Alvy Childress v. Texas Mutual Insurance Company

CourtCourt of Appeals of Texas
DecidedAugust 27, 2020
Docket03-19-00284-CV
StatusPublished

This text of Alvy Childress v. Texas Mutual Insurance Company (Alvy Childress v. Texas Mutual Insurance Company) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Alvy Childress v. Texas Mutual Insurance Company, (Tex. Ct. App. 2020).

Opinion

TEXAS COURT OF APPEALS, THIRD DISTRICT, AT AUSTIN

NO. 03-19-00284-CV

Alvy Childress, Appellant

v.

Texas Mutual Insurance Company, Appellee

FROM THE 340TH DISTRICT COURT OF TOM GREEN COUNTY NO. C180020C, THE HONORABLE JAY K. WEATHERBY, JUDGE PRESIDING

MEMORANDUM OPINION

Pro se appellant Alvy Childress suffered an on-the-job injury in 2015. Appellee

Texas Mutual Insurance Company, his workers’ compensation carrier, determined that a torn

tendon in his shoulder was not compensable. An administrative law judge (ALJ) with the Texas

Department of Insurance, Division of Workers’ Compensation (the Division), held a contested

case hearing and agreed with Texas Mutual; her decision was upheld by an Appeals Panel. See

Tex. Lab. Code §§ 410.151-.169 (Contested Case Hearing), .201-.209 (Appeals Panel).

Childress sought judicial review, see id. §§ 410.251-.308, and the trial court granted summary

judgment in favor of Texas Mutual. We will affirm the trial court’s order.

FACTUAL AND PROCEDURAL SUMMARY

Childress owns a steel-fabrication-and-erection business called ACE Fab, and in

May 2015, while moving an iron beam weighing between 2,000 and 3,000 pounds, he ruptured his right bicep tendon. Texas Mutual accepted the bicep injury as compensable but determined

that a “full thickness tear of his distal supraspinatus tendon” in his right shoulder was

“degenerative in nature and not caused or aggravated by the work place injury.” Childress

appealed, and on September 27, 2017, the ALJ held a contested case hearing to decide: whether

the supraspinatus tear was compensable; whether Childress had reached maximum medical

improvement (MMI) and, if so, when; his impairment rating (IR) if he had reached MMI; and

whether he had disability starting July 25, 2016.1

1 The supreme court has explained IRs and MMI as follows:

An employee receives impairment income benefits according to the employee’s impairment rating, which is the percentage of the whole body’s permanent impairment. To determine the impairment rating, an examining doctor evaluates the permanent effect of the employee’s injury under statutory guidelines. The doctor expresses the rating as a percentage of permanent impairment to the whole body. The greater this percentage, the greater the amount the employee receives as impairment income benefits. . . .

A doctor will not certify an impairment rating until the employee reaches “maximum medical improvement,” the point at which the employee’s injury will not materially improve with additional rest or treatment. The date of maximum medical improvement is fixed when an examining doctor certifies that no further material recovery or lasting improvement can reasonably be anticipated. The [Workers’ Compensation Act] presumes that maximum medical improvement will be reached not later than two years after income benefits begin to accrue.

Until an employee reaches maximum medical improvement, he or she may receive temporary income benefits. Once an employee reaches maximum medical improvement, temporary income benefits end. Whether the injured employee receives any additional income benefits depends largely on the assigned impairment rating.

Rodriguez v. Service Lloyds Ins. Co., 997 S.W.2d 248, 253-54 (Tex. 1999) (citations omitted). 2 In her Decision and Order, the ALJ stated that she had considered Childress’s

proffered “letters of causation” from Dr. Cynthia Goodman, Dr. Johann Van Beest, and Dr. Paul

Vu, as well as testimony by Dr. Brett Bolte, an expert provided by Texas Mutual. The ALJ

summarized Dr. Goodman’s report as opining that “the supraspinatus muscle and tendon are

commonly injured when a person attempts to lift a heavy object” and that the “pulling and

jerking motion” described by Childress “created the supraspinatus injury, which [Dr. Goodman]

characterized as a spontaneous rupture of the flexor tendon in the right upper arm.” She said that

Dr. Vu had “described the traction force” that caused that damaged Childress’s right upper arm,

“point[ing] to” a September 3, 2015 MRI that identified “a full thickness tear of the distal

supraspinatus tendon at its insertion.” However, the ALJ noted, Dr. Vu had not explained how

Childress “was able to continue working for 3 months after his date of injury,” nor had the doctor

“persuasively explain[ed]” how, if the tear was a pre-existing condition aggravated by the

workplace injury, “the condition was enhanced, accelerated, or worsened.” Finally, the ALJ

found Dr. Van Beest’s evidence unpersuasive because although he stated that the workplace

injury “caused injury to the right shoulder,” his report “limits this damage to a rotator cuff strain,

which is not the disputed condition.”

Dr. Bolte, on the other hand, opined that “the right shoulder conditions were

degenerative in nature” and not caused or worsened by the workplace injury. He stated that “an

acute tear of the supraspinatus tendon would be very painful,” would be “unlikely to go

unnoticed for long after an injury,” and would not typically be caused by the kind of injuring

event Childress described. The ALJ summarized Childress’s medical records as starting more

than three months after the date of injury and as stating that Childress “uses arm normally—

concerned about further damage.” She said the first record diagnosed “only a non-traumatic

3 rupture of the bicep tendon” and stated that Childress’s symptoms and pain levels were “mild”;

that at the time, Childress told medical staff that he had “full range of motion”; and that an exam

confirmed that his range of motion was “intact in all extremities.” The ALJ concluded:

After review, there was no qualified expert opinion evidence, based on reasonable medical probability, which provided a persuasive explanation of the causal link between the mechanism of the compensable injury and the right shoulder full thickness tear of the distal supraspinatus tendon. Thus, it is not part of the compensable injury.

The ALJ noted that although Childress had asserted that he had not reached MMI

“because he needs further treatment,” Designated Doctor Clayton Clark determined in September

2016 that Childress had reached MMI on June 22, 2016, and assigned a 1% IR, while Dr. Van

Beest determined Childress reached MMI on July 25, 2016, with a 7% IR. However, the ALJ

observed that Dr. Van Beest “rated a bicep muscle strain, which is not the compensable

injury[, s]o his certification could not be adopted.” She also stated that Childress reached

“statutory MMI on August 19, 2017.” See id. § 401.011(30)(B) (MMI is reached no later than

two years from date on which income benefits begin to accrue). The ALJ recited that Dr. Clark’s

“certification was not contrary to the preponderance of the other medical evidence and is

adopted.” The ALJ determined:

The May 2, 2015, compensable injury does not extend to and include a right shoulder full thickness tear of the distal supraspinatus tendon. Claimant reached maximum medical improvement on June 22, 2016. Claimant’s impairment rating is 1%. Claimant had disability beginning on July 25, 2016, and continuing through September 2, 2016, but not from September 2, 2016, continuing through September 27, 2017, the date of the contested case hearing.

4 After Childress appealed, a Division Appeals Panel issued a notice stating that the

ALJ’s decision was final, the effect of which was the ALJ’s Decision and Order became “the

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Alvy Childress v. Texas Mutual Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/alvy-childress-v-texas-mutual-insurance-company-texapp-2020.