Titles II and XVI: Evaluating Cases Involving Tremolite Asbestos-Related Impairments, 30467-30469 [06-4855]
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30467
Federal Register / Vol. 71, No. 102 / Friday, May 26, 2006 / Notices
for appeals and hearings and in issuing
a decision. Respondents are individuals
who appeal denial of Social Security
disability income and Supplemental
Security Income (SSI) benefits, cessation
of benefits, or who are requesting a
hearing.
Number of
respondents
Collection method
Type of Request: Revision of an OMBapproved information collection.
Average burden per
response:
(minutes)
Frequency of
response
Estimated annual burden
SSA–3441 (Paper Form) .................................................................................
Electronic Disability Collection System (EDCS) ..............................................
I3441 (Internet Form) .......................................................................................
404,506
635,873
72,341
1
1
1
45
45
120
303,380
476,905
144,682
Totals ........................................................................................................
1,112,720
........................
........................
924,967
Estimated Annual Burden: 924,967
hours.
4. Third Party Liability Information
Statement—42 CFR 433.136–433.139—
0960–0323. Identification of sources of
third party insurance liable for medical
care or services for Medicaid
beneficiaries, which could be used to
reduce Medicaid costs, is required
under 42 U.S.C. 1396a(a)(25). Medicaid
State agencies are mandated under 42
CFR 433.136–.139 to obtain this
information on Medicaid applications
and redeterminations as a condition of
Medicaid eligibility. States are
permitted to enter into agreements with
the Commissioner of Social Security to
make Medicaid eligibility
determinations for aged, blind and
disabled beneficiaries in those States.
Applications for and redeterminations
of SSI eligibility in jurisdictions with
Estimated Annual Burden: 6,128
hours.
5. Claimant Statement About Loan of
Food or Shelter; Statement About Food
or Shelter Provided to Another—20 CFR
416.1130–416.1148—0960–0529. Forms
SSA–5062 and SSA–L5063 are used to
obtain statements about food and/or
shelter provided to an SSI claimant or
recipient. SSA uses this information to
determine whether food and/or shelter
are bona fide loans or should be counted
as income for SSI purposes. This
determination can affect eligibility for
SSI and the amount of SSI benefits
payable. The respondents are claimants/
recipients for SSI benefits and
individuals that provide loans of food
and/or shelter to SSI claimants/
recipients.
Type of Request: Extension of an
OMB-approved information collection.
such agreements are also applications
and redeterminations of Medicaid
eligibility. Under these agreements, SSA
obtains third party liability information
using form SSA–8019 and provides that
information to the State agencies which
provide Medicaid under the terms of an
approved plan in Title XIX of the Social
Security Act. The Medicaid State
agencies then use the information
provided to attempt to bill any third
parties liable for medical care, support
or services for a beneficiary to guarantee
that Medicaid remains the payer of last
resort. The respondents are SSI
applicants and beneficiaries.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 73,540.
Frequency of Response: 1.
Average Burden per Response: 5
minutes.
Number of
respondents
Form number
Average burden per
response:
(minutes)
Frequency of
response
Estimated annual burden
SSA–5062 ........................................................................................................
SSA–L5063 ......................................................................................................
65,540
65,540
1
1
10
10
10,923
10,923
Totals ........................................................................................................
131,080
........................
........................
21,846
Estimated Annual Burden: 21,846
hours.
ACTION:
Dated: May 18, 2006.
Elizabeth A. Davidson,
Social Security Administration, Reports
Clearance Officer.
[FR Doc. E6–7995 Filed 5–25–06; 8:45 am]
SUMMARY: In accordance with 20 CFR
402.35(b)(1), the Commissioner of Social
Security gives notice of Social Security
Ruling, SSR 06–01p. This Ruling
provides guidance on the types of
impairments that may result from
tremolite asbestos and how to evaluate
disability claims under titles II and XVI
of the Social Security Act based on
these impairments.
BILLING CODE 4191–02–P
SOCIAL SECURITY ADMINISTRATION
Notice of Social Security ruling.
jlentini on PROD1PC65 with NOTICES
[Social Security Ruling, SSR 06–01p]
DATES:
Titles II and XVI: Evaluating Cases
Involving Tremolite Asbestos-Related
Impairments
FOR FURTHER INFORMATION CONTACT:
AGENCY:
Social Security Administration.
VerDate Aug<31>2005
16:12 May 25, 2006
Jkt 208001
Effective Date: May 25, 2006.
Michelle Hungerman, Office of Medical
Policy, Social Security Administration,
6401 Security Boulevard, Baltimore, MD
21235–6401, 1–410–965–2289 or TTY
PO 00000
Frm 00103
Fmt 4703
Sfmt 4703
1–800–966–5609, for information about
this notice.
Although
we are not required to do so pursuant
to 5 U.S.C. 552(a)(1) and (a)(2), we are
publishing this Social Security Ruling
in accordance with 20 CFR 402.35(b)(1).
Social Security Rulings make
available to the public precedential
decisions relating to this Federal oldage, survivors, disability, supplemental
security income, and special veterans
benefits programs. Social Security
Rulings may be based on determinations
or decisions made at all administrative
levels of adjudication, Federal court
decisions, Commissioner’s decisions,
opinions of the Office of the General
SUPPLEMENTARY INFORMATION:
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30468
Federal Register / Vol. 71, No. 102 / Friday, May 26, 2006 / Notices
Counsel, and policy interpretations of
the law and regulations.
Although Social Security Rulings do
not have the same force and effect as the
statute or regulations, they are binding
on all components of the Social Security
Administration, in accordance with 20
CFR 402.35(b)(1), and are binding as
precedents in adjudicating cases.
If this Social Security Ruling is later
superseded, modified, or rescinded, we
will publish a notice in the Federal
Register to that effect.
(Catalog of Federal Domestic Assistance
Programs 96.001 Social Security Disability
Insurance; 96.006 Supplemental Security
Income)
Dated: May 19, 2006.
Martin Gerry,
Deputy Commissioner, Disability and Income
Security Programs.
Policy Interpretation Ruling
Titles II and XVI: Evaluating Cases
Involving Tremolite Asbestos-Related
Impairments
Purpose: To provide guidance on the
types of impairments that may result
from tremolite asbestos exposure and
how to evaluate disability claims under
titles II and XVI of the Social Security
Act (the Act) based on these
impairments.1
Citations (Authority): Sections 216(i),
223(d), 223(f), 1614(a)(3), and 1614(a)(4)
of the Social Security Act, as amended;
Regulations No. 4, subpart P, sections
404.1502, 404.1505, 404.1508–404.1513,
404.1519–1523, 404.1525–404.1529,
404.1545, 404.1560–404/1569a,
404.1593–404.1594, and appendix; 1;
and Regulations No. 16, subpart I,
sections 416.902, 416.905, 416.906,
416.908–416.913, 416.919, 416.920,
416.921–416.929, 416.945, 416.960–
416.969a, 416.993–416.994a.
Pertinent History
Tremolite is a type of asbestos
sometimes found in the mineral
vermiculite. People may be exposed to
tremolite from vermiculite in mining
jlentini on PROD1PC65 with NOTICES
1 For
simplicity, we refer in this Ruling only to
initial adult claims for disability benefits under
titles II and XVI of the Act, and the steps of the
sequential evaluation process we use to determine
disability in those claims, 20 CFR 401.1520 and
416.920. We use a different sequential evaluation
process for children who apply for benefits based
on disability under title XVI of the Act. We describe
that sequential evaluation process in 20 CFR
416.924. We also use separate sequential evaluation
processes to determine whether an individual’s
disability has ended when we conduct continuing
disability reviews and when we determine that an
individual was disabled only for a specific period.
These rules are set out in 20 CFR 401.1594, 416.994,
and 416.994a. The guidance in this Ruling applies
to all of the appropriate steps in those regulations
as well.
VerDate Aug<31>2005
16:12 May 25, 2006
Jkt 208001
and in work-related activities involving
the production of horticultural items,
construction and insulation materials,
brake pads, and other items. People may
also be exposed to tremolite from living
in an area where such mining or
activities occur or from products made
from vermiculite. exposure to tremolite
asbestos has occurred in the Libby,
Montana area and may have occurred in
other areas as well.
This ruling explains how we
determine if impairments that may be
caused by exposure to tremolite asbestos
meet our definition of disability.2
Sections 216(i) and 1614(a)(3) of the Act
define ‘‘disability’’ 3 as the inability to
engage in any substantial gainful
activity by reason of any medically
determinable physical or mental
impairment (or combination of
impairments) which can be expected to
result in death or which has lasted or
can be expected to last for a continuous
period of not less than 12 months.4
Policy Interpretation
1. What Types of Impairments May
Result from Exposure to Tremolite
Asbestos? When tremolite asbestos is
inhaled, it penetrates the lung tissue by
piercing the walls of the alveolar sacs
and permanently lodges in the pleural
lining. The tremolite accumulates in the
pleural lining, and the affected lung and
pleural areas become inflamed and
scarred. This process may eventually
result in chronic pulmonary
insufficiency, such as asbestosis,
disorders of pulmonary circulation,
pleural plaques, pleural thickening, or
pleural effusions. These impairments
can interfere with the lungs’ ability to
exchange oxygen and carbon dioxide
and can cause difficulty breathing by
interfering with the lungs’ ability to
expand and contract normally. Decrease
in blood flow to the lungs can result in
prolonged right pulmonary artery
hypertension, enlargement of the heart,
and failure of the right ventricle (cor
pulmonale).
2 The term ‘‘we’’ in this Social Security Ruling
has the same meaning as in 20 CFR 404.1502 and
416.902. ‘‘We’’ refers to either the Social Security
Administration or the State agency making the
disability determination; that is, our adjudicators at
all levels of the administrative review process and
our quality reviewers.
3 Except for statutory blindness.
4 For individuals under age 18 claiming benefits
under title XVI, disability will be established if the
individual has a medically determinable physical or
mental impairment (or combination of
impairments) that results in ‘‘marked and severe
functional limitations.’’ See section 1614(a)(3)(C) of
the Act and 20 CFR 416.906. However, for
simplicity, the following discussions refer only to
claims of individuals claiming disability benefits
under title II and individuals age 18 or older
claiming disability benefits under title XVI.
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Sfmt 4703
Inhalation of tremolite asbestos can
also cause several types of cancers,
primarily malignant mesothelioma of
the pleura and bronchogenic carcinoma
of the lung.
Some factors that increase the chances
of developing these impairments
include increased length of exposure to
tremolite asbestos, multiple routes of
exposure to tremolite asbestos (for
example occupational contact and
household contact), and smoking.5
2. How Do We Consider Impairments
Related to Tremolite Asbestos Exposure
in the Sequential Evaluation Process?
As with all impairments, we follow the
five-step sequential evaluation process
in 20 CFR 404.1520 and 416.920 when
we determine whether an individual is
disabled.
Step 1. We first determine whether
the individual is working and whether
the work is substantial gainful activity
(SGA). If the individual is working and
the work is SGA, we will find that the
individual is not disabled, regardless of
the individual’s medical condition, age,
education, and work experience. If the
individual is not engaging in SGA, we
go on to the next step.
Step 2. If the individual is not
working or the work is not SGA, we
then establish whether the individual
has a medically determinable
impairment that is ‘‘severe.’’
The presence of chronic pulmonary
insufficiency is established based on the
individual’s medical history, findings
from a physical examination(s), and
spirometric pulmonary function tests.
Chest x-rays or other appropriate
radiographic imaging techniques (for
example, a computerized axial
tomography (CAT) scan) are often
performed to support the presence of
the impairment. Measurement of
diffusing capacity of the lungs for
carbon monoxide (DLCO), pulse
oximetry, or resting or exercise arterial
blood gas studies (ABGS) may be
performed to determine if the
impairment has resulted in gas
exchange abnormalities. In disorders of
pulmonary circulation, a direct
measurement of pulmonary artery
pressure may have been obtained with
right heart catheterization.
Malignant mesothelioma and
bronchogenic carcinoma are
demonstrated by tissue biopsy. When a
biopsy is performed, we generally need
a copy of both the operative note and
pathology report. If we cannot get these
5 With continuing scientific research, new
medical information may emerge to further clarify
the causes and nature of impairments related to
tremolite asbestos exposure and to provide greater
specificity for clinical and laboratory diagnostic
techniques to document them.
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Federal Register / Vol. 71, No. 102 / Friday, May 26, 2006 / Notices
documents, we will accept the summary
of hospitalization(s) or other medical
reports. This evidence should include
details of the findings at surgery and,
whenever appropriate, the pathological
findings.
Once we determine that an
impairment(s) exists, we evaluate its
severity. As with any other medical
condition, we will find that an
impairment(s) caused by exposure to
tremolite is a ‘‘severe’’ impairment(s)
when, alone or in combination with
another medically determinable
physical or mental impairment(s), it
significantly limits an individual’s
physical or mental ability to do basic
work activities. When making a
determination about whether an
impairment(s) is severe, we will
consider the effects of any symptoms
(such as chest pain or complaints of
shortness of breath on exertion) that
could limit functioning.6 We also
recognize that limitations from
impairments caused by exposure to
tremolite may be more significant than
would be expected based on objective
findings alone. We will find that an
impairment(s) is ‘‘not severe’’ only if it
is a slight abnormality (or a combination
of slight abnormalities) that has no more
than a minimal effect on the
individual’s ability to do basic work
activities.
If the individual does not have a
medically determinable impairment that
is ‘‘severe,’’ we will find that the
individual is not disabled. If the
individual does have a ‘‘severe’’
impairment, we will go on to the next
step.
Step 3. If an individual has a severe
impairment(s), we next consider
whether the impairment meets or
medically equals a listing in the Listing
of Impairments contained in appendix
1, subpart P of 20 CFR part 404.
Chronic Pulmonary Insufficiency: We
evaluate chronic pulmonary
insufficiency under listing 3.02. The
listing contains criteria based on
spirometry, single breath DLCO, or
ABGS. Chronic pulmonary insufficiency
caused by exposure to tremolite asbestos
may not have findings at rest that satisfy
these criteria. If exercise ABGS cannot
be obtained in these situations, we
evaluate the impairment(s) at step 4,
and if necessary, step 5 of the sequential
evaluation process.
Cancer: Malignant mesothelioma of
the pleura meets listing 13.15A.
Bronchogenic carcinoma meets listing
6 See SSR 85–28, ‘‘Titles II and XVI: Medical
Impairments That Are Not Severe’’ and SSR 96–3p,
‘‘Titles II and XVI: Considering Allegations of Pain
and Other Symptoms In Determining Whether a
Medically Determinable Impairment Is Severe.’’
VerDate Aug<31>2005
16:12 May 25, 2006
Jkt 208001
13.14A if it is inoperable, unresectable,
recurrent, or has metastasized to or
beyond the hilar nodes.
If the individual has an impairment(s)
that meets or medically equals the
criteria of one of the foregoing listings
or any other listing and meets the
duration requirement, we will find that
the individual is disabled. If not, we
will continue with the sequential
evaluation process.
Residual Functional Capacity. If we
find that the impairment(s) does not
meet or medically equal a listing, or if
we do not have enough information for
a determination or decision at Step 3,
we will assess the individual’s residual
functional capacity (RFC).7 We must
consider all symptoms that result from
the individual’s impairments, including
those symptoms that result from
impairments that are not severe, when
we evaluate how these symptoms affect
the individual’s functional capacity.8
In addition, if the individual’s treating
source 9 has provided an opinion about
what the individual can still do despite
his or her impairment, we will give this
opinion controlling weight in
determining the individual’s RFC when
the opinion is well-supported by
objective medical evidence and is not
inconsistent with the other substantial
evidence in the case record.10 Even if
the treating source’s opinion is not
given ‘‘controlling weight’’ (for example
it is not well-supported by objective
medical evidence), the opinion is still
entitled to deference and must be
weighed using all of the factors in 20
CFR 404.1527 and 416.927. In many
cases, a treating source’s medical
opinion will be entitled to the greatest
weight and should be adopted even if it
does not meet the test for ‘‘controlling
weight.’’
Steps 4 and 5. After we determine the
individual’s RFC, we then proceed to
the fourth and, if necessary, the fifth
step of the sequential evaluation
process.11 If the individual can do past
relevant work, we will determine that
the individual is not disabled (step 4).
If we determine that the individual’s
impairment(s) precludes the
performance of past relevant work or if
there was no past relevant work, a
finding must be made about the
7 See
20 CFR 404.1520(e) and 416.920(e).
SSR 96–7p, ‘‘Titles II and XVI: Evaluation
of Symptoms in Disability Claims: Assessing the
Credibility of an Individual’s Statements’’ and SSR
96–8p, ‘‘Titles II and XVI: Assessing Residual
Functional Capacity in Initial Claims.’’
9 See 20 CFR 404.1502 and 416.902.
10 See 20 CFR 404.1527 and 416.927; SSR 96–2p,
‘‘Titles II and XVI: Giving Controlling Weight To
Treating Source Medical Opinions.’’
11 See 404.1545 and 416.945.
8 See
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30469
individual’s ability to adjust to other
work (step 5). The usual vocational
considerations must be applied in
determining the individual’s ability to
adjust to other work.12
Effective Date: This Ruling is effective
on the date of its publication in the
Federal Register.
Cross-References: SSR 85–28, ‘‘Titles
II and XVI: Medical Impairments That
Are Not Severe,’’ SSR 96–2p, ‘‘Titles II
and XVI: Giving Controlling Weight To
Treating Source Medical Opinions,’’
SSR 96–3p, ‘‘Titles II and XVI:
Considering Allegations of Pain and
Other Symptoms in Determining
Whether a Medically Determinable
Impairment is Severe,’’ SSR 96–7p,
‘‘Titles II and XVI: Evaluation of
Symptoms in Disability Claims:
Assessing the Credibility of an
Individual’s Statements,’’ and SSR
96–8p, ‘‘Titles II and XVI: Assessing
Residual Functional Capacity in Initial
Claims.’’
[FR Doc. 06–4855 Filed 5–25–06; 8:45 am]
BILLING CODE 4191–02–M
DEPARTMENT OF STATE
[Public Notice 5420]
United States Climate Change Science
Program
The United States Climate Change
Science Program requests expert review
of the Working Group II contribution
(‘‘Climate Change 2007: Impacts,
Adaptation, and Vulnerability’’) to the
Intergovernmental Panel on Climate
Change Fourth Assessment Report.
The Intergovernmental Panel on
Climate Change (IPCC) was established
by the United Nations Environment
Programme (UNEP) and the World
Meteorological Organization (WMO) in
1988. In accordance with its mandate
and as reaffirmed in various decisions
by the Panel, the major activity of the
IPCC is to prepare comprehensive and
up-to-date assessments of policyrelevant scientific, technical, and socioeconomic information relevant for
understanding the scientific basis of
climate change, potential impacts, and
options for mitigation and adaptation.
The First Assessment Report was
completed in 1990, the Second
Assessment Report in 1995, and the
Third Assessment Report in 2001. Three
working group volumes and a synthesis
report comprise the Fourth Assessment
Report, with all to be finalized in 2007.
Working Group I assesses the scientific
12 See 20 CFR 404.1560–404.1569a and 416.960–
416.969a.
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]]>Agencies
[Federal Register Volume 71, Number 102 (Friday, May 26, 2006)]
[Notices]
[Pages 30467-30469]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 06-4855]
-----------------------------------------------------------------------
SOCIAL SECURITY ADMINISTRATION
[Social Security Ruling, SSR 06-01p]
Titles II and XVI: Evaluating Cases Involving Tremolite Asbestos-
Related Impairments
AGENCY: Social Security Administration.
ACTION: Notice of Social Security ruling.
-----------------------------------------------------------------------
SUMMARY: In accordance with 20 CFR 402.35(b)(1), the Commissioner of
Social Security gives notice of Social Security Ruling, SSR 06-01p.
This Ruling provides guidance on the types of impairments that may
result from tremolite asbestos and how to evaluate disability claims
under titles II and XVI of the Social Security Act based on these
impairments.
DATES: Effective Date: May 25, 2006.
FOR FURTHER INFORMATION CONTACT: Michelle Hungerman, Office of Medical
Policy, Social Security Administration, 6401 Security Boulevard,
Baltimore, MD 21235-6401, 1-410-965-2289 or TTY 1-800-966-5609, for
information about this notice.
SUPPLEMENTARY INFORMATION: Although we are not required to do so
pursuant to 5 U.S.C. 552(a)(1) and (a)(2), we are publishing this
Social Security Ruling in accordance with 20 CFR 402.35(b)(1).
Social Security Rulings make available to the public precedential
decisions relating to this Federal old-age, survivors, disability,
supplemental security income, and special veterans benefits programs.
Social Security Rulings may be based on determinations or decisions
made at all administrative levels of adjudication, Federal court
decisions, Commissioner's decisions, opinions of the Office of the
General
[[Page 30468]]
Counsel, and policy interpretations of the law and regulations.
Although Social Security Rulings do not have the same force and
effect as the statute or regulations, they are binding on all
components of the Social Security Administration, in accordance with 20
CFR 402.35(b)(1), and are binding as precedents in adjudicating cases.
If this Social Security Ruling is later superseded, modified, or
rescinded, we will publish a notice in the Federal Register to that
effect.
(Catalog of Federal Domestic Assistance Programs 96.001 Social
Security Disability Insurance; 96.006 Supplemental Security Income)
Dated: May 19, 2006.
Martin Gerry,
Deputy Commissioner, Disability and Income Security Programs.
Policy Interpretation Ruling
Titles II and XVI: Evaluating Cases Involving Tremolite Asbestos-
Related Impairments
Purpose: To provide guidance on the types of impairments that may
result from tremolite asbestos exposure and how to evaluate disability
claims under titles II and XVI of the Social Security Act (the Act)
based on these impairments.\1\
---------------------------------------------------------------------------
\1\ For simplicity, we refer in this Ruling only to initial
adult claims for disability benefits under titles II and XVI of the
Act, and the steps of the sequential evaluation process we use to
determine disability in those claims, 20 CFR 401.1520 and 416.920.
We use a different sequential evaluation process for children who
apply for benefits based on disability under title XVI of the Act.
We describe that sequential evaluation process in 20 CFR 416.924. We
also use separate sequential evaluation processes to determine
whether an individual's disability has ended when we conduct
continuing disability reviews and when we determine that an
individual was disabled only for a specific period. These rules are
set out in 20 CFR 401.1594, 416.994, and 416.994a. The guidance in
this Ruling applies to all of the appropriate steps in those
regulations as well.
---------------------------------------------------------------------------
Citations (Authority): Sections 216(i), 223(d), 223(f), 1614(a)(3),
and 1614(a)(4) of the Social Security Act, as amended; Regulations No.
4, subpart P, sections 404.1502, 404.1505, 404.1508-404.1513, 404.1519-
1523, 404.1525-404.1529, 404.1545, 404.1560-404/1569a, 404.1593-
404.1594, and appendix; 1; and Regulations No. 16, subpart I, sections
416.902, 416.905, 416.906, 416.908-416.913, 416.919, 416.920, 416.921-
416.929, 416.945, 416.960-416.969a, 416.993-416.994a.
Pertinent History
Tremolite is a type of asbestos sometimes found in the mineral
vermiculite. People may be exposed to tremolite from vermiculite in
mining and in work-related activities involving the production of
horticultural items, construction and insulation materials, brake pads,
and other items. People may also be exposed to tremolite from living in
an area where such mining or activities occur or from products made
from vermiculite. exposure to tremolite asbestos has occurred in the
Libby, Montana area and may have occurred in other areas as well.
This ruling explains how we determine if impairments that may be
caused by exposure to tremolite asbestos meet our definition of
disability.\2\ Sections 216(i) and 1614(a)(3) of the Act define
``disability'' \3\ as the inability to engage in any substantial
gainful activity by reason of any medically determinable physical or
mental impairment (or combination of impairments) which can be expected
to result in death or which has lasted or can be expected to last for a
continuous period of not less than 12 months.\4\
---------------------------------------------------------------------------
\2\ The term ``we'' in this Social Security Ruling has the same
meaning as in 20 CFR 404.1502 and 416.902. ``We'' refers to either
the Social Security Administration or the State agency making the
disability determination; that is, our adjudicators at all levels of
the administrative review process and our quality reviewers.
\3\ Except for statutory blindness.
\4\ For individuals under age 18 claiming benefits under title
XVI, disability will be established if the individual has a
medically determinable physical or mental impairment (or combination
of impairments) that results in ``marked and severe functional
limitations.'' See section 1614(a)(3)(C) of the Act and 20 CFR
416.906. However, for simplicity, the following discussions refer
only to claims of individuals claiming disability benefits under
title II and individuals age 18 or older claiming disability
benefits under title XVI.
---------------------------------------------------------------------------
Policy Interpretation
1. What Types of Impairments May Result from Exposure to Tremolite
Asbestos? When tremolite asbestos is inhaled, it penetrates the lung
tissue by piercing the walls of the alveolar sacs and permanently
lodges in the pleural lining. The tremolite accumulates in the pleural
lining, and the affected lung and pleural areas become inflamed and
scarred. This process may eventually result in chronic pulmonary
insufficiency, such as asbestosis, disorders of pulmonary circulation,
pleural plaques, pleural thickening, or pleural effusions. These
impairments can interfere with the lungs' ability to exchange oxygen
and carbon dioxide and can cause difficulty breathing by interfering
with the lungs' ability to expand and contract normally. Decrease in
blood flow to the lungs can result in prolonged right pulmonary artery
hypertension, enlargement of the heart, and failure of the right
ventricle (cor pulmonale).
Inhalation of tremolite asbestos can also cause several types of
cancers, primarily malignant mesothelioma of the pleura and
bronchogenic carcinoma of the lung.
Some factors that increase the chances of developing these
impairments include increased length of exposure to tremolite asbestos,
multiple routes of exposure to tremolite asbestos (for example
occupational contact and household contact), and smoking.\5\
---------------------------------------------------------------------------
\5\ With continuing scientific research, new medical information
may emerge to further clarify the causes and nature of impairments
related to tremolite asbestos exposure and to provide greater
specificity for clinical and laboratory diagnostic techniques to
document them.
---------------------------------------------------------------------------
2. How Do We Consider Impairments Related to Tremolite Asbestos
Exposure in the Sequential Evaluation Process? As with all impairments,
we follow the five-step sequential evaluation process in 20 CFR
404.1520 and 416.920 when we determine whether an individual is
disabled.
Step 1. We first determine whether the individual is working and
whether the work is substantial gainful activity (SGA). If the
individual is working and the work is SGA, we will find that the
individual is not disabled, regardless of the individual's medical
condition, age, education, and work experience. If the individual is
not engaging in SGA, we go on to the next step.
Step 2. If the individual is not working or the work is not SGA, we
then establish whether the individual has a medically determinable
impairment that is ``severe.''
The presence of chronic pulmonary insufficiency is established
based on the individual's medical history, findings from a physical
examination(s), and spirometric pulmonary function tests. Chest x-rays
or other appropriate radiographic imaging techniques (for example, a
computerized axial tomography (CAT) scan) are often performed to
support the presence of the impairment. Measurement of diffusing
capacity of the lungs for carbon monoxide (DLCO), pulse oximetry, or
resting or exercise arterial blood gas studies (ABGS) may be performed
to determine if the impairment has resulted in gas exchange
abnormalities. In disorders of pulmonary circulation, a direct
measurement of pulmonary artery pressure may have been obtained with
right heart catheterization.
Malignant mesothelioma and bronchogenic carcinoma are demonstrated
by tissue biopsy. When a biopsy is performed, we generally need a copy
of both the operative note and pathology report. If we cannot get these
[[Page 30469]]
documents, we will accept the summary of hospitalization(s) or other
medical reports. This evidence should include details of the findings
at surgery and, whenever appropriate, the pathological findings.
Once we determine that an impairment(s) exists, we evaluate its
severity. As with any other medical condition, we will find that an
impairment(s) caused by exposure to tremolite is a ``severe''
impairment(s) when, alone or in combination with another medically
determinable physical or mental impairment(s), it significantly limits
an individual's physical or mental ability to do basic work activities.
When making a determination about whether an impairment(s) is severe,
we will consider the effects of any symptoms (such as chest pain or
complaints of shortness of breath on exertion) that could limit
functioning.\6\ We also recognize that limitations from impairments
caused by exposure to tremolite may be more significant than would be
expected based on objective findings alone. We will find that an
impairment(s) is ``not severe'' only if it is a slight abnormality (or
a combination of slight abnormalities) that has no more than a minimal
effect on the individual's ability to do basic work activities.
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\6\ See SSR 85-28, ``Titles II and XVI: Medical Impairments That
Are Not Severe'' and SSR 96-3p, ``Titles II and XVI: Considering
Allegations of Pain and Other Symptoms In Determining Whether a
Medically Determinable Impairment Is Severe.''
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If the individual does not have a medically determinable impairment
that is ``severe,'' we will find that the individual is not disabled.
If the individual does have a ``severe'' impairment, we will go on to
the next step.
Step 3. If an individual has a severe impairment(s), we next
consider whether the impairment meets or medically equals a listing in
the Listing of Impairments contained in appendix 1, subpart P of 20 CFR
part 404.
Chronic Pulmonary Insufficiency: We evaluate chronic pulmonary
insufficiency under listing 3.02. The listing contains criteria based
on spirometry, single breath DLCO, or ABGS. Chronic pulmonary
insufficiency caused by exposure to tremolite asbestos may not have
findings at rest that satisfy these criteria. If exercise ABGS cannot
be obtained in these situations, we evaluate the impairment(s) at step
4, and if necessary, step 5 of the sequential evaluation process.
Cancer: Malignant mesothelioma of the pleura meets listing 13.15A.
Bronchogenic carcinoma meets listing 13.14A if it is inoperable,
unresectable, recurrent, or has metastasized to or beyond the hilar
nodes.
If the individual has an impairment(s) that meets or medically
equals the criteria of one of the foregoing listings or any other
listing and meets the duration requirement, we will find that the
individual is disabled. If not, we will continue with the sequential
evaluation process.
Residual Functional Capacity. If we find that the impairment(s)
does not meet or medically equal a listing, or if we do not have enough
information for a determination or decision at Step 3, we will assess
the individual's residual functional capacity (RFC).\7\ We must
consider all symptoms that result from the individual's impairments,
including those symptoms that result from impairments that are not
severe, when we evaluate how these symptoms affect the individual's
functional capacity.\8\
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\7\ See 20 CFR 404.1520(e) and 416.920(e).
\8\ See SSR 96-7p, ``Titles II and XVI: Evaluation of Symptoms
in Disability Claims: Assessing the Credibility of an Individual's
Statements'' and SSR 96-8p, ``Titles II and XVI: Assessing Residual
Functional Capacity in Initial Claims.''
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In addition, if the individual's treating source \9\ has provided
an opinion about what the individual can still do despite his or her
impairment, we will give this opinion controlling weight in determining
the individual's RFC when the opinion is well-supported by objective
medical evidence and is not inconsistent with the other substantial
evidence in the case record.\10\ Even if the treating source's opinion
is not given ``controlling weight'' (for example it is not well-
supported by objective medical evidence), the opinion is still entitled
to deference and must be weighed using all of the factors in 20 CFR
404.1527 and 416.927. In many cases, a treating source's medical
opinion will be entitled to the greatest weight and should be adopted
even if it does not meet the test for ``controlling weight.''
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\9\ See 20 CFR 404.1502 and 416.902.
\10\ See 20 CFR 404.1527 and 416.927; SSR 96-2p, ``Titles II and
XVI: Giving Controlling Weight To Treating Source Medical
Opinions.''
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Steps 4 and 5. After we determine the individual's RFC, we then
proceed to the fourth and, if necessary, the fifth step of the
sequential evaluation process.\11\ If the individual can do past
relevant work, we will determine that the individual is not disabled
(step 4). If we determine that the individual's impairment(s) precludes
the performance of past relevant work or if there was no past relevant
work, a finding must be made about the individual's ability to adjust
to other work (step 5). The usual vocational considerations must be
applied in determining the individual's ability to adjust to other
work.\12\
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\11\ See 404.1545 and 416.945.
\12\ See 20 CFR 404.1560-404.1569a and 416.960-416.969a.
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Effective Date: This Ruling is effective on the date of its
publication in the Federal Register.
Cross-References: SSR 85-28, ``Titles II and XVI: Medical
Impairments That Are Not Severe,'' SSR 96-2p, ``Titles II and XVI:
Giving Controlling Weight To Treating Source Medical Opinions,'' SSR
96-3p, ``Titles II and XVI: Considering Allegations of Pain and Other
Symptoms in Determining Whether a Medically Determinable Impairment is
Severe,'' SSR 96-7p, ``Titles II and XVI: Evaluation of Symptoms in
Disability Claims: Assessing the Credibility of an Individual's
Statements,'' and SSR 96-8p, ``Titles II and XVI: Assessing Residual
Functional Capacity in Initial Claims.''
[FR Doc. 06-4855 Filed 5-25-06; 8:45 am]
BILLING CODE 4191-02-M
