ADJ9163216 · March 14, 2022

The panel found the WCJ erred in adding psychiatric permanent disability to orthopedic and CRPS disabilities instead of combining them using the Combined Values Chart, deferring the permanent disability rating for re-rating.

From the decision · page 41. the applicant, while employed during on May 20, 2013 as a mechanic, occupational group number 460, at Lompoc, California by Sousa Tire Service, sustained injury arising out of and in the course of employment to his bilateral arms, hands, shoulders, neck, psych and CRPS.

The WCJ added psychiatric permanent disability to orthopedic and CRPS disabilities instead of combining them using the Combined Values Chart.

Favours Defendant prevailed

This was found to be an error requiring reconsideration and re-rating of permanent disability.

From the decision · page 1Defendant seeks reconsideration of a workers' compensation administrative law judge's (WCJ) Findings and Award of December 21, 2021 wherein it was found that, while employed "during the period of August 28, 2017 through August 28, 2018"1 as a mechanic, applicant sustained industrial injury to his arms, hands, shoulders, neck, psyche and in the form of complex regional pain syndrome (CRPS), causing permanent total (100%) disability. In finding permanent total disability, it was found that applicant had 77% orthopedic disability, 62% CRPS disability and 26% psyche disability. The orthopedic and the CRPS permanent disabilities combined to produce 91% permanent disability utilizing the Combined Values Chart. (2005 Schedule for Rating Permanent Disabilities on p. 8-4.) The psychiatric permanent disability was added to the combined orthopedic and CRPS permanent disabilities, rather than combined utilizing the Combined Values Chart, to find permanent total disability.

Dr. Fowkes-Muto's report did not provide substantial medical evidence to rebut the use of the Combined Values Chart.

Favours Defendant prevailed

This supported the panel's decision to reject adding impairments and defer the rating for re-rating.

From the decision · page 2This report was the only report by Dr. Fowkes-Muto in the evidentiary record. Dr. Fowkes-Muto's report is not substantial medical evidence sufficient to rebut the use of the Combined Values Chart. An overlapping or duplicative disability is not included in a

Agreed with Dr. Mendelson that psychiatric impairments are permanent and stationary and should be added to orthopedic impairments rather than combined using the Combined Values Chart.

Believed psychiatric impairment did not overlap with orthopedic impairment and thus should be added rather than combined.

From the decision · page 2The WCJ based his decision to add the psyche permanent disability to the remainder of the permanent disability on the April 29, 2021 report of treating psychologist Kristyn Fowkes-Muto, PhD, which reads, in its entirety, as follows:

Provided psychiatric impairment rating with a Global Assessment of Functioning score of 58, finding 100% of psychiatric impairment resulted from the industrial injury.

Her findings were incorporated by Dr. Fowkes-Muto but the panel found no compelling reason to add rather than combine impairments.

From the decision · page 2The WCJ based his decision to add the psyche permanent disability to the remainder of the permanent disability on the April 29, 2021 report of treating psychologist Kristyn Fowkes-Muto, PhD, which reads, in its entirety, as follows:

Athens Administrators v. Workers' Comp. Appeals Bd. (Kite) (2013) 78 Cal.Comp.Cases 213 (writ den.)

Use of the Combined Values Chart for permanent disability ratings unless substantial medical evidence supports adding impairments.

The panel applied Kite to reject adding psychiatric impairment to orthopedic impairment without substantial medical evidence.

From the decision · page 3In Athens Administrators v. Workers' Comp. Appeals Bd. (Kite) (2013) 78 Cal.Comp.Cases 213 (writ den.), we held that adding, rather than combining, two different impairments better reflected a worker's impairment when substantial medical evidence supported the notion that the two impairments had a synergistic effect where, in effect, the resultant impairment was more than the sum of the two impairments. In Kite, the evaluator explained why the disparate impairments were not actually disparate, and the impairments in question were all under the physician's expertise. In contrast, here one specialist is suggesting that we add impairments found by her in her own specialty to impairments in completely different body systems found by a different specialists. Dr. Fowkes-Muto incorporated Dr.

Applied Materials v. Workers' Comp. Appeals Bd. (D.C.) (2021) 64 Cal.App.5th 1042, 1097 [86 Cal.Comp.Cases 331]

Physicians may only make disability determinations within their own specialty.

The panel applied this standard to reject Dr. Fowkes-Muto's opinion to add impairments across specialties.

From the decision · page 3Mendelson's GAF score and does not explain how this GAF score does not adequately reflect the applicant's psychiatric permanent impairment. Dr.Fowkes-Muto did not give any compelling reason why these separate impairments should be added, and questions beyond applicant's psychological impairment are beyond Dr. Fowkes- Muto's expertise. (Applied Materials v. Workers' Comp. Appeals Bd. (D.C.) (2021) 64 Cal.App.5th 1042, 1097 [86 Cal.Comp.Cases 331].) Dr. Fowkes-Muto did not explain how the GAF score of 58, combined to whole person impairment, adjusted into a permanent disability rating, and combined with the other permanent disability ratings was inadequate.

Dr. Fowkes-Muto's report was the only report by her in the record and was not substantial medical evidence to rebut the use of the Combined Values Chart.

From the decision · page 2This report was the only report by Dr. Fowkes-Muto in the evidentiary record. Dr. Fowkes-Muto's report is not substantial medical evidence sufficient to rebut the use of the Combined Values Chart. An overlapping or duplicative disability is not included in a