Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Abdominal Aneurysm


Related Terms

  • Abdominal Aortic Aneurysm
  • Aneurysm of the Abdominal Aorta
  • Dissecting Abdominal Aneurysm
  • Fusiform Abdominal Aneurysm
  • Saccular Abdominal Aneurysm

Differential Diagnosis

Specialists

  • Cardiovascular Internist
  • Gastroenterologist
  • Vascular Surgeon

Comorbid Conditions

  • Anatomic factors (e.g., horseshoe kidney)
  • Blood-clotting abnormalities
  • Chronic obstructive pulmonary disease
  • Congestive heart failure (CHF)
  • Gastrointestinal disorders
  • Heart disease
  • Obesity
  • Other vascular disease
  • Respiratory disease

Factors Influencing Duration

Factors that may lengthen disability include the location and size of the aneurysm, the age of the individual, the extent of surgical repair necessary, whether underlying cardiovascular diseases such as hypertension or arteriosclerosis are present, and whether postoperative heart attack (myocardial infarction) or renal failure occurs. The length of disability also depends on job requirements and how rapidly the individual recovers from the surgical procedure. If the job requires strenuous physical labor, the disability will last longer than if work requirements are more sedentary.

Individuals with abdominal aortic aneurysms are generally older, and generally they have atherosclerosis in other places (such as coronary artery disease, carotid artery disease, or peripheral vascular disease in the legs). Thus, many times they are not capable of heavy or very heavy work because of co-morbidities, even if the abdominal aorta has been successfully repaired.

Medical Codes

ICD-9-CM:
441.02 - Dissection of Aorta, Abdominal
441.03 - Dissection of Aorta, Thoracoabdominal
441.3 - Abdominal Aneurysm, Ruptured
441.4 - Abdominal Aneurysm without Mention of Rupture
441.6 - Thoracoabdominal Aneurysm, Ruptured, Ruptured
441.7 - Thoracoabdominal Aneurysm

Overview

An abdominal aortic aneurysm (AAA) refers to a localized weakness and ballooning (dilation) of the aorta in the segment between the kidneys and the branches in the legs (iliac arteries). The aneurysm is termed saccular when it consists of an outpouching on one side of the arterial wall. The aneurysm is termed fusiform when the dilation extends around the circumference of the vessel. When there is actual separation within the wall of the aorta, the aneurysm is termed dissecting. Occurring rarely, dissecting aneurysms of the abdominal aorta usually represent an extension of a process beginning in the thoracic aorta.

AAAs begin as small pea-sized swellings of the normal aorta, which is approximately 2 cm in diameter ("Abdominal Aortic Aneurysm"). They grow at a rate of about one-quarter to one-half inch per year, but the growth rate can vary. Asymptomatic AAAs under 5 cm in diameter are not considered clinically significant but need to be monitored for changes in size. The likelihood of rupture increases as the aneurysm increases in size, and treatment is generally indicated for asymptomatic AAAs over 5 cm in diameter. As the aneurysm expands, increasing pressure is exerted against neighboring structures and may result in potentially lethal complications.

AAAs usually have no symptoms and are most commonly found either during a general physical examination or on an x-ray done for some other reason. Approximately 38% of all abdominal aneurysms are felt (palpated) and diagnosed during a routine physical examination, and 62% are discovered on incidental x-rays (Pearce).
Individuals with hardening of the arteries (atherosclerotic vascular disease), peripheral vascular disease, high blood pressure (hypertension), chronic obstructive pulmonary disease, or connective tissue disorders; those who have experienced trauma; and those who smoke are at increased risk for AAA. Up to 50% of individuals with a popliteal artery aneurysm will also have an AAA (Pearce).

Up to 10% of AAAs are inflammatory in origin and are more likely to be symptomatic, affecting younger individuals (Hellman). Approximately 1.3% of AAAs are caused by infection and have a high mortality rate of up to 70%. More than half of these types of AAA are caused by the organisms Staphylococcus aureus and Salmonella (Davies 331).

Incidence and Prevalence: The incidence of AAA is 2% to 4% of the general population (O’Connor). In autopsy studies, the incidence of AAA is 0.5% to 3.2% (Pearce). The prevalence of AAA in US veterans is 1.4% (Pearce).

The frequency of AAA rupture is 4.4 cases per 100,000 individuals (Pearce), with an overall mortality rate of 15,000 individuals per year (Radvany).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The risk for AAA increases with age, with more than 75% of individuals with AAA older than the age of 60 (O'Connor); the peak incidence of AAA is in individuals aged 70 (Pearce).

Overall, men are 7 times more affected by AAA than women, with the highest frequency of AAA occurring in white males (O'Connor). However, AAAs in women are more likely to rupture at smaller diameters (Pearce). Up to 25% of AAA cases occur in individuals with a first-degree relative also having the condition (Pearce).

Source: Medical Disability Advisor



Diagnosis

History: An individual may not have any symptoms (asymptomatic) and may not be aware of the condition for quite some time, especially if the aneurysm is small; most cases of AAA remain asymptomatic until they rupture (O’Connor). In fewer than 50% of cases, individuals may report an abnormally prominent throbbing (pulsating) lump or mass in the abdomen that is easily seen and felt. Constant pain in the lower back region as a result of pressure on the lumbar nerves may be present. The individual may also describe the pain as a steady, gnawing discomfort in the lower back or abdomen.

Symptoms that progress to severe pain in the lower abdomen or back that radiates to the buttocks, groin, or legs may signal an imminent rupture of the aneurysm. Vomiting and feeling faint (syncope) may also precede AAA rupture. Individuals experiencing severe, abrupt, persistent back and/or abdominal pain may have an aneurysm that has already ruptured. Additional symptoms indicating that rupture has occurred include weakness (paresis), as well as those of hypovolemic shock: low blood pressure (hypotension), sweating (diaphoresis), and fast heart rate (tachycardia). If medical care is not sought immediately, unconsciousness, cardiac arrest, and death may result.

Physical exam: In non-obese individuals, a pulsating mass or swelling in the umbilical area may be evident. A blowing murmur (bruit) can be heard when a stethoscope is placed over the mass. Abdominal aneurysms do not cause diminished pulses in the arms. However, diminished pulses in the legs (peripheral pulses) may be present due to atherosclerotic narrowing of the iliac, femoral, or more distal arteries.

Tests: Routine x-rays of the abdomen may demonstrate an AAA by revealing the calcification that exists in the wall of the aneurysm in less than 50% of instances (O’Connor). Aortography (x-ray of the aorta immediately following injection of x-ray contrast, or “dye”) is a more detailed x-ray procedure that shows the inside of an aneurysm and permits precise measurement of its size and location. Aortography can also differentiate a dissecting aneurysm from a saccular or fusiform aneurysm.

Abdominal ultrasound is a noninvasive alternative to aortography. Some physicians prefer ultrasound to x-ray because ultrasound is readily available at the bedside, does not expose the patient to radiation or contrast agents, and is less costly. Serial ultrasound examinations permit following the size of an AAA to determine when elective surgery should be performed.

Although more costly, serial computed tomography angiograms (CTA) are especially valuable in cases where the AAA is already greater than 5 cm when it is first diagnosed or when the size of the aneurysm is rapidly increasing. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) are other options for patients whose kidneys may not be able to tolerate the dye used with CTA or standard angiograms.

Source: Medical Disability Advisor



Treatment

Treatment is directed at reducing the risk of aneurysm rupture by timely surgical resection of the aneurysm and replacement or reinforcement of the damaged aortic section with a graft. If the aneurysm is small and produces no symptoms, surgery may be delayed; however, even small aneurysms may rupture. A vascular surgeon should be consulted if the aorta is greater than 3 cm in diameter or if any part of the aortic artery is greater than 1.5 times the diameter of an adjacent section (O’Connor). In general, individuals with an AAA smaller than 4 cm should have twice-yearly ultrasounds to track progress; if the AAA grows larger than 4 cm or grows more than 0.5 cm over a 6-month period, surgical repair should be performed (O’Connor).

Urgent but not emergency surgical repair is recommended for aneurysms 5 cm or larger or those that are rapidly becoming larger in individuals without other significant medical problems. Elective surgical repair is often considered for aneurysms between 4 and 6 cm.

Because rupture of an AAA constitutes a medical emergency necessitating immediate surgery, the goal of management is to reduce the risk of rupture. Medications called beta-blockers may be taken to lower blood pressure, thereby decreasing the rate of growth of an AAA. Individuals who smoke are counseled to quit. Regular physical examinations and ultrasound studies are used to detect enlargement that may justify surgical intervention.

Surgical repair of an AAA consists of removal (resection) of the part of the artery affected by the aneurysm (aneurysm resection) and restoration of blood flow using a synthetic or composite graft replacement. This procedure is used in emergency as well as elective situations.

Insertion of an endovascular stent graft may be an option in some cases. A stent is an artificial tube-like device that reinforces the existing arterial wall. The advantage of a stent is that the blood vessel does not need to be excised and blood leakage is less likely, whereas grafts can tear away from the insertion site or leak blood into the abdomen. Stents implanted via an endovascular aneurysm repair (EVAR) access the aorta via a peripheral artery and use catheters to place the stent internally within the aorta while viewing live x-ray pictures of the site. This allows treatment without open resection or removal of the aneurysm, eliminating the need for general anesthesia.

Emergency surgery involves the same procedure as in nonemergency situations, to resect the aneurysm and repair the damaged section of the aorta, with the additional need for stabilizing measures. These measures include the administration of medications to lower blood pressure (antihypertensives), medications to decrease the force of blood vessel contractions (beta-blockers), oxygen for difficulty in breathing, narcotics for pain relief, administration of fluids directly into a vein (intravenous), and, if necessary, whole blood transfusions.

Source: Medical Disability Advisor



Prognosis

Among individuals with a leaking or ruptured AAA, the peri-operative death rate is about 50%; of those who survive transport to the hospital, the survival rate continues to drop an additional 1% each minute surgery is delayed (O’Connor). Among individuals with smaller, unruptured aneurysms, the peri-operative mortality is only 8% (O’Connor). Ninety percent of unruptured, nonemergency aneurysm repairs are successful (“Abdominal Aortic Aneurysm”).

Because the natural progression of an AAA is to rupture, the mortality rate for an untreated AAA is eventually 100% (Pearce).

Source: Medical Disability Advisor



Complications

If an AAA is not effectively managed, the outcome is rupture. Rupture may result in hypovolemic shock, heart attack, stroke, or death. Complications resulting from surgery include bowel ischemia; kidney failure; pneumonia; movement of emboli to the lower extremities, bowel, or kidneys; and leakage from the graft. Complications from stent placement include perforation of the AAA and movement of emboli to the lower extremities, bowel, or kidneys.

Untreated AAA may result in the formation of blood clots inside the aneurysm, leading to peripheral embolisms that may migrate to the lower extremities or other organs (“Abdominal Aortic Aneurysm”).

Following open AAA repair, complications requiring a surgical revision are 2% within the first 5 years (Pearce). Following endovascular repair, up to 10% of individuals require secondary surgical intervention within the first year (Pearce).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Before and after surgery for an AAA, contact sports and activities that require lifting more than 25 pounds or any significant straining should be avoided. Associated atherosclerotic cardiovascular disease involving the heart or legs and causing effort angina and/or claudication may limit activity or require work accommodations in addition to those necessitated by an AAA.

Following open surgical aneurysm repair, individuals may be hospitalized for 4 to 7 days. Full recovery may take 6 weeks to 3 months (“Abdominal Aortic Aneurysm”). Recovery from an endovascular stent graft is shorter, with 2 to 3 days of hospitalization; however, the individual will need extra time off for frequent follow-up visits to ensure the graft is functioning normally (“Abdominal Aortic Aneurysm”).

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • What type of AAA does individual have? Was it ruptured or dissecting?
  • What was the cause of the AAA?
  • Did individual present with a clinical history and symptoms consistent with the diagnosis of abdominal aortic aneurysm?
  • Did individual have symptoms of shock or symptoms suggestive of aneurysm rupture?
  • Was the diagnosis confirmed with a physical exam and diagnostic imaging studies?
  • Was the diagnosis determined promptly?
  • If the diagnosis was uncertain, were other conditions with similar symptoms ruled out?
  • Would individual benefit from consultation with a specialist (cardiologist, vascular surgeon, gastroenterologist)?

Regarding treatment:

  • Was the treatment appropriate for the size and nature of the aneurysm?
  • Was there any unnecessary delay in treatment?
  • Did individual require emergency surgery?

Regarding prognosis:

  • Based on the size of the aneurysm and the presenting symptoms (rupture vs. non-rupture), what was the expected outcome?
  • Does individual have any comorbid conditions that may affect surgical risk or ability to recover?
  • Did individual have any complications that may affect recovery and prognosis?

Source: Medical Disability Advisor



References

Cited

"Abdominal Aortic Aneurysm." VascularWeb. 2009. Society for Vascular Surgery. 21 Aug. 2009 <http://www.vascularweb.org/patients/NorthPoint/Abdominal_Aortic_Aneurysm.html>.

Davies, Mark, John Byrne, and John S. Harvey. "Clostridial Infection of the Abdominal Aorta." Journal of the American College of Surgeons 197 2 (2003): 331-331. MD Consult. Elsevier, Inc. 6 Oct. 2009 <http://home.mdconsult.com/das/journal/view/40781768-2/N/13925091?sid=279058461&source=MI>.

Hellman, David B., D. J. Grand, and J. A. Freischlag. "Inflammatory Abdominal Aortic Aneurysm (Abstract)." JAMA 297 (2007): 395-400.

O'Connor, Robert E. "Aneurysm, Abdominal." eMedicine. Eds. Edward Bessman, et al. 15 Jul. 2008. Medscape. 20 Aug. 2009 <http://emedicine.medscape.com/article/756735-overview>.

Pearce, William H. "Abdominal Aortic Aneurysm." eMedicine. Eds. Jeffrey Lawrence Kaufman, et al. 15 Dec. 2008. Medscape. 21 Aug. 2009 <http://emedicine.medscape.com/article/463354-overview>.

Radvany, Martin G., and Venerando Seguritan. "Abdominal Aortic Aneurysm, Diagnosis." eMedicine. Eds. Eric P. Weinberg, et al. 2 Oct. 2008. Medscape. 21 Aug. 2009 <http://emedicine.medscape.com/article/416266-overview>.

General

Lederle, Frank A. , J. A. Freischlag, and Tassos C. Kyriakides. "Outcomes Following Endovascular vs Open Repair of Abdominal Aortic Aneurysm: A Randomized Trial." JAMA 302 14 (2009): 1535-1542.

Source: Medical Disability Advisor






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