ADJ578425 — California WCAB decision

What the panel ordered

Petitions for Reconsideration denied.

Petitions for Reconsideration filed by applicant regarding ADJ578425 and ADJ1387102 were considered and denied by the panel after review of the WCJ report.

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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.

AOE/COEDefendant prevailedhead · heart · cardiovascular system · neurological · diabetes · hypertension · psyche

Based on the credible testimony and the medical report of PQME Michael Levey, the applicant did not sustain injury arising out of and in the course of employment during the period 8/11/1997 to 6/2/2006.

From the decision · page 17Based upon applicant's credible testimony and the medical report(s) of PQME Michael Levey, M.D., dated 6/24/2020, which are the better reasoned and more persuasive, it is found that applicant did not sustain injury to his head, heart, cardiovascular system, neurological, aggravation of diabetes and hypertension, and psyche arising out of and occurring in the course of employment during the period 8/11/1997 to and including 6/2/2006.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291

The employee bears the burden of proving injury AOE/COE by a preponderance of the evidence.

Applicant must show industrial causation is reasonably probable, not zero.

From the decision · page 16The employee 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]; Lab. Code, § 3600(a); 3202.5.) The Supreme Court of California has long held that an employee need only show that the "proof of industrial causation is reasonably probable." (McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 413 [33 Cal.Comp.Cases 660]) Applicant must only show that industrial causation was "not zero" to show sufficient contribution from work exposure. (Clark, supra, 61 Cal.4th at p. 303.) Decisions of the Appeals Board must be supported by substantial evidence. (Lab. Code, § 5903, 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274 [39 Cal.Comp.Cases 310]; Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312 [35 Cal.Comp.Cases 500]; LeVesque v.

Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc)

Medical opinion must be framed in terms of reasonable medical probability, not speculative, based on pertinent facts and adequate examination and history, with reasoning in support of conclusions.

Medical reports and opinions are not substantial evidence if erroneous, speculative, or based on inadequate histories or incorrect legal theories.

From the decision · page 17Workmen's Comp. Appeals Bd. (1970) 1 Cal.3d 627 [35 Cal.Comp.Cases 16].) 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).) "Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories. Medical opinion also fails to support Board's findings if it is based on surmise, speculation, conjecture or guess." (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d, 162, 169 [36 Cal.Comp.Cases 93].)

ADJ578425 · June 16, 2023

What the panel ordered

What was disputed, and how it came out

The facts that decided it

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What the panel did with the medical opinions

The rules the panel named

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