DECISION NUMBER:

20240050

OBJECTING PARTY:

WORKER

RESPONDENT:

EMPLOYER (NOT PARTICIPATING)

REPRESENTED by:

EMPLOYER REPRESENTATIVE

HEARING:

HEARING IN WRITING

HEARD by:

DATED:

HELEN SHAW, APPEALS RESOLUTION OFFICER

MAY 31, 2024

ISSUE

The worker is objecting to the denial of entitlement for posttraumatic stress disorder (PTSD) in the Case Manager decision of September 15, 2023.

BACKGROUND

The worker was employed as a tool crib technician in automotive manufacturing and had been with the employer since August 1994. The worker developed a gradual onset injury of the bilateral elbows, forearms, wrists and hands, diagnosed as bilateral wrist tendonitis, lateral epicondylitis and a

repetitive strain injury. The worker was 48 years old as of the accepted date of injury on September 11, 2018. The employer was able to accommodate the worker with modified duties.

The worker was diagnosed with Major Depressive Disorder, Moderate, Recurrent with anxious distress and treatment sessions were approved. Entitlement was approved for right CTS release surgery, which took place on January 13, 2021, and full loss of earnings (LOE) benefits were paid from January 9, 2021 to March 1, 2021, when the worker returned to work on modified duties. Sporadic periods of LOE benefits were paid from March 10, 2021 to July 12, 2021, for lost time for medical appointments and during temporary periods when suitable work was not available.

The worker reached maximum medical recovery (MMR) for the workplace injuries as of May 31, 2021, with evidence of a permanent impairment. On November 15, 2021, the worker was awarded an 11% Non-Economic Loss (NEL) benefit for the bilateral elbows, wrists and hands.

The worker stopped work on July 19, 2021, and requested entitlement for a psychotraumatic disability.

Entitlement for a psychotraumatic disability was denied in a decision dated October 26, 2021. The

denial of psychotraumatic entitlement was overturned in an appeal decision dated October 31, 2022, and entitlement was allowed for Major Depressive Disorder, Moderate, Recurrent with anxious distress. The worker was paid full LOE benefits from July 19, 2021 to March 31, 2022. An appeal implementation

decision dated January 16, 2023, extended LOE benefits to January 6, 2023. The worker has continued to be paid full LOE benefits while return-to-work options have been explored.

The worker participated in treatment at a Community Mental Health Program (CMHP), starting on May 4, 2023, and was diagnosed with Major Depressive Episode and PTSD. The Case Manager decision of September 15, 2023 denied entitlement for PTSD because the new diagnosis did not meet the required entitlement criteria. The denial was confirmed in reconsideration decisions dated

October 10, 2023 and April 4, 2024.

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 and find there is no entitlement for PTSD. My reasons are explained below.

According to operational policy 15-04-02, 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.

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.

The worker submitted an Appeal Readiness Form dated February 21, 2024 and a submission dated March 26, 2024. The worker relied on reports from Dr. Barron, the psychologist providing treatment through the CMHP, to support their position that there was exposure to harassment and discrimination at work. The worker argued that the new Godzilla tool crib was poorly designed with no ergonomic study and the worker felt their concerns were ignored by health and safety representatives, ergonomic representatives, managers, and the union. The worker felt they were harassed because of the health and safety issues the worker raised, resulting in the worker being assigned to jobs outside their restrictions.

The employer is not participating in the appeal and did not submit a Respondent Form.

I find entitlement for PTSD is not allowable due to an organic brain injury, since there was no organic brain injury in this claim. I also find that PTSD did not occur as an indirect result of a physical injury due to an emotional reaction to the accident or injury, severe physical impairment or reaction to the treatment process. The injury arose as a gradual onset disablement with no indication that the worker developed a traumatic response to the accident, injury or the treatment process.

Entitlement for Major Depressive Disorder, Moderate, Recurrent with anxious distress was allowed as related to the worker’s extended disablement in this claim. I have considered the worker’s position regarding entitlement for PTSD, but I am not persuaded that the worker developed PTSD in response to the extended disablement. The appeal decision of October 31, 2022, determined that the worker’s psychotraumatic symptoms developed in response to the extended period of disablement involving the bilateral upper extremities, including the struggles the worker was encountering over workplace accommodations. It was the worker’s evidence in that appeal that it was the physical injuries, the limitations imposed by those injuries and the lack of needed workplace accommodations that caused the anxiety and depression. A psychological report dated July 27, 2020 from the Specialty Program indicated that the worker reported their worries were focused on problems at work, worry about the future of their work and financial concerns. The evidence supported the development of Major Depressive Disorder with anxious distress as a result of the extended disablement, but in my view, it does not support that PTSD developed in response to the extended disablement.

The CMHP assessment dated May 4, 2023, and the subsequent progress reports, indicated that the worker reported multiple negative interactions with the employer, union and co-workers since requiring accommodations at work. The report referenced an interaction with a team leader, with the worker claiming the team leader put the worker on the heaviest job in the department that was not consistent with medical restrictions. The worker’s symptoms included chronic pain, depressed mood, feelings of hopelessness and helplessness, anxiety, panic, hyperarousal, exaggerated startle response, a persistent negative emotional state, emotional lability, amotivation, anhedonia, avoidance behaviours, isolation, withdrawal, appetite disturbance, sleep disturbance, fatigue, loss of energy, intrusive recollections of the workplace events, racing thoughts, and difficulty with attention/concentration. The psychologist considered this to be a traumatic mental stress claim due to harassment in the workplace, the employer’s failure to accommodate medical needs and a lack of support from the union. The worker reported vulgarity in communication from peers, bullying, harassment, and refusal of a team leader and some peers to assist in completing tasks that were against medical restrictions.

The difficulty I have with accepting the CMHP findings regarding PTSD, is that this is not a mental stress claim. It has been accepted that the worker developed a psychological response to the extended period of disablement in this claim and that difficulties with workplace accommodations were part of the non- medical, socioeconomic factors contributing to the development of the Major Depressive Episode. The fact that the worker felt unsupported at work, is not sufficient to support a diagnosis of PTSD, which is initiated by exposure to trauma. I acknowledge that the worker felt that actions of the employer, supervisors, co-workers and the union were not sufficiently supportive of the worker’s needs for physical accommodations, but I am not satisfied that supports a diagnosis of PTSD as attributable to the extended disablement in this claim.

The worker has argued that their health and safety concerns were generally ignored by the employer, the union and other workplace parties, but that is not the basis of entitlement in this claim. The worker has entitlement for an impairment of the bilateral elbows, wrists and hands, as well as a psychological response from the extended disablement. The worker’s general concerns regarding their belief that the

employer ignored health and safety concerns is outside the scope of this claim. I find PTSD is not attributable to the injuries in this claim.

CONCLUSION

I conclude there is no entitlement to PTSD. The worker’s objection is denied.

DATED May 31, 2024

Helen Shaw

Appeals Resolution Officer Appeals Services Division