ADJ14789657 · October 24, 2025

The WCJ and WCAB found the applicant permanently and totally disabled with no apportionment based on substantial medical evidence from QME Dr. Rakkar and psychiatric QME Dr. Alvarellos, who rated the applicant's orthopedic and psychiatric impairments and found no overlap in activities of daily living, supporting addition of impairments and rebuttal of the permanent disability schedule (CVC).

From the decision · page 1Defendant seeks reconsideration of the July 16, 2025 Findings and Award (F&A) issued by the workers' compensation administrative law judge (WCJ). By the F&A, as relevant here, the WCJ found that while employed by defendant on April 29, 2021, as a tree trimmer, occupational group number 482, applicant sustained injury arising out of and in the course of his employment to his left hand, neck, right shoulder, right arm, right upper extremity, and psyche resulting in permanent and total disability with no apportionment.

Applicant sustained injury to left hand, neck, right shoulder, right arm, right upper extremity, and psyche on April 29, 2021, while employed as a tree trimmer.

Favours Applicant prevailed

This injury is the basis for the permanent disability and psychiatric impairments found by the medical experts.

From the decision · page 1Defendant seeks reconsideration of the July 16, 2025 Findings and Award (F&A) issued by the workers' compensation administrative law judge (WCJ). By the F&A, as relevant here, the WCJ found that while employed by defendant on April 29, 2021, as a tree trimmer, occupational group number 482, applicant sustained injury arising out of and in the course of his employment to his left hand, neck, right shoulder, right arm, right upper extremity, and psyche resulting in permanent and total disability with no apportionment.

QME Dr. George Rakkar diagnosed CRPS to the left upper extremity and rated 45% WPI plus 3% for pain, and right shoulder 4% WPI, finding applicant at MMI and supporting permanent total disability with no apportionment.

Favours Applicant prevailed

Dr. Rakkar's medical opinion was found substantial and supported the permanent total disability rating with no apportionment.

From the decision · page 6On 2/04/2022, applicant was examined by QME George Rakkar, M.D., who issued his report, dated 2/12/2022. At the time of the evaluation, applicant reported intermittent stabbing pain in his right shoulder, with pain radiating to his neck and down to his hand. He also reported intermittent stabbing pain in his left wrist and hand, with pain radiating to his fingers. He had episodes of numbness and tingling, swelling, cramping, and weakness. Applicant also claimed development of stress, anxiety, depression, and insomnia, for which he was receiving psychological counseling. Dr. Rakkar diagnosed applicant with laceration to the dorsum of the left hand, status post-surgical debridement and closure; left hand pain; left hand and upper extremity dysfunction; left upper extremity neuropathic pain; and right upper extremity compensatory pain. He opined that applicant's need for medical care and impairment stemmed from the 4/29/2021 injury and that he had not yet reached maximum medical improvement (MMI). Dr. Rakkar recommended physical therapy for applicant's left hand and a one-time multidisciplinary consultation to determine applicant's candidacy for a functional restoration program. He deferred to a psychiatrist or psychologist for evaluation of applicant's depressed mood and psychological treatment. (Exhibit 1)

Psychiatric QME Dr. Miguel Alvarellos diagnosed Major Depressive Disorder as a compensable consequence of the injury, rated 30% WPI, and opined psychiatric impairments do not overlap with orthopedic impairments and should be added.

Favours Applicant prevailed

Dr. Alvarellos' psychiatric diagnosis and opinion supported the addition of impairments and permanent total disability finding.

From the decision · page 7On 2/27/2023, applicant was examined by psychiatric QME Miguel Alvarellos, and was diagnosed with Major Depressive Disorder. Dr. Alvarellos opined that the predominant cause of applicant's psychiatric impairment was the result of a compensable consequence of the tragic events that took place on the date of injury, and further opined applicant was permanent and stationary on a psychiatric basis and assigned a GAF of 50, resulting in 30% WPI, with no apportionment indicated. (Exhibit 4)

Applicant's credible testimony and medical opinions of Dr. Rakkar and Dr. Alvarellos rebutted the permanent disability schedule (CVC) by showing no overlap in activities of daily living between psychiatric and orthopedic impairments.

Favours Applicant prevailed

This rebuttal allowed the applicant to be found permanently and totally disabled with no apportionment.

Diagnosed Major Depressive Disorder as compensable consequence of injury, rated 30% WPI with no apportionment, opined psychiatric impairments do not overlap with orthopedic impairments and should be added for total disability rating.

Dr. Alvarellos' psychiatric diagnosis and rating, and opinion on addition of impairments, supported the finding of permanent total disability with no apportionment.

From the decision · page 7On 2/27/2023, applicant was examined by psychiatric QME Miguel Alvarellos, and was diagnosed with Major Depressive Disorder. Dr. Alvarellos opined that the predominant cause of applicant's psychiatric impairment was the result of a compensable consequence of the tragic events that took place on the date of injury, and further opined applicant was permanent and stationary on a psychiatric basis and assigned a GAF of 50, resulting in 30% WPI, with no apportionment indicated. (Exhibit 4)

Diagnosed left hand and upper extremity injuries including CRPS, rated 45% WPI plus 3% for pain, right shoulder 4% WPI, found applicant not at MMI initially but later at MMI, supported permanent total disability with no apportionment, opined orthopedic impairments overlap and should be combined, psychiatric impairments separate and should be added.

Dr. Rakkar's detailed examination, diagnosis, rating, and deposition testimony provided substantial medical evidence supporting permanent total disability and no apportionment.

From the decision · page 6On 2/04/2022, applicant was examined by QME George Rakkar, M.D., who issued his report, dated 2/12/2022. At the time of the evaluation, applicant reported intermittent stabbing pain in his right shoulder, with pain radiating to his neck and down to his hand. He also reported intermittent stabbing pain in his left wrist and hand, with pain radiating to his fingers. He had episodes of numbness and tingling, swelling, cramping, and weakness. Applicant also claimed development of stress, anxiety, depression, and insomnia, for which he was receiving psychological counseling. Dr. Rakkar diagnosed applicant with laceration to the dorsum of the left hand, status post-surgical debridement and closure; left hand pain; left hand and upper extremity dysfunction; left upper extremity neuropathic pain; and right upper extremity compensatory pain. He opined that applicant's need for medical care and impairment stemmed from the 4/29/2021 injury and that he had not yet reached maximum medical improvement (MMI). Dr. Rakkar recommended physical therapy for applicant's left hand and a one-time multidisciplinary consultation to determine applicant's candidacy for a functional restoration program. He deferred to a psychiatrist or psychologist for evaluation of applicant's depressed mood and psychological treatment. (Exhibit 1)

To be substantial evidence, expert medical opinion must be framed in terms of reasonable medical probability, be based on an accurate history and an examination, and set forth reasoning to support the expert conclusions reached.

Applied to Dr. Rakkar's impairment rating and testimony to find it substantial medical evidence.

From the decision · page 9III. DISCUSSION PERMANENT TOTAL DISABILITY IS SUPPORTED BY THE EVIDENCE As discussed above, QME Dr. Rakaar rated applicant's CRPS for his left upper extremity, using Table 13-16, p. 338 under Class 4, resulting in 45% WPI, with an additional 3% WPI for pain, with no apportionment factors to consider. Dr. Rakkar rated applicant's right shoulder using ROM at 4% WPI. Dr. Rakarr's report rates as follows: Left UE CRPS: 100% - (16.01.02.04 - 48 - [1.4] 67 - 482J - 77 - 77%) 77% Right Shoulder ROM: 100% - (16.02.01.00 - 4 - [1.4] 6 - 482I - 9 - 9%) 9% CVC: 77 C 9 = 79% Defendant argues that Dr. Rakkar's impairment rating under Class 4 does not constitute substantial medical evidence as it is based on speculation. To be substantial evidence, expert medical opinion must be framed in terms of reasonable medical probability, be based on an accurate history and an examination, and set forth reasoning to support the expert conclusions reached1. As summarized above, Dr. Rakkar was deposed by able counsel. He was specifically asked to explain his Class 4 rating. Dr.

Vigil v. WCAB (en banc)

Vigil v. Workers' Compensation Appeals Board (en banc) is mandatory authority on all WCJs and WCAB panels regarding rebuttal of the permanent disability schedule (CVC).

Applied to find that applicant successfully rebutted the CVC by showing no overlap in ADLs between psychiatric and orthopedic impairments.

From the decision · page 16Where the medical evidence demonstrates that the impact upon the ADLs overlaps, without more, an applicant has not rebutted the CVC table. Where the medical evidence demonstrates that there is effectively an absence of overlap, the CVC table is rebutted, and it need not be used.10 Defendant further incorrectly argues that "Vigil is not mandatory." As an en banc decision, Vigil is mandatory authority on all WCJs and WCAB panels11. Finally, defendant argues that neither QME in this case has suggested that applicant may never work again. However, a finding of permanent and total disability does not preclude subsequent employment. This is because a finding of permanent and total disability is a metric of applicant's disability and does not bar future employment that conforms to applicant's residual functional capacity.12

Applicant's credible testimony and medical opinions of Dr. Rakkar and Dr. Alvarellos

Extensive review and admission of TikTok videos offered by defendant, which medical experts disagreed reflected applicant's everyday reality

From the decision · page 810: 14-16) Parties proceeded to trial on 1/10/2024, 2/28/2024, 4/22/2024, and 6/12/2024, wherein extensive review of TikTok videos offered by defendant as Exhibits X and Y and testimony took place to determine whether said videos should be provided to the QME's. The matter was submitted for decision on 6/12/2024. On 7/25/2024, an Order Rescinding Submission and Order Setting Matter for Conference issued. On 9/06/2024, after discussion with the parties at the 8/29/2024 Status Conference, applicant's objection to the admissibility of defendant's Exhibits X and Y was overruled, and an Order admitting defendant's Exhibits X (TikTok videos dated 6/10/2022 through 9/02/2023) and Y (List of TikTok videos with interpretations dated 6/10/2022 through 9/02/2023) into evidence and Order to develop the Record issued. The parties were ordered to provide said videos and translations, and copies of the Minutes of Hearing and Summary of Evidence for each of the aforementioned trial dates to QME's Dr. Rakkar and Dr. Alvarellos for comment. With parties having obtained supplemental reporting consistent with the undersigned's Order, a Notice of Intention to Augment the Record and Notice of Intention to Re-submit Matter for decision issued 0n 4/22/2025. On 4/30/2025, defendant objected to the admissibility of Court