What the panel ordered
Petition for Reconsideration granted; February 20, 2026 Findings and Order rescinded; matter returned to trial level for further proceedings.
Applicant seeks reconsideration of the Findings and Order issued on February 20, 2026, by the WCJ, which barred internal injury complaints under Labor Code section 5410 for lack of substantial medical evidence within five years from injury date.
This docket was decided more than once. Shown here is the latest released decision; we also hold November 7, 2025.
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 WCJ's finding that applicant's internal injury complaints were barred by Labor Code section 5410 was unsupported due to lack of substantial medical evidence; applicant timely filed petition to reopen; record development needed; thus, reconsideration granted and matter remanded for further proceedings.
From the decision · page 1Applicant seeks reconsideration of the "Findings and Order" (F&O) issued on February 20, 2026, by the workers' compensation administrative law judge (WCJ). The WCJ found, in pertinent part, that applicant's internal injury complaints are barred by Labor Code1 section 5410 because applicant failed to obtain substantial medical evidence establishing internal injury within five years from his date of injury.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant timely filed a petition to reopen within five years from the date of injury.
Favours Applicant prevailed
This timely filing vested the Appeals Board with jurisdiction to reconsider the entire case, including internal injury claims.
From the decision · page 5Here, applicant's petition to reopen was timely filed. Once applicant timely filed his petition to reopen, the Appeals Board gained jurisdiction to reconsider the entire case. This includes jurisdiction to determine liability for compensable consequence injuries. However, "[a]n injured worker... cannot confer jurisdiction on the Board by filing a petition to reopen an award before the five-year period has expired for anticipated new and further disability to occur thereafter." (Sarabi v. Workers' Comp. Appeals Bd., (2007) 151 Cal. App. 4th 920, 926.)
The WCJ found no substantial medical evidence supporting new and further disability for internal complaints.
Favours Applicant prevailed
Without substantial medical evidence, the WCJ's determination was unsupported and led to rescission of the Findings and Order.
From the decision · page 5The WCJ found that the reporting of applicant's treating physician did not constitute substantial evidence. With no medical evidence to rely on, the WCJ's determination that applicant did not sustain new and further disability is unsupported and thus, we will rescind the F&O. Furthermore, it appears that extensive records were provided to the internal medicine treater, which were referenced in the August 19, 2024 report, but not summarized. (Applicant's Exhibit 14, p. 1, ["I have received 876 pages of medical records for my review and comment."].) Applicant also testified that he developed internal complaints within five years from the date of his injury and no issue of applicant's credibility was raised by the WCJ. Given these facts, it would further appear that development of the record is needed in this matter.
Applicant testified to developing internal complaints within five years from injury date and no credibility issues were raised.
Favours Applicant prevailed
Applicant's credible testimony supports the need for further record development and reconsideration.
From the decision · page 5The WCJ found that the reporting of applicant's treating physician did not constitute substantial evidence. With no medical evidence to rely on, the WCJ's determination that applicant did not sustain new and further disability is unsupported and thus, we will rescind the F&O. Furthermore, it appears that extensive records were provided to the internal medicine treater, which were referenced in the August 19, 2024 report, but not summarized. (Applicant's Exhibit 14, p. 1, ["I have received 876 pages of medical records for my review and comment."].) Applicant also testified that he developed internal complaints within five years from the date of his injury and no issue of applicant's credibility was raised by the WCJ. Given these facts, it would further appear that development of the record is needed in this matter.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc)
A medical opinion must be framed in terms of reasonable medical probability, not speculative, based on pertinent facts and adequate examination, and set forth reasoning in support of conclusions.
The WCJ's finding lacked substantial medical evidence as required by this standard, leading to rescission of the Findings and Order.
From the decision · page 4II. To constitute substantial evidence "... a medical opinion must be framed in terms of reasonable medical probability, it 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, 621 (Appeals Board en banc).) The WCJ and the Appeals Board have a duty to further develop the record where there is insufficient evidence on an issue. (McClune v. Workers' Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117, 1121-1122 [63 Cal.Comp.Cases 261].) The Appeals Board has a constitutional mandate to "ensure substantial justice in all cases." (Kuykendall v. Workers' Comp. Appeals Bd. (2000) 79 Cal.App.4th 396, 403 [65 Cal.Comp.Cases 264].) The Board may not leave matters undeveloped where it is clear that additional discovery is needed. (Id. at p. 404.) The preferred procedure is to allow supplementation of the medical record by the physicians who have already reported in the case. (McDuffie v.
Kuykendall v. Workers' Comp. Appeals Bd. (2000) 79 Cal.App.4th 396
The Appeals Board has a constitutional mandate to ensure substantial justice and must further develop the record where evidence is insufficient.
The Board found the record needed further development due to insufficient evidence on internal complaints.
From the decision · page 4II. To constitute substantial evidence "... a medical opinion must be framed in terms of reasonable medical probability, it 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, 621 (Appeals Board en banc).) The WCJ and the Appeals Board have a duty to further develop the record where there is insufficient evidence on an issue. (McClune v. Workers' Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117, 1121-1122 [63 Cal.Comp.Cases 261].) The Appeals Board has a constitutional mandate to "ensure substantial justice in all cases." (Kuykendall v. Workers' Comp. Appeals Bd. (2000) 79 Cal.App.4th 396, 403 [65 Cal.Comp.Cases 264].) The Board may not leave matters undeveloped where it is clear that additional discovery is needed. (Id. at p. 404.) The preferred procedure is to allow supplementation of the medical record by the physicians who have already reported in the case. (McDuffie v.
Labor Code section 5410
Section 5410 limits the time period to institute proceedings for new and further disability within five years from date of injury.
The WCJ initially barred internal injury complaints under this statute, but the Board found the evidence insufficient to support the bar.
From the decision · page 1Applicant seeks reconsideration of the "Findings and Order" (F&O) issued on February 20, 2026, by the workers' compensation administrative law judge (WCJ). The WCJ found, in pertinent part, that applicant's internal injury complaints are barred by Labor Code1 section 5410 because applicant failed to obtain substantial medical evidence establishing internal injury within five years from his date of injury.
What proof carried it
The evidence the panel weighed, by kind.
Applicant testified he developed internal complaints within five years from injury date; no credibility issue raised
From the decision · page 5The WCJ found that the reporting of applicant's treating physician did not constitute substantial evidence. With no medical evidence to rely on, the WCJ's determination that applicant did not sustain new and further disability is unsupported and thus, we will rescind the F&O. Furthermore, it appears that extensive records were provided to the internal medicine treater, which were referenced in the August 19, 2024 report, but not summarized. (Applicant's Exhibit 14, p. 1, ["I have received 876 pages of medical records for my review and comment."].) Applicant also testified that he developed internal complaints within five years from the date of his injury and no issue of applicant's credibility was raised by the WCJ. Given these facts, it would further appear that development of the record is needed in this matter.
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
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