Treating Physician Information Form/authorization For Release Of Medical Records Form - September 11th Victim Compensation Fund - Page 11

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 History (Symptoms) & Physical
 American Association of Family Physicians
Upper Airway
Inflammatory
Exam Findings*
Diagnosing Rhinitis: Allergic vs. Nonallergic
 Radiographic/imaging (CT of
6
Disorders
(2006)
the sinuses)
3.html
 American Academy of Otolaryngology/Head
and Neck Surgery. Clinical Practice
Guidelines on Adult Sinusitis(2007)
5.full
 History (Symptoms) & Physical
 American Gastroenterological Association
Gastroesophageal
Reflux Disorder
Findings* and/or
(AGA) Medical Position Statement on the
 Response to therapy* and/or
Management of Gastroesophageal Reflux
 Endoscopic evidence of
Disease(2008)
esophagitis, stricture or
5085(08)01606-5/fulltext
Barrett’s metaplasia*
 History (Symptoms) & Physical
 American Academy of Sleep
Sleep Apnea
(Obstructive Sleep
Findings
Medicine(AASM) Clinical Guideline for the
 Interpretation of a
Apnea) "exacerbated
Evaluation, Management and Long-term
by, or related to, a
Care of Obstructive Sleep Apnea in Adults
polysomnogram or sleep study
health condition" in
(2009)
by a sleep medicine specialist
Diagnostic Essentials, --
or pulmonologist, showing
-excluding MSD and
guidelines/OSA_Adults.pdf
evidence of Obstructive Sleep
Malignant Neoplasms.
Apnea*
 History (Symptoms) & Physical
Musculoskeletal
• American Academy of Orthopedic Surgeons
Disorders (MSDs)—
(AAOS) Endorsed Guideline - American Pain
Findings* and/or
 Radiographic/Imaging
Heavy Lifting or
Society Clinical Guideline for the Evaluation
7
Repetitive Strain
and Management of Low Back Pain
Evidence* and/or
 Electrodiagnostic testing (e.g.,
(Diagnosis and Treatment of Low Back Pain:
A Joint Clinical Practice Guideline from the
Electromyography and Nerve
American College of Physicians and the
Conduction Velocity study)
American Pain Society)(2007)
id=736814
6
Upper airway inflammatory disorders is a broad category of health conditions; however, for the purpose of verification for
VCF claims, the category is limited to include only the following conditions: chronic rhinosinusitis or chronic rhinitis (either
irritant or allergic), chronic nasopharyngitis, chronic laryngitis, and upper airway hyperactivity.
7
In the case of a WTC responder only (i.e., not in the case of a survivor) who received any treatment for a WTC-related musculoskeletal
disorder on or before September 11, 2003, the list of health conditions that can be verified includes: (1) low back pain; (2) carpal tunnel
syndrome (CTS); and (3) other musculoskeletal disorders. The term ‘WTC-related musculoskeletal disorder’ means a chronic or recurrent
disorder of the musculoskeletal system caused by heavy lifting or repetitive strain on the joints or musculoskeletal system occurring
during rescue or recovery efforts in the New York City disaster area in the aftermath of the September 11, 2001, terrorist attacks. See 42
U.S.C. § 300mm-22(a)(4).

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