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.

Polycystic Ovary Syndrome


Related Terms

  • PCOS
  • Stein-Leventhal Syndrome

Differential Diagnosis

  • Adrenal cancer
  • Cancer of the ovarian lutein cells (luteoma)
  • Congenital adrenal hyperplasia (late-onset)
  • Corpus luteum
  • Cushing's syndrome
  • Eating disorder(s)
  • Hyperprolactinemia
  • Hyperthyroidism
  • Hypothyroidism
  • Idiopathic hirsutism
  • Insulin resistance
  • Late-onset congenital adrenal hyperplasia
  • Medications (e.g., progestational agents, danazol)
  • Ovarian cancer
  • Premature ovarian failure
  • Tumors of the pituitary (pituitary adenoma)

Specialists

  • Endocrinologist
  • Gynecologist

Comorbid Conditions

  • Coronary artery disease
  • Endometrial cancer
  • Glucose intolerance
  • High blood pressure (hypertension)
  • Insulin resistance (diabetes mellitus type 2)
  • Intravascular thrombosis
  • Obesity

Factors Influencing Duration

If surgery is necessary, the individual will need to take sufficient time for postoperative recovery.

Medical Codes

ICD-9-CM:
256.4 - Polycystic Ovaries; Isosexual Virilization Stein-Leventhal Syndrome

Overview

© Reed Group
Polycystic ovary syndrome (PCOS), also called Stein-Leventhal syndrome, is a hormone (endocrine) disorder that affects women of reproductive age.

The definitions vary slightly, but in general agree that PCOS is characterized by lack of ovulation (oligoovulation or anovulation), abnormalities in the production and metabolism of male hormones (androgen excess), and polycystic ovaries (in the ultrasonographic exam). Anovulation leads to menstrual abnormalities, such as irregularity or absence of menstruation (amenorrhea) and infertility; androgen excess leads to acne and hirsutism. Other features are insulin resistance (often with obesity, type 2 diabetes, and blood cholesterol [lipid] abnormalities); and pregnancy loss. Increased levels of luteinizing hormone and decreased levels of follicle-stimulating hormone also occur. These levels stimulate the ovaries to produce androgen excess and lead to the development of polycystic ovaries. Estrogen production does not occur in the normal cycle pattern. The syndrome is the most common cause of anovulatory infertility. Usually there is no well-defined cause of the androgen abnormalities.

Incidence and Prevalence: Polycystic ovary syndrome is one of the most common hormone (endocrine) disorders, causing symptoms in roughly 5% to 10% of women of reproductive age. The syndrome has an onset in the prepubertal years and can be progressive.

Source: Medical Disability Advisor



Causation and Known Risk Factors

PCOS affects women of reproductive age. The underlying cause of polycystic ovary syndrome is unknown, but it is likely a result of multifactorial elements, with a strong genetic component. The key features include anovulation, androgen excess and polycystic ovaries. Insulin resistance is also observed. Polycystic ovary syndrome is often associated with a family history both of PCOS and of chronic anovulation and androgen excess.

Source: Medical Disability Advisor



Diagnosis

History: Most women with PCOS experience the onset of menstrual periods (menarche) at a normal age but soon begin to have irregular menstrual periods: oligomenorrhea (fewer than 9 menstrual periods per year) or amenorrhea (no menstrual periods for at least 3 months). Anovulation (the absence of egg release by the ovary) causes the irregular menstrual periods and may also lead to difficulty conceiving or infertility.

Physical exam: There may be absence of breast development. Excess male hormones may cause male pattern hairiness or baldness, acne, a deep voice, or increased muscle mass. About 70% of women present with growth of coarse hair in the sideburn area, chin, upper lip, chest, and / or lower abdominal midline (hirsutism). Obesity is common and may be accompanied by glucose intolerance or frank diabetes mellitus (type 2); there may be upper-body obesity with the waist being greater in diameter than the hip (waist-to-hip ratio of greater than 0.85). Abnormal darkening and thickening of the skin in the neck, groin or armpit (acanthosis nigricans) may be present in individuals with insulin resistance. Ovarian enlargement, possibly detectable upon pelvic examination, may be present in one or both ovaries.

Tests: A urine pregnancy test to detect human chorionic gonadotropin (hCG) should be done to exclude pregnancy in any woman of reproductive age who has menstrual irregularities or amenorrhea. In the absence of pregnancy, hCG is low or absent in women with polycystic ovary syndrome. Blood tests are performed to determine levels of hormones, such as testosterone, androstenedione, estradiol, estrone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and fasting insulin. An LH-to-FSH ratio of 3:1 is considered diagnostic of the syndrome. A test for a protein called sex hormone-binding globulin may be done to detect reduced levels typically found in this syndrome. Prolactin levels are usually measured to rule out pituitary gland disorders. Fasting blood glucose and blood lipid profile are also routinely performed. Ultrasound of the ovaries and / or insertion of a viewing instrument through a small incision in the abdomen to examine the ovaries (laparoscopy) may reveal multiple follicles in the ovaries (polycystic ovaries), but this is not necessarily diagnostic.

Source: Medical Disability Advisor



Treatment

Treatment is directed at the symptoms of the disorder. Few treatment approaches improve all aspects of the syndrome. The goals of treatment should include correcting anovulation, reducing metabolic abnormalities and insulin resistance when present, and reducing the action of androgen hormones on tissues. Weight reduction, diet, and exercise are recommended for all women with polycystic ovary syndrome.

Low-dose birth control pills with a combination of estrogen and progesterone (combination hormone therapy) decrease androgen production and help to prevent endometrial hyperplasia and endometrial cancer. Treatment with an insulin-sensitizing agent, such as metformin, may improve insulin sensitivity and decrease blood LH and free testosterone levels. Metformin also restores menstrual cycles in most women treated for at least 4 to 6 months (Williams). Recent successes with ovulation-inducing agents have decreased the use of surgery. Ovarian wedge resection has fallen into disuse due to complications such as adhesion formation. Surgical techniques such as laparoscopic ovarian drilling (cauterization or laser vaporization) may temporarily reduce male hormone levels (androgens), improve fertility, and frequently result in spontaneous restoration of ovulation. However, it does not permanently address the underlying hormone disturbances, its effects on the function of the ovaries in the long term have not yet been evaluated, and complications from the surgery (primarily adhesion formation) tend to outweigh the benefits. Genetic counseling is also important, because up to half of first-degree relatives may have polycystic ovary syndrome or components of it and may benefit from preventive interventions (Williams).

Source: Medical Disability Advisor



Prognosis

Early diagnosis and treatment improves prognosis. Treatment with medication and behavior modification (weight reduction, diet, exercise) is usually successful at managing symptoms and restoring hormonal balance and ovulation. If medication is ineffective, laparoscopic ovarian drilling has attained relative success.

Source: Medical Disability Advisor



Complications

Polycystic ovary syndrome is a progressive disorder that continues from soon after a woman's first menstrual period until menopause. Long-term effects of abnormal estrogen levels may place women with the syndrome at risk for endometrial hyperplasia, endometrial cancer and, possibly, breast cancer. PCOS poses risk of depression.

The syndrome is associated with blood lipid abnormalities, high blood pressure, intravascular thrombosis and an increased risk of cardiovascular disease as well as abnormalities in glucose metabolism (glucose intolerance, insulin resistance, or type 2 diabetes).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions or accommodations are usually not required.

Risk: There is no occupation that places a woman at increased risk of developing or worsening PCOS.

Capacity: Treatment may require time off for doctor visits or to be available for blood testing. A woman may have significant menstrual irregularity which would require lost work time. If severe bleeding occurs, anemia would be likely to accompany this. Comorbid conditions, especially obesity or coronary artery disease may limit ability.

Tolerance: In the absence of severe anemia, a woman’s concern over symptoms would need to be addressed through assurance for time off when doctor visits are required. Consider also the undiagnosed presence of co-morbid conditions as being the tolerance limit, (e.g. obstructive sleep apnea).

Source: Medical Disability Advisor



Maximum Medical Improvement

56 days., medical therapy.

84 days, surgical intervention.

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:

  • Was diagnosis of polycystic ovary syndrome confirmed?
  • Were other conditions producing anovulation ruled out?
  • Are there any underlying conditions that may affect the individual's recovery?

Regarding treatment:

  • Did combination hormone therapy or use of metformin relieve symptoms?
  • If drug therapy was not effective in relieving symptoms, is individual candidate for surgical intervention?
  • What type of procedure is being considered?
  • Has individual complied with behavior modification regimen?
  • What can be done to increase compliance?

Regarding prognosis:

  • Has drug therapy and behavior modification been successful in managing symptoms while restoring hormone balance and ovulation? Are other medication options or combinations available?
  • Would individual benefit from surgery?
  • Would benefits of surgical procedure outweigh risk of complications?

Source: Medical Disability Advisor



References

Cited

Williams, R. H., and Reed P. Larsen, eds. "Disorders of the Female Reproductive System." Williams Textbook of Endocrinology. 10th ed. Philadelphia: Elsevier, Inc., 2003. 627-637. MD Consult. Elsevier, Inc. 22 Feb. 2005 <http://home.mdconsult.com/das/book/44962992-2/view/1091>.

Source: Medical Disability Advisor






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