ADJ18016076 · August 31, 2026

The QME Dr. Fields Brewer's well-reasoned medical opinion, supported by applicant's testimony and medical records, established industrial causation for cervical spine and left shoulder injuries, meeting the burden of proof for compensability.

From the decision · page 11I deferred the issue of earnings and set the matter for status conference regarding the earnings issue; therefore, I did not rule on the issue of earnings. As such, the rate of permanent disability indemnity and attorney’s fees were not yet calculated or awarded. 3. Contentions on reconsideration. In its petition for reconsideration, defendant contends this WCJ erred in relying on the reporting of QME Dr. Fields Brewer regarding compensability of the cervical spine and left shoulder, and WPI opinions. Defendant contends that the WPIs assigned by the QME are not substantial evidence and should not be utilized in determining applicant’s permanent disability. DISCUSSION 1. Compensability of cervical spine and left shoulder Applicant bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing v. Workers’ Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298, 302; Lab. Code, §§ 3600(a); 3202.5.) It is sufficient to show that work was a contributing cause of the injury.

The QME Dr. Fields Brewer's WPI ratings for cervical spine, thoracic spine, lumbar spine, and left shoulder, supported by medical examination and AMA Guides criteria, constitute substantial evidence for a 53% permanent disability rating.

From the decision · page 13other medical opinions, may constitute substantial evidence and the Appeals Board may rely on the medical opinion of a single physician unless it is “based on surmise, speculation, conjecture, or guess.” (Place v. Workmen’s Comp. App. Bd. (1970) 3 Cal.3d 372, 378. In its petition, defendant contends, “Dr. Brewer’s cervical spine impairment rating does not satisfy the AMA Guides 5th Edition requirements for DRE Category III.” DRE Cervical Category III criteria includes: “significant signs of radiculopathy…” (Table 15-5.) Here, QME Dr. Fields Brewer opined applicant’s cervical spine WPI should be placed in DRE III because: - Applicant expresses neck pain radiating to the let upper extremity and numbness/tingling - MRI, multiple-level disc bulging - Diagnosis: cervical radiculopathy (Joint Exhibit 1, p. 12.) That analysis is unrebutted. I adopted the QME’s assigned cervical spine WPI of 17%. Defendant further contends, “Dr. Brewer’s left shoulder impairment rating is methodologically unsupported and speculative” because a left shoulder MRI had not been performed; Dr. Fields Brewer had conducted range of motion studies, however. Utilizing the ROM results, medical records review, examinations of the applicant, and utilization of AMA Guides, Dr. Fields Brewer determined that applicant’s WPI was 4%.

QME Dr. Fields Brewer's medical reports and deposition provided substantial evidence supporting industrial causation of cervical spine and left shoulder injuries

Favours Applicant prevailed

Supported finding of compensability for cervical spine and left shoulder injuries

From the decision · page 11I deferred the issue of earnings and set the matter for status conference regarding the earnings issue; therefore, I did not rule on the issue of earnings. As such, the rate of permanent disability indemnity and attorney’s fees were not yet calculated or awarded. 3. Contentions on reconsideration. In its petition for reconsideration, defendant contends this WCJ erred in relying on the reporting of QME Dr. Fields Brewer regarding compensability of the cervical spine and left shoulder, and WPI opinions. Defendant contends that the WPIs assigned by the QME are not substantial evidence and should not be utilized in determining applicant’s permanent disability. DISCUSSION 1. Compensability of cervical spine and left shoulder Applicant bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing v. Workers’ Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298, 302; Lab. Code, §§ 3600(a); 3202.5.) It is sufficient to show that work was a contributing cause of the injury.

Applicant's credible testimony about pain and limitations corroborated QME's opinions

Favours Applicant prevailed

Supported finding of compensability and need for further medical treatment

From the decision · page 6Over the last 30 days in his mid-back, it hurts a lot. He feels a lot of pain in that spot. It is strong pain. The pain is about an eight more or less. This pain bothers him. He cannot do what he did before – he cannot bend, he cannot sit for a long time, he cannot walk for a long time. In everything that he does, he cannot do what he used to do. It affects him at every level. What makes the pain worse is in basically all of his activities of daily living such as tying a shoelace and walking. It does bother him all the time, but is not exaggeratedly horrible. He takes a pill, ibuprofen, for the pain or laying down helps the pain, laying down face up or face down. He tries to relax and get into a comfortable spot.

Medical records and MRI findings supported diagnoses of cervical radiculopathy and lumbar pathology

Favours Applicant prevailed

Supported substantial evidence for compensability and permanent disability rating

From the decision · page 8She stated: “A review of the additional records today does cause me to alter any previous[ly] authored findings…” After reviewing a February 19, 2024, MRI of the lumbar spine, “the diagnoses have been updated to reflect the lumbar pathology and remove the thoracic pathology.” She diagnosed applicant with: - Lumbar radiculitis - Spondylolisthesis, lumbar region 4) Deposition transcript of QME Dr. Fields Brewer Defendant’s Exhibit A is a deposition transcript of QME Dr. Fields Brewer dated October 14, 2024. Dr. Fields Brewer testified: - She does believe that the symptomatology is based off of the injury to the lumbar spine - There could be a neurological base for his symptoms without a positive MRI if testing and mechanism of injury align - She would reassess her finding of injury to the thoracic spine upon receipt of more current PTP reports - In her October 31, 2023 report, there were positive findings to the cervical spine, loss of range of motion - There are positive findings on the cervical spine MRI

QME Dr. Fields Brewer's WPI ratings and apportionment opinions were adopted as substantial evidence for 53% permanent disability rating

Favours Applicant prevailed

Supported the permanent disability rating outcome

From the decision · page 13other medical opinions, may constitute substantial evidence and the Appeals Board may rely on the medical opinion of a single physician unless it is “based on surmise, speculation, conjecture, or guess.” (Place v. Workmen’s Comp. App. Bd. (1970) 3 Cal.3d 372, 378. In its petition, defendant contends, “Dr. Brewer’s cervical spine impairment rating does not satisfy the AMA Guides 5th Edition requirements for DRE Category III.” DRE Cervical Category III criteria includes: “significant signs of radiculopathy…” (Table 15-5.) Here, QME Dr. Fields Brewer opined applicant’s cervical spine WPI should be placed in DRE III because: - Applicant expresses neck pain radiating to the let upper extremity and numbness/tingling - MRI, multiple-level disc bulging - Diagnosis: cervical radiculopathy (Joint Exhibit 1, p. 12.) That analysis is unrebutted. I adopted the QME’s assigned cervical spine WPI of 17%. Defendant further contends, “Dr. Brewer’s left shoulder impairment rating is methodologically unsupported and speculative” because a left shoulder MRI had not been performed; Dr. Fields Brewer had conducted range of motion studies, however. Utilizing the ROM results, medical records review, examinations of the applicant, and utilization of AMA Guides, Dr. Fields Brewer determined that applicant’s WPI was 4%.

Diagnosed spondylosis in cervicothoracic, thoracolumbar, and lumbosacral regions.

From the decision · page 11iii. Report of George Rakkar, M.D. Joint Exhibit 9 is a Report of Dr. Rakkar dated April 29, 2025. In his report, he diagnosed applicant with: Spondylosis, cervicothoracic, thoracolumbar, lumbosacral regions.  Decision I found applicant sustained injury arising out of and in the course of employment to his lumbar spine, thoracic spine, cervical spine, and left shoulder. I further found: applicant’s occupational group number is 460, defendant met its burden of proof as to apportionment, applicant’s injury resulted in 53 percent permanent disability, and applicant is entitled to further medical treatment 3. 3F

Diagnosed lumbar radiculitis, lumbosacral dorsopathy, thoracic spine strain and sprain, cervical radiculopathy, and left shoulder instability; found industrial causation for cervical spine and left shoulder injuries; assigned WPI ratings and apportionment percentages; recommended further medical treatment.

Her medical reports and deposition provided substantial evidence supporting industrial causation and permanent disability ratings.

From the decision · page 71) Joint Exhibit 7 Joint Exhibit 7 is a QME report of Dr. Fields Brewer dated October 31, 2023. In her report, Dr. Fields Brewer reviewed medical records, took current complaints from the applicant, noted occupational history, prior injuries, and other histories. Applicant was injured when he was lifting

Assigned WPI ratings for cervical spine (17%), thoracic spine (6%), lumbar spine (12%), and left shoulder (4%); found apportionment percentages for industrial causation; supported 53% permanent disability rating.

Her WPI ratings and apportionment opinions were adopted as substantial evidence for permanent disability.

From the decision · page 13other medical opinions, may constitute substantial evidence and the Appeals Board may rely on the medical opinion of a single physician unless it is “based on surmise, speculation, conjecture, or guess.” (Place v. Workmen’s Comp. App. Bd. (1970) 3 Cal.3d 372, 378. In its petition, defendant contends, “Dr. Brewer’s cervical spine impairment rating does not satisfy the AMA Guides 5th Edition requirements for DRE Category III.” DRE Cervical Category III criteria includes: “significant signs of radiculopathy…” (Table 15-5.) Here, QME Dr. Fields Brewer opined applicant’s cervical spine WPI should be placed in DRE III because: - Applicant expresses neck pain radiating to the let upper extremity and numbness/tingling - MRI, multiple-level disc bulging - Diagnosis: cervical radiculopathy (Joint Exhibit 1, p. 12.) That analysis is unrebutted. I adopted the QME’s assigned cervical spine WPI of 17%. Defendant further contends, “Dr. Brewer’s left shoulder impairment rating is methodologically unsupported and speculative” because a left shoulder MRI had not been performed; Dr. Fields Brewer had conducted range of motion studies, however. Utilizing the ROM results, medical records review, examinations of the applicant, and utilization of AMA Guides, Dr. Fields Brewer determined that applicant’s WPI was 4%.

Diagnosed thoracic sprain, pain in thoracic spine, muscle spasm of back, sprain of lumbar spine and pelvis, and low back pain.

From the decision · page 10She gave the following updated opinions regarding apportionment: - Cervical spine: 85% industrial - Thoracic spine: 85% industrial - Lumbar spine: 75% industrial - Left shoulder: 95% industrial ii. Reports of William Fishkin, D.C. Joint Exhibit 8 consists of two reports of PTP Dr. Fishkin. Defendant’s Exhibit I consists of six additional reports of Dr. Fishkin. He diagnosed applicant with: - Thoracic sprain - Pain in thoracic spine - Muscle spasm of back - Sprain of unspecified parts of lumbar spine and pelvis - Low back pain

South Coast Framing v. Workers’ Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298, 302; Lab. Code, §§ 3600(a); 3202.5

Applicant bears the burden of proving injury arising out of and in the course of employment by a preponderance of the evidence; sufficient to show work was a contributing cause

Applied to compensability of cervical spine and left shoulder injuries

From the decision · page 11I deferred the issue of earnings and set the matter for status conference regarding the earnings issue; therefore, I did not rule on the issue of earnings. As such, the rate of permanent disability indemnity and attorney’s fees were not yet calculated or awarded. 3. Contentions on reconsideration. In its petition for reconsideration, defendant contends this WCJ erred in relying on the reporting of QME Dr. Fields Brewer regarding compensability of the cervical spine and left shoulder, and WPI opinions. Defendant contends that the WPIs assigned by the QME are not substantial evidence and should not be utilized in determining applicant’s permanent disability. DISCUSSION 1. Compensability of cervical spine and left shoulder Applicant bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing v. Workers’ Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298, 302; Lab. Code, §§ 3600(a); 3202.5.) It is sufficient to show that work was a contributing cause of the injury.

Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Bd. en banc)

Medical opinion must be well-reasoned, based on adequate history and examination, and disclose solid basis; substantial evidence standard

Applied to evaluation of QME Dr. Fields Brewer's medical opinions and WPI ratings

From the decision · page 13other medical opinions, may constitute substantial evidence and the Appeals Board may rely on the medical opinion of a single physician unless it is “based on surmise, speculation, conjecture, or guess.” (Place v. Workmen’s Comp. App. Bd. (1970) 3 Cal.3d 372, 378. In its petition, defendant contends, “Dr. Brewer’s cervical spine impairment rating does not satisfy the AMA Guides 5th Edition requirements for DRE Category III.” DRE Cervical Category III criteria includes: “significant signs of radiculopathy…” (Table 15-5.) Here, QME Dr. Fields Brewer opined applicant’s cervical spine WPI should be placed in DRE III because: - Applicant expresses neck pain radiating to the let upper extremity and numbness/tingling - MRI, multiple-level disc bulging - Diagnosis: cervical radiculopathy (Joint Exhibit 1, p. 12.) That analysis is unrebutted. I adopted the QME’s assigned cervical spine WPI of 17%. Defendant further contends, “Dr. Brewer’s left shoulder impairment rating is methodologically unsupported and speculative” because a left shoulder MRI had not been performed; Dr. Fields Brewer had conducted range of motion studies, however. Utilizing the ROM results, medical records review, examinations of the applicant, and utilization of AMA Guides, Dr. Fields Brewer determined that applicant’s WPI was 4%.

Place v. Workmen’s Comp. App. Bd. (1970) 3 Cal.3d 372, 378

Relevant and considered opinion of one physician may constitute substantial evidence unless based on speculation

Applied to reliance on QME Dr. Fields Brewer's opinions for permanent disability rating

From the decision · page 13other medical opinions, may constitute substantial evidence and the Appeals Board may rely on the medical opinion of a single physician unless it is “based on surmise, speculation, conjecture, or guess.” (Place v. Workmen’s Comp. App. Bd. (1970) 3 Cal.3d 372, 378. In its petition, defendant contends, “Dr. Brewer’s cervical spine impairment rating does not satisfy the AMA Guides 5th Edition requirements for DRE Category III.” DRE Cervical Category III criteria includes: “significant signs of radiculopathy…” (Table 15-5.) Here, QME Dr. Fields Brewer opined applicant’s cervical spine WPI should be placed in DRE III because: - Applicant expresses neck pain radiating to the let upper extremity and numbness/tingling - MRI, multiple-level disc bulging - Diagnosis: cervical radiculopathy (Joint Exhibit 1, p. 12.) That analysis is unrebutted. I adopted the QME’s assigned cervical spine WPI of 17%. Defendant further contends, “Dr. Brewer’s left shoulder impairment rating is methodologically unsupported and speculative” because a left shoulder MRI had not been performed; Dr. Fields Brewer had conducted range of motion studies, however. Utilizing the ROM results, medical records review, examinations of the applicant, and utilization of AMA Guides, Dr. Fields Brewer determined that applicant’s WPI was 4%.

Applicant's testimony about pain and limitations in cervical spine, left shoulder, thoracic spine, and lumbar spine

From the decision · page 6Over the last 30 days in his mid-back, it hurts a lot. He feels a lot of pain in that spot. It is strong pain. The pain is about an eight more or less. This pain bothers him. He cannot do what he did before – he cannot bend, he cannot sit for a long time, he cannot walk for a long time. In everything that he does, he cannot do what he used to do. It affects him at every level. What makes the pain worse is in basically all of his activities of daily living such as tying a shoelace and walking. It does bother him all the time, but is not exaggeratedly horrible. He takes a pill, ibuprofen, for the pain or laying down helps the pain, laying down face up or face down. He tries to relax and get into a comfortable spot.

Medical records and MRI findings supporting diagnoses of cervical radiculopathy and lumbar pathology

From the decision · page 8She stated: “A review of the additional records today does cause me to alter any previous[ly] authored findings…” After reviewing a February 19, 2024, MRI of the lumbar spine, “the diagnoses have been updated to reflect the lumbar pathology and remove the thoracic pathology.” She diagnosed applicant with: - Lumbar radiculitis - Spondylolisthesis, lumbar region 4) Deposition transcript of QME Dr. Fields Brewer Defendant’s Exhibit A is a deposition transcript of QME Dr. Fields Brewer dated October 14, 2024. Dr. Fields Brewer testified: - She does believe that the symptomatology is based off of the injury to the lumbar spine - There could be a neurological base for his symptoms without a positive MRI if testing and mechanism of injury align - She would reassess her finding of injury to the thoracic spine upon receipt of more current PTP reports - In her October 31, 2023 report, there were positive findings to the cervical spine, loss of range of motion - There are positive findings on the cervical spine MRI