What the panel ordered
Petition for Reconsideration granted; Findings and Award affirmed in part and amended to correct temporary disability dates and defer permanent disability issues.
Defendant filed a Petition for Reconsideration of the Findings and Award issued on October 14, 2025; the WCJ's Report recommended granting reconsideration to amend the temporary disability dates and defer permanent disability issues.
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 Board deferred permanent disability issues due to insufficient substantial medical evidence and the need for further development of the medical record, especially regarding psychiatric disability causation and medication use.
From the decision · page 8We will therefore direct further development of the record and defer issues related to permanent disability.
The Board granted reconsideration to correct the temporary disability period to run from May 11, 2018, to May 10, 2020, less credit for days worked, based on the WCJ's Report and the Petition.
From the decision · page 93. We will amend the F&A as recommended by the WCJ in the Report to correct clerical error in a date so temporary disability runs from May 11, 2018, to May 10, 2020, less credit for days worked.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant's testimony that he takes ibuprofen 800 mg daily for pain, contradicting Dr. Noriega's report of infrequent NSAID use.
Favours Applicant prevailed
This undermined Dr. Noriega's opinion on no industrial impairment related to kidney disease and diabetes, leading to rejection of that opinion as substantial evidence.
From the decision · page 6Use of NSAIDs was reported to the doctor as only being a couple times a month. Based on this history the doctor found no industrial impairment related to the chronic kidney disease, which has its causal nexus with diabetes mellitus and hypertensive vascular disease (Exhibit 104, page 4.) By contrast, applicant testified at trial that since he last saw Dr. Noriega, he takes a lot of the Ibuprofen. (First MOH, page 12, lines 2-3.) It appears this NSAID comes in the form of Ibuprofen 800 milligrams. (Second MOH, page 2, lines 9-11.) We are unable to rely on the medical reporting of Dr. Noriega as substantial medical evidence when his opinions are based on facts no longer germane such as the inaccurate medical
Dr. Brown's psychiatric disability causation opinion was unclear and contradictory, requiring further medical record development.
Favours neutral
The Board deferred permanent disability issues due to insufficient substantial evidence on psychiatric disability causation.
From the decision · page 7While on the surface the conclusion that psychiatric disability was caused by the fall seems obvious, we are unable to determine the cause of psychiatric disability from Dr. Brown's reporting. The record requires clarification on this point. While a lay opinion connecting psychiatric disability to applicant's injury on May 11, 2018, is temporally attractive, such lay opinion does not replace expert medical opinion. Physical pain as described by Dr. Brown "during the course of employment," and physical pain from a specific injury, could conceivably lead to two separately caused psychiatric disabilities. (See, Lab. Code § 5411, 5412.) For causation of injury, not disability, Dr. Brown concludes "100% of the applicant's psychiatric injury resulted from real and/or actual events of the applicant's employment." Without a separate informed and reasoned analysis of the cause of disability, Dr. Brown's opinions regarding disability appear to be based on surmise, speculation, conjecture or guess. (Hegglin, supra, at p. 169.)
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.
Found nominal limitations in activities of daily living; 100% of thoracic, bilateral upper extremity and chest wall disability and 90% of lumbar disability attributable to the May 11, 2018 incident.
From the decision · page 4The most recent rounds of evaluation began on February 24, 2023, resulting in the report of pain management PQME Dr. Helm. "the applicant states he continues to work eight hours a week, four hours twice a week, at his job as a window tinter. He states that the owner of his company is using the employees who are "well," so that the applicant states that he is only given eight hours. He also states that he is not able to work more than eight hours because of his injuries. He states that he turned 62 approximately two months prior to this reevaluation and started receiving Social Security benefits. He states that he continues to work to pay for his Kaiser insurance until he receives Medicare at age 65." (Exhibit 101, PQME Standiford Helm, February 28, 2023, page 2.) Dr. Helm found nominal limitations in activities of daily living (ADLs).
Found no industrial impairment related to chronic kidney disease or diabetes due to reduced medication use, but the Board rejected this opinion as based on inaccurate medical history regarding NSAID use.
Rejected as substantial evidence due to reliance on inaccurate medication history.
From the decision · page 6Use of NSAIDs was reported to the doctor as only being a couple times a month. Based on this history the doctor found no industrial impairment related to the chronic kidney disease, which has its causal nexus with diabetes mellitus and hypertensive vascular disease (Exhibit 104, page 4.) By contrast, applicant testified at trial that since he last saw Dr. Noriega, he takes a lot of the Ibuprofen. (First MOH, page 12, lines 2-3.) It appears this NSAID comes in the form of Ibuprofen 800 milligrams. (Second MOH, page 2, lines 9-11.) We are unable to rely on the medical reporting of Dr. Noriega as substantial medical evidence when his opinions are based on facts no longer germane such as the inaccurate medical
Attributed 100% of psychiatric injury to employment events but found no permanent psychiatric disability; Board found his disability causation opinion unclear and requiring further development.
Opinion on disability causation unclear and contradictory; further development needed.
From the decision · page 7While on the surface the conclusion that psychiatric disability was caused by the fall seems obvious, we are unable to determine the cause of psychiatric disability from Dr. Brown's reporting. The record requires clarification on this point. While a lay opinion connecting psychiatric disability to applicant's injury on May 11, 2018, is temporally attractive, such lay opinion does not replace expert medical opinion. Physical pain as described by Dr. Brown "during the course of employment," and physical pain from a specific injury, could conceivably lead to two separately caused psychiatric disabilities. (See, Lab. Code § 5411, 5412.) For causation of injury, not disability, Dr. Brown concludes "100% of the applicant's psychiatric injury resulted from real and/or actual events of the applicant's employment." Without a separate informed and reasoned analysis of the cause of disability, Dr. Brown's opinions regarding disability appear to be based on surmise, speculation, conjecture or guess. (Hegglin, supra, at p. 169.)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162; Peter Kiewit Sons v. Industrial Acc. Com. (1965) 234 Cal.App.2d 831
The Board rejected Dr. Noriega's and Dr. Brown's opinions as not substantial evidence due to inaccurate medical history and unclear causation analysis.
From the decision · page 61. "Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories. Medical opinion also fails to support the Board's findings if it is based on surmise, speculation, conjecture or guess." (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93]. Further, as the Court of Appeal explained in Peter Kiewit Sons v. Industrial Acc. Com. (1965) 234 Cal.App.2d 831, 838 [30 Cal.Comp.Cases 188]: "Where an issue is exclusively a matter of scientific medical knowledge, expert evidence is essential to sustain a [WCAB] finding; lay testimony or opinion in support of such a finding does not measure up to the standard of substantial evidence. Expert testimony is necessary where the truth is occult and can be found only by resorting to the sciences." Dr. Noriega clearly premised his most recent expert opinions on a reduction in medication use.
What proof carried it
The evidence the panel weighed, by kind.
Applicant's testimony about daily ibuprofen use contradicting medical history reported to Dr. Noriega.
From the decision · page 6Use of NSAIDs was reported to the doctor as only being a couple times a month. Based on this history the doctor found no industrial impairment related to the chronic kidney disease, which has its causal nexus with diabetes mellitus and hypertensive vascular disease (Exhibit 104, page 4.) By contrast, applicant testified at trial that since he last saw Dr. Noriega, he takes a lot of the Ibuprofen. (First MOH, page 12, lines 2-3.) It appears this NSAID comes in the form of Ibuprofen 800 milligrams. (Second MOH, page 2, lines 9-11.) We are unable to rely on the medical reporting of Dr. Noriega as substantial medical evidence when his opinions are based on facts no longer germane such as the inaccurate medical
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