FILED

May 12, 1997

Cecil W. Crowson

Appellate Court Clerk

IN THE SUPREME COURT OF TENNESSEE

AT NASHVILLE

FOR PUBLICATION

Filed: May 12, 1997

LARRY KRICK, )

)

Plaintiff-Appellant, ) LAWRENCE COUNTY 

)

)

Vs. ) HON. JIM T. HAMILTON,

) JUDGE

CITY OF LAWRENCEBURG, )

)

Defendant-Appellee. ) No. 01S01-9511-CV-00220

For Plaintiff/Appellant: For Defendant/Appellee:

Ben Boston James A. Hooper

Christopher V. Sockwell Hopper & Plunk, P.C.

Boston, Bates & Holt Savannah, Tennessee

Lawrenceburg, Tennessee

O P I N I O N

JUDGMENT OF TRIAL COURT

REVERSED; CASE DISMISSED. ANDERSON, J.
-2-

We granted the motion for review to determine whether a policeman’s

coronary artery disease arose out of his employment for the City of

Lawrenceburg. The Lawrence County Circuit Court found that the police officer

sustained a compensable injury in the course and scope of his employment with

the City of Lawrenceburg. On appeal, the Special Workers’ Compensation

Panel reversed and dismissed the case, finding no compensable injury. After

carefully examining the record, we affirm the Panel’s findings of fact and

conclusions of law. The judgment of the trial court is reversed and the case

dismissed.

BACKGROUND

The proof is summarized as follows:

The plaintiff, Larry Krick, aged 44, worked as a police officer for the City of

Lawrenceburg since 1981. On August 24, 1993, Krick was on routine patrol

when he received a call that a woman had been shot and that her husband was

holding a weapon on her. Krick and another police officer went to the residence

of the woman and kicked in the front door to gain access to the house. As they

entered the house, Krick drew his revolver. He and his fellow officer could only

see about two feet in front of them, because the house was littered with boxes

and debris. The officers were forced to crawl through the house to try to find the

woman because of the accumulated boxes. They found the woman in a back

bedroom lying on the bed. The woman had not been shot. No one else was in

the house. 

After the incident, Krick said that he was “nervous” and “tense.” He

experienced shortness of breath and had chest pain. Krick reported the pain to

his supervisor, who advised him to seek medical attention. Krick then went to

Baptist Hospital in Nashville, where he was seen by Dr. Charles Mayes, a

cardiologist. Dr. Mayes diagnosed coronary artery disease. Krick later
1

 Angina pectoris was defined as chest pain due to insufficient blood supply reaching an

area of th e heart.

-3-

underwent quadruple bypass surgery performed by Dr. Robert Hardin, a

cardiovascular surgeon. After approximately nine weeks, Krick returned to work. 

After returning to work, Krick was promoted to lieutenant, and one month before

the trial, he was promoted to captain. At the time of the trial, Krick was the

second ranking police officer on the Lawrenceburg force and handled

administration for the department when the chief of police was absent. 

Krick testified that he had never been told that he had coronary artery

disease prior to August 1993. He said that he had some hypertension, which he

described as a “borderline thing.” Krick was on medication for the high blood

pressure, and stated that it was under control most of the time. He also said that

he had successfully passed physical examinations before going to work for the

police department in July 1981. Approximately one week prior to the incident on

August 24, 1993, Krick became extremely hot and experienced shortness of

breath, but no chest pain, while mowing grass along a riverbank. He had to lie

down in a recliner until he cooled off. He then resumed mowing the yard. 

The medical proof consisted of the testimony of several physicians by

deposition and is summarized as follows: 

Dr. Haresh H. Khatri, a doctor of internal medicine, testified that he had

treated the plaintiff since 1988 and that he had prescribed medication for Krick’s

hypertension. He further stated that the plaintiff smoked one to two packs of

cigarettes per day, and as early as 1991, he had diagnosed the plaintiff as

having high cholesterol. When asked whether Krick’s occupation as a police

officer caused the blocked arteries, which resulted in the plaintiff experiencing

angina1, Dr. Khatri stated that the plaintiff had several risk factors for coronary

artery disease, including smoking, hypertension and elevated cholesterol. He

further stated that activity generally does not cause coronary artery disease, but
2

 Hyperlipidem ia is a gene ral term denoting elevated c oncen trations of f at in the plas ma. 

Taylor, Elizab eth J., Dorland’s Illustrated Medical Dictionary (27th Ed. 1988).

-4-

activity can bring on a heart attack or angina, a symptom of blockage of the

arteries. He finally conceded that he did not know what part job stress played in

the plaintiff’s heart disease.

Dr. H. L. Thomas, a family practitioner, testified that he had treated Krick

since 1978 and had not found any evidence that the plaintiff had coronary artery

disease. He stated that, in his opinion, stress could lead to a coronary spasm,

which could cause a complete blockage of the arteries. He stated that activity

does not cause coronary artery disease, but could cause a coronary spasm. 

Dr. Robert Hardin, the surgeon who performed Krick’s bypass surgery,

testified that prior to the surgery Krick had a 90 percent blockage of the left main

artery, 70 percent blockage of the mid-left anterior descending artery, 80 percent

blockage of the first obtuse marginal artery, and complete occlusion of the right

coronary artery. He also testified that there were multiple factors involved in

Krick’s coronary artery disease, and that stress was one of the factors. Dr.

Hardin testified that after his recovery, Krick had sustained a 15 percent

impairment based on the Fourth Edition of the Guidelines to Permanent

Impairment, published by the American Medical Association. 

Dr. Laurence A. Grossman, a Nashville cardiologist, did not treat Krick,

but reviewed his medical records and the depositions of the plaintiff and Drs.

Khatri and Hardin. Dr. Grossman stated that the plaintiff had “long-standing

coronary heart disease,” as demonstrated by the cardiac catheterization and

coronary arteriographic study performed by Dr. Mayes. He testified that the

three main factors establishing coronary heart disease are cigarette smoking,

hypertension, and hyperlipidemia2. Dr. Grossman emphasized that Krick did not

have a heart attack, but had severe angina, which resulted from the blocked

arteries. Dr. Grossman testified that the August 24, 1993 incident did not cause
-5-

or aggravate Krick’s coronary artery disease. The stress may have aggravated

the symptoms of the disease, the angina, but did not cause the disease.

After considering the evidence, the trial court found that Krick’s coronary

artery disease arose out of and in the course and scope of his employment, and 

that he had sustained a 37 1⁄2 percent vocational occupational disability. 

On appeal, the Special Workers’ Compensation Appeals Panel found that

the evidence preponderates against the finding that the plaintiff’s coronary artery

disease arose out of his employment. The Panel therefore reversed and

dismissed the case. We granted the motion for full court review and now affirm

the Panel’s findings of fact and conclusions of law for the reasons articulated

below.

COMPENSABLE INJURY

In workers’ compensation cases, the scope of review in this Court on

issues of fact is 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)(Supp. 1996); Lollar v.

Wal-Mart Stores, Inc., 767 S.W.2d 143 (Tenn. 1989). Considerable deference

must be accorded the trial court’s factual findings on issues related to the

credibility of witnesses and the weight to be given their testimony. Humphrey v.

David Witherspoon, Inc., 734 S.W.2d 315 (Tenn. 1987). 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. Orman v. Williams Sonoma, Inc., 803 S.W.2d

672, 676-77 (Tenn. 1991). With these principles in mind, we review the record to

determine whether the evidence preponderates against the findings of the trial

court.
-6-

In support of his position that his heart disease was an accidental injury

suffered during the course of his employment, Krick relies upon the statutory

presumption of causation contained in Tenn. Code Ann. § 7-51-201(a)(1). The

statute “establishe[s] a presumption that any impairment of health of [a] law

enforcement officer[ ] 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.” In order to rely

upon the presumption created by Tenn. Code Ann. § 7-51-201(a)(1), Krick must

show that (1) he was employed by a regular law enforcement department; (2) he

suffered from hypertension or heart disease resulting in hospitalization, medical

treatment or disability in the course of employment; and (3) prior to the injury he

had been given a physical examination which did not reveal the heart disease or

hypertension. Stone v. City of McMinnville, 896 S.W.2d 548, 550 (Tenn. 1995). 

Once the prerequisites are established, then the presumption exists. In order to

overcome the presumption, “there 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.” Id. See also

Wingert v. Government of Sumner County, 908 S.W.2d 921 (Tenn. 1995). In

other words, there must be “competent medical evidence” that there is a not a

substantial causal connection.

In this case, the record establishes the three prerequisites necessary to

establish the presumption that the coronary artery disease was an accidental

injury suffered in the course of employment. Clearly, Krick was a police officer

and he suffered the angina in the course of his work. Moreover, he testified that

he had never been told, despite several physical examinations, that he suffered

from coronary artery disease. 
-7-

The issue in this case, therefore, is whether there is competent medical 

evidence that there is not a substantial causal connection between Krick’s work

as a police officer and the coronary artery disease. We agree with the Special

Panel that there is. Accordingly, the defendant has overcome the presumption

of causation. 

In this case, Dr. Grossman, a qualified cardiologist, stated that job stress

played no role in Krick’s coronary artery disease. He stated that the disease was

caused by cigarette smoking, hypertension, and hyperlipidemia. This testimony

is affirmative evidence that there is not a substantial causal connection between

Krick’s work and his heart disease. Moreover, we note that the heart disease

consisted of one completely blocked and three substantially blocked coronary

arteries. Dr. Grossman testified that it was apparent from the tests performed by

Dr. Mayes that the disease was long-standing. The chest pain experienced by

the plaintiff at the time of the August 24, 1993 call was a symptom of the heart

disease, not the disease itself. Moreover, it defies common sense to assume

that Krick’s arteries became occluded as a result of the stress involved in the

August 1993 call.

As the Special Panel recognized, once the presumption of causation

established by Tenn. Code Ann. § 7-51-201(a)(1) is rebutted by the defendant, it

disappears, and the plaintiff must prove, by a preponderance of the evidence,

that his condition resulted from an injury by accident arising out of and in the

course of his employment. Thus, Krick was required to prove that his heart

disease was an injury by accident.

Occupational disease is an injury by accident. Tenn. Code Ann. § 50-6-

102(a)(5). Accordingly, in this case, Krick’s heart disease is deemed to be an

occupational disease if it arose out of and in the course of his employment. 

However, heart disease arises out of employment only if (1) the disease can be
-8-

determined to have followed as a natural incident of the work as a result of the

exposure occasioned by the nature of the employment, (2) it can be fairly traced

to the employment as a proximate cause, (3) it has not originated from a hazard

to which the worker would have been equally exposed outside of the

employment, (4) it is incidental to the character of the employment and not

independent of the relation of employer and employee, (5) it originated from a

risk connected with the employment and flowed from that source as a natural

consequence, though it need not have been foreseen or expected prior to its

contraction, and (6) there is a direct causal connection between the disease and

conditions under which the work is performed. Tenn. Code Ann. § 50-6-301.

We find that the evidence preponderates against a finding that Krick’s

heart disease arose in the course and scope of his employment. The medical

evidence does not establish a causal connection between the conditions of

Krick’s work and his coronary artery disease. Indeed, the evidence establishes

that the disease was instead primarily caused by hypertension, cigarette

smoking, and hyperlipidemia. 

We have held that heart attacks are generally compensable as accidental

injuries when they are precipitated by physical exertion or strain or a specific

incident or series of incidents involving mental or emotional stress of an unusual

or abnormal nature. Bacon v. Sevier County, 808 S.W.2d 46 (Tenn. 1991);

Stone v. City of McMinnville, supra. The key to recovery in instances where it is

alleged that physical activity caused the heart attack, is whether “the disabling

heart attack is precipitated by the physical activity or exertion or physical strain of

the employee’s job.” Id. at 552, quoting Bacon, 808 S.W.2d at 50. In instances

where the plaintiff asserts that emotional stress caused the heart attack, the

disabling condition “must be immediately precipitated by a specific acute or

sudden stressful event.” Stone v. City of McMinnville, 896 S.W.2d at 552,

quoting Bacon, 808 S.W.2d at 52.
-9-

In this case, Krick did not experience a heart attack; he experienced

angina, a symptom of heart disease. The angina may have been caused by the

stress of the August 1993 incident; however, Krick’s disability arose from the

heart disease, not the chest pain. The medical proof preponderates against a

finding that the heart disease was precipitated by the August 1993 incident. 

Thus, Krick has failed to establish the compensability of his heart disease.

CONCLUSION

We therefore conclude that the evidence in this record preponderates

against the trial court’s finding that Krick sustained a compensable injury by

accident. The judgment of the trial court is reversed and the case dismissed. 

Costs on appeal are taxed to the plaintiff/appellant.

 

E. RILEY ANDERSON, JUSTICE

Concur:

Birch, C.J.

Reid and Holder, JJ.

Drowota, J., Not Participating