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.

Endometriosis


Medical Codes

ICD-9-CM:
617.0 - Endometriosis of Uterus
617.1 - Endometriosis of Ovary; Chocolate Cyst of Ovary; Endometrial Cystoma of Ovary
617.2 - Endometriosis of Fallopian Tube
617.3 - Endometriosis of Pelvic Peritoneum
617.4 - Endometriosis of Rectovaginal Septum and Vagina
617.5 - Endometriosis of Intestine
617.6 - Endometriosis in Scar of Skin
617.8 - Endometriosis of Other Specified Sites
617.9 - Endometriosis, Site Unspecified

Related Terms

  • Ectopic Endometrium

Overview

© Reed Group
Endometriosis, a chronic noncancerous disorder of the female reproductive system, develops when specialized tissue that normally lines the uterus (endometrium) grows outside of the uterus. Common sites for endometriosis include ovaries, fallopian tubes, external genitalia (vulva), ligaments supporting the uterus, intestine, bladder, cervix, and vagina. Rarely, endometriosis has been found outside the pelvis and abdomen.

Endometriosis responds to hormones of the menstrual cycle. Each month, endometrial implants grow and thicken, as does the lining of the uterus. If pregnancy does not occur, the implants break down and bleed. Unlike uterine tissue, however, endometrium has no way to leave the body when it breaks down. It becomes trapped, and tissue surrounding it may become irritated. Pain, inflammation, and scar tissue (adhesions) can result.

The cause of endometriosis is unclear, but a common theory is "retrograde menstruation," in which some menstrual blood flows backward out of the fallopian tubes rather than exiting through the vagina. Endometrial cells in the menstrual flow may then attach themselves to various locations. Another theory suggests that endometrial cells may be circulated through lymph or blood.

Rarely, women with medical problems that prevent normal passage of menstrual blood may be at increased risk. Also, some evidence suggests that if cells lining the pelvis become damaged due to previous infection, endometriosis may develop. When a woman becomes pregnant or menopausal, the endometrial implants shrink and much of the pain disappears. However, any scar tissue will remain and may continue to cause pain even though the menstrual cycle has ceased. Symptoms may begin again after pregnancy or, rarely, may be reactivated by hormone replacement therapy after menopause.

Incidence and Prevalence: The exact incidence of endometriosis is unknown, since surgery is required for a positive diagnosis. Endometriosis may affect 10% to 15% of menstruating women aged 25 to 44. It can also affect adolescents. Until recently, a large percentage of women who complained of symptoms were dismissed as being overly sensitive to pain. Many individuals who receive a diagnosis of endometriosis complained of symptoms for up to 6 years before receiving a diagnosis. It is estimated that 25% to 50% of infertile women have endometriosis.

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report no symptoms or a variety of symptoms, with pelvic pain and abnormal or heavy menstrual bleeding being the most commonly reported. The amount of pain is not related to the extent of endometriosis. Severe abdominal and / or lower back pain may begin before a menstrual period and become more severe toward the end of a period. Other possible symptoms are fatigue, pain with intercourse, diarrhea, constipation, painful bowel movements during the menstrual period, rectal bleeding or blood in urine only during the menstrual period, and irregular bleeding or spotting between periods. Cramping or lower abdominal pain may occur any time during a woman’s cycle. A large endometrial growth can cause the sensation of pelvic pressure.

Physical exam: A pelvic examination may detect endometrial growths or tender areas when the uterus, its supporting ligaments, or the ovaries are palpated. Growths may also be seen if located in the upper vagina or on the cervix. However, many women have no abnormal findings on physical examination. Unexplained infertility may raise suspicion of endometriosis.

Tests: Laparoscopy, a minimally invasive surgical procedure, is the most common and accurate method to identify endometriosis. The physician inserts a small, lighted viewing instrument into the abdomen through a small incision below the navel and visually inspects the pelvis and abdomen. Usually a small sample of tissue (biopsy) is removed for microscopic examination. Laparoscopy can reveal location, extent, and size of endometrial growths and help make treatment decisions.

The amount of cancer antigen (CA) 125 (a protein found in pelvic organs of women with endometriosis) may be monitored in women experiencing infertility and pain. Blood levels CA125 levels are higher in cases of moderate-to-severe endometriosis and are used for diagnosis and to follow effects of therapy. A blood test to diagnose endometriosis may eventually be available; it would reveal elevated levels of CA125.

Additional tests may be necessary to rule out other diagnoses with similar symptoms, such as a pregnancy test for ectopic pregnancy, urinalysis for urinary infection, colonoscopy or barium enema to rule out bowel disease (such as diverticulitis), or ultrasound to rule out ovarian cancer.

Source: Medical Disability Advisor



Treatment

The approach to treatment is influenced by the severity of symptoms, the extent of disease, and by the woman's age and desire for future childbearing. Treatment can include observation, medical therapy, surgical therapy, or both.

In women with no symptoms or only mild discomfort, observation may be all that is needed. No evidence has demonstrated that early treatment will prevent or lessen later symptoms. Pain relievers may be useful.

Hormone treatment for endometriosis includes birth control pills, high doses of another female hormone (progestins), or a male hormone derivative. Hormone therapy may help to halt the spread and reduce the pain of endometriosis by interrupting the menstrual cycle. Another treatment option is a synthetic hormone-like substance (GnRH analog) that temporarily interrupts the production of estrogen and produces a medical menopause. This treatment often shrinks the endometrial growths and provides significant relief from symptoms.

Conservative surgical treatment aims to relieve painful symptoms of endometriosis without removing the reproductive organs. Removal or destruction (ablation) of endometrial tissue can be accomplished by ablation techniques such as electrocautery, thermal latex balloon treatment, or laser photovaporization. Endometrial ablation has been performed with a laser for more than 25 years; the method uses hysteroscopic visualization (hysteroscopy) to view the procedure and guide the laser beam. Laser ablation is preceded and followed by drug therapy for endometrial suppression. Tissue biopsies performed after laser photovaporization of the endometrium have shown no inflammation and only minimum regeneration of endometrial tissue. Sometimes sufficient endometrial tissue can be removed by cutting (excising) during diagnostic laparoscopy. Laparoscopic excision of endometrial tissue, laparoscopic lysis of adhesions (adhesiolysis), and cutting of the uterosacral nerves have all been shown effectively reduce pain. After endometrial ablation by any technique, menstruation ceases in 25% to 60% of women, others will experience a decrease in the amount of menstrual bleeding, and only 24% will later have a hysterectomy (Stenchever 2001). Additionally, laparoscopic lysis of adhesions may help increase fertility rates in women who have moderate-to-severe endometriosis. Normal ovaries and fallopian tubes are not treated. Although painful symptoms can be relieved by surgery, symptoms generally return.

More extensive surgery is undertaken only when all other options have failed. This may involve removal of the uterus (hysterectomy) and both ovaries (oophorectomy) and perhaps the fallopian tubes (bilateral salpingo-oophorectomy). Although these surgeries may help prevent a recurrence of endometriosis, they also preclude pregnancy and leave women in a permanent state of menopause.

New types of drugs, such as antiprogestins and aromatase inhibitors, are being studied for the treatment of endometriosis.

Source: Medical Disability Advisor



Prognosis

Most women obtain substantial, if not total, relief from pain and are still able to bear children. Approximately 90% of women with mild-to-moderate endometriosis are able to become pregnant within 5 years (Mayo Clinic Staff). Current treatment offers relief from symptoms, but there is no cure. Endometriosis generally recurs after surgery, although the use of oral contraceptives may slow its progression. The course of endometriosis in any individual cannot be predicted.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • General Surgeon
  • Gynecologist

Source: Medical Disability Advisor



Comorbid Conditions

  • Anemia or another blood disorder

Source: Medical Disability Advisor



Complications

The primary complication is impaired fertility. Adhesions can form and cause intestinal obstruction. Growths on or near the bladder can interfere with urinary function. Blood trapped inside the ovary can accumulate, causing a noncancerous tumor (endometrioma). Recurring chronic pain or infertility may lead to depression and emotional issues. Side effects are frequent with hormonal therapy.

Source: Medical Disability Advisor



Factors Influencing Duration

Disability factors include severity of symptoms, location of growths, method of treatment, complications and job requirements.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

In women who have undergone surgery for endometriosis, work involving lifting, climbing, prolonged standing, or physical exertion may need to be limited throughout the disability period.

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 a family history of endometriosis?
  • Does individual report pelvic pain and abnormal or heavy menstrual bleeding?
  • Does individual report severe abdominal and / or lower back pain that begins before a menstrual period and becomes even more severe toward the end of a period?
  • Does individual have fatigue, pain with intercourse, diarrhea, constipation, painful bowel movements during the menstrual period, rectal bleeding or blood in the urine only during the menstrual period, and irregular bleeding or spotting between periods?
  • Does individual report crampy lower abdominal pain that occurs any time during the cycle?
  • On pelvic examination, were endometrial growths or tender areas present when the uterus was palpated?
  • Were growths also present in the upper vagina or on the cervix?
  • Has individual had a laparoscopy with a biopsy, CA125 levels, pregnancy test, urinalysis, colonoscopy or barium enema, or ultrasound?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Is individual being treated with careful observation, medical therapy, surgery, or a combination?
  • Is individual using pain relievers?
  • Has individual tried hormone therapy?
  • Was surgery necessary?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that may hinder recovery?
  • Does individual have any complications such as adhesions, intestinal obstruction, urinary dysfunction, endometrioma, infertility, depression, or emotional issues?
  • Is individual experiencing side effects of hormonal therapy?

Source: Medical Disability Advisor



References

Cited

Mayo Clinic Staff. "Endometriosis." MayoClinic.com. Mayo Foundation for Medical Education and Research. 4 Oct. 2004 <http://www.mayoclinic.com/invoke.cfm?objectid=BCA261E0-0FFD-4933-87C852CF94968FE2&dsection=4>.

Stenchever, Morton. "Endometrial Ablation." Comprehensive Gynecology. 4th ed. St. Louis: Mosby, Inc., 2001.

Source: Medical Disability Advisor