IN THE SUPREME COURT OF THE STATE OF HAWAIʻI

---o0o---

________________________________________________________________

DEBBIE S. QUEL,

Petitioner/Petitioner-Appellant/Appellant,

vs.

BOARD OF TRUSTEES, EMPLOYEES’ RETIREMENT SYSTEM, STATE OF 

HAWAIʻI,

Respondent/Respondent-Appellee/Appellee

SCWC-16-0000355

CERTIORARI TO THE INTERMEDIATE COURT OF APPEALS

(CAAP-16-0000355; CIVIL NO. 1CC151001308)

FEBRUARY 6, 2020

RECKTENWALD, C.J., NAKAYAMA, McKENNA, POLLACK, AND WILSON, JJ.

OPINION OF THE COURT BY McKENNA, J.

I. Introduction

In 2008, Debbie Quel (“Quel”), an eighteen-year cafeteria 

helper for the State of Hawaiʻi Department of Education (“DOE”), 

applied for “service-connected disability retirement” benefits 

pursuant to Hawaiʻi Revised Statutes (“HRS”) § 88-79(a) (Supp. 

2007), which provides in relevant part that “any member who has 

Electronically Filed

Supreme Court

SCWC-16-0000355

06-FEB-2020

07:59 AM
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been permanently incapacitated for duty . . . as the cumulative 

result of some occupational hazard . . . may be retired by the 

board for service-connected disability[.]” 

There was no dispute that Quel was a “member” “permanently 

incapacitated for duty” “as the cumulative result of” her

working conditions. Quel’s application for “service-connected 

disability retirement” benefits was, however, denied by the 

Board of Trustees of the Employees’ Retirement System of the 

State of Hawaiʻi (“ERS Board”) on the grounds that the working 

conditions that caused Quel’s permanent incapacity did not 

constitute an “occupational hazard” as defined by Hawaiʻi law. 

The Circuit Court of the First Circuit1 (“circuit court”) and the 

Intermediate Court of Appeals (“ICA”) affirmed.

The ERS Board concluded that although Quel’s permanent 

incapacity was due to the cumulative effects of work-related 

activities, she failed to meet her burden of establishing that 

her incapacity resulted from an “occupational hazard.” The ERS 

Board based its decision on Quel’s failure to introduce evidence 

that the “lifting requirements” of her job were “different in 

character from those in the general run of occupations” 

testified to by the ERS Medical Board’s (“Medical Board”)

physician chair and “that her work related problems were limited 

to a relatively few number of occupations.” 

 

1

The Honorable Rhonda A. Nishimura presided.
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On certiorari, Quel contends the ICA, circuit court, and

ERS Board erred in adopting the definition of “occupational 

hazard” contained in Hawaiʻi Administrative Rules 

(“HAR”) § 6-22-2 (effective 1989-2009), which defines the term 

as “a danger or risk which is inherent in, and concomitant to, a 

particular occupation or particular job, if [it is] not a risk 

common to employment in general.” Quel contends HAR § 6-22-2 

contravenes HRS § 88-79(a), as HRS § 88-79(a) affords serviceconnected disability retirement to members for permanent 

incapacity due to “some occupational hazard.” Quel also asserts 

error in the ICA and circuit court’s affirmance of the ERS 

Board’s conclusion that her permanent incapacity did not result 

from an “occupational hazard.”

We hold that HAR § 6-22-2 correctly defines an

“occupational hazard” as “a danger or risk which is inherent in, 

and concomitant to, a particular occupation or particular job, 

if [it is] not a risk common to employment in general[,]” as the 

definition is based on our decisions in Lopez v. Bd. of Trs., 

Emps.’ Ret. Sys., 66 Haw. 127, 129, 657 P.2d 1040, 1042 (1983), 

and Komatsu v. Bd. of Trs., Emps.’ Ret. Sys., 67 Haw. 485, 494, 

693 P.2d 405, 411 (1984). We further hold that the definition 

of “occupational hazard” for purposes of service-connected 

disability retirement benefits does not include a requirement 

that permanent incapacity resulting from the cumulative effects 
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of work-related activities be “limited to a relatively few 

number of occupations.” Finally, we also hold that the ERS 

Board clearly erred in finding and concluding that Quel’s 

permanent capacity did not result from “a danger or risk which 

is inherent in, and concomitant to,” her “particular occupation 

or particular job,” which was “not a risk common to employment 

in general.” 

Accordingly, we vacate the ICA’s July 6, 2018 judgment on 

appeal and the circuit court’s April 13, 2016 (1) “Decision and 

Order Affirming the Final Decision of the Appellee Board of 

Trustees of the Employees’ Retirement System of the State of 

Hawaii and Dismissing Appellant Debbie S. Quel’s Appeal” and 

(2) final judgment. We remand this case to the ERS Board for 

further proceedings consistent with this opinion.

II. Background

A. Factual background

Quel worked for the DOE at Waialua Elementary School, 

Mililani High School, Haleiwa Elementary School, and Wahiawa 

Elementary School, before transferring to Helemano Elementary

School (“Helemano”).

At Helemano, Quel’s daily duties as a cafeteria helper

involved lifting heavy trap doors, putting things into the oven 

for breakfast, scooping rice with her left hand for about 250 

trays, pinching dough, peeling potatoes, cutting vegetables, 
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opening numerous cans with an old-fashioned manual can opener, 

carrying heavy boxes or cases of food products, and serving the 

meals to the students. She also helped cook rice in the oven. 

Because Helemano did not have rice cookers, to cook the rice, 

she would wash the rice in the morning, place the rice into six 

or seven eight-inch pans, then lift and slide the pans over her 

head into the oven, which was taller than Quel. She also 

emptied the vegetables and other food out of the pots used to 

make stew. During Quel’s testimony, she explained that Helemano 

did not have the equipment common in other school cafeterias --

such as rice cookers, electric can openers, and machines for 

cutting vegetables or bread -- which increased the repetitive 

labor she had to do every day. In the summer, Quel did 

custodial-type work, such as buffing floors, shampooing the 

carpet, moving furniture, and cleaning up. 

Quel’s last day of work for the DOE at Helemano was on 

November 12, 2008. The next day, she was seen by a physician, 

who evaluated Quel’s swollen hands and painful shoulders

allegedly caused by repetitive motions and activities at work. 

For the next few years, Quel was seen by various physicians for 

these injuries. She was diagnosed with various work-related 

injuries to her hands, wrists, and shoulders, and underwent 

multiple surgeries to her shoulders, wrists, fingers, and thumb.
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B. Application for service-connected disability benefits

On November 22, 2010, Quel applied for service-connected 

disability retirement benefits with the ERS Board. The Medical 

Board issued a report to the ERS Board on August 22, 2012

(“Medical Board Report”), indicating it had reviewed Quel’s 

application; her employment, personnel, workers’ compensation, 

and medical records; and had interviewed Quel.2 The Medical

Board concluded that Quel was permanently incapacitated for

performing her job as a cafeteria helper. The Medical Board 

also opined, however, that Quel’s permanent incapacity was not 

“the cumulative result of a danger or risk inherent in and 

concomitant to” her occupation. 

On March 11, 2013, the ERS Board reviewed the Medical Board 

Report and made a preliminary decision to deny Quel’s 

application for service-connected disability retirement 

benefits, and informed Quel of her appeal rights. Quel filed an 

 

2 HRS § 88-79(d) (2012) provides:

(d) The board may determine whether or not the disability 

is the result of an accident occurring while in the actual 

performance of duty at some definite time and place and 

that the disability was not the result of wilful negligence 

on the part of the member. The board may accept as 

conclusive:

(1) The certification made by the head of the agency 

in which the member is employed; or

(2) A finding to this effect by the medical board.

HAR Title 6, Chapter 22 governs procedures for certifications and 

findings of the Medical Board relating to matters including service-connected 

disability retirement benefits under HRS § 88-79. HAR § 6-22-1(2) (effective 

1984-2009). 
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appeal on April 29, 2013, and the matter was referred to the 

Office of Administrative Hearings. A hearing was conducted on 

April 10, 2014; Quel and the physician chair of the Medical 

Board appeared at the hearing, represented by counsel. The 

hearings officer received and reviewed evidence regarding Quel’s

employment and medical treatment.

In her post-hearing brief, Quel noted that because the 

Medical Board had conceded she was permanently incapacitated for 

further performance of duty as a cafeteria worker, the only 

issue was whether her repetitive use injuries were the result of 

occupational hazards from working as a cafeteria helper. Quel 

asserted the Medical Board’s recommended denial of her serviceconnected disability retirement benefits was based on an 

erroneously narrow view of “occupational hazard” and not on the 

causation of her injuries, which was left undisputed. She 

contended her medical records, as well as her testimony, clearly 

indicated her injuries were a result of overuse, repetitive use,

or cumulative trauma while performing her job, entitling her to 

service-connected disability retirement benefits. Quel also 

cited to Komatsu as supporting her position. 

In opposition, the Medical Board contended Quel’s permanent 

incapacity was not the cumulative result of an occupational 

hazard, citing to Lopez, Komatsu, and the definition of 

“occupational hazard” in HAR § 6-22-2. The Medical Board argued
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that repetitive use of hands and shoulders is common to various 

other occupations, including administrative assistants, 

custodians, musicians, and medical professionals, all who also 

use their shoulders and hands at work. It further argued that 

Quel’s job description as a cafeteria helper did not list any 

unusual occupational hazards, the use of Quel’s hands and 

shoulders was not uncommon to employment in general, and none of 

the actions in her job description were inherently dangerous. 

The Medical Board requested the ERS Board affirm its preliminary 

decision and deny Quel service-connected disability retirement 

benefits.

On July 23, 2014, the hearings officer issued a recommended 

decision containing fifty-one findings of fact (“FOFs”) and 

twenty-nine conclusions of law (“COLs”). On August 28, 2014,

the ERS Board issued a proposed decision adopting relevant FOFs 

and COLs in the hearings officer’s recommended decision in their 

entirety.

3 After arguments on Quel’s exceptions to the proposed 

decision on May 13, 2015, on June 9, 2015, the ERS Board issued 

its final decision affirming its proposed decision.

In its FOFs, the ERS Board found in relevant part:

46. Repetitive use of the hands and arms is common to 

employment in general. . . . 

 

3 The ERS Board amended COL 1 to indicate that as a noncontributory plan 

member, Quel’s application was actually brought under HRS § 88-285 (Supp. 

2005), not HRS § 88-336 (Supp. 2007), which governs hybrid plan members. As 

the ERS Board also noted, service-connected disability requirement benefits 

under HRS § 88-285 are, in any event, adjudged under the requirements set 

forth in HRS § 88-79. 
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47. Other occupations besides cafeteria helper require 

repetitive use of a person's hands. This includes court 

reporters, clerical workers, people who stock shelves, 

people who pick strawberries, people who cut hair, dish 

washers, mail sorters, data entry workers, musicians, 

people who do sign language, and surgeons. . . .

In its FOFs and COLs, the ERS Board found and concluded in 

relevant part:

16. [] [The ERS Board] finds and concludes [Quel’s] 

incapacitation was due to the cumulative effects of work 

related activities.

17. That conclusion, however, does not end the analysis 

of [Quel’s] claim. [Quel’s] position appears to be . . . 

that work related incapacitating injuries due to repetitive 

work activities equate to an “occupational hazard." The 

[ERS Board] concludes, however, that such a position is

not in accord with the law applicable to ERS serviceconnected disability benefits.

18. The definition of "occupational hazard" is a legal 

one that must follow the specific terms of the statutes and 

regulations applicable to the ERS.

. . . .

22. As the Lopez case explains, the mere fact that a 

medical condition is job related does not lead to the 

conclusion that the condition is the result of an 

occupational hazard.

An occupational hazard is a danger or risk which is 

inherent in[] and concomitant to a particular 

occupation. To be considered an occupational hazard, 

the causative factors must be those which are not 

ordinarily incident to employment in general

and must be different in character from those found 

in the general run of occupations.

66 Haw. at 129, 657 P.2d at 1042. [Emphasis omitted.] 

[Quel] failed to introduce evidence that the lifting

requirements were "different in character" from those in 

the general run of occupations that were the subject of 

[the Medical Board physician chair’s] testimony.

23. The [ERS Board] does not interpret the concept of the 

general run of occupations to automatically include all 

occupations. [Emphasis omitted.] The Medical Board 

introduced evidence that [Quel’s] problems were similar to 

work related problems across a wide spectrum of 

occupations. . . . [Quel] had the burden to introduce 

evidence that her work related problems were limited to a 
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relatively few number of occupations, but she failed to do 

so.

(Emphases added.) 

Thus, the ERS Board concluded Quel’s permanent incapacity 

did not qualify as an “occupational hazard” because she failed 

to show that her work-related problems were “different in 

character from those in the general run of occupations” and 

“were limited to a relatively few number of occupations.” On 

this basis, the ERS Board ruled that Quel was not entitled to 

service-connected disability retirement benefits.

C. Appeal to the circuit court 

Quel filed a notice of appeal to the circuit court. The 

circuit court concluded Quel failed to carry her burden of 

proving her permanent incapacity was the cumulative result of an 

occupational hazard, affirmed the ERS Board, and filed its final 

judgment on April 13, 2016. 

D. Appeal to the ICA

Quel further appealed to the ICA. In its May 18, 2018 

summary disposition order (“SDO”), the ICA ruled the ERS Board 

and the circuit court did not err in relying on the definition 

of “occupational hazard” contained in HAR § 6-22-2. Quel v. Bd.

of Trs., Emps.’ Ret. Sys., No. CAAP-16-0000355, at 3 (App. May

18, 2018). The ICA also concluded Quel failed to prove her work 

conditions were “not ordinarily incident to employment in 

general” and were “different in character from those found in 
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the general run of occupations.” Quel, SDO at 5. The ICA

affirmed the circuit court’s final judgment. Id.

D. Certiorari application

Quel’s certiorari application raises one question:

Whether or not cumulative trauma (i.e., excessive 

kitchen and cafeteria work of cutting, peeling, chopping, 

stirring, missing [sic], pinching, lifting and carrying 

resulting in [Quel’s] upper extremity injuries) is an 

“Occupational Hazard” entitling [Quel] to Service-Connected 

Disability Retirement benefits with the ERS.

III. Standards of Review

A. Interpretation of a statute

Statutory interpretation is a question of law reviewable de 

novo. Citizens Against Reckless Dev. v. Zoning Bd. of Appeals, 

114 Hawai‘i 184, 193, 159 P.3d 143, 152 (2007). When 

interpreting statutes, we look at the following:

When there is ambiguity in a statute, “the meaning of 

the ambiguous words may be sought by examining the context, 

with which the ambiguous words, phrases, and sentences may 

be compared, in order to ascertain their true meaning.” 

Moreover, the courts may resort to extrinsic aids in 

determining legislative intent, such as legislative 

history, or the reason and spirit of the law.

114 Hawai‘i at 193-94, 159 P.3d at 152-53 (citation omitted).

B. Administrative agency appeals

An appellate court reviews administrative decisions by 

applying the following standard:

Review of a decision made by the circuit court upon 

its review of an agency’s decision is a secondary appeal. 

The standard of review is one in which [the appellate] 

court must determine whether the circuit court was right or 

wrong in its decision, applying the standards set forth in 

HRS § 91-14(g) to the agency’s decision. 
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Korean Buddhist Dae Won Sa Temple of Haw. v. Sullivan, 87 Hawai‘i 

217, 229, 953 P.2d 1315, 1327 (1998) (alteration in original

omitted).

4

IV. Discussion

A. The definition of “occupational hazard” in HAR § 6-22-2

is consistent with our case law.

Preliminarily, on certiorari, Quel repeats her contention 

that the definition of “occupational hazard” in HAR § 6-22-2 

contravenes HAR § 88-79(a). She points out HRS § 88-79(a)

provides that “any member who has been permanently incapacitated 

for duty . . . as the cumulative result of some occupational 

hazard . . . may be retired by the board for service-connected 

disability[.]” She argues that HRS § 88-79(a) does not restrict 

“some occupational hazard” to the definition in HAR § 6-22-2, “a 

danger or risk which is inherent in, and concomitant to, a 

 

4 HRS § 91-14 (Supp. 2016), entitled “Judicial review of contested 

cases,” provides in relevant part:

(g) Upon review of the record, the court may affirm the 

decision of the agency or remand the case with instructions 

for further proceedings; or it may reverse or modify the 

decision and order if the substantial rights of the 

petitioners may have been prejudiced because the 

administrative findings, conclusions, decisions, or orders 

are:

(1) In violation of constitutional or statutory 

provisions; 

(2) In excess of the statutory authority or 

jurisdiction of the agency;

(3) Made upon unlawful procedure;

(4) Affected by other error of law;

(5) Clearly erroneous in view of the reliable, 

probative, and substantial evidence on the whole record; or

(6) Arbitrary, or capricious, or characterized by 

abuse of discretion or clearly unwarranted exercise of 

discretion.
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particular occupation or particular job, if [it is] not a risk 

common to employment in general.” Quel therefore contends the 

ICA, circuit court, and ERS Board erred in applying the 

HAR § 6-22-2 definition of “occupational hazard” to her case.

Quel’s contention is without merit, as the definition of 

“occupational hazard” in HAR § 6-22-2 is derived from our 

decisions in Lopez and Komatsu. 

In Lopez, we held that an “occupational hazard” for 

service-connected disability retirement purposes “is a danger or 

risk which is inherent in, and concomitant to a particular 

occupation,” and that the disability’s “causative factors must 

be those which are not ordinarily incident to employment in 

general and must be different in character from those found in 

the general run of occupations.” 66 Haw. at 129, 657 P.2d at 

1042. In that case, a state employee contended the stress and 

pressures from his job contributed to a mental health-related 

disability and that he should be eligible for service-connected 

disability retirement benefits. 66 Haw. at 128, 657 P.2d at 

1041. We adopted the definition above and ruled that the 

pressures and stress in the employee’s job were not 

exceptionally different from those found by other employees in 

other occupations. 66 Haw. at 130, 657 P.2d at 1042.

The next year, we decided Komatsu, which addressed a city 

employee’s service-connected disability retirement claim for an 
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obstructive respiratory defect caused by exposure to mold and 

fungi from a defective workplace air conditioning system, which 

permanently incapacitated him for further performance of duty. 

67 Haw. at 488, 494, 693 P.2d at 407, 411. We examined the 

employee’s specific work environment in addressing whether the 

work environment constituted an occupational hazard, not whether 

the exposure to the contaminants that caused the employee’s

disability was an occupational hazard to office workers in 

general. 67 Haw. at 494, 693 P.2d at 411-12. We stated:

Where, as in this case, the employee was exposed to 

mold or fungi in his particular work environment over a 

lengthy period and the causal nexus between the exposure 

and his disability is undisputed, entitlement to serviceconnected disability retirement benefits is clear. For a 

danger that accompanies a particular job is an 

“occupational hazard” if it is not a risk common to 

employment in general. And since the peril of noxious 

organisms emitting from faulty air-conditioning systems is 

hardly incident to employment generally, we are led to the 

ineluctable conclusion that the intermediate court erred in 

holding Komatsu's disability was not the cumulative result 

of an “occupational hazard.”

Id. (internal citation and footnote omitted). Therefore, 

in Komatsu, we ruled that where a causal nexus between a 

work condition and a disability is undisputed, entitlement 

to service-connected disability retirement benefits is 

clear, and a danger that accompanies a particular job is an 

“occupational hazard” if it is not a risk common to 

employment in general. 

Thus, the definition of “occupational hazard” in 

HAR § 6-22-2 is an amalgam of our definitions of the term in 
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Lopez and Komatsu. Quel’s contention that the ICA, circuit 

court, and ERS Board erred in applying the HAR § 6-22-2 

definition of “occupational hazard” to her case is therefore 

without merit.

B. An occupational hazard does not require a risk be “limited 

to a relatively few number of occupations.”

Although the definition of “occupational hazard” quoted by 

the ERS Board is correct, in denying service-connected 

disability retirement benefits to Quel, the ERS Board added a 

requirement to the definition that does not exist in the law. 

In FOF 47, the ERS Board found that other occupations besides 

cafeteria helpers require repetitive use of a person's hands, 

including “court reporters, clerical workers, people who stock 

shelves, people who pick strawberries, people who cut hair, dish 

washers, mail sorters, data entry workers, musicians, people who 

do sign language, and surgeons.” Based on this finding, the ERS 

Board concluded in COL 23 that Quel’s permanent incapacity did 

not qualify as an “occupational hazard” because she failed to 

show her work-related problems “were limited to a relatively few 

number of occupations.”

Lopez, Komatsu, and HAR § 6-22-2 do not include a 

requirement that permanent incapacity resulting from the 

cumulative effects of work-related activities be “limited to a 

relatively few number of occupations.” Rather, an “occupational
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hazard” is “a danger or risk which is inherent in, and 

concomitant to, a particular occupation or particular job, if 

[it is] not a risk common to employment in general.” 

By defining an occupational hazard to exclude risks common 

to employment in general, we only excluded “work pressures and 

frustrations, in and of themselves, [from] constitut[ing] an 

occupational hazard.”

5 Lopez, 66 Haw. at 129, 657 P.2d at 1042. 

We did not impose an additional requirement that an employee 

prove their work-related problems “were limited to a relatively 

few number of occupations.” In fact, in Komatsu, we rejected a 

requirement that an employee submit data comparing their 

employment to other industries, and noted “the imposition of 

similar requisites in other situations would render 

‘occupational hazard’ well-nigh meaningless . . . . We neither 

intended nor envisioned that Lopez would be so inhibitive.” 

Komatsu, 67 Haw. at 494, 693 P.2d at 411.

Even if all of the occupations listed by the ERS Board in 

FOF 47 were considered, the “danger or risk inherent in, and 

concomitant to” Quel’s “particular occupation or particular job,”

was “not a risk common to employment in general.” In this 

regard, the ERS Board also concluded in COL 22 that Quel failed 

to introduce evidence that “the lifting requirements” of her job 

 

5

However, in Lopez, we noted that “[i]n the workers' compensation 

context, however, the appellant's mental infirmity would probably have been 

compensable.” 66 Haw. at 130 n.1, 130, 657 P.2d at 1042 n.1.
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were "different in character" from those in the occupations 

listed in FOF 47. Even assuming the ERS Board meant to include 

“repetitive use of hands” in COL 22 as not being “different in 

character,” the ERS Board had also noted that Quel’s job duties 

included placing rice into six or seven eight-inch pans and 

lifting them into and lowering them from an oven taller than

her, emptying food out of stew pots, pinching dough, scooping 

rice with her left hand for about 250 trays, peeling potatoes, 

cutting vegetables, and opening numerous cans with an oldfashioned manual can opener instead of an electric can opener.

The cumulative, repetitive work performed by Quel, 

especially without the proper equipment, which led to the 

serious injuries to her hands, wrists, and shoulders, requiring 

multiple surgeries to her shoulders, wrists, fingers, and thumb,

and resulting in her permanent incapacity for duty, is not “a 

risk common to employment in general.” As in Komatsu, a 

determination of whether an “occupational hazard” exists 

requires an analysis of whether a specific work environment 

created the occupational hazard. The nature of Quel’s 

occupation or job, as well as the lack of proper equipment at 

her job site, both contributed to her injuries. 

Thus, the “danger or risk” “inherent in, and concomitant to”

Quel’s “particular occupation” as a cafeteria helper, or to her 

“particular job” at Helemano, was “not a risk common to 
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employment in general.” We therefore also hold the ERS Board 

erred in concluding Quel’s permanent incapacity did not result 

from “a danger or risk which is inherent in, and concomitant 

to,” her “particular occupation or job,” which was “not a risk 

common to employment in general.” 

V. Conclusion

Based on the reasons above, we vacate the ICA’s July 6, 

2018 judgment on appeal and the circuit court’s April 13, 2016 

(1) “Decision and Order Affirming the Final Decision of the 

Appellee Board of Trustees of the Employees’ Retirement System 

of the State of Hawaii and Dismissing Appellant Debbie S. Quel’s 

Appeal” and (2) final judgment. We remand this case to the ERS 

Board for further proceedings consistent with this opinion.

Dan S. Ikehara, /s/ Mark E. Recktenwald

for petitioner

/s/ Paula A. Nakayama

Elmira K.L. Tsang, 

(Jodi L.K. Yi /s/ Sabrina S. McKenna

with her on the briefs)

for respondent /s/ Richard W. Pollack 

/s/ Michael D. Wilson