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— This consolidated CFR Part was last updated by Federal Register(FR) dated 12/04/2009 for §220.13; §220.61; §220.100; §220.101; §220.110; §220.112; §220.114; §220.120; §220.177; §220.178; §220.179; §220.180; §220.181; §220.186; .

Table of Contents

Subpart A — General [ Last FR update*: 03/28/1991 ]
§220.1 — Introduction of part. [ Last FR update*: 03/28/1991 ]
§220.5 — Definitions as used in this part. [ Last FR update*: 03/28/1991 ]
§220.11 — Definitions as used in this subpart. [ Last FR update*: 02/13/1998 ]
§220.12 — Evidence considered. [ Last FR update*: 02/13/1998 ]
§220.14 — Weighing of evidence. [ Last FR update*: 02/13/1998 ]
§220.18 — The reentitlement period. [ Last FR update*: 03/28/1991 ]
§220.25 — General. [ Last FR update*: 03/28/1991 ]
§220.28 — How long the impairment must last. [ Last FR update*: 03/28/1991 ]
§220.35 — Introduction. [ Last FR update*: 03/28/1991 ]
§220.36 — Period of disability. [ Last FR update*: 03/28/1991 ]
Subpart F — Evidence of Disability [ Last FR update*: 03/28/1991 ]
§220.45 — Providing evidence of disability. [ Last FR update*: 03/28/1991 ]
§220.46 — Medical evidence. [ Last FR update*: 03/28/1991 ]
Subpart G — Consultative Examinations [ Last FR update*: 03/28/1991 ]
§220.51 — Notice of the examination. [ Last FR update*: 03/28/1991 ]
§220.60 — Diagnostic surgical procedures. [ Last FR update*: 03/28/1991 ]
§220.63 — Conflict of interest. [ Last FR update*: 03/28/1991 ]
§220.64 — Program integrity. [ Last FR update*: 03/28/1991 ]
Subpart H — Evaluation of Disability [ Last FR update*: 03/28/1991 ]
§220.101 — Evaluation of mental impairments. [ Last FR update*: 12/04/2009 ]
§220.102 — Non-severe impairment(s), defined. [ Last FR update*: 03/28/1991 ]
§220.104 — Multiple impairments. [ Last FR update*: 03/28/1991 ]
Subpart I — Medical Considerations [ Last FR update*: 03/28/1991 ]
§220.110 — Medically disabled. [ Last FR update*: 12/04/2009 ]
Subpart J — Residual Functional Capacity [ Last FR update*: 03/28/1991 ]
Subpart K — Vocational Considerations [ Last FR update*: 03/28/1991 ]
§220.128 — Age as a vocational factor. [ Last FR update*: 03/28/1991 ]
§220.129 — Education as a vocational factor. [ Last FR update*: 03/28/1991 ]
§220.132 — Physical exertion requirements. [ Last FR update*: 03/28/1991 ]
§220.133 — Skill requirements. [ Last FR update*: 03/28/1991 ]
Subpart L — Substantial Gainful Activity [ Last FR update*: 03/28/1991 ]
§220.140 — General. [ Last FR update*: 03/28/1991 ]
§220.145 — Impairment-related work expenses. [ Last FR update*: 03/28/1991 ]
§220.162 — Earnings report. [ Last FR update*: 03/28/1991 ]
§220.163 — Employee penalty deductions. [ Last FR update*: 03/28/1991 ]
§220.164 — Employee end-of-year adjustment. [ Last FR update*: 03/28/1991 ]
§220.170 — The trial work period. [ Last FR update*: 04/30/2007 ]
§220.171 — The reentitlement period. [ Last FR update*: 03/28/1991 ]
§220.176 — When disability continues or ends. [ Last FR update*: 07/01/2003 ]
§220.177 — Terms and definitions. [ Last FR update*: 12/04/2009 ]
§220.179 — Exceptions to medical improvement. [ Last FR update*: 12/04/2009 ]
Cancer [ Last FR update*: 03/28/1991 ]
Type of Cancer [ Last FR update*: 03/28/1991 ]
Magnitude of Disease [ Last FR update*: 03/28/1991 ]
Effects of Treatment [ Last FR update*: 03/28/1991 ]
Prognosis [ Last FR update*: 03/28/1991 ]
Assessment [ Last FR update*: 02/13/1998 ]


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

Source: 56 FR 12980, Mar. 28, 1991, unless otherwise noted.

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

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

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

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

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

Act means the Railroad Retirement Act of 1974.

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

Board means the Railroad Retirement Board.

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

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

Employee is defined in part 203 of this title.

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

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

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

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

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

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

(a) In order to receive an occupational disability annuity an eligible employee must be found by the Board to be disabled for work in his or her regular railroad occupation because of a permanent physical or mental impairment. In this subpart the Board describes in general terms how it evaluates a claim for an occupational disability annuity. In accordance with section 2(a)(2) of the Railroad Retirement Act this subpart was developed with the cooperation of employers and employees. This subpart is supplemented by an Occupational Disability Claims Manual (Manual)1which was also developed with the cooperation of employers and employees.

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

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

[63 FR 7541, Feb. 13, 1998]

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

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

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

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

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

[63 FR 7541, Feb. 13, 1998]

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

[56 FR 12980, Mar. 28, 1991. Redesignated at 63 FR 7541, Feb. 13, 1998]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[56 FR 12980, Mar. 28, 1991, as amended at 63 FR 7541, Feb. 13, 1998; 74 FR 63600, Dec. 4, 2009]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[63 FR 7542, Feb. 13, 1998]

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

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

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

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

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

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

(d) His or her earnings increase.

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

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

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

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

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

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

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

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

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

(i) The annuity beginning date;

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Example 2: The claimant is occupationally disabled using the same medical facts disclosed above, beginning June 16, 1982 (the date of the automobile accident). The claimant files an application for an occupational disability annuity, dated December 1, 1983. However, as of February 1, 1984, and before the Board makes a disability determination, the claimant returns to his regular railroad job and is no longer considered occupationally disabled. The Board reviews the claimant's application in May of 1984 and finds him occupationally disabled for the period June 16, 1982 through January 31, 1984. A disability annuity is payable to the employee from December 1, 1982 through January 31, 1984. (See part 218 of this chapter for the rules on when an annuity may begin).

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

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

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

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

Work is considered to be substantial gainful activity if it—

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

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

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

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

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

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

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

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

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

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

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

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

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

(i) Has applied for a disability annuity; and

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(2) Entitlement to Medicare based upon disability.

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

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

(a) General. The claimant for a disability annuity is responsible for providing evidence of the claimed disability and the effect of the disability on the ability to work. The Board will assist the claimant, when necessary, in obtaining the required evidence. At its discretion, the Board will arrange for an examination by a consultant at the expense of the Board as explained in §§220.50 and 220.51.

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

(1) Age;

(2) Education and training;

(3) Work experience;

(4) Daily activities both before and after the date the claimant says that he or she became disabled;

(5) Efforts to work; and

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

(Approved by the Office of Management and Budget under control numbers 3220-0002, 3220-0030, 3220-0106 and 3220-0141)

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

(1) Licensed physicians;

(2) Licensed osteopaths;

(3) Licensed or certified psychologists;

(4) Licensed optometrists for the measurement of visual acuity and visual fields (a report from a physician may be needed to determine other aspects of eye diseases); and

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

(b) Medical reports. Medical reports should include—

(1) Medical history;

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

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

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

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

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

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

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

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

(c) Completeness. The medical evidence, including the clinical and laboratory findings, must be complete and detailed enough to allow the Board to make a determination about whether or not the claimant is disabled. It must allow the Board to determine—

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

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

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

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

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

(1) Public and private social welfare agencies;

(2) Observations by nonmedical sources;

(3) Other practitioners (for example, naturopaths, chiropractors, audiologists, etc.); and

(4) Railroad and nonrailroad employers.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[56 FR 12980, Mar. 28, 1991, as amended at 74 FR 63600, Dec. 4, 2009]

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

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

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

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

(4) Whether the report is properly signed.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[56 FR 12980, Mar. 28, 1991, as amended at 74 FR 63600, Dec. 4, 2009]

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

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

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

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

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

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

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

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

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

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

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

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

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

[56 FR 12980, Mar. 28, 1991, as amended at 74 FR 63600, Dec. 4, 2009]

(a) Non-severe impairment(s). An impairment or combination of impairments is not severe if it does not significantly limit the claimant's physical or mental ability to do basic work activities.

(b) Basic work activities. Basic work activities means the ability and aptitudes necessary to do most jobs. Examples of these include—

(1) Physical functions such as walking, standing, sitting, lifting, pushing, pulling, reaching, carrying, or handling;

(2) Capacities for seeing, hearing, and speaking;

(3) Understanding, carrying out, and remembering simple instructions;

(4) Use of judgment;

(5) Responding appropriately to supervision, co-workers and usual work situations; and

(6) Dealing with changes in a routine work setting.

(a) Unrelated severe impairments. Two or more unrelated severe impairments cannot be combined to meet the 12-month duration test. If the claimant has a severe impairment(s) and then develops another unrelated severe impairment(s) but neither one is expected to last for 12 months, he or she cannot be found disabled even though the 2 impairments in combination last for 12 months.

(b) Concurrent impairments. If the claimant has 2 or more concurrent impairments which, when considered in combination, are severe, the board must also determine whether the combined effect of the impairments can be expected to continue to be severe for 12 months. If 1 or more of the claimant's impairments improves or is expected to improve within 12 months, so that the combined effect of the claimant's impairments is no longer severe, he or she will be found to not meet the 12-month duration test.

To determine whether the claimant's physical or mental impairment or impairments are of a sufficient medical severity that such impairment or impairments could be the basis of eligiblity under the law, the combined effect of all of the claimant's impairments are considered regardless of whether any such impairment, if considered separately, would be of sufficient severity. If a medically severe combination of impairments is found, it will be considered throughout the disability evaluation process. If a medically severe combination of impairments is not found, the claimant will be determined to be not disabled.

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

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

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

(b) When evaluating a claim for a previous disability, the Board follows the steps in §220.100 to determine whether a disability existed, and follows the steps in §220.180 to determine when the disability ended.

Example 1. The claimant sustained multiple fractures to his left leg in an automobile accident which occurred on June 16, 1982. For a period of 18 months following the accident the claimant underwent 2 surgical procedures which restored the functional use of his leg. After a recovery period following the last surgery, the claimant returned to work on February 1, 1984.

The claimant, although fully recovered medically and regularly employed, filed an application on December 3, 1984 for a determination of disability for the period June 16, 1982 through January 31, 1984. The Board reviewed his claim in January 1985 and determined that he was disabled for the prior period which began June 16, 1982 and continued through January 31, 1984. A disability annuity is payable to the employee only for the period December 1, 1983 through January 31, 1984.

An annuity may not begin any earlier than the 1st of the 12th month before the month in which the application was filed (See part 218 of this chapter for the rules on when an annuity may begin).

Example 2: The claimant is disabled using the same medical facts disclosed above, beginning June 16, 1982 (the date of the automobile accident). The claimant files an application for a disability annuity, dated December 1, 1983. However, as of February 1, 1984, and before the Board makes a disability determination, the claimant returns to full-time work and is no longer considered disabled. The Board reviews the claimant's application in May 1984 and finds him disabled for the period June 16, 1982 through January 31, 1984. A disability annuity is payable to the employee from December 1, 1982 through January 31, 1984. (See part 218 of this chapter for the rules on when an annuity may begin).

(a) “Medically disabled.” The term “medically disabled ”refers to disability based solely on impairment(s) which are considered to be so medically severe as to prevent a person from doing any substantial gainful activity. The Board will base its decision about whether the claimant's impairment(s) is medically disabling on medical evidence only, without consideration of the claimant's residual functional capacity, age, education or work experience. The Board will also consider the medical opinion given by one or more physicians employed or engaged by the Board or the Social Security Administration to make medical judgments. The medical evidence used to establish a diagnosis or confirm the existence of an impairment, and to establish the severity of the impairment includes medical findings consisting of signs, symptoms and laboratory findings. The medical findings must be based on medically acceptable clinical and laboratory diagnostic techniques. If the claimant has more than one impairment, but none of the impairments, by themselves, is medically disabling, the Board will review the signs, symptoms, and laboratory findings of all of the impairments to determine whether the combination of impairments is medically disabling. In general, impairments that the Board considers to be medically disabling are:

(1) Permanent;

(2) Expected to result in death; or

(3) Have a specific length of duration.

(b) Diagnosis of impairments. A diagnosis of a particular impairment is not sufficient for a finding of medical disability, unless the diagnosis is supported by medical findings that are based on medically acceptable clinical and laboratory techniques.

(c) Addiction to alcohol or drugs. If a claimant has a condition diagnosed as addiction to alcohol or drugs, this condition will not, by itself, be a basis for determining whether the claimant is, or is not, disabled. As with any other medical condition, the Board will decide whether the claimant is disabled based on symptoms, signs, and laboratory findings.

[74 FR 63601, Dec. 4, 2009]

(a) General. Under the statute, the Board is responsible for making the decision about whether a claimant meets the statutory definition of disability. A claimant can only be found disabled if he or she is unable to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. (See §220.28). A claimant's impairment must result from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques. (See §220.27). The decision as to whether a claimant is disabled may involve more than medical considerations and the Board may have to consider such factors as age, education and past work experience. Such vocational factors are not within the expertise of medical sources.

(b) Medical opinions that are conclusive. A medical opinion by a treating source will be conclusive as to the medical issues of the nature and severity of a claimant's impairment(s) where the Board finds that (1) it is fully supported by medically acceptable clinical and laboratory diagnostic techniques and (2) it is not inconsistent with the other substantial medical evidence of record. A medical opinion that is not fully supported will not be conclusive.

(c) Medical opinions that are not fully supported. If an opinion by a treating source(s) is not fully supported, the Board will make every reasonable effort (i.e., an initial request and, after 20 days, one follow-up request) to obtain from the claimant's treating source(s) the relevant evidence that supports the medical opinion(s) before the Board makes a determination as to whether a claimant is disabled.

Example: In a case involving an organic mental disorder caused by trauma to the head, a consultative physician, upon interview with the claimant, found only mild disorientation as to time and place. The claimant's treating physician reports that the claimant, as the result of his impairment, has severe disorientation as to time and place. The treating physician supplies office notes which follow the course of the claimant's illness from the date of injury to the present. These notes indicate that the claimant's condition is such that he has some “good days” on which he appears to be unimpaired, but generally support the treating physician's opinion that the claimant is severely impaired. In this case the treating physician's opinion will be given some weight over that of the consultative physician.

(d) Inconsistent medical opinions. Where the Board finds that the opinion of a treating source regarding medical issues is inconsistent with the evidence of record, including opinions of other sources that are supported by medically acceptable clinical and laboratory diagnostic techniques, the Board must resolve the inconsistency. If necessary to resolve the inconsistency, the Board will secure additional independent evidence and/or further interpretation or explanation from the treating source(s) and/or the consultative physician or psychologist. The Board's determination will be based on all the evidence in the case record, including the opinions of the medical sources. In resolving an inconsistency, the Board will give some extra weight to the treating source's supported opinion(s) which interprets the medical findings about the nature and severity of the impairment(s).

Example: In a case involving arthritis of the shoulder, where the X-rays confirm bone destruction, the examinations indicate minimal swelling and inflammation, but the treating source supplies evidence of greater restriction in the range of motion than found by the consultative physician, the Board will ask the treating source for further interpretation of the range of motion studies. If the treating source supplies a reasonable explanation. e.g., that the individual's condition is subject to periods of aggravation, the treating source's explanation will be given some extra weight over that of the consultative physician.

(e) Medical opinions that will not be considered conclusive nor given extra weight. The Board will not consider as conclusive nor give extra weight to medical opinions which are not in accord with the statutory or regulatory standards for establishing disability. Thus, opinions that the individual's impairments are medically disabling where the medical findings which are the basis for that conclusion would not support an impairment so severe as to preclude any substantial gainful activity will not be conclusive nor given extra weight. Likewise, an opinion(s) as to the individual's residual functional capacity which is not in accord with regulatory requirements set forth in §§220.120 and 220.121 will not be conclusive nor given extra weight.

Example 1: A medical opinion states that a claimant is disabled based on blindness, but findings show functional visual accuity in the better eye, after best correction, of 20/100. That medical opinion would not be conclusive or given extra weight.

Example 2: A medical opinion that the individual is limited to light work when the evidence shows that he or she can lift a maximum of 50 pounds and lift 25 pounds frequently will not be considered as conclusive nor given extra weight. This is because the individual's exertional capacity exceeds the criteria set forth in the regulations for light work.

[56 FR 12980, Mar. 28, 1991, as amended at 68 FR 60291, Oct. 22, 2003; 74 FR 63601, Dec. 4, 2009]

Medical findings consist of symptoms, signs, and laboratory findings:

(a) Symptoms are the claimant's own description of his or her physical or mental impairment(s). The claimant's statements alone are not enough to establish that there is a physical or mental impairment(s).

(b) Signs are anatomical, physiological, or psychological abnormalities which can be observed, apart from the claimant's own statements (symptoms). Signs must be shown by medically acceptable clinical diagnostic techniques. Psychiatric signs are medically demonstrable phenomena which indicate specific abnormalities of behavior, affect, thought, memory, orientation and contact with reality. They must also be shown by observable facts that can be medically described and evaluated.

(c) Laboratory findings are anatomical, physiological, or psychological phenomena which can be shown by the use of medically acceptable laboratory diagnostic techniques. Some of these diagnostic techniques include chemical tests, electrophysiological studies (electrocardiogram, electroencephalogram, etc.) x-rays, and psychological tests.

(a) General. In determining whether the claimant is disabled, the Board considers all of the claimant's symptoms, including pain, and the extent to which the claimant's symptoms can reasonably be accepted as consistent with the objective medical evidence and other evidence. By objective medical evidence, the Board means medical signs and laboratory findings as defined in §§220.113(b) and (c) of this part. By other evidence, the Board means the kinds of evidence described in §§220.45 and 220.46 of this part. These include statements or reports from the claimant, the claimant's treating or examining physician or psychologist, and others about the claimant's medical history, diagnosis, prescribed treatment, daily activities, efforts to work, and any other evidence showing how the claimant's impairment(s) and any related symptoms affect the claimant's ability to work. The Board will consider all of the claimant's statements about his or her symptoms, such as pain, and any description by the claimant, the claimant's physician, or psychologist, or other persons about how the symptoms affect the claimant's activities of daily living and ability to work. However, statements alone about the claimant's pain or other symptoms will not establish that the claimant is disabled; there must be medical signs and laboratory findings which show that the claimant has a medical impairment(s) which could reasonably be expected to produce the pain or other symptoms alleged and which, when considered with all of the other evidence (including statements about the intensity and persistence of the claimant's pain or other symptoms which may reasonably be accepted as consistent with the medical signs and laboratory findings), would lead to a conclusion that the claimant is disabled. In evaluating the intensity and persistence of the claimant's symptoms, including pain, the Board will consider all of the available evidence, including the claimant's medical history, the medical signs and laboratory findings and statements about how the claimant's symptoms affect the claimant. (Section 220.112(b) of this part explains how the Board considers opinions of the claimant's treating source and other medical opinions on the existence and severity of the claimant's symptoms, such as pain.) The Board will then determine the extent to which the claimant's alleged functional limitations and restrictions due to pain or other symptoms can reasonably be accepted as consistent with the medical signs and laboratory findings and other evidence to decide how the claimant's symptoms affect the claimant's ability to work.

(b) Need for medically determinable impairment that could reasonably be expected to produce symptoms, such as pain. The claimant's symptoms, such as pain, fatigue, shortness of breath, weakness, or nervousness, will not be found to affect the claimant's ability to do basic work activities unless medical signs or laboratory findings show that a medically determinable impairment(s) is present. Medical signs and laboratory findings, established by medically acceptable clinical or laboratory diagnostic techniques, must show the existence of a medical impairment(s) which results from anatomical, physiological, or psychological abnormalities and which could reasonably be expected to produce the pain or other symptoms alleged. The finding that the claimant's impairment(s) could reasonably be expected to produce the claimant's pain or other symptoms does not involve a determination as to the intensity, persistence, or functionally limiting effects of the claimant's symptoms. The Board will develop evidence regarding the possibility of a medically determinable mental impairment when the Board has information to suggest that such an impairment exists, and the claimant alleges pain or other symptoms but the medical signs and laboratory findings do not substantiate any physical impairment(s) capable of producing the pain or other symptoms.

(c) Evaluating the intensity and persistence of symptoms, such as pain, and determining the extent to which the claimant's symptoms limit his or her capacity for work—(1) General. When the medical signs or laboratory findings show that the claimant has a medically determinable impairment(s) that could reasonably be expected to produce the claimant's symptoms, such as pain, the Board must then evaluate the intensity and persistence of the claimant's symptoms so that it can determine how the claimant's symptoms limit the claimant's capacity for work. In evaluating the intensity and persistence of the claimant's symptoms, the Board considers all of the available evidence, including the claimant's medical history, the medical signs and laboratory findings, and statements from the claimant, the claimant's treating or examining physician or psychologist, or other persons about how the claimant's symptoms affect the claimant. The Board also considers the medical opinions of the claimant's treating source and other medical opinions as explained in §220.112 of this part. Paragraphs (c)(2) through (c)(4) of this section explain further how the Board evaluates the intensity and persistence of the claimant's symptoms and how it determines the extent to which the claimant's symptoms limit the claimant's capacity for work, when the medical signs or laboratory findings show that the claimant has a medically determinable impairment(s) that could reasonably be expected to produce the claimant's symptoms, such as pain.

(2) Consideration of objective medical evidence. Objective medical evidence is evidence obtained from the application of medically acceptable clinical and laboratory diagnostic techniques, such as evidence of reduced joint motion, muscle spasm, sensory deficit or motor disruption. Objective medical evidence of this type is a useful indicator to assist the Board in making reasonable conclusions about the intensity and persistence of the claimant's symptoms and the effect those symptoms, such as pain, may have on the claimant's ability to work. The Board must always attempt to obtain objective medical evidence and, when it is obtained, the Board will consider it in reaching a conclusion as to whether the claimant is disabled. However, the Board will not reject the claimant's statements about the intensity and persistence of the claimant's pain or other symptoms or about the effect the claimant's symptoms have on the claimant's ability to work solely because the available objective medical evidence does not substantiate the claimant's statements.

(3) Consideration of other evidence. Since symptoms sometimes suggest a greater severity of impairment than can be shown by objective medical evidence alone, the Board will carefully consider any other information the claimant may submit about his or her symptoms. The information that the claimant, the claimant's treating or examining physician or psychologist, or other persons provide about the claimant's pain or other symptoms (e.g., what may precipitate or aggravate the claimant's symptoms, what medications, treatments or other methods he or she uses to alleviate them, and how the symptoms may affect the claimant's pattern of daily living) is also an important indicator of the intensity and persistence of the claimant's symptoms. Because symptoms, such as pain, are subjective and difficult to quantify, any symptom-related functional limitations and restrictions which the claimant, his or her treating or examining physician or psychologist, or other persons report, which can reasonably be accepted as consistent with the objective medical evidence and other evidence, will be taken into account as explained in paragraph (c)(4) of this section in reaching a conclusion as to whether the claimant is disabled. The Board will consider all of the evidence presented, including information about the claimant's prior work record, the claimant's statements about his or her symptoms, evidence submitted by the claimant's treating, examining or consulting physician or psychologist, and observations by Board employees and other persons. Section 220.112 of this part explains in detail how the Board considers and weighs treating source and other medical opinions about the nature and severity of the claimant's impairment(s) and any related symptoms, such as pain. Factors relevant to the claimant's symptoms, such as pain, which the Board will consider include:

(i) The claimant's daily activities;

(ii) The location, duration, frequency, and intensity of the claimant's pain or other symptoms;

(iii) Precipitating and aggravating factors;

(iv) The type, dosage, effectiveness, and side effects of any medication the claimant takes or has taken to alleviate the claimant's pain or other symptoms;

(v) Treatment, other than medication, the claimant receives or has received for relief of pain or other symptoms;

(vi) Any measures the claimant uses or has used to relieve pain or other symptoms (e.g., lying flat on the claimant's back, standing for 15 to 20 minutes every hour, sleeping on a board, etc.); and

(vii) Other factors concerning the claimant's functional limitations and restrictions due to pain or other symptoms.

(4) How the Board determines the extent to which symptoms, such as pain, affect the claimant's capacity to perform basic work activities. In determining the extent to which the claimant's symptoms, such as pain, affect the claimant's capacity to perform basic work activities, the Board considers all of the available evidence described in paragraphs (c)(1) through (c)(3) of this section. The Board will consider the claimant's statements about the intensity, persistence, and limiting effects of the claimant's symptoms, and the Board will evaluate the claimant's statements in relation to the objective medical evidence and other evidence, in reaching a conclusion as to whether the claimant is disabled. The Board will consider whether there are any inconsistencies in the evidence and the extent to which there are any conflicts between the claimant's statements and the rest of the evidence, including the claimant's medical history, the medical signs and laboratory findings, and statements by the claimant's treating or examining physician or psychologist or other persons about how the claimant's symptoms affect the claimant. The claimant's symptoms, including pain, will be determined to diminish the claimant's capacity for basic work activities to the extent that the claimant's alleged functional limitations and restrictions due to symptoms, such as pain, can reasonably be accepted as consistent with the objective medical evidence and other evidence.

(d) Consideration of symptoms in the disability determination process. The Board follows a set order of steps to determine whether the claimant is disabled. If the claimant is not doing substantial gainful activity, the Board considers the claimant's symptoms, such as pain, to evaluate whether the claimant has a severe physical or mental impairment(s), and at each of the remaining steps in the process. Section 220.100 explains this process in detail. The Board also considers the claimant's symptoms, such as pain, at the appropriate steps in the Board's review when the Board considers whether the claimant's disability continues. Subpart O of this part explains the procedure the Board follows in reviewing whether the claimant's disability continues.

(1) Need to establish a severe medically determinable impairment(s). The claimant's symptoms, such as pain, fatigue, shortness of breath, weakness, or nervousness, are considered in making a determination as to whether the claimant's impairment or combination of impairment(s) is severe. (See §220.100(b)(2) of this part).

(2) Decision of whether impairment(s) is medically disabling. The Board will not substitute the claimant's allegations of pain or other symptoms for a missing or deficient sign or laboratory finding to raise the severity of the claimant's impairment(s) to that of being medically disabling. If the symptoms, signs, and laboratory findings of the claimant's impairment(s) are found by the Board to be so severe as to prevent any substantial gainful activity, the Board will find the claimant disabled. If it does not, the Board will consider the impact of the claimant's symptoms on the claimant's residual functional capacity. (See paragraph (d)(3) of this section.)

(3) Impact of symptoms (including pain) on residual functional capacity. If the claimant has a medically determinable severe physical or mental impairment(s), but the claimant's impairment(s) is not medically disabling, the Board will consider the impact of the claimant's impairment(s) and any related symptoms, including pain, on the claimant's residual functional capacity. (See §220.120 of this part.)

[68 FR 60291, Oct. 22, 2003, as amended at 74 FR 63601, Dec. 4, 2009]

(a) What treatment the claimant must follow. In order to get a disability annuity, the claimant must follow treatment prescribed by his or her physician if this treatment can restore the claimant's ability to work.

(b) When the claimant does not follow prescribed treatment. If the claimant does not follow the prescribed treatment without a good reason, the Board will find him or her not disabled or, if the claimant is already receiving a disability annuity, the Board will stop paying the annuity.

(c) Acceptable reasons for failure to follow prescribed treatment. The following are examples of a good reason for not following treatment:

(1) The specific medical treatment is contrary to the established teaching and tenets of the claimant's religion.

(2) The prescribed treatment would be cataract surgery for one eye, when there is an impairment of the other eye resulting in a severe loss of vision and is not subject to improvement through surgery.

(3) Surgery was previously performed with unsuccessful results and the same surgery is again being recommended for the same impairment.

(4) The treatment because of its magnitude (e.g., open heart surgery), unusual nature (e.g., organ transplant), or other reason is very risky for the claimant.

(5) The treatment involves amputation of an extremity, or a major part of an extremity.

(a) General. The claimant's impairment(s), and any related symptoms, such as pain, may cause physical and mental limitations that affect what the claimant can do in a work setting. The claimant's residual functional capacity is what the claimant can still do despite the claimant's limitations. If the claimant has more than one impairment, the Board will consider all of the claimant's impairment(s) of which the Board is aware. The Board will consider the claimant's ability to meet certain demands of jobs, such as physical demands, mental demands, sensory requirements, and other functions, as described in paragraphs (b), (c), and (d) of this section. Residual functional capacity is an assessment based upon all of the relevant evidence. It may include descriptions (even the claimant's own) of limitations that go beyond the symptoms, such as pain, that are important in the diagnosis and treatment of the claimant's medical condition. Observations by the claimant's treating or examining physicians or psychologists, the claimant's family, neighbors, friends, or other persons, of the claimant's limitations, in addition to those observations usually made during formal medical examinations, may also be used. These descriptions and observations, when used, must be considered along with the claimant's medical records to enable us to decide to what extent the claimant's impairment(s) keeps the claimant from performing particular work activities. This assessment of the claimant's remaining capacity for work is not a decision on whether the claimant is disabled, but is used as the basis for determining the particular types of work the claimant may be able to do despite the claimant's impairment(s). Then, using the guidelines in §§220.125 and 220.134 of this part the claimant's vocational background is considered along with the claimant's residual functional capacity in arriving at a disability determination or decision. In deciding whether the claimant's disability continues or ends, the residual functional capacity assessment may also be used to determine whether any medical improvement the claimant has experienced is related to the claimant's ability to work as discussed in §220.178 of this part.

(b) Physical abilities. When the Board assesses the claimant's physical abilities, the Board first assesses the nature and extent of the claimant's physical limitations and then determines the claimant's residual functional capacity for work activity on a regular and continuing basis. A limited ability to perform certain physical demands of work activity, such as sitting, standing, walking, lifting, carrying, pushing, pulling, or other physical functions (including manipulative or postural functions, such as reaching, handling, stooping or crouching), may reduce the claimant's ability to do past work and other work.

(c) Mental abilities. When the Board assesses the claimant's mental abilities, the Board first assesses the nature and extent of the claimant's mental limitations and restrictions and then determines the claimant's residual functional capacity for work activity on a regular and continuing basis. A limited ability to carry out certain mental activities, such as limitations in understanding, remembering, and carrying out instructions, and in responding appropriately to supervision, co-workers, and work pressures in a work setting, may reduce the claimant's ability to do past work and other work.

(d) Other abilities affected by impairment(s). Some medically determinable impairment(s), such as skin impairment(s), epilepsy, impairment(s) of vision, hearing or other senses, and impairment(s) which impose environmental restrictions, may cause limitations and restrictions which affect other work-related abilities. If the claimant has this type of impairment(s), the Board considers any resulting limitations and restrictions which may reduce the claimant's ability to do past work and other work in deciding the claimant's residual functional capacity.

(e) Total limiting effects. When the claimant has a severe impairment(s), but the claimant's symptoms, signs, and laboratory findings are not medically disabling, the Board will consider the limiting effects of all of the claimant's impairment(s), even those that are not severe, in determining the claimant's residual functional capacity. Pain or other symptoms may cause a limitation of function beyond that which can be determined on the basis of the anatomical, physiological or psychological abnormalities considered alone; e.g., someone with a low back disorder may be fully capable of the physical demands consistent with those of sustained medium work activity, but another person with the same disorder, because of pain, may not be capable of more than the physical demands consistent with those of light work activity on a sustained basis. In assessing the total limiting effects of the claimant's impairment(s) and any related symptoms, the Board will consider all of the medical and non-medical evidence, including the information described in §220.114 of this part.

[68 FR 60293, Oct. 22, 2003, as amended at 74 FR 63601, Dec. 4, 2009]

(a) For cases at the initial or reconsideration level, the responsibility for determining residual functional capacity rests with the bureau of retirement claims. This assessment is based on all the evidence the Board has, including any statements regarding what the claimant can still do that have been provided by treating or examining physicians, consultative physicians, or any other physician designated by the Board. In any case where there is evidence which indicates the existence of a mental impairment, the bureau of retirement claims will not make a residual functional capacity determination without making every reasonable effort to ensure that a qualified psychiatrist or psychologist has provided a medical review of the case.

(b) For cases at the hearing level or the three-member-Board review level, the responsibility for deciding residual functional capacity rests with the hearings officer or the three-member Board, respectively.

(a) General. The Board will consider vocational factors when the claimant is applying for—

(1) An employee annuity based on disability for any regular employment; (See §220.45(b))

(2) Widow(er) disability annuity; or

(3) Child's disability annuity based on disability before age 22.

(b) Disability determinations in which vocational factors must be considered along with medical evidence. When the Board cannot decide whether the claimant is disabled on medical evidence alone, the Board must use other evidence.

(1) The Board will use information from the claimant about his or her age, education, and work experience.

(2) The Board will consider the doctors' reports, and hospital records, as well as the claimant's own statements and other evidence to determine a claimant's residual functional capacity and how it affects the work the claimant can do. Sometimes, to do this, the Board will need to ask the claimant to have special examinations or tests. (See §220.50.)

(3) If the Board finds that the claimant can no longer do the work he or she has done in the past, the Board will determine whether the claimant can do other work (jobs) which exist in significant numbers in the national economy.

(a) If the claimant can do his or her previous work (his or her usual work or other applicable past work), the Board will determine he or she is not disabled.

(b) If the residual functional capacity is not enough for the claimant to do any of his or her previous work, the Board must still decide if the claimant can do any other work. To determine whether the claimant can do other work, the Board will consider the claimant's residual functional capacity, and his or her age, education, and work experience. Any work (jobs) that the claimant can do must exist in significant numbers in the national economy (either in the region where he or she lives or in several regions of the country).

(a) Arduous work. Arduous work is primarily physical work requiring a high level of strength or endurance. The Board will consider the claimant unable to do lighter work and therefore, disabled if he or she has—

(1) A marginal education (see §220.129);

(2) Work experience of 35 years or more during which he or she did arduous unskilled physical labor; and

(3) A severe impairment which no longer allows him or her to do arduous unskilled physical labor.

(b) Exceptions. The Board may consider the claimant not disabled if—

(1) The claimant is working or has worked despite his or her impairment(s) (except where work is sporadic or not medically advisable); or

(2) Evidence shows that the claimant has training or past work experience which enables him or her to do substantial gainful activity in another occupation with his or her impairment, either full-time or on reasonably regular part-time basis.

Example: B is a 60-year-old miner with a 4th grade education who has a life-long history of arduous physical labor. B says that he is disabled because of arthritis of the spine, hips, and knees, and other impairments. Medical evidence shows a combination of impairments and establishes that these impairments prevent B from performing his usual work or any other type of arduous physical labor. His vocational background does not show that he has skills or capabilities needed to do lighter work which would be readily transferable to another work setting. Under these circumstances, the Board will find that B is disabled.

(a) General. (1) Age refers to how old the claimaint is (chronological age) and the extent to which his or her age affects his or her ability to—

(i) Adapt to a new work situation; and

(ii) Do work in competition with others.

(2) In determining disability, the Board does not consider age alone. The Board must also consider the claimant's residual functional capacity, education, and work experience. If the claimant is unemployed because of his or her age and can still do a significant number of jobs which exist in the national economy, the Board will find that he or she is not disabled. Appendix 2 of this part explains in detail how the Board considers age as a vocational factor. However, the Board does not apply these age categories mechanically in a borderline situation.

(b) Younger person. If the claimant is under age 50, the Board generally does not consider that his or her age will seriously affect the ability to adapt to a new work situation. In some circumstances, the Board considers age 45 a handicap in adapting to a new work setting (see Rule 201.17 in appendix 2 of this part).

(c) Person approaching advanced age. If the claimant is closely approaching advanced age (50-54), the Board considers that the claimant's age, along with a severe impairment and limited work experience, may seriously affect the claimant's ability to adjust to a significant number of jobs in the national economy.

(d) Person of advanced age. The Board considers that advanced age (55 or over) is the point at which age significantly affects the claimant's ability to do substantial gainful activity.

(1) If the claimant is severly impaired and of advanced age, and he or she cannot do medium work (see §220.132), the claimant may not be able to work unless he or she has skills that can be used in less demanding jobs which exist in significant numbers in the national economy.

(2) If the claimant is close to retirement age (60-64) and has a severe impairment, the Board will not consider him or her able to adjust to sedentary or light work unless the claimant has skills which are highly marketable.

(a) General. “Education” is primarily used to mean formal schooling or other training which contributes to the claimant's ability to meet vocational requirements, for example, reasoning ability, communication skills, and arithmetical ability. If the claimant does not have formal schooling, this does not necessarily mean that the claimant is uneducated or lacks these abilities. Past work experience and the kinds of responsibilities the claimant had when he or she was working may show that he or she has intellectual abilities, although the claimant may have little formal education. A claimant's daily activities, hobbies, or the results of testing may also show that the claimant has significant intellectual ability that can be used to work.

(b) How the Board evaluates the claimant's education. The importance of the claimant's educational background may depend upon how much time has passed between the completion of the claimant's formal education and the beginning of the claimant's physical or mental impairment(s) and what the claimant has done with his or her education in a work or other setting. Formal education completed many years before the claimant's impairment(s) began, or unused skills and knowledge that were a part of the claimant's formal education, may no longer be useful or meaningful in terms of ability to work. Therefore, the numerical grade level that the claimant completed in school may not represent his or her actual educational abilities. These educational abilities may be higher or lower than the numerical grade level that the claimant completed. However, if there is no other evidence to contradict it, the Board uses the claimant's numerical grade level to determine the claimant's educational abilities. The term “education” also includes how well the claimant is able to communicate in English since this ability is often acquired or improved by education. In evaluating the claimant's educational level, the Board uses the following categories:

(1) Illiteracy. Illiteracy means the inability to read or write. The Board will consider the claimant illiterate if he or she cannot read or write a simple message such as instructions or inventory lists even though the claimant can sign his or her name. Generally, the illiterate claimant has had little or no formal schooling.

(2) Marginal education. Marginal education means ability in reasoning, arithmetic, and language skills which are needed to do simple, unskilled types of jobs. Generally, this means a 6th grade or less level of education.

(3) Limited education. Limited education means ability in reasoning, arithmetic, and language skills, but not enough to allow a person with these educational qualifications to do most of the more complex duties needed in semi-skilled or skilled jobs. Generally, a limited education is a 7th grade through 11th grade level of education.

(4) High school education and above. High school and above means abilities in reasoning, arithmetic, and language skills acquired through formal schooling at a 12th grade level or above. The claimant with this level of education is generally considered able to do semi-skilled through skilled work.

(5) Inability to communicate in English. Since the ability to speak, read, and understand English is generally learned or increased at school, the Board may consider this an educational factor. Because English is the dominant language of the country, it may be difficult for the claimant who does not speak and understand English to do a job, regardless of the amount of education he or she may have in another language. The claimant's ability to speak, read and understand English will be considered when the Board evaluates what work, if any, he or she can do.

(6) Information about the claimant's education. The Board will ask the claimant how long he or she attended school and whether he or she can speak, understand, read and write in English, and do at least simple calculations in arithmetic. The Board will also consider information about how much formal or informal education the claimant received from his or her previous work, community projects, hobbies and any other activities which might help him or her to work.

(a) General. Work experience means skills and abilities the claimant has acquired through work he or she has done which show the type of work he or she may be expected to do. Work the claimant has already been able to do shows the kind of work that he or she may be expected to do. The Board considers that the claimant's work experience is relevant and applies when it was done within the last 15 years, lasted long enough for him or her to learn to do it, and was substantial gainful activity. This work experience is called “past relevant work.” The Board does not usually consider that work the claimant did 15 years or more before the time the Board is deciding whether he or she is disabled (or when the disability insured status requirement was last met, if earlier) applies. A gradual change occurs in most jobs so that after 15 years, it is no longer realistic to expect that skills and abilities acquired in a job done then continue to apply. The 15-year guide is intended to insure that remote work experience is not currently applied. If the claimant has no work experience or worked only “off-and-on” or for brief periods of time during the 15-year period, the Board generally considers that these do not apply. If the claimant has acquired skills through his or her past work, the Board considers the claimant to have these work skills unless he or she cannot use them in other skilled or semi-skilled work that he or she can do. If the claimant cannot use his or her skills in other skilled or semi-skilled work, the Board will consider his or her work background the same as unskilled. However, even if the claimant has no work experience, the Board may consider that the claimant is able to do unskilled work because it requires little or no judgment and can be learned in a short period of time.

(b) Information about the claimant's work. (1) Sometimes the Board will need information about the claimant's past work to make a disability determination. The Board may request work information from—

(i) The claimant; and

(ii) The claimant's employer or other person who knows about the claimant's work (member of family or co-worker) with the claimant's permission.

(2) The Board will ask for the following information about all the jobs the claimant has had in the last 15 years:

(i) The dates the claimant worked.

(ii) All the duties the claimant did.

(iii) Any tools, machinery, and equipment the claimant used.

(iv) The amount of walking, standing, sitting, lifting and carrying the claimant did during the work day, as well as any other physical and mental duties of the job.

(3) If all the claimant's work in the past 15 years has been arduous and unskilled, and the claimant has very little education, the Board will ask the claimant to tell about all of his or her work from the time he or she first began working. (See §220.45(b).)

(a) General. The Board considers that work exists in the national economy when it exists in significant numbers either in the region where the claimant lives or in several other regions of the country. It does not matter whether—

(1) Work exits in the immediate area in which the claimant lives,

(2) A specific job vacancy exists for the claimant; or

(3) The claimant would be hired if the claimant applied for work.

(b) How the Board determines the existence of work. Work exists in the national economy when there are a significant number of jobs (in one or more occupations) having requirements which the claimant is able to meet with his or her physical or mental ability and vocational qualifications. Isolated jobs that exist in very limited numbers in relatively few locations outside the region where the claimant lives are not considered “work which exists in the national economy.” The Board will not deny the claimant a disability annuity on the basis of the existence of these kinds of jobs. The Board will determine that the claimant is disabled if the work he or she can do does not exist in the national economy. If the work the claimant can do does exist in the national economy, the Board will determine that the claimant is not disabled.

(c) Inability to obtain work. The Board will determine that the claimant is not disabled if he or she has the residual functional capacity and vocational abilities to do work which exists in the national economy but the claimant remains unemployed because of—

(1) His or her inability to get work;

(2) Lack of work in his or her local area;

(3) The hiring practices of employers;

(4) Technological changes in the industry in which the claimant has worked;

(5) Cyclical economic conditions;

(6) No job openings for the claimant;

(7) The claimant not actually being hired to do work he or she could otherwise do; or

(8) The claimant not wishing to do a particular type of work.

(d) Administrative notice of job data. The following sources are used when the Board determines that unskilled, sedentary, light and medium jobs exist in the national economy:

(1) Dictionary of Occupational Titles, published by the Department of Labor.

(2) County Business Patterns, published by the Bureau of the Census.

(3) Census Reports, also published by the Bureau of the Census.

(4) Occupational Analyses, prepared for the Social Security Administration by various State employment agencies.

(5) Occupational Outlook Handbook, published by the Bureau of Labor Statistics.

(e) Use of vocational experts and other specialists. If the issue in determining whether the claimant is disabled is whether his or her work skills can be used in other work and the specific occupations in which they can be used, or there is a similarly complex issue, the Board may use the services of a vocational expert or other specialist. The Board will decide whether to use a vocational expert or other specialist.

To determine the physical exertion requirements of work in the national economy, jobs are classified as “sedentary”, “light”, “medium”, “heavy”, and “very heavy.” These terms have the same meaning as they have in the Dictionary of Occupational Titles, published by the Department of Labor. In making disability determinations the Board uses the following definitions:

(a) Sedentary work. Sedentary work involves lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools. Although a sedentary job is defined as one which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and the other sedentary criteria are met.

(b) Light work. Light work involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds. Even though the weight lifted may be very little, a job is in this category when it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls. To be considered capable of performing a full or wide range of light work, the claimant must have the ability to do substantially all of these activities. If the claimant can do light work, the Board determines that he or she can also do sedentary work, unless there are additional limiting factors such as loss of fine dexerity or inability to sit for long periods of time.

(c) Medium work. Medium work involves lifting no more than 50 pounds at a time with frequent lifting or carrying of objects weighing up to 25 pounds. If the claimant can do medium work, the Board determines that he or she can also do sedentary and light work.

(d) Heavy work. Heavy work involves lifting no more than 100 pounds at a time with frequent lifting or carrying of objects weighing up to 50 pounds. If the claimant can do heavy work, the Board determines that he or she can also do medium, light, and sedentary work.

(e) Very heavy work. Very heavy work involves lifting objects weighing more than 100 pounds at a time with frequent lifting or carrying of objects weighing 50 pounds or more. If the claimant can do very heavy work, the Board determines that he or she can also do heavy, medium, light and sedentary work.

(a) General. To evaluate skills and to help determine the existence in the national economy of work the claimant is able to do, occupations are classified as unskilled, semi-skilled, and skilled. In classifying these occupations, the Board uses materials published by the Department of Labor.

(b) Unskilled work. Unskilled work is work which needs little or no judgment to do simple duties that can be learned on the job in a short period of time (30 days). The job may or may not require considerable strength. A job is considered unskilled if the claimant can usually learn to do the job in 30 days, and little job training and judgment are needed. The claimant does not gain work skills by doing unskilled jobs. For example, jobs are considered unskilled if primary work duties are—

(1) Handling;

(2) Feeding;

(3) Offbearing (placing or removing materials from machines which are automatic or operated by others); or

(4) Machine tending.

(c) Semi-skilled work. Semi-skilled work is work which needs some skills but does not require doing the more complex work duties. A job may be classified as semi-skilled where coordination and dexterity are necessary, as when hand or feet must be moved quickly to do repetitive tasks. Semi-skilled jobs may require—

(1) Alertness and close attention to watching machine processes;

(2) Inspecting, testing, or otherwise looking for irregularities;

(3) Tending or guarding equipment, property, materials, or persons against loss, damage, or injury; or

(4) Other types of activities which are similarly less complex than skilled work but more complex than unskilled work.

(d) Skilled work. Skilled work requires qualifications in which a person uses judgment to determine the machine and manual operations to be performed in order to obtain the proper form, quality, or quantity of material to be produced. Skilled jobs may require—

(1) Laying out work;

(2) Estimating quality;

(3) Determining suitability and needed quantities of materials;

(4) Making precise measurements;

(5) Reading blueprints or other specifications;

(6) Making necessary computations or mechanical adjustments to control or regulate work; or

(7) Dealing with people, facts, figures or abstract ideas at a high level of complexity.

(e) Skills that can be used in other work (transferability)—(1) What the Board means by transferable skills. The Board considers the claimant to have skills that can be used in other jobs, when the skilled or semi-skilled work activities the claimant did in past work can be used to meet the requirements of skilled or semi-skilled work activities of other jobs or kinds of work. This depends largely on the similarity of occupationally significant work activities among different jobs.

(2) How the Board determines skills that can be transferred to other jobs. Transferability is most probable and meaningful among jobs in which—

(i) The same or a lesser degree of skill is required;

(ii) The same or similar tools and machines are used; and

(iii) The same or similar raw materials, products, processes, or services are involved.

(3) Degrees of transferability. There are degrees of transferability of skills ranging from very close similarities to remote and incidental similarities among jobs. A complete similarity of all three factors is not necessary for transferability. However, when skills are so specialized or have been acquired in such an isolated vocational setting (like many jobs in mining, agriculture, or fishing) that they are not readily usable in other industries, jobs, and work settings, they are considered not transferable.

(a) The Dictionary of Occupational Titles includes information about jobs (classified by their exertional and skill requirements) that exist in the national economy. Appendix 2 of this part provides rules using this data reflecting major functional and vocational patterns.

(b) The Board applies that rules in appendix 2 of this part in cases where a claimant is not doing substantial gainful activity and is prevented by a severe impairment(s) from doing vocationally relevant past work.

(c) The rules in appendix 2 of this part do not cover all possible variations of factors. The Board does not apply these rules if one of the findings of fact about the claimant's vocational factors and residual functional capacity is not the same as the corresponding criterion of a rule. In these instances, the Board gives full consideration to all relevant facts in accordance with the definitions and discussions under vocational considerations. However, if the findings of fact made about all factors are the same as the rule, the Board uses that rule to decide whether that claimant is disabled.

(a) General. The claimant's impairment(s) and related symptoms, such as pain, may cause limitations of function or restrictions which limit the claimant's ability to meet certain demands of jobs. These limitations may be exertional, nonexertional, or a combination of both. Limitations are classified as exertional if they affect the claimant's ability to meet the strength demands of jobs. The classification of a limitation as exertional is related to the United States Department of Labor's classification of jobs by various exertional levels (sedentary, light, medium, heavy, and very heavy) in terms of the strength demands for sitting, standing, walking, lifting, carrying, pushing, and pulling. Sections 220.132 and 220.134 of this part explain how the Board uses the classification of jobs by exertional levels (strength demands) which is contained in the Dictionary of Occupational Titles published by the Department of Labor, to determine the exertional requirements of work which exists in the national economy. Limitations or restrictions which affect the claimant's ability to meet the demands of jobs other than the strength demands, that is, demands other than sitting, standing, walking, lifting, carrying, pushing or pulling, are considered nonexertional. Sections 220.100(b)(5) and 220.180(h) of this part explain that if the claimant can no longer do the claimant's past relevant work because of a severe medically determinable impairment(s), the Board must determine whether the claimant's impairment(s), when considered along with the claimant's age, education, and work experience, prevents the claimant from doing any other work which exists in the national economy in order to decide whether the claimant is disabled or continues to be disabled. Paragraphs (b), (c), and (d) of this section explain how the Board applies the medical-vocational guidelines in appendix 2 of this part in making this determination, depending on whether the limitations or restrictions imposed by the claimant's impairment(s) and related symptoms, such as pain, are exertional, nonexertional, or a combination of both.

(b) Exertional limitations. When the limitations and restrictions imposed by the claimant's impairment(s) and related symptoms, such as pain, affect only the claimant's ability to meet the strength demands of jobs (sitting, standing, walking, lifting, carrying, pushing, and pulling), the Board considers that the claimant has only exertional limitations. When the claimant's impairment(s) and related symptoms only impose exertional limitations and the claimant's specific vocational profile is listed in a rule contained in appendix 2 of this part, the Board will directly apply that rule to decide whether the claimant is disabled.

(c) Nonexertional limitations. (1) When the limitations and restrictions imposed by the claimant's impairment(s) and related symptoms, such as pain, affect only the claimant's ability to meet the demands of jobs other than the strength demands, the Board considers that the claimant has only nonexertional limitations or restrictions. Some examples of nonexertional limitations or restrictions include the following:

(i) Difficulty functioning because the claimant is nervous, anxious, or depressed;

(ii) Difficulty maintaining attention or concentration;

(iii) Difficulty understanding or remembering detailed instructions;

(iv) Difficulty in seeing or hearing;

(v) Difficulty tolerating some physical feature(s) of certain work settings, e.g., the claimant cannot tolerate dust or fumes; or

(vi) Difficulty performing the manipulative or postural functions of some work such as reaching, handling, stooping, climbing, crawling, or crouching.

(2) If the claimant's impairment(s) and related symptoms, such as pain, only affect the claimant's ability to perform the nonexertional aspects of work-related activities, the rules in appendix 2 do not direct factual conclusions of disabled or not disabled. The determination as to whether disability exists will be based on the principles in the appropriate sections of the regulations, giving consideration to the rules for specific case situations in appendix 2 of this part.

(d) Combined exertional and nonexertional limitations. When the limitations and restrictions imposed by the claimant's impairment(s) and related symptoms, such as pain, affect the claimant's ability to meet both the strength and demands of jobs other than the strength demands, the Board considers that the claimant has a combination of exertional and nonexertional limitations or restrictions. If the claimant's impairment(s) and related symptoms, such as pain, affect the claimant's ability to meet both the strength and demands of jobs other than the strength demands, the Board will not directly apply the rules in appendix 2 unless there is a rule that directs a conclusion that the claimant is disabled based upon the claimant's strength limitations; otherwise the rules provide a framework to guide the Board's decision.

[68 FR 60294, Oct. 22, 2003]

The work that a claimant has done during any period in which the claimant believes he or she is disabled may show that the claimant is able to do work at the substantial gainful activity level. If the claimant is able to engage in substantial gainful activity, the Board will find that the claimant is not disabled for any regular employment under the Railroad Retirement Act. Even if the work the claimant has done was not substantial gainful activity, it may show that the claimant is able to do more work than he or she actually did. The Board will consider all of the medical and vocational evidence in the claimant's file to decide whether or not the claimant has the ability to engage in substantial gainful activity.

Substantial gainful activity is work activity that is both substantial and gainful.

(a) Substantial work activity. Substantial work activity is work activity that involves doing significant physical or mental activities. The claimant's work may be substantial even if it is done on a part-time basis or if the claimant does less, gets paid less, or has less responsibility than when the claimant worked before.

(b) Gainful work activity. Gainful work activity is work activity that the claimant does for pay or profit. Work activity is gainful if it is the kind of work usually done for pay or profit, whether or not a profit is realized.

(c) Some other activities. Generally, the Board does not consider activities like taking care of one's self, household tasks, hobbies, therapy, school attendance, club activities, or social programs to be substantial gainful activity.

(a) The nature of the claimant's work. If the claimant's duties require use of the claimant's experience, skills, supervision and responsibilities, or contribute substantially to the operation of a business, this tends to show that the claimant has the ability to work at the substantial gainful activity level.

(b) How well the claimant performs. The Board considers how well the claimant does his or her work when the Board determines whether or not the claimant is doing substantial gainful activity. If the claimant does his or her work satisfactorily, this may show that the claimant is working at the substantial gainful activity level. If the claimant is unable, because of his or her impairments, to do ordinary or simple tasks satisfactorily without more supervision or assistance than is usually given other people doing similar work, this may show that the claimant is not working at the substantial gainful activity level. If the claimant is doing work that involves minimal duties that make little or no demands on the claimant and that are of little or no use to the claimant's railroad or non-railroad employer, or to the operation of a business if the claimant is self-employed, this does not show that the claimant is working at the substantial gainful activity level.

(c) If the claimant's work is done under special conditions. Even though the work the claimant is doing takes into account his or her impairment, such as work done in a sheltered workshop or as a patient in a hospital, it may still show that the claimant has the necessary skills and ability to work at the substantial gainful activity level.

(d) If the claimant is self-employed. Supervisory, managerial, advisory or other significant personal services that the claimant performs as a self-employed person may show that the claimant is able to do substantial gainful activity.

(e) Time spent in work. While the time the claimant spends in work is important, the Board will not decide whether or not the claimant is doing substantial gainful activity only on that basis. The Board will still evaluate the work to decide whether it is substantial and gainful regardless of whether the claimant spends more time or less time at the job than workers who are not impaired and who are doing similar work as a regular means of their livelihood.

(a) General. The Board uses several guides to decide whether the work the claimant has done shows that he or she is able to do substantial gainful activity.

(1) The claimant's earnings may show the claimant has done substantial gainful activity. The amount of the claimant's earnings from work the claimant has done may show that he or she has engaged in substantial gainful activity. Generally, if the claimant worked for substantial earnings, this will show that he or she is able to do substantial gainful activity. On the other hand, the fact that the claimant's earnings are not substantial will not necessarily show that the claimant is not able to do substantial gainful activity. The Board will generally consider work that the claimant is forced to stop after a short time because of his or her impairment(s) as an unsuccessful work attempt and the claimant's earnings from that work will not show that the claimant is able to do substantial gainful activity.

(2) The Board considers only the amount the claimant earns. The Board does not consider any income not directly related to the claimant's productivity when the Board decides whether the claimant has done substantial gainful activity. If the claimant's earnings are subsidized, the amount of the subsidy is not counted when the Board determines whether or not the claimant's work is substantial gainful activity. Thus, where work is done under special conditions, the Board only considers the part of the claimant's pay which the claimant actually “earns.” For example, where a handicapped person does simple tasks under close and continuous supervision, the Board would not determine that the person worked at the substantial gainful activity level only on the basis of the amount of pay. A railroad or non-railroad employer may set a specific amount as a subsidy after figuring the reasonable value of the employee's services. If the claimant's work is subsidized and the claimant's railroad and non-railroad employer does not set the amount of the subsidy or does not adequately explain how the subsidy was figured, the Board will investigate to see how much the claimant's work is worth.

(3) If the claimant is working in a sheltered or special environment. If the claimant is working in a sheltered workshop, the claimant may or may not be earning the amounts he or she is being paid. The fact that the sheltered workshop or similar facility is operating at a loss or is receiving some charitable contributions or governmental aid does not establish that the claimant is not earning all he or she is being paid. Since persons in military service being treated for a severe impairment usually continue to receive full pay, the Board evaluates work activity in a therapy program or while on limited duty by comparing it with similar work in the civilian work force or on the basis of reasonable worth of the work, rather than on the actual amount of the earnings.

(b) Earnings guidelines—(1) General. If the claimant is employed, the Board first considers the criteria in paragraph (a) of this section and §220.145, and then the guides in paragraphs (b)(2), (3), (4), (5), and (6) of this section.

(2) Earnings that will ordinarily show that the claimant has engaged in substantial gainful activity. The Board will consider that the earnings from the employed claimant (including earnings from sheltered work, see paragraph (b)(4) of this section) show that the claimant engaged in substantial gainful activity if:

(i) Before January 1, 2001, the earnings averaged more than the amount(s) in Table 1 of this section for the time(s) in which the claimant worked.

(ii) Beginning January 1, 2001, the earnings are more than an amount determined for each calendar year to be the larger of:

(A) The amount for the previous year, or

(B) The amount established by the Social Security Administration to constitute substantial gainful activity for such year.

Table 1—Amounts Indicating Substantial Gainful Activity Performed

For monthsMonthly earnings averaged more than
In calendar years before 1976$200
In calendar year 1976230
In calendar year 1977240
In calendar year 1978260
In calendar year 1979280
In calendar years 1980-1989300
January 1990-June 1999500
July 1999-December 2000700

(3) Earnings that will ordinarily show that the claimant has not engaged in substantial gainful activity. Beginning January 1, 2001, if the claimant's earnings are equal to or less than the amount(s) determined under paragraph (b)(2)(ii) of this section for the year(s) in which the claimant works, the Board will generally consider that the earnings from the claimant's work as an employee will show the claimant has not engaged in substantial gainful activity. Before January 1, 2001, if the claimant's earnings were less than the amount(s) in Table 2 of this section for the year(s) in which the claimant worked, the Board will generally consider that the earnings from the claimant's work as an employee will show that the claimant has not engaged in substantial gainful activity.

Table 2—Amounts Indicating Substantial Gainful Activity Not Performed

For monthsMonthly earnings averaged less than
In calendar years before 1976$130
In calendar year 1976150
In calendar year 1977160
In calendar year 1978170
In calendar year 1979180
In calendar years 1980-1989190
In calendar years 1990-2000300

(4) If the claimant worked in a sheltered workshop. Before January 1, 2001 if the claimant worked in a sheltered workshop or a comparable facility especially set up for severely impaired persons, the Board will ordinarily consider that the claimant's earnings from this work show that the claimant has engaged in substantial gainful activity if the claimant's earnings average more than the amounts in Table 1 of this section. Average monthly earnings from a sheltered workshop or a comparable facility that are equal to or less than those indicated in Table 1 of this section will ordinarily show that the claimant has not engaged in substantial gainful activity without the need to consider the other information, as described in paragraph (b)(6) of this section, regardless of whether they are more or less than those indicated in paragraph (b)(3) of this section. When the claimant's earnings from a sheltered workshop or comparable facility are equal to or less than those amounts indicated in Table 1 of this section, the Board will consider the provisions of paragraph (b)(6) of this section only if there is evidence that the claimant may have done substantial gainful activity. For work performed in a sheltered workshop or comparable facility beginning January 1, 2001, the rules of paragraph (b)(2), (3), and (6) apply the same as they do to any other work done by an employee.

(5) If there is evidence showing that the claimant may have done substantial gainful activity. If there is evidence showing that the claimant may have done substantial gainful activity, the Board will apply the criteria in paragraph (b)(6) of this section regarding comparability and value of services.

(6) Earnings that are not high enough to ordinarily show that the claimant engaged in substantial gainful activity. (i) Before January 1, 2001, if the claimant's average monthly earnings were between the amounts shown in paragraphs (b)(2) and (3) of this section, the Board will generally consider other information in addition to the claimant's earnings (see paragraph (b)(6)(iii) of this section). This rule generally applies to employees who did not work in a sheltered workshop or a comparable facility, although the Board may apply it to some people who work in sheltered workshops or comparable facilities (see paragraph (b)(4) of this section).

(ii) Beginning January 1, 2001, if the claimant's average monthly earnings are equal to or less than the amounts determined under paragraph (b)(2) of this section, the Board will generally not consider other information in addition to the claimant's earnings unless there is evidence indicating that the claimant may be engaging in substantial gainful activity or that the claimant is in a position to defer or suppress his or her earnings.

(iii) Examples of other information the Board may consider include, whether—

(A) The claimant's work is comparable to that of unimpaired people in the claimant's community who are doing the same or similar occupations as their means of livelihood, taking into account the time, energy, skill, and responsibility involved in the work, and

(B) The claimant's work, although significantly less than that done by unimpaired people, is clearly worth the amounts shown in paragraph (b)(2) of this section, according to pay scales in the claimant's community.

[56 FR 12980, Mar. 28, 1991, as amended at 64 FR 62976, Nov. 18, 1999; 72 FR 21101, Apr. 30, 2007]

(a) If the claimant is a self-employed claimant. The Board will consider the claimant's activities and their value to the claimant's business to decide whether the claimant has engaged in substantial gainful activity if the claimant is self-employed. The Board will not consider the claimant's income alone since the amount of income the claimant actually receives may depend upon a number of different factors like capital investment, profit sharing agreements, etc. The Board will generally consider work that the claimant is forced to stop after a short time because of his or her impairment(s) as an unsuccessful work attempt and the claimant's income from that work will not show that the claimant is able to do substantial gainful activity. The Board will evaluate the claimant's work activity on the value to the business of the claimant's services regardless of whether the claimant receives an immediate income for his or her services. The Board considers that the claimant has engaged in substantial gainful activity if—

(1) The claimant's work activity, in terms of factors such as hours, skills, energy output, efficency, duties, and responsibilities, is comparable to that of unimpaired persons in the claimant's community who are in the same or similar businesses as their means of livelihood;

(2) The claimant's work activity, although not comparable to that of unimpaired persons, is clearly worth the amount shown in §220.143(b)(2) when considered in terms of its value to the business, or when compared to the salary that an owner would pay to an employed person to do the work the claimant is doing; or

(3) The claimant renders services that are significant to the operation of the business and receives a substantial income from the business.

(b) What the Board means by significant services—(1) Claimants who are not farm landlords. If the claimant is not a farm landlord and the claimant operates a business entirely by himself or herself, any services that the claimant renders are significant to the business. If the claimant's business involves the services of more than one person, the Board will consider the claimant to be rendering significant services if he or she contributes more than half the total time required for the management of the business or he or she renders management services for more than 45 hours a month regardless of the total management time required by the business.

(2) Claimants who are farm landlords—(i) General. If the claimant is a farm landlord, that is, the claimant rents farm land to another, the Board will consider the claimant to be rendering significant services if the claimant materially participates in the production or the management of the production of the things raised on the rented farm. If the claimant was given social security earnings credits because he or she materially participated in the activities of the farm and he or she continues these same activities, the Board will consider the claimant to be rendering significant services.

(ii) Material participation. (A) The claimant will have established that he or she is materially participating if he or she—

(1) Furnishes a large portion of the machinery, tools, and livestock used in the production of the things raised on the rented farm; or

(2) Furnishes or advances monies or assumes financial responsibility for a substantial part of the expense involved in the production of the things raised on the rented farm.

(B) The claimant will have presented strong evidence that he or she is materially participating if he or she periodically—

(1) Advise or consults with the other person who under the rental agreement produces the things raised on the rented farm; and

(2) Inspects the production activities on the land.

(iii) Production. The term “production” refers to the physical work performed and the expenses incurred in producing the things raised on the farm. It includes activities like the actual work of planting, cultivating, and harvesting of crops, and the furnishing of machinery, implements, seed, and livestock.

(iv) Management of the production. The term “management of the production” refers to services performed in making managerial decisions about the production of the crop, such as when to plant, cultivate, dust, spray or harvest. It includes advising and consulting, making inspections, and making decisions on matters, such as rotation of crops, the type of crops to be grown, the type of livestock to be raised, and the type of machinery and implements to be furnished.

(c) What the Board means by substantial income. After the claimant's normal business expenses are deducted from the claimant's gross income to determine net income, the Board will deduct the reasonable value of any unpaid help, any soil bank payments that were included as farm income, and impairment-related work expenses described in §220.145 that have not been deducted in determining the claimant's net earnings from self-employment. The Board will consider the resulting amount of income from the business to be substantial if—

(1) It averages more than the amounts described in §220.143(b)(2); or

(2) It averages less than the amounts described in §220.143(b)(2) but the livelihood which the claimant gets from the business is either comparable to what it was before the claimant became severely impaired or is comparable to that of unimpaired self-employed persons in the claimant's community who are in the same or similar businesses as their means of livelihood.

(a) General. When the Board figures the claimant's earnings in deciding if the claimant has done substantial gainful activity, the Board will subtract the reasonable costs to the claimant of certain items and services which, because of his or her impairment(s), the claimant needs and uses to enable him or her to work. The costs are deductible even though the claimant also needs or uses the items and services to carry out daily living functions unrelated to his or her work. Paragraph (b) of this section explains the conditions for deducting work expenses. Paragraph (c) of this section describes the expenses the Board will deduct. Paragraph (d) of this section explains when expenses may be deducted. Paragraph (e) of this section describes how expenses may be allocated. Paragraph (f) of this section explains the limitations on deducting expenses. Paragraph (g) of this section explains the Board's verification procedures.

(b) Conditions for deducting impairment-related work expenses. The Board will deduct impairment-related work expenses if—

(1) The claimant is otherwise disabled as defined in §220.26;

(2) The severity of the claimant's impairment(s) requires the claimant to purchase (or rent) certain items and services in order to work;

(3) The claimant pays the cost of the item or service. No deduction will be allowed to the extent that payment has been or will be made by another source. No deduction will be allowed to the extent that the claimant has been, could be, or will be reimbursed for such cost by any other source (such as through a private insurance plan, Medicare or Medicaid, or other plan or agency). For example, if the claimant purchases crutches for $80 but the claimant was, could be, or will be reimbursed $64 by some agency, plan, or program, the Board will deduct only $16;

(4) The claimant pays for the item or service in a month he or she is working (in accordance with paragraph (d) of this section); and

(5) The claimant's payment is in cash (including checks or other forms of money). Payment in kind is not deductible.

(c) What expenses may be deducted—(1) Payments for attendant care services. (i) If because of the claimant's impairment(s) the claimant needs assistance in traveling to and from work, or while at work the claimant needs assistance with personal functions (e.g., eating, toileting) or with work-related functions (e.g., reading, communicating), the payments the claimant makes for those services may be deducted.

(ii) If because of the claimant's impairment(s) the claimant needs assistance with personal functions (e.g., dressing, administering medications) at home in preparation for going to and assistance in returning from work, the payments the claimant makes for those services may be deducted.

(iii)(A) The Board will deduct payments the claimant makes to a family member for attendant care services only if such person, in order to perform the services, suffers an economic loss by terminating his or her employment or by reducing the number of hours he or she worked.

(B) The Board considers a family member to be anyone who is related to the claimant by blood, marriage or adoption, whether or not that person lives with the claimant.

(iv) If only part of the claimant's payment to a person is for services that come under the provisions of paragraph (c)(1) of this section, the Board will only deduct that part of the payment which is attributable to those services. For example, an attendant gets the claimant ready for work and helps the claimant in returning from work, which takes about 2 hours a day. The rest of the attendant's 8-hour day is spent cleaning the claimant's house and doing the claimant's laundry, etc. The Board would only deduct one-fourth of the attendant's daily wages as an impairment-related work expense.

(2) Payment for medical devices. If the claimant's impairment(s) requires that the claimant utilize medical devices in order to work, the payments the claimant makes for those devices may be deducted. As used in this subparagraph, medical devices include durable medical equipment which can withstand repeated use, is customarily used for medical purposes, and is generally not useful to a person in the absence of an illness or injury. Examples of durable medical equipment are wheelchairs, hemodialysis equipment, canes, crutches, inhalators and pacemakers.

(3) Payments for prosthetic devices. If the claimant's impairment(s) requires that the claimant utilize a prosthetic device in order to work, the payments the claimant makes for that device can be deducted. A prosthetic device is that which replaces an internal body organ or external body part. Examples of prosthetic devices are artificial replacements of arms, legs and other parts of the body.

(4) Payments for equipment—(i) Work-related equipment. If the claimant's impairment(s) requires that the claimant utilize special equipment in order to do his or her job, the payments the claimant makes for that equipment may be deducted. Examples of work-related equipment are one-hand typewriters, vision aids, sensory aids for the blind, telecommunication devices for the deaf and tools specifically designed to accommodate a person's impairment(s).

(ii) Residential modifications. If the claimant's impairment(s) requires that the claimant make modifications to his or her residence, the location of the claimant's place of work will determine if the cost of these modifications will be deducted. If the claimant is employed away from home, only the cost of changes made outside of the claimant's home to permit the claimant to get to his or her means of transportation (e.g., the installation of an exterior ramp for a wheelchair confined person or special exterior railings or pathways for someone who requires crutches) will be deducted. Costs relating to modifications of the inside of the claimant's home will not be deducted. If the claimant works at home, the costs of modifying the inside of the claimant's home in order to create a working space to accommodate the claimant's impairment(s) will be deducted to the extent that the changes pertain specifically to the space in which the claimant works. Examples of such changes are the enlargement of a doorway leading into the workspace or modification of the workspace to accommodate problems in dexterity. However, if the claimant is self-employed at home, any cost deducted as a business expense cannot be deducted as an impairment-related work expense.

(iii) Non-medical applicances and equipment. Expenses for appliances and equipment which the claimant does not ordinarily use for medical purposes are generally not deductible. Examples of these items are portable room heaters, air conditioners, humidifiers, dehumidifiers, and electric air cleaners. However, expenses for such items may be deductible when unusual circumstances clearly establish an impairment-related and medically verified need for such an item because it is for the control of the claimant's disabling impairment(s), thus enabling the claimant to work. To be considered essential, the item must be of such a nature that if it were not available to the claimant there would be an immediate adverse impact on the claimant's ability to function in his or her work activity. In this situation, the expense is deductible whether the item is used at home or in the working place. An example would be the need for an electric air cleaner by a person with severe respiratory disease who cannot function in a non-purified air environment. An item such as an exercycle is not deductible if used for general physical fitness. If an exercycle is prescribed and used as necessary treatment to enable the claimant to work, the Board will deduct payments the claimant makes toward its cost.

(5) Payments for drugs and medical services. (i) If the claimant must use drugs or medical services (including diagnostic procedures) to control his or her impairment(s), the payments the claimant makes for them may be deducted. The drugs or services must be prescribed (or utilized) to reduce or eliminate symptoms of the claimant's impairment(s) or to slow down its progression. The diagnostic procedures must be performed to ascertain how the impairment(s) is progressing or to determine what type of treatment should be provided for the impairment(s).

(ii) Examples of deductible drugs and medical services are anti-convulsant drugs to control epilepsy or anticonvulsant blood level monitoring; antidepressant medication for mental impairments; medication used to allay the side effects of certain treatments; radiation treatment or chemotherapy for cancer patients; corrective surgery for spinal impairments; electroencephalograms and brain scans related to a disabling epileptic impairment; tests to determine the efficacy of medication on a diabetic condition; and immunosuppressive medications that kidney transplant patients regularly take to protect against graft rejection.

(iii) The Board will only deduct the costs of drugs or services that are directly related to the claimant's impairment(s). Examples of non-deductible items are routine annual physical examinations, optician services (unrelated to a disabling visual impairment) and dental examinations.

(6) Payments for similar items and services—(i) General. If the claimant is required to utilize items and services not specified in paragraphs (c)(1) through (5) of this section, but which are directly related to his or her impairment(s) and which the claimant needs to work, their costs are deductible. Examples of such items and services are medical supplies and services not discussed above, the purchase and maintenance of a dog guide which the claimant needs to work, and transportation.

(ii) Medical supplies and services not described above. The Board will deduct payments the claimant makes for expendable medical supplies, such as incontinence pads, catheters, bandages, elastic stockings, face masks, irrigating kits, and disposable sheets and bags. The Board will also deduct payments the claimant makes for physical therapy which the claimant requires because of his or her impairment(s) and which the claimant needs in order to work.

(iii) Payments for transportation costs. The Board will deduct transportation costs in these situations:

(A) The claimant's impairment(s) requires that in order to get to work the claimant needs a vehicle that has structural or operational modifications. The modifications must be critical to the claimant's operation or use of the vehicle and directly related to the claimant's impairment(s). The Board will deduct the cost of the modifications, but not the cost of the vehicle. The Board will also deduct a mileage allowance for the trip to and from work. The allowance will be based on data compiled by the Federal Highway Administration relating to vehicle operating costs.

(B) The claimant's impairment(s) requires the claimant to use driver assistance, taxicabs or other hired vehicles in order to work. The Board will deduct amounts paid to the driver and, if the claimant's own vehicle is used, the Board will also deduct a mileage allowance, as provided in paragraph (c)(6)(iii)(A) of this section, for the trip to and from work.

(C) The claimant's impairment(s) prevents the claimant from taking available public transportation to and from work and the claimant must drive his or her (unmodified) vehicle to work. If the Board can verify through the claimant's physician or other sources that the need to drive is caused by the claimant's impairment(s) (and not due to the unavailability of public transportation), the Board will deduct a mileage allowance, as provided in paragraph (c)(6)(iii)(A) of this section, for the trip to and from work.

(7) Payments for installing, maintaining, and repairing deductible items. If the device, equipment, appliance, etc., that the claimant utilizes qualifies as a deductible item as described in paragraphs (c)(2), (3), (4) and (6) of this section, the costs directly related to installing, maintaining and repairing these items are also deductible. (The costs which are associated with modifications to a vehicle are deductible. Except for a mileage allowance, as provided for in paragraph (c)(6)(iii)(A) of this section, the costs which are associated with the vehicle itself are not deductible.)

(d) When expenses may be deducted—(1) Effective date. To be deductible, an expense must be incurred after November 30, 1980. An expense may be considered incurred after that date if it is paid thereafter even though pursuant to a contract or other arrangement entered into before December 1, 1980.

(2) Payments for services. A payment the claimant makes for services may be deducted if the services are received while the claimant is working and the payment is made in a month the claimant is working. The Board considers the claimant to be working even though he or she must leave work temporarily to receive the services.

(3) Payments for items. A payment the claimant makes toward the cost of a deductible item (regardless of when it is acquired) may be deducted if payment is made in a month claimant is working. See paragraph (e)(4) of this section when purchases are made in anticipation of work.

(e) How expenses are allocated—(1) Recurring expenses. The claimant may pay for services on a regular periodic basis, or the claimant may purchase an item on credit and pay for it in regular periodic installments or the claimant may rent an item. If so, each payment the claimant makes for the services and each payment the claimant makes toward the purchase or rental (including interest) is deductible in the month it is made.

Example: B starts work in October 1981 at which time she purchases a medical device at a cost of $4,800 plus interest charges of $720. Her monthly payments begin in October. She earns and receives $400 a month. The term of the installment contract is 48 months. No downpayment is made. The monthly allowable deduction for the item would be $115 ($5,520 divided by 48) for each month of work during the 48 months.

(2) Non-recurring expenses. Part or all of the claimant's expenses may not be recurring. For example, the claimant may make a one-time payment in full for an item or service or make a downpayment. If the claimant is working when he or she makes the payment, the Board will either deduct the entire amount in the month the claimant pays it or allocate the amount over a 12-consecutive-month period beginning with the month of payment, whichever the claimant selects.

Example: A begins working in October 1981 and earns $525 a month. In the same month, he purchases and pays for a deductible item at a cost of $250. In this situation the Board could allow a $250 deduction for October 1981, reducing A's earnings below the substantial gainful activity level for that month.

If A's earnings had been $15 above the substantial gainful activity earnings amount, A probably would select the option of projecting the $250 payment over the 12-month period, October 1981-September 1982, giving A an allowable deduction of $20.83 a month for each month of work during that period. This deduction would reduce A's earnings below the substantial gainful activity level for 12 months.

(3) Allocating downpayments. If the claimant makes a downpayment, the Board will, if the claimant chooses, make a separate calculation for the downpayment in order to provide for uniform monthly deductions. In these situations the Board will determine the total payment that the claimant will make over a 12-consecutive-month period beginning with the month of the downpayment and allocate that amount over the 12 months. Beginning with the 13th month, the regular monthly payment will be deductible. This allocation process will be for a shorter period if the claimant's regular monthly payments will extend over a period of less than 12 months.

Example 1. C starts working in October 1981, at which time he purchases special equipment at a cost of $4,800, paying $1,200 down. The balance of $3,600, plus interest of $540, is to be repaid in 36 installments of $115 a month beginning November 1981. C earns $500 a month. He chooses to have the downpayment allocated. In this situation the Board would allow a deduction of $205.42 a month for each month of work during the period October 1981 through September 1982. After September 1982, the deduction amount would be the regular monthly payment of $115 for each month of work during the remaining installment period.

Explanation:
Downpayment in October 1981$1,200
Monthly payments:
November 1981 through September 19821,265
   12/$2,465=205.42

Example 2. D, while working, buys a deductible item in July 1981, paying $1,450 down. However, his first monthly payment of $125 is not due until September 1981. D chooses to have the downpayment allocated. In this situation, the Board would allow a deduction of $225 a month for each month of work during the period July 1981 through June 1982. After June 1982, the deduction amount would be the regular monthly payment of $125 for each month of work.

Explanation:
Downpayment in July 1981$1,450
Monthly payments:
September 1981 through June 19821,250
   12/$2,700=$225

(4) Payments made in anticipation of work. A payment made toward the cost of a deductible item that the claimant made in any of the 11 months preceding the month he or she started working will be taken into account in determining the claimant's impairment-related work expenses. When an item is paid for in full during the 11 months preceding the month the claiment started working, the payment will be allocated over the 12-consecutive-month period beginning with the month of the payment. However, the only portion of the payment which may be deductible is the portion allocated to the month work begins and the following months. For example, if an item is purchased 3 months before the month work began and is paid for with a one-time payment of $600, the deductible amount would be $450 ($600 divided by 12, multiplied by 9). Installment payments (including a downpayment) that the claimant made for a particular item during the 11 months preceding the month he or she started working will be totalled and considered to have been made in the month of the claimant's first payment for that item within this 11-month period. The sum of these payments will be allocated over the 12-consecutive-month period beginning with the month of the claimant's first payment (but never earlier than 11 months before the month work began). However, the only portion of the total which may be deductible is the portion allocated to the month work begins and the following months. For example, if an item is purchased 3 months before the month work began and is paid for in 3 monthly installments of $200 each, the total payment of $600 will be considered to have been made in the month of the first payment, that is, 3 months before the month work began. The deductible amount would be $450 ($600 divided by 12, multiplied by 9). The amount, as determined by these formulas, will then be considered to have been paid in the first month of work. The Board will deduct either this entire amount in the first month of work or allocate it over a 12-consecutive-month period, beginning with the first month of work, whichever the claimant selects. In the above examples, the claimant would have the choice of having the entire $450 deducted in the first month of work or having $37.50 a month ($450 divided by 12) deducted for each month that he or she works over a 12-consecutive-month period, beginning with the first month of work. To be deductible, the payments must be for durable items such as medical devices, prostheses, work-related equipment, residential modifications, non-medical appliances and vehicle modifications. Payments for services and expendable items such as drugs, oxygen, diagnostic procedures, medical supplies and vehicle operating costs are not deductible for the purpose of this paragraph.

(f) Limits on deductions. (1) The Board will deduct the actual amounts the claimant pays towards his or her impairment-related work expenses unless the amounts are unreasonable. With respect to durable medical equipment, prosthetic devices, medical services, and similar medically-related items and services, the Board will apply the prevailing charges under Medicare (Part B of the title XVIII, Health Insurance for the Aged and Disabled) to the extent that this information is readily available. Where the Medicare guides are used, the Board will consider the amount that the claimant pays to be reasonable if it is no more than the prevailing charge for the same item or service under the Medicare guidelines. If the amount the claimant actually pays is more than the prevailing charge for the same item under the Medicare guidelines, the Board will deduct from the claimant's earnings the amount the claimant paid to the extent he or she establishes that the amount is consistent with the standard or normal charge for the same or similar item or service in his or her community. For items and services that are not listed in the Medicare guidelines, and for items and services that are listed in the Medicare guidelines but for which such guides cannot be used because the information is not readily available, the Board will consider the amount the claimant pays to be reasonable if it does not exceed the standard or normal charge for the same or similar item or service in the claimant's community.

(2) Impairment-related work expenses are not deducted in computing the claimant's earnings for purposes of determining whether the claimant's work was “services” as described in §220.170.

(3) The decision as to whether the claimant performed substantial gainful activity in a case involving impairment-related work expenses for items or services necessary for the claimant to work generally will be based upon the claimant's “earnings” and not on the value of “services” the claimant rendered. (See §§220.143 (b)(6)(i) and (ii), and 220.144(a)). This is not necessarily so, however, if the claimant is in a position to control or manipulate his or her earnings.

(4) No deduction will be allowed to the extent that any other source has paid or will pay for an item or service. No deduction will be allowed to the extent that the claimant has been, could be, or will be reimbursed for payments he or she made. (See paragraph (b)(3) of this section.)

(5) The provisions described in the foregoing paragraphs in this section are effective with respect to expenses incurred on or after December 1, 1980, although expenses incurred after November 1980, as a result of contractual or other arrangements entered into before December 1980, are deductible. For months before December 1980, the Board will deduct impairment-related work expenses from the claimant's earnings only to the extent they exceeded the normal work-related expenses the claimant would have had if the claimant did not have his or her impairment(s). The Board will not deduct expenses, however, for those things with the claimant needed even when he or she was not working.

(g) Verification. The Board will verify the claimant's need for items or services for which deductions are claimed, and the amount of the charges for those items or services. The claimant will also be asked to provide proof that he or she paid for the items or services.

A disability annuity is not payable and the annuity must be returned for any month in which the disabled annuitant works for an employer as defined in part 202 of this chapter.

In addition to the condition in §220.160, the employee's disability annuity is not payable and the employee must return the annuity payment for any month in which the employee earns more than $400 (after deduction of impairment-related work expenses) in employment or self-employment of any kind. Any annuity amounts withheld because the annuitant earned over $400 in a month may be paid after the end of the year, as shown in §220.164. The $400 monthly limit no longer applies when the employee attains retirement age and the disability annuity is converted to a full age annuity. See §220.145 for the definition of impairment-related work expenses.

[56 FR 12980, Mar. 28, 1991, as amended at 68 FR 39010, July 1, 2003]

(a) General. Any annuitant receiving an annuity based on disability must report to the Board any work and earnings as described in §§220.160 and 220.161. The report may be a written or oral statement by the annuitant, or a person acting for the annuitant, made or sent to a representative of the Board. The report should include the name and address of the railroad or non-railroad employer, a description of the work and the amount of gross wages (before deductions) or the net income from self-employment (earnings after deducting business expenses).

(b) Employee reports. In addition to the requirement described in (a), a report of earnings over $400 a month must be made before the employee accepts a disability annuity (the annuity payment is issued and not returned) for the second month after the first month in which earnings are over $400. Along with the report, the employee must return the annuity payment for any month in which he or she earns over $400.

If the employee earns over $400 in a month and does not report it within the time limit shown in §220.162(b), a penalty is imposed. The penalty deduction for the first failure to report equals the annuity amount for the first month in which the employee earned over $400. The deduction for a second or later failure to report equals the annuity amount for each month in which the employee earned over $400 and failed to report it on time.

(a) General. After the end of a year, the employee whose annuity was withheld for earnings over $400 in a month receives a form on which to report his or her earnings for the year.

(b) Earnings are less than $5000. If the employee's yearly earnings are less than $5000, all annuity payments and penalties withheld during the year because of earnings over $4800 are paid.

(c) Earnings are $5000 or more. (1) If the employee's yearly earnings are $5000 or more, the annuity payments are adjusted so that the employee does not have more than one regular deduction for every $400 of earnings over $4800. The last $200 or more of earnings over $4800 is treated as if it were $400. If the annuity rate changes during the year, any annuities due at the end of the year are paid first for months in which the annuity rate is higher. Penalty deductions may also apply as described in paragraph (c)(2) of this section.

(2) If the employee's yearly earnings are $5000 or more and the employee failed to report monthly earnings over $400 within the time limit described in §220.162(b), penalty deductions will also apply. If it is the employee's first failure to report, the penalty deduction is equal to one month's annuity. If it is the employee's second or later failure to report, the penalty deduction equals the annuity amount for each month in which the employee earned over $400 and failed to report it on time.

(d) This section is illustrated by the following examples:

Example 1: Employee is awarded a disability annuity based upon his inability to engage in his regular railroad occupation effective January 1, 1989. During that year, he works April through October, for which he receives $785 per month. He does not report these earnings to the Board until January of the following year. The employee is considered to have earned $5600 (7×$785=$5495, which is rounded up to the nearest $400). He forfeits three months of annuities:

Example 2: The same employee in the following year also works April through October, for which he receives $785 per month. This time he reports the earnings on October 31. This year he forfeits 6 months of annuity payments, 2 due to earnings, computed as above, and 4 more due to penalty deductions for failure to report earnings over $400 for the months April through July. There are no penalty deductions with respect to the months August, September, and October, since the employee reported these earnings prior to accepting an annuity for the second month after the month of earnings in excess of $400.

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

(b) What the Board means by services. When used in this section, services means any activity (whether legal or illegal), even though it is not substantial gainful activity, which is done in employment or self-employment for pay or profit, or is the kind normally done for pay or profit. We generally do not consider work done without remuneration to be services if it is done merely as therapy or training, or if it is work usually done in a daily routine around the house, or in self-care.

(1) If the claimant is an employee. The Board will consider the claimant's work as an employee to be services if:

(i) Before January 1, 2002, the claimant's earnings in a month were more than the amount(s) indicated in Table 1 of this section for the year(s) in which the claimant worked.

(ii) Beginning January 1, 2002, the claimant's earnings in a month are more than an amount determined for each calendar year to be the larger of:

(A) Such amount for the previous year, or

(B) The amount established by the Social Security Administration for such year as constituting the amount of monthly earnings used to determine whether a person has performed services for counting trial work period months.

(2) If the claimant is self-employed. The Board will consider the claimant's activities as a self-employed person to be services if:

(i) Before January 1, 2002, the claimant's net earnings in a month were more than the amount(s) indicated in Table 2 of this section for the year(s) in which the claimant worked, or the hours the claimant worked in the business in a month are more than the number of hours per month indicated in Table 2 for the years in which the claimant worked.

(ii) Beginning January 1, 2002, the claimant worked more than 80 hours a month in the business, or the claimant's net earnings in a month are more than an amount determined for each calendar year to be the larger of:

(A) Such amount for the previous year, or

(B) The amount established by the Social Security Administration for such year as constituting the amount of monthly earnings used to determine whether a person has performed services for counting trial work period months.

Table 1—For Non Self-Employed

For monthsYou earn more than
In calendar years before 1979$50
In calendar years 1979-198975
In calendar years 1990-2000200
In calendar year 2001530

Table 2—For the Self-Employed

For monthsYour net earnings are more thanOr you work in the business more than
(hours)
In calendar years before 1979$5015
In calendar years 1979-19897515
In calendar years 1990-200020040
In calendar year 200153080

(c) Limitations on the number of trial work periods. The annuitant may have only one trial work period during each period in which he or she is disabled for any regular employment as defined in §220.26.

(d) Who is and is not entitled to a trial work period. (1) Generally, the annuitant is entitled to a trial work period if he or she is entitled to an annuity based on disability.

(2) An annuitant is not entitled to a trial work period if he or she is in a second period of disability for which he or she did not have to complete a waiting period before qualifying for a disability annuity.

(e) Payment of the disability annuity during the trial work period. (1) The disability annuity of an employee, child, or widow(er) who is disabled for any regular employment will not be paid for any month in the trial work period in which the annuitant works for an employer covered by the Railroad Retirement Act (see §220.160).

(2) The disability annuity of an employee who is disabled for any regular employment will not be paid for any month in this period in which the employee annuitant earns more than $400 in employment or self-employment (see §§220.161 and 220.164).

(3) If the disability annuity for an employee, child, or widow(er) who is disabled for any regular employment is stopped because of work during the trial work period, and the disability annuitant discontinues that work before the end of the trial work period, the disability annuity may be started again without a new application and a new determination of disability.

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

(i) The annuity beginning date;

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

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

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

(i) The 9th month (whether or not the months have been consecutive) in which the annuitant performed services; or

(ii) The month in which new evidence, other than evidence relating to any work the annuitant did during the trial work period, shows that the annuitant is not disabled, even though he or she has not worked a full 9 months. The Board may find that the annuitant's disability has ended at any time during the trial work period if the medical or other evidence shows that the annuitant is no longer disabled.

[56 FR 12980, Mar. 28, 1991, as amended at 72 FR 21102, Apr. 30, 2007]

(a) General. (1) The reentitlement period is an additional period after the 9 months of trial work during which the annuitant may continue to test his or her ability to work if he or she has a disabling impairment(s).

(2) The disability annuity of an employee, child, or widow(er) who is disabled for any regular employment will not be paid for—

(i) Any month, after the 3rd month, in this period in which the annuitant does substantial gainful activity; or

(ii) Any month in this period in which the annuitant works for an employer covered by the Railroad Retirement Act (see §220.160).

(3) The disability annuity of an employee who is disabled for any regular employment will not be paid for any month in this period in which the employee annuitant earns more than $400 in employment or self-employment (see §§220.161 and 220.164).

(4) If the disability annuity of an employee, child or widow(er) who is disabled for any regular employment is stopped because of work during the trial work period or reentitlement period, and the disability annuitant discontinues that work before the end of either period, the disability annuity may be started again without a new application or a new determination of disability.

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

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

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

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

(1) He or she is not entitled to a trial work period; or

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

If the annuitant is entitled to a disability annuity because he or she is disabled for any regular employment, the annuitant should promptly tell the Board if—

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

(b) He or she returns to work;

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

(d) His or her earnings increase.

There is a statutory requirement that, if an annuitant is entitled to a disability annuity, the annuitant's continued entitlement to such an annuity must be reviewed periodically until the employee or child annuitant reaches full retirement age and the widow(er) annuitant reaches age 60. When the annuitant is entitled to a disability annuity as a disabled employee, disabled widow(er) or as a person disabled since childhood, there are a number of factors to be considered in deciding whether his or her disability continues. The Board must first consider whether the annuitant has worked and, by doing so, demonstrated the ability to engage in substantial gainful activity. If so, the disability will end. If the annuitant has not demonstrated the ability to engage in substantial gainful activity, then the Board must determine if there has been any medical improvement in the annuitant's impairment(s) and, if so, whether this medical improvement is related to the annuitant's ability to work. If an impairment(s) has not medically improved, the Board must consider whether one or more of the exceptions to medical improvement applies. If medical improvement related to ability to work has not occurred and no exception applies, the disability will continue. Even the medical improvement related to ability to work has occurred or an exception applies (see §220.179 for exceptions), in most cases the Board must also show that the annuitant is currently able to engage in substantial gainful activity before it can find that the annuitant is no longer disabled.

[56 FR 12980, Mar. 28, 1991, as amended at 68 FR 39010, July 1, 2003]

There are several terms and definitions which are important to know in order to understand how the Board reviews whether a disability for any regular employment continues:

(a) Medical improvement. Medical improvement is any decrease in the medical severity of an impairment(s) which was present at the time of the most recent favorable medical decision that the annuitant was disabled or continued to be disabled. A determination that there has been a decrease in medical severity must be based on a comparison of prior and current medical evidence showing changes (improvement) in the symptoms, signs or laboratory findings associated with the impairment(s).

Example 1: The claimant was awarded a disability annuity due to a herniated disc. At the time of the Board's prior decision granting the claimant an annuity he had had a laminectomy.

Postoperatively, a myelogram still shows evidence of a persistant deficit in his lumbar spine. He had pain in his back, and pain and a burning sensation in his right foot and leg. There were no muscle weakness or neurological changes and a modest decrease in motion in his back and leg. When the Board reviewed the annuitant's claim to determine whether his disability should be continued, his treating physician reported that he had seen the annuitant regularly every 2 to 3 months for the past 2 years. No further myelograms had been done, complaints of pain in the back and right leg continued especially on sitting or standing for more than a short period of time. The annuitant's doctor further reported a moderately decreased range of motion in the annuitant's back and right leg, but again no muscle atrophy or neurological changes were reported. Medical improvement has not occurred because there has been no decrease in the severity of the annuitant's back impairment as shown by changes in symptoms, signs or laboratory findings.

Example 2: The claimant was awarded a disability annuity due to rheumatoid arthritis. At the time, laboratory findings were positive for this impairment. The claimant's doctor reported persistent swelling and tenderness of the claimant's fingers and wrists and that he complained of joint pain. Current medical evidence shows that while laboratory tests are still positive for rheumatoid arthritis, the annuitant's impairment has responded favorably to therapy so that for the last year his fingers and wrists have not been significantly swollen or painful. Medical improvement has occurred because there has been a decrease in the severity of the annuitant's impairment as documented by the current symptoms and signs reported by his physician. Although the annuitant's impairment is subject to temporary remission and exacerbations, the improvement that has occurred has been sustained long enough to permit a finding of medical improvement. The Board would then determine if this medical improvement is related to the annuitant's ability to work.

(b) Medical improvement not related to ability to do work. Medical improvement is not related to the annuitant's ability to work if there has been a decrease in the severity of the impairment(s) (as defined in paragraph (a) of this section) present at the time of the most recent favorable medical decision, but no increase in that annuitant's functional capacity to do basic work activities as defined in paragraph (d) of this section. If there has been any medical improvement in an annuitant's impairment(s), but it is not related to the annuitant's ability to do work and none of the exceptions applies, the annuity will be continued.

Example: An annuitant was 65 inches tall and weighed 246 pounds at the time his disability was established. He had venous insufficiency and persistent edema in his legs. At the time, the annuitant's ability to do basic work activities was affected because he was able to sit for 6 hours, but was able to stand or walk only occasionally. At the time of the Board's continuing disability review, the annuitant had undergone a vein stripping operation. He now weighed 220 pounds and had intermittent edema. He is still able to sit for 6 hours at a time and to stand or walk only occasionally although he reports less discomfort on walking. Medical improvement has occurred because there has been a decrease in the severity of the existing impairment as shown by his weight loss and the improvement in his edema. This medical improvement is not related to his ability to work, however, because his functional capacity to do basic work activities (i.e., the ability to sit, stand and walk) has not increased.

(c) Medical improvement that is related to ability to do work. Medical improvement is related to an annuitant's ability to work if there has been a decrease in the severity (as defined in paragraph (a) of this section) of the impairment(s) present at the time of the most recent favorable medical decision and an increase in the annuitant's functional capacity to do basic work activities as discussed in paragraph (d) of this section. A determination that medical improvement related to an annuitant's ability to do work has occurred does not, necessarily, mean that such annuitant's disability will be found to have ended unless it is also shown that the annuitant is currently able to engage in substantial gainful activity as discussed in paragraph (e) of this section.

Example 1: The annuitant has a back impairment and has had a laminectomy to relieve the nerve root impingement and weakness in his left leg. At the time of the Board's prior decision, basic work activities were affected because he was able to stand less than 6 hours, and sit no more than 1/2 hour at a time. The annuitant had a successful fusion operation on his back about 1 year before the Board's review of his entitlement. At the time of the Board's review, the weakness in his leg has decreased. The annuitant's functional capacity to perform basic work activities now is unimpaired because he now has no limitation on his ability to sit, walk, or stand. Medical improvement has occurred because there has been a decrease in the severity of his impairment as demonstrated by the decreased weakness in his leg. This medical improvement is related to his ability to work because there has also been an increase in his functional capacity to perform basic work activities (or residual functional capacity) as shown by the absence of limitation on his ability to sit, walk, or stand. Whether or not his disability is found to have ended, however, will depend on the Board's determination as to whether he can currently engage in substantial gainful activity.

Example 2: The annuitant was injured in an automobile accident receiving a compound fracture to his right femur and a fractured pelvis. When he applied for disability annuity 10 months after the accident his doctor reported that neither fracture had yet achieved solid union based on his clinical examination. X-rays supported this finding. The annuitant's doctor estimated that solid union and a subsequent return to full weight bearing would not occur for at least 3 more months. At the time of the Board's review 6 months later, solid union had occurred and the annuitant had been returned to full weight-bearing for over a month. His doctor reported this and the fact that his prior fractures no longer placed any limitation on his ability to walk, stand, and lift, and, that in fact, he could return to full-time work if he so desired.

Medical improvement has occurred because there has been a decrease in the severity of the annuitant's impairments as shown by x-ray and clinical evidence of solid union and his return to full weight-bearing. This medical improvement is related to his ability to work because these findings no longer support an impairment of the severity of the impairment on which the finding that he was medically disabled was based (see §220.178(c)(1)). Whether or not the annuitant's disability is found to have ended will depend on the Board's determination as to whether he can currently engage in substantial gainful activity.

(d) Functional capacity to do basic work activities. (1) Under the law, disability is defined, in part, as the inability to do any regular employment by reason of a physical or mental impairment(s). “Regular employment” is defined in this part as “substantial gainful activity.” In determining whether the annuitant is disabled under the law, the Board will measure, therefore, how and to what extent the annuitant's impairment(s) has affected his or her ability to do work. The Board does this by looking at how the annuitant's functional capacity for doing basic work activities has been affected. Basic work activities means the abilities and aptitudes necessary to do most jobs. Included are exertional abilities such as walking, standing, pushing, pulling, reaching and carrying, and non-exertional abilities and aptitudes such as seeing, hearing, speaking, remembering, using judgment, dealing with changes in a work setting and dealing with both supervisors and fellow workers. The annuitant who has no impairment(s) would be able to do all basic work activities at normal levels; he or she would have an unlimited functional capacity to do basic work activities. Depending on its nature and severity, an impairment(s) will result in some limitation to the functional capacity to do one or more of these basic work activities. Diabetes, for example, can result in circulatory problems which could limit the length of time the annuitant could stand or walk and can result in damage to his or her eyes as well, so that the annuitant also had limited vision. What the annuitant can still do, despite his or her impairment(s), is called his or her residual functional capacity. How the residual functional capacity is assessed is discussed in more detail in §220.120. Unless an impairment is so severe that it is deemed to prevent the annuitant from doing substantial gainful activity (i.e., the impairment(s) is medically disabling), it is this residual functional capacity that is used to determine whether the annuitant can still do his or her past work or, in conjunction with his or her age, education and work experience, do any other work.

(2) A decrease in the severity of an impairment as measured by changes (improvement) in symptoms, signs or laboratory findings can, if great enough, result in an increase in the functional capacity to do work activities. Vascular surgery (e.g., femoropopliteal bypass) may sometimes reduce the severity of the circulatory complications of diabetes so that better circulation results and the annuitant can stand or walk for longer periods. When new evidence showing a change in medical findings establishes that both medical improvement has occurred and the annuitant's functional capacity to perform basic work activities, or residual functional capacity, has increased, the Board will find that medical improvement which is related to the annuitant's ability to do work has occurred. A residual functional capacity assessment is also used to determine whether an annuitant can engage in substantial gainful activity and, thus, whether he or she continues to be disabled (see paragraph (e) of this section).

(3) Many impairment-related factors must be considered in assessing an annuitant's functional capacity for basic work activities. Age is one key factor. Medical literature shows that there is a gradual decrease in organ function with age; that major losses and deficits become irreversible over time and that maximum exercise performance diminishes with age. Other changes related to sustained periods of inactivity and the aging process include muscle atrophy, degenerative joint changes, decrease in range of motion, and changes in the cardiac and respiratory systems which limit the exertional range.

(4) Studies have also shown that the longer the annuitant is away from the workplace and is inactive, the more difficult it becomes to return to ongoing gainful employment. In addition, a gradual change occurs in most jobs so that after about 15 years, it is no longer realistic to expect that skills and abilities acquired in these jobs will continue to apply to the current workplace. Thus, if the annuitant is age 50 or over and had been receiving a disability annuity for a considerable period of time, the Board will consider this factor along with his or her age in assessing the residual functional capacity. This will ensure that the disadvantages resulting from inactivity and the aging process during a longer period of disability will be considered. In some instances where available evidence does not resolve what the annuitant can or cannot do on a sustained basis, the Board may provide special work evaluations or other appropriate testing.

(e) Ability to engage in substantial gainful activity. In most instances, the Board must show that the annuitant is able to engage in substantial gainful activity before stopping his or her annuity. When doing this, the Board will consider all of the annuitant's current impairments not just that impairment(s) present at the time of the most recent favorable determination. If the Board cannot determine that the annuitant is still disabled based on medical considerations alone (as discussed in §§220.110 through 220.115), it will use the new symptoms, signs and laboratory findings to make an objective assessment of functional capacity to do basic work activities (or residual functional capacity) and will consider vocational factors. See §§220.120 through 220.134.

(f) Evidence and basis for the Board's decision. The Board's decisions under this section will be made on a neutral basis without any initial inference as to the presence or absence of disability being drawn from the fact that the annuitant had previously been determined to be disabled. The Board will consider all of the evidence the annuitant submits. An annuitant must give the Board reports from his or her physician, psychologist, or others who have treated or evaluated him or her, as well as any other evidence that will help the board determine if he or she is still disabled (see §220.45). The annuitant must have a good reason for not giving the Board this information or the Board may find that his or her disability has ended (see §220.178(b)(2)). If the Board asks the annuitant, he or she must contact his or her medical sources to help the Board get the medical reports. The Board will make every reasonable effort to help the annuitant in getting medical reports when he or she gives the Board permission to request them from his or her physician, psychologist, or other medical sources, Every reasonable effort means that the Board will make an initial request and, after 20 days, one follow-up request to the annuitant's medical source to obtain the medical evidence necessary to make a determination before the Board evaluates medical evidence obtained from another source on a consultative basis. The medical source will have 10 days from the follow-up to reply (unless experience indicates that a longer period is advisable in a particular case). In some instances the Board may order a consultative examination while awaiting receipt of medical source evidence. Before deciding that an annuitant's disability has ended, the Board will develop a complete medical history covering at least the preceding 12 months (See §220.45(b)). A consultative examination may be purchased when the Board needs additional evidence to determine whether or not an annuitant's disability continues. As a result, the Board may ask the annuitant, upon the Board request and reasonable notice, to undergo consultative examinations and tests to help the Board determine whether the annuitant is still disabled (see §220.50). The Board will decide whether or not to purchase a consultative examination in accordance with the standards in §§220.53 through 220.54.

(g) Point of comparison. For purposes of determining whether medical improvement has occurred, the Board will compare the current medical severity of that impairment(s), which was present at the time of the most recent favorable medical decision that the annuitant was disabled or continued to be disabled, to the medical severity of that impairment(s) at that time. If medical improvement has occurred, the Board will compare the annuitant's current functional capacity to do basic work activities (i.e., his or her residual functional capacity) based on this previously existing impairment(s) with the annuitant's prior residual functional capacity in order to determine whether the medical improvement is related to his or her ability to do work. The most recent favorable medical decision is the latest decision involving a consideration of the medical evidence and the issue of whether the annuitant was disabled or continued to be disabled which became final.

[56 FR 12980, Mar. 28, 1991, as amended at 74 FR 63601, Dec. 4, 2009]

(a) General. Paragraphs (a), (b), and (c) of §220.177 discuss what is meant by medical improvement, medical improvement not related to the ability to work and medical improvement that is related to the ability to work. How the Board will arrive at the decision that medical improvement has occurred and its relationship to the ability to do work, is discussed in paragraphs (b) and (c) of this section.

(b) Determining if medical improvement is related to ability to work. If there is a decrease in medical severity as shown by the symptoms, signs and laboratory findings, the Board then must determine if it is related to the annuitant's ability to do work. In §220.177(d) the relationship between medical severity and limitation on functional capacity to do basic work activities (or residual functional capacity) and how changes in medical severity can affect the annuitant's residual functional capacity is explained. In determining whether medical improvement that has occurred is related to the annuitant's ability to do work, the Board will assess the annuitant's residual functional capacity (in accordance with §220.177(d)) based on the current severity of the impairment(s) which was present at that annuitant's last favorable medical decision. The annuitant's new residual functional capacity will then be compared to the annuitant's residual functional capcity at the time of the Board's most recent favorable medical decision. Unless an increase in the current residual functional capacity is based on changes in the signs, symptoms, or laboratory findings, any medical improvement that has occurred will not be considered to be related to the annuitant's ability to do work.

(c) Additional factors and considerations. The Board will also apply the following in its determinations of medical improvement and its relationship to the annuitant's ability to do work:

(1) Previous impairment was medically disabling. If the Board's most recent favorable decision was based on the fact that the annuitant's impairment(s) at that time was medically disabling, an assessment of his or her residual functional capacity would not have been made. If medical improvement has occurred and the current severity of the prior impairment(s) is no longer medically disabling based on the standard (see §220.100(b)(3)) applied at the time of that decision, the Board will find that the medical improvement was related to the annuitant's ability to work. If the medical findings support impairment(s) that is currently so severe as to be medically disabling, the annuitant is deemed, in the absence of evidence to the contrary, to be unable to engage in substantial gainful activity. If there has been medical improvement to the degree that the impairment(s) is not currently medically disabling, then there has been medical improvement related to the annuitant's ability to work. The Board must, of course, also establish that the annuitant can currently engage in gainful activity before finding that his or her disability has ended.

(2) Prior residual functional capacity assessment made. The residual functional capacity assessment used in making the most recent favorable medical decision will be compared to the residual functional capacity assessment based on current evidence in order to determine if an annuitant's functional capacity for basic work activities has increased. There will be no attempt made to reassess the prior residual functional capacity.

(3) Prior residual functional capacity assessment should have been made, but was not. If the most recent favorable medical decision should have contained an assessment of the annuitant's residual functional capacity (i.e., his or her impairment(s) was not medically disabling) but does not, either because this assessment is missing from the annuitant's file or because it was not done, the Board will reconstruct the residual functional capacity. This reconstructed residual functional capacity will accurately and objectively assess the annuitant's functional capacity to do basic work activities. The Board will assign the maximum functional capacity consistent with an allowance.

Example: The annuitant was previously found to be disabled on the basis that while his impairment was not medically disabling, it did prevent him from doing his past or any other work. The prior adjudicator did not, however, include a residual functional capacity assessment in the rationale of that decision and a review of the prior evidence does not show that such an assessment was ever made. If a decrease in medical severity, i.e., medical improvement, has occurred, the residual functional capacity based on the current level of severity of the annuitant's impairment will have to be compared with his residual functional capacity based on its prior severity in order to determine if the medical improvement is related to his ability to do work. In order to make this comparison, the Board will review the prior evidence and make an objective assessment of the annuitant's residual functional capacity at the time of its most recent favorable medical determination, based on the symptoms, signs and laboratory findings as they then existed.

(4) Impairment subject to temporary remission. In some cases the evidence shows that the annuitant's impairment(s) are subject to temporary remission. In assessing whether medical improvement has occurred in annuitants with this type of impairment(s), the Board will be careful to consider the longitudinal history of the impairment(s), including the occurrence of prior remission, and prospects for future worsenings. Improvement in such impairment(s) that is only temporary, i.e., less than 1 year, will not warrant a finding of medical improvement.

(5) Prior file cannot be located. If the prior file cannot be located, the Board will first determine whether the annuitant is able to now engage in substantial gainful activity based on all of his or her current impairments. (In this way, the Board will be able to determine that his or her disability continues at the earliest point without addressing the often lengthy process of reconstructing prior evidence.) If the annuitant cannot engage in substantial gainful activity currently, his or her disability will continue unless one of the second group of exceptions applies (see §220.179(b)).

[56 FR 12980, Mar. 28, 1991, as amended at 74 FR 63602, Dec. 4, 2009]

(a) First group of exceptions to medical improvement. The law provides for certain limited situations when the annuitant's disability can be found to have ended even though medical improvement has not occurred, if he or she can engage in substantial gainful activity. These exceptions to medical improvement are intended to provide a way of finding that the annuitant is no longer disabled in those limited situations where, even though there has been no decrease in severity of the impairment(s), evidence shows that the annuitant should no longer be considered disabled or never should have been considered disabled. If one of these exceptions applies, the Board must also show that, taking all of the annuitant's current impairment(s) into account, not just those that existed at the time of the Board's most recent favorable medical decision, the annuitant is now able to engage in substantial gainful activity before his or her disability can be found to have ended. As part of the review process, the annuitant will be asked about any medical or vocational therapy that he or she has received or is receiving. Those answers and the evidence gathered as a result as well as all other evidence, will serve as the basis for the finding that an exception applies.

(1) Substantial evidence shows that the annuitant is the beneficiary of advances in medical or vocational therapy or technology (related to his or her ability to work). Advances in medical or vocational therapy or technology are improvements in treatment or rehabilitative methods which have increased the annuitant's ability to do basic work activities. The Board will apply this exception when substantial evidence shows that the annuitant has been the beneficiary of services which reflect these advances and they have favorably affected the severity of his or her impairment(s) or ability to do basic work activities. This decision will be based on new medical evidence and a new residual functional capacity assessment. In many instances, an advanced medical therapy or technology will result in a decrease in severity as shown by symptoms, signs and laboratory findings which will meet the definition of medical improvement. This exception will, therefore, see very limited application.

(2) Substantial evidence shows that the annuitant has undergone vocational therapy (related to his or her ability to work). Vocational therapy (related to the annuitant's ability to work) may include, but is not limited to, additional education, training, or work experience that improves his or her ability to meet the vocational requirements of more jobs. This decision will be based on substantial evidence which includes new medical evidence and a new residual functional capacity assessment. If, at the time of the Board's review the annuitant has not completed vocational therapy which could affect the continuance of his or her disability, the Board will review such annuitant's claim upon completion of the therapy.

Example 1: The annuitant was found to be disabled because the limitations imposed on him by his impairment(s) allowed him to only do work that was at a sedentary level of exertion. The annuitant's prior work experience was work that required a medium level of exertion with no acquired skills that could be transferred to sedentary work. His age, education, and past work experience at the time did not qualify him for work that was below this medium level of exertion. The annuitant enrolled in and completed a specialized training course which qualifies him for a job in data processing as a computer programmer in the period since he was awarded a disability annuity. On review of his claim, current evidence shows that there is no medical improvement and that he can still do only sedentary work. As the work of a computer programmer is sedentary in nature, he is now able to engage in substantial gainful activity when his new skills are considered.

Example 2: The annuitant was previously entitled to a disability annuity because the medical evidence and assessment of his residual functional capacity showed he could only do light work. His prior work was considered to be of a heavy exertional level with no acquired skills that could be transferred to light work. His age, education, and past work experience did not qualify him for work that was below the heavy level of exertion. The current evidence and residual functional capacity show there has been no medical improvement and that he can still do only light work. Since he was originally entitled to a disability annuity, his vocational rehabilitation agency enrolled him in and he successfully completed a trade school course so that he is now qualified to do small appliance repair. This work is light in nature, so when his new skills are considered, he is now able to engage in substantial gainful activity even though there has been no change in his residual functional capacity.

(3) Substantial evidence shows that based on new or improved diagnostic or evaluative techniques the annuitant's impairment(s) is not as disabling as it was considered to be at the time of the most recent favorable decision. Changing methodologies and advances in medical and other diagnostic or evaluative techniques have given, and will continue to give, rise to improved methods for measuring and documenting the effect of various impairments on the ability to do work. Where, by such new or improved methods, substantial evidence shows that the annuitant's impairment(s) is not as severe as was determined at the time of the Board's most recent favorable medical decision, such evidence may serve as a basis for finding that the annuitant can engage in substantial gainful activity and is no longer disabled. In order to be used under this exception, however, the new or improved techniques must have become generally available after the date of the Board's most recent favorable medical decision.

(i) How the Board will determine which methods are new or improved techniques and when they become generally available. New or improved diagnostic techniques or evalutions will come to the Board's attention by several methods. In reviewing cases, the Board often becomes aware of new techniques when their results are presented as evidence. Such techniques and evalutions are also discussed and acknowledged in medical literature by medical professional groups and other governmental entities. Through these sources, the Board develops listings of new techniques and when they become generally available.

(ii) How the annuitant will know which methods are new or improved techniques and when they become generally available. The Board will let annuitants know which methods it considers to be new or improved techniques and when they become available.

Example: The electrocardiographic exercise test has replaced the Master's 2-step test as a measurement of heart function since the time of the annuitant's last favorable medical decision. Current evidence shows that the annuitant's impairment, which was previously evaluated based on the Master's 2-step test, is not now as disabling as was previously thought. If, taking all his current impairments into account, the annuitant is now able to engage in substantial gainful activity, this exception would be used to find that he is no longer disabled even if medical improvement has not occurred.

(4) Substantial evidence demonstrates that any prior disability decision was in error. The Board will apply the exception to medical improvement based on error if substantial evidence (which may be evidence on the record at the time any prior determination of the entitlement to an annuity based on disability was made, or newly obtained evidence which relates to that determination) demonstrates that a prior determination was in error. A prior determination will be found in error only if:

(i) Substantial evidence shows on its face that the decision in question should not have been made (e.g., the evidence in file such as pulmonary function study values was misread or an adjudicative standard such as a medical/vocational rule in appendix 2 of this part was misapplied).

Example 1: The annuitant was granted a disability annuity when it was determined that his epilepsy met Listing 11.02. This listing calls for a finding of major motor seizures more frequently than once a month as documented by EEG evidence and by a detailed description of a typical seizure pattern. As history of either diurnal episodes or nocturnal episodes with residuals interfering with daily activities is also required. On review, it is found that a history of the frequency of his seizures showed that they occurred only once or twice a year. The prior decision would be found to be in error, and whether the annuitant was still considered to be disabled would be based on whether he could currently engage in substantial gainful activity.

Example 2: The annuitant's prior award of a disability annuity was based on vocational rule 201.14 in appendix 2 of this part. This rule applies to a person age 50-54 who has at least a high school education, whose previous work was entirely at semiskilled level, and who can do only sedentary work. On review it is found that at the time of the prior determination the annuitant was actually only age 46 and vocational rule 201.21 should have been used. This rule would have called for a denial of his claim and the prior decision is found to have been in error. Continuation of his disability would depend on a finding of his current inability to engage in substantial gainful activity.

(ii) At the time of the prior evaluation, required and material evidence of the severity of the annuitant's impairment(s) was missing. That evidence becomes available upon review, and substantial evidence demonstrates that had such evidence been present at the time of the prior determination, disability would not have been found.

Example: The annuitant was found disabled on the basis of chronic obstructive pulmonary disease. The severity of his impairment was documented primarily by pulmonary function testing results. The evidence showed that he could do only light work. Spirometric tracings of this testing, although required, were not obtained, however. On review, the original report is resubmitted by the consultative examining physician along with the corresponding spirometric tracings. A review of the tracings shows that the test was invalid. Current pulmonary function testing supported by spirometric tracings reveals that the annuitant's impairment does not limit his ability to perform basic work activities in any way. Error is found based on the fact that required material evidence, which was originally missing, now becomes available and shows that if it had been available at the time of the prior determination, disability would not have been found.

(iii) Substantial evidence which is new evidence relating to the prior determination (of allowance or continuance) refutes the conclusions that were based upon the prior evidence (e.g., a tumor thought to be malignant was later shown to have actually been benign). Substantial evidence must show that had the new evidence (which relates to the prior determination) been considered at the time of the prior decision, the disability would not have been allowed or continued. A substitution of current judgment for that used in the prior favorable decision will not be the basis for applying this exception.

Example: The annuitant was previously found entitled to a disability annuity on the basis of diabetes mellitus which the prior adjudicator believed was medically disabling. The prior record shows that the annuitant has “brittle” diabetes for which he was taking insulin. The annuitant's urine was 3+ for sugar, and he alleged occasional hypoglycemic attacks caused by exertion. His doctor felt the diabetes was never really controlled because he was not following his diet or taking his medication regularly. On review, symptoms, signs and laboratory findings are unchanged. The current adjudicator feels, however, that the annuitant's impairment clearly is not medically disabling. Error cannot be found because it would represent a substitution of current judgment for that of the prior adjudicator that the annuitant's impairment was medically disabling. The exception for error will not be applied retroactively under the conditions set out above unless the conditions for reopening the prior decision are met.

(5) The annuitant is currently engaging in substantial gainful activity. If the annuitant is currently engaging in substantial gainful activity, before the Board determines whether he or she is no longer disabled because of his or her work activity, the Board will consider whether he or she is entitled to a trial work period as set out in §220.170. The Board will find that the annuitant's disability has ended in the month in which he or she demonstrated the ability to engage in substantial gainful activity (following completion of a trial work period, where it applies). This exception does not apply in determining whether the annuitant continues to have a disabling impairment(s) for purposes of deciding his or her eligibility for a reentitlement period.

(b) Second group of exceptions to medical improvement. In addition to the first group of exceptions to medical improvement, the following exceptions may result in a determination that the annuitant is no longer disabled. In these situations the decision will be made without a determination that the annuitant has medically improved or can engage in substantial gainful activity.

(1) A prior determination was fraudulently obtained. If the Board finds that any prior favorable determination was obtained by fraud, it may find that the annuitant is not disabled. In addition, the Board may reopen the claim.

(2) Failure to cooperate with the Board. If there is a question about whether the annuitant continues to be disabled and the Board requests that he or she submit medical or other evidence or go for a physical or mental examination by a certain date, the Board will find that the annuitant's disability has ended if he or she fails (without good cause) to do what is requested. The month in which the annuitant's disability ends will be the first month in which he or she failed to do what was requested.

(3) Inability of the Board to locate the annuitant. If there is question about whether the annuitant continues to be disabled and the Board is unable to find him or her to resolve the question, the Board will suspend annuity payments. If, after a suitable investigation, the Board is still unable to locate the annuitant, the Board will determine that the annuitant's disability has ended. The month such annuitant's disability ends will be the first month in which the question arose and the annuitant could not be found.

(4) Failure of the annuitant to follow prescribed treatment which would be expected to restore the ability to engage in substantial gainful activity. If treatment has been prescribed for the annuitant which would be expected to restore his or her ability to work, he or she must follow that treatment in order to be paid a disability annuity. If the annuitant is not following that treatment and he or she does not have good cause for failing to follow the treatment, the Board will find that his or her disability has ended. The month such annuitant's disability ends will be the first month in which he or she failed to follow the prescribed treatment.

[56 FR 12980, Mar. 28, 1991, as amended at 74 FR 63602, Dec. 4, 2009]

Evaluation steps. To assure that disability reviews are carried out in a uniform manner, that decisions of continuing disability can be made in the most expeditious and administratively efficient way, and that any decisions to stop a disability annuity are made objectively, neutrally and are fully documented, the Board will follow specific steps in reviewing the question of whether an annuitant's disability continues. The Board's review may cease and the disability may be continued at any point if the Board determines that there is sufficient evidence to find that the annuitant is still unable to engage in substantial gainful activity. The steps are—

(a) Is the annuitant engaging in substantial gainful activity? If he or she is (and any applicable trial work period has been completed), the Board will find disability to have ended (see §220.179(a)(5));

(b) If the annuitant is not engaging in substantial gainful activity, does he or she have an impairment or combination of impairments which is medically disabling? If the annuitant's impairment(s) is medically disabling, his or her disability will be found to continue;

(c) If the annuitant's impairment(s) is not medically disabling, has there been medical improvement as defined in §220.177(a)? If there has been medical improvement as shown by a decrease in medical severity, see step (d). If there has been no decrease in medical severity, then there has been no medical improvement; (See step (e));

(d) If there has been medical improvement, the Board must determine whether it is related to the annuitant's ability to do work in accordance with paragraphs (a) through (d) of §220.177, (i.e., whether or not there has been an increase in the residual functional capacity based on the impairment(s) that was present at the time of the most recent favorable medical determination). If medical improvement is not related to the annuitant's ability to do work, see step (e). If medical improvement is related to the annuitant's ability to do work, see step (f);

(e) If the Board found at step (c) that there has been no medical improvement or if it found at step (d) that the medical improvement is not related to the annuitant's ability to work, the Board considers whether any of the exceptions in §220.178 apply. If none of them apply, disability will be found to continue. If one of the first group of exceptions to medical improvement applies, see step (f). If an exception from the second group of exceptions to medical improvement applies, disability will be found to have ended. The second group of exceptions to medical improvement may be considered at any point in this process;

(f) If medical improvement is shown to be related to the annuitant's ability to do work or if one of the first group of exceptions to medical improvement applies, the Board will determine whether all of the annuitant's current impairments in combination are severe. This determination will consider all current impairments and the impact of the combination of those impairments on the ability to function. If the residual functional capacity assessment in step (d) above shows significant limitation of ability to do basic work activities, see step (g). When the evidence shows that all current impairments in combination do not significantly limit physical or mental abilities to do basic work activities, these impairments will not be considered severe in nature, and the annuitant will no longer be consider to be disabled;

(g) If the annuitant's impairment(s) is severe, the Board will assess his or her current ability to engage in substantial gainful activity. That is, the Board will assess the annuitant's residual functional capacity based on all of his or her current impairments and consider whether he or she can still do work that was done in the past. If he or she can do such work, disability will be found to have ended; and

(h) If the annuitant is not able to do work he or she has done in the past, the Board will consider one final step. Given the residual functional capacity assessment and considering the annuitant's age, education and past work experience, can he or she do other work? If the annuitant can do other work, disability will be found to have ended. If he or she cannot do other work, disability will be found to continue.

[56 FR 12980, Mar. 28, 1991, as amended at 74 FR 63603, Dec. 4, 2009]

If the evidence shows that the annuitant is no longer disabled, the Board will find that his or her disability ended in the earliest of the following months—

(a) The month the Board mails the annuitant a notice saying that the Board finds that he or she is no longer disabled based on evidence showing:

(1) There has been medical improvement in the annuitant's impairments related to the ability to work and the annuitant has the capacity to engage in substantial gainful work under the rules set out in §§220.177 and 220.178; or

(2) There has been no medical improvement in the annuitant's impairments related to the ability to work but the annuitant has the capacity to engage in substantial gainful work and one of the exceptions to medical improvement set out in §220.179(a)(1), (2), (3) or (4) applies.

(b) The month in which the annuitant demonstrated his or her ability to engage in substantial gainful activity (following completion of a trial work period);

(c) The month in which the annuitant actually does substantical gainful activity where such annuitant is not entitled to a trial work period;

(d) The month in which the annuitant returns to full-time work, with no significant medical restrictions and acknowledges that medical improvement has occurred, and the Board expected the annuitant's impairment(s) to improve;

(e) The first month in which the annuitant failed without good cause to do what the Board asked, when the rule set out in paragraph (b)(2) of §220.179 applies;

(f) The first month in which the question of continuing disability arose and the Board could not locate the annuitant after a suitable investigation (see §220.179(b)(3));

(g) The first month in which the annuitant failed without good cause to follow prescribed treatment, when the rule set out in paragraph (b)(4) of §220.179 applies; or

(h) The first month the annuitant was told by his or her physician that he or she could return to work provided there is no substantial conflict between the physician's and the annuitant's statements regarding that annuitant's awareness of his or her capacity for work and the earlier date is supported by the medical evidence.

(i) The month the evidence shows that the annuitant is no longer disabled under the rules set out in §§220.177 through 220.180, and he or she was disabled only for a specified period of time in the past as discussed in §220.21 or §220.105;

[56 FR 12980, Mar. 28, 1991, as amended at 74 FR 63603, Dec. 4, 2009]

Before the Board stops a disability annuity, it will give the annuitant a chance to explain why it should not do so.

(a) General. If the Board determines that the annuitant does not meet the disability requirements of the law, the disability annuity will generally stop. Except in the circumstance described in paragraph (d) of this section, the Board will give the annuitant advance written notice when the Board has determined that he or she is not now disabled.

(b) What the advance written notice will tell the annuitant. The advance written notice will provide—

(1) A summary of the information the Board has and an explanation of why the Board believes the annuitant is no longer disabled. If it is because of medical reasons, the notice will tell the annuitant what the medical information in his or her file shows. If it is because of the annuitant's work activity, the notice will tell the annuitant what information the Board has about the work he or she is doing or has done, and why this work shows that he or she is not disabled. If it is because of the annuitant's failure to give the Board information the Board needs or failure to do what the Board asks, the notice will tell the annuitant what information the Board needs and why, or what the annuitant has to do and why;

(2) The date the disability annuity will stop;

(3) An opportunity for the annuitant to submit evidence within a specified period to support continuance of disability before the decision becomes final; and

(4) An explanation of the annuitant's rights to reconsideration and appeal after the decision becomes final.

(c) What the annuitant should do if he or she receives an advance written notice. If the annuitant agrees with the advance written notice, he or she does not need to take any action. If the annuitant desires further information or disagrees with what the Board has told him or her, the annuitant should immediately write or visit a Board office. If the annuitant believes he or she is now disabled, the annuitant should tell the Board why. The annuitant may give the Board any additional or new information, including reports from doctors, hospitals, railroad or non-railroad employers, or others that he or she believes the Board should have. The annuitant should send these as soon as possible to a Board office.

(d) When the Board will not give the annuitant advance written notice. The Board will not give the annuitant advance written notice when the Board determines that he or she is not now disabled if the Board recently told the annuitant that—

(1) The information the Board has shows that he or she is not disabled;

(2) The Board was gathering more information; and

(3) The disability annuity would stop.

If a new severe impairment(s) begins in or before the month in which the last impairment(s) ends, the Board will find that disability is continuing. The impairment(s) need not be expected to last 12 months or to result in death, but it must be severe enough to keep the annuitant from doing substantial gainful activity, or severe enough so that he or she is still disabled.

After the Board finds that the annuitant is disabled, the Board must evaluate the annuitant's impairment(s) from time to time to determine if the annuitant is still eligible for disability cash benefits. The Board calls this evaluation a continuing disability review. The Board may begin a continuing disability review for any number of reasons including the annuitant's failure to follow the provisions of the Railroad Retirement Act or these regulations. When the Board begins such a review, the Board will notify the annuitant that the Board is reviewing the annuitant's eligibility for disability benefits, why the Board is reviewing the annuitant's eligibility, that in medical reviews the medical improvement review standard will apply, that the Board's review could result in the termination of the annuitant's benefits, and that the annuitant has the right to submit medical and other evidence for the Board's consideration during the continuing disability review. In doing a medical review the Board will develop a complete medical history of at least the preceding 12 months in any case in which a determination is made that the annuitant is no longer under a disability. If this review shows that the Board should stop payment of cash benefits, the Board will notify the annuitant in writing and give the annuitant an opportunity to appeal. In §220.186 the Board describes those events that may prompt it to review whether the annuitant continues to be disabled.

(a) General. The Board conducts continuing disability reviews to determine whether or not the annuitant continues to meet the disability requirements of the law. Payment of cash benefits or a period of disability ends if the medical or other evidence shows that the annuitant is not disabled under the standards set out in section 2 of the Railroad Retirement Act or section 223(f) of the Social Security Act.

(b) When the Board will conduct a continuing disability review. A continuing disability review will be started if—

(1) The annuitant has been scheduled for a medical improvement expected diary review;

(2) The annuitant has been scheduled for a periodic review in accordance with the provisions of paragraph (d) of this section;

(3) The Board needs a current medical or other report to see if the annuitant's disability continues. (This could happen when, for example, an advance in medical technology, such as improved treatment for Alzheimer's disease or a change in vocational therapy or technology raises a disability issue.);

(4) The annuitant returns to work and successfully completes a period of trial work;

(5) Substantial earnings are reported to the annuitant's wage record;

(6) The annuitant tells the Board that he or she has recovered from his or her disability or that he or she has returned to work;

(7) A State Vocational Rehabilitation Agency tells the Board that—

(i) The services have been completed; or

(ii) The annuitant is now working; or

(iii) The annuitant is able to work;

(8) Someone in a position to know of the annuitant's physical or mental condition tells the Board that the annuitant is not disabled, that the annuitant in not following prescribed treatment, that the annuitant has returned to work, or that the annuitant is failing to follow the provisions of the Social Security Act, the Railroad Retirement Act, or these regulations, and it appears that the report could be substantially correct; or

(9) Evidence the Board receives raises a question as to whether the annuitant's disability continues.

(c) Definitions. As used in this section—

Medical improvement expected diary— refers to a case which is scheduled for review at a later date because the individual's impairment(s) is expected to improve. Generally, the diary period is set for not less than 6 months or for not more than 18 months. Examples of cases likely to be scheduled for a medical improvement excepted diary are fractures and cases in which corrective surgery is planned and recovery can be anticipated. The term “medical improvement expected diary” also includes a case which is scheduled for a review at a later date because the individual is undergoing vocational therapy, training or an educational program which may improve his or her ability to work so that the disability requirement of the law is no longer met. Generally, the diary period will be the length of the training, therapy, or program of education.

Permanent impairment medical improvement not expected—refers to a case in which any medical improvement in the person's impairment(s) is not expected. This means an extremely severe condition determined on the basis of our experience in administering the disability program to be at least static, but more likely to be progressively disabling either by itself or by reason of impairment complications, and unlikely to improve so as to permit the individual to engage in substantial gainful activity. The interaction of the individual's age, impairment consequences and lack of recent attachment to the labor market may also be considered in determining whether an impairment is permanent. Improvement which is considered temporary under §220.178(c)(3), will not be considered in deciding if an impairment is permanent. Examples of permanent impairments are as follows and are not intended to be all inclusive:

(1) Parkinsonian syndrome with significant rigidity, brady kinesia, or tremor in two extremities, which, singly or in combination, result in sustained disturbance of gross and dexterous movements, or gait and station.

(2) Amyotrophic lateral sclerosis, based on documentation of a clinically appropriate medical history, neurological findings consistent with the diagnosis of ALS, and the results of any electrophysiological and neuroimaging testing.

(3) Diffuse pulmonary fibrosis in an individual age 55 or older which reduces FEV1 to 1.45 to 2.05 (L, BTPS) or less depending on the individual's height.

(4) Amputation of leg at hip.

Nonpermanent impairment refers to a case in which any medical improvement in the person's impairment(s) is possible. This means an impairment for which improvement cannot be predicted based on current experience and the facts of the particular case but which is not at the level of severity of an impairment that is considered permanent. Examples of nonpermanent impairments are: regional enteritis, hyperthyroidism, and chronic ulcerative colitis.

(d) Frequency of review. If an annuitant's impairment is expected to improve, generally the Board will review the annuitant's continuing eligibility for disability benefits at intervals from 6 months to 18 months following the Board's most recent decision. The Board's notice to the annuitant about the review of the annuitant's case will tell the annuitant more precisely when the review will be conducted. If the annuitant's disability is not considered permanent but is such that any medical improvement in the annuitant's impairment(s) cannot be accurately predicted, the Board will review the annuitant's continuing eligibility for disability benefits at least once every 3 years. If no medical improvement is expected in the annuitant's impairment(s), the Board will not routinely review the annuitant's continuing eligibility. Regardless of the annuitant's classification, the Board will conduct an immediate continuing disability review if a question of continuing disability is raised pursuant to paragraph (b) of this section.

(e) Change in classification of impairment. If the evidence developed during a continuing disability review demonstrates that the annuitant's impairment has improved, is expected to improve, or has worsened since the last review, the Board may reclassify the annuitant's impairment to reflect this change in severity. A change in the classification of the annuitant's impairment will change the frequency with which the Board will review the case. The Board may also reclassify certain impairments because of improved tests, treatment, and other technical advances concerning those impairments.

(f) Review after administrative appeal. If the annuitant was found eligible to receive or to continue to receive disability benefits on the basis of a decision by a hearings officer, the three-member Board or a Federal court, the agency will not conduct a continuing disability review earlier than 3 years after that decision unless the annuitant's case should be scheduled for a medical improvement expected or vocational reexamination diary review or a question of continuing disability is raised pursuant to paragraph (b) of this section.

(g) Waiver of timeframes. All cases involving a nonpermanent impairment will be reviewed by the Board at least once every 3 years unless the Board determines that the requirements should be waived to ensure that only the appropriate number of cases are reviewed. The appropriate number of cases to be reviewed is to be based on such considerations as the backlog of pending reviews, the projected number of new applications, and projected staffing levels. Therefore, an annuitant's continuing disability review may be delayed longer than 3 years following the Board's original decision or other review under certain circumstances. Such a delay would be based on the Board's need to ensure that backlogs, and new disability claims workloads are accomplished within available medical and other resources and that such reviews are done carefully and accurately.

[56 FR 12980, Mar. 28, 1991, as amended at 65 FR 20372, Apr. 17, 2000; 74 FR 63603, Dec. 4, 2009]

If the annuitant's impairment was expected to improve and the annuitant returned to full-time work with no significant medical limitations and acknowledges that medical improvement has occurred, the Board may find that the annuitant's disability ended in the month he or she returned to work. Unless there is evidence showing that the annuitant's disability has not ended, the Board will use the medical and other evidence already in the annuitant's file and the fact that he or she has returned to full-time work without significant limitations to determine that the annuitant is no longer disabled. (If the annuitant's impairment is not expected to improve, the Board will not ordinarily review his or her claim until the end of the trial work period, as described in §220.170.)

Example: Evidence obtained during the processing of the annuitant's claim showed that the annuitant had an impairment that was expected to improve about 18 months after the annuitant's disability began. The Board, therefore, told the annuitant that his or her claim would be reviewed again at that time. However, before the time arrived for the annuitant's scheduled medical reexamination, the annuitant told the Board that he or she had returned to work and the annuitant's impairment had improved. The Board investigated immediately and found that, in the 16th month after the annuitant's began, the annuitant returned to full-time work without any significant medical restrictions. Therefore, the Board would find that the annuitant's disability ended in the first month the annuitant returned to full-time work.

Sec.

200.00   Introduction.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

RuleAgeEducationPrevious work experienceDecision
201.01Advanced ageLimited or lessUnskilled or noneDisabled.
201.02......do......doSkilled or semiskilled—skills not transferable1      Do.
201.03......do......doSkilled or semiskilled—skills transferable1Not disabled.
201.04......doHigh school graduate or more—does not provide for direct entry into skilled work2Unskilled or noneDisabled.
201.05......doHigh school graduate or more—provides for direct entry into skilled work2......doNot disabled.
201.06......doHigh school graduate or more—does not provide for direct entry into skilled work2Skilled or semiskilled—skills not transferable1Disabled.
201.07......do......doSkilled or semiskilled—skills transferable1Not disabled.
201.08......doHigh school graduate or more—provides for direct entry into skilled work2Skilled or semiskilled—skills not transferable1      Do.
201.09Closely approaching advanced ageLimited or lessUnskilled or noneDisabled.
201.10......do......doSkilled or semiskilled—skills not transferable      Do.
201.11......do......doSkilled or semiskilled—skills transferableNot disabled.
201.12......doHigh school graduate or more—does not provide for direct entry into skilled work3Unskilled or noneDisabled.
201.13......doHigh school graduate or more—provides for direct entry into skilled work3......doNot disabled.
201.14......doHigh school graduate or more—does not provide for direct entry into skilled work3Skilled or semiskilled—skills not transferableDisabled.
201.15......do......doSkilled or semiskilled—skills transferableNot disabled.
201.16......doHigh school graduate or more—provides for direct entry into skilled work3Skilled or semiskilled—skills not transferable      Do.
201.17Younger individual age 45-49Illiterate or unable to communicate in EnglishUnskilled or noneDisabled.
201.18......doLimited or less—at least literate and able to communicate in English......doNot disabled.
201.19......doLimited or lessSkilled or semiskilled—skills not transferable      Do.
201.20......do......doSkilled or semiskilled—skills transferable      Do.
201.21......doHigh school graduate or moreSkilled or semiskilled—skills not transferable      Do.
201.22......do......doSkilled or semiskilled—skills transferable      Do.
201.23Younger individual age 18-44Illiterate or unable to communicate in EnglishUnskilled or none      Do.4
201.24......doLimited or less—at least literate and able to communicate in English......do      Do.4
201.25......doLimited or lessSkilled or semiskilled—skills not transferable      Do.4
201.26......do......doSkilled or semiskilled—skills transferable      Do.4
201.27......doHigh school graduate or moreUnskilled or none      Do.4
201.28......do......doSkilled or semiskilled—skills not transferable      Do.4
201.29......do......doSkilled or semiskilled—skills transferable      Do.4

1See 201.00(f).

2See 201.00(d).

3See 201.00(g).

4See 201.00(h).

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

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

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

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

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

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

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

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

RuleAgeEducationPrevious work experienceDecision
202.01Advanced ageLimited or lessUnskilled or noneDisabled.
202.02......do......doSkilled or semiskilled—skills not transferable      Do.
202.03......do......doSkilled or semiskilled—skills transferable1Not disabled.
202.04......doHigh school graduate or more—does not provide for direct entry into skilled work2Unskilled or noneDisabled.
202.05......doHigh school graduate or more—provides for direct entry into skilled work2......doNot disabled.
202.06......doHigh school graduate or more—does not provide for direct entry into skilled work2Skilled or semiskilled—skills not transferableDisabled.
202.07......do......doSkilled or semiskilled—skills transferable2Not disabled.
202.08......doHigh school graduate or more—provides for direct entry into skilled work2Skilled or semiskilled—skills not transferable      Do.
202.09Closely approaching advanced ageIlliterate or unable to communicate in EnglishUnskilled or noneDisabled.
202.10......doLimited or less—At least literate and able to communicate in English......doNot disabled.
202.11......doLimited or lessSkilled or semiskilled—skills not transferable      Do.
202.12......do......doSkilled or semiskilled—skills transferable      Do.
202.13......doHigh school graduate or moreUnskilled or none      Do.
202.14......do......doSkilled or semiskilled—skills not transferable      Do.
202.15......do......doSkilled or semiskilled—skills transferable      Do.
202.16Younger individualIlliterate or unable to communicate in EnglishUnskilled or none      Do.
202.17......doLimited or less—At least literate and able to communicate in English......do      Do.
202.18......doLimited or lessSkilled or semiskilled—skills not transferable      Do.
202.19......do......doSkilled or semiskilled—skills transferable      Do.
202.20......doHigh school graduate or moreUnskilled or none      Do.
202.21......do......doSkilled or semiskilled—skills not transferable      Do.
202.22......do......doSkilled or semiskilled—skills transferable      Do.

1See 202.00(f).

2See 202.00(c).

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

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

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

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

RuleAgeEducationPrevious work experienceDecision
203.01Closely approaching retirement ageMarginal or noneUnskilled or noneDisabled.
203.02......doLimited or lessNone      Do.
203.03......doLimitedUnskilledNot disabled.
203.04......doLimited or lessSkilled or semiskilled—skills not transferable      Do.
203.05......do......doSkilled or semiskilled—skills transferable      Do.
203.06......doHigh school graduate or moreUnskilled or none      Do.
203.07......doHigh school graduate or more—does not provide for direct entry into skilled workSkilled or semiskilled—skills not transferable      Do.
203.08......do......doSkilled or semiskilled—skills transferable      Do.
203.09......doHigh school graduate or more—provides for direct entry into skilled workSkilled or semiskilled—skills not transferable      Do.
203.10Advanced ageLimited or lessNoneDisabled.
203.11......do......doUnskilledNot disabled.
203.12......do......doSkilled or semiskilled—skills not transferable      Do.
203.13......do......doSkilled or semiskilled—skills transferable      Do.
203.14......doHigh school graduate or moreUnskilled or none      Do.
203.15......doHigh school graduate or more—does not provide for direct entry into skilled workSkilled or semiskilled—skills not transferable      Do.
203.16......do......doSkilled or semiskilled—skills transferable      Do.
203.17......doHigh school graduate or more—provides for direct entry into skilled workSkilled or semiskilled—skills not transferable      Do.
203.18Closely approaching advanced ageLimited or lessUnskilled or none      Do.
203.19......do......doSkilled or semiskilled—skills not transferable      Do.
203.20......do......doSkilled or semiskilled—skills transferable      Do.
203.21......doHigh school graduate or moreUnskilled or none      Do.
203.22......doHigh school graduate or more—does not provide for direct entry into skilled workSkilled or semiskilled—skills not transferable      Do.
203.23......do......doSkilled or semiskilled—skills transferable      Do.
203.24......doHigh school graduate or more—provides for direct entry into skilled workSkilled or semiskilled—skills not transferable      Do.
203.25Younger individualLimited or lessUnskilled or none      Do.
203.26......do......doSkilled or semiskilled—skills not transferable      Do.
203.27......do......doSkilled or semiskilled—skills transferable      Do.
203.28......doHigh school graduate or moreUnskilled or none      Do.
203.29......doHigh school graduate or more—does not provide for direct entry into skilled workSkilled or semiskilled—skills not transferable      Do.
203.30......do......doSkilled or semiskilled—skills transferable      Do.
203.31......doHigh school graduate or more—provides for direct entry into skilled workSkilled or semiskilled—skills not transferable      Do.

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

[56 FR 12980, Mar. 28, 1991, as amended at 68 FR 60294, Oct. 22, 2003]

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 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:

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

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].

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.

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.

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 type2-year15-year1Disability status2Functional impact3
Brain:
Local261S
Regional27.91S
Distant23.61S
Female Breast:
Regional71.12S
Distant17.81S
Colon:
Local912S
Regional60.12S
Distant61S
Rectal:
Local84.52S
Regional50.72S
Distant5.31S
Esophagus:
Local18.51S
Regional5.21S
Distant1.81S
Hodgkin's Disease:4
Stage 190-953S
Stage 2862S
Stage 3<802S
Stage 4<801S
Kidney/Renal Pelvis:
Local85.43S
Regional56.32S
Distant91S
Larynx:
Local84.22S
Regional52.52S
Distant241S
Acute Lymphocytic Leukemia:
All51.12S
Chronic Lymphocytic Leukemia:
All66.22S
Acute Myelogenous Leukemia:
All9.71S
Chronic Myelogenous Leukemia:
All21.71S
Liver/Intrahepatic Bile Duct:
Local15.11S
Regional5.81S
Distant1.91S
Lung/Bronchus:5
Local45.62S
Regional13.11S
Distant1.31S
Melanomas of Skin:
Regional53.62S
Distant12.81S
Oral Cavity/Pharyngeal:
Local76.22S
Regional40.92S
Distant18.71S
Pancreas:
Local6.11S
Regional3.71S
Distant1.41S
Prostate:
Local913S
Regional80.42S
Distant281S
Stomach:
Local55.41S
Regional17.31S
Distant2.11S
Testicular:
Distant65.51S
Thyroid:
Regional93.13S
Distant47.21S
Bladder:
Regional462S
Distant9.11S

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.

B. Endocrine

Confirmatory testMinimum resultRequirements
BODY PART: ENDOCRINE
CONFIRMATORY TESTS
Diabetes, requiring insulin (IDDM):
Medical record reviewConfirmation of condition and need for insulin useHighly recommended.
Disability testTest resultDisability classification
BODY PART: ENDOCRINE
JOB TITLE: ENGINEER
Diabetes, requiring insulin (IDDM):
Medical record reviewConfirmation of condition and need for insulin useD

C. Cardiac

Confirmatory testMinimum resultRequirements
BODY PART: CARDIAC
CONFIRMATORY TESTS
Angina:
Medical record reviewConfirmed history of ischemia including copies of electrocardiogramRecommended.
Stress testDefinite ischemia on exercise testRecommended.
Thallium studyDefinite ischemia with exerciseRecommended.
Aortic valve disease:
Cardiac catheterizationProven and significantRecommended.
EchocardiogramSignificant valve diseaseRecommended.
Coronary artery disease:
Medical record reviewDocumented ischemia with electrocardiogram confirmationRecommended.
Medical record reviewDocumented myocardial infarctionRecommended.
Stress testPositiveRecommended.
Thallium studyDefinite ischemia with exerciseRecommended.
AngiographyDefinite occlusion (≤60%) of one vesselRecommended.
Cardiomyopathy:
EchocardiogramProven ejection fraction ≤35%Recommended.
CatheterizationPoor global function and not coronary artery diseaseRecommended.
Hypertension:
Medical record reviewDocumentation of hypertension for one yearHighly recommended.
Medical record reviewDefinite diagnosis by cardiologist or internistHighly recommended.
Medical record reviewConfirmation of medication useHighly recommended.
Arrhythmia: heart block:
Medical record reviewProven episode with electrocardiogram confirmationRecommended.
ElectrocardiogramDocumentation of arrhythmiaRecommended.
Mitral valve disease:
Cardiac catheterizationSignificant valve diseaseRecommended.
EchocardiogramSignificant valve diseaseRecommended.
Pericardial disease:
Medical record reviewConfirmed by cardiologist or internistHighly recommended.
Pulmonary hypertension:
Physical examinationIncreased pulmonic sound or pulmonary ejection murmur by cardiologist or internistRecommended.
ElectrocardiogramDefinite right ventricular hypertensionHighly recommended.
Ventricular ectopy:
Medical record reviewDefinite episode within one yearRecommended.
Holter monitoringDefinite arrhythmiaRecommended.
Provocative testingPositive responseRecommended.
Arrhythmia: supraventricular tachycardia:
Medical record reviewDefinite episode within one yearRecommended.
Holter monitoringDefinite arrhythmiaRecommended.
Post heart transplant:
Medical record reviewDocumentedHighly recommended.
Disability testTest resultDisability classification
BODY PART: CARDIAC
JOB TITLE: TRAINMAN
Angina:
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤7 METSD
Medical record reviewUnstable as diagnosed by cardiologistD
Stress testDocumented hypotensive responseD
Stress test: significant ST changesDefinite ischemia ≤7 METSD
Aortic valve disease:
Cardiac catheterizationAortic gradient 25-50 mm HG
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤7 METSD
Coronary artery disease:
Myocardial infarctionMultiple infarctionsD
EchocardiogramConfirmed ventricular aneurysmD
Cardiac catheterizationAortic gradient 25-50 mm HgD
Cardiac catheterizationPoor ejection fraction ≤35%D
Stress testPeak exercise ≤7 METSD
Medical record reviewUnstable as diagnosed by a CardiologistD
Stress testDocumented hypotensive responseD
Stress testDefinite ischemia ≤ 7 METSD
Isotope, e.g., thallium studyDefinite ischemia ≤ 7 METSD
Cardiomyopathy:
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤7 METSD
Hypertension:
Medical record reviewDiastolic ≤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:
HolterDocumented asystole length ≤1.5-2 secondsD
Medical record reviewDocumented syncope with proven arrhythmiaD
Mitral valve disease:
Cardiac catheterizationMitral valve gradient ≥5 mm HgD
Cardiac catheterizationMitral regurgitation severeD
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤7 METSD
Pericardial disease:
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Ventricular ectopy:
Medical record reviewDocumented life threatening arrhythmiaD
HolterUncontrolled ventricular rhythmD
Medical record reviewDocumented related syncopeD
Arrhythmia: supraventricular tachycardia:
Medical record reviewDocumented related syncopeD
Post heart transplant:
Medical record reviewPost heart transplantD
BODY PART: CARDIAC
JOB TITLE: ENGINEER
Angina:
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Medical record reviewUnstable as diagnosed by cardiologistD
Stress testDocumented hypotensive responseD
Stress test: significant ST changesDefinite ischemia ≤5 METSD
Aortic valve disease:
Cardiac catheterizationAortic gradient 25-50 mm HGD
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Coronary artery disease:
Myocardial infarctionMultiple infarctionsD
EchocardiogramConfirmed ventricular aneurysmD
Cardiac catheterizationAortic gradient 25-50 mm HgD
Cardiac catheterizationPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Medical record reviewUnstable as diagnosed by a CardiologistD
Stress testDocumented hypotensive responseD
Stress testDefinite ischemia ≤5 METSD
Isotope, e.g., thallium studyDefinite ischemia ≤5 METSD
Cardiomyopathy:
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Hypertension:
Medical record reviewDiastolic ≤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:
HolterDocumented asystole length ≤1.5-2 secondsD
Medical record reviewDocumented syncope with proven arrhythmiaD
Mitral valve disease:
Cardiac catheterizationMitral valve gradient ≥10 mm HgD
Cardiac catheterizationMitral regurgitation severeD
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Pericardial disease:
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Ventricular ectopy:
Medical record reviewDocumented life threatening arrhythmiaD
HolterUncontrolled ventricular rhythmD
Medical record reviewDocumented related syncopeD
Arrhythmia: supraventricular tachycardia:
Medical record reviewDocumented related syncopeD
Post heart transplant:
Medical record reviewPost heart transplantD
BODY PART: CARDIAC
JOB TITLE: DISPATCHER
Angina:
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Medical record reviewUnstable as diagnosed by cardiologistD
Stress testDocumented hypotensive responseD
Stress test: significant ST changesDefinite ischemia ≤5 METSD
Aortic valve disease:
Cardiac catheterizationAortic gradient 25-50 mm HgD
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Coronary artery disease:
Myocardial infarctionMultiple infarctionsD
EchocardiogramConfirmed ventricular aneurysmD
Cardiac catheterizationAortic gradient 25-50 mm HgD
Cardiac catheterizationPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Medical record reviewUnstable as diagnosed by cardiologistD
Stress testDocumented hypotensive responseD
Stress testDefinite ischemia ≤5 METSD
Isotope, e.g., thallium studyDefinite ischemia ≤5 METSD
Cardiomyopathy:
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Hypertension:
Medical record reviewDiastolic ≤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:
HolterDocumented asystole length ≤1.5-2 secondsD
Medical record reviewDocumented syncope with proven arrhythmiaD
Mitral valve disease:
Cardiac catheterizationMitral valve gradient ≥10 mm HgD
Cardiac catheterizationMitral regurgitation severeD
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Pericardial disease:
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Ventricular ectopy:
Medical record reviewDocumented life threatening arrhythmiaD
HolterUncontrolled ventricular rhythmD
Medical record reviewDocumented related syncopeD
Arrhythmia: supraventricular tachycardia:
Medical record reviewDocumented related syncopeD
Post heart transplant:
Medical record reviewPost heart transplantD
BODY PART: CARDIAC
JOB TITLE: CARMAN
Angina:
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Medical record reviewUnstable as diagnosed by cardiologistD
Stress testDocumented hypotensive responseD
Stress test: significant ST changesDefinite ischemia ≤5 METSD
Aortic valve disease:
Cardiac catheterizationAortic gradient 25-50 mm HG
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Coronary artery disease:
Myocardial infarctionMultiple infarctionsD
EchocardiogramConfirmed ventricular aneurysmD
Cardiac catheterizationAortic gradient 25-50 mm HgD
Cardiac catheterizationPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Medical record reviewUnstable as diagnosed by a CardiologistD
Stress testDocumented hypotensive responseD
Stress testDefinite ischemia ≤ 5 METSD
Isotope, e.g., thallium studyDefinite ischemia ≤ 5 METSD
Cardiomyopathy:
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Hypertension:
Medical record reviewDiastolic ≤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:
HolterDocumented asystole length ≤1.5-2 secondsD
Medical record reviewDocumented syncope with proven arrhythmiaD
Mitral valve disease:
Cardiac catheterizationMitral valve gradient ≥10 mm HgD
Cardiac catheterizationMitral regurgitation severeD
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Pericardial disease:
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Ventricular ectopy:
Medical record reviewDocumented life threatening arrhythmiaD
HolterUncontrolled ventricular rhythmD
Medical record reviewDocumented related syncopeD
Arrhythmia: supraventricular tachycardia:
Medical record reviewDocumented related syncopeD
Post heart transplant:
Medical record reviewPost heart transplantD
BODY PART: CARDIAC
JOB TITLE: SIGNALMAN
Angina:
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤7 METSD
Medical record reviewUnstable as diagnosed by cardiologistD
Stress testDocumented hypotensive responseD
Stress test: significant ST changesDefinite ischemia ≤7 METSD
Aortic valve disease:
Cardiac catheterizationAortic gradient 25-50 mm HGD
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤7 METSD
Coronary artery disease:
Myocardial infarctionMultiple infractionsD
EchocardiogramConfirmed ventricular aneurysmD
Cardiac catheterizationAortic gradient 25-50 mm HgD
Cardiac catheterizationPoor ejection fraction ≤35%D
Stress testPeak exercise ≤7 METSD
Medical record reviewUnstable as diagnosed by cardiologistD
Stress testDocumented hypotensive responseD
Stress testDefinite ischemia ≤7 METSD
Isotope, e.g., thallium studyDefinite ischemia ≤7 METSD
Cardiomyopathy:
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤7 METSD
Hypertension:
Medical record reviewDiastolic ≤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
HolterDocumented asystole length ≤1.5-2 secondsD
Medical record reviewDocumented syncope with proven arrhythmiaD
Mitral valve disease:
Cardiac catheterizationMitral valve gradient ≥5 mm HgD
Cardiac catherizationMitral regurgitation severeD
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤7 METSD
Pericardial disease:
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Ventricular ectopy:
Medical record reviewDocumented life threatening arrhythmiaD
HolterUncontrolled ventricular rhythmD
Medical record reviewDocumented related syncopeD
Arrhythmia: supraventricular tachycardia:
Medical record reviewDocumented related syncopeD
Post heart transplant:
Medical record reviewPost heart transplantD
BODY PART: CARDIAC
JOB TITLE: TRACKMAN
Angina:
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤7 METSD
Medical record reviewUnstable as diagnosed by cardiologistD
Stress testDocumented hypotensive responseD
Stress test: significant ST changesDefinite ischemia ≤7 METSD
Aortic valve disease:
Cardiac catheterizationAortic gradient 25-50 mm HGD
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤7 METSD
Coronary artery disease:
Myocardial infarctionMultiple infarctionsD
EchocardiogramConfirmed ventricular aneurysmD
Cardiac catheterizationAortic gradient 25-50 mm HgD
Cardiac catheterizationPoor ejection fraction ≤35%D
Stress testPeak exercise ≤7 METSD
Medical record reviewUnstable as diagnosed by a cardiologistD
Stress testDocumented hypotensive responseD
Stress testDefinite ischemia ≤7 METSD
Isotope, e.g., thallium studyDefinite ischemia ≤7 METSD
Cardiomyopathy:
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤7 METSD
Hypertension:
Medical record reviewDiastolic ≤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:
HolterDocumented asystole length ≤1.5-2 secondsD
Medical record reviewDocumented syncope with proven arrhythmiaD
Mitral valve disease:
Cardiac catheterizationMitral valve gradient ≥5 mm HgD
Cardiac catheterizationMitral regurgitation severeD
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤7 METSD
Pericardial disease:
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Ventricular ectopy:
Medical record reviewDocumented life threatening arrhythmiaD
HolterUncontrolled ventricular rhythmD
Medical record reviewDocumented related syncopeD
Arrhythmia: supraventricular tachycardia:
Medical record reviewDocumented related syncopeD
Post heart transplant:
Medical record reviewPost heart transplantD
BODY PART: CARDIAC
JOB TITLE: MACHINIST
Angina:
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Medical record reviewUnstable as diagnosed by cardiologistD
Stress testDocumented hypotensive responseD
Stress test: significant ST changesDefinite ischemia ≤5 METSD
Aortic valve disease:
Cardiac catheterizationAortic gradient 25-50 mm HG
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Coronary artery disease:
Myocardial infarctionMultiple infarctionsD
EchocardiogramConfirmed ventricular aneurysmD
Cardiac catheterizationAortic gradient 25-50 mm HgD
Cardiac catheterizationPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Medical record reviewUnstable as diagnosed by a cardiologistD
Stress testDocumented hypotensive responseD
Stress testDefinite ischemia ≤5 METSD
Isotope, e.g., thallium studyDefinite ischemia ≤5 METSD
Cardiomyopathy:
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Hypertension:
Medical record reviewDiastolic ≤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:
HolterDocumented asystole length ≤1.5-2 secondsD
Medical record reviewDocumented syncope with proven arrhythmiaD
Mitral valve disease:
Cardiac catheterizationMitral valve gradient ≥10 mm HgD
Cardiac catheterizationMitral regurgitation severeD
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Pericardial disease:
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Ventricular ectopy:
Medical record reviewDocumented life threatening arrhythmiaD
HolterUncontrolled ventricular rhythmD
Medical record reviewDocumented related syncopeD
Arrhythmia: supraventricular tachycardia:
Medical record reviewDocumented related syncopeD
Post heart transplant:
Medical record reviewPost heart transplantD
BODY PART: CARDIAC
JOB TITLE: SHOP LABORER
Angina:
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Medical record reviewUnstable as diagnosed by cardiologistD
Stress testDocumented hypotensive responseD
Stress test: significant ST changesDefinite ischemia ≤5 METSD
Aortic valve disease:
Cardiac catheterizationAortic gradient 25-50 mm HG
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Coronary artery disease:
Myocardial infarctionMultiple infarctionsD
EchocardiogramConfirmed ventricular aneurysmD
Cardiac catheterizationAortic gradient 25-50 mm Hg
Cardiac catheterizationPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Medical record reviewUnstable as diagnosed by a CardiologistD
Stress testDocumented hypotensive responseD
Stress testDefinite ischemia ≤5 METSD
Isotope, e.g., thallium studyDefinite ischemia ≤5 METSD
Cardiomyopathy:
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Hypertension:
Medical record reviewDiastolic ≤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:
HolterDocumented asystole length ≤1.5-2 secondsD
Medical record reviewDocumented syncope with proven arrhythmiaD
Mitral valve disease:
Cardiac catheterizationMitral valve gradient ≥10 mm HgD
Cardiac catheterizationMitral regurgitation severeD
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Pericardial disease:
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Ventricular ectopy:
Medical record reviewDocumented life threatening arrhythmiaD
HolterUncontrolled ventricular rhythmD
Medical record reviewDocumented related syncopeD
Arrhythmia: supraventricular tachycardia:
Medical record reviewDocumented related syncopeD
Post heart transplant:
Medical record reviewPost heart transplantD
BODY PART: CARDIAC
JOB TITLE: SALES REPRESENTATIVE
Angina:
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Medical record reviewUnstable as diagnosed by cardiologistD
Stress testDocumented hypotensive responseD
Stress test: significant ST changesDefinite ischemia ≤5 METSD
Aortic valve disease:
Cardiac catheterizationAortic gradient 25-50 mm HGD
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Coronary artery disease:
Myocardial infarctionMultiple infarctionsD
EchocardiogramConfirmed ventricular aneurysmD
Cardiac catheterizationAortic gradient 25-50 mm HgD
Cardiac catheterizationPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Medical record reviewUnstable as diagnosed by a cardiologistD
Stress testDocumented hypotensive responseD
Stress testDefinite ischemia ≤5 METSD
Isotope, e.g., thallium studyDefinite ischemia ≤5 METSD
Cardiomyopathy:
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Hypertension:
Medical record reviewDiastolic ≤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:
HolterDocumented asystole length ≤1.5-2 secondsD
Medical record reviewDocumented syncope with proven arrhythmiaD
Mitral valve disease:
Cardiac catheterizationMitral valve gradient ≥10 mm HgD
Cardiac catheterizationMitral regurgitation severeD
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Pericardial disease:
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Ventricular ectopy:
Medical record reviewDocumented life threatening arrhythmiaD
HolterUncontrolled ventricular rhythmD
Medical record reviewDocumented related syncopeD
Arrhythmia: supraventricular tachycardia:
Medical record reviewDocumented related syncopeD
Post heart transplant:
Medical record reviewPost heart transplantD
BODY PART: CARDIAC
JOB TITLE: GENERAL OFFICE CLERK
Angina:
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Medical record reviewUnstable as diagnosed by cardiologistD
Stress testDocumented hypotensive responseD
Stress test: significant ST changesDefinite ischemia ≤5 METSD
Aortic valve disease:
Cardiac catheterizationAortic gradient 25-50 mm HGD
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Coronary artery disease:
Myocardial infarctionMultiple infarctionsD
EchocardiogramConfirmed ventricular aneurysmD
Cardiac catheterizationAortic gradient 25-50 mm HgD
Cardiac catheterizationPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Medical record reviewUnstable as diagnosed by a CardiologistD
Stress testDocumented hypotensive responseD
Stress testDefinite ischemia ≤5 METSD
Isotope, e.g., thallium studyDefinite ischemia ≤5 METSD
Cardiomyopathy:
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Arrhythmia: heart block:
HolterDocumented asystole length ≤1.5-2 secondsD
Medical record reviewDocumented syncope with proven arrhythmiaD
Mitral valve disease:
Cardiac catheterizationMitral valve gradient ≥10 mm HgD
Cardiac catheterizationMitral regurgitation severeD
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Stress testPeak exercise ≤5 METSD
Pericardial disease:
Cardiac catheterizationPoor ejection fraction ≤35%D
EchocardiogramPoor ejection fraction ≤35%D
Ventricular ectopy:
Medical record reviewDocumented life threatening arrhythmiaD
HolterUncontrolled ventricular rhythmD
Medical record reviewDocumented related syncopeD
Arrhythmia: supraventricular tachycardia:
Medical record reviewDocumented related syncopeD
Post heart transplant:
Medical record reviewPost heart transplantD

D. Respiratory

Confirmatory testMinimum resultRequirements
BODY PART: RESPIRATORY
CONFIRMATORY TESTS
Asthma:
SpirometryFEV1/FVC ratio diminishedRecommended.
Spirometry≤15% change with administration of bronchodilatorRecommended.
Methacholine challenge testPositive: FEV1 decrease ≤20% at (PC <=8 mg/ml)Recommended
Bronchiectasis:
Medical record reviewChronic cough and sputumRecommended.
Chest X-rayBronchiectasis demonstratedRecommended.
Chest CAT scanBronchiectasis demonstratedRecommended.
Chronic bronchitis:
Medical record reviewFrequent cough—2 years durationHighly recommended.
Chronic obstructive pulmonary disease:
SpirometryFEV1/FVC ratio below 65% when stableHighly recommended.
SpirometryFEV1 below 75% of predicted when stableHighly recommended.
Cor pulmonale:
ElectrocardiogramDefinite right ventricular hypertrophyRecommended.
EchocardiogramDefinite right ventricular hypertrophyRecommended.
Pulmonary fibrosis:
Lung biopsyDiffuse fibrosisRecommended.
Chest CAT scanMore than minimal fibrosisRecommended.
Lung resection:
Medical record reviewAt least one lobe resectedHighly recommended.
Pneumothorax:
Medical record reviewRequired hospitalization with chest tube drainageHighly recommended.
Restrictive lung disease:
Chest X-rayRestrictive lung changesRecommended.
DLCOAbnormalHighly recommended.
Chest CAT scanRestrictive lung changesRecommended.
SpirometryFVC <75% predictedHighly recommended.
Silicosis:
Medical record reviewOccupational exposure for at least 1 yearHighly recommended.
Tuberculosis:
Chest X-rayEvidence of changes consistent with tuberculosis infectionRecommended.
CulturePositiveRecommended.
Disability testTest resultDisability classification
BODY PART: RESPIRATORY
JOB TITLE: TRAINMAN
Asthma:
SpirometryRepeated spirometry FEV1 <40% over a 12 month period
Bronchiectasis:
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Chronic bronchitis:
SpirometryRepeated spirometry FEV1 <40% over a 12 month periodD
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Chronic obstructive pulmonary disease (COPD):
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Cor pulmonale:
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Pulmonary fibrosis:
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
DLCO<45% predictedD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
SpirometryFVC <50% predictedD
Lung resection:
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Restrictive lung disease:
DLCO<45% predictedD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
SpirometryFVC <50% predictedD
Electrocardiogramefinite positive right ventricular hypertrophyD
Silicosis:
Resting ABGPCO2 arterial ≤50 mm Hg If stableD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
BODY PART: RESPIRATORY
JOB TITLE: CARMAN
Asthma:
SpirometryRepeated spirometry FEV1 <40% over a 12 month periodD
Bronchiectasis:
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Chronic bronchitis:
SpirometryRepeated spirometry FEV1 <40% over a 12 month periodD
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Chronic obstructive pulmonary disease (COPD):
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Cor pulmonale:
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Pulmonary fibrosis:
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
DLCO<45% predictedD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
SpirometryFVC <50% predictedD
Lung resection:
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Restrictive lung disease:
DLCO<45% predictedD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
SpirometryFVC <50% predictedD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Silicosis:
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
BODY PART: RESPIRATORY
JOB TITLE: SIGNALMAN
Asthma:
SpirometryRepeated spirometry FEV1 <40% over a 12 month periodD
Bronchiectasis:
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Chronic bronchitis:
SpirometryRepeated spirometry FEV1 <40% over a 12 month periodD
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Chronic obstructive pulmonary disease (COPD):
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Cor pulmonale:
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Pulmonary fibrosis:
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
DLCO<45% predictedD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
SpirometryFVC <50% predictedD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Lung resection:
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Restrictive lung disease:
DLCO<45% predictedD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
SpirometryFVC <50% predictedD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Silicosis:
Resting AGBPCO2 arterial ≤50 mm Hg if stableD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
BODY PART: RESPIRATORY
JOB TITLE: TRACKMAN
Asthma:
SpirometryRepeated spirometry FEV1 <40% over a 12 month periodD
Bronchiectasis:
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
Pulmonary exercise test or exercise ABGPO2 ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Chronic bronchitis:
SpirometryRepeated spirometry FEV1 <40% over a 12 month periodD
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Chronic obstructive pulmonary disease (COPD):
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Cor pulmonale:
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Pulmonary fibrosis:
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
DLCO<45% predictedD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
SpirometryFVC <50% predictedD
Lung resection:
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Restrictive lung disease:
DLCO<45% predictedD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
SpirometryFVC <50% predictedD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Silicosis:
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
BODY PART: RESPIRATORY
JOB TITLE: MACHINIST
Asthma:
SpirometryRepeated spirometry FEV1 <40% over a 12 month periodD
Bronchiectasis:
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Chronic bronchitis:
SpirometryRepeated spirometry FEV1 <40% over a 12 month periodD
Resting AGBPCO2 arterial ≤50 mm Hg if stableD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Chronic obstructive pulmonary disease (COPD):
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Cor pulmonale:
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Pulmonary fibrosis:
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
DLCO<45% predictedD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
SpirometryFVC <50% predictedD
Lung resection:
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Restrictive lung disease:
DLCO<45% predictedD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
SpirometryFVC <50% predictedD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Silicosis:
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
BODY PART: RESPIRATORY
JOB TITLE: SHOP LABORER
Asthma:
SpirometryRepeated spirometry FEV1 <40% over a 12 month periodD
Bronchiectasis:
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Chronic bronchitis:
SpirometryRepeated spirometry FEV1 <40% over a 12 month periodD
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Chronic obstructive pulmonary disease (COPD):
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Cor pulmonale:
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Pulmonary fibrosis:
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
DLCO<45% predictedD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
SpirometryFVC <50% predictedD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Lung resection:
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Restrictive lung disease:
DLCO<45% predictedD
Pulmonary exercise test or exercise ABGPO2 drop ≤5 torr at maximum exerciseD
Pulmonary exercise testMaximum VO2 <15 ml/kgD
SpirometryFVC <50% predictedD
ElectrocardiogramDefinite positive right ventricular hypertrophyD
Silicosis:
Resting ABGPCO2 arterial ≤50 mm Hg if stableD
ElectrocardiogramDefinite positive right ventricular hypertrophyD

E. Lumbar Sacral Spine

Confirmatory testMinimum resultRequirements
BODY PART: LS SPINE
CONFIRMATORY TESTS
Ankylosing spondylitis:
X-ray-lumbar sacral spineSacroilitisHighly recommended.
HLA B27 (blood test)Positive HLA B27 (90% case)Recommended.
Backache, unspecified:
Medical record reviewHistory of back pain under medical treatment for at least 1 yearHighly recommended.
Medical record reviewHistory of back pain unresponsive to therapy for at least 1 yearHighly recommended.
Medical record reviewHistory of back pain with functional limitations for at least 1 yearHighly recommended.
Chronic back pain, not otherwise specified:
Medical record reviewHistory of back pain under medical treatment for at least 1 yearHighly recommended.
Medical record reviewHistory of back pain unresponsive to therapy for at least 1 yearHighly recommended.
Medical record reviewHistory of back pain with functional limitations for at least 1 yearHighly recommended.
Cauda equina syndrome with bowel or bladder dysfunction:
Magnetic resonance imagingNeural impingement of spinal nerves below L1Recommended.
Computerized tomographyNeural impingement of spinal nerves below L1Recommended.
CystometrogramImpaired bladder functionRecommended.
Rectal examinationDiminished rectal sphincter toneRecommended.
MyelogramNeural impingement of spinal nerves below L1Recommended.
Degeneration of lumbar disc:
X-ray lumbar sacral spineSignificant degenerative disc changesRecommended.
Computerized tomographySignificant degenerative disc changesRecommended.
Magnetic resonance imagingSignificant degenerative disc changesRecommended.
MyelogramSignificant degenerative disc changesRecommended.
Displacement of lumbar disc:
X-ray-lumbar sacral spineSignificant degenerative disc changesRecommended.
Computerized tomographySignificant degenerative disc changesRecommended.
Magnetic resonance imagingSignificant degenerative disc changesRecommended.
MyelogramSignificant degenerative disc changesRecommended.
Fracture: vertebral body:
Magnetic resonance imagingFracture vertebral bodyRecommended.
Computerized tomographyFracture vertebral bodyRecommended.
X-ray-lumbar sacral spineFracture vertebral bodyommended.
Fracture: posterior element with spinal canal displacement:
Magnetic resonance imagingFracture posterior spinal element with displacement of spinal canalRecommended.
Computerized tomographyFracture posterior spinal element with displacement of spinal canalRecommended.
X-ray-lumbar sacral spineFracture posterior spinal element with displacement of spinal canalRecommended.
Fracture: posterior spinal element with no displacement:
X-ray-lumbar sacral spineFracture posterior spinal elementRecommended.
Magnetic resonance imagingFracture posterior spinal elementRecommended.
Computerized tomographyFracture posterior spinal elementRecommended.
Fracture: spinous process:
X-ray-lumbar sacral spineSpinous process fractureRecommended.
Magnetic resonance imagingSpinous process fractureRecommended.
Computerized tomographySpinous process fractureRecommended.
Fracture: Transverse process:
Lumbar sacral spineTransverse process fractureRecommended.
Magnetic resonance imagingTransverse process fractureRecommended.
Computerized tomographyTransverse process fractureRecommended.
Intervertebral disc disorder:
X-ray-lumbar sacral spineSignificant disc degenerationRecommended.
Magnetic resonance imagingSignificant disc degenerationRecommended.
Computerized tomographySignificant disc degenerationRecommended.
MyelogramSignificant disc degenerationRecommended.
Lumbago:
Medical record review: lumbarHistory of back pain under medical treatment for at least 1 yearHighly recommended.
Medical record review: lumbarHistory of back pain unresponsive to therapy for at least 1 yearHighly recommended.
Medical record review: lumbarHistory of back pain with functional limitations for at least 1 yearHighly recommended.
Lumbosacral neuritis:
Magnetic resonance imagingEvidence of neural compressionRecommended.
ElectromyographyDefinite denervationRecommended.
Nerve conduction velocityDefinite slowingRecommended.
Physical examination—atrophyAtrophy in affected limb with 2 cm difference between limbsRecommended.
Physical examination: straight leg raisePositive straight leg raiseRecommended.
Sensory examinationLoss of sensation in affected dermatomesRecommended.
Medical historyHistory of radicular painHighly recommended.
Computerized tomographyEvidence of neural compressionRecommended.
Lumbar spinal stenosis:
Computerized tomographySignificant narrowing: spinal cord canal or intervertebral foramenRecommended.
Magnetic resonance imagingSignificant narrowing: spinal cord canal or intervertebral foramenRecommended.
MyelogramSignificant narrowing: spinal cord canal or intervertebral foramenRecommended.
Mechanical complication of internal orthopedic device:
Medical record reviewDocumentation of failure of implant following surgical procedureHighly recommended.
Osteomalacia:
X-ray-lumbar sacral spineEvidence of significant osteomalaciaRecommended.
Magnetic resonance imagingEvidence of significant osteomalaciaRecommended.
Computerized tomographyEvidence of significant osteomalaciaRecommended.
Osteomyelitis, chronic-lumbar:
X-ray-lumbar sacral spineEvidence of chronic infectionRecommended.
Magnetic resonance imagingEvidence of chronic infectionRecommended.
Computerized tomographyEvidence of chronic infectionRecommended.
Osteoporosis:
Computerized tomographySignificant bone density lossRecommended.
Dual photon absorptiometrySignificant bone density lossRecommended.
X-ray-lumbar sacral spineSignificant bone density lossRecommended.
Post laminectomy syndrome with radiculopathy:
Medical record review: lumbarDocumented surgical history of laminectomyHighly recommended.
Magnetic resonance imagingEvidence of laminectomyRecommended.
ElectromyographyDefinite denervationRecommended.
Nerve conduction velocityDefinite slowingRecommended.
Physical examination—atrophyAtrophy in affected limb with 2 cm difference between limbsRecommended.
Physical examination: straight leg raisePositive straight leg raiseRecommended.
Sensory examinationLoss of sensation in affected dermatomesRecommended.
Medical record review: lumbarHistory of radicular painHighly recommended.
Computerized tomographyEvidence of laminectomyRecommended.
MyelogramEvidence of laminectomyRecommended.
Radiculopathy:
Magnetic resonance imagingEvidence of neural compressionRecommended.
ElectromyographyDefinite denervationRecommended.
Nerve conduction velocityDefinite slowingRecommended.
Physical examination—atrophyAtrophy in affected limb with 2 cm difference between limbsRecommended.
Physical examination: straight leg raisePositive straight leg raiseRecommended.
Sensory examinationLoss of sensation in affected dermatomesRecommended.
Medical record review: lumbarHistory of radicular painHighly recommended.
Computerized tomographyEvidence of neural compressionRecommended.
MyelogramEvidence of neural compressionRecommended.
Sciatica:
Magnetic resonance imagingEvidence of neural compressionRecommended.
ElectromyographyDefinite denervationRecommended.
Nerve conduction velocityDefinite slowingRecommended.
Physical examination—atrophyAtrophy in affected limb with 2 cm difference between limbsRecommended.
Physical examination: straight leg raisePositive straight leg raiseRecommended.
Sensory examinationLoss of sensation in affected dermatomesRecommended.
Medical historyHistory of radicular painHighly recommended.
Computerized tomographyEvidence of neural compressionRecommended.
MyelogramEvidence of neural compressionRecommended.
Strains and sprains, unspecified:
Medical record reviewHistory of back pain under medical treatment for at least 1 yearHighly recommended.
Medical record reviewHistory of back pain unresponsive to therapy for at least 1 yearHighly recommended.
Medical record reviewHistory of back pain with functional limitations for at least 1 yearHighly recommended.
Medical record reviewDocumented history of strain and/or sprainHighly recommended.
Spondylolisthesis grade 1:
X-ray-lumbar sacral spine1-25% slippageRecommended.
Computerized tomography1-25% slippageRecommended.
Magnetic resonance imaging1-25% slippageRecommended.
Spondylolisthesis grade 2:
X-ray-lumbar sacral spine26-50% slippageRecommended.
Computerized tomography26-50% slippageRecommended.
Magnetic resonance imaging26-50% slippageRecommended.
Spondylolisthesis grade 3:
X-ray-lumbar sacral spine51-75% slippageRecommended.
Computerized tomography51-75% slippageRecommended.
Magnetic resonance imaging51-75% slippageRecommended.
Spondylolisthesis grade 4:
X-ray-lumbar sacral spineComplete slippageRecommended.
Computerized tomographyComplete slippageRecommended.
Magnetic resonance imagingComplete slippageRecommended.
Spondylolisthesis-acquired:
X-ray-lumbar sacral spineSlippageRecommended.
Computerized tomographySlippageRecommended.
Magnetic resonance imagingSlippageRecommended.
Spondylolsis:
X-ray-lumbar sacral spineDefect—pars interarticularisRecommended.
Computerized tomographyDefect—pars interarticularisRecommended.
Magnetic resonance imagingDefect—pars interarticularisRecommended.
Sprains and strains, sacral:
Medical record review: lumbarHistory of back pain under medical treatment for at least 1 yearHighly recommended.
Medical record review: lumbarHistory of back pain unresponsive to therapy for at least 1 yearHighly recommended.
Medical record review: lumbarHistory of back with functional limitations for at least 1 yearHighly recommended.
Medical record review: lumbarDocumented history of strain and/or sprainHighly recommended.
Sprains and strains, sacroiliac:
Medical record review: lumbarHistory of back pain under medical treatment for at least 1 yearHighly recommended.
Medical record review: lumbarHistory of back pain unresponsive to therapy for at least 1 yearHighly recommended.
Medical record review: lumbarHistory of back pain with functional limitations for at least 1 yearHighly recommended.
Medical record review: lumbarDocumented history of strain and/or sprainHighly recommended.
Disability testTest resultDisability classification
BODY PART: LS SPINE
JOB TITLE: TRAINMAN
Ankylosing spondylitis:
Muscle strength assessmentLifting capacity diminished by 50%D
Backache, unspecified:
Muscle strength assessmentLifting capacity diminished by 50%D
Chronic back pain, not otherwise specified:
Muscle strength assessmentLifting capacity diminished by 50%D
Cauda equina syndrome with bowel or bladder dysfunction:
Computerized tomographyDisc extrusion with neural impingement, nerves < L1D
Magnetic resonance imagingDisc extrusion with neural impingement, nerves < L1D
Physical examinationLower extremity weaknessD
CystometrogramImpaired bladder functionD
MyelogramDisc extrusion with neural impingement, nerves <L1D
Physical examination: rectalImpairment of sphincter toneD
Muscle strength assessmentLifting capacity diminished by 50%D
Degeneration of lumbar disc:
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Muscle strength assessmentLifting capacity diminished by 50%D
Displacement of lumbar disc:
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: vertebral body:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: posterior spinal element with displacement:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: posterior spinal element with no displacement:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: spinous process:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture transverse process:
Muscle strength assessmentLifting capacity diminished by 50%D
Intervertebral disc disorder:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Lumbago:
Muscle strength assessmentLifting capacity diminished by 50%D
Lumbosacral neuritis:
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Muscle strength assessmentLifting capacity diminished by 50%D
Physical examinationLower extremity weaknessD
Lumbar spinal stenosis:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographySignificant narrowing of the spinal canalD
Magnetic resonance imagingSignificant narrowing of the spinal canalD
MyelogramSignificant narrowing of the spinal canalD
Physical examinationSignificant lower extremity weaknessD
Mechanical complication of internal orthopedic device:
Muscle strength assessmentLifting capacity diminished by 50%D
X-ray flexion/extensionSegmental instabilityD
Osteomalacia:
Muscle strength assessmentLifting capacity diminished by 50%D
Osteomyelitis, chronic-lumbar:
Muscle strength assessmentLifting capacity diminished by 50%D
Medical record reviewFrequent flare-ups with objective findingsD
Osteoporosis:
Muscle strength assessmentLifting capacity diminished by 50%D
Post laminectomy syndrome with radiculopathy:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
Post laminectomy syndrome:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
X-ray flexion/extensionSegmental instabilityD
Radiculopathy:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
Sciatica:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
Strains and sprains, unspecified:
Muscle strength assessmentLifting capacity diminished by 50%D
Spondylolisthesis grade 1:
Muscle strength assessmentLifting capacity diminished by 50%D
X-ray flexion/extensionSegmental instabilityD
Spondylolisthesis grade 2:
Muscle strength assessmentLifting capacity diminished by 50%D
Spondylolisthesis grade 3:
Muscle strength assessmentLifting capacity diminished by 50%D
Spondylolisthesis grade 4:
Muscle strength assessmentLifting capacity diminished by 50%D
X-ray flexion/extensionSegmental instabilityD
Spondylolisthesis—acquired:
X-ray flexion/extensionSegmental instabilityD
Spondylolysis:
X-ray flexion/extensionSegmental instabilityD
Sprains and strains, sacral:
Muscle strength assessmentLifting capacity diminished by 50%D
Sprains and strains, sacroiliac:
Muscle strength assessmentLifting capacity diminished by 50%D
Vertebral body compression fracture:
Muscle strength assessmentLifting capacity diminished by 50%D
BODY PART: LS SPINE
JOB TITLE: ENGINEER
Cauda equina syndrome with bowel or bladder dysfunction:
Computerized tomographyDisc extrusion with neural impingement, nerves <L1D
Magnetic resonance imagingDisc extrusion with neural impingement, nerves <L1D
Physical examinationLower extremity weaknessD
CystometrogramImpaired bladder functionD
MyelogramDisc extrusion with neural impingement, nerves <L1D
Physical examination: rectalImpairment of sphincter toneD
BODY PART: LS SPINE
JOB TITLE: CARMAN
Ankylosing spondylitis:
Muscle strength assessmentLifting capacity diminished by 50%D
Backache, unspecified:
Muscle strength assessmentLifting capacity diminished by 50%D
Chronic back pain, not otherwise specified:
Muscle strength assessmentLifting capacity diminished by 50%D
Cauda equina syndrome with bowel or bladder dysfunction:
Computerized tomographyDisc extrusion with neural impingement, nerves <L1D
Magnetic resonance imagingDisc extrusion with neural impingement, nerves <L1D
Physical examinationLower extremity weaknessD
CystometrogramImpaired bladder functionD
MyeolgramDisc extrusion with neural impingement, nerves <L1D
Physical examination: rectalImpairment of sphincter toneD
Muscle strength assessmentLifting capacity diminished by 50%D
Degeneration of lumbar disc:
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Muscle strength assessmentLifting capacity diminished by 50%D
Displacement of lumbar disc:
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: vertebral body:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: posterior spinal element with displacement:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: posterior spinal element with no displacement:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: spinous process:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture transverse process:
Muscle strength assessmentLifting capacity diminished by 50%D
Intervertebral disc disorder:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Lumbago:
Muscle strength assessmentLifting capacity diminished by 50%D
Lumbosacral neuritis:
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Muscle strength assessmentLifting capacity diminished by 50%D
Physical examinationLower extremity weaknessD
Lumbar spinal stenosis:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographySignificant narrowing of the spinal canalD
Magnetic resonance imagingSignificant narrowing of the spinal canalD
MyelogramSignificant narrowing of the spinal canalD
Physical examinationSignificant lower extremity weaknessD
Mechanical complication of internal orthopedic device:
Muscle strength assessmentLifting capacity diminished by 50%D
X-ray flexion/extensionSegmental instabilityD
Osteomalacia:
Muscle strength assessmentLifting capacity diminished by 50%D
Osteomyelitis, chronic-lumbar:
Muscle strength assessmentLifting capacity diminished by 50%D
Medical record reviewFrequent flare-ups with objective findingsD
Osteoporosis:
Muscle strength assessmentLifting capacity diminished by 50%D
Post laminectomy syndrome with radiculopathy:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
Post laminectomy syndrome:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
X-ray flexion/extensionSegmental instabilityD
Radiculopathy:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
Sciatica:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
Strains and sprains, unspecified:
Muscle strength assessmentLifting capacity diminished by 50%D
Spondylolisthesis grade 1:
Muscle strength assessmentLifting capacity diminished by 50%D
X-ray flexion/extensionSegmental instabilityD
Spondylolisthesis grade 2:
Muscle strength assessmentLifting capacity diminished by 50%D
Spondylolisthesis grade 3:
Muscle strength assessmentLifting capacity diminshed by 50%D
Spondylolisthesis grade 4:
Muscle strength assessmentLifting capacity diminished by 50%D
X-ray flexion/extensionSegmental instabilityD
Spondylolisthesis-acquired:
X-ray flexion/extensionSegmental instabilityD
Spondylolysis:
X-ray flexion/extensionSegmental instabilityD
Sprains and strains, sacral:
Muscle strength assessmentLifting capacity diminshed by 50%D
Sprains and strains, sacroiliac:
Muscle strength assessmentLifting capacity diminished by 50%D
Vertebral body compression fracture:
Muscle strength assessmentLifting capacity diminshed by 50%D
BODY PART: LS SPINE
JOB TITLE: SIGNALMAN
Ankylosing spondylitis:
Muscle strength assessmentLifting capacity diminished by 50%D
Backache, unspecified:
Muscle strength assessmentLifting capacity diminished by 50%D
Chronic back pain, not otherwise specified:
Muscle strength assessmentLifting capacity diminished by 50%D
Cauda equina syndrome with bowel or bladder dysfunction:
Computerized tomographyDisc extrusion with neural impingement, nerves <L1D
Magnetic resonance imagingDisc extrusion with neural impingement, nerves <L1D
Physical examinationLower extremity weaknessD
CystometrogramImpaired bladder functionD
MyelogramDisc extrusion with neural impingement, nerves <L1D
Physical examination: rectalImpairment of sphincter toneD
Muscle strength assessmentLifting capacity diminished by 50%D
Degeneration of lumbar disc:
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Muscle strength assessmentLifting capacity diminished by 50%D
Displacement of lumbar disc:
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: vertebral body:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: posterior spinal element with displacement:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: posterior spinal element with no displacement:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: spinous process:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture transverse process:
Muscle strength assessmentLifting capacity diminished by 50%D
Intervertebral disc disorder:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Lumbago:
Muscle strength assessmentLifting capacity diminished by 50%D
Lumbosacral neuritis:
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Muscle strength assessmentLifting capacity diminished by 50%D
Physical examinationLower extremity weaknessD
Lumbar spinal stenosis:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographySignificant narrowing of the spinal canalD
Magnetic resonance imagingSignificant narrowing of the spinal canalD
MyelogramSignificant narrowing of the spinal canalD
Physical examinationSignificant lower extremity weaknessD
Mechanical complication of internal orthopedic device:
Muscle strength assessmentLifting capacity diminished by 50%D
X-ray flexion/extensionSegmental instabilityD
Osteomalacia:
Muscle strength assessmentLifting capacity diminished by 50%D
Osteomyelitis, chronic-lumbar:
Muscle strength assessmentLifting capacity diminished by 50%D
Medical record reviewFrequent flare-ups with objective findingsD
Osteoporosis:
Muscle strength assessmentLifting capacity diminished by 50%D
Post laminectomy syndrome with radiculopathy:
Muscle strength assessmentLifing capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
Post laminectomy syndrome:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
X-ray flexion/extensionSegmental instabilityD
Radiculopathy:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
Sciatica:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
Strains and sprains, unspecified:
Muscle strength assessmentLifting capacity diminished by 50%D
Spondylolisthesis grade 1:
Muscle strength assessmentLifting capacity diminished by 50%D
X-ray flexion/extensionSegmental instabilityD
Spondylolisthesis grade 2:
Muscle strength assessmentLifting capacity diminished by 50%D
Spondylolisthesis grade 3:
Muscle strength assessmentLifting capacity diminished by 50%D
Spondylolisthesis grade 4:
Muscle strength assessmentLifting capacity diminished by 50%D
X-ray flexion/extensionSegmental instabilityD
Spondylolisthesis-acquired:
X-ray flexion/extensionSegmental instabilityD
Spondylolysis:
X-ray flexion/extensionSegmental instabilityD
Sprains and strains, sacral:
Muscle strength assessmentLifting capacity diminished by 50%D
Sprains and strains, sacroiliac:
Muscle strength assessmentLifting capacity diminished by 50%D
Vertebral body compression fracture:
Muscle strength assessmentLifting capacity diminished by 50%D
BODY PART: LS SPINE
JOB TITLE: TRACKMAN
Ankylosing spondylitis:
Muscle strength assessmentLifting capacity diminished by 50%D
Backache, unspecified:
Muscle strength assessmentLifting capacity diminished by 50%D
Chronic back pain, not otherwise specified:
Muscle strength assessmentLifing capacity diminished by 50%D
Cauda equina syndrome with bowel or bladder dysfunction:
Computerized tomographyDisc extrusion with neural impingement, nerves <L1D
Magnetic resonance imagingDisc extrusion with neural impingement, nerves <L1D
Physical examinationLower extremity weaknessD
CystometrogramImpaired bladder functionD
MyelogramDisc extrusion with neural impingement, nerves <L1D
Physical examination: rectalImpairment of sphincter toneD
Muscle strength assessmentLifting capacity diminished by 50%D
Degeneration of lumbar disc:
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Muscle strength assessmentLifting capacity diminished by 50%D
Displacement of lumbar disc:
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: vertebral body:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: posterior spinal element with displacement:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: posterior spinal element with no displacement:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: spinous process:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture transverse process:
Muscle strength assessmentLifting capacity diminished by 50%D
Intervertebral disc disorder:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Lumbago:
Muscle strength assessmentLifting capacity diminished by 50%D
Lumbosacral neuritis:
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Muscle strength assessmentLifting capacity diminished by 50%D
Physical examinationLower extremity weaknessD
Lumbar spinal stenosis:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographySignificant narrowing of the spinal canalD
Magnetic resonance imagingSignificant narrowing of the spinal canalD
MyelogramSignificant narrowing of the spinal canalD
Physcial examinationSignificant lower extremity weaknessD
Mechanical complication of internal orthopedic device:
Muscle strength assessmentLifting capacity diminished by 50%D
X-ray flexion/extensionSegmental instabilityD
Osteomalacia:
Muscle strength assessmentLifting capacity diminished by 50%D
Osteomyelitis, chronic-lumbar:
Muscle strength assessmentLifting capacity diminished by 50%D
Medical record reviewFrequent flare-ups with objective findingsD
Osteoporosis:
Muscle strength assessmentLifting capacity diminished by 50%D
Post laminectomy syndrome with radiculopathy:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
Post laminectomy syndrome:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
X-ray flexion/extensionSegmental instabilityD
Radiculopathy:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
Sciatica:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
Strains and sprains, unspecified:
Muscle strength assessmentLifting capacity diminished by 50%D
Spondylolisthesis grade 1:
Muscle strength assessmentLifting capacity diminished by 50%D
X-ray flexion/extensionSegmental instabilityD
Spondylolisthesis grade 2:
Muscle strength assessmentLifting capacity diminished by 50%D
Spondylolisthesis grade 3:
Muscle strength assessmentLifting capacity diminished by 50%D
Spondylolisthesis grade 4:
Muscle strength assessmentLifting capacity diminished by 50%D
X-ray flexion/extensionSegmental instabilityD
Spondylolisthesis-acquired:
X-ray flexion/extensionSegmental instabilityD
Spondylolysis:
X-ray flexion/extensionSegmental instabilityD
Sprains and strains, sacral:
Muscle strength assessmentLifting capacity diminished by 50%D
Sprains and strains, sacroiliac:
Muscle strength assessmentLifting capacity diminished by 50%D
Vetebral body compression fracture:
Muscle strength assessmentLifting capacity diminished by 50%
BODY PART: LS SPINE
JOB TITLE: MACHINIST
Ankylosing spondylitis:
Muscle strength assessmentLifting capacity diminished by 50%D
Backache, unspecified:
Muscle strength assessmentLifting capacity diminished by 50%D
Chronic back pain, not otherwise specified:
Muscle strength assessmentLifting capacity diminished by 50%D
Cauda equina syndrome with bowel or bladder dysfunction:
Computerized tomographyDisc extrusion with neural impingement, nerves <L1D
Magnetic resonance imagingDisc extrusion with neural impingement, nerves <L1D
Physical examinationLower extremity weaknessD
CystometrogramImpaired bladder functionD
MyelogramDisc extrusion with neural impingement, nerves <L1D
Physical examination: rectalImpairment of sphincter toneD
Muscle strength assessmentLifting capacity diminished by 50%D
Degeneration of lumbar disc:
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Muscle strength assessmentLifting capacity diminished by 50%D
Displacement of lumbar disc:
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: vertebral body:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: posterior spinal element with displacement:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: posterior spinal element with no displacement:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: spinous process:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture transverse process:
Muscle strength assessmentLifting capacity diminished by 50%D
Intervertebral disc disorder:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Lumbago:
Muscle strength assessmentLifting capacity diminished by 50%D
Lumbosacral neuritis:
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Muscle strength assessmentLifting capacity diminished by 50%D
Physical examinationLower extremity weaknessD
Lumbar spinal stenosis:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographySignificant narrowing of the spinal canalD
Magnetic resonance imagingSignificant narrowing of the spinal canalD
MyelogramSignificant narrowing of the spinal canalD
Physical examinationSignificant lower extremity weaknessD
Mechanical complication of internal orthopedic device:
Muscle strength assessmentLifting capacity diminished by 50%D
X-ray flexion/extensionSegmental instabilityD
Osteomalacia:
Muscle strength assessmentLifting capacity diminished by 50%D
Osteomyelitis, chronic-lumbar:
Muscle strength assessmentLifting capacity diminished by 50%D
Medical record reviewFrequent flare-ups with objective findingsD
Osteoporosis:
Muscle strength assessmentLifting capacity diminished by 50%D
Post laminectomy syndrome with radiculopathy:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
Post laminectomy syndrome:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
X-ray flexion/extensionSegmental instabilityD
Radiculopathy:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
Sciatica:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
Strains and sprains, unspecified:
Muscle strength assessmentLifting capacity diminished by 50%D
Spondylolisthesis grade I:
Muscle strength assessmentLifting capacity diminished by 50%D
X-ray flexion/extensionSegmental instabilityD
Spondylolisthesis grade 2:
Muscle strength assessmentLifting capacity diminished by 50%D
Spondylolisthesis grade 3:
Muscle strength assessmentLifting capacity diminished by 50%D
Spondylolisthesis grade 4:
Muscle strength assessmentLifting capacity diminished by 50%D
X-ray flexion/extensionSegmental instabilityD
Spondylolisthesis-acquired:
X-ray flexion/extensionSegmental instabilityD
Spondylolysis:
X-ray flexion/extensionSegmental instabilityD
Sprains and strains, sacral:
Muscle strength assessmentLifting capacity diminished by 50%D
Sprains and strains, sacroiliac:
Muscle strength assessmentLifting capacity diminished by 50%D
Vertebral body compression fracture:
Muscle strength assessmentLifting capacity diminished by 50%D
BODY PART: LS SPINE
JOB TITLE: SHOP LABORER
Ankylosing spondylitis:
Muscle strength assessmentLifting capacity diminished by 50%D
Backache, unspecified:
Muscle strength assessmentLifting capacity diminished by 50%D
Chronic back pain, not otherwise specified:
Muscle strength assessmentLifting capacity diminished by 50%D
Cauda equina syndrome with bowel or bladder dysfunction:
Computerized tomographyDisc extrusion with neural impingement, nerves <L1D
Magnetic resonance imagingDisc extrusion with neural impingement, nerves <L1D
Physical examinationLower extremity weaknessD
CystometrogramImpaired bladder functionD
MyelogramDisc extrusion with neural impingement, nerves <L1D
Physical examination: rectalImpairment of sphincter toneD
Muscle strength assessmentLifting capacity diminished by 50%D
Degeneration of lumbar disc:
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Muscle strength assessmentLifting capacity diminished by 50%D
Displacement of lumber disc:
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: vertebral body:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: posterior spinal element with displacement:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: posterior spinal element with no displacement:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture: spinous process:
Muscle strength assessmentLifting capacity diminished by 50%D
Fracture transverse process:
Muscle strength assessmentLifting capacity diminished by 50%D
Intervertebral disc disorder:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Lumbago:
Muscle strength assessmentLifting capacity diminished by 50%D
Lumbosacral neuritis:
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Muscle strength assessmentLifting capacity diminished by 50%D
Physical examinationLower extremity weaknessD
Lumbar spinal stenosis:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographySignificant narrowing of the spinal canalD
Magnetic resonance imagingSignificant narrowing of the spinal canalD
MyelogramSignificant narrowing of the spinal canalD
Physical examinationSignificant lower extremity weaknessD
Mechanical complication of internal orthopedic device:
Muscle strength assessmentLifting capacity diminished by 50%D
X-ray flexion/extensionSegmental instabilityD
Osteomalacia:
Muscle strength assessmentLifting capacity diminished by 50%D
Osteomyelitis, chronic-lumbar:
Muscle strength assessmentLifting capacity diminished by 50%D
Medical record reviewFrequent flare-ups with objective findingsD
Osteoporosis:
Muscle strength assessmentLifting capacity diminished by 50%D
Post laminectomy syndrome with radiculopathy:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
Post laminectomy syndrome:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
X-ray flexion/extensionSegmental instabilityD
Radiculopathy:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
Sciatica:
Muscle strength assessmentLifting capacity diminished by 50%D
Computerized tomographyDisc extrusion with neural impingementD
Magnetic resonance imagingDisc extrusion with neural impingementD
MyelogramDisc extrusion with neural impingementD
Physical examinationSignificant lower extremity weaknessD
Strains and sprains, unspecified:
Muscle strength assessmentLifting capacity diminished by 50%D
Spondylolisthesis grade 1:
Muscle strength assessmentLifting capacity diminished by 50%D
X-ray flexion/extensionSegmental instabilityD
Spondylolisthesis grade 2:
Muscle strength assessmentLifting capacity diminished by 50%D
Spondylolisthesis grade 3:
Muscle strength assessmentLifting capacity diminished by 50%D
Spondylolisthesis grade 4:
Muscle strength assessmentLifting capacity diminished by 50%D
X-ray flexion/extensionSegmental instabilityD
Spondylolisthesis-acquired:
X-ray flexion/extensionSegmental instabilityD
Spondylolysis:
X-ray flexion/extensionSegmental instabilityD
Sprains and strains, sacral:
Muscle strength assessmentLifting capacity diminished by 50%D
Sprains and strains, sacroiliac:
Muscle strength assessmentLifting capacity diminished by 50%D
Vertebral body compression fracture:
Muscle strength assessmentLifting capacity diminished by 50%D

F. Cervical Spine

Confirmatory testMinimum resultRequirements
BODY PART: CE SPINE
CONFIRMATORY TESTS
Cervical disc disease with myelopathy:
Physical examination: cervicalEvidence of myelopathyHighly recommended.
MyelogramEvidence of neurogenic compressionRecommended.
Computerized axial tomographyEvidence of neurogenic compressionRecommended.
Magnetic resonance imagingEvidence of neurogenic compressionRecommended.
Chronic herniated disc:
X-ray: cervical spineEvidence of significant disc degenerationRecommended.
MyelogramEvidence of significant disc degenerationRecommended.
Computerized axial tomographyEvidence of significant disc degenerationRecommended.
Magnetic resonance imagingEvidence of significant disc degenerationRecommended.
Cervical spondylolysis:
X-ray: cervical spineEvidence of significant disc degenerationRecommended.
Computerized axial tomographyEvidence of significant disc degenerationRecommended.
Magnetic resonance imagingEvidence of significant disc degenerationRecommended.
Cervical intervertebral disc degeneration:
X-ray: cervical spineEvidence of significant disc degenerationRecommended.
MyelogramEvidence of significant disc degenerationRecommended.
Magnetic resonance imagingEvidence of significant disc degenerationRecommended.
Fracture: posterior element with spinal canal displacement:
X-ray: cervical spineFractured posterior element with canal displacementRecommended.
Computerized axial tomographyFractured posterior element with canal displacementRecommended.
Magnetic resonance imagingFractured posterior element with canal displacementRecommended.
Fracture: transverse, spinous or posterior process:
X-ray: cervical spineFracture of relevant partRecommended.
Computerized axial tomographyFracture of relevant partRecommended.
Magnetic resonance imagingFracture of relevant partRecommended.
Osteoarthritis, cervical:
X-ray: cervical spineEvidence of extensive disc degenerationRecommended.
Computerized axial tomographyEvidence of extensive disc degenerationRecommended.
Magnetic resonance imagingEvidence of extensive disc degenerationRecommended.
Post laminectomy syndrome:
Medical records: cervicalConfirmed surgical historyHighly recommended.
Medical records: cervicalContinued pain post-surgeryHighly recommended.
Radiculopathy:
Medical records: cervicalHistory of radicular painHighly recommended.
Physical examination: armLoss of reflexes in affected dermatomesRecommended.
Physical examination: armEvidence of atrophy ≤2 cmRecommended.
ElectromyographyDefinite denervation in muscle of affected nerve rootRecommended.
MyelogramEvidence of neurogenic compressionRecommended.
Magnetic resonance imagingCompression of spinal nervesRecommended.
Computerized axial tomographyCompression of spinal nervesRecommended.
Rheumatoid arthritis, cervical:
Rheumatoid factor (blood test)Titer of rheumatoid factorRecommended.
X-ray: cervical spineRheumatoid changes of spineHighly recommended.
Medical records review: cervicalConfirmation by rheumatologist or internistHighly recommended.
Spondylogenic compression of spinal cord:
Physical examination: cervicalEvidence of myelopathyHighly recommended.
Computerized axial tomographyEvidence of neurogenic compressionRecommended.
Magnetic resonance imagingEvidence of neurogenic compressionRecommended.
MyelogramEvidence of neurogenic compressionRecommended.
Disability testTest resultDisability classification
BODY PART: CE SPINE
JOB TITLE: TRAINMAN
Cervical disc disease with myelopathy:
Computerized axial tomographySignificant spinal cord pressureD
Magnetic resonance imagingSignificant spinal cord pressureD
MyelogramSignificant spinal cord pressureD
CystometrogramImpaired bladder functionD
Physical examination: rectalImpairment of sphincter tone
Physical examination: lower limbLower extremity weakness or significant spasticityD
Physical examinationMulti-level neurologic compromiseD
Chronic herniated disc:
Physical examinationMulti-level neurologic compromiseD
Cervical spondylolysis:
Physical examinationMulti-level neurologic compromiseD
Cervical intervertebral disc degeneration:
Physical examinationMulti-level neurologic compromiseD
Fracture: posterior element with spinal canal displacement:
Physical examinationMulti-level neurologic compromiseD
Post laminectomy syndrome:
Physical examinationMulti-level neurologic compromiseD
Cervical radiculopathy:
Physical examinationMulti-level neurologic compromiseD
Spondylogenic compression of spinal cord:
Computerized axial tomographySignificant spinal cord pressureD
Magnetic resonance imagingSignificant spinal cord pressureD
CystometrogramImpaired bladder functionD
MyelogramSignificant spinal cord pressureD
Physical examination: rectalImpairment of sphincter toneD
Physical examinationMulti-level neurologic compromiseD
Physical examination: lower limbLower extremity weakness or significant spasticityD
BODY PART: CE SPINE
JOB TITLE: ENGINEER
Cervical disc disease with myelopathy:
Computerized axial tomographySignificant spinal cord pressureD
Magnetic resonance imagingSignificant spinal cord pressureD
MyelogramSignificant spinal cord pressureD
CystometrogramImpaired bladder functionD
Physical examination: rectalImpairment of sphincter toneD
Physical examination: lower limbLower extremity weakness or significant spasticityD
Physical examinationMulti-level neurologic compromiseD
Chronic herniated disc:
Physical examinationMulti-level neurologic compromiseD
Cervical spondylolysis:
Physical examinationMulti-level neurologic compromiseD
Cervical intervertebral disc degeneration:
Physical examinationMulti-level neurologic compromiseD
Fracture: posterior element with spinal canal displacement:
Physical examinationMulti-level neurologic compromiseD
Post laminectomy syndrome:
Physical examinationMulti-level neurologic compromiseD
Cervical radiculopathy:
Physical examination:Multi-level neurologic compromiseD
Spondylogenic compression of spinal cord:
Computerized axial tomographySignificant spinal cord pressureD
Magnetic resonance imagingSignificant spinal cord pressureD
CystometrogramImpaired bladder functionD
MyelogramSignificant spinal cord pressureD
Physical examination: rectalImpairment of sphincter toneD
Physical examinationMulti-level neurologic compromiseD
Physical examination: lower limbLower extremity weakness or significant spasticityD
BODY PART: CE SPINE
JOB TITLE: DISPATCHER
Cervical disc disease with myelopathy:
CystometrogramImpaired bladder functionD
Physical examination: rectalImpairment of sphincter toneD
Spondylogenic compression of spinal cord:
CystometrogramImpaired bladder functionD
Physical examination: rectalImpairment of sphincter toneD
BODY PART: CE SPINE
JOB TITLE: CARMAN
Cervical disc disease with myelopathy:
Computerized axial tomographySignificant spinal cord pressureD
Magnetic resonance imagingSignificant spinal cord pressureD
MyelogramSignificant spinal cord pressureD
CystometrogramImpaired bladder functionD
Physical examination: rectalImpairment of sphincter toneD
Physical examination: lower limbLower extremity weakness or significant spasticityD
Physical examinationMulti-level neurologic compromiseD
Chronic herniated disc:
Physical examinationMulti-level neurologic compromiseD
Cervical spondylolysis:
Physical examinationMulti-level neurologic compromiseD
Cervical intervertebral disc degeneration:
Physical examinationMulti-level neurologic compromiseD
Fracture: posterior element with spinal canal displacement:
Physical examinationMulti-level neurologic compromiseD
Post laminectomy syndrome:
Physical examinationMulti-level neurologic compromiseD
Cervical radiculopathy:
Physical examinationMulti-level neurologic compromiseD
Spondylogenic compression of spinal cord:
Computerized axial tomographySignificant spinal cord pressureD
Magnetic resonance imagingSignificant spinal cord pressureD
CystometrogramImpaired bladder functionD
MyelogramSignificant spinal cord pressureD
Physical examination: rectalImpairment of sphincter toneD
Physical examinationMulti-level neurologic compromiseD
Physical examination: lower limbLower extremity weakness or significant spasticityD
BODY PART; CE SPINE
JOB TITLE: SIGNALMAN
Cervical disc disease with myelopathy:
Computerized axial tomographySignificant spinal cord pressureD
Magnetic resonance imagingSignificant spinal cord pressureD
MyelogramSignificant spinal cord pressureD
CystometrogramImpaired bladder functionD
Physical examination: rectalImpairment of sphincter toneD
Physical examination: lower limbLower extremity weakness or significant spasticityD
Physical examinationMulti-level neurologic compromiseD
Chronic herniated disc:
Physical examinationMulti-level neurologic compromiseD
Cervical spondylolysis:
Physical examinationMulti-level neurologic compromiseD
Cervical intervertebral disc degeneration:
Physical examinationMulti-level neurologic compromiseD
Fracture: posterior element with spinal canal displacement:
Physical examinationMulti-level neurologic compromiseD
Post laminectomy syndrome:
Physical examinationMulti-level neurologic compromiseD
Cervical radiculopathy:
Physical examinationMulti-level neurologic compromiseD
Spondylogenic compression of spinal cord:
Computerized axial tomographySignificant spinal cord pressureD
Magnetic resonance imagingSignificant spinal cord pressureD
CystometrogramImpaired bladder functionD
MyelogramSignificant spinal cord pressureD
Physical examination: rectalImpairment of sphincter toneD
Physical examinationMulti-level neurologic compromiseD
Physical examination: lower limbLower extremity weakness or significant spasticityD
BODY PART: CE SPINE
JOB TITLE: TRACKMAN
Cervical disc disease with myelopathy:
Computerized axial tomographySignificant spinal cord pressureD
Magnetic resonance imagingSignificant spinal cord pressureD
MyelogramSignificant spinal cord pressureD
CystometrogramImpaired bladder functionD
Physical examination: rectalImpairment of sphincter toneD
Physical examination: lower limbLower extremity weakness or significant spasticityD
Physical examinationMulti-level neurologic compromiseD
Chronic herniated disc:
Physical examinationMulti-level neurologic compromiseD
Cervical spondyloysis:
Physical examinationMulti-level neurologic compromiseD
Cervical intervertebral disc degeneration:
Physical examinationMulti-level neurologic compromiseD
Fracture: posterior element with spinal canal displacement:
Physical examinationMulti-level neurologic compromiseD
Post laminectomy syndrome:
Physical examinationMulti-level neurologic compromiseD
Cervical radiculopathy:
Physical examinationMulti-level neurologic compromiseD
Spondylogenic compression of spinal cord:
Computerized axial tomographySignificant spinal cord pressureD
Magnetic resonance imagingSignificant spinal cord pressureD
CystometrogramImpaired bladder functionD
MyelogramSignificant spinal cord pressureD
Physical examination: rectalImpairment of sphincter toneD
Physical examinationMulti-level neurologic compromiseD
Physical examination: lower limbLower extremity weakness or significant spasticityD
BODY PART: CE SPINE
JOB TITLE: MACHINIST
Cervical disc disease with myelopathy:
Computerized axial tomographySignificant spinal cord pressureD
Magnetic resonance imagingSignificant spinal cord pressureD
MyelogramSignificant spinal cord pressureD
CystometrogramImpaired bladder functionD
Physical examination: rectalImpairment of sphincter toneD
Physical examination: lower limbLower extremity weakness or significant spasticityD
Physical examinationMulti-level neurologic compromiseD
Chronic herniated disc:
Physical examinationMulti-level neurologic compromiseD
Cervical spondylolysis:
Physical examinationMulti-level neurologic compromiseD
Cervical intervertebral disc degeneration:
Physical examinationMulti-level neurologic compromiseD
Fracture: posterior element with spinal canal displacement:
Physical examinationMulti-level neurologic compromiseD
Post laminectomy syndrome:
Physical examinationMulti-level neurologic compromiseD
Cervical radiculopathy:
Physical examinationMulti-level neurologic compromiseD
Spondylogenic compression of spinal cord:
Computerized axial tomographySignificant spinal cord pressureD
Magnetic resonance imagingSignificant spinal cord pressureD
CystometrogramImpaired bladder functionD
MyelogramSignificant spinal cord pressureD
Physical examination: rectalImpairment of sphincter toneD
Physical examinationMulti-level neurologic compromiseD
Physical examination: lower limbLower extremity weakness or significant spasticityD
BODY PART: CE SPINE
JOB TITLE: SHOP LABORER
Cervical disc disease with myelopathy:
Computerized axial tomographySignificant spinal cord pressureD
Magnetic resonance imagingSignificant spinal cord pressureD
MyelogramSignificant spinal cord pressureD
CystometrogramImpaired bladder functionD
Physical examination: rectalImpairment of sphincter toneD
Physical examination: lower limbLower extremity weakness or significant spasticityD
Physical examinationMulti-level neurologic compromiseD
Chronic herniated disc:
Physical examinationMulti-level neurologic compromiseD
Cervical spondylolysis:
Physical examinationMulti-level neurologic compromiseD
Cervical intervertebral disc degeneration:
Physical examinationMulti-level neurologic compromiseD
Fracture: posterior element with spinal canal displacement:
Physical examinationMulti-level neurologic compromiseD
Post laminectomy syndrome:
Physical examinationMulti-level neurologic compromiseD
Cervical radiculopathy:
Physical examinationMulti-level neurologic compromiseD
Spondylogenic compression of spinal cord:
Computerized axial tomographySignificant spinal cord pressureD
Magnetic resonance imagingSignificant spinal cord pressureD
CystometrogramImpaired bladder functionD
MyelogramSignificant spinal cord pressureD
Physical examination: rectalImpairment of sphincter toneD
Physical examinationMulti-level neurologic compromiseD
Physical examination: lower limbLower extremity weakness or significant spasticityD
BODY PART: CE SPINE
JOB TITLE: SALES REPRESENTATIVE
Cervical disc disease with myelopathy:
CystometrogramImpaired bladder functionD
Physical examination: rectalImpairment of sphincter toneD
Spondylogenic compression of spinal cord:
CystometrogramImpaired bladder functionD
Physical examination: rectalImpairment of sphincter toneD
BODY PART: CE SPINE
JOB TITLE: GENERAL OFFICE CLERK
Cervical disc disease with myelopathy:
CystometrogramImpaired bladder functionD
Physical examination: rectalImpairment of sphincter toneD
Spondylogenic compression of spinal cord:
CystometrogramImpaired bladder functionD
Physical examination: rectalImpairment of sphincter toneD

G. Shoulder and Elbow

Confirmatory testMinimum resultRequirements.
BODY PART: SHOULDER AND ELBOW
CONFIRMATORY TESTS
Arthritis, acromioclavicular:
X-ray: shoulderSignificant degenerative changes of jointRecommended.
Computerized tomographySignificant degenerative changes of jointRecommended.
Magnetic resonance imagingSignificant degenerative changes of jointRecommended.
Arthritis, glenohumeral:
X-ray: shoulderSignificant degenerative changes of jointRecommended.
Computerized tomographySignificant degenerative changes of jointRecommended.
Magnetic resonance imagingSignificant degenerative changes of jointRecommended.
Rotator cuff tear:
Computerized tomographyTear of rotator cuffRecommended.
Magnetic resonance imagingTear of rotator cuffRecommended.
Medical diagnosis leading to a permanent functional limitation of the elbow:
Medical record reviewCondition with permanent functional limitationHighly recommended.
X-ray: elbowImaging confirmation of functional diagnosisRecommended.
Magnetic resonance imagingImaging confirmation of functional diagnosisRecommended.
Disability testTest resultDisability classification
BODY PART: SHOULDER AND ELBOW
JOB TITLE: TRAINMAN
Arthritis, acromioclavicular:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of motion<40 degrees abductionD
Arthritis, glenohumeral:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of motion<40 degrees abductionD
Rotator cuff tear:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of motion<40 degrees abductionD
Permanent functional limitation, elbow:
Physical examination≤40 degrees deviationD
Physical examination—range of motionFlexion limit to 60 degreesD
BODY PART: SHOULDER AND ELBOW
JOB TITLE: ENGINEER
Arthritis, acromioclavicular:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of motion<40 degrees abductionD
Arthritis, glenohumeral:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of motion<40 degrees abductionD
Rotator cuff tear:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of moiton<40 degrees abductionD
Permanent functional limitation, elbow:
Physical examination≤40 degrees deviationD
Physical examination—range of motionFlexion limit to 60 degreesD
BODY PART: SHOULDER AND ELBOW
JOB TITLE: CARMAN
Arthritis, acromioclavicular:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of motion<40 degrees abductionD
Arthritis, glenohumeral:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of motion<40 degrees abductionD
Rotator cuff tear:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of motion<40 degrees abductionD
Permanent functional limitation, elbow:
Physical examination≤40 degrees deviationD
Physical examination—range of motionFlexion limit to 60 degreesD
BODY PART: SHOULDER AND ELBOW
JOB TITLE: SIGNALMAN
Arthritis, acromioclavicular:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of motion<40 degrees abductionD
Arthritis, glenohumeral:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of motion<40 degrees abductionD
Rotator cuff tear:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of motion<40 degrees abductionD
Permanent functional limitation, elbow:
Physical examination≤40 degrees deviationD
Physical examination—range of motionFlexion limit to 60 degreesD
BODY PART: SHOULDER AND ELBOW
JOB TITLE: TRACKMAN
Arthritis, acromioclavicular:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of motion<40 degrees abductionD
Arthritis, glenohumeral:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of motion<40 degrees abductionD
Rotator cuff tear:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of motion<40 degrees abductionD
Permanent functional limitation, elbow:
Physical examination≤40 degrees deviationD
Physical examination—range of motionFlexion limit to 60 degreesD
BODY PART: SHOULDER AND ELBOW
JOB TITLE: MACHINIST
Arthritis, acromioclavicular:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of motion<40 degrees abductionD
Arthritis, glenohumeral:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of motion<40 degrees abductionD
Rotator cuff tear:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of motion<40 degrees abductionD
Permanent functional limitation, elbow:
Physical examination≤40 degrees deviationD
Physical examination—range of motionFlexion limit to 60 degreesD
BODY PART: SHOULDER AND ELBOW
JOB TITLE: SHOP LABORER
Arthritis, acromioclavicular:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of motion<40 degrees abductionD
Arthritis, glenohumeral:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of motion<40 degrees abductionD
Rotator cuff tear:
Physical examination—range of motion<40 degrees flexionD
Physical examination—range of motion<40 degrees abductionD
Permanent functional limitation, elbow:
Physical examination≤40 degrees deviationD
Physical examination—range of motionFlexion limit to 60 degreesD

H. Hand and Arm

Confirmatory testMinimum resultRequirements
BODY PART: HAND AND ARM
CONFIRMATORY TESTS
Carpal tunnel syndrome:
Medical record reviewPain, paresthesia and weakness in distribution median nerveHighly recommended.
Nerve conduction testingDefinite median nerve conduction slowing at wristHighly recommended.
ElectromyographyDenervation in severe casesRecommended.
Fracture: wrist:
X-ray: wristEvidence of fractureHighly recommended.
Hand: permanent functional limitation:
Medical record reviewDocumentation of medical condition for permanent limitationHighly recommended.
Physical examinationDefinite reproducible evidence of limitationHighly recommended.
Imaging study (e.g. X-ray, CAT, MRI)Positive confirmation of underlying conditionHighly recommended.
Rheumatoid arthritis: hand:
Rheumatoid factorTiter of rheumatoid factorRecommended.
Medical record reviewHistory of objective findings including serological studiesHighly recommended.
X-ray: handCharacteristic rheumatoid changesHighly recommended.
Tenosynovitis:
Medical record reviewHistory of chronic tenosynovitis and objective findingsHighly recommended.
Physical examinationDefinite evidence of tenosynovitisHighly recommended.
Thumb: Permanent functional limitation:
Medical record reviewDocumentation of medical condition for permanent limitationHighly recommended.
Physical examinationDefinite reproducible evidence of limitationHighly recommended.
Imaging study (X-ray, CAT, MRI)Positive confirmation of underlying conditionHighly recommended.
Wrist: Permanent functional limitation:
Medical record reviewDocumentation of medical condition for permanent limitationHighly recommended.
Physical examinationDefinite reproducible evidence of limitationHighly recommended.
Imaging study (e.g. X-ray, CAT, MRI)Positive confirmation of underlying conditionHighly recommended.
Disability testTest resultDisability classification
BODY PART: HAND AND ARM
JOB TITLE: TRAINMAN
Fracture, wrist:
Physical examination—range of motionExtension—limit to 30 degreesD
Physical examination—range of motionFlexion—limit to 30 degreesD
Physical examination—range of motionAnkylosis: ≤20 degrees from neutralD
Rheumatoid arthritis hand:
Physical examinationSignificant deformityD
Medical record reviewSignificant flare-ups, under treatment with rheumatologistD
Medical record reviewExtensive medication use, under treatment with rheumatologistD
Thumb: permanent functional limitation:
Adduction of thumbLoss ≤4 cmD
Ankylosis: degree from neutral<20 degrees extensionD
Ankylosis: degree from neutral<40 degrees flexionD
Loss of extension or flexionMCP or PIP: maximum flexion <40 degreesD
OppositionLoss ≤4 cmD
Wrist: permanent functional limitation:
Physical examination—range of motionExtension—limit to 30 degreesD
Physical examination—range of motionFlexion—limit to 30 degreesD
Physical examination—range of motionAnkylosis: ≤20 degrees from neutralD
BODY PART: HAND AND ARM
JOB TITLE ENGINEER
Fracture, wrist:
Physical examination—range of motionExtension-limit to 30 degreesD
Physical examination—range of motionFlexion-limit to 30 degreesD
Physical examination—range of motionAnkylosis: ≤20 degrees from neutralD
Rheumatoid arthritis hand:
Physical examinationSignificant deformityD
Medical record reviewSignificant flare-ups, under treatment with rheumatologistD
Medical record reviewExtensive medication use, under treatment with rheumatologistD
Thumb: permanent functional limitation:
Adduction of thumbLoss ≤4 cmD
Ankylosis: degree from neutral<20 degrees extensionD
Ankylosis: degree from neutral<40 degrees flexionD
Loss of extension or flexionMCP or PIP: maximum flexion <40 degreesD
OppositionLoss ≤4 cmD
Wrist: permanent functional limitation:
Physical examination—range of motionExtension—limit to 30 degreesD
Physical examination—range of motionFlexion—limit to 30 degreesD
Physical examination—range of motionAnkylosis: ≤20 degrees from neutralD
BODY PART: HAND AND ARM
JOB TITLE: DISPATCHER
Fracture, wrist:
Physical examination—range of motionExtension—limit to 30 degreesD
Physical examination—range of motionFlexion—limit to 30 degreesD
Physical examination—range of motionAnkylosis: ≤20 degrees from neutralD
Rheumatoid arthritis hand:
Physical examinationSignificant deformityD
Medical record reviewSignificant flare-ups, under treatment with rheumatologistD
Medical record reviewExtensive medication use, under treatment with rheumatologistD
Thumb: permanent functional limitation:
Adduction of thumbLoss ≤4 cmD
Ankylosis: degree from neutral<20 degrees extensionD
Ankylosis: degree from neutral<40 degrees flexionD
Loss of extension or flexionMCP or PIP: maximum flexion <40 degreesD
OppositionLoss ≤4 cmD
Wrist: permanent functional limitation:
Physical examination—range of motionExtension—limit to 30 degreesD
Physical examination—range of motionFlexion—limit to 30 degreesD
Physical examination—range of motionAnkylosis: ≤20 degrees from neutralD
BODY PART: HAND AND ARM
JOB TITLE: CARMAN
Fracture, wrist:
Physical examination—range of motionExtension—limit to 30 degreesD
Physical examination—range of motionFlexion—limit to 30 degreesD
Physical examination—range of motionAnkylosis: ≤20 degrees from neutralD
Rheumatoid arthritis hand:
Physical examinationSignificant deformityD
Medical record reviewSignificant flare-ups, under treatment with rheumatologistD
Medical record reviewExtensive medication use, under treatment with rheumatologistD
Thumb: permanent functional limitation:
Adduction of thumb:Loss ≤4 cmD
Ankylosis: degree from neutral<20 degrees extensionD
Ankylosis: degree from neutral<40 degrees flexionD
Loss of extension or flexionMCP of PIP: maximum flexion <40 degreesD
OppositionLoss ≤4 cmD
Wrist: permanent functional limitation:
Physical examination—range of motionExtension—limit to 30 degreesD
Physical examination—range of motionFlexion—limit to 30 degreesD
Physical examination—range of motionAnkylosis: ≤20 degrees from neutralD
BODY PART: HAND AND ARM
JOB TITLE: SIGNALMAN
Fracture, wrist:
Physical examination—range of motionExtension—limit to 30 degreesD
Physical examination—range of motionFlexion—limit to 30 degreesD
Physical examination—range of motionAnkylosis: ≤20 degrees from neutralD
Rheumatoid arthritis hand:
Physical examinationSignificant deformityD
Medical record reviewSignificant flare-ups, under treatment with rheumatologistD
Medical record reviewExtensive medication use, under treatment with rheumatologistD
Thumb: permanent functional limitation:
Adduction of thumbLoss ≤4 cmD
Ankylosis: degree from neutral<20 degrees extensionD
Ankylosis: degree from neutral<40 degrees flexionD
Loss of extension or flexionMCP or PIP: maximum flexion <40 degreesD
OppositionLoss ≤4 cmD
Wrist: permanent functional limitation:
Physical examination—range of motionExtension—limit to 30 degreesD
Physical examination—range of motionFlexion—limit to 30 degreesD
Physical examination—range of motionAnkylosis: ≤20 degrees from neutralD
BODY PART: HAND AND ARM
JOB TITLE: TRACKMAN
Fracture, wrist:
Physical examination—range of motionExtension—limit to 30 degreesD
Physical examination—range of motionFlexion—limit to 30 degreesD
Physical examination—range of motionAnkylosis: ≤20 degrees from neutralD
Rheumatoid arthritis hand:
Physical examinationSignificant deformityD
Medical record reviewSignificant flare-ups, under treatment with rheumatologistD
Medical record reviewExtensive medication use, under treatment with rheumatologistD
Thumb: permanent functional limitation:
Adduction of thumbLoss ≤4 cmD
Ankylosis: degree from neutral<20 degrees extensionD
Ankylosis: degree from neutral<40 degrees flexionD
Loss of extension or flexionMCP or PIP: maximum flexion <40 degreesD
OppositionLoss ≤4 cmD
Wrist: permanent functional limitation:
Physical examination—range of motionExtension—limit to 30 degreesD
Physical examination—range of motionFlexion—limit to 30 degreesD
Physical examination—range of motionAnkylosis: ≤20 degrees from neutralD
BODY PART: HAND AND ARM
JOB TITLE: MACHINIST
Fracture, wrist:
Physical examination—range of motionExtension—limit to 30 degreesD
Physical examination—range of motionFlexion—limit to 30 degreesD
Physical examination—range of motionAnkylosis: ≤20 degrees from neutralD
Rheumatoid arthritis hand:
Physical examinationSignificant deformityD
Medical record reviewSignificant flare-ups, under treatment with rheumatologistD
Medical record reviewExtensive medication use, under treatment with rheumatologistD
Thumb: permanent functional limitation:
Adduction of thumbLoss ≤4 cmD
Ankylosis: degree from neutral<20 degrees extensionD
Ankylosis: degree from neutral<40 degrees flexionD
Loss of extension or flexionMCP or PIP: maximum flexion <40 degreesD
OppositionLoss ≤4 cmD
Wrist: permanent functional limitation:
Physical examination—range of motionExtension—limit to 30 degreesD
Physical examination—range of motionFlexion—limit to 30 degreesD
Physical examination—range of motionAnkylosis: ≤20 degrees from neutralD
BODY PART: HAND AND ARM
JOB TITLE: SHOP LABORER
Fracture, wrist:
Physical examination—range of motionExtension—limit to 30 degreesD
Physical examination—range of motionFlexion—limit to 30 degreesD
Physical examination—range of motionAnkylosis: ≤20 degrees from neutralD
Rheumatoid arthritis hand:
Physical examinationSignificant deformityD
Medical record reviewSignificant flare-ups, under treatment with rheumatologistD
Medical record reviewExtensive medication use, under treatment with rheumatologistD
Thumb: permanent functional limitation:
Adduction of thumbLoss ≤4 cmD
Ankylosis: degree from neutral<20 degrees extensionD
Ankylosis: degree from neutral<40 degrees flexionD
Loss of extension or flexionMCP or PIP: maximum flexion <40 degreesD
OppositionLoss ≤4 cmD
Wrist: permanent functional limitation:
Physical examination—range of motionExtension—limit to 30 degreesD
Physical examination—range of motionFlexion—limit to 30 degreesD
Physical examination—range of motionAnkylosis: ≤20 degrees from neutralD
BODY PART: HAND AND ARM
JOB TITLE: SALES REPRESENTATIVE
Fracture, wrist:
Physical examination—range of motionExtension—limit to 30 degreesD
Physical examination—range of motionFlexion—limit to 30 degreesD
Physical examination—range of motionAnkylosis: ≤20 degrees from neutralD
Rheumatoid arthritis hand:
Physical examinationSignificant deformityD
Medical record reviewSignificant flare-ups, under treatment with rheumatologistD
Medical record reviewExtensive medication use, under treatment with rheumatologistD
Thumb: permanent functional limitation:
Adduction of thumbLoss ≤4 cmD
Ankylosis: degree from neutral<20 degrees extensionD
Ankylosis: degree from neutral<40 degrees flexionD
Loss of extension or flexionMCP or PIP: maximum flexion <40 degreesD
OppositionLoss ≤4 cmD
Wrist: permanent functional limitation:
Physical examination—range of motionExtension—limit to 30 degreesD
Physical examination—range of motionFlexion—limit to 30 degreesD
Physical examination—range of motionAnkylosis: ≤20 degrees from neutralD
BODY PART: HAND AND ARM
JOB TITLE: GENERAL OFFICE CLERK
Fracture, wrist:
Physical examination—range of motionExtension—limit to 30 degreesD
Physical examination—range of motionFlexion—limit to 30 degreesD
Physical examination—range of motionAnkylosis: ≤20 degrees from neutralD
Rheumatoid arthritis hand:
Physical examinationSignificant deformityD
Medical record reviewSignificant flare-ups, under treatment with rheumatologistD
Medical record reviewExtensive medication use, under treatment with rheumatologistD
Thumb: permanent functional limitation:
Adduction of thumbLoss ≤4 cmD
Ankylosis: degree from neutral<20 degree extensionD
Ankylosis: degree from neutral<40 degree flexionD
Loss of extension or flexionMCP or PIP: maximum flexion <40 degreesD
OppositionLoss ≤4 cmD
Wrist: permanent functional limitation:
Physical examination—range of motionExtension—limit to 30 degreesD
Physical examination—range of motionFlexion—limit to 30 degreesD
Physical examination—range of motionAnkylosis: ≤20 degrees from neutralD

I. Hip

Confirmatory testMinimum resultRequirements
BODY PART: HIP
CONFIRMATORY TESTS
Ankylosis, hip:
X-ray: hipExtreme joint destructionHighly Recommended.
Physical examination—range of motionNo mobilityHighly Recommended.
Osteoarthritis, hip:
X-ray: hip<4 mm joint space, or other positive evidenceRecommended.
Magnetic resonance imaging<4 mm joint space, or other positive evidenceRecommended.
Computerized axial tomography<4 mm joint space, or other positive evidenceRecommended.
Osteomyelitis, hip:
X-ray: hipEvidence of chronic infectionRecommended.
Computerized axial tomographyEvidence of chronic infectionRecommended.
Paget's disease:
X-ray: hipOsteolytic or blastic lesionsHighly Recommended.
Alkaline phosphataseIncreased up to 50 timesHighly Recommended.
Hip replacement surgery:
X-ray: hipEvidence of artificial hipRecommended.
Medical record reviewDocumentation of prior hip replacementRecommended.
Disability testTest resultDisability classification
BODY PART: HIP
JOB TITLE: TRAINMAN
Ankylosis, hip:
Physical examination—range of motionAnkylosis 5 degrees or ≤flexionD
Physical examination—range of motionAnkylosis internal rotation ≤5 degreesD
Physical examination—range of motionAnkylosis external rotation ≤10 degreesD
Physical examination—range of motionAnkylosis in abduction ≤5 degreesD
Physical examination—range of motionAnkylosis in adduction ≤5 degreesD
Osteoarthritis, hip:
X-ray: hip0 mm cartilage intervalD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abductionD
Osteomyelitis, chronic hip:
X-ray: hipSignificant joint destructionD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abductionD
Medical record reviewDocumented occurrence of recurring infections with treatmentD
Paget's disease:
X-ray: hipSignificant joint destructionD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abductionD
Hip replacement surgery:
X-ray: hipEvidence of artificial hip jointD
Medical record reviewDocumentation of prior hip replacementD
BODY PART: HIP
JOB TITLE: ENGINEER
Ankylosis, hip:
Physical examination—range of motionAnkylosis 5 degrees or ≤flexionD
Physical examination—range of motionAnkylosis internal rotation ≤5 degreesD
Physical examination—range of motionAnkylosis external rotation ≤10 degreesD
Physical examination—range of motionAnkylosis in abduction ≤5 degreesD
Physical examination—range of motionAnkylosis in adduction ≤5 degreesD
Osteoarthritis, hip:
X-ray: hip0 mm cartilage intervalD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abductionD
Osteomyelitis, chronic hip:
X-ray: hipSignficant joint destructionD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abductionD
Medical record reviewDocumented occurrence of recurring infections with treatmentD
Paget's disease:
X-ray: hipSignificant joint destructionD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abductionD
Hip replacement surgery:
X-ray: hipEvidence of artificial hip jointD
Medical record reviewDocumentation of prior hip replacementD
BODY PART: HIP
JOB TITLE: CARMAN
Ankylosis, hip:
Physical examination—range of motionAnkylosis 5 degrees or ≤flexionD
Physical examination—range of motionAnkylosis internal rotation ≤5 degreesD
Physical examination—range of motionAnkylosis external rotation ≤10 degreesD
Physical examination—range of motionAnkylosis in abduction ≤5 degreesD
Physical examination—range of motionAnkylosis in adduction ≤5 degreesD
Osteoarthritis, hip:
X-ray: hip0 mm cartilage intervalD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abductionD
Osteomyelitis, chronic hip:
X-ray: hipSignificant joint destructionD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abductionD
Medical record reviewDocumented occurrence of recurring infections with treatmentD
Paget's disease:
X-ray: hipSignificant joint destructionD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abductionD
Hip replacement surgery:
X-ray: hipEvidence of artificial hip jointD
Medical record reviewDocumentation of prior hip replacementD
BODY PART: HIP
JOB TITLE: SIGNALMAN
Ankylosis, hip:
Physical examination—range of motionAnkylosis 5 degrees or ≤flexionD
Physical examination—range of motionAnkylosis internal rotation ≤5 degreesD
Physical examination—range of motionAnkylosis external rotation ≤10 degreesD
Physical examination—range of motionAnkylosis in abduction ≤5 degreesD
Physical examination—range of motionAnkylosis in adduction ≤5 degreesD
Osteoarthritis, hip:
X-ray: hip0 mm cartilage intervalD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abductionD
Osteomyelitis, chronic hip:
X-ray: hipSignificant joint destructionD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abductionD
Medical record reviewDocumented occurrence of recurring infections with treatmentD
Paget's disease:
X-ray: hipSignificant joint destructionD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abductionD
Hip replacement surgery:
X-ray: hipEvidence of artificial hip jointD
Medical record reviewDocumentation of prior hip replacementD
BODY PART: HIP
JOB TITLE: TRACKMAN
Ankylosis, hip:
Physical examination—range of motionAnkylosis 5 degrees or ≤flexionD
Physical examination—range of motionAnkylosis internal rotation ≤5 degreesD
Physical examination—range of motionAnkylosis external rotation ≤10 degreesD
Physical examination—range of motionAnkylosis in abduction ≤5 degreesD
Physical examination—range of motionAnkylosis in adduction ≤5 degreesD
Osteoarthritis, hip:
X-ray: hip0 mm cartilage intervalD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abductionD
Osteomyelitis, chronic hip:
X-ray: hipSignificant joint destructionD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abductionD
Medical record reviewDocumented occurrence of recurring infections with treatmentD
Paget's disease:
X-ray: hipSignificant joint destructionD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abductionD
Hip replacement surgery:
X-ray: hipEvidence of artificial hip jointD
Medical record reviewDocumentation of prior hip replacementD
BODY PART: HIP
JOB TITLE: MACHINIST
Ankylosis, hip:
Physical examination—range of motionAnkylosis 5 degrees or ≤flexionD
Physical examination—range of motionAnkylosis internal rotation ≤5 degreesD
Physical examination—range of motionAnkylosis external rotation ≤10 degreesD
Physical examination—range of motionAnkylosis in abduction ≤5 degreesD
Physical examination—range of motionAnkylosis in adduction ≤5 degreesD
Osteoarthritis, hip:
X-ray: hip0 mm cartilage intervalD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abductionD
Osteomyelitis, chronic hip:
X-ray: hipSignificant joint destructionD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abductionD
Medical record reviewDocumented occurrence of recurring infections with treatmentD
Paget's disease:
X-ray: hipSignificant joint destructionD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abudctionD
Hip replacement surgery:
X-ray: hipEvidence of artificial hip jointD
Medical record reviewDocumentation of prior hip replacementD
BODY PART: HIP
JOB TITLE: SHOP LABORER
Ankylosis, hip:
Physical examination—range of motionAnkylosis 5 degrees of ≤flexionD
Physical examination—range of motionAnkylosis internal rotation ≤5 degreesD
Physical examination—range of motionAnkylosis external rotation ≤10 degreesD
Physical examination—range of motionAnkylosis in abduction ≤5 degreesD
Physical examination—range of motionAnkylosis in adduction ≤5 degreesD
Osteoarthritis, hip:
X-ray: hip0 mm cartilage intervalD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abductionD
Osteomyelitis, chronic hip:
X-ray: hipSignificant joint destructionD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abductionD
Medical record reviewDocumented occurrence of recurring infections with treatmentD
Paget's disease:
X-ray; hipSignificant joint destructionD
Physical examination—range of motion30 degrees flexion contractureD
Physical examination—range of motion<50 degrees flexionD
Physical examination—range of motion<5 degrees abductionD
Hip replacement surgery:
X-ray: hipEvidence of artificial hip jointD
Medical record reviewDocumentation of prior hip replacementD

J. Knee

Confirmatory testMinimum resultRequirements
BODY PART: KNEE
CONFIRMATORY TESTS
Arthritis: knee:
X-ray: kneeEvidence of significant degenerative changesRecommended.
Collateral ligament tear with laxity:
Physical examination: kneeEvidence of ligamentous laxityHighly Recommended.
Magnetic resonance imagingEvidence of ligamentous tearRecommended.
Cruciate and collateral ligament tear with laxity:
Magnetic resonance imagingTear of both ligamentsRecommended.
Physical examinationEvidence of ligamentous laxityHighly Recommended.
Medical record reviewDocumentation of tear by arthroscopyRecommended.
Cruciate ligament tear with laxity:
Physical examination: kneeEvidence of ligamentous laxityHighly Recommended.
Magnetic resonance imagingEvidence of cruciate tearRecommended.
Medical record reviewDocumentation of tear by arthroscopyRecommended.
Intercondylar fracture:
X-ray: kneeEvidence of fractureHighly Recommended.
Osteomyelitis: knee:
Medical record reviewDocumented history of osteomyelitis requiring treatmentHighly Recommended.
X-ray: kneeEvidence of chronic infectionRecommended.
Computerized tomographyEvidence of chronic infectionRecommended.
Magnetic resonance imagingEvidence of chronic infectionRecommended.
Osteonecrosis:
X-ray: kneeNecrosis of femoral condyle or tibial plateauRecommended.
Computerized tomographyNecrosis of femoral condyle or tibial plateauRecommended.
Magnetic resonance imagingNecrosis of femoral condyle or tibial plateauRecommended.
Patellofemoral arthritis:
X-ray: kneeEvidence of arthritisRecommended.
Magnetic resonance imagingEvidence of arthritisRecommended.
Physical examinationCrepitation with movementHighly Recommended.
Patellar fracture nonunion with displacement:
X-ray: kneeNonunion and displacementRecommended.
Magnetic resonance imagingNonunion and displacementRecommended.
Computerized tomographyNonunion and displacementRecommended.
Plateau fracture:
X-ray: kneeEvidence of fractureRecommended.
Computerized tomographyEvidence of fractureRecommended.
Magnetic resonance imagingEvidence of fractureRecommended.
Meniscectomy—medial or lateral:
Medical record reviewHistory of surgeryHighly Recommended.
Patellectomy:
Physical examination: kneeAbsent patellaHighly Recommended.
Patellar—subluxation—recurrent:
Medical record reviewHistory of recurrent subluxationHighly Recommended.
Supracondylar fracture:
X-ray: kneeEvidence of fractureRecommended.
Magnetic resonance imagingEvidence of fractureRecommended.
Computerized tomographyEvidence of fractureRecommended.
Total knee replacement:
X-ray: kneePresence of replacement kneeRecommended.
Medical record reviewDocumented surgical historyRecommended.
Tibial shaft fracture:
X-ray: legFracture of shaftRecommended.
Magnetic resonance imagingEvidence of fractureRecommended.
Computerized tomographyEvidence of fractureRecommended.
Disability testTest resultDisability classification
BODY PART: KNEE
JOB TITLE: TRAINMAN
Arthritis knee:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Meniscectomy, medial or lateral:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤degrees)D
Collateral ligament tear with laxity:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Cruciate and collateral ligament tear:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Cruciate ligament tear with laxity:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Intercondylar fracture:
Post fracture angulation≤20 degrees angulationD
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Osteomyelitis, chronic knee:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
Medical record reviewFrequent episodes of infection requiring treatmentD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Osteonecrosis:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Patellofemoral arthritis:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee: patello femoral joint0 mm cartilage interval with degenerative changeD
Patellar fracture nonunion with displacement:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
X-ray kneeNonunion and ≤3 mm displacementD
Plateau fracture:
Post fracture angulation≤20 degrees angulationD
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Patellectomy:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Patellar, subluxation, recurrent:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Supracondylar fracture:
Post fracture angulation≤20 degrees angulationD
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Tibial shaft fracture:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Post fracture angulation≤20 degrees malalignmentD
BODY PART: KNEE
JOB TITLE: ENGINEER
Arthritis knee:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Meniscectomy, medial or lateral:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Collateral ligament tear with laxity:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Cruciate and collateral ligament tear:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Cruciate ligament tear with laxity:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Intercondylar fracture:
Post fracture angulation≤20 degrees angulationD
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Osteomyelitis, chronic knee:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
Medical record reviewFrequent episodes of infection requiring treatmentD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Osteonecrosis:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Patellofemoral arthritis:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee: patello femoral joint0 mm cartilage interval with degenerative changeD
Patellar fracture nonunion with displacement:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
X-ray kneeNonunion and ≤3 mm displacementD
Plateau fracture:
Post fracture angulation≤20 degrees angulationD
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Patellectomy:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Patellar, subluxation, recurrent:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Supracondylar fracture:
Post fracture angulation≤20 degrees angulationD
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Tibial shaft fracture:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Post fracture angulation≤20 degrees malalignmentD
BODY PART: KNEE
JOB TITLE: CARMAN
Arthritis knee:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Meniscectomy, medial or lateral:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Collateral ligament tear with laxity:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Cruciate and collateral ligament tear:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Cruciate ligament tear with laxity:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Intercondylar fracture:
Post fracture angulation≤20 degrees angulationD
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Osteomyelitis, chronic knee:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
Medical record reviewFrequent episodes of infection requiring treatmentD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Osteonecrosis:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Patellofemoral arthritis:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee: patello femoral joint0 mm cartilage interval with degenerative changeD
Patellar fracture nonunion with displacement:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
X-ray kneeNonunion and ≤3 mm displacementD
Plateau fracture:
Post fracture angulation≤20 degrees angulationD
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Patellectomy:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Patellar, subluxation, recurrent:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Supracondylar fracture:
Post fracture angulation≤20 degrees angulationD
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Tibial shaft fracture:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Post fracture angulation≤20 degrees malalignmentD
BODY PART: KNEE
JOB TITLE: SIGNALMAN
Arthritis knee:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Meniscectomy, medial or lateral:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Collateral ligament tear with laxity:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Cruciate and collateral ligament tear:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Cruciate ligament tear with laxity:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Intercondylar fracture:
Post fracture angulation≤20 degrees angulationD
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Osteomyelitis, chronic knee:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
Medical record reviewFrequent episodes of infection requiring treatmentD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Osteonecrosis:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Patellofemoral arthritis:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee: patello femoral joint0 mm cartilage interval with degenerative changeD
Patellar fracture nonunion with displacement:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
X-ray kneeNonunion and ≤3 mm displacementD
Plateau fracture:
Post fracture angulation≤20 degrees angulationD
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Patellectomy:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Patellar, subluxation, recurrent:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Supracondylar fracture:
Post fracture angulation≤20 degrees angulationD
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Tibial shaft fracture:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Post fracture angulation≤20 degrees malalignmentD
BODY PART: KNEE
JOB TITLE: TRACKMAN
Arthritis knee:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Meniscectomy, medial or lateral:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Collateral ligament tear with laxity:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Cruciate and collateral ligament tear:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Cruciate ligament tear with laxity:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Intercondylar fracture:
Post fracture angulation≤20 degree angulationD
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Osteomyelitis, chronic knee:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
Medical record reviewFrequent episodes of infection requiring treatmentD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Osteonecrosis:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Patellofemoral arthritis:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee: patello femoral joint0 mm cartilage interval with degenerative changeD
Patellar fracture nonunion with displacement:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
X-ray kneeNonunion and ≤3 mm displacementD
Plateau fracture:
Post fracture angulation≤20 degrees angulationD
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Patellectomy:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Patellar, subluxation, recurrent:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Supracondylar fracture:
Post fracture angulation≤20 degrees angulationD
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Tibial shaft fracture:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Post fracture angulation≤20 degrees malalignmentD
BODY PART: KNEE
JOB TITLE: MACHINIST
Arthritis knee:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Meniscectomy, medial or lateral:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Collateral ligament tear with laxity:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Cruciate and collateral ligament tear:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Cruciate ligament tear with laxity:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Intercondylar fracture:
Post fracture angulation≤20 degrees angulationD
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Osteomyelitis, chronic knee:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
Medical record reviewFrequent episodes of infection requiring treatmentD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Osteonecrosis:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Patellofemoral arthritis:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee0 mm cartilage interval with degenerative changeD
Patellar fracture nonunion with displacement:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
X-ray kneeNonunion and ≤3 mm displacementD
Plateau fracture:
Post fracture angulation≤20 degrees angulationD
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Patellectomy:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Patellar, subluxation, recurrent:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Supracondylar fracture:
Post fracture angulation≤20 degrees angulationD
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Tibial shaft fracture:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Post fracture angulation≤20 degrees malalignmentD
BODY PART: KNEE
JOB TITLE: SHOP LABORER
Arthritis knee:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Meniscectomy, medial or lateral:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Collateral ligament tear with laxity:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Cruciate and collateral ligament tear:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Cruciate ligament tear with laxity:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Intercondylar fracture:
Post fracture angulation≤20 degrees angulationD
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Osteomyelitis, chronic knee:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
Medical record reviewFrequent episodes of infection requiring treatmentD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Osteonecrosis:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee0-1 mm cartilage interval with degenerative changeD
Patellofemoral arthritis:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Physical examinationValgus deformity, 16-20 degreesD
Physical examinationVarus deformity, 8-12 degreesD
X-ray knee: patellofemoral joint0 mm cartilage interval with degenerative changeD
Patellar fracture nonunion with displacement:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
X-ray kneeNonunion and ≤3 mm displacementD
Plateau fracture:
Post fracture angulation≤20 degrees angulationD
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Patellectomy:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Patellar, subluxation, recurrent:
Physical examination—range of motionRange of motion: flexion <60 degreesD
Physical examination—range of motionFlexion contracture (20 or ≤ degrees)D
Supracondylar fracture:
Post fracture angulation