A. Disorders of the digestive system which
result in a marked impairment usually do so because of interference
with nutrition, multiple recurrent inflammatory lesions, or
complications of disease, such as fistulae, abscesses, or
recurrent obstruction. Such complications usually respond
to treatment. These complications must be shown to persist
on repeated examinations despite therapy for a reasonable
presumption to be made that a marked impairment will last
for a continuous period of at least 12 months.
B. Malnutrition or weight loss from gastrointestinal
disorders. When the primary disorder of the digestive tract
has been established (e.g. enterocolitis, chronic pancreatitis,
postgastrointestinal resection, or esophageal stricture, stenosis,
or obstruction), the resultant interference with nutrition
will be considered under the criteria in 5.08. This will apply
whether the weight loss is due to primary or secondary disorders
of malabsorption, malassimilation or obstruction. However,
weight loss not due to diseases of the digestive tract, but
associated with psychiatric or primary endocrine or other
disorders, should be evaluated under the appropriate criteria
for the underlying disorder.
C. Surgical diversion of the intestinal tract,
including colostomy or ileostomy, are not listed since
they do not represent impairments which preclude all
work activity if the individual is able to maintain
adequate nutrition and function of the stoma. Dumping
syndrome which may follow gastric resection rarely
represents a marked impairment which would continue
for 12 months. Peptic ulcer disease with recurrent
ulceration after definitive surgery ordinarily responds
to treatment. A recurrent ulcer after definitive surgery
must be demonstrated on repeated upper gastrointestinal
roentgenograms or gastroscopic examinations despite
therapy to be considered a severe impairment which
will last for at least 12 months. Definitive surgical
procedures are those designed to control the ulcer
disease process (i.e., vagotomy and pyloroplasty,
subtotal gastrectomy, etc.). Simple closure of a perforated
ulcer does not constitute definitive surgical therapy
for peptic ulcer disease.
5.03 Stricture,
stenosis, or obstruction of the esophagus (demonstrated
by X- ray or endoscopy) with weight loss as described
under § 5.08.
5.04 Peptic ulcer
disease (demonstrated by X-ray or endoscopy). With:
A. Recurrent ulceration after definitive surgery persistent
despite therapy; or
B. Inoperable fistula formation; or
C. Recurrent obstruction demonstrated by X-ray or
endoscopy; 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 X-ray or endoscopy)
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 hypergylcemia, 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--
[CERTAIN MATERIALS OMITTED]
