The lady's father happened to be an orthopedic surgeon as well. He suggested that his daughter to go to San Diego to be evaluated by Dr. Samuel Maywood, an anesthesiologist. Dr. Maywood evaluated the applicant and performed one nerve block which permanently and totally eliminated the pain symptomology. The reason the lady was calling me was to determine whether or not she could sue the five doctors who unsuccessfully evaluated and treated her for over six months. She had lost her job in the interim. She was very upset that one doctor was able to cure her with one nerve block while the other five didn't even know what was going on.

The lady encouraged me to call Dr. Maywood to discuss the matter. I did. Dr. Maywood informed me that the lady had a condition known as Reflex

Dr. Maywood explained RSD as follows: Sometimes when there is a trauma to a particular nerve, that nerve will go into sort of perpetual fight or pain mode. The nerve doesn't relax. This of course causes pain. Unfortunately, this type of condition, after time, can affect surrounding nerves and in fact cause the surrounding nerves to also go into perpetual suspension or pain/fight mode. What Dr. Maywood does is to localize that particular set of nerves and relax them. Once they are given the opportunity to relax, they go back to normal. The lady who had called me had been in pain for well over six months. The pain had been constant and unrelenting. No amount of physical therapy was of assistance. The initial trauma to the nerve area was due to the arthroscopic surgery. Although the arthroscopic surgery was a success, the nerves would not relax.

I have since sent two applicants to Dr. Maywood for treatment of suspected RSD. In both cases, there was an immediate and dramatic response to Dr. Maywood's treatment. In both of these cases, physical therapy had been used extensively. In both of these cases, physical therapy had been of no effect.

I am writing this article to give the lay person some understanding of RSD. I am also writing this article so that hopefully those that are suffering from RSD can receive adequate treatment. It is terrible that some people suffer months and even years with severe pain needlessly. Obviously, if five doctors were unable to properly diagnose or treat RSD for the lady who contacted me, there is a major problem with training in the medical community. Quite frankly, Dr. Maywood is the only doctor that I am aware of that regularly, successfully treats RSD. There may be others, I just don't know of them.

Dr. Maywood is the Director of Special Services with the Third Avenue Out-Patient Surgery Center. Their address is 4045 Third Avenue, Suite 202, San Diego, California, 92103. His phone number is (619) 295-4296.

Wilkinson Applied Even Though Multiple Injuries Not Permanent and Stationary at Same Time

pplicant Lea Diniell sustained four work-related injuries: a 1983 injury to her low back; October 1988 injury to her right knee; a CT through February 1988 to psyche, heart, skin, thyroid and gastrointestinal system; and a CT through March 27, 1992 for the low back and right knee.

WCJ Sauban-Chapla issued a Findings and Award dated May 31, 1996. The WCJ combined PD for all injuries into one rating, totalling 100% PD. The defendants filed a Petition for Reconsideration. Among other things, the defendants contended that the applicant's injuries were not all P&S at the same time. As such, the WCJ erred in combining PD for all injuries into a single 100% PD award.

A Petition for Reconsideration was filed. It was denied. A Petition for Writ of Review was filed as well. It was denied.

In her report to the Workers' Compensation Appeals Board, the WCJ cited the case of Wilkinson v. WCAB, 42 CCC 406 for the proposition that multiple injuries should be rated as one when they occurred with the same employer, for the same body parts, and became permanent and stationary at the same time. However, the WCJ noted that subsequent cases eliminated two of the initial requirements. Injuries no longer have to be to the same body part, nor with the same employer. The WCJ was content in eliminating the third requirement, which was that the injuries be permanent and stationary at the same time.

Dept. of Corporations v. WCAB, 61 CCC 1469

Editor's Note: This case seems to be in opposition to the case of Parker v. WCAB, 57 CCC 608. The Parker Court reaffirmed "Wilkinson's long-standing threshold requirement that successive injuries must occur to the same part of the body." The case also appears to be in opposition to the case of Stoiber v. WCAB, 57 CCC 330. In that case, the Court emphasized that the two injuries were to the same body part during the same employment and became permanent and stationary at the same time. All of these elements were important before there was an application of Wilkinson rule.

A good discussion of the application of the Wilkinson rule is found in the California Law of Employee Injuries and Workers' Compensation, Revised 2nd Edition, by Hanna.

Application of Law Regarding Substantial Evidence

obert Hoy had a twenty year history of hypertension and diabetes, as well as peripheral vascular disease. The risk factors for the vascular condition included diabetes, hypertension, and smoking. Although Hoy had given up smoking, he had smoked two to three packs a day for thirty years.

On January 8, 1992, Mr. Hoy had his right leg amputated below the knee due to gangrene. A year later he had his left leg amputated below the knee for the same reason.

Mr. Hoy filed a workers' compensation claim alleging that the injuries to his legs, feet and cardiovascular system were the result of exposure to cold during the period of his employment at AM/PM.

Drs. Lineback and Bellaci stated that Mr. Hoy's exposure to the cold during his work at AM/PM aggravated the vascular problem in his right leg. The doctors did not think that the left leg amputation was due to the cold exposure.

However, both doctors based their opinions upon what Mr. Hoy had told them regarding how long he had spent in the refrigerated areas. This included the temperature of the refrigerated areas. Both doctors stated that if their assumptions regarding the length of time Mr. Hoy spent in the refrigerated area or their beliefs regarding the temperature were incorrect, then their opinions may very well be different.

At time of trial, a store manager, John Gray, testified on behalf of AM/PM. He stated that the time Mr. Hoy spent in the refrigerated area was much less than what Mr. Hoy had testified to. Mr. Gray also testified that the temperature of the refrigerated area was warmer than that testified by Mr. Hoy.

The matter was tried. WCJ Jackson found that Mr. Gray was credible. However, the judge noted that Hoy had complained of sore and painful feet as the reason he left the job with AM/PM. The judge also noted that the first amputation took place shortly after he left his job. The judge concluded that these facts were persuasive to show an aggravation of some degree of a pre-existing medical problem resulting in the amputation of Mr. Hoy's right leg. The left leg amputation was thought to be non-industrial in origin.

A Petition for Reconsideration was filed. The Board upheld the WCJ. A Petition for Writ of Review was filed. The Court of Appeal reversed.

The Court of Appeal noted that if medical reports are known to be erroneous or based on inadequate medical histories and examination, they cannot constitute substantial evidence. Essentially, medical opinions are only as good as the reasons upon which they're based. In this case, the judge specifically accepted Mr. Gray's testimony as to the essential facts. This being the case, the medical reports, which were based upon Mr. Hoy's testimony, no longer constituted substantial evidence. The proximity of the injury to the date of employment is not sufficient in itself to prove causation. An award based solely on evidence tending to prove only a possibility of industrial causation is conjecture and cannot be sustained.

The Court of Appeal reversed the decision as a matter of law. Mr. Hoy was awarded nothing.

CIGNA Insurance Company v. WCAB, 61 CCC 1378

The CIGNA insurance case is a particularly good one to review regarding the application of the law on substantial evidence. There are numerous case citations which outline the prerequisites regarding substantial evidence. The appellate court essentially does a text book analysis of the issue. For anyone who is a little unclear on the issue of substantial evidence, this is an excellent case to read. While this is a case opinion "not published in the official reports," and as such, a case that I would not normally review in the CompDigest, I think that it does an excellent review of existing case law on the application of substantial evidence.

Employer's Liability For Rehabilitation Services Ends if Modified Employment is Terminated "For Cause"

Michael Anzelde sustained an admitted work-related injury on July 26, 1993. He was subsequently found to be a Qualified Injured Worker.

In November 1993, the employer identified a permanent modified job for Mr. Anzelde. In January 1994, Mr. Anzelde's treating physician approved the plan. The applicant accepted the modified offer in February of 1994. The job was to commence on April 11, 1994.

When Mr. Anzelde reported to work on April 11, 1994, he was placed on administrative leave pending the results of an internal investigation into Mr. Anzelde's alleged illegal activities. This investigation subsequently resulted in Mr. Anzelde's termination on May, 1995.

Mr. Anzelde requested additional rehabilitation benefits. The employer refused. Mr. Anzelde argued that the offer was not made in good faith. The employer responded that they had satisfied their requirements in offering the modified job.

The Rehabilitation Unit agreed with Mr. Anzelde. They issued an order requiring additional benefits after a formal conference on December 9, 1994. This order was appealed. The WCJ Keye agreed with the Rehabilitation Unit's order. The defendant filed a Petition for Reconsideration of the F&A issued by WCJ Keye.

The Board granted the Petition for Reconsideration. They found that the defendant had satisfied its vocational rehabilitation obligations to applicant by making the modified job offer. The Board found that the applicant was no longer entitled to any vocational rehabilitation services.

The Board stated, "The only reason the applicant was unable to work at the modified job created pursuant to the rehabilitation plan was circumstances which were solely within his control, to wit, his participation in unlawful activities which were unrelated to his industrial injury."

Under the rules pertaining to offers of modified work for injuries occurring prior to 1994, an employer's liability for rehabilitation services ends if the modified employment is terminated "for cause." (Labor Code §4644(d), for pre-1994 injuries).

Michael Anzelde v. WCAB, 61 CCC 1458