While working as a paramedic in 1987, Doreen Means was part of the first medical personnel crew to arrive at the scene of a particularly severe accident involving a van carrying five teenagers. She provided aid and declared the teenagers dead. In 1992, she served as a paramedic at an especially gruesome motorcycle accident; the victim had not been wearing a helmet and his scalp had been torn away from his skull. After this accident, she felt that she “woke up” and remembered the teenage van accident, as well as another particularly traumatic accident she attended to in 1987.

After the motorcycle accident, Means frequently missed work and began seeing a psychiatrist and a therapist at the Psychological Services Section of the Baltimore County Police and Fire Departments. She reported to the therapist that she suffered from flashbacks of the van accident, headaches, crying spells, and difficulty concentrating. In clinical notes of June, 1992, the therapist noted that Means's symptoms “sound as though they could possibly be part of a post-traumatic reaction or disorder” She remained under the therapist's care until October, 1992. Means was subsequently evaluated in July and October, 1995, by a psychiatrist, who stated that in his opinion “the initial diagnosis in 1992 should have been Post-Traumatic Stress Disorder, delayed onset.”

Means filed a workers' compensation claim for Post-Traumatic Stress Disorder in February 1994. In January 1995, the Workers' Compensation Commission concluded that she had not suffered an occupational disease arising out of and in the course of her employment. Means filed a petition for judicial review in the Baltimore County Circuit Court. She proffered that the doctor who examined her in 1995 would testify that she suffered from PTSD caused by her employment as a paramedic. But the court granted the County's motion for summary judgment, on the ground that as a matter of law, PTSD may not form the basis of an occupational disease claim. The Maryland Workers' Compensation Act, § 9-10l(g), defines an occupational disease as one “contracted by a covered employee (1) as the result of and in the course of employment; and (2) that causes the covered employee to become temporarily or permanently, partially or totally incapacitated.” § 9-502(D) limits liability to cases where the occupational disease “is due to the nature of an employment in which hazards of the occupational disease exist. . . .” Means appealed.

Held: Reversed, the Court concluding that as a matter of law, PTSD can form the basis of an occupational disease claim. The Court began by noting that as opposed to a claim accompanied by a physical illness, Means had made a “mental-mental” claim, in that she alleged that a mental stimulus (the memory of the traumatic accident) caused a mental injury (PTSD). The Court noted that it had previously held mental-mental claims to be compensable in the context of accidental injury, but Means claimed she suffered from occupational disease—a gradually resulting purely mental disease. The Court went on to state that even though the statute maintained a distinction between accidental injury and occupational disease claims, there was “no sound reason” to treat occupational diseases differently from accidental injury regarding compensation for mental-mental claims. It concluded that PTSD “may be compatible with the general character of occupational disease,” which, in Foble v. Knefely 1176 Md 474, 6 A.2d 48 (1939) it had previously described as “some ailment, disorder, or illness which is the expectable result of working under conditions naturally inherent in the employment...and is ordinarily slow and insidious in its approach.” The Court reminded that it was not holding that Means's alleged PTSD was necessarily compensable as an occupational disease, for she must still meet the statutory requirements of proving she contracted it “as the result of and in the course of employment” and that the illness is due to the nature of a paramedic's job.

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