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.

Chickenpox


Related Terms

  • Varicella
  • Varicella-Zoster Virus

Differential Diagnosis

Specialists

  • Dermatologist
  • Family Physician
  • Infectious Disease Internist
  • Internal Medicine Physician

Comorbid Conditions

  • Compromised immune system

Factors Influencing Duration

Complications such as pneumonia, encephalitis, or bacterial infection can lengthen the disability.

Medical Codes

ICD-9-CM:
052.0 - Chickenpox; Postvaricella Encephalitis
052.1 - Chickenpox; Varicella (Hemorrhagic) Pneumonitis
052.7 - Chickenpox with Other Specified Complications
052.8 - Chickenpox with Unspecified Complication
052.9 - Chickenpox; Varicella without Mention of Complication; Chickenpox NOS; Varicella NOS

Overview

Chickenpox usually is a mild, yet highly contagious disease caused by the virus varicella-zoster (VZV), a type of herpes virus. The disease localizes in the skin causing a characteristic rash of vesicles that scab or crust over creating bumps or the "pox." Chickenpox is spread from person to person by inhaling respiratory droplets or aerosolized viral fluids from an infected individual, or by direct contact with the skin lesions (CDC). It also is possible to get chickenpox from an individual with shingles (herpes zoster) because both conditions are caused by the same herpes virus. Shingles represents a reactivation of the dormant varicella-zoster virus that has been stored in the body since a previous infection with this virus.

On average, the incubation period of chickenpox is 14 to 16 days, with a range of 10 to 21 days (CDC, Papadopoulos). After having chickenpox, an individual typically gains lifelong immunity to the disease. However, VZV may remain dormant within a cranial nerve or a spinal nerve root and may reactivate years later, causing a painful rash with neurologic weakness and loss of sensation (herpes zoster).

Incidence and Prevalence: Infection with VZV occurs in 500 individuals per 100,000 population (Anderson).

Worldwide, incidence of VZV infection is similar to that in the US (Anderson).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Since introduction of the chickenpox vaccine in 1995, the disease is rapidly being eliminated as a childhood disease. More than 90% of individuals who do become infected will do so by the time they are 10 years old (Papadopoulos). Both sexes are affected equally (Roque). The lifetime incidence of VZV in whites is twice that of blacks (Roque).

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report an initial fever and generalized aching and weakness (malaise). Nausea and headache also may occur. This is followed within 1 to 4 days by an itchy rash (Roque). The rash begins on the trunk and then moves to the face, scalp, mouth, proximal limbs, and other parts of the body (centrifugal spread). A few small reddish bumps (papules) develop from the rash over 2 to 4 days and quickly fill with fluid to form blisters (vesicles); they typically appear first in small groupings. The blisters eventually burst or break, forming crusts or scabs over a 1 to 2 week period; the scabs generally fall off within 2 weeks. Additional blisters can develop at any time during this process. Itching from the blisters and scabs can be severe.

Physical exam: The exam may reveal fluid-filled blisters with a reddened base that are clustered, usually small, but variable in size. Some individuals have only a few blisters while others may have several hundred. Other individuals may become infected without presenting any symptoms.

Tests: Usually a history and physical exam will be sufficient to make the diagnosis. Blood tests for VZV-specific antibodies or recovery of virus from early lesions may confirm chickenpox infection. Individuals with breathing difficulties may require a chest x-ray to rule out secondary pneumonia.

Source: Medical Disability Advisor



Treatment

Because chickenpox is a self-limiting disease it usually is treated symptomatically. However, antiviral drugs may be used in some cases to help reduce the severity of symptoms. To be effective, these drugs must be taken within 24 hours of the first appearance of the rash. Antiviral drugs also may be prescribed to reduce the risk of complications in severe cases or for people who are immunocompromised.

Oral antihistamines can be taken for itching; topical treatments (e.g., calamine lotion) can relieve itching and help dry the lesions. Cool water soaks or compresses and bathing with baking soda or powdered oatmeal in a tub of lukewarm water also can relieve itching. Acetaminophen can be given as an analgesic and to reduce fever; aspirin should be avoided in children. The skin should be kept clean and fingernails trimmed to inhibit scratching and help prevent secondary bacterial infections. Once the blisters have crusted over, the individual is no longer infectious (Roque).

Chickenpox can be prevented by vaccination, which is 80% to 90% effective in preventing the disease or in lessening its severity (CDC). The long-term effects of this vaccine, however, are unknown, specifically how it affects the development of herpes zoster later in life.

Source: Medical Disability Advisor



Prognosis

Individuals are infectious for 1 to 2 days before the development of the itchy rash, and for up to 7 days afterward or until all blisters have crusted over (CDC, Papadopoulos). Chickenpox usually resolves in 2 weeks.

Source: Medical Disability Advisor



Complications

Although typically a harmless disease in healthy children, adults with chickenpox are more likely to develop complications, as are those who are immunocompromised. Complications may include prolonged fever, pneumonia, myocarditis, hepatitis, gangrene, glomerulonephritis, and transient arthritis. Rarely, Guillain-Barré syndrome, Reye's syndrome, encephalitis, or cerebellar ataxia may occur. When blisters are scratched open, there is a chance that they can become infected by bacteria, most frequently with staphylococcus. Impetigo, cellulitis, and septicemia also may result from bacterial infection of the blisters. Some secondary infections may become severe enough to require hospitalization. Chickenpox can cause small depression-type scarring, most often around the eyes. Women who acquire chickenpox early in pregnancy have a 1% to 2% risk for fetal congenital malformations (Papadopoulos).

After chickenpox clears, the virus can become dormant in the body causing herpes zoster later in life. A vaccine against herpes zoster is now available. It is recommended for adults over age 60.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Once the individual recovers, there should be no work restrictions needed unless complications have developed.

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:

  • Was individual exposed to someone with chickenpox in the past 10 to 21 days?
  • Did individual initially report a fever, generalized aching, and weakness followed by an itchy rash beginning on the trunk and then spreading to the face, scalp, mouth, limbs, and other parts of the body? Did individual have headache or nausea?
  • Did papules form in a few days and quickly form vesicles? Did they appear first in small groupings? Did vesicles break and form crusts or scabs over a 1 to 2 week period? Are they extremely itchy? Have new vesicles formed? Has the diagnosis of chicken pox been confirmed by a health care provider?
  • Were conditions with similar symptoms ruled out?

Regarding treatment:

  • Is individual being treated symptomatically?
  • Is individual being treated with oral antihistamines? Was antiviral medication necessary?
  • Was individual instructed to use acetaminophen?

Regarding prognosis:

  • Does individual have any conditions that may affect ability to recover?
  • Have any complications developed such as pneumonia, hepatitis, gangrene, glomerulonephritis, encephalitis, Reye's syndrome, Guillain-Barré syndrome, transient arthritis, cerebellar ataxia, secondary infection, or scarring?
  • Is individual pregnant and possibly at risk for fetal congenital malformations?

Source: Medical Disability Advisor



References

Cited

Anderson, Wayne E. "Varicella-Zoster Virus." eMedicine. Eds. Michael Stuart Bronze, et al. 19 Aug. 2009. Medscape. 16 Sep. 2009 <http://emedicine.medscape.com/article/231927-overview>.

Centers for Disease Control and Prevention. "Varicella (Chickenpox) Vaccination." http://cdc.gov. 12 Jun. 2009. 16 Sep. 2009 <http://www.cdc.gov/vaccines/vpd-vac/varicella/default.htm>.

Moon, James E., and Duane E. Hospenthal. "Herpes Zoster." eMedicine. Eds. Mark Raymond Wallace, et al. 1 May. 2009. Medscape. 16 Sep. 2009 <http://emedicine.medscape.com/article/218683-overview>.

Papadopoulos, Anthony J., R. A. Schwartz, and Camila K. Janniger. "Chickenpox." eMedicine. Eds. Susan Swetter, et al. 6 Aug. 2009. Medscape. 16 Sep. 2009 <http://emedicine.medscape.com/article/1131785-overview>.

Roque, Manolette R., Barbara A. Roque, and Stephen C. Foster. "Herpes Zoster." eMedicine. Eds. Kilbourn Gordon, et al. 28 Oct. 2008. Medscape. 16 Sep. 2009 <http://emedicine.medscape.com/article/1202284-overview>.

Source: Medical Disability Advisor






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