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Neoplastic Diseases, Malignant Back to List of Social Security Impairments / Damages
13.01 Category of Impairments, Neoplastic Diseases-Malignant
13.02 Head and neck (except salivary glands--13.07, thyroid gland--13.08, and mandible, maxilla, orbit, or temporal fossa--13.11):
A. Inoperable; or
B. Not controlled by prescribed therapy; or
C. Recurrent after radical surgery or irradiation; or
D. With distant metastases; or
E. Epidermoid carcinoma occurring in the pyriform sinus or posterior third of the tongue.
13.03 Sarcoma of skin:
A. Angiosarcoma with metastases to regional lymph nodes or beyond; or
B. Mycosis fungoides with metastases to regional lymph nodes, or with visceral involvement.
13.04 Sarcoma of soft parts: Not controlled by prescribed therapy.
13.05 Malignant melanoma:
A. Recurrent after wide excision; or
B. With metastases to adjacent skin (satellite lesions) or elsewhere.
13.06 Lymph nodes:
A. Hodgkin's disease or non-Hodgkin's lymphoma with progressive disease not controlled by prescribed therapy; or
B. Metastatic carcinoma in a lymph node (except for epidermoid carcinoma in a lymph node in the neck) where the primary site is not determined after adequate search; or
C. Epidermoid carcinoma in a lymph node in the neck not responding to prescribed therapy.
13.07 Salivary glands - carcinoma or sarcoma with metastases beyond the regional lymph nodes.
13.08 Thyroid gland
A. Anaplastic (undifferentiated) carcinoma of the thyroid: or
B. Carcinoma with metastases beyond the regional lymph nodes, not controlled by prescribed therapy.
13.09 Breast:
A. Inoperable carcinoma; or
B. Inflammatory carcinoma; or
C. Recurrent carcinoma, except local recurrence controlled by prescribed therapy; or
D. Distant metastases from breast carcinoma (bilateral breast carcinoma, synchronous or metachronous, is usually primary in each breast); or
E. Sarcoma with metastases anywhere.
13.10 Skeletal system (exclusive of the jaw):
A. Malignant primary tumors with evidence of metastases and not controlled by prescribed therapy; or
B. Metastatic carcinoma to bone where the primary site is not determined after adequate search.
13.11 Mandible, maxilla, orbit, or temporal fossa:
A. Sarcoma of any type with metastases; or
B. Carcinoma of the antrum with extension into the orbit or ethmoid or sphenoid sinus, or with regional or distant metastases; or
C. Orbital tumors with intracranial extension; or
D. Tumors of the temporal fossa with perforation of skull and meningeal involvement; or
E. Adamantinoma with orbital or intracranial infiltration; or
F. Tumors of Rathke's pouch with infiltration of the base of the skull or metastases.
13.12 Brain or spinal cord:
A. Metastatic carcinoma to brain or spinal cord.
B. Evaluate other tumors under the criteria described in 11.05 and 11.08.
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13.13 Lungs:
A. Unresectable or with incomplete excision; or
B. Recurrence or metastases after resection; or
C. Oat cell (small cell) carcinoma; or
D. Squamous cell carcinoma, with metastases beyond the hilar lymph nodes; or
E. Other histologic types of carcinoma, including undifferentiated and mixed-cell types (but excluding oat cell carcinoma, 13.13C, and squamous cell carcinoma, 13.13D), with metastases to the hilar lymph nodes.
13.14 Pleura or mediastinum:
A. Malignant mesothelioma of pleura; or
B. Malignant tumors, metastatic to pleura; or
C. Malignant primary tumor of the mediastinum not controlled by prescribed therapy.
13.15 Abdomen:
A. Generalized carcinomatosis; or
B. Retroperitoneal cellular sarcoma not controlled by prescribed therapy; or
C. Ascites with demonstrated malignant cells.
13.16 Esophagus or stomach:
A. Carcinoma or sarcoma of the esophagus; or
B. Carcinoma of the stomach with metastases to the regional lymph nodes or extension to surrounding structures; or
C. Sarcoma of stomach not controlled by prescribed therapy; or
D. Inoperable carcinoma; or
E. Recurrence of metastasis after resection.
13.17 Small intestine:
A. Carcinoma, sarcoma, or carcinoid tumor with metastases beyond the regional lymph nodes; or
B. Recurrence of carcinoma, sarcoma, or carcinoid tumor after resection; or
C. Sarcoma, not controlled by prescribed therapy.
13.18 Large intestine (from ileocecal valve to and including anal canal) - carcinoma or sarcoma:
A. Unresectable; or
B. Metastases beyond the regional lymph nodes; or
C. Recurrence or metastases after resection.
13.19 Liver or gallbladder:
A. Primary or metastatic malignant tumors of the liver; or
B. Carcinoma of the gallbladder; or
C. Carcinoma of the bile ducts.
13.20 Pancreas:
A. Carcinoma except islet cell carcinoma; or
B. Islet cell carcinoma which is unresectable and physiologically active.
13.21 Kidneys, adrenal glands, or ureters - carcinoma:
A. Unresectable; or
B. With hematogenous spread to distant sites; or
C. With metastases to regional lymph nodes.
13.22 Urinary bladder-carcinoma. With:
A. Infiltration beyond the bladder wall; or
B. Metastases to regional lymph nodes; or
C. Unresectable; or
D. Recurrence after total cystectomy; or
E. Evaluate renal impairment after total cystectomy under the criteria in 6.02.
13.23 Prostate gland - carcinoma not controlled by prescribed therapy.
13.24 Testicles:
A. Choriocarcinoma; or
B. Other malignant primary tumors with progressive disease not controlled by prescribed therapy.
13.25 Uterus-carcinoma or sarcoma (corpus or cervix):
A. Inoperable and not controlled by prescribed therapy; or
B. Recurrent after total hysterectomy; or
C. Total pelvic exenteration.
13.26 Ovaries-all malignant, primary or recurrent tumors. With:
A. Ascites with demonstrated malignant cells; or
B. Unresectable infiltration; or
C. Unresectable metastases to omentum or elsewhere in the peritoneal cavity; or
D. Distant metastases.
13.27 Leukemia: Evaluate under the criteria of 7.00ff, Hemic and Lymphatic System.
13.28 Uterine (fallopian) tubes--carcinoma or sarcoma:
A. Unresectable, or
B. Metastases to regional lymph nodes.
13.29 Penis-carcinoma, with metastases to regional lymph nodes.
13.30 Vulva-carcinoma, with distant metastases
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