Basic (04-86)
DI 34205.001 Listing of Impairments - Part B (March 16, 1977-January 5, 1986)
100.00 Growth Impairment
A. Impairment of Growth
Impairment of growth may be disabling in itself or it may be an indicator of the severity
of the impairment due to a specific disease process.
Determinations of growth impairment should be based upon the comparison of current
height with at least three previous determinations, including length at birth, if
available. Heights (or lengths) should be plotted on a standard growth chart, such
as derived from the National Center for Health Statistics: NCHS Growth Charts. Height
should be measured without shoes. Body weight corresponding to the ages represented
by the heights should be furnished. The adult heights of the child's natural parents
and the heights and ages of siblings should also be furnished. This will provide a
basis upon which to identify those children whose short stature represents a familial
characteristic rather than a result of disease. This is particularly true for adjudication
under 100.02B.
B. Bone Age Determinations
Bone age determinations should include a full descriptive report of roentgenograms
specifically obtained to determine bone age and must cite the standardization method
used. Where roentgenograms must be obtained currently as a basis for adjudication
under 100.03, views of the left hand and wrist should be ordered. In addition, roentgenograms
of the knee and ankle should be obtained when cessation of growth is being evaluated
in an older child at, or past, puberty.
C. Application of Criteria
The criteria in this section are applicable until closure of the major epiphyses.
The cessation of significant increase in height at that point would prevent the application
of these criteria.
100.01 Category of Impairments, Growth
100.02 Growth Impairment, considered to be related to an additional specific medically determinable impairment,
and ONE of the following:
-
A.
Fall of greater than 15 percentiles in height which is sustained; OR
-
B.
Fall to, or persistence of, height below the third percentile.
100.03 Growth Impairment, not identified as being related to an additional, specific medically determinable
impairment. With:
-
A.
Fall of greater than 25 percentiles in height which is sustained; AND
-
B.
Bone age greater than two standard deviations (2 SD) below the mean for chronological
age (see 100.00B).
101.00 Musculoskeletal System
A. Documentation of Rheumatoid Arthritis
Documentation of the diagnosis of juvenile rheumatoid arthritis should be made according
to an established protocol, such as that published by the Arthritis Foundation, Bulletin
on the Rheumatic Diseases, Vol. 23, 1972-1973 Series, p. 712. Inflammatory signs include
persistent pain, tenderness, erythema, swelling, and increased local temperature of
a joint.
B. Measurements of Joint Motion
The measurements of joint motion are based on the technique for measurements described
in the “Joint Method of Measuring and Recording,” published by the American Academy of Orthopedic Surgeons in 1965, or “The Extremities and Back” in “Guides to the Evaluation of Permanent Impairment,” Chicago, American Medical Association, 1971 Chapter 1, pp. 1-48.
C. Degenerative Arthritis
Degenerative arthritis may be the end stage of many skeletal diseases and conditions,
such as traumatic arthritis, collagen disorders, septic arthritis, congenital dislocation
of the hip, aseptic necrosis of the hip, slipped capital femoral epiphyses, skeletal
dysplasias, etc.
101.01 Category of Impairments, Musculoskeletal
101.02 Juvenile Rheumatoid Arthritis With:
-
A.
Persistence or recurrence of joint inflammation despite six months of medical treatment
and ONE of the following:
-
1.
Limitation of motion of two major joints of 50 percent or greater; OR
-
2.
Fixed deformity of two major weight-bearing joints of 30 degrees or more; OR
-
3.
Radiographic changes of joint narrowing, erosion, or subluxation; OR
-
4.
Persistent or recurrent systemic involvement such as iridocyclitis or pericarditis;
OR
-
101.03 Deficit of Musculoskeletal Function
Due to deformity or musculoskeletal disease and ONE of the following:
-
A.
Walking is markedly reduced in speed or distance despite orthotic or prosthetic devices;
OR
-
B.
Ambulation is possible only with obligatory bilateral upper limb assistance (e.g.,
with walker, crutches); OR
-
C.
Inability to perform age-related personal self-care activities involving feeding,
dressing, and personal hygiene.
101.05 Disorders of the Spine
-
A.
Fracture of vertebra with cord involvement (substantiated by appropriate sensory and
motor loss); OR
-
B.
Scoliosis (congenital idiopathic or neuromyopathic). With:
-
1.
Major spinal curve measuring 60 degrees or greater; OR
-
2.
Spinal fusion of six or more levels. Consider under a disability for 1 year from the
time of surgery; thereafter, evaluate the residual impairment; OR
-
3.
FEV (vital capacity) of 50 percent or less of predicted normal values for the individual's
measured (actual) height; OR
-
C.
Kyphosis or lordosis measuring 90 degrees or greater.
101.08 Chronic Osteomyelitis
With persistence or recurrence of inflammatory signs or drainage for at least six
months despite prescribed therapy, and consistent radiographic findings.
102.00 Special Senses and Speech
A. Visual Impairments in Children
Impairment of central visual acuity should be determined with use of the standard
Snellen test chart. Where this cannot be used, as in very young children, a complete
description should be provided of the findings using other appropriate methods of
examination, including a description of the techniques used for determining the central
visual acuity for distance.
The accommodation reflex is generally not present in children under 6 months of age.
In premature infants, it may not be present until six months plus the number of months
the child is premature. Therefore, absence of accommodative reflex will be considered
as indicating a visual impairment only in children above this age (six months).
Documentation of an opthalmologic disorder must include a description of the ocular
pathology.
B. Hearing Impairments in Children
The criteria for hearing impairments in children take into account that a lesser impairment
in hearing which occurs at an early age may result in a severe speech and language
disorder.
Improvement by a hearing aid, as predicted by the testing procedure, must be demonstrated
to be feasible in that child, since younger children may be unable to use a hearing
aid effectively.
The type of audiometric testing performed must be described and a copy of the results
must be included. The pure tone air conduction hearing levels in 102.08 are based
on American National Standard Institute Specifications for Audiometers, S 3.6 - 1969
(ANSI - 1969). The report should indicate the specifications used to calibrate the
audiometer.
The finding of a severe impairment will be based on the average hearing levels at
500, 1000, 2000, and 3000 Hertz (Hz) in the better ear, and on speech discrimination,
as specified in 102.08.
102.01 Category of Impairments, Special Sense Organs
102.02 Impairment of Central Visual Acuity
-
A.
Remaining vision in the better eye after best correction is 20/200 or less.
-
B.
For children below 3 years of age at time of adjudication:
-
1.
Absence of accommodative reflex (see 102.00A for exclusion of children under six months
of age); OR
-
2.
Retrolental fibroplasia with macular scarring or neovascularization; OR
-
3.
Bilateral congenital cataracts with visualization of retinal red reflex only or when
associated with other ocular pathology.
102.08 Hearing Impairments
-
A.
For children below 5 years of age at time of adjudication, inability to hear air conduction
thresholds at an average of 40 decibels (db) hearing level or greater in the better
ear.
-
B.
For children 5 years of age and above at time of adjudication:
-
1.
Inability to hear air conduction thresholds at an average of 70 decibels (db) or greater
in the better ear; OR
-
2.
Speech discrimination scores at 40 percent or less in the better ear; OR
-
3.
Inability to hear air conduction thresholds at an average of 40 decibels (db) or greater
in the better ear, and a speech and language disorder which significantly affects
the clarity and content of the speech and is attributable to the hearing impairment.
103.00 Respiratory System
A. Documentation of Pulmonary Insufficiency
The reports of spirometric studies for evaluation under Table I must be expressed
in liters. The reported FEV1 should represent the largest of at least three satisfactory attempts, and should
be within 10 percent of another FEV1 . The appropriately labeled spirometric tracing of three FEV maneuvers must be submitted
with the report, showing distance per second on the abscissa and distance per liter
on the ordinate. The unit distance for volume on the tracing should be at least 15
mm. per liter and the paper speed at least 20 mm. per second. The height of the individual
without shoes must be recorded.
The ventilatory function studies should not be performed during or soon after an acute
episode or exacerbation of a respiratory illness. In the presence of acute bronchospasm,
or where the FEV1 is less than that stated in Table 1, the studies should be repeated after the administration
of a nebulized bronchodilator. If a bronchodilator was not used in such instances,
the reason should be stated in the report.
A statement should be made as to the child's ability to understand directions and
to cooperate in performance of the test, and should include an evaluation of the child's
effort. Where tests cannot be performed or completed, the reason (such as a child's
young age) should be stated in the report.
B. Cystic Fibrosis
This section discusses only the pulmonary manifestations of cystic fibrosis. Other
manifestations, complications, or associated diseases must be evaluated under the
appropriate section.
The diagnosis of cystic fibrosis will be based upon appropriate history, physical
examination, and pertinent laboratory findings. Confirmation based upon elevated concentration
of sodium or chloride in the sweat should be included, with indication of the technique
used for collection and analysis.
103.01 Category of Impairments, Respiratory
103.03 Bronchial Asthma
With evidence of progression of the disease despite therapy and documented by ONE
of the following:
-
A.
Recent, recurrent intense asthmatic attacks requiring parenteral medication; OR
-
B.
Persistent prolonged expiration with wheezing between acute attacks and radiographic
findings of peribronchial disease.
103.13 Pulmonary Manifestations of Cystic Fibrosis. With:
-
A.
FEV1 equal to or less than the values specified in Table I (see 103.00A for requirements
of ventilatory function testing); OR
-
B.
For children where ventilatory function testing cannot be performed:
-
1.
History of dyspnea on mild exertion or chronic frequent productive cough; AND
-
2.
Persistent or recurrent abnormal breath sounds, bilateral rales or rhonchi; AND
-
3.
Radiographic findings of extensive disease with hyperaeration and bilateral peribronchial
infiltration.
Height (in centimeters) |
FEV 1 Equal to or Less Than Liters
|
110 or less |
0.6 |
120 |
0.7 |
130 |
0.9 |
140 |
1.1 |
150 |
1.3 |
160 |
1.5 |
170 or more |
1.6 |
104.00 Cardiovascular System
A. General
Evaluation should be based upon history, physical findings, and appropriate laboratory
data. Reported abnormalities should be consistent with the pathologic diagnosis. The
actual electrocardiographic tracing, or an adequate marked photocopy, must be included.
Reports of other pertinent studies necessary to substantiate the diagnosis or describe
the severity of the impairment also must be included.
B. Evaluation
Evaluation of cardiovascular impairments in children requires two steps:
-
1.
The delineation of a specific cardiovascular disturbance, either congenital or acquired.
This may include arterial or venous disease, rhythm disturbance, or disease involving
the valves, septa, myocardium, or pericardium; and
-
2.
Documentation of the severity of the impairment, with medically determinable and consistent
cardiovascular signs, symptoms, and laboratory data. In cases where impairment characteristics
are questionably secondary to the cardiovascular disturbance, additional documentation
of the severity of the impairment (e.g., catheterization data, if performed) will
be necessary.
C. Chest Roentgenogram
A 6 ft. PA film will be considered indicative of cardiomegaly if:
-
1.
The cardiothoracic ratio is over 60 percent at age one year or less, or 55 percent
at more than one year of age; OR
-
2.
The cardiac size is increased over 15 percent from any prior chest roentgenograms;
OR
-
3.
Specific chamber or vessel enlargement is documented in accordance with established
criteria.
D. Tables I, II, and III
The tables below are designed for case adjudication and not for diagnostic purposes.
The adult criteria may be useful for older children and should be used when applicable.
E. Rheumatic Fever
As used in this section, assumes diagnoses made according to the revised Jones criteria.
104.01 Category of Impairments, Cardiovascular
104.02 Chronic Congestive Failure
With TWO or MORE of the following signs:
-
A.
Tachycardia (see Table I).
-
B.
Tachypnea (see Table II).
-
C.
Cardiomegaly on chest roentgenogram (see C. above).
-
D.
Hepatomegaly (more than 2 cm. below the right costal margin in the right midclavicular
line).
-
E.
Evidence of pulmonary edema, such as rales or orthopnea.
-
-
G.
Exercise intolerance manifested as labored respiration on mild exertion (e.g., in
an infant, feeding).
Age |
Apical Heart (beats per minute)
|
Under 1 year |
150 |
1 through 3 years |
130 |
4 through 9 years |
120 |
10 through 15 years |
110 |
Over 15 years |
100 |
Age |
Respiratory Rate Over (per minute)
|
Under 1 year |
40 |
1 through 5 years |
35 |
6 through 9 years |
30 |
Over 9 years |
25 |
104.03 Hypertensive Cardiovascular Disease
With persistently elevated blood pressure for age (see Table III) and ONE of the following:
-
A.
Impaired renal function as described under the criteria in 106.02; OR
-
B.
Cerebrovascular damage as described under the criteria in 111.06; OR
-
C.
Congestive heart failure as described under the criteria in 104.02.
Age |
Systolic (Over) in mm. Hg.
|
Diastolic (Over) in mm. Hg.
|
Under 6 months |
95 |
60 |
6 months to 1 year |
110 |
70 |
1 through 8 years |
115 |
80 |
9 through 11 years |
120 |
80 |
12 through 15 years |
130 |
80 |
Over 15 years |
140 |
80 |
104.04 Cyanotic Congenital Heart Disease
With ONE of the following:
-
A.
Surgery is limited to palliative measure; OR
-
B.
Characteristic squatting, hemoptysis, syncope, or hypercyanotic spells; OR
-
C.
Chronic hematocrit of 55 percent or greater or arterial O2 saturation of less than
90 percent at rest, or arterial oxygen tension of less than 60 Torr at rest.
104.05 Cardiac Arrhythmia
Such as persistent or recurrent heart block or A-V dissociation (with or without therapy)
and ONE of the following:
-
-
B.
Congestive heart failure as described under the criteria in 104.02 of this section;
OR
-
C.
Exercise intolerance with labored respirations on mild exertion (e.g., in infants,
feeding).
104.07 Cardiac Syncope
With at least one documented syncopal episode characteristic of specific cardiac disease
(e.g., aortic stenosis).
104.08 Recurrent Hemoptysis
Associated with either pulmonary hypertension or extensive bronchial collaterals due
to documented chronic cardiovascular disease.
104.09 Chronic Rheumatic Fever or Rheumatic Heart Disease
With:
-
A.
Persistence of rheumatic fever activity for six months or more, with significant murmur(s),
cardiomegaly (see 104.00C), and other abnormal laboratory findings (such as elevated
sedimentation rate or electrocardiographic findings); OR
-
B.
Congestive heart failure as described under the criteria in 104.02 of this section.
105.00 Digestive System
A. Disorders of the Digestive System
Disorders of the digestive system which result in disability usually do so because
of interference with nutrition and growth, multiple recurrent inflammatory lesions,
or other complications of the disease. Such lesions or complications usually respond
to treatment. To constitute a listed impairment, these must be shown to have persisted
or be expected to persist despite prescribed therapy for a continuous period of at
least 12 months.
B. Documentation
Documentation of gastrointestinal impairments should include pertinent operative findings,
radiographic studies, endoscopy, and biopsy reports. Where a liver biopsy has been
performed in chronic liver disease, documentation should include the report of the
biopsy.
C. Growth Retardation and Malnutrition
When the primary disorder of the digestive tract has been documented, evaluate resultant
malnutrition under the criteria described in 105.08. Evaluate resultant growth impairment
under the criteria described in 100.03. Intestinal disorders, including surgical diversions
and potentially correctable congenital lesions, do not represent a severe impairment
if the individual is able to maintain adequate nutrition, growth, and development.
D. Multiple Congenital Anomalies
See related criteria, and consider as a combination of impairments.
105.01 Category of Impairments, Digestive
105.03 Esophageal Obstruction
Caused by atresia, stricture, or stenosis. With malnutrition as described under the
criteria in 105.08.
105.05 Chronic Liver Disease
With ONE of the following:
-
A.
Inoperable biliary atresia demonstrated by x-ray or surgery; OR
-
B.
Intractable ascites not attributable to other causes, with serum albumin of 3.0 gm./100
ml. or less; OR
-
C.
Esophageal varices (demonstrated by angiography, barium swallow, or endoscopy or by
prior performance of a specific shunt or plication procedure); OR
-
D.
Hepatic coma, documented by findings from hospital records; OR
-
E.
Hepatic encephalopathy. Evaluate under the criteria in 112.02; OR
-
F.
Chronic active inflammation or necrosis documented by SGOT persistently more than
100 units or serum bilirubin of 2.5 mg. percent or greater.
105.07 Chronic Inflammatory Bowel Disease
Such as ulcerative colitis, regional enteritis, as documented in 105.00. With ONE
of the following:
-
A.
Intestinal manifestations or complications, such as obstruction, abscess, or fistula
formation which has lasted or is expected to last 12 months; OR
-
B.
Malnutrition as described under the criteria in 105.08; OR
-
C.
Growth impairment as described under the criteria in 100.03.
105.08 Malnutrition
Due to demonstrable gastrointestinal disease causing either a fall of 15 percentiles
of weight which persists or the persistence of weight which is less than the third
percentile (on standard growth charts) and ONE of the following:
-
A.
Stool fat excretion per 24 hours:
-
1.
More than 15 percent in infants less than 6 months.
-
2.
More than 10 percent in infants 6-18 months.
-
3.
More than 6 percent in children more than 18 months; OR
-
B.
Persistent hematocrit of 30 percent or less despite prescribed therapy; OR
-
C.
Serum carotene of 40 mcg./100 ml. or less; OR
-
D.
Serum albumin of 3.0 gm./100 ml. or less.
106.00 Genito-Urinary System
A. General
Determination of the presence of chronic renal disease will be based upon the following
factors:
-
1.
History, physical examination, and laboratory evidence of renal disease.
-
2.
Indications of its progressive nature or laboratory evidence of deterioration of renal
function.
B. Renal Transplant
The amount of function restored and the time required to effect improvement depend
upon various factors including adequacy of post-transplant renal function, incidence
of renal infection, occurrence of rejection crisis, presence of systemic complications
(anemia, neuropathy, etc.) and side effects of corticosteriod or immunosuppressive
agents. A period of at least 12 months is required for the individual to reach a point
of stable medical improvement.
C. Evaluation of Associated Disorders
Evaluate associated disorders and complications according to the appropriate body
system listing.
106.01 Category of Impairments, Genito-Urinary
106.02 Chronic Renal Disease
With:
-
A.
BUN of 30 mg./100 ml. or greater; OR
-
B.
Serum creatinine of 3.0 mg./100 ml. or greater; OR
-
C.
Creatinine clearance equal to or less than 42 ml./min./1.73 m2; OR
-
D.
Chronic renal dialysis program for irreversible renal failure; OR
-
E.
Renal transplant. Consider under a disability for 12 months following surgery; thereafter,
evaluate the residual impairment (see 106.00B).
106.06 Nephrotic Syndrome
With edema not controlled by prescribed therapy. And:
-
A.
Serum albumin less than 2 gm./100 ml.; OR
-
B.
Proteinuria more than 2.5 gm./1.73 m2 /day.
107.00 Hemic and Lymphatic System
A. Sickle Cell Disease
Sickle cell disease refers to a chronic hemolytic anemia associated with sickle cell
hemoglobin, either homozygous or in combination with thalassemia or with another abnormal
hemoglobin (such as C or F).
Appropriate hematologic evidence for sickle cell disease, such as hemoglobin electrophoresis
must be included. Vaso-occlusive, hemolytic, or aplastic episodes should be documented
by description of severity, frequency, and duration.
Disability due to sickle cell disease may be solely the result of a severe, persistent
anemia or may be due to the combination of chronic progressive or episodic manifestations
in the presence of a less severe anemia.
Major visceral episodes causing disability include meningitis, osteomyelitis, pulmonary
infections or infarctions, cerebrovascular accidents, congestive heart failure, genito-urinary
involvement, etc.
B. Coagulation Defects
Chronic inherited coagulation disorders must be documented by appropriate laboratory
evidence such as abnormal thromboplastin generation, coagulation time, or factor assay.
C. Acute Leukemia
Initial diagnosis of acute leukemia must be based upon definitive bone marrow pathologic
evidence. Recurrent disease may be documented by peripheral blood, bone marrow, or
cerebrospinal fluid examination. The pathology report must be included.
The designated duration of disability implicit in the finding of a listed impairment
is contained in 107.11. Following the designated time period, a documented diagnosis
itself is no longer sufficient to establish a severe impairment. The severity of any
remaining impairment must be evaluated on the basis of the medical evidence.
107.01 Category of Impairments, Hemic and Lymphatic
107.03 Hemolytic Anemia
Due to any cause. Manifested by persistence of hematocrit of 26 percent or less despite
prescribed therapy, and reticulocyte count of 4 percent or greater.
107.05 Sickle Cell Disease
With:
-
A.
Recent, recurrent severe vaso-occlusive crises (musculoskeletal, vertebral, abdominal);
OR
-
B.
A major visceral complication in the 12 months prior to application; OR
-
C.
A hyperhemolytic or aplastic crisis within 12 months prior to application; OR
-
D.
Chronic, severe anemia with persistence of hematocrit of 26 percent or less; OR
-
E.
Congestive heart failure, cerebrovascular damage, or emotional disorder as described
under the criteria in 104.02, 111.00ff, or 112.00ff.
107.06 Chronic Idiopathic Thrombocytopenic Purpura of Childhood
With purpura and thrombocytopenia of 40,000 platelets/cu.mm. or less despite prescribed
therapy or recurrent upon withdrawal of treatment.
107.08 Inherited Coagulation Disorder
With:
-
A.
Repeated spontaneous or inappropriate bleeding; OR
-
B.
Hemarthrosis with joint deformity.
107.11 Acute Leukemia
Consider under a disability:
-
A.
For 2 1/2 years from the time of initial diagnosis; OR
-
B.
For 2 1/2 years from the time of recurrence of active disease.
109.00 Endocrine System
A. Cause of Disability
Disability is caused by a disturbance in the regulation of the secretion or metabolism
of one or more hormones which are not adequately controlled by therapy. Such disturbances
or abnormalities usually respond to treatment. To constitute a listed impairment these
must be shown to have persisted or be expected to persist despite prescribed therapy
for a continuous period of at least 12 months.
B. Growth
Normal growth is usually a sensitive indicator of health as well as of adequate therapy
in children. Impairment of growth may be disabling in itself or may be an indicator
of a severe disorder involving the endocrine system or other body systems. Where involvement
of other organ systems has occurred as a result of a primary endocrine disorder, these
impairments should be evaluated according to the criteria under the appropriate sections.
C. Documentation
Description of characteristic history, physical findings, and diagnostic laboratory
data must be included. Results of laboratory tests will be considered abnormal if
outside the normal range or greater than two standard deviations from the mean of
the testing laboratory. Reports in the file should contain the information provided
by the testing laboratory as to their normal values for that test.
D. Hyperfunction of the Adrenal Cortex
Evidence of growth retardation must be documented as described in 100.00. Elevated
blood or urinary free cortisol levels are not acceptable in lieu of urinary 17-hydroxycorticosteroid
excretion for the diagnosis of adrenal cortical hyperfunction.
E. Adrenal Cortical Insufficiency
Documentation must include persistent low plasma cortisol or low urinary 17-hydroxycorticosteroids
or 17-ketogenic steroids and evidence of unresponsiveness to ACTH stimulation.
109.01 Category of Impairments, Endocrine
109.02 Thyroid Disorders
-
A.
Hyperthyroidism (as documented in 109.00C above). With clinical manifestations despite
prescribed therapy, and ONE of the following:
-
1.
Elevated serum thyroxine (T4) and either elevated free T4 or resin T3 uptake; OR
-
2.
Elevated thyroid uptake of radioiodine; OR
-
3.
Elevated serum triiodothyronine (T3).
-
B.
Hypothyroidism. With ONE of the following, despite prescribed therapy:
-
-
2.
Growth impairment as described under the criteria in 100.02A and B; OR
-
109.03 Hyperparathyroidism
As documented in 109.00C with:
-
A.
Repeated elevated total or ionized serum calcium; OR
-
B.
Elevated serum parathyroid hormone.
109.04 Hypoparathyroidism or Pseudohypoparathyroidism
With:
-
A.
Severe recurrent tetany or convulsions which are unresponsive to prescribed therapy;
OR
-
B.
Growth retardation as described under the criteria in 100.02A and B.
109.05 Diabetes Insipidus
Documented by pathologic hypertonic saline or water deprivation test. And ONE of the
following:
-
A.
Intracranial space-occupying lesion, before or after surgery; OR
-
B.
Unresponsiveness to Pitressin; OR
-
C.
Growth retardation as described under the criteria in 100.02A and B; OR
-
D.
Unresponsive hypothalmic thirst center, with chronic or recurrent hypernatremia; OR
-
E.
Decreased visual fields attributable to a pituitary lesion.
109.06 Hyperfunction of the Adrenal Cortex
Primary or secondary with:
-
A.
Elevated urinary 17-hydroxycorticosteroids (or 17-ketogenic steroids) as documented
in 109.00C and above; AND
-
B.
Unresponsiveness to low-dose dexamethasone suppression.
109.07 Adrenal Cortical Insufficiency
As documented in 109.00C and E above with recent, recurrent episodes of circulatory
collapse.
109.08 Juvenile Diabetes Mellitus
As documented in 109.00C requiring parenteral insulin. And ONE of the following, despite
prescribed therapy:
-
A.
Recent, recurrent hospitalizations with acidosis; OR
-
B.
Recent, recurrent episodes of hypoglycemia; OR
-
C.
Growth retardation as described under the criteria in 100.02A or B; OR
-
D.
Impaired renal function as described under the criteria in 106.00ff.
109.09 Iatrogenic Hypercorticoid State
With chronic glucocorticoid therapy resulting in ONE of the following:
-
-
B.
Growth retardation as described under the criteria in 100.02A or B; OR
-
C.
Diabetes mellitus as described under the criteria in 109.08 above OR
-
D.
Myopathy as described under the criteria in 111.06; OR
-
E.
Emotional disorder as described under the criteria in 112.00ff.
109.10 Pituitary Dwarfism
With documented growth hormone deficiency, and growth impairment as described under
the criteria in 100.02B.
109.11 Adrenogenital Syndrome
With:
-
A.
Recent, recurrent salt-losing episodes despite prescribed therapy; OR
-
B.
Inadequate replacement therapy manifested by accelerated bone age and virilization;
OR
-
C.
Growth impairment as described under the criteria in 100.02A or B.
109.12 Hypoglycemia
As documented in 109.00C with recent, recurrent hypoglycemic episodes producing convulsion
or coma.
109.13 Gonadal Dysgenesis (Turner's Syndrome)
Chromosomally proven. Evaluate the resulting impairment under the criteria for the
appropriate body system.
110.00 Multiple Body Systems
A. Catastrophic Congenital Abnormalities or Disease
This section refers only to very serious congenital disorders, diagnosed in the newborn
or infant child.
B. Immune Deficiency Diseases
Documentation of immune deficiency disease must be submitted, and may include quantitative
immunoglobulins, skin tests for delayed hypersensitivity, lymphocyte stimulative tests,
and measurements of cellular immunity mediators.
110.01 Category of Impairments, Multiple Body Systems
110.08 Catastrophic Congenital Abnormalities or Disease
With:
-
A.
A positive diagnosis (such as anencephaly, trisomy D or E, cyclopia, etc.), generally
regarded as being incompatible with extra-uterine life; OR
-
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
-
A.
Hypogammaglobulinemia or dysgammaglobulinemia. With:
-
1.
Recent, recurrent severe infections; OR
-
2.
A complication such as growth retardation, chronic lung disease, collagen disorder,
or tumors.
-
B.
Thymic dysplastic syndromes (such as Swiss, diGeorge).
111.00 Neurological
A. Seizure Disorder
Seizure disorder must be substantiated by at least one detailed description of a typical
seizure. Report of recent documentation should include an electroencephalogram and
neurological examination. Sleep EEG is preferable, especially with temporal lobe seizures.
Frequency of attacks and any associated phenomena should also be substantiated.
Young children may have convulsions in association with febrile illnesses. Proper
use of 111.02 and 111.03 requires that a seizure disorder be established. Although
this does not exclude consideration of seizures occurring during febrile illnesses,
it does require documentation of seizures during nonfebrile periods.
There is an expected delay in control of seizures when treatment is started, particularly
when changes in the treatment regimen are necessary. Therefore, a seizure disorder
should not be considered to meet the requirements of 111.02 and 111.03 unless it is
shown that seizures have persisted more than three months after prescribed therapy
began.
B. Minor Motor Seizures
Classical petit mal seizures must be documented by characteristic EEG pattern, plus
information as to age at onset and frequency of clinical seizures. Myoclonic seizures,
whether of the typical infantile or Lennox-Gastaut variety after infancy, must also
be documented by the characteristic EEG pattern plus information as to age at onset
and frequency of seizures.
C. Motor Dysfunction
As described in 111.06, motor dysfunction may be due to any neurological disorder.
It may be due to static or progressive conditions involving any area of the nervous
system and producing any type of neurological impairment. This may include weakness,
spasticity, lack of coordination, ataxia, tremor, athetosis, or sensory loss. Documentation
of motor dysfunction must include neurologic findings and description of type of neurologic
abnormality (e.g., spasticity, weakness), as well as a description of the child's
functional impairment (i.e., what the child is unable to do because of the abnormality).
Where a diagnosis has been made, evidence should be included for substantiation of
the diagnosis (e.g., blood chemistries and muscle biopsy reports), wherever applicable.
D. Impairment of Communication
The documentation should include a description of a recent comprehensive evaluation,
including all areas of affective and effective communication, performed by a qualified
professional.
111.01 Category of Impairments, Neurological
111.02 Major Motor Seizure Disorder
A. Major Motor Seizures
In a child with an established seizure disorder, the occurrence of more than one major
motor seizure per month despite at least three months of prescribed treatment. With:
-
1.
Daytime episodes (loss of consciousness and convulsive seizures); OR
-
2.
Nocturnal episodes manifesting residuals which interfere with activity during the
day.
B. Major Motor Seizures
In a child with an established seizure disorder, the occurrence of at least one major
motor seizure in the year prior to application despite at least three months of prescribed
treatment. And ONE of the following:
-
-
2.
Significant interference with communication due to speech, hearing, or visual defect;
OR
-
3.
Significant emotional disorder; OR
-
4.
Where significant adverse effects of medication interfere with major daily activities.
111.03 Minor Motor Seizure Disorder
In a child with an established seizure disorder, the occurrence of more than one minor
motor seizure per week, with alteration of awareness or loss of consciousness, despite
at least three months of prescribed treatment.
111.05 Brain Tumors
-
A.
Malignant gliomas (astrocytoma--Grades III and IV, glioblastoma multiforme), medulloblastoma,
ependymoblastoma, primary sarcoma, or brain stem gliomas; OR
-
B.
Evaulate other brain tumors under the criteria for the resulting neurological impairment.
111.06 Motor Dysfunction
Due to any neurological disorder. Persistent disorganization or deficit of motor function
for age involving two extremities, which (despite prescribed therapy) interferes with
age-appropriate major daily activities and results in disruption of:
-
A.
Fine and gross movements; OR
-
111.07 Cerebral Palsy.
With:
-
A.
Motor dysfunction meeting the requirements of 111.06 or 101.03; OR
-
B.
Less severe motor dysfunction (but more than slight) and one of the following:
-
-
2.
Seizure disorder, with at least one major motor seizure in the year prior to application;
OR
-
3.
Significant interference with communication due to speech, hearing, or visual defect;
OR
-
4.
Significant emotional disorder.
111.08 Meningomyelocele (And Related Disorders)
With one of the following despite prescribed treatment:
-
A.
Motor dysfunction meeting the requirements of 101.03 or 111.06; OR
-
B.
Less severe motor dysfunction (but more than slight), and:
-
1.
Urinary or fecal incontinence when inappropriate for age; OR
-
-
C.
Four extremity involvement; OR
-
D.
Noncompensated hydrocephalus producing interference with mental or motor developmental
progression.
111.09 Communication Impairment
Associated with documented neurological disorder, and one of the following:
-
A.
Documented speech deficit which significantly affects the clarity and content of the
speech; OR
-
B.
Documented comprehension deficit resulting in ineffective verbal communication for
age; OR
-
C.
Impairment of hearing as described under the criteria in 102.08.
112.00 Mental and Emotional Disorders
A. Introduction
This section is intended primarily to describe mental and emotional disorders of young
children. The criteria describing medically determinable impairments in adults should
be used where they clearly appear to be more appropriate.
B. Mental Retardation
1. GENERAL
As with any other impairment, the necessary evidence consists of symptoms, signs,
and laboratory findings which provide medically demonstrable evidence of impairment
severity. Standardized intelligence test results are essential to the adjudication
of all cases of mental retardation that are not clearly covered under the provisions
of 112.05A. Developmental milestone criteria may be the sole basis for adjudication
only in cases where the child's young age and/or condition preclude formal standardized
testing by a psychologist or psychiatrist experienced in testing children.
2. MEASURES OF INTELLECTUAL FUNCTIONING
Standardized intelligence tests, such as the Wechsler Preschool and Primary Scale
of Intelligence (WPPSI), the Wechsler Intelligence Scale for Children (WISC), the
Revised Stanford-Binet Scale, and the McCarthey Scales of Children's Abilities, should
be used wherever possible. Key data such as subtest scores should also be included
in the report. Tests should be administered by a qualified and experienced psychologist
or psychiatrist, and any discrepancies between formal test results and the child's
customary behavior and daily activities should be duly noted and resolved.
3. DEVELOPMENTAL MILESTONE CRITERIA
In the event that a child's young age and/or condition preclude formal testing by
a psychologist or psychiatrist experienced in testing children, a comprehensive evaluation
covering the full range of developmental activities should be performed. This should
consist of a detailed account of the child's daily activities together with direct
observations by a professional person; the latter should include indices or manifestations
of social, intellectual, adaptive, verbal, motor (posture, locomotion, manipulation),
language, emotional, and self-care development for age. The above should then be related
by the evaluating or treating physician to establish developmental norms of the kind
found in any widely used standard pediatrics text.
C. Profound Combined Mental-Neurological-
Musculoskeletal Impairments
There are children with profound and irreversible brain damage resulting in total
incapacitation. Such children may meet criteria in either neurological, musculoskeletal,
and/or mental sections; they should be adjudicated under the criteria most completely
substantiated by the medical evidence submitted. Frequently, the most appropriate
criteria will be found under the mental impairment section.
112.01 Category of Impairments, Mental and Emotional
112.02 Chronic Brain Syndrome
With arrest of developmental progression for at least 6 months or loss of previously
acquired abilities.
112.03 Psychosis of Infancy and Childhood
Documented by psychiatric evaluation and supported, if necessary, by the results of
appropriate standardized psychological tests and manifested by marked restriction
in the performance of daily age-appropriate activities; constriction of age-appropriate
interests; deficiency of age-appropriate self-care skills; and impaired ability to
relate to others; together with persistence of one (or more) of the following:
-
A.
Significant withdrawal or detachment; OR
-
B.
Impaired sense of reality; OR
-
C.
Bizarre behavior patterns; OR
-
D.
Strong need for maintenance of sameness, with intense anxiety, fear, or anger when
change is introduced; OR
-
E.
Panic at threat of separation from parent.
112.04 Functional Nonpsychotic Disorders
Documented by psychiatric evaluation and supported, if necessary, by the results of
appropriate standardized psychological tests and manifested by marked restriction
in the performance of daily age-appropriate activites; constriction of age-appropriate
interests; deficiency of age-appropriate self-care skills; and impaired ability to
relate to others; together with persistence of one (or more) of the following:
-
A.
Psychophysiological disorder (e.g., diarrhea, asthma); OR
-
-
-
D.
Phobic, obsessive, or compulsive behavior; OR
-
-
-
G.
Asocial or antisocial behavior.
112.05 Mental Retardation
-
A.
Achievement of only those developmental milestones generally acquired by children
no more than one-half the child's chronological age; OR
-
-
C.
IQ of 60-69, inclusive, and a physical or other mental impairment imposing additional
and significant restriction of function or developmental progression.
113.00 Neoplastic Diseases, Malignant
A. Introduction
Determination of disability in the growing and developing child with a malignant neoplastic
disease is based upon the combined effects of:
-
1.
The pathophysiology, histology, and natural history of the tumor; AND
-
2.
The effects of the currently employed aggressive multimodal therapeutic regimens.
Combinations of surgery, radiation, and chemotherapy or prolonged therapeutic schedules
impart significant additional morbidity to the child during the period of greatest
risk from the tumor itself. This period of highest risk and greatest therapeutically-induced
morbidity defines the limits of disability for most of childhood neoplastic disease.
B. Documentation
The diagnosis of neoplasm should be established on the basis of symptoms, signs, and
laboratory findings. The site of the primary, recurrent, and metastatic lesion must
be specified in all cases of malignant neoplastic diseases. If an operative procedure
has been performed, the evidence should include a copy of the operative note and the
report of the gross and microscopic examination of the surgical specimen, along with
all pertinent laboratory and X-ray reports. The evidence should also include a recent
report directed especially at describing whether there is evidence of local or regional
recurrence, soft part or skeletal metastases, and significant post-therapeutic residuals.
C. Malignant Solid Tumors
As listed under 113.03, include the histiocytosis syndromes except for solitary eosinophilic
granuloma. Thus, 113.03 should not be used for evaluating brain tumors (see 111.05)
or thyroid tumors, which must be evaluated on the basis of whether they are controlled
by prescribed therapy.
D. Duration
Duration of disability from malignant neoplastic tumors is included in 113.02 and
113.03. Following the time periods designated in these sections, a documented diagnosis
itself is no longer sufficient to establish a severe impairment. The severity of a
remaining impairment must be evaluated on the basis of the medical evidence.
113.01 Category of Impairments, Neoplastic Diseases, Malignant
113.02 Lymphoreticular Malignant Neoplasms
Consider under a disability:
-
A.
For 2 1/2 years from the time of initial diagnosis, OR
-
B.
For 2 1/2 years from the time of recurrence of active disease.
113.03 Malignant Solid Tumors
Consider under a disability:
-
A.
For 2 years from the time of initial diagnosis; OR
-
B.
For 2 years from the time of recurrence of active disease.
113.04 Neuroblastoma.
With ONE of the following:
-
A.
Extension across the midline; OR
-
-
-
D.
Onset at age 1 year or older.
113.05 Retinoblastoma
With ONE of the following:
-
A.
Bilateral involvement; OR
-
-
C.
Extension beyond the orbit; OR
-