COURT OF APPEALS OF VIRGINIA
Present: Judges Humphreys, Clements and Senior Judge Coleman
Argued at Richmond, Virginia
WAYNESBORO (CITY OF) POLICE AND
VIRGINIA MUNICIPAL GROUP
SELF-INSURANCE ASSOCIATION
OPINION BY
v. Record No. 1456-00-2 JUDGE SAM W. COLEMAN III
APRIL 17, 2001
SHARON ANN COFFEY, WIDOW, AND
HAROLD BERNARD COFFEY, JR. (DECEASED)
FROM THE VIRGINIA WORKERS' COMPENSATION COMMISSION
Ralph L. Whitt, Jr. (Michael P. Del Bueno;
Williams, Lynch & Whitt; Whitt & Associates,
on briefs), for appellants.
Malcolm Parks (Maloney, Parks, Clarke &
Nathanson, P.C., on brief), for appellee.
The City of Waynesboro Police Department and its insurer
(employer) appeal the Workers' Compensation Commission's
(commission) decision awarding dependent's benefits to Sharon
Ann Coffey (claimant) pursuant to Code §§ 65.2-512 and -515, for
the death of her husband, Harold Bernard Coffey, Jr. (Coffey).
Employer contends the commission erred in finding that Coffey
had heart disease or, if he did have heart disease, erred in
holding that employer failed to rebut the statutory presumption
of Code § 65.2-402(B) that Coffey's heart condition was an
occupational disease covered by the Workers' Compensation Act.
For the following reasons, we affirm.
I. BACKGROUND
Coffey was a fifty-three-year-old police officer for the
City of Waynesboro. He began his career in 1970 as a patrolman
for the city. However, for the past fifteen years, Coffey had
been a desk officer, working rotating shifts. As a desk
officer, Coffey monitored prisoners in lock-up, monitored
entrances and exits of the police station to assure security,
completed paperwork, answered the phones, assisted citizens with
questions, and performed various clerical duties. For several
years before his death, Coffey voluntarily patrolled low-income
housing in Waynesboro two or three times per month, in addition
to his duties as a desk officer.
On May 26, 1996, the day of his death, Coffey and claimant
purchased a television set and a gas grill. Coffey carried the
television into the house, up four steps, and placed the
television in the couple's bedroom. Coffey became winded
carrying the television and grill, but he did not complain of
discomfort. Approximately thirty minutes after Coffey had
carried the television into his house and while he was
programming it, Coffey suddenly dropped the remote control and
fell off the bed and against the wall. He never regained
consciousness.
Immediately after he collapsed, claimant called 911.
Deputy Sheriff John Howard, claimant's son, arrived within a few
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minutes and checked Coffey for a pulse and respiration, but
found none. Emergency medical technicians arrived immediately
thereafter and began administering CPR. Efforts to resuscitate
Coffey, which included chest compressions, electrically shocking
the heart, applying an external cardiac pacemaker, and
administering epinephrine, atropine, and dextrose, failed.
Coffey was pronounced dead at the scene and transported directly
to the funeral home. Without examining the body, Coffey's
family physician for thirty years, Dr. John W. Forbes III,
executed the death certificate, indicating that Coffey died as a
result of acute myocardial infarction. No autopsy was performed
or requested.
Claimant testified that on the day of her husband's death,
he did not complain of any discomfort or illness. She said
immediately before his death he did not appear confused or
disorientated, his speech was clear, and he was not perspiring.
Claimant stated that, although Coffey had seemed winded from
carrying the television, he seemed fine before he died.
Claimant filed a claim for death, medical, and funeral
benefits. The commission awarded her benefits.
II. ANALYSIS
"Matters of weight and preponderance of the evidence, and
the resolution of conflicting inferences fairly deducible from
the evidence, are within the prerogative of the commission, and
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are conclusive and binding on the Court of Appeals." Kim v.
Sportswear, 10 Va. App. 460, 465, 393 S.E.2d 418, 421 (1990)
(citations omitted); see also Code § 65.2-706(A). "Medical
evidence is . . . subject to the commission's consideration and
weighing." Hungerford Mechanical Corp. v. Hobson, 11 Va. App.
675, 677, 401 S.E.2d 213, 215 (1991). "Questions raised by
conflicting medical opinions must be decided by the commission."
Penley v. Island Creek Coal Co., 8 Va. App. 310, 318, 381 S.E.2d
231, 236 (1989). "The fact that there is contrary evidence in
the record is of no consequence if there is credible evidence to
support the commission's finding." Wagner Enters., Inc. v.
Brooks, 12 Va. App. 890, 894, 407 S.E.2d 32, 35 (1991).
A. Finding of Heart Disease
Code § 65.2-402(B) provides:
[H]eart disease causing the death of . . .
members of county, city or town police
departments . . . shall be presumed to be
occupational diseases, suffered in the line
of duty, that are covered by this title
unless such presumption is overcome by a
preponderance of competent evidence to the
contrary.
Thus, the first issue is whether the evidence is sufficient
to prove that Coffey died as a result of a heart attack or heart
disease. See Page v. City of Richmond, 218 Va. 844, 847, 241
S.E.2d 775, 777 (1978).
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Coffey had not been diagnosed with heart disease prior to
his death, and no postmortem examination was conducted. 1
However, six physicians rendered opinions as to the cause of
Coffey's death. See Code § 8.01-401.1 ("[A]ny expert witness
may give testimony and render an opinion or draw inferences from
facts, circumstances, or data made known to . . . such witness
. . . . The expert may testify in terms of opinion or inference
and give his reasons therefor without prior disclosure of the
underlying facts or data . . . ."); Cox v. Oakwood Mining, Inc.,
16 Va. App. 965, 434 S.E.2d 904 (1993) (applying Code
§ 8.01-401.1). Dr. Charles L. Baird, Jr., a cardiologist
retained by employer, testified that based on his review of
claimant's account of Coffey's death and his medical records and
lab reports, Coffey, "more probably than not," died of
ventricular fibrillation induced by extreme exercise. Dr. Baird
stated that ventricular fibrillation "is a fatal arrhythmia
characterized by rapid electrical impulses that are inconsistent
with life unless otherwise a patient undergoes fibrillation."
Ventricular fibrillation may be caused by any number of
conditions, including ischemic heart disease, myocardial
infarction, drugs, exercise, or psychological induction of the
1
Code § 65.2-402(F) provides that the employer may require
a postmortem examination to be conducted to determine the cause
of death when a claim is made for death benefits due to
hypertension or heart disease.
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vasospasm; it is an arrhythmia that may not necessarily be
associated with heart disease. Dr. Baird testified that,
although most instances of ventricular fibrillation are
associated with coronary atherosclerosis, there was no evidence
in this case to suggest that Coffey had coronary
atherosclerosis.
Dr. Robert M. Bennett, a cardiologist retained by employer,
testified that, based on his examination of the evidence
supplied by employer, he was unable to determine, from the
information provided, whether Coffey suffered a myocardial
infarction or whether he had coronary artery disease. Dr.
Bennett opined that, based on the circumstances surrounding his
death, Coffey may have died as a result of any number of causes,
including intracranial bleed, a Berry aneurysm, ruptured
thoracic aneurysm, ruptured abdominal aneurysm, ventricular
fibrillation, massive myocardial infarction, or a massive
pulmonary embolus. Dr. Bennett, however, stated that because of
the lack of information available, it was impossible to conclude
if any of these conditions caused Coffey's death. Dr. Bennett
further stated no evidence suggested that Coffey did not die as
a result of some type of cardiac dysfunction.
Dr. Stuart F. Seides, a cardiologist retained by employer,
opined that because Coffey died suddenly, unexpectedly, and
without warning and because a postmortem examination was not
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performed, he was unable to determine the cause of Coffey's
death. Dr. Seides opined, however, that based on Coffey's
medical background, including the presence of several major risk
factors, and based on the circumstances of his death, it is
statistically probable that Coffey died of a "sudden cardiac
arrhythmia in the setting of underlying coronary heart disease,"
or coronary atherosclerosis.
Dr. Richard A. Schwartz, a clinical cardiologist retained
by claimant, opined that Coffey died of ventricular fibrillation
secondary to coronary artery disease or fatal cardiac
arrhythmia. Dr. Schwartz stated that, based on his review of
Coffey's medical records, there was no indication that Coffey
had cardiac arrhythmia due to a cause other than ischemia, which
is a lack of blood or oxygen to the heart muscle. Although
Dr. Schwartz conceded that there were other causes of cardiac
arrhythmia, he stated that those causes would have been apparent
from Coffey's last physical examination performed the month
before his death. He further stated that, even assuming Coffey
had hypertension, the fact that Coffey was under active
treatment and taking medication for hypertension would eliminate
the condition as a risk factor. Dr. Schwartz stated that there
are several risk factors statistically correlated with heart
disease, including smoking, high blood pressure, elevated
cholesterol, physical inactivity, intercurrent diseases, and
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stress. Dr. Schwartz stated that law enforcement officers are
twice as likely to develop heart disease as others in the
general population.
Dr. William Toomy, an internist who performs physical
examinations for the City of Waynesboro Police Department,
testified that he performed a physical examination of Coffey in
April 1996, a month before his death. At the time of the
examination, Dr. Toomy diagnosed Coffey with exogenous obesity,
treated hypertension, hyperglycemia, hyperlipidemia, and
cigarette addiction. Dr. Toomy also obtained an
electrocardiographic tracing, which did not indicate any
abnormalities. Coffey was not diagnosed with heart disease at
the time. Dr. Toomy noted that Coffey had a family history of
arteriosclerotic heart disease. Dr. Toomy stated that the "most
likely" cause of Coffey's death was cardiac arrhythmia.
Dr. John W. Forbes III, Coffey's treating physician for
thirty years, testified that prior to Coffey's employment as a
police officer, he was not diagnosed with heart disease or
hypertension. However, Dr. Forbes later treated Coffey with
medications for hypertension and chronic anxiety. Based on the
circumstances of Coffey's death and the reports of the rescue
personnel who tried to resuscitate Coffey, Dr. Forbes opined
that Coffey died as a result of acute myocardial infarction.
Dr. Forbes stated that "the most likely cause of the heart
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attack" was atherosclerotic coronary artery disease. Dr. Forbes
rejected the possibility that Coffey died of a stroke or an
aneurysm, because immediately after the incident, Coffey had no
heart activity. Dr. Forbes last saw Coffey in March 1996, at
which time he treated Coffey for high blood pressure, a back
problem, and chronic anxiety.
Credible evidence in the record supports the commission's
finding that Coffey died as a result of heart disease. "An
expert's opinion which is neither based upon facts within his
own knowledge nor established by other evidence is speculative
and possesses no evidential value." Gilbert v. Summers, 240 Va.
155, 160, 393 S.E.2d 213, 215 (1990). However, a doctor's
expert medical opinion is not speculative if based on an
accurate understanding of the relevant facts. See id.; cf.
Clinchfield Coal Co. v. Bowman, 229 Va. 249, 252, 329 S.E.2d 15,
16 (1985) (per curiam) (holding that a doctor's medical opinion
was not credible when based upon a faulty premise); Spruill v.
Commonwealth, 221 Va. 475, 479, 271 S.E.2d 419, 421 (1980)
(stating that a medical opinion is speculative if based on a
"possibility" but admissible and sufficient if based on a
"reasonable probability"); Circuit City Stores, Inc. v. Scotece,
28 Va. App. 383, 387-88, 504 S.E.2d 881, 883-84 (1998) (adopting
standard for admissibility of medical evidence articulated in
Spruill). In rendering their opinions, the physicians had
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access to Coffey's medical records, the records of the emergency
personnel who attempted to resuscitate Coffey, and claimant's
deposition detailing the facts and circumstances immediately
preceding Coffey's death. Dr. Baird opined that Coffey died as
a result of ventricular fibrillation and conceded that, in most
instances, ventricular fibrillation is associated with coronary
atherosclerosis. Dr. Bennett was unable to render a conclusive
opinion as to the cause of death. Dr. Schwartz stated that
Coffey died of ventricular fibrillation secondary to coronary
artery disease, and Dr. Seides opined that Coffey died as a
result of cardiac arrhythmia in the setting of coronary artery
disease. Although employer's experts advanced alternative
causes for Coffey's death, the physicians stated that such
causes other than heart disease were unusual. Therefore,
credible evidence supports the commission's finding that Coffey
died of heart disease. Accordingly, we affirm the commission's
finding that Coffey died from heart disease.
B. Statutory Presumption of Code § 65.2-402(B)
Employer also contends the commission erred in finding that
employer failed to rebut the presumption that Coffey's heart
disease was an occupational disease as provided in Code
§ 65.2-402(B).
Code § 65.2-402(B) provides, in part, that once the
claimant had shown that the law enforcement official died as a
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result of heart disease, the heart disease shall be presumed to
be an occupational disease unless this presumption is
sufficiently rebutted by employer.
The Supreme Court recently held that
[t]o overcome the presumption [contained in
Code § 65.2-402(B)], the employer must show,
by a preponderance of the evidence, both
that 1) the [employee's] disease was not
caused by his employment, and 2) there was a
non-work-related cause of the disease.
Thus, if the employer does not prove by a
preponderance of the evidence both parts of
this two-part test, the employer has failed
to overcome the statutory presumption.
Bass v. City of Richmond Police Dep't, 258 Va. 103, 114, 515
S.E.2d 557, 562-63 (1999) (citations omitted).
Employer's expert witnesses, Drs. Baird, Bennett, and
Seides, all concluded that, assuming Coffey had heart disease,
Coffey's employment was not a causative factor in that disease.
Dr. Baird, although admitting that stress was a factor in the
development of coronary artery disease, stated that Coffey's
"methods of managing stress, whether it be domestic or
occupational, is not the fault of the employer." Dr. Baird
further stated that "the stresses of [Coffey's] occupation is a
minor factor in [his] death." The commission found that,
although Dr. Baird excluded Coffey's employment as a "major"
cause of his death, such a conclusion was insufficient to
exclude occupational stress as a significant contributing cause
of Coffey's death. Dr. Bennett opined that, even assuming
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Coffey had heart disease, he "could reasonably exclude Coffey's
employment as a cause of his heart disease." Dr. Bennett
concluded that stress in Coffey's case was a "very, very minor
factor." Dr. Seides also stated that he could exclude Coffey's
employment as a police officer as a contributing factor in his
death, because to conclude otherwise would be inconsistent with
"our current scientific thinking."
However, claimant's experts, Drs. Schwartz, Toomy, and
Forbes, opined otherwise. Dr. Schwartz concluded that
occupational stress causes or contributes to heart disease.
Dr. Schwartz stated: "It is my opinion that it is more probable
than not that Mr. Coffey's occupational stress as a law
enforcement officer was a major risk factor and significant
contributing cause in the development of his heart disease."
Dr. Schwartz stated that no evidence indicated that Coffey's
heart disease was a result of a congenital defect or abnormality
or the result of trauma to the chest. Dr. Toomy also could not
exclude Coffey's employment as a causal factor in his death.
The commission, however, gave little weight to Dr. Toomy's
opinion, because, as the commission noted, Dr. Toomy was unable
to state whether stress or any of the other risk factors caused
Coffey's heart disease.
Dr. Forbes opined that factors such as smoking,
hypertension, obesity, and job stress contributed to Coffey's
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death. Dr. Forbes stated that Coffey had reported that some of
his anxiety was related, in part, to the suicide of a fellow
police officer. Dr. Forbes could not exclude Coffey's
employment as a contributing factor in the development,
acceleration, or aggravation of his heart disease. Dr. Forbes
filed a supplementary report stating, "In my opinion, Officer
Harold Coffey's occupation as a law enforcement officer was one
of several causes of his heart disease and death." The
commission, in weighing Dr. Forbes' opinion, noted that
Dr. Forbes was unaware of the specific kinds of stress that
Coffey encountered on the job and was not intimately familiar
with the medical literature pertaining to this subject.
Employer contends, and Coffey concedes, that employer
demonstrated the presence of a non-work-related cause of the
disease, the second prong of the Bass two-part test employer was
required to meet in order to rebut the statutory presumption.
The record revealed that Coffey had several non-work-related
risk factors associated with heart disease, including high blood
pressure, obesity, history of tobacco use, a positive family
history of early coronary atherosclerosis, and elevated blood
sugar. Employer further contends that it met the first prong of
the Bass test, by proving that Coffey's heart disease was not
caused by his employment. Employer relies on the opinions of
Drs. Baird, Bennett, and Seides, three cardiac experts retained
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by employer, who unequivocally excluded Coffey's employment as a
causative factor in his death. Dr. Seides concluded, "with a
high degree of medical certainty," that Coffey's employment
could be excluded as a contributing cause in his death, and Dr.
Bennett stated that he "could reasonably exclude [Coffey's]
employment as a cause of his heart disease." Employer contends
the commission erred in concluding that employer failed to prove
by a preponderance of the evidence that Coffey's employment
could be excluded as a cause of his heart disease because the
evidence was, "[a]t best," in "equipoise." We disagree.
In concluding that employer failed to prove that work was
not a cause of Coffey's heart disease, the commission noted that
the medical evidence was in substantial conflict. The
commission stated that "[a]t best, we find the evidence to be in
equipiose, with the opinions of Drs. Forbes and Schwartz
balancing the contrary opinions from other physicians." "If the
rebuttal evidence fails to exclude a work-related factor as
causing the heart disease or if there are conflicting medical
opinions as to whether the employment caused the disease, the
finding of the Commission as to causation is conclusive and
binding on appeal." Virginia Dep't of State Police v. Talbert,
1 Va. App. 250, 253, 337 S.E.2d 307, 308 (1985).
In enacting the statute, "[t]he legislature
knew that the causes of . . . cardiac
diseases are unknown and that the medical
community is split regarding the impact of
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stress and work environment on these
diseases." By enacting the statutory
presumption, the General Assembly resolved
the split in medical opinions in favor of
the employee and adopted the presumption
that the stress of working as a law
enforcement officer causes or contributes to
the development of heart disease.
Medlin v. County of Henrico Police, 34 Va. App. 396, 406, 542
S.E.2d 33, 38 (2001) (citations omitted).
Here, Dr. Seides excluded Coffey's employment as a cause of
his heart disease, concluding that to do otherwise would be
inconsistent with "our current scientific thinking." Dr. Baird
excluded Coffey's employment as a cause, stating that "methods
of managing stress . . . are not the fault of the employer."
Both Drs. Seides' and Baird's opinions impermissibly attempted
to rebut the legislative presumption by negating any causal link
between occupational stress and heart disease, and, thus, is not
probative rebuttal evidence. Id. at 407, 542 S.E.2d at 38-39.
Further, Dr. Bennett, although stating that he could exclude
Coffey's employment as the cause of his heart disease, conceded
that stress was a "minor factor" in this case. As the
commission noted, although Dr. Bennett relegated stress as a
minor factor, Dr. Bennett failed to exclude it as a significant
factor causing his heart disease. Accordingly, the commission
did not err in finding that employer's rebuttal evidence failed
to exclude Coffey's occupational stress as a cause of his heart
disease.
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We find no error in the commission's decision that employer
failed to rebut the statutory presumption of Code § 65.2-402
that Coffey's heart disease was caused by his employment.
Accordingly, we affirm.
Affirmed.
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