NICHOLAS ROWE, Employee/Appellant, v. CITY OF MINNEAPOLIS POLICE DEP’T, Self-Insured Employer/Respondent, and JORDAN CONSULTING AND COUNSELING, Intervenor.

The employee appeals from the compensation judge’s findings that the employee did not sustain a compensable post-traumatic stress disorder (PTSD) injury.  We vacate and remand for specific findings of fact as set out in the opinion below.

The employee, Nicholas Rowe, was born in 1970 and grew up in Minneapolis.  He and his wife met in high school in 1984, have been married more than 25 years, and are the parents of three boys.  (T. 29.)  As a senior in high school in 1988, the employee enlisted in the Minnesota Army National Guard.  While attending college at Mankato State, the employee joined the Reserve Officers’ Training Corps and was later commissioned as an infantry officer.  The employee did not experience combat while in the military and was honorably discharged in 1994.  (T. 30.)

In 1997, the employee applied to become a police officer for the self-insured employer, the City of Minneapolis.  Gary L. Fishler, Ph.D., a psychologist licensed in Minnesota, conducted a pre-employment psychological examination of the employee.  In a report dated February 19, 1997, Dr. Fishler, based upon a personal interview and testing, provided an expert opinion and concluded that the employee had above average intelligence and social judgment and did not appear to have any significant personality or emotional problems.  The report did not evaluate or comment on the employee’s alcohol use.  Based upon the examination, the employee was recommended for the position of police officer.  (Ex. L.)  The self-insured employer hired the employee as a police officer in March 1997.

The employee began drinking alcohol in high school and college, occasionally becoming intoxicated.  (T. 32.)  His social drinking continued during his twenties with friends at happy hours and weddings.  (T. 33.)  Beginning in 2003, the employee would occasionally binge drink to the point of intoxication.  (T. 115, 118.)  The employee’s definition of binge drinking was having too many drinks and being intoxicated maybe once per week.  (T. 119.)  In 2003, his primary care physician recommended that the employee quit drinking.^[1]  (T. 116.)  From 2003 to 2013 there were periods when the employee did not drink for months because of training or for other reasons.  (T. 116.)

The employee experienced several significant traumatic events during his 25-year career as a police officer.  On many occasions, the employee feared for the lives of his partners, civilians, and his own life.  (T. 41.)  In 2007, he joined the special weapons and tactics (SWAT) unit serving high risk warrants.  The employee left the SWAT unit in 2015 when he was promoted to sergeant.  (T. 40.)  In 2019, the employee was assigned to Internal Affairs (IA) until he left the self-insured employer in 2022.

During his career as a police officer the employee responded to five mass shootings, each with more than three persons shot.  (T. 42.)  He was involved in six officer-involved shootings, hundreds of homicide calls, and six incidents involving deceased children under age ten.  (T. 43.)  In 1998, the employee had to chase, fight, and restrain a naked man during a cold winter night after that man had set his own house on fire.  (T. 44.)  In August 2007, the employee responded to the I-35W bridge collapse scene where cars and people were in the Mississippi River.  (T. 45.)  During the bridge collapse response, the employee confronted smoke, dust, fire, and cracking sounds made by the collapsed bridge.  (T. 46.)  Soon after the bridge collapse, the employee responded to a call involving a mother who had accidentally smothered her baby.  (T. 48.)  In November 2007, a close colleague who was a Park Police officer was killed while pursuing a suspect when he was struck by a squad car.  (T. 49.)  After this incident, the employee began to drink hard liquor alone in order to mourn his friend, to relax and decompress, and for distraction.  At this time, the employee began to withdraw from his family and friends, and easily became angry.  (T. 51, 52.)

In 2012, the employee responded to an active shooter call at Accent Signage with the SWAT unit.  Upon deploying at the call, the employee encountered multiple deceased persons with bloody gunshot wounds.  While the employee was in a prone position, fragments of a deceased gunshot victim’s skull became ground into employee’s elbow.  (T. 55.)  The employee was involved in policing while under threat of being wounded or killed for over 90 minutes in this incident.  He felt overwhelmed by this experience.  (T. 55, 56.)

On November 21, 2013, the employee was seen for a routine medical examination with John Northwood, M.D.^[2]  The record notes the employee in 2005 had been prescribed a CPAP machine but ceased using it after five months.  The employee’s alcohol consumption was described as occasional based upon no more than three drinks a day or more than seven drinks per week.  His Patient Health Questionnaire 2 (PHQ-2) score was zero.^[3]  The employee was eating well and working out four to five times per week.  (Ex. I.)

In 2015, the employee was promoted to sergeant.  He assisted in containing the protests at the Fourth Precinct building following the death of a man fatally shot by a police officer during a confrontation.  (T. 63-64.)  The employee was at the Fourth Precinct when shots were fired by agitators into the crowd of protesters, causing a mass casualty scene of more than three persons shot.  (T. 65.)  The employee was subjected to the expressed anger of the protesters as the officers responded to the scene.  (T. 65.)

By 2015, the employee was expressing anger toward one of his sons, withdrawing from family and neighbors, drinking alcohol alone or with close police colleagues, and using Benadryl to fall asleep.  (T. 66-67.)  The employee found going to work overwhelming, and he was reluctant to respond to calls for service.  (T. 67.)  The employee began drinking three to four days a week at this time, including while making breakfast for his kids after working overnight.  (T. 118-21.)  The employee considered his drinking “therapeutic” and helpful to avoid the feelings he was having with past issues, anger, and internal turmoil.  (T. 121.)  The employee joined IA in the autumn of 2019 to avoid street-policing duties.  (T. 68.)

In his IA position, the employee reviewed officer-involved shootings, officer use-of-force incidents, allegations of officer misconduct, and critical incidents.  (T. 69.)  In December 2019, the employee investigated an officer-involved shooting which required him to watch 100 hours or more of video of the incident from police officers’ body cameras.  (T. 71.)  An in-custody death of a resident of South Minneapolis occurred when the employee was working IA.  (T. 73.)  Following that incident, the employee retrieved and forwarded body camera video of the incident.  During the subsequent unrest, he was assigned to the SWAT unit, assisting with logistics, defending the SWAT unit garage from protesters, and encountering protesters on the street.  (T. 75-76.)  After returning to his IA assignment, the employee investigated use-of-force and other complaints which required him to watch extensive video of the civil unrest.  (T. 77-78.)

On October 28, 2021, the employee sought treatment from Beth Jordan of Jordan Consulting and Counseling.^[4]  (Ex. H).  The employee reported he had been engaged in policing for years.  He described to her that his current IA job duties, reviewing footage of officers in traumatic and dangerous positions, triggered reactions.  Ms. Jordan noted the employee’s presenting symptoms as sleep disturbances, depression, anxiety, anger/irritability, hyperarousal, lack of motivation, and intrusive negative thoughts/memories.  The employee described being uncomfortable driving over the I-35W bridge or near the Accent Signage location.  Ms. Jordan’s initial diagnostic impression was adjustment disorder, NOS (not otherwise specified) and ruled out PTSD.  The employee began therapy and Ms. Jordan later revised the employee’s diagnosis to include PTSD.  Ms. Jordan advised the employee to stop working as a police officer.  (T. 87).  The employee has continued therapy with Ms. Jordan on average once per month through the time of the hearing.  (T. 92.)

The employee returned to Dr. Northwood for a preventive health visit on February 16, 2022.  The employee scored 4 on the PHQ-2 and 15 on the PHQ-9.^[5]  His Alcohol Use Disorders Identification Test (AUDIT) score was 13.^[6]  In answering the AUDIT questions, the employee reported drinking alcohol two to three times a week consuming three to four drinks each time he drank.  He also reported that on a monthly basis he consumed five or more drinks, and that he was unable to stop drinking once per month.  The employee further responded that he did not need to drink to get himself going after a heavy drinking session.  The employee reported being nervous and anxious with mood changes.  No relative, friend, doctor, or other health care worker had recently expressed concern about his drinking or suggested that he decrease his alcohol consumption.

On March 3, 2022, Kasey Aleknavicius, Psy.D., L.P., evaluated the employee as part of a retirement disability evaluation.  During the psychological evaluation the employee provided a personal history, underwent a mental status examination, and was administered the following psychological tests: Life Events Checklist for DSM-5^[7] (LEC-5) Extended Version, Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) (past month version), Minnesota Multiphasic Personality Inventory-3 (MMPI-3), PHQ-9 and Generalized Anxiety Disorder 7-item Scale (GAD‑7).  (Ex. A, T. 207.)  Dr. Aleknavicius issued a report dated March 25, 2022.  Using the DSM‑5, Dr. Aleknavicius opined the employee met the criteria for PTSD, major depressive disorder, single episode, moderate, and alcohol use disorder (AUD), moderate, all of which were the result of performing his duties as a police officer for the self-insured employer.  The employee’s symptoms resulted in significant distress and impairment of his social and occupational functioning. Dr. Aleknavicius concluded that the severity of the employee’s PTSD symptoms precluded him from working as a police officer or first responder in any capacity, and she prepared a Report of Workability dated March 25, 2022, restricting the employee from working as a first responder. (Ex. D.)  In her April 20, 2022, PERA disability report, Dr. Aleknavicius restated that the employee’s PTSD symptoms precluded him from working as a police officer.  (Ex. C.)

The employee hired counsel to pursue workers’ compensation benefits on April 4, 2022.  (Ex. V.)  On April 28, 2022, the self-insured employer filed a notice of primary liability determination.  (Ex. S.)  The self-insured employer denied liability for the employee’s workers’ compensation benefits, questioning the validity of employee’s PTSD diagnosis as defined in Minn. Stat. § 176.101, subd. 15(d), challenging whether that the statutory presumption under Minn. Stat. § 176.101, subd. 15(e), applied, and asserting the employee had pre-existing personal mental health conditions unrelated to employment.

On April 25, 2022, the employee returned to Dr. Northwood for PTSD and depression screening follow-up.  The employee’s PHQ-9 score on this visit was 15.  (Ex. I.)  The employee’s responses to the PHQ-9 indicated that he had little interest or pleasure in doing things, had trouble concentrating, felt tired, had trouble falling or staying asleep, felt down, depressed, or hopeless, and was restless.  His blood pressure was 160/102.  The symptoms had continued for more than a month and were severe and worsening.  Dr. Northwood diagnosed the employee with PTSD and prescribed propranolol (Inderal) as needed.^[8]  On May 13, 2022, Dr. Northwood also completed a PERA disability form stating that the employee was unable to perform his duties as a police officer. (Ex. G.) Dr. Northwood noted that the employee’s condition had deteriorated since the riots of 2020.  Dr. Northwood listed AUD as a secondary diagnosis of the employee.

Brandon Z. Erdos, M.D., a board-certified psychiatrist, prepared a disability peer review report dated June 30, 2022.  Based upon his review of available medical data, Dr. Erdos opined that the employee had been properly diagnosed with PTSD, major depressive disorder, and AUD, with all the diagnosed conditions disabling the employee from performing the duties of a police officer.  He further opined that all the disabling and diagnosed psychiatric conditions were the direct result of the employee’s work duties as a police officer.  Dr. Erdos noted that the employee had completed a CAPS-5 PTSD screening by Dr. Aleknavicius on March 3, 2022, which supported the employee meeting criteria A, B, C, D, E, F, G, and H of the DSM-5.  (Ex. F.)

On August 16, 2022, the employee filed a claim petition seeking workers’ compensation benefits in the form of wage loss, medical benefits, and vocational rehabilitation for his PTSD diagnosis.

The employee saw Dr. Northwood for a blood pressure check on September 28, 2022. His blood pressure was 136/88 and PHQ-9 score was 5.  The employee was not taking the previously prescribed propranolol.

On November 3, 2022, Kenneth Young, Psy.D., L.P., conducted an independent psychological evaluation of the employee at the request of the self-insured employer.  Dr. Young interviewed the employee and administered the CAPS-5 (past month version) and the MMPI‑3.  By history, the employee reported a thirst for alcohol daily once he joined IA.  His pattern of drinking included drinking eight to nine beers and three to four shots of liquor several days a week.  Using the DSM‑5, Dr. Young found “no clear and consistent evidence that Mr. Rowe meets, or has ever met, the criteria for PTSD.”  (Ex. 2.)  Dr. Young concluded that the employee met the diagnosis of AUD. He further opined that the employee’s work as a police officer did not contribute to the AUD diagnosis.  Dr. Young also disagreed with Dr. Aleknavicius’s opinions and her CAPS-5 assessment process.  He recommended the employee undergo an evaluation to assess alcohol treatment options.

The employee had a follow-up evaluation with Dr. Aleknavicius at the request of his attorney on February 3, 2023.  During the assessment, the employee was administered the CAPS‑5 (past month version) and the MMPI-3.  (T. 207.)  Dr. Aleknavicius noted that the employee was participating in individual therapy with Ms. Jordan twice a month.  With therapy, the employee’s hypervigilance and intrusive ideation symptoms were less frequent and intense.  The employee reported not consuming alcohol from April to October 2022, with no withdrawal symptoms.  When examined, the employee was drinking three to four days a week, about eight to ten drinks.  In a report dated July 18, 2023, Dr. Aleknavicius diagnosed the employee with PTSD, major depressive disorder, and AUD per the DSM-5-TR.^[9]

On October 12 and 13, 2023, the employee’s claims came on for hearing before a compensation judge.  The parties identified the issues to be determined as: (1) whether the employee was entitled to the statutory presumption that his PTSD was work related pursuant to Minn. Stat. § 176.101, subd. 15(e), and whether the self-insured employer submitted substantial factors to rebut the presumption; (2) whether the employee had a lifetime diagnosis of PTSD per the DSM-5-TR; (3) whether the employee no longer met the statutory definition of PTSD thereby ending his entitlement to benefits; (4) whether the employee suffered from a major depressive disorder or AUD as a consequence of a PTSD diagnosis; and (5) whether the employee is entitled to wage loss, permanent partial disability, and medical benefits, out-of-pocket expenses, a rehabilitation consultation, and penalties.

The employee’s wife testified at the hearing that the employee, prior to becoming a police officer, was outgoing, involved in football, rugby, hunting, fishing, and was a very enjoyable person to be around.  In 2013, the employee began to withdraw socially, became angry, was less patient with his family, and began to drink alone and more often.  She related the employee’s work at IA, which required him to repeatedly review video from body cameras, as causing him to relive troubling experiences.  (T. 133.)  She noted that the employee “loved his job” but “it was eating him up from the inside out.”  (T. 134-35.)  Finally, she also testified that the employee remains hypervigilant when entering urban areas, sits in places to assess threats, and continues to have nightmares and sleep difficulties.  (T. 124-41.)

Both Dr. Young and Dr. Aleknavicius testified at hearing.  Each restated and explained the opinions expressed in their respective reports.  Dr. Aleknavicius testified that she used the DSM-5-TR to evaluate the employee in February 2023.  She explained that although the PTSD diagnostic criteria are identical in the DSM-5 and DSM-5-TR, the text revision edition provides clarity in how to identify and evaluate PTSD symptoms, the course of the disorder, symptom presentation, duration of symptoms, and PTSD risk factors.  (T. 170-71.)  In her opinion, the employee’s mental health condition was not caused by his alcohol use alone.  (T. 183-84, 187.) Based on her evaluation, the employee’s PTSD symptoms pre-dated his problematic use of alcohol and did not occur only when he was drinking.  (T. 185.)  Dr. Aleknavicius explained that the DSM‑5‑TR makes a distinction and clarifies that once a person has met the PTSD diagnostic criteria, the diagnosis continues until all symptoms are in remission.  (T. 219.)

Dr. Young diagnosed the employee with severe AUD and did not consider the employee to have ever had symptoms supporting a PTSD diagnosis.  (T. 313.)  He testified that the PTSD diagnostic criteria in the DSM-5 and DSM-5-TR are the same and that there is no difference from a clinical standpoint between the two editions, as the DSM-5-TR is simply a text revision. (T. 314.)  He acknowledged persons with PTSD commonly have other mental health disorders such as AUD.  (T. 315-16.)  Dr. Young testified about the difficulty on differentiating PTSD from AUD, stating that there is no reliable way to differentiate between PTSD and AUD in the presence of a pre-existing history of alcohol abuse.  (T. 319-20.)

The hearing record closed on November 6, 2023, following submission of written closing arguments.  On December 22, 2023, the judge issued his findings and order.  He found that the employee was entitled to the presumption of compensability for a PTSD work injury in Minn. Stat. § 176.011, subd. 15(e).  Relying on the opinion of Dr. Young, the judge also found that the self-insured employer provided substantial factors rebutting the presumption, and the employee had never met the diagnosis of PTSD under the DSM-5.  In light of the decision that the employee did not suffer from PTSD per the DSM-5, the judge did not make any findings or alternative findings on whether the employee sustained a consequential mental health condition; if the employee had PTSD in the past, should benefits be discontinued per the Chrz decision;^[10] entitlement to temporary total disability benefits; whether the employee conducted a diligent job search; the employee’s entitlement to penalties for a frivolous denial of his claim under Minn. Stat. § 176.225, subd. 1(5), entitlement to permanent partial disability benefits, entitlement to reimbursement of out-of-pocket expenses and medical mileage, entitlement to a rehabilitation consultation, and the intervenor’s entitlement to payment.  The employee appeals to this court.

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).

On appeal, the employee asserts the judge erred as a matter of law in relying on Dr. Young’s report because Dr. Young did not use the DSM-5-TR, the most recent published edition of the DSM, in his analysis.  The employee further asks this court to review the judge’s findings, asserting that the medical report of Dr. Young misstated the employee’s use of alcohol and incorrectly contended there was no evidence of PTSD symptoms at any time during his active employment as a police officer.

In 2013, the legislature changed the statutory definition of occupational disease to include PTSD as a mental impairment, as defined, in relevant part, by Minn. Stat. § 176.011, subd. 15(d):

Under Minn. Stat. § 176.011, subd. 15(d), an employee seeking to recover workers’ compensation benefits for PTSD must prove that: (1) a licensed psychiatrist or psychologist has diagnosed the employee with PTSD, and (2) the diagnostician based the employee’s diagnosis on the most recently published edition of the DSM.  Minn. Stat. § 176.011, subd. 15(a), (d); Chrz, 986 N.W.2d at 486, see also Smith v. Carver Cnty., 931 N.W.2d 390, 396 (Minn. 2019).

Minn. Stat. § 176.011, subd. 15(e), provides that certain groups, including licensed police officers, are entitled to a presumption that the PTSD diagnosis is an occupational disease due to the nature of their employment.  The employer may deny this presumption by communicating to the employee that there are substantial factors which challenge the presumption and diagnosis.

In enacting Minn. Stat. § 176.011, subd. 15(e), the legislature reduced the employee’s burden to prove that a PTSD claim was work-related and thereby afford compensation to a first responder for a presumptive mental health injury.  The financial compensation for police officers with PTSD could reasonably be expected to encourage police officers dealing with post-traumatic stress to seek out and obtain mental health care.  Once a first responder meets the Minn. Stat. § 176.011, subd. 15(e) criteria, the injury is presumed to be work related.  The language of the statute creates a rebuttable presumption that a police officer’s PTSD claim is work-related, shifting the burden of proof to the employer to show that a police officer’s PTSD condition is not related to work.

The statutory language requires an employer to rebut the diagnosis of the employee’s psychologist or psychiatrist by submission of “substantial factors.”  Minn. Stat. § 176.011, subd. 15(e).  In that circumstance, the job of the compensation judge is to determine which of the medical experts’ competing diagnoses have adequate foundation and is more credible and persuasive.  See Gianotti v. Indep. Sch. Dist. 152, 889 N.W.2d 796, 803 (Minn. 2017) (“In weighing medical evidence, a compensation judge has the discretion as the trier of fact to choose between competing and conflicting medical experts’ reports and opinions.”).  This court must affirm a compensation judge’s choice between two expert opinions “unless the facts assumed by the expert in rendering his or her opinion are not supported by the evidence.”  Pelowski v. K-Mart Corp., 627 N.W.2d 89, 93 (Minn. 2001) (citing Nord v. City of Cook, 360 N.W.2d 337, 342–43 (Minn. 1985)).

Unlike many cases where issues turn on competing medical diagnoses, this case involves a presumption.  In assessing the effect of a presumption, albeit prior to the inclusion of PTSD as a covered condition, the Minnesota Supreme Court stated:

Since the inclusion of PTSD in the occupational disease statute, the Minnesota Supreme Court has directly addressed the burden required for rebutting the presumption of a work-related injury following a diagnosis of PTSD, stating:

In enacting the PTSD presumption, the legislature determined that the most recently published edition of the DSM is the touchstone for the required PTSD diagnosis and analysis.  We assign significance to the reference to the statute’s requirement that a diagnosis of PTSD as described “in the most recently published edition of the Diagnostic Manual of Mental Health Disorders by the American Psychiatric Association” in Minn. Stat. § 176.011, subd. 15, and believe that the legislature intended to require that a rebuttal of a PTSD diagnosis, to constitute substantial proof to the contrary, be made through an independent psychological evaluation (IPE) using the most recently published edition of the DSM at the time of the IPE.  Chrz, 986 N.W.2d at 485 (citing Smith, 931 N.W.2d at 396 (psychiatrist or psychologist evaluation of the employee’s PTSD diagnosis based upon the most recently published edition of the DSM)).

In this case, Dr. Young utilized the DSM-5, not the current DSM-5-TR which is the most recently published edition of the DSM at the time of his evaluation of the employee.  Although the diagnostic criteria for PTSD are the same in the DSM-5 and DSM-5-TR, the diagnosis is dependent on more than those criteria.  The major revisions and changes in the DSM‑5‑TR edition from the DSM-5 include the narrative text for each disorder, changes in codes, changes in terms used to describe the disorders, and clarity in identifying and evaluating criterion factors. Accordingly, we conclude that Dr. Young’s failure to utilize the current DSM-5-TR is contrary to Minn. Stat. § 176.011, subd. 15(d) and (e) and his opinion should not have been considered by the judge.  As such, Dr. Young’s opinion and testimony fail to rebut the opinions of Dr. Aleknavicius that the employee met the PTSD diagnosis as stated in the DSM-5-TR, as required by Minn. Stat. § 176.011, subd. 15(d) and (e).  Because Dr. Young’s opinion was not based on the DSM-5-TR, accepting the opinion was error and the judge’s denial of the employee’s statutorily presumed, established, and unrebutted PTSD diagnosis was manifestly contrary to the evidence.

We recognize, as argued by the self-insured employer and as opined by Dr. Young, that the diagnostic criteria for PTSD in the DSM-5 are identical to that in the DSM-5-TR.  However, the statute does not limit the definition of PTSD to only the diagnostic criteria for PTSD in the most recently published edition of the DSM.  Rather, the statute states that PTSD is defined as the “condition as described” in the most recently published edition of the DSM.  To accept the argument that only the diagnostic criteria are important in evaluating a PTSD diagnosis, we would be deciding that certain sections of the DSM-5-TR are not relevant or that the text of the DSM-5-TR is extraneous.  That is not our role.  See Tea v. Ramsey Cnty., 5 N.W.3d 114 (Minn. 2024) (judges are not to independently apply the DSM but rather rely upon the interpretation of the DSM made by medical experts).  Dr. Aleknavicius testified that the DSM-5-TR contains revisions that alter how the diagnostic criteria for PTSD are understood and applied based upon additional scientific findings since the publication of the DSM-5.  There is no contrary evidence.^[11]  Because the statute is unambiguous and only Dr. Aleknavicius’s psychological opinion is based upon the most recently published edition of the DSM, that evidence is compelling and is unrebutted, and is thus determinative.   In general, a finder of fact may not disregard an unopposed medical opinion. Ruether v. State, Mankato Univ., 455 N.W.2d 475, 478, 42 W.C.D. 1118, 1122 (Minn. 1990); Flansburg v. Giza, 284 Minn. 199, 201-02, 169 N.W.2d 744, 746, 25 W.C.D. 3, 6 (1969).  Not only is Dr. Aleknavicius’s opinion unopposed, it is also consistent with and based upon the “most recently published edition” of the DSM as required by statute.

As the employee established the presumption of PTSD applied under Minn. Stat. § 176.011, subd. 15(e), and this presumption was not rebutted by substantial factors, the denial of benefits in the Findings and Order is vacated.  Several issues raised below were not reached by the judge, including whether the employee sustained any consequential mental health injuries; assessment of entitlement to temporary total disability benefits; whether the employee conducted a diligent job search; assessment of entitlement to penalties for a frivolous denial of his claim under Minn. Stat. § 176.225, subd. 1(5);^[12] assessment of entitlement to permanent partial disability benefits; assessment of entitlement to a rehabilitation consultation; assessment of the intervenor’s entitlement to payment; and reimbursement of the employee’s out-of-pocket expenses and medical mileage.  These issues are remanded to the judge for determination.  See Minn. Stat. § 176.371 (all questions of fact and law submitted to the compensation judge shall be disposed of in the decision).