ALJ Geraghty Denies Claim for Cardiac Death Based Upon Causally Related Weight Gain and Risk Factors

Larry B. Breen vs. Electric Boat Corp.  (full decision)

Excerpt


3. Weighing All The Evidence

Once an employer rebuts the Section 20(a) presumption, “the ALJ must weigh all of the
record evidence to determine whether the claimant has established the necessary causal link
between the injury and employment.” Fields, 599 F.3d at 53; see Preston, 380 F.3d at 605;
Brown, 194 F.3d at 5. The Claimant bears the ultimate burden of persuasion. Fields, 599 F.3d at
53; Director, Greenwich Collieries, 512 U.S. at 281. I must now weigh all of the evidence and
determine whether the Claimant has established by a preponderance of the evidence that the
Decedent’s work-related back injuries caused, contributed, or hastened his death.
In the present matter, all of the medical experts agree that Decedent’s coronary artery
disease was the direct cause of his death. All of the physicians also agree that Decedent’s
morbid obesity contributed to his diabetes, hypertension, obstructive sleep apnea and coronary
artery disease. However, the medical experts differ with regard to whether the Decedent’s workrelated
back injuries contributed to his morbid obesity. The key difference in the opinions
between the Claimant’s expert, Dr. Baker, and the Employer’s experts, Dr. Morgan and Dr.
Tousignant, is that the Claimant’s expert states the Decedent’s work-related back injury was a
direct and proximal cause of the Decedent’s morbid obesity. Dr. Baker linked Decedent’s lack
of physical activity to his chronic back pain and he linked Decedent’s overeating, at least in part,
to depression associated with both chronic back pain and PTSD. Based upon this linkage, Dr.
Baker opined that morbid obesity contributed to the other medical conditions which hastened
Decedent’s death, thereby, connecting the back injuries to Decedent’s death many years later. In
contrast, the Employer’s medical experts concluded that the back injuries Decedent sustained
working for Electric Boat did not contribute to his morbid obesity, and rather his progression
from obesity to morbid obesity over the years is attributed to his binge eating disorder, diabetes
treatment and family history of obesity, diabetes and cardiac disease.
In 1983, Decedent had specific physical limitations as a result of his back injuries and
some residual pain. However, he was able to return to work for 11 months in 1988-1989.27

26 Dr. Tousignant noted that individuals with a body mass index above 30, which Decedent had in 1981, are at substantially higher risk for developing diabetes and coronary artery disease. The Decedent’s progression to morbid obesity certainly contributed to both of these medical conditions.
27 The fact Decedent returned to work for 11 months in 1988-89 undermines Mrs. Green’s testimony that from 1984 to the mid 1990’s the Decedent could not sleep, walk, or exercise because those activities bothered his back.
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Thereafter, it appears he did not work. The absence of any medical treatment records for the
period 1984-2000 with the exception of the 1989 visit to Dr. Selden for back pain after hanging
wallpaper does not assist the Claimant in her efforts to prove that the Decedent’s back pain
precluded virtually all physical activity. After the Decedent slipped and fell at the supermarket
in 2000, he reported back pain to the VA, sought treatment and was diagnosed with another
herniated disc and radiculopathy. By that point Decedent had gained almost 100 pounds. The
VA records reflect that Decedent had back pain which limited activity, but the records does not
indicate that Decedent was incapable of any physical activity, and indeed the VA physicians
recommended walking and swimming. Additionally, I am persuaded by Dr. Tousignant’s
opinion that one loses weight by reducing caloric intake, even if one is not physically active. Dr.
Tousignant’s practice specialty is weight loss and I credit his opinion in this regard. The VA
treatment records overwhelmingly demonstrate that the Decedent did not reduce his caloric
intake, but rather engaged in binge eating episodes over a long period of time, had insulin
dependent diabetes, and likely had a glandular condition all of which resulted in significant
additional weight gain.28

Dr. Baker’s belief that the VA treatment records attribute Decedent’s overeating to
depression, related in part, to his chronic daily back pain is not supported by the VA records.
The treatment records for depression covering the period 2004 to 2006 reflect that the depression
resulted from Decedent’s Vietnam experiences and flashbacks from that period as well as from
family interpersonal issues. The treatment records in the period 2008-2009 indicate that the
Decedent’s depression increased over that time as a result of PTSD related to service experiences
and disappointment/frustration over his unsuccessful efforts to sustain weight loss and qualify for
bariatric surgery. Because the VA records do not provide the linkage Dr. Baker claims, his
opinion connecting Decedent’s depression to overeating binges and back pain is not credited.
Accordingly, I find that the Claimant has failed to establish by a preponderance of evidence that
the Decedent’s work-related back injuries caused, contributed, or hasted his death from sudden
cardiac arrhythmia exacerbated by morbid obesity, coronary artery disease, diabetes, and
hypertension. It is, therefore, unnecessary to reach the remaining issues in dispute.

28 The Claimant’ testimony that the Decedent did everything he was supposed to do to lose weight is inconsistent with the contemporaneous treatment records. While he made some attempts to lose weight, the records establish that Decedent’s effort was not consistent and he was unable to make different dietary choices over any sustained period of time. I recognize that Decedent’s struggle was contributed to by an eating disorder and likely a glandular issue. Nevertheless, I cannot credit Claimant’s statements that Decedent complied with all guidance and instruction regarding weight loss efforts.