What the panel ordered
Defendant's Petition for Reconsideration is granted; final decision after reconsideration is deferred pending further review of the merits and entire record.
Defendant seeks reconsideration of the WCJ Findings of Fact and Order issued October 4, 2024, which found injury including hypertension and denied apportionment for hypertension; 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 the apportionment evidence for hypertension failed to meet defendant's burden, but the WCAB granted reconsideration to further develop the record on apportionment.
From the decision · page 42. Whether the apportionment indicated by AME Dr. Hirsch as to hypertension constitutes substantial medical evidence.
The WCJ found applicant's attorney entitled to reasonable attorney fees of 15% of permanent disability indemnity, but this issue is not addressed in the reconsideration order.
From the decision · page 43. Whether Applicant's Attorney is entitled to Attorney's Fees and the amounts and appropriateness thereof.
The WCJ found injury causing and/or exacerbating hypertension, but the WCAB granted reconsideration to further review the sufficiency of the evidence and legal conclusions regarding hypertension injury.
From the decision · page 41. Whether there was injury arising out of and in the course of employment causing hypertension.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
WCJ found injury causing and/or exacerbating hypertension based on Dr. Hirsch's medical opinion.
Favours Applicant prevailed
This finding was the basis for the initial award and denial of apportionment, but was challenged on reconsideration.
From the decision · page 41. the applicant, born [], while employed on June 6, 2017, as a Retail Sales Associate Group No. 214, at Los Angeles, California, by Goodwill Industries of Southern California, sustained injury arising out of and in the course of employment to her left knee, right knee, lumbar spine, dental, and causing and/or exacerbating hypertension.
Dr. Hirsch opined 67% apportionment of permanent disability for hypertension, but WCJ rejected apportionment evidence as insufficient.
Favours Defendant prevailed
This fact is central to the dispute over apportionment and the reconsideration grant.
From the decision · page 58. The apportionment evidence, as it relates to hypertension, as indicated by AME Dr. Hirsch, fails to meet defendant's burden. The applicant is entitled to an unapportioned award.
Applicant did not testify; matter was submitted on medical evidence only.
Favours Defendant prevailed
Lack of testimony limited evidence evaluation, favoring defendant's challenge to injury finding.
From the decision · page 11In finding that applicant sustained injury causing and/or exacerbating hypertension, it is unclear as to whether the WCJ found applicant's orthopedic injuries caused an aggravation of applicant's pre-existing hypertension, or a temporary exacerbation of such condition. It is further unclear as to the extent to which, if any, the subsequent automobile accident and applicant's use of NSAIDS post-accident impacts the findings of the QME as to causation of injury. The existing evidence does not appear to indicate that any medical treatment or period of temporary disability occurred relating to applicant's claim of hypertension. Further, applicant did not testify at the trial, and the matter was submitted on the existing medical evidence.
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.
Diagnosed hypertension with inadequate control and left ventricular hypertrophy; opined it is biologically plausible that orthopedic injuries could cause new onset or worsening of hypertension; opined 67% apportionment of permanent disability; acknowledged incomplete review of all records; issued multiple reports and depositions.
The WCJ relied on Dr. Hirsch's opinion to find injury causing and/or exacerbating hypertension, but the WCAB granted reconsideration to further review the sufficiency of this evidence.
From the decision · page 5On April 30, 2019, applicant was evaluated for her claim of hypertension with Jeffrey Hirsch, M.D., as an AME. Dr. Hirsch examined applicant, reviewed the existing medical records, and issued a report dated May 29, 2019 in which he deferred applicant's orthopedic and dental complaints to the appropriate specialists, and found applicant's weight and hyperlipidemia as well as diabetic issues to be non-industrial. As to hypertension, the AME diagnosed applicant with hypertension with inadequate control on monotherapy and left ventricular hypertrophy by echocardiography. (Ex. X1, p. 9.)
Evaluated orthopedic complaints; found knees and back industrial but not cervical spine or left wrist.
From the decision · page 3She was evaluated by Agreed Medical Evaluator (AME) Neil Halbridge, M.D., for her orthopedic complaints on June 2, 2018. (Ex. X1, p. 11.)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
E.L. Yeager v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922
Substantial evidence requires expert medical opinion framed in reasonable medical probability, based on accurate history and examination, with reasoning supporting conclusions.
Applied to evaluate sufficiency of medical evidence for injury and apportionment.
From the decision · page 12In order to constitute substantial evidence, expert medical opinion must be framed in terms of reasonable medical probability, be based on an accurate history and an examination, and must set forth reasoning to support the expert conclusions reached. (E.L. Yeager v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc).)
Tanenbaum v. Industrial Acc. Com. (1935) 4 Cal.2d 615
An aggravation of a pre-existing condition constitutes an injury if it causes medical treatment and temporary disability.
Applied to define injury for hypertension claim.
What proof carried it
The evidence the panel weighed, by kind.
Applicant did not testify; matter submitted on existing medical evidence only
From the decision · page 11In finding that applicant sustained injury causing and/or exacerbating hypertension, it is unclear as to whether the WCJ found applicant's orthopedic injuries caused an aggravation of applicant's pre-existing hypertension, or a temporary exacerbation of such condition. It is further unclear as to the extent to which, if any, the subsequent automobile accident and applicant's use of NSAIDS post-accident impacts the findings of the QME as to causation of injury. The existing evidence does not appear to indicate that any medical treatment or period of temporary disability occurred relating to applicant's claim of hypertension. Further, applicant did not testify at the trial, and the matter was submitted on the existing medical evidence.
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
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