ADJ11299343 — California WCAB decision

What the panel ordered

Defendant's petition for reconsideration is denied, affirming the WCJ's award of 89% permanent disability without apportionment and future medical treatment.

Defendant filed a petition for reconsideration of the WCJ's Amended Findings and Award dated July 15, 2025, which was denied by the WCAB panel decision on October 17, 2025.

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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.

Permanent disability ratingApplicant prevailedneck · left shoulder · left arm · low back · GERD · constipation · sleep disorder

The WCJ's award of 89% permanent disability without apportionment was upheld because the defense failed to provide sufficient reasoning and evidence to support apportionment.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

Defendant failed to provide sufficient reasoning and evidence to support apportionment of permanent disability.

Favours Applicant prevailed

This failure led to the rejection of apportionment and upheld the 89% permanent disability award to applicant.

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.

QMERejected · pain management

Found injury AOE/COE to left shoulder, left upper extremity, cervical spine, and lumbar spine with whole person impairments and apportioned 50% industrial injury and 50% preexisting lumbar spine conditions.

Provided apportionment opinion but failed to provide sufficient reasoning to support it, leading to rejection of apportionment.

From the decision · page 2Dr. Sabsovich evaluated applicant on April 5, 2022, with a corresponding report, as well as a supplemental report dated July 12, 2023, issuing thereafter. In his April 5, 2022 report, he found injury AOE/COE to applicant's left shoulder, left upper extremity, cervical spine, and lumbar spine with corresponding whole person impairments (WPIs) of 8%, 11%, 7%, and 8%, in addition to a 3% pain add-on. (Applicant's Exhibit 9, pp. 32-35.) For applicant's lumbar impairment, he apportioned "50% for the industrial injury on [October 23, 2017] and 50% for the preexisting lumbar spine conditions." (Id. at p. 36.)

QMERelied upon · pain management

Found injury AOE/COE for cervical spine, lumbar spine, left shoulder, and left elbow.

From the decision · page 2Dr. Murakami evaluated applicant on April 7, 2020, and August 17, 2021, with corresponding reports dated May 5, 2020, and August 27, 2021, issuing thereafter, in addition to a supplemental report dated June 3, 2020. Dr. Murakami found injury AOE/COE for the cervical spine, lumbar spine, left shoulder, and left elbow. (Applicant's Exhibit 5, p. 11.)

QMERejected · internal medicine

Found injury AOE/COE for GERD, constipation, and sleep apnea with apportioned impairments but failed to provide sufficient reasoning to support apportionment.

Apportionment opinion rejected due to lack of sufficient reasoning.

From the decision · page 3Dr. Anderson evaluated applicant on November 3, 2022, with a corresponding report, as well a supplemental dated January 23, 2023, issuing thereafter. In his November 3, 2022 report, Dr. Anderson found injury AOE/COE for applicant's GERD and constipation resulting in a 3% and 5% WPI, respectively, with 60% apportioned to medication usage from the injury and the remaining 40% to preexisting obesity. (Applicant's Exhibit 13, pp. 165-168.) Injury AOE/COE for applicant's sleep apnea was also found, with a resulting 6% WPI apportioned 40% to weight gain from the injury and the remaining 60% to preexisting obesity. (Ibid.) Although injury AOE/COE was found for applicant's exogenous obesity, no impairment was indicated. (Ibid.) Dr. Anderson also found no injury AOE/COE for applicant's deep vein thrombosis, pulmonary embolism, chronic anticoagulation, hypertension, hyperlipidemia, or umbilical hernia. (Id. at p. 165.)

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Department of Corrections and Rehabilitation v. Workers' Comp. Appeals Bd. (Fitzpatrick) (2018) 27 Cal.App.5th 607

Permanent disability rating schedule (PDRS) combined values chart (CVC) is prima facie evidence but rebuttable for permanent disability rating.

The PDRS combined values chart is rebuttable and other methodologies may be used for accuracy in rating impairments.

From the decision · page 6Pursuant to Department of Corrections and Rehabilitation v. Workers' Comp. Appeals Bd. (Fitzpatrick) (2018) 27 Cal.App.5th 607 [83 Cal.Comp.Cases 1680], impairments "are generally combined" using the combined values chart (CVC) found in the permanent disability rating schedule (PDRS). However, the "scheduled rating is not absolute" and other methodologies may be used to calculate permanent disability. (Id. at p. 614.) Thus, while the PDRS is prima facie evidence of an employee's permanent disability, it is rebuttable. (Almaraz v. Environmental Recovery Services/Guzman v. Milpitas Unified School Dist. (Almaraz-Guzman II) (2009) 74 Cal.Comp.Cases 1084, 1106 (Appeals Bd. en banc); see Blackledge v. Bank of America (2010) 75 Cal.Comp.Cases 613 (Appeals Bd. en banc); City of Sacramento v. Workers' Comp. Appeals Bd. (Cannon) (2013) 222 Cal.App.4th 1360.) Ultimately, however, the goal in rating impairments is accuracy. (Milpitas Unified School Dist. v. Workers' Comp. Appeals Bd. (Almaraz-Guzman III) (2010) 187 Cal.App.4th 808, 822 [75 Cal.Comp.Cases 837].)

Athens Administrators v. Workers' Comp. Appeals Bd. (Kite) (2013) 78 Cal.Comp.Cases 213

If impairments have a synergistic effect causing greater disability than the CVC, impairments should be added rather than combined.

Synergistic effect of impairments justifies adding impairments rather than combining for accuracy.

From the decision · page 6In Athens Administrators v. Workers' Comp. Appeals Bd. (Kite) (2013) 78 Cal.Comp.Cases 213 (writ den.), the Appeals Board held that if there is substantial medical evidence that two or more impairments have a synergistic effect which causes the resulting impairment to be greater than that reflected through use of the CVC, the impairments should be added for purposes of accuracy. In Kite, the applicant underwent bilateral hip replacement surgeries and the orthopedic QME opined that there was a "synergistic effect of the injury to the same body parts bilaterally versus body parts from different regions of the body," and, as such, "the best way to combine the impairments to the right and left hips would be to add them versus using the combined values chart, which would result in a lower whole person impairment." (Id. at p. 5.) Accordingly, in Kite, the WCJ found that the impairment for the applicant's hips should be added rather than combined.

Vigil v. County of Kern (2024) 89 Cal.Comp.Cases 686 (Appeals Bd. en banc)

To rebut the CVC and add impairments, applicant must establish impacted activities of daily living and their overlap or amplification.

Applicant must show ADLs impacted by each impairment and how they overlap or amplify to rebut the CVC.

From the decision · page 6Subsequent to Kite, the Appeals Board issued Vigil v. County of Kern (2024) 89 Cal.Comp.Cases 686, 688-689 (Appeals Bd. en banc) wherein it was determined that if an applicant seeks to rebut the CVC and add rather than combine impairments, the applicant must establish 1) The activities of daily living (ADLs) impacted by each impairment, and 2) That the ADLs either do not overlap, or overlap in such a way that it increases or amplifies the impact of the overlapping ADLs.

Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Bd. en banc)

Defendant bears the burden of proof on apportionment and must provide detailed medical opinion with reasoning under correct legal principles.

Medical opinion on apportionment must be framed in reasonable medical probability, based on facts, and provide reasoning to be substantial evidence.

From the decision · page 8Defendant also asserts that the WCJ's decision to withhold apportionment is erroneous, as the record contains "detailed evidence regarding the non-industrial factors." (Petition, pp. 13, 18.) It is well established that defendant carries the burden of proof on the issue of apportionment. (Lab. Code, § 5705; Pullman Kellogg v. Workers' Comp. Appeals Bd. (Normand) (1980) 26 Cal.3d 450, 456 [45 Cal.Comp.Cases 170]; Kopping v.Workers' Comp. Appeals Bd. (2006) 142 Cal.App.4th 1099, 1115 [71 Cal.Comp.Cases 1229]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 613 (Appeals Bd. en banc).) To meet this burden, defendant "must demonstrate that, based upon reasonable medical probability, there is a legal basis for apportionment." (Gay v. Workers' Comp. Appeals Bd. (1979) 96 Cal.App.3d 555, 564 [44 Cal.Comp.Cases 817]; see also Escobedo, supra, at p. 620.)

ADJ11299343 · October 17, 2025

What the panel ordered

What was disputed, and how it came out

The facts that decided it

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What the panel did with the medical opinions

The rules the panel named

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