WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
Decision number : 20172029
OBJECTING PARTY: Worker
REPRESENTED by: Legal Services
RESPONDENT: Employer [not participating]
REPRESENTED by: Representative
HEARING: Hearing in Writing
Date: February 24, 2017
HEARD by: K. Gowans, Appeals Resolution Officer
ISSUE
The worker objects to the May 19, 2016 Case Manager decision which denied extended entitlement to psychotraumatic disability and chronic pain disability (CPD).
BACKGROUND
On August 26, 2011, this then 51 year old machine operator suffered a head and neck injury when she was struck from behind by a robotic arm. Initial entitlement was accepted to a soft tissue neck strain and a concussion. It has been determined that the head injury fully resolved but that the worker was left with a resultant permanent impairment affecting the neck. In February 2013 the worker was granted entitlement to a 14 percent non-economic loss (NEL) benefit for her residual cervical spine permanent impairment.
The worker received full loss of earnings (LOE) benefits for the period of time she remained off work between August 27, 2011 and her return to permanent modified duties on November 28, 2011.
The worker representative has subsequently requested extended entitlement to include psychotraumatic disability and/or chronic pain disability (CPD). In the Case Manager decision dated May 19, 2016 entitlement to psychotraumatic disability as well as CPD was denied.
The worker disagrees with the above noted decision and has brought the case forward to the Appeals Services Division for further consideration. The worker representative completed an Appeal Readiness Form (ARF) on December 2, 2016 requesting that the issue be resolved through a hearing in writing.
AUTHORITY
Policy Document : 15-04-02 Psychotraumatic Disability
Policy Document : 15-04-03 Chronic Pain Disability (CPD)
ANALYSIS
For the reasons set out below, I find there is no basis to accept extended entitlement to either psychotraumatic disability or chronic pain disability (CPD) in this claim.
Policy
The WSIB policy on psychotraumatic disability is found in the Operational policy 15-04-02. In part, it reads as follows:
If it is evident that a diagnosis of a psychotraumatic disability/impairment is attributable to a work-related injury or a condition resulting from a work-related injury, entitlement is granted providing the psychotraumatic disability/impairment became manifest within 5 years of the injury, or within 5 years of the last surgical procedure.
Psychotraumatic disability/impairment is considered to be a temporary condition. Only in exceptional circumstances is this type of disability/impairment accepted as a permanent condition.
Entitlement for 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.
The WSIB policy on chronic pain disability (CPD) entitlement is outlined in operational Policy document 15-04-03. In part, it reads as follows:
Eligibility Criteria
For a worker to qualify for compensation for CPD the following conditions must exist, and must be supported by all of the indicated evidence:
Condition
Evidence
A work-related injury occurred
A claim for compensation for an injury has been submitted and accepted.
Chronic pain is caused by the injury.
Subjective or objective medical or non-medical evidence of the worker's continuous, consistent and genuine pain since the time of the injury,
AND
a medical opinion that the characteristics of the worker's pain (except its persistence and/or its severity) are compatible with the worker's injury, and are such that the physician concludes that the pain resulted from the injury.
The pain persists 6 or more months beyond the usual healing time of the injury
Medical opinion of the usual healing time of the injury, the worker's pre-accident health status, and the treatments received,
AND
subjective or objective medical or non-medical evidence of the worker's continuous, consistent and genuine pain for 6 or more months beyond the usual healing time for the injury.
The degree of pain is inconsistent with organic findings
Medical opinion which indicates the inconsistency.
The chronic pain impairs earning capacity.
Subjective evidence supported by medical or other substantial objective evidence that shows the persistent effects of the chronic pain in terms of consistent and marked life disruption.
File Review
Following the accident, the worker was assessed by her family doctor, Dr. Matthews, who diagnosed her with a concussion and neck strain after being hit on the head by a robotic arm. In the Health Professional’s Report (Form 8) she completed dated September 12, 2011 she noted that the worker complained of numbness and pain in her neck and shoulders since the accident. A referral had been made for the worker to see a neurologist.
The worker saw neurologist, Dr. Chepesiuk on September 16, 2011. He noted that she was still in the acute phase of her injury, which he diagnosed as a neck strain. No abnormal pain behaviours or psychological symptoms were identified.
The case record confirms that the worker was able to return to fulltime, modified work with her employer effective November 28, 2011. There has been no indication put forth to suggest that she has not been able to continue performing her fulltime work duties to date. Of note, memo#95 dated August 20, 2015 documents a conversation that took place with the employer representative who confirmed that the worker has been working full time since November 28, 2011 “with no issues”.
On January 31, 2012 the worker was assessed at a Regional Evaluation Centre (REC) at which time the diagnosis of a cervical strain was confirmed. The worker was said to have demonstrated normal movements and functional patterns, albeit with some pain behaviours and reduced neck range of motion (ROM) values. It was recommended that the worker be referred for a Multidisciplinary Pain Program.
On February 28, 2012 the worker saw neurologist, Dr. Gladstone, for an independent neurological examination. The worker reported to Dr. Gladstone that prior to her accident, she was “healthy and well”. As well, prior to the accident, she “did not do any regular exercise” and enjoyed gardening, watching TV and maintaining her house.
The worker described being hit in the head and neck by a robotic arm on August 26, 2011. She believed she lost consciousness for a couple of seconds and fell to the ground. She reported having headaches and neck pain subsequent to the accident. At the time of the assessment, the worker reported having daily headaches. Notably, it was confirmed that there were “no hearing disturbances”. She also reported having neck pain and poor sleep. It was recorded that the worker feels her “mood is depressed and anxious and indicated that she worries about whether or not she will get better”. It was felt that the “prognosis for her cerebral concussion and whiplash injury is for significant improvement”. Dr. Gladstone indicated that “I anticipate that she will ultimately be able to make a return to full-time work”. He did not feel that she needed a Chronic Pain program.
None-the-less, the worker was referred to a Function and Pain Program (FPP) which began on March 20, 2012. In the report dated April 10, 2012 it was confirmed that the worker had returned to modified employment assembling small parts. The worker was said to be motivated to receive treatment and learn pain management strategies.
The FPP discharge report on file is dated July 18, 2012. It was confirmed that as of July 23, 2012 the worker was performing her full-time regular duties although was not being rotated into all of her pre-injury positions.
Of note, as part of the FPP program, the worker was seen by a consulting psychologist and physician. The psychologist completed a DSM-IV assessment of the worker and found no evidence of any clinical psychological disorders. The Axis 1 diagnosis was “Nil”.
The worker demonstrated the ability to successfully incorporate pain management strategies taught to her during the FPP and that “she was pleased with the progress she made at work”. It was noted that the employer reported that the worker “was back to her normal self”.
It was noted that when the worker met with the consulting psychologist, she “did not present with any significant psychological impairments”. Instead she reported benefitting from the pain management strategies taught to her. She was able to engage in such activities as cleaning and doing the laundry and was not as frightened about aggravating her condition.
The worker was seen in follow-up at the FPP on September 11, 2012. In the report dated October 16, 2012 it was confirmed that the worker remained at fulltime work duties with the employer. There were no activities of daily living (ADLs) limitations identified and it was confirmed that the worker continued to remain instrumental in cleaning her house and engaging in meal preparations. She was said to be active on the weekends, going for walks and socializing with her family and friends.
There is no further medical information on file subsequent to the October 2012 FPP report until a report was received from psychiatrist, Dr. Dhaliwal dated March 3, 2016. Of note, this report needed to be requested by the WSIB Case Manager in response to the worker representative’s request for entitlement to psychotraumatic disability.
The report states that the worker ”gave me a history that she injured her head and she was hit by a robot and she was off for three months and that happened in 2011”. It was then recorded that since that time the worker “is hearing voices”. The doctor elaborates that the worker hears people calling her name but when she turns around no-one is there. Associated with the voices, the worker described feelings of anxiety, depression, sad mood, decreased concentration and focusing.
The doctor alluded to the worker still being at work, but felt she needed to be off due to her “psychotic illness”. He stated he diagnosed her with “psychotic depression in the past with anxiety and panic attacks which is the same now”. He does not provide any indication or dates about when he treated her in the past. Finally, he does not provide a DSM-IV diagnosis other than to say the worker has a “psychotic depression”.
Prior Medical History
A copy of Dr. Matthews’ clinical record for the 5 year period prior to the accident is on file. Of note, in October 2006, reference was made to neck pain and headaches as well as stress. The worker reported only being able to sleep for 5-6 hours a night.
In March 2010, headaches were again reported, with the comment that they felt like “head going to explode”.
On June 30, 2011 the worker underwent nerve conduction studies and was diagnosed with left sided carpal tunnel syndrome.
Submissions
The worker representative has not made any submissions on the issue under appeal.
Assessment
When I assess all of the available information in the claim file, I find no basis to accept entitlement to psychotraumatic disability or chronic pain disability (CPD) in this claim.
With respect to the issue of psychotraumatic disability entitlement, I note that there has been no confirmed DSM-IV diagnosis provided to file to support or even suggest that the worker is suffering from a compensable psychological condition.
The initial medical reporting on file did not identify the worker experiencing any psychological symptoms in relation to the workplace injury. Most convincingly, when she was assessed and provided with treatment at the FPP in 2012, it was specifically noted that there was no psychological condition affecting the worker and the Axis I diagnosis provided on a DSM-IV assessment was identified as “nil”.
The only indication of the worker experiencing a psychological condition is found in the report from Dr. Dhaliwal, 4 ½ years post accident, and 2 years subsequent to the last medical reporting from the FPP. In the report, the doctor does not provide a specific DSM-IV diagnosis but rather suggests that she is suffering from a “psychotic depression”. In describing this condition, the doctor relies heavily on the worker’s assertion that she has been hearing voices in her head since the time of the injury.
This, however, is completely inconsistent with the entire remaining medical documentation on file. There has not been a single report provided to file which documents the worker complaining of hearing voices in her head. In fact, the worker has maintained fulltime, regular employment since at least 2012 with no indication of her experiencing any psychotic features.
Dr. Dhaliwal also references having treated the worker “in the past” however it remains unclear as to when this treatment took place. It would seem that the treatment took place prior to the compensable accident since none of the file documentation identifies the worker being seen by Dr. Dhaliwal subsequent to her injury. He refers to the worker having “high anxiety” and depression, but provides no medical continuity to link these symptoms to the workplace accident.
The overwhelming medical information on file makes no reference what-so-ever to the worker experiencing psychological symptoms related to her accident or injury. The most recent FPP report from 2012 confirms the worker was continuing at work, was able to continue with her activities of daily living (ADLs) and had benefitted immensely from the FPP program.
I find that there is no basis to support that the worker meets any of the three possible criteria that can be considered for entitlement to psychotraumatic disability to exist. As such, the request for psychotraumatic disability entitlement remains denied.
With respect to the issue of CPD entitlement, I find that the worker does not meet all of the required criteria for entitlement to be accepted.
In reviewing the medical documentation provided to file, I note that the worker suffered an organic neck and head injury when she was struck from behind by a robotic arm. She received loss of earnings (LOE) benefits for the period she remained off work from August 2011 to November 28, 2011 while she recovered from the acute effects of her injury. During this period of time, the medical reporting was entirely consistent with an organic injury, diagnosed as a cervical strain.
The worker attended an FPP in 2012 where she was provided with treatment and pain management techniques that allowed her to maintain her fulltime regular employment with the accident employer. The FPP reporting confirms that the worker’s neck complaints are in keeping with the organic cervical strain diagnosis provided to file.
The worker has not suffered a marked life disruption, given that she is able to maintain fulltime regular employment for over 5 years, is able to perform her regular activities of daily living (ADLs) at home and is able to socialize with friends and family without apparent difficulty.
The only anomalous report is the recent report from Dr. Dhaliwal. However, as noted earlier in this decision, his report provides conflicting information when compared to the remainder of the medical reporting on file. Given the conflicting information in the report, I am unable to place any emphasis on the doctor’s opinion. I also note that he does not provide any diagnosis that would be consistent with a chronic pain disability (CPD).
Instead, I accept that the worker’s pain complaints remain entirely consistent with the accepted 14 percent NEL benefit for the chronic cervical strain suffered in the accident.
The worker’s request for entitlement to chronic pain disability (CPD) remains denied.
CONCLUSION
The worker’s request for entitlement to psychotraumatic disability or in the alternative chronic pain disability (CPD) is denied.
DATED February 24, 2017
K. Gowans
Appeals Resolution Officer
Appeals Services Division