FILED
Sep 10, 2026
12:47 PM(CT)
TENNESSEE COURT OF
WORKERS' COMPENSATION
CLAIMS
TENNESSEE BUREAU OF WORKERS’ COMPENSATION
IN THE COURT OF WORKERS’ COMPENSATION CLAIMS
AT CHATTANOOGA
JOSEPH JOHNSON, Docket No. 2025-10-6439
Employee,
v. State File No. 83676-2024
BRADLEY COUNTY SHERIFF’S
DEP’T, Judge Robert Durham
Employer,
And
THE LOCAL GOV’T WORKERS’
COMP. FUND,
Insurer.
EXPEDITED HEARING ORDER GRANTING BENEFITS IN PART
The Court held an expedited hearing on September 2, 2026. Mr. Johnson
received steroid injections for a work-related knee injury and asserted that these
injections led to diabetic complications resulting in a hospital stay and the need for eye surgery.1 Bradley County argued that Mr. Johnson’s eye problems did not arise
primarily out of his knee injury. For the reasons below, the Court orders Bradley
County to pay for Mr. Johnson’s hospital stay but denies his request for benefits
related to his eye surgery.
History of Claim
Mr. Johnson suffered a work-related knee injury on November 21, 2024, that
was surgically repaired in January 2025. He received three steroid injections to
alleviate post-surgical swelling. After receiving the last injection, he was admitted to the hospital for diabetic ketoacidosis from March 3 to 6.
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The parties agreed that there was no dispute about the reasonableness and necessity of medical expenses for treatment of the ketoacidosis or cataracts should the Court determine the conditions were compensable.
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While in the hospital, Mr. Johnson’s vision became blurry, so he sought
treatment from Dr. Seth Ford, an ophthalmologist. Dr. Ford’s exam revealed
“visually significant” cataracts but no signs of significant eye swelling or diabetic retinopathy. He diagnosed Mr. Johnson with “posterior subscapular polar agerelated cataracts” and surgically removed them.
The lack of diabetic retinopathy was significant because Dr. David Byrd, Mr.
Johnson’s family doctor, diagnosed him with type 2 diabetes in early 2022 and
prescribed medication to control it. In March 2024, Mr. Johnson complained that
his “sugar has been in the 200/500 area,” and he had been unintentionally losing
weight. He also told Dr. Byrd that he had stopped taking two of his diabetic
medications. Dr. Byrd diagnosed “Type II diabetes uncontrolled” with
hyperglycemia and prescribed additional medication.
When asked about Mr. Johnson’s hospitalization for ketoacidosis, Dr. Byrd
submitted a statement explaining that he believed Mr. Johnson’s steroid use after his knee surgery caused elevated blood sugar resulting in that diabetic condition. Thus,
his hospitalization was the “direct and natural consequence” of the steroids used to
treat his work-related knee injury.
As for his vision problems, Mr. Johnson testified that while he was in the
hospital, his vision became blurry. He had never experienced this problem before.
He then saw ophthalmologist Seth Ford, M.D. whose exam revealed “visually
significant” cataracts. He did not observe significant eye swelling or signs of diabetic retinopathy. He diagnosed “posterior subscapular polar age-related cataracts” and
surgically removed them. Mr. Johnson testified he has recovered well from the
surgery and can see without problems.
In addition to questions about the cause of Mr. Johnson’s ketoacidosis, Dr.
Byrd was asked whether Mr. Johnson’s eye condition—the cataracts—was the
“direct and natural consequence” of his ketoacidosis. Dr. Byrd deferred to Dr. Ford.
Bradley County’s counsel sent Dr. Ford a causation questionnaire about the
cataracts and the need for surgery. Dr. Ford said that the development of posterior
subscapular cataract is a “known occurrence with corticosteroid exposure,” and the
risk increases with the dosage and the number of shots received. However, he did
not believe that the steroids “contributed to the development or clinically meaningful progression of [Mr. Johnson’s] diagnosed ophthalmologic conditions and/or
cataracts.” In explaining this answer, Dr. Ford noted, “considering his history of
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struggles with glycemic control even before steroid use, I would consider the
possibility as likely as not, but not more.”
Dr. Ford further said that, “In the absence of his labile DM [diabetes], it is
very plausible that the level of steroid treatment I’ve been informed of alone would
not have caused the degree of [posterior subscapular cataract] observed.” While he
felt the steroids caused a “temporary metabolic or refractive change without
permanent structural damage,” he could only say it was “as likely as not” that Mr.
Johnson’s preexisting cataracts were “aggravated or accelerated by steroid
treatment.”
Finally, Dr. Ford affirmed that the “primary cause” of Mr. Johnson’s cataracts
was “the glycemic variability and lack of glycemic control,” although steroid use,
depending on the dosage and frequency, “could very well make both worse.” He
believed it more likely than not that Mr. Johnson had “some degree of PSC [posterior
subscapular cataract] and/or vision impairment” before his knee surgery. Thus, he
did not believe that Mr. Johnson’s need for cataract surgery was “primarily caused”
by treatment for his knee injury.
Findings of Fact and Conclusions of Law
To obtain his requested relief, Mr. Johnson must show a likelihood of
prevailing at a compensation hearing that the steroid use caused the ketoacidosis
resulting in his hospital stay as well as his need for cataract surgery. Tenn. Code
Ann. § 50-6-239(d)(1) (2025). To prove the steroid use caused these conditions, he
must establish that his symptoms and need for treatment primarily arose out of his
work injury. Id. § 50-6-102(12)(A). Further, he must prove causation to a
“reasonable degree of medical certainty,” which requires an expert medical opinion.
Id. § 50-6-102(12)(C). To decide whether Mr. Johnson proved this, the Court must
consider the direct and natural consequences principle.
The Appeals Board explained this principle in Hudgins v. Global Personnel
Solutions, Inc.,2024 TN Wrk. Comp. App. Bd. LEXIS 86, at *14 (Mar. 5, 2024)
(quotations omitted), aff’d, No. E2023-00792-SC-R3-WC, 2024 Tenn. LEXIS 86
(Tenn. Workers’ Comp. Panel Mar. 5, 2024):
As long as the subsequent injury that is alleged to be a natural
consequence flowing from a compensable injury can be shown to have
arisen primarily out of and in the course and scope of employment, it,
too, will be compensable. . . . This requires a finding . . . that the
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employment contributed more than fifty percent in causing an injury
subsequent to a compensable injury for it to also be compensable.
The principle also applies even though the employee suffers from preexisting
conditions that cause the later injury to be more severe in that particular employee
than it would be in others. Gandy v. Marten Transp., Ltd., 2026 TN Wrk. Comp.
App. Bd. LEXIS 13, at *20 (Mar. 5, 2026). In other words, the longstanding axiom
that “an employer takes an employee ‘as is’” still applies. Id.
Here, Dr. Byrd’s uncontradicted opinion is that the steroids Mr. Johnson
received to treat his work-related knee injury caused his blood sugar levels to
elevate, resulting in ketoacidosis, which required immediate hospitalization. Based
on this opinion, the Court finds that Mr. Johnson would likely prove that the March
3 ketoacidosis episode was primarily caused by his work-related accident. So,
Bradley County must pay the reasonable and necessary medical expenses to treat it.
However, the Court cannot make the same finding for Mr. Johnson’s
cataracts. Dr. Ford stated that Mr. Johnson likely suffered from cataracts before his work injury. That, of course, is not fatal to his claim if Mr. Johnson can show the
work accident aggravated—meaning “intensified” or “worsened”—his cataracts to
the point he needed medical treatment. Edwards v. Peoplease, LLC, No. W2024-01034-SC-R3-WC, 2025 Tenn. LEXIS 514, at *26 (Tenn. Dec. 22, 2025). To do
this Mr. Johnson must prove by expert medical evidence “(1) that the work accident
contributed more than fifty percent in causing the aggravation, and (2) that the
aggravation, which was caused by the work accident, contributed more than fifty
percent to disablement or the need for medical treatment.” Id. at *27. He cannot.
Dr. Ford said that, given Mr. Johnson’s struggles with controlling his blood
sugar levels before the steroids, he could not say that they caused a progression of
his cataracts. The best he could say was that “it was as likely as not.” Although he
conceded the steroid use possibly made the cataracts worse, he believed the primary
cause of Mr. Johnson’s cataracts and need for surgery was his “glycemic variability
and lack of glycemic control.” Thus, he could not attribute the knee injury or the
steroid use and ketoacidosis as the primary cause of Mr. Johnson’s cataracts or his
need for surgery.
IT IS ORDERED:
1. Bradley County shall pay the reasonable and necessary medical expenses for
Mr. Johnson’s hospitalization from March 3-6, 2025.
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2. Bradley County is not obligated to pay for Mr. Johnson’s cataract surgery or
any additional medical treatment for this condition.
3. This case is set for a status conference on October 26, 2026, at 2:00 p.m.
Central Time, 3:00 p.m. Eastern Time. The parties must call 615-253-0010
or 855-689-9049 to participate. Failure to call might result in a determination
of the issues without the party’s participation.
4. Unless an interlocutory appeal is filed, compliance with this order must occur within
seven business days of entry of this Order as required by Tennessee Code Annotated
section 50-6-239(d)(3).
ENTERED September 10, 2026.
JUDGE ROBERT DURHAM
Court of Workers’ Compensation Claims
APPENDIX
Exhibits:
1. Requests for Admissions
2. Medical records from Dr. Ford and Dr. Byrd, including questionnaires
3. Bradley Medical Center record
4. Mr. Johnson’s affidavit
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CERTIFICATE OF SERVICE
I certify that a copy of this Order was sent on September 10, 2026.
Name Email Service sent to:
Matthew Coleman X [email protected]
Jennifer White [email protected]
X
PENNY SHRUM, COURT CLERK
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Right to Appeal:
If you disagree with the Court’s Order, you may appeal to the Workers’ Compensation
Appeals Board. To do so, you must:
1. Complete the enclosed form entitled “Notice of Appeal” and file it with the Clerk of the
Court of Workers’ Compensation Claims before the expiration of the deadline.
¾ If the order being appealed is “expedited” (also called “interlocutory”), or if the
order does not dispose of the case in its entirety, the notice of appeal must be filed
within seven (7) business days of the date the order was filed.
¾ If the order being appealed is a “Compensation Order,” or if it resolves all issues
in the case, the notice of appeal must be filed within thirty (30) calendar days of
the date the Compensation Order was filed.
When filing the Notice of Appeal, you must serve a copy on the opposing party (or attorney,
if represented).
2. You must pay, via check, money order, or credit card, a $75.00 filing fee within ten calendar
days after filing the Notice of Appeal. Payments can be made in-person at any Bureau office
or by U.S. mail, hand-delivery, or other delivery service. In the alternative, you may file an
Affidavit of Indigency (form available on the Bureau’s website or any Bureau office)
seeking a waiver of the filing fee. You must file the fully-completed Affidavit of Indigency
within ten calendar days of filing the Notice of Appeal. Failure to timely pay the filing
fee or file the Affidavit of Indigency will result in dismissal of your appeal.
3. You are responsible for ensuring a complete record is presented on appeal. If no court
reporter was present at the hearing, you may request from the Court Clerk the audio
recording of the hearing for a $25.00 fee. If you choose to submit a transcript as part of your
appeal, which the Appeals Board has emphasized is important for a meaningful review of
the case, a licensed court reporter must prepare the transcript, and you must file it with the
Court Clerk. The Court Clerk will prepare the record for submission to the Appeals Board,
and you will receive notice once it has been submitted. For deadlines related to the filing of
transcripts, statements of the evidence, and briefs on appeal, see the applicable rules on the
Bureau’s website at https://www.tn.gov/wcappealsboard. (Click the “Read Rules” button.)
4. After the Workers’ Compensation Judge approves the record and the Court Clerk transmits
it to the Appeals Board, a docketing notice will be sent to the parties.
If neither party timely files an appeal with the Appeals Board, the Court Order
becomes enforceable. See Tenn. Code Ann. § 50-6-239(d)(3) (expedited/interlocutory
orders) and Tenn. Code Ann. § 50-6-239(c)(7) (compensation orders).
For self-represented litigants: Help from an Ombudsman is available at 800-332-2667.
NOTICE OF APPEAL
Tennessee Bureau of Workers’ Compensation
www.tn.gov/workforce/injuries-at-work/
[email protected] -800-332-2667
Docket No.: ________________________
State File No.: ______________________
Date of Injury: _____________________
Employee
v.
Employer
Notice is given that ____________________________________________________________________
[List name(s) of all appealing party(ies). Use separate sheet if necessary.]
appeals the following order(s) of the Tennessee Court of Workers’ Compensation Claims to the Workers’ Compensation Appeals Board;ĐŚĞĐŬŽŶĞŽƌŵŽƌĞĂƉƉůŝĐĂďůĞďŽdžĞƐĂŶĚŝŶĐůƵĚĞƚŚĞĚĂƚĞĨŝůĞͲ ƐƚĂŵƉĞĚŽŶƚŚĞĨŝƌƐƚƉĂŐĞŽĨƚŚĞŽƌĚĞƌ;ƐͿďĞŝŶŐĂƉƉĞĂůĞĚͿ͗
ප Expedited Hearing Order filed on _______________ ප Motion Order filed on ___________________ ප Compensation Order filed on__________________ ප Other Order filed on_____________________ issued by Judge _________________________________________________________________________.
Statement of the Issues on Appeal
Provide a short and plain statement of the issues on appeal or basis for relief on appeal: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
Parties
Appellant(s) (Requesting Party): _________________________________________ ܆Employer ܆Employee Address: ________________________________________________________ Phone: ___________________ Email: __________________________________________________________
Attorney’s Name: ______________________________________________ BPR#: _______________________ Attorney’s Email: ______________________________________________ Phone: _______________________ Attorney’s Address: _________________________________________________________________________
* Attach an additional sheet for each additional Appellant *
LB-1099 rev. 01/20 Page 1 of 2 RDA 11082 Employee Name: _______________________________________ Docket No.: _____________________ Date of Inj.: _______________
Appellee(s) (Opposing Party): ___________________________________________ ܆Employer ܆Employee Appellee’s Address: ______________________________________________ Phone: ____________________ Email: _________________________________________________________
Attorney’s Name: _____________________________________________ BPR#: ________________________ Attorney’s Email: _____________________________________________ Phone: _______________________ Attorney’s Address: _________________________________________________________________________
* Attach an additional sheet for each additional Appellee *
CERTIFICATE OF SERVICE
I, _____________________________________________________________, certify that I have forwarded a true and exact copy of this Notice of Appeal by First Class mail, postage prepaid, or in any manner as described in Tennessee Compilation Rules & Regulations, Chapter 0800-02-21, to all parties and/or their attorneys in this case on this the __________ day of ___________________________________, 20 ____.
[Signature of appellant or attorney for appellant]
LB-1099 rev. 01/20 Page 2 of 2 RDA 11082