Carpenter's Case
Carpenter's Case
Opinion of the Court
David Carpenter (employee), a custodian at an elementary school in the city of Woburn (employer), died at the age of fifty-two while at work and after operating a heavy, commercial snow blower. He experienced “sudden cardiac death” (SCD) due to ventricular arrhythmia.
1. Background. We summarize the facts found by the administrative judge and adopted by the board.
At 12:15 p.m., the employee went to lunch with his wife. During lunch, he did not voice any complaints or indicate that he was not feeling well. He returned to work at approximately 1:30 p.m.. At the time, it was cold outside, with temperatures ranging between nineteen and thirty-three degrees Fahrenheit.
The employee resumed operating the snow blower to improve the paths he had completed before lunch. His coworker heard the motor of the snow blower running continuously and, at approximately 1:50 p.m., went to check on the employee. He found the employee motionless, leaning against a snow drift “higher than a man” beside the snow blower. Emergency medical person
2. Standard of review. An aggrieved party may seek judicial review of a decision of the board concerning workers’ compensation benefits. G. L. c. 152, § 12 (2). As specified in G. L. c. 152, § 12 (2), we review the board’s decision in accordance with the standards set forth in G. L. c. 30A, § 14 (7) (a)-(d), (f), and (g). Scheffer’s Case, 419 Mass. 251, 257-258 (1994). Pursuant to these statutory standards, we may reverse or modify the board’s decision when it is “[i]n violation of constitutional provisions,” “[i]n excess of the statutory authority or jurisdiction of the agency,” “[bjased upon an error of law,” “[mjade upon unlawful procedure,” “[ujnwarranted by facts found . . . where the court is constitutionally required to make independent findings of fact,” or is “[ajrbitrary or capricious, an abuse of discretion, or otherwise not in accordance with law.” G. L. c. 30A, § 14 (7) (a)-(d), (f), and (g). Under these standards, in determining whether the board properly affirmed the administrative judge’s findings, we consider “whether the decision is factually warranted and not ‘[ajrbitrary or capricious,’ in the sense of having adequate evidentiary and factual support and disclosing reasoned decision making.” Scheffer’s Case, supra at 258. See Robinson’s Case, 416 Mass. 454, 457 (1993) (standards identified in G. L. c. 152, § 12 [2], “may overlap with the substantial evidence standard”). Where a statute is involved, “[ajlthough ‘[tjhe interpretation of a statute by the agency charged with primary responsibility for administering it is entitled to substantial deference,’ Gateley’s Case, 415 Mass. 397, 399 (1993), ultimately the ‘duty of statutory interpretation is for the courts.’ Slater’s Case, 55 Mass. App. Ct. 326, 330 (2002).” Moss’s Case, 451 Mass. 704, 709 (2008).
3. Discussion, a. Application of § 7A. The insurer asserts that the employee’s SCD was inevitable and its occurrence at work was coincidental. Consequently, the insurer states that the board erred in affirming the administrative judge’s decision, arguing that he improperly applied § 7A on the issue of the causal link between employment and death. In support of this argument, the insurer contends that the administrative judge’s decision
In Moss’s Case, supra at 707-708, we provided a comprehensive overview of § 7A, see note 2, supra:
“Section 7A is designed to ‘[t]o aid the victimf] of an unwitnessed accident’ who is unable to testify and therefore has difficulty meeting the burden of proving entitlement to compensation under G. L. c. 152. L.Y. Nason, C.W. Koziol, & R.A. Wall, Workers’ Compensation § 17.4 (3d ed. 2003). See id. at § 10.11. The section by its terms establishes prima facie evidence of four separate aspects of a workers’ compensation claim: (1) ‘that the employee was performing his regular duties on the day of injury or death’; (2) ‘that the claim comes within the provisions of [c. 152]’; (3) ‘that sufficient notice of the injury has been given’; and (4) ‘that the injury or death was not occasioned by the willful intention of the employee to injure or kill himself or another.’ G. L. c. 152, § 7A. In Anderson’s Case, [373 Mass. 813 (1977)], this court held that particularly the second of these, ‘the claim comes within the provisions of [c. 152],’ reflected a legislative intent that where an employee was found dead at his job, this fact should establish prima facie evidence that the employee’s death was causally related to his employment. The court stated:
‘For a claim to be compensable it must arise out of and in the course of employment. Clearly a causal relationship is required between the employment duties and the injury or death. In a case such as this one, where the employee was found dead at his place of employment, we construe the statute, § 7A, as establishing, inter alla, prima facie evidence of causal relationship between the employment and the injury or fatality. We believe that was the meaning intended by the Legislature, particularly in its use of the words, “and that the claim comes within the provisions of this chapter.” Anderson’s Case, [supra] at 816-817.’ ”5
An insurer may overcome the prima facie evidentiary effect
“Prima facie evidence, in the absence of contradictory evidence, requires a finding that the evidence is true; the prima facie evidence may be met and overcome by evidence sufficient to warrant a contrary conclusion; even in the presence of contradictory evidence, however, the prima facie evidence is sufficient to sustain the proposition to which it is applicable.”
If an insurer produces “evidence sufficient to warrant a contrary conclusion,” id., on a fact set out in § 7A, a question of fact arises for an administrative judge to decide, and the judge must weigh the evidence and make credibility determinations in reaching a conclusion. Such credibility determinations are within the sole province of an administrative judge and are to be considered final by both the reviewing board and an appellate court. Lettich’s Case, 403 Mass. 389, 394 (1988). See Pilon’s Case, 69 Mass. App. Ct. 167, 169 (2007) (“Findings of fact, assessments of credibility, and determinations of the weight to be given the evidence are the exclusive function of the administrative judge”). Where, as here, “causal relation is a matter beyond the common knowledge and experience of the ordinary layman, the proof must rest upon expert medical testimony.” Buck’s Case, 342 Mass. 766, 769 (1961). “The probative value of this testimony is to be weighed by the fact-finding tribunal.” Fitzgibbons’s Case, 374 Mass. 633, 635 (1978).
Before addressing the insurer’s arguments, we summarize the findings and conclusions of the administrative judge, as well as the conclusions drawn by the board. The administrative judge first determined that the employee was in the course of his employment when he suffered SCO and that, consequently, the prima facie evidentiary effect of § 7A applied. He credited the findings of the limited autopsy conducted of the employee’s heart. The autopsy indicated that the employee was suffering from an occlusion (narrowing) of over ninety per cent of the left anterior descending coronary artery. It also revealed that the
The administrative judge adopted the conclusion, reached both by one of the employee’s medical experts, Dr. Richard D. Patten, and by the insurer’s medical expert, Dr. Milo F. Pulde, that the employee’s SCD resulted from ventricular arrhythmia, see note 1, supra. As to the insurer’s defense under § 1 (7A) concerning the effect of the employee’s preexisting coronary artery disease, the administrative judge adopted Dr. Pulde’s (insurer’s expert) opinion that the employee did, in fact, suffer from a preexisting condition. Specifically, Dr. Pulde gave the opinion that, prior to his death, the employee suffered “with severe multivessel coronary disease with critical ninety-five per cent obstruction of the major left anterior descending artery . . . and less critical disease of the remaining arteries.” Dr. Pulde’s opinion was based on the records of the employee’s primary care physician (PCP), Dr. Arthur S. Kress, which indicated that the employee suffered, on January 4, 2005, from unstable angina
The administrative judge expressly credited the following testimony of Dr. Pulde, elicited during cross-examination, concerning the effect of physical exertion on the employee’s biological death: “[A]ny type of exertion, whether one postulates that [the employee’s death was] ischemia related or substrate related . . . would have precipitated [the employee’s] sudden death and ... his sudden death was likely to occur in any context [in] any type of physical activity and would have occurred independent of that work activity on January 24, 2005” (emphasis added). The administrative judge, however, expressly rejected Dr. Pulde’s opinion that the employee’s work activities on January 24, 2005, did not trigger the medical events that culminated in his SCD.
The administrative judge concluded that “the insurer has not
The board concluded that the administrative judge “properly determined that § 7A applied to this case.” Concerning the administrative judge’s conclusion that Dr. Pulde’s opinion did not overcome the prima facie evidentiary effect of § 7A, the board determined that this conclusion was supported by the record and was “consistent with § 7A’s application.” Additionally, the board decided that the administrative judge’s findings provided the necessary factual predicate to support his adoption of Dr. Kress’s opinion.
Here, the insurer essentially asserts that once the administrative judge adopted some of Dr. Pulde’s opinions, it was inconsistent and erroneous not to apply them all, specifically, Dr. Pulde’s opinion that the employee’s work on January 24, 2005, had no causal relation to his death. Although the insurer did produce evidence, through Dr. Pulde’s testimony, in an attempt to overcome the prima facie evidentiary effect of § 7A (and offered Dr. Pulde’s opinion in support of its defense under § 1 [7A]), the administrative judge was not required to credit all of Dr. Pulde’s testimony, particularly when, as relevant to the issue whether the employee’s death was work-related, there existed contrary evidence, namely Dr. Kress’s opinion, which the administrative judge was entitled to credit.
b. Application of defense under § 1 (7A). Although the administrative judge considered (and rejected) the insurer’s defense under § 1 (7A), the board concluded that, in cases where an employee is found dead at the workplace, only § 7A applies and the “combination injury” defense, see note 3, supra, under
“[A] statute must be interpreted according to the intent of the Legislature ascertained from all its words construed by the ordinary and approved usage of the language, considered in connection with the cause of its enactment, the mischief or imperfection to be remedied and the main object to be accomplished, to the end that the purpose of its framers may be effectuated.” Board of Educ. v. Assessor of Worcester, 368 Mass. 511, 513 (1975), quoting Industrial Fin. Corp. v. State Tax Comm’n, 367 Mass. 360, 364 (1975). “[T]he statutory language itself is the principal source of insight into the legislative purpose.” Hoffman v. Howmedica, Inc., 373 Mass. 32, 37 (1977). We “must ascertain the intent of a statute from all its parts and from the subject matter to which it relates, and must interpret the statute so as to render the legislation effective, consonant with sound reason and common sense.” Harvard Crimson, Inc. v. President & Fellows of Harvard College, 445 Mass. 745, 749 (2006).
The board’s analysis overlooks the workers’ compensation statute (Act) as a whole, as well as the circumstances pursuant to which the defense under § 1 (7A) was enacted. Significantly, the Act contemplates compensation for both work-related deaths and personal injuries; it is not solely concerned with the latter. That a death is not specifically included in the definition of the term “personal injury” is inconsequential. An examination of the definition reveals that the term does not state what a “personal injury” actually is; rather, it includes and excludes only certain categories of personal injuries, and notably neither includes nor excludes a death.
Application of the combination injury defense pursuant to § 1 (7A) effectuates the Legislature’s targeted reform by limiting compensation in certain cases where a noncompensable preexisting condition exists. The obvious concern was to withhold compensation in circumstances where a noncompensable, preexisting condition merely happens to manifest itself at the employee’s workplace and has no relation to the employee’s actual work. See Maggelet’s Case, 228 Mass. 57, 61 (1917). This concern exists not only in circumstances where the noncompensable preexisting condition combines with a compensable injury or disease to result in personal injury, but also in cases where the combination injury results in death.
The insurer asserts that death cannot constitute an injury under the combination injury defense of § 1 (7A) and that, therefore, the employee’s SCD can never be a compensable
Consideration of the effect of a preexisting condition in situations involving a work-related death is not inconsistent with § 7A. If a noncompensable preexisting condition does not exist, only § 7A will apply (if the employee’s death occurred at the workplace), and the defense under § 1 (7A) will not be implicated.
When there is a noncompensable preexisting condition that combines with a compensable injury and results in a workplace death, application of the defense somewhat alters the insurer’s burden of production in rebutting the prima facie evidentiary effect of § 7A. First, the insurer must present evidence that a noncompensable preexisting condition existed at the time of the employee’s death. The production of this evidence, together with appropriate medical expert evidence on the issue of causation, would allow the insurer to argue that the employee’s death was caused solely by the preexisting condition. Second, where an employee’s workplace death does follow a combination injury (and the insurer does not argue that the death resulted solely from the noncompensable preexisting condition), the insurer will need to submit appropriate medical expert evidence that the compensable part of the combination injury (here, the ventricular arrhythmia or fibrillation) was not a major cause of the death, which includes a causal showing that the compensable
c. Administrative judge’s determinations under § 1 (7A). We reject the insurer’s contention that the administrative judge’s decision does not sufficiently analyze the element of causation under § 1 (7A). The judge’s extensive factual findings, supplemented with uncontested evidence from the record, provide the necessary factual predicate to support his conclusions, including his rejection of the insurer’s defense under § 1 (7A).
The board incorrectly concluded that the defense under § 1 (7A) and the prima facie evidentiary effect of § 7A are mutually exclusive. Apart from making this erroneous conclusion, the board properly affirmed the administrative judge’s decision. We therefore affirm the decision of the reviewing board, as so modified.
So ordered.
There was expert medical evidence defining sudden cardiac death (SCD) as “the natural death from cardiac causes that is heralded by the abrupt loss of consciousness within one hour of the onset of symptoms in individuals with or without known pre-existing heart disease, but in who the time and mode of death are unexpected.” Although the risk of SCD is highest in individuals with coronary artery disease (CAD), more than eighty per cent of the incidence of SCD occurs in asymptomatic individuals who have no prior history of CAD and who do not experience a myocardial infarction (heart attack). About eighty per cent of SCDs occur in “nonexertional circumstances.” A person with ventricular arrhythmia has an irregular heart rhythm caused by abnormal electrical impulses in the ventricles of the heart.
General Laws c. 152, § 7A (§ 7A), provides:
“In any claim for compensation where the employee has been killed or found dead at his place of employment or, in the absence of death, is physically or mentally unable to testify, and such testimonial incapacity is causally related to the injury, it shall be prima facie evidence that the employee was performing his regular duties on the day of the injury or death and that the claim comes within the provisions of this chapter, that sufficient notice of the injury has been given and that the injury or death was not occasioned by the willful intention of the employee to injure or kill himself or another.”
The fourth sentence of G. L. c. 152, § 1 (7A) (§ 1 [7A]), provides, in relevant part: “If a compensable injury or disease combines with a preexisting [non-compensable condition] to cause or prolong disability or a need for treatment, the resultant condition shall be compensable only to the extent such compensable injury or disease remains a major but not necessarily predominant cause of disability or need for treatment.” We shall refer to this particular provision as the defense under § 1 (7A) or the “combination injury” defense, see Cornetta’s Case, 68 Mass. App. Ct. 107, 117 (2007).
We occasionally supplement the facts with uncontested evidence from the hearing the administrative judge conducted. See Sikorski’s Case, 455 Mass. 477, 478 (2009).
In Moss’s Case, 451 Mass. 704, 710 (2008), we stated that, while § 7A establishes prima facie evidence of the facts set out in that section, it does not
The employee was five feet, ten inches tall, and weighed 179 pounds. He exercised regularly and was considered to be in good physical condition. The judge found that the employee went to Dr. Kress on January 4, 2005, complaining of upper back and shoulder pain. Dr. Kress conducted an electrocardiogram that was within normal limits. Dr. Kress noted that the employee had several cardiac risk factors, including an elevated cholesterol level that was being treated successfully with medication; a family history of CAD; and a past history of smoking. Dr. Kress scheduled an exercise treadmill test after seeing the employee (it had been scheduled sometime prior to January 24, 2005), but the employee canceled the appointment.
Polymorphic and monomorphic ventricular tachycardia refer to fast heart rhythms arising in the ventricles of the heart. Stedman’s Medical Dictionary 979, 1235, 1550 (25th ed. 1990). These rhythms may deteriorate into ventricular fibrillation, which is defined as “fine, rapid, fibrillary movements of the ventricular muscle that replace the normal contraction,” id. at 580-581, and which, if not corrected with emergency treatment, results in death within a few minutes.
Dr. Pulde explained that “the activity [the employee] performed [on] January 24, 2005, certainly can induce ischemia, but ... it was not an inordinate or excessive amount of physical activity that was disproportionate to any other type of activity done in the work environment, and therefore it should not be considered a trigger based on our definitions of what represents triggers.”
Dr. Patten reached the same conclusion.
Dr. Pulde’s opinion on the issue of work-related exertion was contrary to that of Dr. Kress and Dr. Patten. Dr. Kress’s opinion took into account that the employee had been engaged in “heavy exertion” just before his death. While Dr. Patten opined that the employee’s physical activity on January 24, 2005, was a major contributing factor in his death, his opinion was based on the fact that the employee had engaged in “a significant level” of “strenuous physical activity.” While the record certainly would have supported a finding that on
The administrative judge implicitly rejected critical components of the basis of Dr. Pulde’s opinion that the employee’s death was not precipitated by
Section 1 (7A) of G. L. c. 152 defines the term “personal injury” as follows:
“ ‘Personal injury’ includes infectious or contagious diseases if the nature*447 of the employment is such that the hazard of contracting such diseases by an employee is inherent in the employment. ‘Personal injury’ shall not include any injury resulting from an employee’s purely voluntary participation in any recreational activity, including but not limited to athletic events, parties, and picnics, even though the employer pays some or all of the cost thereof. Personal injuries shall include mental or emotional disabilities only where the predominant contributing cause of such disability is an event or series of events occurring within any employment. If a compensable injury or disease combines with a pre-existing [non-compensable condition] to cause or prolong disability or a need for treatment, the resultant condition shall be compensable only to the extent such compensable injury or disease remains a major but not necessarily predominant cause of disability or need for treatment. No mental or emotional disability arising principally out of a bona fide, personnel action including a transfer, promotion, demotion, or termination except such action which is the intentional infliction of emotional harm shall be deemed to be a personal injury within the meaning of this chapter.”
During cross-examination, Dr. Pulde agreed that when a person goes into arrhythmia and progresses toward what would be SCD, the SCD may be aborted, and the person may survive, if there is an opportunity to provide cardiopulmonary resuscitation and to defibrillate the person within four minutes.
This showing does amount to a heightened standard of causation, see Castillo v. Cavicchio Greenhouses, Inc., 66 Mass. App. Ct. 218, 221 (2006), in comparison to that in § 7A. The standard, however, is to be used only in cases involving the combination injury defense under § 1 (7A), and is not used in a § 7A case where there is no evidence of a preexisting condition.
Reference
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