[Federal Register Volume 63, Number 196 (Friday, October 9, 1998)]
[Proposed Rules]
[Pages 54417-54422]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-27077]


=======================================================================
-----------------------------------------------------------------------

SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404 and 416

[Regulations Nos. 4 and 16]
RIN 0960-AD91


Federal Old-Age, Survivors and Disability Insurance and 
Supplemental Security Income for the Aged, Blind, and Disabled; Medical 
and Other Evidence of Your Impairment(s) and Definition of Medical 
Consultant

AGENCY: Social Security Administration.

ACTION: Proposed rules.

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

SUMMARY: We propose to revise the Social Security and supplemental 
security income (SSI) disability regulations regarding sources of 
evidence for establishing the existence of a medically determinable 
impairment under title II and title XVI of the Social Security Act (the 
Act). We are doing this to clarify and expand the list of acceptable 
medical sources and to revise the definition of the term ``medical 
consultant'' to include additional acceptable medical sources.

DATES: To be sure that your comments are considered, we must receive 
them no later than December 8, 1998.

ADDRESSES: Comments should be submitted in writing to the Commissioner 
of Social Security, P. O. Box 1585, Baltimore, MD 21235, sent by 
telefax to (410) 966-2830, sent by E-Mail to ``[email protected],'' 
or delivered to the Office of Process and Innovation Management, Social 
Security Administration, 2109 West Low Rise Building, 6401 Security 
Boulevard, Baltimore, MD 21235, between 8:00 a.m. and 4:30 p.m. on 
regular business days. Comments may be inspected during these same 
hours by making arrangements with the contact person shown below.

FOR FURTHER INFORMATION CONTACT: Robert J. Augustine, Legal Assistant, 
Social Security Administration, 6401 Security Boulevard, Baltimore, MD 
21235, (410) 966-5121. For information on eligibility or filing for 
benefits, call our national toll-free number, 1-800-772-1213.

SUPPLEMENTARY INFORMATION: The Act provides, in title II, for the 
payment of disability benefits to persons insured under the Act. Title 
II also provides,

[[Page 54418]]

under certain circumstances, for the payment of 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 persons. In addition, the Act provides, in title XVI, for 
SSI payments to persons who are aged, blind, or disabled and who have 
limited income and resources.
    For adults under both the title II and title XVI programs 
(including persons claiming child's insurance benefits based on 
disability under title II), ``disability'' means the inability to 
engage in any substantial gainful activity. For an individual under age 
18 claiming SSI benefits based on disability, ``disability'' means that 
an impairment(s) causes ``marked and severe functional limitations.'' 
Under both title II and title XVI, disability must be the result of a 
medically determinable physical or mental impairment or combination of 
impairments 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.
    The Act also provides that an individual shall not be considered to 
be under a disability unless he or she furnishes such medical and other 
evidence of the existence of such impairment(s) as the Commissioner may 
require.

Explanation of Proposed Revisions

    Sections 404.1513 and 416.913 state that we need reports about the 
individual's impairments from acceptable medical sources; they also 
provide a list of acceptable medical sources. Acceptable medical 
sources have the training and expertise to provide us with the signs 
and laboratory findings based on medically acceptable clinical and 
laboratory diagnostic techniques that establish the existence of a 
medically determinable physical or mental impairment.
    We propose to amend Secs. 404.1513 and 416.913 by revising the list 
of acceptable medical sources and making other changes to these 
sections, as follows.

Sections 404.1513 and 416.913  Medical Evidence of your Impairment.

    We propose to revise the heading to ``Medical and other evidence of 
your impairment(s)'' to more accurately identify the subject of these 
sections, which describe how we use evidence from acceptable medical 
sources and other sources, such as nurse-practitioners, chiropractors, 
school teachers, and social workers. Sections 223(d)(3) and 
1614(a)(3)(D) of the Act require that an individual have a medically 
determinable physical or mental impairment that results from 
anatomical, physiological, or psychological abnormalities which are 
demonstrable by medically acceptable clinical and laboratory diagnostic 
techniques. To establish the existence of a medically determinable 
impairment, we require evidence from acceptable medical sources. As 
indicated in current paragraph (e), we use evidence from other sources 
to help us understand how an adult's impairment(s) affects the ability 
to work and how a child's impairment(s) affects the ability to 
function.
    We propose to revise the heading of, and language in, paragraph (a) 
of these sections to make it clear that we need evidence from 
acceptable medical sources to establish the existence of a medically 
determinable impairment, and that those sources identified in proposed 
paragraphs (a)(1) through (a)(5) are the sources who can provide us 
with this evidence. We propose to add a cross-reference to 
Sec. 404.1508 in Sec. 404.1513(a) and a cross-reference to Sec. 416.908 
in Sec. 416.913(a) because Secs. 404.1508 and 416.908 describe the type 
of medical evidence required to establish the existence of a medically 
determinable impairment.
    We propose to revise paragraph (a)(1) by combining it with current 
paragraph (a)(2) because osteopaths are physicians, and their degree 
may be either Doctor of Medicine or Doctor of Osteopathy, depending on 
the school that conferred the degree. Thus, a licensed physician may be 
either a medical or an osteopathic doctor.
    We propose to renumber current paragraphs (a)(3) and (a)(4) as new 
paragraphs (a)(2) and (a)(3).
    We propose to revise new paragraph (a)(2) by adding language to our 
rules to reflect our current operating instructions which state that 
licensed or certified school psychologists (or licensed or certified 
individuals with other titles who perform the same function as a school 
psychologist in a school setting) are acceptable medical sources for 
purposes of establishing the existence of mental retardation and 
learning disabilities. Prior to adding school psychologists to the list 
of acceptable medical sources in our operating instructions for 
purposes of establishing the existence of mental retardation and 
learning disabilities, we conducted a State-by-State analysis of the 
educational qualifications and other requirements for their licensure 
or certification, and we had discussions with representatives of the 
National Association of School Psychologists on the issue of what 
school psychologists are uniformly qualified to do nationwide. Although 
the term ``licensed or certified psychologists'' encompasses school 
psychologists, we found that there is a lack of national uniformity 
among the States as to what school psychologists are allowed to do 
beyond the areas of mental retardation and learning disabilities. We 
determined, however, that licensed or certified school psychologists 
(or licensed or certified individuals with other titles who perform the 
same functions as a school psychologist in a school setting) are able 
to provide us with a complete medical report of manifestations related 
to mental retardation or learning disabilities. Therefore, we concluded 
that all individuals who are licensed or certified by their States (or 
approved in Michigan, which is equivalent to licensure or certification 
in other States) as school psychologists are medical sources who can 
establish the existence of mental retardation and learning 
disabilities.
    We propose to create a new paragraph (a)(4), which would include as 
acceptable medical sources licensed podiatrists for impairments of the 
foot, or foot and ankle (depending on the delineation in the State 
licensure). These sources are currently included in our operating 
instructions as acceptable medical sources for purposes of establishing 
the existence of a medically determinable impairment of the foot, or 
foot and ankle, because they are licensed to practice medicine and 
perform surgery on a specific part of the body. They can do everything 
that a physician is licensed to do with respect to the foot, or foot 
and ankle, and have equal standing to physicians in this respect; 
therefore, we are adding them to the list of acceptable medical sources 
in our regulations as sources who can establish the existence of a 
medically determinable impairment of the foot, or foot and ankle. New 
paragraph (a)(4) would provide that whether evidence from a podiatrist 
can be used to establish the existence of a medically determinable 
impairment of the foot only, or the foot and ankle, depends on the 
scope of practice of podiatry in a State; i.e., whether the State in 
which the podiatrist practices permits the practice of podiatry on the 
foot only, or on the foot and ankle. Medical reports from podiatrists 
can provide us with all the evidence we require to establish the 
existence of a medically determinable impairment of the foot, or foot 
and ankle.
    We propose to delete current paragraph (a)(5) because, regardless 
of

[[Page 54419]]

who is authorized to send us a medical report, the evidence itself must 
be provided by an acceptable medical source identified in proposed 
paragraphs (a)(1) through (a)(5). Similarly, we propose to delete 
current paragraph (a)(6) (which appears only in Sec. 416.913) because 
it does not matter whether the evaluation by an acceptable medical 
source identified in proposed paragraphs (a)(1) through (a)(5) is 
included in an interdisciplinary team report or is contained in a 
separate report.
    We propose to add a new paragraph (a)(5) to include qualified 
speech-language pathologists as acceptable medical sources who can 
establish the existence of a speech or language impairment. These 
sources are currently included in our operating instructions as medical 
sources who can establish the existence of a medically determinable 
speech or language impairment in title XVI childhood disability cases 
in which the individual is found to be disabled. Prior to adding 
qualified speech-language pathologists to the list of acceptable 
medical sources in our operating instructions, we conducted a State-by-
State analysis of the educational qualifications and other requirements 
for licensure or certification of speech-language pathologists, and we 
had discussions with representatives of the American Speech-Language-
Hearing Association on the issue of what nationwide qualification 
requirements there are for speech-language pathologists. We determined 
that the evaluation report of a qualified speech-language pathologist 
can provide us with the detailed evidence we require about a person's 
communicative ability that enables us to determine the existence of a 
medically determinable speech or language impairment. Under proposed 
paragraph (a)(5), ``qualified speech-language pathologists'' must be 
fully certified by their State's education agency, or licensed by their 
State's professional licensing board, or hold a Certificate of Clinical 
Competence from the American Speech-Language-Hearing Association.
    We propose to switch the text of current paragraph (d) with the 
text of current paragraph (e). We believe that the transposition makes 
it clearer that, when we decide whether the evidence is complete enough 
for a determination, we look at the completeness of the medical 
evidence from acceptable medical sources identified in paragraph (a) 
and at any evidence that may have been provided by other sources, such 
as those identified in new paragraph (d). Thus, the proposal would make 
it clearer that we consider all of the relevant evidence we receive 
from acceptable medical sources and other sources when we make a 
determination about whether the individual is disabled or blind.
    We propose to revise the language in new paragraph (d) (current 
paragraph (e)) by making technical changes for clarity and consistency. 
We also propose to reorganize and renumber the subparagraphs in new 
paragraph (d). We propose to delete the words ``Information from'' in 
the heading of new paragraph (d). We propose to change the first 
sentence of Sec. 404.1513(d) to read: ``In addition to evidence from 
the acceptable medical sources listed in paragraph (a) of this section, 
we may also use evidence from other sources to show the severity of 
your impairment(s) and how it affects your ability to work.'' We 
propose to change the first sentence of Sec. 416.913(d) to read: ``In 
addition to evidence from the acceptable medical sources listed in 
paragraph (a) of this section, we may also use evidence from other 
sources to show the severity of your impairment(s) and how it affects 
your ability to work or, if you are a child, your functioning.'' We 
propose to add a reference to the severity of the individual's 
impairment(s) because we may use evidence from other sources to show 
impairment severity, as well as how it affects the ability to work or, 
in Sec. 416.913(d), a child's functioning. We propose to clarify new 
paragraph (d)(1) by adding ``Medical sources not listed in paragraph 
(a) of this section.'' We propose to add the word ``personnel'' in new 
paragraph (d)(3) because when we refer to ``sources'' we mean people, 
not entities. We propose to begin new paragraph (d)(4) with ``Other 
non-medical sources,'' instead of ``Observations by,'' to make the 
construction of new paragraph (d)(4) parallel to that of new paragraphs 
(d)(1) through (d)(3).
    We have added the phrase ``but are not limited to'' in the second 
sentence of new paragraph (d) of Sec. 404.1513 to clarify that the list 
of other sources is not an exclusive list and to make it consistent 
with the language in current paragraph (e) of Sec. 416.913. We have 
included in paragraph (d)(1) some of the examples of other medical 
sources contained in current paragraphs (e)(3) and (4) of Sec. 416.913. 
We propose to add new paragraph (d)(2) to reflect the provisions of 
current paragraph (e)(5) of Sec. 416.913. We also propose to add the 
language ``(for example, spouses, parents and other caregivers, 
siblings, other relatives, friends, neighbors, and clergy)'' to new 
paragraph (d)(4) to make it consistent with the language in current 
paragraph (e)(2) of Sec. 416.913.
    In new paragraph (d) of Sec. 416.913, we would change the language 
``or, if you are a child, your ability to function independently, 
appropriately, and effectively in an age-appropriate manner'' to ``or, 
if you are a child, your functioning'' because section 1614(a)(3) of 
the Act was amended by Public Law 104-193 on August 22, 1996, which 
added a new paragraph (C) that changed the definition of disability for 
individuals under age 18 claiming SSI benefits. We propose to delete 
the words ``may'' and ``and'' in the second sentence of new paragraph 
(d), and insert the word ``but'' after the phrase ``Other sources 
include'' to make it clear that this list is not exclusive. We propose 
to add ``audiologists'' to new paragraph (d)(1) to make it consistent 
with current paragraph (e)(3) and new paragraph (d)(1) of 
Sec. 404.1513. We would shorten paragraph (d) by consolidating current 
paragraphs (e)(3) and (4) in new paragraph (d)(1) and limiting the 
example of therapists to physical therapists. We propose to delete 
``speech and language therapists'' from the examples in new paragraph 
(d)(1) because we are proposing to include speech-language 
pathologists, which is a more accurate title for these health care 
professionals, in new paragraph (a)(5).
    We propose to delete the word ``medical'' and the phrase 
``including the clinical and laboratory findings'' and add the phrase 
``in your case record'' after the word ``evidence'' in the first 
sentence of new paragraph (e) (current paragraph (d)) of Secs. 404.1513 
and 416.913. We want to make it clear that we do not look only at 
medical evidence from the acceptable medical sources identified in 
paragraph (a), but also at any evidence that might have been provided 
by other sources, as described in new paragraph (d), when we make a 
determination about whether the individual is disabled or blind. Also, 
it is the evidence in the case record, not necessarily each piece of 
evidence, that must be complete and detailed enough to allow us to make 
a determination about whether the individual is disabled or blind. We 
propose to revise new paragraph (e)(1) by deleting the term ``limiting 
effects'' and substituting in its place the word ``severity,'' which 
more accurately conveys the statutory requirement that an individual 
must have a severe impairment to be found disabled. We propose to 
revise the language in new paragraph (e)(2) to more accurately refer to 
whether the duration requirement is met, because the issue of duration 
of the individual's

[[Page 54420]]

impairment(s) may pertain to a period in the past, rather than to a 
period in the future. We propose to revise new paragraph (e)(3) by 
qualifying the language about residual functional capacity because the 
combined evidence must be complete and detailed enough to allow us to 
determine the individual's residual functional capacity only when the 
evaluation steps described in Secs. 404.1520(e) or (f)(1) and 
416.920(e) or (f)(1) apply. We also propose to add the phrase ``or, if 
you are a child, your functioning'' to Sec. 416.913(e)(3) because 
ability to function is the relevant issue that we must determine for a 
child, not residual functional capacity.

Other Changes

Sections 404.1503 and 416.903  Who Makes Disability and Blindness 
Determinations

    We propose to remove the last sentence in paragraph (e) because, 
presently, in cases involving a combination of mental and nonmental 
impairments, the appropriate consultant determines impairment severity 
in his or her area of expertise, and this is reflected in determining 
the overall impact of the combination of impairments on the 
individual's ability to work.

Sections 404.1512 and 416.912  Evidence of Your Impairment

    We propose to change the cross-reference in paragraph (b)(4) from 
paragraph (e) to paragraph (d) because current paragraph (e) would be 
new paragraph (d).

Section 404.1526  Medical Equivalence; Section 416.926  Medical 
Equivalence for Adults and Children; Sections 404.1616 and 416.1016  
Medical or Psychological Consultant

    We propose to revise the second sentence in paragraph (c) of 
Secs. 404.1526 and 416.926 and the first sentence in Secs. 404.1616 and 
416.1016 to indicate that a medical consultant must be an acceptable 
medical source identified in Secs. 404.1513(a)(1) or (a)(3) through 
(a)(5) and 416.913(a)(1) or (a)(3) through (a)(5). We believe the 
acceptable medical sources identified in these sections, in addition to 
physicians, are fully qualified to serve as medical consultants within 
their areas of expertise.

Electronic Versions

    The electronic file of this document is available on the Federal 
Bulletin Board (FBB) at 9:00 a.m. on the date of publication in the 
Federal Register. To download the file, modem dial (202) 512-1387. The 
FBB instructions will explain how to download the file and the fee. 
This file is in WordPerfect and will remain on the FBB during the 
comment period.

Regulatory Procedures

Executive Order 12866

    We have consulted with the Office of Management and Budget (OMB) 
and determined that these proposed rules do not meet the criteria for a 
significant regulatory action under Executive Order 12866. Therefore, 
they are not subject to OMB review.

Regulatory Flexibility Act

    We certify that these proposed regulations will not have a 
significant economic impact on a substantial number of small entities 
because they affect only individuals. Therefore, a regulatory 
flexibility analysis as provided in the Regulatory Flexibility Act, as 
amended, is not required.

Paperwork Reduction Act

    These proposed regulations impose no additional reporting or 
recordkeeping requirements subject to OMB clearance.

(Catalog of Federal Domestic Assistance Program Nos. 96.001, Social 
Security--Disability Insurance; 96.002, Social Security--Retirement 
Insurance; 96.004, Social Security-Survivors Insurance; 96.006, 
Supplemental Security Income)

List of Subjects

20 CFR Part 404

    Administrative practice and procedure, Blind, Disability benefits, 
Old-Age, Survivors, and Disability insurance, Reporting and 
recordkeeping requirements, Social Security.

20 CFR Part 416

    Administrative practice and procedure, Aged, Blind, Disability 
benefits, Public assistance programs, Supplemental Security Income 
(SSI), Reporting and recordkeeping requirements.

    Dated: September 29, 1998.
Kenneth S. Apfel,
Commissioner of Social Security.

    For the reasons set out in the preamble, we propose to amend 
subparts P and Q of part 404 and subparts I and J of part 416 of 20 CFR 
chapter III as set forth below:

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

Subpart P--[Amended]

    1. The authority citation for subpart P of part 404 continues to 
read as follows:

    Authority: Secs. 202, 205(a), (b), and (d)-(h), 216(i), 221(a) 
and (i), 222(c), 223, 225, and 702(a)(5) of the Social Security Act 
(42 U.S.C. 402, 405(a), (b), and (d)-(h), 416(i), 421(a) and (i), 
422(c), 423, 425, and 902(a)(5)); sec. 211(b), Pub. L. 104-193, 110 
Stat. 2105, 2189.

Sec. 404.1503  [Amended]

    2. Section 404.1503 is amended by removing the last sentence of 
paragraph (e).
    3. Section 404.1512 is amended by revising paragraph (b)(4) to read 
as follows:


Sec. 404.1512  Evidence of your impairment.

* * * * *
    (b) * * *
    (4) Information from other sources, as described in 
Sec. 404.1513(d);
* * * * *
    4. Section 404.1513 is amended by revising the heading and 
paragraphs (a), (d), and (e) to read as follows:


Sec. 404.1513  Medical and other evidence of your impairment(s).

    (a) Sources who can provide evidence to establish an impairment. We 
need evidence from acceptable medical sources to establish whether you 
have a medically determinable impairment(s). See Sec. 404.1508. 
Acceptable medical sources are--
    (1) Licensed physicians (medical or osteopathic doctors);
    (2) Licensed or certified psychologists (including school 
psychologists, or other licensed or certified individuals with other 
titles who perform the same function as a school psychologist in a 
school setting, for purposes of establishing mental retardation and 
learning disabilities only);
    (3) Licensed optometrists, for the measurement of visual acuity and 
visual fields (we may need a report from a physician to determine other 
aspects of eye diseases);
    (4) Licensed podiatrists, for purposes of establishing impairments 
of the foot, or foot and ankle only, depending on whether the State in 
which the podiatrist practices permits the practice of podiatry on the 
foot only, or the foot and ankle only; and
    (5) Qualified speech-language pathologists, for purposes of 
establishing speech or language impairments only. For this source, 
``qualified'' means that the pathologist must be fully certified by the 
State

[[Page 54421]]

education agency in the State in which he or she practices, or be 
licensed by the State professional licensing board, or hold a 
Certificate of Clinical Competence from the American Speech-Language-
Hearing Association.
* * * * *
    (d) Other sources. In addition to evidence from the acceptable 
medical sources listed in paragraph (a) of this section, we may also 
use evidence from other sources to show the severity of your 
impairment(s) and how it affects your ability to work. Other sources 
include, but are not limited to--
    (1) Medical sources not listed in paragraph (a) of this section 
(for example, nurse-practitioners, physicians' assistants, naturopaths, 
chiropractors, audiologists, and physical therapists);
    (2) Educational personnel (for example, school teachers, 
counselors, early intervention team members, developmental center 
workers, and daycare center workers);
    (3) Public and private social welfare agency personnel; and (4) 
Other non-medical sources (for example, spouses, parents and other 
caregivers, siblings, other relatives, friends, neighbors, and clergy).
    (e) Completeness. The evidence in your case record must be complete 
and detailed enough to allow us to make a determination about whether 
you are disabled or blind. It must allow us to determine--
    (1) The nature and severity of your impairment(s) for any period in 
question;
    (2) Whether the duration requirement, as described in 
Sec. 404.1509, is met; and
    (3) Your residual functional capacity to do work-related physical 
and mental activities, when the evaluation steps described in 
Sec. 404.1520(e) or (f)(1) apply.
    5. Section 404.1526 is amended by revising the second sentence of 
paragraph (c) to read as follows:


Sec. 404.1526  Medical equivalence.

* * * * *
    (c) Who is a designated medical or psychological consultant. * * * 
A medical consultant must be an acceptable medical source identified in 
Sec. 404.1513(a)(1) or (a)(3) through (a)(5). * * *

Subpart Q--[Amended]

    6. The authority citation for subpart Q of part 404 continues to 
read as follows:

    Authority: Secs. 205(a), 221, and 702(a)(5) of the Social 
Security Act (42 U.S.C. 405(a), 421, and 902(a)(5)).

    7. Section 404.1616 is amended by revising the first sentence of 
the introductory paragraph to read as follows:


Sec. 404.1616  Medical or psychological consultant.

    A medical consultant must be an acceptable medical source 
identified in Sec. 404.1513(a)(1) or (a)(3) through (a)(5). * * *
* * * * *

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

Subpart I--[Amended]

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

    Authority: Secs. 702(a)(5), 1611, 1614, 1619, 1631(a), (c), and 
(d)(1), and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 
1382, 1382c, 1382h, 1383(a), (c), and (d)(1), and 1383b); secs. 4(c) 
and 5, 6(c)-(e), 14(a) and 15, Pub. L. 98-460, 98 Stat. 1794, 1801, 
1802, and 1808 (42 U.S.C. 421 note, 423 note, 1382h note).


Sec. 416.903  [Amended]

    9. Section 416.903 is amended by removing the last sentence of 
paragraph (e).
    10. Section 416.912 is amended by revising paragraph (b)(4) to read 
as follows:


Sec. 416.912  Evidence of your impairment.

* * * * *
    (b) * * *
    (4) Information from other sources, as described in 
Sec. 416.913(d);
* * * * *
    11. Section 416.913 is amended by revising the heading and 
paragraphs (a), (d), and (e) to read as follows:


Sec. 416.913  Medical and other evidence of your impairment(s).

    (a) Sources who can provide evidence to establish an impairment. We 
need evidence from acceptable medical sources to establish whether you 
have a medically determinable impairment(s). See Sec. 416.908. 
Acceptable medical sources are--
    (1) Licensed physicians (medical or osteopathic doctors);
    (2) Licensed or certified psychologists (including school 
psychologists, or other licensed or certified individuals with other 
titles who perform the same function as a school psychologist in a 
school setting, for purposes of establishing mental retardation and 
learning disabilities only);
    (3) Licensed optometrists, for the measurement of visual acuity and 
visual fields (see paragraph (f) of this section for the evidence 
needed for statutory blindness);
    (4) Licensed podiatrists, for purposes of establishing impairments 
of the foot, or foot and ankle only, depending on whether the State in 
which the podiatrist practices permits the practice of podiatry on the 
foot only, or the foot and ankle; and
    (5) Qualified speech-language pathologists, for purposes of 
establishing speech or language impairments only. For this source, 
``qualified'' means that the pathologist must be fully certified by the 
State education agency in the State in which he or she practices, or be 
licensed by the State professional licensing board, or hold a 
Certificate of Clinical Competence from the American Speech-Language-
Hearing Association.
* * * * *
    (d) Other sources. In addition to evidence from the acceptable 
medical sources listed in paragraph (a) of this section, we may also 
use evidence from other sources to show the severity of your 
impairment(s) and how it affects your ability to work or, if you are a 
child, your functioning. Other sources include, but are not limited 
to--
    (1) Medical sources not listed in paragraph (a) of this section 
(for example, nurse-practitioners, physicians' assistants, naturopaths, 
chiropractors, audiologists, and physical therapists);
    (2) Educational personnel (for example, school teachers, 
counselors, early intervention team members, developmental center 
workers, and daycare center workers);
    (3) Public and private social welfare agency personnel; and
    (4) Other non-medical sources (for example, spouses, parents and 
other caregivers, siblings, other relatives, friends, neighbors, and 
clergy).
    (e) Completeness. The evidence in your case record must be complete 
and detailed enough to allow us to make a determination about whether 
you are disabled or blind. It must allow us to determine--
    (1) The nature and severity of your impairment(s) for any period in 
question;
    (2) Whether the duration requirement, as described in Sec. 416.909, 
is met; and
    (3) Your residual functional capacity to do work-related physical 
and mental activities, when the evaluation steps described in 
Sec. 416.920(e) or (f)(1) apply, or, if you are a child, your 
functioning.
* * * * *
    12. Section 416.926 is amended by revising the second sentence of 
paragraph (c) to read as follows:

[[Page 54422]]

Sec. 416.926  Medical equivalence for adults and children.

* * * * *
    (c) Who is a designated medical or psychological consultant. * * * 
A medical consultant must be an acceptable medical source identified in 
Sec. 416.913(a)(1) or (a)(3) through (a)(5). * * *
* * * * *

Subpart J--[Amended]

    13. The authority citation for subpart J of part 416 continues to 
read as follows:

    Authority: Secs. 702(a)(5), 1614, 1631, and 1633 of the Social 
Security Act (42 U.S.C. 902(a)(5), 1382c, 1383, and 1383b).

    14. Section 416.1016 is amended by revising the first sentence of 
the introductory paragraph to read as follows:


Sec. 416.1016  Medical or psychological consultant.

    A medical consultant must be an acceptable medical source 
identified in Sec. 416.913(a)(1) or (a)(3) through (a)(5). * * *
* * * * *
[FR Doc. 98-27077 Filed 10-8-98; 8:45 am]
BILLING CODE 4190-29-P