Vocational Rehabilitation - Expert Performs Employability Assessment Expert Article

A 76 year old woman sustained carpal tunnel syndrome as a result of ongoing and repetitive work tasks at her job. Her physical limitations, education, work history and the current job market affected her ability to benefit from retraining to return to work. RFI was retained to perform a vocational rehabilitation assessment and to make determination as to her employability.

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AR is a 76 year old woman with Bilateral Carpel Tunnel Syndrome (BCTS) who complains of pain in her fingers, hands and arms as a result of job related tasks. Medical documentation has found this condition to be causally related to her job as a general office clerk at Advanced Investigation Services/Law Enforcement Training & Consultants. She is currently pursuing workers compensation benefits as a result of her inability to work. The purpose of this evaluation is to determine her degree of industrial disability and her employability in the current job market.


Primary condition

AR reports that initial pain radiating in both of her hands and arms began in late 2005. She was originally treated by her internist, Dr. B. and eventually diagnosed with BCTS by her neurologist, Dr. K. and second internist, Dr. S. (medical report 112448719, 113794448). In February of 2006 she filed a Workers Compensation claim for the BCTS through her employer, as each of her doctors verified that BCTS is causally related to repetitive hand movements. As her ongoing daily job duties included repetitive hand movements, it was medically determined to be occupationally related (monthly medical exams from February 2006 through October 2009). To clarify any confusion between employee and employer claims, at the WCB hearing of October 30, 2007, Judge JR ordered a medical evaluation by a neurologist specifically from a teaching hospital to perform an impartial medical examination. This examination by Dr. N. confirmed the BCTS diagnosis.

Secondary conditions

AR reports that in October of 2004 she was asked by her supervisor, Mr. T., to leave her desk and go into his office. In getting up from her chair, she heard a snap in her knee, felt pain, and was only able to walk by dragging her leg (WCB hearing October 30, 2007). Her inability to walk was noticed by her employer and coworker. At the completion of her work day she saw her internist, Dr. B., who referred her to Dr. L. for orthopedic consultation. Dr. L. diagnosed a torn meniscus and performed surgery and subsequent treatment. Ms. A. returned to work after two days, however, pain soon returned. At this time she began to see Dr. M., orthopedic surgeon, who performed a knee replacement. Following this surgery she was out of work for approximately four to six weeks and collected workers compensation for this temporary period. AR returned to work at XXXX where she remained until February of 2006. She currently reports some restrictions in standing for long periods of time or walking long distances. In addition to the BCTS and knee replacement, AR reports that she is being treated for diabetes. At the time of interview, she was wearing a surgical boot on her foot as a result of lacerations she sustained when she dropped a can on her foot while attempting to cook. According to AR, the injury had occurred approximately 6 weeks earlier and due to her diabetic condition, the stitches required increased healing time.

Current limitations

AR reports that she has been unemployed since 2006 due to the limitations imposed by her BCTS. In addition to work related limitations, she reports limitations in activities of daily living regarding cooking, lifting, vacuuming, cleaning, standing and walking for long periods of time. She receives ongoing assistance from her extended family who reside in the same apartment building and who help her with her activities of daily living. AR reports that she has a valid New York State driver’s license, a car and still drives on a limited basis.


At the time of onset of her primary disability, AR worked at a company that involved two separate entities: XXXXX and OOOO, performing clerical and bookkeeping related tasks. AR has a 50 year work history which began in 1956. Some of the jobs in which she was employed are no longer in existence today. She worked as a key punch operator for approximately 12 years (1956-1958, 1963-1966, 1967-1974) in three different settings. The combination of these job duties involved time card key punch operations, accounts receivable documentation and company mailings. During the five year hiatus from key punch operations, she completed a manicure class at Wilfred School and began work at the Victoria Hotel in New York as a manicurist. Despite some discrepancies about the years that this occurred, she reports having learned hairdressing on the job and was able to attain a cosmetology license (licensing certification provided includes valid certification from 1965-1971). Within this time period she reports co-ownership and operation of a Beauty Salon in Manhattan. AR reports that she left this vocation as a result of the long hours and commute from her home into Manhattan. When the last company that she was working for as a key punch operator relocated, she acquired more specific business skills at the age of 44 through a six month certificate program in bookkeeping, business machines and office procedures at Adelphi Business School (certificate dated October 6, 1977). After graduating from this program, she worked steadily in the clerical field performing bookkeeping, accounts receivable and payable, collections, data entry and general office skill duties. As the technology advanced, her duties became more computerized but still included typing, writing and phone work. Excluding her most recent position, AR worked in four different companies performing these duties (1985, 1985-1988, 1988-1991, and 1992-1999). She left each of these positions either for advancement or layoff due to company consolidation. In her most recent position (1992-2006) at XXXXX, Inc and OOOO, she performed billing, accounts receivable, accounts payable, collections, answering phones, writing checks and certificates and coordinating security guard placements on a daily basis. This work involved computerized data entry, typewriter usage, writing and balancing ledgers and phone skills. She left this position upon onset of disability.


Within the bounds of reasonable technical certainty, and subject to change if additional information becomes available, it is my professional opinion that:

  1. The daily job tasks described in AR’s position as a general office clerk include repetitive hand movement which has been causally related to Carpel Tunnel Syndrome.
  2. AR is totally disabled from her most recent employment and all work that require repetitive hand movements, fine finger dexterity and small motor skills.
  3. Given AR’s limited education, current work knowledge, age and physical restrictions, transferability of skills or retraining to a new occupation would be contraindicated and unrealistic.
  4. Due to the physical restrictions imposed by her Carpal Tunnel Syndrome and other secondary medical conditions, her limited education, age and concentrated work history, AR’s employability in the current job market is poor

Full report available in the “Details” section of this page.

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