CPD evidence: The individual’s impairment(s) met listing 13.06A at the CPD due to acute leukemia. The listing directs that the individual should be considered under a disability for at least 24 months from the date of the diagnosis or relapse, or at least 12 months from the date of bone marrow or stem cell transplantation, whichever is later. The individual was diagnosed with leukemia on 04/03/2020 and underwent a bone marrow transplantation on 09/17/2020. The adjudicator set the medical re-examination diary for 24 months after the date of diagnosis.

CDR evidence: Conducted in 05/2022. The individual underwent treatment after the CPD, and a bone marrow biopsy from 03/02/2021 showed no active signs of disease and indicated that the individual’s cancer was in remission. Approximately 8 months after the bone marrow biopsy, the individual followed up with the oncologist with complaints of general fatigue, light-headedness, and dizziness. The oncologist ordered lab testing and noticed abnormal white blood cells and platelets. A bone marrow aspirate was completed in 01/2022 that confirmed the presence of recurrent acute leukemia. The individual started chemotherapy again in 02/2022 and treatment is scheduled for a course of approximately 10 months. The individual did not receive another bone marrow transplant after the CPD and was not scheduled for one when the disability examiner spoke with the individual in 05/2022.

Discussion: The adjudicator processes a continuance at step 2 of the Title II and adult Title XVI CDR sequential evaluation process, finding that the individual’s impairment meets listing 13.06A due to a relapse of the individual’s leukemia. The adjudicator sets a medical re-examination diary for 24 months from the date of relapse (i.e., 01/2024). MI and the CPD listing are not considered in this example because the impairment meets a listing at an earlier step in the sequential evaluation process.

CPD evidence: The individual’s impairment(s) met listing 13.10E at the CPD due to breast cancer with secondary lymphedema to an upper extremity. The listing directs that the individual should be considered under a disability for at least 12 months from the date of the surgery that treated the secondary lymphedema. The individual had surgery on the upper extremity on 06/12/2021 and the examiner set the medical re-examination diary for 12 months after the date of this surgery.

CDR evidence: Conducted in 08/2022. The individual continued chemotherapy treatment after the CPD and the surgery to the upper extremity. At a follow-up visit on 06/18/2022, the individual still complained of tenderness and swelling in the upper extremity. Since the surgery, the individual has had difficulty with range of motion due to scar tissue and has persistent numbness and tingling in the hands. She has not had additional surgery to the upper extremity since the last surgery performed 06/12/2021. A PET scan performed in 06/2022 shows the breast cancer has responded to treatment and has reduced in grade, but the cancer is still present. The oncologist notes from 06/2022 indicate that the individual will take a break from chemotherapy for two months to allow her body time to recover, as she has not been tolerating the continuous treatment well and has significant fatigue and weakness.

There is a plan to start at least 6 more cycles of treatment, beginning in 09/2022. At a follow-up in 07/2022, her surgeon notes that an additional surgery to her upper extremity will likely be scheduled after she completes the additional rounds of chemotherapy. The surgeon remarks that another surgery is necessary to reduce scar tissue and try to improve function but feels that given the claimant’s fatigue and difficulty tolerating treatment, an additional surgical recovery period is not ideal while she is enduring chemotherapy treatment.

Discussion: The adjudicator processes a continuance at step 2 of the Title II and adult Title XVI CDR sequential evaluation process and meets listing 13.10E.” The adjudicator sets a medical re-examination diary for 09/2025. MI and the CPD listing are not considered in this example because the impairment meets a current listing earlier in the sequential evaluation process.

The adjudicator reasons that the individual’s impairment persists and determines that a 3-year diary is appropriate given the ongoing treatment and residual limitations in the upper extremity. The adjudicator further reasons that the 3-year diary is appropriate in this situation as the individual continues to exhibit a listing level impairment, has additional chemotherapy and surgery planned, and already received an MIE diary at the CPD. The determination is also consistent with instructions in DI 26525.020B.2.

CPD evidence: The child’s congenital heart disease met listing 104.06D at the CPD. At two months of age, the child underwent surgery due to a life-threatening congenital heart impairment. The child was diagnosed with ventricular septal defect. The adjudicator scheduled the diary to expire on the child’s first birthday.

CDR evidence: The CDR is initiated when the child is 13 months old. Medical evidence notes that the child recovered well from the surgery performed at two months of age, and has no tachypnea, and a normal heart rate and rhythm on examination. O2 saturation on room air is normal on examinations and there are no episodes of syncope or hypoxemia. The child does not have difficulty feeding and is in the seventh percentile in terms of weight-for-length.

Discussion: The examinations indicate successful recovery from the heart surgery to repair a ventricular septal defect and improvement in cardiac function without respiratory impairment. Therefore, MI is demonstrated at Step 1. The CPD listing is no longer met at Step 2, as the listing criteria is not met at the CDR and the minimum timeframe has passed. If a Group II exception does not apply, the adjudicator will continue to Step 3.