The Court That Put the Mind Outside the Workplace

At 150 feet, fire ceases to look like an object and becomes a sky.

That was the sky above Exxon’s Baytown refinery after a pipe ruptured in a hydro-desulfurization unit and released volatile hydrocarbons. The explosion injured workers. The fire burned for eight hours. The damage took Exxon five months to repair.

Into that fire went a process technician whom the litigation calls Employee 2.

He was not a member of the refinery’s emergency-response team. He went anyway. Because he knew the unit’s maze of pipes and valves, firefighters dressed him in protective gear and followed him inside so he could help shut off the fuel feeding the blaze. After he emerged, someone discovered that at least one bypass remained open. Employee 2 was asked to put the gear back on and enter the burning unit again.

He did.

The refinery fire eventually went out. For Employee 2, it did not.

Four health professionals diagnosed him with post-traumatic stress disorder arising from the explosion. His primary-care physician prescribed medication. After Exxon rejected the opinions of his first three providers as insufficiently specialized, Employee 2 found a psychologist through Exxon’s own employee-assistance program. Exxon acknowledged that she possessed the qualifications required by OSHA’s rule. She diagnosed work-related PTSD and recommended that Employee 2 remain away from work for another six months.

On July 21, 2026, the United States Court of Appeals for the Fifth Circuit decided whether the federal workplace-safety system could officially record Employee 2’s condition. The court held that the Occupational Safety and Health Act’s command to maintain records of work-related “illnesses” reaches physical illnesses only. It vacated OSHA’s mental-illness recordkeeping rule and erased the citation against Exxon.

The holding rests on a thumb pressed to the interpretive scale and two invisible words in the text.

Congress said “illnesses.”

The Fifth Circuit made it say “physical illnesses only.”

The case did not determine whether Employee 2 was entitled to medical care, disability leave or workers’ compensation. It concerned whether a qualifying work-related mental illness had to appear on the OSHA forms that record what a workplace has done to the people inside it.

An OSHA log is not a consolation prize for an injured worker. It is part of the informational nervous system of occupational safety. Employers use those records to identify recurring hazards and evaluate their safety programs. Inspectors use them to decide where to look and what dangers require attention. OSHA uses them to target interventions. The Bureau of Labor Statistics uses them to construct the national picture of workplace injury and disease—the picture from which lawmakers, regulators, employers and researchers decide what must be prevented next.

Removing mental illness from that system leaves the clinical diagnosis intact while making it institutionally illegible. The harm can exist in the worker’s medical file while vanishing from the refinery’s safety record, the inspector’s field of vision and the nation’s statistics.

What is not counted does not cease to exist. It merely loses its power to compel attention.

Section 657(c)(2) does not contain the words “mental illness.” Its severity language speaks of first aid, medical treatment, loss of consciousness, restriction of work or motion, and transfer to another job. Nearby provisions discuss toxic materials and harmful “physical agents.” Congress’s reference to “psychological factors” appears in a declaration of purpose concerning research, not in the subsection that directly imposes employer recordkeeping duties. And after Loper Bright, a court may not defer to OSHA simply because the agency’s interpretation is reasonable or longstanding. Judges must exercise independent judgment and identify the best reading of the statute.

A statute may be enacted against a world of paradigmatic physical dangers without being confined to those dangers. Congress often legislates in general categories precisely because it cannot list every factual application the future will present. Congress chose the ordinary category “illnesses.” Its 1970 meaning supplies the boundary, including whether illnesses of the mind fell within it.

The Fifth Circuit never establishes that exclusion. It assumes it, then arranges the surrounding text around the assumption.

Section 657(c)(2) directs the Secretary to require accurate records of work-related “deaths, injuries and illnesses.” It does not say bodily illnesses, physiological illnesses or illnesses caused by physical agents. Indeed, in the very next paragraph Congress expressly used the adjective “physical,” directing employers to maintain records of exposure to harmful “physical agents.” Congress knew how to draw a physical boundary. It drew one where it wanted one.

The court’s interpretation quietly carries that adjective backward from subsection (c)(3) and inserts it before “illnesses” in subsection (c)(2).

Carrying “physical” backward from subsection (c)(3) into subsection (c)(2) amends the statute under the name of interpretation.

Congress placed “psychological factors” in its declaration of purpose rather than the employer-recordkeeping subsection. The phrase supplies statutory context: psychological harm belongs within the Act’s architecture even though the declaration of purpose does not itself impose employer duties.

Congress declared that occupational safety and health would be advanced through research “including the psychological factors involved.” 29 U.S.C. § 651(b)(5). In the same declaration, it called for reporting procedures that would “accurately describe the nature” of the nation’s occupational-safety problem. Research identifies hazards; records show their incidence; statistics reveal their scale; standards and interventions respond to what the evidence discloses. Congress designed those functions to inform one another.

29 U.S.C. § 673 commands the Secretary to maintain an effective program for collecting and analyzing occupational-safety statistics. Those statistics “shall include all disabling, serious, or significant injuries and illnesses.” The statute then says that employer reports for this program are to be based on the records maintained under § 657(c)—the very records at issue in the case.

The word “all” is inconvenient for the Fifth Circuit’s theory. So is the direct connection to § 657(c).

Employee 2’s PTSD was diagnosed repeatedly, treated with prescription medication and serious enough that a qualified psychologist recommended another six months away from the refinery. Yet the court’s interpretation means that such a condition cannot enter the statistical program Congress commanded to encompass “all disabling, serious, or significant” illnesses, because the organ in which the injury manifested was the brain.

Section 673 answers the categorical question before the court. Congress ordered statistics on all serious illnesses, using employer records kept under the very provision the Fifth Circuit was construing.

The court’s treatment of the statute’s severity criteria is no more persuasive. It emphasizes that mental conditions do not ordinarily involve “restriction of work or motion” or “loss of consciousness.” From those selected examples, it infers that Congress must have had physical harms in mind.

OSHA distinguishes days away from work from restricted or light-duty work. Congress separately named medical treatment, and Employee 2’s physician prescribed medication for his PTSD.

Under OSHA’s rules, issuing a prescription constitutes medical treatment. Even without the regulatory definition, medication prescribed by a physician is medical treatment in the ordinary sense of those words.

The court selected the criteria that sounded most physical and ignored the one that matched the facts before it.

That selective reading infects the opinion’s reliance on noscitur a sociis, the canon counseling that a word may be understood through the company it keeps. Because “illnesses” appears beside “deaths” and “injuries,” the panel reasons that illnesses should be understood as another category of physical harm.

But the most obvious quality shared by the three nouns is not physicality. It is occupational causation. They are the deaths, injuries and illnesses produced by work.

A canon can refine a word’s meaning. It cannot collapse one noun into another. If “injuries” already supplied the category and forced “illnesses” to carry essentially the same physical meaning, Congress’s decision to use both becomes difficult to explain. The more natural understanding is additive: Congress grouped distinct forms of workplace harm because it intended to capture all of them.

Nor does the carveout for “minor injuries” establish that every illness must be physical. At most, the wording creates an awkward question about why Congress referred expressly to minor injuries without repeating minor illnesses. Legislative awkwardness is common. It does not authorize a court to narrow the separate noun “illnesses” by half.

A provision discussing bandages and first aid tells us that small cuts need not enter the federal recordkeeping system. It does not tell us that severe PTSD is not an illness.

The dictionary analysis reverses ordinary logic.

The court surveys definitions from around 1970 describing illness as disease, sickness, ailment, malady or a disorder of health. None of those definitions says “physical only.” None says that a disorder ceases to be an illness when it affects the mind. Nevertheless, because the definitions do not expressly mention nonphysical conditions, the court treats their silence as evidence of exclusion.

That is not how definitions work. A definition of a bird as an animal does not exclude seabirds simply because it fails to mention the ocean. “Disorder of health” describes a category. A court may not convert the definition’s breadth into a limitation by demanding that every possible member of the category be separately named.

Employee 2 had been diagnosed with a disorder of health by four professionals. He had been prescribed medication. A psychologist had concluded that returning to the refinery was medically inadvisable for six more months. The dictionaries did not exclude his condition. The court did.

One contemporaneous dictionary, Webster’s Third, removed any possible ambiguity by defining illness as an unhealthy condition of “body or mind.” The panel did not rebut that particular definition with contrary evidence about usage. Instead, it invoked Justice Antonin Scalia’s generalized criticism that Webster’s Third was sometimes too permissive in recording disputed meanings.

A general complaint about a dictionary is not an analysis of a specific definition. Justice Scalia’s displeasure with an edition cannot transmute a definition of “body or mind” into “body only.”

The panel also notes that one dictionary contained a separate entry for “mental illness” directing readers to “insanity,” as though the existence of a separate entry somehow removes mental illness from the larger category of illness. At minimum, the entry proves that “mental illness” was established language when Congress enacted the statute. Whatever the period’s crude or incomplete psychiatric taxonomy, the concept was neither linguistically unavailable nor invented decades later by OSHA.

A separate entry for heart disease would not prove that the heart lies outside the body. A separate entry for mental illness does not prove that the mind lies outside health.

OSHA’s regulation already treated mental illness more cautiously than other workplace injuries and illnesses. It placed mental illness among the exceptions to OSHA’s usual presumption of work-relatedness. Unless the employee voluntarily supplied an opinion from a qualified physician or licensed professional connecting the illness to work, the employer did not have to treat it as work-related at all.

The employer had no obligation to search for undisclosed mental-health conditions. It could obtain another professional opinion. The illness still had to satisfy OSHA’s general severity criteria. And if it was recorded, the employee received special privacy protections.

Together, these safeguards formed the compromise OSHA adopted after extensive rulemaking.

Employers had raised legitimate concerns about privacy, diagnostic uncertainty and contested causation. OSHA responded by making mental illness harder to classify as work-related than ordinary injuries. The agency explained that it had recorded occupational mental illnesses since the Act’s inception, but it nevertheless imposed voluntary disclosure, professional verification, a second-opinion mechanism and special confidentiality protections. OSHA also concluded that abandoning those records would deprive employers, employees and safety professionals of useful information while distorting statistics maintained over many years. 66 Fed. Reg. 5916, 5952–53 (Jan. 19, 2001).

The regulation was a brake, not an accelerator.

Employee 2’s experience reveals how formidable that brake already was. He sought help through Exxon’s programs. Two licensed clinical social workers and his physician diagnosed PTSD, but Exxon concluded that none possessed the specialized qualifications required by the rule. He then found Dr. Chelsea McCann through Exxon’s own EAP portal. She conducted a battery of assessments. Exxon conceded that she was qualified. Even then, the company exercised its right to seek another opinion and relied on a provider who reviewed Employee 2’s records without examining him in person.

Whatever one thinks of the ultimate disagreement among the clinicians, that history bears no resemblance to an agency casually expanding its dominion over the American mind. It shows a worker attempting to pass through a regulatory gate designed to protect both employers and employee privacy.

The Fifth Circuit looked at that gate and mistook it for an invasion.

It is true that regulatory modesty cannot create statutory authority where none exists. A narrow rule may still be unauthorized. But OSHA did not locate its underlying authority in the exception. It located that authority in Congress’s command to record work-related “illnesses.” The exception limited when one subset of those illnesses would be treated as work-related. By describing § 1904.5(b)(2)(ix) as though it created the entire category of mental illness from nothing, the court confused the safeguard with the power it constrained.

The panel vacated the regulation itself. The special protection requiring voluntary disclosure and qualified professional verification disappeared along with the recording obligation.

Loper Bright does not compel that result.

Loper Bright requires independent judgment, not inverse deference. Courts are not supposed to favor an agency because the statute is ambiguous; neither are they supposed to favor the narrowest possible reading because the defendant is an agency. The judicial task remains interpretation: reading the enacted words in their full statutory setting and choosing the best meaning.

Here, the court’s “independent judgment” depends on dictionaries that do not contain the limitation it adopts, a canon that cannot bear the weight placed upon it, selected severity criteria contradicted by the medical treatment in the record, and a statutory context from which § 673 somehow disappears.

Congress did not have to write “including PTSD, depression, anxiety disorders and every other presently or subsequently recognized psychiatric diagnosis.” Legislatures enact categories. Agencies apply them to cases. Courts police the boundaries. But a boundary must come from the law, not from a judge’s intuition that a workplace injury becomes less occupational when it cannot be sutured, splinted or seen on a scan.

The body-mind boundary erected by the Fifth Circuit appears nowhere in Congress’s work. Congress spoke of “illnesses.” It expressly placed psychological factors inside the field of occupational health. It demanded reporting procedures that accurately describe the problem. It ordered statistics encompassing “all” serious or disabling illnesses and connected those statistics to the employer records maintained under § 657(c).

The court turns textualism into sleight of hand: display the statute in one hand, slip the word “physical” into it with the other, and invite the audience to applaud the restraint.

Employee 2 entered the burning refinery twice because he knew which valves were feeding the fire. Occupational records serve a different but equally vital function: They carry the signal from an injury to the institutions capable of recognizing a pattern and preventing its recurrence.

The Fifth Circuit has now severed the nerve through which psychological injury becomes official knowledge.

The PTSD may remain in a physician’s notes. It may remain in a prescription bottle. It may remain in a worker who cannot safely return to the place where the sky caught fire. But under the court’s interpretation, it does not belong in the federal account of what that workplace did.

The fire followed Employee 2 out of the refinery in his mind.

Congress had a word for what followed: illness.

The Fifth Circuit erased it.