ARTICLE
Article: Understanding MRI Findings in Personal Injury Cases A Practical Guide for Chiropractors Treating Texas PI Patients, Part 2 Note: Article provided by TCA Platinum Partner J.D. Silva & Associates Texas law generally recognizes that a preexisting MRI abnormality does not prevent recovery when the occurrence (e.g., motor vehicle collision) aggravates that condition or causes a previously asymptomatic condition to become symptomatic. In other words, a preexisting MRI abnormality does not automatically defeat causation. The central question is whether the condition caused symptoms or limitations before the occurrence and, if so, whether the occurrence produced a new injury or a measurable aggravation. Imaging is important, but the patient's history, examination findings, symptom onset, functional change, and a medically reliable causation opinion often determine how the evidence fits together. When the MRI finding existed but was asymptomatic before the occurrence. This is potentially a very strong plaintiff argument. Texas Pattern Jury Charge?28.8C?addresses an asymptomatic pre-existing condition—the "eggshell plaintiff" situation. It provides that if the pre-existing condition was not causing symptoms before the occurrence but made the plaintiff more susceptible to injury, the defendant can be responsible for damages resulting from the combination of the pre-existing condition and the occurrence.? In plain English: The defendant takes the plaintiff as they find him/her. Example: Before Motor Vehicle Collision: MRI shows C5-6 disc degeneration/bulge, but patient has no neck pain, no treatment, and no functional limitation. After Motor Vehicle Collision: Patient develops immediate neck pain and radicular symptoms. MRI looks substantially similar to the MRI before the motor vehicle collision. That does?not?necessarily mean the crash caused no compensable injury. Texas courts have specifically dealt with this MRI situation. Both Hospadales v. McCoy, 513 S.W.3d 724 (Tex. App. 2017) and Amigos Meat Distributors, L.P. v. Guzman, 526 S.W.3d 511 (Tex. App. 2017) directly address the scenario in which the defense argues that unchanged MRI findings disprove causation. In Hospadales, the defendant argued that MRIs taken after the 2013 accident showed essentially the same injuries as MRIs taken after a 2010 accident, thereby negating causation. The plaintiff's expert, Dr. Rodriguez, acknowledged the near-identical imaging findings but explained that "we don't treat MRIs"—that MRIs "are done to help us rule out problems or be assertive of diagnosis, but we always treat the patient." The court held this testimony was legally sufficient and reliable, rejecting the proposition that identical imaging forecloses a causation finding In Amigos Meat Distributors, the treating surgeon similarly acknowledged that MRI imaging could not reveal when or how the plaintiff's disc degeneration had occurred. The court emphasized that the defense's focus on the MRI's inability to date the damage was unavailing because the surgeon's causation opinion was "largely informed" by the patient's medical history rather than solely by imaging. The court held that legally sufficient causation evidence existed linking the 2011 workplace injury to the plaintiff's 2014 surgery. If the patient already had symptoms before the crash. Texas Pattern Jury Charge 28.8B addresses a preexisting injury or condition that was already causing symptoms at the time of the occurrence. The plaintiff may recover for the additional aggravation caused by the occurrence, but not for symptoms or damages attributable solely to the preexisting condition. So: Before Occurrence AfterOccurrence Primary Causation Issue MRI abnormality,?no symptoms Pain begins after crash Potential?eggshell/aggravation claim MRI abnormality +?existing pain Pain substantially worsens Recoverable?aggravation/increase MRI abnormality + existing symptoms No meaningful change Difficult to attribute additional damages to crash No prior MRI, symptoms begin after crash MRI shows degeneration Causation still possible; MRI alone doesn'testablish age of finding The key for the chiropractor. Avoid stating that the collision created a disc herniation when the imaging cannot establish when the structural finding developed. Instead, address the medical question that the records and examination can support: Did the occurrence, to a reasonable degree of medical probability, aggravate a preexisting condition, cause it to become symptomatic, or materially worsen the patient's symptoms and functional limitations? The opinion should explain why. A bare conclusion is less useful than an opinion tied to the patient's reliable history, the timing and nature of symptoms, objective examination findings, imaging correlation, course of care, functional change, and plausible alternative causes. What to document in the chart. Before the Occurrence Was the patient completely asymptomatic? Any prior neck/back pain? Any prior treatment? Any prior restrictions? Any prior MRI? Any prior diagnosis? Immediately After the Occurrence When did symptoms begin? What body parts became symptomatic? Were the symptoms different from anything experienced before? What activities became difficult? Clinical Examination ROM restrictions Spasm/tenderness Neurological findings Radicular complaints Orthopedic findings Functional limitations Imaging Correlation What does the MRI actually show? Is there a prior MRI for comparison? Is the anatomical level consistent with the patient's symptoms? Clinical Opinion If medically supportable, the provider should clearly state whether,?to a reasonable degree of medical probability, the collision aggravated the pre-existing condition and caused or contributed to the patient's current symptoms. That last part is important because Texas courts require legally sufficient evidence of causation, and expert medical testimony can be critical where the causal relationship is medically complex.? Bottom Line A pre-existing MRI finding is not the same thing as a pre-existing symptomatic injury. A patient can have a degenerative disc, disc bulge, or even herniation visible on an MRI for years without experiencing symptoms. If an occurrence causes that previously asymptomatic condition to become symptomatic or materially worsens it, Texas law can permit recovery for the resulting injury and damages. And?the fact that the post-accident MRI looks similar to the pre-accident MRI does not, by itself, defeat causation. Texas appellate courts have specifically recognized that principle.? Questions? Contact me at Dr.Lawson@jdsilvalaw.com
Article: Understanding MRI Findings in Personal Injury Cases
A Practical Guide for Chiropractors Treating Texas PI Patients, Part 2
Note: Article provided by TCA Platinum Partner J.D. Silva & Associates
Texas law generally recognizes that a preexisting MRI abnormality does not prevent recovery when the occurrence (e.g., motor vehicle collision) aggravates that condition or causes a previously asymptomatic condition to become symptomatic. In other words, a preexisting MRI abnormality does not automatically defeat causation. The central question is whether the condition caused symptoms or limitations before the occurrence and, if so, whether the occurrence produced a new injury or a measurable aggravation. Imaging is important, but the patient's history, examination findings, symptom onset, functional change, and a medically reliable causation opinion often determine how the evidence fits together.
When the MRI finding existed but was asymptomatic before the occurrence.
This is potentially a very strong plaintiff argument. Texas Pattern Jury Charge?28.8C?addresses an asymptomatic pre-existing condition—the "eggshell plaintiff" situation. It provides that if the pre-existing condition was not causing symptoms before the occurrence but made the plaintiff more susceptible to injury, the defendant can be responsible for damages resulting from the combination of the pre-existing condition and the occurrence.?
In plain English: The defendant takes the plaintiff as they find him/her.
Example:
Before Motor Vehicle Collision: MRI shows C5-6 disc degeneration/bulge, but patient has no neck pain, no treatment, and no functional limitation.
After Motor Vehicle Collision: Patient develops immediate neck pain and radicular symptoms. MRI looks substantially similar to the MRI before the motor vehicle collision.
That does?not?necessarily mean the crash caused no compensable injury.
Texas courts have specifically dealt with this MRI situation.
Both Hospadales v. McCoy, 513 S.W.3d 724 (Tex. App. 2017) and Amigos Meat Distributors, L.P. v. Guzman, 526 S.W.3d 511 (Tex. App. 2017) directly address the scenario in which the defense argues that unchanged MRI findings disprove causation.
In Hospadales, the defendant argued that MRIs taken after the 2013 accident showed essentially the same injuries as MRIs taken after a 2010 accident, thereby negating causation. The plaintiff's expert, Dr. Rodriguez, acknowledged the near-identical imaging findings but explained that "we don't treat MRIs"—that MRIs "are done to help us rule out problems or be assertive of diagnosis, but we always treat the patient." The court held this testimony was legally sufficient and reliable, rejecting the proposition that identical imaging forecloses a causation finding
In Amigos Meat Distributors, the treating surgeon similarly acknowledged that MRI imaging could not reveal when or how the plaintiff's disc degeneration had occurred. The court emphasized that the defense's focus on the MRI's inability to date the damage was unavailing because the surgeon's causation opinion was "largely informed" by the patient's medical history rather than solely by imaging. The court held that legally sufficient causation evidence existed linking the 2011 workplace injury to the plaintiff's 2014 surgery.
If the patient already had symptoms before the crash.
Texas Pattern Jury Charge 28.8B addresses a preexisting injury or condition that was already causing symptoms at the time of the occurrence. The plaintiff may recover for the additional aggravation caused by the occurrence, but not for symptoms or damages attributable solely to the preexisting condition.
So:
Before Occurrence
AfterOccurrence
Primary Causation Issue
MRI abnormality,?no symptoms
Pain begins after crash
Potential?eggshell/aggravation claim
MRI abnormality +?existing pain
Pain substantially worsens
Recoverable?aggravation/increase
MRI abnormality + existing symptoms
No meaningful change
Difficult to attribute additional damages to crash
No prior MRI, symptoms begin after crash
MRI shows degeneration
Causation still possible; MRI alone doesn'testablish age of finding
The key for the chiropractor.
Avoid stating that the collision created a disc herniation when the imaging cannot establish when the structural finding developed.
Instead, address the medical question that the records and examination can support: Did the occurrence, to a reasonable degree of medical probability, aggravate a preexisting condition, cause it to become symptomatic, or materially worsen the patient's symptoms and functional limitations?
The opinion should explain why. A bare conclusion is less useful than an opinion tied to the patient's reliable history, the timing and nature of symptoms, objective examination findings, imaging correlation, course of care, functional change, and plausible alternative causes.
What to document in the chart.
Before the Occurrence
Was the patient completely asymptomatic?
Any prior neck/back pain?
Any prior treatment?
Any prior restrictions?
Any prior MRI?
Any prior diagnosis?
Immediately After the Occurrence
When did symptoms begin?
What body parts became symptomatic?
Were the symptoms different from anything experienced before?
What activities became difficult?
Clinical Examination
ROM restrictions
Spasm/tenderness
Neurological findings
Radicular complaints
Orthopedic findings
Functional limitations
Imaging Correlation
What does the MRI actually show?
Is there a prior MRI for comparison?
Is the anatomical level consistent with the patient's symptoms?
Clinical Opinion
If medically supportable, the provider should clearly state whether,?to a reasonable degree of medical probability, the collision aggravated the pre-existing condition and caused or contributed to the patient's current symptoms.
That last part is important because Texas courts require legally sufficient evidence of causation, and expert medical testimony can be critical where the causal relationship is medically complex.?
Bottom Line
A pre-existing MRI finding is not the same thing as a pre-existing symptomatic injury.
A patient can have a degenerative disc, disc bulge, or even herniation visible on an MRI for years without experiencing symptoms. If an occurrence causes that previously asymptomatic condition to become symptomatic or materially worsens it, Texas law can permit recovery for the resulting injury and damages.
And?the fact that the post-accident MRI looks similar to the pre-accident MRI does not, by itself, defeat causation. Texas appellate courts have specifically recognized that principle.?
Questions? Contact me at Dr.Lawson@jdsilvalaw.com