ADJ10614987 — California WCAB decision

What the panel ordered

The Appeals Board panel affirmed the WCJ's Findings and Order of July 13, 2020, denying permanent disability and future medical treatment on an industrial basis.

Petition for Reconsideration of the WCJ's Findings and Order of July 13, 2020, granted and reviewed by the Appeals Board panel.

Read the official decision →

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.

ApportionmentDefendant prevailedbrain · cavernous angioma

The WCJ and Appeals Board found that the industrial seizure did not aggravate the non-industrial cavernous angioma, and the applicant returned to baseline after the seizure. Medical treatment after discovery of the non-industrial condition was non-industrial and not compensable. The PQME's opinion that permanent disability was speculative and not caused by the industrial injury was accepted. Applicant's reliance on Rouseyrol was rejected as factually distinguishable.

From the decision · page 1In the Findings and Order of July 13, 2020, the workers' compensation judge ("WCJ") found that on July 6, 2016, applicant, while employed as a paramedic/firefighter by Cal Fire, sustained injury arising out of and in the course of employment in the form of a brain seizure. The WCJ further found that "unbeknownst to applicant, at the time of the industrial injury he suffered from a non-industrial condition in his brain called a cavernous angioma," that the sleep deprivation required by applicant's work interacted with the non-industrial cavernous angioma to cause a seizure at work on July 6, 2016, and that after the seizure "applicant returned to baseline, without aggravating or worsening the non-industrial cavernous angioma or the propensity to suffer seizures from it." In addition, the WCJ found that the treatment provided up to and including the discovery of the source of the seizure disorder - the non-industrial cavernous angioma - was industrial and compensable, that treatment after the discovery of the non-industrial cavernous angioma is not compensable because it was not required to cure or relieve from the effects of the industrial injury, and that there is no evidence to support an award of future medical treatment on an industrial basis. Finally, the WCJ found that on the issue of the existence and amount of permanent disability, the

The facts that decided it

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

The industrial seizure on July 6, 2016, did not aggravate the non-industrial cavernous angioma.

Favours Defendant prevailed

This fact supported the finding that medical treatment after discovery of the angioma was non-industrial and not compensable.

From the decision · page 1In the Findings and Order of July 13, 2020, the workers' compensation judge ("WCJ") found that on July 6, 2016, applicant, while employed as a paramedic/firefighter by Cal Fire, sustained injury arising out of and in the course of employment in the form of a brain seizure. The WCJ further found that "unbeknownst to applicant, at the time of the industrial injury he suffered from a non-industrial condition in his brain called a cavernous angioma," that the sleep deprivation required by applicant's work interacted with the non-industrial cavernous angioma to cause a seizure at work on July 6, 2016, and that after the seizure "applicant returned to baseline, without aggravating or worsening the non-industrial cavernous angioma or the propensity to suffer seizures from it." In addition, the WCJ found that the treatment provided up to and including the discovery of the source of the seizure disorder - the non-industrial cavernous angioma - was industrial and compensable, that treatment after the discovery of the non-industrial cavernous angioma is not compensable because it was not required to cure or relieve from the effects of the industrial injury, and that there is no evidence to support an award of future medical treatment on an industrial basis. Finally, the WCJ found that on the issue of the existence and amount of permanent disability, the

Applicant returned to baseline after the industrial seizure without worsening the non-industrial condition or seizure propensity.

Favours Defendant prevailed

This fact supported denial of permanent disability and future medical treatment on an industrial basis.

From the decision · page 1In the Findings and Order of July 13, 2020, the workers' compensation judge ("WCJ") found that on July 6, 2016, applicant, while employed as a paramedic/firefighter by Cal Fire, sustained injury arising out of and in the course of employment in the form of a brain seizure. The WCJ further found that "unbeknownst to applicant, at the time of the industrial injury he suffered from a non-industrial condition in his brain called a cavernous angioma," that the sleep deprivation required by applicant's work interacted with the non-industrial cavernous angioma to cause a seizure at work on July 6, 2016, and that after the seizure "applicant returned to baseline, without aggravating or worsening the non-industrial cavernous angioma or the propensity to suffer seizures from it." In addition, the WCJ found that the treatment provided up to and including the discovery of the source of the seizure disorder - the non-industrial cavernous angioma - was industrial and compensable, that treatment after the discovery of the non-industrial cavernous angioma is not compensable because it was not required to cure or relieve from the effects of the industrial injury, and that there is no evidence to support an award of future medical treatment on an industrial basis. Finally, the WCJ found that on the issue of the existence and amount of permanent disability, the

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.

QMERelied upon · neurology

Dr. Shalom opined that the industrial seizure did not worsen or aggravate the non-industrial cavernous angioma, and the applicant returned to baseline after the seizure. The craniotomy surgery was needed on a non-industrial basis. The permanent disability was speculative and not caused by the industrial injury.

The WCJ and Appeals Board relied on Dr. Shalom's medical opinion as substantial evidence that the industrial injury did not cause permanent disability or require compensable medical treatment after discovery of the non-industrial condition.

From the decision · page 1In the Findings and Order of July 13, 2020, the workers' compensation judge ("WCJ") found that on July 6, 2016, applicant, while employed as a paramedic/firefighter by Cal Fire, sustained injury arising out of and in the course of employment in the form of a brain seizure. The WCJ further found that "unbeknownst to applicant, at the time of the industrial injury he suffered from a non-industrial condition in his brain called a cavernous angioma," that the sleep deprivation required by applicant's work interacted with the non-industrial cavernous angioma to cause a seizure at work on July 6, 2016, and that after the seizure "applicant returned to baseline, without aggravating or worsening the non-industrial cavernous angioma or the propensity to suffer seizures from it." In addition, the WCJ found that the treatment provided up to and including the discovery of the source of the seizure disorder - the non-industrial cavernous angioma - was industrial and compensable, that treatment after the discovery of the non-industrial cavernous angioma is not compensable because it was not required to cure or relieve from the effects of the industrial injury, and that there is no evidence to support an award of future medical treatment on an industrial basis. Finally, the WCJ found that on the issue of the existence and amount of permanent disability, the

The rules the panel named

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

Labor Code section 4600

Labor Code section 4600 mandates employer-provided medical treatment for industrial injuries.

The Board applied LC 4600 to determine compensability of medical treatment before and after discovery of the non-industrial cavernous angioma.

From the decision · page 9Labor Code § 4600 states, in pertinent part, the following:

Granado v. Workers' Compensation Appeals Board (1968) 69 Cal.2d 399

Medical treatment is not legally apportionable between industrial and non-industrial causes.

Applicant's reliance on Granado was rejected because the industrial seizure did not aggravate the non-industrial condition, so treatment after discovery was non-industrial and not compensable.

From the decision · page 3We further note that in alleging the WCJ improperly apportioned medical treatment, applicant relies upon Rouseyrol v. Workers' Comp. Appeals Bd. (1991) 234 Cal.App.3d 1476 [56 Cal.Comp.Cases 624]. In Rouseyrol, the Court of Appeal determined that the Board erred in denying medical treatment in the form of attendant care, where due to polio the employee began work with limited use of his left upper extremity and an industrial injury further weakened it. The Court held that Labor Code section 4600 mandates treatment where it is established the industrial injury contributed to the need for treatment; the liability imposed by the statute cannot be avoided by apportioning the need for medical care to non-industrial causes on the premise that the natural progression of the pre-existing disease would have resulted in the same level of care even absent the industrial injury. (Rouseyrol, supra, 234 Cal.App.3d at 1485.)

Rouseyrol v. Workers' Comp. Appeals Bd. (1991) 234 Cal.App.3d 1476

The Board distinguished Rouseyrol v. Workers' Comp. Appeals Bd. (1991) 234 Cal.App.3d 1476 as factually different, where treatment was required because industrial injury contributed to need for care.

The Board found Rouseyrol inapplicable because the non-industrial condition was not aggravated by the industrial injury, so treatment after discovery was non-industrial.

From the decision · page 3We further note that in alleging the WCJ improperly apportioned medical treatment, applicant relies upon Rouseyrol v. Workers' Comp. Appeals Bd. (1991) 234 Cal.App.3d 1476 [56 Cal.Comp.Cases 624]. In Rouseyrol, the Court of Appeal determined that the Board erred in denying medical treatment in the form of attendant care, where due to polio the employee began work with limited use of his left upper extremity and an industrial injury further weakened it. The Court held that Labor Code section 4600 mandates treatment where it is established the industrial injury contributed to the need for treatment; the liability imposed by the statute cannot be avoided by apportioning the need for medical care to non-industrial causes on the premise that the natural progression of the pre-existing disease would have resulted in the same level of care even absent the industrial injury. (Rouseyrol, supra, 234 Cal.App.3d at 1485.)

ADJ10614987 · May 18, 2023

What the panel ordered

What was disputed, and how it came out

Your case already resembles someone else’s. Find whose.

The facts that decided it

What the panel did with the medical opinions

The rules the panel named

What proof carried it

About this page