Chronic Liver Disease

With:

5.05A. Hemorrhaging from esophageal, gastric, or ectopic varices or from portal hypertensive gastropathy, demonstrated by endoscopy, x-ray, or other appropriate medically acceptable imaging, resulting in hemodynamic instability as defined in 5.00D5 (read about 5.00D5 here), and requiring hospitalization for transfusion of at least 2 units of blood. Consider under a disability for 1 year following the last documented transfusion; thereafter, evaluate the residual impairment(s).     

OR

5.05B. Ascites or hydrothorax not attributable to other causes, despite continuing treatment as prescribed, present on at least two evaluations at least 60 days apart within a consecutive 6-month period. Each evaluation must be documented by: 

1. Paracentesis or thoracentesis; or 
2. Appropriate medically acceptable imaging or physical examination and one of the following: 
          a. Serum albumin of 3.0 g/dL or less; or
          b. International Normalized Ratio (INR) of at least 1.5. 

OR 

5.05C. Spontaneous bacterial peritonitis with peritoneal fluid containing an absolute neutrophil count of at least 250 cells/mm³.   

OR 

5.05D. Hepatorenal syndrome as described in 5.00D8 (read about 5.00D8 here) , with one of the following: 

1. Serum creatinine elevation of at least 2 mg/dL; or
2. Oliguria with 24-hour urine output less than 500 mL; or
3. Sodium retention with urine sodium less than 10 mEq per liter

OR   

5.05E. Hepatopulmonary syndrome as described in 5.00D9 (read about 5.00D9 here) , with:

1. Arterial oxygenation (P_aO₂) on room air of:
          a. 60 mm Hg or less, at test sites less than 3000 feet above sea level, or
          b. 55 mm Hg or less, at test sites from 3000 to 6000 feet, or
          c. 50 mm Hg or less, at test sites above 6000 feet; or
2. Documentation of intrapulmonary arteriovenous shunting by contrast-enhanced echocardiography or macroaggregated albumin lung perfusion scan

OR 

5.05F. Hepatic encephalopathy as described in 5.00D10 (read about 5.00D10 here) , with 1 and either 2 or 3:

1. Documentation of abnormal behavior, cognitive dysfunction, changes in mental status, or altered state of consciousness (for example, confusion, delirium, stupor, or coma), present on at least two evaluations at least 60 days apart within a consecutive 6-month period; and

2. History of transjugular intrahepatic portosystemic shunt (TIPS) or any surgical portosystemic shunt; or
3. One of the following occurring on at least two evaluations at least 60 days apart within the same consecutive 6-month period as in F1:
          a. Asterixis or other fluctuating physical neurological abnormalities; or
          b. Electroencephalogram (EEG) demonstrating triphasic slow wave activity; or
          c. Serum albumin of 3.0 g/dL or less; or
          d. International Normalized Ratio (INR) of 1.5 or greater.  

OR 

5.05G. End stage liver disease with SSA CLD scores of 22 or greater calculated as described in 5.00D11 (read about 5.00D11 here) . Consider under a disability from at least the date of the first score.

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  Overview       Section 5.05      Section 5.00D1 - 5.00D4      Section 5.00D5 - 5.00D12

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