME's medical opinion unclear and contradictory regarding whether the applicant's hypertension was an aggravation (new injury) or an exacerbation (not a new injury), and thus not substantial evidence. The WCAB remanded for further proceedings to clarify this issue and to determine applicability of presumption under Labor Code sections 3212.2 and 3212.10.

From the decision · page 7In the instant case, the QME's opinion regarding whether the applicant's current claim for his heart/hypertension is an exacerbation of the prior injuries or an aggravation, and thus a new injury, is unclear. Dr. Acheatel has opined that applicant's hypertension was "a continuation of a previous injury with cumulative involvement since 2005, up until retirement." (Joint Trial Exhibit #1, at p. 7.) In his deposition, Dr. Acheatel testified that it is his medical opinion that applicant's hypertension exacerbated by continuing to work as a correctional officer for defendant. (Joint Trial Exhibit #7, at p. 43.) However, Dr. Acheatel then also testified that applicant's hypertension worsened over time because "his blood pressure was more difficult to control." (Id. at p. 45.) It appears that Dr. Acheatel may misunderstand the legal distinction between an exacerbation and an aggravation. The QME's testimony and reporting is at times, contradictory, and consequently is not substantial medical evidence.

The QME's medical opinion was contradictory and unclear regarding whether the applicant's hypertension was an aggravation (new injury) or an exacerbation (not a new injury).

Favours Defendant prevailed

This lack of clarity led the WCAB to find the opinion not substantial evidence and remand for further proceedings.

From the decision · page 7In the instant case, the QME's opinion regarding whether the applicant's current claim for his heart/hypertension is an exacerbation of the prior injuries or an aggravation, and thus a new injury, is unclear. Dr. Acheatel has opined that applicant's hypertension was "a continuation of a previous injury with cumulative involvement since 2005, up until retirement." (Joint Trial Exhibit #1, at p. 7.) In his deposition, Dr. Acheatel testified that it is his medical opinion that applicant's hypertension exacerbated by continuing to work as a correctional officer for defendant. (Joint Trial Exhibit #7, at p. 43.) However, Dr. Acheatel then also testified that applicant's hypertension worsened over time because "his blood pressure was more difficult to control." (Id. at p. 45.) It appears that Dr. Acheatel may misunderstand the legal distinction between an exacerbation and an aggravation. The QME's testimony and reporting is at times, contradictory, and consequently is not substantial medical evidence.

Applicant's hypertension was a continuation of a previous injury with cumulative involvement since 2005 until retirement. The hypertension was exacerbated by continuing to work as a correctional officer, and worsened over time due to difficulty controlling blood pressure. The QME's opinion was found unclear and contradictory regarding whether this was an aggravation or exacerbation.

The QME's opinion was contradictory and did not clearly distinguish between aggravation and exacerbation, leading the WCAB to find it not substantial evidence.

From the decision · page 2FACTS We will briefly review the relevant facts. Applicant filed an Application for Adjudication of Claim claiming that while employed by defendant, Centinela State Prison, as a correctional officer from December 20, 2012 to August 14, 2018, he sustained injury arising out of and in the course of employment (AOE/COE) to his heart/hypertension. Applicant retired on August 17, 2018. Applicant previously obtained two Awards against defendant. One Award was issued on February 5, 2008 for case VNO0531518 at 5% PD for hypertension based on the findings by the internal agreed medical evaluator (AME), Timothy Reynolds M.D. (Joint Exhibit #15.) The Award was for a specific injury on May 17, 2006 and a cumulative injury from November 6, 1993 to August 7, 2006. (Id.) The second Award for case ADJ8872154 was for a cumulative injury from December 19, 2011 to December 19, 2012. The Award was issued on June 5, 2014 at 41% PD for the circulatory system (heart-hypertension) and psyche based on the findings by internal AME Dr. Ernest Levister, Jr., and psychiatry AME Dr. Carl Marusak. (Joint Exhibit #10.) The panel qualified medical evaluator (QME) Roger Acheatel M.D., evaluated the applicant for his claim of heart/hypertension on March 12, 2019. Dr. Acheatel subsequently issued several supplemental reports and was deposed on two occasions.

Labor Code section 5952(d)

Substantial evidence must be based on reasonable medical probability, accurate history, examination, and reasoning supporting conclusions.

Applied to evaluate the QME's medical opinion for substantial evidence.

From the decision · page 6Any decision of the WCAB 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].) In order to constitute substantial evidence, expert medical opinion must be framed in terms of reasonable medical probability, be based on an accurate history and an examination, and must set forth reasoning to support the expert conclusions reached. (E.L. Yeager v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc).)

LaTourette v. Workers' Comp. Appeals Bd. (1998) 17 Cal.4th 644

Burden of proof for injury arising out of and in the course of employment rests with the employee and must be met by preponderance of evidence.

Applied to the issue of injury AOE/COE.

From the decision · page 6Whether an employee's injury arose out of and in the course of employment is generally a question of fact to be determined in light of the particular circumstances of the case. (Wright v. Beverly Fabrics (2002) 95 Cal.App.4th 346 [67 Cal.Comp.Cases 51].) The burden of proving injury AOE/COE rests with the employee and must be met by a preponderance of the evidence. (LaTourette v. Workers' Comp. Appeals Bd. (1998) 17 Cal.4th 644 [63 Cal.Comp.Cases 253].)

Tanenbaum v. Industrial Acc. Com. (1935) 4 Cal.2d 615

Aggravation is an increase in severity of a pre-existing condition causing new injury; exacerbation is a temporary increase in symptoms without permanent worsening.

Applied to distinguish aggravation from exacerbation in injury analysis.

McClune v. Workers' Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117

The Appeals Board has discretionary authority to develop the record when medical evidence is not substantial or to provide due process.

Applied to justify remand for further development of medical record.

From the decision · page 8The Appeals Board has the discretionary authority to develop the record when the medical record is not substantial evidence or when appropriate to provide due process or fully adjudicate the issues. (McClune v. Workers' Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117, 1121-1122 [63 Cal.Comp.Cases 261]; see also Tyler v. Workers' Comp. Appeals Bd. (1997) 56 Cal.App.4th 389, 394 [62 Cal.Comp.Cases 924]; Lab. Code, § 5701, 5906.) The Appeals Board also has a constitutional mandate to "ensure substantial justice in all cases" and may not leave matters undeveloped where it is clear that additional discovery is needed. (Kuykendall v. Workers' Comp. Appeals Bd. (2000) 79 Cal.App.4th 396, 403-404 [65 Cal.Comp.Cases 264].) The "Board may act to develop the record with new evidence if, for example, it concludes that neither side has presented substantial evidence on which a decision could be based, and even that this principle may be appropriately applied in favor of the employee." (San Bernardino Cmty. Hosp. v. Workers' Comp. Appeals Bd. (McKernan) (1999) 74 Cal.App.4th 928, 937-938 [64 Cal.Comp.Cases 986].) The preferred procedure to develop a deficient record is to allow supplementation of the medical record by the physicians who have already reported in the case. (McDuffie v. Los Angeles County Metropolitan Transit Authority (2002) 67 Cal.Comp.Cases 138 (Appeals Board en banc).)

QME's contradictory and unclear medical opinion on aggravation vs exacerbation

From the decision · page 7In the instant case, the QME's opinion regarding whether the applicant's current claim for his heart/hypertension is an exacerbation of the prior injuries or an aggravation, and thus a new injury, is unclear. Dr. Acheatel has opined that applicant's hypertension was "a continuation of a previous injury with cumulative involvement since 2005, up until retirement." (Joint Trial Exhibit #1, at p. 7.) In his deposition, Dr. Acheatel testified that it is his medical opinion that applicant's hypertension exacerbated by continuing to work as a correctional officer for defendant. (Joint Trial Exhibit #7, at p. 43.) However, Dr. Acheatel then also testified that applicant's hypertension worsened over time because "his blood pressure was more difficult to control." (Id. at p. 45.) It appears that Dr. Acheatel may misunderstand the legal distinction between an exacerbation and an aggravation. The QME's testimony and reporting is at times, contradictory, and consequently is not substantial medical evidence.