DECISION AND ORDER

I. DISCUSSION

Suhail Al-Sahli, D.C., (Petitioner) appealed the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through Envoy Medical Systems, LLC, an Independent Review Organization (IRO), denying Petitioner reimbursement for chiropractic treatment and office visits for the period January 11, 2002, through June 21, 2002, (Disputed Services).

This decision denies the relief sought by Petitioner.

The hearing convened on September 24, 2003, before Administrative Law Judge (ALJ) Stephen J. Pacey. Petitioner appeared pro se, and Neal Moreland represented the City of Pasadena (Respondent). There were no contested issues of notice or jurisdiction. The record closed the same day following adjournment of the hearing.

A. Background.

_____ (Patient) sustained a work related injury on_________, when he slipped on a muddy sidewalk while repairing a break in a water line. Martin Barrash, M.D., a neurosurgeon, diagnosed him with spinal stenosis, a degenerative narrowing of the spinal canal. He continued to work for six weeks until his low back pain became unbearable. On March 13, 1998, Michael Kaldis, M.D., performed a thoracic laminectomy from T3 to T6 with metal rods from T2 to T7. Complications from that surgery caused Patient to become paralyzed in both legs.

B. Petitioner’s Arguments and Evidence.^[1]

Petitioner argued that the treatments improved functions, and tremendous strides were made at Patient’s return to work. Petitioner indicated that when Patient started treatment he was a paraplegic, two years later he is walking with a cane. According to Petitioner, patient had a set-back and gone back to the wheelchair. The treatments were necessary to enable Patient to walk with a cane.

C. Respondent’s Arguments and Evidence.

Respondent argued that Patient has had an extensive course of chiropractic treatment, and the documentation did not reflect that treatment was effective in relieving symptoms or improving Patient’s function. Respondent’s also asserted that Stephen Tomko’s D.C., peer report indicated that Patient’s condition stabilized in a diminished condition and that further treatment would not be more efficient than a home based strength and conditioning program.

Petitioner presented an excerpt^[2] from the courts decision in City of Pasadena V.____95 S.W.3d 494, (Tex. App.-Hous. 2002) that affirmed the trial court’s jury decision that Patient suffered a compensable injury but that he was not disabled. The court quoted Dr. Barrash who testified that Patient was disabled as a result of a pre-existing degenerative back condition wholly unrelated to his employment and that Patient would have required surgery regardless of the injury sustained on November 17, 1977.

Analysis.

Petitioner assisted Patient make tremendous strides progressing from paraplegic status to walking with a cane. This improvement occurred in the past. There is no documentation that the services subject to this dispute have had a demonstrated improvement. Patient has completed a work hardening program and extensive chiropractic treatment. There was no documentation of improving function that appeared to be directed at progression for Patient to return to work. Also the Court of Appeals decision indicated that the chiropractic treatments were not related to the compensable

injury that occurred_________. The ALJ concludes that Petitioner did not prove the disputed services were medically necessary. Additionally, it is the ALJ’s opinion that further treatment would not be any more efficient than a home-based strength and conditioning program.

II. FINDINGS OF FACT

1. ____ (Patient) sustained a work related injury on or about__________, when he slipped on a muddy sidewalk while repairing a break in a water line.
2. Martin Barrash, M.D., a neurosurgeon, diagnosed Patient with spinal stenosis, a degenerative narrowing of the spinal canal.
3. On March 13, 1998, Michael Kaldis, M.D., performed a thoracic laminectomy from T3 to T6 with metal rods from T2 to T7.
4. Complications arose from that surgery causing Patient to become paralyzed in both legs
5. Suhail Al-Sahli, D.C. (Petitioner) seeks reimbursement for chiropractic treatment and office visits for the period January 11, 2002, through June 21, 2002, (Disputed Services).
6. The treatment was not effective in relieving symptoms or improving Patient’s function.
7. Patient’s condition stabilized in a diminished condition and that further treatment would not be more efficient than a home based strength and conditioning program.
8. The Court of Appeals indicated that the chiropractic treatments were not related to the compensable injury that occurred November 17, 1997.
9. City of Pasadena (Respondent) denied reimbursement for the Disputed Services as not medically necessary.
10. By letter dated June 17, 2003, Envoy Medical Systems, LLC, an Independent Review Organization (IRO), concluded that the Disputed Services were not medically necessary for treatment of Patient’s condition.
11. The IRO decision is deemed a Decision and Order of the Texas Workers’ Compensation Commission (Commission).
12. Petitioner timely requested a hearing to contest the Commission’s decision.
13. By letter dated July 23, 2003, the Commission issued a notice of hearing.
14. A hearing was convened by Administrative Law Judge Stephen J. Pacey on September 24, 2003, in the hearing rooms of the State Office of Administrative Hearings.
15. Suhail Al-Sahli, D.C., appeared pro se. Neal Moreland represented Respondent.

III. CONCLUSIONS OF LAW

1. The Texas Workers’ Compensation Commission has jurisdiction to decide the issue presented pursuant to the Texas Workers’ Compensation Act, Tex. Lab. Code Ann. § 413.031.
2. The State Office of Administrative Hearings has jurisdiction over matters related to the hearing in this proceeding, including the authority to issue a decision and order, pursuant to Tex. Lab. Code Ann. § 413.031(k) and Tex. Gov’t. Code Ann. ch. 2003.
3. Petitioner timely requested a hearing in this matter pursuant to 28 Tex. Admin. Code (TAC) §§ 102.7 and 148.3.
4. Notice of the hearing was proper and complied with the requirements of Tex. Gov’t. Code Ann. ch. 2001.
5. An employee who has sustained a compensable injury is entitled to all health care reasonably required by the nature of the injury as and when needed. The employee is specifically entitled to health care that cures or relieves the effects naturally resulting from the compensable injury, promotes recovery, or enhances the ability of the employee to return to or retain employment. Tex. Lab. Code Ann. § 408.021(a).
6. Petitioner had the burden of proof in this matter, which was the preponderance of evidence standard. 28 TAC §§ 148.21(h) and (i); 1 TAC § 155.41(b).
7. Based upon the Findings of Fact, Petitioner failed to prove by a preponderance of the evidence that the chiropractic treatments and office visits for the period January 11, 2002, through June 21, 2002, were medically necessary for treatment of Patient’s condition.

ORDER

THEREFOREIT IS ORDERED that Petitioner Suhail Al-Sahli’s, D.C, request for relief is DENIED.

Signed November 3^rd, 2003.

STEPHEN J. PACEY
Administrative Law Judge
STATE OFFICE OF ADMINISTRATIVE HEARINGS

1. . Petitioner’s documentary evidence offered at the hearing was excluded because it was not filed five days before the hearing nor was it provided to Respondent’s attorney. The Notice of Hearing expressly instructs the parties to file the exhibits five days before the hearing and to provide the opposing party a copy. Respondent objected to the documents admission, and the objection was sustained by the ALJ.↑
2. . Respondent was requested to provide a complete copy of the case, and Respondent was advised of this request.↑