P thru R

Pancreatic Dysfunction - any disease, lesion or disorder that prevents the pancreas from functioning normally. The most common result is diabetes mellitus. See Diabetes Mellitus for disability.

Parkinson's Disease - a chronic disease of the nervous system characterized by tremor, muscular weakness and sclerosis and a peculiar gait. Parkinson's syndrome is chronic and progressive even with therapy. The patient may eventually become unable to care for himself. With the best medical attention, patients usually remain functional for 10-20 years. Mental deterioration is not seen until late in the course of the disease.
Parkinson's disease or syndrome qualifies under a disability with the following signs: significant rigidity, bradykinesia, or tremor in two extremities, which, singly or in combination, result in sustained disturbance ofgross and dexterous movements, or gait or station.

Paroxysmal Supraventricular Tachycardia - a very fast atrial heartbeat that is changing and recurrent in nature. Heart rate is 140-250 beats per minute. This usually occurs first during youth and is usually seen in patients with no organic heart disease. Treatment consists of carotid massage, rest, mild sedation, reassurance, vasopressor agents if hypertensive, electrical cardioversion, cardiac glycoside or cholinesterase inhibitor. For frequent or long-Iasting attacks treatment consist of digitalis, procainamide, quinidine or propanolol. The patient should avoid fatigue, coffee, tea, alcohol, and tobacco. The prognosis is excellent in most cases. See Arrhythmia for disability.

Pelvic Fracture - a break in one or more of the pelvic bones. These fractures may be stable or unstable and soft tissue injury can be serious. Most fractures are named according to the pelvic bone involved. General kinds are:
A. Avulsion fracture-the forcible tearing away of a structure or part (quite common in motorcycle accidents).
B. Malgaigne fracture-type of fracture in which the bone breaks through one set of public rami and the region of the sacroiliac joint. This is an unstable fracture.
C. Stellate fracture-a fracture with several breaks or cracks radiating from a central point of injury. (A stellate fracture of the ileum has a temporary disability of 8-12 weeks). A ruptured bladder, a perforated colon, and laceration of blood vessels are of primary concern and must be treated promptly.
Prognosis depends on the type of fracture and associated injury to internal organs. The main complications are: bladder injury, rupture and severing of the urethra, hemorrhage, thrombophlebitis and embolism, and sciatic nerve damage. The emboli are usually pulmonary, but may be cerebral or renal and cause sudden death or permanent damage.
There is cause for disability as the result of a pelvic fracture with solid union not evident on x-ray and not clinically solid, when such determination is feasible, and return to full weightbearing status did not occur or is not expected to occur within 12 months of onset.

Pelvic Relaxation - a condition resulting from childbirth in which the uterus and bladder become displaced from their normal positions. Surgery is the definitive treatment. The prognosis depends upon the surgeon's skill. There is no cause for disability.

Pemphigus - a rare skin disorder characterized by blisters which affects apparently healthy skin and mucous membranes. Pemphigus foliaceus is usually benign and responds well to treatment, but both pemphigus vulgaris and pemphigus vegetans are slowly progressive, debilitating, difficult to treat, and are usually fatal. It is cause for a disability when it becomes extensive and does not respond to prescribed treatment.

Peptic Ulcer - an open lesion of the mucous lining of the duodenum or stomach. There are several types recognized:
1. Duodenal ulcer-a peptic ulcer in the duodenum, usually in the first few centimeters.
2. Gastric ulcer-occurs along the lesser curvature of the stomach.
3. Channel ulcer-occurs in the pyloric canal.
4. Postbulbar-a peptic ulcer in Meckel's diverticulum.
5. Marginal or stomal-peptic ulcer at the margin of the anastomosis (where the stomach and small intestine join).
6. Jejunal ulcer-a peptic ulcer found in the jejunum.
Duodenal and gastric ulcers are the most common types. With proper therapy, symptoms are relieved in just a few days and with continued prescribed therapy the healing process is completed. See Gastrectomy for criteria for disability in cases of chronic peptic ulcer disease.

Peripheral Neuropathies - any disease of nervous tissue other than the central nervous system (made up of the brain and spinal cord) with sensory, motor , reflex and vasomotor symptoms.
1. Mononeuropathy or mononeuritis-disease of one nerve.
2. Mononeuritis multiplex-disease of 2 or more nerves in separate places.
3. Polyneuropathy, polyneuritis or multiple peripheral neuritis-disease of many nerves at the same time.
Both single and multiplex mononeuritis are marked by pain, weakness, partial paralysis and they are asymmetric. Polyneuropathy is bilaterally symmetrical, most commonly seen with diabetes mellitus or malnutrition and it develops slowly. The patient has peripheral tingling, numbness, burning pain (the pain is worse at night), sensory loss, loss of reflexes, painless ulcers on the digits, weakness, atrophy, hyperemia, sweating, bullae, pallor, dry skin and osteoporosis.
There may be a cause for disability when there is disorganization of function in spite of prescribed therapy.

Perirectal Suppuration - an abscess in the anus that may affect the surrounding tissue. This condition is painful, but prognosis is excellent with proper treatment. In the case of rare supralevator abscess, peritonitis or a fistula in ano may result. There is usually no cause for disability unless there is an intermittent obstruction due to an intractable abscess or formation of a fistula in ano.

Peritoneal Dialysis - the patient's own peritoneum is used as a dialysis filter when chronic kidney failure begins. There are many things to consider: the patient's discomfort during the procedure, hemorrhage around the puncture site, perforation of some abdominal structure, fluid in the chest cavity, protein loss, coma, low blood pressure and peritonitis.
Impairment of renal function due to any chronic kidney disease expected to last 12 months with chronic hemodialysis or peritoneal dialysis necessitated by irreversible renal failure is cause for disability.

Peritonitis (Acute) - an inflammation of the peritoneum usually caused by bacteria but may be due to chemical or mechanical stimuli.
Localized peritonitis frequently occurs in diverticulitis or early appendicitis, while a ruptured appendix or a perforated ulcer or perforated colon from carcinoma or leakage of bile may cause widespread peritonitis. Symptoms are pain, nausea and vomiting, occasionally diarrhea, fever, chills, tenderness, distention, tachycardia, elevated leukocyte count. All or part of the symptoms may appear. If it is untreated, it may be fatal, but it is not a disability.

Persistent Disorganization of Motor Function - in two extremities, resulting in sustained disturbance of gross and dexterous movements, or gait and station. Disorganization of motor function in the form of paresis or paralysis, ataxia and sensory disturbances (any or all of which may be due to cerebral, cerebellar, brain stem, spinal cord, or peripheral nerve dysfunction) which occur singly or in various combinations, frequently provides the sole or partial basis for decision in cases of neurological impairment. The assessment of impairment depends upon the degree of interference with locomotion and/ or interference with the use of fingers, hands, and arms.

Pleural Effusion - fluid around the lungs in the pleural cavity caused by various infections, TB, pneumonia, rheumatic fever, an abscess, cancer, etc. Treatment is based on an analysis of the effusion. Prognosis depends upon the underlying cause of the effusion. Pleural effusion is not cause for a disability, but the underlying cause may be.

Pneumoconiosis - a condition of the respiratory tract that develops after prolonged inhalation of dust-of any kind.
A. Fibrogenic pneumoconiosis or silicosis-caused by inhaling free silica resulting in pulmonary fibrosis.
B. Black lung disease {also known as coal worker's pneumoconiosis, coal miner's pneumoconiosis and anthracosis) -coal dust is deposited throughout the lungs as a result of long-term exposure.
C. Asbestosis-fibrous pneumoconiosis that results from inhalation of asbestos fibers.
D. Chemical pneumoconiosis-results from long-term inhalation of irritant chemical gases and vapors which damages the bronchial mucosa and lung tissue.
Pneumoconiosis is cause for disability as demonstrated by x-ray with nodular or focal fibrosis {nonconglomerative); spirometric evidence of chronic airway obstruction demonstrated by MVV and FEV; or interstitial or disseminated fibrosis or conglomerative disease.

Polyarteritis {also known as polyarteritis nodosa, periarteritis nodosa, and necrotizing angiitis) - a disease of small and medium sized arteries in which there is localized necrosis and inflammation with ischemia of the tissue supplied by the arteries. The most common complaints are fever, abdominal pain, weakness, asthma, hypertension, edema, nausea, vomiting, diarrhea, infrequent urination, headache, convulsions, etc. This disease mimics many other disorders; therefore, tests should be done as a possible diagnosis for unexplained combinations of the above symptoms. Whether acute or chronic, the disease usually causes death be- cause it leads to failure of the heart, kidneys and/or other vital organs. Renal failure due to polyarteritis is the leading cause of death in this category.
Prognosis is very poor even with proper treatment. Disability is considered based upon the organ or system that is impaired.

Polycystic Kidney Disease - a congenital, bilateral kidney disease in which there is gradual replacement of renal tissue by cyst-like structures.

Most patients die of complications due to hypertension or cerebral aneurysm within 10 years of the onset. Criteria for disability are impairment of renal function due to chronic polycystic disease expected to last 12 months with chronic hemodialysis or peritoneal dialysis necessitated by irreversible renal failure; or persistent elevation of serum creatinine to 4 mg per 100 cc or greater or reduction of creatinine clearance to 10 ml per minute (29 liters per 24 hours) or less, over at least 3 months with one of the following:
1. Renal osteodystrophy manifested by severe bone pain and appropriate x-ray abnormalities (e.g., osteitis, fibrosis, severe osteoporosis, pathologic fractures); or
2. Persistent motor or sensory neuropathy; or
3. A clinical episode of pericarditis; or
4. Intractable pruritus; or
5. Persistent fluid overload syndrome resulting in diastolic hypertension (110 mm or above) or signs of vascular congestion; or
6. Persistent anorexia with weight loss; or
7. Persistent hematocrits of 30% or less.

Polycythemia Vera (also known as Erythrocytosis) - an excess of red blood cells. The excess of red blood cells results in an increased amount or volume of blood as well as thicker than normal blood, both of which cause impaired blood flow and causes the heart to work extra hard to pump the increased volume of thick blood. Some symptoms are fatigue, headache, drowsiness, difficulty in concentration, forgetfulness and vertigo.
Treatment reduces symptoms and places the patient in remission for 5-10 years. Death is usually due to complications of myelofibrosis, acute leukemia, etc. Disability is evaluated under the body system affected. For example, Myelofibrosis or Acute Leukemia.

Portal Hypertension - congestion in the liver and spleen secondary to cirrhosis, thrombosis of some blood vessel in the liver, tumor, fibrosis or sclerosis. This disease usually develops silently. The patient may be an alcoholic. Underlying obstructions such as tumor or thrombosis can sometimes be corrected by surgery. Early therapy of cirrhosis can prevent portal hypertension; however, cirrhosis is irreversible. Total abstention from alcohol is the only means of slowing down the process.
The criteria for disability is documentation of portal hypertension with x-ray or endoscopic evidence of esophageal varices with a documented history of massive hemorrhage attributable to those varices; or performance of a shunt operation for esophageal varices; or serum bilirubin of 2.5 mg per 100 cc or greater persisting on repeated examinations for at least 5 months; or hepatic coma; or confirmation of chronic liver disease by liver biopsy and one of the following:
1. Ascites not attributable to other causes, recurring or persisting for at least 3 months, demonstrated by abdominal paracentesis or associated with persistent hypoalbuminemia of 3.0 gm per 100 cc or less.
2. Serum bilirubin of 2.5 mg per cc or greater on repeated examinations.
3. Hepatic cell necrosis or inflammation, persisting for at least 3 months, documented by repeated abnormalities of prothrombin time and enzymes indicative of hepatic dysfunction.

Postgastrointestinal Resection - surgical removal of a portion or all of the stomach and connecting small intestine. The dumping syndrome is a common complication. This condition is usually not cause for disability. For most patients the complications clear up with proper treatment.

Primary Dysmenorrhea - painful menstruation with no demonstrable pelvic disorder. This condition responds well to treatment and is not cause for a disability.

Psoriasis - a chronic and recurrent skin disorder characterized by scaling papules. Psoriasis varies in severity from 1 or 2 patches of dry, scaly skin to widespread manifestation with exfoliation or disabling arthritis.
A. Psoriatic arthritis-very closely resembles rheumatoid arthritis and is just as disabling, but the patient does not have the rheumatoid factor in his/her blood serum.
B. Exfoliative psoriatic dermatitis-very difficult to treat and may lead to disability because the entire skin is red and covered with scales.
C. Pustular psoriasis-sterile pustules usually localized to the palms of the hands and soles of the feet. This may be cause for temporary or permanent disability because it is painful, difficult to treat, and may limit the use of the hands and/or feet.
All forms tend to recur after remission. Psoriasis with extensive lesions, including involvement of the hands or feet which impose a severe limitation of function and which are not responding to prescribed treatment is the basis for a disability claim.
Psoriatic arthritis would be evaluated as rheumatoid arthritis minus a positive blood test for the RA factor.

Psychosis - a mental disorder in which the patient is unable to adapt to the outside world. It is characterized by abnormal behavior, withdrawal from reality or disorganized thought.
Psychosis may be the result of certain organic conditions such as senile or presenile dementia, intracranial infection, central nervous system degenerative disease, delirium tremens or other endocrinologic, metabolic or toxic states. These are considered functional psychotic disorders.
The main types are:
A. Schizophrenia (see Schizophrenia)
1. Hebephrenic
2. Catatonic
3. Paranoid.
B. Senile dementia (see Senile Dementia)
C. Alzheimer's disease. (see Senile Dementia)
Functional psychotic disorders are evaluated for disability on the following criteria (with both A and B):
A. Manifested persistence of one or more of the following clinical signs:
1. Depression or elation; or
2. Agitation; or
3. Psychomotor disturbance; or
4. Hallucinations or delusions; or
5. Autistic or other regressive behavior; or
6. Inappropriateness of affect; or
7. Illogical association of ideas.
B. Resulting persistence of marked restriction of daily activities and constriction of interests and seriously impaired ability to relate to other people.

Pulmonary Embolisms - the lodging of a blood clot in the lung resulting in local obstruction of blood flow. These emboli most often arise from an existing thrombus deep in the pelvic or leg veins.
Treatment consists of bed rest for 5-7 days, anticoagulants, support stockings and surgery in massive cases. Prognosis depends upon the extent of the embolism and the previous condition of the patient. Pulmonary emboli that cause acute cor pul- monale must be treated as a medical emergency.
There is no cause for disability unless there is pulmonary insufficiency as a result and it can be documented by MVV and FEY.

Pulmonary Fibrosis - a disease characterized by lung tissue replacement with tough, fiber-like tissue causing pulmonary impairments. There are several kinds:
A. Pneumoconiosis
1. Silicosis
2. Black lung disease
3. Asbestosis
4. Chemical pneumoconiosis.
B. Cystic fibrosis-affects other systems as well.
See the entries for Pneumoconiosis and Cystic Fibrosis.

Pulmonary Resection - the surgical removal of all or part of a lung. A pulmonary resection may cause restrictive ventilary disorders. There is a disability when there is a total vital capacity equal to, or less than the Social Security Administration specified values corresponding to the person's height.

Pyelonephritis (Acute) - an acute kidney infection which may be secondary to sickle cell disease, neurogenic bladder, diabetes or hypertension.
Treatment consists of the appropriate antibiotic to control the bacteria causing the infection and repeated cultures to make sure it is cleared. Recovery is usually complete but it may recur . Prolonged cases may cause kidney damage, but then it is considered chronic pyelonephritis.
Acute pyelonephritis in itself is not cause for disability. The underlying disease or condition may be.

Pyelonephritis (Chronic) - a chronic, bilateral, inflammatory disease usually caused by bacteria. Progression is rapid and very difficult to treat. A disability exists when there is impairment of renal function, due to any chronic kidney disease with chronic hemodialysis or peritoneal dialysis necessitated by irreversible renal failure; or kidney transplant. Consider under a disability for 12 months following surgery; thereafter, evaluate residual impairment; or persistent elevation of serum creatinine to 4 mg per 100 cc or greater or reduction of creatinine clearance to 20 ml per minute (29 liters per 24 hours) or less, over at least 3 months with one of the following:
1. Renal osteodystrophy manifested by severe bone pain and appropriate x-ray abnormalities (osteitis fibrosa, severe osteoporosis, pathologic fractures); or
2. A clinical episode of pericarditis; or
3. Persistent motor or sensory neuropathy; or
4. Persistent itching; or
5. Persistent fluid overload syndrome resulting in diastolic hypertension (110 mm or above) or signs of vascular congestion; or
6. Persistent anorexia with recent weight loss and current weight meeting the Social Security Administration values; or
7. Persistent hematocrits of 30% or less.

Rectal Prolapse - the herniation of some or all of the layers of the rectum through the anus. Surgery is the definitive treatment. Recurrence varies from a few to 1/3 of all patients. The principal complication following surgery is anal incontinence. Anal incontinence can be corrected with a colostomy, which is no cause for disability.

Regional Enteritis (also known as Granulomatous ileitis; ileocolitis; Crohn's disease) - a degenerative, chronic, intermittent, inflammatory disease which can affect any part of the gastrointestinal system, but most commonly affects the terminal ileum (the lower portion of the small intestine which is about 12 ft. in length). There is chronic diarrhea, abdominal pain, fever, anorexia, weight loss, intestinal stenosis, distention, vomiting, or chronic disability from malnutrition, and painful fistulas and abscesses may form.
There is cause for disability when regional enteritis is demonstrated by operative findings, barium studies, biopsy, or endoscopy 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 extreme weight loss as described by the Social Security Administration.

Renal Failure (Acute) - ischemic or toxic, reversible loss of normal kidney function. The mortality is high even with appropriate therapy. If there is glomerular destruction, death is almost certain. See Pyelonephritis for disability criteria for renal impairment.

Renal Failure (Chronic) - the ability of the kidneys to excrete urine is gradually impaired. This condition is terminal unless there is a successful kidney transplant. See Pyelonephritis for disability criteria for chronic kidney disease.

Renal Function Impairment - impairment or reduction of the ability of the kidneys to extract wastes from the blood and excrete it as urine. It is due to injury, surgery or chronic kidney diseases such as hypertensive vascular disease, chronic nephritis, nephrolithiasis, etc. Usually hemodialysis, peritoneal dialysis or eventually a kidney transplant is necessary. Criteria for disability is listed in detail under Pyelonephritis (Chronic).

Restrictive Pericarditis (Chronic) - a condition in which firm scar tissue forms or there is a gradual accumulation of fluid which fills the pericardial cavity thus preventing normal filling of the ventricles. It is also known as chronic constrictive pericarditis. This condition is usually secondary to such diseases as chronic kidney failure, radiation therapy, cancer, TB, pyogenic, viral or histoplasmosis infection. The only early symptom is diastolic hypertension. Later manifestations are shortness of breath, inability to breathe unless sitting or standing, cough, rales, engorgement of the neck veins, pleural effusion, hepatomegaly, ascites and edema of hands and legs. Surgical decortication (removal of scar tissue) is the treatment of choice with 80% of all cases having good results. If a disability exists, it would be treated the same as CHF, hypertensive vascular disease or ischemic heart disease.

Retinitis Pigmentosa - a hereditary disease in which there is atrophy of the retina, pigment deposits, loss of rods and cones, and cataract formation. Prognosis depends upon the amount of involvement around the optic nerve. If there is a great deal of involvement, progressive blindness occurs. Disability would depend upon the degree of impairment, but most cases are covered by total bilateral blindness.

Retinitis Proliferans - an eye disorder that is the result of recurrent hemorrhage from the retina into the vitreous. It is connective tissue containing blood vessels which project into the vitreous thus impairing vision. This condition is the major cause of blindness and is frequent in diabetics. Control of the diabetes and blood pressure are important in slowing the progression of retinitis proliferans. A new procedure utilizing a laser beam is very successful in slowing the progression of this condition. Disability depends upon the extent of impairment of central visual acuity or peripheral visual fields or loss of visual efficiency.

Rotator Cuff Syndrome - a condition that may be a simple inflammation or a tear of the musculotendinous cuff of the shoulder seen mostly in the middleaged or the elderly. The patient may experience pain and weakness or may not be able to lift the arm.
The period and degree of disability varies according to the severity of the condition. A severe tear requires surgery while most cases of inflammation respond to rest, heat, massage, anti- inflammatory drugs and exercise. Care must be taken to prevent recurrence because this is a painful chronic condition.
Disability falls under the criteria for disability for soft tissue injuries of an upper extremity. This requires a series of staged surgical procedures within 12 months after onset for salvage and/ or restoration of major function of the extremity, such major function not being restored or not expected to be restored within 12 months after onset.