Keteles: Why the Board Kept a 70% Disability Award Despite a Lower Private Rating

When hand and wrist injuries leave lasting limitations, the percentage used to rate your disability can have substantial financial consequences. Different numbers in the same file can be confusing. The first question is why they differ: Did someone find a calculation error, or did someone change the medical findings used in the calculation?

In Keteles v. County of Alameda, Nos. ADJ13757266 and ADJ13757284 (WCAB Jan. 31, 2023), the Appeals Board denied the employer’s petition for reconsideration and left a 70 percent permanent-disability award in place. The panel explained why a private rater’s disagreement with a doctor’s medical findings could not substitute for medical evidence.

The medical evaluator documented lasting problems in both upper extremities

Arleen Keteles worked as a sheriff technician. The Board’s opinion in Keteles describes the judge’s finding of a cumulative injury during December 2017 into January 2018 affecting her right thumb, wrist, elbow and upper-extremity nerves, and her left wrist.

Pain-medicine QME William Brose, M.D., evaluated her in 2019, 2021 and 2022. His reports documented examination findings and reviewed her history and medical records. By the 2022 evaluation, he identified chronic pain, numbness and several conditions affecting her hands, wrists and right arm, including the effects of surgery.

Dr. Brose assessed 37 percent whole person impairment and supplied the medical information used in the disability-rating process. Whole person impairment is the medical impairment measure; the permanent-disability percentage results from applying the rating framework, including occupation and age adjustments, to the accepted findings. Those figures serve different purposes.

A corrected formal rating increased the recommendation from 68 to 70 percent

After the first trial session, the judge issued formal rating instructions to the Disability Evaluation Unit. The DEU rater’s testimony in Keteles describes an initial recommendation of 68 percent permanent disability. While preparing for cross-examination, she identified an incorrect disability number for an elbow component and corrected it. The amended recommendation was 70 percent.

The judge supplied the amended rating to the parties and offered an opportunity to request a continuance. The parties proceeded to trial, where the employer cross-examined the DEU rater and called its own private rater.

That sequence matters. The amended percentage was explained through the rater’s testimony and the underlying instructions. The judge could examine what changed and why.

The private rater changed medical inputs rather than identify a technical error in the amended rating

The employer’s private rater in Keteles assessed 44 percent disability. She questioned whether examination and nerve-test findings supported particular impairments and changed the medical inputs before calculating her rating.

For example, she challenged the support for carpal-tunnel and other nerve impairments. But she testified that she had no medical training and had never worked as a nurse or in a medical office. She had also not reviewed the judge’s formal rating instructions. According to the judge’s report, she identified no technical error in the amended DEU rating.

The panel applied in Keteles the distinction between medical judgment and rating expertise. A rater’s expertise concerns the rating schedule. Diagnosis, clinical findings and other medical questions beyond ordinary knowledge require medical proof. The private rater’s lay opinion could not replace Dr. Brose’s medical assessment.

The Board checked the doctor’s reasoning as well

The employer argued that Dr. Brose had merely relied on rating software without explaining his conclusions. In Keteles, the panel compared that argument with the actual report.

The report described a neurological examination, range of motion, flexibility and grip strength. Its impairment charts contained findings and references to specific chapters, figures and tables in the AMA Guides. The panel found that the claim of an unexplained software result did not fit the medical record.

The incorporated judge’s report in Keteles also recounted Dr. Brose’s explanation of the bilateral hand problems. He described how the unaffected hand would ordinarily help compensate for limitations in the other, and how injuries on both sides impaired that compensation. That explanation connected the impairments to the worker’s daily function.

The panel identified a direct way to challenge a disputed medical conclusion: Request a supplemental report addressing the point or question the doctor in a deposition. The employer instead relied on its private rater’s medical criticisms.

The judge explained why 70 percent was the supported result

The worker’s private rater in Keteles had supplied higher figures—74 percent under a strict AMA Guides rating and 78 percent using the Kite addition approach. The judge considered both parties’ private ratings and found the amended DEU rating better reasoned and consistent with the medical evidence and formal instructions.

The employer also challenged the adequacy of the judge’s explanation under Labor Code section 5313. The panel reviewed the opinion on decision and the judge’s report, found a detailed explanation of the evidence and reasoning, and rejected that challenge. It denied reconsideration in Keteles, preserving the 70 percent award.

How to make sense of competing ratings in your own file

Compare the complete medical report, the judge’s instructions and the different rating calculations. Identify the exact source of the disagreement. A changed disability number, a different medical diagnosis and a disputed examination finding require different explanations.

Keteles shows the value of keeping those questions separate. The medical evidence supported the impairment findings; the formal instructions identified what to rate; and testimony explained the corrected calculation. The employer’s lower figure did not displace that foundation.

Our analysis of Blackledge explains the physician’s, judge’s and rater’s separate roles. For a later example of the functional medical evidence used to add impairments, see Baigmoradi. For help reviewing competing ratings, see our California workers’ compensation practice.