BASIC (08-01)

DI 34125.003 Digestive Listings from 1/6/86 to 9/19/00

5.00 DIGESTIVE SYSTEM

  1. Disorders of the digestive system which result in a marked impairment usually do so because of interference with nutrition, multiple recurrent inflammatory lesions, or complications of disease, such as fistulae, abscesses, or recurrent obstruction. Such complications usually respond to treatment. These complications must be shown to persist on repeated examinations despite therapy for a reasonable presumption to be made that a marked impairment will last for a continuous period of at least 12 months.

  2. Malnutrition or weight loss from gastrointestinal disorders. When the primary disorder of the digestive tract has been established (e.g., enterocolitis, chronic pancreatitis, postgastrointestinal resection, or esophageal stricture, stenosis, or obstruction) the resultant interference with nutrition will be considered under the criteria in 5.08. This will apply whether the weight loss is due to primary or secondary disorders of malabsorption, malassimilation, or obstruction. However, weight loss not due to diseases of the digestive tract, but associated with psychiatric or primary endocrine or other disorders, should be evaluated under the appropriate criteria for the underlying disorder.

  3. Surgical diversion of the intestinal tract, including colostomy or ileostomy, are not listed since they do not represent impairments which preclude all work activity if the individual is able to maintain adequate nutrition and function of the stoma. Dumping syndrome which may follow gastric resection rarely represents a marked impairment which would continue for 12 months. Peptic ulcer disease with recurrent ulceration after definitive surgery ordinarily responds to treatment. A recurrent ulcer after definitive surgery must be demonstrated on repeated upper gastrointestinal roentgenograms or gastroscopic examinations despite therapy to be considered a severe impairment which will last for at least 12 months. Definitive surgical procedures are those designed to control the ulcer disease process (i.e., vagotomy and pyloroplasty, subtotal gastrectomy, etc.). Simple closure of a perforated ulcer does not constitute definitive surgical therapy for peptic ulcer disease.

5.01 Category of Impairments, Digestive System

5.02 Recurrent Upper Gastrointestinal Hemorrhage from undetermined cause with anemia manifested by hematocrit of 30 percent or less on repeated examinations.

5.03 Stricture, Stenosis, or Obstruction of the Esophagus (demonstrated by X-ray or endoscopy) with weight loss as described under §5.08.

5.04 Peptic Ulcer Disease (demonstrated by X-ray or endoscopy). With:

  1. Recurrent ulceration after definitive surgery persistent despite therapy; or

  2. Inoperable fistula formation; or

  3. Recurrent obstruction demonstrated by X-ray or endoscopy; or

  4. Weight loss as described under §5.08.

5.05 Chronic Liver Disease (e.g., portal, postnecrotic, or biliary cirrhosis; chronic active hepatitis; Wilson's disease). With:

  1. Esophageal varices (demonstrated by X-ray or endoscopy) with a documented history of massive hemorrhage attributable to these varices. Consider under a disability for 3 years following the last massive hemorrhage; thereafter, evaluate the residual impairment; or

  2. Performance of a shunt operation for esophageal varices. Consider under a disability for 3 years following surgery; thereafter, evaluate the residual impairment; or

  3. Serum bilirubin of 2.5 mg. per deciliter (100ml.) or greater persisting on repeated examinations for at least 5 months; or

  4. Ascites, not attributable to other causes, recurrent or persisting for at least 5 months, demonstrated by abdominal paracentesis or associated with persistent hypoalbuminemia of 3.0 gm. per deciliter (100 ml.) or less; or

  5. Hepatic encephalopathy. Evaluate under the criteria in 12.02; or

  6. Confirmation of chronic liver disease by liver biopsy (obtained independent of Social Security disability evaluation) and one of the following:

    1. Ascites not attributable to other causes, recurrent or persisting for at least 3 months, demonstrated by abdominal paracentesis or associated with persistent hypoalbuminemia of 3.0 gm. per deciliter (100 ml.) or less; or

    2. Serum bilirubin of 2.5 mg. per deciliter (100 ml.) or greater on repeated examinations for at least 3 months; or

    3. Hepatic cell necrosis or inflammation, persisting for at least 3 months, documented by repeated abnormalities of prothrombin time and enzymes indicative of hepatic dysfunction.

5.06 Chronic ulcerative or granulomatous Colitis (demonstrated by endoscopy, barium enema, biopsy, or operative findings). With:

  1. Recurrent bloody stools documented on repeated examinations and anemia manifested by hematocrit of 30 percent or less on repeated examinations; or

  2. Persistent or recurrent systemic manifestations, such as arthritis, iritis, fever, or liver dysfunction, not attributable to other causes; or

  3. Intermittent obstruction due to intractable abscess, fistula formation, or stenosis; or

  4. Recurrences of findings of A, B, or C above after total colectomy; or

  5. Weight loss as described under §5.08.

5.07 Regional enteritis (demonstrated by operative findings, barium studies, biopsy, or endoscopy). With:

  1. Persistent or recurrent intestinal obstruction evidenced by abdominal pain, distention, nausea, and vomiting and accompanied by stenotic areas of small bowel with proximal intestinal dilation; or

  2. Persistent or recurrent systemic manifestations such as arthritis, iritis, fever, or liver dysfunction, not attributable to other causes; or

  3. Intermittent obstruction due to intractable abscess or fistula formation; or

  4. Weight loss as described under 5.08.

5.08 Weight Loss due to any persisting gastrointestinal disorder. (The following weights are to be demonstrated to have persisted for at least 3 months despite prescribed therapy and expected to persist at this level for at least 12 months.) With:

Tables of Weight Reflecting Malnutrition Scaled According to Height and Sex

  1. Weight equal to or less than the values specified in table I or II; or

  2. Weight equal to or less than the values specified in table III or IV and one of the following abnormal findings on repeated examinations:

    1. Serum albumin of 3.0 gm. per deciliter (100 ml.) or less; or

    2. Hematocrit of 30 percent or less; or

    3. Serum calcium of 8.0 mg. per deciliter (100 ml.) (4.0 mEq./L) or less; or

    4. Uncontrolled diabetes mellitus due to pancreatic dysfunction with repeated hyperglycemia, hypoglycemia, or ketosis; or

    5. Fat in stool of 7 gm. or greater per 24-hour stool specimen; or

    6. Nitrogen in stool of 3 gm. or greater per 24-hour specimen; or

    7. Persistent or recurrent ascites or edema not attributable to other causes.

       

To be used only in connection with 5.08.

Table I—Men

 

Height Without Shoes (inches)

Weight
(pounds)

   61

90   

   62

92   

   63

94   

   64

97   

   65

99   

   66

102   

   67

106   

   68

109   

   69

112   

   70

115   

   71

118   

   72

122   

   73

125   

   74

128   

   75

131   

   76

134   

Table II—Women

 

Height Without Shoes (inches)

Weight
(pounds)

   58

77   

   59

79   

   60

82   

   61

84   

   62

86   

   63

89   

   64

91   

   65

94   

   66

98   

   67

101   

   68

104   

   69

107   

   70

110   

   71

114   

   72

117   

   73

120   

Table III—Men

 

Height Without Shoes (inches)

Weight
(pounds)

   61

95   

   62

98   

   63

100   

   64

103   

   65

106   

   66

109   

   67

112   

   68

116   

   69

119   

   70

122   

   71

126   

   72

129   

   73

133   

   74

136   

   75

139   

   76

143   

Table IV—Women

 

Height Without Shoes (inches)

Weight
(pounds)

   58

82   

   59

84   

   60

87   

   61

89   

   62

92   

   63

94   

   64

97   

   65

100   

   66

104   

   67

107   

   68

111   

   69

114   

   70

117   

   71

121   

   72

124   

   73

128   





To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0434125003
DI 34125.003 - Digestive Listings from 1/6/86 to 9/19/00 - 08/17/2005
Batch run: 01/27/2009
Rev:08/17/2005