ADJ11372081 — California WCAB 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.

Permanent disability ratingApplicant prevailedhead · right shoulder · neck · low back · TMJ · left ear tinnitus · both eyes · loss of consciousness · psyche · left wrist · left index finger · left hand · bilateral hearing loss

The WCJ's apportionment analysis of Dr. Wilson was substantial evidence, but Dr. Friedman's apportionment analysis was not substantial evidence. Applicant's disabilities should be added rather than combined, resulting in a permanent disability percentage exceeding 100 percent, supporting a finding of permanent and total disability.

From the decision · page 1Applicant and defendant Webcor Construction, insured by Property and Casualty Insurance Company of Hartford (defendant) each seek reconsideration of the August 28, 2025 Joint Findings and Award (F&A), wherein the workers' compensation administrative law judge (WCJ) found in Case No. ADJ11372081 that applicant, while employed as a day laborer on March 28, 2018, sustained industrial injury to his head, headaches, right shoulder, neck, low back, TMJ, left ear tinnitus, both eyes, loss of consciousness, and psyche, resulting in permanent total disability. After application of nonindustrial apportionment, the WCJ awarded 80 percent permanent partial disability. In ADJ15621674, the WCJ found that applicant, while similarly employed from March 1, 2017 to May 18, 2018, sustained industrial injury in the form of bilateral hearing loss resulting in no ratable permanent disability. In ADJ11645081, applicant while similarly employed on June 20, 2017, sustained industrial injury to his left wrist, left index finger, and left hand, resulting in 14 percent permanent partial disability.

The facts that decided it

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

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.

AMEGiven great weight · psychiatry

Dr. Friedman opined that applicant's various disability ratings should be added rather than combined under the combined values chart (CVC), and identified 20 percent nonindustrial apportionment.

The WCJ found Dr. Friedman's psychiatric apportionment analysis appropriate for the psychiatric injury but not for non-psychiatric body parts, and gave great weight to his opinion on adding impairments rather than combining them.

QMEGiven great weight · neurology/neurosurgery

Dr. Edelman identified daily headaches related to direct trauma to the head and cervicogenic pain, rating the condition as 8 percent whole person impairment by analogy to a DRE Cervical Category II.

The WCJ and panel found Dr. Edelman's opinion on neurologically mediated headaches credible and part of the ratable disability.

From the decision · page 15In addition to the orthopedic disability described by Dr. Wilson and the psychiatric disability described by Dr. Friedman, we also observe that applicant's ratable disability includes neurologically mediated headaches. Neurosurgery QME Dr. Edelman has observed that applicant suffers from daily headaches related in part to "direct trauma to the head," and to "cervicogenic pain radiating into the back of the head." (Ex. X18, Report of Fredric Edelman, M.D., dated October 4, 2022, at p. 12.) Dr. Edelman diagnosed a "post-traumatic head syndrome which includes a traumatic brain injury." (Id. at p. 13; Ex. X21, Transcript of the Deposition of Fredric Edelman, M.D., dated July 27, 2023, at p. 17:1.) However, the QME has also observed, "the AMA Guides do not address post-traumatic head syndrome or post-traumatic headache." (Ibid.) Accordingly, the QME has rated applicant's condition by analogy to "a DRE Cervical Category II, 8 percent Impairment of the Whole Person. (Table 15-5, Page 392 of the AMA Guides 5th Edition.)" (Ibid.)

AMEGiven great weight · orthopedic medicine

Dr. Wilson opined that injuries to the left wrist, hand, and index finger are solely attributable to the June 1, 2017 injury, and his apportionment analysis was substantial evidence.

The panel found Dr. Wilson's apportionment analysis substantial evidence and relied on it to separate the June 1, 2017 injury ratings from the March 28, 2018 injury ratings.

From the decision · page 11in nature. (See Minutes of Hearing, dated March 3, 2025, at p. 5:4.) Pursuant to the opinions of orthopedic AME Dr. Wilson, applicant's injuries to the left wrist, hand, and index finger are solely attributable to his June 1, 2017 injury. (Ex. X29, Report of Robert Wilson, M.D., dated September 11, 2022, at p. 5.) Applicant cites to no other opinions in the record that would otherwise establish an inability of an evaluating physician to "parcel out, with reasonable medical probability, the approximate percentages to which each distinct industrial injury causally contributed to the employee's overall permanent disability." (Benson, supra, at p. 1560.) Accordingly, and pursuant to section 4663 and Benson, supra, the injured body parts and their corresponding percentages of permanent disability arising out of the June 1, 2017 injury are distinct from the injured body parts and corresponding permanent disability arising out of the March 28, 2018 injury.

The rules the panel named

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

Labor Code section 4660.1; Brodie v. Workers' Comp. Appeals Bd. (2007) 40 Cal.4th 1313; Almaraz v. Environmental Recovery Service/Guzman v. Milpitas Unified School District (2009) 74 Cal.Comp.Cases 1084

Permanent disability is determined by whole person impairment under the AMA Guides and the Permanent Disability Rating Schedule, considering the effect on future earning capacity.

Applied to assess permanent disability ratings and the method of combining impairments.

From the decision · page 9Section 4660.1 provides that permanent disability is determined by consideration of whole person impairment within the four corners of the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition (AMA Guides), as applied by the Permanent Disability Rating Schedule (PDRS) in light of the medical record and the effect of the injury on the worker's future earning capacity. (Brodie v. Workers' Comp. Appeals Bd. (2007) 40 Cal.4th 1313, 1320 [72 Cal.Comp.Cases 565] ["permanent disability payments are intended to compensate workers for both physical loss and the loss of some or all of their future earning capacity"]; Department of Corrections & Rehabilitation v. Workers' Comp. Appeals Bd. (Fitzpatrick) (2018) 27 Cal.App.5th 607, 614 [83 Cal.Comp.Cases 1680]; Almaraz v. Environmental Recovery Service/Guzman v. Milpitas Unified School District (2009) 74 Cal.Comp.Cases 1084 (Appeals Board en banc) as affirmed by the Court of Appeal in Milpitas Unified School Dist. v. Workers' Comp. Appeals Bd. (Guzman) (2010) 187 Cal.App.4th 808 [75 Cal.Comp.Cases 837].)

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

A medical opinion must be framed in terms of reasonable medical probability, based on pertinent facts and adequate examination, and must set forth reasoning supporting its conclusions.

Applied to evaluate the sufficiency of medical opinions, including the use of the term 'synergy' in impairment ratings.

From the decision · page 19We cannot emphasize enough that to constitute substantial evidence "...a medical opinion must be framed in terms of reasonable medical probability, it must not be speculative, it must be based on pertinent facts and on an adequate examination and history, and it must set forth reasoning in support of its conclusions." (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc), (emphasis added).) The term `synergy' is not a "magic word" that immediately rebuts the use of the CVC. Instead, a physician must set forth a reasoned analysis explaining how and why synergistic ADL overlap exists. If parties are searching for a magic word to use during a doctor's deposition, that word is "Why?". Rather than focusing on whether a specific term, including the term synergy, was used, it is imperative that parties focus on an analysis that applies critical thinking based on the principles articulated in Escobedo to support a conclusion based on the facts of the case. Such an analysis must include a detailed description of the impact of ADLs and how those ADLs interact.

ADJ11372081 · November 17, 2025

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