Court Says PTSD Diagnosis Need Not Go Strictly By The Book

Continuing our focus this week on critical developments in Workers’ Compensation, the Minnesota Supreme Court has just resolved a significant uncertainty in the award of comp benefits for Post-Traumatic Stress Disorder (PTSD).

Chadd Smith was a deputy sheriff for the Carver County Sheriff’s Office.  After witnessing his share of homicides, suicides, grisly motor vehicle accidents, shootings, and assaults (sometimes involving people he knew), Smith resigned from his job in July 2016.

The PTSD Diagnosis

Shortly thereafter Smith was evaluated by a licensed psychologist who diagnosed him with PTSD, following the criteria set forth in the latest (fifth) edition of the “Diagnostic and Statistical Manual of Mental Disorders” (“DSM-5”).  Smith then filed a claim for workers compensation benefits but the claim was denied after the independent medical examination (IME) requested by the County and its insurer concluded that Smith did not suffer from PTSD.  The IME provider utilized various testing mechanisms to conclude that Smith did not meet the DSM-5 definition of PTSD.

In response to the denial, Smith initiated a legal claim seeking benefits but the workers’ compensation judge ruled against him, finding the independent medical examiner’s opinion more persuasive than that of Smith’s treating physician.

Smith appealed to the Workers’ Compensation Court of Appeals (WCCA), who reversed.  The WCCA explained that the Minnesota Workers’ Compensation statute sets forth two very specific requirements for a PTSD claim: (1) the diagnosis must be made by a licensed psychologist or psychiatrist; and (2) the diagnosis must be consistent with PTSD “as described in the most recently published edition of the diagnostic and statistical manual of mental disorders by the American Psychiatric Association.”  The WCCA interpreted this to mean that the doctor’s diagnosis must specifically address the eight articulated factors in the DSM-5, and that the compensation judge must then independently evaluate whether the doctor correctly applied those factors.  The compensation judge can rely on an expert opinion that differs from that of the treating care provider but only if the expert also specifically follows the DSM-5’s enumerated criteria.

In this instance, since the independent medical exam did not specifically conform to the eight diagnostic criteria in the DSM-5, the compensation judge should not have relied upon it to counter the conclusions of Smith’s actual health care provider.  They therefore reversed the compensation judge’s decision and ruled in Smith’s favor.

The DSM-5 is a Guideline, Not a Checklist

It was now the County’s turn to appeal and they did so to the Minnesota Supreme Court, who reversed the WCCA and ruled in favor of the County.  In so doing, they explained that the DSM-5 criteria are a guide for trained health care professionals to use in applying their medical training and judgement to a complex mental health assessment. The criteria were not intended to permit judges to apply legalistic analysis to what should be a medical issue.

Indeed, the statutory requirement that PTSD be diagnosed by a medical professional indicates that the legislature did not want lawyers, judges and juries to substitute their judgements for that of competent medical practitioners.  Instead, the decision maker in the legal proceeding should stick to the determination of whether the medical practitioner had a legitimate basis for the diagnosis and, in the case of competing opinions, whether one diagnosis is more persuasive than the other.

Therefore, since the IME did follow the DSM-5 but simply used different evaluative tools to do it was proper for the compensation judge to rely on IME report despite the absence of a point-by-point assessment of the DSM’s eight PTSD factors.

Bottom Line

This decision returns decisions on PTSD to where they belong – in the hands of the medical professional rather than a workers’ compensation judge.  The judge should merely perform the traditional task of reviewing or analyzing experts’ reports to evaluate their credibility, factual foundation and persuasiveness.