On Dec. 4, 2009, plaintiff Thomas Ramar, a retired man in his 70s, was driving on Meridian Avenue, near West San Carlos Street in San Jose, when he was rear-ended by a vehicle operated by James Jacobson. Ramar claimed to his teeth, neck and lower back. Ramar sued Jacobson, alleging the defendant was negligent in the operation of his vehicle. Jacobson conceded liability, but disputed damages., Within four hours of the accident, Ramar sought medical care for headaches, and pain to his neck and lower back, which warranted an MRI of his neck, mid-back and lower back within 24 hours. He presented to a minor injury pain clinic run by Kaiser. Ramar also claimed he hit his head on the steering wheel during the accident, fracturing two teeth, #8 and #7. He subsequently underwent endodontic treatment and prosthetic replacement (caps). Ramar claimed that although he received maintenance chiropractic care as part of his previous disability, he was regularly active in biking, hiking and occasionally playing golf. However, he claimed that post-accident, his lower back condition worsened, resulting in radicular symptoms and severe unrelenting headaches. Thus, Ramar alleged he required lower back and neck surgery due to the subject accident. The plaintiff’s orthopedic surgeon opined that Ramar already had degenerative changes and trauma, but that his lower back and neck changes were attributed to the subject accident. Defense counsel noted that Ramar was a fireman for 30 years prior to the accident and was retired with 100 percent disability due to cumulative , including throwing out his lower back when he carried an overweight person out of a house. Counsel also noted that Ramar had a benign tumor removed from his cervical spine and was medically released on full disability, but had continuous MRIs throughout the years to monitor his progress. The defense’s neurosurgery expert opined that Ramar was not a surgical candidate, as Ramar was able to continue hiking post-accident and only treated his pain with over the counter ibuprofen. He testified that a surgical candidate would be one that is no longer able to walk and who would need prescription strength medicine. The expert also testified that Ramar could have the alleged surgeries, as anyone could, but that due to Ramar’s age, he would be fraught with perils. Defense counsel noted that eight or nine months after the subject accident, Ramar was involved in another rear-ender on the freeway. The defense’s neurosurgery expert opined that there is no way to specifically target the subject accident as the cause of Ramar’s problems because the MRIs that were reviewed, which included MRIs from 2003, 2004, one a day after the subject accident (in 2009), and at the end of 2012, all showed severe, age-related degenerative changes in Ramar’s neck and back, even before the subject accident. He also testified that the MRIs showed degenerative changes since 1985 and moving forward and that by the 2009 MRI, these changes were severe. Defense counsel noted that the plaintiff’s orthopedic surgery expert was not an ongoing treating physician of Ramar’s, but, instead, was referred by plaintiff’s counsel. Defense counsel contended that before the subject accident, Ramar was already treating with a chiropractor consistently, and that after the subject accident, Ramar still continued to do so. Counsel also contended that it was not until Ramar’s third visit with his dentist (post-accident) that the tooth fractures were mentioned. However, according to the dentist’s medical records, the fractures were diagnosed in 2007 as minor. Thus, on cross-examination, the plaintiff’s dental expert admitted that untreated minor fractures can become worse over time, much like a star in a windshield will spider-web out over time. In addition, defense counsel contended that both the treating trauma surgeon that Ramar presented to at the pain clinic and Ramar’s dentist answered that they did not notice any facial trauma when they first saw Ramar.