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  "name_abbreviation": "Twice Over Clean, Inc. v. Industrial Commission",
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    "parties": [
      "TWICE OVER CLEAN, INC., Appellant, v. THE INDUSTRIAL COMMISSION et al. (Howard Haulk, Appellee)."
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      {
        "text": "JUSTICE O\u2019MALLEY\ndelivered the opinion of the court:\nFollowing a heart attack, claimant, Howard Haulk, filed an application for workers\u2019 compensation benefits pursuant to the Workers\u2019 Compensation Act (Act) (820 ILCS 305/1 et seq. (West 2000)). Following the arbitration of claimant\u2019s claim, the arbitrator determined that claimant sustained a compensable accident and awarded claimant medical expenses, temporary total disability benefits, and permanent partial disability benefits. Employer, Twice Over Clean, appealed the arbitrator\u2019s award, and the Industrial Commission (Commission) affirmed and adopted the arbitrator\u2019s decision, with one commissioner dissenting. Employer appealed the Commission\u2019s decision and the circuit court confirmed the Commission\u2019s decision. Employer appealed to this court and we reversed, finding that claimant was barred from recovering benefits due to the operation of the normal daily activity exception. Twice Over Clean, Inc. v. Industrial Comm\u2019n, 337 Ill. App. 3d 805 (2003). Claimant petitioned for leave to appeal to the supreme court. Claimant\u2019s petition was denied, but the supreme court, in the exercise of its supervisory authority, directed this court to vacate its judgment and to reconsider it in light of Sisbro, Inc. v. Industrial Comm\u2019n, 207 Ill. 2d 193 (2003) (Sisbro II), which overtimed our decision in Sisbro, Inc. v. Industrial Comm\u2019n, 327 Ill. App. 3d 868 (2002) (Sisbro I). We therefore vacate our previous decision and submit this in its place, once again reviewing the evidence adduced before the Commission, but this time in light of our supreme court\u2019s decision in Sisbro II, and again we reverse the Commission\u2019s decision.\nThe following facts were adduced at the hearing before the arbitrator. Claimant testified that he worked for employer as a laborer. On January 2, 1997, he was working in Minneapolis, Minnesota, removing asbestos from an old, disused building. On January 2, 1997, claimant began working there at about 7 a.m. and completed work at 4:30 or 5:30 p.m. Claimant testified that the building was unheated and that the inside temperature of about 5\u00b0 F. was colder than the outside temperature of about 15\u00b0 to 20\u00b0 F.\nClaimant testified that he was engaged in removing asbestos that previously had been collected into large bags, each of which weighed around 40 to 45 pounds. Claimant testified that there were about 500 bags which had to be placed into a commercial Dumpster, which was accessed by walking down several stories and across 40 or 50 feet outside of the building. Claimant testified that he conducted the cleanup of the building while wearing a full respirator and protective clothing.\nClaimant testified that he began to experience pains in his chest, neck, and left shoulder in the middle of the afternoon, around 2:30 p.m. He initially ignored the pains and, when they were more intense, sat down for a few minutes until the pains abated sufficiently to allow him to continue working. When claimant ended work and returned to his hotel, he did not feel like eating dinner. At about 7:30, claimant testified that his pains returned once again, but this time, claimant broke into a cold sweat and \u201cgot the dry heaves.\u201d At that point, claimant requested an ambulance and was taken to the hospital, where it was established that claimant had experienced an acute inferior wall myocardial infarction.\nAfter treatment in Minneapolis, claimant was discharged and returned to Peoria, where he was placed under the care of Dr. Cohen, his family physician, and Dr. Gold, a cardiologist.\nDr. Gold did not testify. However, Dr. Cohen testified in an evidence deposition that, based on the history related by claimant, the myocardial infarction was caused by the physical activity in which he engaged on January 2, 1997. On cross-examination, however, Dr. Cohen admitted that he did not know that claimant\u2019s coronary arteries were 90% occluded and that this information would have been significant in rendering his opinion. Dr. Cohen admitted that, given this degree of occlusion, \u201cany activity or no activity could put sufficient stress on the heart to result in a myocardial infarction.\u201d Dr. Cohen further admitted that, based on this information, claimant was a \u201cheart attack waiting to happen.\u201d\nEmployer retained Dr. Wilner, a cardiologist, to review claimant\u2019s medical records. Dr. Wilner concluded that claimant\u2019s work activities did not cause claimant\u2019s myocardial infarction and pointed to enzymatic studies that he interpreted to demonstrate that plaintiffs heart attack did not occur during the afternoon while he was working, but after he had completed his work for the day. On cross-examination, Dr. Wilner conceded that the results of the enzymatic studies could also be interpreted consistently with a heart attack occurring during the hours claimant was working. A number of medical records also were presented to the Commission. These records indicate that claimant told the emergency physicians that he had been experiencing some chest pains during the preceding month, and not solely on the day of January 2, 1997.\nThe arbitrator concluded that claimant had experienced an accidental injury arising out of and in the course of his employment and awarded claimant medical expenses, temporary total disability benefits, and permanent partial disability benefits (the amounts of which are not disputed on appeal). On review, the Commission affirmed and adopted the arbitrator\u2019s decision, but one commissioner dissented, on the grounds that claimant had not proved a causal relationship between his employment and his heart attack. The trial court confirmed the Commission\u2019s decision. Employer appealed and we reversed. Twice Over Clean, 337 Ill. App. 3d 805. Claimant petitioned the supreme court for leave to appeal; claimant\u2019s petition was denied but the supreme court directed us to reconsider our decision in this cause in light of its decision in Sisbro II, 207 Ill. 2d 193.\nOn appeal, employer argues that the Commission\u2019s decision was against the manifest weight of the evidence on the issue of causation. First, employer argues that the Commission erroneously accepted claimant\u2019s and Dr. Cohen\u2019s testimony regarding causation. Second, employer argues that, irrespective of causation, the normal daily activity exception should apply to bar claimant\u2019s recovery.\nIn our prior decision we did not address whether claimant\u2019s work activities contributed to his infarction. We held that claimant was not entitled to compensation irrespective of causation because, as his own physician admitted, his condition of ill-being was so deteriorated that any activity, work-related or not, might be sufficient to cause an infarction. We relied on our statement in Sisbro I that \u201ca claimant is not entitled to compensation, regardless of whether his condition of ill-being was caused by work-related aggravation of a preexisting condition, if his physical condition has so deteriorated that his condition of ill-being could have been produced by normal daily activity.\u201d Sisbro I, 327 Ill. App. 3d at 873. We derived the rule in Sis-bro I from the following statement by the supreme court in County of Cook v. Industrial Comm\u2019n, 69 Ill. 2d 10, 17-18 (1977):\n\u201cThe mere fact that an employee might have suffered a fatal heart attack, even if not working, is immaterial, for the question before the Commission is whether the work that was performed constituted a causal factor. [Citation.] The sole limitation to the above general rule is that where it is shown the employee\u2019s health has so deteriorated that any normal daily activity is an overexertion, or where it is shown that the activity engaged in presented risks no greater than those to which the general public is exposed, compensation will be denied.\u201d (Emphasis added.)\nWe noted that subsequent cases had taken this language as establishing two exceptions to the general rule that compensation is due where a work-related activity causes the aggravation of a preexisting condition. See Sisbro I, 327 Ill. App. 3d at 872. For example, in General Refractories v. Industrial Comm\u2019n, 255 Ill. App. 3d 925, 930-31 (1994), the appellate court said: \u201cGenerally, an employer takes its employees as it finds them, and a preexisting condition does not bar compensation for an injury if the employment was a causative factor. [Citation.] There is an exception to this rule, however, where the employee\u2019s health has so deteriorated that any normal, daily activity could have caused the injury, or where the activity engaged in presents risks no greater than that to which the general public is exposed. [Citation.]\u201d According to the rule applied in General Refractories and Sisbro I, a claimant who seeks compensation for an alleged work-related aggravation of a preexisting condition cannot recover if either the aggravation was not caused by his work activities or, where causation exists, one or both of the exceptions applies.\nIn Sisbro II, our supreme court held that we erred in characterizing the \u201cnormal daily activity\u201d and \u201cno greater risk\u201d factors as exceptions that bar recovery despite the existence of a causal connection between the claimant\u2019s employment and his injury. After reviewing the cases upon which County of Cook relied in describing the \u201cno greater risk\u201d and \u201cnormal daily activity\u201d factors as \u201climitations\u201d on recovery, the supreme court rejected the two-step process we applied in Sisbro I:\n\u201c[These cases] do not stand for the proposition that where a causal connection between work and injury has been established, it can be negated simply because the injury might also have occurred as a result of some \u2018normal daily activity.\u2019 Rather, these cases demonstrate that whether \u2018any normal daily activity is an overexertion\u2019 or whether \u2018the activity engaged in presented risks no greater than those to which the general public is exposed\u2019 are matters to be considered when deciding whether a sufficient causal connection between the injury and the employment has been established in the first instance. We have never found a causal connection to exist between work and injury and then, in a further analytical step, denied recovery based on a \u2018normal daily activity exception\u2019 or a \u2018greater risk exception.\u2019 \u201d (Emphasis added.) Sisbro II, 207 Ill. 2d at 211-12.\nAccording to the supreme court, a claimant\u2019s vulnerability to injury during normal daily activities is not an \u201cexception\u201d that applies to bar recovery despite the existence of a \u201csufficient causal connection\u201d between work and injury, but instead is a \u201climitation\u201d on when a \u201csufficient causal connection\u201d may be found in the first instance. The supreme court denied that it has ever found an injury noncompensable where there existed a \u201csufficient causal connection\u201d between work and injury, because there is no analytical step beyond the causation inquiry.\nBefore we apply it to the facts of this case, we explain our understanding of this rule. Although the supreme court implies in Sis-bro II that the concept of \u201csufficient causal connection\u201d is no innovation, our research discloses that the phrase appears only in one majority opinion and one dissent before Sisbro II. See Brewster Motor Co. v. Industrial Comm\u2019n, 36 Ill. 2d 443, 450 (1967); C.A. Dunham Co. v. Industrial Comm\u2019n, 16 Ill. 2d 102, 115 (1959) (Klingbiel, J., dissenting). In Brewster, the word \u201csufficient\u201d does not appear until the final, conclusory sentence that states the holding of the court on the issue of causation. See Brewster, 36 Ill. 2d at 450 (\u201cIn this manner, [the claimant\u2019s] employment contributed to his injuries and death, and such contribution constitutes a sufficient causal connection between work and accident within the degree of causation necessary to satisfy the \u2018arising out of requirement of our Workmen\u2019s Compensation Act\u201d). There is nothing in the remainder of the opinion to suggest that the word was intended as anything but an embellishment. Likewise, the dissenting opinion in C.A. Dunham, uses the phrase \u201csufficient causal connection\u201d in passing while addressing a counter-factual hypothetical and cites no authority to support the inclusion of \u201csufficient.\u201d See C.A. Dunham, 16 Ill. 2d at 115 (Klingbiel, J., dissenting) (\u201cI do not mean to imply that had [the employee] been employed by the United Air Lines there would have been a sufficient causal connection with his employment\u201d).\nWhat makes a cause \u201csufficient\u201d? If a \u201csufficient cause\u201d is a cause distinguished by some degree of dominance, then the concept indeed is a novelty in workers\u2019 compensation cases because the supreme court has always refused to distinguish among degrees of causation:\n\u201c \u2018To come within the statute the employee must prove that some act or phase of the employment was a causative factor in the ensuing injury. He need not prove it was the sole causative factor, nor even that it was the principle [sic] causative factor, but only that it was a causative factor in the resulting injury.\u2019 \u201d Sershon v. Industrial Comm\u2019n, 63 Ill. 2d 395, 399, (1976), quoting Republic Steel Corp. v. Industrial Comm\u2019n, 26 Ill. 2d 32, 45 (1962).\nSee also Jefferson Electric Co. v. Industrial Comm\u2019n, 64 Ill. 2d 85, 91 (1976) (\u201c[A] work-connected accident need not be the sole, or even the dominant factor causing disability\u201d).\nSisbro II supplies a specialized definition of \u201csufficient causal connection\u201d for aggravation cases, partially relieving us of the problems we see in attempting to define the concept in light of established supreme court precedent. According to Sisbro II, a work activity is a \u201csufficient cause\u201d of the aggravation of a preexisting condition if none of the limitations articulated in County of Cook apply, that is, if the work activity presented risks greater than those to which the general public is exposed and the claimant\u2019s condition was not so deteriorated that his injury could have occurred through normal daily activity. In rejecting the approach we followed in Sisbro I, the supreme court held that the factors are \u201climitations\u201d applied in the course of the causation analysis, not \u201cexceptions\u201d applied after that analysis.\nTo show that its decisions have always employed the two factors in analyzing whether a \u201csufficient cause\u201d exists in the first instance, Sis-bro II discusses three cases decided prior to County of Cook: National Malleable & Steel Castings Co. v. Industrial Comm\u2019n, 32 Ill. 2d 184 (1965) ; Illinois Bell Telephone Co. v. Industrial Comm\u2019n, 35 Ill. 2d 474 (1966) ; and Rock Road Construction Co. v. Industrial Comm\u2019n, 37 Ill. 2d 123 (1967). In National Malleable and Illinois Bell, compensation was denied based on both factors. Rock Road also recognized the factors but found insufficient facts to support the application of either factor. Significantly, Sisbro II does not call into question the results or analyses in these cases, thus reaffirming that compensation will be denied where \u201cthe employee\u2019s health has so deteriorated that any normal daily activity is an overexertion, or where it is shown that the activity engaged in presented risks no greater than those to which the general public is exposed.\u201d County of Cook, 69 Ill. 2d at 18.\nIn National Malleable, the employee, who worked as a grinder in a foundry, was found dead in bed from an overnight heart attack. The evidence showed that the employee reported for work at 5 a.m. the day before his death and sometime thereafter reported to the company\u2019s first aid department complaining of pain across his chest and in both arms. Later that morning he left work. That afternoon, the employee\u2019s wife took him to a hospital where he reported having had chest pains over the previous four-day period. He died sometime that night. A physician who testified in support of the claim for compensation opined that \u201cduring the 4-or-5-day period before the alleged date of accident the [employee] showed definite heart disease and that any exertion whatsoever would be harmful and a precipitating factor, even such things as driving to work, going out to visit the doctor, or walking up and down stairs, all of which were done by the [employee].\u201d National Malleable, 32 Ill. 2d at 187. The expert concluded \u201cthat the cause of death was \u2018involved\u2019 with the [employee\u2019s] final work episode.\u201d National Malleable, 32 Ill. 2d at 187.\nThe supreme court reversed the award of benefits. The court set forth the applicable law:\n\u201cThis court has often held that if a man\u2019s heart gives way under the stress of his normal duties and there is medical evidence to establish causal relationship between the disability or death and the work performed, the payment of compensation is in order. [Citations.] We have held this to be the rule even in those instances where the employee had a previously existing heart condition which is aggravated by a coronary attack while performing physical labor for his employer. [Citations.]\u201d National Malleable, 32 Ill. 2d at 187-88.\nThe court then said:\n\u201cWhere an employee suffers the onset of a coronary attack at some time prior to reporting for work and his complaints and physical condition are the same prior, on, and subsequent to the date of the alleged occurrence, the mere fact that the employee reported for work on the day in question and left early is not sufficient to establish a causal relationship between his employment and resulting injury. There is no evidence that the initial heart attack bore a relationship to the employment and the proof shows that the condition of the employee was the same before, during and after his brief period at the foundry.\u201d National Malleable, 32 Ill. 2d at 189.\nThe court found \u201cno evidence that the [employee] engaged in any physical labor on [the day before his death] but merely that he reported for work.\u201d National Malleable, 32 Ill. 2d at 189-90. On this ground, the court distinguished Bruno v. Industrial Comm\u2019n, 31 Ill. 2d 447 (1964), where, as in National Malleable, \u201cthere were no eyewitnesses to any duties actually performed but only evidence of the usual duties of [the claimant\u2019s] employment,\u201d yet, unlike in National Malleable, there was \u201ccircumstantial evidence that [the claimant] had engaged in physical labor\u201d before his death. National Malleable, 32 Ill. 2d at 188. Finding \u201cno Illinois decisions directly on point,\u201d National Malleable quoted the following remark from a New York case:\n\u201c \u2018[W]here, as here, a heart has deteriorated so that any exertion becomes an over-exertion, where the mere circumstance that the employee was engaged in some kind of physical labor is what impels the doctor to testify that his work caused his death, we would have reached a point, if this award were to be upheld, where all that is necessary to sustain an award is that the employee shall have died of heart disease.\u2019 \u201d National Malleable, 32 Ill. 2d at 189, quoting Burris v. Lewis, 2 N.Y.2d 323, 326, 141 N.E.2d 424, 426 (1957).\nThe court found no causal relationship between the employee\u2019s work and his injury.\nIt takes some probing to discover why Sisbro II cited National Malleable for the notion that causation analysis does not precede, but actually involves, consideration of the \u201cno greater risk\u201d and \u201cnormal daily activity\u201d factors. The express rationale for the denial of compensation in National Malleable was based on the nature of the work activity that preceded the employee\u2019s death. The court found that this activity did not amount to \u201cphysical labor\u201d and hence was not of sufficient intensity to justify a finding of causation. National Malleable, 32 Ill. 2d at 188-90. Presumably, Sisbro II saw this reasoning as incorporating the \u201cno greater risk\u201d factor even though it was couched in different terms than in later cases.\nHowever, there is no express mention in National Malleable of the \u201cnormal daily activity\u201d factor, so one must delve more deeply into the opinion to discover where Sisbro II saw an application of that factor. Significantly, the physician who testified in support of the claim for compensation opined that \u201cduring the 4-or-5-day period before the alleged date of accident the [employee] showed definite heart disease and that any exertion whatsoever would be harmful and a precipitating factor.\u201d (Emphasis added.) National Malleable, 32 Ill. 2d at 187. Consistent with this, the court adopted the above rule from Burris that places decisive weight on the deteriorated nature of an employee\u2019s physical condition and his susceptibility to injury during any exertion. See National Malleable, 32 Ill. 2d at 189.\nWe turn to Burris itself for a complete understanding of the content of this rule. In Burris, the employee collapsed and died of heart failure after assembling wooden frames to serve as molds for a concrete cellar wall. A medical examiner testified that the employee\u2019s heart disease was so advanced at the time of his death that any stress or strain would have precipitated his death. The physician testified \u201cthat it was not necessarily important to know how [sic] heavy weights [the employee] carried while working before his death\u201d because he could even have died at home in bed given his condition. Burris, 2 N.Y.2d at 325, 141 N.E.2d at 425. The physician concluded that the employee\u2019s death \u201cresulted from previous heart disease, which was a competent producing cause irrespective of whether or not he was subjected to any unusual strain.\u201d Burris, 2 N.Y.2d at 325, 141 N.E.2d at 425-26. The court reversed the award of compensation, citing the rule that an injury is compensable only if the job activity from which it arose involved \u201cgreater exertion than the ordinary wear and tear of life.\u201d Burris, 2 N.Y.2d at 326, 141 N.E.2d at 426. The court found no evidence that the employee \u201cdied from any unusual strain connected with his work.\u201d Burris, 2 N.Y.2d at 326, 141 N.E.2d at 426. The court also stated:\n\u201cIt is evident from *** the testimony of this *** medical witness *** that any exertion would have been an overexertion for this unfortunate man, and that in expressing the opinion that the type of work he was doing precipitated his death, the doctor merely meant that he was engaged in some type of activity, and that any kind of activity was sufficient to that end. We do not have here the situation of a man who is employed in a particularly strenuous job, and where there is evidence that a heart attack has been induced by some overexertion which is normal to the ordinary course of arduous employment. *** [T]he precipitating cause need not be something more strenuous than the normal performance of the work demanded, provided that the ordinary course of the work was sufficiently strenuous to require more than normal exertion. But where, as here, a heart has deteriorated so that any exertion becomes an overexertion, where the mere circumstance that the employee was engaged in some kind of physical labor is what impels the doctor to testify that his work caused his death, we would have reached a point, if this award were to be upheld, where all that is necessary to sustain an award is that the employee shall have died of heart disease. *** Here it is plain that in the opinion of the only physician whose testimony could support the award, death resulted from the circumstance that [the employee] had been subjected to any kind of exertion, even the exertion of merely being alive, so that, in this assistant medical examiner\u2019s opinion, death might easily have come during sleep.\u201d (Emphasis added.) Burris, 2 N.Y.2d at 326-27, 141 N.E.2d at 426.\nSignificantly, the quoted discussion places equal emphasis on the nature of the work in which the employee was engaged prior to his injury and on his advanced heart disease, which for him made any exertion an overexertion. Therefore, it appears that compensation in Burris was denied based on considerations identical to the \u201cno greater risk\u201d and \u201cnormal daily activity\u201d factors applied in Illinois cases. The highlighted portion of the analysis, which was later quoted in National Malleable, embodies both factors. National Malleable evinced approval of the result and rationale in Burris by quoting from it. Given National Malleable\u2019s emphasis on the advanced state of the employee\u2019s heart disease, which according to the testifying physician rendered the employee susceptible to death through any exertion, we conclude that the supreme court, like the court in Burris, denied compensation based on both the \u201cno greater risk\u201d and \u201cnormal daily activity\u201d factors.\nAs Sisbro II observes, National Malleable did not engage in any analysis beyond the issue of causation. However, the \u201cno greater risk\u201d and \u201cnormal daily activity\u201d factors nonetheless were applied to deny compensation, indicating that the concept of \u201csufficient cause\u201d as defined by Sisbro II takes into account both factors.\nThe next case Sisbro II examined in its effort to illustrate the concept of \u201csufficient cause\u201d was Illinois Bell. In Illinois Bell, a clerical employee with a severely deteriorated heart suffered chest pains at work after walking several blocks to deliver papers to another office. He was sent home on the recommendation of the company physician. He died that night. The supreme court reversed an award of compensation, finding no causal connection between the employee\u2019s work and his injury:\n\u201cThe company *** contends that the heart attack from which [the employee] died did not arise from his employment but from natural risks to which all persons with his disability are exposed. We agree. Under the view of the evidence most favorable to claimant\u2019s position we can find no proof that [the employee\u2019s] duties involved unusual strain, or anything else that would justify attributing the heart attack to his employment. On the day of his death he walked four blocks to deliver some papers and later returned, no doubt hurrying somewhat because of the wind or other weather condition. But he walked on the streets every day in whatever he might be doing, whether on personal errands or occupational ones. The exertion involved and the risks incurred are nothing more than those to which the general public is equally exposed, and the record in this case shows [the employee] regularly engaged in activities around his home which were at least equally as strenuous as the four-block walk on the day of his death. There is nothing in the facts of this case to show he would not have been equally exposed to the risk of a heart attack entirely apart from his employment. Even the two doctors who testified for the claimant observed that when circumstances were \u2018appropriate\u2019 [the employee] might have a heart attack regardless of his employment.\u2019\u2019 (Emphasis added.) Illinois Bell, 35 Ill. 2d at 476-77.\nSisbro II cited Illinois Bell to show that the \u201cno greater risk\u201d and \u201cnormal daily activity\u201d factors are considered in determining whether causation exists in the first instance. Indeed, both factors are discussed in the quoted discussion. Illinois Bell emphasizes not only the degree of risk involved in the work activity that preceded the employee\u2019s death but also the deteriorated condition of his heart, which, the court notes, would have exposed the employee to injury regardless of his employment. Illinois Bell\u2019s emphasis on the deteriorated condition of the employee was further shown in its citation to the following principles from National Malleable:\n\u201cThe mere fact that [the employee] was at work on the day of his heart attack and left early is not sufficient to establish a causal relationship between his employment and his subsequent death, nor is it enough, where one\u2019s heart has deteriorated so that any exertion becomes an overexertion, to merely show that he had engaged in some kind of physical activity before suffering the attack. [Citation.]\u201d (Emphasis added.) Illinois Bell, 35 Ill. 2d at 477.\nThe last case cited by Sisbro II to explain the \u201climitation\u201d language in County of Cook and the concept of \u201csufficient causal connection\u201d was Rock Road. In Rock Road, the employee, an asphalt truck driver, died of a heart attack while returning to his employer\u2019s plant after delivering two loads of asphalt. The employee\u2019s widow brought a claim for benefits. At the hearing, a physician testified for the claimant that the employee\u2019s work activities on the day of his death caused his heart attack. The three physicians who testified for the employer opined that the work activities were not causally related to the employee\u2019s death. One of the physicians also testified that the employee\u2019s condition would have \u201ccontinue[d] to deteriorate irrespective of exertion.\u201d Rock Road, 37 Ill. 2d at 126. Another physician testified that \u201cdeath was inevitable in [the employee\u2019s] case regardless of what he did.\u201d Rock Road, 37 Ill. 2d at 126.\nThe supreme court affirmed the arbitrator\u2019s award of compensation. The court noted that the general principle that work activity need only be a causative factor in a he. rt attack for it to be compensable is \u201climited by the rule that, where one\u2019s heart has deteriorated to such an extent that any exertion becomes an overexertion, it is not sufficient merely to show that the employee has engaged in some job-connected physical activity prior to his attack. [Citations.]\u201d Rock Road, 37 Ill. 2d at 127. For this limitation the supreme court cited Illinois Bell and National Malleable. The court then analyzed as follows:\n\u201cIt seems likely from this record that the ultimate result of decedent\u2019s heart condition would have been death at some indeterminate future date. It is, of course, possible that this could have occurred in a situation wholly unrelated to work or exertion. But neither of these circumstances necessarily renders an award of compensation against the manifest weight of the evidence [citations] if it may be legitimately inferred from the evidence before the commission that occupational activity or exertion was in fact a causative factor in hastening [the employee\u2019s] death. [Citations.] Whether [the employee\u2019s] condition had progressed to the point where any exertion became an over-exertion, and the death thus noncompensable [citation] was for the commission\u2019s determination. The only evidence to this effect is the doubtful inference to be drawn from the disputed and conflicting testimony of the employer\u2019s medical witnesses. Moreover, the fact that [the employee\u2019s] personal physician advised him that he should not be engaged in the work he did because it was too strenuous points to the opposite conclusion, i.e., that less strenuous work would not have been harmful. Under these circumstances the finding of the Industrial Commission is not against the manifest weight of the evidence. [Citations.]\u201d (Emphasis added.) Rock Road, 37 Ill. 2d at 128-29.\nIn Sisbro II, the supreme court quoted the highlighted portions as indicating Rock Road\u2019s rejection of the argument that the employee should not have been awarded compensation because his \u201ccondition had so deteriorated that any activity might have precipitated the attack.\u201d Sisbro II, 207 Ill. 2d at 211. However, immediately after its discussion of Rock Road, Sisbro II notes that the \u201cnormal daily activity\u201d factor is \u201cto be considered when deciding whether a sufficient causal connection between the injury and the employment has been found in the first instance.\u201d Sisbro II, 207 Ill. 2d at 212. Indeed, Rock Road, upon close examination, does not abrogate the factor. Rock Road acknowledges in the very next sentence after the highlighted portion that a work-related accident is not compensable where the employee\u2019s condition has so deteriorated that any exertion is an overexertion, for in such a situation the exertion involved in the work-related activity cannot be deemed a causal factor in the injury.\nNeither National Malleable, Illinois Bell, nor Rock Road uses the term \u201csufficient cause\u201d or \u201csufficient causal connection.\u201d However, in each of these cases decisive weight is placed on evidence that the employee\u2019s physical condition was so deteriorated that an overexertion would result from any exertion, including the exertions involved in normal daily activity.\nThe relevance of the \u201cnormal daily activity\u201d factor was recognized after Rock Road in Board of Trustees of the University of Illinois v. Industrial Comm\u2019n, 44 Ill. 2d 207 (1969), and Greater Peoria Mass Transit District v. Industrial Comm\u2019n, 81 Ill. 2d 38 (1980).\nIn Board of Trustees, the claimant suffered a ruptured disc while turning in his chair upon hearing a noise. The claimant\u2019s surgeon testified that, based on the claimant\u2019s medical history, \u201cit was reasonable to conclude that the affected disc had degenerated to such a degree prior to the occurrence that normal movement would have caused it to protrude or rupture.\u201d Board of Trustees, 44 Ill. 2d at 209. Based on this testimony, the supreme held that the claimant\u2019s injury was not compensable:\n\u201cThere is no evidence here of a causal connection between the [claimant\u2019s] employment and the injury. The [claimant] simply turned in his chair and suffered the injury. There was no suggestion that the chair was defective or unusual in any way. The medical evidence was that because of its degenerated condition any simple and normal activity would have caused the [claimant\u2019s] disc to rupture. The injury was not caused by a risk incidental to the employment. [Citation.]\u201d Board of Trustees, 44 Ill. 2d at 214-15.\nThus, compensation was denied due to the claimant\u2019s vulnerability to injury during normal daily activity.\nIn Greater Peoria, the claimant, a bus driver, dislocated her shoulder when she lost her balance and fell while bending over to retrieve bus schedules from the floor. She had dislocated her shoulder previously and thereafter was subject to recurrent partial dislocations. The claimant\u2019s surgeon testified \u201cthat any episode of minor trauma\u2014 reaching for a cigarette or combing hair or turning over in bed while asleep \u2014 could have caused [claimant\u2019s] shoulder to dislocate and that her shoulder was a \u2018time bomb\u2019 which would go off at an unpredictable time.\u201d Greater Peoria, 81 Ill. 2d at 42. Based on this testimony, the supreme court held that the claimant\u2019s injury was not compensable:\n\u201c[C]laimant\u2019s doctor testified that her shoulder was a \u2018time bomb\u2019 that could go off at any time and that any normal activity would have precipitated its dislocation. The employer, therefore, merely provided the occasion for its occurrence and did not cause it in any way. Completely absent from the record is any evidence that claimant\u2019s work (1) further deteriorated her shoulder, (2) aggravated it, (3) precipitated its dislocation, or (4) accelerated the occasion for its dislocation. (See 1 A. Larson, Workmen\u2019s Compensation sec 12.20, and cases therein cited (1978).) There is, in short, no indication from the record that, but for her employment, her shoulder would \u2018have gone on functioning reasonably well for an indefinite time.\u2019 (1 A. Larson, Workmen\u2019s Compensation sec. 12.20, at 3-310 (1978).)\u201d Greater Peoria, 81 Ill. 2d at 43.\nThe standard applied in Greater Peoria was whether the employee\u2019s injury could have occurred regardless of the claimant\u2019s employment, that is, through normal daily activity.\nSisbro II, Board of Trustees, and Greater Peoria all persuade us of the continued vitality of County of Cook\u2019s declaration that an injury suffered at work is not compensable \u201cwhere it is shown the employee\u2019s health has so deteriorated that any normal daily activity is an overexertion, or where it is shown that the activity engaged in presented risks no greater than those to which the general public is exposed.\u201d County of Cook, 69 Ill. 2d at 18.\nTurning to the facts of this case, we hold that the \u201cnormal daily activity\u201d limitation bars compensation. Dr. Cohen, claimant\u2019s family physician, opined that claimant\u2019s coronary arteries were so occluded that \u201cany activity or no activity could put sufficient stress on the heart to result in a myocardial infarction.\u201d Dr. Cohen further testified that claimant was a \u201cheart attack waiting to happen.\u201d We cannot imagine a more compelling case for applying the \u201cnormal daily activity\u201d limitation. Dr. Cohen\u2019s testimony as to the likelihood of claimant suffering a heart attack regardless of his employment was entirely undisputed. Hence these facts present a far stronger case for the limitation than Sisbro 7 and Sisbro II, where only one of the medical experts to testify opined that the claimant would have developed his condition of ill-being eventually through normal daily activity, even though both experts recognized that even minor, ordinary activity could cause the claimant\u2019s condition of ill-being. One of our panel who dissented from our holding in Sisbro I pointed out in a special concurrence in our previous decision in this case that the facts here present a more compelling scenario than Sisbro I and Sisbro II for the application of the \u201cnormal daily activity\u201d limitation. See Twice Over Clean, 337 Ill. App. 3d at 811 (Holdridge, J., specially concurring).\nOf course, we are careful to present our conclusion in the analytical framework set forth in Sisbro II. We do not hold that claimant proved a causal connection between his employment and his injury and yet deny him compensation because his condition of ill-being would have occurred regardless of his employment. Rather, we hold that, in light of his susceptibility to a heart attack outside of work, he failed in the first instance to prove a \u201csufficient causal connection\u201d between his work and his injury.\nFor the foregoing reasons, we reverse the judgments of the circuit court and the Commission.\nReversed.\nMcCULLOUGH, EJ., and HOFFMAN and HOLDRIDGE, JJ\u201e concur.\nAlthough the supreme court states that County of Cook relied on all three cases in framing its \u201climitation\u201d language, Rock Road in fact was not cited in County of Cook.\nRock Road is distinguishable on its facts from the present case. In Rock Road, the supreme court noted that there was conflicting testimony regarding the extent of the employee\u2019s deterioration. Here, there is no such conflict. Dr. Cohen alone addressed the extent of claimant\u2019s deterioration, opining that he was a \u201cheart attack waiting to happen.\u201d",
        "type": "majority",
        "author": "JUSTICE O\u2019MALLEY"
      },
      {
        "text": "JUSTICE GOLDENHERSH,\ndissenting:\nI respectfully dissent. The majority denies compensation to claimant under the profound misapprehension that it followed the \u201canalytical framework set forth in Sisbro II.\u201d 348 Ill. App. 3d at 652. The reality of the situation, however, is that the majority failed to learn from the errors in Sisbro I. Because the majority\u2019s disposition is directly in opposition to our Supreme Court\u2019s dictates in Sisbro II, I must dissent.\nIn Sisbro II, our supreme court reversed the order entered by this court in Sisbro I and held there was sufficient evidence in the record to support a finding that claimant\u2019s work-related accidental injury to his ankle aggravated or accelerated claimant\u2019s preexisting condition, and, thus, workers\u2019 compensation was properly awarded by the Commission. Our supreme court specifically found that this court failed to give appropriate deference to the factual findings of the Commission and applied an overly broad interpretation of the \u201cnormal daily activity\u201d limitation on recovery in preexisting condition cases. Our supreme court compared and contrasted numerous cases relied upon by the majority herein and ultimately concluded as follows:\n\u201cWhen an employee with a preexisting condition is injured in the course of his employment, serious questions are raised about the genesis of the injury and the resulting disability. The Commission must decide whether there was an accidental injury which arose out of the employment, whether the accidental injury aggravated or accelerated the preexisting condition or whether the preexisting condition alone was the cause of the injury. Generally, these will be factual questions to be resolved by the Commission. However, the Commission\u2019s decision must be supported by the record and not based on mere speculation or conjecture. If there is an adequate basis for finding that an occupational activity aggravated or accelerated a preexisting condition, and, thereby, caused the disability, the Commission\u2019s award of compensation must be confirmed.\u201d Sisbro II, 207 Ill. 2d at 215, 797 N.E.2d at 678.\nIn reaching this conclusion, our supreme court specifically relied on three other cases in which the claimant suffered a heart attack.\nSisbro II discussed National Malleable & Steel Castings Co. v. Industrial Comm\u2019n, 32 Ill. 2d 184, 204 N.E.2d 748 (1965), Illinois Bell Telephone Co. v. Industrial Comm\u2019n, 35 Ill. 2d 474, 220 N.E.2d 435 (1966), and Rock Road Construction Co. v. Industrial Comm\u2019n, 37 Ill. 2d 123, 227 N.E.2d 65 (1967). In National Malleable and Illinois Bell, compensation was denied because the connection between work and the heart attack was too tenuous, while in Rock Road compensation was allowed because the evidence allowed for a legitimate inference that the \u201c \u2018occupational activity or exertion was in fact a causative factor in hastening the decedent\u2019s death.\u2019 Rock Road Construction, 37 Ill. 2d at 128[, 227 N.E.2d at 68].\u201d Sisbro II, 207 Ill. 2d at 211, 797 N.E.2d at 676. The Sisbro II court pointed out that neither National Malleable nor Illinois Bell \u201cstand[s] for the proposition that where a causal connection between work and injury has been established, it can be negated simply because the injury might also have occurred as a result of some \u2018normal daily activity.\u2019 \u201d Sisbro II, 207 Ill. 2d at 211, 797 N.E.2d at 676. Instead, the court found:\n\u201c[T]hese cases demonstrate that whether \u2018any normal daily activity is an overexertion\u2019 or whether \u2018the activity engaged in presented risks no greater than those to which the general public is exposed\u2019 are matters to be considered when deciding whether a sufficient causal connection between the injury and the employment has been established in the first instance. We have never found a causal connection to exist between work and injury and then, in a further analytical step, denied recovery based on a \u2018normal daily activity exception\u2019 or a \u2018greater risk exception.\u2019 \u201d Sisbro II, 207 Ill. 2d at, 211-12, 797 N.E.2d at 676.\nDespite our supreme court\u2019s instructions in Sisbro II to narrow the \u201cnormal daily activity\u201d limitation, the majority chooses instead to broaden the limitation to bar compensation in the instant case.\nThe majority\u2019s denial of compensation appears to be based entirely upon Dr. Cohen\u2019s responses to questions posed during cross-examination. In response to a hypothetical question, Dr. Cohen admitted that a person with claimant\u2019s degree of occlusion (90% blockage) could suffer a heart attack with any level of activity or even no activity. Dr. Cohen also affirmatively responded to the question, \u201cA person with that degree of occlusion is basically a heart attack waiting to happen, would you agree?\u201d The majority opinion hinges upon these two answers and all but ignores the facts of the instant case which show that claimant\u2019s duties on the day he suffered the heart attack were extremely physical in nature and performed under severe conditions.\nClaimant was hired to remove asbestos from a plant in Minneapolis, Minnesota. Claimant\u2019s travel, lodging, and food expenses were paid by the employer. On the day in question, claimant began working at 7 a.m. The temperature outside was approximately five degrees. The disused plant was not heated, and the temperature indoors was only 10 to 15 degrees. During the course of the day, claimant was required to enter a steel bin in which the temperature was even colder than the outside temperature.\nOn the day in question, claimant removed over 500 large bags of asbestos material. Each bag weighed approximately 40 to 45 pounds. The 500 bags were placed in a commercial Dumpster, which was accessed by walking down several flights of stairs and across 40 to 50 feet outside the building. To make matters worse, claimant was required to wear a full respirator and protective clothing while performing his duties.\nAt approximately 2:30 p.m., claimant started feeling chest pains. He sat down and rested, and while the pain diminished, it never completely dissipated. Claimant left work at 3:30 p.m. and returned to his motel room. The other workers went to eat, but claimant did not feel like eating. His chest pains eventually worsened. After going to bed, claimant woke up in a cold sweat with severe chest pains. He was taken to the hospital where it was determined that he had sustained a myocardial infarction. Under these circumstances, and in light of our Supreme Court\u2019s holding in Sisbro II, the majority is flat out wrong to reverse the Commission\u2019s finding of sufficient causal connection between claimant\u2019s work and his injury.\nLike Rock Road, and unlike National Malleable and Illinois Bell, claimant\u2019s occupational activity and exertion were clearly factors in his heart attack. I can find nothing tenuous between claimant\u2019s work and heart attack under the facts of the instant case. Sisbro II specifically states that the causal connection between work and injury cannot be negated simply because it might have occurred as the result of some normal daily activity. Here, there is clearly an adequate basis for finding that claimant\u2019s occupational activity aggravated or accelerated claimant\u2019s preexisting heart condition and thereby caused his resulting disability. Accordingly, I would affirm the Commission\u2019s award of compensation.",
        "type": "dissent",
        "author": "JUSTICE GOLDENHERSH,"
      }
    ],
    "attorneys": [
      "Allen C. Mueller, of Livingstone, Mueller, O\u2019Brien & Davlin, PC., of Springfield, for appellant.",
      "R. Wayne Harvey and J. Kevin Wolfe, both of Harvey & Stuckel, Chtrd., of Peoria, for appellee."
    ],
    "corrections": "",
    "head_matter": "TWICE OVER CLEAN, INC., Appellant, v. THE INDUSTRIAL COMMISSION et al. (Howard Haulk, Appellee).\nThird District (Industrial Commission Division)\nNo. 3\u201402\u20140353WC\nOpinion filed May 6, 2004.\nRehearing denied June 7, 2004.\nGOLDENHERSH, J., dissenting.\nAllen C. Mueller, of Livingstone, Mueller, O\u2019Brien & Davlin, PC., of Springfield, for appellant.\nR. Wayne Harvey and J. Kevin Wolfe, both of Harvey & Stuckel, Chtrd., of Peoria, for appellee."
  },
  "file_name": "0638-01",
  "first_page_order": 656,
  "last_page_order": 673
}
