ADJ11158729 · November 29, 2022

The WCJ's reliance on QME Dr. Friedman's reports was upheld as substantial evidence, while AME Dr. Angerman's reports were found not to be based on an adequate medical history and thus not substantial evidence.

From the decision · page 4Exh. A2, p. 2.) Although he repeatedly told the parties that he needed to review the medical records, as noted above, Dr. Angerman was not provided those records to review. Thus, his opinions are not based upon an adequate medical history, and in turn, are not substantial evidence. Regarding the reports from QME Dr. Friedman, it is well settled that the relevant and considered opinions of one physician, though inconsistent with other medical opinions, may constitute substantial evidence and that the Appeals Board may rely on the medical opinion of a single physician unless it is "based on surmise, speculation, conjecture, or guess." (Place v. Workmen's Comp. Appeals. Bd. (1970) 3 Cal.3d 372, 378 [35 Cal.Comp.Cases 525, 529].) Applicant argues that Dr. Friedman's opinions as to the issue of impairment "do not correlate with the reviewed diagnostic study [lumbar MRI]." (Petition, p. 4.) It is important to note that pursuant to the American Medical Association Guides to the Evaluation of Permanent Impairment, (AMA Guides):

Dr. Angerman was not provided with complete medical records, including records of a 1992 injury and epidural injections, which made his medical opinions not based on an adequate medical history.

Favours Defendant prevailed

This lack of complete medical records led the WCJ to reject Dr. Angerman's opinions as insubstantial evidence and rely on Dr. Friedman's reports instead.

From the decision · page 4Exh. A2, p. 2.) Although he repeatedly told the parties that he needed to review the medical records, as noted above, Dr. Angerman was not provided those records to review. Thus, his opinions are not based upon an adequate medical history, and in turn, are not substantial evidence. Regarding the reports from QME Dr. Friedman, it is well settled that the relevant and considered opinions of one physician, though inconsistent with other medical opinions, may constitute substantial evidence and that the Appeals Board may rely on the medical opinion of a single physician unless it is "based on surmise, speculation, conjecture, or guess." (Place v. Workmen's Comp. Appeals. Bd. (1970) 3 Cal.3d 372, 378 [35 Cal.Comp.Cases 525, 529].) Applicant argues that Dr. Friedman's opinions as to the issue of impairment "do not correlate with the reviewed diagnostic study [lumbar MRI]." (Petition, p. 4.) It is important to note that pursuant to the American Medical Association Guides to the Evaluation of Permanent Impairment, (AMA Guides):

Dr. Friedman diagnosed and rated permanent disability for two industrial low back injuries, providing substantial evidence for the disability ratings and apportionment.

The WCJ relied on Dr. Friedman's reports as substantial evidence for the disability ratings and apportionment.

From the decision · page 2Given his significant limitations as noted under the section of ADLs, e.g., difficulty sitting, standing, and climbing stairs, I would add a 3% whole person impairment rating for a combined 11% whole person impairment rating. (Def. Exh. B, Dr. Friedman, July 28, 2018, p. 8.) As to the issue of apportionment, Dr. Friedman stated: On reviewing medical records, testimony, etc., it is my medical opinion... since I have no history of prior lumbar spine disability, 40% of the patient's lumbar disability would be secondary to his injury of September 28, 2016 and 60% due to his second injury on August 12, 2017. (Def. Exh. B, p. 7.)

Dr. Angerman's reports were found not to be substantial evidence because they were not based on an adequate medical history and the medical records provided were incomplete.

Dr. Angerman was not provided with complete medical records and his opinions were therefore not based on an adequate medical history, making them insubstantial evidence.

From the decision · page 4Exh. A2, p. 2.) Although he repeatedly told the parties that he needed to review the medical records, as noted above, Dr. Angerman was not provided those records to review. Thus, his opinions are not based upon an adequate medical history, and in turn, are not substantial evidence. Regarding the reports from QME Dr. Friedman, it is well settled that the relevant and considered opinions of one physician, though inconsistent with other medical opinions, may constitute substantial evidence and that the Appeals Board may rely on the medical opinion of a single physician unless it is "based on surmise, speculation, conjecture, or guess." (Place v. Workmen's Comp. Appeals. Bd. (1970) 3 Cal.3d 372, 378 [35 Cal.Comp.Cases 525, 529].) Applicant argues that Dr. Friedman's opinions as to the issue of impairment "do not correlate with the reviewed diagnostic study [lumbar MRI]." (Petition, p. 4.) It is important to note that pursuant to the American Medical Association Guides to the Evaluation of Permanent Impairment, (AMA Guides):

Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc)

A medical opinion must be based on pertinent facts, an adequate examination and accurate history, and must set forth the basis and reasoning in support of the conclusions to be substantial evidence.

The WCJ applied this standard to evaluate the substantiality of the medical opinions from Dr. Friedman and Dr. Angerman.

From the decision · page 4DISCUSSION To be substantial evidence a medical opinion must be based on pertinent facts, on an adequate examination and accurate history, and it must set forth the basis and the reasoning in support of the conclusions. (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc).) When a physician's report is well-reasoned, is not speculative, is based on an adequate history and examination, and sets forth the reasoning behind the physician's opinion, not merely his or her conclusions; the report constitutes substantial evidence. (Granado v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 399 [33 Cal.Comp.Cases 647 McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408 [33 Cal.Comp.Cases 660].) A medical opinion is not substantial evidence if it is based on facts no longer germane, or on an inadequate medical history or examination. (Hegglin v. Workmen's Comp. Appeals Bd.

Dr. Angerman was not provided with complete medical records, including records of a 1992 injury and epidural injections, which affected the adequacy of his medical history and the substantiality of his opinions.

From the decision · page 10Dr. Angerman reviewed the medical records provided to him, which included Dr. Friedman's QME report but does not appear to have included Dr. Darakjian's PR-4 report. Joint Exhibit A-3: AME Report of Alexander Angerman, M.D. 5/17/2019 pp.14-15. Dr. Angerman indicated that he had not been provided with records of a 1992injury disclosed by Petitioner nor records of the epidural injections received by Petitioner. Joint Exhibit A-3: AME Report of Alexander Angerman, M.D. 5/17/2019 p.17. Dr. Angerman was provided with the September 2016 Stockdale Radiology MRI scans (obtained between the injuries) but not the September 2017 Kern Radiology MRI scans (obtained after the second injury). Joint Exhibit A-3: AME Report of Alexander Angerman, M.D. 5/17/2019 pp. 9-10.