Workplace Safety and Insurance Board
Appeals Resolution Officer Decision
DECISION NUMBER: 20100123
OBJECTION BY: Worker
PARTICIPANTS: Worker, Worker Representative
HEARING DATE: N/A
ISSUE
The worker objects to the July 22, 2009 case manager decision denying entitlement for psycho-traumatic disability as a result of the workplace accident and resulting medical condition.
HOW THE ISSUE ARISES
December 12, 1996 this now 60 year old worker injured his low back and right calf when a sofa frame fell on him at work. A November 29, 2001 WSIAT decision accepted entitlement beyond January 15, 1997. The Tribunal accepted the injury resulted in permanent impairment and found the worker entitled to full disability benefits to August 1, 1997. Following this decision a 29% Non Economic Loss (NEL) was assessed for the lumbar spine in September 2003. Labour Market Re-entry (LMR) services were provided and a Suitable Employment or Business (SEB) of elemental sales identified. The final Future Economic Loss (FEL) in February 2007 based the FEL benefit on projected average earnings of $9.50 an hour.
The July 22, 2009 case manager decision denied the request for recognition of psycho-traumatic disability.
AUTHORITY
15-04-02 – Psycho-traumatic Disability
15-04-03 - Chronic Pain Disability
RESOLUTION METHOD AND PROCESS
The worker representative agreed to proceed to a decision based on the evidence and submissions on file.
ASSESSMENT OF THE EVIDENCE
I have reviewed the record and considered the evidence and submissions.
The worker representative has requested entitlement for psychological disability be accepted based on the medical reports provided.
The medical reporting includes reports from Dr. Gagliano (Chronic Pain Management) and Dr. Arbitman (Psychiatrist).
On April 29, 1997 Dr. Gagliano reported treating the worker for chronic pain from February 1997.
On June 27, 2000 Dr. Arbitman diagnosed pain disorder and associated depression. On April 26, 2001 the doctor reported anxiety and depression. The April 23, 2002 report confirmed the diagnosis, medication, and treatment dates. On September 7, 2006 the doctor reported the previous visit was August 9, 2005. The doctor reported he was adding anxiety and depression to his diagnosis of adjustment disorder and pain disorder and prescribed medication.
The medical reporting confirms the worker has been diagnosed as suffering from chronic pain, adjustment disorder, anxiety, and depression. Based on the limited information in relation to a specific chronic pain disorder, noting the accepted organic impairment of 29%, and the depression and anxiety diagnosis I do not consider the case to meet the requirements for consideration for entitlement on the basis of chronic pain disability.
The case has in my view been properly considered based on potential entitlement for psycho-traumatic disability.
The psycho-traumatic disability policy provides for entitlement when a psychiatric condition is attributable to a work related injury or condition resulting from the work injury. Entitlement is considered when the condition becomes manifest within 5 years of the injury and is generally considered a temporary condition. Entitlement may be accepted as an indirect result of a physical injury or when it is shown to be related to extended disablement and non-medical, socioeconomic factors, the majority of which can be directly and clearly related to the work injury. Impairment is evaluated in line with a number of clinical entities of which one is anxiety neurosis with depressive features.
In reviewing the medical reporting I note the treating psychiatrist initially diagnosed pain disorder and associated depression and subsequently diagnosed anxiety and depression in April 2001 and September 2006. Based on this diagnosis I find there to be a basis to consider entitlement.
While the presenting diagnosis is addressed in the relevant policy there are however a number of other factors which I consider relevant to the entitlement decision. These include the fact the worker’s organic condition was not recognized as compensable until following the November 2001 WSIAT decision. In this respect the effect of the absence of entitlement or income can not in my view be excluded from consideration as a causal factor in the worker’s presentation. In this respect I do not consider it appropriate to base entitlement on a worker’s response to the WSIB decision making process. To do so in my view would result in the necessity of providing benefits based on a worker’s reaction to adverse decisions they may receive from the WSIB. I also note the operations division had requested a detailed DSM-IV diagnosis from the treating psychiatrist and such a specific report was never received. I further note the treatment history suggests both a significant delay in the worker initially obtaining psychiatric treatment as well as significant gaps in this treatment. Finally, I note the April 2001 reporting also indicated non-compensable circumstances impacting the worker’s condition.
In summary, while I accept the medical reporting confirms the worker suffers from anxiety and depression I do not consider the psychiatric condition to be shown to arise from factors of which the majority can be directly and clearly related to the work injury. I note the presence of non-compensable factors (adverse decision-making process and personal stressors) which I consider significant factors in the development of the condition. I also note the medical reporting suggests the worker has experienced significant improvement in his condition for extended periods. Based on this view of the evidence I am unable to conclude the compensable injury has resulted in a permanent psycho-traumatic injury. On this basis there is no entitlement for an additional Non Economic Loss (NEL) assessment.
CONCLUSION
The objection is denied.
DATED June 10, 2010
M. Evans
Appeals Resolution Officer
Appeals Branch