This report records the pulmonary function (ventilatory) study done for a coal miner's black lung benefits claim. It captures FEV1, FVC and the FEV1/FVC ratio before and, if given, after a bronchodilator, along with predicted values, the miner's cooperation and understanding, and the equipment used. DCMWC uses the results, measured under the 20 CFR 718 Appendix B standards, to help decide eligibility.
The technician or physician administering the test completes the form and is named in item 13. A physician prints their name and signs the certification that the study was conducted and reported under DOL specifications.
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Report of Ventilatory Study
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Three tracings of the flow-volume loop showing the entire maximum inspiration and forced expiration, and three volume-versus-time spirograms derived electronically from the loop. Each tracing must carry the miner's name and DOL case ID. If MVV is measured, attach two or three MVV tracings depending on how closely the values agree.
The instructions treat it as optional, but if a bronchodilator is administered you must report the values both before and after it, corrected to BTPS, and explain the significance of the results in item 10. Predicted normal values go in column (d).
Yes. Item 13 names the technician or physician who administered the test. A physician must still print their name and sign the certification that the studies were conducted and reported in compliance with Department of Labor specifications and that the results are accurate.