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.
QMERelied upon · psyche
Applicant sustained 18% WPI to psyche with 45% apportionment to non-industrial psyche issues and 55% to subject injury.
Medical opinion on impairment and apportionment to psyche issues was part of the record considered in the overall disability determination.
From the decision · page 2In a report dated March 18, 2016, psyche PQME Dr. Sherman opined that due to anxiety
and depression, applicant sustained an 18% WPI to the psyche with 45% apportionment to non-
industrial psyche issues and the remaining 55% to the subject injury. (Joint Exhibit J, pp. 141-
142.)
AMERelied upon · rheumatology
Applicant is 100% permanently and totally disabled due to chronic pain syndrome complicated by orthopedic sequelae and failed neck and back syndromes. Fibromyalgia symptoms interfere with activities of daily living. Applicant sustained 15% WPI for sleep and arousal disorder with 50% apportionment to non-industrial issues. Applicant is entitled to add-ons for pain and medication effects. Applicant's permanent disability findings were supported despite sub rosa video footage.
Dr. Levine's opinion was considered but defendant's challenge to his findings based on sub rosa video footage was rejected as the footage did not capture the subjective disabling symptoms. The WCAB found Dr. Levine's findings substantial evidence supporting total disability without apportionment.
From the decision · page 2In a report dated January 5, 2021, rheumatology AME, Dr. Levine, noted that due to
applicant's chronic pain syndrome, which is complicated by orthopedic sequelae and failed neck
and back syndromes, applicant should be considered "100% permanently and totally disabled."
(Joint Exhibit O, p. 85-86.) Dr. Levine recommended referral to a vocational expert and noted that
although fibromyalgia is not rated in the AMA Guides, "dissecting out the major symptoms" which
QMERelied upon · neurology
Applicant sustained 5% WPI for headaches and 10% WPI for dizzy spells and vertigo with apportionment to preexisting vestibular problems.
Medical opinion on neurological impairments and apportionment was part of the record considered in the overall disability determination.
From the decision · page 2In a report dated November 11, 2015, neurology PQME Dr. Ratiner opined that applicant
sustained a 5% whole person impairment (WPI) under table 13-5 for his headaches as well as 10%
WPI under table 11-4 for his dizzy spells and vertigo. (Joint Exhibit K, p. 25.) Dr. Ratiner
apportioned 70% of applicant's impairment for dizziness and vertigo to preexisting vestibular
problems and the remaining 30% to the subject injury. In a subsequent report dated April 4, 2018,
Dr. Ratiner amended his findings to reflect 60% apportionment to preexisting vestibular disorder
and 40% to the subject injury after additional medical records showed "severe aggravation" due
to the subject injury. (Joint Exhibit M, p. 145.)
AMERelied upon · orthopedic
Applicant sustained 28% WPI to cervical spine, 23% WPI to lumbar spine, and 5% WPI to right shoulder with work restrictions precluding substantial work (75% loss of pre-injury capacity).
Orthopedic AME opinion on impairment and work restrictions was considered in the overall disability determination.
From the decision · page 4(Id. at p. 38:23-25.)
In his report dated March 7, 2024, Dr. Sisto opined that applicant sustained a 28% WPI to
QMERelied upon · internal medicine
Applicant sustained 30% WPI due to cardiac palpitations and 10% WPI due to medication effects; agreed applicant is permanently and totally disabled musculoskeletally and neurologically.
Internal medicine QME opinion supporting total disability was part of the record considered.
From the decision · page 3In his report dated August 29, 2022, internal PQME, Dr. Kramer, opined that applicant
sustained 30% WPI under Almaraz Guzman due to "bouts of cardiac palpitations" resulting from
atrial fibrillation and sleep disorder and an additional 10% WPI due to usage of the drug Eliquis
which causes an increased risk of bleeding. (Joint Exhibit G, pp. 12-14.) He agreed with Dr. Levine
that applicant was "permanent and totally disabled from a musculoskeletal/neurologic
standpoint[.]" (Id. at p. 13.) Dr. Kramer noted that applicant's "atrial fibrillation arrhythmia was
precipitated by the severe stress he has been under due to his intractable chronic pain state and
secondary high anxiety level, coupled with stress emanating from his pain and anxiety-caused
sleep deprivation." (Ibid.)