[Federal Register Volume 78, Number 99 (Wednesday, May 22, 2013)]
[Proposed Rules]
[Pages 30249-30258]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-11601]
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SOCIAL SECURITY ADMINISTRATION
20 CFR Parts 404 and 416
[Docket No. SSA-2011-0081]
RIN 0960-AG28
Revised Listings for Growth Disorders and Weight Loss in Children
AGENCY: Social Security Administration.
ACTION: Notice of proposed rulemaking.
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SUMMARY: Several body systems in our Listing of Impairments (listings)
contain listings for children based on impairment of linear growth or
weight loss. We propose to replace those listings with new listings,
add a listing to the genitourinary body system for children, and
provide new introductory text for each listing explaining how to apply
the new criteria. The proposed revisions to our listings reflect our
program experience, advances in medical knowledge, comments we received
from medical experts and the public at an outreach policy conference,
and comments we received in response to a notice of intent to issue
regulations and request for comments (request for comments) and an
advance notice of proposed rulemaking (ANPRM). We are also proposing
conforming changes in our regulations for title XVI of the Social
Security Act (Act).
DATES: To ensure that your comments are considered, we must receive
them by no later than July 22, 2013.
ADDRESSES: You may submit comments by any one of three methods--
Internet, fax, or mail. Do not submit the same comments multiple times
or by more than one method. Regardless of which method you choose,
please state that your comments refer to Docket No. SSA-2011-0081 so
that we may associate your comments with the correct regulation.
Caution: You should be careful to include in your comments only
information that you wish to make publicly available. We strongly urge
you not to include in your comments any personal information, such as
Social Security numbers or medical information.
1. Internet: We strongly recommend that you submit your comments
via the Internet. Please visit the Federal eRulemaking portal at http://www.regulations.gov. Use the Search function to find docket number
SSA-2011-0081. The system will issue a tracking number to confirm your
submission. You will not be able to view your comment immediately
because we must post each comment manually. It may take up to a week
for your comment to be viewable.
2. Fax: Fax comments to (410) 966-2830.
3. Mail: Address your comments to the Office of Regulations and
Reports Clearance, Social Security Administration, 107 Altmeyer
Building, 6401 Security Boulevard, Baltimore, Maryland 21235-6401.
Comments are available for public viewing on the Federal
eRulemaking portal at http://www.regulations.gov or in person, during
regular business hours, by arranging with the contact person identified
below.
FOR FURTHER INFORMATION CONTACT: Cheryl A. Williams, Office of Medical
Listings Improvement, Social Security Administration, 6401 Security
Boulevard, Baltimore, Maryland 21235-6401, (410) 965-1020. 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:
What revisions are we proposing?
We propose to:
[[Page 30250]]
Comprehensively revise 100.00, the Growth Impairment body
system for children. We would apply the new listings in the body system
only to infants who were born with low birth weight and to children who
have not attained age 3 who fail to grow at the expected rate and have
developmental delay (failure to thrive or FTT) as a listing level
condition. We would no longer have impairment listings for linear
growth alone.
Revise listing 105.08 in the Digestive System. We would
replace references to measurements on the latest versions of the
Centers for Disease Control and Prevention's (CDC) growth charts with
weight-for-length growth tables that we currently use for children from
birth to attainment of age 2, and the body mass index (BMI)-for-age
growth tables that we currently use for children age 2 to attainment of
age 18. We would also provide more detailed listing criteria and
guidance for applying the revised listing.
Revise listings in the respiratory, cardiovascular, and
immune systems that refer to the CDC's or other growth charts to
incorporate the tables and other criteria we are proposing for listing
105.08. We would also refer to the tables in proposed listing 105.08 in
one of the listings we are proposing for growth failure in children. In
addition, we propose to add a listing in the Genitourinary Impairments
body system similar to the listings in the other body systems.
Revise the introductory text and listings to use the term
``growth failure'' for the body systems with growth listings. Our
program experience shows that we are more likely to see the term
``growth failure'' in medical evidence than other terms now in our
listings. The term ``growth failure'' includes impairment of linear and
weight growth.
Why are we proposing these revisions?
We propose these revisions to reflect medical advances and our
program experience. We last published final rules making comprehensive
revisions to the growth section for children (people under age 18),
section 100.00, on December 6, 1985.\1\ We last published final rules
revising 105.08 in the digestive system on October 19, 2007.\2\ In the
preamble to those rules, we indicated that we would periodically review
and update the listings in light of our program experience and medical
advances. Since that time, however, we have only extended the effective
date of the rules.\3\
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\1\ 50 FR 50068.
\2\ 72 FR 59398.
\3\ We published technical revisions to the listings on April
24, 2002. 67 FR 20018. These revisions included changes to the
growth impairment and digestive system listings for children, but
the revisions were not comprehensive. We extended the expiration
date of the current listings for several body systems, including the
growth impairment and digestive system listings, in final rules
published on June 13, 2012. 77 FR 35264. The final rules extended
the date on which the current growth impairment listings will no
longer be effective to July 1, 2014 and the date on which the
current digestive system listings will no longer be effective to
April 1, 2014. 77 FR 35265.
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How did we develop these proposed revisions?
In developing these proposed revisions, we considered public
comments received in response to the request for comments and the ANPRM
we published in the Federal Register on June 14, 2000 and September 8,
2005.\4\ In the request for comments and ANPRM, we announced our plans
to update and revise the growth impairment listings, and we invited
interested parties to send us written comments and suggestions.\5\ On
November 18, 2005, we hosted a policy outreach conference on ``Growth
Disorders in the Disability Programs'' in Atlanta, Georgia.\6\ From
August 25 through 26, 2005, we hosted a policy outreach conference on
``Respiratory Disorders in the Disability Programs'' in Chicago,
Illinois.\7\ We also considered the Institute of Medicine consensus
report, HIV and Disability: Updating the Social Security Listings, in
setting CD4 values in combination with growth failure in children.\8\
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\4\ June 14, 2000 (65 FR 37321) and September 8, 2005 (70 FR
53323).
\5\ Although we indicated that we would not summarize or respond
to the comments, we read and considered them carefully. You can read
the September 8, 2005 ANPRM and the comments we received in response
to the ANPRM at http://www.regulations.gov. Use the Search function
to find docket number SSA-2006-0181. You can read the June 14, 2000
request for comments at https://federalregister.gov/a/00-14841.
\6\ You can read a transcript of the policy conference at http://www.regulations.gov. Use the Search function to find document ID
number SSA-2006-0181-0002.
\7\ You can read the transcript of the policy conference at
http://www.regulations.gov. Use the Search function to find document
ID number SSA-2006-0149-0002.
\8\ Institute of Medicine. (2010). HIV and disability: Updating
the Social Security Listings. Washington, DC: The National Academies
Press.
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We also considered information from a variety of sources,
including:
Individual medical experts in the field of growth and
development, experts in related fields, representatives from advocacy
groups for people with growth and developmental disorders, and people
with growth and developmental disorders;
People who make and review disability determinations and
decisions for us in State agencies, in our Office of Quality
Performance, and in our Office of Disability Adjudication and Review;
and
The published sources we list in the References section at
the end of this preamble.
What revisions are we proposing and why are we proposing them?
Current section 100.00, Growth Impairment
We propose to change the name of this section to ``Low Birth Weight
and Failure to Thrive'' to reflect the proposed changes to the
listings. We also propose to revise the introductory text to reflect
that we no longer use linear growth alone in the proposed listings. The
proposed introductory text explains the conditions we evaluate in this
section and provides guidance on how to apply the proposed listings.
Additionally, we propose to explain in section 100.00C.2.d that
under listing 100.05A for growth failure, any measurements taken before
the child attains age 2 can be used to evaluate the impairment under
the appropriate listing for the child's age. These measurements must be
taken within a 12-month period and be at least 60 days apart. A child
who attains age 3 could no longer be evaluated under these listings.
However, the measurements could be used to evaluate the child's
impairment under the most affected body system.
Current Listings 100.02 and 100.03, Growth Impairment
We propose to delete these listings because they are based on
linear (height) growth alone. Our adjudicative experience has shown
that a declining linear growth rate is not always indicative of a
disabling condition and that short stature in itself is not disabling.
Proposed Listing 100.04, Low Birth Weight in Infants From Birth To
Attainment of Age 1
We currently find low birth weight (LBW) infants disabled until the
attainment of age 1 under examples 6 and 7 in our functional
equivalence rule.\9\ We believe that it is simpler to provide a listing
for these children. In example 6, we currently find infants from birth
to the attainment of age 1 whose birth weight satisfy the objective
criteria to be disabled. In example 7, we currently find children whose
birth
[[Page 30251]]
weight and gestational age satisfy the objective criteria to be
disabled.
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\9\ See Sec. 416.926a(m)(6) and (m)(7).
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We also propose to provide a table of gestational ages and birth
weights that will help adjudicators determine when an infant's birth
weight, in combination with his or her gestational age, meets the
criteria for LBW under the proposed listing.
We would explain in proposed 100.00B that, for impairments that
meet the requirements in proposed listing 100.04A or 100.04B, we would
follow the guidance in our regulations for considering LBW claims for
medical reviews.\10\
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\10\ See Sec. 416.990(b)(11).
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Proposed Listing 100.05, Failure To Thrive in Children From Birth To
Attainment Of Age 3
We currently provide guidance in our operating instructions for
adjudicators to evaluate failure to thrive (FTT) in children from birth
to attainment of age 2 under 105.08, the listing for malnutrition due
to a digestive disorder.\11\ If the child does not have a digestive
disorder, we determine whether the child's growth disorder medically
equals the digestive listing. This determination can be especially
difficult when there are no identifiable or distinctive physical
findings related to the child's FTT that an adjudicator could compare
to the nutritional deficiency findings required in 105.08A. We are
proposing listing 100.05 in which we would evaluate FTT in children
from birth to attainment of age 3 regardless of whether there is a
known cause for the child's growth failure.
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\11\ POMS DI 24550.001 at https://secure.ssa.gov/poms.nsf/lnx/0424550001.
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Under our program rules, FTT can be a medically determinable
impairment because it results from anatomical, physiological, or
psychological abnormalities shown by medically acceptable clinical and
laboratory diagnostic techniques. There is, however, no single
definition or description of FTT. Medical sources reference various
growth charts and growth percentiles for establishing FTT. Some medical
sources establish a diagnosis of FTT based on the child's growth
failure and various degrees of developmental delay. Others establish
FTT based on growth failure alone. In proposed 100.05, we would require
documentation of both growth failure and developmental delay to
establish FTT as a listing-level condition because our program
experience has shown that growth failure alone is not disabling.
In proposed 100.05A, we would evaluate growth failure by using the
appropriate table(s) under proposed 105.08B in the digestive system to
determine whether a child's growth is less than the third percentile.
We would require three weight-for-length measurements for children from
birth to attainment of age 2 or three body mass index (BMI)-for-age
measurements for children age 2 to attainment of age 3 that are within
a consecutive 12-month period and at least 60 days apart. If a child
attains age 2 during the adjudication period, measurements taken before
the child attains age 2 can be used to evaluate the impairment under
the appropriate listing for the child's age, if the measurements were
obtained within a 12-month period and are at least 60 days apart. We
believe this number and interval of measurements over a consecutive 12-
month period would establish that an infant's or a toddler's rate of
growth reflects actual growth failure and not a short-term delay in
rate of growth. This guidance on growth measurements apply to all
affected body systems. The child does not have to have a digestive
disorder for the purposes of proposed 100.05.
In proposed 100.05B, we would require a report from an acceptable
medical source that establishes the appropriate level of delay in a
child's development. Acceptable medical sources or early intervention
specialists, physical or occupational therapists, and other sources may
conduct standardized developmental assessments and developmental
screenings.\12\ The results of these tests and screenings must include
a statement or records from an acceptable medical source indicating the
child has a developmental delay. We would document the severity of the
developmental delay with test results from a standardized developmental
assessment that compares a child's level of development to the level
typically expected for his or her chronological age. The required level
of severity would be met if the test results indicate that the child's
development is not more than two-thirds of the level typically expected
for the child's age or results in a valid score that is at least two
standard deviations below the mean.
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\12\ See, Sec. Sec. 404.1513(a) and 416.913(a).
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In proposed 100.05C, we would require developmental delay
established by an acceptable medical source and documented by findings
from two narrative developmental reports dated at least 120 days apart
that indicate development not more than two-thirds of the level
typically expected for a child's age. We would require the narrative
report to include the child's developmental history, physical
examination findings, and an overall assessment of the child's
development (that is, more than one or two isolated skills) by the
acceptable medical source. Abnormal findings noted on repeated
examinations, and information in narrative developmental reports, that
may include the results of developmental screening tests, can identify
a child who is not developing or achieving skills within expected
timeframes.
Our current operating instructions limit evaluation of FTT to
children from birth to attainment of age 2. We would extend the age
limit in the proposed listing because our adjudicative experience
indicates that FTT may continue to attainment of age 3. Our
adjudicative experience has been that, by age 3, most children who
develop or continue to experience growth failure will have an
identifiable cause for their growth failure, which we evaluate under
the affected body system.
Proposed Listing 103.06, Growth Failure Due to Any Chronic Respiratory
Disorder
We propose to add 103.06, under the respiratory body system, for
evaluating growth failure in children with chronic respiratory
disorders because growth failure is a common complication of chronic
respiratory disorders in children. We would add the same growth failure
criteria as proposed in 105.08B. We would also provide guidance in the
introductory text to adjudicators on how to evaluate growth failure
under the proposed listing.
Proposed Listing 104.02C
We propose to revise 104.02C, under the cardiovascular body system,
to conform to criteria we are proposing to growth listings in other
body systems. We also propose to change the current title of the
listing from Growth disturbance with to Growth failure as required in 1
or 2. We would add the same growth failure criteria as proposed in
105.08B. We would also provide guidance in the introductory text on how
to evaluate growth failure under the proposed listing.
Proposed Listing 105.08, Growth Failure Due to Any Digestive Disorder
We propose to revise the title of listing 105.08, under the
digestive body system, to change Malnutrition due to any digestive
disorder to Growth failure due to any digestive disorder. We would
provide guidance in the introductory text on how to evaluate growth
failure under the proposed listing.
[[Page 30252]]
We propose to revise the current criteria in 105.08A. We would
require two laboratory values at least 60 days apart within a
consecutive 12-month period instead of a consecutive 6-month period to
be consistent with pediatric standards of care for evaluating growth
over time. We would remove the phrase ``despite continuing treatment as
prescribed'' because we address the issue of following prescribed
treatment elsewhere in our rules.\13\ We would also remove current
105.08A3 because the criterion is no longer a good indicator of
nutritional deficiency. As a result of advances in medical therapy, the
vitamin or mineral deficiencies referred to in the current listing can
be supplemented in the diet.
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\13\ See Sec. 416.930.
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We would change the title of 105.08B from Growth retardation
documented by one of the following to Growth failure as required in 1
or 2. We would also require at least 60 days between the growth
measurements to be consistent with similar rules in other body systems.
In proposed 105.08B, we would add the weight-for-length growth
tables that we currently use for children from birth to attainment of
age 2, and the body mass index (BMI)-for-age growth tables that we use
for children age 2 to attainment of age 18, both of which are in our
current operating instructions for determining growth failure.\14\ We
would no longer refer adjudicators to the Centers for Disease Control
and Prevention's (CDC's) latest recommended growth charts. In making
this proposed change, we considered the CDC's recently published
revised growth charts for children that adopt the World Health
Organization (WHO) standards for monitoring growth in children birth to
age 2.\15\ There are several reasons why we did not adopt these growth
charts for purposes of evaluating growth under our listings. The WHO's
growth charts use a 2.3 percentile standard to represent two standard
deviations below the mean and describe the growth of healthy children
in optimal conditions. However, we currently evaluate growth failure
based on growth measurements that are less than the 3.0 or third
percentile of the tables in our current operating instructions to
represent two standard deviations below the mean. Additionally, the 3.0
or third percentile based on the WHO's growth charts would identify
fewer children than our current third percentile tables, which we base
on CDC's growth charts prior to their adoption of the WHO recommended
growth standards.
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\14\ POMS DI 24550.001 Weight-for-Length Table (Birth to the
Attainment of Age 2) at http://policynet.ba.ssa.gov/poms.nsf/lnx/0424550001.and POMS DI 24550.002 Body-Mass-Index-for-Age Tables (Age
2 to the Attainment of Age 18) at https://secure.ssa.gov/apps10/poms.nsf/lnx/0424550002.
\15\ The CDC's Growth Charts at http://www.cdc.gov/growthcharts/.
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The third percentile BMI-for-age tables we propose to add to
listing 105.08B for children age 2 to attainment of age 18 are based on
CDC's current BMI-for-age growth charts. We propose adding the third
percentile tables in 105.08B instead of growth charts because, in our
adjudicative experience, we have found that plotted growth charts are
not always included in a child's medical records whereas weight and
length or weight measurements are. It is also simpler for our
adjudicators to apply the measurements to the third percentile tables
rather than plotting measurements themselves on a growth chart. Using
weight-for-length measurements also means that adjudicators do not need
to adjust for prematurity.
We believe that it remains programmatically correct for us to
continue to determine growth failure for children from birth to
attainment of age 18 using the tables currently in our operating
instructions. We believe that children who have growth measurements
that are less than the third percentile, and have another impairment
with marked limitations as described in each of the proposed listings
containing growth criteria, are disabled.
Proposed Listing 106.08, Growth Failure Due to Any Chronic Renal
Disease
We propose to add 106.08, under the genitourinary body system, for
evaluating growth failure in children with chronic renal disease
because growth failure is a common complication of chronic renal
disease in children. The kidneys regulate the amounts and interactions
of nutrients, including proteins, minerals, and vitamins, necessary for
growth. Impaired kidney function and the side effects of treatment may
decrease a child's appetite and further limit the utilization of these
nutrients, resulting in growth failure. We would add the same growth
failure criteria as proposed in 105.08B. We would also provide guidance
in the introductory text on how to evaluate growth failure under the
proposed listing.
Proposed Listing 114.08H, Immune Suppression and Growth Failure
We propose to revise 114.08H, under the immune body system, for
children with growth failure due to HIV-induced immune suppression to
conform to criteria we are proposing for growth listings in other body
systems. We would remove the current weight-loss criteria and add
laboratory criteria and the same growth failure criteria as proposed in
105.08B. We propose to quantify the degree of HIV-induced immune
suppression by specifying CD4 laboratory criteria for different ages,
following accepted medical standards of care. We would also provide
guidance in the introductory text on how to evaluate growth failure
under the proposed listing.
Other Changes
We also propose the following conforming changes:
Revise Sec. 416.924b(b) to reflect the removal of
listings 100.002 and 100.03 and the addition of 100.04;
Revise Sec. 416.926a(m) by removing examples 6 and 7 for
children with low birth weight because we are providing listings with
these specific criteria; and
Revise Sec. 416.934 \16\ by adding two presumptive
disability categories for infants with low birth weight. This revision
reflects our longstanding operational instructions for making findings
of presumptive disability for such infants.
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\16\ Section 416.934 provides a list of impairment categories
that employees in our field offices may use to make findings of
presumptive disability in SSI claims without obtaining any medical
evidence. We may make SSI payments based on presumptive disability
or presumptive blindness when there is a high probability that we
will find a claimant disabled or blind when we make our formal
disability determination at the initial level of our administrative
review process. Sec. 416.933.
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What is our authority to make rules and set procedures for determining
whether a person is disabled under the statutory definition?
Under the Act, we have full power and authority to make rules and
regulations and to establish necessary and appropriate procedures to
carry out such provisions. Sections 205(a), 702(a)(5), and 1631(d)(1).
How long would these proposed rules be effective?
If we publish these proposed rules as final rules, they will remain
in effect for 5 years after the date they become effective unless we
extend them or revise and issue them again.
Clarity of These Proposed Rules
Executive Order 12866, as supplemented by Executive Order 13563,
requires each agency to write all rules in plain language. In addition
to your substantive comments on these
[[Page 30253]]
proposed rules, we invite your comments on how to make them easier to
understand.
For example:
Would more, but shorter, sections be better?
Are the requirements in the rules clearly stated?
Have we organized the material to suit your needs?
Could we improve clarity by adding tables, lists, or
diagrams?
What else could we do to make the rules easier to
understand?
Do the rules contain technical language or jargon that is
not clear?
Would a different format make the rules easier to
understand, e.g., grouping and order of sections, use of headings,
paragraphing?
When will we start to use these rules?
We will not use these rules until we evaluate public comments and
publish final rules in the Federal Register. All final rules we issue
include an effective date. We will continue to use our current rules
until that date. If we publish final rules, we will include a summary
of those relevant comments we received along with responses and an
explanation of how we will apply the new rules.
Regulatory Procedures
Executive Order 12866, as Supplemented by Executive Order 13563
We consulted with the Office of Management and Budget (OMB) and
determined that these proposed rules meet the criteria for a
significant regulatory action under Executive Order 12866, as
supplemented by Executive Order 13563. Therefore, OMB reviewed them.
Regulatory Flexibility Act
We certify that these proposed rules would not have a significant
economic impact on a substantial number of small entities because they
affect individuals only. Therefore, a regulatory flexibility analysis
is not required under the Regulatory Flexibility Act, as amended.
Paperwork Reduction Act
These proposed rules do not create any new or affect any existing
collections and, therefore, do not require Office of Management and
Budget approval under the Paperwork Reduction Act.
References
We consulted the following references when we developed these
proposed rules:
Cole, C., Binney, G., Casey, P., Fiascone, J., Hagadorn, J., &
Kim, C. (2002). Criteria for determining disability in infants and
children: Low birth weight. Evidence Reports/Technology Assessments,
70(1), (AHRQ Publication No. 03-E010). Rockville, MD: Agency for
Healthcare Research and Quality. Retrieved from http://www.ahrq.gov/downloads/pub/evidence/pdf/lbw/lbw.pdf
Council on Children with Disabilities, Section on Developmental
Behavioral Pediatrics. (2006). Identifying infants and young
children with developmental disorders in the medical home: An
algorithm for developmental surveillance and screening. American
Academy of Pediatrics, 118(1), 405-420. doi:10.1542/peds.2006-1231
Fattal-Valevski A., Leitner, Y., Kutai, M., Tal-Posener, E.,
Tomer, A., Lieberman, D., * * * Harel, S. (1999). Neurodevelopmental
outcome in children with intrauterine growth retardation: A 3-year
follow-up. Journal of Child Neurology, 14(11), 724-727.
doi:10.111777/088307389901401107
Ficicioglu, C., & Haack, K. (2009). Failure to thrive: When to
suspect inborn errors of metabolism. Pediatrics, 124(3), 972-979.
doi:10.1542/peds.2008-3724
Gahagan, S. (2006). Failure to thrive: A consequence of
undernutrition. Pediatrics in Review, 27(1), 1-11. doi:10.1542/
pir.27-1-e1
Gayle, H., Dibley, M., Marks, J., & Trowbridge, F. (1987).
Malnutrition in the first two years of life: The contribution of low
birth weight to population estimates in the United States. American
Journal of Diseases of Children, 141(5), 531-534. doi:10.1001/
archpedi.1987.04460050073034
Grummer-Strawn, L.M., Krebs, N.F., & Reinhold, C. (2010). Use of
world health organization and CDC growth charts for children aged 0-
59 months in the United States. Centers for Disease Control and
Prevention: Morbidity and Mortality Weekly Report, 59(RR-09), 1-15.
Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5909a1.htm
Institute of Medicine. (2010). Cardiovascular disability:
Updating the Social Security listings. Washington, DC: The National
Academies Press.
Krugman, S.D., & Dubowitz, H. (2003). Failure to thrive.
American Family Physician, 68(5), 879-884. Retrieved from http://www.aafp.org/afp/2003/0901/p879.pdf
Lipkin, P.H. (2009, November). Identifying developmental
problems early: New methods, new initiatives. Developmental
Disorders Presentation. Lecture conducted from Social Security
Administration Headquarters, Baltimore, MD.
Maggioni, A., & Lifshitz, F. (1995). Nutritional management of
failure to thrive. Pediatric Clinics of North America, 42(4), 791-
810.
National Kidney Foundation. (2009). KDOQI Clinical Practice
Guideline for Nutrition in Children with CKD: 2008 Update. American
Journal of Kidney Diseases, 53(3), supplement 2. Retrieved from
http://www.kidney.org/professionals/kdoqi/guidelines_updates/pdf/CPGPedNutr2008.pdf
Olsen, E.M. (2006). Failure to thrive: Still a problem of
definition. Clinical Pediatrics, 45(1), 1-6. doi:10/1177/
000992280604500101
Olsen, E.M., Petersen, J., Skovgaard, A.M., Weile, B.,
J[oslash]rgensen, T., & Wright, C.M. (2006). Failure to thrive: The
prevalence and concurrence of anthropometric criteria in a general
infant population. Archives of Disease in Childhood, 92(2), 109-114.
doi:10.1136/adc.2005.080333
Rabinowitz, S., Madhavi, K., & Rogers, G. (2010, May 4).
Nutritional consideration in failure to thrive. Retrieved from
http://emedicine.medscape.com/article/985007-overview
Schwartz, I.D. (2000). Failure to thrive: An old nemesis in the
new millennium. Pediatrics in Review, 21(8), 257-264. doi:10.1542/
pir.21-8-257
Shackelford, J. (2006). State and jurisdictional eligibility
definitions for infants and toddlers with disabilities under IDEA.
National Early Childhood TA Center Notes, 21, 1-16. Retrieved from
http://www.nectac.org/~pdfs/pubs/SICCoverview.pdf
Simpson, G.A., Colpe, L., & Greenspan, S. (2003). Measuring
functional developmental delay in infants and young children:
Prevalence rates from the NHIS-D. Paediatric and Perinatal
Epidemiology, 17(1), 68-80. doi:10.1046/j.1365-3016.2003.00459.x
Social Security Administration. (2005). Growth disorders in the
disability programs [Conference transcript]. Retrieved from http://www.regulations.gov/#!documentDetail;D=SSA-2006-0181-0002
Social Security Administration. (2005). Respiratory disorders in
the disability programs [Conference transcript]. Retrieved from
http://www.regulations.gov/#!documentDetail;D=SSA-2006-0149-0002
Zenel, J.A. (1997). Failure to thrive: A general pediatrician's
perspective. Pediatrics in Review, 18(11), 371. doi:10.1542/pir.18-
11-371
We will make these references available to you for inspection if
you are interested in reading them. Please make arrangements with the
contact person shown in this preamble if you would like to review any
reference materials.
(Catalog of Federal Domestic Assistance Program Nos. 96.001, Social
Security--Disability Insurance; 96.002, Social Security--Retirement
Insurance; 96.004, Social Security--Survivors Insurance; and 96.006,
Supplemental Security Income)
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).
[[Page 30254]]
Dated: May 9, 2013.
Carolyn W. Colvin,
Acting Commissioner of Social Security.
For the reasons set out in the preamble, we propose to amend 20 CFR
part 404 subpart P and part 416 subpart I as set forth below:
PART 404--FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE
(1950- )
Subpart P--[Amended]
0
1. The authority citation for subpart P of part 404 continues to read
as follows:
Authority: Secs. 202, 205(a)-(b) and (d)-(h), 216(i), 221(a),
(i), and (j), 222(c), 223, 225, and 702(a)(5) of the Social Security
Act (42 U.S.C. 402, 405(a)-(b) and (d)-(h), 416(i), 421(a), (i), and
(j), 422(c), 423, 425, and 902(a)(5)); sec. 211(b), Pub. L. 104-193,
110 Stat. 2105, 2189; sec. 202, Pub. L. 108-203, 118 Stat. 509 (42
U.S.C. 902 note).
0
2. Amend appendix 1 to subpart P of part 404 by revising item 1 of the
introductory text before part A of appendix 1, and in part B of
appendix 1 by:
0
a. Revising the body system name for section 100.00 in the table of
contents,
0
b. Revising section 100.00,
0
c. Adding section 103.00F,
0
d. Adding listing 103.06,
0
e. Revising section 104.00C2b,
0
f. Revising section 104.00C2bii,
0
g. Adding section 104.00C3,
0
h. Revising listing 104.02C,
0
i. Revising section 105.00G,
0
j. Revising listing 105.08,
0
k. Adding section 106.00E5,
0
l. Adding listing 106.08,
0
m. Adding section 114.00F4, and
0
n. Revising listing 114.08H,
The revisions and additions read as follows:
Appendix 1 to Subpart P of Part 404--Listing of Impairments
* * * * *
1. Low Birth Weight and Failure To Thrive (100.00): [DATE 5
YEARS FROM THE EFFECTIVE DATE OF THE FINAL RULE].
* * * * *
Part B
* * * * *
100.00 Low Birth Weight and Failure To Thrive.
* * * * *
100.00 LOW BIRTH WEIGHT AND FAILURE TO THRIVE
A. What conditions do we evaluate under these listings? We
evaluate low birth weight (LBW) in infants from birth to attainment
of age 1 and failure to thrive (FTT) in infants and toddlers from
birth to attainment of age 3.
B. How do we evaluate disability based on LBW under 100.04? In
100.04A and 100.04B, we use an infant's birth weight as documented
by an original or certified copy of the infant's birth certificate
or by a medical record signed by a physician. Birth weight means the
first weight recorded after birth. In 100.04B, gestational age is
the infant's age based on the date of conception as recorded in the
medical record. If your impairment meets the requirements for
listing 100.04A or 100.04B, we will follow the rules in Sec.
416.990(b)(11) of this chapter.
C. How do we evaluate disability based on FTT under 100.05?
1. General. We establish FTT with or without a known cause when
we have documentation of an infant's or a toddler's growth failure
and developmental delay from an acceptable medical source(s) as
defined in Sec. 416.913(a) of this chapter. We require
documentation of growth measurements in 100.05A and developmental
delay described in 100.05B or 100.05C within the same consecutive
12-month period. The dates of developmental testing and reports may
be different from the dates of growth measurements. After the
attainment of age 3, we evaluate growth failure under the affected
body system(s).
2. Growth failure. Under 100.05A, we use the appropriate
table(s) under 105.08B in the digestive system to determine whether
a child's growth is less than the third percentile. The child does
not need to have a digestive disorder for purposes of 100.05.
a. For children from birth to attainment of age 2, we use the
weight-for-length table corresponding to the child's gender (Table I
or Table II).
b. For children age 2 to attainment of age 3, we use the body
mass index (BMI)-for-age table corresponding to the child's gender
(Table III or Table IV).
c. BMI is the ratio of a child's weight to the square of his or
her height. We calculate BMI using the formulas in 105.00G2c.
d. Growth measurements. The weight-for-length measurements for
children birth to the attainment of age 2 and body mass index (BMI)-
for-age measurements for children age 2 to attainment of age 3 that
are required for this listing must be obtained within a 12-month
period and at least 60 days apart. If a child attains age 2 during
the evaluation period additional measurements are not needed. Any
measurements taken before the child attains age 2 can be used to
evaluate the impairment under the appropriate listing for the
child's age. If the child attains age 3 during the evaluation
period, the measurements can be used to evaluate them in the most
affected body system.
3. Developmental delay.
a. Under 100.05B and C, we use reports from acceptable medical
sources to establish delay in a child's development.
b. Under 100.05B, we document the severity of developmental
delay with results from a standardized developmental assessment,
which compares a child's level of development to the level typically
expected for his or her chronological age. If the child was born
prematurely, we may use the corrected chronological age (CCA) for
comparison. (See Sec. 416.924b(b) of this chapter.) CCA is the
chronological age adjusted by a period of gestational prematurity.
CCA = (chronological age)-(number of weeks premature). Acceptable
medical sources or early intervention specialists, physical or
occupational therapist, and other sources may conduct standardized
developmental assessments and developmental screenings. The results
of these tests and screenings must be accompanied by a statement or
records from an acceptable medical source who established the child
has a developmental delay.
c. Under 100.05C, when there are no results from a standardized
developmental assessment in the case record, we need narrative
developmental reports from the child's medical sources in sufficient
detail to assess the severity of his or her developmental delay. A
narrative developmental report is based on clinical observations,
progress notes, and well-baby check-ups. To meet the requirements
for 100.05C, the report must include: the child's developmental
history; examination findings (with abnormal findings noted on
repeated examinations); and an overall assessment of the child's
development (that is, more than one or two isolated skills) by the
medical source. Some narrative developmental reports may include
results from developmental screening tests, which can identify a
child who is not developing or achieving skills within expected
timeframes. Although medical sources may refer to screening test
results as supporting evidence in the narrative developmental
report, screening test results alone cannot establish a diagnosis or
the severity of developmental delay.
D. How do we evaluate disorders that do not meet one of these
listings?
1. We may find infants disabled due to other disorders when
their birth weights are greater than 1200 grams but less than 2000
grams and their weight and gestational age do not meet 100.04. The
most common disorders of prematurity and LBW include retinopathy of
prematurity (ROP), chronic lung disease of infancy (CLD, previously
known as bronchopulmonary dysplasia, or BPD), intraventricular
hemorrhage (IVH), necrotizing enterocolitis (NEC), and
periventricular leukomalacia (PVL). Other disorders include poor
nutrition and growth failure, hearing disorders, seizure disorders,
cerebral palsy, and developmental disorders. We evaluate these
disorders under the affected body systems.
2. We may evaluate infants and toddlers with growth failure that
is associated with a known medical disorder under the body system of
that medical disorder, for example, the respiratory or digestive
body systems.
3. If an infant or toddler has a severe medically determinable
impairment(s) that does not meet the criteria of any listing, we
must also consider whether the child has an impairment(s) that
medically equals a listing (see Sec. 416.926 of this chapter). If
the child's impairment(s) does not meet or medically equal a
listing, we will determine whether the child's impairment(s)
functionally equals the listings (see Sec. 416.926a of this
chapter) considering the factors in Sec. 416.924a of this chapter.
We use the rules in section Sec. 416.994a of this chapter when we
decide whether a child continues to be disabled.
[[Page 30255]]
100.01 Category of Impairments, Low Birth Weight and Failure To
Thrive.
* * * * *
100.04 Low birth weight in infants from birth to attainment of
age 1.
A. Birth weight (see 100.00B) of less than 1200 grams.
OR
B. The following gestational age and birth weight:
------------------------------------------------------------------------
Gestational age (in weeks) Birth weight
------------------------------------------------------------------------
37-40............................... 2000 grams or less.
36.................................. 1875 grams or less.
35.................................. 1700 grams or less.
34.................................. 1500 grams or less.
33.................................. 1325 grams or less.
------------------------------------------------------------------------
100.05 Failure to thrive in children from birth to attainment of
age 3 (see 100.00C), documented by A and B, or A and C.
A. Growth failure as required in 1 or 2:
1. For children from birth to attainment of age 2, three weight-
for-length measurements that are:
a. Within a consecutive 12-month period; and
b. At least 60 days apart; and
c. Less than the third percentile on the appropriate weight-for-
length table in listing 105.08B1; or
2. For children age 2 to attainment of age 3, three body mass
index (BMI)-for-age measurements that are:
a. Within a consecutive 12-month period; and
b. At least 60 days apart; and
c. Less than the third percentile on the appropriate BMI-for-age
table in listing 105.08B2.
AND
B. Developmental delay (see 100.00C1 and C3), established by an
acceptable medical source and documented by findings from one report
of a standardized developmental assessment (see 100.00C3b) that:
1. Shows development not more than two-thirds of the level
typically expected for the child's age; or
2. Results in a valid score that is at least two standard
deviations below the mean.
OR
C. Developmental delay (see 100.00C3), established by an
acceptable medical source and documented by findings from two
narrative developmental reports (see 100.00C3c) that:
1. Are dated at least 120 days apart (see 100.00C1); and
2. Indicate development not more than two-thirds of the level
typically expected for the child's age.
* * * * *
103.00 RESPIRATORY SYSTEM
* * * * *
F. How do we evaluate growth failure due to any chronic
respiratory disorder?
1. To evaluate growth failure due to any chronic respiratory
disorder, we require documentation of the oxygen supplementation
described in 103.06A and the growth measurements in 103.06B within
the same consecutive 12-month period. The dates of oxygen
supplementation may be different from the dates of growth
measurements.
2. Under 103.06B, we use the appropriate table(s) under 105.08B
in the digestive system to determine whether a child's growth is
less than the third percentile.
a. For children from birth to attainment of age 2, we use the
weight-for-length table corresponding to the child's gender (Table I
or Table II).
b. For children age 2 to attainment of age 18, we use the body
mass index (BMI)-for-age table corresponding to the child's gender
(Table III or Table IV).
c. BMI is the ratio of a child's weight to the square of his or
her height. We calculate BMI using the formulas in 105.00G2c.
* * * * *
103.06 Growth failure due to any chronic respiratory disorder
(see 103.00F), documented by:
A. Hypoxemia with the need for at least 1.0 L/min of oxygen
supplementation for at least 4 hours per day and for at least 90
consecutive days.
AND
B. Growth failure as required in 1 or 2:
1. For children from birth to attainment of age 2, three weight-
for-length measurements that are:
a. Within a consecutive 12-month period; and
b. At least 60 days apart; and
c. Less than the third percentile on the appropriate weight-for-
length table under 105.08B1; or
2. For children age 2 to attainment of age 18, three body mass
index (BMI)-for-age measurements that are:
a. Within a consecutive 12-month period; and
b. At least 60 days apart; and
c. Less than the third percentile on the appropriate BMI-for-age
table under 105.08B2.
* * * * *
104.00 CARDIOVASCULAR SYSTEM
* * * * *
C. Evaluating Chronic Heart Failure.
* * * * *
2. What evidence of CHF do we need?
* * * * *
b. To establish that you have chronic heart failure, we require
that your medical history and physical examination describe
characteristic symptoms and signs of pulmonary or systemic
congestion or of limited cardiac output associated with abnormal
findings on appropriate medically acceptable imaging. When a
remediable factor, such as arrhythmia, triggers an acute episode of
heart failure, you may experience restored cardiac function, and a
chronic impairment may not be present.
* * * * *
(ii) During infancy, other manifestations of chronic heart
failure may include repeated lower respiratory tract infections.
* * * * *
3. How do we evaluate growth failure due to CHF?
a. To evaluate growth failure due to CHF, we require
documentation of the clinical findings of CHF described in 104.00C2
and the growth measurements in 104.02C within the same consecutive
12-month period. The dates of clinical findings may be different
from the dates of growth measurements.
b. Under 104.02C, we use the appropriate table(s) under 105.08B
in the digestive system to determine whether a child's growth is
less than the third percentile.
(i) For children from birth to attainment of age 2, we use the
weight-for-length table corresponding to the child's gender (Table I
or Table II).
(ii) For children age 2 to attainment of age 18, we use the body
mass index (BMI)-for-age table corresponding to the child's gender
(Table III or Table IV).
(iii) BMI is the ratio of a child's weight to the square of his
or her height. We calculate BMI using the formulas in 105.00G2c.
* * * * *
104.02 Chronic heart failure while on a regimen of prescribed
treatment, with symptoms and signs described in 104.00C2 and with
one of the following:
* * * * *
C. Growth failure as required in 1 or 2:
1. For children from birth to attainment of age 2, three weight-
for-length measurements that are:
a. Within a consecutive 12-month period; and
b. At least 60 days apart; and
c. Less than the third percentile on the appropriate weight-for-
length table under 105.08B1; or
2. For children age 2 to attainment of age 18, three body mass
index (BMI)-for-age measurements that are:
a. Within a consecutive 12-month period; and
b. At least 60 days apart; and
c. Less than the third percentile on the appropriate BMI-for-age
table under 105.08B2.
* * * * *
105.00 DIGESTIVE SYSTEM
* * * * *
G. How do we evaluate growth failure due to any digestive
disorder?
1. To evaluate growth failure due to any digestive disorder, we
require documentation of the laboratory findings of chronic
nutritional deficiency described in 105.08A and the growth
measurements in 105.08B within the same consecutive 12-month period.
The dates of laboratory findings may be different from the dates of
growth measurements.
2. Under 105.08B, we evaluate a child's growth failure by using
the appropriate table for age and gender.
a. For children from birth to attainment of age 2, we use the
weight-for-length table (see Table I or Table II).
b. For children age 2 to attainment of age 18, we use the body
mass index (BMI)-for-age table (see Tables III or IV).
c. BMI is the ratio of a child's weight to the square of the
child's height. We calculate BMI using one of the following
formulas:
[[Page 30256]]
English Formula
BMI = [Weight in Pounds/(Height in Inches x Height in Inches)] x 703
Metric Formulas
BMI = Weight in Kilograms/(Height in Meters x Height in Meters)
BMI = [Weight in Kilograms/(Height in Centimeters x Height in
Centimeters)] x 10,000
* * * * *
105.08 Growth failure due to any digestive disorder (see
105.00G), documented by A and B:
A. Chronic nutritional deficiency present on at least two
evaluations at least 60 days apart within a consecutive 12-month
period documented by one of the following:
1. Anemia with hemoglobin less than 10.0 g/dL; or
2. Serum albumin of 3.0 g/dL or less;
AND
B. Growth failure as required in 1 or 2:
1. For children from birth to attainment of age 2, three weight-
for-length measurements that are:
a. Within a 12-month period; and
b. At least 60 days apart; and
c. Less than the third percentile on Table I or Table II; or
Table I--Males Birth to Attainment of Age 2 Third Percentile Values for Weight-for-Length
----------------------------------------------------------------------------------------------------------------
Weight Length Weight Length Weight
Length (centimeters) (kilograms) (centimeters) (kilograms) (centimeters) (kilograms)
----------------------------------------------------------------------------------------------------------------
45.0........................ 1.597 64.5........... 6.132 84.5........... 10.301
45.5........................ 1.703 65.5........... 6.359 85.5........... 10.499
46.5........................ 1.919 66.5........... 6.584 86.5........... 10.696
47.5........................ 2.139 67.5........... 6.807 87.5........... 10.895
48.5........................ 2.364 68.5........... 7.027 88.5........... 11.095
49.5........................ 2.592 69.5........... 7.245 89.5........... 11.296
50.5........................ 2.824 70.5........... 7.461 90.5........... 11.498
51.5........................ 3.058 71.5........... 7.674 91.5........... 11.703
52.5........................ 3.294 72.5........... 7.885 92.5........... 11.910
53.5........................ 3.532 73.5........... 8.094 93.5........... 12.119
54.5........................ 3.771 74.5........... 8.301 94.5........... 12.331
55.5........................ 4.010 75.5........... 8.507 95.5........... 12.546
56.5........................ 4.250 76.5........... 8.710 96.5........... 12.764
57.5........................ 4.489 77.5........... 8.913 97.5........... 12.987
58.5........................ 4.728 78.5........... 9.113 98.5........... 13.213
59.5........................ 4.966 79.5........... 9.313 99.5........... 13.443
60.5........................ 5.203 80.5........... 9.512 100.5.......... 13.678
61.5........................ 5.438 81.5........... 9.710 101.5.......... 13.918
62.5........................ 5.671 82.5........... 9.907 102.5.......... 14.163
63.5........................ 5.903 83.5........... 10.104 103.5.......... 14.413
----------------------------------------------------------------------------------------------------------------
Table II--Females Birth to Attainment of Age 2 Third Percentile Values for Weight-for-Length
----------------------------------------------------------------------------------------------------------------
Weight Length Weight Length Weight
Length (centimeters) (kilograms) (centimeters) (kilograms) (centimeters) (kilograms)
----------------------------------------------------------------------------------------------------------------
45.0........................ 1.613 64.5........... 5.985 84.5........... 10.071
45.5........................ 1.724 65.5........... 6.200 85.5........... 10.270
46.5........................ 1.946 66.5........... 6.413 86.5........... 10.469
47.5........................ 2.171 67.5........... 6.625 87.5........... 10.670
48.5........................ 2.397 68.5........... 6.836 88.5........... 10.871
49.5........................ 2.624 69.5........... 7.046 89.5........... 11.074
50.5........................ 2.852 70.5........... 7.254 90.5........... 11.278
51.5........................ 3.081 71.5........... 7.461 91.5........... 11.484
52.5........................ 3.310 72.5........... 7.667 92.5........... 11.691
53.5........................ 3.538 73.5........... 7.871 93.5........... 11.901
54.5........................ 3.767 74.5........... 8.075 94.5........... 12.112
55.5........................ 3.994 75.5........... 8.277 95.5........... 12.326
56.5........................ 4.220 76.5........... 8.479 96.5........... 12.541
57.5........................ 4.445 77.5........... 8.679 97.5........... 12.760
58.5........................ 4.892 78.5........... 8.879 98.5........... 12.981
59.5........................ 5.113 79.5........... 9.078 99.5........... 13.205
60.5........................ 5.333 80.5........... 9.277 100.5.......... 13.431
61.5........................ 5.552 81.5........... 9.476 101.5.......... 13.661
62.5........................ 5.769 82.5........... 9.674 102.5.......... 13.895
63.5........................ 5.769 83.5........... 9.872 103.5.......... 14.132
----------------------------------------------------------------------------------------------------------------
2. For children age 2 to attainment of age 18, three body mass
index (BMI)-for-age measurements that are:
a. Within a consecutive 12-month period; and
b. At least 60 days apart; and
c. Less than the third percentile on Table III or Table IV.
[[Page 30257]]
Table III--Males Age 2 to Attainment of Age 18 Third Percentile Values for BMI-for-Age
----------------------------------------------------------------------------------------------------------------
Age (yrs. and Age (yrs. and
Age (yrs. and mos.) BMI mos.) BMI mos.) BMI
----------------------------------------------------------------------------------------------------------------
2.0 to 2.1.................. 14.5 10.11 to 11.2.. 14.3 14.9 to 14.10.. 16.1
2.2 to 2.4.................. 14.4 11.3 to 11.5... 14.4 14.11 to 15.0.. 16.2
2.5 to 2.7.................. 14.3 11.6 to 11.8... 14.5 15.1 to 15.3... 16.3
2.8 to 2.11................. 14.2 11.9 to 11.11.. 14.6 15.4 to 15.5... 16.4
3.0 to 3.2.................. 14.1 12.0 to 12.1... 14.7 15.6 to 15.7... 16.5
3.3 to 3.6.................. 14.0 12.2 to 12.4... 14.8 15.8 to 15.9... 16.6
3.7 to 3.11................. 13.9 12.5 to 12.7... 14.9 15.10 to 15.11. 16.7
4.0 to 4.5.................. 13.8 12.8 to 12.9... 15.0 16.0 to 16.1... 16.8
4.6 to 5.0.................. 13.7 12.10 to 13.0.. 15.1 16.2 to 16.3... 16.9
5.1 to 6.0.................. 13.6 13.1 to 13.2... 15.2 16.4 to 16.5... 17.0
6.1 to 7.6.................. 13.5 13.3 to 13.4... 15.3 16.6 to 16.8... 17.1
7.7 to 8.6.................. 13.6 13.5 to 13.7... 15.4 16.9 to 16.10.. 17.2
8.7 to 9.1.................. 13.7 13.8 to 13.9... 15.5 16.11 to 17.0.. 17.3
9.2 to 9.6.................. 13.8 13.10 to 13.11. 15.6 17.1 to 17.2... 17.4
9.7 to 9.11................. 13.9 14.0 to 14.1... 15.7 17.3 to 17.5... 17.5
10.0 to 10.3................ 14.0 14.2 to 14.4... 15.8 17.6 to 17.7... 17.6
10.4 to 10.7................ 14.1 14.5 to 14.6... 15.9 17.8 to 17.9... 17.7
10.8 to 10.10............... 14.2 14.7 to 14.8... 16.0 17.10 to 17.11. 17.8
----------------------------------------------------------------------------------------------------------------
Table IV--Females Age 2 to Attainment of Age 18
Third Percentile Values for BMI-for-Age
----------------------------------------------------------------------------------------------------------------
Age (yrs. and Age (yrs. and
Age (yrs. and mos.) BMI mos.) BMI mos.) BMI
----------------------------------------------------------------------------------------------------------------
2.0 to 2.2.................. 14.1 10.8 to 10.10.. 14.0 14.3 to 14.5... 15.6
2.3 to 2.6.................. 14.0 10.11 to 11.2.. 14.1 14.6 to 14.7... 15.7
2.7 to 2.10................. 13.9 11.3 to 11.5... 14.2 14.8 to 14.9... 15.8
2.11 to 3.2................. 13.8 11.6 to 11.7... 14.3 14.10 to 15.0.. 15.9
3.3 to 3.6.................. 13.7 11.8 to 11.10.. 14.4 15.1 to 15.2... 16.0
3.7 to 3.11................. 13.6 11.11 to 12.1.. 14.5 15.3 to 15.5... 16.1
4.0 to 4.4.................. 13.5 12.2 to 12.4... 14.6 15.6 to 15.7... 16.2
4.5 to 4.11................. 13.4 12.5 to 12.6... 14.7 15.8 to 15.10.. 16.3
5.0 to 5.9.................. 13.3 12.7 to 12.9... 14.8 15.11 to 16.0.. 16.4
5.10 to 7.6................. 13.2 12.10 to 12.11. 14.9 16.1 to 16.3... 16.5
7.7 to 8.4.................. 13.3 13.0 to 13.2... 15.0 16.4 to 16.6... 16.6
8.5 to 8.10................. 13.4 13.3 to 13.4... 15.1 16.7 to 16.9... 16.7
8.11 to 9.3................. 13.5 13.5 to 13.7... 15.2 16.10 to 17.0.. 16.8
9.4 to 9.8.................. 13.6 13.8 to 13.9... 15.3 17.1 to 17.3... 16.9
9.9 to 10.0................. 13.7 13.10 to 14.0.. 15.4 17.4 to 17.7... 17.0
10.1 to 10.4................ 13.8 14.1 to 14.2... 15.5 17.8 to 17.11.. 17.1
10.5 to 10.7................ 13.9
----------------------------------------------------------------------------------------------------------------
* * * * *
106.00 GENITOURINARY IMPAIRMENTS
* * * * *
E. What other things do we consider when we evaluate your
genitourinary impairment under specific listings?
* * * * *
5. Growth failure due to any chronic renal disease (106.08).
a. To evaluate growth failure due to any chronic renal disease,
we require documentation of the laboratory findings described in
106.08A and the growth measurements in 106.08B within the same
consecutive 12-month period. The dates of laboratory findings may be
different from the dates of growth measurements.
b. Under 106.08B, we use the appropriate table(s) under 105.08B
in the digestive system to determine whether a child's growth is
less than the third percentile.
(i) For children from birth to attainment of age 2, we use the
weight-for-length table corresponding to the child's gender (Table I
or Table II).
(ii) For children age 2 to attainment of age 18, we use the body
mass index (BMI)-for-age table corresponding to the child's gender
(Table III or Table IV).
(iii) BMI is the ratio of a child's weight to the square of his
or her height. We calculate BMI using the formulas in 105.00G2c.
* * * * *
106.08 Growth failure due to any chronic renal disease (see
106.00E5), with:
A. Serum creatinine of 2 mg/dL or greater, documented at least
two times within a consecutive 12-month period with at least 60 days
between measurements.
AND
B. Growth failure as required in 1 or 2:
1. For children from birth to attainment of age 2, three weight-
for-length measurements that are:
a. Within a consecutive 12-month period; and
b. At least 60 days apart; and
c. Less than the third percentile on the appropriate weight-for-
length table under 105.08B1; or
2. For children age 2 to attainment of age 18, three body mass
index (BMI)-for-age measurements that are:
a. Within a consecutive 12-month period; and
b. At least 60 days apart; and
c. Less than the third percentile on the appropriate BMI-for-age
table under 105.08B2.
* * * * *
114.00 IMMUNE SYSTEM DISORDERS
* * * * *
F. How do we document and evaluate human immunodeficiency virus
(HIV) infection? * * *
* * * * *
4. HIV infection manifestations specific to children.
* * * * *
[[Page 30258]]
d. Growth failure due to HIV immune suppression.
(i) To evaluate growth failure due to HIV immune suppression, we
require documentation of the laboratory values described in 114.08H1
and the growth measurements in 114.08H2 or 114.08H3 within the same
consecutive 12-month period. The dates of laboratory findings may be
different from the dates of growth measurements.
(ii) Under 114.08H2 and 114.08H3, we use the appropriate table
under 105.08B in the digestive system to determine whether a child's
growth is less than the third percentile.
A. For children from birth to attainment of age 2, we use the
weight-for-length table corresponding to the child's gender (Table I
or Table II).
B. For children age 2 to attainment of age 18, we use the body
mass index (BMI)-for-age table corresponding to the child's gender
(Table III or Table IV).
C. BMI is the ratio of a child's weight to the square of his or
her height. We calculate BMI using the formulas in 105.00G2c.
* * * * *
114.08 Human immunodeficiency virus (HIV) infection. * * *
* * * * *
H. Immune suppression and growth failure (see 114.00F4d)
documented by 1 and 2, or by 1 and 3.
1. CD4 measurement:
a. For children from birth to attainment of age 5, CD4
percentage of less than 20 percent; or
b. For children age 5 to attainment of age 18, absolute CD4
count of less than 200 cells/mm\3\, or CD4 percentage of less than
14 percent; and
2. For children from birth to attainment of age 2, three weight-
for-length measurements that are:
a. Within a consecutive 12-month period; and
b. At least 60 days apart; and
c. Less than the third percentile on the appropriate weight-for-
length table under 105.08B1; or
3. For children age 2 to attainment of age 18, three body mass
index (BMI)-for-age measurements that are:
a. Within a consecutive 12-month period; and
b. At least 60 days apart; and
c. Less than the third percentile on the appropriate BMI-for-age
table under 105.08B2.
* * * * *
PART 416--SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND
DISABLED
Subpart I -- [Amended]
0
3. The authority citation for subpart I of part 416 continues to read
as follows:
Authority: Secs. 221(m), 702(a)(5), 1611, 1614, 1619, 1631(a),
(c), (d)(1), and (p), and 1633 of the Social Security Act (42 U.S.C.
421(m), 902(a)(5), 1382, 1382c, 1382h, 1383(a), (c), (d)(1), and
(p), and 1383b); secs. 4(c) and 5, 6(c)-(e), 14(a), and 15, Pub. L.
98-460, 98 Stat. 1794, 1801, 1802, and 1808 (42 U.S.C. 421 note, 423
note, and 1382h note).
0
4. Amend Sec. 416.924b by revising paragraph (b) to read as follows:
Sec. 416.924b Age as a factor of evaluation in the sequential
evaluation process for children.
* * * * *
(b) Correcting chronological age of premature infants. We generally
use chronological age (a child's age based on birth date) when we
decide whether, or the extent to which, a physical or mental impairment
or combination of impairments causes functional limitations. However,
if you were born prematurely, we may consider you younger than your
chronological age when we evaluate your development. We may use a
``corrected'' chronological age (CCA); that is, your chronological age
adjusted by a period of gestational prematurity. We consider an infant
born at less than 37 weeks' gestation to be born prematurely.
(1) We compute your CCA by subtracting the number of weeks of
prematurity (the difference between 40 weeks of full-term gestation and
the number of actual weeks of gestation) from your chronological age.
For example, if your chronological age is 20 weeks but you were born at
32 weeks gestation (8 weeks premature), then your CCA is 12 weeks.
(2) We evaluate developmental delay in a premature child until the
child's prematurity is no longer a relevant factor, generally no later
than about chronological age 2.
(i) If you have not attained age 1 and were born prematurely, we
will assess your development using your CCA.
(ii) If you are over age 1 and have a developmental delay, and
prematurity is still a relevant factor, we will decide whether to
correct your chronological age. We will base our decision on our
judgment and all the facts in your case. If we decide to correct your
chronological age, we may correct it by subtracting the full number of
weeks of prematurity or a lesser number of weeks. If your developmental
delay is the result of your medically determinable impairment(s) and is
not attributable to your prematurity, we will decide not to correct
your chronological age.
(3) Notwithstanding the provisions in paragraph (b)(1) of this
section, we will not compute a CCA if the medical evidence shows that
your treating source or other medical source has already taken your
prematurity into consideration in his or her assessment of your
development. We will not compute a CCA when we find you disabled under
listing 100.04 of the Listing of Impairments.
Sec. 416.926a [Amended]
0
5. Amend Sec. 416.926a by removing paragraphs (m)(6) and (m)(7) and
redesignating paragraph (m)(8) as (m)(6).
0
6. Amend Sec. 416.934 by adding paragraphs (j) and (k) to read as
follows:
Sec. 416.934 Impairments which may warrant a finding of presumptive
disability or presumptive blindness.
* * * * *
(j) Infants weighing less than 1200 grams at birth, until
attainment of 1 year of age.
(k) Infants weighing at least 1200 but less than 2000 grams at
birth, and who are small for gestational age, until attainment of 1
year of age. (Small for gestational age means a birth weight that is at
or more than 2 standard deviations below the mean or that is less than
the 3rd growth percentile for the gestational age of the infant.)
[FR Doc. 2013-11601 Filed 5-21-13; 8:45 am]
BILLING CODE 4191-02-P