Court Opinion

ID: 9856604
Source: CourtListenerOpinion
Date Created: 2023-09-24 06:51:57.929957+00
Date Added: 2024-06-11T09:39:49.187245
License: Public Domain

STEPHENS, Judge,
dissenting.
“[The] rule of causal relation is the very sheet anchor of the [Workers’] Compensation Act. It has kept the Act within the limits of its intended scope, — that of providing compensation benefits for industrial injuries, rather than branching out into the field of general health insurance benefits.” Duncan v. City of Charlotte, 234 N.C. 86, 91, 66 S.E.2d 22, 25 (1951) (citations omitted). Because I do not believe that the medical evidence in this case is sufficient to support the existence of a causal relationship between Plaintiff’s compen-sable back injury of 26 May 2001 and the second surgical procedure performed on his back on 22 April 2002, I respectfully dissent from the majority opinion.
It is undisputed that, sometime around the end of November 2001, Plaintiff slipped on a ramp at his house and fell, landing on his “tailbone or . . . butt.” It is further undisputed that approximately a month earlier, Plaintiff had returned to full-time, full-duty work for his employer in a job that required him to repair gaming machines weighing several hundred pounds. Dr. Silver’s uncontradicted testimony establishes that, according to Plaintiff, he had been doing “very well” at the time he was released to go back to work, but after *617the fall, he “began to have problems with significant pain in his back and pain down both legs.” When, conservative treatment failed to relieve Plaintiff’s symptoms, Dr. Silver performed a second surgery. The majority agree with the Commission that Plaintiff’s slip and fall aggravated his earlier compensable injury, and thus, the second surgery is compensable under the causation theories applied in Horne v. Universal Leaf Tobacco Processors, 119 N.C. App. 682, 459 S.E.2d 797, disc. review denied, 342 N.C. 192, 463 S.E.2d 237 (1995). I disagree.
This Court’s decision in Horne reveals that, following a compen-sable on-the-job injury, Mr. Horne underwent two surgical procedures on his back. While he was still out of work and recovering from the second surgery, he was involved in an automobile accident. Mr. Home’s treating neurosurgeon, Dr. Tomaszek, recommended a fusion to treat Mr. Home’s worsened condition. Owing to the occurrence of the automobile accident, Mr. Horne’s employer denied that the need for the third surgery was causally related to the on-the-job injury. In reversing the Commission’s denial of benefits, this Court noted the uncontradicted testimony of Dr. Tomaszek that (1) the recurrent disk rupture shown on the MRI obtained after the automobile accident was actually present before that accident at the same lumbar level as Mr. Horne’s compensable first surgery, (2) Mr. Home was complaining of “moderately severe” back and leg pain before the automobile accident and was not “comfortable” with his surgical results, (3) the automobile accident worsened the abnormal disk, and (4) the “pathology” leading Dr. Tomaszek to recommend a fusion after the automobile accident “all stems back to the work-related accident.” Horne, 119 N.C. App. at 686-87, 459 S.E.2d at 800. On this uncontra-dicted evidence, this Court concluded that the automobile accident aggravated Mr. Home’s prior compensable injury, and thus, the consequences of that aggravation were also compensable. It is incomprehensible that a different result could have been reached.
Similarly, in Roper v. J.P. Stevens & Co., 65 N.C. App. 69, 73, 308 S.E.2d 485, 488 (1983), disc. review denied, 310 N.C. 309, 312 S.E.2d 652 (1984), this Court determined that plaintiff was entitled to compensation for complications of phlebitis, arthritis, and severe body pain following a compensable on-the-job leg injury because it was “not disputed” that such complications “were the result of plaintiff’s compensable injury.” Accord, Heatherly v. Montgomery Components, Inc., 71 N.C. App. 377, 382, 323 S.E.2d 29, 31 (1984) (plaintiff’s second injury was a “refracture” of his first compensable frac*618ture), disc. review denied, 313 N.C. 329, 327 S.E.2d 890 (1985); Mayo v. City of Washington, 51 N.C. App. 402, 407, 276 S.E.2d 747, 750 (1981) (subsequent incidents “reinjured” plaintiff’s original knee injury).
No such evidence can be found in this case. On the contrary, the uncontradicted testimony of Plaintiff’s treating neurosurgeon, Dr. Silver, establishes the following: (1) Plaintiff sustained a ruptured disc at the lowest level of his lumbar spine as a result of his on-the-job injury, for which Dr. Silver performed a microdiscectomy on the left to remove the disc fragment that was compressing the nerve; (2) Plaintiff did “very well” after that surgery and was able to return full time to physically demanding work; (3) the left leg pain for which Dr. Silver prescribed a steroid medication for Plaintiff over the phone within a week of his return to work was not “an uncommon thing[;]” (4) Dr. Silver next saw Plaintiff almost two months later after Plaintiff fell at home, and Plaintiff told Dr. Silver that since that fall, “he had problems with pain in his back and pain now actually down both legs[,]” whereas the pain from his work injury had been limited to his left leg; (5) the symptoms which Plaintiff experienced after the fall on the ramp were “related to the fall[;]” (6) the degenerative changes seen on the imaging studies performed after the fall were “related to a normal aging process [;]” and (7) the surgery performed by Dr. Silver after the fall was a bilateral hemilaminectomy and facetectomy to remove a portion of the lamina of the bone (the vertebrae) on each side and to remove thickened ligaments to decompress the nerves and “give [them] more room[,]” because Plaintiff’s spinal canal had become narrowed “due to degenerative change, including thickening of the joints themselves and thickening of the ligaments of the joints.” Moreover, when Dr. Silver was directly asked whether “this thickening” that he removed to decompress the nerves in Plaintiff’s spinal canal was “due to postsurgical changes from the first surgery[,]” he unequivocally responded, “No.This was due to degenerative change at that same level [as the first surgery], not actually scar tissue but rather degenerative changes there.” (Emphasis added). This testimony is undisputed.
Dr. Silver was not asked whether the slip and fall aggravated Plaintiff’s earlier work injury. Indeed, the only question he was asked about the potential relationship between the condition for which he performed the second surgery and the preexisting condition of Plaintiff’s back from the work injury was whether the thickening of the joints and ligaments that he removed during that surgery was *619“due to postsurgical changes from the first surgery[] [or] [w]as this scar tissue [?]” As noted above, his uncontradicted answer was unequivocally in the negative, and his explanation establishes that he operated on Plaintiff’s back a second time because of degenerative changes which Plaintiff failed to prove were related in any way to the work injury. In fact, answering questions about his second surgery, Plaintiff testified, “[Dr. Silver] said that I had arthritis . . . around my sciatic nerve that was causing the pain down my leg. ... He said he removed the arthritis around the sciatic nerve.”
Thus, unlike the uncontradicted evidence which overwhelmingly established that a subsequent accident had aggravated the preexisting compensable condition of Mr. Horne’s back, which supported this Court’s holding that “the subsequent aggravation of [the primary com-pensable] injury is a natural consequence that flows from the primary injury[,]” Hore, 119 N.C. App. at 685, 459 S.E.2d at 799 (citation omitted), the evidence in this case fails to establish that Plaintiff’s fall aggravated his primary compensable injury. There is thus no basis for the Commission’s conclusion, under Horne, that Plaintiff’s “pain and medical consequences [after the fall] were a natural progression of the earlier injury.” Furthermore, because there is no evidence that the subsequent fall aggravated Plaintiff’s earlier injury, it is not necessary to reach the issue of whether Plaintiff’s fall was a result of his own intentional conduct. In any event, as the majority notes, the Commission’s determination that Plaintiff’s slip and fall was not “of his own volition[]” was not a contested issue in the case. It is simply an irrelevant issue unless aggravation is first proved.
I agree with the majority’s conclusion that the Commission’s finding of propensity (i.e., that Plaintiff’s first surgery made him more prone to develop degenerative changes) is unsupported by the evidence. I disagree, however, with the majority’s approval of the Commission’s selection of information from the medical records to provide support for its conclusion that a causal relationship exists between Plaintiff’s compensable work injury and second surgery, that is, that because Dr. Silver’s operative report indicates that he also removed scar tissue when he removed the thickened joints and ligaments, the second surgery was necessitated by the original compensable injury. I disagree because, as has already been discussed, Dr. Silver unequivocally testified that he performed the second surgery to relieve narrowing of the spinal canal, and that the narrowing was caused by degenerative changes, specifically thickening of the joints and ligaments, not by “postsurgical changes[,]” and not by scar *620tissue. This testimony was elicited by Plaintiff. Given Dr. Silver’s unambiguous explanation about the reason that he performed the second surgery, it appears that the removal of scar tissue under these circumstances was merely incidental.
Allowing the Commission to ignore the expert’s uncontradicted and unequivocal testimony, and to instead substitute its interpretation of the medical records to arrive at a different opinion than the expert has expressed, goes far beyond viewing the evidence in the light most favorable to the employee. Moreover, in my opinion, acquiescing in the Commission’s actions here contravenes the directives of our Supreme Court which has repeated time and again that in cases involving complicated medical questions, “only an expert can give competent opinion evidence as to the cause of the injury.” Click v. Pilot Freight Carriers, Inc., 300 N.C. 164, 167, 265 S.E.2d 389, 391 (1980) (citing Gillikin v. Burbage, 263 N.C. 317, 139 S.E.2d 753 (1965)). Significantly, the Click Court recognized and relied upon “the continuing medical difficulty in determining the etiology of interver-tebral diseases and injuries[]” in holding that “[r]eliance on Commission expertise is not justified where the subject matter involves a complicated medical question.” Id. at 168, 265 S.E.2d at 391 (citation omitted). Instead,
[i]n the absence of guidance by expert opinion as to whether the accident could or might have resulted in his injury, the Commission could only speculate on the probable cause of his condition. Medical testimony was therefore needed to provide a proper foundation for the Commission’s finding on the question of the injury’s origin.
Id. at 169, 265 S.E.2d at 392.
The question is no less complicated because it concerns the aggravation of a preexisting condition rather than the direct cause of an injury. In fact, the medical causation issues are probably more complex in cases such as this one, involving the existence of a causal link between a traumatic injury and conditions that occur unrelated to trauma, complicated further by the impact of significant recovery from the original traumatic injury before the occurrence of another injurious incident. I am of the opinion that, as in Click, medical testimony was necessary in this case to establish whether Plaintiffs subsequent fall aggravated his original work-related injury. For the reasons stated, I am of the opinion that the evidence fails to estab*621lish the requisite causal connection to make Plaintiff’s subsequent surgery compensable. I thus vote to reverse the decision of the Commission.