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  "name": "CHARLES RAY BILLINGS, Employee, Plaintiff v. GENERAL PARTS, INC., Employer, ZURICH AMERICAN, Carrier, GAB ROBINS, Administering Agent, Defendants",
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    "judges": [
      "Judges STROUD and ARROWOOD concur."
    ],
    "parties": [
      "CHARLES RAY BILLINGS, Employee, Plaintiff v. GENERAL PARTS, INC., Employer, ZURICH AMERICAN, Carrier, GAB ROBINS, Administering Agent, Defendants"
    ],
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      {
        "text": "MARTIN, Chief Judge.\nGeneral Parts, Inc., d/b/a Carquest of Sanford (\u201cdefendant-employer\u201d), Zurich American, and GAB Robins (collectively \u201cdefendants\u201d) appeal an Opinion and Award by the North Carolina Industrial Commission (\u201cCommission\u201d) awarding benefits to employee Charles Ray Billings (\u201cplaintiff\u2019). We affirm.\nThe record reflects that plaintiff was engaged in an employment relationship with defendant-employer on 2 June 2003 as a part-time automotive parts delivery truck driver. The seventy-three-year-old plaintiff had been employed with defendant-employer in this capacity for six years. On that date, plaintiff was returning to defendant-employer\u2019s place of business after making a delivery in defendant-employer\u2019s pickup truck. Plaintiff suffered a blackout while operating the truck, ran off the street near a railroad crossing, and struck a light pole, causing the truck to roll over. At the scene, plaintiff was conscious and alert, but complained of head pain. Plaintiff was transported to Central Carolina Hospital (\u201cCCH\u201d) where he underwent a CT scan of his head on the same day.\nThe CT scan noted a \u201c[s]mall focus of increased attenuation identified adjacent to the superior sylvian fissu[r]e which may possibly represent a [cerebral] contusion.\u201d On 4 June 2003, plaintiff underwent an MRI of the brain. The MRI noted an \u201cacute punctate right cerebellar infarct\u201d and noted there was neither subdural bleeding nor an acute contusion in the left parietal lobe, but could not exclude the presence of a small contusion. Plaintiff was discharged from CCH on 4 June 2003 with diagnoses of a syncopal episode (i.e., a sudden loss of consciousness) and an acute right cerebellar small lacunar infarct (i.e., a stroke).\nAfter a follow-up appointment on 9 June 2003 with his primary care physician, certified internist Dr. Steven Michael, plaintiff was referred to certified neurologist and neurophysiologist Dr. Mohan C. Deochand for further evaluation. On 12 June 2003, Dr. Deochand saw plaintiff who complained of suffering from headaches for several days after his discharge from the hospital. Dr. Deochand diagnosed plaintiff with a right cerebellar infarct. On 16 June 2003, plaintiff returned to Dr. Deochand complaining of \u201cmore bleeding\u201d from his nose.\nOn 22 July 2003, Dr. Michael saw plaintiff for a checkup. Plaintiff complained of episodes of right facial numbness. On 2 August 2003, Dr. Deochand saw plaintiff who complained of pain and weakness in his legs and difficulty walking. Plaintiff also complained of neck pain radiating into the right side of his head. On 5 August 2003, plaintiff arrived in a wheelchair to see Dr. Michael for complaints of headache with nausea and ongoing muscle weakness. Dr. Michael\u2019s neurological exam revealed a slight decrease in the strength of plaintiff\u2019s left upper and lower extremities.\nOn 7 August 2003 at 4:00 a.m., plaintiff was seen at the CCH Emergency Department complaining of a sharp, throbbing headache that woke him up. The following day, he was seen by Dr. Sangeeta Sawhney who admitted plaintiff to CCH\u2019s Intensive Care Unit due to complaints of severe headaches and new onset left-sided weakness. An MRI performed that afternoon showed that plaintiff had \u201cobvious bilateral subdural hematomas present\u201d \u2014 i.e., bleeding in the subdural space of the brain \u2014 that were larger on the right than the left. The subdural hematomas appeared to be \u201csubacute in nature but age [was] indeterminate.\u201d The MRI showed \u201cno other sign of an infarct.\u201d Based on his critical condition, plaintiff was transported to Wake Medical Center (\u201cWake Med\u201d) for further treatment. A CT scan done later that evening showed bilateral subdural fluid collections present and noted a subsequent right to left hemispheric shift.\nOn 9 August 2003, neurosurgeon Dr. Russell Margraf performed a right frontal craniotomy for evacuation and drainage of \u201cacute on subacute subdural hematoma.\u201d Dr. Margraf noted that a \u201cconsiderable amount of dark clot and crank case oil fluid under pressure [was] evacuated\u201d and a drain was sewn into place in plaintiffs head.\nOn 15 August 2003, a neurological consult was requested after an onset of uncontrolled violent movements in plaintiffs right lower extremities. Neurologist Dr. Susan A. Glenn noted that these movements were consistent with a right lower extremity hemiballismus which \u201cmay present a small new stroke, or possibl[e] sequela\u201d of plaintiffs brain injury from the subdural hematomas. A 15 August 2003 MRI reported persistent bilateral subdural hemato-mas and \u201cacute bilateral posterior cerebral artery territory infarc-tions\u201d or strokes.\nAfter plaintiffs condition continued to deteriorate, he was admitted and transferred to Wake Med Rehabilitation Hospital (\u201cWake Med Rehab\u201d) on 18 August 2003 for assistance with control of the hemibal-lismus of the right lower extremity. Plaintiff was noted to be lethargic, disoriented, and incapable of following simple directions. Plaintiff remained at Wake Med Rehab until his discharge and transfer on 5 September 2003 to Laurels of Chatham, a long-term care facility, due to his sharp decline and severe deficits in cognition and mobility. At the time of his discharge from Wake Med Rehab, plaintiff required assistance for feeding, grooming, toileting, and movement. Plaintiffs condition improved during his four-month stay at Laurels of Chatham to allow plaintiff to return home in December 2003, even though he continued to have problems with involuntary movement of his legs. Board certified family medicine specialist Dr. John Corey began treating plaintiff in Laurels of Chatham and continued to see plaintiff after he left the long-term care facility and returned home. Dr. Corey determined that plaintiff was unable to work due to his cognitive impairment and the movement disorders of his legs, and found that plaintiff was completely and permanently disabled as a result of these medical problems.\nOn 31 October 2003, defendant-employer denied plaintiff\u2019s claim on the grounds that plaintiffs injuries were not the direct result of a work-related accident. After receiving evidence, a deputy commissioner filed an Opinion and Award which determined that plaintiffs injuries were the direct result of a work-related accident and ordered defendants to pay for all existing and future medical expenses incurred as a result of plaintiffs motor vehicle accident, as well as total disability benefits from the date of the accident until the Commission decided otherwise. Defendants appealed to the full Commission. On 24 October 2006, the Commission entered an Opinion and Award affirming the deputy commissioner\u2019s decision, with some modifications. This appeal follows.\nOur Supreme Court has \u201crepeatedly held \u2018that our Workers\u2019 Compensation Act should be liberally construed to effectuate its purpose to provide compensation for injured employees or their dependents, and its benefits should not be denied by a technical, narrow, and strict construction.\u2019 \u201d Adams v. AVX Corp., 349 N.C. 676, 680, 509 S.E.2d 411, 413 (1998) (quoting Hollman v. City of Raleigh, 273 N.C. 240, 252, 159 S.E.2d 874, 882 (1968)).\nThe Industrial Commission and the appellate courts have distinct responsibilities when reviewing workers\u2019 compensation claims. See Deese v. Champion Int\u2019l Corp., 352 N.C. 109, 114, 530 S.E.2d 549, 552 (2000). The Industrial Commission is \u201c \u2018the fact finding body,\u2019 \u201d Adams, 349 N.C. at 680, 509 S.E.2d at 413 (quoting Brewer v. Powers Trucking Co., 256 N.C. 175, 182, 123 S.E.2d 608, 613 (1962)), and is \u201c \u2018the sole judge of the credibility of the witnesses and the weight to be given their testimony.\u2019 \u201d Id. (quoting Anderson v. Lincoln Constr. Co., 265 N.C. 431, 433-34, 144 S.E.2d 272, 274 (1965)). On appeal, \u201c \u2018[t]he findings of fact by the Industrial Commission are conclusive ... if supported by any competent evidence.\u2019 \u201d Id. at 681, 509 S.E.2d at 414 (quoting Gallimore v. Marilyn\u2019s Shoes, 292 N.C. 399, 402, 233 S.E.2d 529, 531 (1977)). These findings \u201c \u2018are conclusive on appeal . . . even though there be evidence that would support findings to the contrary.\u2019 \u201d Id. (quoting Jones v. Myrtle Desk Co., 264 N.C. 401, 402, 141 S.E.2d 632, 633 (1965)) (emphasis added). \u201cThe evidence tending to support plaintiff\u2019s claim is to be viewed in the light most favorable to plaintiff, and plaintiff is entitled to the benefit of every reasonable inference to be drawn from the evidence.\u201d Id. (citing Doggett v. South Atl. Warehouse Co., 212 N.C. 599, 194 S.E. 111 (1937)). \u201cAn opinion and award of the Industrial Commission will only be disturbed upon the basis of a patent legal error.\u201d Roberts v. Burlington Indus., Inc., 321 N.C. 350, 354, 364 S.E.2d 417, 420 (1988) (citing Hoffman v. Truck Lines, Inc., 306 N.C. 502, 505, 293 S.E.2d 807, 809 (1982)). Therefore, this Court \u201c \u2018does not have the right to weigh the evidence and decide the issue on the basis of its weight. Th[is] [C]ourt\u2019s duty goes no further than to determine whether the record contains any evidence tending to support the finding.\u2019 \u201d Adams, 349 N.C. at 681, 509 S.E.2d at 414 (quoting Anderson, 265 N.C. at 434, 144 S.E.2d at 274). With these as our guiding principles, we now address defendants-appellants\u2019 assignments of error.\nDefendants have asserted forty-eight assignments of error relating to three issues: (1) whether plaintiffs 2 June 2003 motor vehicle accident \u201carose out of\u2019 his employment with defendant-employer; (2) whether plaintiff\u2019s initial head injury and later subdural hematoma were the result of the 2 June 2003 motor vehicle accident; and (3) whether plaintiff\u2019s second stroke and resulting medical disability were the result of the 2 June 2003 motor vehicle accident. Defendants failed to present arguments addressing Assignments of Error 3 and 4 regarding Finding of Fact 4, as well as Assignments of Error 43 through 48 regarding Conclusions of Law 4, 5, 6, and the Commission\u2019s Award. These assignments of error are deemed abandoned. N.C.R. App. P. 28(a) (2007) (\u201cQuestions raised by assignments of error in appeals from trial tribunals but not then presented and discussed in a party\u2019s brief, are deemed abandoned.\u201d).\nI.\nDefendants first contend the Industrial Commission erred when it concluded that plaintiff\u2019s 2 June 2003 motor vehicle accident arose out of his employment with defendant-employer. We disagree.\n\u201cIn order to be compensable under the Act, an employee\u2019s injury by accident must arise out of and in the scope of employment.\u201d Rackley v. Coastal Painting, 153 N.C. App. 469, 472, 570 S.E.2d 121, 123 (2002). Our Supreme Court has held that \u201ca determination that an injury arose out of and in the course of employment is a mixed question of law and fact, \u2018and where there is evidence to support the Commissioner\u2019s findings in this regard, [the appellate court is] bound by those findings.\u2019 \u201d Rose v. City of Rocky Mount, 180 N.C. App. 392, 396, 637 S.E.2d 251, 254 (2006) (quoting Barham v. Food World, 300 N.C. 329, 331, 266 S.E.2d 676, 678 (1980)) (alteration in original).\n\u201c \u2018In the course of the employment\u2019 is construed to refer to the time, place and circumstances under which the accident occurs.\u201d Warren v. City of Wilmington, 43 N.C. App. 748, 750, 259 S.E.2d 786, 788 (1979) (citing Hinkle v. Lexington, 239 N.C. 105, 79 S.E.2d 220 (1953)). \u201c \u2018Arising out of\u2019 the employment is construed to require that the injury be incurred because of a condition or risk created by the job.\u201d Id. In other words, \u201c[t]he basic question [to answer when examining the arising out of requirement] is whether the employment was a contributing cause of the injury.\u201d Roberts, 321 N.C. at 355, 364 S.E.2d at 421 (citing Allred v. Allred-Gardner, Inc., 253 N.C. 554, 557, 117 S.E.2d 476, 479 (1960)).\n\u201cIt is well established in North Carolina that the Workers\u2019 Compensation Act should be liberally construed and that [wjhere any reasonable relationship to employment exists, or employment is a contributory cause, th[is] [C]ourt is justified in upholding the award as arising out of employment.\u201d Hollin v. Johnston Cty. Council on Aging, 181 N.C. App. 77, 84, 639 S.E.2d 88, 93 (2007) (quoting Kiger v. Bahnson Service Co., 260 N.C. 760, 762, 133 S.E.2d 702, 704 (1963)) (first alteration in original) (internal quotation marks omitted). The employment-related accident \u201c \u2018need not be the sole causative force to render an injury compensable.\u2019 \u201d Holley v. ACTS, Inc., 357 N.C. 228, 231, 581 S.E.2d 750, 752 (2003) (quoting Hansel v. Sherman Textiles, 304 N.C. 44, 52, 283 S.E.2d 101, 106 (1981)).\nOur appellate courts have stated that \u201c[w]hen the employee\u2019s idiopathic condition is the sole cause of the injury, the injury does not arise out of the employment.\u201d Mills v. City of New Bern, 122 N.C. App. 283, 285, 468 S.E.2d 587, 589 (1996) (citing Vause v. Vause Farm Equip. Co., 233 N.C. 88, 92-93, 63 S.E.2d 173, 176 (1951)). However, \u201c[t]he injury does arise out of the employment if the idiopathic condition of the employee combines with \u2018risk[s] attributable to the employment\u2019 to cause the injury.\u201d Id. (quoting Hollar v. Montclair Furniture Co., 48 N.C. App. 489, 496, 269 S.E.2d 667, 672 (1980)) (emphasis added) (second alteration in original). \u201c[I]f the employment \u2018aggravate[s], accelerate[s], or combine[s] with the [employee\u2019s preexisting] disease or infirmity to produce\u2019 the injury, that injury arises out of the employment.\u201d Id. (fifth alteration in original). In other words, \u201c \u2018where the accident and resultant injury arise out of both the idiopathic condition of the workman and hazards incident to the employment, the employer is liable. But not so where the idiopathic condition is the sole cause of the injury.\u2019 \u201d Vause, 233 N.C. at 92-93, 63 S.E.2d at 176 (emphasis added).\n\u201c[W]hen an employee\u2019s duties require him to travel, the hazards of the journey are risks of the employment.\u201d Roberts, 321 N.C. at 359, 364 S.E.2d at 423 (citing Hinkle v. Lexington, 239 N.C. 105, 79 S.E.2d 220 (1953)). \u201c \u2018[A]n injury caused by a highway accident is compensable if the employee at the time of the accident is acting in the course of his employment and in the performance of some duty incident thereto.\u2019 \u201d Id. (quoting Hardy v. Small, 246 N.C. 581, 585, 99 S.E.2d 862, 866 (1957)).\nIn the present case, the parties stipulated that the accident occurred \u201cin the course of\u2019 plaintiff\u2019s employment with defendant-employer. The Commission found that plaintiff suffered a syncopal episode (i.e., blackout) while operating defendant-employer\u2019s truck, after which time the truck ran off the road, hit a light pole, and flipped over. Plaintiff was not \u201coff-duty and engaged in a purely personal errand when the accident occurred.\u201d Chavis v. TLC Home Health Care, 172 N.C. App. 366, 385, 616 S.E.2d 403, 417 (2005) (Tyson, J. dissenting). Plaintiff did not get a warning of an approaching seizure and purposefully \u201cpull[] the truck off the road, park[] it, and [lie] down on the seat in a place of apparent safety, with all of the ordinary dangers of his employment suspended and in repose.\u201d Vause, 233 N.C. at 98, 63 S.E.2d at 180. In this case, plaintiff was returning to defendant-employer\u2019s place of business after making a delivery in defendant-employer\u2019s pickup truck. The Commission concluded:\nThe hazards or risks incidental to plaintiff\u2019s employment were a contributing proximate cause of plaintiff\u2019s accident and resulting injuries. The risk of driving a truck aggravated, accelerated, or combined with plaintiff\u2019s pre-existing condition to produce his injury. Thus, plaintiff\u2019s injuries arose out of and in the course of his employment, as they were the result of his June 2, 2003 work-related accident.\n(Citations omitted.) The Commission\u2019s conclusion was supported by its findings of fact and correct as a matter of law.\nIn support of their contention that plaintiff\u2019s accident did not \u201carise out of\u2019 his employment, defendants alternatively argue that the Commission erroneously relied on Allred v. Allred-Gardner, Inc., 253 N.C. 554, 117 S.E.2d 476 (1960), and argue that plaintiff\u2019s injury doe's not survive an \u201cincreased risk\u201d analysis. Defendants contend that Allred relied on the \u201cpositional risk\u201d analysis to support its conclusion that the plaintiff\u2019s injury was compensable as \u201carising out of\u2019 his employment \u2014 a doctrine now rejected by our courts and replaced by the \u201cincreased risk\u201d analysis. While \u201c[w]e agree that the \u2018increased risk\u2019 test and not the \u2018positional risk\u2019 rale is the law of the State,\u201d we disagree with defendants\u2019 contention that the Commission erroneously applied the latter. Rose, 180 N.C. App. at 401, 637 S.E.2d at 257.\nOur Supreme Court has relied on the \u201cincreased risk\u201d analysis to \u201cdetermine whether injuries arose out of the claimant\u2019s employment\u201d primarily \u201cwhere an employee interrupts his work for his employer to engage in personal conduct unrelated to the employer\u2019s business.\u201d Dodson v. Dubose Steel, Inc., 159 N.C. App. 1, 13, 582 S.E.2d 389, 397 (2003) (Steelman, J., dissenting), rev\u2019d per curiam, 358 N.C. 129, 591 S.E.2d 548 (2004) (for reasons stated in the concurring and dissenting opinion of Steelman, J.). Here, since plaintiff was returning to defendant-employer\u2019s place of business after making a delivery on behalf of defendant-employer in defendant-employer\u2019s pickup truck at the time of the accident, an increased risk analysis is not relevant.\nWe also disagree with defendants\u2019 inference that our State\u2019s acceptance of the increased risk doctrine precludes the Commission from relying on Allred in its conclusions of law. This Court has determined:\nIn Allred, the claimant was driving a track for work when he blacked out and hit a pole. The fact that the plaintiff blacked out due to an idiopathic condition and that he was driving a track for work at the time was sufficient to support a finding that the accident arose out of claimant\u2019s employment. No findings were required that the claimant\u2019s injury was made more severe or caused solely by the fact that he was driving a track.\nRackley, 153 N.C. App. at 474, 570 S.E.2d at 125 (citation omitted). We believe the facts of the present case are consistent with this interpretation of Allred. Therefore, we affirm the Commission\u2019s ruling that plaintiff\u2019s 2 June 2003 motor vehicle accident \u201carose out of\u2019 his employment with defendant-employer and find no error.\nII.\nDefendants next contend that the Industrial Commission erred when it concluded that plaintiff\u2019s initial head injury and later subdural hematoma were the result of the 2 June 2003 motor vehicle accident. Again, we must disagree.\nViewed in the light most favorable to plaintiff, the evidence showed that the 2 June 2003 CT scan found the following: \u201cThere is increased attenuation identified adjacent to the superior portion of the left sylvian fissure. This finding may possibly represent a cerebral contusion.\u201d The 4 June 2003 MRI brain imaging found, in part: \u201cThe head CT previously performed demonstrated a focus of increased attenuation in the left parietal lobe. A small contusion cannot be excluded.\u201d This MRI also found that there was \u201c[n]o evidence of left parietal lobe contusion.\u201d Since both findings were included in the same MRI report, the Commission was correct to allow for the possibility that a small contusion existed. The Discharge Summary further noted that plaintiff was involved in a motor vehicle accident which \u201cle[d] to closed head trauma with injuries sustained to the left side of his head and a left ear laceration.\u201d\nAdditionally, during his 3 June 2003 examination of plaintiff at CCH, neurologist and neurophysiologist Dr. Deochand testified that plaintiff had \u201ca scalp tenderness over the left temporal parietal region\u201d \u2014 a finding that he testified was \u201csignificant.\u201d He also testified that the 4 June 2003 MRI \u201ccould not exclude any contusion over the left parietal region.\u201d\nNeurosurgeon Dr. Margraf testified, \u201cI think if the CAT scan suggested a small contusion, it\u2019s possible that there very well could have been a small contusion there. And the best way to follow that up would be with another CAT scan, not with a[n] MRI scan\u201d because \u201c[a]n MRI scan is very poor at visualizing blood, acute blood, particularly if it\u2019s just a small amount... [a]nd, really, CAT scan is best.\u201d Dr. Margraf further testified that \u201cthe MRI scan is maybe not as sensitive at picking up a small amount of acute blood, such as a small contusion, on the convexity.\u201d\nNext, the Commission found that the \u201cgreater weight of the medical evidence\u201d and the testimony of Dr. Margraf and Dr. Freedman supported a finding that plaintiff\u2019s subdural hematomas were related to the accident.\nDr. Mitchell Freedman, a board certified neurologist, testified that the type of head trauma plaintiff sustained in the 2 June 2003 motor vehicle accident could facilitate the development of subdural hematomas over a period of a month or two. Dr. Freedman further testified that it was quite \u201ccommon\u201d that an MRI performed two days following a head trauma would not reflect any evidence of subdural hematomas that may have been facilitated by that head trauma. He testified that subdural hematomas represent a \u201cvery slow leak of blood\u201d and develop \u201cvery, very insidiously and very slowly.\u201d He said that \u201cvery often\u201d the patients who suffer from subdural hematomas have trauma which dates back to \u201cone, two or even three months before the subdurals were found.\u201d Dr. Freedman testified:\nAssuming there is no other history of other head injuries, then it is more likely than not that the motor vehicle accident was the cause of the subdural. There does not appear in the medical record to be any other specific head injuries of sufficient magnitude to override or to trump that issue as the cause of the subdural.\nDr. Freedman conceded that subdural hematomas can occur spontaneously, but concluded:\n[I]f you have a man who\u2019s had a closed head injury and two months later develops a subdural, . . . and there\u2019s no other interceding explanation, clotting disorders, medical problems, other trauma, then I think you have to say that it is more likely than not that the motor vehicle accident was the cause of the subdural.\nOn cross examination, Dr. Freedman reiterated, \u201c[H]ere\u2019s a guy that\u2019s in a car accident, hits a light pole. He has a laceration of the ear and then two months later has a subdural. It\u2019s kind of a no-brainer.\u201d\nDr. Margraf testified that he ordered a CT scan of plaintiff when he first saw him on 8 August 2003. He testified that the CT scan showed that plaintiff had bilateral subdural hematomas involving both the left and right side, where the right subdural hematoma was larger. Dr. Margraf recommended a craniotomy on plaintiff\u2019s right side, based on the increased size of the right subdural hematoma, in which he would \u201cstart with a relatively simple burr hole for evacuation of the subdural, which is a small removal of bone ... opening the covering around the brain and draining the subdural liquid to release the pressure.\u201d During the surgery, Dr. Margraf found \u201ccrank case oil\u201d or dark blood which he described as \u201ca sign of a more chronic sub-dural, meaning two weeks ... or older.\u201d When asked whether Dr. Margraf had an opinion based on a reasonable degree of medical certainty as to the cause of plaintiff\u2019s bilateral subdural hematomas, Dr. Margraf testified, \u201cI believe that the subdurals, given the history, are related to the traumatic event to the head[ \u2014 i.e., the motor vehicle accident \u2014 ]which [plaintiff] sustained on . . . [2] June 2003.\u201d He testified that it was not unusual that subdural hematomas would not be evident on an MRI scan two days post trauma. Dr. Margraf testified that plaintiff likely had a slowly progressing chronic subdural hematoma, which could be tolerated for some period of time until the increase in pressure caused him to become symptomatic.\nDefendants also rely on Young v. Hickory Business Furniture, 353 N.C. 227, 538 S.E.2d 912 (2000), to argue that there was no competent evidence to find causation of plaintiffs subdural hematomas since the cause could not be definitively established. In Young, plaintiff claimed she developed fibromyalgia as a result of an employment-related injury. Fibromyalgia is \u201can illness or condition of unknown etiology\u201d for which \u201cthere were no physical tests that one [could] perform, or testing of any kind with regard to chemical abnormality in the body, which would indicate whether a person has fibromyalgia.\u201d Young, 353 N.C. at 231, 538 S.E.2d at 915. When considering this issue, the Court noted:\nDue to the complexities of medical science, particularly with respect to diagnosis, methodology and determinations of causation, this Court has held that \u201cwhere 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.\u201d However, when such expert opinion testimony is based merely upon speculation and conjecture, it can be of no more value than that of a layman\u2019s opinion. As such, it is not sufficiently reliable to qualify as competent evidence on issues of medical causation.\nId. at 230, 538 S.E.2d at 915 (citation omitted). In Young, the Court found that, because plaintiffs treating rheumatologist was not only unable to determine the cause of plaintiffs fibromyalgia, but also could not definitively diagnose plaintiff with fibromyalgia, the testimony \u2014 which was the only evidence offered in support of plaintiffs claim \u2014 was \u201cbased entirely upon conjecture and speculation.\u201d Id. at 231, 538 S.E.2d at 915. We do not believe Young is analogous to the present case.\nUnlike fibromyalgia, there are physical tests which can be performed to indicate whether a person has subdural hematomas, and one of those tests was performed in the present case. The 8 August 2003 MRI clearly indicated that plaintiff had \u201cobvious bilateral sub-dural hematomas present\u201d which \u201cappealed] to be subacute in nature but age [was] indeterminate.\u201d Testimony was presented to the Commission that a common cause of subdural hematomas is head trauma like the one suffered by plaintiff in the 2 June accident. However, defendants contend that testimony from some experts indicated that it was possible that plaintiff could have developed the sub-dural hematomas as a result of prior undiagnosed small strokes, spontaneous hemorrhaging due to plaintiffs treatment with Plavix following the 2 June 2003 accident, or due to an intervening fall between plaintiffs 4 June MRI and 8 August MRI.\nThis Court has held that \u201c[s]o long as there is some evidence of substance which directly or by reasonable inference tends to support the findings, this Court is bound by such evidence, even though there is evidence that would have supported a finding to the contrary.\u201d Rose, 180 N.C. App. at 400, 637 S.E.2d at 257 (internal quotation marks omitted). Therefore, based on plaintiffs medical records and the testimony of treating physicians, we hold there is sufficient evidence to support the Commission\u2019s findings that plaintiffs initial head injury and later subdural hematoma were the result of the 2 June 2003 motor vehicle accident. We find no error and affirm the Commission\u2019s findings.\nIII.\nFinally, defendants contend that the Commission erred when it determined that plaintiff\u2019s second stroke and resulting medical disability were the result of the 2 June 2003 motor vehicle accident. Defendants contend that plaintiff\u2019s subdural hematoma was diagnosed and treated successfully by Dr. Margraf with the 9 August 2003 craniotomy and evacuation and drainage of the subdural hematoma.\nThe Commission found that \u201cthe August 9, 2003 surgery performed by Dr. Margraf lessened plaintiff\u2019s disability, helped effect a cure to his subdural hematomas, and gave him relief from that condition.\u201d However, Dr. Margraf testified and the Commission found that, although plaintiff\u2019s initial recovery went well, a few days after the craniotomy, plaintiff suffered increased confusion and \u201cbegan to exhibit some ballistic movements involving the right lower extremity and, to some extent, the right upper extremity.\u201d The 15 August 2003 MRI following the 9 August craniotomy \u201cshowed a persistence of his bilateral subdural hematomas, although the right subdural was significantly smaller following the craniotomy.\u201d Dr. Margraf testified that \u201cthe most obvious conclusion\u201d for the cause of the \u201cnew infarct [or stroke] could be related to the subdural collection and the shift and pressure that [plaintiff] had associated with the subdural. That would be number one on my list.\u201d Finally, Dr. Margraf testified that the sub-dural hematoma was a \u201csignificant contributing factor\u201d to the stroke suffered by plaintiff on 15 August 2003. The Commission gave \u201cgreater weight\u201d to the expert opinion of Dr. Margraf and found that, \u201c[b]ased on the greater weight of the medical evidence, . . . plaintiffs subdural hematomas, resulting medical problems, functional deterioration, and disability are all related to the June 2, 2003 motor vehicle accident that arose out of and in the course of plaintiff\u2019s employment.\u201d\nTherefore, we hold there is sufficient evidence to support the Commission\u2019s findings that plaintiff\u2019s second stroke and resulting impairment were the result of the 2 June 2003 motor vehicle accident. We affirm the Commission\u2019s Opinion and Award.\nAffirmed.\nJudges STROUD and ARROWOOD concur.",
        "type": "majority",
        "author": "MARTIN, Chief Judge."
      }
    ],
    "attorneys": [
      "Wilson and Reives, PLLC, by E. Neil Morris, for plaintiff-appellee.",
      "Brooks Stevens & Pope, PA., by Michael G. Sigmon, for defendants-appellants."
    ],
    "corrections": "",
    "head_matter": "CHARLES RAY BILLINGS, Employee, Plaintiff v. GENERAL PARTS, INC., Employer, ZURICH AMERICAN, Carrier, GAB ROBINS, Administering Agent, Defendants\nNo. COA07-318\n(Filed 18 December 2007)\n1. Workers\u2019 Compensation\u2014 injury by accident arising out of employment \u2014 motor vehicle accident \u2014 increased risk analysis\nThe Industrial Commission did not err in a workers\u2019 compensation case by concluding that plaintiff\u2019s 2 June 2003 motor vehicle accident arose out of his employment with defendant employer when plaintiff had a blackout while he was returning to his employer\u2019s place of business after making a delivery in the employer\u2019s pickup truck, because: (1) an injury arises out of employment if an idiopathic condition of the employee combines with risks attributable to the employment to cause the injury; (2) when an employee\u2019s duties require him to travel, the hazards of the journey are risks of the employment; (3) the increased risk analysis was not relevant in this case when it is used primarily where an employee interrupts his work for his employer to engage in personal conduct unrelated to the employer\u2019s business; and (4) contrary to defendants\u2019 inference, our State\u2019s acceptance of the increased risk doctrine does not preclude the Commission from relying on Allred, 253 N.C. 554 (1960), in its conclusions of law.\n2. Workers\u2019 Compensation\u2014 motor vehicle accident \u2014 initial head injury and later subdural hematoma\nThe Industrial Commission did not err in a workers\u2019 compensation case by concluding that plaintiff employee\u2019s initial head injury and later subdural hematoma were the result of the 2 June 2003 motor vehicle accident based on plaintiff\u2019s medical records and the testimony of treating physicians.\n3. Workers\u2019 Compensation\u2014 medical disability \u2014 arising out of and in course of employment\nThe Industrial Commission did not err in a workers\u2019 compensation case by determining that plaintiff\u2019s second stroke and resulting medical disability were the result of the 2 June 2003 motor vehicle accident, because (1) a doctor testified and the Commission found that although plaintiff\u2019s initial recovery went well, plaintiff\u2019s subdural hematomas, resulting medical problems, functional deterioration, and disability were all related to the 2 June 2003 accident; and (2) there was sufficient evidence to support this finding.\nAppeal by employer from Opinion and Award entered 24 October 2006 by the North Carolina Industrial Commission. Heard in the Court of Appeals 18 September 2007.\nWilson and Reives, PLLC, by E. Neil Morris, for plaintiff-appellee.\nBrooks Stevens & Pope, PA., by Michael G. Sigmon, for defendants-appellants."
  },
  "file_name": "0580-01",
  "first_page_order": 610,
  "last_page_order": 623
}
