"Staged" Conditions are Disabling Under Disability Law

Some listed impairments are staged by treating sources.  Staging is a progression and shows a worsening condition.  While the concept of staging is not considered in the listing, it can be used to argue that a later stage equals the severity of listing criteria.

For example, kidney function level is measured by the calculation of the Glomerular Filtration Rate (GFR) based on the creatinine levels in the blood and the individuals age, race and gender.[i] Stages 3 and 4 can result in significant functional impairment due to anemia, bone disease and other associated symptoms.  But the listing only provides a listing level impairment when the claimant is on dialysis (Stage 5).  One could argue that the claimant equals the kidney listing even before they need dialysis if the GFR is at an earlier stage.  If the claimant also suffers from other diseases, such as diabetes, they may equal in combination, see section below.

Here is another example: gout is one of the inflammatory arthritic conditions considered in the autoimmune system disorders. See the condition listed as crystal deposition disorders at 14.00D6c(iv).  We were able to show that our client equaled 14.09 when diagnostic studies revealed tophus deposits, associated with the most serious stage of gout.

There are many conditions, listed or not, which are in fact staged by health care professionals.  See the following list.

• RSD
• Kidney disease
• Liver disease
• Cardiac
• Cancer
• Multiple Sclerosis
• Gout

Unfortunately, the current listings do not include any kind of staging analysis. In fact, in 1991 the cardiac listings included criteria for chronic heart failure which equate to functional restrictions consistent with NYHA[ii] class III or IV.”[iii] But that criteria was removed in 2006 and replaced with “extreme limitation” language.[iv] Nevertheless, one could argue that a later stage equals a listing because it represents a condition that is of equal medical significance to the required criteria.

[i] http://www.kidney.org/professionals/KDOQI/gfr_calculator.cfm
[ii] New York Heart Association (NYHA) functional classification system:
Class I: patients with no limitation of activities; they suffer no symptoms from ordinary activities.
Class II: patients with slight, mild limitation of activity; they are comfortable with rest or with mild exertion.
Class III: patients with marked limitation of activity; they are comfortable only at rest.
Class IV: patients who should be at complete rest, confined to bed or chair; any physical activity brings on discomfort and symptoms occur at rest.
[iii] 59 Fed. Reg. 6468 See also http://www.ssa.gov/OP_Home/hallex/II-04/II-4-1-7.html
[iv] 71 Fed Reg. 2316