The Minnesota Supreme Court issued a decision on July 17, 2019, concluding that Minnesota Statutes require an employee to prove he or she has been diagnosed with PTSD by a licensed psychologist or psychiatrist in accordance with the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in making a diagnosis. It further found the Workers’ Compensation Court of Appeals (WCCA) erred in reversing the compensation judge’s choice between competing medical experts in a situation where the expert opinion adopted by the compensation judge had adequate foundation.
In Smith v. Carver County, the employee was a former deputy sheriff who witnessed what the Supreme Court described as “numerous situations involving death and injury…” with two of the more significant events occurring in 2007 and 2012. In 2014, one medical professional diagnosed the employee with PTSD, whereas several others diagnosed the employee with other mental conditions, but not PTSD.
One month after his resignation in 2016, the employee was evaluated by Dr. Michael Keller, a licensed psychologist, who took a history and administered several diagnostic tests, ultimately diagnosing the employee with PTSD under the DSM-5. Dr. Paul Arbisi, also a licensed psychologist, evaluated the employee at the request of the employer and insurer and concluded the employee did not have PTSD.
Following a hearing on the matter, the compensation judge adopted the opinion of Dr. Arbisi, finding Dr. Arbisi’s opinions more persuasive than those of Dr. Keller. The WCCA reversed the compensation judge’s decision, describing the governing statute (Minn. Stat. § 176.011, subd. 15(d)) as “unique” and concluding that “a determination of whether a claim for PTSD must go beyond the weighing and choosing between competing expert medical opinions.” The WCCA held that compensation judges must apply the statute to determine whether the employee met his or her burden of proof to establish a compensable claim of PTSD and may rely on expert medical opinion, “so long as the opinion is consistent with the requirements contained in the statute,” i.e., DSM-5. In its analysis, the WCCA found Dr. Arbisi’s opinion was improper because it did not explicitly conform to the PTSD criteria in DSM-5.
The Supreme Court reversed the WCCA’s decision, noting that the language of Minn. Stat. § 176.011 is plain and straightforward. The Court further remarked that in cases of competing medical diagnoses, the job of the compensation judge is to determine whether the expert diagnoses have adequate foundation, and, if both opinions have adequate foundation, decide which professional diagnosis is more credible and persuasive (as in any other workers’ compensation case). Citing the language in the DSM-5 manual limiting the diagnostic criteria to use by trained clinicians, the Court succinctly stated that the DSM is a guideline for medical and health professionals, not a checklist for judges.
In reaching its decision, the Supreme Court carefully reviewed the record, including the depositions and medical opinions of Drs. Keller and Arbisi, and found Dr. Arbisi’s opinion had proper foundation, and, as such, the WCCA erred by overriding the compensation judge’s choice.
This case serves as a reminder that the compensation judge has wide discretion to choose among competing medical opinions so long as such opinions are adequately founded, again reiterating the importance of providing proper foundation to medical experts when litigating a claim.