Pursuant to Section 408.008, a heart attack is a compensable injury only if the following requirements are proven:

(1) the attack can be identified as:

(A) occurring at a definite time and place; and

(B) caused by a specific event occurring in the course and scope of the IW's employment;

(2) the preponderance of the medical evidence regarding the attack indicates that the IW's work rather than the natural progression of a preexisting condition or disease was a substantial contributing factor of the attack; and

(3) the attack was not triggered solely by emotional or mental stress factors, unless it was precipitated by a sudden stimulus.

Burden Of Proof.

The IW has the burden to prove by a preponderance of the evidence that the heart attack is a compensable injury. As such, the IW must establish each of the above elements. Proof establishing requirement (1) may be made through lay testimony, however, proof establishing requirement (2) must be established through expert medical evidence. APD 94448. The preponderance of the medical evidence must indicate that the IW's work was a substantial contributing factor of the attack rather than the natural progression of any heart disease or condition. Allen v. Employer's Casualty Co., 888 S.W.2d 219 (Tex. App.-Amarillo 1994, no writ). While there can be more than one substantial contributing factor to the attack, the IW must prove that the work was the greater factor over the natural progression of an underlying heart condition or disease in order to establish compensability of the attack. APD 93582.

Section (1)(A) And (B): Definite Time And Place/Specific Event Established.

The IW was employed as a firefighter. The IW testified that on February 26, he was called out to a grass fire; that he was required to use a heavy, 300 foot long, fully charged hose, which he was required to carry, sometimes alone; and that after fighting the fire for between a half hour and an hour he began to experience chest pain and fatigue. The IW continued to work for a short time before being taken to the hospital where he was diagnosed with acute inferior myocardial infarction. The HO determined that the IW established that the heart attack occurred at a specific time and place during a specific event, that is while fighting the fire. The HO's determination was supported by sufficient evidence. (Note. The HO's determination regarding the compensability of the heart attack was reversed on other grounds). APD 012157.

Section 408.008(1)(A) And (B): Definite Time And Place/Specific Event Not Established.

The IW was employed as a kitchen helper. The IW testified that on August 24, she began to experience low back, chest, and arm pain approximately a half hour into her shift; that she next began to operate the dishwasher on her own and that this is normally a two person job; that two hours later she was in such pain that she received permission to go home; and that she reported to work the next two days before she saw her doctor on August 26. The IW was referred to a cardiologist who opined that the IW had had a heart attack at some time during the previous 48-72 hours. While the IW testified that she believed the heart attack occurred while she was operating the dishwasher alone on August 26, medical records in evidence stated that the IW's heart attack could not be established as occurring at a definite time/place, nor could any specific event be named as the cause. The HO determined that the IW failed to establish that her heart attack occurred at a definite time and place, and that it was due to a specific work-related event. These determinations presented questions of fact for the HO to resolve. APD 93653.

Section 408.008(2): Work Was A Substantial Contributing Factor Established.

The IW was employed as a flight attendant. On February 5, she was on an airport tram in route to the departing flight she was working. The tram broke down with the doors locked so that no one could exit. Once she was able to exit the tram, the IW had to run to her departure gate with her luggage. Upon boarding the plane, the IW complained of upper arm pain and difficulty breathing. The captain advised the IW not to fly and she was transported to the ER where she was diagnosed as having had a heart attack. The IW had a family history of heart disease, preexisting high cholesterol, and atherosclerosis in three arteries. The opinions of three doctors were introduced into evidence, and all three opined that the IW's work was the major cause of the heart attack. The HO determined that the IW's heart attack was compensable. There was sufficient medical evidence to establish that the IW's work rather than the natural progression of a preexisting condition or disease was a substantial contributing factor of the attack. APD 970148.

Section 408.008(2): Work Was A Substantial Contributing Factor Not Established.

The IW was employed as a mechanic and sustained a heart attack while at work. Medical evidence regarding the causation of the heart attack was offered into evidence and showed that the IW had a family history of heart disease, a 31-year smoking history, high blood pressure, and hypercholesterolemia. The IW's treating doctor stated that work was a contributing cause of the heart attack. The IC's peer review doctor concluded that the IW's employment was not a factor in the heart attack. The HO determined that the IW failed to meet his burden of proof to establish that the work rather than the natural progression of his preexisting heart condition was a substantial contributing factor of the heart attack. Causation of the heart attack presented a question of fact for the HO to resolve. APD 971012.

Section 408.008(3): Attack Not Triggered Solely By Emotional Or Mental Stress Factors, Unless Precipitated By A Sudden Stimulus Not Established.

The IW was employed as a hospital administrator, and the evidence reflected that the job was inherently stressful. The IW sustained a fatal heart attack after work, while at home, on March 7. It was undisputed that the IW had preexisting heart disease and continued to smoke. The IW's beneficiary asserted three causes of the IW's heart attack, (1) the IW had been told to fire two employees or he would be terminated; (2) the IW's boss was generally abusive to him; and (3) the IW had been unduly upset by a memo he had received on the date of his death. An IC peer review doctor issued a report stating that it was the IW's severe preexisting coronary disease, along with continued smoking and obesity which caused the heart attack, not work stress. The HO determined that the beneficiary failed to establish that the IW's heart attack was caused by a sudden stimulus. Whether the heart attack was caused by a sudden stimulus was a question of fact for the HO to resolve. APD 970045.