Highlights of Noteworthy Decisions

Decision 1740 13
E. Smith
  • Cancer (larynx)
  • Intervening causes
  • Dependency benefits (death results from an injury)
  • Significant contribution (of compensable disability to death)
  • Stroke (stress)

The Board granted the worker entitlement for laryngeal cancer in May 2007. He underwent radiation and temporarily required a feeding tube. In September 2008, he suffered a stroke while at home. He was taken to hospital and remained there until he died in January 2009, as a result of aspiration pneumonia. The employer appealed a decision of the Appeals Resolution Officer finding that the compensable laryngeal cancer was a significant contributing factor to the worker's death.

Impact on the worker's swallowing ability from the radiation treatment was not a factor that likely affected the outcome of the stroke. Prior to the stroke, the worker had limitations on his ability to swallow, which were mechanical in nature and affected his diet. This was a result of the radiation therapy. However, medical evidence indicated that his swallowing function was improving and would continue to improve. There was no medical evidence indicating that his swallowing difficulties were life-threatening.
The stroke also affected the swallowing mechanism. The worker suffered a neurological injury to his swallowing mechanism in the stroke. This was expected to be permanent. He would require a permanent feeding tube, which left him at risk for recurrent aspiration pneumonias. Death is described as the most probable outcome of a major stroke with this etiology.
The Vice-Chair found that the stroke had the effect of changing a non-life-threatening difficulty with swallowing which was likely to improve into a situation in which the most likely outcome was death. The stroke overwhelmed the effects of the prior swallowing limitations.
The Vice-Chair also considered the role of stress from the compensable laryngeal cancer as a causal factor to the stroke. Medical evidence indicated that stress was not a factor, considering other predisposing factors present, specifically heart and vascular disease, with cardiac stenting and hypertension, increasing renal failure and a 40-pack-year smoking history. Further, an aneurysm of the size identified in this case would take years or even decades to develop, gradually enlarging over time, and had a 50% risk of rupturing over five years. Thus, the worker was at significant risk at the time. The effect of stress was marginal, if at all.
The appeal was allowed. The worker's cancer was not a significant contributing factor to his death. The worker did not have entitlement to benefits for the stroke or for his resulting death.