§79.16. Proof of medical condition. — Inbound Citations

Proof of medical condition under this subpart will be made in the same manner and according to the same procedures and limitations as are set forth in § 79.16 and § 79.26.

(c) Proof that the claimant contracted a specified compensable disease may be made by the submission of one or more of the contemporaneous medical records listed in this paragraph, provided that the specified document contains an explicit statement of diagnosis and such other information or data from which the appropriate authorities with the National Cancer Institute can make a diagnosis to a reasonable degree of medical certainty. If the medical record submitted does not contain sufficient information or data to make such a diagnosis, the Program will notify the claimant or eligible surviving beneficiary and afford that individual the opportunity to submit additional medical records identified in this paragraph, in accordance with the provisions of § 79.72(b). The medical documentation submitted under this section to establish that the claimant contracted leukemia or a lymphoma must also contain sufficient information from which the appropriate authorities with the National Cancer Institute can determine the type of leukemia or lymphoma contracted by the claimant. Proof of leukemia shall be made by submitting one or more of the documents listed in § 79.16(c).

(i) Pathology report of tissue biopsy;

(ii) Autopsy report;

(iii) Report of serum electrophoresis;

(A) Physician summary report;

(B) Hospital discharge summary report;

(C) Hematology summary or consultation report;

(D) Medical oncology summary or consultation report; or

(E) X-ray report; or

(i) Pathology report of tissue biopsy;

(ii) Autopsy report;

(A) Physician summary report;

(B) Hospital discharge summary report;

(C) Hematology consultation or summary report; or

(D) Medical oncology consultation or summary report; or

(i) Pathology report of tissue biopsy or fine needle aspirate;

(ii) Autopsy report;

(A) Physician summary report;

(B) Hospital discharge summary report;

(C) Operative summary report;

(D) Medical oncology summary or consultation report; or

(i) Pathology report of tissue biopsy or surgical resection;

(ii) Autopsy report;

(A) Physician summary report;

(B) Hospital discharge summary report;

(C) Operative report;

(D) Medical oncology summary or consultation report; or

(E) Radiotherapy summary or consultation report;

(iv) Report of mammogram;

(v) Report of bone scan; or

(i) Pathology report of tissue biopsy or surgical resection;

(ii) Autopsy report;

(iii) Endoscopy report;

(A) Physician summary report;

(B) Hospital discharge summary report;

(C) Operative report;

(D) Radiotherapy report; or

(E) Medical oncology consultation or summary report;

(A) Esophagram;

(B) Barium swallow;

(C) Upper gastrointestinal (GI) series;

(D) Computerized tomography (CT) scan; or

(E) Magnetic resonance imaging (MRI); or

(i) Pathology report of tissue biopsy or surgical resection;

(ii) Autopsy report;

(iii) Endoscopy or gastroscopy report;

(A) Physician summary report;

(B) Hospital discharge summary report;

(C) Operative report;

(D) Radiotherapy report; or

(E) Medical oncology summary report;

(A) Barium swallow;

(B) Upper gastrointestinal (GI) series;

(C) Computerized tomography (CT) series; or

(D) Magnetic resonance imaging (MRI); or

(i) Pathology report of tissue biopsy or surgical resection;

(ii) Autopsy report;

(iii) Endoscopy report;

(A) Physician summary report;

(B) Hospital discharge summary report;

(C) Report of otolaryngology examination;

(D) Radiotherapy summary report;

(E) Medical oncology summary report; or

(F) Operative report;

(A) Laryngograms;

(B) Tomograms of soft tissue and lateral radiographs;

(C) Computerized tomography (CT) scan; or

(D) Magnetic resonance imaging (MRI); or

(i) Pathology report of tissue biopsy;

(ii) Autopsy report;

(iii) Endoscopy report, provided that the examination covered the duodenum and parts of the jejunum;

(iv) Colonoscopy report, provided that the examination covered the distal ileum;

(A) Physician summary report;

(B) Hospital discharge summary report;

(C) Report of gastroenterology examination;

(D) Operative report;

(E) Radiotherapy summary report; or

(F) Medical oncology summary or consultation report;

(A) Upper gastrointestinal (GI) series with small bowel follow-through;

(B) Angiography;

(C) Computerized tomography (CT) scan; or

(D) Magnetic resonance imaging (MRI); or

(i) Pathology report of tissue biopsy or fine needle aspirate;

(ii) Autopsy report;

(A) Physician summary report;

(B) Hospital discharge summary report;

(C) Radiotherapy summary report; or

(D) Medical oncology summary report;

(A) Endoscopic retrograde cholangiopancreatography (ERCP);

(B) Upper gastrointestinal (GI) series;

(C) Arteriography of the pancreas;

(D) Ultrasonography;

(E) Computerized tomography (CT) scan; or

(F) Magnetic resonance imaging (MRI); or

(i) Pathology report of tissue biopsy or surgical resection;

(ii) Autopsy report;

(A) Physician summary report;

(B) Hospital discharge summary report;

(C) Operative report;

(D) Gastroenterology consultation report; or

(E) Medical oncology summary or consultation report;

(A) Ultrasonography;

(B) Endoscopic retrograde cholangiography;

(C) Percutaneous cholangiography; or

(D) Computerized tomography (CT) scan; or

(i) Pathology report of tissue from surgical resection;

(ii) Autopsy report;

(A) Computerized tomography (CT) scan;

(B) Magnetic resonance imaging (MRI); or

(C) Ultrasonography (ultrasound);

(A) Physician summary report;

(B) Hospital discharge summary report;

(C) Operative report;

(D) Radiotherapy report; or

(E) Medical oncology summary or report; or

(i) Pathology report of tissue biopsy or surgical resection;

(ii) Autopsy report;

(A) Physician summary report;

(B) Hospital discharge summary report;

(C) Medical oncology summary report;

(D) Operative report; or

(E) Gastroenterology report;

(A) Computerized tomography (CT) scan;

(B) Magnetic resonance imaging (MRI); or

(i) Pathology report of tissue biopsy or resection, including, but not limited to specimens obtained by any of the following methods:

(A) Surgical resection;

(B) Endoscopic endobronchial or transbronchial biopsy;

(C) Bronchial brushings and washings;

(D) Pleural fluid cytology;

(E) Fine needle aspirate;

(F) Pleural biopsy; or

(G) Sputum cytology;

(ii) Autopsy report;

(iii) Report of bronchoscopy, with or without biopsy;

(A) Physician summary report;

(B) Hospital discharge summary report;

(C) Radiotherapy summary report;

(D) Medical oncology summary report; or

(E) Operative report;

(A) Computerized tomography (CT) scan;

(B) Magnetic resonance imaging (MRI);

(C) X-rays of the chest; or

(D) Chest tomograms; or

(i) Pathology report of tissue biopsy or surgical resection;

(ii) Autopsy report;

(iii) Report of otolaryngology or oral maxillofacial examination;

(A) Physician summary report;

(B) Hospital discharge summary report;

(C) Radiotherapy summary report;

(D) Medical oncology summary report; or

(E) Operative report;

(A) Computerized tomography (CT) scan; or

(B) Magnetic resonance imaging (MRI); or

(i) Pathology report of tissue biopsy or surgical resection;

(ii) Autopsy report;

(iii) Report of cytoscopy, with or without biopsy;

(A) Physician summary report;

(B) Hospital discharge summary report;

(C) Radiotherapy summary report;

(D) Medical oncology summary report; or

(E) Operative report;

(A) Computerized tomography (CT) scan; or

(B) Magnetic resonance imaging (MRI); or

(i) Pathology report of tissue biopsy or surgical resection;

(ii) Autopsy report;

(A) Physician summary report;

(B) Hospital discharge summary report;

(C) Radiotherapy summary report;

(D) Medical oncology summary report; or

(E) Operative report;

(A) Computerized tomography (CT) scan;

(B) Magnetic resonance imaging (MRI); or

(C) CT or MRI with enhancement; or

(i) Pathology report of tissue biopsy;

(ii) Autopsy report;

(iii) Endoscopy report, provided the examination covered the duodenum and parts of the jejunum;

(iv) Colonoscopy report, provided that the examination covered the distal ileum;

(A) Physician summary report;

(B) Hospital discharge summary report;

(C) Report of gastroenterology examination;

(D) Operative report;

(E) Radiotherapy summary report; or

(F) Medical oncology summary or consultation report;

(A) Upper gastrointestinal (GI) series with small bowel follow-through;

(B) Angiography;

(C) Computerized tomography (CT) scan; or

(D) Magnetic resonance imaging (MRI); or

(i) Pathology report of tissue biopsy or surgical resection;

(ii) Autopsy report;

(A) Physician summary report;

(B) Hospital discharge summary report;

(C) Radiotherapy summary report;

(D) Medical oncology summary report; or

(E) Operative report; or