What the panel ordered
Petition for Reconsideration granted; WCJ's Findings and Order rescinded; matter returned for further proceedings and record development.
Petition for Reconsideration of WCJ's Findings and Order dated November 3, 2025, which found no industrial injury; applicant challenged the sufficiency of PQME evidence and premature determination of hearing loss injury.
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.
PQME Dr. McGahan's opinions were not substantial evidence due to inadequate medical history and incorrect legal theory; record requires further development.
From the decision · page 15Here, PQME Dr. McGahan's expert medical opinions are based on inadequate medical history and an incorrect legal theory and therefore are not substantial.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
PQME Dr. McGahan did not take a full history of applicant's repetitive job duties and relied on absence of prior claims.
Favours Applicant prevailed
Led to finding that PQME's opinion was not substantial evidence, requiring record development.
From the decision · page 14(Exhibit H, deposition PQME Dr. McGahan, February 26, 2025, p. 27, lns 4-12.) It is clear that in formulating his opinions, PQME Dr. McGahan did not take a full history of applicant's repetitive job duties. As noted above, PQME Dr. McGahan also states "there were no workers' compensation claims filed to my knowledge." (Exhibit C, PQME Dr. McGahan, July 27, 2024, p. 21.) This despite the fact the record refers to multiple claims, and includes a January 19, 1999 Employee's Claim for Workers' Compensation Benefits (DWC Form 1), claiming a January 15, 1999 back injury. (Exhibit 4, PDF p. 34.) This is not an inconsequential error. A decision must be based on admitted evidence in the record and must be supported by substantial evidence. (Lab. Code, § 5903, 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274, 281 [39 Cal.Comp.Cases 310].) "Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories. Medical opinion also fails to support the Board's findings if it is based on surmise, speculation, conjecture or guess." (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93].)
Parties stipulated at trial that discovery remains open with respect to AOE/COE and all other issues.
Favours Applicant prevailed
Showed that the WCJ's finding of no industrial injury was premature and subject to revision.
From the decision · page 163. Although we have considered this matter pursuant to Shipley as discussed above, we confirm, as an additional ground for our consideration of this matter, our continuing jurisdiction per section 5803. As noted above, at trial the parties stipulated that "[d]iscovery remains open with respect to AOE/COE and all other issues." (MOH, August 5, 2025, p. 2, lns 43-44, emphasis added.) This stipulation is not further discussed by the parties nor the WCJ. Stipulations further the public policies of settling disputes and expediting trials and a stipulation of the parties may not be set aside by the Board absent a finding of good cause. (Lab. Code, § 5702; County of Sacramento v. Workers' Comp. Appeals Bd. (Weatherall) (2000) 77 Cal. App.4th 1114, 1119 [65 Cal.Comp.Cases 1].) Here there is no discussion of this stipulation on discovery and certainly no "good cause" presented to set it aside. Considering this stipulation that "[d]iscovery remains open with respect to AOE/COE and all other issues," it is apparent that the part of the F&O finding that applicant did not sustain any industrial injury without identification of any body parts, it can be treated as an interim order subject to revision as may be warranted by further discovery.
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.
Found applicant's complaints due to natural aging, no industrial causation; opinion found not substantial due to inadequate history and incorrect legal theory.
Opinion based on inadequate medical history and incorrect legal theory, not substantial evidence.
From the decision · page 15Here, PQME Dr. McGahan's expert medical opinions are based on inadequate medical history and an incorrect legal theory and therefore are not substantial.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, § 3208.1
A cumulative injury is one 'occurring as repetitive mentally or physically traumatic activities extending over a period of time, the combined effect of which causes any disability or need for medical treatment.'
PQME's standard requiring disability or need for treatment on last day of work is incorrect; cumulative injury does not require such evidence on a specific day.
From the decision · page 13This analysis misses the mark as a cumulative injury is one "occurring as repetitive mentally or physically traumatic activities extending over a period of time, the combined effect of which causes any disability or need for medical treatment." (Lab. Code, § 3208.1.) There is no requirement that disability or need for treatment be evident in the medical records on a specific day. Under the standard applied by PQME Dr. McGahan, there would be no need for expert medical opinion as the trier of fact would simply be called upon to determine if there was existing medical evidence that medical treatment or work restrictions were due to an industrial injury at the time of the last day of work. Such is not the case.
Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93]
Medical reports and opinions are not substantial evidence if they are based on inadequate medical histories and examinations, or on incorrect legal theories.
PQME's opinion was not substantial evidence due to inadequate history and incorrect legal theory.
From the decision · page 14(Exhibit H, deposition PQME Dr. McGahan, February 26, 2025, p. 27, lns 4-12.) It is clear that in formulating his opinions, PQME Dr. McGahan did not take a full history of applicant's repetitive job duties. As noted above, PQME Dr. McGahan also states "there were no workers' compensation claims filed to my knowledge." (Exhibit C, PQME Dr. McGahan, July 27, 2024, p. 21.) This despite the fact the record refers to multiple claims, and includes a January 19, 1999 Employee's Claim for Workers' Compensation Benefits (DWC Form 1), claiming a January 15, 1999 back injury. (Exhibit 4, PDF p. 34.) This is not an inconsequential error. A decision must be based on admitted evidence in the record and must be supported by substantial evidence. (Lab. Code, § 5903, 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274, 281 [39 Cal.Comp.Cases 310].) "Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories. Medical opinion also fails to support the Board's findings if it is based on surmise, speculation, conjecture or guess." (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93].)
What proof carried it
The evidence the panel weighed, by kind.
PQME Dr. McGahan did not take a full history of applicant's repetitive job duties and relied on absence of prior claims rather than independent expert opinion.
From the decision · page 14(Exhibit H, deposition PQME Dr. McGahan, February 26, 2025, p. 27, lns 4-12.) It is clear that in formulating his opinions, PQME Dr. McGahan did not take a full history of applicant's repetitive job duties. As noted above, PQME Dr. McGahan also states "there were no workers' compensation claims filed to my knowledge." (Exhibit C, PQME Dr. McGahan, July 27, 2024, p. 21.) This despite the fact the record refers to multiple claims, and includes a January 19, 1999 Employee's Claim for Workers' Compensation Benefits (DWC Form 1), claiming a January 15, 1999 back injury. (Exhibit 4, PDF p. 34.) This is not an inconsequential error. A decision must be based on admitted evidence in the record and must be supported by substantial evidence. (Lab. Code, § 5903, 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274, 281 [39 Cal.Comp.Cases 310].) "Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories. Medical opinion also fails to support the Board's findings if it is based on surmise, speculation, conjecture or guess." (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93].)
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