What the panel ordered
Petition for Reconsideration granted; May 31, 2022 Findings of Fact rescinded; matter returned to WCJ for further proceedings and new decision.
Defendant sought reconsideration of the Findings of Fact issued by the WCJ on May 31, 2022, which found injury AOE/COE to applicant's respiratory system based on QME Dr. Gupta's reports; the WCJ recommended denial of reconsideration; the WCAB granted reconsideration, rescinded the Findings, and returned the matter to the WCJ for further proceedings.
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.
Dr. Gupta's reports do not constitute substantial evidence to support the finding of respiratory injury AOE/COE due to inconsistencies in the medical history and diagnoses by other physicians indicating cutaneous, not respiratory, Valley Fever.
From the decision · page 4Here, as noted above, the WCJ found that applicant sustained an injury to his respiratory system. (Finding #1, Findings p. 1.) In her May 20, 2019 treatment report Shubha Kerkar, M.D., diagnosed applicant as having, "1) Disseminated coccidioidomycosis [and] 2) Subcutaneous coccidioidomycosis." (Joint Exh. 1, pp. 72 § 73, review of medical records.) Subsequently, in several treatment reports, during the period from June 18, 2019, through December 19, 2019, Bachir Younes, M.D., diagnosed, "1) Cutaneous coccidioidomycosis 2) Disseminated coccidioidomycosis... [and] 6) skin lesions." (Joint Exh. 1, pp. 73 § 74 to 93 § 94.) Both doctors diagnosed disseminated coccidioidomycosis (infection in tissues other than the lungs) and subcutaneous/cutaneous coccidioidomycosis (on or under the skin) but neither doctor indicated that applicant had Valley Fever (infection in the lungs).The diagnoses made by Dr. Kerkar and Dr. Younes appear to differ from Dr. Gupta's diagnoses of Valley Fever as well as disseminated coccidioidomycosis. As a result, we are unable to determine whether the evidence indicates that applicant sustained a cutaneous injury, a respiratory injury, or both.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Dr. Gupta's medical-legal reports contained an inaccurate history of applicant's exposure to newly dug trenches, inconsistent with applicant's testimony.
Favours Applicant prevailed
This undermined the reliability of Dr. Gupta's opinion on injury AOE/COE to the respiratory system.
From the decision · page 4Further, in his June 27, 2020 report, QME Dr. Gupta said that applicant developed coccidioidomycosis after he worked, "as a field surveyor on a new construction site in Indio, with significant exposure to construction sites and newly dug trenches... ... It is clear from the history that he had significant exposure to construction sites and had as part of his work duties to review and evaluate freshly trenched previous undisturbed land." (Joint Exh. 1, pp. 9 - 10.) Earlier in his report Dr. Gupta had said, "These job duties were done until the beginning of November 2018." (Joint Exh. 1, p. 4.) However, applicant testified that, "[T]here was only one incident where he was near an open trench to test the level of the slurry..." (MOH/SOE, June 30, 2021, p. 8.) Clearly, Dr. Gupta's statements about the extent of applicant's work whereby he was exposed to "newly dug trenches" is inconsistent with applicant's testimony that he went to the trench site on one occasion. Prior to submitting his September 20, 2021 report (Joint Exh. 4) Dr. Gupta was provided the June 30, 2021 MOH/SOE that included applicant's testimony as to the actual amount of time he spent near an open trench. Unfortunately, Dr. Gupta did not acknowledge or otherwise address what appears to be a significant error in the history of applicant's employment, as stated in his medical-legal reports.
Medical diagnoses by Dr. Kerkar and Dr. Younes indicated cutaneous and disseminated coccidioidomycosis but not respiratory Valley Fever.
Favours Applicant prevailed
This conflicted with Dr. Gupta's diagnosis and contributed to the finding that his reports were not substantial evidence.
From the decision · page 4Here, as noted above, the WCJ found that applicant sustained an injury to his respiratory system. (Finding #1, Findings p. 1.) In her May 20, 2019 treatment report Shubha Kerkar, M.D., diagnosed applicant as having, "1) Disseminated coccidioidomycosis [and] 2) Subcutaneous coccidioidomycosis." (Joint Exh. 1, pp. 72 § 73, review of medical records.) Subsequently, in several treatment reports, during the period from June 18, 2019, through December 19, 2019, Bachir Younes, M.D., diagnosed, "1) Cutaneous coccidioidomycosis 2) Disseminated coccidioidomycosis... [and] 6) skin lesions." (Joint Exh. 1, pp. 73 § 74 to 93 § 94.) Both doctors diagnosed disseminated coccidioidomycosis (infection in tissues other than the lungs) and subcutaneous/cutaneous coccidioidomycosis (on or under the skin) but neither doctor indicated that applicant had Valley Fever (infection in the lungs).The diagnoses made by Dr. Kerkar and Dr. Younes appear to differ from Dr. Gupta's diagnoses of Valley Fever as well as disseminated coccidioidomycosis. As a result, we are unable to determine whether the evidence indicates that applicant sustained a cutaneous injury, a respiratory injury, or both.
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.
Applicant contracted Valley Fever in the course and scope of employment with significant exposure to construction sites and trenches; diagnosis included respiratory Valley Fever and disseminated coccidioidomycosis.
Dr. Gupta's opinion was found inconsistent with other physicians' diagnoses and applicant's testimony regarding exposure; his reports were not substantial evidence for respiratory injury AOE/COE.
From the decision · page 4Here, as noted above, the WCJ found that applicant sustained an injury to his respiratory system. (Finding #1, Findings p. 1.) In her May 20, 2019 treatment report Shubha Kerkar, M.D., diagnosed applicant as having, "1) Disseminated coccidioidomycosis [and] 2) Subcutaneous coccidioidomycosis." (Joint Exh. 1, pp. 72 § 73, review of medical records.) Subsequently, in several treatment reports, during the period from June 18, 2019, through December 19, 2019, Bachir Younes, M.D., diagnosed, "1) Cutaneous coccidioidomycosis 2) Disseminated coccidioidomycosis... [and] 6) skin lesions." (Joint Exh. 1, pp. 73 § 74 to 93 § 94.) Both doctors diagnosed disseminated coccidioidomycosis (infection in tissues other than the lungs) and subcutaneous/cutaneous coccidioidomycosis (on or under the skin) but neither doctor indicated that applicant had Valley Fever (infection in the lungs).The diagnoses made by Dr. Kerkar and Dr. Younes appear to differ from Dr. Gupta's diagnoses of Valley Fever as well as disseminated coccidioidomycosis. As a result, we are unable to determine whether the evidence indicates that applicant sustained a cutaneous injury, a respiratory injury, or both.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, 5952(d)
An award, order, or decision of the Appeals Board must be supported by substantial evidence.
Dr. Gupta's reports did not constitute substantial evidence for respiratory injury AOE/COE.
From the decision · page 5It is well established that an 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].) For the reasons discussed above, Dr. Gupta's reports do not constitute substantial evidence upon which a finding of respiratory injury AOE/COE may be based.
What proof carried it
The evidence the panel weighed, by kind.
Applicant's testimony that he was near an open trench only once, contradicting Dr. Gupta's history of significant exposure to newly dug trenches.
From the decision · page 4Further, in his June 27, 2020 report, QME Dr. Gupta said that applicant developed coccidioidomycosis after he worked, "as a field surveyor on a new construction site in Indio, with significant exposure to construction sites and newly dug trenches... ... It is clear from the history that he had significant exposure to construction sites and had as part of his work duties to review and evaluate freshly trenched previous undisturbed land." (Joint Exh. 1, pp. 9 - 10.) Earlier in his report Dr. Gupta had said, "These job duties were done until the beginning of November 2018." (Joint Exh. 1, p. 4.) However, applicant testified that, "[T]here was only one incident where he was near an open trench to test the level of the slurry..." (MOH/SOE, June 30, 2021, p. 8.) Clearly, Dr. Gupta's statements about the extent of applicant's work whereby he was exposed to "newly dug trenches" is inconsistent with applicant's testimony that he went to the trench site on one occasion. Prior to submitting his September 20, 2021 report (Joint Exh. 4) Dr. Gupta was provided the June 30, 2021 MOH/SOE that included applicant's testimony as to the actual amount of time he spent near an open trench. Unfortunately, Dr. Gupta did not acknowledge or otherwise address what appears to be a significant error in the history of applicant's employment, as stated in his medical-legal reports.
Medical records from Dr. Kerkar and Dr. Younes diagnosing cutaneous and disseminated coccidioidomycosis but not respiratory Valley Fever, conflicting with Dr. Gupta's diagnosis.
From the decision · page 4Here, as noted above, the WCJ found that applicant sustained an injury to his respiratory system. (Finding #1, Findings p. 1.) In her May 20, 2019 treatment report Shubha Kerkar, M.D., diagnosed applicant as having, "1) Disseminated coccidioidomycosis [and] 2) Subcutaneous coccidioidomycosis." (Joint Exh. 1, pp. 72 § 73, review of medical records.) Subsequently, in several treatment reports, during the period from June 18, 2019, through December 19, 2019, Bachir Younes, M.D., diagnosed, "1) Cutaneous coccidioidomycosis 2) Disseminated coccidioidomycosis... [and] 6) skin lesions." (Joint Exh. 1, pp. 73 § 74 to 93 § 94.) Both doctors diagnosed disseminated coccidioidomycosis (infection in tissues other than the lungs) and subcutaneous/cutaneous coccidioidomycosis (on or under the skin) but neither doctor indicated that applicant had Valley Fever (infection in the lungs).The diagnoses made by Dr. Kerkar and Dr. Younes appear to differ from Dr. Gupta's diagnoses of Valley Fever as well as disseminated coccidioidomycosis. As a result, we are unable to determine whether the evidence indicates that applicant sustained a cutaneous injury, a respiratory injury, or both.
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