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Medical Causation for Cumulative Trauma Conditions

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by

Denise Iannotti

on 26 April 2016

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Transcript of Medical Causation for Cumulative Trauma Conditions

Six Step Process for Causation & Algorithm
There are six steps every physician must follow to determine casuation and whether a cumulative trauma disorder has an occupational connection.



Step 2 - Clearly define the job duties of the worker.
Walmart is in the best position to provide the most accurate job description to the ATP. The claimant oftentimes exaggerates their job function.


Step 3 - Are there Primary Risk Factors?
Primary Risk factors include but are not limited to the following:

- Use of force combined with repetition constantly for greater than six hours

- Force has to be at least 3-5kg. (6.6-11 pounds)

- 6 hours of lifting 10 pounds or more for greater than 60 times per hour.

- Awkward positioning of hands/wrists
Step 4 - Secondary Risk Factors
Secondary Risk factors include but are not limited to the following:

- Use of force combined with repetition constantly for greater than
four
hours

- Force has to be at least 3-5kg.

- 4 hours of lifting 10 pounds or more for greater than 60 times per hour.

- Awkward positioning of hands/wrists
SPECIFIC JOB POSITIONS AT WALMART

- Most job positions at Walmart do not meet the criteria for any primary and/or secondary risk factors.

- Breaks are factored into the time computation. (task cycles must be constant)

- Cashier? Cake decorator? TLE?

- What about a stocker?
Step 1 - Determine the Diagnosis
Using the history, physical examination and supporting studies, a medical diagnosis must be established.


Step 5 - Secondary Risk Factor only plus diagnosis
- The doctor can compare the secondary risk factor in conjunction with diagnostic-based risk factors tables.

- Usually not a factor for Walmart job descriptions/positions


Cumulative Trauma Conditions - To Deny or not to Deny?
Causation - It is a WEIRD SCIENCE !
Misdiagnosing the claimant
Overall Recommendations
- Most positions at Walmart will not fit within the causation algorithm. Not enough force coupled with repetition.
- A Notice of Contest for further investigation is
always recommended to obtain a specific job
analysis and an IME.
Non-Occupational Risk Factors
- Older age (35-55)

- High BMI (over 30)

- Rheumatoid arthritis
- Diabetes
- Other upper extremity related diagnoses
- Autoimmune disorders
- Make the claimant prove their case!
Full transcript