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. 

 

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

designated for publication. 
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 "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, 
 -3- 

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 
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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 
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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.