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.

Cervical Dysplasia


Related Terms

  • Abnormal Pap Smear

Differential Diagnosis

Specialists

  • Gynecologist

Comorbid Conditions

Factors Influencing Duration

Factors influencing duration include the degree of dysplasia and the individual's response to treatment.

Medical Codes

ICD-9-CM:
622.10 - Noninflammatory Disorders of Cervix; Dysplasia of Cervix, Unspecified; Anaplasia of Cervix
622.11 - Noninflammatory Disorders of Cervix, Mild Dysplasia of Cervix; Cervical Intraepithelial Neoplasia I [CIN I]
622.12 - Noninflammatory Disorders of Cervix, Moderate Dysplasia of Cervix; Cervical Intraepithelial Neoplasia II [CIN II]

Overview

Cervical dysplasia is the development of abnormal, precancerous cells (cellular deviations) in the lining of the uterine cervix. The cells may multiply and become disorganized (poorly differentiated), progressing toward local cervical cancer (carcinoma in situ). It may take up to 10 years for dysplasia to eventually progress to invasive cervical cancer.

Cervical dysplasia may regress, persist, or progress to clinical disease. In 70% of cases, cervical dysplasia is mild and can spontaneously return to normal ("Cervical Dysplasia"). However, cervical dysplasia is considered to be the precursor to cervical cancer.

The main cause of cervical dysplasia is human papilloma virus (HPV) infection. There are more than 100 types of HPV: low-risk types (HPV-6 and HPV-11) are associated with mild dysplasia, and high-risk types (HPV-16 and HPV-18) are associated with severe dysplasia and cervical cancer (Stöppler).

Incidence and Prevalence: Up to 1 million women are diagnosed with cervical dysplasia each year in the US (“Cervical Dysplasia”).

Each year, more than 6 million individuals acquire HPV infection (Bacon); HPV is present in more than 20 million individuals in the US (Bacon).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors associated with the development of abnormal cervical cells include human papilloma virus (HPV) infection, HIV infection, and suppression of the immune system due to drugs or organ transplantation. Women whose mothers took diethylstilbestrol (DES) during pregnancy are also more likely to develop the condition.

Increased risk is associated with the early onset of sexual activity, multiple sexual partners, use of oral contraceptives, smoking, and poor nutrition.

HPV infection, the most common cause of cervical dysplasia, is a sexually transmitted disease that infects more than 75% of women during their lifetime (Stöppler). Most new HPV infections occur between the ages of 15 and 25 (Stöppler), with cervical dysplasia most commonly found in women between the ages of 25 and 35 (“Cervical Dysplasia”).

Source: Medical Disability Advisor



Diagnosis

History: The majority of cervical dysplasias are asymptomatic, but there may be light vaginal discharge or spotting of blood if there is cervical inflammation or an associated infection. Previous infection with HPV should be noted since there is a high incidence of HPV in women with cervical cancer.

Physical exam: In most cases, the pelvic exam is normal; however, a routine pelvic examination may reveal the presence of genital warts caused by HPV infection.

Tests: The Papanicolaou (Pap) test, a laboratory microscopic examination of the cells of the cervix, can detect cervical cancer and is very important in screening; however, definitive diagnosis is based on examination with a magnifying instrument (colposcope) used to examine the vagina and cervix (colposcopy). If abnormal cells are present, a biopsy of cervical tissue is done. Cervicography, a diagnostic method in which a photograph of the cervix is taken, can be used for evidence of dysplastic changes. HPV testing is performed to determine the presence and type of the virus.

Source: Medical Disability Advisor



Treatment

Infection and sexually transmitted disease should be appropriately treated and repeat Pap tests obtained. With mild cervical dysplasia, no immediate treatment is needed since in the majority of cases the dysplasia will spontaneously resolve; women are scheduled for follow-up examination every 6 months. With moderate or severe dysplasia, the affected area should be removed. Procedures used to remove the dysplasia include ablation techniques for milder forms of dysplasia, such as freezing with nitrous oxide (cryocauterization); burning or cauterizing of tissue (cervical cauterization); and laser excision (carbon dioxide laser photoablation). For more severe dysplasia, resection techniques are used, including the loop electrosurgical excision procedure (LEEP), which uses a thin wire loop with an electrical current running through it to remove the abnormal tissue, or cold-knife cone biopsy, in which a cone-shaped piece of tissue is removed from the cervix (conization). Cone biopsies are performed with a laser, a surgical knife, or LEEP. If cancer is found, additional treatments are required unless the biopsy removed all the affected cells.

More advanced tumors may be treated with radiation therapy or removal of the uterus (hysterectomy). A small number of cases may result in hyperplasia of the lining of the uterus (endometrium), in which case the tissue may be removed by dilating the cervix and scraping the inside of the uterus with a curette (dilation and curettage, or D&C).

After treatment, many women are required to have Pap tests at more frequent intervals for a year. Women who have had cervical dysplasia should have yearly Pap tests thereafter for the rest of their lives.

Source: Medical Disability Advisor



Prognosis

If detected early and treated properly, the prognosis for cervical dysplasia is excellent and has a 90% cure rate; the remaining 10% of women will have recurrence of dysplasia, necessitating more treatment (Stöppler). More frequent Pap tests ensure the condition does not go undetected if it recurs. If treatment is delayed, then the risk of developing cervical cancer can increase. When cervical dysplasia is left untreated, 30% to 50% of individuals will develop cervical cancer (“Cervical Dysplasia”).

Source: Medical Disability Advisor



Rehabilitation

In general, rehabilitation of the individual with cervical dysplasia depends greatly on whether the condition regresses, persists, or progresses to a clinical disease. Rehabilitation may be necessary if the area of cervical dysplasia was removed and complications later developed, such as low back pain and abdominal and general muscle weakness. Physical therapy allows individuals to regain strength and stamina lost due to the disease process, treatment, and recuperation from cervical dysplasia.

The frequency and duration of the rehabilitation program vary among individuals with cervical dysplasia. Intensity and progression of the exercise depend on the extent of treatment, whether surgery was required, and the individual's overall health. Therapy for those treated with radiation therapy or hysterectomy is modified according to the course of primary treatment.

Source: Medical Disability Advisor



Complications

Cervical dysplasia may persist or progress into cervical cancer. Cervical cancer may invade tissues of nearby organs and may spread through the lymphatic system to other areas of the body, such as the lungs, brain, bone, and liver.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations are not usually associated with this diagnosis. However, if pain is present, it may have an impact on the individual's ability to perform heavy work.

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 HIV, AIDS, or a suppressed immune system?
  • Does individual smoke or have poor nutrition?
  • Did individual's mother take diethylstilbestrol during pregnancy?
  • Did individual have intercourse at an early age or sexual relations with many partners?
  • Does individual use oral contraceptives?
  • Does individual have genital herpes virus and/or human papilloma virus infection?
  • Has individual had any abnormal vaginal discharge?
  • On physical exam, were genital warts (HPV) present?
  • Has individual had a Pap test?
  • Has individual had a biopsy of the cervical tissue?
  • Did individual have a colposcopy done? Cervicography?
  • Have other conditions with similar symptoms been ruled out?

Regarding treatment:

  • Were any infections and sexually transmitted diseases appropriately treated?
  • Did individual have a repeat Pap test?
  • Was area of dysplasia removed?
  • Was a D&C necessary?
  • Was radiation therapy or hysterectomy indicated?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that may affect the ability to recover?
  • Does individual have any complications, such as cervical dysplasia progressing into cervical cancer? Did individual have a hemorrhage or an infection?

Source: Medical Disability Advisor



References

Cited

"Cervical Dysplasia." Women’s Health Channel. Healthcommunities.com. 21 Jul. 2009 <http://www.womenshealthchannel.com/cervicaldysplasia/index.shtml>.

Bacon, J. L. "Carbon Dioxide Laser Surgery for Cervical Dysplasia." eMedicine. 5 Dec. 2007. Medscape. 21 Jul. 2009 <http://emedicine.medscape.com/article/272382-overview>.

Bacon, Janice L. "Carbon Dioxide Laser Surgery for Cervical Dysplasia." eMedicine. Eds. Karen Loeb Lifford, et al. 5 Dec. 2007. Medscape. 21 Jul. 2009 <http://emedicine.medscape.com/article/272382-overview>.

Stöppler, Melissa Conrad. "Cervical Dysplasia." MedicineNet.com. Ed. William C. Shiel. 16 Apr. 2009. MedicineNet, Inc. 21 Jul. 2009 <http://www.medicinenet.com/cervical_dysplasia/article.htm>.

Source: Medical Disability Advisor






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