[Federal Register Volume 70, Number 80 (Wednesday, April 27, 2005)]
[Notices]
[Pages 21833-21835]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-8390]


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SOCIAL SECURITY ADMINISTRATION


Social Security Ruling, SSR 05-03p.; Title XVI: Determining 
Continuing Disability at Step 2 of the Medical Improvement Review 
Standard Sequential Evaluation Process for Children Under Age 18--
Functional Equivalence

AGENCY: Social Security Administration.

ACTION: Notice of Social Security Ruling.

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SUMMARY: In accordance with 20 CFR 402.35(b)(1), the Commissioner of 
Social Security gives notice of Social Security Ruling, SSR 05-03p. 
This Ruling explains our policies for determining continuing disability 
at step 2 of the medical improvement review standard for children under 
20 CFR 416.994a(b)(2).

EFFECTIVE DATE: April 27, 2005.

FOR FURTHER INFORMATION CONTACT: Judy Hicks, Office of Disability 
Programs, Social Security Administration, 6401 Security Boulevard, 4352 
Annex Building, Baltimore, MD 21235-6401, (410) 965-9119. 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: Although we are not required to do so 
pursuant to 5 U.S.C. 552(a)(1) and (a)(2), we are publishing this 
Social Security Ruling in accordance with 20 CFR 402.35(b)(1).
    Social Security Rulings make available to the public precedential 
decisions relating to the Federal old-age, survivors, disability, 
supplemental security income, and black lung benefits programs. Social 
Security Rulings may be based on case decisions made at all 
administrative levels of adjudication, Federal court decisions, 
Commissioner's decisions, opinions of the Office of the General 
Counsel, and policy interpretations of the law and regulations.
    Although Social Security Rulings do not have the same force and 
effect as the statute or regulations, they are binding on all 
components of the Social Security Administration, in accordance with 20 
CFR 402.35(b)(1), and are to be relied upon as precedents in 
adjudicating cases.
    If this Social Security Ruling is later superseded, modified, or 
rescinded, we will publish a notice in the Federal Register to that 
effect.

(Catalog of Federal Domestic Assistance, Program No. 96.006 
Supplemental Security Income.)

    Dated: April 21, 2005.
Jo Anne B. Barnhart,
Commissioner of Social Security.

 Policy Interpretation Ruling

    Title XVI: Determining Continuing Disability at Step 2 of the 
Medical Improvement Review Standard Sequential Evaluation Process for 
Children Under Age 18--Functional Equivalence.
    Purpose: To explain our policies for determining continuing 
disability at step 2 of the medical improvement review standard (MIRS) 
sequential evaluation process for children under 20 CFR 416.994a(b)(2) 
and to explain how we apply the functional equivalence rule at step 2.
    Citations (Authority): Sections 1614(a)(3), 1614(a)(4), and 1614(c) 
of the Social Security Act; Regulations No. 16, subpart I, sections 
416.924, 416.925, 416.926, 416.926a, and 416.994a.
    Introduction: When we conduct a continuing disability review, we 
use a three-step MIRS sequential evaluation process, outlined in 20 CFR 
416.994a(b).

[[Page 21834]]

    1. At step 1, we determine whether there has been medical 
improvement in the impairment(s) that was present at the time of the 
most recent favorable determination or decision. (20 CFR 
416.994a(b)(1)). We refer to the most recent favorable determination or 
decision as the ``comparison point decision'' (CPD), and we refer to 
the impairment(s) that was present at the time of the most recent 
favorable determination or decision as the ``CPD impairment(s).'' If 
there has been no medical improvement in the CPD impairment(s), we find 
that the child's disability continues. If there has been medical 
improvement, we proceed to step 2.\1\
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    \1\ At each step of the process certain ``exceptions to medical 
improvement'' may apply, under which disability can be found to have 
ended even though medical improvement has not occurred. (20 CFR 
416.994a(e)-(f)). Although we apply the exceptions when appropriate, 
further discussion of the exceptions is unnecessary in this Ruling.
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    2. At step 2, we determine whether the CPD impairment(s) still 
meets or medically or functionally equals ``the severity of the listed 
impairment'' that it met or equaled at the time of the CPD. (20 CFR 
416.994a(b)(2)). If the CPD impairment(s) still meets or medically or 
functionally equals the severity of the listing we considered at the 
CPD, we find that the child is still disabled. As long as we determine 
that the CPD impairment(s) currently meets or medically or functionally 
equals the listing we considered before, we do not have to make the 
same finding we made at the CPD. For example, if we found at the CPD 
that the child's impairment(s) met a listing, and now it no longer 
meets that listing but it medically equals that listing, we find that 
the child's disability continues. Likewise, if we found that the 
child's impairment(s) functionally equaled a listing, and now it meets 
that listing, we find that the child's disability continues. If the CPD 
impairment(s) does not still meet or equal the severity of that listed 
impairment, we proceed to step 3.
    3. At step 3, we determine whether the child is currently disabled, 
considering all current impairments. (20 CFR 416.994a(b)(3)). We 
determine if the child's current impairment(s) is severe, as defined in 
20 CFR 416.924(c). If the impairment(s) is not severe, we find that the 
child's disability has ended. If the impairment(s) is severe, we 
consider whether it meets or medically equals a listing. (20 CFR 
416.924(d), 416.925, 416.926). If it does, we find that the child's 
disability continues. If not, we consider whether it functionally 
equals the listings. (20 CFR 416.926a). If it does, we find that the 
child's disability continues. If not, we find that the child's 
disability has ended.
    On September 11, 2000, we published final rules (the ``2001 
rules'') for evaluating disability in children under the Supplemental 
Security Income program. These rules became effective on January 2, 
2001.\2\ In section 416.926a of the 2001 rules, (20 CFR 416.926a), we 
clarified and simplified our prior rules for evaluating functional 
equivalence \3\ in a number of ways. Under the functional equivalence 
policies that we applied prior to January 2, 2001, we required a 
comparison of the child's impairment(s) to a specific listing.\4\ One 
way in which we clarified and simplified functional equivalence under 
the 2001 rules was to no longer refer to specific listed impairments. 
Instead, we determine whether a child's impairment functionally equals 
the listings. To functionally equal the listings, a child's 
impairment(s) must cause ``marked'' limitations in two domains of 
functioning, or ``extreme'' limitation in one such domain, as described 
in 20 CFR 416.926a.
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    \2\ 65 FR 54747-54790 (2000).
    \3\ We have included the policy of functional equivalence in our 
childhood disability rules since 1991. See 56 FR 5534, 5543, 5561-
5562 (1991).
    \4\ 20 CFR 416.926a(b) (1997); 20 CFR 416.926a(b) (1993); 20 CFR 
416.926a(b) (1991).
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    Therefore, findings of functional equivalence made on or after 
January 2, 2001, are not based on a specific listing.
    Because our current rules about step 2 of the MIRS sequential 
evaluation process refer only to the specific listed impairment(s) that 
we considered at the CPD, we are issuing this ruling to explain how we 
apply the functional equivalence rules at step 2. We also explain how 
we apply step 2 when the CPD was based on functional equivalence to the 
listings.
    Policy Interpretation: When we evaluate functional equivalence at 
step 2 of the MIRS sequential evaluation process for children in 20 CFR 
416.994a(b), we use the current rules for evaluating functional 
equivalence.
    How we apply step 2 of the MIRS sequential evaluation process for 
children depends on the date of and basis for the CPD. A chart that 
summarizes our policies on applying step 2 follows the text.
    a. If the CPD was made before January 2, 2001.
    If the CPD was made before January 2, 2001, it was based either on 
a finding that the child's impairment(s) met or medically equaled a 
specific listing, or functionally equaled a specific listing under the 
rules for functional equivalence that were in effect at the time of the 
CPD.
    When we determine whether a child's disability continues at step 2, 
we first consider whether the CPD impairment(s) now either meets or 
medically equals the same listing that it met, medically equaled, or 
functionally equaled at the CPD, as that listing was written at that 
time. If the CPD impairment(s) now meets or medically equals the 
severity of that listed impairment as it was written at that time, we 
find that the child is still disabled.
    If the CPD impairment(s) does not now meet or medically equal the 
CPD listing, we consider whether the CPD impairment(s) now functionally 
equals the listings under our current rules in 20 CFR 416.926a. If it 
does, we find that the child is still disabled. If it does not, we 
proceed to step 3.
    b. If the CPD was made on or after January 2, 2001.
    If the CPD was made on or after January 2, 2001, it was based 
either on a finding that the child's impairment(s) met or medically 
equaled a listing, or functionally equaled the listings under the 
current rules in 20 CFR 416.926a.
    (1) If the CPD impairment(s) met or medically equaled a listing:
    If our determination or decision at the time of the CPD was that 
the child's impairment(s) met or medically equaled a listing, we 
consider whether the CPD impairment(s) now either meets or medically 
equals that same listing, as it was written at that time. If it does, 
we find that the child is still disabled.
    If the CPD impairment(s) does not now meet or medically equal the 
CPD listing, we consider whether the CPD impairment(s) now functionally 
equals the listings under our current rules in 20 CFR 416.926a. If it 
does, we find that the child is still disabled. If it does not, we 
proceed to step 3.
    (2) If the CPD impairment(s) functionally equaled the listings:
    When we determine whether a child's disability continues at step 2 
and the CPD was based on functional equivalence to the listings, we 
consider only whether the CPD impairment(s) now functionally equals the 
listings. We do not consider whether the impairment(s) now meets or 
medically equals the CPD listing, because there is no specific CPD 
listing. If that impairment(s) now functionally equals the listings 
under our current rules in 20 CFR 416.926a, we find that the child is 
still disabled. If it does not, we proceed to step 3.
    Chart: This chart summarizes the explanations above. Follow a. or 
b. as appropriate.
    a. If the CPD was made before January 2, 2001:

[[Page 21835]]



Does CPD impairment(s) now either meet or            [rarr] YES   Disability Continues \5\
 medically equal the CPD listing?                        [rarr]
                      [darr]
                        NO
                      [darr]
Does CPD impairment(s) now functionally equal the    [rarr] YES   Disability Continues
 listings?                                               [rarr]
                      [darr]
                        NO
                      [darr]
    Proceed to Step 3
 

    b. If the CPD was made on or after January 2, 2001, follow (1) or 
(2) as appropriate:
    (1) CPD impairment(s) met or medically equaled a listing:

Does CPD impairment(s) now either meet or            [rarr] YES   Disability Continues
 medically equal the CPD listing?                        [rarr]
                      [darr]
                        NO
                      [darr]
Does CPD impairment(s) now functionally equal the    [rarr] YES   Disability Continues
 listings?                                               [rarr]
                      [darr]
                        NO
                      [darr]
    Proceed to Step 3
 

    (2) CPD impairment(s) functionally equaled the listings:

Does CPD impairment(s) now functionally equal the    [rarr] YES   Disability Continues
 listings?                                               [rarr]
                      [darr]
                        NO
                      [darr]
    Proceed to Step 3.
 
\5\ The conclusion that disability continues here and elsewhere on this chart is subject to any applicable
  exceptions to the MIRS standard. See footnote 1 above.

    Effective Date: This SSR is effective upon publication in the 
Federal Register.
    Cross-References: Program Operations Manual System, sections DI 
28005.020, 28005.025, and 28005.030.
[FR Doc. 05-8390 Filed 4-26-05; 8:45 am]
BILLING CODE 4191-02-P