The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") that her diagnosis of Post-Traumatic Stress Disorder is not acceptable as being a consequence of the 2016 and 2017 accidents and she is not entitled to further wage loss and medical aid benefits after July 24, 2018. A hearing was held on January 23, 2020 to consider the worker's appeal.

Issue

Whether or not the worker's diagnosis of Post-Traumatic Stress Disorder is acceptable as being a consequence of the 2016 and/or 2017 accidents; and

Whether or not the worker is entitled to further wage loss and medical aid benefits after July 24, 2018.

Decision

The worker's diagnosis of Post-Traumatic Stress Disorder is acceptable as being a consequence of the 2016 and 2017 accidents; and

The worker is entitled to further wage loss and medical aid benefits after July 24, 2018.

Background

Date of Accident - October 11, 2016:

The employer reported to the WCB on November 18, 2016 that the worker injured her neck, shoulders and low back as the result of an accident that occurred during a flight take-off on October 11, 2016. The worker was seen by a healthcare provider on October 15, 2016 and was diagnosed with strains to her neck and shoulders, with rest and anti-inflammatory medication recommended for treatment.

The WCB contacted the worker on November 22, 2016 to discuss her claim. The worker advised that she had not missed any time at work after October 15, 2016, she had not sought any further treatment, and she had already returned to work with no concerns. The worker was advised that her claim was accepted as a no time loss claim and would be closed.

Date of Accident - December 31, 2017:

A Worker Incident Report was filed with the WCB on January 2, 2018 by the worker indicating that she injured the left side of her body, including her shoulder, ribs, chest and hand, and her teeth in a motor vehicle accident on December 31, 2017. The worker was taken to an emergency department after the accident when an x-ray of her left shoulder, ribs and the left side of her chest was taken, which came back normal and she was diagnosed with soft tissue injuries. The WCB contacted the worker on January 12, 2018 and advised that her claim was accepted. Wage loss and medical aid benefits, including dental and physiotherapy treatment, started.

At a February 12, 2018 physiotherapy assessment, it was anticipated that the worker's injuries would require a further six to eight weeks to heal and the treating physiotherapist noted the worker could return to work by March 31, 2018 and a sedentary position with no frequent lifting or bending/twisting was recommended. A Functional Abilities Form was provided to the employer indicating the worker could return to work on March 31, 2018 with restrictions of no prolonged awkward posture and no lifting the first two weeks. The employer advised the WCB on March 22, 2018 that a return to work date of April 20, 2018 was set for the worker. The worker attended for physiotherapy treatment on April 3, 2018 where the physiotherapist noted the worker had a set-back in her recovery from increased activity at home and recommended a delay to the worker's return to work until mid-May 2018.

On April 4, 2018, the WCB contacted the worker to discuss the status of her claim. The worker confirmed that she was working around her property on April 2, 2018 and felt pain. She advised that she sought medical treatment on April 3, 2018 and the physician recommended she not return to work until further testing was completed. In addition, the worker advised the WCB case manager that she had been experiencing post-traumatic stress disorder (PTSD) symptoms approximately a month before, with loud noises like loud voices or dogs barking making her "…crouch down and hold her head…" and she would find herself hiding from the noise in corners or hanging on to the washing machine "…if the dogs started to jump around." She advised her family physician about her symptoms on March 20, 2018 and it was recommended that she be seen by a psychologist. The worker provided the WCB case manager with the name of the psychologist she had been seeking treatment with.

The WCB received a report from the worker's treating psychologist on May 4, 2018. The psychologist opined that the worker met "…the diagnostic criteria for posttraumatic stress disorder (PTSD)…" and that the worker developed PTSD "…as a direct result of the workplace accident of December 31, 2017." The psychologist further provided that the worker's symptoms began during the month of January 2018 and that her diagnosis of PTSD limited the worker's ability to function at her pre-injury job. It was also noted that the psychologist initially met with the worker on October 20, 2016 "…following an earlier traumatic incident…"

On May 29, 2018, the worker's file was reviewed by a WCB psychological consultant. The WCB psychological consultant opined that worker did not meet the "…threshold traumatic events needed for a diagnosis of PTSD" as she was "…not exposed to actual or threatened death, serious injury, or sexual violence…" as a result of the workplace accident on December 31, 2017. It was further provided that the worker had an adjustment disorder with anxiety related to the workplace accident and a restriction of sedentary duties and not driving on northern roads was recommended. Further psychological treatments were also approved.

The worker was advised by the WCB on June 8, 2018 that her psychological claim for an adjustment disorder with anxiety related to the workplace accident was accepted and that her file was being reviewed by a WCB medical advisor with respect to her physical injuries. On June 10, 2018, the worker's file was reviewed by a WCB medical advisor who opined that the worker's diagnosed soft tissue injuries "…generally heal gradually over 6-8 weeks" and even with the reported set back around April 2, 2018, "…there really should be complete recovery by now, 5 plus months later." Accordingly, the WCB medical advisor further opined that workplace restrictions would no longer be required.

The WCB advised the worker on July 17, 2018, that a review of her claim had been completed and a determination had been made that she recovered from the December 31, 2017 workplace accident and entitlement to wage loss benefits would end on July 24, 2018.

Date of Accident - October 11, 2016:

In discussion with her WCB case manager on July 17, 2018, the worker advised that she would like to re-open her claim for the workplace accident on October 11, 2016 as she had been diagnosed with PTSD she related to the October 2016 accident. She noted that "…since that plane crash, she had been fearful of flying and has been suffering in silence." The WCB received a copy of the July 25, 2018 report from the worker's treating psychologist. The psychologist advised that she had seen the worker on October 20, 2016, shortly after the workplace accident. The psychologist further reported her observation of the worker being shaken up and distressed by the October 2016 incident. The psychologist noted that as it was less than one month after the workplace accident, "…it was too early to diagnose posttraumatic stress disorder (PTSD) based on her symptoms" but did opine that based on the traumatic nature of the October 2016 workplace accident, Criterion A for the diagnosis of PTSD had been met as the accident involved a threat of death and/or serious injury. The psychologist went on in her report to describe other "stressful workplace incidents" reported to her by the worker. On August 16, 2018, the WCB accepted a recurrence of the worker's October 2016 workplace accident claim and wage loss benefits were paid commencing July 25, 2018 and further psychological counselling sessions were approved. On August 23, 2018, the worker provided the WCB with further details regarding the other incidents referred to in her treating psychologist's July 25, 2018 report. The employer confirmed on August 23, 2018 that no complaints had been made by the worker related to any ongoing psychological issues following the October 2016 workplace accident nor were there any issues with the worker's attendance since that time.

The worker's file was reviewed by a WCB psychological consultant on December 26, 2018. The WCB psychological consultant noted that the worker's psychologist reported that the worker's PTSD was related to the October 2016 workplace accident but that it would be "…an adjudicative decision regarding the acceptance of the PTSD as being related to the October 11, 2016 plane incident, in the context of having experienced 2 other stressful plane incidents…" and recommended a restriction of not flying in small planes to remote areas. The employer was advised of the restriction on January 8, 2019.

On January 24, 2019, the employer contacted the WCB to advise that they could accommodate the worker in a permanent position and provided the WCB with a copy of the job description of the accommodated position. The WCB contacted the worker and provided her with the information regarding the proposed accommodation on January 25, 2019. The worker's psychologist provided a report to the WCB on January 27, 2019 opining that "…working on or in the near vicinity of airplanes is a return to work barrier."

The employer requested reconsideration of the WCB's August 16, 2018 decision to accept the recurrence and pay the worker wage loss benefits to Review Office on February 14, 2019. The employer provided a chronology of the events from the October 2016 workplace accident to the December 31, 2017 workplace accident and noted that the worker resumed her full regular duties on November 4, 2016 and continued working those duties with no modifications, restrictions or complaints until the December 2017 accident.

The worker's file was reviewed again by the WCB psychological consultant on February 18, 2019 regarding the additional work restriction noted by the worker's treating psychologist. The WCB psychological consultant noted the employer's February 14, 2019 submission to Review Office and opined that as PTSD related to the October 11, 2016 workplace accident had been accepted and the employer's submission noted that the worker did not indicate any stress or anxiety related to her regular duties flying or being around aircraft, the only restriction to her duties would be that she was restricted from flying in small planes to remote areas.

On February 21, 2019, Review Office returned the worker's file to the WCB's Compensation Services for further investigation. Also on February 21, 2019, the WCB received a report from the worker's treating psychologist, from a January 31, 2019 follow-up appointment with the worker. In the report, the psychologist noted that the worker had provided her with a copy of the job description for the accommodated position the employer had offered and opined that the worker would not be able "…to perform this job because it will most likely further trigger posttraumatic stress disorder (PTSD) symptoms and make them worse. Since I have been seeing her, her worst trigger of PTSD symptoms is noise."

The worker was advised by the WCB on February 22, 2019 that her restriction remained "Restricted from flying in small planes to remote areas" and the position offered by her employer was a reasonable accommodation, within her restriction and as the position was set to start as of March 4, 2019, her entitlement to wage loss benefits would end as of March 3, 2019. On February 27, 2019, the WCB received a report from the worker's family physician rescinding the physical abilities report previously prepared and noting the physician's inability to support the worker returning to work in the accommodated position offered by the employer. The employer advised the WCB on March 1, 2019 that the worker had contacted them on February 28, 2019 and declined to return to work in the accommodated position.

Both claims:

The WCB advised the worker on March 7, 2019 that the August 16, 2018 decision to accept wage loss benefits after July 25, 2018 was rescinded. The worker was advised that the October 11, 2016 workplace injury did not meet the criteria under the presumption legislation.

On March 22, 2019, the worker requested reconsideration of the WCB's decision on both claims to Review Office. With her submission, the worker provided a detailed chronology of the events of the October 11, 2016 workplace injury and the symptoms she was suffering from after the accident, up to and including, the December 31, 2017 workplace accident, along with journal entries recording her symptoms. On April 23, 2019, the worker's co-worker provided a submission in support of the worker's reconsideration request. A response was provided by the employer on May 30, 2019, with a further response submitted by the worker on June 11, 2019. A report was also provided to Review Office by the worker's psychologist on June 13, 2019. Copies of all submissions were provided to the parties.

On June 14, 2019, Review Office determined the worker's diagnosis of PTSD was not acceptable and the worker was not entitled to wage loss and medical aid benefits after July 24, 2018. Review Office acknowledged that the worker related her psychological symptoms to the October 11, 2016 workplace accident, two other workplace accident described by the worker and the December 31, 2017 workplace accident; however, Review Office found that the worker's further psychological issues for which she was diagnosed with PTSD by her treating psychologist, are not related to either the October 2016 or December 2017 workplace accidents. Further, Review Office found that the worker did not have a loss of earning capacity or required medical aid treatment after July 24, 2018 for either workplace accident.

The worker's representative filed an appeal with the Appeal Commission on July 8, 2019. An oral hearing was arranged.

Reasons

Applicable Legislation and Policy:

The Appeal Commission and its panels are bound by The Workers Compensation Act (the "Act"), regulations and the policies established by the Workers Compensation Board of Directors.

Section 4(1) of the Act provides that where a worker suffers personal injury by accident arising out of and in the course of employment, compensation shall be paid. That compensation includes wage loss benefits, medical aid, and impairment awards.

Entitlement to wage loss benefits is addressed in section 4(2) of the Act which indicates such benefits are payable for loss of earning capacity resulting from the accident.

The Act provides a presumption involving PTSD:

4(5.8) If a worker

(a) is exposed to a traumatic event or events of a type specified in the Diagnostic and Statistical Manual of Mental Disorders as a trigger for post-traumatic stress disorder; and 

(b) is diagnosed with post-traumatic stress disorder by a physician or psychologist;

the post-traumatic stress disorder must be presumed to be an occupational disease the dominant cause of which is the employment, unless the contrary is proven.

Section 4(5.9) states that the presumption in subsection (5.8) applies to a worker who is diagnosed with post-traumatic stress disorder on or after the day that subsection comes into force.

Section 27(1) of the Act states that the WCB "…may provide a worker with such medical aid as the board considers necessary to cure and provide relief from an injury resulting from an accident."

WCB Policy 44.05.30, Adjudication of Psychological Injuries ("the Psychological Injuries policy") states that claims for psychological injuries will be adjudicated in the same way as claims for physical injuries. The WCB will determine whether:

• there has been an accident arising out of and in the course of employment; 

• the worker has suffered an injury; and 

• the injury was caused by the accident.

WCB Policy 44.10.30.60, Co-operation and Mitigation in Recovery ("the Mitigation policy") elaborates on the responsibilities of both workers and the WCB in ensuring compliance with Section 22 of the Act. The Act requires that workers take all reasonable steps to reduce or eliminate any impairment or loss of earnings resulting from a workplace injury. This is also known as a duty to mitigate. A worker can mitigate the negative effects of a workplace injury by reasonably participating and cooperating in medical treatment and services, and by participating fully in return to work and other programming the WCB considers beneficial to the worker's recovery and return to work.

Worker's Position:

The worker participated in the hearing via video conference and she was represented at the hearing by a worker advisor. The worker advisor provided a written copy of their position to the panel at the commencement of the hearing. During the hearing, the worker responded to questions from the worker advisor as well as the panel members.

The worker advisor commenced her presentation by stating that it was their position that the worker's diagnosis of Post-Traumatic Stress Disorder (PTSD) is medically related to her 2016 and 2017 workplace accidents and further that with the worker having permanent restrictions in place for a compensable psychological injury, a loss of earning capacity exists beyond July 24, 2018, for which wage loss benefits are payable.

The worker advisor reviewed with the panel the various file information regarding her claim. The worker’s diagnosis of PTSD by both her physician and psychologist provides support for the acceptance of her claim that was a result of her 2016 and 2017 accidents.

The worker advisor submitted that the 2017 accident involving a motor vehicle collision contributed to the worker's existing PTSD condition that was the result of the 2016 aircraft incident. In addition to physical injuries, the actual diagnosis of PTSD was made in May of 2018 by the worker's treating psychologist. The worker advisor submitted that the PTSD diagnosis was supported by the WCB psychological advisor.

The worker advisor stated:

It should not be ignored that [the worker] has continuously been diagnosed with PTSD by [psychologist] in her reports dated July 23, 2018, in which she confirmed a number of PTSD symptoms were identified on March 22, 2018. And in her report dated May 4, 2018, she confirmed the diagnostic criteria for Post-Traumatic Stress Disorder has been met in according to the DSM 5.

In [the worker's] case, she did experience traumatic events, which she truly believed that her life was threatened, which includes the 2017 motor vehicle accident, which caused serious injuries of broken ribs and broken teeth, and increased symptoms of PTSD for which she sought further medical attention.

The worker advisor further explained that the Psychological Injuries policy only requires a causal connection between the accident and the injury and that symptoms may occur soon after the accident or long after. The administrative guidelines note that acute reaction to a traumatic event does not mean immediately after the event but rather, acute refers to the severity of the reaction, whenever it occurs.

The worker advisor submitted that there were no underlying pre-existing conditions that are responsible for the worker's psychological injuries and that they believed that only her employment activities were causally connected to the worker's diagnosed PTSD.

The worker claims that the criteria for PTSD has been met under the DSM-V diagnostic assessment manual and that the worker's healthcare providers did not support the worker had recovered from her compensable injuries as of July 24, 2018 or that she was able to return to work at that time

When questioned by the panel why the worker waited until May 2018 to mention the two non-adjudicated workplace events, the worker stated:

Why? Because I thought I was dealing okay. Post-traumatic stress is not something like, you know, I fall and I scrape my elbow and I can see it, these are cumulative events that, you know what, some, something triggers it, and then your world falls apart, and that's what happened to me.

In sum, the worker advisor stated that the worker's diagnosis of PTSD was a result of her 2016 and 2017 workplace accidents and that she had not recovered from that condition when benefits were discontinued effective July 24, 2018.

Employer's Position:

The employer was represented at the hearing by an employer representative. Also attending the hearing was the employer's General Manager as well as the employer's Controller. Prior to the hearing the employer's representative provided information to the panel. The employer's representative made a presentation to the panel and all the individuals representing the employer participated in answering questions from the panel.

The employer's representative expressed concerns over the absence of symptoms related to PTSD for a 14-month period after the 2016 accident. They asserted that a PTSD diagnosis cannot be ascribed to the October 11, 2016 accident. They referred to the WCB consulting psychologist being unable to find a causal relationship to the 2016 accident.

The employer's representative stated:

We share the WCB's psychological advisor [name] concerns that it is difficult to make a connection between the October 11, 2016 accident and the PTSD diagnosis made in 2018. [The worker] had one counselling session offered by the employer and indicated she was fine. She did not attend more counselling sessions, although treatment remained available to her. This suggests that her psychological symptoms were minimal. She did not seek any further medical attention.

She made no complaints to the employer. She did not miss any time from work and actually picked up an extra week of work in December 2016.

She continued to work in her regular duties without any signs of difficulty for almost 14 months until the December 31, 2017 motor vehicle accident. She did not exhibit any of the debilitating symptoms she later claimed. Symptoms which would have made it very difficult for her to work in her demanding position.

The employer's representative questioned the timing of the worker's diagnosis of PTSD. She stated:

She did not seek counselling again until March 22, 2018, 17 months later, at a time when she had largely recovered from the effects of the December 31, 2017 MVA, (motor vehicle accident) and when she was expected back at work. Her symptoms escalated only when return to work planning was discussed.

The employer's representative reviewed information in the file and suggested that there were inconsistencies with the information contained within it. The employer representative also reviewed pictures taken after the 2017 MVA which the employer believed supported that the accident was not "severe" as described by the worker.

The employer representative asked the panel to accept the May 29, 2018 opinion of the WCB psychological consultant that the December 31, 2017 motor vehicle accident may well have been frightening, but it was unlikely that the compensable injury would be at the level of trauma that would lead to PTSD.

With respect to the issue of entitlement to benefits after July 24, 2018, the employer representative stated the following:

There are two main reasons why we believe that [the worker] is not entitled to benefits after July 24, 2018. Medical information did not support total disability, and the employer was willing and able to provide suitable work within restrictions outlined by the WCB.

The employer representative highlighted the ongoing medical information contained in the worker's file in the spring of 2018 that indicated she was recovering from the 2017 MVA as well as the employer's ongoing attempts to accommodate the worker's noted restriction and have her return to work on modified duties.

In sum, the employer's representative submitted that the evidence regarding this claim does not support that the worker suffered PTSD or that she was entitled to further wage loss and benefits after July 24, 2018. However, they also suggested that, notwithstanding the employer's arguments on the matter, if the panel was to determine that a claim for PTSD was acceptable, based on the evidence, it could only be attributable to the 2016 accident.

Analysis:

Issue 1: Whether or not the worker's diagnosis of Post-Traumatic Stress Disorder is acceptable as being a consequence of the 2016 and/or 2017 accidents.

For the appeal on this issue to be successful, the panel must find, on a balance of probabilities, that the worker's diagnosis of PTSD is a consequence of the 2016 and/or 2017 accidents. The panel is able to make the finding that the worker's diagnosis of PTSD is a result of both incidents.

The Worker Injury Report describes the October 11, 2016 accident as follows:

-Medivac call Pt & Escort secured-I was secured [with] aircraft safety belt 

-Aborted take off-causing forward motion. I was on bench seat with forward motion caused me to lurch forward & to left-Lumbar discomfort - bruising on mid back, neck & shoulder pain.

The Employer's Accident Report describes the October 11, 2016 accident as follows

[The worker] was onboard a flight that had an aborted take-off, and had an accident at the end of the runway.

The panel accepts that the October 11, 2016 accident was a traumatic event. This position is supported by the employer's undertaking and encouragement that all workers involved seek counselling to deal with the impact of the incident.

The panel also notes that during the hearing, the worker disclosed that the 2016 accident occurred at the beginning of her employment with the employer. She stated that the accident occurred on the second day of her second rotation in that position and that prior to the worker's employment with the employer, she had never worked in the air flight transportation industry. It is the panel's positon that the worker's relative inexperience with the types of situation noted above would have reasonably contributed to her symptomology.

The Worker Incident Report describes the December 31, 2017 accidents follows:

We were in our crew truck, small Tacoma pick up truck. We were t-boned by another pick up truck

The panel accepts that the 2017 accident may not, in itself, be the primary cause of the worker's ongoing symptomology, but that the event contributed to her overall presentation and diagnosis of PTSD as described by the treating psychologist.

The panel also notes that there is information in the worker's file regarding two other incidents that occurred while she was working. There is a document that was submitted by the worker on August 23, 2018 that describes the two other incidents as follows:

Winter of 2016 Freezing cold night flying from [remote community] to Winnipeg, aft of aircraft me [worker's job title] infant patient, Auntie as guardian/caretaker, Social Services representative. On approach to Richardson International Airport I briefly heard the PIC (pilot in command) speaking to the tower indicating our brakes were frozen, we may need help, there was more talk between PIC and tower that I was not aware of as I was tending to my patient, on decent (sic) patient's guardian asks 'why are all of the emergency vehicles at the runway, are we going to crash?' I responded 'NO' that's not for us…as it turns out yes it was for us. We landed, with a bump - which brought back a sinking feeling in my stomach-flash back to plane crash of Fall 2016, plane veered left we came to a stop perpendicular to runway emergency vehicles all around us- a small bus like vehicle came to pick us up as our aircraft's brakes were not functioning. As trained, I smiled took care of my patient and care givers, shook this off- continued to do my job.

Fall of 2017, Dusk flying into remote airstrip to pick up sick patient, on approach both [co-worker] and I looked at each other as we felt the approach felt fast, approach missed, then steep climb, banking right, no feedback from cockpit, I turned around to look out cockpit window- what I saw frightened me, from my vantage point it looked as though the aircraft was at a 90 degree angle pointing at the ground, we were closed (sic) enough to the ground I could make out structures on the ground, knowing we travel at approximately 250 miles an hour, it seemed to me that we were about to hit the ground and crash, I looked at [co-worker] indicated we needed to brace for impact, smiled feeling like we were about to die, we were holding hands, I braced my legs on the cabinet in front of me, closed my eyes and prepared to crash. We hit the ground hard- at approximately 2G's, the PIC indicated the ceiling panels are designed to release at that force, which they had fallen on us. [Co-worker] and I opened our eyes trying to figure out if we were dead. For a few minutes we were stunned, we thought we were dead and couldn't figure out what was going on. We were brought back to reality when the PIC asked if we were ok- as always we answered yes, dusted ourselves off and went to get our patient. Obviously we found it hard to concentrated (sic), we were stunned, I felt nauseated, the events seems unreal, nothing made sense. Our driver was waiting for us, we asked the driver for 'a few minutes' he drove off to the nursing station where our patient was waiting for us- we did as we are trained to do- take care of our patient- put our fears/feeling on the back burner.

When specifically asked by the panel, the employer's representatives at the hearing did not deny that these two incidences occurred.

While the two incidences in the winter of 2016 and the fall of 2017 were not before the panel as part of either the 2016 or 2017 claims, they are referenced in the medical opinions provided by the worker's treating psychological provider. In particular they are referenced in the May 4, 2018 correspondence submitted to the WCB by the worker's treating psychologist in response to a question posed as whether the worker developed her psychological condition as a result of the December 31, 2017 workplace incident, the response was "Yes, her psychological condition of PTSD developed as a direct result of the accident of December 31, 2017. I understand that she was also involved in previous traumatic incidents while working for the same company."

On July 25, 2018 the worker's psychologist submitted a further progress report where the psychologist provided further information regarding the October 11, 2016 workplace incident. In that report she stated "On October 20, 2016, I observed that [the worker] was shaken up and distressed by the October 11, 2016 workplace accident." In the same report the worker's treating psychologist also describes the 2017 MVA as well as the two other workplace incidents involving the landing with the frozen brakes and the steep/hard landing incidents. Although she noted in that report that the October 11, 2016 workplace accident was qualifying criterion of a traumatic event for a diagnosis of PTSD.

With respect to the 2016 claim, when asked by the WCB to confirm a psychological diagnosis, the WCB psychological advisor provided the following opinion dated December 26, 2018:

The claimant has been diagnosed by her psychologist as having PTSD associated with the initial triggering event from October 2016, and exacerbated by 2 other distressing aircraft incidents that had occurred subsequently that the claimant had spoken to as well in her documentation received August 23, 2018 that outlined her report of having PTSD and associated mood symptomologies

It is the panel's understanding that medical conditions such as PTSD can develop as a result of a single traumatic event or be the result of a number of events that occur within a timeline, and although any one individual event may not result in PTSD developing, the cumulative impact of the multiple events can result in such a condition developing. Further, within this situation where there are four identified events, but only two of them have been adjudicated as compensable injuries, the panel must determine whether the compensable injuries have substantively caused the worker's PTSD. In this instance the panel is able to make that finding given that the two compensable injuries identified were the first and the last events.

During the hearing, the employer's representative submitted that the panel should place weight on the WCB psychological consultant's comments that were outlined in a file note dated February 21, 2019 in which it was noted that the WCB psychological consultant advised that "…it is hard to make a connection between [the worker's] current presentation and the 2016 CI (aborted plane takeoffs (sic))." In response to this opinion, the panel takes the view that this opinion was provided in February 2019, and was made in the context of the worker's current symptoms, As such, the panel places little weight on this opinion in relation to the worker's medical condition, and any resulting entitlement to benefits after July 24, 2018, which is the issue before the panel.

The panel accepts, based on the available medical information, that the worker's two workplace accidents significantly contributed to her PTSD.

The issue of the presumptive legislation was raised at the hearing. Given that the panel has determined that the information on file clearly links the worker's two compensable injuries as contributing factors to her PTSD, there is no reason to apply the presumption criteria in this instance.

The worker's diagnosis of PTSD is acceptable, and her appeal is allowed.

Issue 2: Whether or not the worker is entitled to further wage loss and medical aid benefits after July 24, 2018.

Given the panel's above noted decision that the worker's diagnosis of Post-Traumatic Stress Disorder is acceptable as being a consequence of the 2016 and 2017 accidents, and that part of that decision was based on medical reporting from the worker's treating psychologist, including a report dated July 25, 2018 that confirmed the worker was still actively being treated for her PTSD, the panel accepts that the worker would not have been able to return to pre-accident employment on July 25, 2018 and, as a result, she would be entitled to ongoing WCB benefits including wage loss benefits.

The panel notes that both the employer and the worker made submissions regarding the appropriateness of workplace accommodations that were discussed between the parties in the fall of 2018 and onwards. However, it is the panel's view that the correct issue to be determined is whether the worker is entitled to further wage loss and medical aid benefits after July 24, 2018.

With respect to the issue of duration of benefits beyond July 24, 2018 as well as the appropriateness of any proposed workplace accommodations after July 24, 2018 the panel refers the matters back to WCB for further adjudication.

Based on the foregoing, the worker's appeal is allowed.

Panel Members

B. Hartley, Presiding Officer
P. Challoner, Commissioner
M. Kernaghan, Commissioner

Recording Secretary, J. Lee

B. Hartley - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 18th day of March, 2020