What the panel ordered
Petition for Reconsideration denied; Findings and Award and Order by WCJ affirmed.
Defendant sought reconsideration of the Findings and Award and Order issued by the WCJ on November 1, 2021, which found applicant sustained injury AOE/COE to heart, cardiovascular system, and respiratory system, and suffered 100% permanent and total disability.
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 parties stipulated injury to the respiratory system and the AME acknowledged pneumonia as a presumptive injury for police officers under Labor Code Section 3212, supported by the record and stipulation.
From the decision · page 7Finally, regarding defendant's argument that applicant did not sustain injury to his respiratory system, as noted by the WCJ in his Report:
The AME Dr. Hyman's well-reasoned opinion that the multiple cardiovascular impairments have an additive effect on the heart was found persuasive and supported by substantial evidence, leading to the conclusion that impairments should be added rather than combined.
From the decision · page 6An AME is presumably chosen by the parties because of his or her expertise and neutrality. Therefore, AME Dr. Hyman's opinions should be followed unless there is a good reason to find his opinions unpersuasive. (Power v. Workers' Comp. Appeals Bd. (1986) 179 Cal.App.3d 775, 782 [51 Cal.Comp.Cases 114, 117].) In his reports and deposition testimony, Dr. Hyman repeatedly explained his opinion that applicant's heart is impacted with multiple conditions, and because of the severity of the conditions, his heart cannot properly compensate for any one of the conditions. Therefore, applicant's heart is materially worse than it would be with only one of these conditions and the impairments should be added as opposed to combined due to the additive effect that the conditions have on his heart.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant sustained injury arising out of and in the course of employment to his heart, cardiovascular system, and respiratory system.
Favours Applicant prevailed
This fact was the basis for the WCJ's and WCAB's findings of compensability and permanent total disability.
From the decision · page 7Finally, regarding defendant's argument that applicant did not sustain injury to his respiratory system, as noted by the WCJ in his Report:
AME Dr. Hyman's opinion that the multiple cardiovascular impairments have an additive effect on the heart and should be added rather than combined.
Favours Applicant prevailed
The WCAB found Dr. Hyman's well-reasoned opinion persuasive and supported by substantial evidence, leading to the permanent disability rating outcome favoring applicant.
From the decision · page 6An AME is presumably chosen by the parties because of his or her expertise and neutrality. Therefore, AME Dr. Hyman's opinions should be followed unless there is a good reason to find his opinions unpersuasive. (Power v. Workers' Comp. Appeals Bd. (1986) 179 Cal.App.3d 775, 782 [51 Cal.Comp.Cases 114, 117].) In his reports and deposition testimony, Dr. Hyman repeatedly explained his opinion that applicant's heart is impacted with multiple conditions, and because of the severity of the conditions, his heart cannot properly compensate for any one of the conditions. Therefore, applicant's heart is materially worse than it would be with only one of these conditions and the impairments should be added as opposed to combined due to the additive effect that the conditions have on his heart.
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.
Applicant's multiple cardiovascular conditions have an additive effect on his heart, making the heart materially worse than with any single condition alone, supporting adding impairments rather than combining them.
Dr. Hyman explained that the multiple cardiovascular impairments cause additive effects on the heart, worsening the condition beyond any single impairment, supporting the additive rating method.
From the decision · page 6An AME is presumably chosen by the parties because of his or her expertise and neutrality. Therefore, AME Dr. Hyman's opinions should be followed unless there is a good reason to find his opinions unpersuasive. (Power v. Workers' Comp. Appeals Bd. (1986) 179 Cal.App.3d 775, 782 [51 Cal.Comp.Cases 114, 117].) In his reports and deposition testimony, Dr. Hyman repeatedly explained his opinion that applicant's heart is impacted with multiple conditions, and because of the severity of the conditions, his heart cannot properly compensate for any one of the conditions. Therefore, applicant's heart is materially worse than it would be with only one of these conditions and the impairments should be added as opposed to combined due to the additive effect that the conditions have on his heart.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
AMA Guides to the Evaluation of Permanent Impairment, 5th Edition (2001)
Provides guidelines for combining impairments and supports clinical judgment in impairment evaluation, including additive methods.
From the decision · page 5A scientific formula has not been established to indicate the best way to combine multiple impairments. Given the diversity of impairments and great variability inherent in combining multiple impairments, it is difficult to establish a formula that accounts for all situations. A combination of some impairments could decrease overall functioning more than suggested by just adding the impairment ratings for the separate impairments (e.g. blindness and inability to use both hands). When other multiple impairments are combined, a less than additive approach may be more appropriate. (American Medical Association Guides to the Evaluation of Permanent Impairment, 5th Edition (2001) (AMA Guides), p. 10.)
California Labor Code
Labor Code Section 3212
Supports presumption of pneumonia as an industrial injury for police officers, supporting respiratory system injury finding.
From the decision · page 7Finally, regarding defendant's argument that applicant did not sustain injury to his respiratory system, as noted by the WCJ in his Report:
What proof carried it
The evidence the panel weighed, by kind.
Sub Rosa videotapes showing mild activities of daily living consistent with applicant's history and diagnoses
From the decision · page 3Dr. Hyman received "Sub Rosa videotapes" to review and after reviewing the videotapes he explained:
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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