The Minnesota Supreme Court issued a significant ruling on what evidence a compensation judge must consider and what analysis a compensation judge should employ when determining a valid claim for work-related post-traumatic stress disorder ("PTSD"). In Smith v. Carver County, File No. A19-0199 (July 17, 2019), the Minnesota Supreme Court ruled that a PTSD claim under Minn. Stat. § 176.011, subd. 15(d) requires a diagnosis of PTSD by a licensed psychiatrist or psychologist based on the latest version of the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association ("DSM"). The most recent version currently is referred to as DSM-5. In a case of first impression, the Supreme Court ruled that the statute does not require the compensation judge to "conduct an independent assessment to verify that the diagnosis of a psychologist or psychiatrist conforms to the PTSD criteria set forth in the DSM before accepting the expert's diagnosis."
The employee, Mr. Chadd Smith, was employed by Carver County Sheriff's Office as a deputy sheriff for almost ten years. Mr. Smith had never been diagnosed with PTSD prior to his employment with the sheriff's office. During his ten years on the job, Mr. Smith witnessed a number of incidents including, death by homicide and suicide, serious injury, motor vehicle accidents, shootings, and assaults, some of which involved people he knew or familial situations that were similar to his own. Mr. Smith resigned from his job with the sheriff's office in July 2016. A month later, Mr. Smith was evaluated by a licensed psychologist, Dr. Michael Keller. Dr. Keller administered several diagnostic tests and diagnosed Mr. Smith with PTSD pursuant to the DSM-5 criteria. Mr. Smith filed a workers' compensation claim and sought benefits related to his PTSD diagnosis. At the request of Carver County Sheriff's Office, Mr. Smith was then evaluated by Dr. Paul Arbisi, a licensed psychologist, on May 11, 2017. Dr. Arbisi evaluated Mr. Smith using the CAPS-5 and MMPI-2 tests and ultimately concluded that Mr. Smith did not have PTSD under the DSM-5 criteria.
The case went to a Hearing before Compensation Judge Kelly, who found Dr. Arbisi's opinion more persuasive than Dr. Keller's. The Workers' Compensation Court of Appeals ("WCCA") reversed, consistent with its prior cases strictly interpreting Minn. Stat. § 176.011, subd. 15(d). In those prior cases, the WCCA stated that the employee carries the burden to demonstrate that each of the eight criteria found in the DSM addressing PTSD are met. Here, the WCCA found that Minn. Stat. § 176.011, subd. 15(d) is "unique" and interpreted it as meaning that the doctor's opinions and the judge's decision should follow the requirements of the statute and the DSM-5 criteria. In other words, the WCCA found that compensation judges "may rely on an expert opinion, so long as the opinion is consistent with the requirements contained in the statute." Since the WCCA found that Dr. Arbisi's opinion did not comply with the statutory requirements and his opinion was not in strict compliance with the DSM-5 criteria for a PTSD diagnosis, the WCCA reversed.
The Minnesota Supreme Court (Justice Thissen writing for the majority) reversed the decision of the WCCA, upholding Compensation Judge Kelly's determination. The Court criticized the WCCA's opinion and stated that "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," and that the WCCA opinion "substitutes a compensation judge's legalistic analysis of the DSM-5 for the professional judgment of psychiatrists and psychologists." The Court also found that the WCCA ignores language in the DSM-5 stating that its primary purpose is to "assist trained physicians in the diagnosis" of patients, and that the criteria does "not constitute comprehensive definitions of underlying disorders." Instead, the Court found that the DSM should be used as "a guideline for medical and health professionals, not a checklist for judges." For these reasons, the Court found that it was appropriate for Dr. Arbisi to use instruments, such as the CAPS-5 and the MMPI-2, to apply the DSM-5 criteria and it was proper for the compensation judge to rely on Dr. Arbisi's opinion. The Court instead analyzed the compensation judge's reliance on Dr. Arbisi's opinion under the Nord standard, which is used in any other case where the judge must choose between conflicting expert opinions. This standard is that "the judge's choice between experts must be upheld unless the facts assumed by the expert in rendering his or her opinion are not supported by the evidence." The Smith Court found that the compensation judge properly relied on Dr. Arbisi's opinion, which was supported by adequate factual findings, and reversed the WCCA.
The WCCA has been strictly interpreting the statute allowing for PTSD claims. The Minnesota Supreme Court's decision walks back this trend. The decision could lead to an increase in the PTSD claims. Although the employer and insurer prevailed in Smith, the Court’s holding will allow employees to assert a viable PTSD claim without an opinion that strictly follows and satisfies the precise criteria set forth in the DSM-5. Employees will still need a PTSD diagnosis from a licensed psychiatrist or psychologist that the expert asserts is based on latest version of the DSM. For employers and insurers, medical experts should still be asked to address all of the DSM-5 criteria in detail in determining a PTSD diagnosis. Employers and insurers can still argue that an expert opinion that does not address the DSM-5 criteria with specificity lacks adequate foundation. In this regard, the Supreme Court indicated in a footnote that "nothing in our decision prevents a compensation judge from performing the traditional task of reviewing or analyzing an expert's report in order to evaluate the expert's credibility, factual foundation, or other aspects relevant to a compensation judge’s assessment of an expert's report and conclusions." However, it does appear to be the case that an expert opinion that does not address all of the DSM-5 criteria, or relies on other testing or analysis as well, can still be relied on by a compensation judge under the Smith decision.