Court Opinion

ID: 9391417
Source: CourtListenerOpinion
Date Created: 2023-05-02 12:06:28.56683+00
Date Added: 2024-06-11T17:18:42.178135
License: Public Domain

IN THE COURT OF APPEALS OF NORTH CAROLINA

                                   No. COA22-296

                                 Filed 02 May 2023

NORTH CAROLINA INDUSTRIAL COMMISSION, I.C. No. W94420

ROBERT BREWER, Employee, Plaintiff,

             v.

RENT-A-CENTER, Employer, TRAVELERS INSURANCE CO. (SEDGWICK
CLAIMS SERVICES, Third-Party Administrators), Carrier, Defendants.

      Appeal by Defendants from an Opinion and Award entered 9 November 2021

by the North Carolina Industrial Commission. Heard in the Court of Appeals 5

October 2022.

      Hedrick Gardner Kincheloe & Garofalo LLP, by M. Duane Jones, Neil P.
      Andrews, Linda Stephens, and Brennan Cumalander, for Defendant-
      Appellants.

      Cardinal Law Partners, by Kristin P. Henriksen, for Plaintiff-Appellee.

      WOOD, Judge.

      This appeal is from an Opinion and Award of the Industrial Commission

concluding that Defendants must continue to pay for a former employee’s medical

expenses related to a compensable injury.      At issue is whether the Defendants

produced competent evidence sufficient to rebut the Parsons presumption, which

shifts from an employee to an employer the burden of proof for causation of an injury.

After careful review, we affirm the Opinion and Award of the Industrial Commission.
                               BREWER V. RENT-A-CTR.

                                      Opinion of the Court

                                 I.      Background

      On 1 July 2010, Robert Brewer (“Plaintiff”) fell from a stack of furniture boxes

while working at Rent-A-Center. He injured, among other body parts, his neck, back,

spleen, and kidneys.      As a store manager for Rent-A-Center, Plaintiff was

inventorying items in the company’s stockroom when he fell.

      Rent-A-Center filed an Industrial Commission Form 63 on 23 July 2010, listing

injuries to Plaintiff’s neck, back, spleen, sternum, and kidneys. Through this form,

Rent-A-Center agreed to pay for Plaintiff’s initial treatment, subject to contest within

a prescribed period.    Rent-A-Center never contested payment for the initial or

continued treatment.

      Over the next decade, Plaintiff visited a host of medical professionals to treat

his neck and back pain. Beginning with an initial emergency room visit to Frye

Regional Medical Center on the day of his fall, Plaintiff followed up with his primary

care physician Dr. W. Lee Young within a week. Tests did not show that Plaintiff

had fractured anything in his back, but his doctor prescribed medication to ease his

pain. On 22 October 2010, Plaintiff began orthopedic treatment with Dr. Russell

Gilchrist, a physiatrist, who ordered an MRI.                The MRI “revealed moderate

degenerative changes at C5-6, resulting in moderate canal stenosis and some

flattening of the spinal cord, as well as mild flattening of the spinal cord at C4-5 and

C6-7.” It also showed “mild multilevel degenerative lumbar spondylosis without

significant central canal or neural foraminal stenosis at any level.” Plaintiff received

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                                  Opinion of the Court

a “cervical spine epidural injection” from Dr. Gilchrist without experiencing much

relief from his symptoms.      Subsequently, Dr. Gilchrist referred Plaintiff to a

neurologist and recommended a functional capacity evaluation, but his primary care

physician was unable to provide medical clearance for the evaluation due to Plaintiff’s

prior history of stroke.

      On 3 November 2011, Plaintiff sought a second opinion from Dr. John

Welshofer, a pain management physician, who ordered more MRIs of Plaintiff’s

cervical, thoracic, and lumbar spine. These MRIs revealed mild degenerative disc

disease, several bulging discs, a herniated disc, and stenosis, among other findings.

During 2012, Dr. Gilchrist continued to treat Plaintiff with pain medications.

      On 27 August 2012, Plaintiff underwent an evaluation with Dr. David Jones,

an expert, board-certified neurosurgeon. Dr. Jones found Plaintiff’s cervical spine

MRI to be “fairly impressive” but also believed Plaintiff to be “overly dramatic” and

hesitated to recommend further treatments because he was unable to “figure out at

this point why [Plaintiff] moves the way he does.” He reported he would be willing to

see Plaintiff again after repeat diagnostic studies and a psychological evaluation.

Several months later, another MRI showed worsening disc hemorrhaging. On 2 July

2013, Dr. Jones reevaluated Plaintiff and his updated cervical spine MRI. Dr. Jones

found Plaintiff to be “less dramatic” and more reasonable and recommended Plaintiff

undergo anterior cervical discectomy and fusion (“ACDF”) surgery. However, Dr.

Gilchrist recommended diagnostic testing before having the recommended surgery.

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                                  Opinion of the Court

Plaintiff then received a radiofrequency ablation procedure on 19 December 2013 and

sacroiliac joint injections while continuing his pain medication regimen.

      On 10 January 2014, Plaintiff consulted with Dr. Ralph Maxy, an orthopedic

surgeon who specializes in spine surgery and practices, for a second opinion on the

necessity of an ACDF surgery. Dr. Maxy agreed with the recommendation for surgery

and performed the surgery on 27 January 2014.            Plaintiff was prescribed pain

medication and limited to light duty or no duty. After the surgery, another lumbar

spine MRI was performed on 30 April 2014 and revealed minimal degenerative

changes and was essentially unchanged from Plaintiff’s 2010 lumbar spine MRI. Dr.

Maxy released Plaintiff at a maximum medical improvement for his cervical spine

and assigned a ten-percent permanent partial impairment rating on 16 May 2014.

Although he assigned a zero-percent rating for Plaintiff’s lumbar spine, he noted

Plaintiff would require long-term pain management to wean off his medications over

time. Dr. Maxy assigned permanent restrictions of “no lifting more than five pounds,

avoidance of repetitive bending, twisting, or stooping, and standing or sitting as

tolerated.”

      On 30 July 2014, Dr. Mark Tiffany, a pain management specialist, took over

Plaintiff’s care from Dr. Maxy and began treating Plaintiff “with opioids, muscle

relaxers, and sleep aids, as well as injections and neuropathic cream.” However,

Plaintiff struggled with constipation and diarrhea that Dr. Tiffany attributed to the

medications. During the course of treatment, Dr. Tiffany also diagnosed Plaintiff

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                                  Opinion of the Court

with fibromyalgia and found that Plaintiff’s “work injury was a significant

contributing factor in the development of the condition.” Dr. Tiffany continued to

treat Plaintiff through 2018. In 2019, Dr. Troy Gingerich, a board-certified pain

management specialist and expert in interventional pain medication, took over

Plaintiff’s treatment because Dr. Tiffany had moved to a different practice.

      Dr. Gingerich continued to treat Plaintiff’s condition with injections and pain

medication and ordered a cervical spine CT scan. The CT scan was conducted on 3

July 2019 and did not reveal any new problems.            Thereafter, Dr. Gingerich

recommended Plaintiff undergo a spinal cord stimulator trial for his lumbar spine

and lower extremity pain in the hope that it would treat Plaintiff’s pain and

eventually allow him to reduce his pain medication. Consistent with its agreement,

Rent-A-Center continued to pay for all of Plaintiff’s treatments. However, in 2019,

Rent-A-Center filed an Industrial Commission Form 33 requesting a hearing to

review “the necessity of Plaintiff’s current prescription medication regimen” and a

“determination to stop indemnity benefits” for Plaintiff’s treatment.

      The case was initially heard on 9 December 2020 before Deputy Commissioner

Mary Claire Brown.       Rent-A-Center and their insurance provider Travelers

Insurance Company (together “Defendants”) presented the testimony of several

doctors they had retained who had reviewed Plaintiff’s incident and medical history.

      The Deputy Commissioner ordered Defendants to authorize medical treatment

for Plaintiff’s cervical pain and to continue paying weekly, temporary, and total

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                                   Opinion of the Court

disability benefits to Plaintiff. The Deputy Commissioner allowed Defendants to

discontinue payment of medical compensation for Plaintiff’s lower back, legs, coccyx,

headaches, myofascial pain, fibromyalgia, and “other conditions outside the cervical

spine.” The Deputy Commissioner also ordered that Defendants not be required to

authorize attendant care services, Plaintiff’s Lyrica prescription, or the spinal cord

stimulator. The Opinion and Award also denied Plaintiff’s request for attorney’s fees

and ordered him to submit to an independent medical examination with Dr. Gualtieri.

Both Plaintiff and Defendants appealed the decision to the Full Commission.

      The Full Commission held a hearing on 13 May 2021. The Commission heard

testimony from Dr. Suzanne Novak, a board-certified anesthesiologist and pharmacy

school professor who is not licensed in North Carolina, and Dr. George Young, a

board-certified expert in diagnostic radiology licensed in the state of North Carolina.

In its Opinion and Award, the Commission stated the following concerning Dr.

Young’s testimony:

                    In the present matter, Defendants have failed to
             rebut the Parsons presumption. To the extent Dr. Young
             offered opinions regarding causation, those opinions are all
             based upon his conclusion that Plaintiff’s fall on July 1,
             2010 did not result in an injury to Plaintiff’s cervical and/or
             lumbar spine – in sum, he testified that because Plaintiff
             sustained no injuries (either new injuries or an aggravation
             of preexisting injuries) on July 1, 2010, any treatment
             Plaintiff is now receiving for his cervical and/or lumbar
             spine is unrelated to his fall on July 1, 2010. Such
             testimony is insufficient to rebut the Parsons presumption
             where the existence of injuries to Plaintiff’s cervical and
             lumbar spine has been established by an Award of the

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                                    Opinion of the Court

             Commission in the form of a never-denied Form 63. The
             entire premise of Dr. Young’s opinion (that Plaintiff never
             had any injuries as a result of his July 1, 2010 fall) stands
             in direct contradiction to the admission made by
             Defendants and the award of the Commission establishing
             that Plaintiff sustained injuries to his cervical and lumbar
             spine when he fell on July 1, 2010. Where an expert’s
             opinion is based upon facts not supported by the record, it
             is merely speculation and therefore not competent to prove
             causation. Seay v. Wal-Mart, Inc., 180 N.C. App. 432, 436-
             37, 637 S.E.2d 299, 302 (2006). Accordingly, Dr. Young’s
             testimony is insufficient to rebut the Parsons presumption
             afforded Plaintiff. Young 353 N.C. at 230, 538 S.E.2d at
             915.

The Commission held similarly for Dr. Novak’s testimony before concluding, “As

Defendants have failed to present competent expert medical testimony to rebut the

Parsons presumption, Plaintiff is entitled to payment of medical expenses . . . .”

      In its Opinion and Award issued on 9 November 2021, the Commission ordered

Defendants to continue authorizing all medical expenses related to Plaintiff’s cervical

and lumbar spine conditions and to continue paying temporary total disability

compensation. The Commission denied Plaintiff’s claims for attendant care, for

attorney’s fees pursuant to Section 97-88.1 of our General Statutes, and for medical

treatment for myofascial pain, headaches, and fibromyalgia.          The Commission

further ordered Plaintiff to submit to the independent medical examination with Dr.

Gualtieri. Defendants appealed the Commission’s Opinion and Award pursuant to

Section 7A-29(a).

                           II.     Standard of Review

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                               BREWER V. RENT-A-CTR.

                                  Opinion of the Court

      “The standard of review in workers’ compensation cases has been firmly

established by the General Assembly and by numerous decisions of” our Supreme

Court. Richardson v. Maxim Healthcare/Allegis Grp., 362 N.C. 657, 660, 669 S.E.2d

582, 584 (2008), reh’g denied, 363 N.C. 260, 676 S.E.2d 472 (2009).

             Under the Workers’ Compensation Act, the Commission is
             the sole judge of the credibility of the witnesses and the
             weight to be given their testimony. Therefore, on appeal
             from an award of the Industrial Commission, review is
             limited to consideration of whether competent evidence
             supports the Commission’s findings of fact and whether the
             findings support the Commission’s conclusions of law.

Id. (citations and internal quotation marks omitted). “[A]n award of the Commission

upon such review, as provided in G.S. 97-85, shall be conclusive and binding as to all

questions of fact.” N.C. Gen. Stat. § 97-86 (2022).

      We review the Commission’s conclusions of law de novo. Graham v. Masonry

Reinforcing Corp. of Am., 188 N.C. App. 755, 758, 656 S.E.2d 676, 679 (2008). “Under

a de novo standard of review, this Court considers the matter anew and freely

substitutes its own judgment for that of the trial court.” Reese v. Mecklenburg Cnty.,

200 N.C. App. 491, 497, 685 S.E.2d 34, 38 (2009) (citations omitted).

                               III.   Discussion

      Defendants first argue that the Commission erred when it held that

Defendants did not overcome their burden under the Parsons presumption.

      Generally, “[a] party seeking additional medical compensation pursuant to

N.C. Gen. Stat. § 97-25 must establish that the treatment is ‘directly related’ to the

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                                   Opinion of the Court

compensable injury.” Perez v. Am. Airlines/AMR Corp., 174 N.C. App. 128, 135, 620

S.E.2d 288, 292 (2005).      However, under the Parsons presumption, employee-

plaintiffs who receive a favorable opinion and award from the Industrial Commission

are afforded the rebuttable “presumption that additional medical treatment is

causally related to the original injury.” Gross v. Gene Bennett Co., 209 N.C. App. 349,

351, 703 S.E.2d 915, 917 (2011) (citing Parsons v. Pantry, Inc. 126 N.C. App. 540, 542,

485 S.E.2d 867, 869 (1997)). “To require [a] plaintiff to re-prove causation each time

she seeks treatment for the very injury that the Commission has previously

determined to be the result of a compensable accident is unjust and violates our duty

to interpret the [Workers’ Compensation] Act in favor of injured employees.” Parsons,

126 N.C. App. at 542, 485 S.E.2d at 869. Employer-defendants bear the burden “to

prove the original finding of compensable injury is unrelated to [a plaintiff’s] present

discomfort.” Id. The Parsons presumption extends to cases involving an uncontested

Form 63 as if the plaintiff had received a favorable Opinion and Award from the Full

Commission. Gonzalez v. Tidy Maids, Inc., 239 N.C. App. 469, 476, 768 S.E.2d 886,

892 (2015). If the employer successfully rebuts the presumption, the burden to prove

that the medical treatment is directly related to the compensable injury shifts back

to the employee. Miller v. Mission Hosp., Inc., 234 N.C. App. 514, 519, 760 S.E.2d 31,

35 (2014).

      To overcome the Parsons presumption, a defendant must present competent

evidence that the original, compensable injury is not causally related to a plaintiff’s

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                                  Opinion of the Court

current medical treatment. Seay v. Wal-Mart Stores, Inc., 180 N.C. App. 432, 436,

637 S.E.2d 299, 302 (2006). Whether evidence is competent is a question of law that

this Court reviews de novo. Haponski v. Constructor’s Inc., 87 N.C. App. 95, 97-98,

360 S.E.2d 109, 110 (1987).

      Unlike a determination of competency, “[t]he Commission is the sole judge of

the credibility of the witnesses and the weight to be given their testimony.” Anderson

v. Lincoln Constr. Co., 265 N.C. 431, 433-34, 144 S.E.2d 272, 274 (1965). This Court

“does not have the right to weigh the evidence and decide the issue on the basis of its

weight.” Id. at 434, 144 S.E.2d at 274. It is well established that “[t]he findings of

fact by the Industrial Commission are conclusive on appeal if supported by any

competent evidence.” Gallimore v. Marilyn’s Shoes, 292 N.C. 399, 402, 233 S.E.2d

529, 531 (1977). “The court’s duty goes no further than to determine whether the

record contains any evidence tending to support the finding.” Anderson, 265 N.C. at

434, 144 S.E.2d at 274. “The findings of fact of the Industrial Commission are

conclusive on appeal when supported by competent evidence, even though there be

evidence that would support findings to the contrary.” Jones v. Myrtle Desk Co., 264

N.C. 401, 402, 141 S.E.2d 632, 632 (1965).

      Defendants contend that any expert evidence is sufficiently competent to rebut

the Parsons presumption if that evidence supports, in any way, a theory that current

medical treatment is not related to an original, compensable condition.           This

argument ignores our more nuanced jurisprudence of competent evidence.

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                                   Opinion of the Court

“Competent evidence is evidence that a reasonable mind might accept as adequate to

support the finding.” City of Asheville v. Aly, 233 N.C. App. 620, 625, 757 S.E.2d 494,

499 (2014). In Workers’ Compensation cases, “[t]he quantum and quality of the

evidence required to establish prima facie the causal relationship will of course vary

with the complexity of the injury itself.” Click v. Pilot Freight Carriers, Inc., 300 N.C.

164, 167, 265 S.E.2d 389, 391 (1980). For instance, “[s]peculative and general lay

opinions and bare or vague assertions do not constitute competent evidence.”

Innovative 55, LLC v. Robeson Cnty., 253 N.C. App. 714, 723, 801 S.E.2d 671, 678

(2017).   Even with expert testimony, “ ‘could’ or ‘might’ expert testimony [is]

insufficient to support a causal connection when there is additional evidence or

testimony showing the expert’s opinion to be a guess or mere speculation.” Young v.

Hickory Bus. Furniture, 353 N.C. 227, 233, 538 S.E.2d 912, 916 (2000). Whether

evidence is sufficiently competent may be a confusing question as “[t]reatises on

evidence note that the standards for admissibility of expert opinion testimony have

been confused with the standards for sufficiency of such testimony.” Holley v. ACTS,

Inc., 357 N.C. 228, 232, 581 S.E.2d 750, 753 (2003).

      Here, Rent-A-Center filed a Form 63, specifying injuries to Plaintiff’s neck and

back, among other body parts, and did not contest payment for continued medical

treatment. Thus, Defendants were required to overcome the Parsons presumption

before the Commission could consider ceasing Defendants’ payment obligations; the

burden rested with Defendants to provide the Commission with competent evidence

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                                     Opinion of the Court

that Plaintiff’s current treatment was unrelated to his compensable injury. In an

attempt to do this, Defendants enlisted Doctors Young and Novak who testified as

expert witnesses that they did not believe Plaintiff’s continued medical treatment

was related to his original injury. See Click, 300 N.C. at 167, 265 S.E.2d at 391

(“[W]here the exact nature and probable genesis of a particular type of injury involves

complicated medical questions far removed from the ordinary experience and

knowledge of laymen, only an expert can give competent opinion evidence as to the

cause of the injury.”).

       The Commission determined that Defendants did not produce competent

evidence sufficient to overcome the Parsons presumption. It relied principally upon

Seay v. Wal-Mart Stores, Inc. for this conclusion. In that case, the testimony of a

medical expert was not deemed competent because it was “based on speculation and

conjecture.” Seay, 180 N.C. App. at 436-37, 637 S.E.2d at 302. Specifically, the

directing attorney asked a testifying doctor a hypothetical question about the

employee’s injury.        “[T]he response elicited by plaintiff’s hypothetical question

required Dr. Davidson to assume the truth of facts that were not supported by the

record.   An expert’s opinion that was solicited through the assumption of facts

unsupported by the record is entirely based on conjecture.” Id. at 437, 637 S.E.2d at

303 (citing Thacker v. City of Winston-Salem, 125 N.C. App. 671, 675, 482 S.E.2d 20,

23 (1997)). Expert testimony as to the possible cause of a medical condition is

admissible if helpful but “is insufficient to prove causation, particularly ‘when there

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                                  Opinion of the Court

is additional evidence or testimony showing the expert’s opinion to be a guess or mere

speculation.’ ” Holley, 357 N.C. at 233, 581 S.E.2d at 753 (quoting Young, 353 N.C.

at 233, 538 S.E.2d at 916).

      The Commission’s unchallenged findings of fact regarding Dr. Novak’s

testimony are as follows:

                    38. Defendants retained Suzanne Novak, Ph.D.,
             M.D., a board-certified anesthesiologist and pharmacy
             school professor who is not licensed in North Carolina, to
             perform a records review of Plaintiff’s care and to offer an
             opinion about his conditions and treatment. Dr. Novak
             does not treat patients clinically, is not board certified in
             pain management, did not examine Plaintiff, did not
             provide any treatment to Plaintiff, and has never met him.
             Based upon her records review, Dr. Novak concluded that
             Plaintiff’s current complaints and his current need for
             treatment are unrelated to his original July 1, 2010 work-
             related fall. She ultimately opined that “the claimant has
             some sort of autoimmune disease” unrelated to his July 1,
             2010 fall at work that is the cause of Plaintiff’s current
             symptomology, but she was unable to identify the disease,
             unable to say with any certainty that Plaintiff has any
             specific disease, and did not explain how she could
             definitively say Plaintiff’s symptoms are unrelated to his
             compensable work injuries if she cannot identify the
             autoimmune disease. She testified that there is no clear
             explanation for Plaintiff’s low back or lower extremity
             symptoms and these symptoms are not related to his work
             injury. When asked the basis of her opinion regarding
             Plaintiff’s lumbar spine and lower extremity condition, Dr.
             Novak testified:

                   The number one basis is that he doesn’t have
             imaging studies to support that. His – his imaging studies
             are basically negative and have been since the very
             beginning. What he does have, on the other hand, is he has
             possible lupus, a probably – probable autoimmune disease

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                       BREWER V. RENT-A-CTR.

                           Opinion of the Court

     of some type. He has a sensory polyneuropathy that could
     be extremely painful and could be causing his weakness,
     numbness, in all – in all probability is causing his
     weakness, numbness, falls, if that’s the only reason he’s
     having them. And all of this is related to whatever disease
     – diseases that he has that are not work related and are
     extremely significant.

             39. Dr. Novak testified that Plaintiff “has no spinal
     injury whatsoever,” that his fall did not aggravate any
     preexisting condition, and that Plaintiff’s coccyx pain,
     myofascial pain, fibromyalgia, headaches, and chronic pain
     syndrome are unrelated to his July 2010 fall at work. She
     noted that long-term opioid use was not helping his
     symptoms and that he should be weaned off of them. She
     explained Plaintiff “doesn’t need to be on opioids at all” or
     have further injections, further ablation procedures, or
     occipital nerve blocks for his injuries. She opined that
     Plaintiff is not a candidate for a spinal cord stimulator
     because it will not treat Plaintiff’s cervical spine condition,
     because he has a history of skin break downs, and because,
     in her opinion, he has a yet-undiagnosed medical condition
     that could impact the procedure. Ultimately, Dr. Novak
     testified that “any other treatment” Plaintiff is receiving is
     “wholly unrelated to his July 2010 work accident,”
     including prescription medications. She explained that
     because Cyclobenzaprine is intended to treat acute muscle
     spasms and is contraindicated for anyone with a heart
     condition, that it should not be prescribed for Plaintiff. Dr.
     Novak testified that Plaintiff’s amitriptyline and Lyrica
     prescriptions are also unrelated to his July 2010 injuries.
     She further opined that it was not reasonable and not
     medically necessary to continue to prescribe Plaintiff
     opioids long-term due to the associated risks. When asked
     if she would defer to Plaintiff’s treating physicians, Dr.
     Novak indicated that she would not. Dr. Novak expressed
     all of her opinions to a reasonable degree of medical
     certainty.

The Commission’s unchallenged findings of fact regarding Dr. Young’s

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                                  Opinion of the Court

testimony are as follows:

                    40. Defendants also retained George Young, M.D., a
             board-certified expert in diagnostic radiology licensed in
             the state of North Carolina, to review Plaintiff’s medical
             records and prior imaging studies and render an opinion
             regarding the cause of Plaintiff’s current condition. He
             expressed all of his opinions to a reasonable degree of
             medical certainty. Dr. Young did not examine or evaluate
             Plaintiff in person and has never spoken to him. Based
             upon his review of the November 19, 2010 MRI of Plaintiff’s
             cervical spine, Dr. Young concluded that although Plaintiff
             had degenerative disc disease, disc desiccation, disc
             bulging, foraminal stenosis, and cord flattening, he did not
             have cord compression and there was no indication of an
             acute injury to Plaintiff’s cervical spine at that time. He
             explained that all of the findings present on the November
             19, 2010 MRI were chronic, long-standing, and unrelated
             to Plaintiff’s July 1, 2010 fall and that there was no
             evidence of aggravation shown on the MRI. With regard to
             Plaintiff’s lumbar spine MRI, also from November 19, 2010,
             Dr. Young testified that Plaintiff had degenerative changes
             but no acute injury or abnormalities, and no evidence of
             any exacerbation of a preexisting condition. When asked
             about Plaintiff’s February 4, 2011 thoracic spine MRI, Dr.
             Young opined there were no acute abnormalities and no
             aggravation of a preexisting condition attributable to his
             July 1, 2010 fall. Dr. Young also reviewed Plaintiff’s April
             30, 2014 lumbar spine MRI and indicated that Plaintiff’s
             lumbar spine was stable and unchanged from 2010. Based
             upon his conclusion that Plaintiff’s July 1, 2010 fall was not
             the cause of any injury or aggravation to Plaintiff’s
             cervical, thoracic, or lumbar spine, Dr. Young offered the
             opinion that he is unable to explain the cause of Plaintiff’s
             chronic pain and is unable to relate Plaintiff’s current
             symptoms to the original injury based on the MRIs he
             reviewed. When asked if Plaintiff’s current neck and back
             pain is causally related to the July 2010 work event, Dr.
             Young responded “not on the basis of the MRI scan.”

                   41. Dr. Young agreed with Dr. Novak’s opinion

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                                  Opinion of the Court

             regarding the cause of Plaintiff’s current condition and
             deferred to her regarding the appropriateness of Plaintiff’s
             medication. When questioned about the basis of his
             opinions, he agreed that his opinion regarding causation is
             based solely on his review of Plaintiff’s MRIs. He further
             agreed that a patient can have postsurgical pain. On cross
             examination, Dr. Young indicated that if Dr. Maxy had
             reviewed Plaintiff’s MRIs, he would defer to Dr. Maxy
             regarding the cause of Plaintiff’s current complaints and
             would also defer to Plaintiff’s pain management physician
             regarding the need for pain medications. He further
             agreed that it is possible to have aggravation without
             signal abnormalities on an MRI. Dr. Young ultimately
             agreed he was not offering an opinion regarding whether
             Plaintiff’s current need for pain medications is related to
             his original injury, and that imaging studies are just one
             part of determining a patient’s diagnosis.

      Both Doctors Novak and Young, without ever having examined or treated

Plaintiff, reviewed Plaintiff’s medical history and determined that his current

ailments were not the result of the previous, compensable injury. The Commission

found that the experts essentially denied the existence of an original, compensable

injury and held that such a conclusion was “merely speculation” and, therefore, not

competent because it “stands in direct contradiction to the admission made by

Defendants and the award of the Commission establishing that Plaintiff sustained

injuries . . . when he fell on July 1, 2010.” Therefore, the Commission did not believe

that a reasonable mind would find these experts’ testimonies adequate to overcome

the Parsons presumption in light of the additional evidence showing that their

insufficient clinical experience and certifications and lack of access to Plaintiff

resulted in mere guesswork.       Additionally, Dr. Young stated he would defer a

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                                   Opinion of the Court

causation determination to Dr. Maxy, one of Plaintiff’s treating doctors. Likewise,

we agree and hold that the testimonies of Doctors Young and Novack were speculative

and not sufficiently competent to overcome the Parsons presumption.

      Further, although not explicitly stated in its findings, it is clear the

Commission gave no weight to the testimony of Defendants’ experts. This credibility

determination, unlike the evidentiary determination, is wholly within the discretion

of the Commission. Anderson, 265 N.C. at 433-34, 144 S.E.2d at 274. As this Court

held in Gonzalez v. Tidy Maids, Inc., “even assuming without deciding that this

testimony could adequately show that plaintiff’s current symptoms are unrelated to

her original compensable back injuries, the Commission discredited this testimony,

as it was entitled to do.” 239 N.C. App. 469, 477, 768, S.E.2d 886, 893 (2015).

Similarly, we held in McLeod v. Wal-Mart Stores, Inc. that “[e]ven assuming arguendo

that [the expert] testimony . . . was enough to rebut the Parsons presumption, . . .

‘[t]he [F]ull Commission is the sole judge of the weight and credibility of the evidence.’

” 208 N.C. App. 555, 560, 703 S.E.2d 471, 475 (2010) (quoting Roberts v. Century

Contractors, Inc., 162 N.C. App. 688, 691, 592 S.E.2d 215, 218 (2004)). The weight

given expert evidence is a duty for the Commission to decide, not this Court.

      Contrary to its reception of Doctors Young and Novak, the Commission found

Plaintiff’s treating physicians persuasive. It found Dr. Maxy “noted that Plaintiff had

objective pathology in his cervical spine related to his original injury and resulting

surgery.”   Dr. Maxy is an orthopedic surgeon specializing in spine surgery and

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                               BREWER V. RENT-A-CTR.

                                   Opinion of the Court

practices in North Carolina. He performed spinal surgery on Plaintiff and “testified

that he considered himself in a better position, as a treating physician, to render an

opinion about Plaintiff’s condition.”

      Dr. Tiffany, another treating physician, took over Plaintiff’s care from Dr.

Maxy. Dr. Tiffany was the pain management physician working in the same clinic

and prescribed Plaintiff with medication and performed spinal injections.           The

Commission specifically quoted Dr. Tiffany in saying that while “there is no way to

be certain that these injuries are related to his fall, there’s also no way to be certain

they weren’t.” He noted “that the opinion of a diagnostic radiologist is not as helpful

as that of a treating physician like Dr. Maxy.” The Commission also noted specifically

that he “believes that a clinician who is the treating physician is better equipped to

determine the appropriate medication for a patient than a records review physician.”

      The Commission also noted Dr. Gingerich’s qualifications and testimony. Dr.

Gingerich is a board-certified pain management specialist and an expert in

interventional pain medication. As with the rest of Plaintiff’s doctors, he practices in

this state and had hands-on experience with Plaintiff. Specifically, he treated, and

continues to treat, Plaintiff with injections and pain medications, reviewed his CT

scan, and recommended further treatment. Dr. Gingerich testified as to causation of

Plaintiff’s current pain complaints that, “based on the history that he gave me, it

makes it seem like it was related to the [July 1, 2010] injury.” Dr. Gingerich further

testified that Plaintiff is “more than likely” incapable of gainful employment.

                                           18
                               BREWER V. RENT-A-CTR.

                                   Opinion of the Court

      After considering the entire record, including the testimonies of the experts,

the Commission found that Plaintiff’s ongoing care was “reasonably necessary to

effect a cure or provide relief” “[b]ased upon the preponderance of the evidence in view

of the entire record.”   It is clear from the Commission’s findings that it found

Plaintiff’s physicians more persuasive than Defendant’s experts.

      Because we hold the Commission considered and properly weighed the

testimonies of Defendants’ medical experts before reaching the conclusion that

Defendants did not overcome the Parsons presumption, we need not address

Defendants’ remaining arguments.

                                IV.    Conclusion

      Because the Defendants did not produce competent evidence sufficient to rebut

the Parsons presumption, the Commission did not err when it denied Defendants’

request to cease payments for Plaintiff’s continued medical treatment.

      AFFIRMED.

      Judge DILLON concurs by separate opinion.

      Judge GRIFFIN joins in separate opinion.

                                           19
  No. COA22-296 – Brewer v. Rent-A-Center

           DILLON, Judge, concurring.

           Most mandatory presumptions merely shift a burden of production to the

 opposing party. However, under the current state of our jurisprudence, the Parsons

 presumption also shifts the burden of proof to the opposing party (the employer).

 In this case, it may be that Defendants produced evidence from which the

 Commission could reasonably have found Plaintiff’s requested medical treatment

 is not related to the compensable injuries he suffered in 2010. But because the

 Commission essentially found by the greater weight of the evidence that the

 requested treatment is related to the 2010 injury, I concur.1

           An employee seeking workers’ compensation benefits “has the burden of

 proving that his claim is compensable.” Holley v. ACTS, Inc., 357 N.C. 228, 231,

 581 S.E.2d 750, 752 (2003). However, like plaintiffs in civil actions, an employee

 may be entitled to a presumption of a certain (presumed) fact he must otherwise

 prove where another (basic) fact has been established.

       1   We recognized in Parsons that it was “unjust” to require an employee “to re-prove causation
each time [he] seeks treatment for” his compensable injury. 126 N.C. App. 540, 542, 485 S.E.2d 867,
869 (1997). We extended Parsons to situations where an employee never proves causation in the
first instance because the employer has admitted a claim by filing a Form 63. Gonzalez v. Tidy
Maids, 239 N.C. App. 469, 768 S.E.2d 886 (2015). In this case, Defendants filed a Form 63,
admitting that Plaintiff’s injuries to his “neck” and “back” (and other body parts) were caused, at
least in part, by his workplace fall. See, e.g., Counts v. Black & Decker, 121 N.C. App. 387, 465
S.E.2d 343 (1996) (employee entitled to benefits where work-related is not the sole cause of his
disability). We have suggested that the presumption may be rebutted where the Commission finds
credible the testimony of an employer’s expert that the work-related factor which contributed to an
employee’s original discomfort had resolved, and that his current discomfort is caused solely by a
non-work related factor as McLeod v. Wal-Mart, 208 N.C. App. 555, 560, 703 S.E.2d 471, 475 (2010).
                              BREWER V. RENT-A-CTR.

                                DILLON, J., concurring

      The term presumption “is often loosely used.” Henderson Cty. v. Osteen, 297

N.C. 113, 117, 254 S.E.2d 160, 163 (1979). For example, it is sometimes used to

describe a mere inference:

             [A] presumption has a technical force of weight, and the
             [fact-finder], in the absence of sufficient proof to
             overcome it, should find in accordance with the
             presumption;

             but in the case of a mere inference there is no technical
             force attached to it. The [fact-finder], in case of an
             inference, [is] at liberty to find the ultimate fact one way
             or the other as they may be impressed by the [evidence].

Cogdell v. Wilmington & W. R. Co., 132 N.C. 852, 854, 44 S.E.2d 618, 619 (1903).

With an inference, the factfinder may find a certain fact based on the presence of a

basic fact, even if the opposing party has not offered any rebuttal evidence. For

example, where a factfinder finds that a party intentionally destroys evidence, it

may infer the evidence would have been unfavorable to the party who destroyed it,

though “[n]othing compels the factfinder to ultimately draw [this] inference.”

Reynolds v. Third Motor, 379 N.C. 524, 540, 866 S.E.2d 869, 888 (2021). This type

of presumption is sometimes referred to as a “permissive” presumption. See State

v. Malachi, 371 N.C. 719, 731 n.4, 821 S.E.2d 407, 417 (2018) (“[E]videntiary

presumptions are either ‘permissive,’ ‘conclusive,’ or ‘mandatory’[.]”)

      However, where a presumption is a true presumption, “the presumed fact

must be found to exist unless sufficient evidence of the nonexistence of the basic

                                          2
                                     BREWER V. RENT-A-CTR.

                                       DILLON, J., concurring

 fact is produced or unless the presumed fact is itself disproven.” Henderson, 297

 N.C. at 117, 254 S.E.2d at 163. For example, where a factfinder finds that an

 insured individual covered for an accidental death suffered a violent, unexplained

 death by external means, it must be presumed that the death was accidental if the

 insurance company does not offer sufficient rebuttal evidence. Moore v. Union Fid.

 Life Ins. Co., 297 N.C. 375, 381, 255 S.E.2d 160, 164-65 (1979). In such case,

 sufficient rebuttal evidence could be offered either by showing the basic fact (that

 the death was violent and unexplained) was not true or the presumed fact (that the

 death was not accidental) was not true. This true presumption is also referred to

 as a mandatory presumption. See Malachi, supra.2

           This   appeal    concerns      whether      Defendants       rebutted     the    Parsons

 presumption.       The Parsons presumption is a true (mandatory) presumption,

 requiring the Commission as factfinder to presume as fact that the treatment

 sought by an employee is related to his injury which the Commission had previously

 found to be compensable. And as a true presumption, it is rebuttable.

           With most true presumptions favoring a plaintiff, the burden of proof (also

 referred to as the burden of persuasion) regarding the presumed fact remains with

       2 Our Supreme Court in Malachi describes a third type of presumption, known as a
“conclusive” presumption. Malachi, 371 N.C. at 731, n.4, 821 S.E.2d at 417. A conclusive
presumption is an irrebuttable presumption: For example, in the past, where a plaintiff is under
seven years of age, it is conclusively presumed that he “is incapable of contributory negligence” no
matter the evidence offered by the defendant of the child’s negligent behavior. Walston v. Greene,
247 N.C. 693, 696, 102 S.E.2d 124, 126 (1958).

                                                   3
                              BREWER V. RENT-A-CTR.

                                DILLON, J., concurring

the plaintiff, while the burden of production (also referred to as the burden of going

forward) shifts to the defendant. Generally, where a plaintiff is entitled to a true

presumption and has proven the basic fact, the presumed fact is deemed proved by

the plaintiff unless the defendant has offered evidence sufficient for a reasonable

jury to conclude the presumed fact does not exist. But if the defendant offers

sufficient rebuttal evidence, the factfinder must weigh all the evidence to determine

whether the plaintiff has proven the existence of the presumed fact.

      For example, Rule 301 of our Rules of Evidence provides that a mandatory

presumption “does not shift the burden of proof” to the defendant. N.C. R. Evid.

301 (2021). The Rule merely provides that “the presumed fact shall be deemed

proved” unless the defendant meets his burden of production sufficient to rebut the

presumption. Id. And a defendant meets this burden with evidence “sufficient to

permit reasonable minds to conclude that the presumed fact does not exist.” Id.

      In workers’ compensation law, where it is shown that an employee’s death

occurred while at work and no medical reason for the death can otherwise be

adduced, the employee’s estate is entitled to a presumption – the Pickrell

presumption – that the death was work-related, rather than by suicide. Pickrell v.

Motor Convoy, Inc., 322 N.C. 363, 369-70, 368 S.E.2d 582, 585-86 (1988). Our

Supreme Court described the Pickrell presumption as a “true presumption”, such

that the death is presumed compensable unless the employer “come[s] forward with

                                          4
                              BREWER V. RENT-A-CTR.

                                DILLON, J., concurring

some evidence that the death occurred as a result of a non-compensable cause[.]”

Id. at 371, 368 S.E.2d at 586. Only after the employer rebuts the presumption does

the Commission assess the credibility of the employer’s rebuttal evidence, with the

burden of proof always with the employee’s estate:

             In that event, the Industrial Commission should find the
             facts based on all the evidence adduced, taking into
             account its credibility, and drawing such reasonable
             inferences from the credible evidence as may be
             permissible, the burden of persuasion remaining with
             the claimant.

Id.

      Also in workers compensation law, there is a presumption – known as the

Watkins presumption – that an employee’s compensable disability continues until

he returns to work. See Watkins v. Cent. Motor Lines, Inc., 279 N.C. 132, 137, 181

S.E.2d 588, 592 (1971). However, it is a little less clear whether the Watkins

presumption merely shifts the burden of production (the burden of coming forward)

to the employer to show that the employee is capable of gaining employment or if

the presumption also shifts the burden of proof to the employer.

      For instance, in a 1997 case, our Supreme Court suggests the presumption

merely shifts the burden of production, stating that “the employee need not present

evidence . . . unless and until the employer . . . comes forward with evidence to show”

the existence of a suitable job which the employee can get. Saums v. Raleigh

                                          5
                              BREWER V. RENT-A-CTR.

                                DILLON, J., concurring

Community Hosp., 346 N.C. 760, 763-64, 487 S.E.2d 746, 749 (1997) (quoting

Kennedy v. Duke Univ. Med. Ctr., 101 N.C. App. 24, 33, 398 S.E.2d 677, 682 (1990)).

However, though our Court in Kennedy affirmed a Commission’s determination

that an employer did not adequately rebut the presumption, in part, because the

Commission “has the exclusive authority to assign the weight to the evidence which

was presented.” Kennedy, 101 N.C. App. at 33, 398 S.E.2d at 682. In any event,

our Supreme Court in Saums does not quote this language in Kennedy and

otherwise reminds that “the claimant has the burden of proving the existence of his

disability and its extent.” Saums, 346 N.C. at 763, 487 S.E.2d at 749.

      Three years after Saums, our Supreme Court in dicta quotes Saums and

Kennedy, but suggests that the Watkins presumption also shifts the burden of proof

to the employer:

             “Likewise, in order to rebut plaintiff’s claim of ongoing
             partial disability, in the event such issue arises,
             defendants have the burden of proving ‘not only suitable
             jobs are available, but also that the plaintiff is capable of
             getting one, taking into account both physical and
             vocational limitations.’      Saums [citation] (quoting
             Kennedy [citation].”

Saunders v. Edenton Ob/Gyn Ctr., 352 N.C. 136, 141-42, 530 S.E.2d 62, 66 (2000).

      It is unclear whether our Supreme Court has intended to create a rule that

the Watkins presumption shifts the burden of proof to the employer. Indeed, that

                                          6
                              BREWER V. RENT-A-CTR.

                                DILLON, J., concurring

Court has noted that sometimes courts use “careless speech” at times conflating

burden of proof with the burden of production:

             The terms, “the burden of the issue,” and “the burden of
             proof,” and “the duty to go forward with evidence,” have
             given much perplexity to both the trial and appellate
             courts. The definition and the office of these terms, and
             their application to concrete cases, have been “often
             blurred by careless speech.” (Hill v. Smith, 260 U.S. 592.)

Hunt v. Eure, 189 N.C. 482, 484, 127 S.E. 593, 594 (1925). See also Speas v.

Merchants’ Bank & Trust Co., 188 N.C. 524, 526, 125 S.E. 398, 399-400 (1924).

      The Parsons presumption that is the subject of this appeal was created by

our Court. In Parsons, our Court suggests that the presumption being created

shifted the burden of proof to the employer to show that subsequent medical

treatment was not related to the compensable injury, stating that the Commission

erred “placing the burden on plaintiff to prove causation[.]” Parsons, 126 N.C. App.

at 542, 485 S.E.2d at 869.

      Our Court has repeatedly described the burden on the employer as a burden

of proof and held that it is appropriate for the Commission to weigh the employer’s

evidence to determine whether the presumption had been rebutted (rather than

merely determining whether the employer’s evidence is sufficient to cause a

reasonable factfinder to find the new medical treatment was not related to the

compensable injury). See, e.g., Gross v. Gene Bennett, 209 N.C. App. 349, 351, 703

                                          7
                             BREWER V. RENT-A-CTR.

                               DILLON, J., concurring

S.E.2d 915, 917 (2011) (“the burden of proof is shifted from the plaintiff to the

defendant [to prove causation]”); Miller v. Mission, 234 N.C. App. 514, 519, 760

S.E.2d 31, 35 (2014) (the Parsons presumption is rebutted by the employer, “the

burden of proof shifts back to the plaintiff”); Kluttz-Ellison v. Noah’s Playloft

Preschool, 283 N.C. App. 198, 211, 873 S.E.2d 414, 423 (2022) (the Commission

could weigh employer’s rebuttal evidence when determining whether the evidence

was sufficient to rebut the Parsons presumption); Gonzalez v. Tidy Maids, Inc., 239

N.C. App. 469, 477-78, 768 S.E.2d 886, 893 (2015) (same); McLeod v. Wal-Mart

Stores, Inc., 208 N.C. App. 555, 560, 703 S.E.2d 471, 475 (2010) (same); Spain v.

Spain, 236 N.C. App. 507, 765 S.E.2d 556 (2014) (unpublished) (rejecting an

employer’s argument that the Parsons presumption works like Rule 301

presumptions, which do not shift the burden of proof).

      There are older decisions from our Court, however, suggesting that the

Parsons presumption merely shifts the burden of production to the employer. See,

e.g., Pomeroy v. Tanner, 151 N.C. App. 171, 182, 565 S.E.2d 209, 216-17 (2002)

(Parsons is a “rebuttable presumption” where “the employer has the burden of

producing evidence showing the treatment is not directly related to the

compensable injury); Reinninger v. Prestige, 136 N.C. App. 255, 259, 523 S.E.2d

720, 723 (1999) (same).

                                         8
                      BREWER V. RENT-A-CTR.

                        DILLON, J., concurring

Judge Griffin joins in separate concurrence.

                                  9