ADJ17318401 · March 4, 2025

The WCAB found that the WCJ's injury finding was based on applicant's testimony and immediate emergency room treatment, but substantial medical evidence was required. Dr. Patel's reports were reviewed and found to be based on pertinent facts and adequate examination but unclear as to adequate medical history, partly due to defendant restricting medical records review. The Board concluded further development of the record was necessary to determine if Dr. Patel's opinion was based on adequate medical history.

From the decision · page 8Here, as stated by the WCJ in the Report, the finding of injury to the neck, spine, and bilateral shoulders in the F&A is based upon applicant's testimony as to how the injury occurred and the fact that she sought emergency room treatment immediately. (Report, p. 5.) Under the foregoing authorities, however, substantial medical evidence is required to establish injury AOE/COE. Therefore, we will evaluate QME Dr. Patel's reporting to determine whether the injury finding is supported by substantial medical evidence.

Applicant testified credibly and consistently about the injury mechanism and immediate emergency room treatment.

Favours Applicant prevailed

Supported the injury finding but was insufficient alone without substantial medical evidence.

From the decision · page 4mechanism on injury and her complaints but determined that she was not permanent and stationary. (Ex. 1 at 6-7.)... The QME opines that there is a need for medical treatment for the neck and shoulders including chiropractic treatment, acupuncture, and massage therapy. (Ex. 2 at 2.) At trial on cross-examination, applicant testified that reference to pages 21 to 22 of her deposition, she was working on a computer and she felt discomfort throughout the day so when she pulled to box, which was on the ground, she felt numbness. (MOH/SOE at 6/15-19.) Applicant's testimony in the deposition as to her mechanism of injury is substantially the same as her testimony at trial. (Ex. L at 21-22.)... The QME reviewed applicant's deposition transcript and affirms his findings that the injury is industrial. Applicant testified in a credible and straightforward fashion and there is no contradictory evidence in the record. Therefore, Dr. Patel's findings are consistent with the mechanism of injury.

Defendant restricted the QME's review of medical records to 214 pages, excluding thousands of pages of prior treatment records.

Favours Applicant prevailed

Created uncertainty about whether the QME's opinion was based on adequate medical history, necessitating further record development.

From the decision · page 9Although this record shows that Dr. Patel reviewed 214 pages of medical records and not "thousands of pages of Kaiser records that documented medical treatment... over a decade prior to the alleged 12/19/22 injury," it was defendant who restricted Dr. Patel's review to those 214 pages of records. (Petition, p. 8:13-17; Ex. 3, QME report by Naeem Patel, D.C., June 1, 2024, p. 1.) It follows that Dr. Patel's alleged failure to obtain an adequate medical history resulted from defendant's own conduct and not any conduct on the part of applicant.

Diagnosed cervical spine sprain/strain with cervical radiculitis and bilateral shoulder sprain/strain from December 19, 2022 injury; opined injury occurred during usual work duties and consistent with mechanism and complaints; needs further medical treatment; reports based on pertinent facts and adequate examination but unclear if based on adequate medical history due to limited record review.

The Board reviewed Dr. Patel's reports and found them based on pertinent facts and adequate examination but unclear as to adequate medical history, partly due to defendant restricting medical records review.

From the decision · page 8Here, as stated by the WCJ in the Report, the finding of injury to the neck, spine, and bilateral shoulders in the F&A is based upon applicant's testimony as to how the injury occurred and the fact that she sought emergency room treatment immediately. (Report, p. 5.) Under the foregoing authorities, however, substantial medical evidence is required to establish injury AOE/COE. Therefore, we will evaluate QME Dr. Patel's reporting to determine whether the injury finding is supported by substantial medical evidence.

Labor Code §§ 5903, 5952; Garza v. Workmen's Comp. App. Bd. (1970) 3 Cal.3d 312; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604; Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162

All decisions of the WCAB must be supported by substantial evidence such as medical opinion. A medical opinion must be framed in terms of reasonable medical probability, not speculative, based on pertinent facts and adequate examination and history, and must set forth reasoning in support of its conclusions.

The Board evaluated Dr. Patel's reports to determine if the injury finding was supported by substantial medical evidence, concluding that while the reports were based on pertinent facts and adequate examination, it was unclear if they were based on adequate medical history, necessitating further development of the record.

From the decision · page 7II. Defendant contends that the WCJ erroneously found that applicant sustained injury AOE/COE to the neck, spine and bilateral shoulders because the record lacks substantial medical evidence and the WCJ relied solely upon applicant's testimony. All decisions of the WCAB must be supported by substantial evidence such as medical opinion. (Labor Code § 5903, 5952; Garza v. Workmen's Comp. App. Bd. (Garza) (1970) 3 Cal.3d 312, 317-319 [33 Cal.Comp.Cases 500].) To constitute substantial evidence "... a medical opinion must be framed in terms of reasonable medical probability, it must not be speculative, it must be based on pertinent facts and on an adequate examination and history, and it must set forth reasoning in support of its conclusions." (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc).) "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

Applicant's credible and consistent testimony about the injury mechanism and immediate emergency room treatment

From the decision · page 4mechanism on injury and her complaints but determined that she was not permanent and stationary. (Ex. 1 at 6-7.)... The QME opines that there is a need for medical treatment for the neck and shoulders including chiropractic treatment, acupuncture, and massage therapy. (Ex. 2 at 2.) At trial on cross-examination, applicant testified that reference to pages 21 to 22 of her deposition, she was working on a computer and she felt discomfort throughout the day so when she pulled to box, which was on the ground, she felt numbness. (MOH/SOE at 6/15-19.) Applicant's testimony in the deposition as to her mechanism of injury is substantially the same as her testimony at trial. (Ex. L at 21-22.)... The QME reviewed applicant's deposition transcript and affirms his findings that the injury is industrial. Applicant testified in a credible and straightforward fashion and there is no contradictory evidence in the record. Therefore, Dr. Patel's findings are consistent with the mechanism of injury.

Defendant restricted QME Dr. Patel's review to 214 pages of medical records, excluding thousands of pages of prior treatment records

From the decision · page 9Although this record shows that Dr. Patel reviewed 214 pages of medical records and not "thousands of pages of Kaiser records that documented medical treatment... over a decade prior to the alleged 12/19/22 injury," it was defendant who restricted Dr. Patel's review to those 214 pages of records. (Petition, p. 8:13-17; Ex. 3, QME report by Naeem Patel, D.C., June 1, 2024, p. 1.) It follows that Dr. Patel's alleged failure to obtain an adequate medical history resulted from defendant's own conduct and not any conduct on the part of applicant.