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.

Arteriovenous Aneurysm


Related Terms

  • Arteriovenous Fistula
  • Arteriovenous Malformation
  • AVM

Differential Diagnosis

  • Intermittent leg pain with limping or lameness (claudication)
  • Progressive occlusive disease of the veins and arteries (Buerger's disease)
  • Spasms of arteries in fingers and toes (Raynaud's disease)
  • Vein inflammation

Specialists

  • Thoracic Surgeon

Comorbid Conditions

Factors Influencing Duration

Factors that may influence length of disability include the size and location of the aneurysm, extent of damage caused by the aneurysm such as rupture of the aneurysm before surgery, and late (rather than early) diagnosis and treatment. In rare cases, hemorrhage from aneurysms in the brain can cause temporary or permanent loss of one or more of the senses (i.e., loss of eyesight or speech) and ability to move and walk (ambulation).

Medical Codes

ICD-9-CM:
414.10 - Aneurysm of Heart (Wall); Mural; Ventricular
414.11 - Aneurysm of Coronary Vessels; Aneurysm (Arteriovenous) of Coronary Vessels
414.19 - Aneurysm of Heart, Other; Arteriovenous Fistula, Acquired, of Heart
447.0 - Arteriovenous Fistula, Acquired; Arteriovenous Aneurysm, Acquired
747.60 - Anomaly of the Peripheral Vascular System, Unspecified Site
747.61 - Gastrointestinal Vessel Anomaly
747.62 - Renal Vessel Anomaly
747.63 - Upper Limb Vessel Anomaly
747.64 - Lower Limb Vessel Anomaly
747.69 - Anomalies of Other Specified Sites Of Peripheral Vascular System
747.81 - Anomalies of Cerebrovascular System; Arteriovenous Malformation of Brain; Cerebral Arteriovenous Aneurysm, Congenital; Congenital Anomalies of Cerebral Vessels
747.89 - Other Specified Anomalies of Circulatory, Other; Aneurysm, Congenital, Specified Site Not Elsewhere Classified

Overview

© Reed Group
The wall of an artery, vein, or the heart may bulge or balloon (aneurysm). In an arteriovenous aneurysm, the weakness in the artery results in abnormal communication (arteriovenous fistula) between an artery and a vein resulting in blood flowing directly from an artery into a vein, bypassing the capillaries. If the volume of diverted blood flow is large, tissues downstream receive less blood supply. In addition, the heart may fail because of the increased volume of blood returned to the heart.

Arteriovenous aneurysms occur most commonly in the arms and legs. One of the most common sites is behind the knee joint (popliteal arteries). Aneurysms at this site, particularly if they occur on both sides of the body (bilateral), are associated with abdominal aortic aneurysms. Aneurysms behind the knee rarely rupture but may result in blood clotting (thrombosis) and blood vessel obstruction (occlusion), which damage the affected limb.

Incidence and Prevalence: There is limited literature on AV aneurysms and most information is approximated from epidemiologic information on arteriovenous malformation (AVM) outside of the neurologic system. Arteriovenous malformation can occur in many different sites; however, those that occur in the brain and spinal cord can be especially damaging. Reported incidence rates of neurological AVM vary from 0.89 to 1.34 per 100,000 population (Laakso) and are believed to affect roughly 300,000 Americans. About 12 percent of those with AVM (about 36,000 of the estimated 300,000 Americans with AVM) experience symptoms of varying severity. For a small fraction of the individuals within this group, such symptoms are severe enough to become debilitating or even life threatening. Each year, about 1 percent of those with AVM die as a direct result of the AVM (NINDS).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Arteriovenous malformations occur in males and females of all racial and ethnic backgrounds at roughly equal rates (NINDS).

Arteriovenous aneurysms are usually the result of weakening of the vessel wall by disease such as artery hardening (arteriosclerosis). Less common causes include trauma, inflammation of an artery (arteritis), infection, or an abnormality present at birth (congenital abnormality).

Source: Medical Disability Advisor



Diagnosis

History: Individuals may complain of pain and swelling of blood vessels. A history of high blood pressure (hypertension), tobacco use, inflammation of an artery (arteritis), hardening of arteries (arteriosclerosis), and some sexually transmitted diseases (e.g., syphilis) have been associated with vessel weakness.

Physical exam: If the aneurysm is located near the surface of the skin, a mass can be felt and the affected part is usually enlarged and warm with distended and often pulsating superficial veins. The altered movements involved in the circulation of blood may cause heart failure if a significant portion of the cardiac output is diverted through an experimentally created passage (fistula). Altered pulse sounds and aneurysmal swishing-like sounds (bruits) can be heard over the enlarged mass that may also be visibly pulsating. Symptoms sometimes occur from pressure on contiguous parts, and may include high-pressure arterial flow within the involved veins, swelling at distant points (peripheral edema), abnormalities in the veins of the calf and thigh (venous varicosities), and skin color changes (stasis pigmentation).

Tests: Ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), and perfusion studies correlate the symptoms reported by the individual (i.e., pain and swelling of vessels, a history of hypertension) and the findings from the physical exam (i.e., an enlarged mass under the skin, swishing-like sounds over the enlarged area, swelling at distant points, skin color changes).

Source: Medical Disability Advisor



Treatment

Surgical removal of the aneurysm (aneurysm resection) and restoration of blood vessel continuity with graft replacement of the excised segment is the recommended treatment. Drug therapy (e.g., antihypertensives) may be indicated for less serious cases. Treatment or control of underlying cardiovascular disease prevents or diminishes the possibility of additional degenerative vascular changes. Antibiotics are used at sites of localized bacterial or fungal infections.

Source: Medical Disability Advisor



Prognosis

Size and location of the aneurysm and rupture of the aneurysm before surgery greatly affect outcome after surgery. Overall, surgical removal of the aneurysm (aneurysm resection) and restoration of blood vessel continuity with graft replacement of the surgically removed (excised) segment lead to favorable outcome especially in cases where the individual is diagnosed early and treatment begins in the initial stages of the disease.

Source: Medical Disability Advisor



Complications

If the individual is over age 70 when surgery is performed, the surgery is a higher risk. Rupture prior to surgical repair or other cardiovascular or pulmonary diseases also makes the individual a poor surgical risk. Postoperative hemorrhage may complicate treatment.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals may require transfer to a less physically strenuous job for a period of time after surgery. In general, lifting more than 10 pounds for the first 6 weeks and more than 50 pounds, even after 6 months, should be avoided. Individuals can often return to their preoperative activities after 6 months.

For more information on risk, capacity, and tolerance, refer to "Work Ability and Return to Work," pages 280-281.

Risk: Risk may be seen in jobs that require very heavy isometric work. Concurrent use of anti-coagulants may affect jobs that require working at unprotected heights or have high risk of trauma.

Source: Medical Disability Advisor



Maximum Medical Improvement

14 days (assuming no surgery).

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 individual have vascular or circulatory changes in the leg (popliteal region) or abdomen? History of arteriosclerosis?
  • Does individual have symptoms and clinical history consistent with the diagnosis of arteriovenous aneurysm (i.e., bruits or palpable mass)? Were the symptoms associated with an extremity aneurysm or cerebral aneurysm?
  • Was the diagnosis confirmed with diagnostic imaging studies?
  • Was the underlying cause determined (i.e., congenital or acquired)?
  • Was any underlying infection or inflammation detected?
  • If the diagnosis was uncertain, were other conditions with similar symptoms ruled out?
  • Would individual benefit from consultation with a specialist (neurosurgeon, vascular surgeon, infectious disease specialist, internist, cardiologist)?

Regarding treatment:

  • Were appropriate medications (antihypertensives, antibiotics, antifungal agents) administered for the given symptoms? Did the symptoms subside or stabilize?
  • Was surgical resection considered?

Regarding prognosis:

  • Based on the size and location of the aneurysm and severity of symptoms, what is expected outcome?
  • Does individual have pre-existing conditions that increase operative risk or risk of complications (i.e., cardiac disease, chronic pulmonary disease, renal failure, liver failure, immune suppression, bleeding disorder)?
  • Have any complications developed such as bleeding or infection that may influence length of disability?
  • In cases of cerebral arteriovenous aneurysms, did any associated neurological deficits occur? If so, was neurological rehabilitation recommended?

Source: Medical Disability Advisor



References

Cited

"Arteriovenous Malformations and Other Vascular Lesions of the Central Nervous System ." National Institute of Neurological Disorder and Stroke. Feb. 2011. National Institutes of Health. 8 Apr. 2014 <http://www.ninds.nih.gov/disorders/avms/detail_avms.htm>.

Babu, Sateesh C. "Arteriovenous Fistulas." eMedicine. Ed. Vincent Lopez Rowe. 8 Oct. 2013. Medscape. 8 Apr. 2014 <http://emedicine.medscape.com/article/459842-overview>.

Laakso, A. , et al. "Natural History of Arteriovenous Malformations: Presentation, Risk of Hemorrhage and Mortality." Acta Neurochirurgica 107 (2010): 65-69.

Talmage, J. B. , J. M. Melhorn, and M. H. Hyman, eds. Work Ability and Return to Work, AMA Guides to the Evaluation of. Second ed. Chicago: AMA Press, 2011.

Source: Medical Disability Advisor






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