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 August 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 compensable injury sustained on (date of injury), does not extend to left ankle sprain, right knee sprain, right foot sprain, radiculopathy, radiculopathy lumbar region, or other spondylosis with radiculopathy, lumbar region; (2) the appellant (claimant) reached maximum medical improvement (MMI) on August 19, 2024; and (3) the claimant’s impairment rating (IR) is five percent. The claimant appealed, disputing the ALJ’s determinations of extent of injury, MMI, and IR. The respondent (carrier) responded, urging affirmance of the disputed extent-of-injury conditions, MMI, and IR determinations. The carrier asserted in its response that there was a typographical error in the decision that the claimant reached MMI on August 19, 2024, rather than June 19, 2024.
DECISION
Affirmed in part as reformed 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 lumbar sprain, lumbar strain, left foot sprain, and left foot strain; the Texas Department of Insurance, Division of Workers’ Compensation (Division) appointed (Dr. F) as the designated doctor to determine the issues of MMI, IR, return to work, and extent of injury; and for purposes of MMI and IR, the terms sprain and strain have the same meaning and may be used interchangeably. We note that the stipulation in Finding of Fact 1.E. of the decision states that “[a]side from the conditions at issue for this hearing, there are no other conditions or diagnoses that need to be adjudicated for the purpose of determining [MMI], [IR], return to work, and extent of injury.” A review of the record reflects that the parties actually stipulated that: aside from the conditions at issue for this hearing, there are no other conditions or diagnoses that need to be adjudicated for the purpose of determining MMI and IR. We reform the stipulation in Finding of Fact 1.E. to conform to the actual stipulation made by the parties on the record. The claimant testified that she was injured when boxes fell hitting her on her right side pushing her against some heavy boxes on her left.
EXTENT OF INJURY
The ALJ’s determination that the compensable injury of (date of injury), does not extend to left ankle sprain, right knee sprain, right foot sprain, radiculopathy, radiculopathy lumbar region, or other spondylosis with radiculopathy, lumbar region is supported by sufficient evidence and is affirmed.
MMI/IR
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.
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 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.
Dr. F examined the claimant on October 24, 2024, and certified that the claimant reached MMI on August 19, 2024, with a five percent IR. In his narrative report, Dr. F stated his assessment of the compensable injury is left ankle sprain, right knee sprain, right foot sprain, and lumbar strain. Using 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) Dr. F placed the claimant in Lumbosacral Diagnosis Related Estimate (DRE) Category II: Minor Impairment assessing five percent impairment for the lumbar spine. Dr. F assessed zero percent impairment using range of motion (ROM) measurements for the left foot/ankle, right foot/ankle, and right knee.
On March 17, 2025, a Presiding Officer’s Directive to order designated doctor exam was sent specifying the conditions that comprise the compensable injury and listing the additional conditions the claimant was pursing in the extent of injury issue and requesting the designated doctor to provide alternate certifications. On April 24, 2025, Dr. F re-examined the claimant and issued three alternate certifications that all certified the claimant reached MMI on June 19, 2024, with a five percent IR, including one that rated the compensable injury as determined in this case. Dr. F noted that June 19, 2024, was the clinical note which showed full strength and ROM. Using the AMA Guides, Dr. F placed the claimant in Lumbosacral DRE Category II: Minor Impairment and assessed five percent. Based on ROM measurements Dr. F assessed zero percent impairment for the claimant’s left foot.
The ALJ found that the preponderance of the other medical evidence was not contrary to the certification from Dr. F. However, the ALJ mistakenly found the date of MMI based on the certification that considered and rated conditions that have been determined not to be part of the compensable injury and failed to consider the entire compensable injury rather than the MMI date which considered and rated the compensable injury. The certification of MMI on August 19, 2024, cannot be adopted because it considered conditions that have been determined not to be part of the compensable injury and failed to consider conditions that were stipulated to be part of the compensable injury. The amended certification by Dr. F rated the entire compensable injury in accordance with the AMA Guides and is supported by the evidence.
Accordingly, we reverse the ALJ’s determination that the claimant reached MMI on August 19, 2024, as being against the great weight and preponderance of the evidence and render a new decision that the claimant reached MMI on June 19, 2024.
We affirm the ALJ’s determination that the claimant’s IR is 5%.
SUMMARY
We affirm the ALJ’s determination that the compensable injury of (date of injury), does not extend to left ankle sprain, right knee sprain, right foot sprain, radiculopathy, radiculopathy lumbar region, or other spondylosis with radiculopathy, lumbar region.
We affirm as reformed the stipulation in Finding of Fact No. 1.E. as follows: Aside from the conditions at issue for this hearing, there are no other conditions or diagnoses that need to be adjudicated for the purpose of determining MMI and IR.
We affirm the ALJ’s determination that the claimant’s IR is five percent.
We reverse the ALJ’s determination that the claimant reached MMI on August 19, 2024, and render a new decision that the claimant reached MMI on June 19, 2024.
The true corporate name of the insurance carrier is ACE AMERICAN INSURANCE COMPANY and the name and address of its registered agent for service of process is
C T CORPORATION SYSTEM
1999 BRYAN STREET SUITE 900
DALLAS, TEXAS 75201-3136.
Margaret L. Turner
Appeals Judge
CONCUR:
Cristina Beceiro
Appeals Judge
Carisa Space-Beam
Appeals Judge