Functional Capacity Evaluation Under Duress - Part 5
Posted on Mon, Jan 17, 2011 @ 07:44 AM
In this fifth and last post in a series devoted to writing a summary report for an evaluation administered to an individual who threatens the evaluator with great bodily harm, I discuss the use of Functional Validity to
strengthen the Physical Effort statement.
Here is suggested verbiage for my umbrella statement in this low physical effort evaluation:
Functional Validity and Next Step Options
When a client presents with overt resistance to the evaluation process it is difficult for the evaluator to reach accurate conclusions that support answers to referral questions. Such is the case with this evaluation. It should be noted that not only did Mr. Smith demonstrate overt resistance to the evaluation, but went so far as to begin the evaluation by verbally threatening the evaluator with bodily harm. Among his comments was, “I have a knife in my pocket.” This was followed by, “Do you have a plastic bag? I want to cut you up and put you in it.” He went on to explain, “If I hit you, it’s not my fault.”
As such, the functional validity of this evaluation should be considered to be compromised. Functional validity takes into account the level of physical effort put forth by the client during the evaluation and the reliability of the client’s reports of pain or disability. Though separate in nature, when taken together these aspects of the evaluation are a guide to the expected reliability and validity of the evaluation results.
As Mr. Smith did not participate with high levels of physical effort during testing, standardized interpretation of test results are of little value in determining his true abilities. Physical abilities listed in the Physical Abilities and Job Match chart are based on the evaluator’s observation of demonstrated tolerances during the course of the evaluation.
Mr. Smith did indeed demonstrate a range of physical abilities and aptitudes over the course of this 4 hour process. Even though given reluctantly, this demonstration of ability indicates that Mr. Smith is capable of returning to a range of job classifications. In total his demonstrated abilities may match as many as 1,450 job classifications as listed in the Classification of Jobs database.
However, given Mr. Smith’s reaction to participating in this functional capacity evaluation, the likelihood of successful voluntary return to work and the ability to benefit from further medical or rehabilitation services appears to be low.
End of Functional Validity statement.
Once the Functional Validity statement has been crafted, we turn our attention to the Physical Effort (PE) statement. The PE statement is vital to the reader’s understanding of the evaluation: it lays the foundation for conveyance of an understanding of the client’s investment in the evaluation. It carries with it legal and financial implications should the legal system in which the evaluation occured carry sanctions for failure to remediate, inability to benefit or acts of overt fraud. This important communication must accomplish with clarity and efficiency.
Referring to the PE statement, the evaluator asked me this question: “I normally do not write a summary this way but I wanted to back up my findings here so anyone reading it would not have to search for it in body of FCE. I usually do not create a list this way. Should I do this differently?”
My answer was that, in fact, I believe this is the perfect place for a list of PE findings. Here is his finished PE section:
Physical Effort Findings
Overall test findings, in combination with clinical observations, suggest the presence of low levels of physical effort on Mr. Smith's behalf over the course of the evaluation. Examples of low effort include:
A. Heart rate analysis during large muscle group activities indicates a lack of response to activity.
B. Self- limiting during Isoinertial lifting, push, pull and carry tests.
C. Manual Muscle Test of hands and wrists did not match grip strength testing with dynamometer.
D. Absence of a bell-shaped curve for right hand during grip strength.
E. Exhibition of cog wheeling during manual muscle test.
F. Presence of 20 degrees more shoulder elevation during distraction-based repetitive motion test than during musculoskeletal evaluation goniometric measurements.
G. Straight-leg raise test in supine did not match sitting results.
H. Presence of multiple clinical inconsistencies.
End physical effort statement.
Although I think a couple of the elements of the above list could have been better worded, I present the list for your consideration. The intention is that the presence of the list brings the reader’s attention to the fact that this evaluation contained a series of challenges to Physical Effort.
Note - please comment on the above. Is this type of approach one that would work in your area? Would you like to hear more of a discussion about using the Classification of Jobs to put forth your case for further investment in rehabilitation? Other thoughts you’d care to share?
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