ADJ15186514 · December 13, 2024

The Board found Dr. Jacks' report to be thorough, based on extensive psychiatric consultation, psychological testing, and review of medical records, constituting substantial evidence supporting the PTSD diagnosis and industrial causation, while Dr. Keins' report was found unsubstantial due to lack of medical record review and untimely supplemental report.

From the decision · page 16As to the sufficiency of Dr. Jacks 4/18/2022 IME Report, as summarized herein above, I find it qualifies as substantial medical evidence regarding his diagnosis of Applicant's PTSD. He noted references in the medical records after the September 23, 2019 date listing diagnoses of PTSD. He reviewed several of the work-related traumatic events experienced by Applicant as a Firefighter with the Richmond Fire Department, and found a link between the September 2019 school shooting incident, and subsequent work traumas, and the development of Applicant's PTSD symptomology.

Dr. Jacks' report included extensive psychiatric consultation, psychological testing, and review of medical records supporting PTSD diagnosis and industrial causation.

Favours Applicant prevailed

This report constituted substantial evidence supporting the applicant's claim and was relied upon by the Board.

From the decision · page 16As to the sufficiency of Dr. Jacks 4/18/2022 IME Report, as summarized herein above, I find it qualifies as substantial medical evidence regarding his diagnosis of Applicant's PTSD. He noted references in the medical records after the September 23, 2019 date listing diagnoses of PTSD. He reviewed several of the work-related traumatic events experienced by Applicant as a Firefighter with the Richmond Fire Department, and found a link between the September 2019 school shooting incident, and subsequent work traumas, and the development of Applicant's PTSD symptomology.

Dr. Keins' report lacked review of medical records and her supplemental report was not admitted due to untimeliness.

Favours Applicant prevailed

This deficiency rendered her report unsubstantial and not reliable evidence against the applicant's claim.

From the decision · page 15In this instance, it is not a matter that a small portion of medical records had not been reviewed; in this case none of the medical records were reviewed. This, on its face, presents an "incomplete medical history" sufficient to render Dr. Keins' medical opinion unsubstantial. Again, Dr. Keins herself stated in April 2022 "No medical records were available for review... Prior to my being able to reach binding medial/legal conclusions, it is essential that I review his mental health records to issue a supplemental report" (417/2022 Keins Report, pg 14).

Defendant delayed providing medical records to its own IME for eight months prior to arbitration, preventing timely supplemental report.

Favours Applicant prevailed

This delay was found to be due to lack of diligence and prejudiced the applicant's case, favoring the applicant.

From the decision · page 8Applicant concludes that the Defendant's failure to provide medical records in its possession to its own IME for eight (8) months after they were requested, and only a month prior to the arbitration hearing date, together with Defendant's inability to explain such a lengthy delay, was solely due to lack of diligence on the part of the Defendant (Applicant's Answer 7:26 - 8:6).

Diagnosed PTSD as industrially caused, based on extensive psychiatric consultation, psychological testing, and review of medical records; found 100% industrial causation and no apportionment to non-industrial stressors.

The Board relied on Dr. Jacks' thorough evaluation and found it constituted substantial evidence supporting the PTSD diagnosis and industrial causation.

From the decision · page 16As to the sufficiency of Dr. Jacks 4/18/2022 IME Report, as summarized herein above, I find it qualifies as substantial medical evidence regarding his diagnosis of Applicant's PTSD. He noted references in the medical records after the September 23, 2019 date listing diagnoses of PTSD. He reviewed several of the work-related traumatic events experienced by Applicant as a Firefighter with the Richmond Fire Department, and found a link between the September 2019 school shooting incident, and subsequent work traumas, and the development of Applicant's PTSD symptomology.

Diagnosed non-industrial bipolar disorder without reviewing medical records; supplemental report was not admitted due to untimeliness, rendering her initial report unsubstantial.

The Board found Dr. Keins' report unsubstantial because it lacked review of medical records and the supplemental report was not timely admitted, thus not curing the deficiency.

From the decision · page 15In this instance, it is not a matter that a small portion of medical records had not been reviewed; in this case none of the medical records were reviewed. This, on its face, presents an "incomplete medical history" sufficient to render Dr. Keins' medical opinion unsubstantial. Again, Dr. Keins herself stated in April 2022 "No medical records were available for review... Prior to my being able to reach binding medial/legal conclusions, it is essential that I review his mental health records to issue a supplemental report" (417/2022 Keins Report, pg 14).

Hegglin v WCAB (1971)

Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories.

Applied to reject Dr. Keins' report due to lack of medical record review and untimely supplemental report.

From the decision · page 14First, if this Arbitrator had ruled in favor of the Defendants based on Dr. Keins original 4/7/2022 IME Report, it would have been a dismissal of Applicant's claim on inadequate and incomplete evidence. "Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories." (Hegglin v WCAB (1971 ), 36 CCC 93 [emphasis added]).

Labor Code Section 3212.15

Labor Code Section 3212.15 presumption of PTSD for cumulative trauma injury.

Applied to uphold presumption of compensability for PTSD injury.

From the decision · page 13Second, the CT injury is statutorily presumed to be PTSD (per Labor Code 3212.15). It is Defendant's burden to demonstrate, by substantial evidence, that Applicant's psychological condition is not PTSD. Applicant's only burden is to overcome any such evidence presented.

Defendant's failure to provide medical records to its own IME for eight months prior to arbitration hearing

From the decision · page 8Applicant concludes that the Defendant's failure to provide medical records in its possession to its own IME for eight (8) months after they were requested, and only a month prior to the arbitration hearing date, together with Defendant's inability to explain such a lengthy delay, was solely due to lack of diligence on the part of the Defendant (Applicant's Answer 7:26 - 8:6).

Dr. Jacks' thorough examination, psychological testing, and review of medical records

From the decision · page 8Applicant discusses the evaluation process of Dr. Jacks (to wit: a thorough examination and interview of Applicant; completion of a battery of psychological tests, and review of pertinent medical/psychiatric records (including diagnoses of depression and anxiety, and treatment of same); Dr. Jacks read the physician's review of Applicant's fitness for duty dated 11/2/2021), and his diagnosis of PTSD with the evidence-based rationale for same. Applicant charges that Dr. Jacks' diagnoses were "specifically rooted in his interpretation of the psychological testing, review of pertinent treatment records, and his own examination [of the Applicant]" (Applicant's Answer 6:6-16).