ADJ11351201 · May 7, 2026

The WCAB found the record insufficient to resolve conflicting medical opinions on industrial causation, including orthopedic, neurological, and psychiatric claims, requiring further development of the medical record.

From the decision · page 1Applicant seeks reconsideration of the Findings and Order (F&O) issued on February 27, 2023, by the workers' compensation administrative law judge (WCJ). The WCJ found in pertinent part that applicant did not sustain industrial injury to his eyes, neck, shoulders, arms, hands, fingers, legs, ankles, circulatory and excretory system, and psyche and ordered that applicant take nothing on his claims.

Conflicting medical opinions on industrial causation of orthopedic, neurological, and psychiatric conditions.

Favours neutral

Required further development of the medical record to clarify causation and symptom chronology.

From the decision · page 15entrapments, and internal derangements, yet does so without reconciling the absence of contemporaneous orthopedic complaints while employed or addressing the significant discrepancy between reported functional capacity and observed clinical behavior during PQME Dr. Shokes' evaluation. Dr. Mays also took an incorrect history that applicant suffered a direct toxic exposure injury to both eyes rather than just the left eye and failed to review any of his prior medical records. The competing interpretations of the same claim require clarification that cannot be resolved on the existing record.

Diagnosed nonindustrial cervical spine strain, degenerative joint disease in shoulders and left ankle, and right ankle fracture from prior industrial claim; found no new industrial injury; concluded all current complaints fall outside workers' compensation.

Relied on lack of contemporaneous complaints, radiographic evidence of degenerative changes, and delayed onset of orthopedic pain after legal representation.

From the decision · page 3PQME Dr. Shokes diagnosed a nonindustrial cervical spine strain, nonindustrial degenerative joint disease in the bilateral shoulders and left ankle, and a right ankle tibial fracture related to a previous industrial claim. He noted that applicant initially sought treatment for an eye injury involving water and meat product splash on June 15, 2017. While he underwent treatment for diabetes, hypertension, and nerve palsies, his neurologist eventually removed him from the workplace on September 5, 2017. He did not report any orthopedic injuries to his supervisors prior to his departure. He first complained of orthopedic pain in June 2018 after seeking legal representation. Applicant resisted joint motion and reported non-anatomical pain during various testing modalities. Radiographic evidence confirmed degenerative changes and a prior fracture, but PQME Dr. Shokes found no evidence of a new industrial injury. He emphasized that applicant performed his regular duties without complaint or medical treatment for these areas until several months after he stopped working. Consequently, PQME Dr. Shokes concluded that all current bodily complaints fall outside of the workers' compensation system. (Id. at pp. 29-30.)

Diagnosed overuse syndrome with bilateral shoulder sprains, right shoulder bursitis, left shoulder labrum tear with tendinosis, bilateral cubital tunnel syndrome, left elbow ligament sprains, bilateral wrist and ankle sprains, ganglion cysts, mild osteoarthritis, toxic eye exposure worse on left, and myasthenia gravis; concluded causation primarily work-related due to cumulative trauma from butcher duties.

Based on clinical findings and history of repetitive job duties causing cumulative trauma.

From the decision · page 2In his permanent and stationary report from March 11, 2020, Dr. Mays diagnosed overuse syndrome featuring bilateral shoulder sprains, right shoulder bursitis, and a left shoulder labrum tear with tendinosis. He also identified bilateral cubital tunnel syndrome, left elbow ligament sprains, and bilateral wrist and ankle sprains. The findings included ganglion cysts and tendinosis in the wrists, mild osteoarthritis in the ankles, toxic eye exposure worse on the left, and myasthenia gravis. Dr. Mays concluded that causation of applicant's orthopedic claims was primarily work- related due to cumulative trauma sustained while performing customary butcher duties for two years. (Id. at pp. 7-8.)

Performed ophthalmological evaluation; took history of animal blood products splash to face and eyes; no causation conclusion stated in excerpt.

From the decision · page 3The medical evidence separately addressed the claimed specific injury to the left eye and its sequelae to the neurological system, the circulatory and endocrine systems, and the psyche. In his report dated September 21, 2020, PQME Dr. Sami, after performing an ophthalmological evaluation of applicant, took a history that animal blood products splashed onto his face and eyes.

Diagnosed preexisting hypertension and diabetes; deferred causation pending neurological evaluation; later concluded myasthenia gravis was nonindustrial and prednisone treatment lacked industrial causation; determined no industrial causation for hypertension and diabetes aggravation.

Relied on neurological evaluation finding myasthenia gravis nonindustrial; did not consider later supplemental neurological report.

From the decision · page 5In his report dated November 7, 2020, PQME Dr. Gupta, after performing an internal evaluation of applicant, took a history that he reported that animal blood splattered into his left eye on June 15, 2017, causing him to seek treatment at Martin Luther King Emergency Room. (Joint Ex. 11, p. 2.) He claimed the subsequent work stress from ridicule from his co-workers due to his eye injury aggravated his preexisting diabetes. (Id. at p. 3.) During the physical examination, PQME Dr. Gupta recorded a significantly elevated blood pressure of 188 over 112. He diagnosed applicant with preexisting hypertension and diabetes. (Id. at p. 9.) PQME Dr. Gupta noted that applicant takes prednisone to treat his myasthenia gravis. PQME Dr. Gupta deferred his causation determination pending a neurological evaluation. He explained that, if the neurologist found the myasthenia gravis industrial, the resulting prednisone use and subsequent aggravation of hypertension and diabetes would also be industrial. (Id. at p. 10.)

Performed psychiatric evaluation; found no compensable psychiatric injury; psychological testing showed exaggeration pattern; minimal anxiety or depression; concluded no psychiatric condition compensable under workers' compensation.

Based on mental status exam, psychological testing, and lack of endorsed mental health symptoms.

From the decision · page 5In his report dated January 29, 2019, PQME Dr. Rodriguez, after performing a psychiatric evaluation of applicant, took a history of his employment as a butcher and described physical injuries including a June 15, 2017, incident where meat blood splashed into his left eye. (Joint Ex. 2, p. 8.) He reported experiencing workplace harassment following this injury and noted that co-workers teased him about his eye and called him offensive names. (Id. at p. 10.) Despite these allegations, he denied experiencing any significant depression or anxiety and explicitly stated he did not feel discouraged or irritable. (Id. at pp. 10, 15.) PQME Dr. Rodriguez conducted a mental status examination and recorded normal findings across all objective categories including appearance, behavior, speech, mood, and thought processes. (Id. at pp. 14-15.) Psychological testing via the MMPI showed an exaggeration pattern regarding medical complaints while the

Performed neurological evaluation; concluded myasthenia gravis was nonindustrial; issued supplemental report indicating toxic exposure exacerbated condition; report issued after Gupta's evaluation and not reviewed by Gupta.

From the decision · page 4PQME Dr. Espy issued a supplemental report on January 11, 2022, after reviewing 766 additional pages of medical records. The updated history indicated that Harbor-UCLA Medical Center treated applicant on August 6, 2019, for severe dysphagia and dysarthria after he was without myasthenia gravis medications for one month. (Joint Ex. 12, p. 2.) He underwent a thymectomy on November 13, 2020. (Id. at p. 6.) PQME Dr. Espy concluded, in contrast to his

Labor Code section 3600

Labor Code section 3600 imposes liability only if injury arises out of and in the course of employment; employee must prove industrial causation by showing industrial factors were a contributing cause, with all reasonable doubts resolved in favor of employee.

Applied to determine burden of proof for industrial injury causation.

Labor Code section 3208.3(a) and (b)(1)

To constitute compensable psychiatric injury, employee must have a compensable mental disorder causing disability or need for medical treatment, with actual events of employment predominantly causing the injury.

Applied to evaluate compensability of psychiatric injury claim.

Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604

Medical opinion must be based on reasonable probability, avoid speculation, rely on pertinent facts and adequate examination and history, and explain reasoning to constitute substantial evidence.

Applied to assess the sufficiency of medical evidence for industrial causation.

From the decision · page 12(Lab. Code, § 5903, 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274 [39 Cal.Comp.Cases 310]; Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312 [35 Cal.Comp.Cases 500]; LeVesque v. Workmen's Comp. Appeals Bd. (1970) 1 Cal.3d 627 [35 Cal.Comp.Cases 16].) To constitute substantial evidence, a medical opinion must state its conclusions in terms of reasonable probability, avoid speculation, rely on pertinent facts and an adequate examination and history, and explain the reasoning supporting its conclusions. (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc).) Medical reports and opinions do not constitute substantial evidence when they contain known errors or rely on facts that are no longer germane, inadequate medical histories or examinations, or incorrect legal theories.

Applicant's medical records and conflicting medical opinions regarding industrial causation of orthopedic and neurological conditions

From the decision · page 15entrapments, and internal derangements, yet does so without reconciling the absence of contemporaneous orthopedic complaints while employed or addressing the significant discrepancy between reported functional capacity and observed clinical behavior during PQME Dr. Shokes' evaluation. Dr. Mays also took an incorrect history that applicant suffered a direct toxic exposure injury to both eyes rather than just the left eye and failed to review any of his prior medical records. The competing interpretations of the same claim require clarification that cannot be resolved on the existing record.