ÿWPCÎ> ªØ¦CíAi\>'HÄ’ühþYÜæU Ò¼¼‡8‹]ÉbÆï±I8=uÁa,`–@ø€PP§^¹85ÄxwhÚþ¾-2 ŒW”ìàú<Õ8Ä7–òÆs³¶œŽ´|¡œ† `óW#-õÄJ3qîû ²5S–Žã…¹d_BþÔ˜>+NÔ¾$ë5%.‚‡Y×{­˜v›ar›œyÏ÷ˆW|qŸÜ 6–Õÿ™ˆ? sîÀðÙáÔ©]R» VS~t5ËÊIu&3ƒ²ÛÏfI‡+ ²šþüòÔžÙ(70½Zz£ý&gÜìˆÄÀ¬ ­êû±åÝU ™èKÃúÃ6TÅ¢Ï0vƒ¤ˆÊý­Yd¡Å¼ôªY¿!]°”¦AXÿéàºXÜä¾Y˜Â:¾7|ÇsOg, ¡`nøwL€ÄiŽFK@Ÿ¨*ƒ;ÙþÁ“ìž´™zRJy?›"KkŸE Šw;³á¨c2E± -$›­\ÔF°pñø–~œÒ2£æ£ü–:ä,Ñ‘¶J§ìŠéLn;~vUÈL»X  626©3­¯ZÞjmãÈìó±7xg™f£ÙæïýalýÕ/ÿN#UÊGI?ø·–h,SÖz<¬·#! UN# %q 0(w w@Ÿ 4ß ó T  0³^ 0 DU :UsU :U:<svU:éT#U:wÓ±ç„kÎyhGU:¯ Óé U:¼"áö"U:×$U:%K%U:Y(U:“(ÎÍ(U:›+U:Õ+ B,ç,,U:.hM.U:µ/U:ï/á)0U: 2U:D2 AQ~2ÆÏ2 0D•3 0DÙ3 0D4 D/a4 B4­4 D3³5U:æ5 6U:&7T`7 0D´7Lø7D8L8U:R9ÆŒ9ÆR:Æ;ÆÞ;¤<U:ª=Nä=æ= mè=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è=è= Aÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ=ÿ= 0P~>˜HP LaserJet 8000 DN PSØÚØÚÚØØÚ0(ÈhH  Z 6Times New Roman RegularX($¡¡ Z4E[4\4E]4(e^4Ó€h4k4Vl4 îm4Ó€w4{Z='T43|xw4 JÝ ƒ З$ÝÒ°ÒÒX°ÒÔ€X„ÐXXXÔÓ  Óà ` àòòÚ  Ú2Ú  ÚóóÝ  ÝDr.€Milnor€explained€that€a€myocardial€infarction€is€the€death€of€heart€tissue.€€Dr.Ð ° ÐAnderson€explained€that€a€myocardial€infarction€is€a€heart€attack€in€laymanððs€terms.(c(2ÑA$¤¤Ý ƒ!ÝÝ  ÝÒ°ÒÒX°ÒÔ€XÆ¡XXXÔÓ  Óà ` àòòÚ  Ú0Ú  Úóó(#Ã$òòÚ  Ú0Ú  Úóó,c½¬AZ‹"Arial Regular iÝ ƒ З$ÝÒ°ÒÒX°ÒÔ€X„ÐXXXÔÓ  Óà ` àòòÚ  Ú1Ú  ÚóóÝ  ÝThe€records€from€the€VA€Hospital€indicate€that€plaintiff€refused€hospitalization€evenÐ ° Ðafter€being€informed€that€he€could€have€ð ðan€acute€myocardial€event€and€possibly€deathððÏif€he€left€the€hospital.,c½¬AZ‹"Arial Regular,†r‰AZ‹"Arial Regular iÝ ƒ Ï5$ÝÒ°ÒÒX°ÒÔ€XŠêXXXÔÓ  Óà ` àòòÚ  Ú1Ú  ÚóóÝ  ÝThe€records€from€the€VA€Hospital€indicate€that€plaintiff€refused€hospitalization€evenÐ ° Ðafter€being€informed€that€he€could€have€ð ðan€acute€myocardial€event€and€possibly€deathððÏif€he€left€the€hospital.,c½¬AZ‹"Arial Regular JÝ ƒ Ï5$ÝÒ°ÒÒX°ÒÔ€XŠêXXXÔÓ  Óà ` àòòÚ  Ú2Ú  ÚóóÝ  ÝDr.€Milnor€explained€that€a€myocardial€infarction€is€the€death€of€heart€tissue.€€Dr.Ð ° ÐAnderson€explained€that€a€myocardial€infarction€is€a€heart€attack€in€laymanððs€terms.,c½¬AZ‹"Arial Regular ÉÝ ƒ З$ÝÒ°ÒÒX°ÒÔ€X„ÐXXXÔÓ  Óà ` àòòÚ  Ú3Ú  ÚóóÝ  ÝÔ‡ X„ÐXXX„ÐÔDr.€Milnor€explained€that€a€heart€attack€can€either€occur€over€a€short€period€of€timeÐ ° Ðor€can€be€what€is€called€a€ð ðstuttering€myocardial€infarction,ðð€in€which€there€is€progressiveÏdestruction€of€heart€tissue€over€several€days.€€Ô#†X„ÐXX X„Њ#Ô ÝÝ ƒ З$ÝÒ°ÒÒX°ÒÔ€X„ÐXXXÔÓ  Óà ` àòòÚ  Ú6Ú  ÚóóÝ  ÝDr.€Anderson€explained€that€had€the€plaintiff€suffered€an€event€on€June€27,€1997,Ð ° Ðevidence€that€the€disease€had€been€advanced€could€have€been€seen€by€identifying€aÏplaque€rupture,€a€blood€clot€in€the€coronary€artery,€or€slow€flowing€blood€in€the€coronaryÏartery.€€None€of€these€were€seen€in€the€cardiac€catheterization. Ý ƒ З$ÝÒ°ÒÒX°ÒÔ€X„ÐXXXÔÓ  Óà ` àòòÚ  Ú4Ú  ÚóóÝ  ÝÔ€X„ÐXXX„ÐÔDr.€Milnor€explained€that€a€blood€test€measuring€the€plaintiffððs€creatine€kinase€(CK)Ð ° Ðlevel€was€performed€at€the€VA€Hospital,€along€with€a€stress€test,€serial€electrocardiogramsÏ(EKGs),€and€cardiac€catheterization.€€Creatine€kinase€is€an€enzyme€found€in€all€musclesÏin€the€body,€including€the€heart,€and€the€ð ðcore€CKðð€test,€such€as€the€test€performed€at€theÏVA,€is€a€non„specific€test.€€This€was€also€referred€to€as€a€ð ðCPKðð€test€by€Dr.€Anderson.€€Dr.ÏMilnor€stated€that€the€treadmill€stress€test€has€limited€sensitivity€and€specificity€in€assessingÏcardiac€impairment. ÄÝ ƒ З$ÝÒ°ÒÒX°ÒÔ€X„ÐXXXÔÓ  Óà ` àòòÚ  Ú5Ú  ÚóóÝ  ÝÔ€X„ÐXXX„ÐÔDr.€Anderson€stated€that€there€was€no€finding€in€the€VA€Hospital€records€for€theÐ ° ÐCKMB€test,€which€is€a€more€specific€test€than€the€CK€alone.€€A€CKMB€is€used€to€determineÏif€an€abnormal€CK€level€is€from€injury€to€the€heart€muscle€as€opposed€to€other€muscles€inÏthe€body.€€However,€Dr.€Anderson€explained€that€the€plaintiffððs€total€CK€level€would€haveÏbeen€significantly€elevated€on€July€1€if€there€was€injury€to€his€heart€muscle,€but€theÏplaintiffððs€CK€level€was€normal€(56€U/L€in€a€normal€range€of€30„145€U/L).€€€ ^Ý ƒ З$ÝÒ°ÒÒX°ÒÔ€X„ÐXXXÔÓ  Óà ` àòòÚ  Ú7Ú  ÚóóÝ  ÝÔ‡ X„ÐXXX„ÐÔDr.€Anderson€agreed€that€a€Class€2€impairment€rating€can€be€given€for€anginaÐ ° Ðpectoris€alone€without€a€myocardial€infarction.€€Ô#†X„ÐXX X„Њ#Ô, øð AZ"Arial Regular ÉÝ ƒ Ï5$ÝÒ°ÒÒX°ÒÔ€XŠêXXXÔÓ  Óà ` àòòÚ  Ú3Ú  ÚóóÝ  ÝÔ‡XŠêXXXŠêÔDr.€Milnor€explained€that€a€heart€attack€can€either€occur€over€a€short€period€of€timeÐ ° Ðor€can€be€what€is€called€a€ð ðstuttering€myocardial€infarction,ðð€in€which€there€is€progressiveÏdestruction€of€heart€tissue€over€several€days.€€Ô#†XŠêXX XŠêŠ#Ô,c½¬AZ‹"Arial Regular ×Ý ƒ З$ÝÒ°ÒÒX°ÒÔ€X„ÐXXXÔÓ  Óà ` àòòÚ  Ú8Ú  ÚóóÝ  ÝÔ‡ X„ÐXXX„ÐÔIn€reviewing€the€medical€depositions,€we€note€that€both€experts€have€impeccableÐ ° Ðcredentials,€experience,€and€training,€and€neither€were€treating€physicians€for€the€plaintiff.€ÏWe€are€hesitant€to€completely€disregard€the€testimony€of€either€doctor.Ô#†X„ÐXX X„Њ#Ô,c½¬AZ‹"Arial Regular,c½¬AZ‹"Arial Regular Ý ƒ Ï5$ÝÒ°ÒÒX°ÒÔ€ XŠêXXXÔÓ  Óà ` àòòÚ  Ú4Ú  ÚóóÝ  ÝÔ€!X aXXXŠêÔDr.€Milnor€explained€that€a€blood€test€measuring€the€plaintiffððs€creatine€kinase€(CK)Ð ° Ðlevel€was€performed€at€the€VA€Hospital,€along€with€a€stress€test,€serial€electrocardiogramsÏ(EKGs),€and€cardiac€catheterization.€€Creatine€kinase€is€an€enzyme€found€in€all€musclesÏin€the€body,€including€the€heart,€and€the€ð ðcore€CKðð€test,€such€as€the€test€performed€at€theÏVA,€is€a€non„specific€test.€€This€was€also€referred€to€as€a€ð ðCPKðð€test€by€Dr.€Anderson.€€Dr.ÏMilnor€stated€that€the€treadmill€stress€test€has€limited€sensitivity€and€specificity€in€assessingÏcardiac€impairment.,c½¬AZ‹"Arial Regular, øð AZ"Arial Regular ÄÝ ƒ Ï5$ÝÒ°ÒÒX°ÒÔ€#XŠêXXXÔÓ  Óà ` àòòÚ  Ú5Ú  ÚóóÝ  ÝÔ€$XŠêXXXŠêÔDr.€Anderson€stated€that€there€was€no€finding€in€the€VA€Hospital€records€for€theÐ ° ÐCKMB€test,€which€is€a€more€specific€test€than€the€CK€alone.€€A€CKMB€is€used€to€determineÏif€an€abnormal€CK€level€is€from€injury€to€the€heart€muscle€as€opposed€to€other€muscles€inÏthe€body.€€However,€Dr.€Anderson€explained€that€the€plaintiffððs€total€CK€level€would€haveÏbeen€significantly€elevated€on€July€1€if€there€was€injury€to€his€heart€muscle,€but€theÏplaintiffððs€CK€level€was€normal€(56€U/L€in€a€normal€range€of€30„145€U/L).€€€,c½¬AZ‹"Arial Regular,c½¬AZ‹"Arial Regular d ÝÝ ƒ Ï5$ÝÒ°ÒÒX°ÒÔ€'XŠêXXXÔÓ  Óà ` àòòÚ  Ú6Ú  ÚóóÝ  ÝDr.€Anderson€explained€that€had€the€plaintiff€suffered€an€event€on€June€27,€1997,Ð ° Ðevidence€that€the€disease€had€been€advanced€could€have€been€seen€by€identifying€aÏplaque€rupture,€a€blood€clot€in€the€coronary€artery,€or€slow€flowing€blood€in€the€coronaryÏartery.€€None€of€these€were€seen€in€the€cardiac€catheterization.,c½¬AZ‹"Arial Regular ^Ý ƒ Ï5$ÝÒ°ÒÒX°ÒÔ€)XŠêXXXÔÓ  Óà ` àòòÚ  Ú7Ú  ÚóóÝ  ÝÔ‡*XŠêXXXŠêÔDr.€Anderson€agreed€that€a€Class€2€impairment€rating€can€be€given€for€anginaÐ ° Ðpectoris€alone€without€a€myocardial€infarction.€€Ô#†)XŠêXX XŠêŠ#Ô,c½¬AZ‹"Arial Regular,c½¬AZ‹"Arial Regular ×Ý ƒ Ï5$ÝÒ°ÒÒX°ÒÔ€,XŠêXXXÔÓ  Óà ` àòòÚ  Ú8Ú  ÚóóÝ  ÝÔ‡-XŠêXXXŠêÔIn€reviewing€the€medical€depositions,€we€note€that€both€experts€have€impeccableÐ ° Ðcredentials,€experience,€and€training,€and€neither€were€treating€physicians€for€the€plaintiff.€ÏWe€are€hesitant€to€completely€disregard€the€testimony€of€either€doctor.Ô#†,XŠêXX XŠêŠ#Ô,c½¬AZ‹"Arial Regular,c½¬AZ‹"Arial Regular/0126Cþÿ<<CÿÿƒLevel 1Level 2Level 3Level 4Level 5(3¯$¢¢Ý ƒ!ÝÝ  Ý(3¯$££Ý ƒ!ÝÝ  Ý($$””ò òÚ  Ú1Ú  Úó ó44'÷ÿ dxdüÿP Pd üÝ ƒ0¯"ÝÝ  ÝÔ€7X„ÐXXXÔÔ€7\ÃX7X„ÐÔÓ  Óò òÔ Ad ÔFILEDÔ€7X„ÐX7\ÃÔÐ  ÐÌSeptember€7,€1999ÌÌCecil€Crowson,€Jr.ÌAppellate€Court€ClerkÔdAhÔó ó%%%%'ÿÿdxd,–ûyAZ‹"Arial Regular üÝ ƒ0¯"ÝÝ  ÝÔ€9XÆ¡XXXÔÔ€9ÏÉX9XÆ¡ÔÓ  Óò òÔ Ad ÔFILEDÔ€9XÆ¡X9ÏÉÔÐ  ÐÌSeptember€3,€1999ÌÌCecil€Crowson,€Jr.ÌAppellate€Court€ClerkÔdAhÔó ó,–ûyAZ‹"Arial Regularc:\office\wpwin\template\legal\11deny.wpt(3¯$©©Ý ƒ!ÝÝ  ÝC:\OFFICE\WPWIN\TEMPLATE\STANDARD.WPT üÝ ƒ0¯"ÝÝ  ÝÔ€?X„ÐXXXÔÔ€?\ÃX?X„ÐÔÓ  Óò òÔ Ad ÔFILEDÔ€?X„ÐX?\ÃÔÐ  ÐÌSeptember€7,€1999ÌÌCecil€Crowson,€Jr.ÌAppellate€Court€ClerkÔdAhÔó ó,–ûyAZ‹"Arial RegularLevel 1Level 2Level 3Level 4Level 5‚Level 1Level 2Level 3Level 4Level 5„Level 1Level 2Level 3Level 4Level 5…Level 1Level 2Level 3Level 4Level 5 üÝ ƒ0¯"ÝÝ  ÝÔ€EX„ÐXXXÔÔ€E\ÃXEX„ÐÔÓ  Óò òÔ Ad ÔFILEDÔ€EX„ÐXE\ÃÔÐ  ÐÌSeptember€3,€1999ÌÌCecil€Crowson,€Jr.ÌAppellate€Court€ClerkÔdAhÔó ó,–ûyAZ‹"Arial RegularÿU‹ÿÀÀÀ1yúÿ  <<= 8ÀÿÿÿÿÿÿÿÿÿÿCÿÿ((3/Q$««Ý ƒ!ÝÝ  ÝÔ d ÔÝ ƒ!ÝÝ  Ýñ]4ñ›ñ]4ñÒ°ÒÒX°Òò òÔ‡XÆ¡XXXÔÓÓÓÓÓ  ÓÑTR[° AØ'ÿ Legal3Ø' AØ'ÿ Legalÿ3Ø'TÑÑ8€·iXXdìdÈ8Ññh4ññ^4ñßr€.56<,(j 8` `€€@E ±` ttx0X°ð árßñ^4ññh4ññh4ñßr€.86<,(j 8` `€€@E ±` 8ttxPX°ð  rßñh4ññ^4ññ^4ñÔ_ÔIN€THE€SUPREME€COURT€OF€TENNESSEEÐ ° ÐSPECIAL€WORKERSðð€COMPENSATION€APPEALS€PANELÌAT€JACKSONÌÓˆÓÓvÓó óÌÓÓÌÓ'X‡X‚p“X°œX'ÓJOHN€MATTHEWS,à h àà À àà ‚ à)Ð & v Ðà ` àà ¸ àà  àà h àà À àà ‚ à)ÌÓ6X‡X‚DQ ‘XX‡X‚p“X6Óà ` àPlaintiff/Appellee,€à h àà À àà ‚ à)à D àHENDERSON€CHANCERYÐ ò B Ðà ` àà ¸ àà  àà h àà À àà ‚ à)Ìv.à ` àà ¸ àà  àà h àà À àà ‚ à)à D àNo.€02S01„9809„CH„00085Ð ¾   Ðà ` àà ¸ àà  àà h àà À àà ‚ à)ÌAMERICAN€MANUFACTURERSà À àà ‚ à)à D àHONORABLE€JOE€C.€MORRIS€€€€Ð ŠÚ  ÐMUTUAL€INSURANCE€COMPANYà ‚ à)Ð pÀ  Ðà ` àà ¸ àà  àà h àà À àà ‚ à)Ìà ` àDefendant/Appellant.à À àà ‚ à)à D àÐ <Œ  ÐÌÌÌÌò òòòFor€the€Appellantó óóó:à  àà h àà À àà ‚ àà D àà Q àò òòòFor€the€Appelleeóó:Ð º  ÐÌó óMr.€P.€Allen€Phillipsà  àà h àà À àà ‚ àà D àà Q àMr.€Rickey€BorenÐ ’â ÐAttorney€at€Lawà  àà h àà À àà ‚ àà D àà Q àAttorney€at€LawÐ xÈ Ð106€S.€Liberty€Streetà h àà À àà ‚ àà D àà Q à1269€N.€Highland€AvenueÐ ^® ÐJackson,€TN€38301à  àà h àà À àà ‚ àà D àà Q àJackson,€TN€38301à Ð àà (# àÐ D” Ðà ` àà ¸ àà  àÌÌÌÌÌò ò€€€€€€Ð ¨ ø ÐÌÌÌÌÌÌÌÌÌÌÌòòÓ  ÓM€E€M€O€R€A€N€D€U€M€€€€€€O€P€I€N€I€O€NÐ ¸+'+ ÐÌÌMembers€of€Panelóó:Ð |.Ì). ÐÌó óJustice€Janice€M.€HolderÐ T0¤+0 ÐSenior€Judge€L.€T.€LaffertyÌSpecial€Judge€J.€Steven€StaffordÌÌÌÌÌÌÌò òÓ  ÓREVERSEDà ¸ àà  àà h àà À àà ‚ àà D àà Q àLAFFERTY,€Senior€JudgeÐ j8º39 ÐÔ#†X·iXXXÆ¡E#Ôó óÐ  V9¦4: ÐÔ€ X„ÐXXXƒ„ÔÓÓÓ  ÓÑ7€ƒ„XXdæXXdæ7Ñà@VV,Dàòòò òÔ€ ¼S}¼X X„ÐÔOPINIONˆÐ ° ÐÔ€ X„ÐX¼ ¼S}Ôó óóóà ` àThis€workersðð€compensation€appeal€was€referred€to€the€Special€WorkersððÐ Ä ÐCompensation€Appeals€Panel€of€the€Supreme€Court€pursuant€to€Tenn.€Code€Ann.€ðð50„6„¼225(e)(3)€(Supp.€1998)€for€hearing€and€reporting€to€the€Supreme€Court€of€findings€of€factÏand€conclusions€of€law.à h àÐ ( x Ðà ` àThis€case€was€tried€on€June€25,€1998.€€The€trial€court€found€that€the€plaintiff€sufferedÏa€work„related€injury€on€June€27,€1997,€and€awarded€the€plaintiff€forty„five€percentÏpermanent€partial€disability€to€the€body€as€a€whole.€€The€court€stated€that€the€plaintiffððsÏpresent€disability,€whether€due€to€a€heart€attack€or€from€heart€disease,€was€caused€by€theÏexertion€and€strain€of€lifting€fifty„pound€buckets€in€90„degree€weather€in€the€course€of€hisÏemployment€duties.€€The€defendant,€American€Manufacturers€Mutual€Insurance€Company,Ïhas€appealed€the€trial€courtððs€decision.€€After€a€careful€review€of€the€record,€we€find€that€theÏjudgment€of€the€trial€court€must€be€reversed.€€à Q àÐ ˆØ Ðà ` àAt€the€time€of€trial,€the€plaintiff,€John€Matthews,€testified€that€he€was€47€years€of€age,Ïhad€a€bachelors€degree€in€archeology,€and€had€completed€approximately€one„half€of€hisÏstudies€toward€a€masters€degree€in€anthropology€and€archeology.€€Before€pursuing€hisÏstudies€in€archeology,€the€plaintiff€did€carpentry€work,€served€in€the€military,€and€wasÏemployed€as€a€service€writer€for€a€tire€company.€€After€receiving€his€degree€in€archeology,Ïthe€plaintiff€was€employed€by€Brockington€and€Associates,€the€defendantððs€insured,€as€anÏarcheologist€from€February€of€1997€until€the€alleged€injury€in€June€of€1997.€€At€the€time€ofÏtrial,€he€was€working€as€an€instructor€at€a€job„training€facility€for€the€handicapped.€€Ìà ` àOn€Friday,€June€27,€1997,€the€plaintiff€was€working€outside€with€his€supervisor€at€theÏsite€of€a€proposed€guitar€company€in€a€heat€index€of€104€degrees.€€Their€job€was€toÏuncover€archeological€artifacts€by€removing€five„gallon€buckets€of€mud,€weighing€forty€toÏfifty€pounds€each,€from€a€six„foot€deep€trench.€€The€plaintiff€recalled€that€he€was€perspiringÏheavily.€€At€approximately€3:00€p.m.,€the€plaintiff€felt€a€tightness€with€a€little€pain€below€hisÏcollarbone€and€was€short€of€breath.€€Thinking€that€it€was€the€heat,€he€took€breaks€to€coolÏoff€and€continued€to€work€after€drinking€some€water.€€He€testified€that€he€had€no€priorÏhistory€of€chest€pain€or€heart€disease.€€He€was€able€to€finish€the€dayððs€work,€and€the€chestÏpain€eased€by€approximately€6:00€p.m.€€Over€the€weekend,€the€plaintiff€worked€in€the€yardÐ 9d4: Ðand€around€the€house€but€continued€to€have€chest€tightness€and€pain€if€he€got€hot.€€OnÏMonday,€June€30,€1997,€the€plaintiff€had€a€light€day€at€work€and€experienced€no€problems.€ÏOn€the€way€to€work€Tuesday€morning,€July€1,€the€plaintiff€began€to€have€chest€tightnessÏthat€radiated€down€his€shoulder€into€his€elbow.€€He€told€his€fiancee,€who€was€riding€withÏhim,€that€he€thought€he€was€having€a€heart€attack.€€He€felt€he€could€not€stop€on€theÏcrowded€freeway€and,€instead,€drove€to€his€office€downtown.€€Guy€Weaver,€vice„presidentÏof€Brockington,€saw€the€plaintiffððs€condition€and€took€him€to€the€VA€Hospital€emergencyÏroom.€€On€July€14,€the€plaintiff€underwent€bypass€surgery€for€coronary€artery€disease.€ÏApproximately€two€weeks€after€leaving€the€hospital,€the€plaintiff€asked€Mr.€Weaver€if€heÏcould€return€to€work€in€a€non„field€capacity€but€was€told€to€wait.€€Although€the€plaintiff€wasÏreleased€by€his€doctor€in€October,€no€effort€was€made€to€return€him€to€work€at€BrockingtonÏas€late€as€December€of€1997.€€Ìà ` àSince€leaving€Brockington,€the€plaintiff€had€worked€a€total€of€nineteen€days€as€anÏarcheologist.€He€testified€that€he€had€applied€for€a€number€of€other€jobs€but€felt€that€theÏemployers€were€reluctant€to€hire€him€after€learning€of€his€medical€problems.€€He€finallyÏobtained€full„time€employment€at€a€handicapped€training€facility€in€April€of€1998.€€TheÏplaintiff€stated€that€he€has€worked€outside€in€the€heat€since€his€heart€condition€surfaced€butÏstill€experiences€chest€tightness,€which€requires€medication.€€In€addition,€he€suffers€fromÏoccasional€chest€pain€and€swelling€in€his€left€leg,€where€a€vein€was€harvested€for€theÏbypass,€and€has€difficulty€walking€long€distances€or€standing€for€prolonged€periods€of€time.€ÏThe€plaintiff€also€stated€that€his€stamina€is€not€like€it€was€before€the€incident,€and€heÏcontinues€to€experience€shortness€of€breath.Ìà ` àBryan€Collins,€the€supervising€archeologist€working€with€plaintiff€at€the€time€of€theÏJune€27€incident,€corroborated€the€ñ]4ñœñ]4ñplaintiffððsñ]4ñ›ñ]4ñ€testimony€concerning€the€circumstancesÏsurrounding€the€plaintiffððs€condition.€€He€testified€that€he€and€the€plaintiff€were€doingÏstrenuous€work€in€extreme€heat€and€humidity€and€that€the€plaintiff€experienced€chest€painÏand€breathing€difficulty€around€3:00€p.m.€€Mr.€Collins€was€concerned€that€ñ]4ñœñ]4ñthe€plaintiffñ]4ñ›ñ]4ñ€wasÏhaving€a€heart€attack€and€tried€to€convince€him€to€go€to€a€hospital.€€Because€the€plaintiffÏcontinued€to€have€difficulties€working€after€taking€a€break,€Mr.€Collins€told€him€to€sit€in€theÏtruck€and€finished€most€of€the€work€himself€before€quitting€early€around€4:30€p.m.€€€€€€€€€€€Ð Ì84: Ѐ€€€€€€€€€€€€€€€€€€Medical€expert€testimony€was€received€at€trial€by€depositions€of€two€doctors.€ÏDr.€Pervis€Milnor,€a€cardiologist,€reviewed€the€medical€records€from€the€VA€Hospital€and€Ïexamined€the€plaintiff€on€February€3,€1998,€at€the€request€of€plaintiffððs€attorney.€€Dr.€MilnorÏtestified€that€the€plaintiff€gave€a€history€of€having€developed€chest€pains€on€Friday,€JuneÏ27,€1997,€while€working€at€the€dig€site€in€a€heat€index€of€104€degrees.€€The€plaintiff€told€Dr.ÏMilnor€that€his€chest€pain€had€recurred€several€times€over€the€weekend,€but€he€did€notÏassociate€this€with€exertional€activity.€€Monday,€June€30,€was€uneventful,€but€severe€chestÏpain€sent€the€plaintiff€to€the€VA€Hospital€on€Tuesday€morning,€July€1.€€The€plaintiff€statedÏthat€he€was€told€at€the€VA€Hospital€that€he€had€suffered€a€heart€attack€but€was€allowed€toÏgo€home€at€his€own€request€to€make€arrangements€for€his€child.ñ]4ñ׃ ×ñ]4ññ]4ñ׃×ñ]4ñÝ ƒ 3ÃÝòòÚ  Ú1Ú  ÚóóÝ  Ý×  ×€€A€stress€test€wasÐ Ü, Ðsubsequently€performed€on€July€3,€and€a€cardiac€catheterization€was€performed€on€JulyÏ7.€€The€tests€revealed€multi„vessel€coronary€artery€disease,€which€required€triple€bypassÏsurgery.€€The€plaintiff€denied€any€ñ]4ñœñ]4ñhistoryñ]4ñ›ñ]4ñ€of€chest€pain€prior€to€the€episode€in€the€ditch.€€AÏphysical€exam€revealed€that€the€plaintiff€was€slightly€obese€but€showed€no€significantÏabnormalities€in€his€heart€and€lungs.€€Dr.€Milnor€noted€a€mild€elevation€of€the€plaintiffððsÏcholesterol€and€blood€pressure,€which€Dr.€Milnor€did€not€find€to€be€significant€risk€factors.€ÏThe€fact€the€plaintiff€smoked€cigarettes€put€him€at€risk€for€coronary€disease,€but€Dr.€MilnorÏclassified€him€as€an€average€risk€patient€for€heart€surgery.€€Laboratory€tests€performed€byÏDr.€Milnor€revealed€a€slightly€elevated€serum€cholesterol,€good€oxygen€saturation€beforeÏand€after€exercise,€and€normal€chest€films,€but€the€electrocardiogram€showed€a€loss€of€RÏwave€activity€in€the€anterior€myocardium,€suggesting€a€remote€anterior€myocardialÏinfarction.ñ]4ñ׃ B×ñ]4ññ]4ñ׃B×ñ]4ñÝ ƒ 3ÃÝòòÚ  Ú2Ú  ÚóóÝ  Ý×  ×€€Based€on€the€testing,€plaintiffððs€history€of€chest€pain,€and€the€medical€records,Ð l*¼%* Ðit€was€Dr.€Milnorððs€opinion€that€the€plaintiff€had€sustained€a€myocardial€infarction€that€wasÏprecipitated€by€his€job€activities.€€Dr.€Milnor€explained:ÌÓÓà8 ` àà8¸ ` (#` (#àWhen€you€take€an€individual€in€his€age€group€with€his€smokingÏhistory€and€subject€them€to€a€dehydrating€oppressive,€hot€typeÏof€environment€such€as€he€was€in,€you€both€stress€thatÏindividual€with€the€physiological€ñ]4ñœñ]4ñabnormalities€that€occur€withÏstress,ñ]4ñ›ñ]4ñ€ñ]4ñœñ]4ñbutñ]4ñ›ñ]4ñ€you€also€substantially€reduce€the€body€water€andÐ h3¸.4 Ðthe€circulating€blood€volume,€and€both€of€these€tend€to€relateÏto€a€cascade€of€events€which€often€can€culminate€andÏeventually€in€a€vascular€occlusion€or€an€occlusion€of€a€bloodÏvessel€or€a€reduction€of€blood€supply€to€a€heart€muscleÏsufficient€to€cause€necrosis€or€death€of€that€heart€muscle.€Ð ¸ Ð ¸ Ð  ÐÌà ` àà ¸ àà  àà h àà À àà ‚ à*€*€*€*ÌÌà8 ` àà8¸ ` (#` (#àIn€an€individual€who€has€perfectly€normal€blood€vessels€andÏotherwise€is€in€good€shape,€youððre€not€likely€to€get€in€anyÏvascular€occlusive€disease€.€.€.€but€if€you€take€an€individualÏwho€has€prior€disease€of€his€coronary€arteries,€and€we€wouldÏcertainly€feel€that€this€man€was€a€candidate€for€that€sort€ofÏthing,€then€exposure€to€those€pathological€consequences€couldÏbe€expected€to€cause€occlusion€of€the€blood€vessel€andÏinadequate€blood€supply€to€heart€muscle€or€death€of€heartÏmuscle.Ð ¸ Ð ¸ Ð  ÐÌà ` àà ¸ àà  àà h àà À àà ‚ à*€*€*€*ÌÌà8 ` àà8¸ ` (#` (#à[W]hen€a€person€is€dehydrated,€what€is€lost€out€of€the€bloodÏvessels€is€basically€the€water€and€some€of€the€salt€out€of€theÏblood€vessels.€€What€is€retained€within€the€blood€vessels€areÏthe€blood€cells€and€the€blood€platelets€so€that€the€bloodÏbecomes€thick€and€viscous€and€sluggish,€and€the€way€of€bloodÏflow€„„€particularly€in€the€inner€areas€of€the€body,€the€rate€ofÏblood€flow€is€reduced€and€there€tends€to€be€activation€à @| àof€theÏplatelets€with€a€tendency€to€agglutinate€„„€to€agglutination€byÏthe€little€adhesive€bodies€in€the€blood,€the€platelets,€and€withÏdamaged€blood€vessels,€you€have€the€stage€set€for€theÏdevelopment€of€platelet€thrombi€or€platelet€occlusions,€andÏthen€that€leading€on€to€a€heart€attack€as€we€have€described.Ð ¸ Ð ¸ Ð  ÐÌÓÓà ` àDr.€Milnor€stated€his€opinion€that€the€plaintiffððs€exposure€to€the€dehydratingÏenvironment€at€work€led€to€occlusive€vascular€disease€that€necessitated€plaintiffððs€bypassÏsurgery.€€It€was€Dr.€Milnorððs€opinion€that€the€plaintiff€suffered€a€stuttering€heart€attackñ]4ñ׃×ñ]4ññ]4ñ׃×ñ]4ñÝ ƒ 3ÃÝòòÚ  Ú3Ú  ÚóóÝ  Ý×  ×Ð î%>!% Ðbrought€on€by€his€prolonged€exposure€to€the€heat€and€dehydration.€€Using€the€FourthÏEdition€of€the€AMA€Guidelines,€Dr.€Milnor€gave€the€plaintiff€a€twenty€percent€impairmentÏrating€as€a€Class€2€coronary€heart€disease€patient.€€Dr.€Milnor€based€the€rating€on€anÏassumption€that€plaintiff€had€suffered€a€myocardial€infarction€and€the€fact€that€theÏcatheterization€revealed€sufficient€heart€disease€to€require€bypass€surgery.€€He€stated€thatÏthe€plaintiffððs€angina€alone€would€also€support€an€award€under€Class€2€criteria.€€Dr.€MilnorÏopined€that€a€patient€with€coronary€artery€disease€should€be€restricted€from€heavy€manualÏlabor,€severe€emotional€stress,€and€high€temperatures.€€Dr.€Milnor€testified€that€contributingÏfactors,€such€as€plaintiffððs€smoking€and€high€cholesterol,€could€have€made€cardiac€surgeryÐ 6j17 Ðnecessary€in€the€future,€but€it€was€his€opinion€that€the€events€of€June€27€aggravated€theÏpre„existing€coronary€artery€disease.€€According€to€Dr.€Milnor,€the€tests€performed€at€theÏVA€Hospital€were€not€done€in€a€manner€that€would€show€whether€the€plaintiff€had€a€heartÏattack€before€or€after€July€1.ñ]4ñ׃×ñ]4ññ]4ñ׃×ñ]4ñÝ ƒ 3ÃÝòòÚ  Ú4Ú  ÚóóÝ  Ý×  ×€€He€stated€that€none€of€the€objective€findings€from€his€testingÐ  d Ðor€the€VA€records€showed€that€the€coronary€bypass€surgery€was€caused€by€the€June€27Ïevents,€nor€could€he€say€whether€the€heart€damage€occurred€on€Friday€or€Tuesday€or€anyÏother€specific€time€in€the€past.Ìà ` à€€Dr.€Keith€Anderson,€another€cardiologist,€saw€the€plaintiff€on€May€18,€1998,€for€anÏindependent€examination€requested€by€the€defendantððs€attorney.€€The€plaintiff€gaveÏsubstantially€the€same€version€of€the€events€surrounding€his€heart€disease€and€surgery€asÏhe€gave€to€Dr.€Milnor.€€The€plaintiff€also€indicated€a€history€of€hypertension,Ïhypercholesterolemia,€cigarette€smoking,€and€a€family€history€of€atherosclerotic€heartÏdisease.€€Dr.€Anderson€reviewed€the€medical€records€and€test€results€from€the€VA€HospitalÏand€found€no€evidence€that€the€plaintiff€had€suffered€a€heart€attack€(myocardial€infarction).€ÏTo€the€contrary,€Dr.€Anderson€felt€very€strongly€that€the€plaintiff€had€not€suffered€a€heartÏattack€on€June€27,€because€there€was€documented€evidence€that€the€plaintiff€had€notÏsustained€any€damage€to€his€heart.€€The€plaintiffððs€CK€testñ]4ñ׃Ú×ñ]4ññ]4ñ׃" ×ñ]4ñÝ ƒ 3ÃÝòòÚ  Ú5Ú  ÚóóÝ  Ý×  ×€was€negative€on€July€1,€and€theÐ p!À  Ðcatheterization€report€showed€no€disruption€of€the€coronary€artery€or€pending€infarction€onÏJuly€7.ñ]4ñ׃×ñ]4ññ]4ñ׃&L×ñ]4ñÝ ƒ 3ÃÝòòÚ  Ú6Ú  ÚóóÝ  Ý×  ×€€The€plaintiff€was€also€able€to€complete€a€stress€test€on€July€3€without€precipitatingÐ %X $ Ðmyocardial€injury.€€Dr.€Anderson€explained€that€a€personððs€CK€level€remains€significantlyÐ Ô&$"& Ðelevated€ten€to€fourteen€days€after€an€infarction,€and€the€fact€that€the€plaintiffððs€CK€levelÏwas€normal€on€July€1€essentially€excluded€the€possibility€that€a€heart€attack€had€occurredÏin€the€recent€past.€€An€EKG€performed€on€April€22,€1998,€showed€a€slight,€insignificantÏabnormality€in€one€of€the€leads€but€was€otherwise€unremarkable.€€Ìà ` àIt€was€Dr.€Andersonððs€opinion€that€the€working€conditions€of€June€27,€1997,€did€notÏcause€any€progression€of€the€plaintiffððs€underlying€disease€or€injury€to€his€heart.€€AccordingÏto€Dr.€Anderson,€the€plaintiff€was€suffering€from€angina€on€June€27€caused€by€his€coronaryÏartery€disease.€€Dr.€Anderson€stated€his€opinion€that€the€plaintiffððs€bypass€surgery€was€theÏresult€of€the€advanced€disease,€which€was€present€before€the€June€27€incident.€€He€placedÏthe€plaintiff€in€the€Class€2€category€under€the€ñ]4ñœñ]4ñFourthñ]4ñ›ñ]4ñ€ñ]4ñœñ]4ñEditionñ]4ñ›ñ]4ñ€of€the€AMA€Guidelines€andÏgave€him€a€ten€percent€impairment€rating€for€the€coronary€artery€disease€but€would€not€giveÏhim€an€impairment€rating€related€to€the€June€27,€1997,€incident.ñ]4ñ׃×ñ]4ññ]4ñ׃(×ñ]4ñÝ ƒ 3ÃÝòòÚ  Ú7Ú  ÚóóÝ  Ý×  ×€€The€impairment€ratingÐ tÄ Ðwas€based€on€the€plaintiffððs€previous€history€of€angina€and€the€fact€that€the€plaintiff€wasÏasymptomatic€in€May€of€1998€while€performing€daily€activities€and€upon€physical€exertion.€ÏDr.€Anderson€did€not€place€restrictions€on€the€plaintiffððs€activities,€other€than€his€smoking.€Ïñ]4ñœ›ñ]4ñà ` àDr.€Anderson€testified€that€moderate€lifting€in€extremely€hot€weather€and€perspiringÏcould€cause€a€heart€attack€in€a€predisposed€person,€although€he€did€not€know€how€likelyÏthat€was.€€He€also€agreed€that€an€angina€attack€could€be€precipitated€by€working€in€heat.€ÏHe€stated€that,€if€he€had€come€to€the€conclusion€that€the€plaintiff€had€suffered€a€heartÏattack,€the€plaintiffððs€job€activities€on€June€27€could€have€precipitated€the€attack;€however,Ïhe€stated€that€ð ð[t]here€was€nothing€that€he€[the€plaintiff]€did€on€that€job€that€advanced€hisÏdisease.€€He€just€happened€to€be€on€the€job€when€he€first€had€angina.ðð€€Ìà ` àThe€standard€of€review€of€factual€issues€in€workersðð€compensation€cases€is€òòdeóó€òònovoóóÐ 8,ˆ', Ðupon€the€record€of€the€trial€court€with€a€presumption€of€correctness,€unless€theÏpreponderance€of€the€evidence€is€otherwise.€€Tenn.€Code€Ann.€ðð€50„6„225(e)(2)€(1991€&ÏSupp.€1998);€òòHenson€v.€City€of€Lawrenceburgóó,€851€S.W.2d€809,€812€(Tenn.€1993).€€UnderÐ œ1ì,2 Ðthis€standard,€we€are€required€to€conduct€an€in„depth€examination€of€the€trial€courtððsÏfindings€of€fact€and€conclusions€of€law€to€determine€where€the€preponderance€of€theÏevidence€lies.€€òòSeeóó€òòThomas€v.€Aetna€Life€&€Cas.€Co.óó,€812€S.W.2d€278,€282€(Tenn.€1991)Ð 7P28 Ð(quoting€òòHumphrey€v.€David€Witherspoon,€Inc.óó,€734€S.W.2d€315€(Tenn.€1987);€òòKing€v.Ð ° ÐJones€Truck€Linesóó,€814€S.W.2d€23,€25€(Tenn.€1991).€€In€making€such€a€determination,€thisÐ |Ì ÐCourt€must€give€considerable€deference€to€the€trial€judgeððs€findings€regarding€the€weightÏand€credibility€of€any€oral€testimony€received.€€òòTownsend€v.€Stateóó,€826€S.W.2d€434,€437Ð  d Ð(Tenn.€1992);€òòThomasóó,€812€S.W.2d€at€283.€€However,€the€determination€of€factual€issuesÐ à 0 Ðin€the€present€case€involves€medical€testimony€derived€solely€from€depositions,€so€allÏimpressions€regarding€weight€and€credibility€must€be€drawn€from€the€contents€of€theÏdocuments,€rather€than€an€evaluation€of€live€witnesses.€€òòThomasóó,€812€S.W.2d€at€283.€Ð D”  ÐTherefore,€this€Court€may€draw€its€own€conclusions€about€the€weight,€credibility,€andÏsignificance€of€such€testimony.€€òòSeiber€v.€Greenbrier€Indus.,€Inc.óó,€906€S.W.2d€444,€446Ð Ü, Ð(Tenn.€1995).€Ìà ` àIt€is€well€established€that€the€plaintiff€in€a€workersðð€compensation€case€has€theÏburden€of€proving€causation€and€permanency€of€his€injury€by€the€preponderance€of€theÏevidence€using€expert€medical€testimony.€€òòSeeóó€òòThomasóó,€812€S.W.2d€at€283;€òòRoark€v.Ð  \ ÐLiberty€Mutual€Ins.€Co.óó,€793€S.W.2d€932,€934€(Tenn.€1990).€€However,€such€testimony€isÐ Ø( Ðnot€evaluated€in€total€isolation€but€must€be€considered€in€conjunction€with€the€employeeððsÏtestimony€as€to€how€his€injury€occurred€and€his€subsequent€physical€condition.€€òòThomasóó,Ð p!À  Ð812€S.W.2d€at€283.€€In€determining€where€the€preponderance€of€the€evidence€lies,€thisÏCourt€may€choose€which€expertððs€view€to€believe€among€differing€opinions€and€mayÏconsider€the€expertsðð€qualifications,€circumstances€of€their€examination,€what€informationÏwas€available€to€them,€and€how€important€that€information€was€to€other€experts.€€òòSeeóóÐ  (ð#( ÐòòOrman€v.€Williams€Sonoma,€Inc.óó,€803€S.W.2d€672,€676€(Tenn.€1991).€€€€€€Ð l*¼%* Ðà ` àAlthough€absolute€certainty€is€not€required€to€prove€causation,€the€medical€testimonyÏconnecting€an€injury€to€work„related€activity€must€not€be€so€uncertain€or€speculative€thatÏassigning€liability€to€the€employer€would€be€arbitrary€or€only€a€mere€possibility.€€€òòLivingstonÐ Ð/ +0 Ðv.€Shelby€Williams€Indus.,€Inc.óó,€811€S.W.2d€511,€515€(Tenn.€1991)€(quoting€òòTindall€v.Ð œ1ì,2 ÐWaring€Park€Assððnóó,€725€S.W.2d€935,€937€(Tenn.€1987)).Ð h3¸.4 Ðà ` àTo€constitute€sufficient€medical€proof€to€establish€permanency,€the€expert€witnessÏmust€state€his€opinion€in€language€that€means€that€the€factors€in€favor€of€a€permanentÏdisability€outweigh€those€to€the€contrary.€€òòSingleton€v.€Procon€Productsóó,€788€S.W.2d€809,Ð Ì84: Ð811„12€(Tenn.€1990).€€Words€that€mean,€in€essence,€that€there€is€only€a€likelihood€or€justÏa€possibility€of€the€events€happening€are€not€sufficient€to€carry€the€burden€in€favor€ofÏpermanency.€€òòSeeóó€òòid.óó€at€811.Ð H˜ Ðà ` àThe€defendant€presents€two€issues€on€appeal:€€€(1)€whether€the€trial€court€erred€inÏfinding€that€the€plaintiff€suffered€a€work„related€permanent€disability,€and€(2)€whether€theÏaward€of€forty„five€percent€vocational€disability€is€excessive.€€After€careful€review€of€theÏrecord,€we€find€that€the€evidence€preponderates€against€the€trial€courtððs€finding€of€aÏcompensable€disability€from€the€June€27,€1997,€incident.€€Therefore,€the€judgment€of€theÏtrial€court€must€be€reversed.€€€Ìà ` àThe€defendant€argues€that€the€medical€testimony€does€not€establish€that€the€plaintiffÏhad€a€heart€attack€or€coronary€artery€disease€which€could€be€connected€to€his€workÏactivities.€€We€agree.€€In€order€for€plaintiffððs€disability€to€be€compensable,€it€would€have€toÏresult€either€from€occupational€disease€that€arose€out€of€and€in€the€course€of€employment,Ïa€heart€attack€precipitated€by€employment,€or€by€the€aggravation€of€pre„existing€coronaryÏartery€disease€that€can€be€connected€to€job€activities.€€òòSeeóó€òòKrick€v.€City€of€Lawrenceburgóó,Ð Ø( Ð945€S.W.2d€709,€713€(Tenn.€1997);€òòStone€v.€City€of€McMinnville,óó€896€S.W.2d€548,€552Ð ¤ô Ð(Tenn.€1995);€òòKing€v.€Jones€Truck€Linesóó,€814€S.W.2d€23,€27€(Tenn.€1991)€(quoting€òòSwiftÐ p!À  Ð&€Co.€v.€Howardóó,€186€Tenn.€584,€212€S.W.2d€388,€391€(1948)).€Ð <#Œ" Ðà ` àThe€Supreme€Court€in€òòKrickóó€set€out€the€criteria€found€in€Tenn.€Code€Ann.€Ô‡X„ÐXX X„ÐÔððÔ#† X„ÐXXX„У_#Ô€50„6„301Ð %X $ Ðfor€determining€whether€the€plaintiffððs€coronary€artery€disease€is€an€accidental€injury€thatÏarose€out€of€and€in€the€course€of€employment€as€follows:ÌÓÓà8 ` àà8¸ ` (#` (#à(1)€the€disease€can€be€determined€to€have€followed€as€aÏnatural€incident€of€the€work€as€a€result€of€the€exposureÏoccasioned€by€the€nature€of€the€employment,€(2)€it€can€à @Þ àbe€fairlyÏtraced€to€the€employment€as€a€proximate€cause,€(3)€it€has€notÏoriginated€from€a€hazard€to€which€the€worker€would€have€beenÏequally€exposed€outside€of€the€employment,€(4)€it€is€incidentalÏto€the€character€of€the€employment€and€not€independent€of€theÏrelation€of€employer€and€employee,€(5)€it€originated€from€a€riskÏconnected€with€the€employment€and€flowed€from€that€sourceÏas€a€natural€consequence,€though€it€need€not€have€beenÏforeseen€or€expected€prior€to€its€contraction,€and€(6)€there€is€aÏdirect€causal€connection€between€the€disease€and€conditionsÏunder€which€the€work€is€performed.Ð ¸ Ð ¸ Ð  ÐÌâ âÓÓòòKrickóó,€945€S.W.2d€at€713.€€Applying€the€criteria€to€the€facts€in€this€case,€we€find€that€theÐ 7P28 Ðmedical€evidenceñ]4ñ׃×ñ]4ññ]4ñ׃+×ñ]4ñÝ ƒ 3ÃÝòòÚ  Ú8Ú  ÚóóÝ  Ý×  ×€does€not€establish€a€causal€connection€between€plaintiffððs€coronaryÐ ° Ðâ âartery€disease€and€his€work€activities€on€June€27€or€any€other€time€in€his€employment.€€TheÏobjective€tests€relied€on€by€both€doctors€indicated€that€plaintiffððs€coronary€artery€diseaseÏwas€advanced€and,€therefore,€existed€long€before€June€27.€€The€plaintiff€had€several€riskÏfactors,€including€elevated€cholesterol,€hypertension,€and€a€history€of€smoking,€thatÏcontributed€to€his€disease,€and€neither€doctor€stated€an€opinion€that€the€coronary€arteryÏdisease€itself€was€job„related.€€Therefore,€the€plaintiffððs€coronary€artery€disease€developedÏindependently€of€his€employment€and€is€not€an€accidental€injury€under€our€statutes.Ìà ` àAdditionally,€the€medical€evidence€preponderates€against€a€finding€that€the€plaintiffððsÏdisability€was€attributable€to€a€work„related€heart€attack€or€aggravation€of€the€pre„existingÏcoronary€artery€disease.€€The€key€to€recovery€in€a€case€where€it€is€alleged€that€someÏphysical€activity€or€exertion€caused€a€heart€attack€is€whether€a€disabling€attack€wasÏprecipitated€by€employeeððs€job€activities.€€òòKrickóó,€945€S.W.2d€at€713.€€It€is€also€wellÐ @ Ðestablished€in€this€jurisdiction€that€an€employer€takes€an€employee€as€he€is€and€assumesÏthe€risk€of€having€a€weakened€condition€aggravated€by€an€injury€that€would€not€ordinarilyÏhurt€a€normal,€healthy€person.€€òòKing€v.€Jones€Truck€Linesóó,€814€S.W.2d€23,€27€(Tenn.€1991)Ð ¤ô Ð(quoting€òòSwift€&€Co.€v.€Howardóó,€186€Tenn.€584,€212€S.W.2d€388,€391€(1948)).€€òòSeeóó€òòalsoóóÐ p!À  ÐòòSweat€v.€Superior€Indus.,€Inc.óó,€966€S.W.2d€31,€33€(Tenn.€1998).€€If€the€employment€excitesÐ <#Œ" Ðor€aggravates€a€pre„existing€condition,€causing€a€disability,€then€the€employer€is€liable.€ÏòòKingóó,€814€S.W.2d€at€27.€€However,€there€must€be€an€anatomical€change€or€actualÐ Ô&$"& Ðprogression€of€the€pre„existing€condition€for€the€injury€to€be€compensable,€and€an€increaseÏin€pain€alone€is€not€sufficient€to€sustain€an€award€of€benefits.€€òòSweatóó,€966€S.W.2d€at€33Ð l*¼%* Ð(citing€with€approval€òòCunningham€v.€Goodyear€Tire€&€Rubber€Co.óó,€811€S.W.2d€888,€890Ð 8,ˆ', Ð(Tenn.€1991)).€€€€€€€à  àÐ .T). Ðà ` àThe€plaintiff€relies€on€the€testimony€of€Dr.€Milnor€in€proving€that€he€had€a€heartÏattack€brought€on€by€the€events€of€June€27.€€Dr.€Milnor€was€definite€in€his€opinion€that€theÏplaintiff€did€indeed€suffer€a€heart€attack€and€described€in€detail€the€cascade€of€events€thatÏcould€occur€as€a€result€of€a€person€with€the€plaintiffððs€pre„existing,€yet€unknown,€coronaryÐ 45„06 Ðartery€disease€working€in€the€intense€heat€and€dehydrating€conditions€at€the€dig€site€onÏJune€27.€€Dr.€Milnor€was€persuaded€by€the€plaintiffððs€history€of€chest€pain€lasting€overÏfifteen€or€twenty€minutes,€which€he€stated€creates€a€presumption€of€damage€to€the€heart,Ïand€his€finding€of€a€ð ðremoteðð€infarction€on€the€plaintiffððs€EKG€in€February€of€1998.€ÏHowever,€there€was€no€way€for€Dr.€Milnor€to€pinpoint€when€the€ð ðremoteðð€heart€attackÏoccurred€or€to€connect€the€plaintiffððs€surgery€with€his€job€activities€on€June€27€using€theÏobjective€test€results€from€his€office€or€the€hospital.Ìà ` àDr.€Anderson,€on€the€other€hand,€was€just€as€definite€that€the€plaintiff€did€not€sufferÏa€heart€attack€but€merely€had€angina€from€his€pre„existing€disease.€€Dr.€Anderson€wasÏpersuaded€by€the€blood€tests€and€cardiac€catheterization€done€at€the€VA€Hospital€withinÏdays€after€the€June€27€episode,€which€showed€that€the€plaintiff€did€not€suffer€a€heart€attackÏbut€did€show€advanced€coronary€artery€disease.€€He€disagreed€with€the€presumption€thatÏheart€tissue€damage€occurs€with€chest€pain€lasting€fifteen€or€twenty€minutes,€which€wasÏimportant€in€Dr.€Milnorððs€assessment.€€Dr.€Anderson€also€stated€that€the€events€of€June€27Ïdid€not€aggravate€or€advance€the€plaintiffððs€underlying€disease.€€It€was€his€opinion€thatÏbypass€surgery€was€a€result€of€the€plaintiffððs€advanced€coronary€artery€disease€and€wouldÏhave€been€necessary€in€any€event.€€à ‚ àÐ p!À  Ðà ` àIn€reviewing€all€of€the€medical€testimony,€we€find€that€the€plaintiff€has€failed€to€carryÏhis€burden€of€proving€by€a€preponderance€of€the€evidence€that€he€suffered€a€heart€attackÏas€a€result€of€his€work€activities€on€June€27,€1997.€€None€of€the€tests€run€at€the€VAÏHospital,€during€the€time€when€a€heart€attack€would€have€been€evident,€showed€that€suchÏan€injury€occurred.€€In€fact,€the€results€of€the€test€showed€that€there€was€no€damage€to€theÏheart€muscle.€€Additionally,€none€of€the€tests€run€by€Dr.€Milnor€or€Dr.€Anderson€indicatedÏthat€a€heart€attack€had€occurred€as€a€result€of€the€incident€at€work.€€The€surgery€and€otherÏproblems€that€the€plaintiff€has€experienced,€such€as€leg€pain€from€the€graft€for€the€bypass,Ïchest€pain,€and€loss€of€stamina,€are€a€result€of€pre„existing,€advanced€coronary€arteryÏdisease€that€cannot€be€attributed€to€the€events€of€June€27.€€We€find,€therefore,€that€theÏplaintiffððs€employment€duties€did€not€cause€a€heart€attack.€Ìà ` àFurthermore,€the€evidence€preponderates€against€a€finding€that€the€plaintiffððsÏunderlying€coronary€artery€disease€was€advanced€or€aggravated€by€working€in€the€heat€onÐ Ì84: ÐJune€27.€€None€of€the€objective€tests€performed€at€the€VA€Hospital€shortly€after€the€plaintiffÏbegan€experiencing€chest€pain€nor€any€of€the€tests€performed€by€the€evaluating€physiciansÏshowed€that€the€progress€of€the€disease€was€affected€by€the€plaintiffððs€job€duties.€€ForÏexample,€the€cardiac€catheterization€done€on€July€7€at€the€VA€Hospital€showed€noÏevidence€that€the€underlying€disease€had€been€aggravated€or€advanced€by€the€events€ofÏJune€27.€€It€appears€that€the€plaintiff€just€happened€to€be€at€work€when€he€began€to€feelÏthe€symptoms€of€his€advanced€heart€disease,€which€required€triple€bypass€surgery.€€TheÏproblems€the€plaintiff€has€experienced€since€the€surgery€would€likely€have€occurred€in€anyÏevent,€and€his€resulting€disability€from€the€coronary€artery€disease€is€not€compensableÏunder€workersðð€compensation€law.€€€€€€€€€€€€€€€€€€€€à Q àÐ Ü, Ðà ` àThe€plaintiff€argues€that€his€angina€alone€is€compensable,€even€without€a€heartÏattack.€€We€disagree.€€Although€both€doctors€testified€that€angina€alone€can€be€the€basisÏof€a€disability€rating€under€the€AMA€Guidelines,€the€disability€must€be€caused€by€work„¼related€angina€to€be€compensable.€€òòSeeóó€òòKrick€v.€City€of€Lawrenceburgóó,€945€S.W.2d€709,Ð  \ Ð714€(Tenn.€1997).€€The€facts€of€this€case€are€very€similar€to€those€in€òòKrickóó,€in€which€ourÐ Ø( ÐSupreme€Court€found€that€the€plaintiff€had€failed€to€prove€that€his€heart€disease€and€anginaÏwere€compensable.€€In€òòKrickóó,€a€police€officer,€with€no€previous€history€of€coronary€arteryÐ p!À  Ðdisease,€experienced€shortness€of€breath€and€chest€pain€after€responding€to€a€potentialÏhostage€situation.€€He€was€subsequently€diagnosed€with€advanced€coronary€artery€diseaseÏthat€required€quadruple€bypass€surgery.€€An€internist€testified€that€the€plaintiff€hadÏexperienced€angina,€which€is€a€symptom€of€heart€disease€and€could€be€brought€on€byÏactivity.€€A€family€practitioner€stated€that€stress€could€cause€a€coronary€spasm,€resultingÏin€a€complete€blockage€of€the€arteries.€€The€plaintiffððs€heart€surgeon€testified€that€stressÏwas€one€of€many€factors€involved€in€the€plaintiffððs€coronary€artery€disease€and€assignedÏhim€a€disability€rating.€€Finally,€an€evaluating€cardiologist€who€reviewed€the€plaintiffððsÏmedical€records,€test€results,€and€the€depositions€of€the€internist€and€surgeon,€stated€hisÏopinion€that€the€plaintiff€did€not€have€a€heart€attack,€but€severe€angina,€from€pre„existingÏcoronary€artery€disease.€ñ]4ñœñ]4ññ\4ññ[4ñ€ñ[4ññ\4ññ]4ñ›ñ]4ñ€He€ñ]4ñœñ]4ññZ4ññY4ñalñY4ññZ4ñstatedñ]4ñ›ñ]4ñ€that,€although€the€stress€at€work€could€haveÏaggravated€the€symptoms€of€heart€disease,€ñ]4ñœñ]4ñi.e.,€angina,€itñ]4ñ›ñ]4ñ€was€not€the€cause€of€theÏdisease.€€ñ]4ñœñ]4ñòòÐ  Ì84: ÐId.óóñ]4ñ›ñ]4ñ€at€711„12.€€After€reviewing€the€evidence,€the€Court€held:Ð ° ÐÓÓà8 ` àà8¸ ` (#` (#àIn€this€case,€Krick€did€not€experience€a€heart€attack;€heÏexperienced€angina,€a€symptom€of€heart€disease.€€The€anginaÏmay€have€been€caused€by€the€stress€of€the€August€1993Ïincident;€however,€Krickððs€disability€arose€from€the€heartÏdisease,€not€the€chest€pain.€€The€medical€proof€preponderatesÏagainst€a€finding€that€the€heart€disease€was€precipitated€by€theÏAugust€1993€incident.€€Thus,€Krick€has€failed€to€establish€theÏcompensability€of€his€heart€disease.€€Ð ¸ Ð ¸ Ð  ÐòòÌId.óó€at€714.Ð ’â  ÐÌÓÓà ` àAs€in€òòKrickóó,€the€plaintiff€in€the€present€case€experienced€angina€as€the€first€symptomÐ ^®  Ðof€his€advanced€coronary€artery€disease€after€a€particular€event€at€work.€€However,€hisÏmost€severe€symptoms€did€not€occur€while€working€in€the€heat€on€Friday€but€during€hisÏdrive€to€work€on€the€following€Tuesday.€€The€medical€evidence€shows€that,€while€theÏconditions€on€June€27€could€have€caused€the€disease€to€manifest€itself€through€an€anginaÏattack,€the€plaintiffððs€surgery€and€subsequent€disability€arose€from€the€pre„existing€heartÏdisease€and€not€from€the€chest€pain.€€Neither€the€plaintiffððs€heart€disease€nor€the€anginaÏis€compensable.€€€€€€€Ìà ` àOn€our€òòdeóó€òònovoóó€review,€we€find€that€the€evidence€preponderates€against€the€findingsÐ ¾ Ðof€the€trial€court€in€favor€of€the€plaintiff.€€The€judgment€of€the€trial€court€is€reversed,€and€theÏcase€is€dismissed.Ìà ` àPlaintiff€will€pay€the€costs.ÌÓÓÌà ` àà ¸ àà  àà h àà À àà ‚ à_________________________________________€Ï€€€€€€€€€€€€€€€€€€€à ¸ àà  àà h àà À àà ‚ àL.€T.€LAFFERTY,€SENIOR€JUDGEÐ º' #' ÐCONCUR:ÌÌÌ__________________________________ÌJANICE€M.€HOLDER,€JUSTICEÌÌÌ__________________________________ÌJ.€STEVEN€STAFFORD,€SPECIAL€JUDGE€€€€€€€€€€€€€€€€€€€œñk4ñÐ  Ð/ +0 Ðñk4ññl4ñ›ñl4ññm4ññl4ñ›ñl4ññm4ññl4ñÒ€ÒÒ„XÒÑ` °ÑÑTR[¤ AØ'ÿLegal Red[¤ AØ'ÿ Legal AØ'ÿ Legal AØ'ÿ LegalTÑñl4ññm4ññm4ññl4ññl4ññw4ññm4ñßr€.>6<,(j 8` `€€@Eôf ` ttx0,` ð ærßñm4ññw4ññw4ññw4ññm4ñ›ñm4ññl4ñà@ö ö êàIN€THE€SUPREME€COURT€OF€TENNESSEEˆÌà@uu)êàAT€JACKSONˆÌÌÌÌJOHN€MATTHEWS,à@ÉÉ.êà)ˆà ¼ àÐ Þ ~ Ðà@ÉÉ.êà)ˆà ¼ àHENDERSON€COUNTYÐ Äd Ðà Ø àœPLAINTIFF/APPELLEE›à@ÉÉ.êà)ˆÐ ªJ Ðñl4ññw4ññw4ññl4ñà@ÉÉ.êà)ˆà ¼ àHON.€JOE€C.€MORRISÐ 0 Ðv.à@ÉÉ.êà)ˆà ¼ àCHANCELLORÐ v  Ðà@ÉÉ.êà)ˆÌAMERICAN€MANUFACTURERSà@ÉÉ.êà)ˆà ¼ àS.€CT.€NO.€02S01„9809„CH„00085Ð Bâ  Ðñl4ññw4ñœßt€.D6>.*jx!` `€€@E7` ttx0M(ð ïtß›ñw4ññl4ñMUTUAL€INSURANCE€COMPANY,à@ÉÉ.êà)ˆÐ (È  Ðà@ÉÉ.êà)ˆÌà Ø àœDEFENDANT/APPELLANT›à@ÉÉ.êà)ˆà0 ¼ àÐô” ¼T$¼T$ ÐÌÌÌà@ŒŒ*êàÔ‡ ŠX; ŠX X„ÐÔò òJUDGMENTó óÔ#† X„ÐX Š ŠX;“#ԈРŒ, Ðà@êê.êàˆÌÌÌÓÓà Ø àThis€case€is€before€the€Court€upon€motion€for€review€pursuant€to€Tenn.€CodeÏAnn.€ðð50„6„225(e)(5)(B),€the€entire€record,€including€the€order€of€referral€to€theÏSpecial€Workers'€Compensation€Appeals€Panel,€and€the€Panel's€MemorandumÏOpinion€setting€forth€its€findings€of€fact€and€conclusions€of€law,€which€are€incorporatedÏherein€by€reference;Ìà Ø àWhereupon,€it€appears€to€the€Court€that€the€motion€for€review€is€not€well€takenÏand€should€be€denied;€and€Ìà Ø àIt€is,€therefore,€ordered€that€the€Panel's€findings€of€fact€and€conclusions€of€lawÏare€adopted€and€affirmed,€and€the€decision€of€the€Panel€is€made€the€judgment€of€theÏCourt.Ìà Ø àCosts€will€be€paid€by€œJohn€Matthews,›€for€which€execution€may€issue€ifÏnecessary.Ìà Ø àIt€is€so€ordered.ÌÌÌà Ø àà 0 àà ˆ àà à àà 8 àà ú àà ¼ àPER€CURIAMÌÐ ö9–06 ÐHOLDER,€J.€NOT€PARTICIPATINGÐ  `  ÐѰ` ÑÒ°€ÒÒ°„ÒÓÓÑTRY3Ø'Letterhead[¤ AØ'ÿLegal Red3Ø' Letter AØ'ÿ LegalTÑѰÑñl4ññw4ññl4ñœñl4ññw4ññl4ñœñl4ññw4ññl4ñÔ†ÿÿÔÔ†ÿÿÔÔ  ÔÔ  Ôñl4ññw4ñ›