Opinion ID: 1368115
Heading Depth: 1
Heading Rank: 5

Heading: The lack of support of substantial evidence for the board's determination

Text: (1a) Although, as the board points out, we must sustain its conclusions if they are supported by substantial evidence, we shall explain that they cannnot stand if they rest upon no more than a doctor's surmise. (2) The board initially calls our attention to two principles of appellate review, neither of which we question: (1) that [i]n reviewing the evidence our legislative mandate and sole obligation is to review the entire record to determine whether the board's conclusion was supported by substantial evidence ( LeVesque v. Workmen's Comp. App. Bd. (1970) 1 Cal.3d 627, 637 [83 Cal. Rptr. 208, 463 P.2d 432]); (2) that factual determinations of the board must be upheld if there is substantial evidence in their support and the relevant and considered opinion of one physician, though inconsistent with other medical opinions, may constitute substantial evidence ( Smith v. Workmen's Comp. App. Bd. (1969) 71 Cal.2d 588, 592 [78 Cal. Rptr. 718, 455 P.2d 822]). (3) Expert medical opinion, however, does not always constitute substantial evidence on which the board may rest its decision. Courts have held that the board may not rely on medical reports which it knows to be erroneous ( McCoy v. Industrial Acc. Com. (1966) 64 Cal.2d 82, 92 [48 Cal. Rptr. 858, 410 P.2d 362]), upon reports which are no longer germane. ( Jones v. Workmen's Comp. App. Bd. (1968) 68 Cal.2d 476, 480 [67 Cal. Rptr. 544, 439 P.2d 648]), or upon reports based upon inadequate medical history or examinations ( West v. Industrial Acc. Com. (1947) 79 Cal. App.2d 711, 716 [180 P.2d 972]; Blankenfeld v. Industrial Acc. Com. (1940) 36 Cal. App.2d 690, 698 [98 P.2d 584]). In Zemke v. Workmen's Comp. App. Bd. (1968) 68 Cal.2d 794, 798 [69 Cal. Rptr. 88, 441 P.2d 928], we held that an expert's opinion which does not rest upon relevant facts or which assumes an incorrect legal theory cannot constitute substantial evidence.... An expert opinion is also insufficient to support a board determination when that opinion is based on surmise, speculation, conjecture, or guess. ( Owings v. Industrial Acc. Com. (1948) 31 Cal.2d 689, 692 [192 P.2d 1]; Spillane v. Workmen's Comp. App. Bd. (1969) 269 Cal. App.2d 346, 351 [74 Cal. Rptr. 671]; Industrial Indem. Co. v. Industrial Acc. Com. (1949) 90 Cal. App.2d 262, 265-266 [202 P.2d 585]; Brown v. Indusrial Acc. Com. (1941) 44 Cal. App.2d 6, 12 [111 P.2d 931]; Hendricks v. Industrial Acc. Com. (1938) 25 Cal. App.2d 534, 537 [78 P.2d 189]; see Garza v. Workmen's Comp. App. Bd. (1970) ante, pp. 312, 318, fn. 3 [90 Cal. Rptr. 355, 475 P.2d 451].) Thus in Hendricks the board relied on a medical report which attributed the petitioner's fracture not to his fall but to an uncertain and unexplained pathological condition; the Court of Appeal reversed. In Brown the board granted a petition to terminate liability based upon medical reports which stated that the petitioner still suffered pain but that the doctors could not determine the cause of the pain, and they therefore suspected him of malingering; the court reversed the board's decision, stating that where the finding purporting to support an award is necessarily based on mere surmise, speculation, conjecture or guess, the award will be annulled. (44 Cal. App.2d 6, 12.) In Owings a doctor guessed that the blow to petitioner's head might have caused his diabetes; we reversed the award, observing that [a]n opinion which is based on guess, surmise or conjecture has little, if any, evidentiary value. (31 Cal.2d 689, 692.) (1b) We now apply these principles to Dr. Freed's medical report. At the threshold we note the uncontradicted and unimpeached testimony of petitioner (see Garza v. Workmen's Comp. App. Bd. (1970) supra, ante, pp. 312, 317; LeVesque v. Workmen's Comp. App. Bd. (1970) 1 Cal.3d 627, 639 [83 Cal. Rptr. 208, 463 P.2d 432]; McAllister v. Workmen's Comp. App. Bd. (1968) 69 Cal.2d 408, 413 [71 Cal. Rptr. 697, 445 P.2d 313]) that as of June 1967, his condition was largely dormant and asymptomatic, that he suffered a severe fall on June 26, 1967, and that symptoms of pain and numbness first appeared about four days later. All of the medical reports, including that of Dr. Freed, assume the truth of this testimony. All the examining doctors observed that petitioner's symptoms became progressively more disabling from June of 1967 until his operation a year later; yet no physician suggested that such progression was inconsistent with the hypothesis that the fall in June aggravated a previously dormant condition. Given the truth of this testimony, the fact that petitioner delayed seeking medical attention until his symptoms disabled him from employment attains little probative value. Yet Dr. Freed rested his diagnosis almost exclusively upon the fact that petitioner did not sooner seek medical assistance; that if the disc injury was caused or aggravated by the June 26th fall, he should have had some symptoms immediately at the onset which would have led him to seek medical attention. The conceivable reasons for petitioner's delay in soliciting medical aid fall within the realm of the speculative. (See Garza v. Workmen's Comp. App. Bd. (1970) supra, ante, pp. 312, 319.) His delay may have resulted from his fortitude and determination to overcome the pain and not permit it to interfere with a normal life; it may have symbolized an optimism that in the immediate future the pain would disappear; it may have shown a disenchantment with the medical profession; it may have simply demonstrated that petitioner had an above-average capacity to endure pain; it may have indicated, too, that he feared that further medical treatment would impede his ability to work and support his family. We can conjure a myriad of possible reasons for the delay; Dr. Freed, however, does not favor us with one word in his report as to any interrogation or analysis of the patient in support of the doctor's surmise as to why petitioner did not sooner seek medical help. If we were to accept the doctor's hypothesis, we might well subject the petitioner to a penalty for his very forbearance and fortitude. Dr. Freed did not, so far as his report shows, inquire into petitioner's reasons for his delay; Dr. Freed does not explain why this delay shows that the fall did not precipitate petitioner's symptoms; the doctor offers no other explanation of why petitioner's condition began to deteriorate after June of 1967. Dr. Freed's suggestion that petitioner may suffer from multiple sclerosis or some other neurological disease is a further patent speculation. Dr. Freed did not determine that petitioner was, or was probably, suffering from some neurological disease; he merely suggests that whatever physician is treating petitioner ought to consider that possibility. As Dr. Black's report pointed out, no physician who has examined or treated petitioner has been able to establish a diagnosis of any neurological disease. The reports of Doctors Wolf, Lattin, Bolles, and Black all agree that petitioner's present permanent disability is due in part to injury sustained in his fall of June 26, 1967. The contrary opinion of Dr. Freed cannot serve to support the board's determination. Upon reviewing the entire record in this case we hold that the board lacked substantial evidence to support its finding that petitioner sustained no permanent disability arising from an industrial injury. The decision of the Workmen's Compensation Appeals Board is annulled and the cause remanded to the board for proceedings consistent with the views expressed herein.