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COURT OF APPEALS OF VIRGINIA

Present: Judges Benton, Elder and Overton
Argued at Richmond, Virginia

WESTPOINT STEVENS-DRAKES
BRANCH/WESTPOINT STEVENS, INC.
AND TRAVELERS INDEMNITY COMPANY
OF ILLINOIS MEMORANDUM OPINION BY
JUDGE LARRY G. ELDER
v. Record No. 0008-97-2 JUNE 17, 1997

DOROTHY DAVIS

FROM THE VIRGINIA WORKERS' COMPENSATION COMMISSION

Warren H. Britt (Britt & Gnapp, P.C., on
briefs), for appellants.

Robert L. Flax (Rhetta M. Daniel, on brief),
for appellee.

Westpoint Stevens-Drakes Branch and Travelers Indemnity
Company of Illinois (appellants) appeal an order of the Workers'
Compensation Commission (commission) awarding medical benefits to
Dorothy Davis (claimant). Appellants argue that the evidence was
insufficient as a matter of law to prove that claimant suffered
an "injury by accident." Specifically, appellants argue that the
evidence does not support the commission's factual finding that
claimant's slip at work on March 13, 1995 caused the injuries to
claimant's knee, ankle, and back that were subsequently diagnosed
by her treating physician. For the reasons that follow, we
affirm.
"In order to recover on a workers' compensation claim, a
claimant must prove: (1) an injury by accident, (2) arising out
of and (3) in the course of his employment." Kane Plumbing, Inc.
v. Small, 7 Va. App. 132, 135, 371 S.E.2d 828, 830 (1988)
(citations omitted); see Code 65.2-101. An "injury by
accident" requires proof of "(1) an identifiable incident;
(2) that occurs at some reasonably definite time; (3) an obvious
sudden mechanical or structural change in the body; and (4) a
causal connection between the incident and the bodily change."
Chesterfield County v. Dunn, 9 Va. App. 475, 476, 389 S.E.2d 180,
181 (1990) (citing Lane Co. v. Saunders, 229 Va. 196, 199, 326
S.E.2d 702, 703 (1985)) (emphasis added).
Appellants do not argue that claimant failed to prove that
an identifiable incident occurred at a definite time on March 13
or that Drs. Cook and Ragonesi diagnosed the existence of a
bodily change. Instead, they contend that the evidence was
insufficient to prove that claimant's slip on March 13 caused the
injuries to her knee, ankle, and back.
"Causation is an essential element which must be proven by
claimant in order to receive an award of compensation for an
injury by accident." AMP, Inc. v. Ruebush, 10 Va. App. 270, 274,
391 S.E.2d 879, 881 (1990). "To establish by a preponderance of
the evidence a causal connection between the incident and the
claimed disability, the 'proof must go beyond conjecture.'"
Ratliff v. Rocco Farm Foods, 16 Va. App. 234, 237, 429 S.E.2d 39,
41 (1993) (quoting Southall v. Elridge Reams, Inc., 198 Va. 545,
548, 95 S.E.2d 145, 147 (1956)).
On review, we construe the evidence in the light most
favorable to the party prevailing below. R.G. Moore Bldg. Corp.
v. Mullins, 10 Va. App. 211, 212, 390 S.E.2d 788, 788 (1990).
Factual findings of the commission will be upheld on appeal if
supported by credible evidence. James v. Capitol Steel Constr.
Co., 8 Va. App. 512, 515, 382 S.E.2d 487, 488 (1989). The
determination whether or not a particular incident caused a
particular structural or mechanical change in the body is a
factual finding. See Ingersoll-Rand Co. v. Musick, 7 Va. App.
684, 688, 376 S.E.2d 814, 817 (1989).
We hold that the evidence was sufficient to prove that
claimant suffered an "injury by accident" when she slipped on
March 13. Dr. Ragonesi expressly opined in a report dated March
23, 1995 that claimant's strains of her knee, ankle, and back
were caused when she slipped and caught herself on the
repairman's tool cabinet. Although claimant did not experience
pain in her knee, ankle, and back until the day following her
slip, "pain does not have to be contemporaneous with the accident
to be an injury by accident." Ratliff, 16 Va. App. at 239, 429
S.E.2d at 42.
Appellants argue that Dr. Ragonesi's medical opinion
regarding the causation of claimant's injuries is not credible
evidence and that the commission was therefore left to speculate
about the existence of a causal relationship between claimant's
slip and the diagnosed strain of her knee, ankle, and back. They
assert that Dr. Ragonesi's medical opinion of March 23, 1995 is
incredible because his letter of January 29, 1996 certifying that
he treated claimant shows that his understanding of claimant's
accident was inaccurate. We disagree.
Dr. Ragonesi's letter of January 29, 1996 does not render
his medical opinion of March 23, 1995 incompetent. The
commission errs when it attributes any weight to a medical
opinion based on a faulty premise or misinformation provided by a
claimant. Clinchfield Coal Co. v. Bowman, 229 Va. 249, 252, 329
S.E.2d 15, 16 (1985); Sneed v. Morengo, Inc., 19 Va. App. 199,
205, 450 S.E.2d 167, 171 (1994). Although the summary of
claimant's accident contained in Dr. Ragonesi's letter conflicted
with claimant's testimony at the hearing that she did not
actually fall to the floor, the letter does not indicate that Dr.
Ragonesi's understanding of claimant's accident was flawed at the
time he formed and gave his opinion in March, 1995.
Instead, the record indicates that Dr. Ragonesi's
understanding of claimant's accident at the time he rendered his
opinion was consistent with claimant's testimony at the hearing.
Claimant testified that she slipped and caught herself on the
repairman's tool cabinet before falling to the floor and that she
began experiencing pain the following morning. Contrary to
appellants' assertion, claimant did not testify about either the
direction in which her body fell or the movements of her knee,
ankle, and back during the slip. In his written medical opinion
of March 23, 1995, Dr. Ragonesi summarized his understanding of
claimant's slip:
Description of accident by patient
[Claimant] was walking on concrete floor in
the factory and slipped on a piece of plastic
from one of the machines, fell backwards,
catching herself with her arm, this caused
her to wrench her back on the left side as
well as twist her right ankle and strain her
right knee.
(Emphasis added.) Although Dr. Ragonesi's summary does indicate
the direction of claimant's fall and the movement of her knee,
ankle, and back, it does not indicate when claimant first
experienced pain. Claimant's and Dr. Ragonesi's accounts of the
slip merely provide information not contained in the other.
Because Dr. Ragonesi's understanding of claimant's slip is
consistent with and not contradicted by claimant's testimony, the
commission's reliance on Dr. Ragonesi's medical opinion was not
erroneous.
Because credible evidence supports the commission's finding
that claimant's slip on March 13 caused her injuries, we cannot
say that the evidence was insufficient to prove that claimant
suffered an injury by accident.
For the foregoing reasons, we affirm the commission's award
of medical benefits.
Affirmed.

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