Highlights of Noteworthy Decisions

Decision 1835 21
R. Salisbury
  • Health care (vehicle modification)
  • Health care (support dog)

On November 1, 2014, the worker, who slipped on some ice in the store parking lot and fell, striking his head, neck, upper and lower back, bilateral shoulders, right elbow, left wrist and hand. The worker was granted a non-economic loss (NEL) award of 53 percent for his neck and spinal cord injury with compressive cervical myelopathy, his major depressive disorder and post-traumatic stress, somatic symptom disorder with predominant pain. This award was combined with a prior NEL award in a different claim; therefore, the worker's total whole person impairment was 68 percent.

In this appeal the worker was seeking health care benefits in the purchase of a vehicle, and acquiring a support dog.
There was no Board policy that directly speaks to an entitlement to health care benefits for the purchase of a vehicle. Decision 198/13, allowed a 40% reimbursement benefit for the worker in that case was addressed with reliance on OPM Document No. 11-01-03 "Merits and Justice." A 40% reimbursement was directed in that case on the basis of a finding of exceptional circumstances in the acquisition costs of a much larger vehicle over and above what a regular-sized replacement vehicle might cost.
The Vice-Chair found in this appeal it had not been established that in the absence of a policy that provides entitlement to health care benefits for the purchase of a vehicle to transport a necessary mobility scooter, that the worker's situation was exceptional and warranted application of Board policy on the merits and justice. Neither the WSIA nor Board policy provided for the purchase of a vehicle as a health care benefit. In this case, while it may have been possible for the worker to have used a trailer to tow his mobility scooter behind his existing vehicle, it was asserted that this was not the best practice, and might not be practicable during the winter months. While a different and larger vehicle is arguably more practical than the modification option as provided for by Board policy, the worker's circumstances in this regard were not exceptional and therefore did not warrant the application of the merits and justice. The health care in the form of a vehicle was denied.
With respect to health care in the form of a service dog, the applicable policy is OPM Document No. 17-06-04, "Guide and Support Dogs". The applicable version of this policy is dated February 15, 2013 and provides that a service dog must both be necessary to enhance the worker's independent living and quality of life and be recommended by the worker's health care professional.
There was medical opinion on file that the worked used the service dog to self-regulate and to be able to access and hold negative emotions to communicate in the session. The dog had been extremely valuable to his experience and ability to stay present in sometimes very difficult sessions.The health care in the form of a service dog was allowed.
The appeal was allowed in part.