COURT OF APPEALS OF VIRGINIA 

Present: Judges Willis, Fitzpatrick and Overton 

Argued at Salem, Virginia 

NATIONAL INDUSTRIAL CONSTRUCTORS, INC. AND 

 CONTINENTAL CASUALTY COMPANY 

v. Record No. 2009-95-3 MEMORANDUM OPINION* BY 

 JUDGE NELSON T. OVERTON 

EDWARD LEE WILLIAMS MAY 14, 1996 

 FROM THE VIRGINIA WORKERS' COMPENSATION COMMISSION 

 Monica L. Taylor (Dale W. Webb; Gentry, 

Locke, Rakes & Moore, on brief), for 

appellants. 

 Richard M. Thomas (Rider, Thomas, Cleaveland, 

Ferris & Eakin, on brief), for appellee. 

 

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

designated for publication. 

 National Industrial Constructors and its insurer 

(collectively "National") appeal the decision of the Workers' 

Compensation Commission awarding benefits to the claimant, Edward 

Lee Williams. National contends that the commission erroneously 

found that the treating physician gave a medical opinion linking 

Williams' injury with his work. Finding no error, we affirm the 

commission's award. 

 The parties are fully conversant with the record, and we 

recite only those facts necessary to the disposition of this 

appeal. 

 The dispute arises over the language in the treating 

physician's medical report. The doctor opined in relevant part: 

 The patient raises the question of a 
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relationship between his left elbow 

epicondylitis and the ongoing problems he has 

had with his right elbow, all along. . . . 

It is his opinion that he is attempting to 

guard overall use of his right elbow and 

therefore putting more pressure and strain on 

the left elbow, causing that elbow to become 

more problematic. I feel there clearly is 

some merit in his opinion regarding this. 

Again, there is not one episode of injury 

that has produced this problem, it was more 

an overuse effort over a period of time that 

produced this epicondylitis. 

The full commission found that this phrasing indicated that the 

doctor had adopted the opinion of the claimant that his current 

condition in his left elbow was related to a prior work-related 

injury in his right elbow. Because of this medical opinion, the 

commission awarded benefits. 

 "When the primary injury is shown to have risen 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." Imperial Trash Serv. v. 

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

(quoting Morris v. Badger Powhatan/Figgie Int'l, Inc., 3 Va. App. 

276, 283, 348 S.E.2d 876, 879 (1986)); 1 A. Larson, The Law of 

Workmen's Compensation § 13.00 (1995). The claimant must 

demonstrate that his present injury flows from the primary injury 

to a reasonable degree of medical certainty, a standard that 

would require the doctor to conclude that it is more probable 

than not. See Ross Lab. v. Barbour, 13 Va. App. 373, 377, 412 
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S.E.2d 205, 208 (1991). The exact words used to articulate this 

conclusion hold little significance, if in the correct context 

they express sufficient medical certainty. Wells v. Virginia 

Dep't of Transp., 15 Va. App. 561, 565, 425 S.E.2d 536, 538-39 

(1993). 

 In this case the doctor ultimately agreed with the claimant 

and adopted the conclusion that the claimant's current condition 

was a natural result of his earlier injury. The doctor offered 

no other possible cause for the current condition and cast no 

doubt upon the claimant's theory. The commission did not err in 

finding that, in the context of this report, the doctor's 

language evinced a belief in causation to a reasonable degree of 

medical certainty. 

 Accordingly, the decision is affirmed. 

 Affirmed.