Perdue Farms, Inc. v. McCutchan

WILLIS, Judge.

On appeal from an award of compensation to Thea B. McCutchan, Perdue Farms, Inc. contends that the Workers’ Compensation Commission erred (1) in holding that Ms. McCutchan’s carpal tunnel syndrome (CTS) is a disease, (2) in holding that Code § 65.2-401 pertaining to ordinary diseases of life does not apply, and (3) in holding that Ms. McCutchan suffered a compensable occupational disease as defined by Code § 65.2-400.

On appeal from a denial of benefits, Crystal F. Bowen contends (1) that the commission erred in finding that she had failed to prove that her carpal tunnel syndrome was a disease compensable under Code § 65.2^00, and (2) that the commission erred in failing to enforce a settlement that she had made with her employer.

Because both cases concern the compensability of CTS as an occupational disease and the application of the injury-disease dichotomy enunciated in Merillat Industries, Inc. v. Parks, 246 Va. 429, 436 S.E.2d 600 (1993), we have consolidated them for decision. For the following reasons, we affirm the award of benefits in McCutchan and we reverse the denial of benefits in Bowen.

I.

In Merillat, the Supreme Court held that the Workers’ Compensation Act “requires that the condition for which compensation is sought as an occupational disease must first qualify as a disease.” Id. at 432, 436 S.E.2d at 601.

We first consider the meaning of the word “disease.” We have defined disease as:

any deviation from or interruption of the normal structure or function of any part, organ, or system (or combination thereof) of the body that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology, and prognosis may be known or unknown.

Piedmont Mfg. Co. v. East, 17 Va.App. 499, 503, 438 S.E.2d 769, 772 (1993) (quoting Sloane-Dorland Ann. Medical-Legal Dictionary 209 (1987)). This definition agrees with definitions found in Black’s Law Dictionary and in general dictionaries. See Commonwealth/Department of State Police v. Haga, 18 Va.App. 162, 166, 442 S.E.2d 424, 426 (1994). In Perdue Farms, Inc. v. McCutchan, the commission cited with approval and employed this definition. When a governmental agency construes the meaning of a statutory term that lies within its administrative and enforcement authority, that construction is entitled to great weight before a reviewing court. Haga, 18 Va.App. at 165, 442 S.E.2d at 425. Thus, we recognize the definition enunciated in Piedmont as the general and accepted meaning of the term “disease,” a term which is presumed to be known by the legislature and is employed by it without restriction in Code §§ 65.2-400 and 65.2-401.

Carpal Tunnel Syndrome is defined as:

a complex of symptoms resulting from compression of the median nerve in the carpal tunnel, with pain and burning or tingling paresthesias in the fingers and hand, sometimes extending to the elbow.

Dorland’s Illustrated Medical Dictionary 1289 (26th ed. 1985). This general medical definition places CTS within the definition of disease set forth in Piedmont and approved and applied by the commission in Perdue Farms, Inc. v. McCutchan.

Merillat concerned a torn rotator cuff that was caused by repetitive motion. Because this condition did not result from a single, precipitating event, it was not compensable as an injury by accident. Considering whether the torn rotator cuff was compensable as an occupational disease, the Supreme Court said:

[Njeither the Deputy Commissioner, the Commission, nor the Court of Appeals determined whether the tear to Parks’s rotator cuff was a disease. Rather, they concluded the tear was a compensable “occupational disease” because Parks established a causal connection between the rotator cuff tear and the work place.... This “causality” analysis standing alone, however, does not comply with the requirements of the Act____

Merillat, 246 Va. at 432, 436 S.E.2d at 601. The Court went on to say

We have declined previous invitations to broaden the scope of the Act to include job-related impairments arising from repetitive motion or cumulative trauma. We based our prior position, in part, on our conclusion that the categories of compensable injuries created by the legislature—accidental injury and occupational disease—are separate, meaningful categories. “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....” Holly Farms v. Yancey, 228 Va. 337, 340-41, 321 S.E.2d 298, 300 (1984).

In Morris, we held that gradually incurred traumatic injuries or cumulative trauma conditions were not compensable under the existing injury by accident-occupational disease dichotomy. And we again commented that the “General Assembly, despite repeated invitations to do so, has made no change in the ... rule with respect to injuries gradually incurred, notwithstanding the passage of 47 years.” Morris [v. Morris,] 238 Va. [578] at 586, 385 S.E.2d [858] at 863 [(1989)].

Id. at 433, 436 S.E.2d at 601-02.

II.

The employers argue that, although CTS is a disease within the definition set forth in Piedmont, the foregoing passages from Merillat deny compensability for any condition, be it injury or disease, that arises from repetitive motion or cumulative trauma. We disagree. We do not read Merillat to determine compensability by classifying diseases according to causation. Indeed, Merillat expressly rejects a “causality analysis” as the means of identifying occupational diseases. Rather, Merillat reaffirms the distinction between trauma and disease and the denial of compensation for injury resulting from cumulative trauma. It requires that to be compensable as an occupational disease, the condition must first be identified as a disease.

Despite the pronouncements of Yancey, Morris, Merillat, Piedmont, and Haga, the legislature has retained, without restriction, the term, “disease,” as a qualification for compensation under the Act. Thus, in enforcing the Act and in maintaining the injury-by-aceident/occupational disease dichotomy as required by Merillat, we are called upon, with little aid from professional or lay authorities, to construct a distinction between “injury” and “disease.” The accepted medical, legal, and lay definitions of disease are so broad as to encompass injury, a breadth forbidden by Merillat and Yancey. Common experience teaches that many conditions that are classified unquestionably as diseases are, in fact, cumulative traumas by infectious agents. Nonetheless, we believe that within the framework of conventional understanding, a distinction may be drawn between trauma and injury, on the one hand, and disease on the other.

An injury is “an obvious sudden mechanical or structural change in the body.” Chesterfield Co. v. Dunn, 9 Va.App. 475, 476, 389 S.E.2d 180, 181 (1990). 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. The distinction between injury and disease lies in the “obvious sudden mechanical or structural” aspect of injury. Thus, a torn rotator cuff (Merillat) and a back strain (Yancey) have been held to be injuries, whereas deQuervain’s tenosynovitis (Piedmont) and heart disease (Haga) have been held to be diseases.

III.

On appeal, we view the evidence in the light most favorable to the party prevailing below. Crisp v. Brown’s Tysons Corner Dodge, Inc., 1 Va.App. 503, 504, 339 S.E.2d 916, 916 (1986). The findings of the commission, if based on credible evidence, are conclusive and binding on this Court. Morris v. Badger Powhatan/Figgie Int’l, Inc., 3 Va.App. 276, 279, 348 S.E.2d 876, 877 (1986). “A question raised by conflicting medical opinion is a question of fact.” City of Norfolk v. Dillard, 15 Va.App. 424, 429, 424 S.E.2d 243, 246 (1992). However, to be upheld, the commission’s findings must be supported by the record.

PERDUE v. MCCUTCHAN

On June 1,1992, Ms. McCutchan began working on the production line at Perdue’s plant. She spent ninety percent of her time packing chicken nuggets onto trays and ten percent of her time brushing crumbs off the trays prior to sealing. Several weeks after beginning work, she began experiencing pain in her wrists. The plant nurse told her she was not used to the job, to soak her wrists, and to take Advil.

The pain continued and on February 1, 1993, Ms. McCutchan’s condition was diagnosed by Dr. Ronald L. Schubert as “severe bilateral wrist tendinitis caused by sustained motion.” She continued under Dr. Schubert’s care and on February 23, 1993 was referred by him to Dr. Gordon 0. White, a neurologist. Diagnostic studies revealed “bilateral Carpal Tunnel Syndrome, right more than left.” Ms. McCutchan was also referred to Dr. G. Edward Chappell, Jr., an orthopedist. On March 4, 1993, Dr. Chappell reported that Ms. McCutchan suffered “definite bilateral carpal tunnel syndrome,” which he thought was “caused in significant part by her work on the poultry line.” He noted that Ms. McCutchan had held multiple jobs prior to her employment by Perdue, but none had involved the repetitive use of her hands required by her job at the Perdue plant. On March 18, 1993, Dr. Chappell performed a right carpal tunnel release and anterior wrist synovectomy.

Following surgery, both parties sought Dr. Chappell’s opinion concerning Ms. McCutchan’s condition. By letter of May 19, 1993, Dr. Chappell stated, “[i]t is my opinion that your documented carpal tunnel syndrome is work related.” Per-due’s counsel asked Dr. Chappell to review Ms. McCutchan’s job description and to view a videotape of her job. In his July 1, 1993 response, Dr. Chappell answered “no” to a question asking whether Ms. McCutchan’s CTS was caused by work to the exclusion of other causes. He answered “yes” when asked whether her work aggravated an underlying condition causing the CTS. He answered “no” when asked whether it was impossible to tell the cause of the CTS.

None of Ms. McCutchan’s doctors specifically termed her bilateral CTS a disease. However, the commission may make its determinations on the basis of established medical classification and terminology. Ms. McCutchan’s condition did not present an obvious, sudden, mechanical or structural change in her body. Therefore, we conclude that credible evidence supports the commission’s finding “that the claimant’s diagnosed carpal tunnel syndrome meets the definition of ‘disease’ within the meaning of the Workers’ Compensation Act.”

BOWEN v. AUTOMOTIVE INDUSTRIES, INC., ET AL.

Over the course of approximately eight months, Ms. Bowen worked three different jobs for Automotive Industries, Inc. Each job required her to flex and to apply pressure to her hands and wrists. She developed CTS with resulting disability. In a letter to employer’s counsel, Ms. Bowen’s doctor stated:

Your question was, “is carpal tunnel syndrome a cumulative trauma injury or overuse syndrome sometimes caused by repetitive motion or cumulative trauma?” My answer is yes. Carpal tunnel syndrome results from compression of the median nerve within the carpal tunnel. Any condition that crowds or reduces the capacity of the carpal tunnel may cause these symptoms____

Carpal tunnel syndrome can be seen following trauma such . as Colles’ fracture of the wrist. It is seen in some metabolic and collagen disorders such as obesity, diabetes mellitus, thyroid disfunction and rheumatoid arthritis. Trauma ca[u]sed by repetitive hand motions also have been identified as the cause of carpal tunnel syndrome especially in those patients [whose] work requires forceful finger and wrist flexion and extension----

In her letter, the doctor noted that Ms. Bowen had not waived the physician/patient privilege and that the information furnished in the letter was “general information and not specific to [Ms. Bowen’s] case____”

The commission held that Ms. Bowen had not proved that her carpal tunnel syndrome was a disease. Yet, her proof was substantially the same as Ms. McCutchan’s. No evidence described a specific injury. No evidence described an obvious, sudden, mechanical or structural change in her body. The uncontradicted evidence described a condition that falls squarely within the definition of disease set forth in Piedmont. Thus, the commission erred in holding that Ms. Bowen had failed to prove that she suffered from an occupational disease and in denying her benefits.

Because no memorandum of agreement had been executed and submitted by the parties, the commission did not err in declining to enforce the settlement alleged by Ms. Bowen.

The decision of the Workers’ Compensation Commission in Perdue Farms, Inc. v. Tinea B. McCutchan is affirmed. Its decision in Crystal F. Bowen v. Automotive Industries, Inc. and Employers Insurance of Wausau is reversed, and that case is remanded for the determination and award of benefits.

Record No. 1108-91-3 Affirmed.

Record No. 1532-91-3 Reversed and remanded.