Disability Evaluation Under Social Security
(Blue Book- September 2008)
100.00 Growth Impairment - Childhood
100.01
Category of
Impairments,
Growth
100.02
Growth
impairment,
considered to
be related to
an additional
specific
medically
determinable
impairment
100.03
Growth impairment,
not identified
as being related
to an additional,
specific medically
determinable
impairment
A. Impairment of growth may
be disabling in itself or it may be an indicator of the severity
of the impairment due to a specific disease process. Determinations
of growth impairment should be based upon the comparison of current
height with at least three previous determinations, including
length at birth, if available. Heights (or lengths) should be
plotted on a standard growth chart, such as derived from the National
Center for Health Statistics: NCHS Growth Charts. Height should
be measured without shoes. Body weight corresponding to the ages
represented by the heights should be furnished. The adult heights
of the child's natural parents and the heights and ages of siblings
should also be furnished. This will provide a basis upon which
to identify those children whose short stature represents a familial
characteristic rather than a result of disease. This is particularly
true for adjudication under 100.02B.
B. Bone age determinations should include a full descriptive report of medically acceptable imaging specifically obtained to determine bone age and must cite the standardization method used. Where appropriate medically acceptable imaging must be obtained currently as a basis for adjudication under 100.03, views or scans of the left hand and wrist should be ordered. In addition, appropriate medically acceptable imaging of the knee and ankle should be obtained when cessation of growth is being evaluated in an older child at, or past, puberty. Medically acceptable imaging includes, but is not limited to, x-ray imaging, computerized axial tomography (CAT scan) or magnetic resonance imaging (MRI), with or without contrast material, myelography, and radionuclear bone scans. "Appropriate" means that the technique used is the proper one to support the evaluation and diagnosis of the impairment.
C. The criteria in this section are applicable until closure of the major epiphyses. The cessation of significant increase in height at that point would prevent the application of these criteria.
100.01 Category of Impairments, Growth
100.02 Growth impairment, considered to be related to an additional specific medically determinable impairment, and one of the following:
A. Fall of greater than 15 percentiles in height which is sustained; or
B. Fall to, or persistence of, height below the third percentile.
100.03 Growth impairment. With:
A. Fall of greater than 25 percentiles in height which is sustained; and
B. Bone age greater than two standard deviations (2 SD) below the mean for chronological age (see 100.00B).