ADJ4241704 · October 7, 2024

Substantial medical evidence from Drs. Xeller, Sun, and Ching established that the cervical spine injury is a compensable consequence of prior industrial injuries, entitling applicant to further medical treatment.

From the decision · page 11the basis for their opinions. As such, we find their opinions to be substantial medical evidence. The WCJ references a Utilization Review by Genex, but as it is not medical report, it is not substantial medical evidence upon which we can rely. In light of the entire record, including the substantial medical evidence of Drs. Xeller, Sun, and Ching, applicant met his burden of showing that injuries to his cervical spine are a compensable consequence of his prior industrial injuries. As such, applicant is entitled medical care reasonably required to cure or relieve from the effects of injuries to his cervical spine.

Substantial medical evidence from Drs. Xeller, Sun, and Ching established that the cervical spine injury is a compensable consequence of prior industrial injuries.

Favours Applicant prevailed

This evidence met applicant's burden to show entitlement to further medical treatment for the cervical spine injury.

From the decision · page 11the basis for their opinions. As such, we find their opinions to be substantial medical evidence. The WCJ references a Utilization Review by Genex, but as it is not medical report, it is not substantial medical evidence upon which we can rely. In light of the entire record, including the substantial medical evidence of Drs. Xeller, Sun, and Ching, applicant met his burden of showing that injuries to his cervical spine are a compensable consequence of his prior industrial injuries. As such, applicant is entitled medical care reasonably required to cure or relieve from the effects of injuries to his cervical spine.

Provided reports in 1985 and 1987 evaluating applicant's injuries.

From the decision · page 2BACKGROUND In case number ADJ4241704, applicant claimed injury to various body parts while employed by defendant as a working area manager as a result of a work-related motor vehicle accident on July 20, 1982. In case number ADJ4098181, applicant claimed injury to various body parts while employed by defendant as a working area manager, during the period from January 31, 1983 to January 31, 1984. Both cases went to trial in 1988 and again in 2024. We will briefly review the relevant facts leading up to the 1988 trial. 2 From 1982 until 2016, applicant's primary treating doctor was orthopedic surgeon M. Robert Ching, M.D. (Minutes of Hearing / Summary of Evidence [MOH/SOE], June 5, 2024 trial, p. 2; MOH/SOE, February 17, 1988 trial, p. 4.) Applicant was evaluated by orthopedic qualified medical evaluator (QME) Andrew Burt, M.D., who issued reports on May 15, 1985 (Exhibit A) and May 4, 1987 (Exhibit C).

Provided a report in 1987 evaluating applicant's injuries.

From the decision · page 2Applicant was also evaluated by defense QME Joel Renbaum, M.D., who issued a report on January 5, 1987. (Exhibit B.) On February 17, 1988, the matter proceeded to trial, before the previous WCJ. Applicant was the only witness to provide testimony at trial. Although the medical reports were not described individually in the summary of evidence, reports from both applicant and defendant were admitted into evidence. (MOH/SOE February 17, 1988 trial, p. 2.) On September 7, 1988, the WCJ issued a Joint Findings and Award, which was based on applicant's testimony and medical reports, particularly Dr. Burt's May 4, 1987 report. (Opinion on Decision, dated September 7, 1988, p. 1.) In pertinent part, he found that applicant sustained industrial injury during the period from January 31, 1983 to January 31, 1984 and on July 20, 1982

Diagnosed multilevel cervical spondylosis and recommended physical therapy; did not opine on industrial causation.

Did not opine on industrial causation but provided diagnosis and treatment recommendation for cervical spine condition.

From the decision · page 9On October 26, 2004, Dr. Sun took applicant's history, examined applicant, and reviewed imaging of applicant's cervical and lumbar spine. He diagnosed multilevel cervical spondylosis, C4 to C7 and recommended treatment.

Primary treating physician from 1982 to 2016; opined cervical DJD and radiculopathy were industrially related and required treatment.

Provided a well-reasoned opinion linking cervical spine condition to industrial injury and need for treatment.

From the decision · page 10Dr. Ching, applicant's primary treating physician from 1982 until 2016, stated in a November 2, 2012 report that: "We have been focusing on the follow up of his left hip, but patient states that his neck and left shoulder has continued to give him pain. He has numbness and tingling in his left upper extremity and left hand involving fingers one to four." He diagnosed applicant with cervical DJD with left neuroforaminal encroachment at multiple levels and left upper extremity cervical radiculopathy. He determined that the injury, and therefore the need for medical treatment was industrially related "in view of the immediate symptoms he had right after his industrial injury 28 years ago."

Diagnosed progressive neck pain and degenerative changes related 50% to motor vehicle accident; recommended further testing and treatment.

Provided substantial medical evidence supporting compensable consequence injury and need for treatment.

From the decision · page 9In his February 14, 2013 report, PQME Dr. Xeller discussed applicant's ongoing neck pain, and he noted that in 1982, following the high speed rollover automobile accident, applicant had a cervical collar and had multiple injuries to his head, spine, upper extremities, and lower

Wilson v. State Cal Fire (2019) 84 Cal.Comp.Cases 393 (Appeals Bd. en banc)

An injury must be proximately caused by the employment to be compensable; causation may be direct or as a compensable consequence of a prior injury.

The Board applied this standard to find the cervical spine injury compensable as a consequence of prior industrial injuries.

From the decision · page 8As we stated in our en banc opinion in Wilson v. State Cal Fire (2019) 84 Cal.Comp.Cases

Barnes v. Workers' Comp. Appeals Bd. (2000) 23 Cal.4th 679

The Appeals Board has continuing jurisdiction over all its orders and awards, including future medical treatment awards, even beyond five years from the date of injury.

The Board applied this principle to uphold jurisdiction to order further medical treatment for compensable consequence injuries beyond five years from injury date.

From the decision · page 7II. Subject to the limitations of section 5804, "[t]he appeals board has continuing jurisdiction over all its orders, decisions, and awards made and entered under the provisions of [Division 4]...." (Lab. Code, § 5803.) Section 5804 provides in pertinent part: "No award of compensation shall be rescinded, altered, or amended after five years from the date of the injury except upon a petition by a party in interest filed within such five years...." (Lab. Code, § 5804.) However, the power of the WCAB to enforce an award is not constrained by the limitations set forth in section 5804 with respect to rescinding, altering, or amending an award. (Barnes v. Workers' Comp. Appeals Bd. (2000) 23 Cal.4th 679, 687 [65 Cal.Comp.Cases 780]; Kauffman v. Workers' Comp. Appeals Bd. (1969) 273 Cal.App.2d 829, 838-839 [34 Cal.Comp.Cases 373], emphasis added.) It is well settled that, where there is an existing award of future medical treatment, the WCAB has jurisdiction to enforce that medical treatment award more than five years after the employee's date of injury, even when no petition for new and further disability under section 5410, or no petition to reopen under sections 5803 and 5804, has been timely filed. (Barnes v.

Applicant's testimony and medical reports from Drs. Xeller, Sun, and Ching

From the decision · page 11the basis for their opinions. As such, we find their opinions to be substantial medical evidence. The WCJ references a Utilization Review by Genex, but as it is not medical report, it is not substantial medical evidence upon which we can rely. In light of the entire record, including the substantial medical evidence of Drs. Xeller, Sun, and Ching, applicant met his burden of showing that injuries to his cervical spine are a compensable consequence of his prior industrial injuries. As such, applicant is entitled medical care reasonably required to cure or relieve from the effects of injuries to his cervical spine.