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November 28, 2017
Mr. Raymond J. Skwarek
UCOR, URS / CH2M, Oak Ridge LLC
P.O. Box 4699
Oak Ridge, TN 37831
Dear Mr. Skwarek:
Thank you for your letter to the Occupational Safety and Health Administration (OSHA) regarding 29 CFR Part 1904 - Recording and Reporting Occupational Injuries and Illnesses. Your letter requests clarification of OSHA's injury and illness recordkeeping requirements in reference to the use of a rigid boot as a precautionary measure.
In your letter, you describe a scenario where an employee sprained their ankle while working. An initial x-ray and diagnosis was conducted showing no evidence of a fracture, joint dislocation, and no ankle instability. However, the radiologist recommended a second x-ray to be taken seven days later to conclusively rule out a fracture. As a precautionary measure, the occupational physician recommended that a rigid boot be worn by the employee until the second x-ray was taken. The second x-ray conclusively determined there was no fracture and the rigid boot was immediately removed and not worn again.
Question: Does the use of the rigid boot after the first x-ray, and before the second x-ray, constitute medical treatment?
Response: Section 1904.7(a) of OSHA's recordkeeping regulation requires employers to record work-related injuries and illnesses that result in medical treatment beyond first aid. Section 1904.7(b)(5)(ii)(F) states the use of any non-rigid means of support, such as elastic bandages, wraps, non-rigid back belts, etc., is considered first aid for OSHA recordkeeping purpose. Section 1904.7(b)(5)(ii)(F) further states that orthopedic devices with rigid stays or other systems designed to immobilize parts of the body are considered medical treatment for recordkeeping purposes.
The case described in your letter is a recordable injury. The employee sustained a work-related injury (sprained ankle) while working in the work environment. In response to the sprain, a licensed health care professional directed the employee to wear a rigid boot. For purposes of OSHA recordkeeping, the rigid boot is an orthopedic device used to immobilize the ankle, and therefore is medical treatment beyond first aid. The fact that the rigid boot may also have been used as a preventive, precautionary, or prophylactic measure in this case is not relevant to the determination that the device was used to treat the employee's injury. Similarly, the subsequent x-ray showing no fracture does not change the result that medical treatment beyond first aid had already been provided.
Please see OSHA's April 14, 2016, Letter of Interpretation addressing "To use the rigid brace for pain relief is considered medical treatment beyond first-aid." (https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=30860)
Also please see OSHA's March 19, 2003, Letter of Interpretation addressing "Results of an MRI do not negate the recordability of a physician's recommendation." (https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=24390).
We hope you find this information helpful. OSHA requirements are set by statute, standards, and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in responses to new information. To keep appraised of such developments, you can consult OSHA's website at http://www.osha.gov.
Amanda L. Edens, Director
Directorate of Technical Support and Emergency Management