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 23, 2025, with the record closing on July 25, 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), extends to a subdural hemorrhage, concussion, post-concussion syndrome, post-concussion symptoms with vestibular disorder, headaches, traumatic skull pain, scalp contusion, right side cortical blindness, homonymous bilateral field defects, left side stroke in occipital lobe on the right side, left homonymous hemianopsia and quadrantanopia (visual defects) with right medial occipital infarct, and interhemispheric subdural hematoma (intercranial hemorrhage that occurs between the cerebral/brain hemispheres); (2) the compensable injury of (date of injury), does not extend to irregular flow signal in the mid to distal right posterior cerebral artery or irregular flow signal in the mid to distal hemianopia; (3) the respondent/cross-appellant (claimant) reached maximum medical improvement (MMI) on March 10, 2025; and (4) the claimant’s impairment rating (IR) is 0%.
The appellant/cross-respondent (self-insured) appealed that portion of the ALJ’s extent-of-injury determination that was in favor of the claimant, as well as the MMI determination. The appeal file contains no response from the claimant to the self-insured’s appeal.
The claimant filed a cross-appeal appealing that portion of the ALJ’s extent-of-injury determination that was against him, as well as the MMI and IR determinations. The appeal file contains no response from the self-insured to the claimant’s cross-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 a mild closed head injury, scalp contusion, and a scalp laceration; and (Dr. H) was appointed by the Texas Department of Insurance, Division of Workers’ Compensation (Division) as designated doctor to address the issues of MMI and IR. The claimant, a sheriff’s deputy, was injured on (date of injury), while investigating a motor vehicle accident in icy conditions. While he was investigating one accident, another semi-truck jackknifed on the ice nearby, causing the claimant to slip on the ice and hit his head.
EXTENT OF INJURY
The ALJ’s determinations that the compensable injury of (date of injury), extends to a subdural hemorrhage, concussion, post-concussion syndrome, post-concussion symptoms with vestibular disorder, headaches, traumatic skull pain, scalp contusion, right side cortical blindness, homonymous bilateral field defects, left side stroke in occipital lobe on the right side, left homonymous hemianopsia and quadrantanopia (visual defects) with right medial occipital infarct, and interhemispheric subdural hematoma (intercranial hemorrhage that occurs between the cerebral/brain hemispheres), but not to irregular flow signal in the mid to distal right posterior cerebral artery or irregular flow signal in the mid to distal hemianopia are supported by sufficient evidence and are affirmed.
MMI
The ALJ’s determination that the claimant reached MMI on March 10, 2025, 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 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. 28 Tex. Admin. Code § 130.1(c)(3) (Rule 130.1(c)(3)) provides, in part, 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 that the claimant reached MMI on March 10, 2025, with a 0% IR in accordance with the second certification of Dr. H, the designated doctor. Dr. H examined the claimant on July 14, 2025, and listed the diagnoses rated as mild closed head injury and a scalp laceration. However, Dr. H stated in his narrative report that he grouped the conditions of scalp contusion, scalp laceration, subdural hemorrhage, concussion, post-concussion syndrome, post-concussion symptoms with vestibular disorder, headaches, traumatic skull pain, and interhemispheric subdural hematoma under the condition of mild closed head injury. He further stated that he grouped the conditions of right side cortical blindness, homonymous bilateral field defects, left homonymous hemianopsia or quadrantanopia (visual defects) with right medial occipital infarct under the condition of left side stroke in occipital lobe on the right side. We note that the corresponding Report of Medical Evaluation (DWC-69) only lists the codes for mild closed head injury and scalp laceration and does not have a code for left side stroke in occipital lobe on the right side.
Dr. H assigned a 0% impairment under Chapter 4 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) for the mild closed head injury. He assigned a 0% impairment under Chapter 9 of the AMA Guides for the vestibular system. For the left side stroke in occipital lobe on the right side, Dr. H also assigned 0% impairment. He noted that the claimant had some loss of central visual acuity on the ophthalmological testing done by (Dr. G) and (Dr. T), but he stated he did not believe it was related to the compensable injury. Dr. H further stated, “[r]egarding his visual fields, as discussed previously and based on his clinical testing and his recent confrontational visual fields testing, there i[s] no impairment secondary to loss of visual fields. Overall, he has a [0%] impairment of his whole person regarding the visual system.”
In Chapter 8, The Visual System, on page 8/209, the AMA Guides provide:
Visual impairment occurs in the presence of a deviation from normal in one or more of the functions of the eye, which include: (1) corrected visual acuity for near and far objects; (2) visual field perception; and (3) ocular motility with diplopia. Evaluation of visual impairment is based on evaluation of the three functions.
On page 8/217, in Section 8.4, Steps in Determining Impairment of the Visual System and of the Whole Person, the AMA Guides state:
Step 1: Determine and record the percentage loss of central vision for each eye separately, combining the losses of near and distance vision.
Step 2: Determine and record the percentage loss of visual field for each eye separately (monocular) or for both eyes together (binocular).
Step 3: Determine and record the percentage loss of ocular motility.
Step 4: After determining the level of impairment f each eye, use Table 7 (p. 219) to determine visual system impairment.
Step 5: Consult Table 6 to ascertain the impairment of the whole person that is contributed by impairment of the visual system.
Section 8.2 Visual Fields on page 8/211 discusses the methods for determining visual field acuity, and Table 1 on page 8/210 of the AMA Guides lists the acceptable equipment needed for testing visual field acuity, which includes the Goldmann (kinetic), ARC perimeter (kinetic), Allergan-Humphrey (static, size 3), or the Octopus (static size 3).
Dr. H stated in his narrative report that he used the report of (Dr. K) to assess the claimant’s visual impairment. Dr. H explained that he spoke to a technician from Dr. K’s office to find out what confrontational fields testing was. He stated that “the technician was very kind and took time to explain to me what is done during the exam. They use their hands and fingers to demonstrate a certain number of fingers. These are then placed in the eight different meridians that are measured for visual fields.” Dr. H concluded that based on Dr. K’s confrontational fields testing and the fact that the claimant is functioning well at work, there is no impairment for loss of visual field perception. Dr. H failed to properly apply the AMA Guides in assessing the claimant’s IR by failing to follow a method utilizing the equipment referenced by the AMA Guides and by failing to provide measurements for the claimant’s visual field loss. Accordingly, we reverse the ALJ’s determination that the claimant’s IR is 0%.
There are two more certifications in evidence. Dr. H initially examined the claimant on June 24, 2024, and certified that the claimant reached MMI on June 24, 2024, with a 0% IR considering the conditions of mild closed head injury and scalp laceration. As previously noted, we have affirmed that the claimant’s MMI date is March 10, 2025, and the compensable injury includes a subdural hemorrhage, concussion, post-concussion syndrome, post-concussion symptoms with vestibular disorder, headaches, traumatic skull pain, scalp contusion, right side cortical blindness, homonymous bilateral field defects, left side stroke in occipital lobe on the right side, left homonymous hemianopsia and quadrantanopia (visual defects) with right medial occipital infarct, and interhemispheric subdural hematoma (intercranial hemorrhage that occurs between the cerebral/brain hemispheres). Additionally, the parties stipulated that the compensable injury includes a scalp contusion. Therefore, this certification cannot be adopted.
(Dr. B), the doctor selected by the treating doctor, examined the claimant on November 25, 2024, and certified that the claimant reached MMI on September 23, 2024, with a 35% IR based on the conditions of scalp laceration, scalp contusion, cortical blindness right side of brain, subdural hematoma, and left side homonymous bilateral field defects. As we have affirmed that the claimant’s MMI date is March 10, 2025, and this certification fails to rate the compensable conditions of mild closed head injury, concussion, post-concussion syndrome, post-concussion symptoms with vestibular disorder, headaches, traumatic skull pain, left side stroke in occipital lobe on the right side, left homonymous hemianopsia and quadrantanopia (visual defects) with right medial occipital infarct, and interhemispheric subdural hematoma (intercranial hemorrhage that occurs between the cerebral/brain hemispheres), it cannot be adopted.
There is no certification of IR in the record that can be adopted. Therefore, we remand the issue of IR to the ALJ for further action consistent with this decision.
SUMMARY
We affirm the ALJ’s determinations that the compensable injury of (date of injury), extends to a subdural hemorrhage, concussion, post-concussion syndrome, post-concussion symptoms with vestibular disorder, headaches, traumatic skull pain, scalp contusion, right side cortical blindness, homonymous bilateral field defects, left side stroke in occipital lobe on the right side, left homonymous hemianopsia and quadrantanopia (visual defects with right medial occipital infarct, and interhemispheric subdural hematoma (intercranial hemorrhage that occurs between the cerebral/brain hemispheres), but not to irregular flow signal in the mid to distal right posterior cerebral artery or irregular flow signal in the mid to distal hemianopia.
We affirm the ALJ’s determination that the claimant reached MMI on March 10, 2025.
We reverse the ALJ’s determination that the claimant’s IR is zero percent and remand the IR issue to the ALJ for further action consistent with this decision.
REMAND INSTRUCIONS
Dr. H is the designated doctor in this case. On remand, the ALJ is to determine whether Dr. H is still qualified and available to be the designated doctor. If Dr. H is no longer qualified or available to serve as the designated doctor, then another designated doctor is to be appointed to determine the claimant’s IR for the compensable injury of (date of injury).
The designated doctor shall be requested to re-examine the claimant and to give a certification of IR for the claimant’s compensable injury of (date of injury), based on the claimant’s condition as of the March 10, 2025, MMI date using the AMA Guides and considering the claimant’s medical record and the certifying examination.
The ALJ is to advise the designated doctor that the compensable injury is a mild closed head injury, scalp contusion, scalp laceration, subdural hemorrhage, concussion, post-concussion syndrome, post-concussion symptoms with vestibular disorder, headaches, traumatic skull pain, scalp contusion, right side cortical blindness, homonymous bilateral field defects, left side stroke in occipital lobe on the right side, left homonymous hemianopsia and quadrantanopia (visual defects) with right medial occipital infarct, and interhemispheric subdural hematoma (intercranial hemorrhage that occurs between the cerebral/brain hemispheres), and that the steps for determining the impairment of the visual system in Chapter 8 of the AMA Guides must be followed, including providing all measurements and using any equipment that is required, in accordance with Rule 130.1(c)(3).
After the designated doctor re-examines the claimant and submits a new certification of IR, the parties are to be provided with the designated doctor’s DWC-69 and narrative report. The parties are to be allowed an opportunity to respond. The ALJ is then to make a determination on IR that is 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 Texas Department of Insurance, Division of Workers’ Compensation, 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 (self-insured) and the name and address of its registered agent for service of process is
(NAME)
(ADDRESS)
(CITY), TEXAS (ZIP CODE).
Cristina Beceiro
Appeals Judge
CONCUR:
Carisa Space-Beam
Appeals Judge
Margaret L. Turner
Appeals Judge