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.

Varicose Veins


Related Terms

  • Varices
  • Varicosis
  • Varicosities
  • Varicosity

Differential Diagnosis

  • Abdominal tumor
  • Deep venous thrombosis
  • Klippel-Tr√©naunay syndrome

Specialists

  • General Surgeon
  • Vascular Surgeon

Comorbid Conditions

Factors Influencing Duration

The age of the individual, the severity of symptoms, and the treatment type and response, and job requirements are factors that will influence the length of disability.

Medical Codes

ICD-9-CM:
454.0 - Varicose Veins of Lower Extremities with Ulcer
454.1 - Varicose Veins of Lower Extremities with inflammation; Stasis Dermatitis
454.2 - Varicose Veins of Lower Extremities with Ulcer and Inflammation
454.8 - Varicose Veins of Lower Extremities with Other Complications; Edema; Pain; Swelling
454.9 - Asymptomatic Varicose Veins
456.3 - Sublingual Varices
456.4 - Scrotal Varices; Varicocele
456.5 - Pelvic Varices; Varices of Broad Ligament
456.6 - Vulval Varices; Varices of Perineum
456.8 - Varices of Other Sites; Varicose Veins of Nasal Septum (with Ulcer)

Overview

Varicose veins (varicosities) are enlarged, tortuous veins with weak or nonfunctioning valves. The legs are the most common location for varicose veins to develop.

Because normal veins are responsible for carrying blood back to the heart and lungs to be oxygenated, they have one-way valves that close, forcing blood toward the heart. In the legs, the valves prevent blood from being pulled down into the ankles by gravity. Varicose veins develop when these valves leak or fail, allowing blood to remain in the veins, accumulate, and even flow backwards (reflux); the pooling blood causes the vein to become enlarged and tortuous.

Primary varicose veins only affect the veins just under the skin (superficial veins). They occur because of defective anatomy or inadequate functioning of the valves, conditions that are often hereditary. Secondary varicose veins affect deep veins and most commonly occur as the result of deep venous thrombosis, obstruction of the pelvic veins (e.g. from abdominal tumors), arteriovenous fistula, or trauma. Pregnancy or hormonal changes can induce or exacerbate varicose veins.

Incidence and Prevalence: Varicose veins are the most common type of vascular disease; they occur in 24 million people in the US (Brown). In the US, 36% of women and 19% of men have varicose veins (Bhimji). Estimates suggest that by the time they reach their sixties, 72% of women in the US will have varicose veins (Weiss).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors include a family history (hereditary risk) of varicose veins, female sex, prolonged standing or sitting, pregnancy, artery and vein abnormalities present at birth (congenital anomalies), aging, menopause, conditions that involve straining (e.g., chronic constipation, urinary retention, chronic cough), and obesity (Bhimji).

Source: Medical Disability Advisor



Diagnosis

History: The individual may complain of a gradual onset of pain, swelling, cramping, or aching in the legs; throbbing, burning, or itching of the skin overlying the veins; soreness behind the knee; and ankle swelling. Individuals also may complain of night cramps, a sensation of fullness or heaviness in the legs, or fatigue after standing for long periods with relief obtained when the leg is elevated or when the individual walks.

Physical exam: Diagnosis is based primarily on appearance of the veins with the individual in the standing and lying down positions; however, the deepest veins are not visible. Superficial varicose veins may be visible, enlarged, and may be associated with brownish discolored ankle skin, lower extremity swelling, and skin ulcers on the legs or above the ankles.

Tests: Tests are generally not required for varicose veins. However, for varicose veins with suspected deep venous thrombosis (DVT), a duplex Doppler ultrasound examination or other testing of the extremities may be done to observe blood flow and characterize the vessels. Magnetic resonance venography also may be performed to detect potential obstruction of deep varicose veins in the pelvis and lower extremities.

Source: Medical Disability Advisor



Treatment

Treatment may not be required unless the condition is painful, affects the deeper veins, or is causing skin ulcers. Self-care may help decrease mild symptoms. Whenever possible, the individual should elevate the legs, preferably at the level of, or above, the heart. Other helpful measures include wearing elastic stockings or bandages to compress the varicose veins, avoiding prolonged standing or sitting, and improving circulation by exercising regularly, particularly by walking. Individuals may be counseled to avoid crossing their legs when sitting, reduce or avoid alcohol intake, and to lose weight if obese (Bhimji). Varicose veins associated with pregnancy may spontaneously regress after childbirth, requiring no treatment (Lew).

Severe varicosities may be treated by injection of a chemical into the vein that causes internal scarring (sclerosis), thus blocking the vein (sclerotherapy). This procedure may have to be repeated one or more times.

Surgical correction (vein stripping and ligation) of varicose veins may be done if pain, vein inflammation with formation of blood clots (thrombophlebitis), or skin changes persist; it can also be done for cosmetic reasons. The procedure is performed under general or spinal anesthesia. The surgeon makes a small incision in the groin, and one in the ankle or calf. The surgeon then inserts a wire-like instrument into the large superficial vein in the groin, until the wire comes out the lower incision. The vein is attached to the wire at the groin, and as the surgeon pulls back on the wire, the large vessel that supplies blood to the varicose vessels, along with the wire, is removed. Some additional small incisions may be made to cut away some of the tributary veins.

Other surgical approaches can include ultrasound-guided thermal ablation using radiofrequency or laser therapy (endovenous laser) to close the varicose vein by heating of the tissue. Following any surgical procedure treating varicose veins, a 30 to 40 mm Hg gradient compression stocking typically is used to assist the stoppage of blood flow and to decrease the risk of a deep vein thrombosis (Weiss).

Source: Medical Disability Advisor



Prognosis

Varicose veins are not curable, but treating early symptoms results in an excellent outcome. Individuals who undergo sclerotherapy or vein stripping also have excellent outcomes provided they follow postoperative treatment instructions, and no complications develop. Overall, up to 90% of symptomatic varicose veins are successfully treated with removal or obliteration of the vein (Lew). The two-year recurrence rate of a varicose vein after radiofrequency treatment is 14%; recurrence after vein stripping is 21% (Lew). No treatment can prevent the occurrence of new varicosities.

Individuals with varicose veins are at a higher risk for venous thromboembolism, which is associated with a mortality rate of 30 to 60% (Weiss). Untreated, fragile varicose veins may rarely result in an individual bleeding to death (Weiss).

Source: Medical Disability Advisor



Complications

Complications of varicose veins include venous ulcers, variceal bleeding, thrombophlebitis, superficial venous thrombosis, pulmonary embolism, and chronic stasis dermatitis. Surgical correction of varicose veins may result in nerve injury, bleeding (hematoma), skin burns, and infection. Prolonged standing in one position, often due to job requirements, may complicate recovery.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Allowances may be required for individuals to elevate their legs every 30 minutes (Bhimji). Reducing periods of prolonged standing or sitting also are necessary. Those whose duties require heavy lifting may require transfer to other duties, since abdominal strain may contribute to varicose veins.

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:

  • Are individual's varicose veins primary or secondary?
  • Does individual have a family history of varicose veins?
  • Is individual female? Pregnant? Menopausal? Obese? Of advanced age?
  • Does individual experience periods of prolonged standing or sitting?
  • Does individual have any congenital abnormalities of arteries or veins?
  • Does individual complain of pain, swelling, cramping, or aching in the legs?
  • Does individual have throbbing, burning, or itching of the veins themselves?
  • Does individual have soreness behind the knee and ankle swelling?
  • Do individual's legs have a sensation of fullness or heaviness?
  • Does individual have fatigue after standing for long periods?
  • Is relief obtained when the leg is elevated or when walking?
  • On exam, are there visibly enlarged veins? Brownish discolored ankle skin?
  • Were skin ulcers present on the legs or above the ankles?
  • Was Doppler ultrasound done? Was magnetic resonance venography necessary?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • In milder cases, does individual elevate the legs when possible? Avoid crossing the legs?
  • Does individual wear elastic stockings?
  • Is individual able to avoid prolonged standing or sitting?
  • Does individual walk regularly?
  • Was sclerotherapy done? Has it been repeated?
  • Was vein stripping and ligation done?
  • Was endovenous laser done? Radiofrequency ablation?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that may affect ability to recover?
  • Does individual have any complications such as varicose ulcers, thrombophlebitis, deep venous thrombosis, thrombophlebitis, or pulmonary embolism?

Source: Medical Disability Advisor



References

Cited

Bhimji, Shabir, Amy Smookler, and Mara Aloi. "Varicose Veins." eMedicine Health. Eds. Alan D. Forker, et al. 17 Oct. 2005. WebMD, LLC. 31 Aug. 2009 <http://www.emedicinehealth.com/varicose_veins/article_em.htm>.

Brown, Katherine E. "Chronic Venous Insufficiency." eMedicine. Eds. William H. Pearce, et al. 11 May. 2009. Medscape. 31 Aug. 2009 <http://emedicine.medscape.com/article/461449-overview>.

Lew, Wesley K., Fred A. Weaver, and Craig Feied. "Varicose Veins." eMedicine. 24 Jun. 2009. Medscape. 31 Aug. 2009 <http://emedicine.medscape.com/article/462579-overview>.

Weiss, Robert, and Craig Feied. "Varicose Veins and Spider Veins." eMedicine. Eds. Kelly M. Cordoro, et al. 14 Apr. 2009. Medscape. 31 Aug. 2009 <http://emedicine.medscape.com/article/1085530-overview>.

General

Messina, Louis M., Laura K. Pak, and Lawrence M. Tierney. "Blood Vessels & Lymphatics." CMDT: 2004 Current Medical Diagnosis & Treatment. Ed. Timothy G. Berger. 43rd ed. New York: McGraw-Hill, 2004. 450-451.

Source: Medical Disability Advisor






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