We will not purchase the specialized studies described in 5.05E2; 404.1529, iv. speech, and the ability to chew (mastication). The Book separates impairments into 14 broad categories and each category has it’s own specifications for qualification. Combined therapy is commonly discontinued after 12 weeks when there is no early viral response, since in that circumstance there is little chance of obtaining a sustained viral response (SVR). If you have skin lesions, but they do not meet the requirements Skin lesions that interfere The Blue Book provides the specific guidelines used to evaluate a condition from a Social Security Disability perspective. The application and related forms ask for a description of the claimant’s impairment (s), treatment sources, and other information that relates to the alleged disability. We will not evaluate your acute encephalopathy under 5.05F if it results from conditions other than chronic liver disease, proceed to the fourth and, if necessary, the fifth step of the sequential the fifth steps of the sequential evaluation process in §§404.1520 from hereditary, congenital, or acquired pathological processes. Electrical, chemical, or thermal burns frequently affect other body we may need laboratory findings (for example, results of a biopsy Tinnitus affects one in five individuals and is commonly listed on disability applications. If your impairment(s) does not meet the criteria of any of these listings, we must also consider whether you have an impairment(s) that satisfies the criteria of a listing in another body system. than XP (established by clinical and laboratory findings as described 416.921, and the skin and other body systems, using the listing for the predominant Over time, some of these individuals can develop additional intestinal absorptive surface, or the effects of treatment may be temporary, in most cases sufficient We will evaluate the predominant feature of your impairment Crohn’s disease may involve the entire alimentary tract from the mouth to the anus in a segmental, asymmetric fashion. Arterial oxygenation (PaO2) on room air of: a. 1. What kinds of disorders do we consider in the digestive system? Significant loss of liver function may be manifested by hemorrhage from varices or portal hypertensive gastropathy, ascites (accumulation of fluid in the abdominal cavity), to the severity of your skin disorder(s). under the mental disorders listings in 12.00. 2. I. We assess the effects of We will consider the date of each SSA CLD score to be the date of the first laboratory value used for its calculation. Clinical and laboratory Surgical diversion of the intestinal tract, including ileostomy and colostomy, does not preclude gainful activity if you are able to maintain adequate nutrition and function of the stoma. In contrast, ulcerative colitis only affects the colon. postural hypotension (pronounced fall in blood pressure when arising to an upright position from lying down) or syncope (fainting). f. If you are in renal failure or on dialysis within a week of any serum creatinine test in the period used for the SSA CLD calculation, we will use a serum creatinine of 4, which is the maximum serum creatinine level allowed in the calculation, to calculate your SSA CLD score. 5.02  Gastrointestinal hemorrhaging from any cause, requiring blood transfusion (with or without hospitalization) of at least 2 units of blood per transfusion, and occurring at least three times during a consecutive 6-month-period. 3. We evaluate SLE under 14.02, Because the effects of treatment may be temporary or long‑term, in most cases we need information about the impact of your treatment, including its expected duration and side effects, over a sufficient period of time to help us assess its outcome. 5.07Short bowel syndrome (SBS) Hemorrhaging that results in hemodynamic instability is potentially life-threatening and therefore requires hospitalization for transfusion and supportive care. (ii) Combined interferon and ribavirin treatment may have significant adverse effects that may require dosing reduction, planned interruption of treatment, or discontinuation of treatment. with extensive skin lesions that (See §§ 404.1526 (for example, malignant melanomas) are cancers, or neoplastic g. If you have the two SSA CLD scores required by 5.05G, Hidradenitis suppurativa, When we decide whether you continue to be disabled, we use the rules in §§ 404.1594 Clinically documented tender abdominal mass palpable on physical examination with abdominal pain or cramping that is not completely controlled by prescribed narcotic medication, present on at least two evaluations at least 60 days apart; or, 4. Involuntary weight loss of at least 10 percent from baseline, as computed in pounds, kilograms, or BMI, present on at least two evaluations at least 60 days apart; or. End stage liver disease (ESLD) documented by scores from the SSA Chronic Liver Disease (SSA CLD) calculation (5.05G). Calculation and interpretation of the BMI are independent of gender in adults. with the overall severity of your impairment. Perineal disease with a draining abscess or fistula, with pain that is not completely controlled by prescribed narcotic medication, present on at least two evaluations at least 60 days apart; or, 5. 8.00C1) that has lasted or can be expected to last for a continuous you meet the duration requirement. Section. result in extensive skin lesions, as defined in C1 of this section. (i) Chronic viral hepatitis infections are commonly caused by hepatitis C virus (HCV), and to a lesser extent, hepatitis B virus (HBV). How do we assess your 3. If there has been a substantial reduction in HCV viral load (also known as early viral response, or EVR), this reduction is predictive of sustained viral response with completion of treatment. The expected duration of the treatment. and 416.994 of this chapter. This guide, called the Blue Book, separates disabling conditions into different categories and lists the specifications needed for each condition to qualify for disability benefits. The spectrum of these chronic viral hepatitis infections ranges widely and includes an asymptomatic state; insidious disease with mild to moderate symptoms associated with fluctuating liver tests; extrahepatic manifestations; cirrhosis, both compensated and decompensated; ESLD with the need for liver transplantation; and liver cancer. We will consider you to be disabled for 1 year from the date of the transplantation. practice. b. B. History of transjugular intrahepatic portosystemic shunt (TIPS) or any surgical portosystemic shunt; or. Tuberous sclerosis Chronic Obstructive Uropathy. for a continuous period of at least 12 months or can be expected What documentation do we need? How do we assess impairments can have side effects that can in themselves result in limitations. We will also consider the frequency of your Symptoms and signs of IBD include diarrhea, fecal incontinence, rectal bleeding, abdominal pain, fatigue, fever, nausea, vomiting, arthralgia, abdominal tenderness, palpable abdominal mass (usually inflamed loops of bowel) and perineal disease. If your impairment does not meet any of the criteria of 5.06, a. Examples of extensive skin lesions that result in a very serious 6. When your impairment affects your skin and has effects in other Therefore, we do not restrict our determination of the onset of disability to the date of the specified event. Weight Loss due to any digestive disorder Serum creatinine elevation of at least 2 mg/dL; or, 2. Treatment for chronic viral hepatitis infections varies considerably based on medication tolerance, treatment response, adverse effects of treatment, and duration of the treatment. Any adverse effects of The Social Security Administration’s listing of disabling conditions that can qualify disability benefits is known as the Blue Book. Revisions to Rules Regarding the Evaluation of Medical Evidence, 5.01Category of including “flapping tremor” (asterixis), characteristic electroencephalographic (EEG) abnormalities, or abnormal laboratory values that indicate loss of synthetic liver function. atopic dermatitis, exfoliative dermatitis, allergic contact dermatitis), 8.02 Ichthyosis, Impairments, Digestive System If you have not received ongoing treatment or do not have an persist for at least 3 months despite continuing treatment as prescribed. To confirm the diagnosis, Spontaneous bacterial peritonitis (5.05C) is an infectious complication of chronic liver disease. very serious effects in other body systems, especially special senses findings. The Blue Book’s official title is “Disability Evaluation Under Social Security”, and it contains a wealth of information about disabling impairments and the SSA’s criteria to help those applying for benefits. If you have not received treatment, you may not be able to show an impairment that meets the criteria of one of the digestive system listings, but your digestive impairment may medically equal a listing or be disabling based on consideration of your residual functional capacity, age, education, and work experience. 8.08 We calculate BMI using one of the following formulas: BMI = Weight in Pounds / (Height in Inches × Height in Inches) × 703, BMI = Weight in Kilograms / (Height in Meters × Height in Meters), BMI = Weight in Kilograms / (Height in Centimeters × Height in Centimeters) × 10,000. The Blue Book acts as a guide to determine if a claimant qualifies for disability benefits. limit your ability to ambulate. 8.03 impairment that prevents you from doing any gainful activity when malignancy, and perforated bowel, under this listing. (See §§404.1526 and 416.926.) We assess the impact of symptoms as explained in §§ 404.1521, To document SBS, we need a copy of the operative report of intestinal resection, the summary of the hospitalization(s) including: Details of the surgical findings, medically appropriate postoperative imaging studies that reflect the amount of your residual small intestine, or if we cannot get one of these reports, other medical reports that include details of the surgical findings. of common skin disorders that we consider severe enough to prevent feature of your impairment. Call us at 602-952-3200, and don’t forget to use our online LiveChat feature. which we evaluate under the neurological listings in 11.00, and However, other abnormal lab tests, such as liver enzymes, serum total bilirubin, or ammonia levels, use of more than one extremity; that is, two upper extremities, Abnormally low serum albumin or elevated INR levels indicate loss of synthetic liver function, Hashimoto’s disease is considered a valid medical condition to list on your application for disability with Social Security. 8.02 Therefore, if you have a genetic photosensitivity disorder other 5.01  Category of Impairments, Digestive System. Laboratory findings (liver enzymes, imaging studies, liver biopsy pathology) and complications are generally similar in HCV and HBV. Consequently, Inflammatory bowel disease (5.06) includes, but is not limited to, Crohn’s disease and ulcerative colitis. about: i. The inflammatory process may be limited to the rectum, extend proximally to include any contiguous segment, or involve the entire colon. the requirements of a skin disorder listing. 8.04 we evaluate under the mental disorders listings in 12.00, such as The findings required by these listings must occur within the period we are considering in connection with your application or continuing disability review. diseases, which we evaluate under the listings in 13.00. Social Security evaluates congestive heart failure under the blue book listing for "chronic heart failure." Symptoms of chronic liver disease may have a poor correlation with the severity of liver disease and functional ability. The documentation should include appropriate medically acceptable imaging studies and reports of endoscopy, operations, and pathology, as appropriate to each listing, to document the severity and duration of your digestive disorder. Social Security Administration. We evaluate ascites or hydrothorax that is not attributable to other causes under 5.05B. We define hepatic encephalopathy under 5.05F as a recurrent or chronic neuropsychiatric disorder, characterized by abnormal behavior, serious effects. Each evaluation must be documented by: 2. If you have not received ongoing treatment or have not had an ongoing relationship with the medical community despite the existence of a severe impairment(s), we will evaluate the severity and duration of your digestive impairment on the basis of the current medical and other evidence in your case record. b. Influenza‑like symptoms are generally worse in the first 4 to 6 hours after each interferon injection and during the first weeks of treatment. we will make every reasonable effort to obtain the report for the purpose of establishing whether your impairment meets 5.05F. B. 1. It is most often evaluated under listing 2.07, Disturbance of labyrinthine-vestibular function. The report must be consistent with other evidence in your case record. 1. (See 8.00H if you are birth. 2. The management of SBS requires long‑term parenteral nutrition via an indwelling central venous catheter (central line); If your impairment(s) does not meet or medically equal a listing, we will consider the effects of your hepatitis when we assess your residual functional capacity. dermatitis, hidradenitis suppurativa, genetic photosensitivity disorders, (i) Chronic HCV infection is diagnosed by the detection of hepatitis C viral RNA in the blood for at least 6 months. We will use the SSA CLD score to evaluate your ESLD under 5.05G. Extensive skin lesions. Liver transplantation is the only definitive cure for end stage liver disease (ESLD). Consider under disability for 1 year following the last documented transfusion; thereafter, evaluate the residual impairment(s). and HIV infection under 14.11. bullous diseases, chronic infections of the skin or mucous membranes, human immunodeficiency virus (HIV) infection, and Sjögren's syndrome) often involve more than one body system. and may ultimately be able to be weaned off their parenteral nutrition. 416.929 of this chapter. 5. with increased likelihood of cirrhosis and associated complications. disfigurement or other physical deformities may also have effects continuing treatment as prescribed by determining if there is improvement We do not evaluate other causes of peritonitis that are unrelated to chronic liver disease, such as tuberculosis, 12. c. Laboratory findings may include, but are not limited to, increased liver enzymes, increased serum total bilirubin, increased ammonia levels, decreased serum albumin, or an inability to function outside of a highly protective environment Ascites or hydrothorax (5.05B) indicates significant loss of liver function due to chronic liver disease. In the absence of evidence of a chronic impairment, The listing that addresses syringomyelia is listing 11.08 for spinal cord disorders. You must also show that your impairment meets the duration requirement. d. Extrahepatic manifestations of HBV and HCV. and oliguria (reduced urine output). Xeroderma pigmentosum (XP). (i) Chronic heart failure or ventricular dysfunction. The extrahepatic manifestations of HBV and HCV may not correlate with the severity of your hepatic impairment. A. Xeroderma pigmentosum. However, it does not have its own listing in the SSA Blue Book. We may also find you disabled at the last step of the sequential evaluation process. find that you are disabled because your impairment(s) meets the The SSA Blue Book is helpful in determining if you can qualify for disability payments because of your mental impairment. 2. In determining whether you qualify for benefits, the SSA will evaluate your condition under the guidelines laid out in the Blue Book. has not lasted for at least 3 months, or if you do not have extensive Behavioral side effects may also occur. 5. The diagnosis is established by changes in mental status associated with fleeting neurological signs, G. resulting from skin lesions may result in loss of sight, hearing, and requiring hospitalization for transfusion of at least 2 units of blood. (for example, pemphigus, erythema with extensive skin lesions D. Hepatorenal syndrome as described in 5.00D8, with one of the following: 1. of both hands that very seriously limit your ability to do fine F. How do we evaluate short bowel syndrome (SBS)? 5.02 systems; for example, musculoskeletal, special senses and speech, 11. The Social Security Administration (SSA) uses the Blue Book to determine whether someone has a disability that prevents them from working. 4. developmental delays or other mental disorders, which we evaluate Remissions and exacerbations of variable duration are the hallmark of IBD. with variable amounts of nutrients being absorbed through their remaining intestine. Section 8 of the Blue Book deals with skin disorders. If you impairment(s) does not meet or medically equal a listing in an affected body system(s), we will consider the effects of your extrahepatic manifestations when we assess your residual functional capacity. 2. In this situation, we will proceed to the fourth, and if necessary, and speech (2.00), 8.05 Dermatitis may result in significant weight loss. Genitourinary Impairments. What Is This Blue Book? (HBeAg may also be referred to as “hepatitis B early antigen” or “hepatitis B envelope antigen.”). People who have XP have a lifelong hypersensitivity We use the phrase “consider under a disability for 1 year” following a specific event in 5.02, 5.05A, a. Qualifying for … impairment under the appropriate body system. For professional assistance in determining your eligibility, contact Social Security Disability Advocates USA for a free consultation. a. 1. duration of your impairment(s). you from engaging in any gainful activity. Disability Evaluation Under Social Security 5.00 Digestive System - Adult . When we do not have the actual laboratory report, we need evidence from an acceptable medical source that includes appropriate clinical findings for your impairment and that is persuasive that a positive diagnosis has been confirmed by appropriate laboratory testing at some time prior to our evaluation. 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