ADJ11236772 · April 4, 2025

The Appeals Board affirmed the WCJ's finding that there was no substantial evidence to support a cumulative injury claim during the specified period.

From the decision · page 2We have reviewed the record in this matter, the allegations of the Petition for Reconsideration and the Answer, as well as the contents of the Report. For the reasons set forth below, we grant reconsideration in order to amend the WCJ's decision to find that applicant sustained a specific injury AOE/COE to her head and right upper extremity only on June 24, 2015 in ADJ11236772 (Findings of Fact no. 1, Order), and to include findings of fact that as a result of her specific injury applicant did not suffer disability and does not require any future medical care. Otherwise, we affirm the WCJ's decision as to applicant's cumulative injury in ADJ11236942.

The Appeals Board found substantial evidence to support a specific injury on June 24, 2015 to the head and right upper extremity, based on stipulations and medical records, but no disability or future medical care was supported.

From the decision · page 2We have reviewed the record in this matter, the allegations of the Petition for Reconsideration and the Answer, as well as the contents of the Report. For the reasons set forth below, we grant reconsideration in order to amend the WCJ's decision to find that applicant sustained a specific injury AOE/COE to her head and right upper extremity only on June 24, 2015 in ADJ11236772 (Findings of Fact no. 1, Order), and to include findings of fact that as a result of her specific injury applicant did not suffer disability and does not require any future medical care. Otherwise, we affirm the WCJ's decision as to applicant's cumulative injury in ADJ11236942.

The parties stipulated that applicant sustained a specific injury on June 24, 2015 to the head and right upper extremity.

Favours Applicant prevailed

The stipulation was binding and supported by medical records, leading to the grant of reconsideration and amendment of the decision to find the injury.

From the decision · page 3Next, the parties stipulated that applicant sustained a specific injury on June 24, 2015 to the head and right upper extremity only arising out of and in the course of her employment as a program specialist for defendant Morgan Hill Unified School District (June 24, 2025 specific injury) (Minutes of Hearing and Summary of Evidence, July 3, 2024, p. 2; Pre-Trial Conference Statement, August 30, 2023, p. 2A, Stipulations; see Def. Exh. H, p. 1 [defendant accepted June 24, 2015 injury].) Applicant's medical records from The Permanent Medical Group corroborate the parties' stipulation. (Def. Exh. E, Kaiser Records, at BATES 2481-2516, 2701-2704, 2843- 2846.)

Medical opinions from Dr. Moore and Dr. Feinberg concluded that applicant's condition was pre-existing and not industrially caused, with no disability or future medical care needed.

Favours Defendant prevailed

These opinions were relied upon by the Appeals Board to deny disability and future medical care and to reject cumulative injury claims.

From the decision · page 8The medical record indicates applicant has a long and complex history of pre- existing complaints of migraines, jaw, neck, and upper extremity pain. She underwent jaw surgery with a plate inserted in her left sinus in 1996. Notably, applicant was discharged from care the following day after the 6/24/2015 incident, and the medical record is devoid of any further complaints related to that incident. Dr. Moore and Dr. Feinberg both reviewed and summarized applicant's extensive medical record and opined that applicant's condition is not industrial. The undersigned found Dr. Chen's reports not substantial medical evidence as there is no indication that Dr. Chen reviewed applicant's extensive medical record. Further, due to the conflict of interest with applicant's former counsel, the undersigned is unable to rely on Dr. Chen's opinion. Dr. Moore and Dr. Feinberg examined the applicant, reviewed her extensive medical record and deposition transcript, and concluded that applicant's complaints are all pre-existing and not related to the 6/24/2015 incident nor to cumulative trauma.

Concluded no medical evidence that the 6/24/2015 industrial injury exacerbated or aggravated pre-existing conditions; injuries were pre-existing and not industrially caused.

Reviewed extensive medical records and found no evidence of industrial causation or exacerbation of pre-existing conditions.

From the decision · page 6On 10/05/2020, Dr. Moore re-examined applicant, reviewed and summarized extensive Kaiser Permanente medical records dating back to 2010, and the reports of Dr. Chen. He issued a comprehensive 112-page report noting applicant's symptoms of jaw pain, neck pain, left shoulder and left foot worsening and complaints of worsening jaw and neck pain in the last year and a half. However, on page 105, under diagnosis and causation, Dr. Moore concluded the following:

Assigned permanent impairment ratings but did not find apportionment to prior conditions because applicant had no prior injuries to relevant body parts before working at Morgan Hill USD.

Based on examination and opinion dated 11/15/2019, but conflicted with other medical opinions and was not relied upon due to conflict of interest and lack of record review.

From the decision · page 5Applicant was referred by her attorney to Christopher Chen, M.D., who issued a special primary treating physician report, dated 11/15/2019. He found applicant was permanent and stationary as of 11/15/2019. Dr. Chen assigned 49% WPI for her sinus, nose, and difficulties with breathing, 8% WPI for the cervical spine, and 6% WPI for the bilateral upper extremities. Dr. Chen indicated he did not find apportionment to prior conditions "because prior

Concluded it is not medically probable that any current maladies and complaints are related to employment; work may have aggravated underlying condition but did not contribute to current disability; 100% of condition is nonindustrial.

Examined applicant and reviewed records and deposition; found no medical basis for industrial causation or disability from the 6/24/2015 injury.

From the decision · page 7Due to the conflicting reports and defendant's objection to Dr. Chen's reporting due to the conflict of interest, Steven Feinberg, M.D. was assigned as an Independent Medical Evaluator to opine on AOE/COE for the specific and cumulative trauma claims. On 3/28/2023, Dr. Feinberg examined the applicant, and summarized her extensive medical record and deposition transcript. Dr. Feinberg noted applicant stated she had pre-existing headaches and neck pain related to TMJ problems, but that there had been a worsening of symptoms, which she attributed to her repetitive job duties. Dr. Feinberg discussed applicant's complaints and medical history and opined, "from a medical standpoint, it is probable that she brought to this June 2015 injury significant prior problems/disability with a history of cervical, lumbar and TMJ related issues.

E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922

A medical opinion must be based on reasonable medical probability and supported by substantial evidence; opinions based on speculation or inadequate histories are not substantial evidence.

The Appeals Board applied this standard to evaluate the medical opinions and found some opinions speculative and others supported by medical records.

From the decision · page 4Next, a decision of the Workers' Compensation Appeals Board must be supported by substantial evidence, and to be considered substantial evidence, a medical opinion "must be predicated on reasonable medical probability." (E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 413, 416-17, 419 [33 Cal.Comp.Cases 660].) An opinion is not substantial evidence if it is based on "inadequate medical histories or examinations, on incorrect legal theories, or on surmise, speculation, conjecture, or guess." (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 620-21 (Appeals Bd. en banc).)

Applicant's extensive medical records and deposition testimony showing pre-existing conditions and lack of new injury symptoms after 6/24/2015 injury

From the decision · page 8The medical record indicates applicant has a long and complex history of pre- existing complaints of migraines, jaw, neck, and upper extremity pain. She underwent jaw surgery with a plate inserted in her left sinus in 1996. Notably, applicant was discharged from care the following day after the 6/24/2015 incident, and the medical record is devoid of any further complaints related to that incident. Dr. Moore and Dr. Feinberg both reviewed and summarized applicant's extensive medical record and opined that applicant's condition is not industrial. The undersigned found Dr. Chen's reports not substantial medical evidence as there is no indication that Dr. Chen reviewed applicant's extensive medical record. Further, due to the conflict of interest with applicant's former counsel, the undersigned is unable to rely on Dr. Chen's opinion. Dr. Moore and Dr. Feinberg examined the applicant, reviewed her extensive medical record and deposition transcript, and concluded that applicant's complaints are all pre-existing and not related to the 6/24/2015 incident nor to cumulative trauma.

Conflict of interest with applicant's former counsel affecting weight of Dr. Chen's opinion

From the decision · page 8The medical record indicates applicant has a long and complex history of pre- existing complaints of migraines, jaw, neck, and upper extremity pain. She underwent jaw surgery with a plate inserted in her left sinus in 1996. Notably, applicant was discharged from care the following day after the 6/24/2015 incident, and the medical record is devoid of any further complaints related to that incident. Dr. Moore and Dr. Feinberg both reviewed and summarized applicant's extensive medical record and opined that applicant's condition is not industrial. The undersigned found Dr. Chen's reports not substantial medical evidence as there is no indication that Dr. Chen reviewed applicant's extensive medical record. Further, due to the conflict of interest with applicant's former counsel, the undersigned is unable to rely on Dr. Chen's opinion. Dr. Moore and Dr. Feinberg examined the applicant, reviewed her extensive medical record and deposition transcript, and concluded that applicant's complaints are all pre-existing and not related to the 6/24/2015 incident nor to cumulative trauma.