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The Social Security Administration is revising the medical criteria in the Listing of Impairments (the listings) that it uses to evaluate claims involving malignant neoplastic diseases (cancer) under Titles II and XVI of the Social Security Act (Act). The criteria appear in §13.00 (for adults) and §113.00 (for children) of Appendix 1 to Subpart P of 20 CFR, Part 404. The adopted rules are nearly identical to the rules that were proposed in the notice of proposed rulemaking published on April 28, 2008 (73 Fed. Reg. 22871). The revised criteria will become effective November 5, 2009.
Among the many changes are the following:
l Expansion of the term “inoperable” to explain that the determination of whether a tumor is inoperable may be made before or after “neoadjuvant therapy” (such as chemotherapy or radiation that is designed to reduce the size of the tumor) [ §13.00I1];
l Revision of the definition for “multimodal therapy” and its movement from §13.00E2 and §113.E2 to §13.00I3 and §113.00I2;
l Expansion of the term “unresectable” to explain how the use of adjuvant therapy relates to a determination of whether a tumor is unresectable [§13.00I7];
l Addition of a definition for “metastases” to include spread of the tumor by blood, lymph or other body fluid, but not direct extension of the tumor to other tissues or organs [§13.00I2, §113.00I1];
l Alphabetic reorganization of §13.00I and §113.00I;
l Change in the reference “low grade or indolent lymphoma” to “indolent lymphoma” [§13.00K1];
l Recognition of testicular biopsy as being an acceptable method of documenting recurrent leukemia [§13.00K2a, §113.00K2a];
l Recognition of grade II brain tumors as being malignant [§13.00K6, §113.00K4];
l Specification that recurrence of tumors in the false vocal cord (but not the true vocal cord) would meet the listing [§13.00C];
l Clarification that if there is a recurrence or relapse after three years, the impairment may again meet or medically equal the requirements of a cancer listing [§13.00H2, §13.00H3, §113.00H2, §113.00H3];
l Expansion of the criteria for melanoma to include palpable nodal metastases or metastases to adjacent skin or elsewhere [§13.03B2];
l Replacement of the terms “intermediate or high-grade” and “low-grade or indolent” with the terms “aggressive” and “indolent” [§13.05A];
l Clarification that mycosis fungoides is an indolent lymphoma [§13.05A];
l Addition of a listing for medullary carcinoma [§13.09C, §113.09C];
l Clarification that metastases of breast cancer to the supraclavicular or infraclavicular nodes or to 10 or more axillary nodes is of listing-level severity [§13.10B];
l Expansion of the criteria for carcinoma of the superior sulcus (including Pancoast tumors) to include that a person who receives multimodal antineoplastic therapy would be deemed disabled for at least 18 months from the date of diagnosis [§13.14C added];
l Addtion of a listing for vaginal cancer [§13.23C]; and
l Removal of the listing for ovarian cancer with ruptured ovarian capsule, tumor on the serosal survace of the ovary, ascites with malignant cells, or positive peritoneal washings [§13.23E1c removed and redesignation of §13.23E1d as §13.23E1c].
In addition to the above, a number of nonsubstantive editorial and grammatical changes were made for clarity and consistency.
The full text of the notice finalizing the proposed regulations was published in the October 6, 2009, Federal Register (74 Fed. Reg. 51229).
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