This appeal arises pursuant to the Texas Workers’ Compensation Act, Tex. Lab. Code Ann. § 401.001 et seq. (1989 Act). Contested case hearings (CCH) were held on January 8, 2024, and November 5, 2024, in (city), Texas, with (administrative law judge) presiding as the administrative law judge (ALJ). The ALJ resolved the disputed issues by determining that: (1) the compensable injury of (date of injury), extends to spinal cord infarct at T9-T11, incomplete paraplegia, post COVID-19 chronic neurologic symptoms, neurogenic bladder, and neurogenic bowel; (2) the appellant/cross-respondent (claimant) is not entitled to reimbursement of travel expenses from April 26, 2022, through April 30, 2022, for medical treatment at the direction of (Dr. P); (3) the claimant is not entitled to reimbursement of travel expenses from May 21, 2022, through June 4, 2022, for medical treatment at the direction of Dr. P; (4) the claimant is entitled to reimbursement of travel expenses from October 8, 2022, through October 22, 2022, for medical treatment at the direction of Dr. P, in the amount of $2,764.31; and (5) the claimant is not entitled to reimbursement of travel expenses from April 8, 2023, through April 23, 2023, for medical treatment at the direction of Dr. P.
The claimant appealed the ALJ’s determinations that he was not entitled to reimbursement of travel expenses for the claimed periods. The self-insured (respondent/cross-appellant) responded, urging affirmance. The self-insured cross-appealed the ALJ’s determinations of extent of injury and the claimant’s entitlement to reimbursement of travel expenses from October 8, 2022, through October 22, 2022. The self-insured also contended that the ALJ failed to make findings of fact, conclusions of law, and a decision on an issue that had been added by agreement of the parties at the January 8, 2024, CCH. The appeal file does not contain a response from the claimant to the self-insured’s cross-appeal.
DECISION
Reversed and remanded.
The parties stipulated, in part, that the claimant sustained a compensable injury on (date of injury), in the form of COVID-19. The evidence established that the claimant was diagnosed with COVID-19 on (date of injury), while working with the (city) Fire Department.
At the January 8, 2024, CCH, the parties agreed on the record to add the issue of whether (Dr. B) was appointed to serve as designated doctor on the issue of extent of injury in accordance with Section 408.0041 and Texas Department of Insurance, Division of Workers’ Compensation (Division) rules applicable on the date of his appointment. However, the ALJ failed to make findings of fact, conclusions of law, or a decision on this issue. Accordingly, we reverse the ALJ’s decision as being incomplete, and we remand this case to the ALJ to make findings of fact, conclusions of law, and a decision whether Dr. B was appointed to serve as designated doctor on the issue of extent of injury in accordance with Section 408.0041 and Division rules applicable on the date of his appointment.
EXTENT OF INJURY
The ALJ’s determination of the extent of injury was partially based on Dr. B’s opinion. Given that we have reversed and remanded this case for the ALJ to determine whether Dr. B was appointed to serve as designated doctor on the issue of extent of injury in accordance with Section 408.0041 and Division rules applicable on the date of his appointment, we also reverse the ALJ’s determination that the compensable injury of (date of injury), extends to spinal cord infarct at T9-T11, incomplete paraplegia, post COVID-19 chronic neurologic symptoms, neurogenic bladder, and neurogenic bowel. We remand the issue of extent of injury to the ALJ for further action consistent with this decision.
REIMBURSEMENT OF TRAVEL EXPENSES
The evidence established that the medical treatment at the direction of Dr. P was for the disputed extent-of-injury conditions. Given that we have reversed and remanded this case for the ALJ to determine whether Dr. B was appointed to serve as designated doctor on the issue of extent of injury in accordance with Section 408.0041 and Division rules applicable on the date of his appointment as well as the extent-of-injury issue, we also reverse the ALJ’s determinations on travel reimbursement for the claimed periods, and we remand those issues to the ALJ for further action consistent with this decision.
Pursuant to Section 410.203(c), the Appeals Panel may not remand a case more than once. We note that the ALJ’s decision contains a misstatement of the evidence. In Finding of Fact No. 12 the ALJ found there was no Request to Get Reimbursed for Travel Costs (DWC-48) for the period of April 8, 2023, through April 23, 2023, offered by the claimant in evidence. However, in evidence is a DWC-48 from the claimant dated April 8, 2023, requesting reimbursement for travel costs related to treatment with Dr. P from April 8, 2023, through April 22, 2023.
SUMMARY
We reverse the ALJ’s decision as incomplete, and we remand the case for the ALJ to make findings of fact, conclusions of law, and a decision whether Dr. B was appointed to serve as designated doctor on the issue of extent of injury in accordance with Section 408.0041 and Division rules applicable on the date of his appointment.
We reverse the ALJ’s determination that the compensable injury of (date of injury), extends to spinal cord infarct at T9-T11, incomplete paraplegia, post COVID-19 chronic neurologic symptoms, neurogenic bladder, and neurogenic bowel and remand the extent-of-injury issue to the ALJ for further action consistent with this decision.
We reverse the ALJ’s determination that the claimant is not entitled to reimbursement of travel expenses from April 26, 2022, through April 30, 2022, for medical treatment at the direction of Dr. P and remand this issue to the ALJ for further action consistent with this decision.
We reverse the ALJ’s determination that the claimant is not entitled to reimbursement of travel expenses from May 21, 2022, through June 4, 2022, for medical treatment at the direction of Dr. P and remand this issue to the ALJ for further action consistent with this decision.
We reverse the ALJ’s determination that the claimant is entitled to reimbursement of travel expenses from October 8, 2022, through October 22, 2022, for medical treatment at the direction of Dr. P, in the amount of $2,764.31 and remand this issue to the ALJ for further action consistent with this decision.
We reverse the ALJ’s determination that the claimant is not entitled to reimbursement of travel expenses from April 8, 2023, through April 23, 2023, for medical treatment at the direction of Dr. P and remand this issue to the ALJ for further action consistent with this decision.
REMAND INSTRUCTIONS
On remand the ALJ is to make findings of fact, conclusions of law, and a determination whether Dr. B was appointed to serve as designated doctor on the issue of extent of injury in accordance with Section 408.0041 and Division rules applicable on the date of his appointment that is supported by the evidence. The ALJ is then to make findings of fact, conclusions of law, and a decision on the remaining issues of whether the compensable injury extends to the disputed conditions and whether the claimant is entitled to reimbursement for travel expenses for the claimed periods.
Pending resolution of the remand, a final decision has not been made in this case. However, since reversal and remand necessitate the issuance of a new decision and order by the ALJ, a party who wishes to appeal from such new decision must file a request for review not later than 15 days after the date on which such new decision is received from the Division, pursuant to Section 410.202 which was amended June 17, 2001, to exclude Saturdays and Sundays and holidays listed in Section 662.003 of the Texas Government Code in the computation of the 15-day appeal and response periods. See Appeals Panel Decision 060721, decided June 12, 2006.
The true corporate name of the insurance carrier is (a self-insured governmental entity) and the name and address of its registered agent for service of process is
DEBBIE RACCA-SITTRE, CITY CLERK
100 WEST HOUSTON STREET, CONCOURSE
SAN ANTONIO, TEXAS 78205.
Carisa Space-Beam – Appeals Judge
CONCUR:
Cristina Beceiro – Appeals Judge
Margaret L. Turner – Appeals Judge