ADJ6508173 — California WCAB decision

ADJ6508173 · January 16, 2026

Findings and Award dated November 22, 2021, rescinded and substituted; injury to lungs, upper digestive system (GERD), psyche, and sleep disorder found; injury to METs not found; permanent disability, apportionment, attorney fees, and 15% increase under Labor Code section 4658(d) deferred; temporary disability and further medical treatment awarded

Issues decided

Medical opinions weighed

Authorities named

District office

Marina del Rey

What the panel ordered

Petition for reconsideration granted; Findings and Award rescinded and substituted; permanent disability, apportionment, attorney fees, and 15% increase under Labor Code section 4658(d) deferred for further development

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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.

Permanent disability ratingDeferredlungs · upper digestive system · psyche · sleep disorder

The Board found injury to lungs, upper digestive system (GERD), psyche, and sleep disorder but not to METs, which is a measure of functional limitation, not a body part. The issue of permanent disability, apportionment, and the 15% increase under section 4658(d) was deferred for further development due to incomplete medical opinion and need for further record development.

From the decision · page 2We have considered the allegations in applicant's Petition and defendant's Answer, and the contents of the WCJ's Report with respect thereto. Based upon our review of the record, and for the reasons discussed below, as our Decision After Reconsideration, we will rescind the F&A, and substitute a new F&A that finds that applicant sustained injury to her lungs, upper digestive system (in the form of gastroesophageal reflux disease (GERD), psyche and in the form of a sleep disorder, but not in the form of METs because it is a measure of functional limitation and not a separate body part; and to defer the issue of permanent disability, apportionment and attorney fees, and the issue of whether the increase under section 4658(d) applies.

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 (Appeals Board en banc)

Permanent disability rating must be based on substantial medical evidence and reasonable medical probability, not speculation or incorrect legal theories.

Applied to evaluate the sufficiency of medical opinions on permanent disability and apportionment.

From the decision · page 3It is axiomatic that substantial evidence must support the decisions by the Appeals Board. (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. Workmen'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 the 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].)

Almaraz v. Environmental Recovery Services/Guzman v. Milpitas Unified School District (2009) 74 Cal.Comp.Cases 1084 (Appeals Board en banc)

AMA Guides allow physician judgment and experience in assessing whole person impairment (WPI) beyond rigid application of rating schedules.

Applied to assess the appropriateness of Dr. Gillis's rating method.

From the decision · page 4In addition, while the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) function as advisory frameworks, they are not strict texts subject to rote or literal application. Instead, an evaluating physician may use their experience and expertise to interpret and apply any portion of the entire AMA Guides. Pursuant to Almaraz/Guzman II 74 Cal.Comp.Cases 1084, the Appeals Board held that:

Labor Code sections 4663(a) and 4664(a); Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc)

Apportionment of permanent disability must be based on causation and supported by substantial evidence explaining the 'how and why' of apportionment.

Applied to evaluate apportionment evidence and burden of proof.

From the decision · page 9Apportionment of permanent disability is "based on causation" and the "employer shall only be liable for the percentage of permanent disability directly caused by the injury arising out of and occurring in the course of employment." (Lab.Code, § 4663(a) and 4664(a).) "The plain reading of `causation' in this context is causation of the permanent disability." (Escobedov. Marshalls (2005) 70 Cal.Comp.Cases 604, 611 (Appeals Board enbanc) (Escobedo).) Apportionment now includes pathology, asymptomatic prior conditions, and retroactive prophylactic work preclusions, provided

ADJ6508173 · January 16, 2026

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