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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.

Herpes Simplex


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | 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:
054.0 - Herpes Simplex; Eczema Herpeticum; Kaposis Varicelliform Eruption
054.10 - Herpes Simplex; Genital Herpes, Unspecified; Herpes Progenitalis
054.11 - Herpes Simplex; Genital Herpes; Herpetic Vulvovaginitis
054.12 - Herpes Simplex; Genital Herpes; Herpetic Ulceration of Vulva
054.13 - Herpes Simplex; Genital Herpes; Herpetic Infection of Penis
054.19 - Herpes Simplex; Genital Herpes; Other
054.2 - Herpes Simplex; Herpetic Gingivostomatitis
054.3 - Herpes Simplex; Herpetic Meningoencephalitis; Herpes Encephalitis, Simian B Disease
054.43 - Herpes Simplex with Ophthalmic Complication; Herpes Simplex Disciform Keratitis
054.71 - Visceral Herpes Simplex
054.8 - Herpes Simplex with Unspecified Complication
054.9 - Herpes Simplex without Mention of Complication

Related Terms

  • Cold Sore
  • Fever Blister
  • Genital Herpes
  • Oral Herpes

Overview

Herpes simplex is a virus transmitted by close personal contact that causes infections characterized by an eruption of small fluid-filled blisters (vesicles) or lesions on the skin, accompanied by burning and itching.

There are two types of herpes simplex virus: type I (HSV-I) oral herpes, which usually produces cold sores on the lips; and type II (HSV-II) genital herpes, which usually produces lesions on the penis, in the vaginal area, within the cervix, on the perianal skin, in the urinary tract, or on the buttocks or thighs. However, either virus type can cause oral or genital infection. Herpes can also cause infections inside the mouth (gingivostomatitis), in the eye (keratoconjunctivitis), or on the skin, as well as more serious infections of the nervous system and brain (encephalitis). The most common form of herpes, however, is a cold sore that appears at the edge of the lip. Individuals can be infected with both types of HSV.

After a first episode, the virus has dormant and active phases. When active, HSV usually causes a recurrence of lesions around the same area of the first outbreak. Recurrences vary by individual case, although the rate is lower for HSV-I than HSV-II. When symptoms present themselves, usually indicated by lesions, the virus is active. But the lack of symptoms does not necessarily mean the virus is dormant. This is known as "asymptomatic shedding," and may occur in rectal tissue or in secretions from the penis or vagina. Individuals with new infections are more likely to shed the virus than someone with an infection that is older, and those with more frequent outbreaks may shed the virus more often than those with infrequent outbreaks. HSV-II is more likely to produce shedding.

Recurrence triggers are largely unknown. Some individuals report recurrences due to stress, illness, poor nutrition, menstruation, and high-frequency or vigorous sexual activity.

Incidence and Prevalence: There is no case reporting data for genital herpes. Genital herpes is common in the US, with at least 45 million people having some type of HSV infection. Lifetime seroprevalence may be 20% to 80% (Salvaggio).

Source: Medical Disability Advisor



Causation and Known Risk Factors

HSV-II is more common in women than in men (seropositivity to antibodies to HSV-II, 25% vs. 17%) (Salvaggio). More blacks and Mexican-Americans than whites get the disease. Oral-oral contact, penile-vaginal and/or penile-anal intercourse, genital-oral and/or anal-oral contact, and other body-to-body contact are routes of transmission.

HSV increases an individual's risk of contracting human immunodeficiency virus (HIV).

Source: Medical Disability Advisor



Diagnosis

History: Both oral and genital herpes may be asymptomatic; however, infection may be transmitted even in absence of visible lesions. Burning, tingling, stinging, and pain at the site of infection, accompanied by lesions that appear as a group of small blisters (vesicles) on the skin, are the main symptoms of herpes infections. These lesions most frequently occur on the mouth, lips, and conjunctiva of the eye or, in the case of genital herpes, on the genitalia. Lesions typically ooze and crust over in 7 to 10 days, but may last several weeks. A sore throat, fever, irritability, and an indefinite feeling of lack of health (malaise) can also accompany herpes. The primary or initial infection usually produces no symptoms, but the individual may experience fever, a sore throat or mouth sore before the virus becomes dormant.

Physical exam: Typically, vesicles may be observed on the skin or mucous membranes where the virus came into contact with the body (mouth, lips, eye conjunctiva, or genitalia). The vesicles may spread together, forming a larger lesion, and usually crust over following rupture of the blisters. The exam can sometimes show enlargement and tenderness of the lymph nodes (lymphadenopathy) in the neck or groin.

Tests: The virus can be detected through a viral culture taken from a lesion sample, or from a blood test. A culture will also indicate which type of HSV is present. Microscopic examination of the infected skin cells, or a Tzanck smear, can indicate abnormalities. For rapid diagnosis when encephalitis is suspected, a polymerase chain reaction (PCR) test on cerebrospinal fluid (CSF), or an antibody test on a brain biopsy, can be performed.

Source: Medical Disability Advisor



Treatment

There is no cure for genital herpes, but lesions are typically self-limiting, and extensive treatment is not warranted. The lesion should be kept clean and dry to prevent spreading and the development of secondary bacterial infections. For more severe cases of herpes, antiviral medications such as acyclovir, famciclovir, or valacyclovir are given. Since the use of these antiviral medications began, resistant strains of the virus have been reported. Many individuals find over-the-counter remedies such as camphor to be effective. Mouth rinses that contain lidocaine may provide pain relief. No treatment can prevent the virus from becoming dormant in the body.

Using condoms during intercourse and dental dams during oral-vaginal or oral-anal contact can reduce the risk of contracting genital herpes. The risk of oral herpes may be reduced by using a lip balm containing sunscreen or by otherwise decreasing sun exposure.

Source: Medical Disability Advisor



Prognosis

Herpes lesions of the mouth or genitals typically clear up in 7 to 10 days. Serious infections that have spread to the brain take longer to treat and can be fatal, but that is rare.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Family Physician
  • Infectious Disease Internist

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Complications include systemic infections, meaning that the virus spreads throughout the body. Rarely, encephalitis, inflammation of the bone marrow (myelitis), meningitis, and pain in the nerves (neuralgia) can occur. Genital herpes infections during pregnancy can cause infection in the fetus and can result in spontaneous abortion, premature birth, or congenital abnormalities.

Source: Medical Disability Advisor



Factors Influencing Duration

If the disease has spread to become systemic or caused infection of any organs, the disability will be extended.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals may not be able to use their mouths or lips for a period of time, which may interfere with some types of work. More serious forms of the disease may require more work restrictions.

Risk: Transmission between co-workers is very unlikely because it would require direct contact between an open sore of an infected individual and the broken skin or mucous membranes of a seronegative individual.

Capacity: Capacity may be influenced by the size and location of the lesions, though this would normally only affect individuals who have multiple mouth sore eruptions and their job requires heavy vocal use. Once the infection has become dormant, capacity should not be affected.

Tolerance: Individuals with oral lesions may feel self-conscious about their appearance during an outbreak and may temporarily be unwilling to work in positions that require public interaction. Some individuals with an active HSV-II outbreak may have discomfort with prolonged sitting, which may be improved by wearing loose-fitting clothing.

Source: Medical Disability Advisor



Maximum Medical Improvement

14 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 herpes simplex virus been confirmed?
  • Have other conditions with similar symptoms been ruled out?
  • Does individual have a coexisting condition that may complicate treatment or affect recovery?

Regarding treatment:

  • Although usually self-limiting, have symptoms persisted past expected resolution?
  • If complications occurred (such as systemic infections, encephalitis, myelitis, meningitis, neuralgia, or spontaneous abortion), have they responded to treatment?
  • Does individual's condition warrant a more aggressive treatment with antiviral medication?

Regarding prognosis:

  • Does individual have a lowered or suppressed immune system, resulting in disease episodes that are more severe, last longer, and often show long-term effects of the infection?
  • Would individual benefit from consultation with an infectious disease specialist?
  • If individual is pregnant, has she informed her obstetrician or health care provider about her HSV history?

Source: Medical Disability Advisor



References

Cited

Salvaggio, Michelle R. "Herpes Simplex." eMedicine. Ed. Burke A. Cunha. 5 Jan. 2012. Medscape. 16 Aug. 2014 <http://emedicine.medscape.com/article/218580-overview>.

Source: Medical Disability Advisor