What the panel ordered
Petition for Reconsideration denied; November 9, 2021 Findings and Award affirmed
Petition for Reconsideration filed by defendants State of California, Department of Corrections & Rehabilitation, and State Compensation Insurance Fund, seeking review of the November 9, 2021 Findings and Award
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.
Dr. Stone's opinion that the neck and upper extremity impairments should be combined with the lower extremity impairments by simple addition rather than the Combined Values Chart (CVC) is supported as substantial evidence, leading to a 59% permanent disability rating rather than 51%.
From the decision · page 3Defendant has filed a timely, verified Petition for Reconsideration from the Findings & Award of 11/09/2021, listing the usual statutory grounds. The issue is whether QME Dr. Stone's opinion, that the neck and upper extremity impairments should be combined with the lower extremity impairments by simple addition, qualifies as substantial medical evidence. I found that Dr. Stone's opinion in this regard did so qualify. The Petition for Reconsideration is without merit and should be denied.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Dr. Stone's opinion that the neck and upper extremity impairments do not significantly overlap with the lower extremity impairments in activities of daily living.
Favours Applicant prevailed
This supported the use of the additive method rather than the Combined Values Chart, leading to a higher permanent disability rating of 59%.
From the decision · page 3The upper extremity impairments of reaching overhead, pulling, pushing, reaching and the limited range of motion of the shoulders are not limiting or overlapping with the lower extremity impairments which affect walking, running, climbing stairs, riding in a car, prolonged positions and other like activities. There is some mild overlap in activities such as sexual activities and typing/computer work, which require prolonged sitting and prolonged use of the upper extremities.
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. Stone opined that the neck and upper extremity impairments should be combined with the lower extremity impairments by simple addition rather than using the Combined Values Chart, as the impairments affect different activities of daily living and addition yields a more accurate overall rating.
Dr. Stone explained that the lack of significant overlap in activities of daily living between upper and lower extremity impairments justified the additive method over the CVC.
From the decision · page 3Dr. Robert Stone was selected as the Qualified Medical Evaluator. He submitted six reports. He examined the injured worker three times. In his supplemental report dated March 17, 2021 (Ex. J-2, pp.4, 5 and 6), Dr. Stone analyzed the issue raised by Petitioner, i.e., how the multiple impairments caused by the injury should be combined:
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
AMA Guides, 5th Edition
The Combined Values Chart (CVC) is a formula to ensure summary value for multiple impairments does not exceed 100% Whole Person Impairment, but its use is not mandatory; physicians may apply other methods based on activities of daily living as per AMA Guides, 5th Edition.
The Board accepted Dr. Stone's application of the additive method over the CVC as reasonable and supported by the Guides and case law.
From the decision · page 4The authors of the AMA Guides, 5th Edition, stated that the Combined Values Chart (CVC) was based on a formula that ensured that the summary value for multiple impairments would not exceed 100% Whole Person Impairment. They then stated:
Athens Administrators v. WCAB (Kite) (2013) 78 CCC 213
The Board in Athens Administrators v. WCAB (Kite) (2013) 78 CCC 213 acknowledged that the CVC is rebuttable and physicians must justify their choice of method for combining impairments.
The Board relied on this precedent to uphold Dr. Stone's additive method as justified and supported by substantial evidence.
From the decision · page 4Thus, under the Guides, there is no hard and fast method for combining the disabilities, multiple methods have been legitimately used, based upon the extent to which they affect an individual's ability to perform activities of daily living; and the physician can apply his skills and judgment to decide which method most accurately reflects the overall impairment. In Athens Administrators v. WCAB (Kite) (2013) 78 CCC 213 the Board acknowledged this standard, agreeing that the Guides provision for applying the CVT is rebuttable, with the caveat that the physician must explain and justify the physician's choice of method.
What proof carried it
The evidence the panel weighed, by kind.
Dr. Stone's detailed explanation of the lack of significant overlap in activities of daily living between upper and lower extremity impairments supports the additive method for combining impairments.
From the decision · page 3Dr. Robert Stone was selected as the Qualified Medical Evaluator. He submitted six reports. He examined the injured worker three times. In his supplemental report dated March 17, 2021 (Ex. J-2, pp.4, 5 and 6), Dr. Stone analyzed the issue raised by Petitioner, i.e., how the multiple impairments caused by the injury should be combined:
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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.
- Issues, outcomes and weights were extracted by AI and released only where the source passage checked. Read the official decision before relying on anything here. Not legal advice.
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