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20 CFR Part 220, Appendix 3 to Part 220 - Railroad Retirement Board Occupational Disability Standards | US Law | LII / Legal Information Institute
CFR › Title 20 › Chapter II › Subchapter B › Part 220 › Appendix 3 20 CFR Part 220, Appendix 3 to Part 220 - Railroad Retirement Board Occupational Disability Standards
View PDF at GPOPt. 220, App. 3
Appendix 3 to Part 220—Railroad Retirement Board Occupational Disability Standards
1.01 The Board uses this appendix to adjudicate the occupational disability claims of employees with medical conditions and job titles covered by the Tables in this appendix. The Tables are divided into “Body Parts”, with each Body Part further divided by job title. Under each job title there is a list of impairments and tests with accompanying test results which establish a finding of “D” (disabled). The use of these Tables is a three-step process. In the first step we determine whether the employee's regular railroad occupation is covered by the Tables; next we establish the existence of an impairment covered by the Tables; finally, we reach a disability determination. If we do not find an employee disabled under these Tables, the employee may still be found disabled using Independent Case Evaluation (ICE), as explained in subpart C of this part.
1.02 The Cancer Tables are treated in a different way than other body systems. Different types of cancer and their treatments have different functional impacts. In the Cancer Tables the impact of the impairment is seen as being significant or not significant. Therefore, these tables contain an “S” (significant) which is equivalent to a “D” rating. A detailed explanation of how to use those tables is in that section. The steps to use the remaining Tables are explained below:
2. Confirming the Impairment
2.01 Once we determine that the employee's regular railroad occupation is covered by the Job Titles in the Tables, we must determine the existence of an impairment covered by the Tables. This is done through the use of Confirmatory Tests. These tests can include information from medical records, surgical or operative reports, or specific diagnostic test results. Confirmatory Tests are listed in the initial section regarding each Body Part covered in the Tables. If an impairment cannot be confirmed because of inconsistent medical information, ICE may be required.
2.02 There are two types of Confirmatory Tests as follows.
2.03 “Highly Recommended” Tests—The designation of a confirmatory test as being “highly recommended” means that the test is almost always performed to confirm the existence of the impairment. For many conditions, only one “highly recommended” test finding is suggested to confirm the impairment. However, there may be times when that test is not available or is negative, but other more detailed testing confirms the impairment.
2.04 Example A: To confirm the condition of pulmonary hypertension, the Tables under Body Part C., Cardiac, designate as “highly recommended”: an electrocardiogram which indicates definite right ventricular hypertrophy. However, the impairment may also be confirmed by insertion of a Swan-Ganz catheter into the pulmonary artery and the pulmonary artery pressure measured directly.
2.05 There may be some conditions for which several “highly recommended” tests are suggested to confirm an impairment. In these circumstances, we will use all “highly recommended” tests to establish the existence of the impairment.
2.06 Example B: Under Body Part E., Lumbar Sacral Spine, three highly recommended medical findings are identified for the diagnosis of chronic back pain, not otherwise specified. These findings include:
A. A history of back pain under medical treatment for at least one year, and
B. A history of back pain unresponsive to therapy for at least one year, and
C. A history of back pain with functional limitations for at least one year.
2.07 All three of these criteria must be satisfied to confirm the existence of chronic back pain.
2.08 Sometimes the employee may have undergone detailed testing which is as reliable as one of the “highly recommended” tests listed in the Tables. In cases where an impairment has not been confirmed by one of the designated “highly recommended” tests, the impairment may still be confirmed by “recommended” tests (see below) or by evidence acceptable under section 220.27 of this part.
2.09 Recommended Tests—The designation of a confirmatory test as “recommended” means that the test need not be performed, or be positive, to confirm the impairment. However, a positive test provides significant support for confirming the impairment. If there are no “highly recommended” tests for confirming the impairment, at least one of the “recommended” tests should be positive.
2.10 There are two categories of recommended tests which are described below.
A. Imaging studies—These studies can include MRI, CAT scan, myelogram, or plain film x-rays. For conditions where several of these imaging studies are identified as “recommended” tests, at least one of the test results should be positive and meet the confirmatory test criteria. For some conditions, such as degenerative disc condition, there are several equivalent imaging methods to confirm a diagnosis.
B. Other tests—This category of tests refers to non-imaging studies.
2.11 If there are no “highly recommended” confirmatory tests designated to confirm an impairment and the “recommended” confirmatory tests only include non-imaging procedures, at least one of these tests should be positive to confirm the impairment. The greater the number of tests that are positive, the greater the confidence that the correct diagnosis has been established.
2.12 Example: Under Body Part C., Cardiac, the diagnostic confirmatory tests for ventricular ectopy, a cardiac arrhythmia, include the following “recommended” tests:
A. Medical record review, i.e., a review of the claimant's medical records, or
B. Holter monitoring, or
C. Provocative testing producing a definite arrhythmia.
2.13 In this situation, only one of the “recommended” confirmatory tests need be positive to confirm the impairment. However, the more tests that are positive, the stronger the support for the diagnosis.
2.14 In no circumstance will the Board require that an invasive test be performed to confirm an impairment. Several of the Confirmatory Tests which are described in the Tables are invasive and it is not the intention of the Board to suggest that these be performed. The inclusion of invasive tests in the Tables Confirmatory Tests section is intended to help the Board evaluate the significance of findings from such tests that may have already been performed and which are part of the submitted medical record.
2.15 If an employee's impairment(s) cannot be confirmed by use of the confirmatory tests listed in the Tables, it still may be confirmed by medical evidence described in section 220.27 of this part. However, if a claimant's impairment(s) cannot be confirmed through use of the Tables or under section 220.27, and the medical evidence is complete and in concordance, the claimant will be found not disabled.
3. Disability Determination
3.01 Once the Board determines that the employee's regular railroad occupation is covered by one of the Job Titles in the Tables and that his or her alleged impairment fits into a Body Part covered by the Tables and can be confirmed, we examine the results of any of the disability tests listed under the impairment. If the results from any of these tests indicate a “D” finding, the employee is found disabled. If none of the test results indicate a “D” finding, then the employee's claim is evaluated using ICE.
3.02 Example: A trainman has angina as confirmed by the recommended tests under Body Part A: Cardiac—Angina. An echocardiogram shows that he has poor ejection fraction ≤35%. The employee is rated disabled. If none of the results of the listed disability tests match the results required for a “D” finding, then the employee's claim is evaluated under ICE.
E. Lumbar Sacral Spine
F. Cervical Spine
G. Shoulder and Elbow
H. Hand and Arm
K. Ankle and Foot
Cancer conditions can be viewed as belonging to one of three categories.
Category 1: Significant impact on functional capacity or anticipated life span.
Category 2: Intermediate impact on functional capacity; large individual variability.
Category 3: No significant impact on functional capacity or expected life span.
The factors that are considered in developing these categories include the following:
The functional impact of different malignancies varies tremendously and each malignancy has to be considered on an individual basis.
The disability standards are based upon the magnitude or extent of disease. The extent of disease affects both anticipated life span and the functional capacity or work ability of the individual. Localized cancer including cancer “in situ” can frequently be completely cured and not have an impact on functional capacity or life span. In contrast, many cancers that have distant or significant regional spread generally have a poor prognosis. The magnitude or extent of disease is classified into three categories: local, regional and distant.
The criteria which are used to classify a cancer into one of the three categories are based upon the distillation of several staging methods into a single system [Miller, et al. (1992). Cancer Statistics Review, 1973-1989; NIH Publication No. 92-2789].
Although some types of cancer may be potentially curable with radical surgery and/or radiation therapy, the treatment regimen may result in a significant impairment that could affect functional capacity and ability to work. For example, a person with a laryngeal tumor which had spread regionally could be cured by a complete laryngectomy and radiotherapy. However, this treatment could result in a loss of speech and significantly impair the individual's communicative skills or ability to use certain types of respiratory protective equipment.
Some cancers may have minimal impact on a person's functional capacity, but have a very poor prognosis with respect to life expectancy. For example, an individual with early stage brain cancer may be minimally impaired, but have a poor prognosis and minimal potential for surviving longer than two years. Five and two year survival data are presented in the Cancer Disability Guideline Table which follows.
The Cancer Disability Guideline Table provides information concerning the probability of survival for five years for local, regional, and distant disease for each type of malignancy. In addition, two-year survival data are also presented for all disease stages. The five-year survival data are based upon data collected from population-based registries in Connecticut, New Mexico, Utah, Hawaii, Atlanta, Detroit, Seattle and the San Francisco and East Bay area between 1983 and 1987 (Miller, 1992). The two-year data are from a cohort study initially diagnosed in 1988.
The malignancies are classified as disabling (Category 1), potentially disabling (Category 2) and non-disabling (Category 3). Category 2 conditions must be evaluated with respect to how the worker's tumor affects the worker's ability to perform the job and an assessment of his life span.
Information concerning the potential impact of the malignancy on a worker's ability to perform a job is identified in the Functional Impact column in the table. All railroad occupations in the Tables are considered together. Functional impacts are classified as significant if the treatment or sequelae from treatment including radiotherapy, chemotherapy and/or surgery is likely to impair the worker from performing the job. If the treatment results in a significant impairment of another organ system, the individual should be evaluated for disability associated with impairment of that body part. For example, a person undergoing an amputation for a bone malignancy would have to be evaluated for an amputation of that body part. For many cancers, it is difficult to make generalizations regarding the level of impairment that will occur after the person has initiated or completed treatment. Nonsignificant impacts include those that are unlikely to have any effect on the individual's work capacity.
5-year1
Disability status2
Functional impact3
1Source of 2 and 5 year survival data: Miller BA et al. Cancer Statistics Review 1973-1989. NIH Publication No. 92-2789.
2Disability Status:
Category 1: Significant impact on functional capacity or life span.
Category 2: Intermediate impact.
Category 3: No significant impact on functional capacity or life span.
3Functional Impacts:
(S) Significant—significant potential for the effects of treatment (radiotheraphy, chemotherapy. surgery) to affect functional capacity.
4Hodgkin's disease data presented for each stage derived from American Cancer Society. American Cancer Society Textbook reference for unstaged cancer is derived from Cancer Statistics Review (See 3). In addition to other data, see: American Cancer Society Textbook of Clinical Oncology. Eds: Holleb AI, Fink DJ, Murphy GP, Atlanta: American Cancer Society, Inc. 1991.)
5Small cell carcinoma is classified as a 1.
Female Breast:
Hodgkin's Disease:4
Kidney/Renal Pelvis:
Liver/Intrahepatic Bile Duct:
Lung/Bronchus:5
Melanomas of Skin:
Oral Cavity/Pharyngeal:
BODY PART: ENDOCRINE
Diabetes, requiring insulin (IDDM):
Confirmation of condition and need for insulin use
BODY PART: CARDIAC
Confirmed history of ischemia including copies of electrocardiogram
Definite ischemia on exercise test
Thallium study
Definite ischemia with exercise
Aortic valve disease:
Proven and significant
Documented ischemia with electrocardiogram confirmation
Documented myocardial infarction
Definite occlusion (≤60%) of one vessel
Proven ejection fraction ≤35%
Poor global function and not coronary artery disease
Documentation of hypertension for one year
Definite diagnosis by cardiologist or internist
Confirmation of medication use
Arrhythmia: heart block:
Proven episode with electrocardiogram confirmation
Documentation of arrhythmia
Confirmed by cardiologist or internist
Increased pulmonic sound or pulmonary ejection murmur by cardiologist or internist
Definite right ventricular hypertension
Ventricular ectopy:
Definite episode within one year
Definite arrhythmia
Arrhythmia: supraventricular tachycardia:
Post heart transplant:
JOB TITLE: TRAINMAN
Poor ejection fraction ≤35%
Peak exercise ≤7 METS
Unstable as diagnosed by cardiologist
Documented hypotensive response
Stress test: significant ST changes
Definite ischemia ≤7 METS
Aortic gradient 25-50 mm HG
Confirmed ventricular aneurysm
Unstable as diagnosed by a Cardiologist
Definite ischemia ≤ 7 METS
Isotope, e.g., thallium study
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)
Documented asystole length ≤1.5-2 seconds
Documented syncope with proven arrhythmia
Mitral valve gradient ≥5 mm Hg
Mitral regurgitation severe
Documented life threatening arrhythmia
Uncontrolled ventricular rhythm
Documented related syncope
Peak exercise ≤5 METS
Definite ischemia ≤5 METS
Mitral valve gradient ≥10 mm Hg
JOB TITLE: CARMAN
Definite ischemia ≤ 5 METS
JOB TITLE: SIGNALMAN
Arrhythmia: heart block
JOB TITLE: TRACKMAN
JOB TITLE: SHOP LABORER
JOB TITLE: GENERAL OFFICE CLERK
BODY PART: RESPIRATORY
FEV1/FVC ratio diminished
≤15% change with administration of bronchodilator
Positive: FEV1 decrease ≤20% at (PC <=8 mg/ml)
Chronic cough and sputum
Bronchiectasis demonstrated
Frequent cough—2 years duration
FEV1/FVC ratio below 65% when stable
FEV1 below 75% of predicted when stable
Definite right ventricular hypertrophy
More than minimal fibrosis
Lung resection:
At least one lobe resected
Required hospitalization with chest tube drainage
Restrictive lung changes
FVC <75% predicted
Occupational exposure for at least 1 year
Evidence of changes consistent with tuberculosis infection
Repeated spirometry FEV1 <40% over a 12 month period
Resting ABG
PCO2 arterial ≤50 mm Hg if stable
Pulmonary exercise test or exercise ABG
PO2 drop ≤5 torr at maximum exercise
Pulmonary exercise test
Maximum VO2 <15 ml/kg
Definite positive right ventricular hypertrophy
<45% predicted
FVC <50% predicted
efinite positive right ventricular hypertrophy
Resting AGB
PO2 ≤5 torr at maximum exercise
BODY PART: LS SPINE
X-ray-lumbar sacral spine
HLA B27 (blood test)
Positive HLA B27 (90% case)
Backache, unspecified:
History of back pain under medical treatment for at least 1 year
History of back pain unresponsive to therapy for at least 1 year
History of back pain with functional limitations for at least 1 year
Chronic back pain, not otherwise specified:
Cauda equina syndrome with bowel or bladder dysfunction:
Neural impingement of spinal nerves below L1
Diminished rectal sphincter tone
Degeneration of lumbar disc:
X-ray lumbar sacral spine
Significant degenerative disc changes
Displacement of lumbar disc:
Fracture: vertebral body:
Fracture vertebral body
Fracture: posterior element with spinal canal displacement:
Fracture posterior spinal element with displacement of spinal canal
Fracture: posterior spinal element with no displacement:
Fracture posterior spinal element
Fracture: spinous process:
Fracture: Transverse process:
Lumbar sacral spine
Significant disc degeneration
Medical record review: lumbar
Lumbosacral neuritis:
Evidence of neural compression
Definite denervation
Definite slowing
Physical examination—atrophy
Atrophy in affected limb with 2 cm difference between limbs
Physical examination: straight leg raise
Loss of sensation in affected dermatomes
History of radicular pain
Significant narrowing: spinal cord canal or intervertebral foramen
Mechanical complication of internal orthopedic device:
Documentation of failure of implant following surgical procedure
Evidence of significant osteomalacia
Osteomyelitis, chronic-lumbar:
Significant bone density loss
Post laminectomy syndrome with radiculopathy:
Documented surgical history of laminectomy
Evidence of laminectomy
Strains and sprains, unspecified:
Documented history of strain and/or sprain
Spondylolisthesis grade 1:
1-25% slippage
Spondylolisthesis grade 2:
26-50% slippage
Spondylolisthesis grade 3:
51-75% slippage
Spondylolisthesis grade 4:
Complete slippage
Spondylolisthesis-acquired:
Spondylolsis:
Defect—pars interarticularis
Sprains and strains, sacral:
History of back with functional limitations for at least 1 year
Sprains and strains, sacroiliac:
Lifting capacity diminished by 50%
Disc extrusion with neural impingement, nerves < L1
Disc extrusion with neural impingement, nerves <L1
Physical examination: rectal
Impairment of sphincter tone
Disc extrusion with neural impingement
Fracture: posterior spinal element with displacement:
Fracture transverse process:
Significant narrowing of the spinal canal
Significant lower extremity weakness
X-ray flexion/extension
Frequent flare-ups with objective findings
Post laminectomy syndrome:
Spondylolisthesis—acquired:
Vertebral body compression fracture:
Myeolgram
Lifting capacity diminshed by 50%
Lifing capacity diminished by 50%
Vetebral body compression fracture:
Spondylolisthesis grade I:
Displacement of lumber disc:
BODY PART: CE SPINE
Cervical disc disease with myelopathy:
Physical examination: cervical
Evidence of myelopathy
Evidence of neurogenic compression
Chronic herniated disc:
X-ray: cervical spine
Evidence of significant disc degeneration
Cervical spondylolysis:
Cervical intervertebral disc degeneration:
Fractured posterior element with canal displacement
Fracture: transverse, spinous or posterior process:
Fracture of relevant part
Osteoarthritis, cervical:
Evidence of extensive disc degeneration
Medical records: cervical
Confirmed surgical history
Continued pain post-surgery
Physical examination: arm
Loss of reflexes in affected dermatomes
Evidence of atrophy ≤2 cm
Definite denervation in muscle of affected nerve root
Compression of spinal nerves
Rheumatoid arthritis, cervical:
Rheumatoid factor (blood test)
Titer of rheumatoid factor
Rheumatoid changes of spine
Medical records review: cervical
Confirmation by rheumatologist or internist
Spondylogenic compression of spinal cord:
Significant spinal cord pressure
Physical examination: lower limb
Lower extremity weakness or significant spasticity
Multi-level neurologic compromise
BODY PART; CE SPINE
Cervical spondyloysis:
BODY PART: SHOULDER AND ELBOW
Arthritis, acromioclavicular:
X-ray: shoulder
Significant degenerative changes of joint
Arthritis, glenohumeral:
Medical diagnosis leading to a permanent functional limitation of the elbow:
Condition with permanent functional limitation
Imaging confirmation of functional diagnosis
Physical examination—range of motion
<40 degrees flexion
<40 degrees abduction
Permanent functional limitation, elbow:
≤40 degrees deviation
Flexion limit to 60 degrees
Physical examination—range of moiton
BODY PART: HAND AND ARM
Pain, paresthesia and weakness in distribution median nerve
Definite median nerve conduction slowing at wrist
Denervation in severe cases
Fracture: wrist:
X-ray: wrist
Evidence of fracture
Hand: permanent functional limitation:
Documentation of medical condition for permanent limitation
Definite reproducible evidence of limitation
Imaging study (e.g. X-ray, CAT, MRI)
Positive confirmation of underlying condition
Rheumatoid arthritis: hand:
History of objective findings including serological studies
X-ray: hand
Characteristic rheumatoid changes
History of chronic tenosynovitis and objective findings
Definite evidence of tenosynovitis
Thumb: Permanent functional limitation:
Imaging study (X-ray, CAT, MRI)
Wrist: Permanent functional limitation:
Fracture, wrist:
Extension—limit to 30 degrees
Flexion—limit to 30 degrees
Ankylosis: ≤20 degrees from neutral
Rheumatoid arthritis hand:
Significant flare-ups, under treatment with rheumatologist
Extensive medication use, under treatment with rheumatologist
Loss ≤4 cm
Ankylosis: degree from neutral
<20 degrees extension
Loss of extension or flexion
MCP or PIP: maximum flexion <40 degrees
Extension-limit to 30 degrees
Flexion-limit to 30 degrees
Adduction of thumb:
MCP of PIP: maximum flexion <40 degrees
<20 degree extension
<40 degree flexion
Ankylosis, hip:
Extreme joint destruction
Osteoarthritis, hip:
<4 mm joint space, or other positive evidence
Osteomyelitis, hip:
Osteolytic or blastic lesions
Increased up to 50 times
Evidence of artificial hip
Documentation of prior hip replacement
Ankylosis 5 degrees or ≤flexion
Ankylosis internal rotation ≤5 degrees
Ankylosis external rotation ≤10 degrees
Ankylosis in abduction ≤5 degrees
Ankylosis in adduction ≤5 degrees
0 mm cartilage interval
30 degrees flexion contracture
<50 degrees flexion
<5 degrees abduction
Osteomyelitis, chronic hip:
Significant joint destruction
Documented occurrence of recurring infections with treatment
Evidence of artificial hip joint
Signficant joint destruction
<5 degrees abudction
Ankylosis 5 degrees of ≤flexion
X-ray; hip
Arthritis: knee:
Evidence of significant degenerative changes
Collateral ligament tear with laxity:
Physical examination: knee
Evidence of ligamentous laxity
Evidence of ligamentous tear
Cruciate and collateral ligament tear with laxity:
Tear of both ligaments
Documentation of tear by arthroscopy
Cruciate ligament tear with laxity:
Evidence of cruciate tear
Intercondylar fracture:
Osteomyelitis: knee:
Documented history of osteomyelitis requiring treatment
Necrosis of femoral condyle or tibial plateau
Patellofemoral arthritis:
Patellar fracture nonunion with displacement:
Nonunion and displacement
Plateau fracture:
Meniscectomy—medial or lateral:
Patellectomy:
Patellar—subluxation—recurrent:
History of recurrent subluxation
Supracondylar fracture:
Presence of replacement knee
Documented surgical history
Tibial shaft fracture:
X-ray: leg
Fracture of shaft
Arthritis knee:
Range of motion: flexion <60 degrees
Flexion contracture (20 or ≤ degrees)
Valgus deformity, 16-20 degrees
Varus deformity, 8-12 degrees
0-1 mm cartilage interval with degenerative change
Meniscectomy, medial or lateral:
Flexion contracture (20 or ≤degrees)
Cruciate and collateral ligament tear:
Post fracture angulation
≤20 degrees angulation
Osteomyelitis, chronic knee:
Frequent episodes of infection requiring treatment
X-ray knee: patello femoral joint
0 mm cartilage interval with degenerative change
Nonunion and ≤3 mm displacement
Patellar, subluxation, recurrent:
≤20 degrees malalignment
≤20 degree angulation
X-ray knee: patellofemoral joint
BODY PART: ANKLE AND FOOT
Documented history of ankle fracture
X-ray: ankle
Ankylosis, ankle:
Extensive joint destruction
Arthritis, subtalar joint:
Evidence of significant arthritis: subtalar joint
Arthritis, talonavicular joint:
Significant arthritis: talonavicular joint
Documentation of achilles tendon rupture
Arthritis, ankle:
Significant arthritis
Hindfoot fracture:
X-ray: foot and ankle
Documentation of fracture
Rheumatoid arthritis, foot:
Documented history of condition
Displaced intra-articular fracture
Varus deformity ≤15 degrees
Plantar flexion capability <5 degrees
Plantar flexion contracture 20 degrees
Ankylosis in 20 degree or ≤ dorsiflexion
Ankylosis in 20 degree plantar flexion
Ankylosis in int or ext malrotation ≤15 degrees
Ankylosis in varus 10 or more degrees
Ankylosis in valgus 10 or more degrees
Arthritis, subtalar joint (hindfoot):
X-ray: ankle—subtalar joint
Subtalar joint space 0 mm
Arthritis, talonavicular joint (hindfoot):
X-ray: ankle—talonavicular joint
Talonavicular joint space 0 mm
Plantar flexion capability, <5 degrees
Plantar flexion contracture, 20 degrees
Calcaneal fracture with Boehler angle <95 degrees
Subtalar fracture with Boehler angle <95 degrees
Varus angulation ≤20 degrees (hindfoot)
Valgus angulation ≤20 degrees (hindfoot)
Significant degeneration
Chronic flare-up with treatment
X-ray ankle—talonavicular joint
Ankylosis in 20 degree or ≤ dorisiflexion
Ankylois in int or ext malrotation ≤15 degrees
Chronic flare—up with treatment
Physical examinaton—range of motion
Plantar flexion capability ≤5 degrees
X-ray: angle—talonavicular joint
Job Information Forms
[63 FR 7543, Feb. 13, 1998]
Title 20 published on 2015-04-01.No entries appear in the Federal Register after this date, for 20 CFR Part 220.