ADJ19686963 · September 21, 2026

Given the severe nature of injury and recommendations by treating physicians and PQME, medical care award is supported and granted.

From the decision · page 1316.) In his Opinion on Decision, the PWCJ states “Dr. Richman was silent on the question of treatment” and that Dr. Lo’s opinion on medical care was issued before applicant reached maximum medical improvement (MMI). (Opinion on Decision, p. 9.) The inference raised by the PWCJ is that the applicant may no longer require medical care after having reached MMI status. While we acknowledge the effort and quality put into the F&A, such an inference is not appropriate in this case. Given the severe nature of applicant’s injury, the recommendation for further treatment by two treating physicians, and the PQME’s recommendation issued after achieving MMI that applicant should undergo “octopus telemetry,” an award of medical care is reasonable and well supported. (Id. at p. 462.) Moreover, when applicant seeks a particular treatment modality at defendant’s expense, applicant must still demonstrate by way of medical evidence that the particular treatment sought is reasonable and necessary. (See Lab. Code, §§ 4600, 4610 et seq.) We therefore find that applicant is entitled to medical care and to award medical care.

The record lacks substantial evidence on permanent disability due to unclear medical work restrictions and conflicting vocational opinions; the issue is deferred for further development.

From the decision · page 14Following our independent review of the record occasioned by applicant’s Petition, we are persuaded that the requirement for substantial evidence requires returning this case for further proceedings to develop the record on permanent disability and to amend the F&A including to award medical care. Accordingly, we grant applicant’s Petition for Reconsideration, rescind the June 29, 2026 F&A, substitute the following findings, orders and awards, and return the case to the trial level for further proceedings consistent with this opinion. For the foregoing reasons, IT IS ORDERED that applicant’s July 17, 2026 Petition for Reconsideration is GRANTED. IT IS ORDERED as the Decision After Reconsideration of the Workers’ Compensation Appeals Board that the June 29, 2026 Findings Award and Orders issued by the PWCJ is RESCINDED and SUBSTITUTED as follows:

PQME Dr. Richman did not provide clear medical work restrictions to support vocational opinions

Favours Defendant prevailed

Without clear medical restrictions, vocational opinions lacked substantial evidence, leading to deferral of permanent disability issue.

From the decision · page 9It is therefore necessary to determine how the injury to an employee impairs their rehabilitation. Typically, feasibility for rehabilitation is evaluated by considering medical work restrictions. Here, however, the record lacks clarity regarding the medical work restrictions considered by the VE. The VE originally deferred vocational opinions pending clarification of work restrictions from PQME Dr. Richman. (Exhibit 4, p. 22.) Dr. Richman later acknowledged in a supplemental report that he was being “requested to provide work restrictions to assist the vocational expert,” but he did not actually provide the requested work restrictions. (Exhibit 5, pp. 1-2.)

Vocational expert assumed work restrictions without medical basis

Favours Defendant prevailed

This assumption usurped the medical expert role and rendered vocational opinions insubstantial.

From the decision · page 10(Exhibit 6, p. 5, emphasis added.) Such assumption of work restrictions impermissibly placed the VE in the untenable position of substituting the VE’s lay opinion for the missing required expert medical opinion. The result is not substantial evidence. Curiously, although the VE apparently digested and relied on at least some of treating physician Dr. Alchemy’s reporting in reaching his opinions, none of Dr. Alchemy’s reports were entered into evidence. The VE’s digest of Dr. Alchemy’s June 17, 2025 report includes the restatement of prior work restrictions from Dr. Alchemy of: “Sedentary work. No cognitive complex work, no work at heights, handrails with stairs limited to 1 flight/day.” (Exhibit 6, pp. 5.) These limited work restrictions from Dr. Alchemy are incongruous with the VE’s work restrictions, even when considered in conjunction with PQME Dr. Richman’s opinions. More fundamentally, however, the problem with the VE’s opinions is that in “assuming” work restrictions the VE usurps the role of the medical expert. It is the medical expert that must provide the substantial medical opinion as to work restrictions. Here, that evidence is lacking and without it, the VE’s opinions are not substantial evidence. After the VE issued an opinion on employability, PQME Dr.

Severe nature of injury and recommendations by treating physicians and PQME support award of medical care

Favours Applicant prevailed

Supports granting medical care despite deferral of permanent disability.

From the decision · page 1316.) In his Opinion on Decision, the PWCJ states “Dr. Richman was silent on the question of treatment” and that Dr. Lo’s opinion on medical care was issued before applicant reached maximum medical improvement (MMI). (Opinion on Decision, p. 9.) The inference raised by the PWCJ is that the applicant may no longer require medical care after having reached MMI status. While we acknowledge the effort and quality put into the F&A, such an inference is not appropriate in this case. Given the severe nature of applicant’s injury, the recommendation for further treatment by two treating physicians, and the PQME’s recommendation issued after achieving MMI that applicant should undergo “octopus telemetry,” an award of medical care is reasonable and well supported. (Id. at p. 462.) Moreover, when applicant seeks a particular treatment modality at defendant’s expense, applicant must still demonstrate by way of medical evidence that the particular treatment sought is reasonable and necessary. (See Lab. Code, §§ 4600, 4610 et seq.) We therefore find that applicant is entitled to medical care and to award medical care.

Dr. Richman opined applicant is permanently and totally disabled but did not provide substantial medical evidence or clear work restrictions; his vocational opinions were not substantial evidence.

The decision found Dr. Richman's opinions on permanent total disability were not substantial as they ventured into vocational expertise without clear medical work restrictions.

From the decision · page 9Because Dr. Richman does not question the validity of the provided impairment nor provide references to any standard texts or recent research data to challenge the impairment as prima facie evidence of disability, it appears his opinion on employability improperly ventures from that of a medical expert into the realm of vocational expertise. PQME Dr. Richman’s assessment of vocational permanent total disability is therefore not substantial as being offered outside his area of expertise. Further confounding Dr. Richman’s opinion on permanent total disability is his statement “the parties state that the applicant is vocationally infeasible and that the applicant is permanently / totally disabled 100%.” (Exhibit D, 2, emphasis added.) Although permanent disability is clearly disputed by defendant in this matter, it is unclear to what extent PQME Dr. Richman may have been under the misapprehension that permanent total disability was agreed to by the parties. Such misapprehension may have led PQME Dr.

Dr. Alchemy provided work restrictions indicating sedentary work and limitations on cognitive complexity and physical activity, but his reports were not entered into evidence.

The vocational expert relied on Dr. Alchemy's work restrictions, but the lack of formal evidence entry weakened the vocational opinion's substantiality.

From the decision · page 10(Exhibit 6, p. 5, emphasis added.) Such assumption of work restrictions impermissibly placed the VE in the untenable position of substituting the VE’s lay opinion for the missing required expert medical opinion. The result is not substantial evidence. Curiously, although the VE apparently digested and relied on at least some of treating physician Dr. Alchemy’s reporting in reaching his opinions, none of Dr. Alchemy’s reports were entered into evidence. The VE’s digest of Dr. Alchemy’s June 17, 2025 report includes the restatement of prior work restrictions from Dr. Alchemy of: “Sedentary work. No cognitive complex work, no work at heights, handrails with stairs limited to 1 flight/day.” (Exhibit 6, pp. 5.) These limited work restrictions from Dr. Alchemy are incongruous with the VE’s work restrictions, even when considered in conjunction with PQME Dr. Richman’s opinions. More fundamentally, however, the problem with the VE’s opinions is that in “assuming” work restrictions the VE usurps the role of the medical expert. It is the medical expert that must provide the substantial medical opinion as to work restrictions. Here, that evidence is lacking and without it, the VE’s opinions are not substantial evidence. After the VE issued an opinion on employability, PQME Dr.

Labor Code § 4660.1(a) and (b)

AMA Guides impairment rating is rebuttable with proper medical evidence

Physician may depart from AMA Guides if supported by standard texts or research data; otherwise, AMA Guides impairment is prima facie evidence.

From the decision · page 8(Lab. Code, § 4660.1(a) and (b), emphasis added.) The use of the AMA Guides, however, is rebuttable. (Milpitas Unified School Dist. v. Workers’ Comp. Appeals Bd. (Guzman) (2010) 187 Cal.App.4th 808, 822 [75 Cal.Comp.Cases 837].) If the physician finds the straight AMA Guides impairment to be lacking: The physician should be free to acknowledge his or her reliance on standard texts or recent research data as a basis for his or her medical conclusions, and the WCJ should be permitted to hear that evidence. If the explanation fails to convince the WCJ or WCAB that departure from strict application of the applicable tables and measurements in the Guides is warranted in the current situation, the physician’s opinion will properly be rejected.

Labor Code §§ 5903, 5952(d)

Substantial evidence required for WCAB decisions

The Board must ensure decisions are supported by substantial evidence and further develop the record if evidence is insufficient.

From the decision · page 11Here, substantial evidence is required as decisions of the Appeals Board must be supported by substantial evidence. (Lab. Code, §§ 5903, 5952(d); Lamb v. Workmen’s Comp. Appeals Bd. (1974) 11 Cal.3d 274, 281 [39 Cal.Comp.Cases 310]; Garza v. Workmen’s Comp. Appeals Bd. (1970) 3 Cal.3d 312, 317 [35 Cal.Comp.Cases 500]; LeVesque v. Workmen’s Comp. Appeals Bd. (1970) 1 Cal.3d 627, 637 [35 Cal.Comp.Cases 16].) The WCJ and the Appeals Board have a duty to further develop the record where there is insufficient evidence on an issue. (McClune v. Workers’ Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117, 1121-1122 [63 Cal.Comp.Cases 261].) The Appeals Board has a constitutional mandate to

Hegglin v. Workmen’s Comp. Appeals Bd. (1971) 4 Cal.3d 162

Medical opinions must be based on substantial medical evidence, not speculation or vocational factors

Medical opinions are not substantial evidence if based on speculation or outside medical expertise.

From the decision · page 11If PQME Dr. Richman believes applicant is permanently and totally disabled on a medical basis sufficient to rebut the prima facie AMA Guides impairment, the doctor should state so and describe how such AMA Guides impairment is lacking while providing references to any standard texts or recent research data that provide a basis for what he considers to be the correct impairment. A medical opinion must explain the facts relied on and the reasoning resulting in its conclusions in order to allow a lay trier of fact to evaluate the substantial nature of medical evidence. This is because: 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. Medical opinion also fails to support the Board’s findings if it is based on surmise, speculation, conjecture or guess.

LeBoeuf v. Workers' Comp. Appeals Bd. (1983) 34 Cal.3d 234

Vocational feasibility is evaluated by medical work restrictions; vocational opinions without medical basis are not substantial

Vocational expert must rely on medical work restrictions to assess rehabilitation feasibility.

From the decision · page 9Richman to put forth opinions without full consideration or explanation because he considered the issue of disability settled. Thus, without further clarification PQME Dr. Richman’s opinions are not substantial. Turning to the vocational opinions we observe: Another way the cases have long recognized that a scheduled rating has been effectively rebutted is when the injury to the employee impairs his or her rehabilitation, and for that reason, the employee’s diminished future earning capacity is greater than reflected in the employee’s scheduled rating. This is the rule expressed in LeBoeuf v. Workers' Comp. Appeals Bd. (1983) 34 Cal.3d 234 [193 Cal. Rptr. 547, 666 P.2d 989].

Lack of clear medical work restrictions from PQME Dr. Richman

From the decision · page 9It is therefore necessary to determine how the injury to an employee impairs their rehabilitation. Typically, feasibility for rehabilitation is evaluated by considering medical work restrictions. Here, however, the record lacks clarity regarding the medical work restrictions considered by the VE. The VE originally deferred vocational opinions pending clarification of work restrictions from PQME Dr. Richman. (Exhibit 4, p. 22.) Dr. Richman later acknowledged in a supplemental report that he was being “requested to provide work restrictions to assist the vocational expert,” but he did not actually provide the requested work restrictions. (Exhibit 5, pp. 1-2.)

Vocational expert's assumptions on work restrictions without medical basis

From the decision · page 10(Exhibit 6, p. 5, emphasis added.) Such assumption of work restrictions impermissibly placed the VE in the untenable position of substituting the VE’s lay opinion for the missing required expert medical opinion. The result is not substantial evidence. Curiously, although the VE apparently digested and relied on at least some of treating physician Dr. Alchemy’s reporting in reaching his opinions, none of Dr. Alchemy’s reports were entered into evidence. The VE’s digest of Dr. Alchemy’s June 17, 2025 report includes the restatement of prior work restrictions from Dr. Alchemy of: “Sedentary work. No cognitive complex work, no work at heights, handrails with stairs limited to 1 flight/day.” (Exhibit 6, pp. 5.) These limited work restrictions from Dr. Alchemy are incongruous with the VE’s work restrictions, even when considered in conjunction with PQME Dr. Richman’s opinions. More fundamentally, however, the problem with the VE’s opinions is that in “assuming” work restrictions the VE usurps the role of the medical expert. It is the medical expert that must provide the substantial medical opinion as to work restrictions. Here, that evidence is lacking and without it, the VE’s opinions are not substantial evidence. After the VE issued an opinion on employability, PQME Dr.