ADJ10997880 · August 28, 2023

The WCJ found the physical injuries did not constitute a catastrophic injury under Cal. Lab. Code sec. 4660.1(c)(2)(B), and deferred the permanent disability rating and hypertension injury issues pending further medical development.

From the decision · page 72. The issue of injury in the form of hypertension is deferred with jurisdiction reserved.

The physical injuries did not meet the definition of catastrophic injury under Cal. Lab. Code sec. 4660.1(c)(2)(B) as they were not progressive, not analogous to specified losses, and the patient worked during most of the temporary disability period.

Favours Defendant prevailed

This led to limiting the psychiatric impairment rating under the statute and deferring permanent disability rating and hypertension injury issues.

From the decision · page 6The first and most important aspect is to realize that the injury must be catastrophic absent any consideration for the psychiatric impairment per se. So, it is only the physical injury that can lead to a finding of catastrophic injury.

Found 20% whole person impairment (WPI) for coronary artery disease (CAD) with 20% apportionment to non-industrial factors; found 10% WPI for hypertension but not work-related; found 5% WPI for hemorrhagic disorder due to Plavix use; supported 40% WPI for CAD in supplemental report; rejected apportionment for hemorrhagic dysfunction as it was a direct result of work injury.

His detailed medical file showed pre-existing hypertension not worsened by work; hemorrhagic dysfunction was caused by work injury medication; supported increased CAD rating in supplemental report.

From the decision · page 3The parties selected Dr. Paul Grodan as the PQME in internal medicine. His initial report showed a very stressful work environment (Court's Ex. X-1). But the doctor had no records, so he could not finalize his analysis. After reviewing a voluminous file Dr. Grodan declared Applicant to be P&S in Ex. X-2 (12/9/2018). The factors were 20% wpi for coronary artery disease as described in Ch. 3 of the AMA Guides. He apportioned 20% to non-industrial factors most of which was pre-existing hypertension that was often out of control, obesity and a previous bought with cancer. He felt the patient had a 10% wpi for hypertension as described in Ch.4 of the AMA Guides, but that the detailed medical file demonstrated pre-existing hypertension. Hence hypertension was not work-related since his blood pressure was worse before his employment.

Diagnosed ratable depression with anxiety; found 2/3 of psychiatric impairment was compensable consequence of heart injury; 1/3 impairment due to work stress per se.

His report concluded psychiatric impairment was largely due to heart injury, with a portion due to work stress; this was considered in the permanent disability rating.

From the decision · page 4Dr. Grodan did recommend a psychiatric consult which resulted in Dr. Joshua Pretzky acting as QME (Ex. Y-2). He diagnosed ratable depression with anxiety. There is no doubt at all that the depression and anxiety were caused by the patient's concern for his heart condition. In fact, virtually the entire report from Dr. Pretzky only leads to that conclusion. However, at the end of the report he comments that much of the unreliable results on the MMPI testing stem from Applicant's response to the employment stress per se. Consequently Dr. Pretsky concludes that a portion of the impairment (1/3) is the result of work stress per se. The remaining impairment (2/3) is a compensable consequence of the heart injury. (Ex. Y-2).

Cal. Lab. Code sec. 4660.1(c)

Cal. Lab. Code sec. 4660.1(c) regarding limitation on psychiatric impairment ratings except for catastrophic injuries.

Applied to determine if psychiatric impairment rating should be limited or increased due to catastrophic injury status.

From the decision · page 5Cal. Lab. Code sec. 4660.1 defines permanent disability. Subsection (c)(1) states:

Applicant's testimony and medical records showed he worked during the period he received EDD benefits, entitling Defendant to credit for days worked during temporary disability.

From the decision · page 5However, Applicant worked during that period while he collected EDD benefits at the same time. So, while EDD is entitled to full reimbursement, Defendant is entitled to credit for the period of time worked during that period. Hence Findings of Fact # 10 allows the Defendant credit for those days worked.