Present: All the Justices
A NEW LEAF, INC., ET AL.
v. Record No. 980454 OPINION BY JUSTICE CYNTHIA D. KINSER
January 8, 1999
ELAINE R. WEBB
FROM THE COURT OF APPEALS OF VIRGINIA
In this appeal, we decide whether allergic contact
dermatitis is compensable as an occupational disease under the
Virginia Workers’ Compensation Act (the Act). Because the
claimant’s contact dermatitis was caused by a reaction to
allergens in certain flowers and not by cumulative trauma
induced by repetitive motion, we will affirm the judgment of
the Court of Appeals that the condition is compensable under
the Act.
I.
Elaine Ruth Webb has been employed by A New Leaf, Inc. (A
New Leaf), as a florist since October 1993. In 1994, she
became the store’s senior florist. Her responsibilities
included daily handling, cutting, and arranging of flowers.
She was also in charge of weddings, preparing store designs,
and compiling daily financial reports.
In March 1995, Webb noticed blistered, splotchy areas on
her right index finger and on the palm of her right hand.
Webb described the condition as similar in appearance to a
poison ivy rash. Initially, she believed that the problem was
just an irritation and that she could treat it with
nonprescription lotions. However, the blistering worsened.
Consequently, in August 1995, Webb decided to seek
treatment from her family physician, Dr. John Carpenter.
After examining Webb’s hands, Dr. Carpenter diagnosed
“Dermatitis” but was “unclear whether it [was] fungal or a
contact type of dermatitis or a combination.” Dr. Carpenter
prescribed several medications for the dermatitis. After the
medications did not alleviate Webb’s problem, Dr. Carpenter
recommended that she see a dermatologist. By then, the
blistering had appeared on two of Webb’s fingers and the thumb
on her right hand. It was also present on the same fingers
and thumb on her left hand. From there, the dermatitis had
spread from her left wrist up to her elbow. 1
In November 1995, Dr. Anna M. Magee, a dermatologist,
examined Webb. Dr. Magee diagnosed Webb’s condition as
“Allergic Contact Dermatitis to plants most likely.” She also
prescribed medications to treat the dermatitis, recommended
that Webb wear gloves while performing her florist duties, and
warned Webb about the risks of working with certain flowers.
1
Webb testified that she had never before experienced any
dermatological problems to her hands. In fact, she had not
previously worked with real flowers.
2
Dr. Magee eventually performed a patch test on Webb to
determine which flowers were causing Webb’s problem. On April
4, 1996, Dr. Magee reported that Webb’s allergic contact
dermatitis was attributable to her interaction with tulips and
alstroemeria. 2
In two letter reports, dated April 4, 1996, and July 5,
1996, Dr. Magee opined that Webb was allergic to alstroemeria
and tulips and that, therefore, her condition was an
occupational disease. She also stated that allergic contact
dermatitis is a common problem for florists. Dr. Magee
subsequently confirmed that Webb’s contact dermatitis was
“most likely caused by at least two and probably more physical
contacts with the chemicals contained in alstro[e]meria and
tulips during her employment.”
Webb introduced into evidence two articles dealing with
the relationship between contact dermatitis caused by
allergens found in certain plants and the florist industry:
Cindy Hoogasian, Dermatitis Concerns Continue, FLORIST, March
1990, at 75; Cindy Hoogasian, Dermatitis Concerns Spark
Industry Study, FLORIST, Jan. 1988, at 95. In these articles,
Hoogasian describes allergic contact dermatitis as a “reaction
2
A New Leaf decided to stop stocking alstroemeria. It
still uses tulips since they are in season for only a short
period of time during the year, unlike alstroemeria, which is
available throughout the year.
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of the body’s immune system to the substance to which that
person is sensitive . . . .” (Hoogasian, 1990, supra, at 77).
She states that flowers, such as the alstroemeria and tulip,
contain chemicals or allergens that “cause allergic skin
reactions in some people with skin sensitivities.” (Hoogasian,
1988, supra, at 96). Hoogasian further opines that “[t]here
is little or no fear” the public will develop allergic
sensitivity to the allergen in alstroemeria because “their
actual involvement with the flower is limited.” Id. at 98.
“Only in cases where there is constant contact with the juice
of the alstroemeria, such as a designer or a sales employee
would have, is there cause for concern.” Id.
Webb filed a claim for workers’ compensation benefits on
May 15, 1996. A deputy commissioner of the Virginia Workers’
Compensation Commission (Commission) awarded benefits to Webb,
finding that the contact dermatitis is an occupational disease
under Code § 65.2-400. Upon review, the full Commission
affirmed the award of benefits to Webb. A panel of the Court
of Appeals of Virginia affirmed the decision of the
Commission. A New Leaf, Inc. v. Webb, 26 Va. App. 460, 495
S.E.2d 510 (1998). In explaining its decision, the Court of
Appeals stated:
Credible evidence supports the commission’s factual
finding that claimant’s allergic contact dermatitis was
not caused by “cumulative traumatic insults resulting
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from repetitive motion.” The record indicates that
claimant’s allergic contact dermatitis was not causally
linked to any repetitive motion that she performed at
work. Allergic contact dermatitis is caused by the
reaction of an individual’s immune system with a
substance, such as chemicals contained in certain
flowers, to which that individual has developed a
hypersensitivity. It is not caused by the wear and tear
associated with a repetitive motion. Although [Webb’s]
duties included designing and constructing floral
arrangements and “processing” flowers delivered to [A New
Leaf’s] store, no evidence linked the motions associated
with these activities to the outbreak of dermatitis on
[Webb’s] hands and arms.
Id. at 468, 495 S.E.2d at 514. (Citations omitted). A New
Leaf appeals.
II.
Under the Act, Code §§ 65.2-100 to –1310, a claimant must
prove by a preponderance of the evidence either an “injury by
accident” or an “occupational disease.” Code § 65.2-101; see
also Morris v. Morris, 238 Va. 578, 584, 385 S.E.2d 858, 862
(1989). Webb filed her claim for workers’ compensation
benefits on the basis that contact dermatitis is an
occupational disease. The term “occupational disease” is
defined as “a disease arising out of and in the course of
employment, but not an ordinary disease of life to which the
general public is exposed outside of the employment.” Code
§ 65.2-400(A). Subsection B of Code § 65.2-400 specifies six
factors that are necessary to establish a causal connection
between a disease and a worker’s employment:
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A disease shall be deemed to arise out of the
employment only if there is apparent to the rational
mind, upon consideration of all the circumstances:
1. A direct causal connection between the conditions
under which work is performed and the occupational
disease;
2. It can be seen to have followed as a natural
incident of the work as a result of the exposure
occasioned by the nature of the employment;
3. It can be fairly traced to the employment as the
proximate cause;
4. It is neither a disease to which an employee may
have had substantial exposure outside of the employment,
nor any condition of the neck, back or spinal column;
5. It is incidental to the character of the business
and not independent of the relation of employer and
employee; and
6. It had its origin in a risk connected with the
employment and flowed from that source as a natural
consequence, though it need not have been foreseen or
expected before its contraction.
A New Leaf concedes that Webb proved each of these
factors. Nevertheless, A New Leaf contends that Webb’s
contact dermatitis is not compensable as an occupational
disease because it was caused by repeated exposure to flowers
and thus is the result of cumulative trauma. Relying
primarily on this Court’s decisions in The Stenrich Group v.
Jemmott, 251 Va. 186, 467 S.E.2d 795 (1996), and Merillat
Indus., Inc. v. Parks, 246 Va. 429, 436 S.E.2d 600 (1993), A
New Leaf argues that Webb’s repeated touching of the flowers
gradually caused visible sores and wounds on her hands.
According to A New Leaf, “[t]he touching of the flowers caused
Webb to develop physical wounds on her body, the manifestation
6
of repeated trauma to her hands by the chemicals in the
flowers.” We do not agree.
Pursuant to Code § 65.2-706(A), an award of benefits by
the Commission upon review “shall be conclusive and binding as
to all questions of fact.” However, “whether a worker has
suffered an impairment that constitutes a compensable disease
is a mixed question of law and fact” Jemmott, 251 Va. at 192,
467 S.E.2d at 798. Thus, the Commission’s finding on that
question is not conclusive but is a proper subject for
judicial review. Id.
As in Jemmott, the factual part of the inquiry in this
case is whether Webb suffered an impairment. Id. This
portion includes any facts relevant to the nature and cause of
the impairment sustained by Webb. The legal part of the mixed
question is whether Webb’s allergic contact dermatitis
constitutes an occupational disease within the meaning of the
Act. Id. As already stated, A New Leaf contests only the
legal portion of the inquiry.
We turn now to the two cases upon which A New Leaf relies
in support of its position. In Merillat, we addressed whether
a torn rotator cuff muscle sustained as a result of repetitive
motion was compensable under the Act as an occupational
disease. Upon examining the six factors in Code § 65.2-400(B)
that are required to establish a causal connection between a
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disease and a worker’s employment, we concluded that merely
satisfying the causality test is not sufficient unless “the
condition for which compensation is sought as an occupational
disease . . . first qualif[ies] as a disease.” Id. at 432,
436 S.E.2d at 601. We then stated that the Commission’s
finding of an occupational disease was “not a finding of fact
that the tear was a disease rather than an injury, but a
conclusion based solely on utilization of a causality
analysis.” Id. at 433, 436 S.E.2d at 602. Thus, we concluded
that the worker’s rotator cuff tear was an injury, not an
occupational disease, because it resulted from repetitive
motion. We specifically refused “to broaden the scope of the
Act to include job-related impairments arising from repetitive
motion or cumulative trauma.” Id., 436 S.E.2d at 601-02.
In Jemmott, we again addressed the range of occupational
diseases compensable under the Act and, in doing so,
considered the claims of three workers who had suffered either
carpal tunnel syndrome or “trigger thumb.” The doctors who
had treated the claimants opined that the particular
impairments at issue were diseases, but they also stated that
the impairments were the result of cumulative trauma induced
by repetitive motion. Accordingly, we concluded that each
claimant’s impairment must be classified as an injury, not a
disease. Jemmott, 251 Va. at 198, 467 S.E.2d at 802. In
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reaching that decision, we stated that “just because a doctor
opines that a particular impairment is a disease does not
necessarily make it so.” Id., 467 S.E.2d at 801. We also
emphasized, once again, “that job-related impairments
resulting from cumulative trauma caused by repetitive motion,
however labeled or however defined, are, as a matter of law,
not compensable under the . . . Act.” Id. at 199, 467 S.E.2d
at 802.
Since A New Leaf concedes that Webb proved the six
factors contained in Code § 65.2-400(B), the dispositive
inquiry is whether contact dermatitis “qualif[ies] as a
disease.” Merillat, 246 Va. at 432, 436 S.E.2d at 601. In
making that determination in Merillat and Jemmott, we
considered the nature and cause of the impairments. For
example, the torn rotator cuff muscle “resulted from
repetitive overhead lifting and manipulation with [the
worker’s] left arm.” Merillat, 246 Va. at 430, 436 S.E.2d at
600. Similarly, in Jemmot, one of the doctors who diagnosed
carpal tunnel syndrome testified in a deposition that the
repetitive motions involved in the worker’s job caused “‘micro
trauma,’ meaning ‘a small amount of injury in a repetitive
motion to the same area . . . occur[ring] in patients [who]
flex their wrist and impinge the nerve as it courses through
the carpal tunnel.’” 251 Va. at 189-90, 467 S.E.2d at 797.
9
Likewise, the doctor who diagnosed “trigger thumb” attributed
that impairment to “‘the accumulation or the product of many
repetitious minor injuries to a joint, in the case here of the
thumbs.’” Id. at 191, 467 S.E.2d at 798.
In contrast to the evidence in Merillat and Jemmott, Dr.
Magee stated that Webb is allergic to alstroemeria and tulips
and that the contact dermatitis was caused by Webb’s physical
contact with the chemicals contained in those flowers.
Contact dermatitis was described as a “reaction of the body’s
immune system to the substance to which that person is
sensitive.” (Hoogasian, 1990, supra, at 77). Although the
sores and blisters appeared on Webb’s hands after frequent
handling of the flowers in question, there is no evidence in
the record that Webb’s allergic contact dermatitis resulted
from cumulative trauma arising from repetitive motion.
As the Commission stated in its opinion, “the evidence
reveals exposure over time to a particular causative agent
resulting in an adverse reaction in the form of contact
dermatitis.” The chemicals in alstroemeria and tulips
triggered a dermatological reaction, which is distinct from
the wear and tear resulting from a repetitive motion. Thus,
allergic contact dermatitis, unlike carpal tunnel syndrome,
“trigger thumb,” or a torn rotator cuff muscle, “qualif[ies]
as a disease.” Merillat, 246 Va. at 432, 436 S.E.2d at 601.
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Accordingly, we conclude that Webb’s allergic contact
dermatitis is a compensable occupational disease within the
meaning of the Act.
For these reasons, we will affirm the judgment of the
Court of Appeals.
Affirmed.
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