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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.

Posttraumatic Stress Disorder


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Diagnosis

History: Individuals may report physical complaints such as indigestion, headaches, and fatigue. They may have feelings of ineffectiveness, shame, despair, or hopelessness and feel permanently damaged. Individuals can experience a loss of previously sustained beliefs and become socially withdrawn or have impaired relationships with others. A complete health history may be obtained to assess the influence of previous illness, abuse, or injury.

According to the DSM-IV-TR, an individual with PTSD has been exposed to a traumatic event in which the individual experienced, witnessed, or was confronted with an event or events that involved death or threatened death or severe injury, or a threat to the physical integrity of the individual or others; the individual's response involved intense fear, helplessness, or horror. The individual re-experiences the event over and over again in at least one of the following ways: having recurrent and intrusive distressing recollections (images, thoughts, or perceptions) of the event; having recurrent nightmares; acting or feeling as if the event were happening again (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, such as those that occur on awakening or when intoxicated); feeling intense psychological distress at exposure to internal or external cues that remind the individual of the event; and having physiological reactions on exposure to internal or external cues that remind the individual of the event.

There is persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following: efforts to avoid thoughts, feelings, or conversations associated with the trauma; efforts to avoid activities, places, or individuals that arouse traumatic recollections; an inability to recall an important aspect of the event; notoriously diminished interest or participation in significant activities; feelings of detachment or estrangement from others; an inability to relate emotionally to others (restricted range of affect); and a sense of a foreshortened future (the individual does not expect to have a career, marriage, children, or a normal lifespan). There are also persistent symptoms of increased arousal (not present before the trauma), as indicated by at least two of the following: difficulty falling asleep or staying asleep; irritability or outbursts of anger; difficulty concentrating; being constantly anxious and alert because danger is imagined everywhere (hypervigilance); and exaggerated startle response. The symptoms of PTSD last more than 1 month. The disorder causes clinically significant distress or impairment in social, occupational, or other areas of functioning. Symptoms may last less than 3 months (acute PTSD) or 3 months or more (chronic PTSD)may appear at least 6 months after the stressor (delayed onset) (DSM-IV-TR).

According to the DSM-5, an individual with PTSD was exposed to death or threatened death, severe injury, or sexual violence in at least one of the following ways: directly experiencing the traumatic event (or events, as the case may be); witnessing the event as it occurred to others; learning that the event occurred to a family member or friend (in cases of death or threatened death of a family member or friend, the event must have been violent or accidental); or experiencing repeated or extreme exposure to aversive details of the event (this last criterion does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work-related).

At least one of the following symptoms associated with the event, but beginning after the event occurred, must be present: recurrent, involuntary, and intrusive distressing memories of the event; nightmares in which the content and/or affect of the dream are related to the event; dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the event were recurring (such reactions may occur on a continuum—the most extreme expression is a complete loss of awareness of present surroundings); intense or prolonged psychological distress at exposure to internal or external cues that remind the individual of an aspect of the event; and/or marked physiological reactions to internal or external cues that remind the individual of the event. Beginning after the event occurred, the individual persists in avoiding stimuli associated with the event, as evidenced by one or both of the following: avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the event; and avoidance of or efforts to avoid external reminders (individuals, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the event. There are negative changes in the individual’s cognitions and mood associated with the event, beginning or worsening after the event occurred, as shown by at least two of the following: an inability to remember an important aspect of the event (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs); persistent and exaggerated negative beliefs or expectations about oneself, others, or the world; persistent, distorted cognitions about the cause or consequences of the event that lead the individual to blame himself or herself or others; a persistent negative emotional state (fear, horror, anger, guilt, or shame); notoriously diminished interest or participation in significant activities; feelings of detachment or estrangement from others; and/or a persistent inability to experience positive emotions. The individual shows marked changes in arousal and reactivity, beginning or worsening after the event occurred, as indicated by at least two of the following: irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward individuals or objects; reckless or self-destructive behavior; hypervigilance; exaggerated startle response; problems with concentration; and sleep disturbance (difficulty falling or staying asleep or restless sleep) (DSM-5).

The disorder lasts more than 1 month; produces clinically significant distress or impairment in social, occupational, or other areas of functioning; and is not attributable to the effects of a substance (medication, alcohol) or another medical condition. If the disorder involves dissociative symptoms, in addition to having symptoms meeting the criteria for PTSD given above, the individual experiences either of the following: depersonalization (persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body) and derealization (persistent or recurrent experiences that one’s surroundings are unreal). To use this subtype, the dissociative symptoms must not be attributable to the effects of a substance or another medical condition. Finally, there may be delayed expression of the disorder, if the full diagnostic criteria are not met until 6 months or more after the event, although the onset and expression of some symptoms may be immediate (DSM-5).

Physical exam: The exam may reveal evidence of previous trauma or injury; signs of a physical trauma such as burn scars, abrasions, or contusions; or an increased rate of somatic complaints. A complete physical may be performed to evaluate health status and rule out underlying illness.

Tests: No specific tests are indicated to diagnose PTSD, but there are some psychological tests available that can help support the conclusion that PTSD is present. Autonomic functioning may be evaluated by monitoring heart rate or sweat gland activity. Evidence of impaired attention and concentration may be present, or the range of expressed emotion or affect may be considerably reduced. Individuals may be unreceptive to humor. Psychological testing can help in substantiating the diagnosis but cannot be used as the sole diagnostic tool. A few tests are designed specifically to detect PTSD, but they have mostly been used with combat veterans.

Note: It must be kept in mind that just because a physical diagnosis cannot be established as the cause of the presenting symptomatology, it does not necessarily mean that the cause is a mental one. That is to say that the presence of medically unexplained symptomatology does not necessarily establish the presence of a psychiatric condition. The first step in identifying the presence of a mental disorder is excluding the presence of malingering and/or of factitious disorder. Although factitious disorder is conscious and purposeful, it is classified as a psychiatric disorder. The strong need for this step is especially true whenever there is a medicolegal context associated with the presenting problem(s). Additionally, using DSM-5 and/or ICD-9-CM or ICD-10-CM, the clinician will find that many presentations fail to fit completely within the boundaries of a single mental disorder. There are systematic ways to go about making psychiatric diagnoses, however.

Source: Medical Disability Advisor