[Listing of Impairments: Immune System] Page: 3 of 8
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LISTING OF IMPAIRMENTS-CURRENT
TN 4 6-93
described in paragraph a, provided that
such documentation is consistent with the
prevailing state of medical knowledge and
clinical practice and is consistent with the
other evidence. If no definitive laboratory
evidence is available, HIV infection may
be documented by the medical history,
clinical and laboratory findings, and diag-
nosis(es) indicated in the medical evidence.
For example, a diagnosis of HIV infection
will be accepted without definitive labora-
tory evidence if the individual has an
opportunistic disease (e.g., toxoplasmosis
of the brain, pneumocystis carinii pneumo-
nia (PCP)) predictive of a defect in cell-
mediated immunity, and there is no other
known cause of diminished resistance to
that disease (e.g., long-term steroid treat-
ment, lymphoma). In such cases, every
reasonable effort must be made to obtain
full details of the history, medical findings,
and results of testing.
4. Documentation of the manifestations of HIV
infection. The medical evidence must also in-
clude documentation of the manifestations of
HIV infection. Documentation may be by labo-
ratory evidence or by other generally accept-
able methods consistent with the prevailing
state of medical knowledge and clinical
practice.
a. Documentation of the manifestations of HIV
infection by definitive diagnosis.
The definitive method of diagnosing op-
portunistic diseases or conditions that are
manifestations of HIV infection is by cul-
ture, serological test, or microscopic exam-
ination of biopsied tissue or other material
(e.g., bronchial washings). Therefore, ev-
ery reasonable effort must be made to
obtain specific laboratory evidence of an
opportunistic disease or othercondition
whenever this information is available. If a
histological or other test has been per-
formed, the evidence should include a
copy of the appropriate report. If the
report is not obtainable, the summary of
hospitalization or a report from the treat-
ing source should include details of the
findings and results of the diagnostic stud-
ies (including radiographic studies) or mi-
croscopic examination of the appropriate
tissues or body fluids.
Although a reduced CD4 lymphocyte
count may show that there is an increased
susceptibility to opportunistic infections
and diseases (see 14.OOD 3a, above), that
alone does not establish the presence, se-
verity, or functional effects of a manifesta-
tion of HIV infection.
b. Other acceptable documentation of the man-
ifestations of HIV infection.
Manifestations of HIV infection may also
be documented without the definitive labo-DI 34001.010A. (Cont.)
ratory evidence described in paragraph a,
provided that such documentation is con-
sistent with the prevailing state of medical
knowledge and clinical practice and is
consistent with the other evidence. If no
definitive laboratory evidence is available,
manifestations of HIV infection may be
documented by medical history, clinical
and laboratory findings, and diagnosis(es)
indicated in the medical evidence. In such
cases, every reasonable effort must be
made to obtain full details of the history,
medical findings, and results of testing.
Documentation of cytomegalovirus
(CMV) disease (14.08D) presents special
problems because diagnosis requires identi-
fication of viral inclusion bodies or a posi-
tive culture from the affected organ, and
the absence of any other infectious agent.
A positive serology test identifies infection
with the virus, but does not confirm a
disease process. With the exception of cho-
rioretinitis (which may be diagnosed by an
ophthalmologist), documentation of CMV
disease requires confirmation by biopsy or
other generally acceptable methods consis-
tent with the prevailing state of medical
knowledge and clinical practice.
5. Manifestations specific to women. Most
women with severe immunosuppression sec-
ondary to HIV infection exhibit the typical
opportunistic infections and other condi-
tions, such as pneumocystis carinii pneumo-
nia (PCP), candida esophagitis, wasting syn-
drome, cryptococcosis, and toxoplasmosis.
However, HIV infection may have different
manifestations in women than in men. Adju-
dicators must carefully scrutinize the medi-
cal evidence and be alert to thervariety of
medical conditions specific to or common in
women with HIV infection that may affect
their ability to function in the workplace.
Many of these manifestations (e.g. vulvo-
vaginal candidiasis, pelvic inflammatory
disease) occur in women with or without
HIV infection, but can be more severe or
resistant to treatment, or occur more fre-
quently in a woman whose immune system
is suppressed. Therefore, when evaluating
the claim of a woman with HIV infection,
it is important to consider gynecologic and
other problems specific to women, includ-
ing any associated symptoms (e.g., pelvic
pain), in assessing the severity of the im-
pairment and resulting functional limita-
tions. Manifestations of HIV infection in
women may be evaluated under the specif-
ic criteria (e.g., cervical cancer under
14.08E), under an applicable general cate-
gory (e.g., pelvic inflammatory disease un-
der 14.08A5) or, in appropriate cases, un-
der 14.08N.
6. Evaluation. The criteria in 14.08 do not
describe the full spectrum of diseases or
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[Listing of Impairments: Immune System], chapter, 1993; (https://texashistory.unt.edu/ark:/67531/metadc948307/m1/3/: accessed June 1, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Special Collections.