IN THE SUPREME COURT OF TENNESSEE
AT NASHVILLE
FOR PUBLICATION
Filed: May 12, 1997
LARRY KRICK, )
)
Plaintiff-Appellant, ) LAWRENCE COUNTY
)
)
Vs. ) HON. JIM T. HAMILTON,
) JUDGE
CITY OF LAWRENCEBURG, )
)
Defendant-Appellee. ) No. 01S01-9511-CV-00220
For Plaintiff/Appellant: For Defendant/Appellee:
Ben Boston James A. Hooper
Christopher V. Sockwell Hopper & Plunk, P.C.
Boston, Bates & Holt Savannah, Tennessee
Lawrenceburg, Tennessee
FILED
May 12, 1997
Cecil W. Crowson
Appellate Court Clerk OPINION
JUDGMENT OF TRIAL COURT
REVERSED; CASE DISMISSED. ANDERSON, J.
We granted the motion for review to determine whether a policeman’s
coronary artery disease arose out of his employment for the City of
Lawrenceburg. The Lawrence County Circuit Court found that the police officer
sustained a compensable injury in the course and scope of his employment with
the City of Lawrenceburg. On appeal, the Special Workers’ Compensation
Panel reversed and dismissed the case, finding no compensable injury. After
carefully examining the record, we affirm the Panel’s findings of fact and
conclusions of law. The judgment of the trial court is reversed and the case
dismissed.
BACKGROUND
The proof is summarized as follows:
The plaintiff, Larry Krick, aged 44, worked as a police officer for the City of
Lawrenceburg since 1981. On August 24, 1993, Krick was on routine patrol
when he received a call that a woman had been shot and that her husband was
holding a weapon on her. Krick and another police officer went to the residence
of the woman and kicked in the front door to gain access to the house. As they
entered the house, Krick drew his revolver. He and his fellow officer could only
see about two feet in front of them, because the house was littered with boxes
and debris. The officers were forced to crawl through the house to try to find the
woman because of the accumulated boxes. They found the woman in a back
bedroom lying on the bed. The woman had not been shot. No one else was in
the house.
After the incident, Krick said that he was “nervous” and “tense.” He
experienced shortness of breath and had chest pain. Krick reported the pain to
his supervisor, who advised him to seek medical attention. Krick then went to
Baptist Hospital in Nashville, where he was seen by Dr. Charles Mayes, a
cardiologist. Dr. Mayes diagnosed coronary artery disease. Krick later
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underwent quadruple bypass surgery performed by Dr. Robert Hardin, a
cardiovascular surgeon. After approximately nine weeks, Krick returned to work.
After returning to work, Krick was promoted to lieutenant, and one month before
the trial, he was promoted to captain. At the time of the trial, Krick was the
second ranking police officer on the Lawrenceburg force and handled
administration for the department when the chief of police was absent.
Krick testified that he had never been told that he had coronary artery
disease prior to August 1993. He said that he had some hypertension, which he
described as a “borderline thing.” Krick was on medication for the high blood
pressure, and stated that it was under control most of the time. He also said that
he had successfully passed physical examinations before going to work for the
police department in July 1981. Approximately one week prior to the incident on
August 24, 1993, Krick became extremely hot and experienced shortness of
breath, but no chest pain, while mowing grass along a riverbank. He had to lie
down in a recliner until he cooled off. He then resumed mowing the yard.
The medical proof consisted of the testimony of several physicians by
deposition and is summarized as follows:
Dr. Haresh H. Khatri, a doctor of internal medicine, testified that he had
treated the plaintiff since 1988 and that he had prescribed medication for Krick’s
hypertension. He further stated that the plaintiff smoked one to two packs of
cigarettes per day, and as early as 1991, he had diagnosed the plaintiff as
having high cholesterol. When asked whether Krick’s occupation as a police
officer caused the blocked arteries, which resulted in the plaintiff experiencing
angina1, Dr. Khatri stated that the plaintiff had several risk factors for coronary
artery disease, including smoking, hypertension and elevated cholesterol. He
further stated that activity generally does not cause coronary artery disease, but
1
Angina pectoris was defined as chest pain due to insufficient blood supply reaching an
area of th e heart.
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activity can bring on a heart attack or angina, a symptom of blockage of the
arteries. He finally conceded that he did not know what part job stress played in
the plaintiff’s heart disease.
Dr. H. L. Thomas, a family practitioner, testified that he had treated Krick
since 1978 and had not found any evidence that the plaintiff had coronary artery
disease. He stated that, in his opinion, stress could lead to a coronary spasm,
which could cause a complete blockage of the arteries. He stated that activity
does not cause coronary artery disease, but could cause a coronary spasm.
Dr. Robert Hardin, the surgeon who performed Krick’s bypass surgery,
testified that prior to the surgery Krick had a 90 percent blockage of the left main
artery, 70 percent blockage of the mid-left anterior descending artery, 80 percent
blockage of the first obtuse marginal artery, and complete occlusion of the right
coronary artery. He also testified that there were multiple factors involved in
Krick’s coronary artery disease, and that stress was one of the factors. Dr.
Hardin testified that after his recovery, Krick had sustained a 15 percent
impairment based on the Fourth Edition of the Guidelines to Permanent
Impairment, published by the American Medical Association.
Dr. Laurence A. Grossman, a Nashville cardiologist, did not treat Krick,
but reviewed his medical records and the depositions of the plaintiff and Drs.
Khatri and Hardin. Dr. Grossman stated that the plaintiff had “long-standing
coronary heart disease,” as demonstrated by the cardiac catheterization and
coronary arteriographic study performed by Dr. Mayes. He testified that the
three main factors establishing coronary heart disease are cigarette smoking,
hypertension, and hyperlipidemia 2. Dr. Grossman emphasized that Krick did not
have a heart attack, but had severe angina, which resulted from the blocked
arteries. Dr. Grossman testified that the August 24, 1993 incident did not cause
2
Hyperlipidem ia is a gene ral term denoting elevated c oncen trations of f at in the plas ma.
Taylor, Elizab eth J., Dorland’s Illustrated Medical Dictionary (27th Ed. 1988).
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or aggravate Krick’s coronary artery disease. The stress may have aggravated
the symptoms of the disease, the angina, but did not cause the disease.
After considering the evidence, the trial court found that Krick’s coronary
artery disease arose out of and in the course and scope of his employment, and
that he had sustained a 37 ½ percent vocational occupational disability.
On appeal, the Special Workers’ Compensation Appeals Panel found that
the evidence preponderates against the finding that the plaintiff’s coronary artery
disease arose out of his employment. The Panel therefore reversed and
dismissed the case. We granted the motion for full court review and now affirm
the Panel’s findings of fact and conclusions of law for the reasons articulated
below.
COMPENSABLE INJURY
In workers’ compensation cases, the scope of review in this Court on
issues of fact is de novo upon the record of the trial court, accompanied by a
presumption of the correctness of the findings, unless the preponderance of the
evidence is otherwise. Tenn. Code Ann. § 50-6-225(e)(2)(Supp. 1996); Lollar v.
Wal-Mart Stores, Inc., 767 S.W.2d 143 (Tenn. 1989). Considerable deference
must be accorded the trial court’s factual findings on issues related to the
credibility of witnesses and the weight to be given their testimony. Humphrey v.
David Witherspoon, Inc., 734 S.W.2d 315 (Tenn. 1987). However, where the
issues involve expert medical testimony and all the medical proof is contained in
the record by deposition, as it is in this case, then this Court may draw its own
conclusions about the weight and credibility of that testimony, since we are in the
same position as the trial judge. Orman v. Williams Sonoma, Inc., 803 S.W.2d
672, 676-77 (Tenn. 1991). With these principles in mind, we review the record to
determine whether the evidence preponderates against the findings of the trial
court.
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In support of his position that his heart disease was an accidental injury
suffered during the course of his employment, Krick relies upon the statutory
presumption of causation contained in Tenn. Code Ann. § 7-51-201(a)(1). The
statute “establishe[s] a presumption that any impairment of health of [a] law
enforcement officer[ ] caused by hypertension or heart disease resulting in
hospitalization, medical treatment or any disability, shall be presumed (unless
the contrary is shown by competent medical evidence) to have occurred or to be
due to accidental injury suffered in the course of employment.” In order to rely
upon the presumption created by Tenn. Code Ann. § 7-51-201(a)(1), Krick must
show that (1) he was employed by a regular law enforcement department; (2) he
suffered from hypertension or heart disease resulting in hospitalization, medical
treatment or disability in the course of employment; and (3) prior to the injury he
had been given a physical examination which did not reveal the heart disease or
hypertension. Stone v. City of McMinnville, 896 S.W.2d 548, 550 (Tenn. 1995).
Once the prerequisites are established, then the presumption exists. In order to
overcome the presumption, “there must be affirmative evidence that there is not
a substantial causal connection between the work of the employee so situated
and the occurrence upon which the claim for benefits is based.” Id. See also
Wingert v. Government of Sumner County, 908 S.W.2d 921 (Tenn. 1995). In
other words, there must be “competent medical evidence” that there is a not a
substantial causal connection.
In this case, the record establishes the three prerequisites necessary to
establish the presumption that the coronary artery disease was an accidental
injury suffered in the course of employment. Clearly, Krick was a police officer
and he suffered the angina in the course of his work. Moreover, he testified that
he had never been told, despite several physical examinations, that he suffered
from coronary artery disease.
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The issue in this case, therefore, is whether there is competent medical
evidence that there is not a substantial causal connection between Krick’s work
as a police officer and the coronary artery disease. We agree with the Special
Panel that there is. Accordingly, the defendant has overcome the presumption
of causation.
In this case, Dr. Grossman, a qualified cardiologist, stated that job stress
played no role in Krick’s coronary artery disease. He stated that the disease was
caused by cigarette smoking, hypertension, and hyperlipidemia. This testimony
is affirmative evidence that there is not a substantial causal connection between
Krick’s work and his heart disease. Moreover, we note that the heart disease
consisted of one completely blocked and three substantially blocked coronary
arteries. Dr. Grossman testified that it was apparent from the tests performed by
Dr. Mayes that the disease was long-standing. The chest pain experienced by
the plaintiff at the time of the August 24, 1993 call was a symptom of the heart
disease, not the disease itself. Moreover, it defies common sense to assume
that Krick’s arteries became occluded as a result of the stress involved in the
August 1993 call.
As the Special Panel recognized, once the presumption of causation
established by Tenn. Code Ann. § 7-51-201(a)(1) is rebutted by the defendant, it
disappears, and the plaintiff must prove, by a preponderance of the evidence,
that his condition resulted from an injury by accident arising out of and in the
course of his employment. Thus, Krick was required to prove that his heart
disease was an injury by accident.
Occupational disease is an injury by accident. Tenn. Code Ann. § 50-6-
102(a)(5). Accordingly, in this case, Krick’s heart disease is deemed to be an
occupational disease if it arose out of and in the course of his employment.
However, heart disease arises out of employment only if (1) the disease can be
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determined to have followed as a natural incident of the work as a result of the
exposure occasioned by the nature of the employment, (2) it can be fairly traced
to the employment as a proximate cause, (3) it has not originated from a hazard
to which the worker would have been equally exposed outside of the
employment, (4) it is incidental to the character of the employment and not
independent of the relation of employer and employee, (5) it originated from a
risk connected with the employment and flowed from that source as a natural
consequence, though it need not have been foreseen or expected prior to its
contraction, and (6) there is a direct causal connection between the disease and
conditions under which the work is performed. Tenn. Code Ann. § 50-6-301.
We find that the evidence preponderates against a finding that Krick’s
heart disease arose in the course and scope of his employment. The medical
evidence does not establish a causal connection between the conditions of
Krick’s work and his coronary artery disease. Indeed, the evidence establishes
that the disease was instead primarily caused by hypertension, cigarette
smoking, and hyperlipidemia.
We have held that heart attacks are generally compensable as accidental
injuries when they are precipitated by physical exertion or strain or a specific
incident or series of incidents involving mental or emotional stress of an unusual
or abnormal nature. Bacon v. Sevier County, 808 S.W.2d 46 (Tenn. 1991);
Stone v. City of McMinnville, supra. The key to recovery in instances where it is
alleged that physical activity caused the heart attack, is whether “the disabling
heart attack is precipitated by the physical activity or exertion or physical strain of
the employee’s job.” Id. at 552, quoting Bacon, 808 S.W.2d at 50. In instances
where the plaintiff asserts that emotional stress caused the heart attack, the
disabling condition “must be immediately precipitated by a specific acute or
sudden stressful event.” Stone v. City of McMinnville, 896 S.W.2d at 552,
quoting Bacon, 808 S.W.2d at 52.
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In this case, Krick did not experience a heart attack; he experienced
angina, a symptom of heart disease. The angina may have been caused by the
stress of the August 1993 incident; however, Krick’s disability arose from the
heart disease, not the chest pain. The medical proof preponderates against a
finding that the heart disease was precipitated by the August 1993 incident.
Thus, Krick has failed to establish the compensability of his heart disease.
CONCLUSION
We therefore conclude that the evidence in this record preponderates
against the trial court’s finding that Krick sustained a compensable injury by
accident. The judgment of the trial court is reversed and the case dismissed.
Costs on appeal are taxed to the plaintiff/appellant.
E. RILEY ANDERSON, JUSTICE
Concur:
Birch, C.J.
Reid and Holder, JJ.
Drowota, J., Not Participating
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