The standard for evaluating allegations of work-related cardiovascular injury or death.

The petitioner was employed as a maintenance technician for the respondent, who was contracted to perform maintenance and repair work at the U.S. Coast Guard base in Cape May, New Jersey. On September 11, 2006, the petitioner responded to a complaint of mold in the bathroom of one of the homes on the base. Upon entering the bathroom, the petitioner noticed evidence of mold infiltration on the wall behind the toilet and set about tearing out the dry wall. The door of the bathroom was closed to prevent dust and debris from travelling throughout the rest of the home. The ventilation in the bathroom was poor, and the temperature was high. Within minutes of his initial exertion, the petitioner sustained a brief loss of consciousness and, upon waking, began to experience mild chest pain. The petitioner gathered his tools and returned home where he went straight to bed for the night. The petitioner awoke the following morning with continued chest pain of considerably greater severity, as well as numbness of the left arm. He was taken to the hospital where he was admitted for observation and testing. The petitioner reported a history of chest pain and light-headedness in the days leading up to his September 11, 2006, incident, as well as throughout most of his adult life. The petitioner was ultimately diagnosed with dilated non-ischemic cardiomyopathy and on December 7, 2006, underwent implantation of a cardioverter defibrillator to help stabilize his condition. The petitioner filed a claim with the Division of Workers’ Compensation alleging that his cardiomyopathy resulted from his September 11, 2006, incident. The respondent denied that the petitioner sustained a compensable injury on that date. At trial, the petitioner produced a practitioner board certified in family practice and with limited cardiac experience. This doctor opined that the heat, dust and mold to which the petitioner was exposed on September 11, 2006, either caused or exacerbated his cardiomyopathy. However, he was unable to explain what occurred physiologically within the petitioner to cause cardiac damage and indicated he was uncertain if the petitioner's cardiomyopathy preexisted his September 11, 2006, incident. When questioned as to the relationship between the petitioner's fainting episode and his cardiomyopathy, the petitioner's doctor indicated that he could not adequately explain same. "[However,]" as he went on to testify, "something happened in that room that from that point on this man wasn’t the same any more cardiologically.” The employer presented a board certified cardiologist with an extensive cardiac practice. In relevant part, this doctor stated that he was certain that the petitioner's cardiomyopathy was not caused by his September 11, 2006, incident, and he explained that a non-ischemic cardiomyopathy can be the result of an old viral infection, alcoholism or some structural or genetic abnormality. He stated, "There are a lot of causes of cardiomyopathy, but exposure to heat is not one of them." Rather, the respondent's doctor concluded that the petitioner's fainting was an isolated incident which was likely caused by dehydration brought on by physical exertion in a very hot and poorly ventilated space. Though this doctor did admit that someone with a weak heart would have more difficulty tolerating the physical stresses of life, he indicated that there was no physiological reason to believe that the petitioner's loss of consciousness would have sequelae of any significance related to it, nor did he observe any sequelae clinically. Accordingly, the cardiologist concluded that the petitioner's cardiomyopathy predated his September 11, 2006, incident. In dismissing the petitioner's claim, the judge of compensation relied on N.J.S.A. 34:15-7.2, as well as two seminal New Jersey Supreme Court decisions demonstrating the provision's application. N.J.S.A. 34:15-7.2 provides that: "In any claim for compensation for injury or death from cardiovascular . . . causes, the claimant shall prove by a preponderance of the credible evidence that the injury or death was produced by the work effort or strain involving a substantial condition, event or happening in excess of the wear and tear of the claimant's daily living and in reasonable medical probability caused in a material degree the cardiovascular . . . injury or death resulting therefrom." The New Jersey Supreme Court addressed this statute in Aladits v. Simmons Co., 47 N.J. 115 (1966). In setting forth what is required of an expert witness in cases involving allegations of cardiovascular injury, the Aladits Court opined that the trier of fact should have answers to the following questions: "(1) why the work strain or effort caused or contributed to the attack; (2) how it caused or contributed; (3) what were the physiologic mechanics which followed in the wake of the strain or effort; (4) what went on within the employee if the strain or effort contributed materially to the attack; (5) what, if any, signs or symptoms might be expected to accompany a heart attack or appear immediately thereafter which a layman might observe, or which a doctor might observe or regard as significant[.]" The New Jersey Supreme Court revisited N.J.S.A. 34:15-7.2 in Hellwig v. J. F. Rast & Co., 110 N.J. 37 (1988), and provided further guidance as to its application. As the Court instructed: "[C]ompensation judges should be informed of contemporary medical standards so that they may be knowledgeable and circumspect in their assessment of conclusory expert [testimony, and] require more reliable proof of the connection between work effort and cardiac dysfunction." The Court also cautioned that "expert testimony that supports or contests a finding of causation on the basis of reasoning inconsistent with prevailing medical standards" should be met with skepticism. Applying the requirements of N.J.S.A. 34:15-7.2, as well as the principles set forth in Aladits and Hellwig, the judge of compensation determined that the petitioner had failed to sustain his burden of proof. In arriving at his conclusion, the judge of compensation characterized the opinion of the petitioner’s medical expert as largely conclusory in nature and without sufficient underlying basis to link his conclusions as to the petitioner’s condition to the facts of the case. “(His) opinion,” the judge of compensation reasoned, “was essentially that since petitioner was diagnosed with a heart disorder after the incident of September 11, 2006, the diagnosed condition occurred because of it.” Rather, the judge of compensation found the opinion of the respondent’s medical expert to be considerably more compelling. As the judge of compensation held: "I accept the opinion of [respondent's medical expert] the preexisting nature of petitioner’s condition[.] He explained what occurred physiologically within the petitioner to cause him to faint, and that this incident could not cause or aggravate petitioner’s cardiomyopathy. [As such,] I find that his opinion is more logical and persuasive than the opinion expressed by [petitioner's medical expert]."

Case Law Alert - 1st Qtr 2011