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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.

Functional Neurological Symptom Disorder


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Diagnosis

History: According the DSM-IV-TR, individuals with CD/FNSD have at least one symptom or deficit affecting voluntary motor or sensory function, suggestive of a neurological or other general medical disease (individual has history of a sensory disturbance [i.e., numbness, double vision, blindness, deafness, or hallucinations], muscle disturbance [localized weakness or paralysis, incoordination, difficulty swallowing, or a "lump in the throat"], convulsions [seizures], or some combination of these). Since the initiation or exacerbation of the symptom or deficit is preceded by conflicts or other stressors, psychological factors are judged to be associated with the symptom or deficit. The symptom or deficit is not deliberately produced or feigned (as in factitious disorder or malingering) and after an appropriate workup, the symptom or deficit cannot be explained by a medical disease, or by the effects of a drug or other substance such as alcohol, or as a culturally typical behavior or experience. The symptom or deficit produces clinically significant distress or impairment in occupational, social, or other areas of functioning or warrants medical evaluation. The symptom or deficit, however, is not limited to pain or sexual dysfunction, does not occur only during the course of somatization disorder, and is not better explained by another mental disorder. It is necessary to specify the type of symptom or deficit: with motor symptom or deficit, with sensory symptom or deficit, with seizures or convulsions, or with mixed presentation (DSM-IV-TR).

According to the DSM-5, individuals with CD/FNSD have one or more symptoms of alteration of voluntary motor or sensory function; there is incompatibility between the symptom and recognized neurological or medical conditions; the symptom or deficit is not better accounted for by another medical or mental disorder; and the symptom or deficit produces significant distress or impairment in social, occupational, or other areas of functioning or warrants medical evaluation. The ICD-9-CM code for conversion disorder is 300.11 regardless of the symptom type; the ICD-10-CM code depends on the symptom type. It is necessary to specify the symptom type: with weakness or paralysis, or with abnormal movement (tremor, dystonic movement, myoclonus, gait disorder); with swallowing symptoms; with speech symptom (dysphonia, slurred speech); with attacks or seizures; with anesthesia or sensory loss; with special sensory symptom (hearing, visual, or olfactory disturbance); or with mixed symptoms. Also, it is necessary to specify if the episode is acute (presence of the symptoms during less than 6 months) or persistent (presence of symptoms during 6 months or more), and if there is or is not a psychological stressor (DSM-5).

Physical exam: The exam shows findings inconsistent with medical knowledge. Numbness is often in a pattern resembling a glove or stocking, not the pattern of the known nerve supply. A paralyzed body part may not perform according to known nerve and muscle anatomy. Muscle strength may be normal in muscles opposite the "paralyzed" ones and reflexes are normal. For example, Hoover's sign may be present and/or the patient may be able to walk on her/his tiptoes despite marked weakness of those muscles when they are tested while the patient is in bed. Various specialized examination maneuvers can help the doctor differentiate complaints related to physical causes from those that are conversion symptoms; e.g., in hysterical blindness, nystagmus is observed when the individual is confronted with a moving painted cylinder (optokinetic nystagmus), confirming that from a physiologic standpoint, the visual pathways are intact.

Tests: Neurological tests are normal. Electromyogram (EMG) and nerve conduction velocity testing are normal in "paralyzed" muscles. Somatosensory evoked potential testing is normal in limbs with no sensation. Electroencephalogram (EEG) is normal in conversion seizures. Psychological tests such as the Minnesota Multiphasic Personality Inventory - 2 (MMPI-2) may show a profile characteristic of CD/FNSD.

Note: It must be kept in mind that just because a physical diagnosis cannot be established as the cause of the presenting symptomatology, it does not necessarily mean that the cause is a mental one. That is to say that the presence of medically unexplained symptomatology does not necessarily establish the presence of a psychiatric condition. The first step in identifying the presence of a mental disorder is excluding the presence of malingering and/or of factitious disorder. Although factitious disorder is conscious and purposeful, it is classified as a psychiatric disorder. The strong need for this step is especially true whenever there is a medicolegal context associated with the presenting problem(s). Additionally, using DSM-5 and/or ICD-9-CM or ICD-10-CM, the clinician will find that many presentations fail to fit completely within the boundaries of a single mental disorder. There are systematic ways to go about making psychiatric diagnoses, however.

Source: Medical Disability Advisor