Heard in the Court of Appeals September 10, 2014
Pressly, Thomas & Conley, PA, by Edwin A. Pressly, for Plaintiff.
Hill Evans Jordan & Beatty, PLLC, by Richard T. Granowsky, for Defendants.
STEPHENS, Judge. Judges CALABRIA and ELMORE concur.
Appeal by Defendants from opinion and award entered 10 January 2014 by the North Carolina Industrial Commission, No. W06970.
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 Mayford Wyatt sustained compensable injuries to his brain and spine as a result of a workplace lifting accident on 31 October 2008. We affirm.
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 pounds, the tub weighed approximately 280 pounds. As his co-worker 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 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 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 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, 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, 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 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.