Revised Medical Criteria for Evaluating Neurological Impairments, 19356-19358 [05-7357]
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19356
Federal Register / Vol. 70, No. 70 / Wednesday, April 13, 2005 / Proposed Rules
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 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 §§ 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 §§ 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.
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
15:00 Apr 12, 2005
Dated: March 21, 2005.
Jo Anne B. Barnhart,
Commissioner of Social Security.
[FR Doc. 05–7355 Filed 4–12–05; 8:45 am]
BILLING CODE 4191–02–P
SOCIAL SECURITY ADMINISTRATION
20 CFR Parts 404 and 416
[Regulation Nos. 4 and 16]
RIN 0960–AF35
Revised Medical Criteria for Evaluating
Neurological Impairments
Social Security Administration.
Advance notice of proposed
rulemaking.
AGENCY:
ACTION:
SUMMARY: We are planning to update
and revise the rules we use to evaluate
neurological impairments of adults and
children 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
sections 11.00 and 111.00 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 neurological disorders, and
our program experience, we intend to
publish for public comment a Notice of
Proposed Rulemaking (NPRM) that will
propose specific revisions to the rules.
As part of our long-term planning for
the disability programs, we are also
interested in your ideas for how we may
be able to improve our programs for
people who have neurological disorders,
especially those who would like to
work.
To be sure your comments are
considered, we must receive them by
June 13, 2005.
ADDRESSES: You may give us your
comments by: using our Internet site
facility (i.e., Social Security Online) at
https://policy.ssa.gov/pnpublic.nsf/
LawsRegs or the Federal eRulemaking
Portal at https://www.regulations.gov;
e-mail to regulations@ssa.gov; telefax to
(410) 966–2830, or letter to the
Commissioner of Social Security, P.O.
DATES:
List of Subjects
VerDate jul<14>2003
benefits, Public assistance programs,
Reporting and recordkeeping
requirements, Supplemental Security
Income (SSI).
Jkt 205001
PO 00000
Frm 00017
Fmt 4702
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Box 17703, Baltimore, Maryland 21235–
7703. You may also deliver them to the
Office of 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 in our Internet
site at https://policy.ssa.gov/
pnpublic.nsf/LawsRegs, 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
https://www.gpoaccess.gov/fr/
index.html. It is also available on the
Internet site for SSA (i.e., Social
Security Online) at: https://
policy.ssa.gov/pnpublic.nsf/LawRegs.
FOR FURTHER INFORMATION CONTACT: Fran
O. Thomas, Social Insurance Specialist,
Office of Regulations, Social Security
Administration, 100 Altmeyer Building,
6401 Security Boulevard, Baltimore,
Maryland 21235–6401, (410) 966–9822
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 https://
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
neurological impairments of adults and
children who apply for, or receive,
disability benefits under title II and
Supplemental Security Income (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
people with neurological disorders.
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 people who have
neurological disorders. 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 people
who have neurological disorders,
experts in the evaluation of neurological
E:\FR\FM\13APP1.SGM
13APP1
Federal Register / Vol. 70, No. 70 / Wednesday, April 13, 2005 / Proposed Rules
diseases and injuries, researchers,
people who make disability
determinations and decisions for us,
and any other individuals who may
have ideas for us to consider.
Will We Respond To Your Comments
From This Notice?
No, 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
results of current medical research and
our program experience, we will decide
how to revise the rules we use to
evaluate neurological 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 for
Updating and Revision?
We are considering two sections of
our listings for updating and revision,
sections 11.00 and 111.00. These are the
listings for neurological impairments for
adults (Part A, 11.00) and children (Part
B, 111.00). They include, but are not
limited to, such impairments as
epilepsy, multiple sclerosis, traumatic
brain injury, stroke, cerebral palsy,
muscular dystrophy, and myasthenia
gravis.
Where Can You Find These Rules on
the Internet?
You can find these rules on our
Internet site at these locations:
• Sections 11.00 and 111.00 are in the
Listing of Impairments in appendix 1 to
subpart P of part 404 of our regulations
at https://www.ssa.gov/OP_Home/cfr20/
404/404-ap10.htm.
• You can also look up sections 11.00
and 111.00 of the listings at https://
www.ssa.gov/disability/professionals/
bluebook/.
• 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 Neurological
Impairments?
We last published final rules
containing comprehensive revisions to
the listings for neurological
impairments in the Federal Register on
December 6, 1985 (50 FR 50068).
VerDate jul<14>2003
15:00 Apr 12, 2005
Jkt 205001
Although we also published final rules
revising the preface to the neurological
body system on August 21, 2000 (65 FR
50746), made technical revisions to the
listings that included some changes to
the neurological body system listings on
April 24, 2002, and moved the listings
for malignant brain tumors to our
Malignant Neoplastic Diseases body
system on November 15, 2004 (69 FR
67018), we have not comprehensively
revised the rules since 1985.
The current listings for neurological
impairments for adults (11.00) and
children (111.00) will no longer be
effective on July 1, 2005, 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 sections
11.00 and 111.00 of our listings. For
example, with regard to our listings, we
are interested in knowing if:
• You have concerns about any of the
current neurological listings provisions
for adults or children; such as whether
you think we should change any of our
criteria or whether you think a listing is
difficult to use or understand.
• You would like to see our
neurological listings include something
that they do not include now; such as
conditions and/or new medical criteria
that you believe should be added to the
listings.
• You think it would be beneficial to
change the current disease-specific
listing format to a more inclusive
category format such as ‘‘Vascular
disorders,’’ ‘‘Demyelinating disorders,’’
and ‘‘Movement disorders.’’
• You think these listings should
continue to include functional criteria
that consider all aspects of listed
neurological impairments such as motor
and sensory deficits, cognitive/
behavioral abnormalities, speech/
language limitations, and vision/hearing
losses.
• You are aware of criteria we should
use to define disabling epilepsy at the
listing level.
In addition to your comments about
our regulations, we are also interested in
any ideas you have about how the
disability requirements of the Act and
our regulations affect people who have
neurological disorders, especially those
who would like to work, full-time or
part-time with supports. Your ideas can
address our existing rules and
regulations or suggest changes to the
law. For example, we know that many
people who have neurological disorders
might not need benefits from us if they
could get treatment before their disease
or injury makes them unable to work.
PO 00000
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Fmt 4702
Sfmt 4702
19357
Others may be unable to work but may
not need to stay out of work indefinitely
if they could get treatment or other
interventions. Many people with
permanent impairments can work if
they have a supporting safety net
(including title II disability benefits and
SSI payments). Work can also be
therapeutic for some people. Although
the Act and our regulations include
some access to health care through
Medicare and Medicaid, some
provisions for vocational rehabilitation,
and a number of work incentives, these
provisions are generally for people who
already qualify for benefits under our
disability programs.
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 neurological
impairments.
• ‘‘Management of TreatmentResistant Epilepsy.’’ Evidence Report/
Technology Assessment: Number 77.
Rockville, MD: Agency for Healthcare
Research and Quality (AHRQ
Publication No. 03–E028) April, 2004.
This report is available at https://
www.ncbi.nlm.nih.gov/books/
bv.fcgi?rid=hstat1a.chapter.11665
• ‘‘Criteria to Determine Disability
Related to Multiple Sclerosis.’’ Evidence
Report/Technology Assessment:
Number 100. Rockville, MD: Agency for
Healthcare Research and Quality (AHRQ
Publication No. 03–E028) May, 2004.
This report is available at https://
www.ahrq.gov/clinic/epcsums/
msdissum.htm#contents
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:
• 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 if
you are disabled and have limited
income and resources.
E:\FR\FM\13APP1.SGM
13APP1
19358
Federal Register / Vol. 70, No. 70 / Wednesday, April 13, 2005 / Proposed Rules
How Do We Define Disability?
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 impairments(s) as described above
and that results in . . .
title II ..................................................................
an adult or child ................................................
title XVI ..............................................................
title XVI ..............................................................
a person age 18 or older .................................
a person under age 18 .....................................
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 benefits 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 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 wwill 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 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. All of the sequential
evaluation processes, however, include
steps at which we consider whether
your impairment(s) meets or medically
equals one of our listings.
Under both the title II and title XVI
programs, disability must be the result
VerDate jul<14>2003
15:00 Apr 12, 2005
Jkt 205001
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 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 §§ 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 §§ 404.1526 and 416.926.)
PO 00000
Frm 00019
Fmt 4702
Sfmt 4702
the inability to do any substantial gainful activity (SGA).
the inability to do any SGA.
marked and severe functional limitations.
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: March 21, 2005.
Jo Anne B. Barnhart,
Commissioner of Social Security.
[FR Doc. 05–7357 Filed 4–12–05; 8:45 am]
BILLING CODE 4191–02–P
SOCIAL SECURITY ADMINISTRATION
20 CFR Parts 404 and 416
[Regulation Nos. 4 and 16]
RIN 0960–AF58
Revised Medical Criteria for Evaluating
Respiratory System Disorders
AGENCY:
E:\FR\FM\13APP1.SGM
Social Security Administration.
13APP1
]]>Agencies
[Federal Register Volume 70, Number 70 (Wednesday, April 13, 2005)]
[Proposed Rules]
[Pages 19356-19358]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-7357]
-----------------------------------------------------------------------
SOCIAL SECURITY ADMINISTRATION
20 CFR Parts 404 and 416
[Regulation Nos. 4 and 16]
RIN 0960-AF35
Revised Medical Criteria for Evaluating Neurological Impairments
AGENCY: Social Security Administration.
ACTION: Advance notice of proposed rulemaking.
-----------------------------------------------------------------------
SUMMARY: We are planning to update and revise the rules we use to
evaluate neurological impairments of adults and children 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
sections 11.00 and 111.00 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 neurological disorders, and our program experience, we
intend to publish for public comment a Notice of Proposed Rulemaking
(NPRM) that will propose specific revisions to the rules.
As part of our long-term planning for the disability programs, we
are also interested in your ideas for how we may be able to improve our
programs for people who have neurological disorders, especially those
who would like to work.
DATES: To be sure your comments are considered, we must receive them by
June 13, 2005.
ADDRESSES: You may give us your comments by: using our Internet site
facility (i.e., Social Security Online) at https://policy.ssa.gov/
pnpublic.nsf/LawsRegs or the Federal eRulemaking Portal at https://
www.regulations.gov; e-mail to regulations@ssa.gov; 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 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 in our Internet site at https://policy.ssa.gov/pnpublic.nsf/
LawsRegs, 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 https://
www.gpoaccess.gov/fr/. It is also available on the Internet
site for SSA (i.e., Social Security Online) at: https://policy.ssa.gov/
pnpublic.nsf/LawRegs.
FOR FURTHER INFORMATION CONTACT: Fran O. Thomas, Social Insurance
Specialist, Office of Regulations, Social Security Administration, 100
Altmeyer Building, 6401 Security Boulevard, Baltimore, Maryland 21235-
6401, (410) 966-9822 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 https://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 neurological impairments of adults and children who apply for,
or receive, disability benefits under title II and Supplemental
Security Income (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 people with neurological disorders.
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 people who
have neurological disorders. 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 people who have neurological disorders, experts in the evaluation
of neurological
[[Page 19357]]
diseases and injuries, researchers, people who make disability
determinations and decisions for us, and any other individuals who may
have ideas for us to consider.
Will We Respond To Your Comments From This Notice?
No, 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 results of current
medical research and our program experience, we will decide how to
revise the rules we use to evaluate neurological 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 for Updating and Revision?
We are considering two sections of our listings for updating and
revision, sections 11.00 and 111.00. These are the listings for
neurological impairments for adults (Part A, 11.00) and children (Part
B, 111.00). They include, but are not limited to, such impairments as
epilepsy, multiple sclerosis, traumatic brain injury, stroke, cerebral
palsy, muscular dystrophy, and myasthenia gravis.
Where Can You Find These Rules on the Internet?
You can find these rules on our Internet site at these locations:
Sections 11.00 and 111.00 are in the Listing of
Impairments in appendix 1 to subpart P of part 404 of our regulations
at https://www.ssa.gov/OP_Home/cfr20/404/404-ap10.htm.
You can also look up sections 11.00 and 111.00 of the
listings at https://www.ssa.gov/disability/professionals/bluebook/.
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 Neurological
Impairments?
We last published final rules containing comprehensive revisions to
the listings for neurological impairments in the Federal Register on
December 6, 1985 (50 FR 50068). Although we also published final rules
revising the preface to the neurological body system on August 21, 2000
(65 FR 50746), made technical revisions to the listings that included
some changes to the neurological body system listings on April 24,
2002, and moved the listings for malignant brain tumors to our
Malignant Neoplastic Diseases body system on November 15, 2004 (69 FR
67018), we have not comprehensively revised the rules since 1985.
The current listings for neurological impairments for adults
(11.00) and children (111.00) will no longer be effective on July 1,
2005, 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
sections 11.00 and 111.00 of our listings. For example, with regard to
our listings, we are interested in knowing if:
You have concerns about any of the current neurological
listings provisions for adults or children; such as whether you think
we should change any of our criteria or whether you think a listing is
difficult to use or understand.
You would like to see our neurological listings include
something that they do not include now; such as conditions and/or new
medical criteria that you believe should be added to the listings.
You think it would be beneficial to change the current
disease-specific listing format to a more inclusive category format
such as ``Vascular disorders,'' ``Demyelinating disorders,'' and
``Movement disorders.''
You think these listings should continue to include
functional criteria that consider all aspects of listed neurological
impairments such as motor and sensory deficits, cognitive/behavioral
abnormalities, speech/language limitations, and vision/hearing losses.
You are aware of criteria we should use to define
disabling epilepsy at the listing level.
In addition to your comments about our regulations, we are also
interested in any ideas you have about how the disability requirements
of the Act and our regulations affect people who have neurological
disorders, especially those who would like to work, full-time or part-
time with supports. Your ideas can address our existing rules and
regulations or suggest changes to the law. For example, we know that
many people who have neurological disorders might not need benefits
from us if they could get treatment before their disease or injury
makes them unable to work. Others may be unable to work but may not
need to stay out of work indefinitely if they could get treatment or
other interventions. Many people with permanent impairments can work if
they have a supporting safety net (including title II disability
benefits and SSI payments). Work can also be therapeutic for some
people. Although the Act and our regulations include some access to
health care through Medicare and Medicaid, some provisions for
vocational rehabilitation, and a number of work incentives, these
provisions are generally for people who already qualify for benefits
under our disability programs.
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 neurological impairments.
``Management of Treatment-Resistant Epilepsy.'' Evidence
Report/Technology Assessment: Number 77. Rockville, MD: Agency for
Healthcare Research and Quality (AHRQ Publication No. 03-E028) April,
2004. This report is available at https://www.ncbi.nlm.nih.gov/books/
bv.fcgi?rid=hstat1a.chapter.11665
``Criteria to Determine Disability Related to Multiple
Sclerosis.'' Evidence Report/Technology Assessment: Number 100.
Rockville, MD: Agency for Healthcare Research and Quality (AHRQ
Publication No. 03-E028) May, 2004. This report is available at https://
www.ahrq.gov/clinic/epcsums/msdissum.htm#contents
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:
Workers insured under the Act,
Children of insured workers, and
Widows, widowers, and surviving divorced spouses (see
Sec. 404.336) of insured workers.
Under title XVI of the Act, we provide for Supplemental Security
Income (SSI) payments on the basis of disability if you are disabled
and have limited income and resources.
[[Page 19358]]
How Do We Define Disability?
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:
------------------------------------------------------------------------
Disability means
you have a
medically
determinable
If you file a claim under . . . And you are . . . impairments(s) as
described above
and that results
in . . .
------------------------------------------------------------------------
title II........................ an adult or child. the inability to
do any
substantial
gainful activity
(SGA).
title XVI....................... a person age 18 or the inability to
older. do any SGA.
title XVI....................... a person under age marked and severe
18. functional
limitations.
------------------------------------------------------------------------
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 benefits under title XVI 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 w 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 children 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. All of the sequential evaluation processes, however,
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 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: March 21, 2005.
Jo Anne B. Barnhart,
Commissioner of Social Security.
[FR Doc. 05-7357 Filed 4-12-05; 8:45 am]
BILLING CODE 4191-02-P
