Can an Injured Worker Obtain Permanent Partial Disability for Headaches?

Can an Injured Worker Obtain Permanent Partial Disability for Headaches?

Yes. Permanent Partial Disability (PPD) benefits are based upon subjective headache symptoms as long as the injured worker’s doctor certifies that those symptoms “more likely than not” cause permanent impairment.

Chronic headache conditions can result from either head or neck injuries. However, institutionally, the Department of Labor & Industries attempts to avoid giving credit to a worker’s subjective symptoms when determining their PPD award. When a worker has a headache condition that results from their work-related injury, it is important to first get that condition documented by the Attending Physician and then contended as a covered claim condition to the Department or Self-Insured employer.

The documentation needed from the Attending Physician is a statement that the physician has examined the injured worker and is familiar with their work-related accident or occupational disease history in the stated claim. The Attending Physician must then formally diagnose the headache condition. Then the Attending Physician must provide an opinion that the diagnosed headache condition is “more likely than not” the result of the referenced industrial injury or occupational disease.

Once the worker has the doctor’s certification, as described above, the worker must then contend for the condition to be formally allowed under their claim. This is done by sending a writing to the Self-Insured Employer’s Claims Manager or the Department of Labor & Industries asking for a formal notice of decision stating that the diagnosed headache condition is recognized as an allowed condition under the claim. Once the writing has been submitted, the worker should follow up and keep pressing the issue with the Claims Manager until a formal allowance or segregation (non-allowance) order is issued. This formal contention should be made, and an allowance order should be obtained, as early as possible once a claim-related headache condition is recognized.

How Can A Doctor Certify Permanent Partial Disability for Headaches?

In order to certify headaches as a cause of PPD, the Attending Doctor should review the categories of impairment listed at WAC 296-20-340 and select the “best fit” category. This methodology is based upon the Significant Decision of the Board of Industrial Insurance Appeals, In re Candi Truhn, BIIA Dec., 91 3993 (1993).

The Board’s formal holdings in the Truhn case are as follows:

Chronic migraine headaches related to an industrial injury may result in a permanent functional impairment for which a worker is entitled to receive a permanent partial disability award. Where there was no way to measure the impact of the migraine headaches on the worker’s functioning except by subjective complaint, a better analogy than cervical spine impairment is found in the mental health condition ratings. ….In re Candi Truhn, BIIA Dec., 91 3993 (1993);

and

In the absence of other possible triggers together with the report of migraine complaints within a month following a head or neck injury, a chronic migraine headache condition was causally related to the industrial injury. ….In re Candi Truhn, BIIA Dec., 91 3993 (1993)

For the doctor to certify headache-based PPD, they can utilize the following format:

I have considered [my named patient’s] chronic headache condition within the framework provided by WAC 296-20-340, pursuant to the BIIA decision of Candi Truhn, and I find that on a more probable than not basis, they have a causally-related PPD as indicated by my check-mark below beside the “best-fit” description:

_____ Almost No Residuals Present (Category I)

_____ Mild Residuals Present (Category II). For example: Patient exhibits a mild loss of insight, mildly deficient judgment, or rare difficulty in controlling behavior, anxiety with feelings of tension that occasionally limit activity; lack of energy or mild apathy with malaise; brief phobic reactions under usually avoidable conditions; mildly unusual and overly rigid responses that cause mild disturbance in personal or social adjustment; rare and usually self-limiting psycho-physiological reactions; some difficulties may exist, but the person is able to carry out usual work day activities unassisted. (although the person still experiences minor sequelae of their condition, these are sufficiently-mild that there is no need for formal medical restrictions).

_____ Moderate Residuals Present (Category III). For example: Patient exhibits periodic difficulties such that “a few work day activities require supervision.” (or commensurate formal work restrictions exist).

_____ Marked Residuals Present (Category IV). For example: Patient experiences moderate interference with daily life from frequent and disruptive symptoms that interfere with work or recreation to the point that the patient requires “a moderate amount of supervision and direction of work day activities” (or commensurate formal work restrictions exist).

_____ Extreme Residuals Present (Category V). For example: there are limitations so marked as “to interfere seriously with the physical or mental well-being or activities of others,” i.e., this patient is in significant ways dependent upon others and cannot realistically sustain competitive employment.

What Medical Restrictions Are Likely With Chronic Headache Conditions?

Medical restrictions associated with chronic headaches should consider anything that requires intensive, machine-driven, noisy or vibratory work processes, as well as those that result in triggers to headaches. So, in addition to stating the category of impairment rating, as indicated above, a physician certifying an injured worker’s PPD should clearly also state their permanent work restrictions.

Typical permanent restrictions associated with chronic headache conditions may be expressed as follows:

I recommend that my patient should observe permanent, causally-related medical restrictions to include no working at heights; on ladders or scaffolding; around machine-driven processes; within chaotic or fast-paced industrial environments; working with industrial chemicals or solvents; or in motorized vehicles, to include fork-lifts, cars and trucks. Noisy environments should generally be avoided, but otherwise to tolerance. Constant or repetitive lifting or vibratory processes that can trigger neck strain and resulting headaches should be avoided. Driving distances to and from work should be limited to a distance of not more than 30 minutes of commute time or otherwise to tolerance. Screen time should be limited to tolerance. The employer should be willing to accommodate occasional absenteeism or periods of decreased productivity at work while my patient is afflicted with a headache. These limitations do not prevent high-demand employments, such as those requiring skilled work, as employers may logically be willing to accommodate greater worker needs in order to obtain the benefits associated with skilled labor. Vocational Retraining for same is not precluded, though coursework should be planned according to the same needs indicated by these work restrictions.

If you are an injured worker with a chronic, work-related headache condition, please understand that the information presented on this page is not a valid substitute for legal counsel focused upon the particular needs of your individual case. If you’d like to obtain such counsel, please call Washington Law Center today.