COURT OF APPEALS OF VIRGINIA
Present: Judges Humphr eys, Alston and Decker Argued at Richmond, Virginia

VITAL LINK, INC. AND ARGONAUT INSURANCE COMPANY OPINION BY v. Record No . 1975-17-2 JUDGE ROBERT J. HUMPHREYS JUNE 19, 2018 DENZIL B. HOPE

FROM THE VIRGINIA WORKERS’ COMPENSATION COMMISSION Andrew H. D. Wilson (Two Rivers Law Group, P.C., on brief), f or appellants. Brooke T. Alexander (Bradford E. Goodwin; Reid Goodwin PLC, o n brief), for appellee.
Vital Link, Inc. (“employer”), argues on appeal that the Worke rs’ Compensation Commission (the “Commission”) erre d when it considered a claim of compensable consequence by claimant Denzil B. Hope (“Hope”). Employer argues that the Commission erred in finding that employer had sufficient no tice to defend the claim of comp ensable consequence, erred in finding Hope’s subsequent injury t o be a compensable consequenc e, and erred in awarding medical benefits for the compensable consequence injury. Emplo yer also argues that the Commission erred in finding suffi cient evidence to award Hope c ontinuing wage loss benefits.
I. BACKGROUND It is uncontested that Hope susta ined a compensable work-relat ed injury to his left knee on June 23, 2015. Beginning on August 18, 2015, Dr. Mark E. Bu chanan (“Dr. Buchanan”) began treating Hope for the inj ury. Dr. Buchanan diagnosed Hop e with a displaced acute medial meniscus tear of the left knee and chrondromalacia of the left knee, which required surgery.PUBLISHED- 2 - On September 18, 2015, Dr. Buchanan performed an arthroscopic surgery on Hope’s left knee. The procedure included pe rforming a “chondroplasty of th e medial femoral condyle til [sic] a smooth well contoured pr obe stable surface was created. ” The operative report indicated that the surgery was successf ul, with no complications. On Sep tember 23, 2015, Hope began physical therapy to regai n strength and function. In his post-operative visi ts and during physical therapy, Hope experienced swelling of his left knee and reported significan t pain and discomfort. One po st-operative report noted that Hope “has constant pain that ge ts worse with activity” and that Hope “[g]ets sharp shooting pains as well.” After a kenal og and lidocaine injection into H ope’s left knee did not ease his pain, Dr. Buchanan schedul ed an MRI for December 15, 2015. On December 29, 2015, Dr. Buchanan rev iewed the MRI of Hope’s left knee. According to Dr. Buchanan’s office note, t he MRI showed a “subchondral fr acture” of Hope’s “medial femoral condyle.” Dr. Buchanan also described “full-thickness loss” of cartilage within the joint. Discussing the injury further, D r. Buchanan noted that “[t]he f racture has the appearance of a stress fracture” that “was not pr esent on his previous MRI so i s [sic] not directly related to his work injury but may be due to s tresses on his knee during his p ostop healing.” In January 2016, Dr. Buchanan rel eased Hope to all activities even though Hope continued to experience pain a nd swelling in his left knee. In a letter dated January 13, 2016, employer’s claim administrator informed Hope that his benefits were terminated and that she would “deny any medical bills relat ed to the fracture of the ri ght knee 1 as this is not compensable under the Workers’ compensation claim.” Hope was scheduled for a follow-up appointment with Dr. Buchanan on January 29, 2016, but Hope cancelled on Ja nuary 28, 2016.

1 The letter discusses a fractur e found after reviewing the MRI of Hope’s left knee, but then mistakenly refers to the r ight knee in the last sentence o f the letter.- 3 - Hope returned to work with a diffe rent employer in late March 2016. After doing so, however, Hope’s left knee “beganto swell” and he experienced s ignificant pain. On May 11, 2016, Hope visited his family physician, Dr. Ghayth M. Hammad ( “Dr. Hammad”). Hope did not return to see Dr. Buchanan because it was Hope’s understand ing that Dr. Buchanan was unavailable. Dr. Hammad removed f luid from Hope’s left knee, b ut Hope’s symptoms did not abate. Dr. Hammad subsequentl y arranged for Hope to receive tr eatment from Dr. Sameer G. Badarudeen (“Dr. Badarudeen ”), an orthopedic surgeon. Hope obtained permission from em ployer’s claim administrator t o receive a new MRI from Dr. Badarudeen. While waiti ng for the new MRI, Dr. Badaru deen removed fluid from Hope’s knee and noted Hope’s c onstant pain. Also, in an office note dated June 20, 2016, Dr. Badarudeen stated that upon his review of Hope’s MRI from D ecember 15, 2015, Hope’s femur fracture was “related to hi s Worker’s Comp. injury” witho ut any further discussion. On June 27, 2016, Dr. Badarudeen took a new MRI and compared it to the December 15, 2015 MRI. According to Dr. Badarudeen, the n ew MRI “showed full-thickness cartilage loss and . . . tricompartmental disease[.]” B ased on the ineffectiveness of p revious conservative treatments, Dr. Badarudeen recommended a left total knee replacement. On July 14, 2016, Hope filed a claim for temporary total disab ility benefits from May 11, 2016, and continuing. On the line t itled “Parts of Your Body I njured,” Hope wrote “[i]t was my left knee. Done [sic] had one surgery and waiting on a second one.” Hope did not mark the box indicating he sought a lifetim e award of medical benefits. On October 17, 2016, Dr. Badarudeen pe rformed a left total kne e replacement on Hope. Prior to the surgery, employer’s claim administrator informed b oth Hope and Dr. Badarudeen’s office that employer would not pay for Dr. Badarudeen’s treatme nt of Hope’s left knee.- 4 - Prior to the scheduled hearing b efore the deputy commissioner, Hope moved for a continuance and a de bene esse deposition of his cousin, Ann How ard, who was expected to testify regarding her conversation with employer’s claim admini strator about Hope’s medical treatment with Dr. Badarudeen. 2 Employer objected, noting to the deputy commissioner that there was “currently only one i ssue pending before your Honor a nd that is . . . [Hope’s] claim for temporary total disability benef its.” According to employer, A nn Howard’s testimony was therefore irrelevant to the issu e before the deputy commissione r. Hope countered that a “request for medical benefits is implic it in the filing of an applicatio n for benefits.” Ruling on the issue, the deputy commissioner gr anted Hope’s motion for a de bene esse deposition after finding it appropriate under the circumstances. Following the hearing, the deput y commissioner found that empl oyer had sufficient notice that Hope was seeking medi cal benefits. As a result, th e deputy commissioner awarded both wages and medical benefits, i ncluding compensation for the left total knee replacement performed by Dr. Badarudeen. On November 7, 2017, the full Com mission affirmed the deputy commissioner, finding that “the r ecord demonstrates [that Hope’ s] stress fracture was a compensable consequence of his or iginal injury.” The Commissio n also found that because employer’s insurer denied responsibility for that injury “[Hope ] was free to select a physician of his choosing.” As a result, t he Commission found that employer was “responsible for the reasonable, necessary, and casuall y related medical treatment r endered by Dr. Badarudeen.” Finally, the Commission concluded that evidence in the record e stablished Hope’s ongoing

2 A de bene esse deposition is the sworn testimony of a witness taken in antici pation that the witness will be unavailable to attend a scheduled trial or hearing. The record reflects that, during the pertinent time, Ann H oward was unavailable for the s cheduled hearing because she resided in Kentucky, underwent surgery, and was unable to trave l.- 5 - disability and that the evidence indicate d the need for left to tal knee replacement surgery. This appeal follows.
II. ANALYSIS A. Standard of Review “Although we defer to the commissi on in its role as fact finder , we ‘review questions of law de novo .’” Nelson Cty Sch. v. Woodson, 45 Va. App. 674, 677, 613 S.E. 2d 480, 482 (2005) (quoting Rusty’s Welding S erv., Inc. v. Gibson, 29 Va. App. 119 , 127, 510 S.E.2d 255, 259 (1999) ( en banc )). “While we review questions of law de novo , we construe the Workers’ Compensation Act liberally for the benefit of employees to effe ctuate its remedial purpose of making injured workers whole.” Advance Auto & Indem. Ins. Co. v. Craft, 63 Va. App. 502, 514, 759 S.E.2d 17, 23 (2014) (referencing Fairfax Cty. Sch. Bd . v. Humphrey, 41 Va. App. 147, 154-55, 583 S.E.2d 65, 68 (2003)). B. Compensable Injur ies Under the Act “An injury comes within the scope of the [Workers’ Compensation ] Act if it results from an accident arising out of and in the course of the injured emp loyee’s employment.” Simms v. Ruby Tuesday, Inc., 281 Va. 114, 120, 704 S.E.2d 359, 362 (2011 ). “When an employee sustains such an injury, the Act provides the sole and exclusiv e remedy available against the employer.” Id. (quoting Butler v. Southern States Coop., Inc., 270 Va. 459, 465, 620 S.E.2d 768, 772 (2005)). An employer is requi red under the Act to furnish all medical services that are “necessary services incident to the treatment of an injury sustained in a compe nsable accident.” Haftsavar v. All Am. Carpe t and Rugs, Inc., 59 Va. App. 593, 59 9, 721 S.E.2d 804, 807 (2012) (quoting Ins. Mgmt. Corp. of Tidew ater/Baldwin Bros. & Taylor v . Daniels, 222 Va. 434, 439, 281 S.E.2d 847, 849 (1981)). Subject to review by the Commissi on, “the employer is responsible for medical attenti on if (1) a causal relationship exists between the workplace- 6 - accident and the treatment, and (2) the attending physician dee ms it necessary. The claimant, however, bears the burden of pr oving by a preponderance of the evidence that disputed treatment was medically necessary.” Advance Auto, 63 Va. App. at 523, 75 9 S.E.2d at 28 (quoting Haftsavar, 59 Va. App. at 599, 721 S.E.2d at 807). Derivative injuries that follow and flow from the original work place accident may also be compensable. “The doctrine of compensable consequences allows a claimant to recover for injuries that result from an industrial accident even if those injuries do not manifest during the initial industrial accident, but rather, develop at some point in the future.” Anderson v. Anderson, 65 Va. App. 354, 363, 778 S.E.2d 132, 136 (2015) (ref erencing Berglund Chevrolet, Inc. v. Landrum, 43 Va. App. 742, 751, 601 S.E.2d 693, 697 (200 4)). “When a primary injury under the Workmen’s Compensation Act is shown to have arisen ou t of the course of employment, every natural consequence that flows from the injur y is compensable i f it is a direct and natural result of a primary injury.” Bd. of Supervisors v. Martin, 3 Va. App. 139, 141, 348 S.E.2d 540, 541 (1986) (referencing Womack, Inc. v. Ellis, 209 Va. 588, 591, 166 S.E.2d 265, 268 (1969)). “The simplest application of this principle is the rule that al l the medical consequences and sequelae that flow from the primary injury are compensable.” Berglund, 43 Va. App. at 750, 601 S.E.2d at 697 (quoting 1 Arthur Larson & Lex K. Larson, Lar son’s Workers’ Compensation Law § 10.01 (2003)). When “an initial medical condition itself progresses into complications more serious than the original inj ury; the added complications are of course compensable.” 1 Arthur Larson & Lex K. Larson, Lar son’s Workers’ Compensation L aw § 10.02 (2018). Moreover, “aggravation of the primary injury by medical or surg ical treatment is compensable.” Id. § 10.09; see also Leonard v. Arnold, 218 Va. 210, 214, 237 S.E.2d 97, 99-100 (1977) (distinguishing a new and separat e injury “from a progression, deterioration, or aggravation of- 7 - the injury sustained in the origin al industrial accident[,]” wh ich constitutes a “change in condition”). In Immer & Co. v. Brosnahan, 207 Va. 720, 152 S.E.2d 254 (1967 ), our Supreme Court extended the doctrine of compens able consequences to include a subsequent injur y to a different body part when the subsequent injury bears a sufficient causal connection to the first injury. See Farmington Country Club, Inc. v. Marshall, 47 Va. App. 15, 22-2 3, 622 S.E.2d 233, 237-38 (2005); see also Bartholow D rywall Co. v. Hill, 12 Va. App. 790 , 797, 407 S.E.2d 1, 5 (1991) (holding that “the doctrine of c ompensable consequences is appl icable both to aggravation of a prior compensable injury and a new injury for the purposes of e stablishing compensability of the subsequent injury”). “Under th ese circumstances, ‘the second i njury is treated as if it occurred in the course of and arising out of the employee’s employment.’” Farmington Country Club, 47 Va. App. at 23, 622 S.E.2d at 237 (quoting Leonard, 218 Va. at 214, 237 S.E.2d at 100). The issue in determining compensabil ity “is exclusively the medical issue of causal connection between the primary injury and the subsequent medical complicat ions.” Berglund, 43 Va. App. at 751, 601 S.E.2d at 697 (quoting 1 A rthur Larson & Lex K. Lar son, Larson’s Workers’ Compensation Law § 10.02 (2003)). “[T]he Workers’ Compensation A ct provides that, ‘as long as nec essary after an accident, the employer shall furnish or cause to be furnishe d, free of charge to the injured employee, a physician chosen by the injured e mployee . . . and [any] other necessary medical attention’ related to the compensable in jury.” Woodson, 45 Va. App. at 67 8, 613 S.E.2d at 482 (quoting Code § 65.2-603(A)(1)) (alterations in original). “Because ‘th is statutory duty on the employer is mandatory,’ an injured employ ee is automatically entitled to receive medical benefits once the fact of a compensable injury ha s been established.” Id. at 678 , 613 S.E.2d at 483 (quoting Cash v. Am. Health Ins. Corp., 203 Va. 719, 721, 127 S.E.2d 119, 121 (1962)). “This entitlement- 8 - cannot be negated by the employee’ s failure to specifically request an award of medical benefits in [his] application t o the commission.” Id. C. Whether the Commission violat ed Employer’s Procedural Due P rocess Rights Employer argues that the “Co mmission erred by denying [employer ’s] due process rights when it considered a claimof compensable consequence sua sponte without notice to [employer], and the Commission erre d in finding that ‘[employer ] had sufficient notice to defend a claim of a left knee fracture’ causally related to a compensa ble consequence of [Hope’s] original accident injury.” What constitutes sufficient noti ce in this case for the left fe mur fracture depends on the nature and timing of the compensable consequence. This Court h as held that the doctrine of compensable consequences is applicable bot h to aggravation of a prior compensa ble injury and a new injury f or the purposes of establishing com pensability of the subsequent injury. Where the subsequent inj ury is a new injury, the provi sions of Code § 65.1-87 [now § 65.2-601] are a pplicable from the date of that new injury. When the subse quent injury is a change in condition, the provisions of Code § 65.1-99 [now § 65.2-708] ar e applicable. Bartholow, 12 Va. App. at 797, 407 S.E.2d at 5. Accordingly, w e have found that where a subsequent injury is a new injury to a different body part, the claimant may be required to file a new claim with the Commission to s atisfy the requirements of Co de § 65.2-601. See, e.g., Leonard, 218 Va. at 215, 237 S.E.2d a t 100 (reversing an award for compensable consequence where the employer had timely notice of the new injury but the claimant did not timely file an application with the Commission f or the new injury); see also S turtz v. Chesapeake Corp., 38 Va. App. 672, 677, 568 S.E.2d 381, 384 (2002) (“[When] the subs equent injury is t he result of a new and separate accident, not a change in condition . . . , th e new and separate injury arising out of the first injury requires th e claimant to give notice to emp loyer of the accident and to file a- 9 - claim with the commission with the time limitations described i n Code § 65.1-87 (now Code § 65.2-601).”). In contrast, a change of conditi on is not a new injury but is “ a change in physical condition of the employee as we ll as any change in the conditio ns under which compensation was awarded, suspended, or termina ted which would affect the ri ght to, amount of, or duration of compensation.” Code § 65.2-101. “Upon its own motion or upon the application of any party in interest, on the ground of a change in condition, the Commissio n may review any award of compensation and on such review may make an award ending, dimin ishing or increasing the compensation previously awarded . . . .” Code § 65.2-708 (emphasis added). Where the compensable consequence is a change in condition of the origina l injury after the award, a new claim in not required. See Ser gio’s Pizza v. Soncini, 1 Va. Ap p. 370, 375, 339 S.E.2d 204, 207 (1986) (“In fact, the Commission is authorized to conduct a rev iew for change of condition on its own motion at any time, subject t o due process limitations.”). Here, neither Code § 65.2-601 nor C ode § 65.2-708 applies. The only body part at issue is the medial femur condyle of the left knee. 3 Dr. Buchanan treated the area during arthroscopic surgery when he trimmed and smoot hed the cartilage. Dr. Buchan an later found the fracture in that area of the knee and trie d various treatments. Accordingl y, the subchondral fracture of the left femur condyle at issue here is not a new injury to a diffe rent body part; as factually determined by the Commission, it wa s a subsequent injury in the form of a stress fracture to the very same area of the left knee di rectly related to the surgica l reshaping of a portion of the knee

3 Those who suffer workplace injuries typically lack the precisi on in describing an injured body part that a medical professional would use. It is sufficient to use the commonly understood name for a body part whe n notifying an employer or t he Commission of injuries resulting from a workplace acciden t. The term “knee” generallyrefers to “a joint . . . in the middle part of the human leg tha t is the articulation between t he femur, tibia, and patella . . . the part of the leg that includes thi s joint[.]” Knee, Webster’s T hird New Internati onal Dictionary (1993); see also Vol. 2 Lawyers’ Medical Cyclopedia § 11.27 (6th ed. 2017).- 10 - done as part of the procedure to r epair the damage from the ori ginal workplace injury. Hope was not required to file a claim for new injury under Code § 65.2-6 01. Neither could the Commission review the award for change of condition pursuant to Code § 65.2-708 because no award had yet been given. Until now, we have not had occasion to address notice requirements for compensable consequences, s uch as aggravation or complicati ons due to medical treatment, to the original injury that occur prior to the initi al award. The Act focuses on treatment t o the injured body part. It requ ires employer to provide medical benefits related to Hope’s compensable injury “as long as necessary after [the] accident” and “[any] other necessary medical attention related to the compensable injury.” See Woodson, 45 Va. App. at 678, 613 S.E.2d at 482 (quoting Code § 65.2-603( A)(1)) (emphasis added). An employer is responsible for the medically necessary treatment r egardless of claimant’s “failure to specifically request an award of medical benefits in [his] appl ication to the commission.” See id. at 678, 613 S.E.2d at 483. Moreover, “ we have held that, as lo ng as the employee’s application for benefits provides an empl oyer with notice ‘of the potential issues in a case,’ the claim will satisfy ‘minimal due process safeguards.’” Id. at 681, 613 S.E .2d at 483 (quoting Johnson v. Paul Johnson Plastering, 37 Va. App. 716, 723, 561 S.E.2d 40, 4 4 (2002), rev’d in part on other grounds, 265 Va. 237, 576 S.E.2d 447 (2003)); Code § 65.2-708. Accordingly, we hold that since notice of a workplace injury cl aim to an employer is also sufficient notice that any medi cal treatment in the record of i njured body parts listed in the claim of benefits may be the basis of an award by the Commission, such notice necess arily includes the reasonable possibility of subsequent deterioration or c omplications of the primary in jury or aggravation of the primary injury due to medical or surgical tr eatment. If an employer wishes to defend against compensability f or any or all of the treatment t o the body part or parts listed on the claim form, it must do so at the hearing.- 11 - This reasoning comports w ith the principles of res judicata as well. Virginia’s application of the claim preclusion component of res judicata was best stated a century ago : “Every litigant should have opportunity to present whatever gr ievance he may have” but if given an opportunity to do so and “ having failed to avail himse lf of it, he must accept the consequences.” Miller v. Smith, 109 Va. 651, 655, 64 S.E. 956, 957 (1909). Thus, the “effect of a fina l decree is not only to conclude the parties as to every question actually raised and decided, but as to every claim which proper ly belonged to the subject of litigation and which the parties, bythe exercise of reasonable diligence , might have raised at the time .” Smith v. Holland, 124 Va. 663, 666, 98 S.E. 676, 677 (1919). Brock v. Voith Siemens Hydro Pow er Generation, 59 Va. App. 39, 46, 716 S.E.2d 485, 488 (2011). “These principles apply t o workers’ compensation cases .” Id. at 47, 716 S.E.2d at 488. Thus, “[a final award by the Comm ission] ‘bars relitigation of the same cause of action, or any part thereof which could have b een litigated between the same p arties and their privies.’” K & L Trucking Co. v. Thurber, 1 Va. App. 213, 219, 337 S.E.2d 299, 3 02 (1985). Where subsequent injury to the body part at issue in an initial claim is known t o the parties and evidenced in the record, it is properly consider ed by the Commission as part of the initial award. Given our holding that, for the purpose of procedural due proce ss, notice of a claim for medical benefits is also implie d notice of potential subsequent medical complications for the treatment of injuries to the named body part(s) injured, it onl y remains to determine if employer knew, or reasonably should have kn own, of any subsequent medica l complications. Here, the subsequently discovere d fracture of the medial condyl e of Hope’s left femur was part of the left knee, the only body part at issue in his c laim. Employer was clearly aware of the medical treatment by Dr. Badarudeen as evidenced by its den ial of those medical benefits, its correspondence with the Commi ssion, its submission of medical r ecords to the Commission, and its cross-examination of witnesse s regarding Dr. Badarudeen’s t reatment. Even though Hope did not check the box stating that he w as seeking a medical award i n his claim for benefits, he was- 12 - not required to do so. See Woodson, 45 Va. App. at 678, 613 S. E.2d at 483. He clearly stated on the claim form that the inj ured body part was “my left knee. Done [sic] had one surgery and waiting on a second one.” Because the body part listed on the claim was the body part at issue, no award had yet been entered, and t he medical treatment was inthe record provided to employer, Hope was not required t o file a new claim to provide notice to employer. We conclude that the Commission did no t err in finding employer ha d sufficient notice that treatment by Dr. Badarudeen, including the s ubsequent left total knee rep lacement surgery, would be a potential issue at the hearing. D. The Fracture was a Compensable Consequence Employer further argues that the Commission erred in finding th e left knee fracture to be a compensable consequence and in awarding Hope medical benefits for the treatment provided by Dr. Badarudeen. Under the Act, Hope was allowed to recover for “all the medical consequences and sequelae that flow from the primar y injury.” Berglund, 43 Va. App. at 750, 601 S.E.2d at 697. This included both complications of the original injury and agg ravation of the primary injury caused by medical or surgical treatment. See Woodson, 45 Va. App. at 679, 613 S.E.2d at 483; see also 1 Arthur Larson & Lex K. Larson, Larson’s Workers’ Com pensation Law § 10.09 (2018). Employer acknowledges that the fracture was discovered when Dr. Buchanan ordered an MRI due to Hope’s continued pain a fter arthroscopic surgery. T he Commission found that the MRI showed “a fracture of the medial femoral condyle with full thickness loss of articular cartilage.” Dr. Buchanan noted i n the medical record that the fracture could be explained by stresses on the knee during post- operative healing and he attem pted to treat the fracture as part of the left knee healing. Neither physical therapy nor injections into Hope’s knee reso lved the pain. The Commission noted that the treating physician “advised [Hope ] to avoid bearing weight on- 13 - his left lower extremity.” Des pite Hope’s continued pain in hi s left knee, Dr. Buchanan released him to full duty. The Commission concluded that “D r. Badarudeen’s finding that th ere was a definite connection between [Hope’s] stress fracture and his original in jury, when considered along with Dr. Buchanan’s opinion that the s tress fracture could be relate d to postoperative healing, is sufficient to establish the subc hondral fracture was a compensable consequence of [Hope’s] original injury.” The Commi ssion did not err. The Commission as the factfinder concluded, and the evidence in the record in the light most favorable to Hope, as the party that prevailed below, supports the conclusion that th e fracture found in the left kne e was a complication or aggravation of the primary injury, which is compensable. See 1 Arthur Lars on & Lex K. Larson, Larson’s Workers’ Compensation Law § 10.09 (2018). It was discovered during post-operative treatment and both Dr. Buchanan and Dr. Bad arudeen diagnosed the problem as cartilage loss in the area of the injury. Dr. Buchanan attri buted the cause to post-operativ e healing from the surgery, and Dr. Badarudeen linked the cartilag e loss to the workplace injury. Hope testified that he suffered ongoing pain and swelling of the lef t knee immediately after th e first surgery. Dr. Badarudeen’s treatment to address Hope’s continued pain and swelling in his left knee was thus compensable. E. Change in Treating Physician Employer argues the Commission err ed in ruling that Hope was fr ee to seek unauthorized treatment with Dr. Badarudeen a nd in awarding compensation for that treatment. It argues that if Hope continued to have pain and s welling in his knee, he should have returned to Dr. Buchanan. “As long as necessary after an accident, the employer shall fur nish or cause to be furnished, free of charge to the injured employee, a physician chosen by the injured employee from a panel of at least three physicians selected by the emplo yer and such other necessary medical attention.” Code § 65.2-603 (A)(1). “We have held that the employer’s denial of- 14 - liability under the Act is equi valent to a refusal to provide t he employee with medical services. The employer cannot refuse to pr ovide the employee with full me dical service and also insist that he seek medical care only from physicians it selects.” Goodyea r Tire & Rubber Co. v. Pierce, 9 Va. App. 120, 128, 384 S.E.2d 333, 338 (1989). “[W]here an ins urer denies liabi lity and refuses to pay compensation, the claimant is entitled to choose his ownphysician.” Trammel Crow Co. v. Redmond, 12 Va. App. 610, 615, 405 S.E.2d 632, 635 (1991). If in an emergency or on account of the employer’s failure to provide the medical care during t he period herein specified, or for other good reasons, a physician other than provided by the employer is called to treat the injured employee, during such period, the reasonable cost of s uch service shall be paid by th e employer if ordered so to do by the Commission. Code § 65.2-603(C). “Without a refe rral from an authorized tre ating physician, Code § 65.2-603(C) provides for treatm ent by an unauthorized physici an in an ‘emergency’ or ‘for other good reason.’” Shenandoah Products, Inc. v. Whitlock, 15 Va. App. 207, 212, 421 S.E.2d 483, 485 (1992). [I]f the employee, without authorization but in good faith, obt ains medical treatment different fro m that provided by the employer, and it is determined that the treatment provided by the employe r was inadequate treatment for the employee’s condition and the unauthorized treatment received by the claimant was medically reasonable and necessary treatment, the employer should be responsible, notwith standing the lack of pr ior approval by the employer. Id. at 212, 421 S.E.2d at 486. Here, Hope notified employer that he continued to experience pa in and swelling in his knee after Dr. Buchanan had rel eased him to full duty. Hope co nsulted with employer’s claim administrator before seeing Dr . Badarudeen for another opinion on his left knee pain. The record indicates that the claim adminis trator authorized Dr. Badarudee n to take an MRI of Hope’s left knee “without prejudice.” Nothi ng in the record indicates thatemployer instructed Hope to- 15 - return to Dr. Buchanan. The C ommission did not err in concludi ng that Hope’s actions were a good faith attempt to procure ap propriate medical attention. S ee id. Dr. Buchanan released Hope to full duty even though Hope continued to experience pain and swelling in his knee. Hope was in constant pain, and his family doctor had removed a large volume of f luid from the knee on several occasions. Hope sought advice from both employ er’s claim administrator and his cousin, who was deposed in t his case. Evidence supported aconclusion by the Commission that Dr. Buchanan’s treatment wa s inadequate and that Dr. Badar udeen’s treatment was “medically reasonable and necessary” under the circumstances. See id. Accordingly, “employer should be responsible, notwithsta nding the lack of prior approv al by the employer.” Id. Moreover, when employer denied liability for further treatment of Hope’s left knee and refused to pay for the left knee replacement, Hope was entitled to choo se his own treating physician. See Redmond, 12 Va. App. at 615, 405 S.E.2d at 635. Because treatment of Hope’s left knee was covered as either the original injury or an aggravation of the injury, the m edical treatment of the left kn ee was compensable. Employer was required to provide, “as long as necessary after an acciden t,” compensation for medical expenses “and [any] other necessa ry medical atte ntion related t o the compensable injury.” Woodson, 45 Va. App. at 678, 613 S.E .2d at 482. The Commissiondid not err in concluding that Hope was justified in seeki ng treatment with Dr. Badarudee n and that employer was responsible for the medical expenses. F. Continuing Wage Loss Finally, employer argues that t he Commission erred in awarding Hope continuing wage loss benefits because a “To Whom It May Concern” note was not s ufficient to meet Hope’s burden of proving ongoing disability.- 16 - A party seeking workers’ comp ensation bears the burden of provi ng his disability and the periods of that disability. S ee Hoffman v. Carter, 50 Va. App. 199, 216, 648 S.E.2d 318, 327 (2007). Furthermore, “[t]here is no presumption in the law tha t once a disability has been established, a claimant will be assumed to remain disabled for an indefinite period of time.” Id. (alterations in origin al) (quoting Marshall Erdman & Assocs. v. Loehr, 24 Va. App. 670, 679, 485 S.E.2d 145, 149 (1997)). Whether Hope suffered a continuin g disability is a question of fact. Id. “[W]e are bound by the co mmission’s factual finding s supported by credible evidence, despite the fact that there ma y be evidence to support a contrary finding.” Id. at 209, 648 S.E.2d at 323 (referencing Watkins v. Halco Eng’g., Inc., 225 Va. 97, 101, 300 S.E.2d 761, 763 (1983)). “The opinion of the treating phys ician is entitled to great we ight, although the commission is not required to acc ept it[.]” Un ited Airlines, I nc. v. Hayes, 58 Va. App. 220, 238, 708 S.E.2d 418, 427 (2011) (referencing Pilot Freight Carriers, Inc. v. Reeves, 1 Va. App. 435, 439, 339 S.E.2d 570, 572 (1986)). The Commission accepted as e vidence of Hope’s disability a letter on clinic lette rhead, which listed D r. Badarudeen by nam e, addressed “To Whom It May
Concern.” 4 Dated August 31, 2016, the letter stated that Hope would be a bsent from work from May 13 through October 3, 2016. It note d that surgery was sche duled for October 3, 2016. The Commission was permitted to afford “great weight” to the note s ince, at that time, Dr. Badarudeen was Hope’s trea ting physician. See id. The Commission also expressly noted Hope’s “ongoing symptoms, conserva tive treatment that had been provided without granting relief, and that damage to the cla imant’s cartilage ‘was far to o advanced to have any kind of

4 Employer argues that the Commission erred in accepting the letter because it was addressed “To Whom It May Concern.” We note that employer reli es upon Dr. Buchanan’s “To Whom It May Concern” letter to s how Hope was released to full d uty. In contrast to Dr. Buchanan’s unsigned, typed le tter, Dr. Badarudeen’s letter had handwritten information in the blanks and was signed, though the signature was not identif ied. Unlike Dr. Buchanan’s letter, Dr. Badarudeen’s letter was on a medical center letterh ead with his name pre-printed at the top.- 17 - cartilage restorative surgery.’” Because evidence in the recor d supported the Commission’s factual finding that Hope had e stablished an ongoing disability , we will not disturb it. See Hoffman, 50 Va. App. at 209, 648 S.E.2d at 323.
III. CONCLUSION Hope’s compensable left knee in jury included the related post-s urgical subchondral fracture of the left femur. Becau se the subsequent aggravationof the injury occurred before the initial award by the C ommission and employer was aware of the m edical treatment at issue, employer had sufficient notice th at the treatment could be incl uded in the award. The Commission did not err in any resp ect in awarding benefits base d upon Hope’s evidence of continuing disability. Accordingl y, we affirm the Commission’s decision. Affirmed.