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113.00 Neoplastic Diseases, Malignant

A. Introduction. Determination of disability in the growing and developingchild with a malignant neoplastic disease is based upon the combined effects of:

1. The pathophysiology, histology, and natural history of the tumor; and

2. The effects of the currently employed aggressive multimodal therapeuticregimens.

Combinations of surgery, radiation, and chemotherapy or prolonged therapeuticschedules impart significant additional morbidity to the child during the periodof greatest risk from the tumor itself. This period of highest risk andgreatest therapeutically-induced morbidity defines the limits of disability formost of childhood neoplastic disease.

B. Documentation. The diagnosis of neoplasm should be established on thebasis of symptoms, signs, and laboratory findings. The site of the primary,recurrent, and metastatic lesion must be specified in all cases of malignantneoplastic diseases. If an operative procedure has been performed, the evidenceshould include a copy of the operative note and the report of the gross andmicroscopic examination of the surgical specimen, along with all pertinentlaboratory and X-ray reports. The evidence should also include a recent reportdirected especially at describing whether there is evidence of local or regionalrecurrence, soft part or skeletal metastases, and significant post therapeuticresiduals.

C. Malignant solid tumors, as listed under 113.03, include the histiocytosissyndromes except for solitary eosinophilic granuloma. Thus, 113.03 should notbe used for evaluating brain tumors (see 111.05) or thyroid tumors, which mustbe evaluated on the basis of whether they are controlled by prescribed therapy.

D. Duration of disability from malignant neoplastic tumors is included in113.02 and 113.03. Following the time periods designated in these sections, adocumented diagnosis itself is no longer sufficient to establish a severeimpairment. The severity of a remaining impairment must be evaluated on thebasis of the medical evidence.

113.01 Category of Impairments, Neoplastic Diseases--Malignant

113.02 Lymphoreticular malignant neoplasms.

A. Hodgkin's disease with progressive disease not controlled by prescribedtherapy; or

B. Non-Hodgkin's lymphoma. Consider under a disability:

1. For 2 1/2 years from time of initial diagnosis; or

2. For 2 1/2 years from time of recurrence of active disease.

113.03 Malignant solid tumors. Consider under a disability:

A. For 2 years from the time of initial diagnosis; or

B. For 2 years from the time of recurrence of active disease.

113.04 Neuroblastoma. With one of the following:

A. Extension across the midline; or

B. Distant metastases; or

C. Recurrence; or

D. Onset at age 1 year or older.

113.05 Retinoblastoma. With one of the following:

A. Bilateral involvement; or

B. Metastases; or

C. Extension beyond the orbit; or

D. Recurrence.



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