COURT OF APPEALS OF VIRGINIA 

Present: Judges Benton, Bray and Frank 

Argued at Chesapeake, Virginia 

DONALD R. GODFREY 

 MEMORANDUM OPINION* BY 

v. Record No. 1950-00-1 JUDGE JAMES W. BENTON, JR. 

 APRIL 10, 2001 

CITY OF PORTSMOUTH FIRE DEPARTMENT 

 FROM THE VIRGINIA WORKERS' COMPENSATION COMMISSION 

 Michael A. Kernbach (Jack T. Burgess & 

Associates, P.C., on brief), for appellant. 

 William C. Walker (Taylor & Walker, P.C., on 

brief), for appellee. 

 

* Pursuant to Code § 17.1-413, this opinion is not 

designated for publication. 

 Donald R. Godfrey contends that the Workers' Compensation 

Commission erred in ruling that his employer, the City of 

Portsmouth Fire Department, produced a preponderance of evidence 

to rebut the presumption that his heart disease was an 

occupational disease. See Code § 65.2-402(B). We agree, and we 

reverse and remand this matter to the commission. 

I. 

 At the time of the evidentiary hearing, Donald R. Godfrey 

was fifty-six years old and had worked for the City of 

Portsmouth Fire Department for thirty-five years. Godfrey's 

initial employment physical examination did not indicate signs 
of heart disease and revealed his blood pressure was in normal 

range. As a firefighter, Godfrey later trained to be an 

emergency medical technician. In his job, he was often aroused 

from sleep to respond to fires, emergency medical calls, 

domestic disturbances, shootings, stabbings, automobile 

accidents, and various other emergency events. Godfrey's 

testimony contains descriptions of emergencies involving tragic 

deaths of children, other "terrible things [he has seen] in 

[his] career," and his general job duties. During the years he 

has been employed as a firefighter, Godfrey has developed 

hypertension and high cholesterol. 

 In 1997, Godfrey complained of chest pains and was referred 

to a cardiologist. Dr. Edward O. Lynch performed a diagnostic 

catherization and diagnosed "single vessel disease with high 

grade obstruction of the proximal LAD and first diagnal artery." 

Dr. Lynch later reported that Godfrey has "known two-vessel 

coronary artery disease" and continued as follows: 

Mr. Godfrey's underlying ischemic coronary 

artery disease is related to his gender, 

being an adult male, and his history of 

elevated cholesterol and hypertension. 

There has never been shown any direct 

relationship showing stressful jobs, such as 

fire fighting, police work, or commercial 

airline piloting, to be a causation for 

underlying ischemic heart disease. Mr. 

Godfrey certainly could have been a painter, 

a postman, or any other occupation, and 

could have potentially still developed 

underlying ischemic heart disease because of 

his risk factors. 

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 Godfrey was also treated by another cardiologist, 

Dr. William E. Callaghan. His reports include the following: 

Clearly stress plays some role in control of 

hypertension. Patients with more stressful 

environments are likely to have poorly 

controlled hypertension. . . . [T]here are 

numerous articles which attempt to link the 

level of stress with development of coronary 

disease. To the best of my knowledge, there 

is no definitive study that supports the 

conclusion, although it is in the great 

likelihood because of difficulties in 

measuring stress in an objective fashion. 

. . . I do believe hypertension has played 

some role in this gentleman's coronary 

artery disease. . . . [H]is cholesterol has 

also played a role in his development of 

coronary artery disease. His last total 

cholesterol was 204 with an LDL of 125 both 

of which are quite elevated, but improved on 

medication therapy. 

Dr. Callaghan later confirmed his views. 

I, . . . told Mr. Godfrey that I do feel 

that stress plays a role in the development 

of coronary artery disease. He has 

described today and in the past on a couple 

of occasions, the significant stress that he 

experienced during his employment as a fire 

fighter. Although it is difficult to gauge, 

I have told him that I do believe that 

stress has played a role in his development 

of coronary disease. 

 Dr. Lynch reviewed Dr. Callaghan's first report and 

expressed his disagreement in a letter, which included a report 

issued by two medical associations. In pertinent part, he 

reported as follows: 

For your interest, I have enclosed in this 

letter those risk factors which are thought 

to be prevalent as a contributing factor 

toward the development of ischemic heart 

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disease. They include category 1 risk 

factors, category 2, 3, and 4 with their 

contributions being less significant in the 

lower groups. First let me say that Mr. 

Godfrey's underlying ischemic heart disease 

is secondary to elevated cholesterol, 

hypertension, and his male gender. No where 

on the list of risk factors that was 

convened and established by this conference 

and is now used as a standard of care in the 

practice of cardiology is listed stress and 

nowhere is mentioned specifically job 

stress. There is under category 3, 

psychosocial factors. I have enclosed for 

you the excerpt from this publication that 

outlines those psychosocial factors. Again, 

these factors are not related to a specific 

job stress, but to an individual and are 

usually related to type A personalities, 

patients with depression or hostile 

personalities who are suspected to possibly 

have aggravating risk for the development of 

coronary artery disease. In regards to Dr. 

Callaghan letters, I do agree with him and 

in fact will further mention as he says that 

there is no definitive study that supports 

the conclusion that there is any 

relationship between job stress and coronary 

disease. I will frankly tell you that this 

has been studied and there has never been 

found to be any increased incidents of 

coronary disease among any specific jobs 

such as fireman, policeman, attorneys, 

painters, candlestick makers, or butchers. 

As he mentions, it would be very difficult 

to interpret each individuals level of 

stress. What may be very stressful to one 

person would be inconsequential possibly to 

another. 

 In summary, Dr. Callaghan is correct 

stating that Mr. Godfrey's coronary disease 

is secondary to hypertensive vascular 

disease, hyperlipidemia, and his male 

gender. There is no evidence presently or 

literature to support any job stress related 

incidents as a risk factor for coronary 

disease. 

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II. 

 The commission reviewed the evidence and made the following 

findings: 

 Based on the evidence presented in this 

case, we find that the employer has rebutted 

the presumption and proven that job-related 

stress was not a cause of [Godfrey's] heart 

disease. Dr. Lynch clearly did not believe 

that stress resulting from [Godfrey's] job 

as a firefighter was a cause of his heart 

disease. Although Dr. Callaghan did relate 

job stress to [Godfrey's] heart disease, he 

acknowledged that this was not supported by 

studies. Considering the fact that 

Dr. Lynch was a treating physician and 

Dr. Callaghan's candid acknowledgement that 

his view was not supported by definitive 

studies, we find Dr. Lynch's opinion the 

more persuasive. As such, the employer has 

shown by a preponderance of the evidence 

that [Godfrey's] heart disease was not 

caused by his employment. The employer has 

also established the second prong of the 

test in showing that there was a 

non-work-related cause of the disease. 

Dr. Lynch unequivocally stated that the 

proximate causes of [Godfrey's] condition 

was [Godfrey's] gender and a history of 

elevated cholesterol and hypertension. 

Dr. Callaghan agreed that [Godfrey's] 

hypertension and cholesterol have played a 

role in his condition. In the absence of 

any clear statement from Dr. Callaghan that 

[Godfrey's] job as a firefighter caused or 

contributed to his heart disease, we find 

there is evidence of a non-work-related 

cause of the disease. We therefore find 

that the employer has rebutted the statutory 

presumption of [Code] § 65.2-402. 

III. 

 In pertinent part, Code § 65.2-402 provides as follows: 

B. Hypertension or heart disease causing 

the death of, or any health condition or 

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impairment resulting in total or partial 

disability of (i) salaried or volunteer 

firefighters . . . 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. 

 * * * * * * * 

D. The presumptions described in . . . this 

section shall only apply if persons entitled 

to invoke them have, if requested by the 

. . . governing body employing them, 

undergone preemployment physical 

examinations that (i) were conducted prior 

to the making of any claims under this title 

that rely on such presumptions, (ii) were 

performed by physicians whose qualifications 

are as prescribed by the . . . governing 

body employing such persons, (iii) included 

such appropriate laboratory and other 

diagnostic studies as the . . . governing 

bodies may have prescribed, and (iv) found 

such persons free of respiratory diseases, 

hypertension, cancer or heart disease at the 

time of such examinations. 

The principle is now well established that "[t]o overcome the 

presumption the employer must show, by a preponderance of the 

evidence, both that (1) the claimant's disease was not caused by 

his employment, and (2) there was a non-work-related cause of 

the disease." Bass v. City of Richmond, 258 Va. 103, 114, 515 

S.E.2d 557, 562-63 (1999) (emphasis added). 

 Twenty years ago the Supreme Court ruled that when the 

legislature enacted the statutory presumption that covers 

employees such as firefighters, "[t]he legislature knew that the 

causes of . . . cardiac diseases are unknown and that the 

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medical community is split regarding the impact of stress and 

work environment on these diseases." Fairfax County Fire and 

Rescue Ser. v. Newman, 222 Va. 535, 540, 281 S.E.2d 897, 900 

(1981). Applying that rationale, we recently held as follows: 

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. Testimony which merely 

refutes the premise of such a legislatively 

enacted presumption does not constitute 

proper evidence in rebuttal. Where the 

General Assembly has concluded that there is 

a causal link between stress and heart 

disease, it is not for the commission or the 

courts to reconsider the issue, for to do so 

would defeat the intentions of the 

legislature. It thus follows that, "[i]t is 

impermissible for the [commission] to accept 

the opinion of a physician so disposed as 

the basis for disallowing a claim." . . . 

We, accordingly, hold that evidence that 

merely rebuts generally the underlying 

premise of the statute, which establishes a 

causal link between stress and heart 

disease, is not probative evidence for 

purposes of overcoming the presumption. 

Medlin v. County of Henrico Police, 34 Va. App. 396, 406-07, 542 

S.E.2d 33, 38-39 (2001) (citations omitted). 

 As an employee of the City of Portsmouth Fire Department, 

Godfrey was within the category of employees covered by the 

statutory presumption. Furthermore, the evidence proved Godfrey 

was eligible to invoke the benefit of the presumption because 

his initial employment physical examination showed him to be 

free of heart disease and hypertension. 

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 In finding that the employer rebutted the first prong of 

the presumption, the commission found to be more persuasive 

Dr. Lynch's opinion because it was based in substantial part 

upon studies which establish that no relationship has been shown 

between the stress of being a firefighter and underlying heart 

disease. That evidence, however, does nothing more than attack 

the underlying rationale of the statute, which establishes the 

presumptive link between Godfrey's employment and his disease. 

The studies cited by Dr. Lynch, which were the basis upon which 

the commission found Dr. Lynch's opinion to be more persuasive, 

are not probative of the issue that the employer must 

necessarily prove, i.e., that the heart disease was not caused 

by employment. Id. at 407, 542 S.E.2d at 38-39. When we 

disregard this evidence, we cannot conclude that the employer 

has rebutted the presumption. 

 For these reasons, we reverse the commission's decision and 

remand for rehearing. 

 Reversed and remanded. 

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