DI 34225.005 Digestive Listings from 5/24/02 to 12/17/07

105.00 DIGESTIVE SYSTEM

1. A. 

   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.

2. B. 

   Documentation of gastrointestinal impairments should include pertinent operative findings, appropriate medically acceptable imaging studies, endoscopy, and biopsy reports. 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 is the proper one to support the evaluation and diagnosis of the impairment. Where a liver biopsy has been performed in chronic liver disease, documentation should include the report of the biopsy.

3. 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.

4. 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:

1. A. 

   Inoperable biliary atresia demonstrated by appropriate medically acceptable imaging or surgery; or

2. B. 

   Intractable ascites not attributable to other causes, with serum albumin of 3.0 gm./100 ml. or less; or

3. C. 

   Esophageal varices (demonstrated by endoscopy or other appropriate medically acceptable imaging); or

4. D. 

   Hepatic coma, documented by findings from hospital records; or

5. E. 

   Hepatic encephalopathy. Evaluate under the criteria in 112.02; or

6. 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:

1. A. 

   Intestinal manifestations or complications, such as obstruction, abscess, or fistula formation which has lasted or is expected to last 12 months; or

2. B. 

   Malnutrition as described under the criteria in 105.08; or

3. 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:

1. A. 

   Stool fat excretion per 24 hours:

   1. 1. 

      More than 15 percent in infants less than 6 months.

   2. 2. 

      More than 10 percent in infants 6-18 months.

   3. 3. 

      More than 6 percent in children more than 18 months; or

2. B. 

   Persistent hematocrit of 30 percent or less despite prescribed therapy; or

3. C. 

   Serum carotene of 40 mg./100 ml. or less; or

4. D. 

   Serum albumin of 3.0 gm./100 ml. or less.

105.09 Liver transplant. Consider under a disability for 12 months following the date of surgery; thereafter, evaluate the residual impairment.