ADJ12936570 · February 17, 2026

The Board found that the parties had not established whether the presumption applies, so the issue of rebuttal was premature; the QME report was inadequate to rebut the presumption; thus, the matter was returned to the trial level for further proceedings to determine applicability of the presumption.

From the decision · page 4statutory presumption; however, the parties have not established whether applicant is subject to

Parties did not establish whether applicant is subject to the presumption of compensability under Labor Code section 3212.2.

Favours neutral

Because the presumption's applicability was not established, the issue of rebuttal was premature and the matter was returned to trial level for further proceedings.

From the decision · page 4statutory presumption; however, the parties have not established whether applicant is subject to

QME report did not constitute substantial evidence to rebut the presumption due to inadequate history and improper medical opinion on job stress causation.

Favours Applicant prevailed

This led to the conclusion that defendant did not meet its burden of rebuttal on the present record.

From the decision · page 4compensability as the current reporting of the QME does not constitute substantial evidence. The

Diagnosed hypertension and mild left ventricular hypertrophy; opined 100% nonindustrial causation for hypertension, stating nursing job stress was not a significant contributing factor.

QME report did not constitute substantial evidence to rebut presumption due to inadequate history and improper medical opinion on job stress causation.

From the decision · page 2FACTS Applicant was employed as a registered nurse when he claims to have sustained a cumulative injury through January 29, 2020 to his heart and in the form of hypertension. (Minutes of Hearing and Summary of Evidence, February 2, 2022, p. 2, lines 4-8.) This matter proceeded to trial on the issue of injury arising out of and occurring in the course of employment and "Whether or not the presumption is rebutted by the PQME's findings." (Id. at p. 2, lines 21-24.) Although the framing of the issue implies that the parties agreed that applicant is subject to the presumption of compensability under Labor Code2 section 3212.2, the parties did not stipulate to such a fact. Applicant was seen by qualified medical evaluator (QME) Richard Friedman, M.D., who authored one report in evidence and was deposed. Dr. Friedman took a history of work duties as follows: This 53-year-old male was working as a registered nurse at Calipatria State Prison. He states that he had been doing this for approximately six years and had been a nurse for approximately 10 years. He currently works in the Emergency Room then triage and treatment and states he works approximately 60 hours per week at the present time.

Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc)

A medical opinion must be framed in terms of reasonable medical probability, not speculative, based on pertinent facts and adequate examination and history, and must set forth reasoning in support of conclusions.

The QME report was found inadequate to rebut the presumption because it lacked adequate history and proper medical reasoning.

From the decision · page 3DISCUSSION 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).) "When the foundation of an expert's testimony is determined to be inadequate as a matter of law, we are not bound by an apparent conflict in the evidence created by his bare conclusions." (People v. Bassett (1968) 69 Cal.2d 122, 139.) The WCJ and the Appeals Board have a duty to further develop the record where there is insufficient evidence on an issue. (McClune v. Workers' Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117, 1121-1122 [63 Cal.Comp.Cases 261].) The Appeals Board has a constitutional mandate to "ensure substantial justice in all cases." (Kuykendall v. Workers' Comp. Appeals Bd. (2000) 79 Cal.App.4th 396, 403 [65 Cal.Comp.Cases 264].) The Board may not leave matters undeveloped where it is clear that additional discovery is needed. (Id. at p. 404.) The preferred procedure is to allow supplementation of the medical record by the physicians who have already reported in the case. (McDuffie v.

QME did not take an adequate history of stress on the job; QME injected personal opinion that stress level was no different than other nurses; no evidence produced by defendant to establish this fact

From the decision · page 4compensability as the current reporting of the QME does not constitute substantial evidence. The