Social Security Ruling, SSR 14-3p; Titles II and XVI: Evaluating Endocrine Disorders Other Than Diabetes Mellitus

SUMMARY: We are giving notice of SSR 14-3p. This SSR provides information about specific endocrine disorders other than diabetes mellitus (DM), and explains the types of impairments and limitations that result from those disorders. It also provides guidance on how we evaluate endocrine disorders in disability claims under titles II and XVI of the Social Security Act.

DATES: Effective Date: June 2, 2014.

FOR FURTHER INFORMATION CONTACT: Cheryl A. Williams, Office of Medical Policy, Social Security Administration, 6401 Security Boulevard, Baltimore, Maryland 21235-6401, (410) 965-1020.

SUPPLEMENTARY INFORMATION: Although 5 U.S.C. 552(a)(1) and (a)(2) do not require us to publish this SSR, we are doing so under 20 CFR 402.35(b)(1).

SSRs make available to the public precedential decisions relating to the Federal old-age, survivors, disability, supplemental security income, and special veterans benefits programs. We may base SSRs on determinations or decisions made at all levels of administrative adjudication, Federal court decisions, Commissioner's decisions, opinions of the Office of the General Counsel, or other interpretations of the law and regulations.

Although SSRs do not have the same force and effect as statutes or regulations, they are binding on all of our components. 20 CFR 402.35(b)(1).

This SSR will be in effect until we publish a notice in the Federal Register that rescinds it, or until we publish a new SSR that replaces or modifies it.

(Catalog of Federal Domestic Assistance, Program Nos. 96.001, Social Security--Disability Insurance; 96.002, Social Security--Retirement Insurance; 96.004--Social Security--Survivors Insurance; 96.006, Supplemental Security Income.)

Dated: May 22, 2014.

Carolyn W. Colvin,

Acting Commissioner of Social Security.

Policy Interpretation Ruling

Titles II and XVI: Evaluating Endocrine Disorders Other Than Diabetes Mellitus

Purpose: This SSR provides information about endocrine disorders other than diabetes mellitus (DM), and explains the types of impairments and limitations that result from those disorders. It also provides guidance on how we evaluate endocrine disorders in disability claims under titles II and XVI of the Social Security Act (Act). /1/ We provide information about the types of impairments and limitations that result from DM, and provide guidance on how we evaluate DM in disability claims under titles II and XVI of the Act in SSR 14-2p.

FOOTNOTE 1 For simplicity, we refer in this SSR only to initial claims for benefits. However, the policy interpretations in this SSR also apply to continuing disability reviews of adults and children under sections 223(f) and 1614(a)(4) of the Act, and to redeterminations of eligibility for benefits we make in accordance with section 1614(a)(3)(H) of the Act when a child who is receiving title XVI childhood disability benefits attains age 18. END FOOTNOTE

Citations (Authority): Sections 216(i), 223(d), 223(f), 1614(a)(3), and 1614(a)(4) of the Social Security Act, as amended; Regulations No. 4, subpart P, sections 404.1505, 404.1508, 404.1509, 404.1512-404.1513, 404.1520-404.1520a, 404.1521, 404.1522, 404.1523, 404.1525-404.1530, 404.1545, 404.1546, 404.1560-404.1569a, appendix 1, and appendix 2; and Regulations No. 16, subpart I, sections 416.905, 416.906, 416.908, 416.909, 416.912-416.913, 416.920, 416.920a, 416.921, 416.922, 416.923, 416.924, 416.924a, 416.924b, 416.925, 416.926, 416.926a, 416.927, 416.928, 416.930, 416.945, 416.946, 416.960-416.969a, 416.987, and 416.994-416.994a.

Introduction

On April 8, 2011, we published final rules in the Federal Register in which we removed the listings for evaluating endocrine disorders in adults and in children from the Listing of Impairments (listings) because they no longer accurately identified people who are disabled. /2/ /3/ When we published the final rules, we stated in the preamble that we would provide more detailed information about specific endocrine disorders, the types of impairments and limitations that result from these disorders, and how we evaluate endocrine disorders in disability claims. We are publishing this SSR to provide the policy guidance we said we would provide in the preamble of the final rules.

FOOTNOTE 2 76 FR 19692 (2011). The final rules were effective on June 7, 2011. END FOOTNOTE

FOOTNOTE 3 The listings are in 20 CFR Part 404, Subpart P, Appendix 1. END FOOTNOTE

Policy Interpretation

I. Endocrine Disorders Other Than DM

A. General

Endocrine glands produce hormones responsible for controlling various physiological functions such as metabolism, blood glucose levels, digestion, electrolyte balance, water balance, and sexual function. The major glands in the endocrine system are pituitary, thyroid, parathyroid, adrenal, pancreas, and gonads (testes and ovaries). The glands release hormones into the bloodstream where they travel to targeted organs. When an endocrine gland produces either too much of a hormone (hyperfunction) or too little of a hormone (hypofunction), the hormonal imbalance can cause an endocrine disorder, resulting in complications affecting various parts of the body. Although many endocrine disorders usually require lifelong treatment, medical advances in the diagnosis and treatment of endocrine disorders have resulted in better management of these disorders in adults and children.

B. Types of Endocrine Disorders Other Than DM and Their Treatments

1. Pituitary gland disorders. The pituitary gland, sometimes called the "master gland" of the endocrine system, controls the functions of all other endocrine glands (except for the pancreas).

a. Hyperpituitarism primarily refers to excess production of growth hormone (GH). Excess GH, which is less common in children, causes an overgrowth of the tissues in the body that are still capable of growing. During childhood, increased production of GH can result in skeletal gigantism. Symptoms and signs of gigantism include bones of excessive length, abnormal bone and body proportions, and delayed epiphyseal fusion. Adults may develop acromegaly, due to increased production of GH. Symptoms and signs of acromegaly include: Enlarged bones of the face, jaw, hands and feet; joint pain or swelling; and vision abnormalities. Treatment includes medications that suppress GH production, radiation therapy, and surgery.

b. Hypopituitarism. Decreased blood levels of GH cause delays in bone and physical growth in children. However, low GH levels are not clinically significant in adults. Deficient production of antidiuretic hormone (ADH) may result in diabetes insipidus with excessive urination producing dehydration and electrolyte imbalance. Generally, GH deficiency is treated with growth hormone replacement (hGH) in children and adolescents. Treatment with ADH replacement medications and hydration generally will successfully control the symptoms and signs of diabetes insipidus within 12 months.

2. Thyroid gland disorders. The thyroid gland regulates growth and development, body temperature, metabolic processes, heart rate, blood pressure, and mental function.

a. Hyperthyroidism. Excess production of thyroid hormone may abnormally increase the body's metabolic rate. Symptoms and signs of hyperthyroidism include altered mood, tremors, heart palpitations, hypertension, weight loss, exophthalmos (bulging of the eyes), and goiter (abnormal enlargement of thyroid gland). The most common type of hyperthyroidism is Graves disease, which involves increased secretion of thyroid hormone. Treatment includes lifelong thyroid-suppression medication, radioactive iodine therapy, or surgical removal of the thyroid. Generally, treatment controls the symptoms and signs of hyperthyroidism within 12 months.

b. Hypothyroidism. Low production of thyroid hormone may result in an abnormally slow metabolic rate. Some symptoms and signs of hypothyroidism include weakness or fatigue, dry or coarse skin, slow or depressed speech, and adverse mental changes. Adequate amounts of thyroid hormone are critical for the developing brain and nervous system in newborns and infants. The most common cause of hypothyroidism is Hashimoto thyroiditis, in which the body's immune system mistakenly attacks the thyroid gland. Treatment with thyroid replacement therapy will generally control the symptoms and signs of hypothyroidism within a few months.

3. Parathyroid gland disorders. The four parathyroid glands produce parathyroid hormone or parathormone (PTH), which regulates calcium and phosphorus levels in bone, blood, nerves, muscle, and other body tissues.

a. Hyperparathyroidism. Excess PTH production may cause mildly elevated blood calcium levels (hypercalcemia), which do not always require treatment. Symptoms and signs of hyperparathyroidism include constipation, nausea, vomiting, fatigue, and kidney stones. Hyperparathyroidism may also cause significant depletion of bone calcium, resulting in osteoporosis. Treatment includes surgical removal of the gland(s), which usually resolves the problem.

b. Hypoparathyroidism. Low production of PTH may cause abnormally low levels of blood calcium and increased levels of blood phosphorus. Symptoms and signs include muscle cramps, tetany (muscle spasms), excessive nervousness, and headaches. Treatment includes lifelong calcium, vitamin D oral supplements, and a diet high in calcium and low in phosphorus. Treatment generally controls this condition.

4. Adrenal gland disorders. The adrenal glands produce several types of hormones that regulate carbohydrate, protein, and fat metabolism; proper functioning of the immune system; and the body's ability to respond to stress.

--This is a summary of a Federal Register article originally published on the page number listed below--

Notice of Social Security Ruling (SSR).

Citation: "79 FR 31380"

Document Number: "Docket No. SSA-2013-0048"

Federal Register Page Number: "31380"

"Notices"