COURT OF APPEALS OF VIRGINIA 

Present: Judges Coleman, Elder and Fitzpatrick 

Argued at Richmond, Virginia 

SHAW JEWELERS, ET AL. 

 MEMORANDUM OPINION* BY 

v. Record No. 2320-96-2 JUDGE LARRY G. ELDER 

 MARCH 18, 1997 

BEULAH ALLENE SQUIERS 

 FROM THE VIRGINIA WORKERS' COMPENSATION COMMISSION 

 Mark M. Caldwell, III (Ralph L. Whitt, Jr.; 

Sands, Anderson, Marks & Miller, on brief), 

for appellants. 

 No brief or argument for appellee. 

 Shaw Jewelers and National Union Fire Insurance Company 

(appellants) appeal a decision of the Workers' Compensation 

Commission (commission) awarding medical benefits and temporary 

partial disability benefits to Beulah A. Squires (claimant). 

Appellants contend that the commission erred as a matter of law 

when it concluded that claimant was validly referred by her 

treating physician to a chiropractor. They also contend that the 

medical evidence was insufficient to support the commission's 

conclusion that claimant proved a change of condition since her 

last award of compensation benefits. For the reasons that 

follow, we affirm. 

 Appellants do not argue that the chiropractic treatment 

provided by Dr. Critchfield was either unnecessary or unrelated 

 

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

designated for publication. 
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to claimant's accident. Instead, appellants contend that they 

are not responsible for the treatment provided by Dr. Critchfield 

because claimant did not obtain a legally valid referral from Dr. 

Allen for this treatment. We disagree. 

 It is well established that "'neither the employer nor its 

insurance carrier may limit the treating physician in the medical 

specialist, or treating facilities to which claimant may be 

referred for treatment.'" Jensen Press v. Ale, 1 Va. App. 153, 

158, 336 S.E.2d 522, 525 (1985) (citation omitted). An employer 

is financially responsible for medical expenses arising from the 

referral of a claimant's treating physician that are causally 

related to the workplace injury and deemed necessary by the 

treating physician. See Volvo White Truck Corp. v. Hedge, 1 Va. 

App. 195, 200, 336 S.E.2d 903, 906 (1985). 

 The evidence relevant to Dr. Allen's referral was limited to 

claimant's testimony at the hearing before the deputy 

commissioner and a letter in the record written by Dr. 

Critchfield. At the hearing, the deputy commissioner examined 

claimant about her referral to Dr. Critchfield: 

 Q. Did Doctor Allen refer you to him? 

 A. Got referred through his office, yes, sir. 

 Q. Pardon? 

 A. Through his office. 

 Q. Through his office? 

 A. Yes. 
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 Q. Did you [ask] Doctor Allen to refer you to Doctor 

Critchfield? 

 A. They did through the -- by telephone. 

 Q. Did you ask Doctor Allen to refer you to Doctor 

Critchfield? 

 A. I had talked to him about it. I didn't directly ask 

him in his office at the last visit. I wasn't seen by 

Doctor Critchfield until approval was made by him. 

What he told his secretary or his nurse, they wouldn't 

see me until they had approval. 

In addition, a letter from Dr. Critchfield dated February 10, 

1996 stated that "[claimant] was referred from the office of Dr. 

Allen, whose care she had been under from the time of her 

accident [o]n July 18, 1993." 

 We hold that Dr. Allen's referral of claimant to Dr. 

Critchfield was valid. The record established that claimant 

learned of Dr. Critchfield from a neighbor and mentioned him to 

Dr. Allen. Although Dr. Allen did not make a written referral, 

he told "his secretary or his nurse" that he approved of Dr. 

Critchfield's treatment. One of Dr. Allen's employees then 

communicated his referral by telephone to Dr. Critchfield's 

office. Dr. Critchfield waited for Dr. Allen's referral before 

treating claimant. Although the better practice of referring 

claimants might be to document each referral in writing, we hold 

that the oral communication of Dr. Allen's referral by one of his 

employees constitutes a valid referral under the Workers' 

Compensation Act. 
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 Appellants argue that the referral was invalid because the 

topic of chiropractic care was first broached by claimant. We 

disagree. Although claimant may have brought up the possibility 

of treating her injured back with chiropractic manipulation, Dr. 

Allen had the opportunity to exercise his independent medical 

judgment before recommending this option as a necessary medical 

treatment. Furthermore, this is not a case in which Dr. Allen 

merely "rubber-stamped" his approval of claimant's suggestion in 

order to placate her. The commission found that "there is no 

evidence the referral was solely to satisfy the claimant or that 

it was not intended as a true referral." This finding is not 

contradicted by the evidence in the record and is binding on 

appeal. Code § 65.2-706(A). 

 Appellants next challenge the commission's award of 

temporary partial disability benefits to claimant. They contend 

that the evidence was insufficient to support the commission's 

finding of a change in condition of claimant's back since the 

expiration of her last award in 1994. We disagree. 

 "General principles of work[er]'s compensation law provide 

that 'in an application for review of any award on the ground of 

change in condition, the burden is on the party alleging such 

change to prove his allegations by a preponderance of the 

evidence.'" Great Atl. & Pac. Tea Co. v. Bateman, 4 Va. App. 

459, 464, 359 S.E.2d 98, 101 (1987) (quoting Pilot Freight 

Carriers, Inc. v. Reeves, 1 Va. App. 435, 438-39, 339 S.E.2d 570, 
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572 (1986)). "It is fundamental that a finding of fact made by 

the Commission is conclusive and binding upon this court on 

review. A question raised by conflicting medical opinion is a 

question of fact." Commonwealth v. Powell, 2 Va. App. 712, 714, 

347 S.E.2d 532, 533 (1986). 

 We hold that the evidence was sufficient to prove that 

claimant experienced a change in condition in her back. The 

evidence before the commission consisted of the medical opinions 

of Dr. Allen, claimant's treating physician since her accident in 

1993, Dr. Critchfield, who first examined claimant on January 16, 

1996, and Dr. Debs, who examined claimant on March 22, 1996 at 

the request of appellants. The medical evidence indicates that 

claimant saw Dr. Allen in April and May after experiencing pain 

in the area of her injury. On October 31, 1995, Dr. Allen opined 

in a letter that pain in claimant's back had rendered her 

partially disabled since January, 1995. He stated that since 

January, "[claimant] has had flair ups of her back strain, both 

thoracic and lumbosacral, and also problems with her elbow." Dr. 

Allen referred claimant to Dr. Critchfield for chiropractic 

treatment of this injury in January, 1996. Dr. Critchfield 

indicated in his notes from his initial examination of claimant 

on January 16, 1996 that her current back condition was related 

to her injury in 1993. Dr. Debs, on the other hand, opined that 

"[claimant] is physically able to resume her regular duty 

activities as a jewelry sales clerk at this time." The 
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commission found that "claimant has established a change in 

condition, she no longer can work full time because of her back 

problem." This Court on appeal does not judge the credibility of 

the witnesses or weigh the evidence. See Celanese Fibers Co. v. 

Johnson, 229 Va. 117, 121, 326 S.E.2d 687, 690 (1985). "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). We cannot say that the 

commission's factual finding of a change of condition in 

claimant's back is unsupported by credible evidence in the 

record. 

 For the foregoing reasons, we affirm the commission's award 

of medical benefits and temporary partial disability benefits. 

Affirmed.