[Federal Register Volume 68, Number 90 (Friday, May 9, 2003)]
[Proposed Rules]
[Pages 24896-24898]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-11491]


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SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404 and 416

[Regulations Nos. 4 and 16]
RIN 0960-AF33


Revised Medical Criteria for Evaluating Immune System Disorders

AGENCY: Social Security Administration.

ACTION: Advance notice of proposed rulemaking.

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SUMMARY: We are planning to update and revise the rules that we use to 
evaluate immune system disorders of adults and children who apply for, 
or receive, disability benefits under title II and Supplemental 
Security Income (SSI) payments based on disability under title XVI of 
the Social Security Act (the Act). The rules we plan on revising are 
sections 14.00 and 114.00 in the Listing of Impairments in appendix 1 
to subpart P of part 404 of our regulations (the listings). We invite 
you to send us comments and suggestions for updating and revising these 
rules.
    After we have considered your comments and suggestions, as well as 
information about advances in medical knowledge, treatment, and methods 
of evaluating immune system disorders, and our program experience, we 
intend to publish for public comment a Notice of Proposed Rulemaking 
(NPRM) that will propose specific revisions to the rules.
    As part of our long-term planning for the disability programs, we 
are also interested in your ideas for how we may be able to improve our 
programs for people who have immune system disorders, especially those 
who would like to work.

[[Page 24897]]


DATES: To be sure your comments are considered, we must receive them by 
July 8, 2003.

ADDRESSES: You may give us your comments using: our Internet site 
facility (i.e., Social Security Online) at: http://policy.ssa.gov/pnpublic.nsf/LawsRegs; e-mail to [email protected]; telefax to (410) 
966-2830; or, by letter to the Commissioner of Social Security, P.O. 
Box 17703, Baltimore, Maryland 21235-7703. You may also deliver them to 
the Office of Regulations, Social Security Administration, 100 Altmeyer 
Building, 6401 Security Boulevard, Baltimore, Maryland 21235-6401, 
between 8 a.m. and 4:30 p.m. on regular business days. Comments are 
posted in our Internet site at http://policy.ssa.gov/pnpublic.nsf/LawsRegs, or you may inspect them on regular business days by making 
arrangements with the contact person shown in this preamble.
    Electronic Version: The electronic file of this document is 
available on the date of publication in the Federal Register at http://www.access.gpo.gov/su_docs/aces/aces140.html. It is also available on 
the Internet site for SSA (i.e., Social Security Online): http://www.ssa.gov/regulations/.

FOR FURTHER INFORMATION CONTACT: Suzanne DiMarino, 100 Altmeyer 
Building, 6401 Security Boulevard, Baltimore, Maryland 21235-6401, 
(410) 965-1769 or TTY (410) 966-5609. For information on eligibility or 
filing for benefits, call our national toll-free number 1-800-772-1213 
or TTY 1-800-325-0778, or visit our Internet Web site, Social Security 
Online, at www.ssa.gov.

SUPPLEMENTARY INFORMATION:

What Is the Purpose of This Notice?

    We are planning to update and revise the rules that we use to 
evaluate immune system disorders of adults and children who apply for, 
or receive, disability benefits under title II and Supplemental 
Security Income (SSI) payments based on disability under title XVI of 
the Act. The purpose of this notice is to give you an opportunity to 
send us comments and suggestions for updating and revising those rules 
as we begin the rulemaking process. We are also asking for your 
comments and ideas about how we can improve our disability programs in 
the future for people with immune system disorders.

Who Should Send Us Comments and Suggestions?

    We invite comments and suggestions from anyone who has an interest 
in the rules we use to evaluate claims for benefits filed by people who 
have immune system disorders. We are interested in getting comments and 
suggestions from people who apply for or receive benefits from us, 
members of the general public, advocates and organizations who advocate 
for people who have immune system disorders, experts in the evaluation 
of immune system disorders, researchers, people who make disability 
determinations for us, and any other people who may have ideas for us 
to consider.

Will We Respond to Your Comments from This Notice?

    No, we will not respond directly to comments you send us because of 
this notice. However, after we consider your comments in response to 
this notice, along with other information such as medical research and 
our program experience, we will decide how to revise the rules we use 
to evaluate immune system disorders. When we propose specific revisions 
to the rules, we will publish an NPRM in the Federal Register. In 
accordance with the usual rulemaking procedures we follow, you will 
have a chance to comment on the revisions we propose when we publish 
the NPRM, and we will summarize and respond to the significant comments 
on the NPRM in the preamble to any final rules.

Which Rules Are We Considering for Updating and Revising?

    We are considering two sections of our listings for revision, 
sections 14.00 and 114.00. These are the listings for immune disorders 
for adults (Part A, 14.00) and children (Part B, 114.00). It includes 
such disorders as HIV infection, other Immunoglobulin deficiency 
syndromes or deficiencies of cell-mediated immunity, Systemic Lupus 
Erythematosus, Scleroderma, Polymyositis, Inflammatory Arthritis, and 
other connective tissue disorders.

Where Can You Find These Rules on the Internet?

    You can find these rules on our Internet site at these locations:
    [sbull] Sections 14.00 and 114.00 are in the Listing of Impairments 
in appendix 1 to subpart P of part 404 of our regulations at: http://www.ssa.gov/OP_Home/cfr20/404/404-ap09.htm.
    [sbull] You can also look up sections 14.00 and 114.00 at: http://www.ssa.gov/disability/professionals/bluebook/.
    [sbull] If you do not have Internet access, you can find the Code 
of Federal Regulations in some public libraries, Federal depository 
libraries, and public law libraries.

Why Are We Updating and Revising Our Rules for Evaluating Immune System 
Disorders?

    [sbull] The current listings for immune system disorders for adults 
(14.00) and children (114.00) will no longer be in effect on July 2, 
2003, unless we extend them or revise and promulgate them again, so we 
must consider now whether to update and revise them.
    We published final rules on July 2, 1993, which established body 
system listings in part A and part B of the listings for immune system 
disorders (58 FR 36008). We made those rules effective for five years 
from the date of publication, unless we extended them, or revised and 
issued them again (58 FR 36051). Since that time, we have extended the 
expiration date of the immune body system listings. Most recently, on 
June 28, 2001, we published rules that extended the effective date of 
the current immune system listings until July 2, 2003 (66 FR 34361). 
Although we published final rules in the Federal Register revising some 
of the immune system listings on November 19, 2001 (66 FR 58009), we 
have not comprehensively revised them since 1993.
    We will be considering information from many sources, including the 
following recent documents, for relevance to our policy for evaluating 
immune system diseases.
    [sbull] Kippel, J., Weyand, C., & Wortmann, R. (Eds.). (1997). 
Primer on the Rheumatic Diseases, (11th ed.). Atlanta: Arthritis 
Foundation.
    [sbull] Davidson, A. & Diamond, B. (2001). Autoimmune Diseases. The 
New England Journal of Medicine, 345(5), 1-21.
    [sbull] Marmont, A. (2000). New Horizons in the Treatment of 
Autoimmune Diseases: Immunoablation and Stem Cell Transplantation. 
Annual Reviews, 51, 115-134.
    [sbull] Nash, R.A. (2000). Prospects of Stem Cell Transplantation 
in Autoimmune Diseases. Journal of Clinical Immunology, 20(1), 38-45.
    [sbull] Sicherer, S.H. (et al.). (1998). Primary Immunodeficiency 
Diseases in Adults. Journal of American Medical Association, 279:58.

What Should You Comment About?

    We are interested in any comments and suggestions you have for 
revising sections 14.00 and 114.00 of our listings. For example, with 
regard to our listings, we are interested in knowing if:
    [sbull] You have concerns about any of the current listings 
provisions for adults or children; such as whether you think we should 
change any of our criteria or

[[Page 24898]]

whether you think a listing is difficult to use or understand.
    [sbull] You would like to see our listings include something that 
they do not include now.
    You can also make any other comments or suggestions to help us 
improve our rules for evaluating claims for benefits filed by adults 
and children who have immune system disorders.
    In addition to your comments about our regulations, we are also 
interested in any ideas you have about how the disability requirements 
of the Act and our regulations affect people who have immune system 
disorders, especially those who would like to work, full-time or part-
time with supports. Your ideas can address our existing rules and 
regulations or suggest changes to the law. For example, we know that 
many people who have immune system disorders might not need benefits 
from us if they could get treatment before their disorders make them 
unable to work. Others may be unable to work but may not need to stay 
out of work indefinitely if they could get treatment or other 
interventions. Many people with permanent disorders can work if they 
have a supporting safety net (including title II disability benefits 
and SSI payments). Work can also be therapeutic for some people. 
Although the Act and our regulations include some access to health care 
through Medicare and Medicaid, some provision for vocational 
rehabilitation, and a number of work incentives, these provisions are 
generally for people who already qualify for benefits under our 
disability programs.
    We are interested in your ideas for how we may be able to improve 
our programs for people who have immune system disorders, especially 
those who would like to work full-time or part-time with supports. Your 
ideas can address our existing rules and regulations or suggest changes 
to the law. We will consider your ideas as we develop the NPRM we 
intend to publish for public comment, and, where applicable, as part of 
our long-term planning for the disability program.

Other Information

Who Can Get Disability Benefits?

    Under title II of the Act, we provide for the payment of disability 
benefits if you are disabled and belong to one of the following three 
groups:
    [sbull] Workers insured under the Act,
    [sbull] Children of insured workers, and
    [sbull] Widows, widowers, and surviving divorced spouses (see 20 
CFR 404.336) of insured workers.
    Under title XVI of the Act, we provide for Supplemental Security 
Income (SSI) payments on the basis of disability if you are disabled 
and have limited income and resources.

How Do We Define Disability?

    Under both the title II and title XVI programs, disability must be 
the result of any medically determinable physical or mental impairment 
or combination of impairments that is expected to result in death or 
which has lasted or is expected to last for a continuous period of at 
least 12 months. Our definitions of disability are shown in the 
following table:

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                                                    Disability means you
                                                      have a medically
 If you file a claim under * *  And you are * * *       determinable
               *                                      impairment(s) as
                                                    described above and
                                                   that results in * * *
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title II......................  an adult or a      the inability to do
                                 child.             any substantial
                                                    gainful activity
                                                    (SGA).
title XVI.....................  a person age 18    the inability to do
                                 or older.          any SGA.
title XVI.....................  a person under     marked and severe
                                 age 18.            functional
                                                    limitations.
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What Are the Listings?

    The listings are examples of impairments that we consider severe 
enough to prevent a person from doing any gainful activity, or that 
result in ``marked and severe functional limitations'' in children 
seeking SSI payments under title XVI of the Act. Although we publish 
the listings only in appendix 1 to subpart P of part 404 of our rules, 
we incorporate them by reference in the SSI program in Sec.  416.925 of 
our regulations, and apply them to claims under both title II and title 
XVI of the Act.

How Do We Use the Listings?

    The listings are in two parts. There are listings for adults (part 
A) and for children (part B). If you are a person age 18 or over, we 
apply the listings in part A when we assess your claim, and we never 
use the listings in part B.
    If you are a person under age 18, we first use the criteria in part 
B of the listings. If the listings in part B do not apply, and the 
specific disease process(es) has a similar effect on adults and 
children, we then use the criteria in part A. (See Sec. Sec.  404.1525 
and 416.925.)
    If your impairment(s) does not meet any listing, we will also 
consider whether it medically equals any listing; that is, whether it 
is as medically severe. (See Sec. Sec.  404.1526 and 416.926.)
    We use the listings only to decide that people are disabled or that 
they are still disabled. We will never deny your claim or decide that 
you no longer qualify for benefits simply because your impairment(s) 
does not meet or medically equal a listing. If you have a severe 
impairment(s) that does not meet or medically equal any listing, we may 
still find you disabled based on other rules in the ``sequential 
evaluation process'' that we use to evaluate all disability claims. 
(See Sec. Sec.  404.1520, 416.920, and 416.924.) If you have a severe 
impairment(s) that does not meet or medically equal any listing, we may 
still find you disabled based on other rules in the ``sequential 
evaluation process'' that we use to evaluate all disability claims. 
(See Sec. Sec.  404.1520, 416.920, and 416.924.)

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: April 16, 2003.
Jo Anne B. Barnhart,
Commissioner of Social Security.
[FR Doc. 03-11491 Filed 5-8-03; 8:45 am]
BILLING CODE 4191-02-U