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Causes of permanent work disability in the sheet metal industry are not well characterized.Pension records were used to compare causes of disability among sheet metal workers and the U.S. working population. Subgroup analysis examined the major causes of sheet metal worker disability.Musculoskeletal disorders (MSDs), circulatory disease, and injuries were leading causes of sheet metal worker disability (47.2%, 13.7%, 10.9% of awards, respectively). Award distribution differed from the U.S. working population (P < 0.0001); MSDs and injuries accounted for higher proportions of sheet metal worker awards, particularly at spine, shoulder, and knee.Higher proportions of awards caused by MSD or injury among sheet metal workers may reflect higher rates of work-related injuries and MSDs, a high likelihood of disability with construction work given the same impairment, or higher prevalence of other conditions in the general population. Prevention requires task-specific ergonomic innovations and proven participatory interventions. Am. J. Ind. Med. 59:186–195, 2016. © 2016 Wiley Periodicals, Inc.