A. Listed disorders include impairments involving deficiency of one or more components of the
immune system (i.e., antibody-producing B cells; a number of different types of cells associated with cell-mediated immunity
T-lymphocytes, macrophages and monocytes; and components of the complement system).
B. Dysregulation of the immune system may result in the development of a connective tissue disorder. Connective
tissue disorders include several chronic multi-system disorders that differ in their clinical manifestation, course, and outcome.
These disorders are described in Part A, 14.00B; inflammatory arthritis is also described in 114.00E.
Some of the features of connective tissue disorders in children may differ from the features in adults. When
the clinical features are the same as that seen in adults, the principles and concepts in Part A, 14.00B apply.
The documentation needed to establish the existence of a connective tissue disorder is medical history, physical
examination, selected laboratory studies, appropriate medically acceptable imaging and, in some instances, tissue biopsy.
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. However,
the Social Security Administration will not purchase diagnostic tests or procedures that may involve significant risk, such
as biopsies or angiograms. Generally, the existing medical evidence will contain this information.
In addition to the limitations caused by the connective tissue disorder per se, the chronic adverse
effects of treatment (e.g., corticosteroid-related ischemic necrosis of bone) may result in functional loss.
A longitudinal clinical record of at least 3 months demonstrating active disease despite prescribed treatment
during this period with the expectation that the disease will remain active for 12 months is necessary for assessment of severity
and duration of impairment.
In children the impairment may affect growth, development,
attainment of age-appropriate skills, and performance of age-appropriate activities. The limitations may be the result of
serious loss of function because of disease affecting a single organ or body system, or lesser degrees of functional loss
because of disease affecting two or more organs/body systems associated with significant constitutional symptoms and signs
of severe fatigue, fever, malaise, weight loss, and joint pain and stiffness. We use the term "severe" in these
listings to describe medical severity; the term does not have the same meaning as it does when we use it in connection with
a finding at the second step of the sequential evaluation processes in §§ 404.1520, 416.920, and 416.924.
C. Allergies, growth impairments and Kawasaki disease.
Allergic disorders (e.g., asthma or atopic dermatitis) are discussed and evaluated under the appropriate listing of the affected
2. If growth is affected by the disorder or its treatment by immunosuppressive
drugs, 100.00, Growth impairment, may apply. Children may have growth impairment as a result of the inflammatory arthritides
because of the diseases' potential effects on the immature skeleton, open epiphyses, and young cartilage and bone. In
such situations, the growth impairment should be evaluated under 100.00ff.
disease, also known as mucocutaneous lymph node syndrome, is characterized by multisystem manifestations, but significant
functional impairment is usually due to disease of the coronary arteries, which should be evaluated under 104.00.
D. Human immunodeficiency virus (HIV) infection.
1. HIV infection is
caused by a specific retrovirus and may be characterized by susceptibility to one or more opportunistic diseases, cancers,
or other conditions, as described in 114.08. Any child with HIV infection, including, one with a diagnosis of acquired immunodeficiency
syndrome (AIDS), may be found disabled under this listing if his or her impairment meets any of the criteria in 114.08 or
is of equivalent severity to any impairment in 114.08.
2. Definitions. In 114.08,
the terms "resistant to treatment," "recurrent," and
have the same general meaning as used by the medical community. The precise meaning of any of these terms will depend upon
the specific disease or condition in question, the body system affected, the usual course of the disorder and its treatment,
and the other circumstances of the case.
"Resistant to treatment" means
that a condition did not respond adequately to an appropriate course of treatment. Whether a response is adequate, or a course
of treatment appropriate, will depend on the facts of the particular case.
means that a condition that responded adequately to an appropriate course of treatment has returned after a period of remission
or regression. The extent of response (or remission) and the time periods involved will depend on the facts of the particular
"Disseminated" means that a condition is spread widely over a considerable
area or body system(s). The type and extent of the spread will depend on the specific disease.
3. Documentation of HIV infection in children. The medical evidence must include documentation of HIV infection.
Documentation may be by laboratory evidence or by other generally acceptable methods consistent with the prevailing state
of medical knowledge and clinical practice.
a. Documentation of HIV infection in
children by definitive diagnosis. A definitive diagnosis of HIV infection is documented by one or more of the following laboratory
i] For a child 24 months of age or older, a serum specimen that contains HIV
antibodies. HIV antibodies are usually detected by a screening test. The most commonly used screening test is the ELISA. Although
this test is highly sensitive, it may yield false positive results. Therefore, positive results from an ELISA must be confirmed
by a more definitive test (e.g., Western Blot, immunofluorescence assay). (See paragraph b, below, for information about HIV
antibody testing in children younger than 24 months of age.)
ii] A specimen that
contains HIV antigen (e.g., serum specimen, lymphocyte culture, or cerebrospinal fluid (CSF) specimen).
iii] An imunoglobulin A(IgA) serological assay specific for HIV.
Other test(s) that are highly specific for detection of HIV in children (e.g., polymerase chain reaction (PCR)), or that are
acceptable methods of detection consistent with the prevailing state of medical knowledge.
laboratory testing for HIV infection has been performed, every reasonable effort must be made to obtain reports of the results
of that testing.
b. Other acceptable documentation of HIV infection in children.
As noted in paragraph a, above, HIV infection is not documented in children under 24 months
of age by a serum specimen containing HIV antibodies. This is because women with HIV infection often transfer HIV antibodies
to their newborns. The mother's antibodies can persist in the infant for up to 24 months, even if the infant is not HIV-infected.
Only 20 to 30 percent of such infants are actually infected. Therefore, the presence of serum HIV antibodies alone does not
establish the presence of HIV infection in a child under 24 months of age. However, the presence of HIV antibodies accompanied
by evidence of significantly depressed T-helper lymphocytes (CD4), an abnormal CD4/CD8 ratio, or abnormal immunoglobulin G
(IgG) may be used to document HIV infection in a child under 24 months of age, even though such testing is not a basis for
a definitive diagnosis.
For children from birth to the attainment of 24 months of
age who have tested positive for HIV antibodies (see D3a above), HIV infection may be documented by one or more of the following:
i] For an infant 12 months of age or less, a CD4 (T4) count of 1500/mm3 or less,
or a CD4 count less than or equal to 20 percent of total lymphocytes.
ii] For an
infant from 12 to 24 months of age, a CD4 (T4) count of 750/mm3 or less, or a CD4 count less than or equal to 20
percent of total lymphocytes.
iii] An abnormal CD4/CD8 ratio.
iv] An IgG significantly greater than or less than the normal range for age.
infection in children may also be documented without the definitive laboratory evidence described in paragraph a, or the other
laboratory evidence discussed above, provided that such documentation is consistent with the prevailing state of medical knowledge
and clinical practice and is consistent with the other evidence. If such laboratory evidence is not available, HIV infection
may be documented by the medical history, clinical and laboratory findings, and diagnosis(es) indicated in the medical evidence,
For example, a diagnosis of HIV infection in children will be accepted without definitive laboratory evidence if the child
has an opportunistic disease (e.g., Pneumocystis carinii pneumonia (PCP)) predictive of a defect in cell-mediated immunity,
and there is no other known cause of diminished resistance to that disease (e.g., long-term steroid treatment, lymphoma).
In such cases, every reasonable effort must be made to obtain full details of the history, medical findings, and results of
4. Documentation of the manifestations of HIV infection in children. The
medical evidence must also include documentation of the manifestations of HIV infection in children. Documentation may be
by laboratory evidence or by other generally acceptable methods consistent with the prevailing state of medical knowledge
and clinical practice.
a. Documentation of the manifestations of HIV infection in
children by definitive diagnosis.
The definitive method of diagnosing opportunistic
diseases or conditions that are manifestations of HIV infection in children is by culture, serological test, or microscopic
examination of biopsied tissue or other material (e.g., bronchial washings). Therefore, every reasonable effort must be made
to obtain specific laboratory evidence of an opportunistic disease or other condition whenever this information is available.
If a histological or other test has been performed, the evidence should include a copy of the appropriate report. If the report
is not obtainable, the summary of hospitalization or a report from the treating source should include details of the findings
and results of the diagnostic studies (including radiographic studies) or microscopic examination of the appropriate tissues
or body fluids.
Although a reduced CD4 lymphocyte count in a child may show that
there is an increased susceptibility to opportunistic infections and diseases, that alone does not establish the presence,
severity, or functional effects of a manifestation of HIV infection in a child.
Other acceptable documentation of the manifestations of HIV infection in children.
of HIV infection in children may also be documented without the definitive laboratory evidence described in paragraph a, provided
that such documentation is consistent with the prevailing state of medical knowledge and clinical practice and is consistent
with the other evidence. If no definitive laboratory evidence is available, manifestations of HIV infection may be documented
by medical history, clinical and laboratory findings, and diagnosis(es) indicated in the medical evidence. In such cases,
every reasonable effort must be made to obtain full details of the history, medical findings, and results of testing.
Documentation of cytomegalovirus (CMV) disease ( 114.08D) presents special problems because
diagnosis requires identification of viral inclusion bodies or a positive culture from the affected organ, and the absence
of any other infectious agent. A positive serology test identifies infection with the virus, but does not confirm a disease
process. With the exception of chorioretinitis (which may be diagnosed by an ophthalmologist), documentation of CMV disease
requires confirmation by biopsy or other generally acceptable methods consistent with the prevailing state of medical knowledge
and clinical practice.
5. HIV infection in children. The clinical manifestation and
course of disease in children who become infected with HIV perinatally or in the first 6 years of life may differ from that
in older children and adults. In addition, survival times are shorter for children infected in the first year of life compared
to those who become infected as older children or as adults.
Infants may present
with failure to thrive or pneumocystis carinii pneumonia (PCP); young children may present with recurrent infections, neurological
problems, or developmental abnormalities. Older children may also exhibit neurological abnormalities, such as HIV encephalopathy,
or failure to thrive.
The methods of identifying and evaluating neurological abnormalities
may vary depending on a child's age. For example, in an infant, impaired brain growth can be documented by a decrease
in the growth rate of the head. In older children, impaired brain growth can be documented by brain atrophy on a CAT scan.
Neurological abnormalities can also be observed in a younger child in the loss of previously acquired, or marked delays in
achieving, developmental milestones. In an older child, this type of neurological abnormality would generally be demonstrated
by the loss of previously acquired intellectual abilities. Although loss of previously acquired intellectual abilities can
be documented by a decrease in intelligence quotient (IQ) scores or demonstrated if a child forgets information he or she
previously learned, it can also be shown if the child is unable to learn new information. This could include the sudden acquisition
of a new learning disability.
Children with HIV infection may contract any of a broad
range of bacterial infections. Certain major infections caused by pyogenic bacteria, e.g., some pneumonias, can be severely
limiting, especially in pre-adolescent children. These major bacterial infections should be evaluated under 114.08A5, which
requires two or more such infections within a 2-year period. Although 114.08A5 applies only to children less than 13 ears
of age, an older child may be found to have an impairment of equivalent severity if the circumstances of the case warrant
(e.g., delayed puberty).
Otherwise, bacterial infections are evaluated under 114.08A6.
The criteria of the listing are met if one or more bacterial infection(s) occurs and requires hospitalization or intravenous
antibiotic treatment 3 or more times in 1 year. Pelvic inflammatory disease in older female children should be evaluated under
multiple or recurrent bacterial infections (114.08A6).
6. Evaluation of HIV infection
in children. The criteria in 114.08 do not describe the full spectrum of diseases or conditions manifested by children with
HIV infection. As in any case, consideration must be given to whether a child's impairment(s) meets, medically equals,
or functionally equals the severity of any other listing in appendix 1 of subpart P; e.g., a neoplastic disorder listed in
113.00ff. (See §§404.1526, 416.926, and 416.926a.) Although 114.08 includes cross-references to other listings for
the more common manifestations of HIV infection, additional listings may also apply.
addition, the impact of all impairments, whether or not related to the HIV infection, must be considered. Children with HIV
infection may manifest signs and symptoms of a mental impairment (e.g., anxiety, depression), or of another physical impairment.
Medical evidence should include documentation of all physical and mental impairments, and the impairment(s) should be evaluated
not only under the relevant listing(s) in 114.08, but under any other appropriate listing(s).
It is also important to remember that children with HIV infection, like all others, are evaluated under the full
sequential evaluation process described in Section 416.924. If a child with HIV infection is working and engaging in substantial
gainful activity (SGA), or does not have a severe impairment, the case will be decided at the first or second step of the
sequential evaluation process, and does not require evaluation under these listings. For a child with HIV infection who is
not engaging in SGA and has a severe impairment, but whose impairment(s) does not meet the criteria of a listing, consideration
will be given to whether the child's impairment or combination of impairments is either medically or functionally equivalent
in severity to any listed impairment.
7. Effect of treatment. Medical treatment
must be considered in terms of its effectiveness in ameliorating the signs, symptoms, and laboratory abnormalities of the
specific disorder, or of the HIV infection itself (e.g., antiretroviral agents) and in terms of any side effects of treatment
that may further impair the child.
Response to treatment and adverse or beneficial
consequences of treatment may vary widely. For example, a child with HIV infection who develops otitis media may respond to
the same antibiotic regimen used in treating children without HIV infection, but another child with HIV infection may not
respond to the same regimen. Therefore, each case must be considered on an individual basis, along with the effects of treatment
on the child's ability to function.
A specific description of the drugs or treatment
given (including surgery), dosage, frequency of administration, and a description of the complications or response to treatment
should be obtained. The effects of treatment may be temporary or long-term. As such, the decision regarding the impact of
treatment should be based on a sufficient period of treatment to permit proper consideration.
8. Functional criteria. Paragraph O of 114.08 establishes standards for evaluating manifestations of HIV infection
that do not meet the requirements listed in 114.08A-N. Paragraph O is applicable for manifestations that are not listed in
114.08A-N, as well as those listed in 114.08A-N that do not meet the criteria of any of the rules in 114.08A-N.
For children with HIV infection evaluated under 114.08O, listing-level severity will be assessed in terms of
the functional limitations imposed by the impairment. The full impact of signs, symptoms, and laboratory findings on the child's
ability to function must be considered. Important factors to be considered in evaluating the functioning of children with
HIV infection include but are not limited to: symptoms, such as fatigue and pain, characteristics of the illness, such as
the frequency and duration of manifestations or periods of exacerbation and remission in the disease course; and the functional
impact of treatment for the disease, including the side effects of medication.
meet the criteria in 114.08O, a child with HIV infection must demonstrate a level of restriction in either one or two (depending
on the child's age) of the general areas of functioning applicable to the child's age group. (See 112.00C for additional
discussion of these areas of functioning).
E. Inflammatory arthritis (114.09) includes
a vast array of disorders that differ in cause, course, and outcome. For example, in children inflammatory spondyloarthropathies
include juvenile ankylosing spondylitis, reactive arthropathies, psoriatic arthropathy, and Behçet's disease, as
well as undifferentiated spondylitis. Inflammatory arthritis of peripheral joints likewise comprises many disorders, including
juvenile rheumatoid arthritis, Sjögren's syndrome, psoriatic arthritis, crystal deposition disorders, and Lyme disease.
Clinically, inflammation of major joints may be the dominant problem causing difficulties with ambulation or fine and gross
movements, or the arthritis may involve other joints or cause less restriction of age-appropriate ambulation or other movements
but be complicated by extra-articular features that cumulatively result in serious functional deficit. When persistent deformity
without ongoing inflammation is the dominant feature of the impairment, it should be evaluated under 101.02, or, if there
has been surgical reconstruction, 101.03.
1. Because the features of inflammatory
connective tissue diseases in children are modified by such factors as the child's limited antigenic exposure and immune
reactivity, the acute inflammatory connective tissue diseases must be differentiated from each other in order to evaluate
duration factors and responses to specific treatments. Chronic conditions must be differentiated from short-term reversible
disorders, and also from other connective tissue diseases.
2. In 114.09A, the term
major joints refers to the major peripheral joints, which are the hip, knee, shoulder, elbow, wrist-hand, and ankle-foot,
as opposed to other peripheral joints (e.g., the joints of the hand or forefoot) or axial joints (i.e., the joints of the
spine.) The wrist and hand are considered together as one major joint, as are the ankle and foot. Since only the ankle joint,
which consists of the juncture of the bones of the lower leg (tibia and fibula) with the hindfoot (tarsal bones), but not
the forefoot, is crucial to weight bearing, the ankle and foot are considered separately in evaluating weight bearing.
3. The terms inability to ambulate effectively and inability to perform fine
and gross movements effectively in 114.09A have the same meaning as in 101.00B2b and 101.00B2c and must have lasted, or
be expected to last, for at least 12 months.
4. Inability to ambulate effectively
is implicit in 114.09B. Even though children who demonstrate the findings of 114.09B will not ordinarily require bilateral
upper limb assistance, the required ankylosis of the cervical or dorsolumbar spine will result in an extreme loss of the ability
to see ahead, above, and to the side.
5. As in 114.02 through 114.06, extra-articular
features of an inflammatory arthritis may satisfy the criteria for a listing in an involved extra-articular body system. Such
impairments may be found to meet a criterion of 114.09C. Extra-articular impairments of lesser severity should be evaluated
under 114.09D and 114.09E. Commonly occurring extra-articular impairments include keratoconjunctivitis sicca, uveitis, iridocyclitis,
pleuritis, pulmonary fibrosis or nodules, restrictive lung disease, pericarditis, myocarditis, cardiac arrhythmias, aortic
valve insufficiency, coronary arteritis, Raynaud's phenomena, systemic vasculitis, amyloidosis of the kidney, chronic
anemia, thrombocytopenia, hypersplenism with compromised immune competence (Felty's syndrome), peripheral neuropathy,
radiculopathy, spinal cord or cauda equina compression with sensory and motor loss, and heel enthesopathy with functionally
6. The fact that a child is dependent on steroids, or any other drug,
for the control of inflammatory arthritis is, in and of itself, insufficient to find disability. Advances in the treatment
of inflammatory connective tissue disease and in the administration of steroids for its treatment have corrected some of the
previously disabling consequences of continuous steroid use. Therefore, each case must be evaluated on its own merits, taking
into consideration the severity of the underlying impairment and any adverse effects of treatment.
114.01 Category of Impairments, Immune System
114.02 Systemic lupus erythematosus. Documented as described in 14.00B1 and 114.00B, with:
A. One of the following:
1. Growth impairment,
as described under the criteria in 100.00ff; or
2. Musculoskeletal involvement, as
described under the criteria in 101.00ff; or
3. Muscle involvement, as described
under the criteria in 14.05; or
4. Ocular involvement, as described under the criteria
in 102.00ff; or
5. Respiratory involvement, as described under the criteria in 103.00ff,
6. Cardiovascular involvement, as described under the criteria in 104.00ff or
7. Digestive involvement, as described under the criteria in 105.00ff;
8. Renal involvement, as described under the criteria in 106.00ff; or
9. Hematologic involvement, as described under the criteria in 107.00ff; or
Skin involvement, as described under the criteria in 8.00ff, or
11. Endocrine involvement,
as described under the criteria in 109.00ff; or
12. Neurological involvement as described
under the criteria in 111.00ff; or
13. Mental involvement, as described under the
criteria in 112.00ff.
involvement of two or more organs/body systems listed in paragraph A, with significant, documented, constitutional symptoms
and signs of severe fatigue, fever, malaise, and weight loss. At least one of the organs/body systems must be involved to
at least a moderate level of severity.
114.03 Systemic vasculitis. As described in 14.03 or, if growth impairment, as described under the criteria
114.04 Systemic sclerosis and scleroderma. Documented as described in 14.00B3 and 114.00B, and:
A. As described under the criteria in 14.04 or, if growth impairment, as described under the criteria in 100.00ff.
B. Linear scleroderma, with one of
1. Fixed valgus or varus deformities of both hands or both feet; or
2. Marked destruction or marked atrophy of an extremity; or
3. Facial disfigurement from hypoplasia of the mandible, maxilla, or zygoma resulting in an impairment as described
under the criteria in 112.00ff; or
4. Seizure disorder, as described under the criteria
114.05 Polymyositis or dermatomyositis. Documented as described in 14.00B4 and 114.00B, and:
A. As described under the criteria in 14.05.
B. With one of the following:
1. Multiple joint contractures; or
2. Diffuse cutaneous calcification with formation of an exoskeleton; or
3. Systemic vasculitis as described under the criteria in 14.03.
114.06 Undifferentiated connective tissue disorder. As described under the criteria in 114.02
114.07 Congenital immune deficiency disease.
or dysgammaglobulinemia, with:
1. Documented, recurrent severe infections occurring
3 or more times within a 5-month period; or
2. An associated disorder such as growth
retardation, chronic lung disease, collagen disorder or tumor. Evaluate according to the appropriate body system listing.
B. Thymic dysplastic syndromes (such
as Swiss, diGeorge).
114.08 Human immunodeficiency virus (HIV) infection.
With documentation as described in 114.00D3 and one of the following:
1. Mycobacterial infection (e.g., caused by M. avium-intracellulare,
M. kansasii, or M. tuberculosis) at site other than the lungs, skin, or cervical or hilar lymph nodes; or pulmonary tuberculosis
resistant to treatment; or
2. Nocardiosis; or
Salmonella bacteremia, recurrent non-typhoid; or
4. Syphilis or neurosyphilis - evaluate
sequelae under the criteria for the affected body system (e.g., 102.00 Special Senses and Speech, 104.00 Cardiovascular System,
111.00 Neurological); or
5. In a child less than 13 years of age, multiple or recurrent
pyogenic bacterial infection(s) of the following types: sepsis, pneumonia, meningitis, bone or joint infection, or abscess
of an internal organ or body cavity (excluding otitis media or superficial skin or mucosal abscesses) occurring 2 or more
times in 2 years; or
6. Other multiple or recurrent bacterial infection(s), including
pelvic inflammatory disease, requiring hospitalization or intravenous antibiotic treatment 3 or more times in 1 year.
B. Fungal infections:
1. Aspergillosis; or
2. Candidiasis, at a site other than the skin,
urinary tract, intestinal tract, or oral or vulvovaginal mucous membranes; or candidiasis involving the esophagus, trachea,
bronchi, or lungs; or
3. Coccidioidomycosis, at a site other than the lungs or lymph
4. Cryptococcosis, at a site other than the lungs (e.g., cryptococcal meningitis);
5. Histoplasmosis, at a site other than the lungs or lymph nodes; or
Protozoan or helminthic infections:
1. Cryptosporidiosis, isosporiasis, or microsporidiosis,
with diarrhea lasting for 1 month or longer; or
2. Pneumocystis carinii pneumonia
or extrapulmonary pneumocystis carinii infection; or
3. Strongyloidiasis, extra-intestinal;
4. Toxoplasmosis of an organ other then the liver, spleen, or lymph nodes.
D. Viral infections:
1. Cytomegalovirus disease (documented as described in 114.00D4b) at a site other than the liver, spleen, or
lymph nodes; or
2. Herpes simplex virus causing:
Mucocutaneous infection (e.g., oral, genital, perianal) lasting for 1 month or longer; or
Infection at a site other than the skin or mucous membranes (e.g., bronchitis, pneumonitis, esophagitis, or encephalitis);
c. Disseminated infection; or
zoster, either disseminated or with multidermatomal eruptions that are resistant to treatment; or
4. Progressive multifocal leukoencephalopathy; or
5. Hepatitis, as described
under the criteria in 105.05.
1. Carcinoma of the cervix, invasive, FIGO stage II and beyond;
2. Kaposi's sarcoma with:
oral lesions; or
b. Involvement of the gastrointestinal tract, lungs, or other visceral
c. Involvement of the
skin or mucous membranes, as described under the criteria in 114.08F; or
(e.g., primary lymphoma of the brain, Burkitt's lymphoma,
other Non-Hodgkins lymphoma, Hodgkins disease); or
4. Squamous cell carcinoma of
F. Conditions of the
skin or mucous membranes other than described in B2, D2, or D3, above), with extensive fungating or ulcerating lesions not
responding to treatment (e.g., dermatological conditions such as eczema or psoriasis, vulvovaginal or other mucosal candida,
condyloma caused by human papillornavirus, genital ulcerative disease), or evaluate under the criteria in 8.00ff.
G. Hematologic abnormalities:
1. Anemia, as described under the criteria in 7.02; or
as described under the criteria in 7.15; or
3. Thrombocytopenia., as described under
the criteria in 107.06 or 7.06.
Neurological manifestations of HIV infection (e.g., HIV encephalopathy, peripheral neuropathy), as described under the criteria
in 111.00ff, or resulting in one or more of the following:
1. Loss of previously
acquired, or marked delay in achieving developmental milestones or intellectual ability (including the sudden acquisition
of a new learning disability); or
2. Impaired brain growth (acquired microcephaly
or brain atrophy - see 114.00D5); or
3. Progressive motor dysfunction affecting gait
and station or fine and gross motor skills.
I. Growth disturbance, with:
1. An involuntary weight loss (or failure
to gain weight at an appropriate rate for age) resulting in a fall of 15 percentiles from established growth curve (on standard
growth charts) that persists for 2 months or longer, or
2. An involuntary weight
loss (or failure to gain weight at an appropriate rate for age) resulting in a fall to below the third percentile from established
growth curve (on standard growth charts) that persists for 2 months or longer; or
Involuntary weight loss greater than 10 percent of baseline that persists for 2 months or longer; or
4. Growth impairment as described under the criteria in 100.00ff.
J. Diarrhea, lasting for 1 month or longer, resistant to treatment, and requiring intravenous
hydration, intravenous alimentation, or tube feeding.
K. Cardiomyopathy, as described under the criteria in 104.00ff or 11.04.
L. Lymphoid interstitial pneumonia/pulmonary lymphoid hyperplasia (LIP/PLH complex), with
respiratory symptoms that significantly interfere with age-appropriate activities, and that cannot be controlled by prescribed
M. Nephropathy, as
described under the criteria in 106.00.
One or more of the following infections (other than described in A-M, above), resistant to treatment or requiring hospitalization
or intravenous treatment 3 or more times in 1 year (or evaluate sequelae under the criteria for the affected body system).
1. Sepsis; or
2. Meningitis; or
3. Pneumonia; or
4. Septic arthritis; or
5. Endocarditis; or
6. Sinusitis documented by appropriate medically
O. Any other
manifestation(s) of HIV infection (including any listed in 114.08A-N, but without the requisite findings; e.g., oral candidiasis
not meeting the criteria in 114.08F, diarrhea not meeting the criteria in 114.08J, or any other manifestation(s); e.g., oral
hairy leukoplakia, hepatomegaly), resulting in one of the following:
1. For children
from birth to attainment of age 1, at least one of the criteria in paragraphs A-E of 112.12; or
2. For children age 1 to attainment of age 3, at least one of the appropriate age-group criteria in paragraph
B1 of 112.02; or
3. For children age 3 to attainment of age 18, at least two of the
appropriate age-group criteria in paragraph B2 of 112.02.
114.09 Inflammatory arthritis. Documented as described in 114.00E, with one of the following:
A. History of joint pain, swelling, and tenderness, and signs on current physical examination
of joint inflammation or deformity in two or more major joints resulting in inability to ambulate effectively or inability
to perform fine and gross movements effectively, as defined in 114.00E3 and 101.00B2b and B2c;
B. Ankylosing spondylitis or other spondyloarthropathy, with diagnosis
established by findings of unilateral or bilateral sacroiliitis (e.g., erosions or fusions), shown by appropriate medically
acceptable imaging, with both:
1. History of back pain, tenderness, and stiffness,
2. Findings on physical examination of ankylosis (fixation) of the dorsolumbar
or cervical spine at 45o or more of flexion measured from the vertical position (zero degrees);
C. An impairment as described under the criteria in 114.02A.
D. Inflammatory arthritis, with signs of peripheral
joint inflammation on current examination, but with lesser joint involvement than in A and lesser extra-articular features
than in C, and:
1. Significant, documented constitutional symptoms and signs (e.g.,
fatigue, fever, malaise, weight loss), and
2. Involvement of two or more organs/body
systems (see 114.00E5). At least one of the organs/body systems must be involved to at least a moderate level of severity.
E. Inflammatory spondylitis or other inflammatory
spondyloarthropathies, with lesser deformity than in B and lesser extra-articular features than in C, with signs of unilateral
or bilateral sacroiliitis on appropriate medically acceptable imaging; and with the extra-articular features described in