ADJ16528931 · April 25, 2025

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'."].)

Applicant suffered from pre-existing PTSD and bipolar II disorder, which were exacerbated by work-related traumatic exposures.

Favours Applicant prevailed

This established the psychiatric injury was predominantly caused by employment, meeting the compensability criteria.

From the decision · page 3While I don't have documentation to substantiate the precise onset of any of the applicant's mental disorders, the medical records and my clinical interview with her on 11/16/2022 indicate the applicant's PTSD and bipolar II disorder pre-exist her employment with Sacramento County Child Protective Services by many years. For example, one of the earliest records I reviewed-if not the earliest-indicates the applicant presented with a history of "bipolar disease" (Peck, 10/02/2012) and in my interview with her she indicated a history of PTSD stemming from numerous childhood/adolescent/early adulthood traumas. I am also of the opinion, that while the development of these underlying disorders precede the present Workers' Compensation Claim by many years, the applicant's current presentation represents an exacerbation of the already well-developed psychiatric injury.

Applicant suffers from PTSD, bipolar II disorder, and gambling disorder. The current presentation is an exacerbation of pre-existing mental disorders predominantly caused (over 50%) by work-related factors, resulting in temporary disability and need for medical treatment.

Dr. Mackin's detailed clinical evaluation and review of medical records support his opinion that the applicant's psychiatric injury was predominantly caused by work-related traumatic exposures, leading to temporary disability and need for treatment.

From the decision · page 2Causation:... The opinions offered below are done so with a reasonable degree of medical probability.... As part of present evaluation of (inclusive of the supplemental report and Initial PQME) the applicant I reviewed the voluminous medical records forwarded to me, administered psychological testing and conducted a clinical interview on

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.

Applicant's consistent self-report and medical records documenting traumatic work exposures and psychiatric symptoms such as nightmares, anxiety, and depression.

From the decision · page 4not feeling supported by her immediate supervisor. However, the medical records are quite clear that around May of 2022, the applicant began to suffer from a more acute episode of trauma/stressor-related symptomatology which in tum impacted her experience of anxiety and depression. (Grande 05/19/2022) This more acute episode is well documented and supported by the applicant's consistent self-report to me on 11/16/2022. She was suffering from nightmares, anxiety and depression related to traumatic exposures at work which necessitated additional medication management (Grande, 05/19/2022 and 07/22/2022; Lehman, 06/03/2022 and 08/26/2022; Bito, 08/17/2022; McKee, 08/25/2022; and Espinoza 09/09/2022 and 09/15/2022).