[Federal Register Volume 65, Number 106 (Thursday, June 1, 2000)]
[Rules and Regulations]
[Pages 34950-34959]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-13607]


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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: Final rules.

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SUMMARY: We are revising 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: These rules are effective July 3, 2000.

FOR FURTHER INFORMATION CONTACT: Georgia E. Myers, Regulations Officer, 
Social Security Administration, 6401 Security Boulevard, Baltimore, 
Maryland 21235-6401, 1-410-965-3632 or TTY 1-800-966-5609. For 
information about eligibility or filing for benefits, call our national 
toll-free number, 1-800-772-1213 or TTY 1-800-325-0778.

SUPPLEMENTARY INFORMATION: The Act provides, in title II, for the 
payment of disability benefits to persons insured under the Act. Title 
II also provides, 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.'' 
(Our regulations at Sec. 416.902 explain that, ``[m]arked and severe 
functional

[[Page 34951]]

limitations, when used as a phrase, * * * is a level of severity that 
meets or medically or functionally equals the severity of a listing in 
the Listing of Impairments in appendix 1 of subpart P of part 404 * * 
*.'') 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 Revisions

    Sections 404.1513 and 416.913 provide that we need reports about an 
individual's impairments from acceptable medical sources; they also 
provide a list of ``acceptable medical sources.'' Acceptable medical 
sources are individuals who 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 are amending Secs. 404.1513 and 416.913 by revising the list of 
acceptable medical sources and making other changes to these and other 
sections of our regulations as explained below.
    For clarity, we refer to the new rules, as revised in this 
regulatory publication, as ``final'' rules and to the rules that are 
being changed by these final rules as the ``prior'' rules. However, 
these final rules do not go into effect until 30 days after the date of 
this publication. Therefore, the ``prior'' rules will still be in 
effect for another 30 days.

Sections 404.1513 and 416.913  Medical Evidence of Your Impairment

    We are revising the heading to read, ``Medical and other evidence 
of your impairment(s)'' to more accurately identify the subject of 
these sections. Even though these prior sections were called ``Medical 
evidence of your impairment,'' they have always described how we use 
evidence from both acceptable medical sources and other sources, such 
as (but not limited to) 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. However, as indicated 
in both the prior Secs. 404.1513(e) and 416.913(e) and the final 
Secs. 404.1513(d) and 416.913(d), we also may 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 are revising the heading of Secs. 404.1513(a) and 416.913(a) to 
``Sources who can provide evidence to establish an impairment'' and the 
provisions of these paragraphs as well. These revisions make it clear 
that we need evidence from acceptable medical sources to establish the 
existence of a medically determinable impairment. We then continue to 
list the sources that we consider acceptable medical sources in final 
paragraphs (a)(1) through (a)(5). In addition, as described below, we 
are making some revisions to this list of acceptable medical sources. 
We are also adding 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). The regulations to which we are cross-referring, both 
entitled ``What is needed to show an impairment,'' describe the type of 
medical evidence we require to establish the existence of a medically 
determinable impairment.
    We are revising prior paragraph (a)(1) (``Licensed physicians'') by 
combining it with prior paragraph (a)(2) (``Licensed osteopaths'') 
because osteopaths are physicians. Their medical degree is usually 
Doctor of Osteopathy (D.O.), rather than Doctor of Medicine (M.D.). 
Thus, a licensed physician may be either a medical or an osteopathic 
physician. Because of this consolidation of two paragraphs, we are 
renumbering prior paragraphs (a)(3) and (a)(4) as final paragraphs 
(a)(2) and (a)(3).
    We have also added language to final paragraph (a)(2) (prior 
paragraph (a)(3), ``Licensed or certified psychologists'') to provide 
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 establishing the existence of mental retardation, learning 
disabilities, and borderline intellectual functioning. The final 
provision reflects our longstanding operating instructions. It also 
includes an additional change, which did not appear in the proposed 
rules, that we have made in response to public comments.
    Before including school psychologists as 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 
was a lack of national uniformity among the States as to what school 
psychologists are allowed to do beyond assessing cognitive functioning, 
such as in 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 school psychologists in school settings) are able to 
provide us with a complete medical report of manifestations related to 
these kinds of disorders. Therefore, we concluded that all individuals 
who are licensed or certified by their States as school psychologists 
(or approved in Michigan, which is equivalent to licensure or 
certification in other States) are medical sources who can establish 
the existence of mental retardation and learning disabilities. We 
discuss an additional change below in the Public Comments section, 
where we summarize and respond to the public comments we received 
following our publication of these regulatory provisions in the Federal 
Register as proposed rules on October 9, 1998 (63 FR 54417). The 
additional change is that we have concluded that these individuals are 
also acceptable medical sources for the purpose of establishing the 
existence of borderline intellectual functioning.
    We are adding a new paragraph (a)(4) to include licensed 
podiatrists as acceptable medical sources for impairments of the foot, 
or foot and ankle, depending on the delineation in the State licensure. 
We have included these sources in our operating instructions for many 
years 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

[[Page 34952]]

to the foot, or foot and ankle, and have equal standing to physicians 
in this respect. Final paragraph (a)(4) provides that whether evidence 
from a given podiatrist can be used to establish the existence of a 
medically determinable impairment of the foot only, or the foot and 
ankle, will depend 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 are deleting prior paragraph (a)(5), which provided that persons 
authorized to send us a copy or summary of the medical records of a 
hospital or other institution were acceptable medical sources. 
Regardless of who is authorized to send us a medical report, the 
evidence itself must be provided by an acceptable medical source 
identified in final paragraphs (a)(1) through (a)(5). Similarly, we are 
deleting prior paragraph (a)(6) (that appears only in Sec. 416.913), 
which provided that reports of an interdisciplinary team were 
acceptable medical sources as long as they contained the evaluation and 
signature of an acceptable medical source. It does not matter whether 
the evaluation by an acceptable medical source identified in final 
paragraphs (a)(1) through (a)(5) is included in an interdisciplinary 
team report or is contained in a separate report. Because acceptable 
medical sources are individuals, it is redundant and somewhat 
misleading to provide that an interdisciplinary team report containing 
the evaluation and signature of an acceptable medical source is such a 
source.
    We are adding 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. For several years, we 
have included these individuals in our operating instructions as 
medical sources who can provide evidence to establish the existence of 
a medically determinable speech or language impairment in SSI childhood 
disability cases in which the child is found disabled. The final 
regulation now provides that these individuals are acceptable medical 
sources for speech and language impairments regardless of whether the 
determination or decision is favorable to the individual, and is 
applicable to both adults and children and to disability claims under 
both titles of the Act.
    Before including qualified speech-language pathologists 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. We determined that the evaluation report of a qualified 
speech-language pathologist can provide us with the detailed evidence 
we need about a person's communicative ability that enables us to 
determine the existence of a medically determinable speech or language 
impairment.
    Final paragraph (a)(5) provides that ``qualified'' speech-language 
pathologists are individuals who are licensed by the State professional 
licensing agency, or fully certified by their State's education agency, 
or who hold a Certificate of Clinical Competence from the American 
Speech-Language-Hearing Association. We have cited State licensure as 
the first credential for speech-language pathologists to be consistent 
with the paragraphs for physicians and other acceptable medical sources 
in this section, all of which require that the individual be 
``licensed.'' We have cited the State education agency certification as 
an alternative credential because some States do not have licensing 
agencies for speech-language pathologists; thus, the only State 
credential that speech-language pathologists have in such States is 
State education agency certification. To maintain either State 
licensure or State education agency certification, an individual must 
meet certain criteria (e.g., must obtain 20 continuing education units 
in the field over a 2-year period). We have also cited a Certificate of 
Clinical Competence from the American Speech-Language-Hearing 
Association as another acceptable credential because it indicates that 
a speech-language pathologist has met the stringent criteria for 
education, training, examination, and clinical practice set forth by 
the American Speech-Language-Hearing Association.
    Finally, we have made minor editorial revisions to the provisions 
in Secs. 404.1513(a)(1) through (a)(5) and 416.913(a)(1) through 
(a)(5). The revisions, mostly to correct punctuation, are not 
substantive and are not intended to change the meaning of the 
provisions.
    We are redesignating prior Secs. 404.1513(d) and 416.913(d), 
``Completeness,'' as Secs. 404.1513(e) and 416.913(e). We are 
redesignating prior paragraph (e) of those sections, ``Information from 
other sources,'' as paragraph (d). Our intent in switching the 
positions of these two paragraphs is to make it clearer that, when we 
decide whether the evidence in a case is complete enough for a 
determination, we consider all the evidence in the case record, 
including the medical evidence from acceptable medical sources 
identified in paragraph (a), information from the individual, and any 
evidence that may have been provided by other sources, such as those 
identified in final paragraph (d).
    We are also revising the language in final Secs. 404.1513(d) and 
416.913(d) (prior paragraph (e)) by making technical changes for 
clarity and for consistency between these provisions in parts 404 and 
416, which contained some differences in our prior rules. We are also 
reorganizing and renumbering the subparagraphs in final paragraph (d). 
In addition, we are deleting the words ``Information from'' in the 
heading.
    We are revising 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 are also revising 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.'' In both of these sentences, we are adding 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. In final Sec. 416.913(d), we are changing 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,'' in response 
to section 211 of Public Law 104-193 which, on August 22, 1996, added a 
new paragraph 1614(a)(3)(C) to the Act that changed the definition of 
disability for individuals under age 18 claiming SSI benefits.
    We are adding the phrase ``but are not limited to'' to the second 
sentence of final Sec. 404.1513(d) to clarify that the list of other 
sources is not an exclusive list and to make it consistent with the 
language in prior Sec. 416.913(e) (final Sec. 416.913(d)). We also have 
deleted the words ``may'' and ``and'' from the

[[Page 34953]]

second sentence of final Sec. 416.913(d), and inserted the word ``but'' 
after the phrase ``Other sources include'' to make it consistent with 
the second sentence of final Sec. 404.1513(d).
    In making these changes in the two sections, we are consolidating 
the provisions from prior Secs. 416.913(e)(3) and (e)(4) in final 
paragraph (d)(1) and modifying the example of therapists that was in 
the proposed rules so that it is not restricted to just physical 
therapists. The examples in the proposed rules should not have been 
limited to physical therapists because there are other types of 
therapists, such as occupational therapists, as identified in prior 
Sec. 416.913(e)(4), recreational therapists, and kinesiotherapists. We 
are deleting ``speech and language therapists'' from the examples that 
were in prior Sec. 416.913(e)(4) because, as discussed earlier in this 
preamble, we are amending the regulations to include these individuals 
as acceptable medical sources. (However, in final Sec. 404.1513(a)(5) 
and 416.913(a)(5), we use the term ``speech-language pathologists'' 
because it is a more accurate title for these health care 
professionals.)
    We are clarifying in final Secs. 404.1513(d)(1) and 416.913(d)(1), 
the list of individuals, such as nurse-practitioners and audiologists, 
who provide some medical services by adding the phrase, ``Medical 
sources not listed in paragraph (a) of this section.'' We are including 
in Secs. 404.1513(d)(1) and 416.913(d)(1) some of the examples of other 
medical sources that previously were contained only in prior 
Sec. 404.1513(e)(3) or only in prior Sec. 416.913(e)(3) and (e)(4). The 
prior provisions did not provide all the same examples, and the final 
rules are now consistent in parts 404 and 416.
    Final Secs. 404.1513(d)(2) and 416.913(d)(2) reflect provisions 
that were only in prior Sec. 416.913(e)(5).
    We are adding the word ``personnel'' in final Secs. 404.1513(d)(3) 
and 416.913(d)(3). The prior sections (Secs. 404.1513(e)(1) and 
416.913(e)(1)) referred to public and private social welfare 
``agencies.'' However, when we refer to ``sources'' in these rules, we 
mean people, not entities. This change also makes the provision similar 
to other provisions within these sections.
    We begin final Secs. 404.1513(d)(4) and 416.913(d)(4) with the 
phrase, ``Other non-medical sources,'' instead of ``Observations by,'' 
to make the construction of final paragraph (d)(4) parallel to that of 
final paragraphs (d)(1) through (d)(3). We are also adding the language 
``(for example, spouses, parents and other caregivers, siblings, other 
relatives, friends, neighbors, and clergy)'' to final 
Sec. 404.1513(d)(4) to make it consistent with the language in prior 
Sec. 416.913(e)(2) (final Sec. 416.913(d)(4)).
    As is discussed below in the Public Comments section, we revised 
the proposed first sentence of final Secs. 404.1513(e) and 416.913(e) 
(prior paragraph (d)) to read: ``The evidence in your case record, 
including the medical evidence from acceptable medical sources 
(containing the clinical and laboratory findings) and other medical 
sources not listed in paragraph (a), information you give us about your 
medical condition(s) and how it affects you, and other evidence from 
other sources, must be complete and detailed enough to allow us to make 
a determination or decision about whether you are disabled or blind.'' 
In the Notice of Proposed Rulemaking (NPRM), we proposed to simplify 
the sentence by deleting any reference to the medical evidence and 
referring only to ``the evidence'' in a claim. A commenter believed 
that it would be better to retain reference to the medical evidence and 
simply to refer to the types of evidence we obtain. As in the proposed 
rules, the change in the final rules will clarify that we do not look 
only at medical evidence from the acceptable medical sources identified 
in paragraph (a), but also at information provided by the individual 
and any evidence that might have been provided by other sources, as 
described in final paragraph (d), when we make a determination whether 
the individual is disabled or blind.
    We have revised final 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 are revising the language in final paragraph (e)(2) to more 
accurately refer to whether the duration requirement, as described in 
Secs. 404.1509 and 416.909, is met.
    We are revising final 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 are also adding 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 have removed the last sentence in paragraph (e) because it 
addressed only the role in disability determinations of psychological 
consultants, and did not address the parallel situations of speech-
language pathologists and other consultants. We now provide more 
comprehensive rules in revised paragraphs (c) and (f) of Secs. 404.1616 
and 416.1016. We explain that non-physician medical consultants and 
psychological consultants can only evaluate impairments within their 
area of expertise.

Sections 404.1512 and 416.912  Evidence of Your Impairment.

    We are changing the cross-reference in paragraph (b)(4) from 
paragraph (e) to paragraph (d) to reflect the reversal and 
redesignation of these two paragraphs already explained above.

Sections 404.1526 and 416.926  Medical Equivalence

    We are revising the second sentence in paragraph (c) of 
Secs. 404.1526 and 416.926 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.
    As we discuss below in the Public Comments section, we received 
comments indicating that our intent was unclear. Accordingly, we are 
also revising the last sentence of paragraph (c), the parenthetical 
cross-references to Secs. 404.1616 and 416.1016. The additional 
language we have included in final Secs. 404.1616 and 416.1016 
clarifies that medical consultants who are not physicians are limited 
to evaluating impairments within their specialties; for example, a 
speech-language pathologist functioning as a medical consultant would 
be able to provide an opinion about medical equivalence only with 
respect to a speech or language impairment.

Sections 404.1615 and 416.1015  Making Disability Determinations

    We are removing the last sentence in paragraph (d). In the NPRM, we 
inadvertently failed to propose deleting this last sentence, which is 
the exact same provision contained in the last

[[Page 34954]]

sentence we are removing in paragraph (e) of Secs. 404.1503 and 
416.903. Therefore, for the same reasons discussed earlier for the 
deletion in Secs. 404.1503 and 416.903, we are deleting this last 
sentence as well from Secs. 404.1615(d) and 416.1015(d).

Sections 404.1616 and 416.1016  Medical or Psychological Consultants

    In the NPRM, we proposed to revise 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). As we 
discuss below in the Public Comments section, we received a number of 
comments that indicated to us that our intent was unclear or that 
recommended additional rules defining the authority of medical 
consultants who are not physicians. Accordingly, we have extensively 
revised Secs. 404.1616 and 416.1016.
    The final rules now contain six paragraphs, designated (a) through 
(f). Paragraph (a), ``What is a medical consultant?'' explains that a 
``medical consultant'' is a person who is a member of a team that makes 
disability determinations in a State agency, as explained in 
Secs. 404.1615 and 416.1015, or who is a member of a team that makes 
disability determinations for us when we make disability determinations 
ourselves.
    Paragraph (b), ``What qualifications must a medical consultant 
have?'' provides that a medical consultant must be an acceptable 
medical source identified in Secs. 404.1513(a)(1) and (a)(3) through 
(a)(5) and 416.913(a)(1) and (a)(3) through (a)(5) and names all of the 
acceptable medical sources, in addition to cross-referencing these 
provisions as we had done in the NPRM. We believe that this is a 
clearer way to explain who is included. The paragraph also provides 
that the medical consultant must meet any appropriate qualifications 
for his or her specialty as explained in Sec. Sec. 404.1513(a) or 
416.913(a).
    Final paragraph (c) is called, ``Are there any limitations on what 
medical consultants who are not physicians can evaluate?'' In this 
paragraph, we clarify in response to comments what was always our 
intent: that even though any individual who is an acceptable medical 
source may be a medical consultant, medical consultants who are not 
physicians are limited to evaluations to the same extent that they 
would be limited in providing evidence of a medically determinable 
impairment. We provide an example explaining the limitations of a State 
agency medical consultant who, as a team member that makes disability 
determinations, is a speech-language pathologist.
    Paragraph (d) is called, ``What is a psychological consultant?'' It 
explains that a psychological consultant may function in the same 
capacity as any of the individuals in paragraph (a) except that they 
are limited to the evaluation of mental impairments.
    Paragraph (e) incorporates the second and third sentences of the 
opening paragraph of prior Secs. 404.1616 and 416.1016, and paragraphs 
(a), (b), and (c) of those sections. We have incorporated the 
provisions verbatim. The only differences are in the letter and number 
designations of the paragraph and subparagraphs and the new heading we 
added to final paragraph (e) for consistency with the headings of the 
previous paragraphs. The prior provisions did not use headings.
    Paragraph (f) is called, ``Are there any limitations on what a 
psychological consultant can evaluate?'' It parallels paragraph (c) of 
this section, discussed above.

Public Comments

    We published these regulatory provisions in the Federal Register as 
an NPRM on October 9, 1998 (63 FR 54417). The comment period closed on 
December 8, 1998. We received comments in response to this notice from 
12 individuals and organizations, including government agencies whose 
interests and responsibilities require them to have some expertise in 
the evaluation of medical evidence used in making disability 
determinations under titles II and XVI of the Act. We also received 
comments from a private, non-profit organization for the disabled, an 
individual attorney, health care professional organizations, and an 
employee union.
    Most of the commenters stated that they supported the proposed 
rules. However, a number of commenters offered suggestions for 
revisions and additions, as explained below. Three commenters supported 
the rules without making any recommendations. One commenter opposed all 
of the rules. Because some of the comments were similar, we condensed, 
summarized, or paraphrased them. We have, however, tried to summarize 
the commenters' views accurately and to respond to all of the 
significant issues raised by the commenters that are within the scope 
of these rules.
    Comment: Two commenters recommended that we revise paragraph (a)(2) 
of Secs. 404.1513 and 416.913 to include borderline intellectual 
functioning in the list of impairments that can be established by 
evidence from licensed or certified school psychologists.
    Response: We adopted the comments. As one of the commenters noted, 
borderline intellectual functioning is a medically determinable mental 
impairment that results from psychological abnormalities demonstrable 
by medically acceptable clinical and laboratory diagnostic techniques. 
It is usually assigned to individuals who have an intelligence quotient 
(IQ) score in the 71-84 range and for whom the diagnosis of mental 
retardation has been excluded. School psychologists are qualified to 
assess cognitive abilities at all levels, and we agree that they can 
establish the existence of borderline intellectual functioning.
    Comment: One commenter recommended that we expand proposed 
paragraph (a)(5) of Secs. 404.1513 and 416.913 to permit qualified 
speech-language pathologists to establish speech, language, ``or 
related (e.g., swallowing)'' impairments. The commenter also 
recommended that we expand the qualification criterion in the proposed 
rules concerning meeting State education agency standards to say: ``* * 
* provided such standards are consistent with the highest requirements 
for State-approved or State-recognized certification, licensing, 
registration, or other comparable requirements for speech-language 
pathologists.'' The commenter believed that this would make clear that 
the word ``qualified'' refers to individuals who have met the 
requirements in the State, and would ensure that only those individuals 
with sufficient training and clinical expertise are allowed to provide 
evidence used in making a disability determination.
    Response: We are not adopting the recommendation to consider 
speech-language pathologists as acceptable medical sources for 
``related (e.g., swallowing)'' impairments. Because of the complex 
anatomical and physiological construct involved in the swallowing 
mechanism, specific knowledge and training that encompass the medical 
areas of neurology, otolaryngology, and gastroenterology are required 
for the proper interpretation of laboratory and imaging studies 
necessary in arriving at the diagnosis, prognosis, and treatment 
regimen pertaining to the variety of disorders associated with 
swallowing. Therefore, we will continue to require evidence from a 
licensed physician to establish

[[Page 34955]]

the existence of a medically determinable swallowing impairment.
    We are also not adopting the second comment about State education 
agency standards being consistent with the highest State requirements 
because it would not be feasible for us to constantly monitor such 
standards and requirements in each State.
    For reasons already noted above in the summary of the changes in 
these final rules, we have cited State licensure as the first 
credential in the rule.
    Comment: One commenter recommended that we not delete paragraph 
(a)(6) of Sec. 416.913, the paragraph that addresses interdisciplinary 
assessments in which there is a signature from an acceptable medical 
source. The commenter believed that this paragraph helps to avoid 
confusion about the acceptability of evidence that is signed by both a 
medical and a nonmedical source. The commenter also recommended that we 
add the same provision to Sec. 404.1513.
    Response: We did not adopt the comment because the construction of 
paragraph (a)(6) is confusing and not parallel to the construction of 
the other paragraphs in paragraph (a). Paragraph (a) concerns who is an 
acceptable medical source, not what is ``acceptable medical evidence.'' 
Moreover, an acceptable medical source must be a person, not ``[a] 
report'' as stated in paragraph (a)(6). The fact that an 
interdisciplinary team report is co-signed by both a medical and 
nonmedical source does not mean that the report cannot be considered 
``acceptable medical evidence,'' i.e., evidence from an acceptable 
medical source. Provided that the medical source is an acceptable 
medical source identified in final paragraphs (a)(1) through (a)(5) of 
Sec. Sec. 404.1513 and 416.913, it does not matter whether an 
evaluation signed by an acceptable medical source is included in an 
interdisciplinary team report or is contained in a separate report.
    Comment: Three commenters recommended that we include other medical 
professionals in our list of acceptable medical sources. One commenter 
recommended that we include optometrists for the determination of other 
aspects of eye diseases, in addition to the measurement of visual 
acuity and visual fields. Another commenter recommended that we 
recognize audiologists as acceptable medical sources for purposes of 
establishing hearing or related (e.g., balance) impairments only. This 
source recommended criteria for establishing that an audiologist is 
``qualified'' for our program. The third commenter recommended that we 
include pediatric nurse-practitioners for establishing the existence of 
medically determinable impairments in children.
    Response: We did not adopt the comments. 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. In keeping with these statutory provisions, we generally 
consider licensed physicians and licensed or certified psychologists, 
who are the most qualified health care professionals, as ``acceptable 
medical sources'' who can establish the existence of a medically 
determinable impairment. We have also provided in these final rules 
that podiatrists and speech-language pathologists may be acceptable 
medical sources, not only because of their unique qualifications, but 
because we have determined that there is sufficient standardization of 
their qualifications across the States for us to provide rules for 
their general use in claims. We have not determined this for other 
specialties. Therefore, we believe it would be inappropriate to include 
these additional specialties at this time.
    However, we want to make clear that we consider information from 
the sources named in the comments to be important evidence when we 
determine the severity of an individual's impairment. The rules on who 
is an acceptable medical source address a single, narrow issue in our 
disability evaluations: who can provide evidence to establish whether 
an individual has a medically determinable impairment as required by 
the Act. Once an individual has crossed this threshold, we can and do 
consider all evidence that helps us to determine the severity of the 
impairment and its effects on the individual. For this critical aspect 
of the disability determination process, we will continue to use 
information from the sources named in the comments.
    Comment: One commenter disagreed with our inclusion of licensed or 
certified psychologists, school psychologists and speech-language 
pathologists as ``acceptable medical sources'' in our regulations. The 
commenter said that we should clarify that these sources are acceptable 
sources of evidence but that they are not ``medical'' sources. The 
commenter believed that ``medical'' sources should refer only to 
physicians and that Congress did not intend for us to include any of 
the other sources.
    Response: We did not adopt the comment. Sections 223(d)(3) and 
1614(a)(3)(D) of the Act define a medically determinable impairment as 
one that results from ``anatomical, physiological, or psychological 
abnormalities which are demonstrable by medically acceptable clinical 
and laboratory diagnostic techniques.'' As we noted in the preamble to 
the proposed rules, we have included 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) and speech-language pathologists as ``acceptable medical 
sources'' because we have determined that they can provide us with 
medical evidence to establish the existence of a medically determinable 
impairment within their areas of specialty using ``medically acceptable 
clinical and laboratory diagnostic techniques,'' as defined in section 
223(d)(3) of the Act. We have included licensed or certified 
psychologists in our regulations defining acceptable medical sources 
for many years, and, in fact, section 221(h) of the Act refers to these 
sources as qualified to complete the medical portion of our case review 
where there is evidence which indicates the existence of a mental 
impairment.
    Comment: Five of the commenters commented about the provisions in 
Sec. Sec. 404.1526(c), 404.1616, 416.926(c) and 416.1016 of the 
proposed rules that would define the term ``medical consultant'' to 
include any acceptable medical source in Sec. Sec. 404.1513(a)(1) or 
(a)(3) to (a)(5) and 416.913(a)(1) or (a)(3) to (a)(5). One commenter 
simply noted that this would permit licensed optometrists, licensed 
podiatrists, and qualified speech-language pathologists to function as 
``medical consultants,'' but the commenter did not note approval or 
disapproval or make any recommendations. Two commenters indicated that 
such sources would have limited usefulness as medical consultants in 
the State agencies that make disability determinations for us because 
their expertise is so narrow. One of these commenters recommended that 
we should include provisions defining the authority of these 
individuals in Sec. Sec. 404.1526(c) and 416.926(c), our regulations on 
``Who is a designated medical or psychological consultant'' for 
purposes of determining medical equivalence, and in Sec. Sec. 404.1616 
and 416.1016, our regulations defining the standards for

[[Page 34956]]

who can be a medical or psychological consultant.
    Two commenters opposed expanding the definition of medical 
consultant to include optometrists, podiatrists, and speech-language 
pathologists as medical consultants. One commenter believed that there 
was no rational justification in the proposed regulations for the 
``dramatic'' change, and was concerned that the change would jeopardize 
the integrity of the disability programs, especially if it is 
implemented in conjunction with some of the Disability Redesign 
proposals. This commenter, while opposing the use of the sources as 
medical consultants, otherwise generally agreed with our proposal to 
consider these sources to be acceptable medical sources for purposes of 
providing medical evidence we need to establish the existence of a 
medically determinable impairment.
    The last commenter, who opposed using these sources even as 
``acceptable medical sources'' for establishing the existence of 
medically determinable impairments, focused on the proposal as it 
affected Sec. Sec. 404.1526 and 416.926. This commenter indicated that 
the sources were ``nonqualified.'' The commenter provided a number of 
specific reasons that they should not be permitted to make 
determinations of medical equivalence, primarily because they would be 
making decisions regarding areas for which they have no training or 
expertise and for which they are unlicensed under the law of any State. 
The commenter also recommended that we revise the medical equivalence 
regulations to clarify the various ways in which we make findings of 
medical equivalence. The commenter also stated that we should specify 
that all claims of combined mental and physical disorders should be 
reviewed by a psychiatrist to ensure that all aspects of mental and 
physical disorders are considered in rating the severity of impairment 
at any step of our process for determining disability.
    Response: We are revising Sec. Sec. 404.1616 and 416.1016 in 
response to these comments. We are also adding a cross-reference to 
Sec. Sec. 404.1616 and 416.1016 for medical consultants who are not 
physicians at the end of Sec. Sec. 404.1526(c) and 416.926(c) as we 
have noted in the explanation of the changes.
    As two of the commenters recognized, our intent in the NPRM was to 
limit the authority of licensed optometrists, licensed podiatrists, and 
qualified speech-language pathologists to evaluate impairments with 
regard to their areas of expertise delineated in proposed 
Sec. Sec. 404.1513(a) and 416.913(a). However, the comments made us 
realize that our intent was not clear and could be misinterpreted. 
Therefore, we have expanded final Sec. Sec. 404.1616 and 416.1016 to 
provide explicitly that acceptable medical sources other than 
physicians (i.e., licensed optometrists, licensed podiatrists, and 
qualified speech-language pathologists) may function as medical 
consultants, but their authority in helping to make determinations and 
in providing opinions about medical equivalence and elsewhere is 
limited to their area of expertise.
    Although it was unclear from the comment which disability redesign 
proposals one of the commenters referred to, we disagree with that 
comment. We believe that providing State agencies with the opportunity 
to use these additional specialists in a consulting capacity will 
improve their ability to make timely, accurate decisions.
    With regard to the comment asking us to include the various ways we 
make findings of medical equivalence, we believe that the change is 
outside the scope of our authority because we did not propose the 
change. However, we will consider this comment when we propose other 
changes in the future.
    In making the revisions to Sec. Sec. 404.1616 and 416.1016 in 
response to these comments, we added new paragraphs with letter and 
number designations. Therefore, we had to redesignate the paragraph 
letters and numbers from the prior rules that describe qualified 
psychologists. Apart from the change in the designations of the letters 
and numbers of the paragraphs, we did not change the language of those 
paragraphs.
    In response to the last comment, regarding review by a psychiatrist 
of any case involving a combination of mental and physical disorders, 
we are providing in final paragraph (c) of Sec. Sec. 404.1616 and 
416.1016 that a physician must evaluate the case record, except when 
the mental impairment alone would justify a finding of disability. 
However, we do not agree with the commenter that a psychiatrist will be 
the best physician to assess a combination of mental and physical 
disorders in all claims. There are claims in which it is more 
appropriate to use other specialists for the overall review in 
consultation with a psychiatrist or psychologist.
    Comment: One of the foregoing commenters also pointed out that the 
first sentence of prior Sec. Sec. 404.1616 and 416.1016 seemed 
incomplete. The commenter noted that the heading of these regulations 
referred to ``Medical or psychological consultant,'' yet the first 
sentence referred only to medical consultants. The commenter provided a 
recommended revision that would include psychological consultants.
    Response: We adopted the comment, although not in the exact way 
suggested by the commenter. In response to this, and the comments 
already noted, we have revised the entire sections to clarify their 
provisions.
    Comment: One commenter suggested that we revise proposed 
Sec. Sec. 404.1513(e) and 416.913(e) (prior Sec. Sec. 404.1513(d) and 
416.913(d)) to read: ``The medical evidence, including the clinical and 
laboratory find[ing]s, and other evidence from other sources must be 
complete and detailed enough to allow us to make a determination about 
whether you are disabled or blind.'' The commenter believed that it 
would be better to retain reference in our regulations to the medical 
and other evidence we need to establish the existence of a medically 
determinable impairment and its severity.
    Response: We adopted the comment, but did not use the exact 
language proposed by the commenter. We believe that the commenter's 
proposed language could be misinterpreted to mean that each piece of 
evidence must be complete and detailed enough in and of itself for us 
to make the various findings listed in these regulation sections, or 
that we must try to obtain all available evidence, even after the 
record is complete and detailed enough for us to make a determination 
or decision.
    Therefore, the final rule provides: ``The evidence in your case 
record, including the medical evidence from acceptable medical sources 
(containing the clinical and laboratory findings) and other medical 
sources not listed in paragraph (a), information you give us about your 
medical condition(s) and how it affects you, and other evidence from 
other sources, must be complete and detailed enough to allow us to make 
a determination or decision about whether you are disabled or blind.'' 
We changed the phrase near the end to ``make a determination or 
decision'' for technical reasons. Under our regulations 
Sec. Sec. 404.901 and 416.1401, the term ``determination'' means the 
initial or reconsidered determination, and the term ``decision'' means 
the decision made by an administrative law judge or the Appeals 
Council. This is not a substantive change in the rule, only a 
clarification of its meaning to show that it applies to all of our 
adjudicators.

[[Page 34957]]

Regulatory Procedures

Executive Order 12866

    We have consulted with the Office of Management and Budget (OMB) 
and determined that these final rules do not meet the criteria for a 
significant regulatory action under Executive Order (E.O.) 12866. 
Therefore, they were not subject to OMB review. We have also determined 
that these rules meet the plain language requirements of E.O. 12866 and 
the President's memorandum of June 1, 1998.

Regulatory Flexibility Act

    We certify that these final 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 final regulations impose no new 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, Reporting and recordkeeping 
requirements, Supplemental Security Income (SSI).

    Dated: May 22, 2000.
Kenneth S. Apfel,
Commissioner of Social Security.

    For the reasons set out in the preamble, subparts P and Q of part 
404 and subparts I and J of part 416 of 20 CFR chapter III are amended 
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. Included are school 
psychologists, or other licensed or certified individuals with other 
titles who perform the same function as a school psychologist in a 
school setting, for purposes of establishing mental retardation, 
learning disabilities, and borderline intellectual functioning only;
    (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; and
    (5) Qualified speech-language pathologists, for purposes of 
establishing speech or language impairments only. For this source, 
``qualified'' means that the speech-language pathologist must be 
licensed by the State professional licensing agency, or be fully 
certified by the State education agency in the State in which he or she 
practices, 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 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, including the 
medical evidence from acceptable medical sources (containing the 
clinical and laboratory findings) and other medical sources not listed 
in paragraph (a) of this section, information you give us about your 
medical condition(s) and how it affects you, and other evidence from 
other sources, must be complete and detailed enough to allow us to make 
a determination or decision 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 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 and fourth 
sentences 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). * * * (See Sec. 404.1616 
for limitations on what medical consultants who are not physicians can 
evaluate and the qualifications we consider necessary for a 
psychologist to be a consultant.)

[[Page 34958]]

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)).


Sec. 404.1615  [Amended]

    7. Section 404.1615 is amended by removing the last sentence of 
paragraph (d).

    8. Section 404.1616 is revised to read as follows:


Sec. 404.1616  Medical or psychological consultants.

    (a) What is a medical consultant? A medical consultant is a person 
who is a member of a team that makes disability determinations in a 
State agency, as explained in Sec. 404.1615, or who is a member of a 
team that makes disability determinations for us when we make 
disability determinations ourselves.
    (b) What qualifications must a medical consultant have? A medical 
consultant must be an acceptable medical source identified in 
Sec. 404.1513(a)(1) or (a)(3) through (a)(5); that is, a licensed 
physician (medical or osteopathic), a licensed optometrist, a licensed 
podiatrist, or a qualified speech-language pathologist. The medical 
consultant must meet any appropriate qualifications for his or her 
specialty as explained in Sec. 404.1513(a).
    (c) Are there any limitations on what medical consultants who are 
not physicians can evaluate? Medical consultants who are not physicians 
are limited to evaluating the impairments for which they are qualified, 
as described in Sec. 404.1513(a). Medical consultants who are not 
physicians also are limited as to when they may serve as a member of a 
team that makes a disability determination. For example, a speech-
language pathologist who is a medical consultant in a State agency may 
be a member of a team that makes a disability determination in a claim 
only if a speech or language impairment is the only impairment in the 
claim or if there is a combination of a speech or language impairment 
with another impairment but the speech or language impairment alone 
would justify a finding of disability. In all other cases, a physician 
will be a member of the team that makes a disability determination, 
except in cases in which this function may be performed by a 
psychological consultant as discussed in paragraph (f) of this section 
and Sec. 404.1615(d).
    (d) What is a psychological consultant? A psychological consultant 
is a psychologist who has the same responsibilities as a medical 
consultant explained in paragraph (a) of this section, but who can 
evaluate only mental impairments.
    (e) What qualifications must a psychological consultant have? A 
psychological consultant used in cases where there is evidence of a 
mental impairment must be a qualified psychologist. For disability 
program purposes, a psychologist will not be considered qualified 
unless he or she:
    (1) Is licensed or certified as a psychologist at the independent 
practice level of psychology by the State in which he or she practices; 
and
    (2)(i) Possesses a doctorate degree in psychology from a program in 
clinical psychology of an educational institution accredited by an 
organization recognized by the Council on Post-Secondary Accreditation; 
or
    (ii) Is listed in a national register of health service providers 
in psychology which the Commissioner of Social Security deems 
appropriate; and
    (3) Possesses 2 years of supervised clinical experience as a 
psychologist in health service, at least 1 year of which is post 
masters degree.
    (f) Are there any limitations on what a psychological consultant 
can evaluate? Psychological consultants are limited to the evaluation 
of mental impairments, as explained in Sec. 404.1615(d). Psychological 
consultants also are limited as to when they can serve as a member of a 
team that makes a disability determination. They may do so only when a 
mental impairment is the only impairment in the claim or when there is 
a combination of a mental impairment with another impairment but the 
mental impairment alone would justify a finding of disability.

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

Subpart I--[Amended]

    9. 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]

    10. Section 416.903 is amended by removing the last sentence of 
paragraph (e).

    11. 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);
* * * * *

    12. 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. Included are school 
psychologists, or other licensed or certified individuals with other 
titles who perform the same function as a school psychologist in a 
school setting, for purposes of establishing mental retardation, 
learning disabilities, and borderline intellectual functioning only;
    (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 speech-language pathologist must be 
licensed by the State professional licensing agency, or be fully 
certified by the State education agency in the State in which he or she 
practices, 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,

[[Page 34959]]

physicians' assistants, naturopaths, chiropractors, audiologists, and 
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, including the 
medical evidence from acceptable medical sources (containing the 
clinical and laboratory findings) and other medical sources not listed 
in paragraph (a) of this section, information you give us about your 
medical condition(s) and how it affects you, and other evidence from 
other sources, must be complete and detailed enough to allow us to make 
a determination or decision 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 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.
* * * * *

    13. Section 416.926 is amended by revising the second and fourth 
sentences of paragraph (c) to read as follows:


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). * * * (See Sec. 416.1016 
for limitations on what medical consultants who are not physicians can 
evaluate and the qualifications we consider necessary for a 
psychologist to be a consultant.)
* * * * *

Subpart J--[Amended]

    14. 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).


Sec. 416.1015  [Amended]

    15. Section 416.1015 is amended by removing the last sentence of 
paragraph (d).

    16. Section 416.1016 is revised to read as follows:


Sec. 416.1016  Medical or psychological consultants.

    (a) What is a medical consultant? A medical consultant is a person 
who is a member of a team that makes disability determinations in a 
State agency, as explained in Sec. 416.1015, or who is a member of a 
team that makes disability determinations for us when we make 
disability determinations ourselves.
    (b) What qualifications must a medical consultant have? A medical 
consultant must be an acceptable medical source identified in 
Sec. 416.913(a)(1) or (a)(3) through (a)(5); that is, a licensed 
physician (medical or osteopathic), a licensed optometrist, a licensed 
podiatrist, or a qualified speech-language pathologist. The medical 
consultant must meet any appropriate qualifications for his or her 
specialty as explained in Sec. 416.913(a).
    (c) Are there any limitations on what medical consultants who are 
not physicians can evaluate? Medical consultants who are not physicians 
are limited to evaluating the impairments for which they are qualified, 
as described in Sec. 416.913(a). Medical consultants who are not 
physicians also are limited as to when they may serve as a member of a 
team that makes a disability determination. For example, a speech-
language pathologist who is a medical consultant in a State agency may 
be a member of a team that makes a disability determination in a claim 
only if a speech or language impairment is the only impairment in the 
claim or if there is a combination of a speech or language impairment 
with another impairment but the speech or language impairment alone 
would justify a finding of disability. In all other cases, a physician 
will be a member of the team that makes a disability determination, 
except in cases in which this function may be performed by a 
psychological consultant as discussed in paragraph (f) of this section 
and Sec. 416.1015(d).
    (d) What is a psychological consultant? A psychological consultant 
is a psychologist who has the same responsibilities as a medical 
consultant explained in paragraph (a) of this section, but who can 
evaluate only mental impairments.
    (e) What qualifications must a psychological consultant have? A 
psychological consultant used in cases where there is evidence of a 
mental impairment must be a qualified psychologist. For disability 
program purposes, a psychologist will not be considered qualified 
unless he or she:
    (1) Is licensed or certified as a psychologist at the independent 
practice level of psychology by the State in which he or she practices; 
and
    (2)(i) Possesses a doctorate degree in psychology from a program in 
clinical psychology of an educational institution accredited by an 
organization recognized by the Council on Post-Secondary Accreditation; 
or
    (ii) Is listed in a national register of health service providers 
in psychology which the Commissioner of Social Security deems 
appropriate; and
    (3) Possesses 2 years of supervised clinical experience as a 
psychologist in health service, at least 1 year of which is post 
masters degree.
    (f) Are there any limitations on what a psychological consultant 
can evaluate? Psychological consultants are limited to the evaluation 
of mental impairments, as explained in Sec. 416.1015(d). Psychological 
consultants also are limited as to when they can serve as a member of a 
team that makes a disability determination. They may do so only when a 
mental impairment is the only impairment in the claim or when there is 
a combination of a mental impairment with another impairment but the 
mental impairment alone would justify a finding of disability.

[FR Doc. 00-13607 Filed 5-31-00; 8:45 am]
BILLING CODE 4191-02-U