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.
QMERelied upon · internal medicine
Diagnosed Long COVID Syndrome industrially related; provided detailed, well-reasoned opinions based on extensive record review and history; opined applicant unable to return to work until respiratory condition resolved.
His reports provided substantial medical evidence supporting chronic lung disease diagnosis and industrial causation.
From the decision · page 3(1999) 75
Cal.App.4th 1315, 1328 [64 Cal.Comp.Cases 1231].) This is particularly troubling where, as the
WCJ notes, "lung disease" is not a medical diagnosis, but rather a broad general term for a category
of conditions that prevent the lungs from working properly.
To be substantial evidence, a medical opinion must be well-reasoned, based on an adequate
history and examination, and it must disclose a solid underlying basis for the opinion. (Escobedo
v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Bd. en banc); see also E.L. Yeager
Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71
Cal.Comp.Cases 1687].)
Jonathan C. Ellis, M.D., QME in internal medicine issued reports dated January 25, 2022
(Exhibit 2) and October 30, 2023 (Exhibit 3). Dr. Ellis reviewed at least 2,152 pages of records
(Exhibit 2: QME report of Dr. Ellis, M.D., dated January 25, 2022, pp. 4, 6-58) and took a detailed
history (Id. pp. 68-71, 75-79.) Dr. Ellis explained the basis of his conclusions. (Id. pp. 76-82.) Dr.
Ellis's diagnoses include "Long COVID Syndrome which is industrially related." (Id. p. 82.) Dr.
Ellis provided a detailed analysis, his opinions are well-reasoned, based on an adequate history
QMEGiven great weight · pulmonary and internal medicine
Diagnosed complex case with prolonged hospitalizations post-COVID; found applicant temporarily totally disabled; recommended further diagnostic testing and continued maintenance treatment.
His findings were persuasive and consistent with chronic lung disease diagnosis.
From the decision · page 7The internal pulmonology panel QME, Dr. James Lineback, in his report of November 5,
2024,6 indicates that her primary complaints are chest pain and shortness of breath. She uses a
walker and supplemental oxygen. He diagnoses her with a history of COVID positivity and
shortness of breath, use of home oxygen, history of lung nodules and obstructive sleep apnea. Dr.
Lineback states that this is a "very complex case that involves two prolonged hospitalizations
following COVID positivity." Dr. Lineback finds her to be temporarily totally disabled.
QMEGiven great weight · neurology
Diagnosed Post COVID-19 pneumonia, long COVID syndrome with chronic dyspnea; found applicant not at maximum medical improvement; recommended continued cardiopulmonary therapy; found applicant credible.
His opinion bolstered the finding of chronic lung disease and was credited by the court.
From the decision · page 10Further, PQMEs in the other specialties bolster the court's conclusion that there is a
"chronic lung disease." Neurology PQME Dr. Fortanansce diagnoses Post COVID-19 pneumonia,
long covid syndrome with chronic dyspnea. He finds she is not yet at maximum medical
improvement and "cardiopulmonary therapy should definitely be continued."17 Dr. Fortanansce
states, "I do not feel that she is exaggerating her symptomology. She is a nurse and appeared to be
fairly straightforward in her history."18