ADJ14038029 — California WCAB decision

What the panel ordered

Petition for reconsideration granted; prior decision rescinded; new findings substituted granting benefits for cumulative injury with date of injury December 11, 2020; compensation not barred by statute of limitations.

Applicant sought reconsideration of the September 26, 2023 Findings, Award and Order (F&A) regarding cumulative injury and date of injury determinations.

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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.

Statute of limitationsApplicant prevailedlow back · right leg · gastritis · gastroesophageal reflux disease · insomnia · hypertensive cardiac disease

The date of injury was set at December 11, 2020, when applicant first had compensable disability and knowledge of industrial causation, making the claim timely under section 5405.

From the decision · page 133. Pursuant to Labor Code section 5412, the date of injury was December 11, 2020. 4. Compensation is not barred by Labor Code section 5405. 5. Applicant's gastritis, gastroesophageal reflux disease and related insomnia are

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

The rules the panel named

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

Labor Code section 5412

Date of injury in cumulative injury cases is when employee first suffered disability and knew or should have known it was caused by employment.

Applied to determine date of injury for cumulative injury.

From the decision · page 9causes any disability or need for medical treatment." (Lab. Code, § 3208.1.) The date of a cumulative injury is defined by Section 5412, which provides, "[t]he date of injury in cases of occupational diseases or cumulative injuries is that date upon which the employee first suffered disability therefrom and either knew, or in the exercise of reasonable diligence should have known, that such disability was caused by his present or prior employment." (Lab. Code, § 5412.)

Labor Code section 5405

Compensation barred if claim not filed within one year of date of injury.

Applied to determine timeliness of claim for hypertensive cardiac disease.

From the decision · page 1Applicant seeks reconsideration of the September 26, 2023 Findings, Award and Order (F&A), wherein the workers' compensation administrative law judge (WCJ) found that applicant, while employed as a police officer from January, 1994, to December 31, 2013, sustained industrial injury to his low back and right leg, and in the form of gastritis, gastroesophageal reflux disease, insomnia and hypertensive cardiac disease. The WCJ determined that all of the components of the claimed injury were attributable to a single cumulative injury. The WCJ further determined that the date of injury for applicant's low back and right leg injury was December 16, 2020, and that applicant claim of gastritis and gastroesophageal reflux disease and related insomnia were compensable consequence injuries related to applicant's orthopedic injuries. Finally, the WCJ determined that the date of injury for the claimed hypertensive cardiac disease was June 14, 2013, and that applicant's claim of cardiac injury was barred by Labor Code1 section 5405.

What proof carried it

The evidence the panel weighed, by kind.

Testimony and credibilityfavours Applicant prevailed

Applicant's trial testimony and medical history reflect contemporaneous manifestation of orthopedic and internal medicine complaints.

From the decision · page 8Here, the WCJ determined that the entirety of the claimed injury arose from applicant's cumulative industrial exposures while working as a police officer from January, 1994 through December 31, 2013. (F&A, Opinion on Decision, at pp. 5-6.) The WCJ's opinion is substantiated in the physical and internal medicine QME opinions, who collectively ascribe industrial causation to the cumulative effects of applicant's employment through the end of 2013. (Ex. J-6, Report of Douglas Curran, D.C., dated December 11, 2020, at p. 24; Ex. J-7, Report of Roger Nacouzi, M.D., dated August 19, 2021, at pp. 8-10.) We further note that the applicant's trial testimony and the medical history adduced in the QME reporting reflects the contemporaneous manifestation of applicant's orthopedic and internal medicine complaints. (Minutes, at p. 4:3.) We therefore concur with the WCJ's determination that applicant sustained but one cumulative injury, from January, 1994 to December 31, 2013.

Medical recordsfavours Defendant prevailed

No evidence applicant had compensable disability or knowledge of industrial causation in 2013 despite medical visits and tests.

From the decision · page 10Here, applicant sought medical treatment on June 13, 2013 for heart palpitations and shortness of breath. There are no original records in evidence regarding applicant's medical evaluations in 2013, but the records reviewed by QME Dr. Nacouzi reflect that applicant was discharged from care following a nuclear stress test "that did not show any obvious disease." (Ex. J-7, Report of Roger Nacouzi, M.D., dated August 19, 2021, at p. 4.) While applicant's myocardial perfusion scan did identify enlargement of the ventricles, the medical record reflects no periods of temporary disability, no assessment of permanent disability, no temporary or permanent work restrictions, and no other indicia that applicant sustained permanent disability. (Id. at p. 5; Rodarte, supra, at p. 998.)

ADJ14038029 · March 12, 2024

What the panel ordered

What was disputed, and how it came out

The facts that decided it

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The rules the panel named

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