PUBLISHED
`
`UNITED STATES COURT OF APPEALS
`FOR THE FOURTH CIRCUIT
`
`
`No. 19-1609
`
`
`
`
`
`
`GARY ADAMS,
`
` Plaintiff – Appellant,
`
`
`v.
`
`
`AMERICAN OPTICAL CORPORATION; MINE SAFETY APPLIANCES
`COMPANY,
`
` Defendants – Appellees,
`
`
`and
`
`
`COAST HOLDINGS, INCORPORATED; 3M COMPANY, as successor by
`merger
`to Minnesota Mining and Manufacturing Company and/or
`its
`predecessors/successors in interest,
`
` Defendants.
`
`
`Appeal from the United States District Court for the Western District of Virginia, at Big
`Stone Gap. James P. Jones, District Judge. (2:16-cv-00027-JPJ-JMS)
`
`
`
`
`Argued: September 8, 2020
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`
`
`Decided: November 6, 2020
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`
`
`Before KING and FLOYD, Circuit Judges, and Thomas S. KLEEH, United States District
`Judge for the Northern District of West Virginia, sitting by designation.
`
`
`Affirmed by published opinion. Judge Floyd wrote the opinion, in which Judge King and
`Judge Kleeh joined.
`
`
`
`
`
`

`

`
`ARGUED: Michael Blair Martin, MARTIN WALTON LAW FIRM, Houston, Texas, for
`Appellant. Milton Trent Spurlock, DINSMORE & SHOHL LLP, Louisville, Kentucky;
`Carol Dan Browning, STITES & HARBISON, PLLC, Louisville, Kentucky, for Appellees.
`ON BRIEF: Bethany A. Breetz, STITES & HARBISON, PLLC, Louisville, Kentucky;
`Chad M. Eggspuehler, TUCKER ELIS LLP, Cleveland, Ohio, for Appellees.
`
`
`
`
`
`
`
`2
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`

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`FLOYD, Circuit Judge:
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`
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`Plaintiff-Appellant Gary Adams appeals from a district court order entering
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`summary judgment in favor of Defendants-Appellees American Optical Corporation (AO)
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`and Mine Safety Appliances Company (MSA) (collectively, “Defendants”).1 Defendants
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`moved for summary judgment on the sole basis that Virginia’s two-year statute of
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`limitations barred Adams’s state-law personal injury claims. Thus, the only question
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`before this Court is whether Adams filed his personal injury suit outside the two-year
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`limitations window.
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`
`
`
`
`I.
`
`A.
`
`Between 1981 and 2014, Adams worked as a coal miner, which exposed him to
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`harmful coal dust. During that period, Adams was given and wore respirators allegedly
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`produced by Defendants to protect himself from inhaling excessive amounts of that dust.
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`Adams contends that these respirators failed to protect him from lung disease that he
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`developed by inhaling coal dust, while Defendants argue his illness developed outside the
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`statute of limitations. We begin with a review of Adams’s medical history.
`
`
`1 Adams voluntarily dismissed his claims against Defendant 3M Company. See
`Order of Voluntary Dismissal of 3M Co., Adams v. Am. Optical Corp., No. 2:16-cv-00027
`(W.D. Va. Apr. 22, 2019), ECF No. 81. Claims against Defendant Coast Holdings
`Incorporated were later dismissed by oral order of the court. Oral Order, Adams v. Am.
`Optical Corp., No. 2:16-cv-00027 (W.D. Va. May 17, 2019), ECF No. 110.
`
`
`
`3
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`

`

`
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`To promote the early detection of mining-related illnesses, the National Institute for
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`Occupational Safety and Health (NIOSH) administers a program that gives free x-rays to
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`coal miners. These x-rays are reviewed by NIOSH-certified B-readers who look for any
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`abnormalities in a miner’s lungs.2 However, NIOSH does not use these x-rays to formally
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`diagnose an individual with a specific occupational illness. X-ray evidence of coal dust
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`exposure resembles multiple non-occupational diseases, so any abnormalities must be
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`“clinically correlated” through other forms of testing. J.A. 889–93.
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`
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`In 2000, Adams received a NIOSH x-ray and was later informed by the Mine Safety
`
`and Health Administration (MSHA) that the B-reader found evidence of Category 1 coal
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`workers’ pneumoconiosis (CWP). CWP, known colloquially as “black lung,” is a latent
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`occupational disease marked by fibrosis, or scarring, of the lungs and caused by inhalation
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`of coal dust. It can take years of coal dust exposure for CWP to develop, and it progresses
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`slowly once it occurs. The disease progresses through three stages of simple CWP—
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`beginning with Category 1 and advancing to Category 3—followed by three stages of
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`complicated CWP—beginning with Category A and ultimately becoming Category C.
`
`
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`Adams received another NIOSH x-ray in 2006 and was sent a letter indicating the
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`B-reader found “DEFINITE EVIDENCE of CATEGORY 1 PNEUMOCONIOSIS.” J.A.
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`56. MSHA letters that Adams received in 2000 and 2006 advised him to contact a doctor
`
`
`2 B-readers are physicians who have passed a NIOSH-approved test demonstrating
`their ability to “interpret[] chest radiographs for pneumoconiosis and other diseases.” 42
`C.F.R. § 37.52(b)(2).
`
`
`
`4
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`

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`and informed him that he was eligible to transfer to a less dusty area of the mine. At that
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`time, Adams felt “wide open healthy and wasn’t having any problems,” so he declined to
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`transfer positions. J.A. 558. But in 2007, he decided to visit Dr. Mahmood Alam for
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`further evaluation.3 Dr. Alam performed a CT scan and pulmonary function testing, which
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`led him to conclude that NIOSH’s findings could not be clinically correlated. Dr. Alam
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`did not diagnose Adams with CWP, because he believed at the time that Adams’s abnormal
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`x-ray results were caused by calcified granulomas on his lungs.
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`
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`In 2009, Adams was again screened by NIOSH and received another letter
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`informing him that his x-ray revealed “DEFINITE EVIDENCE OF CATEGORY 1
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`PNEUMOCONIOSIS.” J.A. 67–68. He visited Dr. Alam for a second time and received
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`another CT scan and round of pulmonary function testing. J.A. 1220–21. Based on those
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`results, Dr. Alam continued to believe Adams had calcified granulomas, rather than CWP.
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`J.A. 960.
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`
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`Between 2010 and 2011, various doctors treated Adams for shortness of breath. In
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`2010, Adams’s primary care physician, Dr. April Hall, placed him on an albuterol inhaler
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`to help with symptoms of “obstructive lung function.” J.A. 1074.4 In 2011, Adams
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`continued to experience shortness of breath along with chest pain, so Dr. Hall referred him
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`to a cardiologist, Dr. Jose Velazquez. Dr. Velazquez did not find any coronary artery
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`3 As discussed below, Dr. Alam subsequently became an expert witness for Adams
`in this case.
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`4 Defendants’ expert, Dr. James Lockey, believes that Adams may have also
`suffered from allergies and asthma during this time period.
`
`5
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`

`

`diseases and suggested his difficulty breathing might be caused by an underlying lung
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`disease. However, medical records from this period also suggest Adams had hypertension,
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`which could have contributed to his symptoms. Adams was also referred for a sleep study
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`in 2011, after which he was diagnosed with severe obstructive sleep apnea. Pulmonary
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`function testing ordered in 2011 revealed “no airflow obstruction.” J.A. 1332.
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`Adams received a third x-ray from a non-NIOSH provider on October 25, 2012.
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`The reviewing physician reported that the “[i]nterstitial process in the lungs [was] slightly
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`more impressive than on January 14, 2007[,] consistent with coalworkers pneumoconiosis
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`silicosis. Findings appear worse than on previous study.” J.A. 1249. A subsequent x-ray
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`performed on August 13, 2013 showed that this “interstitial process in the lungs [was]
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`worse than October 25, 2012.” J.A. 1250. Pulmonary function tests in 2013 also indicated
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`a “[m]oderate restriction” of Adams’s lung function. J.A. 999–1000.
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`
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`Up to this point, Adams’s medical records consistently listed CWP as one
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`“differential diagnosis” explaining his pulmonary symptoms.5 However, Adams was not
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`formally diagnosed with CWP between 2000 and 2013. During this time, medical
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`professionals also considered whether his symptoms could be caused by allergies, asthma,
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`chronic bronchitis, granulomas, hypertension, or sleep apnea.
`
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`5 A differential diagnosis is a collection of illnesses that a doctor believes could
`plausibly be causing a patient’s symptoms. As Dr. Alam testified at his deposition, CWP
`will always be part of the differential diagnosis for someone with Adams’s occupational
`history.
`
`6
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`

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`On October 2, 2014, Adams was diagnosed for the first time with Category B
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`complicated CWP—the fifth stage of the disease—after a chest x-ray revealed significant
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`“opacities” and “distortion” in his lungs. J.A. 1421–23. By the time Adams was officially
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`diagnosed with CWP, he struggled to walk uphill, coughed regularly, and experienced
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`chest pain and wheezing with exertion.
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`Today, Adams is unable to play with his grandchildren, walk the seventy-five feet
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`across his property, or shower without breathing problems. Dr. Alam testified that he is a
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`potential candidate for a lung transplant.
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`
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`
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`Adams filed suit in Virginia state court on September 29, 2016, three days shy of
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`B.
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`the two-year anniversary of his diagnosis. His complaint alleged that Defendants’
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`respirators were defectively and negligently manufactured, breached implied warranties,
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`and violated federal regulatory requirements. Adams requested compensatory damages
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`greater than $75,000 and punitive damages greater than $20 million. Defendants 3M (since
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`dismissed) and AO removed the case to the Western District of Virginia on the basis of the
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`court’s diversity jurisdiction.
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`
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`Following discovery, Defendants moved for summary judgment, arguing that
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`Adams filed this suit outside the limitations period. At the summary judgment hearing on
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`May 17, 2019, the district court stated its understanding that Virginia’s two-year statute of
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`limitations for personal injury claims runs from the date an injury is received, rather than
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`the date it is discovered. Because Adams filed suit on September 29, 2016, he would need
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`7
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`

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`to have not only discovered, but also contracted CWP after September 29, 2014, to avoid
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`being time-barred.
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`
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`At the summary judgment hearing, Adams conceded that he was diagnosed with
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`complicated CWP on October 2, 2014, and that it would not be possible for him to have
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`first developed CWP just three days earlier, on September 29, 2014. After the district court
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`questioned how this suit could be timely, Adams urged the court to treat his October 2,
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`2014 diagnosis as the date on which the limitations period began to run, because that was
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`the first time a medical professional “pinpointed” the existence of the disease. J.A. 1644–
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`45.
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`
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`In a written order, the district court granted Defendants’ motions for summary
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`judgment. The court found that undisputed facts in the record proved CWP is a slow-
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`developing disease that could not progress from simple to complicated in the three days
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`between September 29, 2014 and October 2, 2014. Additionally, medical evidence
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`established that Adams developed CWP prior to 2014.6 The court therefore concluded that
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`there was no genuine dispute that Adams first suffered CWP outside the limitations period.
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`
`
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`
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`6 Adams and Defendants directed the district court to a number of Adams’s medical
`records. They also provided the district court with the depositions of Adams and two expert
`witnesses—Dr. Lockey for Defendants and Dr. Alam for Adams. Dr. Alam and Dr. Lockey
`reviewed Adams’s medical records and concluded that Adams developed CWP well before
`2014. Dr. Alam also provided unrebutted testimony that CWP is a “slow, progressive
`disease.” J.A. 989.
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`8
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`

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`II.
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`A.
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`
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`This Court reviews the district court’s order granting summary judgment de novo.
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`Dash v. Mayweather, 731 F.3d 303, 310 (4th Cir. 2013). Summary judgment is appropriate
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`when “there is no genuine dispute as to any material fact and the movant is entitled to
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`judgment as a matter of law.” Fed. R. Civ. P. 56(a). To determine whether there is a
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`genuine dispute of material fact, a court must “construe the evidence, and all reasonable
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`inferences that may be drawn from such evidence, in the light most favorable to the
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`nonmoving party.” Dash, 731 F.3d at 311.
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`
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`Only those facts that could determine the outcome of a case are considered material,
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`see Erwin v. United States, 591 F.3d 313, 320 (4th Cir. 2010), and only genuine disputes
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`about those facts can defeat summary judgment, Anderson v. Liberty Lobby, Inc., 477 U.S.
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`242, 248 (1986). A genuine dispute requires evidence that could allow a reasonable jury
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`to find in favor of the nonmoving party. Id. “The mere existence of a scintilla of evidence”
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`does not create a genuine dispute of material fact. Id. at 252. The record must instead
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`permit the conclusion that “reasonable minds could differ” on the issue. Bouchalt v. Balt.
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`Ravens Football Club, Inc., 346 F.3d 514, 522 (4th Cir. 2003) (quoting Anderson, 477 U.S.
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`at 250).
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`
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`Because this case was originally brought in Virginia state court and removed to
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`B.
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`federal court on the basis of diversity jurisdiction, “we interpret and apply the substantive
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`9
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`law” of Virginia. Castillo v. Emergency Med. Assocs., P.A., 372 F.3d 643, 646 (4th Cir.
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`2004) (citing Erie R.R. v. Tompkins, 304 U.S. 64, 78 (1938)). The substantive law of
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`Virginia includes both statutes and the decisions of the Commonwealth’s highest court
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`interpreting those statutes. See Johnson v. Hugo’s Skateway, 974 F.2d 1408, 1416–17 (4th
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`Cir. 1992) (en banc). This Court treats Virginia’s statute of limitations as substantive when
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`reviewing diversity cases. See Joyce v. A.C. & S., Inc., 785 F.2d 1200, 1203 (4th Cir.
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`1986).
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`
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`Two Virginia statutes guide our resolution of this appeal. The first—Va. Code Ann.
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`§ 8.01-243(A)—governs the statute of limitations for personal injury causes of action.
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`Under section 8.01-243(A), “[u]nless otherwise provided in this section or by other statute,
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`every action for personal injuries, whatever the theory of recovery, . . . shall be brought
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`within two years after the cause of action accrues.” Va. Code Ann. § 8.01-243(A). The
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`second statute—Va. Code Ann. § 8.01-230—governs the accrual of rights of action. Under
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`that provision:
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`In every action for which a limitation period is prescribed, the right of action
`shall be deemed to accrue and the prescribed limitation period shall begin to
`run from the date the injury is sustained in the case of injury to the
`person . . . and not when the resulting damage is discovered, except where
`the relief sought is solely equitable or where otherwise provided . . . .
`
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`Va. Code Ann. § 8.01-230 (emphasis added).
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`We start our analysis by examining the distinction between a “cause of action” and
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`a “right of action” under Virginia law. See First Va. Bank-Colonial v. Baker, 301 S.E.2d
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`8, 13 (Va. 1983) (“This is a distinction with a difference.”). “[A] cause of action is a set of
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`operative facts which, under the substantive law, may give rise to a right of action.” Roller
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`10
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`

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`v. Basic Constr. Co., 384 S.E.2d 323, 326 (Va. 1989). By contrast, a right of action “is the
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`remedial right accorded to that person to enforce a cause of action . . . [that] arises only
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`when that person’s rights are infringed.” Id. The cause of action does not accrue until the
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`plaintiff suffers an injury such that it “has thus ripened into a right of action.” Id. However,
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`the two are not indistinguishable, and one cause of action based on the same breach of a
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`plaintiff’s legal rights may produce separate harms that “give rise to separate rights of
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`action that accrue at different times.” Kiser v. A.W. Chesterton Co., 736 S.E.2d 910, 915
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`(Va. 2013).
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`
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`This distinction has important consequences for the statute of limitations in cases
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`such as this one, which involve latent diseases caused by a plaintiff’s exposure to harmful
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`substances. Virginia courts interpret “injury” under section 8.01-230 to require “positive,
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`physical[,] or mental hurt to the claimant, not legal wrong to him.” Locke v. Johns-
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`Manville Corp., 275 S.E.2d 900, 904 (Va. 1981). The Virginia Supreme Court has thus
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`recognized that a plaintiff’s cause of action in a latent disease case does not accrue on the
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`date of exposure, but instead on the date a plaintiff develops the disease, and thereby
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`acquires the injury giving that plaintiff a right of action. Id. at 904–06.
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`
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`While a disease might occur after a plaintiff’s exposure to a harmful substance, it
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`might also occur before it is discovered. Virginia courts have repeatedly explained that a
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`plaintiff’s cause of action accrues on the actual date of injury, not the date on which that
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`injury is discovered by or communicated to the plaintiff. See Lo v. Burke, 455 S.E.2d 9,
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`13 (Va. 1995); Comptroller of Va. ex rel. Va. Mil. Inst. v. King, 232 S.E.2d 895, 900 (Va.
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`1977); Locke, 275 S.E.2d at 905–06. But see Kiser, 736 S.E.2d at 915 (discussing a specific
`
`11
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`exception to this rule for asbestos-related illnesses). This rule creates obvious difficulties
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`for plaintiffs proceeding under section 8.01-243(A) who develop an illness that does not
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`produce obvious or identifiable symptoms for the first two years. Regardless, a plaintiff is
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`vested with a cause of action as soon as the plaintiff has an illness, even if the plaintiff
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`lacks symptoms. See Locke, 275 S.E.2d at 905; Lo, 455 S.E.2d at 13. Under Virginia law,
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`any “difficulty in ascertaining the existence of a cause of action is irrelevant.” Comptroller
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`of Va., 232 S.E.2d at 900.
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`
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`Creeping diseases, such as CWP, present the additional complication that they can
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`produce “successive” injuries, Joyce, 785 F.2d at 1204–05, each of which vests a plaintiff
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`with a new remedial right of action, see Kiser, 736 S.E.2d at 915–17. Despite the language
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`of section 8.01-230, these new rights of action do not reset the two-year statute of
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`limitations under section 8.01-243(A). In Virginia, when more than one right of action
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`stems from the same underlying breach of a plaintiff’s legal right, those rights of action
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`form part of an indivisible cause of action. Id. at 916–17. “The running of the limitations
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`period [for that cause of action] will not be tolled by the fact that the . . . substantial damages
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`did not occur until a later date.” Shipman v. Kruck, 593 S.E.2d 319, 323 (Va. 2004). This
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`Court accordingly interprets Virginia law to bar suits based on the development of a serious
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`illness when some earlier, more marginal injury already vested the plaintiff with a cause of
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`action more than two years prior. See Joyce, 785 F.2d at 1203–05.
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`
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`Finally, we pause to consider how courts resolve statute of limitations defenses
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`under Virginia law. A defendant must prove by “competent evidence ‘that pinpoints the
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`precise date of injury with a reasonable degree of medical certainty’” that a plaintiff’s suit
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`12
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`was filed outside the limitations period. Lo, 455 S.E.2d at 12 (quoting Locke, 275 S.E.2d
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`at 905). In creeping-disease cases, this Court has held that a defendant need only prove
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`that the plaintiff’s first injury was received outside the limitations window rather than the
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`specific date of injury. See, e.g., Large v. Bucyrus-Erie Co., 707 F.2d 94, 97 (4th Cir.
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`1983) (“The illnesses complained of by plaintiff do not arise at a given point in time;
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`instead, they result over a period of time, the beginning being unknown.”).
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`
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`On appeal, Adams argues that the district court failed to properly consider evidence
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`III.
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`concerning the onset of his occupational injury and erred in interpreting the applicable
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`statute of limitations. Although Adams’s evidence might create genuine disputes about
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`specific factual assertions made by Defendants, there is no genuine dispute about the only
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`material question in this case: whether Adams first developed a respiratory illness outside
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`the limitations period. Nor, for the following reasons, did the district court incorrectly
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`interpret Virginia’s statute of limitations. This Court is therefore obligated to affirm the
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`district court’s grant of summary judgment.
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`
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`Adams first argues that the district court incorrectly applied the summary judgment
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`A.
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`standard by improperly weighing or excluding multiple pieces of evidence in the record.
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`Those claims are summarized as follows:
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`13
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`

`
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`First, Adams claims the district court erred in basing his summary judgment ruling
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`on Dr. Alam’s deposition testimony that “as of 2007 or 2009 . . . Mr. Adams had some
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`degree of CWP scarring in his lungs.” See J.A. 1141. Adams disputes his expert’s opinion,
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`which was based on Dr. Alam’s retrospective review of Adams’s full medical history.
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`Adams argues that the CT scans Dr. Alam performed in 2007 and 2009 only revealed the
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`existence of granulomas on his lungs, which are not caused by CWP.
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`
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`Second, Adams argues that the district court should have excluded the testimony of
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`Dr. Alam about the conclusions of NIOSH B-readers, because Dr. Alam is not himself a
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`B-reader. Adams similarly believes the Court did not give sufficient weight to Dr.
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`Lockey’s testimony, which casts doubt on the B-readers’ findings of Category 1 simple
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`CWP. Adams also generally disputes the inclusion of NIOSH’s conclusions in the court’s
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`factual findings, given that these exams were non-diagnostic.
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`
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`Third, Adams contends that the district court improperly attributed the “[m]oderate
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`restriction” revealed by his 2013 pulmonary function testing to occupational illness. See
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`J.A. 999–1000. He believes this conclusion—which is based on Dr. Alam’s deposition
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`testimony—is disputed, given Dr. Alam’s prior belief that Adams may have suffered from
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`pneumonia as well as Dr. Lockey’s expert opinion that Adams might also have asthma and
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`allergies. Previous doctors had also considered whether hypertension and sleep apnea were
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`to blame for his shortness of breath.
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`
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`Fourth, Adams believes the district court gave “undue weight” to the consistent
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`inclusion of CWP as part of the differential diagnosis and patient history in his medical
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`records. Opening Br. at 17. Adams stresses that a differential diagnosis is merely “a list
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`14
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`of diagnostic possibilities being considered by a healthcare provider,” and therefore cannot
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`prove he had CWP on a particular date absent clinical correlation. Id.
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`
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`Even if this evidence creates genuine disputes about specific medical findings in the
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`record, Adams’s arguments mistake the nature of the dispute before the Court. As the
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`district court correctly held, the only issue to be resolved on summary judgment was
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`whether Adams developed CWP at some point prior to September 29, 2014—the earliest
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`date on which he could have developed the disease without time-barring his September 29,
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`2016 suit. The district court’s framing of the dispute is compelled by two opinions of this
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`Circuit holding that defendants meets their burden under Virginia’s statute of limitations
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`by proving that a slow-developing disease, like CWP, first manifested itself outside the
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`statute of limitations, even if the exact date of injury is unclear. Large, 707 F.2d at 97;
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`Joyce, 785 F.2d at 1205.7
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`
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`Accordingly, so long as some undisputed evidence proves to a reasonable degree of
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`medical certainty that Adams developed CWP prior to September 29, 2014, any disputes
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`7 These prior opinions may be in some tension with the language of the Virginia
`Supreme Court in Locke, given its requirement that the defendant marshal evidence that
`“pinpoints the precise date of injury with a reasonable degree of medical certainty.” 275
`S.E.2d at 905 (emphasis added). However, Large and Joyce were both decided after Locke,
`and this Court’s panel in Large explicitly interpreted Locke to only require proving the pre-
`limitations onset of a creeping disease. Large, 707 F.2d at 97; see also St. George v.
`Pariser, 484 S.E.2d 888, 891 (Va. 1997) (“To carry his burden on the limitations plea,
`therefore, [the defendant] was required to show, with reasonable medical certainty, that
`this injury . . . occurred prior to October 21, 1991.”). The Virginia Supreme Court has not
`corrected this Court’s interpretation of state law, and we are not at liberty to overturn these
`earlier panels’ published opinions. See Brown v. McLean, 159 F.3d 898, 905 (4th Cir.
`1998).
`
`15
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`

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`over the significance of specific pieces of medical evidence are not material. And there is
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`no genuine dispute that Adams developed CWP outside the limitations period. Adams’s
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`own expert, Dr. Alam, testified that “usually black lung is a very slow, progressive disease
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`[developing over a] 10, 15 year period.” J.A. 989. According to Dr. Alam, even in rare,
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`accelerated cases of the disease, it develops over five years. CWP “never occurs
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`overnight.” J.A. 1026. On October 2, 2014, Adams was diagnosed with Category B
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`complicated CWP. As NIOSH letters received by Adams explain, CWP progresses
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`through three stages of simple CWP, followed by three stages of complicated CWP. This
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`means that his disease not only progressed beyond the first stage of complicated CWP, but
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`also progressed through the three initial stages of simple CWP. To fall within the
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`limitations period, this must have occurred in three days, which Adams’s own counsel
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`plainly conceded during the summary judgment hearing did not happen. Although the
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`district court is required to make all reasonable inferences in favor of the plaintiff, Dash,
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`731 F.3d at 311, it would be unreasonable to infer based on this testimony that Adams’s
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`CWP developed within the limitations period. No reasonable jury could conclude
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`otherwise, and therefore summary judgment is appropriate. See Anderson, 477 U.S. at 248.
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`
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`Second, both Dr. Alam and Dr. Lockey testified that Adams developed CWP prior
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`to September 29, 2014, and both experts examined similar medical evidence in reaching
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`that conclusion. Dr. Alam testified that Adams had suffered some form of occupational
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`lung disease by 2009. Importantly, Dr. Alam testified that Adams’s 2012 x-ray, which
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`showed “interstitial process in the lungs, slightly more impressive than January 14, 2007”
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`reflected a worsening of already existing CWP. J.A. 1093–94. Therefore, Dr. Alam
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`believes Adams’s 2013 x-ray revealed the further development of CWP-associated nodules
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`on his lungs.8 Dr. Alam also testified that Adams’s 2013 pulmonary function testing—
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`which indicated moderate lung restriction—was caused by exposure to coal dust.
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`Similarly, Dr. Lockey testified that Adams had developed CWP by 2010 or 2011.
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`He based this conclusion on his review of Adams’s x-rays, which appeared relatively
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`normal prior to 2010, but which showed abnormalities by 2012. Also relevant to his
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`analysis was a review of Adams’s pulmonary function test results, which worsened
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`between 2007 and 2018 at five times the normal rate due to aging, and which he concluded
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`were primarily driven by CWP, not asthma.
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`
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`In light of this evidence, there is no genuine dispute of material fact that Adams’s
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`CWP first manifested itself before September 29, 2014. The only potential material dispute
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`created by Adams’s evidence concerns Dr. Alam’s conclusion that Adams’s 2013
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`pulmonary function test reflected the existence of CWP. It is true both that Dr. Lockey
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`testified that Adams could suffer from asthma and that doctors previously diagnosed him
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`with sleep apnea and hypertension prior to his 2013 testing. Dr. Lockey, however,
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`explicitly testified that CWP, not asthma, was responsible for Adams’s decline in
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`pulmonary function between 2007 and 2018.9
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`8 Adams argues that x-rays can never be used to diagnose CWP. Therefore, without
`clinical correlation, these x-rays do not prove the existence of the illness. However, given
`that Adams’s October 2, 2014 diagnosis is undisputed, these x-rays simply serve as
`evidence of the progression of a disease both parties already agree he has.
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`9 Adams similarly argues that a pulmonary function test revealed normal diffusion
`capacity in 2007 and that the district court improperly relied on a 2011 finding by Dr.
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`Further, Dr. Lockey and Dr. Alam had the benefit of retroactively reviewing
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`Adams’s full medical history when forming their opinions. Based on their knowledge that
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`Adams does in fact have CWP, the experts were able to interpret Adams’s earlier symptoms
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`and test results—including his 2013 pulmonary function test—as evidence of his
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`developing CWP. The fact that earlier doctors could not have known his eventual diagnosis
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`when exploring other causes of Adams’s poor lung function does not create a genuine
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`dispute as to the consistent medical opinion delivered by the experts in this case: Adams
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`had CWP prior to September 29, 2014.
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`Adams also makes a series of arguments urging this Court to reinterpret Virginia’s
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`B.
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`statute of limitations rule to forbid the hindsight review conducted by the experts. Adams
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`contends that because CWP is a latent disease that changes the body in nonobvious ways,
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`it could not be diagnosed until the larger opacities and distortions revealed themselves in
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`Adams’s 2014 x-ray. Without the advantage of retroactive review and knowledge of his
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`diagnosis, Dr. Alam and Dr. Lockey would not have been able to conclude that Adams’s
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`pre-2014 symptoms and test results were caused by CWP. Adams claims that Defendants
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`have thus improperly “bootstrap[ped]” the experts’ post-2014 opinions onto pre-2014
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`Velazquez that Adams’s breathing was marked by “diffuse bronchi and dry crackles.” J.A.
`1081–82. However, this evidence cannot create a genuine, material dispute that Adams
`developed CWP before 2014, in light of expert testimony about Adams’s later x-rays in
`2012 and 2013 as well as his 2013 pulmonary function tests.
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`medical evidence that could not, itself, have demonstrated the existence of CWP to a
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`reasonable degree of medical certainty. Opening Br. at 24–25.
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`
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`Ultimately, Adams argues the district court erred by permitting Defendants to
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`pinpoint the existence of CWP retrospectively by means of expert opinion. Such a rule
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`raises serious fairness concerns because it places Adams in a bind—his cause of action
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`accrued and expired well before sufficiently unambiguous injuries gave him a provable
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`right of action. Adams therefore argues that Virginia’s statute of limitations rule instead
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`sets October 2, 2014—the date of his diagnosis—as the date on which his cause of action
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`accrued, because it was the first time his illness was pinpointed to a reasonable degree of
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`medical certainty as having occurred.
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`
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`However, Adams’s interpretation of Virginia law resembles the sort of discovery
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`rule that was explicitly rejected by Virginia’s General Assembly and that Virginia courts
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`have consistently declined to read into the statute of limitations. See, e.g., Comptroller of
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`Va., 232 S.E.2d at 900 (“We have followed the general rule that the applicable period of
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`limitation begins to run from the moment the cause of action arises rather than from the
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`time of discovery of injury . . . .”); Lo, 455 S.E.2d at 13; Locke, 275 S.E.2d at 905–06.
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`Therefore, in creeping-disease cases, a cause of action may accrue—and trigger the statute
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`of limitations—before a disease “manifests itself by symptoms, since it is the onset of the
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`disease itself that triggers the running of the limitation period.” Lo, 455 S.E.2d at 13.
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`
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`Adams is correct that Virginia law requires proving the onset of a disease with
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`“competent evidence ‘that pinpoints the precise date of injury with a reasonable degree of
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`medical certainty.’” Id. at 12 (citing Locke, 275 S.E.2d at 905). However, because a
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`plaintiff can have a cause of action before developing symptoms, it logically follows that
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`a defendant may pinpoint the date of injury retrospectively to a time before symptoms
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`developed. As the court in Locke recognized, “expert medical testimony will [sometimes]
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`demonstrate the injury occurred weeks, months[,] or even years before the onset of
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`symptoms. Thus, the cause of action would accrue and the limitations period would run
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`from the earlier and not the later time.” 275 S.E.2d at 905 (emphasis added); see also
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`Large, 707 F.2d at 97 (relying on expert testimony to retrospectively establish the date of
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`injury). Adams’s insistence that we instead treat the date of his diagnosis as the accrual
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`date conflates Locke’s requirement that an injury must occur for a cause to accrue with the
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`requirement for how that inj