ADJ8264803 — California WCAB decision

What the panel ordered

Defendant's petition for reconsideration denied; applicant's petition for reconsideration granted; May 14, 2024 Findings and Order rescinded; issues deferred with jurisdiction reserved; record development ordered.

Petitions for reconsideration filed by applicant and defendant; WCJ's May 14, 2024 Findings and Order rescinded; issues deferred and record development ordered.

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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.

Reopening / new and further disabilityMixedneck · right shoulder · back · hernia · respiratory system · thoracic spine · mid-back · atherosclerotic heart disease · left shoulder · feet · psyche

The Board found that the petition for new and further disability was timely filed and that the WCJ properly ordered development of the record due to incomplete medical reporting and the unavailability of the original AME, Dr. Angerman, to issue final opinions on permanent disability and apportionment.

From the decision · page 1Applicant and defendant State Compensation Insurance Fund (defendant) both seek reconsideration of the May 14, 2024 Findings and Order (F&O), wherein the workers' compensation administrative law judge (WCJ) found that applicant, while employed as a heavy equipment operator from April 21, 2010 to April 21, 2011, sustained industrial injury to his neck, right shoulder, back, hernia, respiratory [system], thoracic spine, mid-back and atherosclerotic heart disease. The WCJ determined in relevant part, and with respect to applicant's Petition for New and Further disability, that applicant did not sustain injury to the hands, knees, internal or urological systems, and that the court lacked jurisdiction to award new and further disability to the left shoulder, feet and psyche. The WCJ further determined that development of the record was necessary with respect to the issues of permanent disability and apportionment.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

Applicant filed a timely Petition to Reopen on February 10, 2016, within five years of the injury period ending April 21, 2011.

Favours Applicant prevailed

This timely filing invoked the continuing jurisdiction of the WCAB under Labor Code section 5410, allowing consideration of new and further disability.

From the decision · page 2On February 10, 2016, applicant filed a Petition to Reopen, alleging new and further disability due to "increased symptomatology." The petition is not specific as to the body parts or conditions claimed to have sustained new and further disability.

The original orthopedic AME, Dr. Angerman, became unavailable before issuing final opinions on permanent disability and apportionment.

Favours Applicant prevailed

This necessitated development of the record to fully adjudicate the issues, supporting the Board's order to develop the record.

From the decision · page 5(Id. at p. 5.) The WCJ also notes that the reporting of Dr. Angerman was not completed prior to Dr. Angerman's passing, and that the court "cannot provide an opinion and finding without a final report laying out Applicant's disability, therefore, further development of the record is required." (Id. at p. 6.)

The WCJ found no evidence of industrial injury to hands, knees, internal, urological systems, and no jurisdiction for new and further disability to left shoulder, feet, and psyche within the five-year period.

Favours Defendant prevailed

This limited the scope of compensable new and further disability, supporting partial denial of claims.

From the decision · page 3On May 14, 2024, the WCJ issued her decision, finding in relevant part that applicant did not sustain injury arising out of and occurring in the course of employment to the hands, knees, internal cardiovascular hypertension and high blood pressure, and urological [system]. (Finding of Fact No. 2.) The WCJ further determined that the court lacked jurisdiction to award new and further disability to the left shoulder, feet and psyche, and that the evidentiary record was inadequate to determine the extent of permanent disability and apportionment. (Findings of Fact Nos. 3 & 5.) The WCJ's Opinion on Decision explained that with respect to the left shoulder, the medical record did not establish injury to the body part within five years of the date of injury; with respect to the mid-back, the WCJ noted it was unclear why this body part was in issue, given AME Dr. Angerman's discussion of the body part in 2013; with respect to the hands, knees and feet, the WCJ found no evidence establishing injury arising out of and in the course of employment (AOE/COE). (Opinion on Decision, at p.

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.

AMERelied upon · orthopedic medicine

Declared applicant permanent and stationary in May 2017; did not complete final opinions on permanent disability and apportionment before passing away.

The WCJ ordered record development because Dr. Angerman was no longer available to complete final opinions on disability and apportionment.

From the decision · page 1Defendant contends the WCJ erred in ordering development of the record because the Agreed Medical Evaluator (AME) Dr. Angerman declared applicant to be permanent and

AMERelied upon · internal medicine

Opined that hypertension and urological conditions were nonindustrial.

The WCJ found no industrial injury to hypertension and urological systems based on Dr. Majcher's opinion.

From the decision · page 3On May 14, 2024, the WCJ issued her decision, finding in relevant part that applicant did not sustain injury arising out of and occurring in the course of employment to the hands, knees, internal cardiovascular hypertension and high blood pressure, and urological [system]. (Finding of Fact No. 2.) The WCJ further determined that the court lacked jurisdiction to award new and further disability to the left shoulder, feet and psyche, and that the evidentiary record was inadequate to determine the extent of permanent disability and apportionment. (Findings of Fact Nos. 3 & 5.) The WCJ's Opinion on Decision explained that with respect to the left shoulder, the medical record did not establish injury to the body part within five years of the date of injury; with respect to the mid-back, the WCJ noted it was unclear why this body part was in issue, given AME Dr. Angerman's discussion of the body part in 2013; with respect to the hands, knees and feet, the WCJ found no evidence establishing injury arising out of and in the course of employment (AOE/COE). (Opinion on Decision, at p.

What proof carried it

The evidence the panel weighed, by kind.

Medical recordsfavours Applicant prevailed

Applicant's testimony and medical records showing injury to multiple body parts including neck, right shoulder, back, hernia, respiratory system, thoracic spine, mid-back, and atherosclerotic heart disease.

From the decision · page 1Applicant and defendant State Compensation Insurance Fund (defendant) both seek reconsideration of the May 14, 2024 Findings and Order (F&O), wherein the workers' compensation administrative law judge (WCJ) found that applicant, while employed as a heavy equipment operator from April 21, 2010 to April 21, 2011, sustained industrial injury to his neck, right shoulder, back, hernia, respiratory [system], thoracic spine, mid-back and atherosclerotic heart disease. The WCJ determined in relevant part, and with respect to applicant's Petition for New and Further disability, that applicant did not sustain injury to the hands, knees, internal or urological systems, and that the court lacked jurisdiction to award new and further disability to the left shoulder, feet and psyche. The WCJ further determined that development of the record was necessary with respect to the issues of permanent disability and apportionment.

Medical recordsfavours Defendant prevailed

Lack of evidence supporting injury to hands, knees, internal, urological systems, and lack of evidence for new and further disability to left shoulder, feet, and psyche within jurisdictional period.

From the decision · page 3On May 14, 2024, the WCJ issued her decision, finding in relevant part that applicant did not sustain injury arising out of and occurring in the course of employment to the hands, knees, internal cardiovascular hypertension and high blood pressure, and urological [system]. (Finding of Fact No. 2.) The WCJ further determined that the court lacked jurisdiction to award new and further disability to the left shoulder, feet and psyche, and that the evidentiary record was inadequate to determine the extent of permanent disability and apportionment. (Findings of Fact Nos. 3 & 5.) The WCJ's Opinion on Decision explained that with respect to the left shoulder, the medical record did not establish injury to the body part within five years of the date of injury; with respect to the mid-back, the WCJ noted it was unclear why this body part was in issue, given AME Dr. Angerman's discussion of the body part in 2013; with respect to the hands, knees and feet, the WCJ found no evidence establishing injury arising out of and in the course of employment (AOE/COE). (Opinion on Decision, at p.

ADJ8264803 · July 30, 2024

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

What the panel did with the medical opinions

The rules the panel named

What proof carried it

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