ADJ17103616 · May 22, 2026

The WCJ found the chiropractic QME's opinion on headaches was speculative and not substantial medical evidence, justifying ordering a neurological QME panel; the Appeals Board amended the order to remove language broadly disqualifying chiropractic opinions but affirmed the need for a neurological QME.

From the decision · page 1Applicant seeks reconsideration of the Findings of Fact, Award, and Order issued by the workers' compensation administrative law judge (WCJ) on March 10, 2026. Therein the WCJ found that, while employed as a battery tech and roadside assistant on June 13, 2022, applicant sustained injury arising out of and occurring in the course of employment (AOE/COE) to the cervical spine, thoracic spine, and left shoulder. The WCJ further found that "[t]he record needs further development, with a neurologist, as to whether Applicant sustained a compensable injury to the head (characterized as headaches) because of the June 13, 2022, incident." Based on these findings, the WCJ issued the following order:

The chiropractic QME's opinion on headaches was speculative and lacked reasonable medical probability and specific functional limitations.

Favours Defendant prevailed

This justified the WCJ's order for a neurological QME panel and the Appeals Board's amendment of the order to remove language broadly disqualifying chiropractic opinions but affirming the need for neurological evaluation.

From the decision · page 5The QME' s statement that the applicant's "pain may impact activities of daily living," without identifying any specific functional limitations or clinical findings to support that assertion, is speculative and does not constitute substantial medical evidence. The term "may" reflects mere possibility rather than reasonable medical probability. Medical-legal opinions in workers' compensation proceedings must be framed in terms of reasonable medical probability and must clearly set forth the reasoning and factual basis supporting the conclusions reached. An unsupported statement that a condition may affect daily activities provides no measurable functional analysis, no examples of limitation (such as restrictions in lifting, bending, concentrating, or self-care), and no explanation of causation. As such, it amounts to conjecture rather than a medically reasoned opinion.

E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 620-621 (Appeals Bd. en banc)

Medical opinions must be framed in terms of reasonable medical probability, based on adequate examination and history, and not be speculative; must set forth reasoning and factual basis for conclusions.

The WCJ found the chiropractic QME's opinion on headaches speculative and not substantial medical evidence, justifying ordering a neurological QME panel.

From the decision · page 5Code, § 4060(c)(d), 4061(i), 4062.3(l).) A medical opinion must be framed in terms of reasonable medical probability, it must be based on an adequate examination and history, it must not be speculative, and it must set forth reasoning to support the expert conclusions reached. (E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 620-621 (Appeals Bd. en banc).) "Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories. Medical opinion also fails to support the Board's

QME Chiropractor's statement that pain 'may' impact activities of daily living is speculative and lacks specific functional limitations or clinical findings

From the decision · page 5The QME' s statement that the applicant's "pain may impact activities of daily living," without identifying any specific functional limitations or clinical findings to support that assertion, is speculative and does not constitute substantial medical evidence. The term "may" reflects mere possibility rather than reasonable medical probability. Medical-legal opinions in workers' compensation proceedings must be framed in terms of reasonable medical probability and must clearly set forth the reasoning and factual basis supporting the conclusions reached. An unsupported statement that a condition may affect daily activities provides no measurable functional analysis, no examples of limitation (such as restrictions in lifting, bending, concentrating, or self-care), and no explanation of causation. As such, it amounts to conjecture rather than a medically reasoned opinion.