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  • ACOEM Supports OSHA’s Proposed Occupational Injury and Illness Recording and Reporting Requirements

    March 24, 2010

    David Michaels
    Assistant Secretary of Labor
    Occupational Safety and Health
    U.S. Department of Labor
    200 Constitution Avenue, NW
    Washington, DC 20210

    Dear Mr. Michaels:

    The American College of Occupational and Environmental Medicine (ACOEM) welcomes the opportunity to submit the attached comments on the Notice of Proposed Rulemaking Occupational Injury and Illness Recording and Reporting Requirements.

    ACOEM supports the adoption of the proposed rule with the additional recommendations that are outlined in the attached comments.

    Sincerely,

    Pamela A. Hymel, MD
    President

    Enclosure 

    CC:  OSHA Docket Office
             Docket No. OSHA-2009-0044

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    American College of Occupational and Environmental Medicine
    Notice of Proposed Rulemaking
    Occupational Injury and Illness Recording and Reporting Requirements
    Docket No. OSHA–2009–0044

    March 24, 2010

    The American College of Occupational and Environmental Medicine (ACOEM) expresses its support of this proposed rule change to include a column for work-related musculoskeletal disorders (MSDs) on the OSHA 300 log.

    On average, work-related musculoskeletal disorders account for greater lost-time and medical expenses than injuries due to acute trauma, such as those caused by slips, trips and falls (Cheadle 1994). They also are highly likely to be underreported or “invisible” without the reporting as a separate and distinct category in the OSHA 300 log. Furthermore, the current BLS data is limited to only those cases that have days away from work. Many cases of MSDs are handled by treating physicians and employers without lost time from work and are not captured by the BLS database. Therefore both agencies’ current reporting methodologies fail to capture a more accurate picture of diseases and injuries in the workplace.

    More accurate reporting of MSDs would be anticipated to improve prevention efforts. It would allow employers to more readily identify the incidence of cases and facilitate investigation of workplace hazards and ergonomic risk factors. It would also allow for tracking of outcomes due to primary and secondary prevention efforts, including interventions such as engineering controls, work practices, and employee training and education.

    MSDs are also common diseases and injuries that affect most of the population over a lifetime (NRC/IOM 2001; ACOEM 2008). For the purposes of OSHA reporting the diagnosis of a work-related MSD by the treating physician should be established by the recognition that there is a workplace cause or a material contribution or aggravation due to exposure to ergonomic risk factors. Determination of work-relatedness should be based on standard occupational medicine practices, including establishing an accurate diagnosis; identifying the workplace and non-workplace ergonomic risk factors that may cause or materially contribute or aggravate the disorder; considering the contribution of other concurrent medical conditions; and considering the epidemiologic evidence supporting a link between ergonomic risk factors and the disorder (NIOSH 1977; ACOEM 2004, 2008).

    The definition proposed for MSDs is supported by ACOEM. The disorders described in the notice are generally accepted as MSDs that should be reported. Additionally, it is recommended that Hand Arm Vibration Syndrome be included. It is also recommended that more generic terms be utilized as examples. For example, ulnar and radial neuropathies are preferable terms to “cubital tunnel syndrome and radial tunnel syndrome” which are more narrow and limiting in scope. It is recommended that “Double Crush Syndrome” be removed from the list since it is a theoretical construct without diagnostic criteria (ACOEM 2008).

    ACOEM also agrees that it is very important that the column not be labeled with "repetitive trauma" or similar terms as they convey a method of causation that may not match the actual mechanism of injury (ACOEM 2008).

    In conclusion, ACOEM supports the adoption of the proposed rule with the additional recommendations that are outlined above.

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    References

    Cheadle A, Franklin G, Wolfhagen C, et al. Factors influencing the duration of work-related disability: a population based study of Washington State workers’ compensation. Am J Public Health. 1994; 84:190-6.

    American College of Occupational and Environmental Medicine. Occupational Medicine Practice Guidelines: Evaluation and Management of Common Health Problems and Functional Recovery in Workers. 2nd edition. Glass, LS (Ed.) Elk Grove Village, Ill: American College of Occupational and Environmental Medicine; 2004.

    American College of Occupational and Environmental Medicine. Occupational Medicine Practice Guidelines: Evaluation and Management of Common Health Problems and Functional Recovery in Workers. 2nd edition, 2008 Revision. Hegmann, KT (Ed.) Elk Grove Village, Ill: American College of Occupational and Environmental Medicine; 2008.

    Musculoskeletal Disorders and the Workplace. National Research Council and Institute of Medicine. National Academy Press, Washington, DC, 2001.

    National Institute for Occupational Safety and Health, Kusnetz S, Hutchison MK, eds. A Guide to the Work-relatedness of Disease. U.S. Dept. of Health, Education, and Welfare, Public Health Service, Center for Disease Control, National Institute for Occupational Safety and Health. Rockville, Md.:1979.