# listings

code: 112.15
title: Trauma- and stressor-related disorders
source_url: https://www.ssa.gov/disability/professionals/bluebook/112.00-MentalDisorders-Childhood.htm
summary:
  112.15 Trauma- and stressor-related disorders (see  112.00B11 ), 
          for children age 3 to attainment of age 18, satisfied by A and B, or A and C: 


       


           


              Medical documentation of the requirements of paragrap…

raw_text:
  112.15 Trauma- and stressor-related disorders (see  112.00B11 ), 
          for children age 3 to attainment of age 18, satisfied by A and B, or A and C: 


       


           


              Medical documentation of the requirements of paragraph 1 or 2:
               


                   


                      Posttraumatic stress disorder, characterized by  all  of the following:
                       


                           

  Exposure to actual or threatened death, serious injury, or violence; 


                           

  Subsequent involuntary re-experiencing of the traumatic event (for example, intrusive memories, dreams, or flashbacks); 


                           

  Avoidance of external reminders of the event; 


                           

  Disturbance in mood and behavior (for example, developmental regression, socially withdrawn behavior); and 


                           

  Increases in arousal and reactivity (for example, exaggerated startle response, sleep disturbance). 


                       


                   


                   


                      Reactive attachment disorder, characterized by  two  or all of the following:
                       


                           

  Rarely seeks comfort when distressed; 


                           

  Rarely responds to comfort when distressed; or 


                           

  Episodes of unexplained emotional distress. 


                       


                   


               


           


       


       

  AND 


       


           


              Extreme limitation  of one, or marked limitation of two, of the following areas of mental  functioning (see  112.00F ):
               


                   

  Understand, remember, or apply information (see  112.00E1 ). 


                   

  Interact with others (see  112.00E2 ). 


                   

  Concentrate, persist, or maintain pace (see  112.00E3 ). 


                   

  Adapt or manage oneself (see  112.00E4 ). 


               


           


       


       

  OR 


       


           


              Your mental disorder  in this listing category is “serious and persistent;” that is,
              you have a medically documented history of the existence of the disorder over a period of at least 2 years, and there is evidence of both:
               


                   

  Medical treatment, mental health therapy, psychosocial support(s), 
                  or a highly structured setting(s) that is ongoing and that diminishes the symptoms and signs of your mental disorder 
                  (see  112.00G2b );  and 


                   


                      Marginal adjustment, that is, you have minimal capacity to adapt to changes in your environment or to demands that are not already part of your daily life 
                  (see  112.00G2c ).
                   


               


           


       


      
    
   
    



   

   



       


     
     
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code: 112.00
title: 112.00
source_url: https://www.ssa.gov/disability/professionals/bluebook/112.00-MentalDisorders-Childhood.htm
summary:
  112.00 Mental Disorders 


     
         

  A. How are the listings for mental disorders for children arranged, and what do they require? 


           


               


                   The listings for mental disorders for children are arrange…

raw_text:
  112.00 Mental Disorders 


     
         

  A. How are the listings for mental disorders for children arranged, and what do they require? 


           


               


                   The listings for mental disorders for children are arranged in 12 categories:
                  neurocognitive disorders ( 112.02 );
                  schizophrenia spectrum and other psychotic disorders ( 112.03 );
                  depressive, bipolar and related disorders ( 112.04 );
                  intellectual disorder ( 112.05 );
                  anxiety and obsessive-compulsive disorders ( 112.06 );
                  somatic symptom and related disorders ( 112.07 );
                  personality and impulse-control disorders ( 112.08 );
                  autism spectrum disorder ( 112.10 );
                  neurodevelopmental disorders ( 112.11 );
                  eating disorders ( 112.13 );
                  developmental disorders in infants and toddlers ( 112.14 );
                  and trauma- and stressor-related disorders ( 112.15 ). 
                  All of these listings, with the exception of  112.14 ,
                  apply to children from age three to attainment of age 18. 
                  Listing  112.14  is for children from birth to attainment of age 3.
               


               


                   Listings  112.07 ,
                   112.08 ,  112.10 ,
                   112.11 ,  112.13 ,
                  and  112.14  have two paragraphs,
                  designated A and B; your mental disorder must satisfy the requirements of both paragraphs A and B.
                  Listings  112.02 ,  112.03 ,
                   112.04 ,  112.06 , and  112.15  have three paragraphs,
                  designated A, B, and C; your mental disorder must satisfy the requirements of both paragraphs A and B, or the requirements of both paragraphs A and C. 
                  Listing  112.05  has two paragraphs that are unique to that listing
                  (see  112.00A3 );
                  your mental disorder must satisfy the requirements of either paragraph A or paragraph B.
                   


                       


                           Paragraph A of each listing (except  112.05 )
                          includes the  medical criteria that must be present in your medical evidence. 
                       


                       


                           Paragraph B of each listing (except  112.05 )
                          provides the  functional criteria we assess to evaluate how your mental disorder limits your functioning. 
                          For children ages 3 to 18, these criteria represent the areas of mental functioning a child uses to  perform age-appropriate activities.  
                          They are: understand, remember, or apply information; interact with others; concentrate, persist, or maintain pace; and adapt  or manage oneself.  
                          (See  112.00I  for a discussion of the criteria for children from birth to attainment of age 3 under
                           112.14 .)  We will determine the degree to which your medically determinable mental impairment affects the four areas of mental functioning
                          and your ability to function age-appropriately in a manner comparable to that of other children your age who do not have impairments. 
                          (Hereinafter, the words "age-appropriately" incorporate the qualifying statement,
                          "in a manner comparable to that of other children your age who do not have impairments.") 
                          To satisfy the paragraph B criteria, your  mental disorder must result in "extreme" limitation of one, or "marked" limitation of two,
                          of the four areas of mental functioning. 
                          (When we refer to "paragraph B criteria" or "area[s] of mental functioning" in the introductory text of this body system,
                          we mean the criteria in paragraph B of every listing except  112.05 
                          and  112.14 .)
                       


                       


                           Paragraph C of listings  112.02 ,
                           112.03 ,  112.04 ,
                           112.06 , and  112.15  provides the criteria we use to evaluate "serious and persistent mental disorders." 
                          To satisfy the paragraph C criteria, your mental disorder must be "serious and persistent";
                          that is, there must be a medically documented history of the existence of the disorder over a period of at least 2 years,
                          and evidence that satisfies the criteria in both C1 and C2 (see  112.00G ).
                          (When we refer to "paragraph C" or "the paragraph C criteria" in the introductory text of this body system,
                          we mean the criteria in paragraph C of listings  112.02 ,
                           112.03 ,  112.04 ,
                           112.06 , and  112.15 .)
                       


                   


               


               


                   Listing  112.05  has two paragraphs,
                  designated A and B, that apply to only intellectual disorder. 
                  Each paragraph requires that you have significantly subaverage general intellectual functioning and significant deficits in current adaptive functioning.
               


           


         

  B. Which mental disorders do we evaluate under each listing category for children?  


       


           


               Neurocognitive disorders ( 112.02 ). 
               


                   

  These disorders are characterized in children by a clinically significant deviation in normal cognitive development or by a decline in cognitive functioning.  Symptoms and signs may include, but are not  limited to, disturbances in memory, executive functioning (that is,  higher-level cognitive processes; for example, regulating attention, planning,  inhibiting responses, decision-making), visual-spatial functioning, language  and speech, perception, insight, and judgment. 


                   


                       Examples of disorders that we evaluate in this category include major neurocognitive disorder;
                      mental impairments resulting from medical conditions such as a metabolic disease (for example, juvenile Tay-Sachs disease), human immunodeficiency virus infection,
                      vascular malformation, progressive brain tumor, or traumatic brain injury; or substance-induced cognitive disorder associated with drugs of abuse, medications, or toxins. 
                      (We evaluate neurological disorders under that body system (see  111.00 ). 
                      We evaluate cognitive impairments that result from neurological disorders under  112.02 
                      if they do not satisfy the requirements in  111.00 .  
                      We evaluate catastrophic genetic disorders under listings in  110.00 ,
                       111.00 , or  112.00 ,
                      as appropriate. We evaluate genetic disorders that are not catastrophic under the affected body system(s).)
                   


                   


                       This category does not include the mental disorders that we evaluate under intellectual disorder
                      ( 112.05 ), autism spectrum disorder ( 112.10 ),
                      and neurodevelopmental disorders ( 112.11 ).
                   


               


           


           


               Schizophrenia spectrum and other psychotic disorders ( 112.03 ). 
               


                   

  These disorders are characterized by delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior, causing a clinically significant decline in  functioning.  Symptoms and signs may include,  but are not limited to, inability to initiate and persist in goal-directed  activities, social withdrawal, flat or inappropriate affect, poverty of thought  and speech, loss of interest or pleasure, disturbances of mood, odd beliefs and  mannerisms, and paranoia.


code: 113.00
title: Cancer
summary:
  113.00 Cancer 


         


             A.  What impairments do  these listings cover?  We  use these listings to evaluate all
            cancers (malignant neoplastic diseases) except certain cancers associated with human immunodeficiency vir…

raw_text:
  113.00 Cancer 


         


             A.  What impairments do  these listings cover?  We  use these listings to evaluate all
            cancers (malignant neoplastic diseases) except certain cancers associated with human immunodeficiency virus (HIV) infection.
            We use the criteria in  114.11B  to evaluate primary central nervous system lymphoma,
             114.11C  to evaluate primary effusion lymphoma,
            and  114.11E  to evaluate pulmonary Kaposi sarcoma if you also have HIV infection.
            We evaluate all other cancers associated with HIV infection, for example, Hodgkin lymphoma or non-pulmonary Kaposi sarcoma,
            under this body system or under  114.11F 
            -  I  in the immune system disorders body system.
         



         


             B.  
                What do we consider when we evaluate cancer
                under these listings?
              We consider factors including:
         


         

  1. Origin of the cancer. 


         

  2. Extent of involvement. 


         

  3. Duration, frequency, and response to therapy.  


         

  4. Effects of any post-therapeutic residuals. 


         


             C.   How do we apply these listings?   We apply the criteria
            in a specific listing to a cancer originating from that specific
            site.
         


         

  D.   What evidence do we need?   


         


             1.  We need medical evidence that specifies the type, extent, and site of the primary,
            recurrent, or metastatic lesion. In the rare situation in which the primary site
            cannot be identified, we will use evidence documenting the site(s) of metastasis
            to evaluate the impairment under  13.27  in part A.
         


         


             2. For operative procedures,
            including a biopsy or a needle aspiration, we generally need a
            copy of both the:
         


         

  a. Operative note, and 


         

  b. Pathology report. 


         


              3. When we cannot get these documents, we will accept the summary
            of hospitalization(s) or other medical reports. This evidence should
            include details of the findings at surgery and, whenever appropriate,
            the pathological findings.
         


         


              4.
            In some situations we may also need evidence about recurrence,
            persistence, or progression of the cancer, the response to
            therapy, and any significant residuals. (See  113.00G .)
         


         


              E.  
                When do we need longitudinal
                evidence?
             
         


         

   1.  Cancer with distant metastases.  Most cancer of childhood consist of a local lesion with metastases to regional lymph nodes and, less often, distant metastases. We generally do not need longitudinal evidence for cancer that has metastasized beyond the regional lymph nodes because  this cancer usually meets the requirements of a listing. Exceptions are for  cancer with distant metastases that we expect to respond to anticancer therapy. For these exceptions, we usually need a longitudinal record of 3 months after therapy starts to determine whether the therapy achieved its intended effect, and whether this effect is likely to persist.   


         


              2.  Other cancers . When there are no distant metastases,
            many of the listings require that we consider your response to
            initial anticancer therapy; that is, the initial planned
            treatment regimen. This therapy may consist of a single modality
            or a combination of modalities; that is, multimodal therapy (see  113.00I3 ).
         


         


              3.  Types of treatment .
             


                 


                     
                    Whenever the initial planned
                    therapy is a single modality, enough time must pass to allow
                    a determination about whether the therapy will achieve its intended
                    effect. If the treatment fails, the failure will often happen
                    within 6 months after treatment starts, and there will often
                    be a change in the treatment regimen.
                 


                 


                     
                    Whenever the initial planned therapy is multimodal,
                    we usually cannot make a determination about the effectiveness of the therapy until we can determine the effects of all the planned modalities.
                    In some cases, we may need to defer adjudication until we can assess the effectiveness of therapy.
                    However, we do not need to defer adjudication to determine whether the therapy will achieve its intended effect if we can make a fully favorable determination
                    or decision based on the length and effects of therapy,
                    or the residuals of the cancer or therapy (see  113.00G ).
                 


             


         



         


              F.  
                How do we evaluate
                impairments that do not meet one of the cancer listings?
             
         


         


              1. These listings are only examples of cancer that we consider severe enough to result in marked and
            severe functional limitations. 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 meets the criteria of
            a listing in another body system.
         


         


              2. If you have a severe medically determinable impairment(s) that does not meet a listing,
            we will determine whether your impairment(s) medically equals a listing.
            (See §§ 404.1526 
            and  416.926  of this chapter.)
            If your impairment(s) does not meet or medically equal a listing, we will also consider whether you have an impairment(s) that functionally equals the listings.
            (See § 416.926a  of this chapter.)
            We use the rules in §§ 416.994a  of this chapter when we decide whether you continue to be disabled.
         


         

   G.   How do we consider the effects of anticancer therapy?   


         


             1.   How we consider the effects of therapy under the listings  .
            In many cases, cancers meet listing criteria only if the therapy is not effective and the cancer persists, progresses, or recurs. However, as explained in the following paragraphs, we will not delay adjudication if we can make a fully favorable determination or decision based on the evidence in the case record.
         


         

  2.   Effects can vary widely. 


         

   a. We consider each case on an individual basis because the therapy and its toxicity may vary widely. We will request a specific description of the therapy, including these items:  


         

   i. Drugs given. 


         

  ii. Dosage. 


         

  iii. Frequency of drug administration. 


         

  iv. Plans for continued drug administration. 


         

  v. Extent of surgery. 


         

  vi. Schedule and fields of radiation therapy. 


         


             b. We will also request a description of the complications or adverse effects of
            therapy, such as the following:
         


         

  i. Continuing gastrointestinal symptoms. 


         

  ii. Persistent weakness. 


         

  iii. Neurological complications. 


         

  iv. Cardiovascular complications. 


         

  v. Reactive mental disorders. 


         

  3.  Effects of therapy may change . The severity of the adverse effects of anticancer therapy may change during treatment; therefore, enough time must pass to allow us to evaluate the therapy's effect. The residual effects of treatment are temporary in most instances; however, on occasion, the effects may be disabling for a consecutive period of at least 12 months. In some situations, very serious adverse effects may interrupt and prolong multimodal anticancer therapy for a continuous period of almost 12 months. In these situations, we may determine there is an expectation that your impairment will preclude you from engaging in any age-appropriate activities for at least 12  months.

source_url:
  https://www.ssa.gov/disability/professionals/bluebook/113.00-NeoplasticDiseases-Malignant-Childhood.htm


code: 113.03
title:
  Malignant
  solid
  tumors

summary:
  113.03  Malignant solid tumors 
                 Consider under a disability:
             
         


             A. For 24 months from the date of initial diagnosis. Thereafter, evaluate any residual
            impairment(s) under the criteria f…

raw_text:
  113.03  Malignant solid tumors 
                 Consider under a disability:
             
         


             A. For 24 months from the date of initial diagnosis. Thereafter, evaluate any residual
            impairment(s) under the criteria for the affected body system.
         


         

  OR 


         


             B. For 24 months from the date of recurrence of active disease. Thereafter, evaluate
            any residual impairment(s) under the criteria for the affected body system..

source_url:
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code: 113.05
title: Lymphoma
summary:
  113.05
               
                 
                    Lymphoma (excluding all types of lymphoblastic
                    lymphoma--  113.06 )
                 
             (See  113.00K1 )
         


         

  A. Non-Hodgkin lymphoma (including B…

raw_text:
  113.05
               
                 
                    Lymphoma (excluding all types of lymphoblastic
                    lymphoma--  113.06 )
                 
             (See  113.00K1 )
         


         

  A. Non-Hodgkin lymphoma (including Burkitt's and anaplastic large cell), with either 1 or 2: 


         


            1. Bone marrow, brain, spinal cord, liver, or lung involvement at initial diagnosis.
            Consider under a disability for 24 months from the date of diagnosis. Thereafter,
            evaluate under  113.05A2 , or any residual impairment(s) under the criteria for the affected body system.
         


         

  2. Persistent or recurrent following initial anticancer therapy.  



         

  OR 


         

  B. Hodgkin lymphoma, with either 1 or 2:   


         


             1.  Bone marrow, brain, spinal cord, liver, or lung involvement at initial diagnosis. Consider under a disability for 24 months from the date of diagnosis.
            Thereafter, evaluate under  113.05B2 ,
            or any residual impairment(s) under the criteria for the affected body system.
         


         

  2. Persistent or recurrent following initial anticancer therapy.  



         

  OR 


         


             C. With bone marrow or stem cell transplantation. Consider under a disability until
            at least 12 months from the date of transplantation. Thereafter, evaluate any
            residual impairment(s) under the criteria of the affected body system.
         


         

  OR   


         

   D. Mantle cell lymphoma.

source_url:
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code: 113.06
title: Leukemia
summary:
  113.06  Leukemia  
            (See  113.00K2 )
         


         


             A. Acute leukemia (including all types of lymphoblastic lymphoma and juvenile chronic
            myelogenous leukemia (JCML). Consider under a disability until at l…

raw_text:
  113.06  Leukemia  
            (See  113.00K2 )
         


         


             A. Acute leukemia (including all types of lymphoblastic lymphoma and juvenile chronic
            myelogenous leukemia (JCML). Consider under a disability until at least 24 months
            from the date of diagnosis or relapse, or at least 12 months from the date of
            bone marrow or stem cell transplantation, whichever is later. Thereafter, evaluate
            any residual impairment(s) under the criteria for the affected body system.
         


         

  OR 


         

  B. Chronic myelogenous leukemia (except JCML), as described in 1 or 2: 


         


             1. Accelerated or blast phase (see  113.00K2b ). 
            Consider under a disability until at least 24 months
            from the date of diagnosis or relapse, or at least 12 months from the date of
            bone marrow or stem cell transplantation, whichever is later. Thereafter, evaluate
            any residual impairment(s) under the criteria for the affected body system.
         


         

  2. Chronic phase, as described in a or b: 


         


             a. Consider under a disability until at least 12 months from the date of bone marrow
            or stem cell transplantation. Thereafter, evaluate any residual impairment(s)
            under the criteria for the affected body system.
         


         

  b. Progressive disease following initial anticancer therapy.

source_url:
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code: 113.09
title: Thyroid gland
summary:
  113.09
              Thyroid gland  
             
         


         


             A. Anaplastic (undifferentiated) carcinoma.
         


         

  OR 


         


             B. Carcinoma with metastases beyond the regional lymph nodes progressive…

raw_text:
  113.09
              Thyroid gland  
             
         


         


             A. Anaplastic (undifferentiated) carcinoma.
         


         

  OR 


         


             B. Carcinoma with metastases beyond the regional lymph nodes progressive despite
            radioactive iodine therapy. 


         


         


            OR 


             


             C.   Medullary carcinoma with metastases beyond the regional lymph nodes.

source_url:
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code: 113.12
title: Retinoblastoma
summary:
  113.12  Retinoblastoma 
         


         

  A. With extension beyond the orbit. 


         

  OR 


         

  B. Persistent or recurrent following initial anticancer therapy. 


         

  OR 


         

  C. With regional or distant metastases.

raw_text:
  113.12  Retinoblastoma 
         


         

  A. With extension beyond the orbit. 


         

  OR 


         

  B. Persistent or recurrent following initial anticancer therapy. 


         

  OR 


         

  C. With regional or distant metastases.

source_url:
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code: 113.13
title: Nervous system
summary:
  113.13
              Nervous system 
            (See  113.00K4 .) Primary central nervous system (CNS; that is, brain and spinal cord) cancers, as described in A, B, or C:
         


         

    A. Glioblastoma multiforme, ependymoblastoma, and…

raw_text:
  113.13
              Nervous system 
            (See  113.00K4 .) Primary central nervous system (CNS; that is, brain and spinal cord) cancers, as described in A, B, or C:
         


         

    A. Glioblastoma multiforme, ependymoblastoma, and diffuse intrinsic brain stem gliomas (see  113.00K4a ).  


         

    B. Any Grade III or Grade IV CNS cancer (see  113.00K4b ), including astrocytomas, sarcomas, and medulloblastoma and other primitive neuroectodermal tumors (PNETs).  


         

    C. Any primary CNS cancer, as described in 1 or 2: 


         

    1. Metastatic. 


         

    2. Progressive or recurrent following initial anticancer therapy.

source_url:
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code: 113.21
title: Neuroblastoma
summary:
  113.21   Neuroblastoma 
         


         

  A. With extension across the midline. 


         

  OR 


         

  B. With distant metastases. 


         

  OR 


         

  C. Recurrent. 


         

  OR 


         

    D. With onset at age 1 year or old…

raw_text:
  113.21   Neuroblastoma 
         


         

  A. With extension across the midline. 


         

  OR 


         

  B. With distant metastases. 


         

  OR 


         

  C. Recurrent. 


         

  OR 


         

    D. With onset at age 1 year or older.

source_url:
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code: 113.29
title: 113.29
summary:
  113.29
              Malignant melanoma   (including skin, ocular, or mucosal melanomas), as described in either A, B, or C:
         



         

  A. Recurrent (except an additional primary melanoma at a different site, which is not considered…

raw_text:
  113.29
              Malignant melanoma   (including skin, ocular, or mucosal melanomas), as described in either A, B, or C:
         



         

  A. Recurrent (except an additional primary melanoma at a different site, which is not considered to be recurrent disease) following either 1 or 2:  


         

  1. Wide excision (skin melanoma).  


         

  2. Enucleation of the eye (ocular melanoma). 


         

  OR  


         

  B. With metastases as described in 1, 2, or 3: 


         

  1. Metastases to one or more clinically apparent nodes; that is, nodes that are detected by imaging studies (excluding lymphoscintigraphy) or by clinical evaluation (palpable). 


         

  2. If the nodes are not clinically apparent, with metastases to four or more nodes. 


         

  3. Metastases to adjacent skin (satellite lesions) or distant sites (for example, liver, lung, or brain). 


         

  OR 


         

  C. Mucosal melanoma. 




         


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source_url:
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code: 114.02
title: Systemic lupus erythematosus
source_url: https://www.ssa.gov/disability/professionals/bluebook/114.00-Immune-Childhood.htm
summary:
  114.02   Systemic lupus erythematosus ,
                  as described in  114.00D1 .
                  With involvement of two or more organs/body systems, and with:
               


               

  A.  One of the  organs/body systems involved…

raw_text:
  114.02   Systemic lupus erythematosus ,
                  as described in  114.00D1 .
                  With involvement of two or more organs/body systems, and with:
               


               

  A.  One of the  organs/body systems involved to at least a moderate level of severity; 


               

  AND 


               

  B.  At least two of the  constitutional symptoms and signs (severe fatigue, fever, malaise, or  involuntary weight loss). 


               

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code: 114.03
title: Systemic vasculitis
source_url: https://www.ssa.gov/disability/professionals/bluebook/114.00-Immune-Childhood.htm
summary:
  114.03   Systemic vasculitis ,
                  as described in  114.00D2 .
                  With involvement of two or more organs/body systems, and with:
               


               

  A.  One of the organs/body systems involved to at  lea…

raw_text:
  114.03   Systemic vasculitis ,
                  as described in  114.00D2 .
                  With involvement of two or more organs/body systems, and with:
               


               

  A.  One of the organs/body systems involved to at  least a moderate level of severity; 


               

  AND 


               

  B.  At least two of the constitutional symptoms  and signs (severe fatigue, fever, malaise, or involuntary weight loss). 


               

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code: 114.04
title: Systemic sclerosis (scleroderma)
source_url: https://www.ssa.gov/disability/professionals/bluebook/114.00-Immune-Childhood.htm
summary:
  114.04    Systemic sclerosis (scleroderma). 
                  As described in  114.00D3 . With:
               


               

  A.  Involvement of two or more organs/body systems, with: 


               

  1. One of the organs/body systems  in…

raw_text:
  114.04    Systemic sclerosis (scleroderma). 
                  As described in  114.00D3 . With:
               


               

  A.  Involvement of two or more organs/body systems, with: 


               

  1. One of the organs/body systems  involved to at least a moderate level of severity; and 


               

  2. At least two of the constitutional  symptoms and signs (severe fatigue, fever, malaise, or involuntary weight  loss). 


               

  OR 


               

  B.  One of the following: 


               


                   1. Toe contractures or fixed deformity of one or both feet,
                    and medical documentation of at least  one  of the following: 


  				 


    					 


  						A documented medical need (see  114.00C6 ) for a walker, bilateral canes, or bilateral crutches (see  101.00C6d ) or a wheeled and seated mobility device involving the use of both hands (see  101.00C6e(i) ); or
  					 


    					 


  						An inability to use one upper extremity to independently initiate, sustain, and complete age-appropriate activities involving fine and gross movements (see  114.00C7 ), and a documented medical need (see  114.00C6 ) for a one-handed, 
  						hand-held assistive device (see  101.00C6d ) that requires the use of the other upper extremity or a wheeled and seated mobility device involving the use of one hand (see  101.00C6e(ii) ); or
  					 


  				 


               


               


                   2. Finger contractures or fixed  deformity in both hands  and medical documentation of an inability to use  both  upper extremities to the extent that neither can be used to independently initiate, sustain, and complete age-appropriate activities involving fine and gross movements (see  114.00C7 ); or
               


               


                   3. Atrophy with irreversible damage in one or both lower extremities  and medical documentation of at least  one  of the following: 


  				 


    					 


  						A documented medical need (see  114.00C6 ) for a walker, bilateral canes, or bilateral crutches (see  101.00C6d ) or a wheeled and seated mobility device involving the use of both hands (see  101.00C6e(i) ); or
  					 


    					 


  						An inability to use  one  upper extremity to independently initiate, sustain, and complete age-appropriate activities involving fine and gross movements (see  114.00C7 ), and a documented medical need (see  114.00C6 ) for a one-handed, hand-held assistive device (see  101.00C6d ) that requires the use of the other upper extremity or a wheeled and seated mobility device involving the use of one hand (see  1.00C6e(ii) ); or
  					 


  				 


               


               


                   4. Atrophy with irreversible damage in  both  upper extremities and medical documentation of an inability to use  both  upper extremities to the extent that neither can be used to independently initiate, sustain, and complete age-appropriate activities involving fine and gross movements (see  114.00C7 ); or
               


               

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  C.  Raynaud’s  phenomenon, characterized by: 


               

  1. Gangrene involving at least two extremities; or 


               


                   2. Ischemia with ulcerations of toes or fingers  and medical documentation of at least  one  of the following: 


  				 


    					 


  						A documented medical need (see  114.00C6 ) for a walker, bilateral canes, or bilateral crutches (see  101.00C6d ) or a wheeled and seated mobility device involving the use of both hands (see  101.00C6e(i) ); or
  					 


    					 


  						An inability to use  one  upper extremity to independently initiate, sustain, and complete age-appropriate activities involving fine and gross movements (see  114.00C7 ), and a documented medical need (see  114.00C6 ) for a one-handed, hand-held assistive device (see  101.00C6d ) that requires the use of the other upper extremity or a wheeled and seated mobility device involving the use of one hand (see  1.00C6e(ii) ); or
  					 


    					 


  						An inability to use  both  upper extremities to the extent that neither can be used to independently initiate, sustain, and complete age-appropriate activities involving fine and gross movements (see  114.00C7 ).
  					 


  				 


               


               

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code: 114.05
title: Polymyositis or dermatomyositis
source_url: https://www.ssa.gov/disability/professionals/bluebook/114.00-Immune-Childhood.htm
summary:
  114.05   Polymyositis and dermatomyositis. 
                  As described in  114.00D4 . With:
               


               


                   A.  Proximal limb-girdle (pelvic or shoulder) muscle weakness  and medical documentation of at l…

raw_text:
  114.05   Polymyositis and dermatomyositis. 
                  As described in  114.00D4 . With:
               


               


                   A.  Proximal limb-girdle (pelvic or shoulder) muscle weakness  and medical documentation of at least  one  of the following: 


  				 


    					 


  						A documented medical need (see  114.00C6 ) for a walker, bilateral canes, or bilateral crutches (see  101.00C6d ) or a wheeled and seated mobility device involving the use of both hands (see  101.00C6e(i) ); or
  					 


    					 


  						An inability to use  one  upper extremity to independently initiate, sustain, and complete age-appropriate activities involving fine and gross movements (see  114.00C7 ), and a documented medical need (see  114.00C6 ) for a one-handed, hand-held assistive device (see  101.00C6d ) that requires the use of the other upper extremity or a wheeled and seated mobility device involving the use of one hand (see  101.00C6e(ii) ); or
  					 


    					 


  						An inability to use  both  upper extremities to the extent that neither can be used to independently initiate, sustain, and complete age-appropriate activities involving fine and gross movements (see  114.00C7 ); or
  					 


  				 


               


               

  OR 


               

  B.  Impaired  swallowing (dysphagia) with aspiration due to muscle weakness. 


               

  OR 


               

  C.  Impaired  respiration due to intercostal and diaphragmatic muscle weakness. 


               

  OR 


               

  D.  Diffuse  calcinosis with limitation of joint mobility or intestinal motility.             


               

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code: 114.06
title: Undifferentiated and mixed connective tissue disease
source_url: https://www.ssa.gov/disability/professionals/bluebook/114.00-Immune-Childhood.htm
summary:
  114.06   Undifferentiated and mixed connective tissue disease ,
                  as described in  114.00D5 .
                  With involvement of two or more organs/body systems, and with:
               


               

  A.  One of the organs…

raw_text:
  114.06   Undifferentiated and mixed connective tissue disease ,
                  as described in  114.00D5 .
                  With involvement of two or more organs/body systems, and with:
               


               

  A.  One of the organs/body systems involved to at  least a moderate level of severity; 


               

  AND 


               

  B.  At least two of the constitutional symptoms  and signs (severe fatigue, fever, malaise, or involuntary weight loss). 


               

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code: 114.07
title: Immune deficiency disorders, excluding HIV infection
source_url: https://www.ssa.gov/disability/professionals/bluebook/114.00-Immune-Childhood.htm
summary:
  114.07    Immune deficiency disorders, excluding HIV  infection. 
                  As described in  114.00E . With:
               


               

  A.  One or more of the following infections. The infection(s) must either be resistant to tre…

raw_text:
  114.07    Immune deficiency disorders, excluding HIV  infection. 
                  As described in  114.00E . With:
               


               

  A.  One or more of the following infections. The infection(s) must either be resistant to treatment or require hospitalization or intravenous treatment three or more times in a 12-month period. 


               

  1. Sepsis; or 


               

  2. Meningitis; or 


               

  3. Pneumonia; or 


               

  4. Septic arthritis; or 


               

  5. Endocarditis; or 


               

  6. Sinusitis documented by appropriate medically acceptable imaging. 


               

  OR 


               


                   B.  Stem cell transplantation as described under  114.00E3 .
                  Consider under a disability until at least 12 months from the date of transplantation. Thereafter, evaluate any residual impairment(s) under the criteria for the affected body system.
               


               

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code: 114.09
title: Inflammatory arthritis
source_url: https://www.ssa.gov/disability/professionals/bluebook/114.00-Immune-Childhood.htm
summary:
  114.09    Inflammatory arthritis . 
                  As described in  114.00D6 . With:
               


               

  A.  Persistent inflammation or persistent  deformity of: 


               


                   1. One or more major joints i…

raw_text:
  114.09    Inflammatory arthritis . 
                  As described in  114.00D6 . With:
               


               

  A.  Persistent inflammation or persistent  deformity of: 


               


                   1. One or more major joints in a lower extremity (see  114.00C8 ) and medical documentation of at least  one  of the following: 


  				 


    					 


  						A documented medical need (see  114.00C6 ) for a walker, bilateral canes, or bilateral crutches (see  101.00C6d ) or a wheeled and seated mobility device involving the use of both hands (see  101.00C6e(i) ); or
  					 


    					 


  						An inability to use  one  upper extremity to independently initiate, sustain, and complete age-appropriate activities involving fine and gross movements (see  114.00C7 ), and a documented medical need (see  114.00C6 ) for a one-handed, hand-held assistive device (see  101.00C6d ) that requires the use of the other upper extremity or a wheeled and seated mobility device involving the use of one hand (see  101.00C6e(ii) ); or
  					 


  					
  				 


               


               


                   2. One or more major   joints in each upper extremity  (see  114.00C8 ) and medical documentation of an inability to use  both  upper extremities to the extent that neither can be used to independently initiate, sustain, and complete age-appropriate activities involving fine and gross movements (see  114.00C7 ); or
               


               
               

  B.  Inflammation or deformity in one or more major   joints of an upper or lower extremity (see  114.00C8 ) with: 


               

  1. Involvement of two or more  organs/body systems with one of the organs/body systems involved to at least a moderate level of severity; and 


               

  2. At least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or  involuntary weight loss). 


               

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  OR 


               

  C.  Ankylosing spondylitis or other spondyloarthropathies, with: 


               

  1. Ankylosis (fixation) of the dorsolumbar or cervical spine as shown by appropriate medically acceptable imaging and measured on physical examination at 45° or more of flexion from the  vertical position (zero degrees); or 


               

  2. Ankylosis (fixation) of the dorsolumbar or cervical spine as shown by appropriate medically acceptable imaging and measured on physical examination at 30° or more of flexion (but  less than 45°) measured from the vertical  position (zero degrees), and involvement of two or more organs/body systems  with one of the organs/body systems involved to at least a moderate level of  severity.             


               

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code: 114.10
title: Sjögren’s syndrome
source_url: https://www.ssa.gov/disability/professionals/bluebook/114.00-Immune-Childhood.htm
summary:
  114.10   Sjögren’s syndrome ,
                  as described in  114.00D7 . With involvement of two or more organs/body systems, and with:
               


               

  A.  One of the organs/body systems involved to at least a moderate l…

raw_text:
  114.10   Sjögren’s syndrome ,
                  as described in  114.00D7 . With involvement of two or more organs/body systems, and with:
               


               

  A.  One of the organs/body systems involved to at least a moderate level of severity; 


               

  AND 


               

  B.  At least two of the constitutional symptoms and signs (severe fatigue, fever, malaise, or involuntary weight loss). 


               

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code: 114.11
title: Human immunodeficiency virus (HIV) infection
source_url: https://www.ssa.gov/disability/professionals/bluebook/114.00-Immune-Childhood.htm
summary:
  114.11  Human immunodeficiency virus (HIV) infection. 
                  With documentation as described in  114.00F1  and one of the following:
               


               

  A.  Multicentric (not localized or unicentric) Castleman disease a…

raw_text:
  114.11  Human immunodeficiency virus (HIV) infection. 
                  With documentation as described in  114.00F1  and one of the following:
               


               

  A.  Multicentric (not localized or unicentric) Castleman disease affecting multiple groups of lymph nodes or  organs containing lymphoid tissue (see 114.00F3a). 


               

  OR 


               


                   B.  Primary central nervous system lymphoma
                  (see  114.00F3b ).
               


               

  OR 


               


                   C.  Primary effusion lymphoma
                  (see  114.00F3c ).
               


               

  OR 


               


                   D.  Progressive multifocal leukoencephalopathy
                  (see  114.00F3d ).
               


               

  OR 


               


                   E.  Pulmonary Kaposi sarcoma
                  (see  114.00F3e ).
               


               

  OR 


               


                   F.  Absolute CD4 count or CD4 percentage
                  (see  114.00F4 ):
               


               

  1. For children from birth to attainment of age 1, absolute CD4 count of 500 cells/mm3 or less, or  CD4 percentage of less than 15 percent; or 


               

  2. For children from age 1 to attainment of age 5, absolute CD4 count of 200 cells/mm3 or less, or  CD4 percentage of less than 15 percent; or 


               

  3. For children from age 5 to attainment of age 18, absolute CD4 count of 50 cells/mm3 or less. 


               

  OR 


               


                   G.  Complication(s) of HIV infection requiring at least three hospitalizations within a 12-month period and at least 30 days apart
                  (see  114.00F5 ). Each hospitalization must last at least 48 hours, including hours in a hospital emergency department immediately before the hospitalization.
               


               

  OR 


               


                   H.  A neurological manifestation of HIV  infection (for example, HIV encephalopathy or peripheral neuropathy)
                  (see  114.00F6 ) resulting in one of the following:
               


               

  1. Loss of previously acquired  developmental milestones or intellectual ability (including the sudden onset of  a new learning disability), documented on two examinations at least 60 days  apart; or 


               

  2. Progressive motor dysfunction  affecting gait and station or fine and gross motor skills, documented on two  examinations at least 60 days apart; or 


               

  3. Microcephaly with head circumference  that is less than the third percentile for age, documented on two examinations  at least 60 days apart; or 


               

  4. Brain atrophy, documented by appropriate medically acceptable imaging. 


               

  OR 


               


                   I.  Immune suppression and growth failure
                  (see  114.00F7 ) documented by 1 and 2, or by 1 and 3: 
               


               

  1. CD4 measurement:  


               

  a. For children from birth to attainment of age 5, CD4 percentage of less than 20 percent; or  


               

  b. For children from age 5 to attainment of age 18, absolute CD4 count of less than 200 cells/mm3  or CD4 percentage of less than 14 percent; and  


               

  2. For children from birth to attainment of age 2, three weight-for-length measurements that are:  


               

  a. Within a consecutive 12-month  period; and  


               

  b. At least 60 days apart; and  


               


                   c. Less than the third percentile on the appropriate weight-for-length table
                  under  105.08B1 ; or
               


               

  3. For children from age 2 to attainment of age 18, three BMI-for-age measurements that are:  


               

  a. Within a consecutive 12-month  period; and  


               

  b. At least 60 days apart; and  


               


                   c. Less than the third percentile on  the appropriate BMI-for-age table
                  under  105.08B2 .
               


   

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code: 114.00
title: 114.00
source_url: https://www.ssa.gov/disability/professionals/bluebook/114.00-Immune-Childhood.htm
summary:
  114.00 Immune System Disorders  


     
         

  A.   What disorders   do we evaluate under the immune system  disorders listings? 
       


       

  1.  We evaluate  immune system disorders that cause dysfunction in one or more components of…

raw_text:
  114.00 Immune System Disorders  


     
         

  A.   What disorders   do we evaluate under the immune system  disorders listings? 
       


       

  1.  We evaluate  immune system disorders that cause dysfunction in one or more components of  your immune system.    


               

  a. The dysfunction may be due to problems in antibody  production, impaired cell-mediated immunity, a combined type of  antibody/cellular deficiency, impaired phagocytosis, or complement deficiency.  


               

  b. Immune system disorders may result in recurrent and  unusual infections, or inflammation and dysfunction of the body’s own tissues.  Immune system disorders can cause a deficit in a single organ or body system  that results in extreme (that is, very serious) loss of function. They can also  cause lesser degrees of limitations  in two or more organs or body systems, and when associated with symptoms or signs, such as severe  fatigue, fever, malaise, diffuse  musculoskeletal pain, or involuntary weight loss, can also result in extreme limitation. In children, immune system disorders or their  treatment may also affect growth, development, and the performance of age‑appropriate  activities.  


               

  c. We organize the discussions of immune system  disorders in three categories: Autoimmune disorders; Immune deficiency  disorders, excluding human immunodeficiency virus (HIV) infection; and HIV  infection. 


               

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                   2.  Autoimmune disorders ( 114.00D ).  
                  Autoimmune disorders are caused by dysfunctional immune responses directed against the body’s own tissues, resulting in chronic,
                  multisystem impairments that differ in clinical manifestations, course, and outcome.
                  They are sometimes referred to as rheumatic diseases, connective tissue disorders, or collagen vascular disorders.
                  Some of the features of autoimmune disorders in children differ from the features of the same disorders in adults.
                  The impact of the disorders or their treatment on physical, psychological, and developmental growth of  pre-pubertal children may be considerable,
                  and often differs from that of post-pubertal adolescents or adults.
               


               


                   3.  Immune deficiency disorders, excluding HIV infection ( 114.00E ).  
                  Immune deficiency disorders are characterized by recurrent or unusual infections that respond poorly to treatment, and are often  associated with complications affecting other parts of the body.
                  Immune deficiency disorders are classified as either  primary  (congenital) or  acquired .
                  Children with immune deficiency disorders also have an increased risk of malignancies and of having autoimmune disorders.
               


               


                   4.  Human immunodeficiency virus (HIV) infection ( 114.00F ). 
                  HIV infection may be characterized by increased susceptibility to common infections as well as opportunistic infections, cancers,
                  or other conditions listed in  114.11 .
               


               

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  B.  What information do we need to show that you have an immune system  disorder?  Generally, we need your medical  history, a report(s) of a physical examination, a report(s) of laboratory  findings, and in some instances, appropriate medically acceptable imaging or  tissue biopsy reports to show that you have an immune system disorder.  Therefore, we will make every reasonable effort to obtain your medical history, medical findings, and results of laboratory tests. We explain the information we need  in more detail in the sections below.  


               

  C.  Definitions   


               

  1.  Appropriate medically acceptable imaging  includes, but is not limited to, angiography, x-ray imaging, computerized axial tomography (CAT scan) or magnetic resonance imaging (MRI), with or without contrast material,  myelography, and radionuclear bone scans. “Appropriate” means that the  technique used is the proper one to support the evaluation and diagnosis of the  impairment. 


               

  2.  Constitutional symptoms or signs , as used in these listings, means  severe fatigue, fever, malaise, or involuntary weight loss.  Severe fatigue  means a frequent sense of exhaustion that results in significantly reduced  physical activity or mental function.  Malaise  means frequent feelings of  illness, bodily discomfort, or lack of well-being that result in significantly  reduced physical activity or mental function.     


               

  3.  Disseminated  means that a condition  is spread over a considerable area. The type and extent of the spread will  depend on your specific disease. 


               

  4.  Dysfunction  means that one or more of the body regulatory mechanisms are impaired, causing  either an excess or deficiency of immunocompetent cells or their products. 


               

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  5.  Extra-articular  means “other than the joints”; for example, an organ(s) such as the heart,  lungs, kidneys, or skin. 


               


                   6.  Documented medical need  
                   has the same meaning as in  101.00C6a .
               


               


                   7.  Fine and gross movements  
                  has the same meaning as in  101.00E4 .
               


               


                   8.  Major joint of an upper or a lower extremity  
                  has the same meaning as in  101.00I2  and  101.00I3 .
               


               

  9.  Persistent  means that a sign(s) or symptom(s) has continued over  time. The precise meaning will depend on the specific immune system disorder,  the usual course of the disorder, and the other circumstances of your clinical  course. 


               

  10.  Recurrent  means that a condition that previously responded  adequately to an appropriate course of treatment returns after a period of  remission or regression. The precise meaning, such as the extent of response or  remission and the time periods involved, will depend on the specific disease or  condition you have, the body system affected, the usual course of the disorder  and its treatment, and the other facts of your particular case. 


               

  11.  Resistant to treatment  means that a  condition did not respond adequately to an appropriate course of treatment.  Whether a response is adequate or a course of treatment is appropriate will  depend on the specific disease or condition you have, the body system affected,  the usual course of the disorder and its treatment, and the other facts of your  particular case.   


               

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                   12.  Severe  means medical severity as used by the medical community.
                  The term does not have the same meaning as it does when we use it in connection with a finding at the second step of the sequential evaluation process
                  in §  416.920  of this chapter.
               


               

  D.  How do we document and evaluate the listed autoimmune disorders?   


               

  1.  Systemic lupus erythematosus ( 114.02 ).   


               

  a.  General.  Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that can affect any organ or body  system. It is frequently, but not always, accompanied by constitutional  symptoms or signs (severe fatigue, fever, malaise, involuntary weight loss).  Major organ or body system involvement can include: Respiratory (pleuritis,  pneumonitis), cardiovascular (endocarditis, myocarditis, pericarditis,  vasculitis), renal (glomerulonephritis), hematologic (anemia, leukopenia,  thrombocytopenia), skin (photosensitivity), neurologic (seizures), mental  (anxiety, fluctuating cognition (“lupus fog”), mood disorders, organic brain  syndrome, psychosis), or immune system disorders (inflammatory arthritis).  Immunologically, there is an array of circulating serum auto-antibodies and  pro- and anti-coagulant proteins that may occur in a highly variable pattern.


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