What the panel ordered
June 4, 2021 Joint Findings and Orders rescinded; matter returned to trial level for further proceedings consistent with opinion.
Petitions for reconsideration filed by applicant and defendant; decision after reconsideration rescinds prior findings and returns matter to trial level for further proceedings.
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 presumption under Labor Code section 3213.2 that low back injury is apportionable only to cumulative trauma of wearing a duty belt stands unrebutted due to lack of substantial medical evidence to the contrary, so the lumbar disability is caused by cumulative trauma as a matter of law.
From the decision · page 17Next, we turn to the substantive issues raised by the two Petitions for Reconsideration, which are mostly centered around injury AOE/COE, apportionment, and the applicability of statutory presumptions. Applicant contends in the Petition that there is a rebuttable presumption under section 3213.2 that low back injury is apportionable only to the cumulative trauma of wearing a duty belt. We agree, and accordingly, applicant has sustained a statutorily presumed cumulative industrial injury to the lumbar spine under section 3213.2, which is also presumed to be the sole cause of any permanent disability under section 4663(e).
The issue of apportionment for internal medical conditions is deferred due to lack of substantial medical evidence from Dr. Hyman regarding apportionment, though his opinion on industrial causation of hypertension is followed.
From the decision · page 21With respect to the internal AME, Dr. Hyman, applicant's Petition asserts that the Appeals Board should follow his finding of injury in the form of hypertension, and permanent disability related thereto. We agree that Dr. Hyman's opinion regarding industrial causation of injury in the form of hypertension should be followed, but note that the June 4, 2021 Findings, Award, and Order did this by finding such injury, based on the parties' stipulation thereto. With respect to permanent disability, the WCJ's decision deferred that issue, based on a lack of substantial medical evidence from Dr. Hyman regarding apportionment. We agree with the decision in this respect, and similarly defer the issue of internal apportionment, but we will rescind the decision in all three cases because permanent disability of the low back is necessarily apportioned to cumulative trauma by operation of section 3213.2 and 4663(e) as explained above. (Lab. Code, § 3213.2, 4663(e).)
Dr. Previte's opinion that the duty belt did not cause cumulative injury to the lumbar spine is not substantial medical evidence because it lacks detailed reasoning and is based on a legally incorrect theory, so the presumption of cumulative trauma causing the lumbar disability stands unrebutted.
From the decision · page 19In this case, although the reports and deposition testimony of Dr. Previte attribute applicant's low back injury to a specific industrial injury that occurred in 1997, these opinions are unsupported by any detailed or cogent explanation of how or why the presumptive cumulative effect of wearing a duty belt for more than five years did not contribute in any way whatsoever to applicant's low back condition. Furthermore, Dr. Previte seems to hold the opinion that wearing a duty belt cannot constitute a medically probable cause of cumulative lumbar injury. This position is both unsubstantiated by explanation and based on a legally incorrect theory. As a matter of law, injury to the lumbar spine is presumed under prescribed circumstances. Any medical-legal evaluator who presumes the opposite to be true, without a detailed and cogent rebuttal, fails to meet the standards of substantial medical evidence set forth in Escobedo v. Marshalls (2007) 70 Cal.Comp.Cases 604 (Appeals Board en banc).
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant wore a duty belt for more than five years as a sheriff's deputy, triggering the presumption of cumulative industrial injury to the lumbar spine under Labor Code section 3213.2.
Favours Applicant prevailed
This fact establishes the statutory presumption that the low back injury is caused by cumulative trauma from wearing the duty belt, which was not rebutted by substantial medical evidence.
From the decision · page 17Next, we turn to the substantive issues raised by the two Petitions for Reconsideration, which are mostly centered around injury AOE/COE, apportionment, and the applicability of statutory presumptions. Applicant contends in the Petition that there is a rebuttable presumption under section 3213.2 that low back injury is apportionable only to the cumulative trauma of wearing a duty belt. We agree, and accordingly, applicant has sustained a statutorily presumed cumulative industrial injury to the lumbar spine under section 3213.2, which is also presumed to be the sole cause of any permanent disability under section 4663(e).
Dr. Previte's medical opinion did not persuasively rebut the presumption of cumulative trauma causing the lumbar disability because it lacked detailed reasoning and was based on a legally incorrect theory.
Favours Applicant prevailed
The lack of substantial medical evidence to rebut the presumption means the cumulative trauma presumption stands, favoring the applicant's claim for low back injury causation and apportionment.
From the decision · page 19In this case, although the reports and deposition testimony of Dr. Previte attribute applicant's low back injury to a specific industrial injury that occurred in 1997, these opinions are unsupported by any detailed or cogent explanation of how or why the presumptive cumulative effect of wearing a duty belt for more than five years did not contribute in any way whatsoever to applicant's low back condition. Furthermore, Dr. Previte seems to hold the opinion that wearing a duty belt cannot constitute a medically probable cause of cumulative lumbar injury. This position is both unsubstantiated by explanation and based on a legally incorrect theory. As a matter of law, injury to the lumbar spine is presumed under prescribed circumstances. Any medical-legal evaluator who presumes the opposite to be true, without a detailed and cogent rebuttal, fails to meet the standards of substantial medical evidence set forth in Escobedo v. Marshalls (2007) 70 Cal.Comp.Cases 604 (Appeals Board en banc).
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.
Attributed low back impairment entirely to a specific industrial injury in the mid 1990s and right foot injury to January 18, 2017 event; opined no independent injury to neck or mid back; did not persuasively rebut cumulative trauma presumption for low back injury.
Dr. Previte's opinion lacks detailed reasoning and is based on a legally incorrect theory regarding duty belt injury; therefore, it is not substantial medical evidence to rebut the presumption of cumulative trauma causing lumbar disability.
From the decision · page 19In this case, although the reports and deposition testimony of Dr. Previte attribute applicant's low back injury to a specific industrial injury that occurred in 1997, these opinions are unsupported by any detailed or cogent explanation of how or why the presumptive cumulative effect of wearing a duty belt for more than five years did not contribute in any way whatsoever to applicant's low back condition. Furthermore, Dr. Previte seems to hold the opinion that wearing a duty belt cannot constitute a medically probable cause of cumulative lumbar injury. This position is both unsubstantiated by explanation and based on a legally incorrect theory. As a matter of law, injury to the lumbar spine is presumed under prescribed circumstances. Any medical-legal evaluator who presumes the opposite to be true, without a detailed and cogent rebuttal, fails to meet the standards of substantial medical evidence set forth in Escobedo v. Marshalls (2007) 70 Cal.Comp.Cases 604 (Appeals Board en banc).
Found industrial causation of hypertension and other internal conditions due to cumulative trauma; assigned WPI percentages for skin damage, GERD, hypertensive heart disease, and carotid arterial disease; apportionment deferred due to lack of substantial evidence.
Dr. Hyman's opinion on industrial causation of hypertension is followed, but apportionment is deferred due to insufficient substantial medical evidence.
From the decision · page 21With respect to the internal AME, Dr. Hyman, applicant's Petition asserts that the Appeals Board should follow his finding of injury in the form of hypertension, and permanent disability related thereto. We agree that Dr. Hyman's opinion regarding industrial causation of injury in the form of hypertension should be followed, but note that the June 4, 2021 Findings, Award, and Order did this by finding such injury, based on the parties' stipulation thereto. With respect to permanent disability, the WCJ's decision deferred that issue, based on a lack of substantial medical evidence from Dr. Hyman regarding apportionment. We agree with the decision in this respect, and similarly defer the issue of internal apportionment, but we will rescind the decision in all three cases because permanent disability of the low back is necessarily apportioned to cumulative trauma by operation of section 3213.2 and 4663(e) as explained above. (Lab. Code, § 3213.2, 4663(e).)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code section 3213.2
Presumption of cumulative industrial injury to the lumbar spine under Labor Code section 3213.2
Applies to applicant as a sheriff's deputy who wore a duty belt for more than five years; presumption stands unrebutted due to lack of substantial medical evidence to the contrary.
From the decision · page 17Next, we turn to the substantive issues raised by the two Petitions for Reconsideration, which are mostly centered around injury AOE/COE, apportionment, and the applicability of statutory presumptions. Applicant contends in the Petition that there is a rebuttable presumption under section 3213.2 that low back injury is apportionable only to the cumulative trauma of wearing a duty belt. We agree, and accordingly, applicant has sustained a statutorily presumed cumulative industrial injury to the lumbar spine under section 3213.2, which is also presumed to be the sole cause of any permanent disability under section 4663(e).
Escobedo v. Marshalls (2007) 70 Cal.Comp.Cases 604 (Appeals Board en banc)
Requirement for substantial medical evidence to rebut presumption under Labor Code section 3213.2
Dr. Previte's opinion fails to meet the standard of substantial medical evidence because it lacks detailed reasoning and is based on a legally incorrect theory regarding duty belt injury.
From the decision · page 19In this case, although the reports and deposition testimony of Dr. Previte attribute applicant's low back injury to a specific industrial injury that occurred in 1997, these opinions are unsupported by any detailed or cogent explanation of how or why the presumptive cumulative effect of wearing a duty belt for more than five years did not contribute in any way whatsoever to applicant's low back condition. Furthermore, Dr. Previte seems to hold the opinion that wearing a duty belt cannot constitute a medically probable cause of cumulative lumbar injury. This position is both unsubstantiated by explanation and based on a legally incorrect theory. As a matter of law, injury to the lumbar spine is presumed under prescribed circumstances. Any medical-legal evaluator who presumes the opposite to be true, without a detailed and cogent rebuttal, fails to meet the standards of substantial medical evidence set forth in Escobedo v. Marshalls (2007) 70 Cal.Comp.Cases 604 (Appeals Board en banc).
What proof carried it
The evidence the panel weighed, by kind.
Applicant's credible testimony and WCJ's credibility determination supported by witness Lt. Smith's testimony
From the decision · page 17Given this history of claims management, it seems more probable that the claim file was lost than that it never existed. Defendant's Exhibit 2 shows a supervisor's acknowledgment in 2005 that a 1997 claim did in fact exist. Applicant credibly testified that he reported his 1997 low back injury to Sgt. Huerta and received claims notices from Fimbres for both the 1997 injury and a previous 1996 hand injury. Applicant's testimony clearly distinguishes the 1996 and 1997 injuries, which involved different body parts and mechanisms of injury. Lt. Smith testified that he knew applicant and believed him to be credible, as did the WCJ. We give the WCJ's credibility determination great weight because she had the opportunity to observe the demeanor of the witnesses. (Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312, 318-319 [35 Cal.Comp.Cases 500].) In this case, we conclude there is no evidence of considerable substantiality that would warrant rejecting the WCJ's credibility determination. (Id.)
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