Opinion ID: 1057692
Heading Depth: 2
Heading Rank: 1

Heading: Spondylolisthesis & Permanent Disability

Text: Spondylolisthesis is the forward displacement of one vertebra over another, usually the fifth lumbar [L5] over the body of the sacrum [S1], usually due to a developmental defect in the pars interarticularis. Dorland's Illustrated Medical Dictionary 1779 (31st ed.2007). Spondylolisthesis is usually either congenital or degenerative. Anderson v. Alcoa Fukikara, Ltd., No. 01S01-9802-CH-00019, 1999 WL 32977, at  (Tenn.Workers Comp.Panel Jan.26, 1999); see Wilson v. Worthco, Inc., No. 02S01-9712-CH-00113, 1998 WL 729695, at  (Tenn.Workers Comp.Panel Oct.21, 1998). Although it is unclear from the record whether Employee's spondylolisthesis is congenital or degenerative, it is clear from the record that following the 1995 automobile accident Employee's spondylolisthesis became symptomatic. And, as her medical records indicate, her spondylolisthesis continued to degenerate from 1995 up until and after the June 2004 work injury. Both parties agree that Employee was diagnosed with grade I spondylolisthesis at L5-S1 long prior to her work injury and that the symptoms grew progressively worse. The parties also agree that in 2004 Employee suffered a work-related injury that aggravated the spondylolisthesis, and from this work injury, Employee was entitled to temporary total disability benefits. Ultimately, Employee had surgery to improve her situation. At the time of, and after her surgery, Employee still had grade I spondylolisthesis. The only question in dispute, therefore, is whether the work injury in some way advanced the severity of the pre-existing condition or caused a new, distinct permanent disability as a result of the pre-existing condition, such that Employee is entitled to permanent partial or permanent total disability benefits, or whether the work injury only temporarily aggravated Employee's pre-existing condition such that Employee was only entitled to temporary total disability benefits. See Trosper, No. E2007-00816-SC-WCM-WC, slip op. at 8, ___ S.W.3d at ___ (Tenn. Dec.30, 2008); Smith v. Smith's Transfer Corp., 735 S.W.2d 221, 225-26 (Tenn.1987). This Court has made clear that an aggravation of a pre-existing condition that results only in increased pain, without an actual advancement in the severity of the condition, is not a compensable injury. See, e.g., Trosper, No. E2007-00816-SC-WCM-WC, slip op. at 8, at ___ (Tenn. Dec.30, 2008); Cunningham v. Goodyear Tire & Rubber Co., 811 S.W.2d 888, 891 (Tenn.1991); Smith's Transfer, 735 S.W.2d at 225-26. Although this principle has not always been consistently applied, this Court recently reconfirmed in Trosper [17] that pain, by itself, is not sufficient to support an award of benefits. E2007-00816-SC-WCM-WC, slip op. at 8, at ___ (Tenn. Dec. 30, 2008). The Trosper Court also clarified that, if the work injury advances the severity of the pre-existing condition, or if, as a result of the pre-existing condition, the employee suffers a new, distinct injury other than increased pain, then the work injury is compensable. Id. The same result is reached when there is only increased pain but no anatomical change. Barnett v. Milan Seating Sys., 215 S.W.3d 828, 835 (Tenn.2007). Thus, we analyze this case consistently with the principles set forth in Trosper. Of course, each case turns on its own facts and medical opinions. The record in this case reflects that Employee had an extensive history of back problems prior to her work injury. In 2001, both Drs. Gorzny and Burrus, who treated Employee, diagnosed her as having grade I spondylolisthesis at L5-S1. The condition, including some radiculopathy symptoms, was intermittently symptomatic, requiring medical care on several occasions before June 2004. Cf. Sweat v. Superior Indus., 966 S.W.2d 31, 32-34 (Tenn.1998) (in finding that employee's psoriatic arthritis was a compensable work injury, the Panel emphasized that, in addition to a physician's testimony that employee's work activities resulted in actual progression of his underlying condition, the employee was asymptomatic prior to working for [the employer]). While Employee initially improved after undergoing physical therapy, over time all conservative nonsurgical treatments were unsuccessful. In fact, Employee consulted Dr. Burrus concerning back pain approximately seven weeks before the work injury, and they discussed surgery as a treatment option at that time. Dr. Burrus, the only doctor to treat and examine Employee both before and after the work injury, opined that a repeat MRI scan done after the work injury revealed no significant change to Employee's pre-work injury spondylolisthesis diagnosis. When questioned about his use of the word significant, Dr. Burrus stated that, although he agreed it was possible that the work injury caused an anatomical change in Employee's back, he didn't appreciate that there had been any progression of the spondylolisthesis on either her [x-rays] or on her MRI. Based on these objective studies, Dr. Burrus concluded that the work injury did not cause an anatomical change, or stated differently, the work injury did not advance the severity of her spondylolisthesis. As Dr. Burrus explained, the pain after the work injury was similar to what she had experienced over the years. Specifically, Dr. Burrus explained that he believed the work injury caused a temporary exacerbation of her symptoms, which ultimately resolved themselves to their pre-injury status. When asked whether Employee's complaints of radicular-type pain were an indication of an anatomical change, or other advancement in the severity of her condition, Dr. Burrus explained that although Employee complained of such pain, a subjective finding, he found no objective evidence of radiculopathy. Additionally, Dr. Burrus opined unequivocally that the need for surgery was evident before, and thus not related to, the work injury. Based on this determination, Dr. Burrus did not assign a permanent impairment rating related to the work incident. Dr. Dinkins, who first saw and treated Employee more than seven months after her work injury, also could not state that Employee's work injury caused an anatomical change or otherwise advanced the severity of her spondylolisthesis. Subsequent to Employee's August 2005 surgery, Dr. Dinkins wrote that he was unable to determine whether Employee's injury had temporarily aggravated Employee's pre-existing spondylolisthesis or if the incident had caused a permanent worsening of that condition. While he did testify that she could have had an exacerbation of her symptoms that could put her over the mark to cause her to seek surgical intervention, we are not persuaded that this testimony demonstrates, even by a preponderance of the evidence, that Employee's work injury caused an anatomical change or otherwise permanently advanced the severity of Employee's spondylolisthesis. Dr. Gaw, who did not treat Employee, but performed two independent medical evaluations, opined that the increased pain after June 2004 must have been the result of an anatomical change. However, he was not able to describe what that change was and was unable to provide any objective tests to support that finding. Given this testimony, we accredit, as did the trial court, the testimony of Dr. Burrus, the treating physician, over that of Drs. Dinkins and Gaw. Dr. Burrus had the benefit of observing Employee over a period of years. He saw Employee both before and immediately following the work injury, was aware of her complete medical history, and based his opinion upon his personal knowledge of her condition. Dr. Dinkins' testimony was of limited usefulness because he was unable to determine whether the work injury permanently advanced the severity of her condition. And, Dr. Gaw offered no proof, other than Employee's increase in pain, to support his opinion that Employee's work injury caused an anatomical change, or permanent advancement, of her spondylolisthesis. This Court has repeatedly held that an increase in pain, by itself, is not sufficient to support an award of benefits. See, e.g., Trosper, E2007-00816-SC-WCM-WC, slip op. at 8, ___ S.W.3d at ___ (Tenn. Dec. 30, 2008). Accordingly, we find that the medical proof does not support a finding that Employee suffered a compensable permanent disability as a result of her June 2004 work-related injury, and therefore, Employee is not entitled to permanent total or permanent partial disability benefits.