ADJ15370512 · August 7, 2026

The Board found that the issue of whether the applicant met the 5% or 35% eligibility thresholds under Labor Code section 4751 was not sufficiently developed in the record and deferred the issue for further development at the trial level.

From the decision · page 73. The issue of whether applicant met the 5% or 35% SIBTF eligibility thresholds is deferred.

Applicant sustained a subsequent industrial injury to his low back on April 15, 2021, resulting in 27% permanent partial disability with radiating pain limiting activities of daily living.

Favours Applicant prevailed

This fact establishes the nature and extent of the subsequent injury relevant to eligibility thresholds under Labor Code section 4751.

From the decision · page 2The Applicant suffered an admitted injury to his low back on 4/15/2021. This injury resulted in permanent partial disability of 27%. According to the reports of PQME Chow (Exhibits A-5 and A-6). This back injury caused radiating pain into both lower extremities which limited Applicant’s activities of daily living. As far as I can tell, neither party seriously disputes the effect of this injury. Applicant claimed a higher PD at trial and continues to make this claim, but apparently has not sought reconsideration of the 12/10/2024 F&A finding that the 27% PD found by Dr. Chow continues to exist. Defendant asks the Board to ignore Dr. Chow’s findings of ADL limits imposed by the radiating low back symptoms, but continues to maintain that Dr. Chow’s reports are substantial and should be followed.

Applicant had a preexisting permanent partial disability from heart/cardiovascular disease of 40% whole person impairment affecting bilateral lower extremities by causing pain.

Favours Applicant prevailed

This fact establishes the nature and extent of the preexisting disability relevant to eligibility thresholds under Labor Code section 4751.

From the decision · page 74. Before the subsequent (industrial) injury, applicant has sustained permanent partial disability from heart/cardiovascular disease of 40% WPI which affected applicant’s bilateral lower extremity by causing pain, per the reports of Dr. Mahawar (Exhibits A-1 and A-2). In addition, at the time the subsequent industrial injury occurred, applicant was also suffering from disability due to pre-existing GERD, hypertension, and left knee problems.

The medical evidence did not clearly establish how the preexisting heart disease affected the legs or how the subsequent lumbar injury caused leg pain, leading to deferral for further development.

Favours neutral

This uncertainty prevents a final determination on whether the applicant met the 5% or 35% eligibility thresholds, necessitating further record development.

From the decision · page 6Dr. Mahawar opined that because applicant’s preexisting heart disease resulted in residual discomfort going down into his lower legs and applicant’s subsequent back injury radiated pain into his lower extremities, applicant met the 5% threshold. In order to meet the 5% threshold, section 4751 requires that “the previous disability or impairment affected a hand, an arm, a foot, a leg, or an eye, and the permanent disability resulting from the subsequent injury affects the opposite and corresponding member.” (§ 4751; emphasis added.) It is not clear from Dr. Mahawar’s report how the preexisting heart disease affected applicant’s leg, what the leg discomfort means, and how that is related to his heart. It is also not clear whether the heart disease medically caused impairment in applicant’s legs.

Documented left sided midsternal chest pain radiating to neck and right flank with discomfort going down into lower legs, supporting preexisting heart disease impact on lower extremities.

Used by Dr. Mahawar to support opinion that preexisting heart disease caused lower extremity discomfort relevant to eligibility threshold.

From the decision · page 5Specifically, [] his prior permanent partial disability for his coronary artery disease impacted his lower extremities and right lower flank The 08/21/2015 report of Dr. Thomas Mustoe documented left sided midstemal CP x30 minutes with pain radiating up into his neck and down into his right flank, and further

Found applicant sustained an industrial lumbar injury on April 15, 2021, resulting in 27% permanent partial disability with radiating pain into both lower extremities limiting activities of daily living; opined 85% of lumbar injury due to industrial injury and 15% due to preexisting degenerative changes; found 14% whole person impairment with 2% add-on for pain.

The WCJ found Dr. Chow's reports more convincing on the issue of impairment and eligibility thresholds due to his expertise, neutrality as a PQME, and detailed findings on ADL limitations.

From the decision · page 2The Applicant suffered an admitted injury to his low back on 4/15/2021. This injury resulted in permanent partial disability of 27%. According to the reports of PQME Chow (Exhibits A-5 and A-6). This back injury caused radiating pain into both lower extremities which limited Applicant’s activities of daily living. As far as I can tell, neither party seriously disputes the effect of this injury. Applicant claimed a higher PD at trial and continues to make this claim, but apparently has not sought reconsideration of the 12/10/2024 F&A finding that the 27% PD found by Dr. Chow continues to exist. Defendant asks the Board to ignore Dr. Chow’s findings of ADL limits imposed by the radiating low back symptoms, but continues to maintain that Dr. Chow’s reports are substantial and should be followed.

Agreed with Dr. Chow on WPI rating based on range of motion but included additional impairments based on activities of daily living, resulting in a higher whole person impairment rating (53% vs. 32%); opined preexisting heart disease and left knee injury affected lower extremities causing over 5% permanent disability; opined applicant met 5% eligibility threshold due to combined effects on bilateral lower extremities.

Disagreed with Dr. Chow's impairment rating methodology but opined applicant met the 5% eligibility threshold based on combined effects of preexisting and subsequent injuries on lower extremities.

From the decision · page 2Years before his 2021 injury, Applicant underwent extensive treatment for cardiovascular disease, GERD, hypertension, and left knee problems. After resolution of the industrial injury, Applicant sought an evaluation with Dr. Mahawar. Based upon, inter alia, the history given by the injured worker and some 2,200+ pages of contemporaneous treatment records from Salinas Valley Memorial Hospital and other providers, Dr. Mahawar wrote two reports (exhibits A-1 and A-2) which conclude that (1) the cardiovascular injury and the left knee injury affected the Applicant’s lower extremities and produced over 5% PD, and (2) the

Labor Code section 4751

Labor Code section 4751 eligibility requirements for subsequent injuries benefits.

The Board analyzed whether the applicant met the 5% or 35% eligibility thresholds under section 4751 based on preexisting and subsequent disabilities affecting specified body parts.

Applicant's activities of daily living were limited by radiating pain into both lower extremities from the lumbar spine injury, supported by Dr. Chow's reports.

From the decision · page 2The Applicant suffered an admitted injury to his low back on 4/15/2021. This injury resulted in permanent partial disability of 27%. According to the reports of PQME Chow (Exhibits A-5 and A-6). This back injury caused radiating pain into both lower extremities which limited Applicant’s activities of daily living. As far as I can tell, neither party seriously disputes the effect of this injury. Applicant claimed a higher PD at trial and continues to make this claim, but apparently has not sought reconsideration of the 12/10/2024 F&A finding that the 27% PD found by Dr. Chow continues to exist. Defendant asks the Board to ignore Dr. Chow’s findings of ADL limits imposed by the radiating low back symptoms, but continues to maintain that Dr. Chow’s reports are substantial and should be followed.

Medical records and expert reports support that both preexisting coronary disease and subsequent industrial injury produced permanent disability over 5% affecting lower extremities.

From the decision · page 5I found the reports of Dr. Chow more convincing on this point for several reasons. First, while I do not contest Dr. Mahawar’s ability to comment on this point, disability to the spine fits far more within the expertise of Dr. Chow. Second, Dr. Chow was selected as a PQME in the course of an adversarial process, a reasonable assurance of his neutrality. Dr. Mahawar was selected by the unfettered discretion of Applicant. This gives one a slightly higher confidence in Dr. Chow’s objectivity than Dr. Mahawar’s, at least in this case. Third, the ratings differ only in application of the Guzman method. In any event, the medical records reviewed by Dr. Chow and Dr. Mahawar support their conclusion that both the pre-existing coronary disease and the subsequent industrial injury produced PD of over 5% which affected both lower extremities. (Opinion on Decision, p. 1.)