- Chronic obstructive lung disease
- Dependency benefits (survivor)
- Stroke (ischemic)
The worker's estate appealed a final ARO decision, dated June 12, 2021, which concluded that there was no entitlement to survivors' benefits because the worker's death did not result from his compensable condition of Chronic Obstructive Pulmonary Disease (COPD). Further to NEL ratings performed in 2005, the worker was granted a 45% non-economic loss (NEL) award for the permanent impairment related to COPD. In the evening of June 12, 2020, the worker was brought to a local hospital and diagnosed with a cardioembolic stroke. A cardioembolic stroke is a blockage in a blood vessel in the brain caused by an embolus (a clot) originating from the heart. The worker's condition slowly deteriorated the following day and he passed away on June 13, 2020.
The Panel denied the appeal.The Panel found that the worker's compensable COPD was not a significant contributing factor to the worker's death. The proximate cause of the worker's death was a "left MCA [middle cerebral artery] stroke". Another, more general, term found in the medical reporting is "ischemic stroke", meaning a stroke caused by a blockage.Dr. Spilchuk, a specialist in occupational and internal medicine, noted that the worker had the most common causes of cardioembolic strokes: atrial fibrillation, heart failure, and aortic valve disease, which supported a conclusion that the worker's cardiac conditions were the cause of the stroke. The worker had required immediate treatment which could not be administered because of the worker's other non-compensable medical conditions and prescription medication relating to those conditions. Notably, it was explained that the worker's "COPD/respiratory disease" did not preclude treatment of the blockage. Dr. Spilchuck concluded that the COPD/respiratory disease was not a causal factor of the worker's death on a secondary basis. It was noted that congestive heart failure is associated with COPD when it is very severe such that it typically causes "cor pulmonale". Cor pulmonale is an enlargement of the right ventricle of the heart. The worker did not have this condition. Counsel for the worker referred the Panel to a number of medical journal articles, including an article titled "Chronic Obstructive Pulmonary Disease and Stroke." The Panel noted that the authors of the article were not definitive but, rather, speculative in their statements. The tenor of the article was summed up in its abstract: "We conclude that more studies are needed to further clarify the links between COPD and stroke." In the Panel's view, it was appropriate to give significant weight to Dr. Spilchuk's report and professional medical opinion. That report was based on a review of the medical evidence specific to the worker contained in the WSIB claim file.