War Stories: When “Degenerative, Not Acute” Isn’t a Defense
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War Stories: When “Degenerative, Not Acute” Isn’t a Defense
Insurance carriers love one word more than almost any other: degenerative.
It’s the label they reach for when imaging shows something they don’t want to pay for. They call it pre‑existing. Call it age‑related. Call it incidental. The goal is always the same—turn a real injury into a non‑injury.
This case was no different.
The carrier argued that the injured worker suffered nothing more than a lumbar strain. The MRI, they claimed, showed a Schmorl’s node—something they insisted was degenerative, longstanding, and unrelated to the work accident.
The problem for the carrier was simple.
The evidence didn’t support that story.
Luckily, our Texas workers’ comp attorneys were on the case to save the day.
The Injury the Carrier Tried to Minimize
Our client worked in the field where she delivered tools to other workers. She went to her truck to get a tool and as she was climbing over the tailgate of her truck, a co-worker yelled at her to get her attention. She twisted her upper body to look back at that co-worker while her feet remained stationary and felt a pop in her low back with sharp pain.
The claimant was injured in a work‑related accident that produced immediate and persistent low‑back pain. Conservative treatment failed. Imaging was ordered.
The MRI revealed a Schmorl’s node at the lumbar spine. A Schmorl’s node is a structural injury to the spine where the soft inner material of an intervertebral disc (the nucleus pulposus) is forced upward or downward through the vertebral endplate and into the adjacent vertebral body.
In plain terms, it’s a disc herniation into the bone, not outward toward the spinal canal like a typical disc bulge.
Predictably, the carrier seized on the finding and reframed the case:
- The Schmorl’s node was “degenerative,” not acute
- It pre‑dated the accident
- The claimant’s symptoms were merely a soft‑tissue strain
- Any ongoing complaints were unrelated to work
This is a familiar playbook. Schmorl’s nodes are often asymptomatic, and carriers routinely argue that their presence alone proves a pre‑existing condition.
But presence isn’t causation—and that distinction mattered here.
Why This Wasn’t a Credibility Case
One of the most important aspects of this decision is what it wasn’t about.
This was not a credibility dispute. The insurance company had already accepted liability for a minor strain injury to the low back from the work event. The judge did not have to question whether the claimant was truthful. Instead, the case turned entirely on medical probative value.
That distinction is critical.
When a case hinges on medical evidence, the quality of the opinions—not the quantity—controls the outcome.
The Designated Doctor Got It Right
The designated doctor conducted a thorough evaluation and addressed the central question head‑on:
Was the Schmorl’s node acute and caused by the work accident, or was it a pre‑existing degenerative finding?
One of the most significant pieces of evidence that supported the designated doctor’s findings was the notation on the MRI that there was edema adjacent to the Schmorl’s node. Edema is inflammation, and it is usually seen in the presence of a new injury, not an old one. If you have ever sprained your ankle and had it swell up on you, then you know what edema is. It doesn’t fit the narrative that something is degenerative, not acute.
The designated doctor explained why the imaging, clinical presentation, and timing supported an acute traumatic Schmorl’s node, not a longstanding degenerative condition. The opinion was reasoned, specific, and tied directly to the facts of the injury.
That mattered.
Under Texas workers’ compensation law, a designated doctor’s opinion carries presumptive weight when it is supported by sound medical reasoning. This one was.
The Carrier’s RME Fell Apart
By contrast, the carrier’s required medical examination offered little more than conclusions.
The RME doctor labeled the Schmorl’s node degenerative, not acute, but failed to explain why. There was no meaningful discussion of mechanism of injury, no analysis of symptom onset, and no engagement with the imaging findings beyond the label itself.
That omission proved fatal.
The judge explicitly rejected the RME opinion as conclusory, noting that unsupported conclusions do not constitute probative medical evidence.
In other words, calling something “degenerative” doesn’t make it so.
Why Insurance Companies Call Them “Degenerative”
Carriers often argue Schmorl’s nodes are degenerative, not acute because:
- Many are asymptomatic
- They can exist without prior complaints
- They appear “old” on imaging if not carefully analyzed
But that argument collapses when:
- Symptoms begin immediately after trauma
- The mechanism involves rotation and load
- Treating or designated doctors explain the biomechanics
- The opinion is supported by imaging and clinical findings
Labeling something “degenerative” is not a medical explanation—it’s a conclusion. Courts require reasoning.
How Rotational Force Causes a Schmorl’s Node
Rotational injuries are particularly dangerous to the spine because they create shear forces—forces that twist one part of the spine while another part remains fixed.
In a rotational injury:
- One portion of the body rotates
- Another portion remains stationary
- The disc is compressed and twisted simultaneously
This combination produces vertical pressure plus torsion, which can:
- Crack or weaken the vertebral endplate
- Force disc material through the endplate
- Create an acute Schmorl’s node
This is especially likely when rotation occurs under load—such as stepping into a truck, lifting, twisting, or pivoting while bearing weight.
Why Rotational Schmorl’s Nodes Are Often Symptomatic
Unlike degenerative nodes, traumatic Schmorl’s nodes:
- Involve bone marrow edema
- Trigger an inflammatory response
- Can cause persistent axial back pain
- Often worsen with movement or loading
That’s why injured workers frequently report immediate pain that does not resolve with conservative care.
The Judge’s Analysis—and the Win
The judge adopted the designated doctor’s opinion and found that the Schmorl’s node was part of the compensable injury.
The decision emphasized:
- The designated doctor’s explanation was medically sound
- The RME opinion lacked analysis and support – it was simply conclusory
- The dispute was resolved on probative weight, not credibility
The carrier’s attempt to minimize the injury failed because it relied on labels instead of evidence.
Why This Case Matters
This case is a reminder of several critical principles:
- Schmorl’s nodes are not automatically degenerative
- Acute traumatic Schmorl’s nodes are real and compensable
- Medical opinions must explain why, not just what
- Conclusory RMEs do not defeat well‑reasoned designated doctor opinions
Most importantly, it shows how extent‑of‑injury disputes are actually won—not with rhetoric, but with disciplined medical‑legal analysis. This is why a causation letter is so important in extent of injury cases.
The Takeaway
Insurance carriers will always try to reframe injuries as pre‑existing conditions. But when the evidence is developed correctly, and when medical opinions are held to the standard the law requires, those defenses collapse.
This case wasn’t about sympathy. It wasn’t about credibility.
It was about evidence—and evidence won.
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