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SOCIAL SECURITY LISTING
11.00 Neurological
[Seizures, brain tumors, tremor, cerebral
palsy, involuntary movements, multiple sclerosis, Parkinson’s,
myasthenia gravis, ALS, muscular dystrophy, etc.]
MARTHA’S NOTE:
The following listing has two parts. The first half is an essay
describing how you would prove the various diseases. The second
half is a list of illnesses, by the number. You should read BOTH
parts!!
A. Convulsive disorders.
In convulsive disorders, regardless of etiology degree of
impairment will be determined according to type, frequency,
duration, and sequelae of seizures. At least one detailed
description of a typical seizure is required. Such description
includes the presence or absence of aura, tongue bites,
sphincter control, injuries associated with the attack, and
postictal phenomena. The reporting physician should indicate the
extent to which description of seizures reflects his own
observations and the source of ancillary information. Testimony
of persons other than the claimant is essential for description
of type and frequency of seizures if professional observation is
not available.
Documentation of epilepsy should include at
least one electronencephalogram (EEG).
Under 11.02 and 11.03, the criteria can be
applied only if the impairment persists despite the fact that
the individual is following prescribed anticonvulsive treatment.
Adherence to prescribed anticonvulsive therapy can ordinarily be
determined from objective clinical findings in the report of the
physician currently providing treatment for epilepsy.
Determination of blood levels of phenytoin sodium or other
anticonvulsive drugs may serve to indicate whether the
prescribed medication is being taken. When seizures are
occurring at the frequency stated in 11.02 or 11.03, evaluation
of the severity of the impairment must include consideration of
the serum drug levels. Should serum drug levels appear
therapeutically inadequate, consideration should be given as to
whether this is caused by individual idiosyncrasy in absorption
of metabolism of the drug. Blood drug levels should be evaluated
in conjunction with all the other evidence to determine the
extent of compliance. When the reported blood drug levels are
low, therefore, the information obtained from the treating
source should include the physician's statement as to why the
levels are low and the results of any relevant diagnostic
studies concerning the blood levels. Where adequate seizure
control is obtained only with unusually large doses, the
possibility of impairment resulting from the side effects of
this medication must be also assessed. Where documentation shows
that use of alcohol or drugs affects adherence to prescribed
therapy or may play a part in the precipitation of seizures,
this must also be considered in the overall assessment of
impairment level.
B. Brain tumors.
The diagnosis of malignant brain tumors must be established, and
the persistence of the tumor should be evaluated, under the
criteria described in 13.00B and C for neoplastic disease.
In histologically malignant tumors, the
pathological diagnosis alone will be the decisive criterion for
severity and expected duration (see 11.05A). For other tumors of
the brain, the severity and duration of the impairment will be
determined on the basis of symptoms, signs, and pertinent
laboratory findings (11.05B).
C. Persistent
disorganization of motor function in the form of paresis or
paralysis, tremor or other involuntary
movements, ataxia and sensory disturbances (any or
all of which may be due to cerebral cerbellar, brain stem,
spinal cord, or peripheral nerve dysfunction) which occur singly
or in various combination, frequently provides the sole or
partial basis for decision in cases of neurological impairment.
The assessment of impairment depends on the degree of
interference with locomotion and/or interference with the use of
fingers, hands, and arms.
D. In
conditions which are episodic in character, such as multiple
sclerosis or myasthenia gravis,
consideration should be given to frequency and duration of
exacerbations, length of remissions, and permanent residuals.
E. Multiple sclerosis.
The major criteria for evaluating impairment caused by multiple
sclerosis are discussed in listing 11.09. Paragraph A provides
criteria for evaluating disorganization of motor function and
gives reference to 11.04B (11.04B then refers to 11.00C).
Paragraph B provides references to other listings for evaluating
visual or mental impairments caused by multiple sclerosis.
Paragraph C provides criteria for evaluating the impairment of
individuals who do not have muscle weakness or other significant
disorganization of motor function at rest, but who do develop
muscle weakness on activity as a result of fatigue.
Use of the criteria in 11.09C is dependent
upon (1) documenting a diagnosis of multiple sclerosis, (2)
obtaining a description of fatigue considered to be
characteristic of multiple sclerosis, and (3) obtaining evidence
that the system has actually become fatigued. The evaluation of
the magnitude of the impairment must consider the degree of
exercise and the severity of the resulting muscle weakness.
The criteria in 11.09C deals with motor
abnormalities which occur on activity. If the disorganization of
motor function is present at rest, paragraph A must be used,
taking into account any further increase in muscle weakness
resulting from activity.
Sensory abnormalities may occur, particularly
involving central visual acuity. The decrease in visual acuity
may occur after brief attempts at activity involving near
vision, such as reading. This decrease in visual acuity may not
persist when the specific activity is terminated, as with rest,
but is predictably reproduced with resumption of the activity.
The impairment of central visual acuity in these cases should be
evaluated under the criteria in listing 2.02, taking into
account the fact that the decrease in visual acuity will wax and
wane.
Clarification of the evidence regarding
central nervous system dysfunction responsible for the symptoms
may require supporting technical evidence of functional
impairment such as evoked response tests during exercise.
11.01 Category of Impairments, Neurological
11.02 Epilepsy --major
motor seizures, (grand mal or psychomotor), documented by EEG
and 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 --Minor motor
seizures (petit mal, psychomotor, or focal), documented by EEG
and 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 [Stroke] 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, 11.04A, 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 Tabes dorsalis.
With:
A. Tabetic crises occurring more frequently than once monthly;
or
B. Unsteady, broad-based or ataxic gait causing significant
restriction of mobility substantiated by appropriate posterior
column signs.
11.16 Subacute combined cord
degeneration (pernicious anemia) with disorganization of motor
function as decribed 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
11.15B; 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.
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