ADJ2199336 · March 9, 2021

The WCJ found injury AOE/COE to lumbar spine and psyche but not to other body parts claimed by applicant; the WCAB upheld this finding based on substantial evidence from AME Dr. Green and QME Dr. Jacks.

From the decision · page 1Applicant, acting in pro per, seeks reconsideration of the Findings Awards & Orders (F&A) issued by the WCJ on October 20, 2020, wherein the workers' compensation administrative law judge (WCJ) found in pertinent part that while employed by defendant as a driver/furniture mover, applicant: (1) sustained injury arising out of and occurring in the course of employment (AOE/COE) to his lumbar spine and psyche, during the period from October 9, 1999, through September 21, 2004, but did not sustain injury AOE/COE to his upper or lower extremities, and that the injury caused 21% permanent disability (ADJ2199336); (2) sustained injury AOE/COE to his lumbar spine and psyche, on October 8, 1999, but did

AME Dr. Green examined applicant multiple times, reviewed extensive medical records, and consistently found no injury to additional body parts claimed by applicant.

Favours Defendant prevailed

This substantial evidence supported the WCJ's and WCAB's denial of injury to those body parts.

From the decision · page 5As noted earlier, Dr. Green examined applicant in the capacity of an AME. "[W]orkers' compensation law favors agreed medical examiners in resolving medical disputes fairly and expeditiously." (Green v. Workers' Comp. Appeals Bd. (2005) 127 Cal.App.4th 1426, 1444 [70 Cal.Comp.Cases 294].) The AME was presumably chosen by the parties because of his expertise and neutrality. Therefore, an agreed medical evaluator's opinion should ordinarily be followed unless there is good reason to find that opinion unpersuasive. (Power v Workers' Comp. Appeals Bd. (1986) 179 Cal.App.3d 775, 782 [51 Cal.Comp.Cases 114].)

QME Dr. Jacks diagnosed Major Depressive Disorder caused predominantly by industrial injuries but opined no further psychiatric treatment was needed as applicant lacked insight to benefit.

Favours Defendant prevailed

This opinion supported the denial of future psychiatric treatment.

From the decision · page 6Finally, regarding the psychiatric injuries, the WCJ stated: The parties have stipulated to applicant's psychiatric injury. No additional medical treatment was awarded because Dr. Jacks found the applicant lacked the insight necessary to benefit from psychiatric treatment. (Report, p. 5.)

Diagnosed right lumbar herniated nucleus pulposus, cervical sprain, and lumbar sprain; limited applicant to substantial work between heavy and light work; found no injury to shoulders, knees, head, prostate, ulcers, or additional body parts claimed by applicant; opinions constitute substantial evidence.

The WCJ and WCAB relied on Dr. Green's detailed examinations, medical record reviews, and consistent opinions over multiple evaluations and depositions.

From the decision · page 2On March 16, 2006, applicant was evaluated by orthopedic agreed medical examiner (AME) Stuart A. Green, M.D. (Board Exh. A, Dr. Green, March 16, 2006.) Dr. Green examined

Diagnosed Major Depressive Disorder caused predominantly by industrial injuries; opined no further psychiatric treatment needed as applicant lacked insight to benefit; opinion is substantial evidence supporting denial of future psychiatric treatment.

The WCJ and WCAB relied on Dr. Jacks' psychiatric evaluation and opinion on future treatment needs.

From the decision · page 3Applicant was evaluated by defendant's psychiatric qualified medical examiner (QME) Brain P. Jacks, M.D., on August 6, 2008. (Def. Exh. K, Dr. Jacks, August 6, 2008.) Dr. Jacks diagnosed applicant as having a Major Depressive Disorder and he determined that applicant's industrial injuries were the predominate cause of his psychiatric injury. (Def. Exh. K, pp. 18 § 20.) Regarding future medical treatment, Dr. Jacks stated:

Power v Workers' Comp. Appeals Bd. (1986) 179 Cal.App.3d 775

An agreed medical evaluator's opinion should ordinarily be followed unless there is good reason to find it unpersuasive.

The WCJ and WCAB followed this standard in relying on AME Dr. Green's opinions as substantial evidence.

From the decision · page 5As noted earlier, Dr. Green examined applicant in the capacity of an AME. "[W]orkers' compensation law favors agreed medical examiners in resolving medical disputes fairly and expeditiously." (Green v. Workers' Comp. Appeals Bd. (2005) 127 Cal.App.4th 1426, 1444 [70 Cal.Comp.Cases 294].) The AME was presumably chosen by the parties because of his expertise and neutrality. Therefore, an agreed medical evaluator's opinion should ordinarily be followed unless there is good reason to find that opinion unpersuasive. (Power v Workers' Comp. Appeals Bd. (1986) 179 Cal.App.3d 775, 782 [51 Cal.Comp.Cases 114].)

Place v. Workers' Comp. Appeals Bd. (1970) 3 Cal.3d 372

The relevant and considered opinion of one physician, though inconsistent with other medical opinions, may constitute substantial evidence if based on pertinent facts and adequate examination.

The WCJ and WCAB applied this standard in crediting Dr. Green's detailed medical opinions despite inconsistencies with other opinions.

From the decision · page 5It is well established that the relevant and considered opinion of one physician, though inconsistent with other medical opinions, may constitute substantial evidence. (See Place v. Workers' Comp. Appeals Bd. (1970) 3 Cal.3d 372, [35 Cal.Comp.Cases 525].) To be substantial evidence a medical opinion 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 (Appeals Board en banc).) Based on our review of the reports from Dr. Green it is clear that he examined applicant on three occasions, that he reviewed the extensive medical record, and he explained in detail the basis for his opinions and conclusions. Thus we see no reason to find his opinions unpersuasive. His reports, and his opinions stated therein, constitute substantial evidence.

Applicant's testimony at trial raised shoulder and lower extremity injuries not alleged in original claims.

From the decision · page 5Dr. Green has found no injury to applicant's shoulders, knees, head, prostate, ulcers, or any additional parts of the body.... Other than the alleged lower extremity injury and the shoulder injury raised during the applicant's testimony at his first trial, none of the additional parts of the body were alleged as industrial injuries all these years. (Report, p. 4.)

Extensive medical records and multiple evaluations by AME Dr. Green consistently found no injury to additional body parts claimed by applicant.

From the decision · page 5As noted earlier, Dr. Green examined applicant in the capacity of an AME. "[W]orkers' compensation law favors agreed medical examiners in resolving medical disputes fairly and expeditiously." (Green v. Workers' Comp. Appeals Bd. (2005) 127 Cal.App.4th 1426, 1444 [70 Cal.Comp.Cases 294].) The AME was presumably chosen by the parties because of his expertise and neutrality. Therefore, an agreed medical evaluator's opinion should ordinarily be followed unless there is good reason to find that opinion unpersuasive. (Power v Workers' Comp. Appeals Bd. (1986) 179 Cal.App.3d 775, 782 [51 Cal.Comp.Cases 114].)