Appeals Court Expands Definition of Heart Disease Under Presumption Statute: Downey v. CRAB (AC 25-P-244, August 20, 2026)

A former Ashland police officer whose heart suffered persistent, treatment-resistant abnormal beats has cleared a major hurdle in her fight for accidental disability retirement benefits. The Appeals Court ruled that the Contributory Retirement Appeal Board wrongly dismissed her cardiac condition as a mere symptom, holding instead that premature ventricular contractions can constitute heart disease under the so-called heart law, which presumes a firefighter’s or police officer’s heart condition arose in the line of duty.

The court reversed CRAB’s denial of benefits to Allena Downey and remanded the case for further proceedings.

The Facts

Downey worked as an Ashland police officer from 2002 until September 2013. In late 2012, she began experiencing frequent heart palpitations, shortness of breath, dizziness, and chest pain. Her cardiologist found no significant coronary artery disease but diagnosed her with frequent premature ventricular contractions (PVCs), a type of abnormal heartbeat or arrhythmia.

The PVCs resisted medication. Downey required hospitalization in January 2013 for asthmatic bronchitis, shortness of breath, and heart palpitations, and again in April 2013 for migraines, chest discomfort, and more palpitations.

On September 25, 2013, while at work, Downey responded to a call about an unresponsive person who had collapsed in a bathroom. She unsuccessfully tried to extricate the person to render aid, and the person died. Downey’s heart raced out of control, she became nauseated with a migraine, and a supervisor sent her back to the station. She never returned to work as a police officer.

Her condition persisted. Even off duty, her chest pain and PVCs worsened. In May 2014, she underwent surgical ablation, but the PVCs and symptoms continued. Her cardiologist determined she could not return to police work. During one forty-eight hour monitoring period, Downey experienced 36,124 ventricular ectopic beats, representing fourteen percent of all heartbeats.

The Procedural Journey

In July 2014, Downey applied for both ordinary disability retirement benefits and accidental disability retirement (ADR) benefits. ADR benefits require proof of three elements: inability to perform essential job duties, likely permanence of that inability, and that the disability resulted from a personal injury or hazard while performing duties.

Because Downey passed a physical when hired, the heart law, General Laws chapter 32, section 94, gave her a rebuttable presumption on the third element. The statute provides that any impairment caused by hypertension or heart disease shall be presumed to have been suffered in the line of duty, unless the contrary is shown by competent evidence.

A three-physician panel examined Downey. By January 2015, a majority concluded she satisfied all three elements for ADR benefits. The dissenting physician disagreed on permanent disability and line-of-duty causation.

After MCRS asked the panel to clarify whether Downey suffered from heart disease or hypertension, the majority reiterated their opinions. One described an electrical abnormality, another noted significant PVCs without coronary disease or significant hypertension. One physician said the cause was unknown (idiopathic); the other cited mental exhaustion, stress, and psychiatric diagnoses alongside the PVCs. The dissenting physician blamed psychiatric rather than cardiovascular issues.

MCRS approved ordinary disability retirement but denied ADR benefits in September 2015. A DALA magistrate reversed, finding the heart law presumption applied and all elements were satisfied. CRAB then reversed DALA, concluding Downey did not suffer from any heart disease, that even if the presumption applied it was rebutted by evidence of stress and anxiety from home life plus medication, alcohol, and opiates, and that Downey failed to prove disability from an underlying heart disease as of her last day of work. A Superior Court judge affirmed CRAB’s decision on cross-motions for judgment on the pleadings.

What the Court Held

The Appeals Court reversed the Superior Court judgment and remanded the case to CRAB for further proceedings. Writing for the panel, Justice Hodgens held that CRAB erred by not treating Downey’s PVCs as heart disease under the heart law and by imposing an extra burden on her to prove the cause of the PVCs.

The Reasoning

The court disagreed with CRAB’s premise that PVCs do not constitute heart disease. CRAB had viewed the PVCs as a mere symptom, requiring Downey to prove the PVCs were caused by an underlying heart disease. The heart law does not define heart disease, and prior cases applying the statute have not narrowly defined the phrase as CRAB did.

Appellate decisions have applied the heart law to a range of conditions: coronary occlusion, myocarditis, dissecting aortic aneurysm, embolus to the brain arising in the heart, coronary thrombosis, and aortic stenosis with coronary artery calcification. The court wrote that given the heart’s complex design and varied pathologies, it could not exclude persistent, treatment-resistant PVCs from the broad reach of the phrase heart disease under the statute.

The court cited precedent favoring a broader application of the presumption than a literal reading might suggest, noting the heart law modified the rigidity of eligibility for accidental disability benefits.

The plain language of the heart law does not require proof of etiology, the court continued. To invoke the presumption, Downey had to prove a condition of impaired health caused by heart disease. In other words, she needed to prove the existence of the disease (the undisputed PVCs resistant to treatment), not the more esoteric question of the cause. By placing an additional burden on Downey, CRAB undermined the very purpose of the heart law: to create a presumption of line-of-duty disability without needing to prove further causal connection.

CRAB should have given Downey the benefit of the statutory presumption that the PVCs arose in the line of duty, then determined whether competent evidence rebutted that presumption.

The false premise also tainted CRAB’s alternative conclusion that competent evidence overcame the presumption anyway. Medical records showed Downey experienced a significant number of PVCs resistant to medication and surgery. CRAB’s conclusion that the PVCs were caused by stress, medication, alcohol, and opiates rather than underlying heart disease was the wrong inquiry. CRAB should have determined whether the presumption that the PVCs were suffered in the line of duty had been overcome by competent evidence.

Finally, by not recognizing the PVCs as heart disease, CRAB erred in concluding Downey failed to establish she was disabled as of her last day of work. CRAB found that a cardiologist diagnosed Downey with PVCs in November 2012, that she continued to suffer from them after her last day of employment in 2013, and that on her last day at work her heart was pumping out of control with sharp chest pains. If CRAB properly viewed the PVCs as heart disease, these facts would enable an inference that the disabling PVCs existed when her employment terminated.

Why It Matters

The decision clarifies the reach of the heart law presumption. CRAB and retirement boards cannot require public safety employees to prove the underlying cause of a cardiac condition in order to trigger the presumption. The existence of the condition suffices. The burden then shifts to the employer to rebut the presumption with competent evidence that the condition did not arise in the line of duty.

The ruling also confirms that heart disease under the statute encompasses a broad range of pathologies, not merely the most familiar conditions like coronary artery disease or hypertension. Treatment-resistant arrhythmias qualify. For disabled officers and firefighters, the decision prevents retirement boards from using diagnostic uncertainty as a weapon to deny the statutory presumption. The question is not what caused the heart disease but whether competent evidence shows it did not arise from the job.

Read the full opinion: Downey v. Contributory Retirement Appeal Board (AC-25-P-244, August 20, 2026).