From Big Medical Encyclopedia

EXAMINATION MEDICAL LABOUR (VTE) — the type of examination consisting in determination of duration and degree of disability of the person in connection with a disease or a mutilation, identification of the reasons of disability, establishment of group of disability.

Doctors of various specialties take part in carrying out VTE: therapists, surgeons, neuropathologists, pathologists and other specialists, sometimes are attracted psychologists.

VTE for establishment of group and the reason of disability and indications for prosthetics, providing with vehicles is carried out by medical labor commissions of experts (VTE K), and examination of temporary disability — the medical and consulting commissions (In K K).

History. Great October socialist revolution for the first time in the history of mankind allowed to carry out the wide program of social security, including and one of its sections — examination of working capacity. In the Labour Code of 1918 it was written down

that constant or temporary disability makes sure the medical survey which is carried out by the bureau of medical examination (BME) at city, regional and regional hospital cash desks. Late BVE was turned into maintaining bodies of social security. In 1932. All-Union Council of social insurance entered three-group classification of disability, the cut was the principle of definition of a condition of working capacity taking into account medical and social factors the basis. Same year BVE were reorganized into the medical labor commissions of experts (MLCE). In 1937 VTE was finally transferred to the jurisdiction of bodies of social security (see. Medical labor commission of experts).

For years of socialist construction the provision on VTEK and the list of diseases and defects were regularly revised, at to-rykh the group of disability is established, including it is termless. Since January 1, 1985 the new standard provision on VTEK approved by the Resolution of Council of ministers of the USSR (1984) works.

On the basis of this Situation councils of ministers of federal republics together with republican Councils of labor unions approve regulations on VTEK for each republic.

Organizational bases of vracheb-but-labor examination include the following provisions: the bodies which are carrying out examination of working capacity are uniform for all groups of the population and are created on administratively - to a territorial sign; loss or considerable restriction of working capacity are divided into temporary disability, edges is defined by the attending physician and VKK, and the long or constant, resistant, defined VTEK; to disabled people in the course of examination of working capacity one of groups of disability — I, by II or III — depending on extent of disability is established, each group has kliniko-physiological, social and precepts of law (see Disability). For carrying out additional inspections of a kliniko-expert and functional state in difficult cases in a number of federal republics hospitals or beds in chambers, departments, and also in research in-ta of examination of working capacity of a social security system are allocated; at establishment of disability the reference of VTEK of a uniform form which is equally authoritative in all territory of the USSR is issued.

For years of socialist construction the main standards of VTE were developed and approved by practice, to-rye are based on the principles of the Soviet health care and the principles of social security. The leader from them is the state character of VTE, i.e. the material security of citizens in case of loss of working capacity by them is made at the expense of the state, and the right, the volume and the nature of social security are defined by the expert opinion. Specially created public authorities which are carrying out VTE realize this situation.

The main objectives of VTEK according to standard situation are: definition of a condition

of working capacity, constant or its long loss, establishment of group and reason of disability; definition for disabled people of the conditions and types of work, works and professions available to them for health reasons, and also conditions and methods, with the help to-rykh the broken working capacity can be recovered or increased, validation of use of disabled people at work according to the conclusions of the commissions; assistance to strengthening of health of the population, to the prevention of disability; studying together with bodies of health care, administration of the enterprises, institutions, the organizations and trade-union bodies of the reasons of disability in case of disability and participation in development of actions for prevention of disability and to recovery of working capacity.

One of important problems of VTE is definition of the reason of disability. In each case disability is established for one of the following reasons: the general disease, occupational disease, a labor mutilation, disability since the childhood; for the military personnel — the wound, a contusion, a mutilation received at protection of the USSR or at execution of other obligations of military service or the disease connected with stay at the front, or the injuries sustained as a result of the accident which is not connected with fulfillment of duties of military service or the disease which is not connected with stay at the front, and in specially stipulated by the legislation cases — the disease got at fulfillment of duties of military service. By the legislation of the USSR also other reasons of disability can be established.

The VTE preventive direction provides the prevention of disability by timely transfer of working (employees) in such working conditions, to-rye correspond to a condition of their health that prevents «weighting» of disability thanks to elimination or decrease in negative influence of the production environment.

The rational labor device of disabled people includes use at them residual professional working capacity or training of a new profession, activity within real opportunities of the person and is the social and recreational means promoting development of compensatory resources of an organism, recovery of its social standing.

Medical control of a condition of working ability of disabled people (systematic re-examination) allows to reveal the available changes in the state of health and according to it to return the person to usual work or, on the contrary, to transfer the disabled person to I or

II groups of disability, having increased the level of provision of pensions.

Collective nature and complexity in work of VTEK, participation of representatives in it of trade-union and other public organizations provides objectivity of the expert opinion, its scientific validity as as much as possible reduces a possibility of the wrong decision.

Legal aspects of examination of working capacity. The expert opinion on disability is the statutory act defining the right of workers for social security, for release from work in social production or on more preferential terms of work, the right for free prosthetics, providing with microcars or the automobile cars adapted for disabled people, a dignity. - hens. treatment and other types of the social help. According to the specific facts determined by examination of working capacity arise, the personal rights of citizens for social security on disability change or stop. The legislation provides various rights, volume and the nature of material security depending on social conditions and circumstances under which there was a disability. The right of citizens for material security, in case of a disease, full or partial disability, and also loss of the supporter is fixed in an old age by article 43 of the Constitution of the USSR.

Structure of medical labor commission of experts. For examination of disability owing to various diseases the following In energy industry is formed: general profile; a specialized profile for survey of TB patients, persons with mental disorders, diseases

and defects of an organ of sight, diseases of bodies of blood circulation and other diseases; the mixed profile.

Regional, interdistrict, city In energy industry consist of three doctors, the representative of appropriate authority of social security and the representative of the trade-union organization (trade-union body). In structure republican, regional, regional, central city (in cities of republican subordination) VTEK enter four doctors, the representative of appropriate authority of social security and the representative of the trade-union organization (trade-union body). For the general management of VTEK in the republic, the region, the area, the city (republican subordination) the chief medical labor examination expert is appointed. In the presence of less than five members of structure of the commissions of a duty of the chief expert are assigned to the chairman of one of structures of the commission.

Duties and rights of medical labor commissions of experts. The following duties are assigned to regional, interdistrict, city VTEK: establishment of a condition

of working capacity, long or its constant loss, group, the reason and time of approach of disability, and also extent of disability (as a percentage) to the workers or employees who sustained injuries or lost health in connection with execution by them of labor duties, and their needs in additional types of the help; definition of measures for social and labor rehabilitation; establishment of a causal relationship of death of the supporter with a production injury, occupational disease, stay at the front and other circumstances for the solution of a question of award of pension and remedial to members of the family of the dead; rendering to citizens assistance in search of the documents necessary for carrying out VTE, representation to-rykh by the current legislation is assigned to the persons undergoing survey; check in the place of work of disabled people of correctness of the labor device and their use according to recommendations of the commissions; participation in studying of working conditions, certifications of jobs for the purpose of identification of the factors which are adversely influencing the state of health and working ability of workers and in development of actions for their elimination; definition of conditions and types of work, works and professions available to disabled people; representation through regional, city departments of social security in the corresponding military commissariats of data on all cases of recognition by disabled people of persons liable for call-up and recruits.

Republican, regional, regional, central city (in cities of republican subordination) VTEK perform organizational and methodical management and control of activity of regional, interdistrict, city VTEK, check their decisions and in case of groundlessness change them; re-examine the persons appealing solutions of VTEK; carry out survey in difficult cases of persons in the directions of regional, interdistrict and city VTEK; will examine disabled people for the purpose of definition of needs them in special vehicles; implement the scientific principles and methods of examination developed by research in-ta in practice of work of VTEK prepare offers on further improvement of VTE, study, generalize and extend the best practices of work of VTEK; carry out studying of the reasons of disability and on this basis develop actions for their elimination, prevention of disability and recovery of working ability of citizens; take measures to professional development of workers of VTEK and provide participation of specialists in VTE in professional development of doctors of healthcare institutions.

VTEK have the right: to receive from bodies and healthcare institutions, the administration of the enterprises, institutions, the organizations of the data necessary for work of the commissions, including data on character and working conditions of the persons undergoing survey; to direct the persons undergoing survey in to lay down. - the prof. of establishment for specification of the diagnosis and recovery treatment; to visit in accordance with the established procedure the enterprises, institutions, the organizations, to examine places of production of works, production and service premises, to get acquainted with reports, statistical and other materials on the questions relating to activity of the commissions.

An order of survey of citizens in medical labor commissions of experts. Survey of citizens is carried out to VTEK in to lay down. - the prof. institutions at the place of residence or in the place of an attachment in the direction of the relevant treatment and prevention facility.

VTEK will examine citizens when according to the legislation establishment of disability is connected with providing to them the rights for the social help or with release from performance of the corresponding duties, and in other cases provided by the current legislation. Besides, for the purpose of improvement of service of workers, employees and members of collective farms field meetings of VTEK in corresponding are held to lay down. - the prof. of establishment. For holding field meetings of the commission are provided with transport in the order established by councils of ministers of federal republics.

If the patient for health reasons according to the conclusion of VKK to lay down. - the prof. of establishment cannot be in VTEK, survey is carried out at home or in a hospital where it is on treatment. In exceptional cases (e.g., in the remote, hardly accessible areas) survey of citizens from their consent can be carried out in absentia.

Meetings of VTEK are conducted in full strength, decisions are made after joint discussion of results of survey. Data of expert survey and the decision are entered in the minutes of VTEK and in the act of survey, to-rye are signed by the chairman, other members of the commission and are certified by the press. If the chairman or certain members of the commission do not agree with the made decision, then their dissenting opinion is entered in the act of survey, and the act is submitted within 3-day term in republican, regional, regional, central city (in cities of republican subordination) VTEK, edges makes the decision on this case. Decisions republican, regional, regional, central city (in cities of republican subordination) are accepted by VTEK (including at survey in difficult cases, as control or the appeal and in other cases) by a majority vote members of the commission. At equality of votes the opinion of the chairman of the commission is decisive. The member of the commission not concordant with the made decision states in writing the dissenting opinion, a cut is filed.

Date of establishment of disability day of receipt in VTEK of the documents necessary for survey of the patient is considered.

VTEK give out to the persons undergoing survey, references and

send to 3-day time to the relevant enterprises, institutions, the organizations the notice of the established form of the made decision. Forms of the documents used in work of the commissions are approved by the State committee of the USSR on work and social problems in coordination with the relevant ministries and departments. The persons guilty of pronouncement of intentionally wrong decision, illegal issue of the reference Of energy industry bear the responsibility provided by the current legislation.

Examination of working capacity along with VTE includes also vrachebnostrakhovy examination (VSE), edges are carried out by survey of the insured persons for establishment of percent of disability in connection with an injury, accidental acute poisoning with the noxious plants, chemicals, various medicine taken by the patient or entered into an organism on doctor's orders, substandard foodstuff, etc., and also identification of causes of death according to medical and other documents. Survey insured and determination of percent of disability is made by the medical and insurance commissions of experts (MICE).

Medical and insurance expertize of deaths is carried out vra - chom - the expert of Management of the Gosstrakh (the city, area, edge, the autonomous, federal republic) in the presence of insurance documents, extracts from case histories and out-patient cards, the certificate of bodies of a registry office about death or its copy certified of a notarial order, and in necessary cases — documents of judicial investigating authorities and the act of a medicolegal or pathoanatomical research of a corpse. At the mixed life insurance from accidents and insurance of children (in case of the death of the child) the conclusion of the medical expert is not required. The statement of insurers with a statement of circumstances of death, insurance certificates, extracts from a case history (the out-patient card) form the basis for carrying out survey.

Organization of scientific research for examination of working capacity.

Scientific research on examination of working capacity in RSFSR and nek-ry federal republics is carried out in research in-ta of a social security system, and also in research and medical in-ta of M3 of the USSR and mines - in health care of federal republics. Head scientific institution is Central awards of the Labour Red Banner of scientific research institute of examination of working capacity and the organization of work of disabled people (TsIETIN).

In premilitary years of an in-tama theoretical and organizational and methodical bases of the labor device of disabled people and labor recommendations of VTE K, the medical indication and a contraindication to vocational education, retraining and the rational labor device of disabled people in various industries of the national economy were developed.

In days of the Great Patriotic War the differentiated expert approach to assessment of working capacity of persons with anatomic defects was developed, new diagnostic methods were found and proved, indications to the labor device and recovery of working ability of disabled veterans were specified. All this together with establishment of the corresponding privileges and advantages to disabled people of Patriotic war allowed to provide return of their considerable part to labor collectives.

In a crust, time the attention of in-t is directed to increase in level of diagnosis and quality of VTE at survey of patients and disabled people, to improvement of prevention and decrease in disability, improvement of medical and professional rehabilitation of disabled people, recovery of the social and personal status of disabled people.

Examination of working capacity in foreign countries. In the socialist countries taking into account experience of the USSR national systems of examination of working capacity are developed. In ChSSR, e.g., it is carried out as well as in the USSR, medical commissions of experts, to-rye resolve the following issues: justification of increase in times

of mayors of pension in connection with helplessness for a covering of additional expenses on leaving; recognition of full or partial disability; transfer into other work; providing special privileges to persons with especially heavy disturbance of health and working capacity (including providing carriages and motor transport); the solution of a question of need of sanatorium treatment for unemployed pensioners.

Expertize of working capacity in GDR is carried out by the chief physician of the area (district) on examination of working capacity on the basis of the inspection of the patient and documents prepared by attending physicians. Control of the organization of examination in the country is imposed on the Ministry of Health and social both

specheniye. At the Ministry there is the Central commission of experts which tasks include studying of a condition of disability in the country and the recommendation about its decrease, analysis of complaints and implementation of advisory and control activity.

In the capitalist countries the social security system and examinations of working capacity has other character. In a number of the capitalist countries if necessary functional divisions with the non-constant list of experts are created. In England, e.g., there is no uniform standardized system of assessment of a condition of working capacity.

The request for medical survey for definition of a condition of working capacity goes the patient to the relevant insurance cash desk no later than three years since approach of temporary disability in time, existence a cut is established by the attending physician, I have - (

shchy the relevant contract with cash desk. The main organizer of expert survey the medical expert is. He starts the responsibilities since that moment as he was elected for this case of examination by the attending physician of the patient.

Survey is paid; expenses for it are incured by cash desk of social insurance, edge in nek-ry cases (e.g., at unreasonable, from her point of view, examination) can assign expenses on the patient. Recognition of disability owing to a disease or an injury in many cases is justification for reduction of wages.

Bibliogr.* Medical labor examination, under the editorship of A. F. Tretyakov, M., 1959; Medical labor examination at the present stage, under the editorship of T. A. Raw vodkas, etc.,

M., 1980; Bases of medical labor examination, under the editorship of A. F. Tretyakov, M.,

1960; The Guide to medical labor examination, under the editorship of Yu. D. Arbatskaya,

M., 1977; Social insurance in the USSR, sost. G. S. Simonenko, page 3, M., 1976;

The Reference book of documents on VTE and employment of disabled people, under the editorship of P.A.Mak-kaveyskogo, JI., 1981; The Reference book on the state insurance, under the editorship of

JI. A. Motyleva, page 121, M., 1978.

E. I. Udintsov.