- Causation (medical evidence)
- Cognitive impairment
- Post-concussion syndrome
- Recurrences (compensable injury)
- Alzheimer's disease
- Board Directives and Guidelines (stress, mental) (traumatic event)
- Organic brain injury (mild traumatic)
- Consequences of injury (secondary condition)
- Dementia (frontotemporal)
The worker's estate appealed the following issues: a) initial entitlement for a head injury/concussion; b) entitlement to a recurrence of a head injury/concussion; c) entitlement to Alzheimer's, dementia, personality changes and cognitive impairment; and, d) entitlement to Traumatic Mental Stress (TMS).
The appeal was allowed, in part. Initial entitlement for a head injury/concussion and recurrence was granted.The worker was standing in the vicinity of a compressor, when a pipe exploded and created a blast wave of highly compressed air and a collection of steel/rust particles and dust. The worker was hit with the ensuing blast wave near his right shoulder and head, which included his forehead and the right-side of his face/head. The Panel found, on a balance of probabilities, that the workplace accident of July 21, 2011 resulted in the worker's head injury, inclusive of a concussion and mild traumatic brain injury (TBI). In addition, entitlement for a recurrence was granted, as clinical compatibility and continuity within the meaning of OPM Document No. 15-03-01 had been established. The Panel denied secondary condition entitlement for Alzheimer's, dementia, personality changes and cognitive impairment, on the basis that there was no causal link. In addition, the worker had been diagnosed with Frontotemporal Dementia (FTD). FTD is a "neurodegenerative" condition, which is distinct from Alzheimer's disease, with some overlap in symptomology. There is also a strong genetic and familial basis for the development of the worker's FTD, and a relevant family history existed in this case. It was opined that blast injuries can lead to FTD "if they are repeated" and that "multiple mTBIs result in late-life dementia". In this case the worker only experienced one mild TBI set within the context of the workplace accident, rather than a series of such injuries over time. The Panel concluded that FTD likely accounted for the worker's dementia, personality changes and cognitive impairment.Lastly, entitlement for TMS was denied. Tribunal case law has found that a worker's "subjective" perception is not determinative of whether an event is traumatic, but rather, the situation must be viewed through the lens of a reasonable observer (see Decision No. 2185/11). There was insufficient evidence to conclude that this event "caused, or significantly contributed to, an appropriately diagnosed mental stress injury" within the meaning of Board policy. The worker was also affected by numerous non-compensable factors, including the emerging FTD condition which resulted in various symptoms, and was considered significant from a temporal and clinical perspective.