ADJ10360370 — California WCAB decision

What the panel ordered

Petition for Reconsideration denied; WCJ's award of 100% permanent disability affirmed.

Defendant State of California, Department of Corrections and Rehabilitation, legally uninsured, seeks reconsideration of the September 8, 2021 Findings and Award denying apportionment and affirming 100% permanent disability award.

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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.

ApportionmentApplicant prevailedneck · bilateral shoulders · foot/toe · right side rib · psyche · sleep

The WCJ found that the apportionment determinations of Dr. Duhan and Dr. Mahawar did not constitute substantial medical evidence because they failed to adequately explain how pre-existing conditions caused a specific percentage of the applicant's permanent disability, thus the WCJ properly denied apportionment and awarded 100% permanent disability.

From the decision · page 6The WCJ concluded that applicant was entitled to an unapportioned award, finding the apportionment determinations of Dr. Duhan and Dr. Mahawar did not constitute substantial medical evidence. The WCJ found Dr. Mahawar "merely issued conclusions," did not provide an independent analysis of apportionment, and indicated he agreed with Dr. Duhan, though his apportionment differed from Dr. Mahawar. The WCJ also found Dr. Duhan's apportionment determination lacked sufficient reasoning for his non-industrial apportionment, which he had increased from 25% to 60%.

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 · internal medicine

Initially apportioned 75% of diabetes aggravation to industrial injury, later revised to 40% industrial and 60% non-industrial, but failed to provide sufficient reasoning for the change and for apportionment of permanent disability.

The WCJ found Dr. Duhan's apportionment determination lacked sufficient reasoning and was based on cause of injury rather than cause of disability, thus not substantial medical evidence for apportionment.

From the decision · page 2Dr. Duhan initially apportioned 75% of the cause of the aggravation of her diabetes to the deconditioning resulting from her orthopedic pain.

QMERejected

Found diabetes worsened after industrial injury and partially related to it, opined 50% apportionment to industrial injury but did not provide adequate analysis of how pre-existing diabetes caused a specific percentage of disability.

The WCJ found Dr. Mahawar's apportionment opinion was conclusory and lacked independent analysis, thus not substantial medical evidence for apportionment.

From the decision · page 4Addressing applicant's diabetes, Dr. Mahawar noted her diagnosis in 2013, and the subsequent worsening after her 2014 industrial injury, requiring the use of insulin and the toe amputations. He opined that applicant's diabetes was a non-industrial naturally occurring medical condition that was worsened due to the stress and multiple musculoskeletal injuries from her 2014 industrial injury.

QMEGiven great weight

Evaluated orthopedic injuries and amputation, found 25% non-industrial apportionment for cervical spine impairment but deferred apportionment of toe amputation to Dr. Duhan.

From the decision · page 5Applicant's orthopedic injuries were evaluated by Dr. Victoria Barber, who issued her final report following her March 21, 2018 evaluation.2 (Jt. Ex. 103. 3/21/18 Dr. Barber QME Report.) In the interval since her previous examination, applicant's toes were amputated and Dr. Barber indicated that if her diabetes was considered of industrial causation, the amputation was a compensable consequence. Despite finding applicant was not yet permanent and stationary, Dr. Barber provided impairment ratings for her amputation "presuming appropriate healing as dictated through AMA Guides." (Jt. Ex. 103, p. 4.) Dr. Barber assigned 80% WPI for applicant's amputation resulting in her wheelchair dependence, and provided an 8% WPI impairment rating

ADJ10360370 · November 22, 2021

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

What the panel did with the medical opinions

The rules the panel named

What proof carried it

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