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 · Orthopedic
Reported applicant could not lift right shoulder due to pain by 1/12/2008.
From the decision · page 4Applicant was in need of left shoulder surgery but turned it down due to the bad result from the
right shoulder surgery. Applicant had not worked since the date of injury. See Orthopedic AME
John Carr, M.D., report dated 8/19/2009, pages 1-2, lien claimant's exhibit #6. By 1/12/2008,
applicant could not lift his right shoulder due to pain. See PQME report of Michael Z. Mekjian,
Ph.D., report dated 11/15/2018, page 6, lien claimant's exhibit 7. On 3/14/2011, applicant had a
second surgery to the right shoulder. See PQME report of Michael Z. Mekjian, Ph.D., report dated
11/15/2018, page 7, lien claimant's exhibit 7. In terms of the development of psychiatric
symptoms, applicant reported that he began to notice the onset of depression approximately two
to three years after the accident, beginning in approximately July 2008 or 2009. Applicant reported
being embarrassed about how much time had passed since his injury, and not being able to work
and financially provide for his family.
QMERelied upon · Psychiatry
Reported onset of depression and anxiety approximately two to three years after the accident, with significant risk for chronic invalidism and dependency.
From the decision · page 4Applicant was in need of left shoulder surgery but turned it down due to the bad result from the
right shoulder surgery. Applicant had not worked since the date of injury. See Orthopedic AME
John Carr, M.D., report dated 8/19/2009, pages 1-2, lien claimant's exhibit #6. By 1/12/2008,
applicant could not lift his right shoulder due to pain. See PQME report of Michael Z. Mekjian,
Ph.D., report dated 11/15/2018, page 6, lien claimant's exhibit 7. On 3/14/2011, applicant had a
second surgery to the right shoulder. See PQME report of Michael Z. Mekjian, Ph.D., report dated
11/15/2018, page 7, lien claimant's exhibit 7. In terms of the development of psychiatric
symptoms, applicant reported that he began to notice the onset of depression approximately two
to three years after the accident, beginning in approximately July 2008 or 2009. Applicant reported
being embarrassed about how much time had passed since his injury, and not being able to work
and financially provide for his family.
otherRelied upon · Internal Medicine
Evaluated applicant for headaches, disrupted sleep, teeth grinding, depression, anxiety, weight changes.
From the decision · page 4He began to socially isolate from his family, and did not
want to communicate with friends. Applicant noted the onset of anxiety around this same period.
See PQME report of Michael Z. Mekjian, Ph.D., report dated 11/15/2018, page 5, lien claimant's
exhibit 7. Defendant denied the claim of injury to the teeth and mouth. See defense exhibit F letter
to applicant dated 6/21/2016. On 7/20/2016, applicant underwent an internal medicine evaluation
by Arthur Lipper, M.D. due to complaints of headaches, disrupted sleep, teeth grinding at night,
depression, anxiety, weight loss and weight gain. See PQME report of Michael Z.
otherRelied upon · Dentistry
Reported fractured teeth #9 and #11 due to bruxism on an industrial basis and issued 4 RFAs for treatment.
Dentist not licensed to diagnose sleep apnea; oral appliance treatment not supported for sleep apnea.
From the decision · page 4Mekjian, Ph.D.,
report dated 11/15/2018, page 7, lien claimant's exhibit 7. Applicant was prescribed Trazodone to
assist with sleep by Dr. Armstrong. Applicant was thought to be a significant risk for chronic
invalidism and dependency, due to his history of failed surgical outcomes. See PQME report of
Michael Z. Mekjian, Ph.D., report dated 11/15/2018, page 9, lien claimant's exhibit 7. On
7/25/2016, applicant underwent an evaluation in Dentistry at The Dental Trauma Center. In terms
of problems with the teeth and mouth, applicant had fractured teeth, #9 and #11 on an industrial
basis due to Bruxism. See report of Dr. Schames dated 7/25/2016, page 25, lien claimant's exhibit
#4. Dr. Schames issued 4 RFA's for treatment. Authorization was denied. See defense letter to
Dr. Schames dated 11/3/2016, defense exhibit G. Based upon a review of the entire record, the
undersigned found that suffered from dry mouth, teeth grinding and fractured teeth on an industrial
basis as a compensable consequence of his industrial orthopedic, internal and psychiatric injuries.
Defendant did not reserve the right to conduct retrospective UR. See defense exhibit E,
EOR/EOB/IPR dated 11/8/2016. Defendant did not seek a PQME in Dentistry. Defendant relies
on the declaration of Sylvia Pulido, claims adjuster at SCIF, dated 3/10/2023, defense exhibit D,