Identification Number:
DI 23022 TN 45
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Processing Quick Disability Determination (QDD) and Compassionate Allowance (CAL) in the Disability Determination Services (DDS)
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 230 – Special Issues
Subchapter 22 – Processing Quick Disability Determination (QDD) and Compassionate Allowances (CAL) in the Disability Determination Services (DDS)
Transmittal No. 45, 08/11/2021

Audience

PSC: CS, DEC, DTE, IES, RECONR;
OCO-OEIO: CR, ERE, FCR, FDE, RECONE;
OCO-ODO: DE, DEC, DS, RECONE;
ODD-DDS: ADJ, DHU;

Originating Component

ODP

Effective Date

Upon Receipt

Background

This transmittal contains ten new Compassionate Allowances (CAL) conditions in POMS subsection DI 23022. The new sections contain policy guidance for how to identify and evaluate CAL conditions.

Summary of Changes

DI 23022.080 List of Compassionate Allowance (CAL) Conditions

We updated this section include the 12 new CALs conditions in alphabetical order.

 

DI 23022.238 SYNGAP1-related NSID

This new section provides instructions for how to identify and evaluate SYNGAP1-related NSID, including:

  • Alternate names used for the condition;

  • A description of the condition;

  • The diagnostic testing and physical findings of the condition;

  • Information about the progression of the condition;

  • Examples of treatment of the condition;

  • Suggested medical evidence needed to evaluate the claim; and

  • Suggested listings for evaluation of the claim.

 

DI 23022.266 Pericardial Mesothelioma

This new section provides instructions for how to identify and evaluate Pericardial Mesothelioma, including:

  • Alternate names used for the condition;

  • A description of the condition;

  • The diagnostic testing and physical findings of the condition;

  • Information about the progression of the condition;

  • Examples of treatment of the condition;

  • Suggested medical evidence needed to evaluate the claim; and

  • Suggested listings for evaluation of the claim.

 

DI 23022.283 Refractory Hodgkin Lymphoma

This new section provides instructions for how to identify and evaluate Refractory Hodgkin Lymphoma, including:

  • Alternate names used for the condition;

  • A description of the condition;

  • The diagnostic testing and physical findings of the condition;

  • Information about the progression of the condition;

  • Examples of treatment of the condition;

  • Suggested medical evidence needed to evaluate the claim; and

  • Suggested listings for evaluation of the claim.

 

DI 23022.284 Renpenning Syndrome

This new section provides instructions for how to identify and evaluate Renpenning Syndrome, including:

  • Alternate names used for the condition;

  • A description of the condition;

  • The diagnostic testing and physical findings of the condition;

  • Information about the progression of the condition;

  • Examples of treatment of the condition;

  • Suggested medical evidence needed to evaluate the claim; and

  • Suggested listings for evaluation of the claim.

 

DI 23022.341 Taybi-Linder Syndrome

This new section provides instructions for how to identify and evaluate Taybi-Linder Syndrome, including:

  • Alternate names used for the condition;

  • A description of the condition;

  • The diagnostic testing and physical findings of the condition;

  • Information about the progression of the condition;

  • Examples of treatment of the condition;

  • Suggested medical evidence needed to evaluate the claim; and

  • Suggested listings for evaluation of the claim.

 

DI 23022.373 Congenital Zika Syndrome

This new section provides instructions for how to identify and evaluate Congenital Zika Syndrome, including:

  • Alternate names used for the condition;

  • A description of the condition;

  • The diagnostic testing and physical findings of the condition;

  • Information about the progression of the condition;

  • Examples of treatment of the condition;

  • Suggested medical evidence needed to evaluate the claim; and

  • Suggested listings for evaluation of the claim.

 

DI 23022.382 Desmoplastic Mesothelioma

This new section provides instructions for how to identify and evaluate Desmoplastic Mesothelioma, including:

  • Alternate names used for the condition;

  • A description of the condition;

  • The diagnostic testing and physical findings of the condition;

  • Information about the progression of the condition;

  • Examples of treatment of the condition;

  • Suggested medical evidence needed to evaluate the claim; and

  • Suggested listings for evaluation of the claim.

 

DI 23022.496 SCN8A-related Epilepsy with Encephalopathy

This new section provides instructions for how to identify and evaluate SCN8A-related Epilepsy with Encephalopathy, including:

  • Alternate names used for the condition;

  • A description of the condition;

  • The diagnostic testing and physical findings of the condition;

  • Information about the progression of the condition;

  • Examples of treatment of the condition;

  • Suggested medical evidence needed to evaluate the claim; and

  • Suggested listings for evaluation of the claim.

 

DI 23022.543 CIC-rearranged Sarcoma

This new section provides instructions for how to identify and evaluate CIC-rearranged Sarcoma, including:

  • Alternate names used for the condition;

  • A description of the condition;

  • The diagnostic testing and physical findings of the condition;

  • Information about the progression of the condition;

  • Examples of treatment of the condition;

  • Suggested medical evidence needed to evaluate the claim; and

  • Suggested listings for evaluation of the claim.

 

DI 23022.938 Choroid Plexus Carcinoma

This new section provides instructions for how to identify and evaluate Choroid Plexus Carcinoma, including:

  • Alternate names used for the condition;

  • A description of the condition;

  • The diagnostic testing and physical findings of the condition;

  • Information about the progression of the condition;

  • Examples of treatment of the condition;

  • Suggested medical evidence needed to evaluate the claim; and

  • Suggested listings for evaluation of the claim.

 

DI 23022.080 List of Compassionate Allowance (CAL) Conditions

The following is a complete list of CAL conditions:

Section Title

Section Number

Acute Leukemia

DI 23022.085

Adrenal Cancer -- with distant metastases or inoperable, unresectable or recurrent

DI 23022.090

Adult Non-Hodgkin Lymphoma

DI 23022.921

Adult Onset Huntington Disease

DI 23022.923

Aicardi-Goutieres Syndrome

DI 23022.665

Alexander Disease (ALX) -- Neonatal and Infantile

DI 23022.095

Allan-Herndon-Dudley Syndrome

DI 23022.925

Alobar Holoprosencephaly

DI 23022.670

Alpers Disease

DI 23022.675

Alpha Mannosidosis -- Type II and III

DI 23022.680

Alstrom Syndrome

DI 23022.350

Alveolar Soft Part Sarcoma

DI 23022.927

Amegakaryocytic Thrombocytopenia

DI 23022.355

Amyotrophic Lateral Sclerosis (ALS)

DI 23022.100

Anaplastic Adrenal Cancer -- with distant metastases or inoperable, unresectable or recurrent

DI 23022.105

Angelman Syndrome

DI 23022.600

Aortic Atresia

DI 23022.540

Angiosarcoma

DI 23022.106

Aplastic Anemia

DI 23022.929

Astrocytoma -- GRADE III and IV

DI 23022.110

Ataxia Telangiectasia

DI 23022.360

Atypical Teratoid/Rhabdoid Tumor

DI 23022.111

Batten Disease

DI 23022.365

Beta Thalassemia Major

DI 23022.931

Bilateral Optic Atrophy -- Infantile

DI 23022.933

Bilateral Retinoblastoma

DI 23022.370

Bladder Cancer -- with distant metastases or inoperable or unresectable

DI 23022.115

Breast Cancer -- with distant metastases or inoperable or unresectable

DI 23022.125

CACH -- Vanishing White Matter Disease -- Infantile and Childhood Onset Forms

DI 23022.127

Canavan Disease (CD)

DI 23022.130

Carcinoma of Unknown Primary Site

DI 23022.685

Cardiac Amyloidosis - AL Type

DI 23022.580

Caudal Regression Syndrome - Types III and IV

DI 23022.935

CDKL5 Deficiency Disorder

DI 23022.133

Cerebro Oculo Facio Skeletal (COFS) Syndrome

DI 23022.135

Cerebrotendinous Xanthomatosis

DI 23022.690

Charlevoix-Saguenay Spastic Ataxia

DI 23022.144

Child Neuroblastoma- - with distant metastasis or recurrent

DI 23022.695

Child Non-Hodgkin Lymphoma -- recurrent

DI 23022.700

Child T-Cell Lymphoblastic Lymphoma

DI 23022.937

Chondrosarcoma- - with multimodal therapy

DI 23022.705

Choroid Plexus Carcinoma

DI 23022.938

Chronic Idiopathic Intestinal Pseudo Obstruction

DI 23022.136

Chronic Myelogenous Leukemia -- Blast Phase

DI 23022.140

CIC-rearranged Sarcoma

DI 23022.543

Coffin-Lowry Syndrome

DI 23022.141

Congenital Lymphedema

DI 23022.939

Congenital Myotonic Dystrophy

DI 23022.143

Congenital Zika Syndrome

DI 23022.373

Cornelia de Lange Syndrome -- Classic Form

DI 23022.710

Corticobasal Degeneration

DI 23022.605

Creutzfeldt-Jakob Disease (CJD) -- Adult

DI 23022.145

Cri du Chat Syndrome

DI 23022.375

Degos Disease, Systemic

DI 23022.380

DeSanctis Cacchione Syndrome

DI 23022.941

Desmoplastic Mesothelioma

DI 23022.382

Desmoplastic Small Round Cell Tumors

DI 23022.146

Dravet Syndrome

DI 23022.943

Duchenne Muscular Dystrophy – Adult

DI 23022.940

Early-Onset Alzheimer’s Disease

DI 23022.385

Edwards Syndrome (Trisomy 18)

DI 23022.390

Eisenmenger Syndrome

DI 23022.545

Endometrial Stromal Sarcoma

DI 23022.945

Endomyocardial Fibrosis

DI 23022.550

Ependymoblastoma (Child Brain Tumor)

DI 23022.150

Erdheim Chester Disease

DI 23022.947

Esophageal Cancer

DI 23022.155

Esthesioneuroblastoma

DI 23022.156

Ewing Sarcoma

DI 23022.715

Farber’s Disease (FD) -- Infantile

DI 23022.160

Fatal Familial Insomnia

DI 23022.949

Fibrodysplasia Ossificans Progressiva

DI 23022.395

Fibrolamellar Cancer

DI 23022.163

Follicular Dendritic Cell Sarcoma -- metastatic or recurrent

DI 23022.720

Friedreichs Ataxia (FRDA)

DI 23022.165

Frontotemporal Dementia (FTD) Picks Disease -- Type A – Adult

DI 23022.170

Fryns Syndrome

DI 23022.951

Fucosidosis – Type I

DI 23022.725

Fukuyama Congenital Muscular Dystrophy

DI 23022.400

Fulminant Giant Cell Myocarditis

DI 23022.953

Galactosialidosis – Early and Late Infantile Types

DI 23022.730

Gallbladder Cancer

DI 23022.175

Gaucher Disease (GD) -- Type 2

DI 23022.180

Giant Axonal Neuropathy

DI 23022.181

Glioblastoma Multiforme (Brain Tumor)

DI 23022.185

Glioma Grade III and IV

DI 23022.735

Gluteric Acidemia – Type II

DI 23022.470

GM1 - Gangliodosis - Infantile & Juvenile Forms

DI 23022.186

Head and Neck Cancers -- with distant metastasis or inoperable or uresectable

DI 23022.190

Heart Transplant Graft Failure

DI 23022.555

Heart Transplant Wait List – 1A/1B

DI 23022.560

Hemophagocytic Lymphohistiocytosis

DI 23022.405

Hepatoblastoma

DI 23022.745

Hepatopulmonary Syndrome

DI 23022.955

Hepatorenal Syndrome

DI 23022.957

Histiocytosis Syndromes

DI 23022.750

Hoyeaal-Hreidarsson Syndrome

DI 23022.191

Hutchinson-Gilford Progeria Syndrome

DI 23022.755

Hydranencephaly

DI 23022.760

Hypocomplementemic Urticarial Vasculitis Syndrome

DI 23022.765

Hypophosphatasia- Perinatal (Lethal) and Infantile Onset Types

DI 23022.770

Hypoplastic Left Heart Syndrome

DI 23022.565

I Cell Disease

DI 23022.775

Idiopathic Pulmonary Fibrosis

DI 23022.420

Infantile Free Sialic Acid Storage Disease

DI 23022.780

Infantile Neuroaxonal Dystrophy (INAD)

DI 23022.195

Infantile Neuronal Ceroid-Lipofuscinoses

DI 23022.425

Inflammatory Breast Cancer (IBC)

DI 23022.200

Intracranial Hemangiopericytoma

DI 23022.201

Jervell and Lange-Nielsen Syndrome

DI 23022.959

Joubert Syndrome

DI 23022.202

Junctional Epidermolysis Bullosa Lethal Type

DI 23022.430

Juvenile Onset Huntington Disease

DI 23022.785

Kidney Cancer -- inoperable or unresectable

DI 23022.205

Kleefstra Syndrome

DI 23022.207

Krabbe Disease (KD) -- Infantile

DI 23022.210

Kufs Disease Type A and B

DI 23022.790

Large Intestine Cancer -- with distant metastasis or inoperable, unresectable or recurrent

DI 23022.215

Late Infantile Neuronal Ceroid-Lipofuscinoses

DI 23022.435

Leigh’s Disease

DI 23022.440

Leiomyosarcoma

DI 23022.961

Leptomeningeal Carcinomatosis

DI 23022.216

Lesch-Nyhan Syndrome (LNS)

DI 23022.220

Lewy Body Dementia

DI 23022.610

Liposarcoma – metastatic or recurrent

DI 23022.221

Lissencephaly

DI 23022.795

Liver Cancer

DI 23022.225

Lowe Syndrome

DI 23022.615

Lymphomatoid Granulomatosis - Grade III

DI 23022.800

Malignant Brain Stem Gliomas - Childhood

DI 23022.805

Malignant Ectomesenchymoma

DI 23022.226

Malignant Gastrointestinal Stromal Tumor

DI 23022.963

Malignant Germ Cell Tumor

DI 23022.965

Malignant Multiple Sclerosis

DI 23022.620

Malignant Renal Rhabdoid Tumor

DI 23022.227

Mantle Cell Lymphoma (MCL)

DI 23022.230

Maple Syrup Urine Disease

DI 23022.445

Marshall-Smith Syndrome

DI 23022.231

Mastocytosis - Type IV

DI 23022.815

MECP 2 Duplication Syndrome

DI 23022.967

Medulloblastoma - with metastasis

DI 23022.820

Megacystis Microcolon Intestinal Hypoperistalsis Syndrome

DI 23022.233

Megalencephaly-Capillary Malformation Syndrome

DI 23022.234

Menkes Disease - Classic or Infantile Onset Form

DI 23022.969

Merkel Cell Carcinoma - with metastasis

DI 23022.825

Merosin Deficient Congenital Muscular Dystrophy

DI 23022.450

Metachromatic Leukodystrophy - Late Infantile

DI 23022.235

Mitral Valve Atresia

DI 23022.575

Mixed Dementia

DI 23022.455

MPS I, formerly known as Hurler Syndrome

DI 23022.415

MPS II, formerly known as Hunter Syndrome

DI 23022.410

MPS III, formerly known as Sanfilippo Syndrome

DI 23022.495

Mucosal Melanoma

DI 23022.460

Multicentric Castleman Disease

DI 23022.625

Multiple System Atrophy

DI 23022.630

Myocolonic Epilepsy and Ragged Red Fibers Syndrome

DI 23022.830

Neonatal Adrenoleukodystrophy

DI 23022.465

(Neonatal) Glutaric Acidemia

DI 23022.470

Nephrogenic Systemic Fibrosis

DI 23022.835

NFU-1 Mitochondrial Disease

DI 23022.971

Nicolaides-Baraitser Syndrome

DI 23022.236

Niemann-Pick Disease (NPD) -- type A

DI 23022.240

Niemann-Pick Disease Type C

DI 23022.475

Nonketotic Hyperglycinemia

DI 23022.973

Non-Small Cell Lung Cancer -- with metastases to or beyond the hilar nodes or inoperable, unresectable or recurrent

DI 23022.245

Obliterative Bronchiolitis

DI 23022.840

Ohtahara Syndrome

DI 23022.845

Oligodendroglioma Brain Tumor- Grade III

DI 23022.246

Ornithine Transcarbamylase (OTC) Deficiency

DI 23022.250

Orthochromatic Leukodystrophy with Pigmented Glia

DI 23022.850

Osteogenesis Imperfecta (OI) -- Type II

DI 23022.255

Osteosarcoma, formerly known as Bone Cancer -- with distant metastases or inoperable or unresectable

DI 23022.120

Ovarian Cancer -- with distant metastases or inoperable or unresectable

DI 23022.260

Pallister-Killian Syndrome

DI 23022.261

Pancreatic Cancer

DI 23022.265

Paraneoplastic Pemphigus

DI 23022.635

Patau Syndrome (Trisomy 13)

DI 23022.480

Pearson Syndrome

DI 23022.855

Pelizaeus-Merzbacher Disease -- Classic Form

DI 23022.860

Pelizaeus-Merzbacher Disease -- Connatal Form

DI 23022.865

Pericardial Mesothelioma

DI 23022.266

Peripheral Nerve Cancer -- metastatic or recurrent

DI 23022.870

Peritoneal Mesothelioma

DI 23022.270

Peritoneal Mucinous Carcinomatosis

DI 23022.975

Perry Syndrome

DI 23022.875

Phelan-McDermid Syndrome

DI 23022.977

Pitt Hopkins Syndrome

DI 23022.877

Pleural Mesothelioma

DI 23022.275

Pompe Disease -- Infantile

DI 23022.280

Primary Central Nervous System Lymphoma

DI 23022.640

Primary Effusion Lymphoma

DI 23022.645

Primary Peritoneal Cancer

DI 23022.483

Primary Progressive Aphasia

DI 23022.485

Progressive Bulbar Palsy

DI 23022.281

Progressive Multifocal Leukoencephalopathy

DI 23022.490

Progressive Supranuclear Palsy

DI 23022.650

Prostate Cancer- Hormone Refractory Disease— or with visceral metastases

DI 23022.282

Pulmonary Atresia

DI 23022.585

Pulmonary Kaposi Sarcoma

DI 23022.655

Refractory Hodgkin Lymphoma

DI 23022.283

Renpenning Syndrome

DI 23022.284

Retinopathy of Prematurity - Stage V

DI 23022.979

Rett (RTT) Syndrome

DI 23022.285

Revesez Syndrome

DI 23022.286

Rhabdomyosarcoma

DI 23022.880

Rhizomelic Chondrodysplasia Punctata

DI 23022.885

Richter Syndrome

DI 23022.887

Roberts Syndrome

DI 23022.981

Rubinstein-Taybi Syndrome

DI 23022.287

Salivary Tumors

DI 23022.290

Sandhoff Disease

DI 23022.295

Schindler Disease -- Type I

DI 23022.890

SCN8A-related Epilepsy with Encephalopathy

DI 23022.496

Seckel Syndrome

DI 23022.296

Secondary Adenocarcinoma of the Brain

DI 23022.298

Severe Combined Immunodeficiency - Childhood

DI 23022.983

Single Ventricle

DI 23022.590

Sinonasal Cancer

DI 23022.985

Sjogren-Larsson Syndrome

DI 23022.297

Skin Malignant Melanoma—with metastases

DI 23022.810

Small-Cell Cancer of the Large Intestine

DI 23022.300

Small-Cell Cancer of the Ovary

DI 23022.305

Small-Cell Cancer of the Prostate

DI 23022.310

Small-Cell Cancer of the Thymus

DI 23022.311

Small-Cell Cancer of the Uterus

DI 23022.315

Small-Cell Lung Cancer

DI 23022.320

Small Intestine Cancer -- with distant metastases or inoperable, unresectable or recurrent

DI 23022.325

Smith Lemli Opitz Syndrome

DI 23022.895

Soft Tissue Sarcoma – with distant metastases or recurrent

DI 23022.326

Spinal Muscular Atrophy (SMA) -- Types 0 and 1

DI 23022.330

Spinal Nerve Root Cancer -- metastatic or recurrent

DI 23022.900

Spinocerebellar Ataxia

DI 23022.500

Stiff Person Syndrome

DI 23022.905

Stomach Cancer -- with distant metastases or inoperable, unresectable or recurrent

DI 23022.335

Subacute Sclerosing Panencephalitis

DI 23022.505

Superficial Siderosis of the Central Nervous System

DI 23022.337

SYNGAP1-related NSID

DI 23022.238

Tabes Dorsalis

DI 23022.910

Tay Sachs Disease

DI 23022.510

Taybi-Linder Syndrome

DI 23022.341

Tetrasomy 18p

DI 23022.343

Thanatophoric Dysplasia, Type 1

DI 23022.515

The ALS/Parkinsonism Dementia Complex

DI 23022.660

Thyroid Cancer

DI 23022.340

Transplant Coronary Artery Vasculopathy

DI 23022.987

Tricuspid Atresia

DI 23022.595

Ullrich Congenital Muscular Dystrophy

DI 23022.520

Ureter Cancer -- with distant metastases or inoperable, unresectable or recurrent

DI 23022.345

Usher Syndrome - Type I

DI 23022.989

Ventricular Assist Device Recipient

DI 23022.570

Walker Warburg Syndrome

DI 23022.525

Wolf-Hirschhorn Syndrome

DI 23022.915

Wolman Disease

DI 23022.530

Xeroderma Pigmentosum

DI 23022.920

X-Linked Lymphoproliferative Disease

DI 23022.346

X-Linked Myotubular Myopathy

DI 23022.347

Zellweger Syndrome

DI 23022.535

 

DI 23022.238 SYNGAP1-related NSID

COMPASSIONATE ALLOWANCES INFORMATION

SYNGAP1-RELATED NSID

ALTERNATE NAMES

SYNGAP1-related non-syndromic intellectual disability; MRD5; Syngap1 Gene Mutation Linked To Intellectual Disability, Schizophrenia and Autism; SYNGAP1syndrome; Autosomal dominant intellectual disability 5

DESCRIPTION

SYNGAP1-related NSID is a condition that primarily affects the central nervous system. This condition is caused by changes (mutations) in the SYNGAP1 gene. Almost all reported cases are due to de novo mutations; however, the condition can be passed down to future generations in an autosomal dominant manner. Treatment is based on the signs and symptoms present in each person.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING

Diagnostic testing:Genetic testing is the only way to confirm a diagnosis of SYNGAP1-related NSID. However, an EEG may be used to support the diagnosis.

Physical findings:

  • Epileptic encephalopathy;

  • Microcephaly (abnormally small head);

  • Torticollis (wryneck);

  • Moderate to severe intellectual disability;

  • Seizures;

  • Autism spectrum disorder;

  • Loss of developmental milestones;

  • Generalized hypotonia (decreased muscle tone)

  • Global developmental delay;

  • Language impairment; and

  • Motor delay.

ICD-9: 318.1

ICD-10: F72

PROGRESSION

Individuals with SYNGAP1-related NSID continue to develop, progressing at their own pace. Unless their epilepsy is not well controlled, they do not regress or deteriorate and can always continue to learn.

TREATMENT

OT, PT, and speech therapies to maximize developmental potential. Therapy is purely supportive.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

  • Clinical history and examination that describes the diagnostic features of the impairment;

  • Genetic testing;

  • EEG results;

  • Brain MRI results; and

  • Neuropsychological testing documenting intellectual disability.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

12.05

112.05

 

Equals

 

 

* Adjudicators may, at their discretion, use the Medical Evidence of Record or the listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.

DI 23022.266 Pericardial Mesothelioma

COMPASSIONATE ALLOWANCES INFORMATION

PERICARDIAL MESOTHELIOMA

ALTERNATE NAMES

Malignant Pericardial Mesothelioma; Primary Pericardial Mesothelioma; Primary Pericardial Malignant Mesothelioma

DESCRIPTION

Pericardial Mesothelioma is a rare asbestos-related cancer that originates in the pericardium, the protective membrane lining the heart. This type of mesothelioma is very rare, accounting for less than 1 percent of malignant mesothelioma cases.

Clinical symptoms and signs are frequently nonspecific, and the diagnosis is usually made after surgery or at autopsy.

This form of cancer is most often diagnosed in people between the ages of 50 and 70, with the median age being 55. Approximately 60 percent of cases occur in men.

Due to its rarity and nonspecific symptoms, it is usually diagnosed late when the disease burden is extensive.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING

Diagnostic testing: The diagnosis of pericardial mesothelioma is made by a combination of :

  • Physical examination and medical history;

  • Echocardiogram;

  • Radionuclide;

  • Effusion cytology; and

  • Biopsy of pericardium.

Physical findings:

  • Compression of the heart by fluid;

  • Inflammation of the pericardium;

  • Night sweats;

  • Heart palpitations;

  • Chest pain;

  • Shortness of breath;

  • Unusual lumps of tissue under the skin of the chest;

  • Unexplained weight loss; and

  • Dry unproductive cough.

ICD-9: 164.1

ICD-10: C45.2

PROGRESSION

The prognosis for individuals with this cancer is the poorest of all forms of mesothelioma. The survival time for patients following their initial showing of symptoms is often less than six months.

TREATMENT

There is no standard treatment for pericardial mesothelioma. The treatment options include surgery, chemotherapy, radiotherapy, immunotherapy, or pericardiectomy (surgical procedure involving the partial or whole removal of the pericardium). Because most cases are diagnosed at later stages, these treatment are often palliative.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

  • Biopsy; and

  • Pathology report confirming a diagnosis of pericardial mesothelioma.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

 

Equals

13.15 A

* Adjudicators may, at their discretion, use the Medical Evidence of Record or the listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.

DI 23022.283 Refractory Hodgkin Lymphoma

COMPASSIONATE ALLOWANCES INFORMATION

REFRACTORY HODGKIN LYMPHOMA

ALTERNATE NAMES

Intractable Hodgkin Lymphoma; Refractory HL; Refractory Hodgkin Disease; Refractory Hodgkin's Lymphoma; Refractory Hodgkins Lymphoma; Relapsed Hodgkin Lymphoma; Relapsed Hodgkin's Lymphoma; Relapsed Hodgkins Lymphoma; Relapsing Hodgkin's Lymphoma; Relapsing Hodgkins Lymphoma

DESCRIPTION

Refractory Hodgkin Lymphoma (RHL) is a type of cancer affecting the lymphatic system which either does not respond to treatment or recurs within a year of successful treatment.

Patients with RHL will have previously been diagnosed with classical Hodgkin Lymphoma (HL) and received treatment. Cancer that resists treatment (Refractory) or returns following remission (Relapse) is categorized as RHL.

Hodgkin Lymphoma is distinguished from other lymphomas primarily by the presence of giant cells known as Reed-Sternberg cells.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING

Diagnostic testing: Diagnostic testing for RHL may include:

  • Physical examination;

  • Lymph node biopsy showing Reed-Sternberg cells;

  • Blood tests;

  • Bone marrow biopsy or aspiration; and

  • Imaging studies as CT, MRI, and positron emission tomography (PET).

Physical findings: Physical symptoms of HL and RHL vary, but commonly include:

  • Swollen lymph nodes in the neck, armpit, or groin;

  • Discomfort or feeling of fullness in the abdomen;

  • Fatigue;

  • Shortness of breath; and

  • Unexplained fever, night sweats, or weight loss.

ICD-9: 201

ICD-10: C81

PROGRESSION

The prognosis is poor for HL patients who do not achieve full remission after completing their initial course of treatment, or sustain remission for one year. Approximately 1 in 4 HL diagnoses progress to RHL.

TREATMENT

Treatment of RHL typically consists of salvage chemotherapy, followed by autologous stem cell transplant. The approach to treatment may vary depending on the timing of the relapse, age of individual, general health of the individual, and previous responses to treatment.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

  • Clinical history confirming diagnosis of Hodgkin Lymphoma, and documenting unsuccessful treatment or relapse within one year of completing initial treatment.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

13.05 B and C

RHL, by definition, meets 13.05 B. Most RHL patients will also meet 13.05 C.

Equals

 

 

* Adjudicators may, at their discretion, use the Medical Evidence of Record or the listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.

DI 23022.284 Renpenning Syndrome

COMPASSIONATE ALLOWANCES INFORMATION

RENPENNING SYNDROME

ALTERNATE NAMES

Galobi-Ito-Halls Syndrome; Sutherland-HaanSyndrome; RENS1; Hamel Cerebropalatocardiac Syndrome; Porteous Syndrome; X-Linked Intellectual Deficit, Renpenning type

DESCRIPTION

Renpenning syndromeis a disorder the almost exclusively affects males causing developmental delay, moderate to severe intellectual disability, and distinctive physical features. It is caused by a mutation on the PQBP1 gene at the chromosome locus Xp11.23. This gene provides instructions to make polyglutamine-binding protein. This protein plays a role in processing and transporting RNA and is needed for normal brain development.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING

Diagnostic testing: Genetic testing revealing abnormality in PQBP1 gene is needed to diagnose Renpenning syndrome.

Physical findings: Characteristic physical findings for Renpenning syndrome include:

  • Short stature;

  • Microcephaly (abnormally small head size);

  • Long, narrow face;

  • Outside corners of eyes that slant up (upslanting palpebral fissures);

  • Long bulbous nose with a low-hanging separation between the nostrils (overhanging columella);

  • Shortened philtrum (space between the base of the nose and mouth);

  • Seizures; and

  • Atrophy of skeletal muscles.

About 20 percent of individuals with this disorder also have other features, which may include:

  • Cup-shaped ears;

  • Small testes;

  • Coloboma (malformation of the eye);

  • Cleft palate (opening in the roof of the mouth);

  • Heart abnormalities; and

  • Anal malformations.

ICD-9: 758.9

ICD-10: Q87.5

PROGRESSION

By age 3, the individuals are noted to have regression in mental ability and physical changes. The head stops growing, there is severe muscle wasting, and the face elongates. The individuals are often described as cachectic, and mean IQ is around 30.

Life expectancy is not significantly shortened, though there are some case reports of some individuals dying at an early age. The intellectual disabilities do not improve.

TREATMENT

There is currently no cure for Renpenning syndrome.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

  • Clinical history and examination that describes the diagnostic features of the impairment;

  • Positive genetic testing documenting abnormality in PQBP1 gene; and

  • Neuropsychological testing documenting intellectual disability.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

111.02

112.05

 

Equals

 

 

* Adjudicators may, at their discretion, use the Medical Evidence of Record or the listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.

DI 23022.341 Taybi-Linder Syndrome

COMPASSIONATE ALLOWANCES INFORMATION

TAYBI-LINDER SYNDROME

ALTERNATE NAMES

MOPD 1 and 3; Taybi-Linder Syndrome; Microcephalic Osteodysplastic Primordial Dwarfism 1 and 3

DESCRIPTION

Taybi-Linder syndrome is a rare genetic disease caused by a mutation of the gene RNU4ATAC. It is characterized by bone and central nervous system malformations, in addition to intrauterine growth retardation (IGR). Taybi-Linder syndrome has been associated with incipient diabetes, electrolytic imbalances, hypothyroidism, hypothalamic disorders, hypogonadism, cryptorchidism, micropenis, and hypospadias.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING

Diagnostic testing: Prenatal diagnosis is of the utmost importance. Therefore, fetal ultrasound screening during the second trimester of pregnancy is necessary for diagnosis.

Diagnostic testing for Taybi-Linder syndrome may also include:

  • Genetic testing for the RNU4ATAC gene; and

  • MRI or other imaging showing brain abnormality.

  • Intrauterine and post-natal growth retardation;

  • Microcephaly (abnormally small head);

  • Skeletal dysplasia;

  • Apnea;

Physical findings: Physical findings for Taybi-Linder syndrome may include:

  • Distinct facial features including sparse hair and eyebrows, sloped forehead with protruding eyes, and a flat nasal bridge with micrognathia (small jaw);

  • Dry skin;

  • Seizures;

  • Intellectual disability; and

  • Brain abrnormalities including lissencephaly (smooth brain), hypoplastic frontal lobes, agenesis of the corpus callosum or cerebellar vermis.

ICD-9: 758.9

ICD-10: Q87.1

PROGRESSION

This syndrome is often fatal in the first year of life. With improved genetic testing, individuals have been found in later childhood and adulthood—all with significant disability.

TREATMENT

There is no curative treatment for Taybi-Linder syndrome. Facial abnormalities may require special considerations for airway management during anesthesia. Neurologic symptoms, such as seizures, can be managed medically.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

  • Clinical history and examination that describes the diagnostic features of the impairment;

  • Positive genetic testing documenting presence of the RNU4ATAC gene; and

  • Neuropsychological testing documenting intellectual disability.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

1.17

1.18

1.19

1.20

11.02

12.05

101.17

101.18

101.19

101.20

101.24

110.08

112.05

 

Equals

 

 

* Adjudicators may, at their discretion, use the Medical Evidence of Record or the listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.

DI 23022.373 Congenital Zika Syndrome

COMPASSIONATE ALLOWANCES INFORMATION

CONGENITAL ZIKA SYNDROME

ALTERNATE NAMES

Zika virus disease; ZVD

DESCRIPTION

Congenital Zika syndrome (CZS) is a distinct pattern of birth defects and disabilities due to Zika virus infection during pregnancy.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING

Diagnostic testing:

  • Positive CZS-specific immunoglobulin M capture enzyme-linked immunosorbent assay result on infant cerebrospinal fluid;

  • Positive plaque reduction neutralization testing (PRNT) at birth; and

  • Neuroimaging (cranial ultrasound, computed tomography, or magnetic resonance imaging) any time after birth showing microcephaly.

Physical findings: Although many of the features seen as part of CZS can be caused by other infections during pregnancy, there are five features listed that are rarely seen with other infections or are unique to CZS. Those five features are:

  • Severe microcephaly (abnormally small head) in which the skull has partially collapsed;

  • Decreased brain tissue with a specific pattern of brain damage, including subcortical calcifications;

  • Damage to the back of the eye, including macular scarring and focal retinal pigmentary mottling (spots or blotches with different shades);

  • Congenital contractures, such as clubfoot or arthrogryposis; and

  • Hypertonia restricting body movement soon after birth.

Other findings for CZS may include:

  • Growth retardation;

  • Progressive, irreversible intellectual disability;

  • Brain atrophy and asymmetry;

  • Abnormally formed or absent brain structures;

  • Hydrocephalus (accumulation of cerebrospinal fluid within the brain);

  • Neuronal migration disorders;

  • Excessive and redundant scalp skin;

  • Hyperreflexia (overactive or overresponsive reflexes);

  • Irritability;

  • Tremors;

  • Seizures;

  • Brainstem dysfunction;

  • Dyspagia (difficulty swallowing);

  • Chorioretinal atrophy in the macula;

  • Optic nerve hypoplasia, cupping, and atrophy;

  • Other retinal lesions;

  • Iris colobomas (holes in the iris);

  • Congenital glaucoma;

  • Microphthalmia (abnormally small eyes);

  • Lens subluxation;

  • Cataracts; and

  • Intraocular calcifications.

ICD-9: 066.3

ICD-10: A92.5

PROGRESSION

The average life expectancy for microcephaly is 10 years. Intellectual disability and microcephaly are life-long and disabling.

Around 10 to 12 percent of children born with microcephaly have normal intelligence. Most children have issues with walking, communicating, coordination, and speech issues; and need constant attention and care.

TREATMENT

There is no current treatment available for CZS. Some of the intervention programs like occupational therapy, speech assistance, and special needs help can provide some help.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

  • Clinical history and examination that describes the diagnostic features of the impairment;

  • Positive CZS-specific immunoglobulin; and

  • Neuroimaging (cranial ultrasound, computed tomography, or magnetic resonance imaging) any time after birth showing microcephaly.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

102.02

111.02

111.09

 

Equals

 

 

* Adjudicators may, at their discretion, use the Medical  Evidence of Record or the listings suggested to evaluate the claim. However,  the decision to allow or deny the claim rests with the adjudicator.

DI 23022.382 Desmoplastic Mesothelioma

COMPASSIONATE ALLOWANCES INFORMATION

DESMOPLASTIC MESOTHELIOMA

ALTERNATE NAMES

Desmoplastic Malignant Mesothelioma; DMM

DESCRIPTION

Desmoplastic Mesothelioma is a rare and highly aggressive cancer that most commonly occurs in the pleura, the membranous enclosures surrounding the lungs. It occasionally originates in the linings of the heart (pericardium) and visceral organs (peritoneum). The term “desmoplastic” refers to the signature masses of fibrous connective tissue produced in affected areas.

Unlike other subtypes of mesothelioma, the desmoplastic variant is not as closely linked to asbestos; less than 20% of cases involve confirmed asbestos exposure. Desmoplastic mesothelioma affects males twice as frequently as females, and usually presents after age 40, though it has been observed in patients as young as 12 years of age.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING

Diagnostic testing: Desmoplastic mesothelioma is frequently mistaken for pleural fibrosis upon examination. Biopsy analysis is required to confirm the diagnosis.

Physical findings: Common symptoms include:

  • Shortness of breath;

  • Pain in the chest or abdomen;

  • Lumps or swelling at cancer site; and

  • Sudden weight loss.

ICD-9: 163 (pleural); 158 (peritoneal); 164.1 (pericardial)

ICD-10: C45.0 (pleural); C45.1 (peritoneal); C45.2 (pericardial)

PROGRESSION

Desmoplastic mesothelioma has usually metastasized by the time it is discovered. The prognosis is extremely poor, with a median survival rate of about six months following diagnosis.

TREATMENT

Because desmoplastic mesothelioma tends to be in an advanced stage at the time of diagnosis, surgery is rarely an option. Treatment is palliative and supportive, and includes chemotherapy and targeted radiation to shrink tumors. Draining fluid buildup can increase comfort and ease of breathing.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

  • Clinical history and examination that describes the diagnostic features of the impairment;

  • Imaging reports such as CT scan or MRI scan;

  • Operative reports; and

  • Pathology/biopsy reports.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

13.15 A

 

Equals

 

 

* Adjudicators may, at their discretion, use the Medical Evidence of Record or the listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.

DI 23022.496 SCN8A-related Epilepsy with Encephalopathy

COMPASSIONATE ALLOWANCES INFORMATION

SCN8A-RELATED EPILEPSY WITH ENCEPHALOPATHY

ALTERNATE NAMES

Early Infantile Epileptic Encephalopathy 13; EIEE13; SCN8A Encephalopathy

DESCRIPTION

SCN8A-related Epilepsy with Encephalopathy is a rare autosomal-dominant genetic disorder affecting infants, characterized by recurrent seizures of multiple types, along with intellectual disability. These seizures are described as refractory, meaning that they generally do not respond to or improve with treatment.

While the condition is often evident at birth, some affected infants will exhibit apparently normal development until the onset of seizures, at which point the child will begin to regress from both physical and cognitive standpoints. The severity of intellectual impairment associated with SCN8A-related epilepsy encephalopathy varies from mild to severe.

As the name indicates, the condition is caused by a mutation on the SCN8A gene. The relationship between the genetic anomaly and its distinct effects on intellectual and physical development are poorly understood; some research indicates that these symptoms are more closely correlated with the brain damage resulting from the seizures, rather than the mutation itself.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING

Diagnostic testing:

  • Molecular genetic testing is required to confirm mutation on the SCN8A gene.

Physical findings: Common symptoms include:

  • Seizures of multiple types (absence, tonic-clonic, convulsive);

  • Intellectual disability including autistic features;

  • Motor disorders;

  • Muscle weakness; and

  • Sleep disorders.

ICD-9: 345.81

ICD-10: G40.803

PROGRESSION

Affected infants will begin exhibiting symptoms between birth and 18 months of age, with median onset at 4 months. Treatment is supportive; people with SCN8A-related epilepsy with encephalopathy can survive to adulthood with appropriate care.

In about 10% of identified cases, the infant dies without any obvious cause, a phenomenon known as sudden unexpected death in epilepsy (SUDEP).

TREATMENT

SCN8A-related epilepsy with encephalopathy typically does not respond to traditional anticonvulsive medication. Antiepileptic drugs that block sodium channels (e.g., phenytoin, valproate, carbamazepine) have shown promise in some studies.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

  • Clinical history and examination that describes the diagnostic features of the impairment;

  • Genetic testing confirming mutation of the SCN8A gene; and

  • Imaging reports such as CT scan or MRI scan.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

111.02

 

Equals

 

 

* Adjudicators may, at their discretion, use the Medical Evidence of Record or the listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.

DI 23022.543 CIC-rearranged Sarcoma

COMPASSIONATE ALLOWANCES INFORMATION

CIC-REARRANGED SARCOMA

ALTERNATE NAMES

CIC-DUX4 Rearranged Sarcoma; CIC-DUX4 Sarcoma; Ewing-like Sarcoma; Small Round-Cell Sarcoma With CIC Rearrangement

DESCRIPTION

CIC-rearranged sarcoma is a class of small round-cell tumors that fall under the Ewing sarcoma group of cancers. Although historically grouped with Ewing sarcomas, these tumors are genetically distinct and tend to be more aggressively metastatic than Ewing sarcomas on average.

The tumors tend to occur in soft tissue or visceral organs, but have been observed originating in bone in about 3% of cases. Metastasis is early and rapid, most commonly to the lungs and brain. Males are affected slightly more likely to be affected often than females.

CIC-rearranged sarcomas are so named due to a characteristic fusion in the tumor of the capicua transcriptional repressor (CIC) gene with one of several genes, most commonly the DUX4 retrogene.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING

Diagnostic testing: Preliminary testing for CIC-rearranged sarcoma includes:

  • X-rays;

  • Biopsy;

  • CT scan;

  • MRI; and

  • PET scan.

A definitive diagnosis requires genetic testing to rule out Ewing Sarcoma and other round-cell sarcomas.

Physical findings: Physical symptoms are similar to Ewing sarcoma and may include:

  • Pain and swelling at the tumor site;

  • Necrosis and hemorrhage in surrounding tissue;

  • Fever; and

  • Cyst-like growth with visible blood vessels over the tumor.

ICD-9: 171.9

ICD-10: C49.9

PROGRESSION

CIC-rearranged sarcoma develops and spreads aggressively. Prognosis is poor, even with treatment.

CIC-rearranged sarcoma tumors that have metastasized have a prognosis of less than 2 years. The survival rate is slightly higher when tumors are detected and treated in the localized (pre-metastatic) stage. Localized tumors that can be fully resected have a 5-year survival rate of about 50%.

TREATMENT

Treatment is not well defined but tends to be multimodality with surgery, radiation, and chemotherapy as applicable to each individual case. Recurrence following treatment is common, occurring in about half of cases.

Surgical resection and chemotherapy are the standard treatment options for CIC-rearranged sarcoma. Some studies have shown surgical intervention to be effective at preventing recurrence when the tumor is detected and removed prior to metastasis.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

  • Clinical history and examination that describes the diagnostic features of the impairment;

  • Report that specifies the type, extent, and site of the primary, recurrent, or metastatic lesion;

  • Biopsy or needle aspiration information found in operative notes, pathology reports, summaries of hospitalization or other medical reports that include details of the surgical and pathological findings;

  • Fluorescence in situ Hybridization (FISH) test positive for presence of CIC and negative for EWSR1 (Ewing Sarcoma marker);

  • Imaging tests; and

  • Treatment records including surgical procedures and progress notes.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

13.04 A

13.04 B

113.03

Meeting these listings requires the presence of metastases or persistence or recurrence following initial anti-cancer therapy, which implies a poor prognosis with 5-year survival.

Equals

13.04 A

13.04 B

113.03

Individuals with a diagnosis of CIC-rearranged carcinoma who have survived beyond the 2-year survival rate threshold may equal a listing. Some factors to consider include, the location, deepness, and aggressiveness of the tumors involved.

* Adjudicators may, at their discretion, use the Medical Evidence of Record or the listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.

DI 23022.938 Choroid Plexus Carcinoma

COMPASSIONATE ALLOWANCES INFORMATION

CHOROID PLEXUS CARCINOMA

ALTERNATE NAMES

CPC

DESCRIPTION

Choroid Plexus Carcinoma is a rare malignant cancer of the brain. It grows aggressively, invading surrounding tissue and impairing normal brain function.

The condition is so named because it typically occurs in the ventricles of the choroid plexus structure, which produces and secretes most of the body’s cerebrospinal fluid. It is also occasionally observed originating in the spinal cord.

Choroid Plexus Carcinoma can affect people at any age, but it is usually seen in infants within the first year of life. It is a Grade III tumor, not to be confused with Choroid Plexus Papilloma (Grades I and II), which is non-cancerous.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING

Diagnostic testing: Diagnosis of Choroid Plexus Carcinoma is made based on:

  • Physical and neurological examination;

  • Brain imaging including magnetic resonance imaging (MRI) and computerized tomography (CT) scans; and

  • Genetic testing.

Choroid Plexus Carcinoma tumors appear as a distinct “cauliflower-like” shape on an MRI.

Physical findings: Common physical symptoms of Choroid Plexus Carcinoma include:

  • Headache;

  • Dizziness;

  • Blurred or double vision;

  • Nausea; and

  • Mood disturbances and irritability.

These symptoms are associated with buildup of pressure in the brain as the tumor grows.

ICD-9: 191.5

ICD-10: C71.5

PROGRESSION

Choroid Plexus Carcinoma tumors spread aggressively and prognosis is generally poor. Only about one in four children will survive five years past initial diagnosis, although children who successfully undergo complete tumor resection surgery have a much more favorable outlook, with a five-year survival rate of about 60%.

TREATMENT

Surgical intervention to remove the tumor is the preferred initial course of treatment of Choroid Plexus Carcinoma when possible. However, complete surgical resection often presents high risk of damage to nearby areas of the brain. Partial resection is commonly employed in combination with other treatment modalities including chemotherapy and radiation to mitigate risk to the patient. Follow-up surgery may be necessary in the event of recurrence.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

  • Clinical history and examination that describes the diagnostic features of the impairment;

  • Imaging reports such as CT scan or MRI scan;

  • Operative reports; and

  • Pathology/biopsy reports.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

13.13 A

113.13 B

113.13 C

Treatment of Choroid Plexus Carcinoma is often surgery followed by chemotherapy radiation therapy or both, which would satisfy listing 113.13 C.

Equals

 

 

* Adjudicators may, at their discretion, use the Medical Evidence of Record or the listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.


DI 23022 TN 45 - Processing Quick Disability Determination (QDD) and Compassionate Allowance (CAL) in the Disability Determination Services (DDS) - 8/11/2021