APPEALS RESOLUTION OFFICER DECISION
decision number:
20220109
OBJECTING PARTY:
worker
REPRESENTED by:
worker representative
RESPONDENT:
employer (not participating)
HEARING:
VIDEOCONFERENCE – July 4, 2022
HEARD by:
Stephanie Waters, appeals resolution officer
ISSUE
The worker objects to the Case Manager’s (CM’s) November 1, 2021 decision that denied entitlement for a psychotraumatic disability.
BACKGROUND
Appeals Resolution Officers (AROs) and the Workplace Safety and Insurance Appeals Tribunal (WSIAT) provided detailed summaries of the worker’s claim in previous decisions. I will only provide a brief summary here to avoid repetition.
The worker’s date of hire was December 1, 1994. On April 20, 2018 while working as a road attendant, the worker was pressure washing a snow plow truck when their foot slipped off a step and they fell to the ground on their left hip. The CM granted entitlement for a left hip fracture with subtrochanteric extension, left hip surgery on April 24, 2018, and full loss of earnings benefits beginning April 23, 2018. The worker returned to modified work at reduced hours in November 2018 and received partial loss of earnings benefits until he accepted a new job as a heavy equipment operator on January 25, 2019.
The CM determined the worker’s left hip injury reached maximum medical recovery with a permanent impairment as of May 31, 2019. The worker received a 6% Non-Economic Loss (NEL) benefit for their permanent left hip impairment on September 27, 2019. An ARO confirmed the quantum of this NEL benefit on April 21, 2020.
The worker had a second left hip surgery on August 4, 2020 to remove hardware and returned to work a few weeks later. On July 5, 2021, the WSIAT determined the worker was entitled to a recalculation of their NEL benefit in recognition of the worker’s hip range of motion and surgeries. The worker’s NEL benefit for their left hip increased to 11% on September 3, 2021 following the WSIAT’s decision.
A psychologist diagnosed the worker with adjustment disorder with mixed anxiety and depressed mood on April 9, 2021. In a letter of November 1, 2021, the CM denied entitlement for a psychotraumatic disability because they found the criteria for entitlement were not satisfied. The worker’s representative objected to this decision and submitted an Appeal Readiness Form.
AUTHORITY
Operational Policy Manual
Published
15-04-02 Psychotraumatic Disability
September 7, 2018
ANALYSIS
I have carefully considered all of the available information, legislation and relevant operational policies in reaching this decision. I find the worker is entitled to benefits for a psychotraumatic disability.
The worker’s appeal is allowed.
Worker’s Oral Testimony
The worker testified they completed grade 12 and then entered the workforce. The worker was employed with their current employer in the road division for over 20 years. The work is physical in nature operating plow trucks, overseeing construction crews, and inspecting road and ditch conditions daily. The worker is currently working as a lead hand on a full-time basis.
The worker stated they have had a constant and steady throbbing pain in their left hip since the accident. They feel the surgeries were not successful because they still have a lot of pain and discomfort in their hip. The worker sees a chiropractor for treatment every two weeks, and the chiropractor states the worker’s right side is affected by them compensating for the lack of strength in their left hip.
The worker began experiencing psychological symptoms shortly after the accident, though they did not recall exactly when. The worker describes feeling very depressed due to having constant pain with no improvement from the surgeries. The worker also describes experiencing anxiety at night while waiting for their sleeping medication to take effect because their mind “will not shut down” and they cannot stop thinking about the pain. The worker stated they became more depressed after they had surgery to remove the hardware rod in their hip because this did not help their pain at all. They indicated their anti-depressant medication increased after this surgery.
Before the accident, the worker described themselves as active and social. They performed the physical tasks of their work successfully, completed housekeeping and chores at home, and spent time with family living nearby. The worker also went out on weekends with friends to socially drink and participate in leisure activities such as golfing, snowmobiling, and driving a four-wheel vehicle. The worker stated they usually slept 6-8 hours per night before the accident.
The worker testified their injury and ongoing pain has significantly impacted their daily life. The worker remains able to work but feels very stiff when getting out of the pickup truck to perform work tasks. The worker cannot stand or walk at worksites for as long, has to sit after standing for a while, and cannot assist co-workers with any heavy lifting due to a lack of strength in their left hip and leg. The worker’s spouse has to perform more housekeeping and chores at home due to the worker’s functional limitations and difficulty getting to the floor. The worker stated this makes them feel useless and affects their relationship with their spouse. The worker indicated their hip pain and anxious thoughts make it difficult to fall and stay asleep. They only gets 4-5 hours of sleep per night and feels tired all the time.
The worker stated their injury and pain also significantly affected their social life and relationships. The worker is not as talkative anymore and does not want to go out or see anyone. The worker stated it causes tension at home when they decline social visits with their family living nearby. The worker stated that their enjoyment of life with their spouse is “out the window” because the worker’s injury affected their intimacy and stopped them from completing activities they used to enjoy.
The worker no longer participates in their hobbies with friends or their granddaughter because they do not want to risk falling or further injuring their hip. This is because the surgeon told the worker to be more careful after the rod was removed because the worker’s hip had less support without the rod. The worker explained their left leg has given out and caused them to fall a few times. The worker stated these falls trigger thoughts of the accident.
The worker was asked about the April 2021 psychologist report documenting the worker had worrisome thoughts about the way they were being treated at work. The worker explained some co-workers were worried about their well-being and worried the employer was trying to terminate the worker. The worker stated this never happened before the accident. They did not believe these worries and spoke with their road manager who confirmed there was nothing to worry about. The worker testified they have a good relationship with his employer and there are no work factors contributing to his ongoing psychological symptoms.
The worker stated they have never felt like this before the accident. I asked about the worker’s spouse stating the worker used anti-depressants before when stressed and overworked in the winter as documented in the June 2018 report from the occupational therapist. The worker explained the winter season can be stressful due to the hours of work and managing traffic and pedestrian safety while running a big plow truck, but this is situational due to the season and job needs. The worker also explained they were an acting supervisor sometime before the accident and was psychologically affected dealing with the interpersonal issues between their co-workers. The worker stated they stopped performing this role and felt better afterwards without any ongoing psychological symptoms until after the accident.
The worker testified their belief that their psychological symptoms stem directly from their injury and constant pain. The worker stated they did not think they would still be dealing with this pain and discomfort, and worries because they will need a hip replacement sometime in the future. The worker continues to see their family doctor and a psychiatrist while taking Cymbalta medication for their psychological condition. However, their psychological symptoms have remained the same without improvement.
Worker’s Position
It is the worker representative’s position that the worker is entitled to benefits for a psychotraumatic disability and requires ongoing psychological treatment. They argued the worker’s psychological condition developed as an indirect result of their physical injury because they had an emotional reaction to the accident and injury. The representative also argued the worker’s psychological condition is due to their extended disablement and socioeconomic factors directly and clearly related to the work injury. To support their position, the worker’s representative referenced the worker’s testimony and medical reports on file indicating the worker’s psychological symptoms stemmed from their injury and pain.
Employer’s Position
The employer did not return the Participant Form. They are not participating in the appeal.
Assessment of Entitlement
It is the worker representative’s position that the worker is entitled to benefits for a psychotraumatic disability. Information on file supports this position. When making my decision, I considered the policy that lists the circumstances that must exist or develop to grant entitlement for a psychotraumatic disability.
Policy 15-04-02 (Psychotraumatic Disability) indicates that entitlement is granted 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, providing the psychotraumatic disability/impairment became manifest within 5 years of the injury, or within 5 years of the last surgical procedure.
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.
I find the worker is entitled to benefits for a psychotraumatic disability for the diagnosis of adjustment disorder with mixed anxiety and depressed mood because the third criterion is satisfied.
The worker has an 11% NEL benefit for a permanent left hip impairment. The worker testified, and medical reports confirm, that they have had ongoing pain and limitations related to this compensable injury since the work accident. I find there is clear evidence of an extended disablement due to the work-related injury, and that this was a major contributing factor in the development of the worker’s psychological condition.
Medical evidence from June 2018 until April 2022 documents the worker’s depression and anxiety symptoms were secondary to adjustment issues related to their pain, physical limitations, and lack of recovery from surgery. Medical reports document the worker experienced frustration and anger due to left hip pain and limited mobility. The worker testified they have a steady throbbing hip pain all the time, the pain disrupts their ability to sleep, and they finds it difficult to think about anything other than the pain. The worker testified their pain and their limitations have changed their life and restricted what they can and want to do. This makes the worker worry about further injury, an eventual hip replacement, and their future.
Clinical evidence from numerous healthcare professionals from 2018 to present confirm the worker’s compensable injury had a clear and direct impact on non-medical, socioeconomic factors that also contributed to the worker’s psychological condition. Medical reports and the worker’s testimony establish the worker’s injury made them unable to perform many of their old household chores and daily activities. The worker can no longer participate in their leisure activities of golfing, snowmobiling, fishing, playing horseshoes, or coaching baseball, which has reduced their social interactions with family and friends. The worker no longer feels talkative, does not want to go out or see anyone, and reports a negative impact on their relationship with their spouse. The worker has indicated they cannot stop thinking about the pain and feels guilty and useless because they cannot do what they used to at work and home.
I note an occupational therapist in June 2018 documented a statement from the worker’s spouse that the worker took anti-depressant medication in the past when stressed and overworked during the winter. I also note clinic notes from the family doctor in March 2013, July 2014, September 2014, and March 2017 documenting the worker was stressed, anxious, and depressed. In particular, the family doctor documented in March 2017 that the worker’s job affected their mood.
This is consistent with the worker’s testimony that they experienced periods of psychological symptoms before the accident due to work demands in the winter months and when the worker was an acting supervisor. I accepted the worker’s testimony that these periods of symptoms were temporary and situational in nature because there is insufficient evidence of a pre-existing and continuous psychological impairment before the work accident impacting the worker’s ability to perform their job or activities of daily life.
The psychologist in April 2021 documented the worker had worrisome thoughts about the way they were being treated at work. During testimony, the worker clarified some of their co-workers verbally expressed concern about their well-being and ongoing employment, and that this situation was resolved after a conversation with their manager. I do not find this precludes the worker from entitlement to benefits and instead demonstrates the worker’s injury and extended disablement affected their relationship with co-workers as well as their family and friends.
Additionally, the psychologist documented within the same report that the worker’s injury and pain also interfered with their work, friendships, fun and leisure activities, sex life, and general satisfaction with life. The psychologist concluded the compensable injury and impairment were major contributors to the development of the worker’s psychological condition. I accepted this opinion, and the other medical opinions on file attributing the worker’s psychological condition to the work injury and extended disablement. Although the worker had pre-existing stressors, medical evidence and the worker’s testimony demonstrate the worker was functioning without a psychological impairment prior to the work accident.
I find the vast majority of non-medical, socioeconomic factors contributing to the worker’s psychotraumatic disability are directly and clearly related to the work-related injury. The worker’s compensable pain and limitations affected their sleep as well as their ability to work, perform chores, or participate in hobbies or activities of daily life. The worker’s limitations and psychological symptoms also led to increasing social isolation or tension from their spouse, family, friends, and co-workers. Medical evidence on file clearly establishes these factors are directly related to the work injury and were major contributors in the development of the worker’s psychological condition.
Considering the above, I find criterion three is satisfied. I find the worker’s psychotraumatic disability is shown to be related to the worker’s extended disablement and other non-medical, socioeconomic factors, the majority of which are directly and clearly related to the workplace injuries. As such, I find entitlement for a psychotraumatic disability is in order for the diagnosis of adjustment disorder in accordance with Policy 15-04-02 (Psychotraumatic Disability).
I understand the worker’s representative argued the worker should receive additional psychological treatment for his condition. I note the latest medical report on file regarding the worker’s psychological condition is dated April 1, 2022. The psychologist documented the worker continued to report sleep disturbances, feelings of anxiety and depression, no interest in seeing friends or changing their routine, and worrisome thoughts about their future due to ongoing pain in their left hip and leg. The psychologist indicated the worker had a favourable prognosis but required further cognitive behavioural therapy. This is consistent with the worker’s testimony that they continue to receive psychological treatment in the community but experiences ongoing psychological symptoms, though there is no medical reporting regarding the worker’s condition after this date.
I will return benefits flowing from this decision to the operating area for review and to acquire up-to-date medical reporting from the worker’s treating psychiatrist. I leave it to the operating area’s discretion to determine entitlement to further psychological treatment for the worker’s compensable psychotraumatic disability, when the worker reaches maximum psychological recovery, and if the worker has a permanent psychological impairment at that time.
CONCLUSION
I find the worker is entitled to benefits for a psychotraumatic disability.
The worker’s appeal is allowed.
DATED July 14, 2022
Stephanie Waters
Appeals Resolution Officer
Appeals Services Division