Opinion ID: 1542320
Heading Depth: 3
Heading Rank: 2

Heading: Porter and Landesberg.

Text: This court first considered application of the objective test to a psychological injury claim springing from a physical workplace accident, as opposed to one arising from gradual workplace stress, in Porter, supra, 625 A.2d at 886. In Porter, the petitioner was injured when a gurney struck her while she performed duties as a nursing assistant at George Washington University Hospital. Id. at 888. The petitioner contended that she suffered a disability due to post-traumatic stress disorder and that the disability was traceable to the gurney incident; her board-certified psychiatrist supported this theory at her hearing. Id. In response, her employer relied on testimony from another board-certified psychiatrist who opined that the petitioner's severe depression was linked not to the gurney incident, but stemmed from a preexisting hysterical/hypochondriacal personality disorder marked by cyclothymic features. Id. The Hearing Examiner credited the latter testimony and found that the disability stemmed from a preexisting mental condition; the Director affirmed. Id. On review, this court considered whether the administrative adjudicators applied a standard consistent with the Act, and concluded that they did. The court first reviewed McEvily, and noted that in that case, both the Hearing Examiner and Director implicitly approved the test for causation reflected in the [testifying] psychiatrist's evaluation. . . . `[the psychiatrist] could not find any incident, experience, or ongoing occurrence that represented a significant stressor that would have affected anyone who was not so predisposed [to the depressive reaction]. He concluded that there could be no reasonable assessment of job-related stress, because the nature of that stress was highly subjective to petitioner.' Porter, supra, 625 A.2d at 888 (quoting McEvily, supra, 500 A.2d at 1022) (emphasis in Porter ). Next, the court reviewed Spartin, and confirmed that this court adopted the Dailey objective test. Notably, the court quoted the following passage from Spartin: `an employee predisposed to psychic injury could recover if he is exposed to work conditions so stressful that a normal employee might have suffered similar injury. Thus, an employee with a predisposition to mental illness is not precluded from recovering under Dailey. ' Porter, supra, 625 A.2d at 889 (quoting Spartin, supra, 584 A.2d at 570) (emphasis in Porter ). The court reaffirmed that Dailey fit within the modern trend of compensating emotional injury caused by job stress, regardless of predisposition, but that the test `is objective: it focuses on whether the stresses of the job were so great that they could have caused harm to an average worker. ' Porter, supra, 625 A.2d at 889 (quoting Spartin, supra, 584 A.2d at 569) (emphasis in Porter ). Thus, to this point in the Porter decision, the court merely reaffirmed Spartin's adoption of the Dailey test which itself is a conflation of an objective test focused purely on stressors within the workplace environment with one that takes into account a particular employee's predisposition to a certain injury. According to the court, the hearing examiner found that the petitioner's condition was not causally related to her work injuries, but was related solely to her preexisting disability. Porter, supra, 625 A.2d at 889. The Director affirmed that it was not work-related because no `specific, articulable source' rooted in the job, no `concrete non-personal stressors' had been identified as its cause. Id. (quoting Director) (emphasis in Porter ). The court interpreted these conclusions: [b]oth the examiner and the Director concluded, in other words, that the gurney accident would not have caused a person lacking petitioner's subjective, pre-existing personality disorder to suffer the disability she now experienced. Id. [16] With this as background, the court stated, [a]s in Spartin, we perceive no reason here why the agency's application of an objective causal test to petitioner's claim of emotional injury is inconsistent with the Workers' Compensation Act. Id. Moreover, the court in Porter went on to expand Dailey to cover physical-mental claims as well: Nor is it decisive that petitioner, unlike the claimant in Spartin, cites a specific job-related accident as the cause of her disorder rather than less easily identified conditions of stress in the employment. Whatever the triggering event or condition, the Director may properly apply a rule for causation in this difficult area of emotional injury that discourages spurious claimsone focusing on [1] the objective conditions of the job and [2] their effect on the `normal employee' not predisposed to the injury by a mental disorder. Porter, supra, 625 A.2d at 889 (brackets and emphasis added). The court cites no additional authority for this expansion. Clearly, the court seems to defer to the Director to interpret the Act reasonably in such a way that discourages spurious claims for compensation. However, this expansion reveals the flaw in the Dailey test that becomes particularly heightened in the context of physical-mental claims. In such cases, the physical accident supplies the objective conditions of the job far more clearly than a general allegation of gradual workplace stress, which almost necessarily develops over time. But the Director's concern with the difficulties of proving workplace causation in the case of persons predisposed to mental injury may not displace the protections of the Act. More precisely, neither the Director nor this court may interpret the Act in such a way that prevents those with preexisting conditions from establishing that they are entitled to compensation as to do so would ignore the aggravation rule and be inconsistent with a humanitarian act whose principal purpose is to compensate employees for injuries they prove to be work-related. See Spartin, supra, 584 A.2d at 570 ([A]n employee with a predisposition to mental illness is not precluded from recovering under Dailey. Only when so interpreted is the Dailey standard compatible with the Workers' Compensation Act.). In Dailey, the reason the Director rejected the aggravation of a pre-existing injury argument was because claimant failed to prove legal causationthe examiner did not credit her psychiatrists' testimony that her emotional injury was related to her work conditions. [17] The reason that the objective test was required was because of the inability to pinpoint something different about the work environment or conditions of that job. In the context of physical-mental disabilities, the physical accident is the unexpected occurrence supplying the necessary (and objective) workplace connection. Thus, in cases of physical injury, so long as the claimant proffers competent medical evidence connecting the mental disability to the physical accident (legal causation), the claimant has either established a prima facie case of aggravation or a new injury. That being the case, the objective test is simply unnecessary. Put another way, the pure objective test is always met in physical-mental cases, provided that the claimant proves the connection between the mental condition and the physical accident. Following Porter, this court has continued to apply the Dailey standard to physical mental claims. In Landesberg, the court affirmed the Director and hearing examiner's denial of benefits to an employee who claimed she developed post-traumatic stress disorder following a work-place accident involving the closing of Metro bus doors based on findings that (1) the claimant was predisposed to psychological problems, and (2) per a psychiatrist's opinion, the conditions causing the emotional injury were not so stressful that a reasonable person not predisposed to psychological injury might suffer the same injury. 794 A.2d at 613-14. Relying on Porter, the court noted, psychological injuries are only compensable under the Act if the accident constitutes a sufficient stressor. Id. at 614 (citing Porter, supra, 625 A.2d at 889). The division in McCamey followed Porter and Landesberg: [W]e have held that the statute reaches the aggravation of an employee's physical condition resulting from work-place injuries. But in light of Porter and Landesberg, as well as McEvily and other authorities cited in Porter, Ms. McCamey's position, though ably and conscientiously presented, founders upon our precedents, and it cannot prevail unless those precedents are overruled by the court sitting en banc. McCamey, supra, 886 A.2d at 548 (emphasis in original). We are now presented with that opportunity. In light of the humanitarian nature of the statute, we hold, in cases involving physical-mental claims, that the objective test is inconsistent with the statute's principal purpose of compensating employees who prove a connection between a disability and their work. Accordingly, its use must be overturned. Further, just as the aggravation rule in purely physical claims stems from the general principle that an employer must take an employee as it finds him or her, so too should the aggravation rule apply in physical-mental claims without requiring the employee to point to a hypothetical third personan additional, heightened burden that is necessarily speculative and unnecessary within the context of physical-mental claims where the work-related cause is distinct. Alternatively, if the psychological injury is tied not to the work-related accident, but rather a physical injury that itself arose from the work-related accident, the reviewing body could analyze it as a subsequently occurring injury that could be causally tied to the injury sustained in the workplace accident. Once complainant has established a compensable primary injury (either through the presumption or testimony), the necessary causal connection standard is enunciated in Brown, supra, 700 A.2d at 791-92. DOES's most-recent attempt to elucidate the objective test further reveals the test's flaws and demonstrates that DOES has expanded its applicability beyond a general concern for objectivity to a test that is practically impossible for someone with a predisposition of psychological problems to meet. In West v. Washington Hosp. Ctr., the Compensation Review Board (Board) squarely confronted whether a psychological condition claimed to be the consequence or medical sequelae of a physical injury arising out of and in the course of employment, rather than the result of workplace stress, must meet the same standard for invoking the presumption of compensability under the Act as a psychological injury alleged to have resulted from workplace stress without a physical injury. CRB (Dir.Dkt.) No. 99-97,  (Aug. 5, 2005). [18] In West, the claimant suffered a back injury in a slip-and-fall accident at work and eventually developed chronic depression which she claimed was connected to the accident. Id. at . The hearing examiner declined to apply the Dailey test, believing it to be unnecessary in the context of a physical accident, and instead applied the subsequent medical injury causation standard from Whittaker v. District of Columbia Dep't of Employment Servs., supra note 3, 668 A.2d at 844. West, supra, at -4. On review, the Board examined post- Dailey cases, including cases wherein the Director or this court applied the Dailey objective test to physical-mental claims. The Board conceded that Dailey involved a claim involving job stress, rather than a physical accident, but asserted that the test applied to physical-mental claims as well: [I]t would require an overly restrictive reading of Dailey, and a misapplication of the body of law that Dailey represents, to limit the standard enunciated therein to job stress induced emotional and psychological claims only. . . . It is the nature of the injury asserted ( i.e. emotional and/or psychological injury), rather than the conditions of the workplace environment, that warrants application of the Dailey standard. This is because mental and emotional injury claims are, as the Director explained, inherently more difficult to objectively determine than are claims of physical injury. West, supra, at -13. As support, the Board cites to the Director's statement in Dailey that `[m]ental injury claims are more difficult because of the inherent difficulties of objectively determining the existence of an injury and its source. ' Id. at  (quoting Dailey, supra, at ) (emphasis added). Our reading of the Agency's decisions and our own cases, however, suggests that it is not the fact of injury that is elusive, it is the cause of the injury and the determination of whether that causal event is work-relateda concern included in the italicized portion of Dailey referenced above, but neglected in West. Instead, West reflects a skepticism of whether the employee suffers an injury at all. The Board goes on to set forth its view of Dailey's requirements: [T]he Dailey standard may be satisfied notwithstanding the lack of evidence showing that the psychological or emotional injury sustained by the claimant would have similarly resulted to a non-predisposed individual of normal sensibilities. Required in such instances is evidence as to the nature of the employment-related physical injury sustained, that the claimant's psychological/emotional impairment is at least partially attributable to the sustained physical injury or its aftereffects, and that the claimant was not predisposed to the emotional/psychological injury of which he/she complains. West, supra, at ___ 28-29. Lest there be any doubt as to the Board's view of the importance of the predisposition element, the Board reiterated, [i]t is not, however, the lack of evidence of predisposition that is required, but the affirmative showing of evidence that Respondent was not pre-disposed that is required.  Id. at 29 (emphasis added). As an example of the potential application of this rule, the Board had earlier cited a case where the claimant had met the objective standard by establishing through medical evidence that the claimant was not pre-disposed to the emotional injury she suffered. See West, supra, at  n. 9 (citing Aycock v. Am. Assoc. of Retired Persons, Dir. Dkt. No. 01-30 (Jan. 15, 2002)). This reformulation of the Dailey test exposes its fatal flaw. The shift in focus from the objective work conditions to the individual person and his or her predisposition to injury led not only to the necessity of speculating about hypothetical normal employees, it has led inexorably to the conclusion that persons with pre-existing psychological conditions cannot recover disability benefits if they suffer from the aggravation of their preexisting condition. This is directly antithetical to the well-established aggravation rule, against the well-established principle that the employer must take the employee as it finds him or her, and against the principal purpose of the statute to compensate employees for injuries they can prove are related to employment. Further, it is contrary to this court's admonition in Spartin that the objective test must permit those predisposed to emotional conditions to receive compensation if they have met their burden of proof or else it would contravene the Act.