COURT OF APPEALS OF VIRGINIA
Present: Judges Coleman, Bray and Bumgardner
Argued at Chesapeake, Virginia
GWALTNEY OF SMITHFIELD, LTD. AND
TRAVELERS INDEMNITY COMPANY OF ILLINOIS
MEMORANDUM OPINION* BY
v. Record No. 2505-99-1 JUDGE RUDOLPH BUMGARDNER, III
APRIL 25, 2000
CLARICE CYPRESS
FROM THE VIRGINIA WORKERS' COMPENSATION COMMISSION
J. Derek Turrietta (William W. Nexsen;
Stackhouse, Smith & Nexsen, on brief), for
appellants.
Barbara Evans-Yosief (Gerald G. Poindexter,
on brief), for appellee.
The Workers' Compensation Commission awarded benefits to
Clarice Cypress for left-hand carpal tunnel syndrome but found
that she had unjustifiably refused selective employment.
Gwaltney of Smithfield, Ltd. and its insurer contend that the
commission erred in finding (1) that the claimant's left-hand
carpal tunnel syndrome is a compensable ordinary disease of
life, and (2) that she was entitled to temporary total
disability benefits after June 19, 1998 because of her
right-hand carpal tunnel release surgery. For the following
reasons, we affirm.
* Pursuant to Code § 17.1-413, recodifying Code
§ 17-116.010, this opinion is not designated for publication.
We view the evidence in the light most favorable to the
claimant, the prevailing party below. See R.G. Moore Bldg.
Corp. v. Mullins, 10 Va. App. 211, 212, 390 S.E.2d 788, 788
(1990). "'Whether a disease is causally related to the
employment and not causally related to other factors is . . . a
finding of fact.'" Ross Laboratories v. Barbour, 13 Va. App.
373, 377-78, 412 S.E.2d 205, 208 (1991) (quoting Island Creek
Coal Co. v. Breeding, 6 Va. App. 1, 12, 365 S.E.2d 782, 788
(1988)). When credible evidence supports a finding of fact, it
is conclusive and binding on this Court. See id. The fact that
there is contrary medical evidence in the record is of no
consequence if there is credible evidence to support the
commission's decision. See Chanin v. Eastern Virginia Medical
School, 20 Va. App. 587, 590, 459 S.E.2d 523, 524 (1995).
The claimant was a fatback trimmer who used a motorized
circular knife to trim meat. She held the knife with her right
hand and pulled the meat with her left. The claimant's job
required sixty weight-bearing repetitive motions per minute.
Prior to working for the employer she had no medical problems
involving her hands or wrists.
The claimant sought treatment from the employer's clinic in
November 1996 and again in June 1997 for pain in her "hands and
fingers." She was given an analgesic rub, ice for her hands,
and ibuprofen. The clinic did not refer her to a doctor. In
August 1997, the claimant stopped working because of the pain.
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The employer's medical services coordinator recommended she go
to a doctor.
The claimant saw Dr. Timothy N. Lee, one of the employer's
doctors, on August 27, 1997. Dr. Lee returned the claimant to
modified duty several times from August 28, 1997 through May 26,
1998 and recommended the use of wrist splints. On September 2,
1997, Dr. Lee noted that the claimant should "continue work
restrictions, specifically limited use of left hand but avoid
repetitive grabbing and use with left hand. No use of the right
hand since this continues to be the most symptomatic." When
light duty work was unavailable and the claimant's condition
failed to improve, he took her off work.
In August and September, 1997, Dr. Lee diagnosed the
claimant with tendinitis/tenosynovitis in both hands and wrists.
By September 16, 1997, Dr. Lee diagnosed probable bilateral
carpal tunnel syndrome. He referred her to physical therapy and
to Dr. Bruce I. Tetalman, a rehabilitation specialist with
expertise in performing EMGs. On September 26, 1997, Dr.
Tetalman performed an EMG, which was positive for moderate to
severe carpal tunnel syndrome in both wrists. In his October 3,
1997 EMG report, he diagnosed the claimant with "bilateral
carpal tunnel syndrome of moderate severity, left worse than
right." On October 10, 1997, Dr. Tetalman injected both her
wrists.
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Dr. Lee's October 7, 1997 office note indicated the
claimant had bilateral carpal tunnel syndrome, although he could
not confirm the diagnosis without further testing. He removed
her from work for two weeks. The claimant returned to light
duty on October 20, 1997, but continued to have pains in her
hands and wrists. Dr. Lee reviewed Dr. Tetalman's October 3,
1997 report, the EMG studies, and the claimant's occupational
and medical history. By letter dated November 11, 1997, Dr. Lee
concluded she is "suffering from bilateral carpal tunnel
syndrome and that this condition arose out of and in the course
of her employment." He indicated that there was no evidence of
non-work related causes of her CTS and opined that she "may very
well require surgery for complete resolution of her problem."
In a December 5, 1997 office note, Dr. Lee indicated that
the claimant has severe pain and numbness in both hands and
wrists and that the "Tinel's and Phalen's remain positive." He
continued her current therapy and recommended she stay out of
work because any suitable modified job exacerbated her
condition.
On December 19, 1997, Dr. Lee indicated that conservative
therapy, which consisted of "splinting, s/p steroid injections
in both wrists, anti-inflammatory medications and prolonged
inactivity and time away from work," had not relieved the
claimant's pain. He recommended surgery and referred her to Dr.
Robert F. Brewer, a hand surgeon.
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Dr. Brewer saw the claimant on January 9, 1998. His
consultation note indicated the "[e]xamination is very
questionable in that she does not seem to have a specific
Tinel's sign over the median nerve." He found no objective
indications that the claimant suffered from carpal tunnel
syndrome and believed that her symptoms might have a
psychological component.
In January 1998, Dr. Lee recommended another EMG study.
Dr. Tetalman performed the EMG, and his January 23, 1998 report
indicated the claimant had CTS on the right but not the left.
Dr. Tetalman performed a third EMG April 3, 1998 at the
insurer's request. In his April 6, 1998 letter, Dr. Tetalman
indicated the claimant's left CTS had resolved and the right CTS
"has advanced and is now moderately severe." He also noted that
"initially her carpal tunnel was due to cumulative trauma
disorder."
On May 5 and May 26, 1998, Dr. Lee released the claimant,
who had not worked since November 1997, to light duty and
referred her back to Dr. Tetalman. Dr. Lee's diagnosis in both
reports was bilateral CTS. The claimant's gynecologist advised
against her return to work because of hypertension and suggested
the claimant get a second opinion about the pain and swelling in
her wrists.
The claimant visited Dr. Douglas A. Wayne on June 10, 1998.
His office notes indicate that "she had very distinct positive
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Tinels over the carpal tunnels bilaterally and positive median
nerve compression test and positive Phalens test." Dr. Wayne
found CTS in both wrists and referred her to Dr. Stephen J.
Leibovic, a hand surgeon.
In a June 11, 1998 letter to Dr. Wayne, Dr. Leibovic
concluded that the claimant "clearly has carpal tunnel syndrome,
bilaterally. This is confirmed on the examination and EMG/NCS."
Dr. Leibovic added, "meat packing plants are notorious for work
that is difficult for the hands that can cause carpal tunnel
syndrome. . . . There was in fact no history of pregnancy when
the symptoms began. There is no doubt that her work in the meat
packing plant exacerbated, and possibly caused, the carpal
tunnel syndrome." On June 19, 1998, Dr. Leibovic operated on
the claimant's right hand and scheduled her for left-wrist
surgery.
The commission concluded that the claimant proved her CTS
was a compensable ordinary disease of life under Code
§ 65.2-401. 1 It found that "the claimant has proven that she
suffers from left carpal tunnel syndrome which became
objectively asymptomatic following her removal from the
workplace as of November 4, 1997. . . . [T]he claimant's
1
Code § 65.2-401 provides that an ordinary disease of life
"may be treated as an occupational disease . . . if . . . the
disease exists and arose out of and in the course of employment
. . . and . . . is characteristic of the employment and was
caused by conditions peculiar to such employment."
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treating physicians diagnosed the claimant with left carpal
tunnel syndrome prior to November 1997 and there is no contrary
evidence before us that would lead to a different conclusion."
The employer contends the commission erred because Drs. Lee,
Brewer, and Tetalman indicated that there was no left CTS or the
CTS was of questionable origin.
In order to prove a compensable ordinary disease of life
under Code § 65.2-401, the claimant must establish "by clear and
convincing evidence, to a reasonable medical certainty," that
her injury arose out of and in the course of her employment. 2
See Bradshaw v. Aronovitch, 170 Va. 329, 335, 196 S.E. 684, 686
(1938). Evidence is clear and convincing when it produces in
the fact finder "a firm belief or conviction as to the
allegation sought to be established. It is . . . more than a
mere preponderance, but not to the extent of such certainty as
is required beyond a reasonable doubt as in criminal cases. It
does not mean clear and unequivocal." Fred C. Walker Agency,
Inc. v. Lucas, 215 Va. 535, 540-41, 211 S.E.2d 88, 92 (1975)
(citation omitted).
Claimant's treating physician, Dr. Lee, believed as early
as September 16, 1997 that the claimant had bilateral CTS.
After Dr. Tetalman conducted further tests, Dr. Lee confirmed
2
The General Assembly amended Code § 65.2-401 in 1997 to
delete "to a reasonable medical certainty" and to add "(not a
mere probability)."
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and reiterated his diagnosis of CTS in his November 11, 1997
letter. He unequivocally indicated that the CTS arose out of
and in the course of the claimant's employment. Dr. Tetalman's
EMG report of October 3, 1997, also concludes that the claimant
had bilateral CTS of moderate severity. Dr. Tetalman's April 6,
1998 note indicated that her initial CTS "was due to cumulative
trauma disorder." While Dr. Brewer questioned the origin of the
claimant's symptoms and found no indication of CTS, he evaluated
the claimant in January 1998 after she had been off from work
for several months.
It was reasonable to conclude that an overuse disease would
improve with inactivity. Dr. Brewer's evidence did not
contradict the findings of both Drs. Lee and Tetalman that the
claimant had CTS in the fall of 1997. Additionally, there was
evidence she suffered from CTS as late as the summer of 1998.
The claimant did not engage in any non-work related activities
that could have caused her CTS, and she did not have any
problems with her hands or wrists before working for the
employer. The claimant's previous job as a line worker chopping
meat at another plant is immaterial because her CTS symptoms did
not develop until she worked for the employer.
In National Fruit Product Co. v. Staton, 28 Va. App. 650,
654, 507 S.E.2d 667, 669 (1998), aff'd, __ Va. __, __ S.E.2d __
(2000), the Court affirmed the claimant's award of benefits.
The claimant's doctor opined that there was a "high probability"
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the employment caused her CTS. The court held that the doctor's
opinion, coupled with the claimant's own testimony, satisfied
her burden of proving the injury arose out of and in the course
of her employment by clear and convincing evidence. Unlike
Staton, Dr. Leibovic's opinion that the claimant's employment
"possibly caused" her CTS was not the only evidence of
causation. Dr. Lee, the claimant's treating physician,
definitively stated her CTS arose out of and in the course of
her employment. This November 11, 1997 opinion was
uncontradicted and corroborated the claimant's testimony.
Additionally, Dr. Tetalman indicated that her CTS initially
arose from "cumulative trauma syndrome," which logically
resulted from her work for the employer. Dr. Brewer's
indication in January 1998 that the claimant's symptoms were of
questionable origin does not refute the fall diagnosis. The
commission resolves questions of fact. We conclude there is
credible evidence to support the commission's finding that the
claimant proved she had CTS and that it arose out of and in the
course of her employment.
The employer also argues the commission erred in awarding
temporary total disability benefits after the right-hand carpal
tunnel release surgery June 19, 1998. The employer argues that
the claimant "was not entitled to continuing disability because
the total disability was not attributable to the originally
compensable [right-hand CTS], but instead related to her
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pregnancy." The claimant was diagnosed with right-hand CTS
before she became pregnant in October 1997. While the pregnancy
impeded her recovery, it did not cause the CTS. Dr. Tetalman
attributed "the worsening of the [claimant's] right carpal
tunnel to her pregnancy." The employer's argument that the
surgery was unrelated to the originally compensable ordinary
disease of life is without merit.
For the foregoing reasons, we affirm the commission's
decision.
Affirmed.
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