Adenomyosis - a disease characterized by tumor-like masses of endometrial tissue within
the muscular wall of the uterus. Has no association with endometriosis. The treatment of choice is a hysterectomy,
and it is not usually disabling. This is a benign disease with no significant sequelae. A hysterectomy or medical
management until after menopause resolves the symptoms.
AirWay Disease (Chronic Obstructive) - increased resistance of airflow during forced expirations. This
condition may be the result of narrowing or blocking of the airways due to bronchial disease or from pulmonary emphysema.
This damage is usually irreversible. There may be cause for disability if there is documentation of pulmonary insufficiency
with spirometric evidence. This is demonstrated by maximum voluntary ventilation (MYY) and forced expiratory volume
(FEY), both equal to, or less than, the values specified corresponding to the person's height.
Amyotropic Lateral Sclerosis - a motor nerve disease in which there is muscular weakness and
atrophy beginning in the hands and spreading to the forearms and legs; sensory disorders are present, and death
usually occurs in 2-5 years. There is no known cure. It may be cause for disability if there are significant bulbar (pertaining to
medulla oblongata) signs or significant and persistent disorganization of motor function in two extremities, resulting in sustained
disturbance of gross and dexterous movements, or gait or station. There may be paresis or paralysis, tremor or other involuntary
movements, ataxia (uncoordinated movement) and sensory disturbances. The assessment of impairment depends on the degree
of interference with locomotion and/or interference with the use of fingers, hands and arms.
Anal Fissure - a painful sore located at the anal opening. It is more common in and usually
a problem of young and middle-age adult females. The prognosis is good for most patients, but it depends upon the cause.
There may be cause for disability if unresectable cancer is involved.
Anal Incontinence - the loss of voluntary control of the anal sphincter muscles. Prognosis depends on
the nature of the underlying disease. In cases where involvement is strictly local and not a progressive disease, prognosis
following sphincteroplasty or abdominal colostomy is quite good. A colostomy in itself is not sufficient cause for disability.
Anemia - not enough red blood cells or hemoglobin or both. Three general types are recognized:
(1) iron-deficiency anemia (2) anemia due to a disturbance in the production of red blood cells in bone marrow (3) anemia
due to massive blood loss due to hemorrhage or some disorder which destroys red blood cells. Prognosis is dependent upon the
cause, proper treatment and how well the patient or type disorder responds to treatment. Chronic anemia (hematocrit persisting
at 30% or less due to any cause) requiring one or more blood transfusions on an average of at least one every 2 months is
cause for disability.
Aneurysm - the dilation or "ballooning out" of a blood vessel or a part of the heart due to the pressure of blood on weakened
tissues, forming a sac of clotted blood. Any aneurysm carries the
potential of rupturing and causing death or a clot dislodging and
causing obstruction, irreversible damage or death. Each type of
aneurysm must be treated with respect to its location, size and
the general condition of the patient. Therefore, prognosis is
guarded in all cases. There is cause for disability if x-rays show
that there is acute or chronic dissection not controlled by prescribed
medical or surgical treatment; or congestive heart failure
(as described under criteria for CHF); or renal failure (as
described under criteria for renal failure); or repeated syncopal
Angiosarcoma - a cancerous growth containing
several dilated blood vessels. Prognosis is poor because this
type tends to metastasize rapidly. There may be cause for disability
with proper documentation for angiosarcoma if there is
metastasis to regional lymph nodes or beyond; or if there is
mycosis fungoides with lymph node or visceral involvement.
Ankylosing Spondylitis - an
inflammation of the cartilage of the vertebrae and the adjacent
soft tissue that is a chronic and progressive state in which the
intervertebral joints become immobilized. It is often found in
association with Reiter's syndrome (urethritis), arthritis, conjunctivitis,
and chronic inflammatory diseases such as Crohn's
disease or ulcerative colitis: Ankylosing spondylitis is a progressive
form of arthritis. There may be cause for disability when
there is fixation of the cervical or dorsolumbar spine at 30oor
more of flexion measured from the neutral position, with x-ray
evidence of calcification of the anterior and lateral ligaments;
or bilateral ankylosis of the sacroiliac joints with abnormal apophyseal
articulations, or generalized osteoporosis (established
by x-ray) manifested by pain and limitation ofback motion and
paravertebral muscle spasm with x-ray evidence of either a
compression fracture ofa vertebral body with loss of 50% of the
estimated height of the vertebral body prior to the episode or
multiple fractures of vertebrae with no intervening episodes; or
other vertebrogenic disorders such as herniated nucleus pulposus
or spinal stenosis with pain, muscle spasm and significant
limitation of motion in the spine; and appropriate radicular
distribution of significant motor loss with muscular weakness
and sensory and reflex loss which persisted for 3 months with
prescribed therapy and expected to last at least 12 months.
Antisocial Behavior - behavior
characterized by not wanting to be a part of a crowd or even a
small group. The prognosis depends upon how well the patient
responds to psychotherapy. There may be cause for disability if
there is persistent and marked restriction of daily activities and
constriction of interests and seriously impaired ability to relate
to other people.
Anxiety - a functional mental
disturbance caused by fear. Along with anxiety, there are physical
manifestations of tachycardia, sweating and hyperventilation.
These patients may go on to develop more serious psychopathology,
but most respond well to counseling,
psychotherapy and/or drug therapy. These patients demonstrate
mental abnormalities without structural changes in
brain tissue. Anxiety occurs in connection with some stressful
Aortic Stenosis - constriction or narrowing
of the aorta (the main, large artery leaving
the heart to supply the body with oxygenated blood) that may
be congenital, caused by rheumatic fever, or due to arteriosclerosis.
Aortic stenosis is not clinically significant until the
opening has been reduced by 35% of its original size. As the
disease progresses, angina pectoris may develop, syncope upon
exertion, shortness of breath, congestive heart failure and dizziness
occur. Surgery is the treatment of choice. Prognosis is good
if the general condition of the patient is good. Since angina
pectoris (chest pain of cardiac origin) and CHF are complications
of aortic stenosis, disability is assessed under those classifications.
Aphakia - an eye from which the lens has been
removed; (a) monocular--0ne eye, (b) binocular-both eyes.
Aphakia represents a visual handicap in addition to the loss of
central visual acuity and may be a cause for disability. See
Central Visual Acuity.
Aphasia - the inability to
express thoughts properly via speech; (a) sensory-cannot understand
spoken word, (b) motor-the muscles coordinating
speech cease to function. There is cause for disability when
there is organic loss of speech due to any cause, with inability
to produce by any means speech which can be heard, understood
Arrhythmia - irregular heart action causing an abnormal rhythm. The heart
normally beats about 60-100 times per minute, therefore, a significant
deviation results in arrhythmia. Some types of arrhythmia
are: (a) atrial fibrillation, (b) atrial flutter or tachycardia, (c)
ventricular fibrillation, (d) ventricular tachycardia. Recurrent
episodes of arrhythmia (not due to digitalis toxicity) resulting in
uncontrolled repeated episodes of cardiac syncope and documented
by resting or ambulatory (Holter) EKG are grounds for
Arteriosclerosis Obliterans (also called Chronic Occlusive Arterial
Disease) - blockage of
the arteries that supply the legs and feet. Disability exists when
there is 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 intermittent claudication and absence of peripheral
arterial pulsations in the femoral, popliteal, dorsalis pedis,
and posterior tibial arteries by doppler or plethysmography, in
one extremity; or amputation at or above the tarsal region due
to peripheral vascular disease.
Arthritis - a
chronic syndrome characterized by inflammation of the joints
(usually symmetrical) resulting in progressive destruction of
joint structures. There may be generalized manifestations. Criteria
for disability is:
1. Active rheumatoid arthritis and other inflammatory arthritis, with both A and B:
A. Persistent joint pain, swelling, and tenderness involving
multiple joints with signs of joint inflammation (heat, swelling,
tenderness) despite therapy for at least 3 months, and activity
expected to last over 12 months; and
B. Corroboration of diagnosis at some point in time by either
a positive test for the rheumatoid factor; or antinuclear antibodies;
or elevated sedimentation rate.
2. Arthritis of a major weight-bearing joint (due to any
cause) with limitation of motion and enlargement or effusion in
the affected joint as well as a history of pain and stiffness. With
gross anatomical deformity such as subluxation, contracture,
bony or fibrous ankylosis, or instability; or ankylosis of the hip
outside of the position of function (i.e., at least 20oor more than
30% flexion measured from the neutral position) and x-ray evidence
of either joint space narrowing with osteophytosis or bony
destruction (with erosions or cysts); or reconstructive surgery or
surgical arthrodesis or a major weight bearing joint and return
to full weight-bearing status did not occur, or is not expected to
occur, within 12 months of onset.
3. Arthritis of one major joint in each of the upper extremities
(due to any cause) with limitation of motion and enlargement
of effusion in the affected joints as well as a history ofjoint
pain and stiffness and X-ray evidence of either joint space narrowing
with osteophytosis or bony destruction (with erosions or
cysts). With abduction ofboth arms at the shoulders, including
scapular motion, restricted to less than 90oor gross anatomical
deformity such as subluxation, contracture, bony or fibrous ankylosis,
joint instability, or ulnar deviation.
4. Degenerative joint disease or osteoarthritis, the most common
form of arthritis, is characterized by the loss of cartilage in
the joint, bony destruction and inflammation. For disability see
Arthritis of a Major Weight-Bearing Joint and Arthritis in Each
of the Upper Extremities.
Asthma - hyperirritability of the bronchi and trachea to certain things in one's environment.
Mild attacks need no special treatment, apart from
attempting to remove the offending allergens. Severe attacks
require drug therapy and desensitization. Most cases can be
adequately controlled. There is disability with chronic asthmatic
bronchitis, documentation of pulmonary insufficiency; or episodes
or severe attacks in spite of prescribed treatment, occurring
at least once every 2 months, or on an average of at least
6 times a year and prolonged expiration with wheezing and
rhonchi between attacks.
Atherosclerosis - condition in which the inner
layer of an artery wall becomes thick and irregular from accumulation
of fatty deposits. Coronary artery disease is the most
common type of heart disease and is the leading cause of death
in the United States and other countries. Atherosclerosis particularly
affects the coronary, cerebral and peripheral arteries.
Disability is evaluated under the system that is affected.
Atopic Dermatitis - a form of
hereditary allergic inflammation of theskinthat involves itching
and inflammation of the skin. There may be cause for disability
with extensive lesions, including involvement of the
hands and the feet which impose a severe limitation offunction
and which are not responding to prescribed treatment.
Atrial Fibrillation - 0ccurs when
the atria fail to contract effectively. This condition is frequent
in chronic organic heart disease. The patient experiences palpitations
and irregular heart beats of 160-220 beats per minute.
A major complication is formation of clots in the left atrium.
Electrical cardioversion is the treatment of choice because control
of the ventricular rate is most important. Prognosis is best
in transient cases as it becomes worse with longer episodes,
congestive heart failure, atrial enlargement, and the general
extent of organic heart disease. See criteria for disability under
Atrial Flutter - a condition
resulting from some degree of A V block wherein the atria contract
at a rate of 250-300 beats per minute, while the ventricles
maintain a much slower rate. This condition most commonly
accompanies rheumatic mitral stenosis, thyrotoxicosis, coronary
disease and atrial septal defect. This condition is more
serious than atrial fibrillation and may lead to ventricular
strain, ischemia or infarction. See criteria for disability under
Atrioventricular Dissociation. It also may be evaluated under
ischemic heart disease or myocardial infarction if these develop
Atrioventricular Dissociation (A V Block) - occurs when the,atria and the ventricles
receive signals from different pacemakers. There are first-,
second-, and third-degree blocks.
A. First-Degree Block-only a delay in A V conduction. It
may be due to digitalis intoxication, inflammation, toxins, degenerative
disease of the heart or to increased vagal tone. First-
degree heart block requires no treatment except for the underlying condition.
B. Second-Degree Block-occurs when there is a delay in A V
conduction plus some dropped beats. There are 2 types:
(1) Mobitz Type I-caused by increased vagal tone, is a frequent
complication of myocardial infarction; requires no treatment
unless there is a blood-flow disturbance.
(2) Mobitz Type lI-usually caused by a conduction block or
myocardial infarction or myocarditis. There is extreme syncope
due to abrupt temporary cessation or diminution of blood flow.
This can be fatal.
C. Third-Degree Block-a complete A V block which may
follow second-degree block, accidental surgical trauma, myocardial
infarction or it may be congenital.
Prognosis is uncertain. Without a pacemaker, the patient
(Mobitz Type II and complete A V Block) lives less than a year.
In left coronary insufficiency, mortality is very high even with
a pacemaker and proper therapy. Recurrent arrhythmias may
be cause for disability if they are not due to digitalis toxicity and
result in uncontrolled, repeated episodes of cardiac syncope and
are documented by resting or ambulatory EKG readings.
Back Pain - pain that may be due
to simple muscle strain or spasm, but there are many other
causes. It is often a symptom of other diseases such as renal
disease, prostate in men, pelvic organ disorders in women, or
disease or disorder in other abdominal structures. If there is a
disability, it is based upon the underlying cause of the pain.
Bladder Cancer - usually occurs
between ages 55-65 and is more prevalent in male cigarette
smokers. There is a 5-year survival rate in about 80% of the
patients where there is no invasion of bladder muscle, but it
drops to 10% where there is invasion. There is disability in cases
of urinary bladder carcinoma with infiltration beyond the bladder
wall; or metastasis; or if unresectable; or with recurrence
after total cystectomy.
Brain Tumors - malignant tumors of the brain. All malignant gliomas,
(astrocytoma-grades III and IV, glioblastoma multiforme),
medulloblastoma, ependymoblastoma, or primary sarcoma; or
astrocytoma (grades land 11), meningioma, pituitary tumors,
oligodendrogliomas, ependymoma, clivus chordoma are reasons
Characteristic symptoms are headache, vomiting, personality
changes, papilledema, convulsive seizures, drowsiness, lethargy
and changes in temperature, pulse or respirations. Surgery is
the best treatment, but many are inoperable by the time they
Primary intracranial neoplasms (brain tumors) are divided
into 6 classes:
1. Tumors of the skull: osteoma, hemangioma, granuloma,
xanthoma, osteitis deformans.
2. Tumors of the meninges (the 3 membranes covering the
brain and spinal cord): meningioma, sarcoma, gliomatosis.
3. Tumors of the cranial nerves: glioma of the optic nerve,
schwannoma (neurilemoma) of the 8th and 5th cranial nerves.
4. Tumors of the supportive tissue: gliomas.
5. Tumors of the pituitary and pineal bodies: pituitary adenoma, pinealoma.
6. Congenital tumors: craniopharyngioma, chordoma, germinoma,
teratoma, dermoid cyst, angioma and hemangioblastoma.
Bronchiectasis - enlargement of one or both bronchi usually accompanied by secretion
of large amounts of foul smelling pus. Treatment usually
consists of oxygen, postural drainage, bronchoscopic removal of
secretions, and surgery for lesions not responsive to medical
treatment. Bronchiectasis may be reason for disability when
demonstrated by x-ray and episodes of acute bronchitis or pneumonia
or hemoptysis occurring at least once every 2 months; or
impairment of pulmonary function.
Bullous Pemphigoid - may be
acute or chronic) a disease which affects adults characterized by
the sudden appearance of large blisters on the skin (which up
to this point appeared normal) and which leave pigmented spots
when the blisters leave. This condition may be accompanied by
itching, burning and general constitutional disturbances. The
cause is not known. There may be cause for disability when the
bullous pemphigoid is extensive and does not respond to prescribed treatment.
Cancer Metastatic to the Liver - usually clinically silent. The patient usually has symptoms
only of the primary lesion. Any tumor except primary brain
tumors can metastasize to the liver. There is no effective treatment
known at present and the prognosis is dependent upon the
primary cancer. There is disability in cases of primary or metastatic
malignant tumors of the liver; or carcinoma of the gallbladder;
or carcinoma of the bile ducts, unresectable or with
Cancer of the Fallopian Tubes - the tubes or
oviducts through which eggs pass from the ovaries to the uterus,
Primary cancer in the fallopian tubes is rare, usually unilateral,
and difficult to diagnose preoperatively, Survival rate beyond 5
years is very poor. It is cause for disability if it is unresectable
or with metastasis.
Cancer of the Pancreas - most
prevalent in those over 40. Characterized by jaundice, weight
loss, loss of appetite, nausea and pain (if present, is in mid-back
and is relieved by standing or clasping the knees while sitting).
Prognosis is very poor in all cases; few survive 5 years. There is
disability for carcinoma of the pancreas except Isle of Langerhans
carcinoma, unless the Isle of Langerhans carcinoma is
inoperable and active.
Cancer of the Uterus - a malignancy that arises in the endometrium
and is usually postmenopausal. It constitutes disability if it is inoperable and not
controlled by prescribed therapy; or recurrent after total
hysterectomy; or with total pelvic exenteration.
Carcinoma of the Colon and Rectum - one of the leading causes of cancer death. Older
persons are most affected-especially those in their 70's. It is usually
a malignant transformation of either ulcerative colitis or
certain types of colonic polyps. When there is no metastasis,
more than 70% survive 5 years. Patients with an overall rectal
involvement have a lower survival rate. The majority of all the
surgical patients will eventually have recurrent disease and
most will die of it. Chemotherapy and radiation are not very
successful in recurrent cases. There is a disability when it is
inoperable, or there is metastasis or it recurs.
Carcinoma of the Kidney (also called Hypernephroma) - the most common type of cancer
of the kidney in adults. A nephrectomy and removal of metastasis
when possible is the treatment of choice. There is a 10-year
survival in about 10%, much less in others. There may be disability
when it is unresectable; or with metastasis.
Carcinoma of the Stomach - cancer of the stomach believed to be caused from something in
the environment. Genetics may be a slight factor. Surgical resection,
when possible, is the definitive treatment. The prognosis
depends upon the extent of this malignancy and metastasis.
Disability only if inoperable.
Carotid Artery Arteriosclerosis - the narrowing of the carotid arteries due to fatty
deposits in the walls of the arteries. There may be paralysis on
the side of the body supplied, speech impairment, or blindness.
Usually there is some permanent damage. If the patient is treated
surgically, the prognosis is excellent. Medical management
is less effective. Disability is dependent upon the degree of permanent
damage. It is evaluated under the body system affected.
Cataract - a progressive
hardening and clouding of the lens with or without the inclusion
of the capsule.
A. Lenticular cataract-affects the lens.
B. Capsular cataract-affects the capsule.
C. Capsolenticular cataract-affects both lens and capsule.
A cataract may be (1) hard, soft or fluid (2) partial or complete
or (3) stationary or progressive. If surgery is successful, vision
is restored with contacts or glasses. Disability depends upon the
degree of impairment.
Central Visual Acuity (Loss of) - pertains to
how clearly one sees from the fovea centralis (center of retina).
It may be caused by impaired distant and/ or near vision. Disability
exists when remaining vision in the better eye after best
correction is 20/200 or less.
Cerebral Palsy - temporary or permanent loss of the ability to move or
to control movement or the loss of sensation. There is disability
with an IQ of 69 or less; or abnormal behavior patterns, such as
destructiveness or emotional instability; or significant interference
in communication due to speech, hearing, or visual defect;
or disorganization of motor function.
Cerebrovascular Accident (Stroke, CVA) - involves the cessation
of blood flow to apart of the brain with subsequent local destruction
of brain tissue, in most cases. The sudden and dramatic
neurological deficit appears within seconds, minutes or occasionally
hours. CV A may involve thrombosis, embolism, thromboembolism,
hypertensive hemorrhage, ruptured aneurysm,
etc. The symptoms and physical findings reflect the location of
I. Strokes due to occlusion of:
A. Internal carotid artery-may be asymptomatic or so severe
as to cause death in a few days. Frequently blindness in one
eye and then the other is a warning sign. Other symptoms are
opposite-side paralysis and speech disorders.
B. Middle cerebral artery-opposite-side paralysis, numbness
in limbs, blindness in one eye, inability to understand spoken
words or the inability to speak.
C. Anterior cerebral artery-sensorimotor deficit in the opposite
foot, leg or arm, and changes in the usual behavior pattern.
D. Posterior cerebral artery-may produce uncontrollable
jerking or shaking movement, eyes paralyzed in a stare, coma
and monocular blindness.
II. Other causes of cerebrovascular accident (CV A):
A. Stroke due to embolism-less common; usually develops
rapidly within one minute. Headache, blindness and paralysis
B. Intracranial hemorrhage-begins with a headache, then
over a period of several hours there is slurred speech, paralysis
of limbs and face, vomiting, vertigo, loss of control of gaze and
The threat of a recurrence is very high except in the case of
intracranial hemorrhage. Most neurological deficits are not
greatly helped by physical therapy except for speech disorders.
Massive strokes usually result in death in a matter of hours.
Cervical Cancer - a noninvasive
cancer of the cervix (the neck of the uterus). One of the most
common malignancies of the female reproductive system. For
this reason, regular Pap smears are important for early diagnosis
and treatment. There are 5 classes recognized:
Class I-no abnormal or atypical cells
Class II-benign atypical cells present
Class lII-atypical cells with suspicion of malignancy
Class IV -malignant cells present
Class V -large numbers of malignant cells.
Classes I and II need no treatment other than regular Pap
Classes III, IV and V should be followed by a biopsy of the
cervix to determine if there is evidence of invasive disease. If so,
more evaluation is needed of the lungs, gastrointestinal tract,
urinary tract and lymph nodes. For carcinoma in situ (cancer
that is localized), nearly 100% are completely cured. For more
invasive lesions, less than 10% survive 5 years after diagnosis.
It is in this latter 10% that there may be cause for disability
because it eventually becomes uncontrollable by prescribed
Cervical Radiculopathies - pain
caused by pinched nerves in the cervical spine (neck). The pain
radiates from the neck to the hand arid may be accompanied by
weakness. Cases with no complications usually show improvement
in two weeks with proper bed rest, analgesics and anti-inflammatory
drugs. Prognosis is also good where a laminectomy
(repair of herniated disc) is required. When atrophy of muscles
has occurred, prognosis is not so good.
Disability exists when there is significant loss of use (motor
loss) of the hand along with muscular weakness, sensory and
Cervical Spinal Injury - an injury to the spinal cord in the neck, usually the
result of an automobile accident, sports-related accident or assault.
There is usually loss of sensation below the injury and
paralysis. The prognosis depends upon the extent and location
of the injury. When the spinal cord is completely severed, prognosis
is poor for restoration of function. An injury at or above
cervical vertebra C3 is usually associated with paralysis of the
diaphragm and a respirator is necessary to keep the patient
Disability is evaluated according to the degree of impairment.
Chest Pain of Cardiac Origin - pain which is precipitated by effort and promptly
relieved by sublingual nitroglycerine or rapid acting nitrates or
rest. The character of the pain is described as crushing, squeezing,
burning or oppressive pain in the chest.
In order for chest pain of cardiac origin to qualify as a disability
there must be substantiated evidence: treadmill exercise test,
horizontal or down-sloping ischemic depression of the ST segment
to 1.0 mm or greater; or, multiform, bidirectional or sequentially
described premature ventricular systoles; or transmural myocardial
infarction (ERG); or resting ERG showing
ischemic disease; or development of second- or third-degree
heart block; or angiographic evidence of narrowing of the coronary arteries.
Chronic Brain Syndrome (Organic Brain Syndrome) - results from chronic irreversible
impairment of cerebral tissue function. Impairment is
usually permanent and may be progressive. The degree of impairment
may range from mild to severe. Acute brain syndromes are temporary
and reversible conditions with favorable
prognosis and no significant residual effects. Occasionally, an
acute brain syndrome may progress to chronic.
There is cause for disability when there is demonstrated deterioration
in intellectual functioning, manifested by persistence
in one or more of the following: marked memory defect for
recent events; or impoverished, slowed or perseverative thinking
with confusion or disorientation; or labile, shallow, or coarse
affect; and resulting persistence of marked restriction of daily
activities and constriction of interests and deterioration in personal
habits and seriously impaired ability to relate to other
Chronic Bronchitis - a chronic productive cough for at least 3 months during 2
consecutive years. The most important cause is smoking. No
smoking, antibiotics, postural drainage and plenty of fluids are
the usual course of treatment. Prognosis depends upon the degree
of impaired respiratory function. When there is severe
impairment with carbon dioxide retention, most live less than
5 years. Episodes of severe attacks in spite of prescribed treatment,
occurring at least once every 2 months, or on an average
of at least 6 times a year and prolonged expiration with wheezing
or rhonchi (a rattling sound) between attacks is reason for
Chronic Venous Insufficiency - (of the lower
extremities) occurs after thrombophlebitis in the deep leg veins
and is characterized by edema and dilated superficial veins. The
patient must wear elastic hose to control the edema. Complications
which may arise are pigmentation around the ankle, varicose veins,
dermatitis and ulceration.
There may be disability for chronic venous insufficiency of the
lower extremities with incompetency or obstruction of the deep
venous return, associated with varicose veins, extensive edema,
dermatitis, and recurrent or persistent ulceration which has not
healed following 3 months of prescribed medical or surgical
Cirrhosis - diffuse liver disease in which there is fibrosis, formation of
nodules and loss of liver function. Cirrhosis leads to: portal
hypertension, fluid retention, kidney failure and hepatic coma.
A. Biliary Cirrhosis-cirrhosis due to destruction or obstruction
of the bile ducts. Surgical relief of the obstruction in secondary
biliary cirrhosis is the treatment of choice. There is no
known cure for primary biliary cirrhosis; one can only relieve
the symptoms by a high calorie, balanced diet and give vitamins
A, D, and K, etc.
1. Secondary-caused by some kind of obstruction in the bile
ducts which can be treated surgically or medically.
2. Primary-marked by a gradual deterioration, ascites and
massive upper GI hemorrhage which is terminal. There is no
known cure, it is slowly progressive, and only the symptoms can
B. Laennec's Cirrhosis-a diffuse finely scarring form most
often associated with alcoholism and a poor diet. There is no
cure, but the process can be slowed by denial of alcohol and a
balanced diet. If the patient abstains from alcohol his 5-year
survival rate is 60%; if not, 40%. Massive hemorrhage from
esophageal varices is the major cause of death.
Chronic liver disease (portal, postnecrotic, biliary cirrhosis,
Laennec's cirrhosis, chronic active hepatitis) qualifies as a dis-
ability with x-ray or endoscopic evidence of esophageal varices
and accompanying massive hemorrhages due to these varices;
or serum bilirubin of 2.5 mg per 100 cc or greater for at least 5
months; or performance of a shunt operation for the esophageal
varices; or liver dysfunction; or confirmation by a liver biopsy;
or ascites not attributable to other causes which is recurring or
persistent for at least 3 months and demonstrated by abdominal
paracentesis; or persistent hypoalbuminuria of 3.0 gm per 100
cc or less; or hepatic cell necrosis or inflammation persisting for
3 months documented by repeated abnormalities of prothrombin
time and enzymes indicative of liver dysfunction.
Coagulation Defects - any breakdown in the blood clotting process that results in an
abnormal tendency to bleed. For normal clotting to occur, there
is combined activity of vascular, platelet and plasma factors.
The vascular factor refers to the natural immediate reaction of
blood vessels to constrict wheri injured. The platelets are a component
of blood that begin to adhere to and plug injured sites
and that release certain substances that finish the coagulation
process. These are the coagulation factors which are plasma
proteins (fibrinogen and prothrombin) as well as thromboplastin
and calcium. This condition does not constitute a disability
unless it is extreme, such as hemophilia. Many liver disorders
cause coagulation defects. For those patients with heart or vascular
diseases and who must take anticoagulant drugs, this is a
problem. The treatment and prognosis depend upon the underlying
cause. Even therapy with antihemophilic globulin (AHG)
does not constitute a disability. Coagulation defects with sponta-
neous hemorrhage requiring transfusion at least 3 times during
the 5 months prior to adjudication is cause for disability.
Congestive Heart Failure (CHF) - cessation of the heart's action due to the presence
of congestion (usually fluid in the lungs and/or around the
heart in the pericardium) or vascular congestion. Heart failure
may be left or right sided, may develop gradually or may be
sudden with acute pulmonary edema.
Left ventricular failure manifests as tachycardia, fatigue
with exertion, intolerance to cold, recurring nocturnal short-
ness of breath, cough, rusty tinged or brownish sputum, palpa-
ble and audible 3rd and 4th heart sounds, rales and pleural
Acute pulmonary edema occurs suddenly and is life threatening.
There is extreme cyanosis, shallow, irregular breathing,
restlessness, thready pulse, blood pressure difficult to find,
wheezing and rales. Treatment must be immediate or death is
Symptoms of right ventricular failure are tired feeling, feeling
of fullness in the neck, fullness in the abdomen, sometimes
pain in the upper abdomen, swelling around the ankles, hepatomegaly,
and cyanosis in the nails.
There are no specific findings on EKG for CHF, but chest
x-rays are helpful in evaluating its presence and possible cause.
Disability exists ifCHF is manifested by evidence of vascular
congestion such as hepatomegaly, peripheral or pulmonary
edema with: persistent CHF on clinical examination despite
prescribed therapy; or persistent left ventric:.lar enlargement
and hypertrophy documented by both extension of the cardiac
shadow (left ventricle) to the vertebral column on a left lateral
chest x-ray or PA chest x-ray or certain E KG findings; or persistent "mitral heart involvement" documented by double shadow
on PA chest x-ray (or characteristic distortion of barium-filled
esophagus) and either:
1. EKG showing QRS duration less than 0.12 second with
SVl plus Rv5 (or Rv6) of 35 mm or greater and ST segment
depressed more than 0.5 mm and low diphasic or inverted T
waves in leads with tall R waves; or
2. E KG evidence of right ventricular hypertrophy with R
wave of 5.0 mm or greater in lead V 1 and progressive decrease
in R/S amplitude from lead V 2 to V 6 or V 6; or
Cor pulmonale (chronic) documented by both:
1. Right ventricular enlargement (or prominence of the
right out-flow tract) or chest x-ray or fluoroscopy; and
2. EKG evidence of right ventricular hypertrophy with R
wave of 5.0 mm or greater in lead V 1 to V 6 or V 6.
Convulsive Disorders - any disease or disorder which may produce
convulsions. Some are: epilepsy, eclampsia, tetanus, meningitis,
uremia, poisoning of dietary origin, syphilis, heat stroke,
metabolic disturbances, etc.
The seizures for most of these conditions are temporary and
end when the illness ends. The exceptions are epilepsy and in
cases where a permanent lesion is left in the brain. In such
cases, the seizures are recurring, but usually controllable by
There is no disability unless the convulsive disorder is classified
as epilepsy and meets the SSA requirements.
Cor Pulmonale (CP) - the enlargement of the right ventricle due to lung disease or
disorder. Acute cor pulmonale results from pulmonary embolism.
Chronic cor pulmonale is the result of prolonged pulmonary
dysfunction or disease (chronic bronchitis, emphysema,
surgery, or trauma, etc.). Some symptoms and signs of chronic
CP are shortness of breath, syncope on exertion, x-ray showing
ventricular enlargement and enlargement of pulmonary arter-
ies, E KG evidence, gallc;>p rhythm, distended jugular veins (in -
neck), hepatomegaly, edema, cough, cyanosis, wheezing and substernal pain.
Acute CP shows the symptoms of a pulmonary embolism in
which a clot becomes lodged in the pulmonary artery blocking
the flow of blood from the heart to the lungs. The embolus is
usually from a thromboembolus formed in a deep leg vein, but
may be from a congenital heart disease, some systemic disease,
oral contraceptives, injury or surgery. Some symptoms are:
shortness of breath, breathlessness, rapid and shallow respirations,
anxiety, restlessness, apprehension, pulmonary hypertension,
dull substernal pain, light-headedness, syncope, convulsions,
neurological impairments, cyanosis, cough, hemoptysis,
pleuritic chest pain, fever, and/ or pleural effusion.
Chronic CP may be cause for disability when there is documented
pulmonary insufficiency or accompanying CHF (chron-
Crohn's Disease - Regional Enteritis (another name for Crohn's Disease).
Cystic Fibrosis - a
congenital condition where there is gradual fibrosis of the pancreas,
changes in the respiratory tree which causes obstructions
in the lungs and abnormal sweat chloride levels, fatty stools and
rectal prolapse. It is usually fatal in early childhood, but a few
do make it to adulthood. Disability is based upon the degree of
impairment of the particular body system that is affected the