ADJ12069406 · December 23, 2025

The Board found the record lacked sufficient medical evidence to establish to a reasonable medical probability that the injury was a high velocity eye injury, and deferred the issue for further development at the trial level.

From the decision · page 11Accordingly, we rescind the October 3, 2022 F&O and substitute a new F&O that defers the issues of whether applicant sustained a high velocity eye injury and whether he is entitled to additional temporary disability pursuant to section 4656(c)(3)(F). We return this matter to the trial level for further proceedings consistent with this decision.

Applicant did not testify about the circumstances of his injury, and the documentary evidence contained inconsistent descriptions of the injury mechanism.

Favours Defendant prevailed

This lack of consistent testimony and evidence prevented the Board from making a reasonable medical probability finding on the high velocity nature of the injury.

From the decision · page 10Here, while it is clear from the medical record and the stipulation of the parties that applicant sustained a serious, industrial injury to his left eye, the specific mechanism of injury has not been identified to a reasonable medical probability. (See Lab. Code, § 3202.5; McAllister, supra, 69 Cal.2d at pp. 413, 416§ 417, 419.) Applicant did not testify regarding the "circumstances of his injury" (Gonzalez v. Tres Generaciones, supra, at p. *1) and the documentary evidence includes various similar--but not identical--descriptions of how the injury occurred: "a vine branch hit his left eye" (Defendant's Exh. A, Supervisor's Accident Investigation Form); "one of the vines of the grapevine snapped into my left eye" (Joint Exh. 3, Employee Disability Questionnaire, at p. 2); "a vine branch thrust across his left eye" (Joint Exh. 3, 7/2/19 QME report at p. 10); "a branch of vine hit his left eye (which was on a moving trailer)..." (Id. at p. 13); and, when "he was walking next to a trailer while simultaneously placing wooden post into the trailer.... As he was doing this, a branch from one of the vines struck his left eye causing extreme pain and according to the patient a loss of consciousness that lasted for two hours." (Joint Ex. 2, Dr. Monderer's 12/21/20 QME Report, at p. 2.)

Medical records did not substantively discuss whether the injury was high-velocity as required by Labor Code section 4656(c)(3)(F).

Favours Defendant prevailed

Without medical evidence addressing the high velocity question, the Board could not adjudicate entitlement to additional temporary disability.

From the decision · page 11Moreover, to the extent that the applicant alleges his disability was the result of a high- velocity eye injury, there is no substantive discussion in the medical record of whether such injury was "high-velocity" as contemplated in section 4656(c)(3)(F). (See, e.g., Glick, supra.) The three QME reports do not specifically address this question. Medical reporting on this question is required, in part, because a determination that an injury to the eye is a "high velocity" injury may be inferred from the severity of the injury. (Gonzalez v. Tres Generaciones, supra, at pp. *1-2; Glick, supra, at p. 153; Hanrahan, supra, at p. *8.) Medical reporting must address whether the severity of the injury necessarily supports a conclusion that the injury was a high velocity eye injury.

Applicant sustained a left eye injury with multiple diagnoses including retinal detachment and corneal laceration; he was temporarily totally disabled from the date of injury and required ongoing medical care; ocular impairment was 100% industrial.

From the decision · page 4Dr. Nejad found that applicant, "has not reached to MMI (Maximum Medical Improvement) state regarding to his ocular complaints at this time. He needs to receive proper medical or surgical care including removal of his corneal sutures and possible another RD (retinal detachment) surgery in order to improve his visual acuity in left eye." (Id. at pp. 22-23.) Applicant's ocular impairment was 100% industrial, resulting from his ocular injury on March 15, 2019. (Id. at p. 39.) Regarding disability status, Dr. Nejad found that applicant "has had temporary total disability from date of injury on 03/15/2019 till present. He is not able to work with current condition of his left eye." (Ibid.) Dr. Nejad concluded that applicant required future medical care with his "retina specialist" or other eye clinic "for multi-discipline therapy," noting "All the necessary medical and surgical therapy cost shall be paid by the insurance company." (Id. at p. 40.)

Applicant had a ruptured globe with retinal detachment and multiple surgeries; he was temporarily totally disabled and required ongoing treatment; condition was 100% due to work injury.

From the decision · page 4Applicant was further evaluated by Ophthalmologist Bernard Monderer, M.D., as a QME on December 21, 2020 and on February 17, 2022. (Joint Exh. 2 and Joint Exh. 1.) In Dr. Monderer's first QME report, he wrote that applicant was injured when "he was walking next to a trailer while simultaneously placing wooden post into the trailer.... As he was doing this, a branch from one of the vines struck his left eye causing extreme pain and according to the patient a loss of consciousness that lasted for two hours." (Joint Ex. 2, Dr. Monderer's 12/21/20 QME Report, at p. 2.) Dr. Monderer's diagnoses of applicant's left eye included:

Chavira v. Workers' Comp. Appeals Bd. (1991) 235 Cal.App.3d 463

Temporary disability is incapacity to work expected to improve with medical treatment.

Applied to define temporary disability in this case.

From the decision · page 8Temporary disability is defined as incapacity to work that is reasonably expected to be improved with medical treatment. (Chavira v. Workers' Comp. Appeals Bd. (1991) 235 Cal.App.3d 463, 473 [56 Cal.Comp.Cases 631].) Temporary disability indemnity is intended primarily to substitute for the worker's lost wages, in order to maintain a steady stream of income. (Ibid.)

E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (2006) 145 Cal.App.4th 922

Medical opinion must be predicated on reasonable medical probability and supported by reasoning to constitute substantial evidence.

Applied to evaluate medical evidence regarding high velocity eye injury.

From the decision · page 7It is well established that decisions by the Appeals Board must be supported by substantial evidence. (Lab. Code, § 5903, 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274 [39 Cal.Comp.Cases 310]; Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312 [35 Cal.Comp.Cases 500]; LeVesque v. Workmen's Comp. Appeals Bd. (1970) 1 Cal.3d 627 [35 Cal.Comp.Cases 16].) To constitute substantial evidence "a medical opinion must be predicated on reasonable medical probability." (E.L. Yeager Construction v. Workers' Comp. Appeals Bd., (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687], citing McAllister v. Workmen's Comp. App. Bd. (1968) 69 Cal.2d 408, 413, 416§ 417, 419 [33 Cal.Comp.Cases 660].) A medical opinion "is not substantial evidence if it is based on facts no longer germane, on inadequate medical histories or examinations, on incorrect legal theories, or on surmise, speculation, conjecture, or guess." (Id. citing Hegglin v. Workmen's Comp. App. Bd. (1971) 4 Cal.3d 162, 169.) "Further, a medical report is not substantial evidence unless it sets forth the reasoning behind

Applicant did not testify regarding the circumstances of his injury, and the documentary evidence contained varying descriptions of the injury mechanism.

From the decision · page 10Here, while it is clear from the medical record and the stipulation of the parties that applicant sustained a serious, industrial injury to his left eye, the specific mechanism of injury has not been identified to a reasonable medical probability. (See Lab. Code, § 3202.5; McAllister, supra, 69 Cal.2d at pp. 413, 416§ 417, 419.) Applicant did not testify regarding the "circumstances of his injury" (Gonzalez v. Tres Generaciones, supra, at p. *1) and the documentary evidence includes various similar--but not identical--descriptions of how the injury occurred: "a vine branch hit his left eye" (Defendant's Exh. A, Supervisor's Accident Investigation Form); "one of the vines of the grapevine snapped into my left eye" (Joint Exh. 3, Employee Disability Questionnaire, at p. 2); "a vine branch thrust across his left eye" (Joint Exh. 3, 7/2/19 QME report at p. 10); "a branch of vine hit his left eye (which was on a moving trailer)..." (Id. at p. 13); and, when "he was walking next to a trailer while simultaneously placing wooden post into the trailer.... As he was doing this, a branch from one of the vines struck his left eye causing extreme pain and according to the patient a loss of consciousness that lasted for two hours." (Joint Ex. 2, Dr. Monderer's 12/21/20 QME Report, at p. 2.)

Medical record lacked substantive discussion on whether the injury was high-velocity as required by Labor Code section 4656(c)(3)(F).

From the decision · page 11Moreover, to the extent that the applicant alleges his disability was the result of a high- velocity eye injury, there is no substantive discussion in the medical record of whether such injury was "high-velocity" as contemplated in section 4656(c)(3)(F). (See, e.g., Glick, supra.) The three QME reports do not specifically address this question. Medical reporting on this question is required, in part, because a determination that an injury to the eye is a "high velocity" injury may be inferred from the severity of the injury. (Gonzalez v. Tres Generaciones, supra, at pp. *1-2; Glick, supra, at p. 153; Hanrahan, supra, at p. *8.) Medical reporting must address whether the severity of the injury necessarily supports a conclusion that the injury was a high velocity eye injury.