Worker’s Post-Traumatic Stress Disorder Was Compensable

Takeaway: The Minnesota Supreme Court’s affirmation that post-traumatic stress disorder (PTSD) is compensable under workers’ compensation laws reinforces the need to pay attention to mental health in the workplace.

The Minnesota Supreme Court affirmed that an employee had work-related post-traumatic stress disorder compensable under workers’ compensation laws.

A county social worker reported a work-related injury involving exposure to details of a murder committed by one of her clients. A compensation judge determined that she had compensable post-traumatic stress disorder; the Workers’ Compensation Court of Appeals (WCCA) affirmed. The county sought reversal on the ground that the social worker did not meet the criteria for PTSD listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Because the WCCA’s affirmance of the compensation judge’s PTSD finding was not manifestly contrary to the evidence, the Minnesota Supreme Court affirmed.

The social worker was a case manager with six years’ tenure in an adult mental health unit that served people with a history of mental illness who had trouble functioning in society. She was not on the team that served people who were both mentally ill and dangerous, nor had she received specialized training for that type of role. Nevertheless, she was assigned a client who, while under her care, brutally murdered his girlfriend.

When informed of the details of the murder, the social worker experienced physical and behavioral symptoms including tunnel vision, difficulty sleeping, irritability, and nightmares. Five days after learning of the murder, she reported experiencing a work-related mental health injury. Initially, the county accepted liability and paid a variety of benefits.

The social worker was evaluated and treated by a psychiatrist. After some months on leave, she returned to work but soon became unable to perform her job and missed many workdays. Nearly a year after the murder, the treating psychiatrist diagnosed her with PTSD using DSM criteria. He recommended she remain off work for several more months.

Multiple evaluations ensued.

At the county’s request, the social worker underwent extensive interviewing and psychological testing by a licensed psychologist. Without mentioning DSM criteria, that clinician determined that she had PTSD and was psychologically unable to perform her job.

At the request of the county and its workers’ compensation insurer, a licensed psychiatrist—supported by a clinical psychologist’s assessment—concluded that the social worker’s condition was consistent with her history of anxiety, depression, and attention deficit/hyperactivity disorder, and likely the result of burnout rather than work-related PTSD. The psychiatrist expressly concluded that the social worker did not meet the DSM criteria for PTSD because she had not been exposed to actual or threatened death, serious injury, or sexual violence. At that point, the county discontinued benefits and the social worker filed a claim objecting.

On her own initiative, the social worker underwent another psychological examination by a licensed psychologist, who diagnosed her with PTSD. He found that her symptoms met DSM criteria because they stemmed from work-related exposure to details of the murder

PTSD is a compensable “occupational disease” under Minnesota law. Specifically, PTSD is understood to mean the condition as described in the most recently published edition of the DSM. The compensation judge found the opinions that diagnosed PTSD to be more credible than the ones that did not. Consequently, the judge found that the social worker had sustained a work-related psychological injury consisting of PTSD. The WCCA affirmed that decision. On the county’s appeal, the question was whether the WCCA’s affirmance of the compensation judge’s finding of work-related PTSD was manifestly contrary to the evidence.

When medical professionals provide competing diagnoses, the compensation judge must determine 1) whether the expert diagnoses have adequate foundation, and 2) if both diagnoses have adequate foundation, which of the diagnoses is more credible and persuasive.

In this case, it was undisputed that both diagnoses had adequate foundation, and the compensation judge determined that the PTSD diagnosis was more persuasive. The PTSD diagnosis relied heavily on clinical testing, but the contrary opinion failed even to address the possibility of PTSD. Moreover, the latter concluded that the social worker could not have PTSD because she did not directly experience a traumatic event. “[T]he judge made a choice based on all the evidence before him,” the state high court said. “Because this choice does not clearly require a contrary conclusion, the WCCA’s affirmance of the compensation judge’s finding is not manifestly contrary to the evidence.”

In a prior case, the Minnesota Supreme Court reversed a WCCA decision that would have required compensation judges to read and apply the DSM as if it were an administrative rule or regulation. “Compensation judges are required to make credibility determinations and analyze the persuasiveness of the expert reports in all cases before them,” the court said in that case. “But those judges are applying the law—not diagnosing patients.” The court upheld its precedent and concluded that the WCCA did not err when refusing to alter the factual findings of the compensation judge.

Tea v. Ramsey County, Minn. No. A23-1207 (April 17, 2024).

Margaret M. Clark, J.D., SHRM-SCP, is a freelance writer in Arlington, Va.