ADJ19338918 · September 1, 2026

The Appeals Board found that PQME Dr. Greenberg's reports and deposition testimony constitute substantial medical evidence supporting 100% permanent disability and no apportionment to non-industrial factors, based on objective test data and clinical foundation.

From the decision · page 6In the current case, Dr. McClintock-Greenberg utilized Table 5-12 of the AMA Guides to capture Applicant's impairment, placing Applicant in Class 4 (51% - 100% WPI). (see Ex. 6, QME November 20, 2025 Report, pg. 2). Individuals with a Vo2max of less than 15 mL/(kgmin) or a METS score of less than 4.3 meet the criteria to be placed in Class 4. Applicant's Vo2max reading from the CPET was 10.5 ml/min/kg and his METS score was 2.3 which qualifies him for Class 4. (see Ex. 6, QME November 20, 2025 Report, pg. 2.; Ex. 5, QME Vol. III Deposition pg. 25, line 7). Dr. McClintock-Greenberg explained that the CPET results showed significant loss of lung function, suggesting that Applicant “has rapidly progressive lung disease, and not merely end-stage lung disease.” (see Ex. 6, QME November 20, 2025 Report, pg. 2). He provided 100% WPI, based on Applicant’s “end-stage lung disease due to pulmonary fibrosis with rapid deterioration of [Applicant’s] lung function.” (see Ex. 6, QME November 20, 2025 Report, pg. 3). Dr. McClintock-Greenberg warned that with Applicant’s “rapid decline in lung function, [Applicant] will not be alive in one year if he does not receive a bilateral lung transplant.” (see Ex. 6, QME November 20, 2025 Report, pg. 3).

Applicant's CPET results showed significant loss of lung function with Vo2max of 10.5 ml/min/kg and METS score of 2.3, qualifying for Class 4 impairment (51%-100% WPI).

Favours Applicant prevailed

Supported the finding of 100% whole person impairment and end-stage lung disease.

From the decision · page 6In the current case, Dr. McClintock-Greenberg utilized Table 5-12 of the AMA Guides to capture Applicant's impairment, placing Applicant in Class 4 (51% - 100% WPI). (see Ex. 6, QME November 20, 2025 Report, pg. 2). Individuals with a Vo2max of less than 15 mL/(kgmin) or a METS score of less than 4.3 meet the criteria to be placed in Class 4. Applicant's Vo2max reading from the CPET was 10.5 ml/min/kg and his METS score was 2.3 which qualifies him for Class 4. (see Ex. 6, QME November 20, 2025 Report, pg. 2.; Ex. 5, QME Vol. III Deposition pg. 25, line 7). Dr. McClintock-Greenberg explained that the CPET results showed significant loss of lung function, suggesting that Applicant “has rapidly progressive lung disease, and not merely end-stage lung disease.” (see Ex. 6, QME November 20, 2025 Report, pg. 2). He provided 100% WPI, based on Applicant’s “end-stage lung disease due to pulmonary fibrosis with rapid deterioration of [Applicant’s] lung function.” (see Ex. 6, QME November 20, 2025 Report, pg. 3). Dr. McClintock-Greenberg warned that with Applicant’s “rapid decline in lung function, [Applicant] will not be alive in one year if he does not receive a bilateral lung transplant.” (see Ex. 6, QME November 20, 2025 Report, pg. 3).

CT scans showed no evidence of COPD or emphysematous changes, ruling out tobacco use as a contributing factor to permanent disability.

Favours Applicant prevailed

Supported the finding of no apportionment to non-industrial factors.

From the decision · page 8Dr. McClintock-Greenberg acknowledged Applicant’s history of tobacco use when assessing apportionment of Applicant’s permanent disability to non- industrial factors. (see Ex. 2, QME April 16, 2025 Report, pg. 24). The doctor explained that CT scans are sensitive to picking up emphysematous changes, yet reviewed CT scans of Applicant’s chest found “no evidence of any chronic obstructive pulmonary disease (COPD) … or emphysematous changes.” (see Ex. 2, QME April 16, 2025 Report, pg. 24). Based on Applicant’s CT scan results, Dr. McClintock-Greenberg found Applicant’s prior tobacco use did not contribute at all to Applicant’s permanent disability and provided 0% apportionment to prior tobacco use. (see Ex. 2, QME April 16, 2025 Report, pg. 24).

Dr. Greenberg ruled out cardiac contribution to disability based on CPET raw data review, despite computer-generated ST elevation readings.

Favours Applicant prevailed

Supported the finding of no apportionment to cardiac disease.

From the decision · page 9III Deposition, pg. 18, line 25; pg. 19, line 1-9). The doctor personally reviewed the raw data from the CPET and found “no evidence of any ischemic changes during exercise that indicates that coronary artery disease is limiting the applicant's ability to perform physical activity”. (see Ex. 6, QME November 20, 2025 Report, pg. 2). Dr. McClintock-Greenberg concluded that based on the results of the CPET, there is no indication that coronary artery disease contributed to Applicant’s permanent disability. (see Ex. 6, QME November 20, 2025 Report, pg. 2).

Assigned 100% whole person impairment based on end-stage lung disease due to pulmonary fibrosis with rapid deterioration of lung function, requiring bilateral lung transplant; ruled out cardiac contribution to disability; found no apportionment to non-industrial factors such as tobacco use or coronary artery disease.

Based on objective CPET results, CT scans, and clinical review, Dr. Greenberg's opinion was found substantial medical evidence supporting permanent disability and apportionment findings.

From the decision · page 6In the current case, Dr. McClintock-Greenberg utilized Table 5-12 of the AMA Guides to capture Applicant's impairment, placing Applicant in Class 4 (51% - 100% WPI). (see Ex. 6, QME November 20, 2025 Report, pg. 2). Individuals with a Vo2max of less than 15 mL/(kgmin) or a METS score of less than 4.3 meet the criteria to be placed in Class 4. Applicant's Vo2max reading from the CPET was 10.5 ml/min/kg and his METS score was 2.3 which qualifies him for Class 4. (see Ex. 6, QME November 20, 2025 Report, pg. 2.; Ex. 5, QME Vol. III Deposition pg. 25, line 7). Dr. McClintock-Greenberg explained that the CPET results showed significant loss of lung function, suggesting that Applicant “has rapidly progressive lung disease, and not merely end-stage lung disease.” (see Ex. 6, QME November 20, 2025 Report, pg. 2). He provided 100% WPI, based on Applicant’s “end-stage lung disease due to pulmonary fibrosis with rapid deterioration of [Applicant’s] lung function.” (see Ex. 6, QME November 20, 2025 Report, pg. 3). Dr. McClintock-Greenberg warned that with Applicant’s “rapid decline in lung function, [Applicant] will not be alive in one year if he does not receive a bilateral lung transplant.” (see Ex. 6, QME November 20, 2025 Report, pg. 3).

Lab. Code § 4663

Apportionment of permanent disability must be based on causation and approximate percentages of industrial and non-industrial factors must be determined.

Dr. Greenberg addressed apportionment and found 100% industrial causation with no non-industrial contribution.

From the decision · page 13Section 4663 provides that “[a]pportionment of permanent disability shall be based on causation.” (Lab. Code, § 4663(a).) A doctor who prepares a report addressing the issue of permanent disability due to a claimed industrial injury must address the issue of causation of the permanent disability. (Lab. Code, § 4663(b).) Section 4663 requires that the doctor “make an apportionment determination by finding what approximate percentage of the permanent disability was caused by the direct result of injury arising out of and occurring in the course of employment and what approximate percentage of the permanent disability was caused by other factors both before and subsequent to the industrial injury, including prior industrial injuries.” (Lab. Code, § 4663(c).) Pursuant to section 4663(c) and section 5705, it is defendant that has the burden of establishing the approximate percentage of permanent disability caused by factors other than the industrial injury.

Lab. Code § 4660(c)

Permanent Disability Rating Schedule is prima facie evidence of permanent disability percentage.

The AMA Guides and PDRS were applied to assess permanent disability.

From the decision · page 6The touchstone of the workers' compensation system is industrial injury which results in occupational disability or death. Livitsanos v. Superior Court, 2 Cal.4th 744, 752. The American Medical Association's Guides to the Evaluation of Permanent Impairment (5th Edition, 2001) ("AMA Guides") provides impairment ratings meant to reflect an injured worker's functional limitations and the decrease in the individual's ability to perform common activities of daily living. § 1.2(a). Permanent disability, on the other hand, "causes impairment of earning capacity, impairment of the normal use of a member or a competitive handicap in the open labor market." Brodie v. Workers' Comp. Appeals Bd., 40 Cal.4th 1313, 1320. The California Permanent Disability Rating Schedule ("PDRS") is "prima facie evidence of the percentage of permanent disability to be attributed to each injury covered by the schedule." Lab. Code § 4660(c); Milpitas Unified Sch. Dist. v. Workers' Comp. Appeals Bd., 75 Cal. Comp. Cases 837, *17. For a reporting physician’s conclusions regarding impairment to be considered substantial medical evidence, they must provide a report that is "clear, accurate, and complete". AMA Guides § 2.6.

Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604

Medical opinion must be framed in terms of reasonable medical probability, based on pertinent facts and adequate examination, and set forth reasoning.

Dr. Greenberg's opinion was found to meet the substantial evidence standard under Escobedo.

From the decision · page 12(Bolton) (1983) 34 Cal.3d 159, 164 [48 Cal.Comp.Cases 566], emphasis removed and citations omitted.) To constitute substantial evidence “… a medical opinion must be framed in terms of reasonable medical probability, it must not be speculative, it must be based on pertinent facts and on an adequate examination and history, and it must set forth reasoning in support of its conclusions.” (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc).) Furthermore, the physician must explain the nature of the disease and how and why it is causing disability at the time of the evaluation. (Id.) For the reasons stated by the WCJ, as quoted above, we are persuaded that the opinion of PQME Dr. Greenberg is substantial medical evidence upon which the WCJ appropriately relied on the issues of permanent disability and apportionment. Moreover, conclusions of medical probability do not require an absolute certainty. (McAllister v. Workers’ Comp. Appeals Bd. (1968) Cal.2d 408 [33 Cal.Comp.Cases 660].)

AMA Guides § 2.6 requires impairment ratings to be clear, accurate, and complete to be substantial evidence.

Dr. Greenberg's use of AMA Guides tables to assign impairment was accepted as substantial evidence.

From the decision · page 6The touchstone of the workers' compensation system is industrial injury which results in occupational disability or death. Livitsanos v. Superior Court, 2 Cal.4th 744, 752. The American Medical Association's Guides to the Evaluation of Permanent Impairment (5th Edition, 2001) ("AMA Guides") provides impairment ratings meant to reflect an injured worker's functional limitations and the decrease in the individual's ability to perform common activities of daily living. § 1.2(a). Permanent disability, on the other hand, "causes impairment of earning capacity, impairment of the normal use of a member or a competitive handicap in the open labor market." Brodie v. Workers' Comp. Appeals Bd., 40 Cal.4th 1313, 1320. The California Permanent Disability Rating Schedule ("PDRS") is "prima facie evidence of the percentage of permanent disability to be attributed to each injury covered by the schedule." Lab. Code § 4660(c); Milpitas Unified Sch. Dist. v. Workers' Comp. Appeals Bd., 75 Cal. Comp. Cases 837, *17. For a reporting physician’s conclusions regarding impairment to be considered substantial medical evidence, they must provide a report that is "clear, accurate, and complete". AMA Guides § 2.6.

Objective CPET test results and CT scans showing no evidence of COPD or emphysematous changes, supporting no apportionment to tobacco use or cardiac disease.

From the decision · page 8Dr. McClintock-Greenberg acknowledged Applicant’s history of tobacco use when assessing apportionment of Applicant’s permanent disability to non- industrial factors. (see Ex. 2, QME April 16, 2025 Report, pg. 24). The doctor explained that CT scans are sensitive to picking up emphysematous changes, yet reviewed CT scans of Applicant’s chest found “no evidence of any chronic obstructive pulmonary disease (COPD) … or emphysematous changes.” (see Ex. 2, QME April 16, 2025 Report, pg. 24). Based on Applicant’s CT scan results, Dr. McClintock-Greenberg found Applicant’s prior tobacco use did not contribute at all to Applicant’s permanent disability and provided 0% apportionment to prior tobacco use. (see Ex. 2, QME April 16, 2025 Report, pg. 24).