NO. COA14-335

NORTH CAROLINA COURT OF APPEALS

Filed: 2 December 2014

MAYFORD WYATT,

 Plaintiff,

v. From North Carolina Industrial 

Commission

I.C. No. W06970

HALDEX HYDRAULICS, Employer,

and SENTRY INSURANCE, Carrier, 

Defendants.

Appeal by Defendants from opinion and award entered 10 

January 2014 by the North Carolina Industrial Commission. Heard 

in the Court of Appeals 10 September 2014.

Pressly, Thomas & Conley, PA, by Edwin A. Pressly, for 

Plaintiff.

Hill Evans Jordan & Beatty, PLLC, by Richard T. Granowsky,

for Defendants.

STEPHENS, Judge.

Employer Haldex Hydraulics and its insurer Sentry Insurance 

(collectively, “Defendants”) appeal from an opinion and award of 

the full North Carolina Industrial Commission (“the Commission”) 

filed 10 January 2014. The Commission’s opinion and award 

affirmed an opinion and award by Deputy Commissioner Keischa M. 

Lovelace, filed 13 May 2013, which had determined that Plaintiff 
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Mayford Wyatt sustained compensable injuries to his brain and 

spine as a result of a workplace lifting accident on 31 October 

2008. We affirm.

Background

The evidence before the Commission tended to show that 

Plaintiff began working at Defendant’s Statesville plant in 

1988, where he was employed as a CNC Setup Operator and was 

cross-trained on the operation of several different machines 

used by Defendant to produce hydraulic gear pumps and 

transmissions for companies such as John Deere and Caterpiller.

On 31 October 2008, Plaintiff and a co-worker were 

conducting inventory, counting aluminum parts stored in metal

tubs on metal shelves. To remove the tubs, Plaintiff first slid 

them off the shelves, which were coated with an oil film from 

the gear manufacturing process, then his co-worker grabbed the 

front handle while Plaintiff twisted his body to the left and 

reached into the shelf with his right arm to grab the other 

handle. The two men then placed the tubs on the floor, counted 

and labeled and replaced the parts, and returned the tubs to the 

shelves. Plaintiff was injured when he attempted to remove a 

mislabeled tub that contained parts made of a material much 

heavier than aluminum: instead of an expected weight of 60 to 70 
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pounds, the tub weighed approximately 280 pounds. As his coworker grabbed the front handle, Plaintiff balanced on one knee 

holding the back handle, then twisted and turned with the tub 

and fell to the floor with it. Plaintiff was taken to the

Iredell Memorial Hospital emergency room twice that day due to 

pain in his lower back. As a result of his injuries, Plaintiff 

was out of work from 31 October 2008 through 11 December 2008. 

Defendants accepted the compensability of Plaintiff’s low back 

condition pursuant to a Form 60.

On 9 December 2008, Plaintiff’s primary care physician, Dr. 

Daniel Bellingham, assessed Plaintiff with right L3-4 nerve root 

impingement and referred him to a spine surgeon for 

consultation. Shortly thereafter, Plaintiff was permitted to 

return to work with light duty restrictions of no lifting over 

25 pounds, limited bending and twisting, and no stooping or 

squatting. Plaintiff received ongoing treatment at 

OrthoCarolina, and eventually orthopedic surgeon Dr. Theodore 

Belanger diagnosed Plaintiff’s low back condition as lumbar 

stenosis with persistent back and right leg pain, numbness, and 

weakness, which did not require surgical intervention. In 

December 2009, Plaintiff submitted a Form 25R Evaluation for 

Permanent Impairment. On 25 January 2010, the Industrial 
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Commission approved a Form 26A, Employer’s Admission of 

Employee’s Right to Permanent Partial Disability Compensation, 

awarding Plaintiff $12,932.32 for a permanent partial impairment

rating of 7.5% as a result of his low back injury.

Throughout the treatment of his low back condition in 2009 

and 2010, Plaintiff also complained of seemingly unrelated 

symptoms that began almost immediately after his 31 October 2008 

accident, including dizziness, loss of balance, nausea, stuffy 

ears, sinus pressure, fatigue, insomnia, severe headaches, and 

episodic numbness in his face, tongue, torso, and limbs. During 

the two months he was unable to work in late 2008, Plaintiff’s 

family noticed that he remained in bed and slept most of the 

time, experienced difficulty walking and balancing, could not 

keep his car on the road as he was unable to apply steady 

pressure to the gas pedal, frequently dozed off mid-sentence 

during conversations, and had difficulty understanding, 

prompting his relatives to explain things to him in an 

“elementary way.” Previously an active church member who 

regularly attended services on Wednesday and twice on Sunday, 

Plaintiff did not attend church for almost two months. When he 

returned in December 2008, church members noticed an observable 

decline in his health. Plaintiff had trouble maintaining his 
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balance, dragged his foot when walking, had difficulty hearing, 

and fell into a deep sleep during services and conversations. 

Upon his return to work, Plaintiff’s co-workers observed a 

noticeable decline in his physical abilities: Plaintiff 

regularly slept at his work station, walked slowly, and appeared 

to drag one of his legs while walking. Other machine operators 

had to be assigned to perform Plaintiff’s lifting tasks, and his 

team leader noticed he had trouble understanding directions and 

suffered from balance issues.

Plaintiff’s doctors offered multiple diagnoses, including 

sinusitis and sleep apnea, but his symptoms persisted, and in 

March 2010 he was referred for a neurological consult after an 

MRI of his brain showed a herniated cerebellar tonsil consistent 

with a Chiari malformation. A Chiari malformation is a condition

at the junction of the neck and skull that causes compression of 

the part of the central nervous system where the spine joins the 

brain. There are two types of Chiari malformation: congenital 

Chiari malformations occur from a person’s congenital cranium 

formation, whereas acquired Chiari malformations can develop 

through intracranial hypotension, which is a cerebrospinal fluid 

(“CSF”) balance issue between the brain and the spine that can 

be caused by lifting injuries resulting in cerebrospinal fluid
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leaks. Chiari malformations can result in a condition known as 

“brain sag.” Typically, the brain is supported within the skull 

and spinal column by cerebral spinal fluid, but when spinal 

fluid is at a lower pressure underneath the brain, the brain 

tends to sag down towards the base of the skull. Classic 

symptoms of a Chiari malformation include severe headache 

associated with coughing, problems with balance, dizziness, 

difficulty walking, and cranial nerve dysfunction which can 

cause facial symptoms, tongue numbness, and balance and 

swallowing difficulties. However, symptoms indicative of Chiari 

malformations are also suggestive of other medical conditions 

unrelated to the brain, cervical spine compression, and other 

neurological abnormalities, and it is not uncommon for a person 

to exhibit symptoms of a Chiari malformation over an extended 

period of time before diagnosis.

On 18 March 2010, Plaintiff sought treatment with Dr. John 

Wilson, a board-certified expert in neurological surgery. While 

certain aspects of Dr. Wilson’s examination were indicative of 

Chiari malformation, other aspects suggested a problem further 

down Plaintiff’s cervical spine. A subsequent cervical MRI 

showed significant stenosis with cord signal changes, so Dr. 

Wilson performed an anterior cervical discectomy, decompression, 
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and fusion on 16 April 2010. At his follow-up appointment on 20 

May 2010, Plaintiff reported complete resolution of his 

symptoms, which surprised Dr. Wilson, who had anticipated 

needing to perform a Chiari decompression to alleviate 

Plaintiff’s symptoms. However, on 26 August 2010, Plaintiff 

returned to Dr. Wilson with complaints of dizziness, difficulty 

balancing, facial numbness, bowel control issues, and “things 

not tasting good.” On 12 October 2010, Plaintiff complained of 

the same symptoms, as well as hearing problems, decreased 

sensation on his right side, and double vision. On 1 November 

2010, Dr. Wilson performed two surgical procedures on Plaintiff: 

a Chiari decompression and a C3 laminectomy with C2-C5 fusion. 

At a follow-up appointment on 16 December 2010, Plaintiff 

reported some improvement in his dizziness but complained of

persistent balance difficulties, as well as hand-to-eye 

coordination issues, hearing “echoes,” and falling asleep while 

driving.

On 4 February 2011, Plaintiff was taken to the Iredell 

Memorial Hospital emergency room suffering from quadriparesis 

and then immediately transferred to Wake Forest Baptist Hospital 

for assessment of a neurological emergency. Dr. Thomas Sweasey, 

a board-certified expert in neurosurgery and neurocritical care, 
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was the neurosurgeon on call and determined after reviewing an 

MRI that Plaintiff needed surgery to treat cervical spondylosis, 

severe canal stenosis, and significant spinal cord impingement 

with evidence of cord signal change. Dr. Sweasey performed a 

posterior cervical decompression and fusion. Although Plaintiff 

recovered from his quadriparesis, his MRIs indicated he suffered 

from “brain sag,” and Dr. Sweasey subsequently assumed 

responsibility for Plaintiff’s care as his treating physician. 

Between 15 March 2011 and 27 October 2011, Plaintiff was 

hospitalized four times complaining of extreme somnolence, 

frontal headaches, trouble balancing and walking, dizziness, 

hearing loss, slurred speech, memory and comprehension issues, 

and bladder control problems. At Dr. Sweasey’s direction, 

Plaintiff underwent an array of different diagnostic tests and 

assessments——including lumbar punctures, a ventricular 

peritoneal shunt, and two cranioplasty procedures on the back 

part of his skull——to determine the cause of his “brain sag” and 

the best options for treatment. Dr. Sweasey consulted with 

several specialists, including Dr. Thomas Ellis, co-director of 

the Deep Brain Stimulation Program at Wake Forest, who noted 

that, although Plaintiff’s “presentation is somewhat difficult 

to truly classify as one diagnosis,” his symptoms were “most 
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convincing for communicating hydrocephalus as he has significant 

brain sag.” However, after extensive interviews with Plaintiff 

and his family regarding his medical history and the onset and 

progression of his symptoms, Dr. Sweasey eventually diagnosed 

Plaintiff with cervical cord compression and an acquired Chiari 

malformation caused by intracranial hypotension. 

Plaintiff continued to work for Haldex Hydraulics between 

11 December 2008 and 15 April 2010. On 11 February 2010, 

Plaintiff suffered a fall while working. He received treatment 

at an urgent care office for his back and hip, but did not miss 

any work due to the fall. On 13 April 2010, Plaintiff gave 

written notice to Defendant that he wished to enter a severance 

agreement to begin following his short-term disability leave, 

which ran from 23 April 2010 through the week ending 29 May 

2010. On 4 June 2010, Plaintiff signed a severance agreement, 

release, and waiver, indicating that his employment with 

Defendant terminated 28 May 2010. 

Procedural History

On or about 1 July 2010, Plaintiff filed a Form 18 Notice 

of Accident to Employer and Claim of Employee, Representative, 

or Dependent with the Commission, alleging injuries to his back, 

neck, and leg sustained from his 31 October 2008 accident. 
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Plaintiff subsequently filed a Notice of Change of Condition on 

28 June 2011. On 14 February 2012, Plaintiff’s wife filed a Form 

42 Application for Appointment of Guardian Ad Litem, which the 

Commission ultimately approved, because of Plaintiff’s 

difficulties with his hearing, reasoning, and memory. She also 

averred that she felt it was unsafe to leave Plaintiff alone. On 

5 March 2012, Plaintiff filed a Form 33 Request for Hearing and 

on 26 March 2012, Plaintiff filed an Amended Form 33 stating 

that his injuries were to his back, neck, and brain. Defendants

responded and denied compensability for Plaintiff’s cervical and 

cognitive problems. Deputy Commissioner Lovelace heard the 

matter on 10 August 2012 and issued an opinion and award 

concluding that Plaintiff’s intracranial hypotension, Chiari 

malformation, and cervical spine conditions were causally 

connected to his 31 October 2008 work-related injury; that 

Plaintiff was disabled from working; and that he was entitled to

indemnity and medical compensation. Defendants timely appealed 

the opinion and award to the full Commission on 16 May 2013.

The Full Commission heard the matter on 25 October 2013 and 

issued an opinion and award on 10 January 2014 affirming Deputy 

Commissioner Lovelace’s opinion and award with minor 

modifications, over a dissent without written opinion from 
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Chairman Andrew T. Heath. During the course of its hearing into 

the causation and compensability of Plaintiff’s brain and 

cervical spine injuries, the Commission reviewed depositions 

taken from Dr. Bellingham, Dr. Belanger, Dr. Wilson, and Dr. 

Sweasey. 

Dr. Bellingham, Plaintiff’s primary care physician, did not 

render an opinion regarding the causal relationship between 

Plaintiff’s cervical and brain conditions and the 31 October 

2008 workplace lifting accident, but testified that he did not 

expect Plaintiff’s condition to improve, stating “we can always 

hold out hope, but he hasn’t made a lot of change for quite some 

time.”

Dr. Belanger, an orthopedic surgeon who treated only 

Plaintiff’s low back condition, agreed with the Chiari 

malformation diagnosis but opined within a reasonable degree of 

medical certainty that it was a congenital, rather than 

acquired, condition and that he therefore did “not see how a 

single lifting injury of any sort could cause or contribute in 

any material way to []Chiari malformation, which is a congenital 

anomaly present since birth.” Dr. Belanger also opined to a 

reasonable degree of medical certainty that Plaintiff’s cervical 

spine condition was due to degenerative cervical spondylosis and 
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therefore not caused by any particular event or injury, 

including the 31 October 2008 accident, although he did 

acknowledge it was possible that an acute event could exacerbate 

or aggravate Plaintiff’s underlying condition. However, the 

Commission assigned little weight to Dr. Belanger’s expert 

opinion, given that Dr. Belanger did not treat Plaintiff for 

either his cervical spine or his brain condition, and further 

admitted that only 10 to 15 of the 2,000 to 3,000 patients he 

treats annually need treatment for symptomatic Chiari 

malformations, and he typically refers those patients to 

neurosurgeons. 

Dr. Wilson confined his expert opinion to the conditions 

for which he treated Plaintiff between March and December 2010. 

He testified that while certain aspects of his examination 

indicated a Chiari malformation, Plaintiff was not experiencing 

brain sag at the time of his treatment, and therefore Dr. Wilson 

would not give a causative opinion regarding Plaintiff’s brain 

sag, although he did note that it may have subsequently 

developed as a consequence of the Chiari decompression procedure 

he performed. Further, Dr. Wilson testified that it was 

plausible for a lifting injury to cause brain sag, although that 

was not something he considered in his evaluation of Plaintiff. 
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While Dr. Wilson would not give an opinion regarding an acquired 

Chiari malformation caused by intracranial hypotension, he 

explained that it could occur 

if a person during the course of some kind 

of injury or heavy lifting . . . developed a 

spontaneous CSF leak somewhere in their 

spinal column, and so the CSF is leaking and 

they develop spontaneous intracranial 

hypotension, the brain sags, the cerebellar 

tonsils descend, [and] that is 

hypothetically a possible way you can 

develop this kind of tonsillar descent.

Regarding Plaintiff’s cervical spine condition, Dr. Wilson 

opined that although a Chiari malformation can cause cervical 

cord compression, Plaintiff’s condition was not causally related 

to his 31 October 2008 workplace lifting accident, but was 

instead the result of degenerative cervical spondylosis, which 

Plaintiff’s lifting injury did not exacerbate.

Dr. Sweasey diagnosed Plaintiff with acquired Chiari 

malformation and opined to a reasonable degree of medical 

certainty that the most likely cause was intracranial 

hypotension, of which the most likely proximate cause was a 

spinal fluid leak secondary to Plaintiff’s 31 October workplace 

lifting injury. Dr. Sweasey’s opinion was based upon the 

significant amount of time he spent conducting tests and 

discussing Plaintiff’s case with other specialists, as well as 
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Plaintiff and his family. Dr. Sweasey further opined that 

Plaintiff’s temporary improvement following the procedures Dr. 

Wilson performed in April and November 2010 was indicative of 

intracranial hypotension, explaining that more likely than not, 

every time Plaintiff’s spine is manipulated during a surgical 

procedure, pressure is left on the thecal sac because there is 

some blood left behind, and Plaintiff’s condition improves 

dramatically as the blood helps support the brain. The 

improvement, however, is temporary as Plaintiff’s condition 

worsens as the blood is absorbed by the surrounding tissue. Dr. 

Sweasey also testified that the cause of Plaintiff’s Chiari 

malformation was unknown during Dr. Wilson’s treatment because, 

he explained, Plaintiff was in a very small group of people 

“where the mechanism they acquire, the [C]hiari malformation is 

decreased pressure which allows the brain to sag and the 

cerebellum to sag through the foramen magnum, which then causes 

them to be symptomatic.” Regarding Plaintiff’s cervical cord 

compression, Dr. Sweasey opined that more likely than not 

Plaintiff’s condition resulted from an aggravation of an 

underlying cervical condition sustained during his 31 October 

2008 workplace injury. As Dr. Sweasey explained, consistent with 

Plaintiff’s gradual onset of symptoms, a person may have spinal 
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cord compression and irritation without initially experiencing 

pain but then slowly develop a deficit over time. Dr. Sweasey 

further opined that, more likely than not, Plaintiff’s cervical 

spine issue is related to leakage of spinal fluid from a nerve 

root with the fluid absorbed by the surrounding tissue. Finally, 

Dr. Sweasey opined that, more likely than not, Plaintiff will 

not be able to maintain gainful employment on a permanent basis 

as a result of his injuries.

Ultimately, the Commission assigned the most weight to Dr. 

Sweasey’s expert opinion. As the Commission explained in its 

conclusions of law:

The greater weight of the medical evidence 

showed that symptomatic [C]hiari 

malformations, whether congenital or 

acquired, are rare conditions that are 

treated by neurosurgeons. Both neurosurgeons 

who treated Plaintiff diagnosed Plaintiff 

with a [C]hiari malformation. As stated in 

the findings of fact, the Full Commission 

assigned greater weight to the expert 

opinion of Dr. Sweasey than Dr. Wilson[,] as 

Dr. Wilson limited his expert opinion to his 

treatment time period and did not consider 

the effect of the extensive medical 

treatment, testing, and specialist 

consultations that occurred subsequent to 

Dr. Wilson’s treatment of Plaintiff. In 

contrast, Dr. Sweasey consulted numerous 

specialists, conducted a variety of 

diagnostic tests, interviewed Plaintiff and 

his family extensively[,] and reviewed 

Plaintiff’s voluminous medical records to 

determine Plaintiff’s diagnosis, treatment 
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modalities, and the cause of Plaintiff’s 

condition. Dr. Sweasey’s expert opinion is 

legally sufficient to establish a causal 

connection between Plaintiff’s intracranial 

hypotension and cervical spine condition to 

his work-related injury. 

Thus, based on a preponderance of the evidence of record, the 

Commission found as facts that, as a result of his 31 October 

2008 workplace lifting injury, “Plaintiff sustained an 

intracranial hypotension that caused an acquired [C]hiari 

malformation, or brain sag” and also that “Plaintiff sustained 

an exacerbation or aggravation of his underlying and preexisting cervical spondylosis resulting in cervical stenosis, 

cervical cord compression, and other causally related 

conditions.” 

The Commission also concluded that Plaintiff’s claim was 

timely filed and that Plaintiff had met his burden of proof to 

show he was incapable of earning pre-injury wages in either the 

same or any other employment and that the incapacity to earn 

pre-injury wages was caused by Plaintiff’s injury, given Dr. 

Sweasey’s testimony that more likely than not, Plaintiff will 

not be able to return to gainful employment in the future due to 

his acquired Chiari malformation caused by intracranial 

hypotension. Therefore, the Commission concluded that “Plaintiff 

is entitled to have Defendants pay for all related medical 
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expenses incurred or to be incurred that are necessary and 

reasonable treatment that would effect a cure, give relief or 

lessen Plaintiff’s period of disability” and further ordered 

that Defendants pay Plaintiff $663.35 per week in temporary 

total disability compensation, dating back to 1 November 2010 

and continuing until Plaintiff can return to work. Defendants 

gave timely notice of their intent to appeal the Commission’s 

opinion and award pursuant to N.C. Gen. Stat. § 97-86.

Standard of Review

This Court’s review of an opinion and award by the 

Commission is limited to two inquiries: (1) whether there is any 

competent evidence in the record to support the Commission's 

findings of fact; and (2) whether the Commission’s conclusions 

of law are justified by the findings of fact. See Deese v. 

Champion Int’l Corp., 352 N.C. 109, 116, 530 S.E.2d 549, 553 

(2000). The Commission's conclusions of law are reviewable de 

novo. See Whitfield v. Lab. Corp. of Am., 158 N.C. App. 341, 

348, 581 S.E.2d 778, 783 (2003) (citation omitted). As for the 

Commission’s findings of fact, if supported by competent 

evidence, they are conclusive even if the evidence might also 

support contrary findings. Jones v. Candler Mobile Village, 118 

N.C. App. 719, 721, 457 S.E.2d 315, 317 (1995) (citation 
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omitted). Indeed, the Commission is “the sole judge of the 

credibility of the witnesses and the weight to be given their 

testimony.” Adams v. AVX Corp., 349 N.C. 676, 680, 509 S.E.2d 

411, 413 (1998) (citation omitted). On appeal, this Court “does 

not have the right to weigh the evidence and decide the issue on 

the basis of its weight” because our duty “goes no further than 

to determine whether the record contains any evidence tending to 

support the finding.” Anderson v. Lincoln Constr. Co., 265 N.C. 

431, 434, 144 S.E.2d 272, 274 (1965) (citation omitted).

Causation of Plaintiff’s Brain Condition

Defendants first argue that the Commission erred in 

concluding Dr. Sweasey’s expert medical testimony was legally 

sufficient to establish a causal connection between Plaintiff’s 

brain condition and his work-related lifting accident on 31 

October 2008. Specifically, Defendants contend that Dr. 

Sweasey’s opinion does not constitute competent evidence to 

support the Commission’s causation determination because Dr. 

Sweasey could not definitively confirm the existence of the 

cerebrospinal fluid leak that he testified caused Plaintiff’s 

intracranial hypotension which in turn resulted in Plaintiff’s 

brain sag. Thus, Defendants claim Dr. Sweasey’s opinion was 

based merely upon speculation and conjecture, which, based on
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our Supreme Court’s decision in Young v. Hickory Bus. Furniture, 

353 N.C. 227, 538 S.E.2d 912 (2000), Defendants insist is “not 

sufficiently reliable to qualify as competent evidence on issues 

of medical causation.” Id. at 230, 538 S.E.2d at 915. Therefore, 

Defendants argue that the Commission erred in concluding 

Plaintiff’s brain condition was caused by his work accident and 

compensable under the Workers’ Compensation Act. We disagree.

In Young, our Supreme Court reversed this Court’s opinion 

affirming an award of the Commission due to a complete lack of 

competent evidence to support the Commission’s findings of fact—

—that the plaintiff’s fibromyalgia was caused by a work-related 

accident——because the medical causation testimony the Commission

relied upon was based entirely on one expert’s speculation and 

conjecture. Id. at 231, 538 S.E.2d at 915. A careful review of 

that expert’s testimony revealed that he considered fibromyalgia 

to be “an illness or condition of unknown etiology” and that he 

“frequently could not ascribe a cause for fibromyalgia in his 

patients.” Id. Moreover, the expert admitted there were at least 

three alternative potential causes for the plaintiff’s condition 

but that he had performed no tests to rule them out, although he 

did acknowledge that additional tests “need[ed] to have been 

done.” Id. Instead, his diagnosis relied entirely upon the post 
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hoc ergo propter hoc fallacy, given his testimony that, “I think 

that she does have fibromyalgia and I relate it to the accident 

primarily because, as I noted, it was not there before and she 

developed it afterwards. And that’s the only piece of 

information that relates the two.” Id. at 232, 538 S.E.2d at 

916. The Court ultimately concluded that because the expert’s 

testimony “demonstrate[ed] his inability to express an opinion 

to any degree of medical certainty” as to causation and was 

based “solely on supposition and conjecture,” it was incompetent 

and insufficient to support the Commission’s findings of fact. 

Id. at 233, 538 S.E.2d at 917.

In the present case, Defendants contend Dr. Sweasey’s 

testimony reveals that his medical causation opinion is founded

solely on speculation and conjecture, and is thus analogous to 

the expert opinion rejected as incompetent in Young. 

Specifically, Defendants point to Dr. Sweasey’s testimony that 

“we don’t have any documentation of [a cerebrospinal fluid 

leak]” when he was asked how he reached his opinion that 

Plaintiff’s condition was caused by intracranial hypotension 

resulting from the workplace accident. Additionally, Defendants 

emphasize that Dr. Sweasey acknowledged there are multiple 

mechanisms by which a person can acquire intracranial 
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hypotension, but was unable to state the percentage of cases in 

which the event causing the condition was ultimately identified, 

and did not testify to any diagnostic testing or other actions 

that he took to rule out other potential causes. 

However, the full context of Dr. Sweasey’s testimony 

demonstrates that locating a cerebrospinal fluid leak was just 

one of “three different pathways” by which Dr. Sweasey could 

have arrived at his intracranial hypotension diagnosis. Dr. 

Sweasey went on to explain that his diagnosis was more informed 

by the nature and sequence of Plaintiff’s symptoms and 

Plaintiff’s responses to various tests, treatments, and surgical 

procedures. Notably, Dr. Sweasey testified that the fact 

Plaintiff’s symptoms improve when he is placed in a supine 

position “suggests that there is a pressure differential inside 

of his head that allows the sag to occur when he’s upright,” and 

that Plaintiff’s dramatic temporary improvement immediately 

following an epidural blood patch——which Dr. Sweasey testified 

is a “common treatment for spinal fluid leaks”——and two 

cranioplasties further confirmed that Plaintiff suffered from 

intracranial hypotension, “the most likely proximate cause of 

[which] was a spinal fluid leak secondary to his injury.”
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Defendants also contend that Dr. Sweasey’s opinion is based 

merely upon speculation because his testimony established that

there is no scientific basis for working backwards in time to 

connect Plaintiff’s brain sag to his 31 October 2008 injury. 

Specifically, Defendants highlight Dr. Sweasey’s testimony, when 

asked how to pinpoint precisely how long it takes for brain sag 

to develop after intracranial hypotension, that

I don’t think we have enough cases in our 

literature to say, you know, how long that

is going to take. I’m sure it could be very 

immediate in some individuals. I’m sure it 

could take days in some. I’m sure it could 

take longer in others. But I don’t have any 

way of proving that at this point in time.

Defendants’ argument fails to persuade us. Rather than proving 

his causation opinion “is of no more value than a layman’s 

opinion,” as Defendants insist based on Young, a careful review 

of the transcript of Dr. Sweasey’s testimony makes clear that

his point was that because the medical literature is still 

evolving and different patients experience the onset of their 

symptoms at different times, that makes close observation of 

each individual patient’s history and reactions to treatment all 

the more crucial. And here, unlike the expert in Young, Dr. 

Sweasey spent months consulting with numerous specialists, 

conducting a variety of diagnostic tests and extensive 
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interviews with Plaintiff and his family, and reviewing 

Plaintiff’s voluminous medical records to determine his 

diagnosis, treatment modalities, and the cause of Plaintiff’s

condition, which is why the Commission ultimately found his 

causation opinion most persuasive.

Defendants further attempt to undermine Dr. Sweasey’s 

causation opinion by contrasting it with Dr. Wilson’s testimony. 

As Defendants emphasize, Dr. Wilson testified that the onset of 

brain sag and Chiari malformation are not typically associated 

with traumatic injuries, but can develop in response to Chiari 

decompression surgeries like the one he performed on Plaintiff 

on 1 November 2010. Indeed, Defendants argue that there is no 

competent evidence indicating Plaintiff suffered from 

intracranial hypotension-induced brain sag prior to Dr. Wilson 

performing the Chiari decompression. However, this argument

ignores several of the Commission’s findings of fact which, 

because Defendants do not challenge them, are presumed 

conclusive. First, testimony from Plaintiff’s family, coworkers, and fellow church members describes Plaintiff suffering 

from symptoms of Chiari malformation and brain sag beginning in 

the weeks and months immediately following his 31 October 2008 

accident. Plaintiff saw multiple physicians for treatment of 
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these symptoms, but it took over a year before he was referred 

to a neurologist, which is in keeping with the Commission’s 

finding that symptoms indicative of Chiari malformations are 

also suggestive of other medical conditions unrelated to the 

brain, cervical spine compression, and other neurological 

abnormalities, and it is not uncommon for a person to exhibit 

symptoms of a Chiari malformation over an extended period of 

time before a correct diagnosis is reached. Finally, Defendants 

ignore Dr. Wilson’s own testimony that it is indeed 

hypothetically plausible for a lifting injury to cause brain 

sag. While Dr. Wilson would not give an opinion regarding an 

acquired Chiari malformation caused by intracranial hypotension 

because it was not something he considered in evaluating 

Plaintiff’s condition, he explained that it could occur 

if a person during the course of some kind 

of injury or heavy lifting . . . developed a 

spontaneous CSF leak somewhere in their 

spinal column, and so the CSF is leaking and 

they develop spontaneous intracranial 

hypotension, the brain sags, the cerebellar 

tonsils descend, [and] that is 

hypothetically a possible way you can 

develop this kind of tonsillar descent.

In light of Dr. Sweasey’s testimony and the rest of the 

evidence of record, we conclude Defendant’s objections regarding 

Dr. Sweasey’s inability to pinpoint the exact source of 
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Plaintiff’s intracranial hypotension go more to the weight of 

his opinion than its competence. Indeed, despite their claim 

that Dr. Sweasey’s causation opinion is mere speculation, the 

majority of Defendants’ argument reads more like an invitation

for this Court to reweigh the evidence that was presented before 

the Commission. We recognize that Defendants presented 

substantial evidence that would have supported a contrary 

determination regarding the cause of Plaintiff’s brain 

condition. But as our prior cases make clear, it is not this 

Court’s place or prerogative to second-guess the Commission’s 

credibility determinations so long as its findings of fact are 

supported by competent evidence. See Adams, 349 N.C. at 680, 509 

S.E.2d at 413. Because we do not agree with Defendants’ 

contention that Dr. Sweasey’s opinion was so speculative as to 

render it incompetent, we hold the Commission did not err in 

concluding that his causation opinion was legally sufficient to 

support its determination that Plaintiff’s injury was, in fact, 

compensable under our State’s Workers’ Compensation Act.

Aggravation of Plaintiff’s Cervical Spine Condition

Defendants next argue that the Commission erred in 

concluding that Dr. Sweasey’s causation opinion was legally 

sufficient to establish that Plaintiff’s 31 October 2008 lifting 
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injury caused an exacerbation or aggravation of his underlying 

and pre-existing cervical spine condition. We disagree.

As indicated in the Commission’s findings of fact:

Dr. Sweasey opined that more likely than 

not, Plaintiff’s cervical cord compression 

for which he underwent surgery on April 16, 

2010 and November 1, 2010 resulted from an 

October 31, 2008 aggravation of an 

underlying cervical condition. Dr. Sweasey 

explained that symptom onset was subtle and 

did not become apparent until over time. A 

person may have spinal cord compression and 

spinal cord irritation for which a person 

does not feel pain, but slowly over time the 

person develops a deficit. Dr. Sweasey also 

stated that more likely than not, 

Plaintiff’s cervical spine issue is related 

to leakage of spinal fluid from a nerve root 

with the fluid absorbed by the surrounding 

tissue.

Here again, Defendants challenge the Commission’s findings based 

on their prior argument that Dr. Sweasey’s causation opinion was 

too speculative to be considered competent under Young and 

demonstrates his reliance on the post hoc, ergo propter hoc

fallacy. To support their claim, Defendants highlight Dr. 

Sweasey’s testimony that,

basically looking backwards, and trying to 

find what I considered the common thread 

through the whole picture, you know, 

original spinal surgery, Chiari 

decompression, subsequent spine surgery, 

subsequent shunt, subsequent cranioplasty of 

two different forms, epidural blood patches, 

the common thread when I look back through 
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all of that appears to be intracranial 

hypotension secondary to the lifting injury, 

and more likely than not the problem that we 

discussed as far as a leakage of spinal 

fluid from a nerve root. 

The spine issue in the cervical spine . . . 

appears to have a relationship to that, too. 

So that’s why I label that as likely——more 

likely than not being related to the lifting 

injury, also. Again, it’s my opinion. 

Finding an actual absolute perfect thread 

for that one is harder, but I think 

certainly, you know, I would base my 

opinions and everything more on the 

intracranial hypotension issue. And I think 

that fits better with his picture all the 

way through.

Defendants repeat their allegations that Dr. Sweasey’s testimony 

is incompetent because it failed to pinpoint the location of 

Plaintiff’s cerebrospinal fluid leak and there is no scientific 

basis for working backwards from Plaintiff’s cervical spine 

condition to his 31 October 2008 injury. However, as already 

discussed, these objections go more to the weight of Dr. 

Sweasey’s opinion than its competence. 

Defendants also emphasize that neither Dr. Belanger nor Dr. 

Wilson agreed with Dr. Sweasey’s diagnosis. While this appears 

to be another invitation for this Court to reweigh the evidence 

that was before the Commission, which we decline to do, we also 

note that both Dr. Belanger and Dr. Wilson testified that it was 

plausible that a lifting injury could aggravate a previously 
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asymptomatic degenerative cervical spine condition. Moreover, as 

the Commission indicated, Dr. Wilson agreed that cervical cord 

compression can be related to Chiari malformation and that, in 

this circumstance, causation questions are best viewed 

retrospectively because of the subtle onset of cervical cord 

compression symptoms, which can overlap with Chiari malformation 

symptoms and similarly do not become apparent until over time.

Accordingly, we hold that the Commission did not err in 

concluding that Dr. Sweasey’s causation opinion was legally 

sufficient to establish that Plaintiff’s 31 October 2008 lifting 

injury caused an exacerbation or aggravation of his underlying 

and pre-existing cervical spine condition. 

Timely Notice to Satisfy Statute of Limitations

Defendants next argue that the Commission erred in 

concluding that Plaintiff timely filed a claim for workers’ 

compensation benefits for his Chiari malformation caused by 

intracranial hypotension based on the Form 18 that Plaintiff 

filed on or about 1 July 2010 seeking benefits for injuries to 

his neck, back, and leg. Specifically, Defendants contend that 

because Plaintiff’s Form 18 did not explicitly reference the 

injury to his brain, he should be barred from recovery for his 
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brain sag by our Workers’ Compensation Act’s statute of 

limitations. We disagree

As Defendants point out, N.C. Gen. Stat. § 97-24 

establishes a two-year statute of limitations for claims for 

compensation arising from work-related injuries, and although 

Plaintiff’s accident occurred on 31 October 2008, Plaintiff did 

not file any claims for compensation that specifically 

referenced his resulting brain injury until he filed a Form 33 

on 5 March 2012. Nevertheless, as our Supreme Court has made 

clear, our State’s Workers’ Compensation Act “requires liberal

construction to accomplish the legislative purpose of providing 

compensation for injured employees, and that this overarching 

purpose is not to be defeated by the overly rigorous technical, 

narrow and strict interpretation of its provisions.” Gore v. 

Myrtle/Mueller, 362 N.C. 27, 36, 653 S.E.2d 400, 406 (2007)

(citation and internal quotation marks omitted). 

In the present case, Plaintiff suffers from a rare brain 

condition that is notoriously difficult to properly diagnose 

given its symptoms, and we believe it would defeat the purpose 

of the Act to deny him benefits because he was unable to fully 

diagnose his condition himself within the two-year statute of 
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limitations period. Moreover, because Defendants do not 

challenge the Commission’s finding of fact that 

[C]hiari malformation, tonsillar descent, 

and brain sag affect the region of the body 

where the cervical spine joins the brain 

causing neurological abnormalities 

throughout the central nervous system; 

therefore, the Full Commission finds that 

the Form 18 filed on or about July 1, 2010 

referencing Plaintiff’s back and neck 

sufficiently stated a claim for his medical 

condition related to [C]hiari malformation 

and that his claim is not time barred[,]

we consider it conclusive on appeal. Thus, we agree with the 

Commission’s conclusion of law that the reference in Plaintiff’s 

Form 18 to his neck, back, and leg sufficiently identified the 

body parts affected by his work-related injury. Therefore, 

because Plaintiff filed his Form 18 prior to the expiration of 

the two-year statute of limitations, we hold the Commission did 

not err in concluding Plaintiff’s claim was not time barred.

Temporary Total Disability Benefits and Medical Compensation

Finally, Defendants argue that the Commission erred in its 

conclusions of law that Plaintiff is entitled to temporary total 

disability benefits and medical compensation based on Dr. 

Sweasey’s causation opinion. However, in light of the analysis 

above, we hold that the Commission did not err in concluding 

that Plaintiff’s brain and cervical spine injuries were 
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compensable and that Plaintiff met his burden of proof by 

satisfying the first prong of the Russell test through “the 

production of medical evidence that he is physically or 

mentally, as a consequence of the work related injury, incapable 

of work in any employment.” Russell v. Lowes Product 

Distribution, 108 N.C. App. 762, 765, 425 S.E.2d 454, 457

(citation omitted). Accordingly, the opinion and award of the 

Commission is 

AFFIRMED.

Judges CALABRIA and ELMORE concur.