Revised Listings for Growth Disorders and Weight Loss in Children, 19522-19530 [2015-08185]

Agencies

• Social Security Administration

[Federal Register Volume 80, Number 70 (Monday, April 13, 2015)]
[Rules and Regulations]
[Pages 19522-19530]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2015-08185]


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SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404 and 416

[Docket No. SSA-2011-0081]
RIN 0960-AG28


Revised Listings for Growth Disorders and Weight Loss in Children

AGENCY: Social Security Administration.

ACTION: Final rule.

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SUMMARY: This rule adopts, with one change, the rule for evaluating 
growth disorders in children we proposed in a notice of proposed 
rulemaking (NPRM) published in the Federal Register on May 22, 2013. 
Several body systems in the Listing of Impairments (listings) contain 
listings for children based on impairment of linear growth or weight 
loss. We are replacing those listings with new listings for low birth 
weight (LBW) and failure to thrive; a new listing for genitourinary 
impairments; and revised listings for growth failure in combination 
with a respiratory, cardiovascular, digestive, or immune system 
disorder. These revisions reflect our program experience, advances in 
medical knowledge, and comments we received from medical experts and 
the public.

DATES: This rule is effective June 12, 2015.

[[Page 19523]]


FOR FURTHER INFORMATION CONTACT: Cheryl A. Williams, Office of Medical 
Policy, Social Security Administration, 6401 Security Boulevard, 
Baltimore, Maryland 21235-6401, (410) 965-1020. 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 site, 
Social Security Online, at https://www.socialsecurity.gov.

SUPPLEMENTARY INFORMATION:

Background

    We are adopting, as final, the rule for evaluating growth disorders 
in children we proposed in an NPRM published in the Federal Register on 
May 22, 2013 at 78 FR 30249. We made one addition to this rule as the 
result of a public comment suggesting we provide guidance for 
evaluating LBW in children born at less than 32 weeks gestation or 
weighing less than 1325 grams. We revised the table in listing 100.04B 
to include 32 weeks in the Gestational Age column because we believe 
that this guidance is appropriate.
    The preamble to the NPRM discussed the remaining changes from our 
current rule and our reasons for proposing those changes. To the extent 
that we are adopting the proposed rule as published, we are not 
repeating that information here. Interested readers may refer to the 
preamble to the NPRM, available at https://www.regulations.gov under 
docket number SSA-2011-0081.

Why are we revising the listings for evaluating growth disorders in 
children?

    We are revising the listings for evaluating growth disorders in 
children to update the medical criteria, provide more information on 
how we evaluate growth disorders, reflect our program experience, and 
address adjudicator questions.

Public Comments on the NPRM

    In the NPRM, we provided the public with a 60-day comment period, 
which ended on July 22, 2013. We received six comments. The commenters 
included state agencies that make disability determinations for us, the 
National Association of Disability Examiners, medical organizations, 
such as the American Academy of Pediatrics, and advocacy groups, such 
as the Endocrine Society. We carefully considered all of the comments, 
summarized the commenters' views, and responded to all of the 
significant issues that were within the scope of this rule. Some 
commenters noted provisions with which they agreed and did not make 
suggestions for changes in those provisions. We did not summarize or 
respond to those comments.

Listing 100.04 Low Birth Weight in Infants From Birth to Attainment of 
Age 1

Low Birth Weight

    Comment: One commenter suggested that we provide guidance in the 
listings at 100.04A or 100.04B, or in the introductory text at 100.00, 
on diaries used to schedule continuing disability reviews (CDR) for LBW 
infants. The commenter believes that, while this guidance is already in 
our internal operating instructions, providing it in the regulations 
would reduce the number of incorrect diaries being set for LBW cases.
    Response: We did not adopt this comment. In 100.00B, we include a 
reference to our rule for CDRs for LBW cases at Sec.  416.990(b)(11). 
Additionally, the Act requires, with one exception, that we perform a 
CDR not later than 12 months after the birth of an infant whose LBW is 
a contributing factor material to the determination that the infant is 
disabled. We will continue to provide guidance on diaries for LBW cases 
and cases involving other disabling impairments in our internal 
operating instructions. We do not believe it is necessary to repeat 
this guidance in the regulation.
    Comment: One commenter expressed concern that listing 100.04 
suggests that LBW is a disability. The commenter felt that it should be 
clear that weight is ``a proxy measure for prematurity, dysphagia, and 
other functional impairments that are associated with disabilities, 
rather than weight as a disability itself.'' The commenter did not 
provide suggested language to include in our rule.
    Response: We did not adopt this comment. We agree that, for the 
purposes of listing 100.04, weight is a proxy measure for disability in 
infants from birth to the attainment of age 1. However, we do not 
believe that providing additional guidance is necessary for the clarity 
of our rule. As we noted in the preamble to the proposed rule, we based 
listing 100.04 on sections 416.926a(m)(6) and (m)(7) of our functional 
equivalence rule.\1\ Our adjudicators have over 20 years of experience 
evaluating claims filed on behalf of children based on LBW under our 
functional equivalence rule. In our experience applying this rule, we 
have not found that the type of guidance the commenter suggested is 
necessary in order to apply the rule properly.
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    \1\ 78 FR at 30350.
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Evaluating Infants Born at 33 Weeks Weighing Less Than 1325 Grams

    Comment: One commenter suggested that we add guidance for 
evaluating infants who weigh between 1200 grams and 1325 grams, and who 
are born at gestational ages of 32 weeks or less.
    Response: We partially adopted this comment. We agree that it is 
appropriate to provide guidance for evaluating LBW in infants who are 
born at 32 weeks gestational age. We revised the table in 100.04B to 
provide a birth weight value of 1250 grams or less for the gestational 
age of 32 weeks. However, we did not provide birth weight values for 
gestational ages less than 32 weeks. The birth weight values that we 
would provide for infants born at less than 32 weeks would be less than 
1200 grams and, thus, the birth weight would meet the criterion in 
100.04A.

Listing 100.05 Failure To Thrive in Children From Birth to Attainment 
of Age 3

Growth Measurements

    Comment: One commenter recommended including growth curves in 
100.05A to make administrative processing for pediatricians easier. 
Another commenter suggested that we make determinations based on growth 
measurements alone without requiring a diagnosis of developmental 
delay.
    Response: We did not adopt these comments. In 100.05A, we require 
three weight-for-length measurements or body mass index (BMI)-for-age 
measurements that are within a 12-month period, at least 60-days apart, 
and less than the third percentile on the appropriate table in listing 
105.08B.2. The adjudicator making the disability determination uses the 
information from growth curves provided by the child's pediatrician to 
find the corresponding values on the tables provided. We do not believe 
it is necessary to include the growth curves in the listing because our 
adjudicators use the listing, rather than the pediatrician who 
evaluates a child.
    As we stated in the NPRM, our program experience has shown that 
growth failure alone is not disabling (78 FR at 30251). To meet the 
severity requirements for listing 100.05B, the child must have growth 
failure with a developmental delay of the appropriate severity required 
by the listing. Children with growth failure without developmental 
delay may be evaluated in the appropriate body system of the underlying 
condition causing the growth failure.

[[Page 19524]]

Developmental Testing

    Comment: One commenter questioned the requirement for two narrative 
developmental reports in 100.05C and the requirement that these two 
reports be at least 120 days apart. This commenter suggested that, if 
we keep the requirement for two reports, we should require a shorter 
period of either 30 or 60 days between them. Another commenter also 
expressed concern about the requirements for the evidence of 
developmental delay. This commenter was concerned about the 
availability of these records from providers.
    Response: We did not adopt these comments. In 100.05C, we require 
two narrative developmental reports when a report of a standardized 
developmental assessment required by 100.05B is not available. As we 
explained in the NPRM, abnormal findings noted on repeated 
examinations, and information in narrative developmental reports, that 
may include the results of developmental screening tests, can identify 
a child who is not developing or achieving skills within expected 
timeframes.\2\
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    \2\ 78 FR at 30251.
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    We do not believe that 30 or 60 days is enough time for these kinds 
of changes to appear on testing. We believe that 120 days is an 
appropriate period for developmental testing to be performed and to 
allow for any changes in development to show on testing.
    While we understand the commenter's concern about the availability 
of evidence, we believe that, for the children whose impairments we 
evaluate under listing 100.05, evidence generally will be available 
from providers because these children are likely to be identified, and 
subsequently treated because of their identification, by early 
intervention programs.
    Comment: One commenter noted that most early intervention programs 
use ``a 25 percent delay criteria as opposed to the two-thirds 
criteria'' required in 100.05C. However, the commenter did not provide 
any suggestions for changing the criterion.
    Response: We did not adopt this comment. We recognize that early 
intervention programs often use a 25 percent delay criterion to 
determine eligibility for intervention services and to identify the 
needed services. In contrast, we evaluate a child's delay to determine 
whether the underlying impairment is disabling because it results in 
``marked and severe functional limitations.'' An impairment results in 
``marked and severe functional limitations'' only if it meets, 
medically equals, or functionally equals the listings. An impairment is 
of listing-level severity if it results in ``marked'' limitations in 
two domains of functioning or an ``extreme'' limitation in one 
domain.\3\ The level of delay that we require in 100.05C is consistent 
with our definition of ``marked limitation'' in Sec.  
416.926a(e)(2)(ii).
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    \3\ See 20 CFR 416.926a(a).
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    Comment: One commenter expressed concern about acceptable 
timeframes for performing developmental testing in relation to 
disability determinations stated in 100.05B and 100.05C. The commenter 
suggested that the testing to establish the child's current level of 
development be performed within 6 months of adjudication.
    Response: We partially adopted this comment. We agree that evidence 
about a child's development must be recent and current in relation to a 
disability determination, and we have revised listings 100.05B and 
100.05C2 to clarify this requirement. However, the facts in a specific 
case determine whether the evidence is current. Determining factors 
include, but are not limited to, the age of the child, the amount of 
delay, and the developmental trajectory documented over time. We are 
not setting specific timeframes for when developmental testing must be 
performed, but we are specifying that the evidence must reflect the 
child's current development.

Linear Growth

    Comment: One commenter agreed with our use of weight-for-length and 
BMI-for-age charts to evaluate growth failure, rather than of linear 
(height or length) growth charts. The commenter expressed concern, 
however, that an underlying condition could cause a child to have such 
profound growth failure that BMI for the child's age would become 
normal, despite his or her significant growth failure.
    Response: We did not adopt this comment. We understand the 
commenter's concerns that some children may have underlying conditions 
that cause linear growth impairments while their BMI-for-age 
measurements are normal. After attainment of age 2, most children 
without an underlying medical disorder follow a growth trajectory that 
remains fairly constant during childhood.
    Our adjudicative experience has shown that a declining linear 
growth rate is not always indicative of a disabling condition. Short 
stature, length, or height below the third percentile, in and of 
itself, is not a medically determinable impairment, although it can be 
the result of a medically determinable impairment. We will evaluate 
children with growth failure that does not meet the requirements of 
listings 100.04 and 100.05 and is associated with a known medically 
determinable impairment under the affected body system.
    Comment: One commenter was concerned that, while the majority of 
children over the age of 3 with growth failure have signs and symptoms 
of an underlying disorder in the respiratory, cardiovascular, 
digestive, genitourinary, or immune body system, some children over the 
age of 3 will not. This commenter suggested that we include exceptions 
for conditions, such as Turner syndrome (female hypogonadism) and 
acquired growth hormone deficiency, where growth failure may be a 
significant component of the disease process.
    Response: We did not adopt this comment. After a child attains age 
3, we will evaluate his or her impairment under the affected body 
system. The two examples provided by the commenter are endocrine 
disorders. Although these two disorders are not listed impairments for 
children, they may rise to listing-level severity because of their 
effects in other body systems. As the commenter explained, children 
with Turner syndrome may experience complications, such as heart 
disease, to a degree that is disabling. We would evaluate the 
complications under the affected body system.

Listing 103.06 Growth Failure Due to Any Chronic Respiratory Disorder

    Comment: Two commenters were concerned with the requirement for 
oxygen supplementation in 103.06A. The commenters noted that some 
respiratory disorders, such as asthma, bronchiectasis, and cystic 
fibrosis, could result in listing-level growth failure without 
requiring oxygen supplementation.
    Response: We did not adopt these comments. We agree with the 
commenters that some respiratory disorders could result in listing-
level growth failure without requiring oxygen supplementation; however, 
we did not revise 103.06 as a result. We use other listings, such as 
103.02, 103.03, and 103.04, in the respiratory body system to evaluate 
these disorders.\4\ We believe that these respiratory listings, and our 
functional equivalence rule for evaluating disability in children,

[[Page 19525]]

adequately address the disorders referred to by the commenters.\5\
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    \4\ See 20 CFR part 404, subpart P, Appendix 1.
    \5\ See 20 CFR 416.924a and 416.926a.
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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?

    The Act authorizes us to make rules and regulations and to 
establish necessary and appropriate procedures to implement them.\6\
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    \6\ 42 U.S.C. 405(a), 902(a)(5), and 1383(d)(1).
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When will we use this final rule?

    We will begin to use this final rule on its effective date. We will 
continue to use the current listings until the date this final rule 
becomes effective. We will apply the final rule to new applications 
filed on or after the effective date of the final rule and to claims 
that are pending on or after the effective date.\7\
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    \7\ This means that we will use this final rule on and after its 
effective date in any case in which we make a determination or 
decision. We expect that Federal courts will review our final 
decisions using the rule that was in effect at the time we issued 
the decisions. If a court reverses our final decision and remands a 
case for further administrative proceedings after the effective date 
of this final rule, we will apply this final rule to the entire 
period at issue in the decision we make after the court's remand.
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How long will this final rule be effective?

    This final rule will remain in effect for 5 years after the date it 
becomes effective, unless we extend it or revise and issue it again.

Regulatory Procedures

Executive Order 12866, as Supplemented by Executive Order 13563

    We consulted with the Office of Management and Budget (OMB) and 
determined that this final rule meets the criteria for a significant 
regulatory action under Executive Order 12866, as supplemented by 
Executive Order 13563. Therefore, OMB reviewed this final rule.

Regulatory Flexibility Act

    We certify that this final rule would not have a significant 
economic impact on a substantial number of small entities because they 
affect individuals only. Therefore, a regulatory flexibility analysis 
is not required under the Regulatory Flexibility Act, as amended.

Paperwork Reduction Act

    This final rule does not create any new or affect any existing 
collections and, therefore, does not require OMB approval under the 
Paperwork Reduction Act.

(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; and 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).

Carolyn W. Colvin,
Acting Commissioner of Social Security.

    For the reasons set out in the preamble, we are amending 20 CFR 
part 404 subpart P and part 416 subpart I as set forth below:

PART 404--FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE 
(1950-)

0
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), 
(i), and (j), 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), (i), and 
(j), 422(c), 423, 425, and 902(a)(5)); sec. 211(b), Pub. L. 104-193, 
110 Stat. 2105, 2189; sec. 202, Pub. L. 108-203, 118 Stat. 509 (42 
U.S.C. 902 note).


0
2. Amend appendix 1 to subpart P of part 404 as follows:
0
a. Revise item 1 of the introductory text before part A of appendix 1.
0
b. Amend part B by revising the body system name for section 100.00 in 
the table of contents.
0
c. Revise sections 100.00 and 100.01 of part B.
0
d. Remove sections 100.02 and 100.03 of part B.
0
e. Add sections 100.04 and 100.05 of part B
0
f. Add section 103.00F of part B.
0
g. Add listing 103.06 of part B.
0
h. Revise section 104.00C2b introductory text of part B.
0
i. Revise section 104.00C2b(ii) of part B.
0
j. Add section 104.00C3 of part B.
0
k. Revise listing 104.02C of part B.
0
l. Revise section 105.00G of part B.
0
m. Revise listing 105.08 of part B.
0
n. Redesignate section 106.00C5 of part B as 106.00C6 and add new 
section 106.00C5.
0
o. Add listing 106.08 of part B.
0
p. Add section 114.00F4d of part B.
0
q. Revise listing 114.08H of part B.
    The revisions and additions read as follows:

APPENDIX 1 TO SUBPART P OF PART 404--LISTING OF IMPAIRMENTS

* * * * *
    1. Low Birth Weight and Failure to Thrive (100.00): June 12, 
2020.
* * * * *
    Part B
* * * * *
    100.00 Low Birth Weight and Failure to Thrive.
* * * * *

100.00 LOW BIRTH WEIGHT AND FAILURE TO THRIVE

    A. What conditions do we evaluate under these listings? We 
evaluate low birth weight (LBW) in infants from birth to attainment 
of age 1 and failure to thrive (FTT) in infants and toddlers from 
birth to attainment of age 3.
    B. How do we evaluate disability based on LBW under 100.04? In 
100.04A and 100.04B, we use an infant's birth weight as documented 
by an original or certified copy of the infant's birth certificate 
or by a medical record signed by a physician. Birth weight means the 
first weight recorded after birth. In 100.04B, gestational age is 
the infant's age based on the date of conception as recorded in the 
medical record. If the infant's impairment meets the requirements 
for listing 100.04A or 100.04B, we will follow the rule in Sec.  
416.990(b)(11) of this chapter.
    C. How do we evaluate disability based on FTT under 100.05?
    1. General. We establish FTT with or without a known cause when 
we have documentation of an infant's or a toddler's growth failure 
and developmental delay from an acceptable medical source(s) as 
defined in Sec.  416.913(a) of this chapter. We require 
documentation of growth measurements in 100.05A and developmental 
delay described in 100.05B or 100.05C within the same consecutive 
12-month period. The dates of developmental testing and reports may 
be different from the dates of growth measurements. After the 
attainment of age 3, we evaluate growth failure under the affected 
body system(s).
    2. Growth failure. Under 100.05A, we use the appropriate 
table(s) under 105.08B in the digestive system to determine whether 
a child's growth is less than the third percentile. The child does 
not need to have a digestive disorder for purposes of 100.05.
    a. For children from birth to attainment of age 2, we use the 
weight-for-length table corresponding to the child's gender (Table I 
or Table II).
    b. For children age 2 to attainment of age 3, we use the body 
mass index (BMI)-for-age table corresponding to the child's gender 
(Table III or Table IV).

[[Page 19526]]

    c. BMI is the ratio of a child's weight to the square of his or 
her height. We calculate BMI using the formulas in 105.00G2c.
    d. Growth measurements. The weight-for-length measurements for 
children from birth to the attainment of age 2 and BMI-for-age 
measurements for children age 2 to attainment of age 3 that are 
required for this listing must be obtained within a 12-month period 
and at least 60 days apart. If a child attains age 2 during the 
evaluation period, additional measurements are not needed. Any 
measurements taken before the child attains age 2 can be used to 
evaluate the impairment under the appropriate listing for the 
child's age. If the child attains age 3 during the evaluation 
period, the measurements can be used to evaluate the impairment in 
the affected body system.
    3. Developmental delay.
    a. Under 100.05B and C, we use reports from acceptable medical 
sources to establish delay in a child's development.
    b. Under 100.05B, we document the severity of developmental 
delay with results from a standardized developmental assessment, 
which compares a child's level of development to the level typically 
expected for his or her chronological age. If the child was born 
prematurely, we may use the corrected chronological age (CCA) for 
comparison. (See Sec.  416.924b(b) of this chapter.) CCA is the 
chronological age adjusted by a period of gestational prematurity. 
CCA = (chronological age)--(number of weeks premature). Acceptable 
medical sources or early intervention specialists, physical or 
occupational therapists, and other sources may conduct standardized 
developmental assessments and developmental screenings. The results 
of these tests and screenings must be accompanied by a statement or 
records from an acceptable medical source who established the child 
has a developmental delay.
    c. Under 100.05C, when there are no results from a standardized 
developmental assessment in the case record, we need narrative 
developmental reports from the child's medical sources in sufficient 
detail to assess the severity of his or her developmental delay. A 
narrative developmental report is based on clinical observations, 
progress notes, and well-baby check-ups. To meet the requirements 
for 100.05C, the report must include: The child's developmental 
history; examination findings (with abnormal findings noted on 
repeated examinations); and an overall assessment of the child's 
development (that is, more than one or two isolated skills) by the 
medical source. Some narrative developmental reports may include 
results from developmental screening tests, which can identify a 
child who is not developing or achieving skills within expected 
timeframes. Although medical sources may refer to screening test 
results as supporting evidence in the narrative developmental 
report, screening test results alone cannot establish a diagnosis or 
the severity of developmental delay.
    D. How do we evaluate disorders that do not meet one of these 
listings?
    1. We may find infants disabled due to other disorders when 
their birth weights are greater than 1200 grams but less than 2000 
grams and their weight and gestational age do not meet listing 
100.04. The most common disorders of prematurity and LBW include 
retinopathy of prematurity (ROP), chronic lung disease of infancy 
(CLD, previously known as bronchopulmonary dysplasia, or BPD), 
intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), 
and periventricular leukomalacia (PVL). Other disorders include poor 
nutrition and growth failure, hearing disorders, seizure disorders, 
cerebral palsy, and developmental disorders. We evaluate these 
disorders under the affected body systems.
    2. We may evaluate infants and toddlers with growth failure that 
is associated with a known medical disorder under the body system of 
that medical disorder, for example, the respiratory or digestive 
body systems.
    3. If an infant or toddler has a severe medically determinable 
impairment(s) that does not meet the criteria of any listing, we 
must also consider whether the child has an impairment(s) that 
medically equals a listing (see Sec.  416.926 of this chapter). If 
the child's impairment(s) does not meet or medically equal a 
listing, we will determine whether the child's impairment(s) 
functionally equals the listings (see Sec.  416.926a of this 
chapter) considering the factors in Sec.  416.924a of this chapter. 
We use the rule in Sec.  416.994a of this chapter when we decide 
whether a child continues to be disabled.

100.01 Category of Impairments, Low Birth Weight and Failure to Thrive

    100.04 Low birth weight in infants from birth to attainment of 
age 1.
    A. Birth weight (see 100.00B) of less than 1200 grams.

OR

    B. The following gestational age and birth weight:

------------------------------------------------------------------------
     Gestational age (in weeks)                  Birth weight
------------------------------------------------------------------------
37-40...............................  2000 grams or less.
36..................................  1875 grams or less.
35..................................  1700 grams or less.
34..................................  1500 grams or less.
33..................................  1325 grams or less.
32..................................  1250 grams or less.
------------------------------------------------------------------------

    100.05 Failure to thrive in children from birth to attainment of 
age 3 (see 100.00C), documented by A and B, or A and C.
    A. Growth failure as required in 1 or 2:
    1. For children from birth to attainment of age 2, three weight-
for-length measurements that are:
    a. Within a consecutive 12-month period; and
    b. At least 60 days apart; and
    c. Less than the third percentile on the appropriate weight-for-
length table in listing 105.08B1; or
    2. For children age 2 to attainment of age 3, three BMI-for-age 
measurements that are:
    a. Within a consecutive 12-month period; and
    b. At least 60 days apart; and
    c. Less than the third percentile on the appropriate BMI-for-age 
table in listing 105.08B2.

AND

    B. Developmental delay (see 100.00C1 and C3), established by an 
acceptable medical source and documented by findings from one 
current report of a standardized developmental assessment (see 
100.00C3b) that:
    1. Shows development not more than two-thirds of the level 
typically expected for the child's age; or
    2. Results in a valid score that is at least two standard 
deviations below the mean.

OR

    C. Developmental delay (see 100.00C3), established by an 
acceptable medical source and documented by findings from two 
narrative developmental reports (see 100.00C3c) that:
    1. Are dated at least 120 days apart (see 100.00C1); and
    2. Indicate current development not more than two-thirds of the 
level typically expected for the child's age.
* * * * *

103.00 RESPIRATORY SYSTEM

* * * * *
    F. How do we evaluate growth failure due to any chronic 
respiratory disorder?
    1. To evaluate growth failure due to any chronic respiratory 
disorder, we require documentation of the oxygen supplementation 
described in 103.06A and the growth measurements in 103.06B within 
the same consecutive 12-month period. The dates of oxygen 
supplementation may be different from the dates of growth 
measurements.
    2. Under 103.06B, we use the appropriate table(s) under 105.08B 
in the digestive system to determine whether a child's growth is 
less than the third percentile.
    a. For children from birth to attainment of age 2, we use the 
weight-for-length table corresponding to the child's gender (Table I 
or Table II).
    b. For children age 2 to attainment of age 18, we use the body 
mass index (BMI)-for-age table corresponding to the child's gender 
(Table III or Table IV).
    c. BMI is the ratio of a child's weight to the square of his or 
her height. We calculate BMI using the formulas in 105.00G2c.
* * * * *
    103.06 Growth failure due to any chronic respiratory disorder 
(see 103.00F), documented by:
    A. Hypoxemia with the need for at least 1.0 L/min of oxygen 
supplementation for at least 4 hours per day and for at least 90 
consecutive days.

AND

    B. Growth failure as required in 1 or 2:
    1. For children from birth to attainment of age 2, three weight-
for-length measurements that are:
    a. Within a consecutive 12-month period; and
    b. At least 60 days apart; and
    c. Less than the third percentile on the appropriate weight-for-
length table under 105.08B1; or
    2. For children age 2 to attainment of age 18, three BMI-for-age 
measurements that are:

[[Page 19527]]

    a. Within a consecutive 12-month period; and
    b. At least 60 days apart; and
    c. Less than the third percentile on the appropriate BMI-for-age 
table under 105.08B2.
* * * * *

104.00 CARDIOVASCULAR SYSTEM

* * * * *
    C. Evaluating Chronic Heart Failure
* * * * *
    2. What evidence of CHF do we need?
* * * * *
    b. To establish that you have chronic heart failure, we require 
that your medical history and physical examination describe 
characteristic symptoms and signs of pulmonary or systemic 
congestion or of limited cardiac output associated with abnormal 
findings on appropriate medically acceptable imaging. When a 
remediable factor, such as arrhythmia, triggers an acute episode of 
heart failure, you may experience restored cardiac function, and a 
chronic impairment may not be present.
* * * * *
    (ii) During infancy, other manifestations of chronic heart 
failure may include repeated lower respiratory tract infections.
* * * * *
    3. How do we evaluate growth failure due to CHF?
    a. To evaluate growth failure due to CHF, we require 
documentation of the clinical findings of CHF described in 104.00C2 
and the growth measurements in 104.02C within the same consecutive 
12-month period. The dates of clinical findings may be different 
from the dates of growth measurements.
    b. Under 104.02C, we use the appropriate table(s) under 105.08B 
in the digestive system to determine whether a child's growth is 
less than the third percentile.
    (i) For children from birth to attainment of age 2, we use the 
weight-for-length table corresponding to the child's gender (Table I 
or Table II).
    (ii) For children age 2 to attainment of age 18, we use the body 
mass index (BMI)-for-age table corresponding to the child's gender 
(Table III or Table IV).
    (iii) BMI is the ratio of a child's weight to the square of his 
or her height. We calculate BMI using the formulas in 105.00G2c.
* * * * *

104.02 * * *

* * * * *
    C. Growth failure as required in 1 or 2:
    1. For children from birth to attainment of age 2, three weight-
for-length measurements that are:
    a. Within a consecutive 12-month period; and
    b. At least 60 days apart; and
    c. Less than the third percentile on the appropriate weight-for-
length table under 105.08B1; or
    2. For children age 2 to attainment of age 18, three BMI-for-age 
measurements that are:
    a. Within a consecutive 12-month period; and
    b. At least 60 days apart; and
    c. Less than the third percentile on the appropriate BMI-for-age 
table under 105.08B2.
* * * * *

105.00 DIGESTIVE SYSTEM

* * * * *
    G. How do we evaluate growth failure due to any digestive 
disorder?
    1. To evaluate growth failure due to any digestive disorder, we 
require documentation of the laboratory findings of chronic 
nutritional deficiency described in 105.08A and the growth 
measurements in 105.08B within the same consecutive 12-month period. 
The dates of laboratory findings may be different from the dates of 
growth measurements.
    2. Under 105.08B, we evaluate a child's growth failure by using 
the appropriate table for age and gender.
    a. For children from birth to attainment of age 2, we use the 
weight-for-length table (see Table I or Table II).
    b. For children age 2 to attainment of age 18, we use the body 
mass index (BMI)-for-age table (see Tables III or IV).
    c. BMI is the ratio of a child's weight to the square of the 
child's height. We calculate BMI using one of the following 
formulas:

English Formula
    BMI = [Weight in Pounds/(Height in Inches x Height in Inches)] x 
703
Metric Formulas
    BMI = Weight in Kilograms/(Height in Meters x Height in Meters)
    BMI = [Weight in Kilograms/(Height in Centimeters x Height in 
Centimeters)] x 10,000
* * * * *
    105.08 Growth failure due to any digestive disorder (see 
105.00G), documented by A and B:
    A. Chronic nutritional deficiency present on at least two 
evaluations at least 60 days apart within a consecutive 12-month 
period documented by one of the following:
    1. Anemia with hemoglobin less than 10.0 g/dL; or
    2. Serum albumin of 3.0 g/dL or less;

AND

    B. Growth failure as required in 1 or 2:
    1. For children from birth to attainment of age 2, three weight-
for-length measurements that are:
    a. Within a 12-month period; and
    b. At least 60 days apart; and
    c. Less than the third percentile on Table I or Table II; or

                                                       Table I--Males Birth to Attainment of Age 2
                                                     [Third Percentile Values for Weight-for-Length]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                     Weight            Length            Weight            Length            Weight
                     Length (centimeters)                          (kilograms)      (centimeters)      (kilograms)      (centimeters)      (kilograms)
--------------------------------------------------------------------------------------------------------------------------------------------------------
45.0..........................................................             1.597              64.5             6.132              84.5            10.301
45.5..........................................................             1.703              65.5             6.359              85.5            10.499
46.5..........................................................             1.919              66.5             6.584              86.5            10.696
47.5..........................................................             2.139              67.5             6.807              87.5            10.895
48.5..........................................................             2.364              68.5             7.027              88.5            11.095
49.5..........................................................             2.592              69.5             7.245              89.5            11.296
50.5..........................................................             2.824              70.5             7.461              90.5            11.498
51.5..........................................................             3.058              71.5             7.674              91.5            11.703
52.5..........................................................             3.294              72.5             7.885              92.5            11.910
53.5..........................................................             3.532              73.5             8.094              93.5            12.119
54.5..........................................................             3.771              74.5             8.301              94.5            12.331
55.5..........................................................             4.010              75.5             8.507              95.5            12.546
56.5..........................................................             4.250              76.5             8.710              96.5            12.764
57.5..........................................................             4.489              77.5             8.913              97.5            12.987
58.5..........................................................             4.728              78.5             9.113              98.5            13.213
59.5..........................................................             4.966              79.5             9.313              99.5            13.443
60.5..........................................................             5.203              80.5             9.512             100.5            13.678
61.5..........................................................             5.438              81.5             9.710             101.5            13.918
62.5..........................................................             5.671              82.5             9.907             102.5            14.163
63.5..........................................................             5.903              83.5            10.104             103.5            14.413
--------------------------------------------------------------------------------------------------------------------------------------------------------


[[Page 19528]]


                                                     Table II--Females Birth to Attainment of Age 2
                                                     [Third Percentile Values for Weight-for-Length]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                     Weight            Length            Weight            Length            Weight
                     Length (centimeters)                          (kilograms)      (centimeters)      (kilograms)      (centimeters)      (kilograms)
--------------------------------------------------------------------------------------------------------------------------------------------------------
45.0..........................................................             1.613              64.5             5.985              84.5            10.071
45.5..........................................................             1.724              65.5             6.200              85.5            10.270
46.5..........................................................             1.946              66.5             6.413              86.5            10.469
47.5..........................................................             2.171              67.5             6.625              87.5            10.670
48.5..........................................................             2.397              68.5             6.836              88.5            10.871
49.5..........................................................             2.624              69.5             7.046              89.5            11.074
50.5..........................................................             2.852              70.5             7.254              90.5            11.278
51.5..........................................................             3.081              71.5             7.461              91.5            11.484
52.5..........................................................             3.310              72.5             7.667              92.5            11.691
53.5..........................................................             3.538              73.5             7.871              93.5            11.901
54.5..........................................................             3.767              74.5             8.075              94.5            12.112
55.5..........................................................             3.994              75.5             8.277              95.5            12.326
56.5..........................................................             4.220              76.5             8.479              96.5            12.541
57.5..........................................................             4.445              77.5             8.679              97.5            12.760
58.5..........................................................             4.892              78.5             8.879              98.5            12.981
59.5..........................................................             5.113              79.5             9.078              99.5            13.205
60.5..........................................................             5.333              80.5             9.277             100.5            13.431
61.5..........................................................             5.552              81.5             9.476             101.5            13.661
62.5..........................................................             5.769              82.5             9.674             102.5            13.895
63.5..........................................................             5.769              83.5             9.872             103.5            14.132
--------------------------------------------------------------------------------------------------------------------------------------------------------

    2. For children age 2 to attainment of age 18, three BMI-for-age 
measurements that are:
    a. Within a consecutive 12-month period; and
    b. At least 60 days apart; and
    c. Less than the third percentile on Table III or Table IV.

                                 Table III--Males Age 2 to Attainment of Age 18
                                    [Third Percentile Values for BMI-for-Age]
----------------------------------------------------------------------------------------------------------------
                                            Age (yrs. and                       Age (yrs. and
  Age (yrs. and mos.)          BMI              mos.)              BMI              mos.)              BMI
----------------------------------------------------------------------------------------------------------------
2.0 to 2.1............              14.5     10.11 to 11.2              14.3     14.9 to 14.10              16.1
2.2 to 2.4............              14.4      11.3 to 11.5              14.4     14.11 to 15.0              16.2
2.5 to 2.7............              14.3      11.6 to 11.8              14.5      15.1 to 15.3              16.3
2.8 to 2.11...........              14.2     11.9 to 11.11              14.6      15.4 to 15.5              16.4
3.0 to 3.2............              14.1      12.0 to 12.1              14.7      15.6 to 15.7              16.5
3.3 to 3.6............              14.0      12.2 to 12.4              14.8      15.8 to 15.9              16.6
3.7 to 3.11...........              13.9      12.5 to 12.7              14.9    15.10 to 15.11              16.7
4.0 to 4.5............              13.8      12.8 to 12.9              15.0      16.0 to 16.1              16.8
4.6 to 5.0............              13.7     12.10 to 13.0              15.1      16.2 to 16.3              16.9
5.1 to 6.0............              13.6      13.1 to 13.2              15.2      16.4 to 16.5              17.0
6.1 to 7.6............              13.5      13.3 to 13.4              15.3      16.6 to 16.8              17.1
7.7 to 8.6............              13.6      13.5 to 13.7              15.4     16.9 to 16.10              17.2
8.7 to 9.1............              13.7      13.8 to 13.9              15.5     16.11 to 17.0              17.3
9.2 to 9.6............              13.8    13.10 to 13.11              15.6      17.1 to 17.2              17.4
9.7 to 9.11...........              13.9      14.0 to 14.1              15.7      17.3 to 17.5              17.5
10.0 to 10.3..........              14.0      14.2 to 14.4              15.8      17.6 to 17.7              17.6
10.4 to 10.7..........              14.1      14.5 to 14.6              15.9      17.8 to 17.9              17.7
10.8 to 10.10.........              14.2      14.7 to 14.8              16.0    17.10 to 17.11              17.8
----------------------------------------------------------------------------------------------------------------


                                 Table IV--Females Age 2 to Attainment of Age 18
                                    [Third Percentile Values for BMI-for-Age]
----------------------------------------------------------------------------------------------------------------
                                                              Age (yrs. and              Age (yrs. and
               Age (yrs. and mos.)                   BMI          mos.)         BMI          mos.)         BMI
----------------------------------------------------------------------------------------------------------------
2.0 to 2.2.......................................     14.1     10.8 to 10.10     14.0      14.3 to 14.5     15.6
2.3 to 2.6.......................................     14.0     10.11 to 11.2     14.1      14.6 to 14.7     15.7
2.7 to 2.10......................................     13.9      11.3 to 11.5     14.2      14.8 to 14.9     15.8
2.11 to 3.2......................................     13.8      11.6 to 11.7     14.3     14.10 to 15.0     15.9
3.3 to 3.6.......................................     13.7     11.8 to 11.10     14.4      15.1 to 15.2     16.0
3.7 to 3.11......................................     13.6     11.11 to 12.1     14.5      15.3 to 15.5     16.1
4.0 to 4.4.......................................     13.5      12.2 to 12.4     14.6      15.6 to 15.7     16.2
4.5 to 4.11......................................     13.4      12.5 to 12.6     14.7     15.8 to 15.10     16.3
5.0 to 5.9.......................................     13.3      12.7 to 12.9     14.8     15.11 to 16.0     16.4
5.10 to 7.6......................................     13.2    12.10 to 12.11     14.9      16.1 to 16.3     16.5

[[Page 19529]]

 
7.7 to 8.4.......................................     13.3      13.0 to 13.2     15.0      16.4 to 16.6     16.6
8.5 to 8.10......................................     13.4      13.3 to 13.4     15.1      16.7 to 16.9     16.7
8.11 to 9.3......................................     13.5      13.5 to 13.7     15.2     16.10 to 17.0     16.8
9.4 to 9.8.......................................     13.6      13.8 to 13.9     15.3      17.1 to 17.3     16.9
9.9 to 10.0......................................     13.7     13.10 to 14.0     15.4      17.4 to 17.7     17.0
10.1 to 10.4.....................................     13.8      14.1 to 14.2     15.5     17.8 to 17.11     17.1
10.5 to 10.7.....................................     13.9
----------------------------------------------------------------------------------------------------------------

* * * * *

106.00 GENITOURINARY IMPAIRMENTS

* * * * *
    C. What other factors do we consider when we evaluate your 
genitourinary disorder?
* * * * *
    5. Growth failure due to any chronic renal disease.
    a. To evaluate growth failure due to any chronic renal disease, 
we require documentation of the laboratory findings described in 
106.08A and the growth measurements in 106.08B within the same 
consecutive 12-month period. The dates of laboratory findings may be 
different from the dates of growth measurements.
    b. Under 106.08B, we use the appropriate table(s) under 105.08B 
in the digestive system to determine whether a child's growth is 
less than the third percentile.
    (i) For children from birth to attainment of age 2, we use the 
weight-for-length table corresponding to the child's gender (Table I 
or Table II).
    (ii) For children age 2 to attainment of age 18, we use the body 
mass index (BMI)-for-age table corresponding to the child's gender 
(Table III or Table IV).
    (iii) BMI is the ratio of a child's weight to the square of his 
or her height. We calculate BMI using the formulas in 105.00G2c.
* * * * *
    106.08 Growth failure due to any chronic renal disease (see 
106.00C5), with:
    A. Serum creatinine of 2 mg/dL or greater, documented at least 
two times within a consecutive 12-month period with at least 60 days 
between measurements.

AND

    B. Growth failure as required in 1 or 2:
    1. For children from birth to attainment of age 2, three weight-
for-length measurements that are:
    a. Within a consecutive 12-month period; and
    b. At least 60 days apart; and
    c. Less than the third percentile on the appropriate weight-for-
length table under 105.08B1; or
    2. For children age 2 to attainment of age 18, three BMI-for-age 
measurements that are:
    a. Within a consecutive 12-month period; and
    b. At least 60 days apart; and
    c. Less than the third percentile on the appropriate BMI-for-age 
table under 105.08B2.
* * * * *
114.00 IMMUNE SYSTEM DISORDERS
* * * * *
    F. * * *
* * * * *
    4. HIV infection manifestations specific to children.
* * * * *
    d. Growth failure due to HIV immune suppression.
    (i) To evaluate growth failure due to HIV immune suppression, we 
require documentation of the laboratory values described in 114.08H1 
and the growth measurements in 114.08H2 or 114.08H3 within the same 
consecutive 12-month period. The dates of laboratory findings may be 
different from the dates of growth measurements.
    (ii) Under 114.08H2 and 114.08H3, we use the appropriate table 
under 105.08B in the digestive system to determine whether a child's 
growth is less than the third percentile.
    (A) For children from birth to attainment of age 2, we use the 
weight-for-length table corresponding to the child's gender (Table I 
or Table II).
    (B) For children age 2 to attainment of age 18, we use the body 
mass index (BMI)-for-age table corresponding to the child's gender 
(Table III or Table IV).
    (C) BMI is the ratio of a child's weight to the square of his or 
her height. We calculate BMI using the formulas in 105.00G2c.
* * * * *

114.08 * * *

* * * * *
    H. Immune suppression and growth failure (see 114.00F4d) 
documented by 1 and 2, or by 1 and 3.
    1. CD4 measurement:
    a. For children from birth to attainment of age 5, CD4 
percentage of less than 20 percent; or
    b. For children age 5 to attainment of age 18, absolute CD4 
count of less than 200 cells/mm\3\, or CD4 percentage of less than 
14 percent; and
    2. For children from birth to attainment of age 2, three weight-
for-length measurements that are:
    a. Within a consecutive 12-month period; and
    b. At least 60 days apart; and
    c. Less than the third percentile on the appropriate weight-for-
length table under 105.08B1; or
    3. For children age 2 to attainment of age 18, three BMI-for-age 
measurements that are:
    a. Within a consecutive 12-month period; and
    b. At least 60 days apart; and
    c. Less than the third percentile on the appropriate BMI-for-age 
table under 105.08B2.
* * * * *

PART 416--SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND 
DISABLED

Subpart I--[Amended]

0
3. The authority citation for subpart I of part 416 continues to read 
as follows:

    Authority: Secs. 221(m), 702(a)(5), 1611, 1614, 1619, 1631(a), 
(c), (d)(1), and (p), and 1633 of the Social Security Act (42 U.S.C. 
421(m), 902(a)(5), 1382, 1382c, 1382h, 1383(a), (c), (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, and 1382h note).


0
4. Amend Sec.  416.924b by revising paragraph (b) to read as follows:


Sec.  416.924b  Age as a factor of evaluation in the sequential 
evaluation process for children.

* * * * *
    (b) Correcting chronological age of premature infants. We generally 
use chronological age (a child's age based on birth date) when we 
decide whether, or the extent to which, a physical or mental impairment 
or combination of impairments causes functional limitations. However, 
if you were born prematurely, we may consider you younger than your 
chronological age when we evaluate your development. We may use a 
``corrected'' chronological age (CCA); that is, your chronological age 
adjusted by a period of gestational prematurity. We consider an infant 
born at less than 37 weeks' gestation to be born prematurely.
    (1) We compute your CCA by subtracting the number of weeks of 
prematurity (the difference between 40 weeks of full-term gestation and 
the number of actual weeks of gestation) from your chronological age. 
For example, if your chronological age is 20

[[Page 19530]]

weeks but you were born at 32 weeks gestation (8 weeks premature), then 
your CCA is 12 weeks.
    (2) We evaluate developmental delay in a premature child until the 
child's prematurity is no longer a relevant factor, generally no later 
than about chronological age 2.
    (i) If you have not attained age 1 and were born prematurely, we 
will assess your development using your CCA.
    (ii) If you are over age 1 and have a developmental delay, and 
prematurity is still a relevant factor, we will decide whether to 
correct your chronological age. We will base our decision on our 
judgment and all the facts in your case. If we decide to correct your 
chronological age, we may correct it by subtracting the full number of 
weeks of prematurity or a lesser number of weeks. If your developmental 
delay is the result of your medically determinable impairment(s) and is 
not attributable to your prematurity, we will decide not to correct 
your chronological age.
    (3) Notwithstanding the provisions in paragraph (b)(1) of this 
section, we will not compute a CCA if the medical evidence shows that 
your treating source or other medical source has already taken your 
prematurity into consideration in his or her assessment of your 
development. We will not compute a CCA when we find you disabled under 
listing 100.04 of the Listing of Impairments.


Sec.  416.926a  [Amended]

0
5. Amend Sec.  416.926a by removing paragraphs (m)(6) and (m)(7) and 
redesignating paragraph (m)(8) as (m)(6).

0
6. Amend Sec.  416.934 by adding paragraphs (j) and (k) to read as 
follows:


Sec.  416.934  Impairments which may warrant a finding of presumptive 
disability or presumptive blindness.

* * * * *
    (j) Infants weighing less than 1200 grams at birth, until 
attainment of 1 year of age.
    (k) Infants weighing at least 1200 but less than 2000 grams at 
birth, and who are small for gestational age, until attainment of 1 
year of age. (Small for gestational age means a birth weight that is at 
or more than 2 standard deviations below the mean or that is less than 
the third growth percentile for the gestational age of the infant.)

[FR Doc. 2015-08185 Filed 4-10-15; 8:45 am]
BILLING CODE 4191-02-P