On appeal from the State of New Jersey, Department of Labor, Division of Workers' Compensation.
Approved for Publication October 16, 1996.
Before Judges Shebell, Baime and P.g. Levy. The opinion of the court was delivered by Shebell, P.j.a.d.
The opinion of the court was delivered by: Shebell
The opinion of the court was delivered by
Toms River Board of Education (respondent), appeals from a judgment of the Division of Workers' Compensation awarding its former Superintendent of Schools, Albert J. Dietrich (petitioner), permanent disability of 85% of partial total, 35% cardiac and 50% neuropsychiatric. We are called upon to determine whether the record supports the findings of the Judge of Compensation that petitioner's heart and psychiatric problems were shown to be sufficiently related to stress from the employment. The issue revolves in main part around the Judge's determination that "petitioner sustained an aggravation of his cardiac condition by his employment with respondent." In this regard, we must decide whether the record supports a Conclusion that petitioner's idiopathic myocardiopathy was aggravated in a material degree by the stressful conditions that characterized his employment and that the stress was a substantial condition in excess of the wear and tear of his daily living. See Fiore v. Consol. Freightways, 140 N.J. 452, 659 A.2d 436 (1995).
On December 18, 1991, petitioner filed an Employee's Claim Petition alleging that due to "exposure to significant stress," as Superintendent of Schools for the Toms River Board of Education, he suffered "permanent cardiovascular and neuropsychiatric disability." The respondent filed its Answer contesting both the nature and extent of the injuries and disability, and specifically asserted "the injury resulting from the alleged residual disability are insufficient to form a basis upon which a compensation award can be rendered under the provisions of the revised Workers' Compensation Award Act of 1/1/80." We agree with respondent's view of the case and we reverse the Judgment dated March 22, 1995.
Petitioner was appointed Superintendent of Schools by respondent in 1980 and he served continuously in that capacity until May 14, 1991. As superintendent, the petitioner worked hand-in-hand with the Board of Education and was responsible for what developed over the years into an annual budget of approximately $130 million, 2,600 to 2,800 employees, eleven elementary schools, three intermediate schools, three high schools, and an alternative school. On May 14, 1991, petitioner was admitted to the hospital for a brief stay, and never worked again. He formally retired as Superintendent on December 12, 1991, at the age of fifty-five.
Petitioner experienced chest pains, shortness of breath and cold sweats in April of 1991 while attending a budget meeting. He was seen by a doctor and told to rest. Nonetheless, he continued to work each day, and his complaints continued off and on. Around May 11, 1991, he began experiencing sleeplessness, nervousness, and his left arm bothered him. Petitioner described May 13, 1991 as a normal day at work. However, early on May 14, 1991, while at work, he started with a headache, cold sweats, and pains in his chest radiating down his left arm. He also had some blurred vision and felt warm like his blood pressure was going up. These symptoms were described as flu-like symptoms. Petitioner was admitted to Community Medical Center in Toms River where he stayed until May 17, 1991. He was discharged with the following diagnosis: 1) chest pain (acute myocardial infarction ruled out); 2) upper respiratory infection; 3) atrial arrhythmia; and 4), diabetes mellitus.
On June 24, 1991, petitioner re-entered Community Medical Center for a heart catheterization. There was a finding of global hypokinesia and the left ventricle demonstrated an ejection fraction of 44%. This was considered to be "somewhat" below the normal 50%. The coronary arteries were found to be normal. A follow-up MUGA scan, which utilizes radioactive dye, found the ejection fraction to be 61%. However, the test was considered to be of limited value "due to the poor sensitivity of the study." The final diagnosis of the treating cardiology group was idiopathic cardiomyopathy.
In a letter dated April 13, 1992, petitioner's treating cardiologist, Dr. Pasquariello, wrote:
In summary, Mr. Dietrich is a 55 year old male with a history of an idiopathic cardiomyopathy. His ejection fraction is 44%, which means that the patient's left ventricular function is depressed. This is consistent with a decrease in overall cardiac performance of a mild degree, however, cardiomyopathies of this nature tend to be progressive and it was for this reason we advised Mr. Dietrich that it would be appropriate for him to retire. Physical and emotional stresses may adversely affect the outcome and prognosis of any individual with a depressed left heart function. He has been maintained on medical therapy. There has been no obvious progression since the diagnosis was initially made. However, there has also been no significant improvement. The patient has had a complete cardiovascular work-up without obvious causative nature of this disease being detected and therefore it is considered an idiopathic process. He has remained stable and he was last seen on December 27, 1991 and we expect to see him again in June of 1992.
The testimony showed that petitioner's job at times involved a high level of stress. As petitioner was responsible for an annual budget, for several months each year he worked from ten to twelve hours a day, six to seven days a week. Because of the public nature of his work, petitioner often received criticism from persons seeking seats on the Board of Education. Even though he had tenure, petitioner was concerned at each election as to who would win, as he had to work closely with the board members. He also received harassing or "hang-up" phone calls which he attributed to his work, although the callers were never identified. His wife was followed in her car because it looked like a "company car" and petitioner believed someone was trying to pin something on them. In 1983, a bullet was fired through petitioner's home in Toms River, while he and his wife were in Europe. Petitioner's son testified at trial that around that time he had caught men looking into the house and trespassing on their property. No testimony related the shooting or trespassing to any particular work situation.
Petitioner called Dr. John Cavalieri, a Board of Education physician, who, beginning in 1988, treated petitioner for diabetes and hypertension. The doctor stated petitioner was under a lot of stress with the school system and that his heart condition was stress induced. He did not, however, treat petitioner for his cardiac problem and never saw the petitioner in the hospital. He nonetheless opined that petitioner's cardiovascular condition was caused by the stress raising petitioner's blood sugar. He did not do any tests of petitioner's sugar levels at the time the symptoms became acute. He told petitioner not to return to work because he was concerned that petitioner was going to have a stroke or heart attack due to stress at work.
Dr. Chester Trent, a psychiatrist, began treating petitioner for depression on June 17, 1991. Petitioner was no longer working at this time and he had not worked since May 14, 1991. Dr. Trent saw him approximately once a month for less than a year, during which time he prescribed no medication. Dr. Trent advised petitioner to retire and stated that he thought (the doctor lost his records) petitioner had come to him with symptoms of severe stress and that this stress was impacting on petitioner's physical condition. Dr. Trent also testified that petitioner had obsessive or abnormal thoughts that could have been related to his heart condition. The psychiatrist explained:
Well, certainly he had a lot of pressure, he had family pressures, emotional pressures resulting from his job activity and absolutely, he was worried about his heart.
Petitioner, when asked at trial "what complaints, problems and discomforts have you had over the last six months?", candidly responded:
A. Over the last six months I would say that things have been basically, you know, getting -- there's been a great deal of improvement since I have been out of the work place, in fact, I saw doctor -- I'm trying to think, Fortunato the other day. He was over there for a regular test and everything was fine. He was telling me it was the best thing I had done probably.
Q. From a psychological standpoint, do you feel better since leaving the Board of Education?
Q. Do you continue to have problems or complaints ...