Estate of Patrick L. Brooks v. Town of West Hartford

The claimant was represented by James C. Ferguson, Esq., Ferguson & Doyle, P.C., 35 Marshall Road, Rocky Hill, CT 06067.

The respondents were represented by Frank A. May, Esq., Montstream & May, L.L.P., Salmon Brook Corporate Park, 655 Winding Brook Drive, P.O. Box 1087, Glastonbury, CT 06033-6087.

This Petition for Review from the December 28, 2004 Finding & Dismissal of the Commissioner acting for the Sixth District was heard July 15, 2005 before a Compensation Review Board panel consisting of the Commission Chairman John A. Mastropietro and Commissioners Stephen B. Delaney and Michelle D. Truglia.

OPINION

JOHN A. MASTROPIETRO, CHAIRMAN. The claimant, the estate of Patrick L. Brooks, has petitioned for review from the December 28, 2004 Finding and Dismissal of its workers’ compensation claim by the Commissioner acting for the Sixth District. The estate argues on appeal that the trier erred by dismissing the instant claim for compensation. We find no error on review, and affirm the trial commissioner’s decision.

The trier found that the decedent worked for the respondent Town of West Hartford as a firefighter from September 13, 1992 until his death on November 12, 2002. His pre-employment physical showed no evidence of hypertension or heart disease. Based on the autopsy report and the death certificate issued by the Office of the Chief Medical Examiner, the cause of the decedent’s death appears to be “myocardial sarcoidosis.”

Dr. Dougherty, a cardiologist, testified that the decedent did not have “heart disease,” but rather had systemic sarcoidosis that involved multiple organs, one of which happened to be the heart. Sarcoidosis is a collagen vascular illness that affects multiple parts of the body. As a result of a secondary complication of sarcoidosis, nodules created electrical conduction problems in the decedent’s heart tissue, causing the organ to stop functioning. Dr. Dougherty explained that the analysis was similar to the progress of metastasized cancer. Although the heart was the final common pathway, as is often the case, the systemic illness of sarcoidosis caused the decedent’s death.

The trial commissioner found that this explanation of sarcoidosis was persuasive, and ruled that it did not constitute “heart disease” within the meaning of § 7-433c C.G.S. There was also no evidence that the decedent’s sarcoidosis arose out of and in the course of his employment. This led the trier to grant a subsequent requested correction by the respondents confirming that they had succeeded in meeting the rebuttable presumption of compensability that was statutorily in effect at the time of the decedent’s hire. See P.A. 92-81 (stating that members hired after July 1, 1992 would not be eligible for benefits if municipal employer proves by preponderance of evidence that impairment of health related to hypertension or heart disease is not job-related). Accordingly, the trier dismissed the compensation claim that was filed by the decedent’s estate, which has led us to this appeal.

We will not need to decide whether or not the “preponderance of evidence” standard for rebutting the § 7-433c presumption that was in effect between July 1, 1992 and July 1, 1996 applies to the decedent’s case. The dispositive issue is the first one: whether this board can overrule the trier’s determination that the decedent’s sarcoidosis did not constitute heart disease. One of the primary tenets of our standard of appellate review is that the trial commissioner has the right and the duty to decide how much of the medical evidence presented to him is persuasive and reliable. Duddy v. Filene’s (May Department Stores Co.), 4484 CRB-7-02-1 (October 23, 2002); Pallotto v. Blakeslee Prestress, Inc., 3651 CRB-3-97-7 (July 17, 1998). A commissioner may choose to credit all, part or none of an expert’s testimony. O’Reilly v. General Dynamics Corp., 52 Conn. App. 813, 819 (1999). On review, this board may not second-guess a commissioner’s inferences of evidentiary credibility, and we may reverse factual findings only if they are unsupported by the evidence or if they fail to include undisputed material facts. Id.; Warren v. Federal Express Corp., 4163 CRB-2-99-12 (February 27, 2001).

The trier in this case found Dr. Dougherty’s testimony to be most persuasive. In his September 22, 2003 report, Dr. Dougherty wrote that “Sarcoidosis . . . is diffuse, not isolated to the myocardium, i.e. heart, and as a result, it is the systemic involvement of a diffuse collagen vascular disease that results in death. . . . Unfortunately, systemic sarcoidosis is often fatal and [as] is the case with many illnesses, the heart is the final common pathway, however, as with cancer when the heart stops, the cause of death is the systemic illness, not the heart per se.” Respondents’ Exhibit 1.

In his July 22, 2004 deposition, Dr. Dougherty described sarcoidosis as an “inflammatory disease involving body tissues [that] . . . involves small bumps or nodes or nodules or granulomas within the tissue.” Respondents’ Exhibit 4, p. 5. Its etiology is poorly understood. With this systemic illness, “from the head to the lower legs to the skin to the heart to the lungs and liver and throughout the body these inflammatory nodules can set up housekeeping and land.” Id., p. 6. There is “no rhyme or reason” as to which body parts the disease will affect in a person, though the most common are the lungs, the skin, the lymph nodes, and the liver, in that order. Id., p. 9. “For example, if the patient presents with the left leg not moving correctly, potentially the sarcoid is pushing on the nerves going to the left leg and the neurosurgeon might be involved. If the sarcoidosis affects the heart, potentially the heart muscle or the heart’s electrical system might not work correctly and the cardiologist would be involved.” Id.

In the decedent’s situation, several different organs within the body were affected by sarcoidosis according to Dr. Dougherty, including the lungs and heart. With regard to the heart, granules of tissue deposited themselves in the muscle, creating electrical problems that led to the claimant’s demise. There was no evidence of atherosclerosis (hardening of the heart arteries), removing the possibility of blockages as a cause of death. The decedent had no signs of coronary artery disease, nor did he have signs of vascular disease or a blood clot. Instead, “patchy, pale yellow ill-defined nodules” created the granuloma process of sarcoidosis, which infiltrated the decedent’s heart and took root in his right ventricle (the part of the heart that pumps blood to the lung), with some growing nearly an inch and a half long. Id., pp. 16-20. Also affected were the papillary muscles (which tether the valves connecting blood flow between chambers of the heart) and the intraventricular septum (which houses the electrical pathway that stimulates the beat of the heart). The presence of nodules in the intraventricular septum interfered with this “electrical pathway.” Id., p. 22.

Ultimately, the crux of Dr. Dougherty’s reasoning was that, just as breast cancer or lung carcinoma can clinically manifest in the heart, so can sarcoidosis, which is what happened to the decedent. The diagnosis is not heart disease, however. The trial commissioner found that reasoning persuasive, and accepted that medical opinion. We have no basis to disturb that finding, as the doctor’s reasoning is quite clear.

We recognize that there is an element of “line-drawing” that must take place in defining heart disease. The body is a holistic machine, involving many interdependent parts. Yet, the ingestion of poison, the metastasizing of cancer, or the sudden impact of a bullet or a knife may all cause the heart to stop functioning by the introduction of an external agent, in contrast to coronary artery disease and vascular disease, which affect the structure of the heart itself. Sarcoidosis, as described by Dr. Dougherty, clearly involves the element of an outside agent (tissue granules), even though that agent is one produced by the body itself. We must respect the trial commissioner’s interpretation of that process as not being a form of heart disease under § 7-433c, and honor his reliance on the opinion of Dr. Dougherty. There is insufficient ground for reversal here.