In the Matter of BEVERLY WETZEL, claiming as the widow of WAYNE C. WETZEL and DEPARTMENT OF THE INTERIOR, BUREAU OF INDIAN AFFAIRS, FLATHEAD IRRIGATION PROJECT, St. Ignatius, Mont. Office, medical experts, reference to Case was not in posture for decision whether the death of the employee was causally related to his employment duties where the Office, in view of a conflict in medical opinion, referred the case record to a doctor for an impartial medical opinion; however, the medical records reveal that the doctor had made the original interpretations following the employee's collapse and hospitalization and that he and his associates interpreted the subsequent electrocardiograms. Therefore, under these circumstances, the doctor did not meet the test of an impartial specialist within the meaning of Section 8123(a) of the Act. Under Section 8123(a) of the Act the physician designated as the impartial specialist should be one who is wholly free to make a completely and independent evaluation and judgment, untrammeled by a conclusion rendered on prior examination. Performance of duty, injury in, in general-Heart conditions, The Federal Employees' Compensation Act does not require the Docket No. 75-53; Submitted on the Record; Before FLOYD G. ANSLEY, E. GERALD LAMBOLEY, FRED E. STRINE The issue is whether the death of the employee on September 10, 1973 was causally related to his employment duties, particularly those on June 9, 1972. The employee, born on May 10, 1922, was employed as a lineman. His duties included climbing utility poles, hooking up service, unloading and loading poles with a hydraulically operated boom truck, operating a jackhammer to dig holes for setting poles, hand digging some holes, and general maintenance and construction of power lines. On June 7, 1972, the employee used "a compressor drilling rock blasting and digging the holes by hand to set poles." On June 8 he and his foreman dug a hole and set a power pole using the hydraulic equipment. They also hung a transformer and ran services to a new customer. Then they changed the transformer into a larger size. On June 9, 1972, the employee and two other linemen loaded 850 lb., 35 foot long power poles for two separate jobs. The employee and another employee guided the poles onto the trailer, while the third man operated the boom. They worked on a distribution line, which was a 562 foot extension located in a bushy, tree-covered area, and the employee walked ahead of a line truck locating survey stakes where the poles were to be located. The other two employees unloaded the poles at various places. The employee then walked ahead of the line truck to look for tree stumps. While so engaged, he suddenly collapsed to the ground and became unconscious. A coworker stated, "When I reached him his feet were elevated about three to eight inches off the vertical and his arms were straight by his side." He had saliva coming from his mouth and was pale. The employee was placed in a truck and taken to a doctor about ten miles away. On the trip he regained consciousness. An electrocardiogram made at the hospital on June 9, 1972, showed an abnormality, which was interpreted by Dr. Harold A. Braun, Board-certified in internal medicine and cardiovascular disease, as perhaps showing a very early feature of an acute injury. However, the subsequent electrocardiograms were unchanged, and it was concluded that they were normal. The attending physicians concluded that the employee had had an epileptic seizure, based on the history received from the two coworkers. On June 15, 1972 the employee was seen at the Mason Clinic by Dr. David G. Fryer, a Board-certified neurologist, who was of the opinion that he had had an epileptic seizure. On June 25, 1972, before he had returned to work, the employee had another episode and was hospitalized. An electrocardiogram made on that date was interpreted by Dr. Braun and by Dr. W. J. Lewis, the attending cardiologist and associate of Dr. Braun, as showing a definite inferior myocardial infarction. When the employee returned to work on September 19, 1972, he was given light duty. Dr. Earl Coriell, his attending physician, had placed restrictions against pole climbing, carrying, and lifting anything over 25 pounds. These restrictions were never removed. Commencing December 20, 1972, the employee was assigned to clerical duties in the office until June 11, 1973 when he was assigned to clerical duties at the warehouse. On August 21, 1973, after going home early from work, the employee suffered a heart attack at home. He was hospitalized, and died on September 10, 1973. Dr. Coriell signed a death certificate indicating that the employee had died of a coronary infarction, and of coronary heart disease of one year's duration. There was no autopsy. Appellant filed a death claim alleging that the employee's death was related to the episode at work on June 9, 1972. The claim was accompanied by a statement from Dr. Coriell that "coronary occlusion apparently occurred on job and subsequent course and death all relate to the original episode." A medical adviser of the Office of Workers' Compensation Programs, who examined the case record, was of the opinion that the employee did not have a myocardial infarction on June 9, 1972. The doctor stated that the electrocardiogram and the enzyme studies were normal and pointed out that the discharge diagnosis was epileptic convulsion. The doctor added, "Unless it is established that he had some form of infarction on 6/9/72 his death was not job related." Medical records, including electrocardiograms, were secured. The Office submitted these with the case record and a statement of accepted facts to Dr. Braun for an impartial medical opinion as to whether the employee's death was job related. In a report dated February 2, 1974, Dr. Braun stated that a helpful criterion in determining whether a myocardial infarction is job related is whether the first symptoms developed while or very soon after the employee engaged in some unusually strenuous jobrelated activity. He stated that he did not find anything in the case record indicating that the employee's activities prior to his seizure on June 9, 1972 were anything more than he had performed frequently in the preceding months. Dr. Braun stated that after the employee was hospitalized on June 9, 1972 there was nothing in the past history, physical examination or enzyme study suggesting a recent infarction. He stated that the electrocardiograms of June 9 and 10 were interpreted as probably normal. “I would have done the same." He stated that a comparison of these electrocardiograms with one made in 1958 suggested a possible old inferior infarction but that there was nothing to indicate a recent infarction. Dr. Braun concluded that neither the employee's heart disease nor his death was job related. Subsequently, statements were submitted from Drs. Coriell, Fryer and Thomas A. O'Halloran, who was an attending physician on June 9, 1972. They agreed that, in retrospect, the June 9, 1972 incident was probably cardiac in nature. Dr. Coriell stated that the employee's hospitalization on June 9 did not reveal definite evi dence of a heart attack, "but in view of later happenings I believe the original episode was probably due to cardiac arrhythmia." Dr. Fryer states, "In retrospect, in view of the subsequent history of myocardial ischemia established in Montana, I think it is very possible that the first attack of falling in June 1972 was initiated by a cardiac arrest." Dr. O'Halloran stated, "In view of the subsequent attacks of myocardial infarction, it is my opinion that the original cause of the syncopal attack was coronary artery disease causing a ventricular arrhythmia." The Office medical adviser, after receiving these statements from Drs. Coriell, Fryer, and O'Halloran, indicated that there was no evidence that the employee had coronary insufficiency on June 9 or 10, 1972. On August 6, 1974, the Office issued a compensation order denying the death claim on the ground that the medical evidence did not show a coronary episode had occurred on June 9, 1972, that the myocardial infarction of June 25, 1972 was not job related, and that the employee's death on September 10, 1973 was not related to the employment. The Board finds that the case is not in posture for decision. In view of a conflict in medical opinion, the Office referred the case record to Dr. Braun for an impartial medical opinion. However, the medical records reveal that Dr. Braun had made the original interpretation of the electrocardiogram of June 9, 1972 following the employee's collapse and hospitalization on that date. The records also show that he and his associates interpreted the subsequent electrocardiograms. Therefore, under these circumstances, Dr. Braun did not meet the test of an impartial specialist within the meaning of section 8123(a) of the Act. When this section is invoked, "the physician designated as the impartial specialist should be one who is wholly free to make a completely and independent evaluation and judgment, untrammeled by a conclusion rendered on prior examination."1 It should also be pointed out that Dr. Braun's opinion negating causal relationship relied on the premise that, in order for a myocardial infarction to be job related, the first symptoms must develop while or very soon after the employee engaged in unusually strenuous work activities. However, as the Board has frequently pointed out, "The Federal Employees' Compensation 1 Paul J. Rini, 13 ECAB 557 at 559. It is noted that when Dr. Braun made a report on June 9, 1972 regarding the electrocardiogram of that date he stated, "Pointed and tall T. This may be normal variant but could be a very early feature of acute injury." However, in his report of February 2, 1974 he stated, "There is nothing on the June 9 tracing to suggest acute damage." Act does not require the occurrence of unusual effort or exertion in the employment as a prerequisite for compensability. The claim is compensable if it is established that the performance of regular duties did, in fact, cause or precipitate the heart attack."2 The compensation order of the Office of Workers' Compensation Programs, dated August 6, 1974, is reversed and the case is remanded for submission of the case record to an impartial medical specialist for an opinion on causal relationship and for a de novo determination. 2 Gustave Follick, 17 ECAB 365 at 369, and the cases there cited. (The emphasis in the quotation is that of the Board in the Follick case.) In the Matter of CHARLES W. KEARNEY and DEPARTMENT OF COMMERCE, NATIONAL WEATHER SERVICE, Greer, S.C. Schedule Awards, AMA tables-Pain and Suffering, compensation Case was remanded for Office to redetermine the percentage loss of Schedule awards, in general The amount of the schedule award cannot be based upon the possibility of a further increase in the percentage of the permanent loss. Docket No. 75-62; Submitted on the Record; Before FLOYD G. ANSLEY, E. GERALD LAMBOLEY, FRED E. STRINE The issue is whether appellant has more than a 15 percent employment-related permanent loss of use of his left arm for which he received a schedule award. On July 20, 1973, appellant, a weather service specialist, tripped and fell at work fracturing his left elbow and injuring his right elbow. He came under the care of Dr. Frank H. Stelling, a Boardcertified orthopedic surgeon, who placed his left arm in a splint. The doctor reported that an X-ray of the left elbow showed a |