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 April 25, 2024, with the record closing on March 28, 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 appellant (claimant) reached maximum medical improvement (MMI) on February 20, 2023; and (2) the claimant’s impairment rating (IR) is 4%. The claimant appealed, disputing the ALJ’s determinations. The respondent (self-insured) responded, urging affirmance of the ALJ’s determinations.
DECISION
Affirmed in part and reversed and rendered in part.
The parties stipulated, in part, that the claimant sustained a compensable injury on (date of injury), in the form of bilateral knee sprains, bilateral knee contusions, right knee medial meniscus tear, right hand sprain (which effects the right thumb, right index finger, and right pinky finger), and a right wrist sprain, and that the statutory date of MMI is March 19, 2023. The evidence reflects the claimant was injured on (date of injury), when she fell and landed on her hands and knees.
MMI
The ALJ’s determination that the claimant reached MMI on February 20, 2023, is supported by sufficient evidence and is affirmed.
IR
Section 408.125(c) provides that the report of the designated doctor shall have presumptive weight, and the Texas Department of Insurance, Division of Workers’ Compensation (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 Division initially appointed (Dr. X) as designated doctor on the issues of MMI and IR. Dr. X examined the claimant on March 14, 2022, and certified the claimant had not reached MMI. Dr. X also examined the claimant on November 15, 2022, and again certified the claimant had not reached MMI. As previously mentioned, the parties stipulated that the statutory date of MMI is March 19, 2023, so neither of Dr. X’s certifications could be adopted.
(Dr. M) was subsequently appointed as designated doctor on the issues of MMI and IR. Dr. M examined the claimant on August 25, 2023, and certified she reached MMI statutorily on March 2, 2023, with a 20% IR. As we have affirmed the ALJ’s determination that the claimant reached MMI on February 20, 2023, this certification cannot be adopted. Additionally, the ALJ correctly noted in her discussion that Dr. M did not rate the entire compensable injury.
There are other certifications in evidence. (Dr. R), the claimant’s treating doctor, examined the claimant on February 20, 2023, and issued two certifications. In the first, Dr. R certified the claimant reached MMI on January 1, 2023, with an 8% IR. In the second, Dr. R certified the claimant reached MMI on February 1, 2023, with an 8% IR. As we have affirmed the ALJ’s determination that the claimant reached MMI on February 20, 2023, neither certification can be adopted. Additionally, the ALJ correctly noted in her discussion that Dr. R did not rate the entire compensable injury.
Because there were no certifications that could be adopted, the ALJ issued a Presiding Officer’s Directive and (Dr. B), an out-of-state doctor, was appointed by the Division on the issues of MMI and IR. Dr. B examined the claimant on July 19, 2024, and certified the claimant reached MMI on February 20, 2023, with a 4% IR. Dr. B explained in his accompanying narrative report that he assessed 0% impairment for bilateral knee sprains and contusions, but 4% impairment for the right knee medial meniscal tear based on range of motion (ROM) measurements. Dr. B also assessed 0% impairment for the right hand and wrist sprains, which were “taken collectively as a specific digit injury has not been identified.” Dr. B also noted the right hand sprain, thumb, and digits that “have been identified by [the claimant] and her providers, are symptomatic without objective signs of injury related to the work claim.” Dr. B assessed 0% impairment for the claimant’s right thumb because the claimant had underlying and naturally occurring joint disease of the base of the thumb.
Due to questions regarding Dr. B’s certification the ALJ sent a letter of clarification to Dr. B on March 13, 2025. The ALJ noted that Dr. B had documented 110° of flexion for the claimant’s right knee and 10° of extension lag but assigned 4% whole person impairment (WPI) for the right knee. The ALJ pointed out that Table 41 on page 3/78 of 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) provides that 110° of knee flexion would be 0% WPI, and 10° of extension lag would be 8% WPI. The ALJ also pointed out that the affected digits of the right hand were the thumb, index, and pinky finger, and that the ROM measurements in Dr. B’s report reflected a WPI for the right hand would be at least 4%.
In a response dated March 19, 2025, Dr. B stated that the absence of an IR for the right index and pinky fingers was “due to the lack of evidence linking any functional limitations or deficits in these digits to the compensable injury,” and the measurements documented in his report “do not demonstrate any impairment attributable to the injury in question.” Dr. B further stated that assigning an IR to the digits in question, as well as the right wrist and hand, would not accurately reflect the claimant’s condition as it pertains to the compensable injury. Dr. B used his discretion as a matter of medical judgment to determine the diminished ROM measurements were not attributable to the compensable injury, and we see no error in Dr. B’s assessed 0% impairment for the claimant’s upper extremity.
In response to the question of the claimant’s right knee impairment, Dr. B stated the following:
As noted, the claimant’s right knee flexion was recorded at 110[°], with an extension lag of 10[°]. According to the narrative report on page 8, the [IR] for the right knee is indicated as 4%. You have correctly observed that under Table 41 [page] 3/78 [of the AMA Guides] a flexion of 110[°] would typically correspond to an [IR] of 0%, while an extension lag of 10[°] would correspond to an 8% [IR].
It is important to clarify that no change is necessary to the [IR] as documented. The 4% [IR] reflects the examiner’s professional judgment and ability to work within the confines of the charts, despite the claimant’s unique presentation not fitting perfectly into the standard chart parameters. The charts serve as a guideline, and the examiner is allowed a degree of discretion to account for individual variations that may not be fully captured by the standard measurements.
The claimant contends on appeal that the right knee ROM measurements result in 8% impairment per Table 41, and that the AMA Guides do not allow Dr. B to completely deviate from the measurements determining specific IRs. We agree. Dr. B acknowledged in his LOC response that the claimant’s right knee ROM measurements correspond to 0% WPI for flexion and 8% WPI for extension lag, and nothing in the AMA Guides provides Dr. B discretion to arbitrarily assign a 4% IR under Table 41 based on the claimant’s right knee ROM measurements. We note that Dr. B neither invalidated the claimant’s ROM measurements nor compared her ROM to the contralateral side.
The Appeals Panel has previously stated that, where the certifying doctor’s report provides the component parts of the rating that are to be combined and the act of combining those numbers is a mathematical correction which does not involve medical judgment or discretion, the Appeals Panel can recalculate the correct IR from the figures provided in the certifying doctor’s report and render a new decision as to the correct IR. See Appeals Panel Decision (APD) 171766, decided September 7, 2017; APD 172488, decided December 18, 2017; APD 152464, decided February 17, 2016; APD 121194, decided September 6, 2012; APD 041413, decided July 30, 2004; APD 100111, decided March 22, 2010; and APD 101949, decided February 22, 2011. Under the circumstances of this case, Dr. B’s assigned IR can be mathematically corrected based on the documented measurements for the right knee.
The left knee ROM measurements listed in Dr. B’s report result in 0% impairment under Table 41 as assessed by Dr. B. However, as acknowledged by Dr. B in his LOC response, the right knee ROM measurements listed in his report result in 8% WPI under Table 41. Combining 0% WPI for the claimant’s upper extremity with 0% WPI for the left knee and 8% WPI for the right knee, as corrected, results in 8% WPI, rather than 4% WPI assessed by Dr. B. The ALJ found that the preponderance of the other medical evidence is not contrary to the certification of Dr. B. After a mathematical correction, that finding is supported by the evidence. Accordingly, we reverse the ALJ’s determination that the claimant’s IR is 4%, and we render a new decision that the claimant’s IR is 8%, as mathematically corrected.
SUMMARY
We affirm the ALJ’s determination that the date of MMI is February 20, 2023.
We reverse the ALJ’s determination that the claimant’s IR is 4%, and we render a new decision that the claimant’s IR is 8%, as mathematically corrected.
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
(NAME)
MAYOR OF THE (SELF-INSURED)
(ADDRESS)
(CITY), TEXAS (ZIP CODE).
Carisa Space-Beam
Appeals Judge
CONCUR:
Cristina Beceiro
Appeals Judge
Margaret L. Turner
Appeals Judge