Determining Disability

SUMMARY: The Railroad Retirement Board hereby amends its regulations

with respect to determining when an employee is disabled for his or her

regular railroad occupation. This final rule gives effect to an

agreement between railroad labor and railroad management consistent

with section 2(a)(2) of the Railroad Retirement Act which provides that

labor and management shall cooperate with the Board in developing

standards for determining when an employee's physical or mental

condition disables him or her for work in his or her regular railroad

occupation and thus there exists good cause not to delay its

effectiveness beyond date of publication.

DATES: Effective date: This rule is effective February 13, 1998.

Applicability date: This rule shall be applicable February 13,

1998, but only with respect to applications for a disability annuity

filed on or after January 1, 1998.

ADDRESSES: Secretary to the Board, Railroad Retirement Board, 844 North

Rush Street, Chicago, Illinois 60611.

FOR FURTHER INFORMATION CONTACT: Thomas W. Sadler, Senior Attorney,

Railroad Retirement Board, 844 North Rush Street, Chicago, Illinois

60611, (312) 751-4513, TDD (312) 751-4701.

SUPPLEMENTARY INFORMATION: Section 2(a)(2) of the Railroad Retirement

Act (45 U.S.C. 231a(a)(2)) provides that the Board, with the

cooperation of employers and employees, shall secure the establishment

of standards determining the physical and mental conditions which

permanently disqualify employees from performing their regular

occupation in the railroad industry. The Board has never formally

adopted such standards. The agency, in the past, has used provisional

standards which were adopted in 1946 but which are now outdated. In

1991 the Board adopted Subpart C of Part 220 which provides for

determining disability for work in an employee's regular railroad

occupation. Under this regulation if an employee's physical or mental

condition does not meet a listing found in Appendix 1 of Part 220

(which determines if an individual is able to engage in any employment

both within and outside the railroad industry), the Board determines

the employee's residual functional capacity and compares that to the

demands of his or her regular railroad occupation to determine if the

employee can continue to perform that job. However, Subpart C contains

no specific standards which relate to specific railroad occupations.

The Board amends Subpart C to add such standards with respect to

certain railroad occupations.

Section 220.10 provides for the establishment of an Occupational

Disability Advisory Committee made up of two physicians, one from

recommendations from rail labor, one from recommendations of rail

management. This committee shall review, from time to time, the

disability standards developed by this regulation and the Occupational

Disability Claims Manual (Manual) which supplements this regulation.

The Board shall confer with this Committee before it amends this

regulation or the Manual. It should be noted that the Board is not an

agency subject to the Federal Advisory Committee Act. Accordingly, the

Occupational Disability Advisory Committee will not be subject to that

Act.

Section 220.11 contains the definitions of ``regular railroad

occupation'', ``permanent physical and mental impairment'', and

``residual functional capacity'' as presently found in Part 220. In

addition, it adds the definitions of ``independent case evaluation''

and ``functional capacity test''.

The current Sec. 220.12 is removed, and the current Sec. 220.14

``Evidence Considered'' is redesignated Sec. 220.12.

The introductory language and paragraph (a) of section 220.13

follow the present regulation and describe the sequential evaluation

process for determining disability for an employee's regular railroad

occupation. Initially, if an employee has been medically disqualified

by his employer, the Board will presume that the employee is disabled

for his regular railroad occupation if there is any objective medical

evidence to support that determination. If the employee has not been so

disqualified, the Board will determine if the employee's impairment(s)

meet or equal a listing found in Appendix 1.

Section 220.13(b)(1) provides that if an employee has not been

found disabled in the first two steps described above, the Board will

then determine the employee's regular railroad occupation, based upon

the employee's description of his or her job.

Section 220.13(b)(2)(i) provides that next the Board will determine

if an employee's regular railroad occupation and impairment(s) are

covered under the standards contained in a new Appendix 3 to Part 220.

If both the occupation and impairment(s) are covered, the Board will

confirm the existence of the impairment(s) by using the tests listed in

Appendix 3 or by other valid diagnostic tests which could be used to

establish an impairment as provided for in Sec. 220.27 of this part.

(Section 220.13(b)(2)(ii) of the proposed rule has been revised to

clarify how an impairment is confirmed and that if an employee's

impairment(s) cannot be confirmed, as provided for in this section, the

employee will be found not disabled.) Once the impairment(s) is

confirmed, Appendix 3 is applied to determine if the employee is

disabled. (Section 220.13(b)(2)(iii).)

If the employee's regular railroad occupation and impairment(s) are

not covered by Appendix 3, or if the medical evidence contains

significant differences in interpretation of objective test findings

which cannot be readily resolved, then the Board will not use Appendix

3, but will determine if the employee is disabled using an independent

case evaluation (ICE) as set forth in Sec. 220.13(b)(2)(iv). Likewise,

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

Section 220.13(b)(2)(iv), which describes ICE, is essentially a

more detailed description of the process, which is described in

Sec. 220.13(b)(3) of the present regulation. Under this process the

Board initially determines whether the evidence is complete (Step 1).

The Board next confirms any impairment which has not been confirmed

under Sec. 220.13(b)(2)(ii) (Step 2). Next, the Board will determine

whether there is a concordance of medical findings among physicians. If

there is not, the Board will request additional medical evidence from

the employee's treating physician(s) or procure additional consulting

exams (Step 3). Once the Board establishes a concordance of medical

findings, to the extent that it is possible, it will then assess the

quality of the medical evidence under the factors set forth in

Sec. 220.14. This section sets forth factors which either support or

call into question the validity of the medical findings. Thus, for

example, the opinion of a treating physician, which is fully supported

by medically acceptable clinical and diagnostic techniques, is given

greater weight than one that is not so supported or is inconsistent

with findings of other medical sources. Likewise, the claimant's

description of

[[Page 7539]]

his or her own condition, if consistent with objective medical

findings, is given more weight than one that is not consistent (Step

4). If, after assessment, the Board determines that there is no

substantial objective evidence of an impairment, the Board will

determine that the employee is not disabled.

If through the assessment in Step 4 it is determined that there is

substantial objective evidence of an impairment, then in Step 5 the

Board will determine the demands of the employee's regular railroad

occupation. At this point, the Board will not only consider the

employee's own description of his or her job, but also the employer's

description as well as other sources such as the Dictionary of

Occupational Titles and generic descriptions found in the Occupational

Disability Claims Manual.

Next, the Board will determine the employee's residual functional

capacity based upon the assessment performed in Step 4 and compare it

to the job demands determined in Step 5. If the demands of the

employee's regular railroad occupation exceed the employee's residual

functional capacity, then the Board will find the employee disabled. If

the demands do not exceed the residual functional capacity, then the

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

The Board published this regulation as a proposed rule on September

24, 1997 (62 FR 50056), and invited comments by October 24, 1997. Two

comments were received. One commentator suggested that the Board adopt

the vision and hearing acuity requirements found in 49 CFR 240.121,

which have been adopted by the Federal Railroad Administration for

certification of locomotive engineers. However, the Board does not feel

such a change is needed since an engineer who is disqualified by his

employer for failure to meet the requirements of 49 CFR 240.121 would

ordinarily be presumed disabled under the first paragraph of

Sec. 220.13. Another commentator expressed support for the regulation

because it was in accord with an agreement reached in July 1997 between

representatives of rail labor and rail management concerning

occupational disability.

The final rule contains an Introduction to Appendix 3 which

explains how to use the Appendix. In addition, the Board has corrected

typographical errors in Appendix 3, and made the following substantive

changes in Appendix 3 based upon advice from physicians representing

rail labor and rail management:

A. Cancer

62 FR 50064--Under Assessment, second paragraph, second

line, the phrase ``in the Tables'' was inserted after ``All railroad

occupations.''

62 FR 50065--Footnote 3, Functional Impacts, the reference

to ``(MS) Minimally Significant'' was deleted.

62 FR 50066--Footnote 5 was deleted and footnote 6 was

redesignated footnote 5.

C. Cardiac

62 FR 50066--The confirmatory test for coronary artery

disease, angiography,''Definite significant (>60%) of one vessel,'' was

changed to ``Definite occlusion (>60%) of one vessel.''

62 FR 50067 through 50075--The disability tests, test

results and disability classifications for ``Echocardiogram'' and

``Cardiac catheterization'' with results of ``Decreased ejection

fraction 40-55%'' were deleted for all job titles. These tests were

found in the proposed rule under the listings Angina, Aortic valve

disease, Cardiomyopathy, Mitral valve disease, and Pericardial disease.

62 FR 50067 through 50075--The disability tests for

``Echocardiogram'' and ``Cardiac catheterization'' with results of

``Poor ejection fraction 35%'' for all job titles. These tests were found in

the proposed rule under the listings Angina, Aortic valve disease,

Cardiomyopathy, Mitral valve disease, and Pericardial disease.

62 FR 50067, 50071 and 50072--In the proposed rule one of

the disability tests for ``Mitral valve disease'' for trainman,

signalman and trackman was ``Cardiac catheterization'' with a test

result of ``Mitral valve gradient >10mm Hg.'' This disability test, and

its test result and disability classification was deleted. Another test

result under ``Mitral valve disease'' for ``Cardiac catheterization''

was ``Mitral valve gradient 5-10mm Hg.'' This test result was changed

to ``Mitral valve gradient 5mm Hg.''

62 FR 50068, 50069, 50070, 50073, 50074, 50075--One of the

disability tests for ``Mitral valve disease'' for engineer, dispatcher,

carman, machinist, shop laborer, sales representative, and general

office clerk was ``Cardiac catheterization'' with a test result of

``Mitral valve gradient 5-10mm Hg.'' This disability test, and its test

result and disability classification was deleted. Another test result

under ``Mitral valve disease'' for ``Cardiac catheterization'' was

``Mitral valve gradient >10mm Hg.'' This result was changed to ``Mitral

valve gradient 10mm Hg.''

62 FR 50067, 50070, 50071, 50072--For job titles trainman,

signalman, and trackman the disability tests were revised as follows:

Angina

--Stress test with a result of ``Peak exercise 5-7 METS'' the

disability test, test result, and disability classification were

deleted.

--Stress test with a result of ``Peak exercise 7 METS.''

--Stress test with a result of ``Definite ischemia 7 METS.''

--Stress test with a result of ``Definite ischemia >7 METS'': the

disability test, test result, and disability classification were

deleted.

Aortic Valve Disease

--Stress test with a result of ``Peak exercise 5-7 METS'': the

disability test, test result, and disability classification were

deleted.

--Stress test with a result of ``Peak exercise 7 METS.''

Coronary Artery Disease

--Stress test with a result of ``Peak exercise 5-7 METS'': the

disability test, test result, and disability classification were

deleted.

--Stress test with a result of ``Peak exercise 7 METS.''

--Stress test with a result of ``Definite ischemia 7 METS'' was

revised to read: ``Stress test--Definite ischemia 7 METS.''

--Isotope, e.g., thallium study with a result of ``Definite ischemia 7 METS'' was revised to read: ``Isotope, e.g., thallium study--

definite ischemia 7 METS.''

Cardiomyopathy

--Stress test with a result of ``Peak exercise 5-7 METS'' was revised

to read: ``Stress test--Peak exercise 7 METS.''

Mitral Valve Disease

--Stress test with a result of ``Peak exercise 5-7 METS'' was revised

to read: to ``Peak exercise 7 METS.''

62 FR 50067, 50068, 50069, 50070, 50072, 50073, 50074,

50075--For job titles engineer, dispatcher, carman, machinist, shop

laborer, sales representative, and general office clerk

[[Page 7540]]

the disability tests were revised as follows:

Angina

--Stress test with a result of ``Peak exercise 5-7 METS'' the

disability test, test result and disability classification were

deleted.

--Stress test with a result of ``Peak exercise 5 METS.''

--Stress test: significant ST changes with a result of ``Definite

ischemia 5 METS.''

--Stress test: significant ST changes with a result of ``Definite

ischemia >7 METS'': the disability test, test result, and disability

classification were deleted.

Aortic Valve Disease

--Stress test with a result of ``Peak exercise 5-7 METS'': the

disability test, test result, and disability classification were

deleted.

--Stress test with a result of ``Peak exercise 5 METS.''

Coronary Artery Disease

--Stress test with a result of ``Peak exercise 5-7 METS'': the

disability test, test result, and disability classification were

deleted.

--Stress test with a result of ``Peak exercise 5 METS.''

--Stress test with a result of ``Definite ischemia 7 METS'' was

revised to read: ``Stress test--Definite ischemia 5 METS.''

--Isotope, e.g., thallium study with a result of ``Definite ischemia 7 METS'' was revised to read: ``Isotope, e.g., thallium study--

Definite ischemia 5 METS.''

Cardiomyopathy

--Stress test with a result of ``Peak exercise 5-7 METS'' was revised

to read: ``Stress test--Peak exercise 5 METS.''

Mitral Valve Disease

--Stress test with a result of ``Peak exercise 5-7 METS'' was revised

to read: ``Stress test--Peak exercise 5 METS.''

62 FR 50067 through 50074--For job titles trainman,

engineer, dispatcher, carman, signalman, trackman, machinist, and shop

laborer, under the listing of ``Hypertension,'' the disability test of

``Medical record review'' with a result of ``Diastolic >120 and

systolic >160, 50% of the time''; the disability test, test result, and

disability classification were deleted. For sales representative, under

the listing ``Hypertension,'' the disability test of ``Medical record

review'' with a result of ``Diastolic >120 and systolic >160, 50% of

the time'': the following was added: ``and evidence of end organ damage

(blood creatinine >2; urinary protein >\1/2\ gm; or EKG evidence of

ischemia).''

62 FR 50067 through 50075--For all job titles, under

``Ventricular ectopy,'' the disability test of ``Medical record

review'' with a result of ``Surgical rhythm procedure'' and the

disability classification were deleted.

D. Respiratory

62 FR 50076 through 50080--The listing ``Asbestosis'' was

removed and, consequently, the designated confirmatory tests for this

condition were also removed.

62 FR 50076 through 50080--The listing ``Sleep Apnea'' was

removed and, consequently, the designated confirmatory tests for this

condition were also removed.

62 FR 50076--The confirmatory tests for ``Silicosis,''

``Chest X-ray (ILO interpreted)'' with a minimum result of ``At least

1/0 by NIOSH B reader,'' was removed.

62 FR 50076--The confirmatory test for ``Restrictive lung

disease'' designated ``Diffusing capacity'' was changed to read:

``DLCO.''

62 FR 50076--The parenthetical ``(race adjusted)'' in the

confirmatory test ``Spirometry'' for ``Restrictive lung disease'' was

removed.

62 FR 50077 through 50080--The disability test for

``Pulmonary fibrosis'' and ``Restrictive lung disease'' for trainman,

carman, signalman, trackman, machinist, and shop laborer designated

``Diffusing capacity for CO'' was changed to read: ``DLCO.''

62 FR 50076 through 50080--The disability test for

``Asthma'' and ``Chronic bronchitis'' for trainman, carman, signalman,

trackman, machinist, and shop laborer designated ``Spirometry'' has an

accompanying test result of ``FEV1 with adequate treatment 62 FR 50077 through 50080--Under the listing

Bronchiectasis, Chronic Bronchitis, Chronic Obstructive Pulmonary

Disease (COPD), Pulmonary Fibrosis, and Silicosis for the job titles

trainman, carman, signalman, trackman, machinist, and shop laborer the

disability test ``PCO2 arterial'' was changed to read: ``Resting ABG,''

and its accompanying test result was revised to read: ``PCO2 arterial

>50mm Hg if stable.''

62 FR 50077 through 50080--Under the listings

Bronchiectasis, Chronic Bronchitis, Chronic Obstructive Pulmonary

Disease (COPD), and Pulmonary Fibrosis for the job titles trainman,

carman, signalman, trackman, machinist, and shop laborer the disability

test ``Pulmonary exercise test'' with a test result of ``PO2 drop >5

torr at maximum exercise'' was changed to read ``Pulmonary exercise

test or exercise ABG.''

F. CE Spine

62 FR 50093--Under the listing ``Rheumatoid arthritis:

cervical'' the minimum result under the confirmatory test of

``Rheumatoid factor (blood test)'' was changed from ``High titer'' to

``Titer of rheumatoid factor.''

62 FR 50094 through 50097--The disability test for

``Spondylogenic compression of spinal cord:'' for trainman, engineer,

carman, signalman, trackman, machinist, and shop laborer designated

``Physical examination: lower limb'' has an accompanying test result of

``Lower extremity weakness or spasticity.'' The test result was changed

to: ``Lower extremity weakness or significant spasticity.''

62 FR 50094 through 50097--The disability test for

trainman, engineer, carman, signalman, trackman, machinist, and shop

laborer designated ``Physical examination: cervical'' was changed to

read ``Physical examination.'' This disability test can be found under

the listings Cervical disc disease with myelopathy, Chronic herniated

disc, Cervical spondylolysis, Cervical intervertebral disc

degeneration, Fracture: posterior element with spinal canal

displacement, Post-laminectomy syndrome, Cervical radiculopathy, and

Spondylogenic compression of spinal cord.

G. Shoulder

62 FR 50097--The confirmatory test ``Permanent functional

limitation, elbow:'' was changed to ``Medical diagnosis leading to a

permanent functional limitation of the elbow.''

62 FR 50098 through 50099--The disability test for

trainman, engineer, carman, signalman, trackman, machinist, and shop

laborer under the listing ``Permanent functional limitation, elbow:''

was ``Physical examination--range of motion.'' Its accompanying test

result ``Flexion limit to 60 degrees (30 degrees from 90)'' was changed

to ``Flexion limited to 60 degrees.''

[[Page 7541]]

H. Hand and Arm

62 FR 50099--The confirmatory tests for ``Carpal tunnel

syndrome'' designated ``Physical examination'' with a minimum result of

``Tinel's or Phalen's sign suggestive but not confirming'' was removed.

62 FR 50099--One of the confirmatory tests for

``Rheumatoid arthritis: hand'' is ``Rheumatoid factor.'' The minimum

result for this test was changed from ``High titer'' to ``Titer of

rheumatoid factor.''

62 FR 50100 through 50104--A disability test for trainman,

carman, signalman, trackman, machinist, and shop laborer was ``Strength

(jamar)'' with a test result for dominant and non-dominant hands for

female and male. All references to these tests, their results and

disability classifications were deleted. These disability tests were

found in the proposed rule under the listings: Carpal tunnel syndrome,

Fracture wrist, Hand permanent functional limitation, and Wrist

permanent functional limitation.

62 FR 50100 through 50104--Two of the disability tests for

the listing ``Thumb: permanent functional limitation'' were ``Adduction

of thumb'' and ``Opposition'' with a result of ``Loss 62 FR 50105--One of the confirmatory tests for ``Paget's

disease'' is ``X-ray: hip.'' The minimum result for this test was

changed from ``Osteolytic and blastic lesions'' to ``Osteolytic or

blastic lesions.''

J. Knee

62 FR 50108--The confirmatory test for ``Patellar-7

subluxation-recurrent'' is a ``Medical record review.'' The minimum

result for this testing in the proposed rule was ``History of recurrent

subluxation with associated signs.'' The phrase ``with associated

signs'' was removed.

K. Ankle and Foot

62 FR 50116 through 50120--One of the disability tests for

the listing ``Rheumatoid arthritis, foot:'' is a ``Medical record

review.'' Its accompanying test result in the proposed rule was

``Frequent flare-up with treatment.'' This test result was changed to

``Chronic flare-up with treatment.''

The Board has determined that this is a significant rule under

Executive Order 12866. The Office of Management and Budget has approved

the information collection (Job Information Report, RRB Forms G-251a

and G-251b found in Appendix 3 of this part) associated with this rule

and assigned it OMB control number 3220-0193.

List of Subjects in 20 CFR Part 220

Disability benefits, Railroad employees, Railroad retirement,

Reporting and recordkeeping requirements.

For the reasons set forth in the preamble, part 220 of title 20 of

the Code of Federal Regulations is amended as follows:

PART 220--DETERMINING DISABILITY

1. The authority citation for part 220 continues to read as

follows:

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

2. The heading of subpart C is revised to read as follows:

Subpart C--Disability Under the Railroad Retirement Act for Work in

an Employee's Regular Railroad Occupation

3. Section 220.10 is revised to read as follows:

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

occupation.

(a) In order to receive an occupational disability annuity an

eligible employee must be found by the Board to be disabled for work in

his or her regular railroad occupation because of a permanent physical

or mental impairment. In this subpart the Board describes in general

terms how it evaluates a claim for an occupational disability annuity.

In accordance with section 2(a)(2) of the Railroad Retirement Act this

subpart was developed with the cooperation of employers and employees.

This subpart is supplemented by an Occupational Disability Claims

Manual (Manual) 1 which was also developed with the

cooperation of employers and employees.

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

\1\ The Manual may be obtained from the Board's headquarters at

844 North Rush Street, Chicago, IL 60611.

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

(b) In accordance with section 2(a)(2) of the Railroad Retirement

Act, the Board shall select two physicians, one from recommendations

made by representatives of employers and one from recommendations made

by representatives of employees. These individuals shall comprise the

Occupational Disability Advisory Committee (Committee). This Committee

shall periodically review, as necessary, this subpart and the Manual

and make recommendations to the Board with respect to amendments to

this subpart or to the Manual. The Board shall confer with the

Committee before it amends either this subpart or the Manual.

4. Section 220.11 is revised to read as follows:

Sec. 220.11 Definitions as used in this subpart.

Functional capacity test means one of a number of tests which

provide objective measures of a claimant's maximal work ability and

includes functional capacity evaluations which provide a systematic

comprehensive assessment of a claimant's overall strength, mobility,

endurance and capacity to perform physically demanding tasks, such as

standing, walking, lifting, crouching, stooping or bending, climbing or

kneeling.

Independent Case Evaluation (ICE) means the process for evaluating

claims not covered by Appendix 3 of this part.

Permanent physical or mental impairment means a physical or mental

impairment or combination of impairments that can be expected to result

in death or has lasted or can be expected to last for a continuous

period of not less than 12 months.

Regular railroad occupation means an employee's railroad occupation

in which he or she has engaged in service for hire in more calendar

months than the calendar months in which he or she has been engaged in

service for hire in any other occupation during the last preceding five

calendar years, whether or not consecutive; or has engaged in service

for hire in not less than one-half of all of the months in which he or

she has been engaged in service for hire during the last preceding 15

consecutive calendar years. If an employee last worked as an officer or

employee of a railway labor organization and if continuance in such

employment is no longer available to him or her, the ``regular

occupation'' shall be the position to which the employee holds

seniority rights or the position which he or she left to work for a

railway labor organization.

Residual functional capacity has the same meaning as found in

Sec. 220.120.

Sec. 220.12 [Removed]

Sec. 220.14 [Redesignated as Sec. 220.12]

5. The current Sec. 220.12 ``Permanent physical or mental

impairment, defined.'' is removed, and Sec. 220.14 ``Evidence

considered.'' is redesignated as Sec. 220.12.

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

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

[[Page 7542]]

Sec. 220.13 Establishment of permanent disability for work in regular

railroad occupation.

The Board will presume that a claimant who is not allowed to

continue working for medical reasons by his employer has been found,

under standards contained in this subpart, disabled unless the Board

finds that no person could reasonably conclude on the basis of evidence

presented that the claimant can no longer perform his or her regular

railroad occupation for medical reasons. (See Sec. 220.21 if the

claimant is not currently disabled, but was previously occupationally

disabled for a specified period of time in the past). The Board uses

the following evaluation process in determining disability for work in

the regular occupation:

* * * * *

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

impairment described in paragraph (a) of this section, it will--

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

defined in Sec. 220.11, based upon the employee's own description of

his or her job;

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

(i) The Board first determines whether the employee's regular

railroad occupation is an occupation covered under Appendix 3 of this

part. Second, the Board will determine whether the employee's claimed

impairment(s) is covered under Appendix 3 of this part. If claimant's

regular railroad occupation or impairment(s) is not covered under

Appendix 3 of this part, then the Board will determine if the employee

is disabled under ICE as set forth in paragraph (b)(2)(iv) of this

section.

(ii)(A) If the Board determines that, in accordance with paragraph

(b)(2)(i) of this section, Appendix 3 of this part applies, then the

Board will confirm the existence of the employee's impairment(s)

using--

(1) The ``highly recommended'' and ``recommended'' tests set forth

in Appendix 3 of this part that relate to the body part affected by the

claimant's impairment(s); or

(2) By using valid diagnostic tests accepted by the medical

community as described in Sec. 220.27.

(B) If the employee's impairment(s) cannot be confirmed because

there are significant differences in objective tests such as imaging

study, electrocardiograms or other test results, and these differences

cannot be readily resolved, the Board will determine if the employee is

disabled under ICE as set forth in paragraph (b)(2)(iv) of this

section. However, if the employee's impairment(s) cannot be confirmed,

and there are no significant differences in objective medical tests

which cannot be readily resolved, then the employee will be found not

disabled.

(iii) Once the impairment(s) is confirmed, as provided for in

paragraph (b)(2)(ii) of this section, the Board will apply Appendix 3

of this part. If Appendix 3 of this part dictates a ``D'' (disabled)

finding, the Board will find the claimant disabled.

(iv) If the Board does not find the employee disabled using the

standards in Appendix 3 of this part, then the Board will determine if

the employee is disabled using ICE. To evaluate a claim under ICE the

Board will use the following steps:

(A) Step 1. The Board will determine if the medical evidence is

complete. Under this step the Board may request the claimant to take

additional medical tests such as a functional capacity test or other

consultative examinations;

(B) Step 2. If the employee's impairment(s) has not been confirmed,

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

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

paragraph (b)(2)(ii)(A)(2) of this section;

(C) Step 3. The Board will determine whether the opinions among the

physicians regarding medical findings are consistent, by reviewing the

employee's medical history, physical and mental examination findings,

laboratory or other test results, and other information provided by the

employee or obtained by the Board. If such records reveal that there

are significant differences in the medical findings, significant

differences in opinions concerning the residual functional capacity

evaluations among treating physicians, or significant differences

between the results of functional capacity evaluations and residual

functional capacity examinations, then the Board may request additional

evidence from treating physicians, additional consultative examinations

and/or residual functional capacity tests to resolve the

inconsistencies;

(D) Step 4. When the Board determines that there is concordance of

medical findings, then the Board will assess the quality of the

evidence in accordance with Sec. 220.112, which describes the weight to

be given to the opinions of various physicians, and Sec. 220.114, which

describes how the Board evaluates symptoms such as pain. The Board will

also assess the weight of evidence by utilizing Sec. 220.14, which

outlines factors to be used in determining the weight to be attributed

to certain types of evidence. If, after assessment, the Board

determines that there is no substantial objective evidence of an

impairment, the Board will determine that the employee is not disabled;

(E) Step 5. Next, the Board determines the physical and mental

demands of the employee's regular railroad occupation. In determining

the job demands of the employee's regular railroad occupation, the

Board will not only consider the employee's own description of his or

her regular railroad occupation, but shall also consider the employer's

description of the physical requirements and environmental factors

relating to the employee's regular railroad occupation, as provided by

the employer on the appropriate form set forth in Appendix 3 of this

part, and consult other sources such as the Dictionary of Occupational

Titles and the job descriptions of occupations found in the

Occupational Disability Claims Manual, as provided for in Sec. 220.10;

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

(b)(2)(iv)(D) of this section, the Board shall determine the employee's

residual functional capacity. The Board will then compare the job

demands of the employee's regular railroad occupation, as determined in

paragraph (b)(2)(iv)(E) of this section. If the demands of the

employee's regular railroad occupation exceed the employee's residual

functional capacity, then the Board will find the employee disabled. If

the demands do not exceed the employee's residual functional capacity,

then the Board will find the employee not disabled.

7. A new section 220.14 is added to read as follows:

Sec. 220.14 Weighing of evidence.

(a) Factors which support greater weight. Evidence will generally

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

(1) The residual functional capacity evaluation is based upon

functional objective tests with high validity and reliability;

(2) The medical evidence shows multiple impairments which have a

cumulative effect on the employee's residual functional capacity;

(3) Symptoms associated with limitations are consistent with

objective findings;

(4) There exists an adequate trial of therapies with good

compliance, but poor outcome;

(5) There exists consistent history of conditions between treating

physicians and other health care providers.

[[Page 7543]]

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

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

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

physicians;

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

impact;

(3) There is inconsistency between subjective symptoms and physical

examination findings;

(4) There is evidence of poor compliance with treatment regimen,

keeping appointments, or cooperating with treatment;

(5) There is evidence of exam findings which is indicative of

exaggerated or potential malingering response;

(6) The evidence consists of objective findings of exams that have

poor reliability or validity;

(7) The evidence consists of imaging findings which are nonspecific

and largely present in the general population;

(8) The evidence consists of a residual functional capacity

evaluation which is supported by limited objective data without

consideration for functional capacity testing.

8. Appendix 3--Railroad Retirement Board Occupational Disability

Standards is added to part 220 to read as follows:

Appendix 3--Railroad Retirement Board Occupational Disability Standards

1. Introduction

1.01 The Board uses this appendix to adjudicate the

occupational disability claims of employees with medical conditions

and job titles covered by the Tables in this appendix. The Tables

are divided into ``Body Parts'', with each Body Part further divided

by job title. Under each job title there is a list of impairments

and tests with accompanying test results which establish a finding

of ``D'' (disabled). The use of these Tables is a three-step

process. In the first step we determine whether the employee's

regular railroad occupation is covered by the Tables; next we

establish the existence of an impairment covered by the Tables;

finally, we reach a disability determination. If we do not find an

employee disabled under these Tables, the employee may still be

found disabled using Independent Case Evaluation (ICE), as explained

in subpart C of this part.

1.02 The Cancer Tables are treated in a different way than

other body systems. Different types of cancer and their treatments

have different functional impacts. In the Cancer Tables the impact

of the impairment is seen as being significant or not significant.

Therefore, these tables contain an ``S'' (significant) which is

equivalent to a ``D'' rating. A detailed explanation of how to use

those tables is in that section. The steps to use the remaining

Tables are explained below:

2. Confirming the Impairment

2.01 Once we determine that the employee's regular railroad

occupation is covered by the Job Titles in the Tables, we must

determine the existence of an impairment covered by the Tables. This

is done through the use of Confirmatory Tests. These tests can

include information from medical records, surgical or operative

reports, or specific diagnostic test results. Confirmatory Tests are

listed in the initial section regarding each Body Part covered in

the Tables. If an impairment cannot be confirmed because of

inconsistent medical information, ICE may be required.

2.02 There are two types of Confirmatory Tests as follows.

2.03 ``Highly Recommended'' Tests--The designation of a

confirmatory test as being ``highly recommended'' means that the

test is almost always performed to confirm the existence of the

impairment. For many conditions, only one ``highly recommended''

test finding is suggested to confirm the impairment. However, there

may be times when that test is not available or is negative, but

other more detailed testing confirms the impairment.

2.04 Example A: To confirm the condition of pulmonary

hypertension, the Tables under Body Part C., Cardiac, designate as

``highly recommended'': an electrocardiogram which indicates

definite right ventricular hypertrophy. However, the impairment may

also be confirmed by insertion of a Swan-Ganz catheter into the

pulmonary artery and the pulmonary artery pressure measured

directly.

2.05 There may be some conditions for which several ``highly

recommended'' tests are suggested to confirm an impairment. In these

circumstances, we will use all ``highly recommended'' tests to

establish the existence of the impairment.

2.06 Example B: Under Body Part E., Lumbar Sacral Spine, three

highly recommended medical findings are identified for the diagnosis

of chronic back pain, not otherwise specified. These findings

include:

A. A history of back pain under medical treatment for at least

one year, and

B. A history of back pain unresponsive to therapy for at least

one year, and

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

least one year.

2.07 All three of these criteria must be satisfied to confirm

the existence of chronic back pain.

2.08 Sometimes the employee may have undergone detailed testing

which is as reliable as one of the ``highly recommended'' tests

listed in the Tables. In cases where an impairment has not been

confirmed by one of the designated ``highly recommended'' tests, the

impairment may still be confirmed by ``recommended'' tests (see

below) or by evidence acceptable under section 220.27 of this part.

2.09 Recommended Tests--The designation of a confirmatory test

as ``recommended'' means that the test need not be performed, or be

positive, to confirm the impairment. However, a positive test

provides significant support for confirming the impairment. If there

are no ``highly recommended'' tests for confirming the impairment,

at least one of the ``recommended'' tests should be positive.

2.10 There are two categories of recommended tests which are

described below.

A. Imaging studies--These studies can include MRI, CAT scan,

myelogram, or plain film x-rays. For conditions where several of

these imaging studies are identified as ``recommended'' tests, at

least one of the test results should be positive and meet the

confirmatory test criteria. For some conditions, such as

degenerative disc condition, there are several equivalent imaging

methods to confirm a diagnosis.

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

studies.

2.11 If there are no ``highly recommended'' confirmatory tests

designated to confirm an impairment and the ``recommended''

confirmatory tests only include non-imaging procedures, at least one

of these tests should be positive to confirm the impairment. The

greater the number of tests that are positive, the greater the

confidence that the correct diagnosis has been established.

2.12 Example: Under Body Part C., Cardiac, the diagnostic

confirmatory tests for ventricular ectopy, a cardiac arrhythmia,

include the following ``recommended'' tests:

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

medical records, or

B. Holter monitoring, or

C. Provocative testing producing a definite arrhythmia.

2.13 In this situation, only one of the ``recommended''

confirmatory tests need be positive to confirm the impairment.

However, the more tests that are positive, the stronger the support

for the diagnosis.

2.14 In no circumstance will the Board require that an invasive

test be performed to confirm an impairment. Several of the

Confirmatory Tests which are described in the Tables are invasive

and it is not the intention of the Board to suggest that these be

performed. The inclusion of invasive tests in the Tables

Confirmatory Tests section is intended to help the Board evaluate

the significance of findings from such tests that may have already

been performed and which are part of the submitted medical record.

2.15 If an employee's impairment(s) cannot be confirmed by use

of the confirmatory tests listed in the Tables, it still may be

confirmed by medical evidence described in section 220.27 of this

part. However, if a claimant's impairment(s) cannot be confirmed

through use of the Tables or under section 220.27, and the medical

evidence is complete and in concordance, the claimant will be found

not disabled.

3. Disability Determination

3.01 Once the Board determines that the employee's regular

railroad occupation is covered by one of the Job Titles in the

Tables and that his or her alleged impairment fits into a Body Part

covered by the Tables and can be confirmed, we examine the results

of any of the disability tests listed under the impairment. If the

results from any of these tests indicate a ``D'' finding, the

employee is found disabled. If none of the test results

[[Page 7544]]

indicate a ``D'' finding, then the employee's claim is evaluated

using ICE.

3.02 Example: A trainman has angina as confirmed by the

recommended tests under Body Part A: Cardiac--Angina. An

echocardiogram shows that he has poor ejection fraction

35%. The employee is rated disabled. If none of the

results of the listed disability tests match the results required

for a ``D'' finding, then the employee's claim is evaluated under

ICE.

Tables

A. Cancer

B. Endocrine

C. Cardiac

D. Respiratory

E. Lumbar Sacral Spine

F. Cervical Spine

G. Shoulder and Elbow

H. Hand and Arm

I. Hip

J. Knee

K. Ankle and Foot

A. Cancer

Cancer

Cancer conditions can be viewed as belonging to one of three

categories.

Category 1: Significant impact on functional capacity or

anticipated life span.

Category 2: Intermediate impact on functional capacity; large

individual variability.

Category 3: No significant impact on functional capacity or

expected life span.

The factors that are considered in developing these categories

include the following:

Type of Cancer

The functional impact of different malignancies varies tremendously

and each malignancy has to be considered on an individual basis.

Magnitude of Disease

The disability standards are based upon the magnitude or extent of

disease. The extent of disease affects both anticipated life span and

the functional capacity or work ability of the individual. Localized

cancer including cancer ``in situ'' can frequently be completely cured

and not have an impact on functional capacity or life span. In

contrast, many cancers that have distant or significant regional spread

generally have a poor prognosis. The magnitude or extent of disease is

classified into three categories: local, regional and distant.

The criteria which are used to classify a cancer into one of the

three categories are based upon the distillation of several staging

methods into a single system [Miller, et al. (1992). Cancer Statistics

Review, 1973 - 1989; NIH Publication No. 92 - 2789].

Effects of Treatment

Although some types of cancer may be potentially curable with

radical surgery and/or radiation therapy, the treatment regimen may

result in a significant impairment that could affect functional

capacity and ability to work. For example, a person with a laryngeal

tumor which had spread regionally could be cured by a complete

laryngectomy and radiotherapy. However, this treatment could result in

a loss of speech and significantly impair the individual's

communicative skills or ability to use certain types of respiratory

protective equipment.

Prognosis

Some cancers may have minimal impact on a person's functional

capacity, but have a very poor prognosis with respect to life

expectancy. For example, an individual with early stage brain cancer

may be minimally impaired, but have a poor prognosis and minimal

potential for surviving longer than two years. Five and two year

survival data are presented in the Cancer Disability Guideline Table

which follows.

The Cancer Disability Guideline Table provides information

concerning the probability of survival for five years for local,

regional, and distant disease for each type of malignancy. In addition,

two-year survival data are also presented for all disease stages. The

five-year survival data are based upon data collected from population-

based registries in Connecticut, New Mexico, Utah, Hawaii, Atlanta,

Detroit, Seattle and the San Francisco and East Bay area between 1983

and 1987 (Miller, 1992). The two-year data are from a cohort study

initially diagnosed in 1988.

Assessment

The malignancies are classified as disabling (Category 1),

potentially disabling (Category 2) and non-disabling (Category 3).

Category 2 conditions must be evaluated with respect to how the

worker's tumor affects the worker's ability to perform the job and an

assessment of his life span.

Information concerning the potential impact of the malignancy on a

worker's ability to perform a job is identified in the Functional

Impact column in the table. All railroad occupations in the Tables are

considered together. Functional impacts are classified as significant

if the treatment or sequelae from treatment including radiotherapy,

chemotherapy and/or surgery is likely to impair the worker from

performing the job. If the treatment results in a significant

impairment of another organ system, the individual should be evaluated

for disability associated with impairment of that body part. For

example, a person undergoing an amputation for a bone malignancy would

have to be evaluated for an amputation of that body part. For many

cancers, it is difficult to make generalizations regarding the level of

impairment that will occur after the person has initiated or completed

treatment. Nonsignificant impacts include those that are unlikely to

have any effect on the individual's work capacity.

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

Disability Functional

Cancer type 2-year\1\ 5-year\1\ status\2\ impact\3\

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

Brain:

Local.......................... .................... 26 1 S

Regional....................... .................... 27.9 1 S

Distant........................ .................... 23.6 1 S

Female Breast:

Regional....................... .................... 71.1 2 S

Distant........................ .................... 17.8 1 S

Colon:

Local.......................... .................... 91 2 S

Regional....................... .................... 60.1 2 S

Distant........................ .................... 6 1 S

Rectal:

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

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

[[Page 7545]]

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

Esophagus:

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

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

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

Hodgkin's Disease:\4\

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

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

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

one vessel.

Cardiomyopathy:

Echocardiogram..................... Proven ejection fraction 35% Recommended.

Catheterization.................... Poor global function and not Recommended.

coronary artery disease.

Hypertension:

Medical record review.............. Documentation of Highly recommended.

hypertension for one year.

Medical record review.............. Definite diagnosis by Highly recommended.

cardiologist or internist.

Medical record review.............. Confirmation of medication Highly recommended.

use.

Arrhythmia: heart block:

Medical record review.............. Proven episode with Recommended.

electrocardiogram

confirmation.

Electrocardiogram.................. Documentation of arrhythmia. Recommended.

Mitral valve disease:

Cardiac catheterization............ Significant valve disease... Recommended.

Echocardiogram..................... Significant valve disease... Recommended.

Pericardial disease:

Medical record review.............. Confirmed by cardiologist or Highly recommended.

internist.

Pulmonary hypertension:

Physical examination............... Increased pulmonic sound or Recommended.

pulmonary ejection murmur by

cardiologist or internist.

Electrocardiogram.................. Definite right ventricular Highly recommended.

hypertension.

Ventricular ectopy:

Medical record review.............. Definite episode within one Recommended.

year.

Holter monitoring.................. Definite arrhythmia......... Recommended.

Provocative testing................ Positive response........... Recommended.

Arrhythmia: supraventricular

tachycardia:

Medical record review.............. Definite episode within one Recommended.

year.

Holter monitoring.................. Definite arrhythmia......... Recommended.

Post heart transplant:

Medical record review.............. Documented.................. Highly recommended.

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

[[Page 7547]]

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

Disability test Test result Disability classification

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

BODY PART: CARDIAC

JOB TITLE: TRAINMAN

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

Angina:

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 7 METS........ D

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

cardiologist.

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

response.

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

Aortic valve disease:

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

HG.

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 7 METS........ D

Coronary artery disease:

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

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

aneurysm.

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

Hg.

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

Stress test........................ Peak exercise 7 METS........ D

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

Cardiologist.

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

response.

Stress test........................ Definite ischemia 7 METS... D

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

Cardiomyopathy:

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 7 METS........ D

Hypertension:

Medical record review.............. Diastolic >120 and systolic D

>160, 50% of the time and

evidence of end organ damage

(blood creatinine >2;

urinary protein >\1/2\ gm;

or EKG evidence of ischemia).

Arrhythmia: heart block:

Holter............................. Documented asystole length D

>1.5 - 2 seconds.

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

proven arrhythmia.

Mitral valve disease:

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

Hg.

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

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 7 METS........ D

Pericardial disease:

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Ventricular ectopy:

Medical record review.............. Documented life threatening D

arrhythmia.

Holter............................. Uncontrolled ventricular D

rhythm.

Medical record review.............. Documented related syncope.. D

Arrhythmia: supraventricular

tachycardia:

Medical record review.............. Documented related syncope.. D

Post heart transplant:

Medical record review.............. Post heart transplant....... D

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

BODY PART: CARDIAC

JOB TITLE: ENGINEER

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

Angina:

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

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

cardiologist.

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

response.

Stress test: significant ST changes Definite ischemia 5 METS.... D

Aortic valve disease:

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

HG.

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

Coronary artery disease:

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

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

aneurysm.

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

Hg.

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

Stress test........................ Peak exercise 5 METS........ D

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

Cardiologist.

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

response.

Stress test........................ Definite ischemia 5 METS.... D

[[Page 7548]]

Isotope, e.g., thallium study...... Definite ischemia 5 METS.... D

Cardiomyopathy:

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

Hypertension:

Medical record review.............. Diastolic >120 and systolic D

>160, 50% of the time and

evidence of end organ damage

(blood creatinine >2;

urinary protein >\1/2\ gm;

or EKG evidence of ischemia).

Arrhythmia: heart block:

Holter............................. Documented asystole length D

>1.5 - 2 seconds.

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

proven arrhythmia.

Mitral valve disease:

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

Hg.

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

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

Pericardial disease:

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Ventricular ectopy:

Medical record review.............. Documented life threatening D

arrhythmia.

Holter............................. Uncontrolled ventricular D

rhythm.

Medical record review.............. Documented related syncope.. D

Arrhythmia: supraventricular

tachycardia:

Medical record review.............. Documented related syncope.. D

Post heart transplant:

Medical record review.............. Post heart transplant....... D

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

BODY PART: CARDIAC

JOB TITLE: DISPATCHER

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

Angina:

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

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

cardiologist.

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

response.

Stress test: significant ST changes Definite ischemia 5 METS.... D

Aortic valve disease:

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

Hg.

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

Coronary artery disease:

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

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

aneurysm.

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

Hg.

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

Stress test........................ Peak exercise 5 METS........ D

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

cardiologist.

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

response.

Stress test........................ Definite ischemia 5 METS.... D

Isotope, e.g., thallium study...... Definite ischemia 5 METS.... D

Cardiomyopathy:

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

Hypertension:

Medical record review.............. Diastolic >120 and systolic D

>160, 50% of the time and

evidence of end organ damage

(blood creatinine >2;

urinary protein >\1/2\ gm;

or EKG evidence of ischemia).

Arrhythmia: heart block:

Holter............................. Documented asystole length D

>1.5 - 2 seconds.

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

proven arrhythmia.

Mitral valve disease:

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

Hg.

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

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

Pericardial disease:

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Ventricular ectopy:

Medical record review.............. Documented life threatening D

arrhythmia.

[[Page 7549]]

Holter............................. Uncontrolled ventricular D

rhythm.

Medical record review.............. Documented related syncope.. D

Arrhythmia: supraventricular

tachycardia:

Medical record review.............. Documented related syncope.. D

Post heart transplant:

Medical record review.............. Post heart transplant....... D

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

BODY PART: CARDIAC

JOB TITLE: CARMAN

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

Angina:

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

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

cardiologist.

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

response.

Stress test: significant ST changes Definite ischemia 5 METS.... D

Aortic valve disease:

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

HG.

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

Coronary artery disease:

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

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

aneurysm.

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

Hg.

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

Stress test........................ Peak exercise 5 METS........ D

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

Cardiologist.

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

response.

Stress test........................ Definite ischemia 5 METS... D

Isotope, e.g., thallium study...... Definite ischemia 5 METS... D

Cardiomyopathy:

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

Hypertension:

Medical record review.............. Diastolic >120 and systolic D

>160, 50% of the time and

evidence of end organ damage

(blood creatinine >2;

urinary protein >\1/2\ gm;

or EKG evidence of ischemia).

Arrhythmia: heart block:

Holter............................. Documented asystole length D

>1.5 - 2 seconds.

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

proven arrhythmia.

Mitral valve disease:

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

Hg.

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

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

Pericardial disease:

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Ventricular ectopy:

Medical record review.............. Documented life threatening D

arrhythmia.

Holter............................. Uncontrolled ventricular D

rhythm.

Medical record review.............. Documented related syncope.. D

Arrhythmia: supraventricular

tachycardia:

Medical record review.............. Documented related syncope.. D

Post heart transplant:

Medical record review.............. Post heart transplant....... D

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

BODY PART: CARDIAC

JOB TITLE: SIGNALMAN

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

Angina:

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 7 METS........ D

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

cardiologist.

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

response.

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

Aortic valve disease:

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

HG.

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 7 METS........ D

Coronary artery disease:

Myocardial infarction.............. Multiple infractions........ D

[[Page 7550]]

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

aneurysm.

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

Hg.

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

Stress test........................ Peak exercise 7 METS........ D

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

cardiologist.

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

response.

Stress test........................ Definite ischemia 7 METS.... D

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

Cardiomyopathy:

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 7 METS........ D

Hypertension:

Medical record review.............. Diastolic >120 and systolic D

>160, 50% of the time and

evidence of end organ damage

(blood creatinine >2;

urinary protein >\1/2\ gm;

or EKG evidence of ischemia).

Arrhythmia: heart block

Holter............................. Documented asystole length D

>1.5 - 2 seconds.

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

proven arrhythmia.

Mitral valve disease:

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

Hg.

Cardiac catherization.............. Mitral regurgitation severe. D

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 7 METS........ D

Pericardial disease:

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Ventricular ectopy:

Medical record review.............. Documented life threatening D

arrhythmia.

Holter............................. Uncontrolled ventricular D

rhythm.

Medical record review.............. Documented related syncope.. D

Arrhythmia: supraventricular

tachycardia:

Medical record review.............. Documented related syncope.. D

Post heart transplant:

Medical record review.............. Post heart transplant....... D

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

BODY PART: CARDIAC

JOB TITLE: TRACKMAN

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

Angina:

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 7 METS........ D

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

cardiologist.

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

response.

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

Aortic valve disease:

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

HG.

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 7 METS........ D

Coronary artery disease:

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

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

aneurysm.

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

Hg.

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

Stress test........................ Peak exercise 7 METS........ D

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

cardiologist.

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

response.

Stress test........................ Definite ischemia 7 METS.... D

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

Cardiomyopathy:

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 7 METS........ D

Hypertension:

Medical record review.............. Diastolic >120 and systolic D

>160, 50% of the time and

evidence of end organ damage

(blood creatinine >2;

urinary protein >\1/2\ gm;

or EKG evidence of ischemia).

Arrhythmia: heart block:

Holter............................. Documented asystole length D

>1.5 - 2 seconds.

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

proven arrhythmia.

Mitral valve disease:

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

Hg.

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

[[Page 7551]]

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 7 METS........ D

Pericardial disease:

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Ventricular ectopy:

Medical record review.............. Documented life threatening D

arrhythmia.

Holter............................. Uncontrolled ventricular D

rhythm.

Medical record review.............. Documented related syncope.. D

Arrhythmia: supraventricular

tachycardia:

Medical record review.............. Documented related syncope.. D

Post heart transplant:

Medical record review.............. Post heart transplant....... D

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

BODY PART: CARDIAC

JOB TITLE: MACHINIST

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

Angina:

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

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

cardiologist.

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

response.

Stress test: significant ST changes Definite ischemia 5 METS.... D

Aortic valve disease:

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

HG.

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

Coronary artery disease:

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

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

aneurysm.

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

Hg.

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

Stress test........................ Peak exercise 5 METS........ D

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

cardiologist.

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

response.

Stress test........................ Definite ischemia 5 METS.... D

Isotope, e.g., thallium study...... Definite ischemia 5 METS.... D

Cardiomyopathy:

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

Hypertension:

Medical record review.............. Diastolic >120 and systolic D

>160, 50% of the time and

evidence of end organ damage

(blood creatinine >2;

urinary protein >\1/2\ gm;

or EKG evidence of ischemia).

Arrhythmia: heart block:

Holter............................. Documented asystole length D

>1.5 - 2 seconds.

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

proven arrhythmia.

Mitral valve disease:

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

Hg.

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

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

Pericardial disease:

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Ventricular ectopy:

Medical record review.............. Documented life threatening D

arrhythmia.

Holter............................. Uncontrolled ventricular D

rhythm.

Medical record review.............. Documented related syncope.. D

Arrhythmia: supraventricular

tachycardia:

Medical record review.............. Documented related syncope.. D

Post heart transplant:

Medical record review.............. Post heart transplant....... D

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

BODY PART: CARDIAC

JOB TITLE: SHOP LABORER

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

Angina:

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

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

cardiologist.

[[Page 7552]]

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

response.

Stress test: significant ST changes Definite ischemia 5 METS.... D

Aortic valve disease:

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

HG.

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

Coronary artery disease:

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

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

aneurysm.

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

Hg.

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

Stress test........................ Peak exercise 5 METS........ D

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

Cardiologist.

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

response.

Stress test........................ Definite ischemia 5 METS.... D

Isotope, e.g., thallium study...... Definite ischemia 5 METS.... D

Cardiomyopathy:

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

Hypertension:

Medical record review.............. Diastolic >120 and systolic D

>160, 50% of the time and

evidence of end organ damage

(blood creatinine >2;

urinary protein >\1/2\ gm;

or EKG evidence of ischemia).

Arrhythmia: heart block:

Holter............................. Documented asystole length D

>1.5 - 2 seconds.

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

proven arrhythmia.

Mitral valve disease:

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

Hg.

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

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

Pericardial disease:

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Ventricular ectopy:

Medical record review.............. Documented life threatening D

arrhythmia.

Holter............................. Uncontrolled ventricular D

rhythm.

Medical record review.............. Documented related syncope.. D

Arrhythmia: supraventricular

tachycardia:

Medical record review.............. Documented related syncope.. D

Post heart transplant:

Medical record review.............. Post heart transplant....... D

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

BODY PART: CARDIAC

JOB TITLE: SALES REPRESENTATIVE

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

Angina:

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

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

cardiologist.

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

response.

Stress test: significant ST changes Definite ischemia 5 METS.... D

Aortic valve disease:

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

HG.

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

Coronary artery disease:

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

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

aneurysm.

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

Hg.

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

Stress test........................ Peak exercise 5 METS........ D

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

cardiologist.

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

response.

Stress test........................ Definite ischemia 5 METS.... D

Isotope, e.g., thallium study...... Definite ischemia 5 METS.... D

Cardiomyopathy:

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

[[Page 7553]]

Hypertension:

Medical record review.............. Diastolic >120 and systolic D

>160, 50% of the time and

evidence of end organ damage

(blood creatinine >2;

urinary protein >\1/2\ gm;

or EKG evidence of ischemia).

Arrhythmia: heart block:

Holter............................. Documented asystole length D

>1.5 - 2 seconds.

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

proven arrhythmia.

Mitral valve disease:

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

Hg.

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

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

Pericardial disease:

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Ventricular ectopy:

Medical record review.............. Documented life threatening D

arrhythmia.

Holter............................. Uncontrolled ventricular D

rhythm.

Medical record review.............. Documented related syncope.. D

Arrhythmia: supraventricular

tachycardia:

Medical record review.............. Documented related syncope.. D

Post heart transplant:

Medical record review.............. Post heart transplant....... D

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

BODY PART: CARDIAC

JOB TITLE: GENERAL OFFICE CLERK

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

Angina:

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

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

cardiologist.

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

response.

Stress test: significant ST changes Definite ischemia 5 METS.... D

Aortic valve disease:

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

HG.

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

Coronary artery disease:

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

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

aneurysm.

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

Hg.

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

Stress test........................ Peak exercise 5 METS........ D

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

Cardiologist.

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

response.

Stress test........................ Definite ischemia 5 METS.... D

Isotope, e.g., thallium study...... Definite ischemia 5 METS.... D

Cardiomyopathy:

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

Arrhythmia: heart block:

Holter............................. Documented asystole length D

>1.5 - 2 seconds.

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

proven arrhythmia.

Mitral valve disease:

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

Hg.

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

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Stress test........................ Peak exercise 5 METS........ D

Pericardial disease:

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

Echocardiogram..................... Poor ejection fraction 35%.. D

Ventricular ectopy:

Medical record review.............. Documented life threatening D

arrhythmia.

Holter............................. Uncontrolled ventricular D

rhythm.

Medical record review.............. Documented related syncope.. D

Arrhythmia: supraventricular

tachycardia:

Medical record review.............. Documented related syncope.. D

Post heart transplant:

Medical record review.............. Post heart transplant....... D

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

[[Page 7554]]

D. Respiratory

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

Confirmatory test Minimum result Requirements

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

---------------------------------------------BODY PART: RESPIRATORY---------------------------------------------

CONFIRMATORY TESTS

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

Asthma:

Spirometry......................... FEV1/FVC ratio diminished... Recommended.

Spirometry......................... >15% change with Recommended.

administration of

bronchodilator.

Methacholine challenge test........ Positive: FEV1 decrease >20% Recommended

at (PC 50 mm Hg if D

stable.

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

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

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

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

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

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

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

ventricular hypertrophy.

DLCO............................... 5 torr at maximum D

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 5 torr at maximum D

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg If D

stable.

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

ventricular hypertrophy.

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

BODY PART: RESPIRATORY

JOB TITLE: CARMAN

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

Asthma:

Spirometry......................... Repeated spirometry FEV1 D

50 mm Hg if D

stable.

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

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

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

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

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

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

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

ventricular hypertrophy.

DLCO............................... 5 torr at maximum D

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 5 torr at maximum D

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

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

ventricular hypertrophy.

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

BODY PART: RESPIRATORY

JOB TITLE: SIGNALMAN

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

Asthma:

Spirometry......................... Repeated spirometry FEV1 D

50 mm Hg if D

stable.

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

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

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

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

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

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

DLCO............................... 5 torr at maximum D

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 5 torr at maximum D

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

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

ventricular hypertrophy.

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

BODY PART: RESPIRATORY

JOB TITLE: TRACKMAN

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

Asthma:

Spirometry......................... Repeated spirometry FEV1 D

50 mm Hg if D

stable.

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

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

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

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

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

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

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

ventricular hypertrophy.

DLCO............................... 5 torr at maximum D

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 5 torr at maximum D

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

[[Page 7557]]

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

ventricular hypertrophy.

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

BODY PART: RESPIRATORY

JOB TITLE: MACHINIST

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

Asthma:

Spirometry......................... Repeated spirometry FEV1 D

50 mm Hg if D

stable.

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

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

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

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

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

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

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

ventricular hypertrophy.

DLCO............................... 5 torr at maximum D

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 5 torr at maximum D

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

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

ventricular hypertrophy.

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

BODY PART: RESPIRATORY

JOB TITLE: SHOP LABORER

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

Asthma:

Spirometry......................... Repeated spirometry FEV1 D

50 mm Hg if D

stable.

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

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

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

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

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

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

[[Page 7558]]

DLCO............................... 5 torr at maximum D

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 5 torr at maximum D

ABG. exercise.

Pulmonary exercise test............ Maximum VO2 50 mm Hg if D

stable.

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

ventricular hypertrophy.

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

E. Lumbar Sacral Spine

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

Confirmatory test Minimum result Requirements

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

-----------------------------------------------BODY PART: LS SPINE----------------------------------------------

CONFIRMATORY TESTS

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

Ankylosing spondylitis:

X-ray-lumbar sacral spine.......... Sacroilitis................. Highly recommended.

HLA B27 (blood test)............... Positive HLA B27 (90% case). Recommended.

Backache, unspecified:

Medical record review.............. History of back pain under Highly recommended.

medical treatment for at

least 1 year.

Medical record review.............. History of back pain Highly recommended.

unresponsive to therapy for

at least 1 year.

Medical record review.............. History of back pain with Highly recommended.

functional limitations for

at least 1 year.

Chronic back pain, not otherwise

specified:.

Medical record review.............. History of back pain under Highly recommended.

medical treatment for at

least 1 year.

Medical record review.............. History of back pain Highly recommended.

unresponsive to therapy for

at least 1 year.

Medical record review.............. History of back pain with Highly recommended.

functional limitations for

at least 1 year.

Cauda equina syndrome with bowel or

bladder dysfunction:.

Magnetic resonance imaging......... Neural impingement of spinal Recommended.

nerves below L1.

Computerized tomography............ Neural impingement of spinal Recommended.

nerves below L1.

Cystometrogram..................... Impaired bladder function... Recommended.

Rectal examination................. Diminished rectal sphincter Recommended.

tone.

Myelogram.......................... Neural impingement of spinal Recommended.

nerves below L1.

Degeneration of lumbar disc:

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

disc changes.

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

disc changes.

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

disc changes.

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

disc changes.

Displacement of lumbar disc:.......

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

disc changes.

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

disc changes.

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

disc changes.

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

disc changes.

Fracture: vertebral body:..........

Magnetic resonance imaging......... Fracture vertebral body..... Recommended.

Computerized tomography............ Fracture vertebral body..... Recommended.

X-ray-lumbar sacral spine.......... Fracture vertebral body..... ommended.

Fracture: posterior element with

spinal canal displacement:

Magnetic resonance imaging......... Fracture posterior spinal Recommended.

element with displacement of

spinal canal.

Computerized tomography............ Fracture posterior spinal Recommended.

element with displacement of

spinal canal.

X-ray-lumbar sacral spine.......... Fracture posterior spinal Recommended.

element with displacement of

spinal canal.

[[Page 7559]]

Fracture: posterior spinal element

with no displacement:.

X-ray-lumbar sacral spine.......... Fracture posterior spinal Recommended.

element.

Magnetic resonance imaging......... Fracture posterior spinal Recommended.

element.

Computerized tomography............ Fracture posterior spinal Recommended.

element.

Fracture: spinous process:

X-ray-lumbar sacral spine.......... Spinous process fracture.... Recommended.

Magnetic resonance imaging......... Spinous process fracture.... Recommended.

Computerized tomography............ Spinous process fracture.... Recommended.

Fracture: Transverse process:

Lumbar sacral spine................ Transverse process fracture. Recommended.

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

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

Intervertebral disc disorder:

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

degeneration.

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

degeneration.

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

degeneration.

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

degeneration.

Lumbago:

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

medical treatment for at

least 1 year.

Medical record review: lumbar...... History of back pain Highly recommended.

unresponsive to therapy for

at least 1 year.

Medical record review: lumbar...... History of back pain with Highly recommended.

functional limitations for

at least 1 year.

Lumbosacral neuritis:

Magnetic resonance imaging......... Evidence of neural Recommended.

compression.

Electromyography................... Definite denervation........ Recommended.

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

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

with 2 cm difference between

limbs.

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

raise.

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

affected dermatomes.

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

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

compression.

Lumbar spinal stenosis:

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

spinal cord canal or

intervertebral foramen.

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

spinal cord canal or

intervertebral foramen.

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

spinal cord canal or

intervertebral foramen.

Mechanical complication of internal

orthopedic device:

Medical record review.............. Documentation of failure of Highly recommended.

implant following surgical

procedure.

Osteomalacia:

X-ray-lumbar sacral spine.......... Evidence of significant Recommended.

osteomalacia.

Magnetic resonance imaging......... Evidence of significant Recommended.

osteomalacia.

Computerized tomography............ Evidence of significant Recommended.

osteomalacia.

Osteomyelitis, chronic-lumbar:

X-ray-lumbar sacral spine.......... Evidence of chronic Recommended.

infection.

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

infection.

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

infection.

Osteoporosis:

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

loss.

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

loss.

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

loss.

Post laminectomy syndrome with

radiculopathy:

Medical record review: lumbar...... Documented surgical history Highly recommended.

of laminectomy.

Magnetic resonance imaging......... Evidence of laminectomy..... Recommended.

Electromyography................... Definite denervation........ Recommended.

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

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

with 2 cm difference between

limbs.

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

raise.

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

affected dermatomes.

Medical record review: lumbar...... History of radicular pain... Highly recommended.

Computerized tomography............ Evidence of laminectomy..... Recommended.

Myelogram.......................... Evidence of laminectomy..... Recommended.

Radiculopathy:

Magnetic resonance imaging......... Evidence of neural Recommended.

compression.

Electromyography................... Definite denervation........ Recommended.

[[Page 7560]]

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

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

with 2 cm difference between

limbs.

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

raise.

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

affected dermatomes.

Medical record review: lumbar...... History of radicular pain... Highly recommended.

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

compression.

Myelogram.......................... Evidence of neural Recommended.

compression.

Sciatica:

Magnetic resonance imaging......... Evidence of neural Recommended.

compression.

Electromyography................... Definite denervation........ Recommended.

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

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

with 2 cm difference between

limbs.

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

raise.

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

affected dermatomes.

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

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

compression.

Myelogram.......................... Evidence of neural Recommended.

compression.

Strains and sprains, unspecified:

Medical record review.............. History of back pain under Highly recommended.

medical treatment for at

least 1 year.

Medical record review.............. History of back pain Highly recommended.

unresponsive to therapy for

at least 1 year.

Medical record review.............. History of back pain with Highly recommended.

functional limitations for

at least 1 year.

Medical record review.............. Documented history of strain Highly recommended.

and/or sprain.

Spondylolisthesis grade 1:

X-ray-lumbar sacral spine.......... 1 - 25% slippage............ Recommended.

Computerized tomography............ 1 - 25% slippage............ Recommended.

Magnetic resonance imaging......... 1 - 25% slippage............ Recommended.

Spondylolisthesis grade 2:

X-ray-lumbar sacral spine.......... 26 - 50% slippage........... Recommended.

Computerized tomography............ 26 - 50% slippage........... Recommended.

Magnetic resonance imaging......... 26 - 50% slippage........... Recommended.

Spondylolisthesis grade 3:

X-ray-lumbar sacral spine.......... 51 - 75% slippage........... Recommended.

Computerized tomography............ 51 - 75% slippage........... Recommended.

Magnetic resonance imaging......... 51 - 75% slippage........... Recommended.

Spondylolisthesis grade 4:

X-ray-lumbar sacral spine.......... Complete slippage........... Recommended.

Computerized tomography............ Complete slippage........... Recommended.

Magnetic resonance imaging......... Complete slippage........... Recommended.

Spondylolisthesis-acquired:

X-ray-lumbar sacral spine.......... Slippage.................... Recommended.

Computerized tomography............ Slippage.................... Recommended.

Magnetic resonance imaging......... Slippage.................... Recommended.

Spondylolsis:

X-ray-lumbar sacral spine.......... Defect -- pars Recommended.

interarticularis.

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

interarticularis.

Magnetic resonance imaging......... Defect -- pars Recommended.

interarticularis.

Sprains and strains, sacral:

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

medical treatment for at

least 1 year.

Medical record review: lumbar...... History of back pain Highly recommended.

unresponsive to therapy for

at least 1 year.

Medical record review: lumbar...... History of back with Highly recommended.

functional limitations for

at least 1 year.

Medical record review: lumbar...... Documented history of strain Highly recommended.

and/or sprain.

Sprains and strains, sacroiliac:

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

medical treatment for at

least 1 year.

Medical record review: lumbar...... History of back pain Highly recommended.

unresponsive to therapy for

at least 1 year.

Medical record review: lumbar...... History of back pain with Highly recommended.

functional limitations for

at least 1 year.

Medical record review: lumbar...... Documented history of strain Highly recommended.

and/or sprain.

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

[[Page 7561]]

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

Disability test Test result Disability classification

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

-----------------------------------------------BODY PART: LS SPINE----------------------------------------------

JOB TITLE: TRAINMAN

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

Ankylosing spondylitis:

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

by 50%.

Backache, unspecified:

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

by 50%.

Chronic back pain, not otherwise

specified:

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

by 50%.

Cauda equina syndrome with bowel or

bladder dysfunction:

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

impingement, nerves 2 cm... Recommended.

Electromyography................... Definite denervation in Recommended.

muscle of affected nerve

root.

Myelogram.......................... Evidence of neurogenic Recommended.

compression.

Magnetic resonance imaging......... Compression of spinal nerves Recommended.

Computerized axial tomography...... Compression of spinal nerves Recommended.

Rheumatoid arthritis, cervical:

Rheumatoid factor (blood test)..... Titer of rheumatoid factor.. Recommended.

X-ray: cervical spine.............. Rheumatoid changes of spine. Highly recommended.

Medical records review: cervical... Confirmation by Highly recommended.

rheumatologist or internist.

Spondylogenic compression of spinal

cord:

Physical examination: cervical..... Evidence of myelopathy...... Highly recommended.

Computerized axial tomography...... Evidence of neurogenic Recommended.

compression.

Magnetic resonance imaging......... Evidence of neurogenic Recommended.

compression.

Myelogram.......................... Evidence of neurogenic Recommended.

compression.

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

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

Disability test Test result Disability classification

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

BODY PART: CE SPINE

JOB TITLE: TRAINMAN

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

Cervical disc disease with

myelopathy:

Computerized axial tomography...... Significant spinal cord D

pressure.

Magnetic resonance imaging......... Significant spinal cord D

pressure.

Myelogram.......................... Significant spinal cord D

pressure.

Cystometrogram..................... Impaired bladder function... D

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

Physical examination: lower limb... Lower extremity weakness or D

significant spasticity.

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

compromise.

Chronic herniated disc:

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

compromise.

Cervical spondylolysis:

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

compromise.

Cervical intervertebral disc

degeneration:

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

compromise.

Fracture: posterior element with

spinal canal displacement:

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

compromise.

Post laminectomy syndrome:

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

compromise.

Cervical radiculopathy:

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

compromise.

Spondylogenic compression of spinal

cord:

Computerized axial tomography...... Significant spinal cord D

pressure.

Magnetic resonance imaging......... Significant spinal cord D

pressure.

Cystometrogram..................... Impaired bladder function... D

[[Page 7572]]

Myelogram.......................... Significant spinal cord D

pressure.

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

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

compromise.

Physical examination: lower limb... Lower extremity weakness or D

significant spasticity.

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

BODY PART: CE SPINE

JOB TITLE: ENGINEER

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

Cervical disc disease with

myelopathy:

Computerized axial tomography...... Significant spinal cord D

pressure.

Magnetic resonance imaging......... Significant spinal cord D

pressure.

Myelogram.......................... Significant spinal cord D

pressure.

Cystometrogram..................... Impaired bladder function... D

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

Physical examination: lower limb... Lower extremity weakness or D

significant spasticity.

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

compromise.

Chronic herniated disc:

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

compromise.

Cervical spondylolysis:

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

compromise.

Cervical intervertebral disc

degeneration:

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

compromise.

Fracture: posterior element with

spinal canal displacement:

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

compromise.

Post laminectomy syndrome:

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

compromise.

Cervical radiculopathy:

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

compromise.

Spondylogenic compression of spinal

cord:

Computerized axial tomography...... Significant spinal cord D

pressure.

Magnetic resonance imaging......... Significant spinal cord D

pressure.

Cystometrogram..................... Impaired bladder function... D

Myelogram.......................... Significant spinal cord D

pressure.

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

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

compromise.

Physical examination: lower limb... Lower extremity weakness or D

significant spasticity.

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

BODY PART: CE SPINE

JOB TITLE: DISPATCHER

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

Cervical disc disease with

myelopathy:

Cystometrogram..................... Impaired bladder function... D

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

Spondylogenic compression of spinal

cord:

Cystometrogram..................... Impaired bladder function... D

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

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

BODY PART: CE SPINE

JOB TITLE: CARMAN

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

Cervical disc disease with

myelopathy:

Computerized axial tomography...... Significant spinal cord D

pressure.

Magnetic resonance imaging......... Significant spinal cord D

pressure.

Myelogram.......................... Significant spinal cord D

pressure.

Cystometrogram..................... Impaired bladder function... D

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

Physical examination: lower limb... Lower extremity weakness or D

significant spasticity.

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

compromise.

Chronic herniated disc:

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

compromise.

Cervical spondylolysis:

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

compromise.

Cervical intervertebral disc

degeneration:

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

compromise.

Fracture: posterior element with

spinal canal displacement:

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

compromise.

Post laminectomy syndrome:

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

compromise.

Cervical radiculopathy:

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

compromise.

[[Page 7573]]

Spondylogenic compression of spinal

cord:

Computerized axial tomography...... Significant spinal cord D

pressure.

Magnetic resonance imaging......... Significant spinal cord D

pressure.

Cystometrogram..................... Impaired bladder function... D

Myelogram.......................... Significant spinal cord D

pressure.

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

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

compromise.

Physical examination: lower limb... Lower extremity weakness or D

significant spasticity.

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

BODY PART; CE SPINE

JOB TITLE: SIGNALMAN

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

Cervical disc disease with

myelopathy:

Computerized axial tomography...... Significant spinal cord D

pressure.

Magnetic resonance imaging......... Significant spinal cord D

pressure.

Myelogram.......................... Significant spinal cord D

pressure.

Cystometrogram..................... Impaired bladder function... D

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

Physical examination: lower limb... Lower extremity weakness or D

significant spasticity.

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

compromise.

Chronic herniated disc:

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

compromise.

Cervical spondylolysis:

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

compromise.

Cervical intervertebral disc

degeneration:

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

compromise.

Fracture: posterior element with

spinal canal displacement:

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

compromise.

Post laminectomy syndrome:

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

compromise.

Cervical radiculopathy:

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

compromise.

Spondylogenic compression of spinal

cord:

Computerized axial tomography...... Significant spinal cord D

pressure.

Magnetic resonance imaging......... Significant spinal cord D

pressure.

Cystometrogram..................... Impaired bladder function... D

Myelogram.......................... Significant spinal cord D

pressure.

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

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

compromise.

Physical examination: lower limb... Lower extremity weakness or D

significant spasticity.

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

BODY PART: CE SPINE

JOB TITLE: TRACKMAN

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

Cervical disc disease with

myelopathy:

Computerized axial tomography...... Significant spinal cord D

pressure.

Magnetic resonance imaging......... Significant spinal cord D

pressure.

Myelogram.......................... Significant spinal cord D

pressure.

Cystometrogram..................... Impaired bladder function... D

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

Physical examination: lower limb... Lower extremity weakness or D

significant spasticity.

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

compromise.

Chronic herniated disc:

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

compromise.

Cervical spondyloysis:

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

compromise.

Cervical intervertebral disc

degeneration:

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

compromise.

Fracture: posterior element with

spinal canal displacement:

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

compromise.

Post laminectomy syndrome:

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

compromise.

Cervical radiculopathy:

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

compromise.

Spondylogenic compression of spinal

cord:

Computerized axial tomography...... Significant spinal cord D

pressure.

Magnetic resonance imaging......... Significant spinal cord D

pressure.

Cystometrogram..................... Impaired bladder function... D

Myelogram.......................... Significant spinal cord D

pressure.

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

[[Page 7574]]

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

compromise.

Physical examination: lower limb... Lower extremity weakness or D

significant spasticity.

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

BODY PART: CE SPINE

JOB TITLE: MACHINIST

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

Cervical disc disease with

myelopathy:

Computerized axial tomography...... Significant spinal cord D

pressure.

Magnetic resonance imaging......... Significant spinal cord D

pressure.

Myelogram.......................... Significant spinal cord D

pressure.

Cystometrogram..................... Impaired bladder function... D

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

Physical examination: lower limb... Lower extremity weakness or D

significant spasticity.

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

compromise.

Chronic herniated disc:

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

compromise.

Cervical spondylolysis:

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

compromise.

Cervical intervertebral disc

degeneration:

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

compromise.

Fracture: posterior element with

spinal canal displacement:

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

compromise.

Post laminectomy syndrome:

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

compromise.

Cervical radiculopathy:

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

compromise.

Spondylogenic compression of spinal

cord:

Computerized axial tomography...... Significant spinal cord D

pressure.

Magnetic resonance imaging......... Significant spinal cord D

pressure.

Cystometrogram..................... Impaired bladder function... D

Myelogram.......................... Significant spinal cord D

pressure.

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

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

compromise.

Physical examination: lower limb... Lower extremity weakness or D

significant spasticity.

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

BODY PART: CE SPINE

JOB TITLE: SHOP LABORER

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

Cervical disc disease with

myelopathy:

Computerized axial tomography...... Significant spinal cord D

pressure.

Magnetic resonance imaging......... Significant spinal cord D

pressure.

Myelogram.......................... Significant spinal cord D

pressure.

Cystometrogram..................... Impaired bladder function... D

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

Physical examination: lower limb... Lower extremity weakness or D

significant spasticity.

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

compromise.

Chronic herniated disc:

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

compromise.

Cervical spondylolysis:

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

compromise.

Cervical intervertebral disc

degeneration:

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

compromise.

Fracture: posterior element with

spinal canal displacement:

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

compromise.

Post laminectomy syndrome:

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

compromise.

Cervical radiculopathy:

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

compromise.

Spondylogenic compression of spinal

cord:

Computerized axial tomography...... Significant spinal cord D

pressure.

Magnetic resonance imaging......... Significant spinal cord D

pressure.

Cystometrogram..................... Impaired bladder function... D

Myelogram.......................... Significant spinal cord D

pressure.

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

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

compromise.

Physical examination: lower limb... Lower extremity weakness or D

significant spasticity.

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

[[Page 7575]]

BODY PART: CE SPINE

JOB TITLE: SALES REPRESENTATIVE

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

Cervical disc disease with

myelopathy:

Cystometrogram..................... Impaired bladder function... D

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

Spondylogenic compression of spinal

cord:

Cystometrogram..................... Impaired bladder function... D

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

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

BODY PART: CE SPINE

JOB TITLE: GENERAL OFFICE CLERK

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

Cervical disc disease with

myelopathy:

Cystometrogram..................... Impaired bladder function... D

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

Spondylogenic compression of spinal

cord:

Cystometrogram..................... Impaired bladder function... D

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

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

G. Shoulder and Elbow

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

Confirmatory test Minimum result Requirements.

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

BODY PART: SHOULDER AND ELBOW

CONFIRMATORY TESTS

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

Arthritis, acromioclavicular:

X-ray: shoulder.................... Significant degenerative Recommended.

changes of joint.

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

changes of joint.

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

changes of joint.

Arthritis, glenohumeral:

X-ray: shoulder.................... Significant degenerative Recommended.

changes of joint.

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

changes of joint.

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

changes of joint.

Rotator cuff tear:

Computerized tomography............ Tear of rotator cuff........ Recommended.

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

Medical diagnosis leading to a

permanent functional limitation of

the elbow:

Medical record review.............. Condition with permanent Highly recommended.

functional limitation.

X-ray: elbow....................... Imaging confirmation of Recommended.

functional diagnosis.

Magnetic resonance imaging......... Imaging confirmation of Recommended.

functional diagnosis.

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

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

Disability test Test result Disability classification

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

BODY PART: SHOULDER AND ELBOW

JOB TITLE: TRAINMAN

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

Arthritis, acromioclavicular:

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

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

motion.

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

BODY PART: SHOULDER AND ELBOW

JOB TITLE: ENGINEER

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

Arthritis, acromioclavicular:

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

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

motion.

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

BODY PART: SHOULDER AND ELBOW

JOB TITLE: CARMAN

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

Arthritis, acromioclavicular:

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

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

motion.

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

BODY PART: SHOULDER AND ELBOW

JOB TITLE: SIGNALMAN

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

Arthritis, acromioclavicular:

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

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

motion.

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

BODY PART: SHOULDER AND ELBOW

JOB TITLE: TRACKMAN

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

Arthritis, acromioclavicular:

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

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

motion.

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

BODY PART: SHOULDER AND ELBOW

JOB TITLE: MACHINIST

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

Arthritis, acromioclavicular:

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

[[Page 7577]]

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

motion.

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

BODY PART: SHOULDER AND ELBOW

JOB TITLE: SHOP LABORER

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

Arthritis, acromioclavicular:

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

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

motion.

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

H. Hand and Arm

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

Confirmatory test Minimum result Requirements

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

BODY PART: HAND AND ARM

CONFIRMATORY TESTS

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

Carpal tunnel syndrome:

Medical record review.............. Pain, paresthesia and Highly recommended.

weakness in distribution

median nerve.

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

conduction slowing at wrist.

Electromyography................... Denervation in severe cases. Recommended.

Fracture: wrist:

X-ray: wrist....................... Evidence of fracture........ Highly recommended.

Hand: permanent functional

limitation:

Medical record review.............. Documentation of medical Highly recommended.

condition for permanent

limitation.

Physical examination............... Definite reproducible Highly recommended.

evidence of limitation.

Imaging study (e.g. X-ray, CAT, Positive confirmation of Highly recommended.

MRI). underlying condition.

Rheumatoid arthritis: hand:

Rheumatoid factor.................. Titer of rheumatoid factor.. Recommended.

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

findings including

serological studies.

X-ray: hand........................ Characteristic rheumatoid Highly recommended.

changes.

Tenosynovitis:

Medical record review.............. History of chronic Highly recommended.

tenosynovitis and objective

findings.

Physical examination............... Definite evidence of Highly recommended.

tenosynovitis.

Thumb: Permanent functional

limitation:

Medical record review.............. Documentation of medical Highly recommended.

condition for permanent

limitation.

Physical examination............... Definite reproducible Highly recommended.

evidence of limitation.

Imaging study (X-ray, CAT, MRI).... Positive confirmation of Highly recommended.

underlying condition.

Wrist: Permanent functional

limitation:

Medical record review.............. Documentation of medical Highly recommended.

condition for permanent

limitation.

Physical examination.............

This text is long and has been trimmed here. Open the source document for the complete record.