APPEALS RESOLUTION OFFICER DECISION
decision number:
20220001
OBJECTING PARTY:
worker
REPRESENTED by:
worker representative
RESPONDENT:
employer
REPRESENTED by:
employer representative
HEARING:
TELECONFERENCE – December 14, 2021
HEARD by:
D. Bowker, appeals resolution officer
ADDITIONAL ATTENDEES:
witness
ISSUES
The worker is objecting to the case manager’s decision dated January 8, 2020 that denied entitlement to a recurrence of post-traumatic stress disorder (PTSD).
BACKGROUND
On January 29, 2017, this police officer reported experiencing mental stress and trauma from years of repeated exposures investigating fatal motor collisions. The worker was placed on administrative leave on January 30, 2017 and sought treatment with a psychologist. This claim was established for PTSD.
The worker returned to their full-time hours on October 22, 2017 in a new position. The worker reached maximum medical recovery with permanent restrictions to avoid any involvement with motor vehicle crime/crash related stimuli on March 26, 2018. The worker received a 5% non-economic loss award for their permanent psychological impairment.
On May 21, 2019, the worker stopped working due to a recurrence of their symptoms. The January 8, 2020 decision determined there was no entitlement to a recurrence as there was insufficient evidence of a work-related significant deterioration, there was a new diagnosis of adjustment disorder or other specified trauma/stressor provided by the worker’s psychologist and there was no change in the worker’s permanent restrictions for their PTSD.
The case manager further determined the predominant and most significant factor for the worker’s deterioration was the death of their father and that was the source of the diagnoses of adjustment disorder or other specified trauma/stressor as there was insufficient clinical evidence the compensable PTSD condition was a factor or significant contributor to the worker’s recurrence.
The objection to this decision forms the basis of this appeal.
AUTHORITY
Operational Policy Manual
Published
15-02-05 Recurrences
February 1, 2018
18-03-02 Payment and Reviewing LOE Benefits (Prior to Final Review)
January 2, 2018
ANALYSIS
I have carefully considered all of the available information, legislation and relevant operational policies in reaching this decision. I find the worker has entitlement to a recurrence of their PTSD. I further find the worker is entitled to LOE benefits from May 21, 2019 onward.
Worker Position
The worker representative submits there was not one specific index incident but it is largely apparent the cumulative experience of working in the courthouse lead to an emergence and worsening of the worker’s PTSD. The representative further submits the worker’s duties in the courthouse regularly subjected them to stressful situations and as they had a low tolerance for stress, these duties were not appropriate for a person with PTSD.
The representative argues the worker’s PTSD was re-triggered in the context of work and impacted their ability to cope with other issues in their life, such as the passing of their father and other life stressors.
The representative agrees the worker had low mood and had a reaction to the specific stressor of the death of their father but submits the worker’s symptoms were evidence of abnormal bereavement. The representative further submits the combination of workplace stressors and the death of the worker’s father caused a relapse of their PTSD symptoms.
The representative notes the worker’s PTSD was a gradual and insidious onset in 2017 and again in 2019. The worker was not aware they were struggling and experiencing symptoms of PTSD as their symptoms were manifesting gradually due to cumulative exposures in the workplace. This was similar to the initial onset of their condition.
The representative notes the worker reported difficulty dealing with confrontational situations and did not feel safe returning to work. The June 26, 2020 letter from the worker’s family physician diagnosed severe PTSD and generalized anxiety disorder and stated it was difficult for the worker to deal with stressful situations and confrontation.
The representative further notes the worker’s permanent restrictions prevent them from completing work duties associated with the traffic branch but the duties in the courthouse overlapped with the duties of front line policing, leading to a high degree of routine stress for an individual with a low degree of routine stress
The representative states the worker is a stoic individual who expressed embarrassment due to their symptoms. The worker had suicidal thoughts and once they realized how poorly they were functioning, they re-engaged psychological treatment.
The representative notes the Workplace Safety and Insurance Appeals Tribunal (WSIAT) decision 1269/20 speaks directly to the inherent stress of working in the courts. The representative also notes the worker was required to wear a bulletproof vest, demonstrating the worker was exposed to a dangerous environment with a high degree of routine stress.
The representative argues that although the worker’s position in the courthouse is not viewed as stressful, it is stressful for a person such as the worker with low stress tolerance and PTSD. Given the confrontations and the stress the worker was subject to, the representative states it is not surprising it would take a toll over time on the worker and lead to a slow accumulation of PTSD.
Submission February 21, 2020
The worker representative submitted correspondence dated February 21, 2020, objecting to the decision to deny entitlement to the recurrence.
The representative explained the worker’s role as a court officer requires them to work at the front screening area of the courthouse alongside Special Constables. The worker screens individuals coming into the courthouse and is often placed in confrontational situations when they find individuals who may be bearing drugs, weapons or have warrants for their arrest.
The representative submits the job appears suitable as it meets the defined restrictions from the worker’s psychologist but there was no true analysis to determine if the position was in fact suitable for someone with PTSD.
The representative notes the worker was served with two subpoenas to appear in court to testify at a trial in early 2018 and their lawyer had to appear in court to explain to the judge they were unable to testify as it was related to a traffic matter. It took approximately three months to resolve the issue and that period of time was especially stressful for the worker.
Following those events, the representative states the worker stopped taking their medication as they felt they were doing well and did not realize the effect this would have on them.
The representative notes there was an incident involving a threat upon the courthouse in early 2019 and three police divisions were on lockdown due to the threat of a shooter. For those three days, the worker was on high alert, hand on their gun and ready to react in the event the worker showed up as they threatened they would. The representative states this had an effect on the worker and they were experiencing a decline in their mental health.
The representative further notes in February 2019 the worker’s father was diagnosed with cancer and passed away in March. The representative argues that while this contributed to the worker’s overall decline, it was not the sole factor or predominant cause of their deterioration.
The representative states the worker began to have thoughts of suicide and returned to treatment with their psychologist. They also went back on their medications sometime in May or June 2019.
The representative argues the worker’s recurrence is directly compatible with their original injury and that the deterioration is due in part to the loss of their father but also due to a decline in function related to the work exposures since the worker’s return to work in 2018.
Employer Position
The employer representative submits the paucity of medical evidence makes it difficult to connect the worker’s absence from work to a recurrence of their PTSD. The representative further submits more detail is required from the worker’s psychologist, Dr. Ekblad, and their physician, Dr. Haleem, as each have identified the incident of the worker’s father’s death as leading to a deterioration of their condition.
The representative notes the last report from Dr. Ekblad is from May 2018. The June 2019 report indicates Dr. Ekblad had seen the worker on 6 occasions since the spring of 2019. The representative notes there is a significant gap in the worker’s treatment and Dr. Ekblad’s report states the worker recommenced treatment only after their father passed away.
The representative states it is challenging to connect the worker’s deterioration in the spring of 2019 to specific events in the workplace. The representative further states that while it is established the worker has PTSD, the issue is whether the cause of the recurrence in May 2019 was a compensable incident that resulted in a deterioration of their condition or an intervening event that is not compensable.
The representative argues the available medical evidence speaks to the role of the death of the worker’s father in the worker’s condition. Dr. Ekblad and Dr. Haleem have only mentioned the worker’s father’s death in their reports. The representative argues it was such a significant intervening event, it becomes a non-compensable deterioration in the worker’s condition.
The employer representative notes there was an incident involving the removal of a stool immediately before the worker’s absence and therefore is of some significance. The representative states the focus in the work environment at that time was on the worker and some performance issues, including compliance around prior direction regarding use of the stool.
The representative notes the witness testified the stool was being abused and giving a poor presentation of the police force, especially during busy times when people were coming through the screening area.
The representative further notes the witness received reports the worker was not happy about the stool and left work. The worker was absent following that performance decision and had told others they were not coming back to work.
The representative argues the missing clinical notes would highlight what the worker said to Dr. Ekblad when they went off work and would aid in understanding the real reason for their departure.
The representative notes the case manager denied entitlement to a recurrence based on death of the worker’s father as trigger for their condition and the significance of this experience should not be diminished. The representative submits the worker had just six weeks from the time their father received their diagnosis until they passed away and this is little to no time to prepare oneself. The representative submits this is a traumatic experience for anyone and the impact on the worker should not be impacted.
The representative further submits the incident with the removal of the stool probably impacted the worker as they were more vulnerable due to the death of their father. The representative states the reaction to the stool was also part of a non-compensable, adjustment disorder following their father’s death.
The employer representative is seeking the denial of the worker’s appeal and notes this does not mean the worker was not impacted by the events of 2019 but rather than the reason they were unable to continue working is not work-related.
Relevant Policy
WSIB policy 15-02-05 Recurrences states a worker may be entitled to benefits for a recurrence of a work-related injury/disease if the worker experiences a significant deterioration that
does not result from a significant new incident/exposure, and
is clinically compatible with the original injury/disease.
A significant deterioration refers to a marked degree of deterioration in the work-related impairment that is demonstrated by a measurable change in the clinical findings.
Indicators of a significant deterioration may include
the need for active (non-maintenance) clinical treatment
a change in functional abilities, or
a change in the ability to perform a job or suitable occupation.
While a worker may take an occasional day off from work, this is generally not indicative of a significant deterioration.
If the significant deterioration results from a significant new incident/exposure (work-related or not) a recurrence is not considered. Instead, if the significant new incident/exposure is work-related, a new claim is considered.
If the significant deterioration occurs when there is no new incident/exposure or results from an insignificant new incident/exposure (work-related or not) a recurrence is considered.
A significant new incident/exposure is one of some consequence or importance (e.g., falling from a ladder). An insignificant new incident/exposure is one of negligible consequence or importance (e.g., reaching for an object on a shelf).
To establish that the significant deterioration is clinically compatible with the original injury/disease, the WSIB must determine that
the body parts and/or functions affected now are the same as, or related to, those affected by the original injury/disease, and
there is a causal link between the significant deterioration and the original injury/disease.
To make these determinations, the WSIB considers the nature and severity of the significant deterioration, the original injury/disease and any relevant non-work-related conditions that are present.
The WSIB may also consider whether a worker has experienced continuing symptoms since the original injury/disease. Generally, continuing symptoms are an indicator of a causal link, though they are not required to establish a causal link.
Indicators of continuing symptoms may include
continuing clinical treatment
continuing workplace accommodations, or
evidence that continuing symptoms were reported to health care providers, supervisors or co-workers on an ongoing basis.
According to policy 18-03-02, Payment and Reviewing LOE Benefits (Prior to Final Review), if the nature or seriousness of the injury completely prevents a worker from returning to any type of work, or if the worker is able to return to some form of work but the WSIB determines no suitable work is available, the worker is entitled to full LOE benefits providing the worker co-operates in health care measures and all aspects of the work-reintegration process.
Worker Testimony
The worker testified they returned to work in 2017, initially to the fraud branch on a temporary basis. They transferred to the court branch in January 2018 and were assigned to a downtown courthouse.
The worker stated they were happy to be in the new role as a court officer and enjoyed the social aspect of being able to speak with people going through the screening as it was different from their experience in the fraud office, where they were working alone in a cubicle.
The worker described their job duties in this role. The worker testified they wore their full uniform with full use of force options, including wearing a bulletproof vest, a taser and a gun. The worker was responsible for screening people as they entered the building, similar to security screening procedures at an airport. Individuals would place items to go through an x-ray and would walk through a metal detector.
The worker testified they worked alongside another sworn officer and 2-3 special constables. As a sworn police officer, the worker carries a firearm and a taser. The special constables wear light blue uniforms and do not have firearms or tasers.
The worker stated they were watching for people bringing items into the courthouse such as knives or other weapons. The individual would be asked to surrender the item or to leave the courthouse. The worker stated this was usually when a confrontation would occur as people did not like their item being taken.
The worker stated if an individual entered with drugs or weapons that were not prohibited, they were asked to leave the building with them and return without them. If individuals came in with prohibited drugs, they were arrested and patrol was called to attend the scene and take the person into custody.
The worker testified that every other day they experienced a confrontational situation as they were dealing with people distraught or upset at coming to court. These people frequently included drug users and alcoholics. The worker had to de-escalate screaming, irrational situations and there were times when individuals were physically escorted from the building.
The worker testified when they were first transferred to the courthouse, they were served a subpoena to testify at a trial for an incident that occurred in their previous role in the traffic division. The worker had a restriction to not testify in cases they investigated while working in the traffic branch and let the employer know this. The worker had to engage legal representation on their behalf through their association so they would not have to testify.
Ultimately, the situation was resolved and the worker did not have to testify and a representative spoke on their behalf in court. The worker estimated it took 2-3 months for this situation to resolve from the time they were first served their subpoena to the court date.
The worker testified it was hard to say one specific event triggered them, but rather multiple events accumulated over time. The worker provided examples of confrontational situations that stood out for them.
In 2018, the worker heard on their police radio a male was running from the special constables in the courthouse. The male jumped down over the rail of the stairs to the basement and the worker engaged in a foot pursuit through the bottom of the courthouse and the stairwells. The individual found his way out and escaped. The worker described this as high-stress event that stayed with them.
The worker testified it was common to have disturbances across the street from the courthouse as there was a shelter for abused women located there. The shelter was in the worker’s view when working in the courthouse and they witnessed a few incidents requiring intervention.
The worker recalled one occasion involving an incident where a male and female were involved in a domestic dispute outside the courthouse. The worker had to leave their post to separate the two of them to prevent an assault. The female was later arrested by a patrol officer for other offences
The worker testified in 2018 there was an alert out for a homicide suspect and a male outside the courthouse met the description. The worker stated they went outside and spoke to the person. The worker noted it was stressful as they thought he had a homicide suspect within their clutches. The worker took down the suspect’s particulars and forwarded it on to the homicide unit but it was a high stress incident for them.
The worker testified in 2018 they were required to use physical force to eject an agitated male from the courthouse. The individual was screaming in their face the entire time and was on drugs. The individual was denied access to the courthouse because of their demeanour and the worker had to use force to grab them by the shoulders and escort them out.
The worker testified they felt they had to be vigilant of their surroundings and on high alert as they found drugs and weapons on people coming into the courthouse and they did not want a knife getting into the courthouse.
The worker stated once an incident was over, it took them a long time to calm down. Previously, before they were diagnosed with PTSD, it would take a few minutes for their adrenaline to settle down but now with PTSD, the worker noted they escalate a lot quicker and it takes a lot longer to settle back down.
The worker testified in January 2019 they started having thoughts of suicide. The worker stated they thought about using their gun in the gunroom as they could be in there alone. The worker stated these thoughts would come and go and they talked themselves through it. They were embarrassed by their thoughts.
The worker also stated they felt like they were “boiling over”. The worker stated they began losing their patience and had a low tolerance where it did not take long to reach that boiling point. The worker stated they caught themselves himself screaming in an individual’s face during a confrontation with that person. The worker stated they caught themselves quickly but felt sick to their stomach.
The worker stated they were also was “raging” at their children and one time one of their children ran away because they were frightened. The worker testified they felt ashamed and sick at this behaviour.
The worker testified they felt they were “slowly boiling over” due to continually being exposed to stressors. They stated they did not see the return of their PTSD coming, just as they didn’t see it coming the first time when they were working in the traffic division as they were enjoying their time in the courthouse in the screening position. The worker stated they took a liking to this position and were told they did a good job at that spot.
The worker testified they did not bring their feelings to anyone’s attention, especially when thinking of suicide as they were embarrassed. The worker stated they wrote it off as normal and was just dealing with it. The worker stated they were not even sure what they were feeling and noted that PTSD “just sneaks up and bites you.”
The worker testified in 2019 a male well-known to the courts was in the courthouse and was notified he was wanted on a warrant. This individual took off running past the worker and the worker had to pursue him. The worker tackled him in between the lobby doors and as the male was resisting arrest, the worker had to work with a special constable to get the individual’s hands behind his back to arrest him.
The worker testified in February 2019 his father called and stated he was having cancer surgery. The worker took time off work to be with their father for the surgery. The worker stated they returned home and went back to work. The worker received word their father was declining in March and their father passed away, just 6 weeks after the initial diagnosis. The worker stated they took approximately 4 weeks off work following their father’s death.
The worker testified they returned to work and shortly following their return there was another stressful incident that had them on edge for a few days. The worker stated all of the police divisions in the city were locked down in response to reports of a male with a gun threatening to attend a police facility.
The courthouse could not be locked down and as the worker was working at the front of the courthouse, they testified they were hyper vigilant for three days, waiting for this male to walk into the courthouse.
The worker testified the male’s girlfriend was in custody and it was imminent she would come to the courthouse. The worker stated it was a very stressful over a period of a few days being in a hyper vigilant state while at the same time going through the aftermath of their father’s passing.
The worker testified they began taking annual leave and time off in April because they recognized they were struggling and needed time to themselves. The worker stated they believed their mental health would still have deteriorated had their father not died as they were already heading down that path. The worker stated they felt their father’s passing just accelerated that process.
The worker testified there was a period in 2018 when they stopped taking their antidepressant medication for approximately 6 months as they felt they were doing well mentally. The worker stated they went back on their medication in May 2019 and remain on it at this time.
The worker confirmed there was a pause in their treatment with Dr. Ekblad but they could not recall the specific dates when this occurred. The worker stated they resumed seeing the psychologist following their father’s death.
The worker testified there were several stools at the front of the courthouse and one was in the area where people were screened while going through the metal detectors for the staff to use. The worker stated there was a management meeting on May 15, 2019 and the next day, on May 16, the stool was taken away. The worker stated they were annoyed but did not find it to be “that big of a deal”, especially as there were 3-4 stools on the other side of the counter available to sit upon.
The worker noted he was internally angry about the loss of the stool but did not cause a scene at work and did not think they told the case manager they “blew up” over it or used that specific terminology.
The worker stated they attended work as usual on May 17, 2019, a Friday. The weekend was the Victoria Day holiday weekend and May 20 was a statutory holiday. On May 21, 2019, the worker called in sick to work and went to see Dr. Ekblad about their feelings and suicidal thoughts.
The worker testified the removal of the stool did not impact their decision to stop working. The worker acknowledged it annoyed them but they would not leave a 20-year career as a police officer over this incident. The worker stated they stopped working because Dr. Ekblad recommended it due to their suicidal thoughts.
The worker testified the incident with the stool was a drop in the bucket of their PTSD. The worker stated they were annoyed because one person ruined it for everyone who worked at the front of the courthouse as it looked unprofessional if someone was sitting while they were supposed to be working and screening people.
The worker testified they 100% disagreed they went off work following the stool incident. The worker notes the employer was aware they had plantar fasciitis as they were given permission to wear special shoes. The worker testified they did not tell the employer they needed a stool to accommodate their plantar fasciitis.
The worker testified their care with Dr. Ekblad was transferred over to Dr. Mainland, a neuropsychologist as the worker was having issues with their memory. Dr. Mainland worked with the worker to improve their memory in addition to their psychological issues and their focus is now on managing stress on a daily basis.
The worker could not recall exactly when they began seeing Dr. Mainland but felt it had been for over a year. The worker testified their appointments were virtual. Initially, the worker stated they were seeing Dr. Mainland biweekly but they are now seeing Dr. Mainland on a monthly basis. They note their anger has reduced from the level it was at when they first started seeing Dr. Mainland.
The worker testified they had always wanted to be a police officer and was in the promotional process as an acting sergeant at the time they first went off for their PTSD. The worker could not work in an acting role in their position at the courthouse as they could not work in the cellblocks where the accused were held as they waited to appear before the court.
Currently, the worker testified they try to go to bed around 10 pm each night and if they get a good sleep, they are up at five or six am. There are days when the worker is awoken at four am with a racing mind and they are unable to return to sleep. The worker stated they try to fill their time doing work at home, such as renovation work on their house or woodworking in their shed.
The worker testified they were uncertain about their ability to return to work as they were dealing with anxiety on a daily basis now. The worker was also unsure if they would be able to return to the courthouse.
Witness Testimony
The witness testified that currently they were working as a superintendent in the police force and were responsible for special projects in the chief of police’s office. The witness testified they reported to the deputy chief, who reports directly to the chief of police.
The witness testified they had responsibility for court services at one point and were the inspector for the Court Services Branch from approximately the fall of 2017 to January 2021. The witness stated they were responsible for all police, special constable and civilian operations within the courthouse, administrative paperwork, and the provision of security in and out of the courthouse and within the courthouse itself
The witness confirmed there were staff sergeants, sergeants, constables, special constables, operations and administrative staff reporting to them at that time.
The witness testified the special constables had the power of arrest during work their work hours only and did not carry the same use of force as sworn officers as they were equipped with just pepper spray and a baton. The special constables worked alongside sworn officers in cellblocks providing transportation and movement to the courthouse, and worked at the front of courthouse to screen members of the public, making it safe for everyone to enter.
The witness testified they were aware the worker needed accommodation in the workplace and these restrictions prevented them from doing certain roles within the courthouse. The witness confirmed they were happy to have the worker come and work in the front area as they enjoyed an amicable relationship and the worker was a good person.
The witness confirmed the worker’s job duties involved screening anyone entering the courthouse, including anyone with positive reading after passing through the metal detector. The worker would use a wand to manually check these individuals. The special constables were trained to operate the x-ray machine and were responsible for this duty.
The witness testified there were anywhere from 3-5 special constables working at one time, two sworn officers assigned to the position and an operations sergeant responsible for overall building security that would come and go from the screening area as needed or would provide relief during lunch breaks.
The witness stated depending on the day and who was scheduled in court, there could be days with no problems in the screening area and then they could have a day with three problems in a row. The witness confirmed people passing through the screening area included lawyers, community partners, witnesses, accused, and others.
The witness testified they were aware the stress was a big factor for the worker and they were having issues managing their stress. The witness stated they were also aware the worker was facing challenges with stress-related issues overall with work and their home life. The witness did not have direct contact with the worker about their mental health, as this was something the worker would speak to their direct supervisor about.
The witness testified they discussed ways to manage the monotony of the job and explored ways to move the worker into different areas. This was limited by the worker’s restrictions as they could not be exposed to certain paperwork that would trigger their PTSD. The witness noted they could never have controlled other areas enough for a move to be approved by the human resources department.
The witness stated the role the worker was performing was one of the lowest stress jobs of a constable in the service and noted it was not a stressful position whatsoever.
The witness testified they were made aware community partners such as crown attorneys and legal aid lawyers were complaining to supervisors that the teams in front of security at the front entrance to the courthouse looked sloppy, half-interested and were not paying attention to their surroundings. The complaints stated these employees were on their cell phones, making the police service look unprofessional.
The witness stated they directed supervisors in management meetings to ensure their people were paying attention and avoiding use of their cell phones as it was their job to represent the police service with professionalism.
The witness testified supervisors specifically identified the worker was sitting frequently on a stool and was using their cell phone and this looked unprofessional. The witness stated they took a progressive approach and directed the supervisors to tell their people to sit up, “smarten up” and do their work.
When this was brought up again in May during a management meeting, the witness testified they issued the order that if staff could not listen and continued to sit on the stool, the stool was to be removed from the work area as it was not mandatory to be there.
The witness testified the stool was removed on May 16, 2019 and they were advised by others that the worker was very angry and stated they were not coming back to work if the stool was removed. The witness confirmed they did not hear this from the worker directly.
The witness testified they had met in person once since the worker went off work. They did not discuss specific triggers that caused the worker to go off work but generally discussed how the worker’s ability to do their job as a constable was affected by stress and the death of their family member.
The witness stated the meeting with the worker was a discussion about what a possible return to work would look like, similar to an exposure to the workplace. The witness stated they like the worker as a person and were concerned for them. The majority of their meeting was general, non-specific conversation.
Relevant Case Details
The non-economic loss clinical specialist reviewed the worker’s claim on August 27, 2018 and determined a 5% impairment was the most accurate rating for the worker’s condition. The clinical specialist noted the worker demonstrated overall a mild impairment level with respect to their work-related PTSD.
The clinical specialist indicated there was a degree of emotional disturbance under ordinary stress noting the worker still experienced significant distress when confronted with some reminders of previous trauma and required restrictions/accommodations in the work environment such as not being involved with any motor vehicle crime/crash related stimuli.
The employer spoke with the case manager on September 12, 2019 and advised they had spoken with the worker’s supervisor. The supervisor stated there was an issue with employees sitting on stools and not assisting the public so all the stools were removed to resolve this issue. Many staff members were not happy with this decision.
The supervisor confirmed the worker did not discuss their PTSD symptoms and the only reason they were aware of the worker’s absence from work was due to the removal of the stools from the workplace. The employer confirmed they would have the supervisor provide a statement about this occurrence.
In an e-mail dated August 23, 2019, the inspector responsible for the Court Services Branch noted the only change to the worker’s work environment was the removal of a stool the worker had been sitting on during their work hours to ensure nobody was sitting down when the public walked through the screening area of the courthouse. The inspector further noted the stool was removed on May 16 and the worker left work and did not return on May 17, 2019.
The worker spoke to the case manager on November 18, 2019 and advised they had been able to work from January 2018 to January 2019 with no issues. In January 2019, the worker stated their mood started to decline and they began to experience a return of their symptoms. The worker advised they began having more intrusive thoughts about their previous work investigating collisions.
The worker noted they began losing their patience and raising their voice with individuals at the courthouse. The worker stated the stools were removed at work and as they had plantar fasciitis and felt they really needed the stool to relieve their symptoms, they “blew up” at someone at work. The worker stated they knew it was a minor issue but due to their state of mind, it became a big issue. The worker stated they apologized to the individual.
The worker advised the case manager they began to have suicidal thoughts and contacted their psychologist to return to treatment in April 2019. During that same time, there was a high-alert situation at work where a person was coming into the courthouse with a gun. This incident triggered feels of panic and thoughts of the past for the worker.
The worker also stated their father passed away suddenly in March 2019 and it was a stressful time, especially as they were the executor of the estate. The worker went back on medication for anxiety and depression in May or June 2019.
Relevant Medical Information
Dr. Ekblad, the worker’s psychologist, provided a report dated May 15, 2018 confirming the worker was diagnosed with Other Specified Trauma/Stressor-Related Disorder in response to workplace stress and trauma associated with their work in the traffic branch of the police service.
Dr. Ekblad noted that while the worker had largely recovered from the distress that caused them to be off work for most of 2017, they still experienced significant distress when confronted with some reminders of previous trauma. The worker’s limitations were exclusively related to stimuli involving motor vehicle crashes, motor vehicle crime, motor vehicle police work and materials such as photographs or data directly related to motor vehicle crime/crashes.
A Sick Leave Claim Form completed by Dr. Ekblad on July 2, 2019 diagnosed the worker with adjustment disorder and noted the worker had low mood in response to the specific stressor of their father’s death. The worker’s symptoms were not an example of normal bereavement. The worker was experiencing difficulties with organization, memory and attention.
Dr. Ekblad indicated the worker had resumed treatment in the spring of 2019 and they had met six times at the time of the report, with limited response to treatment. The worker’s sleep and mood were significantly impaired. The worker was unable to return to work due to an inability to manage stressors, severe fatigue and low mood.
In a report dated August 21, 2019, Dr. Ekblad confirmed the worker’s diagnosis remained Other Specified Trauma/Stressor – Related Disorder. Dr. Ekblad noted the combination of the unexpected illness and death of the worker’s father and workplace stressors such as feeling their difficulties were being ignored led to a relapse of their symptoms.
Dr. Ekblad noted the worker was unable to return to work but their accommodations did not need to be altered at that time. The worker was experiencing diminished energy and struggled at times to complete common domestic tasks.
Dr. Ekblad submitted correspondence dated November 7, 2019, confirming the worker’s symptoms began with workplace stress and were exacerbated by the death of their father in March 2019. One noted symptom was a deterioration in mood with decreases in overall mood and increased in irritability. Dr. Ekblad stated the death of the worker’s father led to a worsening of their workplace stress disorder symptoms.
A noted from the worker’s physician Dr. Haleem dated June 26, 2020 stated the worker was experiencing severe symptoms of PTSD and generalized anxiety, making it difficult for them to deal with stressful situations and confrontation. The worker was also experiencing disturbances of sleep and persistent headaches, making it difficult for them to concentrate and focus.
Dr. Haleem noted they were concerned about the worker’s safety to return to work but given the worker’s improvement over the previous months and motivation to return to work, Dr. Haleem anticipated a return to work in 3-6 months.
Assessment of the Evidence
In my review of this case and having regard for the requirements under policy 15-02-05 Recurrences, I find the worker has entitlement to a recurrence.
WSIB policy 15-02-05 Recurrences directs me to determine the worker’s entitlement to benefits for a recurrence by examining whether the evidence supports the worker experienced a significant deterioration that
did not result from a significant new incident/exposure, and
is clinically compatible with the original injury/disease.
Significant Deterioration
A significant deterioration is defined as a marked degree of deterioration in the work-related impairment that is demonstrated by a measurable change in the worker’s clinical findings.
In order to determine the worker has experienced a significant deterioration in the work-related impairment, I must be able to establish their compensable PTSD played a role in their recurrence. Policy 15-02-05 Recurrences does not exclude other, non-work related events that may also be impacting a worker but directs that the work-related injury is the factor of considerable effect or importance in the recurrence.
In this case, the sudden illness and passing of the worker’s father undoubtedly contributed to the worker’s psychological condition. I am of the view, however, that this was not the single contributing factor to their psychological condition. The available evidence before me demonstrates the worker’s compensable PTSD made a significant contribution to their deterioration.
I found the worker to be a credible historian and they presented their testimony in a straightforward manner. The worker described an ambitious individual actively involved in the promotion process prior to their diagnosis of PTSD in 2017. The worker was eventually able to return to work in a new position in a courthouse.
The worker described an onset of symptoms that occurred slowly over time, such as feeling they had to be vigilant of their surroundings in the courthouse, losing their patience and shouting at individuals, including their children. The worker described it as “slowly boiling over”.
I further note the worker’s testimony they began experiencing thoughts of suicide in January 2019, including identifying a place where this could occur. There is no evidence before me to demonstrate the worker previously had suicidal thoughts.
The worker self-managed these feelings until they no longer could and sought medical attention with their psychologist Dr. Ekblad. The worker testified that once they shared these feelings with Dr. Ekblad, they were advised to stop working and to start taking their antidepressant medication again.
In my view, this is evidence of a deterioration in the worker’s condition. The worker had been able to work from October 2017 until May 2019, when they were no longer able to remain at work due to their symptoms. Further, the worker had a six-month period where they were not taking any medication as they felt mentally well. The worker began taking their medication again once they stopped working.
I am persuaded the symptoms Dr. Ekblad documented on July 2, 2019 had been ongoing since at least January 2019, when the worker testified they began experiencing suicidal thoughts. Dr. Ekblad’s August 21, 2019 report specifically commented the combination of the unexpected illness and death of the worker’s father and workplace stressors such as led to a relapse of their symptoms.
Dr. Ekblad confirmed this again in correspondence dated November 7, 2019 when they stated the worker’s symptoms began with workplace stress and were exacerbated by the death of their father in March 2019.
Although the passing of the worker’s father was a concurrent stressor that contributed to their deteriorating condition, I find, on a balance of probabilities, that the work-related PTSD made a significant contribution to the worker’s deterioration.
I therefore find the evidence does support the worker suffered a significant deterioration in their compensable psychological condition.
Did Not Result From a Significant New Incident/Exposure
A significant new incident/exposure is generally defined one of some consequence or importance, such as falling from height whereas an insignificant new incident/exposure is one of negligible consequence or importance, such as reaching for an object.
If the significant deterioration occurs when there is no new incident/exposure or results from an insignificant new incident/exposure (work-related or not) a recurrence is considered.
I note the employer representative’s arguments the death of the worker’s father and the incident involving the removal of the stool were events of such significance, they became non-compensable deteriorations in the worker’s condition. The representative notes the removal of the stool occurred immediately prior to the worker’s absence from work.
I agree with the employer representative that the death of the worker’s father was a significant event. I note the worker stopped working following the passing of their father and remained off work for approximately four weeks on a bereavement leave. The worker testified this time off work was specifically due to their father’s death.
However, I further note the worker subsequently returned to work and remained at work until May. There is no evidence the worker required additional accommodation following this time off or that the worker was unable to do their job upon their return to work.
While the passing of their father was a significant event, I do not find it to be the sole reason for the deterioration of the worker’s condition as they were able to return to work following a period of bereavement leave where the reason they stopped working was exclusively attributed to this death.
The worker testified they began seeing Dr. Ekblad again following the death of their father but did not have a specific date their treatment began. Dr. Ekblad’s notes indicate the worker was seen for six sessions following the death of their father. I note the worker was not directed to stop working by Dr. Ekblad until May. The worker testified once they shared their suicidal thoughts with Dr. Ekblad in May, they were immediately advised to stop working.
I further note the worker testified they did not go back on their medication until they stopped working in May. Based on this timing, I find it more probable the reason the worker began taking their medication again was due to the increase of their PTSD symptoms, including their suicidal thoughts, than the passing of their father.
I also do not find the removal of the stool to constitute a significant new incident. The removal of the stool or the worker’s reaction to it did not have significant consequences for the worker. The worker testified they were annoyed but did not find it to be “that big of a deal”. The worker was not disciplined for any comments they may have made and continued working for another day following the removal of the stool.
While the issue of the stool may have been a concurrent stressor, I do not find it to be the sole cause of the worker’s ongoing impairment or their absence from work. I am placing weight in the worker’s direct testimony they sought treatment with Dr. Ekblad about their feelings and suicidal thoughts. The worker testified these suicidal thoughts began in January 2019, prior to their father’s declining health and continued throughout 2019.
The witness testified the role the worker was performing was one of the lowest stress jobs of a constable in the service and noted it was not a stressful position whatsoever. As a police officer, the worker would be expected to regularly apprehend and arrest individuals or be on the lookout for suspects. The various incidents the worker described in their testimony are not so unusual in the course of the worker’s employment they could be considered to be of some consequence or importance.
I am therefore not persuaded that any of the incidents the worker described represent a significant new incident but rather are examples of routine events the worker was expected to undertake in the course of their employment.
Clinically Compatible with the Original Injury
To establish the significant deterioration is clinically compatible with the original injury, I must determine the areas currently affected are the same as or related to those originally affected and there is a causal link between the significant deterioration and the original injury.
I note there is missing clinical information. Dr. Ekblad’s initial clinical notes from when the worker returned to treatment are not available. There is no documentation at all from Dr. Mainland, the neuropsychologist currently treating the worker.
The available information does consistently confirm the worker sustained a worsening of their PTSD, making it difficult for them to manage stressors and that this PTSD was exacerbated by the death of the worker’s father.
In this case, I find the worker’s psychological condition is clinically compatible and causally linked to the psychological condition accepted in this claim. I once more note Dr. Ekblad’s correspondence the worker experienced a worsening of their workplace stress disorder.
For the reasons I detailed above, I find the evidence does support the worker sustained a significant deterioration in their compensable psychological condition and the criteria to allow entitlement to a recurrence has been met.
WSIB policy 18-03-02 Payment and Reviewing LOE Benefits (Prior to Final Review) allows for the payment of LOE benefits if the nature or seriousness of the injury completely prevents a worker from returning to any type of work.
I also find the compensable psychological condition rendered the worker unable to work. The worker is therefore entitled to full LOE benefits from May 21, 2019 onward.
CONCLUSION
The worker’s objection is allowed. The worker has entitlement to a recurrence. The worker is entitled to full LOE benefits from May 21, 2019 onward. This claim is returned to the operating area to determine the nature and duration of benefits flowing from this decision.
DATED DECEMBER 31, 2021
Donna Bowker
Appeals Resolution Officer
Appeals Services Division