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.

Thoracic Aneurysm


Related Terms

  • Aneurysm of the Thoracic Aorta
  • Thoracic Aortic Aneurysm
  • Thoracic Arch Aneurysm
  • Thoracic Nonsyphilitic Aneurysm

Specialists

  • Anesthesiologist
  • Cardiovascular Internist
  • Emergency Medicine Physician
  • Pulmonologist
  • Vascular Surgeon

Factors Influencing Duration

Factors include the location and size of the aneurysm, whether the aneurysm has ruptured, the age and general health of the individual, and the extent of surgical repair necessary. Underlying cardiovascular diseases such as hypertension or arteriosclerosis and the development of postsurgical complications such as heart attack (myocardial infarction), hemorrhage, thrombosis, kidney damage, stroke, or spinal cord ischemia may significantly extend the recovery period and affect rehabilitation potential. In a small percentage of cases, a residual or recurrent aneurysm will be detected after surgery, extending the disability.

Medical Codes

ICD-9-CM:
441 - Aortic Aneurysm and Dissection
441.01 - Dissection of Aorta, Thoracic
441.2 - Thoracic Aneurysm without Mention of Rupture
441.9 - Aortic Aneurysm of Unspecified Site without Mention of Rupture

Overview

© Reed Group
A thoracic aneurysm refers to an abnormal, localized vessel wall weakness and ballooning (dilation) in one or more of the segments (ascending, arch, and descending) of the thoracic aorta.

Aneurysms can occur in any blood vessel, but are more common in arteries than in veins because of the higher blood pressure in those vessels. Most commonly, the aneurysm extends around the circumference of the vessel (fusiform aneurysm). Some thoracic aneurysms involve a separation in the wall of the vessel (dissecting aneurysm). In other cases, the aneurysm consists of an out-pouching on one side of the arterial wall (saccular aneurysm).

Most aneurysms are approximately pea-sized, although they can be as small as a pinhead or as large as an orange. Aneurysms tend to grow at a rate of one-eighth to one-quarter of an inch per year, although the rate of growth can vary significantly. The likelihood of rupture increases as the aneurysm increases in size. Additionally, as the aneurysm progresses, increasing pressure is exerted against neighboring organs and tissue that may possibly result in potentially lethal complications.

Most commonly, thoracic aorta aneurysms result from the degeneration of the media (or middle) of the aortic wall (cystic medial necrosis). Thoracic aneurysms may be caused by blunt chest trauma and are also associated with Marfan's syndrome and Ehlers-Danlos syndrome. Uncommonly, they are a late-stage complication of syphilis.

Incidence and Prevalence: The incidence of aortic aneurysms is 6 cases per 100,000 (Nelson).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Men, whites, and people 60 to 70 years of age are at greater risk for thoracic aneurysm (Nelson).

Source: Medical Disability Advisor



Diagnosis

History: Patients with a thoracic aorta aneurysm may be asymptomatic. If, however, a patient does present with symptoms, the type of symptoms depend on the type of aneurysm (dissecting, fusiform, or saccular). Symptoms associated with the dissecting type of thoracic aneurysm include the sudden onset of a tearing or ripping sensation in the front of the chest that extends to the neck, shoulders, lower back, and abdomen, but generally not to the jaw and arm. Additional symptoms may include shortness of breath, fainting, pallor, sweating, the development of a bluish tinge around the mouth and on the nailbeds (cyanosis), increased pulse rate, leg weakness, or transient paralysis.

Symptoms associated with a saccular or fusiform aneurysm vary according to the size and location of the aneurysm, as well as the associated effects of increased pressure and/or rupture on the surrounding structures (lungs, trachea, larynx, esophagus, and spinal nerves). Symptoms may worsen as the aneurysm continues to enlarge. Individuals may report an aching pain in the shoulders, or abdomen. They may experience marked respiratory distress, a harsh cough, or wheezing. Hoarseness, loss of voice, or difficulty swallowing may be related to compression of the esophagus.

Physical exam: Nerve pressure may result in a collection of signs noticed upon physical examination, including contraction of the pupil, drooping of the eyelid, and recession of the eyeball into the orbit (Horner's syndrome). Abnormal chest wall pulsations and a pulsating movement of the trachea may also be detected. A ruptured thoracic aneurysm may cause hypotension, tachycardia, and shock.

Tests: A thoracic aneurysm can generally be seen on a chest x-ray. CT, MRI, and ultrasonography scans are useful in determining the size and extent of the aneurysm. An x-ray image of the aorta after a contrast fluid has been injected (contrast aortography) is usually performed if surgery is being considered. An ECG is useful for evaluation purposes. Blood tests, including measurement of hematocrit, BUN, and cardiac enzymes may be performed to assess for additional evidence of rupture, shock, or myocardial infarction.

Source: Medical Disability Advisor



Treatment

Emergency surgery is typically performed on those individuals with a dissecting aneurysm that involves the ascending aorta, particularly if the individual is symptomatic or if the diameter of the aorta measures greater than 5 to 6 cm. Additional stabilizing measures may also be necessary. They include the administration of antihypertensive medications (beta-blockers and nitrates), medications to decrease the force of heart contractions, oxygen for respiratory distress, narcotic analgesics for pain relief, intravenous fluids, and if necessary, whole blood transfusions.

Surgical repair of the aneurysm consists of a resection of the aneurysm and restoration of blood flow using a synthetic or composite graft replacement. If valve insufficiency is present, treatment may also involve replacing the aortic valve. Surgery is similar in magnitude to that of open-heart surgery.

Medical management of aneurysms that involve the descending aorta may be appropriate if the individual is asymptomatic and the aneurysm is less than 5 cm. Long-term therapy with medications to lower blood pressure (antihypertensives) and decrease the force of heart contractions (beta-blockers) can be effective in stabilizing smaller aneurysms. Individuals require regular outpatient follow-up to assess for any change in the aneurysm that could necessitate surgery.

Source: Medical Disability Advisor



Prognosis

The outcome is related to the location and size of the aneurysm and the individual's overall physical health. As an aneurysm enlarges, the risk of rupture increases significantly. Rupture of an aneurysm less than 5 cm wide is uncommon, but the risk increases dramatically when the aneurysm grows larger than 6 cm wide. A ruptured aneurysm requires emergency surgery and results in a poor prognosis.

The mortality rate associated with surgical repair is 5% to 10% (Daller).

Source: Medical Disability Advisor



Complications

The major, life-threatening complication of thoracic aneurysm is rupture and internal bleeding. Bleeding into the pericardium could lead to compression of the heart due to elevated pressure within the thoracic cavity (cardiac tamponade). A thoracic aneurysm could also rupture into the part of the thoracic cavity between the lungs (mediastinum), esophagus, or trachea.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individual tolerance for physical exercise before and after surgery will dictate the level of physical activity that will be possible. Underlying associated conditions, the effects of surgical repair, or the use of postoperative medication may require that individuals be reassigned to a position with less physically demanding requirements. Restrictions will require evaluation on a case-by-case basis.

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 individual experienced blunt chest trauma?
  • Does individual have a history of syphilis? History of congenital connective tissue disorders such as Marfan's syndrome or Ehlers-Danlos syndrome?
  • Does individual report sudden onset of a tearing or ripping sensation in the front of the chest that extends to the neck, shoulders, lower back, and abdomen?
  • Does individual complain of shortness of breath, fainting, sweating, development of a bluish tinge around the mouth and on the nailbeds (cyanosis), increased pulse rate, leg weakness, or transient inability to move (paralysis)? Aching pain in the shoulders, lower body, or abdomen?
  • Does individual experience marked respiratory distress, a brassy cough, or wheezing? Hoarseness, loss of voice, or difficulty swallowing?
  • Was a chest x-ray done? CT, MRI, or ultrasonography?
  • Was an x-ray of the aorta (contrast aortography) taken, if surgery is considered?
  • Was a diagnosis of dissecting, saccular, or fusiform thoracic aneurysm confirmed?

Regarding treatment:

  • Did individual undergo emergency surgery to correct a dissecting aneurysm?
  • Was surgery required for an aneurysm greater than or equal to 6 cm or for a smaller aneurysm prone to rupture?
  • Was removal (resection) of the aneurysm and restoration of blood flow using a synthetic or composite graft replacement performed? Was surgery successful? Any complications?
  • Does individual also have aortic valve insufficiency? If so, is replacement of the aortic valve required?
  • Were antihypertensives prescribed? If so, how is individual responding?

Regarding prognosis:

  • What was the location and size of the aneurysm?
  • Was aneurysm removed in a timely manner?
  • Did any postsurgical complications occur? If so, what were they, and what is expected outcome with treatment?
  • Did the aneurysm rupture? If so, how severe was the loss of blood? What is the expected outcome?

Source: Medical Disability Advisor



References

Cited

Daller, John A. "Thoracic Aortic Aneurysm." MedlinePlus. 13 Apr. 2004. National Library of Medicine. 5 Jan. 2005 <http://www.nlm.nih.gov/medlineplus/ency/article/001119.htm#Causes,%20incidence,%20and%20risk%20factors>.

Nelson, Bret P., Theodore Benzer, and Eric M. Isselbacher. "Aneurysm, Thoracic." eMedicine. Eds. Edward Bessman, et al. 17 Aug. 2004. Medscape. 5 Jan. 2005 <http://emedicine.com/emerg/topic942.htm>.

Source: Medical Disability Advisor






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