ADJ12317646 — California WCAB decision

What the panel ordered

Petition for Reconsideration denied; original Opinion and Order Granting Petition for Reconsideration and Decision After Reconsideration affirmed.

Defendant seeks reconsideration of the Opinion and Order Granting Petition for Reconsideration and Decision After Reconsideration issued on January 29, 2026, which rescinded the Findings and Award issued by the WCJ on November 4, 2025, including the WCJ's findings on apportionment, and substituted it with a new Findings and Award affirming stipulations and returning the matter to trial for permanent disability calculation.

Read the official decision →

This docket was decided more than once. Shown here is the latest released decision; we also hold January 29, 2026.

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.

ApportionmentApplicant prevailedlumbar spine · bilateral hips · heart · hernia

The Appeals Board found that defendant did not meet the burden of proving nonindustrial apportionment with substantial medical evidence, as the opinions of Drs. Amster and Schmitz lacked specificity, reasoning, and supporting evidence as required by Escobedo and Gatten.

From the decision · page 7

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.

QMERejected · Pain Medicine

Found injury AOE/COE to multiple body parts and provided impairment ratings with tentative apportionment findings, but lacked specificity and reasoning for apportionment.

Lacked specificity, reasoning, and supporting evidence for apportionment as required by Escobedo and Gatten.

From the decision · page 7nonindustrial apportionment of impairment for the lumbar spine, bilateral hips, heart, and hernia for the cumulative injury claim ending on May 10, 2019 and that the opinions of Drs. Amster and Schmitz on the issue of apportionment are not written in accordance with the requirements outlined in Escobedo and Gatten given their lack of specificity, lack of reasoning, and lack of supporting evidence.

QMERejected · Internal Medicine/Cardiovascular

Provided apportionment percentages for hypertension and hernia but lacked specificity, reasoning, and supporting evidence for apportionment.

Lacked specificity, reasoning, and supporting evidence for apportionment as required by Escobedo and Gatten.

From the decision · page 7nonindustrial apportionment of impairment for the lumbar spine, bilateral hips, heart, and hernia for the cumulative injury claim ending on May 10, 2019 and that the opinions of Drs. Amster and Schmitz on the issue of apportionment are not written in accordance with the requirements outlined in Escobedo and Gatten given their lack of specificity, lack of reasoning, and lack of supporting evidence.

QMERelied upon · Ophthalmology

Diagnosed eye injuries AOE/COE with 11% WPI and need for future medical treatment; no apportionment indicated.

From the decision · page 3Dr. Edington evaluated applicant on October 14, 2021, and issued a report dated November 5, 2021, wherein he diagnosed applicant with an early cataract in the left eye and psychophakia and status post epiretinal membrane surgery in the right eye. (Exhibit 13, p. 7.) He concluded that applicant sustained injury AOE/COE to his eyes/vision with a resulting 11% WPI based upon visual acuity and field scores, with a continuing need for future medical treatment. (Id. at pp. 9- 10.) Non-industrial apportionment was not indicated.

The rules the panel named

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

Braewood Convalescent Hospital v. Workers' Comp. Appeals Bd. (Bolton) (1983) 34 Cal.3d 159, 164

Substantial evidence requires medical opinions to be reasonable, credible, and supported by reasoning, not speculation or inadequate facts.

Applied to evaluate the sufficiency of apportionment medical evidence.

From the decision · page 6As expressed in our O&O, "The term `substantial evidence' means evidence which, if true, has probative force on the issues. It is more than a mere scintilla, and means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion...It must be reasonable in nature, credible, and of solid value." (Braewood Convalescent Hospital v. Workers' Comp. Appeals Bd. (Bolton) (1983) 34 Cal.3d 159, 164 [48 Cal.Comp.Cases 566], emphasis removed and citations omitted.) Pursuant to E.L. Yeager v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th922, 928 [71 Cal.Comp.Cases 1687], "[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. (citations.) Further, a medical report is not substantial evidence unless it sets forth the reasoning behind the physician's opinion, not merely his or her conclusions. (citation.)" "A medical report which lacks a relevant factual basis cannot rise to a higher level than its own inadequate premises. Such reports do not constitute substantial evidence to support a denial of benefits. (citation.)" (Kyle v. Workers' Comp. Appeals Bd (City and County of San Francisco) (1987) 195 Cal.App.3d 614, 621.)

E.L. Yeager v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928

Medical opinion is not substantial evidence if based on inadequate facts, incorrect legal theories, or speculation.

Applied to assess the validity of apportionment medical opinions.

From the decision · page 6As expressed in our O&O, "The term `substantial evidence' means evidence which, if true, has probative force on the issues. It is more than a mere scintilla, and means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion...It must be reasonable in nature, credible, and of solid value." (Braewood Convalescent Hospital v. Workers' Comp. Appeals Bd. (Bolton) (1983) 34 Cal.3d 159, 164 [48 Cal.Comp.Cases 566], emphasis removed and citations omitted.) Pursuant to E.L. Yeager v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th922, 928 [71 Cal.Comp.Cases 1687], "[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. (citations.) Further, a medical report is not substantial evidence unless it sets forth the reasoning behind the physician's opinion, not merely his or her conclusions. (citation.)" "A medical report which lacks a relevant factual basis cannot rise to a higher level than its own inadequate premises. Such reports do not constitute substantial evidence to support a denial of benefits. (citation.)" (Kyle v. Workers' Comp. Appeals Bd (City and County of San Francisco) (1987) 195 Cal.App.3d 614, 621.)

Lab. Code, 5705; Pullman Kellogg v. Workers' Comp. Appeals Bd. (Normand) (1980) 26 Cal.3d 450, 456; Kopping v.Workers' Comp. Appeals Bd. (2006) 142 Cal.App.4th 1099, 1115; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 613 (Appeals Bd. en banc)

Defendant bears the burden to prove apportionment by reasonable medical probability.

Applied to apportionment burden of proof and evidentiary standards.

From the decision · page 6On the issue of apportionment, defendant carries the burden of proof. (Lab. Code, § 5705; Pullman Kellogg v. Workers' Comp. Appeals Bd. (Normand) (1980) 26 Cal.3d 450, 456 [45 Cal.Comp.Cases 170]; Kopping v.Workers' Comp. Appeals Bd. (2006) 142 Cal.App.4th 1099,

ADJ12317646 · May 4, 2026

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

What the panel did with the medical opinions

The rules the panel named

What proof carried it

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