NewAdultListingsb0 =?=?)TEXtREAdz`z`z` z`0z`@z`Pz``z` pz` z` z` z` z`z`z`z`z`z`z` z`( LISTING OF IMPAIRMENTS The body system listings in parts A and B of the Listing of Impairments will no longer be effective on the following dates unless extended by the Commissioner or revised and promulgated again. 1. Growth Impairment (100.00): July 2, 2003. 2. Musculoskeletal System (1.00 and 101.00): February 19, 2009. 3. Special Senses and Speech (2.00 and 102.00): July 2, 2003. 4. Respiratory System (3.00 and 103.00): July 2, 2003. 5. Cardiovascular System (4.00 and 104.00): July 2, 2003. 6. Digestive System (5.00 and 105.00): July 2, 2003. 7. Genito-Urinary System (6.00 and 106.00): July 2, 2003. 8. Hemic and Lymphatic System (7.00 and 107.00): July 2, 2003. 9. Skin (8.00): July 2, 2003. 10. Endocrine System (9.00 and 109.00): July 2, 2003. 11. Multiple Body Systems (10.00): June 19, 2008, and (110.00): July 2, 2003. 12. Neurological (11.00 and 111.00): July 2, 2003. 13. Mental Disorders (12.00 and 112.00): July 2, 2003. 14. Neoplastic Diseases, Malignant (13.00 and 113.00): July 2, 2003. 15. Immune System (14.00 and 114.00): July 2, 2003. Part A Criteria applicable to individuals age 18 and over and to children under age 18 where criteria are appropriate. Sec. 1.00 Musculoskeletal System. 2.00 Special Senses and Speech. 3.00 Respiratory System. 4.00 Cardiovascular System. 5.00 Digestive System. 6.00 Genito-Urinary System. 7.00 Hemic and Lymphatic System. 8.00 Skin. 9.00 Endocrine System. 10.00 Multiple Body Systems 11.00 Neurological. 12.00 Mental Disorders. 13.00 Neoplastic Diseases, Malignant. 14.00 Immune System. 1.00 MUSCULOSKELETAL SYSTEM 1.01 Category of Impairments, Musculoskeletal 1.02 Major dysfunction of a joint(s) (due to any cause): Characterized by gross anatomical deformity (e.g., subluxation, contracture, bony or fibrous ankylosis, instability) and chronic joint pain and stiffness with signs of limitation of motion or other abnormal motion of the affected joint(s), and findings on appropriate medically acceptable imaging of joint space narrowing, bony destruction, or ankylosis of the affected joint(s). With: A. Involvement of one major peripheral weight-bearing joint (i.e., hip, knee, or ankle), resulting in inability to ambulate effectively, as defined in 1.00B2b; or B. Involvement of one major peripheral joint in each upper extremity (i.e., shoulder, elbow, or wrist-hand), resulting in inability to perform fine and gross movements effectively, as defined in 1.00B2c. 1.03 Reconstructive surgery or surgical arthrodesis of a major weight-bearing joint, with inability to ambulate effectively, as defined in 1.00B2b, and return to effective ambulation did not occur, or is not expected to occur, within 12 months of onset. 1.04 Disorders of the spine (e.g., herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis, vertebral fracture), resulting in compromise of a nerve root (including the cauda equina) or the spinal cord. With: A. Evidence of nerve root compression characterized by neuro-anatomic distribution of pain, limitation of motion of the spine, motor loss (atrophy with associated muscle weakness or muscle weakness) accompanied by sensory or reflex loss and, if there is involvement of the lower back, positive straight-leg raising test (sitting and supine); or B. Spinal arachnoiditis, confirmed by an operative note or pathology report of tissue biopsy, or by appropriate medically acceptable imaging, manifested by severe burning or painful dysesthesia, resulting in the need for changes in position or posture more than once every 2 hours; or C. Lumbar spinal stenosis resulting in pseudoclaudication, established by findings on appropriate medically acceptable imaging, manifested by chronic nonradicular pain and weakness, and resulting in inability to ambulate effectively, as defined in 1.00B2b. 1.05 Amputation (due to any cause). A. Both hands; or or B. One or both lower extremities at or above the tarsal region, with stump complications resulting in medical inability to use a prosthetic device to ambulate effectively, as defined in 1.00B2b, which have lasted or are expected to last for at least 12 months; or C. One hand and one lower extremity at or above the tarsal region, with inability to ambulate effectively, as defined in 1.00B2b; OR D. Hemipelvectomy or hip disarticulation. 1.06 Fracture of the femur, tibia, pelvis, or one or more of the tarsal bones. With: A. Solid union not evident on appropriate medically acceptable imaging and not clinically solid; and B. Inability to ambulate effectively, as defined in 1.00B2b, and return to effective ambulation did not occur or is not expected to occur within 12 months of onset. 1.07 Fracture of an upper extremity with nonunion of a fracture of the shaft of the humerus, radius, or ulna, under continuing surgical management, as defined in 1.00M, directed toward restoration of functional use of the extremity, and such function was not restored or expected to be restored within 12 months of onset. 1.08 Soft tissue injury (e.g., burns) of an upper or lower extremity, trunk, or face and head, under continuing surgical management, as defined in 1.00M, directed toward the salvage or restoration of major function, and such major function was not restored or expected to be restored within 12 months of onset. Major function of the face and head is described in 1.000. 2.00 SPECIAL SENSES AND SPEECH 2.01 Category of Impairments, Special Senses and Speech 2.02 Impairment of visual acuity. Remaining vision in the better eye after best correction is 20/200 or less. 2.03 Contraction of peripheral visual fields in the better eye. A. To 10 degrees or less from the point of fixation; or B. So the widest diameter subtends an angle no greater than 20 degrees; or C. To 20 percent or less visual field efficiency. 2.04 Loss of visual efficiency. The visual efficiency of the better eye after best correction is 20 percent or less. (The percent of remaining visual efficiency is equal to the product of the percent of remaining visual acuity efficiency and the percent of remaining visual field efficiency.) 2.05 [Reserved.] 2.06 Total bilateral ophthalmoplegia. 2.07 Disturbance of labyrinthine-vestibular function (including Meniere's disease), characterized by a history of frequent attacks of balance disturbance, tinnitus, and progressive loss of hearing. With both A and B: A. Disturbed function of vestibular labyrinth demonstrated by caloric or other vestibular tests; and B. Hearing loss established by audiometry. 2.08 Hearing impairments (hearing not restorable by a hearing aid) manifested by: A. Average hearing threshold sensitivity for air conduction of 90 decibels or greater and for bone conduction to corresponding maximal levels, in the better ear, determined by the simple average of hearing threshold levels at 500, 1000 and 2000 hz. (see 2.00B1); or B. Speech discrimination scores of 40 percent or less in the better ear; 2.09 Loss of speech due to any cause, with inability to produce by any means speech that can be heard, understood, or sustained. TABLE NO. 1 -- PERCENTAGE OF VISUAL ACUITY EFFICIENCY CORRESPONDING TO VISUAL ACUITY NOTATIONS FOR DISTANCE IN THE PHAKIC AND APHAKIC EYE (BETTER EYE) Snellen PERCENT VISUAL ACUITY EFFICIENCY Aphakic Aphakic English Metric Phakic fn1 monocu- binocu- lar fn2 lar fn3 20/16 6/5 100 50 75 20/20 6/6 100 50 75 20/25 6/7.5 95 47 71 20/32 6/10 90 45 67 20/40 6/12 85 42 64 20/50 6/15 75 37 56 20/64 6/20 65 32 49 20/80 6/24 60 30 45 20/100 6/30 50 25 37 20/125 6/38 40 20 30 20/160 6/48 30 22 20/200 6/60 20 Column and Use. fn1 Phakic. -- 1. A lens is present in both eyes. 2. A lens is present in the better eye and absent in the poorer eye. 3. A lens is present in one eye and the other eye is enucleated. fn2 Monocular. -- 1. A lens is absent in the better eye and present in the poorer eye. 2. The lenses are absent in both eyes; however, the visual acuity in the poorer eye after best correction in 20/200 or less. 3. A lens is absent from one eye and the other eye is enucleated. fn3 Binocular. -- 1. The lenses are absent from both eyes and the visual acuity in the poorer eye after best correction is greater than 20/200. Display Image Table No. 2 -- Chart of Visual Field Showing Extent of Normal Field and Method of Computing Percent of Visual Field Efficiency 1. Diagram of right eye illustrates extent of normal visual field as tested on standard perimeter at 3/330 (3 mm. white disc at a distance of 330 mm.) under 7 foot-candles illumination. The sum of the eight principal meridians of this field total 500 degrees. 2. The percent of visual field efficiency is obtained by adding the number of degrees of the eight principal meridians of the contracted field and dividing by 500. Diagram of left eye illustrates visual field contracted to 30 degrees in the temporal and down and out meridians and to 20 degrees in the remaining six meridians. The percent of visual field efficiency of this field is: 6 X 20 + 2 X 30 = 180 / 500 = 0.36 or 36 percent remaining visual field efficiency, or 64 percent loss. 3.00 RESPIRATORY SYSTEM 3.01 Category of Impairments, Respiratory System. 3.02 Chronic pulmonary insufficiency. A. Chronic obstructive pulmonary disease, due to any cause, with the FEV[1] equal to or less than the values specified in table I corresponding to the person's height without shoes. (In cases of marked spinal deformity, see 3.00E.); TABLE I FEV [1] Height without equal to shoes (centi- Height without or less meters) shoes (inches) than (L, BTPS) 154 or less 60 or less 1.05 155-160 61-63 1.15 161-165 64-65 1.25 166-170 66-67 1.35 171-175 68-69 1.45 176-180 70-71 1.55 181 or more 75 or more 1.65 Or B. Chronic restrictive ventilatory disease, due to any cause, with the FVC equal to or less than the values specified in Table II corresponding to the person's height without shoes. (In cases of marked spinal deformity, see 3.00E.); TABLE II FVC Height without equal to shoes (centi- Height without or less meters) shoes (inches) than (L, BTPS) 154 or less 60 or less 1.25 155-160 61-63 1.35 161-165 64-65 1.45 166-170 66-67 1.55 171-175 68-69 1.65 176-180 70-71 1.75 181 or more 72 or more 1.85 Or C. Chronic impairment of gas exchange due to clinically documented pulmonary disease. With: 1. Single breath DLCO (see 3.00F1) less than 10.5 ml/min/mm Hg or less than 40 percent of the predicted normal value. (Predicted values must either be based on data obtained at the test site or published values from a laboratory using the same technique as the test site. The source of the predicted values should be reported. If they are not published, they should be submitted in the form of a table or nomogram); or 2. Arterial blood gas values of PO [2] and simultaneously determined PCO [2] measured while at rest (breathing room air, awake and sitting or standing) in a clinically stable condition on at least two occasions, three or more weeks apart within a 6-month period, equal to or less than the values specified in the applicable table III-A or III-B or III-C: TABLE III -- A [Applicable at test sites less than 3,000 feet above sea level] Arterial PO[2] equal to or Arterial PCO[2] (mm. Hg) and less than (mm. Hg) 30 or below 65 31 64 32 63 33 62 34 61 35 60 36 59 37 58 38 57 39 56 40 or above 55 TABLE III -- B [Applicable at test sites 3,000 through 6,000 feet above sea level] Arterial PO[2] equal to or Arterial PCO[2] (mm. Hg) and less than (mm. Hg) 30 or below 60 31 59 32 58 33 57 34 56 35 55 36 54 37 53 38 52 39 51 40 or above 50 TABLE III -- C [Applicable at test sites over 6,000 feet above sea level] Arterial PO[2] or equal to or Arterial PCO[2] (mm. Hg) and less than (mm. Hg) 30 or below 55 31 54 32 53 33 52 34 51 35 50 36 49 37 48 38 47 39 46 40 or above 45 Or 3. Arterial blood gas values of PO [2] and simultaneously determined PCO [2] during steady state exercise breathing room air (level of exercise equivalent to or less than 17.5 ml O [2] consumption/kg/min or 5 METs) equal to or less than the values specified in the applicable table III-A or III-B or III-C in 3.02C2. 3.03 Asthma. With: A. Chronic asthmatic bronchitis. Evaluate under the criteria for chronic obstructive pulmonary disease in 3.02A; Or B. Attacks (as defined in 3.00C), in spite of prescribed treatment and requiring physician intervention, occurring at least once every 2 months or at least six times a year. Each in-patient hospitalization for longer than 24 hours for control of asthma counts as two attacks, and an evaluation period of at least 12 consecutive months must be used to determine the frequency of attacks. 3.04 Cystic fibrosis. With: A. An FEV [1] equal to or less than the appropriate value specified in table IV corresponding to the individual's height without shoes. (In cases of marked spinal deformity, see 3.00E.); Or B. Episodes of bronchitis or pneumonia or hemoptysis (more than blood-streaked sputum) or respiratory failure (documented according to 3.00C), requiring physician intervention, occurring at least once every 2 months or at least six times a year. Each inpatient hospitalization for longer than 24 hours for treatment counts as two episodes, and an evaluation period of at least 12 consecutive months must be used to determine the frequency of episodes; Or C. Persistent pulmonary infection accompanied by superimposed, recurrent, symptomatic episodes of increased bacterial infection occurring at least once every 6 months and requiring intravenous or nebulization antimicrobial therapy. TABLE IV [Applicable only for evaluation under 3.04A -- cystic fibrosis] FEV[1] equal to or Height without Height without less than shoes (centimeters) shoes (inches) (L, BTPS) 154 or less 60 or less 1.45 155-159 61-62 1.55 160-164 63-64 1.65 165-169 65-66 1.75 170-174 67-68 1.85 175-179 69-70 1.95 180 or more 71 or more 2.05 3.05 [Reserved] 3.06 Pneumoconiosis (demonstrated by appropriate imaging techniques). Evaluate under the appropriate criteria in 3.02. 3.07 Bronchiectasis (demonstrated by appropriate imaging techniques). With: A. Impairment of pulmonary function due to extensive disease. Evaluate under the appropriate criteria in 3.02; Or B. Episodes of bronchitis or pneumonia or hemoptysis (more than blood-streaked sputum) or respiratory failure (documented according to 3.00C), requiring physician intervention, occurring at least once every 2 months or at least six times a year. Each in-patient hospitalization for longer than 24 hours for treatment counts as two episodes, and an evaluation of at least 12 consecutive months must be used to determine the frequency of episodes. 3.08 Mycobacterial, mycotic, and other chronic persistent infections of the lung (see 3.00B). Evaluate under the appropriate criteria in 3.02. 3.09 Cor pulmonale secondary to chronic pulmonary vascular hypertension. Clinical evidence of cor pulmonale (documented according to 3.00G) with: A. Mean pulmonary artery pressure greater than 40 mm Hg; Or B. Arterial hypoxemia. Evaluate under the criteria in 3.02C2; Or C. Evaluate under the applicable criteria in 4.02. 3.10 Sleep-related breathing disorders. Evaluate under 3.09 (chronic cor pulmonale) or 12.02 (organic mental disorders). 3.11 Lung transplant. Consider under a disability for 12 months following the date of surgery; thereafter, evaluate the residual impairment. 4.00 CARDIOVASCULAR SYSTEM 4.01 Category of Impairments, Cardiovascular System 4.02 Chronic heart failure while on a regimen of prescribed treatment (see 4.00A if there is no regimen of prescribed treatment). With one of the following: A. Documented cardiac enlargement by appropriate imaging techniques (e.g., a cardiothoracic ratio of greater than 0.50 on a PA chest x-ray with good inspiratory effort or left ventricular diastolic diameter of greater than 5.5 cm on two-dimensional echocardiography), resulting in inability to carry on any physical activity, and with symptoms of inadequate cardiac output, pulmonary congestion, systemic congestion, or anginal syndrome at rest (e.g., recurrent or persistent fatigue, dyspnea, orthopnea, anginal discomfort); OR B. Documented cardiac enlargement by appropriate imaging techniques (see 4.02A) or ventricular dysfunction manifested by S3, abnormal wall motion, or left ventricular ejection fraction of 30 percent or less by appropriate imaging techniques; and 1. Inability to perform on an exercise test at a workload equivalent to 5 METs or less due to symptoms of chronic heart failure, or, in rare instances, a need to stop exercise testing at less than this level of work because of: a. Three or more consecutive ventricular premature beats or three or more multiform beats; or b. Failure to increase systolic blood pressure by 10 mmHg, or decrease in systolic pressure below the usual resting level (see 4.00C2b); or c. Signs attributable to inadequate cerebral perfusion, such as ataxic gait or mental confusion; and 2. Resulting in marked limitation of physical activity, as demonstrated by fatigue, palpitation, dyspnea, or anginal discomfort on ordinary physical activity, even though the individual is comfortable at rest; OR C. Cor pulmonale fulfilling the criteria in 4.02A or B. 4.03 Hypertensive cardiovascular disease. Evaluate under 4.02 or 4.04, or under the criteria for the affected body system (2.02 through 2.04, 6.02, or 11.04A or B). 4.04 Ischemic heart disease, with chest discomfort associated with myocardial ischemia, as described in 4.00E3, while on a regimen of prescribed treatment (see 4.00A if there is no regimen of prescribed treatment). With one of the following: A. Sign- or symptom-limited exercise test demonstrating at least one of the following manifestations at a workload equivalent to 5 METs or less: 1. Horizontal or downsloping depression, in the absence of digitalis glycoside therapy and/or hypokalemia, of the ST segment of at least -0.10 millivolts (-1.0 mm) in at least 3 consecutive complexes that are on a level baseline in any lead (other than aVR) and that have a typical ischemic time course of development and resolution (progression of horizontal or downsloping ST depression with exercise, and persistence of depression of at least -0.10 millivolts for at least 1 minute of recovery); or 2. An upsloping ST junction depression, in the absence of digitalis glycoside therapy and/or hypokalemia, in any lead (except aVR) of at least -0.2 millivolts or more for at least 0.08 seconds after the J junction and persisting for at least 1 minute of recovery; or 3. At least 0.1 millivolt (1 mm) ST elevation above resting baseline during both exercise and 3 or more minutes of recovery in ECG leads with low R and T waves in the leads demonstrating the ST segment displacement; or 4. Failure to increase systolic pressure by 10 mmHg, or decrease in systolic pressure below usual clinical resting level (see 4.00C2b); or 5. Documented reversible radionuclide "perfusion" (thallium <201>) defect at an exercise level equivalent to 5 METs or less; OR B. Impaired myocardial function, documented by evidence (as outlined under 4.00C3 or 4.00C4b) of hypokinetic, akinetic, or dyskinetic myocardial free wall or septal wall motion with left ventricular ejection fraction of 30 percent or less, and an evaluating program physician, preferably one experienced in the care of patients with cardiovascular disease, has concluded that performance of exercise testing would present a significant risk to the individual, and resulting in marked limitation of physical activity, as demonstrated by fatigue, palpitation, dyspnea, or anginal discomfort on ordinary physical activity, even though the individual is comfortable at rest; OR C. Coronary artery disease, demonstrated by angiography (obtained independent of Social Security disability evaluation), and an evaluating program physician, preferably one experienced in the care of patients with cardiovascular disease, has concluded that performance of exercise testing would present a significant risk to the individual, with both 1 and 2: 1. Angiographic evidence revealing: a. 50 percent or more narrowing of a nonbypassed left main coronary artery; or b. 70 percent or more narrowing of another nonbypassed coronary artery; or c. 50 percent or more narrowing involving a long (greater than 1 cm) segment of a nonbypassed coronary artery; or d. 50 percent or more narrowing of at least 2 nonbypassed coronary arteries; or e. Total obstruction of a bypass graft vessel; and 2. Resulting in marked limitation of physical activity, as demonstrated by fatigue, palpitation, dyspnea, or anginal discomfort on ordinary physical activity, even though the individual is comfortable at rest. 4.05 Recurrent arrhythmias, not related to reversible causes such as electrolyte abnormalities or digitalis glycoside or antiarrhythmic drug toxicity, resulting in uncontrolled repeated episodes of cardiac syncope or near syncope and arrhythmia despite prescribed treatment (see 4.00A if there is no prescribed treatment), documented by resting or ambulatory (Holter) electrocardiography coincident with the occurrence of syncope or near syncope. 4.06 Symptomatic congenital heart disease (cyanotic or acyanotic), documented by appropriate imaging techniques (as outlined under 4.00C3) or cardiac catheterization. With one of the following: A. Cyanosis at rest, and: 1. Hematocrit of 55 percent or greater, or 2. Arterial O [2] saturation of less than 90 percent in room air, or resting arterial PO [2] of 60 Torr or less; OR B. Intermittent right-to-left shunting resulting in cyanosis on exertion (e.g., Eisenmenger's physiology) and with arterial PO [2] of 60 Torr or less at a workload equivalent to 5 METs or less; OR C. Chronic heart failure with evidence of ventricular dysfunction, as described in 4.02; OR D. Recurrent arrhythmias as described in 4.05; OR E. Secondary pulmonary vascular obstructive disease with a mean pulmonary arterial pressure elevated to at least 70 percent of the mean systemic arterial pressure. 4.07 Valvular heart disease or other stenotic defects, or valvular regurgitation, documented by appropriate imaging techniques or cardiac catheterization. Evaluate under the criteria in 4.02, 4.04, 4.05, or 11.04. 4.08 Cardiomyopathies, documented by appropriate imaging techniques or cardiac catheterization. Evaluate under the criteria in 4.02, 4.04, 4.05, or 11.04. 4.09 Cardiac transplantation. Consider under a disability for 1 year following surgery; thereafter, reevaluate residual impairment under 4.02 to 4.08. 4.10 Aneurysm of aorta or major branches, due to any cause (e.g., atherosclerosis, cystic medial necrosis, Marfan syndrome, trauma), demonstrated by an appropriate imaging technique. With one of the following: A. Acute or chronic dissection not controlled by prescribed medical or surgical treatment; OR B. Chronic heart failure as described under 4.02; OR C. Renal failure as described under 6.02; OR D. Neurological complications as described under 11.04. 4.11 Chronic venous insufficiency of a lower extremity. With incompetency or obstruction of the deep venous system and one of the following: A. Extensive brawny edema; OR B. Superficial varicosities, stasis dermatitis, and recurrent or persistent ulceration which has not healed following at least 3 months of prescribed medical or surgical therapy. 4.12 Peripheral arterial disease. With one of the following: A. Intermittent claudication with failure to visualize (on arteriogram obtained independent of Social Security disability evaluation) the common femoral or deep femoral artery in one extremity; or B. Intermittent claudication with marked impairment of peripheral arterial circulation as determined by Doppler studies showing: 1. Resting ankle/brachial systolic blood pressure ratio of less than 0.50; or 2. Decrease in systolic blood pressure at the ankle on exercise (see 4.00E4) of 50 percent or more of pre-exercise level at the ankle, and requiring 10 minutes or more to return to pre-exercise level. 5.00 DIGESTIVE SYSTEM 5.01 Category of Impairments, Digestive System 5.02 Recurrent upper gastrointestinal hemorrhage from undetermined cause with anemia manifested by hematocrit of 30 percent or less on repeated examinations. 5.03 Stricture, stenosis, or obstruction of the esophagus (demonstrated by endoscopy or other appropriate medically acceptable imaging) with weight loss as described under listing 5.08. 5.04 Peptic ulcer disease (demonstrated by endoscopy or other appropriate medically acceptable imaging). With: A. Recurrent ulceration after definitive surgery persistent despite therapy; or B. Inoperable fistula formation; or C. Recurrent obstruction demonstrated by endoscopy or other appropriate medically acceptable imaging; or, D. Weight loss as described under 5.08. 5.05 Chronic liver disease (e.g., portal, postnecrotic, or biliary cirrhosis; chronic active hepatitis; Wilson's disease). With: A. Esophageal varices (demonstrated by endoscopy or other appropriate medically acceptable imaging) with a documented history of massive hemorrhage attributable to these varices. Consider under a disability for 3 years following the last massive hemorrhage; thereafter, evaluate the residual impairment; or B. Performance of a shunt operation for esophageal varices. Consider under a disability for 3 years following surgery; thereafter, evaluate the residual impairment; or C. Serum bilirubin of 2.5 mg. per deciliter (100 ml.) or greater persisting on repeated examinations for at least 5 months; or D. Ascites, not attributable to other causes, recurrent or persisting for at least 5 months, demonstrated by abdominal paracentesis or associated with persistent hypoalbuminemia of 3.0 gm. per deciliter (100 ml.) or less; or E. Hepatic encephalopathy. Evaluate under the criteria in listing 12.02; or F. Confirmation of chronic liver disease by liver biopsy (obtained independent of Social Security disability evaluation) and one of the following: 1. Ascites not attributable to other causes, recurrent or persisting for at least 3 months, demonstrated by abdominal paracentesis or associated with persistent hypoalbuminemia of 3.0 gm. per deciliter (100 ml.) or less; or 2. Serum bilirubin of 2.5 mg. per deciliter (100 ml) or greater on repeated examinations for at least 3 months; or 3. Hepatic cell necrosis or inflammation, persisting for at least 3 months, documented by repeated abnormalities of prothrombin time and enzymes indicative of hepatic dysfunction. 5.06 Chronic ulcerative or granulomatous colitis (demonstrated by endoscopy, barium enema, biopsy, or operative findings). With: A. Recurrent bloody stools documented on repeated examinations and anemia manifested by hematocrit of 30 percent or less on repeated examinations; or B. Persistent or recurrent systemic manifestations, such as arthritis, iritis, fever, or liver dysfunction, not attributable to other causes; or C. Intermittent obstruction due to intractable abscess, fistula formation, or stenosis; or D. Recurrence of findings of A, B, or C above after total colectomy; or E. Weight loss as described under 5.08. 5.07 Regional enteritis (demonstrated by operative findings, barium studies, biopsy, or endoscopy). With: A. Persistent or recurrent intestinal obstruction evidenced by abdominal pain, distention, nausea, and vomiting and accompanied by stenotic areas of small bowel with proximal intestinal dilation; or B. Persistent or recurrent systemic manifestations such as arthritis, iritis, fever, or liver dysfunction, not attributable to other causes; or C. Intermittent obstruction due to intractable abscess or fistula formation; or D. Weight loss as described under 5.08. 5.08 Weight loss due to any persisting gastrointestinal disorder: (The following weights are to be demonstrated to have persisted for at least 3 months despite prescribed therapy and expected to persist at this level for at least 12 months.) With: A. Weight equal to or less than the values specified in Table I or II; or B. Weight equal to or less than the values specified in Table III or IV and one of the following abnormal findings on repeated examinations: 1. Serum albumin of 3.0 gm. per deciliter (100 ml.) or less; or 2. Hematocrit of 30 percent or less; or 3. Serum calcium of 8.0 mg. per deciliter (100 ml.) (4.0 mEq./L) or less; or 4. Uncontrolled diabetes mellitus due to pancreatic dysfunction with repeated hyperglycemia, hypoglycemia, or ketosis; or 5. Fat in stool of 7 gm. or greater per 24-hour stool specimen; or 6. Nitrogen in stool of 3 gm, or greater per 24-hour specimen; or 7. Persistent or recurrent ascites or edema not attributable to other causes. Tables of weight reflecting malnutrition scaled according to height and sex -- To be used only in connection with 5.08. TABLE I -- MEN Height (inches) fn1 Weight (pounds) 61 90 62 92 63 94 64 97 65 99 66 102 67 106 68 109 69 112 70 115 71 118 72 122 73 125 74 128 75 131 76 134 fn1 Height measured without shoes. TABLE II -- WOMEN Height (inches) fn1 Weight (pounds) 58 77 59 79 60 82 61 84 62 86 63 89 64 91 65 94 66 98 67 101 68 104 69 107 70 110 71 114 72 117 73 120 fn1 Height measured without shoes. TABLE III -- MEN Height (inches) fn1 Weight (pounds) 61 95 62 98 63 100 64 103 65 106 66 109 67 112 68 116 69 119 70 122 71 126 72 129 73 133 74 136 75 139 76 143 fn1 Height measured without shoes. TABLE IV -- WOMEN Height (inches) fn1 Weight (pounds) 58 82 59 84 60 87 61 89 62 92 63 94 64 97 65 100 66 104 67 107 68 111 69 114 70 117 71 121 72 124 73 128 fn1 Height measured without shoes. 5.09 Liver transplant. Consider under a disability for 12 months following the date of surgery; thereafter, evaluate the residual impairment(s). 6.00 GENITO-URINARY SYSTEM 6.01 Category of Impairments, Genito-Urinary System 6.02 Impairment of renal function, due to any chronic renal disease expected to last 12 months (e.g., hypertensive vascular disease, chronic nephritis, nephrolithiasis, polycystic disease, bilateral hydronephrosis, etc.) With: A. Chronic hemodialysis or peritoneal dialysis necessitated by irreversible renal failure; or B. Kidney transplant. Consider under a disability for 12 months following surgery; thereafter, evaluate the residual impairment (see 6.00C); or C. Persistent elevation of serum creatine in to 4 mg. per deciliter (100 ml.) or greater or reduction of creatinine clearance to 20 ml. per minute (29 liters/24 hours) or less, over at least 3 months, with one of the following: 1. Renal osteodystrophy manifested by severe bone pain and abnormalities shown by appropriate medically acceptable imaging (e.g., osteitis fibrosa, marked osteoporosis, pathologic fractures); or 2. A clinical episode of pericarditis; or 3. Persistent motor or sensory neuropathy; or 4. Intractable pruritus; or 5. Persistent fluid overload syndrome resulting in diastolic hypertension (110 mm. or above) or signs of vascular congestion; or 6. Persistent anorexia with recent weight loss and current weight meeting the values in 5.08, Table III or IV; or 7. Persistent hematocrits of 30 percent or less. 6.06 Nephrotic syndrome, with significant anasarca, persistent for at least 3 months despite prescribed therapy. With: A. Serum albumin of 3.0 gm. per deciler (100 ml.) or less and protenuria of 3.5 gm. per 24 hours or greater; or B. Proteinuria of 10.0 gm. per 24 hours or greater. 7.00 HEMIC AND LYMPHATIC SYSTEM 7.01 Category of Impairments, Hemic and Lymphatic System 7.02 Chronic anemia (hematocrit persisting at 30 percent or less due to any cause). With: A. Requirement of one or more blood transfusions on an average of at least once every 2 months; or B. Evaluation of the resulting impairment under criteria for the affected body system. 7.05 Sickle cell disease, or one of its variants. With: A. Documented painful (thrombotic) crises occurring at least three times during the 5 months prior to adjudication; or B. Requiring extended hospitalization (beyond emergency care) at least three times during the 12 months prior to adjudication; or C. Chronic, severe anemia with persistence of hematocrit of 26 percent or less; or D. Evaluate the resulting impairment under the criteria for the affected body system. 7.06 Chronic thrombocytopenia (due to any cause) with platelet counts repeatedly below 40,000/cubic millimeter. With: A. At least one spontaneous hemorrhage, requiring transfusion, within 5 months prior to adjudication; or B. Intracranial bleeding within 12 months prior to adjudication. 7.07 Hereditary telangiectasia with hemorrhage requiring transfusion at least three times during the 5 months prior to adjudication. 7.08 Coagulation defects (hemophilia or a similar disorder) with spontaneous hemorrhage requiring transfusion at least three times during the 5 months prior to adjudication. 7.09 Polycythemia vera (with erythrocytosis, splenomegaly, and leukocytosis or thrombocytosis). Evaluate the resulting impairment under the criteria for the affected body system. 7.10 Myelofibrosis (myeloproliferative syndrome). With: A. Chronic anemia. Evaluate according to the criteria of 7.02; or B. Documented recurrent systemic bacterial infections occurring at least 3 times during the 5 months prior to adjudication; or C. Intractable bone pain with radiologic evidence of osteosclerosis. 7.11 Acute leukemia (including T-cell lymphoblastic lymphoma). Consider under a disability for 2 1/2 years from the time of initial diagnosis. 7.12 Chronic leukemia. Evaluate according to the criteria of 7.02, 7.06, 7.10B, 7.11, 7.17, or 13.06A. 7.13 Lymphomas. Evaluate under the criteria in 13.06A. 7.14 Macroglobulinemia or heavy chain disease, confirmed by serum or urine protein electrophoresis or immunoelectrophoresias. Evaluate impairment under criteria for affected body system or under 7.02, 7.06, or 7.08. 7.15 Chronic granulocytopenia (due to any cause). With both A and B: A. Absolute neutrophil counts repeatedly below 1,000 cells/cubic millimeter; and B. Documented recurrent systemic bacterial infections occurring at least 3 times during the 5 months prior to adjudication. 7.16 Multiple myeloma (confirmed by appropriate serum or urine protein electrophoresis and bone marrow findings). With: A. Appropriate medically acceptable imaging evidence of bony involvement with intractable bone pain; or B. Evidence of renal impairment as described in 6.02; or C. Hypercalcemia with serum calcium levels persistently greater than 11 mg. per deciliter (100 ml.) for at least 1 month despite prescribed therapy; or D. Plasma cells (100 or more cells/cubic millimeter) in the peripheral blood. 7.17 Aplastic anemias or hematologic malignancies (excluding acute leukemia and T-cell lymphoblastic lymphoma): With bone marrow or stem cell transplantation. Consider under a disability for 12 months following transplantation; thereafter, evaluate according to the primary characteristics of the residual impairment. 8.00 SKIN 8.01 Category of Impairments, Skin 8.02 Exfoliative dermatitis, ichthyosis, ichthyosiform erythroderma. With extensive lesions not responding to prescribed treatment. 8.03 Pemphigus, erythema multiforme bullosum, bullous pemphigoid, dermatitis herpetiformis. With extensive lesions not responding to prescribed treatment. 8.04 Deep mycotic infections. With extensive fungating, ulcerating lesions not responding to prescribed treatment. 8.05 Psoriasis, atopic dermatitis, dyshidrosis. With extensive lesions, including involvement of the hands or feet which impose a marked limitation of function and which are not responding to prescribed treatment. 8.06 Hidradenitis suppurativa, acne conglobata. With extensive lesions involving the axillae or perineum not responding to prescribed medical treatment and not amendable to surgical treatment. 9.00 ENDOCRINE SYSTEM 9.01 Category of Impairments, Endocrine System 9.02 Thyroid Disorders. Evaluate the resulting impairment under the criteria for the affected body system. 9.03 Hyperparathyroidism. With: A. Generalized decalcification of bone on appropriate medically acceptable imaging study and elevation of plasma calcium to 11 mg. per deciliter (100 ml.) or greater; or B. A resulting impairment. Evaluate according to the criteria in the affected body system. 9.04 Hypoparathyroidism. With: A. Severe recurrent tetany; or B. Recurrent generalized convulsions; or C. Lenticular cataracts. Evaluate under the criteria in 2.00ff. 9.05 Neurohypophyseal insufficiency (diabetes insipidus). With urine specific gravity of 1.005 or below, persistent for at least 3 months and recurrent dehydration. 9.06 Hyperfunction of the adrenal cortex. Evaluate the resulting impairment under the criteria for the affected body system. 9.08 Diabetes mellitus. With: A. Neuropathy demonstrated by significant and persistent disorganization of motor function in two extremities resulting in sustained disturbance of gross and dexterous movements, or gait and station (see 11.00C); or B. Acidosis occurring at least on the average of once every 2 months documented by appropriate blood chemical tests (pH or pCO2 or bicarbonate levels); or C. Retinitis proliferans; evaluate the visual impairment under the criteria in 2.02, 2.03, or 2.04. 10.00 MULTIPLE BODY SYSTEMS 10.01 Category of Impairments, Multiple Body Systems 10.06 Down syndrome (excluding mosaic Down syndrome) established by clinical and laboratory findings, as described in 10.00B. Consider the individual disabled from birth. 11.00 NEUROLOGICAL 11.01 Category of Impairments, Neurological 11.02 Epilepsy -- convulsive epilepsy, (grand mal or psychomotor), documented by detailed description of a typical seizure pattern, including all associated phenomena; occurring more frequently than once a month in spite of at least 3 months of prescribed treatment. With: A. Daytime episodes (loss of consciousness and convulsive seizures) or B. Nocturnal episodes manifesting residuals which interfere significantly with activity during the day. 11.03 Epilepsy -- nonconvulsive epilepsy (petit mal, psychomotor, or focal), documented by detailed description of a typical seizure pattern, including all associated phenomena; occurring more frequently than once weekly in spite of at least 3 months of prescribed treatment. With alteration of awareness or loss of consciousness and transient postictal manifestations of unconventional behavior or significant interference with activity during the day. 11.04 Central nervous system vascular accident. With one of the following more than 3 months post-vascular accident: A. Sensory or motor aphasia resulting in ineffective speech or communication; or B. Significant and persistent disorganization of motor function in two extremities, resulting in sustained disturbance of gross and dexterous movements, or gait and station (see 11.00C). 11.05 Brain tumors. A. Malignant gliomas (astrocytoma -- grades III and IV, glioblastoma multiforme), medulloblastoma, ependymoblastoma, or primary sarcoma; or B. Astrocytoma (grades I and II), meningioma, pituitary tumors, oligodendroglioma, ependymoma, clivus chordoma, and benign tumors. Evaluate under 11.02, 11.03, 11.04 A, or B, or 12.02. 11.06 Parkinsonian syndrome with the following signs: Significant rigidity, brady kinesia, or tremor in two extremities, which, singly or in combination, result in sustained disturbance of gross and dexterous movements, or gait and station. 11.07 Cerebral palsy. With: A. IQ of 70 or less; or B. Abnormal behavior patterns, such as destructiveness or emotional instability: or C. Significant interference in communication due to speech, hearing, or visual defect; or D. Disorganization of motor function as described in 11.04B. 11.08 Spinal cord or nerve root lesions, due to any cause with disorganization of motor function as described in 11.04B. 11.09 Multiple sclerosis. With: A. Disorganization of motor function as described in 11.04B; or B. Visual or mental impairment as described under the criteria in 2.02, 2.03, 2.04, or 12.02; or C. Significant, reproducible fatigue of motor function with substantial muscle weakness on repetitive activity, demonstrated on physical examination, resulting from neurological dysfunction in areas of the central nervous system known to be pathologically involved by the multiple sclerosis process. 11.10 Amyotrophic lateral sclerosis. With: A. Significant bulbar signs; or B. Disorganization of motor function as described in 11.04B. 11.11 Anterior poliomyelitis. With: A. Persistent difficulty with swallowing or breathing; or B. Unintelligible speech; or C. Disorganization of motor function as described in 11.04B. 11.12 Myasthenia gravis. With: A. Significant difficulty with speaking, swallowing, or breathing while on prescribed therapy; or B. Significant motor weakness of muscles of extremities on repetitive activity against resistance while on prescribed therapy. 11.13 Muscular dystrophy with disorganization of motor function as described in 11.04B. 11.14 Peripheral neuropathies. With disorganization of motor function as described in 11.04B, in spite of prescribed treatment. 11.15 [Reserved.] 11.16 Subacute combined cord degeneration (pernicious anemia) with disorganization of motor function as described in 11.04B or 11.15B, not significantly improved by prescribed treatment. 11.17 Degenerative disease not elsewhere such as Huntington's chorea, Friedreich's ataxia, and spino-cerebellar degeneration. With: A. Disorganization of motor function as described in 11.04B; or B. Chronic brain syndrome. Evaluate under 12.02. 11.18 Cerebral trauma: Evaluate under the provisions of 11.02, 11.03, 11.04 and 12.02, as applicable. 11.19 Syringomyelia. With: A. Significant bulbar signs; or B. Disorganization of motor function as described in 11.04B. 12.00 MENTAL DISORDERS 12.01 Category of Impairments -- Mental 12.02 Organic Mental Disorders: Psychological or behaviorial abnormalities associated with a dysfunction of the brain. History and physical examination or laboratory tests demonstrate the presence of a specific organic factor judged to be etiologically related to the abnormal mental state and loss of previously acquired functional abilities. The required level of severity for these disorders is met when the requirements in both A and B are satisfied, or when the requirements in C are satisfied. A. Demonstration of a loss of specific cognitive abilities or affective changes and the medically documented persistence of at least one of the following: 1. Disorientation to time and place; or 2. Memory impairment, either short-term (inability to learn new information), intermediate, or long-term (inability to remember information that was known sometime in the past); or 3. Perceptual or thinking disturbances (e.g., hallucinations, delusions); or 4. Change in personality; or 5. Disturbance in mood; or 6. Emotional liability (e.g., explosive temper outbursts, sudden crying, etc.) and impairment in impulse control; or 7. Loss of measured intellectual ability of at least 15 I.Q. points from premorbid levels or overall impairment index clearly within the severely impaired range on neuropsychological testing, e.g., the Luria-Nebraska, Halstead-Reitan, etc.; AND B. Resulting in at least two of the following: 1. Marked restriction of activities of daily living; or 2. Marked difficulties in maintaining social functioning; or 3. Marked difficulties in maintaining concentration, persistence, or pace; or 4. Repeated episodes of decompensation, each of extended duration; OR C. Medically documented history of a chronic organic mental disorder of at least 2 years' duration that has caused more than a minimal limitation of ability to do basic work activities, with symptoms or signs currently attenuated by medication or psychosocial support, and one of the following: 1. Repeated episodes of decompensation, each of extended duration; or 2. A residual disease process that has resulted in such marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause the individual to decompensate; or 3. Current history of 1 or more years' inability to function outside a highly supportive living arrangement, with an indication of continued need for such an arrangement. 12.03 Schizophrenic, Paranoid and Other Psychotic Disorders: Characterized by the onset of psychotic features with deterioration from a previous level of functioning. The required level of severity for these disorders is met when the requirements in both A and B are satisfied, or when the requirements in C are satisfied. A. Medically documented persistence, either continuous or intermittent, of one or more of the following: 1. Delusions or hallucinations; or 2. Catatonic or other grossly disorganized behavior; or 3. Incoherence, loosening of associations, illogical thinking, or poverty of content of speech if associated with one of the following: a. Blunt affect; or b. Flat affect; or c. Inappropriate affect; or 4. Emotional withdrawal and/or isolation; AND B. Resulting in at least two of the following: 1. Marked restriction of activities of daily living; or 2. Marked difficulties in maintaining social functioning; or 3. Marked difficulties in maintaining concentration, persistence, or pace; or 4. Repeated episodes of decompensation, each of extended duration; OR C. Medically documented history of a chronic schizophrenic, paranoid, or other psychotic disorder of at least 2 years' duration that has caused more than a minimal limitation of ability to do basic work activities, with symptoms or signs currently attenuated by medication or psychosocial support, and one of the following: 1. Repeated episodes of decompensation, each of extended duration; or 2. A residual disease process that has resulted in such marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause the individual to decompensate; or 3. Current history of 1 or more years' inability to function outside a highly supportive living arrangement, with an indication of continued need for such an arrangement. 12.04 Affective Disorders: Characterized by a disturbance of mood, accompanied by a full or partial manic or depressive syndrome. Mood refers to a prolonged emotion that colors the whole psychic life; it generally involves either depression or elation. The required level of severity for these disorders is met when the requirements in both A and B are satisfied, or when the requirements in C are satisfied. A. Medically documented persistence, either continuous or intermittent, of one of the following: 1. Depressive syndrome characterized by at least four of the following: a. Anhedonia or pervasive loss of interest in almost all activites; or b. Appetite disturbance with change in weight; or c. Sleep disturbance; or d. Psychomotor agitation or retardation; or e. Decreased energy; or f. Feelings of guilt or worthlessness; or g. Difficulty concentrating or thinking; or h. Thoughts of suicide; or i. Hallucinations, delusions, or paranoid thinking; or 2. Manic syndrome characterized by at least three of the following: a. Hyperactivity; or b. Pressure of speech; or c. Flight of ideas; or d. Inflated self-esteem; or e. Decreased need for sleep; or f. Easy distractability; or g. Involvement in activities that have a high probability of painful consequences which are not recognized; or h. Hallucinations, delusions or paranoid thinking; or 3. Bipolar syndrome with a history of episodic periods manifested by the full symptomatic picture of both manic and depressive syndromes (and currently characterized by either or both syndromes); AND B. Resulting in at least two of the following: 1. Marked restriction of activities of daily living; or 2. Marked difficulties in maintaining social functioning; or 3. Marked difficulties in maintaining concentration, persistence, or pace; or 4. Repeated episodes of decompensation, each of extended duration; OR C. Medically documented history of a chronic affective disorder of at least 2 years' duration that has caused more than a minimal limitation of ability to do basic work activities, with symptoms or signs currently attenuated by medication or psychosocial support, and one of the following: 1. Repeated episodes of decompensation, each of extended duration; or 2. A residual disease process that has resulted in such marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause the individual to decompensate; or 3. Current history of 1 or more years' inability to function outside a highly supportive living arrangement, with an indication of continued need for such an arrangement. 12.05 Mental retardation: Mental retardation refers to significantly subaverage general intellectual functioning with deficits in adaptive functioning initially manifested during the developmental period; i.e., the evidence demonstrates or supports onset of the impairment before age 22. The required level of severity for this disorder is met when the requirements in A, B, C, or D are satisfied. A. Mental incapacity evidenced by dependence upon others for personal needs (e.g., toileting, eating, dressing, or bathing) and inability to follow directions, such that the use of standardized measures of intellectual functioning is precluded; OR B. A valid verbal, performance, or full scale IQ of 59 or less; OR C. A valid verbal, performance, or full scale IQ of 60 through 70 and a physical or other mental impairment imposing an additional and significant work-related limitation of function; OR D. A valid verbal, performance, or full scale IQ of 60 through 70, resulting in at least two of the following: 1. Marked restriction of activities of daily living; or 2. Marked difficulties in maintaining social functioning; or 3. Marked difficulties in maintaining concentration, persistence, or pace; or 4. Repeated episodes of decompensation, each of extended duration. 12.06 Anxiety Related Disorders: In these disorders anxiety is either the predominant disturbance or it is experienced if the individual attempts to master symptoms; for example, confronting the dreaded object or situation in a phobic disorder or resisting the obsessions or compulsions in obsessive compulsive disorders. The required level of severity for these disorders is met when the requirements in both A and B are satisfied, or when the requirements in both A and C are satisfied. A. Medically documented findings of at least one of the following: 1. Generalized persistent anxiety accompanied by three out of four of the following signs or symptoms: a. Motor tension; or b. Autonomic hyperactivity; or c. Apprehensive expectation; or d. Vigilance and scanning; or 2. A persistent irrational fear of a specific object, activity, or situation which results in a compelling desire to avoid the dreaded object, activity, or situation; or 3. Recurrent severe panic attacks manifested by a sudden unpredictable onset of intense apprehension, fear, terror and sense of impending doom occurring on the average of at least once a week; or 4. Recurrent obsessions or compulsions which are a source of marked distress; or 5. Recurrent and intrusive recollections of a traumatic experience, which are a source of marked distress; AND B. Resulting in at least two of the following: 1. Marked restriction of activities of daily living; or 2. Marked difficulties in maintaining social functioning; or 3. Marked difficulties in maintaining concentration, persistence, or pace; or 4. Repeated episodes of decompensation, each of extended duration. OR C. Resulting in complete inability to function independently outside the area of one's home. 12.07 Somatoform Disorders: Physical symptoms for which there are no demonstrable organic findings or known physiological mechanisms. The required level of severity for these disorders is met when the requirements in both A and B are satisfied. A. Medically documented by evidence of one of the following: 1. A history of multiple physical symptoms of several years duration, beginning before age 30, that have caused the individual to take medicine frequently, see a physician often and alter life patterns significantly; or 2. Persistent nonorganic disturbance of one of the following: a. Vision; or b. Speech; or c. Hearing; or d. Use of a limb; or e. Movement and its control (e.g., coordination disturbance, psychogenic seizures, akinesia, dyskinesia; or f. Sensation (e.g., diminished or heightened). 3. Unrealistic interpretation of physical signs or sensations associated with the preoccupation or belief that one has a serious disease or injury; AND B. Resulting in at least two of the following: 1. Marked restriction of activities of daily living; or 2. Marked difficulties in maintaining social functioning; or 3. Marked difficulties in maintaining concentration, persistence, or pace; or 4. Repeated episodes of decompensation, each of extended duration. 12.08 Personality Disorders: A personality disorder exists when personality traits are inflexible and maladaptive and cause either significant impairment in social or occupational functioning or subjective distress. Characteristic features are typical of the individual's long-term functioning and are not limited to discrete episodes of illness. The required level of severity for these disorders is met when the requirements in both A and B are satisfied. A. Deeply ingrained, maladaptive patterns of behavior associated with one of the following: 1. Seclusiveness or autistic thinking; or 2. Pathologically inappropriate suspiciousness or hostility; or 3. Oddities of thought, perception, speech and behavior; or 4. Persistent disturbances of mood or affect; or 5. Pathological dependence, passivity, or aggressivity; or 6. Intense and unstable interpersonal relationships and impulsive and damaging behavior; AND B. Resulting in at least two of the following: 1. Marked restriction of activities of daily living; or 2. Marked difficulties in maintaining social functioning; or 3. Marked difficulties in maintaining concentration, persistence, or pace; or 4. Repeated episodes of decompensation, each of extended duration. 12.09 Substance Addiction Disorders: Behavioral changes or physical changes associated with the regular use of substances that affect the central nervous system. The required level of severity for these disorders is met when the requirements in any of the following (A through I) are satisfied. A. Organic mental disorders. Evaluate under 12.02. B. Depressive syndrome. Evaluate under 12.04. C. Anxiety disorders. Evaluate under 12.06. D. Personality disorders. Evaluate under 12.08. E. Peripheral neuropathies. Evaluate under 11.14. F. Liver damage. Evaluate under 5.05. G. Gastritis. Evaluate under 5.04. H. Pancreatitis. Evaluate under 5.08. I. Seizures. Evaluate under 11.02 or 11.03. 12.10 Autistic disorder and other pervasive developmental disorders: Characterized by qualitative deficits in the development of reciprocal social interaction, in the development of verbal and nonverbal communication skills, and in imaginative activity. Often, there is a markedly restricted repertoire of activities and interests, which frequently are stereotyped and repetitive. The required level of severity for these disorders is met when the requirements in both A and B are satisfied. A. Medically documented findings of the following: 1. For autistic disorder, all of the following: a. Qualitative deficits in reciprocal social interaction; and b. Qualitative deficits in verbal and nonverbal communication and in imaginative activity; and c. Markedly restricted repertoire of activities and interests; OR 2. For other pervasive developmental disorders, both of the following: a. Qualitative deficits in reciprocal social interaction; and b. Qualitative deficits in verbal and nonverbal communication and in imaginative activity; AND B. Resulting in at least two of the following: 1. Marked restriction of activities of daily living; or 2. Marked difficulties in maintaining social functioning; or 3. Marked difficulties in maintaining concentration, persistence, or pace; or 4. Repeated episodes of decompensation, each of extended duration. 13.00 NEOPLASTIC DISEASES, MALIGNANT 13.01 Category of Impairments, Neoplastic Diseases -- Malignant 13.02 Head and neck (except salivary glands -- 13.07, thyroid gland -- 13.08, and mandible, maxilla, orbit, or temporal fossa -- 13.11): A. Inoperable; or B. Not controlled by prescribed therapy; or C. Recurrent after radical surgery or irradiation; or D. With distant metastases; or E. Epidermoid carcinoma occurring in the pyriform sinus or posterior third of the tongue. 13.03 Sarcoma of skin: A. Angiosarcoma with metastases to regional lymph nodes or beyond; or B. Mycosis fungoides with metastases to regional lymph nodes, or with visceral involvement. 13.04 Sarcoma of soft parts: Not controlled by prescribed therapy. 13.05 Malignant melanoma: A. Recurrent after wide excision; or B. With metastases to adjacent skin (satellite lesions) or elsewhere. 13.06 Lymph nodes: A. Hodgkin's disease or non-Hodgkin's lymphoma with progressive disease not controlled by prescribed therapy; or B. Metastatic carcinoma in a lymph node (except for epidermoid carcinoma in a lymph node in the neck) where the primary site is not determined after adequate search; or C. Epidermoid carcinoma in a lymph node in the neck not responding to prescribed therapy. 13.07 Salivary glands -- carcinoma or sarcoma with metastases beyond the regional lymph nodes. 13.08 Thyroid gland: A. Anaplastic (undifferentiated) carcinoma of the thyroid; or B. Carcinoma with metastases beyond the regional lymph nodes, not controlled by prescribed therapy. 13.09 Breast: A. Inoperable carcinoma; or B. Inflammatory carcinoma; or C. Recurrent carcinoma, except local recurrence controlled by prescribed therapy; or D. Distant metastases from breast carcinoma (bilateral breast carcinoma, synchronous or metachronous is usually primary in each breast); or E. Sarcoma with metastases anywhere. 13.10 Skeletal system (exclusive of the jaw): A. Malignant primary tumors with evidence of metastases and not controlled by prescribed therapy; or B. Metastatic carcinoma to bone where the primary site is not determined after adequate search. 13.11 Mandible, maxilla, orbit, or temporal fossa: A. Sarcoma of any type with metastases; or B. Carcinoma of the antrum with extension into the orbit or ethmoid or sphenoid sinus, or with regional or distant metastases; or C. Orbital tumors with intracranial extension; or D. Tumors of the temporal fossa with perforation of skull and meningeal involvement; or E. Adamantinoma with orbital or intracranial infiltration; or F. Tumors of Rathke's pouch with infiltration of the base of the skull or metastases. 13.12 Brain or spinal cord: A. Metastatic carcinoma to brain or spinal cord. B. Evaluate other tumors under the criteria described in 11.05 and 11.08. 13.13 Lungs. A. Unresectable or with incomplete excision; or B. Recurrence or metastases after resection; or C. Oat cell (small cell) carcinoma; or D. Squamous cell carcinoma, with metastases beyond the hilar lymph nodes; or E. Other histologic types of carcinoma, including undifferentiated and mixed-cell types (but excluding oat cell carcinoma, 13.13C, and squamous cell carcinoma, 13.13D), with metastases to the hilar lymph nodes. 13.14 Pleura or mediastinum: A. Malignant mesothelioma of pleura; or B. Malignant tumors, metastatic to pleura; or C. Malignant primary tumor of the mediastinum not controlled by prescribed therapy. 13.15 Abdomen: A. Generalized carcinomatosis; or B. Retroperitoneal cellular sarcoma not controlled by prescribed therapy; or C. Ascites with demonstrated malignant cells. 13.16 Esophagus or stomach: A. Carcinoma or sarcoma of the esophagus; or B. Carcinoma of the stomach with metastases to the regional lymph nodes or extension to surrounding structure; or C. Sarcoma of stomach not controlled by prescribed therapy; or D. Inoperable carcinoma; or E. Recurrence or metastases after resection. 13.17 Small intestine: A. Carcinoma, sarcoma, or carcinoid tumor with metastases beyond the regional lymph nodes; or B. Recurrence of carcinoma, sarcoma, or carcinoid tumor after resection; or C. Sarcoma, not controlled by prescribed therapy. 13.18 Large intestine (from ileocecal valve to and including anal canal) -- carcinoma or sarcoma. A. Unresectable; or B. Metastases beyond the regional lymph nodes; or C. Recurrence or metastases after resection. 13.19 Liver or gallbladder: A. Primary or metastatic malignant tumors of the liver; or B. Carcinoma of the gallbladder; or C. Carcinoma of the bile ducts. 13.20 Pancreas: A. Carcinoma except islet cell carcinoma; or B. Islet cell carcinoma which is unresectable and physiologically active. 13.21 Kidneys, adrenal glands, or ureters -- carcinoma: A. Unresectable; or B. With hematogenous spread to distant sites; or C. With metastases to regional lymph nodes. 13.22 Urinary bladder -- carcinoma. With: A. Infiltration beyond the bladder wall; or B. Metastases to regional lymph nodes; or C. Unresectable; or D. Recurrence after total cystectomy; or E. Evaluate renal impairment after total cystectomy under the criteria in 6.02. 13.23 Prostate gland -- carcinoma not controlled by prescribed therapy. 13.24 Testicles: A. Choriocarcinoma; or B. Other malignant primary tumors with progressive disease not controlled by prescribed therapy. 13.25 Uterus -- carcinoma or sarcoma (corpus or cervix). A. Inoperable and not controlled by prescribed therapy; or B. Recurrent after total hysterectomy; or C. Total pelvic exenteration 13.26 Ovaries -- all malignant, primary or recurrent tumors. With: A. Ascites with demonstrated malignant cells; or B. Unresectable infiltration; or C. Unresectable metastases to omentum or elsewhere in the peritoneal cavity; or D. Distant metastases. 13.27 Leukemia: Evaluate under the criteria of 7.00ff, Hemic and Lymphatic System. 13.28 Uterine (Fallopian) tubes -- carcinoma or sarcoma: A. Unresectable, or B. Metastases to regional lymph nodes. 13.29 Penis -- carcinoma with metastases to regional lymph nodes. 13.30 Vulva -- carcinoma, with distant metastases. 14.00 IMMUNE SYSTEM 14.01 Category of Impairments, Immune System 14.02 Systemic lupus erythematosus. Documented as described in 14.00B1, with: A. One of the following: 1. Joint involvement, as described under the criteria in 1.00; or 2. Muscle involvement, as described under the criteria in 14.05; or 3. Ocular involvement, as described under the criteria in 2.00ff; or 4. Respiratory involvement, as described under the criteria in 3.00ff; or 5. Cardiovascular involvement, as described under the criteria in 4.00ff or 14.04D; or 6. Digestive involvement, as described under the criteria in 5.00ff; or 7. Renal involvement, as described under the criteria in 6.00ff; or 8. Hematologic involvement, as described under the criteria in 7.00ff; or 9. Skin involvement, as described under the criteria in 8.00ff; or 10. Neurological involvement, as described under the criteria in 11.00ff; or 11. Mental involvement, as described under the criteria in 12.00ff. or B. Lesser involvement of two or more organs/body systems listed in paragraph A, with significant, documented, constitutional symptoms and signs of severe fatigue, fever, malaise, and weight loss. At least one of the organs/body systems must be involved to at least a moderate level of severity. 14.03 Systemic vasculitis. Documented as described in 14.00B2, including documentation by angiography or tissue biopsy, with: A. Involvement of a single organ or body system, as described under the criteria in 14.02A. or B. Lesser involvement of two or more organs/body systems listed in 14.02A, with significant, documented, constitutional symptoms and signs of severe fatigue, fever, malaise, and weight loss. At least one of the organs/body systems must be involved to at least a moderate level of severity. 14.04 Systemic sclerosis and scleroderma. Documented as described in 14.00B3, with: A. One of the following: 1. Muscle involvement, as described under the criteria in 14.05; or 2. Respiratory involvement, as described under the criteria in 3.00ff; or 3. Cardiovascular involvement, as described under the criteria in 4.00ff; or 4. Digestive involvement, as described under the criteria in 5.00ff; or 5. Renal involvement, as described under the criteria in 6.00ff. or B. Lesser involvement of two or more organs/body systems listed in paragraph A, with significant, documented, constitutional symptoms and signs of severe fatigue, fever, malaise, and weight loss. At least one of the organs/body systems must be involved to at least a moderate level of severity. or C. Generalized scleroderma with digital contractures. or D. Severe Raynaud's phenomena, characterized by digital ulcerations, ischemia, or gangrene. 14.05 Polymyositis or dermatomyositis. Documented as described in 14.00B4, with: A. Severe proximal limb-girdle (shoulder and/or pelvic) muscle weakness, as described in 14.00B4. or B. Less severe limb-girdle muscle weakness than in 14.05A, associated with cervical muscle weakness and one of the following to at least a moderate level of severity: 1. Impaired swallowing with dysphagia and episodes of aspiration due to cricopharyngeal weakness, or 2. Impaired respiration due to intercostal and diaphragmatic muscle weakness. or C. If associated with malignant tumor, as described under the criteria in 13.00ff. or D. If associated with generalized connective tissue disease, described under the criteria in 14.02, 14.03, 14.04, or 14.06. 14.06 Undifferentiated connective tissue disorder. Documented as described in 14.00B5, and with impairment as described under the criteria in 14.02A, 14.02B, or 14.04. 14.07 Immunoglobulin deficiency syndromes or deficiencies of cell-mediated immunity, excepting HIV infection. Associated with documented, recurrent severe infection occurring 3 or more times within a 5-month period. 14.08 Human immunodeficiency virus (HIV) infection. With documentation as described in 14.00D3 and one of the following: A. Bacterial infections: 1. Mycobacterial infection (e.g., caused by M. avium-intracellulare, M. kansasii, or M. tuberculosis) at a site other than the lungs, skin, or cervical or hilar lymph nodes; or pulmonary tuberculosis resistant to treatment; or 2. Nocardiosis; or 3. Salmonella bacteremia, recurrent non-typhoid; or 4. Syphilis or neurosyphilis -- evaluate sequelae under the criteria for the affected body system (e.g., 2.00 Special Senses and Speech, 4.00 Cardiovascular System, 11.00 Neurological); or 5. Multiple or recurrent bacterial infection(s), including pelvic inflammatory disease, requiring hospitalization or intravenous antibiotic treatment 3 or more times in 1 year. or B. Fungal infections: 1. Aspergillosis; or 2. Candidiasis, at a site other than the skin, urinary tract, intestinal tract, or oral or vulvovaginal mucous membranes; or candidiasis involving the esophagus, trachea, bronchi, or lungs; or 3. Coccidioidomycosis, at a site other than the lungs or lymph nodes; or 4. Cryptococcosis, at a site other than the lungs (e.g., cryptococcal meningitis); or 5. Histoplasmosis, at a site other than the lungs or lymph nodes; or 6. Mucormycosis. or C. Protozoan or helminthic infections: 1. Cryptosporidiosis, isosporiasis, or microsporidiosis, with diarrhea lasting for 1 month or longer; or 2. Pneumocystis carinii pneumonia or extrapulmonary pneumocystis carinii infection; or 3. Strongyloidiasis, extra-intestinal; or 4. Toxoplasmosis of an organ other than the liver, spleen, or lymph nodes. or D. Viral infections: 1. Cytomegalovirus disease (documented as described in 14.00D4b) at a site other than the liver, spleen, or lymph nodes; or 2. Herpes simplex virus causing: a. Mucocutaneous infection (e.g., oral, genital, perianal) lasting for 1 month or longer; or b. Infection at a site other than the skin or mucous membranes (e.g., bronchitis, pneumonitis, esophagitis, or encephalitis); or c. Disseminated infection; or 3. Herpes zoster, either disseminated or with multidermatomal eruptions that are resistant to treatment; or 4. Progressive multifocal leukoencephalopathy; or 5. Hepatitis, as described under the criteria in 5.05. or E. Malignant neoplasms: 1. Carcinoma of the cervix, invasive, FIGO stage II and beyond; or 2. Kaposi's sarcoma with: a. Extensive oral lesions; or b. Involvement of the gastrointestinal tract, lungs, or other visceral organs; or c. Involvement of the skin or mucous membranes, as described under the criteria in 14.08F; or 3. Lymphoma (e.g., primary lymphoma of the brain, Burkitt's lymphoma, immunoblastic sarcoma, other non-Hodgkins lymphoma, Hodgkin's disease); or 4. Squamous cell carcinoma of the anus. or F. Conditions of the skin or mucous membranes (other than described in B2, D2, or D3, above) with extensive fungating or ulcerating lesions not responding to treatment (e.g., dermatological conditions such as eczema or psoriasis, vulvovaginal or other mucosal candida, condyloma caused by human papillomavirus, genital ulcerative disease), or evaluate under the criteria in 8.00ff. or G. Hematologic abnormalities: 1. Anemia, as described under the criteria in 7.02; or 2. Granulocytopenia, as described under the criteria in 7.15; or 3. Thrombocytopenia, as described under the criteria in 7.06. or H. Neurological abnormalities: 1. HIV encephalopathy, characterized by cognitive or motor dysfunction that limits function and progresses; or 2. Other neurological manifestations of HIV infection (e.g., peripheral neuropathy) as described under the criteria in 11.00ff. or I. HIV wasting syndrome, characterized by involuntary weight loss of 10 percent or more of baseline (or other significant involuntary weight loss, as described in 14.00D2) and, in the absence of a concurrent illness that could explain the findings, either: 1. Chronic diarrhea with two or more loose stools daily lasting for 1 month or longer; or 2. Chronic weakness and documented fever greater than 38 degrees C (100.4 degrees F) for the majority of 1 month or longer. or J. Diarrhea, lasting for 1 month or longer, resistant to treatment, and requiring intravenous hydration, intravenous alimentation, or tube feeding. or K. Cardiomyopathy, as described under the criteria in 4.00ff or 11.04. or L. Nephropathy, as described under the criteria in 6.00ff. or M. One or more of the following infections (other than described in A-L, above), resistant to treatment or requiring hospitalization or intravenous treatment 3 or more times in 1 year (or evaluate sequelae under the criteria for the affected body system). 1. Sepsis; or 2. Meningitis; or 3. Pneumonia; or 4. Septic arthritis; or 5. Endocarditis; or 6. Sinusitis documented by appropriate medically acceptable imaging. or N. Repeated (as defined in 14.00D8) manifestations of HIV infection (including those listed in 14.08A-M, but without the requisite findings, e.g., carcinoma of the cervix not meeting the criteria in 14.08E, diarrhea not meeting the criteria in 14.08J, or other manifestations, e.g., oral hairy leukoplakia, myositis) resulting in significant, documented symptoms or signs (e.g., fatigue, fever, malaise, weight loss, pain, night sweats) and one of the following at the marked level (as defined in 14.00D8): 1. Restriction of activities of daily living; or 2. Difficulties in maintaining social functioning; or 3. Difficulties in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace. 14.09 Inflammatory arthritis. Documented as described in 14.00B6, with one of the following: A. History of joint pain, swelling, and tenderness, and signs on current physical examination of joint inflammation or deformity in two or more major joints resulting in inability to ambulate effectively or inability to perform fine and gross movements effectively, as defined in 14.00B6b and 1.00B2b and B2c; or B. Ankylosing spondylitis or other spondyloarthropathy, with diagnosis established by findings of unilateral or bilateral sacroiliitis (e.g., erosions or fusions), shown by appropriate medically acceptable imaging, with both: 1. History of back pain, tenderness, and stiffness, and 2. Findings on physical examination of ankylosis (fixation) of the dorsolumbar or cervical spine at 45 [degrees] or more of flexion measured from the vertical position (zero degrees); or C. An impairment as described under the criteria in 14.02A. or D. Inflammatory arthritis, with signs of peripheral joint inflammation on current examination, but with lesser joint involvement than in A and lesser extra-articular features than in C, and: 1. Significant, documented constitutional symptoms and signs (e.g., fatigue, fever, malaise, weight loss), and 2. Involvement of two or more organs/body systems (see 14.00B6d). At least one of the organs/body systems must be involved to at least a moderate level of severity. or E. Inflammatory spondylitis or other inflammatory spondyloarthropathies, with lesser deformity than in B and lesser extra-articular features than in C, with signs of unilateral or bilateral sacroiliitis on appropriate medically acceptable imaging; and with the extra-articular features described in 14.09D. +Atlմ