ÿWPC‘ :# <UNG %• 0û›U:–4Ðä 1mó 0c`&Ãw@é 0?) 0Dh ¬ 0D¬ ð 0Jö 0T@ 0^” 0hò 0rZ 0|Ì 0†H 0Î AQ^Ư 0Du 0@¹ Bù 1u D/‹ 0dº B D3;U>nU*¬U*ÖB)DC) AMlɹ¾‚v~@vÓ¾˜HP LaserJet 4 PlusHPPCL5MS,ð,,,,,ð0nLHÎ(ÈhH  Z ‹6Times New Roman RegularX(ÓH=$¡¡Ñ  ÑÒH°ÒÒ°ÒÑTR[  AØ'ÿ Legal[  AØ'ÿ Legal AØ'ÿ Legal AØ'ÿ LegalTÑÔ€XÎ_XXXÔÑ7€¾úXXdðXXdð7Ñ, øð AZ‹"Arial Regular•{:$øð 3|x] #)e37=CIQYag­­1.a.i.(1)(a)(i)1)a)(;3¹$´´Ô2)eÔÚ  Ú0Ú  Ú.Ô3  Ôà0  à ReidInman AEBUCDDÊFUG îHÓ€RSÓ€](ï(3Ån$¤¤Ý ƒH=!ÝÑ  ÑÒH°ÒÒ°ÒÑTR[  AØ'ÿ Legal3Ø' AØ'ÿ Legalÿ3Ø'TÑÔ€X8ÛXXXÔÑ7€ÅqXXdìdì7ÑÝ  Ýà ` àòòÚ  Ú0Ú  Úóó(#Ã$òòÚ  Ú0Ú  Úóó($$””ò òÚ  Ú1Ú  Úó óH2 ÿÿ0Indent1Ô2ÔÔ3  Ô2" ÿÿ0Indent2à0 àÔ2ÔÔ3  Ô2, ÿÿ0Indent3à0 àà0 àÔ2ÔÔ3  Ô26 ÿÿ0Indent4à0 àà0 àà0 àÔ2ÔÔ3  Ô2@ ÿÿ0Indent5à0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2J ÿÿ0Indent6à0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2T ÿÿ0Indent7à0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2^ ÿÿ0Indent8à0 àà0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô!"#&Cþÿ<< CÿÿƒLevel 1Level 2Level 3Level 4Level 5(3¯$¢¢Ý ƒ!ÝÝ  Ý("ÿÿ$££Ò  ÒÒ  Ò d ÿÿ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a)(('÷ÿ dxdP ÿÿ8Mac DefaultMac DefaultÓ ` °šXÓüÿP Pd$$$$'ÿÿdxd< Œ 9p`(&Times New Roman< Œ 9p`(Arial< Œ 9p`(Times% Line 7 d33337Border 1dd!#4Cþÿ << Gÿÿ ¿Ý ƒ!ÝÑ  ÑÑ#€d#ÑÔ€0ÔÑ  ÑÒ  ÒÒ H ÒÑ\R AØ'\ÑÔ€1ÔÑ#€d#ÑÝ  ÝÝ ƒ""ÝÝ  ÝÔ€1ÔÓ  Óò òÔ YYY ÔFILEDÔ€1XÔÌÌMarchÏ5,Ï1998ÌÌCecilÏW.ÏCrowsonÌAppellateÏCourtÏClerkÔ  Ôó ó ´Ý ƒ!ÝÑ#€d#ÑÔ€0ÔÑ  ÑÒ  ÒÒ H ÒÑ\R AØ'\ÑÔ€1ÔÑ#€d#ÑÝ  ÝÝ ƒ""ÝÝ  ÝÔ€1ÔÓ  Óò òÔ YYY ÔFILEDÔ€1XÔÌÌMarchÏ5,Ï1998ÌÌCecilÏW.ÏCrowsonÌAppellateÏCourtÏClerkÔ  Ôó óPtPtHHÚ(ÿáÿáùEG(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  ion-F Geneva ÒÒ  ion-F Geneva ÒÝ ƒ!ÝÔ . ÔÔ€0ÔÑ  ÑÒ  ÒÒ H ÒÑ\R AØ'\ÑÔ€1ÔÑ#€22Xd#ÑÑ#€22Xd#ÑÝ  ÝÑ  ÑÓ  ÓÑ À ÑÑ X ÑÓÓÔ€0ÔÔ€0¼Ô›Þ ÞÌà@ àò òIN€THE€SUPREME€COURT€OF€TENNESSEEÌÙ€!ÙœßR€564A1-j|{` 81 `€€@ÿRß›à@ àSPECIAL€WORKERS'€COMPENSATION€APPEALS€PANELÌà@ àAT€NASHVILLEó óÓ  ÓÓÓÌÌÌDOUGLAS€E.€BUMPUS,à àà à)à àÌà àà àà àà àà àà à)à àMONTGOMERY€CIRCUITÌà àPlaintiff/Appelleeà àà àà à)à àÌà àà àà àà àà àà à)à àNO.€01S01„9707„CV„00144Ìv.à àà àà àà àà àà à)à àÌà àà àà àà àà àà à)à àHON.€JAMES€E.€WALTON,ÌBIRMINGHAM„NASHVILLE€à à)à àJUDGEÌEXPRESS,€INC.,€à àà àà àà à)à àÌand€THE€TRAVELERSà àà àà à)ÌINSURANCE€COMPANY,à àà à)Ìà àà àà àà àà àà à)Ìà àDefendants/Appellantsà àà à)ÌÌÌÌÌÌÌò òòòÌFor€the€Appellant:à àà àà àFor€the€Appellee:Ìó óóóœRichard€E.€Spicerà àà àà àà àJulia€F.€SmithÌSpicer,€Flynn€&€Rudstrom,€PLLCà à113€South€Third€StreetÌ424€Church€St.,€Ste.€1350à àà àClarksville,€TN€37040ÌNashville,€TN€37219„21305òòò ò›Ìó óóóÌÌÌÌÌÓ  Óò òòòM€E€M€O€R€A€N€D€U€M€€€O€P€I€N€I€O€NÌÌMembers€of€Panel:ÌÌóóó óJustice€Lyle€ReidÌSenior€Judge€William€H.€InmanÌSpecial€Judge€Joe€C.€Loser,€Jr.ÌÓ  ÓÌÌÌÌÌÌÌÌò òAFFIRMEDà àà àà àà àà àà àINMAN,€à àSenior€JudgeÌó óÌÓÓà àThis€workers'€compensation€appeal€has€been€referred€to€the€SpecialÏWorkers'€Compensation€Appeals€Panel€of€the€Supreme€Court€in€accordanceÏwith€Tenn.€Code€Ann.€ðð€50„6„225(e)(3)€for€hearing€and€reporting€to€theÏSupreme€Court€of€findings€of€fact€and€conclusions€of€law.Ìò òà@ àIÌà àó óThis€is€another€gradually„occurring€injury€case€involving€physicalÏdisability€not€caused€by€trauma,€specific€episode,€or€ððaccidental€injuryðð€as€theÏterm€is€historically€used,€that€would€best€be€resolved€by€appropriateÏlegislation.Ìà àThe€plaintiff€is€a€career€truck€driver€who€developed€osteoarthritis€inÏboth€knees€to€the€extent€that€full€knee€replacements€were€required.€€TheÏœprostheses›€were€successful€and€after€three€months€the€plaintiff€resumed€hisÏtruck€driving€career.€œ€Nevertheless,›€the€trial€judge€found€that€the€plaintiffÏsuffered€a€70€percent€vocational€disability€to€both€legs.€€His€monetary€recoveryÏwas€limited€to€260€weeks€because€of€his€age.Ìà àThe€employer€appeals,€insisting€that:€(1)€the€plaintiffððs€arthriticÏcondition€is€not€compensable€because€non„job€related;€(2)€the€award€isÏexcessive;€and€(3)€the€lump€sum€order€is€improper.Ìò òà@ àIIó óÌà àThe€plaintiff€was€born€in€August,€1934.€€While€he€has€held€a€number€ofÏjobs,€he€is€a€career€over„the„road€truck€driver.€€He€began€working€for€theÏdefendant€in€1984.€€He€is€described€as€a€freight€peddler,€meaning€that€heÏdelivers€and€unloads€the€cargo€he€transports.€€Over€the€years€the€wear€and€tearÏoccasioned€by€lifting€and€carrying€heavy€loads€began€to€affect€his€bodily€joints,Ïparticularly€his€knees.€€In€1987€or€1988,€he€sought€treatment€for€his€kneesÏfrom€œDr.›€James€R.€Smith,€who€diagnosed€arthritis,€about€which€nothing€couldÏbe€done.€€The€condition€worsened,€his€legs€bowed,€and€knee€replacements€wereÏrecommended.Ìò òà@ àIIIÌà àó óDr.€James€Smith€practices€general€internal€medicine,€with€35€yearsÏexperience.€€Through€the€years€he€has€treated€many€patients€for€arthriticÏdiseases,€one€of€whom€is€the€plaintiff.€€In€1987,€he€diagnosed€the€plaintiff€asÏsuffering€from€osteoarthritis,€which€he€described€as€degenerative€changes€ofÏthe€joint€spaces,€deterioration€of€the€cartilages,€and€laying€down€of€new€bonesÏaround€those€joint€spaces€which€will€cause€a€joint€destruction.Ìà àHe€testified€that€ð ðthe€more€wear€and€tear€that€you€place€on€your€jointsÏfrom€any€cause,€you€will€get€more€of€an€acceleration€of€this€process.ððÌIn€1995,€his€examination€of€the€plaintiff€prompted€this€comment,€œmanuscripted›Ïon€the€plaintiffððs€record:ÌÓÓà8 àð ðThe€most€prominent€debility€and€disability€he€has€is€his€severeÏcrippling€degenerative€osteoarthritis.€€The€left€knee€is€by€far€theÍmajor€joint€that€is€affected.€And€with€an€amount€of€deviation€heÏhas€of€the€tibia€at€this€time,€I€am€sure€that€Gene€will€need€to€haveÏreplacement€knee€surgery€within€the€next€year€or€two.€€He€is€nowÏbecoming€very€debilitated€and€disabled€from€walking.€€And€withÏhis€job€as€a€truck€driver€in€and€out€of€a€cab€all€day€deliveringÏparcels€and€boxes,€I€donððt€see€how€he€can€continue€this€work.ððÌÌHe€further€testified:ÌÌà0 àQ:à8 àDoctor,€did€you€take€a€history€at€any€time€during€yourÏseeing€Mr.€Bumpus€as€to€what€heððs€done€for€a€living?ÌÌà0 àA:à8 àTo€my€knowledge,€he€has€been€a€truck€driver€most€of€hisÏlife.ÌÌà0 àQ:à8 àAll€right.€€Are€you€aware€of€what€his€particular€jobÏinvolved?€€And€Iððm€referring€you€to€your€February€27,€ðð95Ïnote.ÌÌà0 àA:à8 àAs€I€understood€it,€he€was€a€delivery€type€of€truck€driver,Ïthat€he€delivered€goods.€€And€that€would€require€getting€inÏand€out€of€his€cab€most€all€day.ÌÌà0 àQ:à8 àDoctor,€what€is€your€opinion,€if€any,€as€to€whether€or€notÏMr.€Bumpusðð€employment€as€a€truck€driver€aggravated€andÏaccelerated€the€physical€changes€in€his€knees€and€legs?Ìà0 àœÌà àA:›à8 àI€think€that€in€all€probability€that€his€getting€in€andÏout€of€the€truck,€weight€bearing,€squatting€possibly,Ïanything€that€put€stress€and€strain€on€the€knee€joint€byÏother€change€in€the€positions€of€the€knees€or€weightÏbearing€would€aggravate€osteoarthritis€and€helpÏaccelerate€it.ÌÌà0 àQ:à8 àDoctor,€does€the€fact€that€you€found€that€the€left€knee,€theÏknee€that€he€would€operate€the€clutch€of€the€semi€with,€theÏfact€that€you€found€it€worse€than€the€right€have€any€bearingÏon€your€finding€this€to€be€accelerated€or€aggravated€by€hisÏjob?ÌÌà àA:à8 àWell,€the€only€thing€I€can€say€is€any€time€you€wouldÏuse€a€knee€or€joint€more€and€more€day€in,€day€out,€IÏthink€that€accelerates€the€process€of€osteoarthritis.€ÌÌò òà@ à.€€€.€€€.€€€.€€€.€ÌÌà àó óQ:à8 àDoctor,€would€you€describe€for€the€judge€theÏprogression€of€the€osteoarthritis€in€Mr.€Bumpus€fromÏwhen€you€first€saw€him€in€1988€till€you€saw€him€inÏ1995?ÌÌà àA:à8 àWell,€I€think€that€as€the€years€went€by,€his€knees€andÏhis€osteoarthritis€had€progressed€and€itððs€gottenÏworse.ÌÌà àQ:à8 àWhat€is€involved€in€the€progression€or€theÏdeterioration€of€the€knee?€€What€happens€in€the€knee?ÌÌà àA:à8 àActually€you€get€a€destruction€of€the€lining€of€theÏcartilaginous€linings€of€the€ends€of€the€bones€and€youÏwill€get€regression€of€the€bones,€more€maybe€on€oneÏside€than€the€opposite€side€.€.€.€.ððÌÌÓÓò ò€€à àó óHe€summarized€his€opinion€by€stating€that€ÌÓ  ÓÓÓà8 àð ð€.€.€.€getting€in€and€out€of€the€truck,€weight€bearing,€squattingÏpossibly,€anything€that€put€stress€and€strain€on€the€knee€joint€.€.€.Ïwould€aggravate€osteoarthritis€and€help€accelerate€it.ððÌÓ  Ó€ÌÓÓò òà@ àIVÌà àó óDr.€Cooper€Beazley,€an€orthopedic€surgeon,€performed€the€kneeÏreplacement€surgery.€€He€testified:ÌÓÓà àQ:à8 àDr.€Bassly,€after€the€surgery,€did€he€attend€anyÏtherapy?ÌÌà àA:à8 àI€believe€he€did€probably€for€a€total€of€about€four€toÏsix€weeks.Ìà àÌà àQ:à8 àWhat€would€be€the€period€of€time,€Dr.€œBeazley,›€heÏwould€have€been€disabled€from€working€because€ofÏhis€knee€condition€and€the€surgery?ÌÌà àA:à8 àTypically€about€three€months.ÌÌà àQ:à8 àWould€that€be€typical€in€this€case?ÌÌà àA:à8 àYes.ÌÌà àQ:à8 àDr.€œBeazley›,€did€you€later€take€a€history€of€what€heÏdid€for€a€living;€and€if€so,€what€would€that€be?ÌÌà àA:à8 àHe€worked€as€a€semi„tractor„trailer„truck€driverÏwhere€he€would€drive€freight€back€and€forth€andÏcrawl€in€and€out€of€the€cab€of€his€truck.ÌÌà àQ:à8 àDid€you€take€a€history,€did€he€do€any€other€physicalÏwork€while€working€as€a€truck€driver?ÌÌà àA:à8 àI€think€he€did€some€loading€and€unloading€also.ÌÌà àQ:à8 àDr.€Beazley,€what€type€of€result€do€you€feel€like€heÏhad€from€the€total€knee€replacements?ÌÌà àA:à8 àI€think€heððs€had€a€good€result€to€date.ÌÌà àQ:à8 àWhat€limitations€would€you€expect€one€to€have€onÏtheir€mobility€after€having€a€total€knee€replacementÏon€both€legs?ÌÌà àA:à8 àWell,€he€doesnððt€have€normal€flexion,€the€ability€toÏbend€the€knee€completely,€but€he€really€has€very€fewÏlimitations.€€The€main€thing€with€him€œis€Iððve›€told€him,Ïthese€are€artificial€knees€and€they€have€to€last,€so€IÏrecommended€he€not€abuse€them.ÌÌà àQ:à8 àWhat€is€the€life€expectancy€of€a€set€of€artificial€knees?ÌÌà àA:à8 àSomebody€in€his€age,€his€body€weight€and€who€isÏvery€compliant,€you€know,€the€percentages€are€thatÏ90€percent€of€those€knees€will€be€functioning€in€tenÏyears.€€Longer€out€than€that,€with€his€type€ofÏprosthesis,€there€is€no€way€to€really€predict.ÌÌà àQ:à8 àAnd,€Dr.€Beazley,€what€is€your€opinion€as€to€theÏamount€of€physical€impairment€he€retains€as€a€resultÏof€the€injury€„€„€as€a€result€of€his€knee€conditions?ÌÌà àA:à8 àThe€AMA€Guide€books€say€35€percent€of€the€lowerÏextremity€for€a€good€result,€which€I€think€he€wouldÏqualify€for€that.ÌÌà àQ:à8 àAll€right.€€Doctor,€is€this€a€case€of€body€as€a€whole€orÏis€the€impairment€confined€to€the€leg€itself?ÌÌà àA:à8 àI€think€that€rating€is€to€the€leg.ÌÌà àQ:à8 àAll€right.€€And€thatððs€AMA€Guidelines,€what€edition?ÌÌœ›à àA:à àThe€red€book,€4th.ÌÌà àQ:à8 àDr.€Beazley,€I€want€to€pass€you€some€restrictions€thatÏIððd€like€for€you€to€look€at.€€Dr.€Beazley,€are€those€theÏrestrictions€that€you€placed€on€him€in€regard€to€hisÏwork€place?€Ìà8 àà8 à[no€squatting€or€kneeling;€limited€climbing]ÌÌà àA:à àYes.ÌÌà àQ:à8 àAre€those€permanent€restrictions?ÌÌà àA:à8 àYes.ÌÌà àQ:à8 àAll€right.€€Dr.€Beazley,€the€impairment€you€haveÏgiven,€is€that€a€permanent€impairment?ÌÌà àA:à8 àThe€one€you€asked€for€is,€yes,€maððam.ÌÌà àQ:à8 àDr.€Beazley,€what€is€your€opinion€as€to€how€long€heÏhad€probably€had€osteoarthritis€in€his€knees?€Ìà àà àà àÌà àA:à8 àWell,€by€history,€at€least€ten€to€fifteen€years.ÌÌà àQ:à8 àDr.€Beazley,€what€causes€arthritis€to€develop€in€theÏknees?ÌÌà àA:à8 àWell,€it€can€just€occur€all€on€its€own.€€Typically,Ïthatððs€what€„€„€in€a€lot€of€people€what€does€happen.€€ItÏcan€occur€after€trauma€or€an€injury.€€It€can€be€aÏdisease€process€that€has€a€strong€family€history€of€it.€ÏBut€typically€osteoarthritis,€there€is€usually€somethingÍthat€will€trigger€it,€although€some€people€are€moreÏsusceptible€to€it€than€others.ÌÌà àQ:à8 àDid€he€have€a€family€history€of€this?ÌÌà àA:à8 àNot€that€I€know€of.€€Not€to€my€knowledge,€no.ÌÌà àQ:à8 àDid€he€have€a€history€of€any€knee€injuries?ÌÌà àA:à àNo.ÌÌà àQ:à8 àDr.€Beazley,€what€is€your€opinion€as€to€whether€orÏnot€his€job€as€a€truck€driver€aggravated€or€acceleratedÏthe€osteoarthritic€condition?ÌÌà àA:à8 àI€think€it€probably€accelerated€it.€€I€mean,€he€wasÏyoung.€€He€was€only€sixty„one€years€old.€€But€IÏbelieve€eventually€he€would€have€had€this€sameÏproblem€at€the€normal€age€that€people€get€it,€in€theirÏseventies,€without€any€precipitating€events.ÌÌà àQ:à8 àOne€more€question,€Doctor,€as€to€the€causation.€€WhatÏis€your€opinion€as€to€what€is€most€likely€theÏcontributing€factor€to€the€acceleration€of€the€arthritis?ÌÌà àA:à8 àWell,€œby›€his€history,€probably€crawling€in€and€out€ofÏthe€truck€multiple€times€a€day€and€having€to€lift€loadsÏup€and€down,€having€to€go€up€and€down€steps€orÏsquat.ððÌÌò òà@ àVÌÌÓÓà àó óDr.€David€Knapp,€a€board„certified€rheumatologist,€examined€theÏplaintiff€on€July€30,€1996€for€evaluation€purposes.€€He€testified:ÌÓ  ÓÓÓà8 àð ðIn€interviewing€this€gentleman,€there€was€no€history€of€a€discreteÏinjury,€fall,€or€similar€insult.€€I€summarized€in€my€letter€that€IÏcannot€say€within€a€reasonable€degree€of€medical€certainty€that€theÏduties€described€would€result€in€a€permanent€exacerbation€of€theÏpre„existing€condition,€osteoarthritis,€nor€would€the€activities€heÏwas€doing€cause€osteoarthritis€of€both€knees€in€the€absence,€again,Ïof€a€discrete€injury€or€insult.ÌÌò òà@ à.€€€.€€€.€€€.€€€.€ÌÌà àó óQ:à8 àCan€you€say€within€a€reasonable€degree€of€medicalÏcertainty€what€caused€this€arthritis€condition?ÌÌà àA:à8 àOsteoarthritis€is€the€most€common€type€of€arthritis,Ïyet€we€are€still€unable€to€come€up€with€a€definiteÏcause€at€this€time.ÌÌà@ à.€€€.€€€.€€€.€€€.ÌÌÔ% € Ôà8 àIn€this€particular€case,€I€did€not€have€any€history€of€discreteÏinjuries.€€I€haveò ò€ó ónot€really€had€occasion,€in€all€these€years,€to€seeÏanyone€in€his€line€of€work€just€develop€osteoarthritis€by€virtue€ofÏclimbing€up€and€down€or€even€handling€cargo.€€In€such€instances,Ïusually,€one€knee€is€involved€and€there€usually€can€be€an€injury.ÌÌà8 àPeople€donððt€normally€injure€both€knees€simultaneously,€although,Ïat€one€point€in€time,€one€knee€can€be€injured,€and€at€another€pointÏin€time,€the€other€knee€could€be€injured.ÌÌà8 àIn€terms€of€osteoarthritis€of€the€knees€requiring€kneeÏreplacements,€I€œjust›€have€not€had€occasion€to€see€a€work„relatedÏcase€that€affected€both€knees.€€Certainly,€I€have€many€patients€withÏosteoarthritis€in€one€or€both€knees.€€They€have€no€work€history€toÏattribute€the€problem€to.€€I€might€add,€many€patients€donððt€evenÏhave€an€injuryò ò€ó óto€attribute€the€problem€to.€€ÌÌà àQ:à8 àBased€on€the€history€or€the€œstatements€that›€the€patientÏtold€you,€based€on€your€knowledge€of€what€he€does€atÏwork,€climbing€up€and€down€and€loading,€doctor,€myÏquestion€is,€are€you€aware€of€any€injury€or€accidentÏthat€might€be€considered€a€triggering€incident,Ïproducing€the€œpatientððs›€need€for€a€knee€replacement?ÌÌà àA:à8 àAt€this€time,€no.ÌÌà àQ:à8 àAside€from€increasing€the€patientððs€pain€or€level€ofÏuncomfortableness,€did€you€reach€an€opinion€as€toÏwhether€or€not€the€patientððs€work€at€Birmingham„Nashville€Express€caused€any€anatomical€progressionsÏof€the€patientððs€œcondition?›ÌÌà àA:à8 àAt€this€time,€I€cannot€reach€that€conclusion€with€aÏreasonable€degree€of€medical€certainty.€€I€cannot€sayÏif€this€truck€gentleman€had€never€worked€driving€aÏtruck€that€he€would€have€ended€up€any€differently€oneÏway€or€the€other,€for€better€or€worse.ÌÌà àà8 àI€can€only€say€that€there€is€no€specific€injury€here€thatÏI€find€in€the€history€or€the€records€that€I€can€attributeÏhis€osteoarthritis€to,€in€a€sense€of€what€we€call€postÏtraumatic€arthritis,€where€one€has€had€a€significantÏinjury€and€later€on,€œdevelops›€degenerative€arthritis.ÌÌà àQ:à8 àDid€the€patientððs€activities€as€a€truck€driver,€gettingÏup€and€down,€loading€and€unloading,€cause€thisÏarthritis?ÌÌà àA:à8 àTo€the€best€of€my€knowledge,€I€know€of€no€event€ofÏwork€that€caused€this€osteoarthritis€in€this€gentleman.ÌÌà àQ:à8 àCould€you,€doctor,€again,€within€a€reasonable€degreeÏof€medical€certainty,€as€with€all€my€questions,Ïknowing€that€the€patient€climbed€up€and€down€aÏtruck,€loaded€and€unloaded€throughout€the€day,€stateÏwithin€a€reasonable€degree€of€medical€certainty€thatÏthat€has€not€contributed€to€the€acceleration€of€theÏpatientððs€arthritic€condition?ÌÌà àA:à8 àI€cannot€state€that€his€continued€occupationÏaccelerated€his€osteoarthritis€or€resulted€in€havingÏknee€replacements€sooner€than€if€he€had€been€aÏcomputer€programmer.ÌÌà0 àà8 àI€cannot€state€that€within€a€reasonable€degree€of€medicalÏcertainty.€€This€is€based€upon€the€fact€that€most€of€myÏpatients€donððt€do€truck€driving€and€they€have€theseÏproblems.ÌÌà àà8 àIn€terms€of€the€concept€of€repetitive€trauma€orÏcumulative€trauma€disorder,€I€think€that€concept€doesÏnot€apply€here.€€Thatððs€usually€limited€to€soft€tissueÏstructures.ÌÌò òœÌÌÌ›à@ àVIó ó€Ìœ›ÌÓ  ÓÓÓœ›à àOur€review€of€the€findings€of€fact€made€by€the€trial€court€is€òòde€novoóóÏupon€the€record€of€the€trial€court,€accompanied€by€a€presumption€of€theÏcorrectness€of€the€finding,€unless€the€preponderance€of€the€evidence€isÏotherwise.€€òòT.C.A.€ðð€€óó50„6„225(e)(2).€€òòStone€v.€City€of€McMinnville,€óó896ÏS.W.2d€548,€550€(Tenn.€1995).€€We€cannot€substitute€our€judgment€for€that€ofÏthe€trial€judge;€a€òòde€novoóó€review€is€a€limited€one€which,€as€we€have€stated,Ïinvolves€a€determination€of€whether€the€evidence€preponderates€against€theÏjudgment.€€òòSee,€Wingert€v.€Government€of€Sumner€County,€óó908€S.W.2d€921Ï(Tenn.€1995).Ìà àUnder€the€Tennessee€Workersðð€Compensation€Law,€injuries€by€accidentÏarising€out€of€and€in€the€course€of€employment€which€cause€either€disablementÏor€death€of€the€employee€are€compensable.€€T.C.A.€ðð€50„6„102(a)(5).€€ð ðInjuryððÏincludes€whatever€lesion€or€change€to€any€part€of€the€system€that€producesÏharm€or€pain€or€lessened€facility€of€the€natural€use€of€any€bodily€activity€orÏcapability.€€òòSee€Fink€v.€Caudle,€óó856€S.W.2d€952€(Tenn.€1993)€and€authorityÏcited€therein.Ìà àWhere€a€condition€gradually€develops€over€a€period€of€time,€resulting€inÏa€definite,€work„connected,€unexpected,€fortuitous€injury,€it€is€compensable€asÏan€injury€by€accident.€€òòBrown€Shoe€Co.€v.€Reed,€óó350€S.W.2d€65€(Tenn.€1961).€ÏThe€date€of€injury€for€a€gradually€occurring€injury€has€ben€fixed€as€the€date€onÍwhich€the€claimant€was€forced€to€quit€work€because€of€severe€pain.€€òòBarker€v.ÏHome„Crest€Corp.,€óó805€S.W.2d€373,€374€(Tenn.€1991).Ìà àThe€employer€takes€the€employee€with€all€pre„existing€conditions,€andÏcannot€escape€liability€when€the€employee,€upon€suffering€a€work„relatedÏinjury,€incurs€disability€far€greater€than€if€he€œhad›€not€had€the€pre„existingÏconditions.€€òòRogers€v.€Shaw,€óó813€S.W.2d€397€(Tenn.€1991).€€The€opinion€of€aÏqualified€expert€with€respect€to€a€claimantððs€clinical€or€physical€impairment€isÏa€factor€which€the€courts€will€consider€along€with€all€other€relevant€facts€andÏcircumstances,€but€it€is€for€the€courts€to€determine€the€percentage€of€theÏœclaimantððs›€industrial€disability.€€òòPittman€v.€Lasco€Industries,€Inc.,€óó908€S.W.2dÏ932€(Tenn.€1995).Ìà àIn€cases€where€there€is€objective€medical€evidence€of€an€aggravation€of€aÏœpre„existing›€condition,€the€Supreme€Court€has€generally€allowed€recovery.€€InÏòòBrown€Shoe,€supra,óó€the€Supreme€Court€allowed€recovery€for€injury€to€theÏulnar€nerve€which€was€gradually€injured€by€use€of€the€workerððs€arm€inÏoperation€of€a€machine.€€The€Court€held€this€constituted€an€injury€within€theÏmeaning€of€the€Workersðð€Compensation€Law.Ìà àIn€òòCrossno€v.€œPublix›€Shirt€Factory,€óó814€S.W.2d€730€(Tenn.€1991),€theÏSupreme€Court€held€the€working€condition€either€caused€the€employeeððs€injuryÏor€aggravated€the€condition,€and€allowed€recovery€where€objective€signs€ofÏaggravation€of€a€pre„existing€condition€occurred€as€a€result€of€the€work€theÏplaintiff€was€performing.€Ìà àIn€òòCunningham€v.€Goodyear€Tire€&€Rubber€Co.,€óó811€S.W.2d€888Ï(Tenn.€1991),€recovery€was€not€allowed€because€the€only€aggravation€of€theÏpre„existing€condition€was€limited€to€an€increase€in€pain,€as€contrasted€to€anÏadvancement€of€the€underlying€condition.Ìà àIn€the€case€at€Bar,€the€plaintiffððs€arthritis€was€a€pre„existing€disease,€notÏcaused€by€his€work.€€If€his€disability€is€compensable,€it€must€be€shown€thatÏemployment€activities€were€the€œcause›€of€further€injury€or€advancement€of€theÏseverity€of€the€pre„existing€condition.€€òòBoling€v.€Raytheon€Company,€óó448ÏS.W.2d€405€(Tenn.€1969).Ìà àWe€have€studied€the€depositional€testimony€of€the€experts,€none€of€whomÏappeared€to€be€an€advocate€for€a€cause.€€Dr.€Dyer€opined€that€the€plaintiffððsÏactivities€in€getting€in€and€out€of€his€truck,€etc.€ð ðwould€aggravate€osteoarthritisÏand€help€accelerate€it.ðð€€While€the€issue€is€close,€very€close,€we€cannot€find€thatÏthe€evidence€preponderates€against€the€judgment,€since€there€is€substantialÏevidence€that€œemployment€activities›€advanced€the€severity€of€the€pre„existingÏdisease.Ìò òà@ àVIIÌà àó óThe€appellant€next€argues€that€an€award€of€70€percent€vocationalÏdisability€to€each€leg€is€excessive.Ìà àThe€plaintiff€has€mechanical€knees,€and€has€returned€to€work.€€But€hisÏð ðnew€kneesðð€will€inevitably€œwear›€out,€if€he€survives€to€70€years€of€age,Ïaccording€to€his€surgeon,€and€he€functions€under€limitations€and€restrictions.Ìà àIn€determining€vocational€disability,€the€Court€must€consider:Ìà à(a)€the€employeeððs€skills€and€training;Ìà à(b)€the€employeeððs€education;Ìà à(c)€the€employeeððs€age;Ìà à(d)€local€job€opportunities;€andÌà à(e)€the€employeeððs€capacity€to€work€at€kinds€of€employment€available€inÏthe€local€market€in€a€disabled€condition.€€òòPerkins€v.€Enterprise€Truck€Lines,ÏInc.,€óó896€S.W.2d€123€(Tenn.€1995).€€Additionally,€the€Court€must€consider€theÏanatomical€impairment€rating€and€the€restrictions€as€determined€by€the€expertÏmedical€testimony.€€òòEmployers€Insurance€Company€of€Atlanta€v.€Heath,€óó536ÏS.W.2d€341€(Tenn.€1976).€€The€Court€must€also€consider€if€the€employee€wasÏable€to€return€to€his€prior€employment.€€òòCorcoran€v.€Foster€Auto€GMC,€Inc.,Ïóó746€S.W.2d€452€(Tenn.€1988).Ìœà àMr.›€Bumpus€is€61€years€of€age,€has€a€high€school€degree,€and€has€a€workÏhistory€of€being€a€sheet€metal€worker,€laborer,€truck€driver,€and€freightÏpeddler.€€He€has€a€òòGuidelinesóó€permanent€impairment€of€35€percent€to€each€legÏand€restrictions€of€no€squatting,€crawling,€kneeling,€and€only€occasionalÏcrouching€or€climbing.€€The€extent€of€permanent€disability€or€vocationalÏdisability€is€determined€by€the€employeeððs€loss€of€earning€capacity,€which€hasÏbeen€defined€as€being€the€extent€of€difficulty€competing€in€an€open€laborÏmarket€in€the€post„injury€condition€in€view€of€the€overall€health€and€workÏhistory€of€the€employee.€€òòHolder€v.€Wilson,€óó723€S.W.2d€104€(Tenn.€1987).€ÍWe€cannot€find€that€the€evidence€preponderates€against€the€award€of€70Ïpercent.Ìò òà@ àVIIIÌà àó óThe€appellant€next€insists€that€the€lump€sum€award€was€improper.€€EachÏcase€is€œdiscrete,›€òòSmith€v.€Gallatin€Nursing€Home,€óó629€S.W.2d€683€(Tenn.Ï1982),€and€a€good€reason€must€be€ascribed€for€the€lump€sum€order.€€òòNorthÏAmerican€Royalties€v.€Thrasher,€óó817€S.W.2d€308€(Tenn.€1991).€€In€the€case€atÏBar,€the€plaintiff€and€his€wife€of€43€years€have€a€stable,€responsibleÏrelationship.€€Mrs.€Bumpus€has€always€managed€the€finances,€and€it€is€notÏcontroverted€that€she€does€so€in€a€conservative,€efficient€manner.€€òòSee,€SkinnerÏv.€CNA€Ins.€Co.,€óó824€S.W.2d€164€(Tenn.€1992).€€We€see€no€error€here.Ìà àThe€judgment€is€affirmed€at€the€costs€of€the€appellant€and€the€case€isÏremanded.€ÌÓÓà àà àÌÌà àà àà àà àà àà àà à____________________________Ìà àà àà àà àà àà àà àWilliam€H.€Inman,€Senior€JudgeÌÌCONCUR:ÌÌÌÌ_____________________________ÌJoe€C.€Loser,€Jr.,€Special€JudgeÌÌÌÌ_____________________________ÌLyle€Reid,€œJusticeÌÇÒ  ÒÒ £ Òòòà@ àIN€THE€SUPREME€COURT€OF€TENNESSEEÌßJ€57;+'b|RY` 81 `€@ÿJßÌà@ àAT€NASHVILLEÌÌÌÌDOUGLAS€E.€BUMPUS,à àà à}à àMONTGOMERY€CIRCUITÌà àà àà àà àà àà à}à àNo.€C10„324€BelowÌà àPlaintiff/Appelleeà àà àà à}Ìà àà àà àà àà àà à}à àHon.€James€E.€Walton,€Ìvs.à àà àà àà àà àà à}à àJudgeÌà àà àà àà àà àà à}ÌBIRMINGHAM„NASHVILLEà àà à}ÌEXPRESS,€INC.€and€TRAVELERSà à}ÌINSURANCE€COMPANY,à àà à}à àNo.€01S01„9707„CV„00144Ìà àà àà àà àà àà à}Ìà àDefendants/Appellantsà àà à}à àAFFIRMED.ÌÌÌà@ àJUDGMENT€ORDERÌÌÌÓ€Óà àà 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€conclusionsÏof€law,€which€are€incorporated€herein€by€reference.Ìà àà àWhereupon,€it€appears€to€the€Court€that€the€Memorandum€OpinionÏof€the€Panel€should€be€accepted€and€approved;€andÌà àà àIt€is,€therefore,€ordered€that€the€Panel's€findings€of€fact€andÏconclusions€of€law€are€adopted€and€affirmed,€and€the€decision€of€the€Panel€isÏmade€the€judgment€of€the€Court.ÌÓ ` ` šXÓà àà àCosts€will€be€paid€by€Defendants/Appellants€and€their€Surety,€forÏwhich€execution€may€issue€if€necessary.ÌÓÓà àà àIT€IS€SO€ORDERED€on€March€5,€1998.ÌÌÌÌà àà àà àà àà àà àà àPER€CURIAMÌóóÌÌÌÌÌÌÌÌ›