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.

Sjögren's Syndrome


Related Terms

  • Keratoconjunctivitis Sicca
  • Sicca Complex
  • Sicca Syndrome
  • Sjögren's Disease
  • Sjogren's Syndrome

Differential Diagnosis

Comorbid Conditions

  • Immunodeficiency conditions or diseases (e.g., AIDS, certain cancers)
  • Rheumatoid arthritis
  • Scleroderma

Factors Influencing Duration

Outdoor workers in a windy, dry environment may have a longer disability than those who work indoors. The severity of symptoms, presence of systemic symptoms, effectiveness of treatment, compliance with treatment recommendations, and development of complications can influence the length of disability.

Medical Codes

ICD-9-CM:
710.2 - Diffuse Diseases of Connective Tissue, Sicca Syndrome; Sjögrens Disease; Keratoconjunctivitis Sicca (Sicca Syndrome)

Overview

Sjögren's syndrome is a chronic autoimmune disease in which white blood cells (lymphocytes) invade fluid-secreting glands, such as the tear (lacrimal) glands and the salivary glands.

The invading lymphocytes destroy gland tissue, leading to gland dysfunction. Although the lacrimal and salivary glands are the most commonly affected, Sjögren's syndrome is a whole body (systemic) disease that can affect any organ. As a result, diagnosis is often delayed, and many cases of Sjögren's syndrome may not be diagnosed.

Sjögren's syndrome is classified into primary and secondary disease. In primary disease the syndrome occurs in the absence of any other autoimmune disorder. Secondary disease refers to Sjögren's syndrome in individuals who have another autoimmune disease, such as scleroderma, polymyositis, lupus, or rheumatoid arthritis.

Incidence and Prevalence: Because there is no broadly accepted set of diagnostic criteria for Sjögren's syndrome, and because the disease often causes variable and nonspecific symptoms in some individuals, the incidence and prevalence are unknown.

Source: Medical Disability Advisor



Causation and Known Risk Factors

The cause of Sjögren's syndrome is unknown, although viral infection, sex hormones, and a genetic predisposition have been implicated as triggers for the autoimmune process. It is estimated that this disease affects 1 million to 4 million individuals in the US (Mayo Clinic Staff). Ninety percent of individuals with Sjögren's syndrome are women. The syndrome is typically diagnosed in individuals over age 40.

Source: Medical Disability Advisor



Diagnosis

History: The individual may complain of dry eyes (xerophthalmia) that feel as if they contain grit or sand and dry mouth (xerostomia). Individuals may report that swallowing is difficult (pharyngeal dysphagia) and that they must drink liquids when eating. Fifty percent of individuals with Sjögren's syndrome report fatigue and symptoms of fibromyalgia. Rarely, individuals with Sjögren's syndrome present with other symptoms, including joint pain (arthralgia), diarrhea, muscle weakness, headaches, dry cough, or multiple sclerosis-like symptoms.

Physical exam: The individual may have red, irritated eyes and may blink or rub the eyes excessively. Examination of the mouth and teeth may reveal inadequate saliva production and possibly tooth decay (dental caries). The parotid glands may be enlarged. Exposure of the hands to cold temperatures may cause extreme whitening of the fingers (Raynaud's phenomenon).

Tests: Blood tests may include erythrocyte sedimentation rate (ESR), complete blood count (CBC), antinuclear antibodies (ANA), rheumatoid factor, and SS-A and SS-B antibodies. Schirmer's test, in which absorbent paper strips are inserted into the lower eyelid, may be performed to quantify tear production. Rose bengal dye may be placed in the eye to evaluate the cornea. Biopsy of the parotid gland or other salivary glands may be conducted to detect the presence of inflammatory cells. A special x-ray (sialogram) may be used to evaluate the flow of saliva into the mouth. A urine sample may to taken to determine if the disease has affected the kidneys.

Source: Medical Disability Advisor



Treatment

There is no cure for Sjögren's syndrome, so treatment is aimed at relieving symptoms and preventing or managing complications. Dry eyes are treated with lubricating eyedrops, moisture chamber panels, contact lenses, and/or glasses. Pilocarpine may be used to stimulate tear or saliva production. The individual should avoid drying factors (e.g., hair dryers, medications such as antihistamines and decongestants that cause drying, wind). Blockage of the lower tear ducts (punctal occlusion) with silicone plugs can conserve natural tears. Dry mouth is treated with saliva substitutes or sugar-free lemon hard candy (to stimulate salivation); the prescription medicine cevimeline is sometimes used. The individual needs to be meticulous regarding oral hygiene, use mechanical cleaning devices, have frequent dental check ups, and receive fluoride treatments. Humidifiers should be used at work and at home. Analgesics and NSAIDs are used to treat arthralgia or other pains. Oral corticosteroids may be given to reduce inflammation and slow the damage to joints. Sometimes an antimalarial drug is given to individuals with inflamed joints.

Source: Medical Disability Advisor



Prognosis

Sjögren's syndrome is a chronic, systemic disease for which no cure exists. It can have a substantial impact on quality of life. Strict adherence to treatment guidelines and frequent evaluation by a physician can minimize symptoms and lead to a favorable outcome.

Source: Medical Disability Advisor



Complications

Tooth decay, chronic oral yeast infection (candidiasis), wasting (atrophy) of the oral mucosa, atrophy of the tongue, small cracks (fissures) on the tongue, irritation and destruction of the membrane that lines the eyelids and exposed surface of the eyeball (conjunctiva), hearing loss, kidney (renal) disease, pneumonia, and skin lesions are potential complications. Individuals with Sjögren's syndrome are at a greater risk of developing malignant lymphoma.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals should avoid dry surroundings and may need a humidifier for the office. Individuals who work outside may need to be reassigned to indoor duties in order to avoid wind.

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:

  • Did individual present with characteristic symptoms of dry eyes, dry mouth, difficulty in swallowing, fatigue, or joint and muscle pain?
  • Were diagnostic findings consistent with a diagnosis of Sjögren's syndrome (i.e., presence of rheumatoid factor, elevated ANA titers, presence of SS-A and SS-B antibodies, etc)?
  • If the diagnosis was uncertain, were other conditions with similar symptoms (such as mumps, sarcoidosis, parotid tumors) ruled out?

Regarding treatment:

  • Has treatment successfully relieved the symptoms?
  • Has individual been instructed regarding self-care techniques to help reduce symptoms (such as hard candies to stimulate saliva, meticulous oral hygiene, use of humidifiers)?
  • Is individual complying with the treatment recommendations?
  • Would additional counseling and instruction be beneficial?

Regarding prognosis:

  • Is individual compliant with treatment plan? What can be done to enhance compliance?
  • Have appropriate work accommodations been made to minimize individual's symptoms (humidifiers)?
  • Has individual suffered any associated complications (such as tooth decay, oral infections, eye inflammation) that could impact recovery and prognosis?
  • Does individual have any comorbid conditions, such as rheumatoid arthritis, scleroderma, HIV, or cancer, that may impact recovery and prognosis?

Source: Medical Disability Advisor



References

Cited

Mayo Clinic Staff. "Sjogren's Syndrome." MayoClinic.com. 26 Nov. 2003. Mayo Foundation for Medical Education and Research. 29 Dec. 2004 <http:www.mayoclinic.com/invoke.cfm?id=DS00147>.

Source: Medical Disability Advisor






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