ADJ9205300 — California WCAB decision

What the panel ordered

Findings and Order rescinded; matter returned to trial level for further proceedings and new decision.

Applicant sought reconsideration of a WCJ's Findings and Order that found his claims barred by res judicata due to a prior settlement for injuries from the same employment. The WCAB granted reconsideration, rescinded the F&O, and remanded for further proceedings.

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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.

AOE/COENot reachedrespiratory system

The record lacks substantial medical evidence of a compensable respiratory injury; Dr. Meth's opinion was speculative and not based on a solid underlying basis.

From the decision · page 12As discussed above, the record lacks substantial medical evidence that applicant has been diagnosed with a compensable respiratory injury. Assuming, arguendo, that applicant's respiratory conditions were disabling at the time of settlement in case number ADJ8596368, the record does not support a finding that applicant knew, or should have known, that his respiratory conditions were job-related when he entered into the C&R. As such, there was no respiratory injury for him to settle in 2014. Conversely, because applicant underwent a medical-legal evaluation for his respiratory condition prior to the settlement in case number ADJ8596368, defendant was on notice of a potential compensable injury to applicant's respiratory system. Based on the principles of contract law generally and the evidence in the record, injury to applicant's respiratory system was not part of the prior settlement in case number ADJ8596368.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

The prior C&R did not include respiratory system as a settled body part, and there was no evidence of compensable respiratory injury at the time of settlement.

Favours Applicant prevailed

This fact meant res judicata did not bar the current claim for respiratory injury.

From the decision · page 11the respiratory system as part of the settlement. The references to various respiratory symptoms going back to at least 2010 are just that - documentation of applicant's statements of his symptoms, not the existence of a compensable injury. To the contrary, there is no evidence that a physician opined at the time of the 2014 agreement that applicant had sustained an injury to his respiratory system. The doctrine of res judicata has no application where, as here, two workers' compensation cases involve different injuries. (Nash v. Workers' Comp. Appeals Bd. (1994) 24 Cal.App.4th 1793, 1812 [59 Cal.Comp.Cases 324]; General Dynamics Corp. v. Workers' Comp. Appeals Bd. (Anderson) (1999) 71 Cal.App.4th 624, 629.)

Dr. Meth's report was speculative and lacked a solid underlying basis for finding compensable respiratory injury.

Favours Defendant prevailed

Without substantial medical evidence, the Board could not find injury AOE/COE to the respiratory system.

From the decision · page 12As discussed above, the record lacks substantial medical evidence that applicant has been diagnosed with a compensable respiratory injury. Assuming, arguendo, that applicant's respiratory conditions were disabling at the time of settlement in case number ADJ8596368, the record does not support a finding that applicant knew, or should have known, that his respiratory conditions were job-related when he entered into the C&R. As such, there was no respiratory injury for him to settle in 2014. Conversely, because applicant underwent a medical-legal evaluation for his respiratory condition prior to the settlement in case number ADJ8596368, defendant was on notice of a potential compensable injury to applicant's respiratory system. Based on the principles of contract law generally and the evidence in the record, injury to applicant's respiratory system was not part of the prior settlement in case number ADJ8596368.

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Nash v. Workers' Comp. Appeals Bd. (1994) 24 Cal.App.4th 1793, 1812; General Dynamics Corp. v. Workers' Comp. Appeals Bd. (Anderson) (1999) 71 Cal.App.4th 624, 629

The doctrine of res judicata does not apply where two workers' compensation cases involve different injuries.

The prior settlement did not include respiratory system injury, so res judicata does not bar the current claim.

From the decision · page 11the respiratory system as part of the settlement. The references to various respiratory symptoms going back to at least 2010 are just that - documentation of applicant's statements of his symptoms, not the existence of a compensable injury. To the contrary, there is no evidence that a physician opined at the time of the 2014 agreement that applicant had sustained an injury to his respiratory system. The doctrine of res judicata has no application where, as here, two workers' compensation cases involve different injuries. (Nash v. Workers' Comp. Appeals Bd. (1994) 24 Cal.App.4th 1793, 1812 [59 Cal.Comp.Cases 324]; General Dynamics Corp. v. Workers' Comp. Appeals Bd. (Anderson) (1999) 71 Cal.App.4th 624, 629.)

County of Sacramento v. Workers' Comp. Appeals Bd. (Brooks) (2013) 215 Cal.App.4th 785, 797; Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (en banc)

A medical report is not substantial evidence unless it sets forth the reasoning behind the physician's opinion and discloses a solid underlying basis.

Dr. Meth's report was found speculative and not substantial evidence for injury AOE/COE.

From the decision · page 10Here, having reviewed the trial record, including Dr. Meth's April 16, 2015 report, the record does not contain substantial medical evidence upon which a finding on the issue of injury AOE/COE can be made. Dr. Meth took a detailed history, examined applicant, and reviewed numerous medical records, however Dr. Meth stated that he was waiting to review the results of a CT scan and the "cause of [applicant's] restrictive lung disease is unclear at this time." (Exhibit Z, at pp. 25-26.) As such, his opinions currently lack a solid underlying basis and are speculative. (County of Sacramento v. Workers' Comp. Appeals Bd. (Brooks) (2013) 215 Cal.App.4th 785, 797 [78 Cal.Comp.Cases 379]; Hegglin, supra; Escobedo, supra.) As discussed above, a medical report is not substantial evidence unless it sets forth the reasoning behind the physician's opinion, not merely their conclusions, and it must disclose a solid underlying basis for the opinion. (Hegglin, supra; Granado v. Workmen's Comp. Appeals Bd. (1970) 69 Cal.2d 399 [33 Cal.Comp.Cases 647]; Escobedo, supra.) Thus, Dr. Meth's opinions do not constitute substantial medical evidence based on the record before us.

ADJ9205300 · July 19, 2022

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

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