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.
PTPRelied upon · orthopedic surgery
Found 90% upper extremity impairment supporting a high degree of permanent disability.
Supported by AMA Guides and consistent with the injury severity.
From the decision · page 15It is worth noting that the 90% upper extremity rating found by Dr. Younai is also supported
by table 16-18 of the AMA Guides, which clearly states that a 100% hand impairment is equivalent
to a 90% upper extremity impairment. At least one commentator has opined that table 16-18 "can
be used as an elegant alternative rating method for an upper extremity joint dysfunction." (Rassp,
Lawyer's Guide to the AMA Guided (2019 ed.), p. 3-191.) Although this was not the table
specifically relied on by Dr. Younai, I see no substantial basis for treating this matter differently
depending on whether table 16-1 or 16-18 is employed to cover the same impairment. To assign a
substantially lower rating to the applicant merely because of the presence of a nonfunctional and
nonusable thumb would simply elevate form over substance.
QMEPartially credited · hand specialist
Orthopedic PQME report supporting a permanent disability rating less than 100%, but rebutted by vocational expert.
Report was considered but vocational expert's findings were found more persuasive.
From the decision · page 41. The findings of the applicant's Medical Provider Network (MPN) treating physician, Dr.
Sean Younai and orthopedic QME Dr. Benjamin Lesin, a hand specialist, each do not
constitute substantial evidence in support of their findings of permanent disability mid are
not supported by the AMA Guides.
QMERelied upon · psychological PQME
Diagnosed chronic PTSD and depressive disorder with poor prognosis, no apportionment found.
Her psychological findings supported the overall disability assessment.
From the decision · page 8PQME psychologist Dr. Malmovski evaluated the applicant on a single occasion on
10/14/16. She prepared a detailed 57 page report with an extensive record review. According to
the history she took, the applicant reported "no use and no control of his right thumb." The
applicant related physical limitations and complaints as well as psychological complaints as noted
above. He mentioned headaches, diarrhea and acid reflux in addition to other complaints. He
denied drinking alcohol or any history of alcohol abuse. Per Dr. Mahnovski, testing results
supported a profile that, "Because [the applicant] is likely to question and mistrust the motives of
those around him, working relationships with others are likely to be very strained, despite the
efforts of others to demonstrate support and assistance." (Exh. 18, pp. 8, 9-10, 13, 17.)
PTPGiven great weight · psychiatry
Provided ongoing psychiatric treatment reports noting pain, sleep difficulties, and flashbacks.
His treatment reports were considered in assessing the applicant's condition.
From the decision · page 7While there were a number of non-MPN treater reports admitted after the earlier trial of
11/16/17, these were given limited consideration as I ruled following that trial that the reports
could not be used in and of themselves to suppm1 an award of benefits pursuant to Labor Code
section 4605. Primarily, I gave consideration to the treatment reports of providers from the
employer's MPN, specifically Dr. Sean Younai in orthopedic surgery and Dr. Stanley Goodman in
psychiatry, and the reporting QMEs, Dr. Benjamin Lesin in orthopedic surgery and psychological
PQME Dr. Natasha Mahnovski.