ADJ15018771 · March 14, 2025

The WCJ found Dr. Holmes's opinions to be substantial medical evidence based on an adequate examination, history, and reasoning, supported by other medical reports, meeting applicant's burden of proof for injury AOE/COE to the shoulders, knees, and ankles. Defendant failed to present contradictory evidence.

From the decision · page 4II. Turning now to the merits of the Petition, defendant contends that applicant failed to meet his burden of proof pursuant to section 3202.5 in establishing injury AOE/COE to the shoulders, knees, and ankles as the reporting of Dr. Holmes "provides an inadequate medical history, is incomplete, and therefore is not substantial evidence." (Petition, pp. 2-3, 11.) Section 3202.5 states, in relevant part, that parties are to "meet the evidentiary burden of proof on all issues by a preponderance of the evidence. Pursuant to section 5705, the burden of proof rests upon the party holding the affirmative of the issue. The burden therefore rests with the applicant (or lien claimant, who steps into the shoes of the applicant). To meet this burden, the applicant must provide substantial evidence of injury AOE/COE.

Dr. Holmes took an adequate examination and history, reviewed extensive medical reports, and provided a well-reasoned opinion supporting injury AOE/COE to the bilateral knees, shoulders, and ankles with ongoing need for future medical treatment.

Favours Applicant prevailed

This supported the WCJ's finding that Dr. Holmes's opinions are substantial medical evidence meeting applicant's burden of proof.

From the decision · page 4(citations) Further, a medical report is not substantial evidence unless it sets forth the reasoning behind the physician's opinion, not merely his or her conclusions. (citations)" (Gatten, supra, at p. 928.) "A medical report which lacks a relevant factual basis cannot rise to a higher level than its own inadequate premises. Such reports do not constitute substantial evidence to support a denial of benefits. (citation)" (Kyle v. Workers' Comp. Appeals Bd (City and County of San Francisco) (1987) 195 Cal.App.3d 614, 621.) In the instant matter, we find that Dr. Holmes took an adequate examination and history, including review of extensive medical reports, and provided a well-reasoned opinion in support of injury AOE/COE to the bilateral knees, shoulders, and ankles with an ongoing need for future medical. We also find that based upon the evidence in the record, including the reports of Dr. Holmes, but also, the reports of Dr. Wood, applicant's burden has been met. We remind defendant that although the onus is on applicant to provide substantial evidence of injury AOE/COE, the

Applicant's credible testimony and medical evidence including Dr. Holmes's reports were cited by the WCJ as basis for the decision.

Favours Applicant prevailed

This credibility supported the WCJ's decision to find injury AOE/COE and entitlement to future medical treatment.

From the decision · page 5Here, the WCJ's December 16, 2024 OOD, clearly indicates that the decision was "[b]ased on the medical evidence and applicant's credible testimony." (OOD, p. 2.) The WCJ also

Found cumulative trauma injury to bilateral shoulders, knees, and ankles from work activities; supported injury AOE/COE and need for future medical treatment.

Adequate examination and history, review of extensive medical reports, well-reasoned opinion, and consistent deposition testimony.

From the decision · page 2The parties proceeded with discovery and retained Dr. Jeffrey Holmes as the panel QME. Dr. Holmes issued five reports dated September 23, 2021, June 22, 2022, September 25, 2023, October 13, 2023, and December 17, 2023. Dr. Holmes was also deposed on November 22, 2024.

Diagnosed right shoulder rotator cuff tear, left shoulder impingement, internal derangement of bilateral knees, and strain of bilateral ankles.

Medical diagnoses supporting injury claims.

From the decision · page 2In his August 31, 2022 report, Dr. Wood diagnosed applicant with right shoulder rotator cuff tear, left shoulder impingement, internal derangement of the bilateral knees, and strain of the bilateral ankles. (Exhibit 11, p. 14.)

E.L. Yeager v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922

Medical opinion must be based on reasonable medical probability, pertinent facts, adequate examination and history, and set forth reasoning, not be speculative.

The WCJ found Dr. Holmes's opinion met these criteria and was substantial evidence supporting injury AOE/COE.

From the decision · page 4Any medical opinion proffered as substantial evidence, however, must be framed in terms of reasonable medical probability, be based on pertinent facts, an adequate examination, and history, set forth reasoning in support of its conclusions, and not be speculative. (E.L. Yeager 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 (Appeals Board en banc).) "[A] medical opinion is not substantial evidence if it is based on facts no longer germane, on inadequate medical histories or examinations, on incorrect legal theories, or on surmise, speculation, conjecture, or guess.

Applicant's credible testimony and medical evidence including Dr. Holmes's reports

From the decision · page 5Here, the WCJ's December 16, 2024 OOD, clearly indicates that the decision was "[b]ased on the medical evidence and applicant's credible testimony." (OOD, p. 2.) The WCJ also