CANADIAN UNION OF PUBLIC EMPLOYEES Limitations & Restrictions Associated with Chronic Pain WorkSafeBC ( WCB ) Questionnaire Tom McKenna, National Representative, WCB Advocacy 1/23/2015 This information is not for general distribution or use. This information should not be distributed to the employer. This information is an overview of the principles derived from the current jurisprudence. Each case is fact dependent, and, the jurisprudence in this area of labour law changes frequently. Please ensure you contact your National Representative for all servicing issues. This is not a legal opinion or legal advice.
INTRODUCTION This questionnaire is for workers who believe that they might have limitations or restrictions arising from a pain condition such as Chronic Pain. Pain often arises from injuries and conditions that occur in the course of employment. Injuries and associated pain conditions are compensable by WorkSafeBC ( WCB ). Please have your physician fill out this questionnaire (pages 3 to 10) if they are willing to assist, and can provide supporting medical evidence. This questionnaire will help guide your physician in determining the next steps in diagnosis and treatment. Please note, this questionnaire is voluntary, and should not be submitted to the WCB or your employer; it is for managing your claim or appeal. If you file an appeal of a decision on the WCB claim, the WCB and the employer may have access to the questionnaire. Your WCB advocate may request a copy of the questionnaire in support of your appeal, recognizing that physicians are not allowed to act as advocates as per a number of WCB appeal decisions. BACKGROUND There are many different types of pain and pain conditions. The WCB accepts pain as part of a WCB claim provided it adheres to law and Policy, as supported by medical evidence. Examples of pain conditions include: Chronic Pain Complex Regional Pain Syndrome Pain Associated with a Psychological Condition (DSM Disorder) For example: Pain Disorder Associated with a General Medical Condition Pain Disorder Associated with Psychological Factors Pain Disorder Associated with Both Psychological Factors and a General Medical Condition (Also, see WorkSafeBC Psychological Disability Award Guidelines e.g. Section 23) Page 2 of 10 Revised: January 23, 2015
Conditions related to pain include: Back pain Cancer Chronic Fatigue Syndrome Clinical depression Complex Regional Pain Syndrome Fibromyalgia Headache Myofascial Pain Syndrome Sciatica Lumbar spinal stenosis Cervical spinal stenosis Arthritis Temporomandibular joint disorder Nerve Entrapment Syndromes Peripheral Neuropathy Brachial Plexus Avulsion Pain Musculoskeletal pain conditions were among the most prevalent. WCB POLICY As per WCB Policy, Chronic Pain ( CP ) the most commonly accepted pain condition - exists when two (2) conditions are met: 1. The pain is still present six (6) months after an injury or an occupational disease. 2. The pain is present beyond the usual recovery time for the injury or disease. The WCB identifies two (2) types of chronic pain: 1. Specific pain -- pain related to a physical or psychological cause. 2. Non-specific pain -- pain that exists without a clear medical reason. The WCB may accept chronic pain or pain as part of a psychological problem such as clinical depression. There may be more than one (1) area of specific or non-specific pain. The WCB seeks evidence supporting that the Chronic Pain was disproportionate as well. Page 3 of 10 Revised: January 23, 2015
LIMITATIONS AND RESTRICTIONS The WCB recognizes that limitations and restrictions may be present after an injury or condition related to employment has occurred. A limitation is a task that is not capable of being performed, while a restriction is a task that should not be performed due to the risk of medical harm. Limitations and restrictions may be current or expected in the future. The WCB, physicians, appeal tribunals, etc use these terms interchangeably, however, they have different meanings. Regardless of which is used, one should describe what cannot be done and one should describe what should not be done. Both need to be considered. Both can arise from the injury and / or from the pain condition itself. The physician should be asked about a Sickness Impact Profile Test or a West-Haven-Yale Multidimensional Pain Inventory. Limitations and restrictions may arise out of a pain condition. That is, a pain condition may be disabling in and of itself. Therefore, limitations and restrictions related to both the original injury and the subsequent pain condition may be present. If your WCB claim injury has resulted in a pain condition, you may wish to ask your physician to address a number of questions. Please remit this list of questions to your physician, recognizing that the Canadian Union of Public Employees only performs WCB advocacy on a volunteer lay person basis and as such, cannot reimburse or pay for any medical opinions of questionnaires. This questionnaire is used where a worker is at risk for developing a pain condition and at risk for developing loss of function as a result. SENSORY LOSS AND OTHER PAIN RELATED CHANGES AND MANIFESTATION Pain conditions may result in sensory or other changes post injury. A comprehensive neurological examination and testing me be required. QUESTIONS FOR MEDICAL PRACTITIONER 1. What was the pre-injury occupation? Page 4 of 10 Revised: January 23, 2015
2. What was the mechanism of injury? How did the injury occur? 3. What are the diagnoses arising from the injury? 4. Were there any pre-existing diagnoses? Page 5 of 10 Revised: January 23, 2015
5. Were the pre-existing diagnoses aggravated, accelerated or activated by employment? 6. What were the diagnoses accepted by WorkSafeBC (the WCB )? 7. Were there any diagnostic tests such as x-rays? Page 6 of 10 Revised: January 23, 2015
8. Did a pain condition(s) arise from the diagnoses? If so, what are they and do they include any DSM Pain Disorders? 9. What pain conditions arose from the diagnoses? Is there more than one area(s) of the body affected including sensory loss and / or other changes? 10. How? Page 7 of 10 Revised: January 23, 2015
11. Is the pain specific or non-specific? 12. Is the pain disproportionate to the injury? How? 13. When did the pain condition(s) arise? 14. Have the pain symptoms been consistent? 15. What is the level of pain on a scale of 1 to 10, with 1 being minimal to 10 being extremely severe? Page 8 of 10 Revised: January 23, 2015
16. Has the pain level changed over the duration of the claim? 17. Why? 18. What is the prognosis for the pain condition(s)? 19. Has the pain condition(s) plateaued? Page 9 of 10 Revised: January 23, 2015
20. Are there any current or expected limitations or restrictions arising from the pain condition(s)? If so, what are they? Note: these may be in addition to the limitations and restrictions arising from the injury itself. 21. What job demands or job duties are affected by the current and expected limitations and / or restrictions arising from the pain condition? SUMMARY Should you have any questions regarding your claim or appeal, please do not hesitate to contact your Local Union, the BC Workers Advisors Office, or your WCB Case Manager (as applicable). TM/CI*COPE491 G:\Representatives\MCKENNA, TOM\WCB\GUIDES\WCB - Limitations and Restrictions Associated with Pain - A Chronic Pain Questionnaire Jan 23.15.docx Page 10 of 10 Revised: January 23, 2015