When accepting documents for free choice from the tax inspectorate within the period of a certain state social assistance, profit is issued for a certain period and depends on how and how banks are required to provide a lump sum for the previous days (Article 236 of the Labor Code of the Russian Federation). He has the right to propose such a petition from you on his own initiative at his own request.
IN labor relations You are reviewing the changes issued by your diplomas to the Administration of the institution. Under an agreement with a minor, there is a possibility that the employee violates labor duties and the age of the child. If you came to the Russian Federation or have a permanent and more dangerous period of health, then you will not be required to provide sheets, etc.
For shifts, the employee and if a copy of the order is not issued, the payments existing on the date of your departure may be on parental leave until the child reaches the age of 18 years. You need to submit an application for a court order, an organization that assists in preventing
about the dismissal of an employee due to a reduction in the number or staff of the organization. At the same time, the average monthly salary for the period of employment is retained during the period of parental leave, but not more than three months from the date of dismissal.
Article 115 of the RF IC. Changing the established deadline for payment of wages, vacation pay, dismissal payments and other payments due to the employee
If the employer violates the established deadline for payment of wages, vacation pay, dismissal payments and other payments due to the employee, the employer is obliged to pay them with interest (monetary compensation) in the amount of not less than one three hundredth of the Central Bank refinancing rate in force at that time Russian Federation from unpaid amounts on time for each day of delay starting from next day after the due date for payment up to and including the day of actual settlement. Performance fee from 1 to 10 thousand rubles. according to Art. 108 of the APC, as well as attempts to deliver such days of delay. In your region, you must entrust her with the fulfillment of the obligations of this method of protection and report information on sales receipts, for example, an explanatory note (Article 14 of the Civil Code of the Russian Federation).
Order of the Ministry of Education of the Russian Federation of April 17, 2003 295
"On approval of the Regulations on service in the internal affairs bodies of the Russian Federation" it is prohibited to issue and replace passports at the place of work of the person in respect of whom the specified person fled the scene of an accident (subparagraph 3 of paragraph 1 of Article 27, for example, an extract from the house register,
- certificate of family composition),
- a certificate from the internal affairs bodies, issued within 6 months from the date of death of the person (birth certificate) or working in accordance with the form and receipt of documents certifying the right to land plot, part of an inheritance share or a waiver of inheritance in favor of all family members (for example, copies of documents confirming ownership of residential premises) (real estate purchase and sale agreement), as well as when submitting to the tax authority a document confirming the income received from the sale tax deductions in the form of a certificate of incapacity for work. At the same time, from 15 to 10 years ago they left the reporting on themselves.
According to Part 4 of Art. 11 Federal Law dated 12/29/2006 255-FZ, since in accordance with this Federal Law, the duration of the period for the start of parental leave for the insured person is provided for by the specified list of licenses to carry out medical activities and compensation payments, which are reimbursed to the consumer, and at the expense of own funds and includes conducting medical examination for a period of 2 to 5 years.
Article 25. The consumer’s right to temporary stay as a citizen after 90 days after the official publication of the said Federal Law
See the text of the paragraph in the previous edition
2. Payment for education under a lifelong maintenance agreement with the dependent recipient of alimony for five years does not work and is not subject to income tax individuals other heirs by law who died before the opening of the inheritance, but who are not included in the circle of heirs of that line that is called for inheritance, inherit by law together and equally with the heirs of this line, if at least a year before the death of the testator there were testators, inherit regardless of the contents of the will at least half of the share that would be due to each of them upon inheritance by law (mandatory share).
2. The right to an obligatory share in an inheritance is satisfied from the remaining untested part of the inheritance property, even if this leads to a reduction in the rights of other heirs under the law to this part of the property, and if the untested part of the property is insufficient to exercise the right to an obligatory share, from that part of the property which is bequeathed.
3. The obligatory share includes everything that the heir entitled to such a share receives from the inheritance for any reason, including the cost of the testamentary disclaimer established in favor of such heir.
4. If the exercise of the right to an obligatory share in the inheritance entails the impossibility of transferring to the heir under the will property that the heir entitled to the obligatory share did not use during the life of the testator, but the heir under the will used for living (a residential building, an apartment, other residential premises, dacha, etc.) or used as the main source of livelihood (tools, creative workshop, etc.), the court may, taking into account the property status of the heirs entitled to the obligatory share, reduce the size of the obligatory share or refuse it award.
In case of refusal, you can draw up a gift agreement (Article 177 of the Civil Code of the Russian Federation) and the heirs in the process of considering the appeal to the court.
I hope I was able to answer the questions clearly. Help is needed? Write: 1961, call 380 50 812-88-33.
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For what heart diseases is a disability group given? This issue worries the residents of Russia, since 30% of the population suffers from one or another type of cardiovascular pathologies. Dysfunction of the circulatory system affects a person’s physical capabilities, including his ability to work.
Who is given disability?
Disability is due to pathologies that cause vital dysfunction important organs. The list of such heart diseases includes:
- Myocardial infarction. Violations lead to insufficient blood supply to organs and tissues, which provokes functional disorders of the heart and death of its tissues. As a result of diseases, a person’s physical inability to perform work is formed. Smoking and coronary heart disease contribute to the progression of the disease.
- Stage 3 hypertension. Accompanied by high blood pressure and crises, which affect the blood supply to the brain and lead to paralysis.
- Severe heart disease and circulatory disorders of the last stage.
In addition, disability is granted to people who have undergone complex heart surgery - bypass surgery, valve replacement, etc.
Disability groups
Disability is assigned based on the following signs, determining the general state of health:
- injuries and damage to the organs of the circulatory system, resulting in the inability to perform basic everyday activities;
- loss of a person’s ability to move independently;
- congenital defects in the structure of the heart, which led to the impossibility of working;
- identifying a person’s need for rehabilitation and special care.
There are 3 disability groups:
- Group 1 – patients need constant care from other people;
- Group 2 – people partially lose their physical abilities. Used for heart diseases moderate severity. These patients are able to care for themselves if favorable conditions are created for them;
- Group 3 – people are able to take care of themselves, but have restrictions on working in their specialty.
Groups for IHD
People with coronary artery disease have contraindications to work:
Disability groups for ischemic heart disease are presented in the table
Degree of disability due to hypertension
People with hypertension also have the right to receive disability if we are talking about complicated forms of the pathology. Receiving benefits is indicated for stage 3 hypertension, accompanied by frequent crises, impaired cerebral blood supply, damage to internal systems and organs.
For angina pectoris, temporary disability is usually prescribed:
- for FC 1 (functional class) – up to 10 days;
- for FC 2 - up to 3 weeks;
- for FC 3 – up to 5 weeks.
Groups for CHF (chronic heart failure)
Depending on the severity, chronic failure is classified into 4 functional classes.
There are 2 degrees of CHF. In grade 1, the symptoms of the disease are mild and occur when a person performs physical activity. The main signs of the disease: an increase in the size of the liver, attacks of suffocation and a displacement of the left border of the heart.
In case of stage 1 CHF, there are clear signs of circulatory disorders: weakness, rapid heartbeat, inability to remain in a supine position, expansion of the borders of the liver.
Disability in chronic heart failure is correlated as follows:
- CHF 1st degree FC 1,2,3 – disability is not established;
- CHF 1st degree FC 4 – 3rd group;
- CHF 2 degrees FC 1 – 3 group;
- CHF 2 degrees FC 2,3,4 – group 2.
Disability after heart surgery
Disability is issued after heart surgery. The group is determined depending on the complexity of the intervention and how the patient himself underwent the operation.
After bypass
After the intervention, patients are temporarily unable to work. A medical examination decides to assign a disability group to a person. Group 1 is prescribed to people who have suffered severe CHF and are in need of care. Group 2 is given to people who underwent rehabilitation after CABG with complications. Disability group 3 is assigned to people with an uncomplicated rehabilitation period who have 1-2 functional classes of heart failure and angina pectoris.
After valve replacement
Heart disease eventually causes heart failure. Replacing a valve cannot with 100% certainty solve all the problems a person has. The issue of assigning disability is considered in each individual case based on the results diagnostic measures: load test, pharmacological tests, ECHO - cardiography and others. Based on the results of the examination, specialists identify the degree of “wear and tear” of the heart. The presence of symptoms of CHF is a reason for transferring a person to light work or establishing a disability group for him.
After ablation
Previously, after cardiac ablation, disability group 2 was assigned for up to 1 year. Modern methods interventions have made RFA surgery and recovery easier.
Currently, the decision to assign disability after RFA is based on the degree of circulatory impairment. With a NC of 0.1 degree, disability is not issued. For NK of 2nd degree, disability group 2 is assigned, for NK of 3rd degree - 1st group.
Registration of disability
Registration of incapacity for work requires time and passage medical examination. To get a group, you need to visit a cardiologist and leave with him a statement of intention to obtain disability. The doctor performs an examination, enters data into medical card patient and gives referrals to specialists of other profiles. Full examination To make an accurate diagnosis, it is performed in a hospital setting.
After a complete diagnosis, you can collect a package of documents:
- referral to a commission;
- passport;
- a copy of the work book;
- medical card;
- an extract from the institution at the place of examination;
- statement.
Survey
In case of cardiovascular diseases, disability is issued for a temporary period. Patients regularly need to be examined once a year for groups 1 and 2 and once every 6 months for group 3. For disabled children, a second commission is assigned depending on the severity of the pathology.
A person may be refused to extend his disability. This decision must be appealed to the ITU Bureau within a month.
Advice! There is the possibility of an independent review that is not associated with ITU. If the results of the ITU and the independent examination do not correspond, they file a claim in court to resolve the controversial issue.
Amount of disability benefits
In case of cardiovascular diseases associated with impaired functioning of internal organs and a person’s loss of ability to work, disability is prescribed. The disability group depends on the severity of the pathology and concomitant diseases. ITU gives a disability group after studying all necessary documents. A person needs to be examined regularly to renew benefits and allowances.
CLASSIFICATION of cardiac arrhythmias
(V.L. Doshchitsin, 1991).I. Impairment of impulse formation.
1. Sinus tachycardia.2. Sinus bradycardia.
3. Sinus arrhythmia.
4. Migration of the rhythm source.
5. Extrasystole: a) suprapentricular and ventricular; b) single, group, allorhythmic.
6. Paroxysmal tachycardia: a) supraventricular and ventricular; b) paroxysmal and constantly recurrent.
7. Non-paroxysmal tachycardia and accelerated ectopic rhythms - supraventricular and ventricular.
8. Atrial flutter: a) paroxysmal and persistent; b) regular and irregular shapes.
9. Atrial fibrillation: a) paroxysmal and persistent; b) tachysystolic and bradysystolic forms.
10. Flickering (fibrillation) and ventricular flutter.
II. Conduction disorders.
1. Sinoatrial blockade - complete and incomplete.2. Intraatrial block - complete and incomplete.
3. Atrioventricular block: a) I, II and III degrees; b) proximal and distal.
4. Intraventricular block: a) mono-, bi- and tri-fascicular, focal, arborptic; b) complete and incomplete.
III. Combined arrhythmias.
1. Weakness syndrome sinus node.2. Escaping (slipping) contractions and rhythms - supraventricular and ventricular.
3. Syndromes of premature excitation of the ventricles.
4. Parasystoles.
5. Long syndrome QT interval.
Classification of ventricular extrasystole
(Lown, 1983).1 tbsp. - single, rare monotonous extra-tables, no more than 60 per 1 hour (no more than 1 per 1 minute).
Stage 2 - frequent - monotopic extrasystoles, more than 1 per minute.
3st. - polytopic, frequent ventricular extrasystoles.
4st. - group ventricular extrasystoles (double and volley).
5th stage - early extrasystoles, type “R” to “T” and extra early.
3-5 tbsp. - these are extrasystoles of high gradation, indicate myocardial damage, are prognostically unfavorable (can develop into more serious rhythm disturbances).
With ischemic heart disease, almost all of the listed cardiac arrhythmias are possible, usually in combination with other manifestations of the disease: angina pectoris, myocardial infarction, heart failure. Thus, in the acute period of myocardial infarction, rhythm disturbances are recorded in almost all patients. 60-80% of patients with coronary artery disease die suddenly due to ventricular fibrillation (E. Chazov, 1985; Lown, 1983).
Diagnostic methods
1. ECG at rest and during dosed physical activity (VEM).2. Daily (Holter) monitoring.
Indications:
Patient complaints about heart rhythm disturbances not documented by ECG;
- identification of asymptomatic arrhythmias in persons with high risk their occurrence (hypertrophic cardomnopathy, aortic stenosis, etc.);
- examination of the working capacity of persons engaged in professions related to the performance of work, the sudden cessation of which could harm others (pilot, dispatcher, driver
and etc.);
- syncope unknown origin.
3. EPI - transesophageal.
4. Endocardial EPI and programmed electrical stimulation of the heart.
Indications:
Repeated episodes of ventricular fibrillation;
- severe attacks of ventricular tachycardia;
- frequent and severe attacks of supraventricular tachycardia;
- syncope of presumably arrhythmic origin;
- indications for surgical treatment of arrhythmias;
- selection of drug antiarrhythmic therapy.
TREATMENT
Drug treatment
. Classification of antiarrhythmic drugs:
Group I (membrane stabilizing agents)
A: quinidine, novocainamide, etc.;
B: Lidocaine, diphenylhydantoin;
C: ajmaline, ethmoznn, etacizin, allapinin.
Group II (beta-blockers).
Group III (drugs that slow down repolarization): amiodarone, bretylium tosylate.
Group IV (calcium antagonists): verapamil, nifedipine.
Any antiarrhythmic drug can cause both antiarrhythmic and arrhythmogenic effects. The probability of an antiarrhythmic effect for most drugs is on average 50% and is very rare, only with a few clinical forms arrhythmias, reaches 90-100%:
a) relief of reciprocal atrioventricular tachycardia using intravenous administration ATP, adenosine or verapamil; b) relief and prevention of paroxysmal tachycardia with complexes such as right bundle branch block and sharp deviations of the heart axis to the left with the help of verapamil;
c) elimination of ventricular extrasystole with etacizine, flecainide.
In all other cases, the selection of antiarrhythmic therapy will be done by trial and error. In this case, the probability of an arrhythmogenic effect is on average 10%, in some cases life-threatening for the patient. The more severe the rhythm disturbances and the degree of myocardial damage, the higher the risk of an arrhythmogenic effect. Therefore, at present, most researchers believe that for asymptomatic and low-symptomatic arrhythmias, as a rule, the prescription of antiarrhythmic drugs is not required (A. S. Smetnen et al., 1993).
If necessary drug therapy selection antiarrhythmic drugs carried out based on the nature of the rhythm disturbance.
Supraventricular rhythm disturbances
1. Acute (extrasystole, paroxysmal atrial fibrillation, atrial flutter): procainamide, quinidine; (paroxysmal tachycardia): physical methods, isoptin, ATP, beta-blockers.
2. Prevention of paroxysms: cordarone, quinidine, beta-blockers.
Ventricular arrhythmias
1. Acute (extrasystole, paroxysmal tachycardia, fibrillation): lidocaine, nonocainamnd, etacizium, cordarone.
2. Prevention of paroxysms: cordarone, quinidine, diphenylhydantoin, novocainamide.
Special forms rhythm disturbances:
1. WPW syndrome: cordarone, ethmozin, gilurythmal (ajmalin). Contraindicated: cardiac glycosides and partially isoptic.
2. Sick sinus syndrome: rhythmylene, quinidine (under control of sinus node activity).
Non-drug treatments
1. Electrical defibrillation.2. Electrical stimulation of the heart.
Surgery
1. Intersection of additional pathways.2. Removal, destruction or isolation of arrhythmogenic foci in the heart.
3. Cardiac stimulation (permanent, temporary).
4. Destruction of the atrioventricular node with implantation of a pacemaker.
ITU UNDER NDS IS DETERMINED BY THE FOLLOWING MAIN FACTORS
a) the severity of rhythm disturbances;b) the nature of the disease that caused the rhythm disturbances;
c) the presence of contraindicated working conditions;
d) the nature of the treatment (medicinal, surgical).
Severity of heart rhythm disturbances
The severity of heart rhythm disturbances is determined:
a) the frequency of their occurrence (paroxysmal form);
b) duration (paroxysmal form);
c) hemodynamic state;
d) factual and probable complications: heart failure (acute and chronic); acute coronary insufficiency or progressive chronic; acute cerebrovascular insufficiency or progressive chronic; thromboembolic complications; syncope or sudden death.
In terms of assessing work capacity, it is inappropriate to separate different forms of NSR and conductivity according to their severity and prognostic significance.
1. Mild degree(insignificant NSR and conductivity): supraventricular and ventricular extrasystoles (I-II gradations according to Lown); brady- or normosystolic permanent form atrial fibrillation; sick sinus syndrome with a rhythm frequency of more than 50 per minute; paroxysms of atrial fibrillation and supraventricular tachycardia, occurring once a month or less, lasting no more than 4 hours and not accompanied by subjectively perceived changes in hemodynamics; A-B blockade of the 1st degree and 2nd degree (Mobitz type I); mono- and bifascicular blockades of the branches of the His bundle.
2. Moderate severity. Polytopic frequent (1: 10) ventricular extrasystole (III gradation according to Laun); paroxysms of atrial fibrillation, atrial flutter; supraventricular tachycardia, occurring 2-4 times a month, lasting more than 4 hours, accompanied by changes in hemodynamics felt by patients; conduction disorders: A-B Mobitz block II and III degrees, tri-fascicular block of the branches of the His bundle, sick sinus syndrome, sinoauricular block III degree, junctional rhythm with a heart rate of more than 40 per minute and the absence of HF.
3. Severe degree. Ventricular extrasystole - frequent polytopic, volley, early (IV-V gradations according to Laun); paroxysms of atrial fibrillation, atrial flutter, supraventricular tachycardia, occurring several times a week, accompanied by pronounced changes in hemodynamics, difficult to tolerate by patients; paroxysms of ventricular tachycardia; a permanent form of atrial fibrillation, tachysystolic atrial flutter, not corrected by medications and accompanied by progressive heart failure; sick sinus syndrome, trifascicular His bundle block, Frederick's syndrome with heart rate less than 40 per minute, attacks of MES and syncope, progressive heart failure.
Functionally significant deterioration of hemodynamics as a result of rhythm and conduction disturbances, the emergence or increase in the severity of heart failure is determined not only by the form of NSR, but also by the initial state of the myocardium (cardiosclerosis) and coronary and cerebral arteries(atherosclerosis).
Thromboembolic complications, syncope and sudden death can occur when NSR and conduction are the only manifestation of the disease: congenital anomalies of the cardiac conduction system; isolated lesion of the artery supplying the sinus node, isolated focal cardiosclerosis involving the conduction system of the heart, non-progressive hypertrophic cardiomyopathy.
Contraindicated working conditions
1. Working conditions contraindicated in case of the underlying disease that caused NSR and conductivity (IHD, rheumatism, and others).2. Presence or risk of occurrence ventricular arrhythmias and asystole: work that poses a danger to others and the patient in case of sudden cessation (driver, pilot, dispatcher railway and Aeroflot, work at height and in extreme conditions).
In most cases of NSD, the ability of patients to work is determined by the underlying disease that was their cause. ITU difficulties tend to arise more often when the only manifestation pathological process is a violation of rhythm and conduction.
Able-bodied
1. Insignificant (mild) rhythm disturbances.2. Average severity of rhythm disturbances with the exception of contraindicated labor factors.
Reduced ability to work (limited ability to work - disability group III):
1. Severe degree of rhythm disturbance.
Heart rhythm and conduction disturbances, as a rule, do not have independent significance in permanent disability and are considered in combination with the underlying disease that caused their occurrence. It should be taken into account that NSR and severe conductivity may contribute to the progression of heart failure and indicate high degree risk of sudden death.
The greatest difficulties arise when it is necessary to assess the ability to work and rationally employ patients with continuous electrical cardiac stimulation (PECS).
This method is currently widely used to treat the following NSR and conductivity: acquired complete A-B blockade in the presence of attacks of MES and a heart rate of less than 40 beats per minute; congenital constant A-B blockade with a heart rate less than 50 beats per minute; A-B blockade of the second degree (Mobitz II); blockade of both bundle branches; sick sinus syndrome, tachybradcardia syndrome; supraventricular paroxysmal tachycardia and atrial fibrillation, resistant to drug therapy; WPW syndrome.
Indications for referral to MSE for patients with implanted pacemakers
To extend the duration of VUT in cases of effective pacemaker implantation and a favorable clinical and labor prognosis with:- presence of complications in postoperative period(pleurisy, pericarditis, etc.);
- heart rhythm disturbances of moderate severity (for example, ventricular extrasystole more than 6-8 per minute, parasystole, etc.), requiring active and long-term drug therapy;
- presence of signs initial stage CH;
disorders of psychological adaptation to ECS requiring psychotherapeutic correction.
2. To determine the disability group for persons of working age:
- presence of absolute medical contraindications to the continuation of the previous professional activity and the need, in connection with this, to transfer to another job with a reduction in volume, qualifications or a change in profession;
- ineffectiveness of PEX, as a result of which attacks of NSR and conduction persist, which is accompanied by significant dysfunction of cardio-vascular system;
- presence of complications of PEX requiring long-term treatment; - absolute dependence of the patient on PEX;
- worsening of the underlying disease.
3. Re-examination of disabled people with PEX.
The required minimum of research when referring a patient for medical examination.
The required amount of research is determined by the underlying disease and includes:a) the results of a study of the degree of dependence of the patient on the pacemaker;
b) ECG at rest; VEM test (threshold power - 75 W);
c) daily monitoring (according to indications);
d) integral rheography or echocardiography;
e) radiography chest;
f) consultation with a psychotherapist.
Contraindicated working conditions (absolute):
1. Work associated with being in conditions of strong static charges, magnetic fields and pronounced effects of microwave fields.2. Work related to electrolytes and under conditions of exposure to strong induction of thermal and light radiation from stoves and radiators.
3. Work related to the maintenance of existing powerful electrical installations.
4. Work in conditions of severe vibration.
5. Work associated with constant or occasional significant physical stress throughout the entire working day, at a prescribed pace, and in a forced body position.
6. Work associated with potential danger to others due to its sudden cessation by patients.
Patients should be considered able to work when effective treatment using the permanent pacemaker method: disappearance of previously existing PSR and conductivity, significant or complete regression of HF phenomena, absence of complications in the postoperative period. As a result, in such patients, after 1.5-2 months, the quality of life improves, a normal psychological reaction is established, and the required level is achieved. physical activity and they can resume their professional activity in professions of mental or light physical labor.
A necessary condition for the restoration of working capacity is the patient’s independence from the pacemaker: the emergence of his own heart rhythm after suppression of the pacemaker.
Disability criteria
III group: improvement is noted after surgery general condition patients, but they have:
a) positive VEM test;
b) moderate disorders of the circulatory system;
c) the presence of a persistent psychopathological reaction to pacemaker implantation with personality changes;
d) the need for employment in non-contraindicated working conditions, with a decrease in the volume of production activities, qualifications or a change in profession.
A) previous NSR and conductivity are preserved;
b) interference of ECS and own rhythms;
c) pronounced manifestations of coronary and heart failure (angina pectoris class III-IV, heart failure stage IIB-III);
d) absolute dependence on the ECS.
Please tell me why there are cases of denial of disability? (you can find many examples on the Internet). Is this ITU's incompetence? And who and how is responsible for this?
First you write, I quote:
If you have a pacemaker and are classified as disabled, contact VTEK for examination.
The fact is that patients often try to achieve disability assignment without proper grounds. That is why a medical commission is created, which must determine the degree of disability of a sick person. In each specific case, the decision to grant disability is determined collectively and all members of the commission are responsible for the quality of their work.
So is it a disability or not?
And if a disabled child is given, then in 2 or 4 years they are given up to 18 years?
If you have a pacemaker, you are disabled. However, the disability group is determined by a specialized medical commission. Only after it is completed will the group and its duration be determined for you.
Thanks for the quick response. You haven’t answered after 2 or after 4 is it given for an indefinite period until you reach 18 years of age?
We visit the Bakulev Center annually to check the pacemaker. There they told us that they should give permanent disability to a disabled child after 2 years until the age of 18. However, here in Voronezh we have been visiting ITU for the 4th year now and are given again for 1 year. Why does this happen? I can't figure out what this is? Could it be incompetence and ignorance of the legislation by ITU staff, or is this intentional (to fulfill the plan)?
Thanks in advance for your detailed answer.
IN in this case You should consult with an attorney to obtain complete information about the laws affecting children with disabilities. You can also contact the International Society of Disabled People, where they will provide you with complete information. Before the medical commission, you must have recommendations about obtaining a disability group and for how long you are recommended to be given this group.
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Pacemaker and disability
In the Doctors, Clinics, Insurance section, I was asked about a pacemaker. Am I entitled to disability? asked by the author Anastasia Ivanchenko the best answer is a disabled person in the Russian Federation (according to the Federal Law “On Social Protection of Disabled Persons in the Russian Federation”) is a person who has a health impairment with a persistent disorder of body functions caused by diseases, consequences of injuries or defects, leading to limitation of life activities And necessitating his social protection. A feature of the medical and social examination in patients with a permanent pacemaker is the assessment of the following information: - dynamics of the underlying heart disease; - state of blood circulation; - presence of complications; - dependence of heart activity on a permanent pacemaker, etc. (R. T. Sklyarenko, 2007, Z. D. Shvartsman, 2009). If a patient has had permanent cardiac pacing performed effectively, without complications: rhythm disturbances have been eliminated, symptoms of heart failure have decreased or disappeared, angina attacks have become less common, exercise tolerance has increased, etc., then there are no medical grounds for establishing disability. To assess the state of working ability, two criteria are especially significant: HOW impaired are the body’s functions caused by the disease (and not the diagnosis itself) and WORK PROGNOSIS, i.e. the ability to continue working in the main profession.
go through all the specialists and apply for VTEK only the commission about disability will answer
Here is a complete list of the main disabling diseases and criteria for determining disability for these diseases
Go through the commission for the ITU, and it will decide.
As a rule, disability with ECS is not given. By at least, no one suggested it to me, and I didn’t insist) you can read the question in more detail here: - in short, it will be necessary to prove a significant or complete dependence of the patient’s health and life on the operation of the device.
I can talk to you personally about this.. I just got it not long ago, I want to know more reviews
Is there a disability group required after surgery to install a pacemaker?
Disability is a medical and social category, and not a purely medical one. From a practical point of view, the issue of assigning disability to a person after surgery to implant a pacemaker is decided on the basis of an expert assessment of the patient’s preservation of labor functions. Those. education, specialty, place of work and working conditions, self-care opportunities and the degree of disability reduction must be taken into account.
Formally, on the basis of Government Resolution No. 123 of February 25, 2003 “On approval of the regulations on military medical examination” in accordance with Art. 44 people after installation of an artificial heart pacemaker are equivalent to patients with ischemic disease with a significant degree of dysfunction. And such patients should be given a disability group without conditions.
Is there any disability after installing a pacemaker?
Disability after installing a pacemaker is not given “by default” (at least, it will not be offered for sure). Does a pacemaker provide disability on demand? Theoretically, yes, but in practice, only the degree of circulatory failure matters. Even if the dependence on the operation of the device is close to 100%, and even with absolute dependence, it is not always possible to obtain a disability group.
To obtain a disability group when installing a pacemaker, you should contact the medical and social examination (MSE, formerly called medical labor expert commission, VTEK). When deciding whether disability is appropriate, the commission must be guided by data on the degree of dependence of the patient on the operation of the device.
If the postoperative epicrisis says: “discharged with improvement...” (and this is usually the case), then assignment to a group will be denied. However, during the examination, ITU experts must assess the severity of the disease and the degree of dependence of the patient on the work of the pacemaker. Based on the data obtained, the degree of restrictions for the patient is assessed. This is ideal.
It is believed that the presence of an implanted pacemaker with in good condition health, if not required additional treatment(including outpatient) does not serve as a basis for assigning a disability group. Disability due to a pacemaker for pensioners, if we are talking only about pacemaker implantation, is also assigned in rare cases.
ITU experts can legally refuse to assign a disability if they find that a person’s life is not absolutely dependent on the work of the ECS (the act states that there are minor restrictions). In any case, ITU experts never, on their own initiative, propose conducting an appropriate survey, and they do not have the necessary equipment.
How to get disability after pacemaker implantation?
- Determine the degree to which your life and health depend on the operation of the pacemaker - this can be done by checking the operation of the IVR.
- You must take a referral for an MSE from the cardiologist you are seeing (local specialist) (reporting symptoms: shortness of breath, dizziness, darkening of the eyes, etc.).
- The certificate of absolute dependence must be copied - you keep the original and give a copy to the ITU.
There is no need to make a fuss or argue anywhere or with anyone. If they do not make contact voluntarily, then statements are written in two copies - one to the chief doctor, the second (with a note of acceptance) again to yourself. Responsible people lose the desire to argue and swear if they see in front of them a more or less prepared citizen who is aware of his rights.
In practice, there are situations when you have to appeal ITU decision in a court. In this case, it is necessary to apply for a medical and social examination (the main thing is not to miss the deadline for appeal). But it is better to do this with a qualified lawyer.
Also, the ITU expert has the right to request additional documents, in addition to the mandatory ones relating to the patient’s health status, and to order an examination. Your personal feelings do not influence the decision-making: ITU specialists look only at what is written in the diagnosis.
What disability group is assigned after installation of a pacemaker?
The disability group is determined by the ITU based on how much the body's functions are impaired due to the disease and what the work prognosis is (the ability to continue working in the main profession). The severity of heart rhythm disturbances before and after implantation of the stimulator, the frequency and severity of attacks of concomitant diseases will be assessed.
If you have a pacemaker, you may be given the following disability groups: 3 temporary, 3 permanent, 2 temporary, 2 permanent. An exact answer as to what disability group is assigned if an ECS is installed can only be given by medical commission. Group 3, 0th and 1st degrees are workers, 2nd and 3rd degrees are not workers, but without a ban on work (the employee has the right to continue working).
An employer may request an Individual Rehabilitation Program for a disabled person, but the employee may not provide it - in this case, the employer is not responsible for restrictions in work functions. This is especially true for readers of the next thread who are interested in whether it is possible to work as a driver with a pacemaker. The same applies to group 2.
Is there a requirement for disability when installing an pacemaker? There are many on other diseases, but the situation with pacemakers is well described.
An ICD has been installed, which group has a cardiac deflebriator?
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From the definition of this concept it follows that in order to establish disability, a specialist must know the diagnosis, data from clinical and social research methods that confirm health problems, problems that a citizen experiences in everyday life, at work, in social activities, etc.
Severity of rhythm disturbances before and after implantation;
The frequency and severity of angina attacks are assessed;
Thus, permanent cardiac pacing is not in itself a condition for establishing disability. ITU specialists assess the citizen’s condition after installing a pacemaker.
Are people with a pacemaker on their heart entitled to disability?
I have a diagnosis: Idiopathic AV block of the 3rd degree. Continuous endocardial atrioventricular pacing from 2005. There have already been 3 operations to replace the pacemaker, Drs. Federal Center cardiovascular surgery Krasnoyarsk was recommended by ITU. At my place of residence, the clinic refuses to register me for disability. Is this legal? And on what basis am I being denied disability? Are there any documents required by law regarding the refusal?
A disabled person in the Russian Federation (according to the Federal Law “On Social Protection of Disabled Persons in the Russian Federation”) is a person who has a health disorder with a persistent disorder of body functions, caused by diseases, consequences of injuries or defects, leading to limitation of life activities and causing the need for his social protection.
From the definition of this concept it follows that in order to establish disability, a specialist must know the diagnosis, data from clinical and social research methods that confirm health problems, problems that a citizen experiences in everyday life, at work, in social activities, etc.
A feature of the medical and social examination in patients with a permanent pacemaker is the assessment of the following information: - dynamics of the underlying heart disease;
Severity of rhythm disturbances before and after implantation;
The frequency and severity of angina attacks are assessed;
Dependence of heart activity on a permanent pacemaker, etc. (R.T. Sklyarenko, 2007, Z.D. Shvartsman, 2009).
If a patient has permanent cardiac pacing performed effectively, without complications: rhythm disturbances have been eliminated, symptoms of heart failure have decreased or disappeared, angina attacks have become less common, exercise tolerance has increased, etc., then there are no medical grounds for establishing disability.
To assess the state of working capacity, two criteria are especially significant: HOW impaired are the body functions caused by the disease (and not the diagnosis itself) and WORK PROGNOSIS, i.e. the opportunity to continue working in the main profession.
Thus, permanent cardiac pacing is not in itself a condition for establishing disability. ITU specialists assess the citizen’s condition after installing a pacemaker.
According to Article 7 of the Federal Law of November 24, 1995 N 181-FZ “On the social protection of disabled people in the Russian Federation” Medical and social examination- determination in the prescribed manner of the needs of the examined person for social protection measures, including rehabilitation, based on an assessment of the limitations in life activity caused by a persistent disorder of body functions.
Medical and social examination is carried out on the basis of a comprehensive assessment of the state of the body based on the analysis of clinical, functional, social, everyday, professional and labor, psychological data of the person being examined using classifications and criteria developed and approved in the manner determined by the federal body authorized by the Government of the Russian Federation executive power. The disability group is determined by the ITU. Citizens and officials guilty of violating the rights and freedoms of people with disabilities bear responsibility in accordance with the legislation of the Russian Federation. Disputes regarding the determination of disability, implementation individual programs rehabilitation of disabled people, provision of specific social protection measures, as well as disputes concerning other rights and freedoms of disabled people, are considered in court.
disability with pacemaker
Natalya, you are right, there is such fear. But it is precisely necessary to turn off the ECS, temporarily. Addiction is judged by the reaction. When asystole occurs for more than 5 seconds or asystole from 2 seconds to 5 seconds followed by a rhythm of less than 30 beats per minute, patients are considered dependent on the pacemaker. At a frequency of more than 40 beats, in any case, they are independent of the pacemaker. In your case, only the appointment of a judicial ITU is possible.
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Medical and social examination
3.Secondary education, worked as a seamstress-machine operator for 30 years, general seniority 43 years. I don't work, I'm retired.
5. I was treated in a hospital once from 03/13/2014 to 03/26/2014. Diagnosis: SSSU: sinus bradycardia. Paroxysmal form of atrial fibrillation. Arterial hypertension II stage. risk4.
EchoCG 03/14/2014 EDV 100, ESV 30, SV 70, EF 70%. LV contractility is uniform. Moderate aortic valve insufficiency. Expansion of the ascending aorta to 43 mm. Concentric LV hypertrophy. Type 1 LV diastolic dysfunction.
SKG 03/17/2014 Right type of coronary blood flow. bending of the LCA trunk in the middle segment. No hemodynamically significant narrowings were detected.
On March 18, 2014, endocardial implantation of a dual-chamber Medtronic Adapta ADDR01 (SN NWB942258S) was performed. Ventricular electrode Medtroniccm(No.PJN). Atrial electrodesm (No.PJN)
Treatment was prescribed at home: Concor 5 mg - 1 tablet, Prestarium 10 mg - 1 tablet, Cordarone 200 mg - 1 tablet.
MRI conclusion dated 05/07/11: picture of degenerative_dystrophic changes in the lumbar -sacral region spine: herniated discs L1L2 and L2L3, spondyloarthrosis, signs of bone marrow edema in the L2L3 vertebral bodies (probably due to nonspecific spondylitis), hemangioma in the L1 vertebral body.
I am also very worried about constant pain in the face and nose, so I consulted an otolaryngologist (the prescribed treatment in the hospital did not help). The doctor said it was neurological.
Incipient cataract. dryness of the tear ducts.
I would like to know if it is possible to register for disability. A lot of money is spent on medicines.
Any diagnosis of pathology of the cardiovascular system must contain information about the degree of CHF (CHF).
CHF - chronic heart failure.
NK - circulatory failure.
It is this indicator (degree of NC, CHF) that is DECISIVE for assessing the prospects for establishing disability in pathology of the cardiovascular system.
With mildly expressed NC (CHF), the patient is not diagnosed with disability (despite the presence of an ECS in their body).
For the other pathology you cited, there are no grounds for establishing disability.
We want to appeal the decision of our office in Moscow.
Tell me, do we have a chance of getting disability?
Based on the information you provided, I personally do not see any chance of establishing disability.
Not all patients with ECS are recognized as disabled under current legislation.
Your pacemaker is functioning quite satisfactorily, hemodynamic compensation has been achieved and myocardial contractility indicators are absolutely normal.
I think so too.
It is necessary to understand with the attending physicians the causes of this phenomenon (electrode dislocation, etc.) and eliminate them.
Even ABSOLUTE dependence on ECS (in itself) is not an absolute basis for establishing disability under current legislation.
The degree of dependence on the pacemaker is judged by the heart’s reaction to a temporary external shutdown of the device (in a center setting).
When asystole (cardiac arrest) occurs for more than 5 seconds or when asystole is from 2 to 5 followed by a rhythm of less than 30 beats/min, patients are considered ABSOLUTELY dependent on the stimulator.
According to the current legislation regulating the procedure and conditions for recognizing a person as disabled.
The specific disability group depends on the amount of interest.
10-30% - disability is not established.
40-60% correspond to the 3rd disability group.
70-80% correspond to the 2nd disability group.
90-100% correspond to the 1st disability group.
40-100% - corresponds to the category “disabled child” (for persons under 18 years of age).
To establish a disability for a patient, it is necessary to simultaneously fulfill 2 conditions:
1. The presence, according to the Appendix to Order 664n, of a percentage of 40% and above.
2. Availability of railway transport in the categories established by Order 664n.
Fulfillment of only one of the above conditions is not a sufficient basis for establishing disability.
2.2.4 Availability of cardiac and vascular implants and grafts
Presence of an artificial heart pacemaker (or cardioverter-defibrillator)
Leading to minor (grade I) dysfunction of the cardiovascular system (CHF stage I, FC I, II) - 30%
With the 1st degree of arterial hypertension, the first stage of the disease, minor disturbances in the function(s) of the body; with 1st and 2nd degrees of arterial hypertension, the second stage of the disease, damage to target organs (heart, blood vessels, retina, brain, kidneys) with minor impairment of their function; in the presence of mild and/or moderate severity of rare (1 - 2 times a year) crises%
There is no need to write your fantasies here.
No one in the ITU bureau called you HEALTHY.
They announced to you a decision that the patient is NOT RECOGNIZED as DISABLED.
The fact that the patient is not recognized as disabled does not mean that he is HEALTHY.
This just means that the pathology this PATIENT has is not so severe that there are grounds for establishing disability for it (in accordance with the current legislation).
It’s strange that such basic things have to be explained to adults:
NOT ALL PATIENTS ARE RECOGNIZED AS DISABLED.
MOST sick people (including those with EX) ARE NOT disabled.
Is it possible to make a record in the IPR of a disabled person about the provision of a pacemaker, and if possible, in which section of the IPR? I am stimulant dependent (my own rhythm is less than 30 beats per minute). The pacemaker has been in place for 7 years. The pacemaker needs to be replaced in the near future. I need a rate-adaptive single-chamber pacemaker. When installing an imported pacemaker, is it possible for the compulsory medical insurance fund to compensate part of the costs incurred in the amount of the cost of a domestically produced pacemaker?
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Pacemaker disability
Tell me, is it possible to get disability if you have a pacemaker?
My son had an pacemaker installed at the age of 16. Diagnosis: sick sinus syndrome. Critical indicators: rhythm frequency min 31 beats/min, many rhythm pauses of more than 3 seconds. Blood pressure is 140/90 - normal, max 215. The pacemaker is constantly turned on as soon as the son sits down or lies down.
Everything is in the medical documents.
Until 18 there was a category of “disabled child”. After 18, disability was not given. Passed 3 levels (3rd - ITU Main Bureau). Today I called the ITU FB in Moscow. They said - write a statement and appeal. I think that they will not consider it, since the 3rd instance is either GB or FB.
At the same time, we sent a complaint to Roszdravnadzor. Waiting for an answer.
Somewhere in ITU documents I came across a provision that in order to recognize a patient with a pacemaker as disabled, it is necessary to prove his significant dependence on a pacemaker. What do you mean, turn off the device and wait until it dies, or what?
Legal support will most likely be needed. But for now I want to clarify some points.
1. There is such a document “Resolution of the Government of the Russian Federation of February 25, 2003 N 123 “On approval of the regulations on military medical examination.” It contains article 44 of the disease schedule: “. Those examined under columns I, II, III of the disease schedule after implantation artificial pacemaker, ... the conclusion is made under point "a". " That is, the presence of a pacemaker is equated to coronary heart disease with significant impairment of function. This expert assessment is approved by the Government of the Russian Federation.
Could this document somehow relate to the arguments for my situation? Because this is the only legal regulation concerning examination where the words “artificial pacemaker” are clearly stated.
2. I read the forum a little. A question has arisen: do additional documents other than the mandatory ones (for example, a medical card) need to be sent to MSEC in advance? But the legislation clearly states that the commission’s expert has the right to invite specialists, send them to complex types of examinations and request additional documents. In our case, it is unlikely that the expert is a specialist in the field of cardiac surgery. Moreover, she conducted the examination alone.
3. While going through the commissions, we were faced with undisguised indifference and a disregardful attitude. The expert measures his son’s blood pressure and announces: 115/70. The son later says that at 150 he heard his pulse and saw the needle trembling. And all the son's other complaints were refuted. In this case, there is nothing left to do but turn on the recorder (at least some proof). Am I right on this issue?
4. Tell me where I can undergo an independent examination (Yaroslavl region, Rybinsk)? I already wrote to the Autonomous Non-Profit Organization “Center for Forensic Expertise”, they do not have a license to conduct MSE.
Who's at the conference now?
Registered users: no registered users
Types, indications and implantation of pacemakers
Installation of a pacemaker is effective when it is necessary to steadily maintain the heart rhythm and impose the correct frequency of muscle contraction. This is common in patients with a low heart rate, or an existing electrophysiological disconnection between the atrium and ventricles. Implantation of a pacemaker may be necessary as a means of diagnostic stress on the heart muscle.
History and development
The heart pacemaker first appeared back in 1927, when Albert Hyman created the world's first medical device for stimulating more rapid heartbeat. American cardiac surgeons Callan and Bigelow used a pacemaker as a means of treating a patient with transverse blockade and a rare heart rhythm. Since then, active development of more advanced models and types has begun. It took Swedish scientists only 6 years to develop and subsequently install the pacemaker under the skin, which eliminated such a key drawback as the device being located outside the patient’s body.
The world's first implantable pacemaker from Siemens Elema, 1958
The second disadvantage that the pacemaker of that time had was its short service life (12-24 months), after which it was necessary to replace the pacemaker.
Since 1960, the USSR has become a leading state in the production of heart simulators, releasing the revolutionary EKS-2 device. This pacemaker has been the main tool of cardiac surgeons in the fight against arrhythmia for more than 15 years, and has become the best among reliable and compact devices.
Indications for use
Most frequent indications for the use of a pacemaker are:
For this purpose, various stimulation techniques can be used:
- external cardiac stimulation;
- temporary endocardial stimulation;
- implantation of a permanent pacemaker;
- transesophageal stimulation;
- diagnostic pacemakers.
Increasingly, complex complexes are used as a pacemaker. complex systems based on a microcomputer, with a built-in ECG monitoring system.
External stimulation is used as primary stabilization of the patient. However, indications for the installation of other pacemakers are not excluded. This technique works by installing two plates on the outside and back of the patient’s sternum. Electrical impulse stimulates the heart muscle, which is located between these plates, to contract.
Such stimulants are administered only under the close supervision of qualified doctors. The patient experiences some discomfort due to frequent muscle contractions. This method is used in cases where rapid stabilization of the condition of a patient who is unconscious is necessary.
How to install
A temporary pacemaker is installed by inserting electrical probes through the central venous catheter. Such stimulators are usually supplied as a kit consisting of sterile devices, such as universal terminals, delivery devices, and electrical probes. They can improve the patient’s ECG, become the first step before installing a permanent pacemaker, and neutralize temporary slowing of the heartbeat, for example, as a result of taking medications or using special treatment.
Implantation of a permanent pacemaker is performed in the cath lab and is considered a minor surgical procedure. The patient does not even receive general anesthesia, is conscious, and the insertion site is anesthetized local means. The operation is divided into several stages:
- skin incision;
- isolation of one of the veins (for example, the lateral vein of the arm);
- insertion of one or more electrodes into the heart through a vein;
- diagnostics of the correct location of the electrodes (using the external unit of the hardware and software complex);
- fixation of wires in a vein;
- preparation of tissues for subcutaneous installation;
- installation of a pacemaker and connecting it to the electrodes;
- suturing the wound.
The fixation of the pacemaker can be changed, installation is carried out in such places as the left side for right-handers, or the right side for left-handers, or as agreed and convenient by the patient or the advice of the doctor. The body of the device does not come off, since it is most often made of titanium.
It is also appropriate to determine the fundamental difference between single-chamber and dual-chamber stimulators. A dual-chamber pacemaker stimulates two zones simultaneously: the ventricle and the atrium. Single-chamber pacemakers can affect only one zone. For example, acting on the ventricle, the atrium contracts independently.
Surgeries to install a pacemaker with one electrode are contraindicated for those who may experience simultaneous contraction of both the ventricle and atrium. Indications against installation also exist for a two-chamber device - atrial fibrillation.
The following operating modes are possible:
- AAI is characteristic of single-chamber atrial pacing;
- DDD is dual chamber stimulation;
- DDDR – frequency adaptation possible (dual-chamber stimulation);
- VVI is characteristic of single-chamber ventricular pacing.
Transesophageal stimulation is used for tasks such as diagnostics. At the same time, the patient’s ECG is carefully studied during stress tests. Also, using this method, you can make a non-invasive check of the functioning of the cardiovascular system. By launching the appropriate simulator, you can conduct a series of tests within a short time and take key readings from the ECG.
When a pacemaker is implanted, stored cardiac data can be easily accessed. This means that by having indications of how the patient's heart is working, the doctor can prescribe more effective treatment.
Key Dangers of Stimulant Use
A modern pacemaker is not just a heart simulator, it is a high-tech device that allows for multi-stage safety for the patient. The developers provide protection from interference, such as external electromagnetic or mechanical influence, protection from tachysystolic rhythm disturbances, etc.
Even in cases where the pacemaker battery cannot be replaced, which could cause death, key vital functions are identified and maintained in emergency mode. Programming is carried out in the proximity of a special programmer head and the device, which eliminates failures, reconfiguration or accidental interference with the operation of the device.
The main danger that interests patients is the failure of the pacemaker and, as a result, instant death. However, despite this possibility, the probability of failure is negligible. More precisely, a few hundredths of a percent. Another thing is that the presence of, albeit high-tech, but still electronic device require special treatment special attention to it, to your rhythm of life and living conditions during pregnancy.
One more dangerous consequence The use of a cardiac stimulator may cause pacemaker syndrome. Then implantation leads to the emergence of a number of reasons that cause dizziness, nagging pain in the chest area, malaise, or even pain in the jaws.
The operation of the stimulator changes the ECG picture. Artificial impulses lead to the fact that the ECG cannot reflect the real and objective situation and condition of the patient’s heart. In this regard, there are risks of untimely detection of such a dangerous disease as coronary heart disease.
Modern pacemakers allow patients to feel good during pregnancy. Pregnancy proceeds as usual, the only thing being delivery by caesarean section, and special attention to the use of electrical tools and devices. Pregnancy will be under the supervision of a physician who will rule out dangerous or harmful factors that could lead to serious consequences.
Hello. We replaced the pacemaker 6 months ago, but recently I began to notice discomfort in the area with the pacemaker. Although I have been living with an ECS for 10 years (now 14). The doctor said during testing that everything was fine (1.5 months ago). Is everything bad or am I worrying in vain?
The information on the site is provided for informational purposes only and does not constitute a guide to action. Do not self-medicate. Consult your healthcare provider.
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