WCAT Decision Number:  
A2102352 (July 6, 2022)  
DECISION OF THE WORKERS’ COMPENSATION APPEAL TRIBUNAL  
WCAT Decision Number:  
A2102352  
WCAT Decision Date:  
July 6, 2022  
Introduction  
[1]  
[2]  
On September 3, 1981, at age 19, the worker sustained a crush injury to his right foot when the  
trailer from the tractor/trailer truck he was operating came down onto that foot.  
The worker filed a claim with the Workers’ Compensation Board (Board)1 that was accepted for  
the crush injury. The worker returned to work in his pre-injury occupation of truck driver on  
December 15, 1981.  
[3]  
[4]  
The September 3, 1981 accident occurred in British Columbia but the worker has resided in  
Alberta throughout the claim.  
In a June 24, 2016 decision, the Board accepted that the worker sustained a Major Depressive  
Disorder (MDD) and post-traumatic stress disorder (PTSD), delayed onset, as compensable  
consequences of his physical injuries. The Board determined that the worker was entitled to  
wage loss benefits for these conditions from March 3, 2015 (the date of the first psychological  
treatment record on file) to May 22, 2016.  
[5]  
[6]  
In a November 28, 2016 decision (Review Reference #R0209422), a review officer with the  
Board’s Review Division referred the June 24, 2016 decision back to the Board with directions  
that the Board investigate when the worker’s compensable MDD and PTSD developed and  
became disabling and whether he was entitled to wage loss benefits for these conditions prior to  
March 3, 2015.  
In a March 9, 2021 decision, a Board case manager determined that the worker was temporarily  
disabled from work by his compensable psychological conditions such that he was entitled to  
wage loss benefits from January 29, 2011 through October 19, 2012. The case manager noted  
that the worker had some employment income during this period and set out the particular  
amounts that would be deducted from his wage loss benefit entitlement between March 14,  
2011 and June 17, 2012. The case manager also determined that the worker’s compensable  
MDD and PTSD stabilized as permanent conditions by October 20, 2012, and referred him to  
1
The Board now operates as WorkSafeBC.  
1
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
Long Term Disability Services for assessment of his entitlement to permanent disability benefits  
as of that date. Finally, the case manager accepted that the worker had a psychological  
limitation with respect to situations involving a lot of conflict or social interaction, and referred  
him to Vocational Rehabilitation Services.  
[7]  
[8]  
The worker requested a review of the March 9, 2021 decision. He submitted that the disability  
associated with his compensable MDD and PTSD commenced prior to the date determined by  
the Board, and he should therefore be entitled to additional benefits under the claim.  
In a November 22, 2021 decision (Review Reference #R0278456), a review officer varied the  
March 9, 2021 decision, in part. The review officer concluded that the worker was entitled to  
additional wage loss benefits for his MDD and PTSD for the period November 1, 2010 through  
January 28, 2011, implicitly concluding that the worker’s psychological disability commenced on  
November 1, 2010. The review officer did not vary any of the other findings in the March 9, 2021  
decision.  
[9]  
The worker has appealed the Review Division decision to the Workers’ Compensation Appeal  
Tribunal (WCAT).  
[10]  
The worker is represented by a consultant who provided WCAT with written submissions. The  
employer no longer has an active account with the Board and does not have a successor, and  
this appeal does not raise matters within the criteria that warrant participation by a deemed  
employer. There is no respondent to the appeal.  
Issue(s)  
[11]  
The issues addressed by the worker in this appeal are:  
What is the correct date for commencement of his entitlement to compensation benefits for  
his MDD and PTSD?  
Is he entitled to a permanent partial disability benefit for his MDD and PTSD, effective March  
or April 1982?  
Jurisdiction and Standard of Proof  
[12]  
This appeal was filed with WCAT under section 288(1) of the Workers Compensation Act (Act),  
which provides for appeals of final decisions by review officers regarding compensation matters.  
Section 308 of the Act gives WCAT exclusive jurisdiction to inquire into, hear, and determine all  
those matters and questions of fact, law, and discretion arising or required to be determined in  
an appeal before it.  
2
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
[13]  
[14]  
This appeal is a rehearing by WCAT, which means that WCAT reviews the record from previous  
proceedings and can hear new evidence. WCAT has inquiry power and the discretion to seek  
further evidence, although it is not required to do so. WCAT exercises an independent  
adjudicative function and has full substitutional authority. It may confirm, vary, or cancel the  
appealed decision or order.  
The standard of proof in this appeal is the balance of probabilities, subject to section 303(5) of  
the Act. Section 304 provides that if WCAT is hearing an appeal regarding the compensation of  
a worker and the evidence supporting different findings on an issue is evenly weighted in that  
case, the appeal tribunal must resolve that issue in a manner that favours the worker.  
[15]  
[16]  
On April 6, 2020, the Act was revised to reorganize and renumber the sections of the Act, and in  
some places to modernize the language of the Act. The revision, now Workers Compensation  
Act, RSCB 2019, c. 1, did not change the law.  
Previous amendments to the Act include a significant number of changes that were effective  
June 30, 2002. As the worker’s injury occurred prior to June 30, 2002, the provisions of the Act  
in effect prior to that date (former Act) apply to his entitlement to compensation benefits for his  
injury, subject to some exceptions. The Board policies that apply to the determination of the  
correct commencement date of the worker’s entitlement to compensation benefits and  
entitlement to a permanent partial disability award, and which are binding on me, are found in  
the Rehabilitation Services and Claims Manual, Volume I (RSCM I), unless otherwise indicated.2  
Background  
[17]  
In the application for compensation the worker signed on September 23, 1981, an unknown  
person recorded that the worker stated that, on September 3, 1981, he was working as a truck  
driver and was at a border crossing compound. His trailer had two pallets of salmon in it  
(2,500 pounds). He climbed up the front of the trailer to switch it to “cycle” from “continuous” run.  
The weight of the salmon brought the trailer down onto his right foot. His right foot was pinned  
momentarily but then the trailer bounced back up and he was able to free his foot. The worker’s  
injury was witnessed by customs officers and other unknown truck drivers. The time of the  
accident was identified as 10:30 p.m.3  
[18]  
The employer’s report of injury also identified the time of the worker’s injury to be 10:30 p.m. on  
September 3, 1981.  
2
Items #1.01, #1.02, and #1.03 in the RSCM I explain the legislative changes in more detail and also  
explain the scope of volumes I and II of the Rehabilitation Services and Claims Manual in relation to  
benefits for injured workers.  
All quotations have been reproduced as written, unless otherwise indicated.  
3
3
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
[19]  
[20]  
At approximately 11:40 p.m. on September 3, 1981, the worker was admitted to a hospital  
where he received emergency medical attention. The time and date of injury was identified as  
9:00 p.m. (2100 hours) on September 3, 1981.  
On September 7, 1981, the worker’s second, third, and fourth toes were amputated through the  
proximal aspect of the proximal phalanges. Subsequently, on September 18, 1981, the worker  
underwent revision amputations on these three toes and skin grafting procedures with filleting of  
the little (fifth) toe. The worker returned to his home in Alberta and, in early October 1981 the  
third right toe metatarsal head was shortened.  
[21]  
[22]  
The worker returned to work as a truck driver on December 15, 1981.  
In early 1982, the worker reported to the Board that he was doing “okay” with driving, but that he  
was having difficulty with unloading his trailer. His doctor had told him that he might not be  
ready for his regular work until the spring.  
[23]  
[24]  
In an April 13, 1982 consultation report, the worker’s surgeon noted that the worker had cold  
sensitivity but the foot was reasonably satisfactory otherwise. The worker reported that he was  
still finding it difficult to do his pre-injury work.  
The Board determined that the worker had been left with a permanent partial impairment and  
arranged for a medical officer with the Alberta Workers’ Compensation Board (Alberta Board) to  
undertake a permanent functional impairment evaluation. During the December 20, 1982  
evaluation, the only complaints the worker reported were that he could not kneel unless he kept  
his right foot flat and he experienced early fatigue when off-loading a lot of goods from his truck.  
The worker was not taking medication of any kind and was back at his regular job as a long-haul  
truck driver with a new employer. The worker had been scheduled to leave on a trip the morning  
of the evaluation and, as he was unable to so, would lose five days’ pay. The worker was  
extremely upset as he had been told that he was only going to receive reimbursement for one  
day of wage loss compensation. The medical examiner reported that the worker was “Well  
otherwise.”  
[25]  
[26]  
In June 1982, a rehabilitation counsellor with the Alberta Board advised the Board that, while  
working for an Alberta employer, the worker was “let go” from their employment after he rolled a  
truck. Following his lay-off from this employment, the worker found a new job as a truck driver.  
In August 1982, a consultant with the Alberta Board advised a Board vocational rehabilitation  
consultant (VRC) that the worker was continuing to pick up odd jobs and that, from a  
re-employment point of view, he did not feel the worker needed any further assistance.  
In a July 18, 1983 decision, the Board granted the worker a permanent partial disability award  
equal to 5.0% of total disability on a functional basis (2.0% for the amputation value of the  
second, third, fourth, and fifth right toes, 0.5% for sensory impairment associated with skin  
4
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
grafting, and 2.5% for right great toe fusion), effective December 1, 1981. As the worker  
returned to truck driving and the Board concluded he did not have any permanent restrictions  
and/or limitations, the Board did not provide the worker with a loss of earnings award. The  
worker received his pension award as a lump sum payment in the amount of $3,092.70.  
[27]  
[28]  
In 1991, the worker required removal of an epidermoid cyst from his right foot. The Board  
reopened the claim and paid him wage loss benefits from February 13 to May 5, 1991. The  
worker was then earning more than he had prior to his injury and had been with the same  
employer for two years. Rather than using the time of injury wage rate ($178 per month), the  
Board based the worker’s reopening wage rate on his current earnings.  
In 2006, the worker sustained a fracture to the distal phalanx of his right great (first) toe while  
working in Alberta. He had been employed as a long-haul truck driver with his current employer  
for two years. The Alberta Board paid the worker wage loss benefits for the time he missed from  
work due to this injury (from April 19, 2006 to September 6, 2006). The Alberta Board concluded  
that the ongoing pain problems the worker had were a result of the 1981 work incident and  
referred that matter to the Board.  
[29]  
In medical records from the physicians who treated the worker for his 2006 injury in Alberta, the  
physicians documented the worker’s report that, following the 1981 work injury, he would have  
occasional discomfort in his right foot but, for the most part, was able to function well. However,  
following the 2006 injury, the worker began to have difficulty weight-bearing on his right foot and  
he developed new symptoms of pain and numbness in the foot. The reports include a  
comprehensive June 14, 2007 return-to-work assessment report by Dr. Olijnik, who documented  
that the worker denied any psychiatric history.  
[30]  
[31]  
In the spring of 2007, the worker went off work due to a worsening of his pain condition and, in  
November 2007, he sought a reopening of his 1981 claim for additional wage loss benefits. The  
Board denied the request for wage loss benefits but accepted that the worker had sustained first  
metatarsophalangeal osteoarthritis as a result of his compensable injury.  
Following an April 22, 2009 WCAT decision (WCAT-2009-01907), the Board paid the worker  
wage loss benefits from July 19, 2007 until May 17, 2008, at which time he had returned to work  
as a full-time truck driver with a new employer. This job was tailored to the worker’s specific  
physical needs, including modifications to his vehicle and duties that did not require him to walk  
on uneven terrain.  
[32]  
As the worker’s earnings prior to the July 19, 2007 reopening exceeded the original rate set on  
the claim (as adjusted with cost of living allowance increases), the worker’s reopening wage rate  
was established on the earnings in the year prior to reopening.  
5
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
[33]  
In May 2008, the worker obtained a position working as a truck driver in which he earned in  
excess of the then-applicable Board maximum wage rate. He had some difficulties with the  
heavy nature of the work and he transferred to a position with the same employer that involved  
less time on his feet and shorter hours. However, he was able to continue working until 2013.  
[34]  
[35]  
In accordance with the findings the WCAT vice chair made in WCAT-2009-01907, the Board  
reassessed the worker’s entitlement to a permanent partial disability award.  
In an October 28, 2010 decision, the Board denied an increase in that award on the basis that  
the worker had already been awarded the maximum value with respect to his right great toe  
impairment and the osteoarthritis would not merit an additional award.  
[36]  
[37]  
A review officer confirmed this decision (Review Reference #R0123280, dated June 10, 2011)  
but directed the Board to further investigate whether the worker was entitled to a loss of  
earnings pension.  
In a November 27, 2012 decision, the Board accepted the following medical restrictions and  
physical limitations under the worker’s claim:  
Medical Restrictions  
preventative restriction of any activities requiring balancing, including  
ladder climbing and working at heights or on sloped incline surfaces, as  
well as activities on uneven surfaces (non sloped).  
Physical Limitations  
Difficulties with deep squatting or crouching( when balanced on right  
forefoot)  
Difficulties with activities requiring foot proprioception  
Difficulties with activities requiring foot proprioception  
Difficulties with activities requiring weight bearing or placing pressure on  
his right forefoot or great toe  
Difficulty with prolonged walking or standing or driving  
Difficulties with stair climbing (with or without rails).  
[38]  
In a July 19, 2013 decision, a Board officer denied the worker a loss of earnings award. The  
Board officer concluded that, while the worker’s pre-injury occupation was no longer suitable, he  
could adapt to the occupation of truck-driving instructor and, by so doing, could exceed his  
pre-injury earnings.  
6
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
[39]  
[40]  
[41]  
In a July 15, 2015 decision (WCAT-2015-02213), a WCAT vice chair concluded that the worker  
was entitled to an award equal to 0.5% of total disability for chronic subjective pain, effective  
December 1, 1981. Due to a subsequent worsening of this subjective pain, the worker was also  
entitled to an additional award equal to 2.0% of total disability, effective March 17, 2008. The  
vice chair concluded that the worker was not entitled to a loss of earnings award as of  
March 17, 2008, but noted that the worker’s representative had mentioned that the worker had  
depression, an altered gait, and left leg and back pain. The vice chair advised that, if the Board  
did not so voluntarily, the worker could ask the Board for adjudication of a reopening of his claim  
and acceptance of additional conditions.  
During the oral hearing of this appeal (held on October 22, 2014 and reconvened on July 6,  
2015), the worker testified that he returned to work as soon as possible after the injury because  
he had a young family to care for. When the pain was unbearable in his right foot, he would use  
the left to control the gas pedal and brake. He stated he did this on a daily basis, and while it  
was admittedly not safe, he needed to do this in order to feed his family. He used only aspirin  
for pain control, however stated he did this in such large quantities that he now has stomach  
issues. He sometimes used anti-inflammatories when the pain was bad. The worker said that on  
occasion he would take a few weeks off work to deal with the pain. He also would soak his foot  
in a warm salt water bath at highway rest stops to relieve the pain.  
The worker also said that, in 1993, when cruise control was introduced in the semi-tractor units,  
he used it frequently in the summer months and, in approximately 1994, he taught his wife to  
drive. Following that, they worked as a long-haul team for approximately 12 years. His wife did  
more of the driving because of his painful foot. Then, in 2008, he began working for a new  
employer on a four on, four off shift doing lighter work. Overall, he worked fewer hours and his  
wife no longer worked with him, but information the worker provided to the Board indicated that  
he was earning in excess of the Board maximum wage rate during this period. The worker said  
that he was able to continue working until 2013. However, he could no longer take the pressure  
of standing on his foot, he also had difficulty with the extreme cold weather at his work location,  
and his doctor told him he could no longer work due to the condition of his foot. His doctor  
recommended surgery to treat the pain in his great toe.  
[42]  
[43]  
The same WCAT vice chair also considered the worker’s appeal of Review Reference  
#R0123280, which had confirmed the Board’s October 28, 2010 decision to deny the worker an  
additional permanent functional impairment award for his compensable osteoarthritis. As a  
preliminary matter, the vice chair arranged for the worker to undergo a permanent functional  
impairment examination.  
Dr. Brooks, a Board disability awards medical advisor (DAMA) undertook the examination on  
February 18, 2016. The worker told Dr. Brooks that, after the trailer fell on his right foot on  
September 3, 1981, he remained trapped for five to five and one-half hours before someone  
found him and, throughout that time, the truck engine continued to run. The worker told  
7
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
Dr. Brooks that he returned to work as a truck driver earlier than expected (on December 15,  
1981) due to family financial needs.  
[44]  
With respect to his mental state, the worker told Dr. Brooks that he had always been anxious  
since the September 3, 1981 work event and he and his first wife felt that his personality  
changed. He became much more vigilant and tended to be a compulsive saver to some degree,  
likely due to fear of his future employability. He also stated that his sleep had not been good  
since the 1981 accident and he had frequent nightmares of being entrapped as well as  
flashbacks to the accident, particularly if he heard a diesel engine similar to the one on the truck  
he was driving in 1981. The worker said that he recalled this sound intensely. Further, the  
worker told Dr. Brooks that he had not worked for almost three years due to his pain.  
[45]  
[46]  
In addition to setting out his clinical findings regarding the worker’s physical condition,  
Dr. Brooks said that the worker seemed to have developed PTSD due to his prolonged  
entrapment under the trailer. Dr. Brooks recommended that the Board obtain and review  
records regarding this condition.  
Based on the results of Dr. Brooks’ evaluation, in a March 22, 2016 decision  
(WCAT-2016-00837), the WCAT vice chair concluded that the worker was entitled to have  
the permanent functional impairment award for his right foot impairment increased by 12.99%  
of total disability, effective March 17, 2008. This consisted of: 0.1% for sensory impairment of  
the superficial peroneal nerve in addition to the prior award of 0.5% for sensory impairment  
related to the skin graft on the dorsal aspect of the foot; 2.5% for the amputation value of the  
great toe in addition to the previously granted 2.5% for ankylosis of the first joint of the joint of  
the toe; 1.75% for impairment of the subtalar and midtarsal range of motion in the mid foot;  
8.14% for restriction in right ankle range of motion; and, 0.5% for cold intolerance. This brought  
the worker’s total permanent functional impairment award to 20.49% of total disability.  
[47]  
[48]  
In June 2016, Dr. Howes, a senior Board psychology advisor reviewed medical information on  
the claim, including updated information that had been obtained to address the psychological  
issue Dr. Brooks raised. This information included a March 3, 2015 letter from psychiatrist  
Dr. Meakins.  
Dr. Meakins reported that:  
During the prior year and one-half, the worker had been unable to work driving because of  
the pain that had resulted from the 1981 injury and that had increased over time.  
The worker said he had been depressed since the accident, but it was difficult to get an  
accurate account as to the onset of the depression and its pattern.  
8
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
It appeared that, at least in recent years, the worker was intermittently depressed with his  
mood deteriorating for periods of up to a week before he transiently felt better for three or  
four days and up to two weeks at most.  
The worker had chronic sleep disturbance and also reported that he had had nightmares of  
the accident since it occurred.  
The worker felt angry about the accident and the effect it had on his life.  
The worker had a brief common-law relationship in his late teens. Following this, he was  
involved in a common-law relationship for 14 years, although it was not clear why that  
relationship broke up. The worker had two daughters, one from each of these relationships.  
The worker was presently living with his third wife, with whom he had a reasonably good  
relationship, and he had been with her for 20 years.  
The worker’s mood and pain levels had improved since he started taking Cymbalta (an  
antidepressant) several years prior.  
[49]  
[50]  
Dr. Meakins concluded that the worker’s primary problem was chronic pain. The worker did not  
appear to have a persistent depression secondary to this pain, but it appeared that the  
deterioration in his mood was related to the ongoing chronic pain.  
The records also included treatment records from registered psychologist Mr. Ulmer. The  
worker was referred to Mr. Ulmer by the physician at a pain clinic the worker had begun  
attending in early 2015 for the purpose of obtaining pain-related information. Mr. Ulmer  
assessed the worker and began providing him with psychotherapy treatment on May 13, 2015.  
The worker told Mr. Ulmer that, during the 1981 work accident, he remained trapped under the  
tractor-trailer all night after sustaining his injury.  
[51]  
[52]  
In a July 22, 2015 clinical note, Mr. Ulmer documented that the worker had told him that,  
following his 1981 injury, he returned to work and hauled industrial gas until the pain from his  
1981 injury became too much to manage. The worker indicated that, approximately two years  
prior to the current appointment, he was forced to quit working because of this pain.  
Mr. Ulmer summarized the treatment he provided to the worker in a May 19, 2016 letter. Based  
on the worker’s reporting of symptoms and disturbances of daily functioning during his initial  
assessment of the worker, Mr. Ulmer diagnosed the worker with delayed onset of PTSD and  
major depression. Mr. Ulmer had been retained to treat the worker’s mood and anxiety  
problems related to chronic pain but, after this assessment, he shifted his focus to treating  
PTSD using cognitive behaviour therapy and mindfulness-based stress reduction. Mr. Ulmer  
said that there was little doubt in his mind that the 1981 accident was the catalyst for the  
worker’s current difficulty with both major depression and PTSD with delayed onset. Speaking  
specifically to the PTSD, the worker was experiencing regular dissociative reactions  
9
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
(flashbacks), recurrent distressing dreams, and involuntary/recurrent persistent avoidance of  
stimuli associated with the traumatic event, including attempts to avoid thoughts or feelings  
about the event and to avoid conversations and places associated with the event.  
[53]  
[54]  
Mr. Ulmer later clarified, in the July 16, 2018 letter referenced below, that although treatment  
was ongoing at that time, in accordance with the worker’s wishes, he had not yet commenced  
actual treatment for PTSD.  
After reviewing this evidence and Dr. Brooks’ report, Dr. Howes concluded in a June 22, 2016  
opinion as follows:  
By report and professional understanding of the etiology and plausible  
connection of depression with chronic pain and PTSD to the traumatic incident of  
the Worker having his foot trapped and crushed under his truck trailer for over  
5 hours- I concur with both Dr. Meakins and Mr. Ulmer who have provided  
treatment for [the worker] that he suffers from Major Depression and PTSD,  
delayed onset.  
[55]  
Dr. Howes attributed the delayed onset of these conditions (rather than at the time of the work  
incident of 1981) to the determination demonstrated by the worker to return to work subsequent  
to the work incident. Dr. Howes noted that, after surgery for amputation and with chronic pain,  
both of which had been accepted on the claim, the worker successfully resumed work for many  
years as a trucker and, more recently, chronic pain had interfered with functional ability in his  
injured foot and he stopped working.  
[56]  
[57]  
[58]  
In Dr. Howes’ opinion, the worker’s psychological conditions were at plateau and no significant  
improvements would be seen over time.  
Neither Mr. Ulmer nor Dr. Howes provided a specific opinion as to the date that the worker’s  
compensable psychological conditions stabilized.  
In a June 24, 2016 decision, a Board officer accepted both MDD and PTSD, delayed onset, as  
compensable consequences under the worker’s 1981 claim. The Board officer concluded that  
the worker was entitled to temporary wage loss benefits for these conditions from March 3, 2015  
(the date of the first psychological treatment record on file) to May 22, 2016. The Board officer  
also accepted permanent psychological restrictions and limitations under the claim, as identified  
by Dr. Howes. The Board officer concluded that the worker’s permanent disability benefit would  
be determined using the loss of function method; as he had been able to return to his pre-injury  
10  
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
occupation and restore his pre-injury earnings, his was not entitled to a loss of earnings  
assessment.4  
[59]  
[60]  
[61]  
The worker had advised that he last worked in 2013 (a year in which he later advised his gross  
earnings were approximately $90,000)5 and, because of the restrictions and limitations that had  
been accepted under the claim, a Board VRC concluded that he was unable to return to truck  
driving. Effective May 23, 2016, the Board began paying the worker vocational rehabilitation  
planning benefits with the objective of developing a suitable return-to-work plan. The worker  
maintained that he was unemployable and declined to participate in vocational rehabilitation  
planning. The Board discontinued the income continuity benefits but then reinstated them after  
the VRC concluded that the worker was presently competitively unemployable. In  
November 2016, the VRC recommended that the Board’s Disability Awards Committee grant  
the worker a loss of earnings award to reflect this.  
The worker requested a review of the June 24, 2016 decision as well as of a related decision  
(dated June 30, 2016) establishing the wage rate upon reopening of his claim, effective  
March 3, 2015. He submitted a July 25, 2016 letter from Dr. Boughen, the physician at the pain  
clinic he had begun attending in January 2015, and an undated letter from Mr. Ulmer (received  
by the Board on July 21, 2016). Dr. Boughen provided the opinion that the worker’s pain and  
physical restrictions, including from hip and back injuries as well as from the right foot injury,  
were contributing to the worker’s inability to maintain employment. Mr. Ulmer wrote that,  
although he first assessed the worker in May 2015, it was his opinion that the worker began to  
experience symptoms of PTSD immediately after the September 1981 work incident and that  
the worker met the full diagnostic criteria for this condition at least six months after the incident.  
In companion decisions dated November 28, 2016 (Review Reference #R0209422 and Review  
Reference #R0209546), a review officer referred both the June 24, 2016 and June 30, 2016  
decisions back to the Board for further investigation of when the worker’s MDD and PTSD  
stabilized. The review officer noted that the Board had not had the opportunity to review the new  
evidence from Mr. Ulmer. In addition, chart notes from Dr. Romano, who was the worker’s  
family physician throughout the claim, showed that the worker had obtained psychological  
treatment in 2011 and 2012 and the Board neither obtained nor reviewed the treatment records.  
4
The Board officer’s finding in this regard was based on erroneous understanding that the Act as  
amended effective June 30, 2002 applied. At the time, the Act required that, before a loss of earnings  
assessment could be undertaken, the Board first consider whether the worker was eligible for such an  
assessment. There was no such requirement in the former Act and, owing to amendments to the  
current Act that removed the eligibility requirement effective January 1, 2021, a worker’s entitlement to  
a loss of earnings benefit must now be considered in all cases, as was required under the former Act.  
5
June 29, 2016 conversation between the worker and a Board Wage Rate Unit officer.  
11  
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
[62]  
[63]  
The Board obtained additional medical records regarding the worker’s psychological condition,  
including records for psychological assessments and treatment that followed the worker’s  
involvement in two non-compensable motor vehicle accidents, in 2010 and 2012.  
These records included treatment records from registered psychologist Ms. Karasick-Franks,  
who provided the worker with psychological treatment for approximately 20 months following an  
October 29, 2010 motor vehicle accident and a subsequent motor vehicle accident on  
January 25, 2012. Ms. Karasick-Franks met the worker for an initial consultation on March 24,  
2011.  
[64]  
Ms. Karasick-Franks documented that, in the October 29, 2010 motor vehicle accident, the  
worker hit the rear quarter of a vehicle that ran a red light at an intersection he was passing  
through;6 he hit his head on the cab of the truck he was driving and felt immediate pain in his  
back. After the accident, he remained off work. He returned to work on December 25, 2010 but  
was only able to complete two shifts and then went off work due to increased pain and high  
anxiety. Since then, he had remained off work and, at the time of the assessment, was receiving  
long-term disability benefits. Prior to the accident, he had been employed full time as a trucker  
for three years by the employer he then worked for.  
[65]  
Ms. Karasick-Franks noted that discussing the impact of the 2010 motor vehicle accident on the  
worker’s life was particularly distressing for him. The worker reported that, since this accident he  
had difficulty coping and that his functioning in many areas of his life had been adversely  
affected. At the time, the worker was off work and was reportedly fearful of returning to work. He  
reported experiencing headaches, constant soreness and stiffness in his right shoulder and  
neck, feeling depressed, having difficulty making decisions, and being easily agitated since the  
accident. Additionally, he reported disturbed sleep due to pain symptoms and reported that he  
frequently felt tired with low energy, had developed a significant phobia and fear of driving, had  
been unable to continue working as a truck driver, and had to pull over when driving due to  
feelings of panic. Ms. Karasick-Franks reported that the worker continued to experience  
flashbacks and reruns of the 2010 accident. In summary, she indicated that the worker was  
presenting with symptoms of depression, acute stress disorder, and driving anxiety  
accompanied by sleep disturbance and persistent pain.  
[66]  
In a November 26, 2011 psychology assessment, Ms. Karasick-Franks noted that the worker  
had had other trauma, including being robbed at gunpoint and two prior motor vehicle accidents.  
The first accident occurred in 1988 when a driver of a small vehicle fell asleep at the wheel and  
hit his truck head on. The worker reported he was not physically injured in this accident and,  
although he was emotionally distressed because the other driver died at impact, he did not miss  
any work following the accident. The second accident occurred in 2002 or 2003 when he was  
6
Court documents later obtained by a Board investigator identify that the vehicle the worker struck was  
an ambulance.  
12  
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
rear-ended by a minivan. The worker reported that he sustained a whiplash injury and, after this  
accident, missed a couple of days of work. Ms. Karasick-Franks also mentioned the traumatic  
amputations following the 1981 work incident. However, the worker did not report experiencing  
psychological consequences following that incident and he specifically denied having  
depression or PTSD symptoms or receiving counselling prior to the October 2010 accident. He  
also said that he was not taking any medication at the time of the October 2010 accident but  
had since been prescribed Tylenol No. 3 and Cipralex (an antidepressant).  
[67]  
In this assessment report, Ms. Karasick-Franks said that the worker seemed to be presenting  
with symptoms of clinical depression, was experiencing anxiety with regards to driving, and was  
experiencing symptoms of PTSD. The symptoms of PTSD included upsetting thoughts and  
memories about the October 2010 accident, disturbing dreams and nightmares about that  
accident, and flashbacks of the accident. Based on her assessment of the worker, which  
included psychometric testing, Ms. Karasick-Franks felt the worker was continuing to experience  
chronic pain and secondary symptoms of depression and has also developed PTSD as a result  
of the October 29, 2010 accident:  
[The worker] was forthright and candid during his interviews and despite  
adversity in the past, he appears to have been a well motivated and goal  
orientated man. At the time of the accident of October 29, 2010, there was no  
evidence of chronic pain, PTSD or driving anxiety. He was functioning well, and it  
is my opinion that the accident of October, 2010 was the index event that  
resulted in the above mentioned symptoms.  
[68]  
[69]  
Ms. Karasick-Franks later documented that the second accident on January 25, 2012  
aggravated the constant pain in the worker’s right shoulder, lower back, and neck and the  
headaches he had had since the 2010 motor vehicle accident. The worker also reported severe  
pain in his right leg and he was unable to sit for more than 15 minutes during sessions with  
Ms. Karasick-Franks.  
A Board investigator obtained additional information regarding the October 29, 2010 motor  
vehicle accident and regarding the worker’s employment history following that accident. This  
information confirmed that the worker had made an insurance claim for psychological injury  
(PTSD, depression, and anxiety) resulting from the accident. Further, the employer for whom  
the worker was working at the time of the October 29, 2010 accident had terminated the  
worker’s employment, effective May 31, 2012, due to insubordination. The worker had returned  
to working his full duties, full time with this employer by mid-April 2012.  
[70]  
On July 19, 2019, the worker’s former representative provide the Board with a copy of additional  
information.  
13  
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
[71]  
This included the signed first page of the worker’s application for compensation and a  
handwritten note from the worker. The worker stated that he had depression before the  
October 29, 2010 accident, “but maybe never mentioned it”:  
I didn’t think it relevant at the time to discuss what happened 30 years before. I  
was not aware of the possibility that I may have PTSD. I had a distrust for the  
field of psychiatry and I would have never considered getting help for my  
feelings.  
[72]  
Elsewhere in the new documentation, the worker said that the information that the Board  
obtained from the second page of his application for compensation was wrong, was in someone  
else’s handwriting, that he was on morphine and on his back in hospital when it was written, and  
that he did not know who had written it. He said that, during the 1981 work incident, he was  
pinned during the night for a lengthy period until another driver saw him and brought a hydraulic  
jack and freed him.  
[73]  
[74]  
The worker also said that, when he was hired in March 2008 by the employer he was working  
for at the time of the October 2010 accident and when he was hired by other employers, he was  
designated as disabled.  
The representative also provided the Board with responses to five questions a Board officer had  
asked the worker about his assessments by Mr. Ulmer, Dr. Brooks, and Ms. Karasick-Franks  
and about his psychological history. The worker advised that:  
He had been off work for four years.  
Prior to the October 29, 2010 accident, he never did anything but work and he never had  
time to deal with his emotion: “Truck driving was my therapy.” He never realized that he  
might have PTSD and he did not consider that getting psychological help could have helped  
him with the anger, fear, nightmares and worry that he has suffered with this injury and  
emotion for over 30 years.  
When assessed by Mr. Ulmer, he discussed the trauma of his initial injury, years of hard  
work, and failed relationships because of the trauma: “I worked hard to run from my emotion  
and it caught up with me.” He said that the 2010 accident did not increase his problems but  
did identify for the first time that he had PTSD. He also said that the 2010 accident did not  
result in any major physical injury and that “PTSD can be dormant for years and triggered  
which was explained to me.” He said this all made sense because the 2010 accident was  
minor and there were no major injuries or major vehicle damage.  
He told Mr. Ulmer about his assessment by Ms. Karasick-Franks.  
He did not tell Dr. Brooks about the October 29, 2010 motor vehicle accident or his  
assessment by Ms. Karasick-Franks. This was because he was there to be assessed for his  
14  
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
chronic pain and his physical injuries and Dr. Brooks did not address the emotional effects  
of the injury.  
He did not report that he had depression before the minor October 29, 2010 accident to  
Ms. Karasick-Franks because he did not think it was relevant at the time, but he had nothing  
to hide and he was truthful.  
[75]  
The worker’s representative also provided the Board with an unsigned letter bearing a  
handwritten date of July 16, 2017 from the partner of 14 years Dr. Meakins identified as the  
worker’s second spouse (referred to as Ms. S in Review Reference #R0278456 and in this  
decision). Ms. S stated that she met the worker in the spring of 1981 and, at the time, he was a  
fun-loving and generous person. Then, in the late summer of 1981, he suffered the accident that  
resulted in the loss of part of his foot. He endured several surgeries and rehabilitation but did  
not let things get him down because he had faith in the system. “But that system let him down.”  
By the fall of 1982, his demeanour changed after the Board gave him a small settlement.  
Ms. S said that the worker was forced to return to work sooner than he was ready to in order to  
support his new family, was in so much pain some days that no amount of foot massages would  
help, and became more and more frustrated. In addition, he began to lose sleep because of  
nightmares and he worried constantly about his future. She said that, “even though he was not  
mentally able to work,” he never resorted to drugs or alcohol to cope.  
[76]  
[77]  
[78]  
Ms. S said that the worker became bitter, angry, and distrustful of authority; the fact that he had  
to communicate with the Board by long distance calls and was unable to personally discuss his  
situation with the Board added to his frustration and resulted in anger, “which he took out on  
those closest to him.”  
In an October 26, 2017 psychology review and opinion, registered psychologist Dr. Feehan  
summarized the relevant documentary evidence. His summary included the observation that,  
prior to 2010, the medical documentation noted concerns about the worker’s injury and medical  
rehabilitation, with no mention of psychological issues.  
Dr. Feehan concluded that the best available information (from Mr. Ulmer and  
Ms. Karasick-Franks) was that the worker has PTSD, given that he met the criteria for this  
condition at the time he was treated by each of them. In addition, the worker continued to  
report mood-related symptomatology and there was a reasonable likelihood that, consistent with  
Dr. Meakins’ diagnosis of persistent depression secondary to pain, an independent  
psychological or psychiatric assessment would provide a diagnosis of persistent depressive  
disorder.  
[79]  
Dr. Feehan concluded that, in the absence of information to the contrary, Mr. Ulmer’s opinion  
that the worker had developed PTSD symptoms at the time of the 1981 work incident and then  
met the full criteria for this condition within six months of the incident should be accepted.  
15  
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
However, after reviewing the further information the worker had provided in response to the  
Board officer’s questions, Dr. Feehan changed this opinion because Mr. Ulmer did not know  
about the October 29, 2010 motor vehicle accident at the time of his assessment.  
[80]  
In a second psychology review and opinion dated October 30, 2017, Dr. Feehan said that, given  
Mr. Ulmer’s likely unawareness of the 2010 accident, which resulted in a far more dramatic  
presentation of symptomatology than did the 1981 incident, and which the worker claimed in  
legal documents to be the source of his PTSD, he now had reduced confidence in Mr. Ulmer’s  
assertions regarding causality. It appeared that, in addition to withholding information about the  
2010 motor vehicle accident from Mr. Ulmer, the worker may also have misrepresented his  
history to Ms. Karasick-Franks regarding the absence of any psychological disturbance prior to  
2010. In each case where the worker obviously omitted important information, he was arguing to  
a different insurance company that all of his psychological problems arose only from injuries for  
which that particular insurance company was responsible. This raised the possibility that the  
worker was misrepresenting by elaboration or by wholesale construction of symptoms.  
[81]  
Dr. Feehan noted that, in the current case, Mr. Ulmer was acting as the worker’s therapist and it  
is usual for a therapist to accept the word of the client, both so that rapport can be established  
and as an act of validation of the client’s experience. There was no evidence that Mr. Ulmer  
conducted a forensic interview or administered forensic tests, nor would it be expected for him  
to do so in his role as a therapist. Dr. Feehan said that, having reviewed the additional  
information, it was unlikely that Mr. Ulmer had a full and accurate picture of the worker’s trauma  
history. In addition to being unaware of the 2010 and 2012 motor vehicle accidents and their  
consequences, Mr. Ulmer likely believed that the 1981 event was potentially more  
psychologically traumatizing than it in fact was (that is, that the worker had been “trapped under  
a tractor-trailer all night”).  
[82]  
Dr. Feehan also noted that, given that the third edition of the The American Psychiatric  
Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) applied in 1981, it  
was unlikely that the worker would have met the full diagnostic criteria for the diagnosis of PTSD  
that applied as of six months after the work incident:  
Unlike its later incarnations, DSM-III requires that “the person has experienced  
an event that is outside the range of usual human experience”. I would consider  
being trapped all night by a foot crushed under equipment to have been “outside  
the range of usual human experience”. I would not consider having my foot  
quickly crushed and then being rapidly rushed to the hospital as outside of the  
range of usual human experience, awful as it is. This issue, though, is not  
particularly germane to our current discussion, as the principal issue surrounds  
not whether he would have met the narrow criteria for PTSD at the time, but  
rather what is the cause of the PTSD that he has currently.  
16  
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
[83]  
Dr. Feehan concluded that the most likely scenario was that the worker did not have PTSD until  
the motor vehicle accident in 2010. Dr. Feehan said that the earlier accident, from 30 years ago,  
may have played a role in the development of the worker’s PTSD, but only in that it would have  
increased his vulnerability to developing this condition:  
Individuals who have experienced past traumatizing events have an increasingly  
greater likelihood of developing PTSD with each subsequent traumatizing event.  
However, this would not constitute a prior PTSD, simply a prior vulnerability. That  
is; the most likely scenario is that his 198[1] injury increased his vulnerability to  
developing PTSD, but did not create PTSD itself. If it had created PTSD, we  
would have had some evidence of psychological impairment or psychological  
limitations over the 30 years prior to his motor vehicle accidents. We do not.  
Increased vulnerability is not the same as a causal factor.  
[84]  
Dr. Feehan clarified that, in his opinion, the motor vehicle accidents in 2010 and 2012 were  
likely to have been the initiating cause of the worker’s PTSD. Further, contrary to his initial  
opinion, he no longer considered that it was more likely than not that the worker had a milder,  
non-disabling PTSD from 1981 to 2011. Now, it was his opinion that the worker may have had  
bothersome psychological symptoms, but that these symptoms would not have met the criteria  
for PTSD or any other psychological disorder: “Even if he had 30 years’ worth of nightmares,  
there is no psychological/psychiatric diagnosis that can be attached to nightmares that occur in  
isolation of the other symptoms required of the diagnosis of PTSD.”  
[85]  
[86]  
During a January 15, 2018 telephone conversation with a Board officer, the worker admitted that  
he chose not to disclose his prior 2010 motor vehicle accident, psychological conditions, and  
significant treatment for the psychological conditions of PTSD and MDD to Mr. Ulmer or to  
Dr. Meakins. The worker said that his reason for this was that this information had no bearing on  
his conditions under the 1981 claim and he did not want to waste anyone’s time with this  
information.  
In a January 29, 2018 decision, the Board officer advised the worker, due to his  
misrepresentation, the decision to accept MDD and PTSD and associated limitations and  
restrictions had been set aside. Instead, the MDD and PTSD conditions had been denied under  
the claim.  
[87]  
[88]  
As a consequence of this decision, the Board declared overpayments of wage loss and  
vocational rehabilitation benefits and discontinued the worker’s vocational rehabilitation benefits.  
The worker requested a review of the January 29, 2018 decision and the related decisions  
declaring the overpayments and denying the worker benefits.  
17  
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
[89]  
[90]  
In support of this request, he obtained a July 16, 2018 letter from Mr. Ulmer. Mr. Ulmer advised  
that he had been undertaking cognitive behavioural therapy with the worker to treat ongoing  
difficulties related to mood, anxiety, interpersonal difficulty, chronic pain, and sleep disturbance.  
He was continuing to see the worker every two months for maintenance sessions but, in  
accordance with the worker’s wishes, had not yet commenced actual treatment for the worker’s  
PTSD.  
Mr. Ulmer acknowledged that the worker had told him that he spent a great deal more time  
under the trailer than he actually did, but said that this might in fact be due to “negative  
alterations in cognition rather than an outright attempt to misrepresent the truth”, and that it  
might be that the worker was exhibiting these alterations by displaying an inability to remember  
this important aspect of his experienced trauma event. While Mr. Ulmer conceded that the  
circumstances of the worker’s case were “suspect”, he cautioned against labeling the worker as  
a malingerer. He said that the worker’s presentation in a clinical setting suggested that his  
PTSD had more to do with the workplace injury than the motor vehicle accidents occurred in  
2010 and 2012.  
[91]  
Mr. Ulmer also acknowledged that the worker withheld information related to the 2010 and 2012  
motor vehicle collisions and his subsequent treatment with Ms. Karasick-Franks. He also said  
that the reason the worker did this “is entirely unknown.” However, his opinion regarding  
causality was based on clinical observation and had not changed. Mr. Ulmer said that the  
unfortunate reality is that the worker did not have any earlier evidence suggesting psychological  
impairment “prior to his first [motor vehicle accident] in 2010.” However, the fact that he did not  
access mental health resources at the time was not necessarily an indicator of “culpability”  
given that: knowledge about trauma and stress-related disorders like PTSD has changed a  
great deal since 1981; and, attitudes towards mental health and the impact of work-related  
injuries on mental health has also undergone significant alteration.  
[92]  
Mr. Ulmer also said that, while the worker did not make any mention of his prior assessment by  
Ms. Karasick-Franks during his initial assessment, and he did not know why the worker did not  
do this, once treatment began he did not inquire further about any prior access to mental health  
resources. Rather, as Dr. Feehan had pointed out, he accepted that the worker’s experience  
and recall of the event was truthful:  
[I]t severely damages the therapeutic alliance to question a patient’s authenticity  
or their potential exaggeration of reported symptoms.  
[93]  
Mr. Ulmer said that he did not use any psychometric instruments and that it is notoriously  
difficult to determine causation for mental health issues concerning an incident that occurred  
over 30 years ago. However, based entirely on clinical observation and time spent with the  
worker in treatment over several years, it was his sincere belief that the 1981 workplace  
accident “is contributing to” the difficulty that the worker was currently having with MDD and  
18  
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
PTSD. He said he felt that the only way to resolve the two opposing opinions from him and from  
Dr. Feehan was to have the worker undergo a psychiatric evaluation that included psychometric  
testing.  
[94]  
In companion decisions dated September 6, 2018,7 a review officer noted that the Board only  
had authority to set aside the January 29, 2018 and related decisions if the decisions were  
made in reliance on misrepresentation. The Board had relied on Mr. Ulmer’s opinion when it  
decided to accept the worker’s claim for PTSD and MDD, and Mr. Ulmer had now stated that  
the worker’s omissions did not change his opinion regarding causation. The review officer found  
that it was unclear whether the Board’s initial decision would have been different if the worker  
had provided complete and accurate information to Mr. Ulmer. Since it was theoretically  
possible that both the 1981 incident and the 2010 and 2012 motor vehicle accidents were  
significant causes of the PTSD and MDD, and since the worker had not yet had a full  
psychological assessment regarding the 1981 work incident, including psychometric testing, the  
review officer was unable to reach a sound conclusion with regard to whether the decision to  
accept PTSD and MDD on the worker’s claim was made in reliance upon misrepresentation on  
the worker’s part. The review officer referred the January 29, 2018 and related decisions back to  
the Board with direction that the Board arrange for a full psychological assessment of the  
worker.  
[95]  
[96]  
On March 13, 2019, the worker underwent a psychology assessment with registered  
psychologist Dr. McGuire. Dr. McGuire interviewed the worker, who was accompanied by his  
current spouse, and administered psychometric testing that included validity testing.  
Dr. McGuire also reviewed the relevant medical and claims history.  
Dr. McGuire set out the results of her assessment in an April 8, 2019 psychology assessment  
report. She concluded that the psychometric test results could not be considered valid due to  
clear indications of substantial over-reporting of concerns on all measures with validity scales,  
as well as on the self-report validity scale. This did not rule out the diagnoses of MDD and  
PTSD and, during the interview, the worker had reported symptoms that were consistent with  
these diagnoses. However, it was not possible to determine the current severity of any genuine  
underlying symptoms. Dr. McGuire said that the reason or motive for over-reporting or  
exaggeration of concerns cannot be determined from invalid test results. Therefore, although  
secondary gain must be considered, the worker’s over-reporting might reflect, at least in part,  
concerns by the worker that he would not be heard unless he could demonstrate how severe his  
symptoms were and how much suffering he was experiencing.  
[97]  
Dr. McGuire said that, in interview, both the worker and his wife focused on issues that were  
tangential to determination of the relative roles of the 1981 claim injury and the 2010 and 2012  
motor vehicle accidents in the worker’s functioning and overall status. It was Dr. McGuire’s  
7
Review References #R0235638, #R0235645, #R0235653, #R0235655, and #R0235658.  
19  
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
impression that both the worker and his wife believed that the severity of the initial injury was  
being minimized by the Board; they both emphasized that the worker was “pinned” for much  
longer than has been acknowledged and that his pain experience and the impact on his physical  
functioning was greater than recognized.  
[98]  
Dr. McGuire was unable to provide an opinion regarding whether the worker’s omission of  
discussion of the motor vehicle accidents with Mr. Ulmer was deliberate. She observed that the  
worker’s description of functioning was quite vague or “impoverished”, and he presented as a  
“man of few words” who offered little information beyond direct responses to questions; even in  
response to direct questioning regarding his discussions with Mr. Ulmer, he simply repeated that  
he perceived the motor vehicle accidents as adding to what he was “already going through”, as  
a result of the 1981 workplace accident. Dr. McGuire was also unable to identify the reasons for  
the worker’s failure to discuss the impact of the 2010 and 2012 motor vehicle accidents with  
Mr. Ulmer and she provided no opinion on this point.  
[99]  
Dr. McGuire understood that the primary reason for the assessment was to address relative  
roles of the initial 1981 injury versus the much more recent motor vehicle accidents in 2010 and  
2012 in the development of MDD and PTSD. As noted, because of the invalid and grossly  
distorted test results, she could not confirm the diagnoses of MDD or PTSD, or any other  
specific mental health diagnosis. Dr. McGuire agreed with Dr. Feehan that it was certainly  
possible that the worker was experiencing some MDD and PTSD symptoms following the 1981  
injury; in interview he described being symptomatic throughout this period. However, he  
continued working after 1981 and, while he had worked for a number of different employers  
between 1981 and 2012, this was without significant gaps between jobs. His symptoms were  
therefore not significantly disabling and were likely “subclinical” throughout this time.  
[100] Dr. McGuire suggested that the worker’s ability to work only two shifts in December 2010 due to  
increased pain and anxiety was a new development in the worker’s symptom presentation given  
that, until that time, he had been able to maintain his employment. She found it likely that the  
worker’s disability due to his psychological symptoms commenced in November 2010 and,  
during that month, he had an acute stress disorder. Then, after his failed attempt to return to  
work in December 2010, his acute stress disorder became PTSD. Dr. McGuire also advised that  
it appeared the worker had reached maximum recovery in October 2012, after attending  
treatment with Ms. Karasick-Franks.  
[101] In a July 22, 2019 decision, a Board officer advised the worker that the decision to accept MDD  
and PTSD, including associated limitations and restrictions, remained set aside. The Board  
officer concluded that the development of any diagnosable mental health condition did not occur  
until after the non-compensable motor vehicle accidents of October 2010 and January 2012.  
20  
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
[102] The worker requested a review of the July 22, 2019 decision. In support, he provided:  
A typewritten summary of his job history from September 3, 1981 through to the May 2012.  
The history identifies numerous truck driving jobs the worker had in this period. The worker  
indicated that his employment in a majority of these jobs ended because of his temper or  
because he quit due to various labour relations issues. He attributed this to his experience  
of pain and anxiety.8  
An undated email from his current spouse (referred to as Ms. G in Review Reference  
#R0278456 and in this decision), who co-drove with him during some of his employment  
from 1994 or 1995 through to 2007.9 The worker’s spouse provided a series of examples of  
situations from approximately 1994 through 2010 where the worker manifested  
psychological issues, including uncontrolled rage. The worker’s spouse said that she was  
unaware of PTSD until 2016 but, when she researched the condition, it explained the  
difficult behaviour and mood swings that the worker experienced.  
Photographs showing a tandem tractor trailer (a double trailer truck) that had been involved  
in a roll-over accident. The worker’s representative identified the photographs as being of  
“the worker’s MVA [motor vehicle accident] in the course of employment in December 1981  
subsequent to the amputation of his left foot and return to work as a truck driver”.10  
A discipline letter dated April 30, 2009 from the 2008 to 2012 employer in which the worker  
was reprimanded for making unacceptable comments at a picket line.11  
[103] The worker submitted that there was no misrepresentation and so his claim should be accepted.  
[104] In a November 20, 2019 decision (Review Reference #R0253067), a review officer varied the  
July 22, 2019 decision. The review officer concluded that the worker likely did not misrepresent  
information knowingly or with reckless disregard as to its accuracy and, even if he did do this,  
8
Information on the claim file indicates that this summary is not complete and it appears to omit some  
significant details as to why the worker left at least some of the various jobs he held in the years 1981  
through 2012. Of particular note, while the worker recalled that he eventually quit the job he had from  
December 15, 1981 through to the spring of 1982 because he was hoping that this would help his  
nightmares, the June 16, 1982 letter from the rehabilitation counsellor at the Alberta Board noted that  
the employer terminated the worker’s position with this employer after the worker rolled a truck.  
9
The worker identified 2007 as the last date his spouse drove with him during the testimony at the  
reconvened hearing held on July 6, 2015 by the vice chair who issued WCAT-2015-02213.  
10 As set out above, the worker’s compensable injury was to his right (not left) foot and four toes on that  
foot (not the entire foot) were amputated. A June 16, 1992 letter from a rehabilitation consultant at the  
Alberta Board notes that the worker’s employment was terminated in 1982 because of this truck-rolling  
incident.  
11 The subsequent termination letter, dated June 7, 2012, is in the materials obtained by the Board  
investigator.  
21  
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WCAT Decision Number:  
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the Board did not rely on that misrepresentation in accepting MDD and PTSD on the worker’s  
claim in 2016.  
[105] The review officer accepted as fact that the worker did not discuss the 2010 and 2012 motor  
vehicle accidents and observed that this omission would be a misrepresentation if the worker  
omitted the information knowingly or with reckless disregard as to its accuracy. However, the  
review officer found insufficient evidence to support that this was a deliberate or reckless  
omission which the Board relied on in accepting his claim for MDD and PTSD.  
[106] The other matter that could amount to misrepresentation was the fact that the worker reported  
that he was pinned under the trailer after the 1981 incident for a much longer period of time than  
the initial documents on the claim suggested. However, Mr. Ulmer had said that the worker’s  
belief about the severity of the 1981 incident could be a cognitive distortion or an inability to  
remember a portion of the trauma, which can be seen with PTSD. Given the worker’s continued  
focus on this issue during Dr. McGuire’s assessment, the review officer considered it most likely  
that his memory of this event was a cognitive distortion or other manifestation of his  
psychological reaction to the trauma, rather than deliberate misrepresentation.  
[107] The review officer went on to find that, even if the worker had misrepresented knowingly or  
recklessly, the evidence nevertheless supported that the decision to accept PTSD and MDD  
may not have been made in reliance upon the worker’s omissions. The review officer noted that:  
The evidence was clear that the worker was involved in a traumatic incident in 1981,  
in which he suffered serious injuries resulting in amputations of several of his toes.  
Dr. Feehan stated that it is accepted that PTSD symptoms can be relatively dormant  
with some individuals and manifest themselves at a later time.  
After becoming fully apprised of the 2010 and 2012 motor vehicle accidents,  
Mr. Ulmer remained of the opinion that the 1981 work incident was at least a  
significant contributing cause of the worker’s PTSD and MDD and this was evidence  
that “supports that the decision to accept PTSD and MDD may not have been made  
in reliance upon the worker’s omissions.”  
[108] The review officer found that the 1981 event was traumatic regardless of the length of time the  
worker was trapped and the full information regarding the nature of the event was readily  
available in the worker’s claim file. Therefore, the review officer did not consider the  
discrepancies regarding the length of time that the worker was trapped to be material.  
[109] The November 20, 2019 decision (Review Reference #R0253067) constitutes a final and  
binding decision that the worker is entitled to acceptance of PTSD and MDD under the claim.  
22  
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Tel: (604) 664-7800 | 1-800-663-2782  
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WCAT Decision Number:  
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[110] In the March 17, 2020 decision, a Board officer advised that the following actions had been or  
would be taken in order to implement the Review Division’s November 20, 2019 decision:  
The claim file had been updated to confirming that MDD and PTSD had been accepted  
under the claim.  
Wage loss benefits from March 3 to May 22, 2016 had been reinstated, thus cancelling the  
overpayment that had previously been declared.  
A VRC had been asked to review the declared overpayment of vocational rehabilitation  
benefits and to take any required action.  
Upon receipt of relevant details, expenses for travel that had been denied after the  
January 29, 2019 decision would be reimbursed.  
The claim had been referred to a disability awards officer for review of the worker’s  
entitlement to a permanent disability award.  
The claim had been referred to a psychologist for a detailed review and opinion regarding  
the timeline of onset and plateau of the worker’s psychological conditions; once this had  
been undertaken, in accordance with the directions of the review officer in Review  
Reference #R0209422 (November 28, 2016), a decision regarding the date of onset of the  
worker’s psychological conditions and whether he was entitled to any wage loss benefits  
prior to March 3, 2015 would be made.  
[111] Registered psychologist Dr. Gill undertook the detailed review of the claim file, including the new  
evidence the worker had provided to the Review Division. Based on this review, Dr. Gill  
concluded that the worker’s PTSD and MDD symptomatology reached clinical levels within the  
month following the October 29, 2010 motor vehicle accident:  
The notes and report from Ms. Karasick-Franks from 2011 represent the first  
documents indicating clinical levels of symptomology. She refers to MDD and  
acute stress disorder. Symptoms of Acute Stress Disorder by definition appear  
within the 1st month after a traumatic event. She also notes that [the worker]  
attempted to return to work on December 25, 2010 but was reportedly able to  
return to work for only 2 shifts due to increased pain and high anxiety. This  
information also suggests a new development in [the worker’s] symptom  
presentation since, until that time (December 2010) [the worker] had been able to  
maintain his employment (across multiple employers). I note that Mr. Ulmer  
expressed the view that [the worker’s] 1981 injury contributed to the development  
of PTSD. That seems feasible. It is most likely that symptoms were subclinical  
until the event of the October 2010 MVA.  
23  
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WCAT Decision Number:  
A2102352 (July 6, 2022)  
[112] Dr. Gill also considered whether, prior to March 3, 2015, there was any period of temporary  
disability due to the worker’s psychological symptoms and, if so, when this temporary disability  
resolved or stabilized. Dr. Gill said that it seemed likely that a period of disability due to  
psychological symptoms commenced as of November 2010 (Acute Stress Disorder occurred  
during that month). There was further indication that the worker experienced disability due to  
psychological symptoms as of December 25, 2010 when he attempted to return to work but was  
unable to sustain the effort due to reported anxiety and pain; the Acute Stress Disorder became  
PTSD. Treatment records from Dr. Romano and Ms. Karasick-Franks indicated that the worker  
continued to experience symptoms of PTSD and depression throughout 2011 and 2012 and,  
following the January 2012 motor vehicle accident, Ms. Karasick-Franks reported that the  
worker’s depressive symptoms worsened and his PTSD was further “triggered”.  
[113] Dr. Gill said that there was some indication that the worker’s condition reached maximum  
recovery by April 18, 2012, by which time the worker had discontinued Cipralex and was  
returning to work after a lengthy period of psychological treatment with Ms. Karasick-Franks.  
However, this attempt at a return to work was not sustained as the worker’s position was  
terminated on May 31, 2012 after a conflict with a manager. Dr. Gill said it was likely that the  
worker’s psychological condition stabilized at some point between April 2012 and October 20,  
2012, but identified the most likely date on which it reached maximum recovery as October 20,  
2012, after substantial treatment with Ms. Karasick-Franks:  
At that time, [the worker] reportedly had experienced some improvement to sleep  
and some increased comfort with driving yet continued to be nervous while  
driving, worried about people on the road and still thought about people driving  
and experienced elevated irritability.  
[114] Dr. Gill also noted that Dr. Romano’s records indicated that the worker’s depressive symptoms  
continued through 2011 and into 2015 (although there were no notations regarding depression  
in 2013) and, at the time he first met Mr. Ulmer in early 2015, the worker was noted to be  
experiencing clinical levels of depressive and post-traumatic anxiety symptoms.  
[115] As noted, in the March 9, 2021 decision, the case manager concluded that the worker’s period  
of temporary disability from work commenced on January 29, 2011. The case manager based  
her decision in this regard on the evidence from Ms. Karasick-Franks and Dr. Gill. The case  
manager acknowledged that, following his failed return to work in December 2010, there  
appeared to be a new development in his symptom presentation since, up until that time, the  
worker had been able to maintain his employment across multiple employers. Nevertheless, as  
the evidence showed that the worker was able to work and had earnings in the period  
January 1, 2011 through January 29, 2011, the case manager concluded the worker’s inability  
to work due to his compensable psychological symptoms began as of January 29, 2011.  
24  
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Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
[116] In his request for review of the March 9, 2021 decision, the worker argued that the decision was  
based on incomplete evidence regarding the onset of the worker’s compensable psychological  
disabilities. The worker sought an earlier commencement date, “consistent with evidence of  
clinical levels of psychological disability.”  
[117] In a supporting submission, the worker’s representative submitted that:  
When the worker was injured in 1981, he was young and had a new family. As such, the  
psychological impact of the worker’s foot injury was compounded by his rapid return to  
employment in order to support his family.  
Dr. Gill’s opinion that the worker’s psychological disability was subclinical until after the  
October 2010 motor vehicle accident was based on a lack of treatment records for the  
worker prior to 2011, was not based on a history from the worker or the people who knew  
the worker from 1981 to 2011, and involved insufficient analysis.  
The worker’s PTSD and MDD symptoms were a large factor in difficulties in the worker’s  
marriages, as supported by the statements from Ms. S and Ms. G.  
Prior to 2011, the worker’s occupation kept him “on the road”, and his psychological  
symptoms, self-image, and stoicism caused him to avoid seeking treatment.  
The lack of treatment records does not indicate that the worker’s PTSD and MDD were  
subclinical. Rather, the lack of such records indicates that the PTSD and MDD were simply  
untreated prior to 2011.  
Since Mr. Ulmer treated the worker over a long period, took a direct history from the worker,  
obtained information from the worker’s current spouse, and reviewed the evidence on the  
claim file, his opinion that the worker’s PTSD was present from six months after the 1981  
work incident should be given more weight than the other opinions on file. In contrast,  
Dr. Gill’s opinion was limited by the materials provided and a lack of direct interaction with  
the worker.  
Given the nature and circumstances of the worker’s physical injury in 1981, his symptoms  
since that date, the observations of those who knew him best since the date of injury, and  
the diagnosis of Mr. Ulmer that the worker suffered from PTSD and MDD since March 1982,  
his PTSD and MDD should be accepted as of that date.  
[118] In Review Reference #R0278456, the review officer defined the issue before her as whether the  
worker was entitled to wage loss benefits prior to January 29, 2011 for his compensable MDD  
and PTSD.  
[119] The review officer acknowledged the submissions of the worker’s representative and the  
evidence from Ms. G. However, she noted that Dr. Gill’s opinion was based on a thorough  
review of all of the relevant evidence on the claim file, which included the July 2016 letter and  
25  
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Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
other evidence from Mr. Ulmer and the evidence from Ms. G. The review officer was satisfied  
that Dr. Gill considered this evidence in reaching his conclusion that, while the worker may have  
developed symptoms of MDD and PTSD after the 1981 work incident, these conditions  
remained subclinical and were not disabling until the month after his October 2010 motor  
vehicle accident. Further, the review officer was satisfied that Dr. Gill provided a detailed  
explanation as to how he reached his conclusions. She recognized that Dr. Gill did not interview  
or treat the worker, but concluded that this was not a reason to give his opinion less weight.  
Rather, she was satisfied there was sufficient medical evidence, including several psychological  
assessments that involved detailed interviews with the worker, to allow Dr. Gill to reach his  
conclusions.  
[120] Based on her review of the evidence on file, including the description of the job history after the  
1981 incident that the worker had prepared, the review officer agreed with Dr. Gill’s comment  
that the worker appeared to have maintained employment from 1981 to 2012 without significant  
gaps between jobs. The review officer noted that this comment was also consistent with the  
worker’s statements to Ms. Karasick-Franks and Dr. McGuire and indicated to the review officer  
that, while the worker may have experienced symptoms of his compensable MDD and PTSD  
prior to the October 2010 motor vehicle accident, he was not disabled from working by these  
conditions until he went off work for an extended period following the October 2010 motor  
vehicle accident.  
[121] As noted, the review officer concluded that the worker was entitled to additional wage loss  
benefits for his PTSD and MDD beginning November 1, 2010. The review officer acknowledged  
that Dr. Gill had described the worker having “further disability” after he unsuccessfully returned  
to work following the October 10, 2010 motor vehicle accident (as of January 29, 2011).  
However, Dr. Gill had also said that the worker’s disability due to his psychological symptoms  
likely commenced as of November 2010, when Dr. Karasick-Franks said the worker had an  
Acute Stress Disorder which later became PTSD. Although it was not entirely clear, the review  
officer was satisfied that Dr. Gill’s reference to the worker’s disabling symptoms in November  
2010 included, at least in part, symptoms associated with the compensable MDD and/or PTSD.  
Submissions  
[122] In this appeal, the worker seeks a finding that he is entitled to a permanent partial disability  
pension equal to 30% of total disability for his compensable MDD and PTSD, dating back to  
April 1982 (Notice of Appeal), or as of March 1, 1982 (submissions by the worker’s  
representative).  
[123] The worker’s representative submitted that the review officer mischaracterized the issue as  
whether the worker was entitled to wage loss benefits prior to January 29, 2011 and that the  
correct issue is the correct date for the commencement of his mental health injuries.  
26  
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
[124] The worker’s representative said that:  
The worker’s decision to return to work as a truck driver very quickly after September 1981  
notwithstanding the nature and severity of his injuries was due to a combination of a denial  
by the worker about the severity of his injuries, his being 19 years old, and his being recently  
married and having a child and wife to support.  
The evidence of Ms. S supports that the worker suffered a pronounced, acute change in his  
personality because of his September 1981 work accident that was consistent with PTSD  
and MDD.  
The expression of PTSD and MDD caused the failure of the worker’s marriage to Ms. S,  
alienation from his birth family (including his brothers with whom he worked successfully  
prior to the injury), immersion in self-isolation, and consistent loss of employment because of  
the expression of his PTSD and MDD symptoms.  
The proper characterization of the worker’s employment history from December 1981 to  
November 2010 in relation to his PTSD and MDD is that his employment with approximately  
45 employers during that time is consistent with acute mental health symptoms which  
caused the worker to be abrasive, defensive, and isolated to a level where he could not  
sustain consistent employment with individual employers. A clear example of this was the  
worker’s employment history with the employer that terminated his employment in 2012,  
after noting his engagement in unreasonable, unnecessary, and unprovoked confrontations.  
The worker’s history of nightmares, isolation, uncommunicativeness, and unpredictable  
behaviour is consistent from December 1981 onward.  
The worker’s PTSD and MDD became so acute after November 2010 that he became  
unemployable; the fact that he worked prior to November 2010 does not mean his  
symptoms were not acute; rather, his coping mechanisms, as with many people with PTSD  
and MDD, require examination to assess the severity of the PTSD and MDD.  
It is possible that both the opinion from Mr. Ulmer that the worker’s symptoms of PTSD  
began immediately after the 1981 injury and that full criteria for PTSD had been met within  
six months of the injury date and Ms. Karasick-Franks’ attribution of the worker’s PTSD to  
the 2010 and 2012 motor vehicle accidents are correct; post-traumatic anxiety tends to be  
cumulative in nature, worsening with each subsequent traumatic event.  
There is no opinion contrary to Mr. Ulmer’s opinion that the worker’s post-traumatic  
symptomatology was present immediately after the 1981 injury and PTSD was present by  
six months after the 1981 injury, and so there is no reason not to accept Mr. Ulmer’s opinion  
in this regard.  
According to Dr. Feehan, it is possible to have PTSD without this condition being disabling  
from work, and the fact that the worker was able to work for many years after his workplace  
27  
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Tel: (604) 664-7800 | 1-800-663-2782  
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WCAT Decision Number:  
A2102352 (July 6, 2022)  
injury suggests that his post-traumatic symptomatology had been mild enough so as not to  
disable him from work.  
Dr. Feehan’s use of the language “his posttraumatic symptomatology had been mild enough  
so as not to disable him from work” does not mean that the PTSD and MDD  
symptomatology was not acute; rather, it means that the severity of the symptoms post 1981  
coupled with the worker’s adaptive strategies allowed him to work.  
Given that that the worker’s PTSD and MDD occurred prior to March 3, 2003, WCAT has  
broad adjudicative discretion that includes the discretion to both determine a date of  
March 1, 1982 for the commencement of the worker’s mental health injuries and to also set  
the amount of the permanent partial disability award.  
Given the history on this claim, the law and policy applicable during each version of the Act  
from 1981 forward, and the fact that, as of 1982, mental health injuries were not a scheduled  
award, WCAT is in as good a position or a better position than the Board to establish the  
correct permanent partial disability award.  
While not binding, the present mental health disability award schedule is of assistance in  
setting the worker’s pension amount.  
Bearing in mind Dr. Feehan’s characterization of the worker’s symptomatology being mild  
enough to enable him to work and the severity of the change in the worker’s personality  
noted by Ms. S, and with reference to the current schedule, a 30% functional disability  
award for his mental health injuries is appropriate.  
Analysis and Findings  
Method of Hearing  
[125] The worker requested that the appeal be heard in writing, through written submissions.  
[126] I have reviewed the record and considered the rule and the other criteria set out in item 7.5  
(Appeal Method) of WCAT’s Manual of Rules of Practice and Procedure (MRPP). It provides  
that, if an appellant requests an oral hearing, WCAT will normally grant that request where the  
appeal involves a significant issue of credibility and/or where there are significant factual issues  
in dispute. Conversely, WCAT will normally conduct an appeal by written submissions where the  
issues are largely medical, legal, or policy based and credibility is not at issue.  
[127] After reviewing the evidence and submissions, I was satisfied that I could address any  
potentially relevant factual disputes by way of the evidence and the written submissions. I  
considered whether to convene an oral hearing for the purpose obtaining additional evidence  
from the worker regarding the onset, nature, and course of his psychological symptoms dating  
back to September 3, 1981.  
28  
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WCAT Decision Number:  
A2102352 (July 6, 2022)  
[128] However, I concluded that any oral evidence received from the worker, who would be the only  
witness with relevant testimony on matters, would likely be subject to the same reliability  
concerns as were evident during Dr. McGuire’s assessment and psychometric testing of the  
worker. Mr. Ulmer identified a number of possible explanations for the worker’s substantial  
over-reporting of concerns on all measures with validity scales and on the self-report validity  
scale, failure to mention the 2010 and 2012 motor vehicle accidents to him, and overstatement  
about the nature of the initial injury, including that: the worker may be a malingerer, may have  
negative alterations in cognition rather than having made an outright attempt to misrepresent  
the truth, or may have an inability to remember important aspects of his experience of trauma.  
Dr. McGuire also identified the possibility that the worker was motivated by a secondary gain or  
that he may have felt that he would not be heard unless he could demonstrate the severity of his  
symptoms and how much suffering he was experiencing. Ultimately, neither Mr. Ulmer nor  
Dr. McGuire were able to identify the actual reason for the worker’s unreliability as a historian,  
but their evidence confirms that, for whatever reason, the worker would not likely be a reliable  
witness if called to testify.  
[129] I have accepted the worker’s request to proceed with this appeal by way of written submissions.  
Scope of WCAT’s Jurisdiction  
[130] The worker’s representative has submitted that the worker developed his compensable MDD  
and PTSD secondary to the traumatic pain associated with his injuries and has suffered from  
these conditions dating back to either March 1, 1982 or April 1982. In addition to seeking a  
decision that the worker’s mental health injuries commenced on one of these dates, he  
submitted that WCAT has authority to set the amount of a permanent functional partial disability  
award for these conditions and should do so in the amount of 30% of total disability, effective  
March 1, 1982.  
[131] The decisions under appeal did not address the matter of the extent of the worker’s entitlement  
to a permanent disability benefit for a compensable MDD or PTSD.  
[132] The scope of the issues that a WCAT vice chair may decide in an appeal is explained in  
item 3.3.1 of WCAT’s MRPP as follows:  
Where a decision of the Review Division is appealed to WCAT, WCAT has  
jurisdiction to address any issue determined in either the Review Division  
decision or the Board decision(s) which was under review, subject to the  
statutory limits on WCAT’s jurisdiction. Similarly, when considering appeals of  
Board decisions which are appealable directly to WCAT, WCAT has jurisdiction  
to address any issue determined in the decision appealed.  
29  
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Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
[133] I acknowledge that the commencement date of the worker’s entitlement to compensation  
benefits for his MDD and PTSD as well as his potential entitlement to a permanent disability  
benefit are matters to be determined in accordance with the Act as it read prior to June 30,  
2002. However, my jurisdiction is confined to the jurisdiction conferred by the Act as it currently  
reads. Therefore, even if, as it read in some form prior to June 30, 2002, the Act allowed  
appellate authorities (the former Workers’ Compensation Review Board and the former  
Workers’ Compensation Appeal Division) to assume jurisdiction over matters that had not first  
been adjudicated by the Board, I do not have authority to do so. I have no authority to address  
the worker’s entitlement to, or the quantum of, any permanent disability benefits relating to his  
compensable injuries. I decline to make any findings in that regard.  
Scope of Decision  
[134] In Review Reference #R0278456, the review officer noted that review officers will normally only  
address those issues that have been put into dispute by the parties. Therefore, aside from  
addressing the issue of whether the worker’s psychological disability commenced prior to  
January 29, 2011 (and going on to decide that the worker was temporarily disabled by his MDD  
and PTSD and so entitled to wage loss benefits as of November 1, 2010),12 the review officer  
did not address the other matters decided in the March 9, 2021 decision.  
[135] Similarly, item 3.3.1 of WCAT’s MRPP provides that, while WCAT has jurisdiction to address  
any issue determined in the Board or Review Division decisions under appeal, WCAT panels  
will generally restrict their decisions to the issues raised by the appellant in his or her notice of  
appeal. I can see no compelling reason to extend my adjudication beyond the issue raised by  
the worker and so have confined my decision to that matter.  
What is the correct date for commencement of the worker’s entitlement to compensation  
benefits for his MDD and PTSD?  
[136] Section 5(1) of the former Act provides that compensation is payable to workers for personal  
injuries arising out of and in the course of their employment. The type of compensation payable  
includes temporary disability (wage loss) benefits where a worker’s compensable injury is  
temporarily disabling, health care benefits for medical expenses and treatments that the Board  
considers reasonably necessary to treat or alleviate the effects of the injury, vocational  
rehabilitation benefits, and permanent functional impairment awards,  
12 For clarity, I note that these other matters, which are also not challenged in this appeal, are: the  
amounts do be deducted from the worker’s wage loss benefits from March 14, 2011 through June 17,  
2012; the date on which the MDD and PTSD stabilized as permanent after March 14. 2011; the  
worker’s entitlement to assessment by the Board’s Long Term Disability Services; and, the worker’s  
entitlement to be referred to Vocational Rehabilitation Services.  
30  
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
[137] Policy item #22.00 of the RSCM I states, in part:  
Once it is established that an injury arose out of and in the course of  
employment, the question arises as to what consequences of that injury are  
compensable. The minimum requirement before one event can be considered as  
the consequence of another is that it would not have happened but for the other.  
[138] The policy goes on to note that not all consequences of work injuries are compensable. A claim  
will be reopened for a later injury only if the work injury was a “significant cause” of the further  
injury.  
[139] In WCAT-2010-01448, a three-member, non-precedent WCAT panel summarized a number of  
prior decisions of the Board’s former Appeal Division, WCAT, and the British Columbia courts  
about the test of causative significance that applies under section 5 of the former Act. The panel  
concluded, in order to establish employment causation, it is not necessary that the employment  
have been the sole cause, the predominant cause, or even a major cause of the disability; it is  
sufficient that the employment was of some causative significance, which was more than  
negligible or trifling (de minimis) in nature. Although not binding on me, I consider the above  
statement to properly explain the meaning of “causative significance” and I also accept that the  
analysis applies to the term “significant cause” that is used in policy item #22.00 of the RSCM I.  
[140] Policy item #22.33 of the RSCM I provides guidance where, as is the case here, a worker seeks  
acceptance of psychological problems arising from a physical injury. That policy provides that  
such problems may be acceptable as compensable consequences of the injury. Prior WCAT  
panels have concluded, and I agree, that a specific psychological diagnosis is not a precondition  
to acceptance of a psychological injury as a compensable consequence of a physical injury.  
However, as stated in policy item #22.33:  
… [T]here must be evidence that the claimant is psychologically disabled. It  
cannot be assumed that such a disability exists simply because the claimant has  
unexplained subjective complaints or is having difficulty in psychologically or  
emotionally adjusting to any physical limitations resulting from the injury  
acceptance of a psychological condition.  
[141] I am bound by the final decisions of the Board and Review Division that were made prior to  
March 9, 2021. As a result, the Board’s acceptance that the September 3, 1981 work incident  
was of causative significance to the MDD and PTSD with which the worker has now been  
diagnosed is binding on me.  
[142] This means that the central issue in this appeal is the date on which the evidence shows that  
the worker was psychologically disabled by these compensable conditions.  
31  
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
[143] I accept that there is sufficient evidence to find that it is at least as likely as not that, as of  
November 1, 2010, the worker was psychologically disabled by the compensable MDD and  
PTSD that were later diagnosed. However, I am not persuaded that there is sufficient positive  
evidence to support that this was the case at any point prior to that date.  
[144] I acknowledge that Mr. Ulmer has expressed a strong opinion that the worker developed  
symptoms of PTSD at the time of the September 3, 1981 work incident and that he met the full  
diagnostic criteria for this condition within six months of that date. However, I do not find his  
opinion persuasive.  
[145] First, Mr. Ulmer has himself identified a reason why his opinion cannot be considered reliable.  
Dr. Feehan noted that Mr. Ulmer was acting as the worker’s therapist and it was usual for a  
therapist to accept the word of the client, both so that rapport can be established and as an act  
of validation of the client’s experience. Even though he acknowledged that the worker’s  
recollection of his experience and recall of the 1981 work incident was not accurate and he did  
not know the reason why the worker did not mention his treatment with Ms. Karasick-Franks or  
the 2010 and 2012 motor vehicle accidents, he said in the same opinion that he accepted that  
the worker’s recall of his experience was truthful because it would have severely damaged his  
therapeutic alliance with the worker to question the worker’s authenticity or his potential  
exaggeration of reported symptoms. As Dr. Feehan pointed out, Mr. Ulmer did not undertake a  
forensic interview or administer psychometric tests and it is apparent that Mr. Ulmer based his  
opinion on facts, as recounted by the worker, that Mr. Ulmer himself admitted were not  
accurate.  
[146] Second, the facts upon which Mr. Ulmer based his conclusion that the worker met the full  
criteria for a PTSD diagnosis13 at least six months after the incident derive from a factual  
account provided by the worker that is contrary to other reliable evidence. Most importantly,  
Ms. S, who had an intimate relationship with the worker on a daily basis in the years following  
September 3, 1981 has provided evidence that the worker did not exhibit any change in  
demeanour until after the Board gave him a small settlement. Although Ms. S identified this  
triggering event to have occurred by the fall of 1982, the documentation in the claim file confirms  
that it was not until July 1983, almost two years after the work incident, that the Board provided  
the worker with this settlement (the $3,092.70 lump sum disability award). In light of this  
evidence, I do not agree with the position of the worker’s representative that the evidence  
supports that the worker suffered a pronounced, acute change in his personality because of his  
September 1981 work accident that is consistent with MDD and PTSD.  
13 Given Dr. Feehan’s clarification that the worker would not have met the criteria for this condition in the  
third edition of the DSM that was in force in 1981, I take Mr. Ulmer to have been referring to the current  
DSM diagnostic criteria in the fifth edition of the DSM, which applied when he initially met the worker in  
May 2015.  
32  
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
[147] I also note that, in addition to identifying the worker’s dissatisfaction with his July 1983 pension  
payout as the trigger for his change in demeanour, this change in demeanour also occurred  
after the December 1981 roll-over accident that the worker’s representative identified in the  
request for review of the Board’s July 22, 2019 decision. As the worker did not mention this  
accident to any of his treatment providers, it cannot be known if this significant event also had a  
role to play in the demeanour change noted by Ms. S in 1983.  
[148] Third, while Mr. Ulmer has discounted that the 2010 and 2012 motor vehicle accidents were of  
causative significance to the development of the worker’s PTSD and MDD, or to an  
exacerbation of a subclinical PTSD or MDD that pre-existed those accidents, he has not  
provided any explanation for this other than the worker’s clinical presentation. Mr. Ulmer only  
started seeing the worker in 2015 and it is unclear how, given these intervening accidents and  
the significant impact on the worker’s psychological function identified by Ms. Karasick-Franks, if  
clinical observation of the worker in 2015 can reasonably be expected to be the same as it  
would have been had he seen the worker in 1981 or at any time prior to the 2010 motor vehicle  
accident. This is particularly so given Mr. Ulmer’s confirmation in the July 16, 2018 letter that, at  
the worker’s request, his treatments of the worker have been designed to avoid exposure to  
prior traumatic events as this is often very difficult to go through and can often exacerbate  
existing psychological difficulties.  
[149] Finally, while it may be that Mr. Ulmer reviewed the full claim, as stated by the worker’s  
representative, Mr. Ulmer made no effort to address what, if any role, the various other  
traumatic incidents the worker was involved in (the 1991 roll-over incident, the 2002 or 2003  
incident following which the worker was emotionally distressed because the other driver was  
killed, the 2008 motor vehicle accident, and the instance where the worker was robbed at  
gunpoint) might have had on his psychological functioning in 2015. As noted, Mr. Ulmer did  
acknowledge the non-compensable 2010 and 2012 motor vehicle accidents, but provided no  
discussion to support that they did not have a causative role in the worker’s MDD and PTSD.  
[150] I acknowledge that the worker may have had a distrust for the field of psychiatry and would  
never have considered getting help for his feelings. Also, I have no reason to doubt that he  
currently believes that he had depression before the October 29, 2010 motor vehicle accident,  
“but maybe never mentioned it,” or to doubt that he currently believes that the expression of  
temper and labour relations issues that led to his employment relationships being terminated is  
the fact that many of his jobs can be attributed to symptoms of MDD or PTSD that resulted from  
the September 3, 1981 work incident. However, I find that there is reliable contrary evidence  
supporting that the worker did not have a psychological disability resulting from his  
compensable MDD or PTSD prior to November 1, 2010.  
[151] As set out above, Ms. Karasick-Franks provided the worker with psychological treatment for  
approximately 20 months following the 2010 and 2012 motor vehicle accidents. During that  
time, she obtained a significant amount of information regarding the worker’s past history,  
33  
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
including the 1981 work accident, following which the worker then said that he did not  
experience psychological consequences, a prior motor vehicle accident in 1998, following which  
he was emotionally distressed because the other driver died, and an instance where he was  
robbed at gunpoint. Because the worker specifically denied that he had depression or PTSD  
symptoms prior to the October 2010 accident other than the period of emotional distress that  
followed the 1998 motor vehicle accident, I am unable to accept that the worker’s current  
recollection that he did have symptoms of depression relating back to the 1981 work accident  
is reliable. Based on her extensive involvement with the worker in 2010 and 2011,  
Ms. Karasick-Franks concluded that the October 19, 2010 motor vehicle accident was the index  
event that resulted in his PTSD, depression, and anxiety symptoms. I accept her opinion in this  
regard.  
[152] Ms. Karasick-Franks’ assessment of the worker was significantly closer in time to the 1981 work  
incident than Mr. Ulmer’s assessment and she first saw him within five months of the  
October 29, 2010 motor vehicle accident, at a time when the worker’s recollection of the effect  
of that accident on his mental health would have been fresh. Further, Ms. Karasick-Franks  
observed that the worker was forthright and candid during her interviews of him, whereas  
Mr. Ulmer has acknowledged that, during his interviews, the worker did not represent central  
facts reliably. Dr. Karasick-Franks’ opinion is also consistent with other earlier evidence  
confirming the absence of disabling pre-October 2010 symptoms of PTSD, depression, and  
anxiety, including: the worker’s report to the Board in early 1982 that he was doing “okay” with  
driving, other than having difficulty with unloading his trailer; The Alberta Board medical officer’s  
December 1982 report that, other than complaints of fatigue and difficulty kneeling, and the  
expression of anger about being reimbursed for only one of five days’ wages he lost by  
attending the evaluation, the worker was otherwise well; the Alberta physician’s records from  
2006 which document that, with the exception of occasional discomfort in his right foot, the  
worker was able to function well up until his 2006 injury; Dr. Oljinik’s June 14, 2007  
documentation that the worker denied a psychiatric history; Dr. Meakins’ March 3, 2015 finding  
that the worker did not have persistent depression secondary to pain, but did have  
deteriorations in his mood related to the pain; and, the absence of any reference to  
psychological symptoms in the records from Dr. Romano (who has been the worker’s family  
physician for over 35 years) until June 21, 2011. I also noted that the claim includes a May 25,  
2016 letter from the information clerk at the Alberta Board who advised that a search had been  
completed and there were no claims or documentation of psychological issues or of a PTSD  
diagnosis in their files relating to the worker.  
[153] Additionally, while the worker did change employers frequently in the years 1981 to 2013, with  
the longest terms of employment lasting over four years (from March 2008 to May 2012), the  
documentation on the claim file supports Dr. McGuire’s conclusion that the worker’s symptoms  
were not significantly disabling and, likely, were subclinical prior to the motor vehicle accident in  
2010. Contrary to the suggestion of the worker’s representative, the fact that the worker’s  
employment may have been terminated in 2012 at least in part because the worker then had  
34  
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  
WCAT Decision Number:  
A2102352 (July 6, 2022)  
clinically relevant symptoms does not support that he also had a psychological disability prior to  
November 1, 2010. I do not find evidence to support that the worker had a history of nightmares,  
isolation, and uncommunicative behaviour that was consistent from December 1981 onward.  
Further, to the extent that the worker experienced such difficulties of this nature prior to  
November 1, 2010, there is insufficient positive evidence showing that the 1981 work accident  
was of causative significance to their development.  
[154] I find insufficient positive evidence to support that, prior to November 1, 2010, it is at least as  
likely as not that the worker had a psychological disability due to his compensable MDD and  
PTSD. Therefore, I confirm the Review Division’s November 22, 2021 decision.  
Conclusion  
[155] I deny the worker’s appeal and confirm the Review Division’s November 22, 2021 decision.  
[156] I conclude that the correct date for commencement of the worker’s entitlement to compensation  
benefits for his MDD and PTSD was, as implicitly found by the review officer, November 1,  
2010.  
[157] As I have no authority to grant the worker a permanent partial disability benefit, I decline to  
make any findings regarding his entitlement to such a benefit.  
[158] There has been no request for reimbursement of appeal expenses. Therefore, I make no order  
in that regard.  
Deirdre Rice  
Vice Chair  
35  
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca  


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