TN 3 (10-99)

DI 34230.005 Multiple Body Listings from 12/12/90 to 10/30/05

110.00 MULTIPLE BODY SYSTEMS

1. A. 

   This section refers to those life-threatening catastrophic congenital abnormalities and other serious hereditary, congenital, or acquired disorders that usually affect two or more body systems and are expected to:

   1. 1. 

      Result in early death or developmental attainment of less than 2 years of age as described in listing 110.08 (e.g., anencephaly or Tay-Sachs); or

   2. 2. 

      Produce long-term, if not life-long, significant interference with age-appropriate activities as described in listings 110.06 and 110.07. (Significant interference with age-appropriate activities is considered to exist where the developmental milestone age did not exceed two-thirds of the chronological age at the time of evaluation and such interference has lasted or could be expected to last at least 12 months.) See 112.00C for a discussion of developmental milestone criteria and evaluation of age-appropriate activities.

      Down syndrome (except for mosaic Down syndrome, which is to be evaluated under listing 110.07) established by clinical findings, including the characteristic physical features, and laboratory evidence is considered to meet the requirement of listing 110.06 commencing at birth.

      Examples of disorders that should be evaluated under listing 110.07 include mosaic Down syndrome, in which a pattern of multiple impairments (including mental retardation) is known to occur, phenylketonuria (PKU), fetal alcohol syndrome, and severe chromic neonatal infections such as toxoplasmosis, rubella syndrome, cytomegalic inclusion disease, and herpes encephalitis.

2. B. 

   Documentation must include confirmation of positive diagnosis by a clinical description of the usual abnormal physical findings associated with the condition and definitive laboratory tests, including chromosomal analysis, where appropriate (e.g., Down syndrome). Medical evidence that is persuasive that a positive diagnosis has been confirmed by appropriate laboratory testing, at some time prior to evaluation, is acceptable in lieu of a copy of the actual laboratory report. Documentation of immune deficiency disease must be submitted and may include quantitative immunoglobulins, skin tests for delayed hypersensitivity, lymphocyte stimulative tests, and measures of cellular immunity mediators.

3. C. 

   When multiple body system manifestations do not meet one of the established criteria of one of the listings, the combined impairments must be evaluated together to determine if they are equal in severity to a listed impairment.

110.01 CATEGORY OF IMPAIRMENTS, MULTIPLE BODY SYSTEM

110.06 Down syndrome (excluding mosaic Down syndrome) established by clinical and laboratory findings, as described in 110.00B. Consider the child disabled from birth.

110.07 Multiple body dysfunction due to any confirmed (see 110.00B) hereditary, congenital, or acquired condition with one of the following:

1. A. 

   Persistent motor dysfunction as a result of hypotonia and/or musculoskeletal weakness, postural reaction deficit, abnormal primitive reflexes, or other neurological impairment as described in 111.00C, and with significant interference with age-appropriate major daily or personal care activities, which in an infant or young child include such activities as head control, swallowing, following, reaching, grasping, turning, sitting, crawling, walking, taking solids, feeding self; or:

2. B. 

   Mental impairment as described under the criteria in 112.05 or 112.12 or:

3. C. 

   Growth impairment as described under the criteria in 100.02A or 100.02B; or:

4. D. 

   Significant interference with communication due to speech, hearing, or visual impairments as described under the criteria in 102.00 and 111.09; or:

5. E. 

   Cardiovascular impairments as described under the criteria in 104.00; or:

6. F. 

   Other impairments such as, but not limited to, malnutrition, hypothyroidism, or seizures should be evaluated under the criteria in 105.08, 109.02 or 111.02 and 111.03, or the criteria for the affected body system.

110.08 Catastrophic congenital abnormalities or disease. With:

1. A. 

   A positive diagnosis (such as anencephaly, trisomy D or E, cyclopia, etc.) generally regarded as being incompatible with extrauterine life; or

2. B. 

   A positive diagnosis (such as cri du chat, Tay-Sachs Disease) wherein attainment of the growth and development level of 2 years is not expected to occur.

110.09 Immune deficiency disease.

1. A. 

   Hypogammaglobulinemia or dysgammaglobulinemia. With:

   1. 1. 

      Recent, recurrent severe infections; or

   2. 2. 

      A complication such as growth retardation, chromic lung disease, collagen disorder, or tumors.

2. B. 

   Thymic dysplastic syndromes (such as Swiss, diGeorge).