Kentucky occupational disease claims, including coal workers' pneumoconiosis and other lung or heart diseases, use this report in litigation before administrative law judges. The physician documents complaints and smoking history, employment history from Form 104, treatment, examination, testing with ILO-classified chest x-rays and pulmonary function tests, diagnosis, AMA Guides impairment, work-related causation, restrictions and treatment recommendations.
A treating or evaluating physician, including a university evaluator, completes sections A through L and signs the L certification, attaching a CV or giving a Physician Index Number.
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Medical Report - Occupational Disease
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Yes. The October 2016 Form 108-OD covers coal workers' pneumoconiosis through ILO classification of chest x-rays, with the ILO form attached. An older Form 108 for CWP still appears on the forms index, but the regulation now incorporates only this edition.
Section I asks whether, within reasonable medical probability, the disease is causally related to the work environment, whether any pulmonary impairment is caused in part by workplace factors such as coal dust or chemicals, and which factors are involved and how they relate to the diagnosis.