Extent of Injury
Facts: The injured employee was hit in the head by a falling piece of iron. She was wearing a hard hat and the iron struck her hard hat. The carrier accepted a strain to the cervical and lumbar portions of the spine.
Issues: The issues included the following extent of injury issue: Does the compensable injury (the cervical strain) extend to and include a cervical disc herniation at C5-6 and cervical radiculitis.
Evidence: The designated doctor (DD) stated that the disputed cervical injuries were aggravated by the cervical strain. In response to a letter of clarification, the DD stated that there was no new damage or harm to the structure of the cervical discs and that the subjective symptoms were from unrelated pre-existing conditions.
CCH D&O: The Hearing Officer found that compensable injury extended to and included a cervical disc herniation at C5-6 and cervical radiculitis. The Hearing Officer relied on reports from four treating and/or referral doctors. However, none of the reports specifically mentioned cervical disc herniation at C5-6 and cervical radiculitis.
AP Holding: The Appeals Panel reversed and rendered. The Appeals Panel explained that whether the compensable injury extends to and includes cervical disc herniation at C5-6 and cervical radiculitis requires expert medical evidence on causation, and because none of the medical reports explained how the mechanism of injury caused the cervical disc herniation at C5-6 and cervical radiculitis, based on reasonable medical probability, the Hearing Officer’s finding on extent of injury was against the great weight and preponderance of the evidence.