Opinion ID: 1306200
Heading Depth: 1
Heading Rank: 1

Heading: Cook's Heart Disease Claim

Text: With respect to this claim, Cook cites the provisions of Code § 65.1-47.1. So far as pertinent here, this Code section provides that any condition or impairment of health of a policeman caused by heart disease resulting in disability shall be presumed to be an occupational disease unless the contrary be shown by a preponderance of competent evidence. In ruling upon Cook's heart disease claim, the Commission held that, while Cook was entitled to the benefit of the statutory presumption, the Department had rebutted the presumption. Cook contends this holding was error. Cook advances two arguments. The first involves the findings of the deputy commissioner who heard the heart disease claim initially. The deputy commissioner denied the claim, holding that Cook was not entitled to the statutory presumption because he had not shown he was free of heart disease at all points in time before the filing of the claim. In the course of his opinion, the deputy commissioner made a finding that Cook stresses in his present argument; the deputy commissioner stated that the cause of Wolff-Parkinson-White Syndrome is unknown. Upon Cook's request, the full Commission reviewed the deputy commissioner's denial of the heart disease claim. The Commission remanded the matter to the deputy commissioner for the reception of additional evidence and the making of new findings, including a determination, if possible, of the cause of Cook's heart disease. Upon remand, the deputy commissioner held that Cook was entitled to the statutory presumption and to compensation for his heart disease; however, the deputy commissioner did not discuss the cause of the disease. Upon the Department's request, the full Commission reviewed the deputy commissioner's holding and reversed on the basis, as noted previously, that the Department had rebutted the statutory presumption. Cook now argues that, because the Department did not appeal the deputy commissioner's initial unknown cause finding, the finding became final and constituted the law of the case. In the face of this finding, Cook asserts, it was error as a matter of law for the Commission to rule that the statutory presumption had been rebutted. We disagree with Cook. We addressed a similar question in Mace v. Merchants Delivery, 221 Va. 401, 270 S.E.2d 717 (1980). There, we held that [a] single award may not be segmented into component parts and that [a]n appeal of a deputy commissioner's award empowers the Industrial Commission to reexamine all of the deputy commissioner's conclusions. 221 Va. at 404 n. 3, 270 S.E.2d at 719 n. 3. Cook attempts to distinguish Mace, but his argument is convoluted and unconvincing. We hold that the decision is applicable here and is dispositive of Cook's contention that the deputy commissioner's unknown cause finding constituted the law of the case. This brings us to Cook's argument that the Commission erred when it ruled the Department had rebutted the statutory presumption. In this connection, we have held that to rebut the statutory presumption the employer must adduce competent medical evidence of a non-work-related cause of the disabling disease .... Page v. City of Richmond, 218 Va. 844, 848, 241 S.E.2d 775, 777 (1978); see also Berry v. County of Henrico, 219 Va. 259, 265, 247 S.E.2d 389, 392 (1978); Fairfax Fire Ser. v. Newman, 222 Va. 535, 539, 281 S.E.2d 897, 900 (1981); Amherst County v. Brockman, 224 Va. ___, ___, 297 S.E.2d 805, 809 (1982). Here, in its effort to rebut the statutory presumption, the Department introduced the report of Dr. George A. Roussel, IV, a Harrisonburg physician who evaluated the reports of Cook's examination at Duke University Medical Center. In his report, Dr. Roussel stated: Wolff-Parkinson-White Syndrome ... is a condition generally thought to be congenital in nature in which the patient has an additional or accessory pathway leading from the atria to the ventricles of the heart.... .... In my experience I have never read of a case or seen an individual whose condition was brought on by stress or was in any way related [to stress], as this condition is generally thought to be a congenital anomaly which is often cured by severing that accessory pathway at operation. Cook argues that this report cannot be given any special weight because Dr. Roussel's qualifications were not established. The failure, however, to establish the qualifications of an expert goes to the admissibility of the expert's opinion, and Cook did not object to Dr. Roussel's report when it was introduced below. Hence, we will not notice the objection now. Rule 5:21. Whether the report was entitled to any special weight was a matter for the Commission to decide. Cook also maintains that Dr. Roussel's report is insufficient to rebut the statutory presumption because the phrase generally thought is equivocal; it leaves doubt concerning the origin of Wolff-Parkinson-White Syndrome and fails to specify who believes the disease is congenital. We think, however, that the Commission could properly construe the generally thought language as a positive statement of belief. We think further that the Commission could fairly infer that the belief was held generally by those in the medical discipline conversant with Wolff-Parkinson-White Syndrome. The Department also introduced the following excerpt from a medical treatise which deals with diseases of the cardiovascular system: The term Wolff-Parkinson-White syndrome is appropriate especially when recurrent paroxysmal tachycardia is associated with the electrocardiographic abnormality. A congenital defect in [atrioventricular] conduction is probably present in all cases and a familial incidence has been observed.... The syndrome is more common in males than in females and may be present at any age. Cook submits that the foregoing statement is insufficient to rebut the statutory presumption because the word probably, used with reference to the presence of congenital defect, connotes nothing more than supposition or speculation. We disagree. A statement that a certain condition is probably present means there is reasonable likelihood of the condition's existence, and this is sufficient to permit a trier of fact to accord the statement probative weight. We conclude that the information adduced by the Department in the form of Dr. Roussel's report and the excerpt from the medical treatise constitutes competent medical evidence of a non-work-related cause of [Cook's Wolff-Parkinson-White Syndrome], within the meaning of the Page test, 218 Va. at 848, 241 S.E.2d at 777. Hence, the Commission did not err in ruling that the Department had rebutted the presumption established by Code § 65.1-47.1. Because Cook relied solely upon the statutory presumption and presented no evidence that his heart disease was in fact work-related, the Commission properly denied him compensation for his heart disease claim.