Physician review of workers' compensation case files: can it affect decision outcomes?

OBJECTIVE: To identify common attributes of Federal workers' compensation cases referred to Navy physicians for medical opinions and to determine the impact of the review on the final case decision. METHODS: Retrospective case study and descriptive analysis of 258 opinion letters written by physicians on referred cases from 2006 to 2010. RESULTS: Navy physician opinions were considered in the outcome in some of the cases, and there was a statistically significant difference between the claim acceptance rate in the study population and the total population. Worker age was correlated with certain claim types. CONCLUSIONS: There is preliminary evidence that the opinion letters of Navy physicians influenced case decisions. Because of the selection bias in how the cases came to the study population, a prospective cohort study is warranted to establish whether this conclusion and the other results noted are valid.

An investigation of aircraft worker anemia: medical surveillance interpretation in an aging workforce.

OBJECTIVE: To identify exposures possibly contributing to anemia cases among hexavalent chromium medical surveillance program enrollees. METHODS: An investigation encompassed metals surveillance programs, extensive workplace sampling and remediation, consultation, evaluation of laboratory accuracy, and follow-up of anemic individuals. RESULTS: Workers had underlying medical conditions that affected surveillance results. There was a systemic error in classification based on hematocrit value. The prevalence of anemia in a workforce averaging 52 years old was 16%. CONCLUSIONS: Anemia may be more prevalent in middle-aged workers than expected. Modern laboratories generally report a calculated hematocrit value, and using hemoglobin for most classification purposes is preferred. Characteristics of a specific workforce, including age, health, hobbies, and diet, should be taken into account when interpreting medical surveillance program findings. The value of a team approach in addressing occupational health problems was demonstrated.

Drowning deaths of U.S. Service personnel associated with motor vehicle accidents occurring in Operation Iraqi Freedom and Operation Enduring Freedom, 2003-2005.

OBJECTIVE: We examined common factors in vehicular drowning deaths that might lead to changes in equipment or training. METHODS: Drowning deaths among service members deployed to Operations Iraqi Freedom or Enduring Freedom, 2003 to 2005, were ascertained using the Armed Forces Medical Examiner Tracking System database. Cases were linked to Army and Navy safety and investigative files. RESULTS: Fifty-two cases of vehicular drowning deaths were identified. These occurred mostly at night, were almost always the result of a rollover, and were most frequently associated with a high-mobility medium-weight vehicle. Seat belts were rarely worn, but the majority of injuries should not have been severe enough to affect egress from the vehicle. These drowning deaths seldom occurred while engaged with the enemy and were rarely associated with bad road conditions or bad weather. CONCLUSIONS: Effective preventive strategies might focus on training and equipment to reduce rollover events and on the expeditious extrication of victims.