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Sunday, November 13, 2016

Weighing Genetic Factors in Cardiovascular Cases

Cardiovascular cases involving occupational risks are complicated causation proof issues in workers' compensation cases. The association of the work exposure and/or effort is usually a challenging proof battle where literature and medical experts are caught in a contentious duel.

While not envisions by the crafters of the model workers' compensation act in 1911, the issue evolved into a litigated dispute over factual basis and the application of law (case or statutory). Complicating the issue are deleterious habits, ie. tobacco smoke, obesity and genetic propensity.

In New Jersey, "any claim for compensation for injury or death from cardiovascular or cerebrovascular causes, the claimant shall prove by a preponderance of the credible evidence that the injury or death was produced by the work effort or strain involving a substantial event or happening in excess of the wear and tear of the claimant's daily living and which in reasonable medical probability caused in a material degree the cardiovascular or cerebrovascular injury or death resulting therefrom." 38 NJPRAC 9.14 Workers' Compensation Law 3rd Ed. (Thomson Reuters). This elevated cardiovascular standard was statutorily enacted in 1979. N.J.S.A. 34:15-7.2. A rebuttable presumption of causality exists for emergency responders in the line of duty. N.J.S.A. 34:15-7.3; L. 1987, c. 382, § 1, eff. Jan. 8, 1988.

Comorbidity factors in New Jersey do not alone bar recovery. "While the medical experts disagreed on the relative roles of the petitioner's occupational exposure and personal risk factors, the Court held the exposure to be a compensable event." Fiore v. Consolidated Freightways, 140 N.J. 452, 659 A.2d 436 (1995). 38 NJPRAC 9.15 Workers' Compensation Law 3rd Ed. (Thomson Reuters)

A study reported in the NEJM today further complicates the causation issue by reaching an unknown determination as to complicating or co-existing factors.

"Both genetic and lifestyle factors contribute to individual-level risk of coronary artery disease. The extent to which increased genetic risk can be offset by a healthy lifestyle is unknown." 

"Across four studies involving 55,685 participants, genetic and lifestyle factors were independently associated with susceptibility to coronary artery disease. Among participants at high genetic risk, a favorable lifestyle was associated with a nearly 50% lower relative risk of coronary artery disease than was an unfavorable lifestyle."
Genetic Risk, Adherence to a Healthy Lifestyle, and Coronary Disease November 13, 2016 DOI: 10.1056/NEJMoa1605086

Self-initiated or employer wellness programs altering lifestyle may yet prove to be the best method of preventing claims. See, Genetic Heart Disease Risk Eased by Healthy Habits, Study Finds, NY Times, Nov. 13, 2016.

The causation and comorbidity risk factor debate will continue as reflected in the NEJM article. The only potential  resolution maybe a future change in workers' compensation medical delivery options, and integration of workers' compensation prevention efforts into companion wellness programs.


Jon L. Gelman of Wayne NJ is the author of NJ Workers’ Compensation Law (West-Thomson-Reuters) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thomson-Reuters). For over 4 decades the Law Offices of Jon L Gelman  1.973.696.7900  has been representing injured workers and their families who have suffered occupational accidents and illnesses.

Updated: 111/14/2016
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