COURT OF APPEALS OF VIRGINIA 

Present: Judges Annunziata, Agee and Senior Judge Coleman 

COMMUNITY MEMORIAL HEALTH CENTER AND 

 RECIPROCAL OF AMERICA 

 MEMORANDUM OPINION*

v. Record No. 0325-01-2 PER CURIAM 

 JULY 3, 2001 

KAREN MARIE WILSON 

 FROM THE VIRGINIA WORKERS' COMPENSATION COMMISSION 

 (Karen A. Gould; Angela C. Fleming; Crews & 

Hancock, P.L.C., on briefs), for appellants. 

 (Ruth E. Nathanson; Maloney, Parks, Clarke & 

Nathanson, P.C., on brief), for appellee. 

 Community Memorial Health Center and its insurer 

(hereinafter referred to as "employer") contend that the 

Workers' Compensation Commission erred in finding that (1) Karen 

Marie Wilson (claimant) proved that her psychological treatment 

with Helaine B. Meadows, Licensed Clinical Social Worker, was 

causally related to claimant's compensable January 16, 1996 

injury by accident; (2) claimant did not unjustifiably refuse to 

attend or continue an independent psychological examination with 

Dr. James B. Wade on August 10, 1999; and (3) claimant did not 

unjustifiably refuse employer's offers of selective employment. 

Upon reviewing the record and the briefs of the parties, we 

 

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

designated for publication. 
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conclude that this appeal is without merit. Accordingly, we 

summarily affirm the commission's decision. See Rule 5A:27. 

I. Causation: Psychological Treatment

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

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

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

actual determination of causation is a factual finding that will 

not be disturbed on appeal if there is credible evidence to 

support the finding." Ingersoll-Rand Co. v. Musick, 7 Va. App. 

684, 688, 376 S.E.2d 814, 817 (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). 

 In ruling that claimant proved by a preponderance of the 

evidence that the psychological treatment rendered by Meadows 

was causally related to claimant's 1996 compensable injury by 

accident, the commission found as follows: 

 We accept the opinions of Dr. [Ronald 

O.] Forbes[, treating psychiatrist,] and 

Meadows, which explained that the 1996 

accident exacerbated or aggravated the 

claimant's preexisting psychological 

problems. It is well settled that the 

employer takes the employee as it finds her, 

with all of her preexisting disabilities and 

infirmities, and it is responsible for the 

effects of an accident that aggravates or 

exacerbates a preexisting condition, even if 

it is a preexisting psychological condition 

otherwise considered an ordinary disease of 

life. Therefore, the employer is 
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responsible for the claimant's psychological 

care to the extent it involved treatment for 

the effects of the work accident. 

 While we recognize that the claimant 

was already under medication by her family 

physician for treatment of depression and 

"panic attacks," the undisputed evidence is 

that the claimant had never before missed 

time for work, nor undergone treatment as 

extensive, before her compensable accident 

in 1996. The claimant's treating 

psychiatrist and her counselor of over two 

years, both agree that the claimant's 

preexisting condition was exacerbated by the 

injury and resulting medical procedures, to 

the point of dysfunction. The claimant's 

primary treating physician, Dr. [Charles H.] 

Bonner, deferred to Dr. Forbes' medical 

expertise in determining the cause of the 

condition and the claimant's need for 

treatment. 

(Citation omitted.) 

 "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, to accept 

the opinions of the treating psychiatrist, Dr. Forbes, and the 

treating counselor, Meadows, and to reject any contrary medical 

opinions. The opinions of Dr. Forbes and Meadows constitute 

credible evidence to support the commission's decision. "The 

fact that there is contrary evidence in the record is of no 

consequence if there is credible evidence to support the 

commission's decision." Wagner Enters., Inc. v. Brooks, 12 Va. 
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App. 890, 894, 407 S.E.2d 32, 35 (1991). Moreover, "[i]n 

determining whether credible evidence exists, the appellate 

court does not retry the facts, reweigh the preponderance of the 

evidence, or make its own determination of the credibility of 

the witnesses." Id. 

II. Independent Psychological Examination

If an employee, without justification, 

refuses to submit to or in some way 

obstructs a medical examination to which an 

employer is entitled, compensation benefits 

will be suspended during the continuation of 

the refusal. 

 Justification is a factual 

determination made upon an objective view of 

all circumstances as they reasonably 

appeared to the claimant. The commission's 

factual findings on this issue are 

conclusive and binding on this Court if 

supported by credible evidence. 

R.G. Moore, 10 Va. App. at 213, 390 S.E.2d at 789 (citation 

omitted). 

 The facts support the commission's finding that the 

claimant was justified in refusing to continue with Dr. Wade's 

August 10, 1999 examination because "she felt that she was in an 

adversarial situation when being questioned by the two [male] 

examiners[, Dr. Wade and his assistant,] in [the] areas [of her 

failed marriages and family life], and became extremely 

emotional and distressed." In light of claimant's unstable 

psychological condition at the time of the examination and her 

perception of the situation, the commission could reasonably 
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infer that claimant was justified in refusing to continue the 

examination on August 10, 1999. Credible evidence, including 

the testimony of claimant and Franklin Wells, supports the 

commission's finding. 

 Because credible evidence supports the commission's finding 

that claimant was justified in refusing to continue Dr. Wade's 

August 10, 1999 examination, we need not address the issue of 

whether claimant cured such refusal. 

III. Refusal Selective Employment

 At the time employer offered selective employment to 

claimant, Dr. Forbes and Meadows had already opined that 

claimant remained totally disabled from work due to her 

psychological condition, which was causally related to her 

compensable 1996 injury by accident. 

 We have found that credible evidence supports the 

commission's finding that claimant's psychological condition was 

causally related to her compensable accident, and that the 

commission, as fact finder, was entitled to accept the opinions 

of Dr. Forbes and Meadows. Accordingly, credible evidence 

supports the commission's finding that because claimant remained 

totally disabled due to conditions causally related to the 

compensable 1996 accident, she did not unjustifiably refuse 

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

Affirmed.