Appeals Panel Issues Reversal, Discusses Role of Designated Doctor Opinions Regarding Extent of Injury

The Appeals Panel has reversed the decision and order of an Administrative Law Judge who determined that the claimant’s compensable injury does not extend to various disputed left shoulder conditions despite an opinion from the designated doctor that the compensable injury so extended. The decision, Texas Division of Workers’ Compensation Appeals Panel Decision No. 210651, decided June 23, 2021, remanded the case to the Administrative Law Judge to re-evaluate the extent issue consistent with its decision.

The claimant testified that he injured his left shoulder when he slipped on some gravel while trying to push a truck. The parties stipulated at the Contested Case Hearing (CCH) that the claimant sustained a compensable injury, at least in the form of a left shoulder sprain and left shoulder strain. However, there remained a dispute as to whether the compensable injury extends to a left shoulder supraspinatus rotator cuff tear, left shoulder infraspinatus rotator cuff tear, left shoulder rotator cuff sprain, and left shoulder impingement syndrome.

The Division had appointed a designated doctor to evaluate extent of injury, and that doctor opined that the compensable injury extended to those conditions. The designated doctor specifically reasoned as follows:

[Claimant] was trying to push a broken down truck out of the backyard with [five] other people. He described that his shoulders were flexed, elbows extended, and wrists pronated. He stepped on a vine that was on top of the gravel and slipped but he held onto the truck with both arms. The mechanism of injury is consistent with a left shoulder supraspinatus/infraspinatus/rotator cuff tear, left shoulder rotator cuff sprain, [and] left shoulder impingement syndrome . . .

Acute tears of the rotator cuff can be the result of forceful injury to the shoulder and straining of the tendon beyond its mechanical limits (emphasis in original). When [Claimant] had both shoulders in flexion, elbows an extension and wrists and pronation to push the truck, it is reasonable that the rotator cuff muscles were stretched beyond their mechanical limit.

The Administrative Law Judge suggested that the designated doctor effectively misunderstood or misconstrued the actual mechanism of injury, and thereby failed to sufficiently establish causation between the reported work event and the development of the disputed conditions. She specifically explained:

The designated doctor . . . seemed to understand the work-related injury, however, his opinion on extent of injury was not consistent with the description of the injury event. He noted that the rotator cuff damage can be caused by repetitive trauma or lifting and throwing motions. The work-related activity is not described as a lifting or throwing motion.

The Appeals Panel noted, however, that the Administrative Law Judge appeared to reference only these comments from the “general discussion” portion of the designated doctor report without recognizing or addressing the more specific commentary included in the causation analysis (as excerpted in the paragraphs above).

In expressing its view that the Administrative Law Judge ultimately misread the designated doctor opinion in this case, the Appeals Panel revisited a number of its prior decisions, including Texas Division of Workers’ Compensation Appeals Panel Decision No. 130723, decided May 6, 2013; Texas Division of Workers’ Compensation Appeals Panel Decision No. 150844, decided June 18, 2015; and Texas Division of Workers’ Compensation Appeals Panel Decision No. 210402, decided May 5, 2021. While the Appeals Panel acknowledged once more that the Administrative Law Judge may accept or reject, in whole or in part, the opinions of a designated doctor, it reaffirmed its willingness to reverse the determination of an Administrative Law Judge regarding extent of injury when such determination is perceived to have resulted from a misreading of a designated doctor opinion.

Based on the above, the Appeals Panel reversed the determination of the Administrative Law Judge that the compensable injury does not extend to the disputed conditions and remanded that determination for further action consistent with its decision.