DI 34105.001 Summary of Changes in the Listing of Impairments (Updated to Include Final Revisions of 8/68)
The Listing of Impairments, published as an appendix to the new regulations, Subpart P, reflects changes made since issuance of Transmittal Letter Number 6, dated 5/10/68. To aid in ready identification of these changes, as they relate to the entire revision issued earlier, this summary of changes has been revised. Those items in the summary marked in the margin by *(asterisk) identify broadly those changes made since 5/10/68. The significant changes in the Listing of Impairments identified by this revised summary should be read and studied.
Listing 1.04 includes new criteria for evaluating major reconstructive surgery to a weight-bearing joint.
Disorders of the spine have been regrouped into Listings 1.05, 1.06, and 1.07. Criteria for evaluating generalized osteoporosis have been added.
Listing 1.08 for osteomyelitis has been revised for clarification, and cites the required manifestations in terms of persistency or recurrence and signs or laboratory findings.
Listing 1.09 provides for evaluation of the loss of use of two extremities through amputation or anatomical deformity, and further clarifies the meaning of anatomical deformity.
Listing 1.10 specifies that an amputation of a lower extremity must be at or above the tarsal region to be considered under this listing.
A Listing for evaluation of a single upper extremity injury has been added. This category includes injuries both to the soft tissue and to the bone which require prolonged surgical management to restore useful function to the extremity.
B. Special Senses
Emphasis has been given to the fact that the criterion for impairment of central visual acuity is based on measurement of distant vision alone. The criteria for evaluating monocular and binocular aphakia have been clarified and a single table for determining central visual efficiency in phakic and aphakic cases is provided.
*In Listing 2.00 ff. all references to correction of central vision by “regular ophthalmic lenses” were deleted. However, 2.00B specifies that correction obtained by special visual aids (e.g., contact lenses) will be considered only if the individual has the ability to wear such aids.
C. Respiratory System
Minor technical changes are intended to clarify documentation requirements for pulmonary tuberculosis and pulmonary insufficiency. A new introductory paragraph on evaluation of pathogenic atypical mycobacteria was added to permit easier identification of these infections and better documented decisions.
Two of the three tables previously provided for evaluation of obstructive airway disease represented lesser levels of impaired function so that consideration of vocational factors was necessary for determinations of disability. Since such consideration is not appropriate in widows' and widowers' claims, these tables are not included in the regulatory Listing of Impairments. The two tables, however, are incorporated into DISM 322.6 for use in claims where use of vocational factors is appropriate.
The separate categories for tuberculosis due to M. tuberculosis and atypical mycobacteria have been combined in Listing 3.08. Listing 3.12 has been added for persistent bronchopleural fistula with empyema.
D. Cardiovascular System
A careful distinction is made between “angina pectoris” and “chest discomfort.” The evaluation of angina pectoris does not require the quantification of degree of effort which results in pain but rather a fully detailed description of the nature of the chest pain and specifically defined electrocardiographic abnormalities which are medically determinable and relevant to the basic question of impairment severity.
*The criteria for evaluating congestive heart failure have been broadened. They now include failure evidenced, not only by enlargement of the transverse diameter but also, by enlargement of the left ventricle or left atrium accompanied by characteristic ECG findings. In addition, specific ECG findings defining left bundle block have been added to Listing 4.06F.
E. Digestive System
Specific evaluation criteria are now included for assessing malnutrition resulting from disorders of the digestive system. New criteria for cirrhosis of the liver and peptic ulcer are intended to remove the ambiguities and references to “permanency” not removed following the 1965 amendments.
F. Genito-Urinary System
Greater specificity has been built into most of the categories.
G. Hemic and Lymphatic
In impairments caused by chronic leukemia and chronic bone marrow failure, the previous vague criteria have been replaced by specific signs and laboratory findings.
The Listing on “Leprosy” was transferred to the Multiple Body System section.
I. Endocrine System
Listing 9.08B3 no longer requires evidence of the condition of the remaining stump or the contralateral extremity when amputation has resulted from diabetic necrosis or peripheral vascular disease.
J. Multiple Body System
Disorders which affect more than one body system, formerly included in other sections of the Listing, were brought together under this heading to make it easier to locate them. For example, leprosy, previously contained in the section on Skin, was transferred to this section, revised slightly and recaptioned “Hansen's Disease” to conform to up-to-date usage. The remainder of the section includes polyarteritis nodosa, disseminated lupus erythematosus, and scleroderma previously found in the Cardiovascular Section and military tuberculosis and tuberculosis adenitis previously found in the Hemic and Lymphatic Section.
The former, non-specific criterion to “evaluate on the basis of resultant neurological involvement” has been replaced by specific signs. Listing 11.05 has been added for the evaluation of primary brain tumors.
L. Mental Disorders
The language in each Listing was revised but without change in the level of severity required. In both the functional psychotic and non-psychotic disorders, the emphasis is placed on the functional end-results of a severe disorder, e.g., restrictions of activities and interests, impairment of ability to relate to other people, etc. The two categories are differentiated by diagnostic signs and findings.
Personality disorders have been included in the criteria for non-psychotic disorders, even though, by themselves, they will rarely meet the criteria for severity. However, some cases may have been denied in the past despite the presence of findings indicative of a severe impairment, because the “label” of personality disorder was attached.
*The title of this Listing has been changed from “Psychiatric” to “Mental Disorders.” Similar changes have been made in the body of the Listing. Certain material of an instructional nature has been removed from the introductory portion of the Listing. Some of the documentation criteria in 12.00D have been refined for specificity.
*Listing 12.02, Chronic Brain Syndromes, has been restructured to be more consistent with the remainder of the Mental Disorder listing. Listing 12.04A no longer includes the phrase “continued preoccupation with somatic complaints” which was redundant to the remaining portion of the criteria. Deleted in Listing 12.05A, Mental Deficiency, is the reference to “without close supervision” as it related to avoidance of physical danger. This phrase was meaningless in explaining the degree of severity required.
M. Neoplastic Diseases--Malignant
The previous very general criteria have been replaced by a set of specific instructions. The introductory language provides broad documentation and evaluation criteria more responsive to our needs. The categories have been developed specifically and arranged according to type of malignancy and/or anatomical location, as appropriate.