WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
Decision Number: 20100028
OBJECTION BY: Worker
PARTICIPANTS: Worker, Worker Representative
OBSERVER: Worker’s son
ISSUE
The worker is appealing for psychotraumatic entitlement.
HOW THE ISSUE ARISES
The history of this file is well summarized in the April 10, 2006 and the April 12, 2008 appeals resolution officer’s (ARO) decisions and will only be summarized briefly here.
This, now 54-year old, upholsterer experienced bilateral-forearm pain after pulling material on a chair on April 2, 2004. There was a diagnosis of acute or chronic myositis of the extensor forearms.
The June 2004 regional evaluation centre (REC) report anticipated that there would be some residual impairment to both forearms.
The worker’s permanent impairments were assessed on November 24, 2004, and he subsequently received an 11 per cent non-economic loss (NEL) award.
The April 10, 2006 ARO decision allowed for 90 per cent cost relief under the Second Injury and Enhancement Fund (SIEF) to the employer.
The August 12, 2008 ARO decision denied the worker entitlement to a NEL re-determination, as the medical evidence did not support that a deterioration had occurred.
In terms of return to work, the worker was referred to a labour market re-entry (LMR) assessment. Subsequently, an LMR plan was established.
The worker’s neurologist reported evidence of a depressive condition as of January 2007.
By August 2008, the worker’s family doctor reported that the worker was experiencing significant psychiatric symptoms, and he was unable to return to work.
The October 30, 2008 Psychological Trauma Program report advised that the worker had a diagnosis of an adjustment disorder with mixed disturbance of emotion and conduct. Although the report found that he had no psychologically related restrictions on any return to work, his emotional volatility and aggressiveness would need to be monitored. There was a recommendation of 15 sessions of psychological treatment that focused on anger management.
The reporting on file was reviewed, and it was determined that there were no psychological restrictions that prevented the worker from returning to his LMR plan. This was confirmed in the letter of March 4, 2009.
The worker and his family doctor disagreed. They felt that the worker could not attend any LMR program due to his psychological condition.
The May 5, 2009 Trillium Mood Disorder Clinic report suggested that the worker could not participate in LMR activities due to a psychologically related condition.
The psychological reporting was analyzed in the May 25, 2009 Workplace Safety and Insurance Board (WSIB) psychological consultant’s review. The review concluded that the worker suffered from an adjustment disorder, which is a temporary condition that would not normally attract entitlement. As well, it was noted that the worker had a long-standing tendency for emotional lability and aggressive behaviour that long pre-dated the work accident. As a result, it was found that compatibility between the psychological condition and the injury was not established. However, in order to help the worker attend his LMR plan, it was suggested that 15 sessions of psychological treatment be approved.
The May 15, 2009 decision accepted the psychological consultant’s opinion, and it denied psychotraumatic entitlement to the worker. However, the 15 treatment sessions were approved to help him cope with his LMR plan.
After further psychological reporting was received, the denial of psychotraumatic entitlement was once again denied in the letter of July 6, 2009.
AUTHORITY
Operational Policy Manual Document (OPM)
- 15-04-02 – Psychotraumatic Disability
ASSESSMENT OF THE EVIDENCE AND TESTIMONY
I have reviewed the record and have examined the evidence and testimony. The key issue in this appeal is the sufficiency of the medical and psychological evidence to support that the worker’s psychological condition meets the requirements under OPM document, 15-04-02, Psychotraumatic Disability. The sub-issues here include: the nature and extent of any pre-existing condition the worker may have had, the relationship of the current condition to his compensable injury, and the extent of his psychological impairment.
During the Hearing, the worker testified that prior to his injury in this claim, he did not have any psychological condition, and he did not receive treatment for any such condition. He acknowledged that he had a history of reacting emotionally to stressful situations, and he saw himself as a loud and somewhat aggressive person. However, this was nothing that ever interfered with his working capacity or required any kind of treatment.
The worker described the onset of his psychological condition as something that occurred gradually after his claim was made in 2004. He insisted that he was not crazy and that he had a difficult time accepting his depression because of the perceived stigma. It was not until his specialist and family doctor suggested this diagnosis that he came to fully understand what he was experiencing.
It was at that time that he was prescribed an anti-depressant. The medication did not help very much. As time passed, he felt that his psychological condition continued to deteriorate.
Pre-existing Psychological Condition
In regard to the issue of any pre-existing condition, I do not note any evidence on the file that would contradict the worker’s stated pre-accident psychological history. I have obtained his previous claims from 1996 and from 2002, and I see no notation of any psychological condition or any behavioural problems. The 2002 family doctor clinical notes make no mention of any psychological condition or difficulties. Neither the worker’s psychiatrist nor his family doctor make mention of any pre-existing condition.
The only reporting that suggests the involvement of a pre-existing condition is in the Psychological Trauma Program reports. While the November 18, 2008 discharge summary advised that the workplace accident was a partial contributor to the onset of the condition, it also suggested that the worker had long-standing tendencies for emotional lability and aggressive behaviour. Additional contributing factors included: the worker’s financial strain, conflict with the WSIB, social isolation, and loss of work role.
In regard to the history of emotional lability and aggressive behaviour, the Psychological Trauma Program assessment involved both a psychiatric assessment and psychological testing. The psychiatric assessment made no suggestion of a pre-existing condition.
However, the psychological testing series suggested the worker did have a history of problematic personality traits including emotional lability, volatility, and aggressiveness. This suggestion arose from the worker’s self-description during the testing. Yet the testing does not indicate whether these traits had been aggravated after the injury or whether the worker had a dysfunctional lifestyle prior to the injury. It is not clear how it came to the conclusion that these traits were long standing.
The Psychological Trauma Program discharge summary accepted that these traits were long standing and had had a significant effect on the development of the worker’s adjustment disorder.
As there is little evidence regarding the duration of these suggested personality traits, we need to look at the worker’s work history and LMR history for evidence. Under the 2002 claim the worker had injured his left-forearm while pulling upholstery material. According to the initial reporting, he had been working consistently with the employer as an upholsterer for nine years. A few months later, he returned to work in modified duties but was later permanently laid off. A subsequent re-employment complaint was resolved with a financial settlement.
Although the worker never returned to work in regular duties with that employer, he was considered to be fit for his regular duties and he was advised that he was not entitled to further LOE benefits.
It appears the worker obtained further upholstery work with two other employers. He started work with the current employer as of September 2003 as an upholsterer. He continued with this work without apparent behavioural difficulties until the pulling of fabric resulted in his bilateral injuries in April 2004. The evidence from the work history does not indicate that he had been affected by any psychological or behavioural problem.
The June 11, 2004, REC report made no mention of any behavioural problems or difficulties with aggressive behaviour. The worker was found to be an excellent candidate for vocational rehabilitation.
The October 2004 vocational testing results and a LMR assessment report made no indications of any behavioural problems or history of aggressive personality traits. The report indicated that personality testing had been carried out as part of the assessment.
The worker began his first LMR plan by December 2004. In the March 2005 Progress Report, the worker was described by the training agency as an “excellent student”, who was motivated to achieve. The only difficulty outlined was his continuing problems with bilateral forearm pain. He completed the in-classroom program successfully with a 91.14 per cent average. There were no apparent behavioural or interpersonal problems during his work placement with an employer. In his computer-skills training, he was described as having a positive attitude and being eager to learn. However, he had physical difficulties with typing, and he was supplied with voice-activation software. He presented well at job interviews.
By July 2006, the LMR service provider concluded that the physical requirements of the worker’s suitable employment or business (SEB) were not suitable for his physical condition. The worker had repeated forearm problems while doing the work, and no amount of modifications appeared to have resolved the problem. The suggested alternative SEB was in security-guard work.
It was not until after this time that we note any psychological-related difficulties.
Given the above-noted evidence, I find it difficult to accept the Psychological Trauma Program’s psychological testing conclusions that indicated the worker had a long-standing pre-existing psychological condition that was more significant that his compensable injury. Indeed, in the report, the severity of the worker’s current psychological condition was downplayed because of the conclusions about a pre-existing condition.
This questionable conclusion formed the basis of the WSIB psychological consultant’s review. The review found the emotional lability and aggressive behaviours were long standing and were the key features of the worker’s current psychological condition. The review concluded that this was the worker’s key problem, and it was not compatible with the injury. Given the premise of the review, I find that the psychological consultant’s conclusions are not supported by the evidence.
As a result, I find that the evidence supports the worker’s testimony that he had no significant pre-existing psychological problems prior to the date of accident.
Relationship to the Injury
In regard to the relationship of the worker’s compensable injury to the psychological condition, I note the following observations:
The evidence does not support that the worker had a significant pre-existing psychological condition or significant maladaptive personality traits;
The worker did not appear to exhibit any behavioural or psychological problems until after the summer and fall 2006. By that time, he repeatedly complained of physiological problems and pain reactions to the duties. Attempts at workstation modifications were not successful;
The worker’s family doctor and psychiatrist have since repeatedly attributed the onset of the worker’s psychological condition to the compensable injury; and
Even though the Psychological Trauma Program conclusions were based on an unsubstantiated impression regarding a pre-existing condition, the report fully acknowledges that the injury played a significant role in the onset of the psychological condition.
Given the above-noted evidence, I find that the worker has a compensably related psychological condition.
Diagnosis
This leaves the issue of the accepted diagnosis. The worker’s psychiatrist and his family doctor have repeatedly contended that the worker’s condition meets the criteria for a DSM-IV diagnosis of major depressive disorder. The Psychological Trauma Program, on the other hand, has concluded that he has an adjustment disorder that is basically superimposed on his significant pre-existing personality traits of emotional lability and aggressive behaviour. However, since we have now determined that there is little available evidence to support that the worker a significant pre-existing condition, more weight must be assigned to the reporting by the worker’s psychiatrist and family doctor.
Hence, I accept that the worker has a compensably related major depressive disorder. I find that the onset of the condition is January 2007. This was when the neurologist first suggested the onset of the condition.
CONCLUSION
I conclude:
There is little evidence to support that the worker had a history of significant pre-existing personality traits that made any significant contribution to his current psychological condition;
The worker’s compensable injury is the most significant contributing factor for his psychological condition; and
The worker has entitlement from January 2007 onwards for a major depressive disorder.
The Operating Area is directed to accept psychotraumatic entitlement from January 2007 onwards.
The worker’s appeal is allowed.
Dated: March 19, 2010
P. Prummel
Appeals Resolution Officer
Appeals Branch