-
1.
These listings are only examples of immune system disorders that we consider severe
enough to prevent you from doing any gainful activity. If your impairment(s) does
not meet the criteria of any of these listings, we must also consider whether you
have an impairment(s) that satisfies the criteria of a listing in another body system.
-
2.
Individuals with immune system disorders, including HIV infection, may manifest signs
or symptoms of a mental impairment or of another physical impairment. For example,
HIV infection may accelerate the onset of conditions such as diabetes or affect the
course of or treatment options for diseases such as cardiovascular disease or hepatitis.
We may evaluate these impairments under the affected body system.
-
a.
Musculoskeletal involvement, such as surgical reconstruction of a joint, under 1.00.
-
b.
Ocular involvement, such as dry eye, under 2.00.
-
c.
Respiratory impairments, such as pleuritis, under 3.00.
-
d.
Cardiovascular impairments, such as cardiomyopathy, under 4.00.
-
e.
Digestive impairments, such as hepatitis (including hepatitis C) or weight loss as
a result of HIV infection that affects the digestive system, under 5.00.
-
f.
Genitourinary impairments, such as nephropathy, under 6.00.
-
g.
Hematologic abnormalities, such as anemia, granulocytopenia, and thrombocytopenia,
under 7.00.
-
h.
Skin impairments, such as persistent fungal and other infectious skin eruptions, and
photosensitivity, under 8.00.
-
i.
Neurologic impairments, such as neuropathy or seizures, under 11.00.
-
j.
Mental disorders, such as depression, anxiety, or cognitive deficits, under 12.00.
-
k.
Allergic disorders, such as asthma or atopic dermatitis, under 3.00 or 8.00 or under
the criteria in another affected body system.
-
l.
Syphilis or neurosyphilis under the criteria for the affected body system; for example,
2.00 Special senses and speech, 4.00 Cardiovascular system, or 11.00 Neurological.
-
3.
If you have a severe medically determinable impairment(s) that does not meet a listing,
we will determine whether your impairment(s) medically equals a listing. (See §§404.1526
and 416.926.) If it does not, you may or may not have the residual functional capacity
to engage in substantial gainful activity. Therefore, we proceed to the fourth, and
if necessary, the fifth steps of the sequential evaluation process in §§404.1520 and
416.920. We use the rules in §§404.1594, 416.994, and 416.994a as appropriate, when
we decide whether you continue to be disabled.
14.01 Category of Impairments, Immune
System Disorders
14.02 Systemic lupus
erythematosus. As described in 14.00D1. With:
-
A.
Involvement of two or more organs/body systems, with:
-
1.
One of the organs/body systems involved to at least a moderate level of severity;
and
-
2.
At least two of the constitutional symptoms or signs (severe fatigue, fever, malaise,
or involuntary weight loss).
OR
-
B.
Repeated manifestations of SLE, with at least two of the constitutional symptoms or
signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the
following at the marked level:
-
1.
Limitation of activities of daily living.
-
2.
Limitation in maintaining social functioning.
-
3.
Limitation in completing tasks in a timely manner due to deficiencies in concentration,
persistence, or pace.
14.03 Systemic
vasculitis. As described in 14.00D2. With:
-
A.
Involvement of two or more organs/body systems, with:
-
1.
One of the organs/body systems involved to at least a moderate level of severity;
and
-
2.
2. At least two of the constitutional symptoms or signs (severe fatigue, fever, malaise,
or involuntary weight loss).
OR
-
B.
Repeated manifestations of systemic vasculitis, with at least two of the constitutional
symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and
one of the following at the marked level:
-
1.
Limitation of activities of daily living.
-
2.
Limitation in maintaining social functioning.
-
3.
Limitation in completing tasks in a timely manner due to deficiencies in concentration,
persistence, or pace.
14.04 Systemic sclerosis
(scleroderma). As described in 14.00D3. With:
-
A.
Involvement of two or more organs/body systems, with:
-
1.
1. One of the organs/body systems involved to at least a moderate level of severity;
and
-
2.
At least two of the constitutional symptoms or signs (severe fatigue, fever, malaise,
or involuntary weight loss).
OR
-
B.
With one of the following:
-
1.
Toe contractures or fixed deformity of one or both feet, resulting in the inability
to ambulate effectively as defined in 14.00C6; or
-
2.
Finger contractures or fixed deformity in both hands, resulting in the inability to
perform fine and gross movements effectively as defined in 14.00C7; or
-
3.
Atrophy with irreversible damage in one or both lower extremities, resulting in the
inability to ambulate effectively as defined in 14.00C6; or
-
4.
Atrophy with irreversible damage in both upper extremities, resulting in the inability
to perform fine and gross movements effectively as defined in 14.00C7.
OR
-
C.
Raynaud's phenomenon, characterized by:
-
1.
Gangrene involving at least two extremities; or
-
2.
Ischemia with ulcerations of toes or fingers, resulting in the inability to ambulate
effectively or to perform fine and gross movements effectively as defined in 14.00C6
and 14.00C7;
OR
-
D.
Repeated manifestations of systemic sclerosis (scleroderma), with at least two of
the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary
weight loss) and one of the following at the marked level:
-
1.
Limitation of activities of daily living.
-
2.
Limitation in maintaining social functioning.
-
3.
Limitation in completing tasks in a timely manner due to deficiencies in concentration,
persistence, or pace.
14.05 Polymyositis and
dermatomyositis. As described in 14.00D4. With:
-
A.
Proximal limb-girdle (pelvic or shoulder) muscle weakness, resulting in inability
to ambulate effectively or inability to perform fine and gross movements effectively
as defined in 14.00C6 and 14.00C7.
OR
-
B.
Impaired swallowing (dysphagia) with aspiration due to muscle weakness.
OR
-
C.
Impaired respiration due to intercostal and diaphragmatic muscle weakness.
OR
-
D.
Diffuse calcinosis with limitation of joint mobility or intestinal motility.
OR
-
E.
Repeated manifestations of polymyositis or dermatomyositis, with at least two of the
constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight
loss) and one of the following at the marked level:
-
1.
Limitation of activities of daily living.
-
2.
Limitation in maintaining social functioning.
-
3.
Limitation in completing tasks in a timely manner due to deficiencies in concentration,
persistence, or pace.
14.06 Undifferentiated and mixed
connective tissue disease. As described in 14.00D5. With:
-
A.
Involvement of two or more organs/body systems, with:
-
1.
1. One of the organs/body systems involved to at least a moderate level of severity;
and
-
2.
2. At least two of the constitutional symptoms or signs (severe fatigue, fever, malaise,
or involuntary weight loss).
OR
-
B.
Repeated manifestations of undifferentiated or mixed connective tissue disease, with
at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise,
or involuntary weight loss) and one of the following at the marked level:
-
1.
Limitation of activities of daily living.
-
2.
Limitation in maintaining social functioning.
-
3.
Limitation in completing tasks in a timely manner due to deficiencies in concentration,
persistence, or pace.
14.07 Immune deficiency disorders,
excluding HIV infection. As described in 14.00E. With:
-
A.
One or more of the following infections. The infection(s) must either be resistant
to treatment or require hospitalization or intravenous treatment three or more times
in a 12-month period.
-
-
-
-
-
-
6.
Sinusitis documented by appropriate medically acceptable imaging
OR
-
B.
Stem cell transplantation as described under 14.00E3. Consider under a disability
until at least 12 months from the date of transplantation. Thereafter, evaluate any
residual impairment(s) under the criteria for the affected body system.
OR
-
C.
Repeated manifestations of an immune deficiency disorder, with at least two of the
constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight
loss) and one of the following at the marked level:
-
1.
Limitation of activities of daily living.
-
2.
Limitation in maintaining social function.
-
3.
Limitation in completing tasks in a timely manner due to deficiencies in concentration,
persistence, or pace.
14.08 [Reserved]
14.09 Inflammatory
arthritis. As described in 14.00D6. With:
-
A.
Persistent inflammation or persistent deformity of:
-
1.
One or more major peripheral weight-bearing joints resulting in the inability to ambulate
effectively (as defined in 14.00C6); or
-
2.
One or more major peripheral joints in each upper extremity resulting in the inability
to perform fine and gross movements effectively (as defined in 14.00C7).
OR
-
B.
Inflammation or deformity in one or more major peripheral joints with:
-
1.
Involvement of two or more organs/body systems with one of the organs/body systems
involved to at least a moderate level of severity; and
-
2.
At least two of the constitutional symptoms or signs (severe fatigue, fever, malaise,
or involuntary weight loss).
OR
-
C.
Ankylosing spondylitis or other spondyloarthropathies, with:
-
1.
Ankylosis (fixation) of the dorsolumbar or cervical spine as shown by appropriate
medically acceptable imaging and measured on physical examination at 45 or more of
flexion from the vertical position (zero degrees); or
-
2.
Ankylosis (fixation) of the dorsolumbar or cervical spine as shown by appropriate
medically acceptable imaging and measured on physical examination at 30 or more of
flexion (but less than 45) measured from the vertical position (zero degrees), and
involvement of two or more organs/body systems with one of the organs/body systems
involved to at least a moderate level of severity.
OR
-
D.
Repeated manifestations of inflammatory arthritis, with at least two of the constitutional
symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and
one of the following at the marked level:
-
1.
Limitation of activities of daily living.
-
2.
Limitation in maintaining social functioning.
-
3.
Limitation in completing tasks in a timely manner due to deficiencies in concentration,
persistence, or pace.
14.10 Sjögren's
syndrome. As described in 14.00D7. With:
-
A.
Involvement of two or more organs/body systems, with:
-
1.
One of the organs/body systems involved to at least a moderate level of severity;
and
-
2.
At least two of the constitutional symptoms or signs (severe fatigue, fever, malaise,
or involuntary weight loss).
OR
-
B.
Repeated manifestations of Sjögren's syndrome, with at least two of the constitutional
symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and
one of the following at the marked level:
-
1.
Limitation of activities of daily living.
-
2.
Limitation in maintaining social functioning.
-
3.
Limitation in completing tasks in a timely manner due to deficiencies in concentration,
persistence, or pace.
14.11 Human immunodeficiency virus (HIV)
infection. With documentation as described in 14.00F1 and one of the following:
-
A.
Multicentric (not localized or unicentric) Castleman disease affecting multiple groups
of lymph nodes or organs containing lymphoid tissue (see 14.00F3a).
OR
-
B.
Primary central nervous system lymphoma (see 14.00F3b).
OR
-
C.
Primary effusion lymphoma (see 14.00F3c).
OR
-
D.
Progressive multifocal leukoencephalopathy (see 14.00F3d).
OR
-
E.
Pulmonary Kaposi sarcoma (see 14.00F3e).
OR
-
F.
Absolute CD4 count of 50 cells/mm3 or less (see 14.00F4).
OR
-
G.
Absolute CD4 count of less than 200 cells/mm3 or CD4 percentage of less than 14 percent,
and one of the following (values do not have to be measured on the same date) (see
14.00F5):
-
1.
BMI measurement of less than 18.5; or
-
2.
Hemoglobin measurement of less than 8.0 grams per deciliter (g/dL).
OR
-
H.
Complication(s) of HIV infection requiring at least three hospitalizations within
a 12-month period and at least 30 days apart (see 14.00F6). Each hospitalization must
last at least 48 hours, including hours in a hospital emergency department immediately
before the hospitalization.
OR
-
I.
Repeated (as defined in 14.00I3) manifestations of HIV infection, including those
listed in 14.11A–H, but without the requisite findings for those listings (for example,
Kaposi sarcoma not meeting the criteria in 14.11E), or other manifestations (including,
but not limited to, cardiovascular disease (including myocarditis, pericardial effusion,
pericarditis, endocarditis, or pulmonary arteritis), diarrhea, distal sensory polyneuropathy,
glucose intolerance, gynecologic conditions (including cervical cancer or pelvic inflammatory
disease, see 14.00F7), hepatitis, HIV-associated dementia, immune reconstitution inflammatory
syndrome (IRIS), infections (bacterial, fungal, parasitic, or viral), lipodystrophy
(lipoatrophy or lipohypertrophy), malnutrition, muscle weakness, myositis, neurocognitive
or other mental limitations not meeting the criteria in 12.00, oral hairy leukoplakia,
osteoporosis, pancreatitis, peripheral neuropathy) resulting in significant, documented
symptoms or signs (for example, but not limited to, fever, headaches, insomnia, involuntary
weight loss, malaise, nausea, night sweats, pain, severe fatigue, or vomiting) and
one of the following at the marked level:
-
1.
Limitation of activities of daily living.
-
2.
Limitation in maintaining social functioning.
-
3.
Limitation in completing tasks in a timely manner due to deficiencies in concentration,
persistence, or pace.