NKUMBA UNIVERSITY

SCHOOL OF SCIENCES

COURSE UNIT: OCCUPATIONAL AND ENVIRONMENTAL HEALTH

Lecturer: Amos Ronald Kalukusu (PhD Fellow)
Email: [email protected] or [email protected]
Tel: 0781457183

CHAPTER FIVE:

RECOGNITION OF
OCCUPATIONAL DISEASES
AND DISORDERS

5.1. Learning Objectives

At the end of this chapter, the student will be

able to:

1. Identify the magnitude of the problems due to

occupational injuries, disorders and diseases.

2. List epidemiological descriptions of

Occupational related health problems.

3. List possible determinants of work related injuries.

4. Discuss the difference types of

occupational disorder and diseases.

5. Explain prevention and control methods of

Occupational disorders .

6. Describe the principles of disability

evaluation methods.
5.2. Introduction

It is difficult to estimate the number of workers involved in meeting

the energy requirements of communities. As noted, in poor
communities much of this work is carried out by family members,
particularly women, who are not formally employed. In addition,
much of this work is carried out by small industries that are not

always recorded in national employment statistics.

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Occupational mortality rates in energy jobs in industrialized
countries are generally 10-30 times lower than in developing
countries (Kjellstrom, 1994; ILO, 1998), indicating that more
effective prevention programs could eliminate more than 90 percent
of the deaths referred to above. Still, energy-related jobs have
inherent health risks that need to be considered when
assessing the full impact of energy production and distribution.

Although too often ignored in discussions of environmental health

risks, the burden of occupational disease and injury is substantial on a
global scale. It is conservatively estimated that with well over 1
million deaths a year, nearly 3 percent of the global burden of ill
health is directly attributable to occupational conditions (Leigh and
others, 1996). This is substantial, accounting for more than motor
vehicles, malaria, or HIV and about equal to tuberculosis or stroke.
Although the fraction due directly to supplying energy is unclear,
energy systems employ many millions of people worldwide in jobs
substantially riskier
than average-particularly in jobs producing solid fuels.

In the early days of the development of employment injury

protection, attention was concentrated on accidents at work. It was
only later that protection was widened to include diseases
contracted during work processes. It proved difficult to define the
diseases which ought properly to be within the protection of the
employment injury law, while excluding common conditions which

are prevalent among the general population.

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Usually the national legislation contains a list of diseases which are,

beyond dispute, of an occupational origin, at least when they are
contracted by a person who has worked in a process, or in contact
with a substance, which can cause the listed disease. In 1925 the
International Labour Conference was able to agree on only three
diseases which could be so prescribed -
lead poisoning, mercury poisoning and anthrax. But research establishes new criteria of proof, and the ac
total of 29.

In Ethiopia there is no systematized recording and reporting on work related injuries organized the nation
gathered from these few industries are incomplete and neither

represents all industries nor show the actual magnitude of work

related injuries of the country. The few studies carried out by
individuals in Textile industries in

1991, 1988, and in tobacco factories, revealed an accident rate

of

200/1000 person/ year, and 183/1000/year respectively. The only

reliable study which can represent all the manufacturing industries in
the one carried out in January 1988 in 105 manufacturing industries
by the occupational health and safety sector, In this study, 11
corporations each representing a group of factories were studied for a
year, using standardized work related injury reporting system

adopted from ILO. In one year, a total of 13,796 accidents were

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reported making an over all work related accident rate of 178/1000

person/ year with a range varying from 10-390/1000 person/year,
depending on the nature of industries. The highest work related
accident rate was detected to be among the sugar plantation workers,
followed by workers in Beverage, Textile and metal work
industries. Out of these 0.08% were
fatal, 46.2% moderate (injuries that required sick leave of a day
or more) and 53.7% mild (injuries that did not require sick leave).

5.3.Epidemiology

Part of body affected, type, causes and day of the week of work related injuries
Among the parts of body affected Brazilian steel workers, the commonest were hands; arms and eye.
The commonest part of body affected among eleven industrial workers in Addis

Ababa was fingers (37.3%) and hands

(11.6%).

• In textile factory study in Addis Ababa, the

most common part of body affected by work-
related injuries were fingers (42%), lower leg
(18.95), and hands (13.3%).

• Reports from Department of Environmental

Health of Ministry of Health of Ethiopia listed
eye, hand and finger as the most affect parts

of the
body.
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Different studies have shown different causes of work-

related injuries.

• According to the study done in eleven urban industries in

Addis Ababa, hit by or against object and fall were the
commonest causes of work-related injuries.

• Findings from textile factory study in Addis

Ababa, demonstrated that the most frequent causes of work- related injury were machinery 42(29
Department of Environmental Health of Ministry of Health of Ethiopia reported that striking (25
%) and flying objects from machines (8.5%) were the major causes of work-related injury.

Regarding the distribution of work-related injuries by the days of the week, most studie
The highest injury rates occurred on Monday’s and

the lowest on Thursday’s and Friday’s.

• Absenteeism is higher on Monday’s than other days of

the week in most industrialized countries, which results
in workers to stand in for absent workers and undertake
unfamiliar jobs on that day.

• The most common time of injury is from 8 am to 10 am.

2. Factors related to work related injuries

• Many authorities believe that work-related injuries

result from a complex interplay of multiple risk
factors.
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• Exposure to physical, mechanical and chemical

hazards and the performance of unsafe practices by
workers are the leading causes of work-related
injuries.

• Similarly, psychosocial factors, work organization,

socio demographic characteristics of
workers and environmental and social conditions are other potentially risk factors
Reports form France, U.S and China revealed that men have the highest rates of work-related injurie
Study done in eleven urban factories in Addis Ababa revealed that the highest rate of work- related in
Age groups less than 30 years were more affected by work-related injuries according to textile factory
Ministry of Labour and Social Affairs of Ethiopia

has reported that the majority (18 %) of work related

injuries were observed in the age group of 25-

29(27).These studies emphasized that work- related

injuries in young subjects were more common due to
lack of experience, lack of job knowledge and know-
how than in other subjects. Furthermore, many
workers begin working at an early age and often

without safety
training.

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• Different investigations reported that low education

status, low monthly salary, low working experience (5
years or less) in present job, lack health and safety
training, sleep disorders, job category and alcoholic
drink consumption were common risk factor for work-

related injuries.
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Socio demographic factors

Work environment
• Sex of workers
•
• Age of workers Type of industry
Level of education •
Health and safety training
Hours worked per week
Supervision of workplace
• Salary of workers •
• Job category
• •
Length of employment

Behavioural Factors

• Alcoholic drink
consumption

• Chat chewing

• Sleep disorder

• Job satisfaction

• Use of personal
protective equipment

Work Related
Injury

Figure 5-1. Determinants of work-related injuries-A Conceptual

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Framework for study of Work-related injury

prevalence. Source: Adapted from Ref.1

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5.4. Occupational disorder by system

Respiratory
Disorders

Work-related respiratory disease is frequently a contributory cause-

and commonly a primary cause-of pulmonary disability. The clinical
evaluation of pulmonary disease includes a
minimum of four elements: 1/a complete history including occupational and environmental exposures, a
function tests.
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Table 5-1 Major types of occupational pulmonary disease

Pathophysiologi Occupational Clinical history Physical Chest x-ray Pulmonary function

c process disease examination pattern

Fibrosis Silicosis Dyspnea on Clubbing, Nodules Restrictive or mixed
exertion, cyanosis obstructive and
shortness of restrictive
breath DLCO normal or
Asbestosis Dyspnea on Clubbing Linear decreased
exertion, cyanosis, densities,
shortness of rales pleural
breath plaques,
calcifications
Reversible Byssinosis, Cough, wheeze, Respiratory Usually Normal or obstructive
airway isocyanate chest tightness, rate , normal with bronchodilator
obstruction asthma shortness of wheeze improvement Normal
(asthma) breath, asthma or high DLCO
attacks
Emphysema Cadmium Cough, Respiratory Hyperaeration Obstructive low DLCO
poisoning sputuma, rate bullae
(chronic) dyspnea expiratory
phase
Granulomas Beryllium Cough, weight Respiratory Small nodules Usually restrictive with
disease loss, shortness rate low DLCO
of breath
Pulmonary Smoke Frothy, bloody Coarse, Hazy, diffuse Usually restrictive with
edema inhalation sputum bubbly rales air-space decreased DLCO,
production disease hypoxemia at rest

DLCO= diffusing capacity; = increased.

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Musculoskeletal
disorders

Work-related musculoskeletal disorders commonly involve the back,

cervical spine, and upper extremities. Understanding of these
problems has developed rapidly during the past decade. Prevention
of a low back pain is a complex challenge. Low back pain
prevention in work settings is best accomplished by a
combination of measures, such as: a/ Job design (ergonomics); b/ Job placement (selection); Training an
care providers).

and
Prevention Control

Jobdesign
(ergonomics)

Mechanical aids

optimum work level

Good workplace layout

Sit/stand workstations

Appropriate packaging

Job placement
(selection)

careful history

Through physical examination

No routine x-ray

Strength testing
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Job-rating programs

Training and
education

Training
workers

Biomechanics of body movement (safe lifting)

Strength and fitness

Back schools

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Training managers

Response to low back pain

Early return to work

Ergonomic principles of job design

Training labour union

representatives

Early return to work

Flexible work rules

Reasonable referrals

Training health care providers

Appropriate medication

Prudent use of x-rays

Limited bed rest

Early return to work (with restrictions, if necessary)

Skin
disorders

Any cutaneous abnormalities or inflammation caused directly or

indirectly by the work environment is an occupational skin disorder.
Work-related cutaneous reaction and clinical syndromes are as varied
as the environments in which people work. Skin disorders are the
most frequently reported occupational diseases. A basic
understanding of occupational skin disorders is therefore essential for
everyone involved in occupational health. Occupational skin
diseases are often
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preventable by a combination of environmental, personal, and
medical measures.

Eye
disorders

Every working day, there are over 2,000 preventable job-related eye
injuries to workers in the United States. Occupational vision

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programs, including pre-placement examinations and requirements

for appropriate eye protectors in certain occupations, can prevent
many of these injuries.

Symptoms and signs of serious eye

injury

Symptoms of serious eye injury indicating immediate referral

are the following:

1.Blurred vision that does not clear with blinking.

2.Loss of all or part of the visual field of an eye

3.Sharp stabbing or deep throbbing pain

4.Double vision

Signs of eye injury that require ophthalmologic evaluation are the following:
1.Black eye

2. Red eye

3. An object on the cornea

4. One eye that does not move as completely as the other

5. One eye protruding forward more than the other

6. One eye with an abnormal pupil size, shape, or

reaction to light, as compared to the other eye

7. A layer of blood between the cornea and the iris

(hyphema)
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8. Laceration of the eyelid, especially if it involves the
lid margin.

9. Laceration or perforation of the eye

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Disorders of the Nervous

System

The nervous system comprised of the brain, spinal cord, and

peripheral nerves, is a complex system responsible for both voluntary
and involuntary control of most body functions. These are
accomplished through a process of receiving and interpreting stimuli
as well as transmitting information to the effectors organs. The
adverse impacts of stressors from the work environment (physical,
chemical, and psychological) are experienced in a variety of ways.
Of the many means by which these effects can be categorized,
somewhat like arbitrary distinctions between neurology and
behavioural effects on the one hand, and psychiatric effects on the
other, to organize this information for the reader-ed

Preventio
n

Because work-related psychological disorders have been identified as

a leading occupational health problem, NIOSH has proposed a
national strategy to protect and promote the psychological health of
workers. The strategy focuses mainly on reducing job stress and
providing employee mental health services (see Annex 1).

Efforts to prevent stress-related disorders focus on ameliorating

major areas of job stress; providing job security and career
opportunity, a supportive social environment, and meaningful,
creative, rewarding work; and making every effort to ensure worker
participation in decision making and control of the work
environment.

Reproductive
disorders
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The prevention of reproductive disorders is an important public

health priority. These problems include abnormalities that affect the
reproductive function of both men and women as well as a wide
range of unwanted pregnancy outcomes. In the United States,
approximately one in seven married couples is involuntarily infertile.
On the same area among newborns,
approximately 7 percent are of low birth weight (<2,500gm), and
3 percent have major congenital malformations.

There are two ways by which occupational specialists can prevent or reduce work-related health risks. T
exposures.

Cardiovascular (CHD)
disorders

Risk factors associated with CHD can be divided into three

categories: personal, hereditary and environmental. Personal risk
factors include sex, age, race, high serum cholesterol, high blood
pressure, and cigarette smoking. There are strong interactions
between these factors that act synergic ally, such that a smoker with
high blood pressure and high serum cholesterol is eight times more at
risk developing CHD than a non smoker who has normal serum
cholesterol and blood pressure.

While the association between personal risk factors and CHD is well
documented, our knowledge of the role of occupational risk factors is
still limited. Several chemical and physical agents have been

suspected of causing CHD in workers chronically exposed to them.

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However scientific evidence indicates a direct causal relationship for

every few of them. For most of these agents, the evidence is based on
isolated case reports or on a few unconfirmed studies.

Table 5-2. Personal risk factors associated with

CHD Risk factor Feature

Sex Mortality for women lags behind that of

men by about 10 years

Risk increases with age

Age

Before age 60, white men have lower death

Race
rates than non white men; the
inverse is true after 60

High
Risk estimated at 1.7-
serum cholesterol 3.5

High blood pressure

Risk estimated at 1.5-
2.1
Cigarette smoking

Risk estimated at 1.5-

2.9

Hepatic
Disorders

High-Risk
Occupations

Occupations with exposure to hepatotoxins are found in huhumany

different industries including munitions, rubber, cosmetics, perfume,
food processing, refrigeration, paint, insecticide and herbicide,
pharmaceutical, plastics, and synthetic chemicals. Usually these
workers are exposed by
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inhalation of fumes. Most hepatotoxins have pungent odors that

warn of their presence, preventing accidental oral ingestion of large
amounts; however, ingestion of imperceptible amounts of
hepatotoxins over long periods of time may cause injury. Skin over
long periods of time may cause injury. skin absorption has

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been a significant cause of disease only with trinitrotoluene (TNT)

exposure in munitions workers and with

methylenedianiline exposure in epoxy resin workers.

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Table 5-3 some causes of occupational liver disease

Disease produced Type of agent Example Types of workers exposed

ACUTE HEPATITIS

hydrocarbons Chloroform cleaners, refrigeration workers

Nitroaromatics Dinitrophenol (DNP) Chemical indicator workers
Ether Dioxin Herbicide and insecticide workers

aromatics (PCBs)

Chlordecone (kepone) disinfectant workers

Chlorobenzenes Solvent workers, dye workers

Halothane Anesthesiologists

c h o e s ta t ic h e p a ti tis R u b er w o rk e rs ,
H e a lth car e w o rk e rs
Acute v i ra l h e p a tit is , ty p e B HMepthaytilteisneBdian
E p o xy e p o xy w o r k e rs,
V ir u s ( s e e Cha p . 1 8 )
resin iline

Subacute hepatic necrosis Nitroaromatic TNT Munitions workers

Imbibing bartenders, wine producers,

whiskey producers
Fibrosis/cirrhosis Day care workers, health care

Virus Hepatitis B and C workers (see Chap.18)

Inorganic element Arsenic Vinyl chloride workers
Haloalkene Vinyl chloride Vinyl chloride workers
Biliary tree carcinoma Unknown agents -

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Renal and Urinary Tract

Disorders

The kidney is a target organ for a number of toxic chemical

compounds. Renal excretion is the major route of elimination for
many toxic compounds. The relatively high renal blood flow, about
one-fourth of total cardiac output, exposes the renal structures to a
relatively high toxic burden. Concentration of
toxins in the glomerular ultra-filtrate through active re-absorption contributes further to the intensity of to
filtration, tubular re- absorption, and filtrate concentration.

5.5.Disability evaluation and ability to work

Over the years, industrialized societies have taken two basic

approaches to dealing with the problems of poverty and social
isolation that frequently befall people with disabilities who have been
unable to achieve gainful employment. One approach, disability
compensation, provides income support for those who are unable to
work because of a disability.

An increasingly popular approach seeks to promote the independence

of people with disabilities to obtain rehabilitation

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services intended to facilitate or maintain employment and remove

barriers to employment by regulating employment practices and
workplace conditions that have tended to exclude people with
disabilities.

Clinicians’ effectiveness in dealing with work ability and

disability evaluations will be enhanced by a clear understanding of (1) key definitions related to the eval
and potential role conflicts for the clinician.

In reviewing the variety of compensation plans and the associated roles for the health care provider, it is
between impairment and disability.

Impairment is commonly defined as the loss of function of an

organ or part of the body compared to what previously existed.
Ideally, impairment can be defined and described in purely medical
terms and quantified in such a way that a reproducible measurement
is developed (for example, severe restrictive lung disease with a total
lung capacity of 1.6 litres).

Disability, on the other hand, is usually defined in terms of the

impact of impairment on societal or work functions. A disability

evaluation would therefore take into account the loss of function

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(impairment) and the patient’s work requirements and home

situation. Certain agencies use a more restrictive definition of
disability; for example, the Social Security Administration defines
disability as “inability to perform any substantial gainful work.”
Often, private disability insurance defines disability as an
“inability to perform the essential
tasks of the usual employment.” However, the determination of disability is always predicated on an asse
presence and extent of disability.

Disability compensation systems frequently request a determination of the extent and permanence of a d
of a medical condition is considered to be totally disabled. If this

person can work but has some limitations and cannot do his or her
customary work, a partial disability exists. Either type of disability is
considered to be temporary as long as a resolution of the disability is
expected. When no significant functional improvement is expected,
or a condition has not changed over a one-year period, it is inferred
that a medical end- result (sometimes called maximal medical
improvement) has been achieved. A temporary (partial or total)
disability would then be

regarded by most systems as a permanent disability.

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Workers’ compensation insurance systems usually require

determination of the work-relatedness of a disability. A work- related
injury or disease refers to conditions; however, it may be difficult to
be certain of the relationship of the injury to the workplace is usually
clear. In chronic conditions, however, it may be difficult to be certain
of the relationship between work
and disease. It is recommended that the physician’s determination of work-relatedness should be based o
epidemiologic evidence linking exposure and disease.

Health professionals must be aware, however, that the legal definition of cause may be less exacting than
worse because of work may legally be work- related. A typical

legal standard of proof is that a condition is work- related if it is

“more likely than not” that the condition would not have been
present or would have been substantially better had the work
exposure not occurred.

Disability compensation
systems

Some of the confusion regarding disability assessment stems from

the multitude of disability compensation systems and plan, since
each may have its own definition of disability and criteria for

assessing impairment. Different countries have designed verifying

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approaches to providing income security to those who find their

wage-earning capacity compromised by injury or disease.

Occupational physicians are most familiar with workers’

compensation insurance, which provides coverage of most federal,
state, and private employees. These plans compensate
for medical expenses and lost wages due to work-related
conditions.

The federal government sponsors the major compensation programs for the severely disabled, throug
any gainful employment, regardless of the cause of disability.

Private disability insurance is often purchased by individuals or provided as an employer or union bene
provide compensation for those who are unable to work at their

regular jobs regardless of the cause of disability, or to supplement

Social Security benefits.

Thus, a patient who can no longer work because of injury or illness

might receive support from his or her employer’s insurer, a federal or
state agency, and /or an insurance policy that has been purchased

privately
.
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Although each plan has different eligibility criteria and

levels of payment, all share a few common features:

1. Every plan incorporates shared risk. Many people or

employers at risk of financial losses contribute to a pool,
from which a few individuals are reimbursed. The
cost of entering the pool is partially determined by the actuarial risk of future events for that person o
2. Because payments into the pool are predictable, finite resources are available to all potential recipie
Workers’ compensation plans often do not replace

lost wages for fewer than 6 days of absence from work, since
doing so might greatly increase the cost of the program.
Many private disability insurance plans do not begin
coverage until 30 days to 6 months of illness absence has
occurred.

3. Before medical evaluation of impairment, a potential

recipient of benefits must first demonstrate legal eligibility.
The basis for eligibility is different in each plan. One must
have worked and contributed to Social Security for 5 of the

past 10 years. Workers’ compensation covers only regular

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employees, not consultants or subcontractors. Private

disability insurance often does not cover illness that occurs
during the first 60 to 90 days of enrolment.

4. Medical information on impairment is requested once a legal

basis for a claim has been established. In every system, a
medical diagnosis is necessary; in
the worker’s compensation system, physicians are
often asked their opinions on the work-relatedness of employees’ conditions, the prognosis for even
5. The information from the physician, however, does not determine whether benefits are awarded o
systems, if there is a significant discrepancy

between the employer’s report of an injury and the

physician’s report, benefits may be withheld pending an
investigation by the insurance company.

6. Benefits are limited and are intended to provide only a

proportion of lost wages, medical expenses related to the
specific impairment, and vocational rehabilitation. Only in
rare circumstances are worker’s compensation benefits
intended to punish gross negligence by an employer in
causing the injury; in all other instances, fault has no bearing

on benefit levels.

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7. Applicants generally have a right of appeal of an

administrative or medical decision, with review by a third
party. In the Social Security system, applicants who are
initially denied benefits can appeal to a second
administrator-physician team, then to an administrative law
judge, and finally to the federal courts,
if desired. In most worker’s compensation plans, the claimant can request an administrative hearing
8. Recently, there has been an increased emphasis on developing resources

forretrainingand
alliedwitheachsystem.
rehabilitation,closely
Beneficiaries are often requiredtoparticipatein
programstomaximizetheir potential for return to alternative, gainful employment.

The purpose of each plan is to reimburse workers for medical

expenses, rehabilitation expenses, and lost wages that result from a
work-related injury or illness. Plans are generally designed to be
non-adversarial so that, in most cases, limited benefits are paid to
injured workers without the necessity of a formal hearing. In most
cases of acute traumatic injuries (for example, fractures or
lacerations occurring at work), the relationship to work is
unquestionable and the system works reasonably well at
compensating the injured worker. In many cases, however, the
relationship to work is less clear, and the demand on the clinician

more complicated, as the following case illustrates.

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A 50-year-old truck driver followed by his physician for 6 years because of chronic low back pain came

back problems were due to his work as a truck driver, whether he should change his vocation because

workers’ compensation claim for work-related

injuries.

The case illustrates some of the difficulties in evaluating and treating

the patient with work in capacity. The patient went to the physician
because his back discomfort was interfering with his ability to do his
job. Like most patients with chronic low back pain, his symptoms
and examination findings were non- specific. The standard
recommendations of rest and avoidance of exacerbating activities
met with transient success, but his symptoms reappeared with his
return to work. It is logical at this point to explore with the patient
any opportunity for job accommodations at work, and, if no
alternatives

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are available, for him to seek employment that would not exacerbate
the symptoms. The patient, for a variety of reasons, however, may
be reluctant to consider changing to another line of work, despite the
discomfort associated with the current job.

With regard to causality, the high prevalence of non-specific

low back pain in the general population and the multi-factional etiology of this common condition make

A patient with severe chronic lung disease was being evaluated for
disability under Social Security. His exposure history was significant
for occupational exposure to asbestos and non- occupational
exposure to cigarette smoke. His physical examination, chest x-ray,
and pulmonary function tests were consistent with diagnoses of (1)
severe obstructive lung disease and possible restrictive lung disease,
and (2) asbestos-related pleural plaques.

The patient’s occupational exposure to asbestos might have played a

small etiologic role in the development of pulmonary insufficiency.

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It is worth noting, however, that this would have no effect on the

patient’s application for SSDI.

Steps in the Disability Evaluation Process

The following questions are involved in disability evaluation:

1.What is the patient’s medical diagnosis?

Does the individual have any impairment is present, is it temporary or permanent?

What is the extent of any impairment?

Is the patient’s impairment or disease caused or aggravated by work?

What is the impact of this impairment on the individual’s ability to obtain employment in spec

occupations and to perform specific jobs? Might

accommodations allow for employment?

6. What other sources of information on work capabilities or

possible accommodations should be considered?

7. In consideration of the answers to the previous questions, to

what, if any, economic benefit is the individual entitled?

In workers’ compensation and in private insurance disability cases,

the physician is often asked whether the impairment is disabling and
to describe how the impairment impedes the performance of usual
job tasks. A clear job description is the basis for evaluating whether
the employee can perform the
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essential functions of the job. Often, this cannot be determined without
knowing what accommodations at

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work might be available. Thus, in the second case, it cannot be

determined whether the patient is totally disabled until it is known
whether any alternate work or accommodations are available. The
same considerations apply to determining disability for private
insurance. A visit to the workplace usually will resolve the lack of
clarity that frequently is present in
standard job descriptions and may have an important role in
encouraging an employer to provide accommodations for the disabled employee.

Most insurance systems reimburse individuals for loss of earning capacity caused by objective impairme
required to predict residual caring capacity when an employee

is no longer able to return to previous work. For example, factors

related to worker autonomy, such as the availability of self- paced
work, educational and experience levels, and self employment, have
been shown to be more important in determining disability status in
patients with rheumatoid arthritis than the extent of medical findings.

In workers’ compensation plans and in most private disability plans,

the treating or reviewing physician is required only to determine that
the impairment is sufficient to prevent work. However, in the Social

Security, Veteran’s Administration, and Black Lung programs, there

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are often specific criteria for impairment that determine whether one
is eligible for benefits, which vary from plan to plan. For example,
the Black Lung and Social security programs have threshold
pulmonary function values; if an applicant’s lung function is better
than the threshold, then he or she does not qualify for disability. In
the veteran’s Administration system, the degree of lost function is
expressed as a percentage of total lung function. Benefits are
assigned based on the percentage of function lost; in contrast, the
Social Security and Black Lung programs usually provide a fixed
amount of benefits only if a worker is totally disabled according to
the threshold criteria. Physicians are often frustrated with the
arbitrary nature of the determination process. Under these criteria,
some individuals with truly disabling impairments will be refused
compensation, while others capable of gainful employment will

receive
benefits.
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5.6. Review Questions

1. What variables would you use to measure the magnitude of the

problems due to occupational health?

2. What are the determinant factors for work related injuries?

3. Describe what occupational disorders mean?

4. Describe what occupational diseases mean?

5. Explain the principle of disability evaluation?

6. List the challenges of disability evaluation

7. List the preventive and control measure of

Occupational disorders?
Occupational Health and Safety