WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
decision number:
20150102
DECISION DATE:
March 3, 2015
OBJECTING PARTY:
Worker
REPRESENTED by:
Worker Representative
RESPONDENT:
Employer (not participating)
HEARING:
Hearing in Writing
HEARD by:
H. Shaw, Appeals Resolution Officer
ISSUE
The worker is objecting to the decision of July 3, 2014 that denied entitlement for a psychotraumatic disability for Chronic Adjustment Disorder with Anxiety and Depressed Mood.
BACKGROUND
The worker was employed as a sommelier in a hotel. On December 19, 2005, at the age of 30, he injured his low back while lifting cases of champagne. He has a 26% Non-Economic Loss (NEL) benefit for a low back strain.
He was provided with Labour Market Re-entry (LMR) services with a suitable employment or business (SEB) of Marketing Consultant. He obtained a university degree in Business Economics. Upon completion of the LMR plan, he was reduced to partial loss of earnings (LOE) benefits on December 1, 2012 to reflect an ability to earn an entry-level wage in the SEB. The worker did not return to work and claimed to be unemployable. An Appeals Services Division (ASD) decision dated July 24, 2013 confirmed he was employable in the SEB.
On November 23, 2012 the worker’s representative sent a letter requesting entitlement for a psychotraumatic disability.
Case Manager’s Decision
On July 3, 2014 the Case Manager denied entitlement for a psychotraumatic disability because the worker had an established psychological condition prior to his work injury.
The Worker’s Position
It is the worker’s position he saw a psychologist only once prior to the workplace injury because of issues related to sleep apnea and that his current condition is the result of the work injury.
AUTHORITY
Operational Policy
15-04-02 Psychotraumatic Disability
ANALYSIS
I find the worker has entitlement for a psychotraumatic disability for the reasons explained below.
Entitlement for a psychotraumatic disability may be established when the following circumstances exist or develop:
Organic brain syndrome secondary to - traumatic head injury - toxic chemicals including gases - hypoxic conditions, or - conditions related to decompression sickness.
As an indirect result of a physical injury - emotional reaction to the accident or injury - severe physical disability/impairment, or - reaction to the treatment process.
The psychotraumatic disability is shown to be related to extended disablement and to non-medical, socioeconomic factors, the majority of which can be directly and clearly related to the work-related injury.
It must become manifest within 5 years of the injury, or within 5 years of the last surgical procedure.
Although the worker had pre-existing mental health issues, the medical evidence suggests his condition was exacerbated by the workplace injury. In May 2005, several months before the workplace injury, clinical notes from his family doctor indicated he was experiencing anxiety and panic attacks. Ativan was prescribed and he was referred for psychotherapy; unfortunately, clinical notes and reports are not available from the psychologist. Clinical notes from his family doctor continued to reference anxiety problems throughout 2006 and 2007. By 2008, chart notes from his family doctor began to make reference to depressive symptoms. There was no mention of depressed mood prior to the workplace injury. In a report dated May 15, 2009, a psychiatrist diagnosed him with a Pain Disorder with Anxiety and Depression attributable to constant back pain.
In May 2014 the worker had a psychological and psychiatric assessment at CAMH. I place significant weight on those reports, because of the comprehensive nature of the assessment. The combined discharge report from the psychiatrist, psychologist and psychometrist diagnosed the worker with an Adjustment Disorder with Mixed Anxiety and Depressed Mood. The workplace accident was considered to be a major contributor to the Adjustment Disorder. The body of the report indicated the worker was feeling sad about the drastic changes in his lifestyle resulting from the injury, including pain, problems playing with his children, changes in his relationship with his wife, inability to engage in his usual activities and feeling dependent on others.
Because some of the pre-accident clinical notes no longer exist, it is difficult to determine the severity of the worker’s pre-existing psychotraumatic impairment. However, based on the CAMH report, I am satisfied the work injury was a significant contributing factor in the development or progression of the Adjustment Disorder with Mixed Anxiety and Depressed Mood.
The report from CAMH indicated his mood and anxiety symptoms would not preclude a return to work and the worker has no psychological restrictions. Based on those findings, the allowance of psychotraumatic entitlement does not restrict his ability to work.
Although I am accepting initial entitlement for a psychotraumatic disability, I am unable to determine if there is a permanent impairment. The CAMH assessment recommended additional treatment for the worker, including psychopharmacological treatment, 8 to 10 sessions of individual treatment with a psychologist and a consultation regarding pain medications. The report indicated he would not be at MMR until after the implementation of the treatment recommendations.
CONCLUSION
I conclude the worker has entitlement for a psychotraumatic disability for an Adjustment Disorder with Mixed Anxiety and Depressed Mood. The Operating Area is to determine if there is a permanent psychotraumatic impairment after implementation of the treatment recommendations.
The objection is allowed.
DATED March 3, 2015
H. Shaw
Appeals Resolution Officer
Appeals Services Division