Based on recommendations from the Small Business Administration's Office of Advocacy and the U.S. Chamber of Commerce, among others, the White House Office of Management and Budget is instructing OSHA to reconsider its rules for employers to record worker "musculoskeletal disorders" (MSD, ergonomic and repetitive motion problems), which constitute about a third of all occupational injuries and illnesses. The issue is whether employers can declare an MSD not "work-related" if it were partly caused or worsened by a worker's personal activities.

For all other injuries and illnesses, OSHA uses a "geographic" test: apart from a few specific exceptions like common colds, an injury or illness is work-related if events or exposures during work either caused or contributed to the problem -- even if other factors also contributed -- on the theory that the problem would not have occurred except for the employee's work activity or environment.

OSHA considered about 500 comments in developing its "plain language" rules, which were published the last day of the Clinton Administration: "Occupational Injury and Illness Recording and Reporting Requirements," Federal Register 66:5916-6135.

Two parts of the regulations engendered such heavy industry objections -- hearing loss and MSD -- that OSHA first postponed their effective date to January 2003 and then to January 2004. In the meantime, OSHA is developing specialized policies on "ergonomic" injuries and its former hearing loss rules remain in effect.

Current OSHA rules treat MSDs just as other illnesses: employers must evaluate whether it more likely than not results from -- or is significantly exacerbated by -- an event or exposure in the work environment. For recordkeeping purposes, an "event" or "exposure" includes any identifiable incident, occurrence, activity, or bodily movement that occurs in the work environment. If an MSD can be attributed to such an event or exposure, the case is work-related, regardless of the nature or extent of the ergonomic risk factors present in the workplace or the worker's job.

OSHA gives this guideline:

"Q. Must there be an identifiable event or exposure in the work environment for there to be a recordable case? What if someone experiences a backache, but cannot identify the particular movement which caused the injury?

A. Usually, there will be an identifiable event or exposure to which the employer or employee can attribute the injury or illness. However, this is not necessary for recordkeeping purposes. If it seems likely that an event or exposure in the work environment either caused or contributed to the case, the case is recordable, even though the exact time or location of the particular event or exposure cannot be identified.

[However] If the backache is known to result from some nonwork related activity outside the work environment and merely surfaces at work, then the employer need not record the case."

Certain industry groups want to turn the MSD rule on its head: if non-work factors cause or aggravate the problem -- even if work is a factor -- the MSD would not be work-related. According to OMB, they "propose including in the definition of 'musculoskeletal disorder' the likelihood that the injury may have been caused in whole or significant part by, and/or significantly exacerbated by, factors unrelated to the afflicted employee's work-related activities. Accordingly, absent a significant and ascertainable degree of work-relatedness, the MSD should not be recorded as a workplace injury or illness."

For example, if a word-processing operator had to switch jobs due to wrist pains (possible "carpal tunnel syndrome"), OSHA would call it work-related even if she also used her wrists at home cooking. But under the industry proposal, if her home cooking "significantly" worsened the pains, the MSD would not be recorded unless she could show her job was a cause, to a "significant and ascertainable degree."

Making such a change for MSD would reverse OSHA's standard principle that an injury or illness is work-related so long as work is a tangible, discernible causal factor, regardless of -- and with no requirement for assessing -- the relative weight of occupational and non-occupational causal factors.

Official MSD reports would drop quickly, and since MSDs comprise such a large proportion, the nation's occupational health and safety statistics could be tilted -- a quick (but not painless) way of cooking the books.