This appeal arises pursuant to the Texas Workers’ Compensation Act, Tex. Lab. Code Ann. § 401.001 et seq. (1989 Act). A contested case hearing (CCH) was held on April 8, 2025, with the record closing on May 8, 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), does not extend to C3 to C7 disc bulge, C4 to C7 stenosis, C4 to C6 facet hypertrophy, C4-5 annular tear, or cervical radiculopathy; (2) the appellant (claimant) reached maximum medical improvement (MMI) on December 22, 2023; (3) the claimant’s impairment rating (IR) is zero percent; and (4) the claimant did not have disability from October 24, 2023, to the date of the CCH. The claimant appealed, disputing the ALJ’s determinations. The claimant contends on appeal in part that the designated doctor’s report on extent of injury contains an incorrect mechanism of injury, and that the designated doctor’s narrative report misstated the medical evidence on which he relied to make his certification of MMI and IR. The appeal file does not contain a response from the respondent (carrier) to the claimant’s appeal.

DECISION

Affirmed in part and reversed and remanded in part.

The parties stipulated, in part, that the claimant sustained a compensable injury on (date of injury), that extends to at least lumbar sprain, lumbar strain, cervical sprain, cervical strain, cervical contusion, and lumbar contusion, and that the Texas Department of Insurance, Division of Workers’ Compensation (Division) appointed (Dr. B) as the designated doctor on the issues of MMI, IR, and extent of injury. The claimant was injured on (date of injury), while assisting in restraining an aggressive patient.

EXTENT OF INJURY

The ALJ determined the compensable injury does not extend to the claimed conditions based in part on the report of Dr. B. The claimant argued on appeal that Dr. B cited an incorrect mechanism of injury in his extent-of-injury report, which makes his report unreliable. The claimant is correct in that Dr. B’s report contains a sentence describing an incorrect mechanism of injury. However, Dr. B’s report also cites the correct mechanism of injury in three other places, and it is clear from his report that he based his opinion that the compensable injury does not extend to the claimed conditions on the correct mechanism of injury. Therefore, the ALJ’s determination that the compensable injury of (date of injury), does not extend to C3 to C7 disc bulge, C4 to C7 stenosis, C4 to C6 facet hypertrophy, C4-5 annular tear, or cervical radiculopathy is supported by sufficient evidence and is affirmed.

DISABILITY

The ALJ’s determination that the claimant did not have disability from October 24, 2023, to the date of the CCH is supported by sufficient evidence and is affirmed.

MMI/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.  Rule 130.1(c)(3) provides 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 the claimant reached MMI on December 22, 2023, with a zero percent IR as certified by Dr. B, the designated doctor. Dr. B examined the claimant on July 3, 2024. Considering the compensable conditions of lumbar sprain, lumbar strain, cervical sprain, cervical strain, cervical contusion, and lumbar contusion, Dr. B certified the claimant reached MMI on December 22, 2023. Using 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), Dr. B placed the claimant in Diagnosis-Related Estimate (DRE) Cervicothoracic Category I: Complaints or Symptoms, and DRE Lumbosacral Category I: Complaints or Symptoms, resulting in a zero percent IR. In the review of records section of his accompanying narrative report Dr. B noted that medical records dated (date of injury), October 24, 2023, and November 8, 2023, showed spinal muscle spasms were present during those examinations.  Dr. B also noted a December 22, 2023, evaluation with (Dr. N) of the claimant’s cervical and lumbar spine, that reflected “[m]uscle spasms negative.”

The claimant contends on appeal that Dr. B incorrectly states in his narrative report that the medical record dated December 22, 2023, shows muscle spasms were negative. In evidence is the December 22, 2023, record referred to by Dr. B in his narrative report. This record does show findings of “[t]rapezius muscle spasm is noted right side,” and “[m]uscle spasm along the paraspinal muscle decreased” for both the cervical and lumbar spine. Dr. B’s statement that this record showed muscle spasms were negative is a misstatement of the medical record, and Dr. B based his certification of MMI and IR in part on this misstatement. Accordingly, we reverse the ALJ’s determinations that the claimant reached MMI on December 22, 2023, and that the claimant’s IR is zero percent.

There is no other certification in evidence. Therefore, we remand the issues of MMI and IR to the ALJ for further action consistent with this decision.

SUMMARY

We affirm the ALJ’s determination that the compensable injury of (date of injury), does not extend to C3 to C7 disc bulge, C4 to C7 stenosis, C4 to C6 facet hypertrophy, C4-5 annular tear, or cervical radiculopathy.

We affirm the ALJ’s determination that the claimant did not have disability from October 24, 2023, to the date of the CCH.

We reverse the ALJ’s determination that the claimant reached MMI on December 22, 2023, and remand the MMI issue to the ALJ for further action consistent with this decision.

We reverse the ALJ’s determination that the claimant’s IR is zero percent and we remand the IR issue to the ALJ for further action consistent with this decision.

REMAND INSTRUCTIONS

Dr. B is the designated doctor in this case. On remand the ALJ is to determine whether Dr. B is still qualified and available to serve as the designated doctor. If Dr. B is still qualified and available, the ALJ is to inform Dr. B of his misstatement in his narrative report of the December 22, 2023, medical record regarding muscle spasms in the cervical and lumbar spine.

If Dr. B is no longer qualified or available to serve as the designated doctor, then another designated doctor is to be appointed on the issues of MMI and IR for the (date of injury), compensable injury. The ALJ is to inform the designated doctor that the compensable injury extends to lumbar sprain, lumbar strain, cervical sprain, cervical strain, cervical contusion, and lumbar contusion, but does not extend to C3 to C7 disc bulge, C4 to C7 stenosis, C4 to C6 facet hypertrophy, C4-5 annular tear, or cervical radiculopathy.

The parties are to be provided with the ALJ’s letter to the designated doctor, the designated doctor’s response, and allowed an opportunity to respond. If another designated doctor is appointed, the parties are to be provided with the Presiding Officer’s Directive to Order Designated Doctor Examination, the designated doctor’s report, and are to be allowed an opportunity to respond. The ALJ is to make determinations on MMI and IR that are supported by the evidence and consistent with this decision.

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 LM INSURANCE CORPORATION and the name and address of its registered agent for service of process is

CORPORATION SERVICE COMPANY

211 EAST 7TH STREET, SUITE 620

AUSTIN, TEXAS 78701-3218.

Carisa Space-Beam

Appeals Judge

CONCUR:

Cristina Beceiro

Appeals Judge

Margaret L. Turner

Appeals Judge