Jose Mendez — ADJ10809397

Applicant Jose Mendez sustained injury to his chest, left shoulder, and lumbar spine while working as an irrigator on December 30, 2016, including a pneumothorax requiring chest tube placement. The WCJ found 45% permanent partial disability based in part on internal medicine/pulmonary QME Dr. James Lineback's reports, which rated applicant's chronic chest wall pain at 15% WPI by analogy under Almaraz/Guzman. Defendant sought reconsideration, arguing Dr. Lineback's reports were not substantial evidence and that the non-orthopedic injury should rate 0%, contending the QME failed to satisfy the four Almaraz/Guzman requirements and relied only on subjective complaints. The Board found that because the AMA Guides contain no criteria for chest wall pain, a strict rating was impossible, and Dr. Lineback properly exercised clinical judgment in rating by analogy to the respiratory system. The Board held the reports constitute substantial evidence and denied reconsideration.