What the panel ordered
Permanent disability, apportionment, and attorney's fees deferred pending further development of the record including reevaluation by Dr. Fenison.
Petition for reconsideration granted, December 23, 2024 Findings, Award and Order rescinded and substituted for further development of the record including reevaluation by Dr. Fenison.
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.
The panel found that the QME's reports were incomplete as they did not include review of updated medical records from Dr. Rho documenting complex regional pain syndrome, thus the record was insufficient to support the denial of permanent disability and further development was required.
From the decision · page 5Here, based upon our review of the record, including the reports of Dr. Fenison, it appears that although diagnostics and records from Dr. Montgomery and Central Occupational Medicine Providers were provided to Dr. Fenison for review, none of the reports from Dr. Rho or Inland Interventional Medical Associates were provided, or if provided, were not reviewed. In light of this, Dr. Fenison's reporting appears to be incomplete.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Dr. Fenison's reports did not include review of updated medical records from Dr. Rho documenting complex regional pain syndrome.
Favours Applicant prevailed
This incomplete record undermined the substantiality of the QME's opinion and required further development of the record before deciding permanent disability.
From the decision · page 5Here, based upon our review of the record, including the reports of Dr. Fenison, it appears that although diagnostics and records from Dr. Montgomery and Central Occupational Medicine Providers were provided to Dr. Fenison for review, none of the reports from Dr. Rho or Inland Interventional Medical Associates were provided, or if provided, were not reviewed. In light of this, Dr. Fenison's reporting appears to be incomplete.
What the panel did with the medical opinions
The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
Found no evidence of neuropathy involving the anterior proximal left lower leg and assigned 0% whole person impairment.
Based on review of clinic notes, prior QME report, and EMG study; did not review updated medical records from Dr. Rho documenting complex regional pain syndrome.
From the decision · page 22.) Applicant underwent a nerve conduction study (NCV/EMG) of the left lower extremity on July 1, 2023 with normal findings. (Exhibit C.) Applicant also underwent various x-rays of the left tibia/fibula and left ankle with normal findings. (Exhibit B, pp. 8-10.) The parties ultimately retained Dr. Anthony Fenison as the panel QME. Dr. Fenison issued an initial report dated June 28, 2023 and a supplemental report dated February 16, 2024. In his February 16, 2024 report, Dr. Fenison found that based upon his review of the additional clinic notes from Central Occupational Medicine Clinic, his prior June 28, 2023 QME report, and the July 1, 2023 EMG, applicant had "0% whole person impairment" as there was "no evidence to support of any type of neuropathy involving the anterior proximal left lower leg." (Exhibit A, p. 2.).
Diagnosed left lower leg abrasion, contusion, pain and strain of anterior muscle group; released applicant to full duty.
From the decision · page 2FACTS Applicant claimed that while employed by defendant as a preloader on February 6, 2023, she sustained an industrial injury to her left leg (shin). Applicant was seen by primary treating physician Dr. William Montgomery of Central Occupational Medicine Providers on July 21, 2023, December 8, 2023, and January 11, 2024. (Exhibits 6-8.) Dr. Montgomery diagnosed applicant with a left lower leg abrasion, contusion, and pain and strain of the muscle(s) and tendon(s) of the anterior muscle group at the lower left leg. (Exhibits 6-8, p. 2.) Applicant was released to work full duty on July 21, 2023. (Exhibit 6, p. 3.) Applicant was referred by Dr. Montgomery to pain management specialist Dr. James Rho of Inland Interventional Medicine Associates and was seen by Dr. Rho on December 20, 2023, January 17, 2024, February 13, 2024 and April 22, 2024. (Exhibits 2-5.) Dr. Rho diagnosed applicant with complex regional pain syndrome of the left lower limb, muscle spasm of the calf, myalgia, and myositis. (Ibid.) In his most recent report dated April 22, 2024, Dr. Rho noted complaints of ongoing left lower extremity pain secondary to complex regional pain syndrome with poor sleep quality due to pain. (Exhibit 5, p.
Diagnosed complex regional pain syndrome, muscle spasm, myalgia, and myositis; noted ongoing pain and poor sleep quality.
From the decision · page 2FACTS Applicant claimed that while employed by defendant as a preloader on February 6, 2023, she sustained an industrial injury to her left leg (shin). Applicant was seen by primary treating physician Dr. William Montgomery of Central Occupational Medicine Providers on July 21, 2023, December 8, 2023, and January 11, 2024. (Exhibits 6-8.) Dr. Montgomery diagnosed applicant with a left lower leg abrasion, contusion, and pain and strain of the muscle(s) and tendon(s) of the anterior muscle group at the lower left leg. (Exhibits 6-8, p. 2.) Applicant was released to work full duty on July 21, 2023. (Exhibit 6, p. 3.) Applicant was referred by Dr. Montgomery to pain management specialist Dr. James Rho of Inland Interventional Medicine Associates and was seen by Dr. Rho on December 20, 2023, January 17, 2024, February 13, 2024 and April 22, 2024. (Exhibits 2-5.) Dr. Rho diagnosed applicant with complex regional pain syndrome of the left lower limb, muscle spasm of the calf, myalgia, and myositis. (Ibid.) In his most recent report dated April 22, 2024, Dr. Rho noted complaints of ongoing left lower extremity pain secondary to complex regional pain syndrome with poor sleep quality due to pain. (Exhibit 5, p.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
E.L. Yeager v. Workers' Comp. Appeals Bd. (2006) 145 Cal.App.4th 922
A medical opinion must be based on reasonable medical probability, pertinent facts, adequate examination and history, and set forth reasoning, not be speculative.
The QME's opinion was incomplete and unsupported as it did not consider updated medical records documenting the applicant's condition.
From the decision · page 5`substantial evidence' means evidence which, if true, has probative force on the issues. It is more than a mere scintilla, and means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion...It must be reasonable in nature, credible, and of solid value." (Braewood Convalescent Hospital v. Workers' Comp. Appeals Bd. (Bolton) (1983) 34 Cal.3d 159, 164 [48 Cal.Comp.Cases 566], emphasis removed and citations omitted.) A medical opinion proffered as substantial evidence 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 Bd.
What proof carried it
The evidence the panel weighed, by kind.
Dr. Fenison did not review updated medical records from Dr. Rho documenting complex regional pain syndrome.
From the decision · page 5Here, based upon our review of the record, including the reports of Dr. Fenison, it appears that although diagnostics and records from Dr. Montgomery and Central Occupational Medicine Providers were provided to Dr. Fenison for review, none of the reports from Dr. Rho or Inland Interventional Medical Associates were provided, or if provided, were not reviewed. In light of this, Dr. Fenison's reporting appears to be incomplete.
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About this page
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