Appeal from the Order of the Workmen's Compensation Appeal Board in case of Lois J. Moore, Claimant, widow of Thomas J. Moore, deceased v. Sears, Roebuck & Company, No. A-75414.
John E. Smith, with him William F. Sweeney and Harvey Pennington, Herting & Renneisen, for petitioner.
Arthur G. Girton, for respondent.
Judges Rogers, DiSalle and Craig, sitting as a panel of three. Opinion by Judge Craig.
[ 48 Pa. Commw. Page 163]
The claimant's decedent suffered a myocardial infarction and died on February 16, 1977. The Workmen's Compensation Appeal Board (board) affirmed the decision of the referee awarding fatal claim benefits under The Workmen's Compensation Act.*fn1 The decedent's employer has appealed.
Claimant's decedent was a refrigerator repairman, exposed for 23 years to extremely cold temperatures and freon gas in his work. At the time of his death, the employer had been paying him temporary total disability compensation for a condition in his hands which his physician referred to as trenchhand or cold-exposure arteritis, a condition of insufficient blood supply to an extremity. His fingers had become chronically sore, cold and at times extremely painful. Spasmodic contractions of the small blood vessels in the fingers ("vasospasm") caused the extreme pain.
To relieve the acute discomfort caused by vasospasm, the treating specialist, Dr. Horwitz, recommended first an arteriogram and then a sympathectomy, a surgical procedure in which a sympathetic nerve regulating blood flow to the hand is severed in order to eliminate the contractions causing the spasms, so that circulation to the extremity could increase.
Shortly after those tests and surgery, decedent developed an atrial fibrillation, a potentially lethal irregularity in the heartbeat. Quinidine quelled the problem at that time. A few months later he suffered the infarction which was the immediate cause of his death.
There is no dispute that claimant's "trenchhand" was a compensable work-related disability.
The referee made the following extensive finding:
The medical evidence shows and the referee finds that the myocardial infarction . . . was
[ 48 Pa. Commw. Page 164]
directly related to the arteritis (the trenchhand) sustained by claimant in his work as a refrigerator repairman and/or from the surgical intervention by claimant's medical expert in an effort to overcome the arteritis and the vasospasm. . . .
The arteritis and subsequent vasospasm were due to the cold exposure. The treatments administered to claimant's decedent were because of this. As a direct result of both the condition and the treatment therefor, in an effort to effect a cure, claimant's decedent suffered the sudden onset of the events [including the atrial fibrillation] that culminated in his death by myocardial infarction. Had claimant's decedent not had the exposure or the treatment, he would not have had the myocardial infarction which resulted in his demise. . . .
The general issue is whether the record reveals competent medical evidence to support adequately the finding of a causal connection between the work-related disability and decedent's death.
[ 48 Pa. Commw. Page 165]
We are confronted with the rule that where there is no obvious causal relationship between an employe's injury or death and a work-related incident, claimant must present unequivocal medical testimony to carry his burden of proof on causation. The medical testimony must establish, not that the injury or condition might have or possibly resulted from the assigned cause, but that in the professional opinion of a qualified medical witness, the result in question did come from the assigned cause. See, e.g., Owens v. Workmen's Compensation Appeal Board, 39 Pa. Commonwealth Ct. 510, 395 A.2d 1032 (1979); American Refrigerator Equipment Co. v. Workmen's Compensation Appeal Board, 31 Pa. Commonwealth Ct. 590, 377 A.2d 1007 (1977); Workmen's Compensation Appeal Page 165} Board v. Bowen, 26 Pa. Commonwealth Ct. 593, 364 A.2d 1387 (1976); Workmen's Compensation Appeal Board v. Allied Chemical Corp., 20 Pa. Commonwealth Ct. 562, 342 A.2d 766 (1975); Workmen's Compensation Appeal Board v. Adley Express Co., 20 Pa. Commonwealth Ct. 251, 340 A.2d 924 (1975); Dunlap v. Workmen's Compensation Appeal Board, 17 Pa. Commonwealth Ct. 19, 330 A.2d 555 (1975).
In this case, employer's medical expert presented a positive opinion that there existed no connection between the arteritis of the hand and the heart attack. The other medical expert witness, Dr. Horwitz, the treating cardiovascular specialist, testified on direct examination as follows:
A. . . . Mr. Moore had exposure to his hand causing an arteritis. There is no question about that at all. That is as close to a certainty ...