[Federal Register Volume 70, Number 173 (Thursday, September 8, 2005)]
[Proposed Rules]
[Pages 53323-53325]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-17790]


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SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404 and 416

[Regulation Nos. 4 and 16]
RIN 0960-AG28


Revised Medical Criteria for Evaluating Growth Impairments

AGENCY: Social Security Administration.

ACTION: Advance notice of proposed rulemaking.

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SUMMARY: We are planning to update and revise the rules we use to 
evaluate growth impairments of individuals under age 18 who apply for, 
or receive, disability benefits under title II and Supplemental 
Security Income (SSI) payments based on disability under title XVI of 
the Social Security Act (the Act). The rules we plan on revising are in 
section 100.00 in the Listing of Impairments in appendix 1 to subpart P 
of part 404 of our regulations (the listings). We invite you to send us 
comments and suggestions for updating and revising these rules.
    After we have considered your comments and suggestions, as well as 
information about advances in medical knowledge, treatment, and methods 
of evaluating growth impairments, along with our program experience, we 
intend to publish for public comment a Notice of Proposed Rulemaking 
(NPRM) that will propose specific revisions to the rules.

DATES: To be sure your comments are considered, we must receive them by 
November 7, 2005.

ADDRESSES: You may give us your comments by: using our Internet site 
facility (i.e., Social Security Online) at http://policy.ssa.gov/erm/rules.nsf.Rules+Open+To+Comment or the Federal eRulemaking Portal at 
http://www.regulations.gov; e-mail to <a href="/cdn-cgi/l/email-protection#b4c6d1d3c1d8d5c0dddbdac7f4c7c7d59ad3dbc2"><span class="__cf_email__" data-cfemail="ef9d8a889a838e9b8680819caf9c9c8ec1888099">[email protected]</span></a>; telefax to 
(410) 966-2830, or letter to the Commissioner of Social Security, P.O. 
Box 17703, Baltimore, Maryland 21235-7703. You may also deliver them to 
the Office of

[[Page 53324]]

Regulations, Social Security Administration, 100 Altmeyer Building, 
6401 Security Boulevard, Baltimore, Maryland 21235-6401, between 8 a.m. 
and 4:30 p.m. on regular business days. Comments are posted on our 
Internet site at http://policy.ssa.gov/erm/rules.nsf/Rules+Open+To+Comment, or you may inspect them on regular business days 
by making arrangements with the contact person shown in this preamble.
    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. It is also available on the Internet 
site for SSA (i.e., Social Security Online) at: http://policy.ssa.gov/erm/rules.nsf/Rules+Open+To+Comment.

FOR FURTHER INFORMATION CONTACT: Rosemarie A. Greenwald, Social 
Insurance Specialist, Office of Regulations, Social Security 
Administration, 100 Altmeyer Building, 6401 Security Boulevard, 
Baltimore, Maryland 21235-6401, (410) 966-7813 or TTY (410) 966-5609. 
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.

SUPPLEMENTARY INFORMATION:

What Is the Purpose of This Notice?

    We are planning to update and revise the rules that we use to 
evaluate growth impairments of individuals under age 18 who apply for, 
or receive, disability benefits under title II and SSI payments based 
on disability under title XVI of the Act. The purpose of this notice is 
to give you an opportunity to send us comments and suggestions for 
updating and revising those rules as we begin the rulemaking process. 
We are also asking for your comments and ideas about how we can improve 
our disability programs in the future for children with growth 
impairments.

Who Should Send Us Comments and Suggestions?

    We invite comments and suggestions from anyone who has an interest 
in the rules we use to evaluate claims for benefits filed by 
individuals under age 18 with growth impairments. We are interested in 
getting comments and suggestions from people who apply for or receive 
benefits from us, members of the general public, advocates and 
organizations who advocate for children who have growth impairments, 
experts in the evaluation of growth impairments, diseases and injuries, 
researchers, people who make disability determinations and decisions 
for us, and any other individual who may have ideas for us to consider.

Will We Respond to Your Comments From This Notice?

    We will not respond directly to comments you send us because of 
this notice. However, after we consider your comments in response to 
this notice, along with other information such as the results of 
current medical research and our program experience, we will decide how 
to revise the rules we use to evaluate growth impairments. When we 
propose specific revisions to the rules, we will publish an NPRM in the 
Federal Register. In accordance with the usual rulemaking procedures we 
follow, you will have a chance to comment on the revisions we propose 
when we publish the NPRM, and we will summarize and respond to the 
significant comments on the NPRM in the preamble to any final rules.

Which Rules Are We Considering Updating and Revising?

    We are considering the updating and revision of section 100.00. 
This is the section for evaluating growth impairments in children (Part 
B, 100.00). This body system addresses linear growth impairments of 
individuals under age 18.

Where Can You Find These Rules on the Internet?

    You can find these rules on our Internet site at these locations:
    <bullet> Section 100.00 is in the Listing of Impairments in 
appendix 1 to subpart P of part 404 of our regulations at http://www.ssa.gov/OP_Home/cfr20/404/404-ap10.htm.
    <bullet> You can also look up section 100.00 of the listings at 
http://www.ssa.gov/disability/professionals/bluebook/.
    <bullet> If you do not have Internet access, you can find the Code 
of Federal Regulations in some public libraries, Federal depository 
libraries, and public law libraries.

Why Are We Updating and Revising Our Rules for Evaluating Growth 
Impairments?

    We first published the growth impairment listings in the Federal 
Register on March 16, 1977 (42 FR 14705). Except for minor changes we 
made to them on December 6, 1985 (50 FR 50068) and April 24, 2002 (67 
FR 20018), we have not comprehensively updated or revised them since 
1977. We published an Advanced Notice of Proposed Rulemaking on June 
14, 2000 (65 FR 37321), in which we asked for suggestions on how we 
could update and revise the growth impairment listings. We received 
very few comments. Because there may have been changes in the 
evaluation and treatment of growth impairments in the last five years, 
we are asking for suggestions from the public once again before we 
decide how to revise the rules for evaluating growth impairments.
    The current listings for growth impairments (100.00) will no longer 
be effective on July 2, 2007, unless we extend them or revise and 
promulgate them again.

What Should You Comment About?

    We are interested in any comments and suggestions you have about 
section 100.00 of our listings. For example, with regard to our 
listings, we are interested in knowing if:
    <bullet> You have concerns about any of the current growth 
impairment listing provisions, such as whether you think we should 
change any of our criteria or whether you think a listing is difficult 
to use or to understand.
    <bullet> You would like our growth impairment listings to include 
something that they do not include now, such as weight-related 
conditions, or you believe new medical criteria, such as Body Mass 
Index (BMI), should be added to the listings.
    We will consider your ideas as we develop the NPRM we intend to 
publish for public comment, and, where applicable, as part of our long-
term planning for the disability program.

What Other Information Will We Consider?

    We will also be considering information from other sources, 
including the following recent documents, for relevance to our policy 
for evaluating growth impairments.
    <bullet> ``Criteria for Determining Disability in Infants and 
Children: Short Stature.'' Evidence Report/Technology Assessment No. 
73. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ 
Publication No. 03-E025) March, 2003. This report is available at: 
http://www.ahrq.gov/clinic/tp/shorttp.htm.
    <bullet> ``Criteria for Determining Disability in Infants and 
Children: Low Birth Weight.'' Evidence Report/Technology Assessment No. 
70. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ 
Publication No. 03-E010) December, 2002. This report is available at 
http://www.ahrq.gov/clinic/tp/lbwdistp.htm.
    <bullet> ``Criteria for Determining Disability in Infants and 
Children: Failure to

[[Page 53325]]

Thrive.'' Evidence Report/Technology Assessment No. 72. Rockville, MD: 
Agency for Healthcare Research and Quality (AHRQ Publication No. 03-
E026) March, 2003. This report is available at http://www.ahrq.gov/clinic/tp/fthrivetp.htm.
    <bullet> Behrman, R.E., Kliegman, R.M., and Jenson, H.B. (Eds.) 
(2004). Nelson Textbook of Pediatrics. Philadelphia, PA: Elsevier 
Science (USA).
    <bullet> McMillan, J.A., DeAngelis, C.D., Feigin, R.D., Warshaw, 
J.B. (Eds.) (1999). Oski's Pediatrics, Principles and Practice. 
Philadelphia, PA: Lippincott Williams & Wilkins.

Other Information

Who Can Get Disability Benefits?

    Under title II of the Act, we provide for the payment of disability 
benefits if you are disabled and belong to one of the following three 
groups:
    <bullet> Workers insured under the Act,
    <bullet> Children of insured workers, and
    <bullet> Widows, widowers, and surviving divorced spouses (see 
Sec.  404.336) of insured workers.
    Under title XVI of the Act, we provide for SSI payments on the 
basis of disability if you are disabled and have limited income and 
resources.

How Do We Define Disability for Individuals Under Age 18?

    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.
    If you are under age 18 and file a claim under title II, disability 
means you have a medically determinable impairment(s) as described 
above and that results in the inability to do any substantial gainful 
activity. If you are under age 18 and file a claim under title XVI, 
disability means you have a medically determinable impairment(s) as 
described above and that results in marked and severe functional 
limitations.

How Do We Decide Whether You Are Disabled?

    If you are under age 18 and seeking benefits under title II of the 
Act, we use a five-step ``sequential evaluation process'' to decide 
whether you are disabled. We describe this five-step process in our 
regulations at Sec. Sec.  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 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, 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 persons under 
age 18 who apply for payments based on disability under title XVI of 
the Act. We describe that sequential evaluation process in Sec.  
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 Sec. Sec.  404.1594, 416.994, 
and 416.994a of our regulations. However, all of these 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 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 Sec.  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 a person age 18 or over, we 
apply the listings in part A when we assess your claim, and we never 
use the listings in part B.
    If you are a person under age 18, we first use the criteria in part 
B of the listings. If the listings in part B do not apply, and the 
specific disease process(es) has a similar effect on adults and 
children, we then use the criteria in part A. (See Sec. Sec.  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. (See Sec. Sec.  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 never deny your claim or decide that 
you no longer qualify for benefits because your impairment(s) does not 
meet or medically equal a listing. If 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.

List of Subjects

20 CFR Part 404

    Administrative practice and procedure, Blind, Disability benefits, 
Old-Age, Survivors, and Disability Insurance, Reporting and 
recordkeeping requirements, Social Security.

20 CFR Part 416

    Administrative practice and procedure, Aged, Blind, Disability 
benefits, Public assistance programs, Reporting and recordkeeping 
requirements, Supplemental Security Income (SSI).

    Dated: August 16, 2005.
Jo Anne B. Barnhart,
Commissioner of Social Security.
[FR Doc. 05-17790 Filed 9-7-05; 8:45 am]
BILLING CODE 4191-02-P


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