Linstad: A Lifting-Loss Explanation Supported the Back-Injury Rating

After a back injury, a low impairment rating can be hard to understand when lifting still limits ordinary life. A useful medical report should connect the number to what you can actually do. If the usual rating method misses an important limitation, the doctor needs to explain both the gap and a better way to measure it.

In Linstad v. City of Richmond, No. ADJ20141060 (WCAB Jan. 21, 2025), a firefighter’s evaluator explained why an eight percent whole-person impairment rating did not adequately capture his loss of lifting capacity. The evaluator used another table within the AMA Guides to assess 15 percent impairment. After rating adjustments, that supported a 33 percent permanent-disability award. The Workers’ Compensation Appeals Board denied the City’s petition for reconsideration and kept the award in place.

The dispute concerned the rating of an admitted back injury

Daniel Linstad injured his lumbar spine while working as a firefighter on December 3, 2017. The City admitted that the injury arose out of and occurred in the course of employment. The dispute concerned its nature and extent, including permanent disability and apportionment.

Under the parties’ alternative dispute-resolution program, each side selected an independent medical evaluator, or IME, and an arbitrator decided the dispute. Linstad selected James Stark, M.D.; the City selected Daniel D’Amico, M.D. After a September 2024 arbitration, the arbitrator found Dr. Stark’s reporting more persuasive and awarded 33 percent permanent disability in October.

The Linstad opinion’s account of the dispute is important when comparing this case with your own. These evaluators were working within that negotiated program. The question on reconsideration was whether the medical explanation supporting the chosen rating was sound.

The doctor explained why eight percent missed the lifting loss

Dr. Stark examined Linstad in July 2021 and diagnosed multilevel degenerative disc and joint disease, with possible nerve involvement based on weakness, sensory loss and atrophy. He deferred his permanent-disability opinion until he could review the MRI findings and an EMG nerve study. The EMG was interpreted as normal.

After reviewing those studies, he placed the strict rating under the AMA Guides in Diagnosis Related Estimate Category II, producing eight percent whole-person impairment. He then addressed the limitation that he believed this approach failed to measure adequately: Linstad’s reduced lifting capacity.

The medical reasoning reproduced in Linstad went beyond a statement that the number seemed too low. The arbitrator’s report described a 40-pound lifting limit and an estimated 50–70 percent loss of lifting capacity. Those figures described the functional limitation being assessed. Dr. Stark reported no basis for apportionment to nonindustrial factors. The doctor still had to explain how an appropriate Guides method translated the limitation into impairment.

The hernia table supplied a measure of the functional loss

Dr. Stark used Table 6-9, a hernia table in the Guides’ digestive-system chapter. He considered its Class II description the best fit for Linstad’s lower-back symptoms and assigned 15 percent whole-person impairment. According to the arbitrator’s report, Dr. Stark selected it because he considered it the only table within the Guides that mentioned lifting. He found its description more accurate for this worker than the diagnosis-related estimate.

The Board’s explanation in Linstad applied Milpitas Unified School District v. Workers’ Compensation Appeals Board (Guzman), 187 Cal.App.4th 808, 822, 828–829 (2010). Accuracy requires a medical explanation connecting the worker’s actual impairment to the chosen method. A physician can use clinical judgment and an alternative within the Guides, but must explain why the usual assessment is inadequate and why the alternative describes the impairment more accurately.

Here, the comparison was specific. The doctor supplied the ordinary rating, identified the lifting loss it failed to capture adequately, selected a table that addressed that function and explained why its description fit Linstad. The Board accepted that reasoning as substantial medical evidence. The choice of a different chapter was supported by the explanation of this worker’s condition.

The City argued that the ordinary rating already accounted for lifting

The City argued that the Guides already incorporate functional limitations and activities of daily living into impairment ratings. On that view, lifting was already contemplated in the ordinary lumbar-spine rating, making the alternative unnecessary.

The response described in Linstad distinguished that general design from the measurement of a particular limitation. The arbitrator acknowledged the Guides’ introductory discussion of daily activities but found that it did not quantify Linstad’s specific loss of lifting ability. Dr. Stark’s alternative supplied a reasoned way to assess that loss.

This was the medical link the Board found persuasive. Saying that the Guides generally consider an activity did not answer the doctor’s explanation of why the selected ordinary method inaccurately measured the impairment in this case. The dispute required a comparison of the actual methods, findings and functional loss.

The medical explanation mattered more than the evaluator’s title

The City also distinguished an earlier case, Cardoza v. Alameda Sheriff’s Department, Nos. ADJ15807564, ADJ15807527 (WCAB Nov. 18, 2022), in which Dr. Stark had acted as an agreed medical evaluator, or AME. It argued that the earlier acceptance of a similar hernia analogy depended on deference to that agreed evaluator.

The Linstad panel’s comparison with that case focused on the medical reasoning. The earlier decision had accepted the explanation of why the diagnosis-related estimate was inaccurate and the alternative was more accurate. Whether serving as an AME or an IME, the doctor’s opinion still had to meet the substantial-medical-evidence requirement.

The Board also noted that both evaluators in Linstad’s case considered an alternative to the strict rating warranted and appropriate. The arbitrator found Dr. Stark’s reporting better reasoned and more persuasive. The opinion therefore turns on the evidentiary basis for his assessment, rather than the evaluator’s title alone.

The impairment percentage and disability award describe different steps

The eight percent and 15 percent figures were medical assessments of whole-person impairment. Thirty-three percent was the resulting permanent-disability rating after adjustment. Keeping those steps separate makes the result understandable: The Board accepted the alternative medical assessment that supported the arbitrator’s award.

For injuries on or after January 1, 2013, Labor Code section 4660.1 incorporates the fifth edition of the AMA Guides, a 1.4 adjustment to whole-person impairment, and age and occupational factors in the rating process. Subdivision (h) expressly preserves the Guzman holding. Linstad’s December 2017 injury fell within that post-2013 period.

Review the medical percentage and the rating calculation together. An assessment of impairment, a percentage describing lost lifting capacity and a final permanent-disability rating each serve a different purpose. In this decision, the supported 15 percent impairment assessment produced the 33 percent award.

The Board kept the award in place

The arbitrator had recommended denying reconsideration or, alternatively, obtaining supplemental reporting from Dr. Stark. After reviewing the record, the Board accepted the existing explanation and denied reconsideration in Linstad. Its decision affirmed the arbitrator’s award.

That result followed the Board’s assessment of the complete medical reasoning described in the opinion. Dr. Stark had explained the strict rating, its shortcoming for Linstad, the alternative within the Guides and the reason the alternative was more accurate.

Review the bridge between the limitation and the number

If your back-injury rating seems disconnected from lasting lifting limitations, bring the complete medical reports, supplements, test results, written restrictions and rating calculation for review. Identify the ordinary method, the findings it used, the functional loss the doctor says it misses and the specific alternative table and class proposed.

Ask how the doctor connected those findings to the alternative assessment. A lifting restriction and a higher percentage need a medical explanation between them. The reasoning should address your actual condition and the chosen method.

Our Kelley analysis examines reports that needed better reasoning before an award could stand. Our Wruck analysis addresses conflicting reports and rating instructions. Linstad shows the specific explanation the Board found sufficient to preserve an award.