Federal Register / Vol. 71, No. 223 / Monday, November 20, 2006 / Rules and Regulations 67037 

§ 750.3 Review of license applications by 

BIS and other government agencies and 

departments. 

* * * * * 

(b) * * * 

(2) * * * 

(v) The Department of Justice is 

concerned with controls relating to 

encryption items and items primarily 

useful for the surreptitious interception 

of wire, oral, or electronic 

communications. 

PART 752—[AMENDED] 

■ 15. The authority citation for 15 CFR 

part 752 continues to read as follows: 

Authority: 50 U.S.C. app. 2401 et seq.; 50 

U.S.C. 1701 et seq.; E.O. 13020, 61 FR 54079, 

3 CFR, 1996 Comp. p. 219; E.O. 13222, 66 FR 

44025, 3 CFR, 2001 Comp., p. 783; Notice of 

August 3, 2006, 71 FR 44551 (August 7, 

2006). 

■ 16. Section 752.3 is amended by 

revising paragraph (a)(7) to read as 

follows: 

§ 752.3 Eligible items. 

(a) * * * 

(7) Communications intercepting 

devices and related software and 

technology controlled by ECCN 5A980, 

5D980, or 5E980 on the CCL; 

* * * * * 

PART 774—[AMENDED] 

■ 17. The authority citation for 15 CFR 

part 774 is revised to read as follows: 

Authority: 50 U.S.C. app. 2401 et seq.; 50 

U.S.C. 1701 et seq.; 10 U.S.C. 7420; 10 U.S.C. 

7430(e); 22 U.S.C. 287c, 22 U.S.C. 3201 et 

seq., 22 U.S.C. 6004; 30 U.S.C. 185(s), 185(u); 

42 U.S.C. 2139a; 42 U.S.C. 6212; 43 U.S.C. 

1354; 46 U.S.C. app. 466c; 50 U.S.C. app. 5; 

Sec. 901–911, Pub. L. 106–387; Sec. 221, Pub. 

L. 107–56; E.O. 13026, 61 FR 58767, 3 CFR, 

1996 Comp., p. 228; E.O. 13222, 66 FR 44025, 

3 CFR, 2001 Comp., p. 783; Notice of August 

3, 2006, 71 FR 44551 (August 7, 2006). 

■ 18. In Supplement No. 1 to Part 774, 

the Commerce Control List, Category 5 

(Telecommunications), is amended by 

revising the ‘‘License Requirements’’

section for Export Control Classification 

Number (ECCN) 5A980 to read as 

follows: 

5A980 Devices primarily useful for the 

surreptitious interception of wire, oral, or 

electronic communications; and parts and 

accessories therefor. 

License Requirements 

Reason for Control: SL, AT. 

Control(s): SL and AT apply to entire 

entry. A license is required for all 

destinations, as specified in § 742.13 of 

the EAR. Accordingly, a column specific 

to this control does not appear on the 

Commerce Country Chart (Supplement 

No. 1 to Part 738 of the EAR). 

Note: This licensing requirement does not 

supersede, nor does it implement, construe 

or limit the scope of any criminal statute, 

including, but not limited to the Omnibus 

Safe Streets Act of 1968, as amended. 

Note: These items are subject to the United 

Nations Security Council arms embargo 

against Rwanda described in § 746.8 of the 

EAR. 

* * * * * 

■ 19. In Supplement No. 1 to Part 774, 

the Commerce Control List, Category 5 

(Telecommunications), is amended by 

adding new Export Control 

Classification Number (ECCN) 5D980 to 

read as follows: 

5D980 Other ‘‘software’’, as follows (see 

List of Items Controlled). 

License Requirements 

Reason for Control: SL, AT. 

Controls: SL and AT apply to entire entry. 

A license is required for all destinations, as 

specified in § 742.13 of the EAR. 

Accordingly, a column specific to this 

control does not appear on the Commerce 

Country Chart (Supplement No. 1 to Part 738 

of the EAR). 

Note: This licensing requirement does not 

supersede, nor does it implement, construe 

or limit the scope of any criminal statute, 

including, but not limited to the Omnibus 

Safe Streets Act of 1968, as amended. 

Note: These items are subject to the United 

Nations Security Council arms embargo 

against Rwanda described in § 746.8 of the 

EAR. 

License Exceptions 

CIV: N/A. 

TSR: N/A. 

List of Items Controlled 

Unit: $ value. 

Related Controls: N/A. 

Related Definitions: N/A. 

Items: 

a. ‘‘Software’’ primarily useful for the 

surreptitious interception of wire, oral, and 

electronic communications. 

b. ‘‘Software’’ primarily useful for the 

‘‘development’’, ‘‘production’’, or ‘‘use’’ of 

equipment controlled by 5A980. 

■ 20. In Supplement No. 1 to Part 774, 

the Commerce Control List, Category 5 

(Telecommunications), is amended by 

adding new Export Control 

Classification Number (ECCN) 5E980 to 

read as follows: 

5E980 ‘‘Technology’’ primarily useful for 

the ‘‘development’’, ‘‘production’’, or ‘‘use’’ 

of equipment controlled by 5A980. 

License Requirements 

Reason for Control: SL, AT. 

Controls: SL and AT apply to entire entry. 

A license is required for all destinations, as 

specified in § 742.13 of the EAR. 

Accordingly, a column specific to this 

control does not appear on the Commerce 

Country Chart (Supplement No. 1 to Part 738 

of the EAR). 

Note: These items are subject to the United 

Nations Security Council arms embargo 

against Rwanda described in § 746.8 of the 

EAR. 

License Exceptions 

CIV: N/A. 

TSR: N/A. 

List of Items Controlled 

Unit: $ value. 

Related Controls: N/A. 

Related Definitions: N/A. 

Items: 

The list of items controlled is contained in 

the ECCN heading. 

* * * * * 

Dated: November 13, 2006. 

Christopher A. Padilla, 

Assistant Secretary for Export 

Administration. 

[FR Doc. E6–19509 Filed 11–17–06; 8:45 am] 

BILLING CODE 3510–33–P 

SOCIAL SECURITY ADMINISTRATION 

20 CFR Part 404 

[Docket No. SSA–2006–0098] 

RIN 0960–AF34 

Revised Medical Criteria for Evaluating 

Visual Disorders 

AGENCY: Social Security Administration. 

ACTION: Final rules. 

SUMMARY: We are revising the criteria in 

the Listing of Impairments (the listings) 

that we use to evaluate claims involving 

visual disorders. We apply these criteria 

when you claim benefits based on 

disability under title II and title XVI of 

the Social Security Act (the Act). The 

revisions reflect our program experience 

and advances in medical knowledge, 

treatment, and methods of evaluating 

visual disorders. 

DATES: These rules are effective 

February 20, 2007. 

FOR FURTHER INFORMATION CONTACT: 

Michelle Hungerman, Social Insurance 

Specialist, Office of Disability and 

Income Security Programs, Social 

Security Administration, 100 Altmeyer 

Building, 6401 Security Boulevard, 

Baltimore, MD 21235–6401, (410) 965–

2289 or TTY (410) 966–5609 for 

information about these rules. For 

information on eligibility or filing for 

benefits, call our national toll-free 

number, 1–800–772–1213 or TTY 1–

800–325–0778, or visit our Internet Web 

site, Social Security Online at http:// 

www.socialsecurity.gov. 


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SUPPLEMENTARY INFORMATION:

Electronic Version 

The electronic file of this document is 

available on the date of publication in 

the Federal Register at http:// 

www.gpoaccess.gov/fr/index.html. 

We are revising and making final the 

rules we proposed for evaluating visual 

disorders in the notice of proposed 

rulemaking (NPRM) published in the 

Federal Register on August 17, 2005 (70 

FR 48342). We provide a summary of 

the provisions of the final rules below, 

with an explanation of the changes we 

have made from the text in the NPRM. 

We then provide summaries of the 

public comments and our reasons for 

adopting or not adopting the 

recommendations in those comments in 

the section ‘‘Public Comments.’’ The 

final rule language follows the Public 

Comments section. 

What programs do these final 

regulations affect? 

These final regulations affect 

disability and blindness determinations 

and decisions that we make under title 

II and title XVI of the Act. In addition, 

to the extent that Medicare entitlement 

and Medicaid eligibility are based on 

whether you qualify for disability or 

blindness benefits under title II or title 

XVI, these final regulations also affect 

the Medicare and Medicaid programs. 

Who can get disability or blindness 

benefits? 

Under title II of the Act, we provide 

for the payment of disability benefits, 

including disability benefits based on 

blindness if you are disabled and belong 

to one of the following three groups: 

• Workers insured under the Act; 

• Children of insured workers; and 

• Widows, widowers, and surviving 

divorced spouses (see § 404.336) of 

insured workers. 

Under title XVI of the Act, we provide 

for Supplemental Security Income (SSI) 

payments on the basis of disability or 

blindness if you are disabled or blind 

and have limited income and resources. 

Is blindness treated differently under 

title II and title XVI? 

Under title II, impairments that result 

in ‘‘blindness’’ are evaluated in the 

same way as other impairments. 

However, under title XVI, ‘‘blindness’’

is considered separately from other 

impairments under different eligibility 

requirements. In other words, under 

title XVI, you may qualify for benefits 

on the basis of ‘‘blindness’’ or on the 

basis of ‘‘disability.’’

How do we define blindness? 

For both the title II and title XVI 

programs, the Act defines blindness as 

‘‘central visual acuity of 20/200 or less 

in the better eye with the use of a 

correcting lens. An eye which is 

accompanied by a limitation in the 

fields of vision such that the widest 

diameter of the visual field subtends an 

angle no greater than 20 degrees shall be 

considered * * * as having a central 

visual acuity of 20/200 or less.’’

(Sections 216(i)(1) and 1614(a)(2) of the 

Act.) We refer to the Act’s definition of 

blindness as ‘‘statutory blindness.’’

If you are seeking benefits under title 

II, your blindness generally must meet 

the 12-month statutory duration 

requirement. However, if you are 

seeking payments under title XVI of the 

Act based on blindness (rather than 

disability, as discussed below), your 

blindness need not meet the 12-month 

statutory duration requirement. Also, if 

you are seeking payments under title 

XVI of the Act based on blindness, there 

is no requirement that you be unable to 

do any substantial gainful activity 

(SGA). However, if you are working, we 

will consider your earnings to 

determine if you are eligible for SSI 

payments. 

How do we define disability? 

If your visual disorder does not meet 

our definition of blindness, you may 

still be eligible for disability benefits. 

Under both the title II and title XVI 

programs, disability must be the result 

of any medically determinable physical 

or mental impairment or combination of 

impairments that is expected to result in 

death or which has lasted or is expected 

to last for a continuous period of at least 

12 months. Our definitions of disability 

are shown in the following table: 

If you file a claim under * * * And you are * * * 

Disability means you have a medically 

determinable impairment(s) as described above 

that results in * * * 

title II ............................................................. an adult or a child ......................................... the inability to do any SGA. 

title XVI .......................................................... a person age 18 or older .............................. the inability to do any SGA. 

title XVI .......................................................... a person under age 18 ................................. marked and severe functional limitations. 

There is also an additional definition 

of disability if you are seeking benefits 

under title II of the Act, have attained 

age 55, and have blindness as defined in 

section 216(i)(1) of the Act: Disability 

means that the blindness has resulted in 

the inability to engage in SGA requiring 

skills or abilities comparable to those of 

any gainful activity in which you 

previously engaged with some regularity 

and over a substantial period of time. 

(See section 223(d)(1)(B) of the Act.) 

How do we decide whether you are 

disabled? 

If you are seeking benefits under title 

II of the Act, or if you are an adult 

seeking payments under title XVI of the 

Act, we use a five-step ‘‘sequential 

evaluation process’’ to decide whether 

you are disabled. We describe this fivestep process in our regulations at 

§§ 404.1520 and 416.920. We follow the 

five steps in order and stop as soon as 

we can make a determination or 

decision. The steps are: 

1. Are you working, and if so, is the 

work you are doing substantial gainful 

activity? If you are working and the 

work you are doing is substantial 

gainful activity, we will find that you 

are not disabled, regardless of your 

medical condition or your age, 

education, and work experience. If you 

are not, we will go on to step 2. 

2. Do you have a ‘‘severe’’

impairment? If you do not have an 

impairment or combination of 

impairments that significantly limits 

your physical or mental ability to do 

basic work activities, we will find that 

you are not disabled. If you do, we will 

go on to step 3. 

3. Do you have an impairment(s) that 

meets or medically equals the severity 

of an impairment in the listings? If you 

do, and the impairment(s) meets the 

duration requirement, we will find that 

you are disabled. If you do not, we will 

go on to step 4. 

4. Do you have the residual functional 

capacity to do your past relevant work? 

If you do, we will find that you are not 

disabled. If you do not, we will go on 

to step 5. 

5. Does your impairment(s) prevent 

you from doing any other work that 

exists in significant numbers in the 

national economy, considering your 

residual functional capacity, age, 


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Federal Register / Vol. 71, No. 223 / Monday, November 20, 2006 / Rules and Regulations 67039 

education, and work experience? If it 

does, and it meets the duration 

requirement, we will find that you are 

disabled. If it does not, we will find that 

you are not disabled. 

We use a different sequential 

evaluation process for children who 

apply for payments based on disability 

under title XVI of the Act. We describe 

that sequential evaluation process in 

§ 416.924 of our regulations. If you are 

already receiving benefits, we also use 

a different sequential evaluation process 

when we decide whether your disability 

continues. See §§ 404.1594, 416.994, 

and 416.994a of our regulations. 

However, all of the processes include 

steps at which we consider whether 

your impairment(s) meets or medically 

equals one of our listings. 

What are the listings? 

The listings are examples of 

impairments that we consider severe 

enough to prevent you as an adult from 

doing any gainful activity. If you are a 

child seeking SSI payments based on 

disability, the listings describe 

impairments that we consider severe 

enough to result in marked and severe 

functional limitations. Although the 

listings are contained only in appendix 

1 to subpart P of part 404 of our 

regulations, we incorporate them by 

reference in the SSI program in 

§ 416.925 of our regulations, and apply 

them to claims under both title II and 

title XVI of the Act. 

How do we use the listings? 

The listings are in two parts. There 

are listings for adults (part A) and for 

children (part B). If you are an 

individual age 18 or over, we apply the 

listings in part A when we assess your 

claim, and we do not use the listings in 

part B. 

If you are an individual under age 18, 

we first use the criteria in part B of the 

listings. If the listings in part B do not 

apply, and your specific disease 

process(es) has a similar effect on adults 

and children, we then use the criteria in 

part A. (See §§ 404.1525 and 416.925.) 

If your impairment(s) does not meet 

any listing, we will also consider 

whether it medically equals any listing; 

that is, whether it is as medically severe 

as an impairment in the listings. (See 

§§ 404.1526 and 416.926.) 

What if you do not have an 

impairment(s) that meets or medically 

equals a listing? 

We use the listings only to decide that 

you are disabled or that you are still 

disabled. We will not deny your claim 

because your impairment(s) does not 

meet or medically equal a listing. If you 

are not doing work that is substantial 

gainful activity, and you have a severe 

impairment(s) that does not meet or 

medically equal any listing, we may still 

find you disabled based on other rules 

in the ‘‘sequential evaluation process’’

described above. Likewise, we will not 

decide that your disability has ended 

only because your impairment(s) does 

not meet or medically equal a listing. 

Also, when we conduct reviews to 

determine whether your disability 

continues, we will not find that your 

disability has ended because we have 

changed a listing. Our regulations 

explain that, when we change our 

listings, we continue to use our prior 

listings when we review your case, if 

you had qualified for disability benefits 

or SSI payments based on our 

determination or decision that your 

impairment(s) met or medically equaled 

the listings. In these cases, we 

determine whether you have 

experienced medical improvement, and 

if so, whether the medical improvement 

is related to the ability to work. If your 

condition(s) has medically improved so 

that you no longer meet or medically 

equal the prior listing, we evaluate your 

case further to determine whether you 

are currently disabled. We may find that 

you are currently disabled depending on 

the full circumstances of your case. (See 

§§ 404.1594(c)(3)(i) and 

416.994(b)(2)(iv)(A).) If you are a child 

who is eligible for SSI payments, we 

follow a similar rule after we decide that 

you have experienced medical 

improvement in your condition(s). See 

§ 416.994a(b)(2). 

Why are we revising the listings for 

visual disorders? 

We are making these revisions to 

update the medical criteria in the 

listings for visual disorders and to 

provide more information about how we 

evaluate visual disorders. 

The listings for visual disorders, 

disturbances of labyrinthine-vestibular 

function, hearing impairments, and loss 

of speech are contained in listings for 

Special Senses and Speech. In these 

final rules, we are making changes only 

to the listings for visual disorders. 

On April 24, 2002, we published final 

rules in the Federal Register (67 FR 

20018) that included technical revisions 

to the listings for special senses and 

speech disorders. Prior to this, we 

published final rules that included 

revisions to the special senses and 

speech listings in the Federal Register 

on December 6, 1985 (50 FR 50068). We 

last published final rules making 

comprehensive revisions to the part A 

special senses and speech listings in the 

Federal Register on March 27, 1979 (44 

FR 18170), and final rules making 

comprehensive revisions to the part B 

special senses and speech listings on 

March 16, 1977 (42 FR 14705). We 

intend to publish separately proposed 

rules that would update the criteria for 

the other disorders included in the 

Special Senses and Speech listings. 

What do we mean by ‘‘final rules’’ and 

‘‘prior rules’’? 

Even though these rules will not go 

into effect until 90 days after 

publication of this notice, for clarity, we 

refer to the changes we are making here 

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

will be changed by these final rules as 

the ‘‘prior rules.’’

When will we start to use these final 

rules? 

We will start to use these final rules 

on their effective date. We will continue 

to use our prior rules until the effective 

date of these final rules. When the final 

rules become effective, we will apply 

them to new applications filed on or 

after the effective date of these rules and 

to claims pending before us, as we 

describe below. 

As is our usual practice when we 

make changes to our regulations, we 

will apply these final rules on or after 

their effective date whenever we make 

a determination or decision, including 

in those claims in which we make a 

determination or decision after remand 

to us from a Federal court. With respect 

to claims in which we have made a final 

decision and that are pending judicial 

review in Federal court, we expect that 

the court’s review of the 

Commissioner’s final decision would be 

made in accordance with the rules in 

effect at the time the final decision of 

the Commissioner was issued. If a court 

reverses the Commissioner’s final 

decision and remands the case for 

further administrative proceedings after 

the effective date of these final rules, we 

will apply the provisions of these final 

rules to the entire period at issue in the 

claim in our new decision issued 

pursuant to the court’s remand. 

How long will these final rules be 

effective? 

These final rules will no longer be 

effective 8 years after the date on which 

they become effective, unless we extend 

them, or revise and issue them again. 

How are we changing the introductory 

text to the special senses and speech 

listings for adults? 

2.00 Special Senses and Speech 

We are removing the following 

sections of prior 2.00: 


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• The last paragraph of 2.00A3, 

‘‘Field of vision.’’

• Paragraph 2.00A4, ‘‘Muscle 

function.’’

• The first paragraph of 2.00A6, 

‘‘Special situations.’’

The last paragraph of prior 2.00A3, 

‘‘Field of vision,’’ explained that when 

the visual field loss was predominantly 

in the lower visual fields, a system such 

as the weighted grid scale for perimetric 

fields as described by B. Esterman in 

1968 could be used for determining 

whether the visual field loss was 

comparable to that described in table 2 

in section 2.00 of the listings. As this 

kind of scale is rarely used, we no 

longer need this guidance in the 

introductory text. 

Prior 2.00A4, ‘‘Muscle function,’’

described the type of impairment 

evaluated under prior listing 2.06, 

‘‘Total bilateral ophthalmoplegia.’’

(Ophthalmoplegia is paralysis of the eye 

muscles.) As the causes of this disorder 

are now more readily detectable and 

treatable, this disorder has become 

extremely rare. Therefore, we are 

removing both the prior listing and the 

guidance in the introductory text that 

addressed this disorder. Instead, we will 

evaluate total bilateral ophthalmoplegia 

and other eye muscle disorders by 

assessing the impact of such disorders 

on your visual efficiency under final 

listing 2.04, or based on your visual 

functioning. 

The first paragraph of prior 2.00A6, 

‘‘Special situations,’’ explained how we 

calculated visual acuity efficiency for 

individuals with aphakia (the absence of 

the anatomical lens of the eye). 

Advances in technology have led to the 

development of effective synthetic 

intraocular lenses. Also, contact lenses 

have been technically refined and may 

be used in those instances in which the 

anatomical lens is not replaced with a 

synthetic lens. Because the synthetic 

intraocular lens or the contact lens 

corrects both the visual acuity and the 

visual field, we compute the visual 

acuity efficiency or visual field 

efficiency as though your eye has an 

anatomical lens. 

We are reorganizing and expanding 

the rest of the introductory text for 

visual disorders to provide additional 

guidance. The following is a detailed 

explanation of the final introductory 

text. 

2.00A—How do we evaluate visual 

disorders? 

This section corresponds to prior 

2.00A, ‘‘Disorders of Vision.’’ We are 

clarifying the information in the prior 

section by reorganizing the material into 

eight subsections and by providing 

additional guidance as explained below. 

2.00A1—What are visual disorders? 

This section corresponds to prior 

2.00A1, ‘‘Causes of impairment.’’ We are 

making nonsubstantive editorial 

changes for clarity. 

2.00A2—How do we define statutory 

blindness? 

This section revises prior 2.00A7, 

‘‘Statutory blindness,’’ to include the 

statutory definition. In response to a 

public comment, we have added an 

explanation that we use your bestcorrected visual acuity for distance in 

the better eye when we determine if you 

have statutory blindness based on visual 

acuity loss. We also clarify that you 

have statutory blindness only if your 

visual disorder meets the criteria of 2.02 

or 2.03A. We further clarify that you do 

not have statutory blindness if your 

visual disorder medically equals the 

criteria of 2.02 or 2.03A, or if it meets 

or medically equals 2.03B, 2.03C, or 

2.04. If your visual disorder medically 

equals the criteria of 2.02 or 2.03A, or 

if it meets or medically equals 2.03B, 

2.03C, or 2.04, we will find that you 

have a disability if your visual disorder 

also meets the duration requirement. 

In the NPRM, this section was headed 

‘‘What is statutory blindness?’’ We are 

changing the heading to be consistent 

with other headings in this section. 

2.00A3—What evidence do we need to 

establish statutory blindness under title 

XVI? 

In this new section, we explain that 

when we make a determination or 

decision that you have statutory 

blindness under title XVI, we require 

evidence showing only that the 

statutory criteria are satisfied; we do not 

need evidence to document the visual 

disorder that causes the blindness. We 

also explain that there is no duration 

requirement for statutory blindness 

under title XVI. 

We are adding this section because 

blindness is treated differently under 

title II and title XVI of the Act. Under 

title II, blindness is generally evaluated 

in the same way as other medical 

impairments. Under title XVI, blindness 

and disability are separate categories, 

and the requirements for eligibility 

based on blindness are different from 

the requirements for eligibility based on 

disability. 

2.00A4—What evidence do we need to 

evaluate visual disorders, including 

those that result in statutory blindness 

under title II? 

We are revising the last sentence of 

prior 2.00A1 to explain what evidence 

we need to evaluate a visual disorder. In 

response to public comments, we have 

revised proposed 2.00A4b to refer to a 

‘‘cortical visual disorder’’ instead of 

‘‘cortical blindness’’ and provided 

additional guidance on cortical visual 

disorders and how to document them. 

2.00A5—How do we measure bestcorrected visual acuity? 

We are revising the guidance in the 

second sentence of prior 2.00A2, 

‘‘Visual acuity,’’ by providing that, in 

addition to testing that uses Snellen 

methodology, we may also use visual 

acuity measurements obtained using 

another testing methodology that is 

comparable to Snellen methodology. We 

also clarify what constitutes bestcorrected visual acuity. 

In the NPRM, we proposed, in 

2.00A5b(i), that we would not use the 

results of visual evoked response (VER) 

testing to determine best-corrected 

visual acuity. This guidance was 

questioned by several commenters who 

indicated that no response to VER 

testing demonstrates that an individual 

cannot see in that eye. We agree with 

these commenters, and have revised 

proposed 2.00A5b(i) to indicate that if 

you have an absent response to VER 

testing in an eye, we can use that result 

to determine that your visual acuity is 

20/200 or less in that eye. However, we 

will not use a positive response to VER 

testing to determine best-corrected 

visual acuity. VER testing evaluates the 

function of the visual pathways from the 

retina, along the optic nerve and optic 

tract, to the vision cortex in the occipital 

lobe of the brain. While this testing can 

provide an estimate of visual acuity, it 

is not a direct measure of visual acuity. 

We also provide that we will not use 

pinhole testing to determine bestcorrected visual acuity. Pinhole testing 

is used to determine whether your 

visual acuity can be improved with a 

corrective lens. However, you may not 

achieve the same degree of correction 

with corrective lenses that you have 

with pinholes. Additionally, even when 

pinhole testing fails to show an 

improvement in your acuity, your acuity 

may improve with corrective lenses. 

Because pinhole testing may 

underestimate or overestimate your 

visual acuity, we will not use it to 

determine your best-corrected visual 

acuity. 


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In response to a public comment, we 

have also added guidance in final 

2.00A5b(i) explaining that we will not 

use automated refraction acuity to 

determine your best-corrected visual 

acuity. An automated refractor is a 

machine that measures how light is 

changed as it enters the eye. It is used 

to provide an estimate of refractive error 

and the prescription for glasses. This 

estimate gives the clinician a place to 

start in determining the best-corrected 

visual acuity; it is not a direct measure 

of visual acuity. 

In response to another public 

comment, we have added guidance in 

final 2.00A5b(ii) to explain that bestcorrected visual acuity for distance is 

your best acuity at 20 feet, and to 

explain how we use visual acuity 

measurements obtained for other 

distances. 

2.00A6—How do we measure visual 

fields? 

This section replaces prior 2.00A3, 

‘‘Field of vision.’’ Prior 2.00A3 

indicated that we would use ‘‘usual 

perimetric methods’’ or other 

‘‘comparable perimetric devices’’ to 

measure the size of the visual field. The 

Goldmann perimeter was cited as a 

comparable perimetric device. 

The National Research Council (NRC), 

in its 2002 report, Visual Impairments: 

Determining Eligibility for Social 

Security Benefits (hereinafter, the ‘‘NRC 

report’’), recommended that ‘‘the 

current SSA standard [for assessing 

visual field loss] should be revised so 

that disability determinations are based 

on the results of automated static 

projection perimetry rather than 

Goldmann (kinetic, nonautomated) 

visual fields.’’ (Citations for the NRC 

report and other sources cited in this 

preamble are available in the NPRM (70 

FR at 48348).) These final rules partially 

adopt this recommendation by 

providing that we will use visual field 

measurements obtained with an 

automated static threshold perimetry 

test performed on a perimeter that meets 

our requirements. However, we have 

decided that we will also continue to 

use visual field measurements obtained 

with Goldmann or other kinetic 

perimetry as these measurements are 

comparable to those obtained with 

automated static threshold perimetry. 

In final 2.00A6a(i), we explain when 

we need visual field testing. In response 

to a public comment, we have deleted 

macular edema as an example of a 

visual disorder that could cause visual 

field loss. 

In final 2.00A6a(ii), we explain that, 

when we need to measure the extent of 

your visual field loss, we will use visual 

field measurements obtained with an 

automated static threshold perimetry 

test performed on a perimeter that meets 

our requirements. We adopted as our 

requirements the criteria recommended 

in the NRC report. We cite the 

Humphrey Field Analyzer as an 

example of an acceptable perimeter 

because the NRC report cited it, and the 

Humphrey Field Analyzer is the most 

widely used automated perimeter in the 

United States to perform this type of 

test. 

The NRC report also cited the 

Octopus perimeter as another example 

of an automated perimeter that meets 

the criteria set out in its 

recommendations. We have not 

included the Octopus perimeter as an 

example of an acceptable perimeter in 

final 2.00A6a(ii), because it is not our 

intention to list in these rules every 

acceptable automated perimeter and the 

Octopus perimeter is not widely used in 

the United States. However, we will 

accept findings from the Octopus 

perimeter or any other automated 

perimeter that satisfies the requirements 

of final 2.00A6a(ii). 

In final 2.00A6a(iii), we describe the 

requirements of an acceptable 

automated static threshold perimetry 

test. 

In final 2.00A6a(iv), we explain that 

we need a test that measures the central 

24 to 30 degrees of the visual field to 

determine statutory blindness. We also 

provide examples of acceptable tests. In 

response to a public comment, we have 

added a reference to final listing 2.03A 

in this section. 

In proposed 2.00A6a(v), we indicated 

that to determine if the criterion in 

listing 2.03B is met, we need a test 

performed on a Humphrey Field 

Analyzer that measures the central 30 

degrees of the visual field. We also 

indicated that we could use comparable 

results from other acceptable 

perimeters. In response to a comment 

that these two statements were 

inconsistent with each other, we have 

clarified this section to explain that 

while the criterion in final listing 2.03B 

is based on using a test performed on a 

Humphrey Field Analyzer that measures 

the central 30 degrees of the visual field, 

we can also use comparable results from 

other acceptable perimeters. We also 

provide an example of a comparable 

result. Additionally, we explain that we 

cannot use tests that do not measure the 

central 30 degrees of the visual field, 

such as the Humphrey 24–2 test, to 

determine if your impairment meets or 

medically equals final listing 2.03B. The 

criterion we use in final listing 2.03B 

adopts the recommendation in the NRC 

report for determining that your visual 

field loss is disabling. That 

recommendation was based on the use 

of a test measuring the central 30 

degrees of the visual field. 

In final 2.00A6a(vi), we explain that 

we measure the extent of visual field 

loss by determining the portion of the 

visual field in which you can see a 

white III4e stimulus. This stimulus 

specification is the same as the 

specification in the second paragraph of 

prior 2.00A3. 

In final 2.00A6a(vii), we explain that 

we need to determine the decibel (dB) 

level that corresponds to a 4e intensity 

for the particular perimeter being used. 

We further explain that we will then use 

the dB printout to determine which 

points would be seen at the 4e intensity 

level. We also give an example that 

explains that, for tests performed on 

Humphrey Field Analyzers, any point 

seen at 10 dB or higher is a point that 

would be seen with a 4e stimulus. 

In final 2.00A6a(viii), we explain that 

we can also use visual field 

measurements obtained using kinetic 

perimetry, such as the Humphrey ‘‘SSA 

Test Kinetic’’ (a kind of automated 

kinetic perimetry) or Goldmann 

perimetry (a kind of manual kinetic 

perimetry). In response to a public 

comment, we have clarified this section 

to make it clear that this type of testing 

may be used instead of automated static 

threshold perimetry. 

We contracted with West Virginia 

University to conduct research to 

determine whether the Humphrey ‘‘SSA 

Test Kinetic’’ is comparable to 

Goldmann perimetry. This research, 

which was completed in April 2000, 

showed that the Humphrey ‘‘SSA Test 

Kinetic’’ is comparable to Goldmann 

perimetry, except that the Humphrey 

‘‘SSA Test Kinetic’’ does not identify 

scotomata, that is, non-seeing areas in 

the visual field surrounded by seeing 

areas. Therefore, in the NPRM, we 

proposed that if we needed additional 

information because your visual 

disorder had progressed to the point 

where it was likely to result in a 

significant limitation in the central 

visual field, such as a scotoma, we 

would supplement the automated 

kinetic perimetry with the results of a 

Humphrey 30–2 or comparable test. 

There were public comments 

questioning this guidance. In response 

to those comments, we have clarified 

this section to state that we will not use 

the results of automated kinetic testing 

to assess your visual field loss in this 

situation. Instead, we will assess your 

visual field loss with automated static 

threshold perimetry or with manual 

kinetic perimetry. 


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In final 2.00A6a(ix), we explain that 

we will not use the results of visual 

field screening tests, such as 

confrontation tests, tangent screen tests, 

or automated static screening tests, to 

determine that your impairment meets 

or medically equals a listing or to 

evaluate your residual functional 

capacity. We also explain that we can 

consider normal results from visual 

field screening tests to determine 

whether your visual disorder is severe 

when these results are consistent with 

the other evidence in your case record. 

We also list some circumstances under 

which we will not consider normal test 

results to be consistent with the other 

evidence in the file. 

Consistent with our removal of the 

guidance on aphakia, we are removing 

the stimulus specifications used to test 

individuals with aphakia contained in 

the first two paragraphs of prior 2.00A3. 

In final 2.00A6b, we revise the 

guidance in the first paragraph of prior 

2.00A3 on the use of corrective lenses 

during visual field testing. We explain 

that eyeglasses must not be worn during 

the visual field examination because 

they limit your field of vision, but 

contact lenses or perimetric lenses may 

be used in order to obtain the most 

accurate visual field measurements. We 

also provide that, for this single 

purpose, you do not need to 

demonstrate that you have the ability to 

use the contact or perimetric lenses on 

a sustained basis. 

2.00A7—How do we calculate visual 

efficiency? 

In this section, we expand the 

guidance in prior 2.00A5, ‘‘Visual 

efficiency,’’ by explaining how we 

calculate visual acuity efficiency, visual 

field efficiency, and visual efficiency. 

The guidance in 2.00A7b is based on the 

first sentence of paragraph 2 of the 

explanatory text following Table 2 in 

the prior rules. We are deleting that 

sentence from the explanation of Table 

2 because we are moving it here. The 

guidance in 2.00A7c is based on prior 

2.00A5 and the parenthetical statement 

at the end of prior listing 2.04, which 

we are deleting because it is redundant. 

In response to a public comment, we are 

also adding an example to 2.00A7c to 

illustrate how visual efficiency is 

calculated. 

2.00A8—How do we evaluate specific 

visual problems? 

This section replaces prior 2.00A6, 

‘‘Special situations.’’ In this section, we 

are adding guidance for evaluating 

specific visual problems. The following 

is a discussion of the section. 

2.00A8a—Statutory blindness 

In this section, we codify a 

longstanding procedure. The most 

commonly used visual acuity test charts 

are charts based on Snellen 

methodology. These charts usually do 

not have lines that measure visual 

acuity between 20/100 and 20/200. 

Therefore, if you are unable to read any 

of the letters on the 20/100 line on a test 

chart based on Snellen methodology, 

your visual acuity will be assessed as 

20/200 or less. 

There are newer test charts (not yet 

widely used, but comparable to charts 

based on Snellen methodology) that do 

have lines to measure visual acuity 

between 20/100 and 20/200. Based on 

medical literature, we know that if your 

visual acuity is between 20/100 and 

20/200 as measured on those newer test 

charts, it would be 20/200 if it were 

measured using the more common chart 

based on Snellen methodology. We 

explain in this section that if your visual 

acuity is measured using one of these 

newer charts and you cannot read any 

of the letters on the 20/100 line, we will 

determine that you have statutory 

blindness based on a visual acuity of 

20/200 or less. We also provide that, 

regardless of the type of test chart used, 

you do not have statutory blindness if 

you can read at least one letter on the 

20/100 line. In response to a public 

comment, we have added examples of 

how we evaluate visual acuity 

measurements between 20/100 and 

20/200. 

2.00A8b—Blepharospasm 

In the NPRM, we described the 

disorder and explained that we must 

consider how the involuntary blinking 

that characterizes it can affect your 

ability to maintain the measured visual 

acuities and visual fields over time. In 

response to a public comment, we have 

revised this section to refer to your 

ability to maintain visual functioning 

over time instead of your ability to 

maintain the measured visual acuities 

and visual fields over time. Also, as we 

reviewed this section to respond to the 

public comment, we realized that 

‘‘closure of the eyelids’’ is a better 

descriptor of how the disease manifests 

than ‘‘eye blinking,’’ and have made this 

nonsubstantive change to more clearly 

describe the disorder. We have also 

made other nonsubstantive editorial 

changes for clarity. 

2.00A8c—Scotoma 

We define the term ‘‘scotoma’’ as a 

non-seeing area in the visual field 

surrounded by a seeing area. We also 

explain that when we measure your 

visual field, we will subtract the length 

of any scotoma, other than the normal 

blind spot, from the overall length of 

any diameter on which it falls. 

2.00C—How do we evaluate 

impairments that do not meet one of the 

special senses and speech listings? 

We are revising the guidance in the 

second paragraph of prior 2.00A6 by 

stating our basic adjudicative principle 

that if the impairment(s) does not meet 

or medically equal the criteria of a 

listing in this body system, we must 

consider whether it meets or medically 

equals the criteria of a listing in another 

body system. If not, we must continue 

the sequential evaluation process (see 

§§ 404.1520 and 416.920) to determine 

whether you are disabled or continue to 

be disabled (see §§ 404.1594, 416.994 

and 416.994a). This new section applies 

to all the impairments in this body 

system, not just visual disorders. 

How are we changing the criteria in the 

special senses and speech listings for 

adults? 

2.01 Category of Impairments, Special 

Senses and Speech 

We are removing the reservation for 

listing 2.05 because it is no longer 

needed. We are also removing prior 

listing 2.06, ‘‘Total bilateral 

ophthalmoplegia,’’ for the reasons cited 

in ‘‘2.00 Special Senses and Speech’’

above. 

Listing 2.02—Loss of visual acuity 

This final listing corresponds to prior 

listing 2.02, ‘‘Impairment of visual 

acuity.’’ We are changing the heading to 

be consistent with other language in 

these final rules. 

Listing 2.03—Contraction of the visual 

field in the better eye 

This final listing corresponds to prior 

listing 2.03, ‘‘Contraction of peripheral 

visual fields in the better eye.’’ We are 

removing prior listing 2.03A, which 

provided that an individual’s visual 

field loss was of listing-level severity 

when the field was contracted to 10 

degrees or less from the point of 

fixation. Prior listing 2.03B provided 

that an individual’s visual field loss was 

of listing-level severity if that loss 

resulted in the widest diameter of the 

field subtending an angle no greater 

than 20 degrees. Any visual field loss 

that satisfied the criterion in prior 

listing 2.03A also satisfied the criterion 

in prior listing 2.03B. Therefore, prior 

listing 2.03A was unnecessary. 

We are redesignating prior listing 

2.03B as final listing 2.03A. In response 

to a public comment, we have added the 

phrase ‘‘around the point of fixation’’ to 


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make it clear that when we measure the 

widest diameter, the diameter must go 

through the point of fixation. 

The NRC report contained a 

recommendation that a mean deviation 

(MD) of ¥22 or worse on an automated 

static threshold perimetry test 

measuring the central 30 degrees of the 

visual field ‘‘would serve as a 

reasonable criterion for disability 

determination.’’ We agree with the NRC 

and are adding this criterion as final 

listing 2.03B. 

Final listing 2.03C corresponds to 

prior listing 2.03C. We are clarifying the 

criterion by indicating that a 

determination of visual field efficiency 

must be based on kinetic perimetry. 

Listing 2.04—Loss of visual efficiency 

This final listing corresponds to prior 

listing 2.04, ‘‘Loss of visual efficiency.’’

As already explained, we are removing 

the parenthetical statement at the end of 

the prior listing because it was 

redundant of information in proposed 

2.00A7c. However, we are adding a 

reference to that section of the final 

introductory text as a reminder of where 

this guidance is contained. 

Table 1—Percentage of Visual Acuity 

Efficiency Corresponding to the BestCorrected Visual Acuity Measurement 

for Distance in the Better Eye 

To be consistent with our removal of 

the introductory text on aphakia, we are 

removing the columns and guidance 

addressing aphakia from prior Table 1. 

We are also removing the entries for 

visual acuities worse than 20/100 for the 

reasons we gave under the explanation 

of final 2.00A8a. In response to a public 

comment, we are removing the entries 

for visual acuities of 20/32 and 20/64 

and adding entries for visual acuities of 

20/30, 20/60, and 20/70. 

Table 2—Charts of Visual Fields 

We are removing the first sentence of 

prior paragraph 2 in the explanation of 

how to use Table 2. That sentence 

provided instructions for calculating the 

percent of visual field efficiency, and 

we moved it to final 2.00A7b. We are 

also making nonsubstantive editorial 

changes for clarity. 

How are we changing the introductory 

text to the special senses and speech 

listings for children? 

102.00 Special Senses and Speech 

Except for minor editorial changes, 

we have repeated much of the 

introductory text of final 2.00A in the 

introductory text to final 102.00A. This 

is because the same basic rules for 

establishing and evaluating the 

existence and severity of visual 

disorders in adults also apply to 

children. Because we have already 

described these provisions under the 

explanation of final 2.00A, the following 

discussions describe only those 

provisions that are unique to the 

childhood rules or that require further 

explanation specific to evaluating 

disability in children. 

We are removing the second 

paragraph of prior 102.00A, ‘‘Visual 

impairments in children.’’ This 

paragraph indicated that the 

accommodative reflex is generally not 

present in children under 6 months of 

age (or, for a premature child, until 6 

months of age plus the number of 

months the child is premature). It also 

provided that the absence of this reflex 

should be considered indicative of a 

visual impairment only in children 

above this age. We included this 

guidance in the prior rules to explain 

that it was not appropriate to use the 

criterion in prior listing 102.02B1 until 

the child reached the required age. 

However, in these final listings, we 

incorporated prior listing 102.02B1 into 

the more general category of abnormal 

anatomical findings evaluated under 

final listing 102.02B2. As the lack of the 

accommodative reflex is not considered 

an abnormal anatomical finding in very 

young children, its absence would not 

satisfy the final listing criterion. 

Therefore, we no longer need this 

explanation. 

102.00A1—What are visual disorders? 

In this section, we expand the 

guidance provided for adults in final 

2.00A1 to indicate that in addition to 

limiting your ability to distinguish 

detail, read, and do fine work, a loss of 

visual acuity may affect your ability to 

perform other age-appropriate activities. 

We added this supplemental guidance 

to reflect the way we evaluate disability 

claims of children. 

102.00A2—How do we define statutory 

blindness? 

In this section, we repeat the guidance 

in final 2.00A2, but refer to the 

childhood listings that show statutory 

blindness. 

102.00A4—What evidence do we need 

to evaluate visual disorders, including 

those that result in statutory blindness 

under title II? 

In this section, which is the same as 

final 2.00A4, we replace and expand the 

third paragraph of prior 102.00A. 

102.00A5—How do we measure bestcorrected visual acuity? 

In this section, we revise the guidance 

in the first paragraph of prior 102.00A. 

In final 102.00A5a, we discuss 

comparable visual acuity testing for 

children who are unable to participate 

in testing using Snellen methodology, 

for example, because they are too young, 

and add guidance for how we evaluate 

children who are unable to participate 

in testing using Snellen methodology or 

other comparable testing. In response to 

a public comment, we have revised 

proposed 102.00A5b by adding 

examples of abnormal anatomical 

findings and abnormal neuroimaging of 

the cerebral cortex that would indicate 

a visual acuity of 20/200 or less. 

102.00A6—How do we measure visual 

fields? 

In this final section, we repeat the 

guidance in final 2.00A6 but in 

102.00A6a(ix) refer to the way we 

evaluate disability in children. 

102.00C—How do we evaluate 

impairments that do not meet one of the 

special senses and speech listings? 

In this section, we repeat the guidance 

in final 2.00C, but include the definition 

of disability for children who are filing 

for or are receiving SSI payments. 

How are we proposing to change the 

criteria in the special senses and speech 

listings for children? 

102.01 Category of Impairments, 

Special Senses and Speech 

We are adding new listings 102.03, 

‘‘Contraction of the visual field in the 

better eye,’’ and 102.04, ‘‘Loss of visual 

efficiency,’’ because they apply to 

children as well as adults. Due to the 

addition of these listings, we are also 

adding Table 1, ‘‘Percentage of Visual 

Acuity Efficiency Corresponding to the 

Best-Corrected Visual Acuity 

Measurements for Distance in the Better 

Eye,’’ and Table 2, ‘‘Charts of Visual 

Fields.’’

These new listings and tables are 

identical to the corresponding adult 

listings and tables. Previously, we used 

prior listings 2.03 and 2.04 (and their 

corresponding tables) to evaluate 

children with visual field and visual 

efficiency impairments. With final 

listings 102.03 and 102.04 we will no 

longer need to refer to the listings in 

part A when we evaluate these 

impairments in children. 

We are also making nonsubstantive 

editorial changes to the heading of this 

section to be consistent with the 

heading of 2.01. 

Listing 102.02—Loss of visual acuity 

This final listing corresponds to prior 

listing 102.02, ‘‘Impairments of visual 

acuity.’’ We are not making any changes 

to prior listing 102.02A. 


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We used prior listing 102.02B to 

evaluate loss of visual acuity in children 

below 3 years of age at the time of 

adjudication. We are removing the age 

criterion and instead will use final 

listing 102.02B to evaluate loss of visual 

acuity in any child who is unable to 

participate in testing using Snellen 

methodology or other comparable visual 

acuity testing and who has clinical 

findings that fixation and visualfollowing behavior are absent in the 

better eye. 

The criteria in prior listing 102.02B 

were all examples of abnormal 

anatomical findings observable during a 

clinical eye examination. When present 

in the better eye, these abnormal 

anatomical findings would be expected 

to result in the absence of fixation and 

visual-following behavior, and would 

indicate a visual acuity of 20/200 or 

less. Rather than list each type of 

abnormal anatomical finding, we 

combined the prior criteria into a 

general category of abnormal anatomical 

findings in final listing 102.02B1. We 

used the phrase ‘‘a visual acuity of 20/ 

200 or worse’’ in proposed listing 

102.02B1. We have revised this phrase 

in final listing 102.02B1 to read ‘‘a 

visual acuity of 20/200 or less’’ to be 

consistent with the statutory language 

that defines blindness. 

Final listings 102.02B2, 102.02B3, and 

102.02B4 add criteria for impairments 

that generally are not observable during 

a clinical eye examination, but are 

diagnosed based on abnormal 

neuroimaging, an abnormal 

electroretinogram, or an absent response 

to VER testing. We did not propose the 

criterion in final listing 102.02B4, an 

absent response to VER testing in the 

better eye, in the NPRM. This criterion 

was added in response to a public 

comment. 

Public Comments 

In the NPRM we published in the 

Federal Register on August 17, 2005 (70 

FR 48342), we provided the public with 

a 60-day comment period that ended on 

October 17, 2005. In addition to our 

notice to the public, we invited 

comments from national medical 

organizations and professionals who 

have expertise in the evaluation of 

visual disorders. As part of our outreach 

efforts, we also invited comments from 

advocacy groups and legal services 

organizations. 

We received comments from 13 

commenters. The commenters included 

advocacy groups, legal services 

organizations, State agencies that make 

disability determinations for us, medical 

organizations, ophthalmologists, and 

other individuals. We carefully 

considered all of the comments. Because 

some of the comments were long, we 

have condensed, summarized, and 

paraphrased them. We believe we have 

presented the commenters’ views 

accurately, and have responded to all of 

the significant issues raised by the 

commenters that were within the scope 

of these rules. 

Statutory Blindness 

Comment: Two commenters suggested 

that we use the term ‘‘blindness’’ in the 

listings only to describe total vision loss 

or near-total vision loss; that is, 

situations in which the individual must 

rely primarily on vision substitution 

skills. They indicated that it is more 

appropriate to use the ranges of ‘‘mild,’’

‘‘moderate,’’ ‘‘severe,’’ and ‘‘profound’’

vision loss as defined in the American 

Medical Association’s Guides to the 

Evaluation of Permanent Impairment, 

Fifth Edition (hereinafter, the ‘‘AMA 

Guides’’) for those individuals who have 

residual vision; that is, those that can 

still benefit from vision enhancement 

aids. As defined in the AMA Guides, the 

term ‘‘severe vision loss’’ reflects the 

statutory standard. 

Response: We were not able to adopt 

this comment because we must follow 

the language of the Act. The definition 

of ‘‘blindness’’ in sections 216(i)(1) and 

1614(a)(2) of the Act is: 

[C]entral visual acuity of 20/200 or less in the 

better eye with the use of a correcting lens. 

An eye which is accompanied by a limitation 

in the fields of vision such that the widest 

diameter of the visual field subtends an angle 

no greater than 20 degrees shall be 

considered * * * as having a central visual 

acuity of 20/200 or less. 

Comment: One commenter noted that 

the definition of blindness in proposed 

2.00A2 and 102.00A2 contained the 

phrase ‘‘with the use of a correcting 

lens.’’ The commenter believed that this 

language can be taken to mean that any 

corrective lens will fulfill the 

requirement and recommended that the 

language be changed to read ‘‘visual 

acuity of 20/200 or less in the better eye 

with the use of best possible corrective 

lens.’’

Response: We partially adopted this 

comment. We have not deleted the 

phrase ‘‘with the use of a correcting 

lens’’ from the definition of blindness in 

final 2.00A2 and 102.00A2 as those 

sections reflect the statutory definition 

of blindness and the phrase is part of 

the statutory language. However, we 

have added a reference to sections 

216(i)(1) and 1614(a)(2) of the Act in 

final sections 2.00A2 and 102.00A2 of 

the rules to make it clearer that we are 

providing the statutory definition. We 

also added guidance indicating that 

when we determine whether the 

statutory definition of blindness based 

on visual acuity is met, we use the bestcorrected visual acuity for distance in 

the better eye. 

Comment: One commenter suggested 

that we expand the definition of 

statutory blindness to include the 

criteria in proposed listings 2.03B and C 

and proposed listing 2.04. The 

commenter indicated that we can 

interpret the statute, and that the 

suggestion would be a reasonable 

interpretation. 

Response: We did not adopt this 

comment. Although we agree that we 

have the authority to interpret the 

statute when necessary, the definition of 

blindness in the Act is clear and 

explicit, and there is nothing in the 

legislative history to suggest that 

Congress intended us to apply any 

standard other than the definitions in 

the statute, which are reflected in final 

listings 2.02 and 2.03A. (S. Rep. No. 90–

744, at 7, 46–47 (1967), as reprinted in 

1967 U.S.C.C.A.N. 2834, 2842, 2886–

2887.) 

Comment: We received several 

comments on our method for evaluating 

visual acuity measurements between 20/ 

100 and 20/200 (proposed 2.00A8a and 

102.00A8a). One commenter said that 

finding statutory blindness based on a 

visual acuity of 20/200 is a more liberal 

standard than that used in any other 

country, and that our proposal to treat 

visual acuity measurements between 20/ 

100 and 20/200 as visual acuity of 20/ 

200 would move us even further out of 

the global mainstream. This commenter 

stated we should instead use visual 

acuity that is worse than 20/160 as our 

standard, and indicated that when the 

clinician does not use a chart containing 

visual acuity measurements between 20/ 

100 and 20/200, the clinician should 

measure best-corrected visual acuity 

from a distance of 10 feet instead of the 

usual 20 feet. Other commenters, 

including the American Optometric 

Association, indicated that our 

approach to interpreting visual acuity 

measurements between 20/100 and 20/ 

200 is sensible because it does not 

adversely affect people who had 

previously been classified as disabled. 

Another commenter wondered whether 

an individual who can see only one 

letter on the 20/100 line of a visual 

acuity chart has functionally better 

vision than someone with best-corrected 

visual acuity of 20/200. However, this 

commenter did acknowledge that a line 

must be drawn somewhere. 

Response: We did not adopt the 

recommendations to change our policy 

on evaluating visual acuity 

measurements between 20/100 and 20/ 


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200. As we indicated in our explanation 

of proposed 2.00A8a in the NPRM (70 

FR at 48346) and in our explanation of 

final 2.00A8a earlier in this preamble, 

the most commonly used visual acuity 

test charts are based on Snellen 

methodology and usually do not have 

lines that measure visual acuity between 

20/100 and 20/200. While there are 

newer test charts that do provide such 

measurements, such as the Early 

Treatment Diabetic Retinopathy Study 

(ETDRS) chart, these charts are not 

widely used in clinical practice. Also, 

we know that if an individual’s visual 

acuity is between 20/100 and 20/200 as 

measured on those newer charts, it 

would be 20/200 if measured using the 

most commonly used charts. Rather 

than evaluating the severity of a visual 

disorder based on the different types of 

charts used to test an individual’s visual 

acuity, we have determined that it is 

more appropriate to assess visual acuity 

for all individuals using the same 

methodology—the one incorporated in 

the most commonly used test charts and 

the one contemplated in the statutory 

definition of blindness. 

Moreover, we do not agree that 

requiring testing at 10 feet, instead of 20 

feet, is a feasible alternative. The testing 

of visual acuity requires a specific 

optics setup in the clinician’s office, and 

in most offices the optics setup is 

designed to obtain visual acuity 

measurements at a 20-foot working 

distance; that is, even when the testing 

lane is not 20 feet long, the optics setup 

is designed to give results comparable to 

those obtained at 20 feet. We believe 

that requiring best-corrected visual 

acuity measurements at a 10-foot 

working distance would greatly restrict 

our ability to use evidence provided by 

the individual’s treating source(s) 

because we do not believe that 

clinicians would reconfigure the optics 

in their offices to obtain measurements 

that are not widely used in the medical 

community. 

Also, we do not believe we should 

expand the standards for statutory 

blindness to encompass individuals 

who can read some, but not all, of the 

letters on the 20/100 line of the visual 

acuity chart. Such a standard would be 

more lenient than the 20/200 definition 

for blindness contained in the Act, even 

when measured on more commonly 

used visual acuity test charts. As we 

indicated above, there is nothing in the 

language of the statute or the legislative 

history to suggest that Congress 

intended that we apply any standard 

other than the strict definitions in the 

statute. 

Comment: One commenter, who 

believed that we were expanding our 

definition of statutory blindness by 

providing that individuals who have 

visual acuity between 20/100 and 20/ 

200 would meet the definition of 

statutory blindness, indicated that it 

was not obvious that the changes we 

proposed would have no cost. The 

commenter recommended that we do a 

field study to ascertain the fiscal impact 

of the proposed rules. 

Response: As we indicated in our 

explanation of proposed 2.00A8a in the 

NPRM (70 FR at 48346) and in our 

explanation of final 2.00A8a earlier in 

this preamble, we are codifying in our 

regulations our longstanding procedure 

for evaluating visual acuity 

measurements between 20/100 and 20/ 

200. We have used this procedure since 

1991. Therefore, the proposed rules did 

not, and these final rules do not, change 

how we evaluate such clinical findings. 

We do not expect there will be any 

impact on program or administrative 

costs, and we do not agree that a field 

study is needed. 

Comment: One commenter indicated 

that our policy on evaluating visual 

acuity measurements between 20/100 

and 20/200 needed to be more clearly 

discussed and suggested that we add 

examples. 

Response: We partially adopted this 

comment by adding examples in final 

2.00A8a and 102.00A8a to illustrate 

how we use visual acuity measurements 

between 20/100 and 20/200 to 

determine whether an individual has 

statutory blindness. 

Comment: Several commenters 

questioned the differences between the 

eligibility requirements for benefits 

based on blindness under title XVI and 

benefits based on disability under title 

II and title XVI. One commenter noted 

that individuals age 18 or older have to 

show an inability to do substantial 

gainful activity (SGA) to receive 

disability benefits, but that the inability 

to do SGA is not required for benefits 

based on blindness under title XVI. 

Three commenters noted that it is not 

necessary to establish the cause of the 

blindness in order to receive benefits 

based on blindness under title XVI, but 

it is necessary to establish the cause of 

any visual loss in order to receive 

disability benefits under either title XVI 

or title II, including disability benefits 

based on blindness under title II. One of 

these commenters indicated that these 

differences, as well as the fact that there 

is no duration requirement for benefits 

based on blindness under title XVI 

while there is such a requirement under 

title II, penalize individuals who receive 

title II disability benefits based on 

blindness. This commenter also 

recommended that if the title XVI 

eligibility requirements are statutory 

and cannot be changed, we should 

apply them when we determine whether 

individuals are disabled based on 

blindness under title II. Another 

commenter indicated that having 

different eligibility criteria could be 

confusing to our adjudicators. 

Response: As we indicated in our 

explanation of proposed 2.00A3 in the 

NPRM (70 FR at 48345) and in our 

explanation of final 2.00A3 earlier in 

this preamble, these rules are required 

by the Act. ‘‘Blindness’’ and ‘‘disability’’

are separate categories under title XVI, 

whereas under title II blindness is 

considered a type of ‘‘disability.’’ The 

statutory requirements for eligibility 

based on blindness under title XVI are 

different from the statutory 

requirements for eligibility based on 

disability under title II and title XVI. As 

a matter of law, we cannot apply the 

title XVI eligibility requirements for 

statutory blindness to title II claims for 

disability. 

We do not believe that our 

adjudicators will be confused by the 

different eligibility criteria in these final 

rules because we have been following 

these different rules for adjudicating 

blindness under title II and title XVI 

since the SSI program began in 1974. 

Therefore, our adjudicators have long 

been aware of these differences. 

Visual Acuity 

Comment: One commenter noted that 

there are some visual acuity tests used 

in low vision clinics that use a testing 

distance of 10 feet. The commenter 

suggested that the regulation explain 

how to interpret these results. 

Response: In response to this 

comment, we expanded our guidance in 

proposed 2.00A5b(ii) and 102.00A5b(ii) 

to address this issue. 

Comment: One commenter suggested 

that we revise proposed 2.00A5b(i) and 

102.00A5b(i) to add ‘‘automated 

refraction acuity’’ as an example of a 

type of visual acuity testing that cannot 

be used to determine best-corrected 

visual acuity. 

Response: We adopted this comment. 

Comment: Two commenters noted 

that while proposed 2.00A5b(i) and 

102.00A5b(i) clarified that VER testing 

cannot be used to measure bestcorrected visual acuity, the proposed 

rules did not describe how VER testing 

should be used. The commenters 

indicated that VER testing can be useful 

in many situations, such as ascertaining 

whether a non-verbal individual is able 

to see, diagnosing cortical visual 

disorders, and evaluating cases in which 

malingering is suspected. One 

commenter asked how we evaluate 


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cases of young children in which 

neuroimaging results are not obtainable, 

but in which the treating source has 

diagnosed a cortical visual disorder, 

there is an absent response to VER 

testing, and fixation and following 

behavior are absent. 

Response: We agree with the 

commenters that when there is an 

absent response to VER testing in an 

eye, we can use that result to determine 

that the visual acuity is 20/200 or less 

in that eye, and we are adding this 

guidance to proposed 2.00A5b and 

102.00A5b. We are also revising 

proposed 2.00A4b and 102.00A4b to 

indicate that we will request a copy of 

VER testing results if this testing was 

performed to help diagnose a cortical 

visual disorder. Lastly, we are adding an 

absent response to VER testing as a 

criterion in final listing 102.02B. 

We also agree that VER testing has 

other uses in clinical practice. However, 

VER testing is one tool among many that 

clinicians use to assess the degree of 

visual loss, and it is beyond the scope 

of these listings to explain how tools 

such as VER testing are used by 

clinicians in making their assessments. 

Comment: One commenter noted that 

proposed 2.05A and 102.05A provided 

that we will use visual acuity testing 

that was carried out using Snellen 

methodology or any other testing 

methodology that is comparable to 

Snellen methodology. The commenter 

indicated that there is no generally 

agreed on definition of Snellen 

methodology, and suggested we use 

‘‘letter chart testing’’ instead of ‘‘Snellen 

methodology.’’

Response: We did not adopt the 

comment. The term ‘‘Snellen 

methodology’’ is well recognized by the 

medical community as meaning a chart 

on which there is one large letter for 20/ 

200 and below it rows of letters in 

progressively smaller sizes that reflect 

the distance at which a normal eye 

would be able to see the letters in that 

row. 

Measuring Visual Acuity in Children 

Comment: One commenter noted that 

proposed listing 102.02A requires bestcorrected visual acuity at distance. The 

commenter also noted that paragraph 

102.00A5a(iii) provides that if a child is 

unable to participate in visual acuity 

testing, fixation and following behavior 

will be considered. The commenter 

indicated that some children retain the 

ability to fix and follow at short 

distances, such as three feet, but not at 

far distances. The commenter asked 

how we assess visual acuity for these 

individuals if neuroimaging is not 

available. 

Response: A child has statutory 

blindness based on visual acuity loss if 

his or her visual acuity is 20/200 or less 

in the better eye with the use of a 

correcting lens. For children who can 

participate in visual acuity testing, we 

determine whether the child has 

statutory blindness by assessing the 

child’s best-corrected visual acuity for 

distance in the better eye. 

However, not all children can 

participate in visual acuity testing. For 

these children, we developed alternative 

criteria in final listing 102.02B for 

determining if their visual acuity loss 

has resulted in statutory blindness. One 

of the requirements of that listing is that 

the visual disorder results in the 

absence of fixation and visual-following 

behavior. The listing contemplates that 

this behavior will be assessed at short 

distances; that is, within a few feet, 

because that is how this behavior is 

assessed in clinical practice. If a child 

can use the better eye to fixate and 

visually follow at short distances, his or 

her impairment does not meet the 

listing. We will then evaluate the visual 

disorder to determine if it medically 

equals a listing or functionally equals 

the listings. 

Comment: One commenter noted that 

proposed listing 102.02B required 

clinical findings that fixation and 

visual-following behavior be absent in 

the better eye and indicated that the 

phrase ‘‘in the better eye’’ is 

unnecessary. The commenter remarked 

that if the better eye cannot fix and 

follow, the lesser eye certainly cannot. 

Response: We did not delete the 

phrase ‘‘in the better eye’’ from final 

listing 102.02B because we believe it is 

necessary to the meaning of the rule. If 

we did not have it, the listing could be 

met if a child could not fixate and 

visually follow in the lesser eye but 

could in the better eye. 

Comment: One commenter noted that 

proposed 102.00A5b(i) provided that 

visual acuity measurements obtained 

with a specialized lens can be used only 

if the child has demonstrated the ability 

to use the lens on a sustained basis. It 

also provided that telescopic lenses 

cannot be used because they 

significantly reduce the visual fields. 

The commenter wanted to know how 

visual acuity is assessed if the child is 

too young to wear specialized lenses on 

a sustained basis and telescopic lenses 

cannot be used. 

Response: If the child can participate 

in visual acuity testing, his or her visual 

acuity will be assessed through 

refraction, and we will use the bestcorrected visual acuity for distance that 

the child will have with regular glasses. 

If the child cannot participate in visual 

acuity testing, we will assess his or her 

ability with the better eye to fixate and 

visually follow. If fixation and visual 

following are absent, we will look at 

anatomical findings, or the results of 

neuroimaging, electroretinography, or 

VER testing, if any of these have been 

done, to determine if they are consistent 

with a finding of visual acuity of 20/200 

or less. If they are not consistent with 

such a finding, we will evaluate the 

visual disorder to determine whether 

there is medical or functional 

equivalence. 

Comment: Two commenters indicated 

we should expand the introductory text 

to provide examples of abnormal 

anatomical findings that would indicate 

a visual acuity of 20/200 or worse in the 

better eye. One commenter indicated the 

examples could include bilateral optic 

atrophy, bilateral optic pallor with 

specific cup-to-disc size detailed, 

findings of bilateral congenital cataracts, 

or presence of Stage III or worse 

retinopathy of prematurity despite 

surgical intervention. One of the 

commenters also asked for examples of 

abnormal neuroimaging of the cerebral 

cortex that would indicate a visual 

acuity of 20/200 or worse in the better 

eye. 

Response: In response to these 

comments we added final 

102.00A5b(iii) to provide examples of 

abnormal anatomical findings and 

abnormal neuroimaging documenting 

damage to the cerebral cortex that 

would indicate best-corrected visual 

acuity of 20/200 or less. We did not 

include bilateral optic pallor with 

specific cup-to-disc size detailed or 

findings of bilateral congenital cataracts 

as examples of abnormal anatomical 

findings that would indicate a visual 

acuity of 20/200 or less in the better eye 

because we do not believe that these 

findings are always indicative of that 

level of visual acuity loss. 

Visual Fields 

Comment: One commenter objected to 

several of our requirements for 

acceptable perimeters in proposed 

2.00A6a(ii) and 102.00A6a(ii) which can 

be used to perform automated static 

threshold testing. The commenter 

believed that the requirements seemed 

to be dictated more by a desire to 

promote the Humphrey Field Analyzer 

than by the requirements of disability 

evaluation. The commenter stated that 

our requirements that the perimeter 

have an internal normative database, a 

statistical analysis package, and 

demonstrate the ability to correctly 

detect visual field loss and correctly 

identify normal visual fields were 

unnecessary. The commenter also 


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indicated that these requirements would 

not permit the use of Goldmann 

perimeters. 

Response: As we indicated in our 

explanation of proposed 2.00A6a in the 

NPRM (70 FR at 48345) and in our 

explanation of final 2.00A6a earlier in 

this preamble, we adopted the criteria 

recommended in the NRC report as our 

requirements for perimeters used to 

perform automated static threshold 

perimetry. We agree with the NRC that 

all the criteria should be satisfied. 

In final 2.00A6a(ii) and 102.00A6a(ii) 

we cite the Humphrey Field Analyzer as 

an example of an acceptable perimeter. 

We cite only the Humphrey Field 

Analyzer because it is not our intention 

to list in these rules every acceptable 

automated perimeter, and the 

Humphrey Field Analyzer is the most 

widely used automated perimeter in the 

United States. 

Goldmann perimeters are manual 

kinetic perimeters. The requirements 

listed in final 2.00A6a(ii) and 

102.00A6a(ii) are for perimeters used to 

perform automated static threshold 

testing; therefore, they are not 

applicable to Goldmann perimeters. 

However, as we indicated in our 

explanation of 2.00A6a in the NPRM (70 

FR at 48345) and in our explanation of 

final 2.00A6a earlier in this preamble, 

we will continue to use visual field 

measurements obtained with kinetic 

perimetry such as Goldmann perimetry. 

Comment: Several commenters noted 

that proposed 2.00A6a(iv) and 

102.00A6a(iv) appeared to conflict with 

proposed 2.00A6a(v) and 102.00A6a(v) 

and requested that we clarify this 

guidance. One commenter indicated 

that we should require a 30-degree test 

for all situations. Another suggested that 

we add a reference to listing 2.03A in 

proposed 2.00A6a(iv). 

Response: We clarified the rules in 

response to the comments. Proposed 

2.00A6a(iv) and 102.00A6a(iv) 

described the automated static threshold 

testing needed to determine if an 

individual’s visual field loss resulted in 

statutory blindness; that is, whether the 

widest diameter of the visual field 

subtended an angle no greater than 20 

degrees and thus satisfied the criterion 

in proposed listing 2.03A or 102.03A. 

Proposed 2.00A6a(v) and 102.00A6a(v) 

described the automated static threshold 

testing needed to determine if an 

individual’s visual field loss satisfied 

the criterion in proposed listing 2.03B 

or 102.03B. The criterion in proposed 

listing 2.03B or 102.03B did not 

represent statutory blindness. Therefore, 

the fact that there were different 

documentation requirements was not a 

conflict. However, in response to these 

comments, we added a reference to final 

listing 2.03A in final 2.00A6a(iv) and a 

reference to final listing 102.03A in final 

102.00A6a(iv). 

We did not adopt the comment to 

require a 30-degree test to determine if 

an individual has statutory blindness 

based on visual field loss. If a 24-degree 

test shows this degree of limitation, we 

believe it is not necessary to obtain a 30- 

degree test. 

Comment: One commenter questioned 

the NRC’s recommendations for visual 

field testing. The commenter believed 

that, while visual field tests that 

measure the central 30 degrees of the 

visual field are valuable for diagnostic 

purposes, the NRC report failed to 

provide evidence that they would also 

be appropriate for disability evaluation; 

that is, for determining the 

consequences of a visual disorder. The 

commenter indicated that evaluation of 

reading and mobility would be better 

measures of visual disability. The 

commenter also suggested that instead 

of adopting the NRC recommendation, 

we should evaluate visual field loss 

using the method described in the AMA 

Guides, Fifth Edition. 

Response: We did not adopt the 

comment. The NRC report 

recommended that we use a mean 

deviation of ¥22, determined by an 

automated static threshold perimetry 

test of the central 30 degrees of the 

visual field, as an indicator of disability. 

The NRC explained that this mean 

deviation corresponds to an individual 

having normal vision within the central 

10-degree radius of the visual field and 

no vision outside this radius. The NRC 

indicated, and we agree, that this mean 

deviation represents extensive visual 

field loss, and we believe that this 

degree of visual field loss is of listinglevel severity. 

The NRC also looked at using reading 

and mobility as indicators of visual 

disability and found that use of these 

measures was not viable. Additionally, 

the NRC recommended we not use ‘‘the 

visual field scoring procedures recently 

published by the American Medical 

Association (1993). The AMA 

guidelines are not based on empirical 

data, the procedures have not been 

validated, and their properties are 

largely unknown.’’

Comment: One commenter noted that 

proposed 2.00A6a(v) and 102.00A6a(v) 

indicated that we need results from a 

Humphrey Field Analyzer but also 

provided that we could use comparable 

results from other acceptable 

perimeters. The commenter believed 

this language was inconsistent. 

Response: In response to this 

comment, we revised proposed 

2.00A6a(v) and 102.00A6a(v) to indicate 

that, while the criterion in final listings 

2.03B and102.03B is based on the use of 

a test performed on a Humphrey Field 

Analyzer, we can also use comparable 

results from other acceptable 

perimeters. 

Comment: One commenter noted that 

our explanation of proposed 2.00A6 

indicated that the NRC report 

recommended that disability 

determinations be based on visual fields 

obtained by automated static threshold 

perimeters rather than by kinetic 

perimeters. The commenter noted that 

while automated static threshold 

perimetry can be used to determine if 

the visual disorder meets listing 2.03B, 

it cannot be used to determine the 

percentage of residual field efficiency. 

Two commenters believed that the fact 

that determinations under proposed 

listing 2.03C required kinetic testing 

contradicted the statement that either 

automated static threshold testing or 

kinetic testing could be used. One of 

these commenters believed that the 

regulations could be interpreted as 

requiring both automated static 

threshold testing and kinetic testing, 

and that such a requirement would 

increase costs for SSA. 

Response: As we indicated in our 

explanation of proposed 2.00A6 in the 

NPRM (70 FR at 48345) and in our 

explanation of final 2.00A6 earlier in 

this preamble, we partially adopted the 

NRC recommendation. We will use 

results of automated static threshold 

perimetry to determine the degree of 

visual field loss, but we will also 

continue to use comparable visual field 

measurements obtained with kinetic 

perimetry. Because we allow for 

different types of testing, final listings 

2.03 and 102.03 provide criteria that can 

be used with the different types of test 

results. As the results of these tests are 

comparable, only one type of testing is 

needed. Therefore, in response to the 

second comment, we clarified proposed 

2.00A6a(viii) and 102.00A6a(viii) to 

state that kinetic perimetry may be used 

instead of automated static threshold 

perimetry. 

Comment: One commenter noted that 

proposed 2.00A6a(viii) and 

102.00A6a(viii) indicated that 

automated kinetic testing may need to 

be supplemented with a Humphrey 

30–2 or comparable test if the visual 

disorder has progressed to the point 

where it is likely to result in a 

significant scotoma. The commenter 

asked if this meant that we should 

merge the test result obtained from the 

SSA test kinetic with the results of the 

automated static threshold testing when 

there is a significant scotoma present 


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and if there is a methodology that we 

want our adjudicators to follow for 

combining these tests. Another 

commenter suggested we revise 

proposed 2.00A6(viii) and 

102.00A6a(viii) to indicate that 

automated kinetic testing needs to be 

supplemented when there is the 

likelihood of a significant limitation in 

the central or mid-peripheral visual 

field. The commenter believed we 

should add a reference to the midperipheral field as this is important in 

conditions such as retinitis pigmentosa, 

but also noted that such a limitation 

might be missed by a Humphrey 30–2 

or comparable test. 

Response: In response to these 

comments, we revised the guidance in 

proposed 2.00A6a(viii) and 

102.00A6a(viii) to indicate that we will 

not use automated kinetic perimetry to 

assess visual field loss if the visual 

disorder has progressed to the point 

where it is likely to result in a 

significant limitation in the central 

visual field. In these situations, we will 

use automated static threshold testing or 

manual kinetic perimetry to evaluate the 

visual field loss. 

We did not adopt the comment that 

asked us to add a reference to the midperipheral field. As we indicate below, 

we believe that measuring the central 30 

degrees of the visual field will provide 

sufficient information to determine 

disability or blindness. 

Comment: One commenter noted that 

the Goldmann and Humphrey kinetic 

tests, which measure to the periphery, 

used in conjunction with the 30–2 

would give a better picture of the visual 

field than the 30–2 alone. 

Response: While we agree with the 

commenter, we believe that a visual 

field test that measures the central 30 

degrees of the visual field will provide 

sufficient information to determine 

blindness or disability. 

Comment: One commenter suggested 

that we revise the language in proposed 

2.00A6a(ix) and 102.00A6a(ix) to state 

that we can use normal test results to 

determine that the visual field loss is 

not severe. 

Response: In response to this 

comment, we have clarified proposed 

2.00A6a(ix) and 102.00A6a(ix) to state 

that we can consider normal results 

from visual field screening tests to 

determine whether the visual disorder is 

severe. 

Comment: One commenter suggested 

we add the words ‘‘around fixation’’ to 

proposed listing 2.03A, the listing for 

contraction of the visual field in the 

better eye, with the widest diameter 

subtending an angle no greater than 20 

degrees. 

Response: We have adopted this 

comment by adding the phrase ‘‘around 

the point of fixation’’ in final listings 

2.03A and 102.03A. This will clarify 

that, when we measure the widest 

diameter, the diameter must go through 

the point of fixation. 

Comment: One commenter suggested 

we add a chart showing how the length 

of a scotoma is subtracted from the 

overall length of any diameter in which 

it falls. 

Response: We did not adopt this 

comment. However, we plan to issue a 

Social Security Ruling to explain the 

procedural aspects of measuring the 

visual field, and we will explain how to 

deduct the length of a scotoma in that 

ruling. 

Comment: Two commenters noted 

that proposed 2.00A6a(i) cited macular 

edema as an example of a disorder that 

could result in visual field loss in adults 

but this disorder was not cited in 

proposed 102.00A6a(i). One of these 

commenters suggested that macular 

edema not be included as an example of 

a disorder that could result in visual 

field loss as it does not result in more 

than minimal field loss. The other 

commenter indicated that macular 

edema should be added to proposed 

102.00A6a(i) as the condition does 

occur in children. 

Response: We agree that macular 

edema generally does not result in 

significant visual field loss; therefore, 

we removed the example in response to 

the comment that asked us to do that. 

Final 2.00A6a(i) and 102.00A6a(i) are 

now the same in this regard. 

Visual Efficiency 

Comment: Two commenters 

recommended that we change the way 

we calculate visual efficiency to use the 

functional vision score (FVS) as 

described in the AMA Guides. 

Response: We did not adopt this 

comment. The FVS is based on an 

assessment of visual acuity and visual 

fields. The visual acuity assessment 

requires the use of an ETDRS-type chart 

which is the preferred visual acuity 

chart for research purposes, but is not 

commonly used in clinical practice. 

Additionally, this visual acuity 

assessment requires a measurement of 

binocular visual acuity, and this 

measurement usually is not performed 

as part of a routine eye examination. 

Also, as we indicated above, the NRC 

report recommended that we not use the 

visual field scoring procedures 

published by the AMA. 

Comment: Three commenters asked 

that we add an example to proposed 

2.00A7 and 102.00A7 to clarify how we 

compute visual efficiency. One of these 

commenters also suggested that we add 

the phrase ‘‘and expressing the product 

in decimals converted to a percentage’’

to the end of proposed 2.00A7c and 

102.00A7c. 

Response: In response to this 

comment, we added an example of a 

visual efficiency calculation and the 

phrase ‘‘and converting the decimal to 

a percentage’’ to proposed 2.00A7c and 

102.00A7c. 

Comment: Two commenters 

recommended that we revise proposed 

Table 1 to show visual acuity efficiency 

ratings for the visual acuities of 20/30, 

20/60, and 20/70 instead of the visual 

acuities of 20/32 and 20/64. One of 

these commenters also suggested we 

add ‘‘aphakic with a contact lens’’ to the 

heading of the last column in Table 1. 

Response: In response to this 

comment we revised proposed Table 1 

to show visual acuity efficiency for the 

visual acuities of 20/30, 20/60, and 20/ 

70 (and their metric equivalents) instead 

of the visual acuities of 20/32 and 20/ 

64. We did not adopt the second 

comment because we removed the 

heading in the last column of proposed 

Table 1 as these rules do not 

differentiate between an eye that is 

phakic, pseudophakic, or aphakic. 

Binocular Vision 

Comment: One commenter suggested 

we use binocular vision instead of 

vision in the better eye when we 

evaluate blindness or disability. 

Response: We did not adopt this 

comment. The Act specifies that we use 

the vision in the better eye, that is, 

monocular vision, to determine 

blindness. Additionally, binocular 

visual acuity is often not measured 

during a routine eye examination. 

Lastly, there are no commonly used 

procedures to measure binocular visual 

fields directly or to derive a binocular 

visual field from monocular visual 

fields. 

Specific Visual Disorders 

Comment: One commenter questioned 

the removal of the guidance in prior 

2.00A4, ‘‘Muscle function.’’ The 

commenter indicated that, although 

total bilateral ophthalmoplegia is very 

rare, paralysis of individual eye muscles 

or groups of eye muscles may cause a 

totally debilitating condition. The 

commenter noted that this type of 

impairment was not addressed in the 

proposed rules. Another commenter 

suggested that we add guidance on how 

to evaluate nystagmus. 

Response: We did not adopt these 

comments as eye muscle disorders 

usually do not result in a listing-level 

loss of visual acuity or visual fields. As 


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we indicated in our explanation of the 

proposed changes to 2.00 in the NPRM 

(70 FR at 48344) and in our explanation 

of the final changes to 2.00 earlier in 

this preamble, we will evaluate 

ophthalmoplegia and other eye muscle 

disorders (such as nystagmus) by 

assessing the impact of the disorder on 

visual efficiency or on the individual’s 

visual functioning. 

Comment: Two commenters asked 

that we provide additional guidance on 

how to evaluate the effect of the 

involuntary blinking involved in 

blepharospasm on the ability to 

maintain measured visual acuity and 

visual fields over time. One of these 

commenters also suggested that we 

change the phrase ‘‘maintain measured 

visual acuities and visual fields over 

time’’ in the last sentence of section 

2.00A8b to ‘‘maintain function over 

time’’ as blepharospasm does not cause 

a decrease in measured acuities or 

fields. 

Response: In response to this 

comment, we revised proposed 2.00A8b 

and 102.00A8b to refer to visual 

functioning instead of visual acuities 

and visual fields. Additionally, as we 

reviewed this section to respond to this 

comment, we realized that we should 

have referred to ‘‘closure of your 

eyelids’’ instead of ‘‘eye blinking,’’ and 

have made this and other 

nonsubstantive editorial changes for 

clarity. We have not provided additional 

guidance on how to evaluate the effect 

of the involuntary eyelid closure. This 

assessment requires medical judgment 

and must be made on a case-by-case 

basis. 

Comment: Two commenters 

expressed concern that deleting our 

prior guidance for evaluating aphakia 

will disadvantage those few individuals 

who are unable to obtain or use 

synthetic intraocular lenses or contact 

lenses. 

Response: As we discussed in our 

explanation of the proposed changes to 

2.00 in the NPRM (70 FR at 48344) and 

in our explanation of the final changes 

to 2.00 earlier in this preamble, we 

deleted the guidance on aphakia as this 

condition is effectively treated with 

synthetic intraocular lenses or contact 

lenses. We do not agree that the very 

few individuals who are unable to 

obtain or use these treatments will be 

adversely affected. If an individual with 

aphakia does not have an impairment 

that meets a listing, we can consider the 

effects of aphakia when we determine 

whether the impairment medically 

equals a listing or when determining 

residual functional capacity or, in 

children, functional equivalence. 

Comment: One commenter suggested 

we add guidance about pseudophakia to 

proposed 2.00A8 and 102.00A8. 

Response: We did not adopt this 

comment as these final rules do not 

differentiate between an eye that is 

phakic, pseudophakic, or aphakic. 

Comment: One commenter suggested 

that we change the phrase ‘‘cortical 

blindness’’ used in proposed 2.00A4b 

and 102.00A4b to ‘‘cortical visual 

impairment.’’ The commenter also 

provided language that describes a 

cortical visual impairment and 

suggested we add the language to 

proposed 2.00A8 and 102.00A8. 

Another commenter noted that 

proposed 2.00A4b cited stroke as an 

example of a catastrophic event that can 

cause cortical blindness in adults. The 

commenter recommended that we 

include the same example in proposed 

102.00A4b for children. 

Response: In response to these 

comments, we changed the phrase 

‘‘cortical blindness’’ to ‘‘cortical visual 

disorder’’ and expanded the discussion 

of cortical visual disorders in proposed 

2.00A4b and 102.00A4b. Our expanded 

discussions include stroke as an 

example of a cause of cortical visual 

disorders in children. 

Comment: One commenter requested 

clarification of what is needed to 

document a catastrophic event that 

causes blindness. The commenter asked 

if mention of the specific event as part 

of the medical history would be 

sufficient, or whether copies of the 

actual hospitalization, operative report, 

or pertinent lab studies would be 

required. 

Response: The mention of a specific 

event as part of a medical history would 

be an allegation that the event took 

place; it would not be documentation of 

the event. To document the catastrophic 

event, we need medical records showing 

the treatment for the event. 

Other Comments 

Comment: One commenter noted that 

our reference to the American Medical 

Association’s Guides to the Evaluation 

of Permanent Impairment, Fifth Edition, 

cited pages 252 and 287–295. The 

commenter indicated that he believed 

we never consulted the fifth edition as 

the page numbers are wrong and the 

content is not used. 

Response: We did reference the fifth 

edition of the AMA Guides. The 

reference to page 252 was an editing 

error. The section of the AMA Guides 

on impairment of visual field is on 

pages 287–295. Although we consulted 

this reference, we decided not to adopt 

the AMA’s procedures for evaluating 

visual field loss for reasons we have 

already given. 

Comment: A number of commenters 

suggested minor editorial changes and 

additions. For example, one commenter 

suggested we add the word 

‘‘impairments’’ to the heading of this 

body system. Another commenter 

suggested we add the acronym ‘‘VTAP’’

after the word ‘‘Humphrey’’ in the last 

sentence of proposed 2.00A6a(iv) and 

102.00A6a(iv). Another commenter 

suggested we change the heading of 

proposed 2.08 and 102.08. 

Response: We did not adopt these 

suggestions. In some cases, we did not 

think they were necessary. In others, we 

did not think that they clarified the 

issues. 

Comment: One commenter asked us 

to clarify the reporting requirements 

under the Paperwork Reduction Act. 

Response: The Paperwork Reduction 

Act (PRA) of 1995, Public Law 104–13, 

requires Federal Government agencies 

that intend to collect information from 

10 or more members of the public to 

seek comment on such information 

collections prior to obtaining Office of 

Management and Budget approval. The 

purpose in seeking public comment is to 

reduce to the extent practicable and 

appropriate the burden imposed on the 

public. Sections 2.00A and 102.00A 

discuss evidentiary reports, such as 

reports of eye examinations that we 

obtain from providers of medical 

evidence. The evidentiary reporting 

requirements are covered by the PRA; 

therefore; we provide an opportunity for 

the public to comment via the PRA 

notice shown in the preamble to the 

proposed rules. 

Regulatory Procedures 

Executive Order 12866 

We have consulted with the Office of 

Management and Budget (OMB) and 

determined that these final rules meet 

the requirements for a significant 

regulatory action under Executive Order 

12866, as amended by Executive Order 

13258. Thus, they were subject to OMB 

review. 

Regulatory Flexibility Act 

We certify that these final rules do not 

have a significant economic impact on 

a substantial number of small entities 

because they affect only individuals. 

Thus, a regulatory flexibility analysis as 

provided in the Regulatory Flexibility 

Act, as amended, is not required. 

Paperwork Reduction Act 

The Paperwork Reduction Act (PRA) 

of 1995 says that no persons are 

required to respond to a collection of 


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67050 Federal Register / Vol. 71, No. 223 / Monday, November 20, 2006 / Rules and Regulations 

information unless it displays a valid 

OMB control number. In accordance 

with the PRA, SSA is providing notice 

that OMB has approved the information 

collection requirements contained in 

Part A, 2.00 and Part B, 102.00 of these 

final rules. The OMB Control Number 

for this collection is 0960–0642, 

expiring March 31, 2008. 

(Catalog of Federal Domestic Assistance 

Program Nos. 96.001, Social Security—

Disability Insurance; 96.002, Social 

Security—Retirement Insurance; 96.004, 

Social Security—Survivors Insurance; and 

96.006, Supplemental Security Income) 

List of Subjects in 20 CFR Part 404 

Administrative practice and 

procedure, Blind, Disability benefits, 

Old-Age, Survivors, and Disability 

Insurance, Reporting and recordkeeping 

requirements, Social Security. 

Dated: August 2, 2006. 

Jo Anne B. Barnhart, 

Commissioner of Social Security. 

■ For the reasons set forth in the 

preamble, we are amending subpart P of 

part 404 of chapter III of title 20 of the 

Code of Federal Regulations as set forth 

below: 

PART 404—FEDERAL OLD-AGE, 

SURVIVORS AND DISABILITY 

INSURANCE (1950– ) 

■ 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. 

Appendix 1 to Subpart P of Part 404—

[Amended] 

■ 2. Appendix 1 to subpart P of part 404 

is amended as follows: 

■ a. Item 3 of the introductory text 

before part A of appendix 1 is amended 

by revising the expiration date. 

■ b. Section 2.00A of part A of appendix 

1 is revised. 

■ c. Section 2.00C is added to part A of 

appendix 1. 

■ d. Listing 2.02 of part A of appendix 

1 is revised. 

■ e. Listing 2.03 of part A of appendix 

1 is revised. 

■ f. Listing 2.04 of part A of appendix 

1 is revised. 

■ g. The reservation for listing 2.05 is 

removed. 

■ h. Listing 2.06 of part A of appendix 

1 is removed. 

■ i. Tables 1 and 2 of section 2.00 of part 

A of appendix 1 are revised. 

■ j. Section 102.00A of part B of 

appendix 1 is revised. 

■ k. Section 102.00C is added to part B 

of appendix 1. 

■ l. Listing 102.01 of part B of appendix 

1 is revised. 

■ m. Listing 102.02 of part B of 

appendix 1 is revised. 

■ n. Listing 102.03 is added to part B of 

appendix 1. 

■ o. Listing 102.04 is added to part B of 

appendix 1. 

■ p. Tables 1 and 2 are added to section 

102.00 of part B of appendix 1. 

The revised text is set forth as follows: 

Appendix 1 to Subpart P of Part 404—

Listing of Impairments 

* * * * * 

3. Special Senses and Speech (2.00 and 

102.00): February 20, 2015. 

* * * * * 

Part A 

* * * * * 

2.00 SPECIAL SENSES AND SPEECH 

A. How do we evaluate visual disorders? 

1. What are visual disorders? Visual 

disorders are abnormalities of the eye, the 

optic nerve, the optic tracts, or the brain that 

may cause a loss of visual acuity or visual 

fields. A loss of visual acuity limits your 

ability to distinguish detail, read, or do fine 

work. A loss of visual fields limits your 

ability to perceive visual stimuli in the 

peripheral extent of vision. 

2. How do we define statutory blindness? 

Statutory blindness is blindness as defined in 

sections 216(i)(1) and 1614(a)(2) of the Social 

Security Act (the Act). The Act defines 

blindness as visual acuity of 20/200 or less 

in the better eye with the use of a correcting 

lens. We use your best-corrected visual 

acuity for distance in the better eye when we 

determine if this definition is met. The Act 

also provides that an eye that has a visual 

field limitation such that the widest diameter 

of the visual field subtends an angle no 

greater than 20 degrees is considered as 

having visual acuity of 20/200 or less. You 

have statutory blindness only if your visual 

disorder meets the criteria of 2.02 or 2.03A. 

You do not have statutory blindness if your 

visual disorder medically equals the criteria 

of 2.02 or 2.03A, or if it meets or medically 

equals 2.03B, 2.03C, or 2.04. If your visual 

disorder medically equals the criteria of 2.02 

or 2.03A, or if it meets or medically equals 

2.03B, 2.03C, or 2.04, we will find that you 

have a disability if your visual disorder also 

meets the duration requirement. 

3. What evidence do we need to establish 

statutory blindness under title XVI? For title 

XVI, the only evidence we need to establish 

statutory blindness is evidence showing that 

your visual acuity in your better eye or your 

visual field in your better eye meets the 

criteria in 2.00A2, provided that those 

measurements are consistent with the other 

evidence in your case record. We do not need 

to document the cause of your blindness. 

Also, there is no duration requirement for 

statutory blindness under title XVI (see 

§§ 416.981 and 416.983). 

4. What evidence do we need to evaluate 

visual disorders, including those that result 

in statutory blindness under title II? 

a. To evaluate your visual disorder, we 

usually need a report of an eye examination 

that includes measurements of the bestcorrected visual acuity or the extent of the 

visual fields, as appropriate. If there is a loss 

of visual acuity or visual fields, the cause of 

the loss must be documented. A standard eye 

examination will usually reveal the cause of 

any visual acuity loss. An eye examination 

can also reveal the cause of some types of 

visual field deficits. If the eye examination 

does not reveal the cause of the visual loss, 

we will request the information that was 

used to establish the presence of the visual 

disorder. 

b. A cortical visual disorder is a 

disturbance of the posterior visual pathways 

or occipital lobes of the brain in which the 

visual system does not interpret what the 

eyes are seeing. It may result from such 

causes as traumatic brain injury, stroke, 

cardiac arrest, near drowning, a central 

nervous system infection such as meningitis 

or encephalitis, a tumor, or surgery. It can be 

temporary or permanent, and the amount of 

visual loss can vary. It is possible to have a 

cortical visual disorder and not have any 

abnormalities observed in a standard eye 

examination. Therefore, a diagnosis of a 

cortical visual disorder must be confirmed by 

documentation of the cause of the brain 

lesion. If neuroimaging or visual evoked 

response (VER) testing was performed, we 

will request a copy of the report or other 

medical evidence that describes the findings 

in the report. 

c. If your visual disorder does not satisfy 

the criteria in 2.02, 2.03, or 2.04, we will also 

request a description of how your visual 

disorder impacts your ability to function. 

5. How do we measure best-corrected 

visual acuity? 

a. Testing for visual acuity. When we need 

to measure your best-corrected visual acuity, 

we will use visual acuity testing that was 

carried out using Snellen methodology or any 

other testing methodology that is comparable 

to Snellen methodology. 

b. Determining best-corrected visual acuity. 

(i) Best-corrected visual acuity is the optimal 

visual acuity attainable with the use of a 

corrective lens. In some instances, this 

assessment may be performed using a 

specialized lens; for example, a contact lens. 

We will use the visual acuity measurements 

obtained with a specialized lens only if you 

have demonstrated the ability to use the 

specialized lens on a sustained basis. 

However, we will not use visual acuity 

measurements obtained with telescopic 

lenses because they significantly reduce the 

visual field. If you have an absent response 

to VER testing in an eye, we can determine 

that your best-corrected visual acuity is 20/ 

200 or less in that eye. However, if you have 

a positive response to VER testing in an eye, 

we will not use that result to determine your 

best-corrected visual acuity in that eye. 

Additionally, we will not use the results of 

pinhole testing or automated refraction 

acuity to determine your best-corrected 

visual acuity. 


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(ii) We will use the best-corrected visual 

acuity for distance in your better eye when 

we determine whether your loss of visual 

acuity satisfies the criteria in 2.02. The bestcorrected visual acuity for distance is usually 

measured by determining what you can see 

from 20 feet. If your visual acuity is 

measured for a distance other than 20 feet, 

we will convert it to a 20-foot measurement. 

For example, if your visual acuity is 

measured at 10 feet and is reported as 10/40, 

we will convert this to 20/80. 

6. How do we measure visual fields? 

a. Testing for visual fields. 

(i) We generally need visual field testing 

when you have a visual disorder that could 

result in visual field loss, such as glaucoma, 

retinitis pigmentosa, or optic neuropathy, or 

when you display behaviors that suggest a 

visual field loss. 

(ii) When we need to measure the extent 

of your visual field loss, we will use visual 

field measurements obtained with an 

automated static threshold perimetry test 

performed on a perimeter, like the Humphrey 

Field Analyzer, that satisfies all of the 

following requirements: 

A. The perimeter must use optical 

projection to generate the test stimuli. 

B. The perimeter must have an internal 

normative database for automatically 

comparing your performance with that of the 

general population. 

C. The perimeter must have a statistical 

analysis package that is able to calculate 

visual field indices, particularly mean 

deviation. 

D. The perimeter must demonstrate the 

ability to correctly detect visual field loss and 

correctly identify normal visual fields. 

E. The perimeter must demonstrate good 

test-retest reliability. 

F. The perimeter must have undergone 

clinical validation studies by three or more 

independent laboratories with results 

published in peer-reviewed ophthalmic 

journals. 

(iii) The test must use a white size III 

Goldmann stimulus and a 31.5 apostilb (10 

cd/m2) white background. The stimuli 

locations must be no more than 6 degrees 

apart horizontally or vertically. 

Measurements must be reported on standard 

charts and include a description of the size 

and intensity of the test stimulus. 

(iv) To determine statutory blindness based 

on visual field loss (2.03A), we need a test 

that measures the central 24 to 30 degrees of 

the visual field; that is, the area measuring 

24 to 30 degrees from the point of fixation. 

Acceptable tests include the Humphrey 30–

2 or 24–2 tests. 

(v) The criterion in 2.03B is based on the 

use of a test performed on a Humphrey Field 

Analyzer that measures the central 30 

degrees of the visual field. We can also use 

comparable results from other acceptable 

perimeters, for example, a mean defect of 22 

on an acceptable Octopus test, to determine 

that the criterion in 2.03B is met. We cannot 

use tests that do not measure the central 30 

degrees of the visual field, such as the 

Humphrey 24–2 test, to determine if your 

impairment meets or medically equals 2.03B. 

(vi) We measure the extent of visual field 

loss by determining the portion of the visual 

field in which you can see a white III4e 

stimulus. The ‘‘III’’ refers to the standard 

Goldmann test stimulus size III, and the ‘‘4e’’

refers to the standard Goldmann intensity 

filters used to determine the intensity of the 

stimulus. 

(vii) In automated static threshold 

perimetry, the intensity of the stimulus 

varies. The intensity of the stimulus is 

expressed in decibels (dB). We need to 

determine the dB level that corresponds to a 

4e intensity for the particular perimeter being 

used. We will then use the dB printout to 

determine which points would be seen at a 

4e intensity level. For example, in Humphrey 

Field Analyzers, a 10 dB stimulus is 

equivalent to a 4e stimulus. A dB level that 

is higher than 10 represents a dimmer 

stimulus, while a dB level that is lower than 

10 represents a brighter stimulus. Therefore, 

for tests performed on Humphrey Field 

Analyzers, any point seen at 10 dB or higher 

is a point that would be seen with a 4e 

stimulus. 

(viii) We can also use visual field 

measurements obtained using kinetic 

perimetry, such as the Humphrey ‘‘SSA Test 

Kinetic’’ or Goldmann perimetry, instead of 

automated static threshold perimetry. The 

kinetic test must use a white III4e stimulus 

projected on a white 31.5 apostilb (10 cd/m2) 

background. In automated kinetic tests, such 

as the Humphrey ‘‘SSA Test Kinetic,’’ testing 

along a meridian stops when you see the 

stimulus. Because of this, automated kinetic 

testing does not detect limitations in the 

central visual field. If your visual disorder 

has progressed to the point at which it is 

likely to result in a significant limitation in 

the central visual field, such as a scotoma 

(see 2.00A8c), we will not use automated 

kinetic perimetry to evaluate your visual 

field loss. Instead, we will assess your visual 

field loss using automated static threshold 

perimetry or manual kinetic perimetry. 

(ix) We will not use the results of visual 

field screening tests, such as confrontation 

tests, tangent screen tests, or automated static 

screening tests, to determine that your 

impairment meets or medically equals a 

listing or to evaluate your residual functional 

capacity. However, we can consider normal 

results from visual field screening tests to 

determine whether your visual disorder is 

severe when these test results are consistent 

with the other evidence in your case record. 

(See §§ 404.1520(c), 404.1521, 416.920(c), 

and 416.921.) We will not consider normal 

test results to be consistent with the other 

evidence if either of the following applies: 

A. The clinical findings indicate that your 

visual disorder has progressed to the point 

that it is likely to cause visual field loss, or 

B. You have a history of an operative 

procedure for retinal detachment. 

b. Use of corrective lenses. You must not 

wear eyeglasses during the visual field 

examination because they limit your field of 

vision. Contact lenses or perimetric lenses 

may be used to correct visual acuity during 

the visual field examination in order to 

obtain the most accurate visual field 

measurements. For this single purpose, you 

do not need to demonstrate that you have the 

ability to use the contact or perimetric lenses 

on a sustained basis. 

7. How do we calculate visual efficiency? 

a. Visual acuity efficiency. We use the 

percentage shown in Table 1 that 

corresponds to the best-corrected visual 

acuity for distance in your better eye. 

b. Visual field efficiency. We use kinetic 

perimetry to calculate visual field efficiency 

by adding the number of degrees seen along 

the eight principal meridians in your better 

eye and dividing by 500. (See Table 2.) 

c. Visual efficiency. We calculate the 

percent of visual efficiency by multiplying 

the visual acuity efficiency by the visual field 

efficiency and converting the decimal to a 

percentage. For example, if your visual acuity 

efficiency is 75 percent and your visual field 

efficiency is 64 percent, we will multiply 

0.75 × 0.64 to determine that your visual 

efficiency is 0.48, or 48 percent. 

8. How do we evaluate specific visual 

problems? 

a. Statutory blindness. Most test charts that 

use Snellen methodology do not have lines 

that measure visual acuity between 20/100 

and 20/200. Newer test charts, such as the 

Bailey-Lovie or the Early Treatment Diabetic 

Retinopathy Study (ETDRS), do have lines 

that measure visual acuity between 20/100 

and 20/200. If your visual acuity is measured 

with one of these newer charts, and you 

cannot read any of the letters on the 20/100 

line, we will determine that you have 

statutory blindness based on a visual acuity 

of 20/200 or less. For example, if your bestcorrected visual acuity for distance in the 

better eye was determined to be 20/160 using 

an ETDRS chart, we will find that you have 

statutory blindness. Regardless of the type of 

test chart used, you do not have statutory 

blindness if you can read at least one letter 

on the 20/100 line. For example, if your bestcorrected visual acuity for distance in the 

better eye was determined to be 20/125+1 

using an ETDRS chart, we will find that you 

do not have statutory blindness as you are 

able to read one letter on the 20/100 line. 

b. Blepharospasm. This movement 

disorder is characterized by repetitive, 

bilateral, involuntary closure of the eyelids. 

If you have this disorder, you may have 

measurable visual acuities and visual fields 

that do not satisfy the criteria of 2.02 or 2.03. 

Blepharospasm generally responds to 

therapy. However, if therapy is not effective, 

we will consider how the involuntary closure 

of your eyelids affects your ability to 

maintain visual functioning over time. 

c. Scotoma. A scotoma is a non-seeing area 

in the visual field surrounded by a seeing 

area. When we measure the visual field, we 

subtract the length of any scotoma, other than 

the normal blind spot, from the overall length 

of any diameter on which it falls. 

* * * * * 

C. How do we evaluate impairments that 

do not meet one of the special senses and 

speech listings? 

1. These listings are only examples of 

common special senses and speech disorders 

that we consider severe enough to prevent an 

individual from doing any gainful activity. If 

your impairment(s) does not meet the criteria 

of any of these listings, we must also 

consider whether you have an impairment(s) 

that satisfies the criteria of a listing in 

another body system. 


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2. If you have a medically determinable 

impairment(s) that does not meet a listing, 

we will determine whether the impairment(s) 

medically equals a listing. (See §§ 404.1526 

and 416.926.) If you have an impairment(s) 

that does not meet or medically equal a 

listing, you may or may not have the residual 

functional capacity to engage in substantial 

gainful activity. Therefore, we proceed to the 

fourth, and if necessary, the fifth steps of the 

sequential evaluation process in §§ 404.1520 

and 416.920. When we decide whether you 

continue to be disabled, we use the rules in 

§§ 404.1594, 416.994, or 416.994a, as 

appropriate. 

2.01 Category of Impairments, Special 

Senses and Speech 

2.02 Loss of visual acuity. Remaining 

vision in the better eye after best correction 

is 20/200 or less. 

2.03 Contraction of the visual field in the 

better eye, with: 

A. The widest diameter subtending an 

angle around the point of fixation no greater 

than 20 degrees; 

OR 

B. A mean deviation of –22 or worse, 

determined by automated static threshold 

perimetry as described in 2.00A6a(v); 

OR 

C. A visual field efficiency of 20 percent 

or less as determined by kinetic perimetry 

(see 2.00A7b). 

2.04 Loss of visual efficiency. Visual 

efficiency of the better eye of 20 percent or 

less after best correction (see 2.00A7c). 

* * * * * 

TABLE 1.—PERCENTAGE OF VISUAL

ACUITY EFFICIENCY CORRESPONDING TO THE BEST-CORRECTED VISUAL ACUITY MEASUREMENT FOR DISTANCE IN THE BETTER

EYE

Snellen Percent 

visual 

acuity efficiency English Metric 

20/16 ................. 6/5 100 

20/20 ................. 6/6 100 

20/25 ................. 6/7.5 95 

20/30 ................. 6/9 90 

20/40 ................. 6/12 85 

20/50 ................. 6/15 75 

20/60 ................. 6/18 70 

20/70 ................. 6/21 65 

20/80 ................. 6/24 60 

20/100 ............... 6/30 50 

TABLE 2.—CHART OF VISUAL FIELDS

1. The diagram of the right eye illustrates 

the extent of a normal visual field as 

measured with a III4e stimulus. The sum of 

the eight principal meridians of this field is 

500 degrees. 

2. The diagram of the left eye illustrates a 

visual field contracted to 30 degrees in two 

meridians and to 20 degrees in the remaining 

six meridians. The percent of visual field 

efficiency of this field is: (2 × 30) + (6 × 20) 

= 180÷500 = 0.36 or 36 percent visual field 

efficiency. 

* * * * * 

Part B 

* * * * * 

102.00 SPECIAL SENSES AND SPEECH 

A. How do we evaluate visual disorders? 

1. What are visual disorders? Visual 

disorders are abnormalities of the eye, the 

optic nerve, the optic tracts, or the brain that 

may cause a loss of visual acuity or visual 

fields. A loss of visual acuity limits your 

ability to distinguish detail, read, do fine 

work, or perform other age-appropriate 

activities. A loss of visual fields limits your 

ability to perceive visual stimuli in the 

peripheral extent of vision. 

2. How do we define statutory blindness? 

Statutory blindness is blindness as defined in 

sections 216(i)(1) and 1614(a)(2) of the Social 

Security Act (the Act). The Act defines 

blindness as visual acuity of 20/200 or less 

in the better eye with the use of a correcting 

lens. We use your best-corrected visual 

acuity for distance in the better eye when we 

determine if this definition is met. The Act 

also provides that an eye that has a visual 

field limitation such that the widest diameter 

of the visual field subtends an angle no 


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greater than 20 degrees is considered as 

having visual acuity of 20/200 or less. You 

have statutory blindness only if your visual 

disorder meets the criteria of 102.02 or 

102.03A. You do not have statutory blindness 

if your visual disorder medically equals the 

criteria of 102.02 or 102.03A, or if it meets 

or medically equals 102.03B, 102.03C, or 

102.04. If your visual disorder medically 

equals the criteria of 102.02 or 102.03A, or 

if it meets or medically equals 102.03B, 

102.03C, or 102.04, we will find that you 

have a disability if your visual disorder also 

meets the duration requirement. 

3. What evidence do we need to establish 

statutory blindness under title XVI? For title 

XVI, the only evidence we need to establish 

statutory blindness is evidence showing that 

your visual acuity in your better eye or your 

visual field in your better eye meets the 

criteria in 102.00A2, provided that those 

measurements are consistent with the other 

evidence in your case record. We do not need 

to document the cause of your blindness. 

Also, there is no duration requirement for 

statutory blindness under title XVI (see 

§§ 416.981 and 416.983). 

4. What evidence do we need to evaluate 

visual disorders, including those that result 

in statutory blindness under title II? 

a. To evaluate your visual disorder, we 

usually need a report of an eye examination 

that includes measurements of the bestcorrected visual acuity or the extent of the 

visual fields, as appropriate. If there is a loss 

of visual acuity or visual fields, the cause of 

the loss must be documented. A standard eye 

examination will usually reveal the cause of 

any visual acuity loss. An eye examination 

can also reveal the cause of some types of 

visual field deficits. If the eye examination 

does not reveal the cause of the visual loss, 

we will request the information that was 

used to establish the presence of the visual 

disorder. 

b. A cortical visual disorder is a 

disturbance of the posterior visual pathways 

or occipital lobes of the brain in which the 

visual system does not interpret what the 

eyes are seeing. It may result from such 

causes as traumatic brain injury, stroke, 

cardiac arrest, near drowning, a central 

nervous system infection such as meningitis 

or encephalitis, a tumor, or surgery. It can be 

temporary or permanent, and the amount of 

visual loss can vary. It is possible to have a 

cortical visual disorder and not have any 

abnormalities observed in a standard eye 

examination. Therefore, a diagnosis of a 

cortical visual disorder must be confirmed by 

documentation of the cause of the brain 

lesion. If neuroimaging or visual evoked 

response (VER) testing was performed, we 

will request a copy of the report or other 

medical evidence that describes the findings 

in the report. 

c. If your visual disorder does not satisfy 

the criteria in 102.02, 102.03, or 102.04, we 

will also request a description of how your 

visual disorder impacts your ability to 

function. 

5. How do we measure best-corrected 

visual acuity? 

a. Testing for visual acuity. 

(i) When we need to measure your bestcorrected visual acuity, we will use visual 

acuity testing that was carried out using 

Snellen methodology or any other testing 

methodology that is comparable to Snellen 

methodology. 

(ii) We consider tests such as the Landolt 

C test or the tumbling-E test, which are used 

to evaluate young children who are unable to 

participate in testing using Snellen 

methodology, to be comparable to testing 

using Snellen methodology. These alternate 

methods for measuring visual acuity should 

be performed by specialists with expertise in 

assessment of childhood vision. 

(iii) If you are unable to participate in 

testing using Snellen methodology or other 

comparable testing, we will consider your 

fixation and visual-following behavior. If 

both these behaviors are absent, we will 

consider the anatomical findings or the 

results of neuroimaging, electroretinogram, or 

VER testing when this testing has been 

performed. 

b. Determining best-corrected visual acuity. 

(i) Best-corrected visual acuity is the optimal 

visual acuity attainable with the use of a 

corrective lens. In some instances, this 

assessment may be performed using a 

specialized lens; for example, a contact lens. 

We will use the visual acuity measurements 

obtained with a specialized lens only if you 

have demonstrated the ability to use the 

specialized lens on a sustained basis. 

However, we will not use visual acuity 

measurements obtained with telescopic 

lenses because they significantly reduce the 

visual field. If you have an absent response 

to VER testing in an eye, we can determine 

that your best-corrected visual acuity is 

20/200 or less in that eye. However, if you 

have a positive response to VER testing in an 

eye, we will not use that result to determine 

your best-corrected visual acuity in that eye. 

Additionally, we will not use the results of 

pinhole testing or automated refraction 

acuity to determine your best-corrected 

visual acuity. 

(ii) We will use the best-corrected visual 

acuity for distance in your better eye when 

we determine whether your loss of visual 

acuity satisfies the criteria in 102.02A. The 

best-corrected visual acuity for distance is 

usually measured by determining what you 

can see from 20 feet. If your visual acuity is 

measured for a distance other than 20 feet, 

we will convert it to a 20-foot measurement. 

For example, if your visual acuity is 

measured at 10 feet and is reported as 10/40, 

we will convert this to 20/80. 

(iii) If you cannot participate in visual 

acuity testing, we will determine that your 

best-corrected visual acuity is 20/200 or less 

in your better eye if your visual disorder 

meets the criteria in 102.02B. To meet 

102.02B1, your impairment must result in the 

absence of fixation and visual-following 

behavior and abnormal anatomical findings 

indicating a visual acuity of 20/200 or less in 

your better eye. Such abnormal anatomical 

findings include, but are not limited to, the 

presence of Stage III or worse retinopathy of 

prematurity despite surgery, hypoplasia of 

the optic nerve, albinism with macular 

aplasia, and bilateral optic atrophy. To meet 

102.02B2, your impairment must result in the 

absence of fixation and visual-following 

behavior and abnormal neuroimaging 

documenting damage to the cerebral cortex 

which would be expected to prevent the 

development of a visual acuity better than 

20/200 in your better eye. Such abnormal 

neuroimaging includes, but is not limited to, 

neuroimaging showing bilateral 

encephalomyelitis or bilateral 

encephalomalacia. 

6. How do we measure visual fields? 

a. Testing for visual fields. 

(i) We generally need visual field testing 

when you have a visual disorder that could 

result in visual field loss, such as glaucoma, 

retinitis pigmentosa, or optic neuropathy, or 

when you display behaviors that suggest a 

visual field loss. 

(ii) When we need to measure the extent 

of your visual field loss, we will use visual 

field measurements obtained with an 

automated static threshold perimetry test 

performed on a perimeter, like the Humphrey 

Field Analyzer, that satisfies all of the 

following requirements: 

A. The perimeter must use optical 

projection to generate the test stimuli. 

B. The perimeter must have an internal 

normative database for automatically 

comparing your performance with that of the 

general population. 

C. The perimeter must have a statistical 

analysis package that is able to calculate 

visual field indices, particularly mean 

deviation. 

D. The perimeter must demonstrate the 

ability to correctly detect visual field loss and 

correctly identify normal visual fields. 

E. The perimeter must demonstrate good 

test-retest reliability. 

F. The perimeter must have undergone 

clinical validation studies by three or more 

independent laboratories with results 

published in peer-reviewed ophthalmic 

journals. 

(iii) The test must use a white size III 

Goldmann stimulus and a 31.5 apostilb (10 

cd/m2) white background. The stimuli 

locations must be no more than 6 degrees 

apart horizontally or vertically. 

Measurements must be reported on standard 

charts and include a description of the size 

and intensity of the test stimulus. 

(iv) To determine statutory blindness based 

on visual field loss (102.03A), we need a test 

that measures the central 24 to 30 degrees of 

the visual field; that is, the area measuring 

24 to 30 degrees from the point of fixation. 

Acceptable tests include the Humphrey 30–

2 or 24–2 tests. 

(v) The criterion in 102.03B is based on the 

use of a test performed on a Humphrey Field 

Analyzer that measures the central 30 

degrees of the visual field. We can also use 

comparable results from other acceptable 

perimeters; for example, a mean defect of 22 

on an acceptable Octopus test, to determine 

that the criterion in 102.03B is met. We 

cannot use tests that do not measure the 

central 30 degrees of the visual field, such as 

the Humphrey 24–2 test, to determine if your 

impairment meets or medically equals 

102.03B. 

(vi) We measure the extent of visual field 

loss by determining the portion of the visual 

field in which you can see a white III4e 

stimulus. The ‘‘III’’ refers to the standard 

Goldmann test stimulus size III, and the 


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‘‘4e’’efers to the standard Goldmann intensity 

filters used to determine the intensity of the 

stimulus. 

(vii) In automated static threshold 

perimetry, the intensity of the stimulus 

varies. The intensity of the stimulus is 

expressed in decibels (dB). We need to 

determine the dB level that corresponds to a 

4e intensity for the particular perimeter being 

used. We will then use the dB printout to 

determine which points would be seen at a 

4e intensity level. For example, in Humphrey 

Field Analyzers, a 10 dB stimulus is 

equivalent to a 4e stimulus. A dB level that 

is higher than 10 represents a dimmer 

stimulus, while a dB level that is lower than 

10 represents a brighter stimulus. Therefore, 

for tests performed on Humphrey Field 

Analyzers, any point seen at 10 dB or higher 

is a point that would be seen with a 4e 

stimulus. 

(viii) We can also use visual field 

measurements obtained using kinetic 

perimetry, such as the Humphrey ‘‘SSA Test 

Kinetic’’ or Goldmann perimetry, instead of 

automated static threshold perimetry. The 

kinetic test must use a white III4e stimulus 

projected on a white 31.5 apostilb (10 cd/m2) 

background. In automated kinetic tests, such 

as the Humphrey ‘‘SSA Test Kinetic,’’ testing 

along a meridian stops when you see the 

stimulus. Because of this, automated kinetic 

testing does not detect limitations in the 

central visual field. If your visual disorder 

has progressed to the point at which it is 

likely to result in a significant limitation in 

the central visual field, such as a scotoma 

(see 102.00A8c), we will not use automated 

kinetic perimetry to evaluate your visual 

field loss. Instead, we will assess your visual 

field loss using automated static threshold 

perimetry or manual kinetic perimetry. 

(ix) We will not use the results of visual 

field screening tests, such as confrontation 

tests, tangent screen tests, or automated static 

screening tests, to determine that your 

impairment meets or medically equals a 

listing, or functionally equals the listings. 

However, we can consider normal results 

from visual field screening tests to determine 

whether your visual disorder is severe when 

these test results are consistent with the other 

evidence in your case record. (See 

§ 416.924(c).) We will not consider normal 

test results to be consistent with the other 

evidence if either of the following applies: 

A. The clinical findings indicate that your 

visual disorder has progressed to the point 

that it is likely to cause visual field loss; or 

B. You have a history of an operative 

procedure for retinal detachment. 

b. Use of corrective lenses. You must not 

wear eyeglasses during the visual field 

examination because they limit your field of 

vision. Contact lenses or perimetric lenses 

may be used to correct visual acuity during 

the visual field examination in order to 

obtain the most accurate visual field 

measurements. For this single purpose, you 

do not need to demonstrate that you have the 

ability to use the contact or perimetric lenses 

on a sustained basis. 

7. How do we calculate visual efficiency? 

a. Visual acuity efficiency. We use the 

percentage shown in Table 1 that 

corresponds to the best-corrected visual 

acuity for distance in your better eye. 

b. Visual field efficiency. We use kinetic 

perimetry to calculate visual field efficiency 

by adding the number of degrees seen along 

the eight principal meridians in your better 

eye and dividing by 500. (See Table 2.) 

c. Visual efficiency. We calculate the 

percent of visual efficiency by multiplying 

the visual acuity efficiency by the visual field 

efficiency and converting the decimal to a 

percentage. For example, if your visual acuity 

efficiency is 75 percent and your visual field 

efficiency is 64 percent, we will multiply 

0.75 × 0.64 to determine that your visual 

efficiency is 0.48, or 48 percent. 

8. How do we evaluate specific visual 

problems? 

a. Statutory blindness. Most test charts that 

use Snellen methodology do not have lines 

that measure visual acuity between 20/100 

and 20/200. Newer test charts, such as the 

Bailey-Lovie or the Early Treatment Diabetic 

Retinopathy Study (ETDRS), do have lines 

that measure visual acuity between 20/100 

and 20/200. If your visual acuity is measured 

with one of these newer charts, and you 

cannot read any of the letters on the 20/100 

line, we will determine that you have 

statutory blindness based on a visual acuity 

of 20/200 or less. For example, if your bestcorrected visual acuity for distance in the 

better eye was determined to be 20/160 using 

an ETDRS chart, we will find that you have 

statutory blindness. Regardless of the type of 

test chart used, you do not have statutory 

blindness if you can read at least one letter 

on the 20/100 line. For example, if your bestcorrected visual acuity for distance in the 

better eye was determined to be 20/125+1 

using an ETDRS chart, we will find that you 

do not have statutory blindness as you are 

able to read one letter on the 20/100 line. 

b. Blepharospasm. This movement 

disorder is characterized by repetitive, 

bilateral, involuntary closure of the eyelids. 

If you have this disorder, you may have 

measurable visual acuities and visual fields 

that do not satisfy the criteria of 102.02 or 

102.03. Blepharospasm generally responds to 

therapy. However, if therapy is not effective, 

we will consider how the involuntary closure 

of your eyelids affects your ability to 

maintain visual functioning over time. 

c. Scotoma. A scotoma is a non-seeing area 

in the visual field surrounded by a seeing 

area. When we measure the visual field, we 

subtract the length of any scotoma, other than 

the normal blind spot, from the overall length 

of any diameter on which it falls. 

* * * * * 

C. How do we evaluate impairments that 

do not meet one of the special senses and 

speech listings? 

1. These listings are only examples of 

common special senses and speech disorders 

that we consider severe enough to result in 

marked and severe functional limitations. If 

your impairment(s) does not meet the criteria 

of any of these listings, we must also 

consider whether you have an impairment(s) 

that satisfies the criteria of a listing in 

another body system. 

2. If you have a medically determinable 

impairment(s) that does not meet a listing, 

we will determine whether the impairment(s) 

medically equals a listing or functionally 

equals the listings. (See §§ 416.926 and 

416.926a.) We use the rules in § 416.994a 

when we decide whether you continue to be 

disabled. 

102.01 Category of Impairments, Special 

Senses and Speech 

102.02 Loss of visual acuity. 

A. Remaining vision in the better eye after 

best correction is 20/200 or less; 

OR 

B. An inability to participate in testing 

using Snellen methodology or other 

comparable visual acuity testing and clinical 

findings that fixation and visual-following 

behavior are absent in the better eye, and: 

1. Abnormal anatomical findings 

indicating a visual acuity of 20/200 or less in 

the better eye; or 

2. Abnormal neuroimaging documenting 

damage to the cerebral cortex which would 

be expected to prevent the development of a 

visual acuity better than 20/200 in the better 

eye; or 

3. Abnormal electroretinogram 

documenting the presence of Leber’s 

congenital amaurosis or achromatopsia; or 

4. An absent response to VER testing in the 

better eye. 

102.03 Contraction of the visual field in 

the better eye, with: 

A. The widest diameter subtending an 

angle around the point of fixation no greater 

than 20 degrees; 

OR 

B. A mean deviation of –22 or worse, 

determined by automated static threshold 

perimetry as described in 102.00A6a(v); 

OR 

C. A visual field efficiency of 20 percent 

or less as determined by kinetic perimetry 

(see 102.00A7b). 

102.04 Loss of visual efficiency. Visual 

efficiency of the better eye of 20 percent or 

less after best correction (see 102.00A7c). 

* * * * * 

TABLE 1.—PERCENTAGE OF VISUAL

ACUITY EFFICIENCY CORRESPONDING TO THE BEST-CORRECTED VISUAL ACUITY MEASUREMENT FOR DISTANCE IN THE BETTER

EYE

Snellen Percent 

visual 

acuity 

efficiency English Metric 

20/16 ................. 6/5 100 

20/20 ................. 6/6 100 

20/25 ................. 6/7.5 95 

20/30 ................. 6/9 90 

20/40 ................. 6/12 85 

20/50 ................. 6/15 75 

20/60 ................. 6/18 70 

20/70 ................. 6/21 65 

20/80 ................. 6/24 60 

20/100 ............... 6/30 50 


sroberts on PROD1PC70 with RULES
Federal Register / Vol. 71, No. 223 / Monday, November 20, 2006 / Rules and Regulations 67055 

TABLE 2.—CHART OF VISUAL FIELDS

1. The diagram of the right eye illustrates 

the extent of a normal visual field as 

measured with a III4e stimulus. The sum of 

the eight principal meridians of this field is 

500 degrees. 

2. The diagram of the left eye illustrates a 

visual field contracted to 30 degrees in two 

meridians and to 20 degrees in the remaining 

six meridians. The percent of visual field 

efficiency of this field is: (2 × 30) + (6 × 20) 

= 180 ÷ 500 = 0.36 or 36 percent visual field 

efficiency. 

[FR Doc. 06–9236 Filed 11–17–06; 8:45 am] 

BILLING CODE 4191–02–P 

DEPARTMENT OF HOMELAND 

SECURITY 

Coast Guard 

33 CFR Part 165 

[CGD01–06–131] 

RIN 1625–AA00 

Safety Zone; Cocheco River Dredging 

Project, Cocheco River, NH 

AGENCY: Coast Guard, DHS. 

ACTION: Temporary final rule. 

SUMMARY: The Coast Guard is 

establishing a temporary safety zone 

around a blasting project between the 

Upper and Lower Narrows of the 

Cocheco River near Dover, NH. This 

safety zone is necessary to provide for 

the safety of persons and vessels in the 

maritime community from the hazards 

associated with a blasting project. Entry 

into this zone by any vessel is 

prohibited unless specifically 

authorized by the Captain of the Port, 

Northern New England. 

DATES: This rule is effective from 8 a.m. 

Eastern Standard Time (EST) on 

November 15, 2006 until 4 p.m. Eastern 

Standard Time (EST) on December 30, 

2006. 

ADDRESSES: Documents indicated in this 

preamble as being available in the 

docket are part of docket CGD01–06–

131 and are available for inspection or 

copying at U.S. Coast Guard Sector 

Northern New England, 259 High Street, 

South Portland, ME 04106 between 8 

a.m. and 4 p.m., Monday through 

Friday, except Federal holidays. 

FOR FURTHER INFORMATION CONTACT: 

Lieutenant Junior Grade J. B. Bleacher, 

Prevention Department, Sector Northern 

New England at (207) 742–5421. 

SUPPLEMENTARY INFORMATION: 

Regulatory Information 

We did not publish a notice of 

proposed rulemaking (NPRM) for this 

regulation. Under 5 U.S.C. 553(b)(B), the 

Coast Guard finds that good cause exists 

for not publishing an NPRM. The final 

details of the project were not 

determined until October 23, 2006 

making it impossible to publish a NPRM 

or a final rule 30 days in advance of the 

desired effective dates. Further, 

postponing the blasting project is 

impractical as ice conditions in the river 

will increase the difficulty of 

completing this project on schedule. 

The Coast Guard finds that immediate 

action is needed to protect mariners 

against the potential hazards associated 

with these blasting operations. Under 5 

U.S.C. 553(d)(3), the Coast Guard also 

finds, for the same reasons, that good 

cause exists for making this rule 

effective less than 30 days after 

publication in the Federal Register. 

Background and Purpose 

On November 1, 2006, Charter 

Environmental, Inc. began dredging 

operations on the Cocheco River 

between the Upper and Lower Narrows 

in order to both widen and deepen the 

river channel. Ledge areas in the river 

will be removed by drilling and blasting 

methods. Blasting operations are 

scheduled to begin November 15, 2006 

and end on December 30, 2006. Charter 

Environmental, Inc. will notify the 

USCG at least 24 hours prior to any 

blasting operation and all blasting will 

be conducted only at high tide. Public 

notifications will be made during the 

effective period via marine safety 

information broadcasts. This regulation 

establishes a 100 yard safety zone 

around all blasting areas. Entry into this 


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