A work-related injury in the state of Ohio is one that is sustained in the course of and arising out of the injured worker’s employment (ORC § 4123.01(C)). A psychiatric condition is compensable provided it arose “from an injury or occupational disease sustained by that claimant or where the claimant’s psychiatric conditions have arisen from sexual conduct in which the claimant was forced by threat of physical harm to engage or participate” (ORC § 4123.01(C)(1)).

Post-traumatic stress disorder (PTSD) is a psychiatric medical condition that is frequently sought to be additionally allowed in a compensable workers’ compensation claim. One such claim was recently decided by the Ohio Supreme Court in Armstrong v. John R. Jurgensen Co., 136 Ohio St.3d 58 (2013), decided June 4, 2013.

The injured worker, Shaun Armstrong, was involved in a horrific motor vehicle accident while operating a one-ton dump truck in the course of his employment with John R. Jurgensen Co. Armstrong was driving the dump truck and had to stop at a yield sign while on an access ramp to a freeway. While at a complete stop, Armstrong noticed a vehicle approaching from behind at a high rate of speed. Armstrong braced for impact. The approaching vehicle struck the dump truck from behind with such force that the vehicle came to rest “basically underneath” the dump truck. Armstrong was in shock as he exited his truck. He noticed that the driver of the other vehicle had his head down and was motionless with blood coming from his nose. Armstrong was transported to an emergency room for treatment when he learned the other driver had died.

Armstrong’s workers’ compensation claim was uncontested and was allowed for cervical strain, thoracic strain and lumbar strain, presumably the diagnoses from the emergency room physician on the date of injury. Armstrong subsequently requested the additional condition of PTSD in his workers’ compensation claim. A staff hearing officer heard Armstrong’s motion for additional condition and granted PTSD, finding a sufficient causal relationship between PTSD and his industrial injury. On appeal, the Industrial Commission of Ohio affirmed the additional condition of PTSD.

Armstrong’s employer, John R. Jurgensen Co., appealed the Industrial Commission’s decision to the Clark County Common Pleas Court. The trial court reversed the Industrial Commission’s decision, holding that PTSD was not compensable because it did not arise from Armstrong’s physical injuries that had been allowed in his workers’ compensation claim. The Second District Court of Appeals affirmed the trial court’s decision and Armstrong appealed this decision to the Ohio Supreme Court.

The issues before the Supreme Court were twofold. First, the Court had to discern legislative intent to the statute at issue (ORC. § 4123.01(C)(1)), i.e., work-related injuries include psychiatric conditions “where the claimant’s psychiatric conditions have arisen from an injury or occupational disease sustained by that claimant . . . .” Secondly, the Court had to determine whether the facts in Armstrong’s claim provided the required causal relationship between PTSD and the workers’ compensation claim as defined in the statute.

With regard to the first issue, the Court held that the statute at issue is unambiguous and under such circumstances, the Court must apply the statute as written. Here, the statute states that the psychiatric condition must have “arisen from an injury . . . .” As Justice French found at page 62, this phrase “contemplates a causal connection between the mental condition and the claimant’s compensable physical injury.”

Armstrong argued that the statute should be interpreted to include not only the physical injuries sustained by the injured worker, but also the mechanism of injury itself, i.e., the entire episode that gave rise to the injured worker’s physical injuries. Citing several Ohio Supreme Court decisions, the Court rejected this argument, again holding that ORC § 4123.01(C)(1) is unambiguous and, therefore, must be applied as written. The Supreme Court affirmed the judgment of the Second District Court of Appeals. The Court held that Armstrong undisputedly sustained compensable physical injuries as a result of his industrial accident, which included cervical strain, thoracic strain and lumbar strain. It was also not disputed that Armstrong suffered from PTSD as a result of the tragic motor vehicle accident. Pursuant to the psychiatric condition statute, it is required that Armstrong establish that PTSD is causally related to his physical injuries (cervical strain, thoracic strain and lumbar strain) and not simply to his involvement in the motor vehicle accident itself.

It should also be noted that the Court considered expert medical testimony from the injured worker’s psychologist, Jennifer Stoechel, Ph.D., and the employer’s psychologist, William L. Howard, Ph.D. Dr. Howard opined that Armstrong’s PTSD resulted from the accident but not the physical injuries of cervical strain, thoracic strain or lumbar strain. Dr. Howard further stated that Armstrong would have developed PTSD even without his physical injuries. In this regard, Dr. Howard testified that Armstrong’s PTSD was caused by his witnessing the accident and “the mental observation of the severity of the injury, the fatality, [and] the fact that it could have been life-threatening to him at some point.” The Court held that Armstrong’s physical injuries did not cause his PTSD and, therefore, his psychiatric condition was not compensable under ORC § 4123.01(C)(1).

In conclusion, for a work-related psychiatric condition to be compensable, there must exist a nexus between the psychiatric condition and the injured worker’s physical injuries or occupational disease. The statutory analysis requires a causal connection to the physical injuries regardless of whether the accident was a simple lifting injury at work or a tragic motor vehicle accident.