Inter-Expert Communications: The Roles of Life Care Planners and Vocational Rehabilitation Experts

Brad Coffey, M.Ed., MBA
CVE, CRC, CDMS, CCM, FVE
Vocational Rehabilitation Counselor and Consultant

Outline

1. Handoff from Functional Evaluator to Vocational Consultant
   1. – 6 paths
   2. – Case situations
2. Reporting in RAPEL format, under Access and under Laborforce participation
   1. – Report examples
   2. – Information exchange with the life care planner
3. Handoff from Vocational Consultant to Economic Consultant
   1. – Case situations with base wage (starting point salary)

Handoff Chain — Basic Components

A PMR MD Exam on a Life Care Plan

50 year-old carpenter, MVA, neck & back injuries:

• 3.11 Examination
  • Cervical range of motion shows mild tenderness
  • Right rotation 70 degrees with pain at the end of rotation
  • Manual muscle test shows just a trace of weakness left ankle, which is 4+/5
• 3.12 Diagnostic Conclusions
  • C5-C6, C6-C7 restricted range of motion
  • radicular symptoms to lower extremities

Neurologist responds to medical inquiry

IME of a 5-Year-old with brachial plexus injury, left arm

• The weakness in his left arm and hand is likely to be permanent.
• He may require orthopedic surgeries in the future for release of tight tendons.
• He may be limited in activities and careers that require constant use of both hands.
• He can use the left hand as a helper hand.
• I do not think … limitation on general stamina.

Nueropsychologist’s Functional Section and Prognosis

16 year-old boy, fertilizer plant explosion, TBI

Funtional Implications: From a cognitive standpoint, deficits in attention, processing speed, and complex memory are likely to have the greatest impact on his future academic and vocational performance.

Emotional assessment indicated a combination of post-traumatic stress disorder, significant somatic concerns, and neurobehavioral dysregulation.

In the workplace, deficits in attention, processing, memory, and concept formation abilities will make it difficult for him to perform at an optimally consistent level. He is likely to have a tendency to make errors which he does not detect. In addition, he may have difficulty organizing his plan of action and executing it as intended because of his impaired executive and attentional functioning.

FCE Inquiry Text

48-year-old factory worker, ankle crush

The purpose of the FCE is for baseline capacities, toward vocational evaluation and identifying future vocational options. Evaluee has been released from surgeon's care as of 02/22/2011; released from chronic pain program as of about Sept 2011.

The payor is the law firm of [redacted]. The legal assistant [redacted] should be call Elizabeth or Amilda to set up either dates we discussed: Wed., Feb 27 at 8 AM or Wed., Mar 6 at 8 AM

Please find enclosed the following records from my file to assist you with orientation to this case:

I have also enclosed DOT/ONET descriptions of: 1) Electrician helper, which generally correlates with [redacted] most recent position from which he is now laid off, and 2) truck driver — a position he has voiced interest in. Please compare FCE results against these occupations.

A copy of the report should be faxed or emailed to my contact information above. Thank you.

An FCE Gives Familiar Factors

The physical demands of the target job were determined by O*Net and The Dictionary of Occupational Titles

FCE Depo Issue — Collusion

Q. Okay. Did you receive a request from a gentleman by the name of Brad Coffey to do an FCE?

A. Yes.

Q. Okay.

A. But I don't know him personally.

Q. All right. And, now, when you agree with Mr. Coffey to do this FCE, were you agreeing to do it the way you thought it should be done, or did Mr. Coffey prescribe what you should do?

A. No. We do the FCE the way we do it.

FCE Depo Issue — Valid Effort

Q. And tell us, first of all, did you believe that the testing was valid and was confirmed by his effort given?

A. Yes, sir.

Q. Okay. And, I guess, that was shown through both the comparison of dynamic through static, as well as the grip test?

A. Yes, sir, it was. And also with the paperwork that he fills out is also important in determining that.

Work-Sample Clinic

Example Access Reporting-Without Injury

58-year-old Exec Secy, MVA, TBI-LOC, etc.

Analysis

Access to Labor Market:

Access is the range of occupational choices a person has and will have, to work in their labor market.

Without the injury, Ms. [redacted] had full choice to work in occupations for which she was educated, skilled and had interest in. Ms. [redacted] held a diploma in executive secretary services and worked in that capacity for several years. Ms. [redacted] had the following acquired skills by education and work history:

Example Access Reporting — With Injury

With the injury, Ms. [redacted] has significantly diminished occupational choice, especially in more skilled secretarial work for which she was trained. Neuropsychological evaluation by Dr. Martinez identified impairments in 2 functional categories found in traumatic brain injury: cognitive and psychosocial.

If Ms. [redacted] is able to get and keep work, she will more likely be able to work in simpler, detailed but not complex, semiskilled office occupations. Representative occupations include file clerk, general office clerk, and receptionist.

Plan for a Real Estate License

Vocational Report Summary- Key Points

58-year-old Exec Secy, MVA, TBI-LOC, etc

In my opinion, within a reasonable degree of vocational rehabilitation certainty, Ms. [redacted] has sustained vocational impairment with diminished past and future earning capacity. Pre-injury Ms. [redacted]'s annual earning capacity is based on her secretarial and administrative skills … valued at $51,945.

Post-injury, if Ms. [redacted] is able to get and keep employment, her earning capacity is projected along 2 options:

1. Ms. [redacted] continues employment indefinitely as a marketing department assistant, and earns $37,440 in 2013 dollars.
2. Ms. [redacted] changes employers and finds other work in semiskilled office occupations. These pay an average of about $29,289 in 2013 dollars.

Leading to the Economist’s Summary

In this presentation, we considered examples of inter-expert situations, toward well-founded, evidence-based opinions.

Sources

• Brookshire, M.L. (2014). Issues in the Handoff to a Forensic Economist. In R. Robinson (Ed.), Foundations of Forensic Vocational Rehabilitation. 429-441. New York, NY: Springer Publishing Co.
• Robinson, C.W. (1994). Using the Dictionary of Occupational Titles in Career Decision Making: A Self-Study Manual. Menomonie, WS: Stout Vocational Rehabilitation Institute.
• Weed, R.O. (1996). Lifecare Planning and Earning Capacity Analysis for Brain Injury Clients… RAPEL Method. NeuroRehabilitation, 7, 119-135.