The young claimant in this workmen's compensation case, after close association for two years with a group of emotionally disturbed youngsters put in his charge by the employer institution, suffered a mental or nervous breakdown diagnosed as paranoid schizophrenia. There is evidence in the record that this is a disease and that it was job-related. Under these circumstances the proper forum to consider this claim is to the Compensation Medical Board to which it should be referred under the provisions of Code Ann. 114-803 (5).
The claimant in this workmen's compensation case was employed for two years as a counselor and senior group leader at Annewakee Foundation, an institution for boys with social and behavioral problems. He was at that time between the ages of 24 and 26. He had in charge a group of ten boys between the ages of 16 and 18 with whom he lived in a very close group, in all aspects of life, being available to them at all times and particularly charged with responsibility for their actions, development, and emotional needs, with the exception of one day per week, and an occasional weekend. Additionally, while it was not a condition of employment, he and other employees were given time and encouraged to attend psychology and sociology classes at a nearby college, and in fact there was considerable interaction between the school and the institution, with occasional classes being held on the campus of the latter.
In 1972, as indicated by his quite unusual directness in classroom participation, it became obvious to one of his professors that he was having deep preoccupations in the areas of religion (the institution had, according to the psychiatric expert witness, a pronounced religious orientation which affected the claimant) and homosexuality (relating to his interpretation of his feelings toward the younger boys in his charge.) He appeared to be having a "religious experience . . . the kinds of things that a person would be going through a mystic state or some sort of hyper state of understanding himself or religious . . ." It was also observed by the institution's staff that the claimant's personality was undergoing some kind of change. On October 3, 1976, he abruptly stood up in a staff meeting and tendered his resignation, which was accepted. The claimant testified that he has no recollection of this or other incidents of about the same time. He remained on the campus, and on October 6 had a minor accident with his car. From that point his behavior was bizarre in the extreme. He was caught in the grip of a full blown psychosis, diagnosed as paranoid schizophrenia, had lost touch with reality and considered himself "a child sent by God to spread love to the world." He was treated by extensive hospitalization, electroshock and psychiatric follow-up, and still suffers occupational disability.
The administrative law judge hearing this claim, in an excellant and thoughtful opinion, denied compensation, a decision affirmed by the full board and the superior court, and claimant appeals.
DEEN, Presiding Judge.
1. There is no doubt that the employer-employee relationship ended on October 3, 1972. Neither the motor vehicle accident nor any other incidents occurring after that time can influence this claim.
2. However, the award recognizes that the psychosis from which claimant suffers was developing prior to his resignation, evidenced by personality changes and by statements he made "about his interpersonal relationships with boys under his guidance . . . made in psychology class at West Georgia College." It also recognizes evidence that the job contributed stress to the developing psychosis ("Sam had his initial breakdown when he was exposed to some things at the job situation") but finds "no evidence of any incidents or stressful episodes occurring." It is true that the evidence fails to delineate particularized traumatic occurrences, and that stress is reflected only in the claimant's reactions to the environment in which he was placed. Yet the evidence as a whole strongly indicates that the claimant, a young man with certain psychological disabilities but in no way out of touch with reality, worked closely for two years at a campus dedicated to the treatment and rehabilitation of psychological and social disorders in the young and, as a result of this experience, became acutely psychotic. The award does not represent a finding that this relationship does not exist, but only that there is a failure of evidence to show the particular stressful incidents initiating it. This finding is in accord with Georgia law, which does not adopt the premise, adopted in American National Red Cross v. Hagen, 327 F2d 559, that a disability occurring in the course of the employment must be presumed to have arisen therefrom, and so to be compensable. The applicable statute there covered accidental injury "arising out of and in the course of the employment and such occupational disease or infection as arises naturally out of such employment or as naturally or unavoidably results from such accidental injury." The paranoid schizophrenia there adjudged compensable arose from general stress in working conditions immediately preceding the onset of the illness. According to 1A Larson, Workmen's Compensation Law, 42.23 "there is already visible a distinct majority position supporting compensability" in cases where a mental or emotional stimulus results in a primarily "nervous" injury. Granted, such cases are often suspect, and must be closely examined, but where, as here, there is no suspicion of malingering or compensation neurosis (see Swift & Co. v. Ware, 53 Ga. App. 500 (186 SE 452)
) Georgia has always recognized as compensable those mental results which result from some initial physical injury. It also recognizes that the injury may be so slight and repetitive that no one occasion by itself causes the disability, and holds that where the cumulative effect does so, the accident will be taken as that point in time where disability results. Shipman v. Employers Mut. Liab. Ins. Co., 105 Ga. App. 487 (125 SE2d 72)
; Thomas v. Ford Motor Co., 123 Ga. App. 512 (181 SE2d 874)
. What we have not recognized, however, is that "psychological or nervous injury precipitated by psychic trauma is compensable to the same extent as physical injury" as held in In re Wolfe v. Sibley, Lindsay & Curr Co., 330 NE2d 603. See to the same effect cases listed in 1A Larson, supra, Par. 42.23, note 81. See also Bernsley v. Telemarine Communications Co., Inc., 336 NYS2d 747, where death from cardiac failure was precipitated by job-related anxieties, and cases there cited. It is true as the award holds, that the mere fact that the job is in a certain minority of persons conducive to this unfortunate result cannot in and of itself be recognized as an accident in the present state of Georgia law, since it does not qualify as an "accident" and the claimant must show both accident and disability.
3. There is, however, another valid approach to the problem in this case. The evidence is undisputed that the claimant suffered from an acute psychotic attack diagnosed as paranoid schizophrenia, a mental illness characterized by loss of perception of reality, which may be, and in the opinion of the psychiatrist was, initiated by the job influences to which the claimant was exposed. This is, according to the expert testimony "a disease process."
A similar situation was presented in Brady v. Royal Mfg. Co., 117 Ga. App. 312 (160 SE2d 424)
where the claimant, following a severely emotional and upsetting job-related dispute, developed symptoms of paralysis in her left arm diagnosed as a conversion reaction. The court held that the claimant could not be said to have suffered an injury resulting from an "accident" as Georgia defines that term. It then stated: "The medical evidence does not indicate that she actually suffers from a paralyzed arm; on the contrary it indicates that she merely thinks it to be paralyzed and will not attempt to use it . . . This may and probably does indicate what claimant suffers from is some type of mental illness. While mental illness is as real as pneumonia, like pneumonia it is an illness. It is not an 'injury' by 'accident'." This statement was the rule in Georgia prior to 1971. As stated in the dissent in Shipman v. Employers Mut. Liab. Ins. Co., 105 Ga. App. 487
, 495, supra: "Both this court and the Supreme Court have held consistently prior to the enactment of the occupational disease statute (Ga. L. 1946, p. 103 et seq.; Code Ann. Ch. 114-8), and since the enactment of that law with respect to occupational diseases not expressly covered therein, that an occupational disease contracted as the result of long continued exposure to conditions of the employment, as distinguished from one contracted as the result of an injury traceable to a definitely established accidental occurrence, is not compensable," and that accordingly it precluded "the award of compensation for a gradual injury, even though the result of trauma." The writer concluded: "The claimant's loss of hearing was due to his long and continued exposure to excessive noise, which was incidental to and a condition of his work. That he was, therefore, suffering from an industrial disease, to my mind admits of little doubt." Thus, in the Shipman case, it was recognized that the disability arose out of and in the course of employment; the dispute was whether it should be classified as accident or occupational disease. Under the evidence of physical trauma to the claimant's eardrums in that case the majority favored the legal theory of accident.
Shipman was decided in 1962. Brady was decided in 1968. In 1971 (Ga. L. 1971, pp. 895, 900) subsection 5 was added to Code 114-803 making compensable unlisted occupational diseases if they met certain conditions: causal condition between the work and the disease, following exposure occurring by reason of employment, with no substantial exposure outside of the employment; that it is not an ordinary disease of life to which the general public is exposed; that it had its origin in a risk connected with the employment, etc.
The evidence here strongly suggests that a disease (acute psychotic character disorder diagnosed paranoid schizophrenia) resulted from pressures of the claimant's job environment (close long term association with and responsibility for a group of disturbed men) resulting in disability to himself. This is a medical question which should properly be referred to the Medical Board for investigation under the provisions of Code 114-819. That board would have for decision whether such diagnosis is correct, whether it was job-related, and whether the conditions of Code 114-803 (5) have been met. The board should consider the record here, with the right of the parties to introduce additional testimony if they desire. The administrative law judge erred in holding, prior to such referral, that Code 114-803 (5) did not apply.
ON MOTION FOR REHEARING.
We accordingly adhere to our original opinion as written.
Motion for rehearing denied.