| U.S. Department of Labor | Office of Workers’ Compensation Programs Division of Energy Employees Occupational Illness Compensation Washington, DC 20210 |  |
Issue Date: November 26, 2018
___________________________________________________________
Effective Date: November 26, 2018
___________________________________________________________
Expiration Date: November 26, 2019
___________________________________________________________
Subject: Pulmonary Function Tests for Impairment Ratings.
Background: Federal (EEOICPA) Procedure Manual (Version 2.3), Exhibit 21-5, Evidence to Support Impairment Rating for Certain Conditions lists various conditions that require specific medical evidence so an impairment evaluation can be completed. The Exhibit currently lists the following requirements as they relate to certain respiratory conditions:
Emphysema, Chronic Obstructive Pulmonary Disease (COPD), Bronchitis, Asbestosis, Chronic Respiratory condition must have the following reported within the past twelve months before impairment rating can take place:
Note from Physician with the following information
• Current symptoms
• Physical exam findings of the area(s) affected
• Current treatment(s) including prescriptions
• Pulmonary Function Test (PFT) with DLCO with pre/post bronchodilator
The 12 month requirement ensures that the Division of Energy Employees Occupational Illness Compensation (DEEOIC) submits the most current information available to the physician conducting the impairment rating. Without a PFT, a physician must rely solely on the detrimental effect that the ratable respiratory disease has on the employee’s ability to perform activities of daily living. The application of PFT results in an impairment rating allows for a more precise and objective impairment assessment, based on Table 5-12 of the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition.
Based on claims experience, DEEOIC has found that a recent PFT (less than 12 months old) may not be available for a physician to consider in calculating an impairment rating due to the medical inability of a patient to perform the test or the unavailability of recent test results due to the death of the employee. Due to the importance of PFT results in calculating a rating using Table 5-12, DEEOIC will submit to the rating physician PFT results older than 12 months, in limited circumstances.
DEEOIC is issuing this Bulletin to notify staff of a procedural change and it will update the PM to reflect this new procedure.
References: Federal (EEOICPA) Procedure Manual Version 2.3.
Purpose: To provide policy guidance regarding a change to the Federal (EEOICPA) Procedure Manual (Version 2.3), Exhibit 21-5, Evidence to Support Impairment Rating for Certain Conditions as it relates to respiratory conditions.
Applicability: All staff.
Actions:
1. Under normal circumstances, for respiratory related impairment ratings where the file does not contain a PFT that occurred within the past 12 months prior to the date of the referral, the employee obtains and submits a current PFT results to the DEEOIC. The submission of recent PFT results ensures the employee obtains an impairment rating based on the objective assessment of his or her present pulmonary dysfunction. The Claims Examiner (CE) includes the PFT report, along with all other necessary and required documentation, in the referral for an impairment rating.
2. In a vast majority of situations, DEEOIC will apply the results of a PFT performed within 12 months of the impairment rating to ensure that the assessment of a respiratory impairment provides for the most current measure of pulmonary deficiency. In two unique circumstances, the CE may refer the most recent PFT even if it is over 12 months of age. The two exceptions include:
· Evidence from a physician that describes an employee’s medical incapacity to undertake a PFT including the severity of a respiratory problem, threat to patient safety, or other well-rationalized justification for forgoing the test.
· The employee is deceased and the most recent PFT is greater than 12 months old.
The rating physician will then use the most recent PFT results when determining the whole person impairment regardless of the age of the test results. The rating physician shall consider the PFT, along with other factors that affect the employee’s ability to perform Activities of Daily Living, to arrive at an opinion of permanent impairment in accordance with the AMA Guides.
Disposition: Retain until incorporated in the Federal (EEOICPA) Procedure Manual.
RACHEL P. LEITON
Director, Division of Energy Employees
Occupational Illness Compensation
Distribution List No. 1: Claims Examiners, Supervisory Claims Examiners, Technical Assistants, Customer Service Representatives, Fiscal Officers, FAB District Managers, Operation Chiefs, Hearing Representatives, and District Office Mail and File Sections.