ADJ16040226 · January 6, 2026

The Appeals Board found that applicant met her burden of proving injury AOE/COE based on substantial medical evidence from QME Dr. McBride, who provided well-reasoned opinions supported by medical history, examination, and records, and that defendant failed to present contradictory evidence sufficient to rebut this.

From the decision · page 7Here, based upon our review of the evidentiary record, including the QME reports of Dr. McBride, we agree with the WCJ that Dr. McBride obtained a thorough history of the injury, and completed a comprehensive examination of applicant and review of applicable medical records. (Report, p. 7.) Further, his opinions are well-reasoned and not based upon surmise, speculation, conjecture, or guess. We remind defendant that although the onus is on applicant to provide substantial evidence of injury AOE/COE, the "burden manifestly does not require the applicant to prove causation by scientific certainty." (Rosas v. Workers' Comp. Appeals Bd. (1993) 16 Cal.App.4th 1692, 1700-1701 [58 Cal.Comp.Cases 313].) Further, once this burden has been met, the burden shifts to defendant to provide evidence in rebuttal. Although defendant references reporting by Dr. Candell, no real contradictory evidence has been presented herein. The record overwhelmingly supports a finding of industrial causation. Accordingly, we agree with the PWCJ that applicant has met her burden in establishing substantial medical evidence of injury AOE/COE to the lumbar spine with a continuing need for future medical treatment.

The Board found the statute of limitations did not bar the claim because the date of injury under Labor Code section 5412 was the cumulative trauma ending on 02-16-2023, when applicant learned from her attorney about the cumulative injury, not the earlier 2014 date.

Applicant sustained a cumulative trauma injury separate and distinct from the 1994 injury, supported by medical evidence and applicant's testimony.

Favours Applicant prevailed

This fact established injury AOE/COE and supported the award of future medical treatment.

From the decision · page 13Applicant testified that she developed new symptoms in 2010 or 2011. As a result, she tried multiple modalities of conservative treatment. In the end, she was surgical in 2014. Dr. Candell's contemporaneous letter in April of 2014 documents the recent changes. All the physicians, even Dr. McIvor, appear to agree that there was a "progression" of symptoms. Dr. McIvor does not offer any explanation as to what caused a drastic deterioration of Applicant's condition or why it occurred two decades after the specific injury. As such, Dr. McIvor's reporting is not substantial medical evidence. Three physicians of four agree Applicant suffered a new, cumulative trauma injury. Accordingly, Applicant suffered a new cumulative trauma due to work duties performed until 2014 (Opinion on Decision, page 9)

The date of injury for statute of limitations purposes was the cumulative trauma ending on 02-16-2023, when applicant learned from her attorney about the cumulative injury.

Favours Applicant prevailed

This fact established that the claim was timely filed and not barred by the statute of limitations.

Applicant sustained a cumulative trauma injury to the lumbosacral region separate and distinct from the 1994 injury, with a provisional 13% whole person impairment rating.

Based on thorough history, comprehensive examination, and review of medical records, Dr. McBride opined injury arose out of and was caused by employment, supported by medical evidence and not speculative.

From the decision · page 2In his initial report, Dr. McBride opined that as a result of applicant's employment, she sustained "a cumulative trauma to her lumbosacral region" with the following diagnoses: a history of lumbar surgery; possible lumbar disc injury with radiculopathy; and lumbosacral sprain. (Exhibit Y, pp. 5-6.) In his subsequent report, he noted that applicant was not yet permanent and stationary but nonetheless issued a provisional impairment rating of 13% whole person impairment using DRE category III for the lumbar spine. (Exhibit Z, p. 2.) He noted that the subject injury was separate and distinct from her prior 1994 injury to the lumbar spine. (Ibid.)

Applicant's condition was an ongoing problem from the 1994 injury with no new separate injury; condition progressed over 20 years.

Dr. McIvor's opinion was rejected as not substantial medical evidence because it did not explain the drastic deterioration in 2010-2014 and was contradicted by other medical opinions and applicant's testimony.

From the decision · page 13Applicant testified that she developed new symptoms in 2010 or 2011. As a result, she tried multiple modalities of conservative treatment. In the end, she was surgical in 2014. Dr. Candell's contemporaneous letter in April of 2014 documents the recent changes. All the physicians, even Dr. McIvor, appear to agree that there was a "progression" of symptoms. Dr. McIvor does not offer any explanation as to what caused a drastic deterioration of Applicant's condition or why it occurred two decades after the specific injury. As such, Dr. McIvor's reporting is not substantial medical evidence. Three physicians of four agree Applicant suffered a new, cumulative trauma injury. Accordingly, Applicant suffered a new cumulative trauma due to work duties performed until 2014 (Opinion on Decision, page 9)

Applicant suffered injury to low back during employment meeting California threshold for industrial injury.

Dr. Johnson's opinion supported the finding of injury AOE/COE as it was based on medical probability and work environment.

From the decision · page 12Matthew Johnson, M.D. is applicant's current primary treating physician.(PTP). In his report of 06/14/2024, he opined:

Labor Code section 3202.5

Burden of proof on all issues by a preponderance of the evidence; burden of proof rests with party holding affirmative of the issue.

Applicant must provide substantial evidence of injury AOE/COE; medical opinion must be based on reasonable medical probability and pertinent facts.

From the decision · page 6Section 3202.5 states, in relevant part, that parties are to "meet the evidentiary burden of proof on all issues by a preponderance of the evidence. Pursuant to section 5705, the burden of proof rests upon the party holding the affirmative of the issue. The burden therefore rests with the applicant (or lien claimant, who steps into the shoes of the applicant). To meet this burden, the applicant must provide substantial evidence of injury AOE/COE. 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.

Labor Code section 5405

The statute of limitations for workers' compensation claims is one year from the date of injury.

Defendant must prove date of injury and that claim was filed more than one year after that date.

From the decision · page 4The statute of limitations is an affirmative defense upon which the defendant carries the burden of proof. (Lab. Code, § 5409.) Defendant must provide evidence which establishes 1) the date of the cumulative injury per statutory and case law, and 2) that applicant filed the claim more than one year after this date. Section 5405(a) states in relevant part that: "[t]he period within which proceedings may be commenced for the collection of the benefits...is one year from any of the following: [] (a) The date of injury." (Lab. Code, § 5405(a).)

Applicant's testimony about new symptoms and physical demands of her job, including bending and lifting daily.

From the decision · page 10Applicant testified that she performed all the duties of her job, which had physical demands. Because tables, cubby shelves, and countertops in the kindergarten classroom were low for the children, she needed to bend often. (MOH/SOE at 8/5-18.) There was circle time on the floor. (Id.) She testified that she would lift daily and lower up to 32 chairs off desks. (Id.) She estimated that 50% of her time or more involved bending or getting down on the same level as the children. (Id.) She performed the same work from 1996 through 2014. (Id., at 12/12-18.) At some point, she was provided with a swivel chair which she used for circle time and when referring to the board on the wall. (Id., at 8/19-20; 12/1-3; 12/8-11.) Applicant retired from this job in spring or summer of 2014 because she felt that she could not keep up with the children and surgery was scheduled in September of that year. (Id., 12/22-25.)

Medical reports of Dr. McBride, Dr. Candell, and Dr. Randall supporting cumulative trauma injury.

From the decision · page 13Applicant testified that she developed new symptoms in 2010 or 2011. As a result, she tried multiple modalities of conservative treatment. In the end, she was surgical in 2014. Dr. Candell's contemporaneous letter in April of 2014 documents the recent changes. All the physicians, even Dr. McIvor, appear to agree that there was a "progression" of symptoms. Dr. McIvor does not offer any explanation as to what caused a drastic deterioration of Applicant's condition or why it occurred two decades after the specific injury. As such, Dr. McIvor's reporting is not substantial medical evidence. Three physicians of four agree Applicant suffered a new, cumulative trauma injury. Accordingly, Applicant suffered a new cumulative trauma due to work duties performed until 2014 (Opinion on Decision, page 9)