ADJ16093500 · August 15, 2024

The Board found that the injury was caused by cumulative trauma from employment duties as supported by the QME Dr. John Gonzalez's reports and deposition, and that the injury arose out of and in the course of employment.

From the decision · page 1Defendant seeks reconsideration of the June 17, 2024 Findings and Award (F&A) wherein the workers' compensation administrative law judge (WCJ) found in relevant part that applicant, while employed by defendant as a custodian during the period from April 26, 2011 through March 22, 2022, sustained injury arising out of and in the course of employment (AOE/COE) to the hands, arms, fingers and elbows; and that applicant was entitled to medical treatment.

The Board found that applicant is entitled to medical treatment for the injury, including treatment for the left trigger ring finger as recommended by the QME Dr. Gonzalez, and that causation is separate from the parts needing treatment.

From the decision · page 3We further note that "notwithstanding whatever an employer does (or does not do)" to contest medical treatment, applicant has the burden of proving, by a preponderance of the evidence, that the treatment in question is medically reasonable and necessary. (State Comp. Ins. Fund v. Workers' Comp. Appeals Bd. (2008) 44 Cal.4th 230, 242 [73 Cal.Comp.Cases 981], citing Lab. Code, § 3202.5 & 4600.) In addition, we note that section 4600 "consistently has been interpreted to require the employer to pay for all medical treatment once it has been established that an industrial injury contributed to an employee's need for it." (See Hikida v. Workers' Comp. Appeals Bd. (2017) 12 Cal.App.5th 1249, 1261 [82 Cal.Comp.Cases 679], italics added, string citations2 and internal quotations omitted; South Coast Framing, supra, 61 Cal.4th 291 [death benefits upheld where drugs prescribed to treat industrial injury contributed to employee's death]; Braewood Convalescent Hospital v. Worker's Comp. Appeals Bd. (1983) 34 Cal.3d 159, 165 [48 Cal.Comp.Cases 566] [employee suffering from pre-existing condition later disabled by industrial injury was entitled to treatment even for a non-industrial condition that was required to cure or relieve effects of industrial injury].)

QME Dr. John Gonzalez opined that applicant's symptoms are associated with cumulative injury to arms, elbows, hands, and fingers caused by repetitive and prolonged work activities.

Favours Applicant prevailed

This medical opinion established causation linking the injury to employment, supporting compensability.

From the decision · page 3In the case at hand, applicant's injury was found to be a result of cumulative trauma sustained by applicant during applicant's employment with defendant from April 26, 2011 through March 22, 2022. As indicated by the Qualified Medical Evaluator (QME), Dr. John Gonzalez, in his August 13, 2022 report: "applicant's symptoms are associated with the cumulative injury." (QME Report of Dr. John Gonzalez, August 13, 2022, p. 6.) Dr. Gonzalez further noted that applicant had recounted cumulative trauma to his "arms, elbows, hands, and fingers" due to "repetitive and prolonged work activities such as vacuuming, mopping, cleaning the toilet, and closing, opening, and locking doors." (Ibid, p. 2.)

Applicant testified at trial confirming onset of upper extremity pain from bathroom duties and reporting the problem to employer.

Favours Applicant prevailed

Applicant's credible testimony supported the finding of injury arising out of employment.

From the decision · page 78/13/22, Exhibit 1, p. 6.) On page 2 of this report under "Mechanism of Injury: the applicant attributed his cumulative trauma in the arms, elbows, hands, and fingers from April 26, 2011 to March 22, 2022, as having result from his repetitive and prolonged work activities such as vacuuming, mopping, cleaning the toilet, and closing, opening, and locking doors. He is not able to recall when he noticed worsening of his pain. The injury was reported to his employer, but no report was filed." (Id., at 2.) At trial, the applicant confirmed the onset of his upper extremity pain began from bathroom duties, and applicant had reported the problem. (SOE Trial 6/3/24, p. 5:10-16.) Dr. Gonzalez had his deposition taken on February 24, 2023 (Exhibit 5), and the doctor was asked about applicant's medical history and outside activities including construction work. Dr. Gonzalez never recanted his opinion that work caused applicant's injury, but the doctor concluded that he would like to review any additional records and re-evaluate the applicant. (Deposition of Dr. Gonzalez dated 2/24/23, Exhibit 5, p. 22:1-10.) In the final report, Dr. Gonzalez reiterated that work caused applicant's injury in the reevaluation report dated December 6, 2023. (QME report of Dr. Gonzalez dated 12/6/23, Exhibit 4, p. 5.)

The Board found that causation is separate from the parts of the body needing ongoing medical treatment, rejecting defendant's argument limiting injury to left trigger ring finger only.

Favours Applicant prevailed

This legal interpretation upheld the broader injury finding and entitlement to treatment.

From the decision · page 4however, has never been a precursor or requirement to a finding of injury AOE/COE. We agree with the WCJ that "causation" is not "predicated on the parts of the body that need treatment."

Applicant's symptoms are associated with cumulative injury to arms, elbows, hands, and fingers caused by repetitive and prolonged work activities. Applicant needs treatment including left ring finger trigger release surgery.

Dr. Gonzalez's reports and deposition consistently opined that the injury was industrially related and caused by cumulative trauma from employment duties.

From the decision · page 3In the case at hand, applicant's injury was found to be a result of cumulative trauma sustained by applicant during applicant's employment with defendant from April 26, 2011 through March 22, 2022. As indicated by the Qualified Medical Evaluator (QME), Dr. John Gonzalez, in his August 13, 2022 report: "applicant's symptoms are associated with the cumulative injury." (QME Report of Dr. John Gonzalez, August 13, 2022, p. 6.) Dr. Gonzalez further noted that applicant had recounted cumulative trauma to his "arms, elbows, hands, and fingers" due to "repetitive and prolonged work activities such as vacuuming, mopping, cleaning the toilet, and closing, opening, and locking doors." (Ibid, p. 2.)

Labor Code section 3600; South Coast Framing v. Workers' Comp. Appeals Bd. (2015) 61 Cal. 4th 291; Department of Rehabilitation v. Workers' Comp. Appeals Bd. (Lauher) (2003) 30 Cal. 4th 1281; Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal. 3d 274; Lundberg v. Workers' Comp. Appeals Bd. (1968) 69 Cal. 2d 436

Injury must arise out of and in the course of employment to be compensable; burden on employee to prove by preponderance; all doubts resolved in favor of employee.

The Board applied these standards to find the injury compensable as arising out of and in the course of employment.

From the decision · page 2Pursuant to Labor Code section1 3600, to be compensable, an injury must arise out of and occur in the course of employment. Further, the employee bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing v. Workers' Comp. Appeals Bd. (2015) 61 Cal. 4th 291, 297§ 298, 302 [80 Cal. Comp. Cases 489]; Lab. Code, § 3600(a); 3202.5.) In applying this requirement, however, all reasonable doubts as to whether an injury arose out of employment are to be resolved in favor of the employee. (Department of Rehabilitation v. Workers' Comp. Appeals Bd. (Lauher) (2003) 30 Cal. 4th 1281, 1290§ 1291 [68 Cal. Comp. Cases 831]; Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal. 3d 274, 280 [39 Cal. Comp. Cases 310]; Lundberg v. Workers' Comp. Appeals Bd. (1968) 69 Cal. 2d 436, 439 [33 Cal. Comp.

Labor Code sections 3202.5 and 4600; State Comp. Ins. Fund v. Workers' Comp. Appeals Bd. (2008) 44 Cal.4th 230; Hikida v. Workers' Comp. Appeals Bd. (2017) 12 Cal.App.5th 1249

Employer must pay for all medical treatment once industrial injury contribution is established.

The Board applied these standards to affirm entitlement to medical treatment for the injury.

From the decision · page 3We further note that "notwithstanding whatever an employer does (or does not do)" to contest medical treatment, applicant has the burden of proving, by a preponderance of the evidence, that the treatment in question is medically reasonable and necessary. (State Comp. Ins. Fund v. Workers' Comp. Appeals Bd. (2008) 44 Cal.4th 230, 242 [73 Cal.Comp.Cases 981], citing Lab. Code, § 3202.5 & 4600.) In addition, we note that section 4600 "consistently has been interpreted to require the employer to pay for all medical treatment once it has been established that an industrial injury contributed to an employee's need for it." (See Hikida v. Workers' Comp. Appeals Bd. (2017) 12 Cal.App.5th 1249, 1261 [82 Cal.Comp.Cases 679], italics added, string citations2 and internal quotations omitted; South Coast Framing, supra, 61 Cal.4th 291 [death benefits upheld where drugs prescribed to treat industrial injury contributed to employee's death]; Braewood Convalescent Hospital v. Worker's Comp. Appeals Bd. (1983) 34 Cal.3d 159, 165 [48 Cal.Comp.Cases 566] [employee suffering from pre-existing condition later disabled by industrial injury was entitled to treatment even for a non-industrial condition that was required to cure or relieve effects of industrial injury].)

Applicant's testimony at trial confirming onset of upper extremity pain from bathroom duties and reporting the problem to employer.

From the decision · page 78/13/22, Exhibit 1, p. 6.) On page 2 of this report under "Mechanism of Injury: the applicant attributed his cumulative trauma in the arms, elbows, hands, and fingers from April 26, 2011 to March 22, 2022, as having result from his repetitive and prolonged work activities such as vacuuming, mopping, cleaning the toilet, and closing, opening, and locking doors. He is not able to recall when he noticed worsening of his pain. The injury was reported to his employer, but no report was filed." (Id., at 2.) At trial, the applicant confirmed the onset of his upper extremity pain began from bathroom duties, and applicant had reported the problem. (SOE Trial 6/3/24, p. 5:10-16.) Dr. Gonzalez had his deposition taken on February 24, 2023 (Exhibit 5), and the doctor was asked about applicant's medical history and outside activities including construction work. Dr. Gonzalez never recanted his opinion that work caused applicant's injury, but the doctor concluded that he would like to review any additional records and re-evaluate the applicant. (Deposition of Dr. Gonzalez dated 2/24/23, Exhibit 5, p. 22:1-10.) In the final report, Dr. Gonzalez reiterated that work caused applicant's injury in the reevaluation report dated December 6, 2023. (QME report of Dr. Gonzalez dated 12/6/23, Exhibit 4, p. 5.)