Understanding aggravation of preexisting conditions

Sprains and strains cause nearly half of work-related injuries involving days away or restrictions. In severe cases, these injuries may require surgery or result in permanent restrictions. For purposes of injury recordkeeping on the OSHA 300 Log, a preexisting (non-work) condition will be recordable if it gets “significantly aggravated” due to an event or exposure in the work environment.

For example, if an employee injures himself outside the workplace (playing sports or doing home repairs), and the condition gets worse because of job duties, the injury becomes “work-related” and the employer may need to record the case on the 300 Log.

The risk of aggravation remains until the employee is fully healed, and a sprain or strain often requires considerable time to heal.

Aggravation defined

OSHA says that a preexisting condition becomes “significantly aggravated” if the employee requires medical treatment, restrictions, or days away that would not otherwise have been necessary if not for the work-related exposure.

To illustrate, suppose an employee strains his back at home, visits a doctor, and is given a prescription muscle relaxant. He then further strains his back at work and (because of the worsened condition) he requires a few days of bed rest to recover. The employer must record that as a “days away” case on the 300 Log.

Aggravated outside work

Adding another layer of complication, an OSHA letter of interpretation dated March 17, 2021, clarified that if a work-related injury (that was not recordable) got aggravated from non-work activities, the case could become recordable. The challenge here is that employees might engage in activities outside of work that make a work-related condition worse.

The letter asked about an employee who experienced pain in his elbow while using a pipe wrench at work on Friday. A health care professional (HCP) did not impose restrictions. That weekend, the employee had military exercises with physical tests that aggravated the injury. The following week, the employee again visited a HCP and was given work restrictions. Since using the wrench on Friday may have contributed to the condition and need for restrictions, OSHA determined that the case was a work-related incident involving restricted work.

Employers should know that non-work injuries can become recordable because of aggravation at work. Keep in mind that work-related injuries which get aggravated outside the workplace can also become recordable cases.