DETERMINING DISABILITY

• Citation: 20 CFR Part 220
• Sections: 98

§ 220.1 Introduction of part.

(a) This part explains how disability determinations are made by the Railroad Retirement Board. In some determinations of disability entitlement, as described below, the Board makes the decision of disability under the Railroad Retirement Act based on the regulations set out in this part. However, in certain other determinations of disability entitlement (as also described below) the Board has the authority to decide whether the claimant is disabled as that term is defined in the Social Security Act and the regulations of the Social Security Administration.

(b) In order for a claimant to become entitled to a railroad retirement annuity based on disability for his or her regular railroad occupation, or to become entitled to a railroad retirement annuity based on disability for any regular employment as an employee, widow(er), or child, he or she must be disabled as those terms are defined in the Railroad Retirement Act. In order for a claimant to become entitled to a period of disability, to early Medicare coverage based on disability, to benefits under the social security overall minimum, or to a disability annuity as a surviving divorced spouse or remarried widow(er), the claimant must be found disabled as that term is defined in the Social Security Act.

§ 220.2 The basis for the Board's disability decision.

(a) The Board makes disability decisions for claims of disability under the Railroad Retirement Act. These decisions are based either on the rules contained in the Board's regulations in this part or the rules contained in the regulations of the Social Security Administration, whichever is controlling.

(b) A disability decision is made only if the claimant meets other basic eligibility requirements for the specific disability benefit for which he or she is applying. For example, a claimant for an occupational disability annuity must first meet the eligibility requirements for that annuity, as explained in part 216 of this chapter, in order for the Board to make a disability decision.

§ 220.3 Determinations by other organizations and agencies.

Determinations of the Social Security Administration or any other governmental or non-governmental agency about whether or not a claimant is disabled under the laws, regulations or standards administered by that agency shall be considered by the Board but are not binding on the Board.

§ 220.5 Definitions as used in this part.

Act means the Railroad Retirement Act of 1974.

Application refers only to a form described in part 217 of this chapter.

Board means the Railroad Retirement Board.

Claimant means the person for whom an application for an annuity, period of disability or Medicare coverage is filed.

Eligible means that a person would meet all the requirements for payment of an annuity but has not yet applied.

Employee is defined in part 203 of this title.

Entitled means that a person has applied and has proven his or her right to have the annuity, period of disability, or Medicare coverage begin.

Medical source refers to both a treating source and a source of record.

Review physician means a medical doctor either employed by or under contract to the Board who upon request reviews medical evidence and provides medical advice.

Social security overall minimum refers to the provision of the Railroad Retirement Act which guarantees that the total monthly annuities payable to an employee and his or her family will not be less than the total monthly amount which would be payable under the Social Security Act if the employee's railroad service were credited as employment under the Social Security Act.

Source of record means a hospital, clinic or other source that has provided a claimant with medical treatment or evaluation, as well as a physician or psychologist who has treated or evaluated a claimant but does not have an ongoing relationship with him or her.

Treating source means the claimant's own physician or psychologist who has provided the claimant with medical treatment or evaluation and who has an ongoing treatment relationship with him or her.

§ 220.10 Disability for work in an employee's regular railroad occupation.

(a) In order to receive an occupational disability annuity an eligible employee must be found by the Board to be disabled for work in his or her regular railroad occupation because of a permanent physical or mental impairment. In this subpart the Board describes in general terms how it evaluates a claim for an occupational disability annuity. In accordance with section 2(a)(2) of the Railroad Retirement Act this subpart was developed with the cooperation of employers and employees. This subpart is supplemented by an Occupational Disability Claims Manual (Manual)

1

which was also developed with the cooperation of employers and employees.

1 The Manual may be obtained from the Board's headquarters at 844 North Rush Street, Chicago, IL 60611.

(b) In accordance with section 2(a)(2) of the Railroad Retirement Act, the Board shall select two physicians, one from recommendations made by representatives of employers and one from recommendations made by representatives of employees. These individuals shall comprise the Occupational Disability Advisory Committee (Committee). This Committee shall periodically review, as necessary, this subpart and the Manual and make recommendations to the Board with respect to amendments to this subpart or to the Manual. The Board shall confer with the Committee before it amends either this subpart or the Manual.

§ 220.11 Definitions as used in this subpart.

Functional capacity test means one of a number of tests which provide objective measures of a claimant's maximal work ability and includes functional capacity evaluations which provide a systematic comprehensive assessment of a claimant's overall strength, mobility, endurance and capacity to perform physically demanding tasks, such as standing, walking, lifting, crouching, stooping or bending, climbing or kneeling.

Independent Case Evaluation (ICE) means the process for evaluating claims not covered by appendix 3 of this part.

Permanent physical or mental impairment means a physical or mental impairment or combination of impairments that can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months.

Regular railroad occupation means an employee's railroad occupation in which he or she has engaged in service for hire in more calendar months than the calendar months in which he or she has been engaged in service for hire in any other occupation during the last preceding five calendar years, whether or not consecutive; or has engaged in service for hire in not less than one-half of all of the months in which he or she has been engaged in service for hire during the last preceding 15 consecutive calendar years. If an employee last worked as an officer or employee of a railway labor organization and if continuance in such employment is no longer available to him or her, the “regular occupation” shall be the position to which the employee holds seniority rights or the position which he or she left to work for a railway labor organization.

Residual functional capacity has the same meaning as found in § 220.120.

§ 220.12 Evidence considered.

The regulations explaining the employee's responsibility to provide evidence of disability, the kind of evidence, what medical evidence consists of, and the consequences of refusing or failing to provide evidence or to have a medical examination are found in § 220.45 through § 220.48. The regulations explaining when the employee may be requested to report for a consultative examination are found in § 220.50 and § 220.51. The regulations explaining how the Board evaluates conclusions by physicians concerning the employee's disability, how the Board evaluates the employee's symptoms, what medical findings consist of, and the need to follow prescribed treatment are found in § 220.112 through § 220.115.

§ 220.13 Establishment of permanent disability for work in regular railroad occupation.

The Board will presume that a claimant who is not allowed to continue working for medical reasons by his employer has been found, under standards contained in this subpart, disabled unless the Board finds that no person could reasonably conclude on the basis of evidence presented that the claimant can no longer perform his or her regular railroad occupation for medical reasons. (See § 220.21 if the claimant is not currently disabled, but was previously occupationally disabled for a specified period of time in the past). The Board uses the following evaluation process in determining disability for work in the regular occupation:

(a) The Board evaluates the employee's medically documented physical and mental impairment(s) to determine if the employee is medically disabled. In order to be found medically disabled, the employee's impairments must be severe enough to prevent a person from doing any substantial gainful activity. The Board makes this determination based on the guidelines set out in § 220.100(b)(3). If the Board finds that an employee has an impairment which is medically disabling, it will find the employee disabled for work in his or her regular occupation without considering the duties of his or her regular occupation.

(b) If the Board finds that the claimant does not have an impairment described in paragraph (a) of this section, it will—

(1) Determine the employee's regular railroad occupation, as defined in § 220.11, based upon the employee's own description of his or her job;

(2) Evaluate whether the claimant is disabled as follows:

(i) The Board first determines whether the employee's regular railroad occupation is an occupation covered under appendix 3 of this part. Second, the Board will determine whether the employee's claimed impairment(s) is covered under appendix 3 of this part. If claimant's regular railroad occupation or impairment(s) is not covered under appendix 3 of this part, then the Board will determine if the employee is disabled under ICE as set forth in paragraph (b)(2)(iv) of this section.

(ii)(A) If the Board determines that, in accordance with paragraph (b)(2)(i) of this section, appendix 3 of this part applies, then the Board will confirm the existence of the employee's impairment(s) using—

( 1 ) The “highly recommended” and “recommended” tests set forth in appendix 3 of this part that relate to the body part affected by the claimant's impairment(s); or

( 2 ) By using valid diagnostic tests accepted by the medical community as described in § 220.27.

(B) If the employee's impairment(s) cannot be confirmed because there are significant differences in objective tests such as imaging study, electrocardiograms or other test results, and these differences cannot be readily resolved, the Board will determine if the employee is disabled under ICE as set forth in paragraph (b)(2)(iv) of this section. However, if the employee's impairment(s) cannot be confirmed, and there are no significant differences in objective medical tests which cannot be readily resolved, then the employee will be found not disabled.

(iii) Once the impairment(s) is confirmed, as provided for in paragraph (b)(2)(ii) of this section, the Board will apply appendix 3 of this part. If appendix 3 of this part dictates a “D” (disabled) finding, the Board will find the claimant disabled.

(iv) If the Board does not find the employee disabled using the standards in appendix 3 of this part, then the Board will determine if the employee is disabled using ICE. To evaluate a claim under ICE the Board will use the following steps:

(A) Step 1. The Board will determine if the medical evidence is complete. Under this step the Board may request the claimant to take additional medical tests such as a functional capacity test or other consultative examinations;

(B) Step 2. If the employee's impairment(s) has not been confirmed, as provided for in paragraph (b)(2)(ii)(A)( 2 ) of this section, the Board will next confirm the employee's impairment(s), as described in paragraph (b)(2)(ii)(A)( 2 ) of this section;

(C) Step 3. The Board will determine whether the opinions among the physicians regarding medical findings are consistent, by reviewing the employee's medical history, physical and mental examination findings, laboratory or other test results, and other information provided by the employee or obtained by the Board. If such records reveal that there are significant differences in the medical findings, significant differences in opinions concerning the residual functional capacity evaluations among treating physicians, or significant differences between the results of functional capacity evaluations and residual functional capacity examinations, then the Board may request additional evidence from treating physicians, additional consultative examinations and/or residual functional capacity tests to resolve the inconsistencies;

(D) Step 4. When the Board determines that there is concordance of medical findings, then the Board will assess the quality of the evidence in accordance with § 220.112, which describes the weight to be given to the opinions of various physicians, and § 220.114, which describes how the Board evaluates symptoms such as pain. The Board will also assess the weight of evidence by utilizing § 220.14, which outlines factors to be used in determining the weight to be attributed to certain types of evidence. If, after assessment, the Board determines that there is no substantial objective evidence of an impairment, the Board will determine that the employee is not disabled;

(E) Step 5. Next, the Board determines the physical and mental demands of the employee's regular railroad occupation. In determining the job demands of the employee's regular railroad occupation, the Board will not only consider the employee's own description of his or her regular railroad occupation, but shall also consider the employer's description of the physical requirements and environmental factors relating to the employee's regular railroad occupation, as provided by the employer on the appropriate form set forth in appendix 3 of this part, and consult other sources such as the Dictionary of Occupational Titles and the job descriptions of occupations found in the Occupational Disability Claims Manual, as provided for in § 220.10;

(F) Step 6. Based upon the assessment of the evidence in paragraph (b)(2)(iv)(D) of this section, the Board shall determine the employee's residual functional capacity. The Board will then compare the job demands of the employee's regular railroad occupation, as determined in paragraph (b)(2)(iv)(E) of this section. If the demands of the employee's regular railroad occupation exceed the employee's residual functional capacity, then the Board will find the employee disabled. If the demands do not exceed the employee's residual functional capacity, then the Board will find the employee not disabled.

§ 220.14 Weighing of evidence.

(a) Factors which support greater weight. Evidence will generally be given more weight if it meets one or more of the following criteria:

(1) The residual functional capacity evaluation is based upon functional objective tests with high validity and reliability;

(2) The medical evidence shows multiple impairments which have a cumulative effect on the employee's residual functional capacity;

(3) Symptoms associated with limitations are consistent with objective findings;

(4) There exists an adequate trial of therapies with good compliance, but poor outcome;

(5) There exists consistent history of conditions between treating physicians and other health care providers.

(b) Factors which support lesser weight. Evidence will generally be given lesser weight if it meets one or more of the following criteria:

(1) There is an inconsistency between the diagnoses of the treating physicians;

(2) There is inconsistency between reports of pain and functional impact;

(3) There is inconsistency between subjective symptoms and physical examination findings;

(4) There is evidence of poor compliance with treatment regimen, keeping appointments, or cooperating with treatment;

(5) There is evidence of exam findings which is indicative of exaggerated or potential malingering response;

(6) The evidence consists of objective findings of exams that have poor reliability or validity;

(7) The evidence consists of imaging findings which are nonspecific and largely present in the general population;

(8) The evidence consists of a residual functional capacity evaluation which is supported by limited objective data without consideration for functional capacity testing.

§ 220.15 Effects of work on occupational disability.

(a) Disability onset when the employee works despite impairment. An employee who has stopped work in his or her regular occupation due to a permanent physical or mental impairment(s) may make an effort to return to work in his or her regular occupation. If the employee is subsequently forced to stop that work after a short time because of his or her impairment(s), the Board will generally consider that work as an unsuccessful work attempt. In this situation, the Board may determine that the employee became disabled for work in his or her regular occupation before the last date the employee worked in his or her regular occupation. No annuity will be payable, however, until after the last date worked.

(b) Occupational disability annuitant work restrictions. The restrictions which apply to an annuitant who is disabled for work in his or her regular occupation are found in §§ 220.160 through 220.164.

§ 220.16 Responsibility to notify the Board of events which affect disability.

If the annuitant is entitled to a disability annuity because he or she is disabled for work in his or her regular occupation, the annuitant should promptly tell the Board if—

(a) His or her impairment(s) improves;

(b) He or she returns to any type of work;

(c) He or she increases the amount of work; or

(d) His or her earnings increase.

§ 220.17 Recovery from disability for work in the regular occupation.

(a) General. Disability for work in the regular occupation will end if—

(1) There is medical improvement in the annuitant's impairment(s) to the extent that the annuitant is able to perform the duties of his or her regular occupation; or

(2) The annuitant demonstrates the ability to perform the duties of his or her regular occupation. The Board provides a trial work period before terminating a disability annuity because of the annuitant's return to work.

(b) Definition of the trial work period. The trial work period is a period during which the annuitant may test his or her ability to work and still be considered occupationally disabled. It begins and ends as described in paragraph (e) of this section. During this period, the annuitant may perform “services” (see paragraph (c) of this section) in as many as 9 months, but these months do not have to be consecutive. The Board will not consider those services as showing that the annuitant's occupational disability has ended until the annuitant has performed services in at least 9 months. However, after the trial work period has ended, the Board will consider the work the annuitant did during the trial work period in determining whether the annuitant's occupational disability has ended at any time after the trial work period.

(c) What the Board means by services in an occupational disability case. When used in this section, “services” means any activity which, even though it may not be substantial gainful activity as defined in § 220.141, is—

(1) Done by a person in employment or self-employment for pay or profit, or is the kind normally done for pay or profit; and

(2) The activity is a return to the same duties of the annuitant's regular occupation or the activity so closely approximates the duties of the regular occupation as to demonstrate the ability to perform those duties.

(d) Limitations on the number of trial work periods. The annuitant may have only one trial work period during each period in which he or she is occupationally disabled.

(e) When the trial work period begins and ends. (1) The trial work period begins with whichever of the following calendar months is the latest—

(i) The annuity beginning date;

(ii) The month after the end of the appropriate waiting period; or

(iii) The month the application for disability is filed.

(2) The trial work period ends with the close of whichever of the following calendar months is the earlier—

(i) The ninth month (whether or not the months have been consecutive) in which the annuitant performed services; or

(ii) The month in which new evidence, other than evidence relating to any work the annuitant did during the trial work period, shows that the annuitant is not disabled, even though the annuitant has not worked a full nine months. The Board may find that the annuitant's disability has ended at any time during the trial work period if the medical or other evidence shows that the annuitant is no longer disabled.

§ 220.18 The reentitlement period.

(a) General. The reentitlement period is an additional period after the nine months of trial work during which the annuitant may continue to test his or her ability to work if the annuitant has a disabling impairment.

(b) When the reentitlement period begins and ends. The reentitlement period begins with the first month following completion of nine months of trial work but cannot begin earlier than December 1, 1980. It ends with whichever is earlier—

(1) The month before the first month in which the annuitant's impairment(s) no longer exists or is not medically disabling; or

(2) The last day of the 36th month following the end of the annuitant's trial work period.

(c) When the annuitant is not entitled to a reentitlement period. The annuitant is not entitled to a reentitlement period if—

(1) The annuitant is not entitled to a trial work period; or

(2) The annuitant's disability ended before the annuitant completed nine months of trial work in that period in which he or she was disabled.

§ 220.19 Payment of the disability annuity during the trial work period and the reentitlement period.

(a) The employee who is entitled to an occupational disability annuity will not be paid an annuity for each month in the trial work period or reentitlement period in which he or she—

(1) Works for an employer covered by the Railroad Retirement Act (see § 220.160); or

(2) Earns more than $400 (after deduction of impairment-related work expenses) in employment or self-employment (see §§ 220.161 and 220.164). See § 220.145 for the definition of impairment-related work expenses.

(b) If the employee's occupational disability annuity is stopped because of work during the trial work period or reentitlement period, and the employee discontinues that work before the end of either period, the disability annuity may be started again without a new application and a new determination of disability.

§ 220.20 Notice that an annuitant is no longer disabled.

The regulation explaining the Board's responsibilities in notifying the annuitant, and the annuitant's rights when the disability annuity is stopped is found in § 220.183.

§ 220.21 Initial evaluation of a previous occupational disability.

(a) In some cases, the Board may determine that a claimant is not currently disabled for work in his or her regular occupation but was previously disabled for a specified period of time in the past. This can occur when—

(1) The disability application was filed before the claimant's occupational disability ended, but the Board did not make the initial determination of occupational disability until after the claimant's disability ended; or

(2) The disability application was filed after the claimant's occupational disability ended but no later than the 12th month after the month the disability ended.

(b) When evaluating a claim for a previous occupational disability, the Board follows the steps in § 220.13 to determine whether an occupational disability existed, and follows the steps in §§ 220.16 and 220.17 to determine when the occupational disability ended.

Example 1:

The claimant sustained multiple fractures to his left leg in an automobile accident which occurred on June 16, 1982. For a period of 18 months following the accident the claimant underwent 2 surgical procedures which restored the functional use of his leg. After a recovery period following the last surgery, the claimant returned to his regular railroad job on February 1, 1984. The claimant, although fully recovered medically and regularly employed, filed an application on December 3, 1984 for a determination of occupational disability for the period June 16, 1982 through January 31, 1984. The Board reviewed his claim in January 1985 and determined that he was occupationally disabled for the prior period which began on June 16, 1982 and continued through January 31, 1984. A disability annuity is payable to the employee only for the period December 1, 1983 through January 31, 1984. An annuity may not begin any earlier than the 1st day of the 12th month before the month in which the application was filed. (See part 218 of this chapter for the rules on when an annuity may begin).

Example 2:

The claimant is occupationally disabled using the same medical facts disclosed above, beginning June 16, 1982 (the date of the automobile accident). The claimant files an application for an occupational disability annuity, dated December 1, 1983. However, as of February 1, 1984, and before the Board makes a disability determination, the claimant returns to his regular railroad job and is no longer considered occupationally disabled. The Board reviews the claimant's application in May of 1984 and finds him occupationally disabled for the period June 16, 1982 through January 31, 1984. A disability annuity is payable to the employee from December 1, 1982 through January 31, 1984. (See part 218 of this chapter for the rules on when an annuity may begin).

§ 220.25 General.

The definition and discussion of disability for any regular employment are found in §§ 220.26 through 220.184.

§ 220.26 Disability for any regular employment, defined.

An employee, widow(er), or child is disabled for any regular employment if he or she is unable to do any substantial gainful activity because of a medically determinable physical or mental impairment which meets the duration requirement defined in § 220.28. In the case of a widow(er), the permanent physical or mental impairment must have prevented work in any regular employment before the end of a specific period (see § 220.30). In the case of a child, the permanent physical or mental impairment must have prevented work in any regular employment since before age 22. To meet this definition of disability, a claimant must have a severe impairment, which makes him or her unable to do any previous work or other substantial gainful activity which exists in the national economy. To determine whether a claimant is able to do any other work, the Board considers a claimant's residual functional capacity, age, education and work experience. See § 220.100 for the process by which the Board evaluates disability for any regular employment. This process applies to employees, widow(er)s, or children who apply for annuities based on disability for any regular employment. This process does not apply to surviving divorced spouses or remarried widow(er)s who apply for annuities based on disability.

§ 220.27 What is needed to show an impairment.

A physical or mental impairment must result from anatomical, physiological, or psychological abnormalities which can be shown by medically acceptable clinical and laboratory diagnostic techniques. A physical or mental impairment must be established by medical evidence consisting of signs, symptoms, and laboratory findings, not only by the claimant's statement of symptoms. (See § 220.113 for further information about what is meant by symptoms, signs, and laboratory findings.) (See also § 220.112 for the effect of a medical opinion about whether or not a claimant is disabled.)

§ 220.28 How long the impairment must last.

Unless the claimant's impairment is expected to result in death, it must have lasted or must be expected to last for a continuous period of at least 12 months. This is known as the duration requirement.

§ 220.29 Work that is considered substantial gainful activity.

Work is considered to be substantial gainful activity if it—

(a) Involves doing significant and productive physical or mental duties; and

(b) Is done or is intended to be done for pay or profit. (See § 220.141 for a detailed explanation of what is substantial gainful activity.)

§ 220.30 Special period required for eligibility of widow(er)s.

In order to be found disabled for any regular employment, a widow(er) must have a permanent physical or mental impairment which prevented work in any regular employment since before the end of a specific period as defined in part 216 of this chapter.

§ 220.35 Introduction.

In addition to its authority to decide whether a claimant is disabled under the Railroad Retirement Act, the Board has authority in certain instances to decide whether a claimant is disabled as that term is defined in the Social Security Act. In making these decisions the Board must apply the regulations of the Social Security Administration in the same manner as does the Secretary of Health and Human Services in making disability decisions under the Social Security Act. Regulations of the Social Security Administration concerning disability are found at part 404, subpart P of this title.

§ 220.36 Period of disability.

(a) General. In order to receive an annuity based upon a disability, an employee must be found disabled under the Railroad Retirement Act. If an employee is found disabled under the Railroad Retirement Act, the Board will determine whether he is disabled under the Social Security Act to qualify for a period of disability as defined in that Act.

(b) Period of disability —(1) Definition and effect. A period of disability is a continuous period of time during which an employee is disabled as that term is defined in § 404.1505 of this title. A period of disability established by the Board—

(i) Preserves the disabled employee's earnings record as it is when the period begins;

(ii) Protects the insured status required for entitlement to social security overall minimum;

(iii) May cause an increase in the rate of an employee, spouse, or survivor annuity; or

(iv) May permit a disabled employee to receive Medicare benefits in addition to an annuity under the Railroad Retirement Act.

(2) Effect on benefits. The establishment of a period of disability for the employee will never cause a denial or reduction in benefits under the Railroad Retirement Act or Social Security Act, but it will always be used to establish Medicare entitlement before age 65.

(3) Who may establish a period of disability. The Railroad Retirement Board or the Social Security Administration may establish a period of disability. However, the decision of one agency is not binding upon the other agency.

(4) When the Board may establish a period of disability. The Board has independent authority to decide whether or not to establish a period of disability for any employee who was awarded an annuity under the Railroad Retirement Act, or who—

(i) Has applied for a disability annuity; and

(ii) Has at least 10 years of railroad service.

(5) When an employee is entitled to a period of disability. An employee is entitled to a period of disability if he or she meets the following requirements:

(i) The employee is disabled under the Social Security Act, as described in § 404.1505 of this title.

(ii) The employee is insured for a period of disability under § 404.130 of this title based on combined railroad and social security earnings.

(iii) The employee files an application as shown in subparagraph (b)(6) of this section.

(iv) At least 5 consecutive months elapse from the month in which the period of disability begins and before the month in which it would end.

(6) Application for a period of disability. (i) An application for an employee disability annuity under the Railroad Retirement Act or an employee disability benefit under the Social Security Act is also an application for a period of disability.

(ii) An employee who is receiving an age annuity or who was previously denied a period of disability must file a separate application for a period of disability.

(iii) In order to be entitled to a period of disability, an employee must apply while he or she is disabled or not later than 12 months after the month in which the period of disability ends.

(iv) An employee who is unable to apply within the 12-month period after the period of disability ends because his or her physical condition limited his or her activities to the extent that he or she could not complete and sign an application or because he or she was mentally incompetent, may apply no later than 36 months after the period of disability ends.

(v) A period of disability can also be established on the basis of an application filed within 3 months after the month a disabled employee died.

(c) Social security overall minimum. The social security overall minimum provision of the Railroad Retirement Act guarantees that the total monthly annuities payable to an employee and his or her family will not be less than the total monthly benefit which would be payable under the Social Security Act if the employee's railroad service were credited as employment under the Social Security Act.

(The information collection requirements contained in paragraph (b)(6) were approved by the Office of Management and Budget under control number 3220-0002)

§ 220.37 When a child's disability determination is governed by the regulations of the Social Security Administration.

(a) In order to receive an annuity based upon disability, a child of a deceased employee must be found disabled under the Railroad Retirement Act. However, in addition to this determination, the child must be found disabled under the Social Security Act in order to qualify for Medicare based upon disability.

(b) Although the child of a living employee may not receive an annuity under the Railroad Retirement Act, he or she, if found disabled under the Social Security Act, may qualify for the following:

(1) Inclusion as a disabled child in the employee's annuity rate under the social security overall minimum.

(2) Entitlement to Medicare based upon disability.

§ 220.38 When a widow(er)'s disability determination is governed by the regulations of the Social Security Administration.

In order to receive an annuity based upon disability, a widow(er) must be found disabled under the Railroad Retirement Act. However, in addition to this determination, the widow(er) must be found disabled under the Social Security Act in order to qualify for early Medicare based upon disability.

§ 220.39 Disability determination for a surviving divorced spouse or remarried widow(er).

A surviving divorced spouse or a remarried widow(er) must be found disabled under the Social Security Act in order to qualify for both an annuity under the Railroad Retirement Act and early Medicare based upon disability. Disability determinations for surviving divorced spouses and remarried widow(er)s are governed by the applicable regulations of the Social Security Administration, found at § 404.1577 of this title.

§ 220.45 Providing evidence of disability.

(a) General. You are responsible for providing all evidence of the claimed disability and the effect of the disability on your ability to work. You must inform the Board about or submit all evidence known to you that relates to the claimed disability. This duty is ongoing and requires you to disclose any additional related evidence about which you become aware. This duty applies at each level of the administrative review process, including the appeals level, if the evidence relates to the period on or before the date of the hearings officer's decision. The Board will assist you, when necessary, in obtaining the required evidence. At its discretion, the Board will arrange for an examination by a consultant at the expense of the Board as explained in §§ 220.50 and 220.51.

(b) Kind of evidence. (1) You must provide medical evidence proving that you have an impairment(s) and how severe it is during the time you claim to be disabled. The Board will consider only impairment(s) you claim to have or about which the Board receives evidence. Before deciding that you are not disabled, the Board will develop a complete medical history ( i.e., evidence from the records of your medical sources) covering at least the preceding 12 months, unless you say that your disability began less than 12 months before you filed an application. The Board will make every reasonable effort to help you in getting medical reports from your own medical sources when you give the Board permission to request them. Every reasonable effort means that the Board will make an initial request and, after 20 days, one follow-up request to your medical source to obtain the medical evidence necessary to make a determination before the Board evaluates medical evidence obtained from another source on a consultative basis. The medical source will have 10 days from the follow-up request to reply (unless experience indicates that a longer period is advisable in a particular case). In order to expedite processing, the Board may order a consultative exam from a non-treating source while awaiting receipt of medical source evidence. If the Board asks you to do so, you must contact the medical sources to help us get the medical reports.

(2) Exceptions. Notwithstanding paragraph (a) of this section, evidence does not include:

(i) Oral or written communications between you and your representative that are subject to the attorney-client privilege, unless you voluntarily disclose the communications to us; or

(ii) Your representative's analysis of your claim, unless you or your representative voluntarily disclose it to us. Your representative's “analysis of your claim” means information that is subject to the attorney work product doctrine, but it does not include medical evidence, medical source opinions, or any other factual matter that we may consider in determining whether or not you are entitled to benefits (see paragraph (b)(2)(iv) of this section).

(iii) The provisions of paragraph (b)(2)(i) of this section apply to communications between you and your non-attorney representative only if the communications would be subject to the attorney-client privilege if your non-attorney representative were an attorney. The provisions of paragraph (b)(2)(ii) of this section apply to the analysis of your claim by your non-attorney representative only if the analysis of your claim would be subject to the attorney work product doctrine if your non-attorney representative were an attorney.

(iv) The attorney-client privilege generally protects confidential communications between an attorney and the attorney's client that are related to providing or obtaining legal advice. The attorney work product doctrine generally protects an attorney's analysis, theories, mental impressions, and notes. In the context of your disability claim, neither the attorney-client privilege nor the attorney work product doctrine allows you to withhold factual information, medical source opinions, or other medical evidence that we may consider in determining whether or not you are entitled to benefits. For example, if you tell your representative about the medical sources you have seen, your representative cannot refuse to disclose the identity of those medical sources to us based on the attorney-client privilege. As another example, if your representative asks a medical source to complete an opinion form related to your impairment(s), symptoms, or limitations, your representative cannot withhold the completed opinion form from us based on the attorney work product doctrine. The attorney work product doctrine would not protect the source's opinions on the completed form, regardless of whether or not your representative used the form in an analysis of your claim or made handwritten notes on the face of the report.

(c) Your responsibility. You must inform us about or submit all evidence known to you that relates to whether or not you are blind or disabled. When you submit evidence received from another source, you must submit that evidence in its entirety, unless you previously submitted the same evidence to us or we instruct you otherwise. The Board may also ask you to provide evidence about:

(1) Your age;

(2) Your education and training;

(3) Your work experience;

(4) Your daily activities both before and after the date you say that you became disabled;

(5) Your efforts to work; and

(6) Any other evidence showing how your impairment(s) affects your ability to work. (In §§ 220.125 through 220.134, we discuss in more detail the evidence the Board needs when it considers vocational factors.)

§ 220.46 Medical evidence.

(a) Acceptable medical sources. The Board needs reports about the claimant's impairment(s) from acceptable medical sources. Acceptable medical sources are—

(1) Licensed physicians (medical or osteopathic doctors);

(2) Licensed or certified psychologists at the independent practice level;

(3) Licensed or certified school psychologists, or other licensed or certified individuals with another title who perform the same function as a school psychologist in a school setting (for impairments of intellectual disability, learning disabilities, and borderline intellectual functioning only);

(4) Licensed optometrists (for impairments of visual disorders, or for the measurement of visual acuity and visual fields only, depending on the scope of practice in the State in which the optometrist practices);

(5) Licensed podiatrists (for impairments of the foot only, or foot and ankle only, depending on the scope of practice in the State in which the podiatrist practices);

(6) Qualified speech-language pathologists (for speech or language impairments only.) For this source, qualified means that the speech-language pathologist must be licensed by the State professional licensing agency, or be fully certified by the State education agency in the State in which the speech-language pathologist practices, or hold a Certificate of Clinical Competence in Speech-Language Pathology from the American Speech-Language-Hearing Association;

(7) Licensed audiologists (for impairments of hearing loss, auditory processing disorders, and balance disorders within the licensed scope of practice only);

(8) Licensed Advanced Practice Registered Nurses or other licensed advance practice nurses with another title (for impairments within the individual's licensed scope of practice only);

(9) Licensed Physician Assistants/Physician Associates (for impairments within the individual's licensed scope of practice); or

(10) Persons authorized to furnish a copy or summary of the records of a medical facility. Generally, the copy or summary should be certified as accurate by the custodian or by any authorized employee of the Railroad Retirement Board, Social Security Administration, Department of Veterans Affairs, or State agency.

(b) Other medical sources. Individuals who are licensed as healthcare workers by a State and are working within the scope of practice permitted under State or Federal law, other than acceptable medical sources identified in paragraph (a) of this section, are other medical sources. Examples include licensed clinical social workers, naturopaths, and chiropractors. The Board will accept and consider evidence from other medical sources about the claimant's impairment(s) and the effect on the claimant's ability to work, but the presence of a medically determinable physical or mental impairment must be established with objective medical evidence from an acceptable medical source as defined in paragraph (a) of this section.

(c) Medical reports. Medical reports should include—

(1) Medical history;

(2) Clinical findings (such as the results of physical or mental status examinations);

(3) Laboratory findings (such as blood pressure, x-rays);

(4) Diagnosis (statement of disease or injury based on its signs and symptoms);

(5) Treatment prescribed, with response to treatment and prognosis; and

(6)(i) Statements about what the claimant can still do despite his or her impairment(s) based on the medical source's findings on factors in paragraphs (c)(1) through (5) of this section (except in disability claims for remarried widow's and surviving divorced spouses). (See § 220.112).

(ii) Statements about what the claimant can still do (based on the medical source's findings on factors in paragraphs (c)(1) through (5) of this section) should describe—

(A) The medical source's opinion about the claimant's ability, despite his or her impairment(s), to do work-related activities such as sitting, standing, moving about, lifting, carrying, handling objects, hearing, speaking, and traveling; and

(B) In cases of mental impairment(s), the medical source's opinion about the claimant's ability to reason or make occupational, personal, or social adjustments. (See § 220.112).

(d) Completeness. The medical evidence, including the clinical and laboratory findings, must be complete and detailed enough for the Board to determine whether the claimant is disabled. Specifically, it must allow the Board to determine—

(1) The nature and limiting effects of the claimant's impairment(s) for any period in question;

(2) The probable duration of the claimant's impairment(s); and

(3) The claimant's residual functional capacity to do work-related physical and mental activities.

(e) Evidence from treating medical sources. A statement by or the opinion of the claimant's treating medical source will not determine whether the claimant is disabled. However, the medical evidence provided by a treating medical source will be considered by the Board in making a disability decision. A treating medical source is a medical source to whom the claimant has been going for treatment on a continuing basis. The claimant may have more than one treating medical source. The Board may use consulting physicians or other medical consultants for specialized examinations or tests, to obtain more complete evidence, and to resolve any conflicts. A consulting physician is a doctor (often a specialist) to whom the claimant is referred for an examination once or on a limited basis. (See § 220.50 for an explanation of when the Board may request a consultative examination.)

(f) Information from non-medical sources. Information from other sources may also help the Board understand how an impairment affects the claimant's ability to work. Other sources include—

(1) Public and private social welfare agency personnel;

(2) Family members, caregivers, friends, and neighbors of the claimant;

(3) Educational personnel such as teachers, counselors, and daycare center workers;

(4) Railroad and nonrailroad employers; and,

(5) The claimants themselves.

(Approved by the Office of Management and Budget under control number 3220-0038)

§ 220.47 Purchase of existing medical evidence.

The Board needs specific medical evidence to determine whether a claimant is disabled. The claimant is responsible for providing that evidence. However, at its discretion, the Board will pay the reasonable cost to obtain medical evidence that it needs and requests from physicians not employed by the Federal government and other non-Federal providers of medical services.

§ 220.48 If the claimant fails to submit medical or other evidence.

The Board may request a claimant to submit medical or other evidence. If the claimant does not submit that evidence, the Board will make a decision on other evidence which is either already available in the claimant's case or which the Board may develop from other sources, including reports of consultative examinations.

§ 220.50 Consultative examinations at the Board's expense.

A consultative examination is a physical or mental examination or test purchased for a claimant at the Board's request and expense. If the claimant's medical sources cannot provide sufficient medical evidence about the claimant's impairment(s) in order to enable the Board to determine whether the claimant is disabled, the Board may ask the claimant to have one or more consultative examinations or tests. The decision to purchase a consultative examination will be made on an individual case basis in accordance with the provisions of §§ 220.53 through 220.56. Selection of the source for the examination will be consistent with the provisions of § 220.64 (Program Integrity).

(Approved by the Office of Management and Budget under control number 3220-0124)

§ 220.51 Notice of the examination.

If the Board arranges for an examination or test, the claimant will be provided with reasonable notice of the date, time, and place of the examination or test and the name of the person who will do it. The Board will also give the examiner any necessary background information about the claimant's impairment(s).

§ 220.52 Failure to appear at a consultative examination.

(a) General. The Board may find that the claimant is not disabled if he or she does not have good reason for failing or refusing to take part in a consultative examination or test which was arranged by the Board. If the individual is already receiving an annuity and does not have a good reason for failing or refusing to take part in a consultative examination or test which the Board arranged, the Board may determine that the individual's disability has stopped because of his or her failure or refusal. The claimant for whom an examination or test has been scheduled should notify the Board as soon as possible before the scheduled date of the examination or test if he or she has any reason why he or she cannot go to the examination or test. If the Board finds that the claimant has a good reason for failure to appear, another examination or test will be scheduled.

(b) Examples of good reasons for failure to appear. Some examples of good reasons for not going to a scheduled examination or test include—

(1) Illness on the date of the scheduled examination or test;

(2) Failure to receive notice or timely notice of an examination or test;

(3) Receipt of incorrect or incomplete information about the examination or test; or

(4) A death or serious illness in the claimant's immediate family.

(c) Objections by a claimant's physician. The Board should be notified immediately if the claimant is advised by his or her treating physician not to take an examination or test. In some cases, the Board may be able to secure the information which is needed in another way or the treating physician may agree to another type of examination for the same purpose.

§ 220.53 When the Board will purchase a consultative examination and how it will be used.

(a)(1) General. The decision to purchase a consultative examination for a claimant will be made after full consideration is given to whether the additional information needed (e.g., clinical findings, laboratory tests, diagnosis, and prognosis, etc.) is readily available from the records of the claimant's medical sources. Upon filing an application for a disability annuity, a claimant will be required to obtain from his or her medical source(s) information regarding the claimed impairments. The Board will seek clarification from a medical source who has provided a report when that report contains a conflict or ambiguity, or does not contain all necessary information or when the information supplied is not based on objective evidence. The Board will not, however, seek clarification from a medical source when it is clear that the source either cannot or will not provide the necessary findings, or cannot reconcile a conflict or ambiguity in the findings provided from the source's records. Therefore, before purchasing a consultative examination, the Board will consider not only existing medical reports, but also the background report containing the claimant's allegations and information about the claimant's vocational background, as well as other pertinent evidence in his or her file.

(2) When the Board purchases a consultative examination, we will use the report from the consultative examination to try to resolve a conflict or ambiguity if one exists. The Board will do this by comparing the persuasiveness and value of the evidence. The Board will also use a consultative examination to secure needed medical evidence the file does not contain such as clinical findings, laboratory tests, a diagnosis or prognosis necessary for decision.

(b) Situations requiring a consultative examination. A consultative examination may be purchased when the evidence as a whole, both medical and non-medical, is not sufficient to support a decision on the claim. In addition, other situations, such as one or more of the following, will normally require a consultative examination (these situations are not all-inclusive):

(1) The specific additional evidence needed for adjudication has been pinpointed and high probability exists for obtaining it through purchase.

(2) The additional evidence needed is not contained in the records of the claimant's treating sources.

(3) Evidence that may be needed from the claimant's treating or other medical sources cannot be obtained for reasons beyond his or her control, such as death or noncooperation of the medical source.

(4) Highly technical or specialized medical evidence which is needed is not available from the claimant's treating sources.

(5) A conflict, inconsistency, ambiguity or insufficiency in the evidence must be resolved.

(6) There is an indication of a change in the claimant's condition that is likely to affect his or her ability to function, but current severity is not documented.

(7) Information provided by any source appears not to be supported by objective evidence.

§ 220.54 When the Board will not purchase a consultative examination.

A consultative examination will not be purchased in the following situations (these situations are not all-inclusive):

(a) In disabled widow(er) benefit claims, when the alleged month of disability is after the end of the 7-year period specified in § 216.38 and there is no possibility of establishing an earlier onset, or when the 7-year period expired in the past and all the medical evidence in the claimant's file establishes that he or she was not disabled on or before the expiration date.

(b) When any issues about the actual performance of substantial gainful activity have not been resolved.

(c) In childhood disability claims, when it is determined that the claimant's alleged childhood disability did not begin before the month of attainment of age 22. In this situation, the claimant could not be entitled to benefits as a disabled child unless found disabled before age 22.

(d) When, on the basis of the claimant's allegations and all available medical reports in his or her case file, it is apparent that he or she does not have an impairment which will have more than a minimal effect on his or her capacity to work.

(e) Childhood disability claims filed concurrently with the employee's claim and entitlement cannot be established for the employee.

(f) Survivors childhood disability claims where entitlement is precluded based on non-disability factors.

§ 220.55 Purchase of consultative examinations at the reconsideration level.

(a) When a claimant requests a review of the Board's initial determination at the reconsideration level of review, consultative medical examinations will be obtained when needed, but not routinely. A consultative examination will not, if possible, be performed by the same physician or psychologist used in the initial claim.

(b) Where the evidence tends to substantiate an affirmation of the initial denial but the claimant states that the treating physician or psychologist considers him or her to be disabled, the Board will assist the claimant in securing medical reports or records from the treating physician.

§ 220.56 Securing medical evidence at the hearings officer hearing level.

(a) Where there is a conflict in the medical evidence at the hearing level of review before a hearings officer, the hearings officer will try to resolve it by comparing the persuasiveness and value of the conflicting evidence. The hearings officer's reasoning will be explained in the decision rationale. Where such resolution is not possible, the hearings officer will secure additional medical evidence (e.g., clinical findings, laboratory test, diagnosis, prognosis, etc.) to resolve the conflict. Even in the absence of a conflict, the hearings officer will also secure additional medical evidence when the file does not contain findings, laboratory tests, a diagnosis, or a prognosis necessary for a decision.

(b) Before requesting a consultative examination, the hearings officer will ascertain whether the information is available as a result of a recent examination by any of the claimant's medical sources. If it is, the hearings officer will request the evidence from that medical practitioner. If contact with the medical source is not productive for any reason, or if there is no recent examination by a medical source, the hearings officer will obtain a consultative examination.

§ 220.57 Types of purchased examinations and selection of sources.

(a) Additional evidence needed for disability determination. The types of examinations and tests the Board will purchase depends upon the additional evidence needed for the disability determination. The Board will purchase only the specific evidence needed. For example, if special tests (such as X-rays, blood studies, or EKG) will furnish the additional evidence needed for the disability determination, a more comprehensive medical examination will not be authorized.

(b) The physician or psychologist selected to do the examination or test must be qualified. The physician's or psychologist's qualifications must indicate that the physician or psychologist is currently licensed in the State and has the training and experience to perform the type of examination or test requested. The physician or psychologist may use support staff to help perform the examination. Any such support staff must meet appropriate licensing or certification requirements of the State. See also § 220.64.

(c) Use of video teleconferencing technology. Video teleconferencing technology (VTT) may be used for a psychological or a psychiatric consultative examination provided that the following requirements are met:

(1) The examining physician or psychologist is currently state-licensed in the state in which the provider practices;

(2) The examining physician or psychologist has the training and experience to perform the type of examination requested;

(3) The examining physician or psychologist has access to video teleconferencing technology;

(4) The examining physician or psychologist is permitted to perform the exam in accordance with state licensing laws and regulations;

(5) The protocol for the examination does not require physical contact;

(6) The claimant has the right to refuse a VTT examination without penalty; and

(7) The VTT examination complies with all requirements in this subpart governing consultative examinations.

§ 220.58 Objections to the designated physician or psychologist.

A claimant or his or her representative may object to his or her being examined by a designated physician or psychologist. If there is a good reason for the objection, the Board will schedule the examination with another physician or psychologist. A good reason may be where the consultative examination physician or psychologist had previously represented an interest adverse to the claimant. For example, the physician or psychologist may have represented the claimant's employer in a worker's compensation case or may have been involved in an insurance claim or legal action adverse to the claimant. Other things the Board will consider are: language barrier, office location of consultative examination physician or psychologist (2nd floor, no elevator, etc.), travel restrictions, and examination by the physician or psychologist in connection with a previous unfavorable determination. If the objection is because a physician or psychologist allegedly “lacks objectivity” (in general, but not in relation to the claimant personally) the Board will review the allegations. To avoid a delay in processing the claimant's claim, the consultative examination in such a case will be changed to another physician or psychologist while a review is being conducted. Any objection to use of the substitute physician or psychologist will be handled in the same manner. However, if the Board or the Social Security Administration had previously conducted such a review and found that the reports of the consultative physician or psychologist in question conform to the Board's guidelines, then the Board will not change the claimant's examination.

§ 220.59 Requesting examination by a specific physician, psychologist or institution—hearings officer hearing level.

In an unusual case, a hearings officer may have reason to request an examination by a particular physician, psychologist or institution. Some examples include the following:

(a) Conflicts in the existing medical evidence require resolution by a recognized authority in a particular specialty:

(b) The impairment requires hospitalization for diagnostic purposes; or

(c) The claimant's treating physician or psychologist is in the best position to submit a meaningful report.

§ 220.60 Diagnostic surgical procedures.

The Board will not order diagnostic surgical procedures such as myelograms and arteriograms for the evaluation of disability under the Board's disability program. In addition, the Board will not order procedures such as cardiac catheterization and surgical biopsy. However, if any of these procedures have been performed as part of a workup by the claimant's treating physician or other medical source, the results may be secured and used to help evaluate an impairment(s)'s severity.

§ 220.61 Informing the examining physician or psychologist of examination scheduling, report content and signature requirements.

Consulting physicians or psychologists will be fully informed at the time the Board contacts them of the following obligations:

(a) General. In scheduling full consultative examinations, sufficient time should be allowed to permit the examining physician to take a case history and perform the examination (including any needed tests).

(b) Report content. The reported results of the claimant's medical history, examination, pertinent requested laboratory findings, discussions and conclusions must conform to accepted professional standards and practices in the medical field for a complete and competent examination. The facts in a particular case and the information and findings already reported in the medical and other evidence of record will dictate the extent of detail needed in the consultative examination report for that case. Thus, the detail and format for reporting the results of a purchased examination will vary depending upon the type of examination or testing requested. The reporting of information will differ from one type of examination to another when the requested examination relates to the performance of tests such as ventilatory function tests, treadmill exercise tests, or audiological tests. The medical report must be complete enough to help the Board determine the nature, severity, duration of the impairment, and residual functional capacity. Pertinent points in the claimant's medical history, such as a description of chest pain, will reflect the claimant's statements of his or her symptoms, not simply the physician's or psychologist's statements or conclusions. The examining physician's or psychologist's report of the consultative examination will include the objective medical facts.

(c) Elements of a complete examination. A complete examination is one which involves all the elements of a standard examination in the applicable medical specialty. When a complete examination is involved, the report will include the following elements:

(1) The claimant's major or chief complaint(s).

(2) A detailed description, within the area of speciality of the examination, of the history of the claimant's major complaint(s).

(3) A description, and disposition, of pertinent “positive,” as well as “negative,” detailed findings based on the history, examination and laboratory test(s) related to the major complaint(s) and any other abnormalities reported or found during examination or laboratory testing.

(4) The results of laboratory and other tests ( e.g., x-rays) performed according to the requirements stated in the Board's directions to the examining physician or psychologist.

(5) The diagnosis and prognosis for the claimant's impairment(s).

(6) A statement as to what the claimant can still do despite his or her impairment(s) (except in disability claims for remarried widows and widowers, and surviving divorced spouses). This statement must describe the consultative physician's or psychologist's opinion concerning the claimant's ability, despite his or her impairment(s), to do basic work activities such as sitting, standing, lifting, carrying, handling objects, hearing, speaking, and traveling: and, in cases of mental impairment(s), the consultative physician's or psychologist's opinion as to the claimant's ability to reason or make occupational, personal, or social adjustments.

(7) When less than a complete examination is required (for example, a specific test or study is needed), not every element is required.

(d) Signature requirements. All consultative examination reports will be personally reviewed and signed by the physician or psychologist who actually performed the examination. This attests to the fact that the physician or psychologist doing the examination or testing is solely responsible for the report contents and for the conclusions, explanations or comments provided with respect to the history, examination and evaluation of laboratory test results.

§ 220.62 Reviewing reports of consultative examinations.

(a) The Board will review the report of the consultative examination to determine whether the specific information requested has been furnished. The Board will consider these factors in reviewing the report:

(1) Whether the report provides evidence which serves as an adequate basis for decision-making in terms of the impairment it assesses.

(2) Whether the report is internally consistent. Whether all the diseases, impairments and complaints described in the history are adequately assessed and reported in the physical findings. Whether the conclusions correlate the findings from the claimant's medical history, physical examination and laboratory tests and explain all abnormalities.

(3) Whether the report is consistent with the other information available to the Board within the specialty of the examination requested. Whether the report fails to mention an important or relevant complaint within the speciality that is noted on other evidence in the file (e.g., blindness in one eye, amputations, flail limbs or claw hands, etc.).

(4) Whether the report is properly signed.

(b) If the report is inadequate or incomplete, the Board will contact the examining consultative physician or psychologist, give an explanation of the Board's evidentiary needs, and ask that the physician or psychologist furnish the missing information or prepare a revised report.

(c) Where the examination discloses new diagnostic information or test results which are significant to the claimant's treatment, the Board will consider referral of the consultative examination report to the claimant's treating physician or psychologist.

(d) The Board will take steps to ensure that consultative examinations are scheduled only with medical sources who have the equipment required to provide an adequate assessment and record of the level of severity of the claimant's alleged impairments.

§ 220.63 Conflict of interest.

All implications of possible conflict of interest between Board medical consultants and their medical practices will be avoided. Board review physicians or psychologists will not perform consultative examinations for the Board's disability programs without prior approval. In addition, they will not acquire or maintain, directly or indirectly, including any member of their families, any financial interest in a medical partnership or similar relationship in which consultative examinations are provided. Sometimes one of the Board's review physicians or psychologists will have prior knowledge of a case (e.g., the claimant was a patient). Where this is so, the physician or psychologist will not participate in the review or determination of the case. This does not preclude the physician or psychologist from submitting medical evidence based on prior treatment or examination of the claimant.

§ 220.64 Program integrity.

The Board will not use in its program any individual or entity who is excluded, suspended, or otherwise barred from participation in the Medicare or Medicaid programs, or any other Federal or Federally-assisted program; who has been convicted, under Federal or State law, in connection with the delivery of health care services, of fraud, theft, embezzlement, breach of fiduciary responsibility or financial abuse; who has been convicted under Federal or State law of unlawful manufacture, distribution, prescription, or dispensing of a controlled substance; whose license to provide health care services is revoked or suspended by any State licensing authority for reasons bearing on professional competence, professional conduct, or financial integrity; who has surrendered such a license while formal disciplinary proceedings involving professional conduct were pending; or who has had a civil monetary assessment or penalty imposed on such individual or entity for any activity described in this section or as a result of formal disciplinary proceedings. Also see §§ 220.53 and 220.57(b).

§ 220.100 Evaluation of disability for any regular employment.

(a) General. The Board uses a set evaluation process, explained in paragraph (b) of this section, to determine whether a claimant is disabled for any regular employment. This evaluation process applies to employees, widow(er)s, and children who have applied for annuities under the Railroad Retirement Act based on disability for any regular employment. Regular employment means substantial gainful activity as that term is defined in § 220.141.

(b) Steps in evaluating disability. A set order is followed to determine whether disability exists. The duration requirement, as described in § 220.28, must be met for a claimant to be found disabled. The Board reviews any current work activity, the severity of the claimant's impairment(s), the claimant's residual functional capacity, and the claimant's age, education, and work experience. If the Board finds that the claimant is disabled or is not disabled at any step in the process, the Board does not review further. (See § 220.105 if the claimant is not currently disabled but was previously disabled for a specified period of time in the past.) The steps are as follows:

(1) Claimant is working. If the claimant is working, and the work is substantial gainful activity, the Board will find that he or she is not disabled regardless of his or her impairments, age, education, or work experience. If the claimant is not performing substantial gainful activity, the Board will follow paragraph (2) of this section.

(2) Impairment(s) not severe. If the claimant does not have an impairment or combination of impairments which significantly limit his or her physical or mental ability to do basic work activities, the Board will find that the claimant is not disabled without consideration of age, education, or work experience. If the claimant has an impairment or combination of impairments which significantly limit his or her ability to do basic work activities, the Board will follow paragraph (3) of this section. (See § 220.102(b) for a definition of basic work activities.)

(3) Impairment(s) is medically disabling. If the claimant has an impairment or a combination of impairments which meets the duration requirement and which the Board finds is medically disabling, the Board will find the claimant disabled without considering his or her age, education or work experience. In determining whether an impairment or combination of impairments is medically disabling, the Board will consider factors such as the nature and limiting effects of the impairment(s); the effects of the treatment the claimant has undergone, is undergoing, and/or will continue to undergo; the prognosis for the claimant; medical records furnished in support of the claimant's claim; whether the severity of the impairment(s) would fall within any of the impairments included in the Listing of Impairments as issued by the Social Security Administration and as amended from time to time (20 CFR part 404, subpart P, appendix 1); or whether the impairment(s) meet such other criteria which the agency by administrative ruling of general applicability has determined to be medically disabling.

(4) Impairment(s) must prevent past relevant work. If the claimant's impairment or combination of impairments is not medically disabling, the Board will then review the claimant's residual functional capacity ( see § 220.120) and the physical and mental demands of past relevant work (see § 220.130). If the Board determines that the claimant is still able to do his or her past relevant work, the Board will find that he or she is not disabled. If the claimant is unable to do his or her past relevant work, the Board will follow paragraph (b)(5) of this section.

(5) Impairment(s) must prevent any other work. (i) If the claimant is unable to do his or her past relevant work because of his or her impairment or combination of impairments, the Board will review the claimant's residual functional capacity and his or her age, education and work experience to determine if the claimant is able to do any other work. If the claimant cannot do other work, the Board will find him or her disabled. If the claimant can do other work, the Board will find the claimant not disabled.

(ii) If the claimant has only a marginal education (see § 220.129) and long work experience (i.e., 35 years or more) in which he or she only did arduous unskilled physical labor, and the claimant can no longer do this kind of work, the Board will use a different rule (see § 220.127) to determine disability.

(c) Once a claimant has been found eligible to receive a disability annuity, the Board follows a somewhat different order of evaluation to determine whether the claimant's eligibility continues as explained in § 220.180.

Appendix 2 Appendix 2 to Part 220—Medical-Vocational Guidelines

Sec.

200.00 Introduction.

201.00 Maximum sustained work capability limited to sedentary work as a result of severe medically determinable impairment(s).

202.00 Maximum sustained work capability limited to light work as a result of severe medically determinable impairment(s).

203.00 Maximum sustained work capability limited to medium work as a result of severe medically determinable impair- ment(s).

204.00 Maximum sustained work capability limited to heavy work (or very heavy work) as a result of severe medically determinable impairment(s).

200.00 Introduction. (a) The following rules reflect the major functional and vocational patterns which are encountered in cases which cannot be evaluated on medical considerations alone, where an individual with a severe medically determinable physical or mental impairment(s) is not engaging in substantial gainful activity and the individual's impairment(s) prevents the performance of his or her vocationally relevant past work. They also reflect the analysis of the various vocational factors (i.e., age, education, and work experience) in combination with the individual's residual functional capacity (used to determine his or her maximum sustained work capability for sedentary, light, medium, heavy, or very heavy work) in evaluating the individual's ability to engage in substantial gainful activity in other than his or her vocationally relevant past work. Where the findings of fact made with respect to a particular individual's vocational factors and residual functional capacity coincide with all of the criteria of a particular rule, the rule directs a conclusion as to whether the individual is or is not disabled. However, each of these findings of fact is subject to rebuttal and the individual may present evidence to refute such findings. Where any one of the findings of fact does not coincide with the corresponding criterion of a rule, the rule does not apply in that particular case and, accordingly, does not direct a conclusion of disabled or not disabled. In any instance where a rule does not apply, full consideration must be given to all of the relevant facts of the case in accordance with the definitions and discussions of each factor in the appropriate sections of the regulations.

(b) The existence of jobs in the national economy is reflected in the “Decisions” shown in the rules; i.e., in promulgating the rules, administrative notice has been taken of the numbers of unskilled jobs that exist throughout the national economy at the various functional levels (sedentary, light, medium, heavy, and very heavy) as supported by the “Dictionary of Occupational Titles” and the “Occupational Outlook Handbook,” published by the Department of Labor; the “County Business Patterns” and “Census Surveys” published by the Bureau of the Census; and occupational surveys of light and sedentary jobs prepared for the Social Security Administration by various State employment agencies. Thus, when all factors coincide with the criteria of a rule, the existence of such jobs is established. However, the existence of such jobs for individuals whose remaining functional capacity or other factors do not coincide with the criteria of a rule must be further considered in terms of what kinds of jobs or types of work may be either additionally indicated or precluded.

(c) In the application of the rules, the individual's residual functional capacity ( i.e., the maximum degree to which the individual retains the capacity for sustained performance of the physical-mental requirements of jobs), age, education, and work experience must first be determined. When assessing the person's residual functional capacity, the Board considers his or her symptoms (such as pain), signs, and laboratory findings together with other evidence the Board obtains.

(d) The correct disability decision (i.e., on the issue of ability to engage in substantial gainful activity) is found by then locating the individual's specific vocational profile. If an individual's specific profile is not listed within this appendix 2, a conclusion of disabled or not disabled is not directed. Thus, for example, an individual's ability to engage in substantial gainful work where his or her residual functional capacity falls between the ranges of work indicated in the rules (e.g., the individual who can perform more than light but less than medium work), is decided on the basis of the principles and definitions in the regulations, giving consideration to the rules for specific case situations in this appendix 2. These rules represent various combinations of exertional capabilities, age, education and work experience and also provide an overall structure for evaluation of those cases in which the judgments as to each factor do not coincide with those of any specific rule. Thus, when the necessary judgments have been made as to each factor and it is found that no specific rule applies, the rules still provide guidance for decisionmaking, such as in cases involving combinations of impairments. For example, if strength limitations resulting from an individual's impairment(s) considered with the judgments made as to the individual's age, education and work experience correspond to (or closely approximate) the factors of a particular rule, the adjudicator then has a frame of reference for considering the jobs or types of work precluded by other, nonexertional impairments in terms of numbers of jobs remaining for a particular individual.

(e) Since the rules are predicated on an individual's having an impairment which manifests itself by limitations in meeting the strength requirements of jobs, they may not be fully applicable where the nature of an individual's impairment does not result in such limitations, e.g., certain mental, sensory, or skin impairments. In addition, some impairments may result solely in postural and manipulative limitations or environmental restrictions. Environmental restrictions are those restrictions which result in inability to tolerate some physical feature(s) of work settings that occur in certain industries or types of work, e.g., an inability to tolerate dust or fumes.

(1) In the evaluation of disability where the individual has solely a nonexertional type of impairment, determination as to whether disability exists shall be based on the principles in the appropriate sections of the regulations, giving consideration to the rules for specific case situations in this appendix 2. The rules do not direct factual conclusions of disabled or not disabled for individuals with solely nonexertional types of impairments.

(2) However, where an individual has an impairment or combination of impairments resulting in both strength limitations and nonexertional limitations, the rules in this subpart are considered in determining first whether a finding of disabled may be possible based on the strength limitations alone and, if not, the rule(s) reflecting the individual's maximum residual strength capabilities, age, education, and work experience provide a framework for consideration of how much the individual's work capability is further diminished in terms of any types of jobs that would be contraindicated by the nonexertional limitations. Also, in these combinations of nonexertional and exertional limitations which cannot be wholly determined under the rules in this appendix 2, full consideration must be given to all of the relevant facts in the case in accordance with the definitions and discussions of each factor in the appropriate sections of the regulations, which will provide insight into the adjudicative weight to be accorded each factor.

201.00 Maximum sustained work capability limited to sedentary work as a result of severe medically determinable impairment(s). (a) Most sedentary occupations fall within the skilled, semi-skilled, professional, administrative, technical, clerical, and benchwork classifications. Approximately 200 separate unskilled sedentary occupations can be identified, each representing numerous jobs in the national economy. Approximately 85 percent of these jobs are in the machine trades and benchwork occupational categories. These jobs (unskilled sedentary occupations) may be performed after a short demonstration or within 30 days.

(b) These unskilled sedentary occupations are standard within the industries in which they exist. While sedentary work represents a significantly restricted range of work, this range in itself is not so prohibitively restricted as to negate work capability for substantial gainful activity.

(c) Vocational adjustment to sedentary work may be expected where the individual has special skills or experience relevant to sedentary work or where age and basic educational competences provide sufficient occupational mobility to adapt to the major segment of unskilled sedentary work. Inability to engage in substantial gainful activity would be indicated where an individual who is restricted to sedentary work because of a severe medically determinable impairment lacks special skills or experience relevant to sedentary work, lacks educational qualifications relevant to most sedentary work (e.g., has a limited education or less) and the individual's age, though not necessarily advanced, is a factor which significantly limits vocational adaptability.

(d) The adversity of functional restrictions to sedentary work at advanced age (55 and over) for individuals with no relevant past work or who can no longer perform vocationally relevant past work and have no transferable skills, warrants a finding of disabled in the absence of the rare situation where the individual has recently completed education which provides a basis for direct entry into skilled sedentary work. Advanced age and a history of unskilled work or no work experience would ordinarily offset any vocational advantages that might accrue by reason of any remote past education, whether it is more or less than limited education.

(e) The presence of acquired skills that are readily transferable to a significant range of skilled work within an individual's residual functional capacity would ordinarily warrant a finding of ability to engage in substantial gainful activity regardless of the adversity of age, or whether the individual's formal education is commensurate with his or her demonstrated skill level. The acquisition of work skills demonstrates the ability to perform work at the level of complexity demonstrated by the skill level attained regardless of the individual's formal educational attainments.

(f) In order to find transferability of skills to skilled sedentary work for individuals who are of advanced age (55 and over), there must be very little, if any, vocational adjustment required in terms of tools, work processes, work settings, or the industry.

(g) Individuals approaching advanced age (age 50-54) may be significantly limited in vocational adaptability if they are restricted to sedentary work. When such individuals have no past work experience or can no longer perform vocationally relevant past work and have no transferable skills, a finding of disabled ordinarily obtains. However, recently completed education which provides for direct entry into sedentary work will preclude such a finding. For this age group, even a high school education or more (ordinarily completed in the remote past) would have little impact for effecting a vocational adjustment unless relevant work experience reflects use of such education.

(h) The term “younger individual” is used to denote an individual age 18 through 49. For those within this group who are age 45-49, age is a less positive factor than for those who are age 18-44. Accordingly, for such individuals; (1) who are restricted to sedentary work, (2) who are unskilled or have no transferable skills, (3) who have no relevant past work or who can no longer perform vocationally relevant past work, and (4) who are either illiterate or unable to communicate in the English language, a finding of disabled is warranted. On the other hand, age is a more positive factor for those who are under age 45 and is usually not a significant factor in limiting such an individual's ability to make a vocational adjustment, even an adjustment to unskilled sedentary work, and even where the individual is illiterate or unable to communicate in English. However, a finding of disabled is not precluded for those individuals under age 45 who do not meet all of the criteria of a specific rule and who do not have the ability to perform a full range of sedentary work. The following examples are illustrative: Example 1: An individual under age 45 with a high school education can no longer do past work and is restricted to unskilled sedentary jobs because of a severe medically determinable cardiovascular impairment (which does not meet or equal the listings in appendix 1). A permanent injury of the right hand limits the individual to sedentary jobs which do not require bilateral manual dexterity. None of the rules in appendix 2 are applicable to this particular set of facts, because this individual cannot perform the full range of work defined as sedentary. Since the inability to perform jobs requiring bilateral manual dexterity significantly compromises the only range of work for which the individual is otherwise qualified (i.e., sedentary), a finding of disabled would be appropriate. Example 2: An illiterate 41 year old individual with mild mental retardation (IQ of 78) is restricted to unskilled sedentary work and cannot perform vocationally relevant past work, which had consisted of unskilled agricultural field work; his or her particular characteristics do not specifically meet any of the rules in appendix 2, because this individual cannot perform the full range of work defined as sedentary. In light of the adverse factors which further narrow the range of sedentary work for which this individual is qualified, a finding of disabled is appropriate.

(i) While illiteracy or the inability to communicate in English may significantly limit an individual's vocational scope, the primary work functions in the bulk of unskilled work relate to working with things (rather than with data or people) and in these work functions at the unskilled level, literacy or ability to communicate in English has the least significance. Similarly the lack of relevant work experience would have little significance since the bulk of unskilled jobs require no qualifying work experience. Thus, the functional capability for a full range of sedentary work represents sufficient numbers of jobs to indicate substantial vocational scope for those individuals age 18-44 even if they are illiterate or unable to communicate in English.

Table No. 1—Residual Functional Capacity: Maximum Sustained Work Capability Limited to Sedentary Work as a Result of Severe Medically Determinable Impairment(s)

Rule

Age

Education

Previous work experience

Decision

201.01

Advanced age

Limited or less

Unskilled or none

Disabled.

201.02

......do

......do

Skilled or semiskilled—skills not transferable 1

Do.

201.03

......do

......do

Skilled or semiskilled—skills transferable 1

Not disabled.

201.04

......do

High school graduate or more—does not provide for direct entry into skilled work 2

Unskilled or none

Disabled.

201.05

......do

High school graduate or more—provides for direct entry into skilled work 2

......do

Not disabled.

201.06

......do

High school graduate or more—does not provide for direct entry into skilled work 2

Skilled or semiskilled—skills not transferable 1

Disabled.

201.07

......do

......do

Skilled or semiskilled—skills transferable 1

Not disabled.

201.08

......do

High school graduate or more—provides for direct entry into skilled work 2

Skilled or semiskilled—skills not transferable 1

Do.

201.09

Closely approaching advanced age

Limited or less

Unskilled or none

Disabled.

201.10

......do

......do

Skilled or semiskilled—skills not transferable

Do.

201.11

......do

......do

Skilled or semiskilled—skills transferable

Not disabled.

201.12

......do

High school graduate or more—does not provide for direct entry into skilled work 3

Unskilled or none

Disabled.

201.13

......do

High school graduate or more—provides for direct entry into skilled work 3

......do

Not disabled.

201.14

......do

High school graduate or more—does not provide for direct entry into skilled work 3

Skilled or semiskilled—skills not transferable

Disabled.

201.15

......do

......do

Skilled or semiskilled—skills transferable

Not disabled.

201.16

......do

High school graduate or more—provides for direct entry into skilled work 3

Skilled or semiskilled—skills not transferable

Do.

201.17

Younger individual age 45-49

Illiterate or unable to communicate in English

Unskilled or none

Disabled.

201.18

......do

Limited or less—at least literate and able to communicate in English

......do

Not disabled.

201.19

......do

Limited or less

Skilled or semiskilled—skills not transferable

Do.

201.20

......do

......do

Skilled or semiskilled—skills transferable

Do.

201.21

......do

High school graduate or more

Skilled or semiskilled—skills not transferable

Do.

201.22

......do

......do

Skilled or semiskilled—skills transferable

Do.

201.23

Younger individual age 18-44

Illiterate or unable to communicate in English

Unskilled or none

Do. 4

201.24

......do

Limited or less—at least literate and able to communicate in English

......do

Do. 4

201.25

......do

Limited or less

Skilled or semiskilled—skills not transferable

Do. 4

201.26

......do

......do

Skilled or semiskilled—skills transferable

Do. 4

201.27

......do

High school graduate or more

Unskilled or none

Do. 4

201.28

......do

......do

Skilled or semiskilled—skills not transferable

Do. 4

201.29

......do

......do

Skilled or semiskilled—skills transferable

Do. 4

1 See 201.00(f).

2 See 201.00(d).

3 See 201.00(g).

4 See 201.00(h).

202.00 Maximum sustained work capability limited to light work as a result of severe medically determinable impairment(s). (a) The functional capacity to perform a full range of light work includes the functional capacity to perform sedentary as well as light work. Approximately 1,600 separate sedentary and light unskilled occupations can be identified in eight broad occupational categories, each occupation representing numerous jobs in the national economy. These jobs can be performed after a short demonstration or within 30 days, and do not require special skills or experience.

(b) The functional capacity to perform a wide or full range of light work represents substantial work capability compatible with making a work adjustment to substantial numbers of unskilled jobs and, thus, generally provides sufficient occupational mobility even for severely impaired individuals who are not of advanced age and have sufficient educational competences for unskilled work.

(c) However, for individuals of advanced age who can no longer perform vocationally relevant past work and who have a history of unskilled work experience, or who have only skills that are not readily transferable to a significant range of semi-skilled or skilled work that is within the individual's functional capacity, or who have no work experience, the limitations in vocational adaptability represented by functional restriction to light work warrant a finding of disabled. Ordinarily, even a high school education or more which was completed in the remote past will have little positive impact on effecting a vocational adjustment unless relevant work experience reflects use of such education.

(d) Where the same factors in paragraph (c) of this section regarding education and work experience are present, but where age, though not advanced, is a factor which significantly limits vocational adaptability (i.e., closely approaching advanced age, 50-54) and an individual's vocational scope is further significantly limited by illiteracy or inability to communicate in English, a finding of disabled is warranted.

(e) The presence of acquired skills that are readily transferable to a significant range of semi-skilled or skilled work within an individual's residual functional capacity would ordinarily warrant a finding of not disabled regardless of the adversity of age, or whether the individual's formal education is commensurate with his or her demonstrated skill level. The acquisition of work skills demonstrates the ability to perform work at the level of complexity demonstrated by the skill level attained regardless of the individual's formal educational attainments.

(f) For a finding of transferability of skills to light work for individuals of advanced age who are closely approaching retirement age (age 60-64), there must be very little, if any, vocational adjustment required in terms of tools, work processes, work settings, or the industry.

(g) While illiteracy or the inability to communicate in English may significantly limit an individual's vocational scope, the primary work functions in the bulk of unskilled work relate to working with things (rather than with data or people) and in these work functions at the unskilled level, literacy or ability to communicate in English has the least significance. Similarly, the lack of relevant work experience would have little significance since the bulk of unskilled jobs require no qualifying work experience. The capability for light work, which includes the ability to do sedentary work, represents the capability for substantial numbers of such jobs. This, in turn, represents substantial vocational scope for younger individuals (age 18-49) even if illiterate or unable to communicate in English.

Table No. 2—Residual Functional Capacity: Maximum Sustained Work Capability Limited to Light Work as a Result of Severe Medically Determinable Impairment(s)

Rule

Age

Education

Previous work experience

Decision

202.01

Advanced age

Limited or less

Unskilled or none

Disabled.

202.02

......do

......do

Skilled or semiskilled—skills not transferable

Do.

202.03

......do

......do

Skilled or semiskilled—skills transferable 1

Not disabled.

202.04

......do

High school graduate or more—does not provide for direct entry into skilled work 2

Unskilled or none

Disabled.

202.05

......do

High school graduate or more—provides for direct entry into skilled work 2

......do

Not disabled.

202.06

......do

High school graduate or more—does not provide for direct entry into skilled work 2

Skilled or semiskilled—skills not transferable

Disabled.

202.07

......do

......do

Skilled or semiskilled—skills transferable 2

Not disabled.

202.08

......do

High school graduate or more—provides for direct entry into skilled work 2

Skilled or semiskilled—skills not transferable

Do.

202.09

Closely approaching advanced age

Illiterate or unable to communicate in English

Unskilled or none

Disabled.

202.10

......do

Limited or less—At least literate and able to communicate in English

......do

Not disabled.

202.11

......do

Limited or less

Skilled or semiskilled—skills not transferable

Do.

202.12

......do

......do

Skilled or semiskilled—skills transferable

Do.

202.13

......do

High school graduate or more

Unskilled or none

Do.

202.14

......do

......do

Skilled or semiskilled—skills not transferable

Do.

202.15

......do

......do

Skilled or semiskilled—skills transferable

Do.

202.16

Younger individual

Illiterate or unable to communicate in English

Unskilled or none

Do.

202.17

......do

Limited or less—At least literate and able to communicate in English

......do

Do.

202.18

......do

Limited or less

Skilled or semiskilled—skills not transferable

Do.

202.19

......do

......do

Skilled or semiskilled—skills transferable

Do.

202.20

......do

High school graduate or more

Unskilled or none

Do.

202.21

......do

......do

Skilled or semiskilled—skills not transferable

Do.

202.22

......do

......do

Skilled or semiskilled—skills transferable

Do.

1 See 202.00(f).

2 See 202.00(c).

203.00 Maximum sustained work capability limited to medium work as a result of severe medically determinable impair- ment(s). (a) The functional capacity to perform medium work includes the functional capacity to perform sedentary, light, and medium work. Approximately 2,500 separate sedentary, light, and medium occupations can be identified, each occupation representing numerous jobs in the national economy which do not require skills or previous experience and which can be performed after a short demonstration or within 30 days.

(b) The functional capacity to perform medium work represents such substantial work capability at even the unskilled level that a finding of disabled is ordinarily not warranted in cases where a severely impaired individual retains the functional capacity to perform medium work. Even the adversity of advanced age (55 or over) and a work history of unskilled work may be offset by the substantial work capability represented by the functional capacity to perform medium work. However, an individual with a marginal education and long work experience (i.e., 35 years or more) limited to the performance of arduous unskilled labor, who is not working and is no longer able to perform this labor because of a severe impairment(s), may still be found disabled even though the individual is able to do medium work.

(c) However, the absence of any relevant work experience becomes a more significant adversity for individuals of advanced age (55 and over). Accordingly, this factor, in combination with a limited education or less, militates against making a vocational adjustment to even this substantial range of work and a finding of disabled is appropriate. Further, for individuals closely approaching retirement age (60-64) with a work history of unskilled work and with marginal education or less, a finding of disabled is appropriate.

Table No. 3—Residual Functional Capacity: Maximum Sustained Work Capability Limited to Medium Work as a Result of Severe Medically Determinable Impairment(s)

Rule

Age

Education

Previous work experience

Decision

203.01

Closely approaching retirement age

Marginal or none

Unskilled or none

Disabled.

203.02

......do

Limited or less

None

Do.

203.03

......do

Limited

Unskilled

Not disabled.

203.04

......do

Limited or less

Skilled or semiskilled—skills not transferable

Do.

203.05

......do

......do

Skilled or semiskilled—skills transferable

Do.

203.06

......do

High school graduate or more

Unskilled or none

Do.

203.07

......do

High school graduate or more—does not provide for direct entry into skilled work

Skilled or semiskilled—skills not transferable

Do.

203.08

......do

......do

Skilled or semiskilled—skills transferable

Do.

203.09

......do

High school graduate or more—provides for direct entry into skilled work

Skilled or semiskilled—skills not transferable

Do.

203.10

Advanced age

Limited or less

None

Disabled.

203.11

......do

......do

Unskilled

Not disabled.

203.12

......do

......do

Skilled or semiskilled—skills not transferable

Do.

203.13

......do

......do

Skilled or semiskilled—skills transferable

Do.

203.14

......do

High school graduate or more

Unskilled or none

Do.

203.15

......do

High school graduate or more—does not provide for direct entry into skilled work

Skilled or semiskilled—skills not transferable

Do.

203.16

......do

......do

Skilled or semiskilled—skills transferable

Do.

203.17

......do

High school graduate or more—provides for direct entry into skilled work

Skilled or semiskilled—skills not transferable

Do.

203.18

Closely approaching advanced age

Limited or less

Unskilled or none

Do.

203.19

......do

......do

Skilled or semiskilled—skills not transferable

Do.

203.20

......do

......do

Skilled or semiskilled—skills transferable

Do.

203.21

......do

High school graduate or more

Unskilled or none

Do.

203.22

......do

High school graduate or more—does not provide for direct entry into skilled work

Skilled or semiskilled—skills not transferable

Do.

203.23

......do

......do

Skilled or semiskilled—skills transferable

Do.

203.24

......do

High school graduate or more—provides for direct entry into skilled work

Skilled or semiskilled—skills not transferable

Do.

203.25

Younger individual

Limited or less

Unskilled or none

Do.

203.26

......do

......do

Skilled or semiskilled—skills not transferable

Do.

203.27

......do

......do

Skilled or semiskilled—skills transferable

Do.

203.28

......do

High school graduate or more

Unskilled or none

Do.

203.29

......do

High school graduate or more—does not provide for direct entry into skilled work

Skilled or semiskilled—skills not transferable

Do.

203.30

......do

......do

Skilled or semiskilled—skills transferable

Do.

203.31

......do

High school graduate or more—provides for direct entry into skilled work

Skilled or semiskilled—skills not transferable

Do.

204.00 Maximum sustained work capability limited to heavy work (or very heavy work) as a result of severe medically determinable impairment(s). The residual functional capacity to perform heavy work or very heavy work includes the functional capability for work at the lesser functional levels as well, and represents substantial work capability for jobs in the national economy at all skill and physical demand levels. Individuals who retain the functional capacity to perform heavy work (or very heavy work) ordinarily will not have a severe impairment or will be able to do their past work—either of which would have already provided a basis for a decision of “not disabled”. Environmental restrictions ordinarily would not significantly affect the range of work existing in the national economy for individuals with the physical capability for heavy work (or very heavy work). Thus an impairment which does not preclude heavy work (or very heavy work) would not ordinarily be the primary reason for unemployment, and generally is sufficient for a finding of not disabled, even though age, education, and skill level of prior work experience may be considered adverse.

Appendix 3 Appendix 3 to Part 220—Railroad Retirement Board Occupational Disability Standards

1. Introduction

1.01 The Board uses this appendix to adjudicate the occupational disability claims of employees with medical conditions and job titles covered by the Tables in this appendix. The Tables are divided into “Body Parts”, with each Body Part further divided by job title. Under each job title there is a list of impairments and tests with accompanying test results which establish a finding of “D” (disabled). The use of these Tables is a three-step process. In the first step we determine whether the employee's regular railroad occupation is covered by the Tables; next we establish the existence of an impairment covered by the Tables; finally, we reach a disability determination. If we do not find an employee disabled under these Tables, the employee may still be found disabled using Independent Case Evaluation (ICE), as explained in subpart C of this part.

1.02 The Cancer Tables are treated in a different way than other body systems. Different types of cancer and their treatments have different functional impacts. In the Cancer Tables the impact of the impairment is seen as being significant or not significant. Therefore, these tables contain an “S” (significant) which is equivalent to a “D” rating. A detailed explanation of how to use those tables is in that section. The steps to use the remaining Tables are explained below:

2. Confirming the Impairment

2.01 Once we determine that the employee's regular railroad occupation is covered by the Job Titles in the Tables, we must determine the existence of an impairment covered by the Tables. This is done through the use of Confirmatory Tests. These tests can include information from medical records, surgical or operative reports, or specific diagnostic test results. Confirmatory Tests are listed in the initial section regarding each Body Part covered in the Tables. If an impairment cannot be confirmed because of inconsistent medical information, ICE may be required.

2.02 There are two types of Confirmatory Tests as follows.

2.03 “Highly Recommended” Tests—The designation of a confirmatory test as being “highly recommended” means that the test is almost always performed to confirm the existence of the impairment. For many conditions, only one “highly recommended” test finding is suggested to confirm the impairment. However, there may be times when that test is not available or is negative, but other more detailed testing confirms the impairment.

2.04 Example A: To confirm the condition of pulmonary hypertension, the Tables under Body Part C., Cardiac, designate as “highly recommended”: an electrocardiogram which indicates definite right ventricular hypertrophy. However, the impairment may also be confirmed by insertion of a Swan-Ganz catheter into the pulmonary artery and the pulmonary artery pressure measured directly.

2.05 There may be some conditions for which several “highly recommended” tests are suggested to confirm an impairment. In these circumstances, we will use all “highly recommended” tests to establish the existence of the impairment.

2.06 Example B: Under Body Part E., Lumbar Sacral Spine, three highly recommended medical findings are identified for the diagnosis of chronic back pain, not otherwise specified. These findings include:

A. A history of back pain under medical treatment for at least one year, and

B. A history of back pain unresponsive to therapy for at least one year, and

C. A history of back pain with functional limitations for at least one year.

2.07 All three of these criteria must be satisfied to confirm the existence of chronic back pain.

2.08 Sometimes the employee may have undergone detailed testing which is as reliable as one of the “highly recommended” tests listed in the Tables. In cases where an impairment has not been confirmed by one of the designated “highly recommended” tests, the impairment may still be confirmed by “recommended” tests (see below) or by evidence acceptable under section 220.27 of this part.

2.09 Recommended Tests—The designation of a confirmatory test as “recommended” means that the test need not be performed, or be positive, to confirm the impairment. However, a positive test provides significant support for confirming the impairment. If there are no “highly recommended” tests for confirming the impairment, at least one of the “recommended” tests should be positive.

2.10 There are two categories of recommended tests which are described below.

A. Imaging studies —These studies can include MRI, CAT scan, myelogram, or plain film x-rays. For conditions where several of these imaging studies are identified as “recommended” tests, at least one of the test results should be positive and meet the confirmatory test criteria. For some conditions, such as degenerative disc condition, there are several equivalent imaging methods to confirm a diagnosis.

B. Other tests —This category of tests refers to non-imaging studies.

2.11 If there are no “highly recommended” confirmatory tests designated to confirm an impairment and the “recommended” confirmatory tests only include non-imaging procedures, at least one of these tests should be positive to confirm the impairment. The greater the number of tests that are positive, the greater the confidence that the correct diagnosis has been established.

2.12 Example: Under Body Part C., Cardiac, the diagnostic confirmatory tests for ventricular ectopy, a cardiac arrhythmia, include the following “recommended” tests:

A. Medical record review, i.e., a review of the claimant's medical records, or

B. Holter monitoring, or

C. Provocative testing producing a definite arrhythmia.

2.13 In this situation, only one of the “recommended” confirmatory tests need be positive to confirm the impairment. However, the more tests that are positive, the stronger the support for the diagnosis.

2.14 In no circumstance will the Board require that an invasive test be performed to confirm an impairment. Several of the Confirmatory Tests which are described in the Tables are invasive and it is not the intention of the Board to suggest that these be performed. The inclusion of invasive tests in the Tables Confirmatory Tests section is intended to help the Board evaluate the significance of findings from such tests that may have already been performed and which are part of the submitted medical record.

2.15 If an employee's impairment(s) cannot be confirmed by use of the confirmatory tests listed in the Tables, it still may be confirmed by medical evidence described in section 220.27 of this part. However, if a claimant's impairment(s) cannot be confirmed through use of the Tables or under section 220.27, and the medical evidence is complete and in concordance, the claimant will be found not disabled.

3. Disability Determination

3.01 Once the Board determines that the employee's regular railroad occupation is covered by one of the Job Titles in the Tables and that his or her alleged impairment fits into a Body Part covered by the Tables and can be confirmed, we examine the results of any of the disability tests listed under the impairment. If the results from any of these tests indicate a “D” finding, the employee is found disabled. If none of the test results indicate a “D” finding, then the employee's claim is evaluated using ICE.

3.02 Example: A trainman has angina as confirmed by the recommended tests under Body Part A: Cardiac—Angina. An echocardiogram shows that he has poor ejection fraction ≤35%. The employee is rated disabled. If none of the results of the listed disability tests match the results required for a “D” finding, then the employee's claim is evaluated under ICE.

Tables

A. Cancer

B. Endocrine

C. Cardiac

D. Respiratory

E. Lumbar Sacral Spine

F. Cervical Spine

G. Shoulder and Elbow

H. Hand and Arm

I. Hip

J. Knee

K. Ankle and Foot

A. Cancer

Cancer

Cancer conditions can be viewed as belonging to one of three categories.

Category 1: Significant impact on functional capacity or anticipated life span.

Category 2: Intermediate impact on functional capacity; large individual variability.

Category 3: No significant impact on functional capacity or expected life span.

The factors that are considered in developing these categories include the following:

Type of Cancer

The functional impact of different malignancies varies tremendously and each malignancy has to be considered on an individual basis.

Magnitude of Disease

The disability standards are based upon the magnitude or extent of disease. The extent of disease affects both anticipated life span and the functional capacity or work ability of the individual. Localized cancer including cancer “in situ” can frequently be completely cured and not have an impact on functional capacity or life span. In contrast, many cancers that have distant or significant regional spread generally have a poor prognosis. The magnitude or extent of disease is classified into three categories: local, regional and distant.

The criteria which are used to classify a cancer into one of the three categories are based upon the distillation of several staging methods into a single system [Miller, et al. (1992). Cancer Statistics Review, 1973-1989; NIH Publication No. 92-2789].

Effects of Treatment

Although some types of cancer may be potentially curable with radical surgery and/or radiation therapy, the treatment regimen may result in a significant impairment that could affect functional capacity and ability to work. For example, a person with a laryngeal tumor which had spread regionally could be cured by a complete laryngectomy and radiotherapy. However, this treatment could result in a loss of speech and significantly impair the individual's communicative skills or ability to use certain types of respiratory protective equipment.

Prognosis

Some cancers may have minimal impact on a person's functional capacity, but have a very poor prognosis with respect to life expectancy. For example, an individual with early stage brain cancer may be minimally impaired, but have a poor prognosis and minimal potential for surviving longer than two years. Five and two year survival data are presented in the Cancer Disability Guideline Table which follows.

The Cancer Disability Guideline Table provides information concerning the probability of survival for five years for local, regional, and distant disease for each type of malignancy. In addition, two-year survival data are also presented for all disease stages. The five-year survival data are based upon data collected from population-based registries in Connecticut, New Mexico, Utah, Hawaii, Atlanta, Detroit, Seattle and the San Francisco and East Bay area between 1983 and 1987 (Miller, 1992). The two-year data are from a cohort study initially diagnosed in 1988.

Assessment

The malignancies are classified as disabling (Category 1), potentially disabling (Category 2) and non-disabling (Category 3). Category 2 conditions must be evaluated with respect to how the worker's tumor affects the worker's ability to perform the job and an assessment of his life span.

Information concerning the potential impact of the malignancy on a worker's ability to perform a job is identified in the Functional Impact column in the table. All railroad occupations in the Tables are considered together. Functional impacts are classified as significant if the treatment or sequelae from treatment including radiotherapy, chemotherapy and/or surgery is likely to impair the worker from performing the job. If the treatment results in a significant impairment of another organ system, the individual should be evaluated for disability associated with impairment of that body part. For example, a person undergoing an amputation for a bone malignancy would have to be evaluated for an amputation of that body part. For many cancers, it is difficult to make generalizations regarding the level of impairment that will occur after the person has initiated or completed treatment. Nonsignificant impacts include those that are unlikely to have any effect on the individual's work capacity.

Cancer type

2-year 1

5-year 1

Disability status 2

Functional impact 3

Brain:

Local

26

1

S

Regional

27.9

1

S

Distant

23.6

1

S

Female Breast:

Regional

71.1

2

S

Distant

17.8

1

S

Colon:

Local

91

2

S

Regional

60.1

2

S

Distant

6

1

S

Rectal:

Local

84.5

2

S

Regional

50.7

2

S

Distant

5.3

1

S

Esophagus:

Local

18.5

1

S

Regional

5.2

1

S

Distant

1.8

1

S

Hodgkin's Disease: 4

Stage 1

90-95

3

S

Stage 2

86

2

S

Stage 3

<80

2

S

Stage 4

<80

1

S

Kidney/Renal Pelvis:

Local

85.4

3

S

Regional

56.3

2

S

Distant

9

1

S

Larynx:

Local

84.2

2

S

Regional

52.5

2

S

Distant

24

1

S

Acute Lymphocytic Leukemia:

All

51.1

2

S

Chronic Lymphocytic Leukemia:

All

66.2

2

S

Acute Myelogenous Leukemia:

All

9.7

1

S

Chronic Myelogenous Leukemia:

All

21.7

1

S

Liver/Intrahepatic Bile Duct:

Local

15.1

1

S

Regional

5.8

1

S

Distant

1.9

1

S

Lung/Bronchus: 5

Local

45.6

2

S

Regional

13.1

1

S

Distant

1.3

1

S

Melanomas of Skin:

Regional

53.6

2

S

Distant

12.8

1

S

Oral Cavity/Pharyngeal:

Local

76.2

2

S

Regional

40.9

2

S

Distant

18.7

1

S

Pancreas:

Local

6.1

1

S

Regional

3.7

1

S

Distant

1.4

1

S

Prostate:

Local

91

3

S

Regional

80.4

2

S

Distant

28

1

S

Stomach:

Local

55.4

1

S

Regional

17.3

1

S

Distant

2.1

1

S

Testicular:

Distant

65.5

1

S

Thyroid:

Regional

93.1

3

S

Distant

47.2

1

S

Bladder:

Regional

46

2

S

Distant

9.1

1

S

1 Source of 2 and 5 year survival data: Miller BA et al. Cancer Statistics Review 1973-1989. NIH Publication No. 92-2789.

2 Disability Status:

Category 1: Significant impact on functional capacity or life span.

Category 2: Intermediate impact.

Category 3: No significant impact on functional capacity or life span.

3 Functional Impacts:

(S) Significant—significant potential for the effects of treatment (radiotheraphy, chemotherapy. surgery) to affect functional capacity.

4 Hodgkin's disease data presented for each stage derived from American Cancer Society. American Cancer Society Textbook reference for unstaged cancer is derived from Cancer Statistics Review (See 3). In addition to other data, see: American Cancer Society Textbook of Clinical Oncology. Eds: Holleb AI, Fink DJ, Murphy GP, Atlanta: American Cancer Society, Inc. 1991.)

5 Small cell carcinoma is classified as a 1.

B. Endocrine

Confirmatory test

Minimum result

Requirements

BODY PART: ENDOCRINE

CONFIRMATORY TESTS

Diabetes, requiring insulin (IDDM):

Medical record review

Confirmation of condition and need for insulin use

Highly recommended.

Disability test

Test result

Disability classification

BODY PART: ENDOCRINE

JOB TITLE: ENGINEER

Diabetes, requiring insulin (IDDM):

Medical record review

Confirmation of condition and need for insulin use

D

C. Cardiac

Confirmatory test

Minimum result

Requirements

BODY PART: CARDIAC

CONFIRMATORY TESTS

Angina:

Medical record review

Confirmed history of ischemia including copies of electrocardiogram

Recommended.

Stress test

Definite ischemia on exercise test

Recommended.

Thallium study

Definite ischemia with exercise

Recommended.

Aortic valve disease:

Cardiac catheterization

Proven and significant

Recommended.

Echocardiogram

Significant valve disease

Recommended.

Coronary artery disease:

Medical record review

Documented ischemia with electrocardiogram confirmation

Recommended.

Medical record review

Documented myocardial infarction

Recommended.

Stress test

Positive

Recommended.

Thallium study

Definite ischemia with exercise

Recommended.

Angiography

Definite occlusion (>60%) of one vessel

Recommended.

Cardiomyopathy:

Echocardiogram

Proven ejection fraction ≤35%

Recommended.

Catheterization

Poor global function and not coronary artery disease

Recommended.

Hypertension:

Medical record review

Documentation of hypertension for one year

Highly recommended.

Medical record review

Definite diagnosis by cardiologist or internist

Highly recommended.

Medical record review

Confirmation of medication use

Highly recommended.

Arrhythmia: heart block:

Medical record review

Proven episode with electrocardiogram confirmation

Recommended.

Electrocardiogram

Documentation of arrhythmia

Recommended.

Mitral valve disease:

Cardiac catheterization

Significant valve disease

Recommended.

Echocardiogram

Significant valve disease

Recommended.

Pericardial disease:

Medical record review

Confirmed by cardiologist or internist

Highly recommended.

Pulmonary hypertension:

Physical examination

Increased pulmonic sound or pulmonary ejection murmur by cardiologist or internist

Recommended.

Electrocardiogram

Definite right ventricular hypertension

Highly recommended.

Ventricular ectopy:

Medical record review

Definite episode within one year

Recommended.

Holter monitoring

Definite arrhythmia

Recommended.

Provocative testing

Positive response

Recommended.

Arrhythmia: supraventricular tachycardia:

Medical record review

Definite episode within one year

Recommended.

Holter monitoring

Definite arrhythmia

Recommended.

Post heart transplant:

Medical record review

Documented

Highly recommended.

Disability test

Test result

Disability classification

BODY PART: CARDIAC

JOB TITLE: TRAINMAN

Angina:

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤7 METS

D

Medical record review

Unstable as diagnosed by cardiologist

D

Stress test

Documented hypotensive response

D

Stress test: significant ST changes

Definite ischemia ≤7 METS

D

Aortic valve disease:

Cardiac catheterization

Aortic gradient 25-50 mm HG

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤7 METS

D

Coronary artery disease:

Myocardial infarction

Multiple infarctions

D

Echocardiogram

Confirmed ventricular aneurysm

D

Cardiac catheterization

Aortic gradient 25-50 mm Hg

D

Cardiac catheterization

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤7 METS

D

Medical record review

Unstable as diagnosed by a Cardiologist

D

Stress test

Documented hypotensive response

D

Stress test

Definite ischemia ≤ 7 METS

D

Isotope, e.g., thallium study

Definite ischemia ≤ 7 METS

D

Cardiomyopathy:

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤7 METS

D

Hypertension:

Medical record review

Diastolic >120 and systolic >160, 50% of the time and evidence of end organ damage (blood creatinine >2; urinary protein > 1 ⁄ 2 gm; or EKG evidence of ischemia)

D

Arrhythmia: heart block:

Holter

Documented asystole length >1.5-2 seconds

D

Medical record review

Documented syncope with proven arrhythmia

D

Mitral valve disease:

Cardiac catheterization

Mitral valve gradient ≥5 mm Hg

D

Cardiac catheterization

Mitral regurgitation severe

D

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤7 METS

D

Pericardial disease:

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Ventricular ectopy:

Medical record review

Documented life threatening arrhythmia

D

Holter

Uncontrolled ventricular rhythm

D

Medical record review

Documented related syncope

D

Arrhythmia: supraventricular tachycardia:

Medical record review

Documented related syncope

D

Post heart transplant:

Medical record review

Post heart transplant

D

BODY PART: CARDIAC

JOB TITLE: ENGINEER

Angina:

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Medical record review

Unstable as diagnosed by cardiologist

D

Stress test

Documented hypotensive response

D

Stress test: significant ST changes

Definite ischemia ≤5 METS

D

Aortic valve disease:

Cardiac catheterization

Aortic gradient 25-50 mm HG

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Coronary artery disease:

Myocardial infarction

Multiple infarctions

D

Echocardiogram

Confirmed ventricular aneurysm

D

Cardiac catheterization

Aortic gradient 25-50 mm Hg

D

Cardiac catheterization

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Medical record review

Unstable as diagnosed by a Cardiologist

D

Stress test

Documented hypotensive response

D

Stress test

Definite ischemia ≤5 METS

D

Isotope, e.g., thallium study

Definite ischemia ≤5 METS

D

Cardiomyopathy:

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Hypertension:

Medical record review

Diastolic >120 and systolic >160, 50% of the time and evidence of end organ damage (blood creatinine >2; urinary protein > 1 ⁄ 2 gm; or EKG evidence of ischemia)

D

Arrhythmia: heart block:

Holter

Documented asystole length >1.5-2 seconds

D

Medical record review

Documented syncope with proven arrhythmia

D

Mitral valve disease:

Cardiac catheterization

Mitral valve gradient ≥10 mm Hg

D

Cardiac catheterization

Mitral regurgitation severe

D

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Pericardial disease:

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Ventricular ectopy:

Medical record review

Documented life threatening arrhythmia

D

Holter

Uncontrolled ventricular rhythm

D

Medical record review

Documented related syncope

D

Arrhythmia: supraventricular tachycardia:

Medical record review

Documented related syncope

D

Post heart transplant:

Medical record review

Post heart transplant

D

BODY PART: CARDIAC

JOB TITLE: DISPATCHER

Angina:

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Medical record review

Unstable as diagnosed by cardiologist

D

Stress test

Documented hypotensive response

D

Stress test: significant ST changes

Definite ischemia ≤5 METS

D

Aortic valve disease:

Cardiac catheterization

Aortic gradient 25-50 mm Hg

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Coronary artery disease:

Myocardial infarction

Multiple infarctions

D

Echocardiogram

Confirmed ventricular aneurysm

D

Cardiac catheterization

Aortic gradient 25-50 mm Hg

D

Cardiac catheterization

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Medical record review

Unstable as diagnosed by cardiologist

D

Stress test

Documented hypotensive response

D

Stress test

Definite ischemia ≤5 METS

D

Isotope, e.g., thallium study

Definite ischemia ≤5 METS

D

Cardiomyopathy:

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Hypertension:

Medical record review

Diastolic >120 and systolic >160, 50% of the time and evidence of end organ damage (blood creatinine >2; urinary protein > 1 ⁄ 2 gm; or EKG evidence of ischemia)

D

Arrhythmia: heart block:

Holter

Documented asystole length >1.5-2 seconds

D

Medical record review

Documented syncope with proven arrhythmia

D

Mitral valve disease:

Cardiac catheterization

Mitral valve gradient ≥10 mm Hg

D

Cardiac catheterization

Mitral regurgitation severe

D

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Pericardial disease:

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Ventricular ectopy:

Medical record review

Documented life threatening arrhythmia

D

Holter

Uncontrolled ventricular rhythm

D

Medical record review

Documented related syncope

D

Arrhythmia: supraventricular tachycardia:

Medical record review

Documented related syncope

D

Post heart transplant:

Medical record review

Post heart transplant

D

BODY PART: CARDIAC

JOB TITLE: CARMAN

Angina:

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Medical record review

Unstable as diagnosed by cardiologist

D

Stress test

Documented hypotensive response

D

Stress test: significant ST changes

Definite ischemia ≤5 METS

D

Aortic valve disease:

Cardiac catheterization

Aortic gradient 25-50 mm HG

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Coronary artery disease:

Myocardial infarction

Multiple infarctions

D

Echocardiogram

Confirmed ventricular aneurysm

D

Cardiac catheterization

Aortic gradient 25-50 mm Hg

D

Cardiac catheterization

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Medical record review

Unstable as diagnosed by a Cardiologist

D

Stress test

Documented hypotensive response

D

Stress test

Definite ischemia ≤ 5 METS

D

Isotope, e.g., thallium study

Definite ischemia ≤ 5 METS

D

Cardiomyopathy:

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Hypertension:

Medical record review

Diastolic >120 and systolic >160, 50% of the time and evidence of end organ damage (blood creatinine >2; urinary protein > 1 ⁄ 2 gm; or EKG evidence of ischemia)

D

Arrhythmia: heart block:

Holter

Documented asystole length >1.5-2 seconds

D

Medical record review

Documented syncope with proven arrhythmia

D

Mitral valve disease:

Cardiac catheterization

Mitral valve gradient ≥10 mm Hg

D

Cardiac catheterization

Mitral regurgitation severe

D

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Pericardial disease:

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Ventricular ectopy:

Medical record review

Documented life threatening arrhythmia

D

Holter

Uncontrolled ventricular rhythm

D

Medical record review

Documented related syncope

D

Arrhythmia: supraventricular tachycardia:

Medical record review

Documented related syncope

D

Post heart transplant:

Medical record review

Post heart transplant

D

BODY PART: CARDIAC

JOB TITLE: SIGNALMAN

Angina:

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤7 METS

D

Medical record review

Unstable as diagnosed by cardiologist

D

Stress test

Documented hypotensive response

D

Stress test: significant ST changes

Definite ischemia ≤7 METS

D

Aortic valve disease:

Cardiac catheterization

Aortic gradient 25-50 mm HG

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤7 METS

D

Coronary artery disease:

Myocardial infarction

Multiple infractions

D

Echocardiogram

Confirmed ventricular aneurysm

D

Cardiac catheterization

Aortic gradient 25-50 mm Hg

D

Cardiac catheterization

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤7 METS

D

Medical record review

Unstable as diagnosed by cardiologist

D

Stress test

Documented hypotensive response

D

Stress test

Definite ischemia ≤7 METS

D

Isotope, e.g., thallium study

Definite ischemia ≤7 METS

D

Cardiomyopathy:

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤7 METS

D

Hypertension:

Medical record review

Diastolic >120 and systolic >160, 50% of the time and evidence of end organ damage (blood creatinine >2; urinary protein > 1 ⁄ 2 gm; or EKG evidence of ischemia)

D

Arrhythmia: heart block

Holter

Documented asystole length >1.5-2 seconds

D

Medical record review

Documented syncope with proven arrhythmia

D

Mitral valve disease:

Cardiac catheterization

Mitral valve gradient ≥5 mm Hg

D

Cardiac catherization

Mitral regurgitation severe

D

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤7 METS

D

Pericardial disease:

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Ventricular ectopy:

Medical record review

Documented life threatening arrhythmia

D

Holter

Uncontrolled ventricular rhythm

D

Medical record review

Documented related syncope

D

Arrhythmia: supraventricular tachycardia:

Medical record review

Documented related syncope

D

Post heart transplant:

Medical record review

Post heart transplant

D

BODY PART: CARDIAC

JOB TITLE: TRACKMAN

Angina:

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤7 METS

D

Medical record review

Unstable as diagnosed by cardiologist

D

Stress test

Documented hypotensive response

D

Stress test: significant ST changes

Definite ischemia ≤7 METS

D

Aortic valve disease:

Cardiac catheterization

Aortic gradient 25-50 mm HG

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤7 METS

D

Coronary artery disease:

Myocardial infarction

Multiple infarctions

D

Echocardiogram

Confirmed ventricular aneurysm

D

Cardiac catheterization

Aortic gradient 25-50 mm Hg

D

Cardiac catheterization

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤7 METS

D

Medical record review

Unstable as diagnosed by a cardiologist

D

Stress test

Documented hypotensive response

D

Stress test

Definite ischemia ≤7 METS

D

Isotope, e.g., thallium study

Definite ischemia ≤7 METS

D

Cardiomyopathy:

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤7 METS

D

Hypertension:

Medical record review

Diastolic >120 and systolic >160, 50% of the time and evidence of end organ damage (blood creatinine >2; urinary protein > 1 ⁄ 2 gm; or EKG evidence of ischemia)

D

Arrhythmia: heart block:

Holter

Documented asystole length >1.5-2 seconds

D

Medical record review

Documented syncope with proven arrhythmia

D

Mitral valve disease:

Cardiac catheterization

Mitral valve gradient ≥5 mm Hg

D

Cardiac catheterization

Mitral regurgitation severe

D

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤7 METS

D

Pericardial disease:

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Ventricular ectopy:

Medical record review

Documented life threatening arrhythmia

D

Holter

Uncontrolled ventricular rhythm

D

Medical record review

Documented related syncope

D

Arrhythmia: supraventricular tachycardia:

Medical record review

Documented related syncope

D

Post heart transplant:

Medical record review

Post heart transplant

D

BODY PART: CARDIAC

JOB TITLE: MACHINIST

Angina:

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Medical record review

Unstable as diagnosed by cardiologist

D

Stress test

Documented hypotensive response

D

Stress test: significant ST changes

Definite ischemia ≤5 METS

D

Aortic valve disease:

Cardiac catheterization

Aortic gradient 25-50 mm HG

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Coronary artery disease:

Myocardial infarction

Multiple infarctions

D

Echocardiogram

Confirmed ventricular aneurysm

D

Cardiac catheterization

Aortic gradient 25-50 mm Hg

D

Cardiac catheterization

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Medical record review

Unstable as diagnosed by a cardiologist

D

Stress test

Documented hypotensive response

D

Stress test

Definite ischemia ≤5 METS

D

Isotope, e.g., thallium study

Definite ischemia ≤5 METS

D

Cardiomyopathy:

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Hypertension:

Medical record review

Diastolic >120 and systolic >160, 50% of the time and evidence of end organ damage (blood creatinine >2; urinary protein > 1 ⁄ 2 gm; or EKG evidence of ischemia)

D

Arrhythmia: heart block:

Holter

Documented asystole length >1.5-2 seconds

D

Medical record review

Documented syncope with proven arrhythmia

D

Mitral valve disease:

Cardiac catheterization

Mitral valve gradient ≥10 mm Hg

D

Cardiac catheterization

Mitral regurgitation severe

D

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Pericardial disease:

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Ventricular ectopy:

Medical record review

Documented life threatening arrhythmia

D

Holter

Uncontrolled ventricular rhythm

D

Medical record review

Documented related syncope

D

Arrhythmia: supraventricular tachycardia:

Medical record review

Documented related syncope

D

Post heart transplant:

Medical record review

Post heart transplant

D

BODY PART: CARDIAC

JOB TITLE: SHOP LABORER

Angina:

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Medical record review

Unstable as diagnosed by cardiologist

D

Stress test

Documented hypotensive response

D

Stress test: significant ST changes

Definite ischemia ≤5 METS

D

Aortic valve disease:

Cardiac catheterization

Aortic gradient 25-50 mm HG

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Coronary artery disease:

Myocardial infarction

Multiple infarctions

D

Echocardiogram

Confirmed ventricular aneurysm

D

Cardiac catheterization

Aortic gradient 25-50 mm Hg

Cardiac catheterization

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Medical record review

Unstable as diagnosed by a Cardiologist

D

Stress test

Documented hypotensive response

D

Stress test

Definite ischemia ≤5 METS

D

Isotope, e.g., thallium study

Definite ischemia ≤5 METS

D

Cardiomyopathy:

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Hypertension:

Medical record review

Diastolic >120 and systolic >160, 50% of the time and evidence of end organ damage (blood creatinine >2; urinary protein > 1 ⁄ 2 gm; or EKG evidence of ischemia)

D

Arrhythmia: heart block:

Holter

Documented asystole length >1.5-2 seconds

D

Medical record review

Documented syncope with proven arrhythmia

D

Mitral valve disease:

Cardiac catheterization

Mitral valve gradient ≥10 mm Hg

D

Cardiac catheterization

Mitral regurgitation severe

D

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Pericardial disease:

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Ventricular ectopy:

Medical record review

Documented life threatening arrhythmia

D

Holter

Uncontrolled ventricular rhythm

D

Medical record review

Documented related syncope

D

Arrhythmia: supraventricular tachycardia:

Medical record review

Documented related syncope

D

Post heart transplant:

Medical record review

Post heart transplant

D

BODY PART: CARDIAC

JOB TITLE: SALES REPRESENTATIVE

Angina:

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Medical record review

Unstable as diagnosed by cardiologist

D

Stress test

Documented hypotensive response

D

Stress test: significant ST changes

Definite ischemia ≤5 METS

D

Aortic valve disease:

Cardiac catheterization

Aortic gradient 25-50 mm HG

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Coronary artery disease:

Myocardial infarction

Multiple infarctions

D

Echocardiogram

Confirmed ventricular aneurysm

D

Cardiac catheterization

Aortic gradient 25-50 mm Hg

D

Cardiac catheterization

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Medical record review

Unstable as diagnosed by a cardiologist

D

Stress test

Documented hypotensive response

D

Stress test

Definite ischemia ≤5 METS

D

Isotope, e.g., thallium study

Definite ischemia ≤5 METS

D

Cardiomyopathy:

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Hypertension:

Medical record review

Diastolic >120 and systolic >160, 50% of the time and evidence of end organ damage (blood creatinine >2; urinary protein > 1 ⁄ 2 gm; or EKG evidence of ischemia)

D

Arrhythmia: heart block:

Holter

Documented asystole length >1.5-2 seconds

D

Medical record review

Documented syncope with proven arrhythmia

D

Mitral valve disease:

Cardiac catheterization

Mitral valve gradient ≥10 mm Hg

D

Cardiac catheterization

Mitral regurgitation severe

D

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Pericardial disease:

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Ventricular ectopy:

Medical record review

Documented life threatening arrhythmia

D

Holter

Uncontrolled ventricular rhythm

D

Medical record review

Documented related syncope

D

Arrhythmia: supraventricular tachycardia:

Medical record review

Documented related syncope

D

Post heart transplant:

Medical record review

Post heart transplant

D

BODY PART: CARDIAC

JOB TITLE: GENERAL OFFICE CLERK

Angina:

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Medical record review

Unstable as diagnosed by cardiologist

D

Stress test

Documented hypotensive response

D

Stress test: significant ST changes

Definite ischemia ≤5 METS

D

Aortic valve disease:

Cardiac catheterization

Aortic gradient 25-50 mm HG

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Coronary artery disease:

Myocardial infarction

Multiple infarctions

D

Echocardiogram

Confirmed ventricular aneurysm

D

Cardiac catheterization

Aortic gradient 25-50 mm Hg

D

Cardiac catheterization

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Medical record review

Unstable as diagnosed by a Cardiologist

D

Stress test

Documented hypotensive response

D

Stress test

Definite ischemia ≤5 METS

D

Isotope, e.g., thallium study

Definite ischemia ≤5 METS

D

Cardiomyopathy:

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Arrhythmia: heart block:

Holter

Documented asystole length >1.5-2 seconds

D

Medical record review

Documented syncope with proven arrhythmia

D

Mitral valve disease:

Cardiac catheterization

Mitral valve gradient ≥10 mm Hg

D

Cardiac catheterization

Mitral regurgitation severe

D

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Stress test

Peak exercise ≤5 METS

D

Pericardial disease:

Cardiac catheterization

Poor ejection fraction ≤35%

D

Echocardiogram

Poor ejection fraction ≤35%

D

Ventricular ectopy:

Medical record review

Documented life threatening arrhythmia

D

Holter

Uncontrolled ventricular rhythm

D

Medical record review

Documented related syncope

D

Arrhythmia: supraventricular tachycardia:

Medical record review

Documented related syncope

D

Post heart transplant:

Medical record review

Post heart transplant

D

D. Respiratory

Confirmatory test

Minimum result

Requirements

BODY PART: RESPIRATORY

CONFIRMATORY TESTS

Asthma:

Spirometry

FEV1/FVC ratio diminished

Recommended.

Spirometry

>15% change with administration of bronchodilator

Recommended.

Methacholine challenge test

Positive: FEV1 decrease >20% at (PC ≤8 mg/ml)

Recommended

Bronchiectasis:

Medical record review

Chronic cough and sputum

Recommended.

Chest X-ray

Bronchiectasis demonstrated

Recommended.

Chest CAT scan

Bronchiectasis demonstrated

Recommended.

Chronic bronchitis:

Medical record review

Frequent cough—2 years duration

Highly recommended.

Chronic obstructive pulmonary disease:

Spirometry

FEV1/FVC ratio below 65% when stable

Highly recommended.

Spirometry

FEV1 below 75% of predicted when stable

Highly recommended.

Cor pulmonale:

Electrocardiogram

Definite right ventricular hypertrophy

Recommended.

Echocardiogram

Definite right ventricular hypertrophy

Recommended.

Pulmonary fibrosis:

Lung biopsy

Diffuse fibrosis

Recommended.

Chest CAT scan

More than minimal fibrosis

Recommended.

Lung resection:

Medical record review

At least one lobe resected

Highly recommended.

Pneumothorax:

Medical record review

Required hospitalization with chest tube drainage

Highly recommended.

Restrictive lung disease:

Chest X-ray

Restrictive lung changes

Recommended.

DLCO

Abnormal

Highly recommended.

Chest CAT scan

Restrictive lung changes

Recommended.

Spirometry

FVC <75% predicted

Highly recommended.

Silicosis:

Medical record review

Occupational exposure for at least 1 year

Highly recommended.

Tuberculosis:

Chest X-ray

Evidence of changes consistent with tuberculosis infection

Recommended.

Culture

Positive

Recommended.

Disability test

Test result

Disability classification

BODY PART: RESPIRATORY

JOB TITLE: TRAINMAN

Asthma:

Spirometry

Repeated spirometry FEV1 <40% over a 12 month period

Bronchiectasis:

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Chronic bronchitis:

Spirometry

Repeated spirometry FEV1 <40% over a 12 month period

D

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Chronic obstructive pulmonary disease (COPD):

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Cor pulmonale:

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Pulmonary fibrosis:

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

DLCO

<45% predicted

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Spirometry

FVC <50% predicted

D

Lung resection:

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Restrictive lung disease:

DLCO

<45% predicted

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Spirometry

FVC <50% predicted

D

Electrocardiogram

efinite positive right ventricular hypertrophy

D

Silicosis:

Resting ABG

PCO2 arterial >50 mm Hg If stable

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

BODY PART: RESPIRATORY

JOB TITLE: CARMAN

Asthma:

Spirometry

Repeated spirometry FEV1 <40% over a 12 month period

D

Bronchiectasis:

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Chronic bronchitis:

Spirometry

Repeated spirometry FEV1 <40% over a 12 month period

D

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Chronic obstructive pulmonary disease (COPD):

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Cor pulmonale:

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Pulmonary fibrosis:

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

DLCO

<45% predicted

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Spirometry

FVC <50% predicted

D

Lung resection:

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Restrictive lung disease:

DLCO

<45% predicted

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Spirometry

FVC <50% predicted

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Silicosis:

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

BODY PART: RESPIRATORY

JOB TITLE: SIGNALMAN

Asthma:

Spirometry

Repeated spirometry FEV1 <40% over a 12 month period

D

Bronchiectasis:

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Chronic bronchitis:

Spirometry

Repeated spirometry FEV1 <40% over a 12 month period

D

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Chronic obstructive pulmonary disease (COPD):

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Cor pulmonale:

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Pulmonary fibrosis:

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

DLCO

<45% predicted

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Spirometry

FVC <50% predicted

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Lung resection:

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Restrictive lung disease:

DLCO

<45% predicted

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Spirometry

FVC <50% predicted

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Silicosis:

Resting AGB

PCO2 arterial >50 mm Hg if stable

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

BODY PART: RESPIRATORY

JOB TITLE: TRACKMAN

Asthma:

Spirometry

Repeated spirometry FEV1 <40% over a 12 month period

D

Bronchiectasis:

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Pulmonary exercise test or exercise ABG

PO2 >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Chronic bronchitis:

Spirometry

Repeated spirometry FEV1 <40% over a 12 month period

D

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Chronic obstructive pulmonary disease (COPD):

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Cor pulmonale:

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Pulmonary fibrosis:

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

DLCO

<45% predicted

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Spirometry

FVC <50% predicted

D

Lung resection:

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Restrictive lung disease:

DLCO

<45% predicted

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Spirometry

FVC <50% predicted

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Silicosis:

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

BODY PART: RESPIRATORY

JOB TITLE: MACHINIST

Asthma:

Spirometry

Repeated spirometry FEV1 <40% over a 12 month period

D

Bronchiectasis:

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Chronic bronchitis:

Spirometry

Repeated spirometry FEV1 <40% over a 12 month period

D

Resting AGB

PCO2 arterial >50 mm Hg if stable

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Chronic obstructive pulmonary disease (COPD):

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Cor pulmonale:

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Pulmonary fibrosis:

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

DLCO

<45% predicted

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Spirometry

FVC <50% predicted

D

Lung resection:

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Restrictive lung disease:

DLCO

<45% predicted

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Spirometry

FVC <50% predicted

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Silicosis:

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

BODY PART: RESPIRATORY

JOB TITLE: SHOP LABORER

Asthma:

Spirometry

Repeated spirometry FEV1 <40% over a 12 month period

D

Bronchiectasis:

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Chronic bronchitis:

Spirometry

Repeated spirometry FEV1 <40% over a 12 month period

D

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Chronic obstructive pulmonary disease (COPD):

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Cor pulmonale:

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Pulmonary fibrosis:

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

DLCO

<45% predicted

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Spirometry

FVC <50% predicted

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Lung resection:

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Restrictive lung disease:

DLCO

<45% predicted

D

Pulmonary exercise test or exercise ABG

PO2 drop >5 torr at maximum exercise

D

Pulmonary exercise test

Maximum VO2 <15 ml/kg

D

Spirometry

FVC <50% predicted

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

Silicosis:

Resting ABG

PCO2 arterial >50 mm Hg if stable

D

Electrocardiogram

Definite positive right ventricular hypertrophy

D

E. Lumbar Sacral Spine

Confirmatory test

Minimum result

Requirements

BODY PART: LS SPINE

CONFIRMATORY TESTS

Ankylosing spondylitis:

X-ray-lumbar sacral spine

Sacroilitis

Highly recommended.

HLA B27 (blood test)

Positive HLA B27 (90% case)

Recommended.

Backache, unspecified:

Medical record review

History of back pain under medical treatment for at least 1 year

Highly recommended.

Medical record review

History of back pain unresponsive to therapy for at least 1 year

Highly recommended.

Medical record review

History of back pain with functional limitations for at least 1 year

Highly recommended.

Chronic back pain, not otherwise specified:

Medical record review

History of back pain under medical treatment for at least 1 year

Highly recommended.

Medical record review

History of back pain unresponsive to therapy for at least 1 year

Highly recommended.

Medical record review

History of back pain with functional limitations for at least 1 year

Highly recommended.

Cauda equina syndrome with bowel or bladder dysfunction:

Magnetic resonance imaging

Neural impingement of spinal nerves below L1

Recommended.

Computerized tomography

Neural impingement of spinal nerves below L1

Recommended.

Cystometrogram

Impaired bladder function

Recommended.

Rectal examination

Diminished rectal sphincter tone

Recommended.

Myelogram

Neural impingement of spinal nerves below L1

Recommended.

Degeneration of lumbar disc:

X-ray lumbar sacral spine

Significant degenerative disc changes

Recommended.

Computerized tomography

Significant degenerative disc changes

Recommended.

Magnetic resonance imaging

Significant degenerative disc changes

Recommended.

Myelogram

Significant degenerative disc changes

Recommended.

Displacement of lumbar disc:

X-ray-lumbar sacral spine

Significant degenerative disc changes

Recommended.

Computerized tomography

Significant degenerative disc changes

Recommended.

Magnetic resonance imaging

Significant degenerative disc changes

Recommended.

Myelogram

Significant degenerative disc changes

Recommended.

Fracture: vertebral body:

Magnetic resonance imaging

Fracture vertebral body

Recommended.

Computerized tomography

Fracture vertebral body

Recommended.

X-ray-lumbar sacral spine

Fracture vertebral body

ommended.

Fracture: posterior element with spinal canal displacement:

Magnetic resonance imaging

Fracture posterior spinal element with displacement of spinal canal

Recommended.

Computerized tomography

Fracture posterior spinal element with displacement of spinal canal

Recommended.

X-ray-lumbar sacral spine

Fracture posterior spinal element with displacement of spinal canal

Recommended.

Fracture: posterior spinal element with no displacement:

X-ray-lumbar sacral spine

Fracture posterior spinal element

Recommended.

Magnetic resonance imaging

Fracture posterior spinal element

Recommended.

Computerized tomography

Fracture posterior spinal element

Recommended.

Fracture: spinous process:

X-ray-lumbar sacral spine

Spinous process fracture

Recommended.

Magnetic resonance imaging

Spinous process fracture

Recommended.

Computerized tomography

Spinous process fracture

Recommended.

Fracture: Transverse process:

Lumbar sacral spine

Transverse process fracture

Recommended.

Magnetic resonance imaging

Transverse process fracture

Recommended.

Computerized tomography

Transverse process fracture

Recommended.

Intervertebral disc disorder:

X-ray-lumbar sacral spine

Significant disc degeneration

Recommended.

Magnetic resonance imaging

Significant disc degeneration

Recommended.

Computerized tomography

Significant disc degeneration

Recommended.

Myelogram

Significant disc degeneration

Recommended.

Lumbago:

Medical record review: lumbar

History of back pain under medical treatment for at least 1 year

Highly recommended.

Medical record review: lumbar

History of back pain unresponsive to therapy for at least 1 year

Highly recommended.

Medical record review: lumbar

History of back pain with functional limitations for at least 1 year

Highly recommended.

Lumbosacral neuritis:

Magnetic resonance imaging

Evidence of neural compression

Recommended.

Electromyography

Definite denervation

Recommended.

Nerve conduction velocity

Definite slowing

Recommended.

Physical examination—atrophy

Atrophy in affected limb with 2 cm difference between limbs

Recommended.

Physical examination: straight leg raise

Positive straight leg raise

Recommended.

Sensory examination

Loss of sensation in affected dermatomes

Recommended.

Medical history

History of radicular pain

Highly recommended.

Computerized tomography

Evidence of neural compression

Recommended.

Lumbar spinal stenosis:

Computerized tomography

Significant narrowing: spinal cord canal or intervertebral foramen

Recommended.

Magnetic resonance imaging

Significant narrowing: spinal cord canal or intervertebral foramen

Recommended.

Myelogram

Significant narrowing: spinal cord canal or intervertebral foramen

Recommended.

Mechanical complication of internal orthopedic device:

Medical record review

Documentation of failure of implant following surgical procedure

Highly recommended.

Osteomalacia:

X-ray-lumbar sacral spine

Evidence of significant osteomalacia

Recommended.

Magnetic resonance imaging

Evidence of significant osteomalacia

Recommended.

Computerized tomography

Evidence of significant osteomalacia

Recommended.

Osteomyelitis, chronic-lumbar:

X-ray-lumbar sacral spine

Evidence of chronic infection

Recommended.

Magnetic resonance imaging

Evidence of chronic infection

Recommended.

Computerized tomography

Evidence of chronic infection

Recommended.

Osteoporosis:

Computerized tomography

Significant bone density loss

Recommended.

Dual photon absorptiometry

Significant bone density loss

Recommended.

X-ray-lumbar sacral spine

Significant bone density loss

Recommended.

Post laminectomy syndrome with radiculopathy:

Medical record review: lumbar

Documented surgical history of laminectomy

Highly recommended.

Magnetic resonance imaging

Evidence of laminectomy

Recommended.

Electromyography

Definite denervation

Recommended.

Nerve conduction velocity

Definite slowing

Recommended.

Physical examination—atrophy

Atrophy in affected limb with 2 cm difference between limbs

Recommended.

Physical examination: straight leg raise

Positive straight leg raise

Recommended.

Sensory examination

Loss of sensation in affected dermatomes

Recommended.

Medical record review: lumbar

History of radicular pain

Highly recommended.

Computerized tomography

Evidence of laminectomy

Recommended.

Myelogram

Evidence of laminectomy

Recommended.

Radiculopathy:

Magnetic resonance imaging

Evidence of neural compression

Recommended.

Electromyography

Definite denervation

Recommended.

Nerve conduction velocity

Definite slowing

Recommended.

Physical examination—atrophy

Atrophy in affected limb with 2 cm difference between limbs

Recommended.

Physical examination: straight leg raise

Positive straight leg raise

Recommended.

Sensory examination

Loss of sensation in affected dermatomes

Recommended.

Medical record review: lumbar

History of radicular pain

Highly recommended.

Computerized tomography

Evidence of neural compression

Recommended.

Myelogram

Evidence of neural compression

Recommended.

Sciatica:

Magnetic resonance imaging

Evidence of neural compression

Recommended.

Electromyography

Definite denervation

Recommended.

Nerve conduction velocity

Definite slowing

Recommended.

Physical examination—atrophy

Atrophy in affected limb with 2 cm difference between limbs

Recommended.

Physical examination: straight leg raise

Positive straight leg raise

Recommended.

Sensory examination

Loss of sensation in affected dermatomes

Recommended.

Medical history

History of radicular pain

Highly recommended.

Computerized tomography

Evidence of neural compression

Recommended.

Myelogram

Evidence of neural compression

Recommended.

Strains and sprains, unspecified:

Medical record review

History of back pain under medical treatment for at least 1 year

Highly recommended.

Medical record review

History of back pain unresponsive to therapy for at least 1 year

Highly recommended.

Medical record review

History of back pain with functional limitations for at least 1 year

Highly recommended.

Medical record review

Documented history of strain and/or sprain

Highly recommended.

Spondylolisthesis grade 1:

X-ray-lumbar sacral spine

1-25% slippage

Recommended.

Computerized tomography

1-25% slippage

Recommended.

Magnetic resonance imaging

1-25% slippage

Recommended.

Spondylolisthesis grade 2:

X-ray-lumbar sacral spine

26-50% slippage

Recommended.

Computerized tomography

26-50% slippage

Recommended.

Magnetic resonance imaging

26-50% slippage

Recommended.

Spondylolisthesis grade 3:

X-ray-lumbar sacral spine

51-75% slippage

Recommended.

Computerized tomography

51-75% slippage

Recommended.

Magnetic resonance imaging

51-75% slippage

Recommended.

Spondylolisthesis grade 4:

X-ray-lumbar sacral spine

Complete slippage

Recommended.

Computerized tomography

Complete slippage

Recommended.

Magnetic resonance imaging

Complete slippage

Recommended.

Spondylolisthesis-acquired:

X-ray-lumbar sacral spine

Slippage

Recommended.

Computerized tomography

Slippage

Recommended.

Magnetic resonance imaging

Slippage

Recommended.

Spondylolsis:

X-ray-lumbar sacral spine

Defect—pars interarticularis

Recommended.

Computerized tomography

Defect—pars interarticularis

Recommended.

Magnetic resonance imaging

Defect—pars interarticularis

Recommended.

Sprains and strains, sacral:

Medical record review: lumbar

History of back pain under medical treatment for at least 1 year

Highly recommended.

Medical record review: lumbar

History of back pain unresponsive to therapy for at least 1 year

Highly recommended.

Medical record review: lumbar

History of back with functional limitations for at least 1 year

Highly recommended.

Medical record review: lumbar

Documented history of strain and/or sprain

Highly recommended.

Sprains and strains, sacroiliac:

Medical record review: lumbar

History of back pain under medical treatment for at least 1 year

Highly recommended.

Medical record review: lumbar

History of back pain unresponsive to therapy for at least 1 year

Highly recommended.

Medical record review: lumbar

History of back pain with functional limitations for at least 1 year

Highly recommended.

Medical record review: lumbar

Documented history of strain and/or sprain

Highly recommended.

Disability test

Test result

Disability classification

BODY PART: LS SPINE

JOB TITLE: TRAINMAN

Ankylosing spondylitis:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Backache, unspecified:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Chronic back pain, not otherwise specified:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Cauda equina syndrome with bowel or bladder dysfunction:

Computerized tomography

Disc extrusion with neural impingement, nerves < L1

D

Magnetic resonance imaging

Disc extrusion with neural impingement, nerves < L1

D

Physical examination

Lower extremity weakness

D

Cystometrogram

Impaired bladder function

D

Myelogram

Disc extrusion with neural impingement, nerves <L1

D

Physical examination: rectal

Impairment of sphincter tone

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Degeneration of lumbar disc:

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Displacement of lumbar disc:

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: vertebral body:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: posterior spinal element with displacement:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: posterior spinal element with no displacement:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: spinous process:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture transverse process:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Intervertebral disc disorder:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Lumbago:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Lumbosacral neuritis:

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Physical examination

Lower extremity weakness

D

Lumbar spinal stenosis:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Significant narrowing of the spinal canal

D

Magnetic resonance imaging

Significant narrowing of the spinal canal

D

Myelogram

Significant narrowing of the spinal canal

D

Physical examination

Significant lower extremity weakness

D

Mechanical complication of internal orthopedic device:

Muscle strength assessment

Lifting capacity diminished by 50%

D

X-ray flexion/extension

Segmental instability

D

Osteomalacia:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Osteomyelitis, chronic-lumbar:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Medical record review

Frequent flare-ups with objective findings

D

Osteoporosis:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Post laminectomy syndrome with radiculopathy:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

Post laminectomy syndrome:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

X-ray flexion/extension

Segmental instability

D

Radiculopathy:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

Sciatica:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

Strains and sprains, unspecified:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Spondylolisthesis grade 1:

Muscle strength assessment

Lifting capacity diminished by 50%

D

X-ray flexion/extension

Segmental instability

D

Spondylolisthesis grade 2:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Spondylolisthesis grade 3:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Spondylolisthesis grade 4:

Muscle strength assessment

Lifting capacity diminished by 50%

D

X-ray flexion/extension

Segmental instability

D

Spondylolisthesis—acquired:

X-ray flexion/extension

Segmental instability

D

Spondylolysis:

X-ray flexion/extension

Segmental instability

D

Sprains and strains, sacral:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Sprains and strains, sacroiliac:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Vertebral body compression fracture:

Muscle strength assessment

Lifting capacity diminished by 50%

D

BODY PART: LS SPINE

JOB TITLE: ENGINEER

Cauda equina syndrome with bowel or bladder dysfunction:

Computerized tomography

Disc extrusion with neural impingement, nerves <L1

D

Magnetic resonance imaging

Disc extrusion with neural impingement, nerves <L1

D

Physical examination

Lower extremity weakness

D

Cystometrogram

Impaired bladder function

D

Myelogram

Disc extrusion with neural impingement, nerves <L1

D

Physical examination: rectal

Impairment of sphincter tone

D

BODY PART: LS SPINE

JOB TITLE: CARMAN

Ankylosing spondylitis:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Backache, unspecified:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Chronic back pain, not otherwise specified:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Cauda equina syndrome with bowel or bladder dysfunction:

Computerized tomography

Disc extrusion with neural impingement, nerves <L1

D

Magnetic resonance imaging

Disc extrusion with neural impingement, nerves <L1

D

Physical examination

Lower extremity weakness

D

Cystometrogram

Impaired bladder function

D

Myeolgram

Disc extrusion with neural impingement, nerves <L1

D

Physical examination: rectal

Impairment of sphincter tone

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Degeneration of lumbar disc:

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Displacement of lumbar disc:

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: vertebral body:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: posterior spinal element with displacement:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: posterior spinal element with no displacement:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: spinous process:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture transverse process:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Intervertebral disc disorder:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Lumbago:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Lumbosacral neuritis:

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Physical examination

Lower extremity weakness

D

Lumbar spinal stenosis:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Significant narrowing of the spinal canal

D

Magnetic resonance imaging

Significant narrowing of the spinal canal

D

Myelogram

Significant narrowing of the spinal canal

D

Physical examination

Significant lower extremity weakness

D

Mechanical complication of internal orthopedic device:

Muscle strength assessment

Lifting capacity diminished by 50%

D

X-ray flexion/extension

Segmental instability

D

Osteomalacia:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Osteomyelitis, chronic-lumbar:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Medical record review

Frequent flare-ups with objective findings

D

Osteoporosis:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Post laminectomy syndrome with radiculopathy:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

Post laminectomy syndrome:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

X-ray flexion/extension

Segmental instability

D

Radiculopathy:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

Sciatica:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

Strains and sprains, unspecified:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Spondylolisthesis grade 1:

Muscle strength assessment

Lifting capacity diminished by 50%

D

X-ray flexion/extension

Segmental instability

D

Spondylolisthesis grade 2:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Spondylolisthesis grade 3:

Muscle strength assessment

Lifting capacity diminshed by 50%

D

Spondylolisthesis grade 4:

Muscle strength assessment

Lifting capacity diminished by 50%

D

X-ray flexion/extension

Segmental instability

D

Spondylolisthesis-acquired:

X-ray flexion/extension

Segmental instability

D

Spondylolysis:

X-ray flexion/extension

Segmental instability

D

Sprains and strains, sacral:

Muscle strength assessment

Lifting capacity diminshed by 50%

D

Sprains and strains, sacroiliac:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Vertebral body compression fracture:

Muscle strength assessment

Lifting capacity diminshed by 50%

D

BODY PART: LS SPINE

JOB TITLE: SIGNALMAN

Ankylosing spondylitis:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Backache, unspecified:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Chronic back pain, not otherwise specified:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Cauda equina syndrome with bowel or bladder dysfunction:

Computerized tomography

Disc extrusion with neural impingement, nerves <L1

D

Magnetic resonance imaging

Disc extrusion with neural impingement, nerves <L1

D

Physical examination

Lower extremity weakness

D

Cystometrogram

Impaired bladder function

D

Myelogram

Disc extrusion with neural impingement, nerves <L1

D

Physical examination: rectal

Impairment of sphincter tone

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Degeneration of lumbar disc:

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Displacement of lumbar disc:

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: vertebral body:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: posterior spinal element with displacement:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: posterior spinal element with no displacement:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: spinous process:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture transverse process:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Intervertebral disc disorder:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Lumbago:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Lumbosacral neuritis:

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Physical examination

Lower extremity weakness

D

Lumbar spinal stenosis:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Significant narrowing of the spinal canal

D

Magnetic resonance imaging

Significant narrowing of the spinal canal

D

Myelogram

Significant narrowing of the spinal canal

D

Physical examination

Significant lower extremity weakness

D

Mechanical complication of internal orthopedic device:

Muscle strength assessment

Lifting capacity diminished by 50%

D

X-ray flexion/extension

Segmental instability

D

Osteomalacia:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Osteomyelitis, chronic-lumbar:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Medical record review

Frequent flare-ups with objective findings

D

Osteoporosis:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Post laminectomy syndrome with radiculopathy:

Muscle strength assessment

Lifing capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

Post laminectomy syndrome:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

X-ray flexion/extension

Segmental instability

D

Radiculopathy:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

Sciatica:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

Strains and sprains, unspecified:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Spondylolisthesis grade 1:

Muscle strength assessment

Lifting capacity diminished by 50%

D

X-ray flexion/extension

Segmental instability

D

Spondylolisthesis grade 2:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Spondylolisthesis grade 3:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Spondylolisthesis grade 4:

Muscle strength assessment

Lifting capacity diminished by 50%

D

X-ray flexion/extension

Segmental instability

D

Spondylolisthesis-acquired:

X-ray flexion/extension

Segmental instability

D

Spondylolysis:

X-ray flexion/extension

Segmental instability

D

Sprains and strains, sacral:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Sprains and strains, sacroiliac:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Vertebral body compression fracture:

Muscle strength assessment

Lifting capacity diminished by 50%

D

BODY PART: LS SPINE

JOB TITLE: TRACKMAN

Ankylosing spondylitis:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Backache, unspecified:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Chronic back pain, not otherwise specified:

Muscle strength assessment

Lifing capacity diminished by 50%

D

Cauda equina syndrome with bowel or bladder dysfunction:

Computerized tomography

Disc extrusion with neural impingement, nerves <L1

D

Magnetic resonance imaging

Disc extrusion with neural impingement, nerves <L1

D

Physical examination

Lower extremity weakness

D

Cystometrogram

Impaired bladder function

D

Myelogram

Disc extrusion with neural impingement, nerves <L1

D

Physical examination: rectal

Impairment of sphincter tone

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Degeneration of lumbar disc:

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Displacement of lumbar disc:

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: vertebral body:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: posterior spinal element with displacement:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: posterior spinal element with no displacement:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: spinous process:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture transverse process:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Intervertebral disc disorder:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Lumbago:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Lumbosacral neuritis:

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Physical examination

Lower extremity weakness

D

Lumbar spinal stenosis:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Significant narrowing of the spinal canal

D

Magnetic resonance imaging

Significant narrowing of the spinal canal

D

Myelogram

Significant narrowing of the spinal canal

D

Physcial examination

Significant lower extremity weakness

D

Mechanical complication of internal orthopedic device:

Muscle strength assessment

Lifting capacity diminished by 50%

D

X-ray flexion/extension

Segmental instability

D

Osteomalacia:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Osteomyelitis, chronic-lumbar:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Medical record review

Frequent flare-ups with objective findings

D

Osteoporosis:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Post laminectomy syndrome with radiculopathy:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

Post laminectomy syndrome:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

X-ray flexion/extension

Segmental instability

D

Radiculopathy:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

Sciatica:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

Strains and sprains, unspecified:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Spondylolisthesis grade 1:

Muscle strength assessment

Lifting capacity diminished by 50%

D

X-ray flexion/extension

Segmental instability

D

Spondylolisthesis grade 2:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Spondylolisthesis grade 3:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Spondylolisthesis grade 4:

Muscle strength assessment

Lifting capacity diminished by 50%

D

X-ray flexion/extension

Segmental instability

D

Spondylolisthesis-acquired:

X-ray flexion/extension

Segmental instability

D

Spondylolysis:

X-ray flexion/extension

Segmental instability

D

Sprains and strains, sacral:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Sprains and strains, sacroiliac:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Vetebral body compression fracture:

Muscle strength assessment

Lifting capacity diminished by 50%

BODY PART: LS SPINE

JOB TITLE: MACHINIST

Ankylosing spondylitis:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Backache, unspecified:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Chronic back pain, not otherwise specified:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Cauda equina syndrome with bowel or bladder dysfunction:

Computerized tomography

Disc extrusion with neural impingement, nerves <L1

D

Magnetic resonance imaging

Disc extrusion with neural impingement, nerves <L1

D

Physical examination

Lower extremity weakness

D

Cystometrogram

Impaired bladder function

D

Myelogram

Disc extrusion with neural impingement, nerves <L1

D

Physical examination: rectal

Impairment of sphincter tone

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Degeneration of lumbar disc:

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Displacement of lumbar disc:

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: vertebral body:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: posterior spinal element with displacement:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: posterior spinal element with no displacement:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: spinous process:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture transverse process:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Intervertebral disc disorder:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Lumbago:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Lumbosacral neuritis:

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Physical examination

Lower extremity weakness

D

Lumbar spinal stenosis:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Significant narrowing of the spinal canal

D

Magnetic resonance imaging

Significant narrowing of the spinal canal

D

Myelogram

Significant narrowing of the spinal canal

D

Physical examination

Significant lower extremity weakness

D

Mechanical complication of internal orthopedic device:

Muscle strength assessment

Lifting capacity diminished by 50%

D

X-ray flexion/extension

Segmental instability

D

Osteomalacia:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Osteomyelitis, chronic-lumbar:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Medical record review

Frequent flare-ups with objective findings

D

Osteoporosis:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Post laminectomy syndrome with radiculopathy:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

Post laminectomy syndrome:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

X-ray flexion/extension

Segmental instability

D

Radiculopathy:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

Sciatica:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

Strains and sprains, unspecified:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Spondylolisthesis grade I:

Muscle strength assessment

Lifting capacity diminished by 50%

D

X-ray flexion/extension

Segmental instability

D

Spondylolisthesis grade 2:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Spondylolisthesis grade 3:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Spondylolisthesis grade 4:

Muscle strength assessment

Lifting capacity diminished by 50%

D

X-ray flexion/extension

Segmental instability

D

Spondylolisthesis-acquired:

X-ray flexion/extension

Segmental instability

D

Spondylolysis:

X-ray flexion/extension

Segmental instability

D

Sprains and strains, sacral:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Sprains and strains, sacroiliac:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Vertebral body compression fracture:

Muscle strength assessment

Lifting capacity diminished by 50%

D

BODY PART: LS SPINE

JOB TITLE: SHOP LABORER

Ankylosing spondylitis:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Backache, unspecified:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Chronic back pain, not otherwise specified:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Cauda equina syndrome with bowel or bladder dysfunction:

Computerized tomography

Disc extrusion with neural impingement, nerves <L1

D

Magnetic resonance imaging

Disc extrusion with neural impingement, nerves <L1

D

Physical examination

Lower extremity weakness

D

Cystometrogram

Impaired bladder function

D

Myelogram

Disc extrusion with neural impingement, nerves <L1

D

Physical examination: rectal

Impairment of sphincter tone

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Degeneration of lumbar disc:

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Displacement of lumber disc:

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: vertebral body:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: posterior spinal element with displacement:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: posterior spinal element with no displacement:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture: spinous process:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Fracture transverse process:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Intervertebral disc disorder:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Lumbago:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Lumbosacral neuritis:

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Muscle strength assessment

Lifting capacity diminished by 50%

D

Physical examination

Lower extremity weakness

D

Lumbar spinal stenosis:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Significant narrowing of the spinal canal

D

Magnetic resonance imaging

Significant narrowing of the spinal canal

D

Myelogram

Significant narrowing of the spinal canal

D

Physical examination

Significant lower extremity weakness

D

Mechanical complication of internal orthopedic device:

Muscle strength assessment

Lifting capacity diminished by 50%

D

X-ray flexion/extension

Segmental instability

D

Osteomalacia:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Osteomyelitis, chronic-lumbar:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Medical record review

Frequent flare-ups with objective findings

D

Osteoporosis:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Post laminectomy syndrome with radiculopathy:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

Post laminectomy syndrome:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

X-ray flexion/extension

Segmental instability

D

Radiculopathy:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

Sciatica:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Computerized tomography

Disc extrusion with neural impingement

D

Magnetic resonance imaging

Disc extrusion with neural impingement

D

Myelogram

Disc extrusion with neural impingement

D

Physical examination

Significant lower extremity weakness

D

Strains and sprains, unspecified:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Spondylolisthesis grade 1:

Muscle strength assessment

Lifting capacity diminished by 50%

D

X-ray flexion/extension

Segmental instability

D

Spondylolisthesis grade 2:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Spondylolisthesis grade 3:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Spondylolisthesis grade 4:

Muscle strength assessment

Lifting capacity diminished by 50%

D

X-ray flexion/extension

Segmental instability

D

Spondylolisthesis-acquired:

X-ray flexion/extension

Segmental instability

D

Spondylolysis:

X-ray flexion/extension

Segmental instability

D

Sprains and strains, sacral:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Sprains and strains, sacroiliac:

Muscle strength assessment

Lifting capacity diminished by 50%

D

Vertebral body compression fracture:

Muscle strength assessment

Lifting capacity diminished by 50%

D

F. Cervical Spine

Confirmatory test

Minimum result

Requirements

BODY PART: CE SPINE

CONFIRMATORY TESTS

Cervical disc disease with myelopathy:

Physical examination: cervical

Evidence of myelopathy

Highly recommended.

Myelogram

Evidence of neurogenic compression

Recommended.

Computerized axial tomography

Evidence of neurogenic compression

Recommended.

Magnetic resonance imaging

Evidence of neurogenic compression

Recommended.

Chronic herniated disc:

X-ray: cervical spine

Evidence of significant disc degeneration

Recommended.

Myelogram

Evidence of significant disc degeneration

Recommended.

Computerized axial tomography

Evidence of significant disc degeneration

Recommended.

Magnetic resonance imaging

Evidence of significant disc degeneration

Recommended.

Cervical spondylolysis:

X-ray: cervical spine

Evidence of significant disc degeneration

Recommended.

Computerized axial tomography

Evidence of significant disc degeneration

Recommended.

Magnetic resonance imaging

Evidence of significant disc degeneration

Recommended.

Cervical intervertebral disc degeneration:

X-ray: cervical spine

Evidence of significant disc degeneration

Recommended.

Myelogram

Evidence of significant disc degeneration

Recommended.

Magnetic resonance imaging

Evidence of significant disc degeneration

Recommended.

Fracture: posterior element with spinal canal displacement:

X-ray: cervical spine

Fractured posterior element with canal displacement

Recommended.

Computerized axial tomography

Fractured posterior element with canal displacement

Recommended.

Magnetic resonance imaging

Fractured posterior element with canal displacement

Recommended.

Fracture: transverse, spinous or posterior process:

X-ray: cervical spine

Fracture of relevant part

Recommended.

Computerized axial tomography

Fracture of relevant part

Recommended.

Magnetic resonance imaging

Fracture of relevant part

Recommended.

Osteoarthritis, cervical:

X-ray: cervical spine

Evidence of extensive disc degeneration

Recommended.

Computerized axial tomography

Evidence of extensive disc degeneration

Recommended.

Magnetic resonance imaging

Evidence of extensive disc degeneration

Recommended.

Post laminectomy syndrome:

Medical records: cervical

Confirmed surgical history

Highly recommended.

Medical records: cervical

Continued pain post-surgery

Highly recommended.

Radiculopathy:

Medical records: cervical

History of radicular pain

Highly recommended.

Physical examination: arm

Loss of reflexes in affected dermatomes

Recommended.

Physical examination: arm

Evidence of atrophy >2 cm

Recommended.

Electromyography

Definite denervation in muscle of affected nerve root

Recommended.

Myelogram

Evidence of neurogenic compression

Recommended.

Magnetic resonance imaging

Compression of spinal nerves

Recommended.

Computerized axial tomography

Compression of spinal nerves

Recommended.

Rheumatoid arthritis, cervical:

Rheumatoid factor (blood test)

Titer of rheumatoid factor

Recommended.

X-ray: cervical spine

Rheumatoid changes of spine

Highly recommended.

Medical records review: cervical

Confirmation by rheumatologist or internist

Highly recommended.

Spondylogenic compression of spinal cord:

Physical examination: cervical

Evidence of myelopathy

Highly recommended.

Computerized axial tomography

Evidence of neurogenic compression

Recommended.

Magnetic resonance imaging

Evidence of neurogenic compression

Recommended.

Myelogram

Evidence of neurogenic compression

Recommended.

Disability test

Test result

Disability classification

BODY PART: CE SPINE

JOB TITLE: TRAINMAN

Cervical disc disease with myelopathy:

Computerized axial tomography

Significant spinal cord pressure

D

Magnetic resonance imaging

Significant spinal cord pressure

D

Myelogram

Significant spinal cord pressure

D

Cystometrogram

Impaired bladder function

D

Physical examination: rectal

Impairment of sphincter tone

Physical examination: lower limb

Lower extremity weakness or significant spasticity

D

Physical examination

Multi-level neurologic compromise

D

Chronic herniated disc:

Physical examination

Multi-level neurologic compromise

D

Cervical spondylolysis:

Physical examination

Multi-level neurologic compromise

D

Cervical intervertebral disc degeneration:

Physical examination

Multi-level neurologic compromise

D

Fracture: posterior element with spinal canal displacement:

Physical examination

Multi-level neurologic compromise

D

Post laminectomy syndrome:

Physical examination

Multi-level neurologic compromise

D

Cervical radiculopathy:

Physical examination

Multi-level neurologic compromise

D

Spondylogenic compression of spinal cord:

Computerized axial tomography

Significant spinal cord pressure

D

Magnetic resonance imaging

Significant spinal cord pressure

D

Cystometrogram

Impaired bladder function

D

Myelogram

Significant spinal cord pressure

D

Physical examination: rectal

Impairment of sphincter tone

D

Physical examination

Multi-level neurologic compromise

D

Physical examination: lower limb

Lower extremity weakness or significant spasticity

D

BODY PART: CE SPINE

JOB TITLE: ENGINEER

Cervical disc disease with myelopathy:

Computerized axial tomography

Significant spinal cord pressure

D

Magnetic resonance imaging

Significant spinal cord pressure

D

Myelogram

Significant spinal cord pressure

D

Cystometrogram

Impaired bladder function

D

Physical examination: rectal

Impairment of sphincter tone

D

Physical examination: lower limb

Lower extremity weakness or significant spasticity

D

Physical examination

Multi-level neurologic compromise

D

Chronic herniated disc:

Physical examination

Multi-level neurologic compromise

D

Cervical spondylolysis:

Physical examination

Multi-level neurologic compromise

D

Cervical intervertebral disc degeneration:

Physical examination

Multi-level neurologic compromise

D

Fracture: posterior element with spinal canal displacement:

Physical examination

Multi-level neurologic compromise

D

Post laminectomy syndrome:

Physical examination

Multi-level neurologic compromise

D

Cervical radiculopathy:

Physical examination:

Multi-level neurologic compromise

D

Spondylogenic compression of spinal cord:

Computerized axial tomography

Significant spinal cord pressure

D

Magnetic resonance imaging

Significant spinal cord pressure

D

Cystometrogram

Impaired bladder function

D

Myelogram

Significant spinal cord pressure

D

Physical examination: rectal

Impairment of sphincter tone

D

Physical examination

Multi-level neurologic compromise

D

Physical examination: lower limb

Lower extremity weakness or significant spasticity

D

BODY PART: CE SPINE

JOB TITLE: DISPATCHER

Cervical disc disease with myelopathy:

Cystometrogram

Impaired bladder function

D

Physical examination: rectal

Impairment of sphincter tone

D

Spondylogenic compression of spinal cord:

Cystometrogram

Impaired bladder function

D

Physical examination: rectal

Impairment of sphincter tone

D

BODY PART: CE SPINE

JOB TITLE: CARMAN

Cervical disc disease with myelopathy:

Computerized axial tomography

Significant spinal cord pressure

D

Magnetic resonance imaging

Significant spinal cord pressure

D

Myelogram

Significant spinal cord pressure

D

Cystometrogram

Impaired bladder function

D

Physical examination: rectal

Impairment of sphincter tone

D

Physical examination: lower limb

Lower extremity weakness or significant spasticity

D

Physical examination

Multi-level neurologic compromise

D

Chronic herniated disc:

Physical examination

Multi-level neurologic compromise

D

Cervical spondylolysis:

Physical examination

Multi-level neurologic compromise

D

Cervical intervertebral disc degeneration:

Physical examination

Multi-level neurologic compromise

D

Fracture: posterior element with spinal canal displacement:

Physical examination

Multi-level neurologic compromise

D

Post laminectomy syndrome:

Physical examination

Multi-level neurologic compromise

D

Cervical radiculopathy:

Physical examination

Multi-level neurologic compromise

D

Spondylogenic compression of spinal cord:

Computerized axial tomography

Significant spinal cord pressure

D

Magnetic resonance imaging

Significant spinal cord pressure

D

Cystometrogram

Impaired bladder function

D

Myelogram

Significant spinal cord pressure

D

Physical examination: rectal

Impairment of sphincter tone

D

Physical examination

Multi-level neurologic compromise

D

Physical examination: lower limb

Lower extremity weakness or significant spasticity

D

BODY PART; CE SPINE

JOB TITLE: SIGNALMAN

Cervical disc disease with myelopathy:

Computerized axial tomography

Significant spinal cord pressure

D

Magnetic resonance imaging

Significant spinal cord pressure

D

Myelogram

Significant spinal cord pressure

D

Cystometrogram

Impaired bladder function

D

Physical examination: rectal

Impairment of sphincter tone

D

Physical examination: lower limb

Lower extremity weakness or significant spasticity

D

Physical examination

Multi-level neurologic compromise

D

Chronic herniated disc:

Physical examination

Multi-level neurologic compromise

D

Cervical spondylolysis:

Physical examination

Multi-level neurologic compromise

D

Cervical intervertebral disc degeneration:

Physical examination

Multi-level neurologic compromise

D

Fracture: posterior element with spinal canal displacement:

Physical examination

Multi-level neurologic compromise

D

Post laminectomy syndrome:

Physical examination

Multi-level neurologic compromise

D

Cervical radiculopathy:

Physical examination

Multi-level neurologic compromise

D

Spondylogenic compression of spinal cord:

Computerized axial tomography

Significant spinal cord pressure

D

Magnetic resonance imaging

Significant spinal cord pressure

D

Cystometrogram

Impaired bladder function

D

Myelogram

Significant spinal cord pressure

D

Physical examination: rectal

Impairment of sphincter tone

D

Physical examination

Multi-level neurologic compromise

D

Physical examination: lower limb

Lower extremity weakness or significant spasticity

D

BODY PART: CE SPINE

JOB TITLE: TRACKMAN

Cervical disc disease with myelopathy:

Computerized axial tomography

Significant spinal cord pressure

D

Magnetic resonance imaging

Significant spinal cord pressure

D

Myelogram

Significant spinal cord pressure

D

Cystometrogram

Impaired bladder function

D

Physical examination: rectal

Impairment of sphincter tone

D

Physical examination: lower limb

Lower extremity weakness or significant spasticity

D

Physical examination

Multi-level neurologic compromise

D

Chronic herniated disc:

Physical examination

Multi-level neurologic compromise

D

Cervical spondyloysis:

Physical examination

Multi-level neurologic compromise

D

Cervical intervertebral disc degeneration:

Physical examination

Multi-level neurologic compromise

D

Fracture: posterior element with spinal canal displacement:

Physical examination

Multi-level neurologic compromise

D

Post laminectomy syndrome:

Physical examination

Multi-level neurologic compromise

D

Cervical radiculopathy:

Physical examination

Multi-level neurologic compromise

D

Spondylogenic compression of spinal cord:

Computerized axial tomography

Significant spinal cord pressure

D

Magnetic resonance imaging

Significant spinal cord pressure

D

Cystometrogram

Impaired bladder function

D

Myelogram

Significant spinal cord pressure

D

Physical examination: rectal

Impairment of sphincter tone

D

Physical examination

Multi-level neurologic compromise

D

Physical examination: lower limb

Lower extremity weakness or significant spasticity

D

BODY PART: CE SPINE

JOB TITLE: MACHINIST

Cervical disc disease with myelopathy:

Computerized axial tomography

Significant spinal cord pressure

D

Magnetic resonance imaging

Significant spinal cord pressure

D

Myelogram

Significant spinal cord pressure

D

Cystometrogram

Impaired bladder function

D

Physical examination: rectal

Impairment of sphincter tone

D

Physical examination: lower limb

Lower extremity weakness or significant spasticity

D

Physical examination

Multi-level neurologic compromise

D

Chronic herniated disc:

Physical examination

Multi-level neurologic compromise

D

Cervical spondylolysis:

Physical examination

Multi-level neurologic compromise

D

Cervical intervertebral disc degeneration:

Physical examination

Multi-level neurologic compromise

D

Fracture: posterior element with spinal canal displacement:

Physical examination

Multi-level neurologic compromise

D

Post laminectomy syndrome:

Physical examination

Multi-level neurologic compromise

D

Cervical radiculopathy:

Physical examination

Multi-level neurologic compromise

D

Spondylogenic compression of spinal cord:

Computerized axial tomography

Significant spinal cord pressure

D

Magnetic resonance imaging

Significant spinal cord pressure

D

Cystometrogram

Impaired bladder function

D

Myelogram

Significant spinal cord pressure

D

Physical examination: rectal

Impairment of sphincter tone

D

Physical examination

Multi-level neurologic compromise

D

Physical examination: lower limb

Lower extremity weakness or significant spasticity

D

BODY PART: CE SPINE

JOB TITLE: SHOP LABORER

Cervical disc disease with myelopathy:

Computerized axial tomography

Significant spinal cord pressure

D

Magnetic resonance imaging

Significant spinal cord pressure

D

Myelogram

Significant spinal cord pressure

D

Cystometrogram

Impaired bladder function

D

Physical examination: rectal

Impairment of sphincter tone

D

Physical examination: lower limb

Lower extremity weakness or significant spasticity

D

Physical examination

Multi-level neurologic compromise

D

Chronic herniated disc:

Physical examination

Multi-level neurologic compromise

D

Cervical spondylolysis:

Physical examination

Multi-level neurologic compromise

D

Cervical intervertebral disc degeneration:

Physical examination

Multi-level neurologic compromise

D

Fracture: posterior element with spinal canal displacement:

Physical examination

Multi-level neurologic compromise

D

Post laminectomy syndrome:

Physical examination

Multi-level neurologic compromise

D

Cervical radiculopathy:

Physical examination

Multi-level neurologic compromise

D

Spondylogenic compression of spinal cord:

Computerized axial tomography

Significant spinal cord pressure

D

Magnetic resonance imaging

Significant spinal cord pressure

D

Cystometrogram

Impaired bladder function

D

Myelogram

Significant spinal cord pressure

D

Physical examination: rectal

Impairment of sphincter tone

D

Physical examination

Multi-level neurologic compromise

D

Physical examination: lower limb

Lower extremity weakness or significant spasticity

D

BODY PART: CE SPINE

JOB TITLE: SALES REPRESENTATIVE

Cervical disc disease with myelopathy:

Cystometrogram

Impaired bladder function

D

Physical examination: rectal

Impairment of sphincter tone

D

Spondylogenic compression of spinal cord:

Cystometrogram

Impaired bladder function

D

Physical examination: rectal

Impairment of sphincter tone

D

BODY PART: CE SPINE

JOB TITLE: GENERAL OFFICE CLERK

Cervical disc disease with myelopathy:

Cystometrogram

Impaired bladder function

D

Physical examination: rectal

Impairment of sphincter tone

D

Spondylogenic compression of spinal cord:

Cystometrogram

Impaired bladder function

D

Physical examination: rectal

Impairment of sphincter tone

D

G. Shoulder and Elbow

Confirmatory test

Minimum result

Requirements.

BODY PART: SHOULDER AND ELBOW

CONFIRMATORY TESTS

Arthritis, acromioclavicular:

X-ray: shoulder

Significant degenerative changes of joint

Recommended.

Computerized tomography

Significant degenerative changes of joint

Recommended.

Magnetic resonance imaging

Significant degenerative changes of joint

Recommended.

Arthritis, glenohumeral:

X-ray: shoulder

Significant degenerative changes of joint

Recommended.

Computerized tomography

Significant degenerative changes of joint

Recommended.

Magnetic resonance imaging

Significant degenerative changes of joint

Recommended.

Rotator cuff tear:

Computerized tomography

Tear of rotator cuff

Recommended.

Magnetic resonance imaging

Tear of rotator cuff

Recommended.

Medical diagnosis leading to a permanent functional limitation of the elbow:

Medical record review

Condition with permanent functional limitation

Highly recommended.

X-ray: elbow

Imaging confirmation of functional diagnosis

Recommended.

Magnetic resonance imaging

Imaging confirmation of functional diagnosis

Recommended.

Disability test

Test result

Disability classification

BODY PART: SHOULDER AND ELBOW

JOB TITLE: TRAINMAN

Arthritis, acromioclavicular:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of motion

<40 degrees abduction

D

Arthritis, glenohumeral:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of motion

<40 degrees abduction

D

Rotator cuff tear:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of motion

<40 degrees abduction

D

Permanent functional limitation, elbow:

Physical examination

>40 degrees deviation

D

Physical examination—range of motion

Flexion limit to 60 degrees

D

BODY PART: SHOULDER AND ELBOW

JOB TITLE: ENGINEER

Arthritis, acromioclavicular:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of motion

<40 degrees abduction

D

Arthritis, glenohumeral:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of motion

<40 degrees abduction

D

Rotator cuff tear:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of moiton

<40 degrees abduction

D

Permanent functional limitation, elbow:

Physical examination

>40 degrees deviation

D

Physical examination—range of motion

Flexion limit to 60 degrees

D

BODY PART: SHOULDER AND ELBOW

JOB TITLE: CARMAN

Arthritis, acromioclavicular:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of motion

<40 degrees abduction

D

Arthritis, glenohumeral:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of motion

<40 degrees abduction

D

Rotator cuff tear:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of motion

<40 degrees abduction

D

Permanent functional limitation, elbow:

Physical examination

>40 degrees deviation

D

Physical examination—range of motion

Flexion limit to 60 degrees

D

BODY PART: SHOULDER AND ELBOW

JOB TITLE: SIGNALMAN

Arthritis, acromioclavicular:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of motion

<40 degrees abduction

D

Arthritis, glenohumeral:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of motion

<40 degrees abduction

D

Rotator cuff tear:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of motion

<40 degrees abduction

D

Permanent functional limitation, elbow:

Physical examination

>40 degrees deviation

D

Physical examination—range of motion

Flexion limit to 60 degrees

D

BODY PART: SHOULDER AND ELBOW

JOB TITLE: TRACKMAN

Arthritis, acromioclavicular:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of motion

<40 degrees abduction

D

Arthritis, glenohumeral:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of motion

<40 degrees abduction

D

Rotator cuff tear:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of motion

<40 degrees abduction

D

Permanent functional limitation, elbow:

Physical examination

>40 degrees deviation

D

Physical examination—range of motion

Flexion limit to 60 degrees

D

BODY PART: SHOULDER AND ELBOW

JOB TITLE: MACHINIST

Arthritis, acromioclavicular:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of motion

<40 degrees abduction

D

Arthritis, glenohumeral:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of motion

<40 degrees abduction

D

Rotator cuff tear:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of motion

<40 degrees abduction

D

Permanent functional limitation, elbow:

Physical examination

>40 degrees deviation

D

Physical examination—range of motion

Flexion limit to 60 degrees

D

BODY PART: SHOULDER AND ELBOW

JOB TITLE: SHOP LABORER

Arthritis, acromioclavicular:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of motion

<40 degrees abduction

D

Arthritis, glenohumeral:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of motion

<40 degrees abduction

D

Rotator cuff tear:

Physical examination—range of motion

<40 degrees flexion

D

Physical examination—range of motion

<40 degrees abduction

D

Permanent functional limitation, elbow:

Physical examination

>40 degrees deviation

D

Physical examination—range of motion

Flexion limit to 60 degrees

D

H. Hand and Arm

Confirmatory test

Minimum result

Requirements

BODY PART: HAND AND ARM

CONFIRMATORY TESTS

Carpal tunnel syndrome:

Medical record review

Pain, paresthesia and weakness in distribution median nerve

Highly recommended.

Nerve conduction testing

Definite median nerve conduction slowing at wrist

Highly recommended.

Electromyography

Denervation in severe cases

Recommended.

Fracture: wrist:

X-ray: wrist

Evidence of fracture

Highly recommended.

Hand: permanent functional limitation:

Medical record review

Documentation of medical condition for permanent limitation

Highly recommended.

Physical examination

Definite reproducible evidence of limitation

Highly recommended.

Imaging study (e.g. X-ray, CAT, MRI)

Positive confirmation of underlying condition

Highly recommended.

Rheumatoid arthritis: hand:

Rheumatoid factor

Titer of rheumatoid factor

Recommended.

Medical record review

History of objective findings including serological studies

Highly recommended.

X-ray: hand

Characteristic rheumatoid changes

Highly recommended.

Tenosynovitis:

Medical record review

History of chronic tenosynovitis and objective findings

Highly recommended.

Physical examination

Definite evidence of tenosynovitis

Highly recommended.

Thumb: Permanent functional limitation:

Medical record review

Documentation of medical condition for permanent limitation

Highly recommended.

Physical examination

Definite reproducible evidence of limitation

Highly recommended.

Imaging study (X-ray, CAT, MRI)

Positive confirmation of underlying condition

Highly recommended.

Wrist: Permanent functional limitation:

Medical record review

Documentation of medical condition for permanent limitation

Highly recommended.

Physical examination

Definite reproducible evidence of limitation

Highly recommended.

Imaging study (e.g. X-ray, CAT, MRI)

Positive confirmation of underlying condition

Highly recommended.

Disability test

Test result

Disability classification

BODY PART: HAND AND ARM

JOB TITLE: TRAINMAN

Fracture, wrist:

Physical examination—range of motion

Extension—limit to 30 degrees

D

Physical examination—range of motion

Flexion—limit to 30 degrees

D

Physical examination—range of motion

Ankylosis: >20 degrees from neutral

D

Rheumatoid arthritis hand:

Physical examination

Significant deformity

D

Medical record review

Significant flare-ups, under treatment with rheumatologist

D

Medical record review

Extensive medication use, under treatment with rheumatologist

D

Thumb: permanent functional limitation:

Adduction of thumb

Loss ≤4 cm

D

Ankylosis: degree from neutral

<20 degrees extension

D

Ankylosis: degree from neutral

<40 degrees flexion

D

Loss of extension or flexion

MCP or PIP: maximum flexion <40 degrees

D

Opposition

Loss ≤4 cm

D

Wrist: permanent functional limitation:

Physical examination—range of motion

Extension—limit to 30 degrees

D

Physical examination—range of motion

Flexion—limit to 30 degrees

D

Physical examination—range of motion

Ankylosis: >20 degrees from neutral

D

BODY PART: HAND AND ARM

JOB TITLE ENGINEER

Fracture, wrist:

Physical examination—range of motion

Extension-limit to 30 degrees

D

Physical examination—range of motion

Flexion-limit to 30 degrees

D

Physical examination—range of motion

Ankylosis: >20 degrees from neutral

D

Rheumatoid arthritis hand:

Physical examination

Significant deformity

D

Medical record review

Significant flare-ups, under treatment with rheumatologist

D

Medical record review

Extensive medication use, under treatment with rheumatologist

D

Thumb: permanent functional limitation:

Adduction of thumb

Loss ≤4 cm

D

Ankylosis: degree from neutral

<20 degrees extension

D

Ankylosis: degree from neutral

<40 degrees flexion

D

Loss of extension or flexion

MCP or PIP: maximum flexion <40 degrees

D

Opposition

Loss ≤4 cm

D

Wrist: permanent functional limitation:

Physical examination—range of motion

Extension—limit to 30 degrees

D

Physical examination—range of motion

Flexion—limit to 30 degrees

D

Physical examination—range of motion

Ankylosis: >20 degrees from neutral

D

BODY PART: HAND AND ARM

JOB TITLE: DISPATCHER

Fracture, wrist:

Physical examination—range of motion

Extension—limit to 30 degrees

D

Physical examination—range of motion

Flexion—limit to 30 degrees

D

Physical examination—range of motion

Ankylosis: >20 degrees from neutral

D

Rheumatoid arthritis hand:

Physical examination

Significant deformity

D

Medical record review

Significant flare-ups, under treatment with rheumatologist

D

Medical record review

Extensive medication use, under treatment with rheumatologist

D

Thumb: permanent functional limitation:

Adduction of thumb

Loss ≤4 cm

D

Ankylosis: degree from neutral

<20 degrees extension

D

Ankylosis: degree from neutral

<40 degrees flexion

D

Loss of extension or flexion

MCP or PIP: maximum flexion <40 degrees

D

Opposition

Loss ≤4 cm

D

Wrist: permanent functional limitation:

Physical examination—range of motion

Extension—limit to 30 degrees

D

Physical examination—range of motion

Flexion—limit to 30 degrees

D

Physical examination—range of motion

Ankylosis: >20 degrees from neutral

D

BODY PART: HAND AND ARM

JOB TITLE: CARMAN

Fracture, wrist:

Physical examination—range of motion

Extension—limit to 30 degrees

D

Physical examination—range of motion

Flexion—limit to 30 degrees

D

Physical examination—range of motion

Ankylosis: >20 degrees from neutral

D

Rheumatoid arthritis hand:

Physical examination

Significant deformity

D

Medical record review

Significant flare-ups, under treatment with rheumatologist

D

Medical record review

Extensive medication use, under treatment with rheumatologist

D

Thumb: permanent functional limitation:

Adduction of thumb:

Loss ≤4 cm

D

Ankylosis: degree from neutral

<20 degrees extension

D

Ankylosis: degree from neutral

<40 degrees flexion

D

Loss of extension or flexion

MCP of PIP: maximum flexion <40 degrees

D

Opposition

Loss ≤4 cm

D

Wrist: permanent functional limitation:

Physical examination—range of motion

Extension—limit to 30 degrees

D

Physical examination—range of motion

Flexion—limit to 30 degrees

D

Physical examination—range of motion

Ankylosis: >20 degrees from neutral

D

BODY PART: HAND AND ARM

JOB TITLE: SIGNALMAN

Fracture, wrist:

Physical examination—range of motion

Extension—limit to 30 degrees

D

Physical examination—range of motion

Flexion—limit to 30 degrees

D

Physical examination—range of motion

Ankylosis: >20 degrees from neutral

D

Rheumatoid arthritis hand:

Physical examination

Significant deformity

D

Medical record review

Significant flare-ups, under treatment with rheumatologist

D

Medical record review

Extensive medication use, under treatment with rheumatologist

D

Thumb: permanent functional limitation:

Adduction of thumb

Loss ≤4 cm

D

Ankylosis: degree from neutral

<20 degrees extension

D

Ankylosis: degree from neutral

<40 degrees flexion

D

Loss of extension or flexion

MCP or PIP: maximum flexion <40 degrees

D

Opposition

Loss ≤4 cm

D

Wrist: permanent functional limitation:

Physical examination—range of motion

Extension—limit to 30 degrees

D

Physical examination—range of motion

Flexion—limit to 30 degrees

D

Physical examination—range of motion

Ankylosis: >20 degrees from neutral

D

BODY PART: HAND AND ARM

JOB TITLE: TRACKMAN

Fracture, wrist:

Physical examination—range of motion

Extension—limit to 30 degrees

D

Physical examination—range of motion

Flexion—limit to 30 degrees

D

Physical examination—range of motion

Ankylosis: >20 degrees from neutral

D

Rheumatoid arthritis hand:

Physical examination

Significant deformity

D

Medical record review

Significant flare-ups, under treatment with rheumatologist

D

Medical record review

Extensive medication use, under treatment with rheumatologist

D

Thumb: permanent functional limitation:

Adduction of thumb

Loss ≤4 cm

D

Ankylosis: degree from neutral

<20 degrees extension

D

Ankylosis: degree from neutral

<40 degrees flexion

D

Loss of extension or flexion

MCP or PIP: maximum flexion <40 degrees

D

Opposition

Loss ≤4 cm

D

Wrist: permanent functional limitation:

Physical examination—range of motion

Extension—limit to 30 degrees

D

Physical examination—range of motion

Flexion—limit to 30 degrees

D

Physical examination—range of motion

Ankylosis: >20 degrees from neutral

D

BODY PART: HAND AND ARM

JOB TITLE: MACHINIST

Fracture, wrist:

Physical examination—range of motion

Extension—limit to 30 degrees

D

Physical examination—range of motion

Flexion—limit to 30 degrees

D

Physical examination—range of motion

Ankylosis: >20 degrees from neutral

D

Rheumatoid arthritis hand:

Physical examination

Significant deformity

D

Medical record review

Significant flare-ups, under treatment with rheumatologist

D

Medical record review

Extensive medication use, under treatment with rheumatologist

D

Thumb: permanent functional limitation:

Adduction of thumb

Loss ≤4 cm

D

Ankylosis: degree from neutral

<20 degrees extension

D

Ankylosis: degree from neutral

<40 degrees flexion

D

Loss of extension or flexion

MCP or PIP: maximum flexion <40 degrees

D

Opposition

Loss ≤4 cm

D

Wrist: permanent functional limitation:

Physical examination—range of motion

Extension—limit to 30 degrees

D

Physical examination—range of motion

Flexion—limit to 30 degrees

D

Physical examination—range of motion

Ankylosis: >20 degrees from neutral

D

BODY PART: HAND AND ARM

JOB TITLE: SHOP LABORER

Fracture, wrist:

Physical examination—range of motion

Extension—limit to 30 degrees

D

Physical examination—range of motion

Flexion—limit to 30 degrees

D

Physical examination—range of motion

Ankylosis: >20 degrees from neutral

D

Rheumatoid arthritis hand:

Physical examination

Significant deformity

D

Medical record review

Significant flare-ups, under treatment with rheumatologist

D

Medical record review

Extensive medication use, under treatment with rheumatologist

D

Thumb: permanent functional limitation:

Adduction of thumb

Loss ≤4 cm

D

Ankylosis: degree from neutral

<20 degrees extension

D

Ankylosis: degree from neutral

<40 degrees flexion

D

Loss of extension or flexion

MCP or PIP: maximum flexion <40 degrees

D

Opposition

Loss ≤4 cm

D

Wrist: permanent functional limitation:

Physical examination—range of motion

Extension—limit to 30 degrees

D

Physical examination—range of motion

Flexion—limit to 30 degrees

D

Physical examination—range of motion

Ankylosis: >20 degrees from neutral

D

BODY PART: HAND AND ARM

JOB TITLE: SALES REPRESENTATIVE

Fracture, wrist:

Physical examination—range of motion

Extension—limit to 30 degrees

D

Physical examination—range of motion

Flexion—limit to 30 degrees

D

Physical examination—range of motion

Ankylosis: >20 degrees from neutral

D

Rheumatoid arthritis hand:

Physical examination

Significant deformity

D

Medical record review

Significant flare-ups, under treatment with rheumatologist

D

Medical record review

Extensive medication use, under treatment with rheumatologist

D

Thumb: permanent functional limitation:

Adduction of thumb

Loss ≤4 cm

D

Ankylosis: degree from neutral

<20 degrees extension

D

Ankylosis: degree from neutral

<40 degrees flexion

D

Loss of extension or flexion

MCP or PIP: maximum flexion <40 degrees

D

Opposition

Loss ≤4 cm

D

Wrist: permanent functional limitation:

Physical examination—range of motion

Extension—limit to 30 degrees

D

Physical examination—range of motion

Flexion—limit to 30 degrees

D

Physical examination—range of motion

Ankylosis: >20 degrees from neutral

D

BODY PART: HAND AND ARM

JOB TITLE: GENERAL OFFICE CLERK

Fracture, wrist:

Physical examination—range of motion

Extension—limit to 30 degrees

D

Physical examination—range of motion

Flexion—limit to 30 degrees

D

Physical examination—range of motion

Ankylosis: >20 degrees from neutral

D

Rheumatoid arthritis hand:

Physical examination

Significant deformity

D

Medical record review

Significant flare-ups, under treatment with rheumatologist

D

Medical record review

Extensive medication use, under treatment with rheumatologist

D

Thumb: permanent functional limitation:

Adduction of thumb

Loss ≤4 cm

D

Ankylosis: degree from neutral

<20 degree extension

D

Ankylosis: degree from neutral

<40 degree flexion

D

Loss of extension or flexion

MCP or PIP: maximum flexion <40 degrees

D

Opposition

Loss ≤4 cm

D

Wrist: permanent functional limitation:

Physical examination—range of motion

Extension—limit to 30 degrees

D

Physical examination—range of motion

Flexion—limit to 30 degrees

D

Physical examination—range of motion

Ankylosis: >20 degrees from neutral

D

I. Hip

Confirmatory test

Minimum result

Requirements

BODY PART: HIP

CONFIRMATORY TESTS

Ankylosis, hip:

X-ray: hip

Extreme joint destruction

Highly Recommended.

Physical examination—range of motion

No mobility

Highly Recommended.

Osteoarthritis, hip:

X-ray: hip

<4 mm joint space, or other positive evidence

Recommended.

Magnetic resonance imaging

<4 mm joint space, or other positive evidence

Recommended.

Computerized axial tomography

<4 mm joint space, or other positive evidence

Recommended.

Osteomyelitis, hip:

X-ray: hip

Evidence of chronic infection

Recommended.

Computerized axial tomography

Evidence of chronic infection

Recommended.

Paget's disease:

X-ray: hip

Osteolytic or blastic lesions

Highly Recommended.

Alkaline phosphatase

Increased up to 50 times

Highly Recommended.

Hip replacement surgery:

X-ray: hip

Evidence of artificial hip

Recommended.

Medical record review

Documentation of prior hip replacement

Recommended.

Disability test

Test result

Disability classification

BODY PART: HIP

JOB TITLE: TRAINMAN

Ankylosis, hip:

Physical examination—range of motion

Ankylosis 5 degrees or >flexion

D

Physical examination—range of motion

Ankylosis internal rotation >5 degrees

D

Physical examination—range of motion

Ankylosis external rotation >10 degrees

D

Physical examination—range of motion

Ankylosis in abduction >5 degrees

D

Physical examination—range of motion

Ankylosis in adduction >5 degrees

D

Osteoarthritis, hip:

X-ray: hip

0 mm cartilage interval

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abduction

D

Osteomyelitis, chronic hip:

X-ray: hip

Significant joint destruction

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abduction

D

Medical record review

Documented occurrence of recurring infections with treatment

D

Paget's disease:

X-ray: hip

Significant joint destruction

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abduction

D

Hip replacement surgery:

X-ray: hip

Evidence of artificial hip joint

D

Medical record review

Documentation of prior hip replacement

D

BODY PART: HIP

JOB TITLE: ENGINEER

Ankylosis, hip:

Physical examination—range of motion

Ankylosis 5 degrees or >flexion

D

Physical examination—range of motion

Ankylosis internal rotation >5 degrees

D

Physical examination—range of motion

Ankylosis external rotation >10 degrees

D

Physical examination—range of motion

Ankylosis in abduction >5 degrees

D

Physical examination—range of motion

Ankylosis in adduction >5 degrees

D

Osteoarthritis, hip:

X-ray: hip

0 mm cartilage interval

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abduction

D

Osteomyelitis, chronic hip:

X-ray: hip

Signficant joint destruction

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abduction

D

Medical record review

Documented occurrence of recurring infections with treatment

D

Paget's disease:

X-ray: hip

Significant joint destruction

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abduction

D

Hip replacement surgery:

X-ray: hip

Evidence of artificial hip joint

D

Medical record review

Documentation of prior hip replacement

D

BODY PART: HIP

JOB TITLE: CARMAN

Ankylosis, hip:

Physical examination—range of motion

Ankylosis 5 degrees or >flexion

D

Physical examination—range of motion

Ankylosis internal rotation >5 degrees

D

Physical examination—range of motion

Ankylosis external rotation >10 degrees

D

Physical examination—range of motion

Ankylosis in abduction >5 degrees

D

Physical examination—range of motion

Ankylosis in adduction >5 degrees

D

Osteoarthritis, hip:

X-ray: hip

0 mm cartilage interval

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abduction

D

Osteomyelitis, chronic hip:

X-ray: hip

Significant joint destruction

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abduction

D

Medical record review

Documented occurrence of recurring infections with treatment

D

Paget's disease:

X-ray: hip

Significant joint destruction

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abduction

D

Hip replacement surgery:

X-ray: hip

Evidence of artificial hip joint

D

Medical record review

Documentation of prior hip replacement

D

BODY PART: HIP

JOB TITLE: SIGNALMAN

Ankylosis, hip:

Physical examination—range of motion

Ankylosis 5 degrees or >flexion

D

Physical examination—range of motion

Ankylosis internal rotation >5 degrees

D

Physical examination—range of motion

Ankylosis external rotation >10 degrees

D

Physical examination—range of motion

Ankylosis in abduction >5 degrees

D

Physical examination—range of motion

Ankylosis in adduction >5 degrees

D

Osteoarthritis, hip:

X-ray: hip

0 mm cartilage interval

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abduction

D

Osteomyelitis, chronic hip:

X-ray: hip

Significant joint destruction

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abduction

D

Medical record review

Documented occurrence of recurring infections with treatment

D

Paget's disease:

X-ray: hip

Significant joint destruction

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abduction

D

Hip replacement surgery:

X-ray: hip

Evidence of artificial hip joint

D

Medical record review

Documentation of prior hip replacement

D

BODY PART: HIP

JOB TITLE: TRACKMAN

Ankylosis, hip:

Physical examination—range of motion

Ankylosis 5 degrees or >flexion

D

Physical examination—range of motion

Ankylosis internal rotation >5 degrees

D

Physical examination—range of motion

Ankylosis external rotation >10 degrees

D

Physical examination—range of motion

Ankylosis in abduction >5 degrees

D

Physical examination—range of motion

Ankylosis in adduction >5 degrees

D

Osteoarthritis, hip:

X-ray: hip

0 mm cartilage interval

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abduction

D

Osteomyelitis, chronic hip:

X-ray: hip

Significant joint destruction

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abduction

D

Medical record review

Documented occurrence of recurring infections with treatment

D

Paget's disease:

X-ray: hip

Significant joint destruction

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abduction

D

Hip replacement surgery:

X-ray: hip

Evidence of artificial hip joint

D

Medical record review

Documentation of prior hip replacement

D

BODY PART: HIP

JOB TITLE: MACHINIST

Ankylosis, hip:

Physical examination—range of motion

Ankylosis 5 degrees or >flexion

D

Physical examination—range of motion

Ankylosis internal rotation >5 degrees

D

Physical examination—range of motion

Ankylosis external rotation >10 degrees

D

Physical examination—range of motion

Ankylosis in abduction >5 degrees

D

Physical examination—range of motion

Ankylosis in adduction >5 degrees

D

Osteoarthritis, hip:

X-ray: hip

0 mm cartilage interval

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abduction

D

Osteomyelitis, chronic hip:

X-ray: hip

Significant joint destruction

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abduction

D

Medical record review

Documented occurrence of recurring infections with treatment

D

Paget's disease:

X-ray: hip

Significant joint destruction

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abudction

D

Hip replacement surgery:

X-ray: hip

Evidence of artificial hip joint

D

Medical record review

Documentation of prior hip replacement

D

BODY PART: HIP

JOB TITLE: SHOP LABORER

Ankylosis, hip:

Physical examination—range of motion

Ankylosis 5 degrees of >flexion

D

Physical examination—range of motion

Ankylosis internal rotation >5 degrees

D

Physical examination—range of motion

Ankylosis external rotation >10 degrees

D

Physical examination—range of motion

Ankylosis in abduction >5 degrees

D

Physical examination—range of motion

Ankylosis in adduction >5 degrees

D

Osteoarthritis, hip:

X-ray: hip

0 mm cartilage interval

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abduction

D

Osteomyelitis, chronic hip:

X-ray: hip

Significant joint destruction

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abduction

D

Medical record review

Documented occurrence of recurring infections with treatment

D

Paget's disease:

X-ray; hip

Significant joint destruction

D

Physical examination—range of motion

30 degrees flexion contracture

D

Physical examination—range of motion

<50 degrees flexion

D

Physical examination—range of motion

<5 degrees abduction

D

Hip replacement surgery:

X-ray: hip

Evidence of artificial hip joint

D

Medical record review

Documentation of prior hip replacement

D

J. Knee

Confirmatory test

Minimum result

Requirements

BODY PART: KNEE

CONFIRMATORY TESTS

Arthritis: knee:

X-ray: knee

Evidence of significant degenerative changes

Recommended.

Collateral ligament tear with laxity:

Physical examination: knee

Evidence of ligamentous laxity

Highly Recommended.

Magnetic resonance imaging

Evidence of ligamentous tear

Recommended.

Cruciate and collateral ligament tear with laxity:

Magnetic resonance imaging

Tear of both ligaments

Recommended.

Physical examination

Evidence of ligamentous laxity

Highly Recommended.

Medical record review

Documentation of tear by arthroscopy

Recommended.

Cruciate ligament tear with laxity:

Physical examination: knee

Evidence of ligamentous laxity

Highly Recommended.

Magnetic resonance imaging

Evidence of cruciate tear

Recommended.

Medical record review

Documentation of tear by arthroscopy

Recommended.

Intercondylar fracture:

X-ray: knee

Evidence of fracture

Highly Recommended.

Osteomyelitis: knee:

Medical record review

Documented history of osteomyelitis requiring treatment

Highly Recommended.

X-ray: knee

Evidence of chronic infection

Recommended.

Computerized tomography

Evidence of chronic infection

Recommended.

Magnetic resonance imaging

Evidence of chronic infection

Recommended.

Osteonecrosis:

X-ray: knee

Necrosis of femoral condyle or tibial plateau

Recommended.

Computerized tomography

Necrosis of femoral condyle or tibial plateau

Recommended.

Magnetic resonance imaging

Necrosis of femoral condyle or tibial plateau

Recommended.

Patellofemoral arthritis:

X-ray: knee

Evidence of arthritis

Recommended.

Magnetic resonance imaging

Evidence of arthritis

Recommended.

Physical examination

Crepitation with movement

Highly Recommended.

Patellar fracture nonunion with displacement:

X-ray: knee

Nonunion and displacement

Recommended.

Magnetic resonance imaging

Nonunion and displacement

Recommended.

Computerized tomography

Nonunion and displacement

Recommended.

Plateau fracture:

X-ray: knee

Evidence of fracture

Recommended.

Computerized tomography

Evidence of fracture

Recommended.

Magnetic resonance imaging

Evidence of fracture

Recommended.

Meniscectomy—medial or lateral:

Medical record review

History of surgery

Highly Recommended.

Patellectomy:

Physical examination: knee

Absent patella

Highly Recommended.

Patellar—subluxation—recurrent:

Medical record review

History of recurrent subluxation

Highly Recommended.

Supracondylar fracture:

X-ray: knee

Evidence of fracture

Recommended.

Magnetic resonance imaging

Evidence of fracture

Recommended.

Computerized tomography

Evidence of fracture

Recommended.

Total knee replacement:

X-ray: knee

Presence of replacement knee

Recommended.

Medical record review

Documented surgical history

Recommended.

Tibial shaft fracture:

X-ray: leg

Fracture of shaft

Recommended.

Magnetic resonance imaging

Evidence of fracture

Recommended.

Computerized tomography

Evidence of fracture

Recommended.

Disability test

Test result

Disability classification

BODY PART: KNEE

JOB TITLE: TRAINMAN

Arthritis knee:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Meniscectomy, medial or lateral:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or >degrees)

D

Collateral ligament tear with laxity:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Cruciate and collateral ligament tear:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Cruciate ligament tear with laxity:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Intercondylar fracture:

Post fracture angulation

>20 degrees angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Osteomyelitis, chronic knee:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

Medical record review

Frequent episodes of infection requiring treatment

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Osteonecrosis:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Patellofemoral arthritis:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee: patello femoral joint

0 mm cartilage interval with degenerative change

D

Patellar fracture nonunion with displacement:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

X-ray knee

Nonunion and >3 mm displacement

D

Plateau fracture:

Post fracture angulation

>20 degrees angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Patellectomy:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Patellar, subluxation, recurrent:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Supracondylar fracture:

Post fracture angulation

>20 degrees angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Tibial shaft fracture:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Post fracture angulation

>20 degrees malalignment

D

BODY PART: KNEE

JOB TITLE: ENGINEER

Arthritis knee:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Meniscectomy, medial or lateral:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Collateral ligament tear with laxity:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Cruciate and collateral ligament tear:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Cruciate ligament tear with laxity:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Intercondylar fracture:

Post fracture angulation

>20 degrees angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Osteomyelitis, chronic knee:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

Medical record review

Frequent episodes of infection requiring treatment

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Osteonecrosis:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Patellofemoral arthritis:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee: patello femoral joint

0 mm cartilage interval with degenerative change

D

Patellar fracture nonunion with displacement:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

X-ray knee

Nonunion and >3 mm displacement

D

Plateau fracture:

Post fracture angulation

>20 degrees angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Patellectomy:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Patellar, subluxation, recurrent:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Supracondylar fracture:

Post fracture angulation

>20 degrees angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Tibial shaft fracture:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Post fracture angulation

>20 degrees malalignment

D

BODY PART: KNEE

JOB TITLE: CARMAN

Arthritis knee:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Meniscectomy, medial or lateral:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Collateral ligament tear with laxity:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Cruciate and collateral ligament tear:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Cruciate ligament tear with laxity:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Intercondylar fracture:

Post fracture angulation

>20 degrees angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Osteomyelitis, chronic knee:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

Medical record review

Frequent episodes of infection requiring treatment

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Osteonecrosis:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Patellofemoral arthritis:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee: patello femoral joint

0 mm cartilage interval with degenerative change

D

Patellar fracture nonunion with displacement:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

X-ray knee

Nonunion and >3 mm displacement

D

Plateau fracture:

Post fracture angulation

>20 degrees angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Patellectomy:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Patellar, subluxation, recurrent:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Supracondylar fracture:

Post fracture angulation

>20 degrees angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Tibial shaft fracture:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Post fracture angulation

>20 degrees malalignment

D

BODY PART: KNEE

JOB TITLE: SIGNALMAN

Arthritis knee:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Meniscectomy, medial or lateral:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Collateral ligament tear with laxity:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Cruciate and collateral ligament tear:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Cruciate ligament tear with laxity:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Intercondylar fracture:

Post fracture angulation

>20 degrees angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Osteomyelitis, chronic knee:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

Medical record review

Frequent episodes of infection requiring treatment

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Osteonecrosis:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Patellofemoral arthritis:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee: patello femoral joint

0 mm cartilage interval with degenerative change

D

Patellar fracture nonunion with displacement:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

X-ray knee

Nonunion and >3 mm displacement

D

Plateau fracture:

Post fracture angulation

>20 degrees angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Patellectomy:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Patellar, subluxation, recurrent:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Supracondylar fracture:

Post fracture angulation

>20 degrees angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Tibial shaft fracture:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Post fracture angulation

>20 degrees malalignment

D

BODY PART: KNEE

JOB TITLE: TRACKMAN

Arthritis knee:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Meniscectomy, medial or lateral:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Collateral ligament tear with laxity:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Cruciate and collateral ligament tear:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Cruciate ligament tear with laxity:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Intercondylar fracture:

Post fracture angulation

>20 degree angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Osteomyelitis, chronic knee:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

Medical record review

Frequent episodes of infection requiring treatment

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Osteonecrosis:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Patellofemoral arthritis:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee: patello femoral joint

0 mm cartilage interval with degenerative change

D

Patellar fracture nonunion with displacement:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

X-ray knee

Nonunion and >3 mm displacement

D

Plateau fracture:

Post fracture angulation

>20 degrees angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Patellectomy:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Patellar, subluxation, recurrent:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Supracondylar fracture:

Post fracture angulation

>20 degrees angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Tibial shaft fracture:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Post fracture angulation

>20 degrees malalignment

D

BODY PART: KNEE

JOB TITLE: MACHINIST

Arthritis knee:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Meniscectomy, medial or lateral:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Collateral ligament tear with laxity:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Cruciate and collateral ligament tear:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Cruciate ligament tear with laxity:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Intercondylar fracture:

Post fracture angulation

>20 degrees angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Osteomyelitis, chronic knee:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

Medical record review

Frequent episodes of infection requiring treatment

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Osteonecrosis:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Patellofemoral arthritis:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee

0 mm cartilage interval with degenerative change

D

Patellar fracture nonunion with displacement:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

X-ray knee

Nonunion and >3 mm displacement

D

Plateau fracture:

Post fracture angulation

>20 degrees angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Patellectomy:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Patellar, subluxation, recurrent:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Supracondylar fracture:

Post fracture angulation

>20 degrees angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Tibial shaft fracture:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Post fracture angulation

>20 degrees malalignment

D

BODY PART: KNEE

JOB TITLE: SHOP LABORER

Arthritis knee:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Meniscectomy, medial or lateral:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Collateral ligament tear with laxity:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Cruciate and collateral ligament tear:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Cruciate ligament tear with laxity:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Intercondylar fracture:

Post fracture angulation

>20 degrees angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Osteomyelitis, chronic knee:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

Medical record review

Frequent episodes of infection requiring treatment

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Osteonecrosis:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee

0-1 mm cartilage interval with degenerative change

D

Patellofemoral arthritis:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Physical examination

Valgus deformity, 16-20 degrees

D

Physical examination

Varus deformity, 8-12 degrees

D

X-ray knee: patellofemoral joint

0 mm cartilage interval with degenerative change

D

Patellar fracture nonunion with displacement:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

X-ray knee

Nonunion and >3 mm displacement

D

Plateau fracture:

Post fracture angulation

>20 degrees angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Patellectomy:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Patellar, subluxation, recurrent:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Supracondylar fracture:

Post fracture angulation

>20 degrees angulation

D

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Tibial shaft fracture:

Physical examination—range of motion

Range of motion: flexion <60 degrees

D

Physical examination—range of motion

Flexion contracture (20 or > degrees)

D

Post fracture angulation

>20 degrees malalignment

D

K. Ankle and Foot

Confirmatory test

Minimum result

Requirements

BODY PART: ANKLE AND FOOT

CONFIRMATORY TESTS

Ankle fracture:

Medical record review

Documented history of ankle fracture

Recommended.

X-ray: ankle

Ankle fracture

Highly recommended.

Ankylosis, ankle:

X-ray: ankle

Extensive joint destruction

Highly recommended.

Physical examination

No mobility

Highly recommended.

Arthritis, subtalar joint:

X-ray: ankle

Evidence of significant arthritis: subtalar joint

Highly recommended.

Arthritis, talonavicular joint:

X-ray: ankle

Significant arthritis: talonavicular joint

Highly recommended.

Achilles tendon rupture:

Medical record review

Documentation of achilles tendon rupture

Highly recommended.

Physical examination

Rupture of achilles tendon

Highly recommended.

Arthritis, ankle:

X-ray: ankle

Significant arthritis

Highly recommended.

Hindfoot fracture:

X-ray: foot and ankle

Documentation of fracture

Highly recommended.

Rheumatoid arthritis, foot:

Medical History

Documented history of condition

Highly recommended.

X-ray: foot

Significant arthritis

Highly recommended.

Disability test

Test result

Disability classification

BODY PART: ANKLE AND FOOT

JOB TITLE: TRAINMAN

Ankle fracture:

X-ray: ankle

Displaced intra-articular fracture

D

Physical examination

Varus deformity >15 degrees

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Ankylosis, ankle:

Physical examination—range of motion

Ankylosis in 20 degree or ≤ dorsiflexion

D

Physical examination—range of motion

Ankylosis in 20 degree plantar flexion

D

Physical examination—range of motion

Ankylosis in int or ext malrotation >15 degrees

D

Physical examination—range of motion

Ankylosis in varus 10 or more degrees

D

Physical examination—range of motion

Ankylosis in valgus 10 or more degrees

D

Arthritis, subtalar joint (hindfoot):

X-ray: ankle—subtalar joint

Subtalar joint space 0 mm

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Physical examination

Varus deformity >15 degrees

D

Arthritis, talonavicular joint (hindfoot):

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

X-ray: ankle—talonavicular joint

Talonavicular joint space 0 mm

D

Physical examination

Varus deformity >15 degrees

D

Achilles tendon rupture:

Physical examination—range of motion

Plantar flexion capability, <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture, 20 degrees

D

Arthritis, ankle:

X-ray: ankle

0 mm

D

Physical examination—range of motion

Plantar flexion capability, <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture, 20 degrees

D

Physical examination

Varus deformity >15 degrees

D

Hindfoot fracture:

X-ray: foot

Calcaneal fracture with Boehler angle <95 degrees

D

X-ray: foot

Subtalar fracture with Boehler angle <95 degrees

D

Physical examination

Varus angulation >20 degrees (hindfoot)

D

Physical examination

Valgus angulation >20 degrees (hindfoot)

D

Rheumatoid arthritis, foot:

X-ray: foot

Significant degeneration

D

Medical record review

Chronic flare-up with treatment

D

BODY PART: ANKLE AND FOOT

JOB TITLE: ENGINEER

Ankle fracture:

X-ray: ankle

Displaced intra-articular fracture

D

Physical examination

Varus deformity >15 degrees

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Ankylosis, ankle:

Physical examination—range of motion

Ankylosis in 20 degree or > dorsiflexion

D

Physical examination—range of motion

Ankylosis in 20 degree plantar flexion

D

Physical examination—range of motion

Ankylosis in int or ext malrotation >15 degrees

D

Physical examination—range of motion

Ankylosis in varus 10 or more degrees

D

Physical examination—range of motion

Ankylosis in valgus 10 or more degrees

D

Arthritis, subtalar joint (hindfoot):

X-ray: ankle—subtalar joint

Subtalar joint space 0 mm

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Physical examination

Varus deformity >15 degrees

D

Arthritis, talonavicular joint (hindfoot):

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

X-ray ankle—talonavicular joint

Talonavicular joint space 0 mm

D

Physical examination

Varus deformity >15 degrees

D

Achilles tendon rupture:

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Arthritis, ankle:

X-ray: ankle

0 mm

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Physical examination

Varus deformity >15 degrees

D

Hindfoot fracture:

X-ray: foot

Calcaneal fracture with Boehler angle <95 degrees

D

X-ray: foot

Subtalar fracture with Boehler angle <95 degrees

D

Physical examination

Varus angulation >20 degrees (hindfoot)

D

Physical examination

Valgus angulation >20 degrees (hindfoot)

D

Rheumatoid arthritis, foot:

X-ray: foot

Significant degeneration

D

Medical record review

Chronic flare-up with treatment

D

BODY PART: ANKLE AND FOOT

JOB TITLE: DISPATCHER

Achilles tendon rupture:

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Arthritis, ankle:

X-ray: ankle

0 mm

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Physical examination

Varus deformity >15 degrees

D

Hindfoot fracture:

X-ray: foot

Calcaneal fracture with Boehler angle <95 degrees

D

X-ray: foot

Subtalar fracture with Boehler angle <95 degrees

D

Physical examination

Varus angulation >20 degrees (hindfoot)

D

Physical examination

Valgus angulation >20 degrees (hindfoot)

D

Rheumatoid arthritis, foot:

X-ray: foot

Significant degeneration

D

Medical record review

Chronic flare-up with treatment

D

BODY PART: ANKLE AND FOOT

JOB TITLE: CARMAN

Ankle fracture:

X-ray: ankle

Displaced intra-articular fracture

D

Physical examination

Varus deformity >15 degrees

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Ankylosis, ankle:

Physical examination—range of motion

Ankylosis in 20 degree or > dorisiflexion

D

Physical examination—range of motion

Ankylosis in 20 degree plantar flexion

D

Physical examination—range of motion

Ankylois in int or ext malrotation >15 degrees

D

Physical examination—range of motion

Ankylosis in varus 10 or more degrees

D

Physical examination—range of motion

Ankylosis in valgus 10 or more degrees

D

Arthritis, subtalar joint (hindfoot):

X-ray: ankle—subtalar joint

Subtalar joint space 0 mm

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Physical examination

Varus deformity >15 degrees

D

Arthritis, talonavicular joint (hindfoot):

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

X-ray: ankle—talonavicular joint

Talonavicular joint space 0 mm

0

Physical examination

Varus deformity >15 degrees

D

Achilles tendon rupture:

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Arthritis, ankle:

X-ray: ankle

0 mm

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Physical examination

Varus deformity >15 degrees

D

Hindfoot fracture:

X-ray: foot

Calcaneal fracture with Boehler angle <95 degrees

D

X-ray: foot

Subtalar fracture with Boehler angle <95 degrees

D

Physical examination

Varus angulation >20 degrees (hindfoot)

D

Physical examination

Valgus angulation >20 degrees (hindfoot)

D

Rheumatoid arthritis, foot:

X-ray: foot

Significant degeneration

D

Medical record review

Chronic flare—up with treatment

D

BODY PART: ANKLE AND FOOT

JOB TITLE: SIGNALMAN

Ankle fracture:

X-ray: ankle

Displaced intra-articular fracture

D

Physical examination

Varus deformity >15 degrees

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Ankylosis, ankle:

Physical examination—range of motion

Ankylosis in 20 degree or > dorsiflexion

D

Physical examination—range of motion

Ankylosis in 20 degree plantar flexion

D

Physical examination—range of motion

Ankylosis in int or ext malrotation >15 degrees

D

Physical examination—range of motion

Ankylosis in varus 10 or more degrees

D

Physical examination—range of motion

Ankylosis in valgus 10 or more degrees

D

Arthritis, subtalar joint (hindfoot):

X-ray: ankle—subtalar joint

Subtalar joint space 0 mm

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Physical examination

Varus deformity >15 degrees

D

Arthritis, talonavicular joint (hindfoot):

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

X-ray: ankle—talonavicular joint

Talonavicular joint space 0 mm

D

Physical examination

Varus deformity >15 degrees

D

Achilles tendon rupture:

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Arthritis, ankle:

X-ray: ankle

0 mm

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Physical examination

Varus deformity >15 degrees

D

Hindfoot fracture:

X-ray: foot

Calcaneal fracture with Boehler angle <95 degrees

D

X-ray: foot

Subtalar fracture with Boehler angle <95 degrees

D

Physical examination

Varus angulation >20 degrees (hindfoot)

D

Physical examination

Valgus angulation >20 degrees (hindfoot)

D

Rheumatoid arthritis, foot:

X-ray: foot

Significant degeneration

D

Medical record review

Chronic flare-up with treatment

D

BODY PART: ANKLE AND FOOT

JOB TITLE: TRACKMAN

Ankle fracture:

X-ray: ankle

Displaced intra-articular fracture

D

Physical examination—range of motion

Varus deformity >15 degrees

D

Physical examination—range of motion

Plantar flexion capability ≤5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Ankylosis, ankle:

Physical examination—range of motion

Ankylosis in 20 degree or > dorsiflexion

D

Physical examination—range of motion

Ankylosis in 20 degree plantar flexion

D

Physical examination—range of motion

Ankylosis in int or ext malrotation >15 degrees

D

Physical examination—range of motion

Ankylosis in varus 10 or more degrees

D

Physical examination—range of motion

Ankylosis in valgus 10 or more degrees

D

Arthritis, subtalar joint (hindfoot):

X-ray: ankle—subtalar joint

Subtalar joint space 0 mm

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Physical examination

Varus deformity >15 degrees

D

Arthritis, talonavicular joint (hindfoot):

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

X-ray: angle—talonavicular joint

Talonavicular joint space 0 mm

D

Physical examination

Varus deformity >15 degrees

D

Achilles tendon rupture:

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Arthritis, ankle:

X-ray: ankle

0 mm

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination

Varus deformity >15 degrees

D

Hindfoot fracture:

X-ray: foot

Calcaneal fracture with Boehler angle <95 degrees

D

X-ray: foot

Subtalar fracture with Boehler angle <95 degrees

D

Physical examination

Varus angulation >20 degrees (hindfoot)

D

Physical examination

Valgus angulation >20 degrees (hindfoot)

D

Rheumatoid arthritis, foot:

X-ray: foot

Significant degeneration

D

Medical record review

Chronic flare-up with treatment

D

BODY PART: ANKLE AND FOOT

JOB TITLE: MACHINIST

Ankle fracture:

X-ray: ankle

Displaced intra-articular fracture

D

Physical examination

Varus deformity >15 degrees

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Ankylosis, ankle:

Physical examination—range of motion

Ankylosis in 20 degree or > dorsiflexion

D

Physical examination—range of motion

Ankylosis in 20 degree plantar flexion

D

Physical examination—range of motion

Ankylosis in int or ext malrotation >15 degrees

D

Physical examination—range of motion

Ankylosis in varus 10 or more degrees

D

Physical examination—range of motion

Ankylosis in valgus 10 or more degrees

D

Arthritis, subtalar joint (hindfoot):

X-ray: ankle—subtalar joint

Subtalar joint space 0 mm

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Physical examination

Varus deformity >15 degrees

D

Arthritis, talonavicular joint (hindfoot):

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

X-ray: ankle—talonavicular joint

Talonavicular joint space 0 mm

D

Physical examination

Varus deformity >15 degrees

D

Achilles tendon rupture:

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Arthritis, ankle:

X-ray: ankle

0 mm

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Physical examination

Varus deformity ≤15 degrees

D

Hindfoot fracture:

X-ray: foot

Calcaneal fracture with Boehler angle <95 degrees

D

X-ray: foot

Subtalar fracture with Boehler angle <95 degrees

D

Physical examination

Varus angulation >20 degrees (hindfoot)

D

Physical examination

Valgus angulation >20 degrees (hindfoot)

D

Rheumatoid arthritis, foot:

X-ray: foot

Significant degeneration

D

Medical record review

Chronic flare-up with treatment

D

BODY PART: ANKLE AND FOOT

JOB TITLE: SHOP LABORER

Ankle fracture:

X-ray: ankle

Displaced intra-articular fracture

D

Physical examination

Varus deformity >15 degrees

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Ankylosis, ankle:

Physical examination—range of motion

Ankylosis in 20 degree or > dorsiflexion

D

Physical examination—range of motion

Ankylosis in 20 degree plantar flexion

D

Physical examination—range of motion

Ankylosis in int or ext malrotation >15 degrees

D

Physical examination—range of motion

Ankylosis in varus 10 or more degrees

D

Physical examination—range of motion

Ankylosis in valgus 10 or more degrees

D

Arthritis, subtalar joint (hindfoot):

X-ray: ankle—subtalar joint

Subtalar joint space 0 mm

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Physical examination

Varus deformity >15 degrees

D

Arthritis, talonavicular joint (hindfoot):

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

X-ray: ankle—talonavicular joint

Talonavicular joint space 0 mm

D

Physical examination

Varus deformity >15 degrees

D

Achilles tendon rupture:

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Arthritis, ankle:

X-ray: ankle

0 mm

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Physical examination

Varus deformity >15 degrees

D

Hindfoot fracture:

X-ray: foot

Calcaneal fracture with Boehler angle <95 degrees

D

X-ray: foot

Subtalar fracture with Boehler angle <95 degrees

D

Physical examination

Varus angulation >20 degrees (hindfoot)

D

Physical examination

Valgus angulation >20 degrees (hindfoot)

D

Rheumatoid arthritis, foot:

X-ray: foot

Significant degeneration

D

Medical record review

Chronic flare-up with treatment

D

Disability test

Test result

Disability classification

BODY PART: ANKLE AND FOOT

JOB TITLE: SALES REPRESENTATIVES

Achilles tendon rupture:

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Arthritis, ankle:

X-ray: ankle

0 mm

D

Physical examination—range of motion

Plantar flexion capability <5 degrees

D

Physical examination—range of motion

Plantar flexion contracture 20 degrees

D

Physical examination

Varus deformity >15 degrees

D

Hindfoot fracture:

X-ray: foot

Calcaneal fracture with Boehler angle <95 degrees

D

X-ray: foot

Subtalar fracture with Boehler angle <95 degrees

D

Physical examination

Varus angulation >20 degrees (hindfoot)

D

Physical examination

Valgus angulation >20 degrees (hindfoot)

D

Rheumatoid arthritis, foot:

X-ray: foot

Significant degeneration

D

Medical record review

Chronic flare-up with treatment

D

Job Information Forms

§ 220.101 Evaluation of mental impairments.

(a) General. The steps outlined in § 220.100 apply to the evaluation of physical and mental impairments. In addition, in evaluating the severity of a mental impairment(s), the Board will follow a special procedure at each administrative level of review. Following this procedure will assist the Board in—

(1) Identifying additional evidence necessary for the determination of impairment severity;

(2) Considering and evaluating aspects of the mental impairment(s) relevant to the claimant's ability to work; and

(3) Organizing and presenting the findings in a clear, concise, and consistent manner.

(b) Use of the procedure to record pertinent findings and rate the degree of functional loss. (1) This procedure requires the Board to record the pertinent signs, symptoms, findings, functional limitations, and effects of treatment contained in the claimant's case record. This will assist the Board in determining if a mental impairment(s) exists. Whether or not a mental impairment(s) exists is decided in the same way the question of a physical impairment is decided, i.e., the evidence must be carefully reviewed and conclusions supported by it. The mental status examination and psychiatric history will ordinarily provide the needed information. (See § 220.27 for further information about what is needed to show an impairment.)

(2) If the Board determines that a mental impairment(s) exists, this procedure then requires the Board to indicate whether certain medical findings which have been found especially relevant to the ability to work are present or absent.

(3) The procedure then requires the Board to rate the degree of functional loss resulting from the impairment(s). Four areas of function considered by the Board as essential to work have been identified, and the degree of functional loss in those areas must be rated on a scale that ranges from no limitation to a level of severity which is incompatible with the ability to perform those work-related functions.

For the first two areas (activities of daily living and social functioning), the rating is done based upon the following five-point scale; none, slight, moderate, marked, and extreme. For the third area (concentration, persistence, or pace), the following five-point scale is used: never, seldom, often, frequent, and constant. For the fourth area (deterioration or decompensation in work or work-like settings), the following four-point scale is used: never, once or twice, repeated (three or more), and continual. The last two points for each of these scales represent a degree of limitation which is incompatible with the ability to perform the work-related function.

(c) Use of the procedure to evaluate mental impairments. Following the rating of the degree of functional loss resulting from the impairment(s), the Board then determines the severity of the mental impairment(s).

(1) If the four areas considered by the Board as essential to work have been rated to indicate a degree of limitation as “none” or “slight” in the first and second area, “never” or “seldom” in the third area, and “never” in the fourth area, the Board can generally conclude that the impairment(s) is not severe, unless the evidence otherwise indicates that there is significant limitation of the claimant's mental ability to do basic work activities (see § 220.102).

(2) If the claimant's mental impairment(s) is severe, the Board must then determine if it is medically disabling using the Board's prior conclusions based on this procedure (i.e., the presence of certain medical findings considered by the Board as especially relevant to a claimant's ability to work and the Board's rating of functional loss resulting from the mental impairment(s)).

(3) If the claimant has a severe impairment(s), but the impairment(s) is not medically disabling, the Board will then do a residual functional capacity assessment for those claimants (employees, widow(er)s, and children) whose applications are based on disability for any regular employment under the Railroad Retirement Act.

(4) At all adjudicative levels, the Board will, in each case, incorporate the pertinent findings and conclusions based on this procedure in its decision rationale. The Board's rationale must show the significant history, including examination, laboratory findings, and functional limitations that the Board considered in reaching conclusions about the severity of the mental impairment(s).