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 December 10, 2024, with the record closing on February 14, 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 sustained on (date of injury), extends to a lumbar sprain, lumbar strain, thoracic sprain, thoracic strain, and right knee sprain; (2) the compensable injury of (date of injury), does not extend to post-traumatic stress disorder (PTSD), major depressive disorder, adjustment disorder with mixed anxiety and depressed mood, disc bulge at L4-5, disc bulge at L5-S1, or right knee internal derangement; (3) the appellant (claimant) reached maximum medical improvement (MMI) on November 3, 2023; and (3) the claimant’s impairment rating (IR) is three percent. The claimant appealed, disputing the ALJ’s determinations of extent of injury that were not favorable to him, MMI, and IR. The respondent (carrier) responded, urging affirmance of the disputed extent-of-injury conditions, MMI, and IR determinations. The ALJ’s determination that the compensable injury extends to a lumbar sprain, lumbar strain, thoracic sprain, thoracic strain, and right knee sprain was not appealed and has become final pursuant to Section 410.169.
DECISION
Affirmed in part and reversed and remanded in part.
The parties stipulated, in part, that on (date of injury), the claimant sustained a compensable injury in the form of at least a left shoulder sprain, left shoulder strain, left elbow sprain, left elbow strain, fracture of the right femur status post intramedullary retrograde nail placement, left wrist sprain, left wrist strain, left T9 rib fracture, and right occipital scalp hematoma. The claimant testified that he was injured when he was struck by a motor vehicle while standing in front of his work truck performing maintenance on the sewer main.
EXTENT OF INJURY
That portion of the ALJ’s determination that the compensable injury does not extend to PTSD, major depressive disorder, adjustment disorder with mixed anxiety and depressed mood, disc bulge at L4-5, disc bulge at L5-S1, or right knee internal derangement is supported by sufficient evidence and is affirmed.
Section 410.168 provides that an ALJ’s decision contain findings of fact and conclusions of law, a determination of whether benefits are due, and an award of benefits due. 28 Tex. Admin. Code § 142.16 (Rule 142.16) provides that an ALJ’s decision shall be in writing and include findings of fact, conclusions of law, and a determination of whether benefits are due, and if so, an award of benefits due.
The Benefit Review Conference Report listed the disputed extent of injury issue as follows: Does the compensable injury of (date of injury), extend to PTSD, major depressive disorder, adjustment disorder with anxiety and depression, a right shoulder rotator cuff tear, sprain and strain of the thoracic and lumbar spine, disc bulges at L4-5 and L5-S1, a right knee sprain and left knee internal derangement?
During the CCH, the record indicates that the parties agreed to amend the issue to state: Does the compensable injury of (date of injury), extend to PTSD, major depressive disorder, adjustment disorder with anxiety and depression, a left shoulder rotator cuff tear, sprain and strain of the thoracic and lumbar spine, disc bulges at L4-5 and L5-S1, a right knee sprain and right knee internal derangement?
The ALJ failed to make a finding of fact, conclusion of law, or decision regarding the certified disputed condition of a left shoulder rotator cuff tear. Because the ALJ’s decision contains no findings of fact, conclusions of law, or decision regarding whether the compensable injury of (date of injury), extends to a left shoulder rotator cuff tear, which was an issue properly before the ALJ to resolve, it does not comply with Section 410.168 and Rule 142.16. Accordingly, we reverse the ALJ’s decision as being incomplete and we remand that portion of the extent-of-injury issue to the ALJ as follows: Does the compensable injury of (date of injury), extend to a left shoulder rotator cuff tear? See Appeals Panel Decision (APD) 132339, decided December 12, 2013; APD 180839, decided June 4, 2018; and APD 201204, decided September 28, 2020.
MMI/IR
Because we have remanded a portion of the extent-of-injury determination, we also reverse the ALJ’s determinations that the claimant reached MMI on November 3, 2023, and that the claimant’s IR is three percent. We remand the issues of MMI and IR to the ALJ for further action consistent with this decision.
SUMMARY
We affirm that portion of the ALJ’s determination that the compensable injury does not extend to PTSD, major depressive disorder, adjustment disorder with mixed anxiety and depressed mood, disc bulge at L4-5, disc bulge at L5-S1, or right knee internal derangement.
We reverse the ALJ’s extent-of-injury determination as being incomplete, and remand the issue of whether the compensable injury of (date of injury), extends to a left shoulder rotator cuff tear to the ALJ for further action consistent with this decision.
We reverse the ALJ’s determination that the claimant reached MMI on November 3, 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 three percent, and remand the IR 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 the compensable injury of (date of injury), extends to a left shoulder rotator cuff tear, the claimant’s date of MMI, and the claimant’s IR.
Dr. B is the designated doctor in this case. If necessary, on remand the ALJ is to determine whether Dr. B is still qualified and available to be the designated doctor. If Dr. B is no longer qualified or available to serve as the designated doctor, and it is necessary for the ALJ to obtain a new certification, then another designated doctor is to be appointed pursuant to Division rules to opine on the issues of MMI and IR. The ALJ is to inform the designated doctor what conditions are included in the compensable injury. The ALJ is to request that the designated doctor give an opinion on the claimant’s date of MMI and rate the entire compensable injury in accordance 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) considering the medical record and the certifying examination.
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 SAN ANTONIO WATER SYSTEM and the name and address of its registered agent for service of process is
ROBERT PUENTE, PRESIDENT CEO
2800 U.S. 281 NORTH
SAN ANTONIO, TEXAS 78212.
Margaret L. Turner
Appeals Judge
CONCUR:
Cristina Beceiro
Appeals Judge
Carisa Space-Beam
Appeals Judge