A thru C

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 episodes.

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 situation.

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 and maintained.

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 disability.

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 Atrioventricular Dissociation.

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 as complications.

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 for disability.
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 are diagnosed.
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 metastases.

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 the lesion.
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 develop instantly.
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 then coma.
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 smears.
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 therapy.

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 reflex loss.

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 alive.
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 people.

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 disability.

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 treatment.

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 be relieved.
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 effusion.
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 certain.
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 proper medication.
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- ic).

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 most.