ADJ11202213 · May 9, 2025

The medical evaluators' opinions on causation lacked sufficient explanation and reasoning to constitute substantial medical evidence, particularly regarding the role of work-related stress and repetitive use in the injuries. The Board found the need for further development of the record to obtain substantial evidence on causation.

From the decision · page 5The conclusions of Dr. Lipper and Dr. Wood with respect to causation of injury do not constitute substantial medical evidence without further explanation. The medical evaluators do not question applicant's reports of stress and repetitive use of the upper extremities at work, yet they fail to persuasively explain how and why these factors played no role in applicant's injuries to the circulatory system and upper extremities. As explained by the California Supreme Court, industrial factors need only be a contributing cause of injury, however slight. (See South Coast Framing, Inc. v. Workers' Comp. Appeals Bd. (2015) 61 Cal.4th 291, 299 [80 Cal.Comp.Cases 489].)

Medical evaluators did not persuasively explain how work-related stress and repetitive use did not contribute to applicant's injuries.

Favours Applicant prevailed

This lack of explanation meant their opinions were not substantial evidence, requiring further record development.

From the decision · page 5The conclusions of Dr. Lipper and Dr. Wood with respect to causation of injury do not constitute substantial medical evidence without further explanation. The medical evaluators do not question applicant's reports of stress and repetitive use of the upper extremities at work, yet they fail to persuasively explain how and why these factors played no role in applicant's injuries to the circulatory system and upper extremities. As explained by the California Supreme Court, industrial factors need only be a contributing cause of injury, however slight. (See South Coast Framing, Inc. v. Workers' Comp. Appeals Bd. (2015) 61 Cal.4th 291, 299 [80 Cal.Comp.Cases 489].)

Applicant's stroke was 100% nonindustrial and not attributable to work stress, but the opinion lacked explanation on how work stress did not contribute and on other medical causes.

Opinion lacked sufficient explanation and reasoning to be substantial evidence on causation.

From the decision · page 3Arthur Lipper, M.D. evaluated applicant as an internal medicine AME on August 15, 2020 and issued a report dated August 28, 2020, which was admitted into evidence as Defendant's Exhibit A. (Ibid., page 5, lines 15-17.) Dr. Lipper's report states that applicant's stroke of March 14, 2017 was "100% nonindustrial" and not attributable to stress while working, but there is no explanation or discussion of how and why applicant's work-related stress did not contribute to the occurrence of the stroke. (Medical report from AME Arthur Lipper, M.D. dated August 28, 2020, page 7, lines 1-19.)

Found no orthopedic cumulative trauma despite EMG showing carpal tunnel syndrome; attributed decreased motor power to stroke without further explanation; did not persuasively explain lack of industrial injury.

Opinion lacked sufficient explanation and reasoning to be substantial evidence on causation.

From the decision · page 2Yokoo was offered into evidence, but a transcript of his deposition of April 27, 2020 was offered into evidence as Defendant's Exhibit D and later admitted into evidence over applicant's objection as explained in the Opinion on Decision. (Ibid., page 3, lines 24-25; Opinion on Decision dated May 18, 2021, numbered page 4, lines 14 ff.) That deposition transcript indicates that Dr. Yokoo evaluated applicant once, on December 20, 2017. (Deposition transcript of Eric Yokoo, M.D. dated April 27, 2020, page 6, lines 21-25.) David Wood, M.D. evaluated applicant as an orthopedic AME on December 19, 2018, and his report of the same date was admitted into evidence as Defendant's Exhibit B (MOH/SOE dated February 10, 2021, page 5, lines 18-20.) A transcript of Dr. Wood's cross-examination of August 1, 2019 was admitted into evidence as Defendant's Exhibit C. (Ibid., page 5, lines 21-23.) Dr. Wood found no orthopedic cumulative trauma, despite decreased motor power, which Dr. Wood attributed to the stroke, and notwithstanding an EMG showing carpal tunnel syndrome, with Dr.

Evaluated applicant once; opinions contrary to current law on presumptions; no report offered into evidence; deposition transcript admitted over objection.

From the decision · page 2FACTS Case Numbers ADJ11202213 and ADJ11202304 were consolidated at trial. (Minutes of Hearing and Summary of Evidence (MOH/SOE) dated February 10, 2021, page 2, lines 13-15.) Applications in both cases were filed on February 15, 2018. The application in Case Number ADJ11202213 alleged that applicant sustained a specific injury of March 14, 2017 to the circulatory system in the form of a stroke arising out of and in the course of employment as a prep cook by Red Lobster Management LLC, insured by Zurich Los Angeles (the Uniform Assigned Name for Zurich North America). The application in Case Number ADJ11202304 alleged a cumulative trauma to the bilateral upper extremities arising out of and in the course of the same employment. Applicant's Petition for an Additional Panel, which was admitted into evidence as Applicant's Exhibit 1, indicates that T. Eric Yokoo, M.D. evaluated applicant as a Panel Qualified Medical Evaluator (PQME) in Physical Medicine and Rehabilitation. After Dr. Yokoo "provided opinions contrary to the current law regarding presumptions" the parties "agreed to have the applicant submit to the evaluation of an agreed medical evaluator" (AME). (Ibid., page 3, lines 6- 8; Applicant's Petition for an Additional Panel, dated November 30, 2020, page 1, lines 23-27.) No report of PQME Dr.

Escobedo v. Marshalls (2007) 70 Cal.Comp.Cases 604 (Appeals Board en banc)

Substantial evidence requires medical reports to set forth reasoning behind opinions, not just conclusions.

The Board found the AME opinions lacked sufficient reasoning to constitute substantial evidence on causation.

From the decision · page 3DISCUSSION It is well established that any decision of the WCAB must be supported by substantial evidence. (Lab. Code, § 5952(d); Escobedo v. Marshalls (2007) 70 Cal.Comp.Cases 604, 620 (Appeals Board en banc), citing 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].) Furthermore, "a medical report is not substantial evidence unless it sets forth the reasoning behind the physician's opinion, not merely his or her conclusions." (Escobedo, cited supra, 70 Cal.Comp.Cases 604, 621, citing Granado v. Workers' Comp. Appeals Bd. (1970) 69 Cal. 2d 399, 407 [33 Cal.Comp.Cases 647] (a mere legal conclusion does not furnish a basis for a finding); Zemke v. Workmen's Comp. Appeals Bd., supra, 68 Cal.2d at pp. 799, 800-801 [33 Cal.Comp.Cases 358] (an opinion that fails to disclose its underlying basis and gives a bare legal

South Coast Framing, Inc. v. Workers' Comp. Appeals Bd. (2015) 61 Cal.4th 291

Industrial factors need only be a contributing cause of injury, however slight.

The Board emphasized that work-related stress and repetitive use need only be a contributing cause to support injury causation.

From the decision · page 5The conclusions of Dr. Lipper and Dr. Wood with respect to causation of injury do not constitute substantial medical evidence without further explanation. The medical evaluators do not question applicant's reports of stress and repetitive use of the upper extremities at work, yet they fail to persuasively explain how and why these factors played no role in applicant's injuries to the circulatory system and upper extremities. As explained by the California Supreme Court, industrial factors need only be a contributing cause of injury, however slight. (See South Coast Framing, Inc. v. Workers' Comp. Appeals Bd. (2015) 61 Cal.4th 291, 299 [80 Cal.Comp.Cases 489].)

Applicant's reports of stress and repetitive use of upper extremities at work were not questioned by medical evaluators but were not persuasively explained away.

From the decision · page 5The conclusions of Dr. Lipper and Dr. Wood with respect to causation of injury do not constitute substantial medical evidence without further explanation. The medical evaluators do not question applicant's reports of stress and repetitive use of the upper extremities at work, yet they fail to persuasively explain how and why these factors played no role in applicant's injuries to the circulatory system and upper extremities. As explained by the California Supreme Court, industrial factors need only be a contributing cause of injury, however slight. (See South Coast Framing, Inc. v. Workers' Comp. Appeals Bd. (2015) 61 Cal.4th 291, 299 [80 Cal.Comp.Cases 489].)