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.

Aortic Aneurysm


Related Terms

  • Descending Aneurysm
  • Fusiform Aneurysm
  • Saccular Aneurysm

Differential Diagnosis

Specialists

  • Cardiovascular Internist
  • Nephrologist
  • Neurologist
  • Pulmonologist
  • Vascular Surgeon

Comorbid Conditions

Factors Influencing Duration

Factors that may influence the length of disability associated with an aortic aneurysm include age of the individual, extent of surgical repair necessary, whether the aneurysm ruptures, and the presence of postoperative complications such as heart attack (myocardial infarction) or kidney (renal) failure. Disability may be permanent for individuals who perform strenuous physical work or have serious postoperative complications.

Medical Codes

ICD-9-CM:
441.2 - Thoracic Aneurysm without Mention of Rupture
441.3 - Abdominal Aneurysm, Ruptured
441.4 - Abdominal Aneurysm without Mention of Rupture
441.5 - Aortic Aneurysm of Unspecified Site, Ruptured
441.6 - Thoracoabdominal Aneurysm, Ruptured, Ruptured
441.7 - Thoracoabdominal Aneurysm

Overview

© Reed Group
An aortic aneurysm refers to an abnormal, localized blood vessel wall weakness and bulging or ballooning (dilation) in a segment of the aorta. The aorta is the largest artery in the body, beginning above the left chamber (ventricle) of the heart (ascending aorta), curving down (aortic arch), and descending to the chest (descending thoracic aorta) and into the abdomen (abdominal aorta). Depending on the location of the aneurysm, it may be termed a thoracic aortic aneurysm or an abdominal aortic aneurysm.

Abdominal aortic aneurysms are more common than thoracic aortic aneurysms and account for approximately 75% of all aortic aneurysms. Abdominal aneurysms usually occur in the segment of the aorta between the kidneys and the arteries that go to the pelvis and legs (iliac arteries). Thoracic aneurysms occur in the ascending, transverse, or descending segments of the aorta.

Most aneurysms are approximately pea-sized, although they can be as small as a pinhead or as large as an orange. Aneurysms tend to grow at a rate of one-eighth to one-quarter of an inch per year, although the rate of growth can vary. The likelihood of rupture, which may be fatal, increases as the aneurysm increases in size. As the aneurysm grows larger, it also exerts increasing pressure against neighboring organs and tissues that may result in potentially lethal complications.

The two primary causes of aneurysms are the build-up of fat cells and debris in the artery wall (atherosclerotic plaque) and high blood pressure (hypertension). Other causes include infection, trauma, inflammation of the arteries, inherited conditions such as Marfan's syndrome, or untreated syphilis. The condition may be also associated with connective tissue diseases such as systemic lupus erythematosus.

Risk factors for thoracic aneurysms include connective tissue disorders (such as Marfan's syndrome) arteriosclerosis, previous dissection of the aorta, prolonged hypertension, and trauma.

Incidence and Prevalence: Three percent of individuals over age 50 will experience an aortic aneurysm. About 9% of men who are in their eighties have an abdominal aortic aneurysm.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors for aortic aneurysms include increasing age, cigarette smoking, and a family tendency to get aneurysms. Aortic aneurysms are 4 to 5 more times likely to occur in men than women. Men over age 55 and women over 70 have an increased incidence of aortic aneurysm.

Individuals at risk for abdominal aortic aneurysms include those aged 65 and older; smokers who have smoked longer than 40 years; and those with systolic blood pressure greater than 160 mmHg, diastolic blood pressure greater than 100 mmHg, atherosclerosis, and high serum total cholesterol.

Source: Medical Disability Advisor



Diagnosis

History: Symptoms vary depending on the location and size of the aneurysm, whether rupture has occurred, and whether there are associated effects due to increased pressure or blood leaking into surrounding organs and tissue. An individual with a thoracic aortic aneurysm may complain of sudden severe chest pain, shortness of breath, fainting, pallor, sweating, a bluish tinge around the mouth and on the nail beds (cyanosis), increased pulse rate, leg weakness, or transient paralysis. Individuals may also experience difficulty breathing, a harsh cough, or wheezing. Compression of the esophagus may cause hoarseness or loss of voice.

With an abdominal aortic aneurysm, individuals may be without symptoms (asymptomatic) and unaware of the condition. Some individuals may complain of an abnormal, pulsating feeling in the abdomen. Constant pain in the lower back region as a result of pressure on the lumbar nerves may be present.

Individuals experiencing severe, persistent chest, back, or abdominal pain may have an aneurysm that has already ruptured. Additional symptoms indicating that rupture has occurred include low blood pressure, weakness, sweating, anxiety, excessive thirst, a fast heart rate (tachycardia), nausea and vomiting, lightheadedness, fainting, dry skin or mouth, or an abdominal mass.

Physical exam: With a thoracic aortic aneurysm, the physician may note an increased pulse rate or a bluish tinge around the mouth and fingernails (cyanosis). Listening to the heart with a stethoscope (auscultation) may reveal an abnormal sound between beats when the heart is at rest (diastolic murmur). An abrupt loss of the pulse at the wrist (radial) and the pulse inside the upper thigh (femoral), or wide variations in pulses or blood pressure between the arms and legs may be noted. The individual may appear to be in shock, which is usually associated with low blood pressure, but the upper number of the blood pressure (systolic) is normal or even elevated.

With an abdominal aortic aneurysm in non-obese individuals, a pulsating mass may be felt when applying light pressure with the fingertips (palpation). Swelling around the navel (umbilicus) may be evident. A soft, blowing sound (bruit) may be heard when through a stethoscope placed over the aneurysm (auscultation). This condition rarely causes a diminished peripheral pulse.

Tests: Thoracic aortic aneurysms may be diagnosed incidentally when a chest x-ray is ordered for an unrelated reason. Electrocardiography (ECG) and echocardiography may help identify a dissecting aneurysm of the aortic root.

Ultrasound can determine the size and extent of an abdominal aneurysm. It is a noninvasive, cost-effective test that is nearly 100% accurate. Other tests may include CT or magnetic resonance imaging (MRI). If there is concern that the aneurysm is located above the renal arteries, which occurs in approximately 10% of cases, aortography may be done. In this procedure, contrast medium is inserted into a blood vessel through the arm or leg, and the flow of the medium is monitored on x-ray, revealing the precise size and location of the aneurysm.

In a study of 198 individuals with abdominal aortic aneurysms, 48% were discovered by history and physical examination, 37% during an imaging or x-ray procedure, and 15% at surgery (laparotomy). Of those detected during an imaging or x-ray procedure, subsequent examination showed that 38% could be felt (palpated) in the abdomen, although the aneurysm had been missed on initial examination. Thorough clinical examination is therefore extremely important in diagnosing this condition.

Blood tests may show decreased hemoglobin levels that indicate blood loss from a leaking or ruptured aneurysm, although in the setting of an acute rupture, the blood tests may not show any change.

Source: Medical Disability Advisor



Treatment

Rupture or potential rupture of an abdominal aortic aneurysm or the presence of a dissecting thoracic aortic aneurysm constitutes a medical emergency. Emergency surgery must be performed. Additional stabilizing measures may also be necessary and can include the administration of medications to reduce blood pressure and decrease vessel contraction force, oxygen for respiratory distress, narcotic analgesics for pain relief, intravenous administration of fluids, and whole blood transfusions.

Although surgery is the only cure for an aortic aneurysm, the timing of surgical repair is based on the risk of surgery compared to the risk of rupture. The risk of rupture is determined by aneurysm location and size, rate of recent growth of the aneurysm, and onset of such symptoms as chest pain associated with the aneurysm. If surgery is to be delayed, the individual is treated medically with diet, exercise, and medication to reduce blood pressure in the hope of stabilizing the damaged section of blood vessel and prevent further weakening of the vessel wall. High-risk cardiac individuals are considered poor surgical risks. Coronary artery problems must be addressed before surgery.

Surgery is recommended for aortic aneurysms 5 cm or larger in individuals without other medical complications. Nonemergency (elective) repair is often considered for aneurysms between 4 and 6 cm. The surgical repair of the aneurysm consists of removing the aneurysm (resection) and restoring blood flow using a synthetic or composite graft replacement. The damaged section of aorta may be replaced with a flexible Dacron tube graft.

Stenting is a different type of surgical repair, where a covered mesh tube is placed inside the aneurysm area of the aorta. This surgery can be performed through the arteries with specialized catheters, thus avoiding the more invasive surgery of an abdominal incision. Not all individuals are candidates for stenting.

Source: Medical Disability Advisor



Prognosis

Reducing the risk of rupture by surgical intervention generally allows the individual a good outcome (prognosis). Nonemergency (elective) surgery carries the risk of death in 2% to 5%. If a rupture is imminent or has occurred, as many as half of individuals may die before or during surgery.

Source: Medical Disability Advisor



Rehabilitation

While individuals are awaiting nonemergency surgery, and following surgery, cardiac rehabilitation programs may be helpful in educating individuals in light exercise that strengthens the heart and lowers blood pressure, while avoiding sudden physical strains that can momentarily increase blood pressure.

Outpatient physical and occupational therapy at a clinic that specializes in cardiac rehabilitation may be warranted for individuals with aortic aneurysm. Cardiac rehabilitation centers offer ECG monitoring of all participants during the exercise sessions. Individuals learn to self-monitor their pulse and to rate the amount of energy they expend by utilizing a rating of perceived exertion scale.

Occupational therapy addresses any fatigue or shortness of breath that may occur during activities of daily living. This therapy may also teach energy conservation techniques, in which activities of daily living such as meal preparation are broken up into smaller components, thereby making tasks more manageable.

Source: Medical Disability Advisor



Complications

Complications include rupture of the aneurysm, which can result in significant deficits or even death from blood loss. Complications of surgical repair include death, stroke, heart attack (myocardial infarction), paralysis (paraplegia) related to decreased blood flow (ischemia) to the spinal cord, and kidney (renal) failure related to decreased blood flow through the renal arteries supplying the kidneys.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Strenuous physical activities need to be eliminated, possibly requiring transfer of the individual to a sedentary position.

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:

  • Does the individual have high cholesterol?
  • Is the individual 65 or older? Has the individual smoked cigarettes for longer than 40 years?
  • Does individual have hypertension, atherosclerosis, or a family history of aneurysms?
  • Does individual complain of sudden, severe chest pain, shortness of breath, fainting, a bluish tinge around mouth and nail beds (cyanosis), increased pulse rate, leg weakness, or transient paralysis, suggesting thoracic aortic aneurysm?
  • Does individual complain of an abnormal pulsating feeling in the abdomen or constant pain in the lower back region, suggesting abdominal aortic aneurysm?
  • Does individual have severe persistent chest, back, or abdominal pain?
  • Was aneurysm ruptured?
  • Were clinical findings consistent with the diagnosis of a thoracic or abdominal aneurysm?
  • What abnormalities did the physician note when individual was examined? Did individual experience shock?
  • Did blood tests show decreased hemoglobin levels, indicating blood loss? Did a chest x-ray show evidence of a thoracic aortic aneurysm? Did abdominal ultrasound reveal an aneurysm? Was CT or MRI required?
  • Did individual receive prompt evaluation by a general or vascular surgeon?

Regarding treatment:

  • Has rupture or imminent rupture necessitated emergency surgery? Did surgery result in any complications such as bleeding? If so, were these addressed and treated?
  • If rupture is not imminent, should elective surgery be delayed to allow stabilization of heart and blood vessel disease?
  • Is medical management optimal or should a second opinion be obtained from appropriate specialists (cardiologist, cardiac surgeon, pulmonologist)?

Regarding prognosis:

  • Was the surgery uncomplicated?
  • Considering the severity of symptoms and the health status of individual, what was the expected outcome?
  • Did the aneurysm rupture prior to surgery? If so, did individual experience any complications associated with the rupture and surgical repair such as stroke, heart attack, paralysis, or renal failure?
  • Were these complications addressed in the treatment plan?
  • Has individual received medical consultation by the appropriate specialists (cardiologist, neurologist, nephrologist)?
  • Have the complications contributed to any permanent disabilities?

Source: Medical Disability Advisor



References

General

Campbell, Brendan T., ed. "Abdominal Aortic Aneurysm." MedlinePlus. Ed. Brendan T. Campbell. 22 Dec. 2004. National Library of Medicine. 19 May 2005 <http://www.nlm.nih.gov/medlineplus/ency/article/000162.htm>.

Daller, John A., ed. "Thoracic Aortic Aneurysm." MedlinePlus. Ed. John A. Daller. 13 Apr. 2004. National Library of Medicine. 19 May 2005 <http://www.nlm.nih.gov/medlineplus/ency/article/001119.htm>.

Source: Medical Disability Advisor






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