Kenneth Lakatis v. Citrus County Sheriff's Office/Florida Sheriff's Risk Management Fund (FSRMF)

FIRST DISTRICT C OURT OF A PPEAL
STATE OF FLORIDA
_____________________________
No. 1D2024-1350
_____________________________
K ENNETH L AKATIS,
Appellant,
v.
C ITRUS COUNTY S HERIFF ’S
O FFICE/F LORIDA S HERIFF ’S R ISK
M ANAGEMENT F UND (FSRMF),
Appellees.
_____________________________
On appeal from the Office of the Judges of Compensation Claims.
Brian J. Anthony, Judge.
Dates of Accident: April 28, 2023, May 1, 2023, and May 15,
2023.
February 18, 2026
R AY, J.
Kenneth Lakatis, a longtime law enforcement officer, appeals
a final order of the Judge of Compensation Claims denying his
workers’ compensation claim for disabling heart disease. Section
112.18 of the Florida Statutes, often referred to as the Heart-Lung
statute, provides that when a qualifying officer becomes disabled
by heart disease, the condition is presumed to have arisen out of
the employment unless the employer/carrier (E/C) rebuts that
presumption 	with 	competent 	evidence. 	Lakatis 	met 	every
requirement to invoke the presumption. The remaining question

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was whether the E/C proved that his coronary artery disease, and
the heart attack that followed, resulted solely from non-work
factors. On this record, the E/C did not make that showing.
Because the Heart-Lung presumption demands more to overcome
it, we set aside the order denying compensability and remand for
further proceedings consistent with this opinion.
I
Lakatis has served with the Citrus County Sheriff’s Office for
fifteen years and works as a patrol sergeant supervising several
deputies. 	His 	position 	requires 	rotating 	twelve-hour 	shifts,
alternating every two months between day and night duty. When
assigned to nights, he averages about six hours of sleep each day.
His duties include supervising personnel, handling complaints and
administrative 	tasks, 	and 	responding 	to 	high-risk 	calls—
responsibilities that regularly expose him to stressful situations.
In late April 2023, while on duty and exercising on a treadmill
in the sheriff’s office gym, Lakatis experienced burning chest
discomfort. The next day, again during his shift, he felt similar
chest pain while lifting and unloading heavy metal poles used for
traffic signs. Early the following morning, he awoke with the same
burning pain and drove himself to the hospital. Cardiac testing
revealed a non-ST-elevation myocardial infarction and diffuse
multivessel coronary artery disease. He underwent triple-bypass
surgery on May 1, 2023. Two weeks later, after discharge, he
returned to the hospital with recurrent chest pain and underwent
another catheterization that resulted in the placement of two
stents. 	He 	remained 	off 	duty 	until 	June 	26, 	2023, 	when 	he
returned to light duty, followed by a full-duty release a month
later.
Lakatis filed petitions for benefits seeking compensability of
his 	disabling 	heart 	disease 	under 	the 	Heart-Lung 	statute,
authorization of a cardiologist, and payment of temporary total
disability benefits, penalties, interest, costs, and attorney’s fees. At
the final hearing, the E/C stipulated that he met all prerequisites
for the statutory presumption: he was a full-time law enforcement
officer; his pre-employment physical revealed no evidence of heart
disease; and he suffered from heart disease resulting in disability.

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The 	only 	dispute 	was 	whether 	the 	E/C 	had 	rebutted 	the
presumption that his disabling condition was work-related.
The parties offered competing medical testimony. The E/C’s
independent 	medical 	examiner 	(IME) 	attributed 	the 	coronary
artery disease and resulting heart attack to non-occupational risk
factors—hypertension, 	hyperlipidemia, 	pre-diabetes, 	obesity,
family history, smoking, and heavy alcohol use—and opined that
these factors “banded together” to cause the disease and the need
for bypass surgery and stenting. Lakatis’s IME agreed that those
risk factors may have played some role but emphasized that
medical science cannot identify which, if any, caused the coronary
artery disease or the acute heart-attack event in this case.
Given 	this 	disagreement, 	the 	JCC 	appointed 	an 	expert
medical advisor (EMA) under section 440.13(9), Florida Statutes.
In his written report, the EMA opined that the “most likely cause”
of 	the 	coronary 	artery 	disease 	was 	a 	constellation 	of 	non-
occupational risk factors—hypertension, hyperlipidemia, smoking,
obesity, and family history—and was “not related” to Lakatis’s
employment. He likewise wrote that the chest-pain episodes and
heart-attack 	event 	were 	triggered 	by 	those 	risk 	factors 	and
accelerated coronary artery disease, and were “not work related.”
In 	his 	deposition, 	however, 	the 	EMA 	offered 	additional
context. He explained that medical science cannot determine “the
exact cause” of coronary artery disease in any individual and that
the disease develops from both known and unknown influences. He
identified seven contributors in Lakatis’s case: an unknown factor,
hypertension, hyperlipidemia, obesity, smoking, family history,
and employment as a law enforcement officer. He testified that
hypertension accounted for roughly 25 percent of the disease, and
that Lakatis’s employment “could have” brought on or exacerbated
that hypertension. He further described law-enforcement work as
a recognized risk factor because of long shifts, day-night reversals,
and long periods of inactivity interrupted by sudden, stressful
exertion that produces adrenaline surges and acutely elevates
blood pressure and heart rate.

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As for the trigger, the EMA testified that “we don’t know,
really, what a trigger is,” but identified family history, smoking,
elevated cholesterol, elevated blood pressure, and an unknown
factor as contributors. On cross-examination, he confirmed that
the written report reflected his ultimate opinions. On redirect,
however, he also reiterated that employment as a law enforcement
officer was a contributing cause of both the coronary artery disease
and the acute heart-attack event, describing the occupational role
as 	“a 	small 	percentage”—“not 	0 	percent,” 	but 	“less 	than 	51
percent.”
The JCC accepted the EMA’s written opinions as “clear and
unequivocal” 	and 	“presumed 	to 	be 	correct” 	under 	section
440.13(9)(c). 	Yet 	the 	JCC 	concluded 	that 	there 	was 	“no
occupational cause” of the disease or the heart-attack event, found
that 	the 	E/C 	rebutted 	the 	Heart-Lung 	presumption 	both 	by
competent evidence and by clear and convincing evidence, and
denied all benefits. Lakatis moved for rehearing, arguing that the
EMA’s 	acknowledgment 	of 	occupational 	causation 	foreclosed
rebuttal as a matter of law. The JCC denied rehearing, and this
appeal followed.
II
Florida’s 	Heart-Lung 	statute 	creates 	a 	rule 	of 	causation
unique to qualifying law enforcement officers, firefighters, and
correctional officers. Relevant here, it provides that when an
officer becomes disabled by a “condition or impairment of health”
caused by heart disease, that disabling impairment “shall be
presumed to have been accidental and to have been suffered in the
line of duty,” unless the E/C establishes the contrary “by competent
evidence.” 	§ 	112.18(1)(a), 	Fla. 	Stat. 	Once 	the 	statutory
prerequisites are met, the claimant bears no burden to prove
occupational causation; the statute shifts the burden of persuasion
to the employer. See Punsky v. Clay Cnty. Sheriff’s Off., 18 So. 3d
577, 583–84 (Fla. 1st DCA 2009) (explaining that the presumption
is a true burden-shifting presumption, not a “bursting bubble”).
Our decisions recognize that disability from heart disease may
arise from two causal components: an underlying cardiac condition
and a precipitating event that turns that condition into a disabling
impairment. When disability follows that pattern, the employer’s

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rebuttal burden extends to both parts of the causal chain. Showing
that the underlying disease is personal or congenital is not enough;
the employer must also rule out an occupational cause of the
trigger.
Take Mitchell v. Miami-Dade County (“Mitchell II”) as an
example. There, the claimant’s congenital heart condition became
disabling only when a separate event triggered an episode of
supraventricular tachycardia. 186 So. 3d 65, 68 (Fla. 1st DCA
2016). As Mitchell II explains, a congenital defect, much like any
preexisting condition, can be aggravated by an event in the course
of 	employment. 	Id. 	And 	when 	disability 	arises 	from 	that
combination, the E/C must rule out an occupational cause of both
the underlying condition and the acute trigger. Id. We reaffirmed
the same principle in Gonzalez v. St. Lucie County Fire District,
holding that the JCC was required to make a distinct finding on
whether the precipitating event had any possible occupational
cause. 186 So. 3d 1106, 1109 (Fla. 1st DCA 2016).
In view of this two-part causal chain, the standard for rebuttal
is 	demanding. 	To 	overcome 	the 	presumption, 	the 	E/C 	must
establish that the disabling impairment was caused entirely by
non-work factors. See City of Jacksonville v. Ratliff, 217 So. 3d 183,
192 (Fla. 1st DCA 2017). Evidence showing that non-occupational
causes were substantial, predominant, or even overwhelmingly
likely does not satisfy that burden. Id. As Ratliff explains, the
presumption remains unless the employer proves that “the” or “all”
possible causes of the underlying condition and the disabling event
were non-occupational. Id.
III
Applying these principles to the record before us, the E/C did
not present competent medical evidence excluding work as a cause
of either the underlying coronary artery disease or the heart attack
that rendered Lakatis disabled.
Start with the disease. The EMA, whose opinions the JCC
described 	as 	“clear 	and 	unequivocal” 	and 	accepted 	as
presumptively 	correct, 	testified 	that 	coronary 	artery 	disease
develops from a mixture of known and unknown factors. In his
written report, he opined that the “most likely cause” of the disease

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in 	Lakatis’s case 	was a 	combination 	of non-occupational risk
factors. 	In 	his 	deposition, 	however, 	he 	identified 	seven
contributors: an unknown factor, hypertension, hyperlipidemia,
obesity, 	smoking, 	family 	history, 	and 	employment 	as 	a 	law
enforcement 	officer. 	He 	further 	explained 	that 	work-related
stressors and exertion accounted for a “small” but nonzero share of
the process.
The E/C argues that the JCC was free to disregard this
testimony as inconsistent, but the record shows otherwise. The
JCC expressly credited the EMA’s views and did not reject his
acknowledgment of occupational causation; he simply treated the
predominance of non-work factors as sufficient rebuttal. That
approach conflicts with the Heart-Lung statute. The question is
not whether non-work causes predominate, but whether the E/C
disproved any occupational causation. Because the EMA placed
employment within the causal chain, the presumption was not
rebutted as to the underlying disease.
The same is true for the triggering event. The heart attack
was preceded by two days of exertional chest pain at work—first
during 	treadmill exercise and 	then while lifting heavy 	metal
poles—and culminated in the acute symptoms that prompted
Lakatis to seek emergency care. The EMA testified that medical
science cannot identify with certainty the precise trigger of an
ischemic event, that an “unknown” factor likely played a role, and
that he could not attribute the trigger solely to non-occupational
causes. 	He 	identified 	the 	same 	set 	of 	contributors, 	including
employment, as potential contributors to the heart attack itself.
The E/C’s own IME similarly acknowledged that the initial chest-
pain episode was precipitated by exertion on the treadmill during
work.
Even so, the E/C contends that the diffuse nature of the
disease precludes any occupational component. But the EMA did
not definitively say that. He stated only that he believed non-
occupational 	factors 	predominated, 	while 	at 	the 	same 	time
acknowledging a small but nonzero occupational role in both the
disease and the triggering event. And, as Ratliff illustrates, where
the medical evidence cannot pinpoint the trigger and still leaves
room for a work-related contribution, the employer cannot meet its

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burden to show that all causes were non-occupational. 217 So. 3d
at 192.
IV
Because the E/C did not carry its burden under the Heart-
Lung statute to exclude occupational causation, the statutory
presumption remains unrebutted. The JCC therefore erred in
denying compensability. We set aside the final order and remand
for 	entry 	of 	an 	order 	finding 	Lakatis’s 	cardiac 	condition
compensable 	under 	section 	112.18(1) 	and 	for 	any 	further
proceedings consistent with this opinion.
S ET A SIDE and R EMANDED.
R OBERTS and T READWELL ,* JJ., concur.
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Not 	final 	until 	disposition 	of 	any 	timely 	and
authorized motion under Fla. R. App. P. 9.330 or
9.331.
_____________________________
Megan E. Oliva of Bichler & Longo, PLLC, Maitland, for Appellant.
William H. Rogner of HR Law, P.A., Orlando, for Appellees.
* 	Judge 	Treadwell 	was 	substituted 	for 	an 	original 	panel
member in this proceeding after oral argument. He has reviewed
the briefs, the record, and the recording of the oral argument.