What Do Functional Capacity Evaluations Measure And What Is Its Purpose?

by Bernard D. Nomberg, Partner, The Nomberg Law Firm

What are functional capacity evaluations and how do I prepare for them?

Functional capacity evaluations (FCE) are typically used by authorized treating physicians in workers’ compensation cases. The FCE, while far from a perfect measuring tool, is one way for a doctor to confirm what his patient’s abilities or inabilities are at the end of the healing process. Once the doctor has determined that his patient (injured worker) has reached maximum medical improvement (MMI), it then must be determined what return to work restrictions are to be considered.

After being ordered by the treating physician, an FCE is typically performed at a physical therapist’s office. This set of physical tests are conducted by a therapist, typically taking between 1 to 3 hours. Depending on what injuries were to the injured worker, the FCE will be tailored to test the limitations of the injured body parts. For example, for a low back injury, the test will include evaluations of lifting, bending, stooping, crawling, walking, etc.

Walking up and down stairs is a measureable task that you could be asked to do as part of a functional capacity evaluation.

Once the FCE has concluded, the therapist administering the test will write up a report and submit it to the authorized treating physician for review and approval. Most treating doctors will generally agree with the findings. However, some of the more involved doctors will elaborate and issue a medical note specifically addressing the injuries at issue.

Often, in conjunction with the FCE, the physical therapist will also be asked to provide permanent physical impairment (PPI) ratings. These ratings are a percentage of permanent impairment loss due to the injuries. The Directory of Occupational Impairment is the book issued by the American Medical Association which addresses PPI ratings. These ratings, in conjunction with the FCE findings, help the doctor form his professional opinions about his patient’s future situation.

These permanent evaluations assist the employer, the workers’ compensation insurance carrier, and the injured worker’s attorney to figure out the last part of most claims. Those issues involve whether the worker can return back to his former employment, whether the employer can accommodate any permanent restrictions, and for the insurance carrier to hopefully make a settlement offer on the claim.

While there are many criticisms of FCEs that I will not go into at this time, pursuant to Alabama law it is the most acceptable method to measure the injured workers’ permanent restrictions or limitations.

The most important advice we give our clients prior to an FCE is 1. do your best and 2. be honest with the therapist.  We typically advise our clients that when they attend an FCE, that they wear comfortable clothes and exercise shoes. Eat their normal diet and take their medications as scheduled. Do not try to be Superman as it is impossible for someone to act the same way during a 1 to 3 hour test like they would over 40 hour work week. Our clients typically get amped up before the testing because they are nervous and want to do well. However, it is important that they realize that it is not their day to set records or to put themselves in a position to be further injured while testing.

A functional capacity evaluation (FCE) is a set of tests, practices and observations that are combined to determine the ability of the evaluated person to function in a variety of circumstances, most often employment, in an objective manner. Previously, I wrote about FCEs and how to prepare for one. In this blog, I want to explain a little more about FCEs, specifically what the results mean.

An FCE can be used to determine fitness to work following an extended period of medical leave. If an employee is unable to return to work, the FCE provides information on prognosis, and occupational rehabilitation measures that may be possible. An FCE can also be used to help identify changes to employee workload, or modifications to working conditions such as ergonomic measures, that the employer may be able to undertake in an effort to accommodate an employee with a disability or medical condition. FCEs are needed to determine if an employee is able to resume working in a capacity “commensurate with his or her skills or abilities”*

During most FCEs, the following measurements are also taken:

• Lifting power
• Push and pull power
• How long one can stand or walk
• Flexibility and reaching
• Grasping and holding capabilities
• Bending capabilities
• Balance capabilities

The following are descriptions of the five terms in which the Strength Factor is expressed:**

S-Sedentary Work – Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

L-Light Work – Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. NOTE: The constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding of a worker even though the amount of force exerted is negligible.

M-Medium Work – Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects. Physical Demand requirements are in excess of those for Light Work.

H-Heavy Work – Exerting 50 to 100 pounds of force occasionally, and/or 25 to 50 pounds of force frequently, and/or 10 to 20 pounds of force constantly to move objects. Physical Demand requirements are in excess of those for Medium Work.

V-Very Heavy Work – Exerting in excess of 100 pounds of force occasionally, and/or in excess of 50 pounds of force frequently, and/or in excess of 20 pounds of force constantly to move objects. Physical Demand requirements are in excess of those for Heavy Work.

While this information addresses “norms” after testing , in the real world, what we really care about is lifting, pushing and pulling. They may be useful in attempting to predict or demonstrate a patient’s “pre-injury” strength. These tables can assist employers in designing safe worksites, and when reviewing FCEs, you will be able to spot unreasonable recommendations.

If you have any questions or concerns about this issue or other issues on the law, please call the Nomberg Law Firm at (205) 930-6900.

Bernard D. Nomberg has practiced workers’ compensation law in Alabama for more than 20 years. Bernard has earned an AV rating from Martindale-Hubbell’s peer-review rating. He has been selected a Super Lawyer by Super Lawyers Magazine as well as a Top Rated Attorney by B-Metro Magazine. Bernard is the Chair of the Alabama State Bar’s Workers’ Compensation Section.