Source: https://www.federalregister.gov/documents/2015/04/13/2015-08185/revised-listings-for-growth-disorders-and-weight-loss-in-children
Timestamp: 2019-05-24 19:37:45
Document Index: 229698896

Matched Legal Cases: ['§\u2009416', '§\u2009416', '§\u2009416', '§\u2009416', '§\u2009416', '§\u2009416', '§\u2009416', '§\u2009416', 'art 404']

A Rule by the Social Security Administration on 04/13/2015
19522-19530 (9 pages)
Listing 100.04 Low Birth Weight in Infants From Birth to Attainment of Age 1
Listing 100.05 Failure To Thrive in Children From Birth to Attainment of Age 3
Listing 103.06 Growth Failure Due to Any Chronic Respiratory Disorder
100.01 Category of Impairments, Low Birth Weight and Failure to Thrive
https://www.federalregister.gov/d/2015-08185 https://www.federalregister.gov/d/2015-08185
Start Further Info Start Printed Page 19523
Response: We did not adopt this comment. In 100.00B, we include a reference to our rule for CDRs for LBW cases at § 416.990(b)(11). Additionally, the Act requires, with one exception, that we perform a CDR not later than 12 months after the birth of an infant whose LBW is a contributing factor material to the determination that the infant is disabled. We will continue to provide guidance on diaries for LBW cases and cases involving other disabling impairments in our internal operating instructions. We do not believe it is necessary to repeat this guidance in the regulation.
Response: We did not adopt this comment. We agree that, for the purposes of listing 100.04, weight is a proxy measure for disability in infants from birth to the attainment of age 1. However, we do not believe that providing additional guidance is necessary for the clarity of our rule. As we noted in the preamble to the proposed rule, we based listing 100.04 on sections 416.926a(m)(6) and (m)(7) of our functional equivalence rule.[1] Our adjudicators have over 20 years of experience evaluating claims filed on behalf of children based on LBW under our functional equivalence rule. In our experience applying this rule, we have not found that the type of guidance the commenter suggested is necessary in order to apply the rule properly.
As we stated in the NPRM, our program experience has shown that growth failure alone is not disabling (78 FR at 30251). To meet the severity requirements for listing 100.05B, the child must have growth failure with a developmental delay of the appropriate severity required by the listing. Children with growth failure without developmental delay may be evaluated in the appropriate body system of the underlying condition causing the growth failure.Start Printed Page 19524
Response: We did not adopt these comments. In 100.05C, we require two narrative developmental reports when a report of a standardized developmental assessment required by 100.05B is not available. As we explained in the NPRM, abnormal findings noted on repeated examinations, and information in narrative developmental reports, that may include the results of developmental screening tests, can identify a child who is not developing or achieving skills within expected timeframes.[2]
Response: We did not adopt this comment. We recognize that early intervention programs often use a 25 percent delay criterion to determine eligibility for intervention services and to identify the needed services. In contrast, we evaluate a child's delay to determine whether the underlying impairment is disabling because it results in “marked and severe functional limitations.” An impairment results in “marked and severe functional limitations” only if it meets, medically equals, or functionally equals the listings. An impairment is of listing-level severity if it results in “marked” limitations in two domains of functioning or an “extreme” limitation in one domain.[3] The level of delay that we require in 100.05C is consistent with our definition of “marked limitation” in § 416.926a(e)(2)(ii).
Response: We did not adopt these comments. We agree with the commenters that some respiratory disorders could result in listing-level growth failure without requiring oxygen supplementation; however, we did not revise 103.06 as a result. We use other listings, such as 103.02, 103.03, and 103.04, in the respiratory body system to evaluate these disorders.[4] We believe that these respiratory listings, and our functional equivalence rule for evaluating disability in children, Start Printed Page 19525adequately address the disorders referred to by the commenters.[5]
The Act authorizes us to make rules and regulations and to establish necessary and appropriate procedures to implement them.[6]
We will begin to use this final rule on its effective date. We will continue to use the current listings until the date this final rule becomes effective. We will apply the final rule to new applications filed on or after the effective date of the final rule and to claims that are pending on or after the effective date.[7]
B. How do we evaluate disability based on LBW under 100.04? In 100.04A and 100.04B, we use an infant's birth weight as documented by an original or certified copy of the infant's birth certificate or by a medical record signed by a physician. Birth weight means the first weight recorded after birth. In 100.04B, gestational age is the infant's age based on the date of conception as recorded in the medical record. If the infant's impairment meets the requirements for listing 100.04A or 100.04B, we will follow the rule in § 416.990(b)(11) of this chapter.
b. For children age 2 to attainment of age 3, we use the body mass index (BMI)-for-age table corresponding to the child's gender (Table III or Table IV).Start Printed Page 19526
b. Under 100.05B, we document the severity of developmental delay with results from a standardized developmental assessment, which compares a child's level of development to the level typically expected for his or her chronological age. If the child was born prematurely, we may use the corrected chronological age (CCA) for comparison. (See § 416.924b(b) of this chapter.) CCA is the chronological age adjusted by a period of gestational prematurity. CCA = (chronological age)—(number of weeks premature). Acceptable medical sources or early intervention specialists, physical or occupational therapists, and other sources may conduct standardized developmental assessments and developmental screenings. The results of these tests and screenings must be accompanied by a statement or records from an acceptable medical source who established the child has a developmental delay.
3. If an infant or toddler has a severe medically determinable impairment(s) that does not meet the criteria of any listing, we must also consider whether the child has an impairment(s) that medically equals a listing (see § 416.926 of this chapter). If the child's impairment(s) does not meet or medically equal a listing, we will determine whether the child's impairment(s) functionally equals the listings (see § 416.926a of this chapter) considering the factors in § 416.924a of this chapter. We use the rule in § 416.994a of this chapter when we decide whether a child continues to be disabled.
32 1250 grams or less.
2. For children age 2 to attainment of age 18, three BMI-for-age measurements that are:Start Printed Page 19527
Start Printed Page 19528
106.08 Growth failure due to any chronic renal disease (see 106.00C5), with:
(1) We compute your CCA by subtracting the number of weeks of prematurity (the difference between 40 weeks of full-term gestation and the number of actual weeks of gestation) from your chronological age. For example, if your chronological age is 20 Start Printed Page 19530weeks but you were born at 32 weeks gestation (8 weeks premature), then your CCA is 12 weeks.
1. 78 FR at 30350.
2. 78 FR at 30251.
3. See 20 CFR 416.926a(a).
4. See 20 CFR part 404, subpart P, Appendix 1.
5. See 20 CFR 416.924a and 416.926a.
6. 42 U.S.C. 405(a), 902(a)(5), and 1383(d)(1).
7. This means that we will use this final rule on and after its effective date in any case in which we make a determination or decision. We expect that Federal courts will review our final decisions using the rule that was in effect at the time we issued the decisions. If a court reverses our final decision and remands a case for further administrative proceedings after the effective date of this final rule, we will apply this final rule to the entire period at issue in the decision we make after the court's remand.