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Means v. Baltimore County3/4/1997
onably characterized as due to the general character of Davis's employment.
We conclude that Means's asserted PTSD may be reasonably characterized as due to the general character of her employment as a paramedic. Unlike the computer operator in Davis who divided his time between programming computers and reading manuals, Means's employment as a paramedic exposed her to events that could potentially cause PTSD.
We conclude that PTSD may be compatible with the general character of occupational disease. We have consistently described occupational disease as "some ailment, disorder, or illness which is the expectable result of working under conditions naturally inherent in the employment and inseparable therefrom, and is ordinarily slow and insidious in its approach." Foble v. Knefely, 176 Md. 474, 486, 6 A.2d 48, 53 (1939); see also Davis, 336 Md. at 233, 647 A.2d at 449; Lovellette v. City of Baltimore, 297 Md. 271, 280, 465 A.2d 1141, 1146 (1983). In the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV), a condition may only be diagnosed as PTSD after the symptoms have persisted for over one month. AMERICAN PSYCHIATRIC ASSOCIATION, QUICK REFERENCE TO THE DIAGNOSTIC CRITERIA FROM DSM-IV 211 (1994). Although the outbreak of symptoms may be experienced a few days to a few weeks after the trauma, symptoms may also be delayed. See H. KAPLAN ET AL., SYNOPSIS OF PSYCHIATRY 610 (7th ed. 1994). Based on these criteria, PTSD can be slow and insidious.
Although the structure and history of the occupational disease statutes reflect an intent by the legislature to treat occupational disease differently from accidental injury in some respects, in light of our holding in Belcher we see no sound reason to treat them differently in this regard. In Miller, we noted one basis for treating occupational disease and accidental injury differently:
The problems of showing disability and causation simply appear less formidable in the [accidental injury ] context. The injury, at least to the lay eye, is relatively easy to see and evaluate, and its connection to the employment is more readily apparent.
Miller, 310 Md. at 185, 528 A.2d at 492. This quotation echoes the criticisms of those who oppose compensation for workers who suffer from PTSD arising out of their employment. This Court has addressed PTSD in other contexts, and we have concluded that expert testimony concerning PTSD is "as evidentiarily reliable as an opinion by an orthopedist who has been engaged only to testify ascribing a plaintiff's subjective complaints of low back pain to soft tissue injury resulting from an automobile accident." State v. Allewalt, 308 Md. 89, 99, 517 A.2d 741, 746 (1986); see also Hutton v. State, 339 Md. 480, 491-93, 663 A.2d 1289, 1294-95 (1995); Acuna v. State, 332 Md. 65, 629 A.2d 1233 (1993). Workers who suffer back pain or soft tissue injury as a result of accidents or diseases arising in the course of employment are not denied compensation due to the difficulty of verification. Judge Orth, writing for the Court in Belcher, observed:
We have come to appreciate that a mind may be injured as well as a body maimed. A person's psychic trauma does not vary depending upon the type of legal action in which the harm is scrutinized. . . . The inability to work and the loss of earning power are the same.
Belcher, 329 Md. at 738, 621 A.2d at 886. Other states that maintain a distinction between accidental injury and occupational disease in their workers' compensation statute similarly have held mental disorders to be compensable as occupational diseases. E.g., City of Aurora v. Industrial Comm'n, 710 P.2d 1122, 1123 (Colo. Ct. App. 1985);
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