“Once the presumption has been overcome, it disappears, and the employee must then prove causation by a preponderance of the evidence as in any other workers’ compensation case.”
How later courts described this case
- “Once the presumption has been overcome, it disappears, and the employee must then prove causation by a preponderance of the evidence as in any other workers’ compensation case.”
Written by the judges who cited it.
The opinion
IN THE SUPREME COURT OF TENNESSEE
AT KNOXVILLE
May 5, 2004 Session
ARTHUR M. BOHANAN v. CITY OF KNOXVILLE
Appeal from the Chancery Court for Knox County
No. 149962-3 Daryl R. Fansler, Chancellor
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No. E2003-01306-SC-R3-CV - Filed June 16, 2004
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The employee, a retired police officer, filed suit seeking workers’ compensation benefits. He
alleged that his job duties caused him to develop hypertension resulting in permanent partial
disability. The employee relies on the statutory presumption of causation for law enforcement
officers found in Tennessee Code Annotated section 7-51-201(a)(1), and concedes that if the
employer has rebutted the presumption, there is insufficient evidence establishing a causal
relationship between his hypertension and his employment. Following a thorough review of the
record and applicable legal principles, we conclude that the City of Knoxville has rebutted the
statutory presumption of causation, and we therefore reverse the judgment of the trial court.
Tenn. Code Ann. § 50-6-225(e)(1); Judgment of the Chancery Court for Knox County
Reversed
WILLIAM M. BARKER, J., delivered the opinion of the court, in which FRANK F. DROWOTA , III,
C.J., and E. RILEY ANDERSON , ADOLPHO A. BIRCH , JR., and JANICE M. HOLDER , JJ. joined.
John T. Batson, Jr. and Hanson R. Tipton, Knoxville, Tennessee, for the appellant, City of
Knoxville.
J. Anthony Farmer, Knoxville, Tennessee, for the appellee, Arthur M. Bohanan.
OPINION
Background
The appellee, Arthur M. Bohanan (“employee”), was fifty-eight years of age at the time of
trial and had recently retired from his employment as a police officer with the City of Knoxville
(“employer”). The employee worked in the Knoxville Police Department patrol division for less
than a year, in the crime lab for twenty-four years, and finally in the Child Pornography Unit
(“CPU”) for approximately two years. His previous employment experience included classifying
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fingerprints for the FBI, serving in the military police for the United States Army, and conducting
investigations for Equifax and the Jefferson County Sheriff’s Department.
After being employed in the CPU for approximately fourteen to sixteen months, the
employee began experiencing symptoms such as insomnia, waking up with cold sweats, blurred
vision, dizziness, tightness in his chest, and weight gain. He alleges that the stress of working in
the CPU caused his symptoms. In early December of 2000, he requested a transfer out of the
CPU but was denied. On January 20, 2001, his symptoms became so severe that his son drove
him to the emergency room, where he was advised that he had extremely high blood pressure.
Following the emergency room visit, the plaintiff’s primary care physician placed him on two
medications to control his blood pressure. The plaintiff testified that he was continuing to take
antihypertensive medications and no longer was experiencing symptoms related to high blood
pressure.
The plaintiff retired from the Knoxville Police Department effective May 31, 2001, but
has since maintained several other jobs. He has continued consulting work which he had started
under the name Bohanan’s Forensics; he has been teaching forensics classes; and he has been
performing work for the Federal Disaster Mortuary and Operational Response Team
(“DMORT”). As a member of DMORT, he went to New York three times after the September
11, 2001 attacks to identify and tag body parts, working approximately thirteen-hour shifts. He
experienced no blood pressure problems while working at Ground Zero.
On February 9, 2001, the employee filed a workers’ compensation claim, alleging that,
under Tennessee Code Annotated section 7-51-201(a)(1), because he was a law enforcement
officer, it is presumed that his health impairment caused by hypertension is due to an accidental
injury suffered in the course of employment and is therefore compensable.1 Three medical
experts testified by deposition: Dr. William Cloud, Dr. Stephen Dill, and Dr. Hal Roseman.
Dr. Cloud, the Medical Director of Employee Health Services for the employer, testified
that his office maintains medical records on city employees. He has examined the employee on a
number of occasions. He testified that the employee’s first blood pressure reading, taken on
April 10, 1986, after he was hired by the employer, was 120/80. The defendant’s blood pressure
was 130/88 on April 12, 2000. Dr. Cloud testified that both of these readings were within the
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Tennessee Code Annotated section 7-51-201(a)(1) provides that:
W henever the state of Tennessee, or any municipal corporation or other political subdivision thereof
that maintains a regular law enforcement department manned by regular and full-time employees and
has established or hereafter establishes any form of compensation to be paid to such law enforcement
officers for any condition or impairment of health which shall result in loss of life or personal injury
in the line of duty or course of employment, there shall be and there is hereby established a
presumption that any impairment of health of such law enforcement officers caused by hypertension
or heart disease resulting in hospitalization, medical treatment or any disability, shall be presumed
(unless the contrary is shown by competent medical evidence) to have occurred or to be due to
accidental injury suffered in the course of employment.
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normal range. Subsequently, on January 22, 2001, the defendant’s blood pressure was 155/98,
and on January 30, 2001, his blood pressure was 155/100. Dr. Cloud testified that neither of
these readings were within the normal range, even though the employee was taking
antihypertensive medication, and that he diagnosed the defendant as having hypertension. On
April 10, 2001, according to Dr. Cloud, the employee’s blood pressure was 132/80, which is
within the normal range.
Dr. Dill, a board certified cardiologist, testified that he evaluated the employee on August
26, 2002, at the request of the employee’s counsel. Dr. Dill testified that the employee has Class
I essential hypertension and that, although he cannot identify a specific causal relationship, he
believes the employee’s vocational stress exacerbated his hypertension. He testified that the
employee has not had any damage to his vital organs as a result of his hypertension. Dr. Dill
opined that the employee has a six to nine percent impairment rating and no restrictions.
Dr. Roseman, also a board certified cardiologist, testified that he evaluated the employee
on December 12, 2001, at the request of the employer’s counsel. Dr. Roseman testified that the
employee told him that he began to feel “yucky” in June and July of 2000 while employed in the
CPU and that his symptoms intensified in October or November of 2000, before culminating in
his emergency room visit on January 20, 2001. Dr. Roseman testified that the employee has had
diastolic hypertension since approximately 1988 and mild hyperlipidemia2 since 1993. He
testified that the employee’s increasing weight since 1983, from 190 pounds to 232 pounds,
most likely caused his elevation in blood pressure and opined within a reasonable degree of
medical certainty that the employee’s work in the CPU was not related to his hypertension.
Moreover, Dr. Roseman testified that the employee may have metabolic syndrome,3 which could
explain his hypertension. Dr. Roseman testified that, because the employee’s hypertension is
easily controlled by minimal medication, the employee has no medical impairment and that he
would place no restrictions upon the employee.
The trial court held that Dr. Roseman’s testimony did not rebut the presumption found in
Tennessee Code Annotated section 7-51-201(a)(1). The trial court found for the employee and
awarded eighteen percent permanent partial disability to the body as a whole. The employer
appealed.
2
Hyperlipidemia, also known as hyperlipemia, refers to “excessive amounts of fat and fatty
substances in the blood.” The Random House Dictionary of the English Language 941 (Stuart Flexner ed., 2d ed.
1987).
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The metabolic syndrome, also called the syndrome of insulin resistance, includes high triglyceride
levels, a low HDL cholesterol level, high blood pressure, resistance to the effects of insulin, a high
level of sugar (glucose) in the blood, and an increased tendency to form blood clots. It also includes
being overweight (particularly if fat accumulates in the abdomen). All of these problems work
together to increase the risk of coronary artery disease.
The Merck Manual of Medical Information 922 (M ark H. Beers ed., 2d ed. 2004).
3
Standard of Review
In workers’ compensation cases, this Court reviews issues of fact de novo upon the record
of the trial court, accompanied by a presumption of the correctness of the findings, unless the
preponderance of the evidence is otherwise. Tenn. Code Ann. § 50-6-225(e)(2) (1999); Jones v.
Sterling Last Corp., 962 S.W.2d 469, 471 (Tenn. 1998). When expert testimony differs, it is
within the discretion of the trial judge to determine which testimony to accept. Kellerman v.
Food Lion, Inc., 929 S.W.2d 333, 335 (Tenn. 1996). “However, where the issues involve expert
medical testimony and all the medical proof is contained in the record by deposition, as it is in
this case, then this Court may draw its own conclusions about the weight and credibility of that
testimony, since we are in the same position as the trial judge.” Krick v. City of Lawrenceburg,
945 S.W.2d 709, 712 (Tenn. 1997).
Analysis
Tennessee Code Annotated section 7-51-201(a)(1) creates a rebuttable presumption “that
any impairment of health of . . . law enforcement officers caused by hypertension or heart disease
resulting in hospitalization, medical treatment or any disability, shall be presumed (unless the
contrary is shown by competent medical evidence) to have occurred or to be due to accidental
injury suffered in the course of employment.” The statutory presumption applies if: 1) the
employee was employed by a regular law enforcement department; 2) the employee suffered
from hypertension or heart disease that necessitated hospitalization, medical treatment, or
disability in the course of employment; and 3) prior to the injury the employee had been given a
physical examination that did not reveal hypertension or heart disease. Tenn. Code Ann. § 7-51-
201(a)(1) (1998); Krick v. City of Lawrenceburg, 945 S.W.2d 709, 712 (Tenn. 1997) (citing
Stone v. City of McMinnville, 896 S.W.2d 548, 550 (Tenn. 1995)).
To rebut the presumption of causation, “[t]here must be affirmative evidence that there is
not a substantial causal connection between the work of the employee so situated and the
occurrence upon which the claim for benefits is based.” Coffey v. City of Knoxville, 866 S.W.2d
516, 519 (Tenn. Workers’ Comp. Panel 1993). Once the presumption has been overcome, it
disappears, and the employee must then prove causation by a preponderance of the evidence as in
any other workers’ compensation case. Krick, 945 S.W.2d at 713; Stone, 896 S.W.2d at 552.
The employer does not dispute that the employee met the three prerequisites for the
statutory presumption to attach. Rather, the employer argues that the expert testimony of Dr.
Roseman was sufficient to rebut the presumption and that the employee failed to establish
causation once the presumption disappeared. The employee conceded at trial that he cannot
prevail if the statutory presumption was overcome, but he argues that Dr. Roseman’s testimony
was insufficient to rebut the presumption.
Dr. Roseman testified that the employee’s hypertension was not the result of his
employment with the police department, but of multiple factors, including progressive weight
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gain and a sedentary lifestyle. Dr. Roseman also testified that the employee has had hypertension
since 1988 and mild hyperlipidemia since 1993 and that he may have metabolic syndrome, which
would explain his hypertension. Dr. Roseman stated that “[i]t is my professional opinion, based
upon a reasonable degree of medical certainty, that Mr. Bohanan’s hypertension does not appear
to be related to his profession as a police officer.” This proof is “affirmative evidence that there
is not a substantial causal connection between the work of the employee so situated and the
occurrence upon which the claim for benefits is based.” Coffey, 866 S.W.2d at 519. By
presenting this competent medical evidence, the employer rebutted the presumption of causation
found in Tennessee Code Annotated section 7-51-201(a)(1), and the burden shifted to the
employee to prove causation.
Conclusion
The employee concedes, and we agree, that he cannot prevail if the statutory presumption
was overcome. Accordingly, because the employer presented medical evidence sufficient to
overcome the statutory presumption of causation, and because the employee has failed to prove
by a preponderance of the evidence that his hypertension was job-related, we reverse the
judgment of the trial court.
Costs of this appeal are taxed against the appellee, Arthur M. Bohanan, and surety, for
which execution may issue if necessary.
___________________________________
WILLIAM M. BARKER, JUSTICE
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