Permanent Disability, WCAB, Workers' Compensation, Yrulegui & Roberts

Add or Combine? How Robasciotti v. Maxim Healthcare Redefines the “Kite” Analysis for Multiple Disabilities

Posted on by Joseph Yrulegui

Introduction

A recent panel decision out of the California Workers’ Compensation Appeals Board—Robasciotti v. Maxim Healthcare (2024 Cal. Wrk. Comp. P.D. LEXIS 365)—provides important lessons on how multiple impairments may be combined or “added” when rating an injured worker’s permanent disability. In particular, it underscores the continued importance of the “Kite doctrine,” which allows for a departure from the AMA Guides’ Combined Values Chart (“CVC”) if certain conditions are met, as clarified by the WCAB’s en banc ruling in Vigil v. County of Kern (2024).

This post summarizes the decision, explains why the WCAB rejected the dental Qualified Medical Evaluator’s (“QME”) analysis regarding the addition (rather than combination) of certain impairments, and concludes with best practices for adjusters dealing with multiple-body-part injuries in workers’ comp cases.

Brief Background of the Robasciotti Decision

  1. Facts & Injury
    • The applicant, a psychiatric technician, suffered industrial injuries to multiple body systems: mouth/teeth, cranial nerve, head (headaches), cervical and lumbar spine, digestive tract, psyche, and speech impairment.
  2. Issues Presented
    • Permanent Disability & Kite Analysis: Applicant’s dental QME argued that the disability from facial, head, and dental injuries should be “added” instead of combined under the CVC. The WCAB ultimately found that the QME’s reasoning fell short of the standards articulated in Kite and Vigil and thus required further development of the record.
  3. Outcome
    • Permanent Disability Deferred: Because the medical evidence did not include an adequate “Kite” analysis (i.e., a full Activities of Daily Living (“ADLs”) assessment), the WCAB deferred the final determination of permanent disability, remanding the case for further development of the medical record.

Revisiting the “Kite Doctrine” and Vigil

The Kite Principle

Under California’s standard rating system, multiple impairments are generally combined via the Combined Values Chart (“CVC”) in the Permanent Disability Rating Schedule. In Athens Administrators v. WCAB (Kite) (2013), the WCAB recognized two scenarios where it may be appropriate to add rather than combine impairments:

  1. No Overlapping ADLs
    If each impairment affects distinct Activities of Daily Living, such that there is truly no duplication of functional loss.
  2. Synergistic Effect
    Even if the impairments overlap in ADLs, they may produce a combined or “amplified” effect that the CVC fails to capture accurately, thus justifying addition rather than combination.

The Vigil Clarification

The WCAB’s en banc decision in Vigil v. County of Kern (2024) further clarified that a conclusory statement—e.g., “these impairments should be added because they’re separate body parts”—is not sufficient. The QME’s opinion must specifically:

  • Identify which ADLs are impacted by each alleged impairment.
  • Demonstrate either:
    1. No overlap of ADLs, or
    2. An overlap that causes a synergistic, amplified effect on those ADLs.

Only when physicians provide a detailed, reasoned explanation grounded in ADL impacts—and why the CVC’s ordinary combination would be inaccurate—can a simple addition of impairments be justified.

Why the WCAB Rejected the QME’s “Kite” Analysis in Robasciotti

In Robasciotti, the dental QME (Dr. Gabriel) testified that the permanent disability percentages for dental, head, and facial injuries should be added rather than combined. However, the WCAB pointed out that:

  1. The QME Focused on Body Parts, Not ADLs
    Dr. Gabriel repeatedly characterized the mouth/teeth, head, and facial injuries as “stand-alone” conditions but did not explain how each impairment specifically affected the applicant’s functional abilities (ADLs).
  2. No Meaningful Discussion of Overlap or Synergy
    Although the QME mentioned ADLs in broad terms, there was no clear assessment of whether these injuries overlapped in their impact on the same daily activities—e.g., speaking, eating, dressing—or whether that overlap created a greater functional loss than the sum of each impairment separately.
  3. Insufficient Substantial Evidence
    Because the doctor simply stated they should be “added” without a thorough ADL-based rationale, the WCAB concluded that the medical opinion did not meet the Vigil standard. Consequently, the record on permanent disability was deemed incomplete, and the WCAB deferred any final PD award until further factual and medical-legal development could be done.

In essence, the WCAB’s rejection boiled down to the requirement that “saying impairments are separate body parts” is not enough to bypass the CVC. The ruling reinforces the central tenet of Vigil: A Kite analysis is valid only where the overlapping or non-overlapping ADLs are explicitly addressed, and a synergistic effect is substantiated by a reasoned medical opinion.

Practical Lessons and Best Practices for Adjusters

  1. Press for an ADL Breakdown
    • At the QME deposition or in supplemental reports, ask about specific ADLs: speaking, chewing, self-care, communication, etc.
    • Ensure the physician identifies precisely how each impairment affects day-to-day functioning and whether any ADLs overlap or amplify each other.
  2. Distinguish Mere Body-Part Labels from Functional Loss
    • A statement that injuries are “completely separate” just because they involve different anatomy is insufficient.
    • The focus must be on whether there is true functional overlap in ADLs and whether that overlap creates a synergistic effect.
  3. Look Out for Conclusory Language
    • If a QME (or treating doctor) simply says, “We add the impairments,” request further explanation before accepting the opinion.
    • A well-supported Kite analysis must detail why the CVC fails to capture the real-world impact on the applicant’s overall functionality.
  4. Consider Proactive Development of the Record
    • If the medical-legal reports are incomplete or vague on ADLs, do not wait for a WCJ to intervene.
    • By actively seeking clarifications, you mitigate the risk of a forced re-trial or a deferral of permanent disability issues.

Why This Case Matters

Many multiple-body-part injury cases will now warrant closer scrutiny of any “Kite” or “add vs. combine” determination. The WCAB’s stance in Robasciotti drives home that an injury’s location (face vs. teeth vs. head) is far less critical than how the injury affects the worker’s ability to perform everyday tasks. Adjusters who diligently confirm that medical opinions address ADL overlap (or synergy) in depth will be better equipped to defend or resolve claims appropriately.

Legal Disclaimer

The information provided in this blog post is for general informational purposes only and does not constitute legal advice. Transmission or receipt of this information does not create an attorney-client relationship. Readers should not act upon this content without seeking legal counsel on their specific situation. Every case is different, and the outcome may vary depending on the unique facts and applicable law.

How Our Firm Can Help

At Yrulegui & Roberts, our dedicated workers’ compensation team tracks the latest case law, including developments in Kite-style analyses, to help employers, carriers, and injured workers navigate these issues effectively. Whether you need guidance on assessing ADL overlap, evaluating medical-legal reports for synergy, or defending a complex multi-body-part claim, our attorneys are here to provide strategic insights and representation.

Contact us at www.rjylaw.com for a consultation. We are committed to ensuring that your claims are handled efficiently and in compliance with the latest standards from the WCAB.

Joseph Yrulegui