ADJ12017211 — California WCAB decision

What the panel ordered

March 3, 2020 Findings of Fact and Order is rescinded; matter returned to WCJ for further proceedings and decision consistent with this opinion.

Applicant sought reconsideration of a WCJ decision denying industrial injury AOE/COE; WCAB granted reconsideration, reviewed the record, and issued this decision after reconsideration.

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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.

AOE/COERemandedcervical spine · thoracic spine · lumbar spine · left shoulder · left elbow · bilateral wrists/hands

The record does not contain substantial medical evidence to support a finding on AOE/COE; Dr. Kattar's opinion was not based on sufficient records or diagnostic testing and did not address all relevant causation factors.

From the decision · page 9Here, having reviewed the trial record, including Dr. Kattar's report, it appears that the record does not contain substantial medical evidence upon which a finding on the issue of injury AOE/COE can be made. Dr. Kattar requested additional records and the results of diagnostic testing and thus his opinions currently lack a solid underlying basis. (County of Sacramento v. Workers' Comp. Appeals Bd. (Brooks) (2013) 215 Cal.App.4th 785, 797 [78 Cal.Comp.Cases 379]; Escobedo, supra; Hegglin, supra.) Furthermore, he does not offer an opinion regarding the

The rules the panel named

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

South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291; Lab. Code §§ 3600(a), 3202.5; McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408; Rosas v. Workers' Comp. Appeals Bd. (1993) 16 Cal.App.4th 1692.

The employee bears the burden of proving injury AOE/COE by a preponderance of the evidence. Proof of industrial causation must be reasonably probable, not certain or convincing.

Applied to determine whether applicant met burden for AOE/COE.

From the decision · page 6The employee bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298, 302 [80 Cal.Comp.Cases 489]; Lab. Code, § 3600(a); 3202.5.) The Supreme Court of California has long held that an employee need only show that the "proof of industrial causation is reasonably probable, although not certain or `convincing.'" (McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 416-417, 419 [33 Cal.Comp.Cases 660].) "That burden manifestly does not require the applicant to prove causation by scientific certainty." (Rosas v. Workers' Comp. Appeals Bd. (1993) 16 Cal.App.4th 1692, 1701 [58 Cal.Comp.Cases 313].)

E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604; Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162.

A medical opinion must be framed in terms of reasonable medical probability, based on adequate examination and history, and set forth reasoning to support conclusions. Medical reports are not substantial evidence if speculative or based on inadequate facts.

Used to evaluate whether Dr. Kattar's report constituted substantial medical evidence.

From the decision · page 9a 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).) "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].)

ADJ12017211 · January 5, 2022

What the panel ordered

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