What the panel ordered
Petition for Reconsideration granted; prior Findings and Order of September 30, 2020, rescinded; new Findings and Order substituted finding injury AOE/COE to left forearm and left thumb; issues regarding neck, left shoulder, and back deferred; matter returned to Arbitrator for further proceedings.
Applicant seeks reconsideration of the Findings and Order issued by the Arbitrator on September 30, 2020, which found no injury AOE/COE to claimed body parts; the Appeals Board grants reconsideration, rescinds the prior F&O, and substitutes a new F&O finding injury AOE/COE to left forearm and left thumb, deferring other body parts for further development.
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 Appeals Board found substantial medical evidence from QME Dr. Campbell supporting injury AOE/COE to left forearm and left thumb, based on his examination, history, and medical record review.
From the decision · page 3Campbell stated that after examining applicant and reviewing the medical record, he believed that from a medical perspective, applicant's left thumb and forearm injury claims should be accepted "as meeting AOE/COE criteria." (App. Exh. 2, p. 15.) Based thereon, we agree with the Arbiter that, "The preponderance of the medical evidence confirms that the Applicant sustained an injury to his thumb on or about 4-15-18." (F&O, p. 3, Opinion on Decision.) However, we also agree with Dr. Campbell's conclusion that since, "... the mechanism of injury is one that could have produced shoulder injury to the labrum and undiagnosed shoulder injury can masquerade as neck pain (referred). I probably should re-evaluate him relative to the shoulder." (App. Exh. 1, p. 3.) It is well established that an award, order, or decision of the Appeals Board must be supported by substantial evidence. (Lab. Code, § 5952(d); Lamb v. Workmen's Comp. Appeals Bd.
The Appeals Board deferred the issues of injury AOE/COE to neck, left shoulder, and back for further medical development and re-evaluation by Dr. Campbell, as the current record lacked substantial evidence.
From the decision · page 4Based thereon, the record needs to be further developed. Normally, when the medical record requires further development, the record should first be supplemented by physicians who have already reported in the case. (See McDuffie v. Los Angeles County Metropolitan Transit Authority (2001) 67 Cal.Comp.Cases 138 (Appeals Board en banc).) Under the circumstances of this matter it is appropriate that applicant be re-evaluated by Dr. Campbell relative to the neck, shoulder, and back injury claims. We also note that upon return of this matter to the Arbiter it is necessary that the exhibits identified in the MOH/SOE be uploaded into the Electronic Adjudication Management System (EAMS) ADJ file and properly identified pursuant to the MOH/SOE.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
QME Dr. Campbell's medical opinion supports injury AOE/COE to left forearm and left thumb based on examination, history, and medical record review.
Favours Applicant prevailed
This opinion provided substantial evidence for the Appeals Board to find injury AOE/COE to these body parts.
From the decision · page 2It is my opinion, the patient's need for treatment, periods of temporary disability, current symptoms and level of permanent disability with regard to the left forearm and left thumb should be accepted as meeting AOE/COE criteria and of industrial origin relative to DOI 4/15/18. ... With regard to the patient's neck and back frankly, the history provided is confusing. Given the history, which again is difficult for me to understand today, paired with an apparent paucity of medical records surrounding the neck and back, at this time I cannot confidently connect the neck and back injury to the specific events of 4/15/18. (App. Exh. 2, p. 15, underlining deleted.)
The medical record lacks substantial evidence for injury AOE/COE to neck, left shoulder, and back without further evaluation and development.
Favours Defendant prevailed
The Appeals Board deferred these issues pending further medical development and re-evaluation by Dr. Campbell.
From the decision · page 2I have gone through prior medical records, and they don't appear to show any left shoulder complaints (as do the current set of records). That said, it did appear the patient had neck pain....although again, appeared to be late onset and the history was confusing/patient seemed to connect this late onset with basketball activities. All that said, the mechanism of injury is one that could have produced shoulder injury to the labrum and undiagnosed shoulder injury can masquerade as neck pain (referred). I probably should re-evaluate him relative to the shoulder. (App. Exh. 1, Dr. Campbell, March 16, 2020, p. 3.)
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.
Dr. Campbell opined that applicant's left forearm and left thumb injuries meet AOE/COE criteria and are industrial in origin, but could not confidently connect neck and back injuries to the April 15, 2018 event without further evaluation. He recommended re-evaluation for shoulder injury.
Based on examination, history, and medical record review, Dr. Campbell found substantial evidence for left forearm and thumb injury AOE/COE but found the history confusing and medical records insufficient for neck and back injuries.
From the decision · page 2It is my opinion, the patient's need for treatment, periods of temporary disability, current symptoms and level of permanent disability with regard to the left forearm and left thumb should be accepted as meeting AOE/COE criteria and of industrial origin relative to DOI 4/15/18. ... With regard to the patient's neck and back frankly, the history provided is confusing. Given the history, which again is difficult for me to understand today, paired with an apparent paucity of medical records surrounding the neck and back, at this time I cannot confidently connect the neck and back injury to the specific events of 4/15/18. (App. Exh. 2, p. 15, underlining deleted.)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, 5952(d); Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc)
An award, order, or decision of the Appeals Board must be supported by substantial evidence, which requires a medical opinion to be based on pertinent facts, adequate examination and history, and reasoning in support of conclusions.
The Appeals Board found Dr. Campbell's opinion on left forearm and thumb injury met the substantial evidence standard, but the record lacked substantial evidence for neck, shoulder, and back injuries without further development.
From the decision · page 4(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.)].) To be substantial evidence a medical opinion must not be speculative, it must be based on pertinent facts and on an adequate examination and history, and it must set forth reasoning in support of its conclusions. (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc).) The Appeals Board has the discretionary authority to develop the record when the medical record is not substantial evidence to determine a threshold issue, such as injury AOE/COE. (Lab. Code, § 5701, 5906; Tyler v. Workers' Comp. Appeals Bd. (1997) 56 Cal.App.4th 389 [62 Cal.Comp.Cases 924]; McClune v. Workers' Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117, 1121-1122 [63 Cal.Comp.Cases 261].) Dr. Campbell's stated that he should re-evaluate. Dr. Campbell's statement is quite clear that absent a re-evaluation of applicant, the record does not contain substantial medical evidence regarding the shoulder, neck, and back injury claim.
What proof carried it
The evidence the panel weighed, by kind.
Applicant's trial testimony and QME Dr. Campbell's reports
From the decision · page 1Applicant contends that the reports of orthopedic qualified medical examiner (QME) William R. Campbell D.O., and applicant's trial testimony, are substantial evidence that applicant sustained injury AOE/COE; and that applicant needs to be re-evaluated by Dr. Campbell to determine whether applicant's neck and back injuries are industrially related.
The same issues, filtered across the whole corpus — or paste your own facts and let the search rank by factor match.
About this page
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