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 July 17, 2024, with the record closing on October 16, 2024, 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 cervical radiculopathy, traumatic brain injury, or post-traumatic stress disorder (PTSD); (2) (Dr. R) was not appointed as designated doctor in accordance with Section 408.0041 and Texas Department of Insurance, Division of Workers’ Compensation (Division) rules; (3) the appellant (claimant) reached maximum medical improvement (MMI) on August 30, 2022; (4) the claimant’s impairment rating (IR) is 5%; and (5) the claimant did not have disability from January 17, 2022, through November 13, 2023, resulting from the compensable injury sustained on (date of injury).
The claimant appealed the ALJ’s extent-of-injury, MMI, IR, and disability determinations. The respondent (carrier) responded, urging affirmance of the appealed determinations. The ALJ’s determination that Dr. R was not appointed as designated doctor in accordance with Section 408.0041 and Division rules was not appealed and has become final pursuant to Section 410.169.
DECISION
Affirmed in part and reversed and rendered in part.
The parties stipulated, in part, that on (date of injury), the claimant sustained a compensable injury that extends to at least a concussion, chest contusion, and cervical strain. The claimant, a control systems specialist, was injured on (date of injury), when he was involved in a motor vehicle accident.
The ALJ is the sole judge of the weight and credibility of the evidence (Section 410.165(a)) and, as the trier of fact, resolves the conflicts and inconsistencies in the evidence. Texas Employers Insurance Association v. Campos, 666 S.W.2d 286 (Tex. App.—Houston [14th Dist.] 1984, no writ). As an appellate reviewing tribunal, the Appeals Panel will not disturb challenged factual findings of an ALJ absent legal error, unless they are so against the great weight and preponderance of the evidence as to be clearly wrong or manifestly unjust. Cain v. Bain, 709 S.W.2d 175, 176 (Tex. 1986); In re King’s Estate, 150 Tex. 662, 244 S.W.2d 660 (1951).
EXTENT OF INJURY
The ALJ’s determination that the compensable injury of (date of injury), does not extend to cervical radiculopathy, traumatic brain injury, or PTSD is supported by sufficient evidence and is affirmed.
DISABILITY
The ALJ’s determination that the claimant did not have disability from January 17, 2022, through November 13, 2023, resulting from the compensable injury sustained on (date of injury), is supported by sufficient evidence and is affirmed.
IR
The ALJ’s determination that the claimant’s IR is 5% is supported by sufficient evidence and is affirmed.
MMI
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.
The ALJ determined that the claimant reached MMI on August 30, 2022, with a 5% IR. In the ALJ’s Discussion section of her decision, she states that (Dr. L), the subsequently appointed designated doctor, considered the claimant’s pre-existing conditions in her evaluation. Therefore, the ALJ found that Dr. L’s certification that held the claimant reached MMI on November 13, 2023, with a 10% IR was contrary to the other medical evidence. The ALJ’s finding is supported by sufficient evidence and is affirmed. Dr. L additionally issued two certifications that both held the claimant reached MMI on November 13, 2023, with a 15% IR; however, both certifications consider and rate PTSD, which we have affirmed is not part of the compensable injury.
In the Discussion section of her decision, the ALJ stated that (Dr. K), the carrier-selected required medical examination doctor, certified the claimant reached MMI on August 30, 2022, with a 5% IR and that his certification was more persuasive and accurately rated the compensable injury. She further stated that Dr. K gave a reasonable explanation for the date of MMI, and the IR was based on 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). However, we note there is no certification from any doctor in evidence that certified the claimant reached MMI on August 30, 2022. The ALJ found the preponderance of the other medical evidence supports Dr. K’s certification; however, the ALJ mistakenly determined that Dr. K certified the claimant reached MMI on August 30, 2022, rather than on June 30, 2023, the actual MMI date certified by Dr. K for the compensable injury.
It is clear from the ALJ’s discussion and the evidence that the ALJ was persuaded that Dr. K’s certification that the claimant reached MMI on June 30, 2023, with a 5% IR was not contrary to the preponderance of the other medical evidence. This is supported by sufficient evidence. Furthermore, there is no certification in evidence from any doctor certifying the claimant reached MMI on August 30, 2022. Accordingly, we reverse the ALJ’s determination that the claimant reached MMI on August 30, 2022, and we render a new decision that the claimant reached MMI on June 30, 2023, as reflected by the evidence and the record. See Appeals Panel Decision (APD) 150665, decided May 21, 2015; see also APD 162622, decided February 27, 2017; and APD 221062, decided August 17, 2022.
SUMMARY
We affirm the ALJ’s determination that the compensable injury of (date of injury), does not extend to cervical radiculopathy, traumatic brain injury, or PTSD.
We affirm the ALJ’s determination that the claimant did not have disability from January 17, 2022, through November 13, 2023, resulting from the compensable injury sustained on (date of injury).
We affirm the ALJ’s decision that the claimant’s IR is 5%.
We reverse the ALJ’s determination that the claimant reached MMI on August 30, 2022, and we render a new decision that the claimant reached MMI on June 30, 2023.
The true corporate name of the insurance carrier is THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT 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.
Cristina Beceiro – Appeals Judge
CONCUR:
Carisa Space-Beam – Appeals Judge
Margaret L. Turner – Appeals Judge