Janine Tea v. Ramsey County, Self-Insured, Relator

STATE OF MINNESOTA

IN SUPREME COURT

A23-1207

Workers’ Compensation Court of Appeals McKeig, J.

Janine Tea,

Respondent,

vs. Filed: April 17, 2024
Office of Appellate Courts
Ramsey County, Self-Insured,

Relator.

________________________

David B. Kempston, Mottaz & Sisk Injury Law, Coon Rapids, Minnesota, for respondent.

Andrew M. Grimsrud, Aafedt, Forde, Gray, Monson & Hager, P.A., Minneapolis,
Minnesota, for relator.
________________________

SYLLABUS

1. The Workers’ Compensation Court of Appeals’ affirmance of the

compensation judge’s finding that the employee has compensable post-traumatic stress

disorder is not manifestly contrary to the evidence because the compensation judge based

his conclusion on the employee’s credibility and the persuasiveness of an expert diagnosis

of post-traumatic stress disorder.

2. In accord with our decision in Smith v. Carver County, 931 N.W.2d 390,

396–97 (Minn. 2019), compensation judges may review the Diagnostic and Statistical

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Manual of Mental Disorders criteria when considering the persuasiveness of expert reports,

but judges may not use those criteria to make their own diagnosis of a claimant’s condition.

Affirmed.

OPINION

MCKEIG, Justice.

We are presented here with a disputed post-traumatic stress disorder (“PTSD”)

claim. Respondent Janine Tea was employed as a social worker for relator Ramsey County

and reported a PTSD injury during her employment related to her exposure to details of a

murder committed by one of her clients. The County initially provided workers’

compensation benefits to Tea but discontinued those benefits after a licensed psychiatrist

concluded she did not have PTSD. Tea filed an objection to the discontinuance of her

benefits and underwent an independent psychological evaluation in which she was

diagnosed with PTSD. The compensation judge determined that Tea has compensable

PTSD. The Workers’ Compensation Court of Appeals (“WCCA”) affirmed.

Ramsey County asks us to reverse, asserting that Tea did not meet the diagnostic

criteria for PTSD listed in the Diagnostic and Statistical Manual of Mental Disorders

(“DSM”). Because the WCCA’s affirmance of the compensation judge’s finding that Tea

has compensable PTSD is not manifestly contrary to the evidence, we affirm.

FACTS

Tea is a licensed social worker whom Ramsey County employed as a case manager

in the Adult Mental Health Case Management unit. In February 2020, one of Tea’s clients

(the “Client”) murdered his girlfriend in an act of horrific brutality. Tea learned of the

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murder and the grisly details over the following week through a series of phone calls and

meetings related to the Client and the crime.

At that point, Tea had worked for Ramsey County for approximately 6 years, and

her clients were people with a history of mental illness who had trouble functioning in

society. A different team of Ramsey County social workers—the forensics team—worked

with people who were both mentally ill and dangerous. Tea was neither on the forensics

team nor had she received the specialized training provided to the forensics team.

Nevertheless, in the summer of 2019, the Client was assigned to her caseload from the

forensics unit.

The day following the murder, Tea received a phone call from a colleague informing

her of the details of the crime. Tea was driving at the time, and upon learning the

“overwhelmingly traumatic information,” she began to experience tunnel vision that forced

her to pull her car off the highway. Throughout that day, Tea remained in her car and on

the phone. Although her condition did not allow her to travel on the highway to her office,

she remained cognizant of the responsibilities that fell to her as the Client’s case manager.

From her car, she made and received calls related to the Client, cancelled or rescheduled

appointments with her other clients for that day, and contacted the Saint Paul Police

Department to ask that they inform the victim’s mother of the murder.

For the next week, Tea was involved in calls and meetings regarding the murder

“every single day, almost all day long,” and had to put all her other client work aside.

During that week, Tea saw details about the murder on the news and began obsessively

researching the murder outside of her working hours. Tea felt a “legal responsibility” for

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the murder because the Client “was on a civil commitment order, and [Tea’s] name was

listed on there as his adult mental health case manager.” Because of this, she worried about

any publicity surrounding the murder that could affect her or her family. Tea became

irritable, had trouble sleeping, and began having nightmares related to the murder.

Five days after she learned of the murder, Tea reported she had suffered a work-

related injury to her mental health. She listed the date of injury as the day of the murder

and the type of injury as secondary trauma related to a violent act committed by a client.

Ramsey County initially accepted liability for Tea’s claim and paid a variety of benefits.

Three days after Tea made the report, Dr. Robert Finn, a Doctor of Nursing Practice,

conducted a psychiatric evaluation of Tea. Dr. Finn strongly suggested that Tea focus on

psychotherapy so her condition did not worsen into PTSD, and he also recommended she

take a month off work. Dr. Finn acknowledged Tea’s previous attention-

deficit/hyperactivity disorder (“ADHD”) diagnosis, and a month later, diagnosed her with

acute stress disorder. He met with Tea monthly, and for the next 3 months, he consistently

found that Tea was unable to successfully manage her trauma and recommended she

remain off work while they tried different medications and additional psychotherapy.

Around 4 months after the murder, Tea reported improved symptoms to Dr. Finn and a

desire to return to work, so she was put on a graduated return-to-work schedule that, over

a period of 6 weeks, would return Tea to full-time work with Ramsey County. In a

subsequent visit, Dr. Finn noted that Tea was doing well in her return to work.

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 Tea’s mental health began to deteriorate again, however, around 4 months after

returning to work full time. She reported to Dr. Finn countertransference 1 concerns with

the psychotherapist she had been seeing since the murder, so Dr. Finn referred her to a new

psychotherapist: Ms. Samantha Colai, a licensed marriage and family therapist. Around

this time, Tea began missing 2 to 3 days of work per week and began struggling with her

duties at work. Dr. Finn noted that Tea’s trauma, depression, and anxiety symptoms were

affecting her executive functioning capabilities, but explained that it was hard to

differentiate those symptoms from those of uncontrolled ADHD.

In February 2021, nearly a year after the Client murdered his girlfriend, Dr. Finn

diagnosed Tea with PTSD based on criteria found in the DSM and recommended that she

remain off work until June of that year. In May 2021, Dr. Finn extended his

recommendation through August. In June 2021, Ramsey County requested that Tea

undergo an interview and psychological testing with Dr. John Hung, a licensed

psychologist, to determine her ability to return to work as a social worker. After more than

12 hours of testing over a span of 3 days, Dr. Hung determined that Tea had PTSD and was

psychologically unable to perform her job as a social worker. Dr. Hung opined in his report

that the changes in Tea’s ability to function “strongly implicate” the murder as a substantial

contributing cause, and further, that it was “not simply one incident of being informed of

1
Transference is a phenomenon in psychotherapy “ ‘whereby the patient displaces
on to the therapist feelings, attitudes, and attributes which properly belong to a significant
attachment figure of the past, usually a parent, and responds to the therapist accordingly.’ ”
St. Paul Fire & Marine Ins. Co. v. Love, 459 N.W.2d 698, 700 (Minn. 1990) (quoting S.
Waldron-Skinner, A Dictionary of Psychotherapy 364 (1986)). Countertransference
occurs “when the therapist transfers his own problems to the patient.” Id.

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the murder,” but also “her heavy and repeated exposure to information about the murder”

over the following days. Dr. Hung’s diagnosis of Tea’s PTSD did not mention the DSM

criteria.

Ramsey County and its workers’ compensation insurer requested an independent

medical evaluation report of Tea’s ongoing complaints. Consequently, Dr. Thomas

Gratzer, a licensed psychiatrist, prepared a report in January 2022 based on his recent

interview with Tea and on a clinical psychological assessment given to her by Dr. Marvin

Logel. In his report, Dr. Gratzer concluded that Tea’s complaints were consistent with her

history of anxiety, depression, and ADHD, and likely the result of “burn out” rather than

the work incident involving the murder by the Client. When making his determination, Dr.

Gratzer expressly concluded that Tea did not meet the DSM criteria for PTSD because she

was not exposed to any actual or threatened death, serious injury, or sexual violence. Dr.

Gratzer’s report also opined that Tea was overreporting trauma resulting from the murder

to justify difficulties that she was having at work. He concluded that Tea did not require a

work restriction. At this point, Ramsey County discontinued Tea’s benefits, to which Tea

responded by filing a claim petition and objection to discontinuance of the benefits.

After Dr. Gratzer submitted his report, Dr. Finn and Ms. Colai both wrote letters

disagreeing with the conclusions in the report. 2 In May 2022, Tea underwent an

independent psychological examination at her own request from Dr. Michael Keller, a

2
Neither Dr. Finn nor Ms. Colai were licensed as either a psychologist or a
psychiatrist, so their medical diagnoses did not satisfy the requirement for a compensable
PTSD claim laid out by statute. See Minn. Stat. § 176.011, subd. 15(d) (2022).

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licensed psychologist. Dr. Keller diagnosed Tea with PTSD, finding that her symptoms

met the DSM criteria because they stemmed from the work-related exposure to details of

the murder. A few months later, Tea began working at a Ramsey County library with

restrictions and a reduced wage compared to her position as a social worker.

At the hearing before the compensation judge, the reports of Dr. Hung, Dr. Gratzer,

and Dr. Keller were all admitted into evidence without objection, and the parties stipulated

that Tea’s medical treatment was necessary. Tea testified and was expressly found to be

credible by the compensation judge. The judge also found credible the opinions of Dr.

Keller, Dr. Hung, and Tea’s treating providers. Neither party contests that both Dr. Keller’s

and Dr. Gratzer’s diagnoses had adequate foundation. Ultimately, the compensation judge

found Dr. Keller, Dr. Hung, and Tea’s treating providers more credible than Dr. Gratzer

and awarded benefits accordingly. The judge found that Tea “sustained a work-related

psychological injury beginning [the day after the murder], the nature and extent of which

is PTSD and Major Depressive Disorder.”

Ramsey County appealed to the WCCA. The WCCA affirmed the compensation

judge’s finding that Tea “sustained work-related PTSD.” Tea v. Ramsey County,

No. WC22-6493, 2023 WL 5094369, at *4 (Minn. WCCA July 28, 2023). 3 Ramsey

County appealed.

3
The WCCA vacated the compensation judge’s finding that Tea sustained a work-
related injury in the nature of major depressive disorder. Tea v. Ramsey County, No.
WC22-6493, 2023 WL 5094369, at *4 (Minn. WCCA July 28, 2023). Major depression
injuries are not compensable by themselves, but we have not considered whether major
depression injuries consequential to a PTSD injury are compensable. See Chrz v. Mower

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 ANALYSIS

The question here is not whether Tea definitively has PTSD, but rather whether the

WCCA’s affirmance of the compensation judge’s findings that Tea sustained work-related

PTSD was manifestly contrary to the evidence. See Lagasse v. Horton, 982 N.W.2d 189,

202 (Minn. 2022). PTSD is a compensable “occupational disease” under Minnesota’s

workers’ compensation statutes. See Minn. Stat. §§ 176.011, subd. 15(a), (d) (2022)

(defining “occupational disease” and “mental impairment”), 176.021, subd. 1 (2022)

(addressing an employer’s liability for compensation). Section 176.011 identifies specific

requirements necessary for PTSD to be a compensable mental impairment:

For the purposes of this chapter, “mental impairment” means a diagnosis of
post-traumatic stress disorder by a licensed psychiatrist or psychologist. For
the purposes of this chapter, “post-traumatic stress disorder” means the
condition as described in the most recently published edition of the
Diagnostic and Statistical Manual of Mental Disorders by the American
Psychiatric Association.

Minn. Stat. § 176.011, subd. 15(d). In this case, Ramsey County asks us to reverse based

on its assertion that Tea did not meet certain diagnostic criteria of the DSM’s description

for PTSD. Ramsey County challenges the finding of compensable PTSD by arguing

(1) that the compensation judge’s finding is manifestly contrary to the evidence, and

(2) that the WCCA’s refusal to re-evaluate the compensation judge’s factual findings was

County, 986 N.W.2d 481, 486 n.2 (Minn. 2023). Here, the WCCA vacated the
compensation judge’s finding that Tea sustained a work-related major depression injury
because that claim was “not pled as a consequential injury.” Tea, 2023 WL 5094369, at *4.
This issue was not appealed to us, so we do not address it further.

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an error of law because it contravened Minn. Stat. § 176.011, subd. 15(d). We evaluate

each argument in turn.

I.

First, we determine whether the WCCA’s affirmance of the compensation judge’s

factual finding that Tea has compensable PTSD is manifestly contrary to the evidence. Our

review here is limited. If the WCCA has affirmed the factual findings of the compensation

judge, we view the facts in the light most favorable to the findings and must uphold those

findings unless they are “manifestly contrary to the evidence.” Schmidt v. Wal-Mart

Stores, Inc., 988 N.W.2d 124, 129 (Minn. 2023). To be manifestly contrary to the evidence,

the evidence must “clearly require[] reasonable minds to adopt a contrary conclusion.”

Lagasse, 982 N.W.2d at 202; see also Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d

54, 61 (Minn. 1984).

A compensation judge can award compensation for PTSD only if the employee

“prove[s] that (1) a psychiatrist or psychologist has diagnosed the employee with PTSD,

and (2) the professional based the employee’s diagnosis on the latest version of the DSM.”

Chrz v. Mower County, 986 N.W.2d 481, 485 (Minn. 2023) (citing Smith v. Carver County,

931 N.W.2d, 390, 396 (Minn. 2019)). 4 When medical professionals provide competing

4
The WCCA noted that the experts in this case used the DSM-5 rather than the most
recent version of the DSM, the DSM-5-TR. Tea, 2023 WL 5094369, at *3. Even so, the
WCCA deemed any question of whether the wrong version of the DSM had been used to
be forfeited by the parties. Id. The PTSD criteria in the DSM-5 and the DSM-5-TR are
identical. Compare Am. Psychiatric Ass’n, Diagnostic and Statistical Manual of Mental
Disorders 271–72 (5th ed. 2013) (DSM-5), with Am. Psychiatric Ass’n, Diagnostic and
Statistical Manual of Mental Disorders, Text Revision 301–03 (5th ed. 2022) (DSM-5-TR).
Additionally, we note that Dr. Gratzer’s report predated the release of the DSM-5-TR. For

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diagnoses, the compensation judge must determine “whether the expert diagnoses have

adequate foundation and, if both have adequate foundation, decide which of the

professional diagnoses is more credible and persuasive.” Juntunen v. Carlton County, 982

N.W.2d 729, 743 n.10 (Minn. 2022) (quoting Smith, 931 N.W.2d at 396) (internal quotation

marks omitted). In this case, the parties do not contest the adequacy of the foundation of

either the report of Dr. Keller, who diagnosed PTSD, or the report of Dr. Gratzer, who did

not diagnose PTSD. Ramsey County did not object to Dr. Keller’s report and concedes

that Dr. Keller’s opinion has foundation.

The compensation judge determined that Dr. Keller’s report was more persuasive

than Dr. Gratzer’s report. In particular, the judge found instructive that Dr. Gratzer relied

heavily upon the clinical testing done by Dr. Logel, but that Dr. Gratzer only “attached

conclusions to the results that conformed to his opinions while failing to address” other

possibilities discussed by Dr. Logel. For example, Dr. Logel indicated in his psychological

test report that Tea’s responses to the clinical testing could either be associated with the

overreporting of symptoms or with “the credible reporting of an individual with substantial

medical problems” while also noting that the described diagnostic protocol was suggestive

of PTSD. Dr. Gratzer did not refer to that latter possibility. Further, Dr. Gratzer concluded

that Tea could not have PTSD because she did not directly experience a traumatic event.

But the compensation judge also noted that Dr. Gratzer failed to address PTSD Criterion

these reasons, the issue of whether the correct version of the DSM was used is not before
us.

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A(4) 5—the very criterion that was Dr. Keller’s basis for diagnosing Tea with PTSD. The

compensation judge contrasted Dr. Gratzer’s opinion with the contrary opinions of Drs.

Keller and Hung 6 and ultimately found the doctors who had diagnosed Tea with PTSD to

be more credible.

A different compensation judge could have certainly reached a different conclusion,

and our ruling is not based upon the premise that Tea unequivocally has PTSD. Yet nothing

in the evidence presented “clearly requires reasonable minds to adopt a contrary

conclusion.” Lagasse, 982 N.W.2d at 202. The compensation judge was presented with

competing expert reports, those reports had adequate foundation, and the judge made a

choice based on all the evidence before him. Because this choice does not clearly require

a contrary conclusion, the WCCA’s affirmance of the compensation judge’s finding is not

manifestly contrary to the evidence.

5
The most recent version of the DSM describes Criterion A(4) for PTSD as
“[e]xposure to actual or threatened death, serious injury, or sexual violence in one (or more)
of the following ways: . . . (4) Experiencing repeated or extreme exposure to aversive
details of the traumatic event(s) (e.g., first responders collecting human remains; police
officers repeatedly exposed to details of child abuse).” Am. Psychiatric Ass’n, Diagnostic
and Statistical Manual of Mental Disorders, Text Revision 301 (5th ed. 2022).

6
Dr. Hung’s diagnosis of Tea’s PTSD did not mention the DSM criteria so this
diagnosis did not satisfy the statutory requirement for a compensable PTSD claim. See
Minn. Stat. § 176.011, subd. 15(d); Chrz, 986 N.W.2d at 483 n.1. Dr. Keller’s diagnosis
of PTSD did use the DSM, so the statutory requirement was met for a finding of PTSD.
Ultimately, the compensation judge did not consider Dr. Hung’s opinion as to whether Tea
had PTSD, but rather to assess the credibility of Dr. Gratzer’s opinion.

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 II.

Next, we must determine whether the WCCA made an error of law by refusing to

itself use the DSM to re-evaluate the compensation judge’s factual finding that Tea has

PTSD. Legal questions, including the interpretation of the Workers’ Compensation Act,

are reviewed de novo. Chrz, 986 N.W.2d at 485.

Ramsey County argues that the WCCA’s refusal to consider its arguments that the

facts here do not conform to the DSM description of PTSD was an error of law. Because

Minn. Stat. § 176.011, subd. 15(d), requires a PTSD diagnosis to be based on the DSM

description, Ramsey County argues the WCCA was required to analyze whether the facts

here show that Tea met the DSM diagnostic criteria. But this argument misreads both the

workers’ compensation law and our case law.

In Smith v. Carver County, a PTSD case, we reversed a WCCA decision that would

have required “compensation judges to independently read and apply the DSM-5 in

accordance with the canons of construction as if it were an administrative rule or

regulation.” 931 N.W.2d at 397. We found this instruction wholly unsupported by the

workers’ compensation statute because it “would require the compensation judge to go far

beyond determining whether the medical professional had an adequate foundation for

diagnosing a worker with (or without) PTSD under the DSM-5.” Id. We also noted that

“when medical diagnosis is required, deference to a professional’s judgment is sensible.”

Id.

Ramsey County argues that this case is distinguishable from Smith based on “(1) the

underlying facts; (2) the compensation judge’s handling of the case; and (3) the WCCA’s

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handling of the case.” Regarding the underlying facts, Ramsey County argues that Smith

is distinguishable because, unlike here, the material facts were disputed. But this is not a

reason the rule in Smith should not apply in this case. Next, Ramsey County argues that

Smith is distinguishable because there, the compensation judge and WCCA handled the

case differently than their counterparts did in this case. In Smith, the compensation judge

did not thoroughly explain his decision in a memorandum, so there was no way to

determine if his decision was based on an incorrect application of the law. Id. at 394, n.1.

In this case, the compensation judge provided a memorandum detailing his reasoning. The

fact that the compensation judge provided a memorandum does nothing to affect the

applicability of the Smith rule. Regarding the WCCA’s handling of this case, the Smith

decision itself is the precise reason for any difference. In Smith, we held that the WCCA’s

review is limited, so undoubtedly the WCCA will apply that rule in subsequent cases, as

the WCCA did here. Thus, for purposes of the issue before us, this case is entirely

analogous to Smith.

Alternatively, Ramsey County asks that we overturn Smith and require

compensation judges and the WCCA to make their own DSM diagnoses of those claiming

a work-related PTSD injury. To justify this request, Ramsey County insists an affirmance

would allow employees with any mental impairment to use a PTSD diagnosis to collect

benefits, regardless of whether the underlying facts meet the DSM criteria. Not only is this

argument seemingly one of public policy, which the Legislature is better positioned to sort

out, see Fletcher Props., Inc. v. City of Minneapolis, 947 N.W.2d 1, 11 (Minn. 2020), it is

also unfounded. Compensation judges are required to make credibility determinations and

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analyze the persuasiveness of the expert reports in all cases before them. But those judges

are applying the law—not diagnosing patients. As we stated in Smith, “the DSM is a

guideline for medical and health professionals, not a checklist for judges.” 931 N.W.2d at

397–98.

We see no reason to overturn Smith or our recent decisions upholding it, and we

uphold it again today. See, e.g., Juntunen, 982 N.W.2d at 739–40 (“[T]he job of the

compensation judge is to determine whether the expert diagnoses have adequate foundation

and, if both have adequate foundation, decide which of the professional diagnoses is more

credible and persuasive . . . .” (quoting Smith, 931 N.W.2d at 396) (internal quotation

marks omitted)); Chrz, 986 N.W.2d at 483 n.1 (noting that one expert’s conclusions could

not be used by the court because the expert had not relied on the DSM when diagnosing

PTSD (relying on Smith, 931 N.W.2d at 396)). Accordingly, the WCCA did not err when

refusing to alter the factual findings of the compensation judge.

The WCCA requested additional guidance on how Smith should be applied, noting

concerns that compensation judges may be precluded from considering the DSM criteria

in choosing between competing experts. Tea, 2023 WL 5094369, at *4 n.14. Our ruling

in Smith in no way prohibits a compensation judge from reviewing the DSM criteria when

determining which of multiple competing expert opinions is most credible and persuasive.

Rather, Smith held that compensation judges are precluded from making their own

diagnoses of the claimants before them. Smith, 931 N.W.2d at 397–99. Where the

compensation judge is asked to determine which of two or more expert opinions is most

credible and persuasive, the judge may consider all the evidence before them—including

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the DSM criteria. A compensation judge may determine that a professional diagnosis of

PTSD that the expert claims is supported by the DSM is, as a matter of fact, inconsistent

with the DSM. But that factual finding must be in relation to evidence offered by another

medical professional—not based upon the judge’s own application of the DSM criteria to

the employee’s symptoms. Accordingly, the WCCA should not make its own diagnosis or

conduct a legalistic analysis of the DSM in reviewing a compensation judge’s decision.

CONCLUSION

For the foregoing reasons, we affirm the decision of the Workers’ Compensation

Court of Appeals.

Affirmed.

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