COURT OF APPEALS OF VIRGINIA 

Present: Judges Frank, Petty and Senior Judge Bumgardner 

Argued at Richmond, Virginia 

DANIEL PETER MOLLOY 

v. Record No. 2552-05-3 

ABBEYSHROUL, INC. AND 

 HARLEYSVILLE MUTUAL 

 INSURANCE COMPANY MEMORANDUM OPINION*

 BY 

 JUDGE RUDOLPH BUMGARDNER, III 

HARLEYSVILLE MUTUAL JULY 18, 2006 

 INSURANCE COMPANY 

v. Record No. 2606-05-3 

DANIEL PETER MOLLOY 

 FROM THE VIRGINIA WORKERS’ COMPENSATION COMMISSION 

 Richard L. McGarry for Daniel Peter Molloy. 

 Michael F. Blair (Tracey Alice Berry; Penn, Stuart & Eskridge, on 

briefs), for Harleysville Mutual Insurance Company. 

 No brief or argument for Abbeyshroul, Inc. 

 Daniel Peter Molloy appeals a decision of the Workers’ Compensation Commission 

denying his claim for benefits and medical expenses related to his injury by accident. The 

claimant contends the commission erred in finding that an independent intervening cause 

attributable to his own intentional conduct caused the amputation of his right arm.1

 On 

 *

 Pursuant to Code § 17.1-413, this opinion is not designated for publication.

1

 While claimant presents three questions in his brief, all three questions relate to the 

commission’s finding that he failed to prove the right arm ischemia and subsequent amputation 

constituted a compensable consequence of his February 10, 2004 injury by accident. We address 

those questions as they relate to that one issue. 
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cross-appeal, Harleysville Mutual Insurance Company contends the commission erred in finding 

an injury by accident arising out of and in the course of his employment and in denying its 

motion to reopen the record for additional testimony. We conclude that credible evidence 

supports the commission’s decision and affirm. Accordingly, we need not address the issues 

raised on cross-appeal.2

 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). The claimant 

was a general manager of Freddy’s Sunset Grill. On the evening of February 9, 2004, he had an 

after-hours meeting with his dining room manager at the restaurant. By the time the meeting 

ended, it was around 1:30 a.m., on February 10, 2004. As the claimant exited the restaurant from 

a side door, he slipped on an icy step and hurt his right arm. 

 The claimant drove to the emergency room, but left before being treated even though he 

believed his arm was broken because he thought the emergency room was too crowded. He went 

home, wrapped his arm with ice in a towel, changed his clothes for bed, and took two Percocet3

that Dr. Gregory Riebel had previously prescribed for him for a back and neck injury. Thirty to 

forty-five minutes later, the claimant took two more Percocet and went to bed. 

 Between 3:30 a.m. and 4:00 a.m., the claimant got out of bed because his arm was 

swollen and painful. He unsuccessfully tried to call his girlfriend. He stated that the pain 

worsened and he became lightheaded “like [he] was going to pass out and [he didn’t] remember 

exactly what happened.” He believed he was “out” for three to four hours. When he awoke 

around 8:00 a.m., he was “foggy” and his arm was “worse.” He described his condition: 

 2

 Abbeyshroul, Inc., the employer, did not participate in the appeal before the full 

commission. 

3

 The commission noted, “Percocet is a brand name for a narcotic analgesic that is used to 

treat moderate to moderately severe pain.” 
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I picked my arms up my fingers went down to my elbow and my 

palm was resting on my forearm and prior to this it was probably 

the worst pain I’ve ever experienced, but at this point I thought I 

was dying and I had, on the surface of my skin I was getting 

different types of like red dots coming to the surface and exploding 

and just fading out. 

He described his hand as being “completely dead.” He made several calls, and at some point, his 

daughter arrived and drove him to the hospital, followed by an ambulance that had responded to 

the claimant’s 911 call. 

 The claimant admitted that he took ten Percocet over the twenty-four-hour period before 

he entered the hospital. He took six Percocet before the meeting that night and four after he 

arrived home.4

 Each Percocet was ten milligrams. The claimant also admitted that pursuant to 

Dr. Riebel’s February 3, 2004 prescription for the Percocet, the most recent prescription obtained 

by the claimant, the maximum recommended dosage was one pill every eight hours. However, 

the claimant asserted that he was told he could take one to two Percocet every four to six hours 

as needed for pain. 

 The hospital emergency department triage notes indicated the claimant “appears 

drugged,” has “slow slurred speech,” and “trouble staying awake.” Those notes also listed the 

claimant’s current medications as Valium and Percocet and that he denied injury. The 

Emergency Physician Report indicated that the claimant took “valium 10 mg and percocet 10 mg 

this AM,” and there was no recent injury. The claimant denied remembering anything about 

what he told the medical personnel about the accident or his injury when he arrived at the 

hospital. 

 Dr. Laurie King, the emergency room physician who examined the claimant, noted that 

the claimant was seen in the emergency room two days earlier, and since then had increasing 

 4

 A Pre-Anesthesia Evaluation form dated February 10, 2004 indicated that claimant 

“took 10 percocet today.” That form also indicated claimant complained of “sev. arm pain, but 

drops off to sleep v. easily.” 
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right shoulder to arm pain with decreased ability to move the arm and decreased sensation. She 

also recorded that the claimant “took valium 10 mg and percocet 10 mg this AM.” Dr. King 

checked the box “no” under whether there was a “recent injury,” but noted that the claimant said 

he “lifted heavy pot 2 [days] ago.” Dr. King noted that the claimant “falls asleep easily when not 

stimulated.” She assessed ischemia of the right upper extremity. The claimant was admitted to 

the hospital. 

 Dr. William Z. H’Doubler examined the claimant February 10, 2004. Dr. H’Doubler 

noted that over the past twenty-four hours the claimant developed increasing pain in his right 

arm. He noted that the claimant “takes a lot of oral analgesics, as well as Percocet, etc., and he 

took a lot of these at home.” Dr. H’Doubler indicated that the claimant presented to the 

emergency room with a “profoundly ischemic right hand.” Dr. H’Doubler noted that the 

claimant “had end stage ischemic changes in the hand with insensate with no motor function and 

with flexion contracture in the fingers.” He diagnosed “[a]cute onset of right upper extremity 

ischemia, which is profound,” and “high risk of limb loss.” 

 Dr. Andrew Roth, a plastic surgeon who consulted on the claimant’s case at 

Dr. H’Doubler’s request on February 10, 2004, noted, “the prognosis is bleak for limb salvage 

below the elbow.” On February 12, 2004, Dr. Roth wrote, “prolonged compression of [right 

upper extremity]” was the “most likely” etiology of the claimant’s condition. 

 Dr. Vashist V. Nobbee examined the claimant on February 10, 2004. In a February 12, 

2004 report, Dr. Nobbee noted that the claimant reported he fell previously and developed 

significant trauma to his right forearm. Dr. Nobbee indicated that the claimant immediately 

noticed discoloration, which progressed to significant pain and discoloration. Dr. Nobbee opined 

“[c]ertainly, the recent trauma may account for the disruption of the arterial flow with evidence 

of thrombosis. However, embolic phenomena remain a concern.” 
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 Dr. Brian Torre examined the claimant February 11, 2004. Dr. Torre noted that the 

claimant sustained “an embolic phenomenon that actually has been going on apparently for quite 

some time intermittently.” Dr. Torre indicated that four days before the claimant’s admission, 

“he started to have severe episodes of pain and cramping in his right arm but presented to the 

emergency room 2/10/04 with obvious complete ischemia of upper extremity.” Dr. Torre noted 

that massive clots were removed and fasciotomies performed. 

 Dr. H’Doubler attempted vascular repair, but on February 14, 2004 Dr. Bertram Spetzler 

amputated the claimant’s arm because of continued ischemia and then gangrene. 

 In a March 19, 2004 discharge summary, Dr. Nobbee recorded that the claimant had 

fallen two weeks prior to admission and suffered significant and extensive right upper limb 

trauma but sought no treatment. Dr. Nobbee indicated that the claimant’s acute arterial occlusion 

of the distal forearm was thought to be related to this trauma, but studies, including MRA and 

TEE, excluded potential embolic sources for the occlusion. 

 Dr. Steven G. Harris, a plastic surgeon, who testified in a post-hearing deposition, treated 

the claimant for burns in 1999, and again in February 2004, after the amputation of the 

claimant’s arm. Dr. Harris testified that the claimant told him he had fallen, that his arm hurt 

after the fall, and that he went to the emergency room after trying to take care of himself. The 

claimant told Dr. Harris that as a result of the fall, he had lost circulation in his arm, and he had 

to have it amputated. The claimant told Dr. Harris that he was on a lot of pain medicine and he 

remembered seeing that his arm was black and in “awful condition” in the emergency room. 

Eventually, Dr. Harris referred the claimant to University of Virginia (UVA) for treatment. In 

describing the event to Dr. Drake at UVA, Dr. Harris stated as follows: 

 I told him that [the claimant] had lost the circulation to his 

arm, probably from compression, that he had been involved in a 

fall, had taken pain medication in an effort to try to make the pain 
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better, had been in one position for a period of time afterwards and 

lost the circulation to his arm. 

 There had been a delay in him coming to the emergency 

room following that episode, and by the time he got to the 

emergency room, his arm was not salvageable. In the operating 

room they did fasciotomies. The vascular surgeon tried to 

revascularize arm, never got good flow reestablished to the hand 

and forearm, and he ended up needing the amputation. 

 Dr. Harris agreed that taking medication and falling asleep on one’s arm was “certainly 

one of the explanations that could explain this phenomenon, this fairly unusual phenomenon.” 

When asked if taking ten Percocet, ten milligrams each, within a twenty-four-hour period, four 

of them within a forty-five-minute period, would make the claimant somewhat comatose, Dr. 

Harris acknowledged that as a plastic surgeon, he did not know the pharmacology of Percocet. 

Dr. Harris opined a person’s reaction to Percocet would be dependent upon body weight and 

narcotics tolerance. Dr. Harris did not know how much Percocet would affect the claimant, but 

he said that taking four Percocet in a forty-five-minute period is dangerous due to its Tylenol 

content. 

 Dr. Harris opined that the claimant “developed compartment syndrome after relatively 

minor trauma.” Dr. Harris did not believe that the claimant suffered from an embolism that 

traveled from another part of his body to his arm. Dr. Harris opined that the claimant had a loss 

of blood flow to his arm, and he offered the following opinion: 

 I think he had a minor injury, he took pain medicine, he 

was asleep for a long period of time, he woke up, his arm was 

black and had obviously had the circulation cut off, and I think it’s 

fair to say that some combination of the minor injury and a period 

of immobility together produced irreversible tissue death in his 

forearm. 

Dr. Harris did not believe that for a person “who had some experience with narcotics,” ten 

Percocet distributed over a twenty-four-hour period would be enough to put that person into a 

profound sleep. However, Dr. Harris opined that a person would have to have “some fairly 
- 7 -

profound pharmacologic or toxic agent on board to sleep through the kind of pain that we are 

talking about before you ever get to the black and grossly swollen stage.” When asked whether 

he had an opinion to a reasonable degree of medical certainty as to why the claimant passed out 

and what caused the period of immobility, Dr. Harris opined that “[t]he record leaves you with 

the impression that it was too much pain medicine, and I don’t know of anything else that was 

turned up during any of his workup or anything else that would lead you to any other 

conclusion.” Dr. Harris agreed “the most likely culprit is too much pain medication.” He 

explained as follows: 

[T]he pain medicine . . . decreases your awareness of pain . . . 

[and] makes you sleepy, [and] that’s a pretty good fit for being in a 

position, one position and not moving. 

 Your arm begins to hurt, but because you are out of it and 

the particular reason that you are out of it is you have a bunch of 

pain medicine on board, it allows you to stay in that terrible 

position for much longer than you would ordinarily do if this pain 

medicine was not in your system. 

Dr. Harris concluded that in his opinion “the fall was the event that led to this sequence of events 

that culminated in the amputation of [the claimant’s] arm.” He opined that it would take at least 

three to four hours of compression for the claimant’s arm to turn black, it’s not something that 

happens in fifteen or twenty minutes. 

 In answering a questionnaire provided to him by the claimant’s counsel, Dr. Harris 

indicated that he did not “believe this is a case of arterial embolism.” Dr. Harris opined that it 

was more likely than not that the degree of uninterrupted compression was a direct cause of the 

thrombi that necessitated the claimant’s amputation. Dr. Harris agreed that unconsciousness 

after the fall, with the arm underneath the chest for four to six hours, could cause blood stasis in 

that area. 
- 8 -

 Dr. Harris disagreed that “a fall on an outstretched [hyper-extended] hand, landing on a 

top, icy landing, with the patient’s buttocks landing three brick steps down, and thus, his forearm 

and upper arm striking the edge of the landing and step below, cause[d] an embolic episode 

which then caused arterial blockage.” Dr. Harris explained, “without significant artherosclerosis 

(hardening), the arterial wall would not be stiff enough to ‘crack’ when struck in this way. The 

elasticity of the arterial wall would make this mechanism of injury very unlikely. Prolonged 

compression is much more likely.” (Emphasis in original.) 

 Based upon this record, a majority of the commission found that while the claimant 

proved he sustained an injury by accident arising out of and in the course of his employment on 

February 10, 2004, he failed to prove that the ischemia and subsequent amputation of his right 

arm constituted a compensable consequence of that industrial accident. The majority found as 

follows: 

[T]he claimant’s self-medicating by consuming medication that 

was not prescribed for this injury, and in a quantity that far 

surpassed the recommended dosage, broke the chain of causation 

between the industrial accident and the amputation. Therefore, the 

amputation was not a compensable consequence of the industrial 

accident—claimant lost his arm because he fell asleep on it after 

taking ten Percocet. 

The majority relied upon the opinions of Drs. Roth and Harris as to the cause of the amputation. 

The majority found that the claimant “by taking more than three times the recommended dosage, 

acted willfully and intentionally. He reasonably should have known that this excessive abuse of 

prescribed medication could be expected to result in injury.” The majority concluded: 

The event that led to the amputation of the claimant’s arm was the 

result of an independent intervening cause attributable to the 

claimant’s own intentional misconduct. The claimant improperly 

took medication, and this broke the chain of causation between the 
- 9 -

original injury, the fall on the steps, and the subsequent 

consequence, amputation of the claimant’s arm. 

We agree.5

 Factual findings made by the commission will be upheld on appeal if supported by 

credible evidence. See James v. Capitol Steel Constr. Co., 8 Va. App. 512, 515, 382 S.E.2d 487, 

488 (1989). “We likewise defer to the commission’s ‘conclusions upon conflicting inferences 

legitimately drawn from proven facts’ – for inferences, like historic facts, are likewise ‘equally 

binding on appeal.’” Berglund Chevrolet, Inc. v. Landrum, 43 Va. App. 742, 750, 601 S.E.2d 

693, 697 (2004) (quoting Watkins v. Halco Eng’g, Inc., 225 Va. 97, 101, 300 S.E.2d 761, 763 

(1983)) (other citations omitted). Moreover, unless we can say as a matter of law that the 

claimant’s evidence sustained his burden of proof, the commission’s findings are binding and 

conclusive upon us. See Tomko v. Michael’s Plastering Co., 210 Va. 697, 699, 173 S.E.2d 833, 

835 (1970). 

In Berglund, we discussed the doctrine of compensable consequences recognizing the 

following: 

 The doctrine . . . attempts, in a single phrase, to summarize 

the attenuation limits of causation in workers’ compensation law. 

“The simplest application of this principle is the rule that all the 

medical consequences and sequelae that flow from the primary 

injury are compensable.” Virginia courts have often used just this 

description, as has the commission. 

 Where such a causal link exists, “the doctrine of 

compensable consequences extends the coverage of the Workers’ 

Compensation Act to the subsequent injury because the subsequent 

 5

 We recognize, as pointed out by claimant in his brief, that the commission on one 

occasion in its opinion used the phrase “intentional misconduct.” However, it is clear from the 

totality of the commission’s opinion and its recitation of the law of compensable consequences 

that the commission properly analyzed the claim in the context of that doctrine to determine 

whether claimant’s conduct constituted an independent intervening cause attributable to his own 

intentional conduct. As the claimant conceded at oral argument “intentional conduct” is 

sufficient to break the chain of causation. Bartholow Drywall v. Hill, 12 Va. App. 790, 794, 601 

S.E.2d 1, 3 (1991). It need not be “intentional misconduct.” 
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injury ‘is treated as if it occurred in the course of and arising out of 

the employee’s employment.’” The doctrine applies “when the 

injury does not arise on the day of the accident, but instead 

develops as a direct consequence of an initial injury.” 

 The doctrine has its limits, however. “The link of causation 

must directly connect the original accidental injury with the 

additional injury for which compensation is sought.” In other 

words, the issue is “essentially one of whether the medical 

evidence proves a causal connection between the primary injury 

and the subsequent occurrence.” “The issue in all of these cases is 

exclusively the medical issue of causal connection between the 

primary injury and the subsequent medical complications. By the 

same token, denials of compensation in this category have 

invariably been the result of a conclusion that the requisite medical 

causal connection did not exist.” 

Berglund, 43 Va. App. at 750-51, 601 S.E.2d at 697 (citations omitted). 

 The commission’s factual finding that the claimant consumed an excessive amount of 

narcotic pain medication to the point of causing him to pass out is supported by credible 

evidence, including the claimant’s testimony, the medical records, and Dr. Harris’s deposition 

testimony. Therefore, we are bound by that finding on appeal. Moreover, credible medical 

evidence, including the opinions of Drs. Roth and Harris, supports the commission’s finding that 

as a result of passing out, compression of the claimant’s arm took place over an extended period 

of time, which ultimately resulted in the amputation of his arm. 

 Under [the] doctrine [of compensable consequences], . . . 

“‘[w]hen the primary injury is shown to have arisen out of and in 

the course of employment, every natural consequence that flows 

from the injury likewise arises out of the employment, unless it is 

the result of an independent intervening cause attributable to 

claimant’s own intentional conduct.’” 

Farmington Country Club, Inc. v. Marshall, 47 Va. App. 15, 22-23, 622 S.E.2d 233, 237 (2005)

(quoting Imperial Trash Serv. v. Dotson, 18 Va. App. 600, 606-07, 445 S.E.2d 716, 720 (1994)) 

(other citation omitted). 
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In this case, credible evidence supports the commission’s conclusion that the claimant’s 

own intentional conduct in taking an excessive amount of narcotic pain medication not 

prescribed for his injury caused the ischemia that led to subsequent amputation of his right arm. 

Dr. Harris opined that the most likely cause of the claimant passing out and falling asleep on his 

arm for a lengthy period of time was his taking an excessive amount of pain medication. 

Because credible evidence supports the commission’s decision that the claimant’s intentional 

conduct broke the chain of causation from the original injury, we cannot find as a matter of law 

that the claimant’s evidence proved the ischemia and subsequent amputation of his right arm 

constituted a compensable consequence of his original injury. 

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

Affirmed.