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West Virginia Income Maintenance Manual Chapter 13

West Virginia Income Maintenance Manual Page 44 Chapter 13 Determining Disability, Incapacity, and Blindness

APPENDIX A: PRESUMPTIVE MEDICAL APPROVAL – SSI-RELATED MEDICAID AND M-WIN, AGE 18 OR OLDER When the individual’s medical condition or diagnosis is not listed in this Appendix, refer to Section 13.6 regarding the presumptive approval process. A.1 DISABILITY OF THE SKELETAL SYSTEM AND MUSCLES The severity is determined by a physical examination, laboratory tests, and x-rays. The following are examples of disability of the skeletal system and muscles that would result in a presumptive medical approval: • Rheumatoid arthritis with a history of joint pain, swelling of major joints, and limitation of motion of joints. • Severe osteo or degenerative arthritis resulting in limitation of motion of both hips or both knees, or a combination of one hip or one knee. Severity results in difficulty in ambulation and may necessitate surgery (arthrodesis) of the hip and knee. • Injuries to the spine with cord involvement, resulting in paraplegia or quadriplegia. • Amputation of two limbs, amputation of a leg at the hip, or amputations due to vascular insufficiency or diabetes mellitus, with inability to use a prosthesis effectively. • Non-union of a fracture of a major extremity, requiring continuing surgical management, with function not expected to be restored fully. • Osteomyelitis of a major joint, as confirmed by x-ray, with persistent drainage, swelling, and redness that has not responded to medical treatment. • Cerebral palsy, muscular dystrophy, or muscular atrophy and marked difficulty in walking (e.g., use of braces), speaking or coordination of the hands or arms. A.2 DISEASES OF THE RESPIRATORY SYSTEM These are confirmed by x-ray spirometry or pulmonary function studies, in addition to physical examination. The following are examples of diseases of the respiratory system that would result in a presumptive medical approval: