September 2, 1992

Mr. Ronnie Powell
Union Carbide Corporation
Suite 300
2525 South Shore Boulevard
League City, Texas 77573

Dear Mr. Powell:

Thank you for your facsimiles dated July 27 and August 18 requesting several interpretations on OSHA injury and illness recordkeeping issues. I will first restate each question, then respond to it. I will also reference the Recordkeeping Guidelines for Occupational Injuries and Illness, 1986, whenever possible.

Q1. Is the draining of blood from a hematoma to be considered medical treatment?

A1. Yes. The draining of any fluids or blood is to be considered medical treatment.

Q2. After a potential chemical exposure from inhalation, an employee is sent to the Medical Department as a precautionary measure. The employee does not allege any symptoms. On a pulmonary function test, the employee's reading is 7% below the last test taken. The normal test variance is +/-10%. Is this considered an abnormal condition?

A2. See Q3.

Q3. Most medical examinations (e.g., pulmonary function test, blood sugar, urine test, blood pressure, etc.) have a normal deviation. If an employee shows a variation, but within the normal deviation for the test, is this considered an abnormal condition? Does it make any difference if this situation occurs during a routine examination or if it occurs after a potential job related event?

A3. If tests performed during a routine or event induced medical examination result in values outside the range of normal test variance, an abnormal condition has been established. Values within the normal range of the test variance would not reflect an abnormal condition. If events or exposures in the workplace either caused or contributed to an abnormal condition, then the condition is considered to be work related for OSHA injury and illness recordkeeping purposes. If the abnormal condition is related to a single instantaneous event, the case should be evaluated using the injury criteria. If it is related to a non-instantaneous exposure(s) or event(s), then it should be recorded as an occupational illness.

The test result in question 2 is not recordable because it is within the normal test variance expected for that particular test.

Q4. What is considered to be an aggravation of an off the job injury, e.g., fractured rib, fractured foot, sprained ankle, etc.? The employee is already experiencing pain. Does pain constitute an aggravation? Does "more pain" constitute an aggravation?

Does there have to be a job related event such as slip, trip, fall, overexertion, etc.? Suppose the aggravation is caused by normal life activities such as standing, walking, breathing, sitting, etc.? For example: o Hemorrhoids aggravated by sitting o An injured back aggravated by rising from a chair or by tieing a shoe o Flu aggravated by walking around the plant

A4. All cases must be work related in order to be recorded on the OSHA Log. If an event or exposure occurs within the work environment, work relationship is presumed. This presumption may be rebutted if symptoms merely surface on the employer's premises, where the symptoms are the result of a nonwork-related event or exposure off premises. (page 34, Q&A C-7, C-8)

In the situations described above, standing, walking, and sitting all constitute work activities that aggravate existing conditions. Work relationship is therefore established. The cases should then be evaluated based upon the recordability criteria for injuries and illnesses.

Q5. For recordkeeping purposes, how is the "back" defined? Does it include the neck and shoulders?

A5. The back consists of the thoracic, lumbar, sacral, and coccygeal regions of the musculoskeletal system. It does not include the neck and shoulders.

Q6. Suppose an employee has no idea how an illness arose. The employee makes no allegation that the illness is work related. The illness is detected at work through a routine examination. Suppose the evidence of work relationship is very weak and is not convincing to the plant physician. It is too weak for him to say that the illness is more likely than not to have been work related. Should this be considered a work related illness?

A6. Sometimes there is no identifiable event or exposure that can be attributed to an employee's illness. When this occurs, the case should be evaluated on whether it seems likely that an event or exposure in the work environment either caused or contributed to the case. The work environment only needs to be a contributing factor in order to establish work relationship. If the physician is able to say that the condition is caused 100% by outside factors, the case need not be recorded. (page 32, B-17)

Q7. Are phobias (e.g., claustrophobia, fear of heights, fear of flying) considered to be recordable case injuries or illnesses if they surface or occur on the work premises? Several specific examples follow:

1. An employee says that he has claustrophobia.

2. An employee says he has claustrophobia when he wears a respirator or when he enters a confined space.

3. An employee is found to have claustrophobia during a respirator fit test, i.e., the employee exhibits symptoms of claustrophobia during the fit test.

4. An employee exhibits symptoms of claustrophobia while wearing a respirator during a drill or while entering a confined space.

5. An employee is restricted from certain work activities (e.g. entering confined spaces) because he has claustrophobia.

Do the same interpretations apply to other phobias such as fear of heights or fear of flying?

A7. A phobia is a pre-existing condition that generally is not caused by the workplace. However, if the pre-existing condition is in some way aggravated by an event or exposure in the workplace, and meets the recordability criteria for injuries or illnesses, it must be recorded. In most cases the exposure, such as wearing a respirator or entering a confined space, will be a non-instantaneous event and the case should be evaluated as an illness. If the employee shows symptoms of the phobia (anxiety, increased pulse rate, increased rate of breathing, etc.) after an event or exposure within the workplace, the case should be recorded.

In the examples above, numbers 1 and 5 would not be recordable cases because there was no event or exposure resulting in symptoms of the phobia. Examples 2, 3, and 4 should be recorded do to workplace exposures resulting in claustrophobic symptoms.

I hope you find this information useful. If you have any further questions, please contact my staff at Area Code (202) 523-1463.

Sincerely,



Stephen A. Newell
Acting Director
Office of Statistics