18052002, 20007737o1.doc

NORTH CAROLINA INDUSTRIAL COMMISSION
I.C. NOS. 18-052002 & 20-007737, LUCINDA WARD, Employee, Plaintiff v. WAKE COUNTY PUBLIC SCHOOL SYSTEM, Employer, SELF-INSURED (CORVEL, Third-Party Administrator), Defendant.
OPINION AND AWARD for the Full Commission by MYRA L. GRIFFIN, Vice-Chair.
Filed: May 7, 2026
	These matters were administratively reviewed by the Full Commission on July 16, 2025, upon Plaintiff's appeal from an Opinion and Award filed by Senior Deputy Commissioner Robert J. Harris on January 22, 2025.  The medical questionnaires completed by the following doctors are considered part of the evidence of record:  Marshall Kuremsky, M.D.; Peter Kovacs, M.D.; Alan Finkel, M.D.; Gita Fleischman, M.D.; George S. Edwards, III, M.D.; Gary L. Smoot, M.D.; Gloria Guifen Liu, M.D.; Eugene Lewis, D.C., M.P.H.; Michael DeCriscio, M.D.; and Sameer Mathur, M.D.
A P P E A R A N C E S
Plaintiff:	Lucinda Ward, Pro se.
Defendant:	Teague Campbell Dennis & Gorham LLP, Raleigh, North Carolina; Matthew D. Flammia, Counsel of Record.
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The Full Commission has reviewed the prior Opinion and Award based upon the record of the proceedings before Senior Deputy Commissioner Harris, Plaintiff's Form 44 Application for Review, and the parties' briefs.  The Full Commission hereby enters the following Opinion and Award pursuant to N.C. Gen. Stat. § 97-85:
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The Full Commission finds as fact and concludes as matters of law the following, which were entered into by the parties as:
STIPULATIONS
The parties are subject to the North Carolina Workers' Compensation Act.
An employer-employee relationship existed between Defendant and Plaintiff.
Defendant is self-insured.
A Form 18 was not filed for the November 26, 2018, incident.
Defendant filed a Form 60, Employer's Admission of Employee's Right to Compensation, on December 12, 2018, accepting the left arm/shoulder sprain and the cervical/neck injuries arising out of the November 26, 2018, incident.
For the November 26, 2018, incident, Plaintiff earned an average weekly wage of $389.50, which results in a compensation rate of $259.68.
A Form 28, Return to Work Report, was filed on December 12, 2018, noting that Plaintiff returned to work on December 5, 2018.
On December 21, 2018, Plaintiff was assessed at maximum medical improvement (MMI) for the November 26, 2018, incident.
Plaintiff completed a Form 18 on March 19, 2020, alleging injuries of head, left shoulder, concussion and cervical strain as a result of the February 19, 2020, incident.
Plaintiff filed a second Form 18 on September 25, 2020, alleging injuries of head, concussion, and left shoulder/arm as a result of the February 19, 2020, incident.
Defendant filed a Form 60, Employer's Admission of Employee's Right to Compensation, on February 27, 2020, accepting the injuries of a contusion to the head, face, and strain of the left shoulder as a result of the February 19, 2020, incident.
Defendant filed a Form 61, Denial of Workers' Compensation Claim (G.S. § 97-18(c) and G.S. § 97-18(d)), on September 14, 2022, denying alleged psychological and mental health issues related to Plaintiff's employment with Defendant and/or the February 19, 2020, incident.
Defendant filed a Form 61, Denial of Workers' Compensation Claim (G.S. § 97-18(c) and G.S. § 97-18(d)), on October 10, 2023, denying the alleged cervical complaints and symptoms.
For the February 19, 2020, incident, Plaintiff earned an average weekly wage of $430.22, resulting in a weekly compensation rate of $286.81.
Plaintiff has been out of work since February 19, 2020, and is receiving ongoing temporary total disability benefits.
On March 16, 2022, Dr. Marshall Kuremsky assessed Plaintiff at MMI and assigned a 10% impairment rating to the left shoulder injury.
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The following were entered into evidence by the Deputy Commissioner as: 
EXHIBITS
Stipulated Exhibit #1 - Executed Pre-Trial Agreement;
Stipulated Exhibit #2 - Commission forms and filings, Plaintiff's medical records, the parties' discovery responses, Plaintiff's recorded statements, claim payment history, Plaintiff's employment file, Form 25Ts and mileage payment records, and a thumb drive with video footage; 
Plaintiff's Exhibit #1 - Correspondence relating to alleged missed temporary total disability payment; 
Plaintiff's Exhibit #2 - Forms 25T relating to treatment for cervical/neck condition with Duke providers; and
Plaintiff's Exhibit #3 - Lien documentation. 
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The Full Commission addresses the following:
ISSUES
Are Plaintiff's current left arm and cervical conditions, specifically pain from the left side of her neck into the top of her left shoulder, causally related to either the injury of November 26, 2018, or February 19, 2020?
Is Plaintiff's current cervical radiculopathy condition, including her C6-C7 disc herniation and radiating pain, numbness, and muscle weakness in the neck and left shoulder, arm, and hand, causally related to either the injury of November 26, 2018, or February 19, 2020?
Are Plaintiff's current left ulnar nerve, tinnitus, and left ear hearing loss causally related to either the injury of November 26, 2018, or February 19, 2020?  
Should Plaintiff be permitted to direct her own care and select Duke Spine as her medical provider?
Is Plaintiff entitled to receive compensation for permanent partial disability benefits as a result of her compensable injuries?
Is Defendant entitled to receive a credit under N.C. Gen. Stat. § 97-42 for overpayment of temporary total disability compensation paid after Plaintiff reached maximum medical improvement?
Is Defendant required to provide payment for unauthorized medical treatment Plaintiff sought on her own? 
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Based upon the preponderance of the evidence in view of the entire record and reasonable inferences flowing therefrom, the Full Commission makes the following:
FINDINGS OF FACT
At the time of the hearing before the Deputy Commissioner, Plaintiff was 66 years old.  On February 6, 2015, Plaintiff began employment as a Safety Assistant with Defendant.  Plaintiff's duties included monitoring students with disabilities while they were being transported to and from school via bus or van. 
Plaintiff was injured arising out of and in the course of her employment with Defendant on November 26, 2018, when the bus she was riding on was involved in a motor vehicle collision.  As a result of the motor vehicle accident, Plaintiff sustained injuries to her left shoulder/arm and cervical neck strain, which Defendant later accepted via the filing of a Form 60, Employer's Admission of Employee's Right to Compensation. 
On November 27, 2018, Plaintiff was seen at FastMed Urgent Care for complaints of pain on the left side of her neck radiating down her left upper extremity.  She was diagnosed with "sprain of joints and ligaments of other parts of neck" and assigned work restrictions.  Later that afternoon, Plaintiff went to the Apex WakeMed Emergency Department and underwent a CT of the cervical spine, which revealed stable degenerative disc disease at C6-7. 
Plaintiff then followed up at Raleigh Urgent Care Center.  On December 21, 2018, she asked to be released from care because she felt like she was "100%" after 4 sessions of physical therapy.  The provider released her from treatment at maximum medical improvement, with an assessment of acute cervical strain, resolved, and left shoulder strain, resolved.  Thereafter, Plaintiff worked with no physical problems and had no further treatment for her left arm/left shoulder or her neck/cervical spine until the occurrence of the second injury in this matter.
On the afternoon of February 19, 2020, Plaintiff sustained her second work injury, which is the subject of I.C. File No. 20-007737.  Plaintiff was sitting in a passenger seat on the right side of the minibus. The driver made a right turn, and although Plaintiff was wearing a lap seatbelt, the momentum of the turn caused her to fall off the seat to her left.  Plaintiff landed on the floor below and struck her left shoulder and the left side of her head and neck on the wheel of a student's wheelchair that was located across the aisle from Plaintiff's seat. Plaintiff did not lose consciousness in the incident. 
On February 27, 2020, Defendant filed a Form 63, Section 1, Notice to Employee of Payment of Compensation Without Prejudice or Payment of Medical Benefits Only Without Prejudice, accepting liability for "contusion to head, face and sprain of left shoulder," and subsequently did not deny the February 19, 2020, injury by accident within the time prescribed by law.  
Defendant subsequently filed two Forms 61, Denial of Workers' Compensation Claim, denying liability for Plaintiff's alleged psychological complaints and mental health issues, as well as her alleged cervical spine complaints and symptoms. 
On February 19, 2020, Plaintiff went to the Apex WakeMed Emergency Department and reported mild left-sided headache, left-sided neck pain with no radicular symptoms into her upper extremities, and proximal lateral left shoulder pain.  Plaintiff underwent a CT scan of her cervical spine, which showed multilevel degenerative changes, with intervertebral disc height loss, marginal osteophytosis, uncovertebral and facet arthropathy worse at C6-C7, but no high-grade spinal canal stenosis, and no fracture or traumatic misalignment. 
On February 20, 2020, Plaintiff was seen at Raleigh Urgent Care Center for complaints of headache and pain behind her left ear.  She was diagnosed with an acute cervical strain and contusion to head and face. 
Plaintiff continued to follow up with Raleigh Urgent Care Center through March 2020, with complaints of neck and left shoulder pain and diagnoses of cervical neck strain, left face contusion, and left shoulder strain.  On March 6, 2020, Plaintiff also complained of headaches with light sensitivity and left shoulder pain with pain down into her left arm.  Plaintiff continued to complain of left shoulder pain going down into her left arm through the end of March 2020.  On March 18, 2020, Plaintiff reported that the pain in the left side of her neck, left face, and left shoulder was much better, although it worsened with activity. 
Plaintiff had an unauthorized visit with her primary care provider, Ragini Madan, M.D., on March 3, 2020, for a consultation regarding her headaches.  Because Defendant was already providing authorized treatment to Plaintiff for that condition, Plaintiff is not entitled to reimbursement from Defendant for the cost of that visit, or the mileage to attend that visit. 
On March 6, 2020, Plaintiff returned to Raleigh Urgent Care Center for a follow-up visit with Allen Mask, M.D., and reported headaches with light sensitivity and left shoulder pain radiating down her arm.  Dr. Mask referred Plaintiff to a neurologist.  Plaintiff continued to report left shoulder pain radiating down her arm through the end of March 2020.  On March 18, 2020, Plaintiff reported a reduction in pain across her left cervical region, face, and shoulder but continued aggravation by activity. 
On April 1, 2020, Plaintiff came under the care of Marshall Kuremsky, M.D., an orthopedic surgeon practicing at Triangle Orthopaedics.  Plaintiff reported pain in her neck and left shoulder.  Dr. Kuremsky diagnosed left shoulder pain, bursitis, and impingement and performed a left shoulder corticosteroid injection.  Plaintiff followed up with Dr. Kuremsky on April 29, 2020, and reported that the injection had provided some initial relief but had worn off, and that she still had pain in her neck and left shoulder that was radiating to her left hand. 
On May 11, 2020, Plaintiff had a neurological consultation with Peter Kovacs, M.D., regarding her headaches and tinnitus.  Dr. Kovacs' impression was that Plaintiff had suffered a mild concussion in the February 9, 2020, incident, that she was having post-concussive symptoms, and that her prognosis was good. 
Plaintiff remained under the care of Dr. Kuremsky for her left shoulder condition, with physical therapy and other conservative measures.  On September 23, 2020, with a diagnosis of left shoulder pain, bursitis, impingement, degenerative labral tear, AC arthritis and rotator cuff tear versus tendinitis, Plaintiff decided to proceed with left shoulder surgery, having failed conservative treatment.  Pending surgery, Plaintiff received work restrictions of no pushing, pulling, lifting, or carrying greater than 20 pounds with the left upper extremity. 
Plaintiff also continued to follow up with Dr. Kovacs for her post-concussive symptoms.  On November 23, 2020, Dr. Kovacs wrote that there was no treatment available for Plaintiff's tinnitus or photophobia. 
On March 3, 2021, Plaintiff presented to Carolina Headache Institute and was evaluated by Alan Finkel, M.D., a neurologist who specializes in pain management and headache medicine.  Dr. Finkel diagnosed her with intractable chronic post-traumatic headache, concussion, intractable chronic migraine without aura, and cervicalgia of occipito-atlanto-axial region, and he started her on various medications. 
On March 8, 2021, Plaintiff returned for her final evaluation with Dr. Kovacs.   Dr. Kovacs addressed Plaintiff's complaints of hearing loss; however, he noted his clinical opinion that such loss was not present.  He further noted that, in the event any hearing loss did exist, it was unlikely to be related to the February 19, 2020, workplace incident.  
On May 21, 2021, Plaintiff underwent audiometry with tympanometry testing, which revealed mild sensorineural hearing loss in the left ear.  She saw Gitanjali Fleischman, M.D., an otolaryngologist, that same day for her complaints of left ear pain and tinnitus.  Plaintiff was diagnosed with sensorineural hearing loss in the left ear, with unrestricted hearing in the right ear.  Dr. Fleischman could not say whether Plaintiff's mild hearing loss in her left ear was related to the February 19, 2020, incident.
On September 21, 2021, Plaintiff underwent surgery on her left shoulder with Dr. Kuremsky, consisting of a supraspinatus repair of a full-thickness tear, a subacromial decompression, a distal clavicle excision, biceps tenodesis, and debridement of degenerative labral tear and low-grade partial-thickness bursal-sided infraspinatus tear.  In her post-surgical follow-up with Dr. Kuremsky on October 4, 2021, and January 19, 2022, Plaintiff reported that she was doing well with no significant issues in her recovery and gradually improving range of motion. 
On March 16, 2022, Plaintiff saw Dr. Kuremsky and reported a sudden significant increase in her left shoulder pain the prior morning before physical therapy.  She could not identify any precipitating incident for the increase in pain.  Plaintiff also reported constant numbness and tingling from her left shoulder down her left arm to her fingers.  She denied neck pain, stating that the pain was mostly in her anterior left shoulder and going down the arm from there.  That day, Dr. Kuremsky placed Plaintiff at maximum medical improvement (MMI) for her left shoulder condition and assigned a permanent restriction of no lifting, pushing, pulling or carrying more than 2 pounds with her left arm and a 10% permanent partial disability rating for her left arm.  Dr. Kuremsky also noted that he was releasing Plaintiff from treatment and was turning her care over to his colleague Amber Gaught, M.D., a physiatrist, for evaluation of her neck condition. 
On March 16, 2022, Plaintiff presented to Dr. Gaught for a pain management consultation.  Plaintiff had been complaining of a "different type of pain, numbness, and tingling in the arm and chest region," and Dr. Kuremsky had referred her to Dr. Gaught for further evaluation to try to determine if this complaint "was cervical radiculopathy and neck related[,] or thoracic outlet syndrome related."  Plaintiff reported to Dr. Gaught that she had pain that started in her trapezial region just above her left shoulder and radiated down into her left elbow and all her fingertips, with constant numbness and tingling.  Plaintiff reported that she had no pain in her neck itself.  Plaintiff also told Dr. Gaught that initially after the February 19, 2020, incident, she was not having the amount of symptoms in her left arm that she was having at the time, but she did not start to have numbness and tingling in her left arm until after the September 2021 shoulder surgery. 
Dr. Gaught wrote in her office note as follows:
My differential diagnosis for this would first be cervical spinal involvement, stenosis or disc herniation causing impingement or chemical neuritis affecting the left cervical roots as the cause of her numbness, tingling, burning, pins-and-needles in the left upper extremity diffusely from the shoulder down to the hand. . . . (W)ith her mechanism of injury (in the February 19, 2020[,] incident), injuring both her head and her shoulder, I think it is reasonable to state that likely the cervical spine was also involved during that initial injury.  Given her current symptoms, we need to rule out cervical pathology.

Dr. Gaught also opined that the other possible diagnoses would be "post-concussive symptomology, though that would be less likely to cause the neuropathic type symptoms diffusely in the left upper extremity," myofascial thoracic outlet syndrome post-surgery, or a traction brachial plexus injury.  Dr. Gaught recommended X-rays and MRI of the cervical spine and nerve conduction study/EMG for the left upper extremity. 
The March 16, 2022, appointment was Plaintiff's only visit with Dr. Gaught, as Dr. Gaught left EmergeOrtho shortly thereafter.
Plaintiff had an independent medical examination (IME) for her left shoulder condition on August 3, 2022, with George S. Edwards, III, M.D., an orthopedic hand and upper extremity specialist.  Dr. Edwards opined that Plaintiff's diagnosis was left shoulder pain post-rotator cuff repair as well as most likely radiculopathy from the cervical spine.  He placed Plaintiff at maximum medical improvement (MMI) regarding her left shoulder, as it appeared to him that the majority of her symptoms were coming from her neck.  He agreed with further workup for her neck pathology, including MRI and EMG, and continued care by a cervical specialist. 
On October 11, 2022, Plaintiff presented to Gary L. Smoot, M.D., a spine specialist, for a comprehensive second opinion regarding her left shoulder condition.  Dr. Smoot wrote that he did not believe there was cervical spine involvement in her symptomology, but that Plaintiff appeared to have "definite myofascial pain findings."  Dr. Smoot recommended the EMG/nerve conduction study, and he had recommendations regarding medication and other treatment modalities to address Plaintiff's pain and left arm symptoms.  Dr. Smoot also wrote, "I was not asked to evaluate the cervical region.  Her case manager informs me that [they are] proceeding with a second opinion with Dr. Sameer Mathur concerning the neck."  The evaluation with Dr. Mathur did not occur until March 20, 2024.
On October 20, 2022, Plaintiff, without authorization from Defendant, presented to Shalini Ramasunder, M.D., an orthopedic surgeon, regarding her left shoulder condition.  Plaintiff reported that, following the September 2021 surgery and 6 months of post-operative physical therapy, her left shoulder felt worse than before the surgery.  She described the pain as radiating down from her left shoulder and into her hand, with burning and numbness as well.  Dr. Ramasunder ordered a left shoulder MRI to assess the rotator cuff repair site, and it showed postsurgical changes with tendinosis, no discernible rotator cuff tear, and mild acromioclavicular joint arthrosis.  On follow-up, Dr. Ramasunder advised Plaintiff that the rotator cuff repair appeared intact and that her left shoulder/arm symptoms could be from ulnar nerve compression.  Dr. Ramasunder told Plaintiff that she did not believe Plaintiff needed any further intervention for her left shoulder other than ongoing physical therapy. 
Plaintiff underwent an EMG/nerve conduction study at Dr. Smoot's office on October 25, 2022.  Dr. Smoot wrote that the findings were most consistent with a mild sensory-only ulnar neuropathy and that there were no findings suggestive of a concomitant carpal tunnel syndrome, peripheral neuropathy, brachial plexopathy, or acute cervical radiculopathy in the left upper extremity.  Plaintiff continued to follow up with Dr. Smoot until April 6, 2023, when he released her from treatment, stating he had no further treatment recommendations.
Plaintiff contends that she did not receive a temporary total disability check in February 2023.  Between January 26, 2023, and March 2, 2023, Defendant issued five weekly temporary total disability checks to Plaintiff, each in the amount of $286.81.  These payments were issued on February 2, 2023 (for February 3, 2023, through February 9, 2023); February 9, 2023; (for February 10, 2023, through February 16, 2023); February 23, 2023 (for February 17, 2023, through February 23, 2023); March 2, 2023, (for February 24, 2023, through March 2, 2023). 
On February 15, 2023, Dr. Finkel recommended that Plaintiff not return to work.  On January 8, 2024, Dr. Finkel also wrote that Plaintiff should remain out of work for activity-related worsening of symptoms, and that Plaintiff "will remain permanently disabled."  Plaintiff continues to treat with Dr. Finkel for her headaches.
Dr. Finkel responded to a medical questionnaire submitted by Senior Deputy Commissioner Harris on behalf of the parties.  Based on Plaintiff's clinical presentation, reports, medical records, and current research, Dr. Finkel opined to a reasonable degree of medical certainty that Plaintiff's concussion is causally related to the compensable February 19, 2020, incident and that her symptoms are permanent.  Drawing on his expertise in traumatic brain injury and headache medicine, Dr. Finkel assigned a 30% permanent partial impairment rating to the head, utilizing the Department of Veterans Affairs Schedule for Ratings to reflect the impact on her daily activities and life trajectory.  
On May 18, 2023, Plaintiff, without authorization from Defendant, presented to Gloria Liu, M.D., a physiatrist.  On May 24, 2023, Plaintiff underwent a cervical MRI, which showed an asymmetric left uncovertebral spur with superimposed left paracentral disc herniation at C6-C7, deforming the ventral spinal cord and resulting in overall moderate spinal canal stenosis and mild to moderate left neural foraminal narrowing.  Dr. Liu believed this herniation was causing Plaintiff's nerve impingement and left arm pain, diagnosed Plaintiff with cervical disc disorder at C6-C7 with radiculopathy, and recommended an injection at C6-C7.  
On June 22, 2023, Plaintiff had a left C7-T1 interlaminar epidural steroid injection (ESI) with Dr. Liu.  A month later, Plaintiff reported that the injection had relieved her pain better than Gabapentin had, but that she still had some pain.  At that point, Plaintiff inquired as to whether chiropractic treatment might help her. 
Upon Dr. Liu's referral, on August 3, 2023, Plaintiff, without authorization from Defendant, presented to Eugene Lewis, D.C., M.P.H, a chiropractor.  Plaintiff reported chronic left neck pain with radiating complaints of pain and paresthesia extending into her left arm to her left hand, and that she could not rotate her head very well.  She reported that these symptoms began with the February 19, 2020, incident and have continued since then.  Dr. Lewis diagnosed Plaintiff with cervical disc disorder with radiculopathy of cervicothoracic region, and he embarked upon a course of chiropractic treatment for Plaintiff.  After 12 chiropractic sessions, Dr. Lewis noted only modest improvement.  On October 12, 2023, physical examination showed no change in the degree of minimal lower cervical spine joint fixation or tenderness over the transverse processes at the inferior aspect of the spine.  Dr. Lewis released Plaintiff from his care, noting that his treatment was no longer beneficial, and he had no further recommendations. 
On October 18, 2023, Plaintiff had a left C6-C7 interlaminar ESI with Dr. Liu. 
On November 13, 2023, Plaintiff presented for an independent medical evaluation (IME) with Michael DeCriscio, D.C., a chiropractor with Carolina Concussion & Physical Medicine, regarding her complaints of left ear tinnitus, neck pain, left arm pain, daily headaches, imbalance, dysregulated sleep, photophobia and phonophobia.  Following his review of medical records, video of the passenger compartment of the bus showing the February 19, 2020, incident, and his examination of Plaintiff, Dr. DeCriscio wrote that she was at MMI for all of the conditions and that he did not recommend any further treatment. 
On March 20, 2024, Plaintiff presented for an IME regarding her left-sided neck and left arm pain with Dr. Mathur, an orthopedic surgeon.  Dr. Mathur noted that, on the day of the February 19, 2020, incident, Plaintiff had a CT scan of the cervical spine that showed degenerative changes at C6-C7, but she did not have a cervical MRI immediately following the injury date (and not until the May 2023 cervical MRI that was recommended by Dr. Liu).  Dr. Mathur believed Plaintiff's then-current symptoms were related to a chronic process, not the February 19, 2020, bus incident.  Further, Dr. Mathur questioned whether her current symptoms were coming from the cervical spine at all, as the EMG findings had shown no evidence of cervical radiculopathy.
At the time of the hearing before the Senior Deputy Commissioner, the only treatment that Defendant is authorizing for Plaintiff is the treatment with Dr. Finkel for her headaches.  Plaintiff continues to have headaches on the left side of her head.  Plaintiff still has trouble moving her head from side to side because of neck pain and stiffness.  She still has pain from the left side of her neck into the top of her left shoulder, and radiation of pain, numbness and tingling down her left arm and her entire left hand.  She also notes numbness from the inside of her left elbow to the end of her left pinky finger. 
With regard to Plaintiff's neck condition, Defendant contends that Plaintiff did not make any significant documented neck complaints from April 2020 until March 2022, when Dr. Kuremsky found her to be at MMI for her left shoulder condition, and that this absence of documented complaints supports their contention that Plaintiff's current neck condition is not causally related to either of the incidents that led to these claims.
In response to the medical questionnaire from the Senior Deputy Commissioner, the following medical providers have opined to a reasonable degree of medical certainty that at least part of Plaintiff's current neck and left upper extremity conditions are or may be causally related to the February 19, 2020, incident:  (1) Dr. Kuremsky - the incident "certainly could have" aggravated a pre-existing neck condition; (2) Dr. Edwards - the current neck and left upper extremity conditions are more likely than not related to the incident; the C6-C7 disc herniation likely preexisted the incident and was aggravated by the incident; the incident materially aggravated Plaintiff's preexisting neck condition and caused that condition to become symptomatic, and Plaintiff's current neck and left upper extremity conditions are related to that aggravation; further medical treatment for Plaintiff's cervical spine and left upper extremity conditions is directly related to the incident and is reasonably required to provide Plaintiff relief for those conditions; (3) Dr. Smoot - although the left upper extremity symptoms of pain, numbness and tingling are not related to the C6-C7 herniation, the incident caused injuries primarily to the left shoulder region, which required surgical intervention, and this resulted in secondary neck issues, such that some of Plaintiff's current neck and left upper extremity symptoms are related to the incident; (4) Dr. Liu - although the incident may have caused an aggravation of Plaintiff's pre-existing neck condition and caused her more pain, Dr. Liu does not know whether the neck and left arm pain are directly related to the incident; (5) Dr. Lewis - the neck symptoms for which he saw Plaintiff were directly related to the incident; (6) Dr. DeCriscio - the neck complaints are associated more with her left shoulder complaint, as portions of the rotator cuff musculature extend into the neck region; the neck complaint was exacerbated by the incident; (7) Dr. Mathur - the neck complaints may be related to the September 2021 shoulder surgery, as the lack of shoulder mobility can result in muscular neck pain.  He further opined that Plaintiff's current left upper extremity condition is not related to her cervical spine, as there is no documentation of neck pain nor any loss of motion of the cervical spine during multiple office visits following the February 19, 2020, injury.  Whether her left upper extremity condition is related to her shoulder pathology, Dr. Mathur stated he would defer to Dr. Kuresmsky as the shoulder specialist.  
In response to the medical questionnaire from the Senior Deputy Commissioner, the following medical providers have opined to a reasonable degree of medical certainty that Plaintiff's C6-C7 disc herniation is not causally related to her February 19, 2020, injury.  Dr. Finkel opined that the finding of disc herniation at C6-C7 "is not likely to have been caused by the mechanism of injury and is a common finding."  Dr. Mathur opined that the C6-C7 disc herniation is not causally related to the work incident.  In formulating his opinion, Dr. Mathur noted that Plaintiff did not have significant neck complaints after the work incident and there is no evidence on the MRI of an acute injury.  Regarding the cervical radiculopathy associated with the C6-C7 disc herniation, Dr. Kuremsky opined to a reasonable degree of medical certainty that Plaintiff's symptoms of constant numbness and tingling from the left shoulder down to the left arm and fingers are not causally related to the February 19, 2020, incident or to the September 21, 2021, left shoulder surgery.  He explained that these symptoms "would have manifested themselves long before [the March 16, 2022, office visit]" if they were related to her compensable left shoulder injury and/or resulting surgery. 
Senior Deputy Commissioner Harris found and concluded that Plaintiff's compensable November 26, 2018, left shoulder and cervical/neck conditions had fully resolved by the end of 2018; and Plaintiff's current neck and left upper extremity conditions are causally related to the compensable February 19, 2020, injury.  As neither party appealed the compensability or causation of Plaintiff's November 26, 2018, conditions or the February 19, 2020, neck and upper extremity conditions, such determinations are binding and conclusive on appeal. 
Based upon the preponderance of the evidence in view of the entire record, including the expert medical testimony and stipulated medical records, the Full Commission finds that Plaintiff's current neck and left upper extremity condition, specifically pain from the left side of her neck into the top of her left shoulder, is causally related to the February 19, 2020, incident and is compensable.  The Full Commission further finds that the medical treatment Plaintiff has received for said condition, including treatment received from Dr. Kovacs, Dr. Kuremsky, Dr. Mask, and Dr. Smoot, is directly related to her compensable February 19, 2020, injury, and that such treatment is medically necessary to effect a cure, provide relief, and lessen the period of disability.
Based upon the preponderance of the evidence in view of the entire record, the Full Commission finds that Plaintiff's current cervical radiculopathy condition, including her C6-C7 disc herniation and radiating pain, numbness, and muscle weakness in the neck and left shoulder, arm, and hand, as opposed to the specific pain from the left side of her neck into the top of her left shoulder, is not causally related to the February 19, 2020, incident or resulting left shoulder surgery and is therefore not compensable.  In reaching this finding, the Full Commission considers the causation opinion of the treating orthopedic surgeon, Dr. Kuremsky, who began treating Plaintiff on April 1, 2020, and performed left shoulder surgery on September 21, 2021.  Since Plaintiff first reported pain, numbness, and tingling down her left arm and into her entire left hand on March 16, 2022, Dr. Kuremsky opined, and the Full Commission finds that Plaintiff's radiation of pain, numbness, and tingling down her left arm and into her entire left hand is not causally related to the February 19, 2020, incident.  The Full Commission further finds that Plaintiff's treatment with Dr. Lewis and Dr. Liu is related to Plaintiff's current unrelated cervical radiculopathy condition.  In reaching this finding, the Full Commission considers the medical questionnaire responses of Dr. Liu, who was unable to provide a causation opinion that Plaintiff's cervical radiculopathy is related to the work incident.
Based upon the preponderance of the evidence in view of the entire record, the Full Commission finds Plaintiff has failed to establish that her current ulnar nerve, tinnitus, or left ear hearing loss conditions are causally related to the compensable November 26, 2018, and February 19, 2020, injuries.  In reaching this finding, the Full Commission notes that the October 25, 2022, EMG showed only mild sensory-only ulnar neuropathy, which Dr. Smoot, the diagnosing physician, characterized as an incidental finding unrelated to either the compensable injury or the subsequent shoulder surgery.  Regarding the auditory claims, Dr. Fleischman admitted that, in the absence of prior audiograms, causation cannot be ascertained; consequently, the Full Commission assigns no weight to her speculative opinion regarding the 2020 incident.  These findings are further corroborated by Dr. Kovacs and Dr. DeCriscio, who both opined that these conditions are not causally related to the compensable injuries.  Accordingly, the Full Commission finds that those conditions are not compensable in either claim. 
Based upon the preponderance of the evidence, the Full Commission finds that Plaintiff has failed to establish that Defendant failed to direct medical treatment in a prompt and adequate manner, or that a change in treating physicians is reasonably necessary to effect a cure, provide relief, or lessen the period of disability.  The Full Commission specifically finds that Defendant provided timely medical care through authorized providers, including Dr. Kovacs, Dr. Kuremsky, Dr. Smoot, and the medical providers at Raleigh Urgent Care, and Plaintiff failed to demonstrate any lack of reasonable treatment created an emergency justifying unauthorized care.  In reaching this finding, the Full Commission notes that, at the time of her unauthorized evaluations with Dr. Liu on May 18, 2023, Dr. Madan on March 3, 2020, and Dr. Ramasunder on October 20, 2022, Plaintiff was already receiving authorized treatment.  Accordingly, Plaintiff is not entitled to have Defendant pay for this unauthorized treatment or a change in treating physicians to Duke Spine. 
Based upon the preponderance of the evidence in view of the entire record, including a review of the claim payment history, the Full Commission finds that Plaintiff has received all the temporary total disability compensation payments to which she has been entitled and that Defendant did not miss any payments in February 2023.  In reaching this finding, the Full Commission considers Defendant-Administrator's claim payment history, which offers a comprehensive record of disbursements.  
Based upon the preponderance of the evidence in view of the entire record, the Full Commission finds that Plaintiff reached MMI regarding her left shoulder condition on March 16, 2022, and on January 8, 2024, regarding her headache condition.  The Full Commission also finds that Plaintiff received a 10% permanent partial impairment rating to the left arm, entitling her to 24 weeks of compensation, and a 30% permanent partial impairment rating to the head.  In reaching these findings, the Full Commission considers the March 16, 2022, visit note from Dr. Kuremsky, the January 8, 2024, visit note from Dr. Finkel, as well as the medical questionnaire responses of Dr. Finkel.  Additionally, the Full Commission, in its discretion, finds that $2,000.00 is the fair and equitable amount of proper compensation for Plaintiff's injury to the head.  
Based upon the preponderance of the evidence in view of the entire record, the Full Commission finds that Plaintiff has received ongoing temporary total disability benefits since the February 19, 2020, incident and remains out of work.  The Full Commission also finds that any permanent partial disability benefits otherwise payable for the left arm or headache conditions have been extinguished by credit for the post-MMI temporary total disability payments after her respective MMI dates of March 16, 2022, and January 8, 2024.  Because Plaintiff is entitled to ongoing temporary total disability benefits until further ordered by the Commission, and the amount of those benefits already paid exceeds the value of her permanent disability ratings, any permanent partial disability rating is exhausted by the credit Defendant is entitled to receive pursuant to N.C. Gen. Stat. § 97-42. 
Based upon the preponderance of the evidence in view of the entire record, the Full Commission finds that the video of the February 19, 2020, incident is credible.  Plaintiff provided no evidence to suggest that said footage was altered or tampered with in any manner. 
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Based upon the foregoing Stipulations and Findings of Fact, the Full Commission makes the following:
CONCLUSIONS OF LAW
Plaintiff sustained compensable injuries by accident on November 26, 2018, and February 19, 2020.  N.C. Gen. Stat. § 97-2(6) (2025).
As neither party appealed the compensability or causation of Plaintiff's November 26, 2018, conditions, the February 19, 2020, neck and upper extremity conditions, or the current headache condition, such determinations are binding and conclusive on appeal.  N.C. Gen. Stat. § 97-85 (2025); N.C. Gen. Stat. § 97-86 (2025); 11 NCAC 23A .0701(a); 11 NCAC 23A .0701(d) (2025). 
Following a compensable injury, new injuries that are the "direct and natural result" of the original compensable injury may also be compensable.  Chaffins v. Tar Heel Capital Corp., 230 N.C. App. 156, 159, 750 S.E.2d 536, 539 (2013).  "To assess whether a treatment is directly related, the Court of Appeals examines the strength of the 'causal relationship' between the condition that requires treatment and the workplace injury."  Kluttz-Ellison v. Noah's Playloft Preschool, 385 N.C. 692, 693, 898 S.E.2d 750, 752 (2024).  "This requires a showing that the condition for which treatment is sought (1) was caused by the workplace injury; (2) was aggravated by the workplace injury; or (3) did not require medical treatment or intervention of any kind before the workplace injury but now requires treatment solely to remedy the workplace injury."  Id.
"[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."  Click v. Pilot Freight Carriers, 300 N.C. 164, 167, 265 S.E.2d 389, 391 (1980).  Medical testimony that relies on speculation and conjecture, or a mere temporal connection, is not sufficiently reliable to qualify as competent evidence concerning the nature and cause of the injury.  Young v. Hickory Bus. Furn., 353 N.C. 227, 230, 538 S.E.2d 912, 915 (2000).  Additionally, all of the causation evidence must meet the standard necessary to establish a causal link.  Holley v. ACTS, Inc., 357 N.C. 228, 234, 581 S.E.2d 750, 754 (2003).
Here, the Full Commission concludes that Plaintiff has not established by competent and credible medical opinion that her current left ulnar nerve, tinnitus, and left ear hearing loss conditions were caused or aggravated by the November 26, 2018, or February 19, 2020, compensable incidents.  In light of the October 25, 2022, EMG and medical opinions from Dr. DeCriscio, Dr. Fleischman, and Dr. Kovacs, Plaintiff's claim for benefits for these conditions must be denied.  § 97-2(6) (2025). 
The Form 60 filed by Defendant on December 12, 2018, constitutes an award of the Commission as to Defendant's acceptance of liability for an injury by accident on November 26, 2018, resulting in injuries to the left arm/shoulder and cervical spine/neck.  Likewise, the Form 63, Section 1, filed by Defendant on February 27, 2020, constitutes an award of the Commission as to Defendant's acceptance of liability for an injury by accident on February 19, 2020, resulting in injuries to the head and left shoulder.  N.C. Gen. Stat. § 97-82(b) (2025)  
N.C. Gen. Stat. § 97-25 requires employers to pay medical compensation when the treatment lessens the period of disability, effects a cure, or gives relief.  Little v. Penn Ventilator Co., 317 N.C. 206, 210, 345 S.E.2d 204, 207 (1986); N.C. Gen. Stat. § 97-2(19), 97-25 (2025).  "Logically implicit" in this statute is the requirement that the medical treatment be "directly related to the original compensable injury."  Pittman v. Thomas & Howard, 122 N.C. App. 124, 130, 468 S.E.2d 283, 286, disc. review denied, 343 N.C. 513, 472 S.E.2d 18 (1996); N.C. Gen. Stat. § 97-82(b) (2025).  
As a result of Defendant's acceptance of Plaintiff's November 26, 2018, left arm/shoulder and cervical/neck injury via the filing of a Form 60, Plaintiff is entitled to a rebuttable presumption that further medical treatment for her current neck and left upper extremity condition, specifically pain from the left side of her neck into the top of her left shoulder, is directly related to her admittedly compensable injury.  N.C. Gen. Stat. § 97-82(b) (2025); Parsons v. Pantry, Inc., 126 N.C. App. 540, 542, 485 S.E.2d 867, 869 (1997).  Thus, it is Defendant's burden to show that the treatment Plaintiff has received for her current neck and left upper extremity condition is not related to her compensable left arm and cervical injury on November 26, 2018.  Id.  Here, the Full Commission concludes that Defendant has failed to present sufficient evidence to rebut the Parsons presumption with respect to Plaintiff's compensable November 26, 2018, injury.  Accordingly, pursuant to N.C. Gen. Stat. § 97-25, the Parsons presumption has not been rebutted, and Defendant is responsible for paying for the medical treatment that has been recommended for Plaintiff's current neck and left upper extremity condition, specifically pain from the left side of her neck into the top of her left shoulder.  Id.
As a result of Defendant's acceptance of Plaintiff's February 19, 2020, head and left shoulder injury via the filing of a Form 63, Section 1, Plaintiff is entitled to a rebuttable presumption that further medical treatment for her current cervical radiculopathy condition, including her C6-C7 disc herniation and radiating pain, numbness, and muscle weakness in the neck and left shoulder, arm, and hand, is directly related to this admittedly compensable injury.  Id.  Thus, it is Defendant's burden to show that the treatment Plaintiff has received for her current cervical radiculopathy condition is not related to her compensable head and left shoulder injury on February 19, 2020.  Id.  Here, the Full Commission concludes that Defendant has presented sufficient competent medical expert testimony that Plaintiff's current cervical radiculopathy condition is unrelated to her compensable injuries.  Thus, Defendants rebutted the Parsons presumption.  The burden then shifted to Plaintiff, and the Full Commission has found as fact that Plaintiff offered insufficient evidence from which to find by the preponderance of the evidence that medical treatment related to her current cervical radiculopathy condition is reasonably necessary or directly related to Plaintiff's compensable injuries.  Accordingly, pursuant to N.C. Gen. Stat. § 97-25, the Parsons presumption has been rebutted, and Defendant is not required to authorize or pay for medical treatment or mileage related to Plaintiff's unrelated current cervical radiculopathy condition, including her treatment with Dr. Liu.  Id.
The employer generally has the right to direct the injured employee's medical treatment.  Kanipe v. Lane Upholstery, 141 N.C. App. 620, 623, 540 S.E.2d 785, 788 (2000) (citing Schofield v. Great Atl. & Pac. Tea Co., Inc., 299 N.C. 582, 586, 264 S.E.2d 56, 60 (1980)).  This right to direct medical care includes the right to select the treating physician.  N.C. Gen. Stat. § 97-25; Schofield, 299 N.C. at 586, 264 S.E.2d at 60; Thompson v. Fed. Express Ground, 175 N.C. App. 564, 568, 623 S.E.2d 811, 813 (2006); Kanipe, 141 N.C. App. at 623-24, 540 S.E.2d at 788.  As Defendant provided timely and adequate medical care through authorized providers, and Plaintiff failed to demonstrate an emergency justifying unauthorized care, the Full Commission concludes that she is not entitled to a change in physicians or to direct her own care at Duke Spine Center.  N.C. Gen. Stat. § 97-25 (2025). 
Maximum medical improvement refers to the point at which the claimant's injury has stabilized and the healing period has ended.  Collins v. Speedway, 165 N.C. App. 113, 120, 598 S.E.2d 185, 190 (2004).  Here, based upon the competent medical records, the Full Commission concludes that Plaintiff reached maximum medical improvement regarding her left shoulder condition on March 16, 2022, and her headache condition on January 8, 2024.  As a result of the February 27, 2020, compensable left shoulder injury, Plaintiff sustained a 10% permanent partial impairment rating to her left arm, which entitles her to compensation for a period of 24 weeks pursuant to N.C. Gen. Stat. § 97-31(13) (2025); Carpenter v. Industrial Piping Co., 73 N.C. 309, 311, 326 S.E.2d 328, 330 (1985). 
Pursuant to N.C. Gen. Stat. § 97-31(24), where "no compensation is payable under any other subdivision of this section," Plaintiff may be entitled to payment of compensation up to $20,000.00 for the loss of or permanent injury to any important external or internal organ.  See Also Harrison v. Gemma Power Sys., LLC, 369 N.C. 572, 582, 799 S.E.2d 855, 862 (2017) (stating that the North Carolina Industrial Commission Rating Guide "recognizes that 'in many cases there are intangible factors which cannot be stereotyped but must be considered,' including but not limited to 'pain, weakness, and dexterity'" (emphasis added)).  Based upon the medical records and the opinion of Dr. Finkel, the Full Commission concludes that Plaintiff has sustained permanent impairment from her headache condition for which Plaintiff is entitled to compensation and for which no compensation is payable under any other subdivision of N.C. Gen. Stat. § 97-31.
The amount of an award pursuant to N.C. Gen. Stat. § 97-31(24) is within the discretion of the Commission.  Aderholt v. A.M. Castle Co., 137 N.C. App. 718, 723, 529 S.E.2d 474, 478 (2000).  In its discretion, the Full Commission concludes Plaintiff is entitled to proper and equitable compensation in the amount of two thousand dollars ($2,000.00) for permanent impairment from her current headache condition.
At the point of maximum medical improvement, Plaintiff is required to elect the more favorable remedy between N.C. Gen. Stat. § 97-29 compensation for temporary total disability and compensation under N.C. Gen. Stat. § 97-31 for permanent partial disability.  Collins v. Speedway Motor Sports Corp., 165 N.C. App. 113, 119, 598 S.E.2d 185, 190 (2004).  Here, the temporary total disability compensation Plaintiff received pursuant to N.C. Gen. Stat. § 97-29 after she reached maximum medical improvement exceeds the amount she is entitled to receive for permanent partial disability of her head and left shoulder under N.C. Gen. Stat. § 97-31.  The Full Commission concludes that temporary total disability compensation is therefore the more favorable remedy, and Plaintiff received those benefits "in lieu of" compensation for permanent partial impairment.  Accordingly, Defendant is entitled to a credit for all temporary total disability compensation paid on or after March 16, 2022, the date Plaintiff reached maximum medical improvement for her left shoulder, and on or after January 8, 2024, the date Plaintiff reached maximum medical improvement for her headache condition.  See Collins, supra.
* * * * * * * * * *
Based upon the foregoing Stipulations, Findings of Fact, and Conclusions of Law, the Full Commission enters the following:
AWARD 
Defendant shall continue to pay Plaintiff weekly temporary total disability compensation until further order of the Commission.
Subject to the provisions of N.C. Gen. Stat. § 97-25.1, Defendant shall authorize and pay for all medical treatment, incurred or to be incurred, necessitated by Plaintiff's compensable February 19, 2020, injury for so long as such treatment is reasonably required to effect a cure, give relief, or lessen any period of disability.  Defendant shall direct Plaintiff's medical treatment for Plaintiff's current neck and left upper extremity condition, specifically pain from the left side of her neck into the top of her left shoulder, and select the physician or physicians to treat those conditions.
Plaintiff's claim for benefits related to her current cervical radiculopathy condition, including her C6-C7 disc herniation and radiating pain, numbness, and muscle weakness in the neck and left shoulder, arm, and hand, is hereby DENIED.
Plaintiff's claim for benefits related to her current left ulnar nerve, left ear hearing loss, and tinnitus conditions is hereby DENIED.
Plaintiff's claim for permanent partial disability compensation is hereby DENIED.
Plaintiff's claim for reimbursement for unauthorized medical treatment and unauthorized medical travel is hereby DENIED.

Commissioners GOODMAN and TAYLOR concur. 

The Full Commission notes that Defendant actually filed a Form 63, Section 1, Notice to Employee of Payment of Compensation Without Prejudice or Payment of Medical Benefits Only Without Prejudice, on February 27, 2020.  The stipulated exhibits do not include a Form 60, Employer's Admission of Employee's Right to Compensation, admitting liability for the February 19, 2020, injury.  However, based upon a review of the Industrial Commission's file, including Defendant's filings, Defendant does not contest the compensability of Plaintiff's February 19, 2020, incident. 
Senior Deputy Commissioner Harris and the parties attempted to locate Dr. Gaught but were unable to do so.  As such, Senior Deputy Commissioner Harris was unable to send a medical questionnaire to Dr. Gaught.
 Senior Deputy Commissioner Harris sent a medical questionnaire to Dr. Ramasunder and followed up repeatedly but never received a response.

I.C NOS. 18-052002 & 20-007737		Page 1