The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker appealed the Workers Compensation Board ("WCB") decision that they are not entitled to wage loss benefits from January 9, 2021 to April 21, 2021. On October 5, 2022, a hearing took place by videoconference to consider the worker's appeal.

Issue

Whether or not the worker is entitled to wage loss benefits from January 9, 2021 to April 21, 2021.

Decision

The worker is entitled to wage loss benefits from January 9, 2021 to April 21, 2021.

Background

The worker provided a Worker Incident Report to the WCB on February 17, 2021 reporting they sustained a psychological injury at work, diagnosed on January 25, 2021 as post-traumatic stress disorder (“PTSD”).

On February 24, 2021, the worker advised the WCB that they were receiving inpatient treatment for substance abuse and before that treatment had been placed in a detoxification unit. The worker advised the WCB that their substance abuse was a means to cope with their PTSD which they related to incident arising out of their employment. The worker described their symptoms and provided information on their exposure to specific traumatic incidents. The worker noted that they discussed the substance abuse issue with their supervisors or coworkers but had not discussed their traumatic experiences.

The Discharge Summary for the worker’s admission to the detoxification unit outlined that the worker was admitted on January 22, 2021 and discharged on January 30, 2021. During that admission, the worker received a diagnosis of “PTSD with unspecified anxiety disorder” and alcohol use disorder and was referred to a rehabilitation treatment facility.

The Employer’s Accident Report provided to the WCB on March 24, 2021 indicated the worker reported to their manager that they had developed work-related PTSD but did not indicate any specific incident at work. The worker’s supervisor advised the WCB on April 7, 2021 that when the worker initially went off work, they advised the supervisor they had a substance abuse issue and were seeking treatment. The supervisor confirmed they were aware the worker had past substance abuse issues and offered support but that the worker had not made any prior complaint regarding psychological issues related to their experience of traumatic events. The supervisor confirmed there was not a specific incident at the time the worker went off work.

On April 14, 2021, the worker advised the WCB they were discharged from the treatment program and returned home but had to quarantine until April 21, 2021. The WCB received the Discharge Summary from the treatment facility on April 20, 2021. That report confirmed the worker’s participation in the program and that they were diagnosed with severe alcohol use disorder concurrent with PTSD.

The WCB referred the worker to a psychologist, who provided a report to the WCB on May 28, 2021 outlining the worker’s description of traumatic events at work that the worker witnessed. The psychologist concluded the criteria for a diagnosis of PTSD and substance use disorder, in early remission, were met, and further, that the worker’s PTSD was not related to a pre-existing condition but was a direct result of exposures to trauma in the course of their work.

A WCB psychological consultant reviewed the worker's file on June 29, 2021 and concluded that substance use disorder was a “…concurrent diagnosis not materially related to the PTSD diagnosis” as the worker’s substance use began before they started working for the employer and they reported a history of such use dating back a number of years. The WCB psychological consultant also noted the worker reported a history of anxiety and depression with nightmares and intrusive ideation stemming from a severe motor vehicle accident in 2009. The consultant stated that while substance use disorder occurs in a higher frequency in people with trauma symptoms or PTSD, a causal relationship between the disorder and PTSD cannot be established and noted that “…those with alcohol use issues are more likely to experience trauma symptoms and/or PTSD, and alcohol use issues may tend to perpetuate and enhance PTSD symptoms.”

On July 6, 2021, the WCB advised the worker their claim for PTSD was accepted and they were entitled to wage loss benefits as of April 22, 2021, but that their prior time loss related to the concurrent diagnosis of alcohol use disorder, which the WCB determined to be unrelated to the compensable diagnosis.

On August 2, 2021, the worker requested Review Office reconsider the WCB’s decision noting they were involved in numerous traumatic events while working, with a lack of support offered by the employer after the events and as a result, found themselves “…turning to alcohol in order to suppress the constant reliving of these traumatic” events. Review Office determined on September 15, 2021 that the worker was not entitled to wage loss benefits from January 9, 2021 to April 21, 2021.

The worker’s representative filed an appeal with the Appeal Commission on April 5, 2022 and a videoconference hearing took place. Following the hearing, the appeal panel requested additional medical information prior to discussing the case further. On May 8, 2025, the appeal panel met again to render a decision on the appeal.

Reasons

Applicable Legislation and Policy

The Appeal Commission and its panels are bound by the provisions of The Workers Compensation Act (the “Act”), regulations under the Act and the policies established by the WCB's Board of Directors. The provisions of the Act in force on the date of accident are applicable to this claim.

A worker is entitled to compensation under s 4(1) of the Act when it is established that they sustained personal injury because of an accident at work. Under s 4(2), a worker injured in an accident is entitled to wage loss benefits for their loss of earning capacity resulting from the accident.

The WCB established WCB Policy 44.10.20.10, Pre-existing Conditions (the "Pre-Existing Policy"), to address eligibility for compensation in circumstances where a worker has a pre-existing condition. The Policy defines a pre-existing condition as any medical condition the worker had prior to their workplace injury, which may contribute to the severity of a workplace injury or significantly prolong a worker's recovery. Workplace injuries can impact pre-existing conditions. A temporary worsening of a worker’s pre-existing condition is considered an aggravation of the pre-existing condition and a permanent worsening of the worker’s condition because of an injury is an enhancement of the pre-existing condition.

Worker’s Position

The worker appeared in the hearing represented by a worker advisor, who made an oral submission in support of the worker’s appeal and relied on additional evidence provided in advance of the hearing.

The worker’s position is that they are entitled to wage loss benefits from January 9, 2021 to April 21, 2021. The worker submits the evidence supports a finding that the worker developed both PTSD and alcohol use disorder arising out of their exposure to traumatic incidents in the course of their work, and that as the worker was receiving treatment in relation to those diagnoses during the period in question, their loss of earning capacity arose out of the compensable workplace accident and they should therefore be entitled to wage loss benefits.

The worker submits that the WCB incorrectly determined that their alcohol use disorder was a pre-existing condition unrelated to the compensable workplace injury and takes the position that they turned to alcohol as a coping mechanism to deal with the symptoms of their PTSD. However, even if the evidence supports a finding that the worker’s alcohol use disorder is a pre-existing condition, the evidence supports a further finding that this condition was aggravated or enhanced by the worker’s subsequent exposures to trauma, and as such, is a compensable condition.

Employer’s Position

The employer was represented in the appeal by an advocate who provided an oral submission outlining the employer’s position that the worker is not entitled to wage loss benefits from January 9, 2021 to April 21, 2021.

The employer’s advocate submitted that the evidence confirms that the worker’s absence from work during the period in question is the result of their alcohol use disorder, which the WCB correctly determined does not relate to the compensable injury but is a pre-existing and non-compensable condition. Further, the advocate noted that the worker’s period of quarantine upon returning to Manitoba from the out-of-province addiction treatment program is unrelated to the compensable injury and as such, the worker also is not entitled to wage loss during that period. Therefore, the employer submits that the worker’s appeal should be denied.

Analysis

The question the panel must answer in this appeal is whether the worker is entitled to wage loss benefits for the period from January 9, 2021, the last day that they worked before the claim was initiated and April 21, 2021, when the worker had returned to Manitoba from their residential treatment program and completed a period of mandatory quarantine. For the worker’s appeal to succeed the panel would have to find that the worker’s loss of earning capacity in this period resulted from and was causally related to the compensable workplace injury. As outlined in the reasons that follow, the panel was able to make such a finding and therefore the worker’s appeal is granted.

The panel noted that the WCB accepted the worker’s claim of a psychological injury incurred as a result of multiple exposures to traumatic events arising out of and in the course of their employment. While the initial treatment providers indicated that the worker’s PTSD arose out of a non-compensable motor vehicle accident in 2009, the WCB accepted that the worker’s diagnosis related to their workplace exposures to a number of traumatic incidents beginning in the summer of 2016 and following. The panel accepts and relies upon these findings in determining this appeal.

The evidence indicates that the diagnosis of PTSD was made concurrently with a diagnosis of alcohol use disorder, and general anxiety disorder. The WCB determined that the worker’s alcohol use disorder is not a compensable condition, and this is the finding that the worker disputes as it resulted in the denial of wage loss benefits during the period when the worker sought treatment in relation to their alcohol use. The panel therefore focused on determining the nature of the relationship between the worker’s alcohol use disorder, their diagnosis of PTSD and their workplace exposures to trauma.

In reviewing the evidence, the panel considered the WCB psychological consultant’s August 9, 2022 opinion that the initial diagnosis for the worker was “claim-related…PTSD and a concurrent and non-compensable diagnosis of an Alcohol Use Disorder”. The WCB psychological consultant concluded that the worker’s Alcohol Use Disorder is a pre-existing condition, based on the history provided by the worker, as detailed in the detoxification unit chart notes from January 2021, indicating a longstanding personal history of alcohol use. Another WCB psychological advisor provided their opinion on June 29, 2021 that the worker’s alcohol use disorder is “not materially related to the PTSD diagnosis” as the worker had “issues with alcohol well before” they started working with the employer in 2016 and as “…the etiology of the substance use disorder is complex and cannot be directly attributed to PTSD, that is, in a causative manner.”

The treating psychologist, however, offered a different conclusion in their November 3, 2022 report, provided in response to the request of the panel, stating that the worker developed alcohol use disorder:

“…as a direct consequence of the traumatic incidents [the worker] was exposed to at work. The incidence of alcohol or drug problems is two to four times more likely in individuals diagnosed with PTSD. The relationship may be bidirectional, but in [the worker’s] case I believe [their] use of alcohol was significantly exacerbated by [their] exposure to trauma.”

The psychologist further noted the worker’s lack of positive and effective coping strategies and stated the worker “…did not have any idea of what to do with the emotions, intrusive memories, and flashbacks [they were] experiencing, and [they] found alcohol helped [them] avoid symptoms….” In an earlier report to the worker advisor, dated March 12, 2022, the treating psychologist noted that the worker turned to alcohol to cope with their distress arising out of the effects of the trauma experienced in their work, and that:

“Over time, alcohol use worsened and [the worker] became suicidal. There is a high rate of comorbidity in individuals diagnosed with PTSD, and [alcohol use disorder] is a common comorbidity. There is evidence that trauma may be related to the development of [alcohol use disorder], although some suggest that those that have pre-existing difficulties with alcohol may be at higher risk of exposure to traumatic situations. …I am of the opinion, that in [the worker’s] case, the effects of the traumas [they were] exposed to overwhelmed [their] coping capabilities and that [their] increased use of alcohol can be related to [their] PTSD diagnosis.”

The panel noted the worker maintained their position throughout this claim that their diagnosed alcohol use disorder is related to their PTSD. On initial contact with the WCB in February 2021, the worker described using alcohol to cope for approximately 4 years, indicating on days off, they consumed 35 oz. of vodka daily. In their August 2021 submission to Review Office, the worker stated that after witnessing numerous “horrific incidents”, they found themselves “turning to alcohol in order to suppress the constant reliving of these traumatic calls.” The worker described that in the residential treatment program they attended beginning in late January 2021, they learned “coping skills and how not to turn to alcohol when dealing with trauma.” The panel noted that the worker acknowledged drinking alcohol, even to intoxication, before obtaining this employment, but stated that the “severity and frequency dramatically changed after…April 2016” when they began this employment.

The panel also considered that the chart notes from detoxification unit admission in January 2021 indicate the worker initially reported a history of anxiety and depression in addition to concerns with their alcohol overuse, and that after a psychiatric assessment on January 26, 2021, the worker was diagnosed with PTSD and unspecified anxiety disorder, as well as alcohol use disorder. The April 11, 2025 report from the medical director of that program, provided at the request of the panel, indicates that the worker “…used alcohol to cope with the negative emotions related to [their] diagnosis of PTSD, with [their] alcohol use becoming problematic shortly after the traumatic episode, approximately 10 years prior to this admission.” Further we note the program director’s comment that “This is a common occurrence, with substance use and substance use disorders worsening related to past experiences of trauma.”

The panel also noted that the worker attended a Concurrent Trauma and Addictions program from February 3, 2021 through April 6, 2021. The Discharge Report from that program indicates that the worker’s treatment goals included learning to deal with their trauma, learning better coping skills, and learning how to stay sober and that by May 2021, the worker’s alcohol use disorder was described by the treating psychologist as being in early remission.

The panel is satisfied that the evidence supports a finding that the worker increased their use of alcohol as a result of their exposure to traumatic incidents in the workplace. As such, we are satisfied that the evidence supports a finding that the worker’s alcohol use disorder and PTSD could have developed concurrently. As noted by the WCB psychological consultant in their June 29, 2021 report, “…those with alcohol use issues are more likely to experience trauma symptoms and/or PTSD, and alcohol use issues may tend to perpetuate and enhance PTSD symptoms.” While it is unclear based on the evidence whether the workplace trauma exposures caused the worker’s alcohol use disorder or the alcohol use disorder is a pre-existing condition that perpetuated and enhanced the worker’s PTSD symptoms, the panel is satisfied that the worker’s repeated exposure to trauma in the course of their work resulted in the worker increasingly relying upon and using alcohol as a means by which to cope with the increasingly intrusive trauma effects they were experiencing. This led to the diagnoses in late January 2021 of concurrent PTSD and alcohol use disorder.

The evidence in relation to the worker’s loss of earning capacity confirms that the worker was diagnosed with PTSD in late January 2021, and the WCB psychological advisor confirmed in their August 2022 opinion that this was a compensable diagnosis as of January 8, 2021. While the worker continued working until January 8, 2021, soon thereafter, they could no longer do so, and on January 22, 2021, the worker sought treatment in a detoxification unit. The panel noted that while the worker initially sought treatment related to their alcohol use, it was because of that treatment that they were first assessed by a psychiatrist who diagnosed PTSD, unspecified anxiety disorder, and alcohol use disorder. The panel finds that the worker’s PTSD did not manifest on their admission to the detoxification program, or on the date diagnosed, but was already present and symptomatic, prior to that date. The treating psychologist addressed the question of the worker’s ability to continue with their pre-accident job duties in their May 28, 2021 report to the WCB. In that report, the psychologist outlined their opinion that the worker was unable to return to their pre-accident job duties due to their PTSD symptoms, although there had been some improvement in those symptoms since January 2021 when the worker entered treatment. The panel accepts and relies on this opinion, and further, finds that it is more likely than not that if the worker’s symptoms were worse when they sought treatment in January 2021 than they were in May 2021, then the worker also would not have been capable of continuing their job duties at that time due to those symptoms.

Based on the evidence before the panel and on the standard of a balance of probabilities, we are satisfied that the worker is entitled to wage loss benefits between January 8, 2021 and April 21, 2021 as they sustained a loss of earning capacity during that period due to injuries sustained arising out of and in the course of their employment. The worker’s appeal is therefore granted.

Panel Members

K. Dyck, Presiding Officer
J. Peterson, Commissioner
M. Kernaghan, Commissioner

Recording Secretary, J. Lee

K. Dyck - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 16th day of May, 2025