WCAT Decision Number:  
A2102416 (July 22, 2022)  
WCAT Decision Number:  
WCAT Decision Date:  
July 22, 2022  
On December 2, 2017, the worker fell from a ladder while working as a framer. He landed on his  
back and left side and sustained T6 and T7 compression fractures, a C7 spinous process  
fracture, and a left scapular fracture inferior to the glenoid.  
The worker filed a claim for compensation that was accepted by the Workers’ Compensation  
Board (Board)1 for the permanent conditions of T6 and T7 compression fractures and chronic  
thoracic back pain. The Board found that the C7 and left scapular fractures had resolved.  
The Board assessed the worker’s permanent partial physical disability as equal to 4.3% of total  
disability on a loss of function basis, consisting of 2.50% for chronic pain, effective June 2,  
2018, and 1.80% for loss of function at the T6 and T7 levels of the spine, effective August 19,  
The Board has accepted that the worker is unable to return to his pre-injury employment but has  
concluded that he can adapt to the alternate occupation of social and community service worker  
In a March 24, 2021 decision, a Board long-term disability officer granted the worker a  
permanent partial disability benefit, payable on a loss of earnings basis, effective August 19,  
2019. The award is based on the difference between the long-term wage rate established on the  
claim and the amount the Board has found the worker is capable of earning from full-time work  
in the CSW occupation.  
In a July 19, 2021 decision, the Board accepted the condition of Other Specified Trauma- and  
Stressor-Related Disorder as a permanent condition on the claim, effective July 5, 2021.  
Assessment of the worker’s entitlement to a permanent partial disability benefit for this condition  
remains outstanding. The Board initially accepted this condition on a temporary basis in a  
November 5, 2019 decision.  
The Board operates as WorkSafeBC.  
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:  
A2102416 (July 22, 2022)  
On November 3, 2021, a review officer with the Board’s Review Division confirmed the  
March 24, 2021 decision (Review Reference #R0279846).  
The worker has appealed the Review Division decision to the Workers’ Compensation Appeal  
Tribunal (WCAT).  
I held an oral videoconference hearing of the appeal on May 10, 2022. The worker and his  
representative participated in the hearing. The employer is not participating in the appeal.  
The issue is: what is the extent of the worker’s loss of earnings benefit for his permanent  
compensable physical conditions, effective August 19, 2019?  
Jurisdiction and Standard of Proof  
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.  
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.  
I am bound to apply the published policies of the board of directors of the Board, subject to the  
provisions of section 304 of the Act. The applicable Board policies for this appeal are set out in  
the Rehabilitation Services and Claims Manual, Volume II.  
At the time of the December 2017 work accident, the worker was employed full time as an  
apprentice carpenter. He was standing on the third rung from the top of an eight-foot ladder and  
was pulling a sheet of plywood off. He thought the plywood would come off easily but was  
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:  
A2102416 (July 22, 2022)  
unaware that there was still one screw on. He exerted more force in pulling and the plywood  
gave way suddenly and unexpectedly. The worker lost his balance and fell backwards off the  
ladder and landed on his left side, on his left shoulder/back. He recalled hitting his head but he  
was wearing his hard hat.  
The worker received emergency medical treatment for his injuries. After assessment by  
orthopaedic surgeon Dr. Krywulak regarding his scapular fracture and by neurosurgeon  
Dr. Goplen regarding his spinal fractures, it was determined that the worker did not require  
surgical intervention.  
In a December 14, 2017 decision, the Board advised the worker that his claim had been  
accepted for a left shoulder/scapular fracture as well as a “spinal/vertebral column fracture”2  
(later identified by the Board as “compression fractures of spine at T6 and T7”).  
After three months of rest, the worker participated in physiotherapy and an occupational  
rehabilitation 2 (OR2) program that included a graduated return to work. At discharge from the  
OR2 program on April 20, 2018, the worker had ongoing subjective reports of pain during  
functional activities. However, he reported that he was at about 80% of where he was before his  
injury, was happy with the progress he had made, and was doing 100% of his job duties at that  
point. The OR2 program provider concluded that the worker was fit to return to work without  
limitations and the worker returned to full-time work as a framer.  
In an April 25, 2018 decision, the Board concluded the worker’s wage loss benefits effective  
April 22, 2018. As well, the Board decided that the worker’s injury had not resulted in any  
permanent conditions and therefore, he would not be assessed for permanent partial disability  
Following this, there was no contact between the Board and the worker until early 2019, when  
the worker asked the Board to reopen his claim and assist him with changing career paths. The  
worker advised that his doctor had told him that it would take up to a year to see full recovery  
from his compensable injuries but, at just over one year, his condition had been getting worse.  
He said that he had a constant ache/pain in his back where the disc “was crushed”. It ached  
worse when he was doing manual labour, but the pain never went away; it was “brutal” and  
constant from the moment he got up until he went to bed. The worker was continuing to work at  
this time.  
In an April 30, 2019 progress report to the Board, Dr. Parsons, the worker’s family physician,  
advised that the worker had developed severe depression. She prescribed Effexor. In prior  
reports dating back to 2017, she had also recorded that the worker was having psychological  
difficulties of varying degrees. Many of these were related to the pain from the worker’s back  
All quotations have been reproduced as written, unless otherwise indicated.  
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:  
A2102416 (July 22, 2022)  
injury, including that he was quite fearful of these symptoms. However, there were also other  
causal factors identified. In October 2018, when the worker was completing courses related to  
his apprenticeship, he was struggling with memory and concentration, having struggled for  
years with math, and he reported that his mood would go down thinking about his difficulties in  
In a May 7, 2019 consultation report, Dr. Ganesan, a physician with an interest in pain  
management, noted that the worker described his pain as a “constant dull ache” which  
worsened with activity.  
A May 19, 2019 CT scan of the worker’s thoracic spine showed a healed burst compression  
fracture at T7 with minimal anterior progression of height loss and a stable minor superior  
endplate compression fracture at T6.  
The worker went off work as of June 26, 2019 owing to pain and he applied for Employment  
Insurance benefits.  
As the worker was suffering emotional, mood, and other psychological issues, the Board  
arranged for him to undergo a psychology assessment with registered psychologist  
Dr. Gambouras. In an August 23, 2019 psychology assessment report, Dr. Gambouras  
concluded that the worker’s psychological difficulties could be directly attributed to the  
December 2, 2017 work injury and subsequent functional changes and pain. Based on the  
background information available to him, cautious interpretation of personality examination  
results overall, and clinical interview data, Dr. Gambouras diagnosed the worker with Other  
Specified Trauma-and Stressor-Related Disorder.  
Dr. Gambouras concluded that psychological restrictions and limitations might be ongoing  
problems for the worker, as follows:  
… [A]s ongoing mood difficulties appear largely dictated by persistence of pain,  
functional problems, if the patient improves to a point, physically, pain-wise, that  
he can in fact return to some level of productive activity, it would be my  
impression that his mood levels would also have hopefully returned to close-to  
premorbid levels, and no or minimal psychological limitations or restrictions  
would therefore be necessary. With that said, it is my impression that, given the  
nature of current emotional and cognitive difficulties (i.e., poor frustration  
tolerance and anxiety with pain exacerbations), the patient will likely have an  
even further reduced capacity in parts of a job that involve a high degree of time  
pressures, sustained mental effort and concentration, or competing activities  
and/or outside distractions in particular on a more painful day. As he has worked  
for several months in carpentry post-injury (only having to stop working due to  
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:  
A2102416 (July 22, 2022)  
pain it appears), there does not seem to be any need, psychologically, for work  
In terms of RTW [return to work] or vocational rehabilitation (VR), it is my  
impression that persistent physical issues, pain (v emotional) factors will serve as  
the primary barriers to sufficient engagement, participation, and benefit from any  
RTW or VR at this time. In this vein, psychologically, he seems reasonably ready  
for VR.  
In August 2019, the worker began working as a railing installer for a new employer where light  
duty work was available.  
In a September 13, 2019 decision, the Board advised the worker that, in addition to the  
previously accepted injuries, the Board had also accepted an undisplaced fracture of the  
spinous process at C7 and chronic back pain under the claim. The C7 fracture had resolved and  
did not result in any permanent conditions. However, the chronic back pain was permanent and  
so he was entitled to a referral to the Board’s Disability Awards Department. The Board  
concluded that the worker was able to return to his pre-injury job and restore his pre-injury  
Neurosurgeon Dr. Faridi assessed the worker on October 29, 2019. He believed that the  
thoracic fractures the worker sustained on December 2, 2017 (a burst fracture at T7 and a mild  
compression fracture at T6) had healed, but booked the worker for an MRI scan to make sure  
the fractures had not affected the spinal cord. The worker was continuing to have pain and  
Dr. Faridi said that, as heavy work most likely would cause pain, the best thing for the worker  
would be to re-educate him in non-labour type work; the worker was currently unable to go back  
to work or lift anything heavy. Dr. Faridi assured the worker that the fracture had healed, that  
nothing needed to be done, and that he should be “okay.”  
As noted, in a November 5, 2019 decision, the Board accepted Other Specified Trauma- and  
Stressor-Related Disorder under the claim. The Board also advised the worker that his claim  
had been reopened as of June 26, 2019 and a payment of wage loss benefits had been issued  
for the time he missed from work up to August 19, 2019. In addition, although he had declined  
to accept these services at this time, the Board remained willing to sponsor his participation in a  
pain and medication management program (PMMP) and to provide him with a block of  
psychological treatments or counselling. Further, his claim had been referred to the Disability  
Awards Department for assessment of his entitlement to a permanent partial disability award for  
the compression fractures of the spine at T6 and T7.  
Dr. Dray, an external provider, medical examination for impairment assessment on  
December 12, 2019. The worker reported that his condition was worse than it was six months  
prior; he was continuing to experience pain, which seemed to be worsening. The worker’s chief  
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:  
A2102416 (July 22, 2022)  
complaints included: an inability to work in excess of a couple of hours before he experienced  
“intense” pain; the inability to participate in sporting activities; requiring pain medication (he was  
taking Tylenol No. 3); persisting “brutal” pain despite eating healthy and performing exercises;  
his neck aching at random times and frequently feeling stiff; cold causing pain that was  
“unbearable”; the inability to perform squats or heavy weights at the gym; and, constant low  
back pain which seemed to be extending into his neck. For financial reasons, the worker had  
moved back home and was living with his parents and he advised that, with respect to  
household activities, he was unable to lift anything in excess of 30 pounds. Also, working for  
long periods of time increased the intensity of his pain and, at that time, was working two to  
three days a week setting up safety railings on flat rooftops. This job was less physical than the  
job he was performing at the time of the injury. The worker also reported that his driving  
tolerance was 45 minutes, at which juncture he has to get out and stretch and sitting in a pub or  
restaurant aggravated his pain. He stated, “Practically everything has changed in a bad way”.  
Dr. Dray reported that: the worker transitioned smoothly from sitting to standing and walked with  
a normal gait; he demonstrated the ability to walk on his toes and heels without difficulty;  
tandem gait was normal, and, he performed a full independent squat. Based on his examination  
findings, Dr. Dray reported that the worker had ongoing pain “in the area of accepted injury  
(thoracic spine) and neck, restricted range of motion in the thoracic spine but normal range in  
the cervical spine and lumbar spine, motor function was intact, and sensation was intact. There  
was no visible spinal deformity and alignment was normal, and there was no muscle wasting  
about the neck, shoulder girdles, or arms, and there was no scapular winging. The worker did  
have a mild palpable deformity at the T7 level and the T6 and T7 vertebrae were tender; also,  
there was tenderness of the paracervical musculature on the right. Dr. Dray concluded that  
there was less than 50% compression associated with the T6 compression fracture and over  
50% compression associated with the T7 compression fracture.  
At the end of December 2019, the worker left his job with the new employer because the  
demands were much the same as those in his previous job.  
A January 6, 2020 x-ray of the worker’s cervical spine and left shoulder revealed no abnormal  
findings at the left shoulder, and no acute abnormalities at the cervical spine.  
On January 16, 2020, the worker saw physiatrist Dr. Rajasekaran regarding ongoing symptoms  
in his left shoulder. On examination, Dr. Rajasekaran found pain-free range of motion in the  
shoulder and full rotator cuff strength. However, impingement testing was positive and the  
shoulder was tender to palpation in the subacromial region. Dr. Rajasekaran said that the  
worker presented with a post-traumatic onset of left shoulder pain. Also, an  
ultrasound examination revealed an intact rotator cuff, but showed mild to moderate  
subacromial-subdeltoid bursitis. Dr. Rajasekaran encouraged the worker to continue with a  
structured exercise program.  
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:  
A2102416 (July 22, 2022)  
On January 22 and 23, 2020, the worker participated in a functional capacity evaluation in order  
to identify his functional abilities and limitations and compare these to his pre-injury position as a  
framer. The assessing kinesiologist identified a number of physical limitations, including in the  
worker’s ability to: tolerate low-level work; engage in prolonged periods of bilateral reaching or  
overhead work; sit beyond one and one-half hours unless provided the opportunity for postural  
breaks every one to one and one-half hours; stand for prolonged periods of time; and, engage in  
fast-paced walking.  
The kinesiologist concluded that the worker was no longer physically able to perform the duties  
of this job; although the worker might be capable of more than what he demonstrated during the  
assessment, given his high levels of pain, poor pain management, and overall consistent  
presentation, he was likely not capable of work in more than a sedentary/light strength category.  
Regarding the worker’s overall working tolerance, the kinesiologist reported that, while the  
worker might be able to tolerate full-time work meeting the limitations identified during the  
assessment, he would have to demonstrate improved management of pain and his  
psycho-emotional status in order to maintain employment, as he became increasingly agitated  
with cumulative testing activity, as well as he presented with emotional distress (i.e. tearful,  
expressed frustration and low mood).  
The MRI of the worker’s thoracic spine that Dr. Faridi had ordered was performed on March 3,  
2020 and showed a remote stable compression fracture of T6 without evidence of cord  
The Board granted the worker the permanent partial disability awards for his chronic thoracic  
back pain and more recently accepted permanent T6 and T7 compression fractures in two  
separate decisions dated March 3, 2020. A review officer later confirmed these decisions  
(Review References #R0262618 and #R0262781, dated August 11, 2020).  
As explained in the loss of function review memorandum that was enclosed with the second  
March 3, 2020 decision, when an anatomic and/or surgical impairment is present as well as loss  
of range of movement of the spine, the final impairment rating is based on the greater of the  
two. In the worker’s case, the loss of range of motion in the thoracic spine that Dr. Dray  
measured was equal to 1.80% of total disability. The evidence also supported that the worker  
had an anatomic impairment at the T6 to T7 level. As explained by the disability awards officer,  
this was also equal to 1.80% of total disability:  
Information in the December 2, 2017 [report for a CT scan] … showed that [the  
worker] has suffered a 50 - 60% loss of vertebrae height at the T7 level, and mild  
superior endplate compression fracture of T6 (although the medical documents  
do not show the percentage of T6 vertebrae height, it is rated at mild, and  
therefore I have given 30% loss of vertebrae height at the T6; the DAMA  
[disability awards medical advisor] report also mentions T6 compression fracture  
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:  
A2102416 (July 22, 2022)  
with less than 50% compression). The impairment for the loss of vertebrae height  
at the T6 and T7 level is rated at 1.80% of total disability.  
Because the award resulted in a payment of less than $200 per month, the worker received his  
permanent partial disability award in a lump sum payment.  
In a March 20, 2020 decision, the Board decided to reopen the worker’s claim for a further  
period of wage loss benefits from December 30, 2019 to March 22, 2020. The Board advised  
the worker that, as of March 23, 2020, he may be entitled to vocational rehabilitation benefits  
and that a Board vocational rehabilitation consultant (VRC) would contact him to explain this  
The Board then began paying the worker vocational rehabilitation planning benefits. The worker  
identified the CSW occupation and, following psychovocational testing, in July 2020, the VRC  
approved the worker’s preferred plan to become a CSW.  
As of July 2020, the Board was covering the cost of mental health treatment for the worker with  
registered psychologist Dr. Williams. On July 20, 2020, Dr. Williams discharged the worker as  
he began participating in a PMMP.  
The worker enrolled in a college community support worker-social services program that was  
scheduled to commence in September 2020. The course included a final practicum.  
At this time, the worker was receiving ongoing mental health support and was participating in a  
In an August 11, 2020 discharge report, the PMMP provider reported that the worker was fit to  
return to work, subject to the following limitations:  
Lifting up to 20-30 lb. from floor to shoulder height on an occasional basis.  
Lifting up to 20 lb. each side (40 lb. total) overhead on an occasional basis.  
Carrying up to 50 lb. on an occasional basis over short distances.  
Pushing/pulling with LIGHT (NOC [National Occupational Classification])  
forces on an occasional basis.  
Reaching above shoulder level on an occasional basis.  
Reaching below shoulder level for up to a frequent basis.  
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:  
A2102416 (July 22, 2022)  
The program provider reported that, overall, the worker had progressed well and had shown  
good engagement and psychological gains:  
He has demonstrated increased use of pain and mood symptom management  
techniques and increased psychological flexibility and acceptance, which he  
shared has helped with decreasing the intensity of his pain catastrophizing  
thoughts, and occurrence of suicidal ideation. [The worker] has shown full  
engagement in the physical exercise component and demonstrated steady  
progress in his exercise regime, spine and shoulder girdle stability and mobility.  
Also, assessment using the Personal Assessment Inventory and Beck Depression Inventory  
revealed only minimal depressive and anxiety symptoms.  
The PMMP provider recommended that the worker continue with the functional and  
rehabilitation exercise program the PMMP had prescribed, continue to apply cognitive  
behavioural and self-management techniques in accordance with instructions the PMMP had  
provided, and continue to seek mental health support for his mood and pain.  
In an August 14, 2020 physician’s progress note, Dr. Parsons noted that the worker had stated  
his pain was the same, unfortunately with no improvement, but he was doing better mentally,  
which had made a difference.  
On August 25, 2020, the workers’ adviser asked the Board to adjudicate whether the worker  
had a permanent psychological condition. The adviser noted that, in the August 2019  
assessment, Dr. Gambouras had stated that:  
Around prognosis, as the patient’s emotional status appears largely related to  
such ongoing factors of pain and overall functional changes, and given that he  
reportedly continues to experience pain (and in fact believes he has gotten  
“worse each year”), it is not surprising that his mood levels have also not  
significantly improved. Accordingly, should the patient’s physical functioning, pain  
not significantly improve in the future (which is beginning to seem more unlikely  
now almost 2 years post-injury), it is difficult to envision his realizing  
improvements to pre-injury mood levels. In this vein, a PFI [permanent functional  
impairment] assessment might be useful after he has been afforded the  
opportunity to sufficiently participate in a Pain Management Program and  
additional MHT [mental health treatment].  
The workers’ adviser noted that the worker had since completed the PMMP, but continued to  
experience significant psychological symptoms.  
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:  
A2102416 (July 22, 2022)  
The worker began his college CSW program in September 2020. This involved attending online  
classes from 8:30 a.m. to 12:30 p.m. five days a week (Monday through Friday).  
Registered psychologist Dr. Doward reviewed the information in the claim file. In an October 15,  
2020 opinion, Dr. Doward said that, while it appeared that there had been significant  
amelioration in the worker’s accepted Other Specified Trauma- and Stressor-Related Disorder,  
it could be expected that further mental health treatment could yield further benefit. Therefore,  
the worker’s psychological condition was not at maximum clinical recovery.  
Dr. Doward noted the following history: the worker was first diagnosed with the condition by  
Dr. Gambouras in August 2019, based upon the worker developing depressive and anxious  
symptoms as a consequence of the pain and consequential functional impacts of his injury;  
Dr. Gambouras recommended a referral to a multidisciplinary pain program with individual  
psychotherapy in follow-up; the worker had already been paying privately for several sessions of  
psychotherapy with Dr. Williams and the Board began sponsoring treatments with Dr. Williams  
for resiliency services and then standard mental health treatment; after completing only six  
further sessions with Dr. Williams, the PMMP was initiated; at discharge from the PMMP, it was  
noted that the worker had been free of passive suicidal ideation for some three weeks, but the  
PMMP report did indicate a need for ongoing mental health support in the community.  
Based on the PMMP recommendation, Dr. Doward recommended that the Board arrange for  
such support.  
In Dr. Doward’s view, the goal for the worker’s condition should be recovery, not plateau.  
Dr. Doward said that the current vocational rehabilitation plan took into account the  
psychological restrictions and limitations Dr. Gambouras had identified in August 2019.  
Dr. Doward noted that the worker had since substantially improved over this status and that,  
even at the time of Dr. Gambouras’ assessment, the worker was deemed capable of  
participating in vocational rehabilitation.  
On October 13, 2020, an occupational therapist whom the Board had retained to assist the  
worker reported to the VRC that the worker had told her that he was doing well in the college  
program and did not have any concerns.  
The Board initially established the worker’s long-term wage rate based on a gross annual  
earnings figure of $45,760. Based on this wage rate, the VRC concluded that the worker would  
restore his pre-injury earnings if he were to adapt to the new occupation of CSW. However, a  
review officer later directed the Board to further investigate and issue a new decision regarding  
the long-term wage rate (Review Reference #R0262883, dated August 20, 2020). Following  
this, the Board established the wage rate on gross annual earnings of $56,670. As the amount  
the Board considered the worker capable of earning over the long term in the new occupation of  
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:  
A2102416 (July 22, 2022)  
CSW were lower than this, the worker became eligible for assessment for a loss of earnings  
On November 29, 2020, the worker began receiving mental health treatment from a registered  
clinical counsellor.  
On December 14, 2020, the VRC completed an employability assessment. Although the Board  
did not accept that the worker had any permanent medical restrictions as a result of his  
permanent physical impairments, the Board did accept that he has two subjective limitations:  
difficulty handling loads above light level; and, decreased tolerance for low-level work. As a  
result, his strength category was adjusted from heavy, as it was prior to his injury, to light. The  
VRC noted that:  
The worker had actively engaged with vocational rehabilitation services and had  
demonstrated an eagerness and determination to return to employment: “He researched his  
preferred occupation, including networking and contacting several schools.”  
The CSW occupation was the worker’s preferred plan.  
The psychovocational assessment had shown that his aptitudes and skills were  
well-matched to the CSW occupation.  
The worker had demonstrated the ability to seek and secure employment and was  
motivated to return to work in a full-time capacity.  
The worker was a young worker (currently 24 years of age), and had over 40 years  
remaining in the workforce; the CSW career would allow him to pursue an occupation that  
would restore his pre-injury earnings.  
The VRC undertook labour market research and also reviewed the data maintained by the  
Board in its Employment Development and Placement (EDAP) system. Based on this  
information, the VRC concluded that the CSW occupation was physically suitable for the worker  
and reasonably available to him. Further, the VRC concluded that, with the supports included in  
the vocational rehabilitation plan,4 the worker would, within three to five years, be able to earn  
$24.85 per hour. The VRC also noted that, as the worker was a young worker, it would be open  
At this time, the Act required that, before undertaking a loss of earnings assessment, the Board had to  
first consider whether the worker was eligible for such an assessment. This eligibility requirement was  
removed from the Act with amendments to the Act that became effective on January 1, 2021. Since  
January 1, 2021, a worker’s entitlement to a loss of earnings benefit must now be considered in all  
cases where the worker has a permanent functional impairment.  
These included 12 weeks of job search allowance, the services of an individual job placement provider,  
and, in principle, a work assessment and training-on-the job sponsorship.  
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:  
A2102416 (July 22, 2022)  
to him to pursue further education for a bachelor degree in the future, which would allow him to  
earn higher earnings.  
In the claim memorandum documenting a January 15, 2021 telephone conversation with the  
worker, the VRC recorded that the worker agreed with the earnings she had recommended in  
the employability assessment. At the time, the worker was having difficulty identifying individuals  
who could act as references during his search for employment and he advised the VRC that he  
had contacted a local food bank to discuss the possibility of volunteering so that he could obtain  
a reference.  
In a February 2021 discharge report, the registered clinical counsellor stated that the worker  
had made little progress with his symptoms of depression, continued to have a negative outlook  
on his recovery and future employment opportunities, and had indicated that his main barrier  
was his pain, which impacted all aspects of his life. The worker reported that he was in constant  
pain and had constant negative ruminating thoughts about his workplace accident and about his  
future. The worker also reported that his main worry is that he was not going to be able to work  
an eight-hour day due to his pain/back injury and that no employer would hire him due to his  
injury. The counsellor felt that if the worker could find the right employer who was willing to  
accommodate his injury, he could have successful employment.  
In a February 25, 2021 decision, the Board advised the worker that, as a result of the change in  
his wage rate, he had been paid an additional lump sum of $6,916.15 in addition to the previous  
lump sum payment he had received for his permanent functional chronic pain and thoracic spine  
On March 19, 2021, the worker called the VRC and advised that he had completed a three-hour  
volunteer shift at the food bank the prior week and his back was still causing him troubles a  
week later (he was still crying in pain). He expressed worry about how he would be able to  
complete his practicum, during which he would have to work eight hours a day for a month.  
In the March 24, 2021 decision, the long-term disability officer explained that, based on the new  
long-term wage rate, his pre-injury net earnings equaled $3,624.95. However, the VRC had  
recommended that, in the long term, the worker was capable of earning $3,183.13 net per  
month from full-time work in the CSW occupation.5 Therefore, he was eligible for a loss of  
earnings award based on the difference between the two figures. In current dollars, this was  
equal to $416.08 per month. The loss of earnings award replaced the prior functional award.  
However, as the worker had received lump sum cash payments of his loss of function award,  
which was equal to $143.95 per month in current dollars, he would receive a current monthly  
benefit of $272.13 ($416.08 minus $143.95).  
Both of these figures are in 2017 dollars.  
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:  
A2102416 (July 22, 2022)  
In an April 1, 2021 physician’s progress report, Dr. Parsons reported that the worker reported  
feeling better that week, but that things had worsened recently after he was doing some  
volunteer work at a food bank and bending over constantly made things worse. The worker  
reported that, with standing or walking, things worsened over one to two hours. He was able to  
sit for three to three and one-half hours, but then had to get up. The worker found that his pain  
could be depressing, but had stopped taking anti-depressants as they “just made him feel numb  
and [he] feels better off them.” Also, the worker admitted to “questioning his life” and what it  
would look like in the future, but he had no active suicidal plans or intent.6  
On April 23, 2021, the worker advised the VRC that he was still passing all his courses at  
school, but he had to stop volunteering because it was painful even doing three to four hours of  
moving up and down boxing items. He again expressed concern that he would not be able to  
complete his practicum. The VRC suggested that the worker look for volunteer work that was  
not as physical and involved more interactions with people, such as at youth service centres or  
doing outreach work. The worker later changed his mind and, on April 29, 2021, advised the  
VRC that he had decided to continue working three shifts at the food bank and just tell them he  
could not do the physical aspects of volunteering.  
On June 2 and 5, 2021, the worker underwent a psychological assessment with Dr. Gambouras  
for the purpose of obtaining a current understanding of the worker’s psychological issues,  
particularly with respect to diagnosis, treatment, and return-to-work issues.  
In a June 8, 2021 report, Dr. Gambouras said that the worker reported that he was in constant  
pain that impacted all aspects of his daily life; he rated his average daily back pain as an 8 on a  
scale of 0 to 10, with 10 being the worst, and he advised that his pain increased with activity and  
decreased with lying down. The worker indicated on numerous occasions that he did not believe  
he would be able to work and that he had uncertainty/stress regarding his future. He also  
indicated a lot of anger towards the Board about how his claim was handled and that he had  
extreme low mood and suicide ideation. He estimated that he could walk for roughly 20 minutes  
before he needed to sit and he advised Dr. Gambouras that two neurosurgeons had said “I’m  
Dr. Gambouras found the worker to be polite and cooperative but said that his mood and affect  
were characterized by much distress (he frequently cried during the assessment in particular  
when discussing the ongoing pain and resultant functional limitations and he also often had  
intense outbursts of anger when discussing his injury and its impact on him). The validity indices  
on two psychometric tests he had administered suggested the presence of considerable  
distortion in self-report, as the worker may typically have attempted to portray himself in a  
particularly pathological or negative manner. Accordingly, Dr. Gambouras said it was possible  
Block capitalization was removed from quotations.  
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:  
A2102416 (July 22, 2022)  
that the current evaluation results served to overestimate, to some degree, the worker’s  
emotional difficulties at the time of the psychological assessment.  
Dr. Gambouras concluded that the worker had realized significant emotional distress (that is,  
low moods and anxiety/stress) secondary to functional changes and pain that resulted from the  
December 2, 2017 work injury. He said it was difficult to provide a definitive opinion as to any  
reduced capacities in functioning secondary to psychological as opposed to physical/pain  
factors. He said that the most significant psychological symptoms currently interfering with  
function were the worker’s marked hopelessness and extremely negative outlook towards the  
future (sometimes even in the face of some positive changes or happenings). However, he felt  
that persistent pain and physical (as opposed to emotional) limitations and problems were the  
worker’s primary barriers to returning to work and it appeared that the worker’s ongoing mood  
difficulties appeared largely dictated by persistence of pain and functional problems.  
Consequently, if the worker’s physical condition and pain improved to a point that he could  
return to some level of productive activity, his mood levels would also hopefully return to close  
to premorbid levels. In that case, no or minimal psychological limitations or restrictions would be  
necessary. Due to the nature of his current psychological symptoms, the worker might have  
reduced capacity to “(1) persevere through (physical) set-backs in school or RTW or  
(2) appreciate or recognize increasing production and accomplishment or any positive  
happenings that might occur (school or RTW-wise, for example).”  
Dr. Gambouras also noted the worker’s accomplishments in the CSW diploma program and his  
experience volunteering and he said that, from a purely psychological (as opposed to physical)  
standpoint, there did not appear to be any specific tasks or activities that would result in harm or  
safety concerns that the worker should avoid.  
Dr. Gambouras noted that the worker did not appear to be open to any additional counselling,  
occupational therapy assistance, or psychotropic medications as he did not believe these  
treatments would be beneficial. Accordingly, in Dr. Gambouras’ opinion, additional talk therapy  
per se (even with a psychologist) would likely not result in significant improvements in emotional  
functioning for this patient over the next 12 months. Further, as the worker was so solely  
focused on his persistent physical symptoms and pain and resultant functional limitations,  
outside of pain and/or medicinal treatments or his realizing mood improvements secondary to  
future resolution of pain or physical problems, it was difficult to envision a mental health  
treatment that would serve to significantly improve his emotional status. Dr. Gambouras noted  
that the worker was awaiting a consultation regarding a possible spinal nerve ablation  
procedure and had also indicated that he was agreeable to participating in an in-person pain  
management program, both of which might improve his pain. Dr. Gambouras was hopeful that  
the worker would realize a return to better mood secondary to his return to work as a CSW,  
which was expected to occur in roughly September 2021. As he hoped that this return to work,  
the pending nerve ablation procedure, or participation in a pain management program would  
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:  
A2102416 (July 22, 2022)  
result in returning the worker’s mood to a better status, he believed that further (significant)  
change in the worker’s psychological function could be expected over the next 12 months.  
In the interim, Dr. Gambouras recommended that the worker’s loved ones and healthcare  
providers continue to monitor his suicidality.  
In a July 19, 2021 decision, the Board accepted the worker’s compensable Other Specified  
Trauma- and Stressor-Related Disorder as a permanent condition under the claim and referred  
him for assessment of his entitlement to a permanent partial disability benefit. Although  
Dr. Gambouras had indicated that there could be improvement in the worker’s psychological  
condition, this was contingent on reduced pain. However, to date, reduced pain had not  
achieved and the Board considered the psychological condition to have stabilized as of July 5,  
As the worker was currently involved in the vocational rehabilitation process, the Board  
postponed making a decision regarding whether the acceptance of this additional permanent  
condition under the claim entitled him to a separate referral for vocational rehabilitation services.  
In conjunction with the acceptance of this permanent psychological condition, the Board also  
accepted a new limitation under the claim: “Reduced capacity in parts of a job that involve a  
high degree of time pressures, sustained mental effort and concentration, or competing  
activities and/or outside distractions in particular on a more painful day.”  
A July 2021 transcript from the college where the worker was completing his CSW education  
shows that the worker obtained a grade point average equal to 86% and attended 98.4% of his  
scheduled classes. The worker began his practicum on July 27, 2021 and this ended on  
September 23, 2021.  
On August 30, 2021, the worker advised the VRC that he felt it was impossible for him to  
complete the job search requirements established under his vocational rehabilitation plan and  
that he was planning to apply for Persons with Disabilities (PWD) benefits as he only wanted to  
work part time for the time being. The VRC explained to the worker that he would receive job  
search assistance when he was ready to look for work and that the Board would also refer him  
to an individualized job placement service to assist him in identifying prospective employers.  
On September 14, 2021, the worker confirmed that he planned to apply for PWD benefits and  
no longer wanted to pursue a job search. He said that, once his PWD benefit application was  
approved, he planned to search for part-time work as a CSW. In order to pursue his application,  
This conclusion was based on the medical advice Dr. Doward provided in a July 5, 2021 clinical review  
and opinion report.  
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:  
A2102416 (July 22, 2022)  
he needed a letter from the Board confirming he was not eligible for additional vocational  
rehabilitation benefits.  
In a September 21, 2021 decision, the VRC advised that his vocational rehabilitation benefits  
had been discontinued.  
In the request for review of the March 24, 2021 decision, the worker agreed in principle with the  
occupational goal of CSW. However, he argued that the Board “significantly overestimated his  
future earnings potential” and erred in deeming him to be capable of earning at the top end of  
the salary range. The worker submitted that it was likely that he would obtain employment at the  
bottom end of the pay range (which went from $16.00 per hour to $24.85 per hour) and so he  
was entitled to an increased loss of earnings benefit based on earnings of $16.00 per hour.  
In particular the worker submitted that:  
His only prior work experience is in the construction industry and the proposed shift to the  
CSW occupation represented a very significant change in direction and something of a “leap  
into the unknown”.  
The psycho-vocational testing conducted in June 2020 concluded that his overall intellectual  
functioning falls within the low average range compared to age-matched peers and that the  
low average results for the verbal IQ scale indicated that he had difficulties in recognizing  
word meanings, reasoning, and applying his knowledge effectively; his results indicated that  
88% of his peers have scored better than him.  
While he had endeavoured to stay optimistic, there were many uncertainties ahead, and  
there was no logical basis for deeming him capable of earning at the highest end of the  
salary range for this occupation when, as yet, he has not even demonstrated the ability to  
gain employment.  
The VRC only considered the physical suitability of the occupation and disregarded the  
significant limitations resulting from his compensable psychological disorder, which were  
likely to have a substantial bearing on his future earnings potential.  
Although his psychological disorder was only deemed to have plateaued as a permanent  
condition on July 5, 2021, it was identified almost two years earlier after having been  
diagnosed through a psychological assessment report in August 2019.  
His psychological condition is likely to have a significant impact on his overall productivity in  
any work setting and the limitations resulting from it are not consistent with the finding that  
he is capable of earning at the highest end of the salary range for the target occupation:  
The now accepted limitation in parts of a job that involve a high degree of time  
pressures, sustain mental effort and concentration, or competing activities and/or  
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:  
A2102416 (July 22, 2022)  
outside distractions, in particular on a more painful day will limit his future  
In addition to this, Dr. Gambouras noted that he may struggle at times to maintain a  
relatively “normal” work pace and to be productive in the expected manner over the  
course of a full work day or week, and anticipated that he would require short breaks  
as needed to “recharge”, thereby interrupting his work performance.  
In Review Reference #R0279846, the review officer noted that policy item C6-40.00 stated that,  
in estimating what a worker is capable of earning after the injury, the Board considers the  
evidence, including the medical evidence, of the limitations imposed by the compensable  
disability and the fitness of the worker for different occupations. The Board also considers the  
evidence about the suitability of the worker for occupations that could reasonably become  
available. Following these considerations, the Board will arrive at a conclusion about suitable  
occupations that the worker could be expected to undertake over the long run that will maximize  
the worker’s long-term earnings potential, up to the pre-injury wage rate. In most cases, “long  
term” refers to three to five years.  
Given that the worker did not take issue with the occupational goal itself, the review officer  
found that it was not necessary to review the suitability and reasonable availability of the  
occupation. She noted that the Board agreed to sponsor the worker in this plan on the basis of  
the worker’s request for this plan and his own research into the occupation.  
The review officer was satisfied that the projected earnings of $24.85 (in 2020 dollars) was a  
reasonable estimate of what the worker could earn in this occupation in three to five years. The  
review officer acknowledged that the earnings potential within the range of earnings in the job  
postings the VRC relied on was at least partially dependent on a worker’s education and  
experience and that, in this case, the worker was starting out with no experience. However, the  
Board had sponsored him in a one-year training program that would assist him to get into the  
occupation and the review officer was satisfied that, after three to five years of experience,  
along with his certificate, the earnings estimate of $24.85 per hour was realistic.  
The review officer also acknowledged that the worker’s employment history was limited to the  
construction industry; however, the Board agreed to sponsor the worker in a significant  
retraining program that would allow him to enter an entirely different field of work. It appeared to  
the review officer that many employers would accept the training program in lieu of related  
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:  
A2102416 (July 22, 2022)  
With regard to the submission that the worker has a psychological disability as well as a  
physical one and this could affect his future earnings potential, the review officer concluded as  
I acknowledge that the worker has further limitations with respect to his  
psychological condition; however, I find it noteworthy that despite the limitations,  
the worker did extremely well in his one-year formal training program and  
achieved outstanding marks and demonstrated excellent attendance.  
Specifically, a review of the worker’s July 2021 transcript revealed that he  
received a course average of 86% (GPA of 3.82) and his attendance was 98.4%.  
With evidence such as this to show potential employers, I am not persuaded by  
the Workers’ Adviser’s argument that the worker is far more likely to obtain  
employment in a lower paid, less demanding job at the bottom end of the pay  
range. I also note that the worker secured a practicum as part of his training  
program, which started on July 27, 2021, as well as participated in related  
volunteer work three days per week.  
In addition, while the $24.85 per hour wage was noted by the VRC to be at the higher end of the  
wage scales in the job postings, the review officer found it noteworthy that the earnings amount  
was comparable to the occupational class average earnings for full-time workers in this  
occupation in 2017 ($3,940 per month) that were on the claim file. Further, the projected wage  
was also analogous to the earnings information obtained through the employer contacts the  
VRC undertook, as summarized in a June 12, 2020 document in which the VRC set out the  
results of her labour market information research.  
New Documentary Evidence  
The worker obtained a January 31, 2022 letter from Dr. Parsons in support of his appeal.  
Dr. Parsons advised that the worker has very severe back pain as a result of his 2017 spinal  
fracture and, unfortunately, after many modalities of treatment, his pain remains as severe or  
worse. Dr. Parsons said that this limits the worker in his daily life in all aspects and, particularly,  
when it comes to employment. Dr. Parsons said that his back has a loss of mobility and his pain  
is significantly worsened by lifting, bending, sitting, and being in a flexed position. Dr. Parsons  
said that the worker is at a disadvantage when it comes to being able to perform almost any  
type of job. Furthermore:  
… this has understandably taken a very negative toll on his mental health -  
somethin[g] he has to reconcile with daily. The total of these two problems is a  
very significant burden for [the worker].  
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:  
A2102416 (July 22, 2022)  
The worker also provided WCAT with a copy of his application for PWD benefits he completed  
on October 24, 2021.  
In the description of disability, the worker described the injuries he believes he sustained on  
December 20, 2017 as follows:  
On Dec 2nd 2017 I fell off a ladder and broke my neck in multiple places, I broke  
my spine (T6, T7, T8) vertebrae which the T7 was crushed over 60% while the  
T6/T8 was crushed 30% or more. I also broke my left side scapula affecting it  
In the medical report section that Dr. Parson’s completed on November 17, 2021, Dr. Parsons  
identified the following diagnoses: T6 and T7 compression fracture causing chronic severe  
back pain (onset December 2017), depression stemming from the chronic pain (onset  
February 2019), and left subacromial/subdeltoid bursitis (onset December 2017). Dr. Parsons  
explained that the worker’s chronic pain limits all of his activities and noted that two attempts of  
nerve blocks, participation at an interventional pain clinic, physiotherapy, intramuscular  
stimulation, Celebrex, counselling, and exercise had all been unhelpful. She prescribes Tylenol  
No. 3 for the worker, “just to make things more tolerable”. Initially, the worker required a back  
brace and, although he did not presently require one, he might in the future.  
Dr. Parsons estimated that the worker’s tolerance for activity was limited in the following  
regards: two to four blocks of unaided walking on a flat surface; lifting under five pounds; and,  
less than one hour of sitting.  
Dr. Parsons said that the worker does not have difficulties with communication, but does have  
significant deficits with cognitive and emotional function. These have been listed below in my  
summary of the written submission the workers’ adviser provided to WCAT after the hearing and  
so will not be repeated here. Dr. Parsons said that, for the most part, the worker’s daily activities  
are very restricted and that he spends most of his day at home laying on the couch or in bed.  
The worker testified that, other than working at a fast food restaurant while he was in high  
school, his only employment has been in the construction industry and doing labour. He started  
his apprenticeship right after he finished grade 12 and was a fourth year apprentice when he  
stopped working in construction. He had been attracted to work in this occupation because he  
liked being outside, liked hanging out with people, liked talking, and liked doing stuff with his  
hands. Overall, he liked his job and, looking back, even though it was intensive and hard work, it  
was great.  
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:  
A2102416 (July 22, 2022)  
[100] The worker confirmed that he went back to work in construction for about eight months after his  
injury. He said that his neurosurgeon gave him the go-ahead to go back to construction, “for  
some reason,” although he did not know why. The neurosurgeon told him that his back would be  
fully healed by a year after the accident. However, his back was not getting better and, if  
anything, it is getting worse. He tried to do part-time work here and there at several places, such  
as driving a delivery truck with roofing parts. He did not have to lift anything and would just drive  
around in a truck, and he could not even do that. One day, he was crying from just driving the  
truck all day and he called his father and told him that he could not do this anymore. His father  
agreed, let him quit, and let him live in his basement for free. He said that he realized his  
neurosurgeon had no idea what he was talking about: “I broke my spine and I should have not  
gone back to work.” He decided not to work in construction anymore.  
[101] The worker said that, since then, he had not done much. He tried to work at the food bank,  
which involved lifting up cans of soup, pasta, and other items, but they made him work  
three-hour shifts. He said he would be crying after doing this lifting. That was all the work he had  
done in four years, up until a week prior to the oral hearing, when he worked a first shift in a new  
[102] I asked the worker to describe what he did during his practicum. He said that he found a  
position with a grocery delivery program and, basically, he was their “taxi boy” for a month and a  
half. He would drive around and take groceries to different places for delivery to people with  
mental health, disability, or drug issues. Employees at the shop would load them into his car  
and, when he got to the individuals to whom the groceries were to be delivered, they would  
come outside their homes and pick them up. He said that he got zero experience from the  
practicum, other than experience being a delivery boy.  
[103] The worker’s new job is a part-time position at a department store, working two to three shifts a  
week for 6 hours a day. He tried to get the employer to agree to only two shifts a week, but the  
employer said it would not hire him unless he agreed to work 12 to 18 hours per week. The  
worker said that he does not lift anything and all he has to do is walk around. He said he knows  
about motors and is responsible for helping customers who are looking for equipment such as  
lawnmowers or power tools. If anything needs to be lifted, he goes and gets someone else do  
[104] The worker said that he is working in his new job in order to keep his sanity and try to make a  
living. However, the worker also said that his sanity is gone. With the exception of the first 15 or  
20 minutes when he gets up in the morning, his back is constantly aching and hurts him no  
matter what he does, and it worsens throughout the day. He said that there is nothing he can do  
to get relief from the pain and this means he does not do much of anything other than sitting in  
at his house. He can lie down, but in reality that does not solve much.  
150, 4600 Jacombs Road, Richmond, B.C. V6V 3B1  
Tel: (604) 664-7800 | 1-800-663-2782  
Fax: (604) 664-7898 | wcat.bc.ca