What the panel ordered
Petition for reconsideration denied
Petition for reconsideration filed and denied by the Appeals Board after review of the WCJ report
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
Applicant did not meet burden of proof through substantial medical evidence; PQME Dr. Schwartz found no evidence of cumulative trauma through the claimed date; PTP Dr. Rosenzweig's opinion was not substantial due to inadequate history; WCJ credibility determination was given great weight.
From the decision · page 14In this case, we agree with the WCJ that applicant did not meet his burden of proof through substantial medical evidence that he sustained a cumulative injury through August 4, 2023. Dr. Schwartz, the panel qualified medical evaluator (PQME), found applicant had reached maximum medical improvement with regard to the previous July 2016 cumulative injury but that there was no evidence of cumulative trauma through August 4, 2023, as claimed herein. (Dr. Schwartz' 9/19/24 report, at p. 2. Defendant's Exhibit C.) The opinion of primary treating physician (PTP) Dr. Rosenzweig was not based on an adequate history because he failed to review any medical records pertaining to the prior 2016 cumulative injury. This fact alone renders his opinion not substantial medical evidence, making further analysis of his opinion unnecessary.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
PQME Dr. Schwartz found no evidence of cumulative trauma through August 4, 2023, and noted applicant's symptoms and reports were completely unreliable.
Favours Defendant prevailed
This medical opinion was relied upon to deny the injury claim due to lack of substantial evidence.
From the decision · page 14In this case, we agree with the WCJ that applicant did not meet his burden of proof through substantial medical evidence that he sustained a cumulative injury through August 4, 2023. Dr. Schwartz, the panel qualified medical evaluator (PQME), found applicant had reached maximum medical improvement with regard to the previous July 2016 cumulative injury but that there was no evidence of cumulative trauma through August 4, 2023, as claimed herein. (Dr. Schwartz' 9/19/24 report, at p. 2. Defendant's Exhibit C.) The opinion of primary treating physician (PTP) Dr. Rosenzweig was not based on an adequate history because he failed to review any medical records pertaining to the prior 2016 cumulative injury. This fact alone renders his opinion not substantial medical evidence, making further analysis of his opinion unnecessary.
PTP Dr. Rosenzweig's opinion was not based on an adequate history and was therefore not substantial medical evidence.
Favours Defendant prevailed
This undermined the applicant's medical evidence supporting injury claim.
From the decision · page 14In this case, we agree with the WCJ that applicant did not meet his burden of proof through substantial medical evidence that he sustained a cumulative injury through August 4, 2023. Dr. Schwartz, the panel qualified medical evaluator (PQME), found applicant had reached maximum medical improvement with regard to the previous July 2016 cumulative injury but that there was no evidence of cumulative trauma through August 4, 2023, as claimed herein. (Dr. Schwartz' 9/19/24 report, at p. 2. Defendant's Exhibit C.) The opinion of primary treating physician (PTP) Dr. Rosenzweig was not based on an adequate history because he failed to review any medical records pertaining to the prior 2016 cumulative injury. This fact alone renders his opinion not substantial medical evidence, making further analysis of his opinion unnecessary.
Applicant provided inconsistent and contradictory testimony and history regarding prior injury and work restrictions.
Favours Defendant prevailed
This credibility issue supported the denial of the claim.
From the decision · page 14In this case, we agree with the WCJ that applicant did not meet his burden of proof through substantial medical evidence that he sustained a cumulative injury through August 4, 2023. Dr. Schwartz, the panel qualified medical evaluator (PQME), found applicant had reached maximum medical improvement with regard to the previous July 2016 cumulative injury but that there was no evidence of cumulative trauma through August 4, 2023, as claimed herein. (Dr. Schwartz' 9/19/24 report, at p. 2. Defendant's Exhibit C.) The opinion of primary treating physician (PTP) Dr. Rosenzweig was not based on an adequate history because he failed to review any medical records pertaining to the prior 2016 cumulative injury. This fact alone renders his opinion not substantial medical evidence, making further analysis of his opinion unnecessary.
What the panel did with the medical opinions
The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
Found no evidence of cumulative trauma through August 4, 2023; noted applicant's symptoms and reports were completely unreliable; found applicant had reached maximum medical improvement for prior injury.
Applicant's inconsistent history and poor credibility; thorough review of 53 documents; no foundation for continuous trauma.
From the decision · page 14In this case, we agree with the WCJ that applicant did not meet his burden of proof through substantial medical evidence that he sustained a cumulative injury through August 4, 2023. Dr. Schwartz, the panel qualified medical evaluator (PQME), found applicant had reached maximum medical improvement with regard to the previous July 2016 cumulative injury but that there was no evidence of cumulative trauma through August 4, 2023, as claimed herein. (Dr. Schwartz' 9/19/24 report, at p. 2. Defendant's Exhibit C.) The opinion of primary treating physician (PTP) Dr. Rosenzweig was not based on an adequate history because he failed to review any medical records pertaining to the prior 2016 cumulative injury. This fact alone renders his opinion not substantial medical evidence, making further analysis of his opinion unnecessary.
Diagnosed multiple disorders and treated applicant over 13 months with little improvement; opinion not based on adequate history and thus not substantial medical evidence.
Did not review prior injury medical records; persistent symptoms without documented improvement; contradictory statements in P&S report.
From the decision · page 14In this case, we agree with the WCJ that applicant did not meet his burden of proof through substantial medical evidence that he sustained a cumulative injury through August 4, 2023. Dr. Schwartz, the panel qualified medical evaluator (PQME), found applicant had reached maximum medical improvement with regard to the previous July 2016 cumulative injury but that there was no evidence of cumulative trauma through August 4, 2023, as claimed herein. (Dr. Schwartz' 9/19/24 report, at p. 2. Defendant's Exhibit C.) The opinion of primary treating physician (PTP) Dr. Rosenzweig was not based on an adequate history because he failed to review any medical records pertaining to the prior 2016 cumulative injury. This fact alone renders his opinion not substantial medical evidence, making further analysis of his opinion unnecessary.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, 5705
The employee bears the initial burden of proving injury arising out of and in the course of employment by a preponderance of the evidence.
Applied to assess burden of proof for injury claim.
From the decision · page 13The employee bears the initial burden of proving injury arising out of and in the course of
Lab. Code, 5903
Decisions by the Appeals Board must be supported by substantial evidence.
Applied to evaluate sufficiency of medical evidence and credibility.
From the decision · page 13employment (AOE/COE) by a preponderance of the evidence. (Lab. Code, § 5705; South Coast
What proof carried it
The evidence the panel weighed, by kind.
Applicant's inconsistent and contradictory testimony and history regarding prior injury and work restrictions
From the decision · page 14In this case, we agree with the WCJ that applicant did not meet his burden of proof through substantial medical evidence that he sustained a cumulative injury through August 4, 2023. Dr. Schwartz, the panel qualified medical evaluator (PQME), found applicant had reached maximum medical improvement with regard to the previous July 2016 cumulative injury but that there was no evidence of cumulative trauma through August 4, 2023, as claimed herein. (Dr. Schwartz' 9/19/24 report, at p. 2. Defendant's Exhibit C.) The opinion of primary treating physician (PTP) Dr. Rosenzweig was not based on an adequate history because he failed to review any medical records pertaining to the prior 2016 cumulative injury. This fact alone renders his opinion not substantial medical evidence, making further analysis of his opinion unnecessary.
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
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