This appeal arises pursuant to the Texas Workers’ Compensation Act, Tex. Lab. Code Ann. § 401.001 et seq. (1989 Act). A contested case hearing was held on March 12, 2025, in (city), Texas, with (administrative law judge) presiding as the administrative law judge (ALJ). The ALJ resolved the disputed issues by deciding that: (1) the compensable injury of (date of injury), extends to a right shoulder strain, but does not extend to aggravation of a C4-5 disc protrusion, C5-6 osteophyte complex, lumbar radiculopathy, aggravation of disc bulges at L3-4, or aggravation of disc bulges at L4-5; (2) the appellant (claimant) reached maximum medical improvement (MMI) on November 27, 2023; (3) the claimant’s impairment rating (IR) is zero percent; and (4) the claimant did not have disability resulting from an injury sustained on (date of injury), from November 10, 2023, through August 1, 2024.
The claimant appealed that portion of the ALJ’s extent-of-injury determination that was against him, as well as the MMI, IR, and disability determinations. The claimant contends on appeal that the adopted certification of MMI and IR does not rate the entire compensable injury. The respondent (carrier) responded, urging affirmance of the appealed determinations.
The ALJ’s determination that the compensable injury of (date of injury), extends to a right shoulder strain was not appealed and has become final pursuant to Section 410.169.
DECISION
Affirmed in apart and reversed and rendered in part.
The parties stipulated, in part, that the claimant sustained a compensable injury on (date of injury), that extends to at least a left shoulder strain, cervical spine strain, and lumbar spine strain; and (Dr. H) was appointed by the Texas Department of Insurance, Division of Workers’ Compensation (Division) as designated doctor to address the issues of MMI, IR, and extent of injury. The claimant, a delivery driver, was injured on (date of injury), when the vehicle he was driving was rear-ended by a large truck.
EXTENT OF INJURY
The ALJ’s determination that the compensable injury of (date of injury), does not extend to aggravation of a C4-5 disc protrusion, C5-6 osteophyte complex, lumbar radiculopathy, aggravation of disc bulges at L3-4, or aggravation of disc bulges at L4-5 is supported by sufficient evidence and is affirmed.
DISABILITY
The ALJ’s determination that the claimant did not have disability resulting from an injury sustained on (date of injury), from November 10, 2023, through August 1, 2024, is supported by sufficient evidence and is affirmed.
MMI AND IR
Section 401.011(30)(A) defines MMI as “the earliest date after which, based on reasonable medical probability, further material recovery from or lasting improvement to an injury can no longer reasonably be anticipated.” Section 408.1225(c) provides that the report of the designated doctor has presumptive weight, and the Division shall base its determination of whether the employee has reached MMI on the report of the designated doctor unless the preponderance of the other medical evidence is to the contrary.
Section 408.125(c) provides that the report of the designated doctor shall have presumptive weight, and the Division shall base the IR on that report unless the preponderance of the other medical evidence is to the contrary, and that, if the preponderance of the medical evidence contradicts the IR contained in the report of the designated doctor chosen by the Division, the Division shall adopt the IR of one of the other doctors. 28 Tex. Admin. Code § 130.1(c)(3) (Rule 130.1(c)(3)) provides, in part, that the assignment of an IR for the current compensable injury shall be based on the injured employee’s condition as of the MMI date considering the medical record and the certifying examination.
The ALJ determined that the claimant reached MMI on November 27, 2023, with a zero percent IR in accordance with the certification of Dr. H, the designated doctor. Dr. H examined the claimant for the purpose of determining MMI and IR on May 15, 2024, and certified that the claimant reached MMI on November 27, 2023, with a zero percent IR for the carrier-accepted conditions of a left shoulder strain, cervical strain, and lumbar strain. As stated above, the ALJ’s determination that the compensable injury extends to a right shoulder strain was not appealed and has become final. As this certification did not rate the compensable right shoulder strain, it cannot be adopted. Therefore, we reverse the ALJ’s determinations that the claimant reached MMI on November 27, 2023, and the claimant’s IR is zero percent.
There are three more certifications in the record. (Dr. V), the treating doctor, examined the claimant on December 20, 2023, and certified that the claimant reached MMI on that same date with no permanent impairment based on the condition of a back strain. As this certification does not rate the entire compensable injury, it cannot be adopted.
(Dr. S), the doctor selected by the treating doctor, examined the claimant on January 17, 2025, and issued two alternative certifications. For the compensable conditions plus the disputed conditions of lumbar disc bulges at L3-4 and L4-5, lumbar radiculopathy, cervical disc osteophytes, and cervical disc protrusion, Dr. S certified that the claimant reached MMI on December 6, 2024, with a six percent IR. As this certification considers and rates the conditions which we have affirmed are not part of the compensable injury, it cannot be adopted. Dr. S also issued a certification that the claimant reached MMI on December 6, 2024, with a six percent IR based on the compensable conditions of a right shoulder strain, left shoulder strain, cervical strain, and lumbar strain. This certification correctly rates the entire compensable injury and is in compliance with the Guides to the Evaluation of Permanent Impairment, fourth edition (1st, 2nd, 3rd, or 4th printing, including corrections and changes as issued by the American Medical Association prior to May 16, 2000) (AMA Guides). Therefore, we render a new decision that the claimant reached MMI on December 6, 2024, and the claimant’s IR is six percent.
SUMMARY
We affirm the ALJ’s determination that the compensable injury of (date of injury), does not extend to aggravation of a C4-5 disc protrusion, C5-6 osteophyte complex, lumbar radiculopathy, aggravation of disc bulges at L3-4, or aggravation of disc bulges at L4-5.
We affirm the ALJ’s determination that the claimant did not have disability resulting from an injury sustained on (date of injury), from November 10, 2023, through August 1, 2024.
We reverse the ALJ’s determination that the claimant reached MMI on November 27, 2023, and render a new decision that the claimant reached MMI on December 6, 2024.
We reverse the ALJ’s determination that the claimant’s IR is zero percent and render a new decision that the claimant’s IR is six percent.
The true corporate name of the insurance carrier is SAFETY NATIONAL CASUALTY CORPORATION and the name and address of its registered agent for service of process is
CT CORPORATION SYSTEM
1999 BRYAN STREET, SUITE 900
DALLAS, TEXAS 75201-3136.
Cristina Beceiro
Appeals Judge
CONCUR:
Carisa Space-Beam
Appeals Judge
Margaret L. Turner
Appeals Judge