The importance of diagnostic studies in defeating a claim for extensive wage loss and permanent impairment and permanent total disability. This case involves a case that went to hearing on December 4, 2018 on the issues of medical expenses, recommended medical care, wage loss for numerous periods, permanent partial disability and permanent total disability benefits. The Petitioner alleged she a back injury – with a host of other symptoms and conditions she believed was related to the work incident – after helping an obese patient move from her bed to the bathroom. The Petitioner received a short course of conservative care and then had no care until an alleged coughing fit caused a flare up in back pain now with radicular symptoms into the right lower extremity. The Medical Panel disagreed and indicated that the flare up was due to pre-existing degenerative conditions. The Petitioner objected and the claim was remanded back to the Medical Panel for clarification of their opinion related to the flare up in pain. The Panel and the Judge determine that although physical therapy records suggest a worsening of pain, there was no specific diagnosis in those records determining a causation of worsening pain. The Court stated: “The Commission has consistently held that medical causation must be established through medical provider opinion statements, not through a claimant’s subjective reporting of her symptoms.” Additionally, the Court and the Panel relied on the fact that the initial MRI showed no acute injury. Given this, the Panel determined that three months after the incident, the industrial injury was not clinically significant in causing Petitioner’s symptoms. There were no opinions to the contrary from any treating provider. Therefore, the Court determined – again – that the Petitioner’s coughing episode severed medical causation. All medical (for the low back only) and wage loss benefits after October 24 2017 were denied and dismissed. All permanent partial disability (PPD) benefits and permanent temporary disability (PTD) benefits were denied and dismissed.