ADJ11994125 · April 18, 2022

The Board found substantial evidence in QME Dr. Cremata's well-reasoned reports and deposition supporting the addition of impairment factors rather than combining them, resulting in a 59% permanent disability rating.

From the decision · page 1Applicant seeks reconsideration of the Findings and Award (F&A) issued by the workers' compensation administrative law judge (WCJ) on February 2, 2022, wherein the WCJ found in pertinent part that applicant sustained injury arising out of and occurring in the course of employment (AOE/COE) to her low back, left knee, and left ankle, and that the injury caused 52% permanent disability.

QME Dr. Cremata's well-reasoned reports and deposition established no overlap between lumbar spine impairments and left knee/ankle impairments, supporting addition of impairment ratings.

Favours Applicant prevailed

This medical opinion was the basis for the Board's decision to grant reconsideration and amend the permanent disability rating to 59%.

From the decision · page 4Here, in his March 5, 2020 report, QME Dr. Cremata said that the limitations on applicant's activities of daily living caused by the lumbar spine injury are "very different" than the limitations caused by the lower extremity injuries. He then stated that the "combined left ankle and left knee impairments should be added to the lumbar impairment to obtain the most accurate impairment for this patient." (Joint Exh. J3, p. 26, emphasis omitted.) During his deposition, as quoted above, Dr. Cremata gave a detailed explanation as to the differences in the impairments caused by applicant's low back and left leg/foot injuries. He also testified that he had considered the issue of overlap and he explained why there was no overlap of the impairment caused by the low back and left leg/foot injuries. (Joint Exh. J4, pp. 40 § 41.) Dr. Cremata's opinions were based on his examinations of applicant, the history he was given, and his review of the extensive medical record. His opinions,

Dr. Cremata diagnosed segmental and somatic dysfunction of the lumbar spine with degenerative joint disease and radiculopathy; left ankle and foot pain; left knee anterior cruciate ligament sprain with mild patellofemoral chondropathy. He concluded the condition reached MMI/P&S as of February 7, 2020, assigning 20% lumbar spine WPI, 3% left knee WPI, and 6% left ankle WPI. He opined that the lumbar impairment should be added to the combined left ankle and knee impairments for an accurate rating due to different functional impacts and no overlap.

Dr. Cremata explained the distinct mechanical nature of the knee and ankle impairments versus the lumbar radiculopathy, supporting addition rather than combination of impairments.

From the decision · page 1Chiropractic qualified medical examiner (QME) Edward E. Cremata, D.C., evaluated

Labor Code Section 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274; Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312; Bstandig v. Workers' Comp. Appeals Bd. (1977) 68 Cal.App.3d 988; Granado v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 399; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc)

Permanent disability rating must be supported by substantial evidence including well-reasoned medical reports and testimony.

The Board applied these standards to find Dr. Cremata's reports and deposition constituted substantial evidence supporting the permanent disability rating.

From the decision · page 4Any award, order, or decision of the Appeals Board must be supported by substantial evidence. (Lab. Code, § 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274, 281 [39 Cal.Comp.Cases 310]; Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312, 317 [35 Cal.Comp.Cases 500].) Medical proof is required on issues such as diagnosis, prognosis, disability, and treatment that are beyond the bounds of ordinary knowledge. (See Bstandig v. Workers' Comp. Appeals Bd. (1977) 68 Cal.App.3d 988, 996 [42 Cal.Comp.Cases 114].) 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]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc).)

AMA Guides 5th Edition (2001)

The AMA Guides 5th Edition provide methods for combining multiple impairments, allowing addition of impairments when no overlap exists.

The Board applied AMA Guides and case law (Athens Administrators v. WCAB (Kite)) to support adding impairments due to no overlap and distinct functional impacts.

From the decision · page 3Impairment, 5th Edition (2001) (AMA Guides):

Applicant's testimony describing pain and functional limitations in back, left knee, and left ankle affecting sleep, walking, standing, and housecleaning activities.

From the decision · page 7As a result of her industrial injury, she has pain in her back, left ankle, and left knee. The back pain goes down the left leg. The pain begins in the vicinity of the left knee and goes down to the ankle. Her pain starts in her back and goes down to the ankle when she extends her leg. Her sleep is disturbed because of pain in the back, left knee, and left ankle. Her walking is limited because of pain in the back, left ankle, and left knee. She has problems standing because of pain in her back, left knee, and left ankle. She has problems doing housecleaning due to pain in those three body parts. This includes mopping. (MOH/SOE, p. 4.)