SSA - POMS: DI 28010.040 - Evaluating Listings with Age-Based Periods of Disability at the Continuing Disability Review (CDR)

A. Definition of “listings with an age-based period of disability”

A listing with an age-based period of disability is a listing that indicates an age as a time period for which the impairment meets the listing. Listings that designate an age-based period of disability will have varied lengths of the diary based on the child’s age at the time of adjudication and the age criteria designated in the listing. We refer to the diary criteria in these listings as “listings with an age-based period of disability.”

Listings that have an age-based period of disability will designate specific criteria:

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For evaluating the impairment through a certain age and includes a subsection once the child has obtained that age (i.e., Listing 102.11), or
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Indicates an age that an impairment should be disabling until (i.e., Listing 105.10, which indicates we consider a child that requires supplemental daily enteral feeding via a gastrostomy, duodenostomy, or jejunostomy under a disability until they have attained age 3).

B. Current listings with an age-based period of disability

The table below displaying listings with age requirements may not be all-inclusive and is subject to change due to updates and revisions in the listings. For the current medical listings, refer to DI 34000.000.

Current listings with Age-Based Periods of Disability

Title XVI Child Listing	Impairment	Age-Based Period of Disability in Listing Criteria Consider under a disability...
102.11A*	Hearing loss treated with cochlear implantation (initial implantation)	Until the attainment of age 5 or for 1 year after initial implantation, whichever is later
102.11B*	Hearing loss treated with cochlear implant with a word recognition score of 60 percent or less determined using the HINT or the HINT-C test	Upon the attainment of age 5 or 1 year after implantation, whichever is later
103.02D1	Chronic respiratory disorders with the presence of a tracheostomy	Until the attainment of age 3
103.02E*	Chronic Respiratory Disorders, with chronic lung disease of infancy (CLD)	For 1 year from the discharge date of the last hospitalization or until the attainment of age 2, whichever is later
105.10	Need for supplemental daily enteral feeding via a gastrostomy, duodenostomy, or jejunostomy due to any cause	Until age 3 under this listing
109.08	Diabetes mellitus in a child that requires daily insulin and has not attained age 6	Until the attainment of age 6

NOTE: The Listings with an age-based period of disability table may not be all-inclusive and is subject to change due to updates and revisions in the listings. For the current medical listings, refer to DI 34005.000. For additional information on evaluating listings that contain a specified time frame or an age requirement (annotated with an asterisk in the table above), see DI 28010.029B.

C. Evaluating impairments that met or equaled a listing with an age-based period of disability in a CDR determination

Adjudicators will follow the child CDR sequential evaluation process as discussed in DI 28005.030. If the adjudicator determines that medical improvement (MI) has occurred at Step 1, the adjudicator will then consider if the prior listing that was met or equaled at the comparison point decision (CPD) continues to be met or equaled at the CDR.

1. Follow the child CDR sequential evaluation process

At the CDR, evaluate the impairments that met or equaled a listing with an age-based period of disability by following the child CDR sequential evaluation process. For additional information about the child CDR sequential evaluation process, see DI 28005.030.

2. Considerations when evaluating child CDR cases with a listing with an age-based period of disability that was attained or passed

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If the adjudicator determines that MI has occurred at Step 1, the adjudicator will then consider if the prior listing that was met or equaled at the CPD continues to be met or equaled at the CDR.
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If a child's impairment(s) met or equaled a listing with an age-specific period of disability at the time of the CPD, and the child has attained or passed the maximum age designated in the listing (or the longest applicable diary length designated in the listing), adjudicators must find the impairment(s) does not meet or medically equal the CPD listing at Step 2 of the Title XVI child CDR sequential evaluation process unless the impairment(s) meets or medically equals a different section of the CPD listing. For example, the child had an esophageal stricture at the CPD, causing the inability to adequately feed by mouth. At 12 months of age, the child underwent gastrostomy placement and required supplemental daily enteral nutrition via a feeding gastrostomy. The diary was set to expire at age 3 and the adjudicator found the child's impairment met listing 105.10. At the CDR, the child has obtained age 4, and the adjudicator must evaluate any residual impairments as directed by listing 105.10 under the appropriate body system(s). In this scenario, the child cannot meet the CPD listing 105.10 as there is no applicable subsection for their age specific to this listing.
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The adjudicator must evaluate any resulting impairment(s) under the appropriate body system criteria as designated in the preamble or as directed in the current listing(s).
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If a Group II exception does not apply, the adjudicator must proceed to Step 3 of the evaluation process to make a CDR determination.

D. Case example

Title XVI child CDR case - age specific period of disability at the CPD

CPD evidence: The child was 1 year and 5 months old at the CPD and met listing 105.10. Listing 105.10 requires the need for supplemental daily enteral feeding via a gastrostomy due to any cause for children who have not attained age 3. The listing further designates that after age 3, the evaluation is based on the residual impairment(s). The evidence indicated that the child had an average of nine diarrhea episodes lasting one-to-two days per month and was in the 10th percentile of weight-for-age.

CDR evidence: The child is age 3 years and 8 months at the time of the CDR. The child still receives supplemental daily enteral feeding via a gastrostomy. The evidence indicates the child is in the 30th percentile of weight-for age and has one-to-two episodes of diarrhea per month lasting approximately one day per episode.

Discussion: Based on the evidence, a finding of MI is appropriate at Step 1. The evidence indicates an increase from the 10th to the 30th percentile of weight for age and a reduction of diarrhea episodes. The adjudicator must find that the child’s impairment(s) no longer meets or medically equals the CPD listing (Step 2) because the child has passed the age specified in the listing. In this example, it is important to note that, at the time of the CDR, the continued presence of a gastrostomy after age 3 would not, by itself, indicate that there has been no MI. A detailed analysis of symptoms, signs, and laboratory findings is necessary, see DI 28010.015 for additional information.

The adjudicator must continue to Step 3 in the Title XVI child CDR sequential evaluation process. Although the child still requires supplemental daily enteral feeding via a gastrostomy, the listing specifies that the criteria only apply for children under age 3 and directs evaluation after age 3 based on the residual impairment(s). The adjudicator will evaluate any residual impairments, such as malnutrition under 105.08, or other medical or developmental disorder(s) (including the disorder(s) that necessitated gastrostomy placement) under the appropriate listing(s). Those impairment(s) and all other current impairment(s) present at the CDR will be evaluated in whether a listing is met or medically equaled.

E. References

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DI 28005.025 Summary Chart of the Continuing Disability Review (CDR) Sequential Evaluation Process for Title XVI Child CDR Cases
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DI 28005.030 Step-by-Step Discussion of the Title XVI Child Continuing Disability Review (CDR) Sequential Evaluation Process
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DI 28010.029 Overview of How to Evaluate Listings with Time Periods for Which an Impairment is Considered Disabling at the Continuing Disability Review (CDR)
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DI 28010.030 Evaluating Listings with a Specified Timeframe at the Continuing Disability Review (CDR)
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DI 28010.035 Evaluating Listings with Minimum Time Periods at the Continuing Disability Review (CDR)

Social Security

Program Operations Manual System (POMS)

DI 28010.040 Evaluating Listings with Age-Based Periods of Disability at the Continuing Disability Review (CDR)