### IN THE S UP REME COURT OF TENNESS EE AT JAC KSON A pr il 1, 200 8 S es sio n

LA C A Y C R EW V

. F IR ST S OU R C E F U R N IT U R E G R OU P d /b /a ANDERSON HI CKEY COMPANY

Appeal by p erm ission from the Sup rem e Court

Special Workers’ Com pensation Ap peals Panel Laud erdale County Chancer y Court No. 12958-38-69 Dewe y Whitenton, Chan cellor

No. W2006-00713-SC-WC M-WC - Filed June 24, 2008

I n 2004, the plaintiff, L aca y Crew, f iled a wor kers’ compensation claim alleg ing injurie s to her lef t and rig ht hands, wrists, and ar ms, while in the course and scope of her employ ment. I n response , the defendant, First Source Furniture Group, d/b/ a Anderson Hickey Company , denied the c laim on iss ue s o f c a

us a tio n. Th e tr ia l c ourt

fo un d th a t Cr e w s us ta ine d a c omp e ns a

ble , g ra du a l in

jur y to b oth upper e x tremities and aw arde d a per manent par

tial vocational d i s abil ity

of 25% to ea ch upper extremity equatingto a judg ment awa rd of $25,479.00. Discre tionary costs in the amount of $150.00

wer e aw arde d for reimbursement to Crew for a doctor’s c ompletion of a Tenne ssee De partment of L abor For m C-32 on Cre w’s beha lf. The Spec ial Workers’ Compensation Appe als Panel found that there was insuffic ient evidenc e of causation and dismissed the ca se. We aff irm the dec ision of the Appea ls Panel.

Tenn. Cod e Ann. § 50-6-225(e ); F ind ings of F act and Conclusion s of L aw of the Special Wo r ke r s’ Co m pe nsa ti on A ppe als P ane l A ffirm e d.

G AR Y R. W ADE , J ., delivere d the opinion of the cour t, in which W I L L I AM M. B ARKE R , C.J ., and C OR NE L I A A. C LARK , and W I L L I AM C. K O CH , J R ., J J ., joined. J ANI CE M. H OL DER , J ., not p ar t i ci p at i n g.

S. Newton Ander son and Ga y le B . L akey , Memphis, Tennesse e, for the a ppellant, First Sou rce Furniture Group d/b/a A nderson Hic key Company.

Steven C. Grubb, Memphis, Tenne ssee, f or the a ppellee, L acay Crew.

OP IN ION I. F actsCr ew t es t i f i ed on di r ec t e xam i nat i on that she cam e bac k t o A nder s on H i cke y i n 1999 i n t he w el di ng 1

d e p a rtm e n t an d th a t sh e d id th a t “[ u ]p to 2 0 0 2 ” fo r “ a b o u t a y e a r a n d a h a lf .” S h e a lso sta te d th a t sh e w e n t b a c k in “abou t ‘ 97
, ‘ 98 ” i n “des k as s em bl y. ”

-2- L aca y Crew (“Crew ”), who was 39 y ear s of age at t he ti me of trial, is a high school g raduate. She a tte nd e d c oll e g e fo r a tim e , s tu dy ingvo ic e ra

ng e and mus ic . H e r w or

k c are e r b e g an w ith pa c kin g a uto mob ile pa

rt s at T e nn e sse e El e c tr op l a t i n g f o r a p p r o xim a te ly

six mo nth s and

pu tti ngpa

rt s on the line for motors f

or fa ns at Mag netek Unive rsal Electric. She beg an working for First Source Fur niture Group, d/b/a A nderson Hic key Company

(“A nderson Hic key”) in 1991, whe re she op e rate d a

br e a k p re ss. Her jo b requ ire d th a t sh e be nd pa rt s th a t w ou ld l a te r b e us e d to a sse mbl e desks. In 1995, she left Ande rson Hicke y and bec am e a substitute teache r. In 1999, when she returne d to Anderson Hic key , she wa s initi ally assig ned to the we lding de partment, whe re she assembled f

iling ca binets and later

beg an to assemble des k s o n t h e li ne. She worke d there 1 continuously

until J anuar

y 28, 2002, when she was pe rmane ntly laid off. Ande rson Hicke y ’s plant closed two months later.

I n October 2001, during the t ime in which she wa s working in desk assembly , Crew use d a

ru bb e r h a mme r w e ig hin g a

pp ro xima te ly

fi ve po un ds to be nd dr awe rs in o rd e r t o a ssu re a pr op e r f it. When a desk on the m oving assembly line lacke d all of t he necessar y parts, Crew , with the help of others, would lift as m uch as 200- 300 pounds of weig ht. Her w ork wa s varied a nd included we lding

and wo rk ingon

the ha nglin e lif tin g fi le s. On he r ow n, sh e c ou ld lif t a pp ro xima te ly 30 to 40 po un ds

.
On Octobe r 13, 2001, Crewnoticed that her wrist was swollen. Ten day s later, the swelling

was worse. She repor

ted her condition to her supervisor beca use she c ould not remove he r ringfrom he r f ing e r. An de rs on

Hi c ke y re fe rr e d h e r t o a

Dr . Ro bb ins

.

Be fore being treated by Dr. Robbins, Crew c ompleted a wor kers’ comp en s at ion questionnaire. She r eporte d that she lifted items from the f loor to the “pe ds,” helped to fit dra wer s on a desk line “ in an upwar d [and] d o wnward motion all day ,” and “ notice[d] tingling in [ her] fi ng e rs and

a lso sw e lli ngof

the fi ng e rs [an d] wri st. ” Duri ng the c ours e of tr e a tme nt o n h e r l e ft

wr ist
, Cr e w b e g an to e xpe ri e nc e pa in i n h e r r ight wri st as we ll. Dr . Ro bb ins , w ho la st s aw C re w i n Dec ember

of 2001, authorized her

return to wor

k with a t en pound lifting restric tion. Ultim ately , he ref err ed her to a Dr. Car l Huff, a

n orthopedic sur g eon.

On Dec ember

21, 2001, Crew ha d her f irst appointment with Dr. Huff . She complained at that time of numbness in her lef t hand and a

g radua l onse t of sy

mptoms occurringin the previous two months associated with re petitious use of her hand at work. She also repor ted that she ha d been

wea ring a bra ce a

nd using medications. Dr. Huf f found that Cre w had ne arly a full ra ng e of motionD r

. H uf f de s cr i bed t he Pha l en’ s t es t as “a com pr es s i on t es t of t he m edi an ne r ve w her e t he w r i s t i s fl exe d f or 2

6 0 se c o n d s, a n d th e n th e y g e t a tin g lin g in th e d istrib u tio n o f th e m e d ia n n e rv e .”

D r

. H uf f

de s cr i bed t he Ti nel ’s si g n a s a “ t ap over t he ner ve” t hat r es ul t s i n a “ r adi at i ng pa r es t hes i a i n t he 3

d istrib u tio n o f th e n e rv e .”

D r

. H uf f

de s cr i bed de Q uer vai n’ s t endoni t i s a s a “st en o si n g t enos ynovi t i s of t he ext ens or t endons t o t he 4

t hu m b, ac t ual l y t he abdu ct or pol l i ci s l on gu s and ext ens or po l l i ci s b r evi s

. . . . [a] s t hey cours e t hroug h t he f i r s t dors al

e x te n so r c o m p a rtm e n t, th e y g e t t ig h tn e ss a n d p re ssu re a n d th is c a u se s p a in w h e n th e se ten d o n s g lid e w ith m o v e m e n t.” It i s al s o kn ow n, am on g ot her t hi ng s , as D e Q uervai n’s t enosyno vi t i s and D e Q uervai n’s Syn drom e. Ten do ni t i s ca n al s o be s pel l ed “t endi ni t i s

. ”

-3- but test ed p o s i t i v e on both a Phalen’ s test and Tinel’s sig n. He a lso noted that she display ed a 2 3 slight we ak n es s of pinch and ha d decr ease d sensation in her thumb and f inge rs. Dr. H uff

a c kn ow le dg e d th a t th e va lid ity of the se re su lts de pe nd s u po n s ub je c tiv e re sp on se s f

ro m a patie nt t o questions relative to sensation. Radiogra phs of Crew’ s left wrist wer e negative. Dr. Huf f orde red

an e le c tr omyog ra

m ( “ EM G” ), wh ic h me a sure s th e sp e e d o f t he tr ans mis sio n o f a

n e le c tr ic a l im

pu lse along the path of the nerve , to deter mine whether Crew wa s suffer ing f rom ca rpal tunnel sy

ndrome. He deemed the EMG as particula rly reliable beca

use it “doesn’ t require patient re sponse.” Dr . Huff

re tur ne d Cr e w to wo rk wi th a fi ve -p ound lif tin g lim it, a re pe tit ive wo rk re str ic tio n, and a wrist immobil izer.

Th re e we e ks late r, Dr . H uf f c on du c te d a

se c on d e xami natio n. I n th e me anti me , th e EM G repor t indicated no ca

rpal tunnel sy

ndrome to the lef

t upper e x tremity

. On p h y s ical examination, howeve r, Dr. H uff f

ound “mar

ked tende rness o v er t h e fi rst dorsal extensor compar tment at the wrist,” “inc rea sed pain” in the same a rea , a diminished streng th of pinch, and a neg ati ve Phalen’ s test and Tinel’s sig n over the median ner ve. Crew ’s ra

ng e of mot i o n rema ined full. Dr. Huf f diag nosed de Querva in’s tendonitis of t he left wrist and ordered a cortisone shot, medications for 4
pa in, an im mob ili zer , and fu rt he r te sti ng . B e c a

us e Cr e w w a s st ill c omp la ini ngof so me numbn e ss in h e r l e ft ha nd , D r. Hu ff

or de re d la

b te sti ngfo r a

rt hr iti c and rheum a tol og ic a l is su e s. He a g a in returne d her to wor

k with the five-pound liftingrestric tion and repe titive work restric tion.

When Crew re turned to Dr. Huff on J anuar y 24, 2002, for a third visit, she reported that her g rip and pinch had “def

initely improved.” Her examination showe d minimal tende rness, her pinc h

and g ri p s tr e ng th we re ne ar no rm a l, and sh e ha d no los s of se ns a tio n. Dr

. Hu ff pr e sc ri be d a n a nti

inflammatory

medication and r eturne d her to wor k without restrictions.

One we ek later, Crew returned to se e Dr . Huff c omplaining of pain in her le ft shoulder a nd

r i g h tw r i s tan d

g e n e r a l i z e d

p a i ni nh e r j o i n t s

. B y t h e n , D r

. H u f f h a d t h e l a

b r e s u l t s f o r r h e u m a t o l o g y, which indicate d that Crew ha d lupus, an inflammatory arthritic c o n d i t i o n

. He noted pain and

sw e lli ng in mul tip le pa

rt s of he r bo dy and state d that it wa s “ po ssi ble ” that he r r e tur n to wo rk a t f ull du ty ha d a g g ra

vate d he r co nd iti on

. I t wa s als o his opi nio n that Cre w w ou ld b e pe rm ane ntl y un a ble to r e s u me r e p e ti ti o u s w o r k

. D r

. H u f

f a dv is e d h e r to s e e k f

o ll o w u p c ar e f o r h e r lu p us from her primary car e phy sician.N o n e o f D r. Ja n o v ic h ’s m e d ic a l re c o rd s p ro v id e d in c lu d e th e A u g u st 2 0 0 2 v isit. 5

N o thin g in th e r e c o rd in d ic a te s tha t C re w s o u g h t a n y m e d ic a l c a re fo r h e r b ilate ra l up p e r e x tre m ity c o m p la ints 6

fro m the ti m e sh e left D r. H u ff ’s ca re o n J a n u a ry 2 4 , 2 0 0 3 a n d he r v isit w ith D r. W e st o n S e p te m b e r 3 , 2 0 0 3

.

D r

. W es t t es t i f i ed by depos i t i on t hat t he s ur ger y w as on J anua r y 24, 2003, but hi s m edi ca l not es i ndi ca t e t he 7

d a te o f p ro c e d u re a s S e p te m b e r 2 4 , 2 0 0 3 . In a n o th e r p a rt o f h is t e s ti m o n y , h e sta te d th a t h e p ro v id e d tre a tm e n t i n Se pt em ber 2003.

-4- I n Dec e mb e r

o f 2 0 0 2 , Cr e w a g a in

s aw D r

. H u f

f o na f o ll o w
- u p b a s is
, c o mp la in in g of numbness in the left hand a nd, for the first time, in the rig ht ha nd. She also display ed trig g eringof her le ft middle fing er, te n d erness over the de Quer vain’s tendons of the left wrist, dec rea sed

s en s at i o n i n h er fing ers, a nd a slig ht weakne ss of pinch in both hands. She re ported a tingling pare sthesia with the Phalen’s test in both wr ists. Dr. Huff or dere d EMGs to both the left and r ight up pe r e xtre mit ie s, bu t r e le a se d Cr e w t o f ull du ty wi th n o r e str ic tio ns

.
On J anuar y 24, 2003, Dr. Huf

f deter mined that the EMG wa s neg ative as to both extremities “with no indication of carpa l tunnel sy ndrome or other periphera l nerve entra pment.” He f

ound no specific patholog ical condition, a f ull rang e of motion, and norma l pinch and g rip streng th, s e n s a tion, and cir culation. He pla ced no restric tions a nd g ave a full duty rele ase. I t w as his opinion, base d on

a re asonable deg ree of medica l cer tainty and any g uidelines for impairme nt, that Crew ha d sustained “[n] o impairment.” I t was his further opinion that if she had left employ ment with Anderson Hic key and begun other work a s a box assembler for nine months, that “the new job would have ca used the

c arp a l tunn e l si nc e he r E MG , w he n I did it l a st w a s n or

ma l.” Dr . H uf

f c on c lud e d th a t any

dis a bil ity to Crew’s uppe r left e x tremity was the r esult of something “af ter she le ft my

office .”

On Aug ust 22, 2002, some eig ht months afte r being laid off by Ander son Hickey

and whe n under the treatment of Dr. Huf f, Cre w v i s ited Dr. John J anovich, a n orthopedic sur g eon. Crew 5 testified that she saw

Dr. Janovich based on a ref err al from her sist er. On t hat date she told him of the pr ob le ms s he wa s h a vin g wi th h e r ha nd s, wr ist s, and arm s. Dr . Jan ov ic h c on du c te d s ome te sts , but rende red no othe r trea tment at that time.

Af te r h e r em plo y me nt en de d at A nd e rs on

Hi c ke y , Cr e w w or

ke d b ri e fl y

a t a Slim F a st p lant, wher e she picked up and stacke d cans eig ht hour s a day
, five day s a wee k with so m e overtime. Be g inning January

2003, she was employ ed for eig ht months by Paslode, making box es and pla cing nails on a conve y or belt. On September 3, 2003, near the end of her employ ment at Paslode, Crew soug ht medical tre atment for the first time since havinglast seen Dr. Huf f. Dr. D avid West, an

o r th opedic surg eon, hea

rd Crew ’s complaint about lef t and rig ht wrist pain with some shoulder pain. 6 He noted a

history o f p ai n fo r approx imately two y ear s with neg ative EMGs on both upper extremiti es. B eca

use of c ontinuing sy

mptoms and the passag e of time, Dr. West conducted a nother EMG, which this time was positive for moderate car pal tunnel on the rig ht wrist. Three wee ks later, Dr. West perf

ormed rig ht car

pal re lease surg ery

on Crew’ s rig ht wrist. He late r co n cl u d ed that 7 Crew ha d heale d well and discha rg ed her on November

18, 2003.-5-

Dr. W est co mp le te d

a T e n n e s s e e D e p artm e n t o f L a b o r C- 3 2 F o r m a n d o p in e d th a t C r ew sustained a 2% perma

nent phy sical impairment to a s chedule d member. H e dete rmined that her imp a ir me nt m or e pr ob a

bly tha n n ot a ro se ou t of

he r empl oy

me nt. B y

de po sit ion , D r. Wes t acknow ledg ed that he w as aw are that Crew’ s empl o y m en t wi th Anderson Hic key was ter minated in January of 2002, and was further awa re that she worke d at Paslode from J an u ar y t o September 2003. Dr

. W es t , who was una ble to deter

mine to a re asonable deg ree of medica l cer tainty which employ er, A nderson Hic key or Paslode, wa s responsible for Crew’ s rig ht c arpa l tunnel condition, ob se rv e d a s f

oll ow s:

Th e on ly tr ue fa c t . . . is that y ou

ha d a ph y sic ian th a t e xami ne d h e r dur ingthe tim e she worke d for Ander son Hickey
, who did a detailed EMG ner ve conduc tion study that reve aled that she did not have ca rpal tunnel, by

EMG. Whether she ha d numbness and pain and disability to he r hand, I didn’t examine he r duringthat time, so Ican’t s ay

. But the EMGwas positive from the time that she left Ande rson Hickey u ntil when Isaw he r. That is the only true stateme nt Iknow. And so y ou could assume that the patient de veloped car pal tunnel during that period, be cause the pr e vio us EM G w a s n or

ma l.

Upon beingquestioned as to the injury to Crew’s r ight wr ist, Dr. W est said, “I think the fa ct is . . . that the patient develope d a positive EMG within nine months of the normal one. So by assumption, that would mean that the se cond employ er would have been at least t he agg ravating cause, if not the

cause .” He also stated that the r epetitive ty pe of work described as being Crew’ s duties at Paslode was the ty

pe of w ork that ca

n commonly

result in car

pal tunnel sy

ndrome, and that based on suc h

a job de sc ri pti on , it

wa s li ke ly

that th e re wa s a p rogre ssi on and a g g ra vatio n o f C re w’ s r ig ht wri st inj ur y . A lth ou g h Cr e w w a s “ havin g pr ob le ms i n te rm s o f what sh e de sc ri be d” pr ior to s e e inghim and while employ ed at Ander son Hickey
, Dr. W est explained it did not “nec essar ily mean she had

car pal tunnel.”

I n April of 2004, Crew

returne d to D r. Janovich with a claim of lef t car pal tunnel sy

ndrome. She saw him throug h November 10, 2004. Dr. Janovich completed a C-32 For m in support of her

c la im. He de te rm ine d th a t Cr e w h a d p a in a nd numbn e ss i n b oth

up pe r e xtre mit ie s w ithtin g lin g in the fing ers a

nd pain. He noted a posi tive Tinel’s and Phale n’s tests on both hands. He dia g nosed bilatera l car

pal tunnel sy

ndrome, bilater al cubital tunnel sy ndrome, chronic radial epicondy litis on the left, a nd tendonitis on the left and trig g er f inge r. On Apr il 19, 2004, Dr. J anovich pe rfor med an EMG on Crew. T here was a positive result. Two months later he found the same positive Tinel’ s and Phalen’ s t es t s an d carpal tunnel sy ndrome. On June 29, 2004, Dr. Janovich perf ormed a left

car pal tunnel re lease as we ll as a trig g er f inge r re lease of the third and fourth digits on the left hand. After the surg ery , Crew’ s sy

mptoms continued, including a positive Tine l’s over the ulnar ne rve at her visit with Dr. Janovich in October of 2004. Crew was rele ased from Dr. J anovich’ s car e we eks later w ith a 5% per

manent par

tial disabilit y

ratingto her upper left extremity
, with numbne ss of the ring fing er on the left. L ike Dr. West, Dr. Janovich che cked the space in the C-32 For m affir ming that “this injury

more proba

bly than not [arose] out of t he [ Plaintiff’s] employ ment.” Dr . J anovich offe red no f

urther pr oof as to ca

usation.-6-

At tr ia l, C re w t e sti fi e d th a t w he n s he be g an h e r j ob a t Pa slo de, sh e was havin g the same prob l em s wi t h her w rists, hands, and ar ms that she previously

had since October

2001, when she worke d at Ander son Hickey

. At one point, she stated that the swelling and numbness had stay ed “the

same wa y it was” whe n she first starte d having problems, and at another point, she testified t hat the condition “[g]ot wo rs e” wh i l e workingat Paslode. She explained that she stopped wor king at Paslode bec ause of

her ha nds, her last surg ery , bad hea lth, a n d “u n co n trollable blood pressur e.”

Crew’ s husband, Donnie Cre w, conf irmed that she star

ted having some problems with her hands and wrists while workingfor Ande rson Hicke y . He r eca lled that Crew ha d first complained about her left hand a

nd then later

complained a

bout her rig ht ha

nd. He also rec alled massag ing he r hands and w hen she returned from wor k beca use of swe lling. Sandra

McElrath, Crew’s sister, testified that she saw swelling in her hands during the per iod she worke d for Ande rson Hicke y and

rec ommended that she see a doctor. McElrath testified that Crew wor e a br ace on her a rm during that time, held h er ha

nds in a “c erta in positi on,” and c omplained of numbness a nd tingling in her han d s and wrists. Ange la Currie, w ho also worke d at Paslode, desc ribed Cre w’s job as building box es, closing them, and havingto “constantly ” do it “all day long.” When questioned about any chang es in Crew’ s condition, Currie testified th at d u ri ng Crew’ s time at Paslode, she noticed that “it was g etting w orse on he r,” a nd that Crew ha d difficulty opening a do o r and holding any thing without dropping it. She also testified that since Crew lef t the job at P aslode, her hands, finge rs, and wrists were still swollen the same a s when she w as at Paslode.

Th e tr ia l c ourt

fo un d th a t Cr e w sus ta ine d a c omp e ns a ble g ra du a l in

jur y to h e r a rm s and wr ist s while emplo ye d

w ith Anderson Hicke y . The c ourt consider ed the c redible la y and medica l testimony and aw arde d perma

nent par tial disabilit y

to the rig ht and left a

rm of 25%. I t f

urther found that the anatomica l impairment was 5% to the le ft u p p er ex tremity , based on the opinion of Dr. Janovich, and 2% to the r ight uppe r extremity , as re ndere d by Dr. West

. T h e t ri al court a lso awar ded discretionar

y costs of $150 as r eimbursement f or th e cost of completion of the Tenne ssee De pa rtme nt o f L a

bo r C -3 2 F or

m by Dr . D a vid

Wes t.

Th e Wor ke rs ’ C omp e ns a tio n Pa

ne l r e ve rs e d, fi nd ingthat Cr e w h a d f a iled to e sta

bli sh

c a us a tio n thro ug h h e r e mpl oy me nt w ithAn de rs on

Hi c ke y . T he pa

ne l sp e c if ic a lly fo un d that bo th EMGs conduc ted by

Dr. Huf f showed no e vidence of car pal tunnel sy

ndrome in Crew ’s left or r ight

wr ist s, and

that he r w or

k at Pa slo de inv olv e d “ the ve ry ty pe s o f r e pe tit iv e mo ti on s tha t . . . c ou ld

cause car pal tunnel sy

ndrome.”

II. Stand ard of Review I n Tenne ssee wor

kers’ compensation cases, this Court revie ws the trial cour t’s finding s of fac t de novo, ac companied by a pre sumption of corre ctness of the finding , unless the evidenc e preponde rate s otherw i s e. Te nn. Code Ann. § 50-6- 225(e) (2) ( 2005 & Supp. 2007); Wilhelm v. Kr og e rs , 2 35 S.W. 3d

12 2, 12 6 ( Te nn . 2 00 7)

. “ Th is s tand ard of re vie w r e qu ir e s u s to e xami ne , in depth, a tria l court’s fa ctual finding s and conc lusions.” Galloway v. Memphis Drum Serv., 822 S.W .2d 584, 586 (Tenn. 1991) (citing Orman v. Wil liams Sonoma, I nc., 803 S.W .2d 672, 675 (Tenn. 1991)). We g ive consider able de fer ence in review ing the trial court’ s findin gs o f cr edibility and-7-

assessment of the weig ht to be g iven to that testimony , when t h e t ri al cour t has hea rd in-cour

t testimony

. Whirlpool Corp. v. Nakhone inh, 69 S.W .3d 164, 167 (Tenn. 2002) . On questions of law,

our standard of revie w is de novo with no presumption of cor rec tness. Wil helm, 235 S.W .3d at 126 (citing Perrin v. Gaylord Entm’t Co., 120 S.W .3d 823, 826 (Tenn. 2003)). The e x tent of vocational disability is a question of fa ct to be dec ided by the trial judg e. Johnson v. L ojac Materials, 100 S.W. 3d 20 1, 20 2 ( Te nn . 2 00 1) . A lth ou g h w or ke rs ’ c omp e ns a tio n law mus t be co ns tr ue d li be ra lly in favor of an injure d employ ee, it is the employ ee’ s burden to prove causation by a pre pondera

nce of the e vidence . See Thomas v. Ae tna L ife & Cas. Co., 812 S.W .2d 278, 283 (Tenn. 1991).

III . A nal ys is Ander son Hickey

first contends that the trial court erre d in awa rding Crew a

25% per manent partial disability to e ach arm. To support its arg ument, Ander son Hickey submits t hat (1) the trial court’s f inding that Cre w’s injuries to bot h u p p er ex tremities and the e x tent of the re lated impairment was c aused by her e mploy

ment with Anderson Hic key is not supported by

the evidenc e; and ( 2 ) th e tr ia l c o u rt e r

r e d b y f a il in g to a

p p ly th e “ la s t in

ju r io u s in ju r y ” r u le in th is case , which

wo uld pr e c lud e re c ov e ry

fr om A nd e rs on

Hi c ke y fo r a ny dis a bil ity c la ims

.

A. Causation Tenne ssee Code A nnotated sec tion 50-6-241 (2005) dic tates that an e mploy ee who sustains

a perma nent partial disability as a result of a workplac e injury is e ntitled to re ceive perma nent par tial disability benef its. The claimant in a worke rs’ c ompensation suit has the burden of proving ever

y element o f h is o r h e r c a s e b y a p r e p o n d e r an c e o f th e e v id e n c e

. E lm o r e v

. T r a v e le r s I n s. Co., 824 S.W .2d 541, 543 (Tenn. 1992) . To be c ompensable unde r worke rs’ c ompensation law, a n injury must “aris[e] out of and in the course of employ ment.” See Tenn. Code Ann. § 50-6- 102(13) ( 2005); Thornton v. RCA Serv. Co., 221 S.W .2d 954, 955 (Tenn. 1949). The phra se “a rising out of

” re fer s to t h e ca u s e o r orig in of the injury and the phr ase “ in the course of” r efe rs to the time, place , and ci rc u m s t an ce s o f th e in

j u ry

. Hi l l v

. E agl e Ben d M fg, I n c. , 9 4 2 S

. W

. 2 d 4 8 3 , 4 8 7 (T en n

. 1 9 9 7 ). If it is ap p ar e n t to th e r a ti o n a l mi n d
, a f te r c o n s id e r in g a ll o f th e c ir c u ms ta n c e s th a t th e r e is a causal

connec tio n b et we en the conditions under which the wor k is require d to be per formed a nd the resulting injury , then such a ccide ntal injury “‘a rises out of o n e’ s em p loy ment.’” Wilhelm, 235 S.W .3d at 127 (quoting Fink v. Caudle, 856 S.W.2d 952, 958 (Tenn. Worker s’ Comp. Panel 1993)).

“We have held in nume rous case s that expert medical testimony is require d to establish the perma nency of an injury

except wher e the perma

nent di sability

is obvious to a lay

man, such a s an amputated leg .” He nley

v. Ro ad wa y E x p., 699 S.W .2d 150, 155 (Tenn. 1985) . Whil e ca usation must be proven throug h medical e vidence , “absolute c erta inty . . . is not requi re d

. ” Fitzge rald v. BTR Sea ling Sy s., 205 S.W .3d 400, 404 (Tenn. 2006) . Be nefits may be aw arde d, there fore , wher e
me dic a l e vid e nc e sh ow s tha t the e mpl oy me nt “ ‘c ou ld o r m ig ht h a ve be e n th e c a us e ’” wh e n th e re is

a lso lay te sti mony

fr om whic h c a

us a tio n ma

y be inf e rr e d. I d. a t 40 4 ( qu oti ngCla rk v. Na sh vil le Mach. Elev at o r Co., 129 S.W .3d 42, 47 (Tenn. 2004) ). “I f medica l testimony is presente d by deposition, this C ourt may make a n ‘i n d ep en d ent assessment of the medica l proof to deter mine wh e re the pr e po nd e ra

nc e of the e vid e nc e lie s. ’” Wilh e lm, 23 5 S. W.3 d at 12 7 ( qu oti ngConne r B ro s. Ex cavating Co. v. L ong , 98 S.W .3d 656, 660 (Tenn. 2003)). “Any rea sonable doubt as to whe ther-8-

the worke r’s injuries ar o se out of his employ ment must be construed in the w orker ’s favor.” Wil helm, 235 S.W .3d at 127.

Th e tr ia l c ourt c on sid e re d the de po sit ion te sti mony of Dr s. Wes t and Hu ff , a s w e ll a s th e C32 For ms that w ere completed by Drs. West and Janovich. I t further hear d testimony

from Crew
, her husband, sister, and long- time f riend and found that Crew “sustained a compen s ab l e, gradual injury to both uppe r extremiti es arising out of and within the course and scope of her e mploy

ment.”

The Pane l disag ree d with the trial court’ s findings spe cifica lly as to ca usation:

Our indepe ndent re view of the record in this case shows that the plaintiff wa s not suffe ring from ca

rpal tunnel sy

ndrome in he r left wrist as of January 7, 2002, when an EMG c onducte d b y Dr . Huff show ed no evide nce of car pal tunnel sy

ndrome. The EMG w as per formed le ss than one month prior to plainti ff’ s lay -off from her employ ment with Anderson Hic key . I n addition, a second EMG conduc ted by Dr. Huff on January

14, 2003, showed no e vidence of ca rpal tunnel sy

ndrome in the plaintiff’s lef

t or rig ht wrists. Only

nine months later did the plaintiff have a positive EMG for c arpa l tunnel sy ndrome. This occ urre d afte r plai n t i ff had obtained employ

ment throug h Paslode, at which he r job duties wer e the very ty pes of re pe tit ive mot ion s th a t, a c c or din g to the me dic a l pro of in thi s ca se , co uld c a us e
c arp a l tunne l sy

nd ro me

. Th e g e ne ri c state me nt c he c ke d by Dr . Jan ov ic h in the C32 form is not sufficient to s upport a findingthat the plaintiff sustained a compensa bl e wor kers c ompensation injury with the defe ndant. Moreove r, the plaintiff’s complaints of swe lling in her left and r ight wr ists prior to the positi ve EMG throug h Dr

. W est ’s offic e have an indepe ndent medica l expl anation–her diag nosis of inflammatory arthritis or lupus.

Prior case law is helpful t o our determination of whether the injury qualifies as “ arising out of” a nd “in the cour se of” Crew’ s employ ment. This Court in Glis son v. Mohon I nternational, I nc.
c o n s id e r e d w h e th e r an in

ju r y ar o s e o u t of th e e mp lo y

me n t. 1 8 5 S. W. 3 d 3 4 8 , 3 5 4 ( T e n n

. 2 0 0 6 )

. We

rea soned that “e x cept in the most obvious ca s es, ca usation must be established throug h medical evidenc e.” I d. (citing Orman, 803 S.W .2d at 676). We a lso e mphasized the importance of the C-32 For m in support of a medica l report in wor kers’ compensation cases. I d. at 354 n.3. We stated that “[a]lt houg h causation cannot be ba sed upon spec ulative or c onjectura l proo f, absolute medica l

cer tainty is not require d, and reasonable doubt must be resolved i n favor of the e mploy ee.” I d. (citing L on g v. Tr i- Con I nd

us ., 99 6 S.W.2 d 173 , 177 (T e nn .1 99 9) ). Ac c or din g ly , if an e mpl oy e e pr e se nts medical e vidence showing that the employ ment could or mi gh t h av e bee n the ca use of his or he r injury when lay testimony

rea sonably

sug g ests causation, it i s appropr iate to awa rd bene fits. I d.

Re le va nt w or ke rs ’ c omp e ns a tio n s tatut e s d ir e c t th a t
(1) [a] n y party may introduce dire ct testimony from a phy sician throug h a wr itten m ed i ca l repor t on a form e stablished by the-9- commissioner of labor and workforc e development ...[and] (2) [t] he written medica l report of

a tre ating or ex am ining phy sician shall be admissible at any

stag e of a

worke rs’ c ompensation claim in lieu of a deposition upon oral e x amination.

Te nn

. Cod e Ann. § 50 -6 -2 35 (c )( 1) -( 2) (2 00 5)

. I n c on se qu e nc e , pa rt ie s may us e a

med ica l r e po rt , c omm on ly

re fe rr e d to a s a

C- 32 F or m, i n li e u o f d e po sit ion s a s e vid e nc e a t tr ia l.

Upon our re view of this re cord, w e ar e per suaded that the Panel prope rly conclude d that the evidenc e pre ponderates ag ains t t h e t ri al court’s f inding that c arpa l tunnel sy ndrome a rose out of Crew’ s employ

ment with Anderson Hic key . Whil e she c omplained of pa in a nd soug ht treatment for her le ft extremity , there is no medical evidence showing that Crew was suffe ring from ca rpal tunnel sy ndrome in her left wrist as of J anuar y 7, 2002–the t ime at which the E MG conduc ted by Dr. Huf f

wa s n e g a tiv e fo r c arp a l tunn e l and le ss t ha n o ne mon th be fo re Cr e w’ s lay -o ff fr om h e r e mpl oy me nt. Moreove r, anothe r EMG c onducted one y ear later showed no car

pal tunnel sy

ndrome in Crew’s lef

t or rig ht wrists. W e have explained that it is “re asonable that the phy sicians havingg reater c ontact wi th [a ] Pla int if

f wo uld have the a dv anta g e and op po rt un ity to p ro vid e a

mor e in- de pth

op ini on , if not a more a cc u ra t e o n e” of any resulting impairment or disability . Orman, 803 S.W.2d at 677. Pursuant to our previous re asoning , Dr. Huf f–the tre ating doctor ne are st to the tim e of e mploy ment with A nderson Hickey

–is in the best position to provide a medica l opinion as to the injuries at issue. I t was his opinion, as stated, that as of his last tre atment, she d i d n o t h av e any ty pe of injury qualifying a s a per

manent impairment. The results of t he EMG first in J anuar y of 2002, as to the lef

t upper e x tremity , and that per formed in January of 2003, as to the left an d ri gh t upper e x tremities support his conclusion.

I t was nine months afte r the sec ond EMG when Cre w first t ested posit ive for car pal tunnel sy ndrome in her

rig ht hand. This followed her eight-month period of employ ment at Paslode, whe re she re peate dly

stacke d cans, a

n activity identified as a

possible cause o f carpal tunnel sy ndrome,

a c c or din g t o m e d i c a l t e s t i m o n y

. D r

. W e s t , w h o b e g an t r e at i n g C r e w m o r e t h an a y e ar an d aha lf afte r her employ ment with Ander son Hickey had ended, provided a C -32 Form which indicate d that Cr e w’ s r ig ht c arp a l tunn e l sy nd rom e we re c a

us e d b y he r “ e mpl oy

me nt, ” wi tho ut s pe c if

ic a lly ide nti fy ingwh ic h e mpl oy e r. I n h is d e po sit ion , D r. Wes t a c kn ow le dg e d th a t he co uld no t c a us a lly

re la te Cr e w’ s im

pa ir me nt o f h e r r ig ht u

pp e r e xtre mit ie s to he r w or k w ithAn de rs on

Hi c ke y

. I n f

a c t, he concede d it was more likely that the prog ression of he r rig ht arm injuries we re c aused by her subsequent employ

ment at Paslode.

Simi larly , any

medical e vidence from Dr . J anovich link in g in ju r y c a u s a ti o n w ith e mploy

ment

came more than two y ear s afte r Crew was laid off at Ander son Hickey

. By chec king a box on the form, Dr . J anovich stated that Crew ’s left uppe r extremity injuries wer e ca

used by her “employ ment.” Ne ither Ande rson Hicke y nor Paslode wa s identified as the e mploy er. Absent any ref ere nce to c ausation throug h the employ ment by Ander son Hickey
, Dr. Janovich’s medica l rec ords do not meet the re quisite burden of pr oof.-10-

Although Cre w testified, without contra diction, that she had complained of swelling in her left and r ight wrists prior to the positive results of the EMGadministered throug h Dr. West’s offic e, those sy mp to ms c o u ld

h a v e b e e na tt

r ib u te d to th e lu p u s d ia g n o s is

. I nf

a c t, D r

. H u f

f a tt r ibuted Cr e w’ s c omp la int s to her arthr iti c c on dit ion . F ur the r, Cr e w c on c e de d th a t he r c on dit ion in b oth hands bec ame “ worse” wh i l e workingat Paslode. That, in addition to her positive lef t upper extremity EMG study

of September

2003–approximately

one y ear and nine months afte r her

e mpl oy me nt w ithAn de rs on Hi ckey and tow ard s th e e nd

of he r e ig ht m on th e mpl oy me nt w ith Pa slo de –le nd s su

pp or t to Dr . We st’ s a sse ssm e nt. Al tho ug h Cr e w may have ha d “ pr ob le ms i n te rm s of what she descr ibed [while working for Ande rson Hicke y ], i t doesn’t nec essar i l y m ea n she had

car pal tunnel,” he said. “I think the fac t is

. . . that the patient develope d a positive EMG within nine months of the normal one. So by assumption, that would mean that the se cond employ er w ould have been at least the ag g ravating c ause, if not the c ause.”

Th e me dic a l re c or ds fa il to lin k Cr e w’ s c arp a l tunne l sy nd ro me to a ny wo rk a sso c iate d w ith An de rs on Hi c ke y

. Th e re is a

n in su ff ic ie nt b a sis to c on c lud e that he r c arp a l tunn e l sy nd ro me “ aro se out of and in the c ourse a nd s co p e o f h er employ

ment” with Ander son Hickey . I n summary , the medical e vidence available is tha t Crew sustained no impair ment while workingfor Ande rson Hickey , as shown by

Dr. Hu ff ’s finding s of normal EMG studies c onducted in January 2002 and J anuar y 2003–during the time of Crew ’s employ ment with Ander son Hickey and one y ear there afte r. Causation must be proven throug h medical e vidence , except when obvi o u s. See Glisson, 185 S.W

. 3 d a t 3 5 4 ; F it zg e r a ld
, 2 0 5 S. W. 3 d a t 4 0 4 ; H e n le y , 6 9 9 S. W. 2 d a t 1 5 5

. I t is o n ly afte r the medical e vidence establishes that duties from a specific employ er ma

y have be en the c ause that lay testimony become s considere d as to ca usation. Glisson, 185 S .W.3d at 354.

I ndeed, la y testimony

confirme d that Crew suff er ed fr om swelling, pa in, numbness, and tingling in her ha

nds and wrists while wor king f or Ande rson Hicke y . Crew testified on he r own behalf , without contradiction, that she ha d complained of problems to Drs. Robbins and Huff and that almost two y ear s later, whe n she saw D r. West, her c omplaint s h ad n o t ch ang ed. The lay testimony
, howeve r, without the support of medical evidenc e, is insuff icient to e stablish a causa l relationship between the e mploy ee’ s work ac tiviti es with Ander son Hickey . S ee Gl isson, 185 S.W .3d at 354; Fitzge rald, 205 S.W.3d at 404; Henley , 699 S.W .2d at 155.

B. L as t I nj ur iou s In

ju r y R ule Ha d Cr e w m e t he r b ur de n o f e sta bli sh inga c a us a l c onne c tio n o f h e r c arp a l tunn e l sy nd ro me to her wor

k at Ander son Hickey
, o u r an aly sis could have r equire d a conside ration of whe ther

e mpl oy e r A nd e rs on

Hi c ke y sh ou ld be he ld l ia

ble in l ig ht o f t

he “ la st i nju

ri ou s in jur y ” ru le . T he la st injurious injury rule require s an employ er to “take a n employ ee a s he finds him.” B axter v. Smi th, 364 S.W .2d 936, 942 (Tenn. 1962). The rule provides that “in deter mining which of

two succe ssive ins ur e rs is l ia

ble in a wo rk e rs ’ c omp e ns a tio n c a se , th e ins ur e r at th e tim e of the e mpl oy e e ’s la st injurious ex posure i s l i ab le for the injury .” B ldg. Materials Corp. v. B ritt, 211 S.W .3d 706, 713S e e Jo se p h H . K in g , Jr ., T h e E x c lu siv e n e ss o f a n E m p lo y e e ’s W o rk e rs ’ C o m p e n sa tio n R e m e d y A g a in st H is 8

E m p l o y er, 5 5 T en n

. L .R ev

. 4 0 5
, 4 2 5 -2 6 (1 9 8 8 ) (d i scu ssi n g t h e i m p lic ati o n s o f t h e e x clu si v e re m ed y ru l e a n d l ast i n j u ri o u s ex p o sure rul e).

-11- (T e nn . 2 00 7)

. I t is ne ith e r t he la st e mpl oy

me nt n or the la st e xpos ur e to the ha zar ds of the dis e a se 8 which impose l i ab i l i t y on an employer; rather, it is the last such exposure that is injurious to t he

e mpl oy e e

. Mo re ll v . A SAR CO , Inc ., 61 1 S. W.2 d 8 30 (T e nn . 1 98 1) . T hu s, in o rd e r f or the ru le to apply , there m u s t be some showing that the employ ee’ s condition worsene d due to the wor king conditions at the second e mploy er, e it h er b y ad v an ceme nt or ag g ravation of the injury . See Mahoney v. NationsBa

nk of Tenne ssee, N.A ., 158 S.W .3d 340, 346 (Tenn. 2005) (empha sis added)

overr uled on other g rounds, B ritt, 211 S.W

. 3d at 713. Converse ly , liability will not attach to an injured employ ee’ s last succe ssive employ er if the employ ee’ s sy mptoms ex perie nced while at the first employ er merely persist. Ba rker v. Home-Cre st Corp., 805 S.W .2d 373, 373-74 (Te nn. 1991). An ag g ravation or exacer

bation of the e mploy ee’ s injury must occur at the second e mploy er. I d. at 375.
Although Ander son Hickey prese nted the last injurious injury rule a s a def ense, the trial court did not directly

addre ss the issue. By finding that Crew “ sustained a c ompensable, g radua l injury to both upper extremities arising out of and within the course and scope of her employ ment,” the trial

c o u rto n l y i mp l i c i t l y c o n s i d e r e d t h e i n j u r y a s a c o n s e qu e n c e o f h e r e mp l o ym e n t a tA n d e r s o nH i c k e y.

We are persua ded that witness testimony implicated the last injurious injury rule. Dr . Huff ref err ed to the “new job” causing Crew’ s car pal t unnel. Dr. West identified a “ second e mploy er”

as “at least the ag g ravating cause , if not the cause .” Crew testified that her

condition “[g]ot worse” while wo rk i n g at Paslode, and Currie stated that Crew ’s condition g ot “worse ” duringher te nure there

.
Whether Crew ’s subsequent wor k at Paslode constituted the last such exposure to injury , see Morell, 611 S.W.2d at 830, and whether her c ondition was ag g ravated by her employ

ment there , see Mahoney
, 158 S.W .3d at 346, are sig nificant que stions. S ee B arke r, 805 S.W.2d at 373-74. Crew argues that “[h]er injury

and problems wer e well documented long befor e she be g an [employ ment

w i t h P a s l o d e ] , ” a n d t h a tA n d e r s o nH i c k e y ’ s p r o o f o f an y “ n e w i n j u r y ” w a s “ s k e t c h y

a tb e s t

. ” In support of her

position, she posit s that “Dr

. West’s strong est statement is that [ Crew’ s] employ ment at Paslode . . . could ‘possibly ’ have ag g ravated the condition i n h er ri ght wrist.” Fur ther, she contends that Townse nd v. State, 826 S.W .2d 434 (Tenn. 1992) and Smith v. S mith’s Tr ansfe r Corp., 7 3 5 S

. W

. 2 d

2 2 1 (T en n

. 1 9 8 7 ) st an d

fo r t h e p ro p o s i t i o nt h at a m er e i n cr ea s e i np ai ni s n o ten o u gh to constitute an injury

by acc ident.

Crew’ s belief that Ander son Hickey had pre sented inade quate medic al evidenc e of a “new injury ” is contra

ry to our ca se law. In Ba

rker , 805 S.W .2d at 373, this Court considered w hich of two insurance car

riers w as oblig ated to pay benef its fo r a carpa l tunnel injury . We held that the

cause of an e mploy ee’ s car pal tunnel injuries was constant, and as such, t he employ ee suf fer ed a ne w injury eac h day

. I d. at 376. Simi larly
, in L awson v. L ear Seating Corp., 944 S.W .2d 340, 342 (Tenn.-12-

1997), the issue we fac ed was when the statute of l imitations should beg in in case s involving g radua l injury , such as c arp al t u n n el s y ndrome. Unde r worke rs’ c ompensation law, g radua lly occur ring injuries, s u ch as ca rpal tunnel sy ndrome, a

re c ompensable a s “ac cidental” injuries, rathe r than

oc c up a t i o n a l

. I d

. a t 3 4 1

. A l t h o u g h i n s o m e i n s t an c e s c ar p a l tu n n e l s y

n dr o m e r e s u l t s f

ro m a traumatic event, i n most case s it is a repe titive stress injury wher e the sy

mptoms appear a

nd worsen over time. I d. We c hara cter ized the injury as a “new trauma” to the claimant’s ha nds eac h day

that she worke d. I d. at 343.

I n our view, the last injurious injury rule prec ludes any liability assessment ag ainst Anderson Hickey . Dr. West confirme d that Crew’ s employ ment at Paslode could have ag g ravated the condition in her rig ht wrist. See Mahone y , 158 S.W .3d at 346 (Te nn. 2005). Dr. West desc ribed the “pr og ression” of

her injury

such that it u l t i m at el y “m anife sted itself enoug h to be a positive EMG.” Crew and Currie notice d that her c ondition worsened dur ing he r employ ment at Paslode. See id. Thus, both medical a nd lay testimony

supports the premise that Crew’ s condition advanc ed, and wa s ag g ravated, duringher time of e mploy ment at Paslode.

Although the Smit h and Townse nd case s hold that there is no injury by acc ident wher e wor

k

a g g ra vate s a pr e e xistin g c on dit ion

merely by

inc re a sin g the pa in, we fi nd that g e ne ra l pr inc ipl e inapplicable in this instance

. Smit h, 735 S.W .2d at 221; Townsend, 826 S.W.2d at 434. I n Smit h, the re wa s n o me dic a l e vid e nce pres ent ed th a t th e e mpl oy e e ’s ke y bo ard ingdu tie s a s a

ty pis t “produc ed any

phy sical cha

ng e or a dvance d the incidenc e” of a cong enital condition, other than incre ased pa in. Smi th, 735 S.W .2d at 224. This Court determined that the work “ ag g ravated” he r
c on dit ion , e ve n if

it w a s n ot t

he so le c a us e , b ut f ound that he r “ on ly pro bl em w a s p a in” and no t a compensa ble “a ccide nt.” I d. at 224-25. In Townsend, medic al proof a s to a k nee injury unrelated employ ment showed a

n “indepe ndently

prog ressive” condition. Townsend, 826 S.W.2 d at 437. Citi ng Smit h, we r eiterated that “ther e is no injury by acc ident wher e work ag g ravates a pre -existi ng
c on dit ion me re ly by inc re a sin g the pa in. ” I d. a t 43 6. We c on c lud e d th a t th e re is a c omp e ns a

ble injury only “if the se verity

of the c ondition is advanc ed, or if it results in a dis abling condition other than incre ased pa in.” I d. at 436.

Cr e w d id n ot pres ent fac ts t o s up po rt any c on te nti on

that he r w or

k at Pa slo de me re ly incre ased the pain. I nstead, she testified, wit hout further explanation, that her condition worsened whi le a t P a s lo d e

. H e r

E M G ’ s , w h ic h w e r e n e g a ti v e w h il e e mp lo y e d a t A n d e r s o nH ic k e y , w ere positive after

her e mploy

ment at Paslode. Dr. West ac tually t es t i fi ed that Crew’ s condition was “ag g ravated” by h er te nure the re, the very kind of medica l evidence implicating the la st injurious rule. Our previous holdings in B arke r and L awson support that deter mination. Be cause of her c arpa l tunne l sy nd ro me , Cr e w s uf

fe re d a ne w a c c ide nt r e su lti ng in i nju ry e a c h d ay . A nd e rs on

Hi c ke y is, there fore , not liable for Cre w’s inj uries under worke rs’ compensation law. See Hudgins v. U. S. Fid. & Guar. Co., 479 S.W.2d 804 (Tenn. 1972) (f inding that the first insuranc e ca rrier ’s demonstration that the employ ee w as injuriously exposed to an occupational dise ase during the second e mploy ment resulted in absolving the first employ er a nd its carr ier of liability

relat i n g t o p erma

nent par tial disability from the disea se eve n though the second employ er was not a party and its liabilit y

was not adjudg ed).-13- C. Las t D ayWo r ke d Ru le I nextricably

linked to the last injurious inj ury rule is the l ast day

worke d rule. Althoug h the parties did not ra i s e this potential issue, the trial cour t’s finding that Crew sustained a vocational disability “ar ising out of her on the job injury of Oc tober 23, 2001” nece ssitates a re view of the rule’s

a pp lic a tio n. I nit ia lly
, g ra du a lly oc c ur ri ng inj ur ie s, su c h a s c arp a l tunn e l sy nd ro me , a re c omp e ns a

ble

a s “ a c c ide nta l” inj ur ie s, ra the r t ha n o c c up a tio na l. L aws on , 94 4 S.W. 2d a t 34 1. Al tho ug h in

so me
c a se s c arp a l tunn e l sy

nd rom e re su lts fr om a

tr a umatic e ve nt, in m os t c a se s it is a re pe tit ive str e ss injury wher e the sy

mptoms appear and worsen over tim e. I d. Be cause sy mptoms can be “episodic”

a s j o b d u t i e s c h an g e , i ti s d i f

f i c u l t , a t b e s t , t o d e t e r

m i n e w h e nt h e “ a c c i d e n tr e s u l t i n g i nt h e i n j u r y”

occur s. I d.

I n Br itt, 211 S .W.3d at 708, the sole issue was whe ther in a workers’ compensation ac tion the e mpl oy e e ’s c la im f

or be ne fi ts w a s ti me -b arr e d b y the statut e of

lim itatio ns . In 1 99 7, B ri tt

re po rt e d b a c k p a in t o h is e mpl oy e r, and a ft e r s ome imp ro ve me nt in hi s con ditio n, su bs e qu e ntl y
re po rt e d th a t hi s b a c k p a in wa s be c omi ng wo rs e

. I d. He so ug ht p e rm ane nt p art ia l di sa bil ity be ne fi ts for the f irst t i m e i n 2 002. I d. Although the trial court he ld that the employ ee’ s claim was timebarr ed by the statute of limitations–since Br itt did not file withi n one year of his orig inal back injury –the Special Worker s’ Compensation Appea ls Panel found that the claim was not time-bar red. I d. Us in g the la st- da

y -w or ke d r ule , th is c ourt

a ff ir me d th a t th e statut e of

lim itatio ns se t f

or th i n Tenne ssee Code Annotated section 50-6-203 does not be g in to run until t he employ ee is pre vented from wor king due to the employ ee’ s injury . I d.; see T en n

. Code Ann. § 50-6- 203(b)( 2) (2005) ; L awson, 944 S.W.2d at 341; Bar ker, 805 S.W.2d at 376.

T h i s l i n e of re as o n i n g i n s t ru ct s u s t h at wh en an i n j u ry s u ch as C re w’ s i s gra d

u al l y o cc u rr i n g, as with her c arpa l tunnel sy ndro m e, the last day

worke d rule is used to help e stablish the date on which the injury

occur red. See Br itt, 211 S .W.3d at 711; L awson, 944 S.W .2d at 341-42; B arke r, 805 S.W .2d at 375. Crew’ s last day of work in which she was experiencing a new injury eac h day

was at Paslode, where she worke d until approx imately Aug ust or September of

2003.

D. P erm anent P artial Disability Aw ard Ander son Hickey

also argues that the e vidence preponde rate s ag ainst the trial court’s a war d of 25% perma

nent partial disability to e ach upper extremity . Be cause we have dete rmined that an

awa rd to Crew w as inappropr iate base d on issues of ca usatio n and pursua

nt to the last injurious injury rule, we need not a ddress this issue.

E. Discret ionary Costs - C- 32 F orm Finally , Ander son Hickey argues that the trial c ourt er re d b y awa rding Crew discr etionary costs of $150 for reimburse ment of char g es she incur red f or a doc tor’s completion of a Tenne ssee Depa rtment of L abor C-32 f

orm. The c ontention is that Dr. West’s te stimony did not relate Cre w’s inj ury t o h e r

e mp l o y m e n tw i t h A n d e r s o nH i c k e y

. R u l e 5 4

. 0 4 ( 1 ) o f

t h e T e n n e s s e e R

u l e s o f C i v il Procedur e provide s, in part, that “[ c]osts

. . . shall be allowed to the preva iling par ty unless the cour

t otherwise dir ects.” Adjudg ing c osts is wit hin the rea sonable discretion of the trial c ourt. L ock v.-14-

Nat’l Union F ire Ins. Co., 809 S.W .2d 483, 490 (Tenn. 1991) . Fur thermore , the trial judg e may apportion the c ost s betwee n the litigants a s is deemed e quitable. Tenn. Code A nn. § 20-12-119 (1 99 4) . A c c or din g ly , th e ju dg me nt o f t he tr ia l c ourt

wi ll n ot b e dis tur

be d o n a pp e a l a bs e nt a showing that the trial judg e abuse d his discretion. Perdue v. G ree n Br anch MiningCo., 837 S.W .2d 56 (Tenn. 1992) ; L ewis v. B ower s, 392 S.W .2d 819, 823 (Tenn.1965)

.
Crew is no longe r the preva iling party

. Moreove r, the infor mation gle aned f

rom Dr. West’s C- 32 fi lin g wa s a dv e rs e to C re w’ s po sit ion

. Thus the tr ia l c ourt e rr e d b y awa rd ingdis c re tio na

ry c os ts to Crew.

IV. Conclusion Crew f ailed to meet he r burde n of establishing causation between he r employ ment at Ander son Hickey

and her car pal tunnel s y

ndrome. Fur

ther, the la st injurious i njury rule pre cludes Ander son Hickey

from beingheld liable for Crew’ s claim. Pursuant to our holding, Cre w is not entitled to discretionar

y costs. We, theref

ore, a ffirm the de cision of the Appe als Panel and r emand to the trial court f

or entry of an or der dismissing the c omplaint. Cost s are assessed to Cre w.

______________________________ GA RY R. WA DE , JUST I CE