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Appeals Panel No. 121927

Posted: Dec 16, 2014
Comments: 0

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.

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