Pre-Existing Conditions

Under the aggravation doctrine, which applies to Accidental Disability Retirement Appeals, in certain circumstances, the aggravation of a pre-existing medical condition into a disability can be compensable under G.L. c. 32 § 7(1) and ADR benefits can rightfully be awarded. Specifically, if the aggravation of a pre-existing condition was caused by a work-related injury and that job-related aggravation was a significant contributing cause to the applicant’s disability, the fact that the applicant had a pre-existing condition will not disqualify him or her from the receipt of an Accidental Disability Retirement.

The question of whether or not an applicant’s pre-existing condition disqualifies him or her from being granted accidental disability retirement benefits is not a legal question. It is a medical question which is to be answered by the PERAC medical panel. The physicians comprising the medical panel should apply their specialized expertise to determine if the applicant was disabled due to the natural progression of the pre-existing condition, which does not satisfy the causation requirement. If the medical panel determines that the work-related injury, accident, or incident was “a significant contributing cause” to the worsening of the pre-existing condition to the point of total disability, the causation element is satisfied.

If the acceleration of a preexisting condition or injury results from an accident or hazard undergone in the performance of the applicant’s duties, causation would be established. However, if the disability is due to the natural progression of the defect or disease, or was not aggravated by the alleged injury sustained or hazard undergone, causation would not be established.

For example, the Contributory Retirement Appeals Board (CRAB) recently ruled that an employee who had a pre-existing back condition was entitled to ADR benefits even though he was able to perform his demanding job with no restrictions prior to September 23, 2009. On that date he engaged in unusually strenuous activity for an unusually long time, in an attempt to carry out his responsibilities to remove flood water from a leak in a housing project basement that had reached a depth of seven inches. For five hours he carried heavy laundry appliances and heavy water buckets up the stairs out of the basement, and carried pumps, hoses, and other equipment back in.

CRAB ruled that the claimant demonstrated that his disability was proximately caused by the above-described work incident, which aggravated his pre-existing degenerative back condition.

The aggravation of his back condition from the intense, heavy labor spanning five hours on the night of September 23 to 24, 2009 qualified as a “personal injury” within the meaning of the retirement law. His back injury was sustained “as a result of, and while in the performance of, his duties at some definite place and at some definite time.” The required causation element was, therefore, satisfied and his pre-existing degenerative back condition did not disqualify him from being awarded an Accidental Disability Retirement.