[Federal Register Volume 71, Number 102 (Friday, May 26, 2006)]
[Notices]
[Pages 30467-30469]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 06-4855]


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SOCIAL SECURITY ADMINISTRATION

[Social Security Ruling, SSR 06-01p]


Titles II and XVI: Evaluating Cases Involving Tremolite Asbestos-
Related Impairments

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 06-01p. 
This Ruling provides guidance on the types of impairments that may 
result from tremolite asbestos and how to evaluate disability claims 
under titles II and XVI of the Social Security Act based on these 
impairments.

DATES: Effective Date: May 25, 2006.

FOR FURTHER INFORMATION CONTACT: Michelle Hungerman, Office of Medical 
Policy, Social Security Administration, 6401 Security Boulevard, 
Baltimore, MD 21235-6401, 1-410-965-2289 or TTY 1-800-966-5609, for 
information about this notice.

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 this Federal old-age, survivors, disability, 
supplemental security income, and special veterans benefits programs. 
Social Security Rulings may be based on determinations or decisions 
made at all administrative levels of adjudication, Federal court 
decisions, Commissioner's decisions, opinions of the Office of the 
General

[[Page 30468]]

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 binding 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    If this Social Security Ruling is later superseded, modified, or 
rescinded, we will publish a notice in the Federal Register to that 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 Programs 96.001 Social 
Security Disability Insurance; 96.006 Supplemental Security Income)

    Dated: May 19, 2006.
Martin Gerry,
Deputy Commissioner, Disability and Income Security Programs.

Policy Interpretation Ruling

Titles II and XVI: Evaluating Cases Involving Tremolite Asbestos-
Related Impairments

    Purpose: To provide guidance on the types of impairments that may 
result from tremolite asbestos exposure and how to evaluate disability 
claims under titles II and XVI of the Social Security Act (the Act) 
based on these impairments.\1\
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    \1\ For simplicity, we refer in this Ruling only to initial 
adult claims for disability benefits under titles II and XVI of the 
Act, and the steps of the sequential evaluation process we use to 
determine disability in those claims, 20 CFR 401.1520 and 416.920. 
We use a different sequential evaluation process for children who 
apply for benefits based on disability under title XVI of the Act. 
We describe that sequential evaluation process in 20 CFR 416.924. We 
also use separate sequential evaluation processes to determine 
whether an individual's disability has ended when we conduct 
continuing disability reviews and when we determine that an 
individual was disabled only for a specific period. These rules are 
set out in 20 CFR 401.1594, 416.994, and 416.994a. The guidance in 
this Ruling applies to all of the appropriate steps in those 
regulations as well.
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    Citations (Authority): Sections 216(i), 223(d), 223(f), 1614(a)(3), 
and 1614(a)(4) of the Social Security Act, as amended; Regulations No. 
4, subpart P, sections 404.1502, 404.1505, 404.1508-404.1513, 404.1519-
1523, 404.1525-404.1529, 404.1545, 404.1560-404/1569a, 404.1593-
404.1594, and appendix; 1; and Regulations No. 16, subpart I, sections 
416.902, 416.905, 416.906, 416.908-416.913, 416.919, 416.920, 416.921-
416.929, 416.945, 416.960-416.969a, 416.993-416.994a.
Pertinent History
    Tremolite is a type of asbestos sometimes found in the mineral 
vermiculite. People may be exposed to tremolite from vermiculite in 
mining and in work-related activities involving the production of 
horticultural items, construction and insulation materials, brake pads, 
and other items. People may also be exposed to tremolite from living in 
an area where such mining or activities occur or from products made 
from vermiculite. exposure to tremolite asbestos has occurred in the 
Libby, Montana area and may have occurred in other areas as well.
    This ruling explains how we determine if impairments that may be 
caused by exposure to tremolite asbestos meet our definition of 
disability.\2\ Sections 216(i) and 1614(a)(3) of the Act define 
``disability'' \3\ as the inability to engage in any substantial 
gainful activity by reason of any medically determinable physical or 
mental impairment (or combination of impairments) which can be expected 
to result in death or which has lasted or can be expected to last for a 
continuous period of not less than 12 months.\4\
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    \2\ The term ``we'' in this Social Security Ruling has the same 
meaning as in 20 CFR 404.1502 and 416.902. ``We'' refers to either 
the Social Security Administration or the State agency making the 
disability determination; that is, our adjudicators at all levels of 
the administrative review process and our quality reviewers.
    \3\ Except for statutory blindness.
    \4\ For individuals under age 18 claiming benefits under title 
XVI, disability will be established if the individual has a 
medically determinable physical or mental impairment (or combination 
of impairments) that results in ``marked and severe functional 
limitations.'' See section 1614(a)(3)(C) of the Act and 20 CFR 
416.906. However, for simplicity, the following discussions refer 
only to claims of individuals claiming disability benefits under 
title II and individuals age 18 or older claiming disability 
benefits under title XVI.
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Policy Interpretation
    1. What Types of Impairments May Result from Exposure to Tremolite 
Asbestos? When tremolite asbestos is inhaled, it penetrates the lung 
tissue by piercing the walls of the alveolar sacs and permanently 
lodges in the pleural lining. The tremolite accumulates in the pleural 
lining, and the affected lung and pleural areas become inflamed and 
scarred. This process may eventually result in chronic pulmonary 
insufficiency, such as asbestosis, disorders of pulmonary circulation, 
pleural plaques, pleural thickening, or pleural effusions. These 
impairments can interfere with the lungs' ability to exchange oxygen 
and carbon dioxide and can cause difficulty breathing by interfering 
with the lungs' ability to expand and contract normally. Decrease in 
blood flow to the lungs can result in prolonged right pulmonary artery 
hypertension, enlargement of the heart, and failure of the right 
ventricle (cor pulmonale).
    Inhalation of tremolite asbestos can also cause several types of 
cancers, primarily malignant mesothelioma of the pleura and 
bronchogenic carcinoma of the lung.
    Some factors that increase the chances of developing these 
impairments include increased length of exposure to tremolite asbestos, 
multiple routes of exposure to tremolite asbestos (for example 
occupational contact and household contact), and smoking.\5\
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    \5\ With continuing scientific research, new medical information 
may emerge to further clarify the causes and nature of impairments 
related to tremolite asbestos exposure and to provide greater 
specificity for clinical and laboratory diagnostic techniques to 
document them.
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    2. How Do We Consider Impairments Related to Tremolite Asbestos 
Exposure in the Sequential Evaluation Process? As with all impairments, 
we follow the five-step sequential evaluation process in 20 CFR 
404.1520 and 416.920 when we determine whether an individual is 
disabled.
    Step 1. We first determine whether the individual is working and 
whether the work is substantial gainful activity (SGA). If the 
individual is working and the work is SGA, we will find that the 
individual is not disabled, regardless of the individual's medical 
condition, age, education, and work experience. If the individual is 
not engaging in SGA, we go on to the next step.
    Step 2. If the individual is not working or the work is not SGA, we 
then establish whether the individual has a medically determinable 
impairment that is ``severe.''
    The presence of chronic pulmonary insufficiency is established 
based on the individual's medical history, findings from a physical 
examination(s), and spirometric pulmonary function tests. Chest x-rays 
or other appropriate radiographic imaging techniques (for example, a 
computerized axial tomography (CAT) scan) are often performed to 
support the presence of the impairment. Measurement of diffusing 
capacity of the lungs for carbon monoxide (DLCO), pulse oximetry, or 
resting or exercise arterial blood gas studies (ABGS) may be performed 
to determine if the impairment has resulted in gas exchange 
abnormalities. In disorders of pulmonary circulation, a direct 
measurement of pulmonary artery pressure may have been obtained with 
right heart catheterization.
    Malignant mesothelioma and bronchogenic carcinoma are demonstrated 
by tissue biopsy. When a biopsy is performed, we generally need a copy 
of both the operative note and pathology report. If we cannot get these

[[Page 30469]]

documents, we will accept the summary of hospitalization(s) or other 
medical reports. This evidence should include details of the findings 
at surgery and, whenever appropriate, the pathological findings.
    Once we determine that an impairment(s) exists, we evaluate its 
severity. As with any other medical condition, we will find that an 
impairment(s) caused by exposure to tremolite is a ``severe'' 
impairment(s) when, alone or in combination with another medically 
determinable physical or mental impairment(s), it significantly limits 
an individual's physical or mental ability to do basic work activities. 
When making a determination about whether an impairment(s) is severe, 
we will consider the effects of any symptoms (such as chest pain or 
complaints of shortness of breath on exertion) that could limit 
functioning.\6\ We also recognize that limitations from impairments 
caused by exposure to tremolite may be more significant than would be 
expected based on objective findings alone. We will find that an 
impairment(s) is ``not severe'' only if it is a slight abnormality (or 
a combination of slight abnormalities) that has no more than a minimal 
effect on the individual's ability to do basic work activities.
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    \6\ See SSR 85-28, ``Titles II and XVI: Medical Impairments That 
Are Not Severe'' and SSR 96-3p, ``Titles II and XVI: Considering 
Allegations of Pain and Other Symptoms In Determining Whether a 
Medically Determinable Impairment Is Severe.''
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    If the individual does not have a medically determinable impairment 
that is ``severe,'' we will find that the individual is not disabled. 
If the individual does have a ``severe'' impairment, we will go on to 
the next step.
    Step 3. If an individual has a severe impairment(s), we next 
consider whether the impairment meets or medically equals a listing in 
the Listing of Impairments contained in appendix 1, subpart P of 20 CFR 
part 404.
    Chronic Pulmonary Insufficiency: We evaluate chronic pulmonary 
insufficiency under listing 3.02. The listing contains criteria based 
on spirometry, single breath DLCO, or ABGS. Chronic pulmonary 
insufficiency caused by exposure to tremolite asbestos may not have 
findings at rest that satisfy these criteria. If exercise ABGS cannot 
be obtained in these situations, we evaluate the impairment(s) at step 
4, and if necessary, step 5 of the sequential evaluation process.
    Cancer: Malignant mesothelioma of the pleura meets listing 13.15A. 
Bronchogenic carcinoma meets listing 13.14A if it is inoperable, 
unresectable, recurrent, or has metastasized to or beyond the hilar 
nodes.
    If the individual has an impairment(s) that meets or medically 
equals the criteria of one of the foregoing listings or any other 
listing and meets the duration requirement, we will find that the 
individual is disabled. If not, we will continue with the sequential 
evaluation process.
    Residual Functional Capacity. If we find that the impairment(s) 
does not meet or medically equal a listing, or if we do not have enough 
information for a determination or decision at Step 3, we will assess 
the individual's residual functional capacity (RFC).\7\ We must 
consider all symptoms that result from the individual's impairments, 
including those symptoms that result from impairments that are not 
severe, when we evaluate how these symptoms affect the individual's 
functional capacity.\8\
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    \7\ See 20 CFR 404.1520(e) and 416.920(e).
    \8\ See SSR 96-7p, ``Titles II and XVI: Evaluation of Symptoms 
in Disability Claims: Assessing the Credibility of an Individual's 
Statements'' and SSR 96-8p, ``Titles II and XVI: Assessing Residual 
Functional Capacity in Initial Claims.''
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    In addition, if the individual's treating source \9\ has provided 
an opinion about what the individual can still do despite his or her 
impairment, we will give this opinion controlling weight in determining 
the individual's RFC when the opinion is well-supported by objective 
medical evidence and is not inconsistent with the other substantial 
evidence in the case record.\10\ Even if the treating source's opinion 
is not given ``controlling weight'' (for example it is not well-
supported by objective medical evidence), the opinion is still entitled 
to deference and must be weighed using all of the factors in 20 CFR 
404.1527 and 416.927. In many cases, a treating source's medical 
opinion will be entitled to the greatest weight and should be adopted 
even if it does not meet the test for ``controlling weight.''
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    \9\ See 20 CFR 404.1502 and 416.902.
    \10\ See 20 CFR 404.1527 and 416.927; SSR 96-2p, ``Titles II and 
XVI: Giving Controlling Weight To Treating Source Medical 
Opinions.''
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    Steps 4 and 5. After we determine the individual's RFC, we then 
proceed to the fourth and, if necessary, the fifth step of the 
sequential evaluation process.\11\ If the individual can do past 
relevant work, we will determine that the individual is not disabled 
(step 4). If we determine that the individual's impairment(s) precludes 
the performance of past relevant work or if there was no past relevant 
work, a finding must be made about the individual's ability to adjust 
to other work (step 5). The usual vocational considerations must be 
applied in determining the individual's ability to adjust to other 
work.\12\
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    \11\ See 404.1545 and 416.945.
    \12\ See 20 CFR 404.1560-404.1569a and 416.960-416.969a.
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    Effective Date: This Ruling is effective on the date of its 
publication in the Federal Register.
    Cross-References: SSR 85-28, ``Titles II and XVI: Medical 
Impairments That Are Not Severe,'' SSR 96-2p, ``Titles II and XVI: 
Giving Controlling Weight To Treating Source Medical Opinions,'' SSR 
96-3p, ``Titles II and XVI: Considering Allegations of Pain and Other 
Symptoms in Determining Whether a Medically Determinable Impairment is 
Severe,'' SSR 96-7p, ``Titles II and XVI: Evaluation of Symptoms in 
Disability Claims: Assessing the Credibility of an Individual's 
Statements,'' and SSR 96-8p, ``Titles II and XVI: Assessing Residual 
Functional Capacity in Initial Claims.''

[FR Doc. 06-4855 Filed 5-25-06; 8:45 am]
BILLING CODE 4191-02-M