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.

Concussion


Related Terms

  • MHI
  • Mild Brain Injury
  • Mild Head Injury
  • Mild Traumatic Brain Injury
  • Minor Head Trauma
  • MTBI

Differential Diagnosis

Specialists

  • Family Physician
  • Neurologist
  • Neurosurgeon
  • Psychiatrist

Comorbid Conditions

Factors Influencing Duration

Length of disability will be affected by the level of concentration required on the job; the severity of the concussion; and any complications such as brain damage, symptoms of post-concussion syndrome, and mental impairment. Mild complaints associated with MTBI and post-concussion syndromes may challenge return to work efforts.

Medical Codes

ICD-9-CM:
850.0 - Concussion with No Loss of Consciousness
850.11 - Concussion, With Loss of Consciousness of 30 Minutes or Less
850.12 - Concussion, With Loss of Consciousness from 31 to 59 Minutes
850.2 - Concussion with Moderate Loss of Consciousness
850.3 - Concussion with Prolonged Loss of Consciousness and Return to Pre-existing Conscious Level
850.4 - Concussion with Prolonged Loss of Consciousness, without Return to Pre-existing Conscious Level
850.5 - Concussion with Loss of Consciousness of Unspecified Duration
850.9 - Concussion, Unspecified

Overview

A concussion describes a sudden change in mental status after a mild head injury, with no immediate or delayed evidence of structural brain damage. The change in mental status may or may not be accompanied by a loss of consciousness (LOC).

Consciousness may be lost for a few seconds in a mild concussion, or for several minutes after a more severe head injury. In a mild concussion, there is a temporary or transient LOC (less than 5 minutes) and possible impairment of the higher mental functions, such as loss of memory of events preceding or following the injury (retrograde or anterograde amnesia) and emotional instability (lability). A severe head trauma produces prolonged unconsciousness with impairment of brain stem function, such as transient loss of respiratory reflex, blood vessel (vasomotor) activity, and dilation of the pupils (mydriasis).

Mild concussions are very common and may occur without loss of consciousness. Mild concussions, like more serious concussions, are associated with confusion or memory loss. But with mild concussion, these complaints clear within 24 hours. The initial physical exam is normal or mildly abnormal with Glasgow Coma Scale ratings of 13 to 15 (see Tests below). Mild concussions may be associated with post-concussion syndrome and subtle changes on psychometric testing lasting for several months. Individuals who have sustained mild concussions are more sensitive to recurrent head trauma. Mild concussions may also be referred to as mild traumatic brain injury (MTBI).

Concussion differs from contusion in that in the former, the injury is functional (affecting the functions but not the structure), whereas in the latter it is organic (pertaining to an organ). If unconsciousness persists for more than 6 hours (coma), it is likely that permanent brain tissue injury has occurred.

Incidence and Prevalence: Most cases of concussion are not severe enough to require hospitalization, and thus the prevalence and incidence of this injury is underreported. There are no current databases that follow the incidence of mild concussion, but the Centers for Disease Control and Prevention (CDC) estimates that about 75% of traumatic brain injuries (TBIs) are concussions or other forms of mild TBI (Summers; CDC). Each year an estimated 1.7 million Americans sustain a TBI; about 1,365,000 are treated in emergency rooms, 275,000 are hospitalized, and about 52,000 of them die (CDC; Faul).

Source: Medical Disability Advisor



Causation and Known Risk Factors

In every age category males are more likely than females to sustain a concussion. The major causes of TBI are falls (35.2%), motor vehicle accidents (17.3%), being struck by or colliding with a stationary or moving object (16.5%), and assaults, including assaults with firearms (10%). Activities such as sports and other recreational activities, and professions that involve the potential for injury or violence are often associated with TBI, especially mild TBI (Faul). American Indian and Alaska Native individuals have the highest death rate among ethnicities from a TBI; black Americans have the second highest death rate (Coronado).

Source: Medical Disability Advisor



Diagnosis

History: The individual may have a history of a blow to the head, followed by LOC. Transient LOC or brief loss of contact with the environment is the characteristic feature of a simple concussion. Individuals with a concussion may be slightly dazed for a few minutes and complain of headaches for 12 hours or longer. Mental confusion may be prolonged. Headaches, retrograde or anterograde amnesia (inability to recall events before or after the injury), and dizziness may be present after concussion. Prolonged LOC may be contingent on swelling, hemorrhage, or diffuse nerve (axonal) injury (DAI), or contusion or laceration of the outer brain (cortex). Severity of the symptoms and recovery time depends on the degree of brain damage. If surgery was needed to repair other injuries occurring at the time of the concussion, post-surgical shock may also be present.

Physical exam: The physical exam may reveal dizziness, mental confusion, clumsy movements, impaired balance, and other injuries. The examiner must also test for abnormal eye movements (tonic deviations of the eyes), rhythmic movements of the eyes (nystagmus), and pupillary reflex abnormalities. One-sided paralysis (hemiplegia), impairment of language function (aphasia), cranial nerve paralysis (palsy), and coma are neurologic signs that suggest severe brain damage.

Tests: The Glasgow Coma Scale (GCS) has been used as a semiquantitative measure of the severity of brain injury, and provides a guide to outcome. Computed tomography (CT) evaluates the acute, serious head injury to identify any evidence of bleeding within the brain or signs of brain damage. Magnetic resonance imaging (MRI) and positron emission tomography (PET) studies may be important in the evaluation of late stages of recovery from head injury but are not important in acute care. Lumbar puncture may be done to examine the cerebrospinal fluid (CSF) if there is question of infection. Electroencephalogram (EEG) is not considered to be a useful test following acute brain injury, but can help identify and guide treatment of persistent symptoms (post-concussion syndrome). Mild concussions (MTBI) may be associated with subtle, long term changes in neuropsychologic or intelligence tests, but these tests generally are not appropriate for medical management and are rarely used.

Source: Medical Disability Advisor



Treatment

Treatment of individuals with concussion includes observation for several hours, physical and mental rest (both night and daytime rest), and temporary reduction of workloads. Headaches can be treated with acetaminophen; it best to avoid nonsteroidal anti-inflammatory drugs (NSAIDs) because of the possibility that these drugs increase the risk of bleeding. The return to work must be authorized by a physician after all signs and symptoms have disappeared, especially if the job involves the risk of re-injury.

About 1% of individuals with an initial diagnosis of mild concussion are later found to have severe brain injury and may require treatment in the intensive care unit (ICU) or even surgical treatment.

Source: Medical Disability Advisor



Prognosis

The outcome for the individual with a concussion is related to the site and severity of the injury. With mild concussions (MTBI) or minor degrees of cerebral swelling, individuals fully recover from LOC. However, minor complaints and subtle changes in thinking or emotions may persist for some time. The mortality rate is almost zero in individuals with simple concussion and less than 2% when there is a mild degree of cerebral swelling.

Source: Medical Disability Advisor



Rehabilitation

Individuals who sustain a concussion may present with a variety of physical and cognitive disabilities, depending on the severity of the injury. Individuals with mild concussions require no specific therapy and are able to return to their prior level of function after a brief period of rest; however, some individuals may go on to require therapy for post-concussion syndrome.

Source: Medical Disability Advisor



Complications

A concussion doubles the risk of an individual of developing epilepsy within the first five years after the injury. There is evidence that multiple concussions over the course of an individual's life may have cumulative effects, with lasting and progressive cognitive impairment. Second impact syndrome may occur in some individuals that suffer a second concussion before signs and symptoms of another concussion have resolved, with rapid and usually fatal brain swelling. Up to 80% of those with mild to moderate brain injury will experience some symptoms of post-concussion syndrome.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals with simple concussion are usually allowed to return to their usual activities after 24 hours of observation. Mild, general post-concussive complaints such as headaches, fatigue, decreased concentration, sleep disturbances, dizziness, or irritability can complicate return to work.

For more information, refer to "Work Ability and Return to Work," pages 326–328.

Risk: Individuals with concussion are not at risk of harm when performing work activities for which they have appropriate intellect and motor skills. Following physician clearance for return to work, the brain does not become injured or get worse with activity. There is no basis for work restrictions, unless post-traumatic seizures are present.

Capacity: Capacity will be unaffected in individuals with simple concussion.

Tolerance: Tolerance is dependent on the individual’s complaints of headache and fatigue and whether post-concussive syndrome is present; this may be mitigated by temporary modification of work tasks.

Source: Medical Disability Advisor



Maximum Medical Improvement

180 days.

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 history of a concussion followed by loss of consciousness?
  • How long was individual unconscious?
  • Does individual complain of a headache or dizziness?
  • On exam, did individual have dizziness, mental confusion, clumsy movements, and impaired balance? Were there other injuries?
  • Was a complete neurological examination done to exclude severe brain damage? Did individual have tonic deviations of the eyes, nystagmus, or pupillary reflex abnormalities? Was hemiplegia, aphasia, or palsy present?
  • What was individual's initial Glasgow Coma Scale score?
  • Has individual had a CT scan, MRI, or PET study? Was a lumbar puncture done? Did individual have an EEG later?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Did individual's treatment consist of observation and discharge?
  • Were headaches treated with acetaminophen?
  • Did a physician authorize the return to work?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary temporary restrictions?
  • Does individual have any conditions that may affect ability to recover?
  • Has individual had more than one concussion?
  • Does individual have any complications such as epilepsy, or lasting and progressive cognitive impairment due to cumulative effects of multiple concussions over the course of the individual’s life?
  • Did individual develop second impact syndrome?
  • Does individual have post-concussion syndrome?

Source: Medical Disability Advisor



References

Cited

Bernhardt, David T. "Concussion." eMedicine. Eds. Craig C. Young, et al. 12 May. 2014. Medscape. 14 May 2014 <http://emedicine.medscape.com/article/92095-overview>.

Bryant, R. "Post-Traumatic Stress Disorder vs Traumatic Brain Injury." Dialogues in Clinical Neuroscience 13 (2011): 251-262.

Centers for Disease Control and Prevention. "Traumatic Brain Injury in the United States: Fact Sheet." CDC. 21 Mar. 2014. Centers for Disease Control and Prevention. 14 May 2014 <http://www.cdc.gov/traumaticbraininjury/get_the_facts.html>.

Coronado, V. G. , et al. "Surveillance for Traumatic Brain Injury-Related Deaths--United States, 1997-2007." Morbidity and Mortality Weekly Report 60 (2011): 1-32.

Cunha, John P. "Concussion." eMedicine Health. Ed. Melissa Conrad Stoppler. WebMD, LLC. 14 May 2014 <http://www.emedicinehealth.com/concussion/article_em.htm>.

Dawodu, Segun T. "Traumatic Brain Injury (TBI): Definition, Epidemiology, Pathophysiology." eMedicine. Eds. Denise I. Campagnolo, et al. 6 Mar. 2013. Medscape. 14 May 2014 <http://emedicine.medscape.com/article/326510-overview>.

Faul, Mark. "Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002-2006." CDC. 7 Jan. 2013. Centers for Disease Control and Prevention. 14 May 2014 <http://www.cdc.gov/traumaticbraininjury/tbi_ed.html>.

Pangilinan, Percival H., et al. "Classification and Complications of Traumatic Brain Injury." eMedicine. Eds. Denise I. Campagnolo, et al. 3 Apr. 2014. Medscape. 14 May 2014 <http://emedicine.medscape.com/article/326643-overview>.

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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