Understanding the Heart Bill
By Richard Alles, Deputy Chief FDNY, Ret.
Recently, we have received an uptick in calls from members with questions about the heart bill. Therefore, I thought this would be a fitting time to give an overview of the law, which, in my view, is the most complicated of the presumptive laws in place to protect sick firefighters.
The heart bill was passed in 1973 for the benefit of NYC firefighters and police officers. It covers active members only. Unlike the lung bill and the cancer bill, the heart bill has not been incorporated into the WTC Disability Law, which covers virtually every member who was active on 9/11/01, into retirement for 25 years.
Generally, a member seeking accident disability retirement has the burden of proving that the disabling injury is the natural result of an accident sustained in city service, and not the result of willful negligence on the part of the member. However, for those members stricken with disabling cardiac disease, the heart bill creates a presumption that the disability was incurred in the line of duty. In other words, once a member proves that the heart disease is disabling, the presumptions created by the heart bill are sufficient to establish that the disease is related to the performance of the member’s duties.
The heart bill does not guarantee an accident disability retirement to every member with a disabling heart condition. Rather, it covers only those members whose heart conditions developed as a result of stress or other occupational strains on the heart. In order to rebut the presumption created by the heart bill, the Medical Board must rule out, by credible medical evidence, underlying stress-related coronary artery disease or hypertension as the cause of the heart ailment.
The Medical Board has successfully rebutted the presumption in the following circumstances:
1. Where there is medical evidence establishing that an applicant’s heart disease is congenital, viral, or the result of any other disease such as rheumatic fever.
2. Where there is medical evidence establishing that stress or other occupational strains on the heart cannot cause the heart condition at issue.
3. Where the member has an idiopathic heart condition (one of unknown cause), unaccompanied by evidence
of stress-related pathologies such as coronary artery disease or hypertension.
4. Where the Medical Board provides sufficient evidence that any stress related pathologies that do exist are not related to the disabling heart condition.
What is and is not disabling under the heart bill?
A. Ischemia is disabling. This can be determined by stress testing. In the absence of angiography, two non-invasive abnormal tests showing ischemia in the same region are acceptable.
B. Hypertensive Heart Disease is disabling in the following cases:
1. Where there is wall thickness 14mm or greater in the presence of hypertension.
2. Where there is wall thickness greater than 11mm but less than 14mm, together with evidence of ischemia (by stress test).
C. Hypertrophic Cardiomyopathy is disabling in the following cases:
1. Where there is wall thickness of 15mm or greater.
2. Where there is eccentric hypertrophy in the presence of hypertension.
D. Dilated Cardiomyopathy is not due to hypertension and is therefore not covered.
E. Myocardial Infarction appropriately documented is disabling.
F. Coronary Artery Stenosis is disabling in the following cases:
1. Proximal 70% stenosis of one or more coronary arteries.
2. Proximal 50% stenosis of one or more coronary arteries and ischemia in the same region.
G. Ventricular Arrhythmias with Exercise or Stress such as ventricular tachycardia or ventricular fibrillation is disabling if associated with coronary heart disease or hypertensive heart disease.
H. Supraventricular Arrhythmias controlled by medications is not disabling.
I. Atrial Afibrillation is a disability because of anticoagulation and if associated with coronary heart disease or hypertensive heart disease is disabling.
I am very much aware that of all of the presumptive bills, the heart bill is the most confusing. Medical questions dealing with the heart are best left to the wonderful doctors and nurses at BHS and, of course, your cardiologist. As I’ve stated in prior articles, your first point of contact regarding disability pension questions is always your union pension trustee. We are always willing to give you a second opinion, should you want one.