Comment on FR Doc # E7-24061

The digestive listings cover a variety of impairments with similar and multiple complications. These complications have varying impact on individuals. Like wise the effects of treatment have a vast range of effectiveness and side effects. Much like the claimants who suffer from HIV+ disease, claimants with Hepatitis and other chronic liver diseases, can experience several moderately severe manifestations of this illness but lack the necessary requisite findings. They may experience ascites, bacterial peritonitis and hepatorenal symptoms, none of which meet the severity of the listing. Yet all of these complications have the potential for symptoms of severe pain, fatigue, nausea, diarrhea and general malaise. The claimant may not be limited in their exertional capabilities or have a vocational profile that would render them disabled by Social Security standards. However, the inability to know from day to day if they will have their pain, nausea and diarrhea under control, or have energy and stamina to carry out simple routine tasks would prevent a sustained capacity for SGA. These factors can be argued at hearing but claimants with such severe functional restrictions are being unfairly denied and forced to wait for years for their benefits. A functional listing would give consistent guidance to those adjudicating Hepatitis and chronic liver disease claims. It is also reasonable to apply the same type of standard functional standard for Listing 5.02 and 5.06 in order to take into account the residual fatigue, weakness, and anemia following hemorrhaging and episodes of stenosis that is not frequent enough to meet the Listings. Because of the diversity of the effects of this series of diseases and the chronicity of most of these impairments, we believe that an addendum to the new Digestive Impairment Category listings should include a functional component similar to the one outlined in listing 14.08N for individuals with immunosuppressant disease.