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Disability Evaluation Under Social Security
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Section | 108.00 Skin Disorders |
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1. Extensive skin lesions.
a. Skin lesions that interfere with the motion of your joints and that very seriously limit your use of more than one extremity; that is, two upper extremities, two lower extremities, or one upper and one lower extremity. b. Skin lesions on the palms of both hands that very seriously limit your ability to do fine and gross motor movements. c. Skin lesions on the soles of both feet, the perineum, and both inguinal areas that very seriously limit your ability to ambulate. 2. Frequency of flare-ups.
3. Symptoms (including pain).
4. Treatment. a. We assess the effects of continuing treatment as prescribed by determining if there is improvement in the symptoms, signs, and laboratory findings of your disorder, and if you experience side effects that result in functional limitations. To assess the effects of your treatment, we may need information about:
b. Because treatment itself
or the effects of treatment may be temporary, in most cases sufficient
time must elapse to allow us to evaluate the impact and expected
duration of treatment and its side effects. Except under 108.07
and 108.08, you must follow continuing treatment as prescribed for
at least 3 months before your impairment can be determined to meet
the requirements of a skin disorder listing. (See 108.00H if you
are not undergoing treatment or did not have treatment for 3 months.)
We consider your specific response to treatment when we evaluate
the overall severity of your impairment. D. How do we assess impairments
that may affect the skin and other body systems? 1. Tuberous sclerosis primarily affects the brain. The predominant features are seizures, which we evaluate under the neurological listings in 111.00, and developmental delays or other mental disorders, which we evaluate under the mental disorders listings in 112.00. 2. Malignant tumors of the skin (for example, malignant melanoma) are cancers, or neoplastic diseases, which we evaluate under the listings in 113.00. 3. Autoimmune disorders and other immune system disorders (for example, systemic lupus erythematosus (SLE), scleroderma, human immunodeficiency virus (HIV) infection, and Sjögren's syndrome) often involve more than one body system. We first evaluate these disorders under the immune system disorders listings in 114.00. We evaluate SLE under 114.02, scleroderma under 114.04, HIV infection under 114.08, and Sjögren's syndrome under 114.10. 4. Disfigurement or deformity
resulting from skin lesions may result in loss of sight, hearing,
speech, and the ability to chew (mastication). We evaluate these
impairments and their effects under the special senses and speech
listings in 102.00 and the digestive system listings in 105.00.
Facial 5. We evaluate erythropoietic porphyries under the hemic and lymphatic listings in 107.00. 6. We evaluate hemangiomas associated with thrombocytopenia and hemorrhage (for example, Kasabach-Merritt syndrome) involving coagulation defects, under the hemic and lymphatic listings in 107.00. But, when hemangiomas impinge on vital structures or interfere with function, we evaluate their primary effects under the appropriate body system. E. How do we evaluate genetic photosensitivity disorders? 1. Xeroderma pigmentosum
(XP). 2. Other genetic photosensitivity
disorders. b. What we will accept as medical evidence instead of the actual laboratory report. When we do not have the actual laboratory report, we need evidence from an acceptable medical source that includes appropriate clinical findings for your impairment and that is persuasive that a positive diagnosis has been confirmed by appropriate laboratory testing at some time prior to our evaluation. To be persuasive, the report must state that the appropriate definitive genetic laboratory study was conducted and that the results confirmed the diagnosis. The report must be consistent with other evidence in your case record. F. How do we evaluate burns?
G. How do we determine if
your skin disorder(s) will continue at a disabling level of severity
in order to meet the duration requirement? H. How do we assess your skin disorder(s) if your impairment does not meet the requirements of one of these listings? 1. These listings are only examples of common skin disorders that we consider severe enough to result in marked and severe functional limitations. For most of these listings, if you do not have continuing treatment as prescribed, if your treatment has not lasted for at least 3 months, or if you do not have extensive skin lesions that have persisted for at least 3 months, your impairment cannot meet the requirements of these skin disorder listings. (This provision does not apply to 108.07 and 108.08.) However, we may still find that you are disabled because your impairment(s) meets the requirements of a listing in another body system, medically equals (see §§ 404.1526 and 416.926 of this chapter) the severity of a listing, or functionally equals the severity of the listings. 2. If you have not received
ongoing treatment or do not have an ongoing relationship with the
medical community despite the existence of a severe impairment(s),
or if your skin lesions have not persisted for at least 3 months
but you are undergoing continuing treatment as prescribed, you may
still have an impairment(s) that meets a listing in another body
system or that medically equals a listing. If you do not have an
impairment(s) that meets or medically equals a listing, we will
consider whether your impairment(s) functionally equals the listings.
(See § 416.924 of this chapter.) When we decide whether you
continue to be disabled, we use the rules in § 416.994a of
this chapter. 108.02 Ichthyosis, with extensive skin lesions that persist for at least 3 months despite continuing treatment as prescribed. 108.03 Bullous disease (for example, pemphigus, erythema multiforme bullosum, epidermolysis bullosa, bullous pemphigoid, dermatitis herpetiformis), with extensive skin lesions that persist for at least 3 months despite continuing treatment as prescribed. 108.04 Chronic infections of the skin or mucous membranes, with extensive fungating or extensive ulcerating skin lesions that persist for at least 3 months despite continuing treatment as prescribed. 108.05 Dermatitis (for example, psoriasis, dyshidrosis, atopic dermatitis, exfoliative dermatitis, allergic contact dermatitis), with extensive skin lesions that persist for at least 3 months despite continuing treatment as prescribed. 108.06 Hidradenitis suppurativa, with extensive skin lesions involving both axillae, both inguinal areas, or the perineum that persist for at least 3 months despite continuing treatment as prescribed. 108.07 Genetic photosensitivity disorders, established as described in 108.00E. A. Xeroderma pigmentosum. Consider the individual disabled from birth. B. Other genetic photosensitivity disorders, with: 1. Extensive skin lesions that have lasted or can be expected to last for a continuous period of at least 12 months, OR 2. Inability to function outside of a highly protective environment for a continuous period of at least 12 months (see 108.00E2). 108.08 Burns, with extensive skin lesions that have lasted or can be expected to last for a continuous period of at least 12 months. (See 108.00F).
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