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*********************************************** 
GEORGE R. DICKERSON v. CITY

OF STAMFORD ET AL.

(SC 20244)

Robinson, C. J., and Palmer, McDonald, D’Auria,

Mullins, Kahn and Ecker, Js.

Syllabus

The named defendant, the city of Stamford, appealed from the decision of

the Compensation Review Board, which vacated the Workers’ Compensation Commissioner’s dismissal of the plaintiff’s claim for benefits

under the statute (§ 7-433c) governing compensation for municipal

police officers or firefighters with hypertension or heart disease. In

2000, while employed as a police officer with the Stamford Police Department, the plaintiff was diagnosed with hypertension, and, in 2004, the

commissioner concluded that the plaintiff’s hypertension was compensable under § 7-433c. The plaintiff retired from the police department in

2004, and, in 2014, he suffered a myocardial infarction as a result of

coronary artery disease. The plaintiff then filed a claim under § 7-433c for

compensation for his coronary artery disease and myocardial infarction,

asserting that these events or conditions were the sequelae of his compensable claim for hypertension. The commissioner concluded that

hypertension and heart disease are two separate diseases for purposes

of § 7-433c and that the plaintiff failed to file a notice of new claim

within one year of his diagnosis of heart disease, in accordance with

the notice provisions of the Workers’ Compensation Act (§ 31-275 et

seq.), and dismissed his claim. The plaintiff appealed from the commissioner’s decision to the board, which vacated the commissioner’s decision, concluding that a cardiac event that occurs subsequent to an initial,

compensable injury under § 7-433c need not be deemed a new injury

and that to require a new notice of claim for a subsequent manifestation

of a compensable injury would be inconsistent with the way in which

workers’ compensation claims have been previously handled under the

act. The board remanded the case to the commissioner to make independent factual findings with respect to whether the plaintiff’s heart disease

was caused by his hypertension or constituted a new injury. On the

city’s appeal from the decision of the board, held:

1. Contrary to the city’s claim, the plaintiff satisfied the jurisdictional prerequisites of § 7-433c and was not required to file notice of new claim

in order to pursue benefits under § 7-433c for his heart disease, and,

accordingly, this court upheld the board’s decision to vacate the commissioner’s dismissal of the plaintiff’s claim for benefits on the basis of the

plaintiff’s failure to file a notice of new claim; this court adopted the

reasoning and result of the companion case of Coughlin v. Stamford

Fire Dept. (334 Conn. ), in which this court held that, when a plaintiff

has a compensable claim for hypertension under § 7-433c, he also may

be eligible for benefits for subsequent heart disease if the heart disease

is causally related to the hypertension.

2. This court determined that a claimant who suffers a compensable primary

injury may also be compensated for a subsequent injury under § 7-

433c when the subsequent injury is the direct and natural result of

the compensable primary injury, and whether a sufficient nexus of

proximate cause exists between the two injuries requires a workers’

compensation commissioner to use a substantial factor causation standard; accordingly, because the commissioner in the present case dismissed the plaintiff’s claim for benefits without making an independent

factual finding as to causation, this court directed that, on remand, the

commissioner shall determine whether the plaintiff’s hypertension was

a substantial factor in the development of his heart disease.

Argued November 12, 2019—officially released March 10, 2020

Procedural History

Appeal from the decision of the Workers’ Compensation Commissioner for the Seventh District dismissing
the plaintiff’s claim for certain workers’ compensation

benefits, brought to the Compensation Review Board,

which vacated the commissioner’s decision and

remanded the case for further proceedings, and the

defendants appealed. Affirmed; further proceedings.

Scott Wilson Williams, for the appellants (defendants).

Andrew J. Morrissey, for the appellee (plaintiff).
Opinion

KAHN, J. The named defendant, the city of Stamford,1

appeals2from the decision of the Compensation Review

Board (board), which vacated the decision of the Workers’ Compensation Commissioner for the Seventh District (commissioner) dismissing the claim for benefits

that the plaintiff, George R. Dickerson, brought pursuant to General Statutes § 7-433c (a).3 Dickerson v. Stamford, No. 6215, CRB 7-17-8 (September 12, 2018). On

appeal, the defendant asserts that the board incorrectly

determined that the commissioner had jurisdiction over

the plaintiff’s claim because, at the time of his diagnosis

and disability, the plaintiff had retired and was no longer

a uniformed member of the Stamford Police Department (department). Furthermore, the defendant asserts

that a claim for a new injury of heart disease cannot

be established on the basis of its causal relationship to

the plaintiff’s initial compensable claim for hypertension because § 7-433c mandates that hypertension and

heart disease be treated as separate and distinct injuries. Therefore, the defendant claims, the plaintiff was

required to give a separate, timely notice of his heart

disease claim within one year of his diagnosis. The

plaintiff responds that the jurisdictional prerequisites

of § 7-433c were met and that his heart disease claim

was timely because it flowed from his compensable

claim for hypertension, and neither a plain reading of

§ 7-433c nor this court’s interpretation of that statute

requires hypertension and heart disease to be treated

as separate diseases when they are causally related.

Finally, the defendant argues that, even if the plaintiff

met the jurisdictional prerequisites and his claim for

heart disease was timely, the plaintiff’s hypertension

must be the sole contributing factor to his heart disease

for the latter claim to be eligible for benefits. The plaintiff responds that the long-standing substantial factor

standard that applies to subsequent injury claims

brought under the Workers’ Compensation Act (act),

General Statutes § 31-275 et seq., also applies to his

claim. We agree with the plaintiff and, accordingly,

affirm the decision of the board.

The record reveals the following undisputed facts

and procedural history. The plaintiff became a regular

member of the department in 1984.4 While employed

as a police officer, the plaintiff was diagnosed with

hypertension on July 17, 2000, and filed a timely claim

for benefits pursuant to § 7-433c. The commissioner, in

an October 7, 2004 finding and award on that claim,

concluded that the plaintiff’s hypertension was compensable and awarded a 40 percent permanent partial disability. The plaintiff retired from the department in 2004.

On September 4, 2014, the plaintiff suffered an inferior wall myocardial infarction as a result of coronary

artery disease and underwent an emergency angioplasty

with a stent placement in his right coronary artery.
The plaintiff then filed a heart disease claim, seeking

compensation for both his coronary artery disease and

myocardial infarction. In doing so, the plaintiff asserted

that these diagnoses were the sequelae of his compensable claim for hypertension. Following a hearing on the

heart disease claim, the commissioner issued an

amended finding and dismissal dated August 28, 2017.5

The commissioner, relying on this court’s decision in

Holston v. New Haven Police Dept., 323 Conn. 607, 149

A.3d 165 (2016), determined that hypertension and heart

disease are two separate diseases for the purpose of

§ 7-433c and that the plaintiff failed to file a notice of

new claim within one year of his diagnosis of heart

disease in accordance with the notice provisions of

the act. Accordingly, the commissioner found that the

plaintiff was not entitled to benefits for heart disease

and dismissed his claim. The plaintiff appealed from

that decision to the board.

In its decision, the board stated that it ‘‘[did] not

believe [that] a cardiac event that occurred at a later

date from an initial compensable injury [pursuant to

§ 7-433c] must, as a matter of law, be deemed a new

injury.’’ (Emphasis in original; internal quotation marks

omitted.) The board observed that this court has consistently held that § 7-433c ‘‘provides for the administration of benefits in the same amount and the same manner as that provided under [the act],’’ and ‘‘to require

a future manifestation of a compensable injury to

require a new notice of claim . . . would be inconsistent with the way [workers’ compensation] claims have

been handled since the inception of the [act].’’ (Internal

quotation marks omitted.) Accordingly, because the

commissioner did not present independent factual findings related to whether the plaintiff’s heart disease was

caused by his hypertension or constituted a new injury,

the board vacated the commissioner’s amended finding

and dismissal and remanded the case for further proceedings. See footnote 6 of this opinion. This appeal

followed.

I

STANDARD OF REVIEW

‘‘The principles that govern our standard of review

in workers’ compensation appeals are well established.

The conclusions drawn by [the commissioner] from

the facts found must stand unless they result from an

incorrect application of the law to the subordinate facts

or from an inference illegally or unreasonably drawn

from them. . . . [Moreover, it] is well established that

[a]lthough not dispositive, we accord great weight to

the construction given to the workers’ compensation

statutes by the commissioner and [the] board. . . .

Cases that present pure questions of law, however,

invoke a broader standard of review than is ordinarily

involved in deciding whether, in light of the evidence,

the agency has acted unreasonably, arbitrarily, illegally
or in abuse of its discretion. . . . We have determined,

therefore, that the traditional deference accorded to an

agency’s interpretation of a statutory term is unwarranted when the construction of a statute . . . has not

previously been subjected to judicial scrutiny [or to]

. . . a governmental agency’s time-tested interpretation . . . .’’ (Footnote omitted; internal quotation

marks omitted.) Holston v. New Haven Police Dept.,

supra, 323 Conn. 611–13. In addition, ‘‘we are mindful

of the proposition that all workers’ compensation legislation, because of its remedial nature, should be broadly

construed in favor of disabled employees. . . . This

proposition applies as well to the provisions of [§] 7-

433c . . . because the measurement of the benefits to

which a § 7-433c claimant is entitled is identical to the

benefits that may be awarded to a [claimant] under

. . . [the act]. . . . We also recognize, however, that

the filing of a timely notice of claim is a condition

precedent to liability and a jurisdictional requirement

that cannot be waived.’’ (Internal quotation marks omitted.) Id., 613.

II

JURISDICTION AND TIMELINESS

We first consider the defendant’s claims that the

plaintiff did not meet the jurisdictional prerequisites of

§ 7-433c because he was retired when he pursued his

claim for heart disease and that the plaintiff failed to

give timely, separate notice of his heart disease claim.

In Coughlin v. Stamford Fire Dept., 334 Conn. ,

A.3d (2020), which we also decide today, we held

that, when a plaintiff has a compensable claim for

hypertension under § 7-433c, the plaintiff may also be

eligible for benefits for subsequent heart disease if, as

required by the act, the plaintiff’s heart disease is causally related to his hypertension. We adopt the reasoning

and result of that decision herein and, therefore, conclude that the plaintiff met the jurisdictional prerequisites of § 7-433c. We hold that the plaintiff was not

required to file a notice of new claim in order to pursue

benefits for his heart disease.

III

CAUSATION

We next turn to the defendant’s contention that the

plaintiff’s hypertension must be the sole contributing

factor to his heart disease for the plaintiff to be eligible

for benefits. ‘‘[O]nce § 7-433c coverage is established,

the measurement of the plaintiff’s benefits under this

statute is identical to the benefits that may be awarded

to a plaintiff under [the act].’’ Felia v. Westport, 214

Conn. 181, 185, 571 A.2d 89 (1990); see also Lambert

v. Bridgeport, 204 Conn. 563, 566, 529 A.2d 184 (1987).

Under the act, a claimant, having suffered a compensable primary injury during the course of his employment,

may also be compensated for a subsequent injury when
the subsequent injury is ‘‘the direct and natural result

of a compensable primary injury.’’ (Internal quotation

marks omitted.) Sapko v. State, 305 Conn. 360, 378–80,

44 A.3d 827 (2012).

Whether a sufficient nexus of proximate cause exists

between the two injuries for the subsequent injury to

be compensable requires commissioners to use a ‘‘substantial factor’’ causation standard. See, e.g., Birnie v.

Electric Boat Corp., 288 Conn. 392, 408–409, 953 A.2d

28 (2008). This court has construed the requirement to

mean that there must exist ‘‘some causal connection’’

between the two injuries. (Emphasis omitted; internal

quotation marks omitted.) Id., 410. ‘‘It has been determined that the substantial factor standard is met if the

employment materially or essentially contributes to

bring about an injury . . . . The term substantial, however, does not connote that the employment must be

the major contributing factor in bringing about the

injury . . . [or] that the employment must be the sole

contributing factor in development of an injury. . . .

[T]he substantial factor causation standard simply

requires that the employment, or the risks incidental

thereto, contribute to the development of the injury

in more than a de minimis way.’’ (Citations omitted;

emphasis altered; internal quotation marks omitted.)

Id., 412–13; see also Filosi v. Electric Boat Corp., 330

Conn. 231, 244–45, 193 A.3d 33 (2018).

In interpreting the act, this court has previously noted

that, ‘‘[u]nless causation under the facts is a matter of

common knowledge, the plaintiff has the burden of

introducing expert testimony to establish a causal link

between the compensable workplace injury and the

subsequent injury.’’ Sapko v. State, supra, 305 Conn.

386. ‘‘When . . . it is unclear whether an employee’s

[subsequent injury] is causally related to a compensable

injury, it is necessary to rely on expert medical opinion.

. . . Unless the medical testimony by itself establishes

a causal relation, or unless it establishes a causal relation when it is considered along with other evidence,

the commissioner cannot reasonably conclude that the

[subsequent injury] is causally related to the employee’s

employment.’’ (Citation omitted; internal quotation

marks omitted.) Marandino v. Prometheus Pharmacy,

294 Conn. 564, 591–92, 986 A.2d 1023 (2010).

In the present case, the commissioner dismissed the

plaintiff’s claim without making an independent factual

finding as to whether the plaintiff’s hypertension was

a substantial factor in the development of his heart

disease. On appeal, the board remanded the case to the

commissioner for further proceedings, noting that, ‘‘[i]n

matters [in which] it is not definitive whether a plaintiff’s cardiac ailment is the manifestation of a prior

injury or a new injury, the commissioner must reach a

factual determination on the issue prior to proceeding

forward.’’6 We conclude that, on remand, the commis-
sioner shall determine whether the plaintiff’s hypertension was a substantial factor in his subsequent development of heart disease.

The decision of the Compensation Review Board is

affirmed and the case is remanded to the board with

direction to remand the case to the commissioner for

further proceedings in accordance with this opinion.

In this opinion the other justices concurred.

1 PMA Management Corporation of New England, a third-party administrator for the city of Stamford, is a defendant in the present case and joined

in this appeal. In the interest of clarity, we hereinafter refer to the city of

Stamford as the defendant.

2 The defendant appealed from the decision of the Compensation Review

Board to the Appellate Court, and we transferred the appeal to this court

pursuant to General Statutes § 51-199 (c) and Practice Book § 65-1.

3 General Statutes § 7-433c (a) provides: ‘‘Notwithstanding any provision

of chapter 568 or any other general statute, charter, special act or ordinance

to the contrary, in the event a uniformed member of a paid municipal fire

department or a regular member of a paid municipal police department who

successfully passed a physical examination on entry into such service, which

examination failed to reveal any evidence of hypertension or heart disease,

suffers either off duty or on duty any condition or impairment of health

caused by hypertension or heart disease resulting in his death or his temporary or permanent, total or partial disability, he or his dependents, as the

case may be, shall receive from his municipal employer compensation and

medical care in the same amount and the same manner as that provided

under chapter 568 if such death or disability was caused by a personal injury

which arose out of and in the course of his employment and was suffered

in the line of duty and within the scope of his employment, and from the

municipal or state retirement system under which he is covered, he or his

dependents, as the case may be, shall receive the same retirement or survivor

benefits which would be paid under said system if such death or disability

was caused by a personal injury which arose out of and in the course of

his employment, and was suffered in the line of duty and within the scope

of his employment. If successful passage of such a physical examination

was, at the time of his employment, required as a condition for such employment, no proof or record of such examination shall be required as evidence

in the maintenance of a claim under this section or under such municipal

or state retirement systems. The benefits provided by this section shall be

in lieu of any other benefits which such policeman or fireman or his dependents may be entitled to receive from his municipal employer under the

provisions of chapter 568 or the municipal or state retirement system under

which he is covered, except as provided by this section, as a result of any

condition or impairment of health caused by hypertension or heart disease

resulting in his death or his temporary or permanent, total or partial disability. As used in this section, ‘municipal employer’ has the same meaning as

provided in section 7-467.’’

4 General Statutes § 7-433c (b) provides in relevant part that ‘‘those persons

who began employment on or after July 1, 1996, shall not be eligible for

any benefits pursuant to this section.’’ In the present case, it is undisputed

that the plaintiff was hired in 1984.

5 The plaintiff filed a motion to correct the initial finding and dismissal,

dated August 17, 2017, seeking the omission of any references to Staurovsky

v. Milford Police Dept., 164 Conn. App. 182, 134 A.3d 1263 (2016), appeal

dismissed, 324 Conn. 693, 154 A.3d 525 (2017), which the plaintiff claimed had

not been an issue for consideration at the formal hearing. The commissioner

granted the motion, resulting in the amended finding and dismissal.

6 The commissioner noted that the parties stipulated to a number of facts,

including that the plaintiff’s long-standing hypertension was a significant

contributing factor in his development of coronary artery disease that ultimately resulted in his myocardial infarction. The plaintiff also submitted,

and the commissioner admitted into evidence as full exhibits, two letters

from the plaintiff’s treating physician, Steven H. Kunkes. Neither party,

however, challenged the board’s decision to remand the case to the commissioner for further proceedings, and, therefore, we affirm the decision of the

board without intimating a view on how the issue of causation is to be

resolved by the commissioner on remand.