Appeals Panel Reverses Decision where ALJ Misstated the Evidence

The appeals panel has reversed the decision and order of an administrative law judge because the ALJ misstated the evidence upon which the disputed issue had been decided. The decision, Texas Division of Workers’ Compensation Appeals Panel Decision No. 201337, decided November 6, 2020, was remanded to the ALJ for further decisions consistent with the appeals panel’s opinion.

The case turned primarily upon an extent of injury question. Among other issues, the ALJ determined that the compensable injury did not extend to an injury to the lumbar spine with the following diagnoses: contusion, a disc bulge at L3-4, spondylolisthesis at L4-5, or a disc bulge at L5-S1 with a right L5 pars particular fracture. The claimant appealed this determination.

The ALJ had observed in the discussion portion of her decision that “[a]side from the lumbar contusion, causation to the remaining conditions is a matter that is sufficiently complex that falls outside the common knowledge and experience of a layperson” and as such requires expert medical causation evidence. The ALJ next noted that the claimant relied upon various medical records from his treating doctor, (Dr. U), and stated:

. . . the medical records from [Dr. U] do not mention the compensable injury which had occurred on (date of injury). The medical records consistently documented that on “8/5/19 [the claimant] was working on his yard and developed lumbar pain. He states the pain radiated from [the] right gluteal, anterior, posterior, and lateral thigh, anterior lower leg and anterior of his foot. He states right sided lumbar pain 15 years ago.” Again, there was no mention of the fall occurring on (date of injury).

The appeals panel wrote that while the ALJ was correct in saying the record contains various medical records from Dr. U that did not mention the claimant’s compensable injury, the record did contain two medical records from Dr. U that did mention the claimant’s compensable injury.

The appeals panel viewed the ALJ’s discussion of the case to be error requiring reversal.

While the ALJ can accept or reject in whole or in part Dr. U’s opinion, the ALJ’s decision in this case is based, in part, on a misstatement of the medical evidence in the record.

The appeals panel ordered the ALJ to correct the misstatement of the evidence on remand and then make a determination whether the compensable injury extends to an injury to the lumbar spine with the disputed diagnoses.