For affirmance -- Chief Justice Weintraub, and Justices Jacobs, Francis, Proctor, Hall, Schettino and Haneman. For reversal -- None. The opinion of the court was delivered by Francis, J.
[39 NJ Page 141] This is a workmen's compensation case. On July 13, 1951 Stanley S. Schiffres suffered a compensable heart attack. The resulting permanent disability was adjudged to be 37.5% of total and such an award was made on January 13, 1953. On January 3, 1955, about three and one-half years after the first incident, a second heart attack occurred. Within a day or so he had a stroke which produced a right side hemiplegia. Thereafter, on January 13, 1956 he filed a petition for additional compensation alleging an increase in disability and that it was chargeable to the 1951 heart attack. On August 29, 1958, before the case was reached for hearing, Schiffres died. Another petition was then filed seeking death benefits for his widow and minor daughter on the theory that the death was caused by the 1951 compensable incident. The Deputy Director awarded compensation for both the second heart attack and the death. The County Court reversed the judgment, whereupon an appeal was taken to the Appellate Division. We certified it on our own motion before argument there.
In 1951 and prior thereto, Schiffres was a school teacher in the New York City public school system. He taught social studies at John Adams High School in Ozone Park, Queens, 18-20 miles from his home in lower Manhattan. In the summer he was director of performing arts at respondent's camp in Layton, New Jersey. In addition, during the winter he acted as metropolitan area representative for the camp, soliciting campers for the ensuing summer on a commission basis, and handling many of the managerial details associated with the operation of the lodge.
On July 13, 1951 Schiffres was 40 years of age. On that day while engaged in his regular duties at the camp, he moved a heavy set of stage steps into place and while doing so, suffered a coronary occlusion. The closure and resulting infarction took place in the anterior wall of the left ventricle of the heart. He was hospitalized until August 19, 1951, and after a short stay at his sister's home, returned to his residence around the end of August. He resumed his school teaching post on November 19 after his sick leave expired.
The great weight of the evidence shows that prior to the occlusion Schiffres had an underlying arteriosclerotic cardiovascular disease. As one of his doctors put it:
"He had coronary sclerosis, I feel prematurely, which accounted for the July 1951 acute anterior coronary infarction. At that particular time he could have been about 40 years of age, which is somewhat young for this condition, but coronary sclerosis has been determined in individuals of that age who do get coronary insults every day. There is no question in my mind that the coronaries were involved at that time * * *."
No one suggests that the coronary sclerosis was originated by the July 1951 work incident. When the occlusion occurred, blood could not pass through and beyond the blocked vessel. The deprivation of blood and oxygen caused necrosis beyond that point but the closure not being of such a vital artery as to produce Schiffres' death, nature began to establish collateral circulation to take the place of the closed vessel.
Thereafter in the course of time, scar tissue formed at the site of the necrosis and, of course, the vessel no longer served any useful function in the blood circulatory system. As the collateral circulation began to establish itself, Schiffres improved and the improvement continued as the heart adapted itself to the altered circulation. By November he was able to return to teaching.
Resumption of teaching did not mean that no permanent incapacity had flowed from his coronary attack. The medical proof makes plain that then and at the hearing in January 1953, the occlusion had left him with some permanent impairment of cardiac reserve. The Deputy Director found its extent to represent 37.5% of total permanent disability. The finding meant that the compensable incident, acting on the underlying sclerosis so as to cause or contribute to the occlusion, had imposed on Schiffres an incapacity of that degree, which disability he was going to have for the rest of his life. The permanently lowered cardiac reserve signified also that he would have to adjust his life and his activities so as to live within the limit of physical capacity remaining with him. The award of the statutory portion of his wages for the period measured by 37.5% of total permanent disability represented the compensation provided under the Workmen's Compensation Act for the loss of that percentage of his physical capacity, and for the limitations, restrictions and discomforts that were to be its concomitants for the remainder of his life.
Dr. Harry E. Kroin who attended Schiffres from July 31, 1951 down to the time of his death, advised him that he would have to live a controlled life with definitely restricted physical activities. Upon the resumption of teaching, the doctor told Schiffres that he should limit his activity to the minimum necessary to perform the usual duties of a teacher. The record shows that at the school provision was made for the delivery of his lectures while seated and for a minimum of standing during classes. Classrooms on the first floor were provided and outside activities normally connected with the teaching occupation were curtailed.
Dr. Kroin advised moving nearer to the school. This was not done. Except for a short period after returning to teaching and until the second coronary occlusion occurred in January 1955, more than three years later, Schiffres took a bus from his house to the subway, rode the subway to the proper station, walked up two flights of steps to the street level, and then took another bus to the school. But he said the twice-a-day, 18-20 mile trip was engaged in with care and restraint upon expenditure of physical exertion.
It appears also that Schiffres continued to act as area representative of the camp and sought to recruit campers for the ensuing summer season. The extent to which this was done in the years between the first and second occlusions is not clear from the record. Since his social activities were restricted according to the testimony, presumably there was also some curtailment of the camp-related efforts. The proof disclosed further that he and his wife were employed at the camp every summer until his death. In the summers between the first and second occlusions, his work was managerial and office detail, requiring little physical effort.
After the second attack and stroke in 1955, he returned to teaching in March 1956, driving himself to school most of the time in a specially adapted automobile. Although his hemiplegia, and the physical limitations it imposed, even after some rehabilitation, must have sharply restricted his capacity for exertion, he continued to teach to the best of his ability to the end of the 1958 school session. He and his wife were again employed at the camp in the summers of 1956, 1957 and 1958. The 1958 camp season ended on August 26 and he returned home. The next two days were spent preparing to return to his regular teaching assignment. He died in bed during the night of August 28.
After Dr. Kroin began to care for Schiffres on July 31, 1951 there were periodic office and home visits, sometimes for advice and treatment for complaints of pain and fatigue, sometimes for checkup and electrocardiograms. The doctor gave him medication when required. The electrocardiograms
showed the healed myocardial infarct in the anterior wall of the left ventricle; its condition was static. The heart rhythm was regular. Schiffres was told that the occasional pain was to be expected and to be judicious about overexertion. Plainly, the chest "jabs" as he described them were an incident of the permanent disability stemming from the original occlusion.
On January 2, 1955 Schiffres attended a camp reunion at a hotel in New York City. The next day he attended his usual school classes. That evening he went to bed early and suffered the second heart attack. He was hospitalized immediately and shortly thereafter had the cerebral hemorrhage of which mention has already been made. In connection with the stroke, it may be noted that about a year earlier on January 5, 1954 he had a cerebral vasospasm, possibly of the left lenticulostriate artery. For about three weeks prior to that date he had experienced numbness and weakness three times a day, especially in the right elbow and hand, with a sensation of swelling in the hand. On January 5, 1954 he had similar sensations of numbness and tingling in the right side of the face with difficulty of articulation and thickness of speech which lasted about 10 minutes. Dr. Kroin "couldn't state definitely" the reason for this cerebral spasm but said statistical evidence shows that "those things" do happen after myocardial infarcts. A neurological and psychiatric specialist who examined Schiffres in February 1957 and appeared for the petitioner at the hearing on the case now before the court, testified that the cerebral spasm had no relation "whatsoever" to the 1951 coronary infarction. In any event, with respect to the cerebral arteries, the overwhelming weight of the medical evidence demonstrates that prior to the 1951 heart attack Schiffres had arteriosclerosis of the cerebral as well as of the coronary arteries.
The second coronary attack of January 3, 1955 was again a myocardial infarct but this time the closure was in a different and opposite part of the heart. As revealed by the ...