COURT OF APPEALS OF VIRGINIA 

Present: Judges Coleman, Elder and Senior Judge Cole 

Argued at Salem, Virginia 

GREAT EASTERN RESORT CORPORATION AND 

 LIBERTY INSURANCE COMPANY 

 OPINION BY 

v. Record No. 1682-99-3 JUDGE SAM W. COLEMAN III 

 FEBRUARY 29, 2000 

PAMELA GORDON 

FROM THE VIRGINIA WORKERS' COMPENSATION COMMISSION 

 Thomas G. Bell, Jr. (Timberlake, Smith, 

Thomas & Moses, P.C., on brief), for 

appellants. 

 No brief or argument for appellee. 

 Great Eastern Resort Corporation and its insurer, Liberty 

Insurance Company, appeal the Workers' Compensation Commission's 

decision awarding Pamela Gordon temporary total disability 

benefits. Great Eastern argues the commission erred in finding 

that Gordon proved by clear and convincing evidence, as required 

by Code § 65.2-401, that her right carpal tunnel syndrome was 

caused by her employment. We disagree and affirm the 

commission's decision. 

BACKGROUND

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

to Gordon, the party prevailing before the commission. See R.G. 

Moore Bldg. Corp. v. Mullins, 10 Va. App. 211, 212, 390 S.E.2d 

788, 788 (1990). So viewed, the evidence proved that Gordon 
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worked for Great Eastern as a night auditor. As an auditor, she 

used her right hand to input the day's revenue and room charges 

on a machine called a "micro." The micro is a computerized cash 

register with a keyboard for entering data and a slot for 

entering invoices or "folios." 

 Gordon worked for Great Eastern eight hours per day, three 

days per week for seven and one-half years. Gordon testified 

that she operated the micro between one and three hours per 

shift, depending on how busy the resort was on a given day. She 

testified that due to the set-up of the work station, she was 

required to place her right hand at a forty-five degree angle 

while using her fingers to key in the data. She also fed 

vouchers and folios into the micro with her left hand. 

 In January 1997, Gordon first noticed numbness in her 

fingers and pain in her right wrist. In January 1998, she 

sought medical treatment from her regular physician, Dr. Raul 

Orviedo, for complaints of a herniated disc in her neck. She 

also reported wrist pain to Dr. Orviedo, who ordered that she 

undergo an MRI due to his concern that her symptoms might be 

related to her neck condition. After reviewing the MRI, Dr. 

Orviedo referred claimant to Dr. John A. Jane, Sr., a 

neurosurgeon. 

 Dr. Jane opined that the numbness in Gordon's hand and arm 

was not related to her neck problem and referred Gordon to Dr. 
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Edward R. Laws, Jr., a neurosurgeon, for another opinion. In a 

May 22, 1998 letter to Dr. Jane, Dr. Laws diagnosed Gordon with 

carpal tunnel syndrome. Dr. Laws noted that Gordon's 

"day-to-day work involves using an instrument called a 'micros' 

which is a type of computerized cash register. She has 

repetitive movements that have precipitated and aggravated the 

carpal tunnel syndrome, with which she presently presents." 

 On June 23, 1998, after operating on Gordon's right hand, 

Dr. Laws wrote that "[h]er symptoms developed and became 

aggravated as she was using . . . an instrument called a micros, 

which I understand is a computerized cash register. This type 

of hand problem is commonly associated with this type of 

repetitive occupational trauma." 

 Gordon denied engaging in any hobbies or activities outside 

of her employment involving repetitive movements of her right 

hand. She admitted she had a long history of smoking two packs 

of cigarettes per day and stated that she told Dr. Laws' nurse 

of this history. Gordon denied having been diagnosed with 

carpal tunnel syndrome before May 1998. 

ANALYSIS

 "Whether a disease is causally related to the employment and 

not causally related to other factors is . . . a finding of fact." 

Island Creek Coal Co. v. Breeding, 6 Va. App. 1, 12, 365 S.E.2d 

782, 788 (1988). We accept the commission's factual findings 
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when they are supported by credible evidence. See James v. 

Capitol Steel Constr. Co., 8 Va. App. 512, 515, 382 S.E.2d 487, 

488 (1989). 

 Since 1997, the Code has provided that "'condition[s] of 

carpal tunnel syndrome are not occupational diseases but are 

ordinary diseases of life as defined in [Code] § 65.2-401.'" 

National Fruit Prod. Co. v. Staton, 28 Va. App. 650, 654, 507 

S.E.2d 667, 669 (1998). For an ordinary disease of life to be 

compensable, a claimant must prove by "clear and convincing 

evidence, (not mere probability)" that the disease (1) arose out 

of and in the course of his employment, (2) did not result from 

causes outside of the employment, and (3) follows as an incident 

of an occupational disease, is an infectious or contagious disease 

contracted in the course of the employment listed in Code 

§ 65.2-401(2)(b), or is characteristic of the employment and was 

caused by conditions peculiar to the employment. Code § 65.2-401; 

see also Lindenfield v. City of Richmond Sheriff's Office, 25 Va. 

App. 775, 784, 492 S.E.2d 506, 510 (1997). However, disability 

resulting from work-related aggravation of a pre-existing disease 

is not compensable. See Ashland Oil Co. v. Bean, 225 Va. 1, 3-4, 

300 S.E.2d 739, 740 (1983) (per curiam). 

"Clear and convincing evidence has been 

defined as 'that measure or degree of proof 

which will produce in the mind of the trier 

of facts a firm belief or conviction as to 

the allegations sought to be established. 

It is intermediate, being more than a mere 
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preponderance, but not to the extent of such 

certainty as is required beyond a reasonable 

doubt as in criminal cases. It does not 

mean clear and unequivocal.'" 

National Fruit, 28 Va. App. at 654, 507 S.E.2d at 669 (citations 

omitted). 

 The employer contends that based on Dr. Laws' reports and 

opinions Gordon's carpal tunnel syndrome necessarily pre-existed 

the repetitive motion at work. The employer reasons that 

because Dr. Laws stated, "the symptoms developed and became 

aggravated as she was using . . . an instrument called a 

micros," and because he used the terminology "precipitated" and 

"aggravated" to describe the development of Gordon's condition, 

the condition had to pre-exist in order to be "aggravated" or 

precipitated. Thus, the employer argues, relying upon the 

holding in Ashland Oil, the aggravation of a pre-existing 

disease is not compensable. The employer further argues that, 

at best, Dr. Laws' report as to causation is ambiguous and 

equivocal and is not sufficient to satisfy the claimant's burden 

under Code § 65.2-401 of proving by clear and convincing 

evidence that this ordinary disease of life was causally related 

to her work. We find that the commission's decision is 

supported by credible evidence and that the proof satisfies the 

clear and convincing standard. 

 Dr. Laws' opinion and Gordon's testimony constitute 

credible evidence to support the commission's findings that 
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Gordon's repetitive motion at work was the cause of her right 

carpal tunnel syndrome and that the disease did not pre-exist 

her repetitive motion at work. "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). Based upon Dr. Laws' 

statements in his May 22, 1998 and June 23, 1998 letters, the 

commission reasonably found that "claimant's employment was the 

'precipitating' factor which caused [her carpal tunnel syndrome] 

to 'develop.'" "Precipitate" is defined as "to cause to move or 

act very rapidly"; "to cause to happen or come to a crisis 

suddenly or unexpectedly." Webster's Third New International 

Dictionary 1784 (1993). On this record, the commission could, 

and obviously did, find that Dr. Laws' use of the terms 

"precipitated" or "aggravated" did not indicate that Gordon had 

a pre-existing disease. Rather, the commission found that his 

use of the terminology described the effect that the repetitive 

motion at work had upon causing or "precipitating" or 

"aggravating" the disease process to the median nerve. 

Significantly, no evidence proved that Gordon had carpal tunnel 

syndrome or experienced symptoms related to the disease prior to 

her work and no evidence proved that any causes outside her work 
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contributed to cause the condition. Furthermore, no evidence 

proved that carpal tunnel syndrome is a condition which may lie 

dormant and only become symptomatic when external aggravating 

factors are brought to bear. 

 "Where reasonable inferences may be drawn from the evidence 

in support of the commission's factual findings, they will not 

be disturbed by this Court on appeal." Hawks v. Henrico County 

Sch. Bd., 7 Va. App. 398, 404, 374 S.E.2d 695, 698 (1988). 

Based upon Dr. Laws' opinions and Gordon's testimony, the 

commission, as the trier of facts, could conclude that the 

evidence proved clearly and convincingly that (1) the repetitive 

trauma at work caused the right carpal tunnel syndrome and (2) 

that prior to the repetitive trauma at work, Gordon did not have 

right carpal tunnel syndrome and did not engage in repetitive 

activity outside work that caused or contributed to cause the 

development of this ordinary disease of life. 

 For these reasons, we affirm the commission's decision. 

Affirmed.