ADJ7937623 · June 27, 2025

The applicant failed to prove by a preponderance of the evidence that he had a pre-existing permanent partial disability that was labor disabling prior to the subsequent industrial injury, despite the hypertension being apportioned 70% to non-industrial factors. The apportionment of present disability to non-industrial causes does not establish that the disability pre-existed the industrial injury without medical opinion supporting that fact.

From the decision · page 1Applicant seeks reconsideration of the "Findings of Fact and Order to Take Nothing on SIBTF Petition" (F&O) issued on August 16, 2021, by the workers' compensation administrative law judge (WCJ). The WCJ found, in pertinent part, that applicant failed to meet the burden of proving a pre-existing permanent partial disability and ordered that applicant take nothing on his claim of benefits from the Subsequent Injuries Benefits Trust Fund (SIBTF).

Applicant's hypertension was apportioned 70% to non-industrial factors and 30% to industrial factors by QME L.V. Alonso.

Favours Defendant prevailed

This medical opinion was critical in determining that the hypertension was not proven to be a pre-existing permanent partial disability that was labor disabling prior to the subsequent industrial injury, leading to denial of SIBTF benefits.

From the decision · page 3With reasonable medical probability, this patient's pre-existent hypertension was aggravated after the February 2011 incident, should be apportioned 70% to nonindustrial factors of pre-existent hypertension and natural progression, and 30% to aggravation by industrial factors of job related emotional stressors, stress reaction, and use of NSAID's.

Opined that the applicant's pre-existent hypertension was aggravated by the industrial injury, with 70% apportioned to nonindustrial factors and 30% to industrial factors including job-related emotional stressors.

The opinion was considered in evaluating whether the hypertension constituted a pre-existing permanent partial disability for SIBTF benefits.

From the decision · page 3With reasonable medical probability, this patient's pre-existent hypertension was aggravated after the February 2011 incident, should be apportioned 70% to nonindustrial factors of pre-existent hypertension and natural progression, and 30% to aggravation by industrial factors of job related emotional stressors, stress reaction, and use of NSAID's.

Reported a gradual onset of orthopedic symptoms from 2002 to 2007, with no treatment or time loss during the last ten years of employment, and no prior orthopedic problems before starting work.

From the decision · page 2A summary of applicant's treating orthopedist (Dr. Philip Sobol), reporting chronicles a claimed gradual onset of orthopedic symptoms, that were unreported, commencing in approximately 2002 for his neck shoulders, back and headaches. His elbows and wrists purportedly gradually becoming symptomatic in May 2003, and his right ankle in 2007. No treatment or time loss due to his work related symptoms were noted during the last ten years of his employment. Applicant worked his usual and customary position until going off work related to stress.

California Labor Code section 4751

Labor Code section 4751

Defines eligibility criteria for SIBTF benefits including preexisting permanent partial disability and subsequent industrial injury.

From the decision · page 4SIBTF is codified in section 4751, which provides:

Escobedo v. Marshalls (2005) 70 Cal. Comp. Cases 604

Clarifies that preexisting disability may be industrial or nonindustrial and must be labor disabling prior to the subsequent injury to qualify for SIBTF benefits.

From the decision · page 6Nevertheless, to qualify for SIF benefits, the injured employee must meet the requirements of section 4751. (Citation.) And the chief requirement for SIF benefits is that the condition must have been "labor disabling" prior to the occurrence of the subsequent industrial injury. (Citations.) Accordingly, if an applicant's non-industrial pathology causes apportionable permanent disability under section 4663 or 4664(a), then SIF benefits will not be payable under section 4751 unless the applicant demonstrates that the pathology was causing permanent disability prior to the subsequent industrial injury. Although this may mean that, in some cases, an injured employee will not get either permanent disability benefits or SIF benefits for the apportioned disability, this is not a major change from pre-SB 899 law, which held that an injured employee was not entitled to SIF benefits based on an asymptomatic disease process that was not labor disabling prior to the industrial injury.

Todd v. Subsequent Injuries Benefits Trust Fund (2020) 85 Cal. Comp. Cases 576

Explains the purpose and requirements of SIBTF benefits and the need to prove preexisting permanent partial disability.

From the decision · page 3As explained in our en banc decision in Todd:

Applicant's hypertension was apportioned 70% to non-industrial factors and 30% to industrial factors by QME L.V. Alonso.

From the decision · page 3With reasonable medical probability, this patient's pre-existent hypertension was aggravated after the February 2011 incident, should be apportioned 70% to nonindustrial factors of pre-existent hypertension and natural progression, and 30% to aggravation by industrial factors of job related emotional stressors, stress reaction, and use of NSAID's.