IN THE SUPREME COURT OF TENNESSEE
AT KNOXVILLE
January 4, 2005 Session
RONNIE DOTSON v. RICE-CHRYSLER-PLYMOUTH-
DODGE, INC., ET AL.
Direct Appeal from the Blount County Chancery Court
No. 02-208 Telford E. Forgety, Chancellor
No. E2004-00669-SC-R3-CV - Filed March 16, 2005
In this workers’ compensation action, the plaintiff sought compensation for a work-related injury
which caused reflex sympathetic dystrophy in his left arm, a scheduled member for workers’
compensation purposes. The plaintiff contended that reflex sympathetic dystrophy which affects
only a scheduled member nevertheless entitles a claimant to body-as-a-whole compensation because
the American Medical Association’s Guides to the Evaluation of Permanent Impairment convert
reflex sympathetic dystrophy to a rating for the body as a whole. Alternatively, the plaintiff
contended that his condition extended beyond his arm because he was denied potential future
treatment options for other, non-work-related injuries and because his arm’s hypersensitivity and
pain caused insomnia, chronic fatigue, and a diminished ability to concentrate. Holding that reflex
sympathetic dystrophy must always be apportioned to the body as a whole, the trial court awarded
the plaintiff permanent total disability benefits. Reversing the trial court, we hold that an award for
reflex sympathetic dystrophy may be limited to the compensation for scheduled members as
provided in Tennessee Code Annotated section 50-6-207(3)(A) to (D) (1999). Further, we hold that
for reflex sympathetic dystrophy to be properly apportioned to the body as a whole under Tennessee
Code Annotated section 50-6-207(3)(F) (1999), the claimant’s injury must affect a portion of the
body not statutorily scheduled, affect a particular combination of members not statutorily provided
for, or cause a permanent injury to an unscheduled portion of the body. Having so held, we
determine that the preponderance of the evidence fails to show that the plaintiff’s condition has
extended beyond his arm as a scheduled member. Therefore, we vacate the trial court’s award of
permanent total disability benefits to the plaintiff and hold that the plaintiff’s permanent disability
award is limited exclusively to 200 weeks of benefits pursuant to Tennessee Code Annotated section
50-6-207(3)(A)(ii)(m) (1999). We remand this case to the trial court for further proceedings
consistent with this opinion, as may be necessary.
Tenn. Code Ann. § 50-6-225(e); Judgment of the Chancery Court Reversed and Vacated;
Case Remanded to the Trial Court
FRANK F. DROWOTA , III, C.J., delivered the opinion of the court, in which E. RILEY ANDERSON ,
ADOLPHO A. BIRCH , JR., JANICE M. HOLDER , and WILLIAM M. BARKER, J.J., joined.
Robert R. Davies, Knoxville, Tennessee, for the appellants, Rice-Chrysler-Plymouth-Dodge, Inc. and
the Hartford.
Louis Andrew McElroy, II, Knoxville, Tennessee, for the appellee, Ronnie Dotson.
OPINION
I. Factual and Procedural Background
The plaintiff, Ronnie Dotson, worked as a delivery driver and stockperson for the defendant
auto dealership, Rice-Chrysler-Plymouth-Dodge, Inc., which was insured by co-defendant, the
Hartford. According to the record, Mr. Dotson was forty-two years old at the time of trial. He has
completed a ninth-grade education, achieving below-average reading and mathematic abilities. His
prior vocational history consisted largely of medium to heavy labor in various unskilled or low-level
semi-skilled positions.
Mr. Dotson had been employed by Rice-Chrysler for about eight years when he suffered a
work-related accident. On August 1, 2001, while dragging to storage a crated 150-pound side-panel
for a van, he slipped on a piece of sheet metal which lay on Rice-Chrysler’s warehouse floor. The
heavy crate fell over, crushing his left hand against a four-by-four inch post.
This accident caused various traumatic injuries. According to the deposition testimony of
Todd R. Griffith, M.D., one of Mr. Dotson’s treating physicians, the impact of the crate fractured
a metacarpal bone in Mr. Dotson’s left hand and caused bruising and swelling. Mr. Dotson also
experienced numbness and tingling in the fingers of his left hand which in Dr. Griffith’s opinion
were caused by “traumatic carpal tunnel syndrome.” With his left hand and forearm in a cast, Mr.
Dotson soon returned to work for four days, but pain in his left hand prevented him from continuing.
Since then he has not worked.
According to Dr. Griffith, by September 2001 Mr. Dotson began experiencing symptoms in
his left hand indicative of reflex sympathetic dystrophy (“RSD”),1 such as increased sweating,
hypersensitivity and pain. Dr. Griffith defined RSD as a “syndrome characterized by increased
sympathetic nervous overdrive to the vessels and nerves in a limb, typically an upper extremity. It
causes changes in temperature, changes in sweating, and most clinically significant[,] severe pain
that is difficult to control.” In Dr. Griffith’s opinion, Mr. Dotson’s RSD was caused by the impact
of the crate upon his left hand. Following surgery on October 5, 2001 which corrected Mr. Dotson’s
1
RSD is also known as complex regional pain syndrome.
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carpal tunnel syndrome, the symptoms of his RSD worsened.
Subsequently, in spite of various treatments, Mr. Dotson’s left hand has suffered chronically
from loss in range of motion, increased sweating, constant hypersensitivity to touch, severe pain, and
a “burning[,] . . . throbbing, aching” sensation. According to Mr. Dotson, even the slightest contact
of any object with his left hand has caused “unbearable” irritation and pain. Although quietude has
served to mitigate this pain, according to Mr. Dotson and his wife, Rebecca Lynn Dotson, his
condition has nevertheless given rise to insomnia, chronic fatigue, and a diminished ability to
concentrate upon tasks.
Dr. Griffith determined on May 16, 2002 that Mr. Dotson had reached maximum medical
improvement. Dr. Griffith regarded the RSD in Mr. Dotson’s left hand as permanent and imposed
a permanent restriction against any vocational use of Mr. Dotson’s left arm. Dr. Griffith further
recommended that he receive specialized chronic pain management. Based on the American
Medical Association’s Guides to the Evaluation of Permanent Impairment (5th ed. 2001) (“AMA
Guides”), Dr. Griffith assigned a 74% anatomical impairment rating to Mr. Dotson’s left upper
extremity and a 44% impairment rating to his body as a whole.
Mr. Dotson brought a workers’ compensation action in the Blount County Chancery Court
against Rice-Chrysler and the Hartford (collectively the “defendants”). At trial, Mr. Dotson
maintained that the RSD in his left arm extended beyond the arm as a scheduled member, Tenn.
Code Ann. § 50-6-207(3)(A)(ii)(m) (1999), thus satisfying the requirements for body-as-a-whole
compensation, § 50-6-207(3)(F). First, Mr. Dotson argued that denial of surgery as a treatment
option for non-work-related lateral epicondylitis (or “tennis elbow”)2 in his right arm amounts to an
extension of the RSD beyond his left arm. Dr. Griffith testified in his deposition that “with the
history of RSD in the left arm, [Mr. Dotson] is at higher risk of developing RSD in his right arm if
he were to undergo a surgical procedure. . . . So I did not give him the option of surgical treatment
of his tennis elbow.” Second, Mr. Dotson argued that the RSD in his left arm has extended to his
body as a whole via the insomnia and fatigue consequent to his chronic pain.
Furthermore, Mr. Dotson alternatively maintained that as a matter of law RSD must always
be classified as injury to the body as a whole regardless of whether the RSD is confined to a
scheduled member. The AMA Guides require conversion of upper extremity impairment caused by
RSD to an anatomical disability rating for the body as a whole. Mr. Dotson contends that because
the Tennessee General Assembly has mandated use of the AMA Guides in rating anatomical
disability, Tenn. Code Ann. § 50-6-204(d)(3) (1999), the AMA Guides’ conversion of RSD to the
body as a whole consequently mandates classification of RSD as injury to the body as a whole.
The defendants responded by arguing that there is insufficient evidence to show that Mr.
2
Lateral epicondylitis involves inflammation and pain in the tissues adjoining the elbow’s
outside bony projection. See Attorneys’ Textbook of Medicine ¶ 4.72 (Roscoe N. Gray et al. eds.,
3d ed. 2001); PDR Medical Dictionary 582 (1995).
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Dotson’s RSD has extended beyond the left arm as a scheduled member. The defendants also
disputed the assertion that RSD must always be classified as injury to the body as a whole. They
emphasized that the AMA Guides convert a variety of scheduled member injuries to a body-as-a-
whole rating but pointed out that such conversion is not always required as a matter of law.
According to the defendants, because Dr. Griffith testified unequivocally that the symptoms of Mr.
Dotson’s RSD were limited to his left arm, he should be limited to compensation for loss of a
scheduled member.
The trial court characterized as insubstantial and “thin” any evidence for extension of RSD
beyond Mr. Dotson’s arm as a scheduled member. Nevertheless, in light of the conversion scheme
for RSD provided in the AMA Guides, the trial court held that as a matter of law “RSD is required
to be converted to the body as a whole.” Having thus determined that Mr. Dotson’s RSD cannot be
limited to scheduled member compensation, the trial court focused on the extent of his vocational
disability. Vocational expert Jane L. Hall testified at trial that in her opinion Mr. Dotson was
permanently and totally disabled vocationally. In contrast, vocational expert Rodney E. Caldwell,
Ph.D. opined in a deposition that Mr. Dotson was 75% vocationally disabled. Taking into account
all the relevant evidence, the trial court found Mr. Dotson to be permanently and totally disabled
within the meaning of Tennessee Code Annotated section 50-6-207(4)(B) (1999). Therefore, the
trial court ordered Rice-Chrysler and the Hartford to pay Mr. Dotson permanent disability benefits
from the date of maximum medical improvement, May 16, 2002, until he becomes eligible for social
security retirement benefits, with an offset for certain lump sum awards.
Rice-Chrysler and the Hartford appealed. We transferred this case for review by the entire
Supreme Court.
II. Analysis
The primary question in this case is whether, for purposes of workers’ compensation, reflex
sympathetic dystrophy must always be classified as injury to the body as a whole, regardless of
whether the effects of RSD are limited to a scheduled member. Because this is a matter of law which
involves construing the workers’ compensation statutory scheme, our standard of review is de novo
with no presumption of correctness. Ivey v. Trans Global Gas & Oil, 3 S.W.3d 441, 446 (Tenn.
1999). We now decide this issue of first impression.
Workers’ compensation claims necessarily fall into one of four statutory classifications: (1)
temporary total disabilities; (2) temporary partial disabilities; (3) permanent partial disabilities; and
(4) permanent total disabilities. Tenn. Code Ann. § 50-6-207(1) to (4) (1999). Each separate
disability classification is independent, serves a specific compensation goal, and provides distinct
benefits. See Davis v. Reagan, 951 S.W.2d 766, 767 (Tenn. 1997). Permanent partial disability is
further subdivided into compensation for loss of enumerated scheduled members, for serious
disfigurement, and for disability apportioned to the body as a whole. Tenn. Code Ann. § 50-6-207(3)
(1999). Restated, our question is whether compensation for RSD may be limited to the specific
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benefits provided for loss of a scheduled member or must always be apportioned to the body as a
whole.
We begin our analysis by addressing the relationship between the workers’ compensation
statutory scheme and the AMA Guides. Tennessee Code Annotated section 50-6-204(d)(3) (1999)
states:
To provide uniformity and fairness for all parties, any medical report prepared by a
physician furnishing medical treatment to a claimant shall use the American Medical
Association Guides to the Evaluation of Permanent Impairment, (American Medical
Association) or the Manual for Orthopedic Surgeons in Evaluating Permanent
Physical Impairment, (American Academy of Orthopedic Surgeons). A physician
shall utilize the most recent edition of either publication in determining the degree
of anatomical impairment. A practitioner shall be required to give an impairment
rating based on one (1) of the two (2) publications noted above.3
The purpose of statutorily-mandated use of the AMA Guides is provided in the statute itself: “[t]o
provide uniformity and fairness for all parties . . . .” Tenn. Code Ann. § 50-6-204(d)(3). As we
explained in Corcoran v. Foster Auto GMC, Inc., 746 S.W.2d 452, 457 (Tenn. 1988), this language
“clearly evidences a legislative intent to standardize the methods of rating percentages of anatomical
disability to minimize arbitrariness and [to] encourage predictability in such assessments by medical
experts.”
Yet in demanding that a medical expert follow the AMA Guides when assessing anatomical
disability, the statute does not somehow elevate the AMA Guides themselves to the status of law.
Rather, the AMA Guides are nothing more than tools for effectuating in a fair and predictable way
the paramount goals and requirements of the workers’ compensation statutory scheme. See
3
Section 50-6-204(d)(3) (1999) was in force when this cause arose and remains applicable
to this appeal. It has since been totally superseded by an amended section now in effect. 2004 Tenn.
Pub. Acts ch. 962, § 13. Tennessee Code Annotated section 50-6-204(d)(3)(A) (Supp. 2004)
provides:
To provide uniformity and fairness for all parties in determining the degree of
anatomical impairment sustained by the employee, a physician, chiropractor or
medical practitioner who is permitted to give expert testimony in a Tennessee court
of law and who has provided medical treatment to an employee or who has examined
or evaluated an employee seeking workers’ compensation benefits shall utilize the
applicable edition of the AMA Guides as established in [section] 50-6-102 or in cases
not covered by the AMA Guides an impairment rating by any appropriate method
used and accepted by the medical community.
For the limited purposes of this opinion, there is no material difference between the versions.
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Thompson v. Leon Russell Enters., 834 S.W.2d 927, 929 (Tenn. 1992) (“[T]he fact [that] a
scheduled injury can be converted, via the [AMA Guides] or the Manual for Orthopedic Surgeons
. . ., to a percentage disability to the body as a whole provides no basis upon which to sustain an
award to the body as a whole under Tennessee Workers’ Compensation Law.”) (emphasis added);
Reagan v. Tenn. Mun. League, 751 S.W.2d 842, 844 (Tenn. 1988) (“The mere fact that a medical
impairment rating to a particular member may translate, for purposes of [the AMA Guides], into a
disability rating to the body as a whole does not alter the rule that if an injury is to a scheduled
member only, the statutory schedules must control the disability award.”) (emphasis added). In
short, the statutory compensation scheme controls the application of the AMA Guides. As the
defendants correctly assert, to require injury to a scheduled member alone to be apportioned to the
body as a whole merely because the AMA Guides so provide would confound the classification
scheme provided in Tennessee Code Annotated section 50-6-207.
Because RSD is not specifically provided for by statute, adjudication of benefits for that
condition is controlled generally by the statutory classification scheme. It is well settled that under
Tennessee workers’ compensation law, an award for permanent injury to a scheduled member alone
is exclusively limited to the award provided by the statutory schedule of Tennessee Code Annotated
section 50-6-207(3)(A) to (D) (1999). Ivey, 3 S.W.3d at 448 (“[W]here an employee’s only injury
is to a scheduled member, he or she may receive only the amount of compensation provided for in
the statutory schedule.”); McIlvain v. Russell Stover Candies, Inc., 996 S.W.2d 179, 185 (Tenn.
1999). By contrast, benefits for injury to the body as a whole, Tenn. Code Ann. § 50-6-207(3)(F)
(1999), are available “where an injury is to a portion of the body not statutorily ‘scheduled,’ where
an injury affects a particular combination of members not statutorily provided for, or where a
scheduled injury causes a permanent injury to an unscheduled portion of the body.” Thompson, 834
S.W.2d at 929 (citations omitted).
In accord with this statutory scheme, we hold that where reflex sympathetic dystrophy affects
a scheduled member alone, an award of permanent disability benefits is limited exclusively to what
the schedule for that member provides. For reflex sympathetic dystrophy to be properly apportioned
to the body as a whole, the claimant’s injury must affect a portion of the body not statutorily
scheduled, affect a particular combination of members not statutorily provided for, or cause a
permanent injury to an unscheduled portion of the body. See id. at 929.4 Therefore, we reverse the
4
Although several unpublished decisions of the Workers’ Compensation Panel have
apportioned RSD to the body as a whole, they have done so because in each case there was injury
to an unscheduled portion of the body, the injury affected a particular combination of members not
statutorily provided for, or a scheduled injury caused a permanent injury to an unscheduled portion
of the body. See, e.g., T.V. Swaw v. Trane Unitary Prods. Commercial, No. M2001-02793-WC-R3-
CV, 2002 WL 31740214 (Tenn. Workers’ Comp. Panel Dec. 9, 2002) (concluding that there was
injury to the body as a whole where RSD in left knee caused right knee injury and where necessary
medication had negative side-effects upon claimant); David Coleman v. Lumbermens Mut. Cas. Co.,
No. W2000-01168-WC-R3-CV, 2001 WL 285209 (Tenn. Workers’ Comp. Panel Mar. 15, 2001)
(concluding that there was injury to the body as a whole where RSD affected shoulder and back and
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trial court’s holding that the RSD in Mr. Dotson’s left arm must be apportioned to the body as a
whole because the AMA Guides so provide, regardless of whether the claimant has otherwise
satisfied the requirements for an award to the body as a whole.
Having thus decided the primary issue, we must now evaluate Mr. Dotson’s injury in light
of the standard which we have adopted. Findings of fact are reviewed de novo upon the record of
the trial court, accompanied by a presumption of correctness unless the preponderance of the
evidence is otherwise. Tenn. Code. Ann. § 50-6-225(e)(2) (1999); McIlvain, 996 S.W.2d at 183.
An appellate court thus conducts an independent review to determine where the preponderance of
the evidence lies. Walker v. Saturn Corp., 986 S.W.2d 204, 207 (Tenn. 1998).
In his deposition, Dr. Griffith testified that, in his expert opinion, Mr. Dotson had RSD in
his left lower arm and that the condition was permanent. According to Dr. Griffith, as a result of the
RSD, Mr. Dotson “basically does not have any functional use of his left arm.” Moreover, at trial
counsel for the defendants conceded that Mr. Dotson’s loss of use of the arm was 100%.
Accordingly, we conclude that Mr. Dotson is entitled to a permanent partial disability award for total
loss of his left arm as a scheduled member. See Tenn. Code Ann. § 50-6-207(3)(A)(ii)(m) (1999)
(“For the loss of an arm, sixty-six and two-third percent (66b%) of the average weekly wages during
two hundred (200) weeks.”).
Further, vacating the trial court’s award of permanent total disability benefits, we hold that
Mr. Dotson’s permanent disability award is limited exclusively to the 200 weeks provided for total
loss of an arm as a scheduled member. See id. The preponderance of the evidence fails to show that
Mr. Dotson’s injury qualifies for an award to the body as a whole. First, Dr. Griffith testified
unequivocally that the symptoms of Mr. Dotson’s RSD were limited to his left arm. The record
contains no conflicting medical testimony.
Second, because RSD in one part of the body increases the risk that subsequent physical
trauma will cause it to spread, Dr. Griffith has ruled out possible future surgery to correct Mr.
Dotson’s non-work-related lateral epicondylitis in his right elbow. However, there is no evidence
that Mr. Dotson has exhausted conservative treatment options short of surgery for his lateral
epicondylitis, and the mere potentiality that treatment options in Mr. Dotson’s case might be
foreclosed in the future is too speculative to be classified as a current injury.
Third, although Mr. Dotson suffers from permanent severe pain and hypersensitivity to touch
in his left arm, the pain and hypersensitivity themselves have not spread beyond his arm. When a
court determines the level of a workers’ compensation award, the pain consequential to a single
injury to a scheduled member alone may not itself be considered a separate, unscheduled injury. See
where claimant suffered from psychiatric condition); Janet L. Brooks v. Lear Seating Corp., No.
03S01-9702-CV-00024, 1998 WL 128960 (Tenn. Workers’ Comp. Panel Mar. 23, 1998)
(concluding that there was injury to the body as a whole where RSD in left knee was combined with
psychiatric disorder and with injuries to the shoulders and hands).
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Murray Ohio Mfg. Co. v. Yarber, 446 S.W.2d 256, 258 (Tenn. 1969) (holding that where scheduled
member compensation has been specifically provided for by statute, “it must be assumed by this
Court that the Legislature was then aware of the concomitant pain, suffering, [and so forth] normally
attendant upon impact injury” and declining to treat leg pain consequent to a leg injury as a separate,
unscheduled injury). To hold otherwise would permit a plaintiff “to sever or splinter concomitant
difficulties of a single injury.” Id. However, where injury to a scheduled member extends beyond
the scheduled member, compensation for injury to the body as a whole may be appropriate.
McWhirter v. Kimbro, 742 S.W.2d 255, 258–59 (Tenn. 1987). Mr. Dotson’s pain and
hypersensitivity do not give rise to body-as-a-whole compensation because they are limited to his
left arm, a scheduled member.5
Fourth, Mr. Dotson has suffered secondarily from insomnia, chronic fatigue, and a
diminished ability to concentrate. Although these sequelae may be factors to consider in determining
vocational disability, see, e.g., Fagg v. Hutch Mfg. Co., 755 S.W.2d 446 (Tenn. 1988), as incidents
of a scheduled injury already adjudged to be a total loss, they do not alter our classification or rating
of Mr. Dotson’s injury. We further note that Mr. Dotson has failed to prove the permanence of these
sequelae by expert medical testimony. In all but the most obvious cases, permanency in workers’
compensation cases must be established by expert medical testimony. Corcoran, 746 S.W.2d at 458;
see Johnson v. Midwesco, Inc., 801 S.W.2d 804, 806 (Tenn. 1990).
II. Conclusion
Reversing the trial court, we hold that a permanent disability award for reflex sympathetic
dystrophy may be limited to the statutory compensation for scheduled members as provided in
Tennessee Code Annotated section 50-6-207(3)(A) to (D) (1999). Further, we hold that for reflex
sympathetic dystrophy to be properly apportioned to the body as a whole under Tennessee Code
Annotated section 50-6-207(3)(F) (1999), the claimant’s injury must affect a portion of the body not
statutorily scheduled, affect a particular combination of members not statutorily provided for, or
cause a permanent injury to an unscheduled portion of the body.
Having so held, we vacate the trial court’s award of permanent total disability benefits to Mr.
Dotson. We hold that because Mr. Dotson’s injury is limited to his left arm as a scheduled member,
5
We acknowledge the apparent anomaly of limiting RSD to scheduled member compensation
when under another classification the condition’s debilitating nature may well entitle the claimant
to permanent total disability benefits. Cf. Ivey, 3 S.W.3d at 448 n.13 (questioning the fairness of
treating “loss of mental faculties” as scheduled member compensation); Roberson v. Loretto Casket
Co., 722 S.W.2d 380, 385 (Tenn. 1986) (acknowledging the arbitrariness of limiting compensation
for loss of one eye to the statutory schedule when the entire visual field is necessarily affected).
Notwithstanding, we must uphold and effectuate the statutory compensation scheme as it is provided
by the legislature. Sullivan ex rel. Hightower v. Edwards Oil Co., 141 S.W.3d 544, 548 (Tenn.
2004).
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his permanent disability award is limited exclusively to what Tennessee Code Annotated section 50-
6-207(3)(A)(ii)(m) (1999) provides. In light of our determination that Mr. Dotson has no use of his
left arm, we award him 200 weeks of permanent partial disability benefits. We remand this case to
the trial court for further proceedings consistent with this opinion, as may be necessary. Costs are
taxed one-half to the plaintiff, Mr. Dotson, and one-half to the defendants, Rice-Chrysler and the
Hartford, for which execution may issue if necessary.
______________________________________
FRANK F. DROWOTA, III, CHIEF JUSTICE
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