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.

Hepatitis, Viral


Related Terms

  • Fulminant Hepatitis
  • Viral Hepatitis

Differential Diagnosis

Specialists

  • Gastroenterologist
  • Infectious Disease Internist

Comorbid Conditions

  • Alcoholism
  • Compromised immune system
  • Cytomegalovirus
  • Infectious mononucleosis
  • Yellow fever

Factors Influencing Duration

The length of disability will be influenced by the type of hepatitis virus causing the infection, the individual's age, other medical conditions affecting immunity, complications, and the need for surgical intervention. Any of these factors may extend the expected period of disability for acute viral hepatitis. If transplantation is required, overall disability may last several months. Chronic forms of hepatitis may result in permanent disability.

Medical Codes

ICD-9-CM:
070.49 - Viral Hepatitis with Hepatic Coma, Other Specified
070.59 - Viral Hepatitis without Mention of Hepatic Coma, Other Specified
070.6 - Viral Hepatitis with Hepatic Coma, Unspecified
070.9 - Hepatitis, Viral without Mention of Hepatic Coma, Unspecified; Viral hepatitis NOS

Overview

Viral hepatitis is a disease that causes liver inflammation and occurs in various forms. The main varieties of viral hepatitis track the alphabet under the names of A, B, C, D, and E. The first three types are the most common, whereas the last two have been identified only in recent years. Newer forms of the disease often are designated as non-A-E hepatitis, including a recently discovered group of G and GB viruses, and a very isolated form of F identified in France.

Symptoms and signs of infection, such as fatigue, fever, nausea, muscle and joint aches, headache, loss of appetite and yellow skin and eyes (jaundice or icterus), are similar for the different viruses. But each form has distinct routes of infection, along with varying complications and prognosis. The main diagnostic categories are hepatitis A, B, or C. More than one type of hepatitis virus sometimes is involved in an infection.

Individuals with weakened immune systems are particularly susceptible to other sources of viral hepatitis, such as infectious mononucleosis (linked to the Epstein-Barr virus), yellow fever, and a form of the herpesvirus known as cytomegalovirus. Viral hepatitis may spread through ingestion of contaminated food or water or sexual contact. Contaminated blood as well as poorly sterilized medical equipment or contaminated blood supplies used in transfusions sometimes spread infections, although recent blood bank screening processes have decreased the risk considerably. Transmission may occur from infected razors, toothbrushes, nail files, a barber's scissors, tattooing equipment, body piercing, or acupuncture needles.

Incidence and Prevalence: The number of acute hepatitis A cases reported in the United States declined by approximately 53%, from 3,579 in 2006 to 1,670 in 2010. After accounting for under-reporting and asymptomatic infections, an estimated 17,000 new infections occurred in 2010. The rate of acute hepatitis A declined from 1.2 cases per 100,000 to 0.5 cases per 100,000 during 2006–2010. Among the reported cases with information on outcome, 1.0% indicated the patient died from hepatitis A (CDC).

In 2010, a total of 3,350 acute cases of hepatitis B were reported. The number of acute cases of hepatitis B dropped by 29% during 2006 to 2010, from 4,713 cases to 3,350 cases. After adjusting for asymptomatic infections and under-reporting, the estimated number of new hepatitis B infections in 2010 was 35,000. Among the reported cases with information on outcome, 1.5% indicated the patient died from hepatitis B (CDC).

The number of acute cases of hepatitis C reported in the United States increased about 6%, from 802 in 2006 to 850 in 2010; however, since 2003 the rates of hepatitis C have roughly plateaued. The national rate of acute cases of hepatitis C remained stable, at 0.3 cases per 100,000 from 2006 through 2010. Among the reported cases with information on outcome, 0.6% indicated the patient died from hepatitis C (CDC).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Intravenous drug users who share needles are at high-risk. Healthcare and paramedical workers are considered a high-risk group because of the possibility of infection from accidental needle pricks.

In the US, viral hepatitis is commonly found on Native American reservations or in Alaskan villages. Travelers to international destinations, particularly in developing countries, are at higher risk of exposure.

The universal vaccination of children against hepatitis B began in 1991. Since then there has been a decline in disease incidence substantially among younger age groups. However, higher rates of hepatitis B continue among adults, particularly among males aged 30–44 years. The decline in hepatitis C incidence after 1992 has been attributed primarily to a decrease in incidence among injection-drug users. The reasons for this decrease were unknown but probably stemmed from changes in behavior and practices, including safe sex and no sharing of needles among injection-drug users (Daniels).

Source: Medical Disability Advisor



Diagnosis

History: Fatigue, nausea, appetite loss, diarrhea, and yellow skin and eyes (jaundice or icterus) often are reported as early symptoms of various forms of viral hepatitis. General itching, dark urine (choluria), and lightening of stools (acholia) may also be reported. The individual could have just returned from travel to an undeveloped area, where substandard sanitation practices may increase the risk of developing hepatitis A. In the case of hepatitis B, individuals may also complain of bad breath and a bitter taste in the mouth.

Later symptoms related to various forms of hepatitis may include headache, fever, influenza-like symptoms, muscle pain (arthralgia), or rash. Symptoms may last only a few weeks or linger for months. Symptoms accompanying hepatitis B or C may be ongoing (chronic). Occasionally, individuals with viral hepatitis such as B or D report that the disease appears to have ended, only to be followed by repeated relapses of symptoms.

Physical exam: The exam may reveal yellow skin and eyes (jaundice). Enlargement of the liver (hepatomegaly) and spleen (splenomegaly) may be detected. Progressive liver disease may be indicated by visible branching capillaries on the skin (spider nevi), redness of the palms of the hand (palmar erythema), and a liver that is firm on examination (palpable). A severe form of hepatitis (fulminant) is indicated when the individual displays abnormal behavior, drowsiness, confusion, sleepiness, and possibly coma.

Tests: Various blood tests (serology) will help determine liver function and possibly lead to identification of the form of hepatitis causing the infection. Analysis of serum albumin or blood platelet count may help identify progressive liver disease. A small piece of the liver may be removed for microscopic examination (liver biopsy). Liver biopsies are sometimes recommended for all cases involving hepatitis C to rule out liver damage.

Source: Medical Disability Advisor



Treatment

Prevention is the best treatment for viral hepatitis. Vaccines are available for hepatitis types A and B, including a combined vaccine. Usually, three injections over a period of 6 months are required to give optimal protection. However, even one vaccination "on the way to the airport," is better than none. Most children in the United States are now routinely vaccinated for hepatitis A and B. In adults, vaccination is recommended for people at high-risk, such as healthcare workers, individuals undergoing kidney dialysis, promiscuous individuals, and individuals traveling to areas where hepatitis infection rates are high. More widespread vaccination programs also are underway in efforts to eradicate the B form of hepatitis. Sterile or disposable needles should be used for acupuncture, ear piercing, or tattooing. Preventive treatment, such as an immune globulin injection, may be recommended for household members or sexual partners of an infected individual.

After hepatitis has been diagnosed, consumption of alcoholic beverages should be avoided. Ample rest and fluids are recommended. A high-calorie diet is desirable and should be limited in fats to minimize nausea. In severe cases, intravenous feeding may be required. Liver transplantation may be performed in some cases of fulminant hepatitis or of end-stage chronic hepatitis and cirrhosis.

Since 2008, treatment for hepatitis B has expanded. Several drugs are now administered orally resulting in viral suppression in 90% of patients taking one of these new oral medications. Treatment success rates for hepatitis C have improved since the addition of polymerase and protease inhibitors to standard pegylated interferon/ribavirin combination therapy (CDC).

Source: Medical Disability Advisor



Prognosis

Symptoms of short-term (acute) viral hepatitis often resolve in 2 to 8 weeks. Damage to the liver may heal within 3 to 6 months after the cessation of active viral infection. No long-term effects are expected from uncomplicated acute viral hepatitis.

The disease tends to be more severe and is more likely to become chronic in individuals who are older, pregnant, or immunodeficient. Liver cancer may occur as a result of hepatitis B and C infections.

Liver transplantation is still the most promising option for fulminant hepatitis or end-stage chronic hepatitis and cirrhosis, but other treatments can be helpful in certain situations (Gotthardt 2007). Life expectancy among adult liver transplant recipients living in the United Kingdom was on average 7 years shorter than the average age-sex matched population. Females had a longer life expectancy and lost fewer years than did males. Those 45 and older also lost fewer years of life compared to younger liver transplant recipients. Those with alcohol liver disease, cancer, and HCV lost more years of life compared to transplant recipients with primary biliary cirrhosis, autoimmune cirrhosis, HBV, sclerosing cholangitis, or cryptogenic sclerosis (Barber).

Source: Medical Disability Advisor



Complications

The type of virus influences the severity of acute viral hepatitis, which may persist and turn into an ongoing (chronic) form. Other complications have been found to be associated with hepatitis C, including thyroiditis, vasculitis, and various immune disorders. When viral hepatitis progresses rapidly with increasingly severe symptoms, it is considered to be in a fulminant form. Simultaneous infection with multiple types of hepatitis viruses may complicate the condition and contribute to the development of more serious symptoms.

Acute infection with hepatitis B may lead to inflammation and joint pain (arthritis), skin eruptions such as hives or rash, widespread inflammation of arteries (polyarteritis nodosa), inflammation of small structures in the kidneys (membranous glomerulonephritis), and reversible nerve damage causing paralysis of the extremities, breathing muscles, and face (Guillain-Barré syndrome). Inflammation associated with hepatitis B complications may also affect heart muscles or tissue (myocarditis). Persons older than 40 years of age and drug addicts are more likely to develop a worsening of the disease (subacute hepatic necrosis). Older individuals also may develop muscle pain similar to rheumatism (polymyalgia rheumatica).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Persons with more severe disease or who are expected to perform strenuous activities will require extended periods of partial disability. If fulminant hepatitis develops, a longer recovery time will be needed, especially if transplantation is required. Some individuals who appear to have recovered may have relapses, requiring additional time off from work.

If individuals infected with hepatitis A work in a food-handling job, some states or countries may require their exclusion from food contact until they recover fully. Theoretically, adequate hygiene, including meticulous hand washing and wearing of gloves and facial masks, should allow even infected workers to work safely.

For more information on risk, capacity, and tolerance, refer to "Work Ability and Return to Work," pages 363-364.

Risk: If a coagulopathy is present, then there would need to be restrictions from use of machinery where the risk of accidental lacerations is high, from working at unprotected heights, and from the use of firearms.

Source: Medical Disability Advisor



Maximum Medical Improvement

Continuing to drink will greatly affect this determination. Complications such as varices or neurologic changes may also impact MMI determination. Generally, a individual would be at MMI by 90 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:

  • Has diagnosis of viral hepatitis been confirmed?
  • Has individual experienced any complications?
  • Does individual have an underlying condition that may affect recovery?
  • Does individual live on an Indian reservation or work on a reservation?
  • Has individual traveled recently? Internationally? To a developing country?

Regarding treatment:

  • Has individual complied with prescribed treatment regarding rest, fluids, limited calorie intake, and abstention from alcohol?
  • Has individual received appropriate tests to identify the form of viral hepatitis to ascertain proper treatment?
  • If individual has severe symptoms, has a liver transplant been considered as an option?

Regarding prognosis:

  • Does individual have a weakened immune system?
  • Is individual an alcoholic?
  • Is extended disability related to factors such as age, pregnancy, or immunodeficiency?
  • Has individual been diagnosed with liver cancer?

Source: Medical Disability Advisor



References

Cited

"Viral Hepatitis Surveillance, United States 2010." CDC. Aug. 2012. Centers for Disease Control and Prevention. 7 Oct. 2013 <http://www.cdc.gov/hepatitis/Statistics/2010Surveillance/>.

Barber, K. , et al. "Life Expectancy of Adult Liver Allograft Recipients in the Uk." Gut 2007 (56): 279-282.

Daniels, D. , S. Grytdal, and A. Wasley. "Surveillance for Acute Viral Hepatitis - United States, 2007." Morbidity and Mortality Weekly Report 58 (2009): 1-27.

Gotthardt, D. , et al. "Fulminant Hepatic Failure: Etiology and Indications for Liver Transplantation." Nephrology, dialysis, transplantation 22 Suppl. 8 (2007): viii5-viii8.

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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