COURT OF APPEALS OF VIRGINIA 

Present: Judges Benton, Coleman and Willis 

BLOCKBUSTER VIDEO/WJP VIDEO 

AND 

ROYAL INSURANCE COMPANY 

 MEMORANDUM OPINION*

v. Record No. 2272-95-1 PER CURIAM 

 FEBRUARY 6, 1996 

SHEREE A. LUDWIG-TILLER 

 FROM THE VIRGINIA WORKERS' 

COMPENSATION COMMISSION 

 (James C. McCaa, III; Taylor & Walker, on 

brief), for appellants. 

 (William W. Nexsen; Timothy P. Murphy; 

Stackhouse, Smith & Nexsen, on brief), for 

appellee. 

 Blockbuster Video/WJP Video and its insurer (hereinafter 

collectively referred to as "employer") appeal from a decision of 

the Workers' Compensation Commission awarding compensation to 

Sheree A. Ludwig-Tiller. Employer contends that the commission 

erred in finding that Ludwig-Tiller's November 19, 1993 

compensable injury by accident caused an exacerbation of her 

pre-existing bipolar condition. Finding no error, we affirm the 

commission's decision. 

 On appeal, we view the evidence in the light most favorable 

to the prevailing party. R.G. Moore Bldg. Corp. v. Mullins, 10 

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

determination of causation is a factual finding that will not be 

 

 *Pursuant to Code § 17-116.010 this opinion is not 

designated for publication. 
 2 

disturbed on appeal if there is credible evidence to support the 

finding." Ingersoll-Rand Co. v. Musick, 7 Va. App. 684, 688, 376 

S.E.2d 814, 817 (1989). "Questions raised by conflicting medical 

opinions must be decided by the commission." Penley v. Island 

Creek Coal Co., 8 Va. App. 310, 318, 381 S.E.2d 231, 236 (1989). 

 An employee who is injured in a work-related accident, and 

whose injuries aggravate or exacerbate a pre-existing condition 

resulting in disability, is entitled to compensation for the 

disability. Ohio Valley Constr. Co. v. Jackson, 230 Va. 56, 58, 

334 S.E.2d 554, 555 (1985). Ludwig-Tiller received a broken leg, 

multiple contusions, and a head injury in a compensable 

automobile accident, which injuries subsequently caused a 

chemical imbalance and depression and aggravated her pre-existing 

bipolar disorder, causing her to be disabled from working. 

 In an April 5, 1994 report, Dr. Richard B. Ellis, LudwigTiller's treating neuro-psychiatrist since 1992, opined as 

follows: 

 It is probable that the motor vehicle 

accident with its associated physical 

disability and emotional distress at a highly 

and demanding time of year contributed 

substantially to the patient's exacerbation 

of illness. As with other medical illnesses, 

such as diabetes or asthma, significant 

stressors can cause a recurrence of symptoms 

in bipolar disorder. Prior to the accident 

she had stabilized to the point of requiring 

followup appointments only every three months 

for medication refills. With the added 

physical and emotional distress, she showed a 

definite decline in her mood and level of 

functioning. 
 3 

 As fact finder, the commission accepted Dr. Ellis' opinion 

and rejected the contrary opinion of Dr. Paul Mansheim, who 

performed a review of Ludwig-Tiller's medical records at 

employer's request. Moreover, the commission noted that Dr. 

Mansheim based his opinion on an inaccurate recitation of LudwigTiller's history. In cases of conflicting medical evidence, 

"[t]he general rule is that when an attending physician is 

positive in his diagnosis . . . , great weight will be given by 

the courts to his opinion." Pilot Freight Carriers, Inc. v. 

Reeves, 1 Va. App. 435, 439, 339 S.E.2d 570, 572 (1986). Dr. 

Ellis' opinion constitutes credible evidence to support the 

commission's decision. "The existence of contrary evidence in 

the record is of no consequence if there is credible evidence to 

support the commission's finding." Wagner Enters., Inc. v. 

Brooks, 12 Va. App. 890, 894, 407 S.E.2d 32, 35 (1991). 

 In addition, employer executed a memorandum of agreement 

four months after the industrial accident, acknowledging its 

liability for medical expenses and disability related to LudwigTiller's compensable "head injury, chemical imbalance, [and] 

depression." The commission entered an award for Ludwig-Tiller's 

disability as a result of these injuries. The medical records, 

the memorandum of agreement, and award support the commission's 

finding that the parties "were fully informed as to [LudwigTiller's] ongoing physical and mental complaints and agreed that 

her chemical imbalance and depression were caused by the 
 4 

industrial accident." The evidence and the award support the 

commission's decision. 

 As to the employer's argument that Ludwig-Tiller's bipolar 

disorder did not qualify as an "injury by accident," but rather 

constituted an ordinary disease of life, which, if exacerbated, 

was not compensable under the Act, the employer did not raise 

these issues before the commission. Accordingly, we will not 

consider these arguments for the first time on appeal. Green v. 

Warwick Plumbing & Heating Corp., 5 Va. App. 409, 413, 364 S.E.2d 

4, 6 (1988); Rule 5A:18. 

 For the reasons stated, we affirm the commission's decision 

holding employer responsible for the cost of medical treatment 

related to Ludwig-Tiller's bipolar condition and any subsequent 

disability. 

 Affirmed.