Opinion ID: 1150599
Heading Depth: 1
Heading Rank: 2

Heading: Causal Connection Between Work Activities and Appellee's Myocardial Infarction on February 18, 1978

Text: The only exertion experienced during purported unusual work-connected stress is the ladder-climbing on February 17, 1978. The appellee's testimony with respect to climbing is the following: Q. So, essentially what you are saying then is this causative exertion on the 17th caused your heart attack which occurred around noon on the 18th? A. No, sir, I didn't say it caused it. I said it contributed to it. The doctor's testimony on the subject is the following: Q. Now, in your opinion,  you have heard the claimant testify that he engaged in exertion by climbing ladders on February 17. Now, in your opinion, is there any direct causal connection between that exertion on the 17th and the fact that this heart attack occurred on the 18th around noon, of thereafter [sic]? A. If we are talking strictly in terms of physical exertion, we would expect the onset of chest pain, the time of the injury to the heart, to be related very closely, within a matter of minutes to a couple of hours after that exertion, if that was really a precipitating event. Q. In your opinion, was this a precipitating event, the exertion on the 17th? A. No, not in his case. Q. And what would you say the precipitating event was? A. I think it's reasonable that the process of loading the snowmobile, even riding it, and as he said, jumping it on the back of a trailer, where he was having to grip and squeeze on the handle of the snowmobile, tense himself, that this could have been the exertion that precipitated it at that time. Q. So, in other words, in your opinion, there is no direct causal connection between the exertion on the 17th and the fact that a myocardial infarction occurred on the 18th? A. I don't think so, no. For the sake of discussion, even if we were to assume that the climbing of the ladders on the 17th qualified as exertion during a period of unusual stress engaged in while appellee was in the course of his employment  there is, nevertheless, no competent evidence to establish the necessary medical causation. This is a requirement of the statute. The statute says such coronary condition is not compensable 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, ... Here, the doctor says the precipitating exertion was not the ladder-climbing on the 17th, which was undertaken while the worker was in the course of his employment, but, instead, the triggering incident was the snowmobile activity on the 18th, which exertion was not undertaken while in the course of the appellee's employment. The required medical causation is not shown and, therefore, the facts simply cannot support the judgment. The claimant, in Beslanwitch v. Valley Dodge Center, Inc., 98 Idaho 390, 565 P.2d 583 (1977), was a business manager for an automobile dealership who, for five months preceding his heart attack, had experienced employment stress due to low profits, the energy crisis, and personnel turnover. He experienced chest pain on the job approximately ten days prior to his myocardial infarction. The court, in commenting with approval upon the commission's action, said: ... After considering the evidence, the Commission decided that appellant's heart attack resulted from his coronary artery disease rather than from his employment. In reaching that decision, the Commission thought it significant that appellant could point to no unusual, employment-related factor which occurred at the time of his heart attack and which could be identified as causing it... . 565 P.2d at 584. The claimant, in Landreneau v. Travelers Insurance Co., La. App., 345 So.2d 177 (1977), was the head of a parts department for a truck and equipment company. His duties required moderate physical exertion. He had, since 1961, been under treatment for high blood pressure and had suffered a prior heart attack. On September 14, 1973, the claimant suffered a heart attack while getting dressed for work, and benefits were claimed on the ground that employment-related stress caused the attack. Medical witnesses were, however, unable to state that there was any direct causal relationship between the claimant's employment stress and his myocardial infarction. Accordingly, benefits were denied. The Louisiana Appellate Court, in affirming, said: In the instant suit plaintiff was never subjected to a violent trauma, and no incident occurred while he was on the job which could be pointed to as the cause of his heart attack or as the beginning of his period of disability... .       We have found that in the present suit plaintiff's employment required very little physical effort or exertion. He was not on the job, and he thus was not discharging his usual and customary duties, when his heart attack occurred. And, the evidence fails to show a causal relationship between his employment and the sudden giving way of a part of his body... . 345 So.2d at 179 and 180. Permanente Medical Group v. Workers' Compensation Appeals Board, 69 Cal. App.3d 770, 138 Cal. Rptr. 373 (1977), involved a firefighter whose last day of work preceded by four days the date upon which he suffered a stroke resulting in permanent total disability. The testimony of claimant's wife and co-employees indicated that the claimant experienced headaches as a result of employment stress prior to the stroke. However, a doctor stated that the claimant was suffering from arteriosclerotic occlusive disease in the left carotid artery and left middle cerebral arterial system which condition was the result of an accumulation of arteriosclerosis in these major vessels  and that this arteriosclerotic occlusive disease was the result of nonindustrial factors such as inheritance and the aging process. A second doctor stated that he was unable to find any evidence that the disease was related to the claimant's work as a fireman. The trial court's finding that the evidence did not support the proposition that the claimant's work caused or aggravated the disease process which caused the stroke was sustained. See, similarly, Gardner v. Employers Mutual Liability Insurance Company, 139 Ga. App. 107, 228 S.E.2d 27 (1976); Woods v. Peerless Plastics, Inc., 220 Kan. 786, 556 P.2d 455 (1976); Carter v. Kansas City Fire & Marine Ins. Company, 138 Ga. App. 601, 226 S.E.2d 755 (1976); Muntzert v. A.B.C. Drug Company, 206 Kan. 331, 478 P.2d 198 (1970); and Dolan v. Steele, 207 Kan. 640, 485 P.2d 1318 (1971). Assuming, as we must, that we are bound to consider only the evidence most favorable to the appellee and give to him the benefit of every favorable inference, there is still no proof of medical causation in this record. Any extra exertion which occurred on the job has not been medically connected with the heart attack. In fact, the admissible evidence is exactly to the contrary. The doctor said the heart attack triggering-factor was the jumping of the snowmobile on the 18th, when the appellee was not on the job, and it was not the climbing of the ladders on the 17th, which took place when he was on the job. Therefore, while the required legal causation may have been present for appellate decision-making purposes (i.e., the climbing of ladders while on the job), the required medical causation was not.