ADJ2024623 — California WCAB decision

ADJ2024623 · May 24, 2022

Findings and Award of May 21, 2019 affirmed except permanent disability finding in ADJ2024623 which is rescinded and deferred; case remanded to trial level for further proceedings and new determination of permanent disability.

Issues decided

Medical opinions weighed

Authorities named

District office

Salinas

What the panel ordered

Petition for reconsideration filed by Allianz Insurance Company challenging findings of permanent disability, apportionment, and psychiatric injury; Appeals Board granted reconsideration and issued Decision After Reconsideration affirming most findings but rescinding and deferring permanent disability finding in ADJ2024623 and remanding for further proceedings.

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What was disputed, and how it came out

Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.

Permanent disability ratingMixedright knee · left knee · psyche

The WCAB found substantial evidence supporting the diagnosis of CRPS and causation by the 01/05/96 injury, but rescinded and deferred the permanent disability finding in ADJ2024623 for further development due to insufficient evidence on permanent disability rating and apportionment.

From the decision · page 1In the Findings and Award of May 21, 2019, the Presiding Workers' Compensation Judge ("PWCJ") found that applicant, while employed as a human resources/payroll employee by Cardinale Automotive Group on July 11, 1995 (ADJ4652674, insurer Republic Indemnity Company) and on January 15, 1996 (ADJ2024623, insurer Allianz Insurance Company), sustained industrial injury to her right knee per the Amended Findings and Award of February 2, 2005, and that in ADJ2024623, applicant sustained industrial injury to her left knee, psyche and complex regional pain syndrome ("CRPS"), causing permanent disability of 100% under the 1978 Schedule for Rating Permanent Disabilities. In his Opinion on Decision, the PWCJ also found that "apportionment [of permanent disability] is 100% to the injury of January 5, 1996 in ADJ2024623MF based upon the opinion of Dr. Brose [pain specialist]," and that "[a]lthough the issue of [Labor Code section 3208.3(d)] is largely moot for permanent disability purposes...applicant did sustain a compensable psychiatric injury based [on her] credible testimony that she worked for over six months."1

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

Applicant's credible testimony that she worked for over six months for the employer before the injury.

Favours Applicant prevailed

Supported compensability of psychiatric injury under Labor Code section 3208.3(d), outweighing conflicting medical reports.

From the decision · page 1In the Findings and Award of May 21, 2019, the Presiding Workers' Compensation Judge ("PWCJ") found that applicant, while employed as a human resources/payroll employee by Cardinale Automotive Group on July 11, 1995 (ADJ4652674, insurer Republic Indemnity Company) and on January 15, 1996 (ADJ2024623, insurer Allianz Insurance Company), sustained industrial injury to her right knee per the Amended Findings and Award of February 2, 2005, and that in ADJ2024623, applicant sustained industrial injury to her left knee, psyche and complex regional pain syndrome ("CRPS"), causing permanent disability of 100% under the 1978 Schedule for Rating Permanent Disabilities. In his Opinion on Decision, the PWCJ also found that "apportionment [of permanent disability] is 100% to the injury of January 5, 1996 in ADJ2024623MF based upon the opinion of Dr. Brose [pain specialist]," and that "[a]lthough the issue of [Labor Code section 3208.3(d)] is largely moot for permanent disability purposes...applicant did sustain a compensable psychiatric injury based [on her] credible testimony that she worked for over six months."1

Multiple medical opinions diagnosing Complex Regional Pain Syndrome (CRPS) caused by the 01/05/96 injury and resulting surgery.

Favours Applicant prevailed

Supported the finding of industrial injury and causation for permanent disability, but permanent disability rating was deferred for further development.

From the decision · page 10Applicant's residual disability and ability to function has been described by all of the AME's. Dr. Brose confirms that applicant suffers from Complex Regional Pain Syndrome in her right leg. (Report, 10/25/07, p. 1 and p. 7; Exh. W-31.)

What the panel did with the medical opinions

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.

AMERelied upon · pain medicine

Diagnosed applicant with Complex Regional Pain Syndrome (CRPS) caused solely by the 01/05/96 injury and resulting surgery, concluding 100% permanent total disability due to CRPS.

Dr. Brose's opinion was well-reasoned, supported by scientific literature, and found substantial evidence for causation and disability, but the WCAB deferred final disability rating for further development.

From the decision · page 10Applicant's residual disability and ability to function has been described by all of the AME's. Dr. Brose confirms that applicant suffers from Complex Regional Pain Syndrome in her right leg. (Report, 10/25/07, p. 1 and p. 7; Exh. W-31.)

AMERecord developed further · psychiatry

Assessed psychiatric disability factors but did not provide a clear opinion on work status or ability; WCAB ordered supplemental report for further development.

Dr. Segal's report was too vague to support a finding of psychiatric disability; WCAB ordered further development.

From the decision · page 5Turning to the issue of psychiatric disability, we note that Dr. Segal, the AME in psychiatry, most recently addressed permanent disability in his report dated November 27, 2015. (Exhibit W42, pp. 11-13.) Dr. Segal assessed applicant with factors of disability ranging from very slight impairment to moderate impairment in eight work function categories. (1978 Schedule for Rating Permanent Disabilities (1990 Ed., p. 1-B.) Dr. Segal further commented, "if one summates the orthopedic, pain specialist, and psychiatric ratings, it approximates her rather poor overall level of functioning." (Exhibit W42, p. 12.) Aside from the fact that Dr. Segal is not an orthopedic or pain specialist, his assessment that applicant has a "poor overall level of functioning" is too vague to support a finding of psychiatric disability. Otherwise, Dr. Segal did not provide an opinion about applicant's work status or work ability. Therefore, the PWCJ should further develop the record by obtaining a supplemental report from Dr. Segal to more specifically describe applicant's psychiatric disability, including her ability to work and her ability to participate in

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Labor Code section 3208.3(d)

Labor Code section 3208.3(d) regarding compensability of psychiatric injury and employment duration requirement.

The WCAB credited applicant's testimony that she worked over six months, supporting compensability of psychiatric injury under this statute.

From the decision · page 1In the Findings and Award of May 21, 2019, the Presiding Workers' Compensation Judge ("PWCJ") found that applicant, while employed as a human resources/payroll employee by Cardinale Automotive Group on July 11, 1995 (ADJ4652674, insurer Republic Indemnity Company) and on January 15, 1996 (ADJ2024623, insurer Allianz Insurance Company), sustained industrial injury to her right knee per the Amended Findings and Award of February 2, 2005, and that in ADJ2024623, applicant sustained industrial injury to her left knee, psyche and complex regional pain syndrome ("CRPS"), causing permanent disability of 100% under the 1978 Schedule for Rating Permanent Disabilities. In his Opinion on Decision, the PWCJ also found that "apportionment [of permanent disability] is 100% to the injury of January 5, 1996 in ADJ2024623MF based upon the opinion of Dr. Brose [pain specialist]," and that "[a]lthough the issue of [Labor Code section 3208.3(d)] is largely moot for permanent disability purposes...applicant did sustain a compensable psychiatric injury based [on her] credible testimony that she worked for over six months."1

Power v. Workers' Comp. Appeals Bd. (1986) 51 Cal. Comp. Cases 114

Substantial evidence standard for medical opinions and causation in workers' compensation cases.

The WCAB found Dr. Brose's opinion substantial evidence supporting causation and disability, but deferred final disability rating for further development.

From the decision · page 1In the Findings and Award of May 21, 2019, the Presiding Workers' Compensation Judge ("PWCJ") found that applicant, while employed as a human resources/payroll employee by Cardinale Automotive Group on July 11, 1995 (ADJ4652674, insurer Republic Indemnity Company) and on January 15, 1996 (ADJ2024623, insurer Allianz Insurance Company), sustained industrial injury to her right knee per the Amended Findings and Award of February 2, 2005, and that in ADJ2024623, applicant sustained industrial injury to her left knee, psyche and complex regional pain syndrome ("CRPS"), causing permanent disability of 100% under the 1978 Schedule for Rating Permanent Disabilities. In his Opinion on Decision, the PWCJ also found that "apportionment [of permanent disability] is 100% to the injury of January 5, 1996 in ADJ2024623MF based upon the opinion of Dr. Brose [pain specialist]," and that "[a]lthough the issue of [Labor Code section 3208.3(d)] is largely moot for permanent disability purposes...applicant did sustain a compensable psychiatric injury based [on her] credible testimony that she worked for over six months."1

ADJ2024623 · May 24, 2022

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

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