A NEW LEAF, INC. et al.
January 8, 1999
Record No. 980454
A NEW LEAF, INC., ET AL.
ELAINE R. WEBB
FROM THE COURT OF APPEALS OF VIRGINIA
Present: All the Justices
OPINION BY JUSTICE CYNTHIA D. KINSER
In this appeal, we decide whether allergic
contact dermatitis is compensable as an occupational disease
under the Virginia Workers’ Compensation Act (the Act).
Because the claimant’s contact dermatitis was caused by a
reaction to allergens in certain flowers and not by cumulative
trauma induced by repetitive motion, we will affirm the judgment
of the Court of Appeals that the condition is compensable under
Elaine Ruth Webb has been employed by A New
Leaf, Inc. (A New Leaf), as a florist since October 1993. In
1994, she became the store’s senior florist. Her
responsibilities included daily handling, cutting, and arranging
of flowers. She was also in charge of weddings, preparing store
designs, and compiling daily financial reports.
In March 1995, Webb noticed blistered, splotchy
areas on her right index finger and on the palm of her right
hand. Webb described the condition as similar in appearance to a
poison ivy rash. Initially, she believed that the problem was
just an irritation and that she could treat it with
nonprescription lotions. However, the blistering worsened.
Consequently, in August 1995, Webb decided to
seek treatment from her family physician, Dr. John Carpenter.
After examining Webb’s hands, Dr. Carpenter diagnosed
"Dermatitis" but was "unclear whether it [was] fungal or a contact type of dermatitis or a combination."
Dr. Carpenter prescribed several medications for the dermatitis.
After the medications did not alleviate Webb’s problem, Dr.
Carpenter recommended that she see a dermatologist. By then, the
blistering had appeared on two of Webb’s fingers and the
thumb on her right hand. It was also present on the same fingers
and thumb on her left hand. From there, the dermatitis had spread
from her left wrist up to her elbow.
In November 1995, Dr. Anna M. Magee, a
dermatologist, examined Webb. Dr. Magee diagnosed Webb’s
condition as "Allergic Contact Dermatitis to plants most
likely." She also prescribed medications to treat the
dermatitis, recommended that Webb wear gloves while performing
her florist duties, and warned Webb about the risks of working
with certain flowers. Dr. Magee eventually performed a patch test
on Webb to determine which flowers were causing Webb’s
problem. On April 4, 1996, Dr. Magee reported that Webb’s
allergic contact dermatitis was attributable to her interaction
with tulips and alstroemeria.
In two letter reports, dated April 4, 1996, and
July 5, 1996, Dr. Magee opined that Webb was allergic to
alstroemeria and tulips and that, therefore, her condition was an
occupational disease. She also stated that allergic contact
dermatitis is a common problem for florists. Dr. Magee
subsequently confirmed that Webb’s contact dermatitis was
"most likely caused by at least two and probably more
physical contacts with the chemicals contained in alstro[e]meria
and tulips during her employment."
Webb introduced into evidence two articles
dealing with the relationship between contact dermatitis caused
by allergens found in certain plants and the florist industry:
Cindy Hoogasian, Dermatitis Concerns Continue, FLORIST,
March 1990, at 75; Cindy Hoogasian, Dermatitis Concerns Spark
Industry Study, FLORIST, Jan. 1988, at 95. In these articles,
Hoogasian describes allergic contact dermatitis as a
"reaction of the body’s immune system to the substance
to which that person is
sensitive . . . ." (Hoogasian, 1990, supra,
at 77). She states that flowers, such as the alstroemeria and
tulip, contain chemicals or allergens that "cause allergic
skin reactions in some people with skin sensitivities."
(Hoogasian, 1988, supra, at 96). Hoogasian further opines
that "[t]here is little or no fear" the public will
develop allergic sensitivity to the allergen in alstroemeria
because "their actual involvement with the flower is
limited." Id. at 98. "Only in cases where there
is constant contact with the juice of the alstroemeria, such as a
designer or a sales employee would have, is there cause for
Webb filed a claim for workers’
compensation benefits on May 15, 1996. A deputy commissioner of
the Virginia Workers’ Compensation Commission (Commission)
awarded benefits to Webb, finding that the contact dermatitis is
an occupational disease under Code Sect. 65.2-400. Upon
review, the full Commission affirmed the award of benefits to
Webb. A panel of the Court of Appeals of Virginia affirmed the
decision of the Commission. A New Leaf, Inc. v. Webb, 26
Va. App. 460, 495 S.E.2d 510 (1998). In explaining its decision,
the Court of Appeals stated:
Credible evidence supports the
commission’s factual finding that claimant’s
allergic contact dermatitis was not caused by
"cumulative traumatic insults resulting from repetitive
motion." The record indicates that claimant’s
allergic contact dermatitis was not causally linked to any
repetitive motion that she performed at work. Allergic
contact dermatitis is caused by the reaction of an
individual’s immune system with a substance, such as
chemicals contained in certain flowers, to which that
individual has developed a hypersensitivity. It is not caused
by the wear and tear associated with a repetitive motion.
Although [Webb’s] duties included designing and
constructing floral arrangements and "processing"
flowers delivered to [A New Leaf’s] store, no evidence
linked the motions associated with these activities to the
outbreak of dermatitis on [Webb’s] hands and arms.
Id. at 468, 495 S.E.2d at 514.
(Citations omitted). A New
Under the Act, Code Sects. 65.2-100 to
–1310, a claimant must prove by a preponderance of the
evidence either an "injury by accident" or an
"occupational disease." Code Sect. 65.2-101; see
also Morris v. Morris, 238 Va. 578, 584, 385 S.E.2d
858, 862 (1989). Webb filed her claim for workers’
compensation benefits on the basis that contact dermatitis is an
occupational disease. The term "occupational disease"
is defined as "a disease arising out of and in the course of
employment, but not an ordinary disease of life to which the
general public is exposed outside of the employment." Code
Sect. 65.2-400(A). Subsection B of Code Sect. 65.2-400
specifies six factors that are necessary to establish a causal
connection between a disease and a worker’s employment:
A disease shall be deemed to arise out of
the employment only if there is apparent to the rational
mind, upon consideration of all the circumstances:
1. A direct causal connection between the
conditions under which work is performed and the occupational
2. It can be seen to have followed as a
natural incident of the work as a result of the exposure
occasioned by the nature of the employment;
3. It can be fairly traced to the
employment as the proximate cause;
4. It is neither a disease to which an
employee may have had substantial exposure outside of the
employment, nor any condition of the neck, back or spinal
5. It is incidental to the character of the
business and not independent of the relation of employer and
6. It had its origin in a risk connected
with the employment and flowed from that source as a natural
consequence, though it need not have been foreseen or
expected before its contraction.
A New Leaf concedes that Webb proved each of
these factors. Nevertheless, A New Leaf contends that Webb’s
contact dermatitis is not compensable as an occupational disease
because it was caused by repeated exposure to flowers and thus is
the result of cumulative trauma. Relying primarily on this
Court’s decisions in The Stenrich Group v. Jemmott,
251 Va. 186, 467 S.E.2d 795 (1996), and Merillat Indus., Inc.
v. Parks, 246 Va. 429, 436 S.E.2d 600 (1993), A New Leaf
argues that Webb’s repeated touching of the flowers
gradually caused visible sores and wounds on her hands. According
to A New Leaf, "[t]he touching of the flowers caused Webb to
develop physical wounds on her body, the manifestation of
repeated trauma to her hands by the chemicals in the
flowers." We do not agree.
Pursuant to Code Sect. 65.2-706(A), an
award of benefits by the Commission upon review "shall be
conclusive and binding as to all questions of fact."
However, "whether a worker has suffered an impairment that
constitutes a compensable disease is a mixed question of law and
fact" Jemmott, 251 Va. at 192, 467 S.E.2d at 798.
Thus, the Commission’s finding on that question is not
conclusive but is a proper subject for judicial review. Id.
As in Jemmott, the factual part of the
inquiry in this case is whether Webb suffered an impairment. Id.
This portion includes any facts relevant to the nature and cause
of the impairment sustained by Webb. The legal part of the mixed
question is whether Webb’s allergic contact dermatitis
constitutes an occupational disease within the meaning of the
Act. Id. As already stated, A New Leaf contests only the
legal portion of the inquiry.
We turn now to the two cases upon which A New
Leaf relies in support of its position. In Merillat, we
addressed whether a torn rotator cuff muscle sustained as a
result of repetitive motion was compensable under the Act as an
occupational disease. Upon examining the six factors in Code
Sect. 65.2-400(B) that are required to establish a causal
connection between a disease and a worker’s employment, we
concluded that merely satisfying the causality test is not
sufficient unless "the condition for which compensation is
sought as an occupational disease . . . first
qualif[ies] as a disease." Id. at 432, 436 S.E.2d at
601. We then stated that the Commission’s finding of an
occupational disease was "not a finding of fact that the
tear was a disease rather than an injury, but a conclusion based
solely on utilization of a causality analysis." Id.
at 433, 436 S.E.2d at 602. Thus, we concluded that the
worker’s rotator cuff tear was an injury, not an
occupational disease, because it resulted from repetitive motion.
We specifically refused "to broaden the scope of the Act to
include job-related impairments arising from repetitive motion or
cumulative trauma." Id., 436 S.E.2d at 601-02.
In Jemmott, we again addressed the range
of occupational diseases compensable under the Act and, in doing
so, considered the claims of three workers who had suffered
either carpal tunnel syndrome or "trigger thumb." The
doctors who had treated the claimants opined that the particular
impairments at issue were diseases, but they also stated that the
impairments were the result of cumulative trauma induced by
repetitive motion. Accordingly, we concluded that each
claimant’s impairment must be classified as an injury, not a
disease. Jemmott, 251 Va. at 198, 467 S.E.2d at 802. In
reaching that decision, we stated that "just because a
doctor opines that a particular impairment is a disease does not
necessarily make it so." Id., 467 S.E.2d at 801. We
also emphasized, once again, "that job-related impairments
resulting from cumulative trauma caused by repetitive motion,
however labeled or however defined, are, as a matter of law, not
compensable under the . . . Act." Id. at
199, 467 S.E.2d at 802.
Since A New Leaf concedes that Webb proved the
six factors contained in Code Sect. 65.2-400(B), the
dispositive inquiry is whether contact dermatitis
"qualif[ies] as a disease." Merillat, 246 Va. at
432, 436 S.E.2d at 601. In making that determination in Merillat
and Jemmott, we considered the nature and cause of the
impairments. For example, the torn rotator cuff muscle
"resulted from repetitive overhead lifting and manipulation
with [the worker’s] left arm." Merillat, 246 Va.
at 430, 436 S.E.2d at 600. Similarly, in Jemmot, one of
the doctors who diagnosed carpal tunnel syndrome testified in a
deposition that the repetitive motions involved in the
worker’s job caused "‘micro trauma,’ meaning
‘a small amount of injury in a repetitive motion to the same
area . . . occur[ring] in patients [who] flex their
wrist and impinge the nerve as it courses through the carpal
tunnel.’" 251 Va. at 189-90, 467 S.E.2d at 797.
Likewise, the doctor who diagnosed "trigger thumb"
attributed that impairment to "‘the accumulation or the
product of many repetitious minor injuries to a joint, in the
case here of the thumbs.’" Id. at 191, 467
S.E.2d at 798.
In contrast to the evidence in Merillat
and Jemmott, Dr. Magee stated that Webb is allergic to
alstroemeria and tulips and that the contact dermatitis was
caused by Webb’s physical contact with the chemicals
contained in those flowers. Contact dermatitis was described as a
"reaction of the body’s immune system to the substance
to which that person is sensitive." (Hoogasian, 1990, supra,
at 77). Although the sores and blisters appeared on Webb’s
hands after frequent handling of the flowers in question, there
is no evidence in the record that Webb’s allergic contact
dermatitis resulted from cumulative trauma arising from
As the Commission stated in its opinion,
"the evidence reveals exposure over time to a particular
causative agent resulting in an adverse reaction in the form of
contact dermatitis." The chemicals in alstroemeria and
tulips triggered a dermatological reaction, which is distinct
from the wear and tear resulting from a repetitive motion. Thus,
allergic contact dermatitis, unlike carpal tunnel syndrome,
"trigger thumb," or a torn rotator cuff muscle,
"qualif[ies] as a disease." Merillat, 246 Va. at
432, 436 S.E.2d at 601. Accordingly, we conclude that Webb’s
allergic contact dermatitis is a compensable occupational disease
within the meaning of the Act.
For these reasons, we will affirm the judgment
of the Court of Appeals.
 Webb testified that she had never
before experienced any dermatological problems to her hands. In
fact, she had not previously worked with real flowers.
 A New Leaf decided to stop stocking alstroemeria. It
still uses tulips since they are in season for only a short
period of time during the year, unlike alstroemeria, which is
available throughout the year.