Texas Board of Chiropractic Examiners Patricia Gilbert, in Her Official Capacity as the Board's Executive Director And Texas Chiropractic Association v. Texas Medical Association, 566 S.W.3d 776

Background

Texas law exempts chiropractors from the Medical Practice Act and limits chiropractic practice to analyzing/evaluating the biomechanical condition of the spine and musculoskeletal system and performing nonsurgical procedures to improve subluxation or biomechanics.
The Texas Board of Chiropractic Examiners adopted a Scope of Practice rule (22 Tex. Admin. Code § 78.13) defining terms and listing permissible procedures; contested provisions included definitions invoking “nerves”/“neuromusculoskeletal,” a provision allowing chiropractors with additional training to perform Technological Instrumented Vestibular-Ocular-Nystagmus Testing (VONT), and language permitting chiropractors to render an “analysis, diagnosis, or other opinion.”
The Texas Medical Association (TMA) sued, arguing those provisions exceeded the statutory chiropractic scope. Prior appeals produced mixed rulings: the court previously upheld limited uses of “diagnosis” in the rule but other challenges continued.
At trial, the court found (1) the rule’s references to “nerves”/“neuro” expanded chiropractic practice beyond the statutory musculoskeletal scope, (2) VONT is a diagnostic neurological test outside chiropractic scope, and (3) the Rule’s use of “diagnosis” exceeded statutory authority.
On appeal, the court affirmed the trial court’s invalidation of the nerves/neuro definitions and the VONT provision, but reversed with respect to the Rule’s use of the word “diagnosis,” relying on the Legislature’s later statutory amendment and controlling precedent.

Issues

Issue	Plaintiff's Argument (TMA)	Defendant's Argument (Board/Association)	Held
Whether including “nerves” or "neuromusculoskeletal" in definitions expands chiropractic scope	Inclusion improperly extends chiropractic to nervous system matters beyond biomechanical spine/musculoskeletal scope	Nerves are integral to subluxation and chiropractic treatment; definitions reflect that functional relationship	Court: Definitions exceeded statutory scope; affirmed invalidation
Whether VONT may be performed by credentialed chiropractors	VONT is a diagnostic neurological test (brain/ear/eye) outside chiropractic scope	VONT can be a useful tool in chiropractic evaluation of biomechanics and balance	Court: VONT exceeds chiropractic scope; affirmed invalidation
Whether Rule’s use of the word “diagnosis” in permitting “analysis, diagnosis, or other opinion” is impermissible	(TMA) Term allows chiropractors to diagnose conditions beyond biomechanical scope	(Board) “Diagnosis” permitted as part of evaluating/treating subluxation and biomechanics	Court: Reversed trial court — “diagnosis” is within statutory scope as amended and under precedent; use of term is valid
Whether prior litigation/jurisdictional defenses bar relitigation of the “diagnosis” issue	Board: Subject-matter/jurisdictional bar/collateral estoppel prevents relitigation	TMA: Collateral estoppel is an affirmative defense, trial court had jurisdiction to hear claims	Court: Did not need to resolve preclusion; proceeded on merits and treated issue in light of statute and precedent

Key Cases Cited

Texas Bd. of Chiropractic Exam’rs v. Texas Med. Ass’n, 375 S.W.3d 464 (Tex. App.—Austin 2012) (analyzing whether chiropractors may render diagnoses limited to biomechanical condition of spine and musculoskeletal system)
Texas State Bd. of Exam’rs of Marriage & Family Therapists v. Texas Med. Ass’n, 511 S.W.3d 28 (Tex. 2017) (agency rule allowing diagnostic assessments consistent with statutory authority to evaluate/remediate)
City of Keller v. Wilson, 168 S.W.3d 802 (Tex. 2005) (standards for legal and factual sufficiency review of findings)
All Am. Life Ins. Co. v. Rylander, 73 S.W.3d 299 (Tex. App.—Austin 2001) (court reviews conclusions of law de novo; statutory construction principles)