Case Title: Kaan v. State ex rel. Wyoming Worker's Compensation Div.

Citation: 

Docket Number: 84-44

State: wyoming

Court: Wyoming Supreme Court

Date: 1984-11-01T00:00:00Z

Document:
Kaan v. State ex rel. Wyoming Worker's Compensation Div.1984 WY 108689 P.2d 1387Case Number: 84-44Decided: 11/01/1984LAWRENCE A. KAAN, APPELLANT (EMPLOYEE-CLAIMANT), 

v. 

STATE OF WYOMING, EX REL. WYOMING WORKER'S COMPENSATION DIVISION, APPELLEE (OBJECTOR-DEFENDANT), 

EMPIRE MOBILE PLUMBING, INC., (EMPLOYER).
Supreme Court of Wyoming

LAWRENCE A. KAAN, APPELLANT 
(EMPLOYEE-CLAIMANT), 

v. 

STATE OF WYOMING, EX REL. WYOMING WORKER'S COMPENSATION DIVISION, 
APPELLEE (OBJECTOR-DEFENDANT), 

EMPIRE MOBILE PLUMBING, 
INC., (EMPLOYER).

 
 
Appeal from the District 
Court, NiobraraCounty, George P. Sawyer, 
J.

 
 
George A. 
Clarke, Lusk, for 
appellant.

A.G. McClintock, 
Atty. Gen., Gerald A. Stack, Deputy Atty. Gen., John W. Renneisen, Senior Asst. 
Atty. Gen., and Terry J. Harris, Asst. Atty. Gen., Cheyenne, for appellee.

Before ROONEY, C.J., and 
THOMAS, ROSE, BROWN and CARDINE, JJ.

BROWN, 
Justice.

[¶1.]     Appellant suffered a 
nonfatal heart attack at work, and appeals the trial court's order disallowing 
his worker's compensation claim. The single issue, fashioned by 
appellant:

"Was the medical 
testimony given coupled with the circumstances of this case sufficient to 
establish a direct causal connection between the condition under which the work 
was performed and the cardiac condition as delineated by W.S. 
26-12-603(b)?"

[¶2.]     We will 
affirm.

[¶3.]     Appellant, Lawrence A. 
Kaan, experienced severe pain while attempting to manually disengage a 
semi-trailer from a towing truck-tractor. Being unable to complete the assigned 
task he received help from another employee. When disengagement was accomplished 
the two employees took the truck-tractor to the garage for repairs. Mr. Kaan 
then went home, but the pain continued. He was taken to a local hospital, given 
emergency treatment and diagnosed as having suffered an acute myocardial 
infarction.1 Eventually coronary bypass surgery 
was performed during which appellant suffered a stroke.

[¶4.]     In response to this 
appeal, we begin by citing the applicable statute, § 27-12-603(b), W.S. 1977, 
which provides:

"Benefits for 
employment-related coronary conditions except those directly and solely caused 
by an injury or disease are not payable unless the employee establishes by 
competent medical authority that there is a direct causal connection between the 
condition under which the work was performed and the cardiac condition, and then 
only if the causative exertion occurs during the actual period of employment 
stress clearly unusual to, or abnormal for, employees in that particular 
employment, and further that the acute symptoms of the cardiac condition are 
clearly manifested not later than four (4) hours after the alleged causative 
exertion."

We held in Claim of McCarley, Wyo., 
590 P.2d 1333 (1979), that § 27-12-603(b) has four 
requirements:

"(1). The claimant must 
establish a period of employment stress unusual or abnormal for employees in 
claimant's occupations;

"(2). Claimant must show 
that he or she engaged in some exertion during the period of unusual or abnormal 
employment stress;

"(3). Claimant must 
establish by competent medical evidence a direct causal connection between such 
exertion and the myocardial infarction; and

"(4). Claimant must show 
that the acute symptoms of the cardiac difficulty were clearly manifested within 
four hours after the alleged causation exertion."

In this appeal 
we are only concerned with the third McCarley requirement, that is, whether 
there was sufficient proof of medical causation.

[¶5.]     Appellant cites Kostamo v. Marquette Iron Mining 
Company, 405 Mich. 105, 274 N.W.2d 411 (1979), for a ruling 
that lay testimony may be relied on to support causal connection. Appellant then 
refers us to the testimony of two fellow employees, and contends that their 
testimony establishes that appellant's heart attack occurred while disengaging 
the semi-trailer from the truck-tractor. That fact is not controverted. However, 
the testimony of his fellow employees does not help to determine whether the 
exertion or stress contributed in a material degree to the myocardial 
infarction.

[¶6.]     Regarding medical 
causation we have said:

"[W]e think that under 
any reasonable view the burden of the trial court in determining the causal 
relationship between a heart injury of a workman and his employment is most 
difficult. Certainly he cannot be satisfied in discharging this upon less than 
the preponderance of believable evidence that the work effort contributed in a 
material degree to the precipitation, aggravation, or acceleration of the 
existing disease." Claim of Vondra, Wyo., 
448 P.2d 313, 318 (1968).

[¶7.]     In this case, 
cardiologist Dr. Kent N. Kreisman was questioned regarding causation. He 
responded:

"A. Let's make it - the 
best I can say is it could have been contributory. Certainly a myocardial 
infarction is not caused by a single condition, a single event. It requires 
narrowing of the coronary arteries. And this develops over many years. The final 
event which pushes a person to block the artery and therefore cause an 
infarction we do not understand. Some occur in the middle of the night at rest. 
Frequently they occur with exercise, such as shoveling snow or doing other 
things. How this relates to this particular man, I can't tell you; but it could 
have played a part. I cannot say with certainty that it did or did 
not."

Dr. Kreisman 
further testified:

"* * * All I can say is 
that it may have been related, it may not have been.

"He may have walked up 
ten minutes earlier and he could have had his heart attack. On the other hand, 
he may not have had his heart attack for another month or two months if he 
hadn't been doing that particular job right then."

[¶8.]     Only a cursory 
recitation of the standards of review is necessary here. Findings of fact made 
by the trial court are presumed to be correct and will not be disturbed absent a 
finding that they are clearly erroneous or contrary to the great weight of the 
evidence. Rocky Mountain Turbines, Inc. 
v. The 660 Syndicate, Inc., Wyo., 623 P.2d 758 (1981). We are not free to 
substitute our determination of the facts when findings of fact by the trial 
court are supported by substantial evidence. Palmeno v. Cashen, Wyo., 
627 P.2d 163 (1981).

[¶9.]     The trial court found 
that appellant failed to establish by competent medical evidence a direct causal 
connection between employment exertion and the myocardial infarction. We agree. 
The policy of liberal construction of the worker's compensation statutes does 
not relieve a claimant of the burden of proving the essential elements of his 
claim by a preponderance of the evidence. Jim's Water Service v. Eayrs, 
Wyo., 590 P.2d 1346 (1979). This court has not construed 
the worker's compensation statutes to require a medical opinion based on 
reasonable medical certainty that the stress caused or precipitated a myocardial 
infarction. Jim's Water Service v. Eayrs, 
supra.

[¶10.]  In Wyoming State Treasurer, ex rel. Wyoming 
Worker's Compensation Division v. Schwilke, Wyo., 649 P.2d 218, 220 (1982), 
we held that the requirement of a direct causal connection was satisfied by the 
physician testifying that "[T]he physical exertion which occurred just prior to 
death was `the most likely' circumstance which actually caused the event." We 
also held, "Testimony such as `most likely' and `contributed to' is of 
sufficient certainty under the standards established in [earlier cases] * * *." 
Id., at 222. 
Later, in Yost v. Wyoming State 
Treasurer, ex rel. Wyoming Worker's Compensation Division, Wyo., 654 P.2d 137, 139 (1982), we held that the direct causal connection was satisfied when 
the medical expert testified "This [exertion] caused arrhythmia and ventricular 
fibrillation and death * * *." The testifying physician in Jim's Water Service v. Eayrs, supra, 
said, "the stress was a `contributing factor' and that the arrhythmia `very 
likely' and `probably' was due to the physical exertion and 
strain."

[¶11.]  From the rules in the cases just cited we 
can distill a simple rule: The causal connection requirement is satisfied if a 
medical expert testifies that it is more probable than not that work exertion or 
stress contributed in a material degree to the precipitation, aggravation, or 
acceleration of a myocardial infarction.

[¶12.]  Here, the physician testified that he 
could not say that it was more probable than not that the exertion contributed 
in a material degree to the onset of the myocardial infarction. He said, "I 
cannot say with certainty that it did or did not." This testimony is 
insufficient to satisfy the causal connection requirement.

[¶13.]  Appellant has not shown by competent 
medical evidence that job exertion or stress contributed in a material degree to 
the precipitation, aggravation or acceleration of his heart 
attack.

[¶14.]  Affirmed.

1 A region of dead or 
dying tissue in the muscle of the heart which is the result of an obstruction to 
the blood circulation, usually by a clot lodged in a coronary artery. 2 Schmidt, 
Attorney's Dictionary of Medicine and Word Finder, p. M-176 
(1984).