ADJ10128397 — California WCAB decision

What the panel ordered

Denied defendant's Petition for Reconsideration and affirmed the previous Decision awarding 96 percent permanent disability without apportionment.

Petitioner State Compensation Insurance Fund (SCIF) seeks reconsideration of the June 23, 2025 Opinion and Order Granting Petition for Reconsideration and Decision after Reconsideration, which amended the April 7, 2025 Findings and Award to a 96 percent permanent disability award based on lack of substantial medical evidence supporting apportionment.

Read the official decision →

This docket was decided more than once. Shown here is the latest released decision; we also hold June 23, 2025.

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.

ApportionmentApplicant prevailedknees · shoulders

The Appeals Board found that neither Dr. Pallia nor Dr. McSweeney provided substantial medical evidence to support apportionment, as their opinions lacked explanation of the mechanism of causation and reasoning for the apportionment percentages, leading to an unapportioned 96 percent permanent disability award.

From the decision · page 13Thus, we concluded that both Dr. Pallia and Dr. McSweeney failed to provide substantial medical evidence that would support a finding of apportionment. We concluded that applicant is therefore entitled to an unapportioned award of 96 percent permanent disability (PD), based on rating strings set forth in the Decision, with impairment percentages and adjustments that do not appear to be contested by the Petition, apart from the absence of apportionment.

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.

QMERejected · orthopedics

Apportioned 80% of shoulder disability and 100% of knee disability to preexisting conditions but did not explain the mechanism or reasoning for these percentages; later opined 80% of permanent disability caused by preexisting conditions but lacked substantial evidence for apportionment.

Lacked explanation of mechanism and reasoning for apportionment percentages, thus not substantial medical evidence.

From the decision · page 3expressed his belief that applicant sustained a rotator cuff tear and a medial meniscus tear prior to his job with Coronado Livery, even though there are no contemporaneous records of a rotator cuff tear prior to 2014 (See Joint 4, Report of Dr. Chris Pallia dated November 8, 2016, pp. 1-3.) Dr. Pallia then apportioned 80 percent of shoulder disability and 100 percent of knee disability to preexisting conditions, but he did not describe the mechanism by which those preexisting conditions were causing present permanent disability. The report did not explain how or why Dr. Pallia chose 80 percent as the percentage of apportionment, as opposed to 70 percent, 90 percent, or some other percentage for the shoulders. Furthermore, the report did not explain how and why applicant's reported strain of the knee and increased pain at work from repeated lifting of heavy suitcases and duffel bags had played no role in his bilateral knee condition.

PTPRejected

Apportioned 25% of permanent disability of the knees to degenerative condition but did not explain the mechanism or reasoning for the percentage; opinion not substantial medical evidence.

Lacked explanation of mechanism and reasoning for apportionment percentage, thus not substantial medical evidence.

From the decision · page 3On February 8, 2021, treating physician James E. McSweeney, M.D., evaluated applicant and issued a permanent and stationary report, admitted into evidence as Applicant's 7. This report, which was the sole treating physician report admitted into evidence at trial, indicated 20 percent Whole Person Impairment (WPI) in each knee using Table 17-35 of the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition (AMA Guides). Dr. McSweeney apportioned 25 percent of permanent disability of the knees to "a rather significant degenerative condition." (Joint 7, Report of Dr. James McSweeney dated February 8, 2021, p. 6, lines 16-17.) Dr. McSweeney did not explain the mechanism of this apportionment, nor why he chose 25 percent as opposed to some other number.

ADJ10128397 · April 24, 2026

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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