[Federal Register Volume 78, Number 148 (Thursday, August 1, 2013)]
[Rules and Regulations]
[Pages 46499-46502]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-18552]


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SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404 and 416

[Docket No. SSA-2012-0066]
RIN 0960-AH52


Change in Terminology: ``Mental Retardation'' to ``Intellectual 
Disability''

AGENCY: Social Security Administration.

ACTION: Final rule.

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SUMMARY: This final rule adopts, without change, the notice of proposed 
rulemaking (NPRM) we published in the Federal Register on January 28, 
2013. We are replacing the term ``mental retardation'' with 
``intellectual disability'' in our Listing of Impairments (listings) 
that we use to evaluate claims involving mental disorders in adults and 
children under titles II and XVI of the Social Security Act (Act) and 
in other appropriate sections of our rules. This change reflects the 
widespread adoption of the term ``intellectual disability'' by 
Congress, government agencies, and various public and private 
organizations.

DATES: This final rule is effective September 3, 2013.

FOR FURTHER INFORMATION CONTACT: Cheryl 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:

Background

    On January 28, 2013, we published an NPRM that proposed replacing 
the term ``mental retardation'' with ``intellectual disability'' in our 
listings that we use to evaluate claims involving mental disorders in 
adults and children under titles II and XVI of the Social Security Act 
(Act) and in other appropriate sections of our rules.\1\ We are 
finalizing the proposed rule without change.
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    \1\ 78 FR 5755.
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Why are we changing the term ``mental retardation'' to ``intellectual 
disability''?

    The term ``intellectual disability'' is gradually replacing the 
term ``mental retardation'' nationwide. Advocates for individuals with 
intellectual disability have rightfully asserted that the term ``mental 
retardation'' has negative connotations, has become offensive to many 
people, and often results in misunderstandings about the nature of the 
disorder and those who have it.
    In October 2010, Congress passed Rosa's Law, which changed 
references to ``mental retardation'' in specified Federal laws to 
``intellectual disability,'' and references to ``a mentally retarded 
individual'' to ``an individual with an intellectual disability.'' \2\ 
Rosa's Law also required the Federal agencies that administer the 
affected laws to make conforming amendments to their regulations. 
Rosa's Law did not specifically include titles II and XVI of the Act 
within its scope, and therefore, did not require any changes in our 
existing regulations. However, consistent with the concerns expressed 
by Congress when it enacted Rosa's Law, and in response to numerous 
inquiries from advocate organizations, we are revising our rules to use 
the term ``intellectual disability'' in the name of our current 
listings and in our other regulations. In so doing, we join other 
agencies that responded to the spirit of the law, even though Rosa's 
Law did not require them to change their terminology.\3\
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    \2\ Public Law 111-256.
    \3\ See 77 FR 29002 and 77 FR 6022-01.
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Public Comments

    In the NPRM, we provided the public a 30-day comment period, which 
ended on February 27, 2013. We received 76 comments. Seventy-one 
commenters enthusiastically supported our proposal to replace the term 
``mentally retarded'' with intellectual disability or another term, 
while only five opposed the change. The comments came from national 
advocacy and disability rights groups, professional organizations, 
disability examiners, parents, and members of the public. We summarized 
and paraphrased the significant comments in our responses below. We 
carefully considered all of the comments. However, we did not make any 
changes to the final rule.

Support for Replacing the Term ``Mental Retardation''

    Comment: Seventy-one commenters enthusiastically supported 
replacing the term ``mentally retarded'' and 66 commenters supported 
the use of the term ``intellectual disability.'' Organizations 
including The Arc, The Consortium for Citizens with Disabilities, The 
National Disability Rights Network, American Association on 
Intellectual and Developmental Disabilities, and National Association 
of State Directors of Special Education, Inc., commented in support of 
our proposed changes.
    Almost all commenters noted the negative connotations and offensive 
nature of term ``mental retardation.'' Often, commenters referred to 
the word ``retarded'' as ``the R-word.'' Several provided personal 
stories about the effect the words ``retarded'' and ``mental 
retardation'' have had on a loved one with a disability and expressed 
their gratitude for our proposing to remove the term from the listings. 
One organization observed that the ``change in terminology is 
consistent with the widely expressed desire of people with intellectual 
disability for the use of modern, respectful language.'' Another 
organization stated, ``We appreciate SSA's commitment to eliminate 
outdated terminology and the negative stereotypes that they perpetuate 
for people with disabilities.'' One commenter, a graduate student in 
vocational rehabilitation, observed how

[[Page 46500]]

``'labeling' an individual can hinder them from participating in the 
community . . . Let's give this population the respect and dignity they 
deserve.''
    Most commenters also supported our proposed adoption of the term 
``intellectual disability.'' One organization noted how our adoption of 
``intellectual disability'' would ``align SSA's medical listings and 
other rules with terminology used by many federal agencies under Rosa's 
Law. This change is long overdue and [they] are glad SSA is taking this 
important step which will help fight stigma in this country.'' Another 
organization observed how ``people will be able to file a claim for 
Social Security benefits based on having an `intellectual disability,' 
rather than being forced to identify themselves with a label that many 
find offensive and degrading.'' In supporting the change, one 
individual commenter stated that `` `intellectual disability' is much 
more respectful than `mental retardation.' '' Another commented, ``It 
is critical that SSA treat applicants respectfully, and using the term 
`intellectual disability' is the respectful terminology.''
    Response: We are glad that the overwhelming majority of commenters 
favored our proposed change and we decided to finalize the proposed 
rule without change.

Keep the Term ``Mental Retardation'' in Our Rules

    Comment: Three commenters, all parents of adult children with 
profound intellectual and developmental disabilities, asked that we not 
replace ``mental retardation'' with the term ``intellectual 
disability.'' They regard ``mental retardation'' as the medical term 
that best describes their children's conditions. The commenters 
expressed concern about the ``imprecise and vague'' nature of the term 
``intellectual disability.'' They fear that the loss of the term 
``mental retardation'' could contribute to a lessening of public 
awareness and concern for individuals like their children and possibly 
the elimination of the public institutional service support systems 
that their children require. A fourth commenter said that while the 
change in terminology may make people feel good, the new term is not as 
descriptive as the current terminology.
    Response: We did not adopt this suggestion. While we appreciate the 
concerns expressed in these comments, the term we use to describe a 
medical disorder does not affect the actual medical definition of the 
disorder or available programs or services. The American Psychiatric 
Association (APA) is responsible for naming, defining, and describing 
mental disorders.
    In the fifth edition of the Diagnostic and Statistical Manual of 
Mental Disorders (DSM-5), the APA replaced ``mental retardation'' with 
``intellectual disability (intellectual developmental disorder).'' \4\ 
The APA included the parenthetical name ``(intellectual developmental 
disorder)'' to indicate that the diagnosed deficits in cognitive 
capacity begin in the developmental period. The authors of the DSM-5 
explain that these revisions bring the DSM-5 into alignment with 
terminology used by the World Health Organization's (WHO) International 
Classification of Diseases, other professional disciplines and 
organizations, such as the American Association on Intellectual and 
Developmental Disabilities, and the U.S. Department of Education.\5\
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    \4\ American Psychiatric Association, Diagnostic and Statistical 
Manual of Mental Disorders, Fifth Edition: DSM-5 (Washington, DC: 
American Psychiatric Publishing, 2013).
    \5\ DSM-5 Intellectual Disability Fact Sheet, APA, 2013. http://psychiatry.org/FILE%20library/PRACTICE/DSM/DSM-5/DSM-5-intellectual-disability-fact-sheet.pdf.
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Use a Term Other Than ``Intellectual Disability''

    Comment: Three individual commenters, for different reasons, 
offered alternatives to ``intellectual disability.'' One preferred 
``developmental disability,'' because it is ``a much more recognized 
and acceptable term over `intellectual disability.' '' Another wanted 
us to ``make the right change,'' and asked, ``What is wrong with 
calling it what it is, `developmental disability,' '' which the 
commenter said, ``fits a lot better than either mental retardation, or 
intellectual disability.'' Another commenter said that, `` 
`intellectual disability' is really no better than `mental retardation' 
because it highlights a defect in intellect or IQ. Perhaps a different 
choice of words--such as `cognitively impaired'--would be more 
appropriate.''
    Response: We did not adopt these suggestions. While there are 
several terms that could effectively replace ``mental retardation'' in 
our current listings and related regulations, we believe that it is 
appropriate to use the term adopted by other Federal agencies in 
response to a Federal statute.

The Term ``Intellectual Disability'' Is Too Broad and, Therefore, 
Unclear

    Comment: One commenter observed that there are ``many gradations'' 
in the type or severity of intellectual disabilities, which the term 
``intellectual disability'' could encompass. The commenter was 
concerned that blanket use of the new term by various entities could 
result in its becoming a ``catch-all term'' in the way that ``mental 
retardation'' became a pejorative term. He suggested that we include an 
explanation about the breadth of conditions encompassed by the new term 
in a definitions section.
    Response: We did not adopt this suggestion. In conjunction with 
publication of this final rule revising the name of current listings 
12.05 and 112.05 and related regulations, we are notifying our regional 
offices and state disability determination services regarding the 
change in terminology. As explained in the NPRM, however, the change 
does not affect how we evaluate a claim based on ``intellectual 
disability'' under listing 12.05 or 112.05, nor any of our other 
current listings or rules pertaining to other mental disorders.

The Change in Terminology Has Unclear Implications for Disability 
Policy and Adjudication

    Comment: One commenter suggested that the change in terminology 
from ``mental retardation'' to ``intellectual disability'' could 
generate confusion among adjudicators, including possible 
misinterpretation and misapplication of other listings. Another 
commenter expressed concern that the ``prominent use of the term 
`disability' in a body system listing'' could prompt some people to 
assume or infer that we would find a person disabled under program 
rules ``simply because the term `disability' is used . . . to describe, 
or designate, an alleged condition.'' A third commenter expressed 
concern that, given our legal definition of ``disabled,'' the term 
``intellectual disability'' is prone to confuse the lay reader, since 
`` `intellectually disabled' persons might not qualify for disability 
benefits because of the manner in which SSA defines disability.'' This 
commenter suggested that we use a qualifying term ``to distinguish 
between ordinary intellectual disability and intellectual disability 
grave enough to warrant disability benefits.'' He suggested that a term 
such as ``SSA-qualified intellectual disability'' would facilitate 
greater lay understanding of the difference between the terms.
    Response: We did not adopt these suggestions. The final rule will 
apply to only the name of listings 12.05 and 112.05 and will not affect 
how we interpret or apply any other listings. We will fully train our 
adjudicators on the effect of this name change.

[[Page 46501]]

    As we noted in the NPRM, unlike other agencies, we are bound by a 
legal definition of the word ``disability.'' The Act and our 
regulations define ``disability'' in specific terms and outline the 
requirements that an individual must meet in order to establish 
entitlement or eligibility to receive disability benefits.\6\ An 
individual may have a medically determinable intellectual impairment, 
such as intellectual disability, but not be ``under a disability'' 
within the meaning of the Act. The name of any disorder, whether mental 
or physical, in no way directs our findings regarding disability. We 
advise all claimants that they will not be found ``disabled'' for the 
purposes of our programs until we determine that their impairments 
satisfy all of the statutory and regulatory requirements for 
establishing disability.
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    \6\ Sections 216(i)(1) and 1614(a)(3)(B)-(C) of the Act.
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The Proposed Term Will Become Outdated and Require More SSA Resources 
To Change

    Comment: One commenter, although appreciating SSA's effort to use 
non-offensive terms, expressed the view that doing so is a waste of 
agency resources because of the ``euphemism treadmill.'' He noted that 
the terms ``mental retardation'' and ``mentally retarded'' were created 
in the mid-20th century to replace other terms that had become 
offensive. By the end of the century, however, the new terms were also 
used in derogatory ways. The commenter predicted that the current 
change to ``intellectual disability'' is ``merely another attempt to 
create a term without a prejudicial history . . . and that this term 
will . . . eventually be used as a pejorative and require more agency 
resources to change again.'' He recommended keeping the current 
wording.
    Response: We did not adopt this suggestion. Speculation about the 
future use of the term ``intellectual disability'' or the subjective 
value of this change will not dictate our policy. The term 
``intellectual disability'' is gradually replacing the term ``mental 
retardation'' in both the public and private sectors, and we believe it 
incumbent upon us to make this change in order to ensure that our 
listings and other rules reflect current terminology.

Regulatory Procedures

Executive Order 12866, as Supplemented by Executive Order 13563

    We consulted with the Office of Management and Budget (OMB) and 
determined that this final rule does not meet the criteria for a 
significant regulatory action under Executive Order 12866, as 
supplemented by Executive Order 13563.

Regulatory Flexibility Act

    We certify that this final rule will not have a significant 
economic impact on a substantial number of small entities because it 
affects individuals only. Therefore, the Regulatory Flexibility Act, as 
amended, does not require us to prepare a regulatory flexibility 
analysis.

Paperwork Reduction Act

    While this rule will not impose new public reporting burdens, it 
will require changes to existing OMB-approved information collections 
that contain the language referenced in this rule. We will make changes 
to the affected information collections via separate non-substantive 
change requests.

(Catalog of Federal Domestic Program Nos. 96.001, Social Security--
Disability Insurance; 96.002, Social Security--Retirement Insurance; 
96.004, Social Security--Survivors Insurance; and No. 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, Medicaid, Reporting and 
recordkeeping requirements, Supplemental Security Income (SSI).

    Dated: July 26, 2013.
Carolyn W. Colvin,
Acting Commissioner of Social Security.
    For the reasons set out in the preamble, we amend 20 CFR chapter 
III as follows:

PART 404--FEDERAL OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE

Subpart P--Determining Disability and Blindness

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).


Sec.  404.1513  [Amended]

0
2. Amend Sec.  404.1513(a)(2) by removing the words ``mental 
retardation'' and adding in their place ``intellectual disability''.

Appendix 1 to Subpart P of Part 404 [Amended]

0
3. Amend Appendix 1 to subpart P of part 404 by:
0
a. Removing the words ``mental retardation'' and adding in their place 
``intellectual disability'' wherever they occur;
0
b. Removing the words ``Mental retardation'' and adding in their place 
``Intellectual disability'' wherever they occur; and
0
c. Removing the words ``Mental Retardation'' and adding in their place 
``Intellectual Disability'' wherever they occur.

Subpart U--Representative Payment

0
4. The authority citation for subpart U of part 404 continues to read 
as follows:

    Authority: Secs. 205(a), (j), and (k), and 702(a)(5) of the 
Social Security Act (42 U.S.C. 405(a), (j), and (k), and 902(a)(5)).


Sec.  404.2045  [Amended]

0
5. Amend the example in Sec.  404.2045(a) by removing the words 
``mentally retarded children'' and adding in their place ``children 
with intellectual disability''.

PART 416--SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND 
DISABLED

Subpart F--Representative Payment

0
6. The authority citation for subpart F of part 416 continues to read 
as follows:

    Authority: Secs. 702(a)(5), 1613(a)(2) and (d)(1) of the Social 
Security Act (42 U.S.C. 902(a)(5) and 1383(a)(2) and (d)(1)).


Sec.  416.645  [Amended]

0
7. Amend the example in Sec.  416.645(a) by removing the words 
``mentally retarded children'' and adding in their place ``children 
with intellectual disability''.

Subpart I--Determining Disability and Blindness

0
8. 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).

[[Page 46502]]

Sec.  416.913  [Amended]

0
9. Amend Sec.  416.913(a)(2) by removing the words ``mental 
retardation'' and adding in their place ``intellectual disability''.
[FR Doc. 2013-18552 Filed 7-31-13; 8:45 am]
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