COURT OF APPEALS OF VIRGINIA 

Present: Judges Bumgardner, Humphreys and Agee 

Argued at Salem, Virginia 

HOWELL METAL COMPANY/COMMERCIAL METALS 

 COMPANY AND HIGHLANDS INSURANCE GROUP 

 OPINION BY 

v. Record No. 1992-00-3 JUDGE RUDOLPH BUMGARDER, III 

 MARCH 27, 2001 

MICHAEL BRANDON ADAMS 

 FROM THE VIRGINIA WORKERS' COMPENSATION COMMISSION 

 Thomas G. Bell, Jr. (Timberlake, Smith, 

Thomas & Moses, P.C., on brief), for 

appellants. 

 Linda D. Slough (Brian J. McNamara; Chandler, 

Franklin & O'Bryan, on brief), for appellee. 

 Howell Metal Company and its insurer appeal the Workers' 

Compensation Commission's decision that psychiatric treatment 

for Michael Brandon Adams was causally related to his work 

injury. We conclude the evidence did not support the finding 

and reverse the decision. 

 On October 21, 1998, the employee received chemical burns 

to his feet, and the employer accepted the claim as compensable. 

In March 1999, the employee's treating physician referred him to 

a psychiatrist. The employee filed an application for payment 

of psychiatric services claiming the need for treatment arose 

out of his work injury. The deputy commissioner denied the 

application finding that the employee had not established the 
psychiatric treatment was "causally connected to his chemical 

burns of 1998." The full commission reversed and awarded 

psychiatric benefits for as long as necessary. 

The employee's treating physician, Dr. Steven L. Phillips, 

noted on February 8, 1999: "I think he has more problems with 

anxiety and depression associated with this injury than he does 

have physical injury itself. I think the sympathetic response 

might be tied in with his emotional response to the entire 

affair and that he might benefit from treatment of anxiety and 

depression." The doctor prescribed an anti-depressant. 

On February 17, 1999, Dr. Phillips assessed the employee's 

condition: "Bilateral burns to feet with persisting symptoms 

with some perpetuation probably resulting from anxiety and 

depression related to the injury." On February 25, 1999, the 

assessment was similar: "Bilateral foot burns with prolonged 

symptoms possibly contributed to by anxiety/depression related 

to the injury." 

On March 31, 1999, Dr. Phillips referred the employee to 

Dr. Jeffrey K. Lightner, a psychiatrist. Dr. Phillips explained 

that he referred the employee "for a psychiatric evaluation in 

order to properly define his condition and also to help 

determine how much of it is related to his work injury. I 

realize that this latter task may be difficult but may be very 

important to the patient as well as his employer." In the 

letter, Dr. Phillips noted, "There may be an element of 

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sympathetically maintained pain involved here . . . ." He 

concluded, "I felt it wise to have him see a professional for 

accurate diagnosis and treatment if needed." 

 Dr. Lightner diagnosed the employee on April 1, 1999 with 

bipolar paranoid reaction. He never made a narrative report of 

his diagnosis. The employee's counsel solicited Dr. Lightner's 

opinion on the causal relation in a one-question letter: "Is it 

your opinion, to a reasonable degree of medical certainty, that 

the treatment you are providing Michael Adams is reasonable, 

necessary, and causally related to his work injury of October 

21, 1998?" The letter provided spaces to check either "yes" or 

"no." Dr. Lightner did not mark one of the two indicated 

answers. Instead, he interlined, "to some degree, but I don't 

know patient's mental state prior to the injury," and drew an 

arrow to the space for indicating the "yes" response. 

Dr. Phillips's notes and letter show that he had not 

reached a decision about the cause of the employee's psychiatric 

condition. Perplexed by the employee's condition, he referred 

the employee to a psychiatrist and deferred to that specialist 

for diagnosis and treatment. Dr. Phillips's note of May 3, 

1999, made after Dr. Lightner's diagnosis, stated the disorder 

was not related to the injury. The employee's "affective 

disorder itself is not a work related illness[,] however his 

work injury may have had some effect on it." In his final 

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response to counsel's inquiry, he could only say that the 

referral itself was "possibly" related to the injury. 

The parties argue opposing interpretations of 

Dr. Lightner's response to counsel's questionnaire. We need not 

choose between them because either would be insufficiently 

based. Dr. Lightner qualified his response "but I don't know 

patient's mental state prior to the injury." The response made 

clear the doctor could not answer the question without the 

patient's history for the last ten years. He could not answer 

the question in the format in which it was posed because he did 

not have sufficient medical history upon which to base an 

opinion. 

Dr. Phillips's note of May 3, 1999 also noted that the lack 

of adequate history prevented him from giving an opinion on 

causation: "I explained to [the employee] that I would be 

unable to say how much effect that the work accident had since I 

have no knowledge of his status prior to three months following 

the injury." In their concluding opinions, both doctors 

indicated they needed additional medical history before 

rendering an opinion on the relation of the psychiatric 

condition to the injury. The commission erred in finding the 

medical evidence credible when it lacked a sufficient base. 

Clinchfield Coal Co. v. Bowman, 229 Va. 249, 252, 329 

S.E.2d 15, 16 (1985), held the commission erred in attributing 

weight to medical evidence based upon a faulty premise. The 

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Court reversed the commission's finding that the doctor was 

credible because the doctor's opinion was based on erroneous 

information supplied by the claimant. "In Dr. McIlwain's first 

report, he assumed that the condition he discovered resulted 

from the 1978 accident. The basis for this assumption was the 

incomplete information furnished by Bowman." Id. at 251-52, 329 

S.E.2d at 16 (emphasis in original). "Whenever a physician's 

diagnosis flows from an assumption that rests upon a faulty 

premise, such as misinformation provided by a claimant, the 

commission may refuse, and often will be required to refuse, to 

attribute any weight to that opinion." Sneed v. Morengo, Inc., 

19 Va. App. 199, 205, 450 S.E.2d 167, 171 (1994) (citation 

omitted). Drs. Phillips's and Lightner's reports were 

insufficient to establish a causal connection between the 

employee's work injury and his psychiatric condition beyond mere 

conjecture. 

The employee testified that ten years before the accident 

he began to drink heavily after his six-month-old son died. He 

admitted himself to a 30-day in-patient alcohol treatment 

program, but he had not had any problems requiring psychiatric 

treatment since then. He had not been diagnosed with either 

bipolar disorder or paranoia before Dr. Lightner's diagnosis. 

An employee's testimony may be considered in determining 

causation, particularly where the medical evidence is 

inconclusive. Russell Stover Candies v. Alexander, 30 Va. App. 

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812, 826, 520 S.E.2d 404, 411 (1999). However, the employee's 

statement that he did not receive psychiatric treatment for ten 

years does not constitute evidence that his current condition 

was causally related to his work injury. Causation is a factual 

question that must be supported by credible evidence. McPeek v. 

P.W. & W. Coal Co., 210 Va. 185, 188, 169 S.E.2d 443, 445 

(1969). 

We conclude that neither the medical evidence nor the 

employee's testimony is sufficient to prove causation. "If the 

expert medical witnesses cannot testify that it is at least more 

probable than not that the disease arose out of and in the 

course of employment, compensation must and should be denied, 

not because the law requires more of medicine than it can 

produce, but because the law requires more than simply proof 

that the disease 'might' have been caused by a particular 

result." Westmoreland Coal Co. v. Campbell, 7 Va. App. 217, 

224, 372 S.E.2d 411, 416 (1988). Accordingly, we reverse. 

 Reversed.

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