Ronnie Dotson filed a workers' compensation claim against Rice-Chrysler-Plymouth-Dodge, Inc. for a work-related injury that led to reflex sympathetic dystrophy (RSD) in his left arm. He argued that RSD, even when confined to a scheduled member, should qualify for body-as-a-whole compensation due to AMA guidelines that convert RSD ratings. Alternatively, Dotson claimed the condition impacted his overall health, limiting future treatment for non-work-related injuries and causing insomnia, chronic fatigue, and concentration issues. The trial court initially agreed, awarding him permanent total disability benefits. However, the Supreme Court of Tennessee reversed this decision, stating that RSD compensation could be limited to scheduled members under Tennessee law. The court specified that for RSD to qualify for body-as-a-whole compensation, it must affect an unscheduled body part, a specific combination of scheduled members, or result in permanent injury to an unscheduled part. Finding no evidence that Dotson's condition extended beyond his arm, the court vacated the permanent total disability award, limiting it to 200 weeks of benefits under Tennessee Code Annotated section 50-6-207(3)(A)(ii). The case was remanded for further proceedings consistent with this ruling.
Todd R. Griffith, M.D., testified that a crate's impact fractured a metacarpal bone in Mr. Dotson’s left hand, causing bruising, swelling, and symptoms of traumatic carpal tunnel syndrome, including numbness and tingling. After a brief return to work, Mr. Dotson could not continue due to ongoing pain. By September 2001, he showed signs of reflex sympathetic dystrophy (RSD), characterized by severe pain, hypersensitivity, and changes in sweating and temperature, which Dr. Griffith attributed to the crate’s impact. Following carpal tunnel surgery on October 5, 2001, Mr. Dotson’s RSD symptoms worsened, leading to chronic pain, loss of motion, and significant discomfort from minimal contact. This condition has caused insomnia, fatigue, and concentration issues. On May 16, 2002, Dr. Griffith concluded that Mr. Dotson had reached maximum medical improvement and deemed the RSD permanent, recommending chronic pain management and imposing restrictions on the use of his left arm. He assigned a 74% anatomical impairment rating for the left upper extremity and a 44% body-wide impairment rating.
Mr. Dotson filed a workers’ compensation claim against Rice-Chrysler and the Hartford, arguing that his RSD extended beyond his left arm, qualifying for body-as-a-whole compensation under Tennessee law. He claimed that the denial of surgery for non-work-related tennis elbow in his right arm increased his risk of RSD there, as testified by Dr. Griffith. Additionally, Mr. Dotson contended that the chronic pain from RSD has affected his entire body, further asserting that RSD should legally be classified as an injury to the body as a whole. He cited the AMA Guides, which require such conversions for upper extremity impairments, and referenced Tennessee law mandating their use in assessing anatomical disability.
Defendants contended that there is inadequate evidence to establish that Mr. Dotson’s reflex sympathetic dystrophy (RSD) extends beyond his left arm, which they classified as a scheduled member. They argued against the notion that RSD must universally be treated as an injury to the body as a whole, noting that while the AMA Guides allow for such conversions, they are not legally mandated. Dr. Griffith's testimony confirmed that Mr. Dotson’s RSD symptoms were confined to his left arm, prompting the defendants to assert that compensation should be limited to the scheduled member.
The trial court found the evidence for the extension of RSD to be insubstantial but ruled that, according to the AMA Guides, RSD should be treated as a body-as-a-whole injury. Consequently, the court assessed Mr. Dotson’s vocational disability. Vocational expert Jane L. Hall testified that he was permanently and totally disabled, while Dr. Rodney E. Caldwell estimated a 75% vocational disability. Considering all evidence, the trial court determined Mr. Dotson to be permanently and totally disabled under Tennessee law, ordering Rice-Chrysler and Hartford to pay permanent disability benefits from May 16, 2002, until he qualifies for social security retirement, with certain offsets.
The case's central legal question is whether RSD must always be classified as an injury to the body as a whole for workers' compensation purposes, irrespective of its effect on scheduled members. The court's review is de novo, and this issue represents a matter of first impression. Workers’ compensation claims categorize into four classifications: temporary total, temporary partial, permanent partial, and permanent total disabilities, each with distinct benefits. The analysis will explore the interaction between the workers’ compensation statutory scheme and the AMA Guides, emphasizing the requirement for physicians to use these guides in assessing permanent impairment ratings.
Statutorily-mandated use of the AMA Guides aims to ensure uniformity and fairness in determining anatomical disability ratings, as outlined in Tenn. Code Ann. 50-6-204(d)(3). The Tennessee Supreme Court, in Corcoran v. Foster Auto GMC, Inc., emphasized that the legislative intent is to standardize disability assessments to reduce arbitrariness and promote predictability. While the statute requires medical experts to use the AMA Guides in evaluations, it does not elevate the Guides to legal status; they serve merely as tools to fulfill the objectives of the workers' compensation system.
The 2004 amendment to the statute requires that physicians or medical practitioners utilize the applicable edition of the AMA Guides or an accepted alternative method when assessing anatomical impairment. Importantly, the translation of a scheduled injury to a percentage disability of the body as a whole does not justify an award beyond what is specified for scheduled members under Tennessee law. The statutory compensation scheme dictates that injuries limited to scheduled members receive only the compensation outlined in the relevant statutory schedules, as confirmed in cases like Thompson v. Leon Russell Enters. and Ivey. Conversely, injuries affecting unscheduled portions of the body or combinations of members not listed in the statute may qualify for broader benefits.
Reflex sympathetic dystrophy (RSD) affecting only a scheduled member limits permanent disability benefits to the statutory provisions for that member. For RSD to be considered as impacting the body as a whole, it must affect an unscheduled body part, a combination of members not specified by statute, or result in permanent damage to an unscheduled area. The court reversed the trial court's decision that Mr. Dotson's RSD in his left arm should be treated as a body-wide injury based solely on the AMA Guides. The appellate court reviewed the evidence, presuming the trial court's findings were correct unless proven otherwise. Dr. Griffith's expert testimony confirmed Mr. Dotson's RSD as permanent, rendering his left arm functionally unusable, which the defendants' counsel acknowledged as a total loss. Consequently, Mr. Dotson is entitled to a permanent partial disability award for the total loss of his left arm, amounting to 66⅔% of his average weekly wages for 200 weeks, as stipulated by Tennessee law. The evidence did not support an award for a body-wide injury; all symptoms were confined to the left arm, with no conflicting medical opinions. Although Mr. Dotson experiences severe pain and hypersensitivity in his left arm, these conditions do not constitute unscheduled injuries. Prior case law supports that pain related to a scheduled member injury cannot be treated as a separate injury for compensation purposes.
A plaintiff cannot separate the complexities of a single injury when seeking compensation. Compensation for injuries to a scheduled member, such as Mr. Dotson's pain and hypersensitivity limited to his left arm, does not warrant body-as-a-whole compensation. Although Mr. Dotson experiences insomnia, chronic fatigue, and concentration issues as secondary effects, these do not change the classification of his injury, which is already considered a total loss. He has not provided expert medical testimony to establish the permanence of these secondary conditions, which is typically required in workers' compensation cases. The court reverses the trial court's decision, stating that a permanent disability award for reflex sympathetic dystrophy is restricted to the statutory compensation for scheduled members under Tennessee law. For this condition to qualify for body-as-a-whole compensation, the injury must affect parts of the body not listed in the statute or result in permanent injury to an unscheduled body part. Since Mr. Dotson's injury is confined to his left arm, his permanent disability award is limited to statutory provisions. As he has no use of his left arm, he is awarded 200 weeks of permanent partial disability benefits. The case is remanded for further proceedings, with costs shared equally between Mr. Dotson and the defendants.
