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
Diagnosed nonindustrial cervical spine strain, degenerative joint disease in shoulders and left ankle, and right ankle fracture from prior industrial claim; found no new industrial injury; concluded all current complaints fall outside workers' compensation.
Relied on lack of contemporaneous complaints, radiographic evidence of degenerative changes, and delayed onset of orthopedic pain after legal representation.
From the decision · page 3PQME Dr. Shokes diagnosed a nonindustrial cervical spine strain, nonindustrial
degenerative joint disease in the bilateral shoulders and left ankle, and a right ankle tibial fracture
related to a previous industrial claim. He noted that applicant initially sought treatment for an eye
injury involving water and meat product splash on June 15, 2017. While he underwent treatment
for diabetes, hypertension, and nerve palsies, his neurologist eventually removed him from the
workplace on September 5, 2017. He did not report any orthopedic injuries to his supervisors prior
to his departure. He first complained of orthopedic pain in June 2018 after seeking legal
representation. Applicant resisted joint motion and reported non-anatomical pain during various
testing modalities. Radiographic evidence confirmed degenerative changes and a prior fracture,
but PQME Dr. Shokes found no evidence of a new industrial injury. He emphasized that applicant
performed his regular duties without complaint or medical treatment for these areas until several
months after he stopped working. Consequently, PQME Dr. Shokes concluded that all current
bodily complaints fall outside of the workers' compensation system. (Id. at pp. 29-30.)
PTPPartially credited
Diagnosed overuse syndrome with bilateral shoulder sprains, right shoulder bursitis, left shoulder labrum tear with tendinosis, bilateral cubital tunnel syndrome, left elbow ligament sprains, bilateral wrist and ankle sprains, ganglion cysts, mild osteoarthritis, toxic eye exposure worse on left, and myasthenia gravis; concluded causation primarily work-related due to cumulative trauma from butcher duties.
Based on clinical findings and history of repetitive job duties causing cumulative trauma.
From the decision · page 2In his permanent and stationary report from March 11, 2020, Dr. Mays diagnosed overuse
syndrome featuring bilateral shoulder sprains, right shoulder bursitis, and a left shoulder labrum
tear with tendinosis. He also identified bilateral cubital tunnel syndrome, left elbow ligament
sprains, and bilateral wrist and ankle sprains. The findings included ganglion cysts and tendinosis
in the wrists, mild osteoarthritis in the ankles, toxic eye exposure worse on the left, and myasthenia
gravis. Dr. Mays concluded that causation of applicant's orthopedic claims was primarily work-
related due to cumulative trauma sustained while performing customary butcher duties for two
years. (Id. at pp. 7-8.)
QMENot substantial evidence · ophthalmology
Performed ophthalmological evaluation; took history of animal blood products splash to face and eyes; no causation conclusion stated in excerpt.
From the decision · page 3The medical evidence separately addressed the claimed specific injury to the left eye and
its sequelae to the neurological system, the circulatory and endocrine systems, and the psyche. In
his report dated September 21, 2020, PQME Dr. Sami, after performing an ophthalmological
evaluation of applicant, took a history that animal blood products splashed onto his face and eyes.
QMEPartially credited · internal medicine
Diagnosed preexisting hypertension and diabetes; deferred causation pending neurological evaluation; later concluded myasthenia gravis was nonindustrial and prednisone treatment lacked industrial causation; determined no industrial causation for hypertension and diabetes aggravation.
Relied on neurological evaluation finding myasthenia gravis nonindustrial; did not consider later supplemental neurological report.
From the decision · page 5In his report dated November 7, 2020, PQME Dr. Gupta, after performing an internal
evaluation of applicant, took a history that he reported that animal blood splattered into his left eye
on June 15, 2017, causing him to seek treatment at Martin Luther King Emergency Room.
(Joint Ex. 11, p. 2.) He claimed the subsequent work stress from ridicule from his co-workers due
to his eye injury aggravated his preexisting diabetes. (Id. at p. 3.) During the physical examination,
PQME Dr. Gupta recorded a significantly elevated blood pressure of 188 over 112. He diagnosed
applicant with preexisting hypertension and diabetes. (Id. at p. 9.) PQME Dr. Gupta noted that
applicant takes prednisone to treat his myasthenia gravis. PQME Dr. Gupta deferred his causation
determination pending a neurological evaluation. He explained that, if the neurologist found the
myasthenia gravis industrial, the resulting prednisone use and subsequent aggravation of
hypertension and diabetes would also be industrial. (Id. at p. 10.)
QMERelied upon · psychiatry
Performed psychiatric evaluation; found no compensable psychiatric injury; psychological testing showed exaggeration pattern; minimal anxiety or depression; concluded no psychiatric condition compensable under workers' compensation.
Based on mental status exam, psychological testing, and lack of endorsed mental health symptoms.
From the decision · page 5In his report dated January 29, 2019, PQME Dr. Rodriguez, after performing a psychiatric
evaluation of applicant, took a history of his employment as a butcher and described physical
injuries including a June 15, 2017, incident where meat blood splashed into his left eye. (Joint Ex.
2, p. 8.) He reported experiencing workplace harassment following this injury and noted that
co-workers teased him about his eye and called him offensive names. (Id. at p. 10.) Despite these
allegations, he denied experiencing any significant depression or anxiety and explicitly stated he
did not feel discouraged or irritable. (Id. at pp. 10, 15.) PQME Dr. Rodriguez conducted a mental
status examination and recorded normal findings across all objective categories including
appearance, behavior, speech, mood, and thought processes. (Id. at pp. 14-15.) Psychological
testing via the MMPI showed an exaggeration pattern regarding medical complaints while the
QMENot substantial evidence · neurology
Performed neurological evaluation; concluded myasthenia gravis was nonindustrial; issued supplemental report indicating toxic exposure exacerbated condition; report issued after Gupta's evaluation and not reviewed by Gupta.
From the decision · page 4PQME Dr. Espy issued a supplemental report on January 11, 2022, after reviewing
766 additional pages of medical records. The updated history indicated that Harbor-UCLA
Medical Center treated applicant on August 6, 2019, for severe dysphagia and dysarthria after he
was without myasthenia gravis medications for one month. (Joint Ex. 12, p. 2.) He underwent a
thymectomy on November 13, 2020. (Id. at p. 6.) PQME Dr. Espy concluded, in contrast to his