What the panel ordered
Petition for Reconsideration denied
Petition for Reconsideration filed by defendant and denied by the WCAB panel
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.
The QME Dr. Fujinaka's opinion was found to be substantial medical evidence supporting industrial causation, consistent with applicant's credible testimony and unrebutted by other medical opinions.
From the decision · page 5The opinion of the QME, Dr. Fujinaka, on the other hand, deals more directly with the issue of causation of applicant's right hand condition. Dr. Fujinaka reviewed numerous medical records, including those of Dr. Slikker. Dr. Fujinaka's opinion on causation is also much more consistent with applicant's unrebutted and credible testimony that she developed her right hand pain over a prolonged period of time while mopping 24 private hospital rooms, each with an attached bathroom over a workweek of 40 hours, with some overtime. Accordingly, I find that the medical evidence supports a finding of industrial injury.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
The QME Dr. Michael Fujinaka's medical opinion supporting industrial causation of the right hand injury.
Favours Applicant prevailed
The WCJ and WCAB gave great weight to this opinion as substantial medical evidence consistent with credible applicant testimony, leading to denial of reconsideration.
From the decision · page 5The opinion of the QME, Dr. Fujinaka, on the other hand, deals more directly with the issue of causation of applicant's right hand condition. Dr. Fujinaka reviewed numerous medical records, including those of Dr. Slikker. Dr. Fujinaka's opinion on causation is also much more consistent with applicant's unrebutted and credible testimony that she developed her right hand pain over a prolonged period of time while mopping 24 private hospital rooms, each with an attached bathroom over a workweek of 40 hours, with some overtime. Accordingly, I find that the medical evidence supports a finding of industrial injury.
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.
Opined that applicant's right hand condition and need for medical treatment stemmed from the January 14, 2020 industrial injury, supporting industrial causation.
His opinion was based on review of numerous medical records and was consistent with applicant's credible testimony.
From the decision · page 5The opinion of the QME, Dr. Fujinaka, on the other hand, deals more directly with the issue of causation of applicant's right hand condition. Dr. Fujinaka reviewed numerous medical records, including those of Dr. Slikker. Dr. Fujinaka's opinion on causation is also much more consistent with applicant's unrebutted and credible testimony that she developed her right hand pain over a prolonged period of time while mopping 24 private hospital rooms, each with an attached bathroom over a workweek of 40 hours, with some overtime. Accordingly, I find that the medical evidence supports a finding of industrial injury.
Initially noted right hand pain from mopping and provided work restrictions; later opined non-industrial causation without adequate explanation or support from hand surgeon's opinion.
Her June 10, 2020 report was inconsistent with other medical evidence and lacked explanation for non-industrial causation conclusion.
From the decision · page 6This claim of injury has been denied by defendant. The medical evidence supports applicant's claim of injury, with the exception of one inconsistent report from her treating physician, Dr. Hadassah Rose Kreiman of June 10. 2020 (Exh. F). Prior to this report, Dr. Kreiman authored four reports from January 14, 2020 through May 8, 2020 (Exh's A, B, C and E) which noted without critique that she was complaining of right hand pain from mopping rooms at work. In each of these four reports, she was provided with work restrictions. She was then seen by a hand surgeon, Dr. William Slikker, who provided applicant with an injection to her right hand as documented in his report of June 9, 2020 (Exh. G). Dr. Slikker does not opine one way or the other whether applicant's claim of injury is industrial or non-industrial. In his June 10, 2020 report, Dr. Kreiman states at page 3 of his June 10, 2020 report, "At this time I find that (sic) patient's right hand condition is nonindustrial based on advanced imaging and [the] opinion of hand surgeon." Dr. Kreiman does not explain what about the images supports his change in opinion on causation. Moreover, there is no opinion of the hand surgeon, Dr. Slikker, which supports the non-industrial conclusion of Dr. Kreiman.
Provided diagnostic evaluation and treatment but did not opine on industrial causation, rendering his opinion inconclusive on causation.
His report listed possible diagnoses but did not conclude on causation, thus not supporting non-industrial causation.
From the decision · page 5Defendant is correct that the reports from the treating physician prior to the June 10, 2020 report do not find industrial causation. They also do not, however, find that the injury is non-industrial. The June 9, 2020 report of the hand specialist, Dr. Slikker, initially states his diagnosis as a generic notation at page 2 of his report of simply "right hand pain." At page 3 of his report, he provided numerous possible diagnoses, listing them as, "Possible flexor tendon middle finger chronic tenosynovitis (lupus spectrum), vs soft tissue mass vs AVM, palmar arch anyerusyn, or foreign body." He then states at page 4 of his report that he "ordered CRP and ESR to evaluate for possible inflammatory arthritis/tenosynovitis." He also recommended that applicant applicant's condition be observed over the next month, and that additional diagnostic studies be performed if her symptoms did not improve. Taken as a whole, the opinion of Dr. Slikker is inconclusive of the cause of applicant's right hand pain.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922
A medical opinion must be predicated on reasonable medical probability, not speculative, based on pertinent facts and adequate examination, and set forth reasoning in support of conclusions.
The QME's opinion met these criteria and was substantial evidence supporting industrial causation.
From the decision · page 1For the reasons stated in the WCJ's Report and Opinion, we agree that the opinion of panel qualified medical examiner (QME) Michael Fujinaka, M.D., is substantial medical evidence upon which the WCJ properly relied. To be considered substantial evidence, a medical opinion "must be predicated on reasonable medical probability." (E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 413, 416§ 17, 419 [33 Cal.Comp.Cases 660].) A physician's report must also 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. (Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 612 (Appeals Board en banc), 70 Cal.Comp.Cases 1506 (writ den.).)
What proof carried it
The evidence the panel weighed, by kind.
Applicant's credible and unrebutted testimony about developing right hand pain from mopping 24 private hospital rooms over a workweek of 40 hours with some overtime.
From the decision · page 5The opinion of the QME, Dr. Fujinaka, on the other hand, deals more directly with the issue of causation of applicant's right hand condition. Dr. Fujinaka reviewed numerous medical records, including those of Dr. Slikker. Dr. Fujinaka's opinion on causation is also much more consistent with applicant's unrebutted and credible testimony that she developed her right hand pain over a prolonged period of time while mopping 24 private hospital rooms, each with an attached bathroom over a workweek of 40 hours, with some overtime. Accordingly, I find that the medical evidence supports a finding of industrial injury.
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About this page
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