What the panel ordered
Petition for Reconsideration denied; WCJ's findings and award affirmed.
Defendant sought reconsideration of the WCJ's Joint Findings of Fact, Award, and Order issued October 16, 2024, which found injury AOE/COE and awarded permanent disability in ADJ14902030, and found no injury AOE/COE in ADJ19260558.
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.
The WCJ found no injury AOE/COE to the circulatory system/heart in ADJ19260558.
From the decision · page 1Defendant seeks reconsideration of the Joint Findings of Fact, Award, and Order (F&A) issued by a workers' compensation administrative law judge (WCJ) on October 16, 2024. In that decision, the WCJ found in pertinent part in Case No ADJ14902030 that applicant, while employed during the period of November 15, 2004 through January 23, 2021 as a firefighter by defendant the City of Daly City, sustained injury arising out of and in the course of employment to the respiratory system and circulatory system/heart and that applicant's injury caused permanent disability of 79% in Case No ADJ14902030, and she awarded permanent disability, attorney's fees, and a life pension; and in Case No. ADJ19260558 that applicant, while employed during the period of January 1, 2005 through January 23, 2021 as a firefighter, by the City of Daly City, did not sustain injury arising out of and in the course of employment to the circulatory system/heart and ordered that applicant take nothing in Case No. ADJ19260558.
The WCJ found that applicant's employment caused a single injury to the respiratory and circulatory system/heart, supported by medical evidence and employment history.
From the decision · page 1Defendant seeks reconsideration of the Joint Findings of Fact, Award, and Order (F&A) issued by a workers' compensation administrative law judge (WCJ) on October 16, 2024. In that decision, the WCJ found in pertinent part in Case No ADJ14902030 that applicant, while employed during the period of November 15, 2004 through January 23, 2021 as a firefighter by defendant the City of Daly City, sustained injury arising out of and in the course of employment to the respiratory system and circulatory system/heart and that applicant's injury caused permanent disability of 79% in Case No ADJ14902030, and she awarded permanent disability, attorney's fees, and a life pension; and in Case No. ADJ19260558 that applicant, while employed during the period of January 1, 2005 through January 23, 2021 as a firefighter, by the City of Daly City, did not sustain injury arising out of and in the course of employment to the circulatory system/heart and ordered that applicant take nothing in Case No. ADJ19260558.
The WCJ found that defendant did not meet its burden to show that any of applicant's disability was caused by nonindustrial factors, as the apportionment analysis was not substantial evidence.
From the decision · page 8Although I do find that Dr. Nacouzi provided sufficient analysis of how applicant's obesity contributed to his impairment, the remainder of the apportionment analysis is not substantial evidence, and therefore his apportionment determination is not substantial evidence. I therefore find that [defendant] has not met its burden on this issue. (Opinion on Decision, January 23, 2025, pp. 1-8, 9, 10-11.)
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Dr. Nacouzi's apportionment analysis was not substantial evidence except as to obesity; no sufficient explanation for apportionment to allergies or prior employment.
Favours Applicant prevailed
Led to finding that defendant did not meet burden on apportionment, resulting in award to applicant.
From the decision · page 8Although I do find that Dr. Nacouzi provided sufficient analysis of how applicant's obesity contributed to his impairment, the remainder of the apportionment analysis is not substantial evidence, and therefore his apportionment determination is not substantial evidence. I therefore find that [defendant] has not met its burden on this issue. (Opinion on Decision, January 23, 2025, pp. 1-8, 9, 10-11.)
Applicant's employment as a firefighter caused a single cumulative injury to the respiratory and circulatory system/heart.
Favours Applicant prevailed
Supported finding of injury AOE/COE and award of permanent disability.
From the decision · page 1Defendant seeks reconsideration of the Joint Findings of Fact, Award, and Order (F&A) issued by a workers' compensation administrative law judge (WCJ) on October 16, 2024. In that decision, the WCJ found in pertinent part in Case No ADJ14902030 that applicant, while employed during the period of November 15, 2004 through January 23, 2021 as a firefighter by defendant the City of Daly City, sustained injury arising out of and in the course of employment to the respiratory system and circulatory system/heart and that applicant's injury caused permanent disability of 79% in Case No ADJ14902030, and she awarded permanent disability, attorney's fees, and a life pension; and in Case No. ADJ19260558 that applicant, while employed during the period of January 1, 2005 through January 23, 2021 as a firefighter, by the City of Daly City, did not sustain injury arising out of and in the course of employment to the circulatory system/heart and ordered that applicant take nothing in Case No. ADJ19260558.
What the panel did with the medical opinions
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.
Treated applicant for pulmonary condition related to occupational exposure.
From the decision · page 2The employer has furnished all medical treatment. The primary treating physician for the pulmonary is Dr. David Goodman, while the primary treating physician for the heart is Dr. Anand Soni.
Treated applicant for heart condition related to occupational exposure.
From the decision · page 2The employer has furnished all medical treatment. The primary treating physician for the pulmonary is Dr. David Goodman, while the primary treating physician for the heart is Dr. Anand Soni.
Diagnosed occupational asthma, apportioned impairment among industrial and nonindustrial factors, but apportionment analysis found not substantial evidence by WCJ.
QME apportioned impairment to obesity, prior employment, and allergies, but WCJ found analysis insufficient except for obesity.
From the decision · page 8Although I do find that Dr. Nacouzi provided sufficient analysis of how applicant's obesity contributed to his impairment, the remainder of the apportionment analysis is not substantial evidence, and therefore his apportionment determination is not substantial evidence. I therefore find that [defendant] has not met its burden on this issue. (Opinion on Decision, January 23, 2025, pp. 1-8, 9, 10-11.)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604
Defendant has the burden of establishing the percentage of permanent disability caused by nonindustrial factors. Medical opinion on apportionment must set forth reasoning in support of its conclusions.
Applied to determine whether defendant met burden on apportionment.
From the decision · page 7The defendant has the burden of establishing the percentage of permanent disability caused by nonindustrial factors. (Escobedo vs. Marshalls (2005) 70 Cal.Comp.Cases 604, 614 (en banc).) In order to be considered substantial medical evidence on apportionment, the medical opinion "must set forth reasoning in support of its conclusions." (Id. at 621.)
Lab. Code, § 3600(a); South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291
Injury AOE/COE must be proven by a preponderance of the evidence; employment must be a contributing cause of injury.
Applied to determine compensability of injury.
From the decision · page 10The employee bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297 298, 302 [80 Cal.Comp.Cases 489]; Lab. Code, § 3600(a) & 3202.5.) An injury must be proximately caused by the employment in order to be compensable. (Lab. Code, § 3600(a)(3); see also Clark, supra, 61 Cal.4th at pp. 297-298.) Proximate cause in workers' compensation requires the employment be a contributing cause of the injury. (Clark, supra, 61 Cal.4th at pp. 297-298 [outlining this standard and analyzing the difference between causation in tort law and causation in workers' compensation].) Here, the WCJ correctly found that the events of applicant's employment during the period of exposure caused a single injury to applicant.
What proof carried it
The evidence the panel weighed, by kind.
Dr. Nacouzi's apportionment analysis was not substantial evidence except as to obesity; insufficient explanation for apportionment to allergies and prior employment.
From the decision · page 8Although I do find that Dr. Nacouzi provided sufficient analysis of how applicant's obesity contributed to his impairment, the remainder of the apportionment analysis is not substantial evidence, and therefore his apportionment determination is not substantial evidence. I therefore find that [defendant] has not met its burden on this issue. (Opinion on Decision, January 23, 2025, pp. 1-8, 9, 10-11.)
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