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.
QMERelied upon · Physical Medicine and Rehabilitation
Found applicant suffered cumulative trauma injury to lower back, bilateral shoulders, left elbow, fingers, bilateral lower extremities/knees, and psychological/emotional problems including dental issues and hypertension, all stemming from employment over 22 years.
Supported the compensability of the dental injury and other cumulative trauma injuries.
From the decision · page 3III. FACTS
Applicant filed a claim of cumulative trauma injury to her shoulders, left arm, left
elbow, fingers, low back, legs, knees, high blood pressure, dental and headaches in
ADJ12445186 entered in EAMS FileNet as of 08/12/2019 together with proof of service on
Zurich and the employer (EAMS Doc. ID No. 29979409).
Petitioner avers for the first time on reconsideration that this claim was timely denied
by the Answer dated 10/23/2019, never proffered in evidence at trial (EAMS Doc. ID No.
30673023). Neither was the Answer listed on the pretrial conference statement (EAMS Doc.
ID No. 47820466).
The parties engaged panel qualified medical examiner Harout Balian, M.D. in the field
of Physical Medicine and Rehabilitation who reported on 04/26/2021(Lien Claimant's Exhibit
5) that applicant did suffer a CT injury to her "lower back, bilateral shoulder (sic), left elbow,
fingers, and bilateral lower extremities / knees," which parts of body were said to be "in my
specialty range." He recorded that applicant presented with headaches and
otherRelied upon · Dentistry
Opined that applicant's facial pain and dental bruxism were caused by clenching teeth and emotional stressors related to orthopedic pain, supporting industrial causation of dental injury.
Provided causation opinion linking dental injury to industrial orthopedic pain and emotional stressors.
From the decision · page 4Medical Evidence
The orthopedic CT injury is fully supported by PQME Dr. Balian.
Petitioner contests the conclusion of Meyer Schames, D.D.S. (Lien Claimant's Exhibit 3,
report of 01/10/2020) on the ground that it fails to include the "how and why" of pain and
emotional stressors being causative of bruxism.
The petition itself quotes Dr. Schames at length, where the doctor opines "clenching her
teeth and bracing her facial musculature in response to orthopedic pain, and also in response to
resultant emotional stressors experienced. This has caused her to develop facial pain" and "due to
the chronicity of the facial pain and the continued bruxism, the applicant's facial pain has evolved
into having Trigeminal Nerve Pain/Central Sensitization components to her facial pain" and "That
otherRelied upon · Psychology
Diagnosed Major Depressive Disorder, Adjustment Disorder with Anxiety and Depressed Mood, and Psychological Factors Affecting Physical Conditions, all directly caused by work exposure, supporting psychological industrial injury.
Supported underlying psychological industrial injury causation for dental issues.
From the decision · page 4A Comprehensive Medical/Legal Psychological Evaluation dated 09/16/2019 was
admitted in evidence from Anthony Francisco, Ph.D. (Lien Claimant's Exhibit 7). Dr. Francisco
reported that applicant suffered from Major Depressive Disorder, Adjustment Disorder with
Anxiety and Depressed Mood and Psychological Factors Affecting Physical Conditions, all of
which were directly caused by work exposure. He took a history of work activities and her report
of symptoms: