ADJ19233122 · October 6, 2025

The Appeals Board found substantial medical evidence from Dr. Hughes supporting injury AOE/COE to multiple body parts and need for continuing medical treatment, rejecting defendant's argument that no compensable disability existed on the date of injury.

From the decision · page 1Defendant seeks reconsideration of the July 3, 2025 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 cashier during the period from September 21, 2022 through September 21, 2023, sustained injury arising out of and in the course of employment (AOE/COE) to the cervical, thoracic, and lumbar spine, bilateral shoulders, and right upper extremity with a need for continuing medical treatment to cure or relieve from the effects of the injury.

Dr. Hughes' medical report and deposition provide substantial evidence of injury AOE/COE to multiple body parts and need for continuing medical treatment.

Favours Applicant prevailed

The Appeals Board relied on Dr. Hughes' detailed examination, relevant medical history, and reasonable medical probability opinions to uphold the injury and treatment findings.

From the decision · page 2FACTS Applicant claimed that while employed by defendant as a cashier during the period from September 21, 2022 through September 21, 2023, she sustained injury AOE/COE to the cervical, thoracic, and lumbar spine, bilateral shoulders, and right upper extremity. The parties proceeded with discovery and retained Dr. Lorenzo T. Hughes as the pain medicine panel Qualified Medical Evaluator (PQME). Dr. Hughes evaluated applicant on January 6, 2025, and issued a corresponding report, which was revised on April 23, 2025, wherein he provided preliminary diagnoses of thoracic spondylosis, lumbar severe stenosis, radiculopathy, and spondylosis, cervical radiculopathy and spondylosis, bilateral shoulder tendinopathy, and right upper extremity ulnar neuropathy at the elbow. (Applicant Exhibit 1, p. 26.) Dr. Hughes opined that there was "industrial causation" for the cumulative injury through the "last day of usual and customary employment to the lumbar spine, thoracic spine, cervical spine, right shoulder, left shoulder, and right upper extremity" and "to a degree of reasonable medical probability" applicant's need for continuing medical care stemmed from the injury. (Id. at p. 27.) On April 25, 2025, Dr.

Applicant sustained cumulative injury AOE/COE to cervical, thoracic, lumbar spine, bilateral shoulders, and right upper extremity with need for continuing medical care.

Dr. Hughes provided detailed examination, relevant medical history, and reasonable medical probability opinions supporting industrial causation and continuing medical treatment need.

From the decision · page 2FACTS Applicant claimed that while employed by defendant as a cashier during the period from September 21, 2022 through September 21, 2023, she sustained injury AOE/COE to the cervical, thoracic, and lumbar spine, bilateral shoulders, and right upper extremity. The parties proceeded with discovery and retained Dr. Lorenzo T. Hughes as the pain medicine panel Qualified Medical Evaluator (PQME). Dr. Hughes evaluated applicant on January 6, 2025, and issued a corresponding report, which was revised on April 23, 2025, wherein he provided preliminary diagnoses of thoracic spondylosis, lumbar severe stenosis, radiculopathy, and spondylosis, cervical radiculopathy and spondylosis, bilateral shoulder tendinopathy, and right upper extremity ulnar neuropathy at the elbow. (Applicant Exhibit 1, p. 26.) Dr. Hughes opined that there was "industrial causation" for the cumulative injury through the "last day of usual and customary employment to the lumbar spine, thoracic spine, cervical spine, right shoulder, left shoulder, and right upper extremity" and "to a degree of reasonable medical probability" applicant's need for continuing medical care stemmed from the injury. (Id. at p. 27.) On April 25, 2025, Dr.

Labor Code section 5412

Date of injury in cumulative injury cases is the date employee first suffered disability and knew or should have known it was caused by employment (Lab. Code § 5412).

Applied to clarify the date of injury and reject defendant's argument conflating date of injury and date of exposure.

From the decision · page 4Turning now to the merits of the Petition, section 3208.1 provides that: "An injury may be either: (a) `specific,' occurring as the result of one incident or exposure which causes disability or need for medical treatment; or (b) `cumulative,' occurring as repetitive mentally or physically traumatic activities extending over a period of time, the combined effect of which causes any disability or need for medical treatment. The date of a cumulative injury shall be the date determined under Section 5412."

Labor Code section 3208.1

An injury may be specific or cumulative; cumulative injury occurs from repetitive activities over time causing disability or need for medical treatment (Lab. Code § 3208.1).

Applied to define cumulative injury and its date determination.

From the decision · page 4Turning now to the merits of the Petition, section 3208.1 provides that: "An injury may be either: (a) `specific,' occurring as the result of one incident or exposure which causes disability or need for medical treatment; or (b) `cumulative,' occurring as repetitive mentally or physically traumatic activities extending over a period of time, the combined effect of which causes any disability or need for medical treatment. The date of a cumulative injury shall be the date determined under Section 5412."

Labor Code section 5500.5

Liability for cumulative injury claims limited to employers during one year preceding date of injury or last exposure (Lab. Code § 5500.5).

Clarified distinction between date of injury and date of exposure for liability purposes.

From the decision · page 4Section 5500.5(a) provides that: "Except as otherwise provided in Section 5500.6, liability for occupational disease or cumulative injury claims filed or asserted on or after [January 1, 1981] shall be limited to those employers who employed the employee during a period of [one year] immediately preceding either the date of injury, as determined pursuant to Section 5412, or the last date on which the employee was employed in an occupation exposing him or her to the hazards of the occupational disease or cumulative injury, whichever occurs first."

Medical opinion must be based on relevant facts, adequate examination, and correct legal theories to constitute substantial evidence (E.L. Yeager v. WCAB, Kyle v. WCAB).

Applied to evaluate Dr. Hughes' report as substantial evidence supporting injury and medical treatment need.

From the decision · page 5As parties are well aware, a decision "must be based on admitted evidence in the record" and supported by substantial evidence. (Lab. Code, § 5903, 5952, subd. (d); Hamilton v. Lockheed Corporation (Hamilton) (2001) 66 Cal.Comp.Cases 473, 476, 478 (Appeals Bd. en banc); 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. Workers' Comp. Appeals Bd. (1970) 1 Cal.3d 627 [35 Cal.Comp.Cases 16].) Pursuant to E.L. Yeager v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687], "[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

Detailed medical examination and report by Dr. Hughes

From the decision · page 2FACTS Applicant claimed that while employed by defendant as a cashier during the period from September 21, 2022 through September 21, 2023, she sustained injury AOE/COE to the cervical, thoracic, and lumbar spine, bilateral shoulders, and right upper extremity. The parties proceeded with discovery and retained Dr. Lorenzo T. Hughes as the pain medicine panel Qualified Medical Evaluator (PQME). Dr. Hughes evaluated applicant on January 6, 2025, and issued a corresponding report, which was revised on April 23, 2025, wherein he provided preliminary diagnoses of thoracic spondylosis, lumbar severe stenosis, radiculopathy, and spondylosis, cervical radiculopathy and spondylosis, bilateral shoulder tendinopathy, and right upper extremity ulnar neuropathy at the elbow. (Applicant Exhibit 1, p. 26.) Dr. Hughes opined that there was "industrial causation" for the cumulative injury through the "last day of usual and customary employment to the lumbar spine, thoracic spine, cervical spine, right shoulder, left shoulder, and right upper extremity" and "to a degree of reasonable medical probability" applicant's need for continuing medical care stemmed from the injury. (Id. at p. 27.) On April 25, 2025, Dr.