Optometrists as Acceptable Medical Sources to Establish a Medically Determinable Impairment, 10456-10459 [E6-2852]
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Federal Register / Vol. 71, No. 40 / Wednesday, March 1, 2006 / Proposed Rules
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Federalism assessment under E.O.
13132.
Paperwork Reduction Act
This proposed rule contains a
collection-of-information requirement
subject to review and approval by the
Office of Management and Budget
(OMB) under the Paperwork Reduction
Act. The requirement has been
submitted to OMB for approval as a
revision to a collection currently
approved under OMB control number
0608–0004.
Notwithstanding any other provisions
of the law, no person is required to
respond to, nor shall any person be
subject to a penalty for failure to comply
with, a collection-of-information subject
to the requirements of the Paperwork
Reduction Act unless that collection
displays a currently valid OMB control
number.
The survey, as proposed, is expected
to result in the filing of about 13,500
foreign affiliate reports by an estimated
1,500 U.S. parent companies. A parent
company must file one form per
affiliate. BEA proposes to change the
survey in two ways—first, to collect
information on payments to and receipts
from foreign affiliates for interest,
royalties and license fees and other
private services gross rather than, as in
the past, net of any taxes withheld, and
second, to remove the requirement for
reporting certain affiliated insurance
transactions that have been problematic
to collect on the BE–577. (BEA plans to
move the reporting requirement for
these transactions to specialized
services surveys that BEA conducts in
the near future.) The respondent burden
for this collection of information is
estimated to vary from 0.5 hour to 4
hours per response, with an average of
1.25 hours per response, including time
for reviewing instructions, searching
existing data sources, gathering and
maintaining the data needed, and
completing and reviewing the collection
of information. Because reports are filed
4 times per year, 54,000 responses
annually are expected. Thus, the total
annual respondent burden of the survey
is estimated at 67,500 hours (13,500
respondents times 4 times 1.25 hours
average burden). This estimate is the
same as the burden hours currently
carried for this collection in the OMB
inventory.
Comments are requested concerning:
(a) Whether the proposed collection of
information is necessary for the proper
performance of the functions of the
agency, including whether the
information will have practical utility;
(b) the accuracy of the burden estimate;
(c) ways to enhance the quality, utility,
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and clarity of the information collected;
and (d) ways to minimize the burden of
the collection of information on the
respondents, including the use of
automated collection techniques or
other forms of information technology.
Comments should be addressed to:
Director, Bureau of Economic Analysis
(BE–1), U.S. Department of Commerce,
Washington, DC 20230, fax: 202–606–
5311; and the Office of Management and
Budget, O.I.R.A., Paperwork Reduction
Project 0608–0004, Attention PRA Desk
Officer for BEA, via the Internet at
pbugg@omb.eop.gov, or by fax at 202–
395–7245.
Regulatory Flexibility Act
The Chief Counsel for Regulation,
Department of Commerce, has certified
to the Chief Counsel for Advocacy,
Small Business Administration (SBA),
under the provisions of the Regulatory
Flexibility Act (5 U.S.C. 605(b)), that
this proposed rulemaking, if adopted,
will not have a significant economic
impact on a substantial number of small
entities. Although the BE–577 survey
does not itself collect data on the size
of the U.S. companies that must
respond, data collected on related BEA
surveys indicate that about 100 of the
estimated 1,500 U.S. parent companies
that must respond to the BE–577 survey
are small businesses according to the
standards established by the Small
Business Administration. The
exemption level for the BE–577 survey
is set in terms of the size of a U.S.
company’s foreign affiliates (foreign
companies owned 10 percent or more by
the U.S. company); if a foreign affiliate
has assets, sales, or net income greater
than the exemption level, it must be
reported. Usually, the U.S. parent
company that is required to file the
report is many times larger than its
largest foreign affiliate.
The 100 U.S. businesses that meet the
SBA small business standards tend to
have few foreign affiliates, and the
foreign affiliates that they do own are
small. With the proposed increase in the
exemption level for the BE–577 survey
from $30 million to $40 million (stated
in terms of the foreign affiliate’s assets,
sales, and net income), small U.S.
businesses will be required to file fewer
reports for their foreign affiliates than
would be required in the absence of this
increase. The estimated annual cost to a
U.S. business reporting for five or fewer
foreign affiliates is estimated to be less
than $1,000.
List of Subjects in 15 CFR Part 806
International transactions, Economic
statistics, U.S. investment abroad,
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Penalties, Reporting and recordkeeping
requirements.
Dated: February 21, 2006.
J. Steven Landefeld,
Director, Bureau of Economic Analysis.
For the reasons set forth in the
preamble, BEA proposes to amend 15
CFR part 806 as follows:
PART 806—DIRECT INVESTMENT
SURVEYS
1. The authority citation for 15 CFR
part 806 is revised to read as follows:
Authority: 5 U.S.C. 301; 22 U.S.C. 3101–
3108; and E.O. 11961 (3 CFR, 1977 Comp.,
p. 86), as amended by E.O. 12318 (3 CFR,
1981 Comp., p. 173) and E.O. 12518 (3 CFR,
1985 Comp., p. 348).
§ 806.14
[Amended]
2. Section 806.14 (e) is amended by
deleting ‘‘$30,000,000’’ and inserting
‘‘$40,000,000’’ in its place.
[FR Doc. 06–1877 Filed 2–28–06; 8:45 am]
BILLING CODE 3510–06–P
SOCIAL SECURITY ADMINISTRATION
20 CFR Parts 404 and 416
[Regulation Nos. 4 and 16]
RIN 0960–AG05
Optometrists as Acceptable Medical
Sources to Establish a Medically
Determinable Impairment
Social Security Administration.
Notice of proposed rulemaking.
AGENCY:
ACTION:
SUMMARY: We propose to revise the
Social Security and Supplemental
Security Income (SSI) disability
regulations regarding sources of
evidence for establishing a medically
determinable impairment under titles II
and XVI of the Social Security Act (the
Act). The revised regulations would
expand the situations in which we
consider licensed optometrists to be
‘‘acceptable medical sources’’.
DATES: To be sure that your comments
are considered, we must receive them
by May 1, 2006.
ADDRESSES: You may give us your
comments by: using our Internet site
facility (i.e., Social Security Online) at
https://policy.ssa.gov/erm/rules.nsf/
Rules+Open+To+Comment 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, MD 21235–7703. You may
also deliver them to the Office of
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Federal Register / Vol. 71, No. 40 / Wednesday, March 1, 2006 / Proposed Rules
Regulations, Social Security
Administration, 100 Altmeyer Building,
6401 Security Boulevard, Baltimore, MD
21235–6401, between 8 a.m. and 4:30
p.m. on regular business days.
Comments are posted on our Internet
site, at https://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.
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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/erm/rules.nsf/
Rules+Open+To+Comment.
FOR FURTHER INFORMATION CONTACT:
Rosemarie A. Greenwald, Social
Insurance Specialist, Social Security
Administration, 100 Altmeyer Building,
6401 Security Boulevard, Baltimore, MD
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 https://
www.socialsecurity.gov.
SUPPLEMENTARY INFORMATION:
What is an ‘‘acceptable medical
source’’?
Our rules provide that you must show
that you have a medically determinable
impairment with evidence from an
acceptable medical source. An
acceptable medical source is an
individual who has the training and
expertise to provide us with the signs
and laboratory findings based on
medically acceptable clinical and
laboratory diagnostic techniques that
establish a medically determinable
physical or mental impairment. Our
regulations identify professionals whom
we consider to be acceptable medical
sources. (See §§ 404.1513(a) and
416.913(a).) They are:
• Licensed physicians (medical or
osteopathic doctors);
• Licensed or certified psychologists.
Included are school psychologists, or
other licensed or certified individuals
with other titles who perform the same
function as a school psychologist in a
school setting, for purposes of
establishing mental retardation, learning
disabilities, and borderline intellectual
functioning only;
• Licensed optometrists, for the
measurement of visual acuity and visual
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fields (for claims under title II, we may
need a report from a physician to
determine other aspects of eye diseases);
• Licensed podiatrists, for purposes
of establishing impairments of the foot,
or foot and ankle only, depending on
whether the State in which the
podiatrist practices permits the practice
of podiatry on the foot only, or the foot
and ankle;
• Qualified speech-language
pathologists, for purposes of
establishing speech or language
impairments only.
Our current rules in §§ 404.1513(d)
and 416.913(d) provide that, once we
have established that you have a
medically determinable impairment, we
consider all other relevant evidence
from other medical and non-medical
sources, including your own statements,
to determine its severity and how it
affects you.
Why are we proposing to change our
rules?
As medical science changes, it is our
duty to review our policies and make
appropriate revisions. In the early
1990s, we discussed expanding the role
of optometrists as acceptable medical
sources with the American Optometric
Association (AOA). However, because
licensing regulations varied
considerably among jurisdictions at that
time, we found that it was not feasible
for us to revise our policy.
Recently, we met with representatives
of the AOA again and obtained
information about the education,
qualifications, and state scope-ofpractice laws related to optometrists.
Based on our review of accreditation
requirements and practice guidelines,
we have determined that, with the
exception of the U.S. Virgin Islands, the
licensing requirements, scope of
treatment, and diagnostic protocols for
licensed optometrists are sufficient to
qualify virtually all licensed
optometrists as acceptable medical
sources for visual disorders. Therefore,
we believe it is now appropriate to
propose to revise our regulations to
authorize licensed optometrists as
acceptable medical sources for visual
disorders in all jurisdictions but the
U.S. Virgin Islands.1
1 The U.S. Virgin Islands do not allow
optometrists to administer or prescribe
pharmaceuticals, including topical application of
pharmaceuticals for diagnostic or treatment
purposes. Because a complete evaluation of the eye
includes the use of diagnostic pharmaceuticals,
optometrists in the U.S. Virgin Islands are not
qualified to perform a complete evaluation of the
eye.
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Why was this solution chosen?
The revised regulations would expand
the situations in which we consider
licensed optometrists to be ‘‘acceptable
medical sources’’. We would be able to
make more decisions based on medical
evidence of record, rather than having to
purchase time-consuming and
expensive consultative examinations.
Therefore, these regulations would help
some individuals with visual disorders
qualify for benefits more quickly.
What rules are we proposing to revise?
We propose to revise
§§ 404.1513(a)(3) and 416.913(a)(3) to
provide that, except in the U.S. Virgin
Islands, licensed optometrists would be
acceptable medical sources for purposes
of establishing a medically determinable
impairment for visual disorders only.
However, we will maintain our current
rules for licensed optometrists in the
U.S. Virgin Islands, where they will
continue to be acceptable medical
sources for measurement of visual
acuity and visual fields only.
What programs would these proposed
regulations affect?
These proposed rules would affect
disability and blindness determinations
and decisions that we make under titles
II and XVI of the Act. In addition, to the
extent that Medicare entitlement and
Medicaid eligibility are based on
whether you qualify for disability
benefits under title II or disability or
blindness under title XVI, these
proposed rules would also affect the
Medicare and Medicaid programs.
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 II of the Act, you may
qualify for a period of disability if you
are insured for disability under Social
Security and are under a disability as
defined in section 216(i)(1) of the Act.
That section defines disability to
include statutory blindness, for
purposes of establishing a period of
disability under title II. If we find that
you are blind and you meet the insured
status requirement, we may establish a
period of disability for you regardless of
whether you can do substantial gainful
activity (SGA). A period of disability
protects your earnings record under
Social Security so that the time you are
disabled will not count against you in
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Federal Register / Vol. 71, No. 40 / Wednesday, March 1, 2006 / Proposed Rules
determining whether you will have
worked long enough to qualify for
benefits and the amount of your
benefits. See §§ 404.320, 404.1505,
404.1581, and 404.1582.
Under title XVI of the Act, we provide
for Supplemental Security Income (SSI)
payments on the basis of disability or
blindness if you are disabled or blind
and have limited income and resources.
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How do we define blindness?
For both the title II and title XVI
programs, the Act defines blindness as
‘‘central visual acuity of 20/200 or less
in the better eye with the use of a
correcting lens. An eye which is
accompanied by a limitation in the
fields of vision such that the widest
diameter of the visual field subtends an
angle no greater than 20 degrees shall be
considered * * * as having a central
visual acuity of 20/200 or less.’’ (See
sections 216(i)(1) and 1614(a)(2) of the
Act.)
Title II of the Act does not provide a
separate category of benefits based on
blindness. However, you may be
entitled to benefits based on disability
under title II of the Act if you are blind.
By contrast, title XVI of the Act
provides for a category of payments
based on blindness as well as a category
of payments based on disability. If you
are blind and meet the SSI income and
resources requirements, you may be
eligible for SSI payments based on
blindness. Your blindness does not have
to meet a 12-month duration
requirement for you to be eligible for
these payments. Also, there is no
requirement that you be unable to do
any SGA. However, if you are working,
we will consider your earnings to
determine if you are eligible for SSI
payments.
How do we decide whether you are
disabled?
If you are applying for disability
benefits under title II of the Act, section
404.1513(a) of our regulations provides
that we need evidence from acceptable
medical sources to establish whether
you have a medically determinable
impairment(s). Therefore, in general, to
be entitled to disability benefits under
title II, your blindness must result from
a medically determinable impairment
and meet the 12-month duration
requirement. (See §§ 404.1508,
404.1513, and 404.1581.) Also, if you
are under age 55, you must be unable to
do any SGA. (See §§ 404.1582 and
404.1584(b).) Even though you are doing
SGA, we may still find that you are
entitled to title II disability benefits if—
• You are blind;
• You are age 55 or older; and
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• You are unable to use the skills or
abilities like the ones you used in any
SGA which you did regularly and for a
substantial period of time. However, we
will not pay you any cash benefits for
any month in which you are doing SGA.
(See §§ 404.1583 and 404.1584(c).)
Section 416.913(a) of our regulations
states that if you are claiming benefits
under title XVI on the basis of disability,
not blindness, your disability must
result from a medically determinable
impairment documented by acceptable
medical sources. However, blindness is
treated differently under title XVI of the
Act. Under title XVI, blindness and
disability are separate categories of SSI
payments, and the requirements for
eligibility based on blindness are
different from the requirements for
eligibility based on disability. Under
title XVI, the only evidence we need to
establish statutory blindness is evidence
showing that your visual acuity or
visual field, in the better eye, meets the
criteria described in the section ‘‘How
do we define blindness?’’ provided that
those measurements are consistent with
the other evidence in your case record.
We do not need to determine the cause
of your blindness for you to be eligible
for SSI payments based on blindness.
Also, there is no duration requirement
for statutory blindness under title XVI
(See §§ 416.981 and 416.983). Section
416.913(f) provides that if you are
applying for benefits under title XVI on
the basis of statutory blindness, we will
require an examination by a physician
skilled in diseases of the eye or by an
optometrist, whichever you may select.
What is a ‘‘medically determinable
impairment’’?
We will not consider you to be
disabled or blind unless you furnish
medical and other evidence that we
need to show that you are disabled or
blind. (See sections 223(d)(5)(A) and
1614(a)(3)(H)(i) of the Act, and
§§ 404.1512(a) and 416.912(a) of our
regulations.) The Act requires that you
show that your disability results from a
medically determinable physical or
mental impairment. A physical or
mental impairment is an impairment
that results from anatomical,
physiological, or psychological
abnormalities which are demonstrable
by medically acceptable clinical and
laboratory diagnostic techniques. (See
sections 223(d)(3) and 1614(a)(3)(D) of
the Act.) Our regulations provide that a
physical or mental impairment must be
established by medical evidence
consisting of signs, symptoms, and
laboratory findings. (See §§ 404.1508
and 416.908.)
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What is our authority to make rules
and set procedures for determining
whether a person is disabled under the
statutory definition?
Section 205(a) of the Act and, by
reference to section 205(a), section
1631(d)(1) provides that:
The Commissioner of Social Security
shall have full power and authority to
make rules and regulations and to
establish procedures, not inconsistent
with the provisions of this title, which
are necessary or appropriate to carry out
such provisions, and shall adopt
reasonable and proper rules and
regulations to regulate and provide for
the nature and extent of the proofs and
evidence and the method of taking and
furnishing the same in order to establish
the right to benefits hereunder.
When will we start to use these rules?
We will not use these rules until we
evaluate the public comments we
receive on them, determine whether
they should be issued as final rules, and
issue final rules in the Federal Register.
If we publish final rules, we will
explain in the preamble how we will
apply them, and summarize and
respond to the public comments. Until
the effective date of any final rules, we
will continue to use our current rules.
Clarity of these proposed rules
Executive Order 12866, as amended
by Executive Order 13258, requires each
agency to write all rules in plain
language. In addition to your
substantive comments on these
proposed rules, we invite your
comments on how to make them easier
to understand.
For example:
• Have we organized the material to
suit your needs?
• Are the requirements in the rules
clearly stated?
• Do the rules contain technical
language or jargon that is not clear?
• Would a different format (grouping
and order of sections, use of headings,
paragraphing) make the rules easier to
understand?
• Would more (but shorter) sections
be better?
• Could we improve clarity by adding
tables, lists, or diagrams?
• What else could we do to make the
rules easier to understand?
Regulatory Procedures
Executive Order 12866
We have consulted with the Office of
Management and Budget (OMB) and
determined that these proposed rules
meet the requirements for a significant
regulatory action under Executive Order
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Federal Register / Vol. 71, No. 40 / Wednesday, March 1, 2006 / Proposed Rules
12866, as amended by Executive Order
13258. Thus, they were subject to OMB
review.
Disability Insurance; 96.002, Social
Security—Retirement Insurance; 96.004,
Social Security—Survivors Insurance;
96.006, Supplemental Security Income.)
902(a)(5), 1382, 1382c, 1382h, 1383(a), (c),
and (d)(1), and (p), and 1383b; secs. 4(c) and
5, 6(c)–(e), 14(a), and 15, Pub. L. 98–460, 98
Stat. 1794, 1801, 1802, and 1808 (42 U.S.C.
421 note, 423 note, 1382h note).
List of Subjects
4. Revise § 416.913(a)(3) to read as
follows:
Regulatory Flexibility Act
We certify that these proposed rules
would not have a significant economic
impact on a substantial number of small
entities because they would affect only
individuals. Thus, a regulatory
flexibility analysis as provided in the
Regulatory Flexibility Act, as amended,
is not required.
Paperwork Reduction Act
These proposed rules do not impose
any new reporting requirements on the
public.
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List of References
During development of these
proposed rules, we reviewed the
following information:
• Council on Optometric Education,
Accreditation Manual: Professional
Optometric Degree Programs, St. Louis,
MO, 10/1998.
• American Optometric Association,
State/Territory Statutory Language the
Practice of Optometry, 3/2002.
• American Optometric Association,
Optometric Clinical Practice Guidelines.
1. Comprehensive Adult Eye and
Vision Examination, St. Louis, MO, 5/1/
1994.
2. Care of the Patient with Primary
Angle Closure Glaucoma, St. Louis, MO,
6/23/1994.
3. Care of the Patient with Anterior
Uveitis, St. Louis, MO, 6/23/1994.
4. Care of the Patient with AgeRelated Macular Degeneration, St.
Louis, MO, 6/23/1994.
5. Care of the Patient with Amblyopia,
St. Louis, MO, 6/29/1994.
6. Care of the Patient with Open Angle
Glaucoma, St. Louis, MO, 3/23/1995.
7. Care of the Patient with Retinal
Detachment and Related Peripheral
Vitreoretinal Disease, St. Louis, MO, 4/
27/1995.
8. Care of the Patient with Strabismus:
Esotropia and Exotropia, St. Louis, MO,
6/28/1995.
9. Care of the Adult Patient with
Cataract, St. Louis, MO, 6/28/1995.
10. Care of the Patient with Diabetes
Mellitus, St. Louis, MO, 5/1/1998.
• National Board of Examiners in
Optometry, ‘‘Topic outline of national
test’’, https://www.optometry.org.
These references are included in the
rulemaking record for these proposed
rules and are available for inspection by
interested individuals making
arrangements with the contact person
shown in this preamble.
(Catalog of Federal Domestic Assistance
Program Nos. 96.001, Social Security—
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10459
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).
§ 416.913 Medical and other evidence of
your impairment(s).
(a) * * *
(3) Licensed optometrists, for
purposes of establishing visual
disorders only (except, in the U.S.
Virgin Islands, licensed optometrists, for
the measurement of visual acuity and
visual fields only). (See paragraph (f) of
this section for the evidence needed for
statutory blindness);
*
*
*
*
*
[FR Doc. E6–2852 Filed 2–28–06; 8:45 am]
Dated: December 20, 2006.
Jo Anne B. Barnhart,
Commissioner of Social Security.
BILLING CODE 4191–02–P
For the reasons set out in the
preamble, we propose to amend subpart
P of part 404 and subpart I of part 416
of chapter III of title 20 of the Code of
Federal Regulations as set forth below:
DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric
Administration
PART 404—FEDERAL OLD-AGE,
SURVIVORS AND DISABILITY
INSURANCE (1950– )
50 CFR Part 600
Subpart P—[Amended]
RIN 0648–AS46
1. The authority citation for subpart P
of part 404 continues to read as follows:
Authority: Secs. 202, 205(a), (b), and (d)–
(h), 216(i), 221(a) and (i), 222(c), 223, 225,
and 702(a)(5) of the Social Security Act (42
U.S.C. 402, 405(a), (b), and (d)–(h), 416(i),
421(a) and (i), 422(c), 423, 425, and
902(a)(5)); sec. 211(b), Pub. L. 104–193, 110
Stat. 2105, 2189.
2. Revise § 404.1513(a)(3) to read as
follows:
§ 404.1513 Medical and other evidence of
your impairment(s).
(a) * * *
(3) Licensed optometrists, for
purposes of establishing visual
disorders only (except, in the U.S.
Virgin Islands, licensed optometrists, for
the measurement of visual acuity and
visual fields only);
*
*
*
*
*
PART 416—SUPPLEMENTAL
SECURITY INCOME FOR THE AGED,
BLIND, AND DISABLED
Subpart I—[Amended]
3. The authority citation for subpart I
of part 416 continues to read as follows:
Authority: Secs. 702(a)(5), 1611, 1614,
1619, 1631(a), (c), and (d)(1), and (p), and
1633 of the Social Security Act (42 U.S.C.
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[Docket No. 050520139–6034–03; I.D.
030305A]
Magnuson-Stevens Act Provisions;
Fishing Capacity Reduction Program;
Bering Sea/Aleutian Islands King and
Tanner Crabs; Industry Fee System for
Fishing Capacity Reduction Loan
National Marine Fisheries
Service (NMFS), National Oceanic and
Atmospheric Administration (NOAA),
Commerce.
ACTION: Proposed rule; request for
comments.
AGENCY:
SUMMARY: NMFS publishes this
proposed rule to exempt any crab
landed under the Community
Development Quota (CDQ) Program
from the fee regulations for the Bering
Sea/Aleutian Islands King and Tanner
Crab Fishing Capacity Reduction
Program, to provide that crab buyers
disburse fee collections to NMFS not
later than the 7th calendar day of each
month, and to provide that the annual
report from each crab buyer shall be
submitted to NMFS by July 1 of each
calendar year. The fee regulations
otherwise remain unchanged. The intent
of this proposed rule is to modify the fee
rules so that they do not apply to any
crab allocated pursuant to the CDQ
Program, and to ease the fee collection
burden for crab buyers.
E:\FR\FM\01MRP1.SGM
01MRP1
]]>Agencies
[Federal Register Volume 71, Number 40 (Wednesday, March 1, 2006)]
[Proposed Rules]
[Pages 10456-10459]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E6-2852]
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SOCIAL SECURITY ADMINISTRATION
20 CFR Parts 404 and 416
[Regulation Nos. 4 and 16]
RIN 0960-AG05
Optometrists as Acceptable Medical Sources to Establish a
Medically Determinable Impairment
AGENCY: Social Security Administration.
ACTION: Notice of proposed rulemaking.
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SUMMARY: We propose to revise the Social Security and Supplemental
Security Income (SSI) disability regulations regarding sources of
evidence for establishing a medically determinable impairment under
titles II and XVI of the Social Security Act (the Act). The revised
regulations would expand the situations in which we consider licensed
optometrists to be ``acceptable medical sources''.
DATES: To be sure that your comments are considered, we must receive
them by May 1, 2006.
ADDRESSES: You may give us your comments by: using our Internet site
facility (i.e., Social Security Online) at https://policy.ssa.gov/erm/
rules.nsf/Rules+Open+To+Comment 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, MD 21235-7703. You may also deliver them to the
Office of
[[Page 10457]]
Regulations, Social Security Administration, 100 Altmeyer Building,
6401 Security Boulevard, Baltimore, MD 21235-6401, between 8 a.m. and
4:30 p.m. on regular business days. Comments are posted on our Internet
site, at https://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 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/erm/rules.nsf/
Rules+Open+To+Comment.
FOR FURTHER INFORMATION CONTACT: Rosemarie A. Greenwald, Social
Insurance Specialist, Social Security Administration, 100 Altmeyer
Building, 6401 Security Boulevard, Baltimore, MD 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 https://www.socialsecurity.gov.
SUPPLEMENTARY INFORMATION:
What is an ``acceptable medical source''?
Our rules provide that you must show that you have a medically
determinable impairment with evidence from an acceptable medical
source. An acceptable medical source is an individual who has the
training and expertise to provide us with the signs and laboratory
findings based on medically acceptable clinical and laboratory
diagnostic techniques that establish a medically determinable physical
or mental impairment. Our regulations identify professionals whom we
consider to be acceptable medical sources. (See Sec. Sec. 404.1513(a)
and 416.913(a).) They are:
Licensed physicians (medical or osteopathic doctors);
Licensed or certified psychologists. Included are school
psychologists, or other licensed or certified individuals with other
titles who perform the same function as a school psychologist in a
school setting, for purposes of establishing mental retardation,
learning disabilities, and borderline intellectual functioning only;
Licensed optometrists, for the measurement of visual
acuity and visual fields (for claims under title II, we may need a
report from a physician to determine other aspects of eye diseases);
Licensed podiatrists, for purposes of establishing
impairments of the foot, or foot and ankle only, depending on whether
the State in which the podiatrist practices permits the practice of
podiatry on the foot only, or the foot and ankle;
Qualified speech-language pathologists, for purposes of
establishing speech or language impairments only.
Our current rules in Sec. Sec. 404.1513(d) and 416.913(d) provide
that, once we have established that you have a medically determinable
impairment, we consider all other relevant evidence from other medical
and non-medical sources, including your own statements, to determine
its severity and how it affects you.
Why are we proposing to change our rules?
As medical science changes, it is our duty to review our policies
and make appropriate revisions. In the early 1990s, we discussed
expanding the role of optometrists as acceptable medical sources with
the American Optometric Association (AOA). However, because licensing
regulations varied considerably among jurisdictions at that time, we
found that it was not feasible for us to revise our policy.
Recently, we met with representatives of the AOA again and obtained
information about the education, qualifications, and state scope-of-
practice laws related to optometrists. Based on our review of
accreditation requirements and practice guidelines, we have determined
that, with the exception of the U.S. Virgin Islands, the licensing
requirements, scope of treatment, and diagnostic protocols for licensed
optometrists are sufficient to qualify virtually all licensed
optometrists as acceptable medical sources for visual disorders.
Therefore, we believe it is now appropriate to propose to revise our
regulations to authorize licensed optometrists as acceptable medical
sources for visual disorders in all jurisdictions but the U.S. Virgin
Islands.\1\
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\1\ The U.S. Virgin Islands do not allow optometrists to
administer or prescribe pharmaceuticals, including topical
application of pharmaceuticals for diagnostic or treatment purposes.
Because a complete evaluation of the eye includes the use of
diagnostic pharmaceuticals, optometrists in the U.S. Virgin Islands
are not qualified to perform a complete evaluation of the eye.
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Why was this solution chosen?
The revised regulations would expand the situations in which we
consider licensed optometrists to be ``acceptable medical sources''. We
would be able to make more decisions based on medical evidence of
record, rather than having to purchase time-consuming and expensive
consultative examinations. Therefore, these regulations would help some
individuals with visual disorders qualify for benefits more quickly.
What rules are we proposing to revise?
We propose to revise Sec. Sec. 404.1513(a)(3) and 416.913(a)(3) to
provide that, except in the U.S. Virgin Islands, licensed optometrists
would be acceptable medical sources for purposes of establishing a
medically determinable impairment for visual disorders only. However,
we will maintain our current rules for licensed optometrists in the
U.S. Virgin Islands, where they will continue to be acceptable medical
sources for measurement of visual acuity and visual fields only.
What programs would these proposed regulations affect?
These proposed rules would affect disability and blindness
determinations and decisions that we make under titles II and XVI of
the Act. In addition, to the extent that Medicare entitlement and
Medicaid eligibility are based on whether you qualify for disability
benefits under title II or disability or blindness under title XVI,
these proposed rules would also affect the Medicare and Medicaid
programs.
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 II of the Act, you may qualify for a period of
disability if you are insured for disability under Social Security and
are under a disability as defined in section 216(i)(1) of the Act. That
section defines disability to include statutory blindness, for purposes
of establishing a period of disability under title II. If we find that
you are blind and you meet the insured status requirement, we may
establish a period of disability for you regardless of whether you can
do substantial gainful activity (SGA). A period of disability protects
your earnings record under Social Security so that the time you are
disabled will not count against you in
[[Page 10458]]
determining whether you will have worked long enough to qualify for
benefits and the amount of your benefits. See Sec. Sec. 404.320,
404.1505, 404.1581, and 404.1582.
Under title XVI of the Act, we provide for Supplemental Security
Income (SSI) payments on the basis of disability or blindness if you
are disabled or blind and have limited income and resources.
How do we define blindness?
For both the title II and title XVI programs, the Act defines
blindness as ``central visual acuity of 20/200 or less in the better
eye with the use of a correcting lens. An eye which is accompanied by a
limitation in the fields of vision such that the widest diameter of the
visual field subtends an angle no greater than 20 degrees shall be
considered * * * as having a central visual acuity of 20/200 or less.''
(See sections 216(i)(1) and 1614(a)(2) of the Act.)
Title II of the Act does not provide a separate category of
benefits based on blindness. However, you may be entitled to benefits
based on disability under title II of the Act if you are blind.
By contrast, title XVI of the Act provides for a category of
payments based on blindness as well as a category of payments based on
disability. If you are blind and meet the SSI income and resources
requirements, you may be eligible for SSI payments based on blindness.
Your blindness does not have to meet a 12-month duration requirement
for you to be eligible for these payments. Also, there is no
requirement that you be unable to do any SGA. However, if you are
working, we will consider your earnings to determine if you are
eligible for SSI payments.
How do we decide whether you are disabled?
If you are applying for disability benefits under title II of the
Act, section 404.1513(a) of our regulations provides that we need
evidence from acceptable medical sources to establish whether you have
a medically determinable impairment(s). Therefore, in general, to be
entitled to disability benefits under title II, your blindness must
result from a medically determinable impairment and meet the 12-month
duration requirement. (See Sec. Sec. 404.1508, 404.1513, and
404.1581.) Also, if you are under age 55, you must be unable to do any
SGA. (See Sec. Sec. 404.1582 and 404.1584(b).) Even though you are
doing SGA, we may still find that you are entitled to title II
disability benefits if--
You are blind;
You are age 55 or older; and
You are unable to use the skills or abilities like the
ones you used in any SGA which you did regularly and for a substantial
period of time. However, we will not pay you any cash benefits for any
month in which you are doing SGA. (See Sec. Sec. 404.1583 and
404.1584(c).)
Section 416.913(a) of our regulations states that if you are
claiming benefits under title XVI on the basis of disability, not
blindness, your disability must result from a medically determinable
impairment documented by acceptable medical sources. However, blindness
is treated differently under title XVI of the Act. Under title XVI,
blindness and disability are separate categories of SSI payments, and
the requirements for eligibility based on blindness are different from
the requirements for eligibility based on disability. Under title XVI,
the only evidence we need to establish statutory blindness is evidence
showing that your visual acuity or visual field, in the better eye,
meets the criteria described in the section ``How do we define
blindness?'' provided that those measurements are consistent with the
other evidence in your case record. We do not need to determine the
cause of your blindness for you to be eligible for SSI payments based
on blindness. Also, there is no duration requirement for statutory
blindness under title XVI (See Sec. Sec. 416.981 and 416.983). Section
416.913(f) provides that if you are applying for benefits under title
XVI on the basis of statutory blindness, we will require an examination
by a physician skilled in diseases of the eye or by an optometrist,
whichever you may select.
What is a ``medically determinable impairment''?
We will not consider you to be disabled or blind unless you furnish
medical and other evidence that we need to show that you are disabled
or blind. (See sections 223(d)(5)(A) and 1614(a)(3)(H)(i) of the Act,
and Sec. Sec. 404.1512(a) and 416.912(a) of our regulations.) The Act
requires that you show that your disability results from a medically
determinable physical or mental impairment. A physical or mental
impairment is an impairment that results from anatomical,
physiological, or psychological abnormalities which are demonstrable by
medically acceptable clinical and laboratory diagnostic techniques.
(See sections 223(d)(3) and 1614(a)(3)(D) of the Act.) Our regulations
provide that a physical or mental impairment must be established by
medical evidence consisting of signs, symptoms, and laboratory
findings. (See Sec. Sec. 404.1508 and 416.908.)
What is our authority to make rules and set procedures for determining
whether a person is disabled under the statutory definition?
Section 205(a) of the Act and, by reference to section 205(a),
section 1631(d)(1) provides that:
The Commissioner of Social Security shall have full power and
authority to make rules and regulations and to establish procedures,
not inconsistent with the provisions of this title, which are necessary
or appropriate to carry out such provisions, and shall adopt reasonable
and proper rules and regulations to regulate and provide for the nature
and extent of the proofs and evidence and the method of taking and
furnishing the same in order to establish the right to benefits
hereunder.
When will we start to use these rules?
We will not use these rules until we evaluate the public comments
we receive on them, determine whether they should be issued as final
rules, and issue final rules in the Federal Register. If we publish
final rules, we will explain in the preamble how we will apply them,
and summarize and respond to the public comments. Until the effective
date of any final rules, we will continue to use our current rules.
Clarity of these proposed rules
Executive Order 12866, as amended by Executive Order 13258,
requires each agency to write all rules in plain language. In addition
to your substantive comments on these proposed rules, we invite your
comments on how to make them easier to understand.
For example:
Have we organized the material to suit your needs?
Are the requirements in the rules clearly stated?
Do the rules contain technical language or jargon that is
not clear?
Would a different format (grouping and order of sections,
use of headings, paragraphing) make the rules easier to understand?
Would more (but shorter) sections be better?
Could we improve clarity by adding tables, lists, or
diagrams?
What else could we do to make the rules easier to
understand?
Regulatory Procedures
Executive Order 12866
We have consulted with the Office of Management and Budget (OMB)
and determined that these proposed rules meet the requirements for a
significant regulatory action under Executive Order
[[Page 10459]]
12866, as amended by Executive Order 13258. Thus, they were subject to
OMB review.
Regulatory Flexibility Act
We certify that these proposed rules would not have a significant
economic impact on a substantial number of small entities because they
would affect only individuals. Thus, a regulatory flexibility analysis
as provided in the Regulatory Flexibility Act, as amended, is not
required.
Paperwork Reduction Act
These proposed rules do not impose any new reporting requirements
on the public.
List of References
During development of these proposed rules, we reviewed the
following information:
Council on Optometric Education, Accreditation Manual:
Professional Optometric Degree Programs, St. Louis, MO, 10/1998.
American Optometric Association, State/Territory Statutory
Language the Practice of Optometry, 3/2002.
American Optometric Association, Optometric Clinical
Practice Guidelines.
1. Comprehensive Adult Eye and Vision Examination, St. Louis, MO,
5/1/1994.
2. Care of the Patient with Primary Angle Closure Glaucoma, St.
Louis, MO, 6/23/1994.
3. Care of the Patient with Anterior Uveitis, St. Louis, MO, 6/23/
1994.
4. Care of the Patient with Age-Related Macular Degeneration, St.
Louis, MO, 6/23/1994.
5. Care of the Patient with Amblyopia, St. Louis, MO, 6/29/1994.
6. Care of the Patient with Open Angle Glaucoma, St. Louis, MO, 3/
23/1995.
7. Care of the Patient with Retinal Detachment and Related
Peripheral Vitreoretinal Disease, St. Louis, MO, 4/27/1995.
8. Care of the Patient with Strabismus: Esotropia and Exotropia,
St. Louis, MO, 6/28/1995.
9. Care of the Adult Patient with Cataract, St. Louis, MO, 6/28/
1995.
10. Care of the Patient with Diabetes Mellitus, St. Louis, MO, 5/1/
1998.
National Board of Examiners in Optometry, ``Topic outline
of national test'', https://www.optometry.org.
These references are included in the rulemaking record for these
proposed rules and are available for inspection by interested
individuals making arrangements with the contact person shown in this
preamble.
(Catalog of Federal Domestic Assistance Program Nos. 96.001, Social
Security--Disability Insurance; 96.002, Social Security--Retirement
Insurance; 96.004, Social Security--Survivors Insurance; 96.006,
Supplemental Security Income.)
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: December 20, 2006.
Jo Anne B. Barnhart,
Commissioner of Social Security.
For the reasons set out in the preamble, we propose to amend
subpart P of part 404 and subpart I of part 416 of chapter III of title
20 of the Code of Federal Regulations as set forth below:
PART 404--FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE
(1950- )
Subpart P--[Amended]
1. The authority citation for subpart P of part 404 continues to
read as follows:
Authority: Secs. 202, 205(a), (b), and (d)-(h), 216(i), 221(a)
and (i), 222(c), 223, 225, and 702(a)(5) of the Social Security Act
(42 U.S.C. 402, 405(a), (b), and (d)-(h), 416(i), 421(a) and (i),
422(c), 423, 425, and 902(a)(5)); sec. 211(b), Pub. L. 104-193, 110
Stat. 2105, 2189.
2. Revise Sec. 404.1513(a)(3) to read as follows:
Sec. 404.1513 Medical and other evidence of your impairment(s).
(a) * * *
(3) Licensed optometrists, for purposes of establishing visual
disorders only (except, in the U.S. Virgin Islands, licensed
optometrists, for the measurement of visual acuity and visual fields
only);
* * * * *
PART 416--SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND
DISABLED
Subpart I--[Amended]
3. The authority citation for subpart I of part 416 continues to
read as follows:
Authority: Secs. 702(a)(5), 1611, 1614, 1619, 1631(a), (c), and
(d)(1), and (p), and 1633 of the Social Security Act (42 U.S.C.
902(a)(5), 1382, 1382c, 1382h, 1383(a), (c), and (d)(1), and (p),
and 1383b; secs. 4(c) and 5, 6(c)-(e), 14(a), and 15, Pub. L. 98-
460, 98 Stat. 1794, 1801, 1802, and 1808 (42 U.S.C. 421 note, 423
note, 1382h note).
4. Revise Sec. 416.913(a)(3) to read as follows:
Sec. 416.913 Medical and other evidence of your impairment(s).
(a) * * *
(3) Licensed optometrists, for purposes of establishing visual
disorders only (except, in the U.S. Virgin Islands, licensed
optometrists, for the measurement of visual acuity and visual fields
only). (See paragraph (f) of this section for the evidence needed for
statutory blindness);
* * * * *
[FR Doc. E6-2852 Filed 2-28-06; 8:45 am]
BILLING CODE 4191-02-P
