decided: November 23, 1977.
ANN MARIE HUDACK, PETITIONER
COMMONWEALTH OF PENNSYLVANIA, WORKMEN'S COMPENSATION APPEAL BOARD, LIVINGSTON CLUB AND ROYAL GLOBE INSURANCE COMPANY, RESPONDENTS
Appeal from the Order of the Workmen's Compensation Appeal Board in case of Ann Marie Hudack v. Livingston Club, No. A-71485.
Michael Prokup, with him Stamberg, Caplan & Calnan, for petitioner.
David G. Welty, for respondent.
President Judge Bowman and Judges Mencer and Blatt, sitting as a panel of three. Opinion by Judge Mencer.
[ 32 Pa. Commw. Page 509]
Ann Marie Hudack (claimant) appeals from a decision of the Workmen's Compensation Appeal Board (Board) affirming a referee's denial of compensation for a heart attack allegedly suffered by the claimant while at work on September 25, 1974. We affirm.
Claimant was employed as a waitress by the Livingston Club. For two weeks prior to September 25, 1974, claimant had been experiencing chest pains which were subsequently diagnosed as manifestations of a pre-existing progressive heart disease known as myocardial ischemia. On the day in question, while claimant was ascending a flight of stairs in the course of her employment, she experienced a severe pain in her chest which required her to sit down on the steps for about five minutes. Claimant worked the rest of the day as scheduled and consulted her family physician the next day. On October 4, 1974, claimant was examined by a cardiologist, Dr. Theodore Donmoyer, who concluded that she had suffered a myocardial infarction (heart attack) at some time during the preceding two weeks.
Heart attacks are compensable injuries under Section 301(c) of The Pennsylvania Workmen's Compensation Act (Act), Act of June 2, 1915, P.L. 736, as amended, 77 P.S. § 411(1), if they (1) arise in the course of employment and (2) are related thereto. Workmen's Compensation Appeal Board v. Auto Express, Inc., 21 Pa. Commonwealth Ct. 559, 346 A.2d
[ 32 Pa. Commw. Page 510829]
(1975). The second element has been interpreted to mean that a claimant must show a causal connection between his work and his heart attack. Workmen's Compensation Appeal Board v. Jeddo Highland Coal Co., 19 Pa. Commonwealth Ct. 90, 94, 338 A.2d 744, 747 (1975). Where this causal connection is not obvious, it must be established by unequivocal medical testimony. Heffer v. GAF Corp., 29 Pa. Commonwealth Ct. 365, 370 A.2d 1254 (1977).
In this case, the referee found, and the Board agreed, that the claimant failed to establish that her heart attack was causally connected to her employment. Claimant contends that the referee and the Board capriciously disregarded the testimony of claimant's cardiologist, Dr. Donmoyer, in reaching this conclusion.*fn1 However, the only testimony concerning causation is so ambiguous and uncertain in nature that we cannot conclude that the referee erred in deciding that the claimant had not established the necessary causal connection.
When asked whether, in his opinion, the claimant's exertion at work was a cause of the myocardial infarction, Dr. Donmoyer's reply was not entirely responsive to the question: "Well at any rate, ascending the stairs is a typical form of effort to cause pain in coronary disease and indeed with her, caused that pain." (Emphasis added.)*fn2 As to whether or not the "pain"
[ 32 Pa. Commw. Page 511]
experienced by the claimant at work was the actual heart attack or simply a manifestation of the pre-existing myocardial ischemia, Dr. Donmoyer testified that it was "impossible" to determine when the heart attack occurred. In view of the uncertain nature of the pain experienced by the claimant on the date in question, the above testimony is not equivalent to testimony that the claimant's exertion at work caused the heart attack. Indeed, in view of the rule which requires that causation be established by unequivocal medical testimony, it is doubtful whether Dr. Donmoyer's testimony would have been sufficient to sustain a finding that the causal connection existed. Compare Heffer v. GAF Corp., supra, with Workmen's Compensation Appeal Board v. Bowen, 26 Pa. Commonwealth Ct. 593, 364 A.2d 1387 (1976). In any event, since Dr. Donmoyer's own testimony created substantial uncertainty as to whether the heart attack was caused by the claimant's duties, it is clear that his testimony was not capriciously disregarded by the referee.*fn3
Since the referee was entitled to conclude that claimant had failed to establish the causal connection between her work and her injury, his decision was properly affirmed by the Board, and we therefore enter the following
[ 32 Pa. Commw. Page 512]
And Now, this 23rd day of November, 1977, the order of the Workmen's Compensation Appeal Board, dated October 7, 1976, affirming the referee's order of March 29, 1976, denying workmen's compensation benefits to Ann Marie Hudack, is hereby affirmed.