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 10, 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 an L5-S1 annular tear, lumbar spine degenerative disc disease, L5-S1 disc bulge, or lumbar facet syndrome; (2) the appellant (claimant) reached maximum medical improvement (MMI) on June 11, 2024; (3) the claimant’s impairment rating (IR) is zero percent; and (4) the claimant had disability from June 4, 2024, through the date of the CCH, resulting from the compensable injury sustained on (date of injury). The claimant appealed the ALJ’s determinations regarding extent of injury, MMI, and IR. The claimant argued on appeal that the ALJ disregarded the designated doctor’s opinion on extent of injury. The respondent (carrier) responded, urging affirmance of the appealed determinations.
The ALJ’s determination that the claimant had disability from June 4, 2024, through the date of the CCH, resulting from the compensable injury sustained on (date of injury), 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 the claimant sustained a compensable injury on (date of injury), that extends to at least a lumbar sprain and lumbar strain; and that the Texas Department of Insurance, Division of Workers’ Compensation (Division) appointed (Dr. H) as designated doctor to address the extent of the compensable injury, MMI, IR, and return to work. The claimant, a water transfer operator, was injured on (date of injury), when he stooped and leaned forward to open a valve and felt a stabbing pain in his back.
EXTENT OF INJURY
The ALJ determined the compensable injury did not extend to any of the claimed conditions in this case. In the Discussion portion of his decision, the ALJ stated that the designated doctor’s opinion regarding the disputed conditions he found compensable was not persuasive. The ALJ’s determination that the compensable injury does not extend to an L5-S1 annular tear or lumbar spine degenerative disc disease is supported by sufficient evidence and is affirmed.
Regarding the claimed conditions of L5-S1 disc bulge and lumbar facet syndrome, the ALJ stated in his decision that “no opinions regarding the L5-S1 disc bulge or lumbar facet syndrome were provided.”
However, a review of the record in this case indicates that Dr. H examined the claimant on November 20, 2024, following a Presiding Officer’s Directive for the purposes of determining MMI, IR, and whether the compensable injury extends to L5-S1 disc bulge, lumbar radiculopathy, and lumbar facet syndrome. Dr. H determined that the compensable injury caused the L5-S1 disc bulge and lumbar facet syndrome but did not cause lumbar radiculopathy.
We view the ALJ’s statement that there were no opinions regarding the L5-S1 disc bulge and lumbar facet syndrome as a misstatement of the evidence and a material misstatement of fact. While the ALJ can accept or reject in whole or in part the evidence in this case, his determination is based upon the incorrect belief that there was no opinion in evidence regarding whether the compensable injury of (date of injury), extends to a L5-S1 disc bulge and lumbar facet syndrome. See Appeals Panel Decision (APD) 172522, decided December 6, 2017, and APD 210449, decided May 24, 2021. Accordingly, we reverse the ALJ’s determination that the compensable injury of (date of injury), does not extend to a L5-S1 disc bulge and lumbar facet syndrome, and we remand the issue of whether the compensable injury of (date of injury), extends to a L5-S1 disc bulge and lumbar facet syndrome for further action consistent with this decision.
MMI AND IR
Because we have reversed and remanded the issue of whether the compensable injury of (date of injury), extends to a L5-S1 disc bulge and lumbar facet syndrome, we also reverse the ALJ’s determinations that the claimant reached MMI on June 11, 2024, and that the claimant’s IR is zero percent, and 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 an L5-S1 annular tear or lumbar spine degenerative disc disease.
We reverse the ALJ’s determination that the compensable injury of (date of injury), does not extend to an L5-S1 disc bulge and lumbar facet syndrome, and we remand the issue of whether the compensable injury of (date of injury), extends to an L5-S1 disc bulge and lumbar facet syndrome for further action consistent with this decision.
We reverse the ALJ’s determination that the claimant reached MMI on June 11, 2024, and we remand the issue of MMI 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 issue of the claimant’s IR to the ALJ for further action consistent with this decision.
REMAND INSTRUCTIONS
On remand the ALJ is to correct his misstatement of the evidence regarding Dr. H’s opinion on the compensability of an L5-S1 disc bulge and lumbar facet syndrome. The ALJ shall consider all of the evidence and make findings of fact, conclusions of law, and a determination on whether the compensable injury of (date of injury), extends to an L5-S1 disc bulge and lumbar facet syndrome. The ALJ is then to make findings of fact, conclusions of law, and a determination on the claimant’s date of MMI and IR that is supported by the evidence.
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 APD 060721, decided June 12, 2006.
The true corporate name of the insurance carrier is TRI-STATE INSURANCE COMPANY OF MINNESOTA 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.
Cristina Beceiro
Appeals Judge
CONCUR:
Carisa Space-Beam
Appeals Judge
Margaret L. Turner
Appeals Judge