ÿWPC{# ;# JUNU %£ 0û©U:¤4Þò w@ 0?O 0DŽ 0JÒ Æ Æâ ƨ Æn 0T4 0^ˆ 0hæ 0rN 0|À 0†< 0 AQRÆ£ 0i 0@€ 0DÀ B D/! 1uP BÅ D3â 0dU>yU*·U*áB) DC4 AMwÓÄË—Èbv~*vÓ¨˜HP LaserJet 4SiHPPCL5MS,ü,,,,,ü0nLhÎ(ÈhH  Z ‹6Times New Roman RegularX(ÓH=$¡¡Ñ  ÑÒH°ÒÒ°ÒÑTR[  AØ'ÿ Legal[  AØ'ÿ Legal AØ'ÿ Legal AØ'ÿ LegalTÑÔ€XÎ_XXXÔÑ7€¾úXXdðXXdð7Ñ, øð AZ‹"Arial RegularWX$3|x÷EH ÖEU×EUØEeÙEeÚEÓ€æEéEVêEîëEÓ€÷E(ï(3w$¤¤Ý ƒH=!ÝÑ  ÑÒH°ÒÒ°ÒÑTR[  AØ'ÿ Legal3Ø' AØ'ÿ Legalÿ3Ø'TÑÔ€X¸ŽXXXÔÑ7€ErXXdìdì7ÑÝ  Ýà ` àòòÚ  Ú0Ú  Úóó(%Ã$òòÚ  Ú1Ú  Úóó2 ÿÿ0Indent1Ô2ÔÔ3  ÔLevel 1Level 2Level 3Level 4Level 5‚Level 1Level 2Level 3Level 4Level 5„Level 1Level 2Level 3Level 4Level 5…Level 1Level 2Level 3Level 4Level 52" ÿÿ0Indent2à0 àÔ2ÔÔ3  Ô2, ÿÿ0Indent3à0 àà0 àÔ2ÔÔ3  Ô26 ÿÿ0Indent4à0 àà0 àà0 àÔ2ÔÔ3  Ô2@ ÿÿ0Indent5à0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2J ÿÿ0Indent6à0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2T ÿÿ0Indent7à0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2^ ÿÿ0Indent8à0 àà0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô !"#%Cþÿ<< CÿÿƒLevel 1Level 2Level 3Level 4Level 5(ï3· $¢¢Ý ƒH=!ÝÑ  ÑÒH°ÒÒ°ÒÑTR[  AØ'ÿ Legal3Ø' AØ'ÿ Legalÿ3Ø'TÑÔ€X¸ŽXXXÔÑ7€ErXXdìdì7ÑÝ  Ý("ÿÿ$££Ò  ÒÒ  Ò($$””ò òÚ  Ú1Ú  Úó ó d'''÷ÿ dxd ÿÿ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a)üÿP Pd$$$$'ÿÿdxdP ÿÿ8Mac DefaultMac DefaultÓ ` °šXÓ< Œ 9p`(&Times New Roman< Œ 9p`(Arial< Œ 9p`(Times% Line 7 d33337Border 1dd "4Cþÿ << Gÿÿ ÉÝ ƒ!ÝÑ  ÑÑ#€d#ÑÔ€0ÔÑ  ÑÒ  ÒÒ H ÒÑ\R AØ'\ÑÔ€1ÔÑ#€d#ÑÝ  ÝÝ ƒ!"ÝÝ  ÝÔ€1ÔÓ  ÓÔ YYY ÔFILEDÔ€1XÔÌÌò òJuneÏ29,Ï1998ÌÌCecilÏCrowson,ÏJr.ÌÔ€1ôÔAppellateÏCourtÏClerkó ó ÁÝ ƒ!ÝÑ#€d#ÑÔ€0ÔÑ  ÑÒ  ÒÒ H ÒÑ\R AØ'\ÑÔ€1ÔÑ#€d#ÑÝ  ÝÝ ƒ $Ýà àòòÚ  ÚÚ  ÚóóÝ  Ý€€The€medical€profession€refers€to€an€arm€as€an€upper€extremity.€€The€statuteÏrefers€to€an€arm€as€a€scheduled€member.€€€Ì ¾Ý ƒ!ÝÑ#€d#ÑÔ€0ÔÑ  ÑÒ  ÒÒ H ÒÑ\R AØ'\ÑÔ€1ÔÑ#€d#ÑÝ  ÝÝ ƒ!"ÝÝ  ÝÔ€1ÔÓ  ÓÔ YYY ÔFILEDÔ€1XÔÌÌò òJuneÏ29,Ï1998ÌÌCecilÏCrowson,ÏJr.ÌÔ€1ôÔAppellateÏCourtÏClerkó óPtPtHHØ(ÿáÿâùFG(üHHØ(d'`Styl{WP}01•ÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃà Ãà Ãà Ãà Ãà ÃÃÃÃÃÃÃÃÃÃÃÐ ÐÐHHÐÐ  ÐÐ2ÐÐÿÿ¸æ$ÿÐÐHHÐÐÐÐÐÐÐÐ  ÐÐ ÐÐ ÐÑÑÑGenevaÑÑ ÑÑ € ÑÑ<Px–ÈÑÒÒÒ443!#4ÒÒ$ *$ÒÒ$*$ÒÒ ÿKK ÒÒ  Geneva ÒÒ  Geneva ÒÓ.,ÓÓÓÓ6ÓÓ ÓßßßßßßßßßßßßßßßßßßÑGenevaÑÑ ÑÒ  ellan Geneva ÒÒ  ellan Geneva ÒÝ ƒ!ÝÔ . ÔÔ€0ÔÑ  ÑÒ  ÒÒ H ÒÑ\R AØ'\ÑÔ€1ÔÑ#€22Xd#ÑÑ#€22Xd#ÑÝ  ÝÑ  ÑÓ  ÓÑ À ÑÑ X Ñò ò›œ›Þ ÞÌ€Ìó óà@ àò òIN€THE€SUPREME€COURT€OF€TENNESSEEÌÙ€ ÙœßR€564A1-j|<Ï` 81 `€€@ÿRß›à@ àSPECIAL€WORKERS'€COMPENSATION€APPEALS€PANELÌà@ àAT€JACKSONó óÌÓ  ÓÌÌÌÌÌÌÌDORIS€BARNES,à àà àà àà à)Ìà àà àà àà àà àà à)à àÌà àPlaintiff/Appelleeà àà àà à)à àCARROLL€CIRCUITà àà àà àà àà àà àà àà à)à àÌv.à àà àà àà àà àà à)à àNO.€€02S01„9710„CV„00087Ìà àà àà àà àà àà à)à àÌCIGNA€INSURANCE€COMPANY,à à)à àHON.€JULIAN€P.€GUINN,Ìà àà àà àà à€à àà à)à àJUDGEÌà àDefendant/Appellantà àà à)ÌÌÌÌÌÌÌò òòòÌFor€the€Appellant:à àà àà àà àFor€the€Appellee:ÌÌóóó óJames€Belew€Webbà àà àà àRicky€L.€BorenÌJason€C.€Scottà àà àà àà àHill€&€Boren,€P.C.Ì1066€S.€Main€Streetà àà àà à1269€N.€Highland€AvenueÌP.O.€Box€679à àà àà àà àP.O.€Box€3539ÌMilan,€TN€€38358à àà àà àà àJackson,€TN€€38303„3539ò òòòÌóóó óÌÌÌÓ  Óò òòòÌÌÌÌM€E€M€O€R€A€N€D€U€M€€€€O€P€I€N€I€O€Nóóó óÌÌò òòòMembers€of€Panel:ÌÌó óóóJustice€Janice€HolderÌSenior€Judge€John€K.€ByersÌSpecial€Judge€J.€Steven€StaffordÌÓ  ÓÌÌÌÌÌÔ% € ÔÌÌÌÌÌÌÌÌÌÌÌAFFIRMEDà àà àà àà àà àà àà àBYERS,€Senior€JudgeÌÌÓ  ÓÓÓòòò òOPINIONó óóóÌÓ  Óà àThis€workers'€compensation€appeal€has€been€referred€to€the€SpecialÏWorkers'€Compensation€Appeals€Panel€of€the€Supreme€Court€in€accordance€withÏTenn.€Code€Ann.€ðð€50„6„225(e)(3)€for€hearing€and€reporting€to€the€Supreme€CourtÏof€findings€of€fact€and€conclusions€of€law.€Ìà àReview€of€the€findings€of€fact€made€by€the€trial€court€is€òòde€novoóó€upon€theÏrecord€of€the€trial€court,€accompanied€by€a€presumption€of€the€correctness€of€theÏfindings,€unless€the€preponderance€of€the€evidence€is€otherwise.€€Tenn.€Code€Ann.€Ïðð€50„6„225(e)(2);€òòStone€v.€City€of€McMinnville,€óó896€S.W.2d€548,€550€(Tenn.€1995).€ÌThe€application€of€this€standard€requires€this€Court€to€weigh€in€more€depth€theÏfactual€findings€and€conclusions€of€the€trial€court€in€a€workersðð€compensation€case.€ÏòòSee€Corcoran€v.€Foster€Auto€GMC,€Inc.,€óó746€S.W.2d€452,€456€(Tenn.€1988).Ìà àThe€trial€court€held€the€plaintiff€had€sustained€a€40€percent€permanent€partialÏdisability€to€the€right€arm× ƒ7 ××  ×€and€a€30€percent€permanent€partial€disability€to€the€leftÍarm€as€a€result€of€a€gradually€occurring€injury€which€arose€in€the€course€of€and€inÏthe€scope€of€her€employment€with€Martin€Marietta€Ordnance€Systems,€Inc.€(ð ðMartinÏMariettaðð).Ìà àThe€defendant,€Cigna€Insurance€Company,€appeals€and€raises€the€followingÏissue€about€the€award€to€the€left€arm:ÌÒ ` ÒÒ H ÒÓÓð ð1)à àWhether€the€trial€courtððs€award€of€30%€permanent€partial€disability€toÏthe€left€upper€extremity€was€contrary€to€the€weight€of€the€evidence€given€theÏ6.35%€anatomical€impairment€awarded€by€the€evaluating€physician€and€theÏzero€percent€(0%)€anatomical€impairment€awarded€by€the€treatingÏphysician?ððÌÌÒ  ÒÒ H ÒÓÓà àWe€find€the€award€of€30€percent€to€the€plaintiffððs€left€arm€was€not€contrary€toÏthe€weight€of€the€evidence€and€affirm€the€judgment€of€the€trial€court.ÌÓ  Óò òFACTSó óÌÓ  Óà àThe€plaintiff,€age€65€at€the€time€of€trial,€testified€she€had€either€a€ninth€or€tenthÏgrade€education.€€Her€work€history€includes€farming€and€working€in€a€sewingÏmachine€factory.€€She€has€never€done€any€type€of€office€work.€€In€1967,€the€plaintiffÏbegan€working€for€Milan€Arsenal,€which€later€became€Martin€Marietta.€€With€theÏexception€of€a€two€year€lay€off€period,€she€worked€there€until€she€retired€in€1997.€€Ìà àThe€plaintiffððs€job€consisted€of€production€work€and€machine€operation€in€theÏx„ray€department.€€In€the€x„ray€department€job€which€lasted€for€three€years,€sheÏpushed€buttons€and€turned€a€knob.€€By€September€1995,€the€plaintiff€hadÏdeveloped€problems€with€both€of€her€arms.€€She€testified€her€arms€would€go€toÏsleep€at€night€and€hurt€during€the€day.€€She€also€testified€her€thumbs€would€hurt.Ìà àBeginning€October€1995,€the€plaintiff€saw€a€series€of€doctors€for€theseÏproblems€and€was€diagnosed€with€mild€bilateral€carpal€tunnel€syndrome€andÏarthritis.€€On€April€23,€1996,€she€underwent€a€carpal€tunnel€release€surgery€on€herÏright€hand€and€a€CMC€joint€replacement€on€her€right€thumb.€€She€testified€sheÍelected€not€to€have€joint€replacement€on€her€left€hand€because€the€surgery€on€herÏright€hand€did€not€seem€successful€enough.€€Ìà àOn€July€8,€1996,€the€plaintiff€returned€to€work€ð ðdoing€rejects,ðð€a€job€thatÏrequired€her€to€walk€as€much€as€it€required€her€to€use€her€hands.€€She€said€this€jobÏwas€much€easier€than€the€jobs€she€had€performed€in€the€past.€€On€March€31,€1997,Ïthe€plaintiff€retired€because€of€the€trouble€she€was€having€with€her€hands.€€SheÏtestified€she€did€not€feel€able€to€work€but€said€she€would€have€continued€to€work€ifÏher€hands€had€not€bothered€her.€€The€plaintiff€testified€she€cannot€unscrew€jars,€hasÏdifficulty€getting€tops€off€of€child„proof€medicine€bottles,€and€cannot€use€a€needle€toÏsew.€€She€testified€she€would€not€be€able€to€return€to€any€of€her€previous€jobsÏbecause€of€the€problems€with€her€hands.€€€€€€€ÌÓ  Óò òMEDICAL€EVIDENCEó óòòÌÓ  Óà àóóDr.€L.€David€Johnson,€a€board€certified€orthopedic€surgeon,€first€saw€theÏplaintiff€on€October€18,€1995.€€He€observed€she€had€pain€with€manipulation€of€theÏcarpometacarpal€(ð ðCMCðð)€joint€of€the€thumbs,€positive€Tinelððs€signs,€no€thenarÏatrophy,€and€she€was€neurovascularly€intact.€€Dr.€Johnsonððs€impression€was€thatÏshe€had€CMC€arthritis€and€carpal€tunnel€syndrome,€both€bilaterally.€€He€placed€herÏin€thumb€wrist€splints€and€referred€her€to€Dr.€Bingham€and€Dr.€Bourland.€€Ìà àDr.€Ronald€C.€Bingham€is€board€certified€in€physical€medicine€andÏrehabilitation,€but€he€limits€his€practice€to€electromyography.€€On€October€23,€1995,Ïhe€conducted€ELG€nerve€conduction€studies€on€the€plaintiff€and€they€revealed€mildÏmedian€neuropathy€in€both€wrists€though€the€right€wrist€was€worse.€€Dr.€BinghamÏsaw€the€plaintiff€on€March€14,€1996€and€found€the€medial€neuropathy€was€presentÏin€both€wrists€with€no€significant€change.Ìòòà àóóDr.€William€Bourland€is€an€orthopedist€with€a€subspecialty€in€hand€surgery.€ÏOn€April€1,€1996,€he€diagnosed€the€plaintiff€with€mild€bilateral€carpal€tunnelÏsyndrome,€bilateral€osteoarthritis,€and€CMC€joint€of€the€thumbs€bilaterally.€€On€AprilÏ23,€1996,€Dr.€Bourland€performed€an€endoscopic€carpal€tunnel€release€surgery€andÏa€CMC€joint€replacement€on€her€right€hand.€€On€May€20,€1996,€he€found€the€plaintiffÏto€have€good€early€motion€following€surgery€and€allowed€her€to€resume€normalÏwork€activities.€€On€September€23,€1996,€he€found€her€to€have€excellent€flexion€andÏextension€of€the€fingers€and€determined€she€had€reached€maximum€medicalÏimprovement.Ìà àIn€a€letter€dated€April€23,€1997,€Dr.€Bourland€opined€the€plaintiff€did€not€retainÏany€permanent€impairment€secondary€to€the€right€carpal€tunnel€syndrome€but€didÏretain€a€13€percent€permanent€impairment€to€the€right€upper€extremity€secondary€toÏthe€CMC€joint€replacement€in€accordance€with€the€òòAMA€Guidesóó.€€Further,€he€opinedÏshe€had€no€impairment€to€the€left€upper€extremity€with€regard€to€carpal€tunnelÏsyndrome€because€she€was€not€symptomatic€and€surgery€was€not€required.Ìòòà àóóDr.€Joseph€C.€Boals,€a€board€certified€orthopedic€surgeon,€saw€the€plaintiff€€Ïon€January€30,€1997€for€an€independent€medical€evaluation€at€the€request€of€herÏcounsel.€€He€found€her€to€have€reduced€grip€strength€in€her€right€hand€secondary€toÏthe€carpal€tunnel€syndrome€and€residuals€from€the€joint€replacement€of€her€rightÏthumb.€€Dr.€Boals€opined€she€sustained€a€22€percent€impairment€to€the€right€upperÏextremity€based€on€the€joint€replacement€and€carpal€tunnel€syndrome.€€RegardingÏthe€left€hand,€he€found€ongoing€degenerative€arthritis€in€the€CMC€joint€of€the€leftÏthumb€and€carpal€tunnel€syndrome€in€the€left€hand,€which€had€improved€and€wasÏnot€presently€symptomatic.€€Dr.€Boals€opined€she€had€a€five€percent€anatomicalÍimpairment€based€on€the€CMC€joint€of€the€left€thumb,€which€would€equate€to€1.35Ïpercent€impairment€to€the€left€upper€extremity.ÌÓ  Óò òANALYSISó óÌÓ  Óà àThe€extent€of€vocational€disability€is€a€question€of€fact€to€be€determined€fromÏall€of€the€evidence,€including€lay€and€expert€testimony.€€òòWorthington€v.€Modine€Mfg.ÏCo.,óó€798€S.W.2d€232,€234€(Tenn.€1990).€Ìà àOur€review€of€the€expert€testimony€reveals€that€Dr.€Bourland€found€theÏplaintiff€had€no€impairment€to€the€left€upper€extremity€while€Dr.€Boals€found€she€hadÏa€five€percent€anatomical€impairment€to€the€CMC€joint,€which€would€equate€to€1.35Ïpercent€impairment€to€the€left€upper€extremity.€€We€note€the€trial€court€has€theÏdiscretion€to€accept€the€opinion€of€one€medical€expert€over€another€medical€expert.€ÏòòJohnson€v.€Midwesco,€Inc.,€óó801€S.W.2d€804,€806€(Tenn.€1990).Ìà àRegarding€the€lay€testimony,€the€plaintiff€testified€she€has€significantÏproblems€with€both€of€her€hands€and€thumbs,€stating€she€retired€because€of€theÏcondition€of€her€hands.€€In€this€case,€as€in€all€workersðð€compensation€cases,€theÏclaimant's€own€assessment€of€her€physical€condition€and€resulting€disabilities€isÏcompetent€testimony€and€cannot€be€disregarded.€òò€Tom€Still€Transfer€Co.€v.€Way,óóÏ482€S.W.2d€775,€777€(Tenn.€1972).Ìà àIn€making€determinations€of€vocational€disability,€the€court€shall€consider€allÏpertinent€factors,€including€lay€and€expert€testimony,€employeeððs€age,€education,Ïskills€and€training,€local€job€opportunities,€and€capacity€to€work€at€types€ofÏemployment€available€in€claimantððs€disabled€condition.€€Tenn.€Code€Ann.òò€ððóó€50„6„241(a)(1);€òòRoberson€v.€Loretto€Casket€Co.,€óó722€S.W.2d€380,€384€(Tenn.€1986).€€OurÏreview€of€these€relevant€factors€shows€the€plaintiff€is€65€years€old,€has€a€limitedÏeducation,€and€has€only€worked€in€jobs€that€require€the€use€of€her€hands.Ìà àFinally,€the€trial€judge€noted€the€plaintiff€ð ðimpresses€the€Court€with€herÏveracity€and€credibility.ðð€€Where€the€trial€judge€has€made€a€determination€basedÏupon€the€testimony€of€witnesses€whom€he€has€seen€and€heard,€great€deferenceÏmust€be€given€to€that€finding€in€determining€whether€the€evidence€preponderatesÏagainst€the€trial€judgeððs€determination.€€òòSeeóó€òòHumphrey€v.€David€Witherspoon,€Inc.,Ïóó734€S.W.2d€315€(Tenn.€1987).Ìà àWe€find€the€evidence€does€not€preponderate€against€the€finding€of€the€trialÏcourt€that€the€plaintiff€is€entitled€to€the€award€of€30€percent€permanent€partialÏdisability€to€the€left€arm.€€Ìà àThe€judgment€of€the€trial€court€is€affirmed€and€the€cost€of€this€appeal€is€taxedÏto€the€defendant.€€à àÌÓÓÌÌÌÌÌÌà àà àà àà àà àà à_____________________________Ìà àà àà àà àà àà àJohn€K.€Byers,€Senior€JudgeÌÌCONCUR:ÌÌÌÌ________________________________ÌJanice€Holder,€JusticeÌÌÌÌ________________________________ÌJ.€Steven€Stafford,€Special€Judge€œÇÑ ` Ñà@ àÔ€1¼ÔIN€THE€SUPREME€COURT€OF€TENNESSEEÌÌà@ àAT€JACKSONÔ€1XÔÌÌÌÓ#` Ü…X^ŠÐ X#ÓDORIS€BARNES,à àà àà à)à àCARROLL€CIRCUITÌÓ#` Ü` ^ŠÐ X#Óà à)à àNO.€€3450ÌÓ#` Ü` ¸ ^ŠÐ X#Óà àPlaintiff/Appellee,à à)à àÌà àà à)à àHon.€Julian€P.€Guinn,Ìvs.à àà à)à àJudgeÌà àà à)ÌCIGNA€INSURANCE€COMPANY,à à)à àNO.€02S01„9710„CV„00087ÌßJ€58;+'b|` ‚- `€@ÿJßà àà à)Ìà àDefendant/Appellant.à à)à àAFFIRMED.ÌÌÌÌà@ àÔ€1¼ÔJUDGMENT€ORDERÔ€1XÔÌÌÓ  ÓÓÓÌÓ` p`  ’XÓà àThis€case€is€before€the€Court€upon€the€entire€record,€including€theÏorder€of€referral€to€the€Special€Workers'€Compensation€Appeals€Panel,€and€theÏPanel's€Memorandum€Opinion€setting€forth€its€findings€of€fact€and€conclusions€ofÏlaw,€which€are€incorporated€herein€by€reference.Ìà àWhereupon,€it€appears€to€the€Court€that€the€Memorandum€Opinion€ofÏthe€Panel€should€be€accepted€and€approved;€andÌà àIt€is,€therefore,€ordered€that€the€Panel's€findings€of€fact€andÏconclusions€of€law€are€adopted€and€affirmed,€and€the€decision€of€the€Panel€is€madeÏthe€judgment€of€the€Court.Ìà àCosts€will€be€paid€by€Appellant,€and€surety,€for€which€execution€mayÏissue€if€necessary.Ìà àIT€IS€SO€ORDERED€this€29th€day€of€June,€1998.ÌÌà àà àà àà àà àà àà àà àPER€CURIAMÌ(Holder,€J.,€not€participating)ÌÌÌÌ›