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Nakamura v. State9/26/2000
d truck at work. His dependents filed a claim for worker's compensation. His employer presented evidence in the form of medical testimony that his pre-existing pathological condition was the sole cause of death. The Board denied compensation based on this evidence, reasoning that his death was due to pre-existing cardiovascular disease and was thus not attributable to his employment.
The supreme court reversed because the net weight of the medical testimony did not amount to substantial evidence sufficient to rebut the presumption of compensability:
For a medical man may give a generalized opinion that there was no connection between an incident at work and a heart attack, and, in his own mind, may mean thereby that a pre-existing pathological condition was the overwhelming factor in bringing about the attack and that the part played by the work was insignificant. But, while it may be sound medically to say that the work did not 'cause' the attack, it may be bad law, because, in general, existing law treats the slightest factor of aggravation as an adequate 'cause'. Id. at 410, 495 P.2d at 1167 (internal quotation marks and citations omitted).
The supreme court went on to specify the kind of evidence required to rebut the presumption of compensability in pre-existing-condition cases:
The primary focus of the medical testimony should have been a discussion on whether the employment effort, whether great or little, in any way aggravated Mr. Akamine's heart condition which resulted in his death. Id. at 412, 495 P.2d at 1168.
As stated again elsewhere in the opinion: " he only consideration should have been whether the attack in fact was aggravated or accelerated by his work activity[.]" Id. at 413, 495 P.2d at 1169.
In this case, Dr. Ponce's report failed to address the question raised by the Board's findings of fact which, per Akamine, was required to be addressed expressly, directly and specifically: whether the work stress engendered by Nakamura's employment in any way exacerbated his injury .
Furthermore, in cases where the testimony of two doctors directly conflict on the issue of an injury 's causal connection to the claimant's employment activity, the legislature has decided that the conflict should be resolved in the claimant's favor. Chung, 63 Haw. at 652, 636 P.2d at 727.
The Board was "clearly erroneous" in failing to resolve the conflict of medical opinions in Nakamura's favor when it in effect adopted Dr. Ponce's conclusion, upon an independent psychiatric examination, that Nakamura was suffering from a pre-existing psychotic disorder which was not exacerbated by an event or events incidental to his employment. Dr. Shimizu, Nakamura's treating physician, presented evidence and an opinion to the contrary and in favor of compensability; hence Chung mandates that hers should have been the conclusion adopted.
Moreover, even though Dr. Ponce and Dr. Shimizu both agreed that Nakamura was suffering from a pre-existing disorder of some kind, evidence of a pre-existing condition, standing alone, does not rebut the presumption of a causal connection between injury and employment conditions.
The Hawaii Supreme Court in Royal State Nat'l Ins. v. Labor Bd., 53 Haw. 32, 487 P.2d 278 (1971), held that " nder identical working conditions some employees may be predisposed to heart attacks, some may be more careless around machinery, and some may be susceptible to mental breakdowns. The employer must take the employee as he finds him." Id. at 39, 487 P.2d at 282 (emphasis added). See also Chung, 63 Haw. at 651, 636 P.2d at 727 (the fact that the claimant had been jogging when his heart attack
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