The Full Board, at its meeting held on October 16, 2012, considered the above captioned case for Mandatory Full Board Review of the Board Panel Memorandum of Decision filed on December 8, 2011.
The issue presented for Mandatory Full Board Review is whether the claimant suffered a myocardial infarction (MI) causally related to his employment.
The Workers' Compensation Law Judge (WCLJ) established the claim for an MI, finding that stress experienced by the claimant as a result of his employment was a contributing factor to his heart attack.
The Board Panel majority rescinded the WCLJ's establishment of the claim, finding that the claimant's MI was caused by his cessation of anti-coagulant medication, and that the claimant's treating physicians' opinions that the claimant's MI could have been caused by work-related stress were speculative.
The dissenting Board Panel member found that the opinions of claimant's treating physicians' were sufficient to establish the claim.
In the claimant's application for Mandatory Full Board Review, he argues that the medical evidence supports a finding that the claimant's MI could have been caused by work stress and this is sufficient to establish the claim.
In rebuttal, the carrier argues that the medical evidence does not support a finding that the claimant's injury was related to his employment.
Upon review, the Full Board votes to adopt the following findings and conclusions.
The claimant, an afternoon library monitor, filed a C-3 (Employee Claim) on September 22, 2009, alleging that he sustained an MI on September 11, 2009, as a result of a stressful work situation. The carrier controverted the claim, arguing that the medical evidence did not support a causal relationship between the claimant's work and his injury.
In a letter dated April 21, 2010, claimant's treating cardiologist, Dr. Sussman, wrote:
This patient is known to have had a myocardial infarction on September 11, 2009. The patient was under a great deal of stress from work at the time. There is no question that this may have contributed to the myocardial infarction itself.
The claimant and the employer's reference librarian testified at a hearing on June 2, 2010.
The claimant testified that he had worked for the employer for over eight years. On April 23, 2009, the claimant, who had recently returned from a vacation, received a call advising him that he was terminated. The claimant was told that the decision to terminate his employment was made by the Board of Trustees, but he was not informed of the reason. The claimant met with the Board of Trustees shortly thereafter, but was still not told why he was fired. The claimant filed an age discrimination suit. In late June, the new library director asked him to return to work, but asked that he sign a two page document setting forth his job responsibilities. The claimant refused to sign the document because it prohibited him from reading while working, and required that he occasionally set up tables and chairs, which the claimant believed was out of title work. The director then offered the claimant his job back without requiring that he sign the document, but offered him fewer hours per week. On September 11, 2009, the claimant was walking through the library and spoke with a fellow employee whom he had not seen in some time. He began relating to the employee the events surrounding his prior termination. The claimant testified that, while speaking, he became lightheaded and felt chest pains from becoming overexcited. The claimant was taken to the hospital, where he was diagnosed as suffering from an MI. The claimant noted that he had prior heart problems and high blood pressure, and had previously had twelve stents inserted to address clogged arteries. The claimant testified that he was not upset about his termination until he began speaking with his fellow employee.
The reference librarian testified that he was supervising the library on September 11, 2009. He testified that he did not know that the claimant had been terminated. He was called to the circulation desk after the claimant felt ill, and he had an ambulance called to take the claimant to the hospital.
At the hearing, the WCLJ precluded the carrier from offering an independent medical examination (IME) on the issue of whether the claimant's MI was causally related to his work because the carrier failed to obtain an IME within the time directed. The WCLJ also established the claim for an MI. The WCLJ's findings were memorialized in a notice of decision filed June 8, 2010.
The carrier requested administrative review, arguing that the WCLJ erred in precluding its IME, and in failing to allow the carrier to cross-examine the claimant's treating physicians. In a decision filed December 7, 2010, the Board Panel affirmed the WCLJ's preclusion of the carrier's IME, but rescinded the establishment of the claim, without prejudice, and directed that the carrier be allowed to cross-examine the claimant's treating physicians.
Dr. Sussman testified by deposition on January 11, 2011, that he began treating the claimant for coronary artery disease in 2003. He noted that the claimant had previously undergone bypass graft surgery in 1994. The claimant also had stents placed in 2004 and 2006. Dr. Sussman stated that the claimant had suspended taking Plavix and aspirin in the week prior to September 11, 2009, because the claimant was to undergo a colonoscopy. Subsequent to his September 11, 2009, MI, claimant reported that he was under a great deal of stress at work. Dr. Sussman testified that the claimant had several pre-existing factors, including coronary artery disease, and poorly controlled diabetes and hyperlipidemia, which contributed to his MI. He also testified that discontinuing Plavix and aspirin prior to a scheduled colonoscopy also contributed to the MI. When asked whether stress at work also contributed to claimant's MI, Dr. Sussman responded, "It very well could" (Deposition, Dr. Sussman, p. 16). He noted that an MI can occur without stress, and it would be impossible to determine whether stress played a role in causing claimant's MI.
Dr. Donahue testified by deposition on January 11, 2011, that he treated the claimant when he arrived at the emergency room on September 11, 2009, and while the claimant was an inpatient at the hospital. While in the hospital the claimant told Dr. Donahue that he was under stress at work and asked whether this could have caused the MI. When asked whether stress at work could have contributed to claimant's MI, Dr. Donahue responded, "I guess it's possible. Though from what I know about his history, I don't think it was the cause of his heart attack" (Deposition, Dr. Donahue, 1/11/2011, p. 15). According to Dr. Donahue, "more than likely it was the recent cessation of anti-coagulant medication which caused claimants MI" (p. 16). Stress could possibly have also played a role, but it was impossible to determine with any certainty. On cross-examination Dr. Donahue testified that it was unlikely that stress was a contributing factor to claimant's MI.
In a reserved decision filed February 8, 2011, the WCLJ established the claim, finding that the job stress experienced by the claimant contributed to his MI.
The claimant bears the burden of establishing "a causal relationship between his employment and his disability by competent medical evidence (see Matter of Sale v Helmsley-Spear, Inc., 6 AD3d 999 ; Matter of Keeley v Jamestown City School Dist., 295 AD2d 876 ). To this end, a medical opinion on the issue of causation must signify 'a probability as to the underlying cause' of the claimant's injury which is supported by a rational basis (Matter of Paradise v Goulds Pump, 13 AD3d 764 ; see Matter of Van Patten v Quandt's Wholesale Distribs., 198 AD2d 539 ).'[M]ere surmise, or general expressions of possibility, are not enough to support a finding of causal relationship' (Matter of Ayala v DRE Maintenance Corp., 238 AD2d 674 , affd 90 NY2d 914 ; see Matter of Zehr v Jefferson Rehab. Ctr., 17 AD3d 811 )" (Matter of Mayette v Village of Massena Fire Dept., 49 AD3d 920 ).
In the present case, neither of the claimant's treating physicians opined that the claimant's MI was likely to have been caused by work-related stress. Both Dr. Donahue and Dr. Sussman testified that, generally, stress can be a precipitating factor leading to an MI. However, Dr. Donahue opined that it was unlikely that the claimant's MI was precipitated by work stress. Dr. Sussman did not provide an opinion on the likelihood that work stress contributed to the claimant's injury. Furthermore, Dr. Donahue testified that the claimant's cessation of anti-coagulants in preparation for a medical procedure was the likely cause. Thus, the medical evidence is insufficient to find that a causal relationship exists between the claimant's employment and his injury.
Therefore, the preponderance of the evidence in the record supports a finding that the claimant's MI was not caused by work-related stress, and the claim should be disallowed.
ACCORDINGLY, the WCLJ decision filed on February 8, 2011, is MODIFIED to rescind the findings of causal relationship. No further action is planned by the Board at this time.