COURT OF APPEALS OF VIRGINIA 

Present: Judges Benton, Humphreys and Senior Judge Overton 

TRELLIS CAFÉ RESTAURANT AND GRILL 

 AND MERCHANTS OF VIRGINIA GROUP 

 SELF-INSURANCE ASSOCIATION 

 MEMORANDUM OPINION*

v. Record No. 0499-03-1 PER CURIAM 

 JULY 1, 2003 

JEAN B. DANO 

 FROM THE VIRGINIA WORKERS' COMPENSATION COMMISSION 

 (Arthur T. Aylward; Thomas C. Bunting; 

Midkiff, Muncie & Ross, P.C., on briefs), for 

appellants. 

 (Stephen F. Forbes; Mark C. Grohler; 

Forbes & Broadwell, on brief), for appellee. 

 Trellis Café Restaurant and Grill and its insurer contend 

the Workers' Compensation Commission erred in finding that 

(1) Jean B. Dano sustained a low back injury as a result of her 

November 13, 1998 compensable injury by accident; (2) Dano 

proved that she developed Chronic Regional Pain Syndrome/Reflex 

Sympathetic Dystrophy (CRPS/RSD) as a result of her injury by 

accident; (3) Dr. Mark Newman's opinions were credible; 

(4) Dano's fall on January 14, 2001 was caused, in part, by her 

compensable knee injury; and (5) Dano's January 14, 2001 fall 

was causally related under the "two causes rule" to her 

 

* Pursuant to Code § 17.1-413, this opinion is not 

designated for publication. 
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compensable knee injury. Upon reviewing the record and the 

parties' briefs, we conclude that this appeal is without merit. 

Accordingly, we summarily affirm the commission's decision. 

Rule 5A:27. 

I. 

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

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

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

Furthermore, we will uphold on appeal the commission's factual 

findings if they are supported by credible evidence. See James 

v. Capitol Steel Constr. Co., 8 Va. App. 512, 515, 382 S.E.2d 

487, 488 (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). 

Low Back Injury

 The commission affirmed the deputy commissioner's finding 

that Dano's claim associated with her low back injury was barred 

by the statute of limitations. Dano did not appeal that ruling. 

Thus, the issue whether the commission erred when it found that 

Dano sustained a low back injury at the time of her compensable 

November 13, 1998 injury by accident is moot. We, therefore, 

will not address it on appeal. 

CRPS/RSD

 In ruling that Dano proved that she developed CRPS/RSD as a 

result of her compensable November 13, 1998 injury by accident, 
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the commission gave greater weight to the opinions of Dr. Mark 

Newman and Dr. Jeffrey D. Moore, the treating physicians. In so 

ruling, the commission made the following findings: 

[Dano] suffered from a significant 

work-related injury to her left knee 

necessitating two surgeries. While we 

recognize that the pain in [Dano's] left 

knee improved throughout 1999 to the point 

that Dr. Newman believed she could return to 

work with certain limited restrictions, we 

also note that [Dano] continued to complain 

of pain in her left knee from the time of 

her industrial accident until immediately 

before her fall on January 14, 2001. In the 

opinion of Dr. Newman, [Dano] developed 

CRPS/RSD as a direct result of her 

work-related injury and that her CRPS/RSD 

caused her continued pain after her two 

surgeries in 1999. 

 Dr. Newman's opinion is supported by 

the conclusion of Dr. Moore, another of 

[Dano's] treating physicians, who thought 

[Dano] was "dealing with a RSD process" when 

he referred her to Dr. Newman. Dr. Gibson, 

an orthopedist, also examined [Dano] on 

October 5, 1999, and concluded that [she] 

"probably" suffered from RSD. 

 In contrast, Dr. Ross, who examined 

[Dano] on behalf of the employer on October 

13, 1999, questioned [Dano's] diagnosis of 

CRPS/RSD. However, Dr. Ross acknowledged 

that there was a temperature differential 

between [Dano's] two limbs -- a symptom of 

CRPS/RSD. Dr. Ross also did not completely 

rule out the possibility that [Dano] 

suffered from CRPS/RSD when he noted that 

her positive reaction to a lumbar 

sympathetic block "would support the 

diagnosis of [RSD/CRPS]." 

 The only doctor who has definitely 

opined that [Dano] did not develop CRPS/RSD 

as a result of her injury on November 13, 

1998, is Dr. Broder. Dr. Broder never 
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examined [Dano]. He merely examined [her] 

medical records and his review of those 

records appears to have been selective and 

somewhat flawed. Moreover, while Dr. 

Newman's expertise is the field of pain 

management and thereby implies a certain 

degree of experience in diagnosing CRPS/RSD, 

Dr. Broder's area of expertise is unclear 

from the record. 

 We also reject the employer's attempt 

to discredit Dr. Newman's diagnosis of 

CRPS/RSD based upon [Dano's] alleged failure 

to advise Dr. Newman of her assault of 1999. 

Dr. Newman never testified that [Dano] did 

not, in fact, advise him of this incident. 

Instead, he testified that he did "not 

recall" if she did. Regardless, 

Dr. Newman's letter dated October 25, 1999, 

to Dr. Moore reflects that [Dano] did tell 

Dr. Newman about her assault soon after it 

occurred. 

 "Medical evidence is not necessarily conclusive, but is 

subject to the commission's consideration and weighing." 

Hungerford Mechanical Corp. v. Hobson, 11 Va. App. 675, 677, 401 

S.E.2d 213, 215 (1991). In its role as fact finder, the 

commission was entitled to weigh the medical evidence. It did 

so and accepted the opinions of the treating physicians, while 

rejecting the contrary opinions of Dr. Ross and Dr. Broder. 

"The fact that there is 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). The opinions of 

Dr. Newman and Dr. Moore constitute credible evidence to support 

the commission's decision. 
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Dano's January 14, 2001 Fall

 Dano testified that on January 14, 2001, immediately before 

she fell and broke her leg, she "had some twitching in [her] 

left knee, and [she] went to step down, and it didn't hold [her] 

weight, and [she] fell." As fact finder, the commission 

accepted Dano's testimony regarding the January 14, 2001 

accident as credible. The commission also concluded that no 

evidence in the record established that Dano ever told anyone 

that she "slipped and fell down while walking on wet stairs at 

home." It is well settled that credibility determinations are 

within the fact finder's exclusive purview. Goodyear Tire & 

Rubber Co. v. Pierce, 5 Va. App. 374, 381, 363 S.E.2d 433, 437 

(1987). 

 Based upon Dano's testimony and the medical evidence, the 

commission ruled that Dano's January 14, 2001 fall was caused, 

in part, by her pre-existing left knee condition. In so ruling, 

the commission found as follows: 

As late as January 10, 2001, just four days 

before her accident, [Dano] complained of "a 

grinding sensation with either going up or 

down stairs" and "an intermittent sharp, 

stabbing sensation at the inferior medial 

portion of her patella." These complaints 

of pain are consistent with [Dano's] later 

description of her fall. 

 We acknowledge that [Dano's] treating 

physician has opined that her fall on 

January 14, 2001, was caused, at least in 

part, by a back spasm. However, he also 

opined that [Dano] probably would have 

fallen due to the condition of her knee even 
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if she had not suffered from back pain 

before she fell. [Dano] testified that she 

fell after she felt a back spasm and after 

she felt a sensation in her left knee. We 

conclude, therefore, that [Dano] fell 

because of two causes, one of which -- her 

back pain -- relates to an injury which is 

barred by the statute of limitations and one 

of which -- the pre-existing condition of 

her left knee -- was a compensable injury. 

 The "two-causes rule" provides that a condition which has 

two causes, one related to a work injury, and one not, is 

compensable and the treatment of that condition is the 

employer's responsibility. See Shelton v. Ennis Bus. Forms, 

Inc., 1 Va. App. 53, 55, 334 S.E.2d 297, 299 (1985). In 

addition, the commission may consider the testimony of a 

claimant in determining causation. Henrico County School Bd. v.

Etter, 36 Va. App. 437, 444, 552 S.E.2d 372, 375 (2001). 

Contrary to employer's argument, the "more probable than not 

rule" is not applicable to this case because that rule 

"'addresses those cases where only one of a number of possible 

factors caused the disability.'" Id. at 446, 552 S.E.2d at 376 

(citation omitted). 

 Dano's testimony, the medical records substantiating her 

continuing complaints of ongoing knee pain, and Dr. Newman's 

opinion provide credible evidence to support the commission's 

finding that Dano's January 14, 2001 fall was caused, in part, 

by her compensable November 13, 1998 knee injury. Accordingly, 

that finding is binding and conclusive upon us on appeal. 
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II. 

 For these reasons, we affirm the commission's decision. 

Affirmed.