Determining Disability

SUMMARY: The Board proposes to amend its regulations in order to adopt

standards for determining when an employee is disabled for his or her

regular railroad occupation.

DATES: Comments should be submitted on or before October 24, 1997.

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 work 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in 1946 but which are now outdated.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 these regulations if an

employee's physical or mental condition does not meet a listing found

in Appendix 1 of Part 200 (which determines if an individual is able to

engage in any employment both within and outside the railroad industry)

then 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 proposes to amend Subpart C to

add such standards with respect to certain railroad occupations.

Proposed Sec. 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 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.

Proposed Sec. 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 proposed to be removed, and the current

Sec. 220.14 ``Evidence Considered'' is proposed to be redesignated

Sec. 220.12.

The introductory language and paragraph (a) of proposed Sec. 220.13

follows the present regulation and describes 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.

Proposed Sec. 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

only upon the employee's description of his or her job.

Proposed Sec. 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)

using valid diagnostic tests set forth in Appendix 3. (Proposed

Sec. 220.13(b)(2)(ii).) Once the impairment(s) is confirmed, Appendix 3

is applied to determine if the employee is disabled. (Proposed

Sec. 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 proposed Sec. 220.13(b)(2)(iv).

Likewise, if Appendix 3 does not yield a ``disabled'' finding ICE will

apply.

Proposed Sec. 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 proposed 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 proposed 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 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 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

[[Page 50057]]

disabled. If the demands do not exceed the residual functional

capacity, then the Board will find the employee not disabled (Step 6).

The Board has determined that this is a significant rule under

Executive Order 12866.

Proposed section 220.13(b)(2)(iv)(E) contains information

collection requirements. As required by the Paperwork Reduction Act of

1995 (44 U.S.C. 3507(d)), the Board has submitted a copy of this

section to the Office of Management and Review (OMB) for its review.

Collection of Information: Job Information Report. This proposed

rule would offer the applicant's railroad employer the opportunity to

voluntarily provide information on the applicant's job duties which may

be utilized in determining the applicant's eligibility to an

occupational disability. Two forms are proposed for this purpose. One

form, G-251a, Employer Job Information (job description), would be used

when a generic job description has been developed for the job the

applicant claims to be his regular job; the other form (G-251b),

Employer Job Information (general), would be used when no generic job

description has been developed. The RRB estimates that each form takes

20 minutes to complete, and that of the estimated 3,500 forms that

would be sent to the applicants' railroad employers annually, 1,750 (or

50 percent) will be completed and returned. The annual burden imposed

as a result of this proposed rule would be 584 hours (1,750 responses

x \1/3\ hour per response).

Organizations and individuals desiring to submit comments on the

information collection requirements should direct them to Laura Oliven,

the Office of Information and Regulatory Affairs, Office of Management

and Budget, New Executive Office Building, 226 Jackson Place, NW., Room

10235, Washington, D.C. 20503 and to Ronald J. Hodapp, Railroad

Retirement Board, 844 North Rush Street, Chicago, Illinois, 60611-2092.

The RRB considers comments by the public on this proposed

collection of information in--

(a) Evaluating whether the proposed collection of information is

necessary for the proper performance of the functions of the RRB,

including whether the information will have a practical use;

(b) Evaluating the accuracy of the RRB's estimate of the burden on

the proposed collection of information, including the validity of the

methodology and assumptions used;

(c) Enhancing the quality, usefulness, and clarity of the

information to be collected; and

(d) Minimizing the burden of collection of information on those who

are to respond, including the use of appropriate electronic,

mechanical, or other automated collection techniques.

OMB is required to make a decision concerning the collection of

information contained in these proposed regulations between 30 and 60

days after publication of this document in the Federal Register.

Therefore, a comment to OMB is best assured of having its full effect

if OMB receives it within 15 days of publication. This does not affect

the deadline for the public to comment to the RRB on the proposed

regulations.

List of Subjects in 20 CFR Part 220

Disability benefits, Railroad employees, Railroad retirement.

PART 220--DETERMINING DISABILITY

For the reasons set forth in the preamble, Part 220 of Title 20 of

the Code of Federal Regulations is proposed to be amended as follows:

1. The authority for Part 220 continues to read as follows:

Authority: 45 U.S.C. 231a; 45 U.S.C. 231f.

2. The title 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 or

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 co-operation of employers and

employees. This subpart is supplemented by an Occupational Disability

Claims Manual (Manual) which was also developed with the co-operation

of employers and employees.

(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,

and 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.

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.

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.

Residual functional capacity has the same meaning as found in

Sec. 220.120 of this part.

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.

[[Page 50058]]

Sec. 220.13 [Amended]

6. Section 220.13 is amended by revising the section heading, the

introductory text and paragraph (b) to read as follows:

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:

(a) * * *

(b) If the Board finds that the claimant does not have an

impairment described in (a) above, it will--

(1) Determine the employee's regular railroad occupation, as

defined in Sec. 220.11 of this part, 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) 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

valid diagnostic tests accepted by the medical community as set forth

in Appendix 3 of this part. See also Sec. 220.27 of this part. Once the

Board determines that Appendix 3 of this part applies, only in

situations where there are significant differences in objective tests

such as imaging study, electrocardiograms or other test results, and

these differences cannot be readily resolved, will the Board determine

if the employee is disabled under the ICE as set forth in paragraph

(b)(2)(iv) of this section.

(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'' 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 impairments(s) has not been

confirmed, as provided for in paragraph (b)(2)(ii) of this section, the

Board will next confirm the employee's impairment(s), as described in

paragraph (b)(2)(ii) 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 of this part, which describes

the weight to be given to the opinions of various physicians, and

Sec. 220.114 of this part, which describes how the Board evaluates

symptoms such as pain. The Board will also assess the weight of

evidence by utilizing Sec. 220.14 of this part 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 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 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 of this part.

(F) Step 6. Based upon the assessment of the evidence in paragraph

(b)(2)(iv) 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.

(b) Factors which support lesser weight. Evidence will generally be

given lesser weight if it meets one or more of the following criteria:

[[Page 50059]]

(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 are 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.

Appendix 3--Railroad Retirement Board Occupational Disability Standards

8. Appendix 3--Railroad Retirement Board Occupational Disability

Standards is added to part 220 to read as follows:

BILLING CODE 7905-01-P

[[Page 50060]]

Appendix 3 to Part 220--Railroad Retirement Board Occupational

Disability Standards

[GRAPHIC] [TIFF OMITTED] TP24SE97.000

[[Page 50061]]

[GRAPHIC] [TIFF OMITTED] TP24SE97.001

[[Page 50062]]

[GRAPHIC] [TIFF OMITTED] TP24SE97.002

[[Page 50063]]

[GRAPHIC] [TIFF OMITTED] TP24SE97.003

BILLING CODE 7905-01-C

[[Page 50064]]

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 which 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 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:

[[Page 50065]]

Local....................................... .............. 84.5 2 S

Regional.................................... .............. 50.7 2 S

Distant..................................... .............. 5.3 1 S

Esophagus:

Local....................................... .............. 18.5 1 S

Regional.................................... .............. 5.2 1 S

Distant..................................... .............. 1.8 1 S

Hodgkin's Disease: \4\

Stage 1..................................... .............. 90-95 3 S

Stage 2..................................... .............. 86 2 S

Stage 3..................................... .............. 60%) Recommended.

of one vessel.

Cardiomyopathy:

Echocardiogram................... Proven ejection fraction 7 METS.... D

Aortic valve disease:

Cardiac catheterization.......... Aortic gradient 25-50 mm HG..

Echocardiogram................... Decreased ejection fraction D

40-55%.

Echocardiogram................... Poor ejection fraction 7 D

METS.

Isotope, e.g., thallium study.... Definite ischemia 7 D

METS.

Cardiomyopathy:

Cardiac catheterization.......... Decreased ejection fraction D

40-55%.

Cardiac catheterization.......... Poor ejection fraction 120 and systolic D

>160, 50% of the time.

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).

Arrhythmic: 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 5-10 mm D

Hg.

Cardiac catheterization.......... Mitral valve gradient >10 mm D

Hg.

Cardiac catheterization.......... Mitral regurgitation severe.. D

Cardiac catheterization.......... Decreased ejection fraction D

50-55%.

Cardiac catheterization.......... Poor ejection fraction 7 METS.... D

Aortic valve disease:

Cardiac catheterization.......... Aortic gradient 25-50 mm HG.. D

Echocardiogram................... Decreased ejection fraction D

40-55%.

Echocardiogram................... Poor ejection fraction 7 D

METS.

Isotope, e.g., thallium study.... Definite ischemia 7 D

METS.

Cardiomyopathy:

Cardiac catheterization.......... Decreased ejection fraction D

40-55%.

Cardiac catheterization.......... Poor ejection fraction 35%... D

Echocardiogram................... Decreased ejection fraction D

40-55%.

Echocardiogram................... Poor ejection fraction 120 and systolic D

>160, 50% of the time.

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 5-10 mm D

Hg.

Cardiac catheterization.......... Mitral valve gradient >10 mm D

Hg.

Cardiac catheterization.......... Mitral regurgitation severe.. D

Cardiac catheterization.......... Decreased ejection fraction D

40-55%.

Cardiac catheterization.......... Poor ejection fraction 7 METS.... D

changes.

[[Page 50069]]

Aortic valve disease:

Cardiac catheterization.......... Aortic gradient 25-50 mm Hg.. D

Echocardiogram................... Decreased ejection fraction D

40-55%.

Echocardiogram................... Poor ejection fraction 7 D

METS.

Isotope, e.g., thallium study.... Definite ischemia 7 D

METS.

Cardiomyopathy:

Cardiac catheterization.......... Decreased ejection fraction D

40-55%.

Cardiac catheterization.......... Poor ejection fraction 120 and systolic D

>160, 50% of the time.

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 5-10 mm D

Hg.

Cardiac catheterization.......... Mitral valve gradient >10 mm D

Hg.

Cardiac catheterization.......... Mitral regurgitation severe.. D

Cardiac catheterization.......... Decreased ejection fraction D

40-55%.

Cardiac catheterization.......... Poor ejection fraction 7 METS.... D

changes.

Aortic valve disease:

Cardiac catheterization.......... Aortic gradient 25-50 mm HG..

Echocardiogram................... Decreased ejection fraction D

40-55%.

Echocardiogram................... Poor ejection fraction 7 D

METS.

Isotope, e.g., thallium study.... Definite ischemia 7 D

METS.

Cardiomyopathy:

Cardiac catheterization.......... Decreased ejection fraction D

40-55%.

Cardiac catheterization.......... Poor ejection fraction 120 and systolic D

>160, 50% of the time.

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 5-10 mm D

Hg.

Cardiac catheterization.......... Mitral valve gradient >10 mm D

Hg.

Cardiac catheterization.......... Mitral regurgitation severe.. D

Cardiac catheterization.......... Decreased ejection fraction D

40-55%.

Cardiac catheterization.......... Poor ejection fraction 7 D

METS.

Isotope, e.g., thallium study.... Definite ischemia 7 D

METS.

Cardiomyopathy:

Cardiac catheterization.......... Decrease ejection fraction 40- D

55%.

Cardiac catheterization.......... Poor ejection fraction 120 and systolic D

>160, 50% of the time.

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 5-10 mm D

Hg.

Cardiac catheterization.......... Mitral valve gradient >10 mm D

Hg.

Cardiac catherization............ Mitral reguragitation severe. D

Cardiac catheterization.......... Decrease ejection fraction 40- D

55%.

Cardiac catheterization.......... Poor ejection fraction 7 METS... D

changes.

Aortic valve disease:

Cardiac catheterization.......... Aortic gradient 25-50 mm HG.. D

Echocardiogram................... Decreased ejection fraction D

40-55%.

Echocardiogram................... Poor ejection fraction 7 D

METS.

Isotope, e.g., thallium study.... Definite ischemia 7 D

METS.

[[Page 50072]]

Cardiomyopathy:

Cardiac catheterization.......... Decreased ejection fraction D

40-55%.

Cardiac catheterization.......... Poor ejection fraction 120 and systolic D

>160, 50% of the time.

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 5-10 mm D

Hg.

Cardiac catheterization.......... Mitral valve gradient >10 mm D

Hg.

Cardiac catheterization.......... Mitral regurgitation severe.. D

Cardiac catheterization.......... Decreased ejection fraction D

40-55%.

Cardiac catheterization.......... Poor ejection fraction 7 METS.... D

changes.

Aortic valve disease:

Cardiac catheterization.......... Aortic gradient 25-50 mm HG..

Echocardiogram................... Decreased ejection fraction D

40-55%.

Echocardiogram................... Poor ejection fraction 7 D

METS.

Isotope, e.g., thallium study.... Definite ischemia 7 D

METS.

Cardiomyopathy:

Cardiac catheterization.......... Decreased ejection fraction D

40-55%.

Cardiac catheterization.......... Poor ejection fraction 120 and systolic D

>160, 50% of the time.

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 5-10 mm D

Hg.

Cardiac catheterization.......... Mitral valve gradient >10 mm D

Hg.

Cardiac catheterization.......... Mitral regurgitation severe.. D

Cardiac catheterization.......... Decreased ejection fraction D

40-55%.

Cardiac catheterization.......... Poor ejection fraction 5 METS........ D

Medical record review............ Unstable as diagnosed by D

cardiologist.

Stress test...................... Documented hypotensive D

response.

Stress test: significant ST Definite ischemia 7 METS.... D

changes.

Aortic valve disease:

Cardiac catheterization.......... Aortic gradient 25-50 mm HG..

Echocardiogram................... Decreased ejection fraction D

40-55%.

Echocardiogram................... Poor ejection fraction 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.......... Decreased ejection fraction D

40-55%.

Cardiac catheterization.......... Poor ejection fraction 7 D

METS.

Isotope, e.g., thallium study.... Definite ischemia 7 D

METS.

Cardiomyopathy:

Cardiac catheterization.......... Decreased ejection fraction D

40-55%.

Cardiac catheterization.......... Poor ejection fraction 120 and systolic D

>160, 50% of the time.

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:

[[Page 50074]]

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 5-10 mm D

Hg.

Cardiac catheterization.......... Mitral valve gradient >10 mm D

Hg.

Cardiac catheterization.......... Mitral regurgitation severe.. D

Cardiac catheterization.......... Decreased ejection fraction D

40-55%.

Cardiac catheterization.......... Poor ejection fraction 7 METS.... D

changes.

Aortic valve disease:

Cardiac catheterization.......... Aortic gradient 25-50 mm HG.. D

Echocardiogram................... Decreased ejection fraction D

40-55%.

Echocardiogram................... Poor ejection fraction 7 D

METS.

Isotope, e.g., thallium study.... Definite ischemia 7 D

METS.

Cardiomyopathy:

Cardiac catheterization.......... Decreased ejection fraction D

40-55%.

Cardiac catheterization.......... Poor ejection fraction 120 and systolic D

>160, 50% of the time.

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 5-10 mm D

Hg.

Cardiac catheterization.......... Mitral valve gradient >10 mm D

Hg.

Cardiac catheterization.......... Mitral regurgitation severe.. D

Cardiac catheterization.......... Decreased ejection fraction D

40-55%.

Cardiac catheterization.......... Poor ejection fraction 5 METS........ D

Coronary artery disease:

Myocardial infarction............ Multiple infarctions......... D

Echocardiogram................... Confirmed ventricular D

aneurysm.

Cardiac catheterization.......... Aortic gradient 25-50 mm Hg.. D

Cardiac catheterization.......... Decreased ejection fraction D

40-55%.

Cardiac catheterization.......... Poor ejection fraction 7 D

METS.

Isotope, e.g., thallium study.... Definite ischemia 7 D

METS.

Cardiomyopathy:

Cardiac catheterization.......... Decreased ejection fraction D

40-55%.

Cardiac catheterization.......... Poor ejection fraction 1.5-2 seconds.

Medical record review............ Documented syncope with D

proven arrhythmia.

Mitral valve disease:

Cardiac catheterization.......... Mitral valve gradient 5-10 mm D

Hg.

Cardiac catheterization.......... Mitral valve gradient >10 mm D

Hg.

Cardiac catheterization.......... Mitral regurgitation severe.. D

Cardiac catheterization.......... Decreased ejection fraction D

40-55%.

Cardiac catheterization.......... Poor ejection fraction 1/FVC ratio diminished.... Recommended.

Spirometry....................... 1 decrease 1/FVC ratio below 65% when Highly recommended.

stable.

Spirometry....................... FEV1 below 75% of predicted Highly recommended.

when stable.

Cor pulmonale:

Electrocardiogram................ Definite right ventribular 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 with Highly recommended.

chest tube drainage.

Restrictive lung disease:

Chest X-ray...................... Restrictive lung changes..... Recommended.

Diffusing capacity............... Abnormal..................... Highly recommended.

Chest CAT scan................... Restrictive lung changes..... Recommended.

Spirometry....................... FVC 2 (arterial................... >50 mm Hg if stable.......... D

Asthma:

Spirometry....................... FEV1 with adequate treatment D

2 arterial)................... >50 mm Hg if stable.......... D

Pulmonary exercise test.......... PO2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 1 with adequate treatment D

2 arterial.................... >50 mm Hg if stable.......... D

Pulmonary exercise test.......... PO2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 arterial.................... >50 mm Hg if stable.......... D

Pulmonary exercise test.......... PO2>5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 arterial.................... >50 mm Hg if stable.......... D

Electrocardiogram................ Definite positive right D

ventricular hypertrophy.

Diffusing capacityfor CO......... 2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 arterial.................... >50 mm Hg If stable.......... D

Electrocardiogram................ Definite positive right D

ventricular hypertrophy.

Sleep apnea--central:

Sleep latency test............... Positive..................... D

Sleep apnea--obstructive:

Sleep latency test............... Positive..................... D

----------------------------------------------------------------------------------------------------------------

BODY PART: RESPIRATORY

JOB TITLE: ENGINEER

----------------------------------------------------------------------------------------------------------------

Sleep apnea--central:

Sleep latency test............... Positive..................... D

Sleep apnea--obstructive:

Sleep latency test............... Positive..................... D

----------------------------------------------------------------------------------------------------------------

BODY PART: RESPIRATORY

JOB TITLE: DISPATCHER

----------------------------------------------------------------------------------------------------------------

Sleep apnea--central:

Sleep latency test............... Positive..................... D

Sleep apnea--obstructive:

Sleep latency test............... Positive..................... D

----------------------------------------------------------------------------------------------------------------

BODY PART: RESPIRATORY

JOB TITLE: CARMAN

----------------------------------------------------------------------------------------------------------------

Asbestosis:

PCO2 (arterial).................. >50 mm Hg if stable.......... D

Asthma:

Spirometry....................... FEV1 with adequate treatment D

2 arterial.................... >50 mm Hg if stable.......... D

Pulmonary exercise test.......... PO2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 1 with adequate treatment D

2 arterial.................... >50 mm Hg if stable.......... D

Pulmonary exercise test.......... PO2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 arterial.................... >50 mm Hg if stable.......... D

Pulmonary exercise test.......... PO2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 arterial.................... >50 mm Hg if stable.......... D

Electrocardiogram................ Definite positive right D

ventricular hypertrophy.

Diffusing capacity for CO........ 2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 arterial.................... >50 mm Hg if stable.......... D

Electrocardiogram................ Definite positive right D

ventricular hypertrophy.

Sleep apnea--central:

Sleep latency test............... Positive test................ D

Sleep apnea--obstructive:

Sleep latency test............... Positive test................ D

----------------------------------------------------------------------------------------------------------------

BODY PART: RESPIRATORY

JOB TITLE: SIGNALMAN

----------------------------------------------------------------------------------------------------------------

Asbestosis:

PCO2 (arterial).................. >50 mm Hg if stable.......... D

Asthma:

Spirometry....................... FEV1 with adequate treatment D

2 arterial.................... >50 mm Hg if stable.......... D

Pulmonary exercise test.......... PO2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 1 with adequate treatment D

2 arterial.................... >50 mm Hg if stable.......... D

Pulmonary exercise test.......... PO2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 arterial.................... >50 mm Hg if stable.......... D

Pulmonary exercise test.......... PO2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 arterial.................... >50 mm Hg if stable.......... D

Diffusing capacity for CO........ 2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 arterial.................... >50 mm Hg if stable.......... D

Electrocardiogram................ Definite positive right D

ventricular hypertrophy.

[[Page 50079]]

Sleep apnea--central:

Sleep latency test............... Positive test................ D

Sleep apnea--obstructive:

Sleep latency test............... Positive test................ D

----------------------------------------------------------------------------------------------------------------

BODY PART: RESPIRATORY

JOB TITLE: TRACKMAN

----------------------------------------------------------------------------------------------------------------

Asbestosis:

PCO2 (arterial).................. >50 mm Hg if stable.......... D

Asthma:

Spirometry....................... FEV1 with adequate treatment D

2 arterial.................... >50 mm Hg if stable.......... D

Pulmonary exercise test.......... PO2 >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 1 with adequate treatment D

2 arterial.................... >50 mm Hg if stable.......... D

Pulmonary exercise test.......... PO2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 arterial.................... >50 mm Hg if stable.......... D

Pulmonary exercise test.......... PO2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 arterial.................... >50 mm Hg if stable.......... D

Electrocardiogram................ Definite positive right D

ventricular hypertrophy.

Diffusing capacity for CO........ 2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 arterial.................... >50 mm Hg if stable.......... D

Electrocardiogram................ Definite positive right D

ventricular hypertrophy.

Sleep apnea--central:

Sleep latency test............... Positive test................ D

Sleep apnea--obstructive:

Sleep latency test............... Positive test................ D

----------------------------------------------------------------------------------------------------------------

BODY PART: RESPIRATORY

JOB TITLE: MACHINIST

----------------------------------------------------------------------------------------------------------------

Asbestosis:

PCO2 arterial.................... >50 mm Hg if stable.......... D

Asthma:

Spirometry....................... FEV, with adequate treatment D

2 arterial.................... >50 mm Hg if stable.......... D

Pulmonary exercise test.......... PO2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 1 with adequate treatment D

2 arterial.................... >50 mm Hg if stable.......... D

Pulmonary exercise test.......... PO2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 arterial.................... >50 mm Hg if stable.......... D

Electrocardiogram................ Definite positive right D

ventricular hypertrophy.

Diffusing capacity for CO........ 2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO 2 arterial.................... >50 mm Hg if stable.......... D

Electrocardiogram................ Definite positive right D

ventricular hypertrophy.

Sleep apnea--central:

Sleep latency test............... Positive test................ D

Sleep apnea--obstructive:

Sleep latency test............... Positive test................ D

----------------------------------------------------------------------------------------------------------------

BODY PART: RESPIRATORY

JOB TITLE: SHOP LABORER

----------------------------------------------------------------------------------------------------------------

Asbestosis:

PCO (arterial)................... >50mm Hg if stable........... D

Asthma:

Spirometry....................... FEV1 with adequate treatment D

2 arterial.................... >50 mm Hg if stable.......... D

Pulmonary exercise test.......... PO2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 1 with adequate treatment D

2 arterial.................... >50 mm Hg if stable.......... D

Pulmonary exercise test.......... PO2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 arterial.................... >50 mm Hg if stable.......... D

Pulmonary exercise test.......... PO2 >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 arterial.................... >50 mm Hg if stable.......... D

Diffusing capacity for CO........ 2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 drop >5 torr at maximum D

exercise.

Pulmonary exercise test.......... Maximum VO2 2 arterial.................... >50 mm Hg if stable.......... D

Electrocardiogram................ Definite positive right D

ventricular hypertrophy.

Sleep apnea--central:

Sleep latency central............ Positive test................ D

Sleep apnea--obstructive:

Sleep latency obstructive........ Positive test................ D

----------------------------------------------------------------------------------------------------------------

[[Page 50081]]

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 disc Recommended.

changes.

Computerized tomography.......... Significant degenerative disc Recommended.

changes.

Magnetic resonance imaging....... Significant degenerative disc Recommended.

changes.

Myelogram........................ Significant degenerative disc Recommended.

changes.

Displacement of lumbar disc:

X-ray-lumbar sacral spine........ Significant degenerative disc Recommended.

changes.

Computerized tomography.......... Significant degenerative disc Recommended.

changes.

Magnetic resonance imaging....... Significant degenerative disc Recommended.

changes.

Myelogram........................ Significant degenerative disc Recommended.

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...... Recommended.

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.

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 spone.............. Transverse process fracture.. Recommended.

Magnetic resonance imaging....... Transverse process fracture.. Recommended.

Computerized tomography.......... Transverse process fracture.. Recommended.

Intervertebral disc disorder:

X-ray-lumbar sacral spine........ Significant disc degeneration Recommended.

Magnetic resonance imaging....... Significant disc degeneration Recommended.

Computerized tomography.......... Significant disc degeneration Recommended.

Myelogram........................ Significant disc degeneration Recommended.

Lumbago:

Medical record review: lumbar.... History of back pain under 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.

[[Page 50082]]

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 with Recommended.

2 cm difference between

limbs.

Physcal examination: straight leg Positive straight leg raise.. Recommended.

raise.

Sensory examination.............. Loss of sensation in affected Recommended.

dermatomes.

Medical history.................. History of radicular pain.... Highly recommended.

Computerized tomography.......... Evidence of neural Recommended.

compression.

Lumbar spinal stenosis:

Computerized tomography.......... Significant narrowing: spinal Recommended.

cord canal or intervertebral

foramen.

Magnetic resonance imaging....... Significant narrowing: spinal Recommended.

cord canal or intervertebral

foramen.

Myelogram........................ Significant narrowing: spinal Recommended.

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 infection Recommended.

Magnetic resonance imaging....... Evidence of chronic infection Recommended.

Computerized tomography.......... Evidence of chronic infection Recommended.

Osteoporosis:

Computerized tomography.......... Significant bone density loss Recommended.

Dual photon absorptiometry....... Significant bone density loss Recommended.

X-ray-lumbar sacral spine........ Significant bone density loss Recommended.

Post laminectomy syndrome with

radiculopathy:

Medical record review: lumbar.... Documented surgical history 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 with Recommended.

2 cm difference between

limbs.

Physical examination: straight Positive straight leg raise.. Recommended.

leg raise.

Sensory examiation............... Loss of sensation in affected Recommended.

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.

Nerve conduction velocity........ Definite slowing............. Recommended.

Physical examination--atrophy.... Atrophy in affected limb with Recommended.

2 cm difference between

limbs.

Physical examination: straight Positive straight leg raise.. Recommended.

leg raise.

Sensory examination.............. Loss of sensation in affected Recommended.

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 with Recommended.

2 cm difference between

limbs.

Physical examination: straight Positive straight leg raise.. Recommended.

leg raise.

Sensory examination.............. Loss of sensation in affected Recommended.

dermatones.

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.

[[Page 50083]]

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 interarticularis Recommended.

Computerized tomography.......... Defect--pars interarticularis Recommended.

MRI.............................. Defect--pars interarticularis Recommended.

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.

----------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------

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 >L1.

Physical examination: rectal..... Impairment of sphincter tone. D

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Degeneration of lumbar disc:

Computerized tomography.......... Disc extrusion with neural D

impingement.

Magnetic resonance imaging....... Disc extrusion with neural D

impingement.

Myelogram........................ Disc extrusion with neural D

impingement.

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Displacement of lumbar disc:

Computerized tomography.......... Disc extrusion with neural D

impingement.

Magnetic resonance imaging....... Disc extrusion with neural D

impingement.

Myelogram........................ Disc extrusion with neural D

impingement.

[[Page 50084]]

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Fracture: vertebral body:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Fracture: posterior spinal element

with displacement:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Fracture: posterior spinal element

with no displacement:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Fracture: spinous process:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Fracture transverse process:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Intervertebral disc disorder:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Computerized tomography.......... Disc extrusion with neural D

impingement.

Magnetic resonance imaging....... Disc extrusion with neural D

impingement.

Myelogram........................ Disc extrusion with neural D

impingement.

Lumbago:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Lumbosacral neuritis:

Computerized tomography.......... Disc extrusion with neural D

impingement.

Magnetic resonance imaging....... Disc extrusion with neural D

impingement.

Myelogram........................ Disc extrusion with neural D

impingement.

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Physical examination............. Lower extremity weakness..... D

Lumbar spinal stenosis:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Computerized tomography.......... Significant narrowing of the D

spinal canal.

Magnetic resonance imaging....... Significant narrowing of the D

spinal canal.

Myelogram........................ Significant narrowing of the D

spinal canal.

Physical examination............. Significant lower extremity D

weakness.

Mechanical complication of internal

orthopedic device:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

X-ray flexion/extension.......... Segmental instability........ D

Osteomalacia:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Osteomyelitis, chronic-lumbar:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Medical record review............ Frequent flare-ups with D

objective findings.

Osteoporosis:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Post laminectomy syndrome with

radiculopathy:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Computerized tomography.......... Disc extrusion with neural D

impingement.

Magnetic resonance imaging....... Disc extrusion with neural D

impingement.

Myelogram........................ Disc extrusion with neural D

impingement.

Physical examination............. Significant lower extremity D

weakness.

Post laminectomy syndrome:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Computerized tomography.......... Disc extrusion with neural D

impingement.

Magnetic resonance imaging....... Disc extrusion with neural D

impingement.

Myelogram........................ Disc extrusion with neural D

impingement.

Physical examination............. Significant lower extremity D

weakness.

X-ray flexion/extension.......... Segmental instability........ D

Radiculopathy:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Computerized tomography.......... Disc extrusion with neural D

impingement.

Magnetic resonance imaging....... Disc extrusion with neural D

impingement.

Myelogram........................ Disc extrusion with neural D

impingement.

Physical examination............. Significant lower extremity D

weakness.

Sciatica:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Computerized tomography.......... Disc extrusion with neural D

impingement.

Magnetic resonance imaging....... Disc extrusion with neural D

impingement.

Myelogram........................ Disc extrusion with neural D

impingement.

Physical examination............. Significant lower extremity D

weakness.

Strains and sprains, unspecified:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Spondylolisthesis grade 1:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

X-ray flexion/extension.......... Segmental instability........ D

Spondylolisthesis grade 2:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Spondylolisthesis grade 3:

[[Page 50085]]

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Spondylolisthesis grade 4:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

X-ray flexion/extension.......... Segmental instability........ D

Spondylisthesis--acquired:

X-ray flexion/extension.......... Segmental instability........ D

Spondylolysis:

X-ray flexion/extension.......... Segmental instability........ D

Sprains and strains, sacral:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Sprains and strains, sacroiliac:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

Vertebral body compression fracture:

Muscle strength assessment....... Lifting capacity diminished D

by 50%.

----------------------------------------------------------------------------------------------------------------

BODY PART: LS SPINE

JOB TITLE: ENGINEER

----------------------------------------------------------------------------------------------------------------

Cauda equina syndrome with bowel or

bladder dysfunction:

Computerized tomography.......... 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)... High titer................... 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.

[[Page 50094]]

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: cervical... Multi-level neurologic D

compromise.

Chronic herniated disc:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical spondylolysis:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical intervertebral disc

degeneration:

Physical examination: cervical... Multi-level neurologic D

compromise.

Fracture: posterior element with

spinal canal displacement:

Physical examination: cervical... Multi-level neurologic D

compromise.

Post laminectomy syndrome:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical radiculopathy:

Physical examination: cervical... 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: cervical... Multi-level neurologic D

compromise.

Physical examination: lower limb. Lower extremity weakness or D

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: cervical... Multi-level neurologic D

compromise.

Chronic herniated disc:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical spondylolysis:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical intervertebral disc

degeneration:

Physical examination: cervical... Multi-level neurologic D

compromise.

Fracture: posterior element with

spinal canal displacement:

Physical examination: cervical... Multi-level neurologic D

compromise.

Post laminectomy syndrome:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical radiculopathy:

Physical examination: cervical... 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: cervical... Multi-level neurologic D

compromise.

Physical examination: lower limb. Lower extremity weakness or D

spasticity.

----------------------------------------------------------------------------------------------------------------

BODY PART: CE SPINE

JOB TITLE: DISPATCHER

----------------------------------------------------------------------------------------------------------------

Cervical disc disease with

myelopathy:

[[Page 50095]]

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: cervical... Multi-level neurologic D

compromise.

Chronic herniated disc:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical spondylolysis:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical intervertebral disc

degeneration:

Physical examination: cervical... Multi-level neurologic D

compromise.

Fracture: posterior element with

spinal canal displacement:

Physical examination: cervical... Multi-level neurologic D

compromise.

Post laminectomy syndrome:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical radiculopathy:

Physical examination: cervical... 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: cervical... Multi-level neurologic D

compromise.

Physical examination: lower limb. Lower extremity weakness or D

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: cervical... Multi-level neurologic D

compromise.

Chronic herniated disc:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical spondylolysis:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical intervertebral disc

degeneration:

Physical examination: cervical... Multi-level neurologic D

compromise.

Fracture: posterior element with

spinal canal displacement:

Physical examination: cervical... Multi-level neurologic D

compromise.

Post laminectomy syndrome:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical radiculopathy:

Physical examination: cervical... 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: cervical... Multi-level neurologic D

compromise.

Physical examination: lower limb. Lower extremity weakness or D

spasticity.

----------------------------------------------------------------------------------------------------------------

[[Page 50096]]

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: cervical... Multi-level neurologic D

compromise.

Chronic herniated disc:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical spondyloysis:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical intervertebral disc

degeneration:

Physical examination: cervical... Multi-level neurologic D

compromise.

Fracture: posterior element with

spinal canal displacement:

Physical examination: cervical... Multi-level neurologic D

compromise.

Post laminectomy syndrome:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical radiculopathy:

Physical examination: cervical... 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: cervical... Multi-level neurologic D

compromise.

Physical examination: lower limb. Lower extremity weakness or D

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: cervical... Multi-level neurologic D

compromise.

Chronic herniated disc:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical spondylolysis:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical intervertebral disc

degeneration:

Physical examination: cervical... Multi-level neurologic D

compromise.

Fracture: posterior element with

spinal canal displacement:

Physical examination: cervical... Multi-level neurologic D

compromise.

Post laminectomy syndrome:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical radiculopathy:

Physical examination: cervical... 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: cervical... Multi-level neurologic D

compromise.

Physical examination: lower limb. Lower extremity weakness or D

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

[[Page 50097]]

Physical examination: rectal..... Impairment of sphincter tone. D

Physical examination: lower limb. Lower extremity weakness or D

significant spasticity.

Physical examination: cervical... Multi-level neurologic D

compromise.

Chronic herniated disc:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical spondylolysis:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical intervertebral disc

degeneration:

Physical examination: cervical... Multi-level neurologic D

compromise.

Fracture: posterior element with

spinal canal displacement:

Physical examination: cervical... Multi-level neurologic D

compromise.

Post laminectomy syndrome:

Physical examination: cervical... Multi-level neurologic D

compromise.

Cervical radiculopathy:

Physical examination: cervical... 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: cervical... Multi-level neurologic D

compromise.

Physical examination: lower limb. Lower extremity weakness or D

spasticity.

----------------------------------------------------------------------------------------------------------------

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

----------------------------------------------------------------------------------------------------------------

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.

Magnetic resonance imaging....... Tear of rotator cuff......... Recommended.

Permanent functional limitation,

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.

----------------------------------------------------------------------------------------------------------------

[[Page 50098]]

----------------------------------------------------------------------------------------------------------------

Disability test Test result Disability classification

----------------------------------------------------------------------------------------------------------------

BODY PART: SHOULDER AND ELBOW

Job TITLE: TRAINMAN

----------------------------------------------------------------------------------------------------------------

Arthritis, acromioclavicular:

Physical examination--range of 40 degrees deviation........ D

Physical examination--range of Flexion limit to 60 degrees D

motion. (30 degrees from 90).

----------------------------------------------------------------------------------------------------------------

BODY PART: SHOULDER AND ELBOW

JOB TITLE: ENGINEER

----------------------------------------------------------------------------------------------------------------

Arthritis, acromioclavicular:

Physical examination--range of 40 degrees deviation........ D

Physical examination--range of Flexion limit to 60 degrees D

motion. (30 degrees from 90).

----------------------------------------------------------------------------------------------------------------

BOFY PSTY: SHOULDER AND ELBOW

JOB TITLE: CARMAN

----------------------------------------------------------------------------------------------------------------

Arthritis, acromioclavicular:

Physical examination--range of 40 degrees deviation........ D

Physical examination--range of Flexion limit to 60 degrees D

motion. (30 degrees from 90).

----------------------------------------------------------------------------------------------------------------

BODY PART: SHOULDER AND ELBOW

JOB TITLE: SIGNALMAN

----------------------------------------------------------------------------------------------------------------

Arthritis, acromioclavicular:

Physical examination--range of 40 degrees deviation........ D

Physical examination--range of Flexion limit to 60 degrees D

motion. (30 degrees from 90).

----------------------------------------------------------------------------------------------------------------

BODY Part: SHOULDER AND ELBOW

JOB TITLE: TRACKMAN

----------------------------------------------------------------------------------------------------------------

Arthritis, acromioclavicular:

Physical examination--range of 40 degrees deviation........ D

Physical examination--range of Flexion limit to 60 degrees D

motion. (30 degrees from 90).

----------------------------------------------------------------------------------------------------------------

BODY PART: SHOULDER AND ELBOW

JOB TITLE: MACHINIST

----------------------------------------------------------------------------------------------------------------

Arthritis, acromioclavicular:

Physical examination--range of 40 degrees deviation........ D

Physical examination--range of Flexion limit to 60 degrees D

motion. (30 degrees from 90).

----------------------------------------------------------------------------------------------------------------

BODY PART: SHOULDER AND ELBOW

JOB TITLE: SHOP LABORER

----------------------------------------------------------------------------------------------------------------

Arthritis, acromioclavicular:

Physical examination--range of 40 degrees deviation........ D

Physical examination--range of Flexion limit to 60 degrees D

motion. (30 degrees from 90).

----------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------

H. Arm and Hand

----------------------------------------------------------------------------------------------------------------

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.

Physical examination............. Tinel's or Phalen's sign- Recommended.

suggestive but not

confirmatory.

Nerve conduction testing......... Definite median nerve Highly recommended.

conduction showing at wrist.

Electromyography................. Denervation in serve 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................ High titer................... Recommended.

Medical record review............ History of objective findings Highly recommended.

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.

[[Page 50100]]

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

----------------------------------------------------------------------------------------------------------------

Carpal tunnel syndrome:

Strength (jamar)................. Dominant hand: 20 degrees from D

motion. neutral.

Hand: permanent functional

limitation:

Strength (jamar)................. Dominant hand: 20 degrees from D

motion. neutral.

----------------------------------------------------------------------------------------------------------------

BODY PART: HAND AND ARM

JOB TITLE ENGINEER

----------------------------------------------------------------------------------------------------------------

Fracture, wrist:

Physical examination--range of Extension-limit to 30 degrees D

motion.

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 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 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 20 degrees from D

motion. neutral.

----------------------------------------------------------------------------------------------------------------

BODY PART: HAND AND ARM

JOB TITLE: CARMAN

----------------------------------------------------------------------------------------------------------------

Carpal tunnel syndrome:

Strength (jamar)................. Dominant hand: 20 degrees from D

motion. neutral.

Hand: permanent functional

limitation:

Strength (jamar)................. Dominant hand: 20 degrees from D

motion. neutral.

----------------------------------------------------------------------------------------------------------------

[[Page 50102]]

BODY PART: HAND AND ARM

JOB TITLE: SIGNALMAN

----------------------------------------------------------------------------------------------------------------

Carpal tunnel syndrome:

Strength (jamar)................. Dominant hand: 20 degrees from D

motion. neutral.

Hand: permanent functional

limitation:

Strength (jamar)................. Dominant hand: 20 degrees from D

motion. neutral.

----------------------------------------------------------------------------------------------------------------

BODY PART: HAND AND ARM

JOB TITLE: TRACKMAN

----------------------------------------------------------------------------------------------------------------

Carpal tunnel syndrome:

Strength (jamar)................. Dominant hand: 20 degrees from D

motion. neutral.

Hand: permanent functional

limitation:

Strength (jamar)................. Dominant hand: 20 degrees from D

motion. neutral.

----------------------------------------------------------------------------------------------------------------

BODY PART: HAND AND ARM

JOB TITLE: MACHINIST

----------------------------------------------------------------------------------------------------------------

Carpal tunnel syndrome:

Strength (jamar)................. Dominant hand: 20 degrees from D

motion. neutral.

Hand: permanent functional

limitation:

Strength (jamar)................. Dominant hand: 20 degrees from D

motion. neutral.

----------------------------------------------------------------------------------------------------------------

BODY PART: HAND AND ARM

JOB TITLE: SHOP LABORER

----------------------------------------------------------------------------------------------------------------

Carpal tunnel syndrome:

Strength (jamar)................. Dominant hand: 20 degrees from D

motion. neutral.

Hand: permanent functional

limitation:

[[Page 50104]]

Strength (jamar)................. Dominant hand: 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 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............ Extenive medication use, D

under treatment with

rheumatologist.

Thumb: permanent functional

limitation:

Adduction of thumb............... Loss 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 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 20 degrees from D

motion. neutral.

----------------------------------------------------------------------------------------------------------------

I. Hip

----------------------------------------------------------------------------------------------------------------

Confirmatory test Minimum result Requirements

----------------------------------------------------------------------------------------------------------------

BODY PART: HIP

CONFIRMATORY TESTS

----------------------------------------------------------------------------------------------------------------

Ankylosis, hip:

X-ray: hip....................... Exteme joint destruction..... Highly Recommended.

Physical examination--range of No mobility.................. Highly Recommended.

motion.

Osteoarthritis, hip:

X-ray: hip....................... 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 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 50106]]

Physical examination--range 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 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 abduction >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 D

motion. flexion.

Physical examination--range of Ankylosis internal rotation D

motion. >5 degrees.

Physical examination--range of Ankylosis internal 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 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 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:

[[Page 50108]]

X-ray: hip....................... 0 mm cartilage interval...... D

Physical examination--range of 30 degrees flexion D

motion. contracture.

Physical examination--range of D

motion. degrees).

Physical examination............. Valgus deformity, 16-20 D

degrees degrees.

Physical examination............. Varus deformity, 8-12 degrees 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 D

motion. degrees).

Cruciate and collateral ligament

tear:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Cruciate ligament tear with laxity:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Intercondylar fracture:

Post fracture angulation......... >20 degrees angulation....... D

Physical examination--range of Range of motion: flexion D

motion. degrees).

Osteomyelitis, chronic knee:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Physical examination............. Valgus deformity, 16-20 D

degrees.

Physical examination............. Valgus 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 D

motion. degrees).

Physical examination............. Valgus deformity, 16-20 D

degrees.

Physical examination............. Varus deformity, 8-12 degrees D

X-ray knee....................... 0-1 mm cartilage interval D

with degenerative change.

Patellofemoral arthritis:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Physical examination............. Valgus deformity, 16-20 D

degrees.

Physical examination............. Varus deformity, 8-12 degrees D

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 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 D

motion. degrees).

Patellectomy:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Patellar, subluxation, recurrent:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Supracondylar fracture:

Post fracture angulation......... >20 degrees angulation....... D

Physical examination--range of Range of motion: flexion D

motion. degrees).

Tibial shaft fracture:

[[Page 50110]]

Physical examination--range of Range of motion: flexion 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 D

motion. degrees.

Physical examination............. Valgus deformity, 16-20 D

degrees.

Physical examination............. Varus deformity, 8-12 degrees D

X-ray knee....................... 0-1 mm cartilage interval D

with degenerative change.

Meniscectomy, medial or lateral:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Collateral ligament tear with laxity:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Cruciate and collateral ligament

tear:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Cruciate ligament tear with laxity:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Intercondylar fracture:

Post fracture angulation......... > 20 degrees angulation...... D

Physical examination--range of Range of motion: flexion D

motion. degrees).

Osteomyelitis, chronic knee:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Physical examination............. Valgus deformity, 16-20 D

degrees.

Physical examination............. Varus deformity, 8-12 degrees D

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 D

motion. degrees).

Physical examination............. Valgus deformity, 16-20 D

degrees.

Physical examination............. Varus deformity, 8-12 degrees D

X-ray knee....................... 0-1 mm cartilage interval D

with degenerative change.

Patellofemoral arthritis:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Physical examination............. Valgus deformity, 16-20 D

degrees.

Physical examination............. Varus deformity, 8-12 degrees D

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 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 D

motion. degrees).

Patellectomy:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Patellar, subluxation, recurrent:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Supracondylar fracture:

Post fracture angulation......... > 20 degrees angulation...... D

Physical examination--range of Range of motion: flexion D

motion. degrees).

Tibial shaft fracture:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Post fracture angulation......... > 20 degrees malalignment.... D

----------------------------------------------------------------------------------------------------------------

BODY PART: KNEE

JOB TITLE: CARMAN

----------------------------------------------------------------------------------------------------------------

Arthritis knee:

[[Page 50111]]

Physical examination--range of Range of motion: flexion D

motion. degrees).

Physical examination............. Valgus deformity, 16-20 D

degrees.

Physical examination............. Varus deformity, 8-12 degrees D

X-ray knee....................... 0-1 mm cartilage interval D

with degenerative change.

Meniscectomy, medial or lateral:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Collateral ligament tear with laxity:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Cruciate and collateral ligament

tear:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Cruciate ligament tear with laxity:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Intercondylar fracture:

Post fracture angulation......... > 20 degrees angulation...... D

Physical examination--range of Range of motion: flexion D

motion. degrees).

Osteomyelitis, chronic knee:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Physical examination............. Valgus deformity, 16-20 D

degrees.

Physical examination............. Varus deformity, 8-12 degrees D

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 D

motion. degrees).

Physical examination............. Valgus deformity, 16-20 D

degrees.

Physical examination............. Varus deformity, 8-12 degrees D

X-ray knee....................... 0-1 mm cartilage interval D

with degenerative change.

Patellofemoral arthritis:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Physical examination............. Valgus deformity, 16-20 D

degrees.

Physical examination............. Varus deformity, 8-12 degrees D

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 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 D

motion. degrees).

Patellectomy:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Patellar, subluxation, recurrent:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Supracondylar fracture:

Post fracture angulation......... >20 degrees angulation....... D

Physical examination--range of Range of motion: flexion D

motion. degrees).

Tibial shaft fracture:

Physical examination--range of Range of motion: flexion 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 D

motion. degrees).

Physical examination............. Valgus deformity, 16-20 D

degrees.

Physical examination............. Valgus 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 D

motion. degrees).

Collateral ligament tear with laxity:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Cruciate and collateral ligament

tear:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Cruciate ligament tear with laxity:

Physical examination--range of Range of motion: flexion D

motion. degrees).

Intercondylar fracture:

Post fracture angulation......... >20 degrees angulation....... D

Physical examination--range of Range of motion: flexion D

motion. degrees).

Osteomyelitis, chronic knee:

Physical examination--ran

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