The reporting and acceptance of a musculoskeletal occupational disease in Germany is based on an extensive procedure. An admissible occupational disease has to be named on the list of occupational diseases defined by a medical specialist committee of the Federal Ministry of Labour and Social Affairs. This committee defines the scientific guidelines for reporting doctors. For most of the occupational diseases these guidelines include information about occupational exposures or defined occupational groups. For the acceptance of an occupational disease, more elaborate criteria have to be fulfilled. In Germany, there are currently fourteen occupational musculoskeletal diseases. Three more occupational diseases are currently being discussed by the medical specialist committee. Disc related diseases of the lumbar spine are the occupational diseases for which there are the most reports. The scientific guidelines include tables with loads and forces. The criteria for acceptance include duration of exposure, frequency of exposure, and kind of exposure (heavy loads, trunk inclination). Only few of the initially reported cases are finally compensated. The identification and compensation of occupational diseases in Germany started as soon as 1885 and developed into a complex process. New input by international comparisons will be beneficial for the future discussion.