What the panel ordered
Petition for Reconsideration is DENIED
Petition for Reconsideration challenging the Joint Findings and Award issued on December 20, 2023
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 WCJ found Dr. McCoy's medical reports to be substantial medical evidence and more persuasive than Dr. Bell's reports, supporting the apportionment and permanent disability findings.
From the decision · page 6The crux of petitioner's argument is that the undersigned WCJ should have relied upon Dr. Bell's QME reports instead of Dr. McCoy's QME reports because Dr. Bell's reports constitute substantial medical evidence and Dr. McCoy's do not. Petition, page 1, lines 24 thru 26; page 2, lines] thru 2. However, Petitioner incorrectly states that the undersigned WCJ found Dr. Bell's reports "non substantial medical evidence with regard to causation." Petition, page 4, lines 19 thru 23. There was no such finding by the WCJ. The undersigned WCJ only found Dr. McCoy's reporting to be more persuasive than Dr. Bell's reporting, not that Dr. Bell's reporting was not substantial medical evidence.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Dr. McCoy's medical reports were thorough, consistent, and objective, supported by MRI evidence showing progressive changes between 2018 and 2019, supporting apportionment of disability between the two injuries.
Favours Defendant prevailed
The WCJ found Dr. McCoy's reports to be substantial medical evidence and more persuasive than Dr. Bell's, leading to the denial of reconsideration.
From the decision · page 6The crux of petitioner's argument is that the undersigned WCJ should have relied upon Dr. Bell's QME reports instead of Dr. McCoy's QME reports because Dr. Bell's reports constitute substantial medical evidence and Dr. McCoy's do not. Petition, page 1, lines 24 thru 26; page 2, lines] thru 2. However, Petitioner incorrectly states that the undersigned WCJ found Dr. Bell's reports "non substantial medical evidence with regard to causation." Petition, page 4, lines 19 thru 23. There was no such finding by the WCJ. The undersigned WCJ only found Dr. McCoy's reporting to be more persuasive than Dr. Bell's reporting, not that Dr. Bell's reporting was not substantial medical evidence.
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 applicant permanent and stationary as of April 12, 2021; issued WPI for left shoulder, not involved in these cases; unaware of 2017 injury.
From the decision · page 4Dr. Petrofsky issued a report dated April 12, 2021. (Joint Exh. E.) In her report, Dr. Petrofsky found the applicant permanent and stationary as of the date of her report, but thereafter issued a whole person impairment (WPI) for the left shoulder, a body part not at issue in either case herein. (Id. at page 7.) Dr. Petrofsky did not review any medical reports prior to May 24, 2019, and it appears she was unaware of the 2017 injury. (Id. at page 5.)
Found two injuries on July 27, 2017 and May 14, 2019; based on MRIs and medical history; apportioned 80% to 2017 injury and 20% to 2019 injury; found applicant permanent and stationary with 5% WPI for right shoulder.
Dr. McCoy's reports were found thorough, consistent, and objective, providing substantial medical evidence for apportionment and permanent disability.
From the decision · page 5The applicant was initially evaluated by Dr. McCoy on May 16, 2023 for the 2017 injury (report dated May 19 2023). (Joint Exh. B.) A supplemental report issued by Dr. McCoy on August 15, 2023. (Joint Exh. A.) Dr. McCoy confirmed his original findings in his supplemental report. Dr. McCoy reported that the applicant sustained an injury on July 27, 2017 and on May 14, 2019. (Joint Exh. B, page 11.) Dr. McCoy based his finding of two injuries, in part, on the fact that the applicant returned to work after the 2017 injury but was not able to do so after the 2019 injury which resulted in necessary shoulder surgery. (Joint Exh. B, page 3.) Additionally, MRIs taken before and after the May 14, 2019 injury showed objective findings supporting a new injury had occurred. (Id.) Dr. McCoy found the applicant permanent and stationary, provided a 5% WPI for applicant's right shoulder, and apportioned 80% to the July 27, 2017 injury and 20% to the May 14, 2019 injury. (Id. at page 12.)
Attributed 100% of symptoms to 2017 injury; did not fully discuss progressive MRI changes; less persuasive due to contradictions and lack of detailed diagnostic discussion.
Dr. Bell's reports were less persuasive and not relied upon due to contradictions and failure to discuss diagnostics in depth.
From the decision · page 7Dr. Bell's reporting is less persuasive due to contradictions in his reporting and failure to discuss the diagnostics in depth. In his August 26, 2022 report, Dr. Bell focuses his causation argument on the applicant telling him that he did not have a "specific injury" on May 14, 2019, but thereafter documents right shoulder and upper extremity symptoms while applicant was performing work on that day. (Joint Exh. D, page 20.)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604,621 (Appeals Board en banc)
To constitute substantial evidence, a medical opinion must be framed in terms of reasonable medical probability, not speculative, based on pertinent facts and adequate examination, and set forth reasoning in support of conclusions.
Applied to evaluate the medical opinions of Dr. McCoy and Dr. Bell regarding apportionment and causation.
From the decision · page 7To 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. Marsha/ls (2005) 70 Cal.Comp.Cases 604,621 (Appeals Board en bane).)
What proof carried it
The evidence the panel weighed, by kind.
Applicant's testimony and medical reports indicate a specific injury on May 14, 2019, including worsening pain and weakness at work, supported by Dr. Bell and Dr. McCoy's reports.
From the decision · page 5Petitioner contends that there was no specific incident on May 14, 2019 which caused injury to the applicant. Petition, page 4, lines 6 thru 9. However, applicant's testimony and medical reports indicate otherwise. The applicant testified to an injury on May 14, 2019. the applicant testified that he injured his ribs, his entire arm, and his hips on that date. (Joint Exh. J, page 36, lines 9 thru 15.) Moreover, Dr. Petrofsky reported a specific incident on May 14, 2019 when the applicant was reaching up to install tile and he felt pain. (Joint Exh. E, page 1.)
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
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