Chapter 6 Specific Injuries

I. Heart Attack, Stroke, and Angina

The general rule is that a heart attack¹ or stroke is compensable as a workers' compensation accident if it is induced by unexpected strain or overexertion in the performance of the duties of a claimant's employment or by unusual and extraordinary conditions of employment. Specifically, Section 42-1-160(C) of the South Carolina Code (Supp. 2008) provides:

Stress, mental injuries, heart attacks, strokes, embolisms, or aneurisms arising out of and in the course of employment unaccompanied by physical injury are not considered compensable if they result from any event or series of events which are incidental to normal employer/employee relations including, but not limited to, personnel actions by the employer such as disciplinary actions, work evaluations, transfers, promotions, demotions, salary reviews, or terminations, except when these actions are taken in an extraordinary and unusual manner.

Accordingly, to constitute a compensable injury, a claimant (or his representative) must establish (1) that the claimant was subjected to either unusual or extraordinary physical exertion, violence or strain, or an unusual or extraordinary condition of the employment while in the course of employment; and (2) that a causal connection existed between this exertion, violence, condition, or strain and the claimant's heart attack.²

The first case to set out these requirements as two separate and distinct elements was Black v. Barnwell County.³ Failure to distinguish between these two elements can sometimes lead to confusion as illustrated in Jones v. Williamsburg County,⁴ where the court explained the evidence was adequate to support the conclusion that the working conditions under which the decedent was engaged in at the time of his fatal seizure, although strenuous and uncomfortable, were usual and ordinary incidents of his employment. That the Commission so concluded is implicit in its finding that his death was not causally connected with or related to the work he was doing... . "A claimant can be subjected to unusual and extraordinary exertion in his work, and still be denied compensation if his heart attack or stroke was not causally connected, as a matter of medical fact, to those unusual and extraordinary conditions."

In order to determine whether a stroke is an "accident" under the Act, the courts use the same test used to determine the compensability for heart attacks. The central case regarding compensability of strokes is Kearse v. South Carolina Wildlife Resources Department, in which the South Carolina Supreme Court held as follows:

We think the rules laid down in the heart cases should be applied to claims for disability or death resulting from a cerebral thrombosis. It is not perceived that there is any fundamental difference in principle between a case where disability results from a coronary thrombosis and one where it results from a cerebral thrombosis.⁵

Angina is compensable only to the extent that it arises out of extreme or unusual work conditions and causes the disability and claimant's inability to work, rather than an underlying heart condition.⁶

A. Unusual Exertion or Strain

Although less clearly set out in early cases, South Carolina now subscribes to the "unusual exertion or strain" test in heart attack and stroke cases. Raley v. City of Camden⁷ was the first South Carolina case to clearly enunciate this standard. Subsequently, in Price v. B. F. Shaw Company,⁸ the claimant died of a coronary thrombosis while performing his usual duties. Compensation was awarded by the Commission and affirmed by the circuit court.

However, the South Carolina Supreme Court reversed the award of compensation based upon the "unusual exertion" standard that in order to be compensable, the injury must result from some unusual exertion or strain than from those normally encountered. The Court commented that to depart from the "unusual exertion" rule would destroy the presumption that a death or injury from heart disease ordinarily results from natural, rather than traumatic, causes⁹ and would convert "the Workers' Compensation Act into the protection furnished by a life insurance policy."¹⁰ Then Associate Justice Taylor Stukes dissented, indicating that nothing in the Workers' Compensation Act created such a requirement.¹¹

In subsequent cases, however, the court has remained "definitely committed to the unusual exertion or strain rule in heart attack cases," as pointed out by Chief Justice Stukes in Sims v. State Commission of Forestry,¹² in which he cited the Price case as laying to rest the controversy in this area.

In order to meet the first requirement under this test, the employee's heart attack must be "induced by unexpected strain or overexertion in the performance of the duties of his employment or by unusual and extraordinary conditions in the employment."¹³ In Price, the court stated:¹⁴

In every case decided by this Court, involving benefits under the Workmen's Compensation Act resulting from heart conditions or other physiological bodily conditions in which award of benefits were adjudged, there was some unusual or extraordinary condition attached to the work environment, or unusual exertion and strain in the performance of the work, or of course, a definite traumatic injury; whereas in those cases in which this court has denied compensation benefits there has been, in each instance, nothing unusual or extraordinary attached to the work environment, no unusual exertion or strain, and where death or disability would have inevitably resulted from the same cause whether the employee was at work or engaged in other pursuits.¹⁵

Whether the particular strenuous activity engaged in by the claimant constitutes the requisite unusual or extraordinary exertion must be determined in light of the claimant's usual and normal work duties.¹⁶

For example, compensation has been allowed in cases¹⁷ in which the employee's heart attack was precipitated by unusual stress placed on the employee's heart by byssinosis contracted during the employment;¹⁸ by his performing unaccustomed manual labor;¹⁹ destroying a liquor still;²⁰ making an unusually strenuous turn while driving a bus;²¹ "doubling-up" in work;²² working an unusually and excessively long work schedule over a period of time;²³ taking on additional responsibilities at work which required the claimant to continuously transverse between two restaurants located some 150 feet apart;²⁴ falling on a window sash;²⁵ when a "hot repairman" climbed up an 87-foot ladder while temperatures reached up to 120 degrees;²⁶ when an employee had an increase from three to seven in the number of looms which he operated in the four months prior to his fatal heart attack;²⁷ and subduing a particularly energetic criminal suspect resisting arrest.²⁸

Compensation has been denied in cases²⁹ in which the employee suffered a heart attack while climbing stairs;³⁰ pushing a cloth truck up a slight incline with a rise of an inch per four to five feet;³¹ when a sheriff, who had an extensive history of heart problems, had a heart attack after working some 20 straight hours while investigating the death of a friend;³² walking about one half mile in the mud and rain;³³ engaging in sexual intercourse after work;³⁴ when a tug boat mate threw a light deck rope five or six feet;³⁵ when a bus driver swerved to avoid pedestrians;³⁶ when a security officer suffered hypertension allegedly as a result of the abandonment by his superiors without arrest of a drug investigation in which the decedent participated;³⁷ when a cement finisher died four days after his last day of work on a job which, although "short crewed," was not behind schedule, nor in a rush posture;³⁸ and when the driver of a heating oil truck had to work substantially greater hours over a period of time, as was normal for him in winter time;³⁹ when a farming hand spent a day helping put out a large fire.⁴⁰

It is important to note that the "unusual exertion" test may be satisfied even though the unusual or excessive strain which precipitates the heart attack, occurs while the employee is engaged in the same general type of tasks as those which he normally performs.⁴¹ For example, in Ricker v. Village Management Corporation,⁴² the claimant, a bus driver, was granted compensation for a heart attack brought on only by an abnormally strenuous turn in his bus.

In addition, in Kearse v. South Carolina Wildlife Resources Department,⁴³ the claimant suffered a cerebral thrombosis while engaged in activities common to his position as a game warden. However, the evidence demonstrated that these activities were continued uninterruptedly over an unusual length of time and some of them required exertion which was extraordinary even for a game warden. The Supreme Court affirmed an award of compensation based on this evidence, stating "[t]he phrase 'unusual or excessive strain' used in many of the cases, is not so limited in its meaning as to include only work of an entirely different character from that customarily done."⁴⁴

However, the "unusual exertion" test is not satisfied when the work involved is overexertion for the particular employee only because of his pre-existing heart condition.⁴⁵

Specifically, in Sims v. South Carolina State Commission of Forestry,⁴⁶ the decedent had been a fire tower watchman for some 16 years. Part of his regular duties included climbing the 100-foot fire tower twice a day. After being hospitalized for a heart condition, his superiors had ordered him not to do his regular duties any longer.

Approximately five months following his hospitalization, the decedent, for unknown reasons, again climbed the tower and shortly thereafter was stricken with a fatal coronary thrombosis. Two doctors testified it was their opinion that climbing the tower triggered the fatal heart attack.

Both the Commission and the circuit court awarded benefits and the Supreme Court's Justice Taylor...