COURT OF APPEALS OF VIRGINIA 

Present: Judges Benton, Coleman and Willis 

CITY OF RICHMOND FIRE & 

 EMERGENCY SERVICES 

 MEMORANDUM OPINION*

v. Record No. 1916-96-2 PER CURIAM 

 JANUARY 28, 1997 

CARL D. SHULER 

 FROM THE VIRGINIA WORKERS' COMPENSATION COMMISSION 

 (Ruth Nathanson; Midkiff & Hiner, on brief), 

for appellant. 

 (Louis D. Snesil; McDonald & Snesil, on 

brief), for appellee. 

 City of Richmond Fire & Emergency Services (employer) 

contends that the Workers' Compensation Commission erred in 

finding that employer's evidence failed to rebut the statutory 

presumption that Carl D. Shuler's heart disease was occupational. 

 Code § 65.2-402(B). Upon reviewing the record and the briefs of 

the parties, we conclude that this appeal is without merit. 

Accordingly, we summarily affirm the commission's decision. Rule 

5A:27. 

 Shuler, age fifty-six, worked thirty years as a firefighter 

for employer. In addition to fighting fires, his job duties 

involved responding to ambulance calls in life-threatening 

situations. Shuler described his job duties as stressful. 

 On June 12, 1995, while mopping the fire station floor, 

 

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

designated for publication. 
 2 

Shuler suffered a heart attack. He was admitted to the hospital 

for emergency cardiac catheterization and a coronary artery 

bypass. 

 In response to employer's insurer's questions, Dr. Harold J. 

Levinson reported that Shuler had atherosclerotic coronary artery 

disease. Dr. Levinson opined that the probable cause of Shuler's 

heart condition was hypertension, hypercholesterolemia, and 

smoking. Dr. Levinson also opined that Shuler's "hypertension 

could in some way be related to his employment." He further 

stated that "[e]xcept for the fact that [Shuler's] work is 

stressful, I could not say with assurity that the disease is work 

related." 

 Dr. Milan P. Krickovic also opined that the probable cause 

of Shuler's coronary artery disease was tobaccoism, hypertension, 

and hypercholesterolemia. He reported that "[r]egarding the risk 

factor relationship to employment--there is no relationship to 

his employment for tobaccoism or hypercholesterolemia, but 

work-induced stress could have aggravated his hypertension." 

Dr. Krickovic opined that he could rule out work as the probable 

cause of Shuler's "arteriosclerotic coronary heart disease." 

 After reviewing Shuler's medical records at employer's 

request, Dr. Michael L. Hess reported that the five major risk 

factors for accelerated coronary artery disease are 

hypercholesterolemia, hypertension, cigarette smoking, diabetes, 

and a positive family history. Dr. Hess opined that "[i]t is 
 3 

extremely unlikely that any stress associated with [Shuler's] job 

as a fireman contributed to the development of his coronary 

artery disease." Dr. Hess stated that Shuler's significant 

cigarette smoking, his hypercholesterolemia, and his positive 

family history represent the etiology of his coronary artery 

disease. 

 Code § 65.2-402 provides that "heart disease . . . resulting 

in total or partial disability of [a firefighter] . . . shall be 

presumed to be [an] occupational disease[], suffered in the line 

of duty, . . . unless such presumption is overcome by a 

preponderance of competent evidence to the contrary." Shuler 

established prima facie entitlement and invoked the presumption 

when he proved his occupation as a firefighter and the occurrence 

of disability caused by one of the diseases identified by Code 

§ 65.2-402. Fairfax Co. Fire & Rescue Dep't v. Mitchell, 14 Va. 

App. 1033, 1035, 421 S.E.2d 668, 670 (1992). "The presumption 

shifts the burden of going forward with the evidence . . . to his 

employer." Id. To rebut the presumption, an employer must 

establish by "a preponderance of competent evidence" a 

non-work-related cause of the employee's heart disease. Code 

§ 65.2-402. See also City of Norfolk v. Lillard, 15 Va. App. 

424, 430, 424 S.E.2d 243, 246-47 (1992). Unless we can say as a 

matter of law that employer's evidence sustained its burden of 

proof, the commission's findings are binding and conclusive upon 

us. Tomko v. Michael's Plastering Co., 210 Va. 697, 699, 173 
 4 

S.E.2d 833, 835 (1970). 

 In holding that employer failed to rebut the presumption, 

the commission relied upon the opinions of Drs. Levinson and 

Krickovic. Drs. Levinson and Krickovic both stated that job 

stress may have contributed to Shuler's hypertension, and they 

both identified hypertension as a probable cause of Shuler's 

coronary artery disease. As correctly noted by the commission, 

compensability is established under the "two causes" rule, when 

evidence proves that work is a contributing cause of the 

disability, even if other causes also contribute. See Duffy v. 

Commonwealth, 22 Va. App. 245, 251, 468 S.E.2d 702, 705 (1996). 

In light of the opinions of Drs. Levinson and Krickovic and the 

lack of evidence that Shuler had heart disease before he began 

his stressful employment, the commission, in its role as fact 

finder, was entitled to give little weight to the contrary 

opinion of Dr. Hess. "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). 

 Accordingly, we affirm the commission's decision. 

 Affirmed.