ADJ14079246 · May 26, 2026

The WCJ's 5% WPI rating for the right shoulder was not supported by substantial medical evidence, and Dr. Mandell's 17% WPI rating based on grip strength loss was not adequately clarified or supported. The Appeals Board found a lack of substantial evidence to support either rating and remanded for further proceedings.

From the decision · page 6However, the WCJ did not follow Dr. Mandell's conclusions and determined that the WPI for the shoulder should be 5%, with a permanent disability rating of 11% and therefore applicant's permanent disability rating, including both the neck and right shoulder, was 26%. (Opinion on Decision (OOD), pp. 4-6; F&A, pp. 1-2.) The WCJ stated that Dr. Mandell's alternative rating might be viable under other circumstances. (OOD, pp. 4-6.) The WCJ explained that Dr. Mandell's use of grip strength was incorrect for an injury above the elbow and that the correct table for applicant's injury was 16-35 on page 510 of the AMA Guidelines. (OOD, pp. 4-6.)

Dr. Mandell's grip strength analysis was the only medical evidence supporting a 17% whole person impairment rating for the right shoulder.

Favours Applicant prevailed

The WCJ rejected this analysis without seeking further clarification, resulting in lack of substantial evidence to support the WPI rating.

From the decision · page 6Since the WCJ rejected the AME's grip strength analysis, the WCJ should have sought further clarification from Dr. Mandell. Dr Mandell's explanation does not address the how and why a metric designed for the below the elbow upper extremity injuries (grip strength) was used instead of the standard interpretation in the AMA Guidelines for a shoulder injury. Dr. Mandell's reports are the only medical evidence on this issue. There is also a lack of substantial medical evidence to support the use of the table identified by the WCJ. (See Blackledge, supra, 75 Cal.Comp.Cases at p. 616.)

Dr. Mandell found applicant had 8% WPI for neck and 5% WPI for right shoulder under strict AMA Guides criteria, but concluded the shoulder rating was inaccurate because it did not account for grip strength loss. He calculated a 17% whole person impairment for the shoulder based on grip strength loss.

Dr. Mandell's opinion was the only medical evidence on the issue and was offered with reasonable medical probability, but the WCJ rejected the grip strength analysis without adequate clarification, leading to lack of substantial evidence.

From the decision · page 2The AME Dr. Mandell submitted two reports. In his report of July 21, 2021, Dr. Mandell reported that applicant's surgery helped a little bit, that he did some physical therapy, and that he was off work for eight months. (Jt. Ex. 2, Report of Peter Mandell, M.D., dated 7/21/21, pp. 1-3.) He has since resumed work full-time. (Jt. Ex. 2, p. 7.) Dr. Mandell found applicant to be permanent and stationary. (Jt. Ex. 2, p. 7.) Dr. Mandell found that applicant had an 8% WPI for his neck. (Jt. Ex. 2, p. 7.) Dr. Mandell provided the following analysis for applicant's shoulder:

Dr. Campbell performed surgery on applicant's right shoulder on July 19, 2019.

From the decision · page 2Applicant sustained injury AOE/COE to his right shoulder and neck while working as a butcher for defendant on June 23, 2018. Applicant was in the cooler at work when some boxes fell and hit him on the neck and right shoulder. On July 19, 2019, primary treating physician (PTP) Dr. William Campbell, D.O. performed surgery on applicant's right shoulder. (Jt. Ex. 6, Surgical Report of William Campbell, D.O., dated 7/19/19, pp. 1-2.)

Brodie v. Workers' Comp. Appeals Bd. (2007) 40 Cal.4th 1313

Permanent disability is the irreversible residual of an injury and compensates for physical loss and loss of future earning capacity.

Applied to assess permanent disability in this case.

From the decision · page 4The workers' compensation system includes compensation for permanent disability. (Brodie v. Workers' Comp. Appeals Bd. (2007) 40 Cal.4th 1313, 1320.) "'[P]ermanent disability is understood as `the irreversible residual of an injury.'" (Id. at p. 1320, quoting Kopping v. Workers' Comp. Appeals Bd. (2006) 142 Cal.App.4th 1099, 1111.) "Thus, permanent disability payments are intended to compensate workers for both physical loss and the loss of some or all of their future earning capacity." (Brodie, supra, at p. 1320, citing Lab. Code, § 4660(a).)

Blackledge v. Bank of America (2010) 75 Cal.Comp.Cases 613

A physician must use AMA Guides to determine whole person impairments and provide reasoning; a single physician's opinion may establish WPI if substantial evidence.

Applied to evaluate medical-legal reports and WPI ratings.

From the decision · page 4When assessing an injured employee's permanent disability, the first step is a comprehensive medical-legal report prepared by a treating or evaluating physician. (Blackledge v. Bank of America (2010) 75 Cal.Comp.Cases 613, 619.) The physician uses the AMA Guides to determine the WPIs for the applicant's medical conditions. (Id. at pp. 619-620.) The physician must set forth their reasoning behind the WPI. (Id. at p. 621.) "The expert opinion of a single physician may establish an injured employee's WPI, provided that the opinion constitutes substantial evidence. (Id. at p. 620, citing Place v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 372, 378§ 379 [35 Cal.Comp.Cases 525, 529-539].) Permanent disability payments are then calculated by converting that degree of permanent disability into an award based on a table. (Department of Corrections & Rehabilitation v. Workers' Comp. Appeals Bd. (Fitzpatrick) (2018) 27 Cal.App.5th 607, 611 [83 Cal.Comp.Cases 1680], citing Ogilvie v. Workers' Comp. Appeals Bd. (2011) 197 Cal.App.4th 1262, 1270 [76 Cal.Comp.Cases 624].)

Almaraz v. Environmental Recovery Services (2009) 74 Cal.Comp.Cases 1084

Scheduled permanent disability ratings may be rebutted by showing factual errors or by using other AMA Guides methods that more accurately reflect impairment.

Applied to consider Dr. Mandell's Guzman rebuttal analysis.

From the decision · page 5Bd. en banc) (Almaraz II), we held that a "scheduled permanent disability rating may be rebutted by successfully challenging the component element of that rating relating to the employee's WPI under the AMA Guides....by establishing that another chapter, table, or method within the four corners of the Guides most accurately reflects the injured employee's impairment." (Id. at pp. 1095-1096.) In Milpitas Unified School District v. Workers' Comp. Appeals Bd. (Guzman) (2010) 187 Cal.App.4th 808 [75 Cal.Comp.Cases 837], the Court of Appeal affirmed our decision in Almaraz II.

lack of substantial medical evidence to support either Dr. Mandell's or the WCJ's WPI rating for the right shoulder

From the decision · page 6Since the WCJ rejected the AME's grip strength analysis, the WCJ should have sought further clarification from Dr. Mandell. Dr Mandell's explanation does not address the how and why a metric designed for the below the elbow upper extremity injuries (grip strength) was used instead of the standard interpretation in the AMA Guidelines for a shoulder injury. Dr. Mandell's reports are the only medical evidence on this issue. There is also a lack of substantial medical evidence to support the use of the table identified by the WCJ. (See Blackledge, supra, 75 Cal.Comp.Cases at p. 616.)