Identification Number:
DI 23022 TN 27
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:
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 230 – Special Issues
Subchapter 22 – Processing Quick Disability Determination (QDD) and Compassionate Allowance (CAL) in the Disability Determination Services (DDS)
Transmittal No. 27, 12/12/2019

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 is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

Summary of Changes

DI 23022.483 Primary Peritoneal Cancer

Adjustment to left column width. No text edits.

 

DI 23022.887 Richter Syndrome

Adjustment to left column width. No text edits.

DI 23022.483 Primary Peritoneal Cancer

COMPASSIONATE ALLOWANCE INFORMATION

PRIMARY PERITONEAL CANCER

ALTERNATE NAMES

Primary Peritoneal Carcinoma; Primary Peritoneal Neoplasm; Primary Peritoneal Tumor; Primary Peritoneal Sarcoma; Serous Surface Papillary Carcinoma; Serous Surface Papillary Cancer; Serous Surface Papillary Sarcoma; Serous Surface Papillary Tumor; Serous Surface Papillary Neoplasm; Extra Ovarian Serous Carcinoma; Extra Ovarian Serous Cancer; Extra Ovarian Serous Neoplasm; Extra Ovarian Serous Tumor; Extra Ovarian Serous Sarcoma; Primary Serous Papillary Carcinoma; Primary Serous Papillary Cancer; Primary Serous Papillary Sarcoma; Primary Serous Papillary Tumor; Primary Serous Papillary Neoplasm

DESCRIPTION

Primary peritoneal cancer (PPC) is cancer that originates in the peritoneum, which is a moist sheet of tissue that lines the abdominal cavity and the surface of the abdominal organs. The peritoneum protects the organs and allows them to move smoothly within the abdomen. The cells of the peritoneum develop from the same type of cells, which form the ovaries, so PPC shares characteristics with ovarian cancer, and though rare PPC can occur in men. The exact cause of PPC is not known, but may be associated with the gene BRCA1/2 (also seen in ovarian cancer).

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

Diagnostic testing: The diagnosis of primary peritoneal cancer is made by:

  • History and physical exam;

  • Pelvic exam;

  • CA 125 Assay;

  • Ultrasound;

  • Computerized Tomography (CT/CAT) scan;

  • Positron Emission Tomography (PET) scan;

  • Magnetic Resonance Imaging (MRI);

  • Chest X-ray; and

  • Biopsy.

Physical findings: The signs and symptoms of primary peritoneal cancer may include:

  • Pain, swelling, or a feeling of pressure in the abdomen or pelvis;

  • Vaginal bleeding that is heavy or irregular, especially after menopause;

  • Vaginal discharge that is clear, white, or colored with blood;

  • Lump in the pelvic area; and

  • Gastrointestinal problems such as gas, bloating, or constipation

ICD-9: 158.8

PROGRESSION

The prognosis for individuals with primary peritoneal cancer is often poor. Median life expectancy is 1-2 years, with a range of 4 months to >5 years, the 5-year survival rate is about 26%.

TREATMENT

The presentation of PPC may be in the advanced stages at initial diagnosis, making curative treatment very difficult. Treatment may include surgery, radiation, and/or chemotherapy. The treatment of primary peritoneal cancer depends on the stage/grade of cancer; whether the patient has extra fluid in the abdomen that causes swelling; whether the cancer is unresectable, metastatic, or recurrent; changes in the BRACA1 or BRACA2 genes; and the patient’s age and general health.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:
  • Clinical history and examination that describes the diagnostic features of the impairment;

  • Pathology/biopsy report of the cancer; and

  • Imaging reports such as CT scan, MRI scan; PET scan, and Ultrasound

Suggested Listings for Evaluation:
DETERMINATION

LISTING

REMARKS

Meets

 

 

Equals

13.23 E

Primary peritoneal cancer, by definition equals 13.23E 1 a – extension to peritoneal surfaces.

* 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 23022.887 Richter Syndrome

COMPASSIONATE ALLOWANCE INFORMATION
RICHTER SYNDROME

ALTERNATE NAMES

Richter Disease; Richter Transformation; Richter’s syndrome; Richter’s Disease; Richter’s Transformation

DESCRIPTION

Richter syndrome (RS) is a rare type of non-Hodgkin lymphoma. This condition occurs when chronic lymphocytic leukemia (CLL) transforms into a fast growing aggressive type of lymphoma, most commonly diffuse large B-cell lymphoma. (DLBCL). The risk of developing RS depends on the genetic mutations in the CLL cell; clinical characteristics; biologic and genetic features of the CLL B-cell clone; and therapy for progressive CLL.

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

Diagnostic testing: Diagnostic testing for individuals with Richter syndrome includes:

  • Blood chemistry studies;

  • Computerized Tomography (CT/CAT) scan;

  • Positron Emission Tomography (PET) scan;

  • Magnetic Resonance Imaging (MRI);

  • Bone marrow aspiration; and

  • Biopsy.

Physical findings: The signs and symptoms of Richter syndrome may include:

  • Increased size of lymph nodes (lymphadenopathy);

  • Painless swelling in the neck, axilla, abdomen, spleen (splenomegaly) or groin; and

  • Unexplained weight loss, fevers and night sweats (commonly referred to as B-symptoms) .

Other signs and symptoms may include:

  • Increased fatigue;

  • Shortness of breath;

  • Dizziness;

  • Palpitations;

  • Low Platelets with characteristic bruising or bleeding;

  • Increase in serum lactate dehydrogenase (LDH); and

  • Elevated serum calcium (hypercalcemia).

ICD-9: 200.7

PROGRESSION

RS indicates the transformation of CLL into an aggressive lymphoma. The median age of occurrence is between 61 years and 70 years. People with CLL are at increased risk of developing a second malignant neoplasm such as cancers of the lung, brain, eye, and malignant melanoma. The median time to occurrence of CLL to RS is 1.8 to 5 years after diagnosis. Approximately 2% to 10% of people who have chronic lymphocytic leukemia develop Richter transformation. Prognosis is very poor with survival generally less than 1 year.

TREATMENT

Richter syndrome lymphoma is treated with the same chemotherapy drugs used for all other aggressive lymphomas, such as chemotherapy, radiation therapy, or antibody or biological therapy. RS is not very responsive to any of the available treatments.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:
  • Clinical history and examination that describes the diagnostic features of the impairment;

  • CT, MRI, or PET scan reports;

  • Pathology/Biopsy reports of the cancer;

  • Surgical procedures; and

  • Up-to-date progress reports.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

 

 

Equals

13.05 D

 

* 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 27 - Processing Quick Disability Determination (QDD) and Compassionate Allowance (CAL) in the Disability Determination Services (DDS) - 12/12/2019