A recent ECAB decision shows how an injury can linger over many years, and a seemingly unrelated body part can cause later health issues that result in further disability or even death.
The original injury to claimant in this case occurred in 1981. Over 30 years later, his widow argued that the death was linked to the original injury. The claimant’s physician proposed a complicated connection between the heart/circulatory condition that caused the claimant’s death. The claimant had suffered a variety of back and nerve injuries while on the job, the resulting pain became so severe that a chronic pain syndrome was developed. Chronic pain syndrome can result in severe, subjective pain complaints that can have wide-ranging consequences over the entire body. Here, the doctor’s opinion was that the chronic pain led to a severe increase in the claimant’s blood pressure. Swelling in the claimant’s extremities put even more strain on the heart, leading to enlargement of the heart (hypertrophy) and the eventual cardiac arrest that led to claimant’s death. There was not universal agreement with this theory, as OWCP had its own doctor who indicated that he could not link the injury with the resulting heart ailment. A board certified cardiologist reviewed the case and indicated that there was medical evidence linking chronic pain to high blood pressure, but that the claimant’s other risk factors were also significant in the ultimate cause of his death. ECAB sent the case back to OWCP to get a supplemental report from the cardiologist indicating if there was any connection between the condition and the death. FECA does not require that an injury be the sole cause of disability or death, merely a contributing factor.