The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on February 25, 2004, at the request of a worker advisor, acting on behalf of the claimant. The Panel discussed this appeal on the same day.

Issue

Whether or not the claimant's psychological/psychiatric conditions, including PTSD are considered a result of his employment.

Decision

That the claimant's psychological/psychiatric conditions, including PTSD are not considered a result of his employment.

Decision: Unanimous

Background

In February 1997, the claimant submitted a claim for compensation benefits indicating that his employment activities as an underground miner over the years caused him to develop a fear of working in confined spaces.

On March 11, 1997, the employer's representative outlined her position that the claimant's claustrophobia condition should not be accepted as a responsibility of the Workers Compensation Board (WCB). She noted that the claimant was not involved in a traumatic incident that would precipitate such a condition nor was this a 'disease' brought on by conditions in the mining industry.

In a signed statement dated April 23, 1997, the claimant stated that it was about 15 years ago when he started to experience feelings of claustrophobia. The first time he felt this way was when he descended underground in a cage. The claimant noted that he suffered a wrist injury in 1996 and was given selective duties on the surface at the mine.  In February 1997, his employer advised him that he would have to go underground again as there were no more selective duties available. This was when he told his employer that his claustrophobia condition was a WCB matter. The claimant provided the WCB with a diagram illustrating the cage and level system in the mine. The claimant added that he felt his condition was due to a blasting incident that took place about 16 years ago.

On June 5, 1997, a WCB adjudicator spoke with a mine employee who recalled that there was one incident a number of years ago where a muck pile was blown up and some of the muck flew at him and the claimant. A chunk of rock knocked off his hard hat. The blast had the potential to hurt someone seriously.

In a report to the attending physician dated March 10, 1989, a consultant noted that the claimant began to notice feelings of claustrophobia about 7 or 8 years ago. The claimant experienced oppressive feelings together with imbalance whenever he went down in the cage.

On March 10, 1997, a psychiatrist commented that the claimant had a specific phobia, namely that he was terrified to get into the cage at work which would take him down to the various mining levels. When in the cage or even whenever thinking about being in the cage, the claimant would have a panic attack characterized by shortness of breath, rapid pulse, tremor and a fear that he was going to come apart. The consultant described various symptoms being experienced by the claimant and commented that he may have a personality disorder.

On May 26, 1997, another physician noted that the claimant was seen on February 10, 1997. The claimant stated that he had been suffering from claustrophobia for about 10 years. The claimant feared going down in the cage underground and that this also extended to elevators in high rise buildings which he avoided.

The claimant was interviewed by a WCB psychiatric consultant on August 13, 1997. The consultant concluded that the claimant had a long standing anxiety disorder with obsessive-compulsive features. She further concluded that the development of this disorder was not causally related to working underground.

On September 24, 1997, the claimant was advised that his claim for compensation had been denied based on Sections 4(1) and 1(1) of The Workers Compensation Act.

On March 13, 2002, the claimant wrote to the WCB indicating that he had been involved in a blasting incident in the late 1970's or early 80's and that he developed post-traumatic stress disorder (PTSD) as a result. He didn't know at the time what was happening to him and it was a number of years after that, when he realized what was going on and its cause. In 1996 he finally realized that he wasn't able to travel underground any more. The claimant provided the WCB with additional pieces of information dated April 5, 2002 in which he outlined traumatic events/incidents that he had experienced during his employment activities and which he alleged caused him high levels of PTSD.

Further medical information received from a physician dated May 2, 2002 indicated that the claimant was first seen regarding his psychiatric illness on January 11, 2002. The claimant exhibited features of depression with comorbid anxiety and the anxiety seemed to fit with a PTSD picture. The physician was also of the view that the workplace environment in the mines was a triggering event for the claimant's PTSD.

On May 10, 2002, a consulting psychiatrist stated, in part, that the claimant's anxiety and depression were related to the episodes and incidents that the claimant had been exposed to while working in the mines. These included being in the vicinity of large explosions, finding colleagues who were dead and buried in rubble and having to work in extremely dangerous situations with an extremely high level of stress. It was felt that the cumulative effects of these various incidents starting in 1980, led to these symptoms.

On September 16, 2002, a WCB psychiatric consultant reviewed the current medical information and commented that a person could develop traumatic stress disorder due to the cumulative effects of being involved in or witnessing traumatic incidents. However, it was noted that the claimant had not sought treatment for his difficulties and that although he had been examined by a psychiatrist in 1998 there was no diagnosis of PTSD. It was also noted that the claimant had previously been examined by a WCB psychiatric consultant on August 13, 1997 and that she was of the opinion the claimant had a longstanding anxiety disorder with obsessive-compulsive features.

In a decision dated September 13, 2002, the claimant was informed by his adjudicator that the WCB did not have sufficient medical evidence to support that he experienced acute reactions to the incidents or that he witnessed these incidents at work. The previous medical information did not confirm a diagnosis of work-related post traumatic stress disorder. On December 12, 2002, this decision was appealed by a worker advisor and a medical report dated December 9, 2002 was submitted for consideration.

Following review of the new medical information, the claimant was advised on April 17, 2003 that the new information did not confirm the diagnosis of post traumatic stress disorder and that it did not establish or support a relationship between the claimant's ongoing difficulties and any incident that occurred at work. Thus, no change would be made to the previous decision of September 13, 2002.

On October 3, 2003, the Review Office considered the case along with several other issues that were brought forward by the claimant with respect to other WCB claims. As to this particular claim, Review Office determined that the worker's psychological/psychiatric conditions, including PTSD, were not considered a result of his employment. Review Office reached its conclusion after considering the medical information on file, the opinion expressed by the WCB's psychiatric consultant and the documents regarding the other events in the mine that the claimant witnessed or claimed to have been a part of during his employment as miner and/or while on the rescue safety team. On November 17, 2003, the worker advisor appealed Review Office's decision and an oral hearing was convened.

Reasons

After having thoroughly reviewed all of the evidence on file as well as having taken into consideration the claimant's oral testimony, we find that the claimant's psychological/psychiatric conditions including PTSD (post traumatic stress disorder) are not, on a balance of probabilities, considered a result of his employment but rather to his personality pattern. During the course of giving his evidence, the claimant recounted several disturbing occurrences at work, which according to him eventually led to his being unable to perform the regular duties of an underground miner. However, we note that the claimant continued to perform his employment duties despite the happening of these distressing events.

In arriving at our decision, we preferred to attach greater weight to the following body of evidence:

• August 13, 1997, WCB's consulting psychiatrist's interview notes - "In summary, this man's long standing anxiety disorder which (sic) obsessive-compulsive features. This is a long standing disorder with some gradual increase in symptomatology over the years. He does, however, continue to have difficulties with his anxiety disorder in the workplace even at surface work. Anxiety disorders with obsessive-compulsive features are not uncommon. This is a long standing disorder in this man. It is a common disorder. Although the symptoms of this disorder are making it difficulty (sic) for him to work underground because of the anxieties he has about riding in the cage, the development of this disorder is not causally related to working underground."
  
  
• March 10, 1997, consulting physician's chart notes - "[The claimant] is a 40 year old male who has a specific phobia. Namely he is terrified to get into the cage at work which will take him down to the various mining levels. Interestingly enough when one does a review of the symptoms, one finds that he washes his hands 20-30 times a day. As far as treating this specific phobia one would look at the services of a qualified clinical psychologist for an assessment regarding behaviour therapy. This I'm sure will present some resistances in treatment and is another indication that we are dealing with someone who has a personality disorder."
  
  
• July 18, 2003, registered psychologist's independent psychological assessment report - "In the course of my assessment I had an opportunity to interview Mr. [the claimant] and to administer to him a variety of psychological questionnaires and tests under the supervision of either myself or my staff member, Ms. [name]. The test results suggest that [the claimant] has a narcissistic personality structure. It is likely that these features of his character have been in existence, at least since adolescence. Having a narcissistic personality would increase his self-preoccupation, augmenting his vulnerability or susceptibility to PTSD, and as well, compromise his ability to cope."
  
  
• September 29, 2003, second WCB consulting psychiatrist's memorandum to file - "Dr. [independent registered psychologist] has given a thorough report, with emphasis on psychological testing, developmental history & psychosocial development. The clt has a Narcissistic Personality Pattern, & this, of course, impacts on how he receives information, processes it & ultimately deals with it. His personality style increases his vulnerability to depression, anxiety, & other psychiatric problems.
  While, at times, PTSD can present some time after the fact, this diagnosis was not raised by Dr. [treating psychiatrist] in 1998. In fact, Dr. [treating psychiatrist] draws a time link between various issues with the clt's wrist claim & his anxiety about working underground.
  Dr. [WCB's first consulting psychiatrist] saw a different picture in 1997, & mentions long standing anxiety with obsessive-compulsive features. She opined that his anxiety about riding in the cage was not causally related to working underground. Elsewhere on file, the clt has indicated that this anxiety developed after witnessing a co-worker being anxious about the cage. There are inconsistencies in the clt's story, and evidence that the clt tends, at times, to be overly dramatic.
  In addition, there are many pre-x and current psychosocial issues not related to the CI that likely have significant impact on the clt's life & difficulties. They include, as documented by Dr. [independent registered psychologist], social, vocational, appearance, family, religious, sexual & attitudinal difficulties.
  His personality pattern is long standing, going back to childhood, adolescence & early adulthood. It would not be caused by his employment at [name of employer]. I see his psychological problems being tied into his personality pattern rather than being a reflection of his work place. His personality structure strongly influences his perception that incidences have occurred &/or his intensity of response to incidences.
  Dr. [current treating psychiatrist] has indicated that the clt suffers from PTSD. However, this is primarily based on the clt's subjective presentation. I am therefore giving more weight to Dr. [independent registered psychologist's] report which includes not only subjective reports, but also extensive psychological testing, with objective data."

The claimant's appeal is hereby dismissed.

Panel Members

R. W. MacNeil, Presiding Officer
P. Challoner, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

R.W. MacNeil - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 1st day of April, 2004