ADJ11144910 · September 3, 2021

The WCAB found that the medical evidence from both the PQME and the primary treating physician was not substantial medical evidence on whether the disputed body parts (neck and back) were injured, due to deficiencies in the reports, including lack of detailed job duty analysis and incomplete record review, requiring further development of the record.

From the decision · page 5In this case, the reporting from both the PQME and applicant's primary treating physician are not substantial medical evidence on the issue of whether the disputed body parts were injured. In his Report, the WCJ noted that "None of the three Ganjianpour reports in evidence indicate a review of records except a single report of PQME Washington. Dr. Washington,...on the other hand has an exhaustive review of records." (Report p. 5.) We agree with the WCJ that Dr. Ganjianpour should have memorialized the documents he reviewed and discussed any documents he relied on in forming his opinions.

Dr. Washington did not address applicant's job duties in detail and did not review a job description or job analysis before preparing his supplemental report.

Favours Applicant prevailed

This deficiency undermined the substantiality of his medical opinion on causation for the neck and back injuries.

From the decision · page 5However, the deficiencies in Dr. Washington's reporting are equally glaring. The "relevant factual basis" for a determination of whether a cumulative trauma injury arose out of employment includes a thorough understanding of an applicant's job duties and the duration and frequency of exposure to potentially injurious activities as part of the job. Dr. Washington did not address applicant's job duties in any detail. Notably, he did not comment on the duration of her employment as a janitor or the number of hours she worked during a day or week.

Applicant's low back complaints arose during the potential cumulative trauma period while employed in the same job, contrary to Dr. Washington's focus on a single employer's liability.

Favours Applicant prevailed

This fact required further development of the record to properly evaluate cumulative trauma causation over the entire employment period.

From the decision · page 5The PQME also appears to have focused on applicant's employment with a particular employer (Crown Building Maintenance). Dr. Washington opined that applicant's low back injury "is not causally related to her employment with Crown Building Maintenance as the applicant had many years of lower back complaints necessitating doctor's visits prior to working for Crown Building Maintenance." (Exh. B, p. 21.) However, applicant's low back complaints arose during the potential cumulative trauma period while she was employed in the same job. As discussed above, Section 5500.5 addresses which employer is liable for a cumulative trauma injury, it does not limit the exposure to be considered when evaluating a cumulative trauma to a single year or a single employer.

Neither the PQME nor the primary treating physician memorialized the documents reviewed or discussed relied documents adequately in forming their opinions.

Favours Applicant prevailed

This lack of documentation led to the conclusion that their reports were not substantial medical evidence, necessitating further proceedings.

From the decision · page 5In this case, the reporting from both the PQME and applicant's primary treating physician are not substantial medical evidence on the issue of whether the disputed body parts were injured. In his Report, the WCJ noted that "None of the three Ganjianpour reports in evidence indicate a review of records except a single report of PQME Washington. Dr. Washington,...on the other hand has an exhaustive review of records." (Report p. 5.) We agree with the WCJ that Dr. Ganjianpour should have memorialized the documents he reviewed and discussed any documents he relied on in forming his opinions.

Dr. Washington opined that the neck condition was not causally related to employment and attributed it to aging; the left shoulder condition was causally related to employment with no apportionment; the left arm/hand, low back, and left hip/leg conditions were not causally related to employment.

Dr. Washington's opinion was considered but found deficient due to lack of detailed job duty analysis and incomplete consideration of cumulative trauma period employment.

From the decision · page 2The parties selected Eleby Washington, M.D., as a PQME in the field of Orthopedics. Dr. Washington noted that applicant worked as a janitor for Crown Building Maintenance beginning in 2013 and was employed by a different maintenance company as a janitor in the same building beginning in 1995. (Exh. B, Elby Washington, M.D., December 11, 2019, Panel Qualified Medical Evaluation, p. 2-3.) "Her job duties required that she do mopping, sweeping and vacuuming in an office building. At any one time she might have to lift 15-20 pounds." (Id. At p. 2.) Dr. Washington stated that the applicant was "disabled from performance of her job as a janitor with Crown Building Maintenance. I would be happy to review a job analysis or job description before commenting further." (Id. At p. 20)

Dr. Ganjianpour initially noted injuries to cervical spine, left shoulder, left elbow, left wrist, and lumbar spine but did not opine on industrial causation for disputed parts initially; later opined that cumulative trauma to cervical spine, left shoulder, and lumbar spine was due to repetitive work duties.

Dr. Ganjianpour's opinion was found deficient for lack of record memorialization and discussion of relied documents, requiring further development.

From the decision · page 2FACTS Mark Ganjianpour, M.D. was applicant's primary treating physician. In his initial evaluation, he stated that "the applicant has been employed by Crown Building Maintenance since April 1995." (Exh. 1, Mark Ganjianpour, M.D., February 19, 2018 Primary Treating Physician Initial Orthopedic Evaluation Report and Authorization Request, p. 3) Dr. Ganjianpour described applicant's job duties as follows:

Lab. Code, 3208.1; Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (en banc)

Substantial medical evidence is required to establish cumulative industrial injury causation, including reasonable medical probability and proper factual basis.

The WCAB applied these standards to evaluate the sufficiency of medical evidence on causation for the neck and back injuries.

From the decision · page 3Section 3208.1 provides that a cumulative industrial injury occurs whenever the repetitive physically traumatic activities of an employee's occupation cause any disability or a need for medical treatment. As with any decision by a WCJ, a decision whether applicant sustained a cumulative injury must be supported by substantial evidence in light of the entire record. (Lab. Code, § 5952(d); See Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274, 281 [39 Cal.Comp.Cases 310]; Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312, 317 [35 Cal.Comp.Cases 500]; LeVesque v. Workmen's Comp. Appeals Bd. (1970) 1 Cal.3d 627, 635 [35 Cal.Comp.Cases 16].)

Deficiencies in medical reports including lack of detailed job duty analysis and incomplete record review

From the decision · page 5In this case, the reporting from both the PQME and applicant's primary treating physician are not substantial medical evidence on the issue of whether the disputed body parts were injured. In his Report, the WCJ noted that "None of the three Ganjianpour reports in evidence indicate a review of records except a single report of PQME Washington. Dr. Washington,...on the other hand has an exhaustive review of records." (Report p. 5.) We agree with the WCJ that Dr. Ganjianpour should have memorialized the documents he reviewed and discussed any documents he relied on in forming his opinions.