20 CFR Part 220, Appendix 3 to Part 220 - Railroad Retirement Board Occupational Disability Standards

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Appendix 3 to Part 220—Railroad Retirement Board Occupational Disability Standards
1. Introduction
1.01 The Board uses this appendix to adjudicate the occupational disability claims of employees with medical conditions and job titles covered by the Tables in this appendix. The Tables are divided into “Body Parts”, with each Body Part further divided by job title. Under each job title there is a list of impairments and tests with accompanying test results which establish a finding of “D” (disabled). The use of these Tables is a three-step process. In the first step we determine whether the employee's regular railroad occupation is covered by the Tables; next we establish the existence of an impairment covered by the Tables; finally, we reach a disability determination. If we do not find an employee disabled under these Tables, the employee may still be found disabled using Independent Case Evaluation (ICE), as explained in subpart C of this part.
1.02 The Cancer Tables are treated in a different way than other body systems. Different types of cancer and their treatments have different functional impacts. In the Cancer Tables the impact of the impairment is seen as being significant or not significant. Therefore, these tables contain an “S” (significant) which is equivalent to a “D” rating. A detailed explanation of how to use those tables is in that section. The steps to use the remaining Tables are explained below:
2. Confirming the Impairment
2.01 Once we determine that the employee's regular railroad occupation is covered by the Job Titles in the Tables, we must determine the existence of an impairment covered by the Tables. This is done through the use of Confirmatory Tests. These tests can include information from medical records, surgical or operative reports, or specific diagnostic test results. Confirmatory Tests are listed in the initial section regarding each Body Part covered in the Tables. If an impairment cannot be confirmed because of inconsistent medical information, ICE may be required.
2.02 There are two types of Confirmatory Tests as follows.
2.03 “Highly Recommended” Tests—The designation of a confirmatory test as being “highly recommended” means that the test is almost always performed to confirm the existence of the impairment. For many conditions, only one “highly recommended” test finding is suggested to confirm the impairment. However, there may be times when that test is not available or is negative, but other more detailed testing confirms the impairment.
2.04 Example A: To confirm the condition of pulmonary hypertension, the Tables under Body Part C., Cardiac, designate as “highly recommended”: an electrocardiogram which indicates definite right ventricular hypertrophy. However, the impairment may also be confirmed by insertion of a Swan-Ganz catheter into the pulmonary artery and the pulmonary artery pressure measured directly.
2.05 There may be some conditions for which several “highly recommended” tests are suggested to confirm an impairment. In these circumstances, we will use all “highly recommended” tests to establish the existence of the impairment.
2.06 Example B: Under Body Part E., Lumbar Sacral Spine, three highly recommended medical findings are identified for the diagnosis of chronic back pain, not otherwise specified. These findings include:
A. A history of back pain under medical treatment for at least one year, and
B. A history of back pain unresponsive to therapy for at least one year, and
C. A history of back pain with functional limitations for at least one year.
2.07 All three of these criteria must be satisfied to confirm the existence of chronic back pain.
2.08 Sometimes the employee may have undergone detailed testing which is as reliable as one of the “highly recommended” tests listed in the Tables. In cases where an impairment has not been confirmed by one of the designated “highly recommended” tests, the impairment may still be confirmed by “recommended” tests (see below) or by evidence acceptable under section 220.27 of this part.
2.09 Recommended Tests—The designation of a confirmatory test as “recommended” means that the test need not be performed, or be positive, to confirm the impairment. However, a positive test provides significant support for confirming the impairment. If there are no “highly recommended” tests for confirming the impairment, at least one of the “recommended” tests should be positive.
2.10 There are two categories of recommended tests which are described below.
A. Imaging studies—These studies can include MRI, CAT scan, myelogram, or plain film x-rays. For conditions where several of these imaging studies are identified as “recommended” tests, at least one of the test results should be positive and meet the confirmatory test criteria. For some conditions, such as degenerative disc condition, there are several equivalent imaging methods to confirm a diagnosis.
B. Other tests—This category of tests refers to non-imaging studies.
2.11 If there are no “highly recommended” confirmatory tests designated to confirm an impairment and the “recommended” confirmatory tests only include non-imaging procedures, at least one of these tests should be positive to confirm the impairment. The greater the number of tests that are positive, the greater the confidence that the correct diagnosis has been established.
2.12 Example: Under Body Part C., Cardiac, the diagnostic confirmatory tests for ventricular ectopy, a cardiac arrhythmia, include the following “recommended” tests:
A. Medical record review, i.e., a review of the claimant's medical records, or
B. Holter monitoring, or
C. Provocative testing producing a definite arrhythmia.
2.13 In this situation, only one of the “recommended” confirmatory tests need be positive to confirm the impairment. However, the more tests that are positive, the stronger the support for the diagnosis.
2.14 In no circumstance will the Board require that an invasive test be performed to confirm an impairment. Several of the Confirmatory Tests which are described in the Tables are invasive and it is not the intention of the Board to suggest that these be performed. The inclusion of invasive tests in the Tables Confirmatory Tests section is intended to help the Board evaluate the significance of findings from such tests that may have already been performed and which are part of the submitted medical record.
2.15 If an employee's impairment(s) cannot be confirmed by use of the confirmatory tests listed in the Tables, it still may be confirmed by medical evidence described in section 220.27 of this part. However, if a claimant's impairment(s) cannot be confirmed through use of the Tables or under section 220.27, and the medical evidence is complete and in concordance, the claimant will be found not disabled.
3. Disability Determination
3.01 Once the Board determines that the employee's regular railroad occupation is covered by one of the Job Titles in the Tables and that his or her alleged impairment fits into a Body Part covered by the Tables and can be confirmed, we examine the results of any of the disability tests listed under the impairment. If the results from any of these tests indicate a “D” finding, the employee is found disabled. If none of the test results indicate a “D” finding, then the employee's claim is evaluated using ICE.
3.02 Example: A trainman has angina as confirmed by the recommended tests under Body Part A: Cardiac—Angina. An echocardiogram shows that he has poor ejection fraction ≤35%. The employee is rated disabled. If none of the results of the listed disability tests match the results required for a “D” finding, then the employee's claim is evaluated under ICE.
Tables
A. Cancer
B. Endocrine
C. Cardiac
D. Respiratory
E. Lumbar Sacral Spine
F. Cervical Spine
G. Shoulder and Elbow
H. Hand and Arm
I. Hip
J. Knee
K. Ankle and Foot
A. Cancer
Cancer
Cancer conditions can be viewed as belonging to one of three categories.
Category 1: Significant impact on functional capacity or anticipated life span.
Category 2: Intermediate impact on functional capacity; large individual variability.
Category 3: No significant impact on functional capacity or expected life span.
The factors that are considered in developing these categories include the following:
Type of Cancer
The functional impact of different malignancies varies tremendously and each malignancy has to be considered on an individual basis.
Magnitude of Disease
The disability standards are based upon the magnitude or extent of disease. The extent of disease affects both anticipated life span and the functional capacity or work ability of the individual. Localized cancer including cancer “in situ” can frequently be completely cured and not have an impact on functional capacity or life span. In contrast, many cancers that have distant or significant regional spread generally have a poor prognosis. The magnitude or extent of disease is classified into three categories: local, regional and distant.
The criteria which are used to classify a cancer into one of the three categories are based upon the distillation of several staging methods into a single system [Miller, et al. (1992). Cancer Statistics Review, 1973-1989; NIH Publication No. 92-2789].
Effects of Treatment
Although some types of cancer may be potentially curable with radical surgery and/or radiation therapy, the treatment regimen may result in a significant impairment that could affect functional capacity and ability to work. For example, a person with a laryngeal tumor which had spread regionally could be cured by a complete laryngectomy and radiotherapy. However, this treatment could result in a loss of speech and significantly impair the individual's communicative skills or ability to use certain types of respiratory protective equipment.
Prognosis
Some cancers may have minimal impact on a person's functional capacity, but have a very poor prognosis with respect to life expectancy. For example, an individual with early stage brain cancer may be minimally impaired, but have a poor prognosis and minimal potential for surviving longer than two years. Five and two year survival data are presented in the Cancer Disability Guideline Table which follows.
The Cancer Disability Guideline Table provides information concerning the probability of survival for five years for local, regional, and distant disease for each type of malignancy. In addition, two-year survival data are also presented for all disease stages. The five-year survival data are based upon data collected from population-based registries in Connecticut, New Mexico, Utah, Hawaii, Atlanta, Detroit, Seattle and the San Francisco and East Bay area between 1983 and 1987 (Miller, 1992). The two-year data are from a cohort study initially diagnosed in 1988.
Assessment
The malignancies are classified as disabling (Category 1), potentially disabling (Category 2) and non-disabling (Category 3). Category 2 conditions must be evaluated with respect to how the worker's tumor affects the worker's ability to perform the job and an assessment of his life span.
Information concerning the potential impact of the malignancy on a worker's ability to perform a job is identified in the Functional Impact column in the table. All railroad occupations in the Tables are considered together. Functional impacts are classified as significant if the treatment or sequelae from treatment including radiotherapy, chemotherapy and/or surgery is likely to impair the worker from performing the job. If the treatment results in a significant impairment of another organ system, the individual should be evaluated for disability associated with impairment of that body part. For example, a person undergoing an amputation for a bone malignancy would have to be evaluated for an amputation of that body part. For many cancers, it is difficult to make generalizations regarding the level of impairment that will occur after the person has initiated or completed treatment. Nonsignificant impacts include those that are unlikely to have any effect on the individual's work capacity.
Cancer type 2-year1 5-year1 Disability status2 Functional impact3
1Source of 2 and 5 year survival data: Miller BA et al. Cancer Statistics Review 1973-1989. NIH Publication No. 92-2789.
2Disability Status:
Category 1: Significant impact on functional capacity or life span.
Category 2: Intermediate impact.
Category 3: No significant impact on functional capacity or life span.
3Functional Impacts:
(S) Significant—significant potential for the effects of treatment (radiotheraphy, chemotherapy. surgery) to affect functional capacity.
4Hodgkin's disease data presented for each stage derived from American Cancer Society. American Cancer Society Textbook reference for unstaged cancer is derived from Cancer Statistics Review (See 3). In addition to other data, see: American Cancer Society Textbook of Clinical Oncology. Eds: Holleb AI, Fink DJ, Murphy GP, Atlanta: American Cancer Society, Inc. 1991.)
5Small cell carcinoma is classified as a 1.
Brain:
Local 26 1 S
Regional 27.9 1 S
Distant 23.6 1 S
Female Breast:
Regional 71.1 2 S
Distant 17.8 1 S
Colon:
Local 91 2 S
Regional 60.1 2 S
Distant 6 1 S
Rectal:
Local 84.5 2 S
Regional 50.7 2 S
Distant 5.3 1 S
Esophagus:
Local 18.5 1 S
Regional 5.2 1 S
Distant 1.8 1 S
Hodgkin's Disease:4
Stage 1 90-95 3 S
Stage 2 86 2 S
Stage 3 <80 2 S
Stage 4 <80 1 S
Kidney/Renal Pelvis:
Local 85.4 3 S
Regional 56.3 2 S
Distant 9 1 S
Larynx:
Local 84.2 2 S
Regional 52.5 2 S
Distant 24 1 S
Acute Lymphocytic Leukemia:
All 51.1 2 S
Chronic Lymphocytic Leukemia:
All 66.2 2 S
Acute Myelogenous Leukemia:
All 9.7 1 S
Chronic Myelogenous Leukemia:
All 21.7 1 S
Liver/Intrahepatic Bile Duct:
Local 15.1 1 S
Regional 5.8 1 S
Distant 1.9 1 S
Lung/Bronchus:5
Local 45.6 2 S
Regional 13.1 1 S
Distant 1.3 1 S
Melanomas of Skin:
Regional 53.6 2 S
Distant 12.8 1 S
Oral Cavity/Pharyngeal:
Local 76.2 2 S
Regional 40.9 2 S
Distant 18.7 1 S
Pancreas:
Local 6.1 1 S
Regional 3.7 1 S
Distant 1.4 1 S
Prostate:
Local 91 3 S
Regional 80.4 2 S
Distant 28 1 S
Stomach:
Local 55.4 1 S
Regional 17.3 1 S
Distant 2.1 1 S
Testicular:
Distant 65.5 1 S
Thyroid:
Regional 93.1 3 S
Distant 47.2 1 S
Bladder:
Regional 46 2 S
Distant 9.1 1 S
B. Endocrine
Confirmatory test Minimum result Requirements
BODY PART: ENDOCRINE
CONFIRMATORY TESTS
Diabetes, requiring insulin (IDDM):
Medical record review Confirmation of condition and need for insulin use Highly recommended.
Disability test Test result Disability classification
BODY PART: ENDOCRINE
JOB TITLE: ENGINEER
Diabetes, requiring insulin (IDDM):
Medical record review Confirmation of condition and need for insulin use D
C. Cardiac
Confirmatory test Minimum result Requirements
BODY PART: CARDIAC
CONFIRMATORY TESTS
Angina:
Medical record review Confirmed history of ischemia including copies of electrocardiogram Recommended.
Stress test Definite ischemia on exercise test Recommended.
Thallium study Definite ischemia with exercise Recommended.
Aortic valve disease:
Cardiac catheterization Proven and significant Recommended.
Echocardiogram Significant valve disease Recommended.
Coronary artery disease:
Medical record review Documented ischemia with electrocardiogram confirmation Recommended.
Medical record review Documented myocardial infarction Recommended.
Stress test Positive Recommended.
Thallium study Definite ischemia with exercise Recommended.
Angiography Definite occlusion (≤60%) of one vessel Recommended.
Cardiomyopathy:
Echocardiogram Proven ejection fraction ≤35% Recommended.
Catheterization Poor global function and not coronary artery disease Recommended.
Hypertension:
Medical record review Documentation of hypertension for one year Highly recommended.
Medical record review Definite diagnosis by cardiologist or internist Highly recommended.
Medical record review Confirmation of medication use Highly recommended.
Arrhythmia: heart block:
Medical record review Proven episode with electrocardiogram confirmation Recommended.
Electrocardiogram Documentation of arrhythmia Recommended.
Mitral valve disease:
Cardiac catheterization Significant valve disease Recommended.
Echocardiogram Significant valve disease Recommended.
Pericardial disease:
Medical record review Confirmed by cardiologist or internist Highly recommended.
Pulmonary hypertension:
Physical examination Increased pulmonic sound or pulmonary ejection murmur by cardiologist or internist Recommended.
Electrocardiogram Definite right ventricular hypertension Highly recommended.
Ventricular ectopy:
Medical record review Definite episode within one year Recommended.
Holter monitoring Definite arrhythmia Recommended.
Provocative testing Positive response Recommended.
Arrhythmia: supraventricular tachycardia:
Medical record review Definite episode within one year Recommended.
Holter monitoring Definite arrhythmia Recommended.
Post heart transplant:
Medical record review Documented Highly recommended.
Disability test Test result Disability classification
BODY PART: CARDIAC
JOB TITLE: TRAINMAN
Angina:
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤7 METS D
Medical record review Unstable as diagnosed by cardiologist D
Stress test Documented hypotensive response D
Stress test: significant ST changes Definite ischemia ≤7 METS D
Aortic valve disease:
Cardiac catheterization Aortic gradient 25-50 mm HG
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤7 METS D
Coronary artery disease:
Myocardial infarction Multiple infarctions D
Echocardiogram Confirmed ventricular aneurysm D
Cardiac catheterization Aortic gradient 25-50 mm Hg D
Cardiac catheterization Poor ejection fraction ≤35% D
Stress test Peak exercise ≤7 METS D
Medical record review Unstable as diagnosed by a Cardiologist D
Stress test Documented hypotensive response D
Stress test Definite ischemia ≤ 7 METS D
Isotope, e.g., thallium study Definite ischemia ≤ 7 METS D
Cardiomyopathy:
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤7 METS D
Hypertension:
Medical record review Diastolic ≤120 and systolic ≤160, 50% of the time and evidence of end organ damage (blood creatinine ≤2; urinary protein ≤1/2 gm; or EKG evidence of ischemia) D
Arrhythmia: heart block:
Holter Documented asystole length ≤1.5-2 seconds D
Medical record review Documented syncope with proven arrhythmia D
Mitral valve disease:
Cardiac catheterization Mitral valve gradient ≥5 mm Hg D
Cardiac catheterization Mitral regurgitation severe D
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤7 METS D
Pericardial disease:
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Ventricular ectopy:
Medical record review Documented life threatening arrhythmia D
Holter Uncontrolled ventricular rhythm D
Medical record review Documented related syncope D
Arrhythmia: supraventricular tachycardia:
Medical record review Documented related syncope D
Post heart transplant:
Medical record review Post heart transplant D
BODY PART: CARDIAC
JOB TITLE: ENGINEER
Angina:
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Medical record review Unstable as diagnosed by cardiologist D
Stress test Documented hypotensive response D
Stress test: significant ST changes Definite ischemia ≤5 METS D
Aortic valve disease:
Cardiac catheterization Aortic gradient 25-50 mm HG D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Coronary artery disease:
Myocardial infarction Multiple infarctions D
Echocardiogram Confirmed ventricular aneurysm D
Cardiac catheterization Aortic gradient 25-50 mm Hg D
Cardiac catheterization Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Medical record review Unstable as diagnosed by a Cardiologist D
Stress test Documented hypotensive response D
Stress test Definite ischemia ≤5 METS D
Isotope, e.g., thallium study Definite ischemia ≤5 METS D
Cardiomyopathy:
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Hypertension:
Medical record review Diastolic ≤120 and systolic ≤160, 50% of the time and evidence of end organ damage (blood creatinine ≤2; urinary protein ≤1/2 gm; or EKG evidence of ischemia) D
Arrhythmia: heart block:
Holter Documented asystole length ≤1.5-2 seconds D
Medical record review Documented syncope with proven arrhythmia D
Mitral valve disease:
Cardiac catheterization Mitral valve gradient ≥10 mm Hg D
Cardiac catheterization Mitral regurgitation severe D
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Pericardial disease:
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Ventricular ectopy:
Medical record review Documented life threatening arrhythmia D
Holter Uncontrolled ventricular rhythm D
Medical record review Documented related syncope D
Arrhythmia: supraventricular tachycardia:
Medical record review Documented related syncope D
Post heart transplant:
Medical record review Post heart transplant D
BODY PART: CARDIAC
JOB TITLE: DISPATCHER
Angina:
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Medical record review Unstable as diagnosed by cardiologist D
Stress test Documented hypotensive response D
Stress test: significant ST changes Definite ischemia ≤5 METS D
Aortic valve disease:
Cardiac catheterization Aortic gradient 25-50 mm Hg D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Coronary artery disease:
Myocardial infarction Multiple infarctions D
Echocardiogram Confirmed ventricular aneurysm D
Cardiac catheterization Aortic gradient 25-50 mm Hg D
Cardiac catheterization Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Medical record review Unstable as diagnosed by cardiologist D
Stress test Documented hypotensive response D
Stress test Definite ischemia ≤5 METS D
Isotope, e.g., thallium study Definite ischemia ≤5 METS D
Cardiomyopathy:
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Hypertension:
Medical record review Diastolic ≤120 and systolic ≤160, 50% of the time and evidence of end organ damage (blood creatinine ≤2; urinary protein ≤1/2 gm; or EKG evidence of ischemia) D
Arrhythmia: heart block:
Holter Documented asystole length ≤1.5-2 seconds D
Medical record review Documented syncope with proven arrhythmia D
Mitral valve disease:
Cardiac catheterization Mitral valve gradient ≥10 mm Hg D
Cardiac catheterization Mitral regurgitation severe D
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Pericardial disease:
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Ventricular ectopy:
Medical record review Documented life threatening arrhythmia D
Holter Uncontrolled ventricular rhythm D
Medical record review Documented related syncope D
Arrhythmia: supraventricular tachycardia:
Medical record review Documented related syncope D
Post heart transplant:
Medical record review Post heart transplant D
BODY PART: CARDIAC
JOB TITLE: CARMAN
Angina:
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Medical record review Unstable as diagnosed by cardiologist D
Stress test Documented hypotensive response D
Stress test: significant ST changes Definite ischemia ≤5 METS D
Aortic valve disease:
Cardiac catheterization Aortic gradient 25-50 mm HG
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Coronary artery disease:
Myocardial infarction Multiple infarctions D
Echocardiogram Confirmed ventricular aneurysm D
Cardiac catheterization Aortic gradient 25-50 mm Hg D
Cardiac catheterization Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Medical record review Unstable as diagnosed by a Cardiologist D
Stress test Documented hypotensive response D
Stress test Definite ischemia ≤ 5 METS D
Isotope, e.g., thallium study Definite ischemia ≤ 5 METS D
Cardiomyopathy:
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Hypertension:
Medical record review Diastolic ≤120 and systolic ≤160, 50% of the time and evidence of end organ damage (blood creatinine ≤2; urinary protein ≤1/2 gm; or EKG evidence of ischemia) D
Arrhythmia: heart block:
Holter Documented asystole length ≤1.5-2 seconds D
Medical record review Documented syncope with proven arrhythmia D
Mitral valve disease:
Cardiac catheterization Mitral valve gradient ≥10 mm Hg D
Cardiac catheterization Mitral regurgitation severe D
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Pericardial disease:
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Ventricular ectopy:
Medical record review Documented life threatening arrhythmia D
Holter Uncontrolled ventricular rhythm D
Medical record review Documented related syncope D
Arrhythmia: supraventricular tachycardia:
Medical record review Documented related syncope D
Post heart transplant:
Medical record review Post heart transplant D
BODY PART: CARDIAC
JOB TITLE: SIGNALMAN
Angina:
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤7 METS D
Medical record review Unstable as diagnosed by cardiologist D
Stress test Documented hypotensive response D
Stress test: significant ST changes Definite ischemia ≤7 METS D
Aortic valve disease:
Cardiac catheterization Aortic gradient 25-50 mm HG D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤7 METS D
Coronary artery disease:
Myocardial infarction Multiple infractions D
Echocardiogram Confirmed ventricular aneurysm D
Cardiac catheterization Aortic gradient 25-50 mm Hg D
Cardiac catheterization Poor ejection fraction ≤35% D
Stress test Peak exercise ≤7 METS D
Medical record review Unstable as diagnosed by cardiologist D
Stress test Documented hypotensive response D
Stress test Definite ischemia ≤7 METS D
Isotope, e.g., thallium study Definite ischemia ≤7 METS D
Cardiomyopathy:
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤7 METS D
Hypertension:
Medical record review Diastolic ≤120 and systolic ≤160, 50% of the time and evidence of end organ damage (blood creatinine ≤2; urinary protein ≤1/2 gm; or EKG evidence of ischemia) D
Arrhythmia: heart block
Holter Documented asystole length ≤1.5-2 seconds D
Medical record review Documented syncope with proven arrhythmia D
Mitral valve disease:
Cardiac catheterization Mitral valve gradient ≥5 mm Hg D
Cardiac catherization Mitral regurgitation severe D
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤7 METS D
Pericardial disease:
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Ventricular ectopy:
Medical record review Documented life threatening arrhythmia D
Holter Uncontrolled ventricular rhythm D
Medical record review Documented related syncope D
Arrhythmia: supraventricular tachycardia:
Medical record review Documented related syncope D
Post heart transplant:
Medical record review Post heart transplant D
BODY PART: CARDIAC
JOB TITLE: TRACKMAN
Angina:
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤7 METS D
Medical record review Unstable as diagnosed by cardiologist D
Stress test Documented hypotensive response D
Stress test: significant ST changes Definite ischemia ≤7 METS D
Aortic valve disease:
Cardiac catheterization Aortic gradient 25-50 mm HG D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤7 METS D
Coronary artery disease:
Myocardial infarction Multiple infarctions D
Echocardiogram Confirmed ventricular aneurysm D
Cardiac catheterization Aortic gradient 25-50 mm Hg D
Cardiac catheterization Poor ejection fraction ≤35% D
Stress test Peak exercise ≤7 METS D
Medical record review Unstable as diagnosed by a cardiologist D
Stress test Documented hypotensive response D
Stress test Definite ischemia ≤7 METS D
Isotope, e.g., thallium study Definite ischemia ≤7 METS D
Cardiomyopathy:
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤7 METS D
Hypertension:
Medical record review Diastolic ≤120 and systolic ≤160, 50% of the time and evidence of end organ damage (blood creatinine ≤2; urinary protein ≤1/2 gm; or EKG evidence of ischemia) D
Arrhythmia: heart block:
Holter Documented asystole length ≤1.5-2 seconds D
Medical record review Documented syncope with proven arrhythmia D
Mitral valve disease:
Cardiac catheterization Mitral valve gradient ≥5 mm Hg D
Cardiac catheterization Mitral regurgitation severe D
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤7 METS D
Pericardial disease:
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Ventricular ectopy:
Medical record review Documented life threatening arrhythmia D
Holter Uncontrolled ventricular rhythm D
Medical record review Documented related syncope D
Arrhythmia: supraventricular tachycardia:
Medical record review Documented related syncope D
Post heart transplant:
Medical record review Post heart transplant D
BODY PART: CARDIAC
JOB TITLE: MACHINIST
Angina:
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Medical record review Unstable as diagnosed by cardiologist D
Stress test Documented hypotensive response D
Stress test: significant ST changes Definite ischemia ≤5 METS D
Aortic valve disease:
Cardiac catheterization Aortic gradient 25-50 mm HG
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Coronary artery disease:
Myocardial infarction Multiple infarctions D
Echocardiogram Confirmed ventricular aneurysm D
Cardiac catheterization Aortic gradient 25-50 mm Hg D
Cardiac catheterization Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Medical record review Unstable as diagnosed by a cardiologist D
Stress test Documented hypotensive response D
Stress test Definite ischemia ≤5 METS D
Isotope, e.g., thallium study Definite ischemia ≤5 METS D
Cardiomyopathy:
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Hypertension:
Medical record review Diastolic ≤120 and systolic ≤160, 50% of the time and evidence of end organ damage (blood creatinine ≤2; urinary protein ≤1/2 gm; or EKG evidence of ischemia) D
Arrhythmia: heart block:
Holter Documented asystole length ≤1.5-2 seconds D
Medical record review Documented syncope with proven arrhythmia D
Mitral valve disease:
Cardiac catheterization Mitral valve gradient ≥10 mm Hg D
Cardiac catheterization Mitral regurgitation severe D
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Pericardial disease:
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Ventricular ectopy:
Medical record review Documented life threatening arrhythmia D
Holter Uncontrolled ventricular rhythm D
Medical record review Documented related syncope D
Arrhythmia: supraventricular tachycardia:
Medical record review Documented related syncope D
Post heart transplant:
Medical record review Post heart transplant D
BODY PART: CARDIAC
JOB TITLE: SHOP LABORER
Angina:
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Medical record review Unstable as diagnosed by cardiologist D
Stress test Documented hypotensive response D
Stress test: significant ST changes Definite ischemia ≤5 METS D
Aortic valve disease:
Cardiac catheterization Aortic gradient 25-50 mm HG
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Coronary artery disease:
Myocardial infarction Multiple infarctions D
Echocardiogram Confirmed ventricular aneurysm D
Cardiac catheterization Aortic gradient 25-50 mm Hg
Cardiac catheterization Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Medical record review Unstable as diagnosed by a Cardiologist D
Stress test Documented hypotensive response D
Stress test Definite ischemia ≤5 METS D
Isotope, e.g., thallium study Definite ischemia ≤5 METS D
Cardiomyopathy:
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Hypertension:
Medical record review Diastolic ≤120 and systolic ≤160, 50% of the time and evidence of end organ damage (blood creatinine ≤2; urinary protein ≤1/2 gm; or EKG evidence of ischemia) D
Arrhythmia: heart block:
Holter Documented asystole length ≤1.5-2 seconds D
Medical record review Documented syncope with proven arrhythmia D
Mitral valve disease:
Cardiac catheterization Mitral valve gradient ≥10 mm Hg D
Cardiac catheterization Mitral regurgitation severe D
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Pericardial disease:
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Ventricular ectopy:
Medical record review Documented life threatening arrhythmia D
Holter Uncontrolled ventricular rhythm D
Medical record review Documented related syncope D
Arrhythmia: supraventricular tachycardia:
Medical record review Documented related syncope D
Post heart transplant:
Medical record review Post heart transplant D
BODY PART: CARDIAC
JOB TITLE: SALES REPRESENTATIVE
Angina:
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Medical record review Unstable as diagnosed by cardiologist D
Stress test Documented hypotensive response D
Stress test: significant ST changes Definite ischemia ≤5 METS D
Aortic valve disease:
Cardiac catheterization Aortic gradient 25-50 mm HG D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Coronary artery disease:
Myocardial infarction Multiple infarctions D
Echocardiogram Confirmed ventricular aneurysm D
Cardiac catheterization Aortic gradient 25-50 mm Hg D
Cardiac catheterization Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Medical record review Unstable as diagnosed by a cardiologist D
Stress test Documented hypotensive response D
Stress test Definite ischemia ≤5 METS D
Isotope, e.g., thallium study Definite ischemia ≤5 METS D
Cardiomyopathy:
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Hypertension:
Medical record review Diastolic ≤120 and systolic ≤160, 50% of the time and evidence of end organ damage (blood creatinine ≤2; urinary protein ≤1/2 gm; or EKG evidence of ischemia) D
Arrhythmia: heart block:
Holter Documented asystole length ≤1.5-2 seconds D
Medical record review Documented syncope with proven arrhythmia D
Mitral valve disease:
Cardiac catheterization Mitral valve gradient ≥10 mm Hg D
Cardiac catheterization Mitral regurgitation severe D
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Pericardial disease:
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Ventricular ectopy:
Medical record review Documented life threatening arrhythmia D
Holter Uncontrolled ventricular rhythm D
Medical record review Documented related syncope D
Arrhythmia: supraventricular tachycardia:
Medical record review Documented related syncope D
Post heart transplant:
Medical record review Post heart transplant D
BODY PART: CARDIAC
JOB TITLE: GENERAL OFFICE CLERK
Angina:
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Medical record review Unstable as diagnosed by cardiologist D
Stress test Documented hypotensive response D
Stress test: significant ST changes Definite ischemia ≤5 METS D
Aortic valve disease:
Cardiac catheterization Aortic gradient 25-50 mm HG D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Coronary artery disease:
Myocardial infarction Multiple infarctions D
Echocardiogram Confirmed ventricular aneurysm D
Cardiac catheterization Aortic gradient 25-50 mm Hg D
Cardiac catheterization Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Medical record review Unstable as diagnosed by a Cardiologist D
Stress test Documented hypotensive response D
Stress test Definite ischemia ≤5 METS D
Isotope, e.g., thallium study Definite ischemia ≤5 METS D
Cardiomyopathy:
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Arrhythmia: heart block:
Holter Documented asystole length ≤1.5-2 seconds D
Medical record review Documented syncope with proven arrhythmia D
Mitral valve disease:
Cardiac catheterization Mitral valve gradient ≥10 mm Hg D
Cardiac catheterization Mitral regurgitation severe D
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Stress test Peak exercise ≤5 METS D
Pericardial disease:
Cardiac catheterization Poor ejection fraction ≤35% D
Echocardiogram Poor ejection fraction ≤35% D
Ventricular ectopy:
Medical record review Documented life threatening arrhythmia D
Holter Uncontrolled ventricular rhythm D
Medical record review Documented related syncope D
Arrhythmia: supraventricular tachycardia:
Medical record review Documented related syncope D
Post heart transplant:
Medical record review Post heart transplant D
D. Respiratory
Confirmatory test Minimum result Requirements
BODY PART: RESPIRATORY
CONFIRMATORY TESTS
Asthma:
Spirometry FEV1/FVC ratio diminished Recommended.
Spirometry ≤15% change with administration of bronchodilator Recommended.
Methacholine challenge test Positive: FEV1 decrease ≤20% at (PC <=8 mg/ml) Recommended
Bronchiectasis:
Medical record review Chronic cough and sputum Recommended.
Chest X-ray Bronchiectasis demonstrated Recommended.
Chest CAT scan Bronchiectasis demonstrated Recommended.
Chronic bronchitis:
Medical record review Frequent cough—2 years duration Highly recommended.
Chronic obstructive pulmonary disease:
Spirometry FEV1/FVC ratio below 65% when stable Highly recommended.
Spirometry FEV1 below 75% of predicted when stable Highly recommended.
Cor pulmonale:
Electrocardiogram Definite right ventricular hypertrophy Recommended.
Echocardiogram Definite right ventricular hypertrophy Recommended.
Pulmonary fibrosis:
Lung biopsy Diffuse fibrosis Recommended.
Chest CAT scan More than minimal fibrosis Recommended.
Lung resection:
Medical record review At least one lobe resected Highly recommended.
Pneumothorax:
Medical record review Required hospitalization with chest tube drainage Highly recommended.
Restrictive lung disease:
Chest X-ray Restrictive lung changes Recommended.
DLCO Abnormal Highly recommended.
Chest CAT scan Restrictive lung changes Recommended.
Spirometry FVC <75% predicted Highly recommended.
Silicosis:
Medical record review Occupational exposure for at least 1 year Highly recommended.
Tuberculosis:
Chest X-ray Evidence of changes consistent with tuberculosis infection Recommended.
Culture Positive Recommended.
Disability test Test result Disability classification
BODY PART: RESPIRATORY
JOB TITLE: TRAINMAN
Asthma:
Spirometry Repeated spirometry FEV1 <40% over a 12 month period
Bronchiectasis:
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Electrocardiogram Definite positive right ventricular hypertrophy D
Chronic bronchitis:
Spirometry Repeated spirometry FEV1 <40% over a 12 month period D
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Electrocardiogram Definite positive right ventricular hypertrophy D
Chronic obstructive pulmonary disease (COPD):
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Electrocardiogram Definite positive right ventricular hypertrophy D
Cor pulmonale:
Electrocardiogram Definite positive right ventricular hypertrophy D
Pulmonary fibrosis:
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Electrocardiogram Definite positive right ventricular hypertrophy D
DLCO <45% predicted D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Spirometry FVC <50% predicted D
Lung resection:
Electrocardiogram Definite positive right ventricular hypertrophy D
Restrictive lung disease:
DLCO <45% predicted D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Spirometry FVC <50% predicted D
Electrocardiogram efinite positive right ventricular hypertrophy D
Silicosis:
Resting ABG PCO2 arterial ≤50 mm Hg If stable D
Electrocardiogram Definite positive right ventricular hypertrophy D
BODY PART: RESPIRATORY
JOB TITLE: CARMAN
Asthma:
Spirometry Repeated spirometry FEV1 <40% over a 12 month period D
Bronchiectasis:
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Electrocardiogram Definite positive right ventricular hypertrophy D
Chronic bronchitis:
Spirometry Repeated spirometry FEV1 <40% over a 12 month period D
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Electrocardiogram Definite positive right ventricular hypertrophy D
Chronic obstructive pulmonary disease (COPD):
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Electrocardiogram Definite positive right ventricular hypertrophy D
Cor pulmonale:
Electrocardiogram Definite positive right ventricular hypertrophy D
Pulmonary fibrosis:
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Electrocardiogram Definite positive right ventricular hypertrophy D
DLCO <45% predicted D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Spirometry FVC <50% predicted D
Lung resection:
Electrocardiogram Definite positive right ventricular hypertrophy D
Restrictive lung disease:
DLCO <45% predicted D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Spirometry FVC <50% predicted D
Electrocardiogram Definite positive right ventricular hypertrophy D
Silicosis:
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Electrocardiogram Definite positive right ventricular hypertrophy D
BODY PART: RESPIRATORY
JOB TITLE: SIGNALMAN
Asthma:
Spirometry Repeated spirometry FEV1 <40% over a 12 month period D
Bronchiectasis:
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Electrocardiogram Definite positive right ventricular hypertrophy D
Chronic bronchitis:
Spirometry Repeated spirometry FEV1 <40% over a 12 month period D
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Electrocardiogram Definite positive right ventricular hypertrophy D
Chronic obstructive pulmonary disease (COPD):
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Electrocardiogram Definite positive right ventricular hypertrophy D
Cor pulmonale:
Electrocardiogram Definite positive right ventricular hypertrophy D
Pulmonary fibrosis:
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
DLCO <45% predicted D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Spirometry FVC <50% predicted D
Electrocardiogram Definite positive right ventricular hypertrophy D
Lung resection:
Electrocardiogram Definite positive right ventricular hypertrophy D
Restrictive lung disease:
DLCO <45% predicted D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Spirometry FVC <50% predicted D
Electrocardiogram Definite positive right ventricular hypertrophy D
Silicosis:
Resting AGB PCO2 arterial ≤50 mm Hg if stable D
Electrocardiogram Definite positive right ventricular hypertrophy D
BODY PART: RESPIRATORY
JOB TITLE: TRACKMAN
Asthma:
Spirometry Repeated spirometry FEV1 <40% over a 12 month period D
Bronchiectasis:
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Pulmonary exercise test or exercise ABG PO2 ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Electrocardiogram Definite positive right ventricular hypertrophy D
Chronic bronchitis:
Spirometry Repeated spirometry FEV1 <40% over a 12 month period D
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Electrocardiogram Definite positive right ventricular hypertrophy D
Chronic obstructive pulmonary disease (COPD):
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Electrocardiogram Definite positive right ventricular hypertrophy D
Cor pulmonale:
Electrocardiogram Definite positive right ventricular hypertrophy D
Pulmonary fibrosis:
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Electrocardiogram Definite positive right ventricular hypertrophy D
DLCO <45% predicted D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Spirometry FVC <50% predicted D
Lung resection:
Electrocardiogram Definite positive right ventricular hypertrophy D
Restrictive lung disease:
DLCO <45% predicted D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Spirometry FVC <50% predicted D
Electrocardiogram Definite positive right ventricular hypertrophy D
Silicosis:
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Electrocardiogram Definite positive right ventricular hypertrophy D
BODY PART: RESPIRATORY
JOB TITLE: MACHINIST
Asthma:
Spirometry Repeated spirometry FEV1 <40% over a 12 month period D
Bronchiectasis:
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Electrocardiogram Definite positive right ventricular hypertrophy D
Chronic bronchitis:
Spirometry Repeated spirometry FEV1 <40% over a 12 month period D
Resting AGB PCO2 arterial ≤50 mm Hg if stable D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Electrocardiogram Definite positive right ventricular hypertrophy D
Chronic obstructive pulmonary disease (COPD):
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Electrocardiogram Definite positive right ventricular hypertrophy D
Cor pulmonale:
Electrocardiogram Definite positive right ventricular hypertrophy D
Pulmonary fibrosis:
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Electrocardiogram Definite positive right ventricular hypertrophy D
DLCO <45% predicted D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Spirometry FVC <50% predicted D
Lung resection:
Electrocardiogram Definite positive right ventricular hypertrophy D
Restrictive lung disease:
DLCO <45% predicted D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Spirometry FVC <50% predicted D
Electrocardiogram Definite positive right ventricular hypertrophy D
Silicosis:
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Electrocardiogram Definite positive right ventricular hypertrophy D
BODY PART: RESPIRATORY
JOB TITLE: SHOP LABORER
Asthma:
Spirometry Repeated spirometry FEV1 <40% over a 12 month period D
Bronchiectasis:
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Electrocardiogram Definite positive right ventricular hypertrophy D
Chronic bronchitis:
Spirometry Repeated spirometry FEV1 <40% over a 12 month period D
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Electrocardiogram Definite positive right ventricular hypertrophy D
Chronic obstructive pulmonary disease (COPD):
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Electrocardiogram Definite positive right ventricular hypertrophy D
Cor pulmonale:
Electrocardiogram Definite positive right ventricular hypertrophy D
Pulmonary fibrosis:
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
DLCO <45% predicted D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Spirometry FVC <50% predicted D
Electrocardiogram Definite positive right ventricular hypertrophy D
Lung resection:
Electrocardiogram Definite positive right ventricular hypertrophy D
Restrictive lung disease:
DLCO <45% predicted D
Pulmonary exercise test or exercise ABG PO2 drop ≤5 torr at maximum exercise D
Pulmonary exercise test Maximum VO2 <15 ml/kg D
Spirometry FVC <50% predicted D
Electrocardiogram Definite positive right ventricular hypertrophy D
Silicosis:
Resting ABG PCO2 arterial ≤50 mm Hg if stable D
Electrocardiogram Definite positive right ventricular hypertrophy D
E. Lumbar Sacral Spine
Confirmatory test Minimum result Requirements
BODY PART: LS SPINE
CONFIRMATORY TESTS
Ankylosing spondylitis:
X-ray-lumbar sacral spine Sacroilitis Highly recommended.
HLA B27 (blood test) Positive HLA B27 (90% case) Recommended.
Backache, unspecified:
Medical record review History of back pain under medical treatment for at least 1 year Highly recommended.
Medical record review History of back pain unresponsive to therapy for at least 1 year Highly recommended.
Medical record review History of back pain with functional limitations for at least 1 year Highly recommended.
Chronic back pain, not otherwise specified:
Medical record review History of back pain under medical treatment for at least 1 year Highly recommended.
Medical record review History of back pain unresponsive to therapy for at least 1 year Highly recommended.
Medical record review History of back pain with functional limitations for at least 1 year Highly recommended.
Cauda equina syndrome with bowel or bladder dysfunction:
Magnetic resonance imaging Neural impingement of spinal nerves below L1 Recommended.
Computerized tomography Neural impingement of spinal nerves below L1 Recommended.
Cystometrogram Impaired bladder function Recommended.
Rectal examination Diminished rectal sphincter tone Recommended.
Myelogram Neural impingement of spinal nerves below L1 Recommended.
Degeneration of lumbar disc:
X-ray lumbar sacral spine Significant degenerative disc changes Recommended.
Computerized tomography Significant degenerative disc changes Recommended.
Magnetic resonance imaging Significant degenerative disc changes Recommended.
Myelogram Significant degenerative disc changes Recommended.
Displacement of lumbar disc:
X-ray-lumbar sacral spine Significant degenerative disc changes Recommended.
Computerized tomography Significant degenerative disc changes Recommended.
Magnetic resonance imaging Significant degenerative disc changes Recommended.
Myelogram Significant degenerative disc changes Recommended.
Fracture: vertebral body:
Magnetic resonance imaging Fracture vertebral body Recommended.
Computerized tomography Fracture vertebral body Recommended.
X-ray-lumbar sacral spine Fracture vertebral body ommended.
Fracture: posterior element with spinal canal displacement:
Magnetic resonance imaging Fracture posterior spinal element with displacement of spinal canal Recommended.
Computerized tomography Fracture posterior spinal element with displacement of spinal canal Recommended.
X-ray-lumbar sacral spine Fracture posterior spinal element with displacement of spinal canal Recommended.
Fracture: posterior spinal element with no displacement:
X-ray-lumbar sacral spine Fracture posterior spinal element Recommended.
Magnetic resonance imaging Fracture posterior spinal element Recommended.
Computerized tomography Fracture posterior spinal element Recommended.
Fracture: spinous process:
X-ray-lumbar sacral spine Spinous process fracture Recommended.
Magnetic resonance imaging Spinous process fracture Recommended.
Computerized tomography Spinous process fracture Recommended.
Fracture: Transverse process:
Lumbar sacral spine Transverse process fracture Recommended.
Magnetic resonance imaging Transverse process fracture Recommended.
Computerized tomography Transverse process fracture Recommended.
Intervertebral disc disorder:
X-ray-lumbar sacral spine Significant disc degeneration Recommended.
Magnetic resonance imaging Significant disc degeneration Recommended.
Computerized tomography Significant disc degeneration Recommended.
Myelogram Significant disc degeneration Recommended.
Lumbago:
Medical record review: lumbar History of back pain under medical treatment for at least 1 year Highly recommended.
Medical record review: lumbar History of back pain unresponsive to therapy for at least 1 year Highly recommended.
Medical record review: lumbar History of back pain with functional limitations for at least 1 year Highly recommended.
Lumbosacral neuritis:
Magnetic resonance imaging Evidence of neural compression Recommended.
Electromyography Definite denervation Recommended.
Nerve conduction velocity Definite slowing Recommended.
Physical examination—atrophy Atrophy in affected limb with 2 cm difference between limbs Recommended.
Physical examination: straight leg raise Positive straight leg raise Recommended.
Sensory examination Loss of sensation in affected dermatomes Recommended.
Medical history History of radicular pain Highly recommended.
Computerized tomography Evidence of neural compression Recommended.
Lumbar spinal stenosis:
Computerized tomography Significant narrowing: spinal cord canal or intervertebral foramen Recommended.
Magnetic resonance imaging Significant narrowing: spinal cord canal or intervertebral foramen Recommended.
Myelogram Significant narrowing: spinal cord canal or intervertebral foramen Recommended.
Mechanical complication of internal orthopedic device:
Medical record review Documentation of failure of implant following surgical procedure Highly recommended.
Osteomalacia:
X-ray-lumbar sacral spine Evidence of significant osteomalacia Recommended.
Magnetic resonance imaging Evidence of significant osteomalacia Recommended.
Computerized tomography Evidence of significant osteomalacia Recommended.
Osteomyelitis, chronic-lumbar:
X-ray-lumbar sacral spine Evidence of chronic infection Recommended.
Magnetic resonance imaging Evidence of chronic infection Recommended.
Computerized tomography Evidence of chronic infection Recommended.
Osteoporosis:
Computerized tomography Significant bone density loss Recommended.
Dual photon absorptiometry Significant bone density loss Recommended.
X-ray-lumbar sacral spine Significant bone density loss Recommended.
Post laminectomy syndrome with radiculopathy:
Medical record review: lumbar Documented surgical history of laminectomy Highly recommended.
Magnetic resonance imaging Evidence of laminectomy Recommended.
Electromyography Definite denervation Recommended.
Nerve conduction velocity Definite slowing Recommended.
Physical examination—atrophy Atrophy in affected limb with 2 cm difference between limbs Recommended.
Physical examination: straight leg raise Positive straight leg raise Recommended.
Sensory examination Loss of sensation in affected dermatomes Recommended.
Medical record review: lumbar History of radicular pain Highly recommended.
Computerized tomography Evidence of laminectomy Recommended.
Myelogram Evidence of laminectomy Recommended.
Radiculopathy:
Magnetic resonance imaging Evidence of neural compression Recommended.
Electromyography Definite denervation Recommended.
Nerve conduction velocity Definite slowing Recommended.
Physical examination—atrophy Atrophy in affected limb with 2 cm difference between limbs Recommended.
Physical examination: straight leg raise Positive straight leg raise Recommended.
Sensory examination Loss of sensation in affected dermatomes Recommended.
Medical record review: lumbar History of radicular pain Highly recommended.
Computerized tomography Evidence of neural compression Recommended.
Myelogram Evidence of neural compression Recommended.
Sciatica:
Magnetic resonance imaging Evidence of neural compression Recommended.
Electromyography Definite denervation Recommended.
Nerve conduction velocity Definite slowing Recommended.
Physical examination—atrophy Atrophy in affected limb with 2 cm difference between limbs Recommended.
Physical examination: straight leg raise Positive straight leg raise Recommended.
Sensory examination Loss of sensation in affected dermatomes Recommended.
Medical history History of radicular pain Highly recommended.
Computerized tomography Evidence of neural compression Recommended.
Myelogram Evidence of neural compression Recommended.
Strains and sprains, unspecified:
Medical record review History of back pain under medical treatment for at least 1 year Highly recommended.
Medical record review History of back pain unresponsive to therapy for at least 1 year Highly recommended.
Medical record review History of back pain with functional limitations for at least 1 year Highly recommended.
Medical record review Documented history of strain and/or sprain Highly recommended.
Spondylolisthesis grade 1:
X-ray-lumbar sacral spine 1-25% slippage Recommended.
Computerized tomography 1-25% slippage Recommended.
Magnetic resonance imaging 1-25% slippage Recommended.
Spondylolisthesis grade 2:
X-ray-lumbar sacral spine 26-50% slippage Recommended.
Computerized tomography 26-50% slippage Recommended.
Magnetic resonance imaging 26-50% slippage Recommended.
Spondylolisthesis grade 3:
X-ray-lumbar sacral spine 51-75% slippage Recommended.
Computerized tomography 51-75% slippage Recommended.
Magnetic resonance imaging 51-75% slippage Recommended.
Spondylolisthesis grade 4:
X-ray-lumbar sacral spine Complete slippage Recommended.
Computerized tomography Complete slippage Recommended.
Magnetic resonance imaging Complete slippage Recommended.
Spondylolisthesis-acquired:
X-ray-lumbar sacral spine Slippage Recommended.
Computerized tomography Slippage Recommended.
Magnetic resonance imaging Slippage Recommended.
Spondylolsis:
X-ray-lumbar sacral spine Defect—pars interarticularis Recommended.
Computerized tomography Defect—pars interarticularis Recommended.
Magnetic resonance imaging Defect—pars interarticularis Recommended.
Sprains and strains, sacral:
Medical record review: lumbar History of back pain under medical treatment for at least 1 year Highly recommended.
Medical record review: lumbar History of back pain unresponsive to therapy for at least 1 year Highly recommended.
Medical record review: lumbar History of back with functional limitations for at least 1 year Highly recommended.
Medical record review: lumbar Documented history of strain and/or sprain Highly recommended.
Sprains and strains, sacroiliac:
Medical record review: lumbar History of back pain under medical treatment for at least 1 year Highly recommended.
Medical record review: lumbar History of back pain unresponsive to therapy for at least 1 year Highly recommended.
Medical record review: lumbar History of back pain with functional limitations for at least 1 year Highly recommended.
Medical record review: lumbar Documented history of strain and/or sprain Highly recommended.
Disability test Test result Disability classification
BODY PART: LS SPINE
JOB TITLE: TRAINMAN
Ankylosing spondylitis:
Muscle strength assessment Lifting capacity diminished by 50% D
Backache, unspecified:
Muscle strength assessment Lifting capacity diminished by 50% D
Chronic back pain, not otherwise specified:
Muscle strength assessment Lifting capacity diminished by 50% D
Cauda equina syndrome with bowel or bladder dysfunction:
Computerized tomography Disc extrusion with neural impingement, nerves < L1 D
Magnetic resonance imaging Disc extrusion with neural impingement, nerves < L1 D
Physical examination Lower extremity weakness D
Cystometrogram Impaired bladder function D
Myelogram Disc extrusion with neural impingement, nerves <L1 D
Physical examination: rectal Impairment of sphincter tone D
Muscle strength assessment Lifting capacity diminished by 50% D
Degeneration of lumbar disc:
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Muscle strength assessment Lifting capacity diminished by 50% D
Displacement of lumbar disc:
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: vertebral body:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: posterior spinal element with displacement:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: posterior spinal element with no displacement:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: spinous process:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture transverse process:
Muscle strength assessment Lifting capacity diminished by 50% D
Intervertebral disc disorder:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Lumbago:
Muscle strength assessment Lifting capacity diminished by 50% D
Lumbosacral neuritis:
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Muscle strength assessment Lifting capacity diminished by 50% D
Physical examination Lower extremity weakness D
Lumbar spinal stenosis:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Significant narrowing of the spinal canal D
Magnetic resonance imaging Significant narrowing of the spinal canal D
Myelogram Significant narrowing of the spinal canal D
Physical examination Significant lower extremity weakness D
Mechanical complication of internal orthopedic device:
Muscle strength assessment Lifting capacity diminished by 50% D
X-ray flexion/extension Segmental instability D
Osteomalacia:
Muscle strength assessment Lifting capacity diminished by 50% D
Osteomyelitis, chronic-lumbar:
Muscle strength assessment Lifting capacity diminished by 50% D
Medical record review Frequent flare-ups with objective findings D
Osteoporosis:
Muscle strength assessment Lifting capacity diminished by 50% D
Post laminectomy syndrome with radiculopathy:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
Post laminectomy syndrome:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
X-ray flexion/extension Segmental instability D
Radiculopathy:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
Sciatica:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
Strains and sprains, unspecified:
Muscle strength assessment Lifting capacity diminished by 50% D
Spondylolisthesis grade 1:
Muscle strength assessment Lifting capacity diminished by 50% D
X-ray flexion/extension Segmental instability D
Spondylolisthesis grade 2:
Muscle strength assessment Lifting capacity diminished by 50% D
Spondylolisthesis grade 3:
Muscle strength assessment Lifting capacity diminished by 50% D
Spondylolisthesis grade 4:
Muscle strength assessment Lifting capacity diminished by 50% D
X-ray flexion/extension Segmental instability D
Spondylolisthesis—acquired:
X-ray flexion/extension Segmental instability D
Spondylolysis:
X-ray flexion/extension Segmental instability D
Sprains and strains, sacral:
Muscle strength assessment Lifting capacity diminished by 50% D
Sprains and strains, sacroiliac:
Muscle strength assessment Lifting capacity diminished by 50% D
Vertebral body compression fracture:
Muscle strength assessment Lifting capacity diminished by 50% D
BODY PART: LS SPINE
JOB TITLE: ENGINEER
Cauda equina syndrome with bowel or bladder dysfunction:
Computerized tomography Disc extrusion with neural impingement, nerves <L1 D
Magnetic resonance imaging Disc extrusion with neural impingement, nerves <L1 D
Physical examination Lower extremity weakness D
Cystometrogram Impaired bladder function D
Myelogram Disc extrusion with neural impingement, nerves <L1 D
Physical examination: rectal Impairment of sphincter tone D
BODY PART: LS SPINE
JOB TITLE: CARMAN
Ankylosing spondylitis:
Muscle strength assessment Lifting capacity diminished by 50% D
Backache, unspecified:
Muscle strength assessment Lifting capacity diminished by 50% D
Chronic back pain, not otherwise specified:
Muscle strength assessment Lifting capacity diminished by 50% D
Cauda equina syndrome with bowel or bladder dysfunction:
Computerized tomography Disc extrusion with neural impingement, nerves <L1 D
Magnetic resonance imaging Disc extrusion with neural impingement, nerves <L1 D
Physical examination Lower extremity weakness D
Cystometrogram Impaired bladder function D
Myeolgram Disc extrusion with neural impingement, nerves <L1 D
Physical examination: rectal Impairment of sphincter tone D
Muscle strength assessment Lifting capacity diminished by 50% D
Degeneration of lumbar disc:
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Muscle strength assessment Lifting capacity diminished by 50% D
Displacement of lumbar disc:
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: vertebral body:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: posterior spinal element with displacement:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: posterior spinal element with no displacement:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: spinous process:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture transverse process:
Muscle strength assessment Lifting capacity diminished by 50% D
Intervertebral disc disorder:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Lumbago:
Muscle strength assessment Lifting capacity diminished by 50% D
Lumbosacral neuritis:
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Muscle strength assessment Lifting capacity diminished by 50% D
Physical examination Lower extremity weakness D
Lumbar spinal stenosis:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Significant narrowing of the spinal canal D
Magnetic resonance imaging Significant narrowing of the spinal canal D
Myelogram Significant narrowing of the spinal canal D
Physical examination Significant lower extremity weakness D
Mechanical complication of internal orthopedic device:
Muscle strength assessment Lifting capacity diminished by 50% D
X-ray flexion/extension Segmental instability D
Osteomalacia:
Muscle strength assessment Lifting capacity diminished by 50% D
Osteomyelitis, chronic-lumbar:
Muscle strength assessment Lifting capacity diminished by 50% D
Medical record review Frequent flare-ups with objective findings D
Osteoporosis:
Muscle strength assessment Lifting capacity diminished by 50% D
Post laminectomy syndrome with radiculopathy:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
Post laminectomy syndrome:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
X-ray flexion/extension Segmental instability D
Radiculopathy:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
Sciatica:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
Strains and sprains, unspecified:
Muscle strength assessment Lifting capacity diminished by 50% D
Spondylolisthesis grade 1:
Muscle strength assessment Lifting capacity diminished by 50% D
X-ray flexion/extension Segmental instability D
Spondylolisthesis grade 2:
Muscle strength assessment Lifting capacity diminished by 50% D
Spondylolisthesis grade 3:
Muscle strength assessment Lifting capacity diminshed by 50% D
Spondylolisthesis grade 4:
Muscle strength assessment Lifting capacity diminished by 50% D
X-ray flexion/extension Segmental instability D
Spondylolisthesis-acquired:
X-ray flexion/extension Segmental instability D
Spondylolysis:
X-ray flexion/extension Segmental instability D
Sprains and strains, sacral:
Muscle strength assessment Lifting capacity diminshed by 50% D
Sprains and strains, sacroiliac:
Muscle strength assessment Lifting capacity diminished by 50% D
Vertebral body compression fracture:
Muscle strength assessment Lifting capacity diminshed by 50% D
BODY PART: LS SPINE
JOB TITLE: SIGNALMAN
Ankylosing spondylitis:
Muscle strength assessment Lifting capacity diminished by 50% D
Backache, unspecified:
Muscle strength assessment Lifting capacity diminished by 50% D
Chronic back pain, not otherwise specified:
Muscle strength assessment Lifting capacity diminished by 50% D
Cauda equina syndrome with bowel or bladder dysfunction:
Computerized tomography Disc extrusion with neural impingement, nerves <L1 D
Magnetic resonance imaging Disc extrusion with neural impingement, nerves <L1 D
Physical examination Lower extremity weakness D
Cystometrogram Impaired bladder function D
Myelogram Disc extrusion with neural impingement, nerves <L1 D
Physical examination: rectal Impairment of sphincter tone D
Muscle strength assessment Lifting capacity diminished by 50% D
Degeneration of lumbar disc:
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Muscle strength assessment Lifting capacity diminished by 50% D
Displacement of lumbar disc:
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: vertebral body:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: posterior spinal element with displacement:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: posterior spinal element with no displacement:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: spinous process:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture transverse process:
Muscle strength assessment Lifting capacity diminished by 50% D
Intervertebral disc disorder:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Lumbago:
Muscle strength assessment Lifting capacity diminished by 50% D
Lumbosacral neuritis:
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Muscle strength assessment Lifting capacity diminished by 50% D
Physical examination Lower extremity weakness D
Lumbar spinal stenosis:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Significant narrowing of the spinal canal D
Magnetic resonance imaging Significant narrowing of the spinal canal D
Myelogram Significant narrowing of the spinal canal D
Physical examination Significant lower extremity weakness D
Mechanical complication of internal orthopedic device:
Muscle strength assessment Lifting capacity diminished by 50% D
X-ray flexion/extension Segmental instability D
Osteomalacia:
Muscle strength assessment Lifting capacity diminished by 50% D
Osteomyelitis, chronic-lumbar:
Muscle strength assessment Lifting capacity diminished by 50% D
Medical record review Frequent flare-ups with objective findings D
Osteoporosis:
Muscle strength assessment Lifting capacity diminished by 50% D
Post laminectomy syndrome with radiculopathy:
Muscle strength assessment Lifing capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
Post laminectomy syndrome:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
X-ray flexion/extension Segmental instability D
Radiculopathy:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
Sciatica:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
Strains and sprains, unspecified:
Muscle strength assessment Lifting capacity diminished by 50% D
Spondylolisthesis grade 1:
Muscle strength assessment Lifting capacity diminished by 50% D
X-ray flexion/extension Segmental instability D
Spondylolisthesis grade 2:
Muscle strength assessment Lifting capacity diminished by 50% D
Spondylolisthesis grade 3:
Muscle strength assessment Lifting capacity diminished by 50% D
Spondylolisthesis grade 4:
Muscle strength assessment Lifting capacity diminished by 50% D
X-ray flexion/extension Segmental instability D
Spondylolisthesis-acquired:
X-ray flexion/extension Segmental instability D
Spondylolysis:
X-ray flexion/extension Segmental instability D
Sprains and strains, sacral:
Muscle strength assessment Lifting capacity diminished by 50% D
Sprains and strains, sacroiliac:
Muscle strength assessment Lifting capacity diminished by 50% D
Vertebral body compression fracture:
Muscle strength assessment Lifting capacity diminished by 50% D
BODY PART: LS SPINE
JOB TITLE: TRACKMAN
Ankylosing spondylitis:
Muscle strength assessment Lifting capacity diminished by 50% D
Backache, unspecified:
Muscle strength assessment Lifting capacity diminished by 50% D
Chronic back pain, not otherwise specified:
Muscle strength assessment Lifing capacity diminished by 50% D
Cauda equina syndrome with bowel or bladder dysfunction:
Computerized tomography Disc extrusion with neural impingement, nerves <L1 D
Magnetic resonance imaging Disc extrusion with neural impingement, nerves <L1 D
Physical examination Lower extremity weakness D
Cystometrogram Impaired bladder function D
Myelogram Disc extrusion with neural impingement, nerves <L1 D
Physical examination: rectal Impairment of sphincter tone D
Muscle strength assessment Lifting capacity diminished by 50% D
Degeneration of lumbar disc:
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Muscle strength assessment Lifting capacity diminished by 50% D
Displacement of lumbar disc:
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: vertebral body:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: posterior spinal element with displacement:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: posterior spinal element with no displacement:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: spinous process:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture transverse process:
Muscle strength assessment Lifting capacity diminished by 50% D
Intervertebral disc disorder:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Lumbago:
Muscle strength assessment Lifting capacity diminished by 50% D
Lumbosacral neuritis:
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Muscle strength assessment Lifting capacity diminished by 50% D
Physical examination Lower extremity weakness D
Lumbar spinal stenosis:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Significant narrowing of the spinal canal D
Magnetic resonance imaging Significant narrowing of the spinal canal D
Myelogram Significant narrowing of the spinal canal D
Physcial examination Significant lower extremity weakness D
Mechanical complication of internal orthopedic device:
Muscle strength assessment Lifting capacity diminished by 50% D
X-ray flexion/extension Segmental instability D
Osteomalacia:
Muscle strength assessment Lifting capacity diminished by 50% D
Osteomyelitis, chronic-lumbar:
Muscle strength assessment Lifting capacity diminished by 50% D
Medical record review Frequent flare-ups with objective findings D
Osteoporosis:
Muscle strength assessment Lifting capacity diminished by 50% D
Post laminectomy syndrome with radiculopathy:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
Post laminectomy syndrome:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
X-ray flexion/extension Segmental instability D
Radiculopathy:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
Sciatica:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
Strains and sprains, unspecified:
Muscle strength assessment Lifting capacity diminished by 50% D
Spondylolisthesis grade 1:
Muscle strength assessment Lifting capacity diminished by 50% D
X-ray flexion/extension Segmental instability D
Spondylolisthesis grade 2:
Muscle strength assessment Lifting capacity diminished by 50% D
Spondylolisthesis grade 3:
Muscle strength assessment Lifting capacity diminished by 50% D
Spondylolisthesis grade 4:
Muscle strength assessment Lifting capacity diminished by 50% D
X-ray flexion/extension Segmental instability D
Spondylolisthesis-acquired:
X-ray flexion/extension Segmental instability D
Spondylolysis:
X-ray flexion/extension Segmental instability D
Sprains and strains, sacral:
Muscle strength assessment Lifting capacity diminished by 50% D
Sprains and strains, sacroiliac:
Muscle strength assessment Lifting capacity diminished by 50% D
Vetebral body compression fracture:
Muscle strength assessment Lifting capacity diminished by 50%
BODY PART: LS SPINE
JOB TITLE: MACHINIST
Ankylosing spondylitis:
Muscle strength assessment Lifting capacity diminished by 50% D
Backache, unspecified:
Muscle strength assessment Lifting capacity diminished by 50% D
Chronic back pain, not otherwise specified:
Muscle strength assessment Lifting capacity diminished by 50% D
Cauda equina syndrome with bowel or bladder dysfunction:
Computerized tomography Disc extrusion with neural impingement, nerves <L1 D
Magnetic resonance imaging Disc extrusion with neural impingement, nerves <L1 D
Physical examination Lower extremity weakness D
Cystometrogram Impaired bladder function D
Myelogram Disc extrusion with neural impingement, nerves <L1 D
Physical examination: rectal Impairment of sphincter tone D
Muscle strength assessment Lifting capacity diminished by 50% D
Degeneration of lumbar disc:
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Muscle strength assessment Lifting capacity diminished by 50% D
Displacement of lumbar disc:
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: vertebral body:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: posterior spinal element with displacement:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: posterior spinal element with no displacement:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: spinous process:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture transverse process:
Muscle strength assessment Lifting capacity diminished by 50% D
Intervertebral disc disorder:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Lumbago:
Muscle strength assessment Lifting capacity diminished by 50% D
Lumbosacral neuritis:
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Muscle strength assessment Lifting capacity diminished by 50% D
Physical examination Lower extremity weakness D
Lumbar spinal stenosis:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Significant narrowing of the spinal canal D
Magnetic resonance imaging Significant narrowing of the spinal canal D
Myelogram Significant narrowing of the spinal canal D
Physical examination Significant lower extremity weakness D
Mechanical complication of internal orthopedic device:
Muscle strength assessment Lifting capacity diminished by 50% D
X-ray flexion/extension Segmental instability D
Osteomalacia:
Muscle strength assessment Lifting capacity diminished by 50% D
Osteomyelitis, chronic-lumbar:
Muscle strength assessment Lifting capacity diminished by 50% D
Medical record review Frequent flare-ups with objective findings D
Osteoporosis:
Muscle strength assessment Lifting capacity diminished by 50% D
Post laminectomy syndrome with radiculopathy:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
Post laminectomy syndrome:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
X-ray flexion/extension Segmental instability D
Radiculopathy:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
Sciatica:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
Strains and sprains, unspecified:
Muscle strength assessment Lifting capacity diminished by 50% D
Spondylolisthesis grade I:
Muscle strength assessment Lifting capacity diminished by 50% D
X-ray flexion/extension Segmental instability D
Spondylolisthesis grade 2:
Muscle strength assessment Lifting capacity diminished by 50% D
Spondylolisthesis grade 3:
Muscle strength assessment Lifting capacity diminished by 50% D
Spondylolisthesis grade 4:
Muscle strength assessment Lifting capacity diminished by 50% D
X-ray flexion/extension Segmental instability D
Spondylolisthesis-acquired:
X-ray flexion/extension Segmental instability D
Spondylolysis:
X-ray flexion/extension Segmental instability D
Sprains and strains, sacral:
Muscle strength assessment Lifting capacity diminished by 50% D
Sprains and strains, sacroiliac:
Muscle strength assessment Lifting capacity diminished by 50% D
Vertebral body compression fracture:
Muscle strength assessment Lifting capacity diminished by 50% D
BODY PART: LS SPINE
JOB TITLE: SHOP LABORER
Ankylosing spondylitis:
Muscle strength assessment Lifting capacity diminished by 50% D
Backache, unspecified:
Muscle strength assessment Lifting capacity diminished by 50% D
Chronic back pain, not otherwise specified:
Muscle strength assessment Lifting capacity diminished by 50% D
Cauda equina syndrome with bowel or bladder dysfunction:
Computerized tomography Disc extrusion with neural impingement, nerves <L1 D
Magnetic resonance imaging Disc extrusion with neural impingement, nerves <L1 D
Physical examination Lower extremity weakness D
Cystometrogram Impaired bladder function D
Myelogram Disc extrusion with neural impingement, nerves <L1 D
Physical examination: rectal Impairment of sphincter tone D
Muscle strength assessment Lifting capacity diminished by 50% D
Degeneration of lumbar disc:
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Muscle strength assessment Lifting capacity diminished by 50% D
Displacement of lumber disc:
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: vertebral body:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: posterior spinal element with displacement:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: posterior spinal element with no displacement:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture: spinous process:
Muscle strength assessment Lifting capacity diminished by 50% D
Fracture transverse process:
Muscle strength assessment Lifting capacity diminished by 50% D
Intervertebral disc disorder:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Lumbago:
Muscle strength assessment Lifting capacity diminished by 50% D
Lumbosacral neuritis:
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Muscle strength assessment Lifting capacity diminished by 50% D
Physical examination Lower extremity weakness D
Lumbar spinal stenosis:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Significant narrowing of the spinal canal D
Magnetic resonance imaging Significant narrowing of the spinal canal D
Myelogram Significant narrowing of the spinal canal D
Physical examination Significant lower extremity weakness D
Mechanical complication of internal orthopedic device:
Muscle strength assessment Lifting capacity diminished by 50% D
X-ray flexion/extension Segmental instability D
Osteomalacia:
Muscle strength assessment Lifting capacity diminished by 50% D
Osteomyelitis, chronic-lumbar:
Muscle strength assessment Lifting capacity diminished by 50% D
Medical record review Frequent flare-ups with objective findings D
Osteoporosis:
Muscle strength assessment Lifting capacity diminished by 50% D
Post laminectomy syndrome with radiculopathy:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
Post laminectomy syndrome:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
X-ray flexion/extension Segmental instability D
Radiculopathy:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
Sciatica:
Muscle strength assessment Lifting capacity diminished by 50% D
Computerized tomography Disc extrusion with neural impingement D
Magnetic resonance imaging Disc extrusion with neural impingement D
Myelogram Disc extrusion with neural impingement D
Physical examination Significant lower extremity weakness D
Strains and sprains, unspecified:
Muscle strength assessment Lifting capacity diminished by 50% D
Spondylolisthesis grade 1:
Muscle strength assessment Lifting capacity diminished by 50% D
X-ray flexion/extension Segmental instability D
Spondylolisthesis grade 2:
Muscle strength assessment Lifting capacity diminished by 50% D
Spondylolisthesis grade 3:
Muscle strength assessment Lifting capacity diminished by 50% D
Spondylolisthesis grade 4:
Muscle strength assessment Lifting capacity diminished by 50% D
X-ray flexion/extension Segmental instability D
Spondylolisthesis-acquired:
X-ray flexion/extension Segmental instability D
Spondylolysis:
X-ray flexion/extension Segmental instability D
Sprains and strains, sacral:
Muscle strength assessment Lifting capacity diminished by 50% D
Sprains and strains, sacroiliac:
Muscle strength assessment Lifting capacity diminished by 50% D
Vertebral body compression fracture:
Muscle strength assessment Lifting capacity diminished by 50% D
F. Cervical Spine
Confirmatory test Minimum result Requirements
BODY PART: CE SPINE
CONFIRMATORY TESTS
Cervical disc disease with myelopathy:
Physical examination: cervical Evidence of myelopathy Highly recommended.
Myelogram Evidence of neurogenic compression Recommended.
Computerized axial tomography Evidence of neurogenic compression Recommended.
Magnetic resonance imaging Evidence of neurogenic compression Recommended.
Chronic herniated disc:
X-ray: cervical spine Evidence of significant disc degeneration Recommended.
Myelogram Evidence of significant disc degeneration Recommended.
Computerized axial tomography Evidence of significant disc degeneration Recommended.
Magnetic resonance imaging Evidence of significant disc degeneration Recommended.
Cervical spondylolysis:
X-ray: cervical spine Evidence of significant disc degeneration Recommended.
Computerized axial tomography Evidence of significant disc degeneration Recommended.
Magnetic resonance imaging Evidence of significant disc degeneration Recommended.
Cervical intervertebral disc degeneration:
X-ray: cervical spine Evidence of significant disc degeneration Recommended.
Myelogram Evidence of significant disc degeneration Recommended.
Magnetic resonance imaging Evidence of significant disc degeneration Recommended.
Fracture: posterior element with spinal canal displacement:
X-ray: cervical spine Fractured posterior element with canal displacement Recommended.
Computerized axial tomography Fractured posterior element with canal displacement Recommended.
Magnetic resonance imaging Fractured posterior element with canal displacement Recommended.
Fracture: transverse, spinous or posterior process:
X-ray: cervical spine Fracture of relevant part Recommended.
Computerized axial tomography Fracture of relevant part Recommended.
Magnetic resonance imaging Fracture of relevant part Recommended.
Osteoarthritis, cervical:
X-ray: cervical spine Evidence of extensive disc degeneration Recommended.
Computerized axial tomography Evidence of extensive disc degeneration Recommended.
Magnetic resonance imaging Evidence of extensive disc degeneration Recommended.
Post laminectomy syndrome:
Medical records: cervical Confirmed surgical history Highly recommended.
Medical records: cervical Continued pain post-surgery Highly recommended.
Radiculopathy:
Medical records: cervical History of radicular pain Highly recommended.
Physical examination: arm Loss of reflexes in affected dermatomes Recommended.
Physical examination: arm Evidence of atrophy ≤2 cm Recommended.
Electromyography Definite denervation in muscle of affected nerve root Recommended.
Myelogram Evidence of neurogenic compression Recommended.
Magnetic resonance imaging Compression of spinal nerves Recommended.
Computerized axial tomography Compression of spinal nerves Recommended.
Rheumatoid arthritis, cervical:
Rheumatoid factor (blood test) Titer of rheumatoid factor Recommended.
X-ray: cervical spine Rheumatoid changes of spine Highly recommended.
Medical records review: cervical Confirmation by rheumatologist or internist Highly recommended.
Spondylogenic compression of spinal cord:
Physical examination: cervical Evidence of myelopathy Highly recommended.
Computerized axial tomography Evidence of neurogenic compression Recommended.
Magnetic resonance imaging Evidence of neurogenic compression Recommended.
Myelogram Evidence of neurogenic compression Recommended.
Disability test Test result Disability classification
BODY PART: CE SPINE
JOB TITLE: TRAINMAN
Cervical disc disease with myelopathy:
Computerized axial tomography Significant spinal cord pressure D
Magnetic resonance imaging Significant spinal cord pressure D
Myelogram Significant spinal cord pressure D
Cystometrogram Impaired bladder function D
Physical examination: rectal Impairment of sphincter tone
Physical examination: lower limb Lower extremity weakness or significant spasticity D
Physical examination Multi-level neurologic compromise D
Chronic herniated disc:
Physical examination Multi-level neurologic compromise D
Cervical spondylolysis:
Physical examination Multi-level neurologic compromise D
Cervical intervertebral disc degeneration:
Physical examination Multi-level neurologic compromise D
Fracture: posterior element with spinal canal displacement:
Physical examination Multi-level neurologic compromise D
Post laminectomy syndrome:
Physical examination Multi-level neurologic compromise D
Cervical radiculopathy:
Physical examination Multi-level neurologic compromise D
Spondylogenic compression of spinal cord:
Computerized axial tomography Significant spinal cord pressure D
Magnetic resonance imaging Significant spinal cord pressure D
Cystometrogram Impaired bladder function D
Myelogram Significant spinal cord pressure D
Physical examination: rectal Impairment of sphincter tone D
Physical examination Multi-level neurologic compromise D
Physical examination: lower limb Lower extremity weakness or significant spasticity D
BODY PART: CE SPINE
JOB TITLE: ENGINEER
Cervical disc disease with myelopathy:
Computerized axial tomography Significant spinal cord pressure D
Magnetic resonance imaging Significant spinal cord pressure D
Myelogram Significant spinal cord pressure D
Cystometrogram Impaired bladder function D
Physical examination: rectal Impairment of sphincter tone D
Physical examination: lower limb Lower extremity weakness or significant spasticity D
Physical examination Multi-level neurologic compromise D
Chronic herniated disc:
Physical examination Multi-level neurologic compromise D
Cervical spondylolysis:
Physical examination Multi-level neurologic compromise D
Cervical intervertebral disc degeneration:
Physical examination Multi-level neurologic compromise D
Fracture: posterior element with spinal canal displacement:
Physical examination Multi-level neurologic compromise D
Post laminectomy syndrome:
Physical examination Multi-level neurologic compromise D
Cervical radiculopathy:
Physical examination: Multi-level neurologic compromise D
Spondylogenic compression of spinal cord:
Computerized axial tomography Significant spinal cord pressure D
Magnetic resonance imaging Significant spinal cord pressure D
Cystometrogram Impaired bladder function D
Myelogram Significant spinal cord pressure D
Physical examination: rectal Impairment of sphincter tone D
Physical examination Multi-level neurologic compromise D
Physical examination: lower limb Lower extremity weakness or significant spasticity D
BODY PART: CE SPINE
JOB TITLE: DISPATCHER
Cervical disc disease with myelopathy:
Cystometrogram Impaired bladder function D
Physical examination: rectal Impairment of sphincter tone D
Spondylogenic compression of spinal cord:
Cystometrogram Impaired bladder function D
Physical examination: rectal Impairment of sphincter tone D
BODY PART: CE SPINE
JOB TITLE: CARMAN
Cervical disc disease with myelopathy:
Computerized axial tomography Significant spinal cord pressure D
Magnetic resonance imaging Significant spinal cord pressure D
Myelogram Significant spinal cord pressure D
Cystometrogram Impaired bladder function D
Physical examination: rectal Impairment of sphincter tone D
Physical examination: lower limb Lower extremity weakness or significant spasticity D
Physical examination Multi-level neurologic compromise D
Chronic herniated disc:
Physical examination Multi-level neurologic compromise D
Cervical spondylolysis:
Physical examination Multi-level neurologic compromise D
Cervical intervertebral disc degeneration:
Physical examination Multi-level neurologic compromise D
Fracture: posterior element with spinal canal displacement:
Physical examination Multi-level neurologic compromise D
Post laminectomy syndrome:
Physical examination Multi-level neurologic compromise D
Cervical radiculopathy:
Physical examination Multi-level neurologic compromise D
Spondylogenic compression of spinal cord:
Computerized axial tomography Significant spinal cord pressure D
Magnetic resonance imaging Significant spinal cord pressure D
Cystometrogram Impaired bladder function D
Myelogram Significant spinal cord pressure D
Physical examination: rectal Impairment of sphincter tone D
Physical examination Multi-level neurologic compromise D
Physical examination: lower limb Lower extremity weakness or significant spasticity D
BODY PART; CE SPINE
JOB TITLE: SIGNALMAN
Cervical disc disease with myelopathy:
Computerized axial tomography Significant spinal cord pressure D
Magnetic resonance imaging Significant spinal cord pressure D
Myelogram Significant spinal cord pressure D
Cystometrogram Impaired bladder function D
Physical examination: rectal Impairment of sphincter tone D
Physical examination: lower limb Lower extremity weakness or significant spasticity D
Physical examination Multi-level neurologic compromise D
Chronic herniated disc:
Physical examination Multi-level neurologic compromise D
Cervical spondylolysis:
Physical examination Multi-level neurologic compromise D
Cervical intervertebral disc degeneration:
Physical examination Multi-level neurologic compromise D
Fracture: posterior element with spinal canal displacement:
Physical examination Multi-level neurologic compromise D
Post laminectomy syndrome:
Physical examination Multi-level neurologic compromise D
Cervical radiculopathy:
Physical examination Multi-level neurologic compromise D
Spondylogenic compression of spinal cord:
Computerized axial tomography Significant spinal cord pressure D
Magnetic resonance imaging Significant spinal cord pressure D
Cystometrogram Impaired bladder function D
Myelogram Significant spinal cord pressure D
Physical examination: rectal Impairment of sphincter tone D
Physical examination Multi-level neurologic compromise D
Physical examination: lower limb Lower extremity weakness or significant spasticity D
BODY PART: CE SPINE
JOB TITLE: TRACKMAN
Cervical disc disease with myelopathy:
Computerized axial tomography Significant spinal cord pressure D
Magnetic resonance imaging Significant spinal cord pressure D
Myelogram Significant spinal cord pressure D
Cystometrogram Impaired bladder function D
Physical examination: rectal Impairment of sphincter tone D
Physical examination: lower limb Lower extremity weakness or significant spasticity D
Physical examination Multi-level neurologic compromise D
Chronic herniated disc:
Physical examination Multi-level neurologic compromise D
Cervical spondyloysis:
Physical examination Multi-level neurologic compromise D
Cervical intervertebral disc degeneration:
Physical examination Multi-level neurologic compromise D
Fracture: posterior element with spinal canal displacement:
Physical examination Multi-level neurologic compromise D
Post laminectomy syndrome:
Physical examination Multi-level neurologic compromise D
Cervical radiculopathy:
Physical examination Multi-level neurologic compromise D
Spondylogenic compression of spinal cord:
Computerized axial tomography Significant spinal cord pressure D
Magnetic resonance imaging Significant spinal cord pressure D
Cystometrogram Impaired bladder function D
Myelogram Significant spinal cord pressure D
Physical examination: rectal Impairment of sphincter tone D
Physical examination Multi-level neurologic compromise D
Physical examination: lower limb Lower extremity weakness or significant spasticity D
BODY PART: CE SPINE
JOB TITLE: MACHINIST
Cervical disc disease with myelopathy:
Computerized axial tomography Significant spinal cord pressure D
Magnetic resonance imaging Significant spinal cord pressure D
Myelogram Significant spinal cord pressure D
Cystometrogram Impaired bladder function D
Physical examination: rectal Impairment of sphincter tone D
Physical examination: lower limb Lower extremity weakness or significant spasticity D
Physical examination Multi-level neurologic compromise D
Chronic herniated disc:
Physical examination Multi-level neurologic compromise D
Cervical spondylolysis:
Physical examination Multi-level neurologic compromise D
Cervical intervertebral disc degeneration:
Physical examination Multi-level neurologic compromise D
Fracture: posterior element with spinal canal displacement:
Physical examination Multi-level neurologic compromise D
Post laminectomy syndrome:
Physical examination Multi-level neurologic compromise D
Cervical radiculopathy:
Physical examination Multi-level neurologic compromise D
Spondylogenic compression of spinal cord:
Computerized axial tomography Significant spinal cord pressure D
Magnetic resonance imaging Significant spinal cord pressure D
Cystometrogram Impaired bladder function D
Myelogram Significant spinal cord pressure D
Physical examination: rectal Impairment of sphincter tone D
Physical examination Multi-level neurologic compromise D
Physical examination: lower limb Lower extremity weakness or significant spasticity D
BODY PART: CE SPINE
JOB TITLE: SHOP LABORER
Cervical disc disease with myelopathy:
Computerized axial tomography Significant spinal cord pressure D
Magnetic resonance imaging Significant spinal cord pressure D
Myelogram Significant spinal cord pressure D
Cystometrogram Impaired bladder function D
Physical examination: rectal Impairment of sphincter tone D
Physical examination: lower limb Lower extremity weakness or significant spasticity D
Physical examination Multi-level neurologic compromise D
Chronic herniated disc:
Physical examination Multi-level neurologic compromise D
Cervical spondylolysis:
Physical examination Multi-level neurologic compromise D
Cervical intervertebral disc degeneration:
Physical examination Multi-level neurologic compromise D
Fracture: posterior element with spinal canal displacement:
Physical examination Multi-level neurologic compromise D
Post laminectomy syndrome:
Physical examination Multi-level neurologic compromise D
Cervical radiculopathy:
Physical examination Multi-level neurologic compromise D
Spondylogenic compression of spinal cord:
Computerized axial tomography Significant spinal cord pressure D
Magnetic resonance imaging Significant spinal cord pressure D
Cystometrogram Impaired bladder function D
Myelogram Significant spinal cord pressure D
Physical examination: rectal Impairment of sphincter tone D
Physical examination Multi-level neurologic compromise D
Physical examination: lower limb Lower extremity weakness or significant spasticity D
BODY PART: CE SPINE
JOB TITLE: SALES REPRESENTATIVE
Cervical disc disease with myelopathy:
Cystometrogram Impaired bladder function D
Physical examination: rectal Impairment of sphincter tone D
Spondylogenic compression of spinal cord:
Cystometrogram Impaired bladder function D
Physical examination: rectal Impairment of sphincter tone D
BODY PART: CE SPINE
JOB TITLE: GENERAL OFFICE CLERK
Cervical disc disease with myelopathy:
Cystometrogram Impaired bladder function D
Physical examination: rectal Impairment of sphincter tone D
Spondylogenic compression of spinal cord:
Cystometrogram Impaired bladder function D
Physical examination: rectal Impairment of sphincter tone D
G. Shoulder and Elbow
Confirmatory test Minimum result Requirements.
BODY PART: SHOULDER AND ELBOW
CONFIRMATORY TESTS
Arthritis, acromioclavicular:
X-ray: shoulder Significant degenerative changes of joint Recommended.
Computerized tomography Significant degenerative changes of joint Recommended.
Magnetic resonance imaging Significant degenerative changes of joint Recommended.
Arthritis, glenohumeral:
X-ray: shoulder Significant degenerative changes of joint Recommended.
Computerized tomography Significant degenerative changes of joint Recommended.
Magnetic resonance imaging Significant degenerative changes of joint Recommended.
Rotator cuff tear:
Computerized tomography Tear of rotator cuff Recommended.
Magnetic resonance imaging Tear of rotator cuff Recommended.
Medical diagnosis leading to a permanent functional limitation of the elbow:
Medical record review Condition with permanent functional limitation Highly recommended.
X-ray: elbow Imaging confirmation of functional diagnosis Recommended.
Magnetic resonance imaging Imaging confirmation of functional diagnosis Recommended.
Disability test Test result Disability classification
BODY PART: SHOULDER AND ELBOW
JOB TITLE: TRAINMAN
Arthritis, acromioclavicular:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of motion <40 degrees abduction D
Arthritis, glenohumeral:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of motion <40 degrees abduction D
Rotator cuff tear:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of motion <40 degrees abduction D
Permanent functional limitation, elbow:
Physical examination ≤40 degrees deviation D
Physical examination—range of motion Flexion limit to 60 degrees D
BODY PART: SHOULDER AND ELBOW
JOB TITLE: ENGINEER
Arthritis, acromioclavicular:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of motion <40 degrees abduction D
Arthritis, glenohumeral:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of motion <40 degrees abduction D
Rotator cuff tear:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of moiton <40 degrees abduction D
Permanent functional limitation, elbow:
Physical examination ≤40 degrees deviation D
Physical examination—range of motion Flexion limit to 60 degrees D
BODY PART: SHOULDER AND ELBOW
JOB TITLE: CARMAN
Arthritis, acromioclavicular:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of motion <40 degrees abduction D
Arthritis, glenohumeral:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of motion <40 degrees abduction D
Rotator cuff tear:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of motion <40 degrees abduction D
Permanent functional limitation, elbow:
Physical examination ≤40 degrees deviation D
Physical examination—range of motion Flexion limit to 60 degrees D
BODY PART: SHOULDER AND ELBOW
JOB TITLE: SIGNALMAN
Arthritis, acromioclavicular:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of motion <40 degrees abduction D
Arthritis, glenohumeral:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of motion <40 degrees abduction D
Rotator cuff tear:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of motion <40 degrees abduction D
Permanent functional limitation, elbow:
Physical examination ≤40 degrees deviation D
Physical examination—range of motion Flexion limit to 60 degrees D
BODY PART: SHOULDER AND ELBOW
JOB TITLE: TRACKMAN
Arthritis, acromioclavicular:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of motion <40 degrees abduction D
Arthritis, glenohumeral:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of motion <40 degrees abduction D
Rotator cuff tear:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of motion <40 degrees abduction D
Permanent functional limitation, elbow:
Physical examination ≤40 degrees deviation D
Physical examination—range of motion Flexion limit to 60 degrees D
BODY PART: SHOULDER AND ELBOW
JOB TITLE: MACHINIST
Arthritis, acromioclavicular:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of motion <40 degrees abduction D
Arthritis, glenohumeral:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of motion <40 degrees abduction D
Rotator cuff tear:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of motion <40 degrees abduction D
Permanent functional limitation, elbow:
Physical examination ≤40 degrees deviation D
Physical examination—range of motion Flexion limit to 60 degrees D
BODY PART: SHOULDER AND ELBOW
JOB TITLE: SHOP LABORER
Arthritis, acromioclavicular:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of motion <40 degrees abduction D
Arthritis, glenohumeral:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of motion <40 degrees abduction D
Rotator cuff tear:
Physical examination—range of motion <40 degrees flexion D
Physical examination—range of motion <40 degrees abduction D
Permanent functional limitation, elbow:
Physical examination ≤40 degrees deviation D
Physical examination—range of motion Flexion limit to 60 degrees D
H. Hand and Arm
Confirmatory test Minimum result Requirements
BODY PART: HAND AND ARM
CONFIRMATORY TESTS
Carpal tunnel syndrome:
Medical record review Pain, paresthesia and weakness in distribution median nerve Highly recommended.
Nerve conduction testing Definite median nerve conduction slowing at wrist Highly recommended.
Electromyography Denervation in severe cases Recommended.
Fracture: wrist:
X-ray: wrist Evidence of fracture Highly recommended.
Hand: permanent functional limitation:
Medical record review Documentation of medical condition for permanent limitation Highly recommended.
Physical examination Definite reproducible evidence of limitation Highly recommended.
Imaging study (e.g. X-ray, CAT, MRI) Positive confirmation of underlying condition Highly recommended.
Rheumatoid arthritis: hand:
Rheumatoid factor Titer of rheumatoid factor Recommended.
Medical record review History of objective findings including serological studies Highly recommended.
X-ray: hand Characteristic rheumatoid changes Highly recommended.
Tenosynovitis:
Medical record review History of chronic tenosynovitis and objective findings Highly recommended.
Physical examination Definite evidence of tenosynovitis Highly recommended.
Thumb: Permanent functional limitation:
Medical record review Documentation of medical condition for permanent limitation Highly recommended.
Physical examination Definite reproducible evidence of limitation Highly recommended.
Imaging study (X-ray, CAT, MRI) Positive confirmation of underlying condition Highly recommended.
Wrist: Permanent functional limitation:
Medical record review Documentation of medical condition for permanent limitation Highly recommended.
Physical examination Definite reproducible evidence of limitation Highly recommended.
Imaging study (e.g. X-ray, CAT, MRI) Positive confirmation of underlying condition Highly recommended.
Disability test Test result Disability classification
BODY PART: HAND AND ARM
JOB TITLE: TRAINMAN
Fracture, wrist:
Physical examination—range of motion Extension—limit to 30 degrees D
Physical examination—range of motion Flexion—limit to 30 degrees D
Physical examination—range of motion Ankylosis: ≤20 degrees from neutral D
Rheumatoid arthritis hand:
Physical examination Significant deformity D
Medical record review Significant flare-ups, under treatment with rheumatologist D
Medical record review Extensive medication use, under treatment with rheumatologist D
Thumb: permanent functional limitation:
Adduction of thumb Loss ≤4 cm D
Ankylosis: degree from neutral <20 degrees extension D
Ankylosis: degree from neutral <40 degrees flexion D
Loss of extension or flexion MCP or PIP: maximum flexion <40 degrees D
Opposition Loss ≤4 cm D
Wrist: permanent functional limitation:
Physical examination—range of motion Extension—limit to 30 degrees D
Physical examination—range of motion Flexion—limit to 30 degrees D
Physical examination—range of motion Ankylosis: ≤20 degrees from neutral D
BODY PART: HAND AND ARM
JOB TITLE ENGINEER
Fracture, wrist:
Physical examination—range of motion Extension-limit to 30 degrees D
Physical examination—range of motion Flexion-limit to 30 degrees D
Physical examination—range of motion Ankylosis: ≤20 degrees from neutral D
Rheumatoid arthritis hand:
Physical examination Significant deformity D
Medical record review Significant flare-ups, under treatment with rheumatologist D
Medical record review Extensive medication use, under treatment with rheumatologist D
Thumb: permanent functional limitation:
Adduction of thumb Loss ≤4 cm D
Ankylosis: degree from neutral <20 degrees extension D
Ankylosis: degree from neutral <40 degrees flexion D
Loss of extension or flexion MCP or PIP: maximum flexion <40 degrees D
Opposition Loss ≤4 cm D
Wrist: permanent functional limitation:
Physical examination—range of motion Extension—limit to 30 degrees D
Physical examination—range of motion Flexion—limit to 30 degrees D
Physical examination—range of motion Ankylosis: ≤20 degrees from neutral D
BODY PART: HAND AND ARM
JOB TITLE: DISPATCHER
Fracture, wrist:
Physical examination—range of motion Extension—limit to 30 degrees D
Physical examination—range of motion Flexion—limit to 30 degrees D
Physical examination—range of motion Ankylosis: ≤20 degrees from neutral D
Rheumatoid arthritis hand:
Physical examination Significant deformity D
Medical record review Significant flare-ups, under treatment with rheumatologist D
Medical record review Extensive medication use, under treatment with rheumatologist D
Thumb: permanent functional limitation:
Adduction of thumb Loss ≤4 cm D
Ankylosis: degree from neutral <20 degrees extension D
Ankylosis: degree from neutral <40 degrees flexion D
Loss of extension or flexion MCP or PIP: maximum flexion <40 degrees D
Opposition Loss ≤4 cm D
Wrist: permanent functional limitation:
Physical examination—range of motion Extension—limit to 30 degrees D
Physical examination—range of motion Flexion—limit to 30 degrees D
Physical examination—range of motion Ankylosis: ≤20 degrees from neutral D
BODY PART: HAND AND ARM
JOB TITLE: CARMAN
Fracture, wrist:
Physical examination—range of motion Extension—limit to 30 degrees D
Physical examination—range of motion Flexion—limit to 30 degrees D
Physical examination—range of motion Ankylosis: ≤20 degrees from neutral D
Rheumatoid arthritis hand:
Physical examination Significant deformity D
Medical record review Significant flare-ups, under treatment with rheumatologist D
Medical record review Extensive medication use, under treatment with rheumatologist D
Thumb: permanent functional limitation:
Adduction of thumb: Loss ≤4 cm D
Ankylosis: degree from neutral <20 degrees extension D
Ankylosis: degree from neutral <40 degrees flexion D
Loss of extension or flexion MCP of PIP: maximum flexion <40 degrees D
Opposition Loss ≤4 cm D
Wrist: permanent functional limitation:
Physical examination—range of motion Extension—limit to 30 degrees D
Physical examination—range of motion Flexion—limit to 30 degrees D
Physical examination—range of motion Ankylosis: ≤20 degrees from neutral D
BODY PART: HAND AND ARM
JOB TITLE: SIGNALMAN
Fracture, wrist:
Physical examination—range of motion Extension—limit to 30 degrees D
Physical examination—range of motion Flexion—limit to 30 degrees D
Physical examination—range of motion Ankylosis: ≤20 degrees from neutral D
Rheumatoid arthritis hand:
Physical examination Significant deformity D
Medical record review Significant flare-ups, under treatment with rheumatologist D
Medical record review Extensive medication use, under treatment with rheumatologist D
Thumb: permanent functional limitation:
Adduction of thumb Loss ≤4 cm D
Ankylosis: degree from neutral <20 degrees extension D
Ankylosis: degree from neutral <40 degrees flexion D
Loss of extension or flexion MCP or PIP: maximum flexion <40 degrees D
Opposition Loss ≤4 cm D
Wrist: permanent functional limitation:
Physical examination—range of motion Extension—limit to 30 degrees D
Physical examination—range of motion Flexion—limit to 30 degrees D
Physical examination—range of motion Ankylosis: ≤20 degrees from neutral D
BODY PART: HAND AND ARM
JOB TITLE: TRACKMAN
Fracture, wrist:
Physical examination—range of motion Extension—limit to 30 degrees D
Physical examination—range of motion Flexion—limit to 30 degrees D
Physical examination—range of motion Ankylosis: ≤20 degrees from neutral D
Rheumatoid arthritis hand:
Physical examination Significant deformity D
Medical record review Significant flare-ups, under treatment with rheumatologist D
Medical record review Extensive medication use, under treatment with rheumatologist D
Thumb: permanent functional limitation:
Adduction of thumb Loss ≤4 cm D
Ankylosis: degree from neutral <20 degrees extension D
Ankylosis: degree from neutral <40 degrees flexion D
Loss of extension or flexion MCP or PIP: maximum flexion <40 degrees D
Opposition Loss ≤4 cm D
Wrist: permanent functional limitation:
Physical examination—range of motion Extension—limit to 30 degrees D
Physical examination—range of motion Flexion—limit to 30 degrees D
Physical examination—range of motion Ankylosis: ≤20 degrees from neutral D
BODY PART: HAND AND ARM
JOB TITLE: MACHINIST
Fracture, wrist:
Physical examination—range of motion Extension—limit to 30 degrees D
Physical examination—range of motion Flexion—limit to 30 degrees D
Physical examination—range of motion Ankylosis: ≤20 degrees from neutral D
Rheumatoid arthritis hand:
Physical examination Significant deformity D
Medical record review Significant flare-ups, under treatment with rheumatologist D
Medical record review Extensive medication use, under treatment with rheumatologist D
Thumb: permanent functional limitation:
Adduction of thumb Loss ≤4 cm D
Ankylosis: degree from neutral <20 degrees extension D
Ankylosis: degree from neutral <40 degrees flexion D
Loss of extension or flexion MCP or PIP: maximum flexion <40 degrees D
Opposition Loss ≤4 cm D
Wrist: permanent functional limitation:
Physical examination—range of motion Extension—limit to 30 degrees D
Physical examination—range of motion Flexion—limit to 30 degrees D
Physical examination—range of motion Ankylosis: ≤20 degrees from neutral D
BODY PART: HAND AND ARM
JOB TITLE: SHOP LABORER
Fracture, wrist:
Physical examination—range of motion Extension—limit to 30 degrees D
Physical examination—range of motion Flexion—limit to 30 degrees D
Physical examination—range of motion Ankylosis: ≤20 degrees from neutral D
Rheumatoid arthritis hand:
Physical examination Significant deformity D
Medical record review Significant flare-ups, under treatment with rheumatologist D
Medical record review Extensive medication use, under treatment with rheumatologist D
Thumb: permanent functional limitation:
Adduction of thumb Loss ≤4 cm D
Ankylosis: degree from neutral <20 degrees extension D
Ankylosis: degree from neutral <40 degrees flexion D
Loss of extension or flexion MCP or PIP: maximum flexion <40 degrees D
Opposition Loss ≤4 cm D
Wrist: permanent functional limitation:
Physical examination—range of motion Extension—limit to 30 degrees D
Physical examination—range of motion Flexion—limit to 30 degrees D
Physical examination—range of motion Ankylosis: ≤20 degrees from neutral D
BODY PART: HAND AND ARM
JOB TITLE: SALES REPRESENTATIVE
Fracture, wrist:
Physical examination—range of motion Extension—limit to 30 degrees D
Physical examination—range of motion Flexion—limit to 30 degrees D
Physical examination—range of motion Ankylosis: ≤20 degrees from neutral D
Rheumatoid arthritis hand:
Physical examination Significant deformity D
Medical record review Significant flare-ups, under treatment with rheumatologist D
Medical record review Extensive medication use, under treatment with rheumatologist D
Thumb: permanent functional limitation:
Adduction of thumb Loss ≤4 cm D
Ankylosis: degree from neutral <20 degrees extension D
Ankylosis: degree from neutral <40 degrees flexion D
Loss of extension or flexion MCP or PIP: maximum flexion <40 degrees D
Opposition Loss ≤4 cm D
Wrist: permanent functional limitation:
Physical examination—range of motion Extension—limit to 30 degrees D
Physical examination—range of motion Flexion—limit to 30 degrees D
Physical examination—range of motion Ankylosis: ≤20 degrees from neutral D
BODY PART: HAND AND ARM
JOB TITLE: GENERAL OFFICE CLERK
Fracture, wrist:
Physical examination—range of motion Extension—limit to 30 degrees D
Physical examination—range of motion Flexion—limit to 30 degrees D
Physical examination—range of motion Ankylosis: ≤20 degrees from neutral D
Rheumatoid arthritis hand:
Physical examination Significant deformity D
Medical record review Significant flare-ups, under treatment with rheumatologist D
Medical record review Extensive medication use, under treatment with rheumatologist D
Thumb: permanent functional limitation:
Adduction of thumb Loss ≤4 cm D
Ankylosis: degree from neutral <20 degree extension D
Ankylosis: degree from neutral <40 degree flexion D
Loss of extension or flexion MCP or PIP: maximum flexion <40 degrees D
Opposition Loss ≤4 cm D
Wrist: permanent functional limitation:
Physical examination—range of motion Extension—limit to 30 degrees D
Physical examination—range of motion Flexion—limit to 30 degrees D
Physical examination—range of motion Ankylosis: ≤20 degrees from neutral D
I. Hip
Confirmatory test Minimum result Requirements
BODY PART: HIP
CONFIRMATORY TESTS
Ankylosis, hip:
X-ray: hip Extreme joint destruction Highly Recommended.
Physical examination—range of motion No mobility Highly Recommended.
Osteoarthritis, hip:
X-ray: hip <4 mm joint space, or other positive evidence Recommended.
Magnetic resonance imaging <4 mm joint space, or other positive evidence Recommended.
Computerized axial tomography <4 mm joint space, or other positive evidence Recommended.
Osteomyelitis, hip:
X-ray: hip Evidence of chronic infection Recommended.
Computerized axial tomography Evidence of chronic infection Recommended.
Paget's disease:
X-ray: hip Osteolytic or blastic lesions Highly Recommended.
Alkaline phosphatase Increased up to 50 times Highly Recommended.
Hip replacement surgery:
X-ray: hip Evidence of artificial hip Recommended.
Medical record review Documentation of prior hip replacement Recommended.
Disability test Test result Disability classification
BODY PART: HIP
JOB TITLE: TRAINMAN
Ankylosis, hip:
Physical examination—range of motion Ankylosis 5 degrees or ≤flexion D
Physical examination—range of motion Ankylosis internal rotation ≤5 degrees D
Physical examination—range of motion Ankylosis external rotation ≤10 degrees D
Physical examination—range of motion Ankylosis in abduction ≤5 degrees D
Physical examination—range of motion Ankylosis in adduction ≤5 degrees D
Osteoarthritis, hip:
X-ray: hip 0 mm cartilage interval D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abduction D
Osteomyelitis, chronic hip:
X-ray: hip Significant joint destruction D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abduction D
Medical record review Documented occurrence of recurring infections with treatment D
Paget's disease:
X-ray: hip Significant joint destruction D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abduction D
Hip replacement surgery:
X-ray: hip Evidence of artificial hip joint D
Medical record review Documentation of prior hip replacement D
BODY PART: HIP
JOB TITLE: ENGINEER
Ankylosis, hip:
Physical examination—range of motion Ankylosis 5 degrees or ≤flexion D
Physical examination—range of motion Ankylosis internal rotation ≤5 degrees D
Physical examination—range of motion Ankylosis external rotation ≤10 degrees D
Physical examination—range of motion Ankylosis in abduction ≤5 degrees D
Physical examination—range of motion Ankylosis in adduction ≤5 degrees D
Osteoarthritis, hip:
X-ray: hip 0 mm cartilage interval D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abduction D
Osteomyelitis, chronic hip:
X-ray: hip Signficant joint destruction D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abduction D
Medical record review Documented occurrence of recurring infections with treatment D
Paget's disease:
X-ray: hip Significant joint destruction D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abduction D
Hip replacement surgery:
X-ray: hip Evidence of artificial hip joint D
Medical record review Documentation of prior hip replacement D
BODY PART: HIP
JOB TITLE: CARMAN
Ankylosis, hip:
Physical examination—range of motion Ankylosis 5 degrees or ≤flexion D
Physical examination—range of motion Ankylosis internal rotation ≤5 degrees D
Physical examination—range of motion Ankylosis external rotation ≤10 degrees D
Physical examination—range of motion Ankylosis in abduction ≤5 degrees D
Physical examination—range of motion Ankylosis in adduction ≤5 degrees D
Osteoarthritis, hip:
X-ray: hip 0 mm cartilage interval D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abduction D
Osteomyelitis, chronic hip:
X-ray: hip Significant joint destruction D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abduction D
Medical record review Documented occurrence of recurring infections with treatment D
Paget's disease:
X-ray: hip Significant joint destruction D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abduction D
Hip replacement surgery:
X-ray: hip Evidence of artificial hip joint D
Medical record review Documentation of prior hip replacement D
BODY PART: HIP
JOB TITLE: SIGNALMAN
Ankylosis, hip:
Physical examination—range of motion Ankylosis 5 degrees or ≤flexion D
Physical examination—range of motion Ankylosis internal rotation ≤5 degrees D
Physical examination—range of motion Ankylosis external rotation ≤10 degrees D
Physical examination—range of motion Ankylosis in abduction ≤5 degrees D
Physical examination—range of motion Ankylosis in adduction ≤5 degrees D
Osteoarthritis, hip:
X-ray: hip 0 mm cartilage interval D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abduction D
Osteomyelitis, chronic hip:
X-ray: hip Significant joint destruction D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abduction D
Medical record review Documented occurrence of recurring infections with treatment D
Paget's disease:
X-ray: hip Significant joint destruction D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abduction D
Hip replacement surgery:
X-ray: hip Evidence of artificial hip joint D
Medical record review Documentation of prior hip replacement D
BODY PART: HIP
JOB TITLE: TRACKMAN
Ankylosis, hip:
Physical examination—range of motion Ankylosis 5 degrees or ≤flexion D
Physical examination—range of motion Ankylosis internal rotation ≤5 degrees D
Physical examination—range of motion Ankylosis external rotation ≤10 degrees D
Physical examination—range of motion Ankylosis in abduction ≤5 degrees D
Physical examination—range of motion Ankylosis in adduction ≤5 degrees D
Osteoarthritis, hip:
X-ray: hip 0 mm cartilage interval D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abduction D
Osteomyelitis, chronic hip:
X-ray: hip Significant joint destruction D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abduction D
Medical record review Documented occurrence of recurring infections with treatment D
Paget's disease:
X-ray: hip Significant joint destruction D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abduction D
Hip replacement surgery:
X-ray: hip Evidence of artificial hip joint D
Medical record review Documentation of prior hip replacement D
BODY PART: HIP
JOB TITLE: MACHINIST
Ankylosis, hip:
Physical examination—range of motion Ankylosis 5 degrees or ≤flexion D
Physical examination—range of motion Ankylosis internal rotation ≤5 degrees D
Physical examination—range of motion Ankylosis external rotation ≤10 degrees D
Physical examination—range of motion Ankylosis in abduction ≤5 degrees D
Physical examination—range of motion Ankylosis in adduction ≤5 degrees D
Osteoarthritis, hip:
X-ray: hip 0 mm cartilage interval D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abduction D
Osteomyelitis, chronic hip:
X-ray: hip Significant joint destruction D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abduction D
Medical record review Documented occurrence of recurring infections with treatment D
Paget's disease:
X-ray: hip Significant joint destruction D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abudction D
Hip replacement surgery:
X-ray: hip Evidence of artificial hip joint D
Medical record review Documentation of prior hip replacement D
BODY PART: HIP
JOB TITLE: SHOP LABORER
Ankylosis, hip:
Physical examination—range of motion Ankylosis 5 degrees of ≤flexion D
Physical examination—range of motion Ankylosis internal rotation ≤5 degrees D
Physical examination—range of motion Ankylosis external rotation ≤10 degrees D
Physical examination—range of motion Ankylosis in abduction ≤5 degrees D
Physical examination—range of motion Ankylosis in adduction ≤5 degrees D
Osteoarthritis, hip:
X-ray: hip 0 mm cartilage interval D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abduction D
Osteomyelitis, chronic hip:
X-ray: hip Significant joint destruction D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abduction D
Medical record review Documented occurrence of recurring infections with treatment D
Paget's disease:
X-ray; hip Significant joint destruction D
Physical examination—range of motion 30 degrees flexion contracture D
Physical examination—range of motion <50 degrees flexion D
Physical examination—range of motion <5 degrees abduction D
Hip replacement surgery:
X-ray: hip Evidence of artificial hip joint D
Medical record review Documentation of prior hip replacement D
J. Knee
Confirmatory test Minimum result Requirements
BODY PART: KNEE
CONFIRMATORY TESTS
Arthritis: knee:
X-ray: knee Evidence of significant degenerative changes Recommended.
Collateral ligament tear with laxity:
Physical examination: knee Evidence of ligamentous laxity Highly Recommended.
Magnetic resonance imaging Evidence of ligamentous tear Recommended.
Cruciate and collateral ligament tear with laxity:
Magnetic resonance imaging Tear of both ligaments Recommended.
Physical examination Evidence of ligamentous laxity Highly Recommended.
Medical record review Documentation of tear by arthroscopy Recommended.
Cruciate ligament tear with laxity:
Physical examination: knee Evidence of ligamentous laxity Highly Recommended.
Magnetic resonance imaging Evidence of cruciate tear Recommended.
Medical record review Documentation of tear by arthroscopy Recommended.
Intercondylar fracture:
X-ray: knee Evidence of fracture Highly Recommended.
Osteomyelitis: knee:
Medical record review Documented history of osteomyelitis requiring treatment Highly Recommended.
X-ray: knee Evidence of chronic infection Recommended.
Computerized tomography Evidence of chronic infection Recommended.
Magnetic resonance imaging Evidence of chronic infection Recommended.
Osteonecrosis:
X-ray: knee Necrosis of femoral condyle or tibial plateau Recommended.
Computerized tomography Necrosis of femoral condyle or tibial plateau Recommended.
Magnetic resonance imaging Necrosis of femoral condyle or tibial plateau Recommended.
Patellofemoral arthritis:
X-ray: knee Evidence of arthritis Recommended.
Magnetic resonance imaging Evidence of arthritis Recommended.
Physical examination Crepitation with movement Highly Recommended.
Patellar fracture nonunion with displacement:
X-ray: knee Nonunion and displacement Recommended.
Magnetic resonance imaging Nonunion and displacement Recommended.
Computerized tomography Nonunion and displacement Recommended.
Plateau fracture:
X-ray: knee Evidence of fracture Recommended.
Computerized tomography Evidence of fracture Recommended.
Magnetic resonance imaging Evidence of fracture Recommended.
Meniscectomy—medial or lateral:
Medical record review History of surgery Highly Recommended.
Patellectomy:
Physical examination: knee Absent patella Highly Recommended.
Patellar—subluxation—recurrent:
Medical record review History of recurrent subluxation Highly Recommended.
Supracondylar fracture:
X-ray: knee Evidence of fracture Recommended.
Magnetic resonance imaging Evidence of fracture Recommended.
Computerized tomography Evidence of fracture Recommended.
Total knee replacement:
X-ray: knee Presence of replacement knee Recommended.
Medical record review Documented surgical history Recommended.
Tibial shaft fracture:
X-ray: leg Fracture of shaft Recommended.
Magnetic resonance imaging Evidence of fracture Recommended.
Computerized tomography Evidence of fracture Recommended.
Disability test Test result Disability classification
BODY PART: KNEE
JOB TITLE: TRAINMAN
Arthritis knee:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Meniscectomy, medial or lateral:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤degrees) D
Collateral ligament tear with laxity:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Cruciate and collateral ligament tear:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Cruciate ligament tear with laxity:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Intercondylar fracture:
Post fracture angulation ≤20 degrees angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Osteomyelitis, chronic knee:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
Medical record review Frequent episodes of infection requiring treatment D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Osteonecrosis:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Patellofemoral arthritis:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee: patello femoral joint 0 mm cartilage interval with degenerative change D
Patellar fracture nonunion with displacement:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
X-ray knee Nonunion and ≤3 mm displacement D
Plateau fracture:
Post fracture angulation ≤20 degrees angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Patellectomy:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Patellar, subluxation, recurrent:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Supracondylar fracture:
Post fracture angulation ≤20 degrees angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Tibial shaft fracture:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Post fracture angulation ≤20 degrees malalignment D
BODY PART: KNEE
JOB TITLE: ENGINEER
Arthritis knee:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Meniscectomy, medial or lateral:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Collateral ligament tear with laxity:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Cruciate and collateral ligament tear:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Cruciate ligament tear with laxity:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Intercondylar fracture:
Post fracture angulation ≤20 degrees angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Osteomyelitis, chronic knee:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
Medical record review Frequent episodes of infection requiring treatment D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Osteonecrosis:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Patellofemoral arthritis:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee: patello femoral joint 0 mm cartilage interval with degenerative change D
Patellar fracture nonunion with displacement:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
X-ray knee Nonunion and ≤3 mm displacement D
Plateau fracture:
Post fracture angulation ≤20 degrees angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Patellectomy:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Patellar, subluxation, recurrent:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Supracondylar fracture:
Post fracture angulation ≤20 degrees angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Tibial shaft fracture:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Post fracture angulation ≤20 degrees malalignment D
BODY PART: KNEE
JOB TITLE: CARMAN
Arthritis knee:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Meniscectomy, medial or lateral:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Collateral ligament tear with laxity:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Cruciate and collateral ligament tear:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Cruciate ligament tear with laxity:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Intercondylar fracture:
Post fracture angulation ≤20 degrees angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Osteomyelitis, chronic knee:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
Medical record review Frequent episodes of infection requiring treatment D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Osteonecrosis:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Patellofemoral arthritis:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee: patello femoral joint 0 mm cartilage interval with degenerative change D
Patellar fracture nonunion with displacement:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
X-ray knee Nonunion and ≤3 mm displacement D
Plateau fracture:
Post fracture angulation ≤20 degrees angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Patellectomy:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Patellar, subluxation, recurrent:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Supracondylar fracture:
Post fracture angulation ≤20 degrees angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Tibial shaft fracture:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Post fracture angulation ≤20 degrees malalignment D
BODY PART: KNEE
JOB TITLE: SIGNALMAN
Arthritis knee:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Meniscectomy, medial or lateral:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Collateral ligament tear with laxity:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Cruciate and collateral ligament tear:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Cruciate ligament tear with laxity:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Intercondylar fracture:
Post fracture angulation ≤20 degrees angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Osteomyelitis, chronic knee:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
Medical record review Frequent episodes of infection requiring treatment D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Osteonecrosis:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Patellofemoral arthritis:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee: patello femoral joint 0 mm cartilage interval with degenerative change D
Patellar fracture nonunion with displacement:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
X-ray knee Nonunion and ≤3 mm displacement D
Plateau fracture:
Post fracture angulation ≤20 degrees angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Patellectomy:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Patellar, subluxation, recurrent:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Supracondylar fracture:
Post fracture angulation ≤20 degrees angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Tibial shaft fracture:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Post fracture angulation ≤20 degrees malalignment D
BODY PART: KNEE
JOB TITLE: TRACKMAN
Arthritis knee:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Meniscectomy, medial or lateral:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Collateral ligament tear with laxity:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Cruciate and collateral ligament tear:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Cruciate ligament tear with laxity:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Intercondylar fracture:
Post fracture angulation ≤20 degree angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Osteomyelitis, chronic knee:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
Medical record review Frequent episodes of infection requiring treatment D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Osteonecrosis:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Patellofemoral arthritis:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee: patello femoral joint 0 mm cartilage interval with degenerative change D
Patellar fracture nonunion with displacement:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
X-ray knee Nonunion and ≤3 mm displacement D
Plateau fracture:
Post fracture angulation ≤20 degrees angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Patellectomy:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Patellar, subluxation, recurrent:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Supracondylar fracture:
Post fracture angulation ≤20 degrees angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Tibial shaft fracture:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Post fracture angulation ≤20 degrees malalignment D
BODY PART: KNEE
JOB TITLE: MACHINIST
Arthritis knee:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Meniscectomy, medial or lateral:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Collateral ligament tear with laxity:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Cruciate and collateral ligament tear:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Cruciate ligament tear with laxity:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Intercondylar fracture:
Post fracture angulation ≤20 degrees angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Osteomyelitis, chronic knee:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
Medical record review Frequent episodes of infection requiring treatment D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Osteonecrosis:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Patellofemoral arthritis:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee 0 mm cartilage interval with degenerative change D
Patellar fracture nonunion with displacement:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
X-ray knee Nonunion and ≤3 mm displacement D
Plateau fracture:
Post fracture angulation ≤20 degrees angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Patellectomy:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Patellar, subluxation, recurrent:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Supracondylar fracture:
Post fracture angulation ≤20 degrees angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Tibial shaft fracture:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Post fracture angulation ≤20 degrees malalignment D
BODY PART: KNEE
JOB TITLE: SHOP LABORER
Arthritis knee:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Meniscectomy, medial or lateral:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Collateral ligament tear with laxity:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Cruciate and collateral ligament tear:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Cruciate ligament tear with laxity:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Intercondylar fracture:
Post fracture angulation ≤20 degrees angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Osteomyelitis, chronic knee:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
Medical record review Frequent episodes of infection requiring treatment D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Osteonecrosis:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee 0-1 mm cartilage interval with degenerative change D
Patellofemoral arthritis:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Physical examination Valgus deformity, 16-20 degrees D
Physical examination Varus deformity, 8-12 degrees D
X-ray knee: patellofemoral joint 0 mm cartilage interval with degenerative change D
Patellar fracture nonunion with displacement:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
X-ray knee Nonunion and ≤3 mm displacement D
Plateau fracture:
Post fracture angulation ≤20 degrees angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Patellectomy:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Patellar, subluxation, recurrent:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Supracondylar fracture:
Post fracture angulation ≤20 degrees angulation D
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Tibial shaft fracture:
Physical examination—range of motion Range of motion: flexion <60 degrees D
Physical examination—range of motion Flexion contracture (20 or ≤ degrees) D
Post fracture angulation ≤20 degrees malalignment D
K. Ankle and Foot
Confirmatory test Minimum result Requirements
BODY PART: ANKLE AND FOOT
CONFIRMATORY TESTS
Ankle fracture:
Medical record review Documented history of ankle fracture Recommended.
X-ray: ankle Ankle fracture Highly recommended.
Ankylosis, ankle:
X-ray: ankle Extensive joint destruction Highly recommended.
Physical examination No mobility Highly recommended.
Arthritis, subtalar joint:
X-ray: ankle Evidence of significant arthritis: subtalar joint Highly recommended.
Arthritis, talonavicular joint:
X-ray: ankle Significant arthritis: talonavicular joint Highly recommended.
Achilles tendon rupture:
Medical record review Documentation of achilles tendon rupture Highly recommended.
Physical examination Rupture of achilles tendon Highly recommended.
Arthritis, ankle:
X-ray: ankle Significant arthritis Highly recommended.
Hindfoot fracture:
X-ray: foot and ankle Documentation of fracture Highly recommended.
Rheumatoid arthritis, foot:
Medical History Documented history of condition Highly recommended.
X-ray: foot Significant arthritis Highly recommended.
Disability test Test result Disability classification
BODY PART: ANKLE AND FOOT
JOB TITLE: TRAINMAN
Ankle fracture:
X-ray: ankle Displaced intra-articular fracture D
Physical examination Varus deformity ≤15 degrees D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Ankylosis, ankle:
Physical examination—range of motion Ankylosis in 20 degree or ≤ dorsiflexion D
Physical examination—range of motion Ankylosis in 20 degree plantar flexion D
Physical examination—range of motion Ankylosis in int or ext malrotation ≤15 degrees D
Physical examination—range of motion Ankylosis in varus 10 or more degrees D
Physical examination—range of motion Ankylosis in valgus 10 or more degrees D
Arthritis, subtalar joint (hindfoot):
X-ray: ankle—subtalar joint Subtalar joint space 0 mm D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Physical examination Varus deformity ≤15 degrees D
Arthritis, talonavicular joint (hindfoot):
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
X-ray: ankle—talonavicular joint Talonavicular joint space 0 mm D
Physical examination Varus deformity ≤15 degrees D
Achilles tendon rupture:
Physical examination—range of motion Plantar flexion capability, <5 degrees D
Physical examination—range of motion Plantar flexion contracture, 20 degrees D
Arthritis, ankle:
X-ray: ankle 0 mm D
Physical examination—range of motion Plantar flexion capability, <5 degrees D
Physical examination—range of motion Plantar flexion contracture, 20 degrees D
Physical examination Varus deformity ≤15 degrees D
Hindfoot fracture:
X-ray: foot Calcaneal fracture with Boehler angle <95 degrees D
X-ray: foot Subtalar fracture with Boehler angle <95 degrees D
Physical examination Varus angulation ≤20 degrees (hindfoot) D
Physical examination Valgus angulation ≤20 degrees (hindfoot) D
Rheumatoid arthritis, foot:
X-ray: foot Significant degeneration D
Medical record review Chronic flare-up with treatment D
BODY PART: ANKLE AND FOOT
JOB TITLE: ENGINEER
Ankle fracture:
X-ray: ankle Displaced intra-articular fracture D
Physical examination Varus deformity ≤15 degrees D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Ankylosis, ankle:
Physical examination—range of motion Ankylosis in 20 degree or ≤ dorsiflexion D
Physical examination—range of motion Ankylosis in 20 degree plantar flexion D
Physical examination—range of motion Ankylosis in int or ext malrotation ≤15 degrees D
Physical examination—range of motion Ankylosis in varus 10 or more degrees D
Physical examination—range of motion Ankylosis in valgus 10 or more degrees D
Arthritis, subtalar joint (hindfoot):
X-ray: ankle—subtalar joint Subtalar joint space 0 mm D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Physical examination Varus deformity ≤15 degrees D
Arthritis, talonavicular joint (hindfoot):
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
X-ray ankle—talonavicular joint Talonavicular joint space 0 mm D
Physical examination Varus deformity ≤15 degrees D
Achilles tendon rupture:
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Arthritis, ankle:
X-ray: ankle 0 mm D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Physical examination Varus deformity ≤15 degrees D
Hindfoot fracture:
X-ray: foot Calcaneal fracture with Boehler angle <95 degrees D
X-ray: foot Subtalar fracture with Boehler angle <95 degrees D
Physical examination Varus angulation ≤20 degrees (hindfoot) D
Physical examination Valgus angulation ≤20 degrees (hindfoot) D
Rheumatoid arthritis, foot:
X-ray: foot Significant degeneration D
Medical record review Chronic flare-up with treatment D
BODY PART: ANKLE AND FOOT
JOB TITLE: DISPATCHER
Achilles tendon rupture:
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Arthritis, ankle:
X-ray: ankle 0 mm D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Physical examination Varus deformity ≤15 degrees D
Hindfoot fracture:
X-ray: foot Calcaneal fracture with Boehler angle <95 degrees D
X-ray: foot Subtalar fracture with Boehler angle <95 degrees D
Physical examination Varus angulation ≤20 degrees (hindfoot) D
Physical examination Valgus angulation ≤20 degrees (hindfoot) D
Rheumatoid arthritis, foot:
X-ray: foot Significant degeneration D
Medical record review Chronic flare-up with treatment D
BODY PART: ANKLE AND FOOT
JOB TITLE: CARMAN
Ankle fracture:
X-ray: ankle Displaced intra-articular fracture D
Physical examination Varus deformity ≤15 degrees D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Ankylosis, ankle:
Physical examination—range of motion Ankylosis in 20 degree or ≤ dorisiflexion D
Physical examination—range of motion Ankylosis in 20 degree plantar flexion D
Physical examination—range of motion Ankylois in int or ext malrotation ≤15 degrees D
Physical examination—range of motion Ankylosis in varus 10 or more degrees D
Physical examination—range of motion Ankylosis in valgus 10 or more degrees D
Arthritis, subtalar joint (hindfoot):
X-ray: ankle—subtalar joint Subtalar joint space 0 mm D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Physical examination Varus deformity ≤15 degrees D
Arthritis, talonavicular joint (hindfoot):
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
X-ray: ankle—talonavicular joint Talonavicular joint space 0 mm 0
Physical examination Varus deformity ≤15 degrees D
Achilles tendon rupture:
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Arthritis, ankle:
X-ray: ankle 0 mm D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Physical examination Varus deformity ≤15 degrees D
Hindfoot fracture:
X-ray: foot Calcaneal fracture with Boehler angle <95 degrees D
X-ray: foot Subtalar fracture with Boehler angle <95 degrees D
Physical examination Varus angulation ≤20 degrees (hindfoot) D
Physical examination Valgus angulation ≤20 degrees (hindfoot) D
Rheumatoid arthritis, foot:
X-ray: foot Significant degeneration D
Medical record review Chronic flare—up with treatment D
BODY PART: ANKLE AND FOOT
JOB TITLE: SIGNALMAN
Ankle fracture:
X-ray: ankle Displaced intra-articular fracture D
Physical examination Varus deformity ≤15 degrees D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Ankylosis, ankle:
Physical examination—range of motion Ankylosis in 20 degree or ≤ dorsiflexion D
Physical examination—range of motion Ankylosis in 20 degree plantar flexion D
Physical examination—range of motion Ankylosis in int or ext malrotation ≤15 degrees D
Physical examination—range of motion Ankylosis in varus 10 or more degrees D
Physical examination—range of motion Ankylosis in valgus 10 or more degrees D
Arthritis, subtalar joint (hindfoot):
X-ray: ankle—subtalar joint Subtalar joint space 0 mm D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Physical examination Varus deformity ≤15 degrees D
Arthritis, talonavicular joint (hindfoot):
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
X-ray: ankle—talonavicular joint Talonavicular joint space 0 mm D
Physical examination Varus deformity ≤15 degrees D
Achilles tendon rupture:
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Arthritis, ankle:
X-ray: ankle 0 mm D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Physical examination Varus deformity ≤15 degrees D
Hindfoot fracture:
X-ray: foot Calcaneal fracture with Boehler angle <95 degrees D
X-ray: foot Subtalar fracture with Boehler angle <95 degrees D
Physical examination Varus angulation ≤20 degrees (hindfoot) D
Physical examination Valgus angulation ≤20 degrees (hindfoot) D
Rheumatoid arthritis, foot:
X-ray: foot Significant degeneration D
Medical record review Chronic flare-up with treatment D
BODY PART: ANKLE AND FOOT
JOB TITLE: TRACKMAN
Ankle fracture:
X-ray: ankle Displaced intra-articular fracture D
Physical examination—range of motion Varus deformity ≤15 degrees D
Physical examinaton—range of motion Plantar flexion capability ≤5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Ankylosis, ankle:
Physical examination—range of motion Ankylosis in 20 degree or ≤ dorsiflexion D
Physical examination—range of motion Ankylosis in 20 degree plantar flexion D
Physical examination—range of motion Ankylosis in int or ext malrotation ≤15 degrees D
Physical examination—range of motion Ankylosis in varus 10 or more degrees D
Physical examination—range of motion Ankylosis in valgus 10 or more degrees D
Arthritis, subtalar joint (hindfoot):
X-ray: ankle—subtalar joint Subtalar joint space 0 mm D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Physical examination Varus deformity ≤15 degrees D
Arthritis, talonavicular joint (hindfoot):
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
X-ray: angle—talonavicular joint Talonavicular joint space 0 mm D
Physical examination Varus deformity ≤15 degrees D
Achilles tendon rupture:
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Arthritis, ankle:
X-ray: ankle 0 mm D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination Varus deformity ≤15 degrees D
Hindfoot fracture:
X-ray: foot Calcaneal fracture with Boehler angle <95 degrees D
X-ray: foot Subtalar fracture with Boehler angle <95 degrees D
Physical examination Varus angulation ≤20 degrees (hindfoot) D
Physical examination Valgus angulation ≤20 degrees (hindfoot) D
Rheumatoid arthritis, foot:
X-ray: foot Significant degeneration D
Medical record review Chronic flare-up with treatment D
BODY PART: ANKLE AND FOOT
JOB TITLE: MACHINIST
Ankle fracture:
X-ray: ankle Displaced intra-articular fracture D
Physical examination Varus deformity ≤15 degrees D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Ankylosis, ankle:
Physical examination—range of motion Ankylosis in 20 degree or ≤ dorsiflexion D
Physical examination—range of motion Ankylosis in 20 degree plantar flexion D
Physical examination—range of motion Ankylosis in int or ext malrotation ≤15 degrees D
Physical examination—range of motion Ankylosis in varus 10 or more degrees D
Physical examination—range of motion Ankylosis in valgus 10 or more degrees D
Arthritis, subtalar joint (hindfoot):
X-ray: ankle—subtalar joint Subtalar joint space 0 mm D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Physical examination Varus deformity ≤15 degrees D
Arthritis, talonavicular joint (hindfoot):
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
X-ray: ankle—talonavicular joint Talonavicular joint space 0 mm D
Physical examination Varus deformity ≤15 degrees D
Achilles tendon rupture:
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Arthritis, ankle:
X-ray: ankle 0 mm D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Physical examination Varus deformity ≤15 degrees D
Hindfoot fracture:
X-ray: foot Calcaneal fracture with Boehler angle <95 degrees D
X-ray: foot Subtalar fracture with Boehler angle <95 degrees D
Physical examination Varus angulation ≤20 degrees (hindfoot) D
Physical examination Valgus angulation ≤20 degrees (hindfoot) D
Rheumatoid arthritis, foot:
X-ray: foot Significant degeneration D
Medical record review Chronic flare-up with treatment D
BODY PART: ANKLE AND FOOT
JOB TITLE: SHOP LABORER
Ankle fracture:
X-ray: ankle Displaced intra-articular fracture D
Physical examination Varus deformity ≤15 degrees D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Ankylosis, ankle:
Physical examination—range of motion Ankylosis in 20 degree or ≤ dorsiflexion D
Physical examination—range of motion Ankylosis in 20 degree plantar flexion D
Physical examination—range of motion Ankylosis in int or ext malrotation ≤15 degrees D
Physical examination—range of motion Ankylosis in varus 10 or more degrees D
Physical examination—range of motion Ankylosis in valgus 10 or more degrees D
Arthritis, subtalar joint (hindfoot):
X-ray: ankle—subtalar joint Subtalar joint space 0 mm D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Physical examination Varus deformity ≤15 degrees D
Arthritis, talonavicular joint (hindfoot):
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
X-ray: ankle—talonavicular joint Talonavicular joint space 0 mm D
Physical examination Varus deformity ≤15 degrees D
Achilles tendon rupture:
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Arthritis, ankle:
X-ray: ankle 0 mm D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Physical examination Varus deformity ≤15 degrees D
Hindfoot fracture:
X-ray: foot Calcaneal fracture with Boehler angle <95 degrees D
X-ray: foot Subtalar fracture with Boehler angle <95 degrees D
Physical examination Varus angulation ≤20 degrees (hindfoot) D
Physical examination Valgus angulation ≤20 degrees (hindfoot) D
Rheumatoid arthritis, foot:
X-ray: foot Significant degeneration D
Medical record review Chronic flare-up with treatment D
Disability test Test result Disability classification
BODY PART: ANKLE AND FOOT
JOB TITLE: SALES REPRESENTATIVES
Achilles tendon rupture:
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Arthritis, ankle:
X-ray: ankle 0 mm D
Physical examination—range of motion Plantar flexion capability <5 degrees D
Physical examination—range of motion Plantar flexion contracture 20 degrees D
Physical examination Varus deformity ≤15 degrees D
Hindfoot fracture:
X-ray: foot Calcaneal fracture with Boehler angle <95 degrees D
X-ray: foot Subtalar fracture with Boehler angle <95 degrees D
Physical examination Varus angulation ≤20 degrees (hindfoot) D
Physical examination Valgus angulation ≤20 degrees (hindfoot) D
Rheumatoid arthritis, foot:
X-ray: foot Significant degeneration D
Medical record review Chronic flare-up with treatment D
Job Information Forms
[63 FR 7543, Feb. 13, 1998]

Title 20 published on 2014-04-01

no entries appear in the Federal Register after this date.