### IN THE S UP REME COURT OF TENNESS EE AT KNOXVI LLE Ja nua ry 4, 200 5 S es sio n

RON NIE D OTSON v. RIC E-C HRY SLER -P LYM OUT HDODGE, I NC., ET AL


### .

Direc t Appeal from the Bloun t County Chancery Court No. 02-208 Telford E. For gety, C hancellor

No. E2004-00669-SC-R3- CV - F iled March 16, 2005

I n this workers’ compensa tion action
, the plaintiff soug ht compensation for a wor k-re lated injury wh ic h c a us e d r e fl e x sy mpathe tic dy st rop hy in h is l e ft arm , a sc he du le d me mbe r f

or wo rk e rs ’

c omp e ns a tio n p ur

po se s. Th e pla int if

f c on te nd e d th a t r efl ex sy mpathe tic dy str op hy wh ic h a ff

e c ts

on ly a sc he du le d me mbe r ne ve rthe le ss e nti tle s a c la ima nt to b od y -a s- a -w ho le c omp e ns a tio n b e c a us e the American Me dical Association’s Guides to the Evaluation of Permanent I m p ai rm ent conve rt ref lex s y mpathetic dy strophy to a ra ting f

or the body

as a w hole. Alternatively , the plaintiff contende d that his condition ex tended b ey o n d h is arm bec ause he was de nied potential future
trea tment options for other, non-w ork-r elated injurie s and bec ause his arm’s hyperse ns i tivityand pain caused insomnia, chronic fatig ue, and a diminis hed ability

to conce ntrate. H olding that r efle x sy mpathetic dy strophy must a lway s be apportioned to the body as a w hole, the trial c ourt awa rded the plaintiff perma nent total disa bility benef

its. Reversing the trial court, we hold that an a war d for ref lex s y mpathetic dy strophy may be limited to the compen s at i o n fo r sche duled member s as provided in Tenne ssee Code Annotated sec tion 50-6-207(3)( A) to (D) (1999). F urther, w e hold that for r efle x sy mpathetic dy strophy to be prope rly

apportioned to the body

as a w hole under

Tenne ssee Code An n o tate d s e c ti o n 5 0

- 6

- 2 0 7 ( 3 ) ( F ) ( 1 9 9 9 )
, th e c la im a n t’ s in ju r y mu s t a f

f e c t a p o r ti o n of the body not statutorilyschedule d, aff ect a particula

r combination of membe rs not statutorily provided for, or cause a permanent injury to an u n s cheduled portion of the body . Having so held, we determ i n e t h at t he pre pondera nce of the evidenc e fa ils to show that the plaintiff’s condition has extended bey ond his arm as a schedule d memb er

. T h erefore , we va cate the trial court’s awa rd of pe rm a ne nt t ota l di sa

bil ity be ne fi ts t o th e pla int if

f andho ld tha t the pla int if f’ s p e rm a ne nt d isa

bil ity

awa rd is limit ed exclusively to 200 wee ks of benefits pursuant to Tenne ssee Code A nnotated sec tion 5 0 -6 -2 0 7 (3 )( A) (i i )( m ) ( 1 9 9 9 ). W e r em an d t h i s c as e t o t h e t ri al co u rt fo r f u rt h erp ro ce ed i n gs

c o n s i s t e n tw i t h t h i s o p i n i o n , a s m a y b e n e c e s s ar y.

Tenn. Cod e Ann. § 50-6-225(e ); Judgm ent of the Chancery Court Reve rsed and V ac at e d; Case Re m anded to the Trial CourtRSD is also known as complex reg ional pain sy ndrome. 1

-2- F RAN K F. D R OW OT A , III
, C.J ., delivere d the opinion of the court, in which E. R I L EY A NDE R S ON , A DOL PH O A. B I RCH , J R ., J ANI CE M. H OL DER , and W I L L I AM M. B ARKE R , J .J ., joined.

Robert R. Davies
, Kn o x v i l l e, T en n es s ee , fo r t h e a p p el l an t s , R i ce-Chry sler-Plymouth-Dodg e, I nc. and the Hartford.

L ouis Andrew Mc Elroy , I I , Knoxvi lle, Tenne ssee, f or the a ppellee, Ronnie D otson.

OP IN ION

I. F ac tu al a nd P r oc e dur al B ac kgr ound

The plainti ff, Ronni e Dotson, worke d as a delivery driver a nd stockperson f or the de fenda nt auto dea lership, Rice-Chry sler-Ply mouth-Dodg e, Inc., which w as i nsured by co-de fenda nt, the Hartford. Ac cording to the record, Mr. Dotson was forty -two y ear s old at the time of trial. He has

c omp le te d a nin th- g ra de e du c a tio n, a c hie vin g be low -a ve ra g e re a din g a ndma the ma tic abil iti e s. Hi s prior vocational history consisted larg ely of medium to heavy labor in va rious unskilled or low-leve l semi-skilled positions

.

Mr. Dotson had be en employ ed by Rice-Chry sler for about eig ht y ear s when he suffe red a work-r elated a ccide nt. On Aug ust 1, 2001, while drag g ing to storag e a crated 150-pound side- panel for a van, he slipped on a

piece of shee t metal which lay on Rice-Chry sler’s wa

rehouse floor. The heavy crate fe ll over, cr

ushing his lef

t hand ag ainst a four -by -four inch post.

This acc ident cause d various traumatic injuries. Acc ording to the deposition testimonyof Todd R. Griffith, M.D., one of Mr. Dotson’s treating phy sicians, the im p ac t o f the c rate fra cture d

a me ta c arp a l bo ne in M r. Do tso n’ s le ft ha nda ndc a us e d b ru isi ng a ndsw e lli ng . M r. Do tson al so experience d numbness and ting ling in the f inge rs of his left h an d which in Dr. G riffith’s opinion

wer e ca used by “traumatic carpal tunnel sy ndrome.” Wit h his left hand and f orea rm in a ca st, Mr. Do t s o n s o o n re t u rn ed t o wo rkfo r fo u r da y s , b u tp ai n i n h i s l ef th an d p re v en t ed h i m fr o m co n t i n u i n g. Since then he ha s not worked.

Ac c or din g to D r. Grif

fi th, by Se pte mbe r 20 01 Mr

. Do tso n be g a n e xpe ri e nc ing sy mpt oms in h i s l ef th an d i n d i ca t i v e o f r ef

l ex s y m p at h et i c d y s t ro p h y (“ R S D” ), s u ch as i n cr ea s ed s we at i n g,

1 hyperse nsitivi ty

and pain. Dr . Griff

ith defined RSD as a “ sy ndrome c hara cterized by incre as ed

s y m p a t h e t i c n e r v o u s o v e r d r i v e t o t h e v e s s e l s a n d n e r v e s i n a l i m b
, t yp i c a l l y a n u p p e r e x t r e m i t y

. It

c a u s e s c h a n g e s i n t e m p e r a t u r e , c h a n g e s i n s w e a t i n g , a n d m o s tc l i n i c a l l y s i g n i f i c a n t [, ] s e v e r e pa in that is difficult to control.” I n Dr. Griffith’s opinion, Mr. Dotson’s RSD was cause d by the impact of the c rate upon his left hand. F ollowing surg ery on October 5, 2001 which cor rec ted Mr. Dotson’sL at eral epicondy litis involves inflammation and pain in the tissues adjoining the elbow’ s 2 outside bony projec tion. See Attorne y s’ Textbook of Medicine ¶ 4.72 ( Roscoe N. Gr ay et al. eds., 3d ed. 2001); PDR Medica l Dictionary 582 (1995).

-3- car pal tunnel sy ndrome, the sy mptoms of his R SD worsene d.

Sub se qu e ntl y , in sp ite of

va ri ou s tr e a tme nts , M r. Do tso n’ s le ft ha ndha s su ff

e re d c hr on ic a lly from loss in rang e of motion, incre ased sweating
, constant hy perse nsitivi ty to touch, sever e pain, a nd a “burning[,]

. . . throbbing
, aching ” sensation. Accor ding to Mr. D otson, even the slig htest contac t of any object with his left hand ha s cause d “unbea rable ” irritation and pa in. Although quietude has

se rv e d to mit ig a te thi s p a in, a c c or din g to M r. Do tso n a ndhis wi fe , Re becca L y nn Do tso n, his

c on dit ion ha s n e ve rthe le ss g iven rise to i ns omn ia , c hr on ic fatig ue , a nda dim ini sh e d a

bil ity to

conce ntrate upon ta sks.

Dr. Griff ith de termined on May 16, 2002 that Mr. Dotson had rea ched ma x i m u m m edical improvement. Dr. G riffith re g arde d the RSD in Mr. Dotson’s left hand a s perma nent and imposed a permanent re striction ag ainst any vocational use of Mr. Dotson’s l ef t ar m

. Dr. Griffith further

rec ommended that he r ece ive spec ialized chroni c p ain manag ement. B ased on the Americ an Me dic a l A sso c ia tio n’ s G uid e s to the Ev a luatio n o f P e rm a ne nt I mpa ir me nt ( 5th e d. 20 01 ) ( “ AM A G u id e s ” )
, D r

. G r if

f ith a s s ig n e d a

7 4 % a n a to mi c a l i mp a irme n t r a ti n g to M r

. D o ts o n ’ s le f t uppe r extremityand a 44% impairment rating to his bodyas a w hole.

Mr. Dots on broug ht a workers’ compensation action in the Blount CountyChance ry Court ag ai n s t Rice-Chry sler and the Hartford (c ollectively the “de fenda nts”). At trial, Mr. D otson maintained that the RSD in his left arm extended bey ond the arm as a s cheduled member, Te nn. Cod e An n. § 50-6 -20 7( 3) (A )( ii) (m ) ( 19 99 ), thu s satis fying the re qu ir e me nts fo r b od y -a s- a -w ho le

c o mp e n s a ti o n , § 5 0

- 6

- 2 0 7 ( 3 ) ( F )

. F ir s t, M r

. D o ts o n ar g u e d th a t d e n ia l o f s u r g e r y a s a tr e a tment option for non-wor

k-re lated later al epicondy litis (or “tennis elbow”) in his rig ht arm amounts to an 2 extension o f t h e RSD bey ond his left arm. Dr . Griff ith testified in his depositi on that “with the his tory of RSD in the le ft arm , [Mr

. Do tso n] is a t hig he r ri sk of de ve lop ing RSD in his ri g ht a rm if he we re to unde rg o a surg ical proc edure . . . . So I did not give him the option of surg ical tre atment of his te nn is e lbo w. ” Se c on d, Mr

. Do tso n arg ue d that the RSD in his le ft arm ha s e xten de d to his body as a w hole via the insomnia and f atig ue conse quent to his chronic pa in.

F u r t h e r m o r e , M r

. D o t s o n a l t e r n a t i v e l y m a i n t a i n e d t h a ta s a m a t t e r o f l a w R S D m u s ta l w a ys be cla ssified as injury t o t h e b o d y as a whole reg ardle ss of whethe r the RSD is confined to a schedule d member. The AMA Guides r equire conver sion of upper e x tremity impairment caused by RSD to a n a na tom ic a l dis abil ity ratin g fo r the bo dy a s a wh ole . M r. Do tso n c on te nd s th a t be c a us e the Tenne ssee Ge nera l Assembly has manda ted use of the AMA Gui d es i n rating anatomica l disability , Tenn. Code Ann. § 50-6-204( d)(3) (1999), the A MA Guides’ c onversion of RSD to the body as a w hole conse quently

mandates c lassification of RSD as injury to the body

as a w hole.

The de fenda nts responded by arg uing that there is insuffic i ent evidence to show that Mr.-4-

Do tso n’ s RSD ha s e xten de d b e y on d th e le ft arm a s a sch edu led me mbe r. Th e de fe nd a nts a lso disputed the assertion that RS D must alway s be cla ssifi ed as i n j u ry t o the body

as a w hole. They emphasized that the AMA Guide s convert a var i et y of sche duled member

injuries to a body -as- awhole rating but pointed out that suc h conver sion is not a lway s require d as a matter of l aw. Acc ording to the defe ndants, bec ause D r. Grif fith testified unequivoca lly that the s y mptoms of Mr. Dotson’s RSD were limit ed t o h i s l eft a rm, he should be limited to compensation for loss of a schedule d member.

Th e tr ia l c ou rt c ha

ra c te ri zeda s in su bs ta nti a l a nd“ thi n” a ny e vid e nc e fo r e xten sio n o f R SD be y on d M r. Do tso n’ s arm a s a sc he du le d me mbe r. Ne ve rthe le ss, in l ig ht o f the c on ve rs ion sc he me for RSD provided in the AMA Guides, the trial court he ld that as a matter of law “ RSD is required to be converted to the body as a w hole.” Ha ving thus de termined that Mr. D otson’s RSD cannot be limit ed to sche duled member compensa tion, the trial court foc used on t he extent of his vocational disability . Voca tional expert J ane L . Hall testified at tria l that in her opinion Mr. Dotson was pe rm a ne ntl y

a ndtot a lly

dis able d v oc a tio na lly

. I n c on tr a st, vo c a tio na l e xpe rt Rod ne y E. Ca ldw e ll, Ph.D. opined in a deposition that Mr. Dotson was 75% vocationally disabled. Taking into account all the re levant evide nce, the trial court f oun d Mr. Dotson to be permanently and totally

disabled within the meaning of Tenne ssee Code A nnotated s ection 50-6- 207(4)( B) (1999). The ref ore, the
tr ia l c ou rt or de re d Ri c e -C hry sle r a ndthe Ha rt fo rdto p a y

Mr . Dot so n pe rm a ne nt dis abil ity be ne fi ts from the date of maxi mum medical improvement, May 16, 2002, until he bec omes elig ible for soc ial

se c ur ity re tir e me nt b e ne fi ts, wi th a n o ff se t f or c e rt a in l ump su m a wa

rd s.
Rice-Chry sler and the Hartford appe aled. We tra nsfer red this ca se for

revie w by

the entire Supreme Court.

II. Ana lys is

The primary

question in this case is whether
, for purposes of wor kers’ compensa tion, reflex sy mpathetic dy strophy

must alway s be cla ssified as injury to t h e b o d yas a w hole, re g ardle ss of whether the ef fec ts of RSD are limited to a sche duled member . Be cause this is a matter of law w hich involves construing the worke rs’ c ompensation statutory scheme , our st andar d of review is de novo with no presumption of corr ectne ss. I vey v. Trans Global Gas & Oil, 3 S.W .3d 441, 446 (Tenn. 1999). We now dec ide this issue of first impression.

Workers’ c ompensation claims nece ssarily fall into one of f our statutory

classifications: (1) temporary

total disabilit ies; (2) temporary partial disabili ties; (3) permane nt partial disabilities; and (4 ) p e rm a ne nt t ota l di sab ilitie s. Te nn . Co de An n. § 5 0- 6- 20 7( 1) to ( 4) (1 99 9) . E a c h s e pa rate disabilityclassification is i ndepende nt, serves a specific compensa tion goa l, and provides distinct be ne fi ts. Se e Da vis v. Re a g a n, 95 1 S. W.2 d 7 66 , 7 67 (T e nn . 1 99 7) . Pe rm a ne nt p art ia l di sa bil ity is further subdivided into compensation for loss of e numera ted sche duled member s , fo r serious disfigur ement, and f

or disability

apportioned to the body as a whole. T enn. Code Ann. § 50- 6-207(3) (1 99 9) . Re state d, ou r q ue sti on is w he the r c ompens ati on fo r R SD m a y be lim ite d to the sp e c if

icSe c tio n 5 0- 6- 20 4( d) (3 ) ( 19 99 ) wa s in for c e wh e n this c a us e aro se a ndre ma ins app lic able 3 to this appeal. I t has since be en totally superse ded by

an ame nded sec tion now i n eff ect. 2004 Tenn. Pub. Acts ch. 962, § 13. Tenne ssee Code A nnotat ed section 50-6-204(d) (3)( A) (Supp. 2004) pr ov ide s:

To p rovi de uniformity

and fa irness for

all parties in dete rmining the deg ree of anatomica l impair m ent s ustained by the employ ee, a

phy sician, chiropr actor

or medical prac titioner who is pe rmitted to g ive expert testimonyin a Tenne ssee c ourt of law and who has provided medical trea tment to an employ ee or who has e x amined

or evaluated an employ ee seeking worke rs’ compensa tion be nefits shall utili z e t he applicable edition of the AMA Guide s as established in [ section] 50-6-102 or in cases
not c o v e r e d b y

th e A M A G u id e s a n imp a irme n t r a ti n g b y a n y ap p r o p r iate me thod

u s e d a n d a c c e p t e d b y t h e m e d i c a l c o m m u n i t y.

F or the lim ite d p ur

po se s o f this op ini on , th e re is n o mate ri a l di ff e re nc e be tw e e n th e ve rs ion s.

-5- be ne fi ts p ro vid e d f

or los s o f a sc he du le d me mbe r o r mus t a lway s be app ort ione d to the bo dy a s a whole.

We beg in our ana ly sis by addre ssing the r elationship betwee n the worke rs’ c ompensation statutory scheme and the AMA Guides. Tenne ssee Code Annotated se ction 50-6-204( d)(3) (1999)
state s:

T o p r o v i d e u n i f

o r m i t y a n d f

a i r n e s s f o r a l l p a r t i e s , a n y m e d i c a l r e p o r t p r e p ar e d b y a phy sician furnishing medic al treatment to a claimant shall use the A merica n Medica l Association Guides to theEvaluation of Permanent I mpairment, (Ame rica n Medica l Association) or the Manual for Orthope d i c S urg eons in Evaluating Permane nt Phy si ca l I mpairment, (Ame rica n Aca demy of Orthope dic Surg eons). A phy sician shall utili ze the most rece nt editio n o f either publication in determining the deg ree of anatomical impairment. A pra ctitioner shall be r eq u i red to g ive an impairme nt rating based on one (1) of the two (2) publications noted above. 3

The purpose of statutorily -manda ted use of the AMA Guides is p r o v id e d in th e s tatu te it s e lf : “ [t ]o provide uniformityand fa irness for all parties . . . .” Tenn. Code Ann. § 50-6-204(d) (3). As w e

ex p l ai n ed i n C o rc o ra n v

. Fo s t er Au t o GM C
, I n c. , 7 4 6 S

. W

. 2 d 4 5 2
, 4 5 7 (T en n

. 1 9 8 8 ), t h i s l an gu age “cle arly evidenc es a leg islative intent to standardize the methods of rating pe rce ntag es of a natomical disabilityto minim ize arbitrariness and [ to] encour ag e pre dictability in such assessments by

medical experts.”

Yet in demanding that a medica l expert follow the AMA Guides whe n assessing anatomica l disability , the s tatute does not somehow elevate the AMA Guides themselves to the status of law

. Rather, the AMA Guides are nothing more than tools for ef fec tuating in a

fair a nd predic table wa y the par amount g oals and re quirements of the worke rs’ co m p ensation statutory scheme . SeeAlt h o ug h sever al unpublished dec isions of the Workers’ Compensation Panel ha ve 4 apportioned RSD to the body as a whole, they have done so beca use in e ach c ase the re w as injury to an unsche duled portion of the body , the injury aff ecte d a particular combination of members not statutorily provided for , or a sc heduled injury cause d a perma nent injury to an unsche duled portion of the body

. See, e.g ., T.V. Swaw v. Tra ne Unitary Prods. Comm erc ial, No. M2001-02793-WC-R3- CV, 2002 WL

3 1 7 4 0 2 1 4 (T en n. Workers’ Comp. Panel De c. 9, 2002) ( concluding that there was injury to the body as a whole where RS D i n left knee cause d rig ht knee injury and whe re ne cessa

ry medication had ne g ative side-e ffe cts upon c la im an t) ; David Coleman v. L umbermens Mut. Cas. Co., No. W2000-01168-W C-R3-CV, 2001 WL 285209 (Tenn. Worke rs’ Comp. Panel Mar. 15, 2001) (conc luding that there was injury to the body

as a w hole wher e RSD aff ecte d shoulder and ba ck and

-6- T h o mp s o n v

. L e o n Ru s s e ll E n te r s

. , 8 3 4 S. W. 2 d 9 2 7
, 9 2 9 ( T e n n

. 1 992) (“[T]he f a c t [ th a t] a schedule d injury

can beconverted, via the [AMA Guides] or t he Manual for Orthopedic Surg eons

. . . , to a p e r c e n ta g e d is ab il it y to th e b o d y as a w hole p r o vi d es no basi s upon which to sustai n an award to the body as a whole under Tennessee Workers’ Com pensation L aw.” ) (e mphasis added) ; Reag an v. Te nn. Mun. L eag ue, 751 S.W.2d 842, 844 (Tenn. 1988) (“The mere fac t that a medica l impairment rating to a particular membe r may translate, f

or purpose s of [the AMA Guides], into a disabi lit y ratin g to the bo dy

a s a wh ole does not alter the rule that if an inj ury is to a scheduled

me mb e r o nly, th e sta tutor y sc he du le s m us t c on tro l th e dis ab ili ty awa rd

. ” ) ( e m p h a s i s a d d e d )

. In short, the statutory

compensa ti o n s ch em e contr ols the application of the A MA Guides. As the defe ndants corr ectly assert, to require injury to a sche duled member

alone to be a

pportioned to the body as a w hole mere ly

beca use the AMA G uides so provide would conf ound the classific ation scheme provided in Tenne ssee Code A nnotated sec tion 50-6-207.

Be cause RSD is not specific ally provided fo r bystatute, adjudica tion of benef its for that condition is controlled g ener ally by the statutory

classification scheme. It is well settled that under Tenne ssee wor

kers’ compensa tion law, an aw ard f or permanent injury

to a schedule d member a lone is ex clusively

limit ed to the awa

rd provided by the statutory schedule of Tenne ssee Code A nnotated section 50-6-207( 3)(A) to ( D) (1999). I vey , 3 S.W .3d at 448 (“[W] here an employ ee’ s only injury is t o a sc he du le d me mbe r, he or sh e ma y re c e ive on ly the a mou nt of c omp e ns a tio n pr ov ide d fo r i n the statutory

schedule. ”) ; McI lvain v. Russell S tover Candies, Inc., 996 S.W.2d 179, 185 (Tenn. 19 99 ). Bycon tr ast , b enef it s fo r i nj uryto th e bo dyas a who le, Ten n. Co de Ann . § 50 -6- 20 7(3 )(F) (1999), a re a vailable “ wher e an injury is to a portion of the body not statutorily‘sche duled,’ whe re an injury aff ects a particula r combination of members not statutorily provided for , or whe re a schedule d injury

cause s a permanent injury to an unsche duled portion of the body .” Thompson, 834 S.W .2d at 929 (c itations omi tted).

I n a c c or d with thi s sta tut ory sc he me , we ho ld tha t w he re re fl e x sy mpathe tic dy str op hy a ff e c ts

a schedule d member alone, an awa rd of perma nent disabilitybenef its is l imited ex clusively

to what the sche dule for that member provide s. For r efle x sy mpathetic dy strophy to be prope rly

apportioned
to the bo dy

a s a wh ole , th e c la ima nt’ s in jury mus t a ff e c t a po rt ion of

the bo dy no t st a tut or ily schedule d, aff

ect a particula r combination o f members not statutorily provided for , or cause a perma nent injury

to a n unschedule d portion of the body . See id. at 929. There fore , we r ever se the 4wher e cla imant suffer ed fr om psy chiatric condition); J anet L . Br ooks v. L ear Seating Corp., No. 03S01-9702-CV-00024, 1998 WL 128960 (Ten n

. W orker s’ Comp. Panel Mar. 23, 1998) (c on c lud ing that th e re wa s inju ry to the bo dy a s a who le wh e re RSD in l e ft kn e e wa s c omb ine d w ith psy chiatric disorder a nd with injuries to the shoulders and ha nds).

-7- tr ia l c ou rt ’s ho ldi ng that th e RSD in M r. Do tson’s le ft arm mus t be app ortio ne d to the bo dy a s a wh ole be c a us e the AM A Gu ide s so pr ov ide
, re g ard le ss of wh e the r the c la ima nt has ot herw ise satisfied the re quirements for an aw ard to the body

as a w hole.

Having thus decided the primary issue, we must now eva luate Mr. Dotson’s injury in light of the standa

rd which w e have adopted. F indings of f act a re r eviewe d de novo upon the re cord of the trial court, acc ompanied by a pre sumption of corre ctness unless the p re p ondera nce of the evidenc e is otherwise . Tenn. Code. Ann. § 50- 6-225(e)(2) (1999); McI lvain, 996 S.W .2d at 183. An appe llate court thus conducts a n independe nt review to determine w here the pre pondera nce of the evidenc e lies. Walker v. Saturn Corp., 986 S.W.2d 204, 207 (Tenn. 1998).

I n h is d e po sit ion, Dr. Griff ith te sti fi e d th a t, i n h is e xpe rt op ini on , M r. Do tso n h a d RSD in his left lower a

rm and that the c ondition was permane nt. Accor ding to Dr . Griff ith, as a re sult of the RSD, Mr. Dotson “b asica lly does not have any

functional use of

his left arm.” Moreove r, at trial counsel for

the def endan t s co n ce d ed that Mr. Dotson’s loss of use of the a rm was 100%

. Acc ording ly , we c onclude that Mr. Dotson is e ntitled to a perma nent partial disability awa rd for total loss of his left arm as a scheduled m ember

. See Tenn. Code Ann. § 50-6-207(3)(A )(ii)(m) (1999) (“F or the loss of an arm, six ty -six and two-third pe rce nt (66 b %) of the ave rag e we ekly

wag es during two hundred ( 200) we eks.”)

.

Further, va cating the trial court’s awa rd of perma nent total disabilit y benef its, we hold that Mr. Dotson’s permanent disability awa rd is limit ed exclusively to the 200 wee ks provided for total loss of an arm as a sche duled member . See id. The preponde ranc e of the e vidence fails to show that Mr. Dotson’s injury

qualifies for an awa

rd to the body

as a w hole. Fir st, Dr. Griff ith testified unequivoca lly

that the sy mptoms of M r. Do t s o n ’s R SD were limit ed to his left arm. The re cord

c o n t a i n s n o c o n f

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

Second, bec ause RSD in one part of the body i n cr ea s es the risk that subsequent phy sical
trauma w ill cause it to sprea d, Dr. Grif fi t h has ruled out possible future surg ery to corre ct Mr. Dotson’s non-work- rela ted l ater al epicondy litis in his rig ht elbow. Howeve r, t here is no evidence that Mr. Dotson has exhausted con s er vative tre atment options short of surg ery for his later al epicondy litis , and the me re potentiality that trea tment options i n Mr. Dotson’s ca se mig ht be fore closed in the futur e is too speculative to be classified a s a cur rent injury

. Third, althoug h Mr. Dotson su ffe rs from pe rmane nt severe pain and hy perse nsitivi ty

to touch in his left arm, the pain and hy perse nsitivi ty

themselves have not spread be y ond his arm. When a

c ou rt de te rm ine s th e le ve l of

a wo rk e rs ’ c omp e ns a tio n a wa rd , th e pa in c on se qu e nti a l to a sin g le injury to a sche duled member

alone may not itself be considered a separ ate, unsc heduled injury . SeeWe acknowle dg e the a ppare nt anomaly

of limiti ng RSD to sche d u le d me mb e r c o mp e n s ation 5 when under another

classifica tion the condition’s debilitating natur e may well entitle the cla imant to permane nt total disabili ty benef its. Cf. I vey , 3 S

. W

. 3 d at 448 n.13 (questioning the fa irness of
trea ting “loss of m ental faculties” as schedule d member compensation); Roberson v. L oretto Casket Co., 722 S.W .2d 380, 385 (Tenn. 1986) (ac knowledg ing the ar bitrariness of

limit ing c ompensation for lo ss of one e y e to the statutory schedule when the e ntire visual field is nec essarily aff ecte d). Notwithstanding, w e must uphold and eff ectua te the statutory compensa tion scheme as i t is provided by the leg islature. Sullivan ex rel. Hig htower v. Edw ards Oil Co., 141 S.W .3d 544, 548 (Tenn. 2004).

-8- Murra y Ohio Mfg

. Co. v. Yar

ber, 446 S.W.2d 256, 258 (Tenn. 1969) ( holding that whe re sc heduled

me mb er c omp e ns a tio n h a s b e e n s pe c if ic a lly pr ov ide d f

or by statut e , “ it m us t be a ssu me d b y thi s Cou rt tha t the L e g isl a tur e wa s the n a wa re of the c on c omi ta nt pa in, su ff e ri ng , [an d so fo rth] no rm a lly attendant upon impac t injury ” and de clining to tre at leg pain consequent to a leg injury as a separate, unschedule d injury ). To hold othe rwise would permit a plaintiff “ to sever or splinter concomitant difficulties of a

single injury .” I d. Howeve r, where injury to a sche duled member extends bey ond the sche duled member , compensa tion for injury to the body

as a w hol e m ay b e appr opriate. McWhirter v. Kimbro, 742 S.W.2d 255, 258– 5 9 (T enn. 1987). Mr. Dotson’s pain and hy pe rs e ns iti vit y

do no t g ive ri se to b od y -a s- a -w ho le c omp e ns a tio n b e c a us e the y are lim ite d to his left arm, a sche duled member

. 5

Fourth, Mr. Dotson has suffe red se condarily from insomnia, chronic fatig ue, and a diminis hed ability

to conce ntrate. A lthough these sequela e may be fa ctors to conside r

in d etermining

vo c a tio na l di sa

bil ity , s e e , e .g ., F a g g v. Hu tc h M fg . Co
., 75 5 S.W. 2d 44 6 (T e nn

. 19 88 ), a s in c ide nts of a sc heduled injury

alre ady adjudg ed to be a

total loss, they

do not alter our c lassification or r ating of Mr . D ots on ’s inj ury . We fu rthe r n ote that Mr . D ots on ha s f a ile d to pr ov e the pe rm a ne nc e of the se

se qu e la e by

e xpe rt me dic a l tes tim on y

. I n all bu t the mos t ob vio us c a se s, pe rm a ne nc y in w or ke rs ’ compensa tion cases must be e stablished by expert medical testimony

. Corcora n, 746 S.W .2d at 458; see Johnson v. Midwesco, I nc., 801 S.W.2d 804, 806 (Tenn. 1990).

II. Conclusi on

Re ve rs ing the tr ia l c ou rt , w e ho ld that a perma ne nt dis abil ity a wa rd fo r r e fl e x sy mpathe tic dy str op hy ma y be lim ite d to the st atutory c omp e ns a tio n f

or sc he du le d me mbe rs a s p ro vid e d in Tenne ssee Code Annotated sec tion 50-6-207(3)( A) to (D) (1999). F urther, w e hold that for r efle x sy mpathetic dy strophy

to be prope rly

apportioned to the body

as a w hole under

Tenne ssee Code Annotated section 50-6-207( 3)(F ) (1999), the c laimant’s injury must affe ct a portion of the body not statutorily schedule d, aff

ect a particula r combination of membe rs not statutorily provided f

or, or

cause a permanent injury

to an unsche duled portion of the body

. Having so held, we va cate the trial court’s awa rd of pe rmane nt total disabili ty benef its to Mr. Dotson. We hold that because Mr. Dots on’s i njury is limit ed to his left arm a s a sche duled member
,-9-

his perma nent di sability awa rd i s limit ed ex clusively to what Tenne ssee Code A nnotated sec tion 50- 6- 20 7( 3) (A )( ii) (m ) ( 19 99 ) p ro vid e s. I n lig ht of ou r de te rm inatio n that Mr

. Do tso n ha s no us e of his le ft arm , we a wa

rd him 20 0 w e e ks of

pe rm a ne nt p art ia l di sa

bil ity be ne fi ts. We r e ma ndthi s c a se to the trial court for further proce eding s consistent with this opinion, as may be nec essary . Costs are taxed one-half to the pla intiff, Mr. Dotson, and one-ha lf to the defe ndants, Rice-Chry sler and the H ar t f o r d
, f o r w h i c h e x e c u t i o n m a y i s s u e i f n e c e s s ar y.

______________________________________ F RA NK F . D RO WOT A, I I I , CH I EF JUSTI CE