ADJ12473312 · March 19, 2024

The WCJ and WCAB found no substantial evidence to establish industrial causation of the spinal cord hemorrhage and paralysis, relying on the agreed medical evaluator Dr. Anderson's opinion that causation was not more likely than not, despite reasonable doubt and timing coincidence.

From the decision · page 2374); that applicant testified he worked for the same employer as a carpenter for seven years without back pain limitation, but within five days of twisting his back when a piece of wood slipped from his grasp and he fell and sustained the compensable right knee injury, a pre-existing but asymptomatic spinal cyst ruptured causing spinal cord hemorrhage and paralysis; that the neurologic agreed medical evaluator (AME) Wayne Anderson, M.D., testified that although he retained a reasonable doubt about the mechanism that caused the spinal cord hemorrhage, he would find some industrial causation if the WCJ determined that reasonable doubt were to be resolved in applicant's favor; that no substantial evidence was presented to establish an alternative mechanism of the spinal cord hemorrhage; and, that the WCJ erred when determining compensability by placing a mistaken burden on applicant to establish "precise causation" of the mechanism of the spinal cord hemorrhage.

The WCJ found no compensable cumulative trauma during the employment period ending August 9, 2019, and the WCAB affirmed this finding.

From the decision · page 1Applicant sought reconsideration from the Findings and Order (F&O) issued by a WCJ on April 25, 2022 wherein the WCJ found that applicant sustained an injury arising out of in the course of his employment (AOE/COE) to his right knee in case number ADJ158123600, but did not sustain an injury AOE/COE in that case to his back or that lead to paralysis; that applicant did not sustain a cumulative injury AOE/COE during the period of employment ending August 9, 2019 in case number ADJ12473312; that the compensable knee injury did not cause permanent disability; and, that there is no need for medical treatment to cure or relieve from the effects of the compensable knee injury. The WCJ ordered that no compensation is payable in these cases.

The WCJ found the compensable knee injury did not cause permanent disability and no medical treatment was needed; the WCAB affirmed this finding.

From the decision · page 1Applicant sought reconsideration from the Findings and Order (F&O) issued by a WCJ on April 25, 2022 wherein the WCJ found that applicant sustained an injury arising out of in the course of his employment (AOE/COE) to his right knee in case number ADJ158123600, but did not sustain an injury AOE/COE in that case to his back or that lead to paralysis; that applicant did not sustain a cumulative injury AOE/COE during the period of employment ending August 9, 2019 in case number ADJ12473312; that the compensable knee injury did not cause permanent disability; and, that there is no need for medical treatment to cure or relieve from the effects of the compensable knee injury. The WCJ ordered that no compensation is payable in these cases.

Agreed medical evaluator Dr. Wayne Anderson was unable to find industrial causation for the spinal cord hemorrhage causing paralysis.

Favours Defendant prevailed

The WCJ and WCAB relied heavily on Dr. Anderson's expert opinion to deny compensability of the back injury and paralysis.

From the decision · page 6The parties engaged two agreed medical evaluators (AMEs), Dr. Joel Renbaum in orthopedics and Dr. Wayne Anderson in neurology. Of course, by the time he saw Dr. Renbaum, on December 18, 2019, applicant was unable to walk or, for that matter, to feel his right knee, so that AME found no residual impairment involving the knee. Dr. Anderson, in his several reports, describes considerable impairment, owing to the paralysis, but arguably no industrial causation of that condition. That being the crux of the matter, this AME's conclusions will be examined a bit more closely.

Applicant's testimony and medical history did not establish a causal link between the work injury and spinal cord hemorrhage.

Favours Defendant prevailed

The lack of substantial evidence supporting causation led to denial of compensability and benefits.

From the decision · page 8After trial, I concluded, chiefly relying on Dr. Anderson's reports and testimony, that applicant had not sustained his burden of proving that his thoracic spine was injured, whether at the time of his knee injury but independently of the knee, as a direct or indirect result of the knee injury, or cumulatively.

Dr. Anderson was unable to find industrial causation for the spinal cord hemorrhage causing paralysis despite reasonable doubt and timing coincidence; he concluded causation was not more likely than not.

Dr. Anderson's extensive analysis and reports concluded no convincing industrial causation for the spinal cord hemorrhage, which was the key issue in the case.

From the decision · page 6The parties engaged two agreed medical evaluators (AMEs), Dr. Joel Renbaum in orthopedics and Dr. Wayne Anderson in neurology. Of course, by the time he saw Dr. Renbaum, on December 18, 2019, applicant was unable to walk or, for that matter, to feel his right knee, so that AME found no residual impairment involving the knee. Dr. Anderson, in his several reports, describes considerable impairment, owing to the paralysis, but arguably no industrial causation of that condition. That being the crux of the matter, this AME's conclusions will be examined a bit more closely.

Dr. Renbaum found no residual impairment involving the knee as applicant was unable to walk or feel the knee at the time of examination.

Dr. Renbaum's examination showed no residual impairment from the knee injury, supporting the denial of permanent disability and medical treatment.

From the decision · page 6The parties engaged two agreed medical evaluators (AMEs), Dr. Joel Renbaum in orthopedics and Dr. Wayne Anderson in neurology. Of course, by the time he saw Dr. Renbaum, on December 18, 2019, applicant was unable to walk or, for that matter, to feel his right knee, so that AME found no residual impairment involving the knee. Dr. Anderson, in his several reports, describes considerable impairment, owing to the paralysis, but arguably no industrial causation of that condition. That being the crux of the matter, this AME's conclusions will be examined a bit more closely.

McAllister v. Workers' Comp. Appeals Bd. (1968) 69 Cal.2d 408

Reasonable doubt in workers' compensation cases must be resolved in favor of the employee, but causation must be established by a preponderance of the evidence.

Applicant argued reasonable doubt should be resolved in his favor, but the WCJ and WCAB found no substantial evidence of industrial causation.

From the decision · page 2Applicant contends that there is substantial medical evidence in the record to find injury AOE/COE to his back and that lead to paralysis in both cases because in workers' compensation cases, any reasonable doubt as to the determination of compensation in workers' compensation must be resolved in favor of the employee (citing among cases, McAllister v. Workers' Comp. Appeals Bd. (1968) 69 Cal.2d 408 [33 Cal.Comp.Cases 660] ("McAllister"); Pacific Employers Ins. Co. v. Industrial Acci. Com. (Ehrhardt) (1942) 19 Cal.2d 622 [1942 Cal. LEXIS 398]; Pacific Employers Ins. Group v. Workers' Comp. Appeals Bd. (Farris) (1966) 247 Cal.App.2d 102 [31 Cal.Comp.Cases 409]; Singer v. Industrial Acci. Com. (1930) 105 Cal. App.

Credibility and weight given to agreed medical evaluators' opinions, especially Dr. Anderson's extensive analysis and testimony

From the decision · page 3The WCJ filed a Report and Recommendation on Petition for Reconsideration (Report) recommending that the Petition for Reconsideration be denied because despite Dr. Anderson's unease with the coincidence of applicant's paralysis just days after the work-related injury to his right knee, and despite extensive examination of medical causation using his medical expertise, Dr. Anderson was unable to say that it was more likely than not that applicant's paralysis was connected to his work. The opinions of agreed medical evaluators (such as Drs. Anderson and Renbaum) are entitled to substantial weight absent a showing that they are based on an incorrect factual history or legal theory, or are otherwise unpersuasive (citing Power v. Workers' Comp. Appeals Bd. (1986) 179 Cal.App.3d 775 [51 Cal.Comp.Cases 114]; Siqueiros v. Workers' Comp. Appeals Bd. (1995) 60 Cal.Comp.Cases 150 (writ den.)).