RHEA, PETER v. TITAN TRANSFER, INC.

Tennessee Court of Workers' Compensation Claims·Decided July 24, 2026·No. 2025-80-0701·Published

Opinion

FILED Jul 24, 2026 02:59 PM(CT) TENNESSEE COURT OF WORKERS' COMPENSATION

CLAIMS

TENNESSEE BUREAU OF WORKERS’ COMPENSATION IN THE COURT OF WORKERS’ COMPENSATION CLAIMS AT JACKSON

PETER RHEA, Docket No. 2025-80-0701 Employee, v. TITAN TRANSFER, INC., State File No. 50622-2018 Employer, and PROTECTIVE INS. CO., Judge Amber E. Luttrell Insurance Carrier.

COMPENSATION ORDER

Mr. Rhea sought permanent and total disability benefits for a work injury. The issues include: 1) whether Mr. Rhea’s lower-extremity contracture injuries primarily arose from his injury; 2) whether his inability to walk primarily arose from his injury; and 3) whether he is entitled to permanent total or permanent partial disability benefits. For the reasons below, the Court finds Mr. Rhea established his injuries are compensable and he is entitled to permanent and total disability.

Claim History

Mr. Rhea worked for Titan Transfer in multiple positions, including shop foreman, lead diesel mechanic, and maintenance manager.

On June 27, 2018, he suffered a crush injury to his lower extremity at work, sustaining multiple fractures to his pelvic ring and distal femur, nerve damage, with later equinus contractures. He also later injured both shoulders from using a manual wheelchair.

Treatment and Expert Proof

Mr. Rhea saw different authorized physicians for treatment, but he primarily treated with Dr. Michael Beebe, an orthopedic surgeon with a subspecialty in

trauma. Dr. Beebe testified that these conditions and need for treatment primarily arose of out of the work injury.

Since 2018, Mr. Rhea has undergone six surgeries. He received physical therapy and medication through pain management. He attained maximum medical improvement on February 9, 2021.

Titan accepted Mr. Rhea’s multiple fractures and bilateral shoulder injuries but disputed causation for Mr. Rhea’s bilateral neuropathy and equinus contractures.

According to Dr. Beebe, equinus contractures occur when, “the heel cord of the Achilles’ tendon gets tight to the point that the foot can no longer go flat, and the toes or the foot itself is pointing downward.” He explained that after the work injury, Mr. Rhea developed “a pretty significant stocking type pattern neuropathy,” which means that his leg was numb and weak from the shin down and the front muscles of the leg became weak. This allowed the heel cord to tighten and pull the foot downward. Mr. Rhea also had foot drop.

Mr. Rhea had no history of equinus contractures or foot drop before the injury, and it acutely developed after the injury. He underwent corrective surgeries for the equinus contractures, with tendon transfers to help prevent it from recurring.

Dr. Beebe also explained that multiple nerve roots come out of the pelvic ring that were injured during the crush injury, causing a traumatic nerve injury. He believed Mr. Rhea also had a “polyneuropathy, meaning it involved multiple nerve roots,” which was confirmed by EMG.

Additionally, Mr. Rhea had preexisting diabetes and experienced an acute episode of ketoacidosis during one of his surgeries. Dr. Beebe said this episode might have been a contributing factor to him developing acute-onset polyneuropathy. He did not know exactly what caused the ketoacidosis, but he said his history of underlying diabetes and the surgery and anesthesia were likely contributing factors. He explained that the surgery itself releases corticosteroids, which increase blood sugar. Also, the drugs and IV drips administered during surgery contain sugar.

Dr. Beebe testified that Mr. Rhea’s injury aggravated, exacerbated, or worsened his “nerve associated issues, the polyneuropathy, the issue with both the legs.” A pelvic ring injury is the type of injury that worsens neuropathy.

He stated that Mr. Rhea requires the use of a wheelchair or walker to move about, which was primarily caused by his work injury. Mr. Rhea is “essentially wheelchair bound with pretty significant assistance [needed] even for transferring, and . . . needs relatively frequent position changes to prevent issues such as skin breakdown.” As a result, Dr. Beebe said, “the vast majority of careers would be difficult for him.”

Dr. Beebe concluded that Mr. Rhea’s injuries are permanent, but he did not testify about an impairment rating because he does not perform his own impairment evaluations.

On cross-examination, Dr. Beebe was questioned about Mr. Rhea’s pre-injury endocrinology treatment. He stated the records showed he had preexisting diabetic neuropathy “from a subjective standpoint . . . [but] from an exam standpoint, he [had] normal sensation, normal vibratory sensation, normal strength, and . . . no reported objective findings of diabetic neuropathy.”

Dr. Beebe disagreed with Titan that Mr. Rhea’s muscle weakness and inability to walk were more attributable to his diabetic neuropathy than his injury. He explained,

Prior to the injury, he did not require any assistive devices to ambulate, regardless of his subjective report of polyneuropathy, his motor and sensory was normal on physical exam by the podiatrist, and he was working and ambulating. And after the injury, he has never shown progress back to normal activity. His progression even in therapy is well below what I would anticipate for somebody at his age and prior functional status.

Dr. Beebe concluded that the weakness in his lower extremities occurred in the hospital immediately after the injury and surgery.

On redirect, Dr. Beebe confirmed that Mr. Rhea’s preexisting endocrinology treatment and therapy records did not change his causation opinions as to Mr. Rhea’s injuries or his lack of mobility, nor did they alter his testimony regarding Mr. Rhea exacerbating and/or aggravating any preexisting diabetic neuropathy.

Mr. Rhea saw Dr. Keith Nord for an independent medical evaluation in 2025 and for an impairment rating. Dr. Nord spent one hour examining Mr. Rhea and three hours reviewing his records and preparing his report. Like Dr. Beebe, Dr. Nord also

testified that Mr. Rhea’s work injury was the primary cause of his injuries and current condition.

He reviewed treatment records of Mr. Rhea’s preexisting diabetes and his ketoacidosis and said,

Diabetic ketoacidosis occurred during the surgery and post-operatively, so it was caused by the injury based on that. Even though he had the underlying diabetes, it triggered that response. Increased stress, infection, all kinds of things like that can trigger diabetic ketoacidosis. The severe bout of that did cause his neuropathy to become substantially worse.

Dr. Nord said that Mr. Rhea’s work was more than 50% the cause of his condition, and “[I]t’s more common for a crush injury to cause weakness and contractures and atrophy than it is diabetic ketoacidosis to cause those.”

Dr. Nord assigned 48% impairment, which consisted of 2% for the distal femur fracture, 4% for each ankle, 10% for the ankle fracture, 2% for each shoulder, 28% for inability to ambulate, and 6% for dysesthetic pain.1 He determined Mr. Rhea would need ongoing care: ongoing pain management, home assistance and care, and continued therapy including aqua therapy. He considered Mr. Rhea unable to return to his previous job and permanently disabled.

On cross-examination, Dr. Nord stated that “the exacerbation of the specific episode with the diabetic ketoacidosis was triggered by the increased stress of the accident and surgery.” It caused a permanent nerve injury. “I think it increased the neuropathy. I can’t say for sure that it caused muscle motor changes. . . [T]hat could also come from the femur. It can come from crush of the nerve, even if it wasn’t the fracture itself.” When asked why Mr. Rhea cannot walk now when he was progressing in therapy early on, Dr. Nord responded that Mr. Rhea had “progressive atrophy in his muscle as well as the flexion contractures in both ankles.” He explained that “[H]e has significant atrophy in his legs now as well, and that’s making him much weaker, making it harder for him to walk.”

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RHEA, PETER v. TITAN TRANSFER, INC., (Tenn. Super. Ct. 2026).

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