What the panel ordered
The Petition for Reconsideration is granted, the June 16, 2025 decision is rescinded, and the matter is returned to the trial level for further proceedings.
Applicant filed a Petition for Reconsideration of the Findings and Award issued June 16, 2025, challenging the substantiality of PQME Dr. Bruce Huffer's report and the 0% permanent disability rating. The WCJ recommended denial of the petition. The Appeals Board granted reconsideration, rescinded the WCJ decision, and returned the matter for further proceedings.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.
PQME Dr. Bruce Huffer's reports lack substantial evidence due to failure to discuss relevant medical records and provide reasoning, rendering his 0% permanent disability rating unsubstantial. Further medical development is necessary.
From the decision · page 7Here, PQME Dr. Bruce Huffer fails to meet even a rudimentary level of review and analysis sufficient to be considered substantial evidence. His opinions are based on an evaluation now more than three years old. It also appears he has not reviewed some of the relevant medical reporting. The failure to discuss the medical record and how it does or does not affect his opinions renders his reporting unsubstantial. This conclusory reporting has been consistent over six reports. It is clear returning to PQME Dr. Huffer at this time would result only in further delay without meaningful result.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
PQME Dr. Bruce Huffer's reports failed to discuss relevant medical records documenting radiculopathy and did not provide reasoning for the 0% impairment rating.
Favours Applicant prevailed
This failure rendered his reports unsubstantial evidence, necessitating further medical development.
From the decision · page 7Here, PQME Dr. Bruce Huffer fails to meet even a rudimentary level of review and analysis sufficient to be considered substantial evidence. His opinions are based on an evaluation now more than three years old. It also appears he has not reviewed some of the relevant medical reporting. The failure to discuss the medical record and how it does or does not affect his opinions renders his reporting unsubstantial. This conclusory reporting has been consistent over six reports. It is clear returning to PQME Dr. Huffer at this time would result only in further delay without meaningful result.
Applicant's testimony of worsening symptoms including back pain, numbness, tingling, and leg weakness supports the need for further medical evaluation.
Favours Applicant prevailed
Supports the conclusion that the prior 0% impairment rating may be inaccurate and further development is necessary.
From the decision · page 4The parties proceeded to trial on April 21, 2025, on issues including permanent disability and the substantial nature of PQME Dr. Bruce Huffer's reporting. Exhibits admitted included Exhibit G which was described as "Not Listed." (Minutes of Hearing and Summary of Evidence (MOH), April 21, 2025, pages 2-4.) Applicant testified in part that "[h]e is still having issues with his back, as it has gotten worse over the intervening years. He feels like he has a needle in his back, and he has numbness in his back and down both legs, as well as tingling. He has weakness in his legs (including in his calves)." (Minutes of Hearing (MOH), April 21, 2025, page 4, lines 43-47.)
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.
Found applicant in DRE Lumbar Category I with 0% whole person impairment; failed to discuss relevant medical records and radiculopathy; reports lack substantial evidence.
Reports are conclusory, lack discussion of medical records including radiculopathy findings, and are not substantial evidence.
From the decision · page 7Here, PQME Dr. Bruce Huffer fails to meet even a rudimentary level of review and analysis sufficient to be considered substantial evidence. His opinions are based on an evaluation now more than three years old. It also appears he has not reviewed some of the relevant medical reporting. The failure to discuss the medical record and how it does or does not affect his opinions renders his reporting unsubstantial. This conclusory reporting has been consistent over six reports. It is clear returning to PQME Dr. Huffer at this time would result only in further delay without meaningful result.
March 8, 2021 report found 8% whole person impairment in DRE Lumbar Category II with impacted activities of daily living; opinion considered outdated.
Opinion is over four years old and not informed by subsequent treatment or worsening symptoms; further development needed.
From the decision · page 7Although the March 8, 2021, report from Charlene Niizawa, M.D., found applicant "has an 8% impairment of the whole person," (Joint Exhibit 102, Charlene Niizawa, M.D., PDF page 4), that opinion is now over four years old, and is not informed by the subsequent treatment nor applicant's testimony that "[h]e is still having issues with his back, as it has gotten worse over the intervening years." (MOH, April 21, 2025, page 4, lines 43-45, emphasis added.) Consequently, Dr. Niizawa's assessment of impairment may no longer be appropriate. Further development of the record is necessary to obtain a medical opinion regarding the significance, if any, of the reference to radiculopathy in the record and applicant's testimony of getting worse.
February 20, 2024 report documenting bilateral lumbar radiculopathy involving L5 nerve root; not digested by PQME Huffer.
Report documents radiculopathy relevant to permanent disability but was not considered by PQME Huffer.
From the decision · page 6PQME Dr. Bruce Huffer's additional supplemental reports provide no new analysis of why a DRE I with 0% WPI is appropriate. (Exhibits A, B and C, PQME Dr. Bruce Huffer.) It also appears PQME Dr. Bruce Huffer did not digest the Feb 20, 2024 report from treating physician Darien Behravan, D.O., which reviews multiple records documenting bilateral lumbar radiculopathy involving the L5 nerve root. (First Joint Exhibit 101.)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162; Granado v. Workers' Comp. Appeals Bd. (1970) 69 Cal.2d 399; Zemke v. Workmen's Comp. Appeals Bd. (1968) 68 Cal.2d 794
Medical reports and opinions are not substantial evidence if they are known to be erroneous, based on inadequate medical histories, or on incorrect legal theories; opinions must set forth reasoning, not mere conclusions.
PQME Dr. Bruce Huffer's reports were conclusory and lacked discussion of relevant medical records, failing to provide substantial evidence.
From the decision · page 6"Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories. Medical opinion also fails to support the Board's findings if it is based on surmise, speculation, conjecture or guess." (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93].)
AMA Guides 5th Edition Table 15-3 provides diagnostic-related estimated categories for lumbar injuries with associated whole person impairment percentages.
Used to evaluate the appropriate permanent disability rating category.
From the decision · page 55th Edition (AMA Guides), provides diagnosis-related estimated (DRE) categories for lumbar injuries at page 384, Table 15-3, which sets out five descriptive categories with associated whole person impairment (WPI) percentages. The descriptive differences as relevant here are "no documentable neurologic impairment" for Category I with 0% WPI, "nonverifiable radicular complaints" for Category II with a range of 5% to 8% WPI, and "[s]igificant signs of radiculopathy" for Category III with a range of 10% to 13% WPI.
What proof carried it
The evidence the panel weighed, by kind.
Applicant's testimony of worsening back pain, numbness, tingling, and leg weakness.
From the decision · page 4The parties proceeded to trial on April 21, 2025, on issues including permanent disability and the substantial nature of PQME Dr. Bruce Huffer's reporting. Exhibits admitted included Exhibit G which was described as "Not Listed." (Minutes of Hearing and Summary of Evidence (MOH), April 21, 2025, pages 2-4.) Applicant testified in part that "[h]e is still having issues with his back, as it has gotten worse over the intervening years. He feels like he has a needle in his back, and he has numbness in his back and down both legs, as well as tingling. He has weakness in his legs (including in his calves)." (Minutes of Hearing (MOH), April 21, 2025, page 4, lines 43-47.)
PQME Dr. Bruce Huffer's failure to discuss relevant medical records and radiculopathy findings.
From the decision · page 7Here, PQME Dr. Bruce Huffer fails to meet even a rudimentary level of review and analysis sufficient to be considered substantial evidence. His opinions are based on an evaluation now more than three years old. It also appears he has not reviewed some of the relevant medical reporting. The failure to discuss the medical record and how it does or does not affect his opinions renders his reporting unsubstantial. This conclusory reporting has been consistent over six reports. It is clear returning to PQME Dr. Huffer at this time would result only in further delay without meaningful result.
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About this page
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