ADJ9419245 — California WCAB decision

What the panel ordered

Reconsideration granted to amend the WCJ's decision to find industrial injury to lumbar and thoracic spine, GERD, hypertension, and sleep disorder; otherwise, the August 5, 2021 Findings, Award and Orders are affirmed.

Defendant filed a timely verified joint petition for reconsideration of the August 5, 2021 Findings, Award and Orders. The WCAB granted reconsideration to amend the decision to find injury AOE/COE to additional body parts and otherwise affirmed the decision.

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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.

Cumulative traumaDefendant prevailed

Applicant failed to meet burden of proof for continuous trauma; medical evidence attributed all injuries to specific injury.

From the decision · page 9The employee has the burden of proof to prove injury arising out of and in the course of employment with substantial evidence (California Labor Code § 3202.5, Garza v. Workmen's Comp. App. Bd. (1970) 3 Cal.3d 312, 317 319). In this case, Pursuant to the reports by Charles Sadler, M.D. and the final report by agreed medical examiner Timothy C. Reynolds, M.D. the entirety of the industrial injuries fall on the specific injury and not on the continuous trauma. Applicant failed to meet his burden of showing a continuous trauma. APPLICANT, WHILE EMPLOYED ON SEPTEMBER 10, 2012 DID NOT SUSTAIN A COMPENSABLE CONSEQUENCE TO HIS PSYCHE AND IN THE FORM OF ERECTILE DYSFUNCTION There is no medical evidence admitted that shows industrial causation for Applicant's psyche and erectile dysfunction injuries.

The facts that decided it

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

PTP Dr. Sadler found the September 10, 2012 injury responsible for 100% of applicant's upper and lower back disability and documented thoracic spine injury.

Favours Applicant prevailed

Supported finding of industrial injury to lumbar and thoracic spine.

From the decision · page 1In his September 17, 2015 report, primary treating physician (PTP) Charles Sadler, M.D., found the September 10, 2012 injury to be responsible for 100% of applicant's upper and lower back disability. (Dr. Sadler's 9/17/15 report, at p. 19, applicant's Exhibit 6.) Injury to the thoracic spine is also documented in the medical history summarized by Dr. Sadler. It is well-established that the relevant and considered opinion of one physician may constitute substantial evidence, even

AME Dr. Reynolds found industrial causation for GERD, hypertension, and sleep disorder.

Favours Applicant prevailed

Supported finding of industrial injury to these conditions.

From the decision · page 2The agreed medical examiner (AME) Timothy Reynolds, M.D., found industrial causation for the GERD, hypertension, and sleep disorder. (Dr. Reynolds' reports dated 9/25/20, at p.4, Exhibit Z1; & dated 8/4/20 at pp. 6-8, Exhibit Z2.) The WCJ properly relied upon the opinion of the AME, who the parties presumably chose because of the AME's expertise and neutrality. The WCJ was presented with no good reason to find the AME's opinion unpersuasive, and we also find none. (See Power v. Workers' Comp. Appeals Bd. (1986) 179 Cal.App.3d 775, 782 [51 Cal.Comp.Cases 114].)

No medical evidence admitted showing industrial causation for psyche and erectile dysfunction injuries.

Favours Defendant prevailed

Resulted in denial of compensable consequence for these conditions.

From the decision · page 9The employee has the burden of proof to prove injury arising out of and in the course of employment with substantial evidence (California Labor Code § 3202.5, Garza v. Workmen's Comp. App. Bd. (1970) 3 Cal.3d 312, 317 319). In this case, Pursuant to the reports by Charles Sadler, M.D. and the final report by agreed medical examiner Timothy C. Reynolds, M.D. the entirety of the industrial injuries fall on the specific injury and not on the continuous trauma. Applicant failed to meet his burden of showing a continuous trauma. APPLICANT, WHILE EMPLOYED ON SEPTEMBER 10, 2012 DID NOT SUSTAIN A COMPENSABLE CONSEQUENCE TO HIS PSYCHE AND IN THE FORM OF ERECTILE DYSFUNCTION There is no medical evidence admitted that shows industrial causation for Applicant's psyche and erectile dysfunction injuries.

Medical evidence attributed all injuries to specific injury on September 10, 2012, not to continuous trauma during April 15, 2015 to April 15, 2016.

Favours Defendant prevailed

Resulted in denial of continuous trauma claim.

From the decision · page 9The employee has the burden of proof to prove injury arising out of and in the course of employment with substantial evidence (California Labor Code § 3202.5, Garza v. Workmen's Comp. App. Bd. (1970) 3 Cal.3d 312, 317 319). In this case, Pursuant to the reports by Charles Sadler, M.D. and the final report by agreed medical examiner Timothy C. Reynolds, M.D. the entirety of the industrial injuries fall on the specific injury and not on the continuous trauma. Applicant failed to meet his burden of showing a continuous trauma. APPLICANT, WHILE EMPLOYED ON SEPTEMBER 10, 2012 DID NOT SUSTAIN A COMPENSABLE CONSEQUENCE TO HIS PSYCHE AND IN THE FORM OF ERECTILE DYSFUNCTION There is no medical evidence admitted that shows industrial causation for Applicant's psyche and erectile dysfunction injuries.

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Place v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 372, 378-379 [35 Cal.Comp.Cases 525]

The relevant and considered opinion of one physician may constitute substantial evidence, even if inconsistent with other medical opinions.

Applied to credit Dr. Sadler's and Dr. Reynolds' opinions as substantial evidence.

From the decision · page 2if inconsistent with other medical opinions. (Place v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 372, 378-379 [35 Cal.Comp.Cases 525].) While injury to the lumbar spine was raised as an issue at trial, the issue of injury to the thoracic spine was not. However, the WCAB's Rules permit pleadings to be amended to conform to proof. (See Cal. Code Regs., tit. 8, former § 10492, now § 10517 (eff. Jan. 1, 2020).)

E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 413, 416–17, 419 [33 Cal.Comp.Cases 660]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 612 (Appeals Board en banc), 70 Cal.Comp.Cases 1506 (writ den.)

A medical opinion must be predicated on reasonable medical probability, not be speculative, be based on pertinent facts and adequate examination and history, and set forth reasoning in support of its conclusions.

Applied to determine whether medical opinions were substantial evidence.

From the decision · page 2For the reasons stated in the WCJ's report, we agree that the opinions of PTP Dr. Sadler and AME Dr. Reynolds are substantial medical evidence upon which the WCJ properly relied. To be considered substantial evidence, a medical opinion "must be predicated on reasonable medical probability." (E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 413, 416§ 17, 419 [33 Cal.Comp.Cases 660].) A physician's report must also 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. (Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; Escobedo v.

Cal. Code Regs., tit. 8, former § 10492, now § 10517 (eff. Jan. 1, 2020)

The WCAB's Rules permit pleadings to be amended to conform to proof.

Allowed amendment to include thoracic spine injury though not raised at trial.

From the decision · page 2if inconsistent with other medical opinions. (Place v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 372, 378-379 [35 Cal.Comp.Cases 525].) While injury to the lumbar spine was raised as an issue at trial, the issue of injury to the thoracic spine was not. However, the WCAB's Rules permit pleadings to be amended to conform to proof. (See Cal. Code Regs., tit. 8, former § 10492, now § 10517 (eff. Jan. 1, 2020).)

ADJ9419245 · October 22, 2021

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

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