Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, 5952(d)
Any award, order, or decision of the Appeals Board must be supported by substantial evidence.
The WCJ's decision was not supported by substantial evidence due to incomplete medical record and inadequate QME report.
From the decision · page 2DISCUSSION
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].) 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 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. (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162
[36 Cal.Comp.Cases 93]; Granado v. Workers' Comp. Appeals Bd. (1970) 69 Cal.2d 399, [33
Lab. Code, 4605
A qualified medical evaluator or authorized treating physician shall address any report procured pursuant to this section and shall indicate whether he or she agrees or disagrees with the findings or opinions stated in the report, and shall identify the bases for this opinion.
Dr. Sciaroni did not have complete medical record and thus her report was not substantial evidence.
From the decision · page 3Nothing contained in this chapter shall limit the right of the employee to provide,
at his or her own expense, a consulting physician or any attending physicians
whom he or she desires. Any report prepared by consulting or attending
physicians pursuant to this section shall not be the sole basis of an award of
compensation. A qualified medical evaluator or authorized treating physician
shall address any report procured pursuant to this section and shall indicate
whether he or she agrees or disagrees with the findings or opinions stated in the
report, and shall identify the bases for this opinion.
(Lab. Code, § 4605.)
McDuffie v. Los Angeles County Metropolitan Transit Authority (2002) 67 Cal.Comp.Cases 138 (Appeals Board en banc)
Sections 5701 and 5906 authorize the WCJ and the Board to obtain additional evidence, including medical evidence, at any time during the proceedings.
The Board ordered supplementation of the medical record and a new QME report to address injury AOE/COE.
From the decision · page 3In our en banc decision, McDuffie v. Los Angeles County Metropolitan Transit Authority
(2002) 67 Cal.Comp.Cases 138 (Appeals Board en banc), we stated that "[s]ections 5701 and 5906
authorize the WCJ and the Board to obtain additional evidence, including medical evidence, at any
time during the proceedings (Citations)." (Id at p. 141.) We also stated that before directing
augmentation of the medical record we must establish, as a threshold matter, that specific medical
opinions are deficient, for example, that they are inaccurate, inconsistent or incomplete. "Where
the medical record requires further development either after trial or submission of the case for
decision," the medical record should first be supplemented by physicians who have already
reported in the case. (Id., at pp. 139, 142.) Under the circumstances of this matter, it is appropriate