De Novo Review and Non‑Permanent Aggravations in Tennessee Workers’ Compensation Law: Commentary on Jo Carol Edwards v. Peoplease, LLC

De Novo Review and Non‑Permanent Aggravations in Tennessee Workers’ Compensation Law:
A Commentary on Jo Carol Edwards v. Peoplease, LLC

1. Introduction

The Tennessee Supreme Court’s decision in Jo Carol Edwards v. Peoplease, LLC (Dec. 22, 2025) is a major workers’ compensation opinion in two interconnected respects:

  1. It clarifies the standard of appellate review in workers’ compensation cases, especially how reviewing courts treat factual findings based on live versus deposition testimony.
  2. It definitively interprets what qualifies as a compensable “aggravation” of a preexisting condition under the 2013 Workers’ Compensation Reform Act, and squarely rejects any requirement of a permanent anatomical change or permanent worsening.

The case arises from a trucking accident in which the employee, Jo Carol Edwards, struck her knees against a dashboard panel, allegedly aggravating preexisting but previously asymptomatic end‑stage arthritis. After conflicting medical opinions, two appeals, and reversals by the Workers’ Compensation Appeals Board, the Supreme Court reinstated the trial court’s award of medical and disability benefits, including permanent total disability.

Beyond resolving Ms. Edwards’s entitlement to benefits, the Court uses this case to:

  • Correct a line of authority that had drifted toward giving too much deference to trial courts’ interpretations of documentary medical proof.
  • Provide a statutory, text‑based definition of “aggravation” in post‑2013 cases, and to distinguish it clearly from earlier case law and from the terminology in the AMA Guides.
  • Clarify the two‑stage, “more than 50%” causation analysis required for aggravation claims.
  • Reinforce that medical experts may not opine on legal questions such as “compensability.”

2. Summary of the Opinion

The Court, in an opinion by Justice Wagner, holds:

  1. Standard of Review Factual findings in workers’ compensation cases are reviewed de novo on the record with a presumption of correctness, as provided by Tenn. Code Ann. §§ 50‑6‑225(a)(2) and 50‑6‑239(c)(7). This standard applies regardless of whether the finding is based on live testimony or deposition testimony.
    • For live in‑court testimony, trial courts’ credibility determinations are reviewed under an abuse of discretion standard and are rarely disturbed.
    • For deposition testimony, appellate courts give no deference to the trial court’s assessment of weight or credibility and may draw their own conclusions from the transcripts.
  2. Definition of Aggravation Under Tenn. Code Ann. § 50‑6‑102(12) (post‑2013), an “aggravation”:
    • Does not require proof of a permanent anatomical change or permanent worsening of the underlying condition.
    • Means, in its ordinary sense, an intensification or worsening of a preexisting disease, condition, or ailment, whether temporary or permanent.
    • Is compensable if, to a reasonable degree of medical certainty, the employee shows:
      1. the employment contributed more than 50% to causing the aggravation (the “injury”), and
      2. the aggravation in turn contributed more than 50% to causing death, disablement, or the need for medical treatment.
  3. Application to Ms. Edwards Applying these rules, the Court finds:
    • The truck accident contributed more than 50% to the aggravation of Ms. Edwards’s preexisting knee arthritis.
    • The aggravation, rather than the preexisting arthritis alone, more likely than not caused the need for bilateral knee replacements and caused her disablement.
    • The statutory presumption in favor of the treating panel physician’s causation opinion under § 50‑6‑102(12)(E) was rebutted by a preponderance of the evidence.
    • The trial court’s awards of medical benefits, temporary total disability, and permanent total disability were supported by the record and must be reinstated.

The judgment of the Workers’ Compensation Appeals Board is reversed, and the Trial Court’s December 12, 2023 order is reinstated in full.

3. Detailed Analysis

3.1 Factual and Procedural Background in Context

On August 14, 2020, Ms. Edwards, a truck driver employed by Peoplease, LLC, suffered a serious accident when a tire blew out and her truck went down an embankment, striking a bridge. Her knees hit a dashboard panel.

Key medical and factual points:

  • Immediate treatment at the University of Mississippi Medical Center documented knee pain and prompted instructions to follow up with a primary care provider.
  • Two urgent care visits in August 2020 (without mention of knee pain) were followed by:
    • Dr. Hutchison (panel treating physician, board‑certified orthopedist): diagnosed end‑stage tricompartmental arthritis in both knees; believed arthritis pre‑dated the accident; opined that the work accident merely exacerbated symptoms and, as he understood the law, such exacerbations were not compensable.
    • Dr. Sweo (another panel orthopedic surgeon): noted severe arthritis, identified a fracture on MRI, and ultimately recommended total left‑knee replacement, later bilateral replacement. He opined that the accident was more than 51% responsible for the need for both knee replacements.
    • Dr. Christian (defense IME orthopedist, post‑remand): testified that an “aggravation” must involve an anatomic change to be compensable and, finding no permanent anatomic change, concluded the accident was not compensable.
    • Dr. Schrader (claimant’s IME orthopedist): concluded that Ms. Edwards had been asymptomatic before the accident; the accident aggravated her arthritis and caused permanent symptoms and functional limitations, making her permanently and totally disabled.
  • Ms. Edwards alone testified live at the Trial Court; she reported no prior knee pain or limitations and visibly limped and used a cane in court.

Procedurally, the case moved through:

  1. Expedited hearing (Tenn. Code Ann. § 50‑6‑239(d)(1)): Trial Court found Ms. Edwards likely to prevail, awarded medical benefits including coverage for left knee replacement, authorization for the right knee, TTD, and mileage. The court explicitly rejected Dr. Hutchison’s view that exacerbations of preexisting conditions are non‑compensable.
  2. First appeal to the Appeals Board: The Board:
    • Held Ms. Edwards was likely to prevail on an aggravation theory for short‑term medical treatment.
    • But reversed as to knee replacements and associated benefits, finding insufficient proof that the accident was the primary (>50%) cause of the surgeries and that the panel physician’s opinion had not been rebutted.
    • Remanded for full adjudication on the merits.
  3. Trial on remand: Additional expert depositions (Drs. Christian and Schrader, plus re‑deposition of Dr. Hutchison). The Trial Court:
    • Found Hutchison’s and Christian’s legal views on aggravation incorrect or flawed.
    • Credited Edwards’s testimony of being asymptomatic before the accident and significantly limited afterward.
    • Adopted Drs. Sweo’s and Schrader’s causation opinions and awarded:
      • Past medical for left knee replacement;
      • Current and future medical for right knee replacement;
      • Temporary total disability benefits;
      • Permanent total disability benefits; and
      • Discretionary costs.
  4. Second appeal to the Appeals Board:
    • By a 2–1 majority, the Board reversed again, holding that knee replacements and disability were not compensable; it viewed the record as failing to overcome the statutory presumption favoring Dr. Hutchison’s causation opinion.
    • Judge Conner dissented, emphasizing the Trial Court’s credibility findings and the evidence that the accident caused new or increased symptoms and hastened the need for surgery.
  5. Supreme Court review: The Court accepted the case (rather than routing it to the Special Workers’ Compensation Appeals Panel) to resolve the standard‑of‑review confusion and to address aggravation injuries under the 2013 Reform Act. It reversed the Appeals Board and reinstated the Trial Court’s order.

3.2 Clarification of the Standard of Review

3.2.1 Statutory Framework and Misapplied Precedents

Workers’ compensation appeals are governed by Tenn. Code Ann. §§ 50‑6‑225(a)(2) and 50‑6‑239(c)(7), both of which prescribe a de novo review on the record with a presumption of correctness for factual findings, “unless the preponderance of the evidence is otherwise.”

Despite this clear language, some panels had drifted toward an abuse of discretion standard for trial courts’ resolution of conflicting medical testimony given by deposition. The opinion traces this drift largely to “loose language” in Madden v. The Holland Group of Tenn., Inc., 277 S.W.3d 896 (Tenn. 2009), where the Court spoke of giving “considerable deference” to factual determinations.

Madden cited Tyron v. Saturn Corp., 254 S.W.3d 321 (Tenn. 2008), but Tyron itself had properly limited deference to credibility and weight determinations about live in‑court testimony, not all factual findings. Nevertheless, later cases such as Kilburn v. Granite State Ins., 522 S.W.3d 384 (Tenn. 2017), repeated the “considerable deference” language, and workers’ compensation panels began to treat all factual issues—sometimes including those based on depositions—as if review were for abuse of discretion.

This opinion explicitly corrects that trajectory:

  • It reaffirms that the statute—not Madden—controls.
  • It holds that deference beyond the statutory presumption is “incorrect and should no longer be followed” for ordinary factual determinations.

3.2.2 Live Testimony vs. Deposition Testimony

The Court distinguishes between:

  • Live, in‑person testimony (e.g., Ms. Edwards’s own testimony), and
  • Deposition testimony (e.g., all medical experts in this case).

For live testimony:

  • Trial courts see and hear witnesses; they are “in the best position to make credibility determinations.”
  • Consistent with cases like Wells v. Tennessee Board of Regents, Woodlawn Memorial Park, Inc. v. Keith, Tobitt v. Bridgestone/Firestone, Inc., and Humphrey v. David Witherspoon, Inc., appellate courts will not disturb these credibility findings absent clear and convincing evidence to the contrary.
  • The Court uses the language of abuse of discretion to describe this highly deferential review of credibility and weight assessments regarding live testimony, in line with civil cases like Goodwin v. Jim Bale Constr., LLC and Bowman v. Bowman.

For deposition testimony:

  • Both trial and appellate courts only have the written record; neither sees the witness’s demeanor.
  • Under Humphrey, Richards v. Liberty Mut. Ins. Co., Houser v. Bi‑Lo, Inc., and Orman v. Williams Sonoma, Inc., when proof is by deposition:
    • “All impressions of weight and credibility must be drawn from the contents thereof.”
    • Reviewing courts may draw their own conclusions about weight and credibility.
    • Therefore, a special, deferential abuse‑of‑discretion standard is inappropriate for credibility findings resting solely on depositions.

In Ms. Edwards’s case, the Appeals Board erroneously applied an abuse of discretion standard to the Trial Court’s evaluation of deposition‑based expert testimony. Both parties conceded this was error, and the Supreme Court confirms it.

Bottom line on standard of review:

  • All factual findings: de novo review on the record with a presumption of correctness (the appellate court independently weighs evidence, but starts with a presumption that the trial court is correct unless the evidence preponderates otherwise).
  • Credibility/weight of live witnesses: effectively abuse of discretion; appellate courts rarely re‑evaluate.
  • Credibility/weight of deposed experts: no deference; the appellate court freely re‑assesses the transcripts.

3.3 Aggravation of Preexisting Conditions Under the 2013 Reform Act

3.3.1 Pre‑2013 Case Law: Trosper and Its Difficulties

Before the 2013 Workers’ Compensation Reform Act, the statute defined “injury” but did not explicitly address “aggravation” of preexisting conditions. Courts filled this gap, most notably in Trosper v. Armstrong Wood Prods., Inc., 273 S.W.3d 598 (Tenn. 2008).

In Trosper, the Court held that aggravation of a preexisting condition is compensable when:

  • The work activity does not merely increase pain, but
  • “advances the severity of the pre‑existing condition” or leads to a “new, distinct injury” separate from increased pain.

While Trosper did not expressly require an anatomical change, lower courts sometimes equated the requirement of a “new” injury with a requirement of a permanent anatomic change, leading to confusion and inconsistent application. Cases like Miller v. Lowe’s Home Centers, Inc. and Paris v. McKee Foods Corp. illustrate these struggles.

3.3.2 The 2013 Reform Act Text: Tenn. Code Ann. § 50‑6‑102(12)

The 2013 Reform Act, effective July 1, 2014 for injuries thereafter, fundamentally reshaped the analysis by:

  • Expressly including aggravation of preexisting conditions in the statutory definition of “injury.”
  • Requiring injuries to “arise primarily out of and in the course and scope of employment.”
  • Elevating medical causation from “could be” to a “more than 50%” contribution standard.

Relevant portions of § 50‑6‑102(12) provide, in substance:

  • “Injury” includes injury by accident, but:
    • (A) Aggravation of a preexisting disease or condition is excluded unless shown, to a reasonable degree of medical certainty, to have arisen primarily out of and in the course and scope of employment.
    • (B) An injury arises “primarily” out of employment only if employment contributed more than 50% in causing the injury, considering all causes.
    • (C) An injury “causes death, disablement or the need for medical treatment” only if, to a reasonable degree of medical certainty, it contributed more than 50% to causing that death, disablement, or need for treatment, considering all causes.
    • (D) “Shown to a reasonable degree of medical certainty” means “more likely than not” in the physician’s opinion, as opposed to speculation.
    • (E) The opinion of the treating panel physician on causation is presumed correct, but this presumption is rebuttable by a preponderance of the evidence.

For injuries after July 1, 2014 (like Ms. Edwards’s), this statutory definition supersedes the judicial gap‑filling of Trosper. The Court therefore describes Trosper and its progeny as “inapposite” for these post‑Reform Act cases.

3.3.3 Defining “Aggravation” by Its Ordinary Meaning

The statute does not define “aggravation” itself, so the Court applies standard textualist tools:

  • It cites State v. Deberry, Ellithorpe v. Weismark, and State v. Robinson for the method of using plain meaning, context, and contemporaneous dictionaries.
  • It consults dictionaries such as Merriam‑Webster, Cambridge, and the Oxford English Dictionary, which converge on definitions like:
    • “An act or circumstance that intensifies something or makes it worse;” or
    • “The act of making something, such as a problem or injury, worse;” or
    • “A circumstance that increases the gravity or seriousness of a situation.”

From these sources, the Court concludes that the natural and ordinary meaning of “aggravation”:

  • Does not inherently require permanence.
  • Means an intensification or worsening of an existing disease, condition, or ailment.

The statutory context reinforces this conclusion. Section 50‑6‑102(12) states that an injury is compensable if it “causes death, disablement or the need for medical treatment.” That phrasing naturally encompasses temporary injuries that lead to medical care but later resolve.

The Court offers a simple hypothetical: an aggravation might arise out of and in the course of employment, require treatment, and then fully resolve. By definition, such an aggravation would not be permanent, but—under the statute—it still qualifies as a compensable injury if it meets the causation thresholds.

3.3.4 Rejection of the AMA Guides’ “Aggravation” Definition

The American Medical Association’s Guides to the Evaluation of Permanent Impairment define “aggravation” as:

“A circumstance or event that permanently worsens a preexisting or underlying condition,” in contrast to “exacerbation,” “recurrence,” or “flare‑up,” which are temporary and return to baseline.

The Court explicitly rejects importing this special, technical definition into the statute for two reasons:

  1. The AMA definition does not match the plain, ordinary meaning of “aggravation” in everyday English.
  2. There is no indication in the workers’ compensation statute that the legislature intended to incorporate the AMA Guides’ terminology for “aggravation” (even though the Guides are referenced elsewhere for impairment ratings, Tenn. Code Ann. § 50‑6‑204(k)(2)(A)).

Accordingly, expert opinions premised on the notion that only permanent aggravations—or only aggravations involving anatomic change—are compensable misstate Tennessee law for post‑2013 injuries.

3.3.5 The Two‑Stage Causation Test for Aggravation Claims

The Court distills § 50‑6‑102(12) into a two‑step causation analysis specifically tailored to aggravation claims:

  1. First causation question – Was there a compensable aggravation?
    The employee must show, to a reasonable degree of medical certainty, that:
    • The work accident contributed more than 50% in causing the aggravation of the preexisting condition, considering all causes.
    • This is the “arises primarily out of and in the course and scope of employment” test.
  2. Second causation question – Did that aggravation cause the disabling consequence or need for treatment?
    The employee must then show, also to a reasonable degree of medical certainty, that:
    • The aggravation itself contributed more than 50% to causing:
    • death, or
    • disablement, or
    • the need for medical treatment,
    • again considering all causes.

In short:

  • Step 1: Employment → Aggravation (>50%)
  • Step 2: Aggravation → Death/Disablement/Treatment (>50%)

And “reasonable degree of medical certainty” (subsection (D)) expressly means “more likely than not”, not mere possibility or speculation.

3.4 Application to Ms. Edwards’s Claim

3.4.1 Did the Accident Cause a Compensable Aggravation?

On the first causation question—whether employment contributed more than 50% in causing the aggravation—the Supreme Court notes that both the Trial Court and Appeals Board agreed that:

“[T]he aggravation of [Ms. Edwards’s] pre-existing knee conditions . . . arose primarily out of the work accident,” and that all physicians acknowledged she suffered increased symptoms and decreased function after the accident.

The Court accepts this shared finding. There is no dispute that:

  • The truck crash was a specific incident arising out of and in the course of employment.
  • Ms. Edwards experienced new or intensified knee pain and decreased function only after the accident.

Thus, the accident contributed more than 50% to causing the aggravation of her underlying arthritis. The first part of the statutory test is satisfied.

3.4.2 Did the Aggravation Cause the Need for Knee Replacements?

The more contested issue is the second causation step: did the post‑accident aggravation, rather than the preexisting arthritis standing alone, contribute more than 50% to the need for knee replacement surgeries?

Several points are key:

  • Symptomatic vs. asymptomatic arthritis All doctors agreed Ms. Edwards had severe, end‑stage arthritis before the accident. But:
    • Ms. Edwards credibly testified she had no knee pain or limitations before the accident.
    • Both Dr. Hutchison and Dr. Christian conceded they would not recommend knee replacement surgery for an asymptomatic patient.
    • Dr. Schrader relied on her lack of prior symptoms and functional limitations as a significant indicator that the accident was the catalyst for her surgical need.
  • Deference to lay credibility findings The Trial Court found Ms. Edwards honest and forthcoming, observed her limping and using a cane, and concluded she was asymptomatic before the crash. The Appeals Board did not find an abuse of discretion in this credibility determination, and the Supreme Court respects that finding. There was “no history” of prior knee complaints, despite her demanding work history.
  • Speculation by defense experts Dr. Hutchison “surmised, without evidence” that Ms. Edwards had pre‑accident symptoms, despite:
    • His admission that she “very well could have had knees that were end stage arthritis, but [had] no symptoms and doing well or minimal symptoms,” and
    • His concession that he would not have recommended surgery had she been asymptomatic.
    The Court characterizes such assumptions, not grounded in record evidence, as entitled to little weight.
  • Drs. Sweo and Schrader’s causation opinions Both physicians concluded, to at least a “more likely than not” standard, that:
    • The accident led to structural issues (fracture, meniscus tear) and biomechanical changes in the knee;
    • The accident triggered or intensified painful symptoms; and
    • The need for knee replacement surgery was more than 50% attributable to the accident‑induced aggravation.

The Court reasons that Ms. Edwards “only became eligible for knee‑replacement surgery once she became symptomatic, and she only became symptomatic after the accident aggravated her pre‑existing arthritis.” She had serious underlying arthritis—but it was the aggravation caused by the accident that produced disabling pain and functional limitations severe enough to necessitate surgery.

Accordingly, the Court holds that Ms. Edwards proved, to a reasonable degree of medical certainty, that the aggravation contributed more than 50% to the need for bilateral knee replacements. This satisfies § 50‑6‑102(12)(C).

3.4.3 Overcoming the Statutory Presumption for the Panel Physician

Under § 50‑6‑102(12)(E), the causation opinion of the treating panel physician—here, Dr. Hutchison—is presumed correct, but the presumption is rebuttable by a preponderance of the evidence.

The Court explains why the presumption is overcome:

  • Dr. Hutchison’s opinion rested on an incorrect view of Tennessee law: that an exacerbation of a preexisting condition is not compensable absent permanent anatomic change.
  • He speculated, contrary to credible lay testimony and without record support, that Ms. Edwards was symptomatic before the accident.
  • The record, including Ms. Edwards’s credible testimony and the opinions of Drs. Sweo and Schrader, pointed strongly in the opposite direction.

The Court thus finds that “the record preponderates against the statutory presumption afforded to Ms. Edwards’ treating physician.” This is important guidance: the presumption is real but not insurmountable, especially if:

  • The panel physician misapprehends the law;
  • Lacks an adequate factual foundation; or
  • Ignores credible lay testimony and other medical evidence.

3.4.4 Temporary and Permanent Total Disability Benefits

Finally, the Court addresses disability benefits, which require proof, to a reasonable degree of medical certainty, that the aggravation was more than 50% the cause of disablement.

(a) Temporary Total Disability (TTD)

Under Tenn. Code Ann. § 50‑6‑207(1)(E), TTD benefits continue until the worker reaches maximum medical improvement (MMI), the point at which “all active medical treatment” ends. Only Dr. Schrader opined on MMI, placing it at September 19, 2022, and the Trial Court accepted that date.

The opinion notes that:

  • Dr. Sweo had restricted Ms. Edwards from working for nearly two years based on her knee injuries and left knee replacement.
  • The Trial Court’s calculation of TTD ended at Dr. Schrader’s MMI date.

The Supreme Court finds that the evidence does not preponderate against the Trial Court’s award of TTD, and reinstates it.

(b) Permanent Total Disability (PTD)

For permanent total disability, the Court emphasizes:

  • Only Dr. Schrader provided detailed functional restrictions—e.g., Ms. Edwards:
    • Could not walk more than 50 feet or for longer than about 5 minutes;
    • Could not walk on uneven ground or climb stairs or ladders;
    • Was limited largely to sedentary work;
    • Could not stand for more than 15–20 minutes at a time;
    • Could not stoop, kneel, crouch, crawl, or lift more than 5 pounds from floor to mid‑chest;
    • Would require unscheduled breaks through the workday.
  • These limitations, in Dr. Schrader’s opinion, were causally related, to a reasonable degree of medical certainty, to the injuries (including the knee aggravation) from the work‑related accident.

The Appeals Board majority discounted Dr. Schrader’s testimony because he considered additional injuries beyond the knees. The Supreme Court, however, holds that:

  • Even if he considered other injuries, his ultimate disability assessment flow from the work‑related accident and, crucially, from the work‑related knee aggravation.
  • His testimony was the only comprehensive restrictions evidence in the record, and nothing in the record preponderates against the Trial Court’s reliance on it.

The Court therefore reinstates the award of permanent total disability.

3.5 Treatment of Expert Testimony and Legal Conclusions

A notable feature of the opinion is its firm line between:

  • Medical experts’ factual opinions about diagnosis, causation, prognosis, and functional limitations; and
  • Improper expert legal conclusions about whether an injury is “compensable” under Tennessee law.

The Court cites Coffey v. City of Knoxville and Tenn. R. Evid. 702:

  • Experts may assist the trier of fact with specialized knowledge.
  • But forming and applying legal standards is “a judicial function” reserved to the court.

In this case:

  • Dr. Hutchison testified that an “exacerbation of symptoms” was not “compensable under Workers’ Compensation,” based on his belief that a permanent anatomic change was required.
  • Dr. Christian equated “aggravation” with anatomic change and similarly opined that the accident was not “compensable.”

The Court characterizes these as legal conclusions based on mistaken understandings of the law. As such, they are not merely competing medical views; they are opinions entitled to little or no weight on the central legal question before the court.

The decision thus sends a strong signal: expert witnesses in workers’ compensation cases should:

  • Stick to medical causation and impairment (e.g., “In my opinion, the accident was more likely than not the cause of X”); and
  • Avoid opining on whether an injury is legally compensable under Tennessee statutes.

3.6 Relationship to and Refinement of Earlier Precedents

The opinion interacts with earlier case law in several ways:

  • Madden and Kilburn (standard of review)
    The Court explicitly narrows prior language suggesting broad “considerable deference” to trial courts’ factual findings, clarifying that:
    • Statutory de novo review with a presumption of correctness governs;
    • Deference is properly limited to live‑testimony credibility determinations.
  • Tyron and related cases
    The Court re‑aligns the law with Tyron, emphasizing that deference applies to credibility and weight assessments of live witnesses, not to all factual determinations or to deposition testimony.
  • Trosper
    The Court acknowledges Trosper but underscores that, for post‑2014 injuries, the Legislature has now directly addressed “aggravation” in the statute. As a result, Trosper’s judicially‑created aggravation standard is no longer the controlling test.
  • Miller, Paris, and other post‑Reform Act cases
    The Court notes that many post‑2013 decisions have wrestled with aggravation under the new statute, often mixing in pre‑2013 concepts or AMA definitions. This opinion gives a definitive statutory reading intended to restore uniformity.

4. Simplifying Key Legal Concepts

4.1 Factual Review: De Novo vs. Abuse of Discretion

  • De novo on the record with presumption of correctness:
    • The appellate court independently reweighs the evidence in the record.
    • But it starts by assuming the trial court got it right; it will overturn a factual finding only if the “preponderance of the evidence is otherwise”—meaning the evidence, as a whole, more likely than not supports a different conclusion.
  • Abuse of discretion (for live‑witness credibility only):
    • The appellate court will not overturn a credibility finding unless it is clearly erroneous—so unreasonable that no reasonable judge could have made it.
    • This is a very deferential standard.

4.2 “More Than 50%” Causation and “Reasonable Degree of Medical Certainty”

  • “More than 50%” means the work‑related cause is the primary cause when all causes are considered—more than all other causes combined.
  • “Reasonable degree of medical certainty” means the doctor believes something is more likely than not (greater than 50% probability), not just “possible.”

4.3 Aggravation vs. New Injury vs. Exacerbation

  • Aggravation (under Tennessee law post‑2013):
    • A work‑related event worsens or intensifies a preexisting health problem, whether temporarily or permanently.
    • Compensable if the work event is >50% cause of the aggravation and the aggravation is >50% cause of death, disablement, or need for treatment.
  • New injury:
    • A distinct, new condition caused by work, not simply a worsening of an old one.
    • Also covered, but analyzed as a direct injury rather than as aggravation of something preexisting.
  • Exacerbation/flare‑up (AMA sense):
    • A temporary symptom increase that returns to baseline.
    • Under Tennessee law, even this kind of short‑term aggravation can be compensable if it meets the statutory causation tests and causes the need for medical treatment—even if it later resolves.

4.4 Statutory Presumption for Panel Physician’s Opinion

  • The causation opinion of the treating physician selected from the employer’s panel is presumed correct.
  • This can be overcome if the employee proves by a preponderance of the evidence that:
    • The panel doctor’s opinion is based on an incorrect legal standard;
    • It rests on speculation or incomplete facts; or
    • It is outweighed by more persuasive, well‑supported medical and lay evidence.

4.5 Maximum Medical Improvement (MMI)

  • MMI is the point where the worker has received all active medical treatment and the condition has plateaued.
  • TTD benefits are generally paid until MMI; after that, any continuing impairment is addressed through permanent partial or total disability benefits.

5. Impact and Future Significance

5.1 For Appellate Review in Workers’ Compensation Cases

This decision will reshape how the Workers’ Compensation Appeals Board and the Special Workers’ Compensation Appeals Panel perform their review:

  • They must apply de novo review with presumption of correctness to all factual findings, including those based on expert depositions.
  • They may no longer defer under an “abuse of discretion” standard when the trial court resolves conflicts in documentary medical proof.
  • They must independently evaluate the weight and credibility of deposition testimony.

Practically, this may lead to:

  • More detailed opinions from the Appeals Board explaining why the evidence does or does not preponderate against the trial court.
  • More rigorous scrutiny of expert depositions, particularly where panel physicians’ opinions are challenged.

5.2 For Claims Involving Degenerative Conditions

The case is especially important for employees with degenerative diseases such as osteoarthritis:

  • It clarifies that a worker whose preexisting condition becomes symptomatic and disabling due to a work accident may have a compensable claim, even if imaging shows no dramatic post‑accident structural change.
  • Permanent anatomical change is not a prerequisite; what matters is whether:
    • the work accident primarily caused the aggravation; and
    • that aggravation primarily caused disablement or the need for treatment.

This should bring greater consistency and fairness to claims where:

  • Imaging reveals significant preexisting degeneration; yet
  • The employee had been working without symptoms or restrictions until a specific work event.

5.3 For Medical Experts and Litigation Strategy

For physicians testifying in Tennessee workers’ compensation cases, this decision counsels:

  • Use the statutory “more likely than not” / “more than 50%” framework explicitly in explaining causation.
  • Refrain from adopting AMA‑Guide‑style distinctions (e.g., “only permanent aggravations are compensable”) as statements of Tennessee law.
  • Avoid opining on whether an injury is “compensable”; instead, focus on medical causation and functional impact.

For lawyers:

  • Challenging the panel physician’s presumption now has a clearer roadmap:
    • Cross‑examine on knowledge of the statutory definition of “aggravation.”
    • Probe assumptions about pre‑injury symptoms and functional status.
    • Highlight inconsistencies with credible lay testimony.
  • Claimant’s counsel will likely:
    • Continue to rely heavily on detailed IME reports that address the statutory causation elements explicitly; and
    • Emphasize pre‑injury functionality to show that work‑related aggravation is the true cause of disablement or treatment.

5.4 For Statutory Interpretation in Workers’ Compensation

The opinion also reinforces a broader interpretive approach:

  • Even after the 2013 shift from “liberal construction” to “fair and impartial construction,” courts will:
    • Adhere closely to statutory text;
    • Use ordinary dictionary meanings for undefined terms; and
    • Be cautious about importing extra‑statutory technical definitions (like the AMA’s) absent clear legislative direction.

This has implications beyond “aggravation,” guiding how courts may read other undefined or partially defined concepts in the Act.

6. Conclusion

Jo Carol Edwards v. Peoplease, LLC marks a pivotal clarification in Tennessee workers’ compensation law.

On review standards, the Court restores fidelity to the statutory command of de novo review with a presumption of correctness, while carefully distinguishing:

  • Highly deferential review of live‑witness credibility; from
  • Non‑deferential review of deposition‑based medical proof.

On aggravation injuries, the Court gives “aggravation” its ordinary meaning: an intensification or worsening of a preexisting condition, whether temporary or permanent. It rejects a rigid requirement of permanent anatomical change and disavows reliance on AMA definitions that do not appear in the statute.

It then operationalizes the 2013 Reform Act’s causation structure for aggravation claims, requiring employees to establish two distinct “more than 50%” links:

  1. From employment to the aggravation; and
  2. From the aggravation to disablement or the need for treatment.

In Ms. Edwards’s case, these principles translate into a concrete outcome: her bilateral knee replacements and resulting temporary and permanent total disability are compensable, because a work‑related aggravation transformed asymptomatic, end‑stage arthritis into disabling pain and functional loss.

For future litigants, judges, and practitioners, this decision will serve as the leading authority in Tennessee on:

  • How appellate bodies must review factual findings in workers’ compensation claims;
  • How to analyze aggravation of preexisting conditions under the 2013 Reform Act; and
  • How to frame and evaluate medical causation evidence in a system that demands more than “could be” but does not insist on permanent anatomical change.

In sum, the opinion both clarifies doctrine and enhances predictability, offering a coherent framework for resolving the increasingly common disputes that arise when work accidents intersect with preexisting degenerative conditions.

Case Details

Year: 2025
Court: Supreme Court of Tennessee

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