Concerning the evaluation of endocrine disorders and islet cell transplantation: The progress in stem cell that includes the possibility of autogenous source, if and when the generation of islet cells is achieved, type 1 diabetes may be transiently or permanently improved, with a possibility of sustained normalization of glucose control and arrest of progression of diabetic complications; with some reversal of some complications. ...more »
On April 8, 2011, we published a final rule that removed most of the listings we used to evaluate endocrine disorders, such as diabetes mellitus in adults, hypoparathyroidism, pituitary dwarfism, and gonadal dysgenesis, located via this link http://www.gpo.gov/fdsys/pkg/FR-2011-04-08/pdf/2011-8389.pdf As we explained in the preamble of the final rule, medical science has made significant advances in detecting endocrine disorders at earlier stages and newer treatments have resulted in better management of these conditions. Consequently, most endocrine disorders do not reach listing-level severity because they do not become sufficiently severe or do not remain at a sufficient level of severity long enough to meet our 12-month duration requirement.
Although we removed most of the listings for endocrine disorders, the final rule included guidance on evaluating endocrine disorders. In addition, we published two Social Security Rulings with additional guidance. These rulings are: SSR 14-2p: Titles II and XVI: Evaluating Diabetes Mellitus (see: here.) and SSR 14-3p: Titles II and XVI: Evaluating Endocrine Disorders Other than Diabetes Mellitus (see: here
Please see the issues below for your comment
Is the guidance we provide in the introductory text to the listings and in SSR 14-3p sufficient for evaluating endocrine disorders other than diabetes mellitus? If you believe it is not sufficient, what additional guidance should we provide?
Is the guidance we provide in the introductory text to the listings and in SSR 14-2p sufficient for evaluating diabetes mellitus? If you believe it is not sufficient, what additional guidance should we provide?
Pancreatic islet cell transplantation is used to treat some people with type 1 diabetes. We are interested in comments on outcomes of this procedure. What are the benefits and risks of this procedure? What guidance should we provide about evaluating diabetes in people who have undergone this procedure?
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Reference DDS admin Ltr. # 931 Genetically targeted Drug treatments for Cancer and SSA's Disability Process. Our medical consultants opine that the approach to rating cancer claims will not change based on this type of treatment. The cancer listings, and resultant ratings, depend upon the response to treatment and the claimant's subsequent ability to perform work. The type of treatment (i.e. genetically targeted drug ...more »
It would appear appropriate to evaluate Islet Cell Transplantation under T-II & T-XVI eligibility in a manner similar to the current criteria for assessing Stem Cell & Bone Marrow Transplants: i.e. 12 months of eligibility from the date of the initial transplantation. After the end of that 12 months, the residuals would be evaluated, including any ongoing complications and side effects of immune suppression medications. ...more »
For Question 1 related to the adequacy of the Introductory Text to the Endocrine Disorders other than Diabetes mellitus, the discussion and guidance are still relevant, appropriate, and clear; and I have no suggestions on changes. For Question 2 related to the adequacy of the Introductory Text specifically for Diabetes Mellitus, additional guidance and consideration of adding a listing for Diabetes Mellitus in adults ...more »
1. We believe the guidance provided in the introductory text to the listings and in SSR 14-3p is sufficient for evaluating endocrine disorders other than diabetes mellitus. 2. We believe the guidance provided in the introductory text to the listings and in SSR 14-2p is sufficient for evaluating diabetes mellitus. However, given that claimants with diabetes mellitus often have coexisting impairments, this may be a good ...more »
For Questions #1 and #2 based on our disability case experience, we find the guidance in the introductory text and SSRs 14-2p and 14-3p sufficient to evaluate endocrine disorders. Therefore, we do not have additional guidance for the second part of those questions. We defer to the medical experts regarding question #3 and specific treatments for diabetes mellitus.
The norm today is for insulin dependent, so called juvenile diabetics, to have a pancreas transplant at the same time as the renal transplant. The post op. immunosuppression is the same and I would think the diary should be the same as for renal transplantation. I.e. if only a pancreas transplant is done, depending, again, on the outcome, the diary should be one year. Other considerations should also be evaluated. ...more »