This appeal arises under the Texas Workers’ Compensation Act of 1989 (1989 Act) TEX. REV. CIV. STAT. ANN. arts. 1.01 through 11.10 (Vernon Supp 1993). On March 3, 1993, a contested case hearing was held in (city), Texas, with (hearing officer) presiding. He determined that appellant (claimant) did not have a compensable heart attack on (date of injury). Claimant disputes certain findings of fact and conclusions of law and asserts that the opinion of the claimant’s treating doctor should be given more weight than that of doctor’s who did not examine him. Respondent (carrier) replied that the decision was not against the great weight and preponderance of the evidence.
DECISION
Finding that the decision and order are supported by sufficient evidence, we affirm.
Claimant is a fireman with the rank of lieutenant. On (date of injury), he reported for duty in the morning and spent approximately two hours in routine cleaning. He, along with two other firemen, then left the station and checked fire hydrant effectiveness for approximately two and one-half hours when he received a call to respond to a gas leak in a school. Prior to receiving that call, he took part in testing approximately 20 fire hydrants, which involves using a heavy wrench to open each so that water flow may be observed. Claimant testified that he and one other fireman performed all the physical acts in checking these hydrants while the third fireman recorded their observations.
Upon reaching the school, claimant entered a school room with no windows in which a propane container was said to be leaking. Claimant could smell the additive in the propane gas and when he grasped the container, the smell was stronger. No testimony described the size of the container, but claimant stated that it was laying in a trash can in the classroom. He had earlier said that he was told the container could not be turned off. While the record is not clear as to whether claimant took the cylinder out of the room, it does reflect that it was taken from the school and then was also taken with claimant to the emergency room.
Claimant described helping to move a fan, which he said weighed 70 pounds, into the classroom to help dissipate the fumes. He did not wear breathing equipment to enter the schoolroom, but he did have on his fire fighting gear, “coat, pants, boots and all.” He helped carry the fan back to the truck when the gas was cleared. He felt “heated.”
Claimant returned to the fire station at about 12:00 noon; within 15 minutes after his return, claimant did not feel good. He told others that he did not feel well. He asked to have his blood pressure taken and lay down on the floor. He was then taken to the hospital. He learned the next day that what he felt was a heart attack.
Claimant’s medical records showed that he was 36 years old at the time of the heart attack. They do not indicate that he had had any prior heart attacks. He was noted to have arrived at the emergency room (ER) with crushing substernal chest pain radiating to the left arm. The ER record stated, “prior event – turning hydrants with response to propane leak.” Claimant was transferred to Hugueley Hospital. On May 7, 1992, claimant’s doctor, (Dr. L), a cardiologist, catherized claimant to obtain angiograms. At that time Dr. L recorded a history, described the procedure, and made conclusions and recommendations.
Dr. L’s catherization report stated that claimant had an acute anterior wall myocardial infarction, that he was treated with “TPA, his electrocardiogram improved dramatically with the infusion of the TPA and he had no further chest pain.” The catherization was used to “evaluate the extent of underlying probable coronary artery disease. The patient’s only other complication is that he had been exposed to a bottled gas earlier on the same morning of the heart attack and there was some question of this having contributed to any spasm in his coronary arteries.”
The catherization showed that claimant’s left anterior descending coronary artery had a proximal 70% lesion with some question of residual clot. The other arteries were normal or had “no significant disease.” Dr. L on May 7, 1992, concluded that claimant had single vessel coronary artery disease–left anterior descending artery. He added, “[t]here is some question that maybe there was some spasm in the left anterior descending artery since the degree of blockage does not appear dramatic.”
A subpoena was issued on November 19, 1992, to Dr. L to answer interrogatories. The answers are not dated but indicate the following:
Q.Does [claimant’s] history reflect that he was exposed to propane gas on or about (date of injury)?
A.Yes
Q.Did (claimant’s) exposure to propane gas, within reasonable medical probability, precipitate his heart attack on or about (date of injury)?
A.Yes
Claimant also obtained a subpoena on November 19, 1992, to (Dr. P) to answer interrogatories. Dr. P did not treat claimant but shows that he is board certified in pathologic anatomy, clinical pathology, and forensic pathology. His answers also are not dated but indicate the following:
Q.Does [claimant’s] history reflect that he was exposed to propane gas on or about (date of injury)?
A.Yes
Q.Did [claimant’s] exposure to propane gas, within reasonable medical probability, precipitate his heart attack on or about (date of injury)?
A.Yes
Dr. P also answered questions for the commission by saying that the heart attack was “brought on by coronary artery spasm induced by his inhaling propane gas.” He added that the work substantially contributed to the injury. On October 19, 1992, Dr. P answered questions from the city by saying that he did not know what concentration of propane gas was necessary to produce a coronary artery spasm and did not know how long exposure to such concentration must last. He referred to an article by Lowry and others, titled “Toxicologic Investigation of Liquid Petroleum Gas Explosion: Human Model for Propane/Ethyl Mercaptan Exposures” reported in J. For. Sci. 36: (2) 386-396, 1991. He was asked the following question to which he answered as shown:
Based on consideration of all of [claimant’s] cardiovascular risk factors, was his work rather than the natural progression of a heart condition or disease a substantial contributing factor of the attack, or was it a combination of his work and other factors that precipitated the attack?
The work precipitated the final event.
The carrier introduced reports of two doctors who reviewed information about the heart attack but did not treat claimant. (Dr. Z), a cardiologist, provided two letters, one dated July 29, 1992, in which he stated that he did not believe that work was a substantial contributing factor to the heart attack; he thought it “unlikely” that propane gas “triggered” the attack. He did opine that “pre-existing atherosclerotic heart disease” was a substantial factor. Dr. Z then provided a letter dated November 24, 1992, in which he stated that he had reviewed the toxicological report about propane gas explosions referred to by Dr. P. He found no indication of causation in that article and states that coronary artery spasm caused by propane gas is not supported by the literature. He reaffirms his opinion that work was not a substantial contributing factor.
The toxicological report in question addressed the results of an explosion through records of autopsy in three of four victims to develop a protocol for investigating deaths by gas explosion. Certain animal studies were referred to in the report including ones involving cats, guinea pigs, and dogs. The report then says:
In the primate, 10% propane induces some myocardial effects, and 20% produces aggravation of these parameters and respiratory depression. Ten percent propane in the mouse and 15% in the dog appear to produce no arrhythmia but weak cardiac sensitization.
(Dr. K) provided a “consultation” dated November 11, 1992. He is a member of the American Board of Medical Toxicology. He calculated the school room in question to be 21 x 51 x 8.25 feet which would contain 1,001 cubic yards. He described the gas container as 6.75 ounces. He then calculated the concentration of the gas to be approximately 1 per 10,000. In answer to questions, he states that there is no evidence that exposure to propane gas causes coronary artery spasms. He cannot interpret claimant’s work as a contributing factor. He adds that the toxicological report discussed, and quoted from, previously is “not relevant.” In March 1993, after the date of the hearing but while the record was left open for this purpose, Dr. K answered cross-interrogatories propounded by claimant. Some questions and Dr. K’s answers follow:
Q.If [claimant] was performing heavy, strenuous, manual labor for an hour and forty five minutes to two hours, continuously, immediately prior to the time he answered the call at the school regarding the propane leak, then could [claimant’s] work, within reasonable medical probability, be a substantial contributing factor of his heart attack?
A.If the word “substantial” is deleted, since heart attacks occur related to narrowing or spasm is (sic) diseased coronary arteries after years of incubating risk factors such as cigarette smoking, high cholesterol and other blood fats, high blood pressure and others, the heavy, strenuous, manual labor if more than “usual” and also “substantial” on top of this underlying incubating time bomb, could help trigger or provoke his underlying coronary disease to a heart attack.
Q.What medical evidence, if any, supports a supposition that [claimant’s] heart attack involved coronary artery spasm?
A.Nothing. On the contrary, his heart attack appears to have been associated with a clot blocking a coronary artery. This is because his electrocardiograms normalized after he received his infusion of clot dissolving medicine (TPA, tissue plasmin activator or Activase), a medicine that does not help relieve coronary spasm, but dissolves blood clots. In addition, his electrocardiogram did not have the characteristic findings of coronary spasm, but rather those of an acute heart attack, which are different. Also, coronary spasm tends to occur at rest, not at work.
Claimant asserts that the opinion of the claimant’s treating doctor should be given more weight than that of other doctors. Dr. L’s opinion as to propane gas and his opinion that propane gas precipitated the attack are quoted in the appeal. The hearing officer, as finder of fact, in weighing the conflicting medical opinion could have concluded that Dr. Z and Dr. K did not just disagree with Dr. L (and Dr. P), but that their opinions and data in evidence refuted the assertion that propane gas caused the heart attack.
The hearing officer did not make findings of fact on each of the three criteria set forth in Article 8308-4.15 of the 1989 Act which control whether a heart attack is compensable. Since his finding adequately applied the standard set forth in Article 8308-4.15 (2) in making Findings of Fact Nos. 12, 13, and 14 which resulted in a decision that the attack was not compensable, findings as to the other two criteria were not necessary.
Finding of Fact No. 12 stated: Claimant’s work activities as a fire fighter on (date of injury), was (sic) not a substantial contributing factor to his heart attack.
Finding of Fact No. 13 stated: Claimant’s exposure to propane gas was not a substantial contributing factor to his heart attack.
Finding of Fact No. 14 stated: Claimant’s natural progression of coronary artery disease was a substantial contributing factor to his heart attack.
The facts provided by the medical records indicating that medicine given to treat clots blocking coronary arteries was very effective and that claimant was found to have 70% blockage of a coronary artery, together with the opinions of Dr. Z and Dr. K and the absence of data showing that propane gas causes artery spasm in humans, were sufficient to support the findings set forth above. Article 8308-4.15(2) recites that medical evidence governs this standard, which must be found favorably to claimant in order to support a finding of compensable heart attack. The hearing officer is the sole judge of the weight and credibility of the evidence. See Article 8308-6.34(e) of the 1989 Act. As finder of fact, he also judges the weight and credibility to be given to conflicting medical evidence. See Atkinson v. U.S. Fidelity & Guaranty Co., 235 S.W.2d 509 (Tex. Civ. App.-San Antonio 1950, writ ref’d n.r.e.) and Hartford Accident & Indem. Co. v. Gant, 346 S.W.2d 359 (Tex. Civ. App.-Dallas 1961, no writ). The appeals panel will not reverse the decision of the hearing officer based on a factual determination unless it is against the great weight and preponderance of the evidence. See In re King’s Estate, 150 Tex 662, 244 S.W.2d 660 (1951).
The decision and order are affirmed.
Joe Sebesta – Appeals Judge
CONCUR:
Thomas A. Knapp – Appeals Judge
Gary L. Kilgore – Appeals Judge