A. Impairment caused by anemia should be
evaluated according to the ability of the in- dividual to adjust to the reduced oxygen car- rying capacity of the blood. A gradual reduc- tion in red cell mass, even to very low val- ues, is often well tolerated in individuals with a healthy cardiovascular system.
B. Chronicity is indicated by persistence of
the condition for at least 3 months. The lab- oratory findings cited must reflect the val- ues reported on more than one examination over that 3-month period.
C. Sickle cell disease refers to a chronic he-
molytic anemia associated with sickle cell hemoglobin, either homozygous or in com- bination with thalassemia or with another abnormal hemoglobin (such as C or F).
Appropriate hematologic evidence for sick- le cell disease, such as hemoglobin electro- phoresis, must be included. Vasoocclusive or aplastic episodes should be documented by description of severity, frequency, and dura- tion.
271
Major visceral episodes include meningitis, osteomyelitis, pulmonary infections or in- farctions, cerebrovascular accidents, conges- tive heart failure, genito-urinary involve- ment, etc.
D. Coagulation defects. Chronic inherited
coagulation disorders must be documented by appropriate laboratory evidence. Prophy- lactic therapy such as with antihemophilic globulin (AHG) concentrate does not in itself imply severity.
E. Acute leukemia. Initial diagnosis of acute
leukemia must be based upon definitive bone marrow pathologic evidence. Recurrent dis- ease may be documented by peripheral blood, bone marrow, or cerebrospinal fluid exam- ination. The pathology report must be in- cluded.
The acute phase of chronic myelocytic (granulocytic) leukemia should be consid- ered under the requirements for acute leu- kemia.
The criteria in 7.11 contain the designated duration of disability implicit in the finding of a listed impairment. Following the des- ignated time period, a documented diagnosis itself is no longer sufficient to establish a marked impairment. The level of any re- maining impairment must be evaluated on the basis of the medical evidence.
7.01 Category of Impairments, Hemic and Lymphatic System
7.02 Chronic anemia (hematocrit persisting at 30 percent or less due to any cause). With:
A. Requirement of one or more blood transfusions on an average of at least once every 2 months; or
B. Evaluation of the resulting impairment under criteria for the affected body system. 7.05 Sickle cell disease, or one of its variants.
With:
A. Documented painful (thrombotic) crises occurring at least three times during the 5 months prior to adjudication; or
B. Requiring extended hospitalization (be- yond emergency care) at least three times during the 12 months prior to adjudication; or
C. Chronic, severe anemia with persistence of hematocrit of 26 percent or less; or
D. Evaluate the resulting impairment under the criteria for the affected body sys- tem.
7.06 Chronic thrombocytopenia (due to any cause) with platelet counts repeatedly below
40,000/cubic millimeter. With:
A. At least one spontaneous hemorrhage, requiring transfusion, within 5 months prior to adjudication; or
B. Intracranial bleeding within 12 months prior to adjudication.
7.07 Hereditary telangiectasia with hemor-
rhage requiring transfusion at least three times during the 5 months prior to adjudica- tion.
7.08 Coagulation defects (hemophilia or a similar disorder) with spontaneous hemor-
rhage requiring transfusion at least three times during the 5 months prior to adjudica- tion.
7.09 Polycythemia vera (with erythrocytosis, splenomegaly, and leukocytosis or thrombo- cytosis). Evaluate the resulting impairment
under the criteria for the affected body sys- tem.
7.10 Myelofibrosis (myeloproliferative syn- drome). With:
A. Chronic anemia. Evaluate according to the criteria of § 7.02; or
B. Documented recurrent systemic bac- terial infections occurring at least 3 times during the 5 months prior to adjudication; or C. Intractable bone pain with radiologic evidence of osteosclerosis.
7.11 Acute leukemia. Consider under a dis-
ability for 21⁄2years from the time of initial
diagnosis.
7.12 Chronic leukemia. Evaluate according
to the criteria of 7.02, 7.06, 7.10B, 7.11, 7.17, or 13.06A.
7.13 Lymphomas. Evaluate under the cri-
teria in 13.06A.
7.14 Macroglobulinemia or heavy chain dis- ease, confirmed by serum or urine protein
electrophoresis or immunoelectrophoresias. Evaluate impairment under criteria for af- fected body system or under 7.02, 7.06, or 7.08. 7.15 Chronic granulocytopenia (due to any cause). With both A and B:
A. Absolute neutrophil counts repeatedly below 1,000 cells/cubic millimeter; and
B. Documented recurrent systemic bac- terial infections occurring at least 3 times during the 5 months prior to adjudication.
7.16 Myeloma (confirmed by appropriate serum or urine protein electrophoresis and bone marrow findings). With:
A. Radiologic evidence of bony involve- ment with intractable bone pain; or
B. Evidence of renal impairment as de- scribed in 6.02; or
C. Hypercalcemia with serum calcium lev- els persistently greater than 11 mg. per deci- liter (100 ml.) for at least 1 month despite prescribed therapy; or
D. Plasma cells (100 or more cells/cubic millimeter) in the peripheral blood.
7.17 Aplastic anemias or hematologic malig- nancies (excluding acute leukemia): With bone
marrow transplantation. Consider under a disability for 12 months following transplan- tation; thereafter, evaluate according to the primary characteristics of the residual im- pairment.
8.00 SKIN
A. Skin lesions may result in a marked,
long-lasting impairment if they involve ex- tensive body areas or critical areas such as the hands or feet and become resistant to treatment. These lesions must be shown to have persisted for a sufficient period of time despite therapy for a reasonable presumption to be made that a marked impairment will
272
last for a continuous period of at least 12 months. The treatment for some of the skin diseases listed in this section may require the use of high dosage of drugs with possible serious side effects; these side effects should be considered in the overall evaluation of impairment.
B. When skin lesions are associated with sys- temic disease and where that is the predomi-
nant problems, evaluation should occur ac- cording to the criteria in the appropriate section. Disseminated (systemic) lupus erythematosus and scleroderma usually in- volve more than one body system and should be evaluated under 10.04 and 10.05. Neoplastic skin lesions should be evaluated under 13.00ff. When skin lesions (including burns) are associated with contractures or limita- tion of joint motion, that impairment should be evaluated under 1.00ff.
8.01 Category of Impairments, Skin 8.02 Exfoliative dermatitis, ichthyosis, ichthyosiform erythroderma. With extensive le-
sions not responding to prescribed treat- ment.
8.03 Pemphigus, erythema multiforme bullosum, bullous pemphigoid, dermatitis her- petiformis. With extensive lesions not re-
sponding to prescribed treatment.
8.04 Deep mycotic infections. With extensive fungating, ulcerating lesions not responding to prescribed treatment.
8.05 Psoriasis, atopic dermatitis, dyshidrosis.
With extensive lesions, including involve- ment of the hands or feet which impose a marked limitation of function and which are not responding to prescribed treatment.
8.06 Hydradenitis suppurative, acne conglobata. With extensive lesions involving
the axillae or perineum not responding to prescribed medical treatment and not amendable to surgical treatment.