We consider any residual impairment(s), such as complications arising from:
a. Graft-versus-host (GVH) disease.
b. Immunosuppressant therapy, such as frequent infections.
c. Significant deterioration of other organ systems.
13.01 Category of Impairments, Malignant Neoplastic Diseases
13.02 Soft tissue tumors of the head and neck (except salivary glands--13.08--and thyroid gland--13.09).
A. Inoperable or unresectable.
OR
B. Persistent disease following initial multimodal antineoplastic therapy.
OR
C. Recurrent disease following initial antineoplastic therapy, except local vocal
cord recurrence.
OR
D. With metastases beyond the regional lymph nodes.
OR
E. Soft tissue tumors of the head and neck not addressed in A-D, with multimodal antineoplastic
therapy. Consider under a disability until at least 18 months from the date of diagnosis.
Thereafter, evaluate any residual impairment(s) under the criteria for the affected
body system.
13.03 Skin.
A. Sarcoma or carcinoma with metastases to or beyond the regional lymph nodes.
OR
B. Melanoma, with either 1 or 2:
1. Recurrent after wide excision (except an additional primary melanoma at a different
site, which is not considered to be recurrent disease).
2. Palpable nodal metastases or metastases to adjacent skin (satellite lesions) or
elsewhere.
13.04 Soft tissue sarcoma.
A. With regional or distant metastases.
OR
B. Persistent or recurrent following initial antineoplastic therapy.
13.05 Lymphoma (including mycosis fungoides, but excluding T-cell lymphoblastic lymphoma—13.06).
(See 13.00K1 and 13.00K2c.)
A. Non-Hodgkin's lymphoma, as described in 1 or 2:
1. Intermediate or high-grade lymphoma persistent or recurrent following initial antineoplastic
therapy.
2. Low-grade or indolent lymphoma requiring initiation of more than one antineoplastic
treatment regimen within a consecutive 12-month period. Consider under a disability
from at least the date of initiation of the treatment regimen that failed within 12
months.
OR
B. Hodgkin's disease with failure to achieve clinically complete remission, or recurrent
disease within 12 months of completing initial antineoplastic therapy.
OR
C. With bone marrow or stem cell transplantation. Consider under a disability until
at least 12 months from the date of transplantation. Thereafter, evaluate any residual
impairment(s) under the criteria for the affected body system.
13.06 Leukemia. (See 13.00K2.)
A. Acute leukemia (including T-cell lymphoblastic lymphoma). Consider under a disability
until at least 24 months from the date of diagnosis or relapse, or at least 12 months
from the date of bone marrow or stem cell transplantation, whichever is later. Thereafter,
evaluate any residual impairment(s) under the criteria for the affected body system.
OR
B. Chronic myelogenous leukemia, as described in 1 or 2:
1. Accelerated or blast phase. Consider under a disability until at least 24 months
from the date of diagnosis or relapse, or at least 12 months from the date of bone
marrow or stem cell transplantation, whichever is later. Thereafter, evaluate any
residual impairment(s) under the criteria for the affected body system.
2. Chronic phase, as described in a or b:
a. Consider under a disability until at least 12 months from the date of bone marrow
or stem cell transplantation. Thereafter, evaluate any residual impairment(s) under
the criteria for the affected body system.
b. Progressive disease following initial antineoplastic therapy.
13.07 Multiple myeloma (confirmed by appropriate serum or urine protein electrophoresis and bone marrow
findings).
A. Failure to respond or progressive disease following initial antineoplastic therapy.
OR
B. With bone marrow or stem cell transplantation. Consider under a disability until
at least 12 months from the date of transplantation. Thereafter, evaluate any residual
impairment(s) under the criteria for the affected body system.
13.08 Salivary glands--carcinoma or sarcoma with metastases beyond the regional lymph nodes.
13.09 Thyroid gland.
A. Anaplastic (undifferentiated) carcinoma.
OR
B. Carcinoma with metastases beyond the regional lymph nodes progressive despite radioactive
iodine therapy.
13.10 Breast (except sarcoma—13.04). (See 13.00K4.)
A. Locally advanced carcinoma (inflammatory carcinoma, tumor of any size with direct
extension to the chest wall or skin, tumor of any size with metastases to the ipsilateral
internal mammary nodes).
OR
B. Carcinoma with distant metastases.
OR
C. Recurrent carcinoma, except local recurrence that remits with antineoplastic therapy.
13.11 Skeletal system--carcinoma or sarcoma.
A. Inoperable or unresectable.
OR
B. Recurrent tumor (except local recurrence) after initial antineoplastic therapy.
OR
C. With distant metastases.
OR
D. All other tumors originating in bone with multimodal antineoplastic therapy. Consider
under a disability for 12 months from the date of diagnosis. Thereafter, evaluate
any residual impairment(s) under the criteria for the affected body system.
13.12 Maxilla, orbit, or temporal fossa.
A. Sarcoma or carcinoma of any type with regional or distant metastases.
OR
B. Carcinoma of the antrum with extension into the orbit or ethmoid or sphenoid sinus.
OR
C. Tumors with extension to the base of the skull, orbit, meninges, or sinuses.
13.13 Nervous system. (See 13.00K6.)
A. Central nervous system neoplasms (brain and spinal cord), as described in 1 or
2:
1. Highly malignant tumors, such as Grades III and IV astrocytomas, glioblastoma multiforme,
ependymoblastoma, medulloblastoma or other primitive neuroectodermal tumors (PNETs)
with documented metastases, diffuse intrinsic brain stem gliomas, or primary sarcomas.
2. Any central nervous system neoplasm progressive or recurrent following initial
antineoplastic therapy.
OR
B. Peripheral nerve or spinal root neoplasm, as described in 1 or 2:
1. Metastatic.
2. Progressive or recurrent following initial antineoplastic therapy.
13.14 Lungs.
A. Non-small-cell carcinoma--inoperable, unresectable, recurrent, or metastatic disease
to or beyond the hilar nodes.
OR
B. Small-cell (oat cell) carcinoma.
13.15 Pleura or mediastinum.
A. Malignant mesothelioma of pleura.
OR
B. Tumors of the mediastinum, as described in 1 or 2:
1. With metastases to or beyond the regional lymph nodes.
2. Persistent or recurrent following initial antineoplastic therapy.
13.16 Esophagus or stomach.
A. Carcinoma or sarcoma of the esophagus.
OR
B. Carcinoma or sarcoma of the stomach, as described in 1 or 2:
1. Inoperable, unresectable, extending to surrounding structures, or recurrent.
2. With metastases to or beyond the regional lymph nodes.
13.17 Small intestine--carcinoma, sarcoma, or carcinoid.
A. Inoperable, unresectable, or recurrent.
OR
B. With metastases beyond the regional lymph nodes.
13.18 Large intestine (from ileocecal valve to and including
anal canal).
A. Adenocarcinoma that is inoperable, unresectable, or recurrent.
OR
B. Squamous cell carcinoma of the anus, recurrent after surgery.
OR
C. With metastases beyond the regional lymph nodes.
13.19 Liver or gallbladder--tumors of the liver, gallbladder, or bile ducts.
13.20 Pancreas.
A. Carcinoma (except islet cell carcinoma).
OR
B. Islet cell carcinoma that is inoperable or unresectable and physiologically active.
13.21 Kidneys, adrenal glands, or ureters--carcinoma.
A. Inoperable, unresectable, or recurrent.
OR
B. With metastases to or beyond the regional lymph nodes.
13.22 Urinary bladder--carcinoma.
A. With infiltration beyond the bladder wall.
OR
B. Recurrent after total cystectomy.
OR
C. Inoperable or unresectable.
OR
D. With metastases to or beyond the regional lymph nodes.
13.23 Cancers of the female genital tract--carcinoma or sarcoma.
A. Uterus (corpus), as described in 1, 2, or 3:
1. Invading adjoining organs.
2. With metastases to or beyond the regional lymph nodes.
3. Persistent or recurrent following initial antineoplastic therapy.
OR
B. Uterine cervix, as described in 1 or 2:
1. Extending to the pelvic wall, lower portion of the vagina, or adjacent or distant
organs.
2. Persistent or recurrent following initial antineoplastic therapy.
OR
C. Vulva, as described in 1, 2, or 3:
1. Invading adjoining organs.
2. With metastases to or beyond the regional lymph nodes.
3. Persistent or recurrent following initial antineoplastic therapy.
OR
D. Fallopian tubes, as described in 1 or 2:
1. Extending to the serosa or beyond.
2. Persistent or recurrent following initial antineoplastic therapy.
OR
E. Ovaries, as described in 1 or 2:
1. All tumors except germ-cell tumors, with at least one of the following:
a. Tumor extension beyond the pelvis; for example, tumor implants on peritoneal, omental,
or bowel surfaces.
b. Metastases to or beyond the regional lymph nodes.
c. Ruptured ovarian capsule, tumor on the serosal surface of the ovary, ascites with
malignant cells, or positive peritoneal washings.
d. Recurrent following initial antineoplastic therapy.
2. Germ-cell tumors--progressive or recurrent following initial antineoplastic therapy.
13.24 Prostate gland--carcinoma.
A. Progressive or recurrent despite initial hormonal intervention.
OR
B. With visceral metastases.
13.25 Testicles--tumor with metastatic disease progressive or recurrent following initial chemotherapy.
13.26 Penis--carcinoma with metastases to or beyond the regional lymph nodes.
13.27 Primary site unknown after appropriate search for primary--metastatic carcinoma or sarcoma, except for
solitary squamous cell carcinoma in the neck.
13.28 Malignant neoplastic diseases treated by bone marrow or stem cell transplantation. (See 13.00L.)
A. Allogeneic transplantation. Consider under a disability until at least 12 months
from the date of transplantation. Thereafter, evaluate any residual impairment(s)
under the criteria for the affected body system.
OR
B. Autologous transplantation. Consider under a disability until at least 12 months
from the date of the first treatment under the treatment plan that includes transplantation.
Thereafter, evaluate any residual impairment(s) under the criteria for the affected
body system.