ADJ14697055 · January 20, 2026

The medical evidence, including reports from Dr. Lewis and Dr. Silva, supports a finding of injury AOE/COE to the bilateral hips, contrary to the WCJ's original finding.

From the decision · page 9Here, based upon our review of the evidentiary record, and the totality of evidence, including the PQME reports of Dr. Lewis and P&S report of Dr. Silva, we believe the medical evidence supports a finding that applicant sustained injury AOE/COE to the bilateral hips. In his report dated October 9, 2023, Dr. Silva reported that there was "bilateral hip pain following [the September 29, 2020] injury." He noted also that there was a demonstrated decrease in applicant's range of motion in the bilateral hips2 which ultimately resulted in permanent disability. (Exhibit 1, pp. 3, 8.) Similarly, Dr. Lewis, in his July 17, 2023 report, opined that applicant sustained compensable consequence injuries to the right knee and bilateral hips with symptoms of "increased discomfort and pain" as a result of the September 29, 2020 injury to the lumbar spine and left knee. (Exhibit C, p. 55.) The medical reporting of both, Drs. Silva and Lewis, however, fail to address whether the cumulative injury also contributed to injury AOE/COE, and if so, the extent of impairment, and allocation of impairment, between the two injuries.

Further medical reporting and clarification are necessary on impairment and apportionment issues due to shortcomings in the existing medical evidence and the WCJ's inconsistent reliance on Dr. Silva and Dr. Lewis.

From the decision · page 10Given the above shortcomings, it appears that further discovery is also necessary on the issues of impairment and apportionment.

Medical evidence from Dr. Lewis and Dr. Silva supports injury AOE/COE to bilateral hips.

Favours Applicant prevailed

This evidence contradicts the WCJ's original finding of no injury to the hips and supports the applicant's claim.

From the decision · page 9Here, based upon our review of the evidentiary record, and the totality of evidence, including the PQME reports of Dr. Lewis and P&S report of Dr. Silva, we believe the medical evidence supports a finding that applicant sustained injury AOE/COE to the bilateral hips. In his report dated October 9, 2023, Dr. Silva reported that there was "bilateral hip pain following [the September 29, 2020] injury." He noted also that there was a demonstrated decrease in applicant's range of motion in the bilateral hips2 which ultimately resulted in permanent disability. (Exhibit 1, pp. 3, 8.) Similarly, Dr. Lewis, in his July 17, 2023 report, opined that applicant sustained compensable consequence injuries to the right knee and bilateral hips with symptoms of "increased discomfort and pain" as a result of the September 29, 2020 injury to the lumbar spine and left knee. (Exhibit C, p. 55.) The medical reporting of both, Drs. Silva and Lewis, however, fail to address whether the cumulative injury also contributed to injury AOE/COE, and if so, the extent of impairment, and allocation of impairment, between the two injuries.

WCJ's award of future medical treatment to bilateral hips despite finding no injury AOE/COE to hips was contradictory.

Favours Applicant prevailed

This inconsistency undermined the original Findings and Award and justified reconsideration and remand.

From the decision · page 8Turning now to the merits of the Petition, defendant contends that the F&A should be set aside as several of the findings are either contradictory or inconsistent with the evidentiary record. Defendant argues that the WCJ's finding of no injury AOE/COE to the bilateral hips, conflicts with his award of future medical treatment to the bilateral hips "to cure or relieve from the effects of the injuries." (F&A, p. 3.) In his Opinion on Decision (OOD), the WCJ confirms that per Dr. Lewis, "[t]here is no industrial injury to the hips" but the WCJ also concedes that "medical records support a finding that the applicant's bilateral hips were a compensable consequence of the applicant[`s] knee injury." (F&A and OOD, pp. 3-4.)

Existing medical evidence on impairment and apportionment was insufficient and inconsistent, requiring further development.

Favours neutral

This lack of clarity prevented a complete and supported decision on permanent disability and apportionment.

From the decision · page 10Given the above shortcomings, it appears that further discovery is also necessary on the issues of impairment and apportionment.

Found injury AOE/COE to lumbar spine and left knee, compensable consequence injuries to right knee and bilateral hips; 10% WPI to lumbar spine, 7% WPI to each knee, 1% WPI to hips; recommended future medical treatment; noted 5% impairment removal for age-related degeneration.

From the decision · page 2The parties proceeded with discovery and Dr. Lewis was selected as the PQME for the September 29, 2020 injury. Dr. Lewis evaluated applicant on at least two occasions and issued corresponding reports dated October 14, 2021, and July 17, 2023, as well as supplemental reports dated October 15, 2022, October 15, 2023, and February 15, 2024. (Exhibits A-E.) The parties also deposed Dr. Lewis on December 18, 2024. (Exhibit F.)

Diagnosed multiple injuries including bilateral hips labrum tear; found 3% WPI to each knee plus 1% extra to right knee; 12% WPI to lumbar spine; 2% WPI to left hip; opined 90% industrial causation and 10% pre-existing; recommended future medical treatment.

From the decision · page 3Applicant received treatment for his injuries, and Dr. Silva issued a permanent and stationary (P&S) report dated October 9, 2023, addressing the September 29, 2020 specific injury. (Exhibit 1.) Dr. Silva diagnosed applicant with a right knee medial meniscus tear, left knee popliteal cyst, left knee chondromalacia, lumbar disc herniation with radiculopathy, a labrum tear in the bilateral hips, and a history of orthopedic surgery. (Exhibit 1, p. 7.) He found a 3% WPI to each knee due to mild arthritis, with an extra 1% WPI to the right knee from a meniscectomy. (Id. at p. 8.) For the lumbar spine, he found a 12% WPI under DRE category III based upon applicant's clinical history and exam findings, including a disc herniation with radiculopathy as well as dermatomal paresthesia, diminished reflexes, and muscle atrophy. (Ibid.) He opined that applicant sustained a 2% WPI to the left hip due to decreased range of motion. (Ibid.) With respect to apportionment, he indicated that applicant's impairment was "90% attributable to the industrial injury and 10% attributable to pre-existing and/or natural degenerative process." (Id. at p. 9.) Future medical was recommended for the bilateral knees, lumbar spine, and bilateral hips. (Ibid.)

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

Medical opinion must be based on reasonable medical probability, pertinent facts, adequate examination and history, and not be speculative to constitute substantial evidence.

Applied to evaluate the medical evidence of Dr. Lewis and Dr. Silva for substantial evidence on permanent disability and injury AOE/COE.

From the decision · page 8In the F&A, the WCJ found that the medical reporting of Dr. Lewis constituted substantial medical evidence on the issue of permanent disability. Any medical opinion proffered as substantial evidence, however, must be framed in terms of reasonable medical probability, be based on pertinent facts, an adequate examination, and history, set forth reasoning in support of its conclusions, and not be speculative. (E.L. Yeager v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc).) "[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. (citations) Further, a medical report is not substantial evidence unless it sets forth the reasoning behind the physician's opinion, not merely his or her conclusions. (citations)" (Gatten, supra, at p. 928.) "A medical report which lacks a relevant factual basis cannot rise to a higher level than its own inadequate premises. Such reports do not constitute substantial evidence to support a denial of benefits.

Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473

Decision must be based on admitted evidence and supported by substantial evidence; record must be complete and clearly designate evidence basis.

Applied to require further development of the record and clarification on impairment and apportionment issues.

From the decision · page 10As explained in Hamilton v. Lockheed Corporation (Hamilton) (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Bd. en banc), a decision "must be based on admitted evidence in the record" (Id. at p. 478) and must be supported by substantial evidence. (Lab. Code, § 5903, 5952, subd. (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. 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.

Medical reports of Dr. Lewis and Dr. Silva supporting injury to bilateral hips

From the decision · page 9Here, based upon our review of the evidentiary record, and the totality of evidence, including the PQME reports of Dr. Lewis and P&S report of Dr. Silva, we believe the medical evidence supports a finding that applicant sustained injury AOE/COE to the bilateral hips. In his report dated October 9, 2023, Dr. Silva reported that there was "bilateral hip pain following [the September 29, 2020] injury." He noted also that there was a demonstrated decrease in applicant's range of motion in the bilateral hips2 which ultimately resulted in permanent disability. (Exhibit 1, pp. 3, 8.) Similarly, Dr. Lewis, in his July 17, 2023 report, opined that applicant sustained compensable consequence injuries to the right knee and bilateral hips with symptoms of "increased discomfort and pain" as a result of the September 29, 2020 injury to the lumbar spine and left knee. (Exhibit C, p. 55.) The medical reporting of both, Drs. Silva and Lewis, however, fail to address whether the cumulative injury also contributed to injury AOE/COE, and if so, the extent of impairment, and allocation of impairment, between the two injuries.

WCJ's inconsistent findings on injury and future medical treatment to bilateral hips

From the decision · page 8Turning now to the merits of the Petition, defendant contends that the F&A should be set aside as several of the findings are either contradictory or inconsistent with the evidentiary record. Defendant argues that the WCJ's finding of no injury AOE/COE to the bilateral hips, conflicts with his award of future medical treatment to the bilateral hips "to cure or relieve from the effects of the injuries." (F&A, p. 3.) In his Opinion on Decision (OOD), the WCJ confirms that per Dr. Lewis, "[t]here is no industrial injury to the hips" but the WCJ also concedes that "medical records support a finding that the applicant's bilateral hips were a compensable consequence of the applicant[`s] knee injury." (F&A and OOD, pp. 3-4.)