ÿWPC» LhiPÇ"Ùø“Â9)I¾Mm‚$””±÷¯27ÀÁM-Uba 7y7þ7†õTH—Ót¹½/ˆ‘åÞù’\¬¨‹N¼<¢*G]g‡ôÏcN1sÚ³6»Yöô>93n¦Ýœz» @áÖ¾Y˜Ç—²Õ‰Mòk|¶zÎ]’Åüè·ÁDûë~_£kú¿³ò/:ç8}e—¿Î¦|#db?—ºÝF]W‚7i ¾ÑZm—©D Iv‘?ãC¨$Ìfƒ¿dlÆ”îÿšhÖÅ>èJwâ6c·‡ó4¦¦VçÁFJv†Ñ5Ï\tðï°ñinË{‰—UØ" ªæh¡Èðãȉ’U‡Ç'º«#~%OÕ´:3€Q»sìCbJ_d+¹"8!ª™à%wnE˜Éª“Æø7ϵ9འ½Cl”!¹ŽlN ª“ÁôIç¨zàÆ²–Ò âÔ’yŒBv÷£‚ׂ×T4fk§’û‘Ú€n¥\¨ ¤[ú§Yï@_䚊2i¹Pià|}ïªÜmA¼nÑ¢qÂÍUsNÑ=ŽäU "üј£¸±Cðà¦=­ð±ÔÑ£AðÖ=«1Ýk-ý±»-( Ðattempted€to€drive€himself€to€the€hospital,€but€he€ended€up€radioing€for€an€ambulanceÏwhich€took€him€to€a€local€hospital€before€he€was€airlifted€to€a€Chattanooga€hospital.€ÏThe€plaintiff€was€diagnosed€as€having€had€a€heart€attack.€€The€plaintiff€underwentÏbypass€surgery€and€returned€to€his€same€job€driving€a€truck€at€the€same€pay€rateÏapproximately€four€weeks€after€the€heart€attack.Ìà ` àThe€plaintiff€has€regularly€smoked€cigarettes€since€he€was€18€years€old€orÏyounger.€€At€the€time€of€his€heart€attack,€he€was€40,€overweight,€had€high€Ïcholesterol,€and€a€family€history€of€atherosclerotic€disease,€all€risk€factors€for€a€heartÏattack.€€However,€he€has€passed€physicals€every€two€years€for€the€12€yearsÏpreceding€this€heart€attack,€including€one€less€than€a€month€before€the€heart€attack.€ÏAgainst€his€doctorsðð€advice,€he€still€smokes€cigarettes€and€occasionally€eats€fattyÏfoods.ò òÐ „Ä Ðó óà ` àThe€trial€court€found€the€depositions€of€Dr.€Hays€and€Dr.€Graham€to€be€ð ðmostÐ P Ðsignificant,ð ð€and€Dr.€Haysðð€testimony€to€be€ð ðunequivocatingðð€and€awarded€benefitsÏincluding€medical€expenses€involved€in€another€bypass€surgery€in€the€future.€ò òÐ è( Ðòòà ` àóóó óThe€plaintiff€relied€on€the€deposition€testimony€of€Dr.€Leonard€J.€Hays,€aÐ ´ô Ðcardiologist,€who€treated€him€at€the€Chattanooga€hospital.€€Regarding€the€causationÏof€the€plaintiffððs€injury,€Dr.€Hays€testified€that€the€work€ð ðcould€have€caused€the€heartÏattack;ðð€ð ðmay€haveðð€contributed€to€it;òò€óócould€have€played€a€role€in€precipitating€it;€couldÐ $X $ Ðhave€triggered€it;€in€all€likelihood€triggered€it;€and,€had€a€rational€causal€relation€to€it.€ÏFinally,€he€testified€that€it€was€ð ðprobableðð€that€the€work€precipitated€the€heart€attack.€€¼à ` àDr.€Hays€conceded€that€the€plaintiff€had€a€significant€coronary€blockage€whichÏwas€a€major€contributing€factor€to€the€heart€attack.€€He€admitted€that,€other€than€theÏhistory€he€received€from€the€plaintiff,€there€was€no€way€to€know€whether€the€heartÏattack€was€really€precipitated€by€the€exertion.€€Dr.€Hays€stated€that€the€heart€attackÏð ðwas€made€possible€by€[the€plaintiffððs]€pre„existing€coronary€disease,ðð€and€was€moreÏrelated€to€it€than€the€exertion.Ìà ` àOn€the€subject€of€industrial€disability,€Dr.€Hays€testified€to€the€plaintiffððsÏpermanent€heart€damage.€€Using€the€òòAMA€Guidesóó€for€coronary€heart€disease,€heÐ 6T28 Ðfound€the€plaintiff€to€have€no€impairment€before€the€heart€attack€but€a€10„30€percentÏimpairment€afterwards.€€He€also€recommended€that€Plaintiff€should€lift€ð ðless€than€50Ïpounds.ðð€€On€cross„examination,€Dr.€Hays€admitted€the€plaintiff€had€blood€flow€betterÐ |;¼7> Ðthan€before€and€narrowed€the€plaintiffððs€range€of€impairment€to€25„29€percent.€ò òÐ À Ðó óHowever,€Dr.€Hays€maintained€that€the€plaintiffððs€impairment€resulted€from€the€heartÐ ˜Ø Ðattack.Ìò òà ` àó óRegarding€future€medical€benefits,€Dr.€Hays€testified€that€he€ð ðsuspected€[theÐ 0 p Ðplaintiff]€probably€willð ð€require€future€surgery€in€10„15€years.€€On€cross,€Dr.€HaysÏstated€that€though€the€bypass€surgery€already€performed€had€more€to€do€with€theÏcoronary€artery€disease,€it€would€be€ð ðdifficult€to€answerðð€the€question€of€whether€anyÏfuture€bypass€surgery€would€be€precipitated€by€work.€€He€further€stated€that€PlaintiffððsÏneed€forò ò€ó ófuture€treatment€was€related€to€ð ðbothðð€his€employment€as€well€as€the€riskÐ ,l Ðfactors€and€pre„existing€condition.Ìà ` àThe€defendant€primarily€relied€on€the€deposition€testimony€of€Dr.€Gordon€D.ÏGraham,€a€board€certified€cardiologist,€who€has€never€seen€the€plaintiff€and€whoÏessentially€reviewed€Dr.€Haysðð€reports€to€form€his€opinions.€€On€the€subject€ofÏcausation,€Dr.€Graham€testified€that€the€plaintiffððs€heart€attack€was€caused€by€theÏð ðrupture€of€a€plaque€within€one€of€his€main€coronary€arteries.ðð€€He€explained€that€inÏthe€plaintiffððs€late€teens€or€early€20s,€he€probably€began€to€develop€some€yellowÏstreaking€along€his€coronary€arteries,€ð ðplaques,ðð€which€filled€with€cholesterol,Ïeventually€ruptured,€and€caused€blood€clots€which€in€turn€caused€a€heart€attack.€€Dr.ÏGraham€stated€that€risk€factors€present€in€the€plaintiffððs€case€accelerated€theÏrupturing€process.€€He€further€testified€that€the€plaintiffððs€heart€attack€on€thatÏparticular€day€was€inevitable€and€that€heart€attacks€happen€at€ð ðrandom€.€.€.Ïthroughout€the€day,ðð€noting€that€statistically€heart€attacks€are€more€common€in€theÏearly€morning€hours.Ìà ` àOn€cross„examination,€Dr.€Graham€admitted€that€he€did€not€know€ð ðwhether€itððsÏsimply€he€was€going€to€have€a€heart€attack€that€dayðð€and€the€plaintiff€just€happenedÏto€be€working,€but€that€the€plaintiff€had€a€risk€of€a€heart€attack€during€that€24€hours,Ïnoting€that€ð ðhis€heart€attack€occurred€while€he€was€unloading€a€truck.€€Why€thatÏhappened€specifically€I€donððt€know.ðð€€When€asked€whether€physical€exertion€canÏcause€a€heart€attack,€Dr.€Graham€stated€that€ð ðphysical€exertion€has€been€associatedÏwith€heart€attacks,ðð€but€because€heart€attacks€statistically€occur€most€frequently€inÏthe€morning,€there€was€no€real€connection€between€physical€exertion€and€heartÏattacks.€€Finally,€Dr.€Graham€admitted€that€ð ðit€is€speculative€as€to€what€makes€thatÐ Œ;Ì7> Ðplaque€rupture€at€a€given€time€.€.€.€we€purely€speculate€as€to€why€that€plaque€on€thatÏday€at€that€hour€chose€to€rupture.ðð€€Ìà ` àRegarding€the€plaintiffððs€industrial€disability,€Dr.€Graham€testified€that€theÏplaintiff€should€lift€less€than€40„60€pounds€because€of€the€bypass€surgery.€€Dr.ÏGraham€could€only€make€assumptions€and€suppositions€about€the€extent€ofÏimpairment€before€the€heart€attack,€but€he€opined€that€the€plaintiff€was€Class€2€bothÏbefore€and€after,€even€though€the€heart€attack€admittedly€caused€some€ð ðloss€ofÏpump€function.ðð€€On€cross„examination,€Dr.€Graham€admitted€that€he€had€noÏlaboratory€tests€to€support€his€opinion€that€the€plaintiff€was€impaired€before€the€heartÏattack.Ìà ` àFirst,€the€defendants€argueò ò€ó óthat€the€plaintiffððs€heart€attack€was€inevitable€andÐ ¸ø Ðthat€he€just€happened€to€be€at€work.€€They€say€that€the€plaintiffððs€heart€attack€was€notÏprecipitated€or€caused€by€his€work€activities€but€by€his€heredity€and€lifestyle.€€Further,Ïthey€say€that€the€treating€physicianððs€testimony€is€to€be€given€no€more€weight€thanÏthe€reviewing€physicianððs€testimony.€€òòKrick€v.€City€of€Lawrenceburg,óó€945€S.W.2d€709Ð ô4 Ð(Tenn.€1997).Ìà ` àWe€find€the€evidence€does€not€preponderate€against€the€trial€courtððs€finding.€€IfÏwork€exertion€precipitates€the€heart€attack,€it€is€compensable,€òòBacon€v.€œSevierÐ \"œ" ÐCounty,ó󛀜808›€S.W.2d€46€(Tenn.€œ1991)ñ‰^ñ,ñ‰^ñ›€even€if€the€employee€suffers€from€œa€ñ†^ññ…^ñPñ…^ññ†^ññˆ^ññ‡^ñPñ‡^ññˆ^ññ‡^ñpñ‡^ñreexisting›Ð ,$l $ Ðheart€œdisease.›€œòòñŠ^ñ€ñŠ^ñTindall›€v.€Waring€Park€Assððn,óó€725€S.W.2d€935€(Tenn.€1987).€€As€longÐ ü%<"& Ðas€an€incident€ð ðcould€beðð€the€cause,€an€award€may€be€properly€given.€€òòReeser€v.Ð Ì' $( ÐYellow€Freight€Sys.,€Inc.,óó€938€S.W.2d€690€(Tenn.€1997).€€Dr.€Haysðð€testimony€that€theÐ œ)Ü%* Ðexertion€at€work€could€have€caused€the€heart€attack€is€sufficient€for€such€a€finding.€Ìà ` àNext,€the€defendants€argueò ò€ó óthat€the€plaintiff€is€not€industrially€disabled€Ð 8-x). Ðbecause€he€now€has€less€risk€of€a€heart€attack,€better€blood€flow,€and€improvedÏcardiovascular€status.€€They€point€out€that€the€plaintiff€returned€to€the€same€job€withÏthe€same€pay.€€Further,€they€say€that€the€plaintiffððs€impairment€was€the€same€beforeÏthe€heart€attack€as€it€was€after€the€heart€attack,€according€to€Dr.€Graham.Ìà ` àDr.€Hays€and€Dr.€Graham€both€testified€that€the€plaintiff€now€has€a€Class€2Ïimpairment€rating.€€Dr.€Graham€could€only€speculate€as€to€the€impairment€ratingÏbefore€the€heart€attack€because€there€was€no€evidence€of€the€plaintiffððs€heart€diseaseÏbefore€the€heart€attack.€€Because€the€plaintiff€was€asymptomatic€before€the€heartÐ ¤;ä7> Ðattack,€he€could€not€have€had€a€Class€2€rating€before€because€such€a€rating€requiresÏsymptoms.€€In€any€event,€both€experts€agreed€that€permanent€damage€was€done€toÏthe€plaintiffððs€heart.€€Regardless€of€whether€the€plaintiff€has€the€same€job,€his€ð ðmarketÏvalueðð€is€diminished.€€We€find€the€evidence€supports€a€finding€of€vocational€disability.Ìà ` àFinally,€the€defendants€argueò ò€ó óthat€the€determination€of€liability€for€futureÐ ð 0 Ðsurgery€expenses€is€contingent€upon€expert€testimony€at€the€time€the€employeeððsÏcondition€requires€surgery,€if€he€does.€€òòHelton€v.€State,óó€800€S.W.2d€823€(Tenn.Ð ”Ô  Ð1990).€€The€determination€of€liability€of€the€defendant€must€be€made€at€the€time€aÏsecond€surgery€occurs,€and€the€relationship€of€such€surgery€to€the€current€heartÏattack€must€then€be€determined.€Ìà ` àWe€affirm€the€judgment€of€the€trial€court€in€all€things€except€the€finding€of€aÏright€to€contingent€and€future€medical€costs,€which€is€reversed.€€The€cost€of€thisÏappeal€is€taxed€to€the€defendants.à  àÐ `  ÐÓÓÌÌà ` àà ¸ àà  àà h àà À àà  à_____________________________Ìà ` àà ¸ àà  àà h àà À àà  àJohn€K.€Byers,€Senior€JudgeÌÌÌÌCONCUR:ÌÌÌÌ________________________________ÌE.€Riley€Anderson,€Chief€JusticeÌÌÌÌ________________________________ÌRoger€E.€Thayer,€Special€œJudgeñ—^ñÐ  r*²&+ Ðñ—^ññ˜^ñ›ñ˜^ññ˜^ñÔ‡¼1"¼XX˜¡Ôà ` àÔ#†X˜¡X¼¼1"±=#ÔÔ‡Š¸ÁŠXX˜¡Ôà ¸ àà  àIN€THE€SUPREME€COURT€OF€TENNESSEE€€Ô#†X˜¡XŠŠ¸Áÿ=#ÔÐ À Ðà@ÌÌ.ÌàˆÌßl€*6&"h 8 `€€ExŸtt06°ž¨çlßâ °°$$âà ` àà ¸ àà  àà h àà À àAT€KNOXVILLEÌÒÒâ °°$$âà è àà @ àà ˜ àà ð àà H àà   àà ø àà P àà ¨ à¼à è àÌà è àà @ àà ˜ àà ð àà H àà   àà ø àà P àà ¨ à¼à è àà @ àà ˜ àÌà è àà @ àà ˜ àà ð àà H à€€€à   àÐ  \ Ðà 8 àà à àà 8 àà  àà 8 àà  àà è àà @ àà ˜ àà ð àà H àà   àà ø àÌÒ(HÒâ °°°"°"âà è àà @ àÌâ °"°"°°âRONALD€UNDERWOODà ð àà H à€€€€)à   à€RHEA€CHANCERY€€Ð Î   Ðà è àà @ àà ˜ àà ð àà H à€€€€)€à   à€No.€8796Ð ´ ô  ÐÒ (Òà è àPlaintiff„Appellee,à ð àà H à€€€€)à   àà ø àà P àà ¨ àÐ šÚ  Ðà è àà @ àà ˜ àà ð à€€€€à H à€€€€)à   àà ø àà P àà ¨ àà  àà X àÐ €À  Ðà è àà @ à€€€€€€€€€€€€€€€€€€€€€€€€à H à€€€€)€à   àNo.€€03S01„9802„CH€„00019Ð f¦  Ðà è àv.à @ àà ˜ àà ð àà H à€€€€)Ð LŒ  Ðà è àà @ àà ˜ àà ð àà H à€€€€)Ìñ ^ññš^ñROBINSON€ñš^ññœ^ñMANUFACTURINGñœ^ññ ^ñà è àà @ àà ˜ àà ð àà H àñ¦^ñ€€€€)ñ¦^ñà   àà ø à€€€ñ¤^ñ€ñ¤^ññ¥^ñ)ñ¥^ñ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð X Ðñ¢^ññ^ñ€ñ^ññ¡^ñRñ¡^ññ¢^ññ£^ñRñ£^ññ¡^ñOBINSON€MANUFACTURINGñ¡^ñ€€€€€€ñ§^ñ)ñ§^ñ€€€€€€€€€€Hon.€Jeffrey€F.€StewartÌCOMPANY,€INC.€and€ARGONAUT€€ñŸ^ññ˜^ñ€ñ˜^ññŸ^ñ)à   àñ¨^ñ€€€€€ñ¨^ñChancellorà ¨ àà  àà X àÐ ä$ ÐINSURANCE€COMPANYà ð àà H à€€€€)Ð Ê  Ðà è à€à @ àà ˜ àà ð àà H à€€€€)Ð °ð Ðà è àDefendants„Appellants.à H à€€€€)à   àà ø àÓ€ÓÐ –Ö Ðà è àà @ àà ˜ àà ð àà H àà   àà ø àÌà è àà @ àà ˜ àà ð à€€€€€€JUDGMENT€ORDERÌ€€€€€€€€Ô‡Xò1 XXX˜¡Ôà è àThis€case€is€before€the€Court€upon€the€entire€à X àÐ ¡á Ðrecord,including€the€order€of€referral€to€the€à  àà X àÐ  I ÐSpecial€Workers'€Compensation€Appeals€Panel,€and€the€à X àÐ JŠ  ÐPanel's€Memorandum€Opinion€setting€forth€its€findings€à X àofÐ ‹Ë" Ðfact€and€conclusions€of€law,€which€are€incorporated€à X àÐ Ì $ Ðherein€by€reference;Ìà è àWhereupon,€it€appears€to€the€Court€that€the€à  àà X àÐ N#Ž( Ðmemorandum€Opinion€of€the€Panel€should€be€accepted€andÏapproved;€andÌà è àIt€is,€therefore,€ordered€that€the€Panel's€à  àà X àÐ 'Q#. Ðfindings€of€facts€and€conclusions€of€law€are€à  àà X àÐ R(’$0 Ðadopted€and€affirmed,€and€the€decision€of€the€Panel€is€madeÏthe€Judgment€of€the€Court.Ìà è àCosts€on€appeal€are€taxed€to€the€appellants,RobinsonÏManufacturing€Company,€Inc.€And€Argonaut€Insurance€Company,Ïand€H.€Richard€Marcus,surety,for€which€execution€may€issueÏif€necessary.€à ˜ àÐ Ø/,< Ð03/05/99à @ àÔ#†X˜¡X XXò1ÔH#Ô›