Revised Medical Criteria for Evaluating Endocrine Disorders, 46792-46795 [05-15905]

Download as PDF 46792 Federal Register / Vol. 70, No. 154 / Thursday, August 11, 2005 / Proposed Rules for practices, methods, and procedures the Administrator finds necessary for safety in air commerce. This regulation is within the scope of that authority because it addresses an unsafe condition that is likely to exist or develop on products identified in this rulemaking action. Regulatory Findings We have determined that this proposed AD would not have federalism implications under Executive Order 13132. This proposed AD would not have a substantial direct effect on the States, on the relationship between the national Government and the States, or on the distribution of power and responsibilities among the various levels of government. For the reasons discussed above, I certify that the proposed regulation: 1. Is not a ‘‘significant regulatory action’’ under Executive Order 12866; 2. Is not a ‘‘significant rule’’ under the DOT Regulatory Policies and Procedures (44 FR 11034, February 26, 1979); and 3. Will not have a significant economic impact, positive or negative, on a substantial number of small entities under the criteria of the Regulatory Flexibility Act. We prepared a regulatory evaluation of the estimated costs to comply with this proposed AD. See the ADDRESSES section for a location to examine the regulatory evaluation. List of Subjects in 14 CFR Part 39 Air transportation, Aircraft, Aviation safety, Safety. The Proposed Amendment Accordingly, under the authority delegated to me by the Administrator, the FAA proposes to amend 14 CFR part 39 as follows: PART 39—AIRWORTHINESS DIRECTIVES 1. The authority citation for part 39 continues to read as follows: Authority: 49 U.S.C. 106(g), 40113, 44701. § 39.13 [Amended] 2. The FAA amends § 39.13 by adding the following new airworthiness directive (AD): McDonnell Douglas: Docket No. FAA–2005– 22062; Directorate Identifier 2003–NM– 219–AD. Comments Due Date (a) The Federal Aviation Administration (FAA) must receive comments on this AD action by September 26, 2005. Affected ADs (b) None. VerDate jul<14>2003 14:00 Aug 10, 2005 Jkt 205001 Applicability (c) This AD applies to all McDonnell Douglas Model DC–9–81 (MD–81), DC–9–82 (MD–82), DC–9–83 (MD–83), DC–9–87 (MD– 87), MD–88, and MD–90–30 airplanes, certificated in any category. Unsafe Condition (d) This AD was prompted by a determination that the holes of certain aft attach fitting assemblies of the spoiler link were not cold-worked during production. We are issuing this AD to prevent fatigue cracking of the aft attach fitting of the spoiler link and consequent failure of the fitting. Failure of the fitting could result in an asymmetrical lift condition and consequent reduced controllability of the airplane. Compliance (e) You are responsible for having the actions required by this AD performed within the compliance times specified, unless the actions have already been done. Inspection (f) Prior to the accumulation of 10,000 total flight hours on the aft attach fitting assembly of the spoiler link, or within 18 months after the effective date of this AD, whichever is later: Inspect the aft attach fitting assembly of the spoiler link to determine the part number, in accordance with Item 1.a). of Section 1.D., ‘‘Description,’’ of Aerotech Manufacturing, Inc., Service Bulletin DC9– 27–01–AMI5139, Revision ‘‘A,’’ dated June 19, 2003. (1) If the part number is not AMI3954558– 1 or AMI3954558–501: No further action is required by this AD, but the provisions of paragraph (h) of this AD continue to apply. (2) If the part number is AMI3954558–1 or AMI3954558–501: Before further flight, inspect the aft attach fitting assembly of the spoiler link to determine the lot number, then determine if the lot number is identified in the ‘‘Lot Number’’ column of the table in Section 1.A.1. of the service bulletin. If the lot number is not identified in the service bulletin, no further action is required by this AD, but the provisions of paragraph (h) of this AD continue to apply. Replacement (g) If the part number of the aft attach fitting assembly of the spoiler link is AMI3954558–1 or AMI3954558–501, and the lot number is identified in the ‘‘Lot Number’’ column of the table in Section 1.A.1. of Aerotech Manufacturing, Inc., Service Bulletin DC9–27–01–AMI5139, Revision ‘‘A,’’ dated June 19, 2003: Before further flight, replace the assembly with a new or serviceable assembly having a lot number that is not identified in the ‘‘Lot Number’’ column of the table in Section 1.A.1. of the service bulletin, in accordance with Item 1.b). of Section 1.D., ‘‘Description,’’ of the service bulletin. Parts Installation (h) As of the effective date of this AD, no person may install, on any airplane, an aft attach fitting assembly of the spoiler link having part number AMI3954558–1 or AMI3954558–501, and having a lot number PO 00000 Frm 00014 Fmt 4702 Sfmt 4702 identified in the ‘‘Lot Number’’ column of the table in Section 1.A.1. of Aerotech Manufacturing, Inc., Service Bulletin DC9– 27–01–AMI5139, Revision ‘‘A,’’ dated June 19, 2003. Alternative Methods of Compliance (AMOCs) (i) The Manager, Los Angeles Aircraft Certification Office, FAA, has the authority to approve AMOCs for this AD, if requested in accordance with the procedures found in 14 CFR 39.19. Issued in Renton, Washington, on August 3, 2005. Kevin M. Mullin, Acting Manager, Transport Airplane Directorate, Aircraft Certification Service. [FR Doc. 05–15881 Filed 8–10–05; 8:45 am] BILLING CODE 4910–13–P SOCIAL SECURITY ADMINISTRATION 20 CFR Parts 404 and 416 RIN 0960–AD78 Revised Medical Criteria for Evaluating Endocrine Disorders Social Security Administration. Advance notice of proposed rulemaking. AGENCY: ACTION: SUMMARY: We are planning to update and revise the rules we use to evaluate endocrine disorders 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 9.00 and 109.00 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 endocrine 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 about how we may be able to improve our programs for people who have endocrine disorders, especially those who would like to work. DATES: To be sure your comments are considered, we must receive them by October 11, 2005. ADDRESSES: You may give us your comments by: using our Internet site E:\FR\FM\11AUP1.SGM 11AUP1 Federal Register / Vol. 70, No. 154 / Thursday, August 11, 2005 / Proposed Rules facility (i.e., Social Security Online) at https://policy.ssa.gov/pnpublic.nsf/ LawsRegs or the Federal eRulemaking Portal at https://www.regulations.gov; email 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/ index.html. It is also available on the Internet site for SSA (i.e., Social Security Online) at: https:// policy.ssa.gov/pnpublic.nsf/LawsRegs. FOR FURTHER INFORMATION CONTACT: Robert Augustine, Social Insurance Specialist, Office of Regulations, Social Security Administration, 100 Altmeyer Building, 6401 Security Boulevard, Baltimore, Maryland 21235–6401, (410) 965–0020 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 endocrine disorders 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 endocrine 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 endocrine disorders. We are interested VerDate jul<14>2003 14:00 Aug 10, 2005 Jkt 205001 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 endocrine disorders, experts in the evaluation of endocrine diseases, 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? 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 endocrine disorders. 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 9.00 and 109.00. These are the listings for endocrine disorders in adults (Part A, 9.00) and children (Part B, 109.00). They include, but are not limited to, such impairments as thyroid disorders, hyperparathyroidism, hypoparathyroidism, neurohypophyseal insufficiency (diabetes insipidus), hyperfunction of the adrenal cortex, adrenal cortical insufficiency, diabetes mellitus, iatrogenic hypercorticoid state, pituitary dwarfism, adrenogenital syndrome, hypoglycemia, and gonadal dysgenesis (Turner’s syndrome). Where Can You Find These Rules on the Internet? You can find these rules on our Internet site at these locations: • Sections 9.00 and 109.00 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 9.00 and 109.00 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, PO 00000 Frm 00015 Fmt 4702 Sfmt 4702 46793 Federal depository libraries, and public law libraries. Why Are We Updating and Revising Our Rules for Evaluating Endocrine Disorders? On August 24, 1999, and April 24, 2002, we published final rules in the Federal Register that included revisions to some of the listings for endocrine disorders (64 FR 46122 and 67 FR 20018, respectively). Prior to that, we last published final rules making comprehensive revisions to the listings for endocrine disorders on December 6, 1985 (50 FR 50068). The current listings for endocrine disorders for adults (9.00) and children (109.00) 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 sections 9.00 and 109.00 of our listings. For example, with regard to our listings, we are interested in knowing if: • You have concerns about any of the provisions in the current endocrine listings, including the provisions for diabetes mellitus in 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 endocrine listings include something that they do not include now, such as conditions or new medical criteria that you believe should be added to the listings. • You think these listings should include criteria for functional limitations and, if so, what those criteria should be. 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 endocrine 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 endocrine disorders might not need benefits from us if they could get treatment before their disorders make 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 E:\FR\FM\11AUP1.SGM 11AUP1 46794 Federal Register / Vol. 70, No. 154 / Thursday, August 11, 2005 / Proposed Rules We will also be considering information from other sources for relevance to our policy for evaluating endocrine disorders, including the following recent documents: • American Diabetes Association: Standards of Medical Care in Diabetes (Position Statement). Diabetes Care 28 (Suppl. 1):S4–S36, 2005. This report is available at https://care.diabetesjournals.org/cgi/ content/full/28/suppl_1/s4. • Behrman, R.E., Kliegman, R.M., and Jenson, H.B. (Eds.) (2004). Nelson Textbook of Pediatrics. Philadelphia, PA: Elsevier Science (USA). • Goldman L. and D. Ausiello (eds). Cecil Textbook of Medicine (22nd edition). Saunders, Philadelphia, 2004. • Silverstein J, Klingensmith G, Copeland K, Plotnick L, Kaufman F, Laffel L, Deeb L, Grey M, Anderson B, Holzmeister LA, Clark N: Care of Children and Adolescents With Type 1 Diabetes: A Statement of the American Diabetes Association. Diabetes Care 28:186–212, 2005. This report is available at https://care.diabetesjournals.org/cgi/ content/full/28/1/186?maxtoshow= &HITS=10&hits=10&RESULT FORMAT=&andorexactfulltext= and&searchid=1112384792902_ 7205&stored&lowbar; search=&FIRSTINDEX=0&sortspec= relevance&volume=28&firstpage= 186&resourcetype=1&journal code=diacare. If you file a claim under . . . and you are . . . 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? 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 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 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? 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. VerDate jul<14>2003 14:29 Aug 10, 2005 Jkt 205001 PO 00000 Frm 00016 Fmt 4702 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. 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 impairment(s) as described above and that results in . . . Sfmt 4702 the inability to do any substantial gainful activity (SGA). the inability to do any SGA. marked and severe functional limitations. continues. See §§ 404.1594, 416.994, and 416.994a of our regulations. However, all of these sequential evaluation processes include a step 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 a person age 18 or over, we apply the listings in part E:\FR\FM\11AUP1.SGM 11AUP1 Federal Register / Vol. 70, No. 154 / Thursday, August 11, 2005 / Proposed Rules 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. 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. Administrative practice and procedure, Aged, Blind, Disability benefits, Public assistance programs, Reporting and recordkeeping requirements, Supplemental Security Income (SSI). Dated: June 30, 2005. Jo Anne B. Barnhart, Commissioner of Social Security. [FR Doc. 05–15905 Filed 8–10–05; 8:45 am] BILLING CODE 4191–02–P 14:00 Aug 10, 2005 Forest Service 36 CFR Part 242 DEPARTMENT OF THE INTERIOR Fish and Wildlife Service 50 CFR Part 100 RIN 1018–AT98 Subsistence Management Regulations for Public Lands in Alaska, Subpart C and Subpart D—2006–2007 Subsistence Taking of Wildlife Regulations AGENCIES: Forest Service, Agriculture; Fish and Wildlife Service, Interior. ACTION: Proposed rule. SUMMARY: This proposed rule would establish regulations for hunting and trapping seasons, harvest limits, methods and means related to taking of wildlife for subsistence uses during the 2006–2007 regulatory year. The rulemaking is necessary because Subpart D is subject to an annual public review cycle. When final, this rulemaking would replace the wildlife taking regulations included in the ‘‘Subsistence Management Regulations for Public Lands in Alaska, Subpart D— 2005–2006 Subsistence Taking of Fish and Wildlife Regulations,’’ which expire on June 30, 2006. This rule would also amend the Customary and Traditional Use Determinations of the Federal Subsistence Board and the General Regulations related to the taking of wildlife. The Federal Subsistence Board must receive your written public comments and proposals to change this proposed rule no later than October 21, 2005. Federal Subsistence Regional Advisory Councils (Regional Councils) will hold public meetings to receive proposals to change this proposed rule on several dates starting from September 20, 2005, through October 21, 2005. See SUPPLEMENTARY INFORMATION for additional information on the public meetings including dates. ADDRESSES: You may submit proposals electronically to Subsistence@fws.gov. See SUPPLEMENTARY INFORMATION for file formats and other information about electronic filing. You may also submit written comments and proposals to the Office of Subsistence Management, 3601 C Street, Suite 1030, Anchorage, Alaska 99503. The public meetings will be held at various locations in Alaska. See SUPPLEMENTARY INFORMATION for DATES: 20 CFR Part 416 VerDate jul<14>2003 DEPARTMENT OF AGRICULTURE Jkt 205001 PO 00000 Frm 00017 Fmt 4702 Sfmt 4702 46795 additional information on locations of the public meetings. FOR FURTHER INFORMATION CONTACT: Chair, Federal Subsistence Board, c/o U.S. Fish and Wildlife Service, Attention: Thomas H. Boyd, Office of Subsistence Management; (907) 786– 3888. For questions specific to National Forest System lands, contact Steve Kessler, Regional Subsistence Program Leader, USDA, Forest Service, Alaska Region, (907) 786–3592. SUPPLEMENTARY INFORMATION: Public Review Process—Regulation Comments, Proposals, and Public Meetings The Federal Subsistence Board (Board), through the Regional Councils, will hold meetings on this proposed rule at the following locations and on the following dates in Alaska: Region 1—Southeast Regional Council, Wrangell, October 11, 2005. Region 2—Southcentral Regional Council, Seldovia, October 19, 2005. Region 3—Kodiak/Aleutians Regional Council, Cold Bay, September 20, 2005. Region 4—Bristol Bay Regional Council, Dillingham, October 6, 2005. Region 5—Yukon-Kuskokwim Delta Regional Council, Bethel, October 13, 2005. Region 6—Western Interior Regional Council, McGrath, October 4, 2005. Region 7—Seward Peninsula Regional Council, Nome, October 13, 2005. Region 8—Northwest Arctic Regional Council, Kotzebue, October 7, 2005. Region 9—Eastern Interior Regional Council, Tanana, October 10, 2005. Region 10—North Slope Regional Council, Kaktovik, October 20, 2005. Specific times and meeting locations will be published in local and statewide newspapers prior to the meetings. Locations and dates may change based on weather or local circumstances. The amount of work on each Regional Council’s agenda will determine the length of the Regional Council meetings. The agenda of each Regional Council meeting will include a review of wildlife issues in the Region, discussion and development of recommendations on fishery proposals for the Region, and staff briefings on matters of interest to the Council. Electronic filing of comments (preferred method): You may submit electronic comments (proposals) and other data to Subsistence@fws.gov. Please submit as MS Word files, avoiding the use of any special characters and any form of encryption. During November 2005, we will compile the written proposals to change Subpart D hunting and trapping E:\FR\FM\11AUP1.SGM 11AUP1

Agencies

[Federal Register Volume 70, Number 154 (Thursday, August 11, 2005)]
[Proposed Rules]
[Pages 46792-46795]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-15905]


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SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404 and 416

RIN 0960-AD78


Revised Medical Criteria for Evaluating Endocrine Disorders

AGENCY: Social Security Administration.

ACTION: Advance notice of proposed rulemaking.

-----------------------------------------------------------------------

SUMMARY: We are planning to update and revise the rules we use to 
evaluate endocrine disorders 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 9.00 
and 109.00 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 endocrine 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 about how we may be able to improve 
our programs for people who have endocrine disorders, especially those 
who would like to work.

DATES: To be sure your comments are considered, we must receive them by 
October 11, 2005.

ADDRESSES: You may give us your comments by: using our Internet site

[[Page 46793]]

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/LawsRegs.

FOR FURTHER INFORMATION CONTACT: Robert Augustine, Social Insurance 
Specialist, Office of Regulations, Social Security Administration, 100 
Altmeyer Building, 6401 Security Boulevard, Baltimore, Maryland 21235-
6401, (410) 965-0020 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 endocrine disorders 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 endocrine 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 endocrine 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 endocrine disorders, experts in the evaluation of 
endocrine diseases, 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?

    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 endocrine disorders. 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 9.00 and 109.00. These are the listings for 
endocrine disorders in adults (Part A, 9.00) and children (Part B, 
109.00). They include, but are not limited to, such impairments as 
thyroid disorders, hyperparathyroidism, hypoparathyroidism, 
neurohypophyseal insufficiency (diabetes insipidus), hyperfunction of 
the adrenal cortex, adrenal cortical insufficiency, diabetes mellitus, 
iatrogenic hypercorticoid state, pituitary dwarfism, adrenogenital 
syndrome, hypoglycemia, and gonadal dysgenesis (Turner's syndrome).

Where Can You Find These Rules on the Internet?

    You can find these rules on our Internet site at these locations:
     Sections 9.00 and 109.00 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 9.00 and 109.00 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 Endocrine 
Disorders?

    On August 24, 1999, and April 24, 2002, we published final rules in 
the Federal Register that included revisions to some of the listings 
for endocrine disorders (64 FR 46122 and 67 FR 20018, respectively). 
Prior to that, we last published final rules making comprehensive 
revisions to the listings for endocrine disorders on December 6, 1985 
(50 FR 50068).
    The current listings for endocrine disorders for adults (9.00) and 
children (109.00) 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 
sections 9.00 and 109.00 of our listings. For example, with regard to 
our listings, we are interested in knowing if:
     You have concerns about any of the provisions in the 
current endocrine listings, including the provisions for diabetes 
mellitus in 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 endocrine listings include 
something that they do not include now, such as conditions or new 
medical criteria that you believe should be added to the listings.
     You think these listings should include criteria for 
functional limitations and, if so, what those criteria should be.
    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 endocrine 
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 endocrine disorders might not need benefits from 
us if they could get treatment before their disorders make 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

[[Page 46794]]

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 for 
relevance to our policy for evaluating endocrine disorders, including 
the following recent documents:
     American Diabetes Association: Standards of Medical Care 
in Diabetes (Position Statement). Diabetes Care 28 (Suppl. 1):S4-S36, 
2005. This report is available at https://care.diabetesjournals.org/
cgi/content/full/28/suppl_1/s4.
     Behrman, R.E., Kliegman, R.M., and Jenson, H.B. (Eds.) 
(2004). Nelson Textbook of Pediatrics. Philadelphia, PA: Elsevier 
Science (USA).
     Goldman L. and D. Ausiello (eds). Cecil Textbook of 
Medicine (22nd edition). Saunders, Philadelphia, 2004.
     Silverstein J, Klingensmith G, Copeland K, Plotnick L, 
Kaufman F, Laffel L, Deeb L, Grey M, Anderson B, Holzmeister LA, Clark 
N: Care of Children and Adolescents With Type 1 Diabetes: A Statement 
of the American Diabetes Association. Diabetes Care 28:186-212, 2005. 
This report is available at https://care.diabetesjournals.org/cgi/
content/full/28/1/186?maxtoshow=&HITS=10&hits=10&RESULT 
FORMAT=&andorexactfulltext= and&searchid=1112384792902-- 
7205&stored_ search=&FIRSTINDEX=0&sortspec= 
relevance&volume=28&firstpage= 186&resourcetype=1&journal code=diacare.

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.

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 . . .   impairment(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 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. However, all of these sequential evaluation processes 
include a step 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

[[Page 46795]]

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: June 30, 2005.
Jo Anne B. Barnhart,
Commissioner of Social Security.
[FR Doc. 05-15905 Filed 8-10-05; 8:45 am]
BILLING CODE 4191-02-P
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