Thursday, May 3, 2018

Below Average Finger Dexterity -- Hearing Examination Develops the Vocational Cross

We discuss average finger dexterity last year with some examples out of the Revised Handbook for Analyzing Jobs.  Most unskilled jobs do not require average or better dexterity; they require below average dexterity.  

The regulations introduce the concept of dexterity as a work function as an example of how the ability to perform light work may not include the ability to perform sedentary work because of a loss of fine dexterity.  The electronic files of the SCO classify dexterity as an aptitude.  We see that in the West, US Publishing, and SkillTran regurgitations of the DOT/SCO.    

The RHAJ, SCO, DOT, and GOE all come out of the same data set last updated in 1991.  We have the reference in the regulations to dexterity and the inclusion in the electronic files classifying work by dexterity.  It is fair game.  First things first, define the terms.  We start with finger dexterity:
The ability to move the fingers and manipulate small objects with the fingers rapidly or accurately.
Immediately we see that frequency has very little to do with finger dexterity.  Rapidity and accuracy form the kernel of the question.  Examples clarify:
F-4:1 Mixes and bakes ingredients according to recipes to produce breads, pastries, and other baked goods:
Finger dexterity is required to work with ingredients and utensils and to perform such tasks as arranging strips of dough across tops of pies, and placing cut or formed dough in pans or on baking boards or trays.
F-4:2 Prepares, seasons, and cooks soups, meats, vegetables, desserts, and other foodstuffs for consumption in medical institutions:
Finger dexterity is required in using knives, brushes, scrapers, and other tools to clean, trim, slice, and dice vegetables, fruits, and meats; in ponioning foods; in turning dials and valves on kitchen equipment; in removing dishes, napkins, and waste materials from food carts; in sorting and stacking dishes; and in lining pans and shelves with paper
The last three examples in the RHAJ for finger dexterity address sewing; turning knobs, buttons, and switches; and using handtools and power tools.    But cooking a meal is a basic activity of daily living that warrants a relevant line of questioning.  
Q:  You told the judge that you cook meals for yourself.  Do you bake?
Q:  You told the judge that you cook meals for yourself.  Do you prepare, season, and cook meats, vegetables, desserts, and other foodstuffs?
 If the answer is no, the followup question is always why?  This gives the client the opportunity to describe weakness, pain, or difficulty moving the joints -- using the word dexterity should be avoided, describing the difficulty should be sought.  If the client cannot perform these activities because of a medically determinable impairment affecting the fingers, you have a basis for asking for a finger dexterity level 5 occupation. 

Manual dexterity provides examples that have ADL application:
M-4:4 Finishes household linens, such as sheets, pillowcases, tablecloths, and napkins:
Manual dexterity is required to shake. sort. fold. and stack laundry; to tie bundles of laundry together. and to feed and guide material into ironer.
M-4:7 Sorts rags and old clothing: 
Manual dexterity is required to rip off buttons, pockets, hooks and eyes. snaps. and other foreign matter.
A careful description of laundry and what the client does to shake, sort, fold, stack, and disassemble articles of clothing points to manual dexterity.  

A limitation to occasional use of the hands/fingers does not address the qualitative functions of hand/finger use.  But we have to ask the question to get it into the record:
Q:  How do the DOT/SCO rate the dexterity requirements for the work that you identified here today?
Then ask the question that assumes a level of dexterity consistent with the testimony and the examples.  Make the record and develop the evidence.  

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