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Luis Pérez-Cordero PD
Rating Specialist |
California
Permanent Disability Ratings WWW.PDRATINGS.COM Voice:
(415)-861-4040 |
Craig
A. Lange Administrator/Med
Report Tech |
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Permanent & Stationary Comprehensive
Medical Report Common Report Errors And How To Fix Them |
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1.
Examples of Integrating Language ·
“The Patient works at
Aeromat involved in battery assembly. She states that the batteries would
weigh about ten pounds. Her work was
repetitive in that she would hold the battery in her left hand and use an air
driven screwdriver in her right hand.
She would do 60 to 70 batteries a day. There would be 8 to 10 batteries in a box. Each battery had a
number of screws per battery. She
also welded wires for the batteries.
She began work on 6/92. She
denied concurrent work or home activities that aggravated her hands. She
denied prior symptoms.” ·
“26-year old right-handed worker works as a legal processing
assistant for Orange County for 10-months.
Job duties at the time of the injury included lifting up to 25lbs., pulling,
pushing of the file shelves, stooping, occasional kneeling, bending, working
overhead with extended reach for retrieving and filing, as well as performing
the scanning tasks. Works on a computer for 7-hours per day, performs fine
hand manipulation 8-hours a day. He
states he answered the phone, occasionally writes phone messages. Does
document scanning in a separate scanning room/area. Job information was obtained from the patient.” – Kaiser
Occupational Medicine Dept. A
Reporting Functional Loss
and/or Work Modifications Lifting Capacity: Without information about the employee’s
pre-injury lifting capacity, restrictions addressing a ‘poundage -range’ can
produce multiple results. Under the Spine/Torso Guideline of
No Very Heavy Lifting, you find the general guidelines for determining ‘loss of lifting capacity’. 1. A
statement “inability to lift 50 pounds”
is not meaningful. Determine loss of pre-injury capacity due to an
inability to lift, by comparing the individual’s pre-injury lifting capacity
with the current lifting capacity.
Take into consideration, the total lifting effort, weight, distance,
endurance, frequency, body position and comparable physical factors with
reference to a particular individual. “What is the specific information of what the person lifted and
carried at work? A general statement
is insufficient. [15- pound maximum
lift and carry limit] The example opinion
generally states applicant had to “lift and carry things” (presumably) at
work. However, there must be facts
about the nature of the work in order to support an opinion that lifting and
carrying things caused injury. What
kinds of items were lifted and carried?
How much did the items weigh?
How often were the items carried?
How far were the items moved?
The questions are numerous. If
the person is lifting and carrying two 2-ounces of paper clips, once a day,
cumulative trauma to the low back from lifting and carrying would seem highly
unlikely. If the person were carrying
100-pound blocks of granite 12 hours a day, cumulative trauma would seem more
plausible. The Judge’s Perspective: Writing Usable Medical Reports, by William J. Ordas / Nikki S. Udkovich. 2.
Reporting Consonant Loss of
Pre-injury lifting capacity: Understanding Scheduled Levels of Pre-injury Capacity Functional Loss Spine/Torso ‘Benchmarks’ address percentages of
work capacity functional loss to perform a specific function or groups of
functions. Once the core of
physical activities (lifting, bending, stooping, etc.) has reached a level of
loss as defined by a Limitation to Light Work, additional guidelines address
limitations of weight bearing functions.
·
No
Very Heavy Lifting:
Approximately a 25% loss of pre-injury capacity
for lifting. ·
No Very Heavy Work: Approximately a 25% loss of
capacity for lifting and other arduous demands. ·
No
Heavy Lifting:
Approximately a 50% loss of lifting capacity.
·
No
Heavy Work:
Approximately a 50% loss of lifting
capacity and other arduous physical demands. (No Sustained Work) ·
No
Repetitive Motions of The Neck/Spine: Approximately 50%
loss for the weighted spinal motions. ·
No
Substantial Work: Approximately a 75% loss of pre-injury capacity for lifting and
demanding physical activities. ·
Limitation
to Light Work:
- Can work with a minimum of demands for physical effort. Page
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Luis Pérez-Cordero PD
Rating Specialist |
California
Permanent Disability Ratings WWW.PDRATINGS.COM Voice:
(415)-861-4040 |
Craig
A. Lange Administrator/Med
Report Tech |
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Permanent & Stationary Comprehensive
Medical Report Common Report Errors And How To Fix Them |
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3.
Example of Consonant Reporting: ·
Preclusion
from No Heavy Lifting: Approximately 50% loss of
pre-injury capacity for lifting. LC§
4660 ·
Example:
Employee’s lifting pre-injury capacity as per the Job Description (RU-91) was
80 pounds. Employee’s current lifting
ability is now limited to between 40-50 pounds. LC§ 4636
4.
Under-Reporting lifting capacity: Open Ended Statements (Vagueness leads to disputes.) A Avoid inconsistencies and reporting inadequacies by considering the already
scheduled terminology for loss of pre-injury capacity as it relates to the
injured employee’s functional loss. Estimate more
exactly (the overall
level of functional loss) when sufficient information is available: i.e. -
your own description of job functions, RU-91, Job Analysis, current job
functions, deportment, etc. 1.
Example of Open Ended
Language:
Lifting Capacity is now 30-45lbs
a.
6A 50%-60% loss of pre-injury lifting
capacity? b.
A 15-20% Loss of Pre-injury lifting
capacity? Page
10 of 15 |
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|
Luis Pérez-Cordero PD
Rating Specialist |
California
Permanent Disability Ratings WWW.PDRATINGS.COM Voice:
(415)-861-4040 |
Craig
A. Lange Administrator/Med
Report Tech |
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Permanent & Stationary Comprehensive
Medical Report Common Report Errors And How To Fix Them |
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5.
Avoiding Identifying Language Becoming
Problematic: “Employee
began working in September 1994, in the capacity of general laborer. Never
returned to work to the same job. Now finishing rehabilitation courses to
become an eco-systems technician.”
“Job duties consisted (but not limited to)
of preparing a mixed salad with croutons.”
“Would work on a
conveyor belt, placing, salad, chicken, croutons or dressing in a small
box. Placing the completed boxes in a
table next to the conveyor belt so other employees could reach them and pack
them.”
“Employee began working
in September 1994, in the capacity of general laborer. Never returned to work
to the same job. Now finishing rehabilitation courses to become an eco-systems
technician. Job duties consisted (but not limited to) of preparing a mixed
salad with croutons. Would work on a conveyor belt, placing, salad, chicken,
croutons or dressing in a small box.
Placing the completed boxes in a table next to the conveyor belt so
other employees could reach them and pack them. “Required to lift/carry
boxes of supplies weighing up to 30lbs. Worked in a standing/bending position
during her shift.”
Page
11 of 15 |
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Luis Pérez-Cordero PD
Rating Specialist |
California
Permanent Disability Ratings WWW.PDRATINGS.COM Voice:
(415)-861-4040 |
Craig
A. Lange Administrator/Med
Report Tech |
|
Permanent & Stationary Comprehensive
Medical Report Common Report Errors And How To Fix Them |
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III
Avoiding Misconceptions When Supporting Work Capacity Functional
Loss: L J Support all
disability: identify and define medical impairment, subjective disability and
the need for work restrictions. L The word ‘prophylactic’ and other ‘buzz words’ should not ‘disguise’
the lack of findings or be the only support for any of your descriptions of
functional loss. Cumulative Trauma: Not in itself a diagnostic validation -
but rather an identifier of a heterogeneous group of diagnoses. There must be
a causal relationship between work activities and the diagnosis, not
merely the presence of the diagnosis, in order to determine work-relatedness.
It is the physician’s responsibility to identify the occupational risk
factors – specific information regarding repetition, force, vibration, cold
exposure, other risk factors, and combinations thereof. “A 61% PD Rating based on a limitation to
Semi-Sedentary Work for an employee who suffered a sprained ankle with residual
disability only of minimal to slight subjective complaints, becoming more
than moderate on prolonged weight bearing, was not supported by substantial
evidence in light of the entire record, and was fundamentally unmerited.
The WCAB Judge did not weigh the Medical Examiner’s conclusion against other
competent evidence, which either diminished or contradicted the
conclusion. Universal City
Studios, Inc. vs. WCAB (Lewis), 44 CCC 113. A
Misconceptions: °
L Following established guidelines for the format of the medical-legal
report, and listing diagnoses, surgical procedures, testing results and need
for treatment, relieves the examiner from the burden of providing a reasoned
opinion supported by examination findings. °
L Objective Measurable Physical Elements and Subjective Disability don’t
have to be in consonance or correlate to the work capacity functional loss
addressed under the work restrictions.
Injured Worker’s Subjective Complaints are sufficient to support all functional loss. °
L The use of
the terms ‘Cumulative Trauma’ dispenses the need for supporting objective
findings. B
Consonant J
or Discordant L Descriptions of Disability: 1.
Example # 1Factors: “ 26-year old right-handed worker works as a legal processing
assistant for Orange County for 10-months.
Job duties at the time of the injury included lifting up to 25lbs.,
pulling, pushing of the file shelves, stooping, occasional kneeling, bending,
working overhead with extended reach for retrieving and filing, as well as
performing the scanning tasks. Works on a computer for 7-hours per day,
performs fine hand manipulation 8-hours a day. He states he answered the phone, occasionally writes phone
messages. Does document scanning in a separate scanning room/area. Job information was obtained from the
patient.” – HMO Occupational
Medicine Dept. a.
P&S Report description of
Factors: °
Objective
Factors – Mild Tenderness at the extensor wad
bilaterally, right ulnar and trapezius muscle. Full range of motion of the
shoulders, elbows, forearms, wrists and hands. No evidence of atrophy in any
of the major groups of the bilateral upper extremities. °
Subjective
Factors: At
rest occasional mild stiffness and pain in the right arm, hand and fingers,
increasing to slight-to-moderate with prolonged gripping, grasping, lifting
and reaching out. Ö
Rater’s Calculation: Einstein-Horner Formulation (for
Overlapping Subjective Factors of Disability): Basic Pain: 00%
= [30%(slight-to-moderate) x (20% prolonged activities) = 06% »
05% Page
12 of 15 |
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Luis Pérez-Cordero PD
Rating Specialist |
California
Permanent Disability Ratings WWW.PDRATINGS.COM Voice:
(415)-861-4040 |
Craig
A. Lange Administrator/Med
Report Tech |
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Permanent & Stationary Comprehensive
Medical Report Common Report Errors And How To Fix Them |
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b.
P&S Report description of
Factors: (Continued) °
Work
Restrictions: “Prophylactically, he is precluded from
scanning more than 1-hour in the morning and one hour in the afternoon as
this requires prolonged gripping, grasping and reaching out tasks. He may
perform other work during the rest of the workday. He may be able to perform
more scanning if the work station in the scanning area is ergonomically
corrected as previously recommended.” Ö
Rater’s Calculation for The
Loss of Pre-injury Capacity: ·
No Prolonged Activities 25% loss » 1/8 weighted
fraction from page 7-6 of The Schedule. °
Appliances Required: Bilateral Soft
Braces. ?? To be used at work? To be used intermittently? Occasionally? To be
used night? Where are the measurable and clinical findings supporting the
need for these devices during working hours?
2. Example # 2 Factors: J “Objective factors of disability include
pain on supraspinatus testing, a positive Hawkins-Kennedy sign on the right
(which improved following a subacromial injection and shoulder arthroscopic
surgery). Shoulder elevation is to 1600.
Also, right grip weakness of approximately 20% as per physical examination. The patient is right hand dominant. The grip weakness was noted on Jamar
Testing in pounds and is listed under Physical Examination. Pain is minimal-to-slight without
provocation.” Page
13 of 15 |
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|
Luis Pérez-Cordero PD
Rating Specialist |
California
Permanent Disability Ratings WWW.PDRATINGS.COM Voice:
(415)-861-4040 |
Craig
A. Lange Administrator/Med
Report Tech |
||||||||||||
|
Permanent & Stationary Comprehensive
Medical Report Common Report Errors And How To Fix Them |
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3. Example # 2 Factors: J “Objective factors of disability include pain
on supraspinatus testing, a positive Hawkins-Kennedy sign on the right (which
improved following a subacromial injection and shoulder arthroscopic
surgery). Shoulder elevation is to 1600.
Also, right grip weakness of approximately 20% as per physical
examination. The patient s right hand
dominant. The grip weakness was noted
on Jamar Testing in pounds and is listed under Physical Examination. Pain is minimal-to-slight without
provocation.” è Work Restrictions: 1. Upper
Arms: “No repetitive work at
or above shoulder level including lifting, reaching, pushing, pulling.” a. 50%
loss »
1/2 weighted fraction from page 7-4 of The Schedule 2. Lower
Arms: “Should avoid very
forceful torquing with his right upper extremity and should avoid very heavy
lifting with the right upper extremity.
He has lost approximately 25% of his total pre-injury capacity for
lifting a. 25% loss » 1/8 weighted fraction from page 7-6 of The Schedule.
4.
Example # 3 Factors: L J “She worked at a mini storage unit. She opened up in the mornings. Her job
consisted of showing units, cleaning, units, ledgering accounts, preparing
late and legal notices, and cleaning the yard. Once a week she moved a
commercial dumpster, on Wednesdays. She tripped and fell on the sidewalk the
day she was injured.” °
Objective Factors
– Normal posture and stance. No muscle wasting or
evidence of atrophy. Full range of
motion of the shoulders, elbows, forearms, wrists and hands. Palpatory tenderness over the base of
the right little finger. Grip (R/L): 70 / 70
(Rapid Exchange) 69/63 – no ratable reduction of grasping power.
Average grip strength for a 57-year old as per Mathiowatz:
57-pounds. X-rays:
No arthritis is noted. Joint
alignment, intact. °
Subjective Factors:
Occasional slight pain in the
right hand that is exacerbated with lifting and
gripping (Q: All lifting and gripping? Forceful Gripping?
Repetitive Gripping?). Should be rated as occasional moderate
pain. Ö
Rater’s Calculation: Einstein-Horner Formulation (for
Overlapping Subjective Factors of Disability): Basic Pain: 01%
= [25%(moderate) – 01 = 24 x 1/4 (occasional)
06 x 40 (activities-full value of
not grasping) =2.4] 3.4 = 03% °
Work Restrictions: “I agree with
Dr. Williamson’s work restrictions.
The work restrictions are no lifting more than 15-pounds with the
right upper extremity and occasional gripping, grasping with the right
hand and occasional typing.
°
Vocational Rehabilitation/ Job
Modifications: Not QIW – can return to her job at Security
Public Storage. Ö
Rater’s Calculation for The
Loss of Pre-injury Capacity: ·
75% loss of pre-injury capacity
for grasping » 4/9 weighted fraction. ·
No typing/Fine Manipulation – 50% loss of pre-injury
capacity 1/3 weighted fraction ·
Can do Occasionally – 75% loss (3/4) x 1/3
= 3/12 »
3/10 Page
14 of 15 |
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Luis Pérez-Cordero PD
Rating Specialist |
California
Permanent Disability Ratings WWW.PDRATINGS.COM Voice:
(415)-861-4040 |
Craig
A. Lange Administrator/Med
Report Tech |
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Permanent & Stationary Comprehensive
Medical Report Common Report Errors And How To Fix Them |
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