S thru Z

Sarcoma of Soft Parts - cancer of tissue other than bone or cartilage. This is cause for disability when the sarcoma is not controlled by prescribed therapy.

Schizophrenia - the most common type of psychosis, characterized by changes in behavior, mood and perception. It usually begins in early adult life. The subtypes are:
A. Hebephrenic schizophrenia-a condition characterized by hypochondria, thought disorganization, inappropriate and unpredictable reactions and various mannerisms.
B. Catatonic schizophrenia--extreme withdrawal, refusal to speak, stiff posture and may be impulsive or dangerous.
C. Paranoid schizophrenia--extreme suspicion of people and things. Delusions and hallucinations are common.
All of these patients are unpredictable and pose a threat of injury to themselves or others. Hospitalization, sedation, ECT , and psychotherapy are a must, with emphasis on returning the patient to a normal life. These patients are usually able to maintain an adequate to marginal level of behavior for variable lengths of time. Recurring breakdowns are the usual and the possibility of homicide or suicide is always present. See Psychosis for disability criteria.

Scleroderma or Progressive Systemic Sclerosis (PSS) (Scleroderma is the skin also.) - A chronic disease of unknown origin, characterized by fibrosis and vascular abnormalities in the skin, joints and internal organs. The disease may be mild with a normal life span, or so severe as to cause death due to CHF, chronic kidney disease, pulmonary manifestations or intestinal malabsorption.
The most common complaints at first are spasms of blood vessels in the fingers followed by cyanosis and swelling in the joints. Other symptoms are generalized joint pain, muscle weakness, intestinal disturbances, symmetrical hardening of the skin on the fingers and arms, the skin becomes shiny and tight with increased discoloration, the face becomes mask-like, with discolorations appearing on the fingers, lips and tongue. Also, pulmonary hypertension develops, a form of biliary cirrhosis develops, tendinitis, ulcers on the fingers, esophageal dysfunction (the most frequent visceral disturbance, eventually occurring in most patients), distention, restrictive and obstructive ventilary disease, pleurisy, pericarditis, pleural effusion, cardiac arrhythmias, conduction disturbances, CHF or chronic renal failure develop.
The criteria for disability is sceleroderma or progressive systemic sclerosis (the diffuse or generalized form), with advanced limitation in the use of the hands due to sclerodactylia (hardening of the fingers) or limitation in other joints; or significant visceral manifestations of digestive, cardiac, pulmonary or renal impairment.

Scoliosis - an abnormal side-to-side curvature of the spine. Whether or not a disability exists is dependent upon the degree of impairment of locomotion or respiratory function.

Senile Dementia and Alzheimer's Disease - 1. Senile dementia-a process of intellectual deterioration which may affect all people over 65. Memory of recent events and judgment are usually affected first.
2. Alzheimer's disease-the same as senile dementia except that it occurs before age 65 and in the absence of any demonstrable cause.
These patients usually become helpless long before death. Death is due to another cause. Both senile dementia and Alzheimer's dementia are considered for disability under Chronic Brain Syndrome when accompanied by both A and B:
A. Demonstrated deterioration in intellectual functioning, manifested by persistence in one or more of the following clini- cal signs:
1. Marked memory defect for recent events; or
2. Impoverished, slowed, perseverative thinking, with confusion or disorientation; or
3. Labile, shallow, or coarse affect.
B. Resulting persistence of marked restriction of daily activities and constriction of interests and deterioration in personal habits and seriously impaired ability to relate to other people.

Sickle Cell Disease - a form of anemia that affects black people and is characterized by sickle-shaped red blood cells. This condition is inherited as a recessive trait. Other names are: sickle cell anemia, Hb S disease, drepanocytic anemia and meniscocytosis. Symptoms of this disease are severe anemia, jaundice, arthralgia with fever , recurrent ulcers about the ankles, episodes of severe abdominal pain and vomiting, partial paralysis and other neurological disturbances, thrombosis and infarction.
There is cause for disability for sickle cell disease (or one of its variants) when it is accompanied by documented painful (thrombotic) crises occurring at least 3 times during the 5 months prior to adjudication; or when it requires extended hospitalization (beyond emergency care) at least 3 times during the 12 months prior to adjudication. The resulting impairment under the criteria for the affected body systems should also be evaluated.

Sigmoid Volvulus - an obstruction of the sigmoid colon. Circulatory impairment may accompany the obstruction causing gangrene. (Congenital megacolon and Chagas' disease may predispose). This disease is seen mostly in the elderly or in those with severe psychiatric or neurological disorders.
Surgery is the definitive treatment. It may require a simple resection or a colostomy.
Sigmoid volvulus and colostomy are not in themselves cause for disability.

Spondylolisthesis and Spondylolysis - these conditions are peculiar to the 5th lumbar vertebra. Spondylolisthesis refers to the subluxation of the 5th lumbar vertebra (L5). Spondylolysis is a condition ofL5 in which the cartilaginous disc of the vertebra breaks down either unilaterally or bilaterally.
The result of both conditions is unilateral (usually) compression of a nerve root which causes pain, partial paralysis, numbness, loss of reflex, wasting of muscles, and sometimes urine retention or anal incontinence. In most cases, 2 weeks of conservative treatment with bed rest (supine and on a firm surface), pain relievers and mild tranquilizers is sufficient. When there is urine retention and/ or anal incontinence or cases that are persistent after prescribed treatment, surgery is indicated. For the cause for disability of spondylolisthesis see herniated nucleus pulposus. The criteria for disability of spondylolysis is x-ray evidence of either a compression fracture of a vertebral body with loss ofat least 50% of the estimated height of the vertebral body prior to the compression fracture, with no intervening direct traumatic episode; or multiple fractures of vertebrae with no intervening direct traumatic episode.

Sprained Back - torn supraspinous ligament. This condition is suggested when the onset is sudden after heavy lifting or other strenuous physical exertion. There is pain and tenderness localized over the area affected.
This condition responds well to treatment and is not cause for a disability.

Status Anginosus - a chronic condition of angina pectoris caused by a blood supply restricted due to hardening and narrowing of arteries supplying the heart muscle. The characteristics of angina are usually constant for any individual, any change in the pattern should be considered a serious change. See Chest Pain ofCardiac Origin for criteria for disability.

Suppurative (Acne) - acne with pus-filled cysts. It may be cause for disability when accompanied by extensive lesions involving the axillae or perineum not responding to prescribed treatment and not amenable to surgical treatment.

Thromboangiitis Obliterans (Buerger's Disease) - an inflammation of the inner lining of small and medium-sized arteries and veins (less frequently in veins) of the extremities in a segmental pattern. There is a definite relationship between heavy smoking and the occurrence and progression of the disease. The onset may be gradual or sudden With rapid development of gangrene. Some symptoms are coldness, numbness, tingling, burning, intermittent claudication, pain when the disease is severe, pallor when leg or arm is elevated, red when standing or in use; there may be ulcers and thrombophlebitis.
There is a disability when accomp~nied by arteriosclerosis obliterans or thromboangiitis with intermittent claudication (arterial spasm with cramping in the leg followed by lameness) with failure to visualize (on arteriogram) the common femoral or deep femoral artery in one extremity; or intermittent claudication and absence of peripheral arterial pulsations in the femoral, popliteal, dorsalis pedis, and posterior tibial arteries by doppler or plethysmography, in one extremity; or amputation at or above the tarsal region due to peripheral vascular disease.

Thrombocytopenia - a deficiency disease that is a result of the decrease in number ofthrombocytes (platelets) in the blood. For various reasons there is failure of production, increased destruction, increased utilization or dilution of the blood platelets. Symptoms are an increased tendency to bleed, demonstrated by bleeding into the skin and mucosa, bleeding in the gastrointestinal tract and genito-urinary system.
Chronic thrombocytopenia (due to any cause) is cause for disability when the platelet count is repeatedly below 40,000/ cubic millimeter, With at least one spontaneous hemorrhage, requiring transfusion, Within 5 months prior to adjudication; or intracranial bleeding within 12 months prior to adjudication.

Tinnitus - "ringing" in the ears. In itself tinnitus is not cause for disability unless it becomes persistent and is associated With a disturbance in balance or a loss of hearing.

Transmural Myocardial Infarction - an infarction (death of tissue) that involves the whole thickness of the myocardium from the epicardium to the endocardium and is characterized by abnormal Q waves on EKG. See Myocardial Infarction for symptoms and disability.

Tuberculosis (TB) - an acute or chronic infection caused by the bacilli, Mycobacterium tuberculosis or Mycobacterium bovis (rare in the U .S.). TB usually affects the lungs, but may spread via the blood or lymph to any part of the body. The disease is most commonly spread through the air.
In the early stages, there are no symptoms. Later, lesions will show on x-ray, fever, fatigue, weight loss, hemoptysis, pleural or chest pain, and dyspnea will develop. Complications of TB are respiratory failure, pulmonary hypertension or cor pulmonale.
The treatment usually consists of 2 antituberculosis drugs for 2 years. The prognosis where there is lung involvement alone is good. When it is more widespread, the prognosis depends upon the extent of the disease. Types of TB other than pulmonary are:
1. Extrapulmonary tuberculosis-spreads by the blood or lymph or by sputum to the upper air passages, mouth and GI tract. Extrapulmonary TB is generally easier to treat because the environments are not as favorable for bacteria growth as the lungs. Treatment follows the same general regimen as pulmonary TB-2 antituberculosis agents for 2 years.
2. Miliary tuberculosis (also called generalized hematogenous or lymphohematogenous tuberculosis)-this type of tuberculosis is spread by the blood and lymph and usually causes tuberculin metastasis in the blood or bone. Chest x-rays and tuberculin tests may be negative. There is high fever, toxemia, and tuberculous meningitis is a common complication. When the bone marrow is involved, there is anemia, thrombocytopenia and possibly leukemia. There is good response to treatment.
3. Central nervous system tuberculosis or tuberculous meningitis-develops when the tubercle bacilli get into the cerebrospinal fluid. There is significant alteration of consciousness from drowsiness to coma. There may be permanent complications such as convulsive disorders, hydrocephalus, mental retardation and neurological impairments. (Usual TB treatment.)
4. Pleural tuberculosis- TB in the pleura caused by pleural effusion and tuberculous empyema (pus in the pleura). A very common complication is bronchopleural fistula which must be drained surgically.
5. Tuberculous pericjirditis-pericarditis caused by the TB bacterium. This causes constrictive pericarditis and may leave chronic constrictive pericarditis. This infection usually responds to TB therapy, but since it is difficult to diagnose, there may be permanent damage.
6. Genito-urinary TB-spread by the bloodstream. Response to therapy is usually prompt.
7. Tuberculosis of the GI tract-TB of the small and large intestines are the most common. Responds well to tuberculin chemotherapy.
8. TB of bones and joints-
a. TB of peripheral joints (usually affects 1 joint at a time) produces a purulent arthritis which responds well to TB therapy.
b. Tuberculous spondylitis (Pott's disease)-a serious form of TB which affects the spine frequently causing neurological damage. Compression of the spinal cord by a paraspinal abscess or granular tissue causes symptoms ranging from minor loss of sphincter control to sudden and irreversible paralysis. Posterior spinal fusion is the treatment of choice, along with TB chemotherapy.
9. Other types are:
a. TB of the adrenals-causes Addison's disease.
b. Tuberculous peritonitis-responds well to treatment.
c. Tuberculous lymphadenitis-responds well to treatment.
d. Tuberculosis of the mouth, middle ear, larynx, and bronchial tree-response of all of these to TB therapy is prompt and permanent.
The criteria for disability evaluation of pulmonary tuberculosis that is caused by Mycobacterium tuberculosis where there is impairment of pulmonary function due to extensive disease should be evaluated under the criteria for chronic obstructive airway disease or diffuse pulmonary fibrosis or other restrictive ventilary disorders.
Tuberculous-meningitis-induced convulsive disorders, mental retardation, and neurological impairments would have to be evaluated under each respective impairment.
Chronic (tuberculous) constrictive pericarditis, joint impairment due to peripheral joint TB, and paralysis due to Pott's disease would have to be evaluated by the criteria for each system involved.

Tumors of the Back - neoplasms classified as both primary and metastatic, benign and malignant are divided into 2 groups:
1. Extramedullary neoplasms-those occurring outside of the spinal column and which affect the bony vertebrae and their associated structures. The first symptoms occur as the result of compression of nerve roots-pain, partial paralysis, sensory loss, and muscular weakness. Sphincter control may be affected and there may be blockage of spinal vessels. These tumors can usually be removed by surgery, but the prognosis depends on the damage already done.
2. Intramedullary neoplasms (gliomas and ependymomas)- those tumors which are inside the spinal column.
The symptoms usually begin with loss of sensation turning to pain in the fingers, then there is a loss of sensation across the back and shoulders, the legs may become weak and spastic, vertigo, facial sensory impairment, speech impairment and early loss of sphincter control may develop. Intramedullary tumors are inoperable except for decompression procedures. Radiotherapy is helpful in some cases. These tumors can only be arrested and recurrence is sure.
There is disability for spinal cord or nerve root lesions due to any cause with disorganization of motor function.

Ulcerative Colitis - a chronic inflammation of the colon which results in ulcers, fibrosis and shortening of the entire colon. Hemorrhage, toxic megacolon and cancer are complications of prolonged or recurrent attacks. Toxic megacolon should be treated as a medical emergency or death may result.
The criteria for disability is chronic ulcerative or granulomatous colitis which must be demonstrated by endoscopy, barium enema, biopsy or operative findings with: recurrent bloody stools documented on repeated examinations and anemia manifested by hematocrit of 30% or less on repeated examinations; or persistent or recurrent manifestations (systemic), such as arthritis, iritis, fever, or liver dysfunction, not attributable to other causes; or intermittent obstruction due to intractable (hard to cure) abscesses, fistula formation, or stenosis; or recurrence of the above after total colectomy; or extreme weight loss {according to the Social Security Administration values).

Unstable Angina {also called acute coronary insufficiency, preinfarction angina or the intermediate syndrome) - Unstable angina is so named because the status of the patient is unstable. Very frequently, unstable angina leads to an acute myocardial infarction. For disability see Chest Pain of Cardiac Origin and Myocardial Infarction (more detailed).

Uterine Leiomyomas or Fibromyomas - as known as fibroid tumors)-these tumors are benign and are the most common tumor of the female reproductive system. The definitive treatment is a hysterectomy with an excellent prognosis. This condition is not cause for disability except in rare cases wherein the fibroids become malignant.

Vaginal Malignancy - cancer in the vagina. Primary malignant tumors arising in the vagina are rare, but metastasis from cancer of the cervix, bladder and rectum are common.
Neither treatment by surgery nor radiation nor chemotherapy is considered satisfactory. Fewer than 1/3 survive 5 years after the diagnosis. In addition, surgical treatment is difficult for the patient to accept because the rectum, bladder and all reproductive organs must be removed.
There is cause for disability under the classification of recurrent malignancy with metastasis under either urinary bladder, uterus, or rectum, etc.

Vagotomy - surgical cutting of the vagus nerve to relieve severe pain usually associated with a gastrectomy or other painful GI condition. A vagotomy in itself does not constitute a cause for disability.

Variant Angina {also called Prinzmetal's angina) - angina characterized by attacks that occur at night while the patient is resting or sleeping, and by unusual changes in E KG readings; usually due to spasms of the coronary arteries. For the criteria for disability see Chest Pain of Cardiac Origin and Myocardial Infarction.

Ventricular Aneurysm - a ballooning-out of the wall ofone of the ventricles of the heart due to weakening of the wall by disease, injury, or abnormality at birth. They usually develop after a transmural myocardial infarction, they do not rupture, they cause ventricular arrhythmias, they show a persistent elevation of S-T segments on EKG and they are a threat as a source of thrombi or emboli. Surgical repair is the definitive treatment when the patient can stand it. If it cannot be repaired, the patient has the symptoms of congestive heart failure.
This condition would be evaluated for disability under Myocardial Infarction since it is the primary disease involved.

Ventricular Fibrillation or Asystole - the ventricles stop contracting effectively and begin a circus-like movement. The patient will lose consciousness immediately, arterial pulse and respiration will be absent, blood pressure will be negligible, the pupils become dilated and the skin turns blue.
Treatment must be immediate because there is irreversible damage to the heart and brain within 2-4 minutes. CPR, electric; shock, and epinephrine are indicated. Therapy must be maintained until normal respirations and heart action return or until the patient is pronounced dead. If the patient survives, there is definitely a disability. It may be under Congestive Heart Failure, or Recurrent Arrhythmias.

Ventricular Tachycardia - the ventricles contract at a high rate of 150-250 beats per minute independently of the atria. It may be caused by myocardial ischemia, infarction, ventricular aneurysm or digitalis or quinidine intoxication. Prognosis depends upon whether or not ventricular fibrillation develops.
Ventricular tachycardia would be classified for disability under ischemic heart disease, myocardial infarction or recurrent arrhythmia (not due to digitalis).

Vertigo - a sensation of dizziness and/or whirling. The prognosis depends upon the underlying cause. There is cause for disability if the vertigo is accompanied by frequent attacks of balance disturbance, tinnitus and a progressive loss of hearing.

Vestibular Disorder (Labyrinthine Vestibular Disturbance) - disturbance of one's equilibrium usually as a result of a disease of or injury to the vestibular branch of the 8th cranial nerve.
There is cause for disability when there is a disturbance of the labyrinthine vestibular function characterized by a history of frequent attacks of balance disturbance, tinnitus, and a progressive loss of hearing with both A and B:
A. Disturbed function of vestibular labyrinth demonstrated by caloric or other vestibular tests; and
B. Hearing loss established by audiometry.

Visual Efficiency (Loss of) - the visual efficiency of one eye is the product of the percentage of central vision efficiency and the percentage of visual field efficiency. There is a disability when the visual efficiency of the better eye after best correction is 20% or less.