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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. 2021-08-0418
Regular Panel Decision
Jun 29, 2022

Edwards-Bradford, Patrece v. Kelloggs USA, LLC

Patrece Edwards-Bradford filed a claim for permanent disability benefits following an alleged work-related assault at Kelloggs USA, LLC in June 2019. The employer disputed the physical altercation and compensability. Treating physicians, Dr. Parsioon and Dr. Murrell, found no discrete injury related to the incident, attributing symptoms to pre-existing degenerative changes, and released her at maximum medical improvement with no impairment. Subsequently, an independent medical evaluation by Dr. Apurva Dalal diagnosed degenerative lumbar stenosis with radiculopathy, linking it to an aggravation of pre-existing arthritis and assigning a 7% impairment rating. The Court, while finding the employee's testimony credible regarding the incident, ultimately denied her claim, ruling that she failed to rebut the statutory presumption of correctness given to the treating physicians' causation and impairment opinions. The decision emphasized Dr. Dalal's inability to demonstrate how the work injury advanced the pre-existing condition or caused a new, distinct injury.

Workers' CompensationWorkplace InjuryAssault ClaimPermanent DisabilityCausation DisputeMedical EvidenceTreating PhysicianIndependent Medical ExaminationDegenerative ConditionLumbar Stenosis
References
2
Case No. MISSING
Regular Panel Decision

Claim of Cameron v. Chalet

This case involves an appeal from a decision by the Workers’ Compensation Board. The Board had ruled that the claimant's injury sustained on April 22, 2000, had resolved, and her ongoing disability was a result of pre-existing extensive degenerative changes, scoliosis, and spinal stenosis throughout her spine. The appellate court found substantial evidence to support the Board's determination. It noted that the resolution of factual discrepancies and conflicting medical opinions falls within the Board's jurisdiction, despite some evidence potentially supporting an opposite conclusion. The decision of the Workers’ Compensation Board was affirmed.

AppealSubstantial EvidencePreexisting ConditionDegenerative ChangesScoliosisSpinal StenosisMedical OpinionsFactual DiscrepanciesCausationDisability Benefits
References
4
Case No. MISSING
Regular Panel Decision

Claim of Lomuscio v. Metropolitan Suburban Bus Authority

Claimant, a bus driver, sustained work-related neck and back injuries in 1993 and 1994, for which she received workers' compensation benefits. She later experienced increased neck discomfort in August 1996 and, in November 1996, while operating a bus, heard a popping sound in her neck, leading to excruciating pain, with a subsequent MRI revealing disc herniations and neuroforaminal stenosis. A Workers’ Compensation Law Judge and the Workers’ Compensation Board concluded her partial disability stemmed from a "new accident" in November 1996, not an exacerbation of prior injuries, and denied continuing benefits. On appeal, the Court found insufficient evidence to solely attribute the partial disability to the November 1996 accident, noting prior medical findings consistent with degenerative changes before the November incident. Consequently, the Board's decision was reversed, and the matter was remitted for further proceedings to determine the causation of her partial disability.

Workers' CompensationPartial DisabilityWork-Related InjuryBus DriverNeck InjuryBack InjuryMRI StudyDisc HerniationNeuroforaminal StenosisOsteophyte
References
1
Case No. 2018-02-0051
Regular Panel Decision
Jun 05, 2018

Hoss, Timothy v. ASR Metals

Timothy Hoss, an employee, filed an expedited hearing request seeking medical benefits for a back injury sustained on October 29, 2014, while working for ASR Metals. The central issues were the causal relationship between his need for treatment and the injury, and the medical necessity of proposed spinal surgery and facet injections. After an initial denial of decompression surgery recommended by Dr. Morgan Lorio, Mr. Hoss was evaluated by neurosurgeon Dr. Jim Brasfield. Dr. Brasfield recommended an L2-L3 MIS decompressive hemilaminectomy and L5-S1 percutaneous facet injections, citing stenosis and radiculopathy. ASR Metals' utilization review physician, Dr. Kimberly Terry, denied these procedures, attributing findings to pre-existing degenerative disc disease. The Court, however, found that ASR Metals failed to overcome the presumption of correctness of the authorized panel physician, Dr. Brasfield, regarding both causation and medical necessity. Consequently, the Court granted Mr. Hoss's requested relief, ordering ASR Metals to schedule the recommended surgical procedures.

Workers' CompensationBack InjurySpinal SurgeryFacet InjectionsMedical NecessityCausationUtilization ReviewPresumption of CorrectnessExpedited HearingMedical Benefits
References
1
Case No. ADJ3265357
Regular
Sep 09, 2009

MARTHA MENDEZ vs. YMCA OF SAN FRANCISCO, TRAVELERS WALNUT CREEK

The Workers' Compensation Appeals Board granted reconsideration and remanded the case to the trial level for recalculation of the permanent disability award. The Board found that the Agreed Medical Evaluator's (AME) opinion of November 8, 2007, which attributed 50% of the applicant's increased permanent disability to non-industrial degenerative changes supported by MRI studies, constituted substantial evidence. This opinion superseded the previous award, which did not adequately account for these degenerative conditions. Therefore, the Workers' Compensation Judge must now recalculate the permanent disability award based on this 50% non-industrial apportionment.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardPetition to ReopenIndustrial InjuryPermanent DisabilityApportionmentAgreed Medical EvaluatorDegenerative ChangesMRI Studies
References
3
Case No. 2024-60-7117
Regular Panel Decision
Oct 31, 2025

Hall, Michael v. TWC Holdings, Inc.

Mr. Hall sought benefits for a back injury, initially from an August 2022 incident and later from an October 2023 chair collapse. He received treatment for the 2022 injury but continued experiencing pain. An MRI in 2023 revealed degenerative disc disease. Orthopedic surgeon Dr. Daniel Burval consistently attributed Mr. Hall's back condition primarily to degenerative causes, not work-related trauma. Consequently, the Court denied Mr. Hall's request for an MRI and temporary disability benefits, citing a lack of medical proof that his condition was more than 50% caused by a work accident, as required by Tenn. Code Ann. § 50-6-102 (12)(C).

Back InjuryDegenerative Disc DiseaseCausationMedical OpinionExpedited HearingDenial of BenefitsPreexisting ConditionOrthopedic SurgeryLumbar SpineWork Accident
References
1
Case No. MISSING
Regular Panel Decision

Rice v. Commissioner of Social Security

Plaintiff Tammy Rice sought judicial review of the Commissioner of Social Security's final decision denying her application for disability benefits. The District Court considered the Commissioner's motion for judgment on the pleadings. The Administrative Law Judge (ALJ) found that Plaintiff had severe impairments of mild degenerative disc disease of the lumbar spine and mild degenerative joint disease of the knees but did not meet or equal a listed impairment. The ALJ determined Plaintiff could perform light work with restrictions, concluding she was not disabled. The Court found the Commissioner's decision supported by substantial evidence and in accordance with applicable legal standards. Consequently, the Commissioner's motion for judgment on the pleadings was granted, and Plaintiff's complaint was dismissed with prejudice.

Social SecurityDisability BenefitsALJ DecisionSubstantial EvidenceMedical EvidenceResidual Functional CapacityTreating Physician RuleFederal Rules of Civil ProcedureRule 12(c)Lumbar Spine
References
28
Case No. MISSING
Regular Panel Decision
Sep 03, 2019

Amendolia, Roseanne v. Emory Valley Center, Inc.

Ms. Amendolia sustained work-related back and neck injuries in June 2017 while employed by Emory Valley, leading to a workers' compensation claim. Disputes arose regarding the causal link of her L4-L5 spinal stenosis, the degree of permanent medical impairment, and her vocational disability. The court adopted Dr. McMahon's causation opinion, finding her work injury caused a L3-L4 disc herniation and aggravated L4-L5 spinal stenosis. However, it sided with Dr. Koenig on impairment ratings, establishing a combined 11% permanent whole-person impairment. Consequently, Ms. Amendolia's claim for permanent and total disability was denied, but she was awarded medical treatment and an original lump-sum payment of $17,165.61, with further claims reserved.

Workers' CompensationSpinal StenosisHerniated DiscPermanent ImpairmentVocational DisabilityMedical CausationAggravation of Preexisting ConditionTreating Physician OpinionIndependent Medical ExaminationAMA Guides
References
9
Case No. 531582
Regular Panel Decision
May 13, 2021

Matter of Matteliano v. Trinity Health Corp.

Caitlyn Matteliano, a nurse assistant, suffered work-related back, knee, and leg injuries in 2015 and 2018. Her treating orthopedic surgeon, Franco Vigna, requested authorization for multi-level lumbar fusion surgery and an external bone growth stimulator due to persistent pain and degenerative disc disease, despite conservative treatments. The employer denied this request based on an independent medical examination by Anthony Leone, who deemed the surgery aggressive and inappropriate given the lack of instability. A Workers' Compensation Law Judge initially denied the request, but the Workers' Compensation Board approved it. The employer appealed, and the Appellate Division, Third Department, affirmed the Board's decision, finding substantial evidence in Vigna's testimony to support the surgery's authorization under medical treatment guidelines for degenerative disc disease where non-surgical management has failed.

Workers' CompensationLumbar Fusion SurgeryMedical Treatment GuidelinesDegenerative Disc DiseaseDiscogenic Back PainIndependent Medical ExaminationPrior AuthorizationAppellate ReviewNurse AssistantWork Injury
References
9
Case No. 04-09-00401-CV
Regular Panel Decision
Jul 21, 2010

Texas Mutual Insurance Company v. Sarah Ochoa

Sarah Ochoa sustained a lumbar sprain injury at work and filed a workers' compensation claim. Texas Mutual Insurance Company, the carrier, initially accepted the lumbar sprain but disputed later claims of extensive lumbar disc pathology as an ordinary disease of life. The hearing officer found a sprain/strain injury superimposed on pre-existing degenerative conditions but also ruled that Texas Mutual waived its right to contest the extent of injury by not timely disputing it within 60 days, making the degenerative conditions compensable. Texas Mutual appealed to the state district court, which granted Ochoa's no-evidence motion for summary judgment. This appellate court reverses and remands the trial court's judgment, holding that the 60-day waiver rule in the Texas Labor Code does not apply to extent-of-injury disputes, citing Texas Supreme Court precedent.

Workers' CompensationSummary JudgmentWaiver RuleExtent of Injury DisputeLumbar SprainDegenerative Disc DiseasePre-existing ConditionAppellate ReviewTexas Labor CodeJudicial Precedent
References
7
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