TN 14 (04-13)
DI 34005.110 Congenital Disorders that Affect Multiple Body Systems
110.00 Congenital Disorders That Affect Multiple Body Systems (Effective Date: 04/05/13)
A. Which disorders do we evaluate under this body system?
We evaluate non-mosaic Down syndrome and catastrophic congenital disorders under this
body system.
B. What is non-mosaic Down syndrome?
Non-mosaic Down syndrome is a genetic disorder. Most children with non-mosaic Down
syndrome have three copies of chromosome 21 in all of their cells (chromosome 21 trisomy);
some have an extra copy of chromosome 21 attached to a different chromosome in all
of their cells (chromosome 21 translocation). Virtually all children with non-mosaic
Down syndrome have characteristic facial or other physical features, delayed physical
development, and intellectual disability. Children with non-mosaic Down syndrome may
also have congenital heart disease, impaired vision, hearing problems, and other disorders.
We evaluate non-mosaic Down syndrome under 110.06. If you have non-mosaic Down syndrome
documented as described in 110.00C, we consider you disabled from birth.
C. What evidence do we need to document non-mosaic Down syndrome under 110.06?
1. Under 110.06A, we will find you disabled based on laboratory findings.
a. To find that your disorder meets 110.06A, we need a copy of the laboratory report
of karyotype analysis, which is the definitive test to establish non-mosaic Down syndrome.
We will not purchase karyotype analysis. We will not accept a fluorescence in situ
hybridization (FISH) test because it does not distinguish between the mosaic and non-mosaic
forms of Down syndrome.
b. If a physician (see §§404.1513(a)(1) and 416.913(a)(1) of this chapter) has not signed
the laboratory report of karyotype analysis, the evidence must also include a physician’s
statement that you have Down syndrome.
c. For purposes of 110.06A, we do not require evidence stating that you have the distinctive
facial or other physical features of Down syndrome.
2. If we do not have a laboratory report of karyotype analysis documenting that you
have non-mosaic Down syndrome, we may find you disabled under 110.06B or 110.06C.
a. Under 110.06B, we need a physician’s report stating: (i) your karyotype diagnosis
or evidence that documents your type of Down syndrome that is consistent with prior
karyotype analysis (for example, reference to a diagnosis of “trisomy 21”) and (ii)
that you have the distinctive facial or other physical features of Down syndrome.
We do not require a detailed description of the facial or other physical features
of the disorder. However, we will not find that your disorder meets 110.06B if we
have evidence—such as evidence of functioning inconsistent with the diagnosis—that
indicates that you do not have non-mosaic Down syndrome.
b. If we do not have evidence of prior karyotype analysis (you did not have testing,
or you had testing but we do not have information from a physician about the test
results), we will find that your disorder meets 110.06C if we have: (i) a physician’s
report stating that you have the distinctive facial or other physical features of
Down syndrome and (ii) evidence that your functioning is consistent with a diagnosis
of non-mosaic Down syndrome. This evidence may include medical or nonmedical information
about your physical and mental abilities, including information about your development,
education, work history, or the results of psychological testing. However, we will
not find that your disorder meets 110.06C if we have evidence—such as evidence of
functioning inconsistent with the diagnosis—that indicates that you do not have non-mosaic
Down syndrome.
D. What are catastrophic congenital disorders?
Some catastrophic congenital disorders, such as anencephaly, cyclopia, chromosome
13 trisomy (Patau syndrome or trisomy D), and chromosome 18 trisomy (Edwards' syndrome
or trisomy E), are usually expected to result in early death. Others such as cri du
chat syndrome (chromosome 5p deletion syndrome) and the infantile onset form of Tay-Sachs
disease interfere very seriously with development. We evaluate catastrophic congenital
disorders under 110.08. The term "very seriously" in 110.08 has the same meaning as
in the term "extreme" in §416.926a(e)(3) of this chapter.
E. What evidence do we need under 110.08?
We need one of the following to determine if your disorder meets 110.08A or B:
1. A laboratory report of the definitive test that documents your disorder (for example,
genetic analysis or evidence of biochemical abnormalities) signed by a physician.
2. A laboratory report of the definitive test that documents your disorder that is not
signed by a physician and a report from a physician stating that you have the disorder.
3. A report from a physician stating that you have the disorder with the typical clinical
features of the disorder and that you had definitive testing that documented your
disorder. In this case, we will find that your disorder meets 110.08A or B unless
we have evidence that indicates that you do not have the disorder.
4. If we do not have the definitive laboratory evidence we need under E1, E2, or E3,
we will find that your disorder meets 110.08A or B if we have: (i) a report from a
physician stating that you have the disorder and that you have the typical clinical
features of the disorder, and (ii) other evidence that supports the diagnosis. This
evidence may include medical or nonmedical information about your development and
functioning.
5. For obvious catastrophic congenital anomalies that are expected to result in early
death, such as anencephaly and cyclopia, we need evidence from a physician that demonstrates
that the infant has the characteristic physical features of the disorder. In these
rare cases, we do not need laboratory testing or any other evidence that confirms
the disorder.
F. How do we evaluate mosaic Down syndrome and other congenital disorders that affect
multiple body systems?
1. Mosaic Down syndrome.
Approximately two percent of children with Down syndrome have the mosaic form. In
mosaic Down syndrome, there are some cells with an extra copy of chromosome 21 and
other cells with the normal two copies of chromosome 21. Mosaic Down syndrome can
be so slight as to be undetected clinically, but it can also be profound and disabling,
affecting various body systems.
2. Other congenital disorders that affect multiple body systems.
Other congenital disorders, such as congenital anomalies, chromosomal disorders, dysmorphic
syndromes, inborn metabolic syndromes, and perinatal infectious diseases, can cause
deviation from, or interruption of, the normal function of the body or can interfere
with development. Examples of these disorders include both the juvenile and late-onset
forms of Tay-Sachs disease, trisomy X syndrome (XXX syndrome), fragile X syndrome,
phenylketonuria (PKU), caudal regression syndrome, and fetal alcohol syndrome. For
these disorders and other disorders like them, the degree of deviation, interruption,
or interference, as well as the resulting functional limitations and their progression,
may vary widely from child to child and may affect different body systems.
3. Evaluating the effects of mosaic Down syndrome or another congenital disorder under
the listings.
When the effects of mosaic Down syndrome or another congenital disorder that affects
multiple body systems are sufficiently severe we evaluate the disorder under the appropriate
affected body system(s), such as musculoskeletal, special senses and speech, neurological,
or mental disorders. Otherwise, we evaluate the specific functional limitations that
result from the disorder under our other rules described in 110.00G.
G. What if your disorder does not meet a listing?
If you have a severe medically determinable impairment(s) that does not meet a listing,
we will consider whether your impairment(s) medically equals a listing. See §416.926
of this chapter. If your impairment(s) does not meet or medically equal a listing,
we will consider whether it functionally equals the listings. See §§416.924a and 416.926a
of this chapter. We use the rules in §416.994a of this chapter when we decide whether
you continue to be disabled.
110.01 Category of Impairments, Congenital Disorders That Affect Multiple Body Systems
110.06 Non-mosaic Down syndrome (chromosome 21 trisomy or chromosome 21 translocation), documented by:
A. A laboratory report of karyotype analysis signed by a physician, or both a laboratory
report of karyotype analysis not signed by a physician and a statement by a physician
that the child has Down syndrome (see 110.00C1).
OR
B. A physician’s report stating that the child has chromosome 21 trisomy or chromosome
21 translocation consistent with karyotype analysis with the distinctive facial or
other physical features of Down syndrome (see 110.00C2a).
OR
C. A physician’s report stating that the child has Down syndrome with the distinctive
facial or other physical features and evidence demonstrating that the child is functioning
at the level of a child with non-mosaic Down syndrome (see 110.00C2b).
110.08 A catastrophic congenital disorder (see 110.00D and 110.00E) with:
A. Death usually expected within the first months of life.
OR
B. Very serious interference with development or functioning.