Proposed 14.00 listings

Three changes strike me as potentially problematic. The first and most important is the recurrent definition of significant constitutional symptoms as any two of malaise, fatigue, fever and involuntary weight loss. This means that two subjective symptoms - fatigue and malaise-will do. Fatigue and malaise generally go together anyway, and are exceedingly common in the general population, as well as in the majority of the depressed. They are poor discriminators of severity. I would propose that fatigue/malaise be one constitutional symptom rather than two. Much as I appreciate the attention to feet, I think that the new citation of toe contractures under the scleroderma listing should be more specific, to bring it into comparison with the next three examples of contracture and atrophy. Ordinary hammer toes are common in both the general population and in scleroderma patients. Hammer toes are, though, contractures, even though only the most severe represent significant incapacity. Finally, I think that the term dorsolumbar ankylosis on the spondylitis listing should make explicit that this is dorsal and lumbar, not either one, as this is what represents the impairment described. I would also not emphasize vision so much in this listing, making it sound like that is the biggest functional deficit.