7538 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

RAILROAD RETIREMENT BOARD

20 CFR Part 220

RIN 3220–AB18

Determining Disability

AGENCY: Railroad Retirement Board.

ACTION: Final rule.

SUMMARY: The Railroad Retirement

Board hereby amends its regulations

with respect to determining when an

employee is disabled for his or her

regular railroad occupation. This final

rule gives effect to an agreement

between railroad labor and railroad

management consistent with section

2(a)(2) of the Railroad Retirement Act

which provides that labor and

management shall cooperate with the

Board in developing standards for

determining when an employee’s

physical or mental condition disables

him or her for work in his or her regular

railroad occupation and thus there

exists good cause not to delay its

effectiveness beyond date of

publication.

DATES: Effective date: This rule is

effective February 13, 1998.

Applicability date: This rule shall be

applicable February 13, 1998, but only

with respect to applications for a

disability annuity filed on or after

January 1, 1998.

ADDRESSES: Secretary to the Board,

Railroad Retirement Board, 844 North

Rush Street, Chicago, Illinois 60611.

FOR FURTHER INFORMATION CONTACT:

Thomas W. Sadler, Senior Attorney,

Railroad Retirement Board, 844 North

Rush Street, Chicago, Illinois 60611,

(312) 751–4513, TDD (312) 751–4701.

SUPPLEMENTARY INFORMATION: Section

2(a)(2) of the Railroad Retirement Act

(45 U.S.C. 231a(a)(2)) provides that the

Board, with the cooperation of

employers and employees, shall secure

the establishment of standards

determining the physical and mental

conditions which permanently

disqualify employees from performing

their regular occupation in the railroad

industry. The Board has never formally

adopted such standards. The agency, in

the past, has used provisional standards

which were adopted in 1946 but which

are now outdated. In 1991 the Board

adopted Subpart C of Part 220 which

provides for determining disability for

work in an employee’s regular railroad

occupation. Under this regulation if an

employee’s physical or mental

condition does not meet a listing found

in Appendix 1 of Part 220 (which

determines if an individual is able to

engage in any employment both within

and outside the railroad industry), the

Board determines the employee’s

residual functional capacity and

compares that to the demands of his or

her regular railroad occupation to

determine if the employee can continue

to perform that job. However, Subpart C

contains no specific standards which

relate to specific railroad occupations.

The Board amends Subpart C to add

such standards with respect to certain

railroad occupations.

Section 220.10 provides for the

establishment of an Occupational

Disability Advisory Committee made up

of two physicians, one from

recommendations from rail labor, one

from recommendations of rail

management. This committee shall

review, from time to time, the disability

standards developed by this regulation

and the Occupational Disability Claims

Manual (Manual) which supplements

this regulation. The Board shall confer

with this Committee before it amends

this regulation or the Manual. It should

be noted that the Board is not an agency

subject to the Federal Advisory

Committee Act. Accordingly, the

Occupational Disability Advisory

Committee will not be subject to that

Act.

Section 220.11 contains the

definitions of ‘‘regular railroad

occupation’’, ‘‘permanent physical and

mental impairment’’, and ‘‘residual

functional capacity’’ as presently found

in Part 220. In addition, it adds the

definitions of ‘‘independent case

evaluation’’ and ‘‘functional capacity

test’’.

The current § 220.12 is removed, and

the current § 220.14 ‘‘Evidence

Considered’’ is redesignated § 220.12.

The introductory language and

paragraph (a) of section 220.13 follow

the present regulation and describe the

sequential evaluation process for

determining disability for an employee’s

regular railroad occupation. Initially, if

an employee has been medically

disqualified by his employer, the Board

will presume that the employee is

disabled for his regular railroad

occupation if there is any objective

medical evidence to support that

determination. If the employee has not

been so disqualified, the Board will

determine if the employee’s

impairment(s) meet or equal a listing

found in Appendix 1.

Section 220.13(b)(1) provides that if

an employee has not been found

disabled in the first two steps described

above, the Board will then determine

the employee’s regular railroad

occupation, based upon the employee’s

description of his or her job.

Section 220.13(b)(2)(i) provides that

next the Board will determine if an

employee’s regular railroad occupation

and impairment(s) are covered under

the standards contained in a new

Appendix 3 to Part 220. If both the

occupation and impairment(s) are

covered, the Board will confirm the

existence of the impairment(s) by using

the tests listed in Appendix 3 or by

other valid diagnostic tests which could

be used to establish an impairment as

provided for in § 220.27 of this part.

(Section 220.13(b)(2)(ii) of the proposed

rule has been revised to clarify how an

impairment is confirmed and that if an

employee’s impairment(s) cannot be

confirmed, as provided for in this

section, the employee will be found not

disabled.) Once the impairment(s) is

confirmed, Appendix 3 is applied to

determine if the employee is disabled.

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

If the employee’s regular railroad

occupation and impairment(s) are not

covered by Appendix 3, or if the

medical evidence contains significant

differences in interpretation of objective

test findings which cannot be readily

resolved, then the Board will not use

Appendix 3, but will determine if the

employee is disabled using an

independent case evaluation (ICE) as set

forth in § 220.13(b)(2)(iv). Likewise, if

Appendix 3 does not yield a ‘‘disabled’’

finding, ICE will apply.

Section 220.13(b)(2)(iv), which

describes ICE, is essentially a more

detailed description of the process,

which is described in § 220.13(b)(3) of

the present regulation. Under this

process the Board initially determines

whether the evidence is complete (Step

1). The Board next confirms any

impairment which has not been

confirmed under § 220.13(b)(2)(ii) (Step

2). Next, the Board will determine

whether there is a concordance of

medical findings among physicians. If

there is not, the Board will request

additional medical evidence from the

employee’s treating physician(s) or

procure additional consulting exams

(Step 3). Once the Board establishes a

concordance of medical findings, to the

extent that it is possible, it will then

assess the quality of the medical

evidence under the factors set forth in

§ 220.14. This section sets forth factors

which either support or call into

question the validity of the medical

findings. Thus, for example, the opinion

of a treating physician, which is fully

supported by medically acceptable

clinical and diagnostic techniques, is

given greater weight than one that is not

so supported or is inconsistent with

findings of other medical sources.

Likewise, the claimant’s description of
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7539

his or her own condition, if consistent

with objective medical findings, is given

more weight than one that is not

consistent (Step 4). If, after assessment,

the Board determines that there is no

substantial objective evidence of an

impairment, the Board will determine

that the employee is not disabled.

If through the assessment in Step 4 it

is determined that there is substantial

objective evidence of an impairment,

then in Step 5 the Board will determine

the demands of the employee’s regular

railroad occupation. At this point, the

Board will not only consider the

employee’s own description of his or

her job, but also the employer’s

description as well as other sources

such as the Dictionary of Occupational

Titles and generic descriptions found in

the Occupational Disability Claims

Manual.

Next, the Board will determine the

employee’s residual functional capacity

based upon the assessment performed in

Step 4 and compare it to the job

demands determined in Step 5. If the

demands of the employee’s regular

railroad occupation exceed the

employee’s residual functional capacity,

then the Board will find the employee

disabled. If the demands do not exceed

the residual functional capacity, then

the Board will find the employee not

disabled (Step 6).

The Board published this regulation

as a proposed rule on September 24,

1997 (62 FR 50056), and invited

comments by October 24, 1997. Two

comments were received. One

commentator suggested that the Board

adopt the vision and hearing acuity

requirements found in 49 CFR 240.121,

which have been adopted by the Federal

Railroad Administration for certification

of locomotive engineers. However, the

Board does not feel such a change is

needed since an engineer who is

disqualified by his employer for failure

to meet the requirements of 49 CFR

240.121 would ordinarily be presumed

disabled under the first paragraph of

§ 220.13. Another commentator

expressed support for the regulation

because it was in accord with an

agreement reached in July 1997 between

representatives of rail labor and rail

management concerning occupational

disability.

The final rule contains an

Introduction to Appendix 3 which

explains how to use the Appendix. In

addition, the Board has corrected

typographical errors in Appendix 3, and

made the following substantive changes

in Appendix 3 based upon advice from

physicians representing rail labor and

rail management:

A. Cancer

• 62 FR 50064—Under Assessment,

second paragraph, second line, the

phrase ‘‘in the Tables’’ was inserted

after ‘‘All railroad occupations.’’

• 62 FR 50065—Footnote 3,

Functional Impacts, the reference to

‘‘(MS) Minimally Significant’’ was

deleted.

• 62 FR 50066—Footnote 5 was

deleted and footnote 6 was redesignated

footnote 5.

C. Cardiac

• 62 FR 50066—The confirmatory test

for coronary artery disease,

angiography,’’Definite significant

(>60%) of one vessel,’’ was changed to

‘‘Definite occlusion (>60%) of one

vessel.’’

• 62 FR 50067 through 50075—The

disability tests, test results and

disability classifications for

‘‘Echocardiogram’’ and ‘‘Cardiac

catheterization’’ with results of

‘‘Decreased ejection fraction 40–55%’’

were deleted for all job titles. These

tests were found in the proposed rule

under the listings Angina, Aortic valve

disease, Cardiomyopathy, Mitral valve

disease, and Pericardial disease.

• 62 FR 50067 through 50075—The

disability tests for ‘‘Echocardiogram’’

and ‘‘Cardiac catheterization’’ with

results of ‘‘Poor ejection fraction <35%’’

were revised to read ‘‘Poor ejection

fraction ≤35%’’ for all job titles. These

tests were found in the proposed rule

under the listings Angina, Aortic valve

disease, Cardiomyopathy, Mitral valve

disease, and Pericardial disease.

• 62 FR 50067, 50071 and 50072—In

the proposed rule one of the disability

tests for ‘‘Mitral valve disease’’ for

trainman, signalman and trackman was

‘‘Cardiac catheterization’’ with a test

result of ‘‘Mitral valve gradient >10mm

Hg.’’ This disability test, and its test

result and disability classification was

deleted. Another test result under

‘‘Mitral valve disease’’ for ‘‘Cardiac

catheterization’’ was ‘‘Mitral valve

gradient 5–10mm Hg.’’ This test result

was changed to ‘‘Mitral valve gradient

≥5mm Hg.’’

• 62 FR 50068, 50069, 50070, 50073,

50074, 50075—One of the disability

tests for ‘‘Mitral valve disease’’ for

engineer, dispatcher, carman, machinist,

shop laborer, sales representative, and

general office clerk was ‘‘Cardiac

catheterization’’ with a test result of

‘‘Mitral valve gradient 5–10mm Hg.’’

This disability test, and its test result

and disability classification was deleted.

Another test result under ‘‘Mitral valve

disease’’ for ‘‘Cardiac catheterization’’

was ‘‘Mitral valve gradient >10mm Hg.’’

This result was changed to ‘‘Mitral valve

gradient ≥10mm Hg.’’

• 62 FR 50067, 50070, 50071,

50072—For job titles trainman,

signalman, and trackman the disability

tests were revised as follows:

Angina

—Stress test with a result of ‘‘Peak

exercise 5–7 METS’’ the disability

test, test result, and disability

classification were deleted.

—Stress test with a result of ‘‘Peak

exercise <5 METS’’ was revised to

read ‘‘Stress test—Peak exercise ≤7

METS.’’

—Stress test with a result of ‘‘Definite

ischemia <7 METS’’ was revised to

read ‘‘Stress test: Significant ST

changes—Definite ischemia ≤7

METS.’’

—Stress test with a result of ‘‘Definite

ischemia >7 METS’’: the disability

test, test result, and disability

classification were deleted.

Aortic Valve Disease

—Stress test with a result of ‘‘Peak

exercise 5-7 METS’’: the disability

test, test result, and disability

classification were deleted.

—Stress test with a result of ‘‘Peak

exercise <5 METS’’ was revised to

read: ‘‘Peak exercise ≤7 METS.’’

Coronary Artery Disease

—Stress test with a result of ‘‘Peak

exercise 5–7 METS’’: the disability

test, test result, and disability

classification were deleted.

—Stress test with a result of ‘‘Peak

exercise <5 METS’’ was revised to

read: ‘‘Stress test —Peak exercise ≤7

METS.’’

—Stress test with a result of ‘‘Definite

ischemia < or >7 METS’’ was revised

to read: ‘‘Stress test—Definite

ischemia ≤7 METS.’’

—Isotope, e.g., thallium study with a

result of ‘‘Definite ischemia < or >7

METS’’ was revised to read: ‘‘Isotope,

e.g., thallium study—definite

ischemia ≤7 METS.’’

Cardiomyopathy

—Stress test with a result of ‘‘Peak

exercise 5–7 METS’’ was revised to

read: ‘‘Stress test—Peak exercise ≤7

METS.’’

Mitral Valve Disease

—Stress test with a result of ‘‘Peak

exercise 5–7 METS’’ was revised to

read: to ‘‘Peak exercise ≤7 METS.’’

• 62 FR 50067, 50068, 50069, 50070,

50072, 50073, 50074, 50075—For job

titles engineer, dispatcher, carman,

machinist, shop laborer, sales

representative, and general office clerk
7540 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

the disability tests were revised as

follows:

Angina

—Stress test with a result of ‘‘Peak

exercise 5–7 METS’’ the disability

test, test result and disability

classification were deleted.

—Stress test with a result of ‘‘Peak

exercise <5 METS’’ was revised to

read: ‘‘Stress test—Peak exercise ≤5

METS.’’

—Stress test: significant ST changes

with a result of ‘‘Definite ischemia <7

METS’’ was revised to read: ‘‘Stress

test—Definite ischemia ≤5 METS.’’

—Stress test: significant ST changes

with a result of ‘‘Definite ischemia >7

METS’’: the disability test, test result,

and disability classification were

deleted.

Aortic Valve Disease

—Stress test with a result of ‘‘Peak

exercise 5–7 METS’’: the disability

test, test result, and disability

classification were deleted.

—Stress test with a result of ‘‘Peak

exercise <5 METS’’ was revised to

read: ‘‘Stress test—Peak exercise ≤5

METS.’’

Coronary Artery Disease

—Stress test with a result of ‘‘Peak

exercise 5–7 METS’’: the disability

test, test result, and disability

classification were deleted.

—Stress test with a result of ‘‘Peak

exercise <5 METS’’ was revised to

read: ‘‘Stress test—Peak exercise ≤5

METS.’’

—Stress test with a result of ‘‘Definite

ischemia < or >7 METS’’ was revised

to read: ‘‘Stress test—Definite

ischemia ≤5 METS.’’

—Isotope, e.g., thallium study with a

result of ‘‘Definite ischemia < or >7

METS’’ was revised to read: ‘‘Isotope,

e.g., thallium study—Definite

ischemia ≤5 METS.’’

Cardiomyopathy

—Stress test with a result of ‘‘Peak

exercise 5–7 METS’’ was revised to

read: ‘‘Stress test—Peak exercise ≤5

METS.’’

Mitral Valve Disease

—Stress test with a result of ‘‘Peak

exercise 5–7 METS’’ was revised to

read: ‘‘Stress test—Peak exercise ≤5

METS.’’

• 62 FR 50067 through 50074—For

job titles trainman, engineer, dispatcher,

carman, signalman, trackman,

machinist, and shop laborer, under the

listing of ‘‘Hypertension,’’ the disability

test of ‘‘Medical record review’’ with a

result of ‘‘Diastolic >120 and systolic

>160, 50% of the time’’; the disability

test, test result, and disability

classification were deleted. For sales

representative, under the listing

‘‘Hypertension,’’ the disability test of

‘‘Medical record review’’ with a result of

‘‘Diastolic >120 and systolic >160, 50%

of the time’’: the following was added:

‘‘and evidence of end organ damage

(blood creatinine >2; urinary protein

>1⁄2 gm; or EKG evidence of ischemia).’’

• 62 FR 50067 through 50075—For all

job titles, under ‘‘Ventricular ectopy,’’

the disability test of ‘‘Medical record

review’’ with a result of ‘‘Surgical

rhythm procedure’’ and the disability

classification were deleted.

D. Respiratory

• 62 FR 50076 through 50080—The

listing ‘‘Asbestosis’’ was removed and,

consequently, the designated

confirmatory tests for this condition

were also removed.

• 62 FR 50076 through 50080—The

listing ‘‘Sleep Apnea’’ was removed

and, consequently, the designated

confirmatory tests for this condition

were also removed.

• 62 FR 50076—The confirmatory

tests for ‘‘Silicosis,’’ ‘‘Chest X-ray (ILO

interpreted)’’ with a minimum result of

‘‘At least 1/0 by NIOSH B reader,’’ was

removed.

• 62 FR 50076—The confirmatory test

for ‘‘Restrictive lung disease’’

designated ‘‘Diffusing capacity’’ was

changed to read: ‘‘DLCO.’’

• 62 FR 50076—The parenthetical

‘‘(race adjusted)’’ in the confirmatory

test ‘‘Spirometry’’ for ‘‘Restrictive lung

disease’’ was removed.

• 62 FR 50077 through 50080—The

disability test for ‘‘Pulmonary fibrosis’’

and ‘‘Restrictive lung disease’’ for

trainman, carman, signalman, trackman,

machinist, and shop laborer designated

‘‘Diffusing capacity for CO’’ was

changed to read: ‘‘DLCO.’’

• 62 FR 50076 through 50080—The

disability test for ‘‘Asthma’’ and

‘‘Chronic bronchitis’’ for trainman,

carman, signalman, trackman,

machinist, and shop laborer designated

‘‘Spirometry’’ has an accompanying test

result of ‘‘FEV1 with adequate treatment

<40% predicted.’’ The test result was

changed to: ‘‘Repeated spirometry FEV1

<40% over a 12-month period.’’

• 62 FR 50077 through 50080—Under

the listing Bronchiectasis, Chronic

Bronchitis, Chronic Obstructive

Pulmonary Disease (COPD), Pulmonary

Fibrosis, and Silicosis for the job titles

trainman, carman, signalman, trackman,

machinist, and shop laborer the

disability test ‘‘PCO2 arterial’’ was

changed to read: ‘‘Resting ABG,’’ and its

accompanying test result was revised to

read: ‘‘PCO2 arterial >50mm Hg if

stable.’’

• 62 FR 50077 through 50080—Under

the listings Bronchiectasis, Chronic

Bronchitis, Chronic Obstructive

Pulmonary Disease (COPD), and

Pulmonary Fibrosis for the job titles

trainman, carman, signalman, trackman,

machinist, and shop laborer the

disability test ‘‘Pulmonary exercise test’’

with a test result of ‘‘PO2 drop >5 torr

at maximum exercise’’ was changed to

read ‘‘Pulmonary exercise test or

exercise ABG.’’

F. CE Spine

• 62 FR 50093—Under the listing

‘‘Rheumatoid arthritis: cervical’’ the

minimum result under the confirmatory

test of ‘‘Rheumatoid factor (blood test)’’

was changed from ‘‘High titer’’ to ‘‘Titer

of rheumatoid factor.’’

• 62 FR 50094 through 50097—The

disability test for ‘‘Spondylogenic

compression of spinal cord:’’ for

trainman, engineer, carman, signalman,

trackman, machinist, and shop laborer

designated ‘‘Physical examination:

lower limb’’ has an accompanying test

result of ‘‘Lower extremity weakness or

spasticity.’’ The test result was changed

to: ‘‘Lower extremity weakness or

significant spasticity.’’

• 62 FR 50094 through 50097—The

disability test for trainman, engineer,

carman, signalman, trackman,

machinist, and shop laborer designated

‘‘Physical examination: cervical’’ was

changed to read ‘‘Physical

examination.’’ This disability test can be

found under the listings Cervical disc

disease with myelopathy, Chronic

herniated disc, Cervical spondylolysis,

Cervical intervertebral disc

degeneration, Fracture: posterior

element with spinal canal displacement,

Post-laminectomy syndrome, Cervical

radiculopathy, and Spondylogenic

compression of spinal cord.

G. Shoulder

• 62 FR 50097—The confirmatory test

‘‘Permanent functional limitation,

elbow:’’ was changed to ‘‘Medical

diagnosis leading to a permanent

functional limitation of the elbow.’’

• 62 FR 50098 through 50099—The

disability test for trainman, engineer,

carman, signalman, trackman,

machinist, and shop laborer under the

listing ‘‘Permanent functional

limitation, elbow:’’ was ‘‘Physical

examination—range of motion.’’ Its

accompanying test result ‘‘Flexion limit

to 60 degrees (30 degrees from 90)’’ was

changed to ‘‘Flexion limited to 60

degrees.’’
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7541

1The Manual may be obtained from the Board’s

headquarters at 844 North Rush Street, Chicago, IL

60611.

H. Hand and Arm

• 62 FR 50099—The confirmatory

tests for ‘‘Carpal tunnel syndrome’’

designated ‘‘Physical examination’’ with

a minimum result of ‘‘Tinel’s or

Phalen’s sign suggestive but not

confirming’’ was removed.

• 62 FR 50099—One of the

confirmatory tests for ‘‘Rheumatoid

arthritis: hand’’ is ‘‘Rheumatoid factor.’’

The minimum result for this test was

changed from ‘‘High titer’’ to ‘‘Titer of

rheumatoid factor.’’

• 62 FR 50100 through 50104—A

disability test for trainman, carman,

signalman, trackman, machinist, and

shop laborer was ‘‘Strength (jamar)’’

with a test result for dominant and nondominant hands for female and male.

All references to these tests, their results

and disability classifications were

deleted. These disability tests were

found in the proposed rule under the

listings: Carpal tunnel syndrome,

Fracture wrist, Hand permanent

functional limitation, and Wrist

permanent functional limitation.

• 62 FR 50100 through 50104—Two

of the disability tests for the listing

‘‘Thumb: permanent functional

limitation’’ were ‘‘Adduction of thumb’’

and ‘‘Opposition’’ with a result of ‘‘Loss

<=7 cm.’’ These disability tests, test

results, and disability classifications

were removed for all job titles.

I. Hip

• 62 FR 50105—One of the

confirmatory tests for ‘‘Paget’s disease’’

is ‘‘X-ray: hip.’’ The minimum result for

this test was changed from ‘‘Osteolytic

and blastic lesions’’ to ‘‘Osteolytic or

blastic lesions.’’

J. Knee

• 62 FR 50108—The confirmatory test

for ‘‘Patellar-7 subluxation-recurrent’’ is

a ‘‘Medical record review.’’ The

minimum result for this testing in the

proposed rule was ‘‘History of recurrent

subluxation with associated signs.’’ The

phrase ‘‘with associated signs’’ was

removed.

K. Ankle and Foot

• 62 FR 50116 through 50120—One

of the disability tests for the listing

‘‘Rheumatoid arthritis, foot:’’ is a

‘‘Medical record review.’’ Its

accompanying test result in the

proposed rule was ‘‘Frequent flare-up

with treatment.’’ This test result was

changed to ‘‘Chronic flare-up with

treatment.’’

The Board has determined that this is

a significant rule under Executive Order

12866. The Office of Management and

Budget has approved the information

collection (Job Information Report, RRB

Forms G–251a and G–251b found in

Appendix 3 of this part) associated with

this rule and assigned it OMB control

number 3220–0193.

List of Subjects in 20 CFR Part 220

Disability benefits, Railroad

employees, Railroad retirement,

Reporting and recordkeeping

requirements.

For the reasons set forth in the

preamble, part 220 of title 20 of the

Code of Federal Regulations is amended

as follows:

PART 220—DETERMINING DISABILITY

1. The authority citation for part 220

continues to read as follows:

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

2. The heading of subpart C is revised

to read as follows:

Subpart C—Disability Under the

Railroad Retirement Act for Work in an

Employee’s Regular Railroad

Occupation

3. Section 220.10 is revised to read as

follows:

§ 220.10 Disability for work in an

employee’s regular railroad occupation.

(a) In order to receive an occupational

disability annuity an eligible employee

must be found by the Board to be

disabled for work in his or her regular

railroad occupation because of a

permanent physical or mental

impairment. In this subpart the Board

describes in general terms how it

evaluates a claim for an occupational

disability annuity. In accordance with

section 2(a)(2) of the Railroad

Retirement Act this subpart was

developed with the cooperation of

employers and employees. This subpart

is supplemented by an Occupational

Disability Claims Manual (Manual) 1

which was also developed with the

cooperation of employers and

employees.

(b) In accordance with section 2(a)(2)

of the Railroad Retirement Act, the

Board shall select two physicians, one

from recommendations made by

representatives of employers and one

from recommendations made by

representatives of employees. These

individuals shall comprise the

Occupational Disability Advisory

Committee (Committee). This

Committee shall periodically review, as

necessary, this subpart and the Manual

and make recommendations to the

Board with respect to amendments to

this subpart or to the Manual. The Board

shall confer with the Committee before

it amends either this subpart or the

Manual.

4. Section 220.11 is revised to read as

follows:

§ 220.11 Definitions as used in this

subpart.

Functional capacity test means one of

a number of tests which provide

objective measures of a claimant’s

maximal work ability and includes

functional capacity evaluations which

provide a systematic comprehensive

assessment of a claimant’s overall

strength, mobility, endurance and

capacity to perform physically

demanding tasks, such as standing,

walking, lifting, crouching, stooping or

bending, climbing or kneeling.

Independent Case Evaluation (ICE)

means the process for evaluating claims

not covered by Appendix 3 of this part.

Permanent physical or mental

impairment means a physical or mental

impairment or combination of

impairments that can be expected to

result in death or has lasted or can be

expected to last for a continuous period

of not less than 12 months.

Regular railroad occupation means an

employee’s railroad occupation in

which he or she has engaged in service

for hire in more calendar months than

the calendar months in which he or she

has been engaged in service for hire in

any other occupation during the last

preceding five calendar years, whether

or not consecutive; or has engaged in

service for hire in not less than one-half

of all of the months in which he or she

has been engaged in service for hire

during the last preceding 15 consecutive

calendar years. If an employee last

worked as an officer or employee of a

railway labor organization and if

continuance in such employment is no

longer available to him or her, the

‘‘regular occupation’’ shall be the

position to which the employee holds

seniority rights or the position which he

or she left to work for a railway labor

organization.

Residual functional capacity has the

same meaning as found in § 220.120.

§ 220.12 [Removed]

§ 220.14 [Redesignated as § 220.12]

5. The current § 220.12 ‘‘Permanent

physical or mental impairment,

defined.’’ is removed, and § 220.14

‘‘Evidence considered.’’ is redesignated

as § 220.12.

6. Section 220.13 is amended by

revising the section heading, the

introductory text, and paragraph (b) to

read as follows:
7542 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

§ 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:

* * * * *

(b) If the Board finds that the claimant

does not have an impairment described

in paragraph (a) of this section, it will—

(1) Determine the employee’s regular

railroad occupation, as defined in

§ 220.11, based upon the employee’s

own description of his or her job;

(2) Evaluate whether the claimant is

disabled as follows:

(i) The Board first determines whether

the employee’s regular railroad

occupation is an occupation covered

under Appendix 3 of this part. Second,

the Board will determine whether the

employee’s claimed impairment(s) is

covered under Appendix 3 of this part.

If claimant’s regular railroad occupation

or impairment(s) is not covered under

Appendix 3 of this part, then the Board

will determine if the employee is

disabled under ICE as set forth in

paragraph (b)(2)(iv) of this section.

(ii)(A) If the Board determines that, in

accordance with paragraph (b)(2)(i) of

this section, Appendix 3 of this part

applies, then the Board will confirm the

existence of the employee’s

impairment(s) using—

(1) The ‘‘highly recommended’’ and

‘‘recommended’’ tests set forth in

Appendix 3 of this part that relate to the

body part affected by the claimant’s

impairment(s); or

(2) By using valid diagnostic tests

accepted by the medical community as

described in § 220.27.

(B) If the employee’s impairment(s)

cannot be confirmed because there are

significant differences in objective tests

such as imaging study,

electrocardiograms or other test results,

and these differences cannot be readily

resolved, the Board will determine if the

employee is disabled under ICE as set

forth in paragraph (b)(2)(iv) of this

section. However, if the employee’s

impairment(s) cannot be confirmed, and

there are no significant differences in

objective medical tests which cannot be

readily resolved, then the employee will

be found not disabled.

(iii) Once the impairment(s) is

confirmed, as provided for in paragraph

(b)(2)(ii) of this section, the Board will

apply Appendix 3 of this part. If

Appendix 3 of this part dictates a ‘‘D’’

(disabled) finding, the Board will find

the claimant disabled.

(iv) If the Board does not find the

employee disabled using the standards

in Appendix 3 of this part, then the

Board will determine if the employee is

disabled using ICE. To evaluate a claim

under ICE the Board will use the

following steps:

(A) Step 1. The Board will determine

if the medical evidence is complete.

Under this step the Board may request

the claimant to take additional medical

tests such as a functional capacity test

or other consultative examinations;

(B) Step 2. If the employee’s

impairment(s) has not been confirmed,

as provided for in paragraph

(b)(2)(ii)(A)(2) of this section, the Board

will next confirm the employee’s

impairment(s), as described in

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

(C) Step 3. The Board will determine

whether the opinions among the

physicians regarding medical findings

are consistent, by reviewing the

employee’s medical history, physical

and mental examination findings,

laboratory or other test results, and

other information provided by the

employee or obtained by the Board. If

such records reveal that there are

significant differences in the medical

findings, significant differences in

opinions concerning the residual

functional capacity evaluations among

treating physicians, or significant

differences between the results of

functional capacity evaluations and

residual functional capacity

examinations, then the Board may

request additional evidence from

treating physicians, additional

consultative examinations and/or

residual functional capacity tests to

resolve the inconsistencies;

(D) Step 4. When the Board

determines that there is concordance of

medical findings, then the Board will

assess the quality of the evidence in

accordance with § 220.112, which

describes the weight to be given to the

opinions of various physicians, and

§ 220.114, which describes how the

Board evaluates symptoms such as pain.

The Board will also assess the weight of

evidence by utilizing § 220.14, which

outlines factors to be used in

determining the weight to be attributed

to certain types of evidence. If, after

assessment, the Board determines that

there is no substantial objective

evidence of an impairment, the Board

will determine that the employee is not

disabled;

(E) Step 5. Next, the Board determines

the physical and mental demands of the

employee’s regular railroad occupation.

In determining the job demands of the

employee’s regular railroad occupation,

the Board will not only consider the

employee’s own description of his or

her regular railroad occupation, but

shall also consider the employer’s

description of the physical requirements

and environmental factors relating to

the employee’s regular railroad

occupation, as provided by the

employer on the appropriate form set

forth in Appendix 3 of this part, and

consult other sources such as the

Dictionary of Occupational Titles and

the job descriptions of occupations

found in the Occupational Disability

Claims Manual, as provided for in

§ 220.10;

(F) Step 6. Based upon the assessment

of the evidence in paragraph

(b)(2)(iv)(D) of this section, the Board

shall determine the employee’s residual

functional capacity. The Board will then

compare the job demands of the

employee’s regular railroad occupation,

as determined in paragraph (b)(2)(iv)(E)

of this section. If the demands of the

employee’s regular railroad occupation

exceed the employee’s residual

functional capacity, then the Board will

find the employee disabled. If the

demands do not exceed the employee’s

residual functional capacity, then the

Board will find the employee not

disabled.

7. A new section 220.14 is added to

read as follows:

§ 220.14 Weighing of evidence.

(a) Factors which support greater

weight. Evidence will generally be given

more weight if it meets one or more of

the following criteria:

(1) The residual functional capacity

evaluation is based upon functional

objective tests with high validity and

reliability;

(2) The medical evidence shows

multiple impairments which have a

cumulative effect on the employee’s

residual functional capacity;

(3) Symptoms associated with

limitations are consistent with objective

findings;

(4) There exists an adequate trial of

therapies with good compliance, but

poor outcome;

(5) There exists consistent history of

conditions between treating physicians

and other health care providers.
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7543

(b) Factors which support lesser

weight. Evidence will generally be given

lesser weight if it meets one or more of

the following criteria:

(1) There is an inconsistency between

the diagnoses of the treating physicians;

(2) There is inconsistency between

reports of pain and functional impact;

(3) There is inconsistency between

subjective symptoms and physical

examination findings;

(4) There is evidence of poor

compliance with treatment regimen,

keeping appointments, or cooperating

with treatment;

(5) There is evidence of exam findings

which is indicative of exaggerated or

potential malingering response;

(6) The evidence consists of objective

findings of exams that have poor

reliability or validity;

(7) The evidence consists of imaging

findings which are nonspecific and

largely present in the general

population;

(8) The evidence consists of a residual

functional capacity evaluation which is

supported by limited objective data

without consideration for functional

capacity testing.

8. Appendix 3—Railroad Retirement

Board Occupational Disability

Standards is added to part 220 to read

as follows:

Appendix 3—Railroad Retirement

Board Occupational Disability

Standards

1. Introduction

1.01 The Board uses this appendix to

adjudicate the occupational disability claims

of employees with medical conditions and

job titles covered by the Tables in this

appendix. The Tables are divided into ‘‘Body

Parts’’, with each Body Part further divided

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

of impairments and tests with accompanying

test results which establish a finding of ‘‘D’’

(disabled). The use of these Tables is a threestep process. In the first step we determine

whether the employee’s regular railroad

occupation is covered by the Tables; next we

establish the existence of an impairment

covered by the Tables; finally, we reach a

disability determination. If we do not find an

employee disabled under these Tables, the

employee may still be found disabled using

Independent Case Evaluation (ICE), as

explained in subpart C of this part.

1.02 The Cancer Tables are treated in a

different way than other body systems.

Different types of cancer and their treatments

have different functional impacts. In the

Cancer Tables the impact of the impairment

is seen as being significant or not significant.

Therefore, these tables contain an ‘‘S’’

(significant) which is equivalent to a ‘‘D’’

rating. A detailed explanation of how to use

those tables is in that section. The steps to

use the remaining Tables are explained

below:

2. Confirming the Impairment

2.01 Once we determine that the

employee’s regular railroad occupation is

covered by the Job Titles in the Tables, we

must determine the existence of an

impairment covered by the Tables. This is

done through the use of Confirmatory Tests.

These tests can include information from

medical records, surgical or operative

reports, or specific diagnostic test results.

Confirmatory Tests are listed in the initial

section regarding each Body Part covered in

the Tables. If an impairment cannot be

confirmed because of inconsistent medical

information, ICE may be required.

2.02 There are two types of Confirmatory

Tests as follows.

2.03 ‘‘Highly Recommended’’ Tests—The

designation of a confirmatory test as being

‘‘highly recommended’’ means that the test is

almost always performed to confirm the

existence of the impairment. For many

conditions, only one ‘‘highly recommended’’

test finding is suggested to confirm the

impairment. However, there may be times

when that test is not available or is negative,

but other more detailed testing confirms the

impairment.

2.04 Example A: To confirm the

condition of pulmonary hypertension, the

Tables under Body Part C., Cardiac, designate

as ‘‘highly recommended’’: an

electrocardiogram which indicates definite

right ventricular hypertrophy. However, the

impairment may also be confirmed by

insertion of a Swan-Ganz catheter into the

pulmonary artery and the pulmonary artery

pressure measured directly.

2.05 There may be some conditions for

which several ‘‘highly recommended’’ tests

are suggested to confirm an impairment. In

these circumstances, we will use all ‘‘highly

recommended’’ tests to establish the

existence of the impairment.

2.06 Example B: Under Body Part E.,

Lumbar Sacral Spine, three highly

recommended medical findings are identified

for the diagnosis of chronic back pain, not

otherwise specified. These findings include:

A. A history of back pain under medical

treatment for at least one year, and

B. A history of back pain unresponsive to

therapy for at least one year, and

C. A history of back pain with functional

limitations for at least one year.

2.07 All three of these criteria must be

satisfied to confirm the existence of chronic

back pain.

2.08 Sometimes the employee may have

undergone detailed testing which is as

reliable as one of the ‘‘highly recommended’’

tests listed in the Tables. In cases where an

impairment has not been confirmed by one

of the designated ‘‘highly recommended’’

tests, the impairment may still be confirmed

by ‘‘recommended’’ tests (see below) or by

evidence acceptable under section 220.27 of

this part.

2.09 Recommended Tests—The

designation of a confirmatory test as

‘‘recommended’’ means that the test need not

be performed, or be positive, to confirm the

impairment. However, a positive test

provides significant support for confirming

the impairment. If there are no ‘‘highly

recommended’’ tests for confirming the

impairment, at least one of the

‘‘recommended’’ tests should be positive.

2.10 There are two categories of

recommended tests which are described

below.

A. Imaging studies—These studies can

include MRI, CAT scan, myelogram, or plain

film x-rays. For conditions where several of

these imaging studies are identified as

‘‘recommended’’ tests, at least one of the test

results should be positive and meet the

confirmatory test criteria. For some

conditions, such as degenerative disc

condition, there are several equivalent

imaging methods to confirm a diagnosis.

B. Other tests—This category of tests refers

to non-imaging studies.

2.11 If there are no ‘‘highly

recommended’’ confirmatory tests designated

to confirm an impairment and the

‘‘recommended’’ confirmatory tests only

include non-imaging procedures, at least one

of these tests should be positive to confirm

the impairment. The greater the number of

tests that are positive, the greater the

confidence that the correct diagnosis has

been established.

2.12 Example: Under Body Part C.,

Cardiac, the diagnostic confirmatory tests for

ventricular ectopy, a cardiac arrhythmia,

include the following ‘‘recommended’’ tests:

A. Medical record review, i.e., a review of

the claimant’s medical records, or

B. Holter monitoring, or

C. Provocative testing producing a definite

arrhythmia.

2.13 In this situation, only one of the

‘‘recommended’’ confirmatory tests need be

positive to confirm the impairment.

However, the more tests that are positive, the

stronger the support for the diagnosis.

2.14 In no circumstance will the Board

require that an invasive test be performed to

confirm an impairment. Several of the

Confirmatory Tests which are described in

the Tables are invasive and it is not the

intention of the Board to suggest that these

be performed. The inclusion of invasive tests

in the Tables Confirmatory Tests section is

intended to help the Board evaluate the

significance of findings from such tests that

may have already been performed and which

are part of the submitted medical record.

2.15 If an employee’s impairment(s)

cannot be confirmed by use of the

confirmatory tests listed in the Tables, it still

may be confirmed by medical evidence

described in section 220.27 of this part.

However, if a claimant’s impairment(s)

cannot be confirmed through use of the

Tables or under section 220.27, and the

medical evidence is complete and in

concordance, the claimant will be found not

disabled.

3. Disability Determination

3.01 Once the Board determines that the

employee’s regular railroad occupation is

covered by one of the Job Titles in the Tables

and that his or her alleged impairment fits

into a Body Part covered by the Tables and

can be confirmed, we examine the results of

any of the disability tests listed under the

impairment. If the results from any of these

tests indicate a ‘‘D’’ finding, the employee is

found disabled. If none of the test results
7544 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

indicate a ‘‘D’’ finding, then the employee’s

claim is evaluated using ICE.

3.02 Example: A trainman has angina as

confirmed by the recommended tests under

Body Part A: Cardiac—Angina. An

echocardiogram shows that he has poor

ejection fraction ≤35%. The employee is

rated disabled. If none of the results of the

listed disability tests match the results

required for a ‘‘D’’ finding, then the

employee’s claim is evaluated under ICE.

Tables

A. Cancer

B. Endocrine

C. Cardiac

D. Respiratory

E. Lumbar Sacral Spine

F. Cervical Spine

G. Shoulder and Elbow

H. Hand and Arm

I. Hip

J. Knee

K. Ankle and Foot

A. Cancer

Cancer

Cancer conditions can be viewed as

belonging to one of three categories.

Category 1: Significant impact on

functional capacity or anticipated life

span.

Category 2: Intermediate impact on

functional capacity; large individual

variability.

Category 3: No significant impact on

functional capacity or expected life

span.

The factors that are considered in

developing these categories include the

following:

Type of Cancer

The functional impact of different

malignancies varies tremendously and

each malignancy has to be considered

on an individual basis.

Magnitude of Disease

The disability standards are based

upon the magnitude or extent of disease.

The extent of disease affects both

anticipated life span and the functional

capacity or work ability of the

individual. Localized cancer including

cancer ‘‘in situ’’ can frequently be

completely cured and not have an

impact on functional capacity or life

span. In contrast, many cancers that

have distant or significant regional

spread generally have a poor prognosis.

The magnitude or extent of disease is

classified into three categories: local,

regional and distant.

The criteria which are used to classify

a cancer into one of the three categories

are based upon the distillation of several

staging methods into a single system

[Miller, et al. (1992). Cancer Statistics

Review, 1973 - 1989; NIH Publication

No. 92 - 2789].

Effects of Treatment

Although some types of cancer may

be potentially curable with radical

surgery and/or radiation therapy, the

treatment regimen may result in a

significant impairment that could affect

functional capacity and ability to work.

For example, a person with a laryngeal

tumor which had spread regionally

could be cured by a complete

laryngectomy and radiotherapy.

However, this treatment could result in

a loss of speech and significantly impair

the individual’s communicative skills or

ability to use certain types of respiratory

protective equipment.

Prognosis

Some cancers may have minimal

impact on a person’s functional

capacity, but have a very poor prognosis

with respect to life expectancy. For

example, an individual with early stage

brain cancer may be minimally

impaired, but have a poor prognosis and

minimal potential for surviving longer

than two years. Five and two year

survival data are presented in the

Cancer Disability Guideline Table

which follows.

The Cancer Disability Guideline Table

provides information concerning the

probability of survival for five years for

local, regional, and distant disease for

each type of malignancy. In addition,

two-year survival data are also

presented for all disease stages. The

five-year survival data are based upon

data collected from population-based

registries in Connecticut, New Mexico,

Utah, Hawaii, Atlanta, Detroit, Seattle

and the San Francisco and East Bay area

between 1983 and 1987 (Miller, 1992).

The two-year data are from a cohort

study initially diagnosed in 1988.

Assessment

The malignancies are classified as

disabling (Category 1), potentially

disabling (Category 2) and non-disabling

(Category 3). Category 2 conditions must

be evaluated with respect to how the

worker’s tumor affects the worker’s

ability to perform the job and an

assessment of his life span.

Information concerning the potential

impact of the malignancy on a worker’s

ability to perform a job is identified in

the Functional Impact column in the

table. All railroad occupations in the

Tables are considered together.

Functional impacts are classified as

significant if the treatment or sequelae

from treatment including radiotherapy,

chemotherapy and/or surgery is likely to

impair the worker from performing the

job. If the treatment results in a

significant impairment of another organ

system, the individual should be

evaluated for disability associated with

impairment of that body part. For

example, a person undergoing an

amputation for a bone malignancy

would have to be evaluated for an

amputation of that body part. For many

cancers, it is difficult to make

generalizations regarding the level of

impairment that will occur after the

person has initiated or completed

treatment. Nonsignificant impacts

include those that are unlikely to have

any effect on the individual’s work

capacity.

Cancer type 2-year1 5-year1 Disability status2 Functional impact3

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
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7545

Cancer type 2-year1 5-year1 Disability status2 Functional impact3

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

1Source of 2 and 5 year survival data: Miller BA et al. Cancer Statistics Review 1973 - 1989. NIH Publication No. 92 - 2789.

2Disability Status:

Category 1: Significant impact on functional capacity or life span.

Category 2: Intermediate impact.

Category 3: No significant impact on functional capacity or life span.

3Functional Impacts:

(S) Significant -- significant potential for the effects of treatment (radiotheraphy, chemotherapy. surgery) to affect functional capacity.

4Hodgkin’s disease data presented for each stage derived from American Cancer Society. American Cancer Society Textbook reference for

unstaged cancer is derived from Cancer Statistics Review (See 3). In addition to other data, see: American Cancer Society Textbook of Clinical

Oncology. Eds: Holleb AI, Fink DJ, Murphy GP, Atlanta: American Cancer Society, Inc. 1991.) 5Small cell carcinoma is classified as a 1.
7546 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

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.
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7547

Disability test Test result Disability classification

BODY PART: CARDIAC

JOB TITLE: TRAINMAN

Angina:

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

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

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

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

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

Aortic valve disease:

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

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

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

Coronary artery disease:

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

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

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

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

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

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

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

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

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

Cardiomyopathy:

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

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

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

Hypertension:

Medical record review ................................................... Diastolic >120 and systolic >160, 50% of the time and

evidence of end organ damage (blood creatinine >2;

urinary protein >1⁄2 gm; or EKG evidence of ischemia).

D

Arrhythmia: heart block:

Holter ............................................................................ Documented asystole length >1.5 - 2 seconds ............... D

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

Mitral valve disease:

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

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

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

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

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

Pericardial disease:

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

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

Ventricular ectopy:

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

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

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

Arrhythmia: supraventricular tachycardia:

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

Post heart transplant:

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

BODY PART: CARDIAC

JOB TITLE: ENGINEER

Angina:

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

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

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

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

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

Aortic valve disease:

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

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

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

Coronary artery disease:

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

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

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

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

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

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

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

Stress test ..................................................................... Definite ischemia ≤5 METS ............................................. D
7548 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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

Cardiomyopathy:

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

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

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

Hypertension:

Medical record review ................................................... Diastolic >120 and systolic >160, 50% of the time and

evidence of end organ damage (blood creatinine >2;

urinary protein >1⁄2 gm; or EKG evidence of ischemia).

D

Arrhythmia: heart block:

Holter ............................................................................ Documented asystole length >1.5 - 2 seconds ............... D

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

Mitral valve disease:

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

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

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

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

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

Pericardial disease:

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

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

Ventricular ectopy:

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

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

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

Arrhythmia: supraventricular tachycardia:

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

Post heart transplant:

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

BODY PART: CARDIAC

JOB TITLE: DISPATCHER

Angina:

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

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

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

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

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

Aortic valve disease:

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

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

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

Coronary artery disease:

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

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

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

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

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

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

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

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

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

Cardiomyopathy:

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

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

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

Hypertension:

Medical record review ................................................... Diastolic >120 and systolic >160, 50% of the time and

evidence of end organ damage (blood creatinine >2;

urinary protein >1⁄2 gm; or EKG evidence of ischemia).

D

Arrhythmia: heart block:

Holter ............................................................................ Documented asystole length >1.5 - 2 seconds ............... D

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

Mitral valve disease:

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

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

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

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

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

Pericardial disease:

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

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

Ventricular ectopy:

Medical record review ................................................... Documented life threatening arrhythmia .......................... D
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7549

Disability test Test result Disability classification

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

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

Arrhythmia: supraventricular tachycardia:

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

Post heart transplant:

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

BODY PART: CARDIAC

JOB TITLE: CARMAN

Angina:

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

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

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

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

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

Aortic valve disease:

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

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

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

Coronary artery disease:

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

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

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

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

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

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

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

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

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

Cardiomyopathy:

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

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

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

Hypertension:

Medical record review ................................................... Diastolic >120 and systolic >160, 50% of the time and

evidence of end organ damage (blood creatinine >2;

urinary protein >1⁄2 gm; or EKG evidence of ischemia).

D

Arrhythmia: heart block:

Holter ............................................................................ Documented asystole length >1.5 - 2 seconds ............... D

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

Mitral valve disease:

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

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

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

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

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

Pericardial disease:

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

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

Ventricular ectopy:

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

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

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

Arrhythmia: supraventricular tachycardia:

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

Post heart transplant:

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

BODY PART: CARDIAC

JOB TITLE: SIGNALMAN

Angina:

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

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

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

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

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

Aortic valve disease:

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

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

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

Coronary artery disease:

Myocardial infarction ..................................................... Multiple infractions ........................................................... D
7550 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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

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

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

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

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

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

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

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

Cardiomyopathy:

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

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

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

Hypertension:

Medical record review ................................................... Diastolic >120 and systolic >160, 50% of the time and

evidence of end organ damage (blood creatinine >2;

urinary protein >1⁄2 gm; or EKG evidence of ischemia).

D

Arrhythmia: heart block

Holter ............................................................................ Documented asystole length >1.5 - 2 seconds ............... D

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

Mitral valve disease:

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

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

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

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

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

Pericardial disease:

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

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

Ventricular ectopy:

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

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

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

Arrhythmia: supraventricular tachycardia:

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

Post heart transplant:

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

BODY PART: CARDIAC

JOB TITLE: TRACKMAN

Angina:

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

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

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

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

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

Aortic valve disease:

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

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

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

Coronary artery disease:

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

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

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

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

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

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

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

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

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

Cardiomyopathy:

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

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

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

Hypertension:

Medical record review ................................................... Diastolic >120 and systolic >160, 50% of the time and

evidence of end organ damage (blood creatinine >2;

urinary protein >1⁄2 gm; or EKG evidence of ischemia).

D

Arrhythmia: heart block:

Holter ............................................................................ Documented asystole length >1.5 - 2 seconds ............... D

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

Mitral valve disease:

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

Cardiac catheterization ................................................. Mitral regurgitation severe ............................................... D
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7551

Disability test Test result Disability classification

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

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

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

Pericardial disease:

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

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

Ventricular ectopy:

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

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

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

Arrhythmia: supraventricular tachycardia:

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

Post heart transplant:

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

BODY PART: CARDIAC

JOB TITLE: MACHINIST

Angina:

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

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

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

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

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

Aortic valve disease:

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

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

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

Coronary artery disease:

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

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

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

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

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

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

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

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

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

Cardiomyopathy:

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

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

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

Hypertension:

Medical record review ................................................... Diastolic >120 and systolic >160, 50% of the time and

evidence of end organ damage (blood creatinine >2;

urinary protein >1⁄2 gm; or EKG evidence of ischemia).

D

Arrhythmia: heart block:

Holter ............................................................................ Documented asystole length >1.5 - 2 seconds ............... D

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

Mitral valve disease:

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

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

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

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

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

Pericardial disease:

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

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

Ventricular ectopy:

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

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

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

Arrhythmia: supraventricular tachycardia:

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

Post heart transplant:

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

BODY PART: CARDIAC

JOB TITLE: SHOP LABORER

Angina:

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

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

Medical record review ................................................... Unstable as diagnosed by cardiologist ............................ D
7552 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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

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

Aortic valve disease:

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

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

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

Coronary artery disease:

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

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

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

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

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

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

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

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

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

Cardiomyopathy:

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

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

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

Hypertension:

Medical record review ................................................... Diastolic >120 and systolic >160, 50% of the time and

evidence of end organ damage (blood creatinine >2;

urinary protein >1⁄2 gm; or EKG evidence of ischemia).

D

Arrhythmia: heart block:

Holter ............................................................................ Documented asystole length >1.5 - 2 seconds ............... D

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

Mitral valve disease:

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

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

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

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

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

Pericardial disease:

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

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

Ventricular ectopy:

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

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

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

Arrhythmia: supraventricular tachycardia:

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

Post heart transplant:

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

BODY PART: CARDIAC

JOB TITLE: SALES REPRESENTATIVE

Angina:

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

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

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

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

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

Aortic valve disease:

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

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

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

Coronary artery disease:

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

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

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

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

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

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

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

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

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

Cardiomyopathy:

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

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

Stress test ..................................................................... Peak exercise ≤5 METS .................................................. D
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7553

Disability test Test result Disability classification

Hypertension:

Medical record review ................................................... Diastolic >120 and systolic >160, 50% of the time and

evidence of end organ damage (blood creatinine >2;

urinary protein >1⁄2 gm; or EKG evidence of ischemia).

D

Arrhythmia: heart block:

Holter ............................................................................ Documented asystole length >1.5 - 2 seconds ............... D

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

Mitral valve disease:

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

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

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

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

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

Pericardial disease:

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

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

Ventricular ectopy:

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

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

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

Arrhythmia: supraventricular tachycardia:

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

Post heart transplant:

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

BODY PART: CARDIAC

JOB TITLE: GENERAL OFFICE CLERK

Angina:

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

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

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

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

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

Aortic valve disease:

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

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

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

Coronary artery disease:

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

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

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

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

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

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

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

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

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

Cardiomyopathy:

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

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

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

Arrhythmia: heart block:

Holter ............................................................................ Documented asystole length >1.5 - 2 seconds ............... D

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

Mitral valve disease:

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

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

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

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

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

Pericardial disease:

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

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

Ventricular ectopy:

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

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

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

Arrhythmia: supraventricular tachycardia:

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

Post heart transplant:

Medical record review ................................................... Post heart transplant ........................................................ D
7554 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

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
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7555

Disability test Test result Disability classification

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: 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
7556 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7557

Disability test Test result Disability classification

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
7558 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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.
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7559

E. Lumbar Sacral Spine—Continued

Confirmatory test Minimum result Requirements

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.
7560 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

E. Lumbar Sacral Spine—Continued

Confirmatory test Minimum result Requirements

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.
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7561

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
7562 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7563

Disability test Test result Disability classification

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
7564 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7565

Disability test Test result Disability classification

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
7566 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7567

Disability test Test result Disability classification

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
7568 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7569

Disability test Test result Disability classification

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
7570 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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.
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7571

F. Cervical Spine—Continued

Confirmatory test Minimum result Requirements

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
7572 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7573

Disability test Test result Disability classification

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
7574 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7575

Disability test Test result Disability classification

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
7576 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7577

Disability test Test result Disability classification

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
7578 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7579

Disability test Test result Disability classification

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
7580 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7581

Disability test Test result Disability classification

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
7582 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7583

Disability test Test result Disability classification

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
7584 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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.
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7585

J. Knee—Continued

Confirmatory test Minimum result Requirements

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
7586 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7587

Disability test Test result Disability classification

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
7588 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7589

Disability test Test result Disability classification

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
7590 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7591

Disability test Test result Disability classification

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
7592 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

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
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7593

Disability test Test result Disability classification

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
7594 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7595

Disability test Test result Disability classification

BODY PART: ANKLE AND FOOT

JOB TITLE: TRACKMAN

Ankle fracture:

X-ray: ankle ................................................................... Displaced intra-articular fracture ...................................... D

Physical examination -- range of motion ...................... Varus deformity >15 degrees .......................................... D

Physical examinaton -- range of motion ....................... Plantar flexion capability <5 degrees ............................... D

Physical examination -- range of motion ...................... Plantar flexion contracture 20 degrees ............................ D

Ankylosis, ankle:

Physical examination -- range of motion ...................... Ankylosis in 20 degree or > dorsiflexion ......................... D

Physical examination -- range of motion ...................... Ankylosis in 20 degree plantar flexion ............................. D

Physical examination -- range of motion ...................... Ankylosis in int or ext malrotation >15 degrees .............. D

Physical examination -- range of motion ...................... Ankylosis in varus 10 or more degrees ........................... D

Physical examination -- range of motion ...................... Ankylosis in valgus 10 or more degrees ......................... D

Arthritis, subtalar joint (hindfoot):

X-ray: ankle -- subtalar joint ......................................... Subtalar joint space 0 mm ............................................... D

Physical examination -- range of motion ...................... Plantar flexion capability <5 degrees ............................... D

Physical examination -- range of motion ...................... Plantar flexion contracture 20 degrees ............................ D

Physical examination .................................................... Varus deformity >15 degrees .......................................... D

Arthritis, talonavicular joint (hindfoot):

Physical examination -- range of motion ...................... Plantar flexion capability <5 degrees ............................... D

Physical examination -- range of motion ...................... Plantar flexion contracture 20 degrees ............................ D

X-ray: angle -- talonavicular joint .................................. Talonavicular joint space 0 mm ....................................... D

Physical examination .................................................... Varus deformity >15 degrees .......................................... D

Achilles tendon rupture:

Physical examination -- range of motion ...................... Plantar flexion capability <5 degrees ............................... D

Physical examination -- range of motion ...................... Plantar flexion contracture 20 degrees ............................ D

Arthritis, ankle:

X-ray: ankle ................................................................... 0 mm ................................................................................ D

Physical examination -- range of motion ...................... Plantar flexion capability <5 degrees ............................... D

Physical examination .................................................... Varus deformity >15 degrees .......................................... D

Hindfoot fracture:

X-ray: foot ..................................................................... Calcaneal fracture with Boehler angle <95 degrees ....... D

X-ray: foot ..................................................................... Subtalar fracture with Boehler angle <95 degrees .......... D

Physical examination .................................................... Varus angulation >20 degrees (hindfoot) ........................ D

Physical examination .................................................... Valgus angulation >20 degrees (hindfoot) ....................... D

Rheumatoid arthritis, foot:

X-ray: foot ..................................................................... Significant degeneration .................................................. D

Medical record review ................................................... Chronic flare-up with treatment ....................................... D

BODY PART: ANKLE AND FOOT

JOB TITLE: MACHINIST

Ankle fracture:

X-ray: ankle ................................................................... Displaced intra-articular fracture ...................................... D

Physical examination .................................................... Varus deformity >15 degrees .......................................... D

Physical examination -- range of motion ...................... Plantar flexion capability <5 degrees ............................... D

Physical examination -- range of motion ...................... Plantar flexion contracture 20 degrees ............................ D

Ankylosis, ankle:

Physical examination -- range of motion ...................... Ankylosis in 20 degree or > dorsiflexion ......................... D

Physical examination -- range of motion ...................... Ankylosis in 20 degree plantar flexion ............................. D

Physical examination -- range of motion ...................... Ankylosis in int or ext malrotation >15 degrees .............. D

Physical examination -- range of motion ...................... Ankylosis in varus 10 or more degrees ........................... D

Physical examination -- range of motion ...................... Ankylosis in valgus 10 or more degrees ......................... D

Arthritis, subtalar joint (hindfoot):

X-ray: ankle -- subtalar joint ......................................... Subtalar joint space 0 mm ............................................... D

Physical examination -- range of motion ...................... Plantar flexion capability <5 degrees ............................... D

Physical examination -- range of motion ...................... Plantar flexion contracture 20 degrees ............................ D

Physical examination .................................................... Varus deformity >15 degrees .......................................... D

Arthritis, talonavicular joint (hindfoot):

Physical examination -- range of motion ...................... Plantar flexion capability <5 degrees ............................... D

Physical examination -- range of motion ...................... Plantar flexion contracture 20 degrees ............................ D

X-ray: ankle -- talonavicular joint .................................. Talonavicular joint space 0 mm ....................................... D

Physical examination .................................................... Varus deformity >15 degrees .......................................... D

Achilles tendon rupture:

Physical examination -- range of motion ...................... Plantar flexion capability <5 degrees ............................... D

Physical examination -- range of motion ...................... Plantar flexion contracture 20 degrees ............................ D

Arthritis, ankle:

X-ray: ankle ................................................................... 0 mm ................................................................................ D

Physical examination -- range of motion ...................... Plantar flexion capability <5 degrees ............................... D

Physical examination -- range of motion ...................... Plantar flexion contracture 20 degrees ............................ D

Physical examination .................................................... Varus deformity >15 degrees .......................................... D
7596 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Disability test Test result Disability classification

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
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7597

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

BILLING CODE 7905–01–P
7598 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Job Information Forms
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7599
7600 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations
Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations 7601
7602 Federal Register / Vol. 63, No. 30 / Friday, February 13, 1998 /Rules and Regulations

Dated: January 14, 1998.

Beatrice Ezerski,

Secretary to the Board.

[FR Doc. 98–2026 Filed 2–12–98; 8:45 am]

BILLING CODE 7905–01–C