Ogden Aviation Services v. Saghy

COURT OF APPEALS OF VIRGINIA

Present: Chief Judge Fitzpatrick, Judge Benton and
Senior Judge Duff
Argued at Alexandria, Virginia

OGDEN AVIATION SERVICES AND
INSURANCE COMPANY OF THE
STATE OF PENNSYLVANIA
OPINION BY
v. Record No. 1179-99-4 CHIEF JUDGE JOHANNA L. FITZPATRICK
APRIL 4, 2000
JOSEPH SAGHY

FROM THE VIRGINIA WORKERS' COMPENSATION COMMISSION

William H. Schladt (Ward & Klein, on brief),
for appellants.

Craig A. Brown (Rebekah R. Arch; Ashcraft &
Gerel, on brief), for appellee.

Ogden Aviation Services and its insurer (collectively

referred to as "employer") contend the Workers' Compensation

Commission ("commission") erred in awarding disability

compensation benefits to Joseph Saghy ("claimant"). On appeal,

employer argues that: (1) the commission applied an improper

standard in determining whether claimant's carpal tunnel

syndrome constituted an injury by accident; and (2) the evidence

was insufficient to show a causal relationship between the

injury and claimant's carpal tunnel syndrome. 1 For the following

reasons, we affirm.

1
Employer also contends the evidence does not support the
alternative conclusion that claimant's carpal tunnel syndrome was
 I.

On February 4, 1998, claimant, an airplane fueler, was

connecting a fuel hose to an aircraft in extremely cold weather.

He was wearing protective gloves. As claimant "started to

elevate the nozzle and hose to the adapter on the aircraft," he

felt the sudden onset of pain extending from the tip of the

fingers of his right hand down his right shoulder. He lost

strength in his right hand and had to use his left hand to

support his right hand and arm. He completed the fueling

assignment and removed his glove. He noticed a puncture wound

on the dorsum of his right hand. Claimant continued his

refueling duties, although he experienced pain and numbness in

his right hand and arm.

When he could no longer work, he reported the incident to

his supervisor and sought treatment in the emergency room of

Columbia Pentagon City Hospital. Dr. James Eschew diagnosed an

"acute contusion with flap laceration – deep bruise with cut."

Claimant was released to return to work the following day with

instructions to keep his right hand clean and dry for four days.

Claimant returned to work and performed his regular duties.

On February 19, 1998, he again sought emergency room treatment,

reporting a history of right hand numbness of two weeks

a compensable consequence of the puncture wound to his hand on
February 4, 1998. Claimant did not allege a compensable
consequence injury, and the commission found that "the puncture
wound did not cause claimant's carpal tunnel syndrome."

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duration. The emergency room record referred to the February 4,

1998 injury. Claimant was diagnosed as suffering from

dysesthesia in the fingers of his right hand. The disability

form completed by the emergency room physician contained a

diagnosis of "probable carpal tunnel syndrome." Claimant was

given lifting restrictions but did not return to work because

the employer did not have light duty work available. Claimant

testified that he never experienced the right arm symptoms prior

to the February 4, 1998 incident.

Claimant was eventually referred to Dr. Edward Alexander,

an orthopedic surgeon, to address his continuing complaints of

right hand numbness. In an office note dated March 16, 1998,

Dr. Alexander reported that x-rays of the wrist and thumb showed

no arthritis. At that time, Dr. Alexander believed claimant

suffered from "synovitis in the thumb carpometacarpal joint

which should settle down." On April 23, 1998, Dr. Alexander

reported that claimant's "right hand remains numb in the pattern

of the median nerve distribution." On May 14, 1998, Dr.

Alexander noted that since the February 4, 1998 injury, claimant

suffered from "numbness" in the median nerve. Because claimant

also reported pain in his left shoulder from a prior injury, Dr.

Alexander clarified that he was only treating claimant for "the

injury of 02/04/98, when he was fueling a plane and had his arm

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give way because of pain, sustaining a laceration to the dorsum

of the hand." 2

Claimant underwent an MRI examination of his right hand and

wrist, which showed "definite mild to moderate carpal tunnel

syndrome." Dr. Alexander opined that claimant's right carpal

tunnel syndrome was directly related to the February 4, 1998

incident and injury. Dr. Alexander recommended that claimant

undergo surgical correction.

On May 16, 1998, claimant was evaluated by Dr. Leo

Goldhammer, a neurologist. Dr. Goldhammer diagnosed a

"[t]raumatic injury of the distal nerves to the digits and

dorsum of the hand" and "[r]ight sided carpal tunnel syndrome,

mild to moderate form." Dr. Goldhammer offered no conclusive

opinion as to the cause of claimant's right carpal tunnel

syndrome.

At employer's request, claimant was examined by Dr. Kevin

Hanley, an orthopedist, on September 1, 1998. Dr. Hanley

diagnosed bilateral carpal tunnel syndrome, right greater than

left. Based on the history given to him by claimant, Dr. Hanley

2
The record establishes that claimant's original claim
included an injury to his left shoulder and to his right hand and
arm as a result of the February 4, 1998 incident. However, the
deputy commissioner found that claimant failed to prove causation
of the left shoulder injury, and the full commission affirmed.
Accordingly, the only issue before us is the claim for right
carpal tunnel syndrome.

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concluded that the puncture wound sustained on February 4, 1998

did not cause the carpal tunnel syndrome.

Dr. Paul A. Devore, claimant's family physician, examined

claimant on September 15, 1998. Dr. Devore opined that

claimant's carpal tunnel syndrome was causally related to his

work injury. "The puncture wou[n]d of the right hand is a

distraction from the fact that he did indeed develop a carpal

tunnel type neuropathy of that hand/wrist area as a result of

the incident of 2/4/98." Dr. Devore also concluded the

neuropathy that resulted in claimant's right hand "was due to

abnormal physical stress placed on the hand as he was trying to

lift that refueling hose with this exceedingly painfully

punctured right hand." (Emphasis added).

Claimant proceeded on the basis of an "injury by accident"

under Code § 65.2-101. In its opinion, the commission held that

the "burden is on [claimant] to show that he suffered an injury

by accident arising out of and in the course of the employment."

(Emphasis added). The commission found that claimant suffered

an "identifiable incident" within the meaning of Code

§ 65.2-101, stating the following: "[T]he 'identifiable

incident' in this case commenced when the claimant felt a sudden

onset of pain in the right arm while lifting the fuel hose and

adapter above shoulder level."

Concluding that claimant's carpal tunnel injury was

causally related to the February 4, 1998 incident, the

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commission found "the opinion of Dr. Alexander, the treating

physician, to be more persuasive." The commission made it clear

"the puncture wound did not cause claimant's carpal tunnel

syndrome, . . . the puncture wound is separate from the carpal

tunnel syndrome" and "the weight of the evidence establishes

that the claimant experienced right arm and hand symptoms

immediately after the precipitating event." Accordingly, the

commission awarded disability compensation benefits for

claimant's "injury by accident."

II. INJURY BY ACCIDENT

This case represents the next step in a long line of cases

addressing the compensability of carpal tunnel syndrome.

Proceeding on a theory of "injury by accident" under Code

§ 65.2-101, claimant alleged that his right carpal tunnel

syndrome was a compensable work-related injury. The commission

agreed and found that claimant proved an "identifiable incident"

on February 4, 1998, and a causal connection between that

incident and claimant's condition. In so doing, the commission

held that carpal tunnel syndrome may be a compensable "injury by

accident" under Code § 65.2-101 or a compensable "ordinary

disease of life" under Code § 65.2-401, depending upon the cause

and how the condition develops. Whether carpal tunnel syndrome

may be incurred as a result of an injury by accident under Code

§ 65.2-101, or whether a carpal tunnel syndrome must always be

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considered an occupational disease, is an issue of first

impression.

Under the Workers' Compensation Act (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.'" A New Leaf, Inc. v. Webb, 257 Va. 190,

195, 511 S.E.2d 102, 104 (1999) (citations omitted). The term

"injury by accident" is defined as an "identifiable incident or

sudden precipitating event [that results] in an obvious sudden

mechanical or structural change in the body." Morris v. Morris,

238 Va. 578, 589, 385 S.E.2d 858, 865 (1989) (citation omitted);

see Chesterfield Co. v. Dunn, 9 Va. App. 475, 476, 389 S.E.2d

180, 181 (1990). An "injury by accident" requires proof of "(1)

an identifiable incident; (2) that occurs at some reasonably

definite time; (3) an obvious sudden mechanical or structural

change in the body; and (4) a causal connection between the

incident and the bodily change." Dunn, 9 Va. App. at 476, 389

S.E.2d at 181.

"It is apparent from the language
employed by the drafters of the Act that it
was originally intended to provide coverage
for the most frequently recurring kinds of
industrial accidents, e.g., injuries
immediately resulting from hazards of the
workplace such as blows from falling objects
. . . [or] falls from ladders . . . ."
Morris v. Morris, 238 Va. 578, 585, 385
S.E.2d 858, 862 (1989). The more difficult
issue through the years has been "whether an
injury resulting from repetitive trauma,
continuing mental or physical stress, or

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 other cumulative events, amounts to an
'injury by accident' within the meaning of
[the Act] . . . ." Id. at 581, 385 S.E.2d
at 859-60.

Southern Express v. Green, 257 Va. 181, 186, 509 S.E.2d 836, 839

(1999). Because carpal tunnel syndrome has been treated as a

cumulative trauma injury in numerous cases, and more recently

the General Assembly has provided special coverage for the

condition as an "ordinary disease of life" under Code

§ 65.2-401, we must determine whether the condition may also be

compensable as an "injury by accident" when it is causally

related to a single, identifiable incident.

In the most recent Supreme Court decision addressing carpal

tunnel syndrome, The Stenrich Group v. Jemmott, 251 Va. 186, 467

S.E.2d 795 (1996), the Court held as a matter of law that

repetitive motion injuries such as "carpal tunnel syndrome" and

"tenosynovitis" are not compensable conditions under the Act.

Id. at 189-91, 199, 467 S.E.2d at 797-98, 802. In determining

that these conditions did not constitute occupational diseases,

the Supreme Court made it clear 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 present provisions of the Act." Id. at

199, 467 S.E.2d at 802.

In response to Stenrich, in 1997 the General Assembly

amended Code § 65.2-400 to provide that "condition[s] of carpal

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tunnel syndrome are not occupational diseases but are ordinary

diseases of life as defined in [Code] § 65.2-401." The General

Assembly also amended Code § 65.2-401 to provide that the

elements required to prove a compensable ordinary disease of

life must be "established by clear and convincing evidence, (not

a mere probability)." 3 See also National Fruit Prod. Co. v.

Staton, 28 Va. App. 650, 654, 507 S.E.2d 667, 669 (1998) (per

curiam) (affirming the commission's award of benefits for carpal

tunnel syndrome under 1997 amendments), aff'd, ___ Va. ___, ___

S.E.2d ___ (2000) (per curiam).

Subject to the 1997 amendments providing recovery for

carpal tunnel syndrome under an "ordinary disease of life

analysis," the Supreme Court has made it clear that cumulative

trauma conditions are not compensable under the Act. See

Stenrich, 251 Va. at 199, 467 S.E.2d at 802; see also Merillat

Indus. v. Parks, 246 Va. 429, 433-34, 436 S.E.2d 600, 602 (1993)

(holding that a torn rotator cuff was not a compensable

"occupational disease" under the Act because the condition was

not a disease, but rather was an injury caused by repetitive

trauma); Morris, 238 Va. at 589, 385 S.E.2d at 865 (concluding

that "injuries resulting from repetitive trauma, continuing

mental or physical stress, or other cumulative events, as well

as injuries sustained at an unknown time, are not 'injuries by

3
We note that the amendment deleted from the statute the
words "to a reasonable medical certainty."

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accident' within the meaning of Code § 65.1-7 [now Code

§ 65.2-101]"); Aistrop v. Blue Diamond Coal Co., 181 Va. 287,

293, 24 S.E.2d 546, 548 (1943) (concluding that an "injury of

gradual growth, . . . caused by the cumulative effect of many

acts done or many exposures to conditions prevalent in the work,

no one of which can be identified as the cause of the harm, is

definitely excluded from compensation"). However, these cases

do not preclude a finding that carpal tunnel syndrome, in an

appropriate case supported by credible evidence in the record,

may be the result of an "identifiable incident," bringing the

injury within the purview of Code § 65.2-101.

The Supreme Court has consistently recognized that a

claimant may recover compensation benefits by meeting the

requirements of an "injury by accident" under Code § 65.2-101.

See Green, 257 Va. at 187, 509 S.E.2d at 839 (citing Morris, 238

Va. at 589, 385 S.E.2d at 864-65; Aistrop, 181 Va. at 293, 24

S.E.2d at 548) (other citations omitted)). While a majority of

the cases have addressed carpal tunnel syndrome as either a

repetitive injury or an occupational disease, none have

considered whether the condition may be the result of one single

act or identifiable incident.

The Act makes a distinction between an "injury by accident"

and an "occupational disease." See Code § 65.2-101 (defining

"injury"); Code § 65.2-400 (defining "occupational disease");

see also Holly Farms v. Yancy, 228 Va. 337, 341, 321 S.E.2d 298,

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300 (1984) ("A definition of either 'injury' or 'disease' that

is so broad as to encompass any bodily ailment of whatever

origin is too broad because it would make unnecessary and

meaningless the two categories specifically set forth in the

Act."). Additionally, the Supreme Court has recognized that the

term "disease" does not equate with the term "injury."

Stenrich, 251 Va. at 193 n.1, 467 S.E.2d at 799 n.1. The term

"injury" does not include a disease in any form, as used in Code

§ 65.2-101, but is "language of limitation." Id. Therefore,

"just because a doctor opines that a particular impairment is a

disease does not necessarily make it so. . . . [W]hether a

claimant suffers from a disease within the contemplation of the

Act is a mixed question of law and fact, and whether a proper

definition has been used to test the authenticity of a doctor's

opinion is strictly a legal one." Id. at 198, 467 S.E.2d at

801.

"A disease is a condition which may arise from any number

of causes, including trauma, that impairs the function of the

body or any part thereof." Perdue Farms, Inc. v. McCutchan, 21

Va. App. 65, 71, 461 S.E.2d 431, 434 (1995). "The distinction

between injury and disease lies in the 'obvious sudden

mechanical or structural' aspect of injury." Id.; see also A.

Larson, Workers' Compensation Law § 41.13 (noting that the

traditional distinction between "occupational diseases" and

"accidental injuries" was "both the fact that [diseases] could

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not be said to be unexpected, since they were recognized as

inherent hazard of continued exposure to conditions of the

particular employment, and the fact that [diseases] were gradual

rather than sudden in onset").

In light of these distinctions, we conclude that a

claimant's carpal tunnel syndrome may be compensable as an

"injury by accident" or an "occupational disease," depending on

how it develops. See Rocco Turkeys, Inc. v. Lemus, 21 Va. App.

503, 507, 465 S.E.2d 156, 158 (1996).

[Carpal tunnel syndrome], which is a
condition that exhibits a characteristic set
of symptoms caused by compression of the
median nerve in the carpal tunnel, will
qualify as a disease when it develops as the
body's response to environmental factors,
infective agents, or inherent defects of the
body. [Carpal tunnel syndrome] may be
caused by a number of precipitating factors
or events, such as repetitive motion,
cumulative trauma, obesity, rubella,
pregnancy, rheumatoid arthritis, gout, and
hypothyroidism, or a traumatic injury.

Id. (citing 2 Cecil Textbook of Medicine 1563 (19th ed. 1992))

(emphasis added). Accordingly, we hold that carpal tunnel

syndrome may qualify as an "injury by accident" under Code

§ 65.2-101 or as an "occupational disease" under Code

§ 65.2-401, depending upon its pathology or how it is incurred. 4

4
The commission has previously held that carpal tunnel
syndrome may be compensable as an "injury by accident." See
Begley v. Buster Brown Apparel, Inc., No. 179-21-69 (March 7,
1997). In Begley, the claimant "identified a sudden, specific
precipitating event, and her testimony [was] uncontradicted and
[was] corroborated by the medical evidence." The commission

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To hold otherwise would differentiate one type of injury by

accident from all others, an outcome not sanctioned by the Act.

We must also determine whether the commission applied the

proper burden of proof in finding that claimant's carpal tunnel

syndrome was compensable under the Act. Because claimant

suffered from carpal tunnel syndrome, a condition specifically

provided for in Code § 65.2-401, employer argues that claimant

was required to prove his claim--even if an "injury by

accident"--by a "clear and convincing evidence" standard. The

commission rejected employer's argument, stating:

Code Section 65.2-400 defining the term
"occupational disease" was amended to
provide that, effective July 1, 1997, carpal
tunnel syndrome would not [be] considered an
occupational disease but is an ordinary
disease of life as defined in 65.2-401.
This does not, as urged by the employer,
mean that, by extension, all carpal tunnel
cases should be subject to the higher burden
of proof under Section 65.2-401 of clear and
convincing evidence rather than a mere
preponderance.

If such were the true [sic], any
claimant alleging carpal tunnel syndrome as
a compensable consequence of his industrial
accident would be required to meet the
statutory burden under that Code Section.
This is inconsistent with existing case law.
The intent of the General Assembly when
amending Section 65.2-400 was to delineate
which Code Section carpal tunnel syndrome
should be considered when the claimant was

found that the claimant's injury "was not a cumulative trauma
injury, but an injury by accident compensable under the [Act].
The claimant described a sudden onset of pain which occurred at
a specific time and place while performing a single act."

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 proceeding under an occupational disease
theory, not to require claimant's [sic] to
meet a higher burden of proof in
all carpal tunnel syndrome cases, regardless
of the theory.

(Emphasis added) (footnote omitted).

We conclude the commission applied the proper burden of

proof in determining whether claimant's carpal tunnel syndrome

was compensable under the Act. While the heightened burden of

proof of "clear and convincing evidence" is required for those

"ordinary disease of life" claims brought under Code § 65.2-401, 5

5
Code § 65.2-401 provides:

An ordinary disease of life to which the
general public is exposed outside of the
employment may be treated as an occupational
disease for purposes of this title if each
of the following elements is established by
clear and convincing evidence, (not a mere
probability):
1. That the disease exists and arose
out of and in the course of employment as
provided in § 65.2-400 with respect to
occupational diseases and did not result
from causes outside of the employment, and
2. That one of the following exists:
a. It follows as an incident of
occupational disease as defined in this
title; or
b. It is an infectious or contagious
disease contracted in the course of one's
employment in a hospital or sanitarium or
laboratory or nursing home as defined in
§ 32.1-123, or while otherwise engaged in
the direct delivery of health care, or in
the course of employment as emergency rescue
personnel and those volunteer emergency
rescue personnel referred to in § 65.2-101;
or

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a claimant is required to prove an "injury by accident" under

Code § 65.2-101 by only a preponderance of the evidence. See

Webb, 257 Va. at 195, 511 S.E.2d at 104; Morris, 238 Va. at 584,

385 S.E.2d at 862 (citing A.N. Campbell & Co. v. Messenger, 171

Va. 374, 379, 199 S.E. 511, 514 (1938)). Thus, it is clear that

"[t]he claimant had the burden of establishing, by a

preponderance of the evidence, and not merely by conjecture or

speculation, that [he] suffered an injury by accident which

arose out of and in the course of the employment." Central

State Hosp. v. Wiggers, 230 Va. 157, 159, 335 S.E.2d 257, 258-59

(1985) (citations omitted) (emphasis added). Here, the

commission correctly held that claimant was required to prove

the existence of an "injury by accident" under Code § 65.2-101

by a preponderance of the evidence.

III. CAUSATION

Employer next contends the evidence fails to support the

commission's finding that claimant's carpal tunnel syndrome was

caused by the injury on February 4, 1998. Employer argues that

claimant's only complaint at the time of injury was a "sharp

pain" in his right hand and that he did not report numbness or

weakness in the hand consistent with a carpal tunnel injury.

c. It is characteristic of the
employment and was caused by conditions
peculiar to such employment.

(Emphasis added).

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 "On appeal, we view the evidence in the light most

favorable to the claimant, who prevailed before the commission."

Allen & Rocks, Inc. v. Briggs, 28 Va. App. 662, 672, 508 S.E.2d

335, 340 (1998) (citations omitted). "A question raised by

conflicting medical opinion is a question of fact." WLR Foods

v. Cardosa, 26 Va. App. 220, 230, 494 S.E.2d 147, 152 (1997).

"'Decisions of the commission as to questions of fact, if

supported by credible evidence, are conclusive and binding on

this Court.'" Id. (quoting Manassas Ice & Fuel Co. v. Farrar,

13 Va. App. 227, 229, 409 S.E.2d 824, 826 (1991)). "'The fact

that there is contrary evidence in the record is of no

consequence.'" Id. (quoting Wagner Enters., Inc. v. Brooks, 12

Va. App. 890, 894, 407 S.E.2d 32, 35 (1991)).

In the instant case, the evidence established that on

February 4, 1998, claimant was injured while connecting a fuel

hose to an aircraft in extremely cold weather. As he lifted the

hose and adapter above his shoulders, he felt the sudden onset

of pain extending from the fingers of his right hand to his

right shoulder. The disability form completed by the emergency

room physician contained a diagnosis of "probable carpal tunnel

syndrome." Claimant was eventually referred to Dr. Alexander,

who diagnosed him as suffering from right carpal tunnel

syndrome. Dr. Alexander ultimately opined that claimant's right

carpal tunnel syndrome was directly related to the February 4,

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1998 incident and he recommended that claimant undergo surgical

correction.

"Medical evidence is not necessarily conclusive, but is

subject to the commission's consideration and weighing."

Hungerford Mechanical Corp. v. Hobson, 11 Va. App. 675, 677, 401

S.E.2d 213, 214 (1991). In its role as fact finder, the

commission was entitled to weigh the medical evidence. The

commission did so and specifically found Dr. Alexander's opinion

"to be more persuasive," while rejecting the contrary medical

opinions. See Fingles Co. v. Tatterson, 22 Va. App. 638, 641,

472 S.E.2d 646, 647 (1996) (the opinion of a treating physician

is entitled to great weight). Dr. Alexander's opinion, coupled

with claimant's testimony, constitutes credible evidence to

support the commission's finding that claimant proved a causal

connection between his right carpal tunnel syndrome and his

February 4, 1998 injury by accident.

This conclusion is supported by the Supreme Court's

decision in Green, 257 Va. 181, 509 S.E.2d 836. In Green, the

Supreme Court considered "whether chilblains that the claimant

suffered as a result of being exposed to cold temperature in a

walk-in cooler during a four-hour period consitute[d] an 'injury

by accident' under [the Act]." Id. at 183, 509 S.E.2d at 837.

When the claimant filed her claim for compensation benefits, she

alleged an "injury by accident" under Code § 65.2-101.

Outlining the appropriate test, the Supreme Court wrote:

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 [T]o establish an "injury by accident," a
claimant must prove (1) that the injury
appeared suddenly at a particular time and
place and upon a particular occasion, (2)
that it was caused by an identifiable
incident or sudden precipitating event, and
(3) that it resulted in an obvious
mechanical or structural change in the human
body.

Id. at 187, 509 S.E.2d at 839 (citations omitted).

In Green, the Supreme Court concluded that the claimant's

chilblains were not an "'injury of gradual growth . . . caused

by the cumulative effect of many acts done or many exposures to

conditions prevalent in the work, no one of which can be

identified as the cause of the harm . . . .'" Id. at 189, 509

S.E.2d at 841 (citations omitted). Rather, the evidence

established that

the chilblains were "the result of some
particular piece of work done or condition
encountered on a definite occasion . . . ."
[Aistrop, 181 Va. at 239, 24 S.E.2d at 548].
In other words, Green's chilblains resulted
from a single exposure to cold temperature
on a definite occasion during the
performance of a specific piece of work,
i.e., an "identifiable incident." Morris,
238 Va. at 589, 385 S.E.2d at 865. It was
not caused by repeated exposures over a
period of months or years.

Id.

Similar to the situation in Green, the evidence in the

instant case proved that claimant's carpal tunnel syndrome was

not an injury of gradual growth or the result of cumulative

trauma. Indeed, the commission specifically found that

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claimant's injuries occurred while performing a single act,

stating the following:

The record establishes, and we so find, that
the "identifiable incident" in this case
commenced when the claimant felt a sudden
onset of pain in the right arm while lifting
the fuel hose and adapter above shoulder
level. He then lost strength shortly
thereafter in his right arm. At some
juncture during this incident the claimant
also suffered a puncture wound to the dorsum
of his right hand. As in a motor vehicle
accident that can cause more than one
structural or mechanical change in the body
so too did this incident cause greater than
one bodily change. The event causing these
two insults to the body must be viewed as a
unitary whole rather than two disparate
occurrences. Regardless of the sequence,
the injuries occurred while claimant was
performing a single act.

(First emphasis added). Here, credible evidence supports the

commission's finding that claimant proved (1) that his carpal

tunnel syndrome appeared suddenly at a particular time and place

and upon a particular occasion, (2) that it was caused by an

identifiable incident or sudden precipitating event, and (3)

that it resulted in an obvious sudden mechanical or structural

change in the human body. See id. at 187, 509 S.E.2d at 839.

Accordingly, we affirm the commission's finding that claimant's

carpal tunnel syndrome constituted an "injury by accident"

within the meaning of Code § 65.2-101.

Affirmed.

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