By Taylor Skees, staff attorney, Memphis

After a protracted, multi-appeal journey, the Supreme Court of Tennessee last week delivered the final word on Edwards v. Peoplease and gave critical guidance on appellate standards of review and the analysis of aggravation injuries.

The opinion is a must-read for any workers’ compensation practitioner and judge.

Facts and procedural history

Jo Carol Edwards injured her knees in a truck accident at work and needed two full knee replacements. The main issue is whether she required the surgeries due to her underlying arthritis, or whether her work accident primarily caused the need for the surgeries by aggravating her arthritis.

Dr. Jason Hutchison, Edwards’s authorized treating physician, testified that he believed her knee problems stemmed from “severely arthritic knees” that were symptomatic before her work accident. He said her knee surgeries shouldn’t be compensable.

Dr. Timothy Sweo, a second-opinion doctor, testified that Edwards could be asymptomatic pre-accident despite having arthritic knees. He thought the accident caused “changes [to] the motion in the knee” that resulted in her symptoms and more than 51% caused the need for surgery.

After an expedited hearing, the trial court found that Dr. Hutchison “misapprehended” the law when he concluded that the exacerbation of a preexisting condition is not compensable. The court agreed with Dr. Sweo’s conclusion that the work accident caused the need for her surgeries.

Peoplease appealed, and the Appeals Board affirmed that the work injury aggravated Edwards’s knee problems but held she didn’t rebut Dr. Hutchison’s presumption of correctness as the authorized physician. The Board found Edwards was not likely to show the work injury primarily caused the need for the knee replacements.

The Appeals Board remanded the case, and the parties deposed more doctors. Peoplease deposed Dr. Hutchison again, who believed Edwards likely experienced knee symptoms before her work accident “despite her testimony and work history to the contrary.”

Dr. Claiborne Christian, deposed by Peoplease, didn’t consider Edwards’s symptoms compensable and testified “an aggravation is synonymous with an anatomic change” under workers’ compensation law.

Dr. Lawrence Schrader, deposed by Edwards, related her knee aggravation more likely than not to her work accident. He also stated that she was asymptomatic before the accident and the accident permanently aggravated her arthritis. This was consistent with her testimony and work history.

The second time around, the trial court found Dr. Hutchison’s opinion “incorrect,” Dr. Christian’s opinion “flawed,” and that Dr. Schrader’s opinion “offer[ed] the more probable explanation” for Edwards’s injuries. Combining the medical opinions with her testimony, the court found Edwards rebutted Dr. Hutchison’s presumption and “proved by a preponderance of the evidence that the work accident aggravated her knee arthritis.”

Peoplease, unsurprisingly, appealed again. The Appeals Board again held that Edwards failed to overcome Dr. Hutchison’s presumption. It found that Edwards’s limitations must’ve predated the accident, and that Edwards would’ve had the knee surgeries regardless of the work accident. It rejected the trial court’s reliance on Dr. Schrader because his diagnosis differed from the other three doctors.

Presiding Judge Timothy Connor dissented, saying a preponderance of the evidence showed that the truck accident “caused new symptoms or an increase in symptoms that led to functional limitations” that supported the trial court’s finding. The preponderance also supported the trial court’s finding that Edwards credibly testified.

Edwards appealed, and the full Tennessee Supreme Court took the case to discuss the standard of review and to define when an aggravation is compensable in workers’ compensation cases.

Standard of Review

Appellate courts in Tennessee have applied an abuse-of-discretion standard when reviewing expert deposition testimony on appeal. The Supreme Court said the history of applying this standard to all factual determinations “is incorrect and should no longer be followed.”

An appellate court should review credibility determinations based on in-person testimony with an abuse-of-discretion standard. However, an appellate court should give no deference to credibility determinations based on deposition transcripts. The appellate court is in the same position as the trial court to make credibility determinations because a deposition transcript doesn’t involve “the appearance of witnesses” or “oral testimony at trial.”

The standard of review for these factual findings is “de novo on the record with a presumption of correctness unless the preponderance of the evidence shows otherwise.”

Aggravation

The Supreme Court stated that aggravation, for purposes of the statute, means “an intensification or worsening of a preexisting disease, condition or ailment, permanent or not, that contributes more than fifty percent in causing death, disability or the need for medical treatment.”

In analyzing aggravation injuries, courts should “focus on the two causation requirements to be demonstrated by expert medical proof.” The employee must first show that the work accident contributed more than 50% in causing the aggravation. Then, the employee must prove that the aggravation, which was caused by the work accident, contributed more than 50% to the disablement or the need for medical treatment.

Compensability of Edwards’s Aggravation Injury

Applying the two causation requirements to this case, the Supreme Court found that the work accident contributed more than 50% in causing the aggravation because all of the physicians in this case acknowledged that her work accident caused the aggravation.

The main question therefore was whether the aggravation caused the need for her knee replacements.

The Supreme Court noted that nothing in the record, beyond bare assumptions of doctors, showed that Edwards experienced knee-related symptoms before her work accident. She thus “only became eligible for knee-replacement surgery once she became symptomatic, and she only became symptomatic after the accident aggravated her pre-existing arthritis.”

The Supreme Court also had a problem with conclusions reached by Drs. Hutchison and Christian. Just as lawyers and judges aren’t doctors and cannot make independent medical determinations without supporting expert medical testimony, doctors aren’t permitted to make legal conclusions. Drs. Hutchison and Christian concluded in their deposition testimony that Edwards’s injury was “not compensable,” and the Supreme Court pointed out that these legal conclusions “should have been disregarded.”

Additionally, Drs. Hutchison and Christian focused on anatomic changes in Edwards’s knee. The Supreme Court found this focus “inapposite here” because an aggravation doesn’t require an anatomic change and “was never a bright-line requirement in aggravation cases.”

The Supreme Court agreed with the trial court that Edwards rebutted Dr. Hutchison’s opinion and “proved by a preponderance of the evidence that the accident aggravated her knee arthritis by causing disabling pain and the need for bilateral knee replacements.” It therefore reversed the Appeals Board’s decision.

Conclusion

When it took up Edwards v. Peoplease, the Tennessee Supreme Court found an opportunity to give much-needed appellate guidance on reviewing deposition testimony. It also armed parties and judges with a two-pronged analysis for handling future aggravation injuries.