DI 34125.007 Digestive Listings from 05/24/02 to 12/17/07
5.00 DIGESTIVE SYSTEM
A. Disorders of the digestive system which result in a marked impairment usually do so because of interference with nutrition,
multiple recurrent inflammatory lesions, or complications of disease, such as fistulae,
abscesses, or recurrent obstruction. Such complications usually respond to treatment.
These complications must be shown to persist on repeated examinations despite therapy
for a reasonable presumption to be made that a marked impairment will last for a continuous
period of at least 12 months.
B. Malnutrition or weight loss from gastrointestinal disorders. When the primary disorder of the digestive tract
has been established (e.g., enterocolitis, chronic pancreatitis, postgastrointestinal
resection, or esophageal stricture, stenosis, or obstruction) the resultant interference
with nutrition will be considered under the criteria in §5.08. This will apply whether
the weight loss is due to primary or secondary disorders of malabsorption, malassimilation,
or obstruction.
C. Surgical diversion of the intestinal tract, including colostomy or ileostomy, are not listed since they do not represent impairments
which preclude all work activity if the individual is able to maintain adequate nutrition
and function of the stoma. Dumping syndrome which may follow gastric resection rarely
represents a marked impairment which would continue for 12 months. Peptic ulcer disease
with recurrent ulceration after definitive surgery ordinarily responds to treatment.
To be considered a severe impairment which will last for at least 12 months, a recurrent
ulcer after definitive surgery must be demonstrated, despite therapy, by repeated
appropriate medically acceptable imaging of the upper gastrointestinal tract or by
or gastroscopic examinations. Medically acceptable imaging includes, but is not limited
to, x-ray imaging, computerized axial tomography (CAT scan) or magnetic resonance
imaging (MRI), with or without contrast material, myelography, and radionuclear bone
scans. “Appropriate” means that the technique used is the proper one to support the evaluation and diagnosis
of the impairment. Definitive surgical procedures are those designed to control the
ulcer disease process (i.e., vagotomy and pyloroplasty, subtotal gastrectomy, etc.).
Simple closure of a perforated ulcer does not constitute definitive surgical therapy
for peptic ulcer disease.
5.01 Category of Impairments, Digestive System
5.02 Recurrent Upper Gastrointestinal Hemorrhage from undetermined cause with anemia manifested by hematocrit of 30 percent or less on repeated examinations.
5.03 Stricture, stenosis, or obstruction of the esophagus
(demonstrated by endoscopy or other appropriate medically acceptable imaging) with weight loss as described under 5.08.
5.04 Peptic ulcer disease (demonstrated by endoscopy or other appropriate medically acceptable imaging). With:
-
A.
Recurrent ulceration after definitive surgery persistent despite therapy; or
-
B.
Inoperable fistula formation; or
-
C.
Recurrent obstruction demonstrated by endoscopy or other appropriate medically acceptable
imaging; or
-
D.
Weight loss as described under 5.08.
5.05 Chronic liver disease (e.g., portal, postnecrotic, or biliary cirrhosis; chronic active hepatitis; Wilson's
disease). With:
A. Esophageal varices (demonstrated by endoscopy or other appropriate medically acceptable
imaging) with a documented history of massive hemorrhage attributable to these varices.
Consider under a disability for 3 years following the last massive hemorrhage; thereafter,
evaluate the residual impairment; or
B. Performance of a shunt operation for esophageal varices. Consider under a disability
for 3 years following surgery; thereafter, evaluate the residual impairment; or
C. Serum bilirubin of 2.5 mg. per deciliter (100ml.) or greater persisting on repeated
examinations for at least 5 months; or
D. Ascites, not attributable to other causes, recurrent or persisting for at least
5 months, demonstrated by abdominal paracentesis or associated with persistent hypoalbuminemia
of 3.0 gm. per deciliter (100 ml.) or less; or
E. Hepatic encephalopathy. Evaluate under the criteria in 12.02; or
F. Confirmation of chronic liver disease by liver biopsy (obtained independent of
Social Security disability evaluation) and one of the following:
1. Ascites not attributable to other causes, recurrent or persisting for at least
3 months, demonstrated by abdominal paracentesis or associated with persistent hypoalbuminemia
of 3.0 gm. per deciliter (100 ml.) or less; or
2. Serum bilirubin of 2.5 mg. per deciliter (100 ml.) or greater on repeated examinations
for at least 3 months; or
3. Hepatic cell necrosis or inflammation, persisting for at least 3 months, documented
by repeated abnormalities of prothrombin time and enzymes indicative of hepatic dysfunction.
5.06 Chronic ulcerative or granulomatous Colitis (demonstrated by endoscopy, barium enema, biopsy, or operative findings). With:
A. Recurrent bloody stools documented on repeated examinations and anemia manifested
by hematocrit of 30 percent or less on repeated examinations; or
B. Persistent or recurrent systemic manifestations, such as arthritis, iritis, fever,
or liver dysfunction, not attributable to other causes; or
C. Intermittent obstruction due to intractable abscess, fistula formation, or stenosis;
or
D. Recurrences of findings of A, B, or C above after total colectomy; or
E. Weight loss as described under 5.08.
5.07 Regional enteritis (demonstrated by operative findings, barium studies, biopsy, or endoscopy). With:
A. Persistent or recurrent intestinal obstruction evidenced by abdominal pain, distention,
nausea, and vomiting and accompanied by stenotic areas of small bowel with proximal
intestinal dilation; or
B. Persistent or recurrent systemic manifestations such as arthritis, iritis, fever,
or liver dysfunction, not attributable to other causes; or
C. Intermittent obstruction due to intractable abscess or fistula formation; or
D. Weight loss as described under 5.08.
5.08 Weight Loss due to any persisting gastrointestinal disorder. (The following weights are to be demonstrated to have persisted for at least 3 months
despite prescribed therapy and expected to persist at this level for at least 12 months.)
With:
Tables of Weight Reflecting Malnutrition Scaled According to Height and Sex
A. Weight equal to or less than the values specified in table I or II; or
B. Weight equal to or less than the values specified in table III or IV and one of
the following abnormal findings on repeated examinations:
1. Serum albumin of 3.0 gm. per deciliter (100 ml.) or less; or
2. Hematocrit of 30 percent or less; or
3. Serum calcium of 8.0 mg. per deciliter (100 ml.) (4.0 mEq./L) or less; or
4. Uncontrolled diabetes mellitus due to pancreatic dysfunction with repeated hyperglycemia,
hypoglycemia, or ketosis; or
5. Fat in stool of 7 gm. or greater per 24-hour stool specimen; or
6. Nitrogen in stool of 3 gm. or greater per 24-hour specimen; or
7. Persistent or recurrent ascites or edema not attributable to other causes.
To be used only in connection with 5.08.
Table I—Men
Height Without Shoes (inches)
|
Weight (pounds)
|
61
|
90
|
62
|
92
|
63
|
94
|
64
|
97
|
65
|
99
|
66
|
102
|
67
|
106
|
68
|
109
|
69
|
112
|
70
|
115
|
71
|
118
|
72
|
122
|
73
|
125
|
74
|
128
|
75
|
131
|
76
|
134
|
Table II—Women
Height Without Shoes (inches
|
Weight (pounds)
|
58
|
77
|
59
|
79
|
60
|
82
|
61
|
84
|
62
|
86
|
63
|
89
|
64
|
91
|
65
|
94
|
66
|
98
|
67
|
101
|
68
|
104
|
69
|
107
|
70
|
110
|
71
|
114
|
72
|
117
|
73
|
120
|
Table III—Men
Height Without Shoes (inches)
|
Weight (pounds)
|
61
|
95
|
62
|
98
|
63
|
100
|
64
|
103
|
65
|
106
|
66
|
109
|
67
|
112
|
68
|
116
|
69
|
119
|
70
|
122
|
71
|
126
|
72
|
129
|
73
|
133
|
74
|
136
|
75
|
139
|
76
|
143
|
Table IV—Women
Height Without Shoes (inches)
|
Weight (pounds)
|
58
|
82
|
59
|
84
|
60
|
87
|
61
|
89
|
62
|
92
|
63
|
94
|
64
|
97
|
65
|
100
|
66
|
104
|
67
|
107
|
68
|
111
|
69
|
114
|
70
|
117
|
71
|
121
|
72
|
124
|
73
|
128
|
5.09 Liver transplant. Consider under a disability for 12 months following the date of surgery; thereafter
evaluate the residual impairment(s).