ADJ5787628 · May 5, 2025

The AME Dr. Wood testified that a neurologist may add additional functional loss that he was missing, establishing good cause for an additional neurology QME panel.

From the decision · page 10Here, the parties obtained a medical-legal evaluation from the orthopedic AME, Dr. Wood. But when Dr. Wood was asked under oath whether his final opinions accurately reflected applicant's condition orthopedically, he testified that they did but added that "a neurologist may add additional functional loss that I was missing." (Jt. Ex. Q, Deposition Transcript of David Wood, July 28, 2020, p. 18:9-23.)

Applicant's testimony showed increased symptomatology of the shoulder not evaluated by Dr. Wood, so the issues of new symptoms were deferred for further evaluation.

From the decision · page 11As we have explained, McDuffie authorizes augmentation of the medical record where the evaluator's medical opinion is incomplete. In this case, since applicant's testimony shows increased symptomatology of the shoulder which has not been evaluated by Dr. Wood, augmentation of the record is appropriate. Since AME Dr. Wood has previously reported on this case, Dr. Wood should evaluate the increased symptomatology of the shoulders. However, since we will order an additional QME panel in neurology, we recommend that the newly selected QME in neurology evaluate the alleged carpal tunnel syndrome. (McDuffie, supra, (stating that follow- up or supplemental evaluations should be obtained from the same physicians who have previously reported on the case to the extent possible).)

The Board deferred all other issues to the trial level for further proceedings consistent with the decision to grant an additional neurology panel.

From the decision · page 12with Southern California Permanente Medical Group aka/ Kaiser Foundation Health Plan on May 5, 2005 to his lumbar, internal in the form of a pulmonary embolism, and psyche. 2. Applicant's psychiatric injury was a result of his orthopedic injury. 3. Applicant did not sustain injury arising out of and in the course of employment to his lower extremities. 4. The issue of whether applicant sustained new and different symptoms in the form of carpal tunnel syndrome is deferred. 5. The issue of whether applicant sustained new and different symptoms in the form of shoulder rupture is deferred. 6. The issue of whether applicant has the ability to compete in the open labor market or be retrained for suitable gainful employment is deferred. 7. The issue of the amount of permanent disability is deferred. 8. The issue of apportionment is deferred. 9. Applicant is entitled to further medical treatment to cure or relieve from the effects of this injury. 10. The issue of attorney's fees is deferred. 11. All other issues are deferred.

Dr. Wood testified that a neurologist may add additional functional loss that he was missing.

Favours Applicant prevailed

This testimony established good cause for an additional neurology QME panel, leading to the Board granting the petition for reconsideration and ordering the additional panel.

From the decision · page 10Here, the parties obtained a medical-legal evaluation from the orthopedic AME, Dr. Wood. But when Dr. Wood was asked under oath whether his final opinions accurately reflected applicant's condition orthopedically, he testified that they did but added that "a neurologist may add additional functional loss that I was missing." (Jt. Ex. Q, Deposition Transcript of David Wood, July 28, 2020, p. 18:9-23.)

Applicant testified to increased upper extremity symptoms and diagnoses of carpal tunnel syndrome and shoulder rupture.

Favours Applicant prevailed

This testimony showed new symptoms not evaluated by Dr. Wood, justifying deferral of these issues for further evaluation.

From the decision · page 11Here, applicant testified that his upper extremities symptoms have increased since he was evaluated by Dr. Wood and that he received a diagnosis of carpal tunnel syndrome which he believes resulted from his use of canes and a walker. (Minutes of Hearing and Summary of Evidence, October 3, 2024, pp. 6:8-11, 7:13-20.) He further testified that he was injured in early 2024 while treating with a physical therapist and was diagnosed with a shoulder muscle rupture. (Id., p. 6:19-24.)

Defendant's Declaration of Readiness dated May 14, 2024 referenced prior settlement efforts and MSCs, complying with section 10742 and found valid.

Favours Defendant prevailed

This supported the Board's finding that the DOR was proper, rejecting applicant's contention of impropriety.

From the decision · page 5In this instance, the language in the Declaration of Readiness specifically references a prior MSC, as well as the specific date of 12-29-23 along with the AME re- evaluation and MMI reporting by multiple evaluators and without any evidence offered to the contrary, the undersigned finds the Declaration of Readiness dated 5- 14-24 complies with section 10742 and is valid. Furthermore, considering the

Dr. Wood testified that his final opinions accurately reflected applicant's orthopedic condition but acknowledged that a neurologist may add additional functional loss that he was missing.

Dr. Wood's testimony established good cause for an additional neurology QME panel because he acknowledged potential additional functional loss outside his expertise.

From the decision · page 10Here, the parties obtained a medical-legal evaluation from the orthopedic AME, Dr. Wood. But when Dr. Wood was asked under oath whether his final opinions accurately reflected applicant's condition orthopedically, he testified that they did but added that "a neurologist may add additional functional loss that I was missing." (Jt. Ex. Q, Deposition Transcript of David Wood, July 28, 2020, p. 18:9-23.)

Dr. Wood did not request another panel specialty but was open to another opinion.

Dr. Wood's testimony during cross-examination showed he was comfortable with his rating but open to another opinion, supporting the need for an additional panel.

From the decision · page 6Petitioner contends that the AME testified that a neurological evaluation would be relevant during his cross-examination.... Petitioner further argues that when an AME/QME identifies a medical dispute that falls outside of his/her expertise, an additional panel is appropriate.... [I]n review of Dr. Wood cross-examination, Dr. Wood stated "... I'm comfortable with my rating." (Jnt Ex Q pg 9, line 10-16). Dr. Wood went on to state that he is "always happy to have another opinion.." but did not request another panel specialty.... New and Different Symptoms... Petitioner fails to acknowledge that upper extremities/carpal tunnel were not alleged nor included in either Pre-Trial Conference Statement nor issues at Trial. Petitioner is now attempting to include an issue not raised at the MSC or Trial.

Cal. Code Regs., tit. 8, 31.7(b)(1) and (b)(3)

Standards for additional QME panels in different specialties and the process for ordering them.

From the decision · page 8Administrative Director Rule 31.7(b) provides: (b) Upon a showing of good cause that a panel of QME physicians in a different specialty is needed to assist the parties reach an expeditious and just resolution of disputed medical issues in the case, the Medical Director shall issue an additional panel of QME physicians selected at random in the specialty requested. For the purpose of this section, good cause means:

McDuffie v. Workers' Comp. Appeals Bd., 27 Cal.4th 798 (2002)

McDuffie v. WCAB

The Board must establish that specific medical opinions are deficient or incomplete before ordering augmentation of the medical record.

From the decision · page 10authorize the WCJ and the Board to obtain additional evidence, including medical evidence, at any time during the proceedings (citations) [but] [b]efore directing augmentation of the medical record... the WCJ or the Board must establish as a threshold matter that specific medical opinions are deficient, for example, that they are... incomplete." (McDuffie, supra, at p. 141.)

Applicant's testimony of increased upper extremity symptoms and diagnosis of carpal tunnel syndrome and shoulder rupture

From the decision · page 11Here, applicant testified that his upper extremities symptoms have increased since he was evaluated by Dr. Wood and that he received a diagnosis of carpal tunnel syndrome which he believes resulted from his use of canes and a walker. (Minutes of Hearing and Summary of Evidence, October 3, 2024, pp. 6:8-11, 7:13-20.) He further testified that he was injured in early 2024 while treating with a physical therapist and was diagnosed with a shoulder muscle rupture. (Id., p. 6:19-24.)

Defendant's Declaration of Readiness dated May 14, 2024 referencing prior settlement efforts and MSCs

From the decision · page 5Petitioner contends that the WCJ erred when failing to find Defendant's DOR dated May 14, 2024 improper. Although the issue was raised in the Pre Trial Conference Statement dated 7-1-2024, applicant did not offer any evidence at Trial to support his contentions. In his Petition for Reconsideration, applicant argues, "defendant merely lists the various physician's names involved in the case." However, in review of the Declaration of Readiness dated 5-14-2024 (EAM#51919725), the statement provided by Defendant references the prior MSC which was set for 6-12- 23 indicating it was taken off calendar pending an AME re-evaluation which has since been obtained and final MMI reports have been received from three named doctors. Reference was also made to "attempts made 12/29/2023 to resolve have been unsuccessfully".