ADJ14966902 — California WCAB decision

What the panel ordered

Petition for Reconsideration denied. WCJ's finding that applicant's head contusion accelerated her brain cancer and that the cancer constitutes an injury AOE/COE is affirmed.

Defendant sought reconsideration of the WCJ's Findings and Award dated July 17, 2023, which found applicant's head contusion accelerated her brain cancer and that the cancer constitutes an injury AOE/COE.

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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.

AOE/COEApplicant prevailedhead · brain

The WCJ and Appeals Board found Dr. Santiago-Dieppa's deposition testimony to be substantial medical evidence that the applicant's head trauma accelerated the growth of her pre-existing brain tumor, making the cancer a compensable consequence of the industrial injury.

From the decision · page 4The parties proceeded to trial on May 22, 2023. The issues submitted for decision included the parts of body injured, and "Was the applicant's cancer caused or accelerated by the accepted workers' compensation injury, which was a contusion to the scalp." (Minutes of Hearing and Summary of Evidence (MOH/SOE), May 22, 2023, p. 2.)

The facts that decided it

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.

PTPRelied upon · neurosurgery

Dr. Santiago-Dieppa opined that while the trauma did not cause the tumor, it accelerated its growth, and that this acceleration was medically probable and at least one percent or more. He based his opinion on the patient's history and medical literature.

Deposition testimony and treating records found credible and well-reasoned by WCJ and Appeals Board.

From the decision · page 3Q... So did the falling of the shelf landing on her head, it didn't cause the tumor, right? A. It's my opinion that the trauma did not cause the tumor. It's my opinion that the shelf striking her head may have caused the rapid growth and presentation that she presented to my clinic with which is in agreement with what has been described in some cases in the literature. Q. Would you say that the trauma of the shelf falling on her head accelerated the growth of the meningioma? A. Based off the patient's history and the case reports in the literature, I would say, that's medically probable. Q So you can state within reasonable medical probability that the shelf falling and landing on her head at work accelerated the meningioma? A. That is correct. Q. Okay. And that acceleration is at least one percent or more; is that accurate? A. That is accurate. (App. Exh. 3, pp. 22 § 23

QMERejected · neurology

Dr. Berman opined that only the scalp contusion was industrial and that the brain tumor was not caused or accelerated by the industrial injury.

Opinion found less persuasive and not substantial evidence by WCJ and Appeals Board.

From the decision · page 4I previously commented that the patient was diagnosed with an anaplastic meningioma which is a WHO [World Health Organization] grade 3 intracranial/ cranial tumor. This lesion contains anaplastic or essentially pre-malignant cells that can very easily undergo a malignant transformation if not properly treated. The fact that the patient suffered a scalp contusion essentially over the area where the mass had been developing is purely coincidental. The scalp contusion in no way led to this lesion arising or progressing. The fact that the lesion progressed rapidly following the date of injury emphasizes the aggressiveness of this lesion and has virtually nothing to do with the scalp contusion itself. The scalp/skull/dural mass is purely non-industrial. The specific industrial injury suffered by the patient is a scalp contusion which has resolved. (Def. Exh. B, Blake W. Berman, D.O., October 28, 2022, p. 4.)

What proof carried it

The evidence the panel weighed, by kind.

Testimony and credibilityfavours Applicant prevailed

Applicant's testimony regarding the onset and rapid growth of the tumor at the site of the head injury was found reliable and supported by medical literature.

From the decision · page 3Q. So when you are reaching this conclusion that the head trauma that she suffered at work, specifically the shelf falling and landing on her head, when you reached the conclusion that that trauma accelerated the meningioma within medical probability, what are you basing your opinion on? A. Two pieces of evidence. Number one, the patient's history of illness. I found her to be reliable. The patient clearly stated to me that she did not have this lesion prior to the shelf hitting her head and then very soon, within two weeks of the shelf hitting her head, she had rapid and sustained growth. Number two, as has been described in the literature, there are case reports and an association between head trauma and the presentation of these primary extradural meningiomas. Q. So the mechanism of her injury supports that the tumor's growth was accelerated? A. That is correct. (App. Exh. 3, pp. 23 § 24.)

expert methodologyfavours Applicant prevailed

Medical literature cited by Dr. Santiago-Dieppa supporting the association between head trauma and accelerated tumor growth.

From the decision · page 3Q. So when you are reaching this conclusion that the head trauma that she suffered at work, specifically the shelf falling and landing on her head, when you reached the conclusion that that trauma accelerated the meningioma within medical probability, what are you basing your opinion on? A. Two pieces of evidence. Number one, the patient's history of illness. I found her to be reliable. The patient clearly stated to me that she did not have this lesion prior to the shelf hitting her head and then very soon, within two weeks of the shelf hitting her head, she had rapid and sustained growth. Number two, as has been described in the literature, there are case reports and an association between head trauma and the presentation of these primary extradural meningiomas. Q. So the mechanism of her injury supports that the tumor's growth was accelerated? A. That is correct. (App. Exh. 3, pp. 23 § 24.)

ADJ14966902 · September 27, 2023

What the panel ordered

What was disputed, and how it came out

The facts that decided it

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What the panel did with the medical opinions

The rules the panel named

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