[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