ADJ8963138 · July 28, 2026

The WCAB found that the WCJ's findings of no injury to the right knee and left hand/wrist were not supported by substantial evidence due to stale medical reports and inaccurate medical history, requiring further development of the record.

From the decision · page 7[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].) “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.” (Hegglin v. Workmen’s Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93]. A. It appears the last treating report reviewed by AME Lundeen was the report from Boyd Johnson, D.O., dated October 6, 2022. (EXH BB, p. 13.) The case came to trial on March 17, 2026, more than three years after this last treating report. In the FFA&O, the WCJ ordered the parties to develop the record “on the issues of Permanent and Stationary, Permanent Disability, and Apportionment and body parts.” (FFA&O, p. 3, emphasis added.) The WCJ specifically noted the AME’s last “medical report is stale” and further “that the applicant’s condition has materially changed with regards to her activities of daily living and pain.” (Opinion on Decision, pp.

AME Lundeen's opinion on causation of the right knee was based on an inaccurate medical history and did not acknowledge relevant medical evidence such as right hip contusion and PQME Butler's reports.

Favours Applicant prevailed

This undermined the substantiality of the medical evidence supporting no injury to the right knee, requiring further development of the record.

From the decision · page 9antalgic list brought on by the left leg over the past two years.” (EXH AA, p. 28.) And further, “[f]lare of the right knee, aggravation. Causation: Sustained injuries to the lumbar spine, left leg, right wrist, and right knee secondary to her fall on 06/08/10.” (EXH AA, p. 29.) Here AME Lundeen starts from the false premise that there are no documented complaints of right knee pain as result of the injury. While we note that AME Lundeen does question PQME Butler’s opinions on causation, questioning opinions on causation is different than incorrectly stating those opinions do not exist. It is apparent AME Lundeen’s opinions are premised on an incorrect medical history. Similarly, the statement that none of the medical record reports provide any diagnosis related to right knee injury is not born out by the record. In his July 11, 2012 report PQME Butler diagnosed a “[f]lare of the right knee, aggravation.” (EXH AA, p. 29.) PQME Butler’s next report of September 1, 2015 includes that applicant sustained a compensable consequence involving the right knee secondary to gait modification brought on by the left knee and the sciatic left leg. (EXH AA, p. 45.) Again, although AME Lundeen does discuss PQME Butler’s opinions at length, it is the fact that the AME starts his reasoning based on facts not congruent with the record that is concerning.

Medical reports were stale and did not support the WCJ's findings of no injury to the right knee and left hand/wrist.

Favours Applicant prevailed

The staleness of medical reports and material change in applicant's condition undermined the findings and justified further record development.

From the decision · page 7[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].) “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.” (Hegglin v. Workmen’s Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93]. A. It appears the last treating report reviewed by AME Lundeen was the report from Boyd Johnson, D.O., dated October 6, 2022. (EXH BB, p. 13.) The case came to trial on March 17, 2026, more than three years after this last treating report. In the FFA&O, the WCJ ordered the parties to develop the record “on the issues of Permanent and Stationary, Permanent Disability, and Apportionment and body parts.” (FFA&O, p. 3, emphasis added.) The WCJ specifically noted the AME’s last “medical report is stale” and further “that the applicant’s condition has materially changed with regards to her activities of daily living and pain.” (Opinion on Decision, pp.

Opined that the left shoulder pain is a compensable consequence of the industrial right shoulder and right hand/wrist injury, but the left hand/wrist and right knee pain conditions should be considered non-industrial.

AME Lundeen's opinion on causation of injury for the left hand/wrist was not substantial because he did not provide necessary explanation and abandoned the trier of fact to connect dots. His opinion on causation of the right knee was based on an inaccurate medical history and was not substantial evidence.

From the decision · page 10should be considered on a non-industrial basis.” (Exhibit BB, p. 17.) Curiously, also in his final report AME Lundeen opined the “left shoulder pain condition is a compensable consequence of this patient's industrial right shoulder and right hand and wrist injury” without explaining how the left shoulder would be a compensable consequence injury, but the left hand/wrist would not. (Exhibit BB, p. 17.) The AME does digest the significant left hand/wrist pathology but does not provide necessary explanation as to why there is not an industrial left hand/wrist injury. Without providing the reasoning behind his opinion on left hand/wrist causation, AME Lundeen abandons the trier of fact to connect dots. Medical opinion may not leave it to the lay trier of fact to find and connect relevant facts in support of an opinion. Such reasoning is the medical expert’s realm and is required for a medical opinion to be substantial evidence. AME Lundeen’s opinion on causation of injury for the left hand/wrist is not substantial.

Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473, 475 (Appeals Board en banc)

The WCJ must refer to the evidence in the opinion on decision and clearly designate the evidence forming the basis of the decision.

Applied to require clear designation of evidence supporting findings.

From the decision · page 76, 7.) Where, as here, the medical reporting is admittedly “stale” and “applicant’s condition has materially changed with regards to her activities of daily living and pain,” it cannot be said substantial evidence supports a body part causation finding based on that medical reporting. This is especially true where the WCJ orders development of the record in multiple issues including “body parts.” The findings of no injury to the right knee and left hand/wrist are not supported by substantial evidence and further development of the record is appropriate. B. For the right knee we note the following also supports the need to develop the record. 1. As required by section 5313 and explained in Hamilton, “the WCJ is charged with the responsibility of referring to the evidence in the opinion on decision, and of clearly designating the evidence that forms the basis of the decision.” (Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473, 475 (Appeals Board en banc).)

Peter Kiewit Sons v. I.A.C. (1965) 234 Cal.App.2d 831, 838 [30 Cal.Comp.Cases 188]

Expert testimony is necessary where the truth is occult and can be found only by resorting to the sciences.

Applied to emphasize the necessity of expert medical opinion for causation findings.

Peter Kiewit Sons v. I.A.C. (1965) 234 Cal.App.2d 831, 838 [30 Cal.Comp.Cases 188]

Where an issue is exclusively a matter of scientific medical knowledge, expert evidence is essential to sustain a WCAB finding; lay testimony or opinion does not measure up to the standard of substantial evidence.

Applied to reject lay testimony as insufficient evidence for medical causation.

Medical reports and opinions were stale and did not support the WCJ's findings on injury to right knee and left hand/wrist.

From the decision · page 7[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].) “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.” (Hegglin v. Workmen’s Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93]. A. It appears the last treating report reviewed by AME Lundeen was the report from Boyd Johnson, D.O., dated October 6, 2022. (EXH BB, p. 13.) The case came to trial on March 17, 2026, more than three years after this last treating report. In the FFA&O, the WCJ ordered the parties to develop the record “on the issues of Permanent and Stationary, Permanent Disability, and Apportionment and body parts.” (FFA&O, p. 3, emphasis added.) The WCJ specifically noted the AME’s last “medical report is stale” and further “that the applicant’s condition has materially changed with regards to her activities of daily living and pain.” (Opinion on Decision, pp.

AME Lundeen's opinion on right knee causation was based on an inaccurate medical history and did not acknowledge relevant medical evidence such as right hip contusion and PQME Butler's reports.

From the decision · page 9antalgic list brought on by the left leg over the past two years.” (EXH AA, p. 28.) And further, “[f]lare of the right knee, aggravation. Causation: Sustained injuries to the lumbar spine, left leg, right wrist, and right knee secondary to her fall on 06/08/10.” (EXH AA, p. 29.) Here AME Lundeen starts from the false premise that there are no documented complaints of right knee pain as result of the injury. While we note that AME Lundeen does question PQME Butler’s opinions on causation, questioning opinions on causation is different than incorrectly stating those opinions do not exist. It is apparent AME Lundeen’s opinions are premised on an incorrect medical history. Similarly, the statement that none of the medical record reports provide any diagnosis related to right knee injury is not born out by the record. In his July 11, 2012 report PQME Butler diagnosed a “[f]lare of the right knee, aggravation.” (EXH AA, p. 29.) PQME Butler’s next report of September 1, 2015 includes that applicant sustained a compensable consequence involving the right knee secondary to gait modification brought on by the left knee and the sciatic left leg. (EXH AA, p. 45.) Again, although AME Lundeen does discuss PQME Butler’s opinions at length, it is the fact that the AME starts his reasoning based on facts not congruent with the record that is concerning.