A. Loss of Use of an Upper Extremity

Guidelines for evaluating the impact of loss of use of an upper extremity on residual functional capacity are located in DI 25020.005A.5.

B. Recovery Time Following Laminectomy or Spinal Fusion

When evaluating a claim where the applicant has had a fusion or laminectomy, the preoperative pathology, the operative findings, the surgical procedure, and the response to the surgery including considerations of any postoperative complications must be considered in determining when a claimant has or will be capable of resuming SGA.

The findings should be considered in light of the claimant's past customary work. While an individual with satisfactory recuperation following laminectomy and disc excision may be able to return to sedentary and light work activity at two months, a period of 3 or 4 months may be necessary for the same individual to return to medium work activity.

In the absence of unusual preoperative pathology and/or complications of surgery and healing, the recuperative period for return to work ordinarily would not exceed 6 months.

Care should be taken not to place excessive weight on unsupported postoperative complaints or symptoms.

C. Developing Evidence Where Surgical Procedures Are Planned

In those cases where a series of staged surgical procedures has been proposed and the first surgical event has taken place before the end of the waiting period, medical evidence pertinent to this procedure and the subsequent planned procedures should be obtained before completing the disability determination. Evidence dealing with surgical outcome and prognosis may impact on questions of disability duration and residual functional capacity assessment.

In those cases where a surgical procedure has been proposed but has not occurred before the end of the waiting period, the latest medical evidence must be evaluated on its merits. The treating source's opinion would be particularly meaningful if the source is appropriately qualified and the medical evidence reasonably supports the opinion.