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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.

Hodgkin's Disease


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 | Maximum Medical Improvement | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
201.00 - Hodgkins Paragranuloma, Unspecified Site
201.08 - Hodgkins Paragranuloma, Lymph Nodes of Multiple Sites
201.40 - Hodgkins Disease, Lymphocytic-histiocytic Predominance, Unspecified Site
201.48 - Hodgkins Disease, Lymphocytic-histiocytic Predominance, Lymph Nodes of Multiple Sites
201.50 - Hodgkins Disease, Nodular Sclerosis, Unspecified Site
201.58 - Hodgkins Disease, Nodular Sclerosis, Lymph Nodes of Multiple Sites
201.60 - Hodgkins Disease, Mixed Cellularity, Unspecified Site
201.68 - Hodgkins Disease, Mixed Cellularity, Lymph Nodes of Multiple Sites
201.70 - Hodgkins Disease, Lymphocytic Depletion, Unspecified Site
201.78 - Hodgkins Disease, Lymphocytic Depletion, Lymph Nodes of Multiple Sites
201.90 - Hodgkins Disease, Unspecified, Unspecified Site
201.98 - Hodgkins Disease, Unspecified, Lymph Nodes of Multiple Sites

Related Terms

  • Hodgkin's Lymphoma
  • Lymphatic Cancer

Overview

Hodgkin's disease accounts for about 14% of cancers that develop in lymphatic tissue, and for about 0.6% of all cancers. All other types of lymphoma are called non-Hodgkin's lymphomas. Lymphatic tissue includes lymph nodes connected throughout the body by a network of vessels, the spleen, thymus, and bone marrow. Lymph nodes make and store lymphocytes, a type of white blood cell. Lymphatic vessels transport the lymphocytes in a clear fluid called lymph to the bloodstream. Hodgkin's disease is caused by the development of an abnormal type of lymphocyte called a Reed-Sternberg cell. This cell divides rapidly and replicates uncontrollably, destroying the normal structure and function of the tissue within the lymphatic system.

Hodgkin's disease usually begins as a painless swelling of a lymph node, most commonly in the chest, neck, or underarms; it then spreads to adjoining nodes. It may also spread to the bloodstream and be carried to distant sites including the liver, lungs, and bone marrow.

There is no definitive cause for Hodgkin's disease, but the same virus (Epstein-Barr virus) responsible for infectious mononucleosis is found in the tumor cells of about 50% of individuals with some types of Hodgkin's disease. Individuals who have had mononucleosis have about a fourfold increased risk of developing EB virus containing Hodgkin's disease with a mean latency of about 4 years. Individuals with reduced immunity because of HIV infection, immunosuppressive medication, or immune deficiency diseases may also have greater risk for Hodgkin's disease. A genetic predisposition has also been noted, as well as a relationship to certain human leukocyte (white blood cell) antigens (HLA).

Incidence and Prevalence: Hodgkin's disease affects 2.9 per 100,000 people in the US (Argiris). About 8,000 cases are diagnosed in the US each year, compared to 800 in Canada (Kaufman). The incidence rate has been declining for over 20 years at a rate of about 0.9% per year ("Hodgkin's Disease"). Because of advances in treatment, the death rate has fallen more than 60% in the past 30 years ("Detailed Guide"). Incidence of Hodgkin's disease is 59,000 individuals worldwide (Argiris).

Source: Medical Disability Advisor



Causation and Known Risk Factors

There may be a genetic predisposition toward Hodgkin's disease; about 1% of individuals with this condition will have a family history of the disease, and siblings of individuals with Hodgkin's disease have a 3 to 5 times greater risk of developing the disease ("Hodgkin's Disease").

The incidence of Hodgkin's disease is higher in men than in women by a ratio of 1.4 to 1 ("Hodgkin's Disease"). Hodgkin's disease is more common in whites than in blacks or Asians. Generally, Hodgkin's disease has a bimodal distribution, affecting predominantly young adults (15 to 34 years of age) or older individuals (50 years or older); peak incidence is between ages 20 and 24, and again between ages 80 and 84 ("Detailed Guide"; Kaufman).

Source: Medical Disability Advisor



Diagnosis

History: Individuals are often asymptomatic. Some will report a painless, swollen lump in the neck, groin (ilioinguinal-femoral region), or under the arm. Others will report vague symptoms such as persistent fever, weight loss, night sweats, itching (pruritus), and fatigue. Characteristically, the fever is cyclic (Pel-Ebstein fever) and may recur at variable intervals of several days to many weeks.

Physical exam: Enlarged lymph nodes, nearly always in the neck or armpit, but occasionally in the groin, are usually noted during physical examination. The nodes may be hard, rubbery, or soft. Enlargement of both the spleen (splenomegaly) and liver (hepatomegaly) may be noticed during palpation of the abdomen. If the cancer is advanced, large masses may appear on the neck, producing the "bull-neck" appearance characteristic of late-stage Hodgkin's disease.

Tests: Blood tests include complete blood count (CBC) to evaluate numbers of red blood cells (RBCs) and white blood cells (WBCs), hemoglobin, and platelets. RBCs and hemoglobin may be reduced due to anemia. WBCs may be elevated as part of the immune system response to disease or inflammation. Blood chemistries such as blood protein (serum albumin), uric acid, and liver enzymes will be performed. An erythrocyte sedimentation rate (ESR) may be done to determine if inflammation is present.

Definitive diagnosis of Hodgkin's disease requires taking a sample of tissue (biopsy) from an enlarged lymph node, staining the tissue cells (immunohistochemical staining), and examining them under a microscope. A pathologist will examine the stained cells to identify Reed-Sternberg cells typical of Hodgkin's disease; staging of the disease can be done at the same time by classifying cells from different sites. The cells may be stained (immunophenotyping) to identify molecules on the cell surface. Classical Hodgkin lymphoma cells express CD15 and CD 30, variably express CD20, and do not express CD 3 or CD 45.

If the biopsy confirms the diagnosis of Hodgkin's disease, additional tests will be conducted. Other tests may include a chest x-ray (radiographic examination) to identify enlarged lymph nodes in the middle of the chest (mediastinal mass). A CT scan, MRI, positron emission tomography (PET), gallium scan, or an exploratory abdominal surgical procedure (laparotomy) may help determine if the disease has spread outside the lymph system. A sample of bone marrow (bone marrow biopsy) may reveal bone involvement.

Source: Medical Disability Advisor



Treatment

Complete cure is now the goal of treatment, which may consist primarily of chemotherapy and radiation therapy. Treatment depends upon the stage of the disease at diagnosis and the individual's age. Staging is based on clinical signs and symptoms, the number and location of affected nodes, whether nodes are on only one side of the diaphragm or both, and whether there is evidence of spreading to either bone marrow or spleen or outside the lymphatic system.

Source: Medical Disability Advisor



Prognosis

Hodgkin's disease responds very well to treatment. Overall, the 1-year survival rate is 91%, the 5-year survival rate is 84%, the 10-year survival rate is 76%, and the 15-year survival rate is 68% ("Detailed Guide"). Most recurrences are usually treated effectively with chemotherapy and/or radiation. Only 15% of individuals with Hodgkin's disease relapse following successful treatment with both chemotherapy and radiation (Argiris). After 15 to 20 years, individuals are more likely to die from a different type of malignancy than from a recurrence of Hodgkin's disease ("Detailed Guide").

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • General Surgeon
  • Hematologist
  • Oncologist
  • Radiology Oncologist

Source: Medical Disability Advisor



Rehabilitation

Formal therapy is not typically prescribed for patients with Hodgkin lymphoma.

Source: Medical Disability Advisor



Comorbid Conditions

  • Diabetes
  • HIV/AIDS
  • Immunosuppressant therapy for rheumatologic disease or transplant maintenance
  • Liver disease

Source: Medical Disability Advisor



Complications

Complications of Hodgkin's disease can include lymph node enlargement or fluid accumulation in various locations in the body, resulting in the following emergency situations: obstruction of the airway, obstruction of the major vein that returns blood to the heart (superior vena caval obstruction), compression of the heart (pericardial tamponade), spinal cord compression, obstruction of the hepatic (liver) duct (extrahepatic biliary obstruction), or pressure on nerves in the head or periphery (cranial and peripheral neuropathies).

Complications of radiation treatment for Hodgkin's disease include development of secondary cancers such as acute nonlymphocytic leukemia, radiation-induced carcinomas and sarcomas, and non-Hodgkin's lymphoma. Additionally, radiation therapy to the neck region may result in an underactive thyroid (hypothyroidism) several years after treatment is completed.

Chemotherapy often results in acute, though reversible, toxicity leading to nausea, vomiting, and neurologic disorders. Infections may occur as a result of immunosuppression by chemotherapeutic agents being used in treatment or as a result of Hodgkin's disease itself. Other complications of chemotherapy may include heart or lung disorders and female infertility.

Source: Medical Disability Advisor



Factors Influencing Duration

Factors that influence the length of disability include the stage of the disease when it is first detected, the treatment methods used and their complexity, and the individual's response to treatment. Individuals older than 50 years tend to have more advanced disease and do less well in response to combination chemotherapy and irradiation than do younger individuals. Disability may result from the adverse effects of radiation or chemotherapy, not only from the disease itself.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals with Hodgkin's disease will experience high levels of fatigue with normal levels of physical exertion. Chemotherapy and radiation therapy can cause additional weakness and fatigue. Also, individuals who have exploratory abdominal surgery (laparotomy) may require more sedentary, nonphysical work for a period of time. Heavy physical labor is usually restricted following surgery (laparotomy), chemotherapy, and/or radiation therapy treatments. Work responsibilities may need to be modified until recovery is complete.

Risk: According to "Work Ability and Return to Work," "Risk in cancer survivors may be due to chemotherapy. If there is physical exam or electrodiagnostic test evidence of chemotherapy associated peripheral neuropathy, balance may fbe impaired, and restrictions that would prevent climbing to heights may be indicated. If corticosteroids or chemotherapy have resulted in osteoporosis, restrictions to prevent pathologic fracture may be indicated (including limited climbing to heights and limited heavy lifting). As long as immune system suppression exists after treatment, patients should be restricted from working with sick animals or humans and from fungal exposure (e.g. gardening)" (page 406).

Capacity: According to "Work Ability and Return to Work," "Patients may have residual myopathy after chemotherapy, and functional testing may be indicated to quantitate residual functional capacity. Some chemotherapy agents have cardiac and pulmonary toxicity, and treadmill testing of exercise ability may be helpful to establish current ability. Similarly, some cancer surgery (eg, pneumonectomy) will decrease cardiopulmonary function (capacity for work or exercise). Similarly, anemia may be significant during and after chemotherapy, and treadmill exercise testing can give both the physician and the patient an idea about exercise or work capacity" (pages 406-407).

Tolerance: The reader is strongly encouraged to read Chapter 21 of "Work Ability and Return to Work" as tolerance issues tend to predominate, especially after normal expected surgical healing. Chemotherapy can have effects on functioning, which limits tolerance for the work environment. Ideally, reduced work hours may accommodate that limitation while creating a permissive environment for eventual return to full time work. According to "Work Ability and Return to Work," "Patients undergoing chemotherapy and/or radiation therapy typically have symptoms like nausea, diarrhea, and fatigue that are clearly due to their treatment, and in Western society these symptoms are traditionally judged to be severe enough to justify certification of work absence during the active phase of cancer treatment. Despite these symptoms, many of the self-employed and uninsured return to work" (page 407).

Accommodations: Reduced hours of work and reduction in heavy physical demands may permit return to limited duty work during radiation and/or chemotherapy.

Source: Medical Disability Advisor



Maximum Medical Improvement

Individuals undergoing chemotherapy are not at MMI until 90 days post-chemo.

Individuals who require surgery only would be at MMI at 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 a tissue sample (biopsy) been taken from an enlarged lymph node to make a definitive diagnosis of Hodgkin's disease?
  • What subtype disease is present? Is individual infected with the human immunodeficiency virus (HIV)?
  • What subtype of diseased was diagnosed, and what stage was the illness before treatment was started?

Regarding treatment:

  • How did individual respond to the treatment? Was the treatment successful?

Regarding prognosis:

  • Is this a recurrence (approximately 3 years after diagnosis) or a relapse (3 to 20 years after treatment)? Have complications resulted from chemotherapy and/or radiation therapy?
  • How will complications be treated, and what is the expected outcome with treatment?
  • Would individual benefit from psychological counseling?

Source: Medical Disability Advisor



References

Cited

"Detailed Guide: Hodgkin's Disease." American Cancer Society. 18 Jan. 2013. 19 Apr. 2013 <http://www.cancer.org/cancer/hodgkindisease/detailedguide/index>.

"Hodgkin's Disease." MD Consult. Elsevier, Inc. 12 Oct. 2004 <http://home.mdconsult.com/das/stat/view/41552076-4/ctt?nid=109703&sid=280922653>.

Argiris, Athanassios, and Virginia Kaklamani. "Hodgkin Disease." eMedicine. Eds. Kaushik A. Shastri, et al. 7 Jun. 2012. Medscape. 19 Apr. 2013 <http://emedicine.medscape.com/article/201886-overview>.

Bessell, E. M. , et al. "Long-term survival after treatment for Hodgkin's disease (1973-2002): improved survival with successive 10-year cohorts." British Journal of Cancer 107 (2012): 531.

Kaufman, D., and D. Longo. "Hodgkin’s Disease." Clinical Oncology. Eds. Martin D. Abeloff, et al. 2nd ed. New York: Churchill Livingstone, Inc., 2620-2621.

Siegel, R. , D. Naishadham, and A. Jemal. "Cancer statistics." CA: A Cancer Journal for Clinicians 63 (2013): 11.

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