What the panel ordered
The March 11, 2021 Findings, Award and Order is rescinded and the matter is returned to the trial level for further proceedings.
Defendant's Petition for Reconsideration of the March 11, 2021 Findings, Award and Order was granted for further study; this is the Decision After Reconsideration.
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.
The QME's opinions on CVC rebuttal, apportionment, and temporary disability were conclusory and not supported by substantial medical evidence. The record does not sufficiently establish the periods of temporary disability, and the apportionment opinions lack adequate explanation. The award is not supported by substantial evidence and must be rescinded.
From the decision · page 8opinions contained within the medical reporting are conclusory and provide no indication for why the QME reached the conclusion that he did. As explained in Vigil, the QME must provide a reasoned analysis to rebut the CVC, and that analysis must constitute substantial medical evidence. Accordingly, the present award of permanent disability is not supported by substantial medical evidence and must be rescinded.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
QME's opinions on CVC rebuttal, apportionment, and temporary disability were conclusory and unsupported by substantial evidence.
Favours Defendant prevailed
The lack of substantial medical evidence required the rescission of the award and remand for further proceedings.
From the decision · page 8opinions contained within the medical reporting are conclusory and provide no indication for why the QME reached the conclusion that he did. As explained in Vigil, the QME must provide a reasoned analysis to rebut the CVC, and that analysis must constitute substantial medical evidence. Accordingly, the present award of permanent disability is not supported by substantial medical evidence and must be rescinded.
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.
Initially apportioned 100% of right knee to industrial injury and 50% of left knee to industrial injury, later changed to 20% of each knee due to degenerative changes. Opined impairments should be added, not combined, based on Kite. Opinions found conclusory and not substantial evidence by the Board.
QME's opinions on CVC rebuttal, apportionment, and temporary disability were found to be conclusory and unsupported by substantial evidence.
From the decision · page 8opinions contained within the medical reporting are conclusory and provide no indication for why the QME reached the conclusion that he did. As explained in Vigil, the QME must provide a reasoned analysis to rebut the CVC, and that analysis must constitute substantial medical evidence. Accordingly, the present award of permanent disability is not supported by substantial medical evidence and must be rescinded.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604
A medical opinion must be framed in terms of reasonable medical probability, not be speculative, be based on pertinent facts and an adequate examination and history, and set forth reasoning in support of its conclusions.
Applied to determine that QME's opinions were not substantial evidence.
From the decision · page 7conclusions." (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc).) "When the foundation of an expert's testimony is determined to be inadequate as a matter of law, we are not bound by an apparent conflict in the evidence created by his bare conclusions." (People v. Bassett (1968) 69 Cal.2d 122, 139.)
Vigil v. County of Kern, 2024 Cal. Wrk. Comp. LEXIS 23 (en banc)
The Combined Values Chart (CVC) in the PDRS may be rebutted and impairments may be added where applicant establishes the impact of each impairment on ADLs and that either there is no overlap or the overlap increases the impact.
Applied to determine that QME did not provide sufficient analysis to rebut the CVC.
From the decision · page 8The Combined Values Chart (CVC) in the Permanent Disability Ratings Schedule (PDRS) may be rebutted and impairments may be added where an applicant establishes the impact of each impairment on the activities of daily living (ADLs) and that either:
What proof carried it
The evidence the panel weighed, by kind.
QME's opinions on CVC rebuttal, apportionment, and temporary disability were conclusory and lacked sufficient explanation or analysis, failing to constitute substantial medical evidence.
From the decision · page 8opinions contained within the medical reporting are conclusory and provide no indication for why the QME reached the conclusion that he did. As explained in Vigil, the QME must provide a reasoned analysis to rebut the CVC, and that analysis must constitute substantial medical evidence. Accordingly, the present award of permanent disability is not supported by substantial medical evidence and must be rescinded.
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
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