Appeal of Stetson

• Decision Date: 18 March 1994
• Docket Number: No. 92-362,92-362
• Parties: Appeal of Carl D. STETSON (New Hampshire Department of Labor Compensation Appeals Board).
• Court: New Hampshire Supreme Court

Page 245

639 A.2d 245

138 N.H. 293

Appeal of Carl D. STETSON (New Hampshire Department of Labor Compensation Appeals Board).

No. 92-362.

Supreme Court of New Hampshire.

March 18, 1994.

William P. Briggs, P.A., Kittery, ME (William P. Briggs on the brief and orally), for petitioner.

Devine, Millimet & Branch, P.A., Manchester (Richard E. Galway, orally and on the brief, and Julie Ann Boyle on brief), for Berlin City Ford.

THAYER, Justice.

The petitioner, Carl D. Stetson, appeals the decision of the New Hampshire Department of Labor Compensation Appeals Board (board) denying workers' compensation benefits based upon its determination that Stetson's claimed injury, a 100 percent occlusion of his left anterior descending artery, was not the result of stress generated by his employment. We affirm.

The petitioner suffered severe chest pains, sweating, and fainting on May 7, 1990, while employed by Berlin City Ford. He was taken from the dealership to the Androscoggin Valley Hospital where he was admitted as a cardiac patient. Testing performed at the hospital during his seventy-two hour stay revealed no clear abnormalities, and he was diagnosed as having angina. After being discharged from the hospital, the petitioner was referred to Dr. Emil Pollak of Mary Hitchcock Hospital. Two months later, because the petitioner did not respond to treatment for angina, a cardiac catheterization was performed, which revealed a 100 percent occlusion of the left anterior descending artery, a seventy-five percent occlusion of the circumflexed coronary artery, and a lesser occlusion in the right coronary artery.

Dr. Pollak, the petitioner's expert, opined that it was medically probable that the total occlusion of the left descending artery occurred on May 7, 1990, as a result of the stress that the petitioner experienced at work on that day. Based upon his belief that total occlusion could not occur absent severe pain unless there existed a collateral blood supply to the heart, Dr. Pollak opined that the occlusion most likely occurred on or about the time that the petitioner experienced severe chest pains at work. The employer's expert, Dr. Elliot L. Sagall, disagreed with Dr. Pollak's analysis. Based upon a review of the petitioner's medical records, he testified that while the occlusion possibly occurred on May 7, 1990, there were various equally possible explanations for the angina symptoms. He stated that he could not say with reasonable medical certainty or probability that the 100 percent occlusion occurred on May 7, 1990, or that it occurred as a result of stress from the petitioner's job. He opined that the occlusion which petitioner claims as his injury might just as probably have occurred before or after May 7 as on that day.

The board accepted Dr. Sagall's opinion, and found that "it is equally plausible that the 100% occlusion developed before May 7 as after." In so doing, the board considered Dr. Pollak's testimony that collateral sources of blood feeding the petitioner's left descending artery could have rendered the condition asymptomatic, and could account for the lack of damage to the heart tissue in spite of the blockage. The board also accepted Dr. Sagall's explanation that a total occlusion could exist without pain to the petitioner. The board therefore held that the petitioner had failed to present sufficient evidence to establish his claim that the stress at work on May 7, 1990, triggered physiological changes resulting in the total occlusion of the artery on that date.

We do not overturn agency decisions or orders, absent an error of law, "unless the court is satisfied, by a clear preponderance of the evidence before it, that such order is unjust or unreasonable." RSA 541:13 (1974); Appeal of Nolan, 134 N.H. 723, 727-28, 599 A.2d 112, 115 (1991).

To obtain workers' compensation benefits for a heart-related disability, the plaintiff must prove both legal and medical causation. Cheshire Toyota/Volvo, Inc. v. O'Sullivan, 129 N.H. 698, 700-01, 531 A.2d 714, 715 (1987); New Hampshire Supply Co. v. Steinberg, 119 N.H. 223, 230, 400 A.2d 1163, 1168 (1979). In order to show legal causation where, as here, the petitioner suffered from preexisting coronary artery disease, the petitioner must show that his employment "contribute[d] something substantial" to the heart-related condition by demonstrating that the work-related stress was greater than that encountered in his non-employment life. Steinberg, 119 N.H. at 231, 400 A.2d at 1168. The board found that the petitioner's job was extremely stressful on a regular basis, and that on May 7, 1990, the petitioner experienced a "very demanding morning." While the board does not so state explicitly, from its factual finding of the stressful work environment, it apparently concluded that the petitioner had met the test for legal causation.

As for medical causation, the petitioner bears the burden of proving, by a preponderance of the evidence, that his work-related stress caused or contributed to the occlusion as a matter of medical fact. See Bartlett Tree Experts Co. v. Johnson, 129 N.H. 703, 709, 532 A.2d 1373, 1376 (1987). The petitioner contends that the board misapplied this standard, arguing that "[t]he fact that Mr. Stetson's collapse followed prolonged worsening employment-related stress as well as immediate and acute physical exertion from pounding vigorously on a counter meets the medical causation element of Steinberg, that the...