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.

Venous Thrombosis and Embolism


Related Terms

  • Blood Clot
  • Deep Vein Thrombosis (DVT)
  • Pulmonary Embolism
  • Superficial thrombophlebitis
  • Thrombophlebitis
  • Venous Blood Clot

Differential Diagnosis

Specialists

  • Cardiovascular Internist
  • Internal Medicine Physician
  • Pulmonologist
  • Vascular Surgeon

Comorbid Conditions

Factors Influencing Duration

The location of the thrombosis or embolus, the organ system affected, the age and health status of the individual, and the response to treatment may influence the length of disability.

Medical Codes

ICD-9-CM:
453 - Venous Embolism and Thrombosis, Other
453.2 - Venous Embolism and Thrombosis of inferior Vena Cava
453.3 - Venous Embolism and Thrombosis of Renal Vein
453.4 - Acute venous Embolism and Thrombosis of Deep Vessels of Lower Extremity
453.40 - Acute venous Embolism and Thrombosis of Deep Vessels of Lower Extremity; Of Vena Cava, Venous Embolism and Thrombosis of Unspecified Deep Vessels of Lower Extremity; Deep Vein Thrombosis NOS; DVT NOS
453.41 - Acute venous Embolism and Thrombosis of Deep Vessels of Lower Extremity; Of Vena Cava, Venous Embolism and Thrombosis of Deep Vessels of Proximal Lower Extremity; Femoral; Iliac; Popliteal; Thigh; Upper leg NOS
453.42 - Acute venous Embolism and Thrombosis of Deep Vessels of Lower Extremity; Of Vena Cava, Venous Embolism and Thrombosis of Deep Vessels of Distal lower Extremity; Calf; Lower leg NOS; Peroneal; Tibial
453.8 - Acute venous embolism and thrombosis of other specified veins
453.81 - Acute venous embolism and thrombosis of superficial veins of upper extremity
453.82 - Acute Venous Embolism and Thrombosis of Deep Veins of Upper Extremity
453.83 - Acute Venous Embolism and Thrombosis of Upper Extremity, Unspecified
453.84 - Acute Venous Embolism and Thrombosis of Axillary Veins
453.85 - Acute venous embolism and thrombosis of subclavian veins
453.86 - Acute venous embolism and thrombosis of internal jugular veins
453.87 - Acute venous embolism and thrombosis of other thoracic veins
453.89 - Acute venous embolism and thrombosis of other specified veins
453.9 - Venous Thrombosis and Embolism of Other Unspecified Site

Overview

Venous thrombosis is the development of a blood clot (thrombus) in a vein due to reduced blood flow and abnormal coagulation. It usually begins with injury to the vein and progresses to a state of increased coagulation (hypercoagulability) and clot formation (thrombosis). An embolus results when the thrombus or a piece of the clot breaks away from the site where it originated and travels through the bloodstream. Thrombosis frequently is accompanied by inflammation of the vein (phlebitis) at the site of injury and reduced blood flow in the vein (venous stasis), a condition known as thrombophlebitis. The terms "thrombosis" and "thrombophlebitis" often are used as synonyms and generally refer to the same condition.

Underlying all cases of deep venous thrombosis (DVT) and development of thromboemboli are three conditions known as the Virchow triad. They include venostasis, hypercoagulability, and injury to the innermost lining of the blood vessel (vessel intimal injury).

Thrombosis can occur in veins near the surface of the skin (superficial thrombophlebitis) or in deeper veins (DVT). Emboli rarely develop with superficial thrombophlebitis. DVT is most likely to develop in the legs. The primary concern with DVT is potential migration of an embolus to the lung (pulmonary embolus), which can be fatal and requires immediate resolution. With today's advanced imaging technologies and diagnostic procedures, the association between DVT and pulmonary embolism (PE) has become so strong that physicians now consider the two conditions as one disease.

Incidence and Prevalence: Autopsy studies show that approximately 80% of the time DVT and PE are a missed diagnosis, suggesting that the true incidence and prevalence of the condition cannot be estimated accurately. However, it is estimated that the annual incidence of VTE is 80 cases per 100,000 population, and 600,000 individuals are hospitalized for DVT with or without embolism (Schreiber). The incidence in hospitalized patients ranges from 20% to 70% (Schreiber).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Important risk factors for superficial venous thrombosis formation include varicose veins, the use of IV catheters, and medication infused through the catheters that can irritate the vein. Other factors that increase risk of progression to DVT and embolism include prolonged bed rest, prolonged sitting, particularly after traveling long distances, and blood coagulation disorders. Heart failure, trauma, abdominal cancers, pregnancy, and stroke also may add to the risk of thrombosis and embolism. Use of birth control pills (oral contraceptives) may increase a woman's risk of developing thrombi or emboli.

The greatest risk factor for thrombi or emboli development is having a prior history of DVT, which almost guarantees a recurrence when undergoing surgery of any kind. Individuals who undergo surgery for orthopedic (e.g., hip replacement) or neurologic problems without preventative treatment for DVT and PE are more likely to experience venous thrombosis. In general, the longer the surgery, the greater the risk of venous embolism or thrombosis in someone with a history of the condition.

Although age is not an independent risk factor, other risk factors increase with age, placing individuals over 40 years of age at greater risk for developing superficial thrombophlebitis that can progress to DVT. In diagnosed cases of venous thromboembolism (VTE), 1 out of every 20 deaths occurs in those over age 50 (Patel). The male to female ratio for DVT is 1.2:1, and men are at greater risk than women for VTE as a complication of DVT (Schreiber). Risk for VTE also increases with aging in both sexes and occurs most often in individuals older than age 75, in individuals with cancer or an acute infectious disease, and those with a history of embolism (Schreiber).

Source: Medical Disability Advisor



Diagnosis

History: An individual with superficial thrombophlebitis may complain of redness, tenderness, and a feeling of warmth near the suspected thrombus. DVT produces no symptoms in 50% of individuals; the other 50% may complain of swelling, tenderness and pain in the calf, ankle and foot; skin discoloration; warmth in the affected area; and pain with standing or walking that is relieved with leg elevation. Involvement of an arm or neck vein can produce pain or swelling in the affected area. An individual with a PE may complain of an abrupt onset of shortness of breath (dyspnea) and rapid breathing (tachypnea), as well as feeling anxious and having chest pain. Individuals may report a history of recent surgery, prolonged periods of bed rest, inactivity, trauma, varicose veins, a previous clotting disorder or a history of DVT. A family history of thrombosis may also be described.

Physical exam: Light pressure applied with the fingertips (palpation) may reveal a hardened (indurated), cord-like vein and redness (erythema) or warmth at the site of superficial thrombophlebitis. In cases of suspected DVT there may be swelling, and palpation over the veins in the groin, behind the knee (popliteal) or inside the thigh may reveal tenderness (about 75% of individuals) and pain (about 50% of individuals). Superficial veins may be prominent. Deep calf tenderness on forced dorsiflexion of the foot with the knee straight (Homans' sign) also may be demonstrated (less than 33% of patients with confirmed DVT, but found in more than 50% of patients without DVT) (Schreiber). A bluish discoloration of the lower leg (phlegmasia cerulea dolens) or painful white inflammation and the absence of pulses due to associated arterial spasm (phlegmasia alba dolens) may be noted in DVT. DVT is difficult to diagnose on the basis of signs and symptoms alone and may be more definitive when clinical signs correlate with the number of risk factors identified and results of diagnostic testing.

With PE, rapid respirations are evident, and the individual may appear anxious, even panic-stricken. Examination of the lungs may reveal wheezing.

Tests: If PE is suspected, blood coagulation studies will be done, including a D-dimer assay for fibrin fragments, prothrombin time (PT), partial thromboplastin time (PTT), platelet count, platelet aggregation, and a rapid qualitative red blood cell agglutination assay.

Noninvasive tests used to diagnose venous thrombosis are duplex ultrasonography with Doppler flow studies and impedance plethysmography (IPG). If neither of these tests confirms the diagnosis, either magnetic resonance venography (MRV) or computed tomography (CT) venography may be performed. Contrast venography is no longer performed in favor of less invasive techniques such as magnetic resonance imaging (MRI) and CT. MRV is the test of choice for superficial venous thrombus in the lower legs and pelvis.

One test for PE is the lung perfusion scan, in which a radioisotope is injected into a vein, allowing observation of pulmonary and venous blood flow via digital imaging. CT scanning also may visualize PE. If neither of these tests can confirm the diagnosis, the definitive diagnostic test for PE is pulmonary arteriography, in which dye is injected into the arm and then observed via x-ray as it travels through the lungs.

Source: Medical Disability Advisor



Treatment

Superficial thrombophlebitis is treated with warm compresses applied to the affected limb, leg elevation at rest for periods of time, nonsteroidal anti-inflammatory drugs (NSAIDs), gradually increased ambulation, and gradient compression stockings (thrombo-embolism deterrent [TED] hose). Treatment of DVT may require hospitalization because of the threat of embolism. DVT requires anticoagulant therapy as soon as possible after diagnosis is confirmed. Heparin (low-molecular-weight heparin) used immediately prevents thrombus extension and often can reduce the risk of thrombus formation and embolus migration. It does not dissolve the existing clot but prevents recurrence of thrombosis. It is often given alternately with warfarin (Coumadin) therapy to more effectively reverse hypercoagulability. Thrombolytic therapy may be given in those with DVT to dissolve the original clot and prevent PE. It does not prevent new clot formation and must be followed by oral anticoagulation therapy (i.e., warfarin). A “bird cage” filter may be placed in the large vein returning blood to the heart from the lower part of the body (inferior vena cava) to prevent PE in an individual with DVT. The procedure involves giving local anesthesia, insertion of the cage-like filter into the femoral artery in the groin, and threading it into place in the inferior vena cava the using ultrasound imaging to guide the placement.

Leg elevation is required when individuals are at rest, but bed rest is controversial because recent studies suggest that elevation of the leg and the immobility of bed rest promote venostasis, an important precursor to DVT (Schreiber). In the US, bed rest and decreased ambulation may be recommended to prevent embolization of the blood clot, but in Europe ambulation is encouraged to reduce venous stasis. Individuals with recurrent venous thrombosis or risk factors that are not correctable (e.g., prior DVT, advanced stage cancer) typically are required to take anticoagulants on a regular basis for 3 to 6 months or longer to prevent the possibility of recurrence.

Source: Medical Disability Advisor



Prognosis

Twenty to thirty percent of individuals with untreated superficial thrombophlebitis will develop DVT (Patel). PE is the leading cause of preventable deaths in hospitalized patients, particularly those with more than one underlying condition such as cancer, recent surgery, and major trauma. Twenty percent of individuals with DVT progress to PE, which results in death in 10% to 20% of cases (Schreiber). Following surgery, 25% of individuals who develop a DVT will progress to PE, which results in a mortality rate of more than 30% (Patel).

Long-term morbidity after DVT is associated with post-thrombotic syndrome that may follow DVT within two years.

Source: Medical Disability Advisor



Complications

PE is the most frequent life-threatening complication of DVT. About 20% of DVT cases progress to venous insufficiency, clot development, and embolization (Schreiber). Massive PE is a leading cause of death in hospitalized individuals, accounting for 300,000 deaths each year in the US (Schreiber). Long-term complications of DVT include venous ulceration and venous insufficiency in lower leg veins.

Complications of venous thrombosis also include post-thrombotic syndrome and chronic venous insufficiency. Hemorrhage, including cerebral hemorrhage, is associated with the use of thrombolytic treatment for PE. Use of anticoagulant therapy is associated with development of coagulation problems.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Allowances for elevation of the legs and a reduction in periods of prolonged sitting and standing will be required. Individuals taking anticoagulant medication may require transfer if their duties involve the possibility of injury to themselves. Time away for doctor and laboratory appointments will be required.

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:

  • Does individual have a history of blood coagulation disorders, heart failure, major trauma, abdominal cancer, infection, or stroke?
  • Does individual have a history of varicose veins?
  • Has individual recently had an intravenous (IV) catheter in place? Was any medication administered through the catheter?
  • Is individual currently pregnant or has the individual recently given birth?
  • Does individual take oral contraceptives or other estrogen therapy?
  • Has individual been on prolonged bed rest, such as for recovery after surgery or for a lengthy illness?
  • Has individual experienced prolonged sitting, particularly for traveling long distances?
  • Has individual undergone recent orthopedic, chest, or abdominal surgery?
  • Does individual complain of redness, tenderness, and a feeling of warmth along a superficial vein? Tenderness in the groin or back of the knee?
  • On physical examination for DVT is skin discoloration evident?
  • Does individual have pain with standing or walking, which is relieved with leg elevation?
  • Were duplex ultrasonography with Doppler flow studies and IPG done?
  • If neither of these tests confirmed the diagnosis, was MRV or CT venography done? Was DVT localized in the lower leg or thigh?
  • If PE was suspected, was a lung perfusion scan, CT scan or pulmonary arteriography performed?
  • Were blood coagulation studies done? D-dimer assay?
  • Was a diagnosis of superficial thrombophlebitis or DVT confirmed?
  • How were conditions with similar symptoms ruled out?

Regarding treatment:

  • For superficial thrombophlebitis, was treatment with warm compresses applied to the affected limb, leg elevation, and NSAIDs given?
  • Did individual require hospitalization for DVT?
  • If so, were anticoagulant and thrombolytic medications administered?
  • Once out of bed, was individual instructed to TED hose? Was continued ambulation recommended?
  • Was surgery performed? Was a filter inserted in the inferior vena cava to prevent PE?
  • Will individual be required to take anticoagulants on a regular basis?
  • Is individual compliant with medication and other treatment regimens?

Regarding prognosis:

  • Was underlying cause of thrombosis a reversible or temporary condition, such as recovery from surgery or pregnancy?
  • Does individual have underlying heart and/or lung disorders? Other conditions that may affect ability to recover?
  • Was this an initial diagnosis or a recurrence?
  • Did individual seek treatment promptly for superficial thrombophlebitis? If not, has DVT developed?
  • Has individual developed complications such as pulmonary embolus, post-thrombotic syndrome, or chronic venous insufficiency? Heart attack or stroke?
  • Has thrombolytic therapy caused hemorrhage?
  • How will complications be treated, and what is the expected outcome with treatment?
  • How will chronic or recurrent venous thrombosis and other complications affect the daily activities of individual?

Source: Medical Disability Advisor



References

Cited

Patel, Kaushl (Kevin), and Craig Feied. "Deep Venous Thrombosis." eMedicine. Eds. William H. Pearce, et al. 16 Jan. 2009. Medscape. 30 Sep. 2008 <http://emedicine.medscape.com/article/462390-overview>.

Schreiber, Donald. "Deep Venous Thrombosis and Thrombophlebitis." eMedicine. Eds. Francis Counselman, et al. 5 Aug. 2009. Medscape. 28 Sep. 2009 <http://emedicine.com/emerg/topic122.htm>.

Source: Medical Disability Advisor






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