DI 23022: Processing Quick Disability Determination (QDD) and Compassionate Allowances (CAL) in the Disability Determination Services (DDS)
TN 16 (03-18)
COMPASSIONATE ALLOWANCE INFORMATION | |
CREUTZFELDT-JAKOB DISEASE (CJD) - Adult | |
DESCRIPTION |
Creutzfeldt-Jakob disease (CJD) is a rare, rapidly progressive, invariably fatal brain disorder primarily characterized by mental deterioration, although motor problems can be significant in many cases. CJD belongs to a group of human and animal diseases known as transmissible spongiform encephalopathies (TSE) or prion diseases. Spongiform refers to the characteristic appearance of infected brains, which become filled with holes until they resemble sponges under a microscope. Typically, onset of symptoms occurs at about age 60 and runs a rapid course. There are four major categories of CJD: sporadic CJD, hereditary CJD, acquired or iatrogenic CJD and variant CJD. |
ALTERNATE NAMES |
Jakob-Creutzfeldt Disease, Jakobs Disease, Subacute Spongiform Encephalopathy, Variant (V-CJD) Bovine Spongiform Encephalopathy (BSE), Fatal Familial Insomnia (FFI), Gerstmann-Straussler-Scheinker (GSS) Disease, Prion disease |
DIAGNOSTIC TESTING AND CODING |
The diagnosis of CJD is suspected when there are typical clinical symptoms such as rapidly progressing dementia with myoclonus (twitching). Currently, there is no single diagnostic test for CJD except for brain biopsy. The first concern is to rule out treatable forms of dementia such as encephalitis or chronic meningitis. The following investigations can be performed to support the diagnosis:
Brain biopsy is the definite diagnostic test, but is performed only in selected cases because the procedure may be dangerous to the individual. Since a correct diagnosis of CJD does not help the individual, brain biopsy is discouraged unless it is needed to rule out a treatable disorder. |
TREATMENT |
There is no treatment that can cure or control CJD. Current treatment is aimed at alleviating symptoms and making the patient as comfortable as possible. Opiate drugs can help relieve pain, and the drugs clonazepam and sodium valproate may help relieve involuntary muscle jerks. |
PROGRESSION |
About 90 percent of patients die within 1 year. In the early stages of disease, patients may have failing memory, behavioral changes, lack of coordination and visual disturbances. As the illness progresses, mental deterioration becomes pronounced and involuntary movements, blindness, weakness of extremities, and coma may occur. |
SUGGESTED PROGRAMMATIC ASSESSMENT* | ||
Suggested MER for Evaluation: Clinical notes and results of neurological examination that establish the presence of rapidly progressive dementia or neurodegenerative illness. If available, ancillary studies, i.e., spinal tap, cerebrospinal fluid analysis, detection of 14-3-3 protein in spinal fluid, electroencephalogram (EEG) and brain biopsy are helpful as supportive evidence. | ||
Suggested Listings for Evaluation: | ||
DETERMINATION |
LISTING |
REMARKS |
Meets Listing |
11.17 |
Clinical diagnosis of CJD resulting in marked restrictions of activities of daily living and social interactions and |
11.17 |
Clinical diagnosis of CJD with significant and persistent disorganization of motor function in two extremities as described in 11.04 B. |
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Medical Equals |
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator. |