Cosentino: Missing Psychiatric Restrictions Left a Total-Disability Record Unfinished

Cosentino v. Ehlen, Spiess & Haight, Inc., No. ADJ7316783 (WCAB Sept. 24, 2026), examined a multi-specialty record supporting a 100-percent permanent-disability award. The panel left several industrial-injury findings intact, including injury to the teeth, but deferred headaches, memory loss, permanent disability, apportionment, and attorney’s fees for further proceedings. The decision illustrates why an extensive record may still lack the particular medical findings needed to support a vocational conclusion.

The September 24 opinion is a citable WCAB panel decision whose reasoning is persuasive rather than binding on other panels or workers’ compensation judges.

The award combined established injuries with unresolved specialty questions

The worker’s claim arose from office-management employment during 2005–2009. The trial award found industrial injury to several orthopedic, psychiatric, and dental areas and found permanent total disability without apportionment. The insurer challenged the disability finding and the support for headaches, memory loss, and teeth. The panel’s opening disposition preserved the award except for specified deferred issues. Cosentino, slip op. at 1–2.

The dental evidence received a different treatment from the neurological complaints. The dental evaluator explained how the accepted temporomandibular-joint condition and related industrial factors damaged the teeth. The panel upheld that injury finding. By contrast, the headache and memory-loss issues required final neurological clarification; the absence of that clarification did not itself establish that the complaints were nonindustrial. Id. at 11–12.

An impairment score did not supply the missing work restrictions

Orthopedic work restrictions were already present in Dr. Ovadia’s reporting and were confirmed at deposition. The psychiatric evaluator supplied an impairment assessment and discussed functioning and possible work with accommodations, but had not assigned psychiatric work restrictions. The panel expressly distinguished diminished functioning from work restrictions. That gap mattered because the vocational expert’s ultimate conclusion depended on the medical foundation. Id. at 5, 7–8, 16.

The panel also found the opinions on combining or adding impairments inadequate. Evaluators deferred to one another, and the record lacked the medical explanation necessary to resolve the question. A stated percentage or a reference to another specialty was not a substitute for a reasoned answer about the particular interaction of impairments. Id. at 15–16.

The vocational opinion could not create the absent medical facts

The applicant’s vocational expert analyzed rehabilitation and employability but also interjected views about the effect of preexisting and nonindustrial medical conditions. The panel criticized that approach, the missing psychiatric restrictions, and the lack of final neurological reporting reviewed by either vocational expert. Its reasoning concerned the foundation of these reports, not a categorical rejection of vocational evidence. Id. at 9–11, 16.

For contrast, Valencia addressed vocational observations and testing linked to medical restrictions that were already established. The different records explain why similar disability questions can produce different evidentiary outcomes.

The panel ordered development rather than a final disability result

Although the existing evidence did not establish the claimed rebuttal of the scheduled rating, the panel recognized a credible argument that the industrial injury might preclude work. It therefore allowed further medical and vocational development. It also directed preparation of previously ordered hearing transcripts absent resolution by the parties. Cosentino, slip op. at 16–17.

The operative order deferred permanent disability, apportionment, and fees while retaining the specified industrial-injury findings. It did not substitute a lower rating, deny every benefit, or finally award 100-percent disability. Id. at 18–19. For a worker reviewing a similar file, the useful next question is which medical finding remains missing, not which expert’s bottom-line percentage sounds more favorable. Our guide to vocational reports without medical restrictions explains that document comparison.