ÿWPC eUB– %ØUBÞ nX0 0rˆúwF4H 0¶\ 0D 0JV 0T  Æô ƺ Æ€ ÆF 0^ 0hj 0rÒ 0|D 0†À 0F AQÖÆ' 0Ží 0@{ 0D» 1uÿ D/t 0d£ B D3$ BWU6tU*ªB)ÔDCý AM@"f¯"v~7vÓµ Bˆ B*¥ BBÏ<þ6X9`(*Courier 12pt10cpiXô\  `*Times New RomanTT3|P6«<þ6X9`(*Courier 12pt10cpiXXxþ6X@ÉJQX@ô\  `*Times New RomanTTXXPô\  PŽ6QXP(J ´$¡¡Ô€X¾òXXXÔÔ€XÕ XXX¾òÔÓ  Ó !"V#™$£%£&£' î()*Ó€6WX$(N(f(3è^$¤¤Ý ƒ ´!ÝÔ€XÒmXXXÔÔ€XmøXXXÒmÔÓ  ÓÝ  Ýà  àòòÚ  Ú0Ú  Úóó(#Ã$òòÚ  Ú0Ú  Úóó2 ÿÿ0Indent1Ô2ÔÔ3  Ô2" ÿÿ0Indent2à0 àÔ2ÔÔ3  ÔLevel 1Level 2Level 3Level 4Level 5‚Level 1Level 2Level 3Level 4Level 5„Level 1Level 2Level 3Level 4Level 5…Level 1Level 2Level 3Level 4Level 52, ÿÿ0Indent3à0 àà0 àÔ2ÔÔ3  Ô26 ÿÿ0Indent4à0 àà0 àà0 àÔ2ÔÔ3  Ô2@ ÿÿ0Indent5à0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2J ÿÿ0Indent6à0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2T ÿÿ0Indent7à0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2^ ÿÿ0Indent8à0 àà0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô !"#%Cþÿ<< CÿÿƒLevel 1Level 2Level 3Level 4Level 5(f3C³$¢¢Ý ƒ ´!ÝÔ€XÒmXXXÔÔ€XmøXXXÒmÔÓ  ÓÝ  Ý("ÿÿ$££Ò  ÒÒ  Ò($$””ò òÚ  Ú1Ú  Úó ó ÿÿ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a)'''÷ÿ dxdP ÿÿ8Mac DefaultMac DefaultÓ ` °šXÓüÿP Pd****'ÿÿdxd d< Œ 9p`(Courier New< Œ 9p`(Arial% Line 7 d22227Border 1dd "3Cþÿ << Gÿÿ Ý ƒ!ÝÔ€0ÔÔ€ÔÓ  ÓÝ  ÝÝ ƒ!"ÝÝ  ÝÔ€1ÔÔ€1ÔÓ  ÓÔ YYY ÔFILEDÔ€1XÔÌÌò òJuly€7,€1998ÌÌCecil€Crowson,€Jr.ÌÔ€1ôÔAppellate€Court€Clerkó ó \Ñ\R AØ'\Ñ Ý ƒ!ÝÔ€0ÔÔ€ÔÓ  ÓÝ  ÝÝ ƒ!"ÝÝ  ÝÔ€1ÔÔ€1ÔÓ  ÓÔ YYY ÔFILEDÔ€1XÔÌÌò òJuly€7,€1998ÌÌCecil€Crowson,€Jr.ÌÔ€1ôÔAppellate€Court€Clerkó óPtPtHHÚ(ÿáÿâùFG(üHHÚ(d'hStyl{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  h HD: Geneva ÒÒ  h HD: Geneva Òûÿ   d&ÿÿ0 d d>Thick Double° Pd PdÝ ƒ!ÝÔ . ÔÔ€0ÔÔ€ÔÓ  ÓÝ  ÝÒ  ÒÒ X ÒÓ  ÓÑ\R AØ'\Ñò òÔ€1ÔÞ ÞÌIN›€THE€SUPREME€COURT€OF€TENNESSEEÌSPECIAL€WORKERS'€COMPENSATION€PANELÌAT€JACKSON€ó óÌÓ  ÓÌÌÌÓ  ÓJOHNNY€T.€BROWN,à àà àà à)Ìà àà àà àà àà àà à)à àTENNESSEE€CLAIMS€COMMISSIONÌà àClaimant€/€Appellee,à àà à)à àAT€NASHVILLEÌà àà àà àà àà àà à)Ìv.à àà àà àà àà àà à)à àNO.€2A01„9701„BC„0001Ìà àà àà àà àà àà à)à à(€Claims€Comm.€No.€Below€104181„02)ÌSTATE€OF€TENNESSEE,à àà àà à)Ìà àà àà àà àà àà à)à àHON.€MARTHA€B.€BRASFIELDÌà àDefendant€/€Appellant.à àà à)à àCOMMISSIONER,€WESTERN€DIV.ÌÌÌò òòòFor€the€Appellant:à àà àà àà àà àFor€the€Appellee:ÌÌó óóóMary€G.€Moodyà àà àà àà àà àLarry€R.€DorningÌAssistant€Attorney€Generalà àà àà à403€E.€Main€StreetÌ426€Fifth€Avenue€Northà àà àà àà àHohenwald,€Tennessee€38462„1541€ÌSecond€Floor,€Cordell€Hull€Bldg.ÌNashville,€Tennessee€37243à àà àà àThomas€F.€BloomÌà àà àà àà àà àà àà à500€Church€Street,€5th€FloorÌà àà àà àà àà àà àà àNashville,€Tennessee€37219ÌÙ€ ÙœßR€453A1-j|Îÿ:` Å `€€@ÿRß›ÌÌÌÌÌÌÌÌÌÌÓ  Óò òòòMEMORANDUM€OPINIONÌÓ  ÓÌÌÌÌÓ  Óóóó óÌòòò òMembers€of€PanelÌóóó óJustice€Janice€HolderÌSenior€Judge€John€K.€ByersÌSpecial€Judge€Robert€L.€ChildersÌÌÌÌÌÌÌÌÌÌÌÌÌÓ  Óò òAFFIRMEDà àà àà àà àà àà àà àCHILDERS,€Special€Judgeó óÌÌÓÓà àÌà àThis€workersðð€compensation€appeal€has€been€referred€to€the€Special€WorkersððÏCompensation€Appeals€Panel€of€the€Supreme€Court€in€accordance€with€TÔ€1ôÔENNÔ€1XÔ.€CÔ€1ôÔODEÔ€1XÔÏAÔ€1ôÔNNÔ€1XÔ.€ðð€50„6„225€(e)(3)€for€hearing€and€reporting€to€the€Supreme€Court€of€findings€ofÏfact€and€conclusions€of€law.Ìà àIn€this€case€the€Commissioner€of€Claims€found€that€the€œclaimant/appellee›€wasÏentitled€to€total€disability€payments€from€August€9,€œ1994›€through€November€9,€1994,€inÏthe€amount€of€$3,617.57.€€The€Commissioner€also€found€that€the€claimant€sustained€aÏpermanent€partial€impairment€of€50%€to€the€body€as€a€whole€in€the€amount€of€$55,050.€ÏFurther,€the€Commissioner€found€that€the€State€was€not€liable€for€payment€of€anyÏmedical€expenses€incurred€for€the€services€of€œJackson„Madison›€County€GeneralÏassociated€with€the€œclaimantððs›€August€9,€œ1994›€surgery€or€for€any€deposition€fees€orÏmedical€bills€of€Dr.€George€Copple,€Dr.€Ray€Hester€or€Dr.€Joseph€P.€Rowland.€ÏAttorneyððs€fees€in€the€amount€of€$11,733.51€(20%)€were€awarded€to€the€claimant.€ÏBecause€the€evidence€preponderates€in€favor€of€the€decision€of€the€ClaimsÏCommissioner,€we€affirm.Ìà àThe€State€admits€in€November€œ1991›€that€the€claimant,€Johnny€T.€Brown,€then€aÏ40„year„old€male,€sustained€a€back€injury€while€pushing€a€two„hundred€pound€tent€outÏof€the€back€of€a€truck,€a€duty€within€the€scope€of€his€employment€as€a€maintenanceÏsupervisor€at€Paris€Landing€State€Park.€€Mr.€Brown€is€a€high€school€graduate€withÏextensive€experience€in€construction,€maintenance€and€electrical€work.€€He€also€hasÏexperience€in€tobacco€farming€and€in€computer€applications.Ìà àWhen€the€injury€occurred,€the€claimant€did€not€go€directly€to€the€emergencyÏroom,€but€later€saw€his€family€physician€Dr.€Charles€Tucker.€€Dr.€Tucker€ordered€a€CTÏscan€and€an€MRI€and,€in€his€Attending€Physicianððs€Report€of€November€21,€1991,Ïdiagnosed€the€claimant€with€a€ð ðlumbar€strain€from€lifting€heavy€objects.ðð€€Dr.€TuckerÏthen€referred€the€claimant€to€Dr.€Robert€Merriweather,€a€neurosurgeon.Ìà àDr.€Merriweather€treated€the€claimant€conservatively€with€physical€therapy€andÏanti„inflammatory€and€pain€medications.€€During€the€course€of€treatment,€Dr.ÏMerriweather€conducted€a€physical€examination€and€reviewed€the€MRI€ordered€by€Dr.ÏTucker.€€In€addition,€Dr.€Merriweather€ordered€a€myelogram€and€post„myelogram€œCTÌÓ  Ó2ÌÓ  Ó›€scan€which€revealed€no€evidence€of€a€disc€herniation.€€Dr.€Merriweather€stated€thatÏœthe€tests›€indicated€a€ð ðconjoined€nerve€root€on€the€right€at€L5„S1.ðð€€Dr.€œMerriweatherÏreleased›€the€claimant€to€return€to€work€with€no€restrictions€on€January€6,€1992.Ìà àMr.€Brown€returned€to€work€where,€because€of€a€decrease€in€the€number€ofÏmaintenance€workers,€he€was€required€to€perform€some€of€the€maintenance€duties€inÏaddition€to€his€supervisory€duties.€€He€informed€his€supervisor€that€his€back€pain€wasÏsuch€that€he€was€unable€to€perform€these€expanded€duties.€€On€February€27,€1992€theÏclaimant€returned€to€Dr.€Merriweather,€who€opined€that€Mr.€Brown€had€reachedÍmaximum€medical€improvement.€€Dr.€Merriweather€offered€no€opinion€as€to€causationÏand€assessed€permanent€anatomical€impairment€at€5%.€€He€later€revised€that€figure€toÏ10„15%€or€as€high€as€20%€depending€on€the€claimantððs€job€capacity.€€Dr.ÏMerriweather€released€the€claimant€for€œlight›€œduty.›€€œAlthough›€he€was€never€officiallyÏterminated€by€the€œState,€the€claimant€was€informed€that€there€was€no€light€dutyÏavailable.›Ìà àShortly€after€February€27,€œ1992›€claimant€requested€a€list€of€three€doctors€fromÏthe€Division€of€Claims€Administration€(DCA).€€From€the€list€provided€by€the€DCA,Ïclaimant€selected€and€next€saw€Dr.€Cooper€W.€Beazley€on€two€dates:€July€œ27,1992›Ïand€November€18,€1992.€€Dr.€Beazley,€an€orthopaedic€surgeon,€treated€the€claimantÏconservatively€and€diagnosed€him€with€ð ðpersistent€sciatica€with€very€mild€disc€bulging.ðð€ÏDr.€Beazley€recommended€an€epidural€cortisone€shot€and€assessed€the€permanentÏanatomical€impairment€rating€at€3%€to€the€body€as€a€whole€based€solely€on€theÏclaimants€ð ðcomplaints€of€chronic€pain.ðð€€Dr.€Beazley€did€not€offer€an€opinion€onÏcausation.€€€€€€Ìà àDuring€this€period€of€treatment,€the€claimant€applied€for€disability€through€theÏTennessee€Consolidated€Retirement€System,€but€the€claim€was€denied.€€However,€asÏa€part€of€the€application€process€the€claimant€was€referred€to€Dr.€Carl€W.€Huff,€whomÏhe€first€saw€on€February€5,€1992.€€Dr.€Huff€performed€an€Isostation€200€œtest,›€but€he€didÏnot€express€an€opinion€on€causation.€€Dr.€Huff€noted€a€ð ðgood„faith€effortðð€by€Mr.€BrownÏand€prescribed€a€rehabilitation€program.€€€Dr.€Huff€saw€the€claimant€€again€on€May€12,Ï1993€and€performed€another€Isostation€200€test.€€Dr.€Huff€noted€that€the€secondÏIsostation€200€test€result€differed€from€the€earlier€one,€indicating€a€discrepancy€in€theÏpain€pattern€œÌÓ  Ó3ÌÓ  Óand›€ð ðexaggeratedðð€responses.Ìà àIn€July€1993€the€Vocational€Rehabilitation€Counselor€arranged€for€the€claimantÏto€be€evaluated€by€Dr.€Ray€Hester,€a€neurosurgeon.€€Dr.€Hester€diagnosed€theÏclaimant€with€ð ða€degenerative€joint€at€L4„5€with€a€bulging€disc.ðð€€He€assessed€theÏpermanent€anatomical€impairment€rating€at€7%€to€the€body€as€a€whole.€€Dr.€HesterÏalso€noted€evidence€of€symptom€magnification€syndrome.Ìà àThe€Vocational€Rehabilitation€Section€later€referred€œMr.€Brown›€to€Dr.€JosephÏRowland,€a€neurosurgeon.€€Dr.€Rowland€saw€œhim›€in€May€1994€and€diagnosedÏð ðdegenerative€disc€disease€and€a€possible€injured€disc€at€L5€on€the€right€side.ðð€€Dr.ÏRowland€performed€a€hemilaminectomy€during€which€he€found€only€ð ðarthritic,Ïdegenerativeðð€changes€in€the€spine.€€He€found€no€evidence€of€acute€injury€to€the€spineÏand€later€testified€that€the€œwork„related›€injury€could€not€have€caused€or€furtheredÏdegeneration€but€could€have€made€the€condition€more€painful.€€Dr.€Rowland€testified€inÏhis€deposition€that€œMr.€Brown›€had€a€9%€disability€to€the€body€as€related€to€a€discÏoperation.ððÌà àOur€review€is€òòde€novoóó€on€the€record€accompanied€by€a€presumption€that€theÏfindings€of€fact€made€by€the€trial€court€are€correct€unless€the€evidence€preponderatesÏotherwise.€€TÔ€1ôÔENNÔ€1XÔ.€CÔ€1ôÔODEÔ€1XÔ€AÔ€1ôÔNNÔ€1XÔ.€ðð€50„6„225(e).€€Ìà àWe€find€that€the€evidence€preponderates€in€favor€of€the€finding€œthat€theÏclaimant/appellee€sustained€permanent€disability›€œthat€arose€out€of€and€within€theÏcourse€and€scope€of€his€employment€in€November,€1991.›Ìà àThe€record€in€this€case€reveals€that€the€claimant/appellee€was€asymptomaticÏbefore€this€injury€occurred.€€Mr.€Brown€testified€during€direct€examination€at€trial€that€heÍœhad€had›€only€one€back€injury€prior€to€the€November€1991€injury€in€question,€a€strainedÏmuscle€in€the€left€side€of€his€back€in€1990.€€On€cross€examination€he€agreed€that€heÏreported€that€he€strained€his€back€in€1990.€€He€also€admitted€that€he€may€have€filed€aÏreport€in€May€1991€that€he€twisted€his€back€jumping€from€a€backhoe.€€He€also€agreedÏthat€if€the€records€showed€that€he€reported€straining€his€back€in€1982€lifting€bags€ofÏgravel,€and€that€he€reported€hurting€his€back€while€crawling€in€a€tunnel€in€1981,€theÏrecords€would€be€correct,€but€that€he€did€not€remember€these€incidents.€€He€stated€that€œÌÓ  Ó4ÌÓ  Óhe›€did€not€receive€medical€treatment€for€any€of€these€incidents€that€he€recalls.€€There€isÏno€proof€in€the€record€that€he€received€any€medical€treatment€for€any€of€theseÏincidents.Ìà àThe€record€further€shows€that€after€the€November€1991€injury€he€was€treated€byÏseveral€different€physicians€and€was€in€substantial€pain.€€During€this€time€he€alsoÏreceived€anti„inflammatory€and€pain€medications.€€He€attempted€to€return€to€work€inÏJanuary€1992€with€expanded€duties,€but€later€told€his€supervisor€that€he€was€unable€toÏperform€his€job.€€His€employer€then€gave€him€a€lay„off€slip.€€œHe€then›€returned€œto€see›€Dr.ÏœMerriweather€who›€later€returned€Mr.€Brown€to€light€duty,€but€no€light€duty€wasÏavailable.Ìà àWith€regard€to€pain,€Mr.€Brown€testified€that€he€was€in€a€great€deal€of€pain€fromÏthe€time€of€the€November€1991€injury€to€the€surgery€by€Dr.€Rowland€on€August€8,€1994.€ÏDr.€Rowland€testified€that€when€he€next€saw€Mr.€Brown€after€the€surgery€on€August€31,Ï1994,€Mr.€Brown€stated€he€was€ð ðdoing€much€better€and€having€much€less€pain.ðð€€WhenÏDr.€Rowland€saw€Mr.€Brown€again€on€November€2,€1994,€his€office€notes€ð ðpatientÏstated€he€is€much€better,€but€still€does€not€think€he€can€return€to€work.ðð€€Ìà àAt€trial€claimant/appellee€testified€that€he€had€pain€every€day,€ð ðall€day€long€andÏall€night€long€.€.€.€I€couldnððt€sleepðð,€from€the€date€of€the€November€1991€injury€to€theÏAugust€1994€surgery.€€He€took€pain€and€anti„inflammatory€medications€all€during€thisÏtime.€€After€the€August€1994€surgery€he€testified€that€he€was€much€better,€but€ð ðthere€areÏnights€that€I€donððt€sleep.ðð€€He€further€testified€œthat,›€€ð ðI€may€sleep€in€the€recliner€ratherÏthan€the€bed,€but€I€do€sleep€now.ðð€€Mr.€Brown€also€asked€the€Court€to€allow€him€toÏstand€periodically€during€the€trial€because€ð ðthe€sitting€created€pressure€or€strain€on€myÏback,€and€even€after€the€surgery€if€I€get€active€or€if€I€sit€for€quite€a€while€then€the€painÏreturns€and€.€.€.€sitting€here€is€just€more€than€I€can€handle.ðð€€He€also€testified€that€he€stillÏhas€to€take€pain€and€anti„inflammatory€medications.Ìà àRelevant€expert€medical€testimony€exists€in€this€case€regarding€aggravation€ofÏthe€claimant/appelleeððs€pre„existing€degenerative€arthritis.€€During€the€crossÏexamination€of€Dr.€Rowland€in€his€deposition€the€following€exchange€took€place:Ìà àà àQ.à àBy€œaggravation€of›€an€arthritic€condition,€do€you€mean€make€it€moreÏà àà àpainful,€or€do€you€mean€make€it€progress€more€rapidly?ÌÓ  ÓœÌ5ÌÓ  Ó›à àà àA.à àMake€it€more€painful.Ìà àà àQ.à àBut€it€cannot€make€it€progress€more€rapidly?Ìà àà àA.à àUnless€it€is€a€severe€injury€where€the€bones€are€injuredÏthemselves.Ìà àà àQ.à àAnd€that€would€be€such€as€a€blow€to€the€back?Ìà àà àA.€à àYes,€sir.ÌHowever,€on€further€direct€examination€Dr.€Rowland€testified€as€follows:Ìà àà àQ.à àDoctor,€Iððm€a€little€bit€confused.€€I€want€to€know,€could€the€injury€thatÏà àà àhe€described€to€you€in€1991€have€caused€or€contributed€to€the€problemÏà àà àthat€you€ultimately€corrected€in€his€back?Ìà àà àA.à àAgain,€sir,€in€my€opinion,€the€patient€had€arthritic€changes€in€hisÏà àà àback,€it€could€have€been€aggravated€from€his€lifting€incident.€ò òÌó óà àIf€a€work€injury€aggravates€a€pre„existing€condition€merely€by€increasing€theÏpain,€the€claim€is€not€compensable.€€òòTownsend€v.€Stateóó,€826€S.W.€2d€434€(Tenn.Ï1992);€òòCunningham€v.€Goodyear€Tire€and€Rubber€Co.,€óó811€S.W.2d€888€œ(Tenn.€1991).›€ÏThe€medical€evidence€must€show€that,€in€addition€to€the€manifestation€of€increasedÏpain,€there€is€a€permanent€anatomical€change€in€the€pre„existing€injury€or€condition.€ÏòòTalley€v.€Virginia€Insurance€Reciprocalóó,€775€S.W.€2d€587€(Tenn.€1989).€€Further,€theÏclaimant€must€show€that€there€is€a€causal€relationship€between€that€anatomicalÏchange€and€the€work„related€injury€to€the€pre„existing€condition.€€œòòBoling›€v.€RaytheonÏCo.óó,€448€S.W.€2d€405€(Tenn.€1969).Ìà àExcept€in€the€most€obvious€and€routine€cases,€the€claimant€in€a€œworkers›Ïcompensation€action€must€establish€causation€by€expert€medical€evidence.€€òòOrman€v.ÏWilliams€Sonoma,€Inc.,€óó803€S.W.2d€672,€676€œ(Tenn.€1991).›€€Although€causationÏcannot€be€based€upon€speculative€or€conjectural€proof,€absolute€medical€certainty€isÏnot€required€and€reasonable€doubt€is€to€be€construed€in€favor€of€the€employee.€€òòWhiteÏv.€Werthan€Indus.,€óó824€S.W.2d€158,€159€œ(Tenn.€1992).›€€€It€is€entirely€appropriate€for€aÏtrial€judge€to€predicate€an€award€on€medical€testimony€to€the€effect€that€a€givenÏincident€ð ðcould€beðð€the€cause€of€the€employeeððs€injury,€when€the€trial€judge€also€hasÏheard€lay€testimony€from€which€it€may€reasonably€be€inferred€that€the€incident€was€inÏfact€the€cause€of€the€injury.€€€€òòOrman,€óó803€S.W.2d€at€676.€€ÌÓ  Óà àœ6ÌÓ  Óà àWhile›€it€is€true€that€Dr.€Rowland€testified€that€the€November€1991€incident€madeÏthe€arthritic€condition€more€painful,€but€did€not€make€it€progress,€he€also€testified€thatÏthe€arthritic€changes€in€Brownððs€back€could€have€been€aggravated€from€his€NovemberÏ1991€lifting€incident.€€Taken€as€a€whole€the€evidence€shows€that:Ìà à(1)€€€Mr.€Brown€was€asymptomatic€before€the€November€1991€œincident;›Ìà à(2)€€€the€August€1994€surgery€would€not€have€been€necessary€but€for€Ìà à€€€€€€€€the€pain€caused€by€the€November€1991€incident;Ìà à(3)€€€Mr.€Brown€now€has€a€9%€anatomical€disability€to€the€body€Ìà à€€€€€€€€as€a€result€of€the€August€1994€surgery,€and;Ìà à(4)€€€Mr.€Brown€continues€to€have€pain€after€the€surgery.€€œÌà àDr.›€œRowland€also›€testified,€as€to€future€œsymptoms,›€that€there€œis€always›€a€10%Ïchance€of€a€recurrent€disc€problem,€and€œthat›€there€is€always€a€chance€that€people€whoÏhave€disc€œoperations›€will€have€pain€post„op.Ìà àAs€the€Court€stated€in€òòThomas€v.€Aetna€Life€&€Casualty€Company€et€al,€óó812ÏS.W.€2d€278€œ(Tenn.€1991),›€ð ð[w]hile€causation€and€permanency€of€an€injury€must€beÏproved€by€expert€medical€testimony,€such€testimony€must€be€considered€in€conjunctionÏwith€the€lay€testimony€of€the€employee€as€to€how€the€injury€occurred€and€theÏœemployeeððs›€subsequent€condition.ððÌà àWhen€considered€in€conjunction€with€the€claimant/appelleeððs€testimony,€anyÏequivocation€reflected€in€Dr.€Rowlandððs€testimony€as€to€causation€constitutes€exactlyÏthe€type€of€reasonable€doubt€that€must€be€construed€in€favor€of€the€employee€andÏcompensability.€€òòWhite,€óó824€S.W.2d€at€160.€€Ìà àThe€evidence€in€this€record€shows€that€the€claimant/appellee€had€surgeryÍœresulting›€from€the€November€1991€injury,€and€that€he€now€has€a€permanent€disabliltyÏbecause€of€the€surgery€and€permanent€pain.€€€An€employer€is€responsible€for€workersÏcompensation€benefits,€even€though€the€claimant€may€have€been€suffering€from€aÏserious€pre„existing€condition€or€disability,€if€the€employment€causes€an€actualÏprogression€or€aggravation€of€the€prior€disabling€condition€or€disease€which€producesÏincreased€pain€that€is€disabling.€€òòHill€v.€Eagle€Bend€Mfg.€Co.,€óó942€S.W.€2d€489€œÌ(Tenn.€1997).ÌÓ  Ó7ÌÓ  Ó›€à àWhen€the€opinions€of€medical€experts€differ€in€a€workers€compensation€case,Ïthe€trial€court€has€absolute€discretion€to€accept€the€opinion€of€one€medical€expert€overÏanother.€€òòJohnson€v.€œMidwesco›,€Inc.óó,€801€œS.W.›€2d€804€(Tenn.€1990).€€Furthermore,Ïthere€is€a€clear€distinction€between€anatomical€impairment€as€determined€by€aÏphysician€and€vocational€disability€which€results€from€such€impairment.€€òòœHinson›€v.€œWal„Mart›€Stores€Incóó.,€654€S.W.2d€675€(Tenn.€1983).€€The€trial€court€is€not€limited€toÏestimates€of€anatomical€impairment€in€determining€the€percentage€that€plaintiff€hasÏbecome€disabled€as€a€result€of€the€injury.€€òòBailey€v.€Knox€County€Tennesseeóó,€732€S.W.Ï2d€587€(Tenn.€1987).€€Ìà àIn€determining€whether€there€has€been€a€decrease€in€the€employeeððs€capacityÏto€earn€wages€in€any€line€of€work€available€to€the€employee€and€in€assigningÏpermanent€partial€disability,€the€trial€court€should€consider€both€expert€and€layÏtestimony,€as€well€as€the€employeeððs€age,€education,€skills,€training,€local€jobÏopportunities,€and€capacity€to€work€at€types€of€employment€available€in€the€claimantððsÏdisabled€condition.€€òòœOrman›€v.€Williams€œSonoma›,€Inc.óó,€803€S.W.€2d€672,€678€(Tenn.Ï1991).Ìà àThe€record€before€us€reflects€that€Mr.€Brown€has€a€high€school€education€andÏthat€all€of€his€training€and€employment€experience€involved€physical€labor€and€the€useÏof€his€back.€€The€record€also€reflects€that€he€cannot€sit€or€stand€for€long€periods€of€timeÏwithout€pain,€and€that€he€continues€to€take€medication€for€the€pain.€€The€numerousÏphysicians€who€treated€Mr.€Brown€opined€that€he€sustained€permanent€anatomicalÏimpairment€ranging€from€3%€to€œ20%.€€Furthermore,€the€vocational€expert,€Dr.€Copple,Ïopined€that€Mr.€Brown€sustained€a€60„70%€vocational€disability.›Ìà àWe€find€that€the€evidence€in€the€record€preponderates€in€favor€of€the€ClaimsÏCommissionerððs€award€of€50%€permanent€partial€disability€to€the€body€as€a€whole,€andÏtemporary€total€disability€benefits€from€August€9,€1994€through€November€9,€1994.€ÏThe€judgment€of€the€Claims€Commissioner€is€affirmed€and€the€case€is€remanded€to€theÏClaims€Commission€for€the€entry€of€any€order€necessary€to€carry€out€this€judgment.€ÏThe€cost€of€this€appeal€is€assessed€against€the€defendant/appellant.€€€ÌœÌÓ  Ó8›à àà àà àà àà àà àà àÌÓ  Óà àà àà àà àà àà àà àœ€€€€€€€€€€ÓÓòòÌÌà àà àà àà àà àà àà à___________________________óó›Ìœà àà àà àà àà àà àà àRobert›€L.€Childers,€Special€JudgeÌÓÓÌCONCUR:ÌÓÓòò€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€óóÌJustice€Janice€HolderÌÓÓÌÓÓòò€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€óóÌJohn€K.€Byers,€Senior€Judgeà àà àà àà àà à€€€ÌÓÓÌÌÌÌÌÓ  ÓÌà àà àà àà àà àÌÌœÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÓ  Ó9Ñ€6ÑÇÑ ` ÑÇÒ ° ÒÒ ° ÒÓ  ÓÓÓßJ€47;+'b|+` Å `€@ÿJßà@ àÔ€1¼ÔIN€THE€SUPREME€COURT€OF€TENNESSEEÌÌà@ àAT€JACKSONÔ€1XÔÌÌÌÓ#` Ü` ¸ pœÐ X#ÓJOHNNY€T.€BROWN,à à)à àTENNESSEE€CLAIMS€COMMISSIONÌà àà à)à àNO.€€104181„02Ìà àClaimant/Appellee,à à)à àÌà àà à)à àHon.€Martha€B.€Brasfield,Ìvs.à àà à)à àCommissionerÌà àà à)ÌSTATE€OF€TENNESSEE,à à)à àNO.€02S01„9704„BC„00036Ìà àà à)Ìà àDefendant/Appellant.à à)à àAFFIRMED.ÌÓ#` Ü…X^ŠÐ X#ÓÌÌÌà@ àÔ€1¼ÔJUDGMENT€ORDERÔ€1XÔÌÌÌÓ` p`  ’XÓÓÓà àThis€case€is€before€the€Court€upon€the€entire€record,€including€the€orderÏof€referral€to€the€Special€Workers'€Compensation€Appeals€Panel,€and€the€Panel'sÏMemorandum€Opinion€setting€forth€its€findings€of€fact€and€conclusions€of€law,€whichÏare€incorporated€herein€by€reference.Ìà àWhereupon,€it€appears€to€the€Court€that€the€Memorandum€Opinion€of€theÏPanel€should€be€accepted€and€approved;€andÌà àIt€is,€therefore,€ordered€that€the€Panel's€findings€of€fact€and€conclusions€ofÏlaw€are€adopted€and€affirmed,€and€the€decision€of€the€Panel€is€made€the€judgment€ofÏthe€Court.Ìà àCosts€will€be€paid€by€Appellant,€for€which€execution€may€issue€ifÏnecessary.Ìà àIT€IS€SO€ORDERED€this€7th€day€of€July,€1998.ÌÌà àà àà àà àà àà àà àà àPER€CURIAMÌ(Holder,€J.,€not€participating)ÌÌÌÌ