ADJ13610807 — California WCAB decision

ADJ13610807 · February 3, 2025

The WCAB granted defendant's petition for reconsideration, rescinded the Amended Findings of Fact, and substituted new Findings of Fact finding injury to applicant's heart, deferring injury to all other body parts and other issues.

Issues decided

Medical opinions weighed

Authorities named

District office

San Bernardino

What the panel ordered

Defendant sought reconsideration of the WCJ's Findings of Fact issued October 24, 2024, and Amended Findings issued November 7, 2024. The WCAB granted reconsideration, rescinded the Amended Findings, and substituted new Findings of Fact.

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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.

AOE/COEApplicant prevailedheart

The WCJ and QMEs Fischer and Navab provided substantial medical evidence that applicant's sudden cardiac arrest was industrially related, meeting the burden of proof by a preponderance of the evidence and reasonable probability standard.

From the decision · page 3(1993) 16 Cal.App.4th 1692, 1701 [58 Cal.Comp.Cases 313], emphasis added.) As discussed by the WCJ, applicant met her burden of proving injury AOE/COE, based in part on the opinions of panel Qualified Medical Evaluator (QME) in cardiology Stuart Fischer, M.D. (Exhibits 1A - 1G) and panel QME in neurology Pedram Navab, M.D. (Exhibits 2A - 2H). Although the WCJ and both QMEs refer to "cardiac arrest" we note that this is not a body part. Additionally, we note that it is axiomatic that an injury must be to a body part and, as such, any finding of injury AOE/COE must identify at least one body part. (See Lab. Code, § 3600(a), 5401(a); Clark, supra, at 297-298.) Therefore we will amend Findings of Fact No. 1 and No. 2 to find that applicant sustained injury to her heart.

The facts that decided it

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

Applicant's sudden cardiac arrest occurred on May 14, 2020, while working for City of Hope National Medical Center.

Favours Applicant prevailed

This date and employment establish the injury arose out of and in the course of employment.

From the decision · page 1Defendant seeks reconsideration of the Findings of Fact issued by the workers' compensation administrative law judge (WCJ) on October 24, 2024.1 On November 7, 2024, the WCJ issued Amended Findings. (Lab. Code, § 5805; Cal. Code Regs., tit. 8, § 10966.) The WCJ found in pertinent part that 1) applicant sustained injury arising out of and in the course of employment (AOE/COE) on May 14, 2020, while working for City of Hope National Medical Center, in case number ADJ13610807; and 2) applicant sustained injury AOE/COE during the period May 14, 2019 to May 14, 2020, while working for City of Hope National Medical Center, San Antonio Regional Hospital, and Pomona Valley Hospital Medical Center, in case number ADJ13610806.

Medical opinions of Drs. Stuart Fischer and Pedram Navab found industrial causation reasonably probable for applicant's sudden cardiac arrest.

Favours Applicant prevailed

Their opinions provided substantial medical evidence supporting injury AOE/COE.

From the decision · page 3(1993) 16 Cal.App.4th 1692, 1701 [58 Cal.Comp.Cases 313], emphasis added.) As discussed by the WCJ, applicant met her burden of proving injury AOE/COE, based in part on the opinions of panel Qualified Medical Evaluator (QME) in cardiology Stuart Fischer, M.D. (Exhibits 1A - 1G) and panel QME in neurology Pedram Navab, M.D. (Exhibits 2A - 2H). Although the WCJ and both QMEs refer to "cardiac arrest" we note that this is not a body part. Additionally, we note that it is axiomatic that an injury must be to a body part and, as such, any finding of injury AOE/COE must identify at least one body part. (See Lab. Code, § 3600(a), 5401(a); Clark, supra, at 297-298.) Therefore we will amend Findings of Fact No. 1 and No. 2 to find that applicant sustained injury to her heart.

Applicant was extremely stressed during the early days of the pandemic, supported by medical records including psychologist notes and nephrologist telemedicine follow-up.

Favours Applicant prevailed

Stress was a contributing industrial factor to the sudden cardiac arrest, supporting compensability.

From the decision · page 18Frankly, it is clear that applicant was extremely stressed during the early days of the pandemic, as evidenced by the medical records predating her SCA, including notes from her psychologist (Exhibit B) and an entry from her nephrologist, Abid Rizvi, M.D. (Exhibit 5), dated 4//8/2020 (Page 6 of Exhibit 5). In this entry of a telemedicine follow- up, the doctor notes, "Patient having severe anxiety attack and patient also complaining of sore throat since last night." The doctor noted that she looked anxious and was in mild to moderate distress and breathing fast. He recommended she take Ativan for the anxiety attack, azithromycin for the sore throat. If applicant was determined to have "severe anxiety" as a result of contracting a sore throat in the early days of the pandemic, and was concerned enough to suspend her psychologist appointments for fear of either sharing or contracting the corona virus, it stands to reason that becoming unwell on 5/14/2024 and experiencing symptoms which could potentially be related to Covid, was an acutely stressful event for the applicant, which could have triggered her SCA.

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.

QMERelied upon · cardiology

Attributed applicant's sudden cardiac arrest to be at least 1% industrially-related, supporting injury AOE/COE to the heart.

The WCJ and QMEs found substantial medical evidence for injury AOE/COE based on Fischer's opinion.

From the decision · page 3(1993) 16 Cal.App.4th 1692, 1701 [58 Cal.Comp.Cases 313], emphasis added.) As discussed by the WCJ, applicant met her burden of proving injury AOE/COE, based in part on the opinions of panel Qualified Medical Evaluator (QME) in cardiology Stuart Fischer, M.D. (Exhibits 1A - 1G) and panel QME in neurology Pedram Navab, M.D. (Exhibits 2A - 2H). Although the WCJ and both QMEs refer to "cardiac arrest" we note that this is not a body part. Additionally, we note that it is axiomatic that an injury must be to a body part and, as such, any finding of injury AOE/COE must identify at least one body part. (See Lab. Code, § 3600(a), 5401(a); Clark, supra, at 297-298.) Therefore we will amend Findings of Fact No. 1 and No. 2 to find that applicant sustained injury to her heart.

QMERelied upon · neurology

Opined applicant's anoxic brain injury partially arose out of and was partially caused by employment, supporting injury AOE/COE to the heart.

The WCJ and QMEs found substantial medical evidence for injury AOE/COE based on Navab's opinion.

From the decision · page 3(1993) 16 Cal.App.4th 1692, 1701 [58 Cal.Comp.Cases 313], emphasis added.) As discussed by the WCJ, applicant met her burden of proving injury AOE/COE, based in part on the opinions of panel Qualified Medical Evaluator (QME) in cardiology Stuart Fischer, M.D. (Exhibits 1A - 1G) and panel QME in neurology Pedram Navab, M.D. (Exhibits 2A - 2H). Although the WCJ and both QMEs refer to "cardiac arrest" we note that this is not a body part. Additionally, we note that it is axiomatic that an injury must be to a body part and, as such, any finding of injury AOE/COE must identify at least one body part. (See Lab. Code, § 3600(a), 5401(a); Clark, supra, at 297-298.) Therefore we will amend Findings of Fact No. 1 and No. 2 to find that applicant sustained injury to her heart.

The rules the panel named

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

Lab. Code, 3600

Injury must arise out of and occur in the course of employment (Lab. Code, 3600).

Applicant bears burden of proving injury AOE/COE by preponderance of evidence.

From the decision · page 3II. To be compensable, an injury must arise out of and occur in the course of employment. (Lab. Code, § 3600.) The employee bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298, 302 [80 Cal.Comp.Cases 489]; Lab. Code, § 3600(a); 3202.5.) Medical evidence that industrial causation was reasonably probable, although not certain, constitutes substantial evidence for a finding of injury AOE/COE. (McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 417 [33 Cal.Comp.Cases 660].) "That burden manifestly does not require the applicant to prove causation by scientific certainty." (Rosas v. Worker's Comp. Appeals Bd.

Rosas v. Worker's Comp. Appeals Bd. (1993) 16 Cal.App.4th 1692

Applicant must prove industrial causation by reasonable probability, not scientific certainty.

Medical evidence that industrial causation was reasonably probable constitutes substantial evidence for injury AOE/COE.

From the decision · page 3II. To be compensable, an injury must arise out of and occur in the course of employment. (Lab. Code, § 3600.) The employee bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298, 302 [80 Cal.Comp.Cases 489]; Lab. Code, § 3600(a); 3202.5.) Medical evidence that industrial causation was reasonably probable, although not certain, constitutes substantial evidence for a finding of injury AOE/COE. (McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 417 [33 Cal.Comp.Cases 660].) "That burden manifestly does not require the applicant to prove causation by scientific certainty." (Rosas v. Worker's Comp. Appeals Bd.

South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291

Work is a contributing cause of the injury to meet causation requirement.

Sufficient if work is a contributing cause of the injury.

From the decision · page 14Applicant bears the burden of proving injury AOE/COE by a preponderance of the evidence, which is defined by LC 3202.5 as "evidence that, when weighed with that opposed to it, has more convincing force and the greater probability of truth. When weighing the evidence, the test is not the relative number of witnesses, but the relative convincing force of the evidence." (Labor Code 3202.5.) Per the holding in South Coast Framing (supra), for the purpose of meeting the causation requirement in a workers' compensation injury claim, it is sufficient if the work is a contributing cause of the injury. (Supra, at Pgs. 298-299). Per the holding in Rosas vs. WCAB (1993) 16 Cal. App.4th 1692 (58 CCC 313), "The applicant in a workers' compensation proceeding has the burden of proving industrial causation by a `reasonable probability.' (citation) That burden manifestly does not require the applicant to prove causation by scientific certainty." (Supra, at Pgs. 1700- 1701). Further, the holding in McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408 (33 CCC 660) also holds that medical evidence that industrial evidence was reasonably probable, although not certain, constitutes substantial evidence for a finding of injury AOE/COE.

What proof carried it

The evidence the panel weighed, by kind.

Medical recordsfavours Applicant prevailed

Applicant was extremely stressed during the early days of the pandemic, evidenced by medical records including psychologist notes and nephrologist telemedicine follow-up noting severe anxiety attack.

From the decision · page 18Frankly, it is clear that applicant was extremely stressed during the early days of the pandemic, as evidenced by the medical records predating her SCA, including notes from her psychologist (Exhibit B) and an entry from her nephrologist, Abid Rizvi, M.D. (Exhibit 5), dated 4//8/2020 (Page 6 of Exhibit 5). In this entry of a telemedicine follow- up, the doctor notes, "Patient having severe anxiety attack and patient also complaining of sore throat since last night." The doctor noted that she looked anxious and was in mild to moderate distress and breathing fast. He recommended she take Ativan for the anxiety attack, azithromycin for the sore throat. If applicant was determined to have "severe anxiety" as a result of contracting a sore throat in the early days of the pandemic, and was concerned enough to suspend her psychologist appointments for fear of either sharing or contracting the corona virus, it stands to reason that becoming unwell on 5/14/2024 and experiencing symptoms which could potentially be related to Covid, was an acutely stressful event for the applicant, which could have triggered her SCA.

expert methodologyfavours Applicant prevailed

Declaration of Philip J. Podrid, M.D., author of cited medical article, was not based on evaluation of applicant or review of records and was given little evidentiary weight.

From the decision · page 10Defense merely relies upon a short declaration of a physician who authored an article (Philip J. Podrid, M.D. Exhibit F), but who did not evaluate the applicant, did not review any medical reports or records of the applicant, did not review witness testimony, which declaration cannot meet any standard for a sufficient medical report and which was not subject to cross-examination. Frankly, this article was reluctantly admitted into evidence over strenuous objection only because I knew that I could give it little to no evidentiary weight in this case, as set forth in the first full paragraph of Page 12 of the Opinion on Decision. The affidavit was not shown to have been peer- reviewed and it certainly doesn't cite to any studies performed relative to sudden cardiac arrest or sudden cardiac death during the pandemic, so any opinions expressed relative to the applicant are useless as evidence, lacking in substantiality and were not given evidentiary weight.

ADJ13610807 · February 3, 2025

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

What the panel did with the medical opinions

The rules the panel named

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