OCCUPATIONAL PNEUMONITIS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

There are a variety of lung diseases that may have occupational components.   One of these lung diseases is Pneumonitis.  If a Worker succumbs to Pneumonitis, and there is an occupational component as to its cause, they would be able to file and pursue a workers’ compensation claim to obtain medical treatment and monetary benefits for their lung condition.

This article will discuss Pneumonitis, how it can be work-related, and a discussion of various caselaw that addressed issues relating to the disease.

What Pneumonitis? Is It the Same as Pneumonia?

Pneumonitis is a medical condition which involves the inflammation of lung tissue.

The medical disease Pneumonia is essentially a subset of Pneumonitis.  It is an inflammation of the lungs caused by an infection.

What Are the Symptoms of Pneumonitis?

Symptoms of Pneumonitis can include difficulty breathing and a dry, nonproductive, cough. If the condition progresses to Chronic Pneumonitis, symptoms can also include fatigue, loss of appetite and unintentional weight loss. Mayo Clinic.

Are There Degrees of Pneumonitis?

Yes. There are varying degrees of Pneumonitis.  The degrees are Acute, Subacute and Chronic.

Pneumonitis is very serious.  If it goes unnoticed or untreated can cause irreversible lung damage.

What Tests and Treatments are there for Pneumonitis?

Pneumonitis is a complex medical condition. Therefore, a thorough evaluation by a specialist is recommended.  This specialist will conduct the physical examination and order testing.

The testing with respect to Pneumonitis can include blood tests, bronchoalveolar lavage (BAL), chest x-rays, computed tomography (CT), inhalation challenge tests lung biopsies, lung function tests, and precipitin tests.  Mayo Clinic.

How Is Pneumonitis Diagnosed?

Diagnosis of the condition can be complicated. It can take a long time to diagnose. In writing this blog, this matter must be deferred to a specialist without further comment.

The diagnosis of HP in general remains often challenging as there is no gold standard test and the diagnosis is made from a combination of procedures. In addition, the diagnosis of OHP requires ascertaining the work relatedness of the disease with a high level of confidence. A multidisciplinary approach, including clinicians, radiologists, pathologists, and occupational physicians/hygienists, is strongly recommended to improve the diagnosis of OHP, as demonstrated for IPF  Quirce S, Vandenplas O, Campo P, Cruz MJ, de Blay F, Koschel D, Moscato G, Pala G, Raulf M, Sastre J, Siracusa A, Tarlo SM, Walusiak-Skorupa J, Cormier Y. Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy. 2016 Jun;71(6):765-79. doi: 10.1111/all.12866. Epub 2016 Mar 11. PMID: 26913451.

What is Occupational Hypersensitivity Pneumonitis (OHP)?

“Based on the key features of the disease that were outlined by previous authors 411 and the EAACI nomenclature for allergic diseases 12, the following consensus definition is proposed: ‘OHP is an immunologic lung disease with variable clinical presentation and outcome resulting from lymphocytic and frequently granulomatous inflammation of the peripheral airways, alveoli, and surrounding interstitial tissue which develops as the result of a non‐IgE‐mediated allergic reaction to a variety of organic or low molecular weight agents that are present in the work environment’. Quirce S, Vandenplas O, Campo P, Cruz MJ, de Blay F, Koschel D, Moscato G, Pala G, Raulf M, Sastre J, Siracusa A, Tarlo SM, Walusiak-Skorupa J, Cormier Y. Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy. 2016 Jun;71(6):765-79. doi: 10.1111/all.12866. Epub 2016 Mar 11. PMID: 26913451.

What Is the Treatment for the Condition?

Treatment for some medical conditions is not just medical care.

In the case of Pneumonitis, one of the forms of treatment is avoidance of harmful exposure.   This can include the removal of causative substances, the replacement of products that have the causative substances, changes in work that will avoid exposures to the causative substances, and avoidance in general of known sources of the causative substances.

Treatments can include corticosteroids or other immunosuppressants. Treatment can include oxygen therapy, bronchodilators, opioids, and lung transplants.  Mayo Clinic.

In viewing the range and scope of treatments, it is fair to say that Pneumonitis should be viewed as a serious medical condition.

What Are the Causes of Pneumonitis? What Are Occupational Causes of Pneumonitis?

Common causes of pneumonitis include airborne irritants at your job or from your hobbies. In addition, some types of cancer treatments and dozens of drugs can cause pneumonitis.

With respect to work-related exposure, “A large number of occupational agents/antigens have been described as potential causative agents of HP in a wide variety of occupations. These offending agents can be classified into six broad categories that include bacteria, fungi, animal (glyco) proteins, plant (glyco) proteins, low molecular weight chemicals, and metals (Table 2). Using a quantitative structure–activity relationship (QSAR) model, it was found that chemicals causing OHP tend to have a higher predicted asthma hazard, are more lipophilic, and are more likely to be protein cross‐linkers than those causing occupational asthma .” Quirce S, Vandenplas O, Campo P, Cruz MJ, de Blay F, Koschel D, Moscato G, Pala G, Raulf M, Sastre J, Siracusa A, Tarlo SM, Walusiak-Skorupa J, Cormier Y. Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy. 2016 Jun;71(6):765-79. doi: 10.1111/all.12866. Epub 2016 Mar 11. PMID: 26913451.

What Types of Occupations That Are At Risk of Pneumonitis?

The following are occupations that may be at risk for the disease: aircraft industry, animal feeding, bagasse workers [slaughterhouse], bird breeders, ceramic workers, cheese workers, chemical and polyurethane industry, compost workers, cork workers, cosmetic industry, dental technicians,  farmers, florists, food processors, hard metal workers, humidifiers, laboratory workers, maple bark strippers, malt workers, mushroom workers, painters, paprika slicers, pearl industry, peat moss processors, pharmaceutical industry, plastic industry, plastic workers, potato riddlers, seaweed workers, smelters, stucco workers, textile workers, tobacco growers, wine makers, wood workers, and yacht manufacturing. Quirce S, Vandenplas O, Campo P, Cruz MJ, de Blay F, Koschel D, Moscato G, Pala G, Raulf M, Sastre J, Siracusa A, Tarlo SM, Walusiak-Skorupa J, Cormier Y. Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy. 2016 Jun;71(6):765-79. doi: 10.1111/all.12866. Epub 2016 Mar 11. PMID: 26913451.

Is There An Alternative Theory of Industrial Causation for Pneumonitis?

Yes.  Radiation treatment has been considered as a source of this disease.

Treatment for an industrial injury can give rise to a work injury claim.   Thus, if there is a work-related medical condition that involves radiation treatment, they may possibly be able to pursue a claim.   This may be the case with cancers such as lung or breast.

Is There Any Caselaw Concerning Pneumonitis?

Yes.  There have been a variety of cases with respect to the disease.

The pneumonia presumption for safety and law enforcement officers was found to not apply in the case of pneumonitis.  As noted above, pneumonia is a subset of the disease.

Pneumonitis was found work-related for a meat cutter.  The WCAB panel determined that the applicant developed compensable hypersensitivity pneumonitis while working as a meat cutter. See Costco Wholesale Corp vs. WCAB (2010) 75 C.C.C. 1187 (writ denied.)

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

 

WORKPLACE VIOLENCE AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Workplace Violence is a serious concern in California.  Some of the most infamous workplace violence episodes have occurred in California.  This includes the San Ysidro McDonalds shootings, the Piper Tech shootings, and the San Bernardino terrorist shootings.

Not all workplace violence involves fatalities. There are many workplace violence events of a non-fatal variety.   These violence acts are significant in the workers’ compensation area because workers who are either injured in the incident or suffer emotional injury as a result of witnessing the events.  These effected workers are entitled to seek medical treatment and disability benefits through the workers’ compensation system.

There was a recent study of interest which provides insight to workers with respect to these incidents.

This article will discuss non-fatal workplace violence, how it interacts with the workers’ compensation system and the rights that an Injured Worker has relating to those incidents.

What Were the Non-Fatal Workplace Violence Studied?

In a recent study, non-fatal violence in the workplace was investigated.   In the study, the types of crime included rape/sexual assault (including attempted rape, sexual attack with serious/minor assault, sexual assault without injury, unwanted sexual contact without force, and verbal threat of rape/sexual assault); robbery (including attempted robbery); aggravated assault (attack or attempted attack with a weapon, regardless of whether or not an injury occurred, and attack without a weapon when serious injury resulted, and including aggravated assault with injury, attempted aggravated assault with weapon, and threatened assault with weapon); simple assault (attack without a weapon resulting in no or minor injury, and including simple assault with injury and assault without weapon without injury); and verbal threat of assault.” Siegel, M. Johnson, CY, Lawson CC, Ridenour M Hartley D. Nonfatal Violent Workplace Crime Characteristics and Rates by Occupation- United States, 2007-2015. MMWR Morb Mortal Wkly Rep 2020;69: 324-328.

What Are the Frequency Rates of the Different Forms of Violence?

The most frequently reported type of crime was threat of assault (44%), followed by simple assault (37%), aggravated assault (13%), rape/sexual assault (3%), and robbery (3%). Siegel, M. Johnson, CY, Lawson CC, Ridenour M Hartley D. Nonfatal Violent Workplace Crime Characteristics and Rates by Occupation- United States, 2007-2015. MMWR Morb Mortal Wkly Rep 2020;69: 324-328.

Note: workplace violence does not necessary translate into matters of physical harm to workers. Threats of assault can cause psychological injury or give rise to physiological stress responses such as a heart attack. Likewise, witnessing these various events might give rise to such problems as well.

Are the Violence Rates Different Between Occupations?

Yes. In the study, “[d]uring 2007–2010, occupations with the highest rates of violent workplace crimes were Protective services (e.g., first responders) (101 crimes per 1,000 workers); Community and social services (19); Healthcare practitioners and technicians (17), Healthcare support occupations (17); Education, training, and library occupations (eight); and Transportation and material moving occupations (seven.)” Siegel, M. Johnson, CY, Lawson CC, Ridenour M Hartley D. Nonfatal Violent Workplace Crime Characteristics and Rates by Occupation- United States, 2007-2015. MMWR Morb Mortal Wkly Rep 2020; 69:324-328.

Note: It is interesting to note which areas of the workforce in which the acts occur.  It appears that the key factor is the significant contact that workers have with the public.

Are All Workplace Violence Episodes a Valid Work Injury?

No.  There are several issues that can come up.  First, there is the initial aggressor rule.  Second, if the alleged criminal has a relationship to the victim, there may be some issue of controversy as to whether it was a workplace event versus an event that happened at the workplace.  Legal analysis would be recommended in those circumstances.

Is there a Difference Physical Injuries versus Psychological Injuries?

Yes. Psychological Injuries have thresholds that must be met in order to prevail.

The Labor Code Section 3208.3 provides lower burdens for violent acts.  It is noted in the section that “in the case of employees whose injuries resulted from being a victim of a violent act or from direct exposure to a significant violent act, the employee shall be required to demonstrate by a preponderance of the evidence that actual events of employment were a substantial cause of the injury.”  Further, ““substantial cause” means at least 35 to 40 percent of the causation from all sources combined.”

Further, there are other sections that may assist on a psychiatric claim.  They, however, require a factual analysis. Therefore, they may be relevant but will not be discussed within this article.

Additionally, for certain safety and law enforcement officers, there is a post-traumatic stress disorder presumption.  Click here for an article discussing it.

Are There Any Other Sources of Benefits?

Yes. The State of California has a Victims of Crime Program which can also provide benefits in some circumstances.  Click here for an article discussing it.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

 

EXERTIONAL HEAT SYNDROME: HEATED WORK ENVIRONMENTS, WORK INJURIES AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Heat Exertion can produce serious injuries in the workplace. The medical condition is commonly known as Exertional Heat Illness (ESI.) Heat Illnesses are multi-causal. Human’s body temperatures can be elevated by a number of factors. First, there is the heat and humidity in the environment. Second, there is the clothing and equipment being used by the worker. Third, there is the nature, extent and the duration of the activities.

This article is focused towards the Heat Exertion as opposed to the Heat Exposure. Note: Heat Exertional Illness is a huge concern for military. Thus, this matter has been studied within that context. Heat Exertion is a concern for all military personnel. Even Military Working Dogs have been studied. Predicting military working dog core temperature during exertional heat strain: Validation of a Canine Thermal Model Catherine O’Brien William J.Tharion Anthony J.Karis Heather M.Sullivan https://doi.org/10.1016/j.jtherbio.2020.102603Get rights and content

In the civilian setting, there are also various occupations that involve serious issues that can bring rise to heat exertional illness.

This article will discuss Heat Exertion Illness, risk factors involved with HEI, the nature and extent of injuries arising from heat exertion, and how it can be addressed within a workers’ compensation setting.

What Is Exertional Heat Illness (EHI)?

Exertional Heat illnesses (EHI) is essentially a variety of medical conditions that may occur during physical exertion that is performed in hot and humid environments. This can be the case when there is performance of strenuous physical activities for extended durations in hot environments.

In the civilian workforce, HEI may impact occupations such as Agriculture, Construction Workers, Police Officers, and Refinery Workers.

For instance, with respect to Wildland Fire Fighters, a study noted the nature and extent of the clothing and equipment that they carry. The study noted that “WLFFs wear standard fire equipment: Nomex long-sleeve shirt and pants, mid-calf leather logger boots, a 100% cotton short-sleeve undershirt, leather gloves, hard hat, and a 12 to 20 kg pack containing food, water, safety gear, and work tools.” High Work Output Combined With High Ambient Temperatures Caused Heat Exhaustion in a Wildland Firefighter Despite High Fluid Intake John S.Cuddy MS Brent C. Ruby PhD https://doi.org/10.1016/j.wem.2011.01.008

Why is EHI a Serious Concern?

Due to the fact that EHI can cause a variety of medical conditions, there is also a wide range of medical problems that EHI can cause.

Mild forms of EHI can include heat cramps. Severe forms of EHI can include heat stroke. Severe EHI can lead to multiorgan damage and death. Alele FO, Malau-Aduli BS, Malau-Aduli AEO, J Crowe M. Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies. Int J Environ Res Public Health. 2020 Sep 25;17(19):E7037. doi: 10.3390/ijerph17197037. PMID: 32993024.

Does Body Temperature Play a Role?

Yes. Body Core Temperature plays a role in the severity of the injury. Temperatures less than 40 degrees Celsius (104 degrees Farenheit) percent are associated with milder symptoms and temperatures greater than 40 degrees Celsius brought on more serious symptoms which provided central nervous system symptoms such as dizziness, confusion, and loss of consciousness. Alele FO, Malau-Aduli BS, Malau-Aduli AEO, J Crowe M. Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies. Int J Environ Res Public Health. 2020 Sep 25;17(19):E7037. doi: 10.3390/ijerph17197037. PMID: 32993024.

What are the Main Risk Factors in EHI?

There are a variety of risk factors that can impact EHI. The main risk factors in the study were gender, physical fitness, obesity, previous history of heat illness, motivation, hot environmental conditions, and service unit. Alele FO, Malau-Aduli BS, Malau-Aduli AEO, J Crowe M. Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies. Int J Environ Res Public Health. 2020 Sep 25;17(19):E7037. doi: 10.3390/ijerph17197037. PMID: 32993024.

“[T]these risk factors into three groups—host (individual physiologically limiting), environmental and organizational (training organization) factors. Supra.

Are There Risk Factors of Interest?

Yes.

Females were more likely to experience EHI than males.

High Body Mass Index (BMI) individuals are more likely to experience EHI.

Lower Physical Fitness individuals are more likely to experience EHI.

Over Motivated Individuals are more likely to experience EHI. One reason being is that they may not pace themselves.

A prior history of heat illness makes individuals more susceptible to heat stroke or severe heat illness.

Hot conditions such as summer seasons and in hot weather conditions make individuals at greater risk of EHI.

Some Units, task dependent and equipment dependent groups, can have increased risk of EHI versus other units. . Alele FO, Malau-Aduli BS, Malau-Aduli AEO, J Crowe M. Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies. Int J Environ Res Public Health. 2020 Sep 25;17(19):E7037. doi: 10.3390/ijerph17197037. PMID: 32993024.

If a Worker is Suffering from a Heat-Related Illness, What Should They Do?

If the Injured Worker was exposed to excessive heat in the workforce, they can consider filing a workers’ compensation claim. This would allow them to claim medical care, monetary benefits in the form of temporary and permanent disability benefits. Also, vocational rehabilitation benefits may be indicated. If a fatality situation, a death claim for the dependents may be indicated.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

BODY ARMOR, WORK INJURIES AND LAW ENFORCEMENT: POLICE OFFICERS, SHERIFFS AND INJURIES DUE TO EQUIPMENT: WHAT YOU NEED TO KNOW

Law Enforcement Officers are required to carry various items as part of their job duties. Equipment, such as Duty Belts, have been recognized as being damaging to the lumbar spine. Due to that fact, the State of California has enacted a Back Injury Presumption for with respect to Law Enforcement Officers who wear duty belts.

Besides Duty Belts, there is other Law Enforcement equipment that has become implicated as to causing physical injury. One of these items is Body Armor. Body Armor has become popular for Law Enforcement to wear to protect them. Body Armor, however, can be physically restrictive. This restrictiveness can be a source of musculoskeletal injury. It should be noted that this Body Armor can be life saving for officers. Police Officers: Surviving a real life-threatening incident while wearing body armor Xiong, Houawa 2014 May URI: https://scholarworks.csustan.edu/handle/011235813/703 (in thesis data, all 24 officers studied survived life-threatening incidents and were able to to return to full duty after the incidents.)

This article will discuss Law Enforcement Officers’ use of Body Armor, the problems with respect to such equipment, and whether it has been found to cause physical problems.

What Is Body Armor?

There are different types of body armor. There is body amor that is designed for military use. Also, there is a different body armor that is designed with respect to Law Enforcement. This different body armor is called Light Armor. The armors of the light variety care called Individual Light Armor Vests or ILAVs.

Are There Any Studies Concerning Light Armor Vests?

Yes. A recent study compared ILVAs versus Normal Station Wear.

What are the Problems with Light Body Armor?

“Wearing body armour has also been found to compromise trunk posture (Phillips et al., 2016) and reduce range of motion in multiple planes (Lenton et al., 2016). Axial trunk rotation has been shown to be reduced by up to 12° when wearing military-styled body armour (Lenton et al., 2016). A generalized increase in trunk and hip forward flexion during tasks has also been associated with wearing body armour (Lenton et al., 2016; Phillips et al., 2015). The effects of both a forward trunk posture and any compromise in trunk or shoulder mobility may further affect an officer’s ability to compensate for any balance compromise and put them at greater risk of falls and subsequent injury (Dempsey et al., 2013).” The effects of body armour on mobility and postural control of police officers Ben Schram Robin Orr Ben Hinton Geoff Norris Rodney Pope https://doi.org/10.1016/j.jbmt.2020.03.001

What Were The Findings of the Study?

The study found “[s]ignificant differences were found between ILAV or N conditions in various components of the FMS, including right Straight Leg Raise, left shoulder mobility, and both right and left quad rotary stability. No significant differences were found in any of the balance measures between these conditions.” Supra.

The conclusions made were that the “ILAVs can significantly affect police officer mobility and therefore may contribute to injury risk and decreased ability to complete occupational tasks, though this should be weighed against protective benefits. ILAVs should therefore be carefully selected to minimise injury risk without detracting from occupational performance.” Supra. [emphasis added]

Are There Any Issues of Controversy with Respect to Body Armor?

Yes. One matter that can become an issue with respect Body Armor is the fact that there are multiple types of body armor which have different styles. There was a study that compared different ILAV and found that there were differences in the comfort and performance. The perceived effects and comfort of various body armour systems on police officers while performing occupational tasks B. Schram1* , B. Hinton2 , R. Orr , R. Pope and G. Norris Schram et al. Annals of Occupational and Environmental Medicine (2018) 30:15 https://doi.org/10.1186/s40557-018-0228-x.

In sum, there are different brands that may have different impacts on the officers wearing them.

What Does Caselaw Say with Respect to Body Armor?

A search review was done with respect to this article. As the writing of this article, there have been no reported cases concerning injury related to the use of body armor. This caselaw search does not reveal as to whether such claims have been made and have been accepted as legitimate injury claims. Rather, the search indicates that there has been no controversy to the point that there has been any noteworthy or reported litigation involving body armor.

What Is the Future?

Many Law Enforcement Departments have received grants and funds to provide body armor to their departments. As a result, there will be more increased use of body armor. This increased use may likely cause musculoskeletal problems which may give rise to a physical injury. This type of physical injury would be the basis for filing a workers’ compensation claim.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

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