34950 Federal Register / Vol. 65, No. 106 / Thursday, June 1, 2000 / Rules and Regulations

‘‘A United States person may comply or

agree to comply in the normal course of

business with the unilateral and specific

selection by a boycotting country * * * of

* * * specific goods, * * * provided that

* * * with respect to goods, the items, in the

normal course of business, are identifiable as

to their source or origin at the time of their

entry into the boycotting country by (a)

uniqueness of design or appearance or (b)

trademark, trade name, or other identification

normally on the items themselves, including

their packaging.’’

* * * * *

13. Supplement No. 8 to part 760 is

amended by revising the phrase

‘‘§ 760.1(d)(13) of this part’’ to read

‘‘§ 760.1(d)(3)’’ in the third

undesignated paragraph.

14. Supplement No. 9 to part 760 is

amended by revising the phrase

‘‘§ 760.3(f) of this part’’ to read

‘‘§ 760.3(g)’’ the first undesignated

paragraph.

15. Supplement No. 10 to part 760 is

amended by revising the phrase ‘‘non

exclusionary, non blacklisting

statement’’ to read ‘‘non-exclusionary,

non-blacklisting statement’’ in the

undesignated paragraph that follows

paragraph heading (b).

16. Supplement No. 11 to part 760 is

amended:

a. By placing quotation marks around

the undesignated paragraph that follows

the phrase ‘‘§ 760.5(a)(4) of this part

status in part’’; and

b. By revising the parenthetical phrase

‘‘(§ 760.5(a)(6) of this part)’’ to read

‘‘(§ 760.5(b)(6)’’ in the last undesignated

paragraph.

17. Supplement No. 12 to part 760 is

amended:

a. By placing beginning and ending

quotation marks around the first and

second undesignated paragraphs,

respectively, that follow the phrase

‘‘Example (v) under § 760.4 of this part

(Evasion) provides:’’

b. By revising the phrase ‘‘recently

imposed by the government’’ to read

‘‘imposed by the government’’ in the

undesignated paragraph that begins

with the phrase ‘‘This interpretation

deals with’’; and

c. By placing quotation marks around

the undesignated paragraph that begins

with the phrase ‘‘Declaration: I, the

undersigned’’.

18. Supplement No. 13 to part 760 is

amended:

a. By revising the phrase ‘‘§ 760.3(c) of

this part’’ to read ‘‘§ 760.3(d)’’ in the

undesignated paragraph following the

heading ‘‘Summary’’;

b. By placing quotation marks around

the third undesignated paragraph

following the heading ‘‘Regulatory

Background’’;

c. By revising the phrase ‘‘§ 760.3(c)’’

part’’ to read ‘‘§ 760.3(d)’’ in the fourth

undesignated paragraph following the

heading ‘‘Regulatory Background’’;

d. By revising the heading ‘‘Analysis

of the New Contractual Language’’ to

read ‘‘Analysis of Additional

Contractual Language’’;

e. By revising the phrase ‘‘of a new

contractual clause’’ to read ‘‘of a

contractual clause’’ in the undesignated

paragraph following the newly revised

heading ‘‘Analysis of the New

Contractual Language’’;

f. By revising the heading ‘‘Boycott of

Boycotted Country’’ to read ‘‘Boycott of

[Name of Boycotted Country]’’;

g. By revising the phrase ‘‘§ 760.3(c) of

this part’’ to read ‘‘§ 760.3(d)’’ in the last

undesignated paragraph of this

supplement.

19. Supplement No. 14 to part 760 is

amended:

a. By placing beginning and ending

quotation marks around the first and

second undesignated paragraphs,

respectively, following the sentence

‘‘The following language has appeared

in tender documents issued by a

boycotting country:’’ in paragraph (a);

b. By revising the phrase ‘‘Agreement

to Refuse to Do Business’’ to read

‘‘Agreements to Refuse to Do Business’’

in the last sentence of the third

undesignated paragraph following the

sentence ‘‘The following language has

appeared in tender documents issued by

a boycotting country:’’ in paragraph (a);

c. By revising the phrase

‘‘§ 760.6(a)(1) of this part’’ to read

‘‘§ 760.5(a)(1) of this part’’ in the last

undesignated paragraph following the

sentence ‘‘The following language has

appeared in tender documents issued by

a boycotting country:’’ in paragraph (a);

and

d. By placing beginning and ending

quotation marks around the first and

second undesignated paragraphs,

respectively, that follow the sentence

‘‘The following terms frequently appear

on letters of credit covering shipment to

Iraq:’’ in paragraph (b).

Dated: May 18, 2000.

R. Roger Majak,

Assistant Secretary for Export

Administration.

[FR Doc. 00–13251 Filed 5–31–00; 8:45 am]

BILLING CODE 3510–33–P

SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404 and 416

[Regulations Nos. 4 and 16]

RIN 0960–AD91

Federal Old-Age, Survivors and

Disability Insurance and Supplemental

Security Income for the Aged, Blind,

and Disabled; Medical and Other

Evidence of Your Impairment(s) and

Definition of Medical Consultant

AGENCY: Social Security Administration.

ACTION: Final rules.

SUMMARY: We are revising the Social

Security and Supplemental Security

Income (SSI) disability regulations

regarding sources of evidence for

establishing the existence of a medically

determinable impairment under title II

and title XVI of the Social Security Act

(the Act). We are doing this to clarify

and expand the list of acceptable

medical sources and to revise the

definition of the term ‘‘medical

consultant’’ to include additional

acceptable medical sources.

DATES: These rules are effective July 3,

2000.

FOR FURTHER INFORMATION CONTACT:

Georgia E. Myers, Regulations Officer,

Social Security Administration, 6401

Security Boulevard, Baltimore,

Maryland 21235–6401, 1–410–965–3632

or TTY 1–800–966–5609. For

information about eligibility or filing for

benefits, call our national toll-free

number, 1–800–772–1213 or TTY 1–

800–325–0778.

SUPPLEMENTARY INFORMATION: The Act

provides, in title II, for the payment of

disability benefits to persons insured

under the Act. Title II also provides,

under certain circumstances, for the

payment of child’s insurance benefits

based on disability and widow’s and

widower’s insurance benefits for

disabled widows, widowers, and

surviving divorced spouses of insured

persons. In addition, the Act provides,

in title XVI, for SSI payments to persons

who are aged, blind, or disabled and

who have limited income and resources.

For adults under both the title II and

title XVI programs (including persons

claiming child’s insurance benefits

based on disability under title II),

‘‘disability’’ means the inability to

engage in any substantial gainful

activity. For an individual under age 18

claiming SSI benefits based on

disability, ‘‘disability’’ means that an

impairment(s) causes ‘‘marked and

severe functional limitations.’’ (Our

regulations at § 416.902 explain that,

‘‘[m]arked and severe functional

Federal Register / Vol. 65, No. 106 / Thursday, June 1, 2000 / Rules and Regulations 34951

limitations, when used as a phrase,

* * * is a level of severity that meets

or medically or functionally equals the

severity of a listing in the Listing of

Impairments in appendix 1 of subpart P

of part 404 * * *.’’) Under both title II

and title XVI, disability must be the

result of a medically determinable

physical or mental impairment or

combination of impairments that can be

expected to result in death or that has

lasted or can be expected to last for a

continuous period of at least 12 months.

The Act also provides that an

individual shall not be considered to be

under a disability unless he or she

furnishes such medical and other

evidence of the existence of such

impairment(s) as the Commissioner may

require.

Explanation of Revisions

Sections 404.1513 and 416.913

provide that we need reports about an

individual’s impairments from

acceptable medical sources; they also

provide a list of ‘‘acceptable medical

sources.’’ Acceptable medical sources

are individuals who have the training

and expertise to provide us with the

signs and laboratory findings based on

medically acceptable clinical and

laboratory diagnostic techniques that

establish the existence of a medically

determinable physical or mental

impairment.

We are amending §§ 404.1513 and

416.913 by revising the list of acceptable

medical sources and making other

changes to these and other sections of

our regulations as explained below.

For clarity, we refer to the new rules,

as revised in this regulatory publication,

as ‘‘final’’ rules and to the rules that are

being changed by these final rules as the

‘‘prior’’ rules. However, these final rules

do not go into effect until 30 days after

the date of this publication. Therefore,

the ‘‘prior’’ rules will still be in effect

for another 30 days.

Sections 404.1513 and 416.913

Medical Evidence of Your Impairment

We are revising the heading to read,

‘‘Medical and other evidence of your

impairment(s)’’ to more accurately

identify the subject of these sections.

Even though these prior sections were

called ‘‘Medical evidence of your

impairment,’’ they have always

described how we use evidence from

both acceptable medical sources and

other sources, such as (but not limited

to) nurse-practitioners, chiropractors,

school teachers, and social workers.

Sections 223(d)(3) and 1614(a)(3)(D) of

the Act require that an individual have

a medically determinable physical or

mental impairment that results from

anatomical, physiological, or

psychological abnormalities which are

demonstrable by medically acceptable

clinical and laboratory diagnostic

techniques. To establish the existence of

a medically determinable impairment,

we require evidence from acceptable

medical sources. However, as indicated

in both the prior §§ 404.1513(e) and

416.913(e) and the final §§ 404.1513(d)

and 416.913(d), we also may use

evidence from other sources to help us

understand how an adult’s

impairment(s) affects the ability to work

and how a child’s impairment(s) affects

the ability to function.

We are revising the heading of

§§ 404.1513(a) and 416.913(a) to

‘‘Sources who can provide evidence to

establish an impairment’’ and the

provisions of these paragraphs as well.

These revisions make it clear that we

need evidence from acceptable medical

sources to establish the existence of a

medically determinable impairment. We

then continue to list the sources that we

consider acceptable medical sources in

final paragraphs (a)(1) through (a)(5). In

addition, as described below, we are

making some revisions to this list of

acceptable medical sources. We are also

adding a cross-reference to § 404.1508 in

§ 404.1513(a) and a cross-reference to

§ 416.908 in § 416.913(a). The

regulations to which we are crossreferring, both entitled ‘‘What is needed

to show an impairment,’’ describe the

type of medical evidence we require to

establish the existence of a medically

determinable impairment.

We are revising prior paragraph (a)(1)

(‘‘Licensed physicians’’) by combining it

with prior paragraph (a)(2) (‘‘Licensed

osteopaths’’) because osteopaths are

physicians. Their medical degree is

usually Doctor of Osteopathy (D.O.),

rather than Doctor of Medicine (M.D.).

Thus, a licensed physician may be

either a medical or an osteopathic

physician. Because of this consolidation

of two paragraphs, we are renumbering

prior paragraphs (a)(3) and (a)(4) as final

paragraphs (a)(2) and (a)(3).

We have also added language to final

paragraph (a)(2) (prior paragraph (a)(3),

‘‘Licensed or certified psychologists’’) to

provide that licensed or certified school

psychologists, or licensed or certified

individuals with other titles who

perform the same function as a school

psychologist in a school setting, are

acceptable medical sources for

establishing the existence of mental

retardation, learning disabilities, and

borderline intellectual functioning. The

final provision reflects our longstanding

operating instructions. It also includes

an additional change, which did not

appear in the proposed rules, that we

have made in response to public

comments.

Before including school psychologists

as acceptable medical sources in our

operating instructions for purposes of

establishing the existence of mental

retardation and learning disabilities, we

conducted a State-by-State analysis of

the educational qualifications and other

requirements for their licensure or

certification, and we had discussions

with representatives of the National

Association of School Psychologists on

the issue of what school psychologists

are uniformly qualified to do

nationwide. Although the term

‘‘licensed or certified psychologists’’

encompasses school psychologists, we

found that there was a lack of national

uniformity among the States as to what

school psychologists are allowed to do

beyond assessing cognitive functioning,

such as in the areas of mental

retardation and learning disabilities. We

determined, however, that licensed or

certified school psychologists (or

licensed or certified individuals with

other titles who perform the same

functions as school psychologists in

school settings) are able to provide us

with a complete medical report of

manifestations related to these kinds of

disorders. Therefore, we concluded that

all individuals who are licensed or

certified by their States as school

psychologists (or approved in Michigan,

which is equivalent to licensure or

certification in other States) are medical

sources who can establish the existence

of mental retardation and learning

disabilities. We discuss an additional

change below in the Public Comments

section, where we summarize and

respond to the public comments we

received following our publication of

these regulatory provisions in the

Federal Register as proposed rules on

October 9, 1998 (63 FR 54417). The

additional change is that we have

concluded that these individuals are

also acceptable medical sources for the

purpose of establishing the existence of

borderline intellectual functioning.

We are adding a new paragraph (a)(4)

to include licensed podiatrists as

acceptable medical sources for

impairments of the foot, or foot and

ankle, depending on the delineation in

the State licensure. We have included

these sources in our operating

instructions for many years as

acceptable medical sources for purposes

of establishing the existence of a

medically determinable impairment of

the foot, or foot and ankle, because they

are licensed to practice medicine and

perform surgery on a specific part of the

body. They can do everything that a

physician is licensed to do with respect

34952 Federal Register / Vol. 65, No. 106 / Thursday, June 1, 2000 / Rules and Regulations

to the foot, or foot and ankle, and have

equal standing to physicians in this

respect. Final paragraph (a)(4) provides

that whether evidence from a given

podiatrist can be used to establish the

existence of a medically determinable

impairment of the foot only, or the foot

and ankle, will depend on the scope of

practice of podiatry in a State; i.e.,

whether the State in which the

podiatrist practices permits the practice

of podiatry on the foot only, or on the

foot and ankle. Medical reports from

podiatrists can provide us with all the

evidence we require to establish the

existence of a medically determinable

impairment of the foot, or foot and

ankle.

We are deleting prior paragraph (a)(5),

which provided that persons authorized

to send us a copy or summary of the

medical records of a hospital or other

institution were acceptable medical

sources. Regardless of who is authorized

to send us a medical report, the

evidence itself must be provided by an

acceptable medical source identified in

final paragraphs (a)(1) through (a)(5).

Similarly, we are deleting prior

paragraph (a)(6) (that appears only in

§ 416.913), which provided that reports

of an interdisciplinary team were

acceptable medical sources as long as

they contained the evaluation and

signature of an acceptable medical

source. It does not matter whether the

evaluation by an acceptable medical

source identified in final paragraphs

(a)(1) through (a)(5) is included in an

interdisciplinary team report or is

contained in a separate report. Because

acceptable medical sources are

individuals, it is redundant and

somewhat misleading to provide that an

interdisciplinary team report containing

the evaluation and signature of an

acceptable medical source is such a

source.

We are adding a new paragraph (a)(5)

to include qualified speech-language

pathologists as acceptable medical

sources who can establish the existence

of a speech or language impairment. For

several years, we have included these

individuals in our operating

instructions as medical sources who can

provide evidence to establish the

existence of a medically determinable

speech or language impairment in SSI

childhood disability cases in which the

child is found disabled. The final

regulation now provides that these

individuals are acceptable medical

sources for speech and language

impairments regardless of whether the

determination or decision is favorable to

the individual, and is applicable to both

adults and children and to disability

claims under both titles of the Act.

Before including qualified speechlanguage pathologists in our operating

instructions, we conducted a State-byState analysis of the educational

qualifications and other requirements

for licensure or certification of speechlanguage pathologists, and we had

discussions with representatives of the

American Speech-Language-Hearing

Association. We determined that the

evaluation report of a qualified speechlanguage pathologist can provide us

with the detailed evidence we need

about a person’s communicative ability

that enables us to determine the

existence of a medically determinable

speech or language impairment.

Final paragraph (a)(5) provides that

‘‘qualified’’ speech-language

pathologists are individuals who are

licensed by the State professional

licensing agency, or fully certified by

their State’s education agency, or who

hold a Certificate of Clinical

Competence from the American SpeechLanguage-Hearing Association. We have

cited State licensure as the first

credential for speech-language

pathologists to be consistent with the

paragraphs for physicians and other

acceptable medical sources in this

section, all of which require that the

individual be ‘‘licensed.’’ We have cited

the State education agency certification

as an alternative credential because

some States do not have licensing

agencies for speech-language

pathologists; thus, the only State

credential that speech-language

pathologists have in such States is State

education agency certification. To

maintain either State licensure or State

education agency certification, an

individual must meet certain criteria

(e.g., must obtain 20 continuing

education units in the field over a 2-year

period). We have also cited a Certificate

of Clinical Competence from the

American Speech-Language-Hearing

Association as another acceptable

credential because it indicates that a

speech-language pathologist has met the

stringent criteria for education, training,

examination, and clinical practice set

forth by the American SpeechLanguage-Hearing Association.

Finally, we have made minor editorial

revisions to the provisions in

§§ 404.1513(a)(1) through (a)(5) and

416.913(a)(1) through (a)(5). The

revisions, mostly to correct punctuation,

are not substantive and are not intended

to change the meaning of the provisions.

We are redesignating prior

§§ 404.1513(d) and 416.913(d),

‘‘Completeness,’’ as §§ 404.1513(e) and

416.913(e). We are redesignating prior

paragraph (e) of those sections,

‘‘Information from other sources,’’ as

paragraph (d). Our intent in switching

the positions of these two paragraphs is

to make it clearer that, when we decide

whether the evidence in a case is

complete enough for a determination,

we consider all the evidence in the case

record, including the medical evidence

from acceptable medical sources

identified in paragraph (a), information

from the individual, and any evidence

that may have been provided by other

sources, such as those identified in final

paragraph (d).

We are also revising the language in

final §§ 404.1513(d) and 416.913(d)

(prior paragraph (e)) by making

technical changes for clarity and for

consistency between these provisions in

parts 404 and 416, which contained

some differences in our prior rules. We

are also reorganizing and renumbering

the subparagraphs in final paragraph

(d). In addition, we are deleting the

words ‘‘Information from’’ in the

heading.

We are revising the first sentence of

§ 404.1513(d) to read: ‘‘In addition to

evidence from the acceptable medical

sources listed in paragraph (a) of this

section, we may also use evidence from

other sources to show the severity of

your impairment(s) and how it affects

your ability to work.’’ We are also

revising the first sentence of

§ 416.913(d) to read: ‘‘In addition to

evidence from the acceptable medical

sources listed in paragraph (a) of this

section, we may also use evidence from

other sources to show the severity of

your impairment(s) and how it affects

your ability to work or, if you are a

child, your functioning.’’ In both of

these sentences, we are adding a

reference to the severity of the

individual’s impairment(s) because we

may use evidence from other sources to

show impairment severity, as well as

how it affects the ability to work or, in

§ 416.913(d), a child’s functioning. In

final § 416.913(d), we are changing the

language ‘‘or, if you are a child, your

ability to function independently,

appropriately, and effectively in an ageappropriate manner’’ to ‘‘or, if you are

a child, your functioning,’’ in response

to section 211 of Public Law 104–193

which, on August 22, 1996, added a

new paragraph 1614(a)(3)(C) to the Act

that changed the definition of disability

for individuals under age 18 claiming

SSI benefits.

We are adding the phrase ‘‘but are not

limited to’’ to the second sentence of

final § 404.1513(d) to clarify that the list

of other sources is not an exclusive list

and to make it consistent with the

language in prior § 416.913(e) (final

§ 416.913(d)). We also have deleted the

words ‘‘may’’ and ‘‘and’’ from the

Federal Register / Vol. 65, No. 106 / Thursday, June 1, 2000 / Rules and Regulations 34953

second sentence of final § 416.913(d),

and inserted the word ‘‘but’’ after the

phrase ‘‘Other sources include’’ to make

it consistent with the second sentence of

final § 404.1513(d).

In making these changes in the two

sections, we are consolidating the

provisions from prior §§ 416.913(e)(3)

and (e)(4) in final paragraph (d)(1) and

modifying the example of therapists that

was in the proposed rules so that it is

not restricted to just physical therapists.

The examples in the proposed rules

should not have been limited to

physical therapists because there are

other types of therapists, such as

occupational therapists, as identified in

prior § 416.913(e)(4), recreational

therapists, and kinesiotherapists. We are

deleting ‘‘speech and language

therapists’’ from the examples that were

in prior § 416.913(e)(4) because, as

discussed earlier in this preamble, we

are amending the regulations to include

these individuals as acceptable medical

sources. (However, in final

§ 404.1513(a)(5) and 416.913(a)(5), we

use the term ‘‘speech-language

pathologists’’ because it is a more

accurate title for these health care

professionals.)

We are clarifying in final

§§ 404.1513(d)(1) and 416.913(d)(1), the

list of individuals, such as nursepractitioners and audiologists, who

provide some medical services by

adding the phrase, ‘‘Medical sources not

listed in paragraph (a) of this section.’’

We are including in §§ 404.1513(d)(1)

and 416.913(d)(1) some of the examples

of other medical sources that previously

were contained only in prior

§ 404.1513(e)(3) or only in prior

§ 416.913(e)(3) and (e)(4). The prior

provisions did not provide all the same

examples, and the final rules are now

consistent in parts 404 and 416.

Final §§ 404.1513(d)(2) and

416.913(d)(2) reflect provisions that

were only in prior § 416.913(e)(5).

We are adding the word ‘‘personnel’’

in final §§ 404.1513(d)(3) and

416.913(d)(3). The prior sections

(§§ 404.1513(e)(1) and 416.913(e)(1))

referred to public and private social

welfare ‘‘agencies.’’ However, when we

refer to ‘‘sources’’ in these rules, we

mean people, not entities. This change

also makes the provision similar to

other provisions within these sections.

We begin final §§ 404.1513(d)(4) and

416.913(d)(4) with the phrase, ‘‘Other

non-medical sources,’’ instead of

‘‘Observations by,’’ to make the

construction of final paragraph (d)(4)

parallel to that of final paragraphs (d)(1)

through (d)(3). We are also adding the

language ‘‘(for example, spouses,

parents and other caregivers, siblings,

other relatives, friends, neighbors, and

clergy)’’ to final § 404.1513(d)(4) to

make it consistent with the language in

prior § 416.913(e)(2) (final

§ 416.913(d)(4)).

As is discussed below in the Public

Comments section, we revised the

proposed first sentence of final

§§ 404.1513(e) and 416.913(e) (prior

paragraph (d)) to read: ‘‘The evidence in

your case record, including the medical

evidence from acceptable medical

sources (containing the clinical and

laboratory findings) and other medical

sources not listed in paragraph (a),

information you give us about your

medical condition(s) and how it affects

you, and other evidence from other

sources, must be complete and detailed

enough to allow us to make a

determination or decision about

whether you are disabled or blind.’’ In

the Notice of Proposed Rulemaking

(NPRM), we proposed to simplify the

sentence by deleting any reference to

the medical evidence and referring only

to ‘‘the evidence’’ in a claim. A

commenter believed that it would be

better to retain reference to the medical

evidence and simply to refer to the

types of evidence we obtain. As in the

proposed rules, the change in the final

rules will clarify that we do not look

only at medical evidence from the

acceptable medical sources identified in

paragraph (a), but also at information

provided by the individual and any

evidence that might have been provided

by other sources, as described in final

paragraph (d), when we make a

determination whether the individual is

disabled or blind.

We have revised final paragraph (e)(1)

by deleting the term ‘‘limiting effects’’

and substituting in its place the word

‘‘severity,’’ which more accurately

conveys the statutory requirement that

an individual must have a severe

impairment to be found disabled. We

are revising the language in final

paragraph (e)(2) to more accurately refer

to whether the duration requirement, as

described in §§ 404.1509 and 416.909, is

met.

We are revising final paragraph (e)(3)

by qualifying the language about

residual functional capacity because the

combined evidence must be complete

and detailed enough to allow us to

determine the individual’s residual

functional capacity only when the

evaluation steps described in

§§ 404.1520(e) or (f)(1) and 416.920(e) or

(f)(1) apply. We are also adding the

phrase ‘‘or, if you are a child, your

functioning’’ to § 416.913(e)(3) because

ability to function is the relevant issue

that we must determine for a child, not

residual functional capacity.

Other Changes

Sections 404.1503 and 416.903 Who

Makes Disability and Blindness

Determinations.

We have removed the last sentence in

paragraph (e) because it addressed only

the role in disability determinations of

psychological consultants, and did not

address the parallel situations of

speech-language pathologists and other

consultants. We now provide more

comprehensive rules in revised

paragraphs (c) and (f) of §§ 404.1616 and

416.1016. We explain that nonphysician medical consultants and

psychological consultants can only

evaluate impairments within their area

of expertise.

Sections 404.1512 and 416.912

Evidence of Your Impairment.

We are changing the cross-reference

in paragraph (b)(4) from paragraph (e) to

paragraph (d) to reflect the reversal and

redesignation of these two paragraphs

already explained above.

Sections 404.1526 and 416.926

Medical Equivalence

We are revising the second sentence

in paragraph (c) of §§ 404.1526 and

416.926 to indicate that a medical

consultant must be an acceptable

medical source identified in

§§ 404.1513(a)(1) or (a)(3) through (a)(5)

and 416.913(a)(1) or (a)(3) through

(a)(5). We believe the acceptable

medical sources identified in these

sections, in addition to physicians, are

fully qualified to serve as medical

consultants within their areas of

expertise.

As we discuss below in the Public

Comments section, we received

comments indicating that our intent was

unclear. Accordingly, we are also

revising the last sentence of paragraph

(c), the parenthetical cross-references to

§§ 404.1616 and 416.1016. The

additional language we have included

in final §§ 404.1616 and 416.1016

clarifies that medical consultants who

are not physicians are limited to

evaluating impairments within their

specialties; for example, a speechlanguage pathologist functioning as a

medical consultant would be able to

provide an opinion about medical

equivalence only with respect to a

speech or language impairment.

Sections 404.1615 and 416.1015

Making Disability Determinations

We are removing the last sentence in

paragraph (d). In the NPRM, we

inadvertently failed to propose deleting

this last sentence, which is the exact

same provision contained in the last

34954 Federal Register / Vol. 65, No. 106 / Thursday, June 1, 2000 / Rules and Regulations

sentence we are removing in paragraph

(e) of §§ 404.1503 and 416.903.

Therefore, for the same reasons

discussed earlier for the deletion in

§§ 404.1503 and 416.903, we are

deleting this last sentence as well from

§§ 404.1615(d) and 416.1015(d).

Sections 404.1616 and 416.1016

Medical or Psychological Consultants

In the NPRM, we proposed to revise

the first sentence in §§ 404.1616 and

416.1016 to indicate that a medical

consultant must be an acceptable

medical source identified in

§§ 404.1513(a)(1) or (a)(3) through (a)(5)

and 416.913(a)(1) or (a)(3) through

(a)(5). As we discuss below in the Public

Comments section, we received a

number of comments that indicated to

us that our intent was unclear or that

recommended additional rules defining

the authority of medical consultants

who are not physicians. Accordingly,

we have extensively revised §§ 404.1616

and 416.1016.

The final rules now contain six

paragraphs, designated (a) through (f).

Paragraph (a), ‘‘What is a medical

consultant?’’ explains that a ‘‘medical

consultant’’ is a person who is a

member of a team that makes disability

determinations in a State agency, as

explained in §§ 404.1615 and 416.1015,

or who is a member of a team that

makes disability determinations for us

when we make disability

determinations ourselves.

Paragraph (b), ‘‘What qualifications

must a medical consultant have?’’

provides that a medical consultant must

be an acceptable medical source

identified in §§ 404.1513(a)(1) and (a)(3)

through (a)(5) and 416.913(a)(1) and

(a)(3) through (a)(5) and names all of the

acceptable medical sources, in addition

to cross-referencing these provisions as

we had done in the NPRM. We believe

that this is a clearer way to explain who

is included. The paragraph also

provides that the medical consultant

must meet any appropriate

qualifications for his or her specialty as

explained in § § 404.1513(a) or

416.913(a).

Final paragraph (c) is called, ‘‘Are

there any limitations on what medical

consultants who are not physicians can

evaluate?’’ In this paragraph, we clarify

in response to comments what was

always our intent: that even though any

individual who is an acceptable medical

source may be a medical consultant,

medical consultants who are not

physicians are limited to evaluations to

the same extent that they would be

limited in providing evidence of a

medically determinable impairment. We

provide an example explaining the

limitations of a State agency medical

consultant who, as a team member that

makes disability determinations, is a

speech-language pathologist.

Paragraph (d) is called, ‘‘What is a

psychological consultant?’’ It explains

that a psychological consultant may

function in the same capacity as any of

the individuals in paragraph (a) except

that they are limited to the evaluation of

mental impairments.

Paragraph (e) incorporates the second

and third sentences of the opening

paragraph of prior §§ 404.1616 and

416.1016, and paragraphs (a), (b), and

(c) of those sections. We have

incorporated the provisions verbatim.

The only differences are in the letter

and number designations of the

paragraph and subparagraphs and the

new heading we added to final

paragraph (e) for consistency with the

headings of the previous paragraphs.

The prior provisions did not use

headings.

Paragraph (f) is called, ‘‘Are there any

limitations on what a psychological

consultant can evaluate?’’ It parallels

paragraph (c) of this section, discussed

above.

Public Comments

We published these regulatory

provisions in the Federal Register as an

NPRM on October 9, 1998 (63 FR

54417). The comment period closed on

December 8, 1998. We received

comments in response to this notice

from 12 individuals and organizations,

including government agencies whose

interests and responsibilities require

them to have some expertise in the

evaluation of medical evidence used in

making disability determinations under

titles II and XVI of the Act. We also

received comments from a private, nonprofit organization for the disabled, an

individual attorney, health care

professional organizations, and an

employee union.

Most of the commenters stated that

they supported the proposed rules.

However, a number of commenters

offered suggestions for revisions and

additions, as explained below. Three

commenters supported the rules

without making any recommendations.

One commenter opposed all of the rules.

Because some of the comments were

similar, we condensed, summarized, or

paraphrased them. We have, however,

tried to summarize the commenters’

views accurately and to respond to all

of the significant issues raised by the

commenters that are within the scope of

these rules.

Comment: Two commenters

recommended that we revise paragraph

(a)(2) of §§ 404.1513 and 416.913 to

include borderline intellectual

functioning in the list of impairments

that can be established by evidence from

licensed or certified school

psychologists.

Response: We adopted the comments.

As one of the commenters noted,

borderline intellectual functioning is a

medically determinable mental

impairment that results from

psychological abnormalities

demonstrable by medically acceptable

clinical and laboratory diagnostic

techniques. It is usually assigned to

individuals who have an intelligence

quotient (IQ) score in the 71–84 range

and for whom the diagnosis of mental

retardation has been excluded. School

psychologists are qualified to assess

cognitive abilities at all levels, and we

agree that they can establish the

existence of borderline intellectual

functioning.

Comment: One commenter

recommended that we expand proposed

paragraph (a)(5) of §§ 404.1513 and

416.913 to permit qualified speechlanguage pathologists to establish

speech, language, ‘‘or related (e.g.,

swallowing)’’ impairments. The

commenter also recommended that we

expand the qualification criterion in the

proposed rules concerning meeting

State education agency standards to say:

‘‘* * * provided such standards are

consistent with the highest

requirements for State-approved or

State-recognized certification, licensing,

registration, or other comparable

requirements for speech-language

pathologists.’’ The commenter believed

that this would make clear that the word

‘‘qualified’’ refers to individuals who

have met the requirements in the State,

and would ensure that only those

individuals with sufficient training and

clinical expertise are allowed to provide

evidence used in making a disability

determination.

Response: We are not adopting the

recommendation to consider speechlanguage pathologists as acceptable

medical sources for ‘‘related (e.g.,

swallowing)’’ impairments. Because of

the complex anatomical and

physiological construct involved in the

swallowing mechanism, specific

knowledge and training that encompass

the medical areas of neurology,

otolaryngology, and gastroenterology are

required for the proper interpretation of

laboratory and imaging studies

necessary in arriving at the diagnosis,

prognosis, and treatment regimen

pertaining to the variety of disorders

associated with swallowing. Therefore,

we will continue to require evidence

from a licensed physician to establish

Federal Register / Vol. 65, No. 106 / Thursday, June 1, 2000 / Rules and Regulations 34955

the existence of a medically

determinable swallowing impairment.

We are also not adopting the second

comment about State education agency

standards being consistent with the

highest State requirements because it

would not be feasible for us to

constantly monitor such standards and

requirements in each State.

For reasons already noted above in

the summary of the changes in these

final rules, we have cited State licensure

as the first credential in the rule.

Comment: One commenter

recommended that we not delete

paragraph (a)(6) of § 416.913, the

paragraph that addresses

interdisciplinary assessments in which

there is a signature from an acceptable

medical source. The commenter

believed that this paragraph helps to

avoid confusion about the acceptability

of evidence that is signed by both a

medical and a nonmedical source. The

commenter also recommended that we

add the same provision to § 404.1513.

Response: We did not adopt the

comment because the construction of

paragraph (a)(6) is confusing and not

parallel to the construction of the other

paragraphs in paragraph (a). Paragraph

(a) concerns who is an acceptable

medical source, not what is ‘‘acceptable

medical evidence.’’ Moreover, an

acceptable medical source must be a

person, not ‘‘[a] report’’ as stated in

paragraph (a)(6). The fact that an

interdisciplinary team report is cosigned by both a medical and

nonmedical source does not mean that

the report cannot be considered

‘‘acceptable medical evidence,’’ i.e.,

evidence from an acceptable medical

source. Provided that the medical

source is an acceptable medical source

identified in final paragraphs (a)(1)

through (a)(5) of § § 404.1513 and

416.913, it does not matter whether an

evaluation signed by an acceptable

medical source is included in an

interdisciplinary team report or is

contained in a separate report.

Comment: Three commenters

recommended that we include other

medical professionals in our list of

acceptable medical sources. One

commenter recommended that we

include optometrists for the

determination of other aspects of eye

diseases, in addition to the

measurement of visual acuity and visual

fields. Another commenter

recommended that we recognize

audiologists as acceptable medical

sources for purposes of establishing

hearing or related (e.g., balance)

impairments only. This source

recommended criteria for establishing

that an audiologist is ‘‘qualified’’ for our

program. The third commenter

recommended that we include pediatric

nurse-practitioners for establishing the

existence of medically determinable

impairments in children.

Response: We did not adopt the

comments. Sections 223(d)(3) and

1614(a)(3)(D) of the Act require that an

individual have a medically

determinable physical or mental

impairment that results from

anatomical, physiological, or

psychological abnormalities which are

demonstrable by medically acceptable

clinical and laboratory diagnostic

techniques. In keeping with these

statutory provisions, we generally

consider licensed physicians and

licensed or certified psychologists, who

are the most qualified health care

professionals, as ‘‘acceptable medical

sources’’ who can establish the

existence of a medically determinable

impairment. We have also provided in

these final rules that podiatrists and

speech-language pathologists may be

acceptable medical sources, not only

because of their unique qualifications,

but because we have determined that

there is sufficient standardization of

their qualifications across the States for

us to provide rules for their general use

in claims. We have not determined this

for other specialties. Therefore, we

believe it would be inappropriate to

include these additional specialties at

this time.

However, we want to make clear that

we consider information from the

sources named in the comments to be

important evidence when we determine

the severity of an individual’s

impairment. The rules on who is an

acceptable medical source address a

single, narrow issue in our disability

evaluations: who can provide evidence

to establish whether an individual has

a medically determinable impairment as

required by the Act. Once an individual

has crossed this threshold, we can and

do consider all evidence that helps us

to determine the severity of the

impairment and its effects on the

individual. For this critical aspect of the

disability determination process, we

will continue to use information from

the sources named in the comments.

Comment: One commenter disagreed

with our inclusion of licensed or

certified psychologists, school

psychologists and speech-language

pathologists as ‘‘acceptable medical

sources’’ in our regulations. The

commenter said that we should clarify

that these sources are acceptable sources

of evidence but that they are not

‘‘medical’’ sources. The commenter

believed that ‘‘medical’’ sources should

refer only to physicians and that

Congress did not intend for us to

include any of the other sources.

Response: We did not adopt the

comment. Sections 223(d)(3) and

1614(a)(3)(D) of the Act define a

medically determinable impairment as

one that results from ‘‘anatomical,

physiological, or psychological

abnormalities which are demonstrable

by medically acceptable clinical and

laboratory diagnostic techniques.’’ As

we noted in the preamble to the

proposed rules, we have included

licensed or certified school

psychologists (or licensed or certified

individuals with other titles who

perform the same function as a school

psychologist in a school setting) and

speech-language pathologists as

‘‘acceptable medical sources’’ because

we have determined that they can

provide us with medical evidence to

establish the existence of a medically

determinable impairment within their

areas of specialty using ‘‘medically

acceptable clinical and laboratory

diagnostic techniques,’’ as defined in

section 223(d)(3) of the Act. We have

included licensed or certified

psychologists in our regulations

defining acceptable medical sources for

many years, and, in fact, section 221(h)

of the Act refers to these sources as

qualified to complete the medical

portion of our case review where there

is evidence which indicates the

existence of a mental impairment.

Comment: Five of the commenters

commented about the provisions in

§ § 404.1526(c), 404.1616, 416.926(c)

and 416.1016 of the proposed rules that

would define the term ‘‘medical

consultant’’ to include any acceptable

medical source in § § 404.1513(a)(1) or

(a)(3) to (a)(5) and 416.913(a)(1) or (a)(3)

to (a)(5). One commenter simply noted

that this would permit licensed

optometrists, licensed podiatrists, and

qualified speech-language pathologists

to function as ‘‘medical consultants,’’

but the commenter did not note

approval or disapproval or make any

recommendations. Two commenters

indicated that such sources would have

limited usefulness as medical

consultants in the State agencies that

make disability determinations for us

because their expertise is so narrow.

One of these commenters recommended

that we should include provisions

defining the authority of these

individuals in § § 404.1526(c) and

416.926(c), our regulations on ‘‘Who is

a designated medical or psychological

consultant’’ for purposes of determining

medical equivalence, and in

§ § 404.1616 and 416.1016, our

regulations defining the standards for

34956 Federal Register / Vol. 65, No. 106 / Thursday, June 1, 2000 / Rules and Regulations

who can be a medical or psychological

consultant.

Two commenters opposed expanding

the definition of medical consultant to

include optometrists, podiatrists, and

speech-language pathologists as medical

consultants. One commenter believed

that there was no rational justification

in the proposed regulations for the

‘‘dramatic’’ change, and was concerned

that the change would jeopardize the

integrity of the disability programs,

especially if it is implemented in

conjunction with some of the Disability

Redesign proposals. This commenter,

while opposing the use of the sources as

medical consultants, otherwise

generally agreed with our proposal to

consider these sources to be acceptable

medical sources for purposes of

providing medical evidence we need to

establish the existence of a medically

determinable impairment.

The last commenter, who opposed

using these sources even as ‘‘acceptable

medical sources’’ for establishing the

existence of medically determinable

impairments, focused on the proposal as

it affected § § 404.1526 and 416.926.

This commenter indicated that the

sources were ‘‘nonqualified.’’ The

commenter provided a number of

specific reasons that they should not be

permitted to make determinations of

medical equivalence, primarily because

they would be making decisions

regarding areas for which they have no

training or expertise and for which they

are unlicensed under the law of any

State. The commenter also

recommended that we revise the

medical equivalence regulations to

clarify the various ways in which we

make findings of medical equivalence.

The commenter also stated that we

should specify that all claims of

combined mental and physical

disorders should be reviewed by a

psychiatrist to ensure that all aspects of

mental and physical disorders are

considered in rating the severity of

impairment at any step of our process

for determining disability.

Response: We are revising

§ § 404.1616 and 416.1016 in response

to these comments. We are also adding

a cross-reference to § § 404.1616 and

416.1016 for medical consultants who

are not physicians at the end of

§ § 404.1526(c) and 416.926(c) as we

have noted in the explanation of the

changes.

As two of the commenters recognized,

our intent in the NPRM was to limit the

authority of licensed optometrists,

licensed podiatrists, and qualified

speech-language pathologists to evaluate

impairments with regard to their areas

of expertise delineated in proposed

§ § 404.1513(a) and 416.913(a).

However, the comments made us realize

that our intent was not clear and could

be misinterpreted. Therefore, we have

expanded final § § 404.1616 and

416.1016 to provide explicitly that

acceptable medical sources other than

physicians (i.e., licensed optometrists,

licensed podiatrists, and qualified

speech-language pathologists) may

function as medical consultants, but

their authority in helping to make

determinations and in providing

opinions about medical equivalence and

elsewhere is limited to their area of

expertise.

Although it was unclear from the

comment which disability redesign

proposals one of the commenters

referred to, we disagree with that

comment. We believe that providing

State agencies with the opportunity to

use these additional specialists in a

consulting capacity will improve their

ability to make timely, accurate

decisions.

With regard to the comment asking us

to include the various ways we make

findings of medical equivalence, we

believe that the change is outside the

scope of our authority because we did

not propose the change. However, we

will consider this comment when we

propose other changes in the future.

In making the revisions to

§ § 404.1616 and 416.1016 in response

to these comments, we added new

paragraphs with letter and number

designations. Therefore, we had to

redesignate the paragraph letters and

numbers from the prior rules that

describe qualified psychologists. Apart

from the change in the designations of

the letters and numbers of the

paragraphs, we did not change the

language of those paragraphs.

In response to the last comment,

regarding review by a psychiatrist of any

case involving a combination of mental

and physical disorders, we are

providing in final paragraph (c) of

§ § 404.1616 and 416.1016 that a

physician must evaluate the case record,

except when the mental impairment

alone would justify a finding of

disability. However, we do not agree

with the commenter that a psychiatrist

will be the best physician to assess a

combination of mental and physical

disorders in all claims. There are claims

in which it is more appropriate to use

other specialists for the overall review

in consultation with a psychiatrist or

psychologist.

Comment: One of the foregoing

commenters also pointed out that the

first sentence of prior § § 404.1616 and

416.1016 seemed incomplete. The

commenter noted that the heading of

these regulations referred to ‘‘Medical or

psychological consultant,’’ yet the first

sentence referred only to medical

consultants. The commenter provided a

recommended revision that would

include psychological consultants.

Response: We adopted the comment,

although not in the exact way suggested

by the commenter. In response to this,

and the comments already noted, we

have revised the entire sections to

clarify their provisions.

Comment: One commenter suggested

that we revise proposed § § 404.1513(e)

and 416.913(e) (prior § § 404.1513(d)

and 416.913(d)) to read: ‘‘The medical

evidence, including the clinical and

laboratory find[ing]s, and other

evidence from other sources must be

complete and detailed enough to allow

us to make a determination about

whether you are disabled or blind.’’ The

commenter believed that it would be

better to retain reference in our

regulations to the medical and other

evidence we need to establish the

existence of a medically determinable

impairment and its severity.

Response: We adopted the comment,

but did not use the exact language

proposed by the commenter. We believe

that the commenter’s proposed language

could be misinterpreted to mean that

each piece of evidence must be

complete and detailed enough in and of

itself for us to make the various findings

listed in these regulation sections, or

that we must try to obtain all available

evidence, even after the record is

complete and detailed enough for us to

make a determination or decision.

Therefore, the final rule provides:

‘‘The evidence in your case record,

including the medical evidence from

acceptable medical sources (containing

the clinical and laboratory findings) and

other medical sources not listed in

paragraph (a), information you give us

about your medical condition(s) and

how it affects you, and other evidence

from other sources, must be complete

and detailed enough to allow us to make

a determination or decision about

whether you are disabled or blind.’’ We

changed the phrase near the end to

‘‘make a determination or decision’’ for

technical reasons. Under our regulations

§ § 404.901 and 416.1401, the term

‘‘determination’’ means the initial or

reconsidered determination, and the

term ‘‘decision’’ means the decision

made by an administrative law judge or

the Appeals Council. This is not a

substantive change in the rule, only a

clarification of its meaning to show that

it applies to all of our adjudicators.

Federal Register / Vol. 65, No. 106 / Thursday, June 1, 2000 / Rules and Regulations 34957

Regulatory Procedures

Executive Order 12866

We have consulted with the Office of

Management and Budget (OMB) and

determined that these final rules do not

meet the criteria for a significant

regulatory action under Executive Order

(E.O.) 12866. Therefore, they were not

subject to OMB review. We have also

determined that these rules meet the

plain language requirements of E.O.

12866 and the President’s memorandum

of June 1, 1998.

Regulatory Flexibility Act

We certify that these final regulations

will not have a significant economic

impact on a substantial number of small

entities because they affect only

individuals. Therefore, a regulatory

flexibility analysis as provided in the

Regulatory Flexibility Act, as amended,

is not required.

Paperwork Reduction Act

These final regulations impose no

new reporting or recordkeeping

requirements subject to OMB clearance.

(Catalog of Federal Domestic Assistance

Program Nos. 96.001, Social SecurityDisability Insurance; 96.002, Social

Security-Retirement Insurance; 96.004,

Social Security-Survivors Insurance;

96.006, Supplemental Security Income.)

List of Subjects

20 CFR Part 404

Administrative practice and

procedure, Blind, Disability benefits,

Old-Age, Survivors, and Disability

Insurance, Reporting and recordkeeping

requirements, Social Security.

20 CFR Part 416

Administrative practice and

procedure, Aged, Blind, Disability

benefits, Public assistance programs,

Reporting and recordkeeping

requirements, Supplemental Security

Income (SSI).

Dated: May 22, 2000.

Kenneth S. Apfel,

Commissioner of Social Security.

For the reasons set out in the

preamble, subparts P and Q of part 404

and subparts I and J of part 416 of 20

CFR chapter III are amended as set forth

below:

PART 404—FEDERAL OLD-AGE,

SURVIVORS AND DISABILITY

INSURANCE (1950— )

Subpart P—[Amended]

1. The authority citation for subpart P

of part 404 continues to read as follows:

Authority: Secs. 202, 205(a), (b), and (d)–

(h), 216(i), 221(a) and (i), 222(c), 223, 225,

and 702(a)(5) of the Social Security Act (42

U.S.C. 402, 405(a), (b), and (d)–(h), 416(i),

421(a) and (i), 422(c), 423, 425, and

902(a)(5)); sec. 211(b), Pub. L. 104–193, 110

Stat. 2105, 2189.

§ 404.1503 [Amended]

2. Section 404.1503 is amended by

removing the last sentence of paragraph

(e).

3. Section 404.1512 is amended by

revising paragraph (b)(4) to read as

follows:

§ 404.1512 Evidence of your impairment.

* * * * *

(b) * * *

(4) Information from other sources, as

described in § 404.1513(d);

* * * * *

4. Section 404.1513 is amended by

revising the heading and paragraphs (a),

(d), and (e) to read as follows:

§ 404.1513 Medical and other evidence of

your impairment(s).

(a) Sources who can provide evidence

to establish an impairment. We need

evidence from acceptable medical

sources to establish whether you have a

medically determinable impairment(s).

See § 404.1508. Acceptable medical

sources are—

(1) Licensed physicians (medical or

osteopathic doctors);

(2) Licensed or certified

psychologists. Included are school

psychologists, or other licensed or

certified individuals with other titles

who perform the same function as a

school psychologist in a school setting,

for purposes of establishing mental

retardation, learning disabilities, and

borderline intellectual functioning only;

(3) Licensed optometrists, for the

measurement of visual acuity and visual

fields (we may need a report from a

physician to determine other aspects of

eye diseases);

(4) Licensed podiatrists, for purposes

of establishing impairments of the foot,

or foot and ankle only, depending on

whether the State in which the

podiatrist practices permits the practice

of podiatry on the foot only, or the foot

and ankle; and

(5) Qualified speech-language

pathologists, for purposes of

establishing speech or language

impairments only. For this source,

‘‘qualified’’ means that the speechlanguage pathologist must be licensed

by the State professional licensing

agency, or be fully certified by the State

education agency in the State in which

he or she practices, or hold a Certificate

of Clinical Competence from the

American Speech-Language-Hearing

Association.

* * * * *

(d) Other sources. In addition to

evidence from the acceptable medical

sources listed in paragraph (a) of this

section, we may also use evidence from

other sources to show the severity of

your impairment(s) and how it affects

your ability to work. Other sources

include, but are not limited to—

(1) Medical sources not listed in

paragraph (a) of this section (for

example, nurse-practitioners,

physicians’ assistants, naturopaths,

chiropractors, audiologists, and

therapists);

(2) Educational personnel (for

example, school teachers, counselors,

early intervention team members,

developmental center workers, and

daycare center workers);

(3) Public and private social welfare

agency personnel; and

(4) Other non-medical sources (for

example, spouses, parents and other

caregivers, siblings, other relatives,

friends, neighbors, and clergy).

(e) Completeness. The evidence in

your case record, including the medical

evidence from acceptable medical

sources (containing the clinical and

laboratory findings) and other medical

sources not listed in paragraph (a) of

this section, information you give us

about your medical condition(s) and

how it affects you, and other evidence

from other sources, must be complete

and detailed enough to allow us to make

a determination or decision about

whether you are disabled or blind. It

must allow us to determine—

(1) The nature and severity of your

impairment(s) for any period in

question;

(2) Whether the duration requirement

described in § 404.1509 is met; and

(3) Your residual functional capacity

to do work-related physical and mental

activities, when the evaluation steps

described in § 404.1520(e) or (f)(1)

apply.

5. Section 404.1526 is amended by

revising the second and fourth

sentences of paragraph (c) to read as

follows:

§ 404.1526 Medical equivalence.

* * * * *

(c) Who is a designated medical or

psychological consultant. * * * A

medical consultant must be an

acceptable medical source identified in

§ 404.1513(a)(1) or (a)(3) through (a)(5).

* * * (See § 404.1616 for limitations on

what medical consultants who are not

physicians can evaluate and the

qualifications we consider necessary for

a psychologist to be a consultant.)

34958 Federal Register / Vol. 65, No. 106 / Thursday, June 1, 2000 / Rules and Regulations

Subpart Q—[Amended]

6. The authority citation for subpart Q

of part 404 continues to read as follows:

Authority: Secs. 205(a), 221, and 702(a)(5)

of the Social Security Act (42 U.S.C. 405(a),

421, and 902(a)(5)).

§ 404.1615 [Amended]

7. Section 404.1615 is amended by

removing the last sentence of paragraph

(d).

8. Section 404.1616 is revised to read

as follows:

§ 404.1616 Medical or psychological

consultants.

(a) What is a medical consultant? A

medical consultant is a person who is a

member of a team that makes disability

determinations in a State agency, as

explained in § 404.1615, or who is a

member of a team that makes disability

determinations for us when we make

disability determinations ourselves.

(b) What qualifications must a

medical consultant have? A medical

consultant must be an acceptable

medical source identified in

§ 404.1513(a)(1) or (a)(3) through (a)(5);

that is, a licensed physician (medical or

osteopathic), a licensed optometrist, a

licensed podiatrist, or a qualified

speech-language pathologist. The

medical consultant must meet any

appropriate qualifications for his or her

specialty as explained in § 404.1513(a).

(c) Are there any limitations on what

medical consultants who are not

physicians can evaluate? Medical

consultants who are not physicians are

limited to evaluating the impairments

for which they are qualified, as

described in § 404.1513(a). Medical

consultants who are not physicians also

are limited as to when they may serve

as a member of a team that makes a

disability determination. For example, a

speech-language pathologist who is a

medical consultant in a State agency

may be a member of a team that makes

a disability determination in a claim

only if a speech or language impairment

is the only impairment in the claim or

if there is a combination of a speech or

language impairment with another

impairment but the speech or language

impairment alone would justify a

finding of disability. In all other cases,

a physician will be a member of the

team that makes a disability

determination, except in cases in which

this function may be performed by a

psychological consultant as discussed in

paragraph (f) of this section and

§ 404.1615(d).

(d) What is a psychological

consultant? A psychological consultant

is a psychologist who has the same

responsibilities as a medical consultant

explained in paragraph (a) of this

section, but who can evaluate only

mental impairments.

(e) What qualifications must a

psychological consultant have? A

psychological consultant used in cases

where there is evidence of a mental

impairment must be a qualified

psychologist. For disability program

purposes, a psychologist will not be

considered qualified unless he or she:

(1) Is licensed or certified as a

psychologist at the independent practice

level of psychology by the State in

which he or she practices; and

(2)(i) Possesses a doctorate degree in

psychology from a program in clinical

psychology of an educational institution

accredited by an organization

recognized by the Council on PostSecondary Accreditation; or

(ii) Is listed in a national register of

health service providers in psychology

which the Commissioner of Social

Security deems appropriate; and

(3) Possesses 2 years of supervised

clinical experience as a psychologist in

health service, at least 1 year of which

is post masters degree.

(f) Are there any limitations on what

a psychological consultant can

evaluate? Psychological consultants are

limited to the evaluation of mental

impairments, as explained in

§ 404.1615(d). Psychological consultants

also are limited as to when they can

serve as a member of a team that makes

a disability determination. They may do

so only when a mental impairment is

the only impairment in the claim or

when there is a combination of a mental

impairment with another impairment

but the mental impairment alone would

justify a finding of disability.

PART 416—SUPPLEMENTAL

SECURITY INCOME FOR THE AGED,

BLIND, AND DISABLED

Subpart I—[Amended]

9. The authority citation for subpart I

of part 416 continues to read as follows:

Authority: Secs. 702(a)(5), 1611, 1614,

1619, 1631(a), (c), and (d)(1), and 1633 of the

Social Security Act (42 U.S.C. 902(a)(5),

1382, 1382c, 1382h, 1383(a), (c), and (d)(1),

and 1383b); secs. 4(c) and 5, 6(c)-(e), 14(a)

and 15, Pub. L. 98–460, 98 Stat. 1794, 1801,

1802, and 1808 (42 U.S.C. 421 note, 423 note,

1382h note).

§ 416.903 [Amended]

10. Section 416.903 is amended by

removing the last sentence of paragraph

(e).

11. Section 416.912 is amended by

revising paragraph (b)(4) to read as

follows:

§ 416.912 Evidence of your impairment.

* * * * *

(b) * * *

(4) Information from other sources, as

described in § 416.913(d);

* * * * *

12. Section 416.913 is amended by

revising the heading and paragraphs (a),

(d), and (e) to read as follows:

§ 416.913 Medical and other evidence of

your impairment(s).

(a) Sources who can provide evidence

to establish an impairment. We need

evidence from acceptable medical

sources to establish whether you have a

medically determinable impairment(s).

See § 416.908. Acceptable medical

sources are—

(1) Licensed physicians (medical or

osteopathic doctors);

(2) Licensed or certified

psychologists. Included are school

psychologists, or other licensed or

certified individuals with other titles

who perform the same function as a

school psychologist in a school setting,

for purposes of establishing mental

retardation, learning disabilities, and

borderline intellectual functioning only;

(3) Licensed optometrists, for the

measurement of visual acuity and visual

fields (see paragraph (f) of this section

for the evidence needed for statutory

blindness);

(4) Licensed podiatrists, for purposes

of establishing impairments of the foot,

or foot and ankle only, depending on

whether the State in which the

podiatrist practices permits the practice

of podiatry on the foot only, or the foot

and ankle; and

(5) Qualified speech-language

pathologists, for purposes of

establishing speech or language

impairments only. For this source,

‘‘qualified’’ means that the speechlanguage pathologist must be licensed

by the State professional licensing

agency, or be fully certified by the State

education agency in the State in which

he or she practices, or hold a Certificate

of Clinical Competence from the

American-Speech-Language-Hearing

Association.

* * * * *

(d) Other sources. In addition to

evidence from the acceptable medical

sources listed in paragraph (a) of this

section, we may also use evidence from

other sources to show the severity of

your impairment(s) and how it affects

your ability to work or, if you are a

child, your functioning. Other sources

include, but are not limited to—

(1) Medical sources not listed in

paragraph (a) of this section (for

example, nurse-practitioners,

Federal Register / Vol. 65, No. 106 / Thursday, June 1, 2000 / Rules and Regulations 34959

physicians’ assistants, naturopaths,

chiropractors, audiologists, and

therapists);

(2) Educational personnel (for

example, school teachers, counselors,

early intervention team members,

developmental center workers, and

daycare center workers);

(3) Public and private social welfare

agency personnel; and

(4) Other non-medical sources (for

example, spouses, parents and other

caregivers, siblings, other relatives,

friends, neighbors, and clergy).

(e) Completeness. The evidence in

your case record, including the medical

evidence from acceptable medical

sources (containing the clinical and

laboratory findings) and other medical

sources not listed in paragraph (a) of

this section, information you give us

about your medical condition(s) and

how it affects you, and other evidence

from other sources, must be complete

and detailed enough to allow us to make

a determination or decision about

whether you are disabled or blind. It

must allow us to determine—

(1) The nature and severity of your

impairment(s) for any period in

question;

(2) Whether the duration requirement

described in § 416.909 is met; and

(3) Your residual functional capacity

to do work-related physical and mental

activities, when the evaluation steps

described in § 416.920(e) or (f)(1) apply,

or, if you are a child, your functioning.

* * * * *

13. Section 416.926 is amended by

revising the second and fourth

sentences of paragraph (c) to read as

follows:

§ 416.926 Medical equivalence for adults

and children.

* * * * *

(c) Who is a designated medical or

psychological consultant. * * * A

medical consultant must be an

acceptable medical source identified in

§ 416.913(a)(1) or (a)(3) through (a)(5).

* * * (See § 416.1016 for limitations on

what medical consultants who are not

physicians can evaluate and the

qualifications we consider necessary for

a psychologist to be a consultant.)

* * * * *

Subpart J—[Amended]

14. The authority citation for subpart

J of part 416 continues to read as

follows:

Authority: Secs. 702(a)(5), 1614, 1631, and

1633 of the Social Security Act (42 U.S.C.

902(a)(5), 1382c, 1383, and 1383b).

§ 416.1015 [Amended]

15. Section 416.1015 is amended by

removing the last sentence of paragraph

(d).

16. Section 416.1016 is revised to read

as follows:

§ 416.1016 Medical or psychological

consultants.

(a) What is a medical consultant? A

medical consultant is a person who is a

member of a team that makes disability

determinations in a State agency, as

explained in § 416.1015, or who is a

member of a team that makes disability

determinations for us when we make

disability determinations ourselves.

(b) What qualifications must a

medical consultant have? A medical

consultant must be an acceptable

medical source identified in

§ 416.913(a)(1) or (a)(3) through (a)(5);

that is, a licensed physician (medical or

osteopathic), a licensed optometrist, a

licensed podiatrist, or a qualified

speech-language pathologist. The

medical consultant must meet any

appropriate qualifications for his or her

specialty as explained in § 416.913(a).

(c) Are there any limitations on what

medical consultants who are not

physicians can evaluate? Medical

consultants who are not physicians are

limited to evaluating the impairments

for which they are qualified, as

described in § 416.913(a). Medical

consultants who are not physicians also

are limited as to when they may serve

as a member of a team that makes a

disability determination. For example, a

speech-language pathologist who is a

medical consultant in a State agency

may be a member of a team that makes

a disability determination in a claim

only if a speech or language impairment

is the only impairment in the claim or

if there is a combination of a speech or

language impairment with another

impairment but the speech or language

impairment alone would justify a

finding of disability. In all other cases,

a physician will be a member of the

team that makes a disability

determination, except in cases in which

this function may be performed by a

psychological consultant as discussed in

paragraph (f) of this section and

§ 416.1015(d).

(d) What is a psychological

consultant? A psychological consultant

is a psychologist who has the same

responsibilities as a medical consultant

explained in paragraph (a) of this

section, but who can evaluate only

mental impairments.

(e) What qualifications must a

psychological consultant have? A

psychological consultant used in cases

where there is evidence of a mental

impairment must be a qualified

psychologist. For disability program

purposes, a psychologist will not be

considered qualified unless he or she:

(1) Is licensed or certified as a

psychologist at the independent practice

level of psychology by the State in

which he or she practices; and

(2)(i) Possesses a doctorate degree in

psychology from a program in clinical

psychology of an educational institution

accredited by an organization

recognized by the Council on PostSecondary Accreditation; or

(ii) Is listed in a national register of

health service providers in psychology

which the Commissioner of Social

Security deems appropriate; and

(3) Possesses 2 years of supervised

clinical experience as a psychologist in

health service, at least 1 year of which

is post masters degree.

(f) Are there any limitations on what

a psychological consultant can

evaluate? Psychological consultants are

limited to the evaluation of mental

impairments, as explained in

§ 416.1015(d). Psychological consultants

also are limited as to when they can

serve as a member of a team that makes

a disability determination. They may do

so only when a mental impairment is

the only impairment in the claim or

when there is a combination of a mental

impairment with another impairment

but the mental impairment alone would

justify a finding of disability.

[FR Doc. 00–13607 Filed 5–31–00; 8:45 am]

BILLING CODE 4191–02–U

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Food and Drug Administration

21 CFR Part 5

Delegations of Authority and

Organization; Food and Drug

Administration

AGENCY: Food and Drug Administration,

HHS.

ACTION: Final rule.

SUMMARY: The Food and Drug

Administration (FDA) is amending the

general redelegations of authority from

the Commissioner of Food and Drugs to

other officers of FDA. On June 20, 1999,

the Commissioner of Food and Drugs

restructured FDA ‘‘to create a more

streamlined and efficient Office of the

Commissioner that will provide

leadership without compromising

programmatic effectiveness.’’ In this

restructuring, organizational