Almaraz/Guzman — rebutting the strict Guides

How later panels applied it

Newest released decisions whose legal-standard extraction named this holding. Each quotes the passage and links to the official PDF. The leading case is cited the way courts cite it; our own cards stay ADJ, date, and issue. Litigated tail — not a win rate.

• ADJ12941269 · 2026-10-09 · Oakland District OfficeAlmaraz/Guzman

  Determinative passage · p.9(Lab. Code, § 4660.1(a) and (b), emphasis added.) The use and incorporation of the AMA Guides is acknowledged in the PDRS itself, with exception for claims of psychiatric impairment. (PDRS, p. 1-2; 1-12.) The use of the AMA Guides, however, is rebuttable. (Milpitas Unified School Dist. v. Workers’ Comp. Appeals Bd. (Guzman) (2010) 187 Cal.App.4th 808, 822 [75 Cal.Comp.Cases 837].) Because the AMA Guides’ incorporation into the PDRS is rebuttable, the first step in the assessment of disability, is to determine the impairment for the injured body part(s) under the AMA Guides. This allows a physician to determine if rebuttal of a strict rating AMA Guide impairment is necessary. If the physician finds the straight AMA Guides impairment to be lacking: [t]he physician should be free to acknowledge his or her reliance on standard texts or recent research data as a basis for his or her medical conclusions, and the WCJ

  The Board requires substantial expert medical evidence to support work restrictions and impairment ratings, and rejects lay opinion as insufficient.

  Official decision · page 9 →
• ADJ6958667 · 2026-09-11 · Van Nuys District OfficeAlmaraz/Guzman

  Determinative passage · p.8B. Defendant contends Applicant is not entitled to 51 % PD for sleep because Dr. Bertoldi did not provide an Almaraz/Guzman analysis; however, Dr. Bertoldi found Applicant's sleep impairment was caused by a pituitary dysfunction. Thus, the 45% WPI utilizing Chapter 10 of the AMA Guides was Dr. Bertoldi's straight rating, and Almaraz/Guzman does not apply. Any award, order, or decision of the Appeals Board must be supported by substantial evidence. (Lab. Code Section 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal. 3d 274, 281 [39 Cal. Comp. Cases 310]; Garza v. Workmen's Compensation Appeals Board, Mcdonnell-Douglas Aircraft Company, et. al., (1970) 3 Cal. 3d 312, 317 935 Cal. Comp. Cases 16].); LeVesque v. Workmen's Comp. Appeals Bd. (1970) 1 Cal. 3d 627,635 [35 Cal. Comp. Cases 16].). In Blackledge v. Bank of America (2010) 75 CCC 613, the WCAB held that it is the physician's role to determine the injured worker's WPI under the AMA Guides and to support that

  The 51% PD rating for sleep impairment was upheld as a straight AMA Guides rating based on hypothalamic-pituitary axis disorder.

  Official decision · page 8 →
• ADJ14292485 · 2026-09-04 · Santa Rosa District OfficeAlmaraz/Guzman

  Determinative passage · p.11In addition to the WCJ’s Report, which we adopt and incorporate, we observe the following. Section 4660.1 provides that permanent disability is determined by consideration of whole person impairment within the four corners of the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition (AMA Guides), as applied by the Permanent Disability Rating Schedule (PDRS) in light of the medical record and the effect of the injury on the worker’s future earning capacity. (Brodie v. Workers’ Comp. Appeals Bd. (2007) 40 Cal.4th 1313, 1320 [72 Cal.Comp.Cases 565] [“permanent disability payments are intended to compensate workers for both physical loss and the loss of some or all of their future earning capacity”]; Department of Corrections & Rehabilitation v. Workers’ Comp. Appeals Bd. (Fitzpatrick) (2018) 27 Cal.App.5th 607, 614 [83 Cal.Comp.Cases 1680]; Almaraz v. Environmental Recovery Service/Guzman v. Milpitas Unified School District (2009) 74 Cal.Comp.Cases 1084 (Appeals Board en banc) as affirmed by the Court of Appeal in Milpitas Unified School Dist. v. Workers’ Comp.

  Applied to assess applicant's permanent disability and total disability status based on medical and vocational evidence.

  Official decision · page 11 →
• ADJ18042476 · 2026-08-10 · Sacramento District OfficeAlmaraz/Guzman

  Determinative passage · p.9Applicant contends that the WCJ erred by not using the QME’s “Almaraz/Guzman” rating. Applicant further contends that the WCJ incorrectly found that his occupational group number in the PDRS is 360, and not 470. An “Almaraz/Guzman” rating refers to a rating fashioned by a physician using material found within the AMA Guides in a discretionary manner that deviates from its exact instructions in order to achieve a more accurate assessment of impairment. (Almaraz/Guzman, supra, 187 Cal.App.4th 808.) The court held that (1) an employee's impairment may be determined by reference to any applicable portion of the AMA Guides, and (2) this determination may be used to rebut the rating of permanent disability established by the PDRS. The court reasoned that the language of section 4660 permits reliance on the entire AMA Guides in deriving an impairment rating in a particular case, and Chapters 1 and 2 of the AMA Guides provide instructions that permit a physician to use clinical judgment in deciding how to apply the remaining chapters. (Id. at p.

  The QME was permitted to use Table 6-9 of the AMA Guides as an alternative method to assess impairment, but the explanation must be substantial evidence.

  Official decision · page 9 →
• ADJ14149688 · 2026-07-27 · San Francisco District OfficeAlmaraz/Guzman

  Determinative passage · p.10en banc) (commonly known as, and hereinafter referred to as Almaraz II), we held that a “scheduled permanent disability rating may be rebutted by successfully challenging the component element of that rating relating to the employee’s WPI under the AMA Guides….by establishing that another chapter, table, or method within the four corners of the Guides most accurately reflects the injured employee’s impairment.” (Almaraz II, 74 Cal.Comp.Cases at pp. 1095-1096.) In Milpitas Unified School District v. Workers’ Comp. Appeals Bd. (Guzman) (2010) 187 Cal.App.4th 808 [75 Cal.Comp.Cases 837], the Court affirmed our decision in Almaraz II. In order for an applicant to prevail on this whole person impairment (WPI) assigned under Almaraz II, additional evidence is necessary: The doctor is expected to 1) provide a strict rating per the AMA Guides, 2) explain why the strict rating does not accurately reflect the applicant’s disability, 3) provide an alternative rating using the four corners of the AMA Guides, and 4) explain why that alternative rating most accurately reflects applicant’s level of disability. (Id. at pp. 828-829.)

  The QME's impairment rating did not meet the specific parameters required by Almaraz/Guzman and was rejected.

  Official decision · page 10 →
• ADJ14589712 · 2026-06-12 · San Francisco District OfficeAlmaraz/Guzman

  Determinative passage · p.6III. Defendant further contends that applicant failed to satisfy the requirements outlined under Vigil for rebuttal of the CVC method of rating with respect to the bilateral knees. (Petition, p. 4.) Pursuant to section 4660.1, the Permanent Disability Rating Schedule (PDRS) is prima facie evidence of an injured employee's permanent disability. (Lab. Code, § 4660; cf. Ogilvie v. Workers' Comp. Appeals Bd. (2011) 197 Cal.App.4th 1262, 1274-1277 [76 Cal.Comp.Cases 624].) The PDRS provides that the ratings for multiple body parts arising out of the same injury are "generally" combined using the CVC, which is appended to the PDRS. (2005 PDRS, at p. 1- 10.)Yet, because it is part of the PDRS, the CVC is rebuttable and a reporting physician is not precluded from utilizing a method other than the CVC to determine an employee's whole person impairment so long as the physician's opinion remains within the four comers of the AMA Guides.

  Applicant may rebut CVC by showing ADLs impacted and non-overlapping or amplifying effects.

  Official decision · page 6 →
• ADJ14079246 · 2026-05-26 · San Francisco District OfficeAlmaraz/Guzman

  Determinative passage · p.5Bd. en banc) (Almaraz II), we held that a "scheduled permanent disability rating may be rebutted by successfully challenging the component element of that rating relating to the employee's WPI under the AMA Guides....by establishing that another chapter, table, or method within the four corners of the Guides most accurately reflects the injured employee's impairment." (Id. at pp. 1095-1096.) In Milpitas Unified School District v. Workers' Comp. Appeals Bd. (Guzman) (2010) 187 Cal.App.4th 808 [75 Cal.Comp.Cases 837], the Court of Appeal affirmed our decision in Almaraz II.

  Applied to consider Dr. Mandell's Guzman rebuttal analysis.

  Official decision · page 5 →
• ADJ7483164 · 2026-03-16 · Sacramento District OfficeAlmaraz/Guzman

  Determinative passage · p.9Section 4660 provides that permanent disability is determined by consideration of whole person impairment within the four corners of the AMA Guides, as applied by the Permanent Disability Rating Schedule (PDRS) in light of the medical record and the effect of the injury on the worker's future earning capacity. (Brodie v. Workers' Comp. Appeals Bd. (2007) 40 Cal.4th 1313, 1321 [72 Cal.Comp.Cases 565] ["permanent disability payments are intended to compensate workers for both physical loss and the loss of some or all of their future earning capacity"]; Department of Corrections & Rehabilitation v. Workers' Comp. Appeals Bd. (Fitzpatrick) (2018) 27 Cal.App.5th 607, 614 [83 Cal.Comp.Cases 1680] (Fitzpatrick); Milpitas Unified School Dist. v. Workers' Comp. Appeals Bd. (Guzman) (2010) 187 Cal.App.4th 808 [75 Cal.Comp.Cases 837] (Guzman).)

  Applied to assess permanent disability rating and rebuttal of scheduled rating.

  Official decision · page 9 →