The issue in this workers’ compensation case is whether claimant’s heart attack, which occurred while he was driving a company car during his employment as a route supervisor for a milk distribution company, was job-related. The referee found that it was. The Workers’ Compensation Board (Board) reversed. On de novo review, ORS 656.298(6), we find that the preponderance of the evidence supports legal and medical causation and we reverse.
The incident at issue occurred on December 28, 1979, after claimant had driven from McMinnville to Milwaukie to deliver a 30-pound crate of whipping cream. On his return trip, he suffered pains deep in his chest and began to sweat so heavily that water dripped from his hair and his clothing was soaked. He stopped in Sherwood, telephoned his office and asked them to send someone to get him. When no one showed up, he began to drive again, but pulled off the road again near Newberg. He was picked up and taken to the Newberg Hospital by his immediate supervisor. He was diagnosed as having suffered an acute myocardial infarction. The treating physician’s report states that there was no previous history of exertional chest pain or "definite heart disease.”
To recover compensation for an on-the-job heart attack, claimant must show, first, that he exerted himself in carrying out his job and, second, that the exertion was a material contributing factor in producing the heart attack. The first is a question of legal causation; the second determines the issue of medical causation. Coday v. Willamette Tug & Barge Co.,
Both the referee and the Board agreed that claimant had established legal causation. The record clearly shows claimant was, in the days immediately preceding his heart attack, subject to physical stress, as well as substantial emotional stress. Claimant testified that, while his normal duties were basically management and sales, during holiday seasons
The next day, December 27, claimant went to work at 4 a.m. and drove a tractor and 35-foot trailer of products from McMinnville to Eugene. Upon his return to McMinnville he was called in by his immediate supervisor and told he had to discipline a driver about whom the firm had received complaints.
The facts thus amply demonstrate that claimant was suffering from a high degree of emotional stress: he was subject to "a lot of anxiety” over the disciplining of the driver, whom he himself had hired from another employer and whom he had previously felt to be an exceptional worker; his work hours were the cause of confrontations with his wife and tensions at home; and he was also
The question remaining is whether claimant established medical causation. This, of course, is a matter which must be established by medical experts. Dr. Sutherland, the treating physician, said that to his knowledge claimant’s work was not a causative factor, but Dr. Sutherland’s knowledge was based only on the St. Vincent’s medical reports and a written statement of an interview conducted with claimant by a claims investigator for the insurer. There were reports from two other physicians in evidence. Dr. Griswold, a professor of medicine at the University of Oregon Medical School, a certified internist and former head of the University of Oregon Medical School’s Division of Cardiovascular-Renal Diseases, never saw the claimant but stated in a letter to employer’s insurer that after reviewing the medical records from St. Vincent’s and the Newberg hospitals, Dr. Sutherland’s letter of March 6 and the insurer’s taped interview, "I cannot state that there was no relationship to [sic] his work activity and his myocardial infarction. On the other hand, * * * it can only be defined in the realm of possibility and not reasonable medical probability that his work activity was a substantial material contributing factor to his heart attack.”
At the hearing before the referee, Dr. Rosencrans, a board-certified internist on the staff of Salem and Polk Community hospitals, testified. He also had not examined the patient, but had reviewed Dr. Griswold’s report and the documents upon which it relied. In addition, Dr. Rosencrans, alone of the three physicians, had the opportunity to include in his analysis claimant’s account of the significant anxiety he felt over the upcoming disciplining of the driver, his exhaustion for several days preceding the incident, the
"[Claimant’s attorney]: Now, Doctor, based upon a reasonable, medical probability, do you have an opinion as to whether or not the man’s work activities and the stress that they produced on him — the working horns and also the situation, as far as firing this gentleman and the pressures of his job, as far as keeping products on the table — was a major, contributing factor to his myocardial infarction?
"Dr. Rosencrans: Yes, I agree. It would be a major, contributing factor. I think the man was overworked. This was an excessive load sort of thing I would not recommend to any patient that had coronary artery disease, and he did. He did a lot of heavy lifting, and he was under this anxiety, which works synergistically, which increased the stress upon him, so I think it was a major, contributing factor and I think that — that would be the most likely — you know — if you want to theorize about why he had the heart attack at that particular time, that would be my theory.”
The Board found claimant had failed to establish medical causation and that the referee erred in relying on the opinion of Dr. Rosencrans, because he was not a board-certified cardiologist and had not examined the claimant. The Board found the opinion of Dr. Sutherland most persuasive, because he was the treating physician, and stated "Dr. Sutherland did not believe the claimant’s work was the cause of his coronary artery disease or of his myocardial infarction.” We disagree. None of the three doctors said claimant’s work could not be the medical cause of his heart attack, and no other equally plausible theory was advanced. Compare Raines v. Hines Lbr Co.,
While the opinion of the treating physician is generally given great credence because of that doctor’s opportunity to see and treat the patient during the initial phases of disability, this is not a case in which such deference is appropriate. We said in Hammons v. Perini Corp.,
We find Dr. Rosencrans’ testimony, because it was based on more complete information, to be the most persuasive of that offered by the three physicians. The testimony of the other two doctors does not refute Dr. Rosencrans’ view that claimant’s work activity was a causative factor in his heart attack. On de novo review, we must determine which medical hypothesis is correct. Coday v. Willamette Tug & Barge, supra,
Reversed.
Notes
Claimant testified at the hearing that he had suffered chest pains approximately a year before this incident, and had been given an electrocardiogram and was found not be suffering from heart problems, but from "nerves.”
Claimant stated these holiday periods were Fourth of July, Labor Day, Thanksgiving, Christmas, New Years and Memorial Day.
Such discipline, according to applicable union procedures, involves counseling of the employe and a written reprimand.
Both the Board and the employer, on appeal, expend a significant effort in "credential squabbling” over Dr. Rosencrans and Dr. Griswold. Though the Board found Dr. Griswold to be a "well-known cardiologist” and Dr. Rosencrans not to be board certified, the record before us shows only that both are certified by the American Board of Internal Medicine. Dr. Sutherland’s resume indicates that he is also certified in cardiovascular disease by that Board. In any event, Dr. Rosencrans, who is at least a practicing cardiologist, was formerly a resident in psychiatry; thus his added expertise in considering the impact of emotional stress upon the body’s physical system may give his opinion added credibility.