[Federal Register Volume 70, Number 70 (Wednesday, April 13, 2005)]
[Proposed Rules]
[Pages 19351-19353]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-7356]


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SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404 and 416

[Regulation Nos. 4 and 16]
RIN 0960-AG21


New Medical Criteria for Evaluating Language and Speech Disorders

AGENCY: Social Security Administration.

ACTION: Advance notice of proposed rulemaking.

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SUMMARY: We are considering whether to propose new rules for evaluating 
language and speech disorders. The new rules would apply to 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). Specifically, we 
are considering whether to add a new body system in the Listing of 
Impairments in appendix 1 to subpart P of part 404 of our regulations 
(the listings) for these disorders. We invite you to send us comments 
about whether we should establish these new rules, as well as 
suggestions about what the proposed rules should include.
    We will consider your comments and suggestions, as well as 
information about advances in medical knowledge, treatment, and methods 
of evaluating language and speech disorders, along with our program 
experience. If we decide to propose new listings for language and 
speech disorders, we will publish them as proposed rules for public 
comment in a Notice of Proposed Rulemaking (NPRM).
    As part of our long-term planning for the disability programs, we 
are also interested in your ideas for how we may improve our programs 
for people with disabilities, including people who have disabilities 
based on language and speech disorders, and especially those who would 
like to work.

DATES: To be sure your comments are considered, we must receive them by 
June 13, 2005.

ADDRESSES: You may give us your comments by: Using our Internet site 
facility (i.e., Social Security Online) at http://policy.ssa.gov/pnpublic.nsf/LawsRegs or the Federal eRulemaking Portal at http://www.regulations.gov; e-mail to [email protected]; telefax to (410) 
966-2830; or 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, 107 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 on 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.gpoaccess.gov/fr/index.html. It is also available on the Internet 
site for SSA (i.e., Social Security Online) at: http://policy.ssa.gov/pnpublic.nsf/LawsRegs.

FOR FURTHER INFORMATION CONTACT: Robert J. Augustine, Social Insurance 
Specialist, Office of Regulations, Social Security Administration 107 
Altmeyer Building, 6401 Security Boulevard, Baltimore, Maryland 21235-
6401, (410) 965-0020 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 http://www.socialsecurity.gov.

SUPPLEMENTARY INFORMATION:

What Is the Purpose of This Notice?

    We are considering whether to add a new body system to our listings 
for evaluating language and speech disorders. The new listings would 
apply to 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 about whether 
we should establish these new rules, and if so, suggestions about what 
these proposed rules should include. We are also asking for your 
comments and ideas about how we can improve our disability programs in 
the future for people with language and speech disorders.

Who Should Send Us Comments and Suggestions?

    We invite comments and suggestions from anyone who has an interest 
in how we evaluate claims for benefits in our disability programs that 
are filed by people who have language and speech disorders. We are 
interested in comments and suggestions from people who apply for or 
receive benefits from us, including people who have language or speech 
disorders. We are also interested in comments and suggestions from 
members of the general public, individuals and organizations that 
advocate for people who have language and speech disorders, speech-
language pathologists, physicians, other health care professionals, 
researchers, vocational specialists, 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 along with other 
information, such as that gained from relevant textbooks and our 
disability program experience, we will decide whether to propose new 
rules for evaluating language and speech disorders. If we propose new 
rules, we will publish them in an NPRM in the Federal Register. In 
accordance with the usual rulemaking procedures, you will have a chance 
to comment on the proposed new rules when we publish the NPRM. In the 
preamble to any final rules, we will summarize and respond to the 
significant comments made on the NPRM.

Why Are We Considering New Listings for Language and Speech Disorders?

    In our current listings, language and speech disorders are 
addressed in six separate listings in part A, and in 12 separate 
listings in part B, and these listings are spread across five different 
body systems (Special Senses and Speech; Multiple Body Systems; 
Neurological; Mental Disorders; Immune System). Some of these listings 
have narrow applicability, while others use different terminology to 
describe a language or speech impairment. Therefore, we are considering 
whether it would be better to establish a new body system that would 
(1) Describe disability at the listing level for individuals who have 
very serious language or speech problems, (2) provide a more focused, 
but also more comprehensive, means of evaluating

[[Page 19352]]

language and speech problems than in the current listings, and (3) use 
more consistent terms and clearer severity criteria.

What Should You Comment About?

    We are interested in any comments and suggestions you have about 
how we should consider language and speech disorders under the 
listings. We are interested in knowing whether you think it is a good 
idea to establish a new body system in our listings for language and 
speech disorders and, if so, what the new listings should say. For 
example, do you have ideas about how we should:
     Describe listing-level severity for adults and children 
with particular kinds of language and speech disorders?
     Consider other impairments that commonly occur together 
with language and speech disorders?
     Consider impairments that result in language or speech 
problems?
     Consider language and speech from a developmental 
standpoint?
     Incorporate academic and social communication demands on 
children?
     Incorporate criteria relevant to our definition of 
disability for adults?
    We are also interested in knowing what guidelines you think we 
should include in the introductory section of the new body system.
    The listings are only a part of our rules for evaluating 
disability. You can also make comments or suggestions to help us 
improve our other rules for evaluating claims for benefits filed by 
adults and children who have language and speech disorders.
    In addition to your comments about possible new rules for 
evaluating language and speech disorders, we also welcome your comments 
about how the disability requirements of the Act and our regulations 
affect people who have language and speech disorders, especially those 
who would like to work, either full-time or part-time with supports. 
Your ideas can address our existing rules and regulations, or you can 
suggest changes to the law. For example, we know that many people who 
have certain 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, therapy, 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. These may be issues, however, that you would like 
to address.
    We are interested in your ideas for how we may be able to improve 
our programs for people with disabilities, including people who have 
disabilities based on language and speech disorders. If we decide to 
propose new rules for evaluating these disorders, we will consider your 
ideas as we develop the NPRM for public comment. Where applicable, we 
will also consider them as part of our long-term planning for the 
disability programs.

What Other Information Will We Consider?

    We will be considering information from many sources, including the 
following documents, for relevance to our policy for evaluating 
language and speech disorders.
     American Speech-Language-Hearing Association Ad Hoc 
Committee on Service Delivery in the Schools. (1993). Definitions of 
communication disorders and variations. Asha, 35 (Suppl. 10), 40-41.
     Bleile, K.M. (2003). Manual of Articulation and 
Phonological Disorders: Infancy through Adulthood (2nd ed.). Clifton 
Park, NY: Delmar Learning.
     Curlee, R.F. (1999). Stuttering and Related Disorders of 
Fluency (2nd ed.). New York: Thieme New York.
     Hillis, A.E. (2002). The Handbook of Adult Language 
Disorders: Integrating Cognitive Neuropsychology, Neurology, and 
Rehabilitation. New York: Psychology Press.
     Paul, R. (2001). Language Disorders from Infancy through 
Adolescence: Assessment and Interventions (2nd ed.). St. Louis, MO: 
Mosby.
     Rubin, J.S., Sataloff, R.T., and Korovin, G.S. (2003). 
Diagnosis and Treatment of Voice Disorders (2nd ed.). Clifton Park, NY: 
Delmar Learning.
     Shipley, K.G., and McAfee, J.G. (2004). Assessment in 
Speech-Language Pathology: A Resource Manual (3rd ed.). Clifton Park, 
NY: Delmar Learning.
     Tomblin, J.B., Morris, H.L., and Spriestersbach, D.C. 
(Eds.) (2000). Diagnosis in Speech-Language Pathology. San Diego, CA: 
Singular Publishing Group, Inc.

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:
     Workers insured under the Act, Children of insured 
workers, and
     Widows, widowers, and surviving divorced spouses (see 
Sec.  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
                                                        that you have a
                                                           medically
                                                         determinable
 If you file a claim under . . .   And you are . . .  physical or mental
                                                         impairment or
                                                        combination of
                                                       impairments that
                                                       results in . . .
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title II........................  an adult or a       the inability to
                                   child.              do any
                                                       substantial
                                                       gainful activity
                                                       (SGA).
title XVI.......................  a person age 18 or  the inability to
                                   older.              do any SGA.
title XVI.......................  a person under age  marked and severe
                                   18.                 functional
                                                       limitation.
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[[Page 19353]]

How Do We Decide Whether You Are Disabled?

    If you are seeking benefits under title II of the Act, or if you 
are an adult seeking benefits under title XVI of the Act, we use a 
five-step ``sequential evaluation process'' to decide whether you are 
disabled. We describe this five-step process in our regulations at 
Sec. Sec.  404.1520 and 416.920. We follow the five steps in order, and 
we stop as soon as we can make a determination or decision. The steps 
are:
    1. Are you working, and is the work you are doing substantial 
gainful activity? If you are working and the work you are doing is 
substantial gainful activity, we will find that you are not disabled, 
regardless of your medical condition or your age, education, and work 
experience. If you are not, we will go on to step 2.
    2. Do you have a ``severe'' impairment? If you do not have an 
impairment or combination of impairments that significantly limits your 
physical or mental ability to do basic work activities, we will find 
that you are not disabled. If you do, we will go on to step 3.
    3. Do you have an impairment(s) that meets or medically equals the 
severity of an impairment in the listings? If you do, and the 
impairment(s) meets the duration requirement, we will find that you are 
disabled. If you do not, we will go on to step 4.
    4. Do you have the residual functional capacity to do your past 
relevant work? If you do, we will find that you are not disabled. If 
you do not, we will go on to step 5.
    5. Does your impairment(s) prevent you from doing any other work 
that exists in significant numbers in the national economy, considering 
your residual functional capacity, age, education, and work experience? 
If it does, and it meets the duration requirement, we will find that 
you are disabled. If it does not, we will find that you are not 
disabled.
    We use a different sequential evaluation process for children who 
apply for payments based on disability under title XVI of the Act. We 
describe that sequential evaluation process in Sec.  416.924 of our 
regulations.
    If you are already receiving benefits, we also use a different 
sequential evaluation process when we decide whether your disability 
continues. See Sec. Sec.  404.1594, 416.994, and 416.994a of our 
regulations. All of the sequential evaluation processes, however, 
include steps at which we consider whether your impairment(s) meets or 
medically equals one of our listings.

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 evaluate your impairment(s); we 
never use the listings in part B.
    If you are a person under age 18, we first use the criteria in part 
B. 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.)

What If You Do Not Have An Impairment(s) That Meets or Medically Equals 
a Listing?

    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 any 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.) Likewise, we will not 
decide that your disability has ended only because your impairment(s) 
does not meet or medically equal a listing.

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: March 21, 2005.
Jo Anne B. Barnhart,
Commissioner of Social Security.
[FR Doc. 05-7356 Filed 4-12-05; 8:45 am]
BILLING CODE 4191-02-P