On February 7, 2009, this tow-truck driver employee was assisting a stranded motorist when a passing truck veered toward him. Employee tried to jump onto the bed of the tow-truck but the oncoming truck's mirror hit his right hand as it passed at highway speed, causing him to twist his torso. Diagnostic studies suggested employee sustained no internal physical injuries, but employee continued to complain of extreme pain, sleep interruption, cognitive problems and memory loss, and a dramatic tremor in his right hand, none of which the doctors could explain. Employer's authorized treating physician Dr. Corsolini suspected a psychiatric component to employee's problems, but before a neuropsychiatric evaluation could be accomplished, employer's insurer sent employee for a functional capacity evaluation, where he failed the validity criteria. Employer then denied any further authorized treatment without looking into the question of psychiatric injury. Employee subsequently underwent extensive unauthorized treatment for his pain complaints, symptoms such as a hand tremor and right leg sensory deficit, and also for post-traumatic stress disorder (PTSD). The primary issue before us is whether the accident caused PTSD. The parties present conflicting testimony from several doctors.
Employee presents Drs. Swaim, Pro, Stuckmeyer, and the psychologist Suzanne McKenna, each of whom opined employee developed PTSD as a result of the accident. Employer's psychologist Dale Halfaker also opined employee possibly has PTSD. On the other hand, employer presents Dr. Hughes, who opined employee is a "fraud" who "made up" his PTSD symptoms.
The ALJ credited Dr. Hughes's theory that employee did not sustain PTSD as a result of the accident because PTSD symptoms are supposed to appear within an hour to two weeks after trauma, and employee's symptoms didn't emerge until months later. But this theory ignores the fact employee was complaining about sleep disturbance (one of the primary symptoms of PTSD) in his initial treatments with Dr. Corsolini following the accident, and continued to do so until he received treatment on his own for PTSD. And Dr. Hughes agreed on cross-examination that the DSM-IV¹ states PTSD symptoms can
¹ Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Dr. Hughes agreed this is the authoritative text for classification/description of psychiatric disorders.
Improve: Timothy Pearson
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occur months or years after trauma. When asked to explain, in light of this admission, why he believed employee's symptoms should have appeared immediately, Dr. Hughes opined that delayed onset cases are usually the result of more intense traumas like childhood sex abuse or military service. This testimony suggests Dr. Hughes believes the accident just wasn't serious or traumatic enough, even though employee was exposed to the imminent threat of catastrophic injury or death when he narrowly avoided a direct bodily impact from the speeding truck. We note that Dr. Hughes also failed to recognize that Dr. Kukal treated employee for PTSD, and that these treatments helped resolve his symptoms.
After careful consideration of all the expert medical testimony on the issue, we disagree with the administrative law judge that Dr. Hughes is more credible than the other doctors. Throughout his report and testimony, Dr. Hughes digressed from the purely medical issue presented and ventured into personal attacks on employee. For example, Dr. Hughes dismissed employee's symptoms as "bogus," mocked employee's religious beliefs, and even went so far as to recommend employee be investigated for insurance fraud. By way of comparison, Dr. Corsolini, when asked about comments in his treatment notes indicating employee was lapsing into a disabled role, testified: "I don't claim to read people's minds. It's just a way of trying to describe what I see. Now, lapsing into the disabled role is again not necessarily someone [sic] does on purpose. It's a lot more complicated than that." Faced with a complicated issue of medical causation, we find no assistance in Dr. Hughes's glib take on employee's psychiatric complaints.
We find more credible Drs. Swaim, Stuckmeyer, and Pro on the issue whether employee developed PTSD as a result of the accident. Employee testified that his treatment for PTSD resulted in an excellent recovery, but Dr. Pro opined that employee will remain more susceptible to PTSD as a result of the accident. In light of these factors, we find that employee's permanent disability referable to PTSD amounts to a 17.5% permanent partial psychiatric disability of the body as a whole.
There remains the issue of employee's pseudo-seizures, inexplicable hand tremor, and right leg sensory deficit with foot drop. None of employee's experts were able to credibly testify that these symptoms were associated with PTSD or otherwise linked to the accident. Dr. Swaim acknowledged that he could not state that the accident was the prevailing factor causing employee to suffer seizures or foot drop. Dr. Pro testified that "at least to a certain extent" the "trajectory of the problem would suggest" that the accident caused employee to suffer some seizures, but also testified that we don't really know what caused them. To the extent Dr. Pro opined that employee's seizures, tremors, and foot drop were caused by the work injury, we find his testimony lacking credibility.
**Conclusions of Law**
**Medical causation of PTSD**
Section 287.020.3(1) RSMo sets forth the standard for medical causation applicable to this claim and provides, as follows:
An injury by accident is compensable only if the accident was the prevailing factor in causing both the resulting medical condition and