ADJ11027260 — California WCAB decision

What the panel ordered

The April 19, 2021 Findings and Order is affirmed, confirming injury AOE/COE to brain, circulatory system (heart), and neurological system (stroke) under Labor Code section 3212.5 presumption.

Petition for Reconsideration granted; decision after reconsideration issued affirming the WCJ's April 19, 2021 Findings and Order.

Read the official decision →

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.

AOE/COEApplicant prevailedbrain · circulatory system (heart) · neurological system (stroke)

The presumption of industrial causation under Labor Code section 3212.5 applies because the applicant's patent foramen ovale (PFO) manifested during employment and was a necessary factor in causing the stroke. The defendant failed to prove that a contemporaneous nonwork-related event was the sole cause of the injury, as the injury resulted from a combination of industrial and nonindustrial factors, with the PFO being industrially related. The opinion of the neutral neurology AME supporting industrial causation was persuasive.

From the decision · page 6The heart trouble presumption is a presumption affecting the burden of proof and is

The facts that decided it

What proof carried it

The evidence the panel weighed, by kind.

Medical recordsfavours Applicant prevailed

The presumption of industrial causation under Labor Code section 3212.5 was not rebutted because the injury resulted from a combination of industrial and nonindustrial factors, with the PFO being industrially related.

From the decision · page 7We observe initially that the causation of the stroke as described by Dr. Hyman did not arise solely out of a contemporaneous nonwork-related event. Dr. Hyman opined that applicant's genetic predisposition toward clotting resulted in the formation of blood clots in the legs, possibly developing during applicant's flight to Colorado. The clots would have then circulated to the heart and passed through the PFO to the cerebral arteries, causing the stroke and cerebral hemorrhage. (Ex. CC, report of AME Mark Hyman, M.D., dated December 3, 2018, at p.2.) However, Dr. Hyman's formulation requires the convergence of multiple separate causative factors: (1) a genetic predisposition toward developing blood clots, (2) development of the blood clots while sitting during air travel or other sedentary activity, and (3) the existence of, and passage of the blood clot through, a PFO. The record does not establish that any of these factors, standing alone, would have resulted in the stroke. Rather, it was the convergence of presumptively industrial and nonindustrial factors which resulted in applicant's cerebrovascular injury. Accordingly, a nonwork-related factor is not solely responsible for the injury.

expert methodologyfavours Applicant prevailed

The opinion of neurology AME Dr. Shorr, who attributed causation to atrial fibrillation, was persuasive and favored the applicant.

From the decision · page 8We note further the opinion of AME Dr. Shorr, who attributes causation to atrial fibrillation, rather than to a blood clot transiting the PFO. Dr. Shorr observes that applicant had documented atrial fibrillation at the time of the stroke, a condition that is "a much more common cause of stroke than embolization via PFO." (Ex. RR, report of neurology AME Robert Shorr, M.D., dated April 28, 2020, at p.17.) The agreed medical examiner has been chosen by the parties because of his expertise and neutrality, and the AME's opinion should ordinarily be followed unless there is good reason to find that opinion unpersuasive. (Power v. Workers' Comp. Appeals Bd. (1986) 179 Cal. App. 3d 775, 782 [51 Cal. Comp. Cases 114].) Moreover, the Workers' Compensation Appeals Board is empowered to resolve conflicts in the evidence. (Garza v. Workers' Comp. Appeals Bd. (1970) 3 Cal. 3d 312, 317 [35 Cal. Comp. Cases 500].)

ADJ11027260 · March 4, 2022

What the panel ordered

What was disputed, and how it came out

The facts that decided it

Your case already resembles someone else’s. Find whose.

What the panel did with the medical opinions

The rules the panel named

What proof carried it

About this page