COURT OF APPEALS OF VIRGINIA 

Present: Chief Judge Moon, Judges Baker, Benton, Coleman, 

 Willis, Elder, Bray, Fitzpatrick, Annunziata and 

 Overton 

Argued at Richmond, Virginia 

LEADBETTER, INC. 

 AND PENNSYLVANIA MANUFACTURERS 

 INDEMNITY INSURANCE COMPANY OPINION BY 

 JUDGE JAMES W. BENTON, JR. 

v. Record No. 1457-94-2 DECEMBER 19, 1995 

BENJAMIN PENKALSKI 

UPON REHEARING EN BANC 

 FROM THE VIRGINIA WORKERS' COMPENSATION COMMISSION 

 S. Vernon Priddy, III (Jennifer G. Marwitz; 

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

 for appellants. 

 Malcolm Parks, III (Susan Elaine Sieger; 

 Maloney, Barr & Huennekens, on brief), 

 for appellee. 

 Leadbetter, Inc. and its insurer appeal from the 

commission's award of temporary total disability benefits to 

Benjamin Penkalski. Leadbetter contends the commission erred in 

(1) failing to apply the rule of American Furniture Co. v. Doane, 

230 Va. 39, 334 S.E.2d 548 (1985), (2) applying the "two causes 

rule" in awarding temporary total benefits, (3) concluding that 

Penkalski's work-related injury by accident partially caused his 

inability to perform light duty work, (4) finding that any amount 

of partial disability attributable to the injury by accident 

supports the award because it contributes to Penkalski's 

temporary total disability, (5) finding that part of Penkalski's 

loss of earning capacity is attributable to the compensable 
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injury by accident, and (6) ruling that Penkalski had no 

obligation to market his residual work capacity. A panel of this 

Court, with one judge dissenting, reversed the commission's 

award. See Leadbetter, Inc. v. Penkalski, 20 Va. App. 454, 457 

S.E.2d 790 (1995). This Court granted Penkalski's petition for a 

rehearing en banc. For the reasons that follow, we affirm the 

commission's award. 

 The parties stipulated many facts of this case and generally 

do not dispute the material facts. Viewed in the light most 

favorable to Penkalski, who prevailed before the commission, see

R.G. Moore Bldg. Corp. v. Mullins, 10 Va. App. 211, 212, 390 

S.E.2d 788, 788 (1990), the evidence proved that in April 1991 

Penkalski fell and broke both ankles while employed by 

Leadbetter. His injuries required surgery and other 

rehabilitation. Pursuant to a memorandum of agreement, Penkalski 

received an award for temporary total disability benefits. 

 Under the treatment of Dr. E. Claiborne Irby, Jr., the 

attending physician, Penkalski made progress and was able to walk 

following surgery. His rehabilitation after surgery involved 

exercising his ankles daily as directed by Dr. Irby. With Dr. 

Irby's permission, Penkalski began performing restricted light 

duty selective work for Leadbetter in September 1991. Throughout 

1991 and 1992, Dr. Irby reported that Penkalski continued to 

experience swelling, aching, and discomfort. The doctor ordered 

him to continue daily stretching and other ankle exercises. In 
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addition, Dr. Irby reported that Penkalski suffered a 30% 

permanent partial loss of function of the left leg and a 20% loss 

of function of the right leg. The commission awarded Penkalski 

87.5 weeks of permanent partial disability benefits for the loss 

of function of the legs. 

 As of December 10, 1992, Penkalski was performing 

restrictive light duty selective work for Leadbetter within the 

limitations outlined by his doctor. On December 11, 1992, 

Penkalski suffered a heart attack. Following Penkalski's heart 

attack, another doctor performed an angioplasty. During that 

procedure, arterial plaque was loosened and settled in 

Penkalski's toes and feet and caused injury to his toes and feet. 

 Penkalski suffered ischemia of his feet and lost additional 

function of his feet as a consequence of his ischemia. The heart 

attack, the ischemia of the feet, and the treatment for those 

conditions were not a result of Penkalski's compensable accident 

and were not work related. However, Penkalski was still disabled 

by his ankle injuries when he had the heart attack, and he had 

received orders from Dr. Irby to regularly exercise his ankles. 

 Further complications from the loosened arterial plaque 

resulted in the amputation of parts of Penkalski's toes. 

Confined to a wheelchair by the heart attack and the resulting 

complications, Penkalski could no longer perform the exercises 

prescribed by Dr. Irby. The condition of his ankles 

deteriorated, increasing his disability. 
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 In September 1993, both Dr. Irby and Dr. John T. Funai 

reported that Penkalski was totally disabled. Dr. Irby found the 

total disability resulted from "two causes, one of which is work 

related and one which is not." Dr. Funai opined that "the 

combination of [Penkalski's] cardiac condition and the potential 

loss of a foot prohibits any future employment." Since April 9, 

1991, Penkalski has been incapacitated at all times, has been 

unable to perform the full range of his pre-injury duties, and 

has suffered chronic pain and swelling in his ankles. 

 Penkalski's entitlement to permanent partial disability 

benefits ended September 30, 1993. Because he received no 

additional disability benefits from Leadbetter, Penkalski filed a 

change in condition application for benefits. Based upon Dr. 

Irby's reports, the deputy commissioner found that the evidence 

proved that Penkalski's "disability has two causes, one related 

to employment and one not related." Relying on decisions from 

the Supreme Court and this Court, the deputy commissioner entered 

an award in favor of Penkalski. On review, the commission 

affirmed the deputy commissioner's award. 

 An employee is entitled to recover compensation for an 

aggravation or exacerbation of a compensable injury by accident 

even when the event that caused the aggravation or exacerbation 

did not involve the workplace. Fairfax Hospital v. DeLaFleur, 

221 Va. 406, 409, 270 S.E.2d 720, 722 (1980). See also Wilson v. 

Workers' Compensation Comm'r, 328 S.E.2d 485, 489 (W. Va. 1984); 
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1 Arthur Larson, The Law of Workmen's Compensation, §§ 13.00-

13.24 (1994). "It is well established that where . . . the chain 

of causation from the original industrial injury to the condition 

for which compensation is sought is direct, and not interrupted 

by any intervening cause attributable to the [employee's] own 

intentional conduct, then the subsequent [condition] should be 

compensable." American Smelting & Refining Co. v. Industrial 

Comm'n, 544 P.2d 1133, 1135 (Ariz. Ct. App. 1976). See also

Department of Highways v. McCoy, 193 S.W.2d 410, 412 (Ky. 1946) 

(an employee who suffered a work-related hernia was entitled to 

receive compensation for an aggravation of the hernia caused by 

the inability to operate due to a subsequently developed 

unrelated onset of tuberculosis). Recovery of compensation for a 

subsequent aggravation is barred only if the subsequent 

aggravation "is the result of an independent intervening cause 

attributable to [the employee's] own intentional conduct." 1 

Larson, supra, § 13.00. Numerous courts have recognized this 

principle with factual variations "but as long as the causal 

connection is in fact present the compensability of the 

subsequent condition is beyond question." Id. § 13.11(b) 

(footnote omitted). 

 Another well-established principle holds that "where a 

disability has two causes: one related to the employment and one 

unrelated [to the employment] . . . full benefits will be 

allowed." Bergmann v. L & W Drywall, 222 Va. 30, 32, 278 S.E.2d 
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801, 803 (1981). This principle requires the commission to award 

compensation because "the employment is a contributing factor to 

the disability." Id.; see also Smith v. Fieldcrest Mills, Inc., 

224 Va. 24, 28-29, 294 S.E.2d 805, 807-08 (1982). These two 

principles intersect in this case and mandate an affirmance of 

the commission's decision. 

 Dr. Irby reported that complications resulting from the 

heart operation caused Penkalski to suffer foot and toe problems. 

 The severity of those problems prevented Penkalski from 

exercising his ankles and resulted in a marked decrease in his 

ankle motion. Thus, the condition of Penkalski's ankles 

deteriorated. As a consequence, Dr. Irby initially barred him 

from "doing any job where he has to do prolonged standing or 

walking due to his ankles." In September 1993, Dr. Irby reported 

that Penkalski was totally disabled from any employment as a 

result of his work-related injury and the exacerbation of that 

injury. Based upon Dr. Irby's reports, the commission found that 

Penkalski's foot ischemia exacerbated and worsened his workrelated ankle disability. In addition, the commission found that 

Penkalski was totally disabled. This Court must defer to the 

commission's findings because they are based on Dr. Irby's 

reports and other credible evidence in the record. See Rose v. 

Red's Hitch & Trailer Servs., Inc., 11 Va. App. 55, 60, 396 

S.E.2d 392, 395 (1990). 

American Furniture Co. v. Doane, 230 Va. 39, 334 S.E.2d 548 
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 (1985), is not an impediment to upholding the award. In Doane, 

the employee suffered a work-related injury to her back. After 

the employee had surgery and recovered, the attending physician 

released the employee to return to light duty work. Id. at 41, 

334 S.E.2d at 549-50. The employee failed to report for light 

duty work because of impairments to her hand and arm that were 

"unrelated" to the back injury. Id. The two conditions were 

"unrelated" because they neither flowed from the same workrelated cause nor resulted in disability to the same body member. 

 Thus, the Court held that "Doane failed to carry her burden of 

persuasion to show the necessary causal connection between her 

arm impairment and her compensable injury." Id. at 43, 334 

S.E.2d at 550-51. 

 In Eppling v. Schultz Dining Programs, 18 Va. App. 125, 442 

S.E.2d 219 (1994), this Court applied Doane in a case where an 

employee was terminated because of excessive absences caused by 

health problems that were "unrelated" to her work-related injury. 

Id. at 128, 442 S.E.2d at 221. No evidence in that case proved 

that Eppling's "unrelated" problem had exacerbated or aggravated 

the work-related injury. 

 Dr. Irby's report clearly states the relationship between 

the complications that resulted from the heart attack and the 

work-related injury. The evidence proved that after the arterial 

plaque settled in his feet and caused complications, Penkalski 

could not perform the ankle exercises previously prescribed for 
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him by Dr. Irby and he suffered additional disability. Thus, the 

commission had a medical basis upon which to conclude that as a 

result of Penkalski's heart attack, Penkalski suffered severe 

injuries to his feet, was unable to continue his exercises, and 

lost significant and additional motion in his injured ankles. 

Dr. Irby's report stated that Penkalski was "disabled from any 

work that requires prolonged standing and walking." He further 

reported that the disability resulted from two causes, "one is 

work-related and one is not." In addition, the commission 

specifically quoted from Dr. Irby's May 27, 1993, report in 

finding that Penkalski had proved that the non-work-related 

condition contributed to and aggravated his compensable injury. 

 When, as in this case, the medical evidence proved that the 

work-related disability was aggravated or exacerbated by the nonwork-related problem, the resulting disability is compensable. 

Bergmann, 222 Va. at 32, 278 S.E.2d at 803. Furthermore, Dr. 

Irby's medical opinion established that Penkalski's inability to 

perform sustained standing and walking was a disability that had 

two causes. One cause was the worsening condition of Penkalski's 

ankles, the work-related injury. 

 Leadbetter has failed to show the commission committed 

error. Credible evidence supports the commission's finding that 

Penkalski's total disability is due in part to his work-related 

injury. The medical evidence supports the award of temporary 

total disability. Therefore, we affirm the commission's decision 
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and vacate the prior panel decision. 

 Affirmed.