What the panel ordered
Petition for Reconsideration granted; final decision after reconsideration deferred pending further review of the merits and entire record.
Applicant seeks reconsideration of the First Amended Findings, Award and Orders issued by the WCJ on December 16, 2024, which found injury arising out of employment and awarded disability benefits and medical treatment. The WCJ issued an amended award reducing the continuous trauma rating from 68% to 15%. The Appeals Board granted reconsideration to further develop the record and deferred final 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.
The Appeals Board found the medical record on apportionment was not properly developed and granted reconsideration for further development.
From the decision · page 6Here, based on our review, we are not persuaded that the record is properly developed. Where the medical evidence or opinion on an issue is incomplete, stale, and no longer germane, or is based on an inaccurate history, or speculation, it does not constitute substantial evidence. (Place v. Workers' Comp. Appeals Bd. (1970) 3 Cal.3d 372, 377-379 [35 Cal.Comp.Cases 525]; Escobedo, supra, 70 Cal.Comp.Cases at p. 621 (Appeals Board en banc).)
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
The medical record on apportionment was incomplete, stale, or based on inaccurate history or speculation.
Favours Applicant prevailed
This lack of substantial medical evidence prevented the Appeals Board from affirming the WCJ's apportionment finding.
From the decision · page 6Here, based on our review, we are not persuaded that the record is properly developed. Where the medical evidence or opinion on an issue is incomplete, stale, and no longer germane, or is based on an inaccurate history, or speculation, it does not constitute substantial evidence. (Place v. Workers' Comp. Appeals Bd. (1970) 3 Cal.3d 372, 377-379 [35 Cal.Comp.Cases 525]; Escobedo, supra, 70 Cal.Comp.Cases at p. 621 (Appeals Board en banc).)
The Appeals Board granted reconsideration to allow further development of the medical record and factual issues.
Favours Applicant prevailed
Granting reconsideration was necessary to enable a just and reasoned decision on the merits.
From the decision · page 6It is unclear from our preliminary review that there is substantial medical evidence to support the WCJ's decision. Taking into account the statutory time constraints for acting on the petition, and based upon our initial review of the record, we believe reconsideration must be granted to allow sufficient opportunity to further study the factual and legal issues in this case. We believe that this action is necessary to give us a complete understanding of the record and to enable us to issue a just and reasoned decision. Reconsideration is therefore granted for this purpose and for such further proceedings as we may hereafter determine to be appropriate.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473
Decisions of the Appeals Board must be based on admitted evidence in the record and supported by substantial evidence.
The Appeals Board reviewed the record and found the medical evidence insufficient to support the WCJ's decision.
From the decision · page 4Decisions of the Appeals Board "must be based on admitted evidence in the record." (Hamilton v. Lockheed Corporation (Hamilton) (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Board en banc).) The Appeals Board has a constitutional mandate to "accomplish substantial justice" in all cases. (Kuykendall v. Workers' Comp. Appeals Bd. (2000) 79 Cal.App.4th 396, 403 [65 Cal.Comp.Cases 264].) The Board has "a duty to develop an adequate record" and "it is well established that the WCJ or the Board may not leave undeveloped matters which its acquired specialized knowledge should identify as requiring further evidence." (Id., at pp. 403- 404.)
E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (2006) 145 Cal.App.4th 922
A medical opinion must be predicated on reasonable medical probability and disclose reasoning to constitute substantial evidence.
The Appeals Board emphasized that medical reports must include reasoning and not be based on speculation.
From the decision · page 4It is well established that decisions by the Appeals Board must be supported by substantial evidence. (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 be predicated on reasonable medical probability." (E.L. Yeager Construction v. Workers' Comp. Appeals Bd., (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687], citing McAllister v. Workmen's Comp. App. Bd. (1968) 69 Cal.2d 408, 413, 416§ 417, 419.) A medical opinion "is not substantial evidence if it is based on facts no longer germane, on inadequate medical histories or examinations, on incorrect legal theories, or on surmise, speculation, conjecture, or guess." (Id.,
Labor Code section 4663
Apportionment of permanent disability must be based on causation and include approximate percentages of industrial and non-industrial causes.
The Appeals Board reviewed the requirements for apportionment under Labor Code section 4663.
From the decision · page 5Section 4663, regarding apportionment of permanent disability, provides, in relevant part: (a) Apportionment of permanent disability shall be based on causation.
Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604
A physician's report must disclose familiarity with apportionment concepts and set forth the basis for the opinion to be substantial evidence.
The Appeals Board requires detailed explanation in apportionment reports to rely on them as substantial evidence.
From the decision · page 5To comply with section 4663, a physician's report in which permanent disability is addressed must also address apportionment of that permanent disability. (Escobedo v. Marshalls (Escobedo) (2005) 70 Cal.Comp.Cases 604 [2005 Cal. Wrk. Comp. LEXIS 71] (Appeals Bd. en banc).) However, the mere fact that a physician's report addresses the issue of causation of permanent disability and makes an apportionment determination by finding the approximate respective percentages of industrial and non-industrial causation does not necessarily render the report substantial evidence upon which we may rely. Rather, the report must "disclose familiarity with the concepts of apportionment, describe in detail the exact nature of the apportionable disability, and set forth the basis for the opinion, so that the Board can determine whether the physician is properly apportioning under correct legal principles." (Id. at p. 621.)
What proof carried it
The evidence the panel weighed, by kind.
The medical evidence or opinion on apportionment was incomplete, stale, or based on inaccurate history or speculation.
From the decision · page 6Here, based on our review, we are not persuaded that the record is properly developed. Where the medical evidence or opinion on an issue is incomplete, stale, and no longer germane, or is based on an inaccurate history, or speculation, it does not constitute substantial evidence. (Place v. Workers' Comp. Appeals Bd. (1970) 3 Cal.3d 372, 377-379 [35 Cal.Comp.Cases 525]; Escobedo, supra, 70 Cal.Comp.Cases at p. 621 (Appeals Board en banc).)
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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.
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