Opinion
BOARD No. 03060595
Filed: September 25, 1998
REVIEWING BOARD DECISION
(Judges Maze-Rothstein, Carroll Levine)
APPEARANCES
Cynthia A. Spinola, Esq., for the employee at hearing.
Cynthia A. Spinola, Esq., and Kenneth P. Ferris, Esq., for the employee on brief.
William J. Doherty, Esq., for the self-insurer.
With his claim for a closed period of G.L.c. 152, § 34, temporary total and ongoing § 35 partial weekly compensation benefits denied by a hearing decision, the employee appeals. As one ground, he asserts that the judge mischaracterized the opinion of his treating physician and relied on that mischaracterization in determining the issue of causal relationship. We recommit the case for further findings or clarification.
William Croze was a machinist. At hearing he was forty-nine years old. Since 1972, after graduating high school, he worked for the employer, Kimberly Clark Corporation. Prior to February 1995 he worked substantial overtime, mostly on a voluntary basis. (Dec. 3, 4.)
On February 16, 1995 Croze felt ill while working his normal 7:00 AM to 3:00 PM shift. He nevertheless completed his duties. During the prior two weeks he had experienced epigastric pain and chest pain radiating to his shoulders. Pain was generally brought on by the exertions of lifting, climbing stairs and briskly walking in cold air. (Dec. 4.)
After completing work on February 16, 1995, Croze dined out with his wife and then returned home to watch television. He felt better during the evening. He went to bed but was called into work for an overtime shift, from 2:00 AM to 7:00 AM, during which time he performed "heavy exertional activities" that brought on not only epigastric and chest pain, radiating arm pain but also weakness, shortness of breath, light headedness and blurred vision. (Dec. 4, 5.)
After leaving work, Croze went home and called his internist with whom he had a previously scheduled appointment for evaluation of his epigastric and radiating arm pain. He saw his doctor at approximately 10:00 AM. An EKG monitor revealed that Croze had suffered a heart attack. He was immediately transported to a hospital. He underwent cardiac catheterization on February 21, 1995. On May 22, 1995 he returned to work in a light duty capacity with no overtime. On January 5, 1996 he underwent a second cardiac catheterization and placement of a stent. That procedure kept him out of work from January 23, 1996 until March 10, 1996. He can no longer work overtime due to his restrictions. (Dec. 5, 6.)
The employee filed a claim for benefits which the self-insurer resisted. Following a § 10A conference denying his claim, he appealed to a hearing de novo. The parties opted out of the § 11A impartial medical examination, in favor of submitting their own medical expertise. (Dec. 3.) The employee offered his hospitalization records and the deposition of Dr. Elliott Sagall. The doctor's opinion was that the heavy exertional activities at work on February 17, 1995, caused the employee's myocardial infarction that day during his shift between 2:00 AM and 7:00 AM (Dec. 7.) The self-insurer proffered the deposition of Dr. Milo Pulde who opined that the heart attack on or about February 16, 1995 was the natural, inevitable result of the employee's progressive and severe single vessel coronary artery disease causally related to the employee's acknowledged multiple cardiac risk factors. Dr. Pulde further felt there was no causal relationship between the employee's work or any exertional activities and his need for cardiac catheterization. (Dec. 6.)
Under the provisions of 452 CMR 1.10(7), when initial liability has not been established the parties may agree at the time of conference that an impartial physician is not required. Such agreement must be in writing.
The self-insurer also submitted a document titled "Attending Physician's Statement" completed as part of the employee's application for short-term disability benefits. In response to the question "Did the sickness or injury occur on the job?" the "yes" box was checked. On the following line, however, the doctor added, "unrelated to employment causally." The form is signed by Dr. Michael Kaplan. (Ir. Exhibit 2.)
However, on the same form, in response to the question "did the employee have specific problems on the job?" the "yes" box is also checked with the following explanatory language: "long hours and stress precipitated problems with heart [sic]."
The judge dismissed the claim, finding the employee's myocardial infarction did not arise out of or in the course of his employment. (Dec. 7-8.) The employee raises several arguments, one of which is dispositive. He asserts that the judge mischaracterized Dr. Kaplan's opinion on causality and then relied on the error.
In his decision the administrative judge made the following general finding:
based on the testimony of Dr. Pulde, which I adopt, the Employee did not sustain a personal injury, a myocardial infarction, arising out of and in the course of his employment on February 16 or 17, 1995. On this issue I also adopt the finding of his treating doctor, Michael Kaplan, that his myocardial infarction was "unrelated to employment causally".
(Dec. 7.)
The employee argues that in order to properly characterize Dr. Kaplan's opinion it must be looked at in its entirety and directs us to other portions of the same document which seemingly support causal relation.
At the outset we note that a judge is only required to state reasons for rejecting a medical opinion when it is the sole medical opinion in evidence. See Wheaton v. New England Pump, 11 Mass. Workers' Comp. Rep. 38, 41 (1997). Here, there was more than one medical opinion, leaving the judge free to adopt some, all or none of them so long as the opinion adopted adequately supported the ultimate finding on the issue. Vero v. Paul A. Dever School, 9 Mass. Workers' Comp. Rep. 36, 38 (1995); Martins v. Longview Fibre Co., 7 Mass. Workers' Comp. Rep. 72, 73 (1993).
We do not agree with the employee's contention that Dr. Kaplan's opinion was mischaracterized per se. Rather, we find Dr. Kaplan's opinion internally inconsistent and therefore insufficient to support the finding of no causal relationship.
The decision and the record reveal that evidence exists to support the ultimate conclusion of non-entitlement to weekly benefits as Dr. Pulde's opinion on the employee's myocardial infarction could suffice. Nonetheless, it was inaccurate to find that Dr. Kaplan, whose opinion the judge adopted along with that of Dr. Pulde, did not causally relate the employee's myocardial infarction to his work activities. (Dec. 7.) The document, given its inconsistency, is equivocal at best. As such, it is competent evidence of neither a positive or negative position on causation. Because Dr. Kaplan's deposition was not taken, the causal statements remain irreconcilable and we can not discern how much the judge relied on it. Where the degree of reliance on incompetent evidence cannot be determined, it is appropriate to recommit the case to resolve the issue. See G. L. c. 152, § 11C; O'Neil v. E.G. G., 9 Mass. Workers' Comp. Rep. 72, 73 (1995).
Accordingly, we recommit the decision for clarification and further findings consistent herewith.
So ordered.
________________________ Susan Maze-Rothstein Administrative Law Judge
________________________ Martine Carroll Administrative Law Judge
________________________ Frederick E. Levine Administrative Law Judge
FILED: September 25, 1998.