TAMI L. PETRIE, Employee/Appellant, v. TODD COUNTY, SELF-INSURED/MINN. COUNTIES INTERGOVERNMENTAL TRUST, Self-Insured Employer/Respondent, and BLUE CROSS BLUE SHIELD OF MINN. AND BLUE PLUS, Intervenors.

The employee appeals the compensation judge’s denial of her claim of post-traumatic stress disorder as a result of altercations while working as a correctional officer for Todd County. We reverse in part, vacate in part, and remand for further consideration.

Tami L. Petrie, the employee, has worked for Todd County, the self-insured employer, as a correctional officer since 2003. She testified that she had been involved in three altercations with inmates while working for the employer, one in 2006 and two in 2016. On September 12, 2016, an inmate lunged at her as she entered a cell with a tray, requiring the employee to restrain her and pin her down, then place her in restraints. The next incident, two days later, involved an inmate trying to grab medications from the employee and push his way out of a cell. After the altercation resolved, the cell was searched and a weapon made from a pair of eyeglasses was found hidden in a hole of the cell wall. The employee testified that the same inmate had previously been found with another weapon made out of a piece of a table. On September 20, 2016, the employee filed a First Report of Injury stating that the employee had “wrestled with inmate to get [medications] from him and was hit across her back.” (Ex. 14, see also Finding 13.)

On September 22, 2016, the employee began attending therapy sessions with Patti Venekamp, M.S., L.P., a licensed psychologist, through an employee assistance program. The employee was taken off work as of that date. During the five sessions the employee had with this therapist through October 20, 2016, the employee reported experiencing difficulty with sleeping and anxiety from these work incidents.

On October 24, 2016, Kelsey Landis, M.S., at Psychotherapeutic Resources evaluated the employee, who reported flashbacks, avoidance, hypervigilance, being easily startled, worry, anxiety, and fear due to the incidents. The employee was treated with cognitive behavior therapy and supportive therapy by Pamela Becker, M.A., who opined that the employee met the criteria for post-traumatic stress disorder (PTSD) in a report dated January 12, 2017.

The employee also treated with Susan K. Rutten Wasson, M.D., her primary care physician, on September 28, 2016. Dr. Rutten Wasson noted the employee’s increasing symptoms of anxiety, agoraphobia, and panic attacks, and opined that the employee “clearly” had PTSD. (Ex. H.)

Beginning in February 2017, the employee underwent therapy sessions with Greta Kramer, M.S., at Milestone Counseling, Inc. The employee reported the September 2016 incidents and symptoms of depression, anxiety, flashbacks, intrusive recollections, avoidance, diminished interests, feeling detached, persistent negative beliefs and emotions, hypervigilance, and irritability. Ms. Kramer diagnosed PTSD and depression.

On January 9, 2017, the employee filed a claim petition listing the nature of her injuries as PTSD and a back injury, and seeking temporary total disability benefits, treatment expenses, and a rehabilitation consultation.

On April 21, 2017, the employee underwent an independent psychiatric examination with Dr. Scott M. Yarosh, a licensed psychiatrist, who diagnosed major depression, dependent personality, malingering, and PTSD. He opined that the employee’s psychiatric condition was caused by pre-existing factors and past trauma and that the work incidents caused a temporary aggravation of her pre-existing PTSD condition. In July 2017, after reviewing surveillance video^[1] of the incidents, Dr. Yarosh changed his opinion regarding the causation of the employee’s PTSD. He opined that the work incidents were routine, did not cause any physical injury, and were not gruesome, egregious, or dramatic. He concluded that the work incidents did not cause or aggravate the employee’s pre-existing mental health condition. The employer denied the employee’s claim on the basis of Dr. Yarosh’s opinion.

A hearing was held on February 8, 2018. The employee testified at the hearing that prior to the September 2016 work incidents, she had no anxiety or fear of working at the jail. Her supervisor, Scott Wright, was the jail administrator. He testified by deposition that physical incidents involving correctional officers and inmates happened about once or twice a year, that the employee had not had any performance issues before these incidents, and that the employee appeared anxious and emotional after the incidents when she would come into the office to turn in doctor slips. (Ex. Q.)

The compensation judge found that Dr. Yarosh’s opinion did not meet the statutory criteria for a diagnosis of PTSD under Minn. Stat. § 176.011, subd. 15(d), and denied the employee’s claims. (Findings 30 and 31.) The judge did not consider whether the employee’s PTSD was causally related to her work incidents or whether the employee’s injury could be considered a “physical-mental” injury. The employee appeals.

On appeal, the Workers’ Compensation Court of Appeals must determine whether “the findings of fact and order [are] clearly erroneous and unsupported by substantial evidence in view of the entire record as submitted.” Minn. Stat. § 176.421, subd. 1(3). Substantial evidence supports the findings if, in the context of the entire record, “they are supported by evidence that a reasonable mind might accept as adequate.” Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 59, 37 W.C.D. 235, 239 (Minn. 1984). Where evidence conflicts or more than one inference may reasonably be drawn from the evidence, the findings are to be affirmed. Id. at 60, 37 W.C.D. at 240. Similarly, findings of fact should not be disturbed, even though the reviewing court might disagree with them, “unless they are clearly erroneous in the sense that they are manifestly contrary to the weight of evidence or not reasonably supported by the evidence as a whole.” Northern States Power Co. v. Lyon Food Prods., Inc., 304 Minn. 196, 201, 229 N.W.2d 521, 524 (1975).

A decision which rests upon the application of a statute or rule to essentially undisputed facts generally involves a question of law which the Workers’ Compensation Court of Appeals may consider de novo. Krovchuk v. Koch Oil Refinery, 48 W.C.D. 607, 608 (W.C.C.A. 1993), summarily aff’d (Minn. June 3, 1993).

The employee argues that the compensation judge erred by finding the employee had not established a compensable claim for PTSD with a diagnosis from a licensed psychiatrist or psychologist pursuant to Minn. Stat. § 176.011, subd. 15(d).

An employer is liable for workers’ compensation in every case of personal injury arising out of and in the course of employment. Minn. Stat. § 176.021, subd. 1. Pursuant to Minn. Stat. § 176.011, subd. 16, personal injury includes occupational disease^[2] and any mental impairment as defined by Minn. Stat. § 176.011, subd. 15(d), which includes post-traumatic stress disorder.^[3] A diagnosis of PTSD by a licensed psychiatrist or psychologist is required in order for PTSD to be compensable. Minn. Stat. § 176.011, subd. 15(d). Generally, questions of medical causation fall within the province of the compensation judge. Felton v. Anton Chevrolet, 513 N.W.2d 457, 50 W.C.D. 181 (Minn. 1994).

In this case, the compensation judge found that the evidence did not establish that the employee had “been diagnosed with post-traumatic stress disorder by a licensed psychiatrist or psychologist,” citing Minn. Stat. § 176.011, subd. 15(d). (Finding 30.) While the judge noted that Dr. Yarosh had diagnosed the employee with PTSD which the doctor concluded was not causally related to her employment, the judge concluded that the employee had not met the statutory criteria for a compensable claim for PTSD. (Finding 31, Memorandum at 7.) The employee asserts that Dr. Yarosh’s diagnosis meets the statutory requirement and that causation for the employee’s condition must be considered as a separate element of the statute, citing Minn. Stat. § 176.011, subds. 15(a) and 16. The employee contends that the compensation judge should have considered the other evidence in the record regarding causation of the employee’s PTSD condition, including testimony by the employee and reports by Dr. Rutten Wasson and the employee’s therapists, before determining whether the employee’s claim of PTSD was compensable under the statute. Since the judge made no findings on causation, the employee requests a remand for further proceedings.

We note that Minn. Stat. § 176.011, subd. 15(d), does not require that the diagnosis of PTSD by a licensed psychiatrist or psychologist include an opinion regarding causation for that condition. The employee does have a PTSD diagnosis from a licensed psychiatrist as required by Minn. Stat. § 176.911, subd. 15(d). Whether the employee’s PTSD condition is causally related to a work incident is a question of fact for the compensation judge to determine considering the entire record. While Dr. Yarosh’s opinion states that the employee’s PTSD condition is not causally related to the work incidents, there is evidence in the record from the employee, her primary care physician, and her therapists which could support a finding that her PTSD condition is causally related to the work incidents.

We reverse the compensation judge’s Finding 30 as manifestly contrary to the evidence, as it is unequivocal that Dr. Yarosh diagnosed the employee with PTSD.^[4] We vacate the judge’s denial of the employee’s claims embodied in Findings 31 through 33 and Orders 1 through 3. We therefore remand for findings as to whether the September 2016 work incidents caused, aggravated, or precipitated the employee’s mental condition of PTSD.

The employee also argues that the compensation judge erred by not addressing her claim as a “physical-mental” injury, a claim which was also raised at the hearing. (T. 87.) The employee asserts that the compensation judge failed to determine whether the employee sustained a physical injury to her back as a substantial result of the workplace incident on September 14, 2016, and whether that injury was a substantial contributing factor to the development of a mental injury or post-traumatic stress disorder. The employer argues that the judge did not need to address this issue because the employee had not shown that her back claim was a separate, distinct, and treatable injury, and also that the back injury did not require any treatment, did not affect her ability to work, and was not a basis of her claim for benefits.

Workers' compensation claims involving psychological/mental injuries are divided into three categories: mental stimulus producing physical injury, physical stimulus producing mental injury, and mental stimulus producing mental injury. Before the workers’ compensation statute was amended in 2013, only claims for compensation based on the first two categories were compensable, while claims where a mental stimulus resulted in mental injury were denied. See Johnson v. Paul's Auto & Truck Sales, Inc., 409 N.W.2d 506, 40 W.C.D. 137 (Minn. 1987); Lockwood v. Indep. Sch. Dist. No. 877, 312 N.W.2d 924, 34 W.C.D. 305 (Minn. 1981). The amendment to the statute which added PTSD as a compensable condition states that “[p]hysical stimulus resulting in a mental injury . . . shall remain compensable.” Minn. Stat. § 176.011, subds. 15(a), 16.

In order to find a compensable physical injury resulting from mental stress, the physical impairment must be capable of discrete treatment apart from any treatment of psychological impairment. Johnson, 409 N.W.2d at 508, 40 W.C.D. at 140. There is, however, no requirement that the physical injury actually be treated or meet any specific degree of severity. Mitchell v. White Castle Systems, Inc., 290 N.W.2d 753, 32 W.C.D. 288 (Minn. 1980); Russell v. Opportunity Partners, Inc., No. WC06-109 (W.C.C.A. Sept. 18, 2006). Where a work‑related physical injury causes, aggravates, accelerates, or precipitates a mental injury, or is a substantial contributing factor of a mental injury, that mental injury is also compensable. See Hartman v. Cold Spring Granite Co., 243 Minn. 264, 67 N.W.2d 656, 18 W.C.D. 206 (1954); see also Miels v. Northwestern Bell Tel. Co., 355 N.W.2d 710, 715, 37 W.C.D. 164, 170 (Minn. 1984). This court has interpreted prior caselaw to "require evidence of a bodily reaction, that is, some physical injury or illness, which in turn causes or aggravates the psychological injury.” Larson v. McNamara Contracting, 48 W.C.D. 105, 111 (W.C.C.A. 1992), summarily aff’d (Minn. Feb. 4, 1993). We not aware, however, of any case law or statute requiring that a PTSD diagnosis be made by a licensed psychologist or licensed psychiatrist where compensation is claimed under a physical-mental injury analysis.

There is evidence in the record that the employee sustained a back injury during the September 14, 2016, work incident. The judge found that the inmate bumped or struck the employee on her back and that was the first time the employee had been hit by an inmate (Finding 13), but did not address the employee’s physical-mental injury claim.

We conclude that the compensation judge erred by not addressing a contested issue of fact and law that had been submitted at the hearing. See Minn. Stat. § 176.371; see also Costello v. Clay Cty. Sheriff’s Dep’t, No. WC07-119 (W.C.C.A. June 7, 2007). We remand for consideration of this claim, including a determination of whether the employee suffered a physical injury which arose out of and in the course of her employment,^[5] and if so, whether the employee’s PTSD condition was caused, aggravated, or precipitated by the physical injury.