[Federal Register Volume 63, Number 30 (Friday, February 13, 1998)]
[Rules and Regulations]
[Pages 7538-7602]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-2026]
[[Page 7537]]
_______________________________________________________________________
Part V
Railroad Retirement Board
_______________________________________________________________________
20 CFR Part 220
Determining Disability; Final Rule
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /
Rules and Regulations
[[Page 7538]]
RAILROAD RETIREMENT BOARD
20 CFR Part 220
RIN 3220-AB18
Determining Disability
AGENCY: Railroad Retirement Board.
ACTION: Final rule.
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SUMMARY: The Railroad Retirement Board hereby amends its regulations
with respect to determining when an employee is disabled for his or her
regular railroad occupation. This final rule gives effect to an
agreement between railroad labor and railroad management consistent
with section 2(a)(2) of the Railroad Retirement Act which provides that
labor and management shall cooperate with the Board in developing
standards for determining when an employee's physical or mental
condition disables him or her for work in his or her regular railroad
occupation and thus there exists good cause not to delay its
effectiveness beyond date of publication.
DATES: Effective date: This rule is effective February 13, 1998.
Applicability date: This rule shall be applicable February 13,
1998, but only with respect to applications for a disability annuity
filed on or after January 1, 1998.
ADDRESSES: Secretary to the Board, Railroad Retirement Board, 844 North
Rush Street, Chicago, Illinois 60611.
FOR FURTHER INFORMATION CONTACT: Thomas W. Sadler, Senior Attorney,
Railroad Retirement Board, 844 North Rush Street, Chicago, Illinois
60611, (312) 751-4513, TDD (312) 751-4701.
SUPPLEMENTARY INFORMATION: Section 2(a)(2) of the Railroad Retirement
Act (45 U.S.C. 231a(a)(2)) provides that the Board, with the
cooperation of employers and employees, shall secure the establishment
of standards determining the physical and mental conditions which
permanently disqualify employees from performing their regular
occupation in the railroad industry. The Board has never formally
adopted such standards. The agency, in the past, has used provisional
standards which were adopted in 1946 but which are now outdated. In
1991 the Board adopted Subpart C of Part 220 which provides for
determining disability for work in an employee's regular railroad
occupation. Under this regulation if an employee's physical or mental
condition does not meet a listing found in Appendix 1 of Part 220
(which determines if an individual is able to engage in any employment
both within and outside the railroad industry), the Board determines
the employee's residual functional capacity and compares that to the
demands of his or her regular railroad occupation to determine if the
employee can continue to perform that job. However, Subpart C contains
no specific standards which relate to specific railroad occupations.
The Board amends Subpart C to add such standards with respect to
certain railroad occupations.
Section 220.10 provides for the establishment of an Occupational
Disability Advisory Committee made up of two physicians, one from
recommendations from rail labor, one from recommendations of rail
management. This committee shall review, from time to time, the
disability standards developed by this regulation and the Occupational
Disability Claims Manual (Manual) which supplements this regulation.
The Board shall confer with this Committee before it amends this
regulation or the Manual. It should be noted that the Board is not an
agency subject to the Federal Advisory Committee Act. Accordingly, the
Occupational Disability Advisory Committee will not be subject to that
Act.
Section 220.11 contains the definitions of ``regular railroad
occupation'', ``permanent physical and mental impairment'', and
``residual functional capacity'' as presently found in Part 220. In
addition, it adds the definitions of ``independent case evaluation''
and ``functional capacity test''.
The current Sec. 220.12 is removed, and the current Sec. 220.14
``Evidence Considered'' is redesignated Sec. 220.12.
The introductory language and paragraph (a) of section 220.13
follow the present regulation and describe the sequential evaluation
process for determining disability for an employee's regular railroad
occupation. Initially, if an employee has been medically disqualified
by his employer, the Board will presume that the employee is disabled
for his regular railroad occupation if there is any objective medical
evidence to support that determination. If the employee has not been so
disqualified, the Board will determine if the employee's impairment(s)
meet or equal a listing found in Appendix 1.
Section 220.13(b)(1) provides that if an employee has not been
found disabled in the first two steps described above, the Board will
then determine the employee's regular railroad occupation, based upon
the employee's description of his or her job.
Section 220.13(b)(2)(i) provides that next the Board will determine
if an employee's regular railroad occupation and impairment(s) are
covered under the standards contained in a new Appendix 3 to Part 220.
If both the occupation and impairment(s) are covered, the Board will
confirm the existence of the impairment(s) by using the tests listed in
Appendix 3 or by other valid diagnostic tests which could be used to
establish an impairment as provided for in Sec. 220.27 of this part.
(Section 220.13(b)(2)(ii) of the proposed rule has been revised to
clarify how an impairment is confirmed and that if an employee's
impairment(s) cannot be confirmed, as provided for in this section, the
employee will be found not disabled.) Once the impairment(s) is
confirmed, Appendix 3 is applied to determine if the employee is
disabled. (Section 220.13(b)(2)(iii).)
If the employee's regular railroad occupation and impairment(s) are
not covered by Appendix 3, or if the medical evidence contains
significant differences in interpretation of objective test findings
which cannot be readily resolved, then the Board will not use Appendix
3, but will determine if the employee is disabled using an independent
case evaluation (ICE) as set forth in Sec. 220.13(b)(2)(iv). Likewise,
if Appendix 3 does not yield a ``disabled'' finding, ICE will apply.
Section 220.13(b)(2)(iv), which describes ICE, is essentially a
more detailed description of the process, which is described in
Sec. 220.13(b)(3) of the present regulation. Under this process the
Board initially determines whether the evidence is complete (Step 1).
The Board next confirms any impairment which has not been confirmed
under Sec. 220.13(b)(2)(ii) (Step 2). Next, the Board will determine
whether there is a concordance of medical findings among physicians. If
there is not, the Board will request additional medical evidence from
the employee's treating physician(s) or procure additional consulting
exams (Step 3). Once the Board establishes a concordance of medical
findings, to the extent that it is possible, it will then assess the
quality of the medical evidence under the factors set forth in
Sec. 220.14. This section sets forth factors which either support or
call into question the validity of the medical findings. Thus, for
example, the opinion of a treating physician, which is fully supported
by medically acceptable clinical and diagnostic techniques, is given
greater weight than one that is not so supported or is inconsistent
with findings of other medical sources. Likewise, the claimant's
description of
[[Page 7539]]
his or her own condition, if consistent with objective medical
findings, is given more weight than one that is not consistent (Step
4). 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.
If through the assessment in Step 4 it is determined that there is
substantial objective evidence of an impairment, then in Step 5 the
Board will determine the demands of the employee's regular railroad
occupation. At this point, the Board will not only consider the
employee's own description of his or her job, but also the employer's
description as well as other sources such as the Dictionary of
Occupational Titles and generic descriptions found in the Occupational
Disability Claims Manual.
Next, the Board will determine the employee's residual functional
capacity based upon the assessment performed in Step 4 and compare it
to the job demands determined in Step 5. 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 residual functional capacity, then the
Board will find the employee not disabled (Step 6).
The Board published this regulation as a proposed rule on September
24, 1997 (62 FR 50056), and invited comments by October 24, 1997. Two
comments were received. One commentator suggested that the Board adopt
the vision and hearing acuity requirements found in 49 CFR 240.121,
which have been adopted by the Federal Railroad Administration for
certification of locomotive engineers. However, the Board does not feel
such a change is needed since an engineer who is disqualified by his
employer for failure to meet the requirements of 49 CFR 240.121 would
ordinarily be presumed disabled under the first paragraph of
Sec. 220.13. Another commentator expressed support for the regulation
because it was in accord with an agreement reached in July 1997 between
representatives of rail labor and rail management concerning
occupational disability.
The final rule contains an Introduction to Appendix 3 which
explains how to use the Appendix. In addition, the Board has corrected
typographical errors in Appendix 3, and made the following substantive
changes in Appendix 3 based upon advice from physicians representing
rail labor and rail management:
A. Cancer
62 FR 50064--Under Assessment, second paragraph, second
line, the phrase ``in the Tables'' was inserted after ``All railroad
occupations.''
62 FR 50065--Footnote 3, Functional Impacts, the reference
to ``(MS) Minimally Significant'' was deleted.
62 FR 50066--Footnote 5 was deleted and footnote 6 was
redesignated footnote 5.
C. Cardiac
62 FR 50066--The confirmatory test for coronary artery
disease, angiography,''Definite significant (>60%) of one vessel,'' was
changed to ``Definite occlusion (>60%) of one vessel.''
62 FR 50067 through 50075--The disability tests, test
results and disability classifications for ``Echocardiogram'' and
``Cardiac catheterization'' with results of ``Decreased ejection
fraction 40-55%'' were deleted for all job titles. These tests were
found in the proposed rule under the listings Angina, Aortic valve
disease, Cardiomyopathy, Mitral valve disease, and Pericardial disease.
62 FR 50067 through 50075--The disability tests for
``Echocardiogram'' and ``Cardiac catheterization'' with results of
``Poor ejection fraction <35%'' were="" revised="" to="" read="" ``poor="" ejection="" fraction="">35%'' for all job titles. These tests were found in
the proposed rule under the listings Angina, Aortic valve disease,
Cardiomyopathy, Mitral valve disease, and Pericardial disease.
62 FR 50067, 50071 and 50072--In the proposed rule one of
the disability tests for ``Mitral valve disease'' for trainman,
signalman and trackman was ``Cardiac catheterization'' with a test
result of ``Mitral valve gradient >10mm Hg.'' This disability test, and
its test result and disability classification was deleted. Another test
result under ``Mitral valve disease'' for ``Cardiac catheterization''
was ``Mitral valve gradient 5-10mm Hg.'' This test result was changed
to ``Mitral valve gradient 5mm Hg.''
62 FR 50068, 50069, 50070, 50073, 50074, 50075--One of the
disability tests for ``Mitral valve disease'' for engineer, dispatcher,
carman, machinist, shop laborer, sales representative, and general
office clerk was ``Cardiac catheterization'' with a test result of
``Mitral valve gradient 5-10mm Hg.'' This disability test, and its test
result and disability classification was deleted. Another test result
under ``Mitral valve disease'' for ``Cardiac catheterization'' was
``Mitral valve gradient >10mm Hg.'' This result was changed to ``Mitral
valve gradient 10mm Hg.''
62 FR 50067, 50070, 50071, 50072--For job titles trainman,
signalman, and trackman the disability tests were revised as follows:
Angina
--Stress test with a result of ``Peak exercise 5-7 METS'' the
disability test, test result, and disability classification were
deleted.
--Stress test with a result of ``Peak exercise <5 mets''="" was="" revised="" to="" read="" ``stress="" test--peak="" exercise="">7 METS.''
--Stress test with a result of ``Definite ischemia <7 mets''="" was="" revised="" to="" read="" ``stress="" test:="" significant="" st="" changes--definite="" ischemia="">7 METS.''
--Stress test with a result of ``Definite ischemia >7 METS'': the
disability test, test result, and disability classification were
deleted.
Aortic Valve Disease
--Stress test with a result of ``Peak exercise 5-7 METS'': the
disability test, test result, and disability classification were
deleted.
--Stress test with a result of ``Peak exercise <5 mets''="" was="" revised="" to="" read:="" ``peak="" exercise="">7 METS.''
Coronary Artery Disease
--Stress test with a result of ``Peak exercise 5-7 METS'': the
disability test, test result, and disability classification were
deleted.
--Stress test with a result of ``Peak exercise <5 mets''="" was="" revised="" to="" read:="" ``stress="" test="" --peak="" exercise="">7 METS.''
--Stress test with a result of ``Definite ischemia < or="">7 METS'' was
revised to read: ``Stress test--Definite ischemia 7 METS.''
--Isotope, e.g., thallium study with a result of ``Definite ischemia < or="">7 METS'' was revised to read: ``Isotope, e.g., thallium study--
definite ischemia 7 METS.''
Cardiomyopathy
--Stress test with a result of ``Peak exercise 5-7 METS'' was revised
to read: ``Stress test--Peak exercise 7 METS.''
Mitral Valve Disease
--Stress test with a result of ``Peak exercise 5-7 METS'' was revised
to read: to ``Peak exercise 7 METS.''
62 FR 50067, 50068, 50069, 50070, 50072, 50073, 50074,
50075--For job titles engineer, dispatcher, carman, machinist, shop
laborer, sales representative, and general office clerk
[[Page 7540]]
the disability tests were revised as follows:
Angina
--Stress test with a result of ``Peak exercise 5-7 METS'' the
disability test, test result and disability classification were
deleted.
--Stress test with a result of ``Peak exercise <5 mets''="" was="" revised="" to="" read:="" ``stress="" test--peak="" exercise="">5 METS.''
--Stress test: significant ST changes with a result of ``Definite
ischemia <7 mets''="" was="" revised="" to="" read:="" ``stress="" test--definite="" ischemia="">5 METS.''
--Stress test: significant ST changes with a result of ``Definite
ischemia >7 METS'': the disability test, test result, and disability
classification were deleted.
Aortic Valve Disease
--Stress test with a result of ``Peak exercise 5-7 METS'': the
disability test, test result, and disability classification were
deleted.
--Stress test with a result of ``Peak exercise <5 mets''="" was="" revised="" to="" read:="" ``stress="" test--peak="" exercise="">5 METS.''
Coronary Artery Disease
--Stress test with a result of ``Peak exercise 5-7 METS'': the
disability test, test result, and disability classification were
deleted.
--Stress test with a result of ``Peak exercise <5 mets''="" was="" revised="" to="" read:="" ``stress="" test--peak="" exercise="">5 METS.''
--Stress test with a result of ``Definite ischemia < or="">7 METS'' was
revised to read: ``Stress test--Definite ischemia 5 METS.''
--Isotope, e.g., thallium study with a result of ``Definite ischemia < or="">7 METS'' was revised to read: ``Isotope, e.g., thallium study--
Definite ischemia 5 METS.''
Cardiomyopathy
--Stress test with a result of ``Peak exercise 5-7 METS'' was revised
to read: ``Stress test--Peak exercise 5 METS.''
Mitral Valve Disease
--Stress test with a result of ``Peak exercise 5-7 METS'' was revised
to read: ``Stress test--Peak exercise 5 METS.''
62 FR 50067 through 50074--For job titles trainman,
engineer, dispatcher, carman, signalman, trackman, machinist, and shop
laborer, under the listing of ``Hypertension,'' the disability test of
``Medical record review'' with a result of ``Diastolic >120 and
systolic >160, 50% of the time''; the disability test, test result, and
disability classification were deleted. For sales representative, under
the listing ``Hypertension,'' the disability test of ``Medical record
review'' with a result of ``Diastolic >120 and systolic >160, 50% of
the time'': the following was added: ``and evidence of end organ damage
(blood creatinine >2; urinary protein >\1/2\ gm; or EKG evidence of
ischemia).''
62 FR 50067 through 50075--For all job titles, under
``Ventricular ectopy,'' the disability test of ``Medical record
review'' with a result of ``Surgical rhythm procedure'' and the
disability classification were deleted.
D. Respiratory
62 FR 50076 through 50080--The listing ``Asbestosis'' was
removed and, consequently, the designated confirmatory tests for this
condition were also removed.
62 FR 50076 through 50080--The listing ``Sleep Apnea'' was
removed and, consequently, the designated confirmatory tests for this
condition were also removed.
62 FR 50076--The confirmatory tests for ``Silicosis,''
``Chest X-ray (ILO interpreted)'' with a minimum result of ``At least
1/0 by NIOSH B reader,'' was removed.
62 FR 50076--The confirmatory test for ``Restrictive lung
disease'' designated ``Diffusing capacity'' was changed to read:
``DLCO.''
62 FR 50076--The parenthetical ``(race adjusted)'' in the
confirmatory test ``Spirometry'' for ``Restrictive lung disease'' was
removed.
62 FR 50077 through 50080--The disability test for
``Pulmonary fibrosis'' and ``Restrictive lung disease'' for trainman,
carman, signalman, trackman, machinist, and shop laborer designated
``Diffusing capacity for CO'' was changed to read: ``DLCO.''
62 FR 50076 through 50080--The disability test for
``Asthma'' and ``Chronic bronchitis'' for trainman, carman, signalman,
trackman, machinist, and shop laborer designated ``Spirometry'' has an
accompanying test result of ``FEV1 with adequate treatment <40% predicted.''="" the="" test="" result="" was="" changed="" to:="" ``repeated="" spirometry="" fev1=""><40% over="" a="" 12-month="" period.''=""> 62 FR 50077 through 50080--Under the listing
Bronchiectasis, Chronic Bronchitis, Chronic Obstructive Pulmonary
Disease (COPD), Pulmonary Fibrosis, and Silicosis for the job titles
trainman, carman, signalman, trackman, machinist, and shop laborer the
disability test ``PCO2 arterial'' was changed to read: ``Resting ABG,''
and its accompanying test result was revised to read: ``PCO2 arterial
>50mm Hg if stable.''
62 FR 50077 through 50080--Under the listings
Bronchiectasis, Chronic Bronchitis, Chronic Obstructive Pulmonary
Disease (COPD), and Pulmonary Fibrosis for the job titles trainman,
carman, signalman, trackman, machinist, and shop laborer the disability
test ``Pulmonary exercise test'' with a test result of ``PO2 drop >5
torr at maximum exercise'' was changed to read ``Pulmonary exercise
test or exercise ABG.''
F. CE Spine
62 FR 50093--Under the listing ``Rheumatoid arthritis:
cervical'' the minimum result under the confirmatory test of
``Rheumatoid factor (blood test)'' was changed from ``High titer'' to
``Titer of rheumatoid factor.''
62 FR 50094 through 50097--The disability test for
``Spondylogenic compression of spinal cord:'' for trainman, engineer,
carman, signalman, trackman, machinist, and shop laborer designated
``Physical examination: lower limb'' has an accompanying test result of
``Lower extremity weakness or spasticity.'' The test result was changed
to: ``Lower extremity weakness or significant spasticity.''
62 FR 50094 through 50097--The disability test for
trainman, engineer, carman, signalman, trackman, machinist, and shop
laborer designated ``Physical examination: cervical'' was changed to
read ``Physical examination.'' This disability test can be found under
the listings Cervical disc disease with myelopathy, Chronic herniated
disc, Cervical spondylolysis, Cervical intervertebral disc
degeneration, Fracture: posterior element with spinal canal
displacement, Post-laminectomy syndrome, Cervical radiculopathy, and
Spondylogenic compression of spinal cord.
G. Shoulder
62 FR 50097--The confirmatory test ``Permanent functional
limitation, elbow:'' was changed to ``Medical diagnosis leading to a
permanent functional limitation of the elbow.''
62 FR 50098 through 50099--The disability test for
trainman, engineer, carman, signalman, trackman, machinist, and shop
laborer under the listing ``Permanent functional limitation, elbow:''
was ``Physical examination--range of motion.'' Its accompanying test
result ``Flexion limit to 60 degrees (30 degrees from 90)'' was changed
to ``Flexion limited to 60 degrees.''
[[Page 7541]]
H. Hand and Arm
62 FR 50099--The confirmatory tests for ``Carpal tunnel
syndrome'' designated ``Physical examination'' with a minimum result of
``Tinel's or Phalen's sign suggestive but not confirming'' was removed.
62 FR 50099--One of the confirmatory tests for
``Rheumatoid arthritis: hand'' is ``Rheumatoid factor.'' The minimum
result for this test was changed from ``High titer'' to ``Titer of
rheumatoid factor.''
62 FR 50100 through 50104--A disability test for trainman,
carman, signalman, trackman, machinist, and shop laborer was ``Strength
(jamar)'' with a test result for dominant and non-dominant hands for
female and male. All references to these tests, their results and
disability classifications were deleted. These disability tests were
found in the proposed rule under the listings: Carpal tunnel syndrome,
Fracture wrist, Hand permanent functional limitation, and Wrist
permanent functional limitation.
62 FR 50100 through 50104--Two of the disability tests for
the listing ``Thumb: permanent functional limitation'' were ``Adduction
of thumb'' and ``Opposition'' with a result of ``Loss <=7 cm.''="" these="" disability="" tests,="" test="" results,="" and="" disability="" classifications="" were="" removed="" for="" all="" job="" titles.="" i.="" hip=""> 62 FR 50105--One of the confirmatory tests for ``Paget's
disease'' is ``X-ray: hip.'' The minimum result for this test was
changed from ``Osteolytic and blastic lesions'' to ``Osteolytic or
blastic lesions.''
J. Knee
62 FR 50108--The confirmatory test for ``Patellar-7
subluxation-recurrent'' is a ``Medical record review.'' The minimum
result for this testing in the proposed rule was ``History of recurrent
subluxation with associated signs.'' The phrase ``with associated
signs'' was removed.
K. Ankle and Foot
62 FR 50116 through 50120--One of the disability tests for
the listing ``Rheumatoid arthritis, foot:'' is a ``Medical record
review.'' Its accompanying test result in the proposed rule was
``Frequent flare-up with treatment.'' This test result was changed to
``Chronic flare-up with treatment.''
The Board has determined that this is a significant rule under
Executive Order 12866. The Office of Management and Budget has approved
the information collection (Job Information Report, RRB Forms G-251a
and G-251b found in Appendix 3 of this part) associated with this rule
and assigned it OMB control number 3220-0193.
List of Subjects in 20 CFR Part 220
Disability benefits, Railroad employees, Railroad retirement,
Reporting and recordkeeping requirements.
For the reasons set forth in the preamble, part 220 of title 20 of
the Code of Federal Regulations is amended as follows:
PART 220--DETERMINING DISABILITY
1. The authority citation for part 220 continues to read as
follows:
Authority: 45 U.S.C. 231a; 45 U.S.C. 231f.
2. The heading of subpart C is revised to read as follows:
Subpart C--Disability Under the Railroad Retirement Act for Work in
an Employee's Regular Railroad Occupation
3. Section 220.10 is revised to read as follows:
Sec. 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.
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\1\ The Manual may be obtained from the Board's headquarters at
844 North Rush Street, Chicago, IL 60611.
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(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.
4. Section 220.11 is revised to read as follows:
Sec. 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
Sec. 220.120.
Sec. 220.12 [Removed]
Sec. 220.14 [Redesignated as Sec. 220.12]
5. The current Sec. 220.12 ``Permanent physical or mental
impairment, defined.'' is removed, and Sec. 220.14 ``Evidence
considered.'' is redesignated as Sec. 220.12.
6. Section 220.13 is amended by revising the section heading, the
introductory text, and paragraph (b) to read as follows:
[[Page 7542]]
Sec. 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 Sec. 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:
* * * * *
(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 Sec. 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 Sec. 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 Sec. 220.112, which describes the weight to
be given to the opinions of various physicians, and Sec. 220.114, which
describes how the Board evaluates symptoms such as pain. The Board will
also assess the weight of evidence by utilizing Sec. 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 Sec. 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.
7. A new section 220.14 is added to read as follows:
Sec. 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.
[[Page 7543]]
(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.
8. Appendix 3--Railroad Retirement Board Occupational Disability
Standards is added to part 220 to read as follows:
Appendix 3--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
[[Page 7544]]
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.
----------------------------------------------------------------------------------------------------------------
Disability Functional
Cancer type 2-year\1\ 5-year\1\ status\2\ 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
[[Page 7545]]
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.="" [[page="" 7546]]="" b.="" endocrine="" ----------------------------------------------------------------------------------------------------------------="" confirmatory="" test="" minimum="" result="" requirements="" ----------------------------------------------------------------------------------------------------------------="" body="" part:="" endocrine="" confirmatory="" tests="" ----------------------------------------------------------------------------------------------------------------="" diabetes,="" requiring="" insulin="" (iddm):="" medical="" record="" review..............="" confirmation="" of="" condition="" highly="" recommended.="" and="" need="" for="" insulin="" use.="" ----------------------------------------------------------------------------------------------------------------="" ----------------------------------------------------------------------------------------------------------------="" disability="" test="" test="" result="" disability="" classification="" ----------------------------------------------------------------------------------------------------------------="" body="" part:="" endocrine="" job="" title:="" engineer="" ----------------------------------------------------------------------------------------------------------------="" diabetes,="" requiring="" insulin="" (iddm):="" medical="" record="" review..............="" confirmation="" of="" condition="" d="" and="" need="" for="" insulin="" use.="" ----------------------------------------------------------------------------------------------------------------="" c.="" cardiac="" ----------------------------------------------------------------------------------------------------------------="" confirmatory="" test="" minimum="" result="" requirements="" ----------------------------------------------------------------------------------------------------------------="" body="" part:="" cardiac="" confirmatory="" tests="" ----------------------------------------------------------------------------------------------------------------="" angina:="" medical="" record="" review..............="" confirmed="" history="" of="" recommended.="" ischemia="" including="" copies="" of="" electrocardiogram.="" stress="" test........................="" definite="" ischemia="" on="" recommended.="" exercise="" test.="" thallium="" study.....................="" definite="" ischemia="" with="" recommended.="" exercise.="" aortic="" valve="" disease:="" cardiac="" catheterization............="" proven="" and="" significant......="" recommended.="" echocardiogram.....................="" significant="" valve="" disease...="" recommended.="" coronary="" artery="" disease:="" medical="" record="" review..............="" documented="" ischemia="" with="" recommended.="" electrocardiogram="" confirmation.="" medical="" record="" review..............="" documented="" myocardial="" recommended.="" infarction.="" stress="" test........................="" positive....................="" recommended.="" thallium="" study.....................="" definite="" ischemia="" with="" recommended.="" exercise.="" angiography........................="" definite="" occlusion="" (="">60%) of Recommended.
one vessel.
Cardiomyopathy:
Echocardiogram..................... Proven ejection fraction 35% Recommended.
Catheterization.................... Poor global function and not Recommended.
coronary artery disease.
Hypertension:
Medical record review.............. Documentation of Highly recommended.
hypertension for one year.
Medical record review.............. Definite diagnosis by Highly recommended.
cardiologist or internist.
Medical record review.............. Confirmation of medication Highly recommended.
use.
Arrhythmia: heart block:
Medical record review.............. Proven episode with Recommended.
electrocardiogram
confirmation.
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 Highly recommended.
internist.
Pulmonary hypertension:
Physical examination............... Increased pulmonic sound or Recommended.
pulmonary ejection murmur by
cardiologist or internist.
Electrocardiogram.................. Definite right ventricular Highly recommended.
hypertension.
Ventricular ectopy:
Medical record review.............. Definite episode within one Recommended.
year.
Holter monitoring.................. Definite arrhythmia......... Recommended.
Provocative testing................ Positive response........... Recommended.
Arrhythmia: supraventricular
tachycardia:
Medical record review.............. Definite episode within one Recommended.
year.
Holter monitoring.................. Definite arrhythmia......... Recommended.
Post heart transplant:
Medical record review.............. Documented.................. Highly recommended.
----------------------------------------------------------------------------------------------------------------
[[Page 7547]]
----------------------------------------------------------------------------------------------------------------
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 D
cardiologist.
Stress test........................ Documented hypotensive D
response.
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 D
aneurysm.
Cardiac catheterization............ Aortic gradient 25 - 50 mm D
Hg.
Cardiac catheterization............ Poor ejection fraction 35%.. D
Stress test........................ Peak exercise 7 METS........ D
Medical record review.............. Unstable as diagnosed by a D
Cardiologist.
Stress test........................ Documented hypotensive D
response.
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 D
>160, 50% of the time and
evidence of end organ damage
(blood creatinine >2;
urinary protein >\1/2\ gm;
or EKG evidence of ischemia).
Arrhythmia: heart block:
Holter............................. Documented asystole length D
>1.5 - 2 seconds.
Medical record review.............. Documented syncope with D
proven arrhythmia.
Mitral valve disease:
Cardiac catheterization............ Mitral valve gradient 5 mm D
Hg.
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 D
arrhythmia.
Holter............................. Uncontrolled ventricular D
rhythm.
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 D
cardiologist.
Stress test........................ Documented hypotensive D
response.
Stress test: significant ST changes Definite ischemia 5 METS.... D
Aortic valve disease:
Cardiac catheterization............ Aortic gradient 25 - 50 mm D
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 D
aneurysm.
Cardiac catheterization............ Aortic gradient 25 - 50 mm D
Hg.
Cardiac catheterization............ Poor ejection fraction 35%.. D
Stress test........................ Peak exercise 5 METS........ D
Medical record review.............. Unstable as diagnosed by a D
Cardiologist.
Stress test........................ Documented hypotensive D
response.
Stress test........................ Definite ischemia 5 METS.... D
[[Page 7548]]
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 D
>160, 50% of the time and
evidence of end organ damage
(blood creatinine >2;
urinary protein >\1/2\ gm;
or EKG evidence of ischemia).
Arrhythmia: heart block:
Holter............................. Documented asystole length D
>1.5 - 2 seconds.
Medical record review.............. Documented syncope with D
proven arrhythmia.
Mitral valve disease:
Cardiac catheterization............ Mitral valve gradient 10 mm D
Hg.
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 D
arrhythmia.
Holter............................. Uncontrolled ventricular D
rhythm.
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 D
cardiologist.
Stress test........................ Documented hypotensive D
response.
Stress test: significant ST changes Definite ischemia 5 METS.... D
Aortic valve disease:
Cardiac catheterization............ Aortic gradient 25 - 50 mm D
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 D
aneurysm.
Cardiac catheterization............ Aortic gradient 25 - 50 mm D
Hg.
Cardiac catheterization............ Poor ejection fraction 35%.. D
Stress test........................ Peak exercise 5 METS........ D
Medical record review.............. Unstable as diagnosed by D
cardiologist.
Stress test........................ Documented hypotensive D
response.
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 D
>160, 50% of the time and
evidence of end organ damage
(blood creatinine >2;
urinary protein >\1/2\ gm;
or EKG evidence of ischemia).
Arrhythmia: heart block:
Holter............................. Documented asystole length D
>1.5 - 2 seconds.
Medical record review.............. Documented syncope with D
proven arrhythmia.
Mitral valve disease:
Cardiac catheterization............ Mitral valve gradient 10 mm D
Hg.
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 D
arrhythmia.
[[Page 7549]]
Holter............................. Uncontrolled ventricular D
rhythm.
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 D
cardiologist.
Stress test........................ Documented hypotensive D
response.
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 D
aneurysm.
Cardiac catheterization............ Aortic gradient 25 - 50 mm D
Hg.
Cardiac catheterization............ Poor ejection fraction 35%.. D
Stress test........................ Peak exercise 5 METS........ D
Medical record review.............. Unstable as diagnosed by a D
Cardiologist.
Stress test........................ Documented hypotensive D
response.
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 D
>160, 50% of the time and
evidence of end organ damage
(blood creatinine >2;
urinary protein >\1/2\ gm;
or EKG evidence of ischemia).
Arrhythmia: heart block:
Holter............................. Documented asystole length D
>1.5 - 2 seconds.
Medical record review.............. Documented syncope with D
proven arrhythmia.
Mitral valve disease:
Cardiac catheterization............ Mitral valve gradient 10 mm D
Hg.
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 D
arrhythmia.
Holter............................. Uncontrolled ventricular D
rhythm.
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 D
cardiologist.
Stress test........................ Documented hypotensive D
response.
Stress test: significant ST changes Definite ischemia 7 METS.... D
Aortic valve disease:
Cardiac catheterization............ Aortic gradient 25 - 50 mm D
HG.
Echocardiogram..................... Poor ejection fraction 35%.. D
Stress test........................ Peak exercise 7 METS........ D
Coronary artery disease:
Myocardial infarction.............. Multiple infractions........ D
[[Page 7550]]
Echocardiogram..................... Confirmed ventricular D
aneurysm.
Cardiac catheterization............ Aortic gradient 25 - 50 mm D
Hg.
Cardiac catheterization............ Poor ejection fraction 35%.. D
Stress test........................ Peak exercise 7 METS........ D
Medical record review.............. Unstable as diagnosed by D
cardiologist.
Stress test........................ Documented hypotensive D
response.
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 D
>160, 50% of the time and
evidence of end organ damage
(blood creatinine >2;
urinary protein >\1/2\ gm;
or EKG evidence of ischemia).
Arrhythmia: heart block
Holter............................. Documented asystole length D
>1.5 - 2 seconds.
Medical record review.............. Documented syncope with D
proven arrhythmia.
Mitral valve disease:
Cardiac catheterization............ Mitral valve gradient 5 mm D
Hg.
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 D
arrhythmia.
Holter............................. Uncontrolled ventricular D
rhythm.
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 D
cardiologist.
Stress test........................ Documented hypotensive D
response.
Stress test: significant ST changes Definite ischemia 7 METS.... D
Aortic valve disease:
Cardiac catheterization............ Aortic gradient 25 - 50 mm D
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 D
aneurysm.
Cardiac catheterization............ Aortic gradient 25 - 50 mm D
Hg.
Cardiac catheterization............ Poor ejection fraction 35%.. D
Stress test........................ Peak exercise 7 METS........ D
Medical record review.............. Unstable as diagnosed by a D
cardiologist.
Stress test........................ Documented hypotensive D
response.
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 D
>160, 50% of the time and
evidence of end organ damage
(blood creatinine >2;
urinary protein >\1/2\ gm;
or EKG evidence of ischemia).
Arrhythmia: heart block:
Holter............................. Documented asystole length D
>1.5 - 2 seconds.
Medical record review.............. Documented syncope with D
proven arrhythmia.
Mitral valve disease:
Cardiac catheterization............ Mitral valve gradient 5 mm D
Hg.
Cardiac catheterization............ Mitral regurgitation severe. D
[[Page 7551]]
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 D
arrhythmia.
Holter............................. Uncontrolled ventricular D
rhythm.
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 D
cardiologist.
Stress test........................ Documented hypotensive D
response.
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 D
aneurysm.
Cardiac catheterization............ Aortic gradient 25 - 50 mm D
Hg.
Cardiac catheterization............ Poor ejection fraction 35%.. D
Stress test........................ Peak exercise 5 METS........ D
Medical record review.............. Unstable as diagnosed by a D
cardiologist.
Stress test........................ Documented hypotensive D
response.
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 D
>160, 50% of the time and
evidence of end organ damage
(blood creatinine >2;
urinary protein >\1/2\ gm;
or EKG evidence of ischemia).
Arrhythmia: heart block:
Holter............................. Documented asystole length D
>1.5 - 2 seconds.
Medical record review.............. Documented syncope with D
proven arrhythmia.
Mitral valve disease:
Cardiac catheterization............ Mitral valve gradient 10 mm D
Hg.
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 D
arrhythmia.
Holter............................. Uncontrolled ventricular D
rhythm.
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 D
cardiologist.
[[Page 7552]]
Stress test........................ Documented hypotensive D
response.
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 D
aneurysm.
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 D
Cardiologist.
Stress test........................ Documented hypotensive D
response.
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 D
>160, 50% of the time and
evidence of end organ damage
(blood creatinine >2;
urinary protein >\1/2\ gm;
or EKG evidence of ischemia).
Arrhythmia: heart block:
Holter............................. Documented asystole length D
>1.5 - 2 seconds.
Medical record review.............. Documented syncope with D
proven arrhythmia.
Mitral valve disease:
Cardiac catheterization............ Mitral valve gradient 10 mm D
Hg.
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 D
arrhythmia.
Holter............................. Uncontrolled ventricular D
rhythm.
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 D
cardiologist.
Stress test........................ Documented hypotensive D
response.
Stress test: significant ST changes Definite ischemia 5 METS.... D
Aortic valve disease:
Cardiac catheterization............ Aortic gradient 25 - 50 mm D
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 D
aneurysm.
Cardiac catheterization............ Aortic gradient 25 - 50 mm D
Hg.
Cardiac catheterization............ Poor ejection fraction 35%.. D
Stress test........................ Peak exercise 5 METS........ D
Medical record review.............. Unstable as diagnosed by a D
cardiologist.
Stress test........................ Documented hypotensive D
response.
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
[[Page 7553]]
Hypertension:
Medical record review.............. Diastolic >120 and systolic D
>160, 50% of the time and
evidence of end organ damage
(blood creatinine >2;
urinary protein >\1/2\ gm;
or EKG evidence of ischemia).
Arrhythmia: heart block:
Holter............................. Documented asystole length D
>1.5 - 2 seconds.
Medical record review.............. Documented syncope with D
proven arrhythmia.
Mitral valve disease:
Cardiac catheterization............ Mitral valve gradient 10 mm D
Hg.
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 D
arrhythmia.
Holter............................. Uncontrolled ventricular D
rhythm.
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 D
cardiologist.
Stress test........................ Documented hypotensive D
response.
Stress test: significant ST changes Definite ischemia 5 METS.... D
Aortic valve disease:
Cardiac catheterization............ Aortic gradient 25 - 50 mm D
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 D
aneurysm.
Cardiac catheterization............ Aortic gradient 25 - 50 mm D
Hg.
Cardiac catheterization............ Poor ejection fraction 35%.. D
Stress test........................ Peak exercise 5 METS........ D
Medical record review.............. Unstable as diagnosed by a D
Cardiologist.
Stress test........................ Documented hypotensive D
response.
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 D
>1.5 - 2 seconds.
Medical record review.............. Documented syncope with D
proven arrhythmia.
Mitral valve disease:
Cardiac catheterization............ Mitral valve gradient 10 mm D
Hg.
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 D
arrhythmia.
Holter............................. Uncontrolled ventricular D
rhythm.
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
----------------------------------------------------------------------------------------------------------------
[[Page 7554]]
D. Respiratory
----------------------------------------------------------------------------------------------------------------
Confirmatory test Minimum result Requirements
----------------------------------------------------------------------------------------------------------------
---------------------------------------------BODY PART: RESPIRATORY---------------------------------------------
CONFIRMATORY TESTS
----------------------------------------------------------------------------------------------------------------
Asthma:
Spirometry......................... FEV1/FVC ratio diminished... Recommended.
Spirometry......................... >15% change with Recommended.
administration of
bronchodilator.
Methacholine challenge test........ Positive: FEV1 decrease >20% Recommended
at (PC <=8 mg/ml).="" 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="" highly="" recommended.="" duration.="" chronic="" obstructive="" pulmonary="" disease:="" spirometry.........................="" fev1/fvc="" ratio="" below="" 65%="" highly="" recommended.="" when="" stable.="" spirometry.........................="" fev1="" below="" 75%="" of="" predicted="" highly="" recommended.="" when="" stable.="" cor="" pulmonale:="" electrocardiogram..................="" definite="" right="" ventricular="" recommended.="" hypertrophy.="" echocardiogram.....................="" definite="" right="" ventricular="" recommended.="" hypertrophy.="" 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="" highly="" recommended.="" with="" chest="" tube="" drainage.="" 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="" highly="" recommended.="" least="" 1="" year.="" tuberculosis:="" chest="" x-ray........................="" evidence="" of="" changes="" recommended.="" consistent="" with="" tuberculosis="" infection.="" 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 D
stable.
Pulmonary exercise test or exercise PO2 drop >5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" chronic="" bronchitis:="" spirometry.........................="" repeated="" spirometry="" fev1="" d=""><40% over="" a="" 12="" month="" period.="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Pulmonary exercise test or exercise PO2 drop >5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" chronic="" obstructive="" pulmonary="" disease="" (copd):="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Pulmonary exercise test or exercise PO2 drop >5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" cor="" pulmonale:="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" pulmonary="" fibrosis:="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Electrocardiogram.................. Definite positive right D
ventricular hypertrophy.
DLCO............................... <45% predicted..............="" d="" [[page="" 7555]]="" pulmonary="" exercise="" test="" or="" exercise="" po2="" drop="">5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" spirometry.........................="" fvc=""><50% predicted..........="" d="" lung="" resection:="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" restrictive="" lung="" disease:="" dlco...............................=""><45% predicted..............="" d="" pulmonary="" exercise="" test="" or="" exercise="" po2="" drop="">5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" spirometry.........................="" fvc=""><50% predicted..........="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" silicosis:="" resting="" abg........................="" pco2="" arterial="">50 mm Hg If D
stable.
Electrocardiogram.................. Definite positive right D
ventricular hypertrophy.
----------------------------------------------------------------------------------------------------------------
BODY PART: RESPIRATORY
JOB TITLE: CARMAN
----------------------------------------------------------------------------------------------------------------
Asthma:
Spirometry......................... Repeated spirometry FEV1 D
<40% over="" a="" 12="" month="" period.="" bronchiectasis:="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Pulmonary exercise test or exercise PO2 drop >5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" chronic="" bronchitis:="" spirometry.........................="" repeated="" spirometry="" fev1="" d=""><40% over="" a="" 12="" month="" period.="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Pulmonary exercise test or exercise PO2 drop >5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" chronic="" obstructive="" pulmonary="" disease="" (copd):="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Pulmonary exercise test or exercise PO2 drop >5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" cor="" pulmonale:="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" pulmonary="" fibrosis:="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Electrocardiogram.................. Definite positive right D
ventricular hypertrophy.
DLCO............................... <45% predicted..............="" d="" pulmonary="" exercise="" test="" or="" exercise="" po2="" drop="">5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" spirometry.........................="" fvc=""><50% predicted..........="" d="" lung="" resection:="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" restrictive="" lung="" disease:="" dlco...............................=""><45% predicted..............="" d="" pulmonary="" exercise="" test="" or="" exercise="" po2="" drop="">5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" spirometry.........................="" fvc=""><50% predicted..........="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" silicosis:="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Electrocardiogram.................. Definite positive right D
ventricular hypertrophy.
----------------------------------------------------------------------------------------------------------------
BODY PART: RESPIRATORY
JOB TITLE: SIGNALMAN
----------------------------------------------------------------------------------------------------------------
Asthma:
Spirometry......................... Repeated spirometry FEV1 D
<40% over="" a="" 12="" month="" period.="" bronchiectasis:="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Pulmonary exercise test or exercise PO2 drop >5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" chronic="" bronchitis:="" spirometry.........................="" repeated="" spirometry="" fev1=""><40% d="" over="" a="" 12="" month="" period.="" [[page="" 7556]]="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Pulmonary exercise test or exercise PO2 drop >5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" chronic="" obstructive="" pulmonary="" disease="" (copd):="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Pulmonary exercise test or exercise PO2 drop >5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" cor="" pulmonale:="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" pulmonary="" fibrosis:="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
DLCO............................... <45% predicted..............="" d="" pulmonary="" exercise="" test="" or="" exercise="" po2="" drop="">5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" spirometry.........................="" fvc=""><50% predicted..........="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" lung="" resection:="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" restrictive="" lung="" disease:="" dlco...............................=""><45% predicted..............="" d="" pulmonary="" exercise="" test="" or="" exercise="" po2="" drop="">5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" spirometry.........................="" fvc=""><50% predicted..........="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" silicosis:="" resting="" agb........................="" pco2="" arterial="">50 mm Hg if D
stable.
Electrocardiogram.................. Definite positive right D
ventricular hypertrophy.
----------------------------------------------------------------------------------------------------------------
BODY PART: RESPIRATORY
JOB TITLE: TRACKMAN
----------------------------------------------------------------------------------------------------------------
Asthma:
Spirometry......................... Repeated spirometry FEV1 D
<40% over="" a="" 12="" month="" period.="" bronchiectasis:="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Pulmonary exercise test or exercise PO2 >5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" chronic="" bronchitis:="" spirometry.........................="" repeated="" spirometry="" fev1="" d=""><40% over="" a="" 12="" month="" period.="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Pulmonary exercise test or exercise PO2 drop >5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" chronic="" obstructive="" pulmonary="" disease="" (copd):="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Pulmonary exercise test or exercise PO2 drop >5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" cor="" pulmonale:="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" pulmonary="" fibrosis:="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Electrocardiogram.................. Definite positive right D
ventricular hypertrophy.
DLCO............................... <45% predicted..............="" d="" pulmonary="" exercise="" test="" or="" exercise="" po2="" drop="">5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" spirometry.........................="" fvc=""><50% predicted..........="" d="" lung="" resection:="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" restrictive="" lung="" disease:="" dlco...............................=""><45% predicted..............="" d="" pulmonary="" exercise="" test="" or="" exercise="" po2="" drop="">5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" spirometry.........................="" fvc=""><50% predicted..........="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" silicosis:="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
[[Page 7557]]
Electrocardiogram.................. Definite positive right D
ventricular hypertrophy.
----------------------------------------------------------------------------------------------------------------
BODY PART: RESPIRATORY
JOB TITLE: MACHINIST
----------------------------------------------------------------------------------------------------------------
Asthma:
Spirometry......................... Repeated spirometry FEV1 D
<40% over="" a="" 12="" month="" period.="" bronchiectasis:="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Pulmonary exercise test or exercise PO2 drop >5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" chronic="" bronchitis:="" spirometry.........................="" repeated="" spirometry="" fev1="" d=""><40% over="" a="" 12="" month="" period.="" resting="" agb........................="" pco2="" arterial="">50 mm Hg if D
stable.
Pulmonary exercise test or exercise PO2 drop >5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" chronic="" obstructive="" pulmonary="" disease="" (copd):="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Pulmonary exercise test or exercise PO2 drop >5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" cor="" pulmonale:="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" pulmonary="" fibrosis:="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Electrocardiogram.................. Definite positive right D
ventricular hypertrophy.
DLCO............................... <45% predicted..............="" d="" pulmonary="" exercise="" test="" or="" exercise="" po2="" drop="">5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" spirometry.........................="" fvc=""><50% predicted..........="" d="" lung="" resection:="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" restrictive="" lung="" disease:="" dlco...............................=""><45% predicted..............="" d="" pulmonary="" exercise="" test="" or="" exercise="" po2="" drop="">5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" spirometry.........................="" fvc=""><50% predicted..........="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" silicosis:="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Electrocardiogram.................. Definite positive right D
ventricular hypertrophy.
----------------------------------------------------------------------------------------------------------------
BODY PART: RESPIRATORY
JOB TITLE: SHOP LABORER
----------------------------------------------------------------------------------------------------------------
Asthma:
Spirometry......................... Repeated spirometry FEV1 D
<40% over="" a="" 12="" month="" period.="" bronchiectasis:="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Pulmonary exercise test or exercise PO2 drop >5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" chronic="" bronchitis:="" spirometry.........................="" repeated="" spirometry="" fev1="" d=""><40% over="" a="" 12="" month="" period.="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Pulmonary exercise test or exercise PO2 drop >5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" chronic="" obstructive="" pulmonary="" disease="" (copd):="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Pulmonary exercise test or exercise PO2 drop >5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" cor="" pulmonale:="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" pulmonary="" fibrosis:="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
[[Page 7558]]
DLCO............................... <45% predicted..............="" d="" pulmonary="" exercise="" test="" or="" exercise="" po2="" drop="">5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" spirometry.........................="" fvc=""><50% predicted..........="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" lung="" resection:="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" restrictive="" lung="" disease:="" dlco...............................=""><45% predicted..............="" d="" pulmonary="" exercise="" test="" or="" exercise="" po2="" drop="">5 torr at maximum D
ABG. exercise.
Pulmonary exercise test............ Maximum VO2 <15 ml/kg.......="" d="" spirometry.........................="" fvc=""><50% predicted..........="" d="" electrocardiogram..................="" definite="" positive="" right="" d="" ventricular="" hypertrophy.="" silicosis:="" resting="" abg........................="" pco2="" arterial="">50 mm Hg if D
stable.
Electrocardiogram.................. Definite positive right D
ventricular hypertrophy.
----------------------------------------------------------------------------------------------------------------
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 Highly recommended.
medical treatment for at
least 1 year.
Medical record review.............. History of back pain Highly recommended.
unresponsive to therapy for
at least 1 year.
Medical record review.............. History of back pain with Highly recommended.
functional limitations for
at least 1 year.
Chronic back pain, not otherwise
specified:.
Medical record review.............. History of back pain under Highly recommended.
medical treatment for at
least 1 year.
Medical record review.............. History of back pain Highly recommended.
unresponsive to therapy for
at least 1 year.
Medical record review.............. History of back pain with Highly recommended.
functional limitations for
at least 1 year.
Cauda equina syndrome with bowel or
bladder dysfunction:.
Magnetic resonance imaging......... Neural impingement of spinal Recommended.
nerves below L1.
Computerized tomography............ Neural impingement of spinal Recommended.
nerves below L1.
Cystometrogram..................... Impaired bladder function... Recommended.
Rectal examination................. Diminished rectal sphincter Recommended.
tone.
Myelogram.......................... Neural impingement of spinal Recommended.
nerves below L1.
Degeneration of lumbar disc:
X-ray lumbar sacral spine.......... Significant degenerative Recommended.
disc changes.
Computerized tomography............ Significant degenerative Recommended.
disc changes.
Magnetic resonance imaging......... Significant degenerative Recommended.
disc changes.
Myelogram.......................... Significant degenerative Recommended.
disc changes.
Displacement of lumbar disc:.......
X-ray-lumbar sacral spine.......... Significant degenerative Recommended.
disc changes.
Computerized tomography............ Significant degenerative Recommended.
disc changes.
Magnetic resonance imaging......... Significant degenerative Recommended.
disc changes.
Myelogram.......................... Significant degenerative Recommended.
disc changes.
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 Recommended.
element with displacement of
spinal canal.
Computerized tomography............ Fracture posterior spinal Recommended.
element with displacement of
spinal canal.
X-ray-lumbar sacral spine.......... Fracture posterior spinal Recommended.
element with displacement of
spinal canal.
[[Page 7559]]
Fracture: posterior spinal element
with no displacement:.
X-ray-lumbar sacral spine.......... Fracture posterior spinal Recommended.
element.
Magnetic resonance imaging......... Fracture posterior spinal Recommended.
element.
Computerized tomography............ Fracture posterior spinal Recommended.
element.
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 Recommended.
degeneration.
Magnetic resonance imaging......... Significant disc Recommended.
degeneration.
Computerized tomography............ Significant disc Recommended.
degeneration.
Myelogram.......................... Significant disc Recommended.
degeneration.
Lumbago:
Medical record review: lumbar...... History of back pain under Highly recommended.
medical treatment for at
least 1 year.
Medical record review: lumbar...... History of back pain Highly recommended.
unresponsive to therapy for
at least 1 year.
Medical record review: lumbar...... History of back pain with Highly recommended.
functional limitations for
at least 1 year.
Lumbosacral neuritis:
Magnetic resonance imaging......... Evidence of neural Recommended.
compression.
Electromyography................... Definite denervation........ Recommended.
Nerve conduction velocity.......... Definite slowing............ Recommended.
Physical examination -- atrophy.... Atrophy in affected limb Recommended.
with 2 cm difference between
limbs.
Physical examination: straight leg Positive straight leg raise. Recommended.
raise.
Sensory examination................ Loss of sensation in Recommended.
affected dermatomes.
Medical history.................... History of radicular pain... Highly recommended.
Computerized tomography............ Evidence of neural Recommended.
compression.
Lumbar spinal stenosis:
Computerized tomography............ Significant narrowing: Recommended.
spinal cord canal or
intervertebral foramen.
Magnetic resonance imaging......... Significant narrowing: Recommended.
spinal cord canal or
intervertebral foramen.
Myelogram.......................... Significant narrowing: Recommended.
spinal cord canal or
intervertebral foramen.
Mechanical complication of internal
orthopedic device:
Medical record review.............. Documentation of failure of Highly recommended.
implant following surgical
procedure.
Osteomalacia:
X-ray-lumbar sacral spine.......... Evidence of significant Recommended.
osteomalacia.
Magnetic resonance imaging......... Evidence of significant Recommended.
osteomalacia.
Computerized tomography............ Evidence of significant Recommended.
osteomalacia.
Osteomyelitis, chronic-lumbar:
X-ray-lumbar sacral spine.......... Evidence of chronic Recommended.
infection.
Magnetic resonance imaging......... Evidence of chronic Recommended.
infection.
Computerized tomography............ Evidence of chronic Recommended.
infection.
Osteoporosis:
Computerized tomography............ Significant bone density Recommended.
loss.
Dual photon absorptiometry......... Significant bone density Recommended.
loss.
X-ray-lumbar sacral spine.......... Significant bone density Recommended.
loss.
Post laminectomy syndrome with
radiculopathy:
Medical record review: lumbar...... Documented surgical history Highly recommended.
of laminectomy.
Magnetic resonance imaging......... Evidence of laminectomy..... Recommended.
Electromyography................... Definite denervation........ Recommended.
Nerve conduction velocity.......... Definite slowing............ Recommended.
Physical examination -- atrophy.... Atrophy in affected limb Recommended.
with 2 cm difference between
limbs.
Physical examination: straight leg Positive straight leg raise. Recommended.
raise.
Sensory examination................ Loss of sensation in Recommended.
affected dermatomes.
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 Recommended.
compression.
Electromyography................... Definite denervation........ Recommended.
[[Page 7560]]
Nerve conduction velocity.......... Definite slowing............ Recommended.
Physical examination -- atrophy.... Atrophy in affected limb Recommended.
with 2 cm difference between
limbs.
Physical examination: straight leg Positive straight leg raise. Recommended.
raise.
Sensory examination................ Loss of sensation in Recommended.
affected dermatomes.
Medical record review: lumbar...... History of radicular pain... Highly recommended.
Computerized tomography............ Evidence of neural Recommended.
compression.
Myelogram.......................... Evidence of neural Recommended.
compression.
Sciatica:
Magnetic resonance imaging......... Evidence of neural Recommended.
compression.
Electromyography................... Definite denervation........ Recommended.
Nerve conduction velocity.......... Definite slowing............ Recommended.
Physical examination -- atrophy.... Atrophy in affected limb Recommended.
with 2 cm difference between
limbs.
Physical examination: straight leg Positive straight leg raise. Recommended.
raise.
Sensory examination................ Loss of sensation in Recommended.
affected dermatomes.
Medical history.................... History of radicular pain... Highly recommended.
Computerized tomography............ Evidence of neural Recommended.
compression.
Myelogram.......................... Evidence of neural Recommended.
compression.
Strains and sprains, unspecified:
Medical record review.............. History of back pain under Highly recommended.
medical treatment for at
least 1 year.
Medical record review.............. History of back pain Highly recommended.
unresponsive to therapy for
at least 1 year.
Medical record review.............. History of back pain with Highly recommended.
functional limitations for
at least 1 year.
Medical record review.............. Documented history of strain Highly recommended.
and/or sprain.
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 Recommended.
interarticularis.
Computerized tomography............ Defect -- pars Recommended.
interarticularis.
Magnetic resonance imaging......... Defect -- pars Recommended.
interarticularis.
Sprains and strains, sacral:
Medical record review: lumbar...... History of back pain under Highly recommended.
medical treatment for at
least 1 year.
Medical record review: lumbar...... History of back pain Highly recommended.
unresponsive to therapy for
at least 1 year.
Medical record review: lumbar...... History of back with Highly recommended.
functional limitations for
at least 1 year.
Medical record review: lumbar...... Documented history of strain Highly recommended.
and/or sprain.
Sprains and strains, sacroiliac:
Medical record review: lumbar...... History of back pain under Highly recommended.
medical treatment for at
least 1 year.
Medical record review: lumbar...... History of back pain Highly recommended.
unresponsive to therapy for
at least 1 year.
Medical record review: lumbar...... History of back pain with Highly recommended.
functional limitations for
at least 1 year.
Medical record review: lumbar...... Documented history of strain Highly recommended.
and/or sprain.
----------------------------------------------------------------------------------------------------------------
[[Page 7561]]
----------------------------------------------------------------------------------------------------------------
Disability test Test result Disability classification
----------------------------------------------------------------------------------------------------------------
-----------------------------------------------BODY PART: LS SPINE----------------------------------------------
JOB TITLE: TRAINMAN
----------------------------------------------------------------------------------------------------------------
Ankylosing spondylitis:
Muscle strength assessment......... Lifting capacity diminished D
by 50%.
Backache, unspecified:
Muscle strength assessment......... Lifting capacity diminished D
by 50%.
Chronic back pain, not otherwise
specified:
Muscle strength assessment......... Lifting capacity diminished D
by 50%.
Cauda equina syndrome with bowel or
bladder dysfunction:
Computerized tomography............ Disc extrusion with neural D
impingement, nerves < l1.="" magnetic="" resonance="" imaging.........="" disc="" extrusion="" with="" neural="" d="" impingement,="" nerves="">< l1.="" physical="" examination...............="" lower="" extremity="" weakness....="" d="" cystometrogram.....................="" impaired="" bladder="" function...="" d="" myelogram..........................="" disc="" extrusion="" with="" neural="" d="" impingement,="" nerves="">2 cm... Recommended.
Electromyography................... Definite denervation in Recommended.
muscle of affected nerve
root.
Myelogram.......................... Evidence of neurogenic Recommended.
compression.
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 Highly recommended.
rheumatologist or internist.
Spondylogenic compression of spinal
cord:
Physical examination: cervical..... Evidence of myelopathy...... Highly recommended.
Computerized axial tomography...... Evidence of neurogenic Recommended.
compression.
Magnetic resonance imaging......... Evidence of neurogenic Recommended.
compression.
Myelogram.......................... Evidence of neurogenic Recommended.
compression.
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
Disability test Test result Disability classification
----------------------------------------------------------------------------------------------------------------
BODY PART: CE SPINE
JOB TITLE: TRAINMAN
----------------------------------------------------------------------------------------------------------------
Cervical disc disease with
myelopathy:
Computerized axial tomography...... Significant spinal cord D
pressure.
Magnetic resonance imaging......... Significant spinal cord D
pressure.
Myelogram.......................... Significant spinal cord D
pressure.
Cystometrogram..................... Impaired bladder function... D
Physical examination: rectal....... Impairment of sphincter tone ..........................................
Physical examination: lower limb... Lower extremity weakness or D
significant spasticity.
Physical examination............... Multi-level neurologic D
compromise.
Chronic herniated disc:
Physical examination............... Multi-level neurologic D
compromise.
Cervical spondylolysis:
Physical examination............... Multi-level neurologic D
compromise.
Cervical intervertebral disc
degeneration:
Physical examination............... Multi-level neurologic D
compromise.
Fracture: posterior element with
spinal canal displacement:
Physical examination............... Multi-level neurologic D
compromise.
Post laminectomy syndrome:
Physical examination............... Multi-level neurologic D
compromise.
Cervical radiculopathy:
Physical examination............... Multi-level neurologic D
compromise.
Spondylogenic compression of spinal
cord:
Computerized axial tomography...... Significant spinal cord D
pressure.
Magnetic resonance imaging......... Significant spinal cord D
pressure.
Cystometrogram..................... Impaired bladder function... D
[[Page 7572]]
Myelogram.......................... Significant spinal cord D
pressure.
Physical examination: rectal....... Impairment of sphincter tone D
Physical examination............... Multi-level neurologic D
compromise.
Physical examination: lower limb... Lower extremity weakness or D
significant spasticity.
----------------------------------------------------------------------------------------------------------------
BODY PART: CE SPINE
JOB TITLE: ENGINEER
----------------------------------------------------------------------------------------------------------------
Cervical disc disease with
myelopathy:
Computerized axial tomography...... Significant spinal cord D
pressure.
Magnetic resonance imaging......... Significant spinal cord D
pressure.
Myelogram.......................... Significant spinal cord D
pressure.
Cystometrogram..................... Impaired bladder function... D
Physical examination: rectal....... Impairment of sphincter tone D
Physical examination: lower limb... Lower extremity weakness or D
significant spasticity.
Physical examination............... Multi-level neurologic D
compromise.
Chronic herniated disc:
Physical examination............... Multi-level neurologic D
compromise.
Cervical spondylolysis:
Physical examination............... Multi-level neurologic D
compromise.
Cervical intervertebral disc
degeneration:
Physical examination............... Multi-level neurologic D
compromise.
Fracture: posterior element with
spinal canal displacement:
Physical examination............... Multi-level neurologic D
compromise.
Post laminectomy syndrome:
Physical examination............... Multi-level neurologic D
compromise.
Cervical radiculopathy:
Physical examination:.............. Multi-level neurologic D
compromise.
Spondylogenic compression of spinal
cord:
Computerized axial tomography...... Significant spinal cord D
pressure.
Magnetic resonance imaging......... Significant spinal cord D
pressure.
Cystometrogram..................... Impaired bladder function... D
Myelogram.......................... Significant spinal cord D
pressure.
Physical examination: rectal....... Impairment of sphincter tone D
Physical examination............... Multi-level neurologic D
compromise.
Physical examination: lower limb... Lower extremity weakness or D
significant spasticity.
----------------------------------------------------------------------------------------------------------------
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 D
pressure.
Magnetic resonance imaging......... Significant spinal cord D
pressure.
Myelogram.......................... Significant spinal cord D
pressure.
Cystometrogram..................... Impaired bladder function... D
Physical examination: rectal....... Impairment of sphincter tone D
Physical examination: lower limb... Lower extremity weakness or D
significant spasticity.
Physical examination............... Multi-level neurologic D
compromise.
Chronic herniated disc:
Physical examination............... Multi-level neurologic D
compromise.
Cervical spondylolysis:
Physical examination............... Multi-level neurologic D
compromise.
Cervical intervertebral disc
degeneration:
Physical examination............... Multi-level neurologic D
compromise.
Fracture: posterior element with
spinal canal displacement:
Physical examination............... Multi-level neurologic D
compromise.
Post laminectomy syndrome:
Physical examination............... Multi-level neurologic D
compromise.
Cervical radiculopathy:
Physical examination............... Multi-level neurologic D
compromise.
[[Page 7573]]
Spondylogenic compression of spinal
cord:
Computerized axial tomography...... Significant spinal cord D
pressure.
Magnetic resonance imaging......... Significant spinal cord D
pressure.
Cystometrogram..................... Impaired bladder function... D
Myelogram.......................... Significant spinal cord D
pressure.
Physical examination: rectal....... Impairment of sphincter tone D
Physical examination............... Multi-level neurologic D
compromise.
Physical examination: lower limb... Lower extremity weakness or D
significant spasticity.
----------------------------------------------------------------------------------------------------------------
BODY PART; CE SPINE
JOB TITLE: SIGNALMAN
----------------------------------------------------------------------------------------------------------------
Cervical disc disease with
myelopathy:
Computerized axial tomography...... Significant spinal cord D
pressure.
Magnetic resonance imaging......... Significant spinal cord D
pressure.
Myelogram.......................... Significant spinal cord D
pressure.
Cystometrogram..................... Impaired bladder function... D
Physical examination: rectal....... Impairment of sphincter tone D
Physical examination: lower limb... Lower extremity weakness or D
significant spasticity.
Physical examination............... Multi-level neurologic D
compromise.
Chronic herniated disc:
Physical examination............... Multi-level neurologic D
compromise.
Cervical spondylolysis:
Physical examination............... Multi-level neurologic D
compromise.
Cervical intervertebral disc
degeneration:
Physical examination............... Multi-level neurologic D
compromise.
Fracture: posterior element with
spinal canal displacement:
Physical examination............... Multi-level neurologic D
compromise.
Post laminectomy syndrome:
Physical examination............... Multi-level neurologic D
compromise.
Cervical radiculopathy:
Physical examination............... Multi-level neurologic D
compromise.
Spondylogenic compression of spinal
cord:
Computerized axial tomography...... Significant spinal cord D
pressure.
Magnetic resonance imaging......... Significant spinal cord D
pressure.
Cystometrogram..................... Impaired bladder function... D
Myelogram.......................... Significant spinal cord D
pressure.
Physical examination: rectal....... Impairment of sphincter tone D
Physical examination............... Multi-level neurologic D
compromise.
Physical examination: lower limb... Lower extremity weakness or D
significant spasticity.
----------------------------------------------------------------------------------------------------------------
BODY PART: CE SPINE
JOB TITLE: TRACKMAN
----------------------------------------------------------------------------------------------------------------
Cervical disc disease with
myelopathy:
Computerized axial tomography...... Significant spinal cord D
pressure.
Magnetic resonance imaging......... Significant spinal cord D
pressure.
Myelogram.......................... Significant spinal cord D
pressure.
Cystometrogram..................... Impaired bladder function... D
Physical examination: rectal....... Impairment of sphincter tone D
Physical examination: lower limb... Lower extremity weakness or D
significant spasticity.
Physical examination............... Multi-level neurologic D
compromise.
Chronic herniated disc:
Physical examination............... Multi-level neurologic D
compromise.
Cervical spondyloysis:
Physical examination............... Multi-level neurologic D
compromise.
Cervical intervertebral disc
degeneration:
Physical examination............... Multi-level neurologic D
compromise.
Fracture: posterior element with
spinal canal displacement:
Physical examination............... Multi-level neurologic D
compromise.
Post laminectomy syndrome:
Physical examination............... Multi-level neurologic D
compromise.
Cervical radiculopathy:
Physical examination............... Multi-level neurologic D
compromise.
Spondylogenic compression of spinal
cord:
Computerized axial tomography...... Significant spinal cord D
pressure.
Magnetic resonance imaging......... Significant spinal cord D
pressure.
Cystometrogram..................... Impaired bladder function... D
Myelogram.......................... Significant spinal cord D
pressure.
Physical examination: rectal....... Impairment of sphincter tone D
[[Page 7574]]
Physical examination............... Multi-level neurologic D
compromise.
Physical examination: lower limb... Lower extremity weakness or D
significant spasticity.
----------------------------------------------------------------------------------------------------------------
BODY PART: CE SPINE
JOB TITLE: MACHINIST
----------------------------------------------------------------------------------------------------------------
Cervical disc disease with
myelopathy:
Computerized axial tomography...... Significant spinal cord D
pressure.
Magnetic resonance imaging......... Significant spinal cord D
pressure.
Myelogram.......................... Significant spinal cord D
pressure.
Cystometrogram..................... Impaired bladder function... D
Physical examination: rectal....... Impairment of sphincter tone D
Physical examination: lower limb... Lower extremity weakness or D
significant spasticity.
Physical examination............... Multi-level neurologic D
compromise.
Chronic herniated disc:
Physical examination............... Multi-level neurologic D
compromise.
Cervical spondylolysis:
Physical examination............... Multi-level neurologic D
compromise.
Cervical intervertebral disc
degeneration:
Physical examination............... Multi-level neurologic D
compromise.
Fracture: posterior element with
spinal canal displacement:
Physical examination............... Multi-level neurologic D
compromise.
Post laminectomy syndrome:
Physical examination............... Multi-level neurologic D
compromise.
Cervical radiculopathy:
Physical examination............... Multi-level neurologic D
compromise.
Spondylogenic compression of spinal
cord:
Computerized axial tomography...... Significant spinal cord D
pressure.
Magnetic resonance imaging......... Significant spinal cord D
pressure.
Cystometrogram..................... Impaired bladder function... D
Myelogram.......................... Significant spinal cord D
pressure.
Physical examination: rectal....... Impairment of sphincter tone D
Physical examination............... Multi-level neurologic D
compromise.
Physical examination: lower limb... Lower extremity weakness or D
significant spasticity.
----------------------------------------------------------------------------------------------------------------
BODY PART: CE SPINE
JOB TITLE: SHOP LABORER
----------------------------------------------------------------------------------------------------------------
Cervical disc disease with
myelopathy:
Computerized axial tomography...... Significant spinal cord D
pressure.
Magnetic resonance imaging......... Significant spinal cord D
pressure.
Myelogram.......................... Significant spinal cord D
pressure.
Cystometrogram..................... Impaired bladder function... D
Physical examination: rectal....... Impairment of sphincter tone D
Physical examination: lower limb... Lower extremity weakness or D
significant spasticity.
Physical examination............... Multi-level neurologic D
compromise.
Chronic herniated disc:
Physical examination............... Multi-level neurologic D
compromise.
Cervical spondylolysis:
Physical examination............... Multi-level neurologic D
compromise.
Cervical intervertebral disc
degeneration:
Physical examination............... Multi-level neurologic D
compromise.
Fracture: posterior element with
spinal canal displacement:
Physical examination............... Multi-level neurologic D
compromise.
Post laminectomy syndrome:
Physical examination............... Multi-level neurologic D
compromise.
Cervical radiculopathy:
Physical examination............... Multi-level neurologic D
compromise.
Spondylogenic compression of spinal
cord:
Computerized axial tomography...... Significant spinal cord D
pressure.
Magnetic resonance imaging......... Significant spinal cord D
pressure.
Cystometrogram..................... Impaired bladder function... D
Myelogram.......................... Significant spinal cord D
pressure.
Physical examination: rectal....... Impairment of sphincter tone D
Physical examination............... Multi-level neurologic D
compromise.
Physical examination: lower limb... Lower extremity weakness or D
significant spasticity.
----------------------------------------------------------------------------------------------------------------
[[Page 7575]]
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 Recommended.
changes of joint.
Computerized tomography............ Significant degenerative Recommended.
changes of joint.
Magnetic resonance imaging......... Significant degenerative Recommended.
changes of joint.
Arthritis, glenohumeral:
X-ray: shoulder.................... Significant degenerative Recommended.
changes of joint.
Computerized tomography............ Significant degenerative Recommended.
changes of joint.
Magnetic resonance imaging......... Significant degenerative Recommended.
changes of joint.
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 Highly recommended.
functional limitation.
X-ray: elbow....................... Imaging confirmation of Recommended.
functional diagnosis.
Magnetic resonance imaging......... Imaging confirmation of Recommended.
functional diagnosis.
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
Disability test Test result Disability classification
----------------------------------------------------------------------------------------------------------------
BODY PART: SHOULDER AND ELBOW
JOB TITLE: TRAINMAN
----------------------------------------------------------------------------------------------------------------
Arthritis, acromioclavicular:
Physical examination -- range of <40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" motion.="" arthritis,="" glenohumeral:="" physical="" examination="" --="" range="" of=""><40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" motion.="" rotator="" cuff="" tear:="" physical="" examination="" --="" range="" of=""><40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" motion.="" permanent="" functional="" limitation,="" elbow:="" physical="" examination...............="">40 degrees deviation....... D
Physical examination -- range of Flexion limit to 60 degrees. D
motion.
----------------------------------------------------------------------------------------------------------------
BODY PART: SHOULDER AND ELBOW
JOB TITLE: ENGINEER
----------------------------------------------------------------------------------------------------------------
Arthritis, acromioclavicular:
Physical examination -- range of <40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" motion.="" [[page="" 7576]]="" arthritis,="" glenohumeral:="" physical="" examination="" --="" range="" of=""><40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" motion.="" rotator="" cuff="" tear:="" physical="" examination="" --="" range="" of=""><40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" moiton.="" permanent="" functional="" limitation,="" elbow:="" physical="" examination...............="">40 degrees deviation....... D
Physical examination -- range of Flexion limit to 60 degrees. D
motion.
----------------------------------------------------------------------------------------------------------------
BODY PART: SHOULDER AND ELBOW
JOB TITLE: CARMAN
----------------------------------------------------------------------------------------------------------------
Arthritis, acromioclavicular:
Physical examination -- range of <40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" motion.="" arthritis,="" glenohumeral:="" physical="" examination="" --="" range="" of=""><40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" motion.="" rotator="" cuff="" tear:="" physical="" examination="" --="" range="" of=""><40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" motion.="" permanent="" functional="" limitation,="" elbow:="" physical="" examination...............="">40 degrees deviation....... D
Physical examination -- range of Flexion limit to 60 degrees. D
motion.
----------------------------------------------------------------------------------------------------------------
BODY PART: SHOULDER AND ELBOW
JOB TITLE: SIGNALMAN
----------------------------------------------------------------------------------------------------------------
Arthritis, acromioclavicular:
Physical examination -- range of <40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" motion.="" arthritis,="" glenohumeral:="" physical="" examination="" --="" range="" of=""><40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" motion.="" rotator="" cuff="" tear:="" physical="" examination="" --="" range="" of=""><40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" motion.="" permanent="" functional="" limitation,="" elbow:="" physical="" examination...............="">40 degrees deviation....... D
Physical examination -- range of Flexion limit to 60 degrees. D
motion.
----------------------------------------------------------------------------------------------------------------
BODY PART: SHOULDER AND ELBOW
JOB TITLE: TRACKMAN
----------------------------------------------------------------------------------------------------------------
Arthritis, acromioclavicular:
Physical examination -- range of <40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" motion.="" arthritis,="" glenohumeral:="" physical="" examination="" --="" range="" of=""><40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" motion.="" rotator="" cuff="" tear:="" physical="" examination="" --="" range="" of=""><40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" motion.="" permanent="" functional="" limitation,="" elbow:="" physical="" examination...............="">40 degrees deviation....... D
Physical examination -- range of Flexion limit to 60 degrees. D
motion.
----------------------------------------------------------------------------------------------------------------
BODY PART: SHOULDER AND ELBOW
JOB TITLE: MACHINIST
----------------------------------------------------------------------------------------------------------------
Arthritis, acromioclavicular:
Physical examination -- range of <40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" motion.="" arthritis,="" glenohumeral:="" physical="" examination="" --="" range="" of=""><40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" motion.="" rotator="" cuff="" tear:="" physical="" examination="" --="" range="" of=""><40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" motion.="" permanent="" functional="" limitation,="" elbow:="" physical="" examination...............="">40 degrees deviation....... D
[[Page 7577]]
Physical examination -- range of Flexion limit to 60 degrees. D
motion.
----------------------------------------------------------------------------------------------------------------
BODY PART: SHOULDER AND ELBOW
JOB TITLE: SHOP LABORER
----------------------------------------------------------------------------------------------------------------
Arthritis, acromioclavicular:
Physical examination -- range of <40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" motion.="" arthritis,="" glenohumeral:="" physical="" examination="" --="" range="" of=""><40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" motion.="" rotator="" cuff="" tear:="" physical="" examination="" --="" range="" of=""><40 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><40 degrees="" abduction.......="" d="" motion.="" permanent="" functional="" limitation,="" elbow:="" physical="" examination...............="">40 degrees deviation....... D
Physical examination -- range of Flexion limit to 60 degrees. D
motion.
----------------------------------------------------------------------------------------------------------------
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 Highly recommended.
weakness in distribution
median nerve.
Nerve conduction testing........... Definite median nerve Highly recommended.
conduction slowing at wrist.
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 Highly recommended.
condition for permanent
limitation.
Physical examination............... Definite reproducible Highly recommended.
evidence of limitation.
Imaging study (e.g. X-ray, CAT, Positive confirmation of Highly recommended.
MRI). underlying condition.
Rheumatoid arthritis: hand:
Rheumatoid factor.................. Titer of rheumatoid factor.. Recommended.
Medical record review.............. History of objective Highly recommended.
findings including
serological studies.
X-ray: hand........................ Characteristic rheumatoid Highly recommended.
changes.
Tenosynovitis:
Medical record review.............. History of chronic Highly recommended.
tenosynovitis and objective
findings.
Physical examination............... Definite evidence of Highly recommended.
tenosynovitis.
Thumb: Permanent functional
limitation:
Medical record review.............. Documentation of medical Highly recommended.
condition for permanent
limitation.
Physical examination............... Definite reproducible Highly recommended.
evidence of limitation.
Imaging study (X-ray, CAT, MRI).... Positive confirmation of Highly recommended.
underlying condition.
Wrist: Permanent functional
limitation:
Medical record review.............. Documentation of medical Highly recommended.
condition for permanent
limitation.
Physical examination............... Definite reproducible Highly recommended.
evidence of limitation.
Imaging study (e.g. X-ray, CAT, Positive confirmation of Highly recommended.
MRI). underlying condition.
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
Disability test Test result Disability classification
----------------------------------------------------------------------------------------------------------------
BODY PART: HAND AND ARM
JOB TITLE: TRAINMAN
----------------------------------------------------------------------------------------------------------------
Fracture, wrist:
Physical examination -- range of Extension -- limit to 30 D
motion. degrees.
Physical examination -- range of Flexion -- limit to 30 D
motion. degrees.
Physical examination -- range of Ankylosis: >20 degrees from D
motion. neutral.
Rheumatoid arthritis hand:
Physical examination............... Significant deformity....... D
Medical record review.............. Significant flare-ups, under D
treatment with
rheumatologist.
[[Page 7578]]
Medical record review.............. Extensive medication use, D
under treatment with
rheumatologist.
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="" d=""><40 degrees.="" opposition.........................="" loss="" 4="" cm...................="" d="" wrist:="" permanent="" functional="" limitation:.="" physical="" examination="" --="" range="" of="" extension="" --="" limit="" to="" 30="" d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" --="" limit="" to="" 30="" d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" ankylosis:="">20 degrees from D
motion. neutral.
----------------------------------------------------------------------------------------------------------------
BODY PART: HAND AND ARM
JOB TITLE ENGINEER
----------------------------------------------------------------------------------------------------------------
Fracture, wrist:
Physical examination -- range of Extension-limit to 30 D
motion. degrees.
Physical examination -- range of Flexion-limit to 30 degrees. D
motion.
Physical examination -- range of Ankylosis: >20 degrees from D
motion. neutral.
Rheumatoid arthritis hand:
Physical examination............... Significant deformity....... D
Medical record review.............. Significant flare-ups, under D
treatment with
rheumatologist.
Medical record review.............. Extensive medication use, D
under treatment with
rheumatologist.
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="" d=""><40 degrees.="" opposition.........................="" loss="" 4="" cm...................="" d="" wrist:="" permanent="" functional="" limitation:="" physical="" examination="" --="" range="" of="" extension="" --="" limit="" to="" 30="" d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" --="" limit="" to="" 30="" d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" ankylosis:="">20 degrees from D
motion. neutral.
----------------------------------------------------------------------------------------------------------------
BODY PART: HAND AND ARM
JOB TITLE: DISPATCHER
----------------------------------------------------------------------------------------------------------------
Fracture, wrist:
Physical examination -- range of Extension -- limit to 30 D
motion. degrees.
Physical examination -- range of Flexion -- limit to 30 D
motion. degrees.
Physical examination -- range of Ankylosis: >20 degrees from D
motion. neutral.
Rheumatoid arthritis hand:
Physical examination............... Significant deformity....... D
Medical record review.............. Significant flare-ups, under D
treatment with
rheumatologist.
Medical record review.............. Extensive medication use, D
under treatment with
rheumatologist.
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="" d=""><40 degrees.="" opposition.........................="" loss="" 4="" cm...................="" d="" wrist:="" permanent="" functional="" limitation:="" physical="" examination="" --="" range="" of="" extension="" --="" limit="" to="" 30="" d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" --="" limit="" to="" 30="" d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" ankylosis:="">20 degrees from D
motion. neutral.
----------------------------------------------------------------------------------------------------------------
BODY PART: HAND AND ARM
JOB TITLE: CARMAN
----------------------------------------------------------------------------------------------------------------
Fracture, wrist:
Physical examination -- range of Extension -- limit to 30 D
motion. degrees.
Physical examination -- range of Flexion -- limit to 30 D
motion. degrees.
Physical examination -- range of Ankylosis: >20 degrees from D
motion. neutral.
Rheumatoid arthritis hand:
Physical examination............... Significant deformity....... D
Medical record review.............. Significant flare-ups, under D
treatment with
rheumatologist.
[[Page 7579]]
Medical record review.............. Extensive medication use, D
under treatment with
rheumatologist.
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="" d=""><40 degrees.="" opposition.........................="" loss="" 4="" cm...................="" d="" wrist:="" permanent="" functional="" limitation:="" physical="" examination="" --="" range="" of="" extension="" --="" limit="" to="" 30="" d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" --="" limit="" to="" 30="" d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" ankylosis:="">20 degrees from D
motion. neutral.
----------------------------------------------------------------------------------------------------------------
BODY PART: HAND AND ARM
JOB TITLE: SIGNALMAN
----------------------------------------------------------------------------------------------------------------
Fracture, wrist:
Physical examination -- range of Extension -- limit to 30 D
motion. degrees.
Physical examination -- range of Flexion -- limit to 30 D
motion. degrees.
Physical examination -- range of Ankylosis: >20 degrees from D
motion. neutral.
Rheumatoid arthritis hand:
Physical examination............... Significant deformity....... D
Medical record review.............. Significant flare-ups, under D
treatment with
rheumatologist.
Medical record review.............. Extensive medication use, D
under treatment with
rheumatologist.
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="" d=""><40 degrees.="" opposition.........................="" loss="" 4="" cm...................="" d="" wrist:="" permanent="" functional="" limitation:="" physical="" examination="" --="" range="" of="" extension="" --="" limit="" to="" 30="" d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" --="" limit="" to="" 30="" d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" ankylosis:="">20 degrees from D
motion. neutral.
----------------------------------------------------------------------------------------------------------------
BODY PART: HAND AND ARM
JOB TITLE: TRACKMAN
----------------------------------------------------------------------------------------------------------------
Fracture, wrist:
Physical examination -- range of Extension -- limit to 30 D
motion. degrees.
Physical examination -- range of Flexion --limit to 30 D
motion. degrees.
Physical examination -- range of Ankylosis: >20 degrees from D
motion. neutral.
Rheumatoid arthritis hand:
Physical examination............... Significant deformity....... D
Medical record review.............. Significant flare-ups, under D
treatment with
rheumatologist.
Medical record review.............. Extensive medication use, D
under treatment with
rheumatologist.
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="" d=""><40 degrees.="" opposition.........................="" loss="" 4="" cm...................="" d="" wrist:="" permanent="" functional="" limitation:="" physical="" examination="" --="" range="" of="" extension="" --="" --="" limit="" to="" 30="" d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" --="" limit="" to="" 30="" d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" ankylosis:="">20 degrees from D
motion. neutral.
----------------------------------------------------------------------------------------------------------------
BODY PART: HAND AND ARM
JOB TITLE: MACHINIST
----------------------------------------------------------------------------------------------------------------
Fracture, wrist:
Physical examination -- range of Extension -- limit to 30 D
motion. degrees.
Physical examination -- range of Flexion -- limit to 30 D
motion. degrees.
Physical examination -- range of Ankylosis: >20 degrees from D
motion. neutral.
Rheumatoid arthritis hand:
Physical examination............... Significant deformity....... D
Medical record review.............. Significant flare-ups, under D
treatment with
rheumatologist.
[[Page 7580]]
Medical record review.............. Extensive medication use, D
under treatment with
rheumatologist.
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="" d=""><40 degrees.="" opposition.........................="" loss="" 4="" cm...................="" d="" wrist:="" permanent="" functional="" limitation:="" physical="" examination="" --="" range="" of="" extension="" --="" limit="" to="" 30="" d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" --="" limit="" to="" 30="" d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" ankylosis:="">20 degrees from D
motion. neutral.
----------------------------------------------------------------------------------------------------------------
BODY PART: HAND AND ARM
JOB TITLE: SHOP LABORER
----------------------------------------------------------------------------------------------------------------
Fracture, wrist:
Physical examination -- range of Extension -- limit to 30 D
motion. degrees.
Physical examination -- range of Flexion -- limit to 30 D
motion. degrees.
Physical examination -- range of Ankylosis: >20 degrees from D
motion. neutral.
Rheumatoid arthritis hand:
Physical examination............... Significant deformity....... D
Medical record review.............. Significant flare-ups, under D
treatment with
rheumatologist.
Medical record review.............. Extensive medication use, D
under treatment with
rheumatologist.
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="" d=""><40 degrees.="" opposition.........................="" loss="" 4="" cm...................="" d="" wrist:="" permanent="" functional="" limitation:="" physical="" examination="" --="" range="" of="" extension="" --="" limit="" to="" 30="" d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" --="" limit="" to="" 30="" d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" ankylosis:="">20 degrees from D
motion. neutral.
----------------------------------------------------------------------------------------------------------------
BODY PART: HAND AND ARM
JOB TITLE: SALES REPRESENTATIVE
----------------------------------------------------------------------------------------------------------------
Fracture, wrist:
Physical examination -- range of Extension -- limit to 30 D
motion. degrees.
Physical examination -- range of Flexion -- limit to 30 D
motion. degrees.
Physical examination -- range of Ankylosis: >20 degrees from D
motion. neutral.
Rheumatoid arthritis hand:
Physical examination............... Significant deformity....... D
Medical record review.............. Significant flare-ups, under D
treatment with
rheumatologist.
Medical record review.............. Extensive medication use, D
under treatment with
rheumatologist.
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="" d=""><40 degrees.="" opposition.........................="" loss="" 4="" cm...................="" d="" wrist:="" permanent="" functional="" limitation:="" physical="" examination="" --="" range="" of="" extension="" --="" limit="" to="" 30="" d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" --="" limit="" to="" 30="" d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" ankylosis:="">20 degrees from D
motion. neutral.
----------------------------------------------------------------------------------------------------------------
BODY PART: HAND AND ARM
JOB TITLE: GENERAL OFFICE CLERK
----------------------------------------------------------------------------------------------------------------
Fracture, wrist:
Physical examination -- range of Extension -- limit to 30 D
motion. degrees.
Physical examination -- range of Flexion -- limit to 30 D
motion. degrees.
Physical examination -- range of Ankylosis: >20 degrees from D
motion. neutral.
Rheumatoid arthritis hand:
Physical examination............... Significant deformity....... D
Medical record review.............. Significant flare-ups, under D
treatment with
rheumatologist.
[[Page 7581]]
Medical record review.............. Extensive medication use, D
under treatment with
rheumatologist.
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="" d=""><40 degrees.="" opposition.........................="" loss="" 4="" cm...................="" d="" wrist:="" permanent="" functional="" limitation:="" physical="" examination="" --="" range="" of="" extension="" --="" limit="" to="" 30="" d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" --="" limit="" to="" 30="" d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" ankylosis:="">20 degrees from D
motion. neutral.
----------------------------------------------------------------------------------------------------------------
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 No mobility................. Highly Recommended.
motion.
Osteoarthritis, hip:
X-ray: hip......................... <4 mm="" joint="" space,="" or="" other="" recommended.="" positive="" evidence.="" magnetic="" resonance="" imaging.........=""><4 mm="" joint="" space,="" or="" other="" recommended.="" positive="" evidence.="" computerized="" axial="" tomography......=""><4 mm="" joint="" space,="" or="" other="" recommended.="" positive="" evidence.="" osteomyelitis,="" hip:="" x-ray:="" hip.........................="" evidence="" of="" chronic="" recommended.="" infection.="" computerized="" axial="" tomography......="" evidence="" of="" chronic="" recommended.="" infection.="" paget's="" disease:="" x-ray:="" hip.........................="" osteolytic="" or="" blastic="" highly="" recommended.="" lesions.="" 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="" recommended.="" replacement.="" ----------------------------------------------------------------------------------------------------------------="" ----------------------------------------------------------------------------------------------------------------="" disability="" test="" test="" result="" disability="" classification="" ----------------------------------------------------------------------------------------------------------------="" body="" part:="" hip="" job="" title:="" trainman="" ----------------------------------------------------------------------------------------------------------------="" ankylosis,="" hip:="" physical="" examination="" --="" range="" of="" ankylosis="" 5="" degrees="" or="" d="" motion.="">flexion.
Physical examination -- range of Ankylosis internal rotation D
motion. >5 degrees.
Physical examination -- range of Ankylosis external rotation D
motion. >10 degrees.
Physical examination -- range of Ankylosis in abduction >5 D
motion. degrees.
Physical examination -- range of Ankylosis in adduction >5 D
motion. degrees.
Osteoarthritis, hip:
X-ray: hip......................... 0 mm cartilage interval..... D
Physical examination -- range of 30 degrees flexion D
motion. contracture.
Physical examination -- range of <50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abduction........="" d="" motion.="" osteomyelitis,="" chronic="" hip:="" x-ray:="" hip.........................="" significant="" joint="" d="" destruction.="" physical="" examination="" --="" range="" of="" 30="" degrees="" flexion="" d="" motion.="" contracture.="" physical="" examination="" --="" range="" of=""><50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abduction........="" d="" motion.="" medical="" record="" review..............="" documented="" occurrence="" of="" d="" recurring="" infections="" with="" treatment.="" paget's="" disease:="" x-ray:="" hip.........................="" significant="" joint="" d="" destruction.="" physical="" examination="" --="" range="" of="" 30="" degrees="" flexion="" d="" motion.="" contracture.="" physical="" examination="" --="" range="" of=""><50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abduction........="" d="" motion.="" hip="" replacement="" surgery:="" x-ray:="" hip.........................="" evidence="" of="" artificial="" hip="" d="" joint.="" medical="" record="" review..............="" documentation="" of="" prior="" hip="" d="" replacement.="" ----------------------------------------------------------------------------------------------------------------="" [[page="" 7582]]="" body="" part:="" hip="" job="" title:="" engineer="" ----------------------------------------------------------------------------------------------------------------="" ankylosis,="" hip:="" physical="" examination="" --="" range="" of="" ankylosis="" 5="" degrees="" or="" d="" motion.="">flexion.
Physical examination -- range of Ankylosis internal rotation D
motion. >5 degrees.
Physical examination -- range of Ankylosis external rotation D
motion. >10 degrees.
Physical examination -- range of Ankylosis in abduction >5 D
motion. degrees.
Physical examination -- range of Ankylosis in adduction >5 D
motion. degrees.
Osteoarthritis, hip:
X-ray: hip......................... 0 mm cartilage interval..... D
Physical examination -- range of 30 degrees flexion D
motion. contracture.
Physical examination -- range of <50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abduction........="" d="" motion.="" osteomyelitis,="" chronic="" hip:="" x-ray:="" hip.........................="" signficant="" joint="" destruction="" d="" physical="" examination="" --="" range="" of="" 30="" degrees="" flexion="" d="" motion.="" contracture.="" physical="" examination="" --="" range="" of=""><50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abduction........="" d="" motion.="" medical="" record="" review..............="" documented="" occurrence="" of="" d="" recurring="" infections="" with="" treatment.="" paget's="" disease:="" x-ray:="" hip.........................="" significant="" joint="" d="" destruction.="" physical="" examination="" --="" range="" of="" 30="" degrees="" flexion="" d="" motion.="" contracture.="" physical="" examination="" --="" range="" of=""><50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abduction........="" d="" motion.="" hip="" replacement="" surgery:="" x-ray:="" hip.........................="" evidence="" of="" artificial="" hip="" d="" joint.="" medical="" record="" review..............="" documentation="" of="" prior="" hip="" d="" replacement.="" ----------------------------------------------------------------------------------------------------------------="" body="" part:="" hip="" job="" title:="" carman="" ----------------------------------------------------------------------------------------------------------------="" ankylosis,="" hip:="" physical="" examination="" --="" range="" of="" ankylosis="" 5="" degrees="" or="" d="" motion.="">flexion.
Physical examination -- range of Ankylosis internal rotation D
motion. >5 degrees.
Physical examination -- range of Ankylosis external rotation D
motion. >10 degrees.
Physical examination -- range of Ankylosis in abduction >5 D
motion. degrees.
Physical examination -- range of Ankylosis in adduction >5 D
motion. degrees.
Osteoarthritis, hip:
X-ray: hip......................... 0 mm cartilage interval..... D
Physical examination -- range of 30 degrees flexion D
motion. contracture.
Physical examination -- range of <50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abduction........="" d="" motion.="" osteomyelitis,="" chronic="" hip:="" x-ray:="" hip.........................="" significant="" joint="" d="" destruction.="" physical="" examination="" --="" range="" of="" 30="" degrees="" flexion="" d="" motion.="" contracture.="" physical="" examination="" --="" range="" of=""><50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abduction........="" d="" motion.="" medical="" record="" review..............="" documented="" occurrence="" of="" d="" recurring="" infections="" with="" treatment.="" paget's="" disease:="" x-ray:="" hip.........................="" significant="" joint="" d="" destruction.="" physical="" examination="" --="" range="" of="" 30="" degrees="" flexion="" d="" motion.="" contracture.="" physical="" examination="" --="" range="" of=""><50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abduction........="" d="" motion.="" hip="" replacement="" surgery:="" x-ray:="" hip.........................="" evidence="" of="" artificial="" hip="" d="" joint.="" medical="" record="" review..............="" documentation="" of="" prior="" hip="" d="" replacement.="" ----------------------------------------------------------------------------------------------------------------="" body="" part:="" hip="" job="" title:="" signalman="" ----------------------------------------------------------------------------------------------------------------="" ankylosis,="" hip:="" physical="" examination="" --="" range="" of="" ankylosis="" 5="" degrees="" or="" d="" motion.="">flexion.
Physical examination -- range of Ankylosis internal rotation D
motion. >5 degrees.
Physical examination -- range of Ankylosis external rotation D
motion. >10 degrees.
Physical examination -- range of Ankylosis in abduction >5 D
motion. degrees.
Physical examination -- range of Ankylosis in adduction >5 D
motion. degrees.
Osteoarthritis, hip:
X-ray: hip......................... 0 mm cartilage interval..... D
Physical examination -- range of 30 degrees flexion D
motion. contracture.
[[Page 7583]]
Physical examination -- range of <50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abduction........="" d="" motion.="" osteomyelitis,="" chronic="" hip:="" x-ray:="" hip.........................="" significant="" joint="" d="" destruction.="" physical="" examination="" --="" range="" of="" 30="" degrees="" flexion="" d="" motion.="" contracture.="" physical="" examination="" --="" range="" of=""><50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abduction........="" d="" motion.="" medical="" record="" review..............="" documented="" occurrence="" of="" d="" recurring="" infections="" with="" treatment.="" paget's="" disease:="" x-ray:="" hip.........................="" significant="" joint="" d="" destruction.="" physical="" examination="" --="" range="" of="" 30="" degrees="" flexion="" d="" motion.="" contracture.="" physical="" examination="" --="" range="" of=""><50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abduction........="" d="" motion.="" hip="" replacement="" surgery:="" x-ray:="" hip.........................="" evidence="" of="" artificial="" hip="" d="" joint.="" medical="" record="" review..............="" documentation="" of="" prior="" hip="" d="" replacement.="" ----------------------------------------------------------------------------------------------------------------="" body="" part:="" hip="" job="" title:="" trackman="" ----------------------------------------------------------------------------------------------------------------="" ankylosis,="" hip:="" physical="" examination="" --="" range="" of="" ankylosis="" 5="" degrees="" or="" d="" motion.="">flexion.
Physical examination -- range of Ankylosis internal rotation D
motion. >5 degrees.
Physical examination -- range of Ankylosis external rotation D
motion. >10 degrees.
Physical examination -- range of Ankylosis in abduction >5 D
motion. degrees.
Physical examination -- range of Ankylosis in adduction >5 D
motion. degrees.
Osteoarthritis, hip:
X-ray: hip......................... 0 mm cartilage interval..... D
Physical examination -- range of 30 degrees flexion D
motion. contracture.
Physical examination -- range of <50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abduction........="" d="" motion.="" osteomyelitis,="" chronic="" hip:="" x-ray:="" hip.........................="" significant="" joint="" d="" destruction.="" physical="" examination="" --="" range="" of="" 30="" degrees="" flexion="" d="" motion.="" contracture.="" physical="" examination="" --="" range="" of=""><50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abduction........="" d="" motion.="" medical="" record="" review..............="" documented="" occurrence="" of="" d="" recurring="" infections="" with="" treatment.="" paget's="" disease:="" x-ray:="" hip.........................="" significant="" joint="" d="" destruction.="" physical="" examination="" --="" range="" of="" 30="" degrees="" flexion="" d="" motion.="" contracture.="" physical="" examination="" --="" range="" of=""><50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abduction........="" d="" motion.="" hip="" replacement="" surgery:="" x-ray:="" hip.........................="" evidence="" of="" artificial="" hip="" d="" joint.="" medical="" record="" review..............="" documentation="" of="" prior="" hip="" d="" replacement.="" ----------------------------------------------------------------------------------------------------------------="" body="" part:="" hip="" job="" title:="" machinist="" ----------------------------------------------------------------------------------------------------------------="" ankylosis,="" hip:="" physical="" examination="" --="" range="" of="" ankylosis="" 5="" degrees="" or="" d="" motion.="">flexion.
Physical examination -- range of Ankylosis internal rotation D
motion. >5 degrees.
Physical examination -- range of Ankylosis external rotation D
motion. >10 degrees.
Physical examination -- range of Ankylosis in abduction >5 D
motion. degrees.
Physical examination -- range of Ankylosis in adduction >5 D
motion. degrees.
Osteoarthritis, hip:
X-ray: hip......................... 0 mm cartilage interval..... D
Physical examination -- range of 30 degrees flexion D
motion. contracture.
Physical examination -- range of <50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abduction........="" d="" motion.="" osteomyelitis,="" chronic="" hip:="" x-ray:="" hip.........................="" significant="" joint="" d="" destruction.="" physical="" examination="" --="" range="" of="" 30="" degrees="" flexion="" d="" motion.="" contracture.="" physical="" examination="" --="" range="" of=""><50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abduction........="" d="" motion.="" medical="" record="" review..............="" documented="" occurrence="" of="" d="" recurring="" infections="" with="" treatment.="" paget's="" disease:="" x-ray:="" hip.........................="" significant="" joint="" d="" destruction.="" physical="" examination="" --="" range="" of="" 30="" degrees="" flexion="" d="" motion.="" contracture.="" [[page="" 7584]]="" physical="" examination="" --="" range="" of=""><50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abudction........="" d="" motion.="" hip="" replacement="" surgery:="" x-ray:="" hip.........................="" evidence="" of="" artificial="" hip="" d="" joint.="" medical="" record="" review..............="" documentation="" of="" prior="" hip="" d="" replacement.="" ----------------------------------------------------------------------------------------------------------------="" body="" part:="" hip="" job="" title:="" shop="" laborer="" ----------------------------------------------------------------------------------------------------------------="" ankylosis,="" hip:="" physical="" examination="" --="" range="" of="" ankylosis="" 5="" degrees="" of="" d="" motion.="">flexion.
Physical examination -- range of Ankylosis internal rotation D
motion. >5 degrees.
Physical examination -- range of Ankylosis external rotation D
motion. >10 degrees.
Physical examination -- range of Ankylosis in abduction >5 D
motion. degrees.
Physical examination -- range of Ankylosis in adduction >5 D
motion. degrees.
Osteoarthritis, hip:
X-ray: hip......................... 0 mm cartilage interval..... D
Physical examination -- range of 30 degrees flexion D
motion. contracture.
Physical examination -- range of <50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abduction........="" d="" motion.="" osteomyelitis,="" chronic="" hip:="" x-ray:="" hip.........................="" significant="" joint="" d="" destruction.="" physical="" examination="" --="" range="" of="" 30="" degrees="" flexion="" d="" motion.="" contracture.="" physical="" examination="" --="" range="" of=""><50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abduction........="" d="" motion.="" medical="" record="" review..............="" documented="" occurrence="" of="" d="" recurring="" infections="" with="" treatment.="" paget's="" disease:="" x-ray;="" hip.........................="" significant="" joint="" d="" destruction.="" physical="" examination="" --="" range="" of="" 30="" degrees="" flexion="" d="" motion.="" contracture.="" physical="" examination="" --="" range="" of=""><50 degrees="" flexion.........="" d="" motion.="" physical="" examination="" --="" range="" of=""><5 degrees="" abduction........="" d="" motion.="" hip="" replacement="" surgery:="" x-ray:="" hip.........................="" evidence="" of="" artificial="" hip="" d="" joint.="" medical="" record="" review..............="" documentation="" of="" prior="" hip="" d="" replacement.="" ----------------------------------------------------------------------------------------------------------------="" j.="" knee="" ----------------------------------------------------------------------------------------------------------------="" confirmatory="" test="" minimum="" result="" requirements="" ----------------------------------------------------------------------------------------------------------------="" body="" part:="" knee="" confirmatory="" tests="" ----------------------------------------------------------------------------------------------------------------="" arthritis:="" knee:="" x-ray:="" knee........................="" evidence="" of="" significant="" recommended.="" degenerative="" changes.="" collateral="" ligament="" tear="" with="" laxity:="" physical="" examination:="" knee.........="" evidence="" of="" ligamentous="" highly="" recommended.="" laxity.="" 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="" highly="" recommended.="" laxity.="" medical="" record="" review..............="" documentation="" of="" tear="" by="" recommended.="" arthroscopy.="" cruciate="" ligament="" tear="" with="" laxity:="" physical="" examination:="" knee.........="" evidence="" of="" ligamentous="" highly="" recommended.="" laxity.="" magnetic="" resonance="" imaging.........="" evidence="" of="" cruciate="" tear...="" recommended.="" medical="" record="" review..............="" documentation="" of="" tear="" by="" recommended.="" arthroscopy.="" intercondylar="" fracture:="" x-ray:="" knee........................="" evidence="" of="" fracture........="" highly="" recommended.="" osteomyelitis:="" knee:="" medical="" record="" review..............="" documented="" history="" of="" highly="" recommended.="" osteomyelitis="" requiring="" treatment.="" x-ray:="" knee........................="" evidence="" of="" chronic="" recommended.="" infection.="" computerized="" tomography............="" evidence="" of="" chronic="" recommended.="" infection.="" magnetic="" resonance="" imaging.........="" evidence="" of="" chronic="" recommended.="" infection.="" osteonecrosis:="" x-ray:="" knee........................="" necrosis="" of="" femoral="" condyle="" recommended.="" or="" tibial="" plateau.="" computerized="" tomography............="" necrosis="" of="" femoral="" condyle="" recommended.="" or="" tibial="" plateau.="" magnetic="" resonance="" imaging.........="" necrosis="" of="" femoral="" condyle="" recommended.="" or="" tibial="" plateau.="" patellofemoral="" arthritis:="" x-ray:="" knee........................="" evidence="" of="" arthritis.......="" recommended.="" magnetic="" resonance="" imaging.........="" evidence="" of="" arthritis.......="" recommended.="" physical="" examination...............="" crepitation="" with="" movement...="" highly="" recommended.="" [[page="" 7585]]="" 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="" highly="" recommended.="" subluxation.="" 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="" range="" of="" motion:="" flexion=""><60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Meniscectomy, medial or lateral:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or="" d="" motion.="">degrees).
Collateral ligament tear with laxity:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Cruciate and collateral ligament
tear:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Cruciate ligament tear with laxity:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Intercondylar fracture:
Post fracture angulation........... >20 degrees angulation...... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Osteomyelitis, chronic knee:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
Medical record review.............. Frequent episodes of D
infection requiring
treatment.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Osteonecrosis:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Patellofemoral arthritis:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
[[Page 7586]]
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee: patello femoral joint.. 0 mm cartilage interval with D
degenerative change.
Patellar fracture nonunion with
displacement:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
X-ray knee......................... Nonunion and >3 mm D
displacement.
Plateau fracture:
Post fracture angulation........... >20 degrees angulation...... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Patellectomy:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Patellar, subluxation, recurrent:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Supracondylar fracture:
Post fracture angulation........... >20 degrees angulation...... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Tibial shaft fracture:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Post fracture angulation........... >20 degrees malalignment.... D
----------------------------------------------------------------------------------------------------------------
BODY PART: KNEE
JOB TITLE: ENGINEER
----------------------------------------------------------------------------------------------------------------
Arthritis knee:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Meniscectomy, medial or lateral:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Collateral ligament tear with laxity:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Cruciate and collateral ligament
tear:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Cruciate ligament tear with laxity:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Intercondylar fracture:
Post fracture angulation........... >20 degrees angulation...... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Osteomyelitis, chronic knee:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
Medical record review.............. Frequent episodes of D
infection requiring
treatment.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Osteonecrosis:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Patellofemoral arthritis:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee: patello femoral joint.. 0 mm cartilage interval with D
degenerative change.
Patellar fracture nonunion with
displacement:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" [[page="" 7587]]="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
X-ray knee......................... Nonunion and >3 mm D
displacement.
Plateau fracture:
Post fracture angulation........... >20 degrees angulation...... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Patellectomy:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Patellar, subluxation, recurrent:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Supracondylar fracture:
Post fracture angulation........... >20 degrees angulation...... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Tibial shaft fracture:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Post fracture angulation........... >20 degrees malalignment.... D
----------------------------------------------------------------------------------------------------------------
BODY PART: KNEE
JOB TITLE: CARMAN
----------------------------------------------------------------------------------------------------------------
Arthritis knee:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Meniscectomy, medial or lateral:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Collateral ligament tear with laxity:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Cruciate and collateral ligament
tear:.
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Cruciate ligament tear with laxity:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Intercondylar fracture:
Post fracture angulation........... >20 degrees angulation...... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Osteomyelitis, chronic knee:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
Medical record review.............. Frequent episodes of D
infection requiring
treatment.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Osteonecrosis:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Patellofemoral arthritis:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee: patello femoral joint.. 0 mm cartilage interval with D
degenerative change.
Patellar fracture nonunion with
displacement:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
X-ray knee......................... Nonunion and >3 mm D
displacement.
Plateau fracture:
Post fracture angulation........... >20 degrees angulation...... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" [[page="" 7588]]="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Patellectomy:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Patellar, subluxation, recurrent:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Supracondylar fracture:
Post fracture angulation........... >20 degrees angulation...... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Tibial shaft fracture:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Post fracture angulation........... >20 degrees malalignment.... D
----------------------------------------------------------------------------------------------------------------
BODY PART: KNEE
JOB TITLE: SIGNALMAN
----------------------------------------------------------------------------------------------------------------
Arthritis knee:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Meniscectomy, medial or lateral:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Collateral ligament tear with laxity:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Cruciate and collateral ligament
tear:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Cruciate ligament tear with laxity:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Intercondylar fracture:
Post fracture angulation........... >20 degrees angulation...... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Osteomyelitis, chronic knee:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
Medical record review.............. Frequent episodes of D
infection requiring
treatment.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Osteonecrosis:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Patellofemoral arthritis:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee: patello femoral joint.. 0 mm cartilage interval with D
degenerative change.
Patellar fracture nonunion with
displacement:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
X-ray knee......................... Nonunion and >3 mm D
displacement.
Plateau fracture:
Post fracture angulation........... >20 degrees angulation...... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Patellectomy:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Patellar, subluxation, recurrent:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" [[page="" 7589]]="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Supracondylar fracture:
Post fracture angulation........... >20 degrees angulation...... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Tibial shaft fracture:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Post fracture angulation........... >20 degrees malalignment.... D
----------------------------------------------------------------------------------------------------------------
BODY PART: KNEE
JOB TITLE: TRACKMAN
----------------------------------------------------------------------------------------------------------------
Arthritis knee:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Meniscectomy, medial or lateral:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Collateral ligament tear with laxity:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Cruciate and collateral ligament
tear:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Cruciate ligament tear with laxity:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Intercondylar fracture:
Post fracture angulation........... >20 degree angulation....... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Osteomyelitis, chronic knee:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
Medical record review.............. Frequent episodes of D
infection requiring
treatment.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Osteonecrosis:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Patellofemoral arthritis:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee: patello femoral joint.. 0 mm cartilage interval with D
degenerative change.
Patellar fracture nonunion with
displacement:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
X-ray knee......................... Nonunion and >3 mm D
displacement.
Plateau fracture:
Post fracture angulation........... >20 degrees angulation...... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Patellectomy:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Patellar, subluxation, recurrent:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Supracondylar fracture:
Post fracture angulation........... >20 degrees angulation...... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
[[Page 7590]]
Tibial shaft fracture:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Post fracture angulation........... >20 degrees malalignment.... D
----------------------------------------------------------------------------------------------------------------
BODY PART: KNEE
JOB TITLE: MACHINIST
----------------------------------------------------------------------------------------------------------------
Arthritis knee:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Meniscectomy, medial or lateral:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Collateral ligament tear with laxity:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Cruciate and collateral ligament
tear:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Cruciate ligament tear with laxity:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Intercondylar fracture:
Post fracture angulation........... >20 degrees angulation...... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Osteomyelitis, chronic knee:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
Medical record review.............. Frequent episodes of D
infection requiring
treatment.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Osteonecrosis:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Patellofemoral arthritis:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee......................... 0 mm cartilage interval with D
degenerative change.
Patellar fracture nonunion with
displacement:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
X-ray knee......................... Nonunion and >3 mm D
displacement.
Plateau fracture:
Post fracture angulation........... >20 degrees angulation...... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Patellectomy:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Patellar, subluxation, recurrent:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Supracondylar fracture:
Post fracture angulation........... >20 degrees angulation...... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Tibial shaft fracture:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Post fracture angulation........... >20 degrees malalignment.... D
----------------------------------------------------------------------------------------------------------------
[[Page 7591]]
BODY PART: KNEE
JOB TITLE: SHOP LABORER
----------------------------------------------------------------------------------------------------------------
Arthritis knee:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Meniscectomy, medial or lateral:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Collateral ligament tear with laxity:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Cruciate and collateral ligament
tear:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Cruciate ligament tear with laxity:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Intercondylar fracture:
Post fracture angulation........... >20 degrees angulation...... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Osteomyelitis, chronic knee:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
Medical record review.............. Frequent episodes of D
infection requiring
treatment.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Osteonecrosis:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee......................... 0 - 1 mm cartilage interval D
with degenerative change.
Patellofemoral arthritis:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Physical examination............... Valgus deformity, 16 - 20 D
degrees.
Physical examination............... Varus deformity, 8 - 12 D
degrees.
X-ray knee: patellofemoral joint... 0 mm cartilage interval with D
degenerative change.
Patellar fracture nonunion with
displacement:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
X-ray knee......................... Nonunion and >3 mm D
displacement.
Plateau fracture:
Post fracture angulation........... >20 degrees angulation...... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Patellectomy:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Patellar, subluxation, recurrent:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Supracondylar fracture:
Post fracture angulation........... >20 degrees angulation...... D
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Tibial shaft fracture:
Physical examination -- range of Range of motion: flexion <60 d="" motion.="" degrees.="" physical="" examination="" --="" range="" of="" flexion="" contracture="" (20="" or=""> D
motion. degrees).
Post fracture angulation........... >20 degrees malalignment.... D
----------------------------------------------------------------------------------------------------------------
[[Page 7592]]
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 Recommended.
fracture.
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 Highly recommended.
arthritis: subtalar joint.
Arthritis, talonavicular joint:
X-ray: ankle....................... Significant arthritis: Highly recommended.
talonavicular joint.
Achilles tendon rupture:
Medical record review.............. Documentation of achilles Highly recommended.
tendon rupture.
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 Highly recommended.
condition.
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 D
fracture.
Physical examination............... Varus deformity >15 degrees. D
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" ankylosis,="" ankle:="" physical="" examination="" --="" range="" of="" ankylosis="" in="" 20="" degree="" or=""> D
motion. dorsiflexion.
Physical examination -- range of Ankylosis in 20 degree D
motion. plantar flexion.
Physical examination -- range of Ankylosis in int or ext D
motion. malrotation >15 degrees.
Physical examination -- range of Ankylosis in varus 10 or D
motion. more degrees.
Physical examination -- range of Ankylosis in valgus 10 or D
motion. more degrees.
Arthritis, subtalar joint (hindfoot):
X-ray: ankle -- subtalar joint..... Subtalar joint space 0 mm... D
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Arthritis, talonavicular joint
(hindfoot):
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" x-ray:="" ankle="" --="" talonavicular="" joint="" talonavicular="" joint="" space="" 0="" d="" mm.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Achilles tendon rupture:
Physical examination -- range of Plantar flexion capability, D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture,="" d="" motion.="" 20="" degrees.="" arthritis,="" ankle:="" x-ray:="" ankle.......................="" 0="" mm........................="" d="" physical="" examination="" --="" range="" of="" plantar="" flexion="" capability,="" d="" motion.=""><5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture,="" d="" motion.="" 20="" degrees.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Hindfoot fracture:
X-ray: foot........................ Calcaneal fracture with D
Boehler angle <95 degrees.="" x-ray:="" foot........................="" subtalar="" fracture="" with="" d="" boehler="" angle=""><95 degrees.="" physical="" examination...............="" varus="" angulation="">20 degrees D
(hindfoot).
Physical examination............... Valgus angulation >20 D
degrees (hindfoot).
Rheumatoid arthritis, foot:
X-ray: foot........................ Significant degeneration.... D
Medical record review.............. Chronic flare-up with D
treatment.
----------------------------------------------------------------------------------------------------------------
[[Page 7593]]
BODY PART: ANKLE AND FOOT
JOB TITLE: ENGINEER
----------------------------------------------------------------------------------------------------------------
Ankle fracture:
X-ray: ankle....................... Displaced intra-articular D
fracture.
Physical examination............... Varus deformity >15 degrees. D
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" ankylosis,="" ankle:="" physical="" examination="" --="" range="" of="" ankylosis="" in="" 20="" degree="" or=""> D
motion. dorsiflexion.
Physical examination -- range of Ankylosis in 20 degree D
motion. plantar flexion.
Physical examination -- range of Ankylosis in int or ext D
motion. malrotation >15 degrees.
Physical examination -- range of Ankylosis in varus 10 or D
motion. more degrees.
Physical examination -- range of Ankylosis in valgus 10 or D
motion. more degrees.
Arthritis, subtalar joint (hindfoot):
X-ray: ankle -- subtalar joint..... Subtalar joint space 0 mm... D
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Arthritis, talonavicular joint
(hindfoot):
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" x-ray="" ankle="" --="" talonavicular="" joint.="" talonavicular="" joint="" space="" 0="" d="" mm.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Achilles tendon rupture:
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" arthritis,="" ankle:="" x-ray:="" ankle.......................="" 0="" mm........................="" d="" physical="" examination="" --="" range="" of="" plantar="" flexion="" capability="" d="" motion.=""><5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Hindfoot fracture:
X-ray: foot........................ Calcaneal fracture with D
Boehler angle <95 degrees.="" x-ray:="" foot........................="" subtalar="" fracture="" with="" d="" boehler="" angle=""><95 degrees.="" physical="" examination...............="" varus="" angulation="">20 degrees D
(hindfoot).
Physical examination............... Valgus angulation >20 D
degrees (hindfoot).
Rheumatoid arthritis, foot:
X-ray: foot........................ Significant degeneration.... D
Medical record review.............. Chronic flare-up with D
treatment.
----------------------------------------------------------------------------------------------------------------
BODY PART: ANKLE AND FOOT
JOB TITLE: DISPATCHER
----------------------------------------------------------------------------------------------------------------
Achilles tendon rupture:
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" arthritis,="" ankle:="" x-ray:="" ankle.......................="" 0="" mm........................="" d="" physical="" examination="" --="" range="" of="" plantar="" flexion="" capability="" d="" motion.=""><5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Hindfoot fracture:
X-ray: foot........................ Calcaneal fracture with D
Boehler angle <95 degrees.="" x-ray:="" foot........................="" subtalar="" fracture="" with="" d="" boehler="" angle=""><95 degrees.="" physical="" examination...............="" varus="" angulation="">20 degrees D
(hindfoot).
Physical examination............... Valgus angulation >20 D
degrees (hindfoot).
Rheumatoid arthritis, foot:
X-ray: foot........................ Significant degeneration.... D
Medical record review.............. Chronic flare-up with D
treatment.
----------------------------------------------------------------------------------------------------------------
BODY PART: ANKLE AND FOOT
JOB TITLE: CARMAN
----------------------------------------------------------------------------------------------------------------
Ankle fracture:
X-ray: ankle....................... Displaced intra-articular D
fracture.
Physical examination............... Varus deformity >15 degrees. D
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" ankylosis,="" ankle:="" physical="" examination="" --="" range="" of="" ankylosis="" in="" 20="" degree="" or=""> D
motion. dorisiflexion.
Physical examination -- range of Ankylosis in 20 degree D
motion. plantar flexion.
[[Page 7594]]
Physical examination -- range of Ankylois in int or ext D
motion. malrotation >15 degrees.
Physical examination -- range of Ankylosis in varus 10 or D
motion. more degrees.
Physical examination -- range of Ankylosis in valgus 10 or D
motion. more degrees.
Arthritis, subtalar joint (hindfoot):
X-ray: ankle -- subtalar joint..... Subtalar joint space 0 mm... D
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Arthritis, talonavicular joint
(hindfoot):
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" x-ray:="" ankle="" --="" talonavicular="" joint="" talonavicular="" joint="" space="" 0="" 0="" mm.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Achilles tendon rupture:
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" arthritis,="" ankle:="" x-ray:="" ankle.......................="" 0="" mm........................="" d="" physical="" examination="" --="" range="" of="" plantar="" flexion="" capability="" d="" motion.=""><5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Hindfoot fracture:
X-ray: foot........................ Calcaneal fracture with D
Boehler angle <95 degrees.="" x-ray:="" foot........................="" subtalar="" fracture="" with="" d="" boehler="" angle=""><95 degrees.="" physical="" examination...............="" varus="" angulation="">20 degrees D
(hindfoot).
Physical examination............... Valgus angulation >20 D
degrees (hindfoot).
Rheumatoid arthritis, foot:
X-ray: foot........................ Significant degeneration.... D
Medical record review.............. Chronic flare -- up with D
treatment.
----------------------------------------------------------------------------------------------------------------
BODY PART: ANKLE AND FOOT
JOB TITLE: SIGNALMAN
----------------------------------------------------------------------------------------------------------------
Ankle fracture:
X-ray: ankle....................... Displaced intra-articular D
fracture.
Physical examination............... Varus deformity >15 degrees. D
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" ankylosis,="" ankle:="" physical="" examination="" --="" range="" of="" ankylosis="" in="" 20="" degree="" or=""> D
motion. dorsiflexion.
Physical examination -- range of Ankylosis in 20 degree D
motion. plantar flexion.
Physical examination -- range of Ankylosis in int or ext D
motion. malrotation >15 degrees.
Physical examination -- range of Ankylosis in varus 10 or D
motion. more degrees.
Physical examination -- range of Ankylosis in valgus 10 or D
motion. more degrees.
Arthritis, subtalar joint (hindfoot):
X-ray: ankle -- subtalar joint..... Subtalar joint space 0 mm... D
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Arthritis, talonavicular joint
(hindfoot):
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" x-ray:="" ankle="" --="" talonavicular="" joint="" talonavicular="" joint="" space="" 0="" d="" mm.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Achilles tendon rupture:
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" arthritis,="" ankle:="" x-ray:="" ankle.......................="" 0="" mm........................="" d="" physical="" examination="" --="" range="" of="" plantar="" flexion="" capability="" d="" motion.=""><5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Hindfoot fracture:
X-ray: foot........................ Calcaneal fracture with D
Boehler angle <95 degrees.="" x-ray:="" foot........................="" subtalar="" fracture="" with="" d="" boehler="" angle=""><95 degrees.="" physical="" examination...............="" varus="" angulation="">20 degrees D
(hindfoot).
Physical examination............... Valgus angulation >20 D
degrees (hindfoot).
Rheumatoid arthritis, foot:
X-ray: foot........................ Significant degeneration.... D
Medical record review.............. Chronic flare-up with D
treatment.
----------------------------------------------------------------------------------------------------------------
[[Page 7595]]
BODY PART: ANKLE AND FOOT
JOB TITLE: TRACKMAN
----------------------------------------------------------------------------------------------------------------
Ankle fracture:
X-ray: ankle....................... Displaced intra-articular D
fracture.
Physical examination -- range of Varus deformity >15 degrees. D
motion.
Physical examinaton -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" ankylosis,="" ankle:="" physical="" examination="" --="" range="" of="" ankylosis="" in="" 20="" degree="" or=""> D
motion. dorsiflexion.
Physical examination -- range of Ankylosis in 20 degree D
motion. plantar flexion.
Physical examination -- range of Ankylosis in int or ext D
motion. malrotation >15 degrees.
Physical examination -- range of Ankylosis in varus 10 or D
motion. more degrees.
Physical examination -- range of Ankylosis in valgus 10 or D
motion. more degrees.
Arthritis, subtalar joint (hindfoot):
X-ray: ankle -- subtalar joint..... Subtalar joint space 0 mm... D
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Arthritis, talonavicular joint
(hindfoot):
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" x-ray:="" angle="" --="" talonavicular="" joint="" talonavicular="" joint="" space="" 0="" d="" mm.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Achilles tendon rupture:
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" arthritis,="" ankle:="" x-ray:="" ankle.......................="" 0="" mm........................="" d="" physical="" examination="" --="" range="" of="" plantar="" flexion="" capability="" d="" motion.=""><5 degrees.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Hindfoot fracture:
X-ray: foot........................ Calcaneal fracture with D
Boehler angle <95 degrees.="" x-ray:="" foot........................="" subtalar="" fracture="" with="" d="" boehler="" angle=""><95 degrees.="" physical="" examination...............="" varus="" angulation="">20 degrees D
(hindfoot).
Physical examination............... Valgus angulation >20 D
degrees (hindfoot).
Rheumatoid arthritis, foot:
X-ray: foot........................ Significant degeneration.... D
Medical record review.............. Chronic flare-up with D
treatment.
----------------------------------------------------------------------------------------------------------------
BODY PART: ANKLE AND FOOT
JOB TITLE: MACHINIST
----------------------------------------------------------------------------------------------------------------
Ankle fracture:
X-ray: ankle....................... Displaced intra-articular D
fracture.
Physical examination............... Varus deformity >15 degrees. D
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" ankylosis,="" ankle:="" physical="" examination="" --="" range="" of="" ankylosis="" in="" 20="" degree="" or=""> D
motion. dorsiflexion.
Physical examination -- range of Ankylosis in 20 degree D
motion. plantar flexion.
Physical examination -- range of Ankylosis in int or ext D
motion. malrotation >15 degrees.
Physical examination -- range of Ankylosis in varus 10 or D
motion. more degrees.
Physical examination -- range of Ankylosis in valgus 10 or D
motion. more degrees.
Arthritis, subtalar joint (hindfoot):
X-ray: ankle -- subtalar joint..... Subtalar joint space 0 mm... D
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Arthritis, talonavicular joint
(hindfoot):
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" x-ray:="" ankle="" --="" talonavicular="" joint="" talonavicular="" joint="" space="" 0="" d="" mm.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Achilles tendon rupture:
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" arthritis,="" ankle:="" x-ray:="" ankle.......................="" 0="" mm........................="" d="" physical="" examination="" --="" range="" of="" plantar="" flexion="" capability="" d="" motion.=""><5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
[[Page 7596]]
Hindfoot fracture:
X-ray: foot........................ Calcaneal fracture with D
Boehler angle <95 degrees.="" x-ray:="" foot........................="" subtalar="" fracture="" with="" d="" boehler="" angle=""><95 degrees.="" physical="" examination...............="" varus="" angulation="">20 degrees D
(hindfoot).
Physical examination............... Valgus angulation >20 D
degrees (hindfoot).
Rheumatoid arthritis, foot:
X-ray: foot........................ Significant degeneration.... D
Medical record review.............. Chronic flare-up with D
treatment.
----------------------------------------------------------------------------------------------------------------
BODY PART: ANKLE AND FOOT
JOB TITLE: SHOP LABORER
----------------------------------------------------------------------------------------------------------------
Ankle fracture:
X-ray: ankle....................... Displaced intra-articular D
fracture.
Physical examination............... Varus deformity >15 degrees. D
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" ankylosis,="" ankle:="" physical="" examination="" --="" range="" of="" ankylosis="" in="" 20="" degree="" or=""> D
motion. dorsiflexion.
Physical examination -- range of Ankylosis in 20 degree D
motion. plantar flexion.
Physical examination -- range of Ankylosis in int or ext D
motion. malrotation >15 degrees.
Physical examination -- range of Ankylosis in varus 10 or D
motion. more degrees.
Physical examination -- range of Ankylosis in valgus 10 or D
motion. more degrees.
Arthritis, subtalar joint (hindfoot):
X-ray: ankle -- subtalar joint..... Subtalar joint space 0 mm... D
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Arthritis, talonavicular joint
(hindfoot):
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" x-ray:="" ankle="" --="" talonavicular="" joint="" talonavicular="" joint="" space="" 0="" d="" mm.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Achilles tendon rupture:
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" arthritis,="" ankle:="" x-ray:="" ankle.......................="" 0="" mm........................="" d="" physical="" examination="" --="" range="" of="" plantar="" flexion="" capability="" d="" motion.=""><5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Hindfoot fracture:
X-ray: foot........................ Calcaneal fracture with D
Boehler angle <95 degrees.="" x-ray:="" foot........................="" subtalar="" fracture="" with="" d="" boehler="" angle=""><95 degrees.="" physical="" examination...............="" varus="" angulation="">20 degrees D
(hindfoot).
Physical examination............... Valgus angulation >20 D
degrees (hindfoot).
Rheumatoid arthritis, foot:
X-ray: foot........................ Significant degeneration.... D
Medical record review.............. Chronic flare-up with D
treatment.
[[Page 7597]]
----------------------------------------------------------------------------------------------------------------
Disability test Test result Disability classification
----------------------------------------------------------------------------------------------------------------
BODY PART: ANKLE AND FOOT
JOB TITLE: SALES REPRESENTATIVES
----------------------------------------------------------------------------------------------------------------
Achilles tendon rupture:
Physical examination -- range of Plantar flexion capability D
motion. <5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" arthritis,="" ankle:="" x-ray:="" ankle.......................="" 0="" mm........................="" d="" physical="" examination="" --="" range="" of="" plantar="" flexion="" capability="" d="" motion.=""><5 degrees.="" physical="" examination="" --="" range="" of="" plantar="" flexion="" contracture="" d="" motion.="" 20="" degrees.="" physical="" examination...............="" varus="" deformity="">15 degrees. D
Hindfoot fracture:
X-ray: foot........................ Calcaneal fracture with D
Boehler angle <95 degrees.="" x-ray:="" foot........................="" subtalar="" fracture="" with="" d="" boehler="" angle=""><95 degrees.="" physical="" examination...............="" varus="" angulation="">20 degrees D
(hindfoot).
Physical examination............... Valgus angulation >20 D
degrees (hindfoot).
Rheumatoid arthritis, foot:
X-ray: foot........................ Significant degeneration.... D
Medical record review.............. Chronic flare-up with D
treatment.
----------------------------------------------------------------------------------------------------------------
BILLING CODE 7905-01-P
[[Page 7598]]
Job Information Forms
[GRAPHIC] [TIFF OMITTED] TR13FE98.000
[[Page 7599]]
[GRAPHIC] [TIFF OMITTED] TR13FE98.001
[[Page 7600]]
[GRAPHIC] [TIFF OMITTED] TR13FE98.002
[[Page 7601]]
[GRAPHIC] [TIFF OMITTED] TR13FE98.003
[[Page 7602]]
Dated: January 14, 1998.
Beatrice Ezerski,
Secretary to the Board.
[FR Doc. 98-2026 Filed 2-12-98; 8:45 am]
BILLING CODE 7905-01-C
