[Federal Register Volume 73, Number 74 (Wednesday, April 16, 2008)]
[Proposed Rules]
[Pages 20564-20566]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-8111]


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SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404 and 416

[Docket No. SSA 2007-0102]
RIN 0960-AG74


Revised Medical Criteria for Evaluating Cardiovascular Disorders

AGENCY: Social Security Administration.

ACTION: Advance notice of proposed rulemaking.

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SUMMARY: We are requesting your comments on whether and how we should 
update and revise the criteria we use to evaluate claims involving 
cardiovascular disorders in adults and children. These criteria are 
found in sections 4.00 and 104.00 of the Listing of Impairments in 
appendix 1 to subpart P of part 404 of our regulations (the listings). 
We are requesting your comments as part of our ongoing effort to ensure 
that the listings are up-to-date.
    After we have considered your comments and suggestions, other 
information about advances in medical knowledge, treatment, and methods 
of evaluating cardiovascular disorders, and our program experience 
using the current listings, we will determine whether we should revise 
any of the cardiovascular listings. If we propose specific revisions to 
the listings, we will publish a Notice of Proposed Rulemaking (NPRM) in 
the Federal Register.

DATES: To be sure that your comments are considered, we must receive 
them no later than June 16, 2008.

ADDRESSES: You may submit comments by one of four methods--Internet, 
facsimile, regular mail, or hand-delivery. Please do not submit the 
same comments multiple times or by more than one method. Regardless of 
which of the following methods you choose, please state that your 
comments refer to Docket No. SSA-2007-0102 to ensure that we can 
associate your comments with the correct regulation:
    1. Federal eRulemaking portal at http://www.regulations.gov. (This 
is the most expedient method for submitting your comments, and we 
strongly urge you to use it.) In the Comment or Submission section of 
the webpage, type ``SSA-2007-0102'', select ``Go'', and then click 
``Send a Comment or Submission.'' The Federal eRulemaking portal issues 
you a tracking number when you submit a comment.
    2. Telefax to (410) 966-2830.
    3. Letter to the Commissioner of Social Security, P.O. Box 17703, 
Baltimore, Maryland 21235-7703.
    4. Deliver your comments to the Office of Regulations, Social 
Security Administration, 922 Altmeyer Building, 6401 Security 
Boulevard, Baltimore, Maryland 21235-6401, between 8 a.m. and 4:30 p.m. 
on regular business days.
    All comments are posted on the Federal eRulemaking portal, although 
they may not appear for several days after receipt of the comment. You 
may also inspect the comments on regular business days by making 
arrangements with the contact person shown in this preamble.
    Caution: Our policy for comments we receive from members of the 
public is to make them available for public viewing in their entirety 
on the Federal eRulemaking portal at http://www.regulations.gov. 
Therefore, you should be careful to include in your comments only 
information that you wish to make publicly available on the Internet. 
We strongly urge you not to include any personal information, such as 
your Social Security number or medical information, in your comments.

FOR FURTHER INFORMATION CONTACT: Diane Braunstein, Director, Office of 
Compassionate Allowances and Listings Improvement, Social Security 
Administration, 4468 Annex Building, 6401 Security Boulevard, 
Baltimore, MD 21235-6401, (410) 965-1020, for information about this 
notice. 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 site, Social Security Online, at http://www.socialsecurity.gov.

SUPPLEMENTARY INFORMATION:

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.

What is the purpose of this ANPRM?

    The purpose of this ANPRM is to give you an opportunity to send us 
comments and suggestions on whether and how we might update and revise 
listings 4.00 and 104.00 for evaluating cardiovascular disorders. We 
last published final rules revising the criteria that we use to 
evaluate cardiovascular disorders in the Federal Register on January 
13, 2006 (71 FR 2311). We are publishing this ANPRM as part of our 
ongoing effort to ensure that our criteria are effective and reflect 
the latest advances in medicine.

On which rules are we inviting comments?

    We are interested in any comments and suggestions you have on 
whether and how we might revise, update, and clarify sections 4.00 and 
104.00 of the listings. You can find the current rules for these 
listings on the Internet at the following locations:
     Sections 4.00 and 104.00 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-ap10.htm.
     Section 4.00 of the listings is also available at http://www.ssa.gov/disability/professionals/bluebook/4.00-Cardiovascular-Adult.htm.

[[Page 20565]]

     Section 104.00 of the listings is also available at http://www.ssa.gov/disability/professionals/bluebook/104.00-Cardiovascular-Childhood.htm.
    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.

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 cardiovascular 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 
represent people who have cardiovascular disorders, State agencies that 
make disability determinations for us, experts in the evaluation of 
cardiovascular disorders, and researchers.

What should you comment about?

    We are interested in any comments and suggestions you have on how 
we might update and revise sections 4.00 and 104.00 of our listings. 
For example, with regard to our listings, we are interested in knowing 
if:
     You have concerns about any of the provisions in the 
current cardiovascular listings, such as whether you think we should 
change any of our criteria or whether you think a listing is difficult 
to use or to understand.
     You would like to see our cardiovascular listings include 
something that they do not include now, such as other cardiovascular 
disorders, additional medical technologies, specific laboratory 
studies, or new medical criteria.
     You think our cardiovascular listings should include 
additional functional criteria and, if so, what those criteria should 
be.
     You think there are cardiac diseases or conditions, 
however rare, that have such a devastating effect on patients that we 
should presume that they are unable to work.
     You think new imaging techniques can provide new standards 
for allowing us to presume disability for certain advanced diseases and 
conditions.

Will we respond to your comments from this notice?

    We will not respond directly to comments you send us in response to 
this ANPRM. However, after we consider your comments along with other 
information, such as medical research and other information about 
advances in medical knowledge, treatment, methods of evaluating 
cardiovascular disease, and our program experience, we will decide 
whether and how to revise the listings we use to evaluate 
cardiovascular disorders. If we propose revisions to these listings, we 
will publish an NPRM in the Federal Register. In accordance with the 
usual rulemaking procedures we follow, if we publish an NPRM, you will 
have a chance to comment on the revisions we propose, and we will 
summarize and respond to the significant comments on the NPRM in the 
preamble to any final rules.

Other Information

Who can get disability benefits?

    Under title II of the Social Security Act (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 can be 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 that
                                                      results in . . .
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title II......................  an adult or child  the inability to do
                                                    any substantial
                                                    gainful activity
                                                    (SGA).
title XVI.....................  an individual age  the inability to do
                                 18 or older.       any SGA.
title XVI.....................  an individual      marked and severe
                                 under age 18.      functional
                                                    limitations.
------------------------------------------------------------------------

How do we decide whether you are disabled?

    If you are applying for benefits under title II of the Act, or if 
you are an adult applying for payments 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 
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 SGA? If you are 
working and the work you are doing is SGA, 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 (RFC) 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 RFC, 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. See 
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, 
416.924, 416.994, and 416.994a of our

[[Page 20566]]

regulations. However, all of these processes 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 you as an adult from doing any gainful activity. If 
you are a child seeking SSI payments under title XVI of the Act, the 
listings describe impairments that we consider severe enough to result 
in marked and severe functional limitations. Although the listings are 
contained only in appendix 1 to subpart P of part 404 of our 
regulations, 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 an individual 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 an individual under age 18, we first use the criteria in 
part B of the listings. Part B contains criteria that apply only to 
individuals who are under age 18. If the criteria in part B do not 
apply, we may use the criteria in part A when those criteria give 
appropriate consideration to the effects of the impairment(s) in 
children. (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 as an impairment in the listings. (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 you are disabled or that 
you are still disabled. We will not deny your claim or decide that you 
no longer qualify for benefits 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. 
Likewise, we will not decide that your disability has ended only 
because your impairment(s) no longer meets or medically equals 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, Reporting and recordkeeping 
requirements, Supplemental Security Income (SSI).

    Dated: March 20, 2008.
Michael J. Astrue,
Commissioner of Social Security.
[FR Doc. E8-8111 Filed 4-15-08; 8:45 am]
BILLING CODE 4191-02-P