TN 8 (11-12)
DI 23022.981 Roberts Syndrome
COMPASSIONATE ALLOWANCE INFORMATION
Roberts Disease; Appelt-Gerken-Lenz Syndrome; Appelt-Gerken-Lenz Disease; Hypomelia Hypotrichosis Facial Hemangioma Syndrome; Hypomelia Hypotrichosis Facial Hemangioma Disease; Pseudothaliodomide Syndrome; Roberts SC Phocomelia Disease; Tetraphocomelia-Cleft-Palate Syndrome
Roberts Syndrome (RS) is a genetic disorder characterized by pre and postnatal growth failure, severe symmetrical limb malformations (with upper extremities more affected than lower extremities), and facial abnormalities. Some individuals with RS may have heart, kidney and genital abnormalities. Developmental delay and mild to moderate intellectual impairment is present in half of affected individuals. RS is caused by mutations in the ESCO2 gene, resulting in abnormal chromosome separation during cell division.
DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING
Diagnostic testing: Molecular genetic testing for ESCO2 gene mutations, resulting in absence of functional ESCO2 protein.
Physical findings: Symmetric, shortened arm and leg bones (hypomelia), or sometimes hands and feet located very close to the body (phocomelia); missing toes or finger; joint contractures; microcephaly; cleft palate; micrognathia; encephalocele (protrusion of the brain from the skull); and heart, kidney, or genital abnormalities.
ICD-9: 755.24 or 755.34
ONSET AND PROGRESSION
RS is a congenital disorder that is characterized by pre and postnatal growth failure. There is variation in the severity of clinical manifestations, and the most severe forms of RS are often stillborn or die shortly after birth. The less severely affected may live to adulthood. Individuals with the milder form of RS may have normal intellectual and social functioning abilities. Mortality in the newborn period or early childhood is due to cardiac or renal malformations.
The treatment and management of RS is symptomatic, such as corrective surgery for cleft palate and limb deformities; prostheses, and developmental services including speech and language if cleft deformities are present. School age children require individualized and flexible instructional curricula. Standard treatment is needed for individuals with cardiac defects and renal abnormalities.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for evaluation:
Clinical examination that describes diagnostic features of the impairment and laboratory findings (see above) are needed to confirm the diagnosis.
Developmental assessment or psychological testing to address allegations of mental impairments may be warranted.
Suggested Listings for Evaluation:
1.02A or B
101.02A or B
Evaluate genitourinary or cardiac impairments under the appropriate listings.
* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.