{ "id": 491657, "name": "BRENDA JOYCE HOLLEY, Employee v. ACTS, INC., Employer, LIBERTY MUTUAL INSURANCE COMPANY, Carrier", "name_abbreviation": "Holley v. ACTS, Inc.", "decision_date": "2003-06-13", "docket_number": "No. 482A02", "first_page": "228", "last_page": "235", "citations": [ { "type": "official", "cite": "357 N.C. 228" } ], "court": { "name_abbreviation": "N.C.", "id": 9292, "name": "Supreme Court of North Carolina" }, "jurisdiction": { "id": 5, "name_long": "North Carolina", "name": "N.C." }, "cites_to": [ { "cite": "567 S.E.2d 457", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2002, "opinion_index": -1 }, { "cite": "152 N.C. App. 369", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 9250147 ], "year": 2002, "opinion_index": -1, "case_paths": [ "/nc-app/152/0369-01" ] }, { "cite": "132 S.E.2d 865", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1963, "pin_cites": [ { "page": "867" } ], "opinion_index": 0 }, { "cite": "260 N.C. 435", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8575143 ], "year": 1963, "pin_cites": [ { "page": "437" } ], "opinion_index": 0, "case_paths": [ "/nc/260/0435-01" ] }, { "cite": "388 S.E.2d 454", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1989, "opinion_index": 0 }, { "cite": "325 N.C. 706", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 2491752, 2490697, 2488168, 2489207, 2489951 ], "year": 1989, "opinion_index": 0, "case_paths": [ "/nc/325/0706-02", "/nc/325/0706-03", "/nc/325/0706-05", "/nc/325/0706-01", "/nc/325/0706-04" ] }, { "cite": "384 S.E.2d 549", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1989, "pin_cites": [ { "page": "553" } ], "opinion_index": 0 }, { "cite": "96 N.C. App. 28", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8520030 ], "year": 1989, "pin_cites": [ { "page": "35" } ], "opinion_index": 0, "case_paths": [ "/nc-app/96/0028-01" ] }, { "cite": "453 S.E.2d 871", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1995, "pin_cites": [ { "page": "874", "parenthetical": "a case that erroneously relied on Lockwood, an opinion on the admissibility of expert opinion testimony, to find \"could\" or \"might\" testimony sufficient to prove causation" } ], "opinion_index": 0 }, { "cite": "118 N.C. App. 76", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 11916563 ], "year": 1995, "pin_cites": [ { "page": "80-81", "parenthetical": "a case that erroneously relied on Lockwood, an opinion on the admissibility of expert opinion testimony, to find \"could\" or \"might\" testimony sufficient to prove causation" } ], "opinion_index": 0, "case_paths": [ "/nc-app/118/0076-01" ] }, { "cite": "138 S.E.2d 541", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1964, "pin_cites": [ { "page": "545", "parenthetical": "quoting Stansbury, North Carolina Evidence \u00a7 137, at 332 (2d ed. 1963)" } ], "opinion_index": 0 }, { "cite": "262 N.C. 663", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8570996 ], "year": 1964, "pin_cites": [ { "page": "668", "parenthetical": "quoting Stansbury, North Carolina Evidence \u00a7 137, at 332 (2d ed. 1963)" } ], "opinion_index": 0, "case_paths": [ "/nc/262/0663-01" ] }, { "cite": "358 S.E.2d 49", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1987, "opinion_index": 0 }, { "cite": "320 N.C. 167", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 4728805, 4731467, 4729521, 4723670, 4730200 ], "year": 1987, "opinion_index": 0, "case_paths": [ "/nc/320/0167-04", "/nc/320/0167-01", "/nc/320/0167-05", "/nc/320/0167-03", "/nc/320/0167-02" ] }, { "cite": "353 S.E.2d 433", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 2, "year": 1987, "pin_cites": [ { "page": "436" }, { "page": "437" } ], "opinion_index": 0 }, { "cite": "84 N.C. App. 598", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 12169034 ], "weight": 2, "year": 1987, "pin_cites": [ { "page": "603" }, { "page": "604-05" } ], "opinion_index": 0, "case_paths": [ "/nc-app/84/0598-01" ] }, { "cite": "23 S.E.2d 292", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1942, "pin_cites": [ { "page": "296", "parenthetical": "discussing the standard for compensability when a work-related accident results in death" } ], "opinion_index": 0 }, { "cite": "222 N.C. 358", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8630398 ], "year": 1942, "pin_cites": [ { "page": "365", "parenthetical": "discussing the standard for compensability when a work-related accident results in death" } ], "opinion_index": 0, "case_paths": [ "/nc/222/0358-01" ] }, { "cite": "538 S.E.2d 912", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 4, "year": 2000, "pin_cites": [ { "page": "915" }, { "page": "916" }, { "page": "916" } ], "opinion_index": 0 }, { "cite": "353 N.C. 227", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 135777 ], "weight": 3, "year": 2000, "pin_cites": [ { "page": "230" }, { "page": "233" }, { "page": "233" } ], "opinion_index": 0, "case_paths": [ "/nc/353/0227-01" ] }, { "cite": "265 S.E.2d 389", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 2, "year": 1980, "pin_cites": [ { "page": "391" }, { "page": "391" } ], "opinion_index": 0 }, { "cite": "300 N.C. 164", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8559969 ], "weight": 2, "year": 1980, "pin_cites": [ { "page": "167" }, { "page": "168" } ], "opinion_index": 0, "case_paths": [ "/nc/300/0164-01" ] }, { "cite": "283 S.E.2d 101", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1981, "pin_cites": [ { "page": "106" } ], "opinion_index": 0 }, { "cite": "304 N.C. 44", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8565283 ], "year": 1981, "pin_cites": [ { "page": "52" } ], "opinion_index": 0, "case_paths": [ "/nc/304/0044-01" ] }, { "cite": "117 S.E.2d 476", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1960, "pin_cites": [ { "page": "479" } ], "opinion_index": 0 }, { "cite": "253 N.C. 554", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8626303 ], "year": 1960, "pin_cites": [ { "page": "557" } ], "opinion_index": 0, "case_paths": [ "/nc/253/0554-01" ] }, { "cite": "133 S.E.2d 702", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1963, "pin_cites": [ { "page": "704", "parenthetical": "quoting Allred v. Allred-Gardner, Inc., 253 N.C. 554, 557, 117 S.E.2d 476, 479 (1960)" } ], "opinion_index": 0 }, { "cite": "260 N.C. 760", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8576353 ], "year": 1963, "pin_cites": [ { "page": "762", "parenthetical": "quoting Allred v. Allred-Gardner, Inc., 253 N.C. 554, 557, 117 S.E.2d 476, 479 (1960)" } ], "opinion_index": 0, "case_paths": [ "/nc/260/0760-01" ] }, { "cite": "57 S.E.2d 760", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1950, "pin_cites": [ { "page": "761" } ], "opinion_index": 0 }, { "cite": "231 N.C. 477", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8630523 ], "year": 1950, "pin_cites": [ { "page": "479" } ], "opinion_index": 0, "case_paths": [ "/nc/231/0477-01" ] }, { "cite": "357 S.E.2d 683", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 2, "year": 1987, "pin_cites": [ { "page": "685" }, { "page": "685" } ], "opinion_index": 0 }, { "cite": "320 N.C. 155", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 4728549 ], "weight": 2, "year": 1987, "pin_cites": [ { "page": "158" }, { "page": "158-59" } ], "opinion_index": 0, "case_paths": [ "/nc/320/0155-01" ] }, { "cite": "530 S.E.2d 54", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2000, "pin_cites": [ { "page": "60" } ], "opinion_index": 0 }, { "cite": "352 N.C. 98", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 685033 ], "year": 2000, "pin_cites": [ { "page": "106" } ], "opinion_index": 0, "case_paths": [ "/nc/352/0098-01" ] }, { "cite": "509 S.E.2d 411", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1998, "pin_cites": [ { "page": "413" } ], "opinion_index": 0 }, { "cite": "349 N.C. 676", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 571666 ], "year": 1998, "pin_cites": [ { "page": "680" } ], "opinion_index": 0, "case_paths": [ "/nc/349/0676-01" ] }, { "cite": "133 S.E.2d 220", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1963, "pin_cites": [ { "page": "222" } ], "opinion_index": 0 }, { "cite": "260 N.C. 576", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8575638 ], "year": 1963, "pin_cites": [ { "page": "578" } ], "opinion_index": 0, "case_paths": [ "/nc/260/0576-01" ] }, { "cite": "530 S.E.2d 62", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2000, "pin_cites": [ { "page": "65" } ], "opinion_index": 0 }, { "cite": "352 N.C. 136", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 685096 ], "year": 2000, "pin_cites": [ { "page": "140" } ], "opinion_index": 0, "case_paths": [ "/nc/352/0136-01" ] }, { "cite": "567 S.E.2d 457", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 3, "year": 2002, "pin_cites": [ { "page": "463-64" }, { "page": "462" } ], "opinion_index": 0 }, { "cite": "152 N.C. App. 369", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 9250147 ], "weight": 2, "year": 2002, "pin_cites": [ { "page": "376-77" } ], "opinion_index": 0, "case_paths": [ "/nc-app/152/0369-01" ] } ], "analysis": { "cardinality": 861, "char_count": 16118, "ocr_confidence": 0.76, "pagerank": { "raw": 1.2715658945594246e-06, "percentile": 0.9889408610308941 }, "sha256": "82e00032fb5e8a63336d7cc7fca9a18817d6851b7e48f6bb4f930970f2d40630", "simhash": "1:394044bae4bf474b", "word_count": 2603 }, "last_updated": "2023-07-14T16:54:45.083013+00:00", "provenance": { "date_added": "2019-08-29", "source": "Harvard", "batch": "2018" }, "casebody": { "judges": [], "parties": [ "BRENDA JOYCE HOLLEY, Employee v. ACTS, INC., Employer, LIBERTY MUTUAL INSURANCE COMPANY, Carrier" ], "opinions": [ { "text": "LAKE, Chief Justice.\nThis case arises from proceedings before the North Carolina Industrial Commission and raises the issue of whether the Commission\u2019s findings of fact were supported by competent evidence establishing causation between an employment-related injury and the development of deep vein thrombosis (DVT), a condition caused by a blood clot in a deep vein which obstructs blood flow and causes inflammation.\nAt the time of the incident, plaintiff was forty-nine years old. She was on blood pressure medication to control her hypertension and was under a doctor\u2019s care to lose weight. Since 1995, plaintiff had been taking the estrogen replacement drug Premarin, which increases the risk of blood clots. Her medical history also included treatment for benign breast tumors and complaints of leg cramps. According to medical treatises relied on by the Commission, some of the risk factors for DVT are: age greater than forty; use of estrogen;. history of tumors; and preexisting conditions such as heart disease, obesity and hypertension.\nOn 13 July 1996, while working as a certified nurses\u2019 assistant for employer-defendant ACTS, Inc., a retirement center/rest home facility, plaintiff twisted her leg on the carpet and felt a sudden pain in her left calf. She reported the injury immediately but finished working her shift, and afterwards, went home to soak her injured leg. The next day, plaintiff sought medical care for her sore leg at Presbyterian Hospital, where she was examined by Dr. Jason Ratterree, an emergency room physician. Dr. Ratterree diagnosed plaintiff with a pulled calf muscle but wrote in his medical report that he might have suspected \u201cDVT in etiology had not the patient told me that there was sudden pain during slight traumatic episode.\u201d Plaintiff was treated with anti-inflammatory and pain medications for a pulled calf muscle, was sent home with a bandage and crutches, and was ordered to stay off her left leg for three days. As a preventive measure, Dr. Ratterree told plaintiff to stop taking her estrogen replacement drug. If her pain increased, plaintiff was told to return to the hospital for a Doppler study of the leg to determine whether she might have a blood clot. Plaintiff returned to work on 22 July 1996, following a week of bed rest. Approximately five weeks later, following a weekend in bed with a stomach virus, plaintiff awoke with a painful, swollen leg. On 3 September 1996, she returned to the emergency room for treatment. On that date, her doctor ordered a Doppler study of her left leg, which revealed that plaintiff had DVT. After her release from the hospital three days later, plaintiff was seen regularly by internist Dr. Dietlinde Zipkin until 16 November 1996 when she returned to light-duty work. Plaintiff continued to experience leg pain and was hospitalized again in June of 1997 for \u201cchronic DVT.\u201d She returned to work on 11 July 1997.\nWhen plaintiff filed a workers\u2019 compensation claim, defendants denied payment on the grounds that plaintiff\u2019s medical problems stemmed from \u201ca pre-existing condition that was not aggravated or accelerated by a compensable accident or occupational disease.\u201d On 31 August 1999, plaintiff filed a request for a hearing before the Commission seeking: lost wages; payment of medical expenses; payment for permanent partial disability; and payment for permanent injury to internal organs or parts of the body, which she claimed resulted from the accident at work. On 22 March 2000, a deputy commissioner heard the matter and, on 27 June 2000, filed an opinion and award concluding that plaintiff\u2019s DVT was not the result of her injury by accident to her left leg arising out of and in the course and scope of her employment, and denying all claims. On 24 January 2001, the full Commission reviewed the case and, on 26 February 2001, filed its opinion and award concluding that plaintiff\u2019s DVT was the result of a compensable injury at work and awarding benefits. One commissioner dissented, maintaining that the evidence failed to establish a causal connection between the twisting injury and the DVT. Defendants gave notice of appeal to the Court of Appeals.\nOn 20 August 2002, a divided panel of the Court of Appeals held that competent evidence supported the full Commission\u2019s determination that plaintiff\u2019s accident on 13 July 1996 caused her DVT. Holley v. ACTS, Inc., 152 N.C. App. 369, 567 S.E.2d 457 (2002). The dissenting judge held that plaintiff had failed to establish a causal connection between the compensable injury and her ensuing DVT and that the expert testimony was mere speculation. Id. at 378-79, 567 S.E.2d at 463-64.\nThe specific issue before this Court is whether there was competent evidence presented to establish a causal connection between the original injury by accident to plaintiff\u2019s leg on 13 July 1996 and her diagnosis of DVT on 3 September 1996. The Court of Appeals\u2019 majority determined that competent evidence was presented sufficient to support the Commission\u2019s findings of fact and conclusions of law. We disagree.\nIn deciding an appeal from an award of the Industrial Commission, appellate courts may set aside a finding of fact only if it lacks evidentiary support. Saunders v. Edenton Ob/Gyn Ctr., 352 N.C. 136, 140, 530 S.E.2d 62, 65 (2000); McRae v. Wall, 260 N.C. 576, 578, 133 S.E.2d 220, 222 (1963). Although the Industrial Commission is the sole judge of the credibility and the evidentiary weight to be given to witness testimony, Adams v. AVX Corp., 349 N.C. 676, 680, 509 S.E.2d 411, 413 (1998), the Commission\u2019s conclusions of law are fully reviewable, Lanning v. Fieldcrest-Cannon, Inc., 352 N.C. 98, 106, 530 S.E.2d 54, 60 (2000). \u201cWhen the Commission acts under a misapprehension of the law, the award must be set aside and the case remanded for a new determination using the correct legal standard.\u201d Ballenger v. ITT Grinnell Indus. Piping, Inc., 320 N.C. 155, 158, 357 S.E.2d 683, 685 (1987).\nIn a workers\u2019 compensation claim, the employee \u201chas the burden of proving that his claim is compensable.\u201d Henry v. A.C. Lawrence Leather Co., 231 N.C. 477, 479, 57 S.E.2d 760, 761 (1950). An injury is compensable as employment-related if \u201c \u2018any reasonable relationship to employment exists.\u2019 \u201d Kiger v. Bahnson Serv. Co., 260 N.C. 760, 762, 133 S.E.2d 702, 704 (1963) (quoting Allred v. Allred-Gardner, Inc., 253 N.C. 554, 557, 117 S.E.2d 476, 479 (1960)). Although the employment-related accident \u201cneed not be the sole causative force to render an injury compensable,\u201d Hansel v. Sherman Textiles, 304 N.C. 44, 52, 283 S.E.2d 101, 106 (1981), the plaintiff must prove that the accident was a causal factor by a \u201cpreponderance of the evidence,\u201d Ballenger, 320 N.C. at 158-59, 357 S.E.2d at 685. See also 1 Kenneth S. Broun, Brandis and Broun on North Carolina Evidence \u00a7 41, at 137 (5th ed. 1998).\nIn cases involving \u201ccomplicated 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 Click v. Pilot Freight Carriers, Inc., 300 N.C. 164, 167, 265 S.E.2d 389, 391 (1980). \u201cHowever, when such expert opinion testimony is based merely upon speculation and conjecture, ... it is not sufficiently reliable to qualify as competent evidence on issues of medical causation.\u201d Young v. Hickory Bus. Furn., 353 N.C. 227, 230, 538 S.E.2d 912, 915 (2000). \u201c[T]he evidence must be such as to take the case out of the realm of conjecture and remote possibility, that is, there must be sufficient competent evidence tending to show a proximate causal relation.\u201d Gilmore v. Hoke Cty. Bd. of Educ., 222 N.C. 358, 365, 23 S.E.2d 292, 296 (1942) (discussing the standard for compensability when a work-related accident results in death).\nTreatises on evidence note that the standards for admissibility of expert opinion testimony have been confused with the standards for sufficiency of such testimony. See 1 Henry Brandis, Jr., Brandis on North Carolina Evidence \u00a7 137, at 549 n.57 (2d rev. ed. 1982); Dale E Stansbury, The North Carolina Law of Evidence \u00a7 137, at 108 n.67a (Henry Brandis, Jr., 2d ed. Supp. 1970). Prior to 1983, an expert was not allowed to testify on causation \u201cwith outright certainty since that would supposedly invade the \u2018province of the jury.\u2019 \u201d Cherry v. Harrell, 84 N.C. App. 598, 603, 353 S.E.2d 433, 436, disc. rev. denied, 320 N.C. 167, 358 S.E.2d 49 (1987); see also N.C.G.S. \u00a7 8C-1, Rule 704 (2001) (not changed since its adoption in 1983). Therefore, medical experts were asked only whether \u201c \u2018a particular event or condition could or might have produced the result in question, not whether it did produce such result.\u2019 \u201d Lockwood v. McCaskill, 262 N.C. 663, 668, 138 S.E.2d 541, 545 (1964) (quoting Stansbury, North Carolina Evidence \u00a7 137, at 332 (2d ed. 1963)). With the adoption of Rule 704 in 1983, experts were allowed to testify more definitively as to causation. N.C.G.S. \u00a7 8C-1, Rule 704. While the \u201ccould\u201d or \u201cmight\u201d question format circumvented the admissibility problem, it led to confusion that such testimony was sufficient to prove causation. See Alva v. Charlotte Mecklenburg Hosp. Auth., 118 N.C. App. 76, 80-81, 453 S.E.2d 871, 874 (1995) (a case that erroneously relied on Lockwood, an opinion on the admissibility of expert opinion testimony, to find \u201ccould\u201d or \u201cmight\u201d testimony sufficient to prove causation). Although expert testimony as to the possible cause of a medical condition is admissible if helpful to the jury, Cherry, 84 N.C. App. at 604-05, 353 S.E.2d at 437, it is insufficient to prove causation, particularly \u201cwhen there is additional evidence or testimony showing the expert\u2019s opinion to be a guess or mere speculation,\u201d Young, 353 N.C. at 233, 538 S.E.2d at 916.\nIn the case sub judice, the Court of Appeals\u2019 majority held that the Industrial Commission\u2019s findings of fact regarding plaintiff\u2019s DVT were not based on speculative expert medical testimony and were, therefore, competent to show that plaintiff\u2019s DVT was a result of her 13 July 1996 accident at work. Holley, 152 N.C. App. at 376-77, 567 S.E.2d at 462. However, a review of the expert testimony reveals that neither of plaintiff\u2019s physicians could establish the required causal connection between plaintiff\u2019s accident and her DVT.\nIn his deposition, Dr. Ratterree made a number of comments that demonstrate the speculative nature of his opinion. Dr. Ratterree testified that DVT is a consideration anytime a patient has calf pain, but he thought it was a \u201clow possibility\u201d in plaintiff\u2019s case given her sudden acute injury. Dr. Ratterree said that \u201cby far 90 percent or greater\u201d of his DVT patients have not suffered any injury. He testified that plaintiff could have been developing a blood clot prior to the injury at work, concluding: \u201cIt\u2019s just a galaxy of possibilities.\u201d On cross-examination, Dr. Ratterree responded to questioning as follows:\nQ. Can you say to a reasonable degree of medical certainty or a reasonable degree of medical probability that the incident related to you by Ms. Holley was a significant contributing factor in causing DVT?\nA. I can\u2019t say that, no.\nDr. Zipkin was equally uncertain about the etiology of plaintiff\u2019s DVT. In her letter of 14 April 1997 to plaintiff\u2019s attorney, Dr. Zipkin stated: \u201cI am unable to say with any degree of certainty whether or not the above mentioned work injury is related to the development of her DVT.\u201d (Emphasis added.) During her deposition, Dr. Zipkin testified in part as follows:\nQ. ... what, in your opinion, could or might have caused this DVT?\nA. I don\u2019t really know what caused the DVT.\nQ. Is it fair to say that you can\u2019t state to a reasonable degree of medical certainty what caused the DVT in this particular incident?\nA. It is fair to state, yes.\nThe entirety of the expert testimony in the instant case suggests that a causal connection between plaintiff\u2019s accident and her DVT was possible, but unlikely. Doctors are trained not to rule out medical possibilities no matter how remote; however, mere possibility has never been legally competent to prove causation. See, e.g., Young, 353 N.C. at 233, 538 S.E.2d at 916. Although medical certainty is not required, an expert\u2019s \u201cspeculation\u201d is insufficient to establish causation. See id. As the foregoing testimony indicates, plaintiff\u2019s doctors were unable to express an opinion to any degree of medical certainty as to the cause of plaintiff\u2019s DVT.\nWhen dealing with a complicated medical question such as the genesis of DVT, expert medical testimony is necessary to provide a proper foundation for the Commission\u2019s findings. \u201cReliance on Commission expertise is not justified where the subject matter involves a complicated medical question.\u201d Click, 300 N.C. at 168, 265 S.E.2d at 391. Therefore, we hold that the medical evidence as to causation in this case was insufficient to support the Industrial Commission\u2019s findings of fact and conclusions of law.\nFinally, plaintiff argues that defendants failed to prove that plaintiff\u2019s preexisting conditions were the sole cause of her DVT and that, to the contrary, no evidence was presented that plaintiff\u2019s DVT was caused by anything other than her work-related accident. This argument is unpersuasive. Plaintiff has the burden to prove each element of compensability, Harvey v. Raleigh Police Dep\u2019t, 96 N.C. App. 28, 35, 384 S.E.2d 549, 553, disc. rev. denied, 325 N.C. 706, 388 S.E.2d 454 (1989); see also Taylor v. Twin City Club, 260 N.C. 435, 437, 132 S.E.2d 865, 867 (1963). Furthermore, evidence of plaintiff\u2019s age and medical history of hypertension, breast tumors, leg cramps, and estrogen use suggests other potential causes of plaintiff\u2019s DVT.\nWe hold that the entirety of causation evidence before the Commission failed to meet the reasonable degree of medical certainty standard necessary to establish a causal link between plaintiff\u2019s twisting injury and her DVT. The opinion of the Court of Appeals, affirming the Industrial Commission\u2019s findings of fact, is, therefore, reversed, and this case is remanded to that court for further remand to the North Carolina Industrial Commission for disposition in accordance with this opinion.\nREVERSED AND REMANDED.", "type": "majority", "author": "LAKE, Chief Justice." } ], "attorneys": [ "Griffin, Smith, Caldwell, Helder & Helms, P.A., by Annika M. Brock; The Law Offices of George W. Lennon, by George W. Lennon; and Scudder & Hedrick, by Samuel A. Scudder, for plaintiff-appellee.", "Hedrick, Batman, Gardner & Kincheloe, L.L.P., by Terry L. Wallace and Neil P. Andrews, for defendant-appellants.", "Smith Moore LLP, by Jeri L. Whitfield and Caroline H. Lock, on behalf of the North Carolina Association of Defense Attorneys, amicus curiae." ], "corrections": "", "head_matter": "BRENDA JOYCE HOLLEY, Employee v. ACTS, INC., Employer, LIBERTY MUTUAL INSURANCE COMPANY, Carrier\nNo. 482A02\n(Filed 13 June 2003)\nWorkers\u2019 Compensation\u2014 findings of fact \u2014 causation\u2014speculation \u2014 reasonable degree of medical certainty\nThe Industrial Commission\u2019s findings of fact in a workers\u2019 compensation case were not supported by competent evidence establishing causation between an employment-related injury and the development of deep vein thrombosis (DVT), because: (1) although expert testimony as to the possible cause of a medical condition is admissible if helpful to the jury, it is insufficient to prove causation when there is additional evidence or testimony showing the expert\u2019s opinion to be a guess or mere speculation; (2) a review of the expert testimony revealed that neither of plaintiff employee\u2019s physicians could establish with any degree of medical certainty the required causal connection between plaintiff\u2019s accident and her DVT; and (3) evidence of plaintiff\u2019s age and medical history of hypertension, breast tumors, leg cramps, and estrogen use suggested other potential causes of plaintiffs DVT.\nAppeal pursuant to N.C.G.S. \u00a7 7A-30(2) from the decision of a divided panel of the Court of Appeals, 152 N.C. App. 369, 567 S.E.2d 457 (2002), remanding with instructions an opinion and award entered 26 February 2001 by the North Carolina Industrial Commission. Heard in the Supreme Court 13 March 2003.\nGriffin, Smith, Caldwell, Helder & Helms, P.A., by Annika M. Brock; The Law Offices of George W. Lennon, by George W. Lennon; and Scudder & Hedrick, by Samuel A. Scudder, for plaintiff-appellee.\nHedrick, Batman, Gardner & Kincheloe, L.L.P., by Terry L. Wallace and Neil P. Andrews, for defendant-appellants.\nSmith Moore LLP, by Jeri L. Whitfield and Caroline H. Lock, on behalf of the North Carolina Association of Defense Attorneys, amicus curiae." }, "file_name": "0228-01", "first_page_order": 274, "last_page_order": 281 }