COURT OF APPEALS OF VIRGINIA 

Present: Chief Judge Moon, Senior Judges Cole and Duff 

WLR FOODS, INC. 

AND 

PACIFIC EMPLOYERS INSURANCE COMPANY 

v. Record No. 0965-95-3 MEMORANDUM OPINION*

 PER CURIAM 

SCOTT L. CUBBAGE NOVEMBER 21, 1995 

FROM THE VIRGINIA WORKERS' COMPENSATION COMMISSION 

 Cathleen P. Welsh (Wharton, Aldhizer & Weaver, on 

brief), for appellants. 

 A. Thomas Lane, Jr., for appellee. 

 WLR Foods, Inc. and its insurer appeal a decision of the 

Workers' Compensation Commission awarding benefits to Scott L. 

Cubbage for the occupational diseases of bilateral tenosynovitis 

and bilateral carpal tunnel syndrome. Employer contends that the 

commission erred in finding that (1) Cubbage made a claim for 

left-sided tenosynovitis; (2) Cubbage's right-sided tenosynovitis 

constitutes a "disease" within the meaning of occupational 

disease under the Workers' Compensation Act ("the Act"); (3) 

Cubbage's bilateral carpal tunnel syndrome constitutes a 

"disease" under the Act causally related to his employment; (4) 

Cubbage proved that Dr. Irvin E. Hess communicated a diagnosis of 

work-related bilateral carpal tunnel syndrome to him; and (5) 

Cubbage's bilateral carpal tunnel syndrome is a compensable 

 

 *Pursuant to Code § 17-116.010 this opinion is not 

designated for publication. 
consequence of his bilateral tenosynovitis. For the following 

reasons, we reverse the commission's decision as to the first 

question presented and affirm the remainder of its decision. 

FACTS 

 The facts are not in dispute. Cubbage began working for 

employer in September 1993. His job duties involved hanging 

chickens on a shackle and pulling skins from various chicken 

parts. In November 1993, he began to notice pain in his hands. 

 On January 20, 1994, Cubbage sought medical treatment from 

Dr. Irvin Hess, an orthopedic surgeon. Dr. Hess initially 

diagnosed flexor tenosynovitis more severe on the right than the 

left. Because he suspected early carpal tunnel syndrome, Dr. 

Hess referred Cubbage to Dr. Zack Perdue for nerve conduction 

studies. These studies revealed that Cubbage suffered from 

bilateral carpal tunnel syndrome more on the right than the left. 

 Dr. Perdue opined that the repetitive nature of Cubbage's work 

caused his bilateral carpal tunnel syndrome. 

 Dr. Hess opined that because he had no history of a specific 

trauma, it was probable that Cubbage's tenosynovitis was related 

to his repetitive work. However, he disagreed with Dr. Perdue's 

opinion concerning Cubbage's bilateral carpal tunnel syndrome. 

Dr. Hess testified that he could not opine within a reasonable 

degree of medical certainty that Cubbage's bilateral carpal 

tunnel syndrome was caused by his work. Dr. Hess admitted that 

it was very difficult to separate the two conditions. 
 3 

 I. LEFT-SIDED TENOSYNOVITIS 

 On April 20, 1994, Cubbage filed an application for hearing 

and claim for benefits with the commission alleging an 

occupational disease of bilateral carpal tunnel syndrome causally 

related to his employment. At the September 7, 1994 hearing, 

Cubbage made a claim for benefits based upon left-sided carpal 

tunnel syndrome and right-sided tenosynovitis and/or carpal 

tunnel syndrome. 

 No evidence in the record shows that Cubbage ever made a 

claim before the commission for an occupational disease of leftsided tenosynovitis. Absent such a claim, the commission did not 

have jurisdiction to award benefits for this condition. 

Accordingly, we reverse the commission's award of compensation to 

Cubbage for left-sided tenosynovitis. 

II. and III. RIGHT-SIDED TENOSYNOVITIS

 AND CARPAL TUNNEL SYNDROME 

A. "Disease" Issue: 

 In Piedmont Mfg. Co. v. East, 17 Va. App. 499, 503, 438 

S.E.2d 769, 772 (1993), we 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. 

 "[T]he definition enunciated in Piedmont [has been 

recognized by this Court] as the general and accepted meaning of 
 4 

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." Perdue Farms, Inc. v. McCutchan, 21 

Va. App. 65, 68, 461 S.E.2d 431, 435 (1995) (carpal tunnel 

syndrome is a disease under the Act). 

 Tenosynovitis is defined as "inflammation of a tendon 

sheath." Dorland's Illustrated Medical Dictionary 1316 (26th ed. 

1985). Using this general medical definition of tenosynovitis, 

as we did for carpal tunnel syndrome in Perdue, we find that 

tenosynovitis falls within the definition of disease set forth in 

Piedmont and approved of in Perdue.1 

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

to the prevailing party below. R.G. Moore Bldg. Corp. v. 

Mullins, 10 Va. App. 211, 212, 390 S.E.2d 788, 788 (1990). We 

must uphold the commission's factual findings if supported by 

credible evidence. James v. Capitol Steel Constr. Co., 8 Va. 

App. 512, 515, 382 S.E.2d 487, 488 (1989). 

 As in Perdue, Cubbage's right-sided tenosynovitis and 

bilateral carpal tunnel syndrome did not present as obvious, 

sudden, mechanical or structural changes in his body. Based upon 

our holding in Perdue and Dr. Hess' diagnoses, we conclude that 

credible evidence supports the commission's findings that 

Cubbage's right-sided tenosynovitis and bilateral carpal tunnel 

 

 1In his September 12, 1994 deposition, Dr. Hess defined 

tenosynovitis in a manner consistent with this general medical 

definition of tenosynovitis. 
 5 

syndrome are conditions characterized as "diseases" within the 

meaning of the Act. 
 6 

B. Causation Issue: 

 "'Whether a disease is causally related to the employment 

and not causally related to other factors is . . . a finding of 

fact.' . . . When there is credible evidence to support it, such 

a finding of fact is 'conclusive and binding' on this Court." 

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)). 

 The commission weighed the conflict between Dr. Perdue's 

opinion that Cubbage's bilateral carpal tunnel syndrome was 

caused by the repetitive nature of his work and Dr. Hess' 

testimony that he could not render such an opinion to a 

reasonable degree of medical certainty. The commission accepted 

Dr. Perdue's opinion, which constitutes credible evidence to 

support its finding that Cubbage proved his bilateral carpal 

tunnel syndrome was causally related to his employment. 

"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). 

 IV. Communication of Diagnosis of Occupational Disease 

 Cubbage's testimony and Dr. Hess' records and testimony 

provide credible evidence to support the commission's finding 

that Dr. Hess communicated a diagnosis of an occupational disease 

to Cubbage at the time of his initial examination on January 20, 

1994. Dr. Hess testified that he told Cubbage on January 20, 
 7 

1994 that he suffered from tenosynovitis causally related to his 

work. Cubbage testified that on February 7, 1994, Dr. Hess told 

him he had bilateral carpal tunnel syndrome caused by his work. 

 Because our rulings on issues (I) through (IV) dispose of 

this appeal, we will not address question presented (V). For the 

reasons stated, the commission's decision is reversed in part, 

and affirmed in part. 

 Reversed in part, affirmed in part.