WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20100193
OBJECTION BY: Worker
PARTICIPANTS: Worker, Worker’s representative
HEARING DATE: November 02, 2010
ISSUE
The worker claims entitlement under the Workplace Safety and Insurance Board’s (WSIB) psychotraumatic disability policy.
HOW THE ISSUE ARISES
This claim was allowed for tendonitis of the left forearm as a result of his working duties as a Mechanics Assistant.
The employer was unable to accommodate the worker with modified duties and the Workplace Safety and Insurance Board (WSIB) referred the worker for a labour market re-entry (LMR) assessment. The worker has been in receipt of benefits as he participates in a LMR program.
The worker subsequently submitted a claim for psychotraumatic entitlement claiming that he had developed a depression which was in part related to his compensable injury.
The WSIB granted the worker a non-economic loss (NEL) award of 5 per cent to recognize his organic impairment.
The claim for psychotraumatic entitlement was reviewed by the WSIB’s consultant psychologist who concluded that the evidence did not support that the worker’s depression and general anxiety disorder were a result of the worker’s left arm tendonitis. Entitlement was therefore denied.
At the hearing, the worker provided testimony and his representative made submissions.
AUTHORITY
Operational Policy Manual (OPM) document:
- 15-04-02 – Psychotraumatic Disability
ASSESSMENT OF THE EVIDENCE
I note the information contained in the claim file and the opinion of the WSIB’s consultant psychologist as stated in memo 103.
Memo 103 provides a significant and in depth analysis of the issue under objection and the available evidence on file. The consultant psychologist also provided a very thoughtful and well reasoned decision.
Of significance, the following is noted:
The original injury was not the result of a traumatic incident nor did the worker require any significant medical treatment such as surgery. He has been treated conservatively.
It is acknowledged on file that the worker does have a learning disability which has caused some distress and difficulties with his LMR program. However, the WSIB has made reasonable attempts to mitigate the impacts by allowing the worker to reduce his participation at time in the program and also to reduce the course load when necessary.
The first mention of any possible psychotraumatic condition is in the family physician’s Health Professional’s Report (Form 8) dated November 22, 2005. At that time, the doctor that the worker had a non-compensable stomach condition and an anxiety neurosis. The worker was referred to a psychiatrist in early August 2005. The psychiatrist provided a report to the WSIB dated April 12, 2006.
In the report of April 12, 2006 the worker was noted to have been referred for major depression, generalized anxiety disorder and learning disorders with reading expression. The psychiatrist provided anti-depressant medication and discharged the worker to be followed by his family physician. The worker was then referred again for reasons of depression, explosive tendencies and irritability for which his medications were changed and he was followed by the psychiatrist with little improvement. It is also noted that the second referral to the psychiatrist occurred during the process of the worker participating in a pain management program which reported to be helpful to him coping with pain and mood.
The psychiatrist reported on September 26, 2006 that the worker’s depression had increased and recommended that the LMR be discontinued until this was in remission.
In his April 25, 2007 report, the psychiatrist reported that the worker had no symptomatology and that his mood was stable and that he was “doing well”. In a letter dated May 22, 2007, the psychiatrist reported that the worker requested a letter stating that he could not work at all for psychiatric reasons. The doctor stated that he “cannot just give him a letter indicating he is unable to do any kind of work. One needs a serious medical disorder to prevent from doing any type of work and this is not the case....”
The psychiatric report of August 25, 2005 which was sent to the WSIB on May 29, 2007 was a copy of the psychiatrist’s initial consultation report. On this, the worker was diagnosed with suffering with a major depression, generalized anxiety disorder, mild to moderate severity with a Global Assessment of Functioning (GAF) of 60. As noted by the WSIB’s consultant psychologist, the symptoms listed in the psychiatrists report do not support the diagnosis of depression according to the DSM-IV criteria. The psychologist noted that the symptoms do not meet all of the criteria and some of the symptoms that the psychiatrist lists are likely not due to mood. The psychologist noted that the memory/concentration problems are clearly pre-existing, consistent with the worker’s poor academic abilities. The sleep problems are not consistent with those typically accompanying depression but could be related to anxiety or the pain. The diagnostic criteria for generalized anxiety disorder have less requirements and are less stringent although there is no mention of core criteria (uncontrollable worry about a number of issues). The psychologist also noted that there is no mention of observable depressive symptoms or anxiety in the mental status with only “persistent frustration” documented. The WSIB’s psychologist also noted that the GAF score of 60 is the highest number that can be assigned to diagnoses with moderate symptoms or moderate impairment of functioning. He noted that the GAF number of 61 would indicate only “some mild symptoms or some difficulty in functioning but generally functioning pretty well”. In conclusion, the WSIB’s consultant psychologist stated; “In other words, his impairments from psychiatric reasons are really not much, and not likely sufficient to impair him from work or from school.”
With respect to causation, the consultant psychologist noted the following:
There is no mention of the worker having pain anywhere in the psychologist’s report of August 2005. The psychologist noted that generally speaking, depressive and anxiety symptoms that are an indirect result or secondary to an accident are related to pain and limitations that resulted directly from the accident. This does not seem to be the case with the worker. Rather, it seems that he has developed some issues of entitlement to being retrained in areas that would not be appropriate for him.
The psychologist also noted that there are a number of significant factors that could easily be negatively affecting the worker’s mood. These include: a non-compensable motor vehicle accident on April 19, 2005 which occurred a few weeks before the worker began upgrading for his LMR. In that accident, he suffered a severe whiplash, with injuries to his head, back and shoulders after being struck on the driver’s side of the car when he was making a left turn (at the hearing, the worker downplayed this accident stating that it was only minor and he did not suffer any injuries). The consultant psychologist noted that the type of pain would generally be more limiting of normal daily activities than his very specific left hand restrictions and thus would generally be more likely to generate secondary emotional symptoms.
From reviewing the other evidence on file, the consultant psychologist noted that the worker reported anxiety attacks and migraines more likely resulting from the whiplash after the car accident, causing an inability to focus and low attendance. By November 2005 his attendance was not improving. Other factors affecting the worker’s attendance and ability to focus included the recent birth of a child, the recent car accident and recent death of a family member. The WSIB accommodated the worker by decreasing his course load on two occasions. It was subsequently determined that the worker did indeed have a learning disability which the WSIB accepted and accommodated by providing one-on-one instruction. The psychiatrist noted that there were difficulties with the choice of LMR program and as noted in August 24, 2007 memo, the worker requested a NEL reassessment and required additional monies to pay off some debts. He also requested psychiatric entitlement as he felt he “should be compensated for his emotional upset as a result of the work injury because everything has changed in his life.”
The consultant psychologist provided the opinion that the worker was not suffering from significant psychological symptoms that would constitute and Axis 1 diagnosis. He also noted that this is very clearly not a case of traumatic stress entitlement. He also noted that he did not believe that this was a case of psychotraumatic disability entitlement. He reasons were that the physical injury and limitations would be very unlikely to result in significant secondary psychological problems. As well, it was noted that a detailed careful review of all of the file reveals a wealth of contradictions in reporting of psychological problems. He opined that not only do DSM-IV clinical criteria not seem to be met for such, including very questionable evidence of any Axis 1 diagnosis resulting secondary to the injury, but the WSIB Operational Policy criteria for psychological disability are also not met.
The psychologist opined: “It is very clear that there is a lot more going on here than just a compensable left arm injury, including but not limited to non-compensable health issues, family history of depression, and particularly the motor vehicle accident of April 19, 2005. The psychologist noted that while the upgrading program was not within the worker’s academic capabilities, accommodations were made by the WSIB to mitigate the difficulties experienced.
The consultant psychologist also noted that a previous review conducted in December 2006, it was noted that there was insufficient information to establish compatibility between a psych condition and the work accident and further information was requested with regards to the worker’s psychological symptoms, history, treatments and prognosis. The submission of the treating psychiatrist did not really answer the questions asked by the WSIB medical consultant as it was not current. It was stated that should the question of entitlement be raised by the worker again, before any psychiatric entitlement could be granted, he would request information about the other non-compensable factors, including but not limited to the car accident. This would include copies of all of the family physician’s notes and records, including prior to the work accident, copies of these for any family physician whom he may have had previously, copies of individual sessions noted by his psychiatrist and a copy of his accident benefits file with regards to the car accident.
The final opinion was that the psychiatric diagnosis of major depression and generalized anxiety disorder were not an indirect result of the worker’s compensable left arm tendonitis.
Prior to the hearing, the worker’s representative faxed me a copy of a letter received from the treating psychiatrist dated August 13, 2010. In that letter, the psychiatrist noted that he could not make any diagnosis of a condition prior to the injury since he had not seen the worker since August 2005. He noted that the DSM-IV diagnosis as of June 2009 was of major depression with a generalized anxiety disorder. The GAF is judged to be at 50.
In looking at this report, this is apparently in response to a request from the worker’s representative to the doctor in a letter apparently dated July 26, 2010. A copy of this letter was not provided to the WSIB, therefore I cannot determine what questions the doctor was responding to. In addition, I note that the doctor apparently last saw the worker in August 2005.
At the hearing, the worker stated that he feels that he can work as a DZ Driver, a Home Inspector, or a Heavy Equipment Operator and does not feel that he can do Customer Service work. He testified that he does not have any issues with driving and is able to assist at home with housekeeping and looking after his children aged 5, 11 and 13. He does find that he is short tempered at times and there are marital stresses as his wife only works part-time. When asked what his current restrictions are in terms of working he stated it was his anger and anxiety.
The evidence from the worker as well as the evidence on file does not, in my view support that the worker has entitlement under the WSIB’s psychotraumatic disability policy.
As noted by the consultant psychologist, the evidence on file does not support that the worker’s major depression and anxiety disorder is a result of the worker’s compensable left arm tendonitis. The injury was relatively minor in nature and not the result of a traumatic incident. The worker did not have any surgery as a result of his injury and was treated conservatively. The worker has received ongoing LOE benefits, and LMR assistance without interruption. The WSIB has made accommodations as necessary in the LMR program to mitigate the effect of the learning disability.
I also note that there are non-compensable stressors as documented by the WSIB’s consultant psychologist which have combined to break any chain of causation to the compensable injury. The worker and his representative are well aware of the additional information suggested by the WSIB’s consultant psychologist to be obtained in the event that the worker does continue to claim psychiatric entitlement, but yet did not provide any of these pieces of information to the file. In addition, noting the worker’s own testimony with regards to his current status and abilities, as well as noting the fact that the worker does not require ongoing regular treatments, the evidence does not support that the worker continues to suffer with any ongoing psychiatric condition or disability which can be related to the compensable left arm tendonitis.
The available evidence does not support that the worker has entitlement under the psychotraumatic disability policy.
CONCLUSION
The evidence does not support entitlement under the WSIB’s psychiatric disability policy.
The worker’s objection is denied.
DATED December 2, 2010
N. Kissoore Appeals Resolution Officer Appeals Branch