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." 
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"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  jon@gelmans.com  has been representing injured workers and their families who have suffered occupational accidents and illnesses.

Updated: 111/14/2016

Daylight Saving Time “fall back” doesn’t equal sleep gain

Today's post is shared from harvard.edu and it highlights the need for caution in the workplace following a shift in the time schedule so that bodies can adjust and accidents are avoided because of the exhaustion caused by the semi-yearly statutory time shift.

Daylight Saving Time officially ends at 2:00 am this Sunday. In theory, “falling back” means an extra hour of sleep this weekend.


Winston Churchill once described Daylight Saving Time like this: “An extra yawn one morning in the springtime, an extra snooze one night in the autumn… We borrow an hour one night in April; we pay it back with golden interest five months later.”

That’s an overly optimistic view. In reality, many people don’t, or can’t, take advantage of this weekend’s extra hour of sleep. And the resulting shift in the body’s daily sleep-wake cycle can disrupt sleep for several days.

Research teams around the world have tried to determine if losing or gaining an hour of sleep because of Daylight Saving Time make a difference in health. Michigan researchers, writing in the American Journal of Cardiology, showed a small increase in heart attacks on the first day (Sunday) of the spring transition to Daylight Saving Time, when we “lose” an hour of sleep. This echoed a Swedish study published in the New England Journal of Medicine showing a small increase in heart attacks after the start of Daylight Saving Time and a small decrease at its end.

Other researchers have looked at driving accidents, workplace safety, and even school performance, with mixed results.

Click here to read the entire article.

How is this still a thing?

Donald Trump And The Art Of Asbestos

Today's post is shared from huffingtonpost.com

According to the Republican presidential nominee, the anti-asbestos movement is a conspiracy rigged by the mob. Yes, the mob.

For nearly five months, people around the country have been campaigning for or against Donald Trump. As one of the most polarizing presidential candidates of the century, we’ve watched debate after debate, commercial after commercial and repeatedly said, “Wow.”

There’s no doubt certain aspects of Trump’s beliefs are startling, overwhelming and offensive. But what the media shows is just one side.

Among all of Trump’s absurd ideologies, such as extreme vetting of immigrants and building a giant wall to keep them out, he also supports the use of asbestos. As a known carcinogen responsible for an estimated 10,000 American deaths a year, it’s surprising that a presidential candidate would uphold an industry that promoted its use.

But then again, is it?

Click here to read the entire article.