D thru K

Deaf Mutism - the condition that exists when one cannot hear or speak. Cases of alleged "deaf mutism" should be documented by a hearing evaluation. If they qualify, then disability is in order.

Deep Mycotic Infection - a deep infection caused by a microorganism affecting the deep layers of the skin. There may be disability when there is extensive spreading and the lesions do not respond to prescribed treatment.

Delusions - a belief in something that is not real; such as when one imagines he is Adolf Hitler. There is cause for disability when there is resulting persistence of marked restriction of daily activities and constriction of interests and seriously impaired ability to relate to others. It is considered Functional Psychotic Disorders for a disability.

Depression - a mental disorder wherein one is very sad, seems to have lost hope, and lacks feelings of self-worth.
A. Reactive depression-a state of depression in reaction to some personal loss such as the death of a loved one. It is characterized by symptoms of hopelessness, lack of interest in one's own life, inability to manage daily affairs, a sense of guilt and behavior in a manner unlike the usual self. Certain diseases predispose to reactive depression: myocardial infarction, Parkinson's disease, cancer and multiple sclerosis.
B. Manic depression-usually affects those in middle and late adulthood. The patient alternates between periods of deep depression and great excitement. These patients are often suicidal when in the depression stage.
C. Involutional melancholia-this disorder most often affects elderly females of low socioeconomic background. As their intellectual and physical abilities begin to decrease, these patients are unable to stay in touch with reality.
The main danger in all forms of depression is suicide. The majority of all these can be successfully treated by psychoanalysis, electroconvulsive therapy (ECT) and/ or drugs. There may be a disability if the patient does not respond to treatment.

Dermatitis Herpetiformis - a chronic eruption of inflamed, blister-like, intensely itching and burning pimples that appear on the elbows, knees, sacrum, buttocks, back of the neck, face and head. This is fairly uncommon and usually affects 15-60-year-olds. Disability exists when the lesions are extensive and do not respond to prescribed treatment.

Detached Retina - the retina becomes separated from the underlying layer and there is complete loss of vision where the retina is detached. If surgical repair of the retina is successful, good results are obtained. There may be a recurrence. Disability is based upon loss of visual efficiency. Visual efficiency of the better eye after best correction is 20% or less. (The percent of remaining visual efficiency equals the product of the percent of remaining central visual efficiency and the percent of remaining visual field efficiency).

Diabetes Insipidus (or Polyuria) - the patient produces large quantities of urine that is pale and watery, usually occurs in the young and is secondary to tumors of the pituitary or head injury, etc. Dehydration is a constant danger .
A. Nephrogenic diabetes insipidus-an inherited condition in which kidney function is normal except for the ability to concentrate urine.
B. Vasopressin-sensitive diabetes insipidus-a chronic or temporary disorder caused by a deficiency of vasopressin (ADH) and characterized by the production of excessive amounts of dilute urine and extreme thirst. This is caused by injury or tumors of the pituitary gland.
There may be cause for disability with a urine specific gravity of 1.005 or below, persistent for at least 3 months with recurrent dehydration.

Diabetes Mellitus - a metabolic disease caused by an insufficient insulin secretion from the Isle of Langerhans of the pancreas which results in an elevated blood sugar. There are two forms:
A. Juvenile-the onset is during childhood or early teens. There is frequent urination, extreme thirst, hunger, fatigue, weakness and weight loss. It requires intramuscular (lM) injec- tions of insulin and it is difficult to control.
B. Mature-the onset is during adulthood; fatigue, weight loss, blurred vision, impotency, nonhealing sores and the feet may be insensitive to pain. This form is more easily controlled by diet and oral or injected insulin.
The longer a patient has diabetes, the more likely he is to experience complications. The most common chronic ones are: diabetic retinopathy, kidney disorders and nerve disorders. Acute complications are ketoacidosis and coma. There is cause for disability with neuropathy demonstrated by significant and persistent disorganization of motor function in two extremities resulting in sustained disturbance of gross dexterous movements, or gait and station; or acidosis occurring at least on the average of once every 2 months documented by appropriate blood chemical tests (pH, pCO3 or bicarbonate levels); or amputation at, or above, the tarsal (toe) region due to diabetic necrosis or peripheral vascular disease; or retinitis proliferans.

Disseminated Lupus Erythematosus - that affects the whole system in which there is inflammation of the skin with scaly patches. Respiratory infections, pleurisy, pleural effusion, pericarditis, arthritis, endocarditis and nephrotic syndrome accompany DLE.
DLE may be reason for disability when it is established by a positive LE preparation or biopsy or positive antinuclear antibody (ANA) test, and there is involvement of renal or cardiac or pulmonary or gastrointestinal or central nervous system on a frequent basis.

Down's Syndrome (Mongolism) - a genetic disorder wherein the child is born with a small head and a broad face, an abnormally large distance between the eyes, flattening of parts of the skull, a protuberant tongue, low set ears and varying degrees of mental retardation. The prognosis depends upon the degree of mental impairment, but usually I can expect a near normal life span. Disability depends upon IQ and marked dependence on others for personal needs.

Dumping Syndrome - ingested food is dumped into the jejunum too quickly after eating. This happens after gastric surgery in some cases. It may cause symptoms of weakness, dizziness, sweating, nausea, vomiting and palpitations soon after eating. Within about two hours diarrhea sets in. This condition usually responds to treatment and is generally not cause for disability unless it is recurrent and/ or persistent despite treatment.

Duodenal Ulcer - a local destruction of mucosa in the duodenum by peptic secretions. About 4/5 are managed successfully medically. In the other 1/5, surgery is eventually needed. Possible complications of surgery are calcium deficiency, anemia, bowel obstruction, continuing pain and the dumping syndrome.
Disability exists when peptic ulcer disease is demonstrated by x-ray or endoscopy with recurrent ulceration after definitive surgery or is persistent despite therapy; or inoperable fistula formation; or recurrent obstruction demonstrated by x-ray or endoscopy; or weight loss due to this disease.

Dysidrosis - a disorder of the sweat glands which never affects children or the aged. The contents of the sweat glands are retained. Presence of the disorder with extensive lesions which are not responding to prescribed treatment, including involvement of the hands or feet which imposes a severe limitation of function constitutes a disability.

Edema - swelling due to an excess accumulation of fluid.
A. Renal-edema caused by kidney disorder or disease.
B. Pretibial-edema over the tibia of the lower leg.
C. Preorbital-edema around the eye.
D. Pulmonary-swelling or retention of fluid in the lungs due to disease or injury.
Edema in itself is not a disease but rather a symptom of some other disease or disorder. Therefore, disability is based upon the underlying condition or disease.

Emphysema - distention of the air spaces in the lungs. It is usually caused by smoking and there is agenetic predisposition in those patients with a deficiency of the enzyme Alpha-l-Antitrypsin. Treatment consists of not smoking and an attempt to stop its progression. Early treatment of respiratory ailments is a must. Prognosis is dependent upon the degree of parenchymal destruction as this is irreversible. There is a gradual progression of shortness of breath. (Parenchyma-refers to the essential parts of an organ.)
Disability depends upon the degree of pulmonary insufficiency and accompanying (usually) cor pulmonale properly documented.

End Organ Damage - damage to the heart, brain, kidneys or retinae due to injury or disease. If a disability exists, it depends upon the disease or disorder, the organ involved, and the degree of impairment.

Endometrial Cancer - an invasive malignancy of the inner lining of the uterus. It is usually postmenopausal and is best diagnosed by biopsy. The treatment of choice is a total hysterectomy with the majority of the patients being completely cured.

Enteritis (Regional) - inflammation of the small intestine. For disability, regional enteritis must be demonstrated by barium studies, biopsy, or endoscopy and with: persistent or recurrent intestinal obstruction evidenced by abdominal pain, distention, nausea, and vomiting and accompanied by stenotic areas of small bowel with proximal intestinal dilation; or persistent or recurrent systemic manifestations such as arthritis, iritis, fever, or liver dysfunction, not attributable to other causes; or intermittent obstruction due to intractable abscess or fistula formation; or significant weight loss. Other names for regional enteritis are: granulomatous ileitis, ileocolitis, and Crohn's disease.

Epidermoid Carcinoma of the Anus - cancer of the anus. This type of carcinoma usually develops silently and by the time it is diagnosed, it has metastasized to the regional lymph nodes and beyond. Disabiiity exists when the cancer is inoperable; or there is metastasis beyond the regional lymph nodes; or recurrence and metastasis after resection.

Epilepsy - a disturbance of the consciousness during which generalized convulsions may occur. It is episodal in nature. There are four main types:
A. Grand mal-often preceded by an aura followed by convulsions, unconsciousness, frothing at the mouth and the face turns blue.
B. Petit mal-very mild in nature and lasts only a short time. Those around may be unaware of any change in the person.
C. Psychomotor-an aura is experienced immediately before the seizure, the patient is unable to respond to simple questions, may continue a previously commenced action, there is convulsive movement of the lips, head, or arms, may become violent if restrained and the attacks last for varying lengths of time.
D. Focal motor seizures-the patient usually remains conscious unless motor activity becomes generalized. The convulsive movement is usually limited to just one limb or one side of the body.
Most epileptics show no evidence of mental deterioration and with appropriate therapy experience a decrease in frequency or a complete cessation of seizures. In cases of secondary epilepsy, the prognosis depends upon the underlying disease.
Disability for grand mal seizures or psychomotor: documentation by EEG and by detailed description of a typical seizure pattern, including all associated phenomena; occurring more frequently than once a month, in spite of at least 3 months of . prescribed treatment, with: diurnal episodes (loss of consciousness and convulsive seizures); or nocturnal episodes manifesting residuals which interfere significantly with activities during the day.
Disability for minor motor seizures (petit mal, psychomotor, or focal): documentation by EEG and by detailed description of a typical seizure pattern, including all associated phenomena; occurring more frequently than once weekly in spite of at least 3 months prescribed treatment.

Erythema - red spots covering the skin caused by capillary congestion. There are many different kinds and they arise from a variety of causes. It is disabling when the lesions are extensive and do not respond to prescribed treatment.

Exfoliative Dermatitis - (acute or subacute) a very severe, generalized skin disorder with red spots and scaling. This is a potentially life threatening disease and recurrences are frequent. The exact cause is unknown and onset is rapid. There is a disability with extensive lesions not responding to prescribed treatment.

Fibrosis - abnormal formation of fiber-like tissue or scar tissue.
A. Pulmonary fibrosis-scar tissue that forms in the lungs after inflammation, pneumonia and TB.
B. Focal fibrosis-fibrosis in isolated spots or areas.
C. Disseminated fibrosis-fibrosis that is generalized or widespread throughout most of the lung or other organ.
D. Interstitial fibrosis-fibrosis in the air sacs (alveoli) of the lungs.
Fibrosis is progressive and debilitating. There is no known cure unless the affected part can be excised and then there may be recurrence. Disability depends upon the system involved and the degree of impairment.

Field of Vision - the "field" or space within which an object can be seen without moving the head and keeping the eyes on a fixed point. Disability exists when there is contraction of the peripheral visual fields in the better eye to 10¡ or less from the point of fixation; or so the widest diameter subtends an angle no greater than 20¡; or to 20% or less visual field efficiency.

Fistula in Ano - a track or passage leading from the anal canal to the skin near the anal opening. Most of the time these are secondary to anorectal abscesses or to operations or anal fissures (a tear in the lower anal canal). Fistulas may be single or multiple with a purulent drainage and recurring abscess formation. They may also indicate regional enteritis or colitis.
If the fistula is secondary, the primary cause must be treated or the fistula will not heal. Primary fistula in ano is treated best by surgical excision. A permanent or temporary colostomy may be necessary. It is grounds for disability only when persistent and does not respond to treatment.

Functional Non psychotic Disorders - characterized by demonstrable mental abnormalities without structural changes in brain tissue. Disorders that fall into this category are psychophysiological: anxiety, depressive neurosis, paranoia, schizophrenia, hysteria, antisocial behavior , passive-aggressive behavior, inadequate personality, sexual deviation, alcohol and drug addiction. All of the above disorders may constitute disability if they are persistent. (See entry on Neurosis).

Gastrectomy - surgical removal of part or all of the stomach.
A. Total gastrectomy-removal of the whole stomach.
B. Partial gastrectomy-removal of a portion of the stomach.
Indications for gastrectomy are perforation of an ulcer, obstruction that does not respond to medical management, hemorrhage (2 or more major ones), malignancy, etc. The type of surgery (partial or total) depends upon the patient's condition and the disease.
The "dumping syndrome," anemia, weight loss and diarrhea are complications after such surgery. The condition that neces- sitated surgery is often recurrent.
Disability exists in peptic ulcer disease (demonstrated by x-ray or endoscopy), with: recurrent ulceration after definitive surgery persistent despite therapy; or inoperable fistula formation; or recurrent obstruction demonstrated by x-ray or endoscopy; or extreme weight loss.

Gastric Ulcer - small, localized destruction of the mucosa by peptic secretion in the antrum body or prepyloric region of the stomach. Ifmalignant, a gastric resection should be done; ifbenign, treat it medically. Gastric ulcers recur more often and are more likely to require surgery than duodenal ulcers. Disability requirements are the same as those outlined in the entry for gastrectomy under Peptic Ulcer Disease.

Glaucoma - pressure inside the eye.
1. Primary
a. Angle-closure glaucoma-(also known as acute, uncompensated, iris block, narrow-angle and congestive glaucoma). The shallow anterior chamber is congested due to all extreme anterior attachment of the iris to the ciliary body thus blocking outflow of aqueous humor.
b. Open-angle glaucoma-(also called simple, chronic, compensated, wide-angle, and glaucoma simplex). There is a disturbance in the flow of aqueous humor between the anterior chamber and the canal of Schlemm.
2. Secondary-results from a preexisting disease.
Primary open-angle glaucoma should be managed medically and prognosis is good if the patient follows instructions. Surgery is the definitive treatment for angle-closure glaucoma and these patients do well. Prognosis in secondary glaucoma depends upon the extent of the underlying disease. Disability depends upon the degree of visual impairment.

Goodpasture's Syndrome - an antiglomerular basement membrane disease with lung and kidney complications. The condition is terminal and progression is rapid. This disease most often affects young males and is characterized by severe hemoptysis, shortness of breath, iron deficiency anemia, hematuria, proteinuria and rapidly progressive renal failure. There is no known cure.

Granulocytopenia (Chronic) - a chronic reduction in blood granulocytes resulting in increased susceptibility to bacterial infections and ulcers in proportion to the duration and severity of the granulocytopenia. There is a history of multiple focal skin infections, perirectal region infections and respiratory infections. Severe granulocytopenia lasting longer than four weeks usually results in death. There is cause for disability with absolute neutrophil counts repeatedly below 1,000 cells per cubic millimeter; and documented recurrent systemic bacterial infections occurring at least three times during the five months prior to adjudication.

Groin Hernias (Femoral, Inguinal) - the abnormal bulging or protruding of a structure from its normal place through a congenital or acquired place. An external truss is of no value; surgery is the definitive treatment.
A. Femoral-the descending of the intestines and femoral vessels through the femoral ring (over the legs).
B. lnguinal-the intestines pass through the inguinal canal (the most common).
Prognosis is excellent unless it has become strangulated and gangrene has set in. There is no cause for disability.

Hansen's Disease (Leprosy) - a slowly progressive, infectious disease that causes lesions of the skin or nerve tissue. Leprosy is classified as a disability as an active disease or considered as "under a disability" while hospitalized.

Head and Neck (Malignancies) - There is cause for disability if it is inoperable; or not controlled by prescribed therapy; or recurrent after radical surgery or irradiation; or with distant metastasis; or epidermoid carcinoma occurring in the pyriform sinus or posterior third of the tongue.

Heart Block - a condition in which the electrical impulses which travel through the heart's special conduction system to trigger heartbeat is slowed or blocked to such a degree that an artificial pacemaker is required to keep the patient alive. (See Atrioventricular Dissociation for disability criteria, further definition and classification.)

Heart Failure - occurs when the heart cannot pump sufficient blood to meet the needs of the body. This is a condition secondary to a preexisting disease or dysfunction. The treatment is first aimed at the underlying cause, then reduce the cardiac workload, reduce fluid retention and increase contractility of the heart. Acute pulmonary edema should be treated as a medical emergency. Prognosis is dependent upon the underlying disease. Disability exists with diagnosis and proper documentation of the impairment. See Congestive Heart Failure.

Hemodialysis - a process of purifying the blood, outside the body, of wastes normally excreted through the kidneys. Due to some disorder this normal process . has been hampered or has ceased.
Hemodialysis is done only when there is severe, life-threatening, impairment of renal function. Disability exists when the impairment due to any chronic renal disease is expected to last 12 months with chronic hemodialysis necessitated by irreversible kidney failure. Causes of the renal failure may be hypertensive vascular disease, chronic nephritis, nephrolithiasis, polycystic disease, bilateral hydronephrosis, etc.

Hemophilia - the condition is a heredjtary, sex-linked recessive trait passed from mothers to their sons. It is an abnormal tendency to bleed.
Chronic inherited coagulation defects must be documented by appropriate laboratory evidence. Prophylactic therapy such as with antihemophilic globulin (AHG) concentrate does not in itself imply severity. Coagulation defects with spontaneous hemorrhage requiring transfusion at least 3 times during the 5 months prior to adjudication does constitute a disability.

Herniated Nucleus Pulposus (also known as herniated, rup- tured, or prolapsed intervertebral disc; disc syndrome) - this condition is characterized by pain which is worse on movement, coughing, laughing, straining at stool, etc. There may be partial paralysis or numbness in the legs or the muscles supplied by the impaired or "pinched" nerve may become weak and wasted. Compression of the cauda equina (end of spinal cord) may cause urine retention or incontinence.
Herniated nucleus pulposus may qualify as a disability when it persists for at least 3 months despite prescribed treatment and is expected to last 12 months with pain, muscle spasm, and Rignificant limitation of motion in the spine; and appropriate radicular distribution of significant motor loss with muscle weakness and sensory and reflex loss.

Hiatal Hernia - a part of the stomach protrudes through a weak area of the diaphragm into the chest cavity. There are two main types:
A. Rolling herriia-the gastroesophageal junction remains in place and the gastric cardia enters the chest cavity (more common in women).
B. Sliding hernia-(most frequent) a portion of the stomach and the gastroesophageal junction both enter the chest cavity.
The condition is usually no problem if the patient sleeps with the head of the bed elevated 6 inches and takes antacids when needed. There is no cause for disability.

Hodgkin's Disease - a chronic inflammatory disease accompanied by malignant cells in the lymph nodes. Symptoms are usually unexplained fever, lymph node enlargement and intense itching. Diagnosis by biopsy and lymphangiogram are essential. There are 5 stages recognized:
Stage I-the disease is limited to 1 lymph node region.
Stage II-the disease involves 2 or more lymph node regions on the same side of the diaphragm.
Stage lII-the disease is on both sides of the diaphragm in- volving the lymph nodes or spleen.
Stage IV -involvement outside the lymph nodes such as in the bone marrow, lungs or liver.
Subclassification A-absence of constitutional symptoms.
Subclassification B-the presence of constitutional symptoms of weight loss, fever, and night sweats.
Subclassification E-extranodal involvement of an organ adjacent to a lymph node.
For example, a patient with lung involvement would be classified as Stage II E not Stage IV.
The cure rate for all stages is better than 80%. Therapy consists of a splenectomy, radiation and/ or chemotherapy. Chemotherapy is reserved for Stage III Band IV.
There is cause for disability when the Hodgkin's disease becomes progressive and not controlled by prescribed therapy.

Huntington's Chorea - a dominant inherited trait characterized by involuntary movements, difficulty in speaking, unsteady gait and some degree of dementia. There is a very poor prognosis. The dementia and involuntary movements run a slow, parallel, downhill course. Suicide is common in these patients.
Huntington's chorea may qualify for disability with: disorganization of motor function (significant and persistent disorganization of motor function in 2 extremities resulting in sustained disturbance of gross and dexterous movements, or gait or station); or unsteady, broadbased or ataxic gait causing significant restriction of mobility substantiated by appropriate posterior column signs; or chronic brain syndrome. (See Chronic Brain Syndrome.)

Hydradenitis - inflammation of,a sweat gland. A disability exists with extensive lesions under the arms or on the perineum not responding to prescribed treatment and not conducive to surgical treatment.

Hydronephrosis - formation of a cyst in the kidney due to obstruction of outflow tubes.
A. Bilateral-involves both kidneys.
B. Unilateral-involves one kidney.
Acute hydronephrosis is usually manifested by severe pain while chronic patients may be asymptomatic or have bouts of dull flank pain. Both are usually accompanied by hematuria, fever, pyuria (pus in the urine due to infection), kidney stones (in chronic cases) and vague gastrointestinal symptoms. The definitive treatment for primary hydronephrosis is surgery and the prognosis is good.
Prognosis is guarded for secondary hydronephrosis. Disability due to secondary hydronephrosis is based upon the degree of impairment in kidney function and/ or the primary disease.

Hyperglycemia - an increase above normal limits of blood sugar. Normal is 60-100 mg per 100 cc of blood. In the aged, it is 70-120 mg per 100 cc of blood. The earliest symptom is polyuria then thirst, hunger, blurred vision, nonhealing sores and weight loss. This condition is also known as diabetes mellitus. (See Diabetes Mellitus.)

Hyperparathyroidism - a condition that exists when there is an oversecretion of parathyroid hormone. There is decalcification of bones, weakness, loss of muscle tone, kidney stones, etc.
There is a disability when there is generalized decalcification of bone on x-ray and an elevation of plasma calcium to 11 mg per 100 cc or greater; or a resulting impairment. Evaluate according to the criteria in the affected body system.

Hypertension - high blood pressure; generally over 140/ 90. Factors which may predispose one to hypertension are obesity, age, race (blacks are more likely to have and in more serious form), inheritance and oral contraceptives.
Hypertension in itself is not a disability, but leads to disability when arteriosclerosis, atherosclerosis, kidney damage, heart damage, decreased blood flow to the brain or visual impairment, etc., develop.

Hypertensive Vascular Disease - refers to any disease or condition that affects the blood vessels and is related to hypertension. Two important ones are arteriosclerosis and atherosclerosis. Disability is in accordance with the body part or system affected.

Hypoparathyroidism - a condition caused by a deficiency of parathyroid hormone usually following accidental removal of or damage to the parathyroids during thyroid or other throat surgery. It is characterized by tetany, impairment of breathing, cataracts, and papilledema. There may be disability if there is severe recurrent tetany; or lenticular cataracts.

Intestinal Obstruction -
A. Partial-the intestine is only partially blocked, and if treated in time, will usually open up without surgery.
B. Complete-the intestine is totally blocked and must be opened quickly or gangrene will set in.
C. Recurrent-the patient has a history of recurring obstructions either partial or total.
These obstructions can be managed medically many times and where surgery is indicated, prognosis is usually good. An obstruction is not cause for disability unless it becomes recurrent and is unresponsive to treatment.

Kidney Transplant - a kidney taken from a donor and placed in the recipient in hopes that some kidney function may be restored. There is a disability when there is impairment of renal function due to chronic kidney disease expected to last 12 months and transplant is the alternative. The patient is considered under disability for 12 months following surgery; thereafter, evaluate for residual impairment.

Kyphoscoliosis - curvature of the spine which is angular or lateral in the thoracic region of the spine. Kyphoscoliosis may crowd the lungs to the extent that there is a restrictive ventilary disorder with total vital capacity equal to, or less than, values specified by the Social Security Administration corresponding to a person's height (Disability).

Kyphosis - curvature in the thoracic (upper) region of the spine. Usually kyphosis is not cause for disability unless there is documented functional loss.