WSIAT Decision Search

• Consequences of injury (secondary condition)
• Health care (medical aid) (drugs)
• Pensions (assessment) (chronic pain)

No Summary Available

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• Health care (attendance allowance)
• Health care (clothing allowance)

The worker was granted entitlement for a 34% Non-Economic Loss (NEL) award for reflex sympathetic dystrophy (RSD) of the right leg. The worker also received a 35% NEL award for post-traumatic stress disorder (PTSD) that combined with the right lower extremity rating to yield a whole person rating of 53%. The worker appealed the October 8, 2024 ARO decision which denied entitlement to a Personal Care Allowance (PCA) and a Clothing Allowance.

The Panel denied the appeal.

WSIB Policy 17-06-05 states that workers with permanent impairments and at least 60% NEL awards may be entitled to a PCA for assistance with activities of daily living (ADL). The worker's need for assistance was assessed through home visits and ADL scales. Occupational Therapists' reports in 2007 and 2010 observed that the worker was largely independent in personal care activities, such as bathing, dressing, grooming, and mobility, with no significant evidence supporting the need for skilled, personal, or general attendant care.

The worker testified to daily assistance from family members for ADLs and child care, but the Panel found no corroborating evidence, and noted the worker's documented memory difficulties, thus placing limited weight on this testimony. The Panel also clarified that PCA benefits are intended for the injured worker's own care, not for care of children or other non-injured parties.

WSIB Policy 17-07-03 allows clothing allowances only for damage caused by approved medical devices worn for at least one year after recieving a permanent impairment or disability award. Ankle Foot Orthotics (AFOs) are explicitly excluded from clothing allowance entitlement. The worker's claim for clothing allowance due to damage from an AFO was denied as the policy excludes AFOs. Claims related to a knee brace and low back brace were also denied due to lack of evidence of clothing damage caused by these devices.

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• Loss of earnings {LOE} (employability)
• Permanent impairment {NEL} (degree of impairment) (psychotraumatic disability)
• Suitable occupation
• Work transition plan (adequacy of program)

No Summary Available

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• Loss of earnings {LOE} (employability)
• Permanent impairment {NEL}
• Psychotraumatic disability

No Summary Available

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• Loss of earnings {LOE} (eligibility) (impairment)

The employer appealed an ARO decision granting the worker full LOE benefits from October 15, 2021, to July 26, 2022, and continuing to age 65, following a traumatic mental stress injury sustained in 2014 while working as a paramedic. The worker was diagnosed with PTSD and Major Depressive Disorder and had been on full LOE benefits since 2015 without returning to work.

The Panel denied the appeal.

The worker testified that symptoms from PTSD and depression prevented any employment, citing anxiety, memory issues, and inability to handle driving or public interaction. Volunteer work was limited and accommodated to avoid social interaction. The worker remained cooperative with return-to-work efforts but was unsuccessful.

Reports from treating professionals, including a psychologist and psychotherapist, consistently indicated severe symptoms and functional impairments preventing return to work. Restrictions included part-time hours only, avoidance of customer service roles, and gradual return. Later reports confirmed poor prognosis and inability to perform any gainful employment.

The Vaccine Courier position offered was deemed unsuitable by the worker's therapists due to trauma triggers and symptom severity. The Panel found no evidence of a bona fide part-time work offer within the worker's medical restrictions.

The Panel did not accept that the worker's daily living activities or prior vocational assessment demonstrated capacity for employment. The worsening of symptoms after 2020 and absence of suitable work offers undermined the employer's position that the worker was capable of work. Volunteer activities were viewed as therapeutic rather than indicative of work capacity.

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• Board Directives and Guidelines (stress, mental) (traumatic event)

The worker witnessed multiple traumatic events while employed as a paramedic between 1983 and 1998. As a result of the COVID-19 pandemic, the worker's workload increased significantly and remained elevated throughout 2020 and 2021. On January 15, 2021, the worker had a mental health crisis. The issue for determination was whether the worker was entitled to benefits for Traumatic Mental Stress (TMS).

The Vice-Chair allowed the appeal.

The significant 23-year delay in the onset of PTSD symptoms and diagnosis of the condition did not constitute a bar to entitlement because the evidence supported a causal link between the workplace traumatic events and the diagnosed PTSD condition. Emotional disturbances during the intervening years and the absence of other trauma or mental health history supported this conclusion.

A report by an independent psychiatrist, Dr. Chandrasena, indicated that: "delayed onset PTSD", defined as PTSD with symptoms appearing more than six months after the exposure to trauma, may occur many years later. The report also referenced a study which notes that individuals with a higher level of education, such as the worker, were more likely to have delayed onset PTSD rather than early onset PTSD.

The COVID-19 and workload related stressors which triggered the delayed onset PTSD were not the cause of the worker's PTSD. The event which triggered the onset of the worker's mental health crisis in 2021 was not, itself, a traumatic event as per WSIB policy. However, this was not a bar to entitlement. The distinction was analogized to a situation of a worker who develops an allergy to a chemical as a result of exposures at work; when the allergy is subsequently triggered outside of the workplace, it is nonetheless compensable.

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• Aggravation (preexisting condition) (psychotraumatic disability)
• Loss of earnings {LOE} (employability)
• Permanent impairment {NEL} (degree of impairment) (psychotraumatic disability)
• Post-traumatic stress disorder

No Summary Available

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• Loss of earnings {LOE} (eligibility) (impairment)
• Suitable employment (suitable for worker's capabilities)

No Summary Available

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• Loss of earnings {LOE} (employability)
• Loss of earnings {LOE} (level of benefits) (hours of work)
• Procedure (alternative dispute resolution) (early intervention)

No Summary Available

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• Strains and sprains (ankle)

The worker appealed a December 27, 2023 ARO decision denying entitlement for a left ankle injury sustained on February 8, 2023. The worker claimed to have twisted his left ankle on a rocky embankment while working, resulting in a fall. Initially, he thought it was a sprain and continued working, but later required surgery after worsening symptoms.

The Panel allowed the appeal.

A pre-accident MRI showed a split tendon tear, but the worker's surgery in August 2023 revealed new, more severe tears including a complete tear of the peroneal longus tendon and ligament tears, attributed to the workplace accident.

The Panel found the worker's testimony credible, consistent, and aligned with medical and documentary evidence, despite the absence of witnesses and initial delay in reporting the injury to the WSIB. The Panel concluded that the worker sustained a work-related left ankle injury on February 8, 2023, establishing proof of accident and compatibility of diagnosis under Policy 11-01-01 and the five-point check system.

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