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Jul 18, 2019

Minnesota High Court Explains PTSD Evidentiary Requirements

Minn. Stat. § 176.011, subd. 15(d) (2018), which requires the employee to prove that the employee has been diagnosed with post-traumatic stress disorder (PTSD) by a licensed psychologist or psychiatrist and that the diagnosing professional use the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in making the diagnosis, does not require a compensation judge to conduct an independent assessment to verify that the diagnosis was indeed in conformity with the DSM before accepting the expert’s diagnosis, held the Supreme Court of Minnesota yesterday, in Smith v. Carver County, 2019 Minn. LEXIS 381 (June 17, 2019). Based upon that holding, the Court reversed a decision by the state’s Workers’ Compensation Court of Appeals that in turn had reversed and remanded a compensation judge’s determination that a former deputy sheriff had failed to establish his PTSD claim related to numerous traumatic events that he experienced while working. As with the case in other disputes involving medical expert opinions, the judge is entitled to weigh the evidence and make his or her findings.

Background

Smith, a former deputy sheriff for Carver County, sought workers’ compensation benefits for PTSD, which he claimed resulted from numerous traumatic incidents that he experienced while working. The County denied responsibility. Two licensed psychologists assessed Smith—one diagnosed Smith with PTSD; the other did not. The compensation judge found the psychologist who did not diagnose Smith with PTSD to be more persuasive, adopted that psychologist’s report, and dismissed Smith’s claim petition.

The Workers’ Compensation Court of Appeals (WCCA) reversed. The WCCA determined, inter alia, that a 2013 amendment to the law required that a compensation judge conduct an independent assessment to verify that the diagnosis of a psychologist or psychiatrist conformed to the PTSD criteria in the current version of the DSM-5, commonly known as DSM-5, before accepting the expert’s diagnosis.

The 2013 Amendment

Coverage under the Workers’ Compensation Act was expanded in 2013 to allow injured workers to recover workers’ compensation benefits for a “mental impairment” (see Minn. Stat. § 176.011, subd. 16), defined as “a diagnosis of post-traumatic stress disorder by a licensed psychiatrist or psychologist,” id., subd. 15(d). Prior to the amendment, Minnesota did not allow recovery of benefits for so-called “mental-mental” injuries, including PTSD (see Larson’s Workers’ Compensation Law, § 56.04, et seq.).

The Supreme Court indicated that the language of the section, after the amendment, was straightforward. For an employee to recover workers’ compensation benefits for PTSD arising out of and in the course of employment, the employee must prove that a psychiatrist or psychologist has diagnosed him or her with PTSD and that the professional based the employee’s diagnosis on the latest version of the DSM.

Conflicting Medical Evidence

The Court noted that neither Smith nor the County suggested that the statutory language prevented an employer from submitting a diagnosis from a psychiatrist or psychologist based on the latest version of the DSM that contradicted the diagnosis of the employee’s medical professional. In that circumstance, the Court said, as in every other workers’ compensation case where the parties submit competing medical diagnoses, the job of the compensation judge was to determine whether the expert diagnoses had adequate foundation and, if both had adequate foundation, decide which of the professional diagnoses was more credible and persuasive. The Court stressed that, as a general rule, the WCCA must affirm a compensation judge’s choice between two expert opinions unless the facts assumed by the expert in rendering his or her opinion were not supported by the evidence.

WCCA’s Opinion Went Way Too Far

The Court explained that the WCCA’s opinion would require the compensation judge to go far beyond determining whether the medical professional had an adequate foundation for diagnosing a worker with (or without) PTSD under the DSM-5.

Instead, under the WCCA’s approach, the compensation judge must lay each expert’s report on the desk next to the DSM-5 and assess whether the medical professional’s opinion conformed with the precise wording of the DSM-5 as the compensation judge interprets those words [Opinion, p. 11].

The Court said that, as Smith had acknowledged at oral argument, the WCCA opinion tells compensation judges to independently read and apply the DSM-5 in accordance with the canons of construction as if it were an administrative rule or regulation. Yet nothing in the language of Minn. Stat. § 176.011, subds. 15(a), (d), 16, even remotely suggested that such an exercise was required. In short, the WCCA opinion substituted a compensation judge’s legalistic analysis of the DSM-5 for the professional judgment of psychiatrists and psychologists. According to the Court, Minn. Stat. § 176.011, subd. 15(d), did nothing more than require that a diagnosis of PTSD in a workers’ compensation case be done by a licensed psychiatrist or psychologist based on the latest version of the DSM.

Weighing the Evidence

Turning to the compensation judge’s decision that the County’s expert’s diagnosis was more persuasive than that offered by Smith’s expert, the Court reminding the parties that the WCCA must affirm the judge’s findings unless they are clearly erroneous and unsupported by substantial evidence in view of the entire record as submitted. A compensation judge may rely on an expert opinion if it has an adequate factual foundation.

After carefully reviewing the record, including the depositions and medical opinions of the two physicians, the Court concluded that the County’s expert’s opinion was based on enough facts, formed a reasonable opinion, and thus was not based on speculation or conjecture. The physician **reviewed Smith’s medical history, conducted an in-person evaluation and interview, and then produced a detailed report summarizing his findings, evaluation, and diagnosis. The doctor was also deposed and rigorously cross-examined by counsel. The Court added that critically, the doctor had based his diagnosis on the DSM-5 criteria for PTSD. Accordingly, the Court concluded that the County’s expert’s opinion included the facts and data upon which he relied in forming his opinion, explained the basis for his opinion, and did not assume facts that were not supported by the evidence. The WCCA erred in overriding the compensation judge’s choice of medical expert testimony.