What the panel ordered
Petition for Reconsideration is granted; final decision after reconsideration is deferred pending further review of the merits and entire record.
Applicant seeks reconsideration of the August 19, 2025 Findings and Order issued by the WCJ, which denied additional benefits for new and further disability; the WCAB grants reconsideration and defers final decision pending further review.
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.
The WCJ found no substantial evidence that the current total disability was solely due to the industrial injury; the WCAB deferred final decision for further review.
From the decision · page 4The WCJ emphasizes at the outset that there is little doubt that applicant is permanently and totally disabled. However, it is applicant's burden to demonstrate, through substantial medical evidence, that the industrial injury of July 8, 2013, is the cause of applicant's alleged new and further disability. After a thorough review of the medical reporting of Dr. Wieseltier, Dr. McSweeney, and Dr. Ziegler, as well as the independent medical evaluation of Dr. John Lane, the WCJ finds that none of these physicians have provided clear and substantial evidence regarding how, why, and to what extent applicants' current total disability is due to the injury of July 8, 2013. This case has been on this WCJ's trial calendar on eight separate occasions. Therefore, applicant has had more than adequate opportunity to develop the record and provide the court with substantial evidence. The WCJ has repeatedly reviewed applicant's evidence and determined that none of the medical reporting was substantial evidence on the issues presented, and further discovery was necessary. Therefore, after receiving no additional medical reporting that addresses the industrial causation issue, the WCJ eventually found it necessary to order an
The WCAB granted reconsideration because the WCJ's decision lacked substantial evidence to determine if the new disability was due to the industrial injury, and further review was necessary.
From the decision · page 8V. Accordingly, we grant applicant's Petition for Reconsideration, and order that a final decision after reconsideration is deferred pending further review of the merits of the Petition for Reconsideration and further consideration of the entire record in light of the applicable statutory and decisional law. While this matter is pending before the Appeals Board, we encourage the parties to participate in the Appeals Board's voluntary mediation program. Inquiries as to the use of our mediation program can be addressed to WCABmediation@dir.ca.gov. For the foregoing reasons, IT IS ORDERED that applicant's Petition for Reconsideration is GRANTED.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant is permanently and totally disabled but medical evidence does not show that this disability is solely due to the industrial injury of July 8, 2013.
Favours neutral
This fact led the WCJ to deny additional benefits and the WCAB to grant reconsideration for further review.
From the decision · page 4On August 19, 2025, the WCJ issued the following Finding of Fact: "Applicant is permanently and totally disabled. However, the medical reports submitted into evidence do not indicate how and why applicant's current total disability is due solely to the industrial injury of July 8, 2013. The medical reporting of the various treating and examining physicians establishes that applicant is suffering from numerous other non-industrial physical and non- compensable psychiatric disabilities that do not arise from the date of injury in this claim. The WCJ is therefore unable to award any additional benefits for this date of injury based upon the current medical record."
Applicant has other non-industrial physical and psychiatric disabilities not arising from the date of injury.
Favours Defendant prevailed
This fact undermines the claim that the current total disability is due solely to the industrial injury, affecting the award of benefits.
From the decision · page 4On August 19, 2025, the WCJ issued the following Finding of Fact: "Applicant is permanently and totally disabled. However, the medical reports submitted into evidence do not indicate how and why applicant's current total disability is due solely to the industrial injury of July 8, 2013. The medical reporting of the various treating and examining physicians establishes that applicant is suffering from numerous other non-industrial physical and non- compensable psychiatric disabilities that do not arise from the date of injury in this claim. The WCJ is therefore unable to award any additional benefits for this date of injury based upon the current medical record."
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.
Did not provide clear and substantial evidence that the current total disability is due solely to the industrial injury of July 8, 2013.
The WCJ found the medical reporting of Dr. Wieseltier insufficient to establish causation of the current total disability by the industrial injury.
From the decision · page 4The WCJ emphasizes at the outset that there is little doubt that applicant is permanently and totally disabled. However, it is applicant's burden to demonstrate, through substantial medical evidence, that the industrial injury of July 8, 2013, is the cause of applicant's alleged new and further disability. After a thorough review of the medical reporting of Dr. Wieseltier, Dr. McSweeney, and Dr. Ziegler, as well as the independent medical evaluation of Dr. John Lane, the WCJ finds that none of these physicians have provided clear and substantial evidence regarding how, why, and to what extent applicants' current total disability is due to the injury of July 8, 2013. This case has been on this WCJ's trial calendar on eight separate occasions. Therefore, applicant has had more than adequate opportunity to develop the record and provide the court with substantial evidence. The WCJ has repeatedly reviewed applicant's evidence and determined that none of the medical reporting was substantial evidence on the issues presented, and further discovery was necessary. Therefore, after receiving no additional medical reporting that addresses the industrial causation issue, the WCJ eventually found it necessary to order an
Did not provide clear and substantial evidence that the current total disability is due solely to the industrial injury of July 8, 2013.
The WCJ found the medical reporting of Dr. McSweeney insufficient to establish causation of the current total disability by the industrial injury.
From the decision · page 4The WCJ emphasizes at the outset that there is little doubt that applicant is permanently and totally disabled. However, it is applicant's burden to demonstrate, through substantial medical evidence, that the industrial injury of July 8, 2013, is the cause of applicant's alleged new and further disability. After a thorough review of the medical reporting of Dr. Wieseltier, Dr. McSweeney, and Dr. Ziegler, as well as the independent medical evaluation of Dr. John Lane, the WCJ finds that none of these physicians have provided clear and substantial evidence regarding how, why, and to what extent applicants' current total disability is due to the injury of July 8, 2013. This case has been on this WCJ's trial calendar on eight separate occasions. Therefore, applicant has had more than adequate opportunity to develop the record and provide the court with substantial evidence. The WCJ has repeatedly reviewed applicant's evidence and determined that none of the medical reporting was substantial evidence on the issues presented, and further discovery was necessary. Therefore, after receiving no additional medical reporting that addresses the industrial causation issue, the WCJ eventually found it necessary to order an
Found to be the most substantial evidence concerning the issues before the court; no clear causation established for current total disability due to the industrial injury.
The WCJ relied on Dr. Lane's independent medical evaluation as the most substantial evidence but found it did not establish causation of the current total disability by the industrial injury.
From the decision · page 5independent medical evaluation with Dr. John Lane, who is widely used in this community as an agreed medical evaluator. The reporting of Dr. Lane is found to be the most substantial evidence concerning the issues before the court and bears careful consideration and reliance upon the physician's expert medical opinion on the issues presented. At trial, applicant testified that he has been found to be 100% disabled by the Veterans Administration as a result of injuries he sustained in the Navy prior to the industrial injury in this case. The examining physicians have not indicated whether applicant's current disabilities are due to the effects of the prior injury in the Navy or a worsening of the industrial injury in question, or the natural progression of some other disease.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code section 5909
Petition for reconsideration must be acted upon within 60 days of transmission to the Appeals Board.
The Appeals Board acted timely on the petition for reconsideration filed by applicant.
From the decision · page 2I. Preliminarily, we note that former Labor Code1 section 5909 provided that a petition for reconsideration was deemed denied unless the Appeals Board acted on the petition within 60 days from the date of filing. (Lab. Code, § 5909.) Effective July 2, 2024, section 5909 was amended to state in relevant part that: (a) A petition for reconsideration is deemed to have been denied by the appeals board unless it is acted upon within 60 days from the date a trial judge transmits a case to the appeals board.
Labor Code section 5410
An injured worker who has previously received benefits is entitled to claim new and further disability within five years of the date of injury.
Applicant filed a timely petition to reopen within five years of the injury date.
From the decision · page 5out the original injury, and arising within five years of the original injury. (Cal. Lab. Code § 5410;
Labor Code sections 5903, 5952(d)
The WCAB must be supported by substantial evidence, which means evidence that a reasonable mind might accept as adequate to support a conclusion.
The WCJ's denial of additional benefits was based on lack of substantial evidence linking disability to the industrial injury.
From the decision · page 6Moreover, it is well established that decisions by the Appeals Board must be supported by substantial evidence. (Lab. Code, § 5903, 5952(d); Lamb v. Workmen's Comp. Appeals Bd.
What proof carried it
The evidence the panel weighed, by kind.
Applicant's testimony of 100% disability by Veterans Administration due to prior Navy injuries
From the decision · page 5independent medical evaluation with Dr. John Lane, who is widely used in this community as an agreed medical evaluator. The reporting of Dr. Lane is found to be the most substantial evidence concerning the issues before the court and bears careful consideration and reliance upon the physician's expert medical opinion on the issues presented. At trial, applicant testified that he has been found to be 100% disabled by the Veterans Administration as a result of injuries he sustained in the Navy prior to the industrial injury in this case. The examining physicians have not indicated whether applicant's current disabilities are due to the effects of the prior injury in the Navy or a worsening of the industrial injury in question, or the natural progression of some other disease.
Lack of medical explanation linking urinary incontinence to industrial injury
From the decision · page 5The treating orthopedic physician has indicated that applicant is suffering from urinary incontinence, yet, after many months, there has been no examination or explanation from a urologist in order to determine whether this is caused by the industrial injury of July 8, 2013. In addition, applicant is suffering from serious psychiatric disabilities. However, the psychiatric qualified medical evaluator has stated that applicant's psychiatric disability is a compensable consequence of applicant's industrial and nonindustrial physical injuries. Therefore, pursuant to the requirements of labor code section 4660.1(c)(1), the WCJ is precluded from considering the psychiatric disability in any award of permanent disability. Applicant's remedy under these facts may possibly be through a petition to the Subsequent Injuries Benefit Trust Fund. However, applicant has failed to meet their evidentiary burden as required in the present case in order to obtain benefits for the date of injury that is currently before the court.
Psychiatric qualified medical evaluator's statement that psychiatric disability is a compensable consequence of both industrial and nonindustrial injuries, precluding award under Labor Code section 4660.1(c)(1)
From the decision · page 5The treating orthopedic physician has indicated that applicant is suffering from urinary incontinence, yet, after many months, there has been no examination or explanation from a urologist in order to determine whether this is caused by the industrial injury of July 8, 2013. In addition, applicant is suffering from serious psychiatric disabilities. However, the psychiatric qualified medical evaluator has stated that applicant's psychiatric disability is a compensable consequence of applicant's industrial and nonindustrial physical injuries. Therefore, pursuant to the requirements of labor code section 4660.1(c)(1), the WCJ is precluded from considering the psychiatric disability in any award of permanent disability. Applicant's remedy under these facts may possibly be through a petition to the Subsequent Injuries Benefit Trust Fund. However, applicant has failed to meet their evidentiary burden as required in the present case in order to obtain benefits for the date of injury that is currently before the court.
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