ADJ14038029 · March 12, 2024

The date of injury was set at December 11, 2020, when applicant first had compensable disability and knowledge of industrial causation, making the claim timely under section 5405.

From the decision · page 133. Pursuant to Labor Code section 5412, the date of injury was December 11, 2020. 4. Compensation is not barred by Labor Code section 5405. 5. Applicant's gastritis, gastroesophageal reflux disease and related insomnia are

Applicant did not have compensable disability or knowledge of industrial causation for hypertensive cardiac disease in 2013 despite medical treatment and tests.

Favours Applicant prevailed

This fact supports finding that the date of injury was not in 2013, thus claim is not barred by statute of limitations.

From the decision · page 10Here, applicant sought medical treatment on June 13, 2013 for heart palpitations and shortness of breath. There are no original records in evidence regarding applicant's medical evaluations in 2013, but the records reviewed by QME Dr. Nacouzi reflect that applicant was discharged from care following a nuclear stress test "that did not show any obvious disease." (Ex. J-7, Report of Roger Nacouzi, M.D., dated August 19, 2021, at p. 4.) While applicant's myocardial perfusion scan did identify enlargement of the ventricles, the medical record reflects no periods of temporary disability, no assessment of permanent disability, no temporary or permanent work restrictions, and no other indicia that applicant sustained permanent disability. (Id. at p. 5; Rodarte, supra, at p. 998.)

The first evidence of compensable disability and knowledge of industrial causation was the December 11, 2020 QME report by Dr. Curran.

Favours Applicant prevailed

This fact establishes the date of injury under Labor Code section 5412 and supports claim timeliness.

From the decision · page 11The first evidence in the record establishing compensable disability was the December 11, 2020 report of QME Dr. Curran wherein the QME identified the existence of a cumulative injury ending in 2013. (Ex. J-6, Report of Douglas Curran, D.C., dated December 11, 2020, at pp. 22- 23.) The same report offers the first evidence establishing medical advice to the applicant that his disability was caused by his employment. (Id. at p. 24.) Accordingly, the convergence of the disability and knowledge of its industrial causation required by section 5412 was December 11, 2020.

Diagnosed cumulative injury through last day worked in 2013; applicant not yet permanent and stationary as of November 12, 2020.

Supports cumulative injury and date of injury determination.

From the decision · page 2On December 11, 2020, QME Dr. Curran issued a report detailing the results of his evaluation of applicant on November 12, 2020. Therein, Dr. Curran noted applicant's description of the injury as occurring over time, filed in response to medical information received from treating physician Dr. Wong in April, 2020, following a reading of applicant's lumbar MRI study. (Ex. J- 6, Report of Douglas Curran, D.C., dated December 11, 2020, at p. 4.) The QME undertook a clinical examination of the applicant, reviewed the submitted medical history, and diagnosed a cumulative injury through applicant's last day worked in 2013. The QME opined that applicant was not yet permanent and stationary.

Concluded cumulative injury through December 31, 2013 including hypertensive cardiac disease and related conditions.

Supports cumulative injury and compensability of cardiac condition.

From the decision · page 3On August 19, 2021, Roger Nacouzi, M.D., evaluated applicant as the QME in internal medicine. The applicant related a history to QME Dr. Nacouzi which included treatment in 20122 when applicant was seen in the emergency room for hypertension and palpitations. (Ex. J-7, Report of Roger Nacouzi, M.D., dated August 19, 2021, p. 7.) Applicant was diagnosed at the time with "stress-induced chest symptoms" and was started on blood pressure medications. (Ibid.)

Labor Code section 5412

Date of injury in cumulative injury cases is when employee first suffered disability and knew or should have known it was caused by employment.

Applied to determine date of injury for cumulative injury.

From the decision · page 9causes any disability or need for medical treatment." (Lab. Code, § 3208.1.) The date of a cumulative injury is defined by Section 5412, which provides, "[t]he date of injury in cases of occupational diseases or cumulative injuries is that date upon which the employee first suffered disability therefrom and either knew, or in the exercise of reasonable diligence should have known, that such disability was caused by his present or prior employment." (Lab. Code, § 5412.)

Labor Code section 5405

Compensation barred if claim not filed within one year of date of injury.

Applied to determine timeliness of claim for hypertensive cardiac disease.

From the decision · page 1Applicant seeks reconsideration of the September 26, 2023 Findings, Award and Order (F&A), wherein the workers' compensation administrative law judge (WCJ) found that applicant, while employed as a police officer from January, 1994, to December 31, 2013, sustained industrial injury to his low back and right leg, and in the form of gastritis, gastroesophageal reflux disease, insomnia and hypertensive cardiac disease. The WCJ determined that all of the components of the claimed injury were attributable to a single cumulative injury. The WCJ further determined that the date of injury for applicant's low back and right leg injury was December 16, 2020, and that applicant claim of gastritis and gastroesophageal reflux disease and related insomnia were compensable consequence injuries related to applicant's orthopedic injuries. Finally, the WCJ determined that the date of injury for the claimed hypertensive cardiac disease was June 14, 2013, and that applicant's claim of cardiac injury was barred by Labor Code1 section 5405.

Applicant's trial testimony and medical history reflect contemporaneous manifestation of orthopedic and internal medicine complaints.

From the decision · page 8Here, the WCJ determined that the entirety of the claimed injury arose from applicant's cumulative industrial exposures while working as a police officer from January, 1994 through December 31, 2013. (F&A, Opinion on Decision, at pp. 5-6.) The WCJ's opinion is substantiated in the physical and internal medicine QME opinions, who collectively ascribe industrial causation to the cumulative effects of applicant's employment through the end of 2013. (Ex. J-6, Report of Douglas Curran, D.C., dated December 11, 2020, at p. 24; Ex. J-7, Report of Roger Nacouzi, M.D., dated August 19, 2021, at pp. 8-10.) We further note that the applicant's trial testimony and the medical history adduced in the QME reporting reflects the contemporaneous manifestation of applicant's orthopedic and internal medicine complaints. (Minutes, at p. 4:3.) We therefore concur with the WCJ's determination that applicant sustained but one cumulative injury, from January, 1994 to December 31, 2013.

No evidence applicant had compensable disability or knowledge of industrial causation in 2013 despite medical visits and tests.

From the decision · page 10Here, applicant sought medical treatment on June 13, 2013 for heart palpitations and shortness of breath. There are no original records in evidence regarding applicant's medical evaluations in 2013, but the records reviewed by QME Dr. Nacouzi reflect that applicant was discharged from care following a nuclear stress test "that did not show any obvious disease." (Ex. J-7, Report of Roger Nacouzi, M.D., dated August 19, 2021, at p. 4.) While applicant's myocardial perfusion scan did identify enlargement of the ventricles, the medical record reflects no periods of temporary disability, no assessment of permanent disability, no temporary or permanent work restrictions, and no other indicia that applicant sustained permanent disability. (Id. at p. 5; Rodarte, supra, at p. 998.)