ÿWPC8 (y¹lz”¤½W8m ØàÃà<\¥OXu€ÞÔê¯%Æ}©9ñaNëîb À0`û¦´W¯{æRW½hܱM׊^7ÂWÉi«5K­øúeÓç·€°õ~õÞN®ë݈#œ$¥Á…QT0õ*û~Ïõþ`saDÈo€œ Ÿ!qAÚ¡ä27в¶ÑÛ¼0£5UC30>ñìÕkvÞëˆ\$ ¢¨ú·%—J“¬Ê©‡»õëédŒÅjNNÊ7‘¾:‰ öb3¯6§“v£¢m^úàëñhñ1š R˜{¬_Q™Ó“|p2í]ê–ùÜÌƽ´ÀöD<ɱ~»~r\˜â¢Ä5RCx‚@{Ä|÷N­*ÇÁáN2,dÏ)…ÎaÅè—DŠ¡w^ÄVòp¡Ë"±û7Á˜=¤F³€GFå3Æ™_². è!ìOy'ìÅ…*2‰ìíšíKE6û6iQ´Èô"‰ÇõÒ¦„< 5É\±f—ðb#Á\ % ^ # 0ˆ/ U N· w 4 z Ò— i x mz U @‘ ÆÑ Æ— Æ] Æ#éNñ/ó 0D"Eff 0Ãhhhhhhhhhhhhhhhhhhhhhhb++++++++++++++++++++++++++++++++++++ 0ë3333 B 0¤; D5ß D- 0KAA ASŒÆß 0¤¥ 0DI A«˜HP LaserJet 4050 Series PCL 5eÈÈ,,,,ÈÈ0»Àp+s (`£ª$¡¡Ñ€.ÑÑ8€½­»»d»»d8ÑÑ ý ÑÓ  Ó(í€"  Z6Times New Roman RegularXq+ œ$ ˜C:\PROGRA~1\COREL\WORDPE~1\TEMPLATE\CUSTOM~1\REVISE~1.WPTC:\Program Files\Corel\WordPerfect Office 2000\Template\Custom WP Templates\revised standard opinion.wpt3|xÿU‹ÿÀÀÀ(ÆúI Z‹(Times New Roman Level 1Level 2Level 3Level 4Level 5‚Level 1Level 2Level 3Level 4Level 5„Level 1Level 2Level 3Level 4Level 5…Level 1Level 2Level 3Level 4Level 5  %Ý ƒR|{$ÝÓ  Óà  àòòÚ  Ú1Ú  ÚóóÔ€ôîÕò»»ÔÝ  ÝÔ_ÔÔ€ ôîÕòòôîÕÔAlthough€the€issues€concerning€the€employeeððs€impairment€ratings€and€the€extent€of€her€disability€were€notÐ ° Ðreached€by€the€Panel,€we€find€that€the€trial€court€properly€resolved€these€questions.€€Moreover,€we€find€that€the€evidenceÐ tÄ Ðdoes€not€preponderate€against€the€trial€courtððs€decision€to€commute€only€twenty€percent€of€the€award€to€a€lump€sum.€(#Ã$òòÚ  Ú0Ú  Úóó(›2tÏ$§§Ý ƒ£ª!ÝÑ€.ÑÑ8€Mõ»»dXXdì8ÑÑ ý ÑÓ  ÓÝ  ÝÔ€ »Mõ»»»Ô- ù-(|G2|{$¤¤Ý ƒ£ª!ÝÑ€.ÑÑ8€Mõ»»dXXdì8ÑÑ ý ÑÓ  ÓÝ  Ýà  àòòÚ  Ú0Ú  ÚóóÔ€ôîÕò»»Ô d(|3Ik$££Ý ƒ£ª!ÝÑ€.ÑÑ8€Mõ»»dXXdì8ÑÑ ý ÑÓ  ÓÝ  ÝVVVV)ÿÿ!dxdx)!ÈÈÈÈdxdx( ±þ$’’ò òFigure€Ú  Ú1Ú  Úó ó^_X`YEþÿ<<CÿÿƒLevel 1Level 2Level 3Level 4Level 5(|3Ik$¢¢Ý ƒ£ª!ÝÑ€.ÑÑ8€Mõ»»dXXdì8ÑÑ ý ÑÓ  ÓÝ  Ý($$””ò òÚ  Ú1Ú  Úó óX[Z&OLE 2.0 Box <=8ÿÿÿÿÿÿÿÿÿÿCÿÿ HKKKKÝ ƒ£ª!ÝÑ€.ÑÑ8€Mõ»»ddÈ8ÑÑ ý ÑÓ  ÓÝ  ÝÔ_ÔÑ  ÑÑ ùý ÑÑ  ÑÔ€¼Mõ»»»ÔÑ8€ QXXdì»»d8ÑÑÈÑà@™ ™ ìàÔ€ ¼Mõ»»¼MõÔÔ‡ î ¶î» ¼MõÔIN€THE€SUPREME€COURT€OF€TENNESSEEˆÐ ° Ðà@kk$ìàAT€NASHVILLEÔ#† ¼Mõ»î î ¶F#ԈРÖ& Ðà0  àà0` (#(#àà0¸ ` (#` (#àà0¸ (#¸ (#àAssigned€on€Briefs€May€1,€2001ÐüL(#(# ÐÓ  ÓÔ‡ X QX» ¼MõÔÌò òÔ#† ¼Mõ»X X Q„#ÔMARGARET€TOBITTòòóó€v.€BRIDGESTONE/FIRESTONE,€INC.òòóóÔ‡ X QX» ¼MõÔó óÐ úJ ÐÌà@@½½ìàò ò€Appeal€€by€Permission€from€the€Supreme€Court€Ð ú J ÐSpecial€Workersðð€Compensation€Appeals€PanelÐ æ 6 ÐCircuit€Court€for€Warren€CountyÐ Ò " Ðà@@øøìàNo.€9351€€€€€€Hon.€Charles€D.€Haston,€JudgeÐ ¾   ÐÌÌà@@ìì*ìàßA€V) °°` d€÷E<` AßÐ ‚Ò  ÐÌà@@TTìàNo.€M2000„00279„SC„WCM„CV€„€Filed€August€29,€Ô_Ô2001Ô_ÔÐ }Í  ÐÌßA€V) °°` dE<T` AßÐ U¥ Ðó óÌò òó óÓ  ÓÔ#† ¼Mõ»X X Q#Ôà  àÔ€ X QX» ¼MõÔIn€this€workersðð€compensation€case,€the€employer,€Bridgestone/Firestone,€Inc.,€has€appealedÐ P  Ðfrom€a€judgment€of€the€Circuit€Court€of€Warren€County€awarding€the€employee,€Margaret€Tobitt,Ð <Œ Ðfifty€percent€permanent€partial€disability€benefits€to€the€body€as€a€whole,€with€twenty€percent€of€theÐ (x Ðaward€commuted€to€a€lump€sum.€€The€trial€court€found€that€the€employee€suffered€an€aggravationÐ d Ðof€a€pre„existing€jaw€condition€after€she€was€struck€by€a€car€while€walking€through€the€employerððsÐ P Ðparking€lot.€€The€employer€appealed,€arguing€that€(1)€the€employee€failed€to€prove€that€she€sufferedÐ ì< Ðan€injury€arising€out€of€her€employment,€(2)€the€trial€court€incorrectly€combined€the€employeeððsÐ Ø( Ðmedical€impairment€ratings,€and€(3)€the€award€of€fifty€percent€was€excessive.€€The€Special€WorkersððÐ Ä ÐCompensation€Appeals€Panel,€upon€reference€for€findings€of€fact€and€conclusions€of€law€pursuantÐ ° Ðto€Tenn.€Code€Ann.€ðð50„6„225(e)(3),€found€that€there€was€insufficient€evidence€of€causation€toÐ œì Ðwarrant€an€award€of€benefits€and€thus€reversed€the€trial€courtððs€judgment.€€Thereafter,€the€employeeÐ ˆØ Ðfiled€a€motion€for€full€Court€review€of€the€Panelððs€decision€pursuant€to€Tenn.€Code€Ann.€ðð50„6„Ð tÄ Ð225(e)(5)(B).€€We€granted€the€motion€to€consider€whether€the€evidence€preponderates€against€theÐ `° Ðtrial€courtððs€finding€that€the€employeeððs€injury€arose€out€of€her€employment.€€After€carefullyÐ L œ Ðexamining€the€record€and€considering€the€relevant€authorities,€we€agree€with€the€trial€courtððs€findingÐ 8!ˆ  Ðthat€the€employee€established€a€causal€connection€between€her€injury€and€being€struck€by€the€car.€Ð $"t! ÐAccordingly,€the€trial€courtððs€judgment€is€affirmed.׃×Ý ƒ#ÃÝòòÚ  Ú1Ú  ÚóóÝ  Ý×  ×Ð #`" ÐÌÓ¡Óò òTenn.€Code€Ann.€ðð50„6„225(e);€Findings€of€Fact€and€Conclusions€of€Law€by€SpecialÐ è$8 $ ÐWorkersðð€Compensation€Appeals€Panel€Reversed;€Judgment€of€the€Circuit€Court€AffirmedÐ Ô%$!% Ðó óÌâ âÐ ¬'ü"'ù ÐòòÓ  ÓÓ=€Mõ»Ð»dÐd=ÓFrankóó€F.€Ô_ÔDòòrowotaÔ_Ôóó,€III,€delivered€the€opinion€of€the€court,€in€whichòòóó€òòóóJòòaniceóó€M.€Hòòolderóó,€andòòóóÐ ° ÐòòWilliam€M.€Barker€óó,€JJ,€joined.€€òòE.€Riley€Anderson,€C.óó€J.,€filed€a€dissenting€opinion.€€Ô_ÔAòòdolphoÔ_ÔóóÐ œì ÐA.€Bòòirch€Jr.óó,€J.€not€participating.Ð ˆØ Ðâ âÌB.€Timothy€Pirtle,€McMinnville,€Tennessee,€for€the€appellant,€Bridgestone/Firestone,€Inc.Ð `° ÐÌJohn€L.€Norris,€Nashville,€Tennessee,€for€the€appellee,€Margaret€Tobitt.Ð 8 ˆ ÐÓ'ÓÌÌÌà@@OO&ìàò òOPINIONó óÐ è 8  ÐÌòòò òBackgroundóóó ó€Ð À  ÐÓ  ÓÌà  àMargaret€Tobitt€(ð ðemployeeðð)€was€employed€by€Bridgestone/Firestone,€Inc.€(ð ðemployerðð)€inÐ œì  Ðits€plant€as€an€operating€technician.€€The€employee€suffered€from€problems€related€to€herÐ ˆØ  Ðtemporomandibular€joints€(ð ðTMJðð),€which€were€not€work„related,€such€as€jaw€pain,€an€inability€toÐ tÄ Ðcompletely€open€her€mouth,€and€clenching€and€grinding€her€teeth.€€Her€treating€oral€andÐ `° Ðmaxillofacial€surgeon,€Dr.€Anthony€Urbanek,€performed€surgery€in€May€1995€to€remove€the€disksÐ Lœ Ðfrom€the€jaw€joints€on€both€sides€of€her€face.€€According€to€Dr.€Urbanek,€the€employee€was€doingÐ 8ˆ Ðð ðreasonably€wellðð€following€the€surgery€and€her€pain€had€diminished€by€fifty€percent€as€of€OctoberÐ $t Ð1995.€€Dr.€Urbanek€believed€that€the€employeeððs€prognosis€was€good€and€that€she€would€eventuallyÐ ` Ðreturn€to€work€without€significant€pain.€€According€to€the€employee,€she€ð ðwas€doing€fineðð€in€theÐ üL Ðmonths€following€the€May€1995€surgery.€€Ð è8 ÐÌà  àOn€November€8,€1995,€the€employee€was€leaving€work€when€she€was€struck€by€a€car€on€theÐ À Ðemployerððs€property.€€She€was€walking€to€the€employee€parking€lot€after€her€shift€ended€when€theÐ ¬ü Ðcar€hit€her€in€the€knees,€knocking€her€to€the€ground.€€She€felt€pain€in€her€knee€and€wrist€and€herÐ ˜è Ðð ðhead€hurt€instantly.ðð€€Susan€Peterson,€a€co„worker€who€was€walking€with€the€employee€at€the€timeÐ „Ô Ðof€the€accident,€saw€her€lying€on€the€pavement€with€her€head€against€a€curb.€€Ð pÀ ÐÌà  àThe€employee€was€treated€at€the€scene€by€paramedics.€€One€of€the€paramedics,€BrianÐ H!˜ ÐRaymond,€testified€that€the€employee€had€no€loss€of€consciousness,€was€awake,€€alert,€and€in€noÐ 4"„  Ðacute€distress.€€He€stated€that€the€employee€complained€of€pain€in€her€wrist€and€knee€and€that€heÐ  #p! Ðapplied€splints€to€her€arm€and€leg.€€A€cervical€collar€was€placed€on€the€employeeððs€neck,€whichÐ  $\" Ðrequired€Raymond€to€manipulate€her€head€and€jaw.€€Raymondððs€report€did€not€reflect€any€complaintsÐ ø$H # Ðby€the€employee€regarding€her€head€or€jaw.€€According€to€Raymond,€her€ð ðhead€and€neck€were€withinÐ ä%4!$ Ðnormal€limits.ðð€€Ð Ð& "% ÐÌà  àThe€employee€was€taken€to€a€hospital€where€she€was€treated€for€wrist€and€knee€injuries.€€TheÐ ¨(ø#' Ðemployee€testified€that€while€in€the€emergency€room€she€mentioned€ð ðseveral€timesðð€that€she€wasÐ ”)ä$( Ðhaving€pain€in€her€head.€€At€one€point€she€asked€a€nurse,€ð ðwhat€about€my€head?ðð€€ElizabethÐ €*Ð%) ÐMaynard,€a€co„worker€who€was€with€the€employee€in€the€emergency€room,€corroborated€theÐ l+¼&* Ðemployeeððs€testimony€that€she€asked€a€nurse€about€the€pain€in€her€head.€€Maynard€also€testified€thatÐ ° Ðshe,€Maynard,€asked€the€employee€how€her€knee€was€doing€and€the€employee€responded,€ð ðmy€kneeÐ œì Ðis€fine,€my€head€is€killing€me.ðð€€The€emergency€room€records€indicate€that€the€employee€was€treatedÐ ˆØ Ðfor€pain€in€her€arm€and€knee,€but€no€other€complaints€were€noted.€€Kristin€Stallard,€the€nurse€whoÐ tÄ Ðsigned€the€emergency€room€report,€had€no€independent€recollection€of€the€employee.€€The€nurse€whoÐ `° Ðactually€treated€the€employee€did€not€testify.€€Ð L œ ÐÌà  àOn€the€day€after€the€accident,€the€employeeððs€head€ð ðfelt€like€it€was€a€pumpkin.€€It€justÐ $ t Ðthrobbed,€and€it€felt€so€big.ðð€€The€employee€testified,€ð ðmy€whole€head€was€just€killing€me.ðð€€SheÐ  ` Ðdescribed€the€pain€to€a€nurse€at€the€employerððs€plant€and€obtained€permission€to€see€Dr.€Urbanek.€Ð ü L  ÐOn€November€10,€1995,€two€days€after€the€accident,€the€employee€returned€to€Dr.€Urbanek€andÐ è 8  Ðexplained€that€she€had€been€hit€by€a€car€and€was€having€severe€headaches€and€jaw€soreness.€€An€x„Ð Ô$  Ðray€was€performed€which€Dr.€Urbanek€believed€revealed€a€fracture€of€the€condyle€(the€ball€of€the€jawÐ À  Ðjoint).€€He€placed€the€employee€on€pain€medication€and€ordered€a€CT€scan,€which€did€not€reveal€aÐ ¬ü  Ðfracture.€€When€the€employeeððs€pain€failed€to€subside€following€conservative€treatment,€Dr.€UrbanekÐ ˜è  Ðwired€her€jaw€shut,€but€the€pain€continued.€€Dr.€Urbanek€then€performed€exploratory€surgery€on€theÐ „Ô  Ðemployeeððs€jaw€and€inserted€a€metal€replacement€for€the€disk€that€had€been€previously€removed.€€Dr.Ð pÀ ÐUrbanek€did€not€observe€any€fractures€during€this€surgery,€although€he€testified€that€the€employeeððsÐ \¬ Ðsymptoms€ð ðwere€consistent€with€damage€of€some€kind€consistent€with€a€fracture.ðð€€Despite€theÐ H˜ Ðnegative€diagnostic€test€results,€he€maintained€both€at€the€time€he€treated€the€employee€and€at€theÐ 4„ Ðtime€he€testified€that€the€employee€did€have€a€fracture€of€the€condyle€caused€by€the€accident.€Ð  p ÐAccording€to€Dr.€Urbanek,€the€employeeððs€symptoms€ð ðwere€consistent€with€additional€injury€to€herÐ  \ Ð[jaw]€joint.ðð€Ð øH ÐÌ€€€€€€€€€€After€the€surgery€performed€by€Dr.€Urbanek,€the€employee€continued€to€have€pain€in€her€jaw.€Ð Ð  ÐIn€addition,€nerve€damage€caused€by€the€surgery€caused€her€mouth€to€droop€and€left€her€unable€toÐ ¼  Ðclose€her€right€eye€or€lift€her€eyebrow.€€The€employeeððs€face€looked€like€she€had€a€stroke,€and€sheÐ ¨ø Ðhad€to€tape€her€right€eye€shut.€€She€could€not€blink€and€had€difficulty€eating.€Ð ”ä ÐÌà  àThe€employee€was€referred€to€Dr.€Samuel€McKenna,€an€oral€and€maxillofacial€surgeon,€toÐ l¼ Ðaddress€her€continuing€pain€and€the€nerve€damage€caused€by€the€most€recent€surgery.€€Dr.€McKennaÐ X ¨ Ðoperated€on€the€employee€in€September€1996€and€again€in€February€1998€in€an€effort€to€eliminateÐ D!” Ðthe€employeeððs€pain€and€correct€her€facial€symptoms.€€Although€these€surgeries€helped€with€theÐ 0"€  Ðsymptoms,€the€employee€continued€to€have€pain.€€Dr.€McKenna€opined,€based€on€the€history€givenÐ #l! Ðto€him€by€the€employee,€that€there€was€an€injury€to€the€jaw€joint€from€the€car€accident€and€that€theÐ $X" Ðsecond€surgery€performed€by€Dr.€Urbanek€was€required€as€a€result€of€that€accident.€€Like€Dr.Ð ô$D # ÐUrbanek,€his€impression€was€that€the€employee€had€fractured€her€lower€jaw.€€According€to€Dr.Ð à%0!$ ÐMcKenna,€a€fracture€ð ðwould€speak€some€to€the€magnitude€of€the€trauma€.€.€.€but€itððs€still€possible€toÐ Ì&"% Ðinjure€the€joint€without€a€fracture.ðð€€Dr.€McKenna€released€the€employee€to€return€to€work€underÐ ¸'#& Ðinstructions€to€avoid€any€trauma€to€her€face€and€jaw,€avoid€working€in€a€hard„hat€environment,€andÐ ¤(ô#' Ðavoid€exposure€to€vibrations.€€He€assessed€ten€percent€impairment€to€the€whole€body€for€the€jawÐ )à$( Ðinjury€resulting€from€the€car€accident.€€This€impairment€rating€did€not€take€into€account€the€damageÐ |*Ì%) Ðto€the€employeeððs€facial€nerves.€€Ð h+¸&* Їà  àThe€employee€also€saw€Dr.€Debra€Sherman,€an€ophthalmic€plastic€surgeon.€€Dr.€ShermanÐ ° Ðperformed€two€surgeries€to€improve€the€employeeððs€ability€to€close€her€eye€and€the€position€of€herÐ œì Ðeyebrow.€€Dr.€Sherman€was€unable€to€repair€the€employeeððs€involuntary€blink€function€and,Ð ˆØ Ðtherefore,€she€continues€to€suffer€blurred€vision€and€dryness€in€her€right€eye.€€Also,€she€is€unable€toÐ tÄ Ðmove€the€muscles€that€control€her€eyebrow€and€forehead.€€Dr.€Sherman€assessed€a€ten€percentÐ `° Ðimpairment€rating€based€on€the€damage€to€the€employeeððs€facial€nerves,€but€this€rating€did€not€takeÐ L œ Ðinto€account€the€impairment€related€to€her€jaw.€Ð 8 ˆ ÐÌà  àAside€from€the€medical€proof,€there€was€considerable€testimony€about€the€adverse€effect€ofÐ  ` Ðthe€employeeððs€injury€on€her€job€performance.€€Co„workers€of€the€employee€testified€that€prior€toÐ ü L  Ðthe€accident€she€had€a€great€attitude€and€was€a€hard€worker€in€an€environment€where€the€work€wasÐ è 8  Ðhot,€heavy,€and€involved€long€hours.€€After€the€accident,€however,€the€employee€has€had€a€difficultÐ Ô$  Ðtime€at€work.€€She€has€had€trouble€performing€some€of€her€duties€and€has€had€problems€with€co„Ð À  Ðworkers€complaining€that€she€was€not€ð ðpulling€her€full€load€on€the€floor,ðð€particularly€when€sheÐ ¬ü  Ðworked€with€her€eye€taped€shut.€€The€employee€cannot€use€hand€tools€because€of€vibrations€that€hurtÐ ˜è  Ðher€jaw€and€head,€and€she€cannot€operate€certain€equipment€such€as€fork€lifts.€€She€has€had€to€wearÐ „Ô  Ðgoggles,€put€drops€in€her€eyes€several€times€a€day,€and€must€watch€her€jaw€like€ð ðitððs€a€soft€spot€onÐ pÀ Ða€babyððs€head.ðð€€Although€the€employee€attempts€to€be€the€same€hard€worker€she€was€prior€to€theÐ \¬ Ðaccident,€her€condition€makes€it€very€difficult€for€her.Ð H˜ ÐÌà  àThe€trial€court€found€that€the€employeeððs€injury€arose€out€of€her€employment€and€awardedÐ  p Ðfifty€percent€permanent€partial€disability€to€the€whole€body.€€Twenty€percent€of€the€award€wasÐ  \ Ðcommuted€to€a€lump€sum.€€The€Special€Workersðð€Compensation€Appeals€Panel€reversed,€concludingÐ øH Ðthat€the€evidence€preponderated€against€the€trial€courtððs€finding€of€a€causal€relationship€between€theÐ ä4 Ðcar€accident€and€the€employeeððs€current€problems.€€The€Panel€opined€that€there€ð ðappears€to€be€noÐ Ð  Ðobjective€evidence€to€support€the€contention€that€the€[employee]€suffered€any€trauma€to€her€jaw€inÐ ¼  Ðthe€November€1995€work„related€accident.ðð€€€Thereafter,€we€granted€the€employeeððs€motion€for€fullÐ ¨ø ÐCourt€review€to€consider€whether€the€evidence€preponderates€against€the€trial€courtððs€finding€thatÐ ”ä Ðher€injury€arose€out€of€her€employment.€€Ð €Ð ÐÓ  ÓÌÌò òòòStandard€of€Reviewó óóóÐ D!” ÐÓ  Óà  àThe€standard€of€review€in€a€case€such€as€this€is€òòde€novoóó€upon€the€record€of€the€trial€court,Ð 0"€  Ðaccompanied€by€a€presumption€of€the€correctness€of€the€findings,€unless€the€preponderance€of€theÐ #l! Ðevidence€is€otherwise.€€Tenn.€Code€Ann.€ðð50„6„225(e)(2).€€When€issues€regarding€credibility€ofÐ $X" Ðwitnesses€and€the€weight€to€be€given€their€testimony€are€before€a€reviewing€court,€considerableÐ ô$D # Ðdeference€must€be€accorded€the€trial€courtððs€factual€findings.€€òòKrick€v.€City€of€Lawrenceburgóó,€945Ð à%0!$ ÐS.W.2d€709,€712€(Tenn.€1997).€€However,€this€Court€may€draw€its€own€conclusions€about€the€weightÐ Ì&"% Ðand€credibility€of€expert€testimony€when€the€medical€proof€is€presented€by€deposition,€as€it€was€here,Ð ¸'#& Ðsince€we€are€in€the€same€position€as€the€trial€judge€to€evaluate€such€testimony.€€òòKrickóó,€945€S.W.2dÐ ¤(ô#' Ðat€712;€òòOrman€v.€Williams€Sonomaóó,òò€Inc.óó,€803€S.W.2d€672,€676„77€(Tenn.€1994).Ð )à$( ÐÌÓ  Óòòò òÐ h+¸&* ÐCompensabilityóóó óÐ ° ÐÓ  Óà  àIn€order€to€be€eligible€for€workersðð€compensation€benefits,€an€employee€must€suffer€anÐ œì Ðð ðinjury€by€accident€arising€out€of€and€in€the€course€of€employment.ðð€€Tenn.€Code.€Ann.€ðð€50„6„Ð ˆØ Ð102(12).€€The€phrase€ð ðarising€out€ofðð€refers€to€the€cause€or€origin€of€the€injury.€€òòHill€v.€EagleÐ tÄ ÐBend€Mfg.,€Inc.óó,€942€S.W.2d€483,€487€(Tenn.€1997).€€An€injury€arises€out€of€employment€ð ðwhenÐ `° Ðthere€is€apparent€to€the€rational€mind,€upon€a€consideration€of€all€the€circumstances,€a€causalÐ L œ Ðconnectionðð€between€the€work€and€the€injury€for€which€benefits€are€sought.€€òòHouser€v.€Bi„Lo,Ð 8 ˆ ÐInc.óó,€36€S.W.3d€68,€71€(Tenn.€2001).€€In€most€cases,€causation€must€be€established€by€expertÐ $ t Ðmedical€evidence,€which€may€consist€of€medical€testimony€to€the€effect€that€a€given€incidentÐ  ` Ðð ðcould€beðð€the€cause€of€the€employeeððs€injury€when€there€is€also€lay€testimony€from€which€itÐ ü L  Ðreasonably€may€be€inferred€that€the€accident€caused€the€injury.€€òòResser€v.€Yellow€Freight€Sys.,Ð è 8  ÐInc.óó,€938€S.W.2d€690,€692€(Tenn.€1997).€€However,€an€employee€may€not€base€his€or€her€claimÐ Ô$  Ðon€speculative€or€conjectural€proof.€€òòHillóó,€942€S.W.2d€at€487.€€Ð À  ÐÌà  àWith€these€principles€in€mind,€we€review€the€record€in€the€present€case€to€determineÐ ˜è  Ðwhether€the€employeeððs€injury€arose€out€of€her€employment.€€The€specific€question€before€us€isÐ „Ô  Ðwhether€her€symptoms€were€merely€the€old€symptoms€from€the€pre„existing€TMJ€condition€orÐ pÀ Ðwhether€the€car€accident€and€resulting€surgeries€aggravated€the€pre„existing€TMJ€condition.€€€Ð \¬ ÐÌà  àThe€record€reflects€that€the€employee€was€being€treated€for€a€painful€problem€with€herÐ 4„ Ðnonwork„related€TMJ€condition,€which€resulted€in€Dr.€Urbanek€performing€surgery€in€May€1995.€Ð  p ÐAt€the€time€of€the€car€accident€in€November€1995,€the€employee€was€doing€ð ðreasonably€wellððÐ  \ Ðaccording€to€Dr.€Urbanek,€her€prognosis€was€good,€and€Dr.€Urbanek€expected€that€she€would€beÐ øH Ðable€to€return€to€work€without€significant€pain.€€According€to€the€employee,€she€ð ðwas€doing€fineððÐ ä4 Ðin€the€months€following€the€surgery.€€Ð Ð  ÐÌ€€€€€€€€€€When€the€employee€was€hit€by€the€car€on€November€8,€1995,€she€was€knocked€to€theÐ ¨ø Ðground€and€was€seen€lying€on€the€pavement€with€her€head€against€a€curb.€€The€employee€testifiedÐ ”ä Ðthat€ð ðher€head€hurt€instantly.ðð€€She€mentioned€the€pain€in€her€head€ð ðseveral€timesðð€in€theÐ €Ð Ðemergency€room,€and€at€one€point€asked€a€nurse,€ð ðwhat€about€my€head?ðð€€Maynard,€the€co„Ð l¼ Ðworker€who€was€with€the€employee€in€the€emergency€room,€corroborated€the€employeeððsÐ X ¨ Ðtestimony€that€she€asked€the€nurse€about€the€pain€in€her€head.€€Maynard€further€testified€thatÐ D!” Ðwhen€she€asked€the€employee€how€her€knee€was€doing,€the€employee€responded,€ð ðmy€knee€isÐ 0"€  Ðfine,€my€head€is€killing€me.ðð€€On€the€day€after€the€accident,€the€employeeððs€head€ð ðfelt€like€aÐ #l! Ðpumpkin.€€It€just€throbbed,€and€it€felt€so€big.ðð€€The€employee€testified,€ð ðmy€whole€head€was€justÐ $X" Ðkilling€me.ðð€€She€described€the€pain€to€a€nurse€at€the€employerððs€plant€and€obtained€permission€toÐ ô$D # Ðsee€Dr.€Urbanek.€€She€explained€to€Dr.€Urbanek€that€she€had€been€hit€by€a€car€and€was€havingÐ à%0!$ Ðsevere€headaches€and€jaw€soreness.€€Despite€negative€diagnostic€test€results,€Dr.€UrbanekÐ Ì&"% Ðmaintained€both€at€the€time€he€treated€the€employee€and€at€the€time€he€testified€that€the€employeeÐ ¸'#& Ðhad€fractured€her€jaw€in€the€accident.€€He€testified€that€her€symptoms€ð ðwere€consistent€withÐ ¤(ô#' Ðdamage€of€some€kind€consistent€with€a€fracture,ðð€and€that€after€the€accident€she€had€symptomsÐ )à$( Ðthat€ð ðwere€consistent€with€additional€injuryðð€to€her€jaw.€€He€had€to€wire€her€jaw€shut€and€laterÐ |*Ì%) Ðperform€surgery€that€caused€nerve€damage€that€left€the€employee€unable€to€close€her€right€eye,€liftÐ h+¸&* Ðher€eyebrow,€or€blink.€€Her€face€looked€like€she€had€a€stroke€and€she€had€to€keep€her€right€eyeÐ ° Ðtaped€shut.€€Ð œì ÐÌà  àDr.€McKenna,€who€performed€two€additional€surgeries,€testified€that€there€was€an€injuryÐ tÄ Ðto€the€jaw€joint€from€the€car€accident€and€that€the€surgery€performed€by€Dr.€Urbanek€thatÐ `° Ðdamaged€the€facial€nerves€was€required€as€a€result€of€that€accident.€€Like€Dr.€Urbanek,€hisÐ L œ Ðimpression€was€that€the€employee€had€fractured€her€lower€jaw.€€In€Dr.€McKennaððs€opinion,€theÐ 8 ˆ Ðpresence€of€a€fracture€ð ðwould€speak€some€to€the€magnitude€of€the€trauma€.€.€.€but€itððs€stillÐ $ t Ðpossible€to€injure€the€joint€without€a€fracture.ðð€€He€agreed€that€the€employee€had€not€fullyÐ  ` Ðrecovered€from€the€first€TMJ€surgery€at€the€time€of€the€accident,€but€that€ð ðit€looked€like€she€wasÐ ü L  Ðdoing€pretty€well.ðð€Ð è 8  ÐÌà  àBased€on€this€lay€and€medical€testimony,€we€conclude€that€the€evidence€preponderates€inÐ À  Ðfavor€of€the€trial€courtððs€finding€that€the€car€accident€aggravated€the€employeeððs€pre„existingÐ ¬ü  Ðcondition.€€Although€aggravation€of€a€pre„existing€condition€is€not€compensable€if€it€results€onlyÐ ˜è  Ðin€increased€pain,€there€is€evidence€in€this€record,€most€of€which€is€unrefuted,€that€there€was€anÐ „Ô  Ðanatomical€change€or€actual€progression€of€the€employeeððs€underlying€condition.€€òòSeeóó€òòSweat€v.Ð pÀ ÐSuperior€Industries,€Incóó.,€966€S.W.2d€31,€32„33€(Tenn.€1998).€€Unlike€many€workersððÐ \¬ Ðcompensation€cases€in€which€there€are€competing€medical€witnesses,€there€is€no€medical€opinionÐ H˜ Ðrefuting€causation€in€this€case.€€To€the€contrary,€the€testimony€of€the€doctors€supports€a€finding€ofÐ 4„ Ðtrauma€as€a€result€of€the€accident€that€necessitated€treatment€by€Dr.€Urbanek€which,€in€turn,€led€toÐ  p Ðdamage€to€the€employeeððs€facial€nerves.€€òòSeeóó€òòMcClaster€v.€Methodist€Hospital€of€Memphisóó,€550Ð  \ ÐS.W.2d€240€(Tenn.€1977)€(holding€that€an€injury€resulting€directly€from€surgical€treatment€of€aÐ øH Ðcompensable€injury€is€itself€compensable).€€To€hold€otherwise€would€require€us€to€reject€theÐ ä4 Ðuncontraverted€testimony€of€the€employee€that€her€previous€condition€had€worsened€since€theÐ Ð  Ðaccident.€€In€addition,€we€would€have€to€reject€the€corroborating€testimony€of€her€co„workers€thatÐ ¼  Ðher€head€was€found€against€the€curb€(allowing€the€inference€that€she€hit€her€head€when€she€fell€toÐ ¨ø Ðthe€ground)€and€that€she€complained€of€head€pain€in€the€emergency€room,€regardless€of€whetherÐ ”ä Ðrecords€of€the€paramedics€or€emergency€room€reflect€such€complaints.€€And€finally,€we€wouldÐ €Ð Ðhave€to€reject€the€medical€proof€that€there€was€an€anatomical€change€or€progression€of€theÐ l¼ Ðemployeeððs€underlying€condition.€€Rather€than€rejecting€all€of€this€proof,€we€conclude€as€the€trialÐ X ¨ Ðcourt€did€that€the€employeeððs€injury€arose€out€of€her€employment.€€Ð D!” ÐÌà@  %ìàò òòòConclusionóóó óˆÐ #l! Ðà  àIn€view€of€the€foregoing€discussion,€we€hold€that€the€evidence€does€not€preponderateÐ $X" Ðagainst€the€trial€courtððs€finding€of€causation.€€Accordingly,€the€trial€court€is€affirmed.€€Costs€ofÐ ô$D # Ðthis€appeal€are€taxed€to€the€employer.€€Ð à%0!$ ÐÌÌÌÌà  àà ` àà ¸ àà  àà h àà À à__________________________________Ð |*Ì%) Ðà  àà ` àà ¸ àà  àà h àà À àFRANK€F.€Ô_ÔDROWOTAÔ_Ô,€III,€JUSTICEÐ h+¸&* ЇÌ