ADJ13783750 · August 14, 2025

The WCJ's findings on internal claims were final but lacked adequate record development and due process; the Appeals Board has authority to develop the record and provide due process, so the issue is deferred for further development.

From the decision · page 1Applicant seeks reconsideration of the May 14, 2025 Findings and Award (F&A) wherein the workers' compensation administrative law judge (WCJ) found, in relevant part, that while employed as a truck driver for defendant during the period from September 3, 2019 through October 19, 2020 (ADJ13783750), applicant sustained injury arising out of and in the course of employment (AOE/COE) to the head, cervical spine, back, arm, and knees. The WCJ also found a separate July 25, 2020 (ADJ16743471) injury AOE/COE to the head, cervical and lumbar spine, knees, and legs. The WCJ found no injury AOE/COE for applicant's internal claims of diabetes, hypertension, and hyperlipidemia.

Substantial evidence supports injury AOE/COE findings for these body parts.

From the decision · page 1Applicant seeks reconsideration of the May 14, 2025 Findings and Award (F&A) wherein the workers' compensation administrative law judge (WCJ) found, in relevant part, that while employed as a truck driver for defendant during the period from September 3, 2019 through October 19, 2020 (ADJ13783750), applicant sustained injury arising out of and in the course of employment (AOE/COE) to the head, cervical spine, back, arm, and knees. The WCJ also found a separate July 25, 2020 (ADJ16743471) injury AOE/COE to the head, cervical and lumbar spine, knees, and legs. The WCJ found no injury AOE/COE for applicant's internal claims of diabetes, hypertension, and hyperlipidemia.

The WCJ's findings on internal claims of diabetes, hypertension, and hyperlipidemia were final but lacked adequate record development and due process.

Favours Applicant prevailed

This justified the Appeals Board's exercise of authority to grant reconsideration and defer the issue for further development.

From the decision · page 6Here, applicant contends that he was "not provided adequate notice that findings on nature and extent of injury (specifically, internal conditions)" would be adjudicated since the "parties explicitly limited the [trial] issues to [injury] AOE/COE." (Petition pp. 2-3.) The WCJ's issuance of a final decision with respect to applicant's claims of diabetes, hypertension, and hyperlipidemia therefore "constitutes a violation of Applicant's due process rights" since causation with respect to numerous other body parts, including the head, cervical and lumbar spine, arm, knees, and legs, had already been established. (Petition, pp. 2-3; F&A pp. 2-3.) Applicant contends that further discovery including a "post-trial deposition of [internal PQME] Dr. Meth" is necessary with respect to his internal claims. (Petition, p. 2.)

There is substantial evidence supporting injury AOE/COE to the head, cervical spine, back, arm, knees, legs, and head (internal) for the two injury periods.

Favours Applicant prevailed

Supports the WCJ's findings on these body parts and the denial of injury for other internal conditions.

From the decision · page 1Applicant seeks reconsideration of the May 14, 2025 Findings and Award (F&A) wherein the workers' compensation administrative law judge (WCJ) found, in relevant part, that while employed as a truck driver for defendant during the period from September 3, 2019 through October 19, 2020 (ADJ13783750), applicant sustained injury arising out of and in the course of employment (AOE/COE) to the head, cervical spine, back, arm, and knees. The WCJ also found a separate July 25, 2020 (ADJ16743471) injury AOE/COE to the head, cervical and lumbar spine, knees, and legs. The WCJ found no injury AOE/COE for applicant's internal claims of diabetes, hypertension, and hyperlipidemia.

Found injury AOE/COE to the cervical and lumbar spine, bilateral knees, and head (headaches) as a result of the specific injury.

From the decision · page 2Marc Meth as the internal PQME, and Dr. Marshall Lewis as the orthopedic PQME. Dr. Lewis was later replaced with Dr. Basem Attum. In a report dated April 19, 2022, Dr. Levine found injury AOE/COE to the cervical and lumbar spine, bilateral knees, and head (headaches) as a result of the specific injury. (Joint Exhibit CC, p. 19.) In a report dated April 7, 2021, Dr. Lewis expressed some confusion regarding the cumulative trauma injury date but ultimately found injury AOE/COE to the head, neck, back, arm and knee. (Joint Exhibit BB, pp. 41-42.) In a report dated May 9, 2023, Dr. Attum also found injury AOE/COE to the head, cervical and lumbar spine, right shoulder, and bilateral knees. (Joint Exhibit AA, p. 51.)

Found injury AOE/COE to the head, neck, back, arm and knee.

From the decision · page 2Marc Meth as the internal PQME, and Dr. Marshall Lewis as the orthopedic PQME. Dr. Lewis was later replaced with Dr. Basem Attum. In a report dated April 19, 2022, Dr. Levine found injury AOE/COE to the cervical and lumbar spine, bilateral knees, and head (headaches) as a result of the specific injury. (Joint Exhibit CC, p. 19.) In a report dated April 7, 2021, Dr. Lewis expressed some confusion regarding the cumulative trauma injury date but ultimately found injury AOE/COE to the head, neck, back, arm and knee. (Joint Exhibit BB, pp. 41-42.) In a report dated May 9, 2023, Dr. Attum also found injury AOE/COE to the head, cervical and lumbar spine, right shoulder, and bilateral knees. (Joint Exhibit AA, p. 51.)

Found injury AOE/COE to the head, cervical and lumbar spine, right shoulder, and bilateral knees.

From the decision · page 2Marc Meth as the internal PQME, and Dr. Marshall Lewis as the orthopedic PQME. Dr. Lewis was later replaced with Dr. Basem Attum. In a report dated April 19, 2022, Dr. Levine found injury AOE/COE to the cervical and lumbar spine, bilateral knees, and head (headaches) as a result of the specific injury. (Joint Exhibit CC, p. 19.) In a report dated April 7, 2021, Dr. Lewis expressed some confusion regarding the cumulative trauma injury date but ultimately found injury AOE/COE to the head, neck, back, arm and knee. (Joint Exhibit BB, pp. 41-42.) In a report dated May 9, 2023, Dr. Attum also found injury AOE/COE to the head, cervical and lumbar spine, right shoulder, and bilateral knees. (Joint Exhibit AA, p. 51.)

Opined that applicant's pre-diabetes, hypertension, and hyperlipidemia were non-industrial.

From the decision · page 3In a report dated February 13, 2024, Dr. Meth opined that applicant's pre-diabetes, hypertension, and hyperlipidemia were non-industrial. (Joint Exhibit EE, p. 39.)

Labor Code sections 5313, 5903, 5952; Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473; Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274; Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312; LeVesque v. Workers' Comp. Appeals Bd. (1970) 1 Cal.3d 627

A decision must be based on admitted evidence in the record and supported by substantial evidence; the record must be complete and allow parties to ascertain the basis for the decision.

The WCJ's findings on internal claims were final but the record was incomplete; the Appeals Board has authority to develop the record and provide due process.

From the decision · page 4II. Turning now to the merits of the Petition, it is well established that a decision "must be based on admitted evidence in the record" and supported by substantial evidence. (Lab. Code, § 5903, 5952, subd. (d); Hamilton v. Lockheed Corporation (Hamilton) (2001) 66 Cal.Comp.Cases 473, 476, 478 (Appeals Bd. en banc); 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. Workers' Comp. Appeals Bd. (1970) 1 Cal.3d 627 [35 Cal.Comp.Cases 16].) An adequate and complete record is necessary to understand the basis for the WCJ's decision. (Lab. Code, § 5313; see also Cal. Code Regs., tit. 8, § 10787.) "It is the responsibility of the parties and the WCJ to ensure that the record is complete when a case is submitted for decision on the record. At a minimum, the record must contain, in properly organized

Kuykendall v. Workers' Comp. Appeals Bd. (2000) 79 Cal.App.4th 396; Tyler v. Workers' Comp. Appeals Bd. (1997) 56 Cal.App.4th 389; McClune v. Workers' Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117

The Appeals Board has a constitutional mandate to ensure substantial justice and discretionary authority to develop the record when appropriate to provide due process or fully adjudicate the issues.

The Appeals Board exercised its authority to grant reconsideration and defer the issue of internal injuries for further development.

From the decision · page 5It is also well established that the Appeals Board has a constitutional mandate to ensure "substantial justice in all cases." (Kuykendall v. Workers' Comp. Appeals Bd. (2000) 79 Cal.App.4th 396, 403 [65 Cal.Comp.Cases 264].) Accordingly, the Appeals Board has the discretionary authority to develop the record when appropriate to provide due process or fully adjudicate the issues. (Lab. Code, § 5701, 5906; Tyler v. Workers' Comp. Appeals Bd. (1997) 56 Cal.App.4th 389 [62 Cal.Comp.Cases 924]; see also McClune v. Workers' Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117 [63 Cal.Comp.Cases 261].) As explained in Tyler, "The principle of allowing full development of the evidentiary record to enable a complete adjudication of the issues is consistent with due process in connection with workers' compensation claims." (Tyler, supra, at p. 394.)

Rucker v. Workers' Comp. Appeals Bd. (2000) 82 Cal.App.4th 151; Carstens v. Pillsbury (1916) 172 Cal. 572; Gangwish v. Workers' Comp. Appeals Bd. (2001) 89 Cal.App.4th 1284

Under both California and U.S. Constitutions, parties have a fundamental right to due process and a fair hearing, including the opportunity to call and cross-examine witnesses and introduce evidence.

Applicant was not provided adequate notice that internal conditions would be adjudicated, violating due process; further discovery is necessary.

From the decision · page 5Under both the California and United States Constitutions, all parties to a workers' compensation proceeding retain the fundamental right to due process and a fair hearing. (Rucker v. Workers' Comp. Appeals Bd. (2000) 82 Cal.App.4th 151, 157-158 [65 Cal.Comp.Cases 805].) A fair hearing is "... one of `the rudiments of fair play' assured to every litigant..." (Id. at p. 158.) As stated by the California Supreme Court in Carstens v. Pillsbury (1916) 172 Cal. 572, "the commission... must find facts and declare and enforce rights and liabilities, - in short, it acts as a court, and it must observe the mandate of the constitution of the United States that this cannot be done except after due process of law." (Id. at p. 577.) A fair hearing includes, but is not limited to, the opportunity to call and cross-examine witnesses, introduce and inspect exhibits, and offer evidence in rebuttal. (See Gangwish v. Workers' Comp. Appeals Bd. (2001) 89 Cal.App.4th 1284, 1295 [66 Cal.Comp.Cases 584]; Rucker, supra, at p. 157- 158 citing Kaiser Co. v. Industrial Acci. Com. (Baskin) (1952) 109 Cal.App.2d 54, 58 [17 Cal.Comp.Cases 21]; Katzin v. Workers' Comp. Appeals Bd. (1992) 5 Cal.App.4th 703, 710 [57 Cal.Comp.Cases 230].)

The WCJ's findings on internal claims were final but lacked adequate record development and due process.

From the decision · page 6Here, applicant contends that he was "not provided adequate notice that findings on nature and extent of injury (specifically, internal conditions)" would be adjudicated since the "parties explicitly limited the [trial] issues to [injury] AOE/COE." (Petition pp. 2-3.) The WCJ's issuance of a final decision with respect to applicant's claims of diabetes, hypertension, and hyperlipidemia therefore "constitutes a violation of Applicant's due process rights" since causation with respect to numerous other body parts, including the head, cervical and lumbar spine, arm, knees, and legs, had already been established. (Petition, pp. 2-3; F&A pp. 2-3.) Applicant contends that further discovery including a "post-trial deposition of [internal PQME] Dr. Meth" is necessary with respect to his internal claims. (Petition, p. 2.)