GQ Corner

Q. Claimant sustained a work injury which resulted in a
fractured lower extremity. She underwent surgery, and suffered a stroke while coming out of anesthesia. Since the stroke she has been diagnosed with adjustment disorder, acute stress reaction, and symptoms of depression and anxiety.

Are these compensable diagnoses?

A. The first question is whether or not claimant has received a diagnosis of an actual psychological disease or disorder (AP 091367).  Adjustment disorder and acute stress reaction certainly meet that standard.  “Symptoms of anxiety and depression” on their own most likely do not, just as pain is a mere symptom and not in itself proof of an injury. However, there are depression-related diagnoses such as acute depressive disorder that would meet this standard.

The next question is whether you have evidence of a causal link, within reasonable medical probability, between the compensable injury and the psychological disease or disorder. The AP has long held that injuries or diseases arising from medical treatment for the compensable injury can themselves be compensable, provided there is proof of a causal relationship. AP 032594, citing AP 93672 and 93855.

In AP 010321, as an example, the claimant sustained a lumbar injury on April 28, 1997. The injury was followed by low back surgery on July 28, 1997. The claimant testified that his pain did not improve. When his treating physician told him that he may never improve, the claimant indicated that he became overwhelmed and attempted suicide. The claimant’s treating surgeon suggested that the claimant’s depression was the result of the injury and subsequent need for surgery.  The RME doctor indicated in his reports that the claimant’s depression resulted from his pain and his fear that he could never return to his prior occupation. A peer review stated that the claimant’s depression “is clearly precipitated by that injury and subsequent impairment of functioning”.  In finding the claimant’s depression compensable, the AP held “the full consequences of the original injury together with the effects of the treatment upon the general health and body of the worker are to be considered.”

Finally, the AP has also held that “the fact that there may be more than one cause of the Claimant’s depression does not preclude a finding of compensability, provided there is a causal link between the compensable injury and the depression”. AP 030056.