Job Choice, Spinal Pain And Workers’ Compensation

Your job choice may impact you having spinal pain.  Neck and Back pain may have a relationship to your job satisfaction.  A recent study suggests that workers’ spinal pain may have some connection to whether the workers like their job.  Skillgate E, Isacson Hjortzberg M, Strömwall P, Hallqvist J, Onell C, Holm LW, Bohman T. Non-Preferred Work and the Incidence of Spinal Pain and Psychological Distress—A Prospective Cohort Study. International Journal of Environmental Research and Public Health. 2021; 18(19):10051. https://doi.org/10.3390/ijerph181910051

This article will discuss the possible relationship between spinal pain and job satisfaction.

How Did the Study View Job Satisfaction?

A non-preferred work is, here, defined as reporting working in a non-preferred profession and/or non-preferred workplace. Skillgate E, Isacson Hjortzberg M, Strömwall P, Hallqvist J, Onell C, Holm LW, Bohman T. Non-Preferred Work and the Incidence of Spinal Pain and Psychological Distress—A Prospective Cohort Study. International Journal of Environmental Research and Public Health. 2021; 18(19):10051. https://doi.org/10.3390/ijerph181910051

This study essentially looked at those who liked their job and those who didn’t.

Is There Other Research Results Concerning Pain Intensity and Job Satisfaction?

Yes. There have been studies suggesting a positive association with job satisfaction and pain.  It was reported that “people who did not like their workplace experienced higher pain intensity compared to those who did like their job.” The study did not address any causal relationship, however.  Supra.

What was the Current Study’s Conclusions?

“Non-preferred work seems to be associated with a higher incidence of developing spinal pain, psychological distress and spinal pain with concurrent psychological distress, especially if the possibility to change job is low. “ Supra.

In sum, workers stuck with an unhappy job are more likely to have spinal pain versus those who have job satisfaction.

What Does This Mean?

This study, to some degree, supports the nature and extent of an Injured Workers’ pain.  Injured Workers, who have jobs with little satisfaction, may legitimately suffer more spinal pain than those who have job satisfaction.   Therefore, there is perhaps a valid argument to make that these Injured Workers should have their pain assessments discounted.

What If I Need Legal Advice?

If you would like a free consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years. Contact us today for more information.

THE EMPLOYEE’S DISABILITY QUESTIONNAIRE AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Injured Workers, in their Workers’ Compensation Claim, may be evaluated by a Qualified Medical Evaluator (QME) or an Agreed Medical Evaluator (AME.)

With respect to these Evaluations, Injured Workers are required to fill out a variety of forms.     The DWC-AD Form 100 is one of those forms. It is the “Employee’s Disability Questionnaire.”

This article will discuss the “Employee’s Disability Questionnaire,” the questions that are asked, and how an Injured Workers’ case can be impacted  the form.

Why is the DWC-AD 100 A Disability Evaluation Unit (DEU) Form?   

QME reports or AME reports are sent to the Disability Evaluation Unit (DEU) are often sent to the DEU for a rating.  Ratings determine Injured Workers’ Permanent Disability Percentages.

The form’s questions assist the DEU with information that impacts the rating formula.

What Is the Form’s Purpose?

The form is intended to “aid the doctor in determining your permanent impairment or disability.”

Who Gives the Injured Worker the Form?

Generally, the form may be sent to the Injured Worker in advance of the QME or AME evaluation.   Sometimes, the evaluator’s offices will provide it to the worker.

What Happens to the Form?  

The evaluator includes the form as part of their report.  Insurance Companies, Attorneys and Injured Workers will receive it.  For Unrepresented Injured Workers, the report, with the form,  will be sent to the DEU for a rating.

What Questions Are Asked?

General identification information are requested which include providing your name, your social security number, your mailing address, your date of birth, and your date of injury.

You will also be asked your Employer’s Name, and the nature of Employer’s Business.  You will be asked for the insurance company’s claim number(s.)

There are questions about the evaluation. You will also be asked how the Evaluator was selected.  This can be by panel, agreement or sometimes at the request of a Workers’ Compensation Judge.   They will ask evaluation details including the name of the doctor and the date of the examination.

Your will be asked about your job duties at the time of injury.

You will be asked about the disability caused by your injury. Note:  Since this is form is attached to the QME report, it is your one opportunity to write down your unedited and unfiltered complaints. Judges, Insurance Companies, and Attorneys will be able to view your form and compare them to the QME’s reporting.

You will be asked about how the injury affects your work. Note: again, this is your one opportunity to write down to tell everyone involved your unedited and unfiltered opinion.

You will be asked as to whether you had a disability as a result of another injury or illness, If so, they ask you when and to describe it.

Why Are These Answers Important?

Your questionnaire’ answers assist the DEU with generating a Permanent Disability Rating.  The for helps the DEU specifically with two issues: Occupational Group Number and Apportionment.

The Occupational Group Number can change a disability rating.  It can cause it so go up, go down or remain the same.

The DEU will use the form to address apportionment.  The questions provides information for  the Disability Evaluation Unit so that they may make an annotation concerning apportionment.   Apportionment determines how much of the disability relates to the injury.  DEU ratings will often contain notes on apportionment.

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 over 27 years. Contact us today for more information.

WORK-RELATED ROTATOR CUFF SHOULDER INJURIES, SURGERY, AND RETURN TO WORK: SHOULDERS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Shoulders are at risk of industrial injury and are subject to many workers’ compensation claims.  The shoulder is a complex body part. As a result, there are variety of medical treatments that can be applied.  One type of shoulder injury is to the rotator cuff.  Rotator cuff tears account for over 4.5 million annual physician visits due to rotator cuff tears in the United States .Rotator cuff tears are one of the most common forms of upper extremity injury in the workers’ compensation population. Gutman M J, Patel M S, Katakam A, et al. (March 31, 2021) Understanding Outcomes and the Ability to Return to Work After Rotator Cuff Repair in the Workers’ Compensation Population. Cureus 13(3): e14213. doi:10.7759/cureus.14213.  One form a treatment for rotator cuff injuries is surgery.

This article will discuss shoulders, rotator cuff surgeries, and a recent study concerning rotator cuff surgeries.

What Types of Surgeries Can Be Performed on Shoulders?

 There are a variety of shoulder surgeries that are available.   Shoulder surgeries include rotator cuff tear, total shoulder arthropathy and reverse shoulder arthropathy.  Surgery choice is based upon the nature of the injury and what needs to be repaired.

What is the Rotator Cuff?

The rotator cuff is a group of four muscles that come together as tendons to form a covering around the head of the humerus in the shoulder. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm. AAOC

What Are Symptoms of Rotator Cuff Injuries?

The symptoms for rotator cuff tears can include pain at rest and at night, pain when lifting and lowering your arm, pain with specific movements, weakness when lifting or rotating your arm and cracking when moving your shoulder. AAOC

What Is Rotator Cuff Surgery?

A rotator cuff surgery will attempt to repair the torn tendons.   This can include re-attaching them to the bone. AAOC

Does Occupation Matter with Respect to Rotator Cuff Surgeries?

Per the study, “the majority of patients with workers’ compensation claims have excellent outcomes from rotator cuff repair. Those patients that returned to work were more likely to work as non-laborers, had better functional scores and greater satisfaction with their treatment. Patients with three tendon tear repairs demonstrated worse functional outcomes than small full-thickness tendon repairs.” Gutman M J, Patel M S, Katakam A, et al. (March 31, 2021) Understanding Outcomes and the Ability to Return to Work After Rotator Cuff Repair in the Workers’ Compensation Population. Cureus 13(3): e14213. doi:10.7759/cureus.14213.

In sum, occupations such as clerical staff will have better results and happiness from the surgery versus physical laborers.  Generally, laborers are individuals that work in the construction field, do warehouse work, and do heavy work.

What Were the Study Results with Respect to Dominant versus Non-Dominant Hand?

Yes. The study “found that patients who did not RTW [return to work] had a higher frequency of rotator cuff tear in the dominant arm. This was especially evident when looking at patients who held labor-intensive occupations that required use of their upper extremities. In general, laborers were less likely to return to work than non-laborers (p = 0.032), but when they had sustained a dominant arm injury, the ability to RTW [return to work) was decreased even further in 90% of laborers with non-dominant cuff tears able to return to work compared to only 54% of laborers with dominant arm cuff tears.” Gutman M J, Patel M S, Katakam A, et al. (March 31, 2021) Understanding Outcomes and the Ability to Return to Work After Rotator Cuff Repair in the Workers’ Compensation Population. Cureus 13(3): e14213. doi:10.7759/cureus.14213.

Is Rotator Cuff Surgery Generally Successful with Respect to Injured Workers’ Return to Work?

The study found “the majority of patients achieved excellent functional outcomes and the ability to return to work. Gutman M J, Patel M S, Katakam A, et al. (March 31, 2021) Understanding Outcomes and the Ability to Return to Work After Rotator Cuff Repair in the Workers’ Compensation Population. Cureus 13(3): e14213. doi:10.7759/cureus.14213.

Is Pain a Factor?

Yes, per the study, “shoulder function and shoulder pain scores were highly predictive of ability to RTW [return to work.] Patients who returned to work had significantly higher shoulder satisfaction and shoulder function.” Gutman M J, Patel M S, Katakam A, et al. (March 31, 2021) Understanding Outcomes and the Ability to Return to Work After Rotator Cuff Repair in the Workers’ Compensation Population. Cureus 13(3): e14213. doi:10.7759/cureus.14213.

Do the Number of Tears Operated on Matter?

Yes. Per the study, “three tendon tears have been shown to have the highest rate of re-tear rate and worse functional outcomes. In the current study, while size of tear (p = 0.12) was not predictive of ability to RTW [return to work], patients with three torn tendons experienced the lowest rates of returning to work and the worst functional outcomes.” Gutman M J, Patel M S, Katakam A, et al. (March 31, 2021) Understanding Outcomes and the Ability to Return to Work After Rotator Cuff Repair in the Workers’ Compensation Population. Cureus 13(3): e14213. doi:10.7759/cureus.14213.

What Does This Study Mean for Injured Workers?

Insurance Companies may use this study to make assessments on an injured Workers’ ability to return to work.  Specifically, Injured Workers who are laborers who injured had their dominant shoulder operated on will likely have return to work difficulties.

Insurance Companies may be encouraged to authorize additional post-surgical therapy if there are signs of functional improvement.  Functional improvement plays an important factor on   return to work issues.

Insurance Companies will be concerned in rotator cuff shoulder surgeries involving three tears.  Carriers may approach these cases with the view that they may be problematic for both return to work issues and for future medical care needs.

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.

THE LOWER EXTREMITY FUNCTIONAL SCALE (LEFS) AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

In Workers’ Compensation, Doctors and Medical Evaluators, in order to address matters of disability and impairment, frequently use testing. Testing can be in the form of self-reporting questionnaires filled out by Injured Workers.

Many Injured Workers have injuries to their lower extremities.  Lower extremity injuries can include the hips, knees, ankles and feet.

This article will describe the Lower Extremity Functional Scale (LEFS), what the questions are asked, how it is scored, and what it means to an Injured Worker.

What is the Lower Extremity Functional Scale?

“The Lower Extremity Functional Scale (LEFS) is a questionnaire containing 20 questions about a person’s ability to perform everyday tasks.” Honorhealth.com

What is the Purpose of the LEFS?

“The LEFS can be used by clinicians as a measure of patients’ initial function, ongoing progress and outcome, as well as to set functional goals. The LEFS can be used to evaluate the functional impairment of a patient with a disorder of one or both lower extremities. It can be used to monitor the patient over time and to evaluate the effectiveness of an intervention.” Honorhealth.com

How Are You to Answer the Questions?

When provided the LEFS, there is language on the form. It provides as follows: “We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your lower limb problem for which you are currently seeking attention. Please provide an answer for each activity.”  Honorhealth.com

“Today, do you or would you have any difficulty at all with:”

What Are the Activities That Are to Be Assessed?

There are twenty activities that are to be addressed within the LEFS:

Usual work, housework or school activities

Usual hobbies, recreational or sporting activities.

Walking between rooms

Getting into or out of the bath

Walking between rooms

Putting on shoes or socks

Squatting

Lifting an object, like a bag of groceries from the floor

Performing light activities around a home

Performing heavy activities around a home

Getting into or out of a car

Walking 2 blocks

Walking a mile.

Going up or down 10 stairs (about 1 flight of stairs)

Standing for 1 hour

Sitting for 1 hour

Running on even ground

Running on uneven ground

Making sharp turns while running fast

Hopping

Rolling over in bed

How Are the Questions Answered?

The questions are answered with respect to a level of difficulty.  The levels of difficulty are as follows: extreme difficulty or inability to perform activity, quite a bit of difficulty, moderate difficulty, a little bit of difficulty, and no difficulty.

How Is It Scored?

Each level of difficulty is assigned a number from 0 to 4.  The range being from “O” for being extreme difficulty or inability to perform to “4” being able to perform with no difficulty.

Extreme Difficulty or Unable to Perform Activity (0)

Quite a Bit of Difficulty (1)

Moderate Difficulty (2)

A Little Bit of Difficulty (3)

No difficulty (4)

What Is the Total Score?

The total score can range from 0 to 80.  The lower the score implies the greater the disability.

How Can This Scale Be Used in Workers’ Compensation?

In California, the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th Edition, employs the use of “activities of daily living” (ADL) to address impairment.   “Activities of daily living” include the following items

Per the AMA Guides 5th Edition, Table 1-2, See Page 599, the following are the definitions of each ADL. These ADLs include standing, sitting, walking, climbing stairs, lifting, dressing oneself and bathing.

Thus, the LEFS may assist doctors and examiners as to the nature and extent of the injury’s impact on the ADLs.   The ADL assessment can impact the assignment of the permanent impairment number.

Are There Any Concerns with Respect to LEFS?

The LEFS presents problems with respect to workers’ compensation.

First, the scale is to be filled out with respect to the individual’s perception as of the day of the evaluation.  Thus, if someone’s condition gets worse during the day from prolonged weight bearing, their answer in the morning may be different from that in the afternoon. Likewise, there is the issue of the Injured Worker having good days versus bad days. Further, there is the issue of whether the assessment is made with respect to one being medicated or not.  For example, an Injured Worker may be able to perform well on activities while on narcotics but have problems without.

Second, the scale may be used for credibility issues.  Since the scale documents activities on a particular day, contemporaneous sub rosa film may show the Injured Worker performing activities either consistent or inconsistent with their answers.

Third, the scale asks a “would” question concerning the activities.  To some extent, the Injured Worker is being asked to speculate as to their ability to perform certain functions.  In workers’ compensation, speculation cannot be used as a basis for an award and is therefore problematic.

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 over 28 years. Contact us today for more information.

 

VISUAL ANALOG PAIN SCALE (VAPS) AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

In the Workers’ Compensation System, Doctors and Medical Evaluators ask Injured Workers to fill out various scales and questionnaires. One of these scales is the Visual Analog Pain Scale (VAPS.)

Scales and questionnaires can impact an Injured Worker’s ability to get treatment and disability payments. Therefore, Injured Worker should understand how to answer them properly.

This article will discuss the Visual Analog Pain Scale(VAPS), how the VAPS is administered, how VAPS is to be answered, how VAPS is graded, and how VAPS can be used within the workers’ compensation setting.

What is VAPS? What Is it Designed to Measure?

The Visual Analog Pain Scale is “a unidimensional measure of pain intensity, which is utilized in diverse adult populations.”  Measure of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP) Gillian A. Hawker, Samra Mian, Tetyana Kendzerska Melissa French 07 November 2011 https: //doi.org/10.1002/acr.20543

The VAPS is intended to explore the issue of pain.

What Does VAPS Look Like?

The VAP Scale can be set up either horizontally or vertically. Supra.

This is an example of a scale:    0 “no pain”   |————————————————–| 100 “worst imaginable pain.”

How Many Questions Are There in VAPS?

One. It is the simple answering of one’s pain level.  This is done by marking a spot on the spectrum to describe the pain. Supra.  The spot can be measured and assigned a number.  See below.  Some scales allow for the patient to assign a number.

How is the Score Interpreted?

“A higher score indicates greater pain intensity. Based on the distribution of pain VAS scores in post surgical patients (knee replacement, hysterectomy, or laparoscopic myomectomy) who described there postoperative pain intensity as none, mild, moderate, or severe, the following cut points on the pain VAS have been recommended: no pain (0-4mm), mild pain (5-44mm), moderate pain (45-74 mm) , and severe pain (75-100 mm) ” Supra.

Why Are These Terms important?

In workers’ compensation, the evaluators look at pain. Pain is often characterized by the terms of slight, moderate or severe.

The definitions for slight, moderate and severe are different in the field of industrial medicine. California used to use them to assign permanent disability.  In order to do so, they defined the terms.  The 1997 Permanent Disability Rating Schedule defined the terms as follows: “Pain is not always disabling. It becomes disabling when its degree affects function. Regulations define four degrees of subjective pain – minimal, slight, moderate and severe. By definition, minimal (mild) pain is not disabling because it causes no handicap in the activity precipitating the pain. However, slight, moderate and severe pain reflect increasingly greater degrees of handicap on work activity, and are ratable factors of disability.” P.1-7.  While these terms are no longer used for permanent disability purposes, they are frequently documented in medical reports.

Pain’s nature and extent, in certain circumstances, can be a factor in assessing whole person impairment. Whole person impairment is then translated into permanent disability.

How Can Testing Impact Injured Workers’ Claims?

Testing creates credibility issues.  When an Injured Worker provides a 100 score, it means either that they are in severe pain, they are exaggerating, or that they are making a cry for help.  In cases with minor injuries, high scores will impact the credibility of the pain reporting.

Also, an injured Worker may wish to ask how the question should be answered. Pain level when medicated or pain level during a certain period of time, i.e. this moment or this week, are legitimate questions.

What Is the Problem with this VAP Scale?

Pain assessments can be confounded with respect to an individual’s “pain reference.”

Some individuals have never experienced severe pain in their life.  For women who have experienced childbirth and for those who have passed a kidney stone, their pain references, however, can be in the severe range.  Thus, an individual’s past medical conditions is important to review as a reference.

It is quite conceivable that they have experienced pain in the 90s up to 100.   Some individuals also have strong pain tolerances.  A 70 to them would be a 95 to others Thus, these individual’s reporting may only be relevant when compared to other  assigned scores provided on different dates of evaluation or treatment.

How Should an Injured Worker Answer the VAPS?

An Injured Worker should make their best effort to accurately describe their pain.

If there is any confusion concerning how to answer or mark the scale, you should clarify with the evaluator. For instance, you could be a 50 on medications and a 70 without.  Thus, it is important that the doctor or evaluator understand your reason for assigning a particular level of pain.

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 over 28 years. Contact us today for more information.

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