CAUSATION – PSYCHOLOGICAL CONDITION. Substantial evidence, including medical records, expert psychological opinion, and lay testimony supported the finding that the employee had failed to prove that he sustained a work-related PTSD condition within the meaning of DSM-5 and the Minnesota Workers’ Compensation Act.
Compensation Judge: Kathleen Behounek
Attorneys: Jerry W. Sisk and Thomas D. Mottaz, Law Office of Thomas Mottaz, Coon Rapids, Minnesota, for the Appellant. Richard W. Schmidt and Michael R. Johnson, Cousineau, Waldhauser & Kieselbach, P.A., Mendota Heights, Minnesota, for the Respondent.
Affirmed.
PATRICIA J. MILUN, Chief Judge
The employee argues that the compensation judge erred as a matter of law by finding the employee did not sustain a compensable work-related injury on May 17, 2016, in the nature of post-traumatic stress disorder (PTSD), as manifested though his anxiety and depression. We conclude that the compensation judge’s findings are supported by substantial evidence, and affirm.
Bruce M. Holzschuh, the employee, began working for the self-insured employer, MNSCU Metropolitan State University (MNSCU), as an admissions counselor in 2000. In 2006, he was assigned to create an admissions and transition assistance program for MNSCU applicants and students who were military veterans. After he created the program, MNSCU assigned him to work as the coordinator of veteran student services. In this role, the employee was the program’s sole permanent staff member, assisted by work-study students. The duties of this position involved meeting with veteran students to provide them with guidance and counseling related to their school activities, benefits, and funding. The employee is not a licensed psychologist or health care professional and has no formal training as a psychological counselor; however, he testified that much of his job involved listening to military veteran students discuss the psychological effects they were experiencing from traumatic situations they had encountered during their combat service. The employee frequently heard them recount the graphic details of injuries they had sustained during military service, or of the injuries or deaths of fellow soldiers, adversaries, and noncombatants.
The employee had previously sustained a low back injury during prior work as a cement finisher. He had been unable to return to construction work after that injury, and continued to have chronic pain from the low back condition while employed at MNSCU. In 2011, his back condition was exacerbated in a car accident and he underwent lumbar fusion surgery. In 2015, he underwent the implantation of a spinal cord stimulator.
In 2014, the employee was diagnosed with a moderate major depressive disorder, and in 2015 he applied for social security disability benefits. He attempted a return to work in his job with the employer but this was ultimately unsuccessful. He has not returned to work again since May 17, 2016.
On May 19, 2016, the employee told his family physician that he had been feeling more depressed, stressed, and overwhelmed. He attributed the increased symptoms of stress to his work with the veteran students. He then began treating with a licensed medical and family therapist, Miriam Zachary, who diagnosed the employee with PTSD caused by repeated exposure to the details of the traumatic events related by the military veterans he had counseled during his work for the employer. The employee also treated for his psychological condition during this period with a certified nurse practitioner, Lauren Benolkin. Over the next several months, he received psychological counseling from Ms. Zachary and was prescribed medications by CNP Benolkin. The employee has not received further psychological treatment since August 2016.
The employee filed a claim petition seeking workers’ compensation benefits as a result of an alleged PTSD condition stemming from his work for the employer. He obtained a psychological evaluation from Dr. David Lund, Psy.D., on March 20, 2017. Dr. Lund opined that the employee met the criteria for a diagnosis of PTSD in the DSM-5, the most recently published edition of the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association.[1]
The self-insured employer had the employee evaluated by psychologist Dr. Paul Arbisi, Ph.D., for an independent psychological examination. Dr. Arbisi opined that the employee did not meet the diagnostic criteria of PTSD as set out in DSM-5. He disagreed with Dr. Lund over whether, under the facts unique to this case, hearing second-hand the details of traumatic incidents experienced by others constituted a sufficient “exposure” to traumatic events to meet the DSM-5 criteria. Dr. Arbisi further noted an absence of the aversive behaviors necessary to a diagnosis of PTSD, in that the employee had shown no stress or difficulty in reviewing with him the details of the accounts of such traumatic incidents that he had heard from veterans during his work with them; that the employee stated that his most unpleasant dreams were of “not being able to succeed [at helping veteran students]” rather than of the traumatic incidents of which he had been told; and that the employee remained in frequent contact with many of his former veteran students.
In a follow-up report, Dr. Lund repeated his views and disagreed with Dr. Arbisi.
The matter came on for hearing before a compensation judge on August 17 and September 20, 2018. Following the hearing, the judge found that the employee had failed to prove that he had a PTSD condition within the meaning of DSM-5 and the Minnesota Workers’ Compensation Act. 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 sought benefits based on a claim of post-traumatic stress disorder as defined by the provisions of Minn. Stat. § 176.011, subd. 15(d), which provides:
For the purposes of this chapter, “mental impairment” means a diagnosis of post-traumatic stress disorder by a licensed psychiatrist or psychologist. For the purposes of this chapter, “post-traumatic stress disorder” means the condition as described in the most recently published edition of the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association. For purposes of section 79.34, subdivision 2, one or more compensable mental impairment claims arising out of a single event or occurrence shall constitute a single loss occurrence.
The diagnostic criteria for PTSD in adults in the DSM-5 is set out in that work as code 309.81. A diagnosis of PTSD requires that specific diagnostic criteria be met, which are set out in sections labeled A through H. The first of these, Criterion A, requires:
Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.
Diagnostic and Statistical Manual of Mental Disorders, 271, code 309.81 (Am. Psychiatric Ass’n 5th ed., 2013).
There was no claim that the employee met subparts 1-3 of Criterion A of code 309.81. The issue before the compensation judge was whether the employee’s work activities met subpart 4 of that criterion. The employee’s medical expert, Dr. Lund, was of the opinion that the employee’s work activities did meet subpart 4. The employer and insurer’s expert, Dr. Arbisi, offered a contrary opinion. The compensation judge reviewed the testimony presented by the employee regarding the nature of his contacts with veteran students, considered the expert opinions of the medical witnesses, and, as her memorandum demonstrates, applied the criteria of the DSM-5. She concluded that the work-related stories of aversive details relating to traumatic events in this case did not meet the requirements of Criterion A of code 309.81 of the DSM-5.
Under the substantial evidence standard, we affirm the compensation judge’s findings and order.
[1] We note that the requisite factors for a diagnosis of PTSD have evolved with the publication of each successive edition of the Diagnostic and Statistical Manual.