ÿWPC‹ ¥…ÎA§@fÛê¢ý۳х¤ ]¾ÇröA϶Íè˜ ùïJ]ã]焵JEÖk$?óÍd¤`DVÅÑÜHö‘Cà Ѳ¶o¤ò§È¢Þ|77Ù-ö“•­¼7MÔuS½G£:îUzFûÁ'£b ÄÖÆŒÇ ƒŸn\¤g©9ÆíµÏÛ›ñEçñþG·¾üFÒqö›ÓA |NEUfZ)˜ÈÔÀeOKj4Ó]`mÏ¥ÅpQŒ(ÁªüøØßÃJ%•»-%32˜ ©ýš¬,È~p¾OÚð¤4x–»‰ûUlŒP 2Æé“yœx.‹Écí—Pý›G&q;)dú—œó‹FíÖ¤²`µ&0LÆÞ9}¶6}z>n‘ûwUÓ÷'ÍXt]Õ"7'ÃZQó†Ü¦VÉ©b *ÚÖó‚ìƒ.„Û{éåï¹€#ðZ½&èLm*ñìɈŸ)—ñˆ>Íz«Pµ’ô81­]Z2Ï,”#˜¯y£'ÚÛ`ø1"dŒ âwÄ× ¢ ¹°0÷Áòs®")cÊG§øcè.²©kUNI %— 0(w@Å4(0 0³E 0DøU :<”vU: U:D ž~ D/ &K U:q )« U:Ô- AQ;ÆŒ 0DR 0D– 0DÚÚ B B; D3X˜HP LaserJet 4SiHPPCL5MS,ü,,,,,ü0nLlÎ(ÈhH  Z 6Times New Roman RegularX($¡¡ KLDMN"eO PQÓ€]^V_ðh:&3|x_ Ý ƒ Ð/$ÝÒ°ÒÒX°ÒÔ€XÊšXXXÔÓ  Óà ` àòòÚ  Ú2Ú  ÚóóÝ  ÝIn€his€deposition,€Dr.€Engelberg€previously€described€these€nerve€roots€as€beingÐ ° Ðlocated€in€the€lower€spine.€(c(2Ð/$¤¤Ý ƒ!ÝÝ  ÝÒ°ÒÒX°ÒÔ€X†˜XXXÔÓ  Óà ` àòòÚ  Ú0Ú  Úóó(#Ã$òòÚ  Ú0Ú  Úóó,c½¬AZ‹"Arial Regular ŠÝ ƒ Ð/$ÝÒ°ÒÒX°ÒÔ€XÊšXXXÔÓ  Óà ` àòòÚ  Ú1Ú  ÚóóÝ  ÝDr.€Engelberg€explained€that€this€is€a€primary€central€nervous€system€tumor€arisingÐ ° Ðfrom€the€ependyma€that€lines€the€cavities€of€the€brain€and€spinal€cord€and€is€part€of€a€groupÏof€primary€supporting€cells€in€the€brain€and€spinal€cord.€,c½¬AZ‹"Arial Regular,†r‰AZ‹"Arial Regular ”Ý ƒ Ð/$ÝÒ°ÒÒX°ÒÔ€XÊšXXXÔÓ  Óà ` àòòÚ  Ú3Ú  ÚóóÝ  ÝThroughout€his€deposition,€Dr.€Boals€referred€to€the€injury€as€a€ð ðsprainðð€andÐ ° Ðsometimes€as€a€ð ðstrain.ðð€€In€this€opinion,€these€terms€will€be€used€interchangeably€as€thereÏis€nothing€in€the€record€by€which€we€can€differentiate€the€two.'''÷ÿ dxd Ý ƒ!¯"ÝÝ  ÝÔ€X†˜XXXÔÔ€»\XX†˜ÔÓ  ÓÔ Ad ÔFILEDÔ€X†˜X»\ÔÐ  ÐÌò òApril€21,€1999Ð šš ÐÌCecil€Crowson,€Jr.ÌÔ€ôtâ ôXX†˜ÔAppellate€Court€Clerkó ó,c½¬AZ‹"Arial Regular Ý ƒ!¯"ÝÝ  ÝÔ€XÊšXXXÔÔ€­ZXXÊšÔÓ  ÓÔ Ad ÔFILEDÔ€XÊšX­ZÔÐ  ÐÌò òFebruary€25,€1999Ð šš ÐÌCecil€Crowson,€Jr.ÌÔ€ô"éôXXÊšÔAppellate€Court€Clerkó ó,c½¬AZ‹"Arial Regular #Ý ƒ!¯"ÝÝ  ÝÔ‡ XÊšXXXÔÔ‡ ­ZX XÊšÔÓ  ÓÔ Ad ÔFILEDÔ#† XÊšX ­Z:#ÔÐ  ÐÌò òFebruary€25,€1999Ð šš ÐÌCecil€Crowson,€Jr.ÌÔ‡ ô"éôX XÊšÔAppellate€Court€Clerkó ó !"#Cþÿ<< CÿÿƒLevel 1Level 2Level 3Level 4Level 5(3¯$¢¢Ý ƒ!ÝÝ  Ý(3¯$££Ý ƒ!ÝÝ  Ý($$””ò òÚ  Ú1Ú  Úó ó düÿP Pd%%%%'ÿÿdxdÝ ƒ!ÝÝ  ÝñNñ›ñNññNñ›ñNñÒ°ÒÒX°Òò òÔ‡XÊšXXXÔÓÓÓÓÓ  ÓÑTR[  AØ'ÿ Legal3Ø' AØ'ÿ Legalÿ3Ø'TÑÑ7€\µXXdðXXdð7ÑñQñœñQññ]ññQñßr€(<,(j 8` `€€@E ±` ttx$X°ð ÕrßñQññ]ññ]ñßr€(<,(j 8` `€€@E ±` ttx$X°ð Õrßñ]ññQñ›ñQñIN€THE€SUPREME€COURT€OF€TENNESSEEÐ ° ÐSPECIAL€WORKERSðð€COMPENSATION€APPEALS€PANELÌAT€JACKSONÌÓ“ÓÓÓó óÌÓÓÌÓ'X‡X‚p“X°œX'ÓJAMES€MICHAEL€RICHARDSON,à ‚ 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 àGibson€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„9804„CH„00039Ð ¾   Ðà ` àà ¸ àà  àà h àà À àà ‚ à)ÌA.€O.€SMITH€COMPANY,à h àà À àà ‚ à)à D àHonorable€George€R.€Ellis,€Chancellor€€€€Ð ŠÚ  Ðà ` àà ¸ àà  àà h àà À àà ‚ à)Ìà ` àDefendant/Appellant.à À àà ‚ à)à D àÐ V¦  ÐÌÌÌÌò òòòFor€the€Appellantó óóó:à  àà h àà À àà ‚ àà D àà Q àò òòòFor€the€Appelleeóó:Ð Ô$ ÐÌó óGregory€D.€Jordanà  àà h àà À àà ‚ àà D àà Q àT.€J.€Emison,€Jr.Ð ¬ü ÐJeffery€G.€Fosterà  àà h àà À àà ‚ àà D àà Q àP.€O.€Box€13Ð ’â ÐRainey,€Kizer,€Butler,à h àà À àà ‚ àà D àà Q àAlamo,€TN€€38001Ð xÈ Ѐ€Reviere€&€Bell,€P.L.C.à h àà À àÐ ^® Ð105€South€HighlandÌP.€O.€Box€1147ÌJackson,€TN€€38302„1147ÌÌÌÌÌò ò€€€€€€Ð Ž!Þ  ÐÌÌÌÌÌÌÌÌÌÌÌòòÓ  ÓM€E€M€O€R€A€N€D€U€M€€€€€€O€P€I€N€I€O€NÐ ž,î', ÐÌÌMembers€of€Panelóó:Ð b/²*/ ÐÌó óJustice€Janice€M.€HolderÐ :1Š,1 ÐSenior€Judge€John€K.€ByersÌSenior€Judge€F.€Lloyd€TatumÌÌÌÌÌÌÌò òÓ  ÓREVERSED€AND€DISMISSEDà À àà ‚ àà D àà Q àà  àTATUM,€Senior€JudgeÐ P9 4: ÐÔ#†X\µXXXÊšP#Ôó óÐ  <:Œ5; ÐÔ€ XÊšXXX\µÔÓÓÓ  ÓÑ7€\µXXdðXXdð7Ñà@[[,Dàòòò òÔ€ ¼=w¼X XÊšÔOPINIONˆÐ ° ÐÔ€ XÊšX¼ ¼=wÔó óóóà ` àThis€workersðð€compensation€appeal€was€referred€to€the€Special€WorkersððÐ Ø( 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 < Œ Ðà ` àThis€case€was€tried€on€February€24,€1998.€€The€chancellor€found€that€there€was€noÏperiod€of€temporary€total€disability,€but€awarded€the€plaintiff€fifteen€percent€(15%)Ïpermanent€partial€disability€to€the€whole€body€as€a€result€of€a€work„related€accident€inÏDecember€1988€or€January€1989.€€Defendant,€A.€O.€Smith€Company,€has€appealed€theÏchancellorððs€decision€as€not€supported€by€a€preponderance€of€the€evidence.€€After€carefulÏreview,€we€find€that€the€judgment€of€the€trial€court€must€be€reversed.€€à Ð àÐ T Ðà ` àAt€the€time€of€trial,€the€Plaintiff,€James€Michael€Richardson,€testified€that€he€was€aÏ50„year„old€man€with€a€high€school€education€and€vocational€training€as€an€industrialÏelectrician.€€His€post„high€school€employment€experience€involved€mostly€electrical€work.€ÏHe€was€subsequently€employed€by€the€defendant€as€an€electrical,€mechanicalÏmaintenance€man€and€€was€working€as€an€appraiser€for€an€insurance€adjusting€companyÏat€the€time€of€trial.€€Ìà ` àHe€recounted€the€events€surrounding€his€back€injury€as€follows.€€In€late€DecemberÏof€1988€or€early€January€of€1989,€the€plaintiff€felt€ð ða€hurtingðð€in€his€lower€back€while€helpingÏanother€employee€lift€a€25„horsepower€electric€motor€onto€a€stand.€€He€reported€the€injuryÏto€his€supervisor€immediately.€€Believing€that€the€injury€was€a€minor€strain,€the€plaintiffÏsought€two€or€three€treatments€from€a€chiropractor,€but€his€symptoms€worsened.€€He€wasÏultimately€seen€by€Dr.€Jerry€Engelberg,€a€neurosurgeon.€€After€an€MRI€was€performed,€Dr.ÏEngelberg€told€the€plaintiff€that€he€had€a€tumor,€an€ependymoma,€in€his€spine€that€hadÏcaused€some€spinal€damage.€€According€to€the€plaintiffððs€testimony,€Dr.€Engelberg€told€himÏhe€needed€immediate€surgery,€because€there€was€a€risk€that€he€might€never€walk€againÏif€he€were€to€stumble€or€miss€a€step.€€After€surgery€was€performed,€the€plaintiff€receivedÏradiation€and€chemotherapy€treatments€under€the€supervision€of€an€oncologist,€Dr.€KirbyÏSmith.€€Ìà ` àAt€the€time€of€the€trial,€the€plaintiff€still€had€complaints€of€low€back€cramps,€difficultyÐ (9x4: Ðsleeping€at€night,€and€inability€to€drive€more€than€30€minutes€because€of€his€discomfort.€ÏHe€testified€that€he€is€also€unable€to€do€many€things€that€he€could€formerly€do,€such€asÏriding€motorcycles,€because€he€cannot€tolerate€any€bouncing.€The€plaintiff€stated€that€heÏstill€follows€Dr.€Smithððs€instructions€not€to€twist€or€lift€weight€over€25€to€30€pounds.€€He€alsoÏtestified€that€he€can€no€longer€do€the€type€of€maintenance€or€electrical€work€he€could€priorÏto€January€1989,€because€he€is€unable€to€do€the€lifting€required,€and€the€radiationÏtreatments€have€made€it€difficult€for€him€to€think€very€well€if€he€gets€hot€or€tired.€€His€senseÏof€balance€has€also€been€greatly€affected,€so€he€does€not€work€at€heights€without€beingÏsure€that€there€is€something€to€hold€on€to.€€œñOñ€The€plaintiff€testified€that€he€was€able€toÏperform€his€current€job€as€an€appraiser€with€Tenco,€which€involves€a€variety€of€bodilyÏmovements,€such€as€stooping,€kneeling,€walking,€and€climbing€over€and€around€debris€ifÏdone€very€carefully.€€His€salary€at€Tenco€for€the€past€six€years€has€averaged€approximatelyÏ$35,000.00€to€$36,000.00€per€year.€€€€€€€€€ñOñ›Ìà ` àMedical€expert€testimony€was€received€at€trial€by€depositions€of€three€doctors.€€Dr.ÏJerry€Engelberg,€a€Memphis€neurosurgeon,€first€saw€the€plaintiff€on€February€1,€1989,€withÏcomplaints€of€pain€in€his€lower€back,€mainly€at€night,€and€problems€with€urination€andÏerection.€€The€doctor€stated€that€the€plaintiff€related€this€to€the€January€injury€at€work.€€AnÏinitial€neurological€examination€was€not€remarkable,€and€x„rays€of€the€plaintiffððs€spine€wereÏessentially€normal.€€However,€the€plaintiffððs€symptoms€indicated€a€possible€tumor,€and€anÏMRI€was€ordered.€€The€test€revealed€a€mass,€which€was€determined€to€be€anÏependymoma,׃ ×Ý ƒ #ÃÝòòÚ  Ú1Ú  ÚóóÝ  Ý×  ×€located€in€the€lumbar€region€at€L2„3€of€the€plaintiffððs€lower€back.€€€Dr.Ð p!À  ÐEngelberg€stated€that€no€disc€herniation€was€found€at€any€time.€€During€surgery€to€removeÏthe€tumor€on€February€21,€1989,€Dr.€Engelberg€found€that€it€had€spread€throughout€nerveÏroots€(cauda€equina)€at€the€lower€end€of€the€spine€and€had€formed€a€sheet€of€tumor€cellsÏin€the€tissue€covering€the€nerve€roots€(subarachnoid€space),€which€made€total€removalÏimpossible.€€The€tumors€that€could€not€be€surgically€removed€were€treated€with€radiationÏto€the€brain€and€spinal€cord,€along€with€chemotherapy.€€It€was€Dr.€Engelbergððs€medicalÏopinion€that€the€lifting€incident€did€not€cause€the€tumor€found€in€the€plaintiffððs€spine,€nor€wasÏit€a€factor€in€the€spread€of€the€tumor.€€Dr.€Engelberg€stated€that€the€symptoms€were€mostÏlikely€caused€by€the€tumor€pressing€on€the€nerve€roots.׃ B×Ý ƒ #ÃÝòòÚ  Ú2Ú  ÚóóÝ  Ý×  ×€€He€based€his€opinion€on€the€factÐ œ1ì,2 Ðthat€the€plaintiff€had€low€back€pain€at€night€and€problems€with€urination€and€erection.€€DiscÐ h3¸.4 Ðpain€or€pain€from€a€ruptured€disc€usually€hurts€when€the€individual€is€standing€up€andÏbearing€weight,€and€the€symptoms€described€by€the€plaintiff€indicated€ð ðsomething€otherÏthan€a€disc€problem.ðð€€When€asked€whether€the€plaintiff€has€any€anatomical€impairmentÏrelated€to€the€February€1989€lifting€incident,€Dr.€Engelberg€replied,€ð ðI€would€not€awardÏanatomical€impairment.€€I€think€the€source€of€this€manððs€pain€is€the€tumor€compressingÏnerve€roots,€and€I€would€not€know€on€what€basis€to€award€any€impairment€here.ðð€€€He€alsoÏstated€that€the€plaintiff€would€have€been€temporarily€disabled€for€approximately€six€monthsÏfrom€the€surgery€and€the€radiation,€which€he€explained€ð ðhas€to€take€a€significant€amountÏout€of€you€physically.€.€.€.ðð€€According€to€Dr.€Engelberg,€the€radiation€and€chemotherapyÏtreatments€have€certain€unavoidable€side€effects,€such€as€severe€fatigue€and€nausea.€€HeÏstated€that€the€plaintiff€will€require€medical€care€for€his€tumor€condition€for€the€rest€of€hisÏlife.€Ìà ` àDr.€Kirby€Smith,€an€oncologist,€treated€the€plaintiff€over€a€51„month€period€fromÏ1989€to€1993.€€At€Dr.€Engelbergððs€request,€Dr.€Smith€first€saw€the€plaintiff€in€the€hospitalÏon€March€3,€1989,€after€his€surgery.€€Dr.€Smith€stated€that€the€plaintiffððs€tumors€wereÏconcentrated€in€the€lumbar€spine€at€the€L2„3€level,€with€other€tumors€present€in€the€sacralÏand€lower€thoracic€areas.€€He€testified€that,€at€the€time€of€this€first€visit,€the€tumors€hadÏaffected€the€plaintiffððs€spinal€cord€function,€in€that€he€was€having€back€pain€and€urinaryÏhesitancy.€€According€to€Dr.€Smithððs€testimony,€early€studies€and€the€myelogram€showedÏan€obstruction€in€the€L2„3€region€that€was€interfering€with€spinal€cord€function€at€that€level.€ÏDr.€Smith€stated€that€the€plaintiffððs€low€back€pain€ð ðwas€probably€coming€from€the€tumor€inÏthe€lumbar€spine€area.ðð€€The€plaintiffððs€post„operative€course€of€treatment€involved€radiationÏto€a€large€area€of€the€spinal€column€and€chemotherapy€administered€during€June,€July,€andÏAugust€of€1989.€€This€reduced€the€size€of€some€tumors€and€arrested€the€growth€of€all€theÏtumors,€according€to€several€MRIs.€€Ìà ` àDr.€Smith€stated€that€the€most€recent€scan€in€May€of€1993€still€showed€evidence€ofÏthe€tumor,€but€the€plaintiffððs€initial€complaints€of€back€pain€had€gradually€become€lessÏnoticeable€over€the€period€of€treatment.€€€At€the€plaintiffððs€last€visit€on€June€9,€1993,€Dr.ÏSmith€testified€that€the€plaintiffððs€chief€complaints€were€sinus€problems,€some€neck€pain,Ïand€ð ða€little€bit€of€low€back€pain,€particularly€on€the€right€side€of€his€back.ðð€€At€that€time,€aÐ Ì84: Ðphysical€examination€was€performed,€and€no€neurological€abnormalities€related€to€his€backÏwere€found.€€Although€Dr.€Smith€was€unaware€of€the€lifting€incident€during€his€initialÏconsultation€with€the€plaintiff,€when€presented€with€the€facts€surrounding€the€incident,€Dr.ÏSmith€stated€his€opinion€that€the€lifting€incident€could€not€have€caused€the€tumor€nor€wasÏit€likely€to€have€speeded€up€the€tumorððs€growth.€€Based€on€the€myelograms,€x„rays,€andÏfindings€in€surgery,€Dr.€Smith€stated€that€the€tumors€probably€had€been€there€for€a€numberÏof€months€before€January€of€1989,€when€the€lifting€incident€occurred.€€He€testified€thatÏthere€was€a€possibility€that€the€lifting€incident€made€the€tumor€become€symptomatic€soonerÏthan€it€would€have€otherwise.€€ñNñœñNñDr.ñNñ›ñNñ€Smith€also€stated€that€the€plaintiffððs€back€pain€wouldÏultimately€have€become€noticeable,€and€that€ð ðlifting€or€no€lifting€he€would€have€developedÏthe€symptoms€that€brought€him€to€Dr.€Engelberg,€and€the€same€findings€would€have€beenÏthere,€which€would€have€led€to€the€surgery.ðð€Ìà ` àAccording€to€Dr.€Smithððs€testimony,€there€is€no€way€to€predict€how€much€longer€theÏplaintiffððs€back€would€have€been€asymptomatic€if€the€lifting€incident€had€not€occurred,€but,Ïbecause€the€plaintiff€had€almost€a€complete€block€in€the€lumbar€region€of€his€spine,€heÏprobably€would€have€noticed€symptoms€in€the€lumbar€region€sooner€than€in€the€upperÏthoracic€spine.€€Dr.€Smith€also€stated€that€the€plaintiff€is€not€as€active€as€he€was€before€theÏsurgery,€and€that€he€will€ultimately€have€problems€with€the€cancer€again€in€the€future.€€€€€€Ïà ` àThe€plaintiff€offered€the€deposition€of€Dr.€Joseph€C.€Boals,€III,€an€orthopedic€surgeonÏwho€saw€the€plaintiff€on€March€28,€1995.€€Dr.€Boals€testified€that€the€plaintiff€came€to€himÏat€the€request€of€plaintiffððs€attorney€and€wanted€him€to€ð ðlisten€to€his€story,€to€his€history,Ïevaluate€the€findings€and€let€him€know€if€there€was€any€impairment€from€that€injury.ðð€€Dr.ÏBoals€stated€that€it€was€his€opinion€that€the€plaintiff€suffered€a€low€back€strain׃×Ý ƒ #ÃÝòòÚ  Ú3Ú  ÚóóÝ  Ý×  ×€from€theÐ 8,ˆ', Ðtrauma,€but€that€the€overall€symptomatology€that€followed€the€lifting€incident€ð ðhad€to€beÏclouded€by€the€pre„existing€tumor,ðð€so€that€ð ðthe€pain€and€suffering€and€the€things€thatÏhappened€to€him€thereafter€cannot€all€be€attributed€to€the€lumbar€strain.ðð€€He€testified€thatÏnot€all€back€strains€cause€permanent€impairment.€€When€asked€for€his€medical€opinion€asÏto€any€permanent€physical€impairment€to€the€plaintiff€as€a€result€of€the€back€strain€asÐ 45„06 Ðopposed€to€the€tumor,€Dr.€Boals€answered:ÌÓÓà8 ` àà8¸ ` (#` (#àWell,€of€course,€this€is€probably€the€most€difficult€kind€ofÏassessment€that€any€evaluator€could€ever€be€asked€to€make.€ÏYou€have€a€patient€with€a€bad€tumor€on€his€spine,€that€hasÏbeen€injured€on€the€job.Ð ¸ Ð ¸ Ð  ÐÌà8 ` àà8¸ ` (#` (#àI€am€handcuffed€to€know€what€the€eventual€outcome€of€thatÏlumbar€strain€would€be€because€of€the€presence€of€this€tumor.€ÏThis€gentleman€could€have€healed€this€sprain€in€four€to€six€à @ à¼weeks€and€had€no€additional€complaints€of€pain,€and€couldÏhave€moved€on€through€his€life.Ð ¸ Ð ¸ Ð  ÐÌà8 ` àà8¸ ` (#` (#àHowever,€because€the€tumor€was€there€and€because€he€isÏprobably€going€to€continue€to€have€ñNñœñNñtroubleñNñ›ñNñ€with€this€area€of€hisÏback€until€his€demise,€there€is€no€way€to€know€whether€or€notÏthat€strain€would€have€completely€healed.Ð ¸ Ð ¸ Ð  ÐÌà8 ` àà8¸ ` (#` (#àGiving€both€sides€the€benefit€of€the€doubt,€I€cannot€say€that€theÏtwenty€or€thirty€or€fifty€percent€impairment€he€has€got€with€theÏtumor€is€caused€by€this€sprain,€but€I€do€think€that€probably€IÏwould€assign€five€percent€of€the€body€as€a€whole€to€the€factÏthat€the€sprain€at€least€aggravated€or€brought€on€additionalÏsymptomatology€that€resulted€in€this€diagnosis.Ð ¸ Ð ¸ Ð  ÐÌà8 ` àà8¸ ` (#` (#àNow,€one€might€say€that€the€examiner€could€take€the€standÏand€say€this€was€going€to€happen€anyway,€but€the€fact€that€itÏhappened€at€work€and€the€fact€that€he€had€a€lifting€episodeÏthat€created€an€injury€makes€me€feel€that€at€least€part€of€thisÏinitiation€of€treatment€and€flare„up€of€the€tumor,€if€you€will,€wasÏcaused€by€the€injury.Ð ¸ Ð ¸ Ð  ÐÌà8 ` àà8¸ ` (#` (#àI€have€no€way€of€knowing€exactly€how€much€it€caused,€so€I€amÏarbitrarily€picking€this€number€out€of€the€sky€and€trying€to€beÏrealistic€and€not€giving€him€thirty€or€forty€percent€for€theÏdamage€which€he€has€to€his€spine€now,€but€I€would€assign€fiveÏpercent€to€the€work€injury.Ð ¸ Ð ¸ Ð  ÐÌÓÓà ` àDr.€Boals€further€testified€that€the€mere€fact€that€a€lumbar€strain€was€diagnosed€inÏthe€beginning€does€not€necessarily€mean€that€the€plaintiff€has€a€five€percent€impairmentÏfrom€that€injury.€€Dr.€Boals€explained€that€the€Guidelines€suggest€an€impairment€of€fiveÏpercent€in€the€lumbar€spine€when€there€is€a€documented€injury€that€persists€for€six€monthsÏwith€symptomatology,€accompanied€by€loss€of€motion€or€arthritis€on€the€x„ray.€€He€testifiedÏthat€he€was€ð ðmaybe€stretching€this€a€little€bitðð€to€say€that€the€tumor€was€probably€preventingÏthe€strain€from€healing€over€a€six„month€period,€which€would€put€the€plaintiff€in€the€fiveÏpercent€category€under€the€Guidelines.€€He€also€stated€that€he€is€not€a€cancer€specialistÏand€would€not€try€to€discuss€the€etiology€of€the€cancer€or€the€part€it€has€played€in€theÏplaintiffððs€back€pain€symptoms,€as€an€oncologist€would€be€in€a€better€position€to€do€that.€ÏHe€explained€that:Ð Ì84: ÐÓÓà8 ` àà8¸ ` (#` (#àñNñœñNñIfñNñ›ñNñ€the€oncologist€takes€the€position€ñNñœñNññNñœñNñthat€thatñNñ›ñNññNñ›ñNñ€was€going€toÏhappen€anyway,€thatððs€one€thing,€but€the€way€we€have€alwaysÏtreated€work€injuries€was€this:€€If€the€patient€reported€an€injuryÏand€had€a€documented€tenderness€in€his€back,€evidence€of€aÏsprain,€than€it€was€work€related€if€there€was€an€incident.Ð ¸ Ð ¸ Ð  ÐÌÓ2CÓWhen€asked€if€he€would€disagree€with€a€physician€who€treated€the€plaintiff€close€to€the€dateÏof€injury€and€felt€that€all€of€the€pain€plaintiff€experienced€was€related€to€the€tumor,€Dr.€BoalsÏstated,€ð ðIf€he€can€logically€set€forth€a€reason€for€that,€I€have€no€problem€with€it.ðð€€InÏresponse€to€a€final€question€about€the€speculative€nature€of€his€assignment€of€a€fiveÏpercent€impairment€rating€to€the€plaintiff,€Dr.€Boals€replied,€ð ðI€think€this€case€is€speculativeÏanyway.ððÌà ` àThe€standard€of€review€of€factual€issues€in€workersðð€compensation€cases€is€òòdeóó€òònovoóóÐ Ü, Ðupon€the€record€of€the€trial€court€with€a€presumption€of€correctness,€unless€theÏpreponderance€of€the€evidence€is€otherwise.€€Tenn.€Code€Ann.€ðð50„6„225(e)(2)€ñNñœñNñ(1991€&ñNñ›ñNñÏSupp.€1998);€òòHenson€v.€City€of€Lawrenceburgóó,€851€S.W.2d€809,€812€(Tenn.€1993).€€ThisÐ @ ÐCourt€now€determines€where€the€preponderance€of€the€evidence€lies.€€œñNñœñNñòòñPñKingñPññPñKeenñPññNñ›ñNñ›€v.€Jones€TruckÐ  \ ÐLinesóó,€814€S.W.2d€23,€25€(Tenn.€1991).€€When€the€trial€record€contains€oral€testimony€ofÐ Ø( Ðwitnesses,€this€Court€must€give€considerable€deference€to€the€trial€judgeððs€findingsÏregarding€the€weight€and€credibility€of€that€ñNñœñNñtestimony.€ñNñ›ñNñ€ñNñœñNñòòTownsendñNñ›ñNñ€v.€Stateóó,€826€S.W.2d€434,Ð p!À  Ð437€(Tenn.€1992).€€However,€when€the€determination€of€factual€issues€involves€medicalÏtestimony€derived€solely€from€depositions,€as€in€the€present€case,€this€Court€is€in€the€sameÏposition€as€the€trial€judge€when€reading€the€testimony€and€may€draw€its€own€conclusionsÏabout€the€weight,€credibility,€and€significance€to€be€given€to€such€testimony.€€òòSeiber€v.Ð  (ð#( ÐGreenbrier€Indus.,€Inc.óó,€906€S.W.2d€444,€446€(Tenn.€1995).€€òòSeeóó€òòalsoóó€òòHensonóó,€851€S.W.2dÐ l*¼%* Ðat€812;€òòLanders€v.€Firemanððs€Fund€Ins.€Co.óó,€775€S.W.2d€355,€356€(Tenn.€1989).Ð 8,ˆ', Ðà ` àThe€plaintiff€in€a€workersðð€compensation€case€has€the€burden€of€proving€causationÏand€permanency€of€his€injury€by€the€preponderance€of€the€evidence.€€òòSeeóó€òòRoark€v.€LibertyÐ Ð/ +0 ÐMutual€Ins.€Co.óó,€793€S.W.2d€932,€934€(Tenn.€1990).€€The€claimant€must€use€expertÐ œ1ì,2 Ðmedical€testimony€to€establish€causation€and€permanency,€but€such€testimony€must€beÏconsidered€in€conjunction€with€the€employeeððs€testimony€as€to€how€his€injury€occurred€andÏhis€subsequent€physical€condition.€€òòThomas€v.€Aetna€Life€&€Casualtyóó,€812€S.W.2d€278,€283Ð 7P28 Ð(Tenn.€1991).€€When€there€is€differing€testimony€from€medical€experts,€this€Court€mayÐ Ì84: Ðchoose€which€view€to€believe€and€may€consider€the€expertsðð€qualifications,€theÏcircumstances€of€their€examination,€what€information€was€available€to€them,€and€theÏimportance€of€that€information€to€other€experts€in€making€such€a€determination.€€òòSeeóóÐ H˜ ÐòòOrman€v.€Williams€Sonoma,€Inc.óó,€803€S.W.2d€672,€676€(Tenn.€1991).€€€€€€Ð  d Ðà ` àTo€prove€causation,€a€workersðð€compensation€claimant€must€establish€a€causalÏrelationship€between€the€claimed€disability€and€the€employment€activity€by€expertÏñNñœñNñtestimony.ñKñ€ñKññNñ›ñNñ€ñNñœñNñòòIdóó.ñNñ›ñNñ€€Generally,€an€injury€is€considered€to€have€arisen€out€of€and€is€in€the€courseÐ xÈ  Ðof€employment€if€it€has€a€rational€connection€to€the€claimantððs€work€and€occurred€while€heÏwas€engaged€in€his€duties.€€òòId.óó€€Although€absolute€certainty€is€not€required€to€proveÐ ` Ðcausation,€the€medical€testimony€connecting€the€injury€with€the€work„related€activity€mustÏnot€be€so€uncertain€or€speculative€that€assigning€liability€to€the€employer€would€be€arbitraryÏor€only€a€mere€possibility.€€€òòLivingston€v.€Shelby€Williams€Industries,€Inc.óó,€811€S.W.2d€511,Ð tÄ Ð515€(Tenn.€ñNñœñNñ1991)€(quotingñNñ›ñNñ€ñNñœñNñòòTindallñNñ›ñNñ€v.€Waring€Park€Assððnóó,€725€S.W.2d€935,€937€(Tenn.Ð @ ÐñNñœñNñ1987)).ñNñ›ñNñÌà ` àTo€constitute€sufficient€medical€proof€that€is€probative€on€the€issue€of€permanency,Ïthe€expert€witness€must€state€his€opinion€in€language€that€means€that€the€factors€in€favorÏof€a€permanent€disability€outweigh€those€against€permanency.€€òòSingleton€v.€ProconÐ p!À  ÐProductsóó,€788€S.W.2d€809,€811„12€(Tenn.€1990).€€Words€such€as€ð ðitððs€just€a€possibility,ððÐ <#Œ" Ðð ðvery€ñNñœñNñpossiblyñMñ€ñMñ.ñNñ›ñNñ€.€.€but€I€couldnððt€tell€you€that,€and€nobody€else€can,ðð€and€ð ðI€canððt€say€whetherÏit€will€or€wonððt,€it€would€be€more€subject€to€it,€there€is€more€of€a€possibility€of€itðð€ñNñœñNñamountñLñsñLññNñ›ñNñ€toÏsaying€that€there€is€only€a€likelihood€or€just€a€possibility€of€the€events€happening€and€areÏnot€sufficient€to€carry€the€burden€in€favor€of€permanency.€€òòSeeóó€òòSingletonóó,€788€S.W.2d€atÐ l*¼%* Ð811€(discussing€òòOwens€Illinois,€Inc.€v.€Laneóó,€576€S.W.2d€348€(Tenn.€1978)€andòò€MarylandÐ 8,ˆ', ÐCasualty€Co.€v.€Youngóó,€362€S.W.2d€241,€243€(Tenn.€1962));€òòOwens€Illinois,€Inc.€v.€Laneóó,Ð .T). Ð576€S.W.2d€348,€350€(Tenn.€1978).Ìà ` àA.O.€Smith€Company€has€presented€only€one€issue€on€appeal,€that€is€whether€theÏtrial€court€erred€in€finding€that€the€plaintiff€sustained€a€permanent€partial€disability€as€aÏresult€of€the€1989€lifting€incident.€€In€his€brief,€the€plaintiff€states:€ð ðThis€is€a€chronic€backÏstrain€case,€not€a€case€of€aggravation€of€a€preexisting€malignant€spinal€tumor.ðð€€He€statedÏthat€all€issues€raised€by€the€pleadings€concerning€accelerated€growth€or€spread€of€theÐ Ì84: Ðmalignancy€in€plaintiffððs€spine€were€abandoned.Ìà ` àAfter€careful€review€of€the€record,€we€find€that€the€evidence€preponderates€againstÏthe€trial€courtððs€finding€of€a€permanent€disability€from€the€back€strain.€€In€reviewing€theÏdepositions,€we€find€that€the€only€expert€witness€who€connected€any€part€of€the€plaintiffððsÏsymptoms€and€disability€to€the€1989€lifting€incident€was€Dr.€Boals,€and€his€testimony€isÏsomewhat€equivocal,€arbitrary,€and€speculative.€€For€example,€he€stated€that€there€was€noÏway€that€he€could€know€whether€the€original€strain€would€have€completely€healed€becauseÏof€the€presence€of€the€tumor.€€Dr.€Boalsððs€assignment€of€a€five€percent€disability€rating€toÏthe€body€as€a€whole€under€the€Guidelines€was€based€on€his€speculation€that€the€tumor€hadÏprevented€the€back€strain€from€healing€for€six€months.€€However,€he€also€stated€that€heÏwas€arbitrarily€picking€the€five€percent€figure€and€admitted€that€an€opinion€on€the€tumorððsÏeffect€on€the€plaintiffððs€symptoms€should€be€deferred€to€an€oncologist.€€His€ownÏassessment€of€the€plaintiffððs€case€was€that€it€was€speculative.Ìà ` àIn€looking€at€Dr.€Boalsððs€testimony€as€a€whole,€we€find€that€the€language€he€usedÏin€stating€his€opinions€shows€only€a€mere€possibility,€as€opposed€to€a€probability,€that€theÏPlaintiff€suffered€a€permanent€disability€from€the€lifting€incident.€€Such€evidence€isÏinsufficient€to€satisfy€the€plaintiffððs€burden€of€proof€on€causation€or€permanency.€€We€alsoÏobserve€that€Dr.€Boals€only€saw€the€plaintiff€one€time,€which€was€over€six€years€after€theÏlifting€incident.€€There€is€no€evidence€in€the€record€to€indicate€that€Dr.€Boals€performed€anyÏtests€or€examined€the€claimant,€other€than€taking€his€medical€history,€listening€to€hisÏaccount€of€the€events,€and€evaluating€the€medical€findings€to€see€if€a€permanentÏimpairment€was€present.€€Neither€Dr.€Engelberg€nor€Dr.€Smith€diagnosed€the€plaintiff€asÏhaving€a€back€strain€or€connected€his€symptoms€to€such€an€injury,€although€they€saw€theÏplaintiff€immediately€after€the€lifting€incident.€€It€was€Dr.€Boals€who€first€raised€this€diagnosisÏsix€years€after€the€accident.€€€€€€€à À àÐ Ð/ +0 Ðà ` àOn€the€other€side€of€the€coin€are€the€testimonies€of€the€plaintiffððs€treatingÏneurosurgeon€and€oncologist,€Dr.€Engelberg€and€Dr.€Smith,€which€are€basically€consistent.€ÏBoth€doctors€saw€the€plaintiff€within€a€month€or€two€of€the€lifting€incident,€and€eachÏperformed€tests€and€examinations€on€the€plaintiffððs€back.€€Both€doctors€stated€theirÏopinions€that€the€plaintiffððs€back€pain€symptoms€were€most€likely€caused€by€the€tumor€inÐ Ì84: Ðthe€lumbar€region€of€the€spine,€which,€due€to€its€size€and€spread,€was€present€before€theÏlifting€incident.€€No€disc€herniations€were€found€by€Dr.€Engelberg€in€any€of€the€tests€or€inÏsurgery€from€February€1989€onward,€and€Dr.€Smith€testified€that€the€plaintiffððs€complaintsÏof€back€pain€had€diminished€over€the€course€of€treating€the€tumor.€€Dr.€Engelberg€statedÏthat€his€opinion€to€a€reasonable€degree€of€medical€certainty€was€that€there€was€noÏanatomical€impairment€to€the€plaintiff€from€the€lifting€incident€and€essentially€no€basis€toÏaward€one,€because€the€source€of€the€plaintiffððs€pain€was€the€tumor€compressing€the€nerveÏroots.€€€Dr.€Smith€also€expressed€the€opinion€to€a€reasonable€degree€of€medical€certaintyÏthat€the€plaintiffððs€back€pain€would€ultimately€have€surfaced€with€the€same€symptoms,€theÏsame€findings,€and€the€same€surgery,€regardless€of€the€lifting€incident.€€In€addition,€thereÏwas€no€evidence€of€trauma€to€the€tumor.€€Dr.€Engelberg€assigned€a€six„month€period€ofÏdisability€to€the€adverse€side€effects€of€the€surgery€and€treatments€related€to€the€tumor,€andÏboth€he€and€Dr.€Smith€stated€that€the€cancer€would€cause€the€plaintiff€problems€for€the€restÏof€his€life.€€Neither€treating€physician€connected€the€plaintiffððs€back€pain€or€resultingÏdisability€to€a€back€strain.€€€€Ìà ` àIn€assigning€weight€and€significance€to€these€doctorsðð€testimony,€it€is€important€toÏnote€some€additional€facts€in€this€case.€€It€was€Dr.€Engelberg€who€actually€saw€the€tumorÏand€its€placement€in€the€plaintiffððs€spinal€column€during€surgery.€€By€this€time,€the€majorÏportion€of€the€tumor€had€almost€completely€blocked€the€lumbar€region€of€the€spine,€whereÏthe€plaintiff€was€feeling€the€pain,€and€was€pressing€on€the€nerve€roots.€€€Dr.€Smith€also€sawÏthe€plaintiff€close€to€the€time€of€the€lifting€incident€and€treated€his€tumor€for€an€extendedÏperiod€of€approximately€51€months.€€Dr.€Boals€stated€in€his€testimony€that€an€oncologist,Ïin€this€case€Dr.€Smith,€would€be€in€a€better€position€to€give€any€medical€opinionsÏconcerning€the€effects€of€the€tumor€on€the€plaintiffððs€symptoms,€and€that€he€would€notÏdisagree€with€a€treating€physician€who€attributed€all€of€plaintiffððs€pain€to€the€tumor,€if€he€hadÏlogical€reasons€for€doing€so.€€Dr.€Engelberg,€as€the€treating€physician,€did€give€his€opinionsÏand€logical€medical€reasons€for€attributing€the€plaintiffððs€pain€to€the€tumor€and€not€to€a€backÏstrain.Ìà ` àIn€his€brief,€the€plaintiff€argues€that€his€testimony,€coupled€with€that€of€Dr.€Boals,€isÏsufficient€to€support€an€award€in€this€case.€€We€disagree.€€The€preponderance€of€theÐ Ì84: Ðevidence€establishes€that€plaintiffððs€symptoms€and€disability€were€caused€by€the€tumor.€ÏThe€plaintiff€has€failed€to€establish€by€a€preponderance€of€the€evidence€that€his€difficultiesÏwere€caused€by€the€industrial€accident.Ìà ` àOn€our€òòdeóó€òònovoóó€review,€we€find€that€the€evidence€preponderates€against€the€findingsÐ  d Ðof€the€trial€court€in€favor€of€the€plaintiff.€€The€judgment€of€the€trial€court€is€thereforeÏreversed,€and€the€case€is€dismissed.Ìà ` àPlaintiff€will€pay€the€costs.ÌÌÓÓà ` àà ¸ àà  àà h àà À àà ‚ à_________________________________________€Ï€€€€€€€€€€€€€€€€€€€à ¸ àà  àà h àà À àà ‚ àF.€LLOYD€TATUM,€SENIOR€JUDGEÐ öF ÐÌÌCONCUR:ÌÌÌÌ________________________________ÌJANICE€M.€HOLDER,€JUSTICEÌÌÌÌ________________________________ÌJOHN€K.€BYERS,€SENIOR€JUDGEà ‚ à€€€€€€€€€€€€€Ð ¤ô Ðà ` à€€€€€€€œñ^ñÐ  Š Ú Ðñ^ññ_ñà@  DàÔ‡ »½t »X XÊšÔIN€THE€SUPREME€COURT€OF€TENNESSEEˆÐ ° ÐÌà@mm*DàAT€JACKSONÔ#† XÊšX » »½t½t#ÔˆÐ È ÐÌÌÓ<°,X…XDp XX‡X‚DQ ‘X<ÓJAMES€MICHAEL€RICHARDSON,à œ à)à È àGIBSON€CHANCERYÐ   ð ÐÓ<°,X°D‚, X°,X…XDp X<Óà œ à)à È àNO.€H3829Ð † Ö ÐÓ<°,°Dp X°,X°D‚, X<Óà ` àPlaintiff/Appellee,à œ à)à È àÐ l ¼ Ðà ` àà œ à)à È àHon.€George€R.€Ellis,Ð R ¢ Ðvs.à ` àà œ à)à È àChancellorÐ 8 ˆ  Ðà ` àà œ à)ÌA.€O.€SMITH€COMPANY,à œ à)à È àNO.€02S01„9804„CH„00039Ð T  Ðßt€(>.*jx„F` `€€@E¤0` ttx$ÜêÐ  tßà ` àà œ à)Ìà ` àDefendant/Appellant.à œ à)à È àREVERSED€&€DISMISSED.Ð Ð  ÐÌÌÌà@þþ(DàÔ‡ »½t »X XÊšÔJUDGMENT€ORDERÔ#† XÊšX » »½ty#ԈРh¸ ÐÌÓÓÌÓ6°À°` p’X°,°Dp X6Óà ¸ àThis€case€is€before€the€Court€upon€the€entire€record,€including€the€order€ofÏreferral€to€the€Special€Workers'€Compensation€Appeals€Panel,€and€the€Panel'sÏMemorandum€Opinion€setting€forth€its€findings€of€fact€and€conclusions€of€law,€which€areÏincorporated€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€of€theÏCourt.Ìà ¸ àCosts€will€be€paid€by€Appellee,€for€which€execution€may€issue€if€necessary.Ìà ¸ àIT€IS€SO€ORDERED€this€25th€day€of€February,€1999.ÌÌà ¸ àà È àà  àà x àà Ð àà (# à¼à ¸ àà È àPER€CURIAMÌÌÌñ_ñ›