Minnesota Supreme Court Interprets Amendment to the Minnesota Workers' Compensation Act for Claims of PTSD
In Smith v. Carver County, 931 N.W.2d 390 (Minn. 2019), the Minnesota Supreme Court considered whether a compensation judge's decision to deny benefits to a claimant was based on appropriate assessment under the state's amended workers' compensation law.
Facts of the Case
Chadd Smith worked as a deputy sheriff in Carver County, Minnesota, for almost ten years. Prior to his employment, he had never been diagnosed with posttraumatic stress disorder (PTSD), and was mentally and physically cleared for duty by a preemployment examination. In the course of his duties, he was exposed to several scenes of death and violence. These included responding to the suicide death of a high school classmate, helping recover a corpse that had been crushed by heavy construction machinery, and responding to a car fire where a passenger trapped inside was unable to be saved. Among the traumatic events that Mr. Smith witnessed, he identified two as particularly distressing: providing aid to a car accident victim who died on the scene, and responding to the choking death of an infant and later attending the infant's autopsy.
Mr. Smith began experiencing insomnia, night terrors, and digestive symptoms. He was evaluated by multiple professionals who diagnosed him with a variety of mental ailments. One professional diagnosed PTSD in 2014. Mr. Smith resigned from his position in June 2016. In July 2016, Mr. Smith was evaluated by Dr. Michael Keller, a licensed psychologist. Dr. Keller observed Mr. Smith to be tense, anxious, tearful, and hyper-vigilant. Dr. Keller's interview, chart review, and psychological testing led him to diagnose PTSD, major depression, and anxiety disorder in Mr. Smith.
Mr. Smith submitted a claim for workers' compensation based on his diagnosis of PTSD. Carver County requested an independent evaluation which was conducted by licensed psychologist, Dr. Paul Arbisi. Dr. Arbisi elicited symptoms including hypervigilance, mood swings, and insomnia. Based on his evaluation, he diagnosed somatic symptom disorder and adjustment disorder in Mr. Smith, but not PTSD. The compensation judge ruled that Dr. Arbisi's report, which failed to make a diagnosis of PTSD, was the more persuasive of the two. He denied benefits to Mr. Smith, as PTSD was the only psychological diagnosis eligible for benefits under the authoritative statute, Minn. Stat. § 176.001-.862 (2018).
Mr. Smith appealed to the Workers' Comp-ensation Court of Appeals (WCCA). The WCCA noted that the applicable statute requires any psychiatric or psychological diagnosis to be based on the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The WCCA said that the statute requires a compensation judge to not merely gauge the persuasiveness of a medical expert's opinion, but ensure that psychiatric or psychological diagnoses are based on DSM criteria.
The WCCA held that the compensation judge's decision to adopt Dr. Arbisi's opinion was improper because the judge did not explicitly determine whether Dr. Arbisi's opinion conformed to DSM-5 criteria. The WCCA reversed the compensation judge's decision in part, vacated in part, and remanded the case to the lower court. Carver County appealed to the Minnesota Supreme Court.
Ruling and Reasoning
The Supreme Court of Minnesota reviewed the workers' compensation statute de novo. The state's workers' compensation statute had been amended in 2013 to allow compensation for injured workers on the basis of a “mental impairment,” specifically a diagnosis of PTSD (Minn. Stat. § 176.011, subd. 15(d) (2018)). Prior to this amendment, psychological or psychiatric conditions were not eligible for compensation. The WCCA had determined that the language of the statute required a compensation judge to ensure that any diagnosis offered by a licensed psychologist or psychiatrist conformed to the latest DSM criteria. The court disagreed and reinstated the compensation judge's decision. To interpret the statute, the court sought to establish the Minnesota legislature's intent when this amendment was passed.
The court reviewed the established role of compensation judges in assessing medical opinions, namely determining whether those opinions have “adequate foundation” or were, in other words, supported by the evidence. The court noted that in cases of competing expert opinions, assuming the judge finds that both have adequate foundation, the compensation judge rules based on the persuasiveness and credibility of the opinions. The court opined that the WCCA cannot reverse a compensation judge's decision unless it determines that an expert opinion accepted by the judge was “not supported by the evidence” (Smith, p 396).
The court determined that the Minnesota legislature did not intend to change the scope of a com-pensation judge's decision-making with its 2013 amendment. It stated that the WCCA's interpretation of the statute would require a compensation judge to “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” (Smith, p 397).
The court ruled that, instead, interpretation of clinical data and clinical decision-making should be deferred to licensed psychiatrists and psychologists when diagnosing PTSD. The court further highlighted disclaimers within the DSM-5 itself that it is to be used as a guide exclusively for clinical and research experts and argued that it is “not a checklist for judges” (Smith, p 398). The court therefore concluded that it would be outside of a judge's purview to disagree with a psychologist or psychiatrist about whether a diagnosis is based on the latest DSM criteria.
The court subsequently reviewed the opinions and depositions provided by Drs. Keller and Arbisi. The court determined that Dr. Arbisi relied on DSM-5 criteria to form his medical opinion and failed to find that Dr. Arbisi's diagnosis was “clearly erroneous.” The court therefore concluded that the WCCA had no standing to reverse the compensation judge's ruling.
Discussion
In Smith, the Minnesota Supreme Court's opinion clarified the role of a compensation judge in legal proceedings in confirming an adequate factual basis of clinical opinions and ruling based solely on credibility and persuasiveness. The decision also underscores that clinical interpretation and decision-making fall within the domain of mental health experts, not judges.
The Minnesota legislature's 2013 amendment allowing for workers' compensation to PTSD diagnoses in employees will provide relief for those who meet the applicable diagnostic criteria. Prior to this amendment, mental disabilities were not eligible for workers' compensation. While adopting PTSD as a compensable illness is laudable, this case highlights residual imperfections in the state's workers' compensation law. For instance, in their evaluations, both Drs. Keller and Arbisi found that Mr. Smith was indeed experiencing disabling symptoms, including insomnia and emotional distress. But because Dr. Arbisi did not consider these symptoms to be consistent with the specific diagnosis of PTSD, Mr. Smith was determined to be ineligible for benefits.
In its ruling, the Minnesota Supreme Court highlighted the complexities of providing a psychiatric diagnosis. It further acknowledged that competing diagnoses submitted by opposing experts could each have an adequate foundation. Yet, under the current workers' compensation act in Minnesota, only a diagnosis of PTSD is eligible. Eligibility based merely on diagnosis rather than disability therefore introduces an arbitrary threshold that can be further addressed by the Minnesota legislature.
- © 2020 American Academy of Psychiatry and the Law
