20 CFR Part 220 — Determining Disability

PART 220—DETERMINING DISABILITY Authority: 45 U.S.C. 231a; 45 U.S.C. 231f. Source: 56 FR 12980, Mar. 28, 1991, unless otherwise noted. Subpart A—General § 220.1 Introduction of part. (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. § 220.2 The basis for the Board's disability decision. (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. § 220.3 Determinations by other organizations and agencies. 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. Subpart B—General Definitions of Terms Used in This Part § 220.5 Definitions as used in this part. Act Application Board Claimant Eligible Employee Entitled Medical source Review physician Social security overall minimum Source of record Treating source Subpart C—Disability Under the Railroad Retirement Act for Work in an Employee's Regular Railroad Occupation § 220.10 Disability for work in an employee's regular railroad occupation. (a) In order to receive an occupational disability annuity an eligible employee must be found by the Board to be disabled for work in his or her regular railroad occupation because of a permanent physical or mental impairment. In this subpart the Board describes in general terms how it evaluates a claim for an occupational disability annuity. In accordance with section 2(a)(2) of the Railroad Retirement Act this subpart was developed with the cooperation of employers and employees. This subpart is supplemented by an Occupational Disability Claims Manual (Manual) 1 1 (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] § 220.11 Definitions as used in this subpart. Functional capacity test Independent Case Evaluation Permanent physical or mental impairment Regular railroad occupation Residual functional capacity [63 FR 7541, Feb. 13, 1998] § 220.12 Evidence considered. 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] § 220.13 Establishment of permanent disability for work in regular railroad occupation. The Board will presume that a claimant who is not allowed to continue working for medical reasons by his employer has been found, under standards contained in this subpart, disabled unless the Board finds that no person could reasonably conclude on the basis of evidence presented that the claimant can no longer perform his or her regular railroad occupation for medical reasons. (See § 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 ( 2 (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. (B) Step 2. 2 2 (C) Step 3. (D) Step 4. (E) Step 5. (F) Step 6. [56 FR 12980, Mar. 28, 1991, as amended at 63 FR 7541, Feb. 13, 1998; 74 FR 63600, Dec. 4, 2009] § 220.14 Weighing of evidence. (a) Factors which support greater weight. (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. (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] § 220.15 Effects of work on occupational disability. (a) Disability onset when the employee works despite impairment. (b) Occupational disability annuitant work restrictions. § 220.16 Responsibility to notify the Board of events which affect disability. 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. § 220.17 Recovery from disability for work in the regular occupation. (a) General. (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. (c) What the Board means by services in an occupational disability case. (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. (e) When the trial work period begins and ends. (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. § 220.18 The reentitlement period. (a) General. (b) When the reentitlement period begins and ends. (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. (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. § 220.19 Payment of the disability annuity during the trial work period and the reentitlement period. (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. § 220.20 Notice that an annuitant is no longer disabled. 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. § 220.21 Initial evaluation of a previous occupational disability. (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). Subpart D—Disability Under the Railroad Retirement Act for Any Regular Employment § 220.25 General. The definition and discussion of disability for any regular employment are found in §§ 220.26 through 220.184. § 220.26 Disability for any regular employment, defined. 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. § 220.27 What is needed to show an impairment. 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.) § 220.28 How long the impairment must last. 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. § 220.29 Work that is considered substantial gainful activity. 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.) § 220.30 Special period required for eligibility of widow(er)s. 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. Subpart E—Disability Determinations Governed by the Regulations of the Social Security Administration § 220.35 Introduction. 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. § 220.36 Period of disability. (a) General. (b) Period of disability Definition and effect. (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. (3) Who may establish a period of disability. (4) When the Board may establish a period of disability. (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. (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. (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 information collection requirements contained in paragraph (b)(6) were approved by the Office of Management and Budget under control number 3220-0002) § 220.37 When a child's disability determination is governed by the regulations of the Social Security Administration. (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. § 220.38 When a widow(er)'s disability determination is governed by the regulations of the Social Security Administration. 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. § 220.39 Disability determination for a surviving divorced spouse or remarried widow(er). 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. Subpart F—Evidence of Disability § 220.45 Providing evidence of disability. (a) General. (b) Kind of evidence. i.e., (2) Exceptions. (i) Oral or written communications between you and your representative that are subject to the attorney-client privilege, unless you voluntarily disclose the communications to us; or (ii) Your representative's analysis of your claim, unless you or your representative voluntarily disclose it to us. Your representative's “analysis of your claim” means information that is subject to the attorney work product doctrine, but it does not include medical evidence, medical source opinions, or any other factual matter that we may consider in determining whether or not you are entitled to benefits (see paragraph (b)(2)(iv) of this section). (iii) The provisions of paragraph (b)(2)(i) of this section apply to communications between you and your non-attorney representative only if the communications would be subject to the attorney-client privilege if your non-attorney representative were an attorney. The provisions of paragraph (b)(2)(ii) of this section apply to the analysis of your claim by your non-attorney representative only if the analysis of your claim would be subject to the attorney work product doctrine if your non-attorney representative were an attorney. (iv) The attorney-client privilege generally protects confidential communications between an attorney and the attorney's client that are related to providing or obtaining legal advice. The attorney work product doctrine generally protects an attorney's analysis, theories, mental impressions, and notes. In the context of your disability claim, neither the attorney-client privilege nor the attorney work product doctrine allows you to withhold factual information, medical source opinions, or other medical evidence that we may consider in determining whether or not you are entitled to benefits. For example, if you tell your representative about the medical sources you have seen, your representative cannot refuse to disclose the identity of those medical sources to us based on the attorney-client privilege. As another example, if your representative asks a medical source to complete an opinion form related to your impairment(s), symptoms, or limitations, your representative cannot withhold the completed opinion form from us based on the attorney work product doctrine. The attorney work product doctrine would not protect the source's opinions on the completed form, regardless of whether or not your representative used the form in an analysis of your claim or made handwritten notes on the face of the report. (c) Your responsibility. (1) Your age; (2) Your education and training; (3) Your work experience; (4) Your daily activities both before and after the date you say that you became disabled; (5) Your efforts to work; and (6) Any other evidence showing how your impairment(s) affects your ability to work. (In §§ 220.125 through 220.134, we discuss in more detail the evidence the Board needs when it considers vocational factors.) [89 FR 78238, Sept. 25, 2024] § 220.46 Medical evidence. (a) Acceptable medical sources. (1) Licensed physicians (medical or osteopathic doctors); (2) Licensed or certified psychologists at the independent practice level; (3) Licensed or certified school psychologists, or other licensed or certified individuals with another title who perform the same function as a school psychologist in a school setting (for impairments of intellectual disability, learning disabilities, and borderline intellectual functioning only); (4) Licensed optometrists (for impairments of visual disorders, or for the measurement of visual acuity and visual fields only, depending on the scope of practice in the State in which the optometrist practices); (5) Licensed podiatrists (for impairments of the foot only, or foot and ankle only, depending on the scope of practice in the State in which the podiatrist practices); (6) Qualified speech-language pathologists (for speech or language impairments only.) For this source, qualified (7) Licensed audiologists (for impairments of hearing loss, auditory processing disorders, and balance disorders within the licensed scope of practice only); (8) Licensed Advanced Practice Registered Nurses or other licensed advance practice nurses with another title (for impairments within the individual's licensed scope of practice only); (9) Licensed Physician Assistants/Physician Associates (for impairments within the individual's licensed scope of practice); or (10) 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) Other medical sources. (c) Medical reports. (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 factors in paragraphs (c)(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 factors in paragraphs (c)(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). (d) Completeness. (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. (e) Evidence from treating medical sources. (f) Information from non-medical sources. (1) Public and private social welfare agency personnel; (2) Family members, caregivers, friends, and neighbors of the claimant; (3) Educational personnel such as teachers, counselors, and daycare center workers; (4) Railroad and nonrailroad employers; and, (5) The claimants themselves. (Approved by the Office of Management and Budget under control number 3220-0038) [56 FR 12980, Mar. 28, 1991, as amended at 90 FR 4627, Jan. 16, 2025] § 220.47 Purchase of existing medical evidence. 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. § 220.48 If the claimant fails to submit medical or other evidence. 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. Subpart G—Consultative Examinations § 220.50 Consultative examinations at the Board's expense. 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) § 220.51 Notice of the examination. 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). § 220.52 Failure to appear at a consultative examination. (a) General. (b) Examples of good reasons for failure to appear. (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. § 220.53 When the Board will purchase a consultative examination and how it will be used. (a)(1) General. (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. (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. § 220.54 When the Board will not purchase a consultative examination. 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. § 220.55 Purchase of consultative examinations at the reconsideration level. (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. § 220.56 Securing medical evidence at the hearings officer hearing level. (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. § 220.57 Types of purchased examinations and selection of sources. (a) Additional evidence needed for disability determination. (b) The physician or psychologist selected to do the examination or test must be qualified. (c) Use of video teleconferencing technology. (1) The examining physician or psychologist is currently state-licensed in the state in which the provider practices; (2) The examining physician or psychologist has the training and experience to perform the type of examination requested; (3) The examining physician or psychologist has access to video teleconferencing technology; (4) The examining physician or psychologist is permitted to perform the exam in accordance with state licensing laws and regulations; (5) The protocol for the examination does not require physical contact; (6) The claimant has the right to refuse a VTT examination without penalty; and (7) The VTT examination complies with all requirements in this subpart governing consultative examinations. [56 FR 12980, Mar. 28, 1991, as amended at 87 FR 27513, May 9, 2022] § 220.58 Objections to the designated physician or psychologist. 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. § 220.59 Requesting examination by a specific physician, psychologist or institution—hearings officer hearing level. 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. § 220.60 Diagnostic surgical procedures. 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. § 220.61 Informing the examining physician or psychologist of examination scheduling, report content and signature requirements. Consulting physicians or psychologists will be fully informed at the time the Board contacts them of the following obligations: (a) General. (b) Report content. (c) Elements of a complete examination. (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., (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. [56 FR 12980, Mar. 28, 1991, as amended at 74 FR 63600, Dec. 4, 2009] § 220.62 Reviewing reports of consultative examinations. (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. § 220.63 Conflict of interest. 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. § 220.64 Program integrity. 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). Subpart H—Evaluation of Disability § 220.100 Evaluation of disability for any regular employment. (a) General. (b) Steps in evaluating disability. (1) Claimant is working. (2) Impairment(s) not severe. (3) Impairment(s) is medically disabling. (4) Impairment(s) must prevent past relevant work. see (5) Impairment(s) must prevent any other work. (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] § 220.101 Evaluation of mental impairments. (a) General. (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. (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. (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] § 220.102 Non-severe impairment(s), defined. (a) Non-severe impairment(s). (b) Basic work activities. (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. § 220.103 Two or more unrelated impairments—initial claims. (a) Unrelated severe impairments. (b) Concurrent impairments. § 220.104 Multiple impairments. 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. § 220.105 Initial evaluation of a previous disability. (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). Subpart I—Medical Considerations § 220.110 Medically disabled. (a) “ Medically disabled.” (1) Permanent; (2) Expected to result in death; or (3) Have a specific length of duration. (b) Diagnosis of impairments. (c) Addiction to alcohol or drugs. [74 FR 63601, Dec. 4, 2009] § 220.111 [Reserved] § 220.112 Conclusions by physicians concerning the claimant's disability. (a) General. (b) Medical opinions that are conclusive. (c) Medical opinions that are not fully supported. 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. 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. 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] § 220.113 Symptoms, signs, and laboratory findings. Medical findings consist of symptoms, signs, and laboratory findings: (a) Symptoms (b) Signs (c) Laboratory findings § 220.114 Evaluation of symptoms, including pain. (a) General. (b) Need for medically determinable impairment that could reasonably be expected to produce symptoms, such as pain. (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 General. (2) Consideration of objective medical evidence. (3) Consideration of other evidence. e.g., (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., (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. (d) Consideration of symptoms in the disability determination process. (1) Need to establish a severe medically determinable impairment(s). See (2) Decision of whether impairment(s) is medically disabling. See (3) Impact of symptoms (including pain) on residual functional capacity. See [68 FR 60291, Oct. 22, 2003, as amended at 74 FR 63601, Dec. 4, 2009] § 220.115 Need to follow prescribed treatment. (a) What treatment the claimant must follow. (b) When the claimant does not follow prescribed treatment. (c) Acceptable reasons for failure to follow prescribed 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. Subpart J—Residual Functional Capacity § 220.120 The claimant's residual functional capacity. (a) General. (b) Physical abilities. (c) Mental abilities. (d) Other abilities affected by impairment(s). (e) Total limiting effects. [68 FR 60293, Oct. 22, 2003, as amended at 74 FR 63601, Dec. 4, 2009] § 220.121 Responsibility for assessing and determining residual functional capacity. (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. Subpart K—Vocational Considerations § 220.125 When vocational background is considered. (a) General. (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. (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. § 220.126 Relationship of ability to do work and residual functional capacity. (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). § 220.127 When the only work experience is arduous unskilled physical labor. (a) Arduous work. (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. (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. § 220.128 Age as a vocational factor. (a) General. Age (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. (c) Person approaching advanced age. (d) Person of advanced age. (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. § 220.129 Education as a vocational factor. (a) General. (b) How the Board evaluates the claimant's education. (1) Illiteracy. (2) Marginal education. (3) Limited education. (4) High school education and above. (5) Inability to communicate in English. (6) Information about the claimant's education. § 220.130 Work experience as a vocational factor. (a) General. Work experience (b) Information about the claimant's work. (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).) § 220.131 Work which exists in the national economy. (a) General. (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. (c) Inability to obtain work. (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. (1) Dictionary of Occupational Titles, (2) County Business Patterns, (3) Census Reports, (4) Occupational Analyses, (5) Occupational Outlook Handbook, (e) Use of vocational experts and other specialists. § 220.132 Physical exertion requirements. 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. (b) Light work. (c) Medium work. (d) Heavy work. (e) Very heavy work. § 220.133 Skill requirements. (a) General. (b) Unskilled work. (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. (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. (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) What the Board means by transferable skills. (2) How the Board determines skills that can be transferred to other jobs. (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. § 220.134 Medical-vocational guidelines in appendix 2 of this part. (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. § 220.135 Exertional and nonexertional limitations. (a) General. (b) Exertional limitations. (c) Nonexertional limitations. (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., (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. [68 FR 60294, Oct. 22, 2003] Subpart L—Substantial Gainful Activity § 220.140 General. 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. § 220.141 Substantial gainful activity, defined. Substantial gainful activity is work activity that is both substantial and gainful. (a) Substantial work activity. (b) Gainful work activity. (c) Some other activities. § 220.142 General information about work activity. (a) The nature of the claimant's work. (b) How well the claimant performs. (c) If the claimant's work is done under special conditions. (d) If the claimant is self-employed. (e) Time spent in work. § 220.143 Evaluation guides for an employed claimant. (a) General. (1) The claimant's earnings may show the claimant has done substantial gainful activity. (2) The Board considers only the amount the claimant earns. (3) If the claimant is working in a sheltered or special environment. (b) Earnings guidelines General. (2) Earnings that will ordinarily show that the claimant has engaged in substantial gainful activity. (i) Before January 1, 2001 (ii) Beginning January 1, 2001 (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 months Monthly earnings averaged more than In calendar years before 1976 $200 In calendar year 1976 230 In calendar year 1977 240 In calendar year 1978 260 In calendar year 1979 280 In calendar years 1980-1989 300 January 1990-June 1999 500 July 1999-December 2000 700 (3) Earnings that will ordinarily show that the claimant has not engaged in substantial gainful activity. Table 2—Amounts Indicating Substantial Gainful Activity Not Performed For months Monthly earnings averaged less than In calendar years before 1976 $130 In calendar year 1976 150 In calendar year 1977 160 In calendar year 1978 170 In calendar year 1979 180 In calendar years 1980-1989 190 In calendar years 1990-2000 300 (4) If the claimant worked in a sheltered workshop. (5) If there is evidence showing that the claimant may have done substantial gainful activity. (6) Earnings that are not high enough to ordinarily show that the claimant engaged in substantial gainful activity. (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] § 220.144 Evaluation guides for a self-employed claimant. (a) If the claimant is a self-employed claimant. (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 Claimants who are not farm landlords. (2) Claimants who are farm landlords General. (ii) Material participation. ( 1 ( 2 (B) The claimant will have presented strong evidence that he or she is materially participating if he or she periodically— ( 1 ( 2 (iii) Production. (iv) Management of the production. (c) What the Board means by substantial income. (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. § 220.145 Impairment-related work expenses. (a) General. (b) Conditions for deducting impairment-related work expenses. (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 Payments for attendant care services. (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. (3) Payments for prosthetic devices. (4) Payments for equipment Work-related equipment. (ii) Residential modifications. (iii) Non-medical appliances and equipment. (5) Payments for drugs and medical services. (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 General. (ii) Medical supplies and services not described above. (iii) Payments for transportation costs. (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. (d) When expenses may be deducted Effective date. (2) Payments for services. (3) Payments for items. (e) How expenses are allocated Recurring expenses. 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. 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. 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 1982 1,265 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 1982 1,250 12 / $2,700 = $225 (4) Payments made in anticipation of work. (f) Limits on deductions. (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. Subpart M—Disability Annuity Earnings Restrictions Source: 56 FR 12980, Mar. 28, 1991, as amended at 91 FR 51383, Aug. 10, 2026, unless otherwise noted. § 220.160 How work for a railroad employer affects a disability annuity. 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. § 220.161 How non-railroad work affects an employee disability annuity. (a) General. (b) Monthly allowable earnings amount. Calendar years 2006 and earlier. (2) Calendar year 2007. (3) Calendar years 2008 and later. (i) The amount for the previous year, or (ii) The amount calculated by multiplying $700 by the ratio of the national average wage index for the year 2 calendar years before the year for which the amount is being calculated to the national average wage index for the year 2005. An amount calculated under this paragraph will be rounded to the nearest multiple of $10 (amounts ending in $5 will be rounded up.) (4) Annual notice. § 220.162 Earnings report. (a) General. (b) Employee reports. § 220.163 Employee penalty deductions. If the employee earns over the monthly allowable earnings amount in a month and does not report it within the time limit shown in § 220.162(b), a penalty deduction may be imposed. The penalty deduction for the first failure to report equals the annuity amount for the first month in which the employee earned over the monthly allowable earnings amount. The deduction for a second or later failure to report equals the annuity amount for each month in which the employee earned over the monthly allowable earnings amount and failed to report it on time. § 220.164 Employee end-of-year adjustment. (a) General. (b) Earnings are less than or equal to the annual allowable earnings amount. (c) Earnings are more than the annual allowable earnings amount. (2) If the employee's total earnings for a year exceed the annual allowable earnings amount by more than one-half the monthly allowable earnings amount and the employee failed to report monthly earnings over the monthly allowable earnings amount 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 the monthly allowable earnings amount and failed to report it on time. Example 1 to paragraph (c): An employee is awarded a disability annuity based upon his inability to engage in his regular railroad occupation effective January 1, 2025. During the year, he works in non-railroad employment from April to September and earns $2,100 per month for these six months. The employee properly reports his excess earnings and returns the annuity payments for these months. At the end of the year, his total annual earnings are $12,600 ($2,100 times 6 months), which does not exceed the annual allowable earnings limit of $15,120 ($1,260 times 12 months) for 2025. Therefore, at the end-of-year adjustment, the Board will repay the returned annuity payments for April through September to the employee. (This occurs even if the employee failed to report the earnings to the Board within two months, because no penalty deduction is made when the employee's total annual earnings are less than the annual allowable earnings amount.) Example 2 to paragraph (c): An employee is awarded a disability annuity based upon his inability to engage in his regular railroad occupation effective January 1, 2025. During that year, he works in non-railroad employment from April to September and earns $2,550 per month for those six months. He does not report these earnings to the Board until the following January. At the end of the year, his total annual earnings are $15,300 ($2,550 times 6 months), which exceeds the annual allowable earnings limit of $15,120 (12 times $1,260) for 2025. The employee's excess earnings for 2025 total $180 ($15,300 minus $15,120), which is less than one-half of the monthly allowable earnings amount (one-half of $1,260 equals $630.) Therefore, at the end-of-year adjustment, no deductions for excess earnings and no penalty deductions for failing to report will be applied. Example 3 to paragraph (c): An employee is awarded a disability annuity based upon his inability to engage in his regular railroad occupation effective January 1, 2025. During that year, he works in non-railroad employment from April to September and earns $3,000 per month for those six months. He does not report these earnings to the Board until the following January. At the end of the year, his total annual earnings are $18,000 ($3,000 times 6 months), which exceeds the annual allowable earnings limit of $15,120 (12 times $1,260) for 2025. The employee's excess earnings for 2025 total $2,880 ($18,000 minus $15,120). The employee's total excess earnings divided by the monthly allowable earnings limit equals 2.286, which rounds to two ($2,880 divided by $1,260). At the end of the year, the employee has two months of annuity payments deducted for earnings. Additionally, the employee incurs a penalty deduction of one month's annuity payment because he failed to report his excess earnings for April through September 2025 and it is the first time a penalty deduction is ever applied. Therefore, a total of three annuity payments are deducted. Example 4 to paragraph (c): The same employee from example 3 works again in 2026 in non-railroad employment from April to September, earning $3,100 per month for those six months. This time, he reports his earnings on September 30. At the end of the year, his total annual earnings are $18,600 ($3,100 times 6 months), which exceeds the annual allowable earnings limit of $15,840 (12 times $1,320) for 2026. The employee's excess earnings for 2026 total $2,760 ($18,600 minus $15,840). The employee's total excess earnings divided by the monthly allowable earnings limit equals 2.091, which rounds to two ($2,760 divided by $1,320). At the end of the year, the employee has two months of annuity payments deducted for earnings. Additionally, the employee incurs penalty deductions of three months' annuity payments for April, May, and June 2026 because he failed to report his monthly excess earnings during the year for those months before accepting the annuity for the second month following those months, and it is not his first penalty deduction for failing to report. Therefore, a total of five months of annuity payments are deducted. (d) Annual allowable earnings amount Calendar years 2006 and earlier. (2) Calendar year 2007 and later. (3) Annual notice. Subpart N—Trial Work Period and Reentitlement Period for Annuitants Disabled for Any Regular Employment § 220.170 The trial work period. (a) Definition of the trial work period. (b) What the Board means by services. (1) If the claimant is an employee. (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 (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. (i) Before January 1, 2002 (ii) Beginning January 1, 2002 (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 months You earn more than In calendar years before 1979 $50 In calendar years 1979-1989 75 In calendar years 1990-2000 200 In calendar year 2001 530 Table 2—For the Self-Employed For months Your net earnings are more than Or you work in the business more than In calendar years before 1979 $50 15 In calendar years 1979-1989 75 15 In calendar years 1990-2000 200 40 In calendar year 2001 530 80 (c) Limitations on the number of trial work periods. (d) Who is and is not entitled to a trial work period. (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. (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. (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] § 220.171 The reentitlement period. (a) General. (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. (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. (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. Subpart O—Continuing or Stopping Disability Due to Substantial Gainful Activity or Medical Improvement § 220.175 Responsibility to notify the Board of events which affect disability. 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. § 220.176 When disability continues or ends. 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] § 220.177 Terms and definitions. 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. 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. 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. 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 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. i.e., (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. (f) Evidence and basis for the Board's decision. (g) Point of comparison. [56 FR 12980, Mar. 28, 1991, as amended at 74 FR 63601, Dec. 4, 2009] § 220.178 Determining medical improvement and its relationship to the annuitant's ability to do work. (a) General. (b) Determining if medical improvement is related to ability to work. (c) Additional factors and considerations. (1) Previous impairment was medically disabling. see (2) Prior residual functional capacity assessment made. (3) Prior residual functional capacity assessment should have been made, but was not. 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. (5) Prior file cannot be located. [56 FR 12980, Mar. 28, 1991, as amended at 74 FR 63602, Dec. 4, 2009] § 220.179 Exceptions to medical improvement. (a) First group of exceptions to medical improvement. (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). (2) Substantial evidence shows that the annuitant has undergone vocational therapy (related to his or her ability to work). 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. (i) How the Board will determine which methods are new or improved 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. 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. (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. (b) Second group of exceptions to medical improvement. (1) A prior determination was fraudulently obtained. (2) Failure to cooperate with the Board. (3) Inability of the Board to locate the annuitant. (4) Failure of the annuitant to follow prescribed treatment which would be expected to restore the ability to engage in substantial gainful activity. [56 FR 12980, Mar. 28, 1991, as amended at 74 FR 63602, Dec. 4, 2009] § 220.180 Determining continuation or cessation of disability. Evaluation steps. (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] § 220.181 The month in which the Board will find that the annuitant is no longer disabled. 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] § 220.182 Before a disability annuity is stopped. Before the Board stops a disability annuity, it will give the annuitant a chance to explain why it should not do so. § 220.183 Notice that the annuitant is not disabled. (a) General. (b) What the advance written notice will tell the annuitant. (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. (d) When the Board will not give the annuitant advance written notice. (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. § 220.184 If the annuitant becomes disabled by another impairment(s). 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. § 220.185 The Board may conduct a review to find out whether the annuitant continues to be 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. § 220.186 When and how often the Board will conduct a continuing disability review. (a) General. (b) When the Board will conduct a continuing disability review. (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. Medical improvement expected diary— Permanent impairment medical improvement not expected—refers (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 (d) Frequency of review. (e) Change in classification of impairment. (f) Review after administrative appeal. (g) Waiver of timeframes. [56 FR 12980, Mar. 28, 1991, as amended at 65 FR 20372, Apr. 17, 2000; 74 FR 63603, Dec. 4, 2009] § 220.187 If the annuitant's medical recovery was expected and the annuitant returned to work. 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. Appendix 1 to Part 220 [Reserved] Appendix 2 to Part 220—Medical-Vocational Guidelines 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. (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., (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). (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) Rule Age Education Previous work experience Decision 201.01 Advanced age Limited or less Unskilled or none Disabled. 201.02 ......do ......do Skilled or semiskilled—skills not transferable 1 Do. 201.03 ......do ......do Skilled or semiskilled—skills transferable 1 Not disabled. 201.04 ......do High school graduate or more—does not provide for direct entry into skilled work 2 Unskilled or none Disabled. 201.05 ......do High school graduate or more—provides for direct entry into skilled work 2 ......do Not disabled. 201.06 ......do High school graduate or more—does not provide for direct entry into skilled work 2 Skilled or semiskilled—skills not transferable 1 Disabled. 201.07 ......do ......do Skilled or semiskilled—skills transferable 1 Not disabled. 201.08 ......do High school graduate or more—provides for direct entry into skilled work 2 Skilled or semiskilled—skills not transferable 1 Do. 201.09 Closely approaching advanced age Limited or less Unskilled or none Disabled. 201.10 ......do ......do Skilled or semiskilled—skills not transferable Do. 201.11 ......do ......do Skilled or semiskilled—skills transferable Not disabled. 201.12 ......do High school graduate or more—does not provide for direct entry into skilled work 3 Unskilled or none Disabled. 201.13 ......do High school graduate or more—provides for direct entry into skilled work 3 ......do Not disabled. 201.14 ......do High school graduate or more—does not provide for direct entry into skilled work 3 Skilled or semiskilled—skills not transferable Disabled. 201.15 ......do ......do Skilled or semiskilled—skills transferable Not disabled. 201.16 ......do High school graduate or more—provides for direct entry into skilled work 3 Skilled or semiskilled—skills not transferable Do. 201.17 Younger individual age 45-49 Illiterate or unable to communicate in English Unskilled or none Disabled. 201.18 ......do Limited or less—at least literate and able to communicate in English ......do Not disabled. 201.19 ......do Limited or less Skilled or semiskilled—skills not transferable Do. 201.20 ......do ......do Skilled or semiskilled—skills transferable Do. 201.21 ......do High school graduate or more Skilled or semiskilled—skills not transferable Do. 201.22 ......do ......do Skilled or semiskilled—skills transferable Do. 201.23 Younger individual age 18-44 Illiterate or unable to communicate in English Unskilled or none Do. 4 201.24 ......do Limited or less—at least literate and able to communicate in English ......do Do. 4 201.25 ......do Limited or less Skilled or semiskilled—skills not transferable Do. 4 201.26 ......do ......do Skilled or semiskilled—skills transferable Do. 4 201.27 ......do High school graduate or more Unskilled or none Do. 4 201.28 ......do ......do Skilled or semiskilled—skills not transferable Do. 4 201.29 ......do ......do Skilled or semiskilled—skills transferable Do. 4 1 2 3 4 202.00 Maximum sustained work capability limited to light work as a result of severe medically determinable impairment(s). (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) Rule Age Education Previous work experience Decision 202.01 Advanced age Limited or less Unskilled or none Disabled. 202.02 ......do ......do Skilled or semiskilled—skills not transferable Do. 202.03 ......do ......do Skilled or semiskilled—skills transferable 1 Not disabled. 202.04 ......do High school graduate or more—does not provide for direct entry into skilled work 2 Unskilled or none Disabled. 202.05 ......do High school graduate or more—provides for direct entry into skilled work 2 ......do Not disabled. 202.06 ......do High school graduate or more—does not provide for direct entry into skilled work 2 Skilled or semiskilled—skills not transferable Disabled. 202.07 ......do ......do Skilled or semiskilled—skills transferable 2 Not disabled. 202.08 ......do High school graduate or more—provides for direct entry into skilled work 2 Skilled or semiskilled—skills not transferable Do. 202.09 Closely approaching advanced age Illiterate or unable to communicate in English Unskilled or none Disabled. 202.10 ......do Limited or less—At least literate and able to communicate in English ......do Not disabled. 202.11 ......do Limited or less Skilled or semiskilled—skills not transferable Do. 202.12 ......do ......do Skilled or semiskilled—skills transferable Do. 202.13 ......do High school graduate or more Unskilled or none Do. 202.14 ......do ......do Skilled or semiskilled—skills not transferable Do. 202.15 ......do ......do Skilled or semiskilled—skills transferable Do. 202.16 Younger individual Illiterate or unable to communicate in English Unskilled or none Do. 202.17 ......do Limited or less—At least literate and able to communicate in English ......do Do. 202.18 ......do Limited or less Skilled or semiskilled—skills not transferable Do. 202.19 ......do ......do Skilled or semiskilled—skills transferable Do. 202.20 ......do High school graduate or more Unskilled or none Do. 202.21 ......do ......do Skilled or semiskilled—skills not transferable Do. 202.22 ......do ......do Skilled or semiskilled—skills transferable Do. 1 2 203.00 Maximum sustained work capability limited to medium work as a result of severe medically determinable impair- ment(s). (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) Rule Age Education Previous work experience Decision 203.01 Closely approaching retirement age Marginal or none Unskilled or none Disabled. 203.02 ......do Limited or less None Do. 203.03 ......do Limited Unskilled Not disabled. 203.04 ......do Limited or less Skilled or semiskilled—skills not transferable Do. 203.05 ......do ......do Skilled or semiskilled—skills transferable Do. 203.06 ......do High school graduate or more Unskilled or none Do. 203.07 ......do High school graduate or more—does not provide for direct entry into skilled work Skilled or semiskilled—skills not transferable Do. 203.08 ......do ......do Skilled or semiskilled—skills transferable Do. 203.09 ......do High school graduate or more—provides for direct entry into skilled work Skilled or semiskilled—skills not transferable Do. 203.10 Advanced age Limited or less None Disabled. 203.11 ......do ......do Unskilled Not disabled. 203.12 ......do ......do Skilled or semiskilled—skills not transferable Do. 203.13 ......do ......do Skilled or semiskilled—skills transferable Do. 203.14 ......do High school graduate or more Unskilled or none Do. 203.15 ......do High school graduate or more—does not provide for direct entry into skilled work Skilled or semiskilled—skills not transferable Do. 203.16 ......do ......do Skilled or semiskilled—skills transferable Do. 203.17 ......do High school graduate or more—provides for direct entry into skilled work Skilled or semiskilled—skills not transferable Do. 203.18 Closely approaching advanced age Limited or less Unskilled or none Do. 203.19 ......do ......do Skilled or semiskilled—skills not transferable Do. 203.20 ......do ......do Skilled or semiskilled—skills transferable Do. 203.21 ......do High school graduate or more Unskilled or none Do. 203.22 ......do High school graduate or more—does not provide for direct entry into skilled work Skilled or semiskilled—skills not transferable Do. 203.23 ......do ......do Skilled or semiskilled—skills transferable Do. 203.24 ......do High school graduate or more—provides for direct entry into skilled work Skilled or semiskilled—skills not transferable Do. 203.25 Younger individual Limited or less Unskilled or none Do. 203.26 ......do ......do Skilled or semiskilled—skills not transferable Do. 203.27 ......do ......do Skilled or semiskilled—skills transferable Do. 203.28 ......do High school graduate or more Unskilled or none Do. 203.29 ......do High school graduate or more—does not provide for direct entry into skilled work Skilled or semiskilled—skills not transferable Do. 203.30 ......do ......do Skilled or semiskilled—skills transferable Do. 203.31 ......do High school graduate or more—provides for direct entry into skilled work Skilled 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). [56 FR 12980, Mar. 28, 1991, as amended at 68 FR 60294, Oct. 22, 2003] Appendix 3 to Part 220—Railroad Retirement Board Occupational Disability Standards 1. Introduction 1.01 The Board uses this appendix to adjudicate the occupational disability claims of employees with medical conditions and job titles covered by the Tables in this appendix. The Tables are divided into “Body Parts”, with each Body Part further divided by job title. Under each job title there is a list of impairments and tests with accompanying test results which establish a finding of “D” (disabled). The use of these Tables is a three-step process. In the first step we determine whether the employee's regular railroad occupation is covered by the Tables; next we establish the existence of an impairment covered by the Tables; finally, we reach a disability determination. If we do not find an employee disabled under these Tables, the employee may still be found disabled using Independent Case Evaluation (ICE), as explained in subpart C of this part. 1.02 The Cancer Tables are treated in a different way than other body systems. Different types of cancer and their treatments have different functional impacts. In the Cancer Tables the impact of the impairment is seen as being significant or not significant. Therefore, these tables contain an “S” (significant) which is equivalent to a “D” rating. A detailed explanation of how to use those tables is in that section. The steps to use the remaining Tables are explained below: 2. Confirming the Impairment 2.01 Once we determine that the employee's regular railroad occupation is covered by the Job Titles in the Tables, we must determine the existence of an impairment covered by the Tables. This is done through the use of Confirmatory Tests. These tests can include information from medical records, surgical or operative reports, or specific diagnostic test results. Confirmatory Tests are listed in the initial section regarding each Body Part covered in the Tables. If an impairment cannot be confirmed because of inconsistent medical information, ICE may be required. 2.02 There are two types of Confirmatory Tests as follows. 2.03 “Highly Recommended” Tests—The designation of a confirmatory test as being “highly recommended” means that the test is almost always performed to confirm the existence of the impairment. For many conditions, only one “highly recommended” test finding is suggested to confirm the impairment. However, there may be times when that test is not available or is negative, but other more detailed testing confirms the impairment. 2.04 Example A: 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: 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 B. Other tests 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: 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: Tables A. Cancer B. Endocrine C. Cardiac D. Respiratory E. Lumbar Sacral Spine F. Cervical Spine G. Shoulder and Elbow H. Hand and Arm I. Hip J. Knee K. Ankle and Foot A. Cancer Cancer Cancer conditions can be viewed as belonging to one of three categories. Category 1: Significant impact on functional capacity or anticipated life span. Category 2: Intermediate impact on functional capacity; large individual variability. Category 3: No significant impact on functional capacity or expected life span. The factors that are considered in developing these categories include the following: Type of Cancer The functional impact of different malignancies varies tremendously and each malignancy has to be considered on an individual basis. Magnitude of Disease The disability standards are based upon the magnitude or extent of disease. The extent of disease affects both anticipated life span and the functional capacity or work ability of the individual. Localized cancer including cancer “in situ” can frequently be completely cured and not have an impact on functional capacity or life span. In contrast, many cancers that have distant or significant regional spread generally have a poor prognosis. The magnitude or extent of disease is classified into three categories: local, regional and distant. The criteria which are used to classify a cancer into one of the three categories are based upon the distillation of several staging methods into a single system [Miller, et al. (1992). Cancer Statistics Review, 1973-1989; NIH Publication No. 92-2789]. Effects of Treatment Although some types of cancer may be potentially curable with radical surgery and/or radiation therapy, the treatment regimen may result in a significant impairment that could affect functional capacity and ability to work. For example, a person with a laryngeal tumor which had spread regionally could be cured by a complete laryngectomy and radiotherapy. However, this treatment could result in a loss of speech and significantly impair the individual's communicative skills or ability to use certain types of respiratory protective equipment. Prognosis Some cancers may have minimal impact on a person's functional capacity, but have a very poor prognosis with respect to life expectancy. For example, an individual with early stage brain cancer may be minimally impaired, but have a poor prognosis and minimal potential for surviving longer than two years. Five and two year survival data are presented in the Cancer Disability Guideline Table which follows. The Cancer Disability Guideline Table provides information concerning the probability of survival for five years for local, regional, and distant disease for each type of malignancy. In addition, two-year survival data are also presented for all disease stages. The five-year survival data are based upon data collected from population-based registries in Connecticut, New Mexico, Utah, Hawaii, Atlanta, Detroit, Seattle and the San Francisco and East Bay area between 1983 and 1987 (Miller, 1992). The two-year data are from a cohort study initially diagnosed in 1988. Assessment The malignancies are classified as disabling (Category 1), potentially disabling (Category 2) and non-disabling (Category 3). Category 2 conditions must be evaluated with respect to how the worker's tumor affects the worker's ability to perform the job and an assessment of his life span. Information concerning the potential impact of the malignancy on a worker's ability to perform a job is identified in the Functional Impact column in the table. All railroad occupations in the Tables are considered together. Functional impacts are classified as significant if the treatment or sequelae from treatment including radiotherapy, chemotherapy and/or surgery is likely to impair the worker from performing the job. If the treatment results in a significant impairment of another organ system, the individual should be evaluated for disability associated with impairment of that body part. For example, a person undergoing an amputation for a bone malignancy would have to be evaluated for an amputation of that body part. For many cancers, it is difficult to make generalizations regarding the level of impairment that will occur after the person has initiated or completed treatment. Nonsignificant impacts include those that are unlikely to have any effect on the individual's work capacity. Cancer type 2-year 1 5-year 1 Disability status 2 Functional impact 3 Brain: Local 26 1 S Regional 27.9 1 S Distant 23.6 1 S Female Breast: Regional 71.1 2 S Distant 17.8 1 S Colon: Local 91 2 S Regional 60.1 2 S Distant 6 1 S Rectal: Local 84.5 2 S Regional 50.7 2 S Distant 5.3 1 S Esophagus: Local 18.5 1 S Regional 5.2 1 S Distant 1.8 1 S Hodgkin's Disease: 4 Stage 1 90-95 3 S Stage 2 86 2 S Stage 3 <80 2 S Stage 4 <80 1 S Kidney/Renal Pelvis: Local 85.4 3 S Regional 56.3 2 S Distant 9 1 S Larynx: Local 84.2 2 S Regional 52.5 2 S Distant 24 1 S Acute Lymphocytic Leukemia: All 51.1 2 S Chronic Lymphocytic Leukemia: All 66.2 2 S Acute Myelogenous Leukemia: All 9.7 1 S Chronic Myelogenous Leukemia: All 21.7 1 S Liver/Intrahepatic Bile Duct: Local 15.1 1 S Regional 5.8 1 S Distant 1.9 1 S Lung/Bronchus: 5 Local 45.6 2 S Regional 13.1 1 S Distant 1.3 1 S Melanomas of Skin: Regional 53.6 2 S Distant 12.8 1 S Oral Cavity/Pharyngeal: Local 76.2 2 S Regional 40.9 2 S Distant 18.7 1 S Pancreas: Local 6.1 1 S Regional 3.7 1 S Distant 1.4 1 S Prostate: Local 91 3 S Regional 80.4 2 S Distant 28 1 S Stomach: Local 55.4 1 S Regional 17.3 1 S Distant 2.1 1 S Testicular: Distant 65.5 1 S Thyroid: Regional 93.1 3 S Distant 47.2 1 S Bladder: Regional 46 2 S Distant 9.1 1 S 1 2 Category 1: Significant impact on functional capacity or life span. Category 2: Intermediate impact. Category 3: No significant impact on functional capacity or life span. 3 (S) Significant—significant potential for the effects of treatment (radiotheraphy, chemotherapy. surgery) to affect functional capacity. 4 5 B. Endocrine Confirmatory test Minimum result Requirements BODY PART: ENDOCRINE CONFIRMATORY TESTS Diabetes, requiring insulin (IDDM): Medical record review Confirmation of condition and need for insulin use Highly recommended. Disability test Test result Disability classification BODY PART: ENDOCRINE JOB TITLE: ENGINEER Diabetes, requiring insulin (IDDM): Medical record review Confirmation of condition and need for insulin use D C. Cardiac Confirmatory test Minimum result Requirements BODY PART: CARDIAC CONFIRMATORY TESTS Angina: Medical record review Confirmed history of ischemia including copies of electrocardiogram Recommended. Stress test Definite ischemia on exercise test Recommended. Thallium study Definite ischemia with exercise Recommended. Aortic valve disease: Cardiac catheterization Proven and significant Recommended. Echocardiogram Significant valve disease Recommended. Coronary artery disease: Medical record review Documented ischemia with electrocardiogram confirmation Recommended. Medical record review Documented myocardial infarction Recommended. Stress test Positive Recommended. Thallium study Definite ischemia with exercise Recommended. Angiography Definite occlusion (>60%) of one vessel Recommended. Cardiomyopathy: Echocardiogram Proven ejection fraction ≤35% Recommended. Catheterization Poor global function and not coronary artery disease Recommended. Hypertension: Medical record review Documentation of hypertension for one year Highly recommended. Medical record review Definite diagnosis by cardiologist or internist Highly recommended. Medical record review Confirmation of medication use Highly recommended. Arrhythmia: heart block: Medical record review Proven episode with electrocardiogram confirmation Recommended. Electrocardiogram Documentation of arrhythmia Recommended. Mitral valve disease: Cardiac catheterization Significant valve disease Recommended. Echocardiogram Significant valve disease Recommended. Pericardial disease: Medical record review Confirmed by cardiologist or internist Highly recommended. Pulmonary hypertension: Physical examination Increased pulmonic sound or pulmonary ejection murmur by cardiologist or internist Recommended. Electrocardiogram Definite right ventricular hypertension Highly recommended. Ventricular ectopy: Medical record review Definite episode within one year Recommended. Holter monitoring Definite arrhythmia Recommended. Provocative testing Positive response Recommended. Arrhythmia: supraventricular tachycardia: Medical record review Definite episode within one year Recommended. Holter monitoring Definite arrhythmia Recommended. Post heart transplant: Medical record review Documented Highly recommended. Disability test Test result Disability classification BODY PART: CARDIAC JOB TITLE: TRAINMAN Angina: Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤7 METS D Medical record review Unstable as diagnosed by cardiologist D Stress test Documented hypotensive response D Stress test: significant ST changes Definite ischemia ≤7 METS D Aortic valve disease: Cardiac catheterization Aortic gradient 25-50 mm HG Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤7 METS D Coronary artery disease: Myocardial infarction Multiple infarctions D Echocardiogram Confirmed ventricular aneurysm D Cardiac catheterization Aortic gradient 25-50 mm Hg D Cardiac catheterization Poor ejection fraction ≤35% D Stress test Peak exercise ≤7 METS D Medical record review Unstable as diagnosed by a Cardiologist D Stress test Documented hypotensive response D Stress test Definite ischemia ≤ 7 METS D Isotope, e.g., thallium study Definite ischemia ≤ 7 METS D Cardiomyopathy: Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤7 METS D Hypertension: Medical record review Diastolic >120 and systolic >160, 50% of the time and evidence of end organ damage (blood creatinine >2; urinary protein > 1 2 D Arrhythmia: heart block: Holter Documented asystole length >1.5-2 seconds D Medical record review Documented syncope with proven arrhythmia D Mitral valve disease: Cardiac catheterization Mitral valve gradient ≥5 mm Hg D Cardiac catheterization Mitral regurgitation severe D Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤7 METS D Pericardial disease: Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Ventricular ectopy: Medical record review Documented life threatening arrhythmia D Holter Uncontrolled ventricular rhythm D Medical record review Documented related syncope D Arrhythmia: supraventricular tachycardia: Medical record review Documented related syncope D Post heart transplant: Medical record review Post heart transplant D BODY PART: CARDIAC JOB TITLE: ENGINEER Angina: Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Medical record review Unstable as diagnosed by cardiologist D Stress test Documented hypotensive response D Stress test: significant ST changes Definite ischemia ≤5 METS D Aortic valve disease: Cardiac catheterization Aortic gradient 25-50 mm HG D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Coronary artery disease: Myocardial infarction Multiple infarctions D Echocardiogram Confirmed ventricular aneurysm D Cardiac catheterization Aortic gradient 25-50 mm Hg D Cardiac catheterization Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Medical record review Unstable as diagnosed by a Cardiologist D Stress test Documented hypotensive response D Stress test Definite ischemia ≤5 METS D Isotope, e.g., thallium study Definite ischemia ≤5 METS D Cardiomyopathy: Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Hypertension: Medical record review Diastolic >120 and systolic >160, 50% of the time and evidence of end organ damage (blood creatinine >2; urinary protein > 1 2 D Arrhythmia: heart block: Holter Documented asystole length >1.5-2 seconds D Medical record review Documented syncope with proven arrhythmia D Mitral valve disease: Cardiac catheterization Mitral valve gradient ≥10 mm Hg D Cardiac catheterization Mitral regurgitation severe D Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Pericardial disease: Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Ventricular ectopy: Medical record review Documented life threatening arrhythmia D Holter Uncontrolled ventricular rhythm D Medical record review Documented related syncope D Arrhythmia: supraventricular tachycardia: Medical record review Documented related syncope D Post heart transplant: Medical record review Post heart transplant D BODY PART: CARDIAC JOB TITLE: DISPATCHER Angina: Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Medical record review Unstable as diagnosed by cardiologist D Stress test Documented hypotensive response D Stress test: significant ST changes Definite ischemia ≤5 METS D Aortic valve disease: Cardiac catheterization Aortic gradient 25-50 mm Hg D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Coronary artery disease: Myocardial infarction Multiple infarctions D Echocardiogram Confirmed ventricular aneurysm D Cardiac catheterization Aortic gradient 25-50 mm Hg D Cardiac catheterization Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Medical record review Unstable as diagnosed by cardiologist D Stress test Documented hypotensive response D Stress test Definite ischemia ≤5 METS D Isotope, e.g., thallium study Definite ischemia ≤5 METS D Cardiomyopathy: Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Hypertension: Medical record review Diastolic >120 and systolic >160, 50% of the time and evidence of end organ damage (blood creatinine >2; urinary protein > 1 2 D Arrhythmia: heart block: Holter Documented asystole length >1.5-2 seconds D Medical record review Documented syncope with proven arrhythmia D Mitral valve disease: Cardiac catheterization Mitral valve gradient ≥10 mm Hg D Cardiac catheterization Mitral regurgitation severe D Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Pericardial disease: Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Ventricular ectopy: Medical record review Documented life threatening arrhythmia D Holter Uncontrolled ventricular rhythm D Medical record review Documented related syncope D Arrhythmia: supraventricular tachycardia: Medical record review Documented related syncope D Post heart transplant: Medical record review Post heart transplant D BODY PART: CARDIAC JOB TITLE: CARMAN Angina: Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Medical record review Unstable as diagnosed by cardiologist D Stress test Documented hypotensive response D Stress test: significant ST changes Definite ischemia ≤5 METS D Aortic valve disease: Cardiac catheterization Aortic gradient 25-50 mm HG Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Coronary artery disease: Myocardial infarction Multiple infarctions D Echocardiogram Confirmed ventricular aneurysm D Cardiac catheterization Aortic gradient 25-50 mm Hg D Cardiac catheterization Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Medical record review Unstable as diagnosed by a Cardiologist D Stress test Documented hypotensive response D Stress test Definite ischemia ≤ 5 METS D Isotope, e.g., thallium study Definite ischemia ≤ 5 METS D Cardiomyopathy: Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Hypertension: Medical record review Diastolic >120 and systolic >160, 50% of the time and evidence of end organ damage (blood creatinine >2; urinary protein > 1 2 D Arrhythmia: heart block: Holter Documented asystole length >1.5-2 seconds D Medical record review Documented syncope with proven arrhythmia D Mitral valve disease: Cardiac catheterization Mitral valve gradient ≥10 mm Hg D Cardiac catheterization Mitral regurgitation severe D Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Pericardial disease: Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Ventricular ectopy: Medical record review Documented life threatening arrhythmia D Holter Uncontrolled ventricular rhythm D Medical record review Documented related syncope D Arrhythmia: supraventricular tachycardia: Medical record review Documented related syncope D Post heart transplant: Medical record review Post heart transplant D BODY PART: CARDIAC JOB TITLE: SIGNALMAN Angina: Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤7 METS D Medical record review Unstable as diagnosed by cardiologist D Stress test Documented hypotensive response D Stress test: significant ST changes Definite ischemia ≤7 METS D Aortic valve disease: Cardiac catheterization Aortic gradient 25-50 mm HG D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤7 METS D Coronary artery disease: Myocardial infarction Multiple infractions D Echocardiogram Confirmed ventricular aneurysm D Cardiac catheterization Aortic gradient 25-50 mm Hg D Cardiac catheterization Poor ejection fraction ≤35% D Stress test Peak exercise ≤7 METS D Medical record review Unstable as diagnosed by cardiologist D Stress test Documented hypotensive response D Stress test Definite ischemia ≤7 METS D Isotope, e.g., thallium study Definite ischemia ≤7 METS D Cardiomyopathy: Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤7 METS D Hypertension: Medical record review Diastolic >120 and systolic >160, 50% of the time and evidence of end organ damage (blood creatinine >2; urinary protein > 1 2 D Arrhythmia: heart block Holter Documented asystole length >1.5-2 seconds D Medical record review Documented syncope with proven arrhythmia D Mitral valve disease: Cardiac catheterization Mitral valve gradient ≥5 mm Hg D Cardiac catherization Mitral regurgitation severe D Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤7 METS D Pericardial disease: Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Ventricular ectopy: Medical record review Documented life threatening arrhythmia D Holter Uncontrolled ventricular rhythm D Medical record review Documented related syncope D Arrhythmia: supraventricular tachycardia: Medical record review Documented related syncope D Post heart transplant: Medical record review Post heart transplant D BODY PART: CARDIAC JOB TITLE: TRACKMAN Angina: Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤7 METS D Medical record review Unstable as diagnosed by cardiologist D Stress test Documented hypotensive response D Stress test: significant ST changes Definite ischemia ≤7 METS D Aortic valve disease: Cardiac catheterization Aortic gradient 25-50 mm HG D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤7 METS D Coronary artery disease: Myocardial infarction Multiple infarctions D Echocardiogram Confirmed ventricular aneurysm D Cardiac catheterization Aortic gradient 25-50 mm Hg D Cardiac catheterization Poor ejection fraction ≤35% D Stress test Peak exercise ≤7 METS D Medical record review Unstable as diagnosed by a cardiologist D Stress test Documented hypotensive response D Stress test Definite ischemia ≤7 METS D Isotope, e.g., thallium study Definite ischemia ≤7 METS D Cardiomyopathy: Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤7 METS D Hypertension: Medical record review Diastolic >120 and systolic >160, 50% of the time and evidence of end organ damage (blood creatinine >2; urinary protein > 1 2 D Arrhythmia: heart block: Holter Documented asystole length >1.5-2 seconds D Medical record review Documented syncope with proven arrhythmia D Mitral valve disease: Cardiac catheterization Mitral valve gradient ≥5 mm Hg D Cardiac catheterization Mitral regurgitation severe D Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤7 METS D Pericardial disease: Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Ventricular ectopy: Medical record review Documented life threatening arrhythmia D Holter Uncontrolled ventricular rhythm D Medical record review Documented related syncope D Arrhythmia: supraventricular tachycardia: Medical record review Documented related syncope D Post heart transplant: Medical record review Post heart transplant D BODY PART: CARDIAC JOB TITLE: MACHINIST Angina: Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Medical record review Unstable as diagnosed by cardiologist D Stress test Documented hypotensive response D Stress test: significant ST changes Definite ischemia ≤5 METS D Aortic valve disease: Cardiac catheterization Aortic gradient 25-50 mm HG Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Coronary artery disease: Myocardial infarction Multiple infarctions D Echocardiogram Confirmed ventricular aneurysm D Cardiac catheterization Aortic gradient 25-50 mm Hg D Cardiac catheterization Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Medical record review Unstable as diagnosed by a cardiologist D Stress test Documented hypotensive response D Stress test Definite ischemia ≤5 METS D Isotope, e.g., thallium study Definite ischemia ≤5 METS D Cardiomyopathy: Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Hypertension: Medical record review Diastolic >120 and systolic >160, 50% of the time and evidence of end organ damage (blood creatinine >2; urinary protein > 1 2 D Arrhythmia: heart block: Holter Documented asystole length >1.5-2 seconds D Medical record review Documented syncope with proven arrhythmia D Mitral valve disease: Cardiac catheterization Mitral valve gradient ≥10 mm Hg D Cardiac catheterization Mitral regurgitation severe D Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Pericardial disease: Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Ventricular ectopy: Medical record review Documented life threatening arrhythmia D Holter Uncontrolled ventricular rhythm D Medical record review Documented related syncope D Arrhythmia: supraventricular tachycardia: Medical record review Documented related syncope D Post heart transplant: Medical record review Post heart transplant D BODY PART: CARDIAC JOB TITLE: SHOP LABORER Angina: Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Medical record review Unstable as diagnosed by cardiologist D Stress test Documented hypotensive response D Stress test: significant ST changes Definite ischemia ≤5 METS D Aortic valve disease: Cardiac catheterization Aortic gradient 25-50 mm HG Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Coronary artery disease: Myocardial infarction Multiple infarctions D Echocardiogram Confirmed ventricular aneurysm D Cardiac catheterization Aortic gradient 25-50 mm Hg Cardiac catheterization Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Medical record review Unstable as diagnosed by a Cardiologist D Stress test Documented hypotensive response D Stress test Definite ischemia ≤5 METS D Isotope, e.g., thallium study Definite ischemia ≤5 METS D Cardiomyopathy: Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Hypertension: Medical record review Diastolic >120 and systolic >160, 50% of the time and evidence of end organ damage (blood creatinine >2; urinary protein > 1 2 D Arrhythmia: heart block: Holter Documented asystole length >1.5-2 seconds D Medical record review Documented syncope with proven arrhythmia D Mitral valve disease: Cardiac catheterization Mitral valve gradient ≥10 mm Hg D Cardiac catheterization Mitral regurgitation severe D Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Pericardial disease: Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Ventricular ectopy: Medical record review Documented life threatening arrhythmia D Holter Uncontrolled ventricular rhythm D Medical record review Documented related syncope D Arrhythmia: supraventricular tachycardia: Medical record review Documented related syncope D Post heart transplant: Medical record review Post heart transplant D BODY PART: CARDIAC JOB TITLE: SALES REPRESENTATIVE Angina: Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Medical record review Unstable as diagnosed by cardiologist D Stress test Documented hypotensive response D Stress test: significant ST changes Definite ischemia ≤5 METS D Aortic valve disease: Cardiac catheterization Aortic gradient 25-50 mm HG D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Coronary artery disease: Myocardial infarction Multiple infarctions D Echocardiogram Confirmed ventricular aneurysm D Cardiac catheterization Aortic gradient 25-50 mm Hg D Cardiac catheterization Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Medical record review Unstable as diagnosed by a cardiologist D Stress test Documented hypotensive response D Stress test Definite ischemia ≤5 METS D Isotope, e.g., thallium study Definite ischemia ≤5 METS D Cardiomyopathy: Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Hypertension: Medical record review Diastolic >120 and systolic >160, 50% of the time and evidence of end organ damage (blood creatinine >2; urinary protein > 1 2 D Arrhythmia: heart block: Holter Documented asystole length >1.5-2 seconds D Medical record review Documented syncope with proven arrhythmia D Mitral valve disease: Cardiac catheterization Mitral valve gradient ≥10 mm Hg D Cardiac catheterization Mitral regurgitation severe D Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Pericardial disease: Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Ventricular ectopy: Medical record review Documented life threatening arrhythmia D Holter Uncontrolled ventricular rhythm D Medical record review Documented related syncope D Arrhythmia: supraventricular tachycardia: Medical record review Documented related syncope D Post heart transplant: Medical record review Post heart transplant D BODY PART: CARDIAC JOB TITLE: GENERAL OFFICE CLERK Angina: Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Medical record review Unstable as diagnosed by cardiologist D Stress test Documented hypotensive response D Stress test: significant ST changes Definite ischemia ≤5 METS D Aortic valve disease: Cardiac catheterization Aortic gradient 25-50 mm HG D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Coronary artery disease: Myocardial infarction Multiple infarctions D Echocardiogram Confirmed ventricular aneurysm D Cardiac catheterization Aortic gradient 25-50 mm Hg D Cardiac catheterization Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Medical record review Unstable as diagnosed by a Cardiologist D Stress test Documented hypotensive response D Stress test Definite ischemia ≤5 METS D Isotope, e.g., thallium study Definite ischemia ≤5 METS D Cardiomyopathy: Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Arrhythmia: heart block: Holter Documented asystole length >1.5-2 seconds D Medical record review Documented syncope with proven arrhythmia D Mitral valve disease: Cardiac catheterization Mitral valve gradient ≥10 mm Hg D Cardiac catheterization Mitral regurgitation severe D Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Stress test Peak exercise ≤5 METS D Pericardial disease: Cardiac catheterization Poor ejection fraction ≤35% D Echocardiogram Poor ejection fraction ≤35% D Ventricular ectopy: Medical record review Documented life threatening arrhythmia D Holter Uncontrolled ventricular rhythm D Medical record review Documented related syncope D Arrhythmia: supraventricular tachycardia: Medical record review Documented related syncope D Post heart transplant: Medical record review Post heart transplant D D. Respiratory Confirmatory test Minimum result Requirements BODY PART: RESPIRATORY CONFIRMATORY TESTS Asthma: Spirometry FEV1/FVC ratio diminished Recommended. Spirometry >15% change with administration of bronchodilator Recommended. Methacholine challenge test Positive: FEV1 decrease >20% at (PC ≤8 mg/ml) Recommended Bronchiectasis: Medical record review Chronic cough and sputum Recommended. Chest X-ray Bronchiectasis demonstrated Recommended. Chest CAT scan Bronchiectasis demonstrated Recommended. Chronic bronchitis: Medical record review Frequent cough—2 years duration Highly recommended. Chronic obstructive pulmonary disease: Spirometry FEV1/FVC ratio below 65% when stable Highly recommended. Spirometry FEV1 below 75% of predicted when stable Highly recommended. Cor pulmonale: Electrocardiogram Definite right ventricular hypertrophy Recommended. Echocardiogram Definite right ventricular hypertrophy Recommended. Pulmonary fibrosis: Lung biopsy Diffuse fibrosis Recommended. Chest CAT scan More than minimal fibrosis Recommended. Lung resection: Medical record review At least one lobe resected Highly recommended. Pneumothorax: Medical record review Required hospitalization with chest tube drainage Highly recommended. Restrictive lung disease: Chest X-ray Restrictive lung changes Recommended. DLCO Abnormal Highly recommended. Chest CAT scan Restrictive lung changes Recommended. Spirometry FVC <75% predicted Highly recommended. Silicosis: Medical record review Occupational exposure for at least 1 year Highly recommended. Tuberculosis: Chest X-ray Evidence of changes consistent with tuberculosis infection Recommended. Culture Positive Recommended. Disability test Test result Disability classification BODY PART: RESPIRATORY JOB TITLE: TRAINMAN Asthma: Spirometry Repeated spirometry FEV1 <40% over a 12 month period Bronchiectasis: Resting ABG PCO2 arterial >50 mm Hg if stable D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Electrocardiogram Definite positive right ventricular hypertrophy D Chronic bronchitis: Spirometry Repeated spirometry FEV1 <40% over a 12 month period D Resting ABG PCO2 arterial >50 mm Hg if stable D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Electrocardiogram Definite positive right ventricular hypertrophy D Chronic obstructive pulmonary disease (COPD): Resting ABG PCO2 arterial >50 mm Hg if stable D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Electrocardiogram Definite positive right ventricular hypertrophy D Cor pulmonale: Electrocardiogram Definite positive right ventricular hypertrophy D Pulmonary fibrosis: Resting ABG PCO2 arterial >50 mm Hg if stable D Electrocardiogram Definite positive right ventricular hypertrophy D DLCO <45% predicted D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Spirometry FVC <50% predicted D Lung resection: Electrocardiogram Definite positive right ventricular hypertrophy D Restrictive lung disease: DLCO <45% predicted D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Spirometry FVC <50% predicted D Electrocardiogram efinite positive right ventricular hypertrophy D Silicosis: Resting ABG PCO2 arterial >50 mm Hg If stable D Electrocardiogram Definite positive right ventricular hypertrophy D BODY PART: RESPIRATORY JOB TITLE: CARMAN Asthma: Spirometry Repeated spirometry FEV1 <40% over a 12 month period D Bronchiectasis: Resting ABG PCO2 arterial >50 mm Hg if stable D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Electrocardiogram Definite positive right ventricular hypertrophy D Chronic bronchitis: Spirometry Repeated spirometry FEV1 <40% over a 12 month period D Resting ABG PCO2 arterial >50 mm Hg if stable D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Electrocardiogram Definite positive right ventricular hypertrophy D Chronic obstructive pulmonary disease (COPD): Resting ABG PCO2 arterial >50 mm Hg if stable D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Electrocardiogram Definite positive right ventricular hypertrophy D Cor pulmonale: Electrocardiogram Definite positive right ventricular hypertrophy D Pulmonary fibrosis: Resting ABG PCO2 arterial >50 mm Hg if stable D Electrocardiogram Definite positive right ventricular hypertrophy D DLCO <45% predicted D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Spirometry FVC <50% predicted D Lung resection: Electrocardiogram Definite positive right ventricular hypertrophy D Restrictive lung disease: DLCO <45% predicted D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Spirometry FVC <50% predicted D Electrocardiogram Definite positive right ventricular hypertrophy D Silicosis: Resting ABG PCO2 arterial >50 mm Hg if stable D Electrocardiogram Definite positive right ventricular hypertrophy D BODY PART: RESPIRATORY JOB TITLE: SIGNALMAN Asthma: Spirometry Repeated spirometry FEV1 <40% over a 12 month period D Bronchiectasis: Resting ABG PCO2 arterial >50 mm Hg if stable D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Electrocardiogram Definite positive right ventricular hypertrophy D Chronic bronchitis: Spirometry Repeated spirometry FEV1 <40% over a 12 month period D Resting ABG PCO2 arterial >50 mm Hg if stable D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Electrocardiogram Definite positive right ventricular hypertrophy D Chronic obstructive pulmonary disease (COPD): Resting ABG PCO2 arterial >50 mm Hg if stable D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Electrocardiogram Definite positive right ventricular hypertrophy D Cor pulmonale: Electrocardiogram Definite positive right ventricular hypertrophy D Pulmonary fibrosis: Resting ABG PCO2 arterial >50 mm Hg if stable D DLCO <45% predicted D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Spirometry FVC <50% predicted D Electrocardiogram Definite positive right ventricular hypertrophy D Lung resection: Electrocardiogram Definite positive right ventricular hypertrophy D Restrictive lung disease: DLCO <45% predicted D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Spirometry FVC <50% predicted D Electrocardiogram Definite positive right ventricular hypertrophy D Silicosis: Resting AGB PCO2 arterial >50 mm Hg if stable D Electrocardiogram Definite positive right ventricular hypertrophy D BODY PART: RESPIRATORY JOB TITLE: TRACKMAN Asthma: Spirometry Repeated spirometry FEV1 <40% over a 12 month period D Bronchiectasis: Resting ABG PCO2 arterial >50 mm Hg if stable D Pulmonary exercise test or exercise ABG PO2 >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Electrocardiogram Definite positive right ventricular hypertrophy D Chronic bronchitis: Spirometry Repeated spirometry FEV1 <40% over a 12 month period D Resting ABG PCO2 arterial >50 mm Hg if stable D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Electrocardiogram Definite positive right ventricular hypertrophy D Chronic obstructive pulmonary disease (COPD): Resting ABG PCO2 arterial >50 mm Hg if stable D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Electrocardiogram Definite positive right ventricular hypertrophy D Cor pulmonale: Electrocardiogram Definite positive right ventricular hypertrophy D Pulmonary fibrosis: Resting ABG PCO2 arterial >50 mm Hg if stable D Electrocardiogram Definite positive right ventricular hypertrophy D DLCO <45% predicted D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Spirometry FVC <50% predicted D Lung resection: Electrocardiogram Definite positive right ventricular hypertrophy D Restrictive lung disease: DLCO <45% predicted D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Spirometry FVC <50% predicted D Electrocardiogram Definite positive right ventricular hypertrophy D Silicosis: Resting ABG PCO2 arterial >50 mm Hg if stable D Electrocardiogram Definite positive right ventricular hypertrophy D BODY PART: RESPIRATORY JOB TITLE: MACHINIST Asthma: Spirometry Repeated spirometry FEV1 <40% over a 12 month period D Bronchiectasis: Resting ABG PCO2 arterial >50 mm Hg if stable D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Electrocardiogram Definite positive right ventricular hypertrophy D Chronic bronchitis: Spirometry Repeated spirometry FEV1 <40% over a 12 month period D Resting AGB PCO2 arterial >50 mm Hg if stable D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Electrocardiogram Definite positive right ventricular hypertrophy D Chronic obstructive pulmonary disease (COPD): Resting ABG PCO2 arterial >50 mm Hg if stable D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Electrocardiogram Definite positive right ventricular hypertrophy D Cor pulmonale: Electrocardiogram Definite positive right ventricular hypertrophy D Pulmonary fibrosis: Resting ABG PCO2 arterial >50 mm Hg if stable D Electrocardiogram Definite positive right ventricular hypertrophy D DLCO <45% predicted D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Spirometry FVC <50% predicted D Lung resection: Electrocardiogram Definite positive right ventricular hypertrophy D Restrictive lung disease: DLCO <45% predicted D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Spirometry FVC <50% predicted D Electrocardiogram Definite positive right ventricular hypertrophy D Silicosis: Resting ABG PCO2 arterial >50 mm Hg if stable D Electrocardiogram Definite positive right ventricular hypertrophy D BODY PART: RESPIRATORY JOB TITLE: SHOP LABORER Asthma: Spirometry Repeated spirometry FEV1 <40% over a 12 month period D Bronchiectasis: Resting ABG PCO2 arterial >50 mm Hg if stable D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Electrocardiogram Definite positive right ventricular hypertrophy D Chronic bronchitis: Spirometry Repeated spirometry FEV1 <40% over a 12 month period D Resting ABG PCO2 arterial >50 mm Hg if stable D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Electrocardiogram Definite positive right ventricular hypertrophy D Chronic obstructive pulmonary disease (COPD): Resting ABG PCO2 arterial >50 mm Hg if stable D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Electrocardiogram Definite positive right ventricular hypertrophy D Cor pulmonale: Electrocardiogram Definite positive right ventricular hypertrophy D Pulmonary fibrosis: Resting ABG PCO2 arterial >50 mm Hg if stable D DLCO <45% predicted D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Spirometry FVC <50% predicted D Electrocardiogram Definite positive right ventricular hypertrophy D Lung resection: Electrocardiogram Definite positive right ventricular hypertrophy D Restrictive lung disease: DLCO <45% predicted D Pulmonary exercise test or exercise ABG PO2 drop >5 torr at maximum exercise D Pulmonary exercise test Maximum VO2 <15 ml/kg D Spirometry FVC <50% predicted D Electrocardiogram Definite positive right ventricular hypertrophy D Silicosis: Resting ABG PCO2 arterial >50 mm Hg if stable D Electrocardiogram Definite positive right ventricular hypertrophy D E. Lumbar Sacral Spine Confirmatory test Minimum result Requirements BODY PART: LS SPINE CONFIRMATORY TESTS Ankylosing spondylitis: X-ray-lumbar sacral spine Sacroilitis Highly recommended. HLA B27 (blood test) Positive HLA B27 (90% case) Recommended. Backache, unspecified: Medical record review History of back pain under medical treatment for at least 1 year Highly recommended. Medical record review History of back pain unresponsive to therapy for at least 1 year Highly recommended. Medical record review History of back pain with functional limitations for at least 1 year Highly recommended. Chronic back pain, not otherwise specified: Medical record review History of back pain under medical treatment for at least 1 year Highly recommended. Medical record review History of back pain unresponsive to therapy for at least 1 year Highly recommended. Medical record review History of back pain with functional limitations for at least 1 year Highly recommended. Cauda equina syndrome with bowel or bladder dysfunction: Magnetic resonance imaging Neural impingement of spinal nerves below L1 Recommended. Computerized tomography Neural impingement of spinal nerves below L1 Recommended. Cystometrogram Impaired bladder function Recommended. Rectal examination Diminished rectal sphincter tone Recommended. Myelogram Neural impingement of spinal nerves below L1 Recommended. Degeneration of lumbar disc: X-ray lumbar sacral spine Significant degenerative disc changes Recommended. Computerized tomography Significant degenerative disc changes Recommended. Magnetic resonance imaging Significant degenerative disc changes Recommended. Myelogram Significant degenerative disc changes Recommended. Displacement of lumbar disc: X-ray-lumbar sacral spine Significant degenerative disc changes Recommended. Computerized tomography Significant degenerative disc changes Recommended. Magnetic resonance imaging Significant degenerative disc changes Recommended. Myelogram Significant degenerative disc changes Recommended. Fracture: vertebral body: Magnetic resonance imaging Fracture vertebral body Recommended. Computerized tomography Fracture vertebral body Recommended. X-ray-lumbar sacral spine Fracture vertebral body ommended. Fracture: posterior element with spinal canal displacement: Magnetic resonance imaging Fracture posterior spinal element with displacement of spinal canal Recommended. Computerized tomography Fracture posterior spinal element with displacement of spinal canal Recommended. X-ray-lumbar sacral spine Fracture posterior spinal element with displacement of spinal canal Recommended. Fracture: posterior spinal element with no displacement: X-ray-lumbar sacral spine Fracture posterior spinal element Recommended. Magnetic resonance imaging Fracture posterior spinal element Recommended. Computerized tomography Fracture posterior spinal element Recommended. Fracture: spinous process: X-ray-lumbar sacral spine Spinous process fracture Recommended. Magnetic resonance imaging Spinous process fracture Recommended. Computerized tomography Spinous process fracture Recommended. Fracture: Transverse process: Lumbar sacral spine Transverse process fracture Recommended. Magnetic resonance imaging Transverse process fracture Recommended. Computerized tomography Transverse process fracture Recommended. Intervertebral disc disorder: X-ray-lumbar sacral spine Significant disc degeneration Recommended. Magnetic resonance imaging Significant disc degeneration Recommended. Computerized tomography Significant disc degeneration Recommended. Myelogram Significant disc degeneration Recommended. Lumbago: Medical record review: lumbar History of back pain under medical treatment for at least 1 year Highly recommended. Medical record review: lumbar History of back pain unresponsive to therapy for at least 1 year Highly recommended. Medical record review: lumbar History of back pain with functional limitations for at least 1 year Highly recommended. Lumbosacral neuritis: Magnetic resonance imaging Evidence of neural compression Recommended. Electromyography Definite denervation Recommended. Nerve conduction velocity Definite slowing Recommended. Physical examination—atrophy Atrophy in affected limb with 2 cm difference between limbs Recommended. Physical examination: straight leg raise Positive straight leg raise Recommended. Sensory examination Loss of sensation in affected dermatomes Recommended. Medical history History of radicular pain Highly recommended. Computerized tomography Evidence of neural compression Recommended. Lumbar spinal stenosis: Computerized tomography Significant narrowing: spinal cord canal or intervertebral foramen Recommended. Magnetic resonance imaging Significant narrowing: spinal cord canal or intervertebral foramen Recommended. Myelogram Significant narrowing: spinal cord canal or intervertebral foramen Recommended. Mechanical complication of internal orthopedic device: Medical record review Documentation of failure of implant following surgical procedure Highly recommended. Osteomalacia: X-ray-lumbar sacral spine Evidence of significant osteomalacia Recommended. Magnetic resonance imaging Evidence of significant osteomalacia Recommended. Computerized tomography Evidence of significant osteomalacia Recommended. Osteomyelitis, chronic-lumbar: X-ray-lumbar sacral spine Evidence of chronic infection Recommended. Magnetic resonance imaging Evidence of chronic infection Recommended. Computerized tomography Evidence of chronic infection Recommended. Osteoporosis: Computerized tomography Significant bone density loss Recommended. Dual photon absorptiometry Significant bone density loss Recommended. X-ray-lumbar sacral spine Significant bone density loss Recommended. Post laminectomy syndrome with radiculopathy: Medical record review: lumbar Documented surgical history of laminectomy Highly recommended. Magnetic resonance imaging Evidence of laminectomy Recommended. Electromyography Definite denervation Recommended. Nerve conduction velocity Definite slowing Recommended. Physical examination—atrophy Atrophy in affected limb with 2 cm difference between limbs Recommended. Physical examination: straight leg raise Positive straight leg raise Recommended. Sensory examination Loss of sensation in affected dermatomes Recommended. Medical record review: lumbar History of radicular pain Highly recommended. Computerized tomography Evidence of laminectomy Recommended. Myelogram Evidence of laminectomy Recommended. Radiculopathy: Magnetic resonance imaging Evidence of neural compression Recommended. Electromyography Definite denervation Recommended. Nerve conduction velocity Definite slowing Recommended. Physical examination—atrophy Atrophy in affected limb with 2 cm difference between limbs Recommended. Physical examination: straight leg raise Positive straight leg raise Recommended. Sensory examination Loss of sensation in affected dermatomes Recommended. Medical record review: lumbar History of radicular pain Highly recommended. Computerized tomography Evidence of neural compression Recommended. Myelogram Evidence of neural compression Recommended. Sciatica: Magnetic resonance imaging Evidence of neural compression Recommended. Electromyography Definite denervation Recommended. Nerve conduction velocity Definite slowing Recommended. Physical examination—atrophy Atrophy in affected limb with 2 cm difference between limbs Recommended. Physical examination: straight leg raise Positive straight leg raise Recommended. Sensory examination Loss of sensation in affected dermatomes Recommended. Medical history History of radicular pain Highly recommended. Computerized tomography Evidence of neural compression Recommended. Myelogram Evidence of neural compression Recommended. Strains and sprains, unspecified: Medical record review History of back pain under medical treatment for at least 1 year Highly recommended. Medical record review History of back pain unresponsive to therapy for at least 1 year Highly recommended. Medical record review History of back pain with functional limitations for at least 1 year Highly recommended. Medical record review Documented history of strain and/or sprain Highly recommended. Spondylolisthesis grade 1: X-ray-lumbar sacral spine 1-25% slippage Recommended. Computerized tomography 1-25% slippage Recommended. Magnetic resonance imaging 1-25% slippage Recommended. Spondylolisthesis grade 2: X-ray-lumbar sacral spine 26-50% slippage Recommended. Computerized tomography 26-50% slippage Recommended. Magnetic resonance imaging 26-50% slippage Recommended. Spondylolisthesis grade 3: X-ray-lumbar sacral spine 51-75% slippage Recommended. Computerized tomography 51-75% slippage Recommended. Magnetic resonance imaging 51-75% slippage Recommended. Spondylolisthesis grade 4: X-ray-lumbar sacral spine Complete slippage Recommended. Computerized tomography Complete slippage Recommended. Magnetic resonance imaging Complete slippage Recommended. Spondylolisthesis-acquired: X-ray-lumbar sacral spine Slippage Recommended. Computerized tomography Slippage Recommended. Magnetic resonance imaging Slippage Recommended. Spondylolsis: X-ray-lumbar sacral spine Defect—pars interarticularis Recommended. Computerized tomography Defect—pars interarticularis Recommended. Magnetic resonance imaging Defect—pars interarticularis Recommended. Sprains and strains, sacral: Medical record review: lumbar History of back pain under medical treatment for at least 1 year Highly recommended. Medical record review: lumbar History of back pain unresponsive to therapy for at least 1 year Highly recommended. Medical record review: lumbar History of back with functional limitations for at least 1 year Highly recommended. Medical record review: lumbar Documented history of strain and/or sprain Highly recommended. Sprains and strains, sacroiliac: Medical record review: lumbar History of back pain under medical treatment for at least 1 year Highly recommended. Medical record review: lumbar History of back pain unresponsive to therapy for at least 1 year Highly recommended. Medical record review: lumbar History of back pain with functional limitations for at least 1 year Highly recommended. Medical record review: lumbar Documented history of strain and/or sprain Highly recommended. Disability test Test result Disability classification BODY PART: LS SPINE JOB TITLE: TRAINMAN Ankylosing spondylitis: Muscle strength assessment Lifting capacity diminished by 50% D Backache, unspecified: Muscle strength assessment Lifting capacity diminished by 50% D Chronic back pain, not otherwise specified: Muscle strength assessment Lifting capacity diminished by 50% D Cauda equina syndrome with bowel or bladder dysfunction: Computerized tomography Disc extrusion with neural impingement, nerves < L1 D Magnetic resonance imaging Disc extrusion with neural impingement, nerves < L1 D Physical examination Lower extremity weakness D Cystometrogram Impaired bladder function D Myelogram Disc extrusion with neural impingement, nerves <L1 D Physical examination: rectal Impairment of sphincter tone D Muscle strength assessment Lifting capacity diminished by 50% D Degeneration of lumbar disc: Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Muscle strength assessment Lifting capacity diminished by 50% D Displacement of lumbar disc: Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Muscle strength assessment Lifting capacity diminished by 50% D Fracture: vertebral body: Muscle strength assessment Lifting capacity diminished by 50% D Fracture: posterior spinal element with displacement: Muscle strength assessment Lifting capacity diminished by 50% D Fracture: posterior spinal element with no displacement: Muscle strength assessment Lifting capacity diminished by 50% D Fracture: spinous process: Muscle strength assessment Lifting capacity diminished by 50% D Fracture transverse process: Muscle strength assessment Lifting capacity diminished by 50% D Intervertebral disc disorder: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Lumbago: Muscle strength assessment Lifting capacity diminished by 50% D Lumbosacral neuritis: Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Muscle strength assessment Lifting capacity diminished by 50% D Physical examination Lower extremity weakness D Lumbar spinal stenosis: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Significant narrowing of the spinal canal D Magnetic resonance imaging Significant narrowing of the spinal canal D Myelogram Significant narrowing of the spinal canal D Physical examination Significant lower extremity weakness D Mechanical complication of internal orthopedic device: Muscle strength assessment Lifting capacity diminished by 50% D X-ray flexion/extension Segmental instability D Osteomalacia: Muscle strength assessment Lifting capacity diminished by 50% D Osteomyelitis, chronic-lumbar: Muscle strength assessment Lifting capacity diminished by 50% D Medical record review Frequent flare-ups with objective findings D Osteoporosis: Muscle strength assessment Lifting capacity diminished by 50% D Post laminectomy syndrome with radiculopathy: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D Post laminectomy syndrome: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D X-ray flexion/extension Segmental instability D Radiculopathy: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D Sciatica: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D Strains and sprains, unspecified: Muscle strength assessment Lifting capacity diminished by 50% D Spondylolisthesis grade 1: Muscle strength assessment Lifting capacity diminished by 50% D X-ray flexion/extension Segmental instability D Spondylolisthesis grade 2: Muscle strength assessment Lifting capacity diminished by 50% D Spondylolisthesis grade 3: Muscle strength assessment Lifting capacity diminished by 50% D Spondylolisthesis grade 4: Muscle strength assessment Lifting capacity diminished by 50% D X-ray flexion/extension Segmental instability D Spondylolisthesis—acquired: X-ray flexion/extension Segmental instability D Spondylolysis: X-ray flexion/extension Segmental instability D Sprains and strains, sacral: Muscle strength assessment Lifting capacity diminished by 50% D Sprains and strains, sacroiliac: Muscle strength assessment Lifting capacity diminished by 50% D Vertebral body compression fracture: Muscle strength assessment Lifting capacity diminished by 50% D BODY PART: LS SPINE JOB TITLE: ENGINEER Cauda equina syndrome with bowel or bladder dysfunction: Computerized tomography Disc extrusion with neural impingement, nerves <L1 D Magnetic resonance imaging Disc extrusion with neural impingement, nerves <L1 D Physical examination Lower extremity weakness D Cystometrogram Impaired bladder function D Myelogram Disc extrusion with neural impingement, nerves <L1 D Physical examination: rectal Impairment of sphincter tone D BODY PART: LS SPINE JOB TITLE: CARMAN Ankylosing spondylitis: Muscle strength assessment Lifting capacity diminished by 50% D Backache, unspecified: Muscle strength assessment Lifting capacity diminished by 50% D Chronic back pain, not otherwise specified: Muscle strength assessment Lifting capacity diminished by 50% D Cauda equina syndrome with bowel or bladder dysfunction: Computerized tomography Disc extrusion with neural impingement, nerves <L1 D Magnetic resonance imaging Disc extrusion with neural impingement, nerves <L1 D Physical examination Lower extremity weakness D Cystometrogram Impaired bladder function D Myeolgram Disc extrusion with neural impingement, nerves <L1 D Physical examination: rectal Impairment of sphincter tone D Muscle strength assessment Lifting capacity diminished by 50% D Degeneration of lumbar disc: Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Muscle strength assessment Lifting capacity diminished by 50% D Displacement of lumbar disc: Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Muscle strength assessment Lifting capacity diminished by 50% D Fracture: vertebral body: Muscle strength assessment Lifting capacity diminished by 50% D Fracture: posterior spinal element with displacement: Muscle strength assessment Lifting capacity diminished by 50% D Fracture: posterior spinal element with no displacement: Muscle strength assessment Lifting capacity diminished by 50% D Fracture: spinous process: Muscle strength assessment Lifting capacity diminished by 50% D Fracture transverse process: Muscle strength assessment Lifting capacity diminished by 50% D Intervertebral disc disorder: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Lumbago: Muscle strength assessment Lifting capacity diminished by 50% D Lumbosacral neuritis: Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Muscle strength assessment Lifting capacity diminished by 50% D Physical examination Lower extremity weakness D Lumbar spinal stenosis: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Significant narrowing of the spinal canal D Magnetic resonance imaging Significant narrowing of the spinal canal D Myelogram Significant narrowing of the spinal canal D Physical examination Significant lower extremity weakness D Mechanical complication of internal orthopedic device: Muscle strength assessment Lifting capacity diminished by 50% D X-ray flexion/extension Segmental instability D Osteomalacia: Muscle strength assessment Lifting capacity diminished by 50% D Osteomyelitis, chronic-lumbar: Muscle strength assessment Lifting capacity diminished by 50% D Medical record review Frequent flare-ups with objective findings D Osteoporosis: Muscle strength assessment Lifting capacity diminished by 50% D Post laminectomy syndrome with radiculopathy: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D Post laminectomy syndrome: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D X-ray flexion/extension Segmental instability D Radiculopathy: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D Sciatica: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D Strains and sprains, unspecified: Muscle strength assessment Lifting capacity diminished by 50% D Spondylolisthesis grade 1: Muscle strength assessment Lifting capacity diminished by 50% D X-ray flexion/extension Segmental instability D Spondylolisthesis grade 2: Muscle strength assessment Lifting capacity diminished by 50% D Spondylolisthesis grade 3: Muscle strength assessment Lifting capacity diminshed by 50% D Spondylolisthesis grade 4: Muscle strength assessment Lifting capacity diminished by 50% D X-ray flexion/extension Segmental instability D Spondylolisthesis-acquired: X-ray flexion/extension Segmental instability D Spondylolysis: X-ray flexion/extension Segmental instability D Sprains and strains, sacral: Muscle strength assessment Lifting capacity diminshed by 50% D Sprains and strains, sacroiliac: Muscle strength assessment Lifting capacity diminished by 50% D Vertebral body compression fracture: Muscle strength assessment Lifting capacity diminshed by 50% D BODY PART: LS SPINE JOB TITLE: SIGNALMAN Ankylosing spondylitis: Muscle strength assessment Lifting capacity diminished by 50% D Backache, unspecified: Muscle strength assessment Lifting capacity diminished by 50% D Chronic back pain, not otherwise specified: Muscle strength assessment Lifting capacity diminished by 50% D Cauda equina syndrome with bowel or bladder dysfunction: Computerized tomography Disc extrusion with neural impingement, nerves <L1 D Magnetic resonance imaging Disc extrusion with neural impingement, nerves <L1 D Physical examination Lower extremity weakness D Cystometrogram Impaired bladder function D Myelogram Disc extrusion with neural impingement, nerves <L1 D Physical examination: rectal Impairment of sphincter tone D Muscle strength assessment Lifting capacity diminished by 50% D Degeneration of lumbar disc: Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Muscle strength assessment Lifting capacity diminished by 50% D Displacement of lumbar disc: Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Muscle strength assessment Lifting capacity diminished by 50% D Fracture: vertebral body: Muscle strength assessment Lifting capacity diminished by 50% D Fracture: posterior spinal element with displacement: Muscle strength assessment Lifting capacity diminished by 50% D Fracture: posterior spinal element with no displacement: Muscle strength assessment Lifting capacity diminished by 50% D Fracture: spinous process: Muscle strength assessment Lifting capacity diminished by 50% D Fracture transverse process: Muscle strength assessment Lifting capacity diminished by 50% D Intervertebral disc disorder: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Lumbago: Muscle strength assessment Lifting capacity diminished by 50% D Lumbosacral neuritis: Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Muscle strength assessment Lifting capacity diminished by 50% D Physical examination Lower extremity weakness D Lumbar spinal stenosis: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Significant narrowing of the spinal canal D Magnetic resonance imaging Significant narrowing of the spinal canal D Myelogram Significant narrowing of the spinal canal D Physical examination Significant lower extremity weakness D Mechanical complication of internal orthopedic device: Muscle strength assessment Lifting capacity diminished by 50% D X-ray flexion/extension Segmental instability D Osteomalacia: Muscle strength assessment Lifting capacity diminished by 50% D Osteomyelitis, chronic-lumbar: Muscle strength assessment Lifting capacity diminished by 50% D Medical record review Frequent flare-ups with objective findings D Osteoporosis: Muscle strength assessment Lifting capacity diminished by 50% D Post laminectomy syndrome with radiculopathy: Muscle strength assessment Lifing capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D Post laminectomy syndrome: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D X-ray flexion/extension Segmental instability D Radiculopathy: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D Sciatica: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D Strains and sprains, unspecified: Muscle strength assessment Lifting capacity diminished by 50% D Spondylolisthesis grade 1: Muscle strength assessment Lifting capacity diminished by 50% D X-ray flexion/extension Segmental instability D Spondylolisthesis grade 2: Muscle strength assessment Lifting capacity diminished by 50% D Spondylolisthesis grade 3: Muscle strength assessment Lifting capacity diminished by 50% D Spondylolisthesis grade 4: Muscle strength assessment Lifting capacity diminished by 50% D X-ray flexion/extension Segmental instability D Spondylolisthesis-acquired: X-ray flexion/extension Segmental instability D Spondylolysis: X-ray flexion/extension Segmental instability D Sprains and strains, sacral: Muscle strength assessment Lifting capacity diminished by 50% D Sprains and strains, sacroiliac: Muscle strength assessment Lifting capacity diminished by 50% D Vertebral body compression fracture: Muscle strength assessment Lifting capacity diminished by 50% D BODY PART: LS SPINE JOB TITLE: TRACKMAN Ankylosing spondylitis: Muscle strength assessment Lifting capacity diminished by 50% D Backache, unspecified: Muscle strength assessment Lifting capacity diminished by 50% D Chronic back pain, not otherwise specified: Muscle strength assessment Lifing capacity diminished by 50% D Cauda equina syndrome with bowel or bladder dysfunction: Computerized tomography Disc extrusion with neural impingement, nerves <L1 D Magnetic resonance imaging Disc extrusion with neural impingement, nerves <L1 D Physical examination Lower extremity weakness D Cystometrogram Impaired bladder function D Myelogram Disc extrusion with neural impingement, nerves <L1 D Physical examination: rectal Impairment of sphincter tone D Muscle strength assessment Lifting capacity diminished by 50% D Degeneration of lumbar disc: Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Muscle strength assessment Lifting capacity diminished by 50% D Displacement of lumbar disc: Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Muscle strength assessment Lifting capacity diminished by 50% D Fracture: vertebral body: Muscle strength assessment Lifting capacity diminished by 50% D Fracture: posterior spinal element with displacement: Muscle strength assessment Lifting capacity diminished by 50% D Fracture: posterior spinal element with no displacement: Muscle strength assessment Lifting capacity diminished by 50% D Fracture: spinous process: Muscle strength assessment Lifting capacity diminished by 50% D Fracture transverse process: Muscle strength assessment Lifting capacity diminished by 50% D Intervertebral disc disorder: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Lumbago: Muscle strength assessment Lifting capacity diminished by 50% D Lumbosacral neuritis: Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Muscle strength assessment Lifting capacity diminished by 50% D Physical examination Lower extremity weakness D Lumbar spinal stenosis: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Significant narrowing of the spinal canal D Magnetic resonance imaging Significant narrowing of the spinal canal D Myelogram Significant narrowing of the spinal canal D Physcial examination Significant lower extremity weakness D Mechanical complication of internal orthopedic device: Muscle strength assessment Lifting capacity diminished by 50% D X-ray flexion/extension Segmental instability D Osteomalacia: Muscle strength assessment Lifting capacity diminished by 50% D Osteomyelitis, chronic-lumbar: Muscle strength assessment Lifting capacity diminished by 50% D Medical record review Frequent flare-ups with objective findings D Osteoporosis: Muscle strength assessment Lifting capacity diminished by 50% D Post laminectomy syndrome with radiculopathy: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D Post laminectomy syndrome: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D X-ray flexion/extension Segmental instability D Radiculopathy: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D Sciatica: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D Strains and sprains, unspecified: Muscle strength assessment Lifting capacity diminished by 50% D Spondylolisthesis grade 1: Muscle strength assessment Lifting capacity diminished by 50% D X-ray flexion/extension Segmental instability D Spondylolisthesis grade 2: Muscle strength assessment Lifting capacity diminished by 50% D Spondylolisthesis grade 3: Muscle strength assessment Lifting capacity diminished by 50% D Spondylolisthesis grade 4: Muscle strength assessment Lifting capacity diminished by 50% D X-ray flexion/extension Segmental instability D Spondylolisthesis-acquired: X-ray flexion/extension Segmental instability D Spondylolysis: X-ray flexion/extension Segmental instability D Sprains and strains, sacral: Muscle strength assessment Lifting capacity diminished by 50% D Sprains and strains, sacroiliac: Muscle strength assessment Lifting capacity diminished by 50% D Vetebral body compression fracture: Muscle strength assessment Lifting capacity diminished by 50% BODY PART: LS SPINE JOB TITLE: MACHINIST Ankylosing spondylitis: Muscle strength assessment Lifting capacity diminished by 50% D Backache, unspecified: Muscle strength assessment Lifting capacity diminished by 50% D Chronic back pain, not otherwise specified: Muscle strength assessment Lifting capacity diminished by 50% D Cauda equina syndrome with bowel or bladder dysfunction: Computerized tomography Disc extrusion with neural impingement, nerves <L1 D Magnetic resonance imaging Disc extrusion with neural impingement, nerves <L1 D Physical examination Lower extremity weakness D Cystometrogram Impaired bladder function D Myelogram Disc extrusion with neural impingement, nerves <L1 D Physical examination: rectal Impairment of sphincter tone D Muscle strength assessment Lifting capacity diminished by 50% D Degeneration of lumbar disc: Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Muscle strength assessment Lifting capacity diminished by 50% D Displacement of lumbar disc: Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Muscle strength assessment Lifting capacity diminished by 50% D Fracture: vertebral body: Muscle strength assessment Lifting capacity diminished by 50% D Fracture: posterior spinal element with displacement: Muscle strength assessment Lifting capacity diminished by 50% D Fracture: posterior spinal element with no displacement: Muscle strength assessment Lifting capacity diminished by 50% D Fracture: spinous process: Muscle strength assessment Lifting capacity diminished by 50% D Fracture transverse process: Muscle strength assessment Lifting capacity diminished by 50% D Intervertebral disc disorder: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Lumbago: Muscle strength assessment Lifting capacity diminished by 50% D Lumbosacral neuritis: Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Muscle strength assessment Lifting capacity diminished by 50% D Physical examination Lower extremity weakness D Lumbar spinal stenosis: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Significant narrowing of the spinal canal D Magnetic resonance imaging Significant narrowing of the spinal canal D Myelogram Significant narrowing of the spinal canal D Physical examination Significant lower extremity weakness D Mechanical complication of internal orthopedic device: Muscle strength assessment Lifting capacity diminished by 50% D X-ray flexion/extension Segmental instability D Osteomalacia: Muscle strength assessment Lifting capacity diminished by 50% D Osteomyelitis, chronic-lumbar: Muscle strength assessment Lifting capacity diminished by 50% D Medical record review Frequent flare-ups with objective findings D Osteoporosis: Muscle strength assessment Lifting capacity diminished by 50% D Post laminectomy syndrome with radiculopathy: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D Post laminectomy syndrome: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D X-ray flexion/extension Segmental instability D Radiculopathy: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D Sciatica: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D Strains and sprains, unspecified: Muscle strength assessment Lifting capacity diminished by 50% D Spondylolisthesis grade I: Muscle strength assessment Lifting capacity diminished by 50% D X-ray flexion/extension Segmental instability D Spondylolisthesis grade 2: Muscle strength assessment Lifting capacity diminished by 50% D Spondylolisthesis grade 3: Muscle strength assessment Lifting capacity diminished by 50% D Spondylolisthesis grade 4: Muscle strength assessment Lifting capacity diminished by 50% D X-ray flexion/extension Segmental instability D Spondylolisthesis-acquired: X-ray flexion/extension Segmental instability D Spondylolysis: X-ray flexion/extension Segmental instability D Sprains and strains, sacral: Muscle strength assessment Lifting capacity diminished by 50% D Sprains and strains, sacroiliac: Muscle strength assessment Lifting capacity diminished by 50% D Vertebral body compression fracture: Muscle strength assessment Lifting capacity diminished by 50% D BODY PART: LS SPINE JOB TITLE: SHOP LABORER Ankylosing spondylitis: Muscle strength assessment Lifting capacity diminished by 50% D Backache, unspecified: Muscle strength assessment Lifting capacity diminished by 50% D Chronic back pain, not otherwise specified: Muscle strength assessment Lifting capacity diminished by 50% D Cauda equina syndrome with bowel or bladder dysfunction: Computerized tomography Disc extrusion with neural impingement, nerves <L1 D Magnetic resonance imaging Disc extrusion with neural impingement, nerves <L1 D Physical examination Lower extremity weakness D Cystometrogram Impaired bladder function D Myelogram Disc extrusion with neural impingement, nerves <L1 D Physical examination: rectal Impairment of sphincter tone D Muscle strength assessment Lifting capacity diminished by 50% D Degeneration of lumbar disc: Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Muscle strength assessment Lifting capacity diminished by 50% D Displacement of lumber disc: Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Muscle strength assessment Lifting capacity diminished by 50% D Fracture: vertebral body: Muscle strength assessment Lifting capacity diminished by 50% D Fracture: posterior spinal element with displacement: Muscle strength assessment Lifting capacity diminished by 50% D Fracture: posterior spinal element with no displacement: Muscle strength assessment Lifting capacity diminished by 50% D Fracture: spinous process: Muscle strength assessment Lifting capacity diminished by 50% D Fracture transverse process: Muscle strength assessment Lifting capacity diminished by 50% D Intervertebral disc disorder: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Lumbago: Muscle strength assessment Lifting capacity diminished by 50% D Lumbosacral neuritis: Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Muscle strength assessment Lifting capacity diminished by 50% D Physical examination Lower extremity weakness D Lumbar spinal stenosis: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Significant narrowing of the spinal canal D Magnetic resonance imaging Significant narrowing of the spinal canal D Myelogram Significant narrowing of the spinal canal D Physical examination Significant lower extremity weakness D Mechanical complication of internal orthopedic device: Muscle strength assessment Lifting capacity diminished by 50% D X-ray flexion/extension Segmental instability D Osteomalacia: Muscle strength assessment Lifting capacity diminished by 50% D Osteomyelitis, chronic-lumbar: Muscle strength assessment Lifting capacity diminished by 50% D Medical record review Frequent flare-ups with objective findings D Osteoporosis: Muscle strength assessment Lifting capacity diminished by 50% D Post laminectomy syndrome with radiculopathy: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D Post laminectomy syndrome: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D X-ray flexion/extension Segmental instability D Radiculopathy: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D Sciatica: Muscle strength assessment Lifting capacity diminished by 50% D Computerized tomography Disc extrusion with neural impingement D Magnetic resonance imaging Disc extrusion with neural impingement D Myelogram Disc extrusion with neural impingement D Physical examination Significant lower extremity weakness D Strains and sprains, unspecified: Muscle strength assessment Lifting capacity diminished by 50% D Spondylolisthesis grade 1: Muscle strength assessment Lifting capacity diminished by 50% D X-ray flexion/extension Segmental instability D Spondylolisthesis grade 2: Muscle strength assessment Lifting capacity diminished by 50% D Spondylolisthesis grade 3: Muscle strength assessment Lifting capacity diminished by 50% D Spondylolisthesis grade 4: Muscle strength assessment Lifting capacity diminished by 50% D X-ray flexion/extension Segmental instability D Spondylolisthesis-acquired: X-ray flexion/extension Segmental instability D Spondylolysis: X-ray flexion/extension Segmental instability D Sprains and strains, sacral: Muscle strength assessment Lifting capacity diminished by 50% D Sprains and strains, sacroiliac: Muscle strength assessment Lifting capacity diminished by 50% D Vertebral body compression fracture: Muscle strength assessment Lifting capacity diminished by 50% D F. Cervical Spine Confirmatory test Minimum result Requirements BODY PART: CE SPINE CONFIRMATORY TESTS Cervical disc disease with myelopathy: Physical examination: cervical Evidence of myelopathy Highly recommended. Myelogram Evidence of neurogenic compression Recommended. Computerized axial tomography Evidence of neurogenic compression Recommended. Magnetic resonance imaging Evidence of neurogenic compression Recommended. Chronic herniated disc: X-ray: cervical spine Evidence of significant disc degeneration Recommended. Myelogram Evidence of significant disc degeneration Recommended. Computerized axial tomography Evidence of significant disc degeneration Recommended. Magnetic resonance imaging Evidence of significant disc degeneration Recommended. Cervical spondylolysis: X-ray: cervical spine Evidence of significant disc degeneration Recommended. Computerized axial tomography Evidence of significant disc degeneration Recommended. Magnetic resonance imaging Evidence of significant disc degeneration Recommended. Cervical intervertebral disc degeneration: X-ray: cervical spine Evidence of significant disc degeneration Recommended. Myelogram Evidence of significant disc degeneration Recommended. Magnetic resonance imaging Evidence of significant disc degeneration Recommended. Fracture: posterior element with spinal canal displacement: X-ray: cervical spine Fractured posterior element with canal displacement Recommended. Computerized axial tomography Fractured posterior element with canal displacement Recommended. Magnetic resonance imaging Fractured posterior element with canal displacement Recommended. Fracture: transverse, spinous or posterior process: X-ray: cervical spine Fracture of relevant part Recommended. Computerized axial tomography Fracture of relevant part Recommended. Magnetic resonance imaging Fracture of relevant part Recommended. Osteoarthritis, cervical: X-ray: cervical spine Evidence of extensive disc degeneration Recommended. Computerized axial tomography Evidence of extensive disc degeneration Recommended. Magnetic resonance imaging Evidence of extensive disc degeneration Recommended. Post laminectomy syndrome: Medical records: cervical Confirmed surgical history Highly recommended. Medical records: cervical Continued pain post-surgery Highly recommended. Radiculopathy: Medical records: cervical History of radicular pain Highly recommended. Physical examination: arm Loss of reflexes in affected dermatomes Recommended. Physical examination: arm Evidence of atrophy >2 cm Recommended. Electromyography Definite denervation in muscle of affected nerve root Recommended. Myelogram Evidence of neurogenic compression Recommended. Magnetic resonance imaging Compression of spinal nerves Recommended. Computerized axial tomography Compression of spinal nerves Recommended. Rheumatoid arthritis, cervical: Rheumatoid factor (blood test) Titer of rheumatoid factor Recommended. X-ray: cervical spine Rheumatoid changes of spine Highly recommended. Medical records review: cervical Confirmation by rheumatologist or internist Highly recommended. Spondylogenic compression of spinal cord: Physical examination: cervical Evidence of myelopathy Highly recommended. Computerized axial tomography Evidence of neurogenic compression Recommended. Magnetic resonance imaging Evidence of neurogenic compression Recommended. Myelogram Evidence of neurogenic compression Recommended. Disability test Test result Disability classification BODY PART: CE SPINE JOB TITLE: TRAINMAN Cervical disc disease with myelopathy: Computerized axial tomography Significant spinal cord pressure D Magnetic resonance imaging Significant spinal cord pressure D Myelogram Significant spinal cord pressure D Cystometrogram Impaired bladder function D Physical examination: rectal Impairment of sphincter tone Physical examination: lower limb Lower extremity weakness or significant spasticity D Physical examination Multi-level neurologic compromise D Chronic herniated disc: Physical examination Multi-level neurologic compromise D Cervical spondylolysis: Physical examination Multi-level neurologic compromise D Cervical intervertebral disc degeneration: Physical examination Multi-level neurologic compromise D Fracture: posterior element with spinal canal displacement: Physical examination Multi-level neurologic compromise D Post laminectomy syndrome: Physical examination Multi-level neurologic compromise D Cervical radiculopathy: Physical examination Multi-level neurologic compromise D Spondylogenic compression of spinal cord: Computerized axial tomography Significant spinal cord pressure D Magnetic resonance imaging Significant spinal cord pressure D Cystometrogram Impaired bladder function D Myelogram Significant spinal cord pressure D Physical examination: rectal Impairment of sphincter tone D Physical examination Multi-level neurologic compromise D Physical examination: lower limb Lower extremity weakness or significant spasticity D BODY PART: CE SPINE JOB TITLE: ENGINEER Cervical disc disease with myelopathy: Computerized axial tomography Significant spinal cord pressure D Magnetic resonance imaging Significant spinal cord pressure D Myelogram Significant spinal cord pressure D Cystometrogram Impaired bladder function D Physical examination: rectal Impairment of sphincter tone D Physical examination: lower limb Lower extremity weakness or significant spasticity D Physical examination Multi-level neurologic compromise D Chronic herniated disc: Physical examination Multi-level neurologic compromise D Cervical spondylolysis: Physical examination Multi-level neurologic compromise D Cervical intervertebral disc degeneration: Physical examination Multi-level neurologic compromise D Fracture: posterior element with spinal canal displacement: Physical examination Multi-level neurologic compromise D Post laminectomy syndrome: Physical examination Multi-level neurologic compromise D Cervical radiculopathy: Physical examination: Multi-level neurologic compromise D Spondylogenic compression of spinal cord: Computerized axial tomography Significant spinal cord pressure D Magnetic resonance imaging Significant spinal cord pressure D Cystometrogram Impaired bladder function D Myelogram Significant spinal cord pressure D Physical examination: rectal Impairment of sphincter tone D Physical examination Multi-level neurologic compromise D Physical examination: lower limb Lower extremity weakness or significant spasticity D BODY PART: CE SPINE JOB TITLE: DISPATCHER Cervical disc disease with myelopathy: Cystometrogram Impaired bladder function D Physical examination: rectal Impairment of sphincter tone D Spondylogenic compression of spinal cord: Cystometrogram Impaired bladder function D Physical examination: rectal Impairment of sphincter tone D BODY PART: CE SPINE JOB TITLE: CARMAN Cervical disc disease with myelopathy: Computerized axial tomography Significant spinal cord pressure D Magnetic resonance imaging Significant spinal cord pressure D Myelogram Significant spinal cord pressure D Cystometrogram Impaired bladder function D Physical examination: rectal Impairment of sphincter tone D Physical examination: lower limb Lower extremity weakness or significant spasticity D Physical examination Multi-level neurologic compromise D Chronic herniated disc: Physical examination Multi-level neurologic compromise D Cervical spondylolysis: Physical examination Multi-level neurologic compromise D Cervical intervertebral disc degeneration: Physical examination Multi-level neurologic compromise D Fracture: posterior element with spinal canal displacement: Physical examination Multi-level neurologic compromise D Post laminectomy syndrome: Physical examination Multi-level neurologic compromise D Cervical radiculopathy: Physical examination Multi-level neurologic compromise D Spondylogenic compression of spinal cord: Computerized axial tomography Significant spinal cord pressure D Magnetic resonance imaging Significant spinal cord pressure D Cystometrogram Impaired bladder function D Myelogram Significant spinal cord pressure D Physical examination: rectal Impairment of sphincter tone D Physical examination Multi-level neurologic compromise D Physical examination: lower limb Lower extremity weakness or significant spasticity D BODY PART; CE SPINE JOB TITLE: SIGNALMAN Cervical disc disease with myelopathy: Computerized axial tomography Significant spinal cord pressure D Magnetic resonance imaging Significant spinal cord pressure D Myelogram Significant spinal cord pressure D Cystometrogram Impaired bladder function D Physical examination: rectal Impairment of sphincter tone D Physical examination: lower limb Lower extremity weakness or significant spasticity D Physical examination Multi-level neurologic compromise D Chronic herniated disc: Physical examination Multi-level neurologic compromise D Cervical spondylolysis: Physical examination Multi-level neurologic compromise D Cervical intervertebral disc degeneration: Physical examination Multi-level neurologic compromise D Fracture: posterior element with spinal canal displacement: Physical examination Multi-level neurologic compromise D Post laminectomy syndrome: Physical examination Multi-level neurologic compromise D Cervical radiculopathy: Physical examination Multi-level neurologic compromise D Spondylogenic compression of spinal cord: Computerized axial tomography Significant spinal cord pressure D Magnetic resonance imaging Significant spinal cord pressure D Cystometrogram Impaired bladder function D Myelogram Significant spinal cord pressure D Physical examination: rectal Impairment of sphincter tone D Physical examination Multi-level neurologic compromise D Physical examination: lower limb Lower extremity weakness or significant spasticity D BODY PART: CE SPINE JOB TITLE: TRACKMAN Cervical disc disease with myelopathy: Computerized axial tomography Significant spinal cord pressure D Magnetic resonance imaging Significant spinal cord pressure D Myelogram Significant spinal cord pressure D Cystometrogram Impaired bladder function D Physical examination: rectal Impairment of sphincter tone D Physical examination: lower limb Lower extremity weakness or significant spasticity D Physical examination Multi-level neurologic compromise D Chronic herniated disc: Physical examination Multi-level neurologic compromise D Cervical spondyloysis: Physical examination Multi-level neurologic compromise D Cervical intervertebral disc degeneration: Physical examination Multi-level neurologic compromise D Fracture: posterior element with spinal canal displacement: Physical examination Multi-level neurologic compromise D Post laminectomy syndrome: Physical examination Multi-level neurologic compromise D Cervical radiculopathy: Physical examination Multi-level neurologic compromise D Spondylogenic compression of spinal cord: Computerized axial tomography Significant spinal cord pressure D Magnetic resonance imaging Significant spinal cord pressure D Cystometrogram Impaired bladder function D Myelogram Significant spinal cord pressure D Physical examination: rectal Impairment of sphincter tone D Physical examination Multi-level neurologic compromise D Physical examination: lower limb Lower extremity weakness or significant spasticity D BODY PART: CE SPINE JOB TITLE: MACHINIST Cervical disc disease with myelopathy: Computerized axial tomography Significant spinal cord pressure D Magnetic resonance imaging Significant spinal cord pressure D Myelogram Significant spinal cord pressure D Cystometrogram Impaired bladder function D Physical examination: rectal Impairment of sphincter tone D Physical examination: lower limb Lower extremity weakness or significant spasticity D Physical examination Multi-level neurologic compromise D Chronic herniated disc: Physical examination Multi-level neurologic compromise D Cervical spondylolysis: Physical examination Multi-level neurologic compromise D Cervical intervertebral disc degeneration: Physical examination Multi-level neurologic compromise D Fracture: posterior element with spinal canal displacement: Physical examination Multi-level neurologic compromise D Post laminectomy syndrome: Physical examination Multi-level neurologic compromise D Cervical radiculopathy: Physical examination Multi-level neurologic compromise D Spondylogenic compression of spinal cord: Computerized axial tomography Significant spinal cord pressure D Magnetic resonance imaging Significant spinal cord pressure D Cystometrogram Impaired bladder function D Myelogram Significant spinal cord pressure D Physical examination: rectal Impairment of sphincter tone D Physical examination Multi-level neurologic compromise D Physical examination: lower limb Lower extremity weakness or significant spasticity D BODY PART: CE SPINE JOB TITLE: SHOP LABORER Cervical disc disease with myelopathy: Computerized axial tomography Significant spinal cord pressure D Magnetic resonance imaging Significant spinal cord pressure D Myelogram Significant spinal cord pressure D Cystometrogram Impaired bladder function D Physical examination: rectal Impairment of sphincter tone D Physical examination: lower limb Lower extremity weakness or significant spasticity D Physical examination Multi-level neurologic compromise D Chronic herniated disc: Physical examination Multi-level neurologic compromise D Cervical spondylolysis: Physical examination Multi-level neurologic compromise D Cervical intervertebral disc degeneration: Physical examination Multi-level neurologic compromise D Fracture: posterior element with spinal canal displacement: Physical examination Multi-level neurologic compromise D Post laminectomy syndrome: Physical examination Multi-level neurologic compromise D Cervical radiculopathy: Physical examination Multi-level neurologic compromise D Spondylogenic compression of spinal cord: Computerized axial tomography Significant spinal cord pressure D Magnetic resonance imaging Significant spinal cord pressure D Cystometrogram Impaired bladder function D Myelogram Significant spinal cord pressure D Physical examination: rectal Impairment of sphincter tone D Physical examination Multi-level neurologic compromise D Physical examination: lower limb Lower extremity weakness or significant spasticity D BODY PART: CE SPINE JOB TITLE: SALES REPRESENTATIVE Cervical disc disease with myelopathy: Cystometrogram Impaired bladder function D Physical examination: rectal Impairment of sphincter tone D Spondylogenic compression of spinal cord: Cystometrogram Impaired bladder function D Physical examination: rectal Impairment of sphincter tone D BODY PART: CE SPINE JOB TITLE: GENERAL OFFICE CLERK Cervical disc disease with myelopathy: Cystometrogram Impaired bladder function D Physical examination: rectal Impairment of sphincter tone D Spondylogenic compression of spinal cord: Cystometrogram Impaired bladder function D Physical examination: rectal Impairment of sphincter tone D G. Shoulder and Elbow Confirmatory test Minimum result Requirements. BODY PART: SHOULDER AND ELBOW CONFIRMATORY TESTS Arthritis, acromioclavicular: X-ray: shoulder Significant degenerative changes of joint Recommended. Computerized tomography Significant degenerative changes of joint Recommended. Magnetic resonance imaging Significant degenerative changes of joint Recommended. Arthritis, glenohumeral: X-ray: shoulder Significant degenerative changes of joint Recommended. Computerized tomography Significant degenerative changes of joint Recommended. Magnetic resonance imaging Significant degenerative changes of joint Recommended. Rotator cuff tear: Computerized tomography Tear of rotator cuff Recommended. Magnetic resonance imaging Tear of rotator cuff Recommended. Medical diagnosis leading to a permanent functional limitation of the elbow: Medical record review Condition with permanent functional limitation Highly recommended. X-ray: elbow Imaging confirmation of functional diagnosis Recommended. Magnetic resonance imaging Imaging confirmation of functional diagnosis Recommended. Disability test Test result Disability classification BODY PART: SHOULDER AND ELBOW JOB TITLE: TRAINMAN Arthritis, acromioclavicular: Physical examination—range of motion <40 degrees flexion D Physical examination—range of motion <40 degrees abduction D Arthritis, glenohumeral: Physical examination—range of motion <40 degrees flexion D Physical examination—range of motion <40 degrees abduction D Rotator cuff tear: Physical examination—range of motion <40 degrees flexion D Physical examination—range of motion <40 degrees abduction D Permanent functional limitation, elbow: Physical examination >40 degrees deviation D Physical examination—range of motion Flexion limit to 60 degrees D BODY PART: SHOULDER AND ELBOW JOB TITLE: ENGINEER Arthritis, acromioclavicular: Physical examination—range of motion <40 degrees flexion D Physical examination—range of motion <40 degrees abduction D Arthritis, glenohumeral: Physical examination—range of motion <40 degrees flexion D Physical examination—range of motion <40 degrees abduction D Rotator cuff tear: Physical examination—range of motion <40 degrees flexion D Physical examination—range of moiton <40 degrees abduction D Permanent functional limitation, elbow: Physical examination >40 degrees deviation D Physical examination—range of motion Flexion limit to 60 degrees D BODY PART: SHOULDER AND ELBOW JOB TITLE: CARMAN Arthritis, acromioclavicular: Physical examination—range of motion <40 degrees flexion D Physical examination—range of motion <40 degrees abduction D Arthritis, glenohumeral: Physical examination—range of motion <40 degrees flexion D Physical examination—range of motion <40 degrees abduction D Rotator cuff tear: Physical examination—range of motion <40 degrees flexion D Physical examination—range of motion <40 degrees abduction D Permanent functional limitation, elbow: Physical examination >40 degrees deviation D Physical examination—range of motion Flexion limit to 60 degrees D BODY PART: SHOULDER AND ELBOW JOB TITLE: SIGNALMAN Arthritis, acromioclavicular: Physical examination—range of motion <40 degrees flexion D Physical examination—range of motion <40 degrees abduction D Arthritis, glenohumeral: Physical examination—range of motion <40 degrees flexion D Physical examination—range of motion <40 degrees abduction D Rotator cuff tear: Physical examination—range of motion <40 degrees flexion D Physical examination—range of motion <40 degrees abduction D Permanent functional limitation, elbow: Physical examination >40 degrees deviation D Physical examination—range of motion Flexion limit to 60 degrees D BODY PART: SHOULDER AND ELBOW JOB TITLE: TRACKMAN Arthritis, acromioclavicular: Physical examination—range of motion <40 degrees flexion D Physical examination—range of motion <40 degrees abduction D Arthritis, glenohumeral: Physical examination—range of motion <40 degrees flexion D Physical examination—range of motion <40 degrees abduction D Rotator cuff tear: Physical examination—range of motion <40 degrees flexion D Physical examination—range of motion <40 degrees abduction D Permanent functional limitation, elbow: Physical examination >40 degrees deviation D Physical examination—range of motion Flexion limit to 60 degrees D BODY PART: SHOULDER AND ELBOW JOB TITLE: MACHINIST Arthritis, acromioclavicular: Physical examination—range of motion <40 degrees flexion D Physical examination—range of motion <40 degrees abduction D Arthritis, glenohumeral: Physical examination—range of motion <40 degrees flexion D Physical examination—range of motion <40 degrees abduction D Rotator cuff tear: Physical examination—range of motion <40 degrees flexion D Physical examination—range of motion <40 degrees abduction D Permanent functional limitation, elbow: Physical examination >40 degrees deviation D Physical examination—range of motion Flexion limit to 60 degrees D BODY PART: SHOULDER AND ELBOW JOB TITLE: SHOP LABORER Arthritis, acromioclavicular: Physical examination—range of motion <40 degrees flexion D Physical examination—range of motion <40 degrees abduction D Arthritis, glenohumeral: Physical examination—range of motion <40 degrees flexion D Physical examination—range of motion <40 degrees abduction D Rotator cuff tear: Physical examination—range of motion <40 degrees flexion D Physical examination—range of motion <40 degrees abduction D Permanent functional limitation, elbow: Physical examination >40 degrees deviation D Physical examination—range of motion Flexion limit to 60 degrees D H. Hand and Arm Confirmatory test Minimum result Requirements BODY PART: HAND AND ARM CONFIRMATORY TESTS Carpal tunnel syndrome: Medical record review Pain, paresthesia and weakness in distribution median nerve Highly recommended. Nerve conduction testing Definite median nerve conduction slowing at wrist Highly recommended. Electromyography Denervation in severe cases Recommended. Fracture: wrist: X-ray: wrist Evidence of fracture Highly recommended. Hand: permanent functional limitation: Medical record review Documentation of medical condition for permanent limitation Highly recommended. Physical examination Definite reproducible evidence of limitation Highly recommended. Imaging study (e.g. X-ray, CAT, MRI) Positive confirmation of underlying condition Highly recommended. Rheumatoid arthritis: hand: Rheumatoid factor Titer of rheumatoid factor Recommended. Medical record review History of objective findings including serological studies Highly recommended. X-ray: hand Characteristic rheumatoid changes Highly recommended. Tenosynovitis: Medical record review History of chronic tenosynovitis and objective findings Highly recommended. Physical examination Definite evidence of tenosynovitis Highly recommended. Thumb: Permanent functional limitation: Medical record review Documentation of medical condition for permanent limitation Highly recommended. Physical examination Definite reproducible evidence of limitation Highly recommended. Imaging study (X-ray, CAT, MRI) Positive confirmation of underlying condition Highly recommended. Wrist: Permanent functional limitation: Medical record review Documentation of medical condition for permanent limitation Highly recommended. Physical examination Definite reproducible evidence of limitation Highly recommended. Imaging study (e.g. X-ray, CAT, MRI) Positive confirmation of underlying condition Highly recommended. Disability test Test result Disability classification BODY PART: HAND AND ARM JOB TITLE: TRAINMAN Fracture, wrist: Physical examination—range of motion Extension—limit to 30 degrees D Physical examination—range of motion Flexion—limit to 30 degrees D Physical examination—range of motion Ankylosis: >20 degrees from neutral D Rheumatoid arthritis hand: Physical examination Significant deformity D Medical record review Significant flare-ups, under treatment with rheumatologist D Medical record review Extensive medication use, under treatment with rheumatologist D Thumb: permanent functional limitation: Adduction of thumb Loss ≤4 cm D Ankylosis: degree from neutral <20 degrees extension D Ankylosis: degree from neutral <40 degrees flexion D Loss of extension or flexion MCP or PIP: maximum flexion <40 degrees D Opposition Loss ≤4 cm D Wrist: permanent functional limitation: Physical examination—range of motion Extension—limit to 30 degrees D Physical examination—range of motion Flexion—limit to 30 degrees D Physical examination—range of motion Ankylosis: >20 degrees from neutral D BODY PART: HAND AND ARM JOB TITLE ENGINEER Fracture, wrist: Physical examination—range of motion Extension-limit to 30 degrees D Physical examination—range of motion Flexion-limit to 30 degrees D Physical examination—range of motion Ankylosis: >20 degrees from neutral D Rheumatoid arthritis hand: Physical examination Significant deformity D Medical record review Significant flare-ups, under treatment with rheumatologist D Medical record review Extensive medication use, under treatment with rheumatologist D Thumb: permanent functional limitation: Adduction of thumb Loss ≤4 cm D Ankylosis: degree from neutral <20 degrees extension D Ankylosis: degree from neutral <40 degrees flexion D Loss of extension or flexion MCP or PIP: maximum flexion <40 degrees D Opposition Loss ≤4 cm D Wrist: permanent functional limitation: Physical examination—range of motion Extension—limit to 30 degrees D Physical examination—range of motion Flexion—limit to 30 degrees D Physical examination—range of motion Ankylosis: >20 degrees from neutral D BODY PART: HAND AND ARM JOB TITLE: DISPATCHER Fracture, wrist: Physical examination—range of motion Extension—limit to 30 degrees D Physical examination—range of motion Flexion—limit to 30 degrees D Physical examination—range of motion Ankylosis: >20 degrees from neutral D Rheumatoid arthritis hand: Physical examination Significant deformity D Medical record review Significant flare-ups, under treatment with rheumatologist D Medical record review Extensive medication use, under treatment with rheumatologist D Thumb: permanent functional limitation: Adduction of thumb Loss ≤4 cm D Ankylosis: degree from neutral <20 degrees extension D Ankylosis: degree from neutral <40 degrees flexion D Loss of extension or flexion MCP or PIP: maximum flexion <40 degrees D Opposition Loss ≤4 cm D Wrist: permanent functional limitation: Physical examination—range of motion Extension—limit to 30 degrees D Physical examination—range of motion Flexion—limit to 30 degrees D Physical examination—range of motion Ankylosis: >20 degrees from neutral D BODY PART: HAND AND ARM JOB TITLE: CARMAN Fracture, wrist: Physical examination—range of motion Extension—limit to 30 degrees D Physical examination—range of motion Flexion—limit to 30 degrees D Physical examination—range of motion Ankylosis: >20 degrees from neutral D Rheumatoid arthritis hand: Physical examination Significant deformity D Medical record review Significant flare-ups, under treatment with rheumatologist D Medical record review Extensive medication use, under treatment with rheumatologist D Thumb: permanent functional limitation: Adduction of thumb: Loss ≤4 cm D Ankylosis: degree from neutral <20 degrees extension D Ankylosis: degree from neutral <40 degrees flexion D Loss of extension or flexion MCP of PIP: maximum flexion <40 degrees D Opposition Loss ≤4 cm D Wrist: permanent functional limitation: Physical examination—range of motion Extension—limit to 30 degrees D Physical examination—range of motion Flexion—limit to 30 degrees D Physical examination—range of motion Ankylosis: >20 degrees from neutral D BODY PART: HAND AND ARM JOB TITLE: SIGNALMAN Fracture, wrist: Physical examination—range of motion Extension—limit to 30 degrees D Physical examination—range of motion Flexion—limit to 30 degrees D Physical examination—range of motion Ankylosis: >20 degrees from neutral D Rheumatoid arthritis hand: Physical examination Significant deformity D Medical record review Significant flare-ups, under treatment with rheumatologist D Medical record review Extensive medication use, under treatment with rheumatologist D Thumb: permanent functional limitation: Adduction of thumb Loss ≤4 cm D Ankylosis: degree from neutral <20 degrees extension D Ankylosis: degree from neutral <40 degrees flexion D Loss of extension or flexion MCP or PIP: maximum flexion <40 degrees D Opposition Loss ≤4 cm D Wrist: permanent functional limitation: Physical examination—range of motion Extension—limit to 30 degrees D Physical examination—range of motion Flexion—limit to 30 degrees D Physical examination—range of motion Ankylosis: >20 degrees from neutral D BODY PART: HAND AND ARM JOB TITLE: TRACKMAN Fracture, wrist: Physical examination—range of motion Extension—limit to 30 degrees D Physical examination—range of motion Flexion—limit to 30 degrees D Physical examination—range of motion Ankylosis: >20 degrees from neutral D Rheumatoid arthritis hand: Physical examination Significant deformity D Medical record review Significant flare-ups, under treatment with rheumatologist D Medical record review Extensive medication use, under treatment with rheumatologist D Thumb: permanent functional limitation: Adduction of thumb Loss ≤4 cm D Ankylosis: degree from neutral <20 degrees extension D Ankylosis: degree from neutral <40 degrees flexion D Loss of extension or flexion MCP or PIP: maximum flexion <40 degrees D Opposition Loss ≤4 cm D Wrist: permanent functional limitation: Physical examination—range of motion Extension—limit to 30 degrees D Physical examination—range of motion Flexion—limit to 30 degrees D Physical examination—range of motion Ankylosis: >20 degrees from neutral D BODY PART: HAND AND ARM JOB TITLE: MACHINIST Fracture, wrist: Physical examination—range of motion Extension—limit to 30 degrees D Physical examination—range of motion Flexion—limit to 30 degrees D Physical examination—range of motion Ankylosis: >20 degrees from neutral D Rheumatoid arthritis hand: Physical examination Significant deformity D Medical record review Significant flare-ups, under treatment with rheumatologist D Medical record review Extensive medication use, under treatment with rheumatologist D Thumb: permanent functional limitation: Adduction of thumb Loss ≤4 cm D Ankylosis: degree from neutral <20 degrees extension D Ankylosis: degree from neutral <40 degrees flexion D Loss of extension or flexion MCP or PIP: maximum flexion <40 degrees D Opposition Loss ≤4 cm D Wrist: permanent functional limitation: Physical examination—range of motion Extension—limit to 30 degrees D Physical examination—range of motion Flexion—limit to 30 degrees D Physical examination—range of motion Ankylosis: >20 degrees from neutral D BODY PART: HAND AND ARM JOB TITLE: SHOP LABORER Fracture, wrist: Physical examination—range of motion Extension—limit to 30 degrees D Physical examination—range of motion Flexion—limit to 30 degrees D Physical examination—range of motion Ankylosis: >20 degrees from neutral D Rheumatoid arthritis hand: Physical examination Significant deformity D Medical record review Significant flare-ups, under treatment with rheumatologist D Medical record review Extensive medication use, under treatment with rheumatologist D Thumb: permanent functional limitation: Adduction of thumb Loss ≤4 cm D Ankylosis: degree from neutral <20 degrees extension D Ankylosis: degree from neutral <40 degrees flexion D Loss of extension or flexion MCP or PIP: maximum flexion <40 degrees D Opposition Loss ≤4 cm D Wrist: permanent functional limitation: Physical examination—range of motion Extension—limit to 30 degrees D Physical examination—range of motion Flexion—limit to 30 degrees D Physical examination—range of motion Ankylosis: >20 degrees from neutral D BODY PART: HAND AND ARM JOB TITLE: SALES REPRESENTATIVE Fracture, wrist: Physical examination—range of motion Extension—limit to 30 degrees D Physical examination—range of motion Flexion—limit to 30 degrees D Physical examination—range of motion Ankylosis: >20 degrees from neutral D Rheumatoid arthritis hand: Physical examination Significant deformity D Medical record review Significant flare-ups, under treatment with rheumatologist D Medical record review Extensive medication use, under treatment with rheumatologist D Thumb: permanent functional limitation: Adduction of thumb Loss ≤4 cm D Ankylosis: degree from neutral <20 degrees extension D Ankylosis: degree from neutral <40 degrees flexion D Loss of extension or flexion MCP or PIP: maximum flexion <40 degrees D Opposition Loss ≤4 cm D Wrist: permanent functional limitation: Physical examination—range of motion Extension—limit to 30 degrees D Physical examination—range of motion Flexion—limit to 30 degrees D Physical examination—range of motion Ankylosis: >20 degrees from neutral D BODY PART: HAND AND ARM JOB TITLE: GENERAL OFFICE CLERK Fracture, wrist: Physical examination—range of motion Extension—limit to 30 degrees D Physical examination—range of motion Flexion—limit to 30 degrees D Physical examination—range of motion Ankylosis: >20 degrees from neutral D Rheumatoid arthritis hand: Physical examination Significant deformity D Medical record review Significant flare-ups, under treatment with rheumatologist D Medical record review Extensive medication use, under treatment with rheumatologist D Thumb: permanent functional limitation: Adduction of thumb Loss ≤4 cm D Ankylosis: degree from neutral <20 degree extension D Ankylosis: degree from neutral <40 degree flexion D Loss of extension or flexion MCP or PIP: maximum flexion <40 degrees D Opposition Loss ≤4 cm D Wrist: permanent functional limitation: Physical examination—range of motion Extension—limit to 30 degrees D Physical examination—range of motion Flexion—limit to 30 degrees D Physical examination—range of motion Ankylosis: >20 degrees from neutral D I. Hip Confirmatory test Minimum result Requirements BODY PART: HIP CONFIRMATORY TESTS Ankylosis, hip: X-ray: hip Extreme joint destruction Highly Recommended. Physical examination—range of motion No mobility Highly Recommended. Osteoarthritis, hip: X-ray: hip <4 mm joint space, or other positive evidence Recommended. Magnetic resonance imaging <4 mm joint space, or other positive evidence Recommended. Computerized axial tomography <4 mm joint space, or other positive evidence Recommended. Osteomyelitis, hip: X-ray: hip Evidence of chronic infection Recommended. Computerized axial tomography Evidence of chronic infection Recommended. Paget's disease: X-ray: hip Osteolytic or blastic lesions Highly Recommended. Alkaline phosphatase Increased up to 50 times Highly Recommended. Hip replacement surgery: X-ray: hip Evidence of artificial hip Recommended. Medical record review Documentation of prior hip replacement Recommended. Disability test Test result Disability classification BODY PART: HIP JOB TITLE: TRAINMAN Ankylosis, hip: Physical examination—range of motion Ankylosis 5 degrees or >flexion D Physical examination—range of motion Ankylosis internal rotation >5 degrees D Physical examination—range of motion Ankylosis external rotation >10 degrees D Physical examination—range of motion Ankylosis in abduction >5 degrees D Physical examination—range of motion Ankylosis in adduction >5 degrees D Osteoarthritis, hip: X-ray: hip 0 mm cartilage interval D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abduction D Osteomyelitis, chronic hip: X-ray: hip Significant joint destruction D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abduction D Medical record review Documented occurrence of recurring infections with treatment D Paget's disease: X-ray: hip Significant joint destruction D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abduction D Hip replacement surgery: X-ray: hip Evidence of artificial hip joint D Medical record review Documentation of prior hip replacement D BODY PART: HIP JOB TITLE: ENGINEER Ankylosis, hip: Physical examination—range of motion Ankylosis 5 degrees or >flexion D Physical examination—range of motion Ankylosis internal rotation >5 degrees D Physical examination—range of motion Ankylosis external rotation >10 degrees D Physical examination—range of motion Ankylosis in abduction >5 degrees D Physical examination—range of motion Ankylosis in adduction >5 degrees D Osteoarthritis, hip: X-ray: hip 0 mm cartilage interval D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abduction D Osteomyelitis, chronic hip: X-ray: hip Signficant joint destruction D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abduction D Medical record review Documented occurrence of recurring infections with treatment D Paget's disease: X-ray: hip Significant joint destruction D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abduction D Hip replacement surgery: X-ray: hip Evidence of artificial hip joint D Medical record review Documentation of prior hip replacement D BODY PART: HIP JOB TITLE: CARMAN Ankylosis, hip: Physical examination—range of motion Ankylosis 5 degrees or >flexion D Physical examination—range of motion Ankylosis internal rotation >5 degrees D Physical examination—range of motion Ankylosis external rotation >10 degrees D Physical examination—range of motion Ankylosis in abduction >5 degrees D Physical examination—range of motion Ankylosis in adduction >5 degrees D Osteoarthritis, hip: X-ray: hip 0 mm cartilage interval D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abduction D Osteomyelitis, chronic hip: X-ray: hip Significant joint destruction D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abduction D Medical record review Documented occurrence of recurring infections with treatment D Paget's disease: X-ray: hip Significant joint destruction D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abduction D Hip replacement surgery: X-ray: hip Evidence of artificial hip joint D Medical record review Documentation of prior hip replacement D BODY PART: HIP JOB TITLE: SIGNALMAN Ankylosis, hip: Physical examination—range of motion Ankylosis 5 degrees or >flexion D Physical examination—range of motion Ankylosis internal rotation >5 degrees D Physical examination—range of motion Ankylosis external rotation >10 degrees D Physical examination—range of motion Ankylosis in abduction >5 degrees D Physical examination—range of motion Ankylosis in adduction >5 degrees D Osteoarthritis, hip: X-ray: hip 0 mm cartilage interval D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abduction D Osteomyelitis, chronic hip: X-ray: hip Significant joint destruction D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abduction D Medical record review Documented occurrence of recurring infections with treatment D Paget's disease: X-ray: hip Significant joint destruction D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abduction D Hip replacement surgery: X-ray: hip Evidence of artificial hip joint D Medical record review Documentation of prior hip replacement D BODY PART: HIP JOB TITLE: TRACKMAN Ankylosis, hip: Physical examination—range of motion Ankylosis 5 degrees or >flexion D Physical examination—range of motion Ankylosis internal rotation >5 degrees D Physical examination—range of motion Ankylosis external rotation >10 degrees D Physical examination—range of motion Ankylosis in abduction >5 degrees D Physical examination—range of motion Ankylosis in adduction >5 degrees D Osteoarthritis, hip: X-ray: hip 0 mm cartilage interval D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abduction D Osteomyelitis, chronic hip: X-ray: hip Significant joint destruction D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abduction D Medical record review Documented occurrence of recurring infections with treatment D Paget's disease: X-ray: hip Significant joint destruction D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abduction D Hip replacement surgery: X-ray: hip Evidence of artificial hip joint D Medical record review Documentation of prior hip replacement D BODY PART: HIP JOB TITLE: MACHINIST Ankylosis, hip: Physical examination—range of motion Ankylosis 5 degrees or >flexion D Physical examination—range of motion Ankylosis internal rotation >5 degrees D Physical examination—range of motion Ankylosis external rotation >10 degrees D Physical examination—range of motion Ankylosis in abduction >5 degrees D Physical examination—range of motion Ankylosis in adduction >5 degrees D Osteoarthritis, hip: X-ray: hip 0 mm cartilage interval D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abduction D Osteomyelitis, chronic hip: X-ray: hip Significant joint destruction D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abduction D Medical record review Documented occurrence of recurring infections with treatment D Paget's disease: X-ray: hip Significant joint destruction D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abudction D Hip replacement surgery: X-ray: hip Evidence of artificial hip joint D Medical record review Documentation of prior hip replacement D BODY PART: HIP JOB TITLE: SHOP LABORER Ankylosis, hip: Physical examination—range of motion Ankylosis 5 degrees of >flexion D Physical examination—range of motion Ankylosis internal rotation >5 degrees D Physical examination—range of motion Ankylosis external rotation >10 degrees D Physical examination—range of motion Ankylosis in abduction >5 degrees D Physical examination—range of motion Ankylosis in adduction >5 degrees D Osteoarthritis, hip: X-ray: hip 0 mm cartilage interval D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abduction D Osteomyelitis, chronic hip: X-ray: hip Significant joint destruction D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abduction D Medical record review Documented occurrence of recurring infections with treatment D Paget's disease: X-ray; hip Significant joint destruction D Physical examination—range of motion 30 degrees flexion contracture D Physical examination—range of motion <50 degrees flexion D Physical examination—range of motion <5 degrees abduction D Hip replacement surgery: X-ray: hip Evidence of artificial hip joint D Medical record review Documentation of prior hip replacement D J. Knee Confirmatory test Minimum result Requirements BODY PART: KNEE CONFIRMATORY TESTS Arthritis: knee: X-ray: knee Evidence of significant degenerative changes Recommended. Collateral ligament tear with laxity: Physical examination: knee Evidence of ligamentous laxity Highly Recommended. Magnetic resonance imaging Evidence of ligamentous tear Recommended. Cruciate and collateral ligament tear with laxity: Magnetic resonance imaging Tear of both ligaments Recommended. Physical examination Evidence of ligamentous laxity Highly Recommended. Medical record review Documentation of tear by arthroscopy Recommended. Cruciate ligament tear with laxity: Physical examination: knee Evidence of ligamentous laxity Highly Recommended. Magnetic resonance imaging Evidence of cruciate tear Recommended. Medical record review Documentation of tear by arthroscopy Recommended. Intercondylar fracture: X-ray: knee Evidence of fracture Highly Recommended. Osteomyelitis: knee: Medical record review Documented history of osteomyelitis requiring treatment Highly Recommended. X-ray: knee Evidence of chronic infection Recommended. Computerized tomography Evidence of chronic infection Recommended. Magnetic resonance imaging Evidence of chronic infection Recommended. Osteonecrosis: X-ray: knee Necrosis of femoral condyle or tibial plateau Recommended. Computerized tomography Necrosis of femoral condyle or tibial plateau Recommended. Magnetic resonance imaging Necrosis of femoral condyle or tibial plateau Recommended. Patellofemoral arthritis: X-ray: knee Evidence of arthritis Recommended. Magnetic resonance imaging Evidence of arthritis Recommended. Physical examination Crepitation with movement Highly Recommended. Patellar fracture nonunion with displacement: X-ray: knee Nonunion and displacement Recommended. Magnetic resonance imaging Nonunion and displacement Recommended. Computerized tomography Nonunion and displacement Recommended. Plateau fracture: X-ray: knee Evidence of fracture Recommended. Computerized tomography Evidence of fracture Recommended. Magnetic resonance imaging Evidence of fracture Recommended. Meniscectomy—medial or lateral: Medical record review History of surgery Highly Recommended. Patellectomy: Physical examination: knee Absent patella Highly Recommended. Patellar—subluxation—recurrent: Medical record review History of recurrent subluxation Highly Recommended. Supracondylar fracture: X-ray: knee Evidence of fracture Recommended. Magnetic resonance imaging Evidence of fracture Recommended. Computerized tomography Evidence of fracture Recommended. Total knee replacement: X-ray: knee Presence of replacement knee Recommended. Medical record review Documented surgical history Recommended. Tibial shaft fracture: X-ray: leg Fracture of shaft Recommended. Magnetic resonance imaging Evidence of fracture Recommended. Computerized tomography Evidence of fracture Recommended. Disability test Test result Disability classification BODY PART: KNEE JOB TITLE: TRAINMAN Arthritis knee: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee 0-1 mm cartilage interval with degenerative change D Meniscectomy, medial or lateral: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or >degrees) D Collateral ligament tear with laxity: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Cruciate and collateral ligament tear: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Cruciate ligament tear with laxity: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Intercondylar fracture: Post fracture angulation >20 degrees angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Osteomyelitis, chronic knee: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D Medical record review Frequent episodes of infection requiring treatment D X-ray knee 0-1 mm cartilage interval with degenerative change D Osteonecrosis: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee 0-1 mm cartilage interval with degenerative change D Patellofemoral arthritis: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee: patello femoral joint 0 mm cartilage interval with degenerative change D Patellar fracture nonunion with displacement: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D X-ray knee Nonunion and >3 mm displacement D Plateau fracture: Post fracture angulation >20 degrees angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Patellectomy: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Patellar, subluxation, recurrent: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Supracondylar fracture: Post fracture angulation >20 degrees angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Tibial shaft fracture: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Post fracture angulation >20 degrees malalignment D BODY PART: KNEE JOB TITLE: ENGINEER Arthritis knee: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee 0-1 mm cartilage interval with degenerative change D Meniscectomy, medial or lateral: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Collateral ligament tear with laxity: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Cruciate and collateral ligament tear: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Cruciate ligament tear with laxity: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Intercondylar fracture: Post fracture angulation >20 degrees angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Osteomyelitis, chronic knee: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D Medical record review Frequent episodes of infection requiring treatment D X-ray knee 0-1 mm cartilage interval with degenerative change D Osteonecrosis: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee 0-1 mm cartilage interval with degenerative change D Patellofemoral arthritis: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee: patello femoral joint 0 mm cartilage interval with degenerative change D Patellar fracture nonunion with displacement: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D X-ray knee Nonunion and >3 mm displacement D Plateau fracture: Post fracture angulation >20 degrees angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Patellectomy: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Patellar, subluxation, recurrent: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Supracondylar fracture: Post fracture angulation >20 degrees angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Tibial shaft fracture: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Post fracture angulation >20 degrees malalignment D BODY PART: KNEE JOB TITLE: CARMAN Arthritis knee: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee 0-1 mm cartilage interval with degenerative change D Meniscectomy, medial or lateral: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Collateral ligament tear with laxity: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Cruciate and collateral ligament tear: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Cruciate ligament tear with laxity: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Intercondylar fracture: Post fracture angulation >20 degrees angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Osteomyelitis, chronic knee: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D Medical record review Frequent episodes of infection requiring treatment D X-ray knee 0-1 mm cartilage interval with degenerative change D Osteonecrosis: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee 0-1 mm cartilage interval with degenerative change D Patellofemoral arthritis: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee: patello femoral joint 0 mm cartilage interval with degenerative change D Patellar fracture nonunion with displacement: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D X-ray knee Nonunion and >3 mm displacement D Plateau fracture: Post fracture angulation >20 degrees angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Patellectomy: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Patellar, subluxation, recurrent: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Supracondylar fracture: Post fracture angulation >20 degrees angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Tibial shaft fracture: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Post fracture angulation >20 degrees malalignment D BODY PART: KNEE JOB TITLE: SIGNALMAN Arthritis knee: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee 0-1 mm cartilage interval with degenerative change D Meniscectomy, medial or lateral: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Collateral ligament tear with laxity: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Cruciate and collateral ligament tear: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Cruciate ligament tear with laxity: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Intercondylar fracture: Post fracture angulation >20 degrees angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Osteomyelitis, chronic knee: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D Medical record review Frequent episodes of infection requiring treatment D X-ray knee 0-1 mm cartilage interval with degenerative change D Osteonecrosis: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee 0-1 mm cartilage interval with degenerative change D Patellofemoral arthritis: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee: patello femoral joint 0 mm cartilage interval with degenerative change D Patellar fracture nonunion with displacement: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D X-ray knee Nonunion and >3 mm displacement D Plateau fracture: Post fracture angulation >20 degrees angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Patellectomy: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Patellar, subluxation, recurrent: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Supracondylar fracture: Post fracture angulation >20 degrees angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Tibial shaft fracture: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Post fracture angulation >20 degrees malalignment D BODY PART: KNEE JOB TITLE: TRACKMAN Arthritis knee: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee 0-1 mm cartilage interval with degenerative change D Meniscectomy, medial or lateral: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Collateral ligament tear with laxity: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Cruciate and collateral ligament tear: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Cruciate ligament tear with laxity: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Intercondylar fracture: Post fracture angulation >20 degree angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Osteomyelitis, chronic knee: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D Medical record review Frequent episodes of infection requiring treatment D X-ray knee 0-1 mm cartilage interval with degenerative change D Osteonecrosis: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee 0-1 mm cartilage interval with degenerative change D Patellofemoral arthritis: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee: patello femoral joint 0 mm cartilage interval with degenerative change D Patellar fracture nonunion with displacement: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D X-ray knee Nonunion and >3 mm displacement D Plateau fracture: Post fracture angulation >20 degrees angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Patellectomy: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Patellar, subluxation, recurrent: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Supracondylar fracture: Post fracture angulation >20 degrees angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Tibial shaft fracture: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Post fracture angulation >20 degrees malalignment D BODY PART: KNEE JOB TITLE: MACHINIST Arthritis knee: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee 0-1 mm cartilage interval with degenerative change D Meniscectomy, medial or lateral: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Collateral ligament tear with laxity: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Cruciate and collateral ligament tear: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Cruciate ligament tear with laxity: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Intercondylar fracture: Post fracture angulation >20 degrees angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Osteomyelitis, chronic knee: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D Medical record review Frequent episodes of infection requiring treatment D X-ray knee 0-1 mm cartilage interval with degenerative change D Osteonecrosis: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee 0-1 mm cartilage interval with degenerative change D Patellofemoral arthritis: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee 0 mm cartilage interval with degenerative change D Patellar fracture nonunion with displacement: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D X-ray knee Nonunion and >3 mm displacement D Plateau fracture: Post fracture angulation >20 degrees angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Patellectomy: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Patellar, subluxation, recurrent: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Supracondylar fracture: Post fracture angulation >20 degrees angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Tibial shaft fracture: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Post fracture angulation >20 degrees malalignment D BODY PART: KNEE JOB TITLE: SHOP LABORER Arthritis knee: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee 0-1 mm cartilage interval with degenerative change D Meniscectomy, medial or lateral: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Collateral ligament tear with laxity: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Cruciate and collateral ligament tear: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Cruciate ligament tear with laxity: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Intercondylar fracture: Post fracture angulation >20 degrees angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Osteomyelitis, chronic knee: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D Medical record review Frequent episodes of infection requiring treatment D X-ray knee 0-1 mm cartilage interval with degenerative change D Osteonecrosis: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee 0-1 mm cartilage interval with degenerative change D Patellofemoral arthritis: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Physical examination Valgus deformity, 16-20 degrees D Physical examination Varus deformity, 8-12 degrees D X-ray knee: patellofemoral joint 0 mm cartilage interval with degenerative change D Patellar fracture nonunion with displacement: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D X-ray knee Nonunion and >3 mm displacement D Plateau fracture: Post fracture angulation >20 degrees angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Patellectomy: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Patellar, subluxation, recurrent: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Supracondylar fracture: Post fracture angulation >20 degrees angulation D Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Tibial shaft fracture: Physical examination—range of motion Range of motion: flexion <60 degrees D Physical examination—range of motion Flexion contracture (20 or > degrees) D Post fracture angulation >20 degrees malalignment D K. Ankle and Foot Confirmatory test Minimum result Requirements BODY PART: ANKLE AND FOOT CONFIRMATORY TESTS Ankle fracture: Medical record review Documented history of ankle fracture Recommended. X-ray: ankle Ankle fracture Highly recommended. Ankylosis, ankle: X-ray: ankle Extensive joint destruction Highly recommended. Physical examination No mobility Highly recommended. Arthritis, subtalar joint: X-ray: ankle Evidence of significant arthritis: subtalar joint Highly recommended. Arthritis, talonavicular joint: X-ray: ankle Significant arthritis: talonavicular joint Highly recommended. Achilles tendon rupture: Medical record review Documentation of achilles tendon rupture Highly recommended. Physical examination Rupture of achilles tendon Highly recommended. Arthritis, ankle: X-ray: ankle Significant arthritis Highly recommended. Hindfoot fracture: X-ray: foot and ankle Documentation of fracture Highly recommended. Rheumatoid arthritis, foot: Medical History Documented history of condition Highly recommended. X-ray: foot Significant arthritis Highly recommended. Disability test Test result Disability classification BODY PART: ANKLE AND FOOT JOB TITLE: TRAINMAN Ankle fracture: X-ray: ankle Displaced intra-articular fracture D Physical examination Varus deformity >15 degrees D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Ankylosis, ankle: Physical examination—range of motion Ankylosis in 20 degree or ≤ dorsiflexion D Physical examination—range of motion Ankylosis in 20 degree plantar flexion D Physical examination—range of motion Ankylosis in int or ext malrotation >15 degrees D Physical examination—range of motion Ankylosis in varus 10 or more degrees D Physical examination—range of motion Ankylosis in valgus 10 or more degrees D Arthritis, subtalar joint (hindfoot): X-ray: ankle—subtalar joint Subtalar joint space 0 mm D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Physical examination Varus deformity >15 degrees D Arthritis, talonavicular joint (hindfoot): Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D X-ray: ankle—talonavicular joint Talonavicular joint space 0 mm D Physical examination Varus deformity >15 degrees D Achilles tendon rupture: Physical examination—range of motion Plantar flexion capability, <5 degrees D Physical examination—range of motion Plantar flexion contracture, 20 degrees D Arthritis, ankle: X-ray: ankle 0 mm D Physical examination—range of motion Plantar flexion capability, <5 degrees D Physical examination—range of motion Plantar flexion contracture, 20 degrees D Physical examination Varus deformity >15 degrees D Hindfoot fracture: X-ray: foot Calcaneal fracture with Boehler angle <95 degrees D X-ray: foot Subtalar fracture with Boehler angle <95 degrees D Physical examination Varus angulation >20 degrees (hindfoot) D Physical examination Valgus angulation >20 degrees (hindfoot) D Rheumatoid arthritis, foot: X-ray: foot Significant degeneration D Medical record review Chronic flare-up with treatment D BODY PART: ANKLE AND FOOT JOB TITLE: ENGINEER Ankle fracture: X-ray: ankle Displaced intra-articular fracture D Physical examination Varus deformity >15 degrees D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Ankylosis, ankle: Physical examination—range of motion Ankylosis in 20 degree or > dorsiflexion D Physical examination—range of motion Ankylosis in 20 degree plantar flexion D Physical examination—range of motion Ankylosis in int or ext malrotation >15 degrees D Physical examination—range of motion Ankylosis in varus 10 or more degrees D Physical examination—range of motion Ankylosis in valgus 10 or more degrees D Arthritis, subtalar joint (hindfoot): X-ray: ankle—subtalar joint Subtalar joint space 0 mm D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Physical examination Varus deformity >15 degrees D Arthritis, talonavicular joint (hindfoot): Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D X-ray ankle—talonavicular joint Talonavicular joint space 0 mm D Physical examination Varus deformity >15 degrees D Achilles tendon rupture: Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Arthritis, ankle: X-ray: ankle 0 mm D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Physical examination Varus deformity >15 degrees D Hindfoot fracture: X-ray: foot Calcaneal fracture with Boehler angle <95 degrees D X-ray: foot Subtalar fracture with Boehler angle <95 degrees D Physical examination Varus angulation >20 degrees (hindfoot) D Physical examination Valgus angulation >20 degrees (hindfoot) D Rheumatoid arthritis, foot: X-ray: foot Significant degeneration D Medical record review Chronic flare-up with treatment D BODY PART: ANKLE AND FOOT JOB TITLE: DISPATCHER Achilles tendon rupture: Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Arthritis, ankle: X-ray: ankle 0 mm D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Physical examination Varus deformity >15 degrees D Hindfoot fracture: X-ray: foot Calcaneal fracture with Boehler angle <95 degrees D X-ray: foot Subtalar fracture with Boehler angle <95 degrees D Physical examination Varus angulation >20 degrees (hindfoot) D Physical examination Valgus angulation >20 degrees (hindfoot) D Rheumatoid arthritis, foot: X-ray: foot Significant degeneration D Medical record review Chronic flare-up with treatment D BODY PART: ANKLE AND FOOT JOB TITLE: CARMAN Ankle fracture: X-ray: ankle Displaced intra-articular fracture D Physical examination Varus deformity >15 degrees D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Ankylosis, ankle: Physical examination—range of motion Ankylosis in 20 degree or > dorisiflexion D Physical examination—range of motion Ankylosis in 20 degree plantar flexion D Physical examination—range of motion Ankylois in int or ext malrotation >15 degrees D Physical examination—range of motion Ankylosis in varus 10 or more degrees D Physical examination—range of motion Ankylosis in valgus 10 or more degrees D Arthritis, subtalar joint (hindfoot): X-ray: ankle—subtalar joint Subtalar joint space 0 mm D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Physical examination Varus deformity >15 degrees D Arthritis, talonavicular joint (hindfoot): Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D X-ray: ankle—talonavicular joint Talonavicular joint space 0 mm 0 Physical examination Varus deformity >15 degrees D Achilles tendon rupture: Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Arthritis, ankle: X-ray: ankle 0 mm D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Physical examination Varus deformity >15 degrees D Hindfoot fracture: X-ray: foot Calcaneal fracture with Boehler angle <95 degrees D X-ray: foot Subtalar fracture with Boehler angle <95 degrees D Physical examination Varus angulation >20 degrees (hindfoot) D Physical examination Valgus angulation >20 degrees (hindfoot) D Rheumatoid arthritis, foot: X-ray: foot Significant degeneration D Medical record review Chronic flare—up with treatment D BODY PART: ANKLE AND FOOT JOB TITLE: SIGNALMAN Ankle fracture: X-ray: ankle Displaced intra-articular fracture D Physical examination Varus deformity >15 degrees D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Ankylosis, ankle: Physical examination—range of motion Ankylosis in 20 degree or > dorsiflexion D Physical examination—range of motion Ankylosis in 20 degree plantar flexion D Physical examination—range of motion Ankylosis in int or ext malrotation >15 degrees D Physical examination—range of motion Ankylosis in varus 10 or more degrees D Physical examination—range of motion Ankylosis in valgus 10 or more degrees D Arthritis, subtalar joint (hindfoot): X-ray: ankle—subtalar joint Subtalar joint space 0 mm D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Physical examination Varus deformity >15 degrees D Arthritis, talonavicular joint (hindfoot): Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D X-ray: ankle—talonavicular joint Talonavicular joint space 0 mm D Physical examination Varus deformity >15 degrees D Achilles tendon rupture: Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Arthritis, ankle: X-ray: ankle 0 mm D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Physical examination Varus deformity >15 degrees D Hindfoot fracture: X-ray: foot Calcaneal fracture with Boehler angle <95 degrees D X-ray: foot Subtalar fracture with Boehler angle <95 degrees D Physical examination Varus angulation >20 degrees (hindfoot) D Physical examination Valgus angulation >20 degrees (hindfoot) D Rheumatoid arthritis, foot: X-ray: foot Significant degeneration D Medical record review Chronic flare-up with treatment D BODY PART: ANKLE AND FOOT JOB TITLE: TRACKMAN Ankle fracture: X-ray: ankle Displaced intra-articular fracture D Physical examination—range of motion Varus deformity >15 degrees D Physical examination—range of motion Plantar flexion capability ≤5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Ankylosis, ankle: Physical examination—range of motion Ankylosis in 20 degree or > dorsiflexion D Physical examination—range of motion Ankylosis in 20 degree plantar flexion D Physical examination—range of motion Ankylosis in int or ext malrotation >15 degrees D Physical examination—range of motion Ankylosis in varus 10 or more degrees D Physical examination—range of motion Ankylosis in valgus 10 or more degrees D Arthritis, subtalar joint (hindfoot): X-ray: ankle—subtalar joint Subtalar joint space 0 mm D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Physical examination Varus deformity >15 degrees D Arthritis, talonavicular joint (hindfoot): Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D X-ray: angle—talonavicular joint Talonavicular joint space 0 mm D Physical examination Varus deformity >15 degrees D Achilles tendon rupture: Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Arthritis, ankle: X-ray: ankle 0 mm D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination Varus deformity >15 degrees D Hindfoot fracture: X-ray: foot Calcaneal fracture with Boehler angle <95 degrees D X-ray: foot Subtalar fracture with Boehler angle <95 degrees D Physical examination Varus angulation >20 degrees (hindfoot) D Physical examination Valgus angulation >20 degrees (hindfoot) D Rheumatoid arthritis, foot: X-ray: foot Significant degeneration D Medical record review Chronic flare-up with treatment D BODY PART: ANKLE AND FOOT JOB TITLE: MACHINIST Ankle fracture: X-ray: ankle Displaced intra-articular fracture D Physical examination Varus deformity >15 degrees D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Ankylosis, ankle: Physical examination—range of motion Ankylosis in 20 degree or > dorsiflexion D Physical examination—range of motion Ankylosis in 20 degree plantar flexion D Physical examination—range of motion Ankylosis in int or ext malrotation >15 degrees D Physical examination—range of motion Ankylosis in varus 10 or more degrees D Physical examination—range of motion Ankylosis in valgus 10 or more degrees D Arthritis, subtalar joint (hindfoot): X-ray: ankle—subtalar joint Subtalar joint space 0 mm D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Physical examination Varus deformity >15 degrees D Arthritis, talonavicular joint (hindfoot): Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D X-ray: ankle—talonavicular joint Talonavicular joint space 0 mm D Physical examination Varus deformity >15 degrees D Achilles tendon rupture: Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Arthritis, ankle: X-ray: ankle 0 mm D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Physical examination Varus deformity ≤15 degrees D Hindfoot fracture: X-ray: foot Calcaneal fracture with Boehler angle <95 degrees D X-ray: foot Subtalar fracture with Boehler angle <95 degrees D Physical examination Varus angulation >20 degrees (hindfoot) D Physical examination Valgus angulation >20 degrees (hindfoot) D Rheumatoid arthritis, foot: X-ray: foot Significant degeneration D Medical record review Chronic flare-up with treatment D BODY PART: ANKLE AND FOOT JOB TITLE: SHOP LABORER Ankle fracture: X-ray: ankle Displaced intra-articular fracture D Physical examination Varus deformity >15 degrees D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Ankylosis, ankle: Physical examination—range of motion Ankylosis in 20 degree or > dorsiflexion D Physical examination—range of motion Ankylosis in 20 degree plantar flexion D Physical examination—range of motion Ankylosis in int or ext malrotation >15 degrees D Physical examination—range of motion Ankylosis in varus 10 or more degrees D Physical examination—range of motion Ankylosis in valgus 10 or more degrees D Arthritis, subtalar joint (hindfoot): X-ray: ankle—subtalar joint Subtalar joint space 0 mm D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Physical examination Varus deformity >15 degrees D Arthritis, talonavicular joint (hindfoot): Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D X-ray: ankle—talonavicular joint Talonavicular joint space 0 mm D Physical examination Varus deformity >15 degrees D Achilles tendon rupture: Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Arthritis, ankle: X-ray: ankle 0 mm D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Physical examination Varus deformity >15 degrees D Hindfoot fracture: X-ray: foot Calcaneal fracture with Boehler angle <95 degrees D X-ray: foot Subtalar fracture with Boehler angle <95 degrees D Physical examination Varus angulation >20 degrees (hindfoot) D Physical examination Valgus angulation >20 degrees (hindfoot) D Rheumatoid arthritis, foot: X-ray: foot Significant degeneration D Medical record review Chronic flare-up with treatment D Disability test Test result Disability classification BODY PART: ANKLE AND FOOT JOB TITLE: SALES REPRESENTATIVES Achilles tendon rupture: Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Arthritis, ankle: X-ray: ankle 0 mm D Physical examination—range of motion Plantar flexion capability <5 degrees D Physical examination—range of motion Plantar flexion contracture 20 degrees D Physical examination Varus deformity >15 degrees D Hindfoot fracture: X-ray: foot Calcaneal fracture with Boehler angle <95 degrees D X-ray: foot Subtalar fracture with Boehler angle <95 degrees D Physical examination Varus angulation >20 degrees (hindfoot) D Physical examination Valgus angulation >20 degrees (hindfoot) D Rheumatoid arthritis, foot: X-ray: foot Significant degeneration D Medical record review Chronic flare-up with treatment D Job Information Forms [63 FR 7543, Feb. 13, 1998]

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