Legal Summaries Contents Home Page Contents
COMPENSABLE CONSEQUENCES
Once an injury is compensable, the employer is liable for the full extent of the injury: the fact that complications arise or the injury worsens does not alter the compensable nature of the injury. When the primary injury is shown to have arisen out of and in the course of employment, every natural consequence that flows from the injury likewise arises out of the employment, unless it is the result of an independent intervening cause attributable to claimant's own intentional conduct. Imperial Trash Service v. Dotson, 18 Va. App. 600, 606-07, 445 S.E.2d 716, 720 (1994) (quoting Morris v. Badger Powhatan/Figgie Int'l, Inc., 3 Va. App. 276, 283, 348 S.E.2d 876, 879 (1986)). In other words, where a causal connection between the initial compensable injury and the subsequent injury is established, the doctrine of compensable consequences extends the coverage of the Workers' Compensation Act to the subsequent injury because the subsequent injury is treated as if it occurred in the course of and arising out of the employee's employment. American Filtrona Co. v. Hanford, 16 Va. App. 159, 162-63, 428 S.E.2d 511,513 (1993) (quoting Bartholow Drywall Co. v. Hill, 12 Va. App. 790, 793-94, 407 S.E.2d 1, 3 (1991)).
"'It is well settled that where the construction of a statute has been uniform for many years in administrative practice, and has been acquiesced in by the General Assembly, such construction is entitled to great weight . . . .'" Holly Farms v. Carter, 15 Va. App. 29, 42-43, 422 S.E.2d 165, 172(1992) (quoting Dan River Mills, Inc. v. Unemployment Comm'n, 195 Va. 997, 1002, 81 S.E.2d 620, 623 (1954)). The commission consistently has affirmed its adoption of the chain of causation rule in suicide cases. See, e.g., Ball v. Food Distributors, VWC File No. 144-77-52 (April 16, 1996); Stone v. Formex, Inc., VWC File No. 165-25-59 (May 15, 1996); Wheeler v. Pomalco Corporation, VWC File No. 152-93-29 (October 7, 1992); Confer v. Arban & Carosi, Inc., 63 O.I.C. 66 (1984). Accordingly, the Court of Appeals upheld both the commission's construction of the statute and the rationale of the majority rule. Food Distribs. v. Estate of Ball, 24 Va. App. 692, 697, 485 S.E.2d 155, 158 (1997).
In Virginia, the doctrine of compensable consequences is well established and has been in existence for many years." Williams Indus., Inc. v. Wagoner, 24 Va. App. 181, 186, 480 S.E.2d 788, 790 (1997). This doctrine, also known as the chain of causation rule, provides that where the chain of causation from the original industrial injury to the condition for which compensation is sought is direct, and not interrupted by any intervening cause attributable to the employee's own intentional conduct, then the subsequent condition should be compensable. Food Distribs. v. Estate of Ball, 24 Va. App. 692, 697, 485 S.E.2d 155, 158 (1997) (quoting Leadbetter, Inc. v. Penkalski, 21 Va. App. 427, 432, 464 S.E.2d 554, 556 (1995)). When the question is whether compensability should be extended to a subsequent injury or aggravation related in some way to the primary injury, the rules that come into play are essentially based upon the concepts of direct and natural results, and the claimant's own conduct as an independent intervening cause. Williams Indus., Inc., 24 Va. App. at 186, 480 S.E.2d at 790. The simplest application of this principle is the rule that all the medical consequences and sequelae that flow from the primary injury are compensable. American Filtrona Co. v. Hanford, 16 Va. App. 159, 163, 428 S.E.2d 511, 513 (1993). "[W]here a causal connection between the initial compensable injury and the subsequent injury is established . . . the subsequent injury 'is treated as if it occurred in the course of and arising out of the employee's employment.'" Bartholow Drywall Co. v. Hill, 12 Va. App. 790,794, 407 S.E.2d 1, 3 (1991) (quoting Leonard v. Arnold, 218 Va. 210, 214, 237 S.E.2d 97, 100 (1977)).See Amoco Foam Products Company v. Johnson, Record No. 980139 (Va. Supreme Court, January 8, 1999) WP Version.
Jemmott does not bar compensation for a cumulative trauma injury which is found to be a compensable consequence of an original injury by accident. The commission did not err in refusing to apply the rule set forth in The Stenrich Group v. Jemmott, 251 Va. 186, 199, 467 S.E.2d 795, 802 (1996) (holding 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 present provisions of the Act" as injuries by accident or occupational diseases), and Middlekauff v. Allstate Ins. Co., 247 Va. 150, 154, 439 S.E.2d 394, 397 (1994) (reiterating the view that a gradually incurred injury is not an injury by accident within the meaning of the Act) to bar compensation. Nothing in Jemmott expressly overruled or altered the well-established doctrine of compensable consequences. Super Fresh Food Markets, Inc. v. Rejino C. Stultz, Record No. 1276-98-4 (October 6, 1998); Allen & Rocks, Inc. v. Perry Lee Briggs, Record No. 0768-98-3 (December 22, 1998)(knee problems gradually caused by change in gait resulting from compensable back injury are a compensable consequence of the back injury). The Court in Stenrich did not consider whether the rule regarding gradually incurred injuries applies to "chain of causation" or "compensable consequence" injuries. The difference between a primary injury and an injury that is a compensable consequence of the primary injury is significant. Professor Larson explains: "A distinction must be observed between causation rules affecting the primary injury . . . and causation rules that determine how far the range of compensable consequences is carried, once the primary injury is causally connected with the employment. As to the primary injury, it has been shown that the "arising" test is a unique one quite unrelated to common-law principles of legal cause, and . . . the employee's own contributory negligence is ordinarily not an intervening cause preventing initial compensability. But when the question is whether compensability should be extended to a subsequent injury or aggravation related in some way to the primary injury, the rules that come into play are essentially based upon the concept of "direct and natural results," and of claimant's own conduct as an independent intervening cause. The basic rule is that a subsequent injury, whether an aggravation of the original injury or a new and distinct injury, is compensable if it is the direct and natural result of a compensable primary injury. The simplest application of this principle is the rule that all medical consequences and sequelae that flow from the primary injury are compensable.... The first group, about which there is no legal controversy, comprises the cases in which an initial medical condition itself progresses into complications more serious than the original injury; the added complications are of course compensable. . . [O]nce the work-connected character of any injury, such as a back injury, has been established, the subsequent progression of that condition remains compensable so long as the worsening is not shown to have been produced by an independent nonindustrial cause. A. Larson, The Law of Workmen's Compensation, Sec. 13.11, 13.11(a). Allen & Rocks, Inc. v. Perry Lee Briggs, Record No. 0768-98-3 (December 22, 1998) (knee problems gradually caused by change in gait resulting from compensable back injury are a compensable consequence of the back injury).
The doctrine of compensable consequences arose from a line of Supreme Court cases discussing chain of causation principles. In Justice v. Panther Coal Co., 173 Va. 1, 2 S.E.2d 333 (1939), the claimant fractured his pelvis in the course of his employment. While in the hospital for treatment of the compensable injury, the claimant died from acute lobar pneumonia. See id. at 3, 2 S.E.2d at 334. Reversing the commission's denial of benefits, the Court wrote: "Decedent was hale and hearty for several years immediately preceding the accident. He was never sick during this period. After the accident, exposure and operation, he was confined to the hospital where we presume all proper precautions were taken to prevent the onslaught of pneumonia from any source. Notwithstanding these precautions, pneumonia developed in an otherwise apparently vigorous and healthy man within five days from the date of the accident and within three days from the date ether was administered, resulting in death some five days later. In the absence of positive affirmative evidence, tending to establish a break in the chain of causation, the inevitable conclusion from the evidence is that the death of the decedent resulted 'naturally and unavoidably from the accident.'"Id. at 7, 2 S.E.2d at 336 (emphasis added). In Leonard v. Arnold, 218 Va. 210, 237 S.E.2d 97 (1977), the Court adopted the term "compensable consequences" and provided the following rule: "When a primary injury under the Workmen's Compensation Act is shown to have arisen out of the course of employment, every natural consequence that flows from the injury is compensable if it is a direct and natural result of a primary injury. . . . This doctrine extends the canopy of the Workmen's Compensation Act to the resulting injury. This is so because the second injury is treated as if it occurred in the course of and arising out of the employee's employment." Id. at 214, 237 S.E.2d at 99-100. See also Immer & Co. v. Brosnahan, 207 Va. 720, 727-28, 152 S.E.2d 254, 258-59 (1967) (applying chain of causation rule and awarding compensation benefits for the claimant's injuries sustained in an automobile accident while enroute to a medical provider for treatment of original work-related injury). In Virginia, the doctrine of compensable consequences "is well established and has been in existence for many years." Williams Indus., Inc. v. Wagoner, 24 Va. App. 181, 186, 480 S.E.2d 788, 790 (1997). This doctrine, also known as the chain of causation rule, provides that "where the chain of causation from the original industrial injury to the condition for which compensation is sought is direct, and not interrupted by any intervening cause attributable to the employee's own intentional conduct, then the subsequent condition should be compensable." Food Distribs. v. Estate of Ball, 24 Va. App. 692, 697, 485 S.E.2d 155, 158 (1997) (quoting Leadbetter, Inc. v. Penkalski, 21 Va. App. 427, 432, 464 S.E.2d 554, 556 (1995)) (emphasis added). [W]hen the question is whether compensability should be extended to a subsequent injury or aggravation related in some way to the primary injury, the rules that come into play are essentially based upon the concepts of direct and natural results, and the claimant's own conduct as an independent intervening cause. Williams Indus., Inc. v. Wagoner, 24 Va. App. at 186, 480 S.E.2d at 790 (citation omitted) (emphasis added). "The simplest application of this principle is the rule that all the medical consequences and sequelae that flow from the primary injury are compensable." American Filtrona Co. v. Hanford, 16 Va. App. 159, 163, 428 S.E.2d 511, 513 (1993) (citation omitted) (emphasis added). Id. at 273-74, 494 S.E.2d at 172-73. Allen & Rocks, Inc. v. Perry Lee Briggs, Record No. 0768-98-3 (December 22, 1998) (knee problems caused by change in gait resulting from compensable back injury are a compensable consequence of the back injury).
The phrases "chain of causation," "direct and natural results," and "all the medical consequences and sequelae" anticipate the possibility of more than just one event; the doctrine of compensable consequences is not limited to merely one immediate consequence of an industrial injury. Compensable consequences include injuries sustained not as an immediate result of the original injury but as a result of some intermediate event which was itself a result of the original injury. See Immer & Co. v. Brosnahan, 207 Va. 720, 152 S.E.2d 254 (1967) (injuries sustained in car accident while traveling to treatment for original injury are compensable); Food Distribs. v. Estate of Ball, 24 Va. App. 692, 699-700, 485 S.E.2d 155, 159 (1997) (suicide is compensable if the [work-related] injury produces mental derangement and the mental derangement produces suicide); Imperial Trash Serv. v. Dotson, 18 Va. App. 600, 602, 445 S.E.2d 716, 718 (1994) (death was compensable where claimant died as a result of cardiac arrest caused by [work-related] heatstroke); American Filtrona Co. v. Hanford, 16 Va. App. 159, 164, 428 S.E.2d 511, 514 (1993). (employer responsible for costs of hepatitis found to have resulted from a blood transfusion or any other medical treatment necessitated by the original industrial injury). See also Code Sec. 65.2-605 (consequences of treatment provider malpractice are compensable as part of the original injury).
Compensable consequence of a compensable consequence. Contrary to the Court of Appeals' ruling in Amoco Foam Products Company v. Johnson, 26 Va. App.267, 494 S.E.2d 169 (1997), it does not logically follow that merely because a 1994 injury was causally related to a compensable 1992 accident and a 1995 injury was causally related to the 1994 injury, then the 1995 injury was causally related to the 1992 accident. The link of causation must directly connect the original accidental injury with the additional injury for which compensation is sought. Thus, the Court of Appeals erred in holding that claimant's 1995 knee injury was a compensable consequence of her 1992 ankle injury. Based on a record not showing a causal connection between the original 1992 injury and the 1995 injury, a requirement for compensability of the latter injury, the claimant may not recover for a compensable consequence of a compensable consequence. Medical testimony only revealed a causal connection between the 1995 injury and the 1994 compensable consequence, and the original 1992 injury was not an immediate cause of the 1995 injury. Amoco Foam Products Company v. Johnson Medical testimony only revealed a causal connection between the 1995 injury and the 1994 compensable consequence, and the original 1992 injury was not an immediate cause of the 1995 injury. Amoco Foam Products Company v. Johnson, Record No. 980139 (Va. Supreme Court, January 8, 1999) WP Version..
"When the primary injury is shown to have arisen out of and in the course of employment, every natural consequence that flows from the injury likewise arises out of the employment, unless it is the result of an independent intervening cause attributable to claimant's own intentional conduct." Imperial Trash Serv. v. Dotson, 18 Va. App. 600, 606-07, 445 S.E.2d 716, 720 (1994) (quoting Morris v. Badger Powhatan/Figgie Int'l, Inc., 3 Va. App. 276, 283, 348 S.E.2d 876, 879 (1986)). "In other words, where a causal connection between the initial compensable injury and the subsequent injury is established . . . the subsequent injury is treated as if it occurred in the course of and arising out of the employee's employment." Bartholow Drywall Co. v. Hill, 12 Va. App. 790, 794, 407 S.E.2d 1, 3 (1991) (citations omitted). This reasoning underscores the causal connection between the primary and consequential injuries.
Emotional or psychological conditions resulting from an accidental event are compensable. See E.C. Womack, Inc. v. Ellis, 209 Va. 588, 591-93, 166 S.E.2d 265, 269 (1969); Hercules, Inc. v. Gunther, 13 Va. App. 357, 362, 412 S.E.2d 185, 188 (1991). Despite the provisions of Code Sec. 65.2-306(A)(1) providing in pertinent part that "[n]o compensation shall be awarded to the employee or his dependents for an injury or death caused by: (1) The employee's willful misconduct or intentional self-inflicted injury," the commission has awarded benefits for suicide caused by the compensable accident. See, e.g., Confer v. Arban & Carosi, Inc., 63 O.I.C. 66 (1984) (a case in which the issues were whether decedent's suicide was statutorily barred and whether the suicide was caused by decedent's initial injury.) In Confer, the commission adopted the majority rule: [T]he appropriate test to be adopted in Virginia is that designated as the chain-of-causation rule, wherein where the injury and its consequences directly result in the worker's loss of normal judgment and domination by a disturbance of the mind causing the suicide, his suicide is compensable, with a suicide committed by the worker suffering from this degree of disturbance not to be considered "willful" or an "intentional" injury even though the action is volitional since the suicide relates back to the original injury rather than existing independently of the injury. Id. at 80. Additionally, the commission explained as follows: [W]e agree with the basic tenet behind those cases adhering to the chain of causation, that recent psychiatric advances point to the fact that the consequences of an accidental injury can be so devastating that they influence the employee's mind to the point that the employee understands the consequences of the act of destruction but the employee is unable to resist the impulse to take his own life. Under such circumstances we do not find that the act is independent of the accident nor that it is willful within the meaning of [the statute]." Id. at 80-81.
The commission's findings, based upon Dr. Shield's reports, support the commission's conclusion that claimant's psychological disability was a compensable consequence of his injury by accident. See Ohio Valley Constr. Co. v. Jackson, 230 Va. 56, 58, 334 S.E.2d 554, 555 (1985); Seneca Falls Greenhouse & Nursery v. Layton, 9 Va. App. 482, 485-86, 389 S.E.2d 184, 186-87 (1990).The commission aptly acknowledged and applied the principle that "great weight should be given to the evidence of an attending physician." C.D.S. Constr. Servs. v. Petrock, 218 Va. 1064, 1071, 243 S.E.2d 236, 241 (1978). Citing Dr. Shield's four-year treatment of Slaughter and his extensive reports, the commission found that his opinions and diagnoses were more persuasive than those of Dr. Brown Although there were other stressors in claimant's life, the psychological and medical reports place overwhelming emphasis on the injury of October 1988 as the cause of claimant's depression. Dr. Brown's opinion that the injury at work was merely incidental to a disease which progressed on a natural path leading to his present disability is belied by the evidence that claimant was able to earn a livelihood and be a productive member of society despite his depression and psychosomatic symptoms until he began to unravel after the incident of October 24, 1988, following which he became virtually dysfunctional. Dr. Shield testified that although claimant had psychiatric problems before the 1988 injury, "the October [1988] accident caused his psychiatric decompensation. . . and the disability." Dr. Shield opined that Slaughter's 1988 work injury was a precipitating event of claimant's "decompensation" (defined by Dr. Shield as "just plain fall[ing] apart"). He believed claimant to be a hard-working, motivated individual until the pain from his injury caused his emotional collapse. He described the injury as "the straw that broke the camel's back." Dr. Shield testified that Slaughter "was in a massive, massive emotional decompensation" that was caused by his depression over the pain that resulted from his work-related injury. Bassett Burkeville Veneer v. Richard Raymond Slaughter, Jr., Record No. 2212-94-3 (January 30, 1996).
The commission did not err in finding that claimant's psychological problems were caused by her compensable accident. Although one psychiatrist believed claimant's psychological problems preexisted and in fact caused her injury, another psychiatrist who had seen claimant not long after her accident believed her complaints and the clinical findings are quite consistent with a post traumatic stress disorder coupled with a paranoid personality and that claimant's psychological decomposition was set in motion by the injury. The "question [of causation] raised by 'conflicting expert medical opinions' is one of fact." Eccon Constr. Co. v. Lucas, 221 Va. 786, 790, 273 S.E.2d 797, 799 (1981). Thus, the commission's "finding upon conflicting medical evidence that a certain condition does or does not exist is . . . a conclusive finding of fact." McPeak v. P.W.& W. Coal Co., 210 Va. 185, 188, 169 S.E.2d 443, 445 (1969). "The deference that we give to the commission's fact finding on medical questions is based upon the 'unwisdom of an attempt by . . . [courts] uninitiated into the mysteries [of the medical science debate] to choose between conflicting expert medical opinions.'" Stancill v. Ford Motor Co., 15 Va. App. 54, 58, 421 S.E.2d 872, 874 (1992) (citation omitted). Given these principles of appellate review, we have held that "[t]he commission's findings are binding even if the weight of the evidence is contrary to those findings." Kane Plumbing v. Small, 7 Va. App. 132, 136, 371 S.E.2d 828, 831 (1988). We apply this standard because "[a] greater number of medical opinions does not necessarily constitute a preponderance of the evidence." Island Creek Coal Co. v. Honaker, 9 Va. App. 336, 339, 388 S.E.2d 271, 273 (1990). "The probative weight to be accorded [medical] evidence is for the Commission to decide; and if it is in conflict with other medical evidence, the Commission is free to adopt that view 'which is most consistent with reason and justice.'" C.D.S. Const. Services v. Petrock, 218 Va. 1064, 1070, 243 S.E.2d 236, 240 (1978). Georgia-Pacific Corporation v. Michalene L. Robinson, Record No. 1644-99-2 (March 21, 2000). WP Version.
A claimant's proof of the required causal connection must go beyond mere conjecture. Southall v. Eldridge Reams, Inc., 198 Va. 545, 548, 95 S.E.2d 145, 147 (1956)."Possibility is not enough," when proving causation. Eccon Company v. Lucas, 221 Va. 786, 791, 273 S.E.2d 797, 799 (1981); Rust Engineering Co. v. Ramsey, 194 Va. 975, 76 S.E.2d 195 (1953); Wellmore Coal Corporation v. Dallas E. McClanahan, Record No. 1922-98-3 (March 16, 1999). WP Version.
Evidence in the record was sufficient to prove that claimant's 1993 compensable back injury caused the current condition suffered by the claimant. The claimant's symptoms were in the same locations as the symptoms from the original injury, his symptoms persisted to the present, and he remained under the same doctor's treatment since 1993. The commission had awarded the claimant temporary total disability awards through June 16, 1996, thereby establishing the causal relationship at least through that date. There was no evidence of any new specific intervening injury. Although claimant's doctor gave an affirmative response to a question asking whether he agreed that it was just as probable the L5 disc rupture was caused by cumulative or specific events at his new employment as attributable to the 1993 work accident, the doctor also stated, "Patient current complaints are related to 3-29-93 injury." Other notes refer to the new herniation as a "recurrent L5 disc herniation." Wellmore Coal Corporation v. Dallas E. McClanahan, Record No. 1922-98-3 (March 16, 1999). WP Version.
The commission did not err in finding that claimant proved that his current psychiatric condition and disability constituted a compensable consequence of his January 15, 1997 industrial accident and April 1997 re-injury. It is well settled that when an injury by accident accelerates or aggravates a pre-existing condition, disability resulting therefrom is compensable. See Russell Loungewear v. Gray, 2 Va. App. 90, 95, 341 S.E.2d 824, 826 (1986). Likewise, when a compensable injury by accident aggravates or contributes to a pre-existing psychological condition, the subsequent "[e]motional harm following physical injury is compensable, even when the physical injury does not directly cause the emotional consequence." Seneca Falls Greenhouse & Nursery v. Layton, 9 Va. App. 482, 486, 389 S.E.2d 184, 187 (1990). Claimant suffered psychological problems of depression and anxiety prior to the work-related accident, but his mental condition had not affected his ability to work. Although claimant left work after an argument with his supervisor, the medical records indicate that his mental instability causing him to leave work was from the residuals of the original work injury and subsequent aggravations. Volvo Cars of North America v. A. Altizer, Record No. 1329-99-3 (October 19, 1999). WP Version.
Legal Summaries Contents Home Page Contents