[Federal Register Volume 64, Number 196 (Tuesday, October 12, 1999)]
[Proposed Rules]
[Pages 55215-55217]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-26459]
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SOCIAL SECURITY ADMINISTRATION
20 CFR Part 404
[Regulations No. 4]
RIN 0960-AF03
Federal Old-Age, Survivors, and Disability Insurance; Determining
Disability and Blindness; Addition of Medical Criteria for Evaluating
Down Syndrome in Adults
AGENCY: Social Security Administration (SSA).
ACTION: Proposed rule.
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SUMMARY: We are proposing to add a new listing to provide for the
evaluation of Down syndrome for adults. Our current regulations only
include a listing for evaluating Down syndrome in children; we evaluate
claims filed by adults with Down syndrome under other listings. We
believe that establishing a separate listing for this disorder in the
adult listings will acknowledge the lifelong impact and severity of
this disorder, and will simplify our adjudication of claims filed by
adults with Down syndrome.
DATES: To be sure that your comments are considered, we must receive
them no later than December 13, 1999.
ADDRESSES: Comments should be submitted in writing to the Commissioner
of Social Security, PO Box 17703, Baltimore, MD 21235-7703, sent by
telefax to (410) 966-2830, sent by E-mail to regulations@ssa.gov, or
delivered to the Office of Process and Innovation Management, Social
Security Administration, L2109 West Low Rise Building, 6401 Security
Boulevard, Baltimore, MD 21235-6401, between 8 a.m. and 4:30 p.m. on
regular business days. Comments received may be inspected during these
hours by making arrangements with the contact person shown below.
FOR FURTHER INFORMATION CONTACT: Michelle Hungerman, Social Insurance
Specialist, Office of Disability, Social Security Administration, 3-A-9
Operations Building, 6401 Security Boulevard, Baltimore, Maryland,
21235-6401, (410) 965-2289 or TTY (410) 966-5609.
SUPPLEMENTARY INFORMATION:
Background
We pay disability benefits under title II of the Social Security
Act (the Act) to disabled individuals who are insured under the Act. We
also pay child's insurance benefits based on disability and widow's and
widower's insurance benefits for disabled widows, widowers, and
surviving divorced spouses of insured individuals. In addition, we pay
Supplemental Security Income (SSI) payments under title XVI of the Act
to persons who are disabled and who have limited income and resources.
For adults under both the title II and title XVI programs, and for
persons claiming child's insurance benefits based on disability under
title II, ``disability'' means that an impairment(s) results in an
inability to engage in any substantial gainful activity. Disability
must also be the result of medically determinable physical or mental
impairment(s) that can be expected to result in death or that has
lasted or can be expected to last for a continuous period of at least
12 months.
Our longstanding regulations at Secs. 404.1520 and 416.920 provide
for a five-step sequential evaluation process to determine if someone
is disabled. At step 3 of this process, we decide whether an individual
who is not engaging in substantial gainful activity and who has an
impairment(s) that is severe (steps 1 and 2), has an impairment(s) that
meets or is medically equivalent in severity to the criteria of an
impairment in the listings. The listings describe, for each of several
major body systems, impairments that are considered severe enough to
prevent a person from doing any gainful activity. Although the listings
are contained only in part 404, they are incorporated by reference in
the SSI program by Sec. 416.925 of our regulations.
[[Page 55216]]
The listings are divided into part A and part B. The criteria in
part A are applied in evaluating impairments of persons age 18 or over.
The criteria in part B are applied in evaluating impairments of persons
under age 18. (See Secs. 404.1525 and 416.925.)
Explanation of Proposed Regulation
We propose to add a new listing to evaluate claims filed by
individuals age 18 or older who have non-mosaic Down syndrome. Since
1990, we have evaluated claims for individuals under age 18 who have
non-mosaic Down syndrome under listing 110.06, but we do not have a
Down syndrome listing for adults. Instead, we evaluate most of these
claims under listing 12.05-Mental Retardation--which requires
measurement of intellectual functioning. Almost all adults with Down
syndrome also have moderate to severe musculoskeletal abnormalities,
and many have other impairments, including cardiac, gastrointestinal,
oral/facial and skeletal abnormalities. Therefore, we may also evaluate
the physical impairments that such individuals may have under the
appropriate body system listings.
For individuals under age 18, current listing 110.06 represents
what we have known for some time: That when we obtain appropriate
evidence, virtually all individuals who have non-mosaic Down syndrome
will be found disabled under our rules. Therefore, the listing is met
by showing that the individual has Down syndrome (excluding mosaic Down
syndrome) that has been established by clinical findings, including the
characteristic physical features, and laboratory evidence, including
chromosomal analysis.
When listing 110.06 is met, disability is established from birth.
In recognition of the fact that Down syndrome rarely, if ever, improves
to the point that an individual would not meet our definition of
disability, we now propose to simplify our adjudication of cases of all
individuals with non-mosaic Down syndrome by providing a corresponding
listing in part A. For example, the addition of this listing will
simplify the process of performing disability redeterminations at age
18 for individuals who are eligible for SSI as children on the basis of
non-mosaic Down syndrome. Even though it would be the only listing in
section 10.00, we propose to number the new listing as listing 10.06,
to correspond to listing 110.06 in part B.
As in the childhood listing, proposed listing 10.06 would provide
that an individual age 18 or older who has non-mosaic Down syndrome
established by clinical and laboratory findings, including chromosomal
analysis, is disabled. We also propose new sections 10.00A and 10.00B
in the preface to the listing to provide rules for documenting non-
mosaic Down syndrome. The proposed rules are similar to those in the
corresponding sections of part B, 110.00A and 110.00B. Proposed 10.00A
includes a provision similar to one in current 110.00A.2 that an
individual with Down syndrome is considered disabled since birth. We
included this in the proposed rule for adults to establish that the 12-
month duration requirement has been met.
As in part B, we are proposing to exclude mosaic Down syndrome from
the listing. Mosaic Down syndrome is a rare form of the condition that
is manifested in a wide range of impairment severity. The condition can
be profound and disabling, but it can also be so slight as to go
undetected. Therefore, it would not be appropriate to conclude that the
impairment is always disabling. However, we will still find individuals
with mosaic Down syndrome disabled if their impairments meet or are
medically equivalent in severity to the requirements of other listings,
or, if their impairments are severe, at the fifth step of the
sequential evaluation process based on a residual functional capacity
assessment and consideration of their age, education, and work
experience.
Finally, we are proposing a new section 10.00C. This paragraph
provides guidance for evaluating other chromosomal abnormalities.
Other Changes
Section 10.00 of part A of the listings is currently reserved for
future use. We are now proposing to add a new preface (10.00A, 10.00B,
and 10.00C) and new listing 10.06 in this section. For this reason, and
because Down syndrome often has physical as well as mental effects, we
propose the heading ``Multiple body systems'' for this section. We are
also proposing to make minor editorial changes to the introductory text
and table of contents to part A of appendix 1, to reflect the
provisions of the proposed rule.
Clarity of This Proposed Rule
Executive Order 12866 and the President's memorandum of June 1,
1998 (63 FR 31885), require each agency to write all rules in plain
language. In addition to your substantive comments on this proposed
rule, we invite your comments on how to make this proposed rule easier
to understand.
For example:
Have we organized the material to suit your needs?
Are the requirements in the rule clearly stated?
Does the rule contain technical language or jargon that is
not clear?
Would a different format (grouping and order of sections,
use of headings, paragraphing) make the rule easier to understand?
What else could we do to make the rule easier to
understand?
Electronic Versions
The electronic file of this document is available on the internet
at http://www.access.gpo.gov/su__docs/aces/aces140.html>. It is also
available on the internet site for SSA (i.e., ``SSA Online'') at http:/
/www.ssa.gov/.
Regulatory Procedures
Executive Order 12866
We have consulted with the Office of Management and Budget (OMB)
and determined that this proposed rule does not meet the criteria for a
significant regulatory action under Executive Order 12866. Thus, it was
not subject to OMB review.
Regulatory Flexibility Act
We certify that the proposed rule, if promulgated, will not have a
significant economic impact on a substantial number of small entities
because it only affects individuals. Therefore, a regulatory
flexibility analysis as provided in the Regulatory Flexibility Act, as
amended, is not required.
Paperwork Reduction Act
This proposed regulation imposes no reporting/recordkeeping
requirements necessitating clearance by OMB.
(Catalog of Federal Domestic Assistance Program Nos. 96.001, Social
Security-Disability Insurance; 96.002, Social Security-Retirement
Insurance; 96.004, Social Security-Survivors Insurance; 96.006,
Supplemental Security Income)
List of Subjects in 20 CFR Part 404
Administrative practice and procedure, Blind, Disability benefits,
Old-Age, Survivors and Disability Insurance, Reporting and
recordkeeping requirements, Social Security.
Dated: September 14, 1999.
Kenneth S. Apfel,
Commissioner of Social Security.
For the reasons set out in the preamble, we propose to amend part
404, subpart P, of chapter III of title 20 of the Code of Federal
Regulations to read as follow:
[[Page 55217]]
PART 404--FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE
(1950- )
1. The authority citation for subpart P of part 404 continues to
read as follow:
Authority: Secs. 202, 205(a), (b) and (d)-(h), 216(i), 221(a)
and (i), 222(c), 223, 225, and 702(a)(5) of the Social Security Act
(42 U.S.C. 402, 405(a), (b) and (d)-(h), 416(i), 421(a) and (i),
422(c), 423, 425, and 902(a)(5); sec. 211(b), Pub.L. 104-193, 110
Stat. 2105, 2189.
Appendix 1 to Subpart P of Part 404--[Amended]
2. Appendix 1 to subpart P of part 404 is amended as follows:
a. Item 11 of the introductory text before Part A of appendix 1 is
revised.
b. The Table of Contents for part A of appendix 1 is amended by
adding section 10.00.
c. Section 10.00 is added to Part A of appendix 1.
The added and revised text reads as follows:
Appendix 1 to Subpart P of Part 404--Listing of Impairments
* * * * *
11. Multiple Body Systems (10.00 and 110.00): July 2, 2001.
* * * * *
Part A
* * * * *
10.00 Multiple Body Systems
* * * * *
10.00 MULTIPLE BODY SYSTEMS
A. Down syndrome (except for mosaic Down syndrome (see 10.00C))
established by clinical findings, including the characteristic
physical features, and laboratory evidence is considered to meet the
requirement of listing 10.06, commencing at birth.
B. Documentation must include confirmation of a positive
diagnosis by a clinical description of the usual abnormal physical
findings associated with the condition and definitive laboratory
tests, including chromosomal analysis. Medical evidence that is
persuasive that a positive diagnosis has been confirmed by
appropriate laboratory testing, at some time prior to evaluation, is
acceptable in lieu of a copy of the actual laboratory report.
C. Other chromosomal abnormalities, e.g., mosaic Down syndrome,
fragile X syndrome, phenylketonuria, and fetal alcohol syndrome,
produce a pattern of multiple impairments but manifest in a wide
range of impairment severity. Therefore, the effects of these
impairments should be evaluated under the affected body system.
10.01 Category of Impairments, Multiple Body Systems
10.06 Down syndrome (excluding mosaic Down syndrome)
established by clinical and laboratory findings, as described in
10.00B. Consider the individual disabled from birth.
* * * * *
[FR Doc. 99-26459 Filed 10-8-99; 8:45 am]
BILLING CODE 4190-29-P
