ADJ12901281 — California WCAB decision

What the panel ordered

The WCAB granted the petition for reconsideration, rescinded the WCJ's Findings and Order of May 20, 2024, and returned the matter to the trial level for further proceedings and decision consistent with the opinion.

Applicant sought reconsideration of the WCJ's Findings and Order of May 20, 2024, which found no industrial injury and issued a take nothing order. The WCAB granted reconsideration, rescinded the WCJ's decision, and returned the matter to the trial level for further development of the medical record and decision.

Read the official decision →

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/COERemandednervous system · psyche · body systems · stress · fibromyalgia · chronic fatigue · neck

The WCAB found that the WCJ and QME reports did not adequately address industrial causation, particularly regarding the physical injury and psychiatric injury distinction, and that further development of the medical record was necessary to clarify causation percentages and the role of fibromyalgia and depression.

From the decision · page 1Applicant seeks reconsideration of a workers' compensation administrative law judge's (WCJ) Findings and Order of May 20, 2024, wherein it was found that applicant did not sustain industrial injury to her nervous system, psyche, "body systems," or in the forms of stress, fibromyalgia, chronic fatigue or neck pain while employed as a corporate marketing manager during a cumulative period ending December 29, 2017. The WCJ thus issued an order that applicant take nothing by way of her workers' compensation claim. In making these findings, the WCJ relied on the opinions of qualified medical evaluators (QME) psychiatrist Andrea R. Bates, M.D. and rheumatologist Seymour Levine, M.D., who opined that applicant did not sustain industrial injury.

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.

QMERelied upon · rheumatologist

Noted that depression and drug withdrawal symptoms could mimic fibromyalgia symptoms; emphasized that the key inquiry was not the diagnosis of fibromyalgia but whether the physical complaints required rheumatological treatment.

Dr. Shaw emphasized the relevant inquiry was the physical complaints and need for treatment rather than a fibromyalgia diagnosis.

From the decision · page 1Applicant was initially evaluated in this matter by rheumatologist Richard N. Shaw, M.D. While Dr. Shaw noted that applicant's treating physicians had diagnosed her with fibromyalgia, Dr. Shaw noted that both depression and drug withdrawal symptoms from narcotics used to treat

QMERecord developed further · psychiatrist

Concluded that the applicant's mental health diagnosis and impairment were predominantly due to non-industrial factors, but the report lacked sufficient explanation for the causation percentages assigned and needed clarification.

The panel found Dr. Bates's causation percentages inadequately explained and requiring clarification.

From the decision · page 2Dr. Levine then noted that Dr. Bates "was of the opinion with reasonable medical probability that this patient's mental health diagnosis and consequent impairment and functioning were predominantly, greater than 51%, due to non-industrial factors. She pointed out that her mental health disorder was preexisting with which I agree based upon review of the patient's records." (October 27, 2022 report at p. 39.) Although Dr. Levine wrote in his report that "As I see it, this patient's case is a psychiatric/psychological case in terms of the explanation for her clinical complaints and not a rheumatological or orthopedic case" (October 27, 2022 report at p. 39), in his deposition testimony, Dr. Levine noted that the rheumatological care that applicant had been receiving for fibromyalgia was appropriate. (November 8, 2023 deposition at p. 10.)

QMERecord developed further · rheumatologist

Diagnosed fibromyalgia but attributed symptoms primarily to depression; opined that the psychiatric condition was preexisting and non-industrial; noted that rheumatological care was appropriate despite non-industrial causation conclusion.

Dr. Levine's opinion linked physical symptoms to depression and non-industrial psychiatric condition, but the panel found the need for clarification on causation and the relationship between fibromyalgia and depression.

From the decision · page 2Dr. Shaw passed away and applicant was then evaluated by Dr. Levine. However, in contrast to Dr. Shaw, Dr. Levine wrote, "[T]he issue for me in this patient's case is whether she has fibromyalgia, and, if she does have fibromyalgia, is it work related." (October 27, 2022 report at p. 36.) Dr. Levine noted in his report that applicant did meet the 1990 criteria for the diagnosis of fibromyalgia but that he felt that applicant's symptoms were best explained by depression. "It is not necessary to invoke a separate diagnosis of fibromyalgia noting this patient's longstanding history of depression which may be accompanied by all the somatic symptoms of which this patient complains." (October 27, 2022 report at p. 39.)

ADJ12901281 · August 13, 2024

What the panel ordered

What was disputed, and how it came out

Your case already resembles someone else’s. Find whose.

The facts that decided it

What the panel did with the medical opinions

The rules the panel named

What proof carried it

About this page