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"Aggravation" refers to  an acceleration or "lighting up" of a pre-existing disease. In the leading case, Tanenbaum v. Industrial Acc. Com. (1935) 4 Cal.2d 615, the Supreme Court stated, "It is now definitely settled that the acceleration, aggravation or "lighting up" of a preexisting disease is an injury in the occupation causing the same....[T]he employer takes the employee subject to his condition when he enters the employment, and that therefore compensation is not to be denied merely because the workman's physical condition was such as to cause him to suffer a disability from an injury."  An aggravation is considered to be a new injury.

"Exacerbation" generally means a temporary flaring up or worsening of a pre-existing condition and is not a new injury.

"Recurrence" is not a new injury but a return of symptoms or signs as part of the natural progression of a disease or condition.
Label Item Links Comments
Labor Code See Comments Before SB 899 (2004), LC 4663 apportioned: "In case of any disease existing prior to a compensable injury..." Current LC §4663 removed the word "aggravation" but kept the concept with "other factors."
Cases Tanenbaum v. Industrial Acc. Com.

Granado v. WCAB
Tanenbaum v. Industrial Acc. Com.

Granado v. WCAB
Practice Tips The terms "aggravation," "exacerbation" and "recurrence" have technical meanings in medicine and California workers' compensation law. It is important to get examiners to use the words precisely and to question how they distinguished an "aggravation" from an "exacerbation" or "recurrence," whether dealing with AOE-COE or apportionment issues.

Note, too, the definition in the AMA Guides:
"Aggravation, for the purposes of the Guides, refers to a factor(s) (eg, physical, chemical, biological, or medical condition) that alters the course or progression of the medical impairment." (p. 12)

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