ADJ16528931 — California WCAB decision

What the panel ordered

Petition for reconsideration denied; Findings of Fact, Awards and Orders affirmed.

Petition for reconsideration of Findings of Fact, Awards and Orders issued on February 5, 2025, denied by the Appeals Board panel on April 25, 2025.

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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.

Psyche AOE/COEApplicant prevailedpsyche

The medical evidence, including the PQME report of Dr. Mackin, established by a preponderance of the evidence that applicant sustained a psychiatric injury predominantly caused by work-related traumatic exposures, resulting in temporary disability and need for medical treatment.

From the decision · page 9First, the factor must be an "event"; i.e., it must be "something that takes place" (American Heritage Dict. (4th ed. 2000) p. 616) in the employment relationship. Second, the event must be "of employment"; i.e., it must arise out of an employee's working relationship with his or her employer. (Pacific Gas & Electric Co. v. Workers' Comp. Appeals Bd. (Bryan) (2004) 114 Cal. App. 4th 1174, 1181 [8 Cal. Rptr. 3d 467, 69 Cal. Comp. Cases 21]; see also Verga v. Workers' Comp. Appeals Bd. (2008) 159 Cal.App.4th 174, 186 [73 Cal. Comp. Cases 63] [actual events of employment "'can be interpreted' as requiring the employee to establish 'objective evidence of harassment, persecution, or other basis for the alleged psychiatric injury'."].)

The rules the panel named

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

Labor Code section 3208.3

A psychiatric injury shall be compensable if it is a mental disorder causing disability or need for medical treatment, diagnosed under accepted psychiatric criteria, and predominantly caused by actual events of employment.

Applied to determine compensability of applicant's psychiatric injury.

From the decision · page 8II. Defendant argues that the record lacks substantial medical evidence to support the finding that applicant sustained injury AOE/COE to her psyche. Specifically, defendant argues that Dr. Mackin's reporting fails to establish that applicant's "pre-existing condition was aggravated by employment events" because it uses "the word `exacerbation' in referring to the effect of the employment events on applicant's condition" rather than "the term `aggravation.'" (Petition, pp. 4:25-28, 5:16-17.) We observe that applicant 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]; § 3600(a); 3202.5.) As to applicant's claim of injury to her psyche, section 3208.3 provides: (a) A psychiatric injury shall be compensable if it is a mental disorder which causes disability or need for medical treatment, and it is diagnosed pursuant to procedures promulgated under paragraph (4) of subdivision (j) of Section 139.2 or, until these procedures are promulgated, it is diagnosed using the terminology and criteria of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised, or the terminology and diagnostic criteria

Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604

Medical opinion must be framed in terms of reasonable medical probability, based on pertinent facts and adequate examination, and set forth reasoning supporting conclusions.

Applied to evaluate the sufficiency of medical evidence despite terminology used by the physician.

From the decision · page 10We cannot emphasize enough that to constitute substantial evidence "... a medical opinion must be framed in terms of reasonable medical probability, it must not be speculative, it must be based on pertinent facts and on an adequate examination and history, and it must set forth reasoning in support of its conclusions." (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc), (emphasis added).) The term 'synergy' is not a "magic word" that immediately rebuts the use of the CVC. Instead, a physician must set forth a reasoned analysis explaining how and why synergistic ADL overlap exists. If parties are searching for a magic word to use during a doctor's deposition, that word is "Why?". Rather than focusing on whether a specific term, including the term synergy, was used, it is imperative that parties focus on an analysis that applies critical thinking based on the principles articulated in Escobedo to support a conclusion based on the facts of the case.

ADJ16528931 · April 25, 2025

What the panel ordered

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The facts that decided it

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