- Post-traumatic stress disorder
- Board Directives and Guidelines (stress, mental) (traumatic event)
- Generalized anxiety disorder
The worker claimed entitlement for Traumatic Mental Stress (TMS). The worker had been employed by the employer, a municipal government, as a client service worker for about 19 years. She worked at a shelter for homeless people. After witnessing the aftermath of a client's assault on a co-worker, the worker was diagnosed with generalized anxiety disorder with depressive features and Post-Traumatic Stress Disorder (PTSD).
The Panel allowed the appeal. The Panel accepted that the worker was exposed to three clearly identifiable and objectively traumatic events leading to her diagnoses.OPM Document No. 15-03-02, "Traumatic Mental Stress," sets out the provisions regarding the nature of the stress that must be experienced in order for a worker to qualify for entitlement for a traumatic mental stress condition. The examples provided in this policy imply first hand exposure to a traumatic event. However, for a diagnosis of PTSD, the Diagnostic and Statistical Manual of Mental Disorders (DSM) requires a medical professional to assess the causation of the condition in making the diagnosis. "First hand" exposure must be read in light of the DSM diagnostic criteria of PTSD that is a result of any of the circumstances medically considered as traumatic under the DSM-5, Part A criteria for PTSD (see Decision No. 1780/22). Injuring events are not required to be similar in nature to the events listed in the policy in order to be considered "objectively traumatic" (see Decision No. 1741/21). The policy also states that entitlement for TMS may be granted due to the cumulative effect of multiple traumatic events.With respect to the first incident, a snake (boa constrictor) escaped from a bag that had been brought into the shelter by a client. Traps containing dead mice were placed in various locations throughout the shelter, including under the worker's desk. The snake remained on the loose for about two weeks before finally being discovered. The worker testified that she experienced extreme anxiety working at the shelter while the snake was on the loose. She was afraid that it could appear at any moment from underneath her desk or in a washroom. Although the worker never actually saw the snake during the two weeks that it was on the loose, the Panel accepted her testimony on how this situation affected her. This was an objectively traumatic situation. The fact that the snake was someone's pet was not evidence that the snake was not dangerous or not a real threat to the health and safety of the worker. In the next incident, the worker was threatened with physical assault by a client at a bus stop. The incident was preceded by the client being highly disrespectful and verbally abusive toward her near the end of her shift. The Panel found that this incident was objectively traumatic. The worker was the object of a threat of physical violence and she believed the threat to be serious and harmful to herself. In the next incident, the worker witnessed a co-worker bleeding from the face and screaming after being assaulted by a client. The worker testified that she was afraid the client might come back into the shelter. The Panel found this incident to be objectively traumatic. Although the worker was not the object of the assault and was not an eye witness to the assault, she saw first hand the immediate aftermath of the assault and resultant facial bleeding and hysterical state of her co-worker. In the Panel's view, these facts of the 3rd incident were analogous to and resembling the WSIB's policy example of, "being the object of threats of physical violence where the worker believes the threats are serious and harmful to self or others." The Panel was satisfied that the worker heard and saw part of the events in question, notably, the resultant bleeding, traumatized co-worker, and heard her screams directly. Although it was not the most traumatic incident experienced by the worker, the incident on October 17, 2018, resulted in the worker seeking medical attention for her anxiety, depression and PTSD. The TMS policy expressly states that entitlement is available for injured workers who experience a "final reaction to a series of traumatic events."