Workers comp medical expertIn November 2012, the claimant, an investigator with the City District Attorney’s Office, suffered an ischemic stroke at his residence. He filed a claim for workers’ compensation benefits. After a hearing, a workers’ compensation law judge found that his stroke was causally related to his employment and awarded benefits.

However, upon review, the Worker’s Compensation Board reversed the award, finding that there was insufficient medical evidence to establish the requisite causal relationship between claimant’s employment and his disability. The claimant’s subsequent application for reconsideration and/or full Board review was denied, and he appealed.

Judge John C. Egan Jr. of the Supreme Court of New York, Appellate Division, Third Department, writing the opinion of the court, stated that as the party seeking benefits, the claimant bore the burden of establishing—by competent medical evidence—a causal connection between his employment and the claimed disability. Egan went on to say that while the Board can’t rely upon expert opinion evidence that “amounts to nothing more than pure speculation,” Workers’ Compensation Law doesn’t require that medical opinions “be expressed with absolute or reasonable medical certainty.”

Instead, Judge Egan said that all that’s required is that it be reasonably apparent that the expert meant to signify a probability as to the cause and that his or her opinion be supported by a rational basis. Applying that standard to the evidence adduced at the hearing, the Board found the claimant’s medical proof to be lacking. That finding, the judge held, was supported by the record.

The claimant testified that the stress caused by his assignment to protect a key witness in a murder trial caused his stroke. His medical expert witness—his treating physician—stated in his written report that such work-related stress was “likely to be a contributory factor to [claimant’s] ischemic stroke.” Nonetheless, the physician’s written report also noted that the claimant had “a number of risk factors for ischemic stroke,” including diabetes, hypertension and hyperlipidemia, and the physician acknowledged during his deposition testimony that claimant “was on multiple medications” to treat his documented diabetes, high blood pressure and high cholesterol.

The claimant’s physician reiterated that opinion during the course of his deposition, again stating that such stress was “likely to be a contributory factor” with respect to claimant’s stroke, the physician also variously testified that work-related stress “may have been” or “could’ve been a contributory factor.” The claimant’s physician again acknowledged that claimant had “other multiple risk factors for ischemic stroke.” Hypertension was “the major risk factor” leading the claimant’s physician to conclude that work-related stress “most likely was not the only factor” underlying his stroke.

Further, the claimant’s medical expert confirmed that, even “outside of the stress that he was facing at work,” claimant “[a]bsolutely” would “still be at risk for the same kind of stroke.”

Finally, the physician conceded that, while the claimed stress “certainly may have been a contributory factor, . . . there’s absolutely no way to tell if [claimant] would have had [the stroke] without the stress” as “[t]here’s no objective way of testing it.”

Judge Egan explained that given the claimant’s multiple and independent risk factors for a stroke, as well as his expert physician’s equivocal testimony as to the role that stress “may” or “could” have played in contributing to claimant’s disability, the Board was free to characterize—and ultimately reject—the medical evidence offered by claimant as speculative.

Without sufficient medical evidence to establish a causal relationship between the claimant’s employment and his disability, the Board’s decision was affirmed.


Qualls v Bronx District Attorney’s Office, 2017 N.Y. App. Div. LEXIS 409; 2017 NY Slip Op 00365 (N.Y.Supr.Ct. January 19, 2017)