Impairment of growth may be disabling in itself or it may be an indicator of the severity of the impairment due to
a specific disease process. Determinations of growth impairment should be based upon the comparison of current height with
at least three previous determinations, including length at birth, if available, Heights (or lengths) should be plotted on
a standard growth chart, such as derived from the National Center for Health Statistics: NCHS Growth Charts. Height should
be measured without shoes. Body weight corresponding to the ages represented by the heights should be furnished. The adult
heights of the child's natural parents and the heights and ages of siblings should also be furnished. This will provide
a basis upon which to identify those children whose short stature represents a familial characteristic rather than a result
of disease. This is particularly true for adjudication under 100.02B.
age determinations should include a full descriptive report of medically acceptable imaging specifically obtained
to determine bone age and must cite the standardization method used. Where appropriate medically acceptable imaging must be
obtained currently as a basis for adjudication under 100.03, views or scans of the left hand and wrist should be ordered.
In addition, appropriate medically acceptable imaging of the knee and ankle should be obtained when cessation of growth is
being evaluated in an older child at, or past, puberty. Medically acceptable imaging includes, but is not limited to,
x-ray imaging, computerized axial tomography (CAT scan) or magnetic resonance imaging (MRI), with or without contrast material,
myelography, and radionuclear bone scans. "Appropriate" means that the technique used is the proper one to support
the evaluation and diagnosis of the impairment.
C. The criteria in this section are
applicable until closure of the major epiphyses. The cessation of significant increase in height at that point would prevent
the application of these criteria.
100.01 Category of Impairments, Growth
100.02 Growth impairment, considered to be related to an additional specific medically determinable impairment, and one of the following:
A. Fall of greater than 15 percentiles in height which is sustained; or
B. Fall to, or persistence of, height below the third percentile.
100.03 Growth impairment, not identified as being related to an additional, specific medically determinable impairment. With:
A. Fall of greater than 25 percentiles in height which is sustained; and
Bone age greater than two standard deviations (2 SD) below the mean for chronological age (see 100.00B).