Cystic fibrosis (documented as described in 3.00J2) SSDI Claims in Rhode Island

Medical criteria

SSA Blue Book listing

3.04 Cystic fibrosis (documented as described in 3.00J2)

Listing criteria (20 CFR Appendix 1, Part A)

with A, B, C, D, E, F, or G: A. FEV 1 (see 3.00E) less than or equal to the value in Table VII-A or VII-B for your age, gender, and height without shoes (see 3.00E3a). | Table VII—FEV 1 Criteria for 3.04A | Height without shoes (centimeters) < means less than | Height without shoes (inches) < means less than | Table VII-A | Table VII-B | | --- | --- | --- | --- | --- | | Age 18 to attainment of age 20 | Age 20 or older | | Females FEV 1 less than or equal to (L, BTPS) | Males FEV 1 less than or equal to (L, BTPS) | Females FEV 1 less than or equal to (L, BTPS) | Males FEV 1 less than or equal to (L, BTPS) | | <153.0 | <60.25 | 1.65 | 1.90 | 1.45 | 1.60 | | 153.0 to <159.0 | 60.25 to <62.50 | 1.75 | 2.05 | 1.55 | 1.75 | | 159.0 to <164.0 | 62.50 to <64.50 | 1.85 | 2.15 | 1.65 | 1.90 | | 164.0 to <169.0 | 64.50 to <66.50 | 1.95 | 2.30 | 1.75 | 2.00 | | 169.0 to <174.0 | 66.50 to <68.50 | 2.05 | 2.45 | 1.85 | 2.15 | | 174.0 to <180.0 | 68.50 to <70.75 | 2.20 | 2.60 | 2.00 | 2.30 | | 180.0 to <185.0 | 70.75 to <72.75 | 2.35 | 2.75 | 2.10 | 2.45 | | 185.0 or more | 72.75 or more | 2.40 | 2.85 | 2.20 | 2.55 | OR B. Exacerbations or complications (see 3.00J3) requiring three hospitalizations of any length within a 12-month period and at least 30 days apart (the 12-month period must occur within the period we are considering in connection with your application or continuing disability review). OR C. Spontaneous pneumothorax, secondary to CF, requiring chest tube placement. OR D. Respiratory failure (see 3.00N) requiring invasive mechanical ventilation, noninvasive ventilation with BiPAP, or a combination of both treatments, for a continuous period of at least 48 hours, or for a continuous period of at least 72 hours if postoperatively. OR E. Pulmonary hemorrhage requiring vascular embolization to control bleeding. OR F. S p O 2 measured by pulse oximetry (see 3.00H3) either at rest, during a 6MWT, or after a 6MWT, less than or equal to the value in Table VIII, twice within a 12-month period and at least 30 days apart (the 12-month period must occur within the period we are considering in connection with your application or continuing disability review). | Tables VIII—S p O 2 Criteria for 3.04F | Test site altitude (feet above sea level) | S p O 2 less than or equal to | | --- | --- | --- | | Less than 3,000 | 89 percent. | | 3,000 through 6,000 | 87 percent. | | Over 6,000 | 85 percent. | OR G. Two of the following exacerbations or complications (either two of the same or two different, see 3.00J3 and 3.00J4) within a 12-month period (the 12-month period must occur within the period we are considering in connection with your application or continuing disability review): 1. Pulmonary exacerbation requiring 10 consecutive days of intravenous antibiotic treatment. 2. Pulmonary hemorrhage (hemoptysis with more than blood-streaked sputum but not requiring vascular embolization) requiring hospitalization of any length. 3. Weight loss requiring daily supplemental enteral nutrition via a gastrostomy for at least 90 consecutive days or parenteral nutrition via a central venous catheter for at least 90 consecutive days. 4. CFRD requiring daily insulin therapy for at least 90 consecutive days. 3.05 [Reserved] 3.06 [Reserved]

Body system category

3.00 Respiratory Disorders

Common denial reason

Cystic fibrosis claims are commonly denied when FEV1, hospitalization history, or pulmonary exacerbation records do not satisfy listing thresholds.