COURT OF APPEALS OF VIRGINIA 

Present: Judges Benton, Bumgardner and Frank 

Argued at Richmond, Virginia 

DAN RIVER, INC. 

 MEMORANDUM OPINION* BY 

v. Record No. 3020-99-2 JUDGE RUDOLPH BUMGARDNER, III 

 JUNE 20, 2000 

SAMMY TERRY 

 FROM THE VIRGINIA WORKERS' COMPENSATION COMMISSION 

 Martha White Medley (Daniel, Vaughan, 

Medley & Smitherman, P.C., on brief), for 

appellant. 

 J. Gregory Webb (Michie, Hamlett, Lowry, 

Rasmussen & Tweel, P.C., on brief), for 

appellee. 

 

* Pursuant to Code § 17.1-413, recodifying Code 

§ 17-116.010, this opinion is not designated for publication. 

 Dan River, Inc. appeals an award of benefits to Sammy Terry 

by the Workers' Compensation Commission. The employer argues 

the commission erred in finding the employee established a 

causal connection between the accident and injury, and in 

finding he sustained his burden of proving a compensable injury 

by accident. The employer argues that it is just as likely that 

the employee's disabling condition was caused by his poorly 

controlled diabetes as by his work-related injury. Finding no 

error, we affirm. 
 On appeal, we view the evidence, and all reasonable 

inferences deducible therefrom, in the light most favorable to 

the prevailing party below. See R.G. Moore Bldg. Corp. v. 

Mullins, 10 Va. App. 211, 212, 390 S.E.2d 788, 788 (1990). The 

factual findings by the commission that are supported by 

credible evidence are conclusive and binding upon this Court. 

See Code § 65.2-706; Manassas Ice & Fuel Co. v. Farrar, 13 Va. 

App. 227, 229, 409 S.E.2d 824, 826 (1991). 

The employee was a diabetic dependent on insulin for twenty 

years. While working for the employer, he tripped on a 3 by 1/2 

inch bolt that protruded from the floor. The employee noted his 

great toe was sore but found nothing visibly wrong. He 

inspected his foot again that evening and the next morning 

before returning to work, but again he found nothing wrong. The 

employee regularly checked his feet and two days later observed 

a black spot on the underside of his toe. The employee went to 

the emergency room and advised the nurse that his toe had been 

red and swollen and he "possibly hit [his] foot." He was 

admitted to the hospital. 

 The admitting doctor, Dr. Thomas M. Alabanza, diagnosed 

cellulitis, a severe infection, of the left toe. The doctor 

wrote the cellulitis seemed to stem from "what appears to be a 

sore at the bottom of the big toe. . . . Patient has a sore at 

the bottom of [his] toe where there might have been a break in 

the skin." A bone scan revealed the employee had osteomyelitis, 

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inflammation of the bone. Dr. Alabanza wrote: "it is highly 

unlikely for cellulitis to develop without trauma or injury. 

Diabetics are not at high risk of developing cellulitis without 

trauma," and trauma "is a most common cause" of cellulitis. 

Dr. Cesar S. Guanzon amputated the employee's left toe. He 

noted that cellulitis could develop several days after blunt 

trauma and that breaking the skin is not necessary for an 

infection to develop because sometimes there is an "internal 

break that you can't see right away." Dr. Guanzon stated that 

diabetics were prone to develop infection after blunt trauma 

more often than the general population. Dr. John Harrelson, who 

treated the employee after the amputation, noted the employee 

experienced "no other specific foot problems until Thanksgiving 

Day 1997 when he struck his foot on an iron pipe at work and 

developed an ulcer over the left great toe." 

The employee must prove his injury was caused by the 

work-related injury. See Westmoreland Coal Co. v. Russell, 31 

Va. App. 16, 19-20, 520 S.E.2d 839, 840-41 (1999). "'The actual 

determination of causation is a factual finding,' and '[t]he 

testimony of a claimant may . . . be considered in determining 

causation, especially where the medical evidence is 

inconclusive.'" Russell Stover Candies v. Alexander, 30 Va. 

App. 812, 826, 520 S.E.2d 404, 411 (1999) (citations omitted). 

Where the evidence, or the reasonable inferences drawn 

therefrom, support the commission's findings, they will not be 

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disturbed on review, even though some evidence supports a 

contrary finding. See id. at 825, 520 S.E.2d at 411. 

The employee had no problems with his feet before he 

tripped and hit his toe at work. At first, he did not notice 

any problems, but evidence proved that cellulitis could develop 

several days after blunt trauma and was unlikely to occur 

without trauma. The evidence also showed that diabetics were 

more prone than the general population to develop infection. 

The record supports the commission's finding that the employee 

injured his toe at work and his diabetes aggravated the injury 

to the extent of requiring amputation. Diabetes affected the 

employee's recovery from the injury, but diabetes did not cause 

the condition. 

The employer cites Kings Market v. Porter, 227 Va. 478, 317 

S.E.2d 146 (1984), and argues that mere conjecture is not 

sufficient to establish a causal connection between an initial 

injury and a current disability. In Porter, the employee filed 

a change in condition application thirteen years after the 

initial injury. The application was supported by a doctor's 

opinion that she was unable to work because of the changed 

condition. The Supreme Court reversed the award of benefits 

because there was no proof of a causal connection between the 

changed condition and the work injury. See id. at 484, 317 

S.E.2d at 149. The instant case does not entail linking a 

changed condition with an earlier accident. To the contrary, 

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the amputation occurred within two weeks of the injury, and 

medical evidence established the causal connection. The record 

supports the award of benefits. Accordingly, we affirm the 

award of benefits. 

 Affirmed.

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