ADJ12560810 · March 25, 2024

The WCAB found that the initial QME report was not substantial evidence due to incomplete records, but the subsequent reports supported that the psychiatric injury was predominantly caused by employment events, warranting further proceedings.

From the decision · page 1Applicant seeks reconsideration of the Findings and Order (F&O) issued by the workers' compensation administrative law judge (WCJ) on January 4, 2024, wherein the WCJ found that applicant's psychiatric injury was not predominantly caused by actual events of employment, and the WCJ ordered that applicant take nothing by way of his injury claim.

Dr. Spencer's initial QME report was not substantial evidence due to incomplete medical records and inadequate examination.

Favours Applicant prevailed

This led the WCAB to rescind the initial Findings and Order and order further development of the record.

From the decision · page 4Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc).) As noted above, in our Opinion we discussed the fact that in his initial report, and deposition testimony, Dr. Spencer clearly explained that he was unable to perform an adequate examination of applicant and that the medical record he reviewed did not constitute an accurate history. He repeatedly indicated that in order to be fully informed, and to be able to provide an appropriate analysis as to the issue of injury AOE/COE, he needed to review the complete medical record, and he stated that it might be appropriate for him to re-evaluate applicant.

Dr. Spencer's subsequent reports after re-evaluation supported that the psychiatric injury was predominantly caused by employment events.

Favours Applicant prevailed

This supported granting reconsideration, amending the claim to cumulative injury, and remanding for further proceedings.

From the decision · page 1Applicant contends that the October 6, 2022, and May 24, 2023, reports from psychiatric qualified medical examiner (QME) Edward L. Spencer, M.D., are substantial evidence that the actual events of applicant's employment were the predominant cause of his psychiatric injury.

Dr. Spencer initially stated he lacked complete medical records and needed re-evaluation. After reviewing extensive records and re-examining the applicant, he opined that the psychiatric injury was predominantly caused by perceived chronic adverse work circumstances (55%), acute workplace events (25%), and cannabis use (20%).

The WCAB found Dr. Spencer's initial report was not substantial evidence due to incomplete records, but his subsequent reports after re-evaluation were substantial evidence supporting causation of the psychiatric injury by employment events.

From the decision · page 1Applicant contends that the October 6, 2022, and May 24, 2023, reports from psychiatric qualified medical examiner (QME) Edward L. Spencer, M.D., are substantial evidence that the actual events of applicant's employment were the predominant cause of his psychiatric injury.

Labor Code section 3208.3; Rolda v. Pitney Bowes (2001) 66 Cal.Comp.Cases 241 (Appeals Board en banc)

Labor Code section 3208.3 requires a Rolda analysis to determine compensability of psychiatric injury involving personnel actions.

The WCAB outlined the four-step Rolda analysis required for compensability determination if injury AOE/COE is found.

From the decision · page 5did sustain a psychiatric injury AOE/COE, it is important to note that Labor Code section 3208.3

Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc)

To be substantial evidence a medical opinion must be based on pertinent facts, on an adequate examination and accurate history, and it must set forth the basis and the reasoning in support of the conclusions.

The WCAB applied this standard to find the initial QME report was not substantial evidence due to incomplete records and inadequate examination, but the subsequent reports were substantial evidence.

From the decision · page 4DISCUSSION Pursuant to Appeals Board rule 10517, "Pleadings may be amended by the Workers' Compensation Appeals Board to conform to proof." (Cal. Code Regs., tit. 8, § 10517.) Having reviewed the entire record, including applicant's trial testimony and the reports from QME Dr. Spencer, it is clear that although the injury claim was pled as a specific injury, applicant is actually claiming a cumulative psychiatric injury, occurring over the course of his employment with defendant. Based thereon, we will amend the application to accurately identify applicant's cumulative psychiatric injury claim. To be substantial evidence a medical opinion must be based on pertinent facts, on an adequate examination and accurate history, and it must set forth the basis and the reasoning in support of the conclusions. (Escobedo v.

Dr. Spencer's initial report and deposition testimony were not substantial evidence due to incomplete medical records and inadequate examination.

From the decision · page 4Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc).) As noted above, in our Opinion we discussed the fact that in his initial report, and deposition testimony, Dr. Spencer clearly explained that he was unable to perform an adequate examination of applicant and that the medical record he reviewed did not constitute an accurate history. He repeatedly indicated that in order to be fully informed, and to be able to provide an appropriate analysis as to the issue of injury AOE/COE, he needed to review the complete medical record, and he stated that it might be appropriate for him to re-evaluate applicant.