TENNESSEE BUREAU OF WORKERS' COMPENSATION 

IN THE COURT OF WORKERS' COMPENSATION CLAIMS 

AT CHATTANOOGA 

Samuel Panzarella, 

Employee, 

v. 

Amazon.com, Inc., 

Employer. 

) Docket No.: 2015-01-0383 

) 

) State File No.: 79681 2015 

) 

) Judge: Audrey A. Headrick 

) 

) 

) 

COMPENSATION HEARING ORDER 

FILED 

January 31.2017 

1N COURT OF 

WORKERS' COl iPENS:\TION 

CLAL\IS 

Time 11:47 AM 

This matter came before the undersigned Workers' Compensation Judge upon 

remand from the Tennessee Workers' Compensation Appeals Board. The Appeals Board 

issued an order on January 18, 2017, vacating and remanding this Court's November 23, 

2016 order, which ordered medical artd temporary disability benefits and treated the 

October 28 trial as an expedited hearing instead of a compensation hearing. In its 

January 18 order, this Court concluded that the issue of whether Mr. Panzarella was 

entitled to permanent partial disability benefits was not ripe for a decision. The Appeals 

Board remanded the case to this Court to treat the -proceeding as a trial on the merits and 

to determine the benefits, if any, due to Mr. Panzarella based upon the evidence presented 

at trial. 1 After doing so, this Court finds Mr. Panzarella did not establish by a 

preponderance of the evidence that he sustained a compensable injury. 

History of Claim 

This case involves an incident that occurred on August 21, 2015, while Mr. 

Panzarella performed a packing job at Amazon. Mr. Panzarella testified he ran out of 

labels at his workstation and walked to another station to get more. As he was walking, 

he saw a piece of paper lying on the floor. Mr. Panzarella's undisputed testimony was 

1 For expedited hearings, a judge may award medical and/or temporary disability benefits upon finding that the 

employee is likely to prevail at a hearing on the merits. Tenn. Code Ann . § 50-6-239(d)(l) (2016). At a 

compensation hearing, a trial on the merits, the employee must prove each element of his claim by a preponderance 

ofthe evidence. Tenn. Code Ann. § 50-6-239(d)(l) (2016). 
that Amazon requires its employees to pick up any paper lying on the floor, and to do so 

by bending at his knees, holding the item to the center of one's body, and standing back 

up. As Mr. Panzarella squatted to pick the paper up from the floor, his left knee "went 

out" and he hit the knee on the floor when he fell. When Mr. Panzarella stood up, he 

stated he felt intense pain behind his left knee. 

After his fall, Mr. Panzarella went to AmCare, Amazon's on-site medical clinic. 

Mr. Panzarella stated that, while walking to AmCare, his left knee "gave way" and he fell 

again. The provider at AmCare provided him with a Non-Occupational Complaint 

Report to complete, which instructed him to describe the reason for his visit at AmCare. 

(Ex. 6.) Mr. Panzarella wrote, "muscle spasm in calf [illegible] radiate to behind knee 

caused loss of balance 2 times" with a date of onset as "8-21-15." !d. He indicated on 

the form that this was a new complaint and testified he had no problems or treatment for 

his left knee prior to his fall on August 21. Mr. Panzarella stated the AmCare provider 

did not want to complete the necessary documents to send him to the emergency room, so 

he told the provider he would see his doctor after work. The typed form completed by 

the AmCare provider classified the injury as "non-work related" and noted that Mr. 

Panzarella "chose to see his PCP about it and will do so soon if the spasms persist." !d. 

Amazon did not offer Mr. Panzarella a panel of physicians. 

After his shift was over, Mr. Panzarella saw Jill Yeager, a physician's assistant 

(PA) at Fast Access Healthcare. (Ex. 2.) He gave a history of having "chronic pain in R 

ankle, compensating on L leg & caused a fall onto L knee." !d. Mr. Panzarella testified 

he had chronic right ankle pain from standing ten hours per night. PA Yeager's office 

note indicated Mr. Panzarella's leg buckled, causing him to fall to the floor. 

Mr. Panzarella returned to Amazon right after he saw PA Yeager. He stated Nic 

Elliott, Human Resource Assistant, presented him with a Request for Medical 

Infonnation Letter (RMI). (Ex. 7.) The RMI letter required him to have his healthcare 

provider complete the RMI form. Mr. Panzarella continued treatment with P A Yeager, 

who completed Amazon's RMI form and marked "undetermined" on the form regarding 

work-relatedness. !d. The following month, PA Yeager completed an Attending 

Physician's Statement of Work Capacity and Impairment and checked "yes" when asked 

if Mr. Panzarella's left knee condition was "due to injury or illness arising out of the 

patient's employment." !d. 

PA Yeager subsequently ordered a left-knee MRI and referred Mr. Panzarella to 

see an orthopedic surgeon. Amazon later offered Mr. Panzarella a panel of physicians 

from which he selected Dr. Barry Vaughn. On the one occasion when Mr. Panzarella 

saw Dr. Vaughn, he reported the following history: 

Patient reports leaning forward to pick up a piece of paper at work. When 

he twisted his left knee, he felt a tearing sensation in the posteromedial 
aspect. His knee then gave way and he fell onto the knee applying a valgus 

stress to the knee. He has had left knee pain with swelling, popping and 

giving way since the injury. 

(Ex. 3.) Dr. Vaughn reviewed Mr. Panzarella's MRI and x-rays and performed a physical 

examination. He diagnosed Mr. Panzarella with medial meniscus derangement, medial 

collateral ligament (MCL) sprain, and anterior cruciate ligament (ACL) sprain. Dr. 

Vaughn recommended surgery for the meniscus tear followed by physical therapy. 

Dr. Vaughn testified regarding Mr. Panzarella's meniscus tear. He stated Mr. 

Panzarella did not indicate to him that his right ankle had anything to do with his left 

knee giving out. Dr. Vaughn explained that a meniscus tear is usually caused by a 

twisting-type injury. He confinned Mr. Panzarella reported to him that his left knee 

twisted before he fell onto it. Dr. Vaughn stated his diagnosis of a meniscus tear is 

consistent with the type of injury reported by Mr. Panzarella. Once he fell onto his knee, 

Dr. Vaughn suspected it likely caused his ACL and MCL sprains. When asked if the 

injury occurred at work, Dr. Vaughn replied that Mr. Panzarella's description is that it 

occurred at work and PA Yeager's report documented he had a swollen knee when he 

reported his injury to her. 

During cross-examination, counsel questioned Dr. Vaughn regarding the cause of 

Mr. Panzarella's fall. The following dialogue occurred: 

Q: And again, according to the history he gave you, there was no hazard on 

the floor or in his work environment that caused him to have this muscle 

cramp and his knee or leg to give way, was there? 

A: Other than picking up the piece of paper, no. 

Q: And his knee or leg could have given out and he could have developed 

this cramp whether he was at work or anywhere else doing this maneuver, 

couldn't he? 

A: Correct. 

Q: And Mr. Panzarella is overweight; correct? 

A: Correct. 

Q: Could that be a factor in him losing his balance and falling when 

bending over? 

A: It can be, yes. 
!d. 

Counsel also questioned Dr. Vaughn regarding the act of bending over in relation 

to Mr. Panzarella's knee or leg giving way. When asked whether Mr. Panzarella's knee 

would have gone out when it did if he had not bent over to pick up the paper, he 

responded, "no." !d. Under cross-examination, Dr. Vaughn explained, "[i]t kind of 

depends on the position that he put himself in to retrieve the paper ... I mean, basically, 

it depends on how the action was performed." !d. Counsel asked, "[s]o it would depend 

on the action as opposed to whether or not there was a piece of paper in the floor or he 

was bending down to tie his shoes; correct?" !d. Dr. Vaughn responded, "[c]ertainly the 

action is what's responsible, correct." !d. 

Dr. Vaughn confirmed that Mr. Panzarella is not yet at maximum medical 

improvement. Other than the one-time visit with Dr. Vaughn, Amazon has not 

authorized any other treatment. Jt argues that Mr. Panzarella is not entitled to any 

benefits under the Workers' Compensation Law because he suffered an idiopathic injury 

and provided no medical proof of a hazard incident to his employment. 

Evidentiary Ruling 

During Dr. Vaughn's deposition, Mr. Panzarella's counsel made an evidentiary 

objection. Counsel for Amazon posed the following 98-word question to Dr. Vaughn: 

!d. 

Q: I was going to say that if we were to assume that in order for Mr. 

Panzarella's injury to arise out of his employment, the maneuver of bending 

down to pick up the piece of paper and the development of the muscle 

cramp, or whatever caused his leg or knee to give way, needs to have been 

caused by a hazard or a danger peculiar to his work environment or be 

caused by some kind of risk inherent in his employment, if you were to 

assume that, would you agree his injury doesn't arise out of his 

employment? 

A: If you make that assumption, I suppose so, yes. 

Counsel for Mr. Panzarella objected twice as to form on the basis that the question 

required Dr. Vaughn to provide a legal opinion. The Court agrees. The question is 

lengthy, confusing, and appears to ask Dr. Vaughn to provide a legal opinion. Although 

it is undisputed that Dr. Vaughn is qualified as a medical expert, he is not qualified to 

provide a legal opinion. Accordingly, the Court sustains the objection. 
Findings of Fact and Conclusions of Law 

The following legal principles govern this case. Mr. Panzarella has the burden of 

proof on all essential elements of his claim. Tenn. Code Ann. § 50-6-239(c)(6) (2015); 

Scott v. Integrity Staffing Solutions, 2015 TN Wrk. Comp. App. Bd. LEXIS 24, at *6 

(Aug. 18, 2015). "[A]t a compensation hearing where the injured employee has arrived 

at a trial on the merits, the employee must establish by a preponderance of the evidence 

that he or she is, in fact, entitled to the requested benefits." Willis v. All Staff, 2015 TN 

Wrk. Comp. App. Bd. LEXIS *42, at* 18 (Nov. 9, 2015); see also Tenn. Code Ann. § 50-

6-239(c)(6) (2016). Stated another way, preponderance of the evidence simply means 

more likely than not. 

Since Amazon contests the compensability of Mr. Panzarella's claim, the Court 

applies the following specific legal principles. For his injury to be compensable, Mr. 

Panzarella must show his injury arose "primarily" out of and in the course and scope of 

his employment at Amazon. Tenn. Code Ann. § 50-6-102(14) (2016). The course of 

employment requirement refers to the time, place, and circumstances of the injury. Hill 

v. Eagle Bend Mfg., Inc., 942 S.W.2d 483, 487 (Tenn. 1997). However, the arising out of 

employment requirement refers to causation. Reeser v. Yellow Freight Sys., Inc., 938 

S.W.2d 690, 692 (Tenn. 1997). An injury arises out of employment when there is a 

causal connection between the conditions under which the work is required to be 

performed and the resulting injury. Fritts v. Safety Nat'! Cas. Corp., 163 S.W.3d 673, 

678 (Tenn. 2005). 

The legal analysis does not stop there. Mr. Panzarella must show, "to a reasonable 

degree of medical certainty that [the injury] contributed more than fifty percent (50%) in 

causing the ... disablement or need for medical treatment, considering all causes." The 

legislature defined "[ s ]hown to a reasonable degree of medical certainty" to mean the 

physician must opine "it is more likely than not considering all causes, as opposed to 

speculation or possibility." Further, as the panel physician, Dr. Vaughn's opinion 

regarding causation "shall be presumed correct but this presumption shall be rebuttable 

by a preponderance ofthe evidence." Tenn. Code Ann.§ 50-6-102(14) (2016). 

Applying these principles to the facts of this case, the Court finds Mr. Panzarella 

has not met his burden and is not entitled to the requested benefits. As the Appeals Board 

has reiterated in Dugger v. Home Health Care of Middle TN, LLC, et al., 2016 TN Wrk. 

Comp. App. Bd. LEXIS 13, at *9-10 (March 16, 2016): 

"The mere presence of the employee at the place of injury because of the 

employment is not enough, as the injury must result from a danger or 

hazard peculiar to the work or be caused by a risk inherent in the nature of 

the work." (Citation omitted). Accordingly, "an injury purely coincidental, 

or contemporaneous, or collateral, with the employment, ... will not cause 
the injury ... to be considered as arising out of the employment." (Citation 

omitted). 

In this Court's November 23, 2016 order, which the Appeals Board vacated and 

remanded, the Court applied a different evidentiary standard because it considered the 

matter as one presented to the Court in an Expedited Hearing. Specifically, the Court did 

not find Amazon's idiopathic injury defense persuasive and held that Mr. Panzarella was 

"likely to prevail at a hearing on the merits in establishing that his injury arose primarily 

from a hazard incident to his employment at Amazon." When applying this lesser 

evidentiary standard, the Court interpreted the proof differently than it would have had it 

applied the "preponderance of the evidence" standard the Court is required to apply 

during a Compensation Hearing. McCord v. Advantage Human Resourcing, 2015 TN 

Wrk. Comp. App. Bd. LEXIS 6, at * 16, 17 (Mar. 27, 2015). When interpreting and 

analyzing the proof under the preponderance of the evidentiary standard, the Court finds 

Mr. Panzarella failed to establish the compensability of his claim. 

Under the preponderance of the evidence standard, the Court holds that Mr. 

Panzarella failed to meet his burden of establishing that his right knee condition arose 

primarily out of his employment. Dr. Vaughn never opined that Mr. Panzarella's knee 

injury arose "primarily" out of his employment. Instead, he agreed that Mr. Panzarella's 

knee could have given out and developed a cramp whether he was at work or 

elsewhere. (Ex. 4.) Dr. Vaughn explained that the action of bending over was 

responsible for Mr. Panzarella's knee giving way. He also acknowledged that another 

factor that could cause Mr. Panzarella to lose his balance and fall when bending over is 

the fact that he is overweight. Id. Yet another factor that could cause Mr. Panzarella to 

lose his balance and fall is the history he provided to P A Yeager immediately following 

his injury. Her records reflect that Mr. Panzarella complained of having "chronic pain in 

Rankle, compensating on L leg & caused a fall onto L knee." (Ex. 2.) 

Accordingly, after careful consideration of the evidence as a whole, this Court 

concludes Mr. Panzarella failed to establish, by a preponderance of the evidence, his left 

knee condition arose primarily out of and in the course or scope of his employment with 

Amazon. In light of the Court's holding, Mr. Panzarella's request for medical benefits, 

temporary disability benefits, and permanent disability benefits is denied. 

Because Mr. Panzarella failed to present sufficient evidence to establish that his 

left knee condition arose primarily out of and in the course and scope of his employment, 

the idiopathic defense raised by Amazon is pretermitted. 

This Court taxes the court costs of $150.00 to Amazon pursuant to Tennessee 

Compilation Rules and Regulations Rule 0800-02-21-.07 (2016). Further, Amazon shall 

prepare and submit a Statistical Data Form for this matter within ten calendar days of the 

date of judgment. 
IT IS, THEREFORE, ORDERED that the claim of Mr. Panzarella against Amazon 

or its workers' compensation carrier is denied. 

IT IS SO ORDERED. 

ENTERED this the 31st day of January, 2017. 

kb_abcffl Judge Audr A. Headrick 

Court of Workers' Compensation Claims 
APPENDIX 

Technical record: 

1. Petition for Benefit Determination 

2. Dispute Certification Notice 

3. Request for Initial Hearing 

4. Agreed Order Setting Case for Expedited Hearing 

5. Notice of Filing Notice of Denial 

6. Notice of Filing of Medical Records from Physicians Quality Care 

7. Motion for Status Conference 

8. Order Setting Initial Hearing 

9. Initial Hearing Order 

10. Motion for Conference 

11. Statement Concerning Up to Date Medical Records 

12. Notice of Filing Medical Reports from Parkridge East Hospital 

13. Amended Petition for Benefit Determination 

14. Order Amending Initial Hearing Order 

15. Dispute Certification Notice 

16. Amazon's Pre-Hearing Statement 

17. Order Cancelling and Resetting Compensation Hearing 

18. Notice of Compensation Hearing 

19. Mr. Panzarella's Pre-Compensation Hearing Statement 

20.Amazon's Hearing Brief 

2l.Mr. Panzarella's Trial Brief 

The Court did not consider attachments to Technical Record filings unless admitted into 

evidence during the Compensation Hearing. The Court considered factual statements in 

these filings or any attachments to them as allegations unless established by the evidence. 

Exhibits: 

1. MRI and x-rays from Chattanooga Imaging 

2. Medical records of Fast Access Healthcare 

3. Medical records ofDr. Barry Vaughn 

4. Deposition of Dr. Vaughn 

5. Medical records ofParkridge East Hospital 

6. Non-Occupational Complaint Report 

7. Request for medical information letter from Amazon 
CERTIFICATE OF SERVICE 

I hereby certify that a true and correct copy of this Compensation Hearing Order was sent 

to the following recipients by the following methods of service on this the 31st day of January, 

2017. 

Name Certified First Via 

Mail Class Fax 

Mail 

Bob Wharton 

Kristen Stevenson 

Fax Via Email Address 

Number Email 

X wharton@hjwlawfirm.com 

kcstevenson@mijs.com 

X 

ffi~ m, Clerk of Court 

Court of orkers' Compensation Claims 

WC.CourtClerk@tn.gov