Noting that a medical opinion need not be expressed with absolute medical certainty as long as it signified a probability of the underlying cause that was supported by a rational basis and was not based upon a general expression of possibility, a New York appellate court reversed a decision by the state’s Workers’ Compensation Board that had denied benefits related to a PTSD claim filed by a firefighter who testified to having been subjected to multiple “horrific” work-related emergency situations and who was diagnosed by his treating psychologist has have work-related PTSD [Matter of Reith v. City of Albany, 2021 N.Y. App. Div. LEXIS 7199 (3d Dept., Dec. 23, 2021). The board had broad discretion, but it could not ignore uncontradicted medical opinion.
Claimant, who had a long career as a firefighter, filed a claim for workers’ compensation benefits in 2018, alleging that he suffered PTSD brought on by “countless horrific, work-related emergency situations” that he had encountered during his long career. Following a hearing, a WCLJ established the claim for work-related PTSD and authorized medical treatment. Upon administrative review, the Board disallowed the claim, finding that the 2017 amendment to N.Y. Workers’ Comp. Law § 10(3) did not apply and, further, that claimant’s medical proof was insufficient to establish that he sustained a causally-related psychological injury. Claimant appealed to Appellate Division and additionally sought reconsideration and/or full Board review.
The 2017 Amendment to § 10(3)
Prior to the enactment of N.Y. Workers’ Comp. Law § 10(3)(b) in April 2017, a claimant seeking to recover for a psychological injury was required to demonstrate that the stress that caused the claimed mental injury was greater than that which other similarly situated workers experienced in the normal work environment. The statutory amendment, however, effectively removed that hurdle for certain first responders by providing that where a firefighter (or other qualified responder) files a claim for mental injury premised upon extraordinary work-related stress incurred in a work-related emergency, the Board may not disallow the claim, upon a factual finding that the stress was not greater than that which usually occurs in the normal work environment. That is to say that the objective standard in § 10(3) does not apply to qualified first responders after the 2017 amendment.
Traumatic Incidents During 26-Year Career
During the hearing, claimant explained that he had witnessed several traumatic incidents during his nearly 26-year career as a firefighter, including a suicide, a triple homicide of children, car accidents with fatalities and individuals who had been “dead for days stuck to the floor.” He also recounted spraining his ankle after he slipped on brain matter while rendering aid to a victim, experiencing CPR regurgitation while attempting to resuscitate a fellow firefighter, and dragging a woman out of a fire, which resulted in de-gloving her.
Claimant began experiencing PTSD symptoms in January 2018, prompting him to seek professional treatment. His medical professional indicated he had experienced “anxiety of a clinically significant magnitude,” and that he had been subjected to extraordinary work-related stress.
The appellate court said the question distilled to whether claimant satisfied his burden of demonstrating a causal relationship between his employment and his documented PTSD diagnosis. The court noted that the requisite medical opinion evidence need not be expressed with absolute or reasonable medical certainty. It did, however, need to “signify a probability of the underlying cause that is supported by a rational basis and not be based upon a general expression of possibility” [Opinion, p. 4].
The court said the medical opinion evidence preferred by claimant satisfied this burden. According to the appellate court, the Board reasoned that the medical evidence lacked specificity as to the particular events alleged to have caused claimant’s PTSD. The court, however, found that critique unwarranted. It indicated that the nature of each incident was understandably traumatic, obviating the need for further graphic detail. The Board’s conclusion that claimant’s treating psychologist failed to provide a “rational basis” for his opinion because he failed to “sufficiently describe those traumatic experiences” failed to duly account for the psychologist’s and claimant’s actual testimony, said the court. While the Board was certainly authorized to weigh the medical evidence, it could not reject outright uncontroverted medical testimony as to causation. Finding the Board’s decision not supported by substantial evidence, the appellate court reversed the decision and remanded the case for further proceedings not inconsistent with the court’s opinion.