In re Englebrake v. CSI Enterprises, C.A. No. 04A-03-002-RFS (DE 12/22/2004), C.A. No. 04A-03-002-RFS.
| Decision Date | 22 December 2004 |
| Docket Number | C.A. No. 04A-03-002-RFS. |
| Parties | RE: GEORGE ENGLEBRAKE v. CSI ENTERPRISES. |
| Court | Supreme Court of Delaware |
Henry C. Davis, Esquire, Henry Clay Davis III, P.A., Georgetown, Delaware.
John J. Klusman, Esq., Susan A. List, Esq., Tybout Re dfearn & Pell, Wilmington, Delaware.
Dear Counsel:
This is my decision regarding George Englebrake's appeal of the Industrial Accident Board's decision denying his petition to determine additional compensation due. For the reasons set forth herein, the Board's decision is affirmed in part and reversed in part and remanded for further proceedings consistent with this opinion.
On March 12, 2001, the Claimant, George Englebrake ("Englebrake") was injured in a compensable work accident when he attempted to lift a solid core forklift tire in to his work van. At the time, he was an employee with CSI Enterprises ("CSI"). CSI agreed that the injury was compensable and paid total disability benefits to Englebrake until July of 2002. On July 10, 2002, the parties signed a partial disability agreement. Then, on August 1, 2002, a document was signed by Claimant's attorney and CSI's attorney acknowledging that the Claimant was no longer totally disabled and that the he would not oppose CSI's termination petition.
About ten to twelve months after his accident, Englebrake began to experience anxiety attacks. In May of 2002, he began seeing Dr. David August (" Dr. August"), a board certified psychiatrist, for treatment of the psychological symptoms he had been experiencing since the accident. Claimant discussed with the psychiatrist marital problems and his obsession with his inability to work. This was not the first time Englebrake had seen a psychiatrist. He had also been treated before the accident for marital difficulties with a previous wife and for alcohol abuse.
Mr. Englebrake filed a Petition to Determine Additional Compensation Due with the Industrial Accident Board ("the Board"), in order to seek payment for Dr. August's services. A hearing was held on January 16, 2004 at which Dr. August testified by deposition. The Claim ant also testified and Dr. Neil S. Kaye ("Dr. Kaye"), another board certified psychiatrist, testified by deposition on behalf of CSI. In a decision dated February 13, 2004, the Board denied the petition. Englebrake has appealed that decision, claiming that the Board did not apply the correct standard of causation and that there was not substantial evidence sufficient to support its conclusions.
Englebrake first saw Dr. August on May 14, 2002 almost fourteen months after his accident. Dr. August believed that he was ref erred to him by his primary care doctor, Dr. Gabriel Somori ("Dr. Somori"), and by his lawyer because he was having trouble coping with the pain. Englebrake had begun having anxiety attacks sometime after the accident. He was afraid of leaving his home and was obsessively thinking about the wo rk injury and about his fears of not being able to work again. He was also concerned about his relationship with his wife.
Dr. August noted that the Claimant had had previous mental health problems before the accident, but the doctor felt they were unrelated to the present ones. Englebrake had been hospitalized for alcohol abuse in the nineties and had had marital difficulties with a previous wife. He had been treated with the antidepressants, Effexor and Prozac, prior to the accident. Dr. August continued the Claimant on the Effexor and increased his dosage. The doctor noted that the medication was effective against both depression and panic disorders. Dr. August also prescribed Dexedrine to help Englebrake with the drowsiness side effect of his pain medications.1 Englebrake visited Dr. August about once every two weeks and sometimes more frequently. Dr. August testified that when he first saw the Claimant, he thought his depression was in complete remission. He was treating him for anxiety problems and to help him man age his pain medications. Englebrake claimed that he was no longer drinking. Dr. August observed that he was having difficulty adjusting to the changes in his lifestyle caused by the pain and disability. He was also having marital problems with his second wife. In addition, Englebrake was no longer able to pursue his hob by of racing cars.
When he was questioned by counsel for CSI, Dr. August explained that he did not feel the fourteen month passage of time from the date of the accident to his first visit was abnormal. He believed it was acceptable because over time chronic pain gets worse and long-term pain exhausts a person's coping mechanisms. He hypothesized that a person with a back injury might find it hard to cope with the realization over time that he is not going to heal and that his life might be forever changed.
Next, Mr. Englebrake testified that he had been taking Effexor, in a lower dose, for about four years and that some time before the accident he had seen a different psychiatrist. For his pain, Dr. Somori had prescribed him Oxycotin and Oxycodon. He went to see Dr. August because about ten to twelve months after the accident he had begun to have anxiety attacks when he realized his life had permanently changed. It was his idea to seek out a psychiatrist.
In the nineties he was divorced from his first wife and had been prescribed Effexor to help him cope with the fallout from the divorce and custody issues. He was at some point hospitalized for alcohol related problems, but claimed he had not had a drink in about a year. In addition to increasing his dose of Effexor, Dr. August also prescribed Valium to him to help ease the panic attacks.
Dr. Kaye saw Englebrake on two occasions, on January 16, 2003 and on November 10, 2003. He also reviewed the medical and psychiatric records. Dr. Kaye's diagnosis of the Claimant was the same as Dr. August's — a single episode of major depression that was in remission with the current treatment, alcohol abuse, panic disorder and agoraphobia.2 Englebrake had a normal mental status exam. He had sadness, but not to a clinical degree, and he had monotony and drowsiness, possibly due to the pain medications.
Dr. Kaye noted that Englebrake had been taking 150mg of Effexor before the accident and that his dosage was increased to 225 mg after he saw Dr. August. It was later increased again by another 75 mg. Englebrake was still drinking when he met with Dr. Kaye; however, his drinking was reduced and was even less at the time of the second meeting.
Dr. Kaye did not feel that Englebrake's mental condition was related to the work injury. His alcohol abuse predated the injury and the major depression was in remission. According to the doctor, he was on almost the same dose of Effexor before and after the accident. Dr. Kaye also stated that a panic disorder is not caused by a particular event or stressor, but is instead a long-standing condition that ebbs and flows. He believed that the fourteen month passage of time from the accident to the Claimant's first visit with Dr. August showed the symptoms could not have been causally related to the accident. He felt the time period indicated he really did not need the treatment and that the care he was getting from his primary care physician was adequate. He pointed out that the psychotherapy was more focused on other aspects of the Claimant's life, rather than on pain management.
When Englebrake met with Dr. Kaye in November of 2003, his condition was basically the same. His appointments with Dr. August had been shortened, and he expressed to Dr. Kaye a desire to have more time to discuss his marital problems. He felt his anxiety was much better, but it still flared up on occasion. Englebrake also expressed a desire to talk about older issues, such as his father's physical abuse and problems in his first marriage. He said his anxiety felt like what he used to feel waiting for his father to come home and abuse him.
Dr. Kaye opined that with work-related injuries you do not get symptoms like the Claimant's. Generally, a doctor would expect to treat the patient for pain management and for depression secondary to the pain. He would expect to find post traumatic stress disorder. The symptoms of depression would appear fairly soon after the accident occurred.
In its decision on February 13, 2004, the Board believed the opinions of Dr. Kaye to be more credible and persuasive than those of Dr. August. In finding that the work injury did not trigger the anxiety attacks, it was most persuaded by the fact that the Claimant had a history of panic attacks and that their latest manifestation did not occur until ten to twelve months after the injury. It was also swayed by Dr. Kaye's testimony that Englebrake's treatment issues centered on marital problems and child hood is sues.
The Board was not convinced by Dr. August's testimony because he could not provide them with a persuasive reason as to why so many months had lapsed before the first anxiety attack. In addition, while he stated that chronic pain can cause the psychiatric symptoms, he had agreed that Dr. Somori had the Claimant's pain under control. Dr. August also was not aware that Englebrake had signed an agreement terminating his total disability. Furthermore, the Board found Mr. Englebrake's testimony to be inconsistent. He also could not adequately explain exactly what, because of the accident, it was that caused his panic attacks. Moreover, Englebrake told the Board he had not had a drink for a year, although he had reported to Dr. Kaye in November of 2003, about three months before the Board hearing, that he was still drinking on occasion.
At issue in this case is whether the Board had substantial evidence to find the Claimant's psychiatric condition was not triggered or aggravated by the work-related accident.
The Supreme...
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