|
Social Security listing
5.00 Digestive System
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.
5.01 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 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]
|
|
|
|
|
