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.

Neurofibromatosis


Related Terms

  • BAN
  • Bilateral Acoustic Neurofibromatosis
  • Central Bilateral Acoustic NF
  • NF
  • NF1
  • NF2
  • Peripheral NF
  • Von Recklinghausen's Disease

Differential Diagnosis

  • Bannayan-Riley-Ruvalcaba syndrome
  • Congenital generalized fibromatosis
  • Juvenile hyaline fibromatosis
  • Klippel-Trénaunay-Weber syndrome
  • Leopard syndrome
  • McCune Albright syndrome
  • Multiple endocrine neoplasia syndrome type 2B
  • Multiple intradermal nevi
  • Multiple lipomatosis
  • NF1 and NF2 share certain symptoms, and must be differentiated from each other
  • Proteus syndrome

Specialists

  • Neurologist
  • Neurosurgeon
  • Oncologist

Comorbid Conditions

Factors Influencing Duration

The length of disability depends upon the severity of symptoms and whether or not surgery is required. Older individuals may be expected to have longer recovery times following surgery that requires general anesthesia.

Medical Codes

ICD-9-CM:
237.70 - Neurofibromatosis, Unspecified
237.71 - Neurofibromatosis, Type I; von Recklinghausens Disease
237.72 - Neurofibromatosis, Type II; Acoustic Neurofibromatosis

Overview

Neurofibromatosis (NF) is a rare condition characterized by the growth of various-sized non-cancerous (benign) tumors on nerves in or leading away from the brain and spinal cord (peripheral nerves), and lesions in the vascular system and other organ systems. The tumors arise from abnormal development of neural crest cells (nerve cells) in the central nervous system. There are two distinct forms of NF: NF1 (von Recklinghausen NF, formerly called peripheral NF) and NF2 (bilateral acoustic NF [BAN], formerly called central NF).

NF1 is the most common form, affecting nerves throughout the body. NF1 tumors or neurofibromas occur as groups of soft, fibrous swellings and areas of abnormal skin coloration. Occasionally they may develop on nerves leading away from the brain (cranial nerves). Individuals with NF1 may develop severe physical disfigurement as the disease progresses, often associated with bone involvement.

NF2 is a rare type of NF characterized by multiple tumors on the cranial and spinal nerves, and by other lesions of the brain and spinal cord. The hallmark of acoustic NF2 is tumor growth (schwannoma) on the nerves to the ears (auditory or eighth cranial nerve). NF2 is not associated with disfigurement although hearing or visual disorders may develop.

Neurofibromatosis is considered an inherited genetic condition that develops as the result of an autosomal dominant trait. Gene abnormalities are found on chromosome 17 for NF1 and on chromosome 22 for NF2. It occurs as a result of random gene mutation in 50% of cases (Goetz 670).

Incidence and Prevalence: NF1 is one of the most commonly inherited genetic disorders. It occurs in 1 of every 4000 individuals and is found worldwide. NF2 is rare and occurs in 1 of every 40,000 individuals. About 50% of NF is inherited, while 50% occurs as a genetic mutation (Goetz 670).

Source: Medical Disability Advisor



Diagnosis

History: Individuals with NF1 usually report pale, coffee-colored patches (cafe-au-lait spots) on the skin of the trunk and pelvis, and may report tumors on or under the skin (dermal tumors or fibroma molluscum). Other complaints may include headaches, severe itching, gastrointestinal pain or chronic constipation, seizures, and vision abnormalities. Individuals with NF2 usually complain of a ringing in the ears (tinnitus) and deafness. Also, they may complain of vision and memory problems, weakness in their facial muscles, skin tumors, and an inability to maintain their balance.

Physical exam: For both NF1 and NF2, manipulation of the skin by touch (palpation) usually reveals moveable, small, solid lumps (nodules) on or under the skin. The skin nodules may be unsightly. In some cases, there may be an underlying bony abnormality and abnormal freckling in the armpit (axillary) or pelvic (inguinal) area. Coffee-colored (cafe-au-lait) spots on the skin of the trunk and pelvis are common in individuals with NF1, appearing less often on limbs; these spots are typically present from childhood and become more pronounced in young adults. The presence of six or more café au lait spots and two or more neurofibromas is usually considered a definitive diagnosis of NF1, particularly if another family member also has the condition. Individuals with NF1 may also exhibit abnormal curvature of the spine (scoliosis); high blood pressure (hypertension); abnormal height, weight, and head circumference; an abnormal shape (asymmetry) of the face; and nodules in the eye (Lisch nodules).

Tests: NF1 and NF2 can be differentiated through gene studies, in which abnormalities will be found on chromosome 17 with NF1 and chromosome 22 with NF2. Magnetic resonance imaging (MRI), especially gadolinium-enhanced MRI, is considered to be more sensitive than CT for the visualization of small neurofibromas, and may be useful in identifying complications resulting from tumor growth. Individuals with NF2 will be advised to have their hearing checked (audiology test) on a routine basis. X-rays may be the imaging modality used to investigate bone involvement caused by neurofibromatosis. Appropriate diagnostic testing may be required for other organs involved.

Source: Medical Disability Advisor



Treatment

Although there is no cure for neurofibromatosis, surgical removal of the neurofibromas may be necessary depending upon their location and whether or not they cause complications in other organ systems or produce debilitating effects. Depending on the location of neurofibromas, radiotherapy may be used to reduce mass effect if small tumors begin to grow significantly. General appearance along with speech, hearing, and visual acuity can be adversely affected in both forms of the disease, although physical defects are most common with NF1 and sensory defects are more associated with NF2. Plastic surgery may be a useful treatment to correct the disfigurement that results from NF1.

Source: Medical Disability Advisor



Prognosis

Neurofibromatosis is a progressive and unpredictable disease that is associated with a variety of clinical outcomes and complications; prognosis is dependent on age, severity of the disease, and which organ systems may be affected by the growth of neurofibromas. Individuals with NF1 and NF2 are subject to developing other types of tumors and malignancies. The life expectancy of individuals with neurofibromatosis may be reduced by 10 to 15 years, most often as a result of malignancies such as peripheral nerve sheath tumors or soft tissue sarcomas (Seymour-Dempsey 553-63). The outcome for acoustic neurofibromas associated with NF2 may be loss of hearing or facial palsy, which can occur with or without surgical removal of the tumors.

Source: Medical Disability Advisor



Rehabilitation

If general anesthesia was used during surgical removal of a tumor, intermittent positive pressure breathing exercises may be useful in preventing postoperative pulmonary complications. Also, certain exercises may be performed to reduce postoperative pain and speed recovery.

In the case of NF1, physical defects may produce social adjustment problems and, as the disease progresses, ongoing treatment may include interaction with a clinical social worker and a vocational counselor. The clinical social worker can help the individual mobilize his or her resources to cope with the disease. The social worker may also serve as an advocate for the individual when dealing with the medical establishment and other agencies. A vocational counselor can be of assistance when problems arise in the individual's relationship with work and career.

Source: Medical Disability Advisor



Complications

Tumors (neurofibromas) that occur in the central nervous system may cause vision and hearing impairment, and onset of seizures (epilepsy). Hearing deficit is most commonly associated with NF2 as a result of tumor (schwannoma) growth on the auditory nerves. Individuals with either type of NF are more prone to cancers of the nerves that are not contained within the brain or spinal cord (peripheral nerves), brain tumors (meningiomas, gliomas, optic nerve gliomas), abnormal bone growths (cysts), abnormal gland cells (pheochromocytoma), abnormal curvature of the spine (scoliosis), and fluid accumulation in the brain (obstructive hydrocephalus).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations may include considerations for hearing or visual impairment. Also, the individual's general health and well being may suffer as the disease progresses, and work responsibilities may need to be modified accordingly. If the disease should progress to the severe stage, it may significantly compromise the individual's ability to function. In this case, disability may be permanent.

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:

  • What symptoms does individual have?
  • What were the findings on physical exam?
  • Has individual received appropriate diagnostic testing to establish the diagnosis?
  • Have any conditions with similar symptoms been ruled out?

Regarding treatment:

  • Has individual received appropriate treatment?
  • Is there a clinical social worker and vocational counselor on the team?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have diabetes, any systemic disease of the cardiovascular system, or any other neurological disorder?
  • Does individual have any complications, such as cancers of the peripheral nerves, meningiomas, gliomas, optic nerve gliomas, bone cysts, pheochromocytoma, scoliosis, or obstructive hydrocephalus?

Source: Medical Disability Advisor



References

Cited

Goetz, Christopher. "Neurofibromatosis von Recklinghausen’s Disease." Textbook of Clinical Neurology. 2nd ed. Philadelphia: W.B. Saunders, 2003. 670-673.

Seymour-Dempsey, K., and R. Andrassy. "Neurofibromatosis: Implications for the General Surgeon." Journal of American College of Surgeons 195 4 (2002): 553-563.

Source: Medical Disability Advisor






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