COURT OF APPEALS OF VIRGINIA 

Present: Judges Frank, Kelsey and Senior Judge Willis 

Argued at Richmond, Virginia 

BERGLUND CHEVROLET, INC. AND 

 VADA GROUP SELF-INSURANCE ASSOCIATION 

 OPINION BY 

v. Record No. 2897-03-3 JUDGE D. ARTHUR KELSEY 

 SEPTEMBER 7, 2004 

RICHARD LEE LANDRUM 

FROM THE VIRGINIA WORKERS’ COMPENSATION COMMISSION 

 Iris W. Redmond (Midkiff, Muncie & Ross, on brief), for appellants. 

 No brief or argument for appellee. 

 Berglund Chevrolet, Inc. and the VADA Group Self-Insurance Association (collectively 

“Berglund”) contend that the Workers’ Compensation Commission erred by finding that Richard 

Landrum’s sexual dysfunction was a compensable consequence of a work-related injury. 

Berglund also argues that the statute of limitations and equitable doctrine of laches bar 

Landrum’s claim. Finding no error in the commission’s findings, we affirm its award. 

I. 

We view the evidence on appeal in the light most favorable to Landrum, the prevailing 

party before the commission. Clinchfield Coal Co. v. Reed, 40 Va. App. 69, 72, 577 S.E.2d 538, 

539 (2003). 

While at work on August 26, 1994, Landrum suffered a back injury when a co-employee 

pulled a chair from beneath him as he was sitting down. Landrum fell, “landing on his buttock 

with his back striking the wall.” Landrum described feeling a shock “extend up his spine to 
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about his head and down into both legs to about the knees.” He reported the accident and 

received a workers’ compensation award for a herniated disc, requiring lower back surgery. 

Soon after the accident, Landrum began feeling a “severe” and “steady constant pain” in 

his “private area.” Within a few months, he started experiencing intermittent episodes of sexual 

dysfunction. Landrum explained the problem, at that time, “was more in the nature of pain 

rather than actual erectile dysfunction.” 

Landrum visited Dr. John Heil, a clinical psychologist, in September 1999. Dr. Heil 

evaluated Landrum and concluded he suffered from “major depression” and “pain disorder with 

psychological factors.” Over the next several months, Landrum began taking a variety of 

anti-depressant medications. 

In early 2000, Landrum experienced increased episodes of sexual dysfunction. The 

symptoms grew worse as time progressed, but it was not until March 2002 that Landrum 

disclosed his condition to Dr. John Daugherty, his treating physician. Dr. Daugherty prescribed 

Viagra based upon his medical opinion that: 

Mr. Landrum is regularly followed through our office for 

complications of a closed head injury that occurred on 6/08/90 

with associated chronic headaches. He, in addition, has a history 

of back injuries associated with both the headaches and back pain, 

a chronic pain syndrome/complex regional pain disorder. As a 

result of the combination of these problems and the medications 

used to treat them, he has difficulty with erectile dysfunction, 

improved with Viagra. It is difficult to blame a specific 

medication or injury and it is likely that it is the combination of 

both injuries and his medications that have contributed to his 

sexual dysfunction. 

It is my feeling that both injuries play a role in causing his sexual 

dysfunction, along with the associated treating medications and 

therefore there should be some divided responsibility relative to 

coverage of the patient’s Viagra. 

(Emphasis added). The 1990 accident referred to by Dr. Daugherty involved a preexisting injury 

caused when “a meat hook or some type of metal hook” hit Landrum in the forehead. 
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Focusing more on Landrum’s depression rather than his pain syndrome, Dr. Heil offered 

this psychological opinion in a December 2002 report: 

Based on the timeline of onset and clinical circumstances, it is my 

impression that there is a preponderance of evidence to suggest 

that this is due to his on-the-job injury of August 24, 1994. 

Specifically, sexual performance was not a problem prior to the 

injury. To the extent it may be influenced by stress, depression, or 

medication use, it, in turn, appears to relate back to this injury — 

as use of mediation [sic] and issues of depression and anxiety do 

appear to have arisen from this injury. In addition, Mr. Landrum 

has been in a well established, positive, supportive, marital 

relationship which would preclude performance anxiety as a likely 

precipitant in this case. In fact, failure to perform sexually has 

added stress to this relationship, which is the most important 

element of his support system. 

(Emphasis added).1

 

Based upon these opinions, Landrum filed a claim with the commission for payment of 

his Viagra prescriptions and for one of his visits with Dr. Daugherty. After reviewing the 

evidence, the deputy commissioner awarded the Viagra prescription benefits on the ground that 

Landrum’s sexual dysfunction was “a direct result of side-effects from medications prescribed to 

treat his injury, and the cost of managing those side effects is the defendant’s responsibility.” 

Because Landrum’s condition did not become constant until shortly before he reported it 

to his employer, the deputy declined to apply the doctrine of laches. The deputy did not address 

Berglund’s statute of limitations defense. 

The deputy refused to order Berglund Chevrolet to pay Dr. Daugherty’s invoice, finding 

that particular office visit unrelated to the workplace accident. 

1

 Landrum also began receiving psychiatric care from Dr. Robert Murdock in September 

2002. Dr. Murdock concluded the “primary basis of [Landrum’s] sexual dysfunction may be one 

or more of [his] psychiatric medications, most especially Celexa and Amitriptyline. Since this 

type of anti-depressant appears essential to control [his] psychiatric symptoms and as Viagra 

appears to be the only medicine likely to offset this particular side-effect, I recommend that 

[Landrum’s] request to have it authorized through your Workman’s Compensation insurance be 

granted.” 
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On review, the full commission unanimously affirmed. The commission held that “the 

evidence predominates in establishing that the claimant has developed sexual/erectile 

dysfunction (and a need for Viagra), at least in part, as a direct consequence of the workplace 

injury to his back.” The commission also determined neither the statute of limitations nor the 

doctrine of laches barred Landrum’s claim. The denial of Dr. Daugherty’s invoice, the 

commission agreed, was proper because Landrum did not prove this treatment related to his 

employment injury or its medical sequelae. 

II. 

On three grounds, Berglund appeals the commission’s award of Viagra prescription 

benefits to Landrum. First, Berglund argues that Landrum’s sexual dysfunction cannot be fairly 

characterized as a compensable consequence of his 1994 workplace injury. Second, in any 

event, the sexual dysfunction should be treated as a new and separate injury for purposes of the 

statute of limitations. Third, Berglund contends the equitable doctrine of laches bars the claim 

even if the statute of limitations does not do so. The commission disagreed with each of these 

assertions, as do we. 

 We begin with the governing standard of review. By statute, an award of the commission 

“shall be conclusive and binding as to all questions of fact.” Code § 65.2-706(A). “This 

appellate deference is not a mere legal custom, subject to a flexible application, but a statutory 

command,” Cent. Va. Obstetrics & Gynecology Assocs. v. Whitfield, 42 Va. App. 264, 279, 590 

S.E.2d 631, 639 (2004), one that we scrupulously obey both in principle and in practice when 

reviewing questions of causation, see, e.g., Steadman v. Liberty Fabrics, Inc., 41 Va. App. 796, 

803, 589 S.E.2d 465, 469 (2003); S.P. Terry Co. v. Rubinos, 38 Va. App. 624, 632, 567 S.E.2d 

584, 588 (2002); Lee County Sch. Bd. v. Miller, 38 Va. App. 253, 260, 563 S.E.2d 374, 377 

(2002). 
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We likewise defer to the commission’s “conclusions upon conflicting inferences, 

legitimately drawn from proven facts” ⎯ for inferences, like historic facts, are likewise “equally 

binding on appeal.” Watkins v. Halco Eng’g, Inc., 225 Va. 97, 101, 300 S.E.2d 761, 763 (1983); 

see also Hall v. Winn Dixie Stores, Inc., 41 Va. App. 835, 843, 589 S.E.2d 484, 488 (2003). 

Such deference is warranted “even though there is evidence in the record to support a contrary 

finding.” S.P. Terry Co., 38 Va. App. at 632, 567 S.E.2d at 588 (citations omitted). Acting 

within its factfinding discretion, therefore, the commission “is free to adopt that view ‘which is 

most consistent with reason and justice.’” Georgia-Pac. Corp. v. Robinson, 32 Va. App. 1, 5, 

526 S.E.2d 267, 269 (2000) (quoting C.D.S. Constr. Servs. v. Petrock, 218 Va. 1064, 1070, 243 

S.E.2d 236, 240 (1978)) (bracketed material omitted). 

A. 

The doctrine of compensable consequences attempts, in a single phrase, to summarize the 

attenuation limits of causation in workers’ compensation law. “The simplest application of this 

principle is the rule that all the medical consequences and sequelae that flow from the primary 

injury are compensable.” 1 Arthur Larson & Lex K. Larson, Larson’s Workers’ Compensation 

Law § 10.01, at 10-3 (2003). Virginia courts have often used just this description, see, e.g., 

Leonard v. Arnold, 218 Va. 210, 214, 237 S.E.2d 97, 99 (1977); Sturtz v. Chesapeake Corp., 38 

Va. App. 672, 677, 568 S.E.2d 381, 384 (2002); Am. Filtrona Co. v. Hanford, 16 Va. App. 159, 

163, 428 S.E.2d 511, 513 (1993), as has the commission, see, e.g., Fuller v. Meadow Creek 

Wood Shop, 2004 Va. Wrk. Comp. LEXIS 139, at *7 (2004). 

Where such a causal link exists, “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.’” Bartholow Drywall Co. v. Hill, 12 Va. App. 790, 794, 407 S.E.2d 1, 3 (1991) 
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(quoting Leonard, 218 Va. at 214, 237 S.E.2d at 100). The doctrine applies “when the injury 

does not arise on the day of the accident, but instead develops as a direct consequence of an 

initial injury.” Paul Johnson Plastering v. Johnson, 265 Va. 237, 244, 576 S.E.2d 447, 451 

(2003) (citation omitted). 

The doctrine has its limits, however. “The link of causation must directly connect the 

original accidental injury with the additional injury for which compensation is sought.” Amoco 

Foam Prods. Co. v. Johnson, 257 Va. 29, 33, 510 S.E.2d 443, 445 (1999) (emphasis added); see

also Paul Johnson Plastering, 265 Va. at 244, 576 S.E.2d at 452. In other words, the issue is 

“essentially one of whether the medical evidence proves a causal connection between the 

primary injury and the subsequent occurrence.” Williams Indus. v. Waggoner, 24 Va. App. 181, 

188, 480 S.E.2d 788, 791 (1997). “The issue in all of these cases is exclusively the medical issue 

of causal connection between the primary injury and the subsequent medical complications. By 

the same token, denials of compensation in this category have invariably been the result of a 

conclusion that the requisite medical causal connection did not exist.” 1 Arthur Larson, et al., 

supra § 10.02, at 10-5.2

In this case, Dr. Daugherty attributed Landrum’s sexual dysfunction (and, thus, his need 

for Viagra) to the original workplace injury. Dr. Daugherty focused on the combination of the 

“chronic pain syndrome/complex regional pain disorder” caused in part by the workplace 

accident and “the medications used to treat them.” In his view, the causal chain was not 

interrupted by any intervening accidents, unrelated injuries, idiopathic conditions, or causal 

influences for which Landrum should bear responsibility. Finding Dr. Daugherty’s opinion 

 2

 Even so, that does not mean a finding of causation must be “based exclusively on 

medical evidence. ‘The testimony of a claimant may also be considered in determining 

causation, especially where the medical testimony is inconclusive.’” Lee County Sch. Bd. v. 

Miller, 38 Va. App. 253, 260, 563 S.E.2d 374, 377-78 (2002) (quoting Dollar Gen’l Store v. 

Cridlin, 22 Va. App. 171, 176, 468 S.E.2d 152, 154 (1996)). 
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persuasive, the commission concluded “the evidence predominates in establishing that the 

claimant has developed sexual/erectile dysfunction (and a need for Viagra), at least in part, as a 

direct consequence of the workplace injury to his back.” (Emphasis added).3

Berglund contends Dr. Daugherty’s opinion lacks sufficient certitude to justify the 

commission’s reliance on it. His medical opinion attributed the sexual dysfunction to a cluster of 

causes ⎯ the 1990 head injury, the 1994 back injury, the chronic pain syndrome, and the pain 

medications ⎯ but did not separate out any specific predominating cause. Instead, Dr. 

Daugherty concluded only that the sexual dysfunction was a “result of the combination of these 

problems and the medications used to treat them.” 

Berglund’s point, however, goes only to the weight of the evidence, not its probative 

sufficiency. A medical opinion finding causation in part, if established with the requisite 

certitude, can be relied upon by the factfinder as persuasive. See Smith v. Fieldcrest Mill, 224 

Va. 24, 29, 294 S.E.2d 805, 808 (1982) (holding that compensable cause need only be a 

“contributing factor” (emphasis in original)); Bergmann v. L & W Drywall, 222 Va. 30, 32, 278 

S.E.2d 801, 803 (1981). “The extent or degree to which the work-related cause contributed is 

not important. It matters only that the work-related cause contributed in some part to claimant’s 

disability.” Henrico County Sch. Bd. v. Etter, 36 Va. App. 437, 446, 552 S.E.2d 372, 376 

(2001). It was unnecessary, therefore, for Dr. Daugherty’s expert opinion to segregate the 

work-related part from the non-work-related part. 

 3

 The commission also considered the opinions of Dr. Heil and Dr. Murdock. Because 

Dr. Daugherty’s opinion is a sufficient factual predicate for the commission’s causation finding, 

we need not address Berglund’s argument that the opinions of Dr. Heil and Dr. Murdock involve 

theories of indirect, sequential causation rejected by Amoco Foam Prods. Co. and Paul Johnson 

Plastering. What was lacking in both of those cases is present here: an expert medical opinion 

directly linking the original injury to the subsequent medical sequelae. 
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In our case, the commission found the sexual dysfunction was “at least in part” a 

consequence of the workplace injury. Given the weight afforded the opinion of a treating 

physician ⎯ particularly one involving medical causation4 ⎯ coupled with the compounding 

weight that opinion has once it has been accepted as true by the factfinder, we see no basis for 

overturning the commission’s decision to treat Landrum’s sexual dysfunction as a compensable 

consequence of his workplace injury. 

B. 

Berglund next claims that even if Landrum’s sexual dysfunction was compensable, the 

commission erred by not applying the statute of limitations to bar Landrum’s claim. We 

disagree. 

The timeliness of a compensable consequence claim depends on the type of injury 

suffered. “Where the subsequent injury is a new injury, the provisions of Code § [65.2-601] are 

applicable from the date of that new injury. When the subsequent injury is a change in 

condition, the provisions of Code § [65.2-708(A)] are applicable.” Bartholow Drywall Co., 12 

Va. App. at 797, 407 S.E.2d at 5. Thus, “new and separate” claims that causally relate to the 

original accident, but not the original injury, must be filed within the original limitations period 

 4

 Though not necessarily conclusive, “the opinion of the treating physician is entitled to 

great weight.” H.J. Holz & Son, Inc. v. Dumas-Thayer, 37 Va. App. 645, 655, 561 S.E.2d 6, 11 

(2002) (citing Fingles Co. v. Tatterson, 22 Va. App. 638, 641, 472 S.E.2d 646, 647 (1996)). “A 

doctor’s statement that a certain condition is probably connected to the injury means there is a 

reasonable likelihood of causation, which ‘is sufficient to permit a trier of fact to accord the 

statement probative weight.’” Marriott Int’l Inc. v. Carter, 34 Va. App. 209, 215, 539 S.E.2d 

738, 741 (2001) (quoting Cook v. City of Waynesboro Police Dep’t, 225 Va. 23, 30, 300 S.E.2d 

746, 749 (1983)). 
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outlined in Code § 65.2-601, which requires filing “within two years after the accident.” See

also Sturtz, 38 Va. App. at 676, 568 S.E.2d at 383.5

On the other hand, if the consequent injury is a mere change in condition ― some form 

of medical sequelae of the original injury, though not of the accident itself ― the claim falls 

within the limitations period of Code § 65.2-708(A), which requires filing within 24 months 

from the “last day for which compensation was paid, pursuant to an award” by the commission. 

When the medical evidence shows “an unbroken ‘chain of causation,’ the subsequent accident 

and injuries flowing from it are treated as part of the original claim and do not result in the 

establishment of a new, original, separate and independent claim file.” Sturtz, 38 Va. App. at 

676-77, 568 S.E.2d at 383; see also Bartholow Drywall Co., 12 Va. App. at 793, 407 S.E.2d at 

2-3. 

In this case, the commission correctly viewed Landrum’s sexual dysfunction as a change 

in condition, not a new and separate injury. This holding tracks Dr. Daugherty’s opinion 

attributing the sexual dysfunction to a combination of the “chronic pain syndrome/complex 

regional pain disorder” caused in part by the workplace accident and “the medications used to 

treat them.” As a result, Landrum’s claim was subject to the statute of limitations period 

codified in Code § 65.2-708(A). By filing his claim for benefits in November 2002, while under 

an open award of temporary total disability benefits, Landrum acted before the time limitation 

outlined in Code § 65.2-708(A) even began to run. 

 5 See also Southwest Va. Tire, Inc. v. Bryant, 31 Va. App. 655, 660, 525 S.E.2d 563, 566 

(2000) (“A change in an employee’s physical condition that is compensable under Code 

§ 65.2-708 includes, among certain other changes, any ‘progression, deterioration, or 

aggravation’ of a previously compensated injury. However, ‘a new and separate accidental 

injury’ may not be compensated as a change in condition of a previous injury.” (citations 

omitted)). 
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C. 

We likewise find no fault in the commission’s refusal to dismiss Landrum’s claim under 

the equitable doctrine of laches. We define laches as “‘the neglect or failure to assert a known 

right or claim for an unexplained period of time under circumstances prejudicial to the adverse 

party.’” Bazzle v. Bazzle, 37 Va. App. 737, 747, 561 S.E.2d 50, 55 (2002) (quoting Princess 

Anne Hills v. Susan Constant Real Est., 243 Va. 53, 58, 413 S.E.2d 599, 602 (1992)). The 

doctrine has no fixed guidelines ― “‘no rigid rule can be laid down as to what delay will 

constitute laches; every suit must depend upon its own circumstances.’” Stewart v. Lady, 251 

Va. 106, 114, 465 S.E.2d 782, 786 (1996) (quoting Puckett v. Jessee, 195 Va. 919, 930, 81 

S.E.2d 425, 431 (1954)). The litigant raising laches as a defense bears the burden of 

demonstrating both the requisite delay and prejudice. Barr v. S.W. Rodgers Co., 34 Va. App. 50, 

58, 537 S.E.2d 620, 624 (2000). 

The commission acted within its factfinding discretion when it found that the delayed 

emergence of Landrum’s sexual dysfunction, not a neglectful failure to assert his claim, explains 

the interval between his 1994 back injury and his 2002 claim for Viagra prescription benefits. 

Landrum acknowledged suffering occasional episodes of sexual dysfunction “soon after his 

workplace accident,” but considered the situation “more in the nature of pain rather than actual 

erectile dysfunction.” It was not until “probably right at the year 2000,” he explained, that his 

sexual dysfunction truly emerged. And even then, the condition was intermittent and did not 

become chronic until later. 

In addition, Berglund did not demonstrate any prejudice because of the timing of the 

claim. No evidence was lost; no witnesses unfound; no temporary opportunities to mitigate 

Landrum’s medical problems squandered. Under these circumstances, the commission did not 

err in refusing to bar Landrum’s claim under the equitable doctrine of laches. 
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III. 

Credible evidence supports the commission’s finding that Landrum’s sexual dysfunction 

was a compensable consequence of his workplace injury. Because the claim was properly 

characterized as a medical sequelae rather than a new and separate injury, the commission 

correctly held Code § 65.2-601’s statute of limitations did not apply. Given the circumstances 

explaining Landrum’s delay in asserting his claim and Berglund’s lack of prejudice, we also hold 

the commission did not err in refusing to dismiss Landrum’s claim under the equitable doctrine 

of laches. 

 Affirmed.