106 CMR 703.192
EAEDC Medical Standards
(A) Musculoskeletal System.
(1) Arthritis of Any Major Joint (Hips, Knees, Hands or Feet). Arthritis of any major joint
must be substantiated by:
(a) the presence of three or more of the following clinical findings lasting for more than
15 days and expected to last for at least 30 days:
1. pain;
2. swelling;
3. tenderness;
4. warmth;
5. redness;
6. stiffness; or
7. limitation of motion; and
(b) corroboration of the diagnosis by at least two of the following:
1. positive serologic test for rheumatoid factor; or anti-nuclear antibody or HLAB
antigen;
2. elevated sedimentation rate;
3. positive joint fluid culture;
4. elevation of white blood count;
5. significant anatomical deformity; or
6. x-ray evidence of significant joint space narrowing or bony destruction.
(2) Disorders of the Spine. Disorders of the spine must be demonstrated by one of the
following:
(a) x-ray evidence of significant arthritic changes manifested by ankylosis, or fixation,
or motion limitation (objective);
(b) Bone density evidence of significant osteoporosis manifested by pain and real
motion limitation;
(c) evidence of other vertebragenic disorders (e.g., herniated nucleus pulposus or spinal
stenosis), with:
1. pain and significant limitation of motion in the spine; and
2. appropriate radicular distribution of significant sensory, motor, or flex
abnormalities; or
(d) evidence of acute back strain with pain and significant limitation of motion lasting
more than 15 days and expected to last for at least 30 days.
(3) Fracture of a Major Bone. When solid union has not occurred and incapacity is
expected to last for at least 30 days.
(4) Soft Tissue Injuries or Loss. Soft tissue injuries or loss, including burns, must be
demonstrated by one of the following, which lasts more than 15 days and can be expected
to last for at least 30 days:
(a) significant loss which prohibits function of an upper or lower extremity;
(b) significant body surface involvement; or
(c) involvement of critical areas such as hands and feet that prevents their use.
(B) Special Senses and Speech.
(1) Impairment of Central Visual Acuity. Remaining vision in the better eye after best
correction must be 20/100 or less and must be expected to last for at least 30 days.
(2) Contraction of Peripheral Visual Fields. Contraction of peripheral visual fields in the
better eye must be:
(a) to 20° or less from point of fixation;
(b) so the widest diameter subtends an angle no greater than 25°; or
(c) to 25% or less visual field efficiency; and
must be expected to last at least 30 days.
(3) Hearing Impairments. Hearing must not be restorable by a hearing aid, and the
impairment must be manifested by one of the following:
(a) average hearing threshold sensitivity for air conduction of 90 decibels or greater; and
for bone conduction to corresponding maximal levels, in the better ear, determined by
the simple average of hearing threshold levels at 500, 1000, and 2000 Hz; or
(b) speech discrimination scores of 40% or less in the better ear; and must be expected
to last for at least 30 days.
(4) Disturbance of Labyrinthine-vestibular Function. Disturbance of labyrinthine-vestibular
function (including Meniere’s disease) must be demonstrated by one or more attacks of
balance disturbance and tinnitus within the 30-day period immediately preceding application
for EAEDC. The symptoms must persist for at least 30 days and affect daily functions and
the diagnosis must be corroborated by:
(a) hearing loss established by audiometry; or
(b) standard vestibular test (ENG) with or without hearing loss established by
audiometry.
(C) Respiratory System.
(1) Chronic Obstructive Airway Disease. Spirometric evidence of airway obstruction must
be demonstrated by maximum voluntary ventilation (MVV) and one-second forced
expiratory volume (FEV1) with both values equal to or less than those specified in Table I,
corresponding to height and expected to last for at least 30 days.
Table I
MVV
FEV1
equal to or
equal to or
Height
less than
less than
(inches)
(L/Min)
And
(L)
57 or less
1.5
1.5
1.5
1.6
1.6
1.6
1.6
1.7
1.7
1.7
1.8
1.8
1.8
1.9
1.9
1.9
73 or more
1.9
(2) Diffuse Pulmonary Fibrosis. Diffuse pulmonary fibrosis due to any cause must be
demonstrated by both of the following, and expected to last for at least 30 days:
(a) Total vital capacity (VC) must be equal to or less than the values specified in Table
II, corresponding to height; and
Table II
VC
Height or less than
equal to
(inches)
(L)
57 or less
1.7
1.8
1.8
1.9
1.9
2.0
2.0
2.1
2.1
2.2
2.2
2.3
2.3
2.4
2.4
2.5
73 or more
2.5
(b) Arterial oxygen tension (po2) at rest and simultaneously determined arterial carbon
dioxide tension (PCO2) values must be equal to or less than those specified in Table III.
Table III
Arterial po2
Arterial pco2
equal to or less than
(mm Hg)
(mm Hg)
30 or below
40 or above
(3) Other Restrictive Ventilatory Disorders. Other restrictive ventilatory disorders (such
as kyphoscoliosis, thoracoplasty, and pulmonary resection) must be substantiated by total
vital capacity (VC) equal to or less than the values specified in Table IV, corresponding to
height and expected to last at least 30 days.
Table IV
VC
Height
equal to
(inches)
or less than (L)
1.5
1.6
1.6
1.6
1.6
1.7
1.7
1.7
1.8
1.8
1.8
1.9
(4) Active Pulmonary Tuberculosis. Active pulmonary tuberculosis must be corroborated
by either:
(a) positive culture; or
(b) x-ray evidence of increasing lesions or cavitation; and
expected to last at least 30 days.
(5) Other Respiratory Disorders. Other respiratory disorders must be shown by the presence
of at least two of the following 106 CMR 702.192(C)(5)(a), (b), or (c) for more than 15 days
and expected to last at least 30 days:
(a) shortness of breath, wheezing, rhonchi, rales, cough, or fever;
(b) significant x-ray changes; or
(c) significant laboratory abnormalities.
(D) Cardiovascular System.
(1) Open Heart Surgery. The period of incapacity will be expected to last at least 30 days
and meet the criteria in 106 CMR 703.192(D)(3) or (4).
(2) Ischemic Heart Disease.
(a) Ischemic heart disease, with chest pain of cardiac origin, must be corroborated by
one of the following:
1. significantly diminished exercise tolerance corroborated by results of ETT;
2. significant ischemic changes on resting EKG;
3. EKG evidence of myocardial infarction at some time and symptoms if EKG
evidence is more than six months old;
4. development of significant arrhythmia;
5. angiographic evidence (obtained independently) of coronary artery disease; or
6. development of left bundle branch block.
(b) If ischemic heart disease is ruled out after an extensive work-up the period of
incapacity will be 90 days if:
1. symptoms lasted at least 15 days; or
2. substantial work activity is precluded by a physician’s orders for at least 90 days.
(3) Congestive Heart Failure. Congestive heart failure must be manifested by evidence of
vascular congestion such as hepatomegaly, or peripheral or pulmonary edema, with either of
the following present, and expected to last at least 30 days.
(a) evidence of congestive heart failure on clinical examination; or
(b) significant x-ray or EKG changes.
(4) Arteriosclerosis Obliterans or Thromboangiitis. Arteriosclerosis obliterans or
thromboangiitis must be substantiated by both:
(a) intermittent claudication; and
(b) absence of peripheral arterial pulsations below the knee; and be expected to last for
at least 30 days.
(5) Venous Insufficiency of the Lower Extremity. Venous insufficiency of the lower
extremity must be expected to last at least 30 days and be associated with two or more of the
following:
(a) varicosities;
(b) brawny edema;
(c) stasis dermatitis; and
(d) ulceration
(E) Digestive System. Impairments affecting the digestive system that are considered
incapacitating are listed:
(1) Gastrointestinal Disorders.
(a) Gastrointestinal disorders must be substantiated by the presence of three or more of
the following symptoms lasting more than seven days and expected to last at least 30
days:
1. pain;
2. nausea;
3. vomiting;
4. diarrhea;
5. bloody stools; or
6. abdominal distension.
(b) Gastrointestinal disorders expected to last more than 90 days must demonstrate the
presence of clinical findings under of significant pathology demonstrated by x-ray,
endoscopy, barium enema, biopsy, or other objective criteria; or the presence of one of
the following:
1. abscess or fistula formation;
2. hematocrit of 30% or less;
3. serum albumin of 3.0 g per deciliter (100 ml) or less;
4. serum calcium of 8.0 mg per deciliter;
5. fat in stool of 7.0 m or greater per 24-hour specimen;
6. nitrogen in stool of 3.0 g or greater per 24-hour specimen;
7. evidence of pancreatic dysfunction; or
8. systemic manifestations such as arthritis, iritis, or liver dysfunction not
attributable to other causes.
(2) Diseases of the Liver.
(a) Acute Hepatitis (Viral A, B, Non-A, Non-B). Incapacity expected to last more than
90 days must meet the criteria in 106 CMR 703.192(E)(2)(b).
(b) Chronic Liver Disease. Chronic liver diseases (portal, postnecrotic, or biliary
cirrhosis, chronic active hepatitis, Wilson’s disease) must be substantiated by a history
of significant and unresolved hyperbilirubinemia, ascites due to hypoalbuminemia, or
mental confusion lasting more than 15 days and expected to last at least 30 days; or if the
impairment persists is expected to last more than 90 days and is accompanied by
confirmation of liver disease by liver biopsy and demonstration (clinical) of two of the
following:
1. bleeding from esophageal varices; or
2. hepatic cell necrosis or inflammation;
3. hepatic encephalopathy.
(3) Weight Loss. Weight loss due to any gastrointestinal disorder must be substantiated by
weight equal to or less than the values specified in Table V (for men) or Table VI (for
women), corresponding to height and expected to last at least 30 days.
Table V — Men
Table VI — Women
Height
Weight
Height
Weight
(inches)
(pounds)
(inches)
(pounds)
Weight loss which continues for more than 90 days despite treatment and proper nutrition, must meet the
criteria in 106 CMR 703.192(E)(1) or (2)(b).
(F) Genitourinary System.
Impairment of Renal Function. Impairment of renal function due to any cause must be
substantiated by one of the following, which lasts more than 15 days and can be expected to last
at least 30 days:
(1) elevation of serum creatinine;
(2) hematocrit of 30% or less;
(3) renal osteodystrophy manifested by bone pain and appropriate radiographic
abnormalities;
(4) documented fluid overload syndrome;
(5) anorexia;
(6) hemodialysis or peritoneal dialysis; or
(7) proteinuria.
(G) Hemic and Lymphatic Systems.
(1) Anemia. Anemia must be substantiated by one of the following:
(a) hematocrit of 30% or less if, acute or not tolerated; or
(b) one or more blood transfusions required within the 30-day period immediately
preceding application for EAEDC, and the incapacity is expected to last at least 30 days.
(2) Sickle Cell Disease. Sickle cell disease or one of its variants must be substantiated by
a documented painful thrombotic crisis within the 30 day period immediately preceding
application for EAEDC; and expected to last for at least 30 days.
(3) Hemorrhage. Hemorrhage due to any traumatic or nontraumatic cause must be
substantiated by one or more blood transfusions required within the 30-day period
immediately preceding application for EAEDC.
(H) Skin. All skin disorders and infections that last more than 15 days and that can be expected
to last for at least 30 days will possibly be considered incapacitating when one of the following
is present:
(1) Involvement of extensive body areas; or
(2) Involvement of critical areas such as hands, feet, axillae, perineum, or face.
(I) Endocrine System. Diabetes mellitus must be substantiated by one of the following:
(1) Peripheral neuropathy manifested by decreased sensation and loss of vibration and
positional sense;
(2) Significant visual impairment according to the criteria in 106 CMR 703.192(B)(1) and
(2), Special Senses and Speech;
(3) Amputation due to diabetic necrosis or peripheral vascular disease; or
(4) A documented episode of acidosis within the 30-day period immediately preceding
application for EAEDC, and the incapacity is expected to last for at least 30 days.
(J) Multiple Body Systems.
(1) Lupus Erythematosus. Disseminated lupus erythematosus must be established by a
positive LE preparation or biopsy or positive ANA test. Exacerbation (involving renal,
cardiac, pulmonary, gastrointestinal, or central nervous systems) must have occurred within
the 30-day period immediately preceding application for EAEDC, and have lasted more than
15 days and be expected to last for at least 30 days.
(2) Obesity. Obesity must be substantiated by weight equal to or greater than the values
specified in Table VII for males or Table VIII for females and one of the following:
(a) a history of significant pain and limitation of motion in any weight-bearing joint or
the spine;
(b) significant hypertension;
(c) a history of significant cardiovascular difficulties;
(d) chronic venous insufficiency with pain or superficial varicosities; or
(e) significant respiratory difficulties; and
The incapacity is expected to last for at least 30 days.
Table VII — Men
Table VIII — Women
Height
Weight
Height
Weight
(inches)
(pounds)
(inches)
(pounds)
(K) Neurological System.
(1) Central Nervous System Vascular Accident. The period of incapacity is expected to last
for at least 30 days and two of the following persists:
(a) ineffective speech or communication;
(b) significant disorganization of motor function in one or more extremities interfering
with locomotion or use of fingers, hands and arms; and
(c) significant mental status abnormalities.
(2) Epilepsy. Major motor seizures (or partial complex), documented by EEG and by
clinically detailed description of a typical seizure pattern, including all associated
phenomena; occurring more frequently than once a month, in spite of at least one month of
prescribed treatment; expected to last at least 30 days with:
(a) Daytime episodes (loss of consciousness and convulsive seizures); or
(b) Nocturnal episodes manifesting residuals which interfere significantly with activity
during the day.
(3) Epilepsy. Minor seizures (petit mal, psychomotor, or focal), documented by EEG and
by detailed description of a typical seizure pattern, including all associated phenomena;
occurring more frequently than once weekly in spite of at least one month of prescribed
treatment: with alteration of awareness or loss of consciousness and transient postictal
manifestations of unconventional behavior or significant interference with activity during the
day; and expected to last for at least 30 days.
(4) Parkinsonian Syndrome. This must include the following signs: significant rigidity;
bradykinesia, or tremor in two extremities or one, if in dominant hand with significant loss
of dexterity which, singly or in combination, result in sustained disturbance of gross and
dexterous movements, or gait and station; and expected to last for at least 30 days.
(5) Spinal Cord or Nerve Root Lesions. This must be due to any course with
disorganization of motor function expected to last for at least 30 days with significant and
persistent disorganization of motor function in a single extremity, resulting in sustained
disturbance of gross and dexterous movements, or gait and station.
(6) Multiple Sclerosis. With disorganization of motor function expected to last for at least
30 days with:
(a) significant and persistent disorganization of motor function in two extremities, or
one dominant upper extremity, resulting in sustained disturbance of gross and dexterous
movements, or gait and station; or marked motor fatiguability;
(b) impairment of central visual acuity. Remaining vision in the better eye after best
correction must be 20/100 or less and must be expected to last at least 30 days.
(c) contraction of peripheral visual fields. Contraction of peripheral vision fields in the
better eye that is expected to last at least 30 days must be:
1. To 20° or less from the point of fixation; or
2. So the widest diameter subtends an angle no greater than 25°; or
3. To 25% or less visual field efficiency; or
(7) Myasthenia Gravis. This must be expected to last for at least 30 days with:
(a) significant difficulty with speaking, swallowing, or breathing while on prescribed
therapy; or
(b) significant motor weakness of muscles of extremities on repetitive activity against
resistance while on prescribed therapy.
(8) Myotonic Muscular Dystrophy. This must include disorganization of motor function
expected to last for at least 30 days with significant and persistent disorganization of motor
function in two extremities, resulting in sustained disturbance of gross and dexterous
movements, or gait and station.
(9) Peripheral Neuropathies. With disorganization of motor function in spite of prescribed
treatment expected to last for at least 30 days with significant and persistent disorganization
of motor function in one extremity, resulting in sustained disturbance of gross and dexterous
movements, or gait and station.
(10) Subacute Combined Cord Degeneration (Pernicious Anemia). This must include
disorganization of motor function as descried below not significantly improved by prescribed
treatment and expected to last for at least 30 days with:
(a) significant and persistent disorganization of motor function in one extremity,
resulting in sustained disturbance of gross and dexterous movements, or gait and station;
and
(b) unsteady, broad-based or ataxic gait causing significant restriction of mobility
substantiated by appropriate posterior column signs.
(11) Cerebral Trauma. Evaluate under the provisions for epilepsy - Major motor, epilepsy -
minor motor, cerebral nervous system vascular accident or organic mental disorders.
(L) Mental Disorders.
(1) The following definitions should be used when referencing 106 CMR 703.192.
(a) Need for Medical Evidence. The existence of a medically determinable impairment
must be established by medical evidence consisting of clinical signs, symptoms and/or
laboratory test findings. These findings may be intermittent or persistent depending on
the nature of the disorder. Clinical signs are medically demonstrable phenomena which
reflect specific abnormalities of behavior, affect, thought, memory, orientation or contact
with reality. These signs are typically assessed by a psychiatrist. Symptoms or
complaints are presented by the individual. Signs and symptoms generally cluster
together to constitute recognizable clinical syndromes (mental disorders). Both
symptoms and signs which are part of any diagnosed mental disorder must be considered
in evaluating severity.
(b) Assessment of Severity. For mental disorders, severity is assessed in terms of the
functional limitations imposed by the impairment. Where “marked” is used as a standard
for measure the degree of limitation, it means more than moderate, but less than extreme.
A marked limitation may arise when several activities or functions are impaired or even
when only one is impaired, so long as the degree of limitation is such as to seriously
interfere with the ability to function independently, appropriately and effectively.
1. Activities of daily living including adaptive activities such as cleaning, shopping,
cooking, taking public transportation, paying bills, maintaining a residence, caring
appropriately for one’s grooming and hygiene, using telephones and directories, using
a post office, etc. In the context of the individual’s overall situation, the quality of
these activities is judged by their independence, appropriateness and effectiveness.
It is necessary to define the extent to which the individual is capable of initiating and
participating in activities independent of supervision or direction.
“Marked” is not the number of activities which are restricted but the overall
degree of restriction or combination of restrictions which must be judged.
2. Social functioning refers to an individual’s capacity to interact appropriately and
communicate effectively with other individuals. “Marked” is not the number of areas
in which social functioning is impaired, but the overall degree of interference in a
particular area or combination of areas of functioning.
3. Concentration, persistence and pace refer to the ability to sustain focused
attention sufficiently long to permit the timely completion of tasks commonly found
in work settings. In activities of daily living, concentration may be reflected in terms
of ability to complete tasks in everyday household routines. Deficiencies in
concentration, persistence and pace are best observed in work and work-like settings.
4. Documentation. The presence of a mental disorder should be documented
primarily on the basis of reports from individual providers, such as psychiatrists, and
facilities such as hospitals and clinics. Adequate descriptions of functional
limitations must be obtained from these or other sources which may include
programs and facilities where the individual has been observed over a considerable
period of time.
Information from both medical and nonmedical sources may be used to obtain
detailed descriptions of the individual’s activities of daily living; social functioning;
concentration, persistence and pace; or ability to tolerate increased mental demands
(stress). This information can be provided by programs such as community mental
health centers, day care centers, sheltered workshops, etc. It can also be provided by
others, including family members, who have knowledge of the individual’s
functioning. In some cases descriptions of activities of daily living or social
functioning given by individuals or treating sources may be insufficiently detailed
and/or may be in conflict with the clinical picture otherwise observed or described
in the examination or reports. Evidence may include treatment notes, hospital
discharge summaries, and work evaluation or rehabilitation progress notes if these
are available. It is necessary to resolve any inconsistencies or gaps that may exist in
order to obtain a proper understanding of the individual’s functional restrictions.
Some individuals may have attempted to work or may actually have worked
during the period of time pertinent to the determination of disability. This may have
been an independent attempt at work, or it may have been in conjunction with a
community mental health or other sheltered program which may have been of either
short or long duration. Information concerning the individual’s behavior during any
attempt to work and the circumstances surrounding termination of the work effort are
particularly useful in determining the individual’s ability or inability to function in
a work setting.
5. Chronic Mental Impairments. Particular problems are often involved in
evaluating mental impairments in individuals who have long histories of repeated
hospitalizations or prolonged outpatient care with supportive therapy and medication.
Individuals with chronic psychotic disorders commonly have their lives structured
in such a way to minimize stress and reduce their signs and symptoms. Such
individuals may be much more impaired for work than their signs and symptoms
would indicate. The results of a single examination may not adequately describe
these individuals’ sustained ability to function. It is therefore, vital to include all
pertinent and available information relative to the individual’s condition, especially
at times of increased stress.
6. Effect of Medication. Attention must be given to the effect of medication on the
individual’s signs, symptoms and ability to function. While psychotropic
medications may control certain primary manifestations of a mental disorder, e.g.,
hallucinations, such treatment may or may not affect the functional limitations
imposed by the mental disorder. In such cases where overt symptomatology is
attenuated by the psychotropic medications, particular attention should be included
on the functional restrictions which may persist. These functional restrictions are
important for the measure of impairment severity.
Neuroleptics, the medicines used in the treatment of some mental illnesses, may
cause drowsiness, blunted effect, or other side effects involving other body systems.
Such side effects must be considered in evaluating overall impairment severity.
Where adverse effects of medications contribute to the impairment severity and the
impairment does not meet the listings but is nonetheless severe, such adverse effects
must be considered in the assessment of the disability.
7. Effect of Treatment. It must be remembered that with adequate treatment some
individuals suffering with chronic mental disorders not only have their symptoms and
signs ameliorated but also return to a level of function close to that of their premorbid
status.
(2) Dementia with or without Delirium. Psychological, cognitive or behavioral
abnormalities associated with a dysfunction of the brain. History and physical examination
or laboratory tests demonstrate the presence of specific organic factor judges to be
etiologically related to the abnormal mental state and loss of previously acquired functional
abilities.
The required level of severity for these disorders is met when the requirements in
106 CMR 703.192(L)(2)(a) and (b) are satisfied, and they are expected to last for at least 30
days.
(a) Demonstration of loss of specific cognitive abilities or affective changes and the
medically documented persistence of at least one of the following:
1. disorientation to time and place;
2. substantial memory loss impairment;
3. perceptual or thinking disturbances (e.g., hallucinations, delusions);
4. change in personality;
5. disturbance in mood;
6 emotional liability (e.g., explosive temper outbursts, sudden crying, etc.) and
impairment in impulse control; or
7. loss of measured intellectual ability of at least 15 I.Q. points from premorbid
levels or overall impairment index clearly within the moderately to severely impaired
range on neuropsychological testing, e.g., the Luria-Nebraska, Halstead-Reitan, etc.;
and
(b) Resulting in at least one of the following:
1. marked restriction of activities of daily living;
2. marked difficulties in maintaining social functioning;
3. deficiencies of concentration, persistence or pace resulting in frequent failure to
complete tasks in a timely manner (in work settings or elsewhere); or
4. repeated episodes of deterioration or decompensation in work or work-like settings
which cause the individual to withdraw from that situation or to experience exacerbation
of signs and symptoms (which may include deterioration of adaptive behaviors).
(3) Schizophrenic, Paranoid and Other Psychotic Disorders. Characterized by the onset of
psychotic features with deterioration from a previous level of functioning.
The required level of severity for these disorders is met when the requirements in
106 CMR 703.192(L)(3)(a) and (b) are satisfied, or when the requirements in 106 CMR
703.192(L)(3)(c) are satisfied; and they are expected to last for at least 30 days.
(a) Medically documented persistence, either continuous or intermittent, of one or more
of the following:
1. delusions or hallucinations;
2. catatonic or other grossly disorganized behavior;
3. incoherence, loosening of associations, illogical thinking, or poverty of content
of speech if associated with one of the following:
a. blunt affect;
b. flat affect; or
c. inappropriate affect; or
4. emotional withdrawal and/or isolation; and
(b) Resulting in at least one of the following:
1. marked restriction of activities of daily living; or
2. marked difficulties in maintaining social functioning; or
3. deficiencies of concentration, persistence or pace resulting in frequent failure to
complete tasks in a timely manner (in work settings or elsewhere); or
4. repeated episodes of deterioration or decompensation in work or work-like
settings which cause the individual to withdraw from that situation or to experience
exacerbation of signs and symptoms (which may include deterioration of adaptive
behaviors); or
(c) Medically documented history of one or more episodes of acute symptoms, signs and
functional limitations which at the time met the requirements in 106 CMR
703.192(L0(3)(a) and (b), although these symptoms or signs are currently attenuated by
medication or psychosocial support, and one of the following:
1. repeated episodes of deterioration or decompensation in situations which cause
the individual to withdraw from the situation or to experience exacerbation of signs
or symptoms (which may include deterioration of adaptive behaviors); or
2. documented current history of two or more years inability to function outside of
a highly supportive living situation.
(4) Affective Disorders. Characterized by a disturbance of mood, accompanied by a full or
partial manic or depressive syndrome. Mood refers to a prolonged emotion that colors the
whole psychic life, generally involving either depression or elation.
The required level of severity for these disorders is met when the requirements in
106 CMR 703.192(L)(4)(a) and (b) are satisfied, and they are expected to last at least 30
days.
(a) Medically documented persistence, either at least one of the following:
1. depressive syndrome characterized by at least three of the following:
a. anhedonia or pervasive loss of interest in almost all activities;
b. appetite disturbance with change in weight;
c. sleep disturbance;
d. psychomotor agitation or retardation;
e. decreased energy;
f. feelings of guilt or worthlessness;
g. difficulty concentrating or thinking;
h. thoughts of suicide; or
i. hallucinations, delusions or paranoid thinking; or
2. Manic syndrome characterized by at least two of the following:
a. hyperactivity;
b. pressure of speech;
c. flight of ideas;
d. inflated self-esteem;
e. decreased need for sleep;
f. easy distractibility;
g. involvement in activities that have a high probability of painful consequences
which are not recognized; or
h. hallucinations, delusions or paranoid thinking; or
3. Bipolar syndrome with a history of episodic periods manifested by the full
symptomatic picture of both manic and depressive syndromes (and currently
characterized by either or both syndromes); and
(b) Resulting in at least one of the following:
1. marked restriction of activities of daily living;
2. marked difficulties in maintaining social functioning;
3. deficiencies of concentration, persistence or pace resulting in frequent failure to
complete tasks in a timely manner (in working settings or elsewhere); or
4. repeated episodes of deterioration or decompensation in work or work-like
settings which cause the individual to withdraw from that situation or to experience
exacerbation of signs and symptoms (which may include deterioration of adaptive
behaviors).
(5) Mental Retardation and Autism. Mental retardation refers to a significantly subaverage
general intellectual functioning with deficits in adaptive behavior initially manifested during
the developmental period (before 22 years of age). (Note: The scores specified in 106 CMR
703.192(L)(5)(a) through (d) refer to those obtained on the WAIS, and are used only for
reference purposes. Scores obtained on other standardized and individually administered
tests are acceptable, but the numerical values obtained must indicate a similar level of
intellectual functioning.) Autism is a pervasive developmental disorder characterized by
social and significant communication deficits originating in the developmental period.
The required level of severity for this disorder is met when the requirements in 106 CMR
703.192(L)(5)(a), (b), (c), or (d) are satisfied.
(a) Mental incapacity evidenced by dependence upon others for personal needs, e.g.,
toileting, eating, dressing, or bathing, an inability to follow directions, such that the use
of standardized measures of intellectual functioning is precluded;
(b) A valid verbal, performance, or full scale IQ of 59 or less;
(c) A valid verbal, performance, or full scale IQ of 60 through 69 and a physical or other
mental impairment imposing additional and significant work-related limitation of
function; or
(d) A valid verbal, performance, or full scale IQ of 60 through 69 or in the case of
autism, gross deficits of social and communicative skills with one of the following:
1. marked restriction of activities of daily living;
2. marked difficulties in maintaining social functioning;
3. deficiencies of concentration, persistence or pace resulting in frequent failure to
complete tasks in a timely manner (in work settings or elsewhere); or
4. repeated episodes of deterioration or decompensation in work or work-like
settings which cause the individual to withdraw from that situation or to experience
exacerbation of signs and symptoms (which may include deterioration or adaptive
behaviors).
(6) Anxiety Related Disorders. In these disorders, anxiety is either the predominant
disturbance or it is experienced if the individual attempts to master symptoms; for example,
confronting the dreaded object or situation in a phobic disorder or resisting the obsessions
or compulsions in obsessive compulsive disorders.
The required level of severity for these disorders is met when the requirements in
106 CMR 703.192(L)(6)(a) and (b) are satisfied, or when the requirements in 106 CMR
703.192(L)(6)(a) and (c) are satisfied, and the incapacity is expected to last at least 30 days.
(a) Medically documented findings of at least one of the following:
1. generalized persistent anxiety accompanied by two out of four of the following
signs or symptoms:
a. motor tension;
b. autonomic hyperactivity;
c. apprehensive expectation; or
d. vigilance and scanning; or
2. a persistent irrational fear of a specific object, activity, or situation;
3. recurrent severe panic attacks manifested by a sudden unpredictable onset of
intense apprehension, fear, terror and sense of impending doom occurring on the
average of at least once a week;
4. recurrent obsessions or compulsions which are a source of marked distress; or
5. recurrent and intrusive recollections of a traumatic experience, which are a source
of marked distress; and
(b) Resulting in at least one of the following:
1. marked restriction of activities of daily living;
2. marked difficulties in maintain social functioning;
3. deficiencies of concentration, persistence or pace resulting in frequent failure to
complete tasks in a timely manner (in work settings or elsewhere); or
4. repeated episodes of deterioration or decompensation in work or work-like
settings which cause the individual to withdraw from that situation or to experience
exacerbation of signs and symptoms (which may include deterioration of adaptive
behaviors); or
(c) resulting in complete inability to function independently outside the area of one’s
home.
(7) Psychophysiological Disorders. Physical symptoms for which there are no demonstrable
organic findings or known physiological mechanisms.
The required level of severity for these disorders is met when the requirements of
106 CMR 703.192(L)(7)(a) and (b) are satisfied, and the incapacity is expected to last for at
least 30 days.
(a) Medically documented by evidence of one of the following:
1. a history of multiple physical symptoms of several years duration, beginning
before age 30, that have caused the individual to take medicine frequently, see a
physician often and alter life patterns significantly;
2. persistent nonorganic disturbance of one of the following:
a. vision;
b. speech;
c. hearing;
d. use of a limb;
e. movement and its control (e.g., coordination disturbance, psychogenic
seizures, akinesia, dyskinesia); or
f. sensation (e.g., diminished or heightened); or
3. Unrealistic interpretation of physical signs or sensations associated with the
preoccupation or belief that one has a serious disease or injury; and
(b) Resulting in two of the following:
1. marked restriction of activities of daily living;
2. marked difficulties in maintaining social functioning;
3. deficiencies of concentration, persistence or pace resulting in frequent failure to
complete tasks in a timely manner (in work settings or elsewhere); or
4. repeated episodes of deterioration or decompensation on work or work-like
settings which cause the individual to withdraw from that situation or to experience
exacerbation of signs and symptoms (which may include deterioration of adaptive
behavior).
(8) Personality Disorders. A personality disorder exists when personality traits are
inflexible and maladaptive and cause either significant impairment in social or occupational
functioning or subjective distress. Characteristic features are typical of the individual’s long
term functioning and are not limited to discrete episodes of illness.
The required level of severity for these disorders is met when the requirement of
106 CMR 703.192(L)(8)(a) and (b) are satisfied, and the incapacity is expected to last at least
30 days.
(a) Deeply ingrained, maladaptive patterns of behavior associated with one of the
following:
1. seclusiveness or autistic thinking;
2. pathologically inappropriate suspiciousness or hostility;
3. oddities of thought, perception, speech and behavior;
4. persistent disturbances of mood or affect;
5. pathological dependence, passivity, or aggressivity; or
6. intense and unstable interpersonal relationships and impulsive and damaging
behavior; and
(b) Resulting in two of the following:
1. marked restriction of activities of daily living;
2. marked difficulties in maintaining social functioning;
3. deficiencies of concentration, persistence or pace resulting in frequent failure to
complete tasks in a timely manner (in work settings or elsewhere); or
4. repeated episodes of deterioration or decompensation in work or work-like
settings which cause the individual to withdraw from that situation or to experience
exacerbation of signs and symptoms (which may include deterioration of adaptive
behavior).
(9) Substance Addiction Disorders. Physical changes or behavioral changes associated with
the regular use of legal substances that affect the central nervous system when accompanied
by an impairment listed elsewhere in these standards.
The required level of severity for these substance addiction disorders is met when the
requirements in any of the following disorders in 106 CMR 703.192(L)(9)(a) through (i) are
satisfied, and the incapacity is expected to last for at least 30 days.
(a) Organic Mental Disorders. Evaluate under Dementia with or without Delirium
(106 CMR 703.192(L)(2)).
(b) Depressive Syndrome. Evaluate under Affective Disorders (106 CMR
703.192(L)(4)).
(c) Anxiety Disorders. Evaluate under Anxiety Related Disorders (106 CMR
703.192(L)(6)).
(d) Personality Disorders. Evaluate under Personality Disorders (106 CMR
703.192(L)(8)).
(e) Peripheral Neuropathies. Evaluate under Neurological System Impairments
(106 CMR 703.192(K)).
(f) Liver Damage. Evaluate under Digestive System Impairments (Diseases of the
Liver) (106 CMR 703.192(E)(2)).
(g) Gastritis. Evaluate under Digestive System Impairments (Diseases of the Liver)
(106 CMR 703.192(E)(2)).
(h) Pancreatitis. Evaluate under Digestive System Impairments (Gastrointestinal
Disorders) (106 CMR 703.192(E)(1)).
(i) Seizures. Evaluate under Neurological System Impairments (Epilepsy - Major Motor
Seizure and Epilepsy - Minor Motor Seizure) (106 CMR 703.192(K)(2) and (3)).
(M) Immuno-suppressive Disorders.
(1) Indicator Diseases Diagnosed Definitively. The required level of incapacity associated
with the following is met when the incapacity is expected to last for at least 30 days.
(a) Candidiasis of the esophagus, trachea, bronchi, or lungs.
(b) Coccidioidomycosis, disseminated (at a site other than or in addition to lungs or
cervical or hilar lymph nodes).
(c) Cryptococcosis, extrapulmonary.
(d) Cryptosporidiosis with diarrhea persisting over one month.
(e) Cytomegalovirus disease of an organ other than liver, spleen, lymph nodes in an
individual over one month of age.
(f) Genital Herpes, chronic, recurrent, wide spread, resistant to therapy.
(g) Herpes Simplex virus infection causing a mucocutaneous ulcer that persists longer
than one month, or bronchitis, pneumonitis, or esophagitis for any duration affecting an
individual over one month of age.
(h) HIV Encephalopathy (also called “HIV dementia”, “AIDS dementia”, or “subacute
encephalitis due to HIV”).
(i) Histoplasmosis, disseminated (at a site other than or in addition to lungs or cervical
or hilar lymph nodes).
(j) Isoporiasis with diarrhea persisting over one month.
(k) Kaposi’s Sarcoma at any age.
(l) Leukoencephalopathy, progressive multifocal leukoencephalopathy.
(m) Lymphoma of the Brain (primary) at any age.
(n) Lymphoid Interstitial Pneumonia and/or Pulmonary Lymphoid Hyperplasia
(LIP/PLH complex) affecting a child younger than 13 years old.
(o) Any Mycobacterial Disease caused by mycobacteria other than M. Tuberculosis,
disseminated (at a site other than or in addition to lungs, skin, or cervical or hilar lymph
nodes).
(p) Pneumocystis Carinii Pneumonia.
(q) Pelvic Inflammatory Disease, chronic, recurrent, resistant to therapy.
(r) Salmonella (Nontyphoid) septicemia, recurrent.
(s) Systemic Toxoplasmosis.
(t) Toxoplasmosis of the brain.
(u) One of the following with documented HIV infection:
1. Anal Squamous Cell Carcinoma;
2. Invasive Carcinoma of Cervix FIGO stage II or more;
3. Nocardiosis;
4. Non-Hodgkins Lymphoma; or
5. Strongyloidiasis, extra-intestinal.
(2) Individuals should be considered to have an impairment that equals the severity of the
listings with or without documented evidence of HIV infection and must have the following
laboratory and clinical features:
(a) A T4 Lymphocyte Count of Less than or Equal to 200 Cells/mm3 (or 25% or less
T4 lymphocytes); or
(b) One or more of the following persisting over a two-month period:
1. Anemia (Hematocrit value less than 30%);
2. Granulocytopenia (absolute neutrophil count less than or equal to 1000/mm3);
3. Thrombocytopenia (platelet count less than or equal to 40,000/mm3);
4. Documented Fever (daily greater than or equal to 100.4°F or 38°C);
5. Undesired Weight loss greater than or equal to 10% of baseline;
6. Oral Recurrent Candidiasis;
7. Oral hairy leukoplakia;
8. Recurrent Herpes Zoster;
9. Persistent, Unresponsive Diarrhea;
10. Mucosal (including vulvovaginal candidiasis other than listed in 106 CMR
703.192(M)(1)(a) or new added vulvovaginal conditions);
11. Persistent dermatological conditions such as Eczema or psoriasis; or
12. Persistent or recurrent radiographically documented Sinusitis; and
(c) Interference with activities of daily living resulting in marked restriction of activities
such that the individual needs help with most activity including climbing stairs,
shopping, cooking and housework.
(N) Neoplastic Diseases - Malignant. Intractable pain, and/or ongoing therapy side effects,
disease process or treatment which has caused a disability covered elsewhere in these standards.
(O) Medically Equivalent Impairment(s) and Combinations of Impairments.
(1) If an applicant or client has an anatomical, physiological or psychological impairment(s)
that is not specifically included in the medical standards specified in 106 CMR 703.192(A)
through (N) but is documented by medically acceptable clinical and/or diagnostic techniques
and is medically equal in severity to a medical standard, the applicant or client shall be
considered as having impairment that meets a medical standard for purposes of 106 CMR
703.191. For purposes of determining if an impairment is medically equal in severity to a
medical standard, the medical standard that is most closely analogous to the impairment shall
be used.
(2) In making the determination required by 106 CMR 703.192(O)(1), the applicant’s or
client’s description of his or her symptoms (including pain) shall be taken into consideration
to the extent that:
(a) such symptoms are the result of a physical or mental impairment(s) as defined in
106 CMR 703.192 that is confirmed by acceptable clinical and/or laboratory diagnostic
techniques; and
(b) such physical or mental impairments could reasonably produce such symptoms.
An applicant or client must have a physical or mental impairment to be determined
disabled. Symptoms alone are not sufficient.
(3) If a specific medical finding required to meet a medical standard specified in 106 CMR
703.192(A) through (N) is not indicated by the competent medical authority (see 106 CMR
701.600: Definition of Terms) on the medical report but a medical finding of equal clinical
significance is indicated, the latter medical finding may be substituted for the required
medical finding.
(4) If an applicant or client has more than one impairment and none of the impairments
separately are medically equivalent to a medical standard specified in 106 CMR 703.192(A)
through (N), the impairments shall be considered to meet a medical standard if they, in
combination with each other, are medically equivalent to a medical standard. For purposes
of determining if an impairment is medically equal in severity to a medical standard, the
medical standard that is most closely analogous to the combined impairments shall be used.