ADJ10737010 · October 14, 2026

The Board deferred the issue of injury to psyche, left leg, and other disputed conditions to allow further development of the record with medical reporting.

From the decision · page 163) applicant is entitled to develop the record relative to the disputed body parts; and otherwise affirm the F&A; and we will return the matter to the trial level for further proceedings consistent with this decision. For the foregoing reasons, IT IS ORDERED, as the Decision After Reconsideration of the Workers' Compensation Appeals Board, that the Findings and Award issued on December 28, 2021 is RESCINDED and the following is SUBSTITUTED therefor: FINDINGS OF FACT 1. the applicant, born [], while employed at Sherman Oaks, California by Polaris Property Management, sustained injury to the lumbar spine, right hip, right leg, and in the form of abdominal hernia arising out of and in the course of employment on April 17, 2016.

The Board found that the medical record was incomplete and required further development for permanent disability and apportionment issues, deferring these issues for further medical reporting and supplementation.

From the decision · page 163) applicant is entitled to develop the record relative to the disputed body parts; and otherwise affirm the F&A; and we will return the matter to the trial level for further proceedings consistent with this decision. For the foregoing reasons, IT IS ORDERED, as the Decision After Reconsideration of the Workers' Compensation Appeals Board, that the Findings and Award issued on December 28, 2021 is RESCINDED and the following is SUBSTITUTED therefor: FINDINGS OF FACT 1. the applicant, born [], while employed at Sherman Oaks, California by Polaris Property Management, sustained injury to the lumbar spine, right hip, right leg, and in the form of abdominal hernia arising out of and in the course of employment on April 17, 2016.

Medical record was incomplete and did not include latest diagnostic studies of lumbar spine after April 2019.

Favours Applicant prevailed

This lack of complete medical evidence required deferral of permanent disability and apportionment issues for further development.

From the decision · page 12Falkinstein’s reporting to date is not informed by the latest diagnostic studies of the lumbar spine, we are persuaded that the record requires further development regarding permanent disability of that body part. We further note that supplementation of the record on permanent disability of the lumbar spine should be from Dr. Falkinstein per McDuffie, and that this supplementation should be informed by review of all pertinent medical records, including but not limited to the diagnostic studies of March 3, 2020 and October 15, 2020. We also recognize that the WCJ found that applicant has permanent disability of 50% based upon Dr. Falkinstein’s ratings not only for the lumbar spine but the right hip, with apportionment

Applicant testified to treatment for disputed body parts for years preceding trial.

Favours Applicant prevailed

Supported deferral and further development of injury claims to psyche, left leg, and other disputed conditions.

From the decision · page 16record was incomplete; and, as we have explained, the WCJ could have ordered development of the record on that basis to enable full adjudication of the issue on the merits in a manner consistent with due process. (McDuffie, supra, at p. 241.) Instead, the WCJ found that development of the record would be “inappropriate” based upon applicant’s lay testimony that he had received treatment for the injury to the disputed body parts for years preceding trial. (Report, pp. 5, 7.) Based upon the foregoing authorities, we conclude that this was error. Accordingly, we will substitute findings that (1) the issue of whether applicant sustained injury to the head, back, hips, leg, foot, psyche, internal, and dental is deferred; and (2) applicant is entitled to develop the record as to these disputed body parts. In doing so, we recommend that the parties obtain medical reporting from the treating physicians or an agreed or qualified medical evaluator so that the issue of injury to these body parts may be properly framed for trial.

Found applicant permanent and stationary as of November 10, 2017, with 50% permanent disability rating apportioned 75% industrial and 25% non-industrial due to degenerative changes and pre-existing conditions; recommended further medical treatment and surgery.

His reports provided substantial medical evidence on permanent disability and apportionment, but the Board found the record incomplete and requiring further development.

From the decision · page 3The parties stipulated that while employed as a maintenance worker by defendant on April 17, 2016, applicant sustained injury to the lumbar spine, right hip, right leg, and abdominal hernia. (Id., p. 2:4-7) The WCJ admitted into evidence medical reporting and deposition testimony by panel qualified medical evaluator (PQME) Yuri Falkinstein, M.D., including reports dated November 10, 2017, and October 18, 2019. (Jt. Ex. AA, PQME Report of Yuri Falkinstein, M.D., November 10, 2017; Jt. Ex. BB, PQME Report of Yuri Falkinstein, M.D., October 18, 2019.) Dr. Falkinstein’s November 10, 2017 report states: DIAGNOSES

Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604

Medical opinion must be framed in terms of reasonable medical probability, based on pertinent facts and adequate examination, and set forth reasoning in support of conclusions to constitute substantial evidence.

Applied to evaluate medical evidence on apportionment and permanent disability.

From the decision · page 13Specifically, applicant argues that his preexisting osteoarthritis of the right hip cannot support apportionment because there is no evidence that he would have required hip replacement surgery in the absence of industrial injury. In Escobedo the Appeals Board held that (1) section 4663 requires the reporting physician to make an apportionment determination; (2) apportionment to other factors allows apportionment to causation, including pathology, prior conditions, and retroactive work restrictions; (3) applicant holds the initial burden to prove industrial injury and also has the added burden of establishing the approximate percentage of permanent disability directly related to the industrial injury; (4) defendant has the burden of establishing the approximate permanent disability caused by other factors; and (5) a medical report addressing apportionment may not be relied upon unless it constitutes substantial evidence.

Applicant's lay testimony of treatment for disputed body parts for years preceding trial

From the decision · page 16record was incomplete; and, as we have explained, the WCJ could have ordered development of the record on that basis to enable full adjudication of the issue on the merits in a manner consistent with due process. (McDuffie, supra, at p. 241.) Instead, the WCJ found that development of the record would be “inappropriate” based upon applicant’s lay testimony that he had received treatment for the injury to the disputed body parts for years preceding trial. (Report, pp. 5, 7.) Based upon the foregoing authorities, we conclude that this was error. Accordingly, we will substitute findings that (1) the issue of whether applicant sustained injury to the head, back, hips, leg, foot, psyche, internal, and dental is deferred; and (2) applicant is entitled to develop the record as to these disputed body parts. In doing so, we recommend that the parties obtain medical reporting from the treating physicians or an agreed or qualified medical evaluator so that the issue of injury to these body parts may be properly framed for trial.