Present: All the Justices 

AMOCO FOAM PRODUCTS 

COMPANY 

OPINION BY JUSTICE A. CHRISTIAN COMPTON 

v. Record No. 980139 January 8, 1999 

ESSIE L. JOHNSON 

FROM THE COURT OF APPEALS OF VIRGINIA 

 In this appeal of an award under the Workers' Compensation 

Act, we review the Court of Appeals' application of the doctrine 

of compensable consequences. 

 In July 1992, appellee Essie L. Johnson, the claimant, 

sustained a compensable left ankle injury that arose out of and 

in the course of her employment with appellant Amoco Foam 

Products Company, the employer. Following lengthy treatment and 

June 1994 surgery on the ankle, the claimant fell at home in 

August 1994 while recovering from the surgery when the ankle 

gave way, causing injury to her right knee. 

 In a September 1995 opinion, the Workers' Compensation 

Commission affirmed a deputy commissioner's ruling that the 1994 

right knee injury was a compensable consequence of the July 1992 

industrial accident, and awarded compensation accordingly. The 

self-insured employer did not appeal this award. 

 The present case arises from the claimant's application 

seeking payment of compensation as a result of a further right 
knee injury that occurred in November 1995 when her right knee 

"gave out" at home causing her to fall. The claimant sought 

permanent disability benefits as a result of a 20% loss of use 

to the right leg caused by the August 1994 compensable 

consequence injury. The claimant also sought compensation for a 

period of total work incapacity of about 30 days during 

November-December 1995 as a result of the further right knee 

injury occurring in November 1995. 

 In a January 1997 opinion, the Commission affirmed a deputy 

commissioner's decision awarding benefits. The deputy found 

that the claimant's November 1995 fall was a compensable 

consequence of her August 1994 accident, which, in the 

Commission's words, "was previously adjudged to be a compensable 

consequence of the claimant's original industrial injury." 

 Following the employer's appeal, a panel of the Court of 

Appeals unanimously affirmed the Commission. Amoco Foam Prod. 

Co. v. Johnson, 26 Va. App. 267, 494 S.E.2d 169 (1997). In 

framing the issue, the Court of Appeals said: "The 

determination that the 1994 knee injury was a compensable 

consequence of claimant's ankle injury is res judicata. It is 

undisputed that claimant's original 1992 injury was not the 

immediate cause of her 1995 injury. Consequently, the issue 

before us is whether as a matter of law the commission may award 

benefits for an injury caused by a compensable consequence, or, 

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in other words, whether a claimant may recover for a compensable 

consequence of a compensable consequence." Id. at 273, 494 

S.E.2d at 172. 

 Answering the question in the affirmative, the Court of 

Appeals stated: "In the instant case, the evidence established 

that claimant's 1995 knee injury was causally related to her 

1994 knee injury which was causally related to her initial ankle 

injury. This chain of causation is direct and natural, and 

there is no evidence of any intervening cause attributable to 

claimant's conduct. Furthermore, claimant's 1994 compensable 

consequence knee injury becomes a primary injury, and the injury 

it caused in 1995 is clearly a compensable consequence of it. 

We hold that claimant's November 1995 knee injury is a 

compensable consequence of her 1994 knee injury and of her 1992 

ankle injury." Id. at 275-76, 494 S.E.2d at 173-74. The 

employer appeals. 

 The question is whether the Court of Appeals was correct in 

answering the foregoing question affirmatively. We hold that 

the court erred. 

 Any discussion of the doctrine of compensable consequences 

must recognize the basic concept that a disputed accidental 

injury must arise out of and be in the course of employment in 

order to be compensable. See Code § 65.2-101 (defining 

"Injury"). 

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 This Court first addressed the compensable consequences 

idea in Immer and Co. v. Brosnahan, 207 Va. 720, 152 S.E.2d 254 

(1967). There, the question presented was "whether an employee 

who suffers a compensable injury may be awarded compensation for 

additional injuries suffered in an automobile accident occurring 

while the employee is en route from his place of employment to a 

doctor's office for further treatment of the original injury." 

Id. at 721, 152 S.E.2d at 255. The Court stated, regarding the 

second injury, "[t]he struggle seems to be with determining 

whether such an additional injury 'arises out of the 

employment.' The eternal search in making the . . . 

determination is to find the presence or absence of a 'causal 

connection' between the incidents of employment and the 

additional injuries." Id. at 722, 152 S.E.2d at 255-56. 

Affirming the employee's award of compensation, the Court said 

the evidence in that case established such a causal connection. 

Id. at 728, 152 S.E.2d at 259. 

 Citing Brosnahan, the Court discussed the doctrine of 

compensable consequences in Leonard v. Arnold, 218 Va. 210, 237 

S.E.2d 97 (1977). There, a claimant was injured in a restaurant 

when he fell while on crutches required for treatment of an 

initial industrial injury. This Court pointed out that the 

"doctrine extends the canopy of the Workman's Compensation Act 

to the resulting injury . . . because the second injury is 

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treated as if it occurred in the course of and arising out of 

the employee's employment." Id. at 214, 237 S.E.2d at 100. 

 Under the Brosnahan test, the crucial inquiry here is 

whether there is a causal connection between the incidents of 

employment giving rise to the 1992 ankle injury and the 

additional 1995 knee injury. The record in this case clearly 

establishes there is not. 

 The Court of Appeals stated: "It is undisputed that 

claimant's original 1992 injury was not an immediate cause of 

her 1995 injury." This conclusion is fully supported by the 

relevant medical testimony. The claimant's attending physician 

reported in April 1996: "Essie Johnson fell originally in 

August of 1994. She had another fall in November 1995, but I 

tend to think that this was largely due to the injury of August 

1994. She was having pain at the time of November 1995 

following the injury of August 1994 and her knee 'buckled' on 

her. I tend to think that her continued pain is what actually 

caused her to buckle, and that this is all causily [sic] related 

to the August 1994 injury." 

 In sum, the record fails to establish a causal connection 

between the original injury and the November 1995 injury, a 

requirement for compensability of the latter injury. In other 

words, the latter injury did not arise out of the employment 

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because there is absence of a causal connection between the 

incidents of claimant's employment and the 1995 injury. 

 Under these circumstances, contrary to the Court of 

Appeals' ruling, it does not logically follow that merely 

because the 1994 injury was causally related to the 1992 

accident and the 1995 injury was causally related to the 1994 

injury, then the 1995 injury was causally related to the 1992 

accident. The link of causation must directly connect the 

original accidental injury with the additional injury for which 

compensation is sought. Thus, the Court of Appeals erred in 

holding that claimant's November 1995 knee injury was a 

compensable consequence of her 1992 ankle injury. 

 Accordingly, we will reverse the judgment of the Court of 

Appeals affirming the award of compensation for total work 

incapacity from November 13 through December 12, 1995, and will 

enter final judgment here dismissing the application for those 

benefits. This judgment, however, does not affect the award of 

compensation "for 20% permanent loss of the right leg." Those 

permanent disability benefits are not legitimately in question 

in this appeal because they were based on the ruling that the 

August 1994 injury was a compensable consequence of the 1992 

injury, a ruling that was not appealed. 

Reversed and final judgment.

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