The final rule that makes changes to the listing for Congenital Disorders that Affect Multiple Body Systems (Listing 110.00) went into effect on April 5, 2013. The disorders evaluated under this listing and affected by the changes include non-mosaic Down syndrome and catastrophic congenital disorders such as anencephaly, cyclopia, Patau syndrome, and Edwards’ syndrome, among others.
Non-mosaic Down syndrome is listed under 110.06. The evidence the Social Security Administration (SSA) looks at when evaluating a claim under 110.06 centers around laboratory findings, specifically a report of karyotype analysis, the determinative test to establish non-mosaic Down syndrome. However, if you do not have a karyotype analysis documenting that you have non-mosaic Down syndrome, you may still be found disabled under 110.06B or 110.06C. To meet a listing under 110.06B, SSA needs a physician’s report that states that your karyotype evidence is consistent with prior karyotype analysis, and that you have the distinctive facial or other physical features of Down syndrome. Under 110.06C, a claimant may be found disabled even without having information about prior karyotype analysis if SSA receives a physician’s report stating that you have the distinctive facial or other physical features of Down syndrome and evidence that your functioning is consistent with a diagnosis of non-mosaic Down syndrome.
Also effected by the new rule are catastrophic congenital disorders, which SSA evaluates under listing 110.08. Listing 110.08 is broken down into two parts: A and B. To determine whether you meet one of these listings, SSA requires one of the following:
1. A laboratory report of the test that documents your disorder, signed by aphysician.
2. A laboratory report of the test that documents your disorder that is not signed by a physician and a report from a physician saying that you have the disorder.
3. A report from a physician that states that you have the disorder and that you had definitive testing that documented your disorder.
If SSA does not have definitive laboratory evidence, you may still be found to meet 110.08A or B if SSA has a report from a physician that states that you have the disorder and that you have the typical clinical features of that disorder, and other evidence that supports that diagnosis.
