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Reconsideration granted to address errors in permanent disability rating and apportionment. Matter returned for new rating considering walker use and clarifying apportionment.
The applicant sought reconsideration of a denied authorization for Synvisc knee injections. The original Independent Medical Review (IMR) denied the request, finding no documentation of the applicant's osteoarthritis failing to respond to conservative treatment. The Appeals Board found this IMR determination was based on a plainly erroneous finding of fact, as medical records in the file directly contradicted this assertion. Therefore, the Board granted the applicant's appeal, rescinded the WCJ's decision, and remanded the case for a new IMR.
Applicant sought reconsideration of a $23\%$ permanent disability award, arguing the $40\%$ apportionment to non-industrial factors lacked substantial medical evidence. The Workers' Compensation Appeals Board denied reconsideration, adopting the trial judge's report. The Board found the Qualified Medical Evaluator's apportionment was based on substantial medical evidence, including applicant's pre-existing osteoarthritis and a prior knee replacement, which explained the causation for the permanent disability. The Board also confirmed timely action on the petition within the statutory 60-day period.
The Appeals Board rescinded the original award due to an insufficient apportionment of permanent disability. The Board found that the QME's opinion, which attributed 75% of the applicant's left knee disability to pre-existing osteoarthritis, lacked adequate reasoning and was not substantial evidence. Therefore, the case was returned for further development of the record regarding apportionment, specifically concerning the QME's rationale. The Board clarified that while the applicant sustained an admitted injury to her left knee, the extent of permanent disability and its causation require further medical evaluation.
The Appeals Board affirmed the WCJ's decision, finding applicant reached permanent and stationary status on October 3, 2008, based on Agreed Medical Evaluator (AME) Dr. Chun's substantial evidence. The Board also upheld the 90% apportionment of permanent disability to applicant's pre-existing degenerative osteoarthritis, finding Dr. Chun's opinion supported by Dr. Rimoldi's report. The applicant's arguments regarding the P&S date and apportionment were rejected as misplaced or not supported by substantial evidence.
This case involves a dispute over whether the 1997 or 2005 disability rating schedule applies to applicant Joaquin Granados's left knee and back injury, and the appropriateness of apportionment. The Appeals Board granted reconsideration, rescinded the previous award, and returned the matter for new rating instructions. This decision was based on the finding that no medical report established applicant reached permanent and stationary status prior to January 1, 2005, thus mandating the application of the 2005 Schedule. Furthermore, the Board found Dr. Nottage's apportionment report to be substantial evidence, unlike Dr. Schwartz's, and ordered further proceedings based on Dr. Nottage's findings.
The Workers' Compensation Appeals Board denied the applicant's Petition for Reconsideration. The Board adopted the WCJ's report, which found that the applicant was only temporarily disabled from June 1, 2007, to July 23, 2007, and was not entitled to further travel expense reimbursement. The WCJ determined that while one physician's opinion could constitute substantial evidence, that opinion lacked sufficient clarity and consistency to support the applicant's broader claims of temporary disability and cumulative trauma to the left knee and back. The Board affirmed that a single physician's considered opinion can be substantial evidence, even if inconsistent with other medical opinions.
The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior "take nothing" order, remanding the case for further development of the medical record. Applicant alleged a cumulative trauma knee injury, but the Qualified Medical Evaluator's (QME) opinion, relied upon by the judge, was deemed not substantial medical evidence. The Board found the QME failed to adequately inquire into the applicant's job duties or demonstrate a clear understanding of cumulative trauma. The case will be returned for selection of a new QME to re-evaluate the claim.
The WCAB granted reconsideration, rescinded the prior decision, and returned the matter for further proceedings due to issues with the date of injury and apportionment of disability.
This case involved a firefighter/paramedic seeking increased permanent disability for knee injuries. The Appeals Board denied reconsideration, upholding the administrative law judge's decision. The judge's decision was based on the agreed medical examiner's opinion, which apportioned 30% of the permanent disability to non-industrial factors, including a prior knee injury and the natural progression of arthritis.
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