Zilverio Rivera — ADJ10815565

Police officer Zilverio Rivera suffered a stroke on February 20, 2017 while twisting his neck in his patrol car. The PQME in internal medicine, Dr. Benrazavi, clinically opined that applicant most likely had Bow Hunter's Syndrome (BHS), a congenital vascular defect, but deferred a definitive diagnosis and causation opinion pending a Digital Subtraction Angiography (DSA) test, which carries a roughly 5% risk of triggering another stroke. The WCJ found industrial injury and awarded medical treatment and temporary disability; defendant sought reconsideration arguing applicant failed to prove industriality and that the decision lacked substantial medical evidence. The Appeals Board concluded that applicant's refusal to undergo the risky DSA test was reasonable under Labor Code section 4056 and that Dr. Benrazavi must nonetheless provide a supplemental opinion on diagnosis and industrial causation based on reasonable medical probability. The Board rescinded the Findings and Award and remanded to the trial level for the supplemental PQME opinion and a new decision.