Lorenzana: A Later Grip Examination Supported a 28 Percent Disability Award

When a hand injury makes it harder to hold, grasp or carry things, different medical ratings can be difficult to understand. A report written soon after surgery may describe a different condition from an examination a year later. Your claim deserves a clear explanation of what changed and how the final rating accounts for the limitations that remain.

In Lorenzana v. Aegis Senior Communities, No. ADJ16452926 (WCAB May 19, 2025), the Workers’ Compensation Appeals Board denied the employer’s challenge to a 28 percent permanent-disability award. The adopted judge’s report explained why a later examination supported rating grip loss after pain with gripping had improved, why an earlier pain add-on was absent from the final rating and why the accepted apportionment was better supported.

The doctors evaluated the hand at different stages of recovery

Maria Lorenzana worked as a caregiver. The judge found a cumulative injury to her right wrist, thumb and fingers during June 13, 2012 through July 7, 2022. The central dispute concerned the medical assessment of her lasting impairment, particularly loss of grip strength.

The medical history described in Lorenzana compared panel QME John Welborn’s opinion with treating physician Adam Stoller’s reporting. In August 2023, Dr. Welborn found maximum medical improvement and assessed 8 percent whole person impairment based on surgery and thumb impairment. He found grip weakness but considered it unrated because she had pain with gripping.

Dr. Stoller’s November 2023 report also assessed grip loss and included a pain add-on. At that point, however, he expected further improvement with postsurgical therapy and had not found her condition medically stable. Those earlier findings were part of a developing treatment record.

By his July 29, 2024 final report, Dr. Stoller found maximum medical improvement. He reported that she no longer had pain with gripping, grasping or holding with the right hand. Pain remained when she pushed firmly with the right thumb. The later examination discussed in Lorenzana therefore distinguished pain in a specific activity from pain that interfered with the grip-strength assessment.

The final report explained why grip loss could be rated

The adopted report quoted the AMA Guides’ restriction on rating decreased strength where decreased motion, painful conditions, deformities or missing parts prevent effective application of maximal force in the evaluated region. That concern asks whether the examination can meaningfully measure the strength loss.

The grip-strength analysis in Lorenzana focused on the changed examination. Dr. Welborn had last seen her in August 2023, only a few months after surgery. Dr. Stoller’s later examination found no pain with grip testing. The judge accepted that pain had subsided during recovery and no longer limited her ability to apply maximal force in that region.

That medical explanation supported including the grip-loss impairment in this rating. Dr. Stoller assessed 20 percent upper-extremity impairment for reduced grip strength, converted to 12 percent whole person impairment. Those are medical impairment measures, rather than the final percentage of permanent disability.

Current Labor Code section 4660.1 uses the AMA Guides’ physical-impairment descriptions and measurements, with the statutory adjustment and age and occupation factors. A useful review therefore follows the medical findings through the rating calculation, rather than treating every percentage in a report as interchangeable.

The 28 percent rating contained no pain add-on

The employer argued that Dr. Stoller had improperly added 2 percent whole person impairment for pain. The pain-add-on discussion in Lorenzana compared that argument with the final report. The earlier, pre-stability report had mentioned the add-on. The July 2024 final report reflected improved pain and included none.

The judge likewise included no pain add-on in the 28 percent award. Challenging an earlier percentage did not identify an error in the final medical opinion or the rating actually used.

The rating calculation reproduced in Lorenzana showed adjusted, apportioned permanent-disability components of 2 percent for the thumb, 12 percent for the arthroplasty and 17 percent for grip loss. The Combined Values Chart combined those components into 28 percent.

Apportionment needed an explained cause of permanent disability

The reports also disagreed about how much permanent disability came from nonindustrial causes. That allocation is called apportionment. Under current section 4663, the physician must address the causes of permanent disability and explain the approximate percentages attributable to the industrial injury and other factors.

The competing apportionment opinions in Lorenzana included Dr. Welborn’s references to ligamentous laxity, an unidentified specific injury, the cumulative injury and activities “at home.” The judge found the various percentages unclear and insufficiently supported. The report’s reference to home activities failed to identify the activities or explain how and why they caused permanent disability.

In his final report, Dr. Stoller attributed 25 percent to nonindustrial ligamentous laxity. The judge found that assessment more consistent and logical. The adopted reasoning in Lorenzana applied Escobedo v. Marshalls, 70 Cal.Comp.Cases 604, 611 (WCAB 2005) (en banc), requiring an explanation of the “how and why” behind the apportioned factors.

The accepted award thus included a supported nonindustrial allocation. The practical question is what medical reasoning supports each cause and percentage in the final report, rather than whether a pre-existing condition is named somewhere in the file.

The employer’s other objections were tested against the report

The employer also asserted that Dr. Stoller had omitted daily-function details. The report review in Lorenzana identified his discussion of chopping, twisting jars and doorknobs, typing, working a full day, filing and answering phones. The objection had to be measured against that actual discussion.

Other criticisms concerned surgical records and allegedly missing reports. The judge noted that the employer had not identified which records or reports were missing or explained how an omission affected the doctor’s opinion. The adopted report also rejected a challenge to early telehealth evaluations, referring to post-COVID changes in the examination regulations.

The judge applied Place v. Workmen’s Compensation Appeals Board, 3 Cal.3d 372, 378 (1970), and Escobedo, 70 Cal.Comp.Cases at 620–621, in evaluating the medical foundation. A single physician’s opinion may supply substantial evidence when it has the required basis and reasoning. Here, the judge found Dr. Stoller’s opinion adequately supported and found no need to develop the record further.

The denial of reconsideration preserved the award

The formal order in Lorenzana denied reconsideration. The Board adopted the judge’s report, leaving the February 11, 2025 findings and award of 28 percent permanent disability in place.

The examination dates, changed pain findings, final impairment assessment, supported apportionment and actual rating calculation supplied the basis for the result. The treating physician’s reasoning supplied the accepted foundation.

Compare the examinations, not just the percentages

Keep the operative report, therapy records, earlier evaluations and the final report together. Compare the dates, the stage of recovery and what each examiner recorded during grip testing. Identify whether the remaining pain affects gripping, a different movement or the ability to apply force during the test.

Then trace the final rating. Which impairment components were included? Was an earlier pain add-on retained or removed? How did the age, occupation and other rating adjustments, apportionment and combination produce the final percentage? Ask for the calculation and the medical explanation supporting its inputs.

If an objection concerns missing information, identify the specific record and the medical conclusion it could affect. If it concerns apportionment, locate the explanation of how the named condition or activity caused permanent disability. That makes a disagreement concrete enough to review.

Our Keteles analysis distinguishes a rater’s calculation work from medical judgment. Lorenzana focuses on the medical difference between examinations during recovery and the final grip-strength rating that supported the award.