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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.

Chronic Fatigue Syndrome


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Rehabilitation | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
780.71 - Chronic Fatigue Syndrome

Related Terms

  • Encephalomyalgia

Overview

Chronic Fatigue Syndrome (CFS) is a label applied to persons who report severe chronic fatigue out of proportion to their efforts. The label CFS implies that a major component is the symptom of chronic fatigue and not the fatigue associated with serious medical illness, sleep problems or life stresses. Only a small fraction of persons who report chronic fatigue symptoms meet the criteria for CFS.

Chronic Fatigue Syndrome is usually characterized by fatigue lasting 6 or more months; absence of other illness that could explain the fatigue; fatigue that interferes with activities of daily living (ADLs), work, school, and socializing; and the presence of four or more of eight concurrent symptoms. The eight concurrent symptoms are sore throat, tender cervical or axillary lymph glands, muscle pain, multi-joint pain, headaches, unrefreshing sleep, post-exertion malaise, and cognitive dysfunction. Other symptoms frequently reported by individuals with CFS are low grade fevers and chronic flu-like symptoms.

There is no known cause for CFS. Based on available evidence to date, there is no convincing evidence that CFS is an infectious disorder, a neuroendocrine disorder, or an immunologic disorder. However, individuals with CFS often report worsening of fatigue during their allergy season, and after immunotherapy treatment. The primary task for the physician is to exclude known and treatable conditions as the cause for the chronic fatigue symptoms. Chronic fatigue itself is not CFS.

Considerable controversy continues to surround the cause (etiology), definition, diagnosis, and treatment of persons with this disorder.

Incidence and Prevalence: Incidence is 2 to 7.3 per 100,000 individuals in the US. Between 400,000 to 800,000 Americans are currently affected with CFS (Reynolds).

Source: Medical Disability Advisor



Causation and Known Risk Factors

CFS affects women 4 to 8 times more frequently than men, and occurs most often in young and middle-aged adults (Silver; Emmons). The majority of individuals with CFS are white (Cunha).

Source: Medical Disability Advisor



Diagnosis

History: CFS implies that: (1) there is an unexplained persistent or relapsing post-exertional fatigue of at least 6 months duration, (2) the fatigue is of new or definite onset, (3) the fatigue is out of proportion to an ongoing exertional effort, (4) the fatigue is not substantially alleviated by rest, (5) it results in substantial reduction in previous levels of activities of daily living.

In addition, four or more of the following symptoms must begin after the onset of fatigue and be present concurrently with the period of fatigue: (1) self-reported difficulty with memory or concentration leading to self limitation in previous levels of activities of daily living, (2) sensation of sore throat, (3) tender lymph nodes, (4) widespread nonanatomic muscle pain, (5) multi-joint pain without joint swelling or redness, (6) headache, (7) nonrestorative sleep, (8) post-exertional malaise lasting more than 24 hours.

Physical exam: The physical examination is normal.

Tests: There is no test(s) that confirms the diagnosis of CFS. Routine laboratory testing is reserved for ruling out other medical conditions.

The diagnosis based on the above criteria should only be established after there has been a complete history and physical examination with appropriate diagnostic studies to exclude other conditions that may be diagnosed to explain the symptoms. In the absence of other concurrent medical conditions suggested by history, physical examination or routine laboratory testing, the diagnosis of CFS is based on the person's self-report.

Source: Medical Disability Advisor



Treatment

There is no specific treatment for CFS. Management of individuals with CFS focuses on alleviating symptoms through general conditioning, exercise to improve endurance, and utilizing cognitive therapy modalities.

Psychologic symptoms are often associated with CFS. Hence, cognitive and behavioral interventions may be useful in the treatment of CFS; for example, education, counseling and a structured plan to increase physical and social activity. Medication treatment is reserved for specific symptoms indicative of depression or anxiety.

The following therapies have not been validated through adequately designed controlled trials, may have unwanted side effects, may serve to reinforce counterproductive behaviors, and are not recommended for the treatment of CFS: antifungal and antiviral agents, thyroid hormone supplement, intravenous immunoglobulins, and low-dose steroid therapy.

Source: Medical Disability Advisor



Prognosis

The prognosis for individuals with this disorder is unknown because there are no scientifically valid outcome studies upon which to base an opinion regarding prognosis.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Clinical Psychologist
  • Family Physician
  • Internal Medicine Physician
  • Psychiatrist

Source: Medical Disability Advisor



Rehabilitation

Physical, occupational, and cognitive behavioral therapy may be indicated for individuals diagnosed with chronic fatigue syndrome. Physical therapy focuses on establishing an exercise program that the individual can perform several times a week. Individuals are told that while normal exercise intensity can cause symptoms of CFS to resurface, gentle exercises with a gradual increase in intensity can increase function, boost the immune system, and decrease stress and depression. Exercises such as gentle stretching, aerobic exercise such as walking, and aquatic exercise programs can be supervised by an outpatient physical therapist with focus on the individual's independence in performing the program regularly. Yoga and Tai Chi also improve symptoms of CFS.

Occupational therapy focuses on reducing fatigue that may occur with daily tasks. Occupational therapists teach energy conservation techniques where activities of daily living such as meal preparation are broken into smaller components that make tasks more manageable. Individuals learn to perform more demanding tasks such as doing the laundry during the part of the day when their energy levels are the highest. Individuals also learn to pace tasks throughout the day to avoid the provocation of symptoms.

Cognitive behavioral therapy can help individuals suffering from CFS to form coping mechanisms for dealing with CFS and alleviate the distress this disease may cause. Support groups may also be helpful for individuals and their families to discuss issues they may face; however, they may also reinforce dysfunctional behavior by focusing on symptomatology rather than function.

Source: Medical Disability Advisor



Comorbid Conditions

  • Affective or anxiety disorders
  • Obesity
  • Psychoses
  • Somatization disorder

Source: Medical Disability Advisor



Complications

Complications can arise from treatment (i.e., unwanted side effects or reinforcement of counterproductive behaviors) or from the person's behavior (i.e., self-limitation of physical activities leading to deconditioning and increased fatigue with exertion).

Source: Medical Disability Advisor



Factors Influencing Duration

The factors influencing duration of disability are unknown because there are no scientifically valid studies that have determined the factors influencing duration of disability in this disorder.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals with this disorder have no identifiable objective medical basis for their symptoms; that is, individuals with this disorder report symptoms but have normal physical examinations and normal findings on diagnostic testing. Consequently, there is no objective medical basis upon which to predicate work restrictions or accommodations.

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 an unexplained persistent or relapsing post-exertional fatigue of at least 6 months duration? Is fatigue of new or definite onset? Is fatigue out of proportion to an ongoing exertional effort? Does rest not substantially alleviate fatigue?
  • Does fatigue result in substantial reduction in previous levels of activities of daily living?
  • After onset of fatigue, does individual have difficulty with memory or concentration leading to self-limitation in previous levels of activities of daily living? Does individual have the sensation of sore throat? Tender lymph nodes? Is there widespread nonanatomic muscle pain? Multi-joint pain without joint swelling or redness? Headache? Non-restorative sleep? Post-exertional malaise lasting more than 24 hours?
  • Have alternative diagnoses been investigated?

Regarding treatment:

  • Have unproven treatments resulted in unwanted side effects?
  • Have treatment methods reinforced counterproductive behaviors?
  • Were cognitive and behavioral interventions employed?

Regarding prognosis:

  • Were psychosocial factors such as family and workplace dynamics considered?

Source: Medical Disability Advisor



References

Cited

Cunha, Burke A. "Chronic Fatigue Syndrome." eMedicine. Eds. Wesley W. Emmons, et al. 7 Nov. 2004. Medscape. 22 Oct. 2004 <http://emedicine.com/med/topic3392.htm#section~differentials>.

Emmons, Wesley W., et al. "Chronic Fatigue Syndrome." eMedicine Health. Eds. Joseph Richard Masci, et al. 1 Oct. 2004. WebMD, LLC. 22 Oct. 2004 <http://www.emedicinehealth.com/articles/9217-1.asp>.

Reynolds, K. J. "The Economic Impact of Chronic Fatigue Syndrome." Cost Effectiveness and Resource Allocation 2 1 (2004): 4-4.

Silver, D. S., and D. J. Wallace. "The Management of Fibromyalgia-Associated Syndromes." Rheumatic Diseases Clinics of North America 28 2 (2002): 405-417.

Source: Medical Disability Advisor