2010 20247

Thursday,
August 19, 2010
Part II
Social Security
Administration
20 CFR Parts 404 and 416
Revised Medical Criteria for Evaluating
Mental Disorders; Proposed Rule
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51336 Federal Register / Vol. 75, No. 160 / Thursday, August 19, 2010 / Proposed Rules
SOCIAL SECURITY ADMINISTRATION • Mail: Address your comments to We are now proposing to update and
the Office of Regulations, Social revise the listings for mental disorders
20 CFR Parts 404 and 416 Security Administration, 137 Altmeyer to reflect our adjudicative experience
Building, 6401 Security Boulevard, and the advances in medical knowledge,
[Docket No. SSA–2007–0101] Baltimore, Maryland 21235–6401. treatment, and methods of evaluating
Comments are available for public mental disorders that have occurred
RIN 0960–AF69
viewing on the Federal eRulemaking since we last revised them
Revised Medical Criteria for Evaluating portal at http://www.regulations.gov or comprehensively. As we explain below,
Mental Disorders in person, during regular business the proposed rules also reflect
hours, by arranging with the contact recommendations from a report we
AGENCY: Social Security Administration. person identified below. commissioned, comments we received
Notice of proposed rulemaking
ACTION: FOR FURTHER INFORMATION CONTACT: in response to an ANPRM, and
(NPRM). Cheryl A. Williams, Office of Medical information from a policy conference
Listings Improvement, Social Security we held about mental disorders in the
SUMMARY: We propose to revise the Administration, 6401 Security disability programs.
criteria in the Listing of Impairments Boulevard, Baltimore, Maryland 21235– How did we develop these proposed
(listings) that we use to evaluate claims 6401, (410) 965–1020. For information rules?
involving mental disorders in adults on eligibility or filing for benefits, call
and children under titles II and XVI of In addition to our adjudicative
our national toll-free number, 1–800– experience and review of advances in
the Social Security Act (Act). We also 772–1213, or TTY 1–800–325–0778, or
propose to remove certain sections of medical knowledge, treatment, and
visit our Internet site, Social Security methods of evaluating mental disorders,
our regulations and incorporate some of Online, at http://
their provisions into other sections of we asked experts and the public to
www.socialsecurity.gov. provide us with information that helped
our regulations. The proposed revisions
reflect our adjudicative experience, SUPPLEMENTARY INFORMATION: us develop the proposals.
advances in medical knowledge, 1. In 2000, we commissioned a report
Electronic Version from the National Research Council
recommendations from a report we
commissioned, and comments we The electronic file of this document is (NRC), Mental Retardation: Determining
received from experts and the public in available on the date of publication in Eligibility for Social Security Benefits
response to an advance notice of the Federal Register at http:// (NRC report), published in 2000.5 The
proposed rulemaking (ANPRM) and at www.gpoaccess.gov/fr/index.html. primary focus of the report was on
an outreach policy conference. persons who have mental retardation in
Why are we proposing to revise the what is called the ‘‘mild’’ range in the
DATES: To ensure that your comments listings for mental disorders? current edition of the DSM, the
are considered, we must receive them We have not comprehensively revised Diagnostic and Statistical Manual of
no later than November 17, 2010. section 12.00 of the listings—the mental Mental Disorders, Fourth Edition, Text
ADDRESSES: You may submit comments disorders body system for adults Revision (DSM–IV–TR); 6 that is, with
by any one of three methods—Internet, (persons who are at least 18 years old)— intelligence quotient (IQ) scores from
fax, mail. Do not submit the same since we published it in the Federal 50–55 to approximately 70. The NRC
comments multiple times or by more Register on August 28, 1985.1 We last committee:
than one method. Regardless of which published final rules that • Examined the scientific bases
method you choose, please state that comprehensively revised section regarding intelligence and adaptive
your comments refer to Docket No. 112.00—the mental disorders listings for behavior, the relationship between
SSA–2007–0101 so that we may children (persons under age 18)—on them, and the assessment of both;
associate your comments with the December 12, 1990.2 • Examined differential diagnosis;
correct regulation. Although the 1985 and 1990 listings and
Caution: You should be careful to were significant advancements in our • Searched the related literature.
include in your comments only rules at the time we published them, 2. We published an ANPRM in the
information that you wish to make they were based in part on prior Federal Register on March 17, 2003.7
publicly available. We strongly urge you editions of the American Psychiatric We informed the public that we were
not to include in your comments any Association’s Diagnostic and Statistical planning to update and revise the rules
personal information, such as Social Manual of Mental Disorders (DSM).3 We
Security numbers or medical adults that we published in 1985 and some of the
have also gained considerable childhood rules that we published in 1990; we also
information. adjudicative experience in the decades proposed in §§ 404.1520a and 416.920a new rules
• Internet: We strongly recommend since we published those adult and for evaluating mental disorders in children. 56 FR
that you submit your comments via the child listings. 33130. On August 21, 2000, we published final
Internet. Please visit the Federal rules for only some of the provisions we proposed
We published some updates to the in the NPRM. 65 FR 50746, corrected at 65 FR
eRulemaking portal at http:// mental disorders listings in 2000. Those 60584. We explained in the preamble to that notice
www.regulations.gov. Use the Search updates improved the rules, but did not that medical changes and changes in the law since
function to find docket number SSA– comprehensively revise or update the time we published the NPRM required us to
2007–0101. The system will issue a review some of our proposed revisions and to defer
them.4 action on those proposed revisions. We also
tracking number to confirm your published minor revisions to the childhood mental
submission. You will not be able to 1 50 FR 35038 (1985). disorders listings on February 11, 1997, and
view your comment immediately 2 55 FR 51208 (1990). September 11, 2000, because of changes in the law.
because we must post each comment 3 The 1985 adult listings were based in part on 62 FR 6408 and 65 FR 54747.
5 Citation in the References section at the end of
manually. It may take up to a week for the third edition of the DSM (the DSM–III), and the
1990 childhood listings were based in part on the this preamble.
your comment to be viewable. revised third edition (the DSM–III–R). 6 Complete citation in the References section of
• Fax: Fax comments to (410) 966– 4 On July 18, 1991, we published an NPRM and this preamble.
2830. proposed to update and revise many of the rules for 7 68 FR 12639 (2003).
Federal Register / Vol. 75, No. 160 / Thursday, August 19, 2010 / Proposed Rules 51337
we use to evaluate mental disorders and incompatible with the ability to work.11 disorders listing categories except
invited interested persons and The paragraph B criteria provide proposed listings 12.05 and 112.05.
organizations to send us comments and descriptions of the four areas of • Clarify our definitions of the terms
suggestions for updating and revising functioning that we use to establish the ‘‘marked’’ and ‘‘extreme.’’
the mental disorders listings. We also severity of a person’s mental disorder. A As we have already noted, some of the
asked for comments on the NRC report.8 mental disorder is of listing-level proposed revisions reflect comments
We received almost 500 letters and e- severity if it satisfies two of the and recommendations we received from
mails in response to the notice, many paragraph B criteria.12 persons who responded to the ANPRM
from persons who have mental Some listings 13 also include a fourth and from others who attended the 2003
disorders or who have family members part, which we call ‘‘paragraph C’’ conference. Some of the proposed
with such disorders. We also received criteria. The paragraph C criteria are revisions based on comments and
comments from medical experts, alternatives to paragraph B for recommendations include:
advocates, and our adjudicators.9 establishing the severity of certain Some commenters recommended that
chronic mental disorders. In the we include all mental disorders
3. We hosted a policy conference
paragraph C criteria, we recognize that described in the most recent version of
called ‘‘Mental Disorders in the
psychosocial supports, treatment, or the DSM. We agreed with the
Disability Programs’’ in Washington, DC,
both may control the more obvious commenters that the listings should
on September 23 and 24, 2003. At this
symptoms and signs of a chronic mental include more mental disorders than
conference, we received comments and
disorder, so that a person may not they do now, but we did not agree that
suggestions for updating and revising
appear to be as limited as he or she we should include all mental disorders.
our rules from physicians who treat
actually is. The paragraph C criteria Some mental disorders are unlikely to
patients with mental disorders, other
provide a way for finding listing-level result in functional limitations of
professionals and advocates who work
disability in persons whose listing-level severity or meet the
with persons who have mental
impairments do not meet the current duration requirement, and some are
disorders, and adjudicators who make
paragraph B criteria, but who cannot otherwise inappropriate for inclusion in
disability determinations and decisions
tolerate the stress of work. our listings. Instead, we propose to
for us in the State agencies and in our
broaden most of the current listing
Office of Disability Adjudication and What major revisions are we categories and to add some new listings.
Review. proposing? The proposed new paragraph B
Although we are not summarizing or We propose to revise both the content criteria reflect comments from several
formally responding to most of the and the structure of the adult and mental health advocates who
comments we received, many of the childhood mental disorders listings. The recommended that we provide criteria
changes we propose reflect those proposed mental disorders listings do for evaluating a person’s functioning in
comments. not include an introductory diagnostic work-related terms. These advocates
How are the current mental disorders paragraph or a set of specific paragraph thought that we should: (1) Look at the
listings structured, and what do they A diagnostic criteria. Instead, a person impact of an impairment across
require? would need only show that he or she domains of functioning critical for an
has a mental disorder that: adult to function in competitive
For most of the listed mental (1) Is covered by one of the ten listing employment, (2) create criteria that
disorders, the current listings are in categories, and reflect a person’s lack of skills in
three, or sometimes four, parts.10 The (2) Except for certain listings under managing life and work, and (3)
first part of every mental disorder listing 12.05, results in marked limitations of consider whether the person has the
is a brief introductory paragraph that two or extreme limitation of one of four capacity to exercise independent
provides a general diagnostic paragraph B ‘‘mental abilities’’ or judgment and truly care for himself or
description of the disorder(s) covered by satisfies the paragraph C criteria. herself in a meaningful way without
the listing. The second part of most of We are also proposing to: structure. We would also use the same
these listings contains ‘‘paragraph A’’ • Broaden most of the current listing criteria for children beginning at age 3,
criteria, which are the specific categories to include more mental although in terms appropriate to
symptoms, signs, and laboratory disorders. childhood functioning.14
findings that substantiate the presence • Add listings. We also agreed with several
of particular mental disorders. An • Provide new paragraph B criteria. commenters who recommended that we
impairment cannot meet a mental • Revise the paragraph C criteria and add a criterion for ‘‘extreme’’ limitation
disorder listing unless it satisfies the extend them to all of the mental in paragraph B, so that a person’s
diagnostic description and the mental disorder can meet a listing with
paragraph A criteria of that listing. The 11 At the end of this preamble, we provide
either ‘‘extreme’’ limitation in only one
third part of most mental disorder information about two projects we have underway of the paragraph B criteria or ‘‘marked’’
listings contains ‘‘paragraph B’’ criteria, that may help us to better identify the requirements limitation in two. We already have such
which for adults describe impairment- of work in the future. While the outcome of these criteria for children from birth to age 3
related functional limitations that are projects may affect rules that we may propose in the in the current listings, but not for older
future, we believe that these long-term projects do
not affect our decision to proceed with these children or adults. We agreed with
commenters who suggested that we use
8 68 FR at 12640. proposed rules now.

9 If you would like to read the comments, you can 12 We use different paragraph B criteria in the
find them on our Internet site at: https:// childhood listings to describe functional limitations 14 For children under age 3, we are proposing to
s044a90.ssa.gov/apps10/erm/rules.nsf/ in children of varying ages. add a new listing with paragraph B criteria that
Rules+Closed+To+Comment. Click on the link for 13 Adult listings 12.02, 12.03, 12.04, and 12.06. largely reflect the same mental abilities that we
‘‘0960–AF69: Revised Medical Criteria for There are no current childhood mental disorders propose in the paragraph B criteria for children
Evaluating Mental Disorders.’’ listings with paragraph C criteria, but we can use beginning at age 3 and for adults, but in terms
10 In the adult listings, the exceptions are listings the adult paragraph C criteria in appropriate child appropriate for children in this age group. Thus, we
12.05 (mental retardation) and 12.09 (substance cases. See the seventh paragraph of current would establish a fairly seamless continuum of
addiction disorders). 112.00A. evaluation from birth into adulthood.
the definitions of ‘‘marked’’ and functioning; that is, the person’s disorders we do not currently list. We
‘‘extreme’’ limitations that are in functioning over time. The commenters would also add listing 12.11 to cover
Supplemental Security Income (SSI) noted that such a change would these disorders in adults.
childhood disability regulations that we realistically reflect the way that mental • Add a separate listing 112.13 for
had recently issued. health care is provided to most persons eating disorders in children, now
We are also proposing to revise the with chronic mental impairments. covered by listing 112.07, and listing
paragraph C criteria based in part on 12.13 to cover these disorders in adults.
comments that our current requirement What other significant revisions are we
proposing? • Add listing 112.14, Developmental
for a medically documented 2-year Disorders of Infants and Toddlers (Birth
history is unclear given the 1-year We also propose to: to Attainment of Age 3), and remove
duration requirement in the definition • Remove §§ 404.1520a and 416.920a, current listing 112.12, Developmental
of disability. We also agreed with Evaluation of Mental Impairments. and Emotional Disorders of Newborn
commenters who recommended that we However, we would incorporate some of and Younger Infants (Birth to attainment
change the criterion in paragraph C for the provisions of these rules into other of age 1).
‘‘decompensation’’ to ‘‘deterioration’’ sections of our regulations.
because the former term is not • Expand, update, and reorganize the Proposed 12.00—Introductory Text to
appropriate in all cases. It refers to a introductory text of the listings. the Adult Mental Disorders Listings
state of extreme deterioration, often • Change the term ‘‘Mental The following is a detailed
leading to hospitalization. We also Retardation’’ to ‘‘Intellectual Disability/ description of the changes we are
agreed with a recommendation to add Mental Retardation (ID/MR).’’ proposing to the introductory text.
paragraph C criteria to the other mental • Remove listings 12.09, Substance
disorders listings since the criteria Addiction Disorders, and 112.09, Proposed 12.00A—What are the mental
could apply to other types of mental Psychoactive Substance Dependence disorders listings, and what do they
disorders. The only exception is under Disorders. require?
listings 12.05 and 112.05, where we do • Revise the heading of listing 112.11
Proposed 12.00A1
not believe it is necessary. from ‘‘Attention Deficit Hyperactivity
Finally, we agreed with a Disorder’’ to ‘‘Other Disorders Usually In this section, we name the ten
recommendation to expand and clarify First Diagnosed in Childhood or proposed listing categories. These
our rules to recognize that non- Adolescence.’’ This proposed listing categories generally reflect major
physician professional sources, such as would still include attention-deficit/ diagnostic categories in the DSM–IV–
therapists and social workers, are often hyperactivity disorder, but would also TR. We propose to change the names of
the mental health providers who can include tic disorders, now in current six current listing categories, to remove
best provide a person’s history and listing 112.07 (Somatoform, Eating, and a listing, and to add two listings, as
longitudinal evidence about Tic Disorders), and other mental shown in the table below.
Current listing category Proposed listing category
12.02 Organic Mental Disorders ............................................................ 12.02 Dementia and Amnestic and Other Cognitive Disorders.
12.03 Schizophrenic, Paranoid and Other Psychotic Disorders ........... 12.03 Schizophrenia and Other Psychotic Disorders.
12.04 Affective Disorders ....................................................................... 12.04 Mood Disorders.
12.05 Mental Retardation ....................................................................... 12.05 Intellectual Disability/Mental Retardation (ID/MR).
12.06 Anxiety Related Disorders ........................................................... 12.06 Anxiety Disorders.
12.07 Somatoform Disorders ................................................................. 12.07 Somatoform Disorders.
12.08 Personality Disorders ................................................................... 12.08 Personality Disorders.
12.09 Substance Addiction Disorders .................................................... [Removed—see proposed 12.00H].
12.10 Autistic Disorder and Other Pervasive Developmental Disorders 12.10 Autism Spectrum Disorders.
12.11 Other Disorders Usually First Diagnosed in Childhood or Ado-
lescence.
12.13 Eating Disorders.
Proposed 12.00A2 ability to do any gainful activity,’’ which a paragraph B, but it is somewhat
other rules explain is the standard of different from the ‘‘paragraph B’’ criteria
In this section, we explain the severity in the listings. Sections common to all of the other listings. We
structure of the mental disorders listings 404.1525(a) and 416.925(a). For this include a similar statement regarding
and how a person’s impairment can the paragraph C criteria in proposed
reason, our proposal to add a criterion
meet a listing. The standard for meeting 12.00A2c, where we briefly explain
for ‘‘extreme’’ limitation in the mental
a listing based on ‘‘marked’’ limitations those criteria.
disorder listings would simplify our
of two of the paragraph B mental
rules, allowing for a finding that an Proposed 12.00A3
abilities is the same as in the current
impairment meets, rather than equals, a
mental disorders listings. The standard In this section, we explain how a
for meeting a listing based on ‘‘extreme’’ listing.
person’s ID/MR meets proposed listing
limitation of one mental ability would In paragraph A2b(ii) of this section, 12.05.
be new in the listings. Under current we explain that, whenever we use the
§§ 404.1520a(c)(4) and 416.920a(c)(4), phrase ‘‘the paragraph B criteria’’ or Proposed 12.00B—How do we describe
however, a mental disorder that results ‘‘paragraph B’’ in the introductory text, the mental disorders listing categories?
in ‘‘extreme’’ limitation medically equals we mean the paragraph B criteria of In this new section, we describe the
a listing. Under these rules, ‘‘extreme’’ every mental disorder listing except listing categories we use in the mental
limitation ‘‘represents a degree of listing 12.05. We are including this disorders listings. We then provide
limitation that is incompatible with the statement because listing 12.05 also has examples of symptoms and signs that
persons with disorders in each category the disorder and the persons who have For the diagnosis of intellectual disability,
may have. We also give examples of it. The term ‘‘intellectual disability’’ is significant limitations in adaptive behavior
specific mental disorders in each now widely used internationally and is should be established through the use of
standardized measures normed on the
category except listing 12.05, which gradually replacing ‘‘mental retardation’’
general population, including people with
covers only ID/MR. The information in in the United States. disabilities and people without disabilities.
the description of each category is not For these reasons, and consistent with On these standardized measures, significant
all-inclusive. We provide only basic many other organizations, we are limitations in adaptive behavior are
information about some of the most proposing to introduce the term operationally defined as performance that is
commonly occurring mental disorders ‘‘intellectual disability’’ in these approximately 2 standard deviations below
as examples of the kinds of disorders listings.15 Even though ‘‘mental the mean of either (a) one of the following
retardation’’ is offensive to many three types of adaptive behavior: conceptual,
that we evaluate under each listing
persons, we are not proposing to remove social, or practical, or (b) an overall score on
category. a standardized measure of conceptual, social,
The descriptions in 12.00B are similar it from our listings at this time; rather, and practical skills. * * * 17
to the current introductory diagnostic we refer to ‘‘intellectual disability’’ and
paragraphs and the paragraph A criteria, ‘‘mental retardation’’ together as the The American Psychological
but we are not simply moving the same disorder.16 We have a number of Association’s Manual of Diagnosis and
introductory diagnostic paragraphs and reasons for doing this, including the Professional Practice in Mental
the current paragraph A criteria from following: Retardation states:
the listings into the introductory text. • Although the term ‘‘mental Significant limitations in adaptive
While the evidence must show that the retardation’’ is gradually being replaced functioning are determined from the findings
person has a mental disorder in one of in the United States, it is still widely of assessment by using a comprehensive,
used and familiar to most persons. individual measure of adaptive behavior. For
the listing categories, the mental adaptive behavior measures, the criterion of
disorder does not have to match one of • The DSM–IV–TR and some other
significance is a summary index score that is
the examples in proposed 12.00B. We leading clinical practice manuals still two or more standard deviations below the
will find that any mental disorder meets use the term. mean for the appropriate norming sample or
one of these listings when it can be • Many medical reports, school that is within the range of adaptive behavior
included in one of the listings categories records, and other documents that are associated with the obtained IQ range sample
and satisfies the other criteria of the included in case files contain the term. in the instrument norms. * * * For adaptive
• A number of Federal and State behavior measures that provide factor or
appropriate listing for that mental summary scores, the criterion of significance
benefit programs still use the term.
disorder. is multidimensional; that is, two or more of
Also, since we recognize that not
The sections of proposed 12.00B do these scores lie two or more standard
everyone in the United States is familiar
not require explanation, except for deviations below the mean for the
with the term ‘‘intellectual disability,’’
proposed 12.00B1 and 12.00B4. appropriate norming sample or lie within the
we want to be clear in these rules that range of adaptive behavior associated with
Proposed 12.00B1—Dementia and we evaluate only what some persons the intellectual level consistent with the
Amnestic and Other Cognitive Disorders still call ‘‘mental retardation’’ under obtained intelligence quotient, as indicated
(12.02) listing 12.05 and not other forms of by the instrument norms.18
In the DSM–IV–TR, this category is cognitive impairments, such as learning The DSM–IV–TR states:
called ‘‘Delirium, dementia, and disorders (which we would evaluate
under proposed listing 12.11). The essential feature of mental retardation
amnestic and other cognitive disorders.’’ is significantly subaverage intellectual
We do not include the term ‘‘delirium’’ Proposal To Require ‘‘Significant’’ functioning (Criterion A) that is accompanied
because delirium will generally not Deficits in Adaptive Functioning To by significant limitations in adaptive
meet the 12-month duration Demonstrate ID/MR functioning in at least two of the following
requirement. skills areas: communication, self-care, home
The introductory diagnostic living, social/interpersonal skills, use of
In proposed 12.00B1c, we include paragraph in current listing 12.05 does community resources, self-direction,
traumatic brain injury (TBI) as an not describe a level of severity for functional academic skills, work, leisure,
example of a mental disorder we can deficits of adaptive functioning. In health, and safety (Criterion B).19
evaluate under proposed listing 12.02. proposed 12.00B4a, which describes the
We continue to include a reference to Therefore, the proposed requirement
characteristics of ID/MR, we would for ‘‘significant’’ deficits in adaptive
11.00F in the neurological section of our require ‘‘significant’’ deficits of adaptive
listings, as we do in current 12.00D10, functioning is generally consistent with
functioning. Major associations that the diagnostic criteria used in the
to ensure that our adjudicators give full provide diagnostic criteria for mental
consideration to both the neurological clinical community.
retardation generally refer to
and mental limitations resulting from ‘‘significant’’ deficits or limitation. Proposed Clarification of Our Rule on
TBI. The most recent edition of the the Developmental Period for ID/MR
Proposed 12.00B4—Intellectual American Association on Intellectual In the introductory paragraph of
Disability/Mental Retardation (ID/MR) and Developmental Disabilities (AAIDD) listing 12.05, we explain that a person’s
(12.05) manual states:
17 American Association on Intellectual and
Proposed Name Change 15 For more information about the use of new Developmental Disabilities, Intellectual Disability:
terms to replace ‘‘mental retardation,’’ please refer Definition, Classification, and Systems of Supports,
As we noted earlier, we propose to 11th Edition, Washington, DC (2010), page 43.
to the 2002 report, ‘‘Usage of the Term ‘Mental
change the name ‘‘Mental Retardation’’ Retardation’: Language, Image and Public 18 Jacobson, John W., and Mulick, James A., eds.,
to ‘‘Intellectual Disability/Mental Education,’’ available on our Web site at http:// Manual of Diagnosis and Professional Practice in
Retardation (ID/MR).’’ The term ‘‘mental www.socialsecurity.gov/disability/ Mental Retardation, American Psychological
retardation’’ has taken on negative MentalRetardationReport.pdf. Complete citation in Association, Washington, DC (1996), page 13.
the References section of this preamble. 19 American Psychiatric Association, Diagnostic
connotations over the years, is offensive 16 We are also proposing to introduce the and Statistical Manual of Mental Disorders, Fourth
to many persons, and results in abbreviation ‘‘ID/MR,’’ so we will not be using the Edition, Text Revision, (DSM–IV–TR), Washington,
misunderstandings about the nature of phrase ‘‘mental retardation’’ as often as we do now. DC (2000), page 41.
mental retardation must be manifested of adaptive functioning. The approach would consider how a mental disorder
during the ‘‘developmental period; [that in these proposed rules is more in affects the person’s underlying mental
is,] * * * before age 22.’’ We propose to keeping with modern definitions of ID/ abilities and, thus, results in limitations
simplify this language by removing our MR, especially in the 2010 edition of the in functioning. In addition, we have
reference to the ‘‘developmental period’’ AAIDD manual, which emphasizes the tailored the criteria to children using
and referring only to the period before ‘‘multidimensional’’ aspects of defining terms appropriate to childhood
age 22. The proposed change would not ID/MR.22 We also know from our case functioning. We believe this approach
be substantive since the phrase reviews that only a relatively few provides a seamless set of severity
‘‘developmental period’’ means the claimants who qualify under current criteria in the proposed listings from
period before the person attained age 22. listing 12.05 do not have ID/MR, and we childhood into adulthood.23
Also, in proposed 12.00B4c, we believe that the improvements we are We are not proposing to change the
explain that ID/MR initially manifested making in these proposed rules will types of evidence we would consider
before age 22 is often demonstrated by make our determinations and decisions when we rate the severity of a person’s
evidence from that period, but that, even more accurate. Thus, we believe limitations under the proposed
when we do not have such evidence, we that, properly applied, the proposed paragraph B criteria. We know that most
will still find that a person has ID/MR rules will correctly identify persons persons are not working when they
if the current evidence and the history who have the disorder. apply for benefits; so, we must use
of the impairment are consistent with In proposed 12.00B4e, we would information from their medical and
the diagnosis ‘‘and there is no evidence clarify a number of provisions about other sources about how they function
to indicate an onset after age 22.’’ The listing 12.05C: in their daily activities in order to draw
quoted language is a clarification of our • We explain that the other physical conclusions about the functional
rules. In the current introductory or mental impairment must be a limitations they would have in a work
paragraph of listing 12.05, we provide ‘‘severe’’ impairment, as defined in our setting. This is essentially the same
that the evidence must demonstrate ‘‘or regulations. We also explain that we do thing we do when we determine at step
support[ ]’’ onset of the impairment not count impairments that are not 2 of the sequential evaluation process
before age 22. We added this language ‘‘severe’’ even if they prevent a person that a person is limited in the ability to
in 2000 to better explain what we mean from doing past relevant work. Both of do basic work activities and when we
by evidence demonstrating that the these provisions are in the fourth assess residual functional capacity
disorder was initially manifested before paragraph of current 12.00A. (RFC) for steps 4 and 5.
age 22,20 but we have received questions • Current listing 12.05C provides that Proposed 12.00C1—Understand,
indicating that our intent is still not the other impairment must ‘‘impos[e] an Remember, and Apply Information
clear. Therefore, we are proposing to additional and significant work-related (Paragraph B1)
clarify the provision even further. limitation of functioning.’’ (Emphasis
In proposed 12.00B4d, we would added.) We propose to clarify this In this section, we define the
continue to include our rule that we provision by specifying that the proposed paragraph B1 criterion and
accept the lowest IQ score on a test that limitation(s) caused by the other give examples of when a person uses
provides more than one score (for physical or mental impairment must be this ability to perform work activities.
example, a verbal, performance, and full separate from the limitations caused by We explain later in this preamble why
scale IQ in a Wechsler series test). For the ID/MR. we are proposing to remove the current
a number of reasons, the NRC paragraph B1 criterion, ‘‘activities of
recommended that we change our rule Proposed 12.00C—What are the daily living.’’
to consider only the composite or ‘‘total’’ paragraph B criteria?
Proposed 12.00C2—Interact With Others
score (such as full scale IQ).21 We In this section, we describe the four (Paragraph B2)
decided not to propose the change at paragraph B criteria that we propose to
use to assess a person’s impairment- In this section, we define the
this time because we believe it is
related limitation in functioning in the proposed paragraph B2 criterion and
unnecessary and keeping our current
mental disorder listings. The proposed give examples of when a person uses
rule will help us to adjudicate some
paragraph B criteria are the mental this ability to relate to and work with
cases more quickly than we would if we
abilities an adult uses to function in a supervisors, co-workers, and the public
accepted the NRC recommendation. We
work setting; that is, the abilities to: in a work setting. This criterion is
are putting more emphasis in these rules
• Understand, remember, and apply related to, but would replace, the
on the need to confirm the validity of
information (paragraph B1); current paragraph B2 criterion, ‘‘social
test results with other evidence,
• Interact with others (paragraph B2); functioning.’’ We propose to remove
especially of a person’s day-to-day
• Concentrate, persist, and maintain some of the information in current
functioning. We are also clarifying that
pace (paragraph B3); and 12.00C2 because it is not as useful in the
a person must have ‘‘significant’’ deficits
• Manage oneself (paragraph B4). context of the proposed B2 criterion as
20 In explaining the change, we said: We based the proposed criteria in part it is for the current criterion. For
We have always interpreted [the word on critical work-related limitations and example, we propose to remove the
‘‘manifested’’] to include the common clinical abilities that we consider at other steps current examples of limitation and
practice of inferring a diagnosis of mental in the five-step sequential evaluation strength in social functioning because
retardation when the longitudinal history and we are proposing to focus on the mental
process that we use to determine
evidence of current functioning demonstrate that

the impairment existed before the end of the disability in adults. We also propose to abilities needed to work. In the
developmental period. Nevertheless, we also can use an approach for evaluating proposed rule, we include examples of
see that the rule was ambiguous. Therefore, we limitations similar to the approach we
expanded the phrase setting out the age limit to 23 As we have already noted, and explain later in
read: ‘‘i.e., the evidence demonstrates or supports use in determining functional
detail, we provide a somewhat different set of
onset of the impairment before age 22.’’ equivalence for children under SSI. We paragraph B criteria for children who have not
65 FR at 50772, August 21, 2000. attained age 3. However, those criteria are related
21 See, for example, the NRC report, pages 31 and 22 See especially Chapter 4 regarding the role of to the proposed paragraph B criteria we would use
108. intelligence testing in diagnosing ID/MR. for all other children and for adults.
what a person is expected to do when under these listings in proposed 12.00G, loss of adaptive functioning.’’ We also
using the mental ability to interact with What evidence do we need to evaluate explain that loss of adaptive functioning
others in a work setting; for example, your mental disorder? is manifested by difficulties in
cooperating with co-workers or We include information from the fifth performing ADLs (current paragraph
accepting criticism from a supervisor. paragraph of current 12.00C3 about B1), maintaining social relationships
An evaluation of the effects of a mental ‘‘marked’’ limitation in proposed (current paragraph B2), or maintaining
disorder on a person’s mental ability to 12.00D1c. We also elaborate on what we concentration, persistence, or pace
interact with others entails, among other mean by using a mental ability (current paragraph B3). Therefore, we
things, a judgment of whether the independently, appropriately, seldom use the paragraph B4 criterion
person would be able to cooperate and effectively, and on a sustained basis to because we define it in terms of the first
accept criticism. function in a work setting. three current paragraph B criteria. This
We would remove other information same redundancy would exist if we kept
Proposed 12.00C4—Manage Oneself
in current 12.00C2 about social the paragraph B4 criterion with the
(Paragraph B4)
functioning because we include it and proposed criteria.
give it more general application The proposed paragraph B4 criterion We recognize that most mental
elsewhere in the proposed introductory would include aspects of functioning disorders are subject to periods of
text. For example, current 12.00C2 that we currently consider when we exacerbation; therefore, in proposed
refers to social functioning as the assess RFC, such as the ability to 12.00G6, we continue to require
‘‘capacity to interact independently, respond to demands and changes in the adjudicators to consider temporary
appropriately, effectively, and on a workplace. It reflects the critical role increases in symptoms and signs and
sustained basis with other people,’’ and that self-management plays in being their effect on a person’s functioning
explains that ‘‘[w]e do not define able to function independently, over time when they rate limitations of
‘marked’ by a specific number of appropriately, effectively, and on a the proposed paragraph B criteria. In the
different behaviors in which social sustained basis in a work setting. It also proposed paragraph C criteria, we
functioning is impaired, but by the includes the aspects of the current would also continue to factor in a
nature and overall degree of interference paragraph B1 criterion (activities of history of episodes of deterioration, as
with function.’’ These two general daily living) that deal with health and we explain below.
statements apply to the rating of safety, as described in current 12.00C1.
impairment-related limitations for all Proposed 12.00D—How do we use the
Proposal To Remove the Current paragraph B mental abilities to
the paragraph B criteria, not just social Paragraphs B1 and B4 Criteria
functioning. Therefore, in these evaluate your mental disorder?
proposed rules, we revise the statements We propose to remove the current In this section, we propose to
slightly and include them in proposed paragraph B1 criterion, activities of consolidate a provision that is in current
12.00D, where we define ‘‘marked’’ and daily living (ADLs), because limitations 12.00A with guidance about rating
‘‘extreme’’ limitations for all four of the in ADLs are the manifestation of impairment severity that appears in
paragraph B mental abilities. limitations of any one, several, or several different sections of current
sometimes all, of the four mental 12.00C. For example, in current
Proposed 12.00C3—Concentrate, abilities in these proposed rules. For
Persist, and Maintain Pace (Paragraph 12.00C1, C2, and C3, we explain ‘‘We do
example, a person may have difficulty not define ‘marked’ by a specific
B3) using public transportation or shopping number of activities [or behaviors or
The proposed paragraph B3 criterion (both of which are examples of ADLs in tasks] in which functioning is impaired,
is the same as the current paragraph B3 current 12.00C1) because of limitation but by the nature and overall degree of
criterion, ‘‘maintaining concentration, of the ability to understand, remember, interference with function.’’ Instead of
persistence, or pace,’’ except that we and apply information, the ability to stating it three times, we include this
propose to change ‘‘or’’ to ‘‘and.’’ This interact with others, or both. These guidance in a single section, proposed
would not be a substantive change in ADLs may also be limited by problems 12.00D1c. We also propose to include
the paragraph B3 criterion, but only a with the ability to concentrate or persist, guidance from our childhood disability
clarification of the overall requirement. or with the ability to manage oneself. rules that is applicable to evaluating
In a work setting, just as a person is Therefore, we do not believe that mental disorders in adults and children.
expected to understand, remember, and limitations in ADLs should be
apply information, he or she is also considered in a single separate area. Proposed 12.00D1
expected to be able to concentrate, Rather, we would use information about In this section, we provide general
persist, and maintain pace. how the person functions in his or her information about the paragraph B
We propose to move some of the ADLs, together with other information mental abilities. For example, we
information in current 12.00C3 to other in the case record, to determine how the explain that:
sections of the proposed introductory proposed four mental abilities are • ‘‘Marked’’ or ‘‘extreme’’ limitation
text because the information includes affected by the person’s mental disorder. reflects the overall degree to which a
useful guidance that applies to all of the Since these abilities are necessary to mental disorder interferes with a
proposed paragraph B criteria. For function in a work setting, we would person’s use of an ability and does not
example, there is detailed information then be able to more realistically necessarily reflect a specific type or
about clinical examinations, determine a person’s capacity for work, number of activities that a person has
psychological testing, mental status even in situations in which he or she is difficulty doing.
examinations, and work evaluation, but not working or has never worked. • No single piece of information
we would consider these types of We describe the current paragraph B4 (including test scores) can establish
evidence when we assess limitations in criterion—repeated episodes of whether a person has marked or extreme
the other paragraph B criteria too. For decompensation, each of extended limitation.
this reason, we propose to provide all duration—in current 12.00C4 as • We consider the kind and extent of
the guidance about the medical and ‘‘exacerbations or temporary increases in supports a person receives and the
nonmedical evidence we may consider symptoms or signs accompanied by a characteristics of any highly structured
setting in which the person spends time 416.920a(c)(4) as a frame of reference to functioning with IQ tests or other kinds
in order to function. help define the terms ‘‘marked’’ and of tests.
In proposed 12.00D1d, we state that ‘‘extreme.’’ The rules for the PRT We based the language of the
the more extensive the supports or the describe ‘‘marked’’ as the fourth point on proposed rule on our policy for
more structure a person needs in order a five-point rating scale—none, mild, considering test results when we
to function, the more limited we will moderate, marked, and extreme. In the determine disability in children under
find the person to be. This is a principle proposed rules, we explain that we do SSI. Sections 416.924a(a)(1)(ii) and
that we use in the childhood disability not require our adjudicators to use such 416.926a(d)(4). This general policy is
rules, and it is applicable to adults as a scale, but that ‘‘marked’’ would be the applicable to our evaluation of test
well.24 fourth point on a scale of ‘‘no limitation, results in claims of adults and children
Proposed 12.00D2—What We Mean By slight limitation, moderate limitation, with mental disorders as well; so, we
‘‘Marked’’ Limitation marked limitation, and extreme are proposing to incorporate it in the
limitation.’’ With this guideline, it is mental disorders listings. We include
The proposed definition of ‘‘marked’’ unnecessary to also state that ‘‘marked’’
limitation generally corresponds to the similar policy statements in our current
falls between ‘‘moderate’’ and ‘‘extreme.’’
definitions in current 12.00C and mental disorders listings. In current
We use the word ‘‘slight’’ instead of
112.00C. We also incorporate provisions 12.00D5c, we state, ‘‘In considering the
‘‘mild’’ to make clear that it is at a level
from § 416.926a, the regulation for validity of a test result, we should note
consistent with an impairment that is
functional equivalence for children, and resolve any discrepancies between
not ‘‘severe,’’ as we explain the term in
which provides a more detailed SSR 85–28,27 and to preserve guidance formal test results and the individual’s
definition of the term than we do in the that is consistent with the provision in customary behavior and daily
current mental disorders listings and current §§ 404.1520a(d)(1) and activities.’’ (Emphasis added.) In current
which we propose to apply to adults. 416.920(a)(d)(1). 12.00D6a, we state, ‘‘[S]ince the results
One of the provisions from of intelligence tests are only part of the
§ 416.926a(e) that we are including in Proposed 12.00D3—What We Mean By overall assessment, the narrative report
this definition explains that ‘‘marked’’ is ‘‘Extreme’’ Limitation that accompanies the test results should
the equivalent of functioning we would comment on whether the IQ scores are
The proposed definition of ‘‘extreme’’ considered valid and consistent with the
expect to find on standardized testing
limitation is based on the definition in developmental history and the degree of
with scores that are at least two, but less
§ 416.926a(e), and is in terms that are functional limitation’’ (emphasis
than three, standard deviations below
related to our definition of ‘‘marked.’’ added).28 We believe, however, that the
the mean. We added this provision to
For example, while ‘‘marked’’ limitation language in the childhood regulations is
our functional equivalence rules in
can generally be shown by a score on a clearer and more comprehensive.
200025 to codify guidance that we had
standardized test that is at least two, but
given to our adjudicators during
less than three, standard deviations Proposed 12.00E—What are the
training.26 We believe that this guidance
below the mean, ‘‘extreme’’ limitation paragraph C criteria, and how do we
is also useful for understanding the term
can generally be shown by a score that use them to evaluate your mental
as we apply it to adults and children
is at least three standard deviations disorder?
under the mental disorders listings. A
below the mean. As we do in
person whose functioning is two Both the current and proposed
§ 416.926a(e), we also explain that,
standard deviations below the mean is paragraph C criteria are alternative
while ‘‘extreme’’ is the rating we give to
in approximately the second percentile severity criteria for situations in which
the worst limitations, it does not
of the population; that is, about 98 a person has achieved only marginal
necessarily mean a total lack or loss of
percent of the population functions at a adjustment, and the symptoms and
ability to function. Similarly to
higher level. It is also a meaningful signs of his or her mental disorder are
proposed 12.00D2, we also propose to
concept to many mental health diminished because of psychosocial
provide a guideline based on
professionals. supports or treatment. The current
§§ 404.1520a(c)(4) and 416.920a(c)(4)
We are not including in these paragraph C criteria for listings 12.02,
that describes ‘‘extreme’’ as the last point
proposed rules the description of 12.03, and 12.04 require a ‘‘Medically
on a five-point rating scale.
‘‘marked’’ as ‘‘more than moderate but documented history of a [specified
less than extreme’’ from current 12.00C Proposed 12.00D4—How We Consider chronic mental disorder] of at least 2
and 112.00C. Instead, we propose to use Your Test Results years’ duration that has caused more
an explanation based on the language than a minimal limitation of [the] ability
describing the rating scale for the In this proposed section, we would
clarify how we intend for our to do basic work activities, with
Psychiatric Review Technique (PRT) in symptoms or signs currently attenuated
current §§ 404.1520a(c)(4) and adjudicators to consider test scores
under listing 12.05 or any other listing; by medication or psychosocial support.’’
24 See, for example, §§ 416.924a(b)(5)(ii) and that is, that the other objective medical They also require one of three criteria
(b)(5)(iv); Social Security Ruling (SSR) 09–1p, ‘‘Title evidence and the other evidence about described, in part, as:
XVI: Determining Childhood Disability Under the the effects of a mental disorder on a
Functional Equivalence Rule—The ‘Whole Child’ 28 In current 12.00D5b, we also state that ‘‘a report
Approach’’ (74 FR 7527 (2009)), available at: http:// person’s functioning must be consistent
of test results should include both the objective data
with the score. There continues to be
www.socialsecurity.gov/OP_Home/rulings/ssi/02/ and any clinical observations’’ that corroborate the

SSR2009-01-ssi-02.html; and SSR 09–2p, ‘‘Title XVI: confusion about the extent to which we data. This is another current rule that provides that
Determining Childhood Disability—Documenting a rely on IQ scores in listing 12.05 or we must consider whether the person’s functioning
Child’s Impairment-Related Limitations’’ (74 FR is consistent with the test score, although in this
7625 (2009)), available at: http:// whenever we assess mental abilities or
case it is in a clinical setting. Since we are
www.socialsecurity.gov/OP_Home/rulings/ssi/02/ proposing to remove the detailed guidance about
SSR2009-02-ssi-02.html. 27 SSR 85–28, ‘‘Titles II and XVI: Medical testing that is in current 12.00D, we are proposing
25 65 FR 54747, 54757.
Impairments That Are Not Severe,’’ available at a new section 12.00B4d in the introductory text that
26 Childhood Disability Training, SSA Office of http://www.socialsecurity.gov/OP_Home/rulings/di/ will continue to address this issue for IQ testing in
Disability, Pub. No. 64–075, March 1997. 01/SSR85-28-di-01.html. ID/MR.
• Repeated episodes of completely separate term from the whether the mental disorder satisfies
decompensation, each of extended DSM–IV–TR so there is no confusion. the paragraph B criteria. Also, in
duration (C1); We also believe that the proposed term proposed 12.00E2c, we use the word
• A residual disease process that has is more descriptive of what we intend ‘‘deterioration’’ instead of
resulted in marginal adjustment (C2); or by the paragraph C criteria. ‘‘decompensation’’ in response to the
• A current history of 1 or more years’ The term ‘‘serious and persistent public comments we have already
inability to function outside a highly mental disorders,’’ is also similar to the described.
supportive living arrangement (C3). terms ‘‘serious and persistent mental
We incorporate the same three criteria illness,’’ (SPMI), ‘‘serious mental Proposed 12.00F—How do we consider
in the proposed rules, but we have illness,’’ and other descriptions used psychosocial supports, highly
simplified their content and application. widely in Federal and State statutes and structured settings, and treatment when
For example, rather than counting the regulations, and in other areas related to we evaluate your functioning?
episodes of decompensation as required mental health treatment and services. This section includes some of the
by current 12.00C4,29 we simply require These terms generally refer to the same information in the fourth paragraph of
that the person have: kinds of serious, chronic illnesses for current 12.00C3 and current 12.00E, F,
• A ‘‘serious and persistent’’ mental which we intend the paragraph C G, and H. We provide a greatly
disorder with continuing treatment, criteria; for example, schizophrenia, expanded list of examples of
psychosocial support, or a highly bipolar disorder, major depressive psychosocial supports and highly
structured setting that diminishes the disorder, agoraphobia, panic disorder, structured settings in proposed 12.00F2
symptoms and signs of the disorder and posttraumatic stress disorder. We and guidance about the effects of
(proposed C1); and do not propose to adopt the exact term treatment in proposed 12.00F3. These
• Marginal adjustment (proposed C2) ‘‘SPMI’’ or any specific definition from changes respond to comments from
as described in proposed 12.00E2c. other sources because there is no several sources who recommended that
The description of marginal standard definition for the term, and the proposed rules should reflect the
adjustment in proposed 12.00E2c some definitions would be narrower fact that controlling a person’s
includes essentially all of the current than we intend.30 symptoms with medications and
criteria, but is broader and, we believe, In proposed 12.00E2a, we explain that community supports does not eliminate
more accurate. We explain that marginal a ‘‘serious and persistent mental the underlying mental disorder and that
adjustment reflects a person’s fragile disorder’’ is established by a medically we should not interpret evidence of a
existence in his or her environment, documented history of the existence of person’s active involvement in a
with minimal capacity to adapt to the disorder over a period of at least 1 supported work setting by itself to mean
changes in the environment or demands year. In order to satisfy the proposed that the person is not disabled.
that are not already part of his or her paragraph C criteria, a person with a
daily life. We believe that this approach serious and persistent mental disorder Proposed 12.00G—What evidence do
more realistically reflects the nature of must satisfy two additional criteria. He we need to evaluate your mental
serious and persistent mental disorders. or she: disorder?
The current paragraph C criterion for • Must be in continuing treatment,
Proposed 12.00G corresponds to the
listing 12.06 ‘‘reflects the uniqueness of have psychosocial supports, or be in a
information in current 12.00D1 through
agoraphobia’’ (in current 12.00F) and highly structured setting (paragraph C1);
D3; however, we have expanded the
requires the ‘‘complete inability to and
• Must have achieved ‘‘only marginal information from the current rules and
function independently outside the area reorganized it in what we believe is a
of one’s home.’’ We continue to include adjustment’’ as defined in paragraph C2.
These two provisions describe a very more user-friendly format.
this criterion under proposed listing We have not included text
12.06C by providing in proposed serious impairment. Anyone who has a
mental disorder that has persisted for at corresponding to current 12.00B, Need
12.00E2c that ‘‘marginal adjustment’’ for medical evidence, because the
includes the inability to function least 1 year and that satisfies the
paragraph C1 and C2 criteria will by information in that section is
‘‘outside your home.’’ unnecessary, appears in other
For accuracy and clarity, we propose definition have a ‘‘serious and persistent
mental disorder.’’ regulations, or appears in other
to use the term ‘‘serious and persistent provisions of these proposed rules.31
mental disorders’’ instead of ‘‘chronic To ensure that we make allowances
based on the paragraph C criteria as Also, the last two sentences of current
mental impairments,’’ as in current
quickly as possible, we would also 12.00B explain that symptoms and signs
12.00E. As used in the DSM–IV–TR, the
provide in proposed 12.00E1 that our cluster together to constitute
word ‘‘chronic’’ is a ‘‘specifier’’ of certain
adjudicators can apply the paragraph C recognizable mental disorders described
mental disorders and provides
criteria without first considering in the listings, and that the symptoms
information about the duration of
and signs may be intermittent or
certain diagnostic criteria. The duration 30 For example, in 2003, the President’s New continuous. We believe this information
varies by the disorder, and not all Freedom Commission on Mental Health defined is too general to be helpful and would
disorders have a ‘‘chronic’’ specifier. For ‘‘adults with a serious mental illness’’ as ‘‘persons be unnecessary in these proposed rules
example, the DSM–IV–TR uses age 18 and over, who currently or at any time
during the past year, have had a diagnosable given the information we provide in
‘‘chronic’’ as a specifier for
mental, behavioral, or emotional disorder of proposed 12.00B. We also provide
Posttraumatic Stress Disorder when
sufficient duration to meet diagnostic criteria guidance about mental disorders that
symptoms last at least 3 months, but for specified within DSM–III–R that has resulted in are subject to exacerbations and
a major depressive episode when the functional impairment which substantially
full criteria have been continuously met interferes with, or limits one or more major life
activities.’’ (Citation in the References section of this 31 For example, the rule in current 12.00B that we
for 2 years. We are proposing to use a preamble. Footnotes omitted.) For our disability must establish the existence of a medically
determination purposes, the 12-month duration determinable impairment that meets the duration
29 Three episodes within 1 year, or an average of requirement in the Act applies instead of the requirement also appears in §§ 404.1508, 404.1509,
once every 4 months, each lasting for at least 2 various duration requirements in the DSM specific 404.1520, 416.908, 416.909, and 416.920 of our
weeks. to different mental disorders. regulations.
remissions—that is, that can be kinds of ‘‘medical sources’’ under precipitating and aggravating factors,
intermittent—in proposed 12.00G6. §§ 404.1513(d)(1) and 416.913(d)(1) of and the functional limitations that
Likewise, we do not include the rule our regulations. While only certain result. This is a description of how we
in the first paragraph of current 12.00D persons, such as physicians and evaluate any impairment that is subject
that the medical evidence must be licensed or certified psychologists, are to exacerbations, and we would
sufficiently complete and detailed as to ‘‘acceptable medical sources,’’ we agreed consider the same kinds of information
symptoms, signs, and laboratory with commenters who said that we in evaluating any such mental disorder.
findings to permit an independent should emphasize the role that other It is also similar to our rules for
determination. We already have a medical sources can play in our evaluating symptoms in §§ 404.1529
provision that says essentially the same disability evaluations. For this reason, and 416.929. Likewise, the information
thing. Sections 404.1513(e) and we also provide that evidence from in the paragraph about descriptions of a
416.913(e). other medical sources can be ‘‘especially person’s anxiety reaction from medical
Proposed 12.00G1—General helpful’’ to our assessment of the and other sources is already covered by
severity of mental disorders and their other rules, including proposed 12.00G,
Proposed 12.00G1 explains that we effects on functioning. This provision is in which we would provide extensive
need evidence to assess the existence consistent with guidance we provide in information about the kinds of evidence
and severity of a person’s mental SSR 06–3p.33 we may obtain from medical and other
disorder and its effects on the person’s We also provide an expanded list of sources.
ability to function in a work setting. We the types of evidence that may be
also include guidance about the available from medical sources. The list Proposed 12.00G3—Evidence From You
evidence we need from acceptable includes the information in current and Persons Who Know You
medical sources 32 and other sources 12.00D1a regarding cultural background Proposed 12.00G3 corresponds to
and include references to our basic rules and sensory, motor, and speaking current 12.00D1b and the second
on evidence and symptoms. abnormalities that may affect our sentence of current 12.00D1c. In the
As we note below, we are proposing evaluation of a person’s mental proposed rule, we have simplified the
to remove current 12.00D4, which disorder. Finally, we do not include language and removed unnecessary
describes mental status examinations. information from current 12.00D1a that statements.
However, we have included a sentence only repeats provisions of our other
in proposed 12.00G1 that is based on Proposed 12.00G4—Evidence From
regulations.
the last sentence of current 12.00D4. We propose to remove current School, Vocational Training, Work, and
The current sentence provides that the 12.00D4, which discusses the mental Work-Related Programs
individual facts of a case determine the status examination in detail. Current Proposed 12.00G4 generally
specific areas of mental status that must 12.00D4 does not provide any rules for corresponds to the last sentences of
be emphasized during a mental status our adjudicators to apply, and the current 12.00D1c and 12.00D3, but we
examination. We propose to revise that elements of the mental status propose to add information about school
statement so that it applies to all examination are more thoroughly and evidence and to expand the information
evidence, not just mental status effectively described in standard about vocational training and work-
examinations; that is, to provide that psychiatric and psychological textbooks. related programs. We also explain that
individual case facts determine the type We also provide guidance about the we will consider information from work
and extent of evidence we need to make elements of mental status examinations attempts or current work activity when
our determination or decision. This will in the booklet, Consultative we need it to show the severity of a
help to clarify that we do not need, and Examinations: A Guide for Health person’s mental disorder and how it
will not ask for, evidence from all of the Professionals.34 In the proposed rules, affects his or her ability to function.
sources we describe in 12.00G in every we list the mental status examination as
Proposed 12.00G5—Evidence From
case. one aspect of the evidence we typically
Psychological and Psychiatric Measures
expect from medical sources.
Proposed 12.00G2—Evidence From We also propose to remove current We propose to remove the detailed
Medical Sources 12.00D11, which describes the information on psychological testing in
In proposed 12.00G2, we reorganize documentation needed for specific current 12.00D5 through D9 because
and expand the information in current anxiety disorders. Although the most of this information is educational
12.00D1a and incorporate information paragraph uses words that are specific and procedural, and tests are constantly
from current 12.00D1c to explain that to anxiety disorders, it does not require being revised and updated. Instead, we
we will consider all relevant evidence anything that we would not ordinarily would provide general and policy-
from the person’s physician or require to evaluate other mental related test information in an SSR.35
psychologist and from other medical disorders. For example, it requires Therefore, in this section we would
sources who are not ‘‘acceptable medical information about a typical reaction, explain only in general terms how we
sources,’’ such as therapists and licensed and if there are panic attacks, a consider the results of psychological
clinical social workers. We include description of the nature, frequency, and psychiatric measures.
information about other medical sources and duration of the attacks, the
Proposed 12.00G6—Need for
under the heading, ‘‘Evidence from
Longitudinal Evidence
medical sources,’’ rather than ‘‘Other 33 SSR 06–3p, ‘‘Titles II and XVI: Considering
information,’’ as in current 12.00D1c, Opinions and Other Evidence from Sources Who Proposed 12.00G6 generally
Are Not ‘Acceptable Medical Sources’ in Disability corresponds to current 12.00D2,
because we consider these sources to be Claims; Considering Decisions on Disability by
Other Governmental and Nongovernmental although we have slightly expanded the
32 ‘‘Acceptable medical sources’’ are physicians, Agencies,’’ 71 FR 45593 (2006). Also available at:
licensed or certified psychologists, and certain http://www.socialsecurity.gov/OP_Home/rulings/di/ 35 However, we are proposing to include a
other types of medical sources who can provide 01/SSR2006-03-di-01.html. provision that explains how we decide whether an
evidence to establish the existence of a medically 34 SSA Pub. No. 64–025, November 1999. IQ test score is ‘‘valid’’ in proposed 12.00B4d and
determinable impairment. Sections 404.1513(a) and Available at: http://www.socialsecurity.gov/ general guidance for considering test results in
416.913(a). disability/professionals/greenbook/index.htm. proposed 12.00D4.
provisions and changed some of the to our rules for this policy. Sections allowances by reducing the number of
terms we use. In 12.00G6a, we explain 404.1535 and 416.935. cases in which we must make more
that we will consider how a person labor-intensive determinations of
12.00I—How do we evaluate mental
functions longitudinally, taking into medical equivalence. For example,
disorders that do not meet one of the
consideration any periods of because of the paragraph A criteria, we
mental disorders listings? do not list dysthymic disorder and
exacerbation or remission. We explain
that we will not make a determination Although this proposed section would cyclothymic disorder in current listing
based solely on periods of exacerbation be new to the mental disorders listings, 12.04; when these relatively common
or remission, but will consider all it is in large part similar to guidance we mental disorders are of listing-level
factors related to these occurrences and provide in other body systems; for severity, we must make a finding of
any other relevant evidence so that we example, 4.00I3 (Cardiovascular medical equivalence to listing 12.04 and
understand how a person functions over System), 8.00H (Skin Disorders), and explain why they medically equal the
time. 13.00F (Malignant Neoplastic Diseases). listing. Under the proposed rules, if a
Proposed 12.00G6b is new. It explains We also explain that a mental disorder person with one of these disorders has
that, if a person has a serious mental may cause a physical impairment(s) and limitations in functioning that satisfy
disorder, we would expect there to be how we would evaluate such an the paragraph B or paragraph C criteria,
evidence of its effects on his or her impairment(s). We include an example the disorder would meet listing 12.04.
functioning over time, even if the of a cardiovascular impairment that In drafting these proposed rules, we
person does not have an ongoing results from an eating disorder to clarify were mindful of possible concerns that
relationship with the medical the guidance in current 12.00D12 the listings would no longer provide
community. Such evidence could come, (Eating Disorders), which reminds specific criteria that adjudicators could
for example, from family members, adjudicators to consider the physical identify in order to establish the
neighbors, or former employers. consequences of eating disorders. existence of a specific mental disorder
Proposed 12.00G6c generally under a listing. For example, we
corresponds to the fourth paragraph of 12.01 Category of Impairment, Mental considered whether our adjudicators
current 12.00C3. It explains that a Disorders might need to refer to the DSM more
person’s ability to function in an Proposal To Remove the Introductory often and whether administrative law
unfamiliar or one-time situation, such as Paragraphs and Paragraph A Criteria judges (ALJs) might have to use more
a consultative examination, does not medical experts at hearings. We do not
necessarily show how he or she will be We believe that the current paragraph believe that the proposed rules should
able to function in a work setting under A criteria in each listing (except for be a cause for these kinds of concerns
the stresses of a normal workday and current listing 12.05) are too because our adjudicators already make
workweek on a sustained basis. prescriptive; they omit from the listings determinations about the nature of
Proposed 12.00G6d is new. It explains mental disorders that we often see in mental disorders apart from the issue of
how we consider the effects of stress. disability claims. The proposal to ‘‘meeting’’ listings, and the proposed
We based the proposed provisions on remove the paragraph A criteria would listings put less emphasis on the need
guidance in SSR 85–15.36 Although this make the listings more comprehensive to establish a specific diagnosis than the
SSR is specifically about evaluating by including any and all mental current rules do. In this regard,
disability at step 5 of the sequential disorders that can be identified within adjudicators would only continue to do
evaluation process, its guidance about a listing category. By including such what they do now: we do not believe
stress is also relevant to other steps of disorders, we would address questions that they will need to consult the DSM
the process. from our adjudicators about which or that ALJs will need medical expert
listings to use to evaluate some mental testimony with greater frequency.38 The
Proposed 12.00H—How do we evaluate disorders not described by the current major difference will be that, after
substance use disorders? paragraph A criteria. The proposed determining the existence and nature of
We propose to add this section change would also make the mental the mental disorder, our adjudicators
because we are also proposing to disorders listings consistent with many will not then have to make findings
remove listing 12.09, Substance of our other listings. For example, we about whether there is evidence
addiction disorders, for reasons we have a number of musculoskeletal and demonstrating specific paragraph A
explain later in this preamble. We neurological listings that describe criteria prescribed in each of the current
explain the requirement in the Act and categories of impairments rather than listing categories. This change will
our regulations 37 that, if we find a specific diagnoses. As in the proposed simplify our current rules.
person disabled and there is medical mental disorders listings, listing-level
severity in these listings is shown by Proposed Changes to Specific Listings
evidence establishing a substance use
limitations of functioning. in This Body System
disorder, we must determine whether
the disorder is a contributing factor The proposed changes would also Proposed Listing 12.05
material to the determination of respond in part to the many commenters We propose to make minor editorial
disability. We also include a reference on the ANPRM who suggested specific revisions in current listing 12.05. As we
mental disorders that we should add to show in the chart below, current listing
36 SSR 85–15, ‘‘Titles II and XVI: Capability To Do the current listings. While adding names 12.05 starts with an introductory
Other Work—The Medical-Vocational Rules As a of specific mental disorders to the paragraph that provides our diagnostic
Framework for Evaluating Solely Nonexertional listings would broaden their scope
Impairments,’’ available at: http:// description of mental retardation. The
www.socialsecurity.gov/OP_Home/rulings/di/02/ somewhat, it could still omit some
SSR85-15-di-02.html. mental disorders within each listing 38 The DSM also includes many diagnoses that are
37 Sections 223(d)(2)(C) and 1614a(3)(J) of the Act; category. The proposed rules allow us to characterized as ‘‘NOS’’: Not Otherwise Specified.
§§ 404.1535 and 416.935 of the regulations. In include the disorders the commenters Partly because of these diagnoses, we expect that
drafting this rule, we also considered whether to there will be fewer issues about whether a person
propose revisions and updates to §§ 404.1535 and
asked us to add and more. has a particular kind of mental disorder that
416.935. We decided that, if we propose revisions The proposed change would also requires additional development or rationale to
to those rules, we should do so in a separate NPRM. simplify our adjudication of some explain the finding about the nature of the disorder.
current listing also includes four sets of incorporate by reference two of the in other instructions—there continues to
severity criteria (paragraphs A through elements of the diagnostic description be some confusion about whether a
D). If a person’s mental disorder satisfies (‘‘significantly subaverage general person’s impairment must satisfy the
the diagnostic description in the intellectual functioning’’ and definition of ‘‘mental retardation’’ in the
introductory paragraph and any one of ‘‘significant deficits of adaptive introductory paragraph of listing 12.05
the four sets of criteria, we find that it functioning’’) into each of the proposed and what that definition means. We
meets the listing. As with all of the listings by requiring that a person hope to lessen that confusion by
other mental disorders listings, we demonstrate ID/MR ‘‘as defined in including a reference to the definition
propose to remove the introductory 12.00B4.’’ Although we have clarified within each section of listing 12.05.
paragraph of listing 12.05. Unlike in the the current listing on several Below is a chart comparing current
other listings, however, we would occasions—both in the listing itself and listing 12.05 with our proposed changes:
Current listing 12.05 Proposed listing 12.05
12.05 Mental retardation: Mental retardation refers to significantly 12.05 Intellectual Disability/Mental Retardation (ID/MR) satisfying A,
subaverage general intellectual functioning with deficits in adaptive B, C, or D.
functioning initially manifested during the developmental period; i.e.,
the evidence demonstrates or supports onset of the impairment be-
fore age 22.
The required level of severity for this disorder is met when the require-
ments in A, B, C, or D are satisfied.
A. Mental incapacity evidenced by dependence upon others for per- A. ID/MR as defined in 12.00B4, with mental incapacity evidenced by
sonal needs (e.g., toileting, eating, dressing, or bathing) and inability dependence upon others for personal needs (for example, toileting,
to follow directions, such that the use of standardized measures of eating, dressing, or bathing) and inability to follow directions, such
intellectual functioning is precluded; that the use of standardized measures of intellectual functioning is
OR precluded.
OR
B. A valid verbal, performance, or full scale IQ of 59 or less; B. ID/MR as defined in 12.00B4, with a valid IQ score of 59 or less (as
OR defined in 12.00B4d) on an individually administered standardized
test of general intelligence having a mean of 100 and a standard de-
viation of 15 (see 12.00D4).
OR
C. A valid verbal, performance, or full scale IQ of 60 through 70 and a C. ID/MR as defined in 12.00B4, with a valid IQ score of 60 through 70
physical or other mental impairment imposing an additional and sig- (as defined in 12.00B4d) on an individually administered standard-
nificant work-related limitation of function; ized test of general intelligence having a mean of 100 and a stand-
OR ard deviation of 15 (see 12.00D4) and with another ‘‘severe’’ physical
or mental impairment (see 12.00B4e).
OR
D. A valid verbal, performance, or full scale IQ of 60 through 70, result- D. ID/MR as defined in 12.00B4, with a valid IQ score of 60 through 70
ing in at least two of the following: (as defined in 12.00B4d) on an individually administered standard-
1. Marked restriction of activities of daily living; or ized test of general intelligence having a mean of 100 and a stand-
2. Marked difficulties in maintaining social functioning; or ard deviation of 15 (see 12.00D4), resulting in marked limitation of at
3. Marked difficulties in maintaining concentration, persistence, or least two of the following mental abilities:
pace; or 1. Ability to understand, remember, and apply information (see
4. Repeated episodes of decompensation, each of extended dura- 12.00C1).
tion. 2. Ability to interact with others (see 12.00C2).
3. Ability to concentrate, persist, and maintain pace (see 12.00C3).
4. Ability to manage oneself (see 12.00C4).
Proposed listing 12.05D corresponds • An impairment meets current current 12.00A, because it explains how
to current listing 12.05D, but refers to listing 12.09F by meeting the criteria in listing 12.09 is structured. As we have
the proposed paragraph B criteria listing 5.05 for chronic liver disease. already noted, however, we are
instead of the current paragraph B In both cases, claimants who qualify proposing a new section 12.00H that
criteria. Otherwise, it is the same as the under these listings would still qualify would briefly state our policy on how,
current listing. under the listings to which they cross- in our disability determinations, we
refer, provided that their substance use consider the effects of substance use
Proposal To Remove Current Listing disorders are not material to our disorders. The proposed section would
12.09 determination of disability. We have also provide a cross-reference to our
been removing reference listings from rules for determining whether a
We propose to remove current listing all of the body systems as we revise
12.09, Substance Addiction Disorders, substance use disorder is a contributing
them, and the changes we are proposing factor material to disability. Sections
because it is a reference listing. in this NPRM would be consistent with
Reference listings refer to criteria in 404.1535 and 416.935.
that approach.39
other listings and are redundant because If we remove listing 12.09, we would Proposed Listings 12.11 and 12.13
we use the other listings to evaluate also remove the fifth paragraph of
disability. For example: Proposed listing 12.11, Other
39 Examples of relatively recent such changes Disorders Usually First Diagnosed in
• An impairment meets current include the ‘‘Revised Medical Criteria for Evaluating Childhood or Adolescence, is based on
listing 12.09A by meeting the criteria for Digestive Disorders,’’ 72 FR 59398 (October 19, the first diagnostic category in the
any listing under 12.02 for organic 2007), and the ‘‘Revised Medical Criteria for
Evaluating Immune System Disorders,’’ 73 FR 14570 DSM–IV–TR and would correct some
mental disorders. (March 18, 2008). omissions in our current listings.
Proposed listing 12.13, Eating Disorders, children differs significantly from the signs associated with the various
would provide a listing for adults that signs and symptoms of the same disorders we would evaluate under
corresponds to a childhood listing we disorders in adults. These explanations proposed listing 112.14, however brief,
have had since 1990. We agreed with in the current rules ensure that would be too lengthy.
several commenters on the ANPRM who adjudicators appropriately evaluate In proposed 112.00I6, we would
asked us to add a listing for eating medically determinable mental expand our rules for deferring a
disorders in adults since we use disorders in children. In the proposed determination for infants, now in
childhood listings only for persons who rules, we describe such differences more
current 112.00D2. The provisions
are under age 18 (including persons specifically in proposed 112.00B; for
recognize that young infants typically
who are nearly age 18), but persons age example, we include examples of early
experience some irregularities in
18 and older also have these disorders. childhood eating disorders (proposed
observable behaviors (such as sleep
As a consequence of this proposed listing 112.13) that are not appropriate
cycles, attending to faces, and self-
change, we would also remove most of for the adult listing. We also provide
calming), which can make it difficult to
the guidance we now provide in age-appropriate paragraph B criteria for
document the presence, severity, or
12.00D12 because we would no longer infants and toddlers in proposed
duration of a developmental disorder(s).
need it. 112.00I.
Under our current listings, • The seventh paragraph of current In some cases, deferring our
adjudicators can find that the disorders 112.00A, which explains why we do not determination allows us to obtain a
we would cover under proposed listings include separate paragraph C criteria in longitudinal medical history and, if
12.11 and 12.13 medically equal a current listings 112.02, 112.03, 112.04, necessary, standardized developmental
listing. Thus, the principal effect of and 112.06. We would not need this testing. The rule in proposed 112.00I6a
adding these listings would be to paragraph because we are now addresses full-term infants who have
streamline our processing of cases that proposing to include the same not attained age 6 months, while
involve these impairments. paragraph C criteria in the childhood proposed 112.00I6b addresses infants
listings that we propose for the adult who were born prematurely. We also
Proposed 112.00—Introductory Text to propose to update the rule for premature
rules.
the Childhood Mental Disorders infants to reflect our rules in
Listings Proposed 112.00I § 416.924b(b) for adjusting age for
We repeat much of the introductory In proposed 112.00I of the prematurity.
text of proposed 12.00 in the introductory text—How do we use Current 112.00D2 provides that we
introductory text of proposed 112.00. 112.14 to evaluate developmental may defer adjudication for full-term
This is because the same basic rules for disorders of infants and toddlers from infants until they are 3 months old and
evaluating mental disorders in adults birth to attainment of age 3?—we to an unspecified older age for
also apply to mental disorders in include the same kinds of information premature infants. We propose to
children from birth to the attainment of for infants and toddlers as we do for change this rule to say that, when we
age 18. Because we have already older children in the other sections of must defer adjudication in these claims,
described these provisions above, the the introductory text. For example, we we will wait until the child is at least
following discussions describe only describe ‘‘developmental disorders’’ and 6 months old regardless of whether he
those provisions that are unique to the define the four proposed paragraph B or she was born full term or
childhood rules or that require further criteria for infants and toddlers and the prematurely. We would use
explanation. We describe only the major terms ‘‘marked’’ and ‘‘extreme’’ for this chronological age for full-term infants
provisions pertinent to 112.00. For age group.40 We also include and corrected chronological age for
example, we do not explain: information about how we consider premature infants. Based on our
• References to ‘‘children’’ instead of supports an infant or toddler receives.41 adjudicative experience and the
adults; In proposed 112.00I2, we describe
information we obtained when we
• References to a child’s ability to do only the broad characteristics of
developed these proposed rules, we
age-appropriate activities, as opposed to developmental disorders rather than
believe that 3 months is inadequate to
an adult’s ability to function in a work specific characteristics of any particular
setting; establish whether some infants have
medically determinable impairment that
• References to the functional listing-level developmental disorders.
would be identified as a developmental
equivalence provision at step 3 of the However, we also explain in proposed
disorder. Unlike the proposed adult
sequential evaluation process for 112.00I6c that we will not always defer
listing categories and the other proposed
children instead of steps 4 and 5 of the child listing categories—which include adjudication. There will be many cases
process for adults; and related kinds of mental disorders under in which we can determine that an
• Examples for children that are each listing category—proposed listing infant younger than age 6 months has a
different from the examples we provide 112.14 would include several kinds of developmental disorder that meets or
for adults, such as the information about unrelated disorders; for example, medically equals proposed listing
the listing categories in 12.00B and pervasive developmental disorders, 112.14 or a listing in another body
112.00B. developmental coordination disorder, system or a combination of impairments
As a result of replacing all of current and ‘‘developmental delay.’’ We believe that functionally equals the listings.
112.00A with text that is the same as, or that any summary of the symptoms and There will also be cases in which we
similar to, proposed 12.00A and B, we can determine that a child is not
would remove the following provisions, 40 We define the terms ‘‘marked’’ and ‘‘extreme’’ as disabled before age 6 months. We would
among others: they apply to infants and toddlers in proposed defer adjudication only when it appears
• The second paragraph of current 112.00I4c, d, e, and f. The definitions generally that an infant has a significant
112.00A, which explains that there are reflect those in the functional equivalence developmental delay but we need to
regulation.
certain diagnostic categories applicable 41 We also address issues related to wait so that we can get adequate
only to children and that the developmental disorders in proposed 112.00G, the evidence to be sure of our
presentation of mental disorders in section on evidence. determination.
112.01 Category of Impairment, 112.05B and D would cover any child the attainment of age 3. We would no
Mental Disorders with ID/MR who could qualify under longer have separate criteria for children
The proposed childhood listing current listing 112.05A. from age 1 to the attainment of age 3 in
categories are the same as the adult Current listing 112.05F is a variation the other mental disorders listings
categories, except that we are also on current listing 112.05D, the listing because we would evaluate all mental
proposing new listing 112.14 for for children who have ID/MR with an IQ disorders for children in that age group
children from birth to the attainment of of 60–70 and another ‘‘severe’’ physical under proposed listing 112.14.
age 3. As a consequence of this new or mental impairment. Instead of
requiring an IQ of 60–70, current listing How We Evaluate Children From Birth
listing, we would also remove listing to Age 3 Under the Current Listings
112.12, which is for children from birth 112.05F requires that the child have a
to the attainment of age 1. As we noted ‘‘marked’’ limitation of the first Current listing 112.12 includes four
earlier, we describe only those paragraph B criterion, ‘‘cognitive/ areas for rating severity in children from
provisions that are unique to the communicative function.’’ In our birth to age 1: Cognitive/communicative
childhood rules. adjudicative experience, we do not see functioning; motor development;
cases of children whose impairments apathy, over-excitability, or fearfulness;
Proposed Listing 112.05 meet this listing. In the unlikely event and social interaction. We evaluate the
Proposed listing 112.05 is the same as that we receive a claim in which a child mental disorders of children age 1 to the
proposed listing 12.05. As in all the appears to have ID/MR but has not had attainment of age 3 under the same
other proposed listings, we are making IQ testing, we will purchase IQ testing listings as for older children; that is,
changes to remove references to to determine whether the impairment current listings 112.02 through 112.11.
children under age 3 because of our new meets proposed listing 112.05C unless However, we provide separate severity
proposed listing 112.14, which is for all we can find that the child is disabled on criteria for this age group and only three
children from birth to the attainment of some other basis, such as under our paragraph B criteria: Motor
age 3. rules for functional equivalence in development, cognitive/communicative
Current listing 112.05 has six § 416.926a. function, and social function.
paragraphs, designated A through F. We Children in both groups (birth to the
Proposal To Remove Listing 112.09 attainment of age 1 and age 1 to the
propose to remove listings 112.05A and
F so that listings 112.05 and 12.05 are Current listing 112.09, Psychoactive attainment of age 3), can qualify under
the same. Current listings 112.05B, C, D, Substance Dependence Disorders, is the current listing by showing extreme
and E correspond to current adult different from current listing 12.09 in limitation of one paragraph B criterion
listings 12.05A, B, C, and D. As we have that it is not a reference listing; rather, or marked limitations of two. For both
already explained, we are proposing to it consists of an introductory paragraph age groups, we define the severity
keep current listings 12.05A, B, C, and and paragraph A and B criteria. We are ratings in terms of the attainment of
D with minor changes we have already proposing to remove it because children developmental milestones: for extreme
described, and we would do the same with substance use disorders must limitation, the attainment of
for children, redesignating the listings satisfy the same requirement that development or functioning at a level
so they have the same letters; for applies to substance use disorders in generally acquired by children no more
example, current listing 112.05B would adults; that is, if we find that a child is than one-half the child’s chronological
become listing 112.05A and current disabled, we must also determine age, and for marked limitation, the
listing 112.05E would become listing whether the child’s substance use attainment of development or
112.05D. There are also minor disorder is a contributing factor material functioning at a level generally acquired
differences between the proposed child to our determination of disability. by children no more than two-thirds the
and adult rules because we need to use Section 416.935. When we find that a child’s chronological age.
language specific to children. child is disabled because of a substance
use disorder that meets listing 112.09, Proposed Listing 112.14
We would remove current listing
112.05A and F because we do not the substance use disorder is always Proposed listing 112.14 is similar in
believe we need them. Current listing material to the determination of structure to the other proposed listings
112.05A would be redundant of other disability, and a child cannot qualify for for children and adults. It would require
proposed listings. A child age 3 or older benefits based on a mental disorder that a child to have a developmental
with ID/MR has a mental disorder that meets listing 112.09. disorder that results in extreme
meets this listing with ‘‘marked’’ limitation in using one, or marked
Proposed Listing 112.14— limitations in using two, developmental
limitations in at least two of the current Developmental Disorders of Infants and
paragraph B functional criteria for abilities to acquire and maintain the
Toddlers skills a child needs to function age-
children. Under proposed 112.05B, a
child with ID/MR with a valid IQ of 59 We propose to replace current listing appropriately. The four proposed
or less would have an impairment that 112.12, Developmental and Emotional paragraph B criteria for this age group
meets the listing without reference to Disorders of Newborn and Younger are:
the paragraph B functional criteria.42 Infants (Birth to attainment of age 1), • The ability to plan and control
Under proposed 112.05D, a child with with a new listing 112.14, motor movement (paragraph B1),
ID/MR with an IQ of 60 to 70 and Developmental Disorders of Infants and • The ability to learn and remember
‘‘marked’’ limitations in two of the Toddlers, that we will use to evaluate (paragraph B2),
these disorders in children from birth to • The ability to interact with others
proposed paragraph B criteria would
(paragraph B3), and
have an impairment that meets that
112.05E requires a ‘‘valid’’ IQ of 60–70, which • The ability to regulate physiological
listing.43 Thus, proposed listings means that the child must have a ‘‘marked’’ functions, attention, emotion, and
limitation in the first paragraph B criterion for behavior (paragraph B4).
42 This redundancy occurs in the current listing children, ‘‘cognitive/communicative function.’’ The
too. rest of current listing 112.05E requires a ‘‘marked’’
These criteria are similar to the
43 Although the rule is less clear, this redundancy limitation in one of the three remaining paragraph current severity criteria for both age
also occurs in the current listing. Current listing B criteria. groups and describe the developmental
abilities typically assessed in children the term in current listing 112.12, publish the proposed listings. Although
from birth to age 3. ‘‘emotional and developmental not exclusively for applying the listings,
• The proposed paragraph B1 disorders,’’ because we believe it is the PRT is mostly related to the use of
criterion would serve the same function sufficiently broad to encompass all the listings, and the changes we are
as the ‘‘motor’’ criteria for children from aspects of a young child’s development, proposing would make the PRT less
birth to age 1 in current listing 112.12B including emotional disorders. useful in this regard. For example, most
and age 1–3 in current listing The proposed paragraph B pages of the PRTF restate the paragraph
112.02B1a. developmental abilities for children A diagnostic criteria from the current
• The proposed paragraph B2 from birth to age 3 are also related to the listings, and we do not have such
criterion would address abilities proposed paragraph B mental abilities criteria in the proposed listings.47 Our
covered in ‘‘cognitive/communicative for children ages 3–18: adjudicators can record the other
functioning’’ in current listings 112.12A • The ability to learn and remember findings associated with the PRT and
and 112.02B1b.44 corresponds to the paragraph B1 the PRTF (for example, how they rate
• The proposed paragraph B3 criterion for children age 3–18, the the paragraph B criteria and whether an
criterion would address the ability ability to understand, remember, and RFC assessment is needed) on other
covered in ‘‘social function’’ in current apply information. documents. In fact, in 2000 we removed
listings 112.12D and 112.02B1c. • The ability to interact with others is the requirement for ALJs and the
• The proposed paragraph B4 the same as the paragraph B2 criterion Appeals Council to complete the PRTF
criterion would address the problems for children age 3–18. because they already explain in their
with self-regulation in current listing • The ability to regulate physiological decisions how they apply the PRT
112.12C, ‘‘Apathy, over-excitability, or functions, attention, emotion, and rules.48 We also plan to provide
fearfulness, demonstrated by an absent behavior corresponds to the proposed standard electronic decision templates
or grossly excessive response to visual, paragraphs B3 and B4 criteria for at all levels of review, and these
auditory, or tactile stimulation.’’ children age 3–18. We would combine templates will document the findings in
The fourth proposed paragraph B these abilities under one criterion to mental disorder determinations and
criterion would also allow us to reflect clinical practice and the fact that decisions at each of the relevant steps of
consider more developmental issues the abilities are differentiated less well our process for determining disability.
than we now do under listing 112.12C. in children from birth to age 3. When a We already use such templates in
It reflects recent literature regarding child attains age 3, we would assess his decisions at the hearing level of our
early child development.45 or her ability to regulate attention under administrative review process.49
We are proposing to evaluate infants the proposed B3 criterion for children There are provisions of §§ 404.1520a
and toddlers in a single age grouping for age 3 and older (the ability to and 416.920a that we are proposing to
several reasons. We believe that, from concentrate, persist, and maintain pace) keep in the same or similar form in
the perspective of medical evaluation and the child’s ability to regulate other sections of these proposed rules,
and diagnosis, the developmental physiological functions, emotion, and as follows:
period of birth to the attainment of age behavior under the proposed B4 1. In current §§ 404.1520a(e)(1) and
3 is better viewed as a continuum rather criterion for such children (the ability to 416.920a(e)(1), we provide that State
than two distinct age groups. We also manage oneself). agency medical and psychological
believe that it is more appropriate to consultants have the overall
Why are we proposing to remove responsibility for assessing the medical
consider children age 1–3 in terms of §§ 404.1520a and 416.920a, Evaluation
their development and ‘‘developmental severity of mental impairments. We also
of Mental Impairments? provide that a State agency disability
disabilities’’ or ‘‘developmental
disorders,’’ not of the mental disorder In the 1985 rules, we introduced the examiner may assist in preparing the
categories that we propose to use for PRT as an adjudicative tool for PRTF; however, the medical or
older children and adults. Medical and evaluating disability in adults due to psychological consultant with overall
health care professionals in the field of mental disorders.46 Sections 404.1520a responsibility for assessing the mental
infant and early childhood mental and 416.920a. The purpose of the impairment must review and sign the
health have not reached consensus on technique was to help our adjudicators document to attest that it is complete
appropriate mental disorder diagnoses organize and evaluate all the findings in and that he or she is responsible for its
for this age group. Except in cases the case to ensure fair and equitable content. We also provide rules requiring
involving the most profound and disability evaluations. There was disability hearing officers, ALJs, and the
obvious impairments, many concern at the time that the new listings Appeals Council (when the Appeals
pediatricians and developmental were novel and complex, so in Council makes a decision), to document
specialists prefer to wait until a child is conjunction with the publication of the how they applied the PRT in their
age 3 or older before making a definitive new adult mental disorder listings in determinations and decisions.
diagnosis; in cases of children who are 1985, we also mandated in the We believe that, with appropriate
under age 3, we often see a diagnosis of regulations the use of a ‘‘standard changes to reflect the removal of the
‘‘developmental delay.’’ document,’’ called the Psychiatric
We propose to use the term Review Technique Form or ‘‘PRTF’’ 47 It would also not be useful to have a form that
(SSA–2506–BK), to ensure that repeats the examples and summary guidance in

‘‘developmental disorders’’ instead of proposed 12.00B since the examples and summaries
adjudicators at all levels of
are primarily informational. As we explained earlier

44 In those two listings, for children from birth to administrative review would properly in this preamble, proposed 12.00B generally
age 3 for whom standardized intelligence testing apply the new listings. provides only examples to illustrate the kinds of
may not be appropriate because of the child’s young We are now proposing to remove mental disorders that are included in the listing
age or condition, we can use evidence about the categories.
child’s communication as an alternative to, or proxy
these sections because we believe that 48 65 FR at 50757–58.
for, evidence about the child’s cognitive we will no longer need the PRT if we 49 The system of templates used at the hearing
functioning, which is the focus of the area of level is called ‘‘Findings Integrated Templates,’’ or
‘‘cognitive/communicative functioning.’’ 46 We never extended the use of the PRT to FIT. You can read about FIT at: http://
45 See the References section of this preamble. children. www.socialsecurity.gov/appeals/fit/.
PRT and PRTF, the provisions in make their structure and language system disorders. We believe that,
§§ 404.1520a(e)(1) and 416.920a(e)(1) simpler and clearer. We also designate because of the nature of the changes we
would still be useful if we put them in all paragraphs in the proposed rules are proposing in these mental disorders
terms that apply to our adjudication of with letters or numbers to make it easier listings, it would no longer be
cases involving mental disorders under to refer to them, and provide headings appropriate to incorporate the criteria in
these proposed listings and at other for all of the major sections and many the childhood mental disorders listings
steps of the sequential evaluation of the subsections. by reference if we publish the proposed
process. For example, instead of We also propose to make a number of rules as final rules. Moreover, children
providing that State agency disability conforming changes in other body with claims for SSI can qualify under
examiners may assist medical and systems that would reflect the changes our rules for functional equivalence to
psychological consultants in preparing in the proposed mental disorders the listings, which consider their
the PRTF, we would provide that State listings, specifically, the respiratory functional limitations in domains that
agency disability examiners may assist system for adults (3.00), multiple body we designed to cover all childhood
in reviewing the claim and preparing systems for adults and children (10.00 physical and mental functioning. The
documents that contain the medical and 110.00), neurological for adults very small number of children who
portion of the case review and any (11.00), and immune disorders for qualify under the functional criteria in
applicable RFC assessment. The children (114.00) 50 In addition, we the immune disorders listings would
proposed revisions are in §§ 404.1503, propose to add a new section 111.00F to still be able to qualify under our
404.1615, 416.903, and 416.1015 and provide our policy for evaluating functional equivalence criteria.
would apply to both adults and traumatic brain injury (TBI) in the We are not proposing a similar change
children. childhood listings. The information is to the adult listings for immune
2. In current §§ 404.1520a(e)(3) and essentially the same as in current disorders in 14.00. Each of those listings
416.920a(e)(3), we provide that, if an 11.00F. also contains criteria for evaluating
ALJ: Each of the current listings in functioning, but we do not cross-refer to
• Requires the services of a medical 114.00—the immune disorders system the adult mental disorders listings;
expert to assist in applying the PRT, but for children—includes criteria that rather, we include specific functional
• Such services are not available, cross-refer to the functional criteria in criteria within each of the adult listings.
the ALJ may return the case to the State current listings 112.02 and 112.12. We Also, we do not have functional
agency for completion of a PRTF under are proposing to remove these listing equivalence rules for adults.
the provisions of §§ 404.941 and criteria without replacement. According Finally, we propose to update a
416.1441. Although we would no longer to our data, we almost never use them, provision in § 416.934. Section 416.934
have a PRT or PRTF under these and in some cases, we have never used provides a list of impairment categories
proposed rules, we propose to include them. For example, from fiscal year (FY) that employees in our field offices may
a provision in §§ 404.941 and 416.1441 2003 through FY 2007, only two use to make findings of presumptive
that would let ALJs continue to ask children were allowed under the disability in SSI claims without
State agency medical and psychological functional listing for human obtaining any medical evidence.52
consultants to evaluate claims involving immunodeficiency virus (HIV) infection Section 416.934(h) applies to claimants
mental disorders when they need the at the initial level of adjudication. We who are at least 7 years old. It uses the
services of a medical expert and no added functional criteria to all of the outdated term ‘‘mental deficiency.’’ It
expert is available. other child immune system listings also refers to allegations that a child ‘‘is
We would not keep the guidance in beginning in June 2008, but in FY 2009, unable to attend any type of school.’’
§§ 404.1520a(d)(1) and 416.920a(d)(1) only 13 children qualified at the initial We propose to revise § 416.934(h) to:
about ratings that indicate that a mental level under those new listings.51 • Reduce the lower age limit from age
disorder is ‘‘not severe’’ because we Under the current 114.00 listings, we 7 to age 4,
would no longer have the PRT and its use the functional criteria in the • Refer to ID/MR and other cognitive
rating system. We also believe that the childhood mental disorders listings to impairments, and
guidance is unnecessary since it evaluate both physical and mental • Remove the statement about
provides only that persons who have no limitations that result from immune inability to attend school and replace it
limitations or only mild limitations with a new requirement.
probably have impairments that are ‘‘not 50 Some of these changes would remove reference The proposed new requirement is an
severe.’’ This guidance only restates in listings (or portions of reference listings) that cross- allegation of a complete inability to
language specific to mental disorders refer to the mental disorders listings. Reference independently perform basic self-care
listings are listings that are met by satisfying the
what our other rules already provide. criteria of other listings. The reference listings for
activities (such as toileting, eating,
See, for example, §§ 404.1520(c), mental disorders are redundant because we dressing, or bathing) made by another
404.1521, 416.920(c), and 416.921 of our evaluate mental effects of impairments using the person who files on behalf of the
regulations. listings in 12.00 and 112.00. We have been claimant. We based the proposed
If we remove §§ 404.1520a and removing reference listings from all of the body
systems as we revise them, and the changes we are
criterion on proposed listings 12.05A
416.920a, we would also remove current proposing in this NPRM are consistent with that and 112.05A, but it is somewhat
12.00I, ‘‘Technique for reviewing approach. Examples of recent such changes include different than the listing criterion,
evidence in mental disorders claims to the ‘‘Revised Medical Criteria for Evaluating which does not necessarily require a
determine the level of impairment Digestive Disorders,’’ 72 FR 59398 (October 19,
‘‘complete’’ inability to perform basic
2007), and the ‘‘Revised Medical Criteria for

severity,’’ in the introductory text to the Evaluating Immune System Disorders,’’ 73 FR 14570 self-care activities. We proposed this
current listings. (March 18, 2008).
51 We published the functional criteria for the 52 We may make SSI payments based on
Other Proposed Changes other listings in the immune body system in March presumptive disability or presumptive blindness
Throughout these proposed rules, we 2008, and the rules became effective June 16, 2008. when there is a high degree of probability that we
73 FR 14570. From June 16, 2008, through will find a claimant disabled or blind when we
make nonsubstantive editorial changes September 30, 2009, we found that only 21 children make our formal disability determination at the
to update medical terminology in the qualified under the immune listings containing initial level of our administrative review process. 20
introductory text and the listings and to functional criteria, including the HIV listing. CFR 416.931.
criterion because the regulation section disability claimants.53 As the results of in plain language. In addition to your
has a very narrow and specific purpose: the OIS Development Project may substantive comments on these
to allow employees in our field offices, inform our criteria regarding the proposed rules, we invite your
who do not make disability physical and mental-cognitive comments on how to make them easier
determinations and will not be functioning required to do substantial to understand.
reviewing medical evidence for these gainful activity, the research may also For example:
cases, to authorize presumptive inform related criteria for gainful work • Have we organized the material to
disability payments while the State articulated in our Listing of suit your needs?
agency is determining whether the Impairments. • Are the requirements in the rules
claimant is disabled. • Our evaluation of disability often clearly stated?
involves both medical and functional
We propose to reduce the lower age • Do the rules contain technical
criteria. The Clinical Research Center at
limit to age 4 because we believe that language or jargon that is not clear?
the National Institutes of Health has
age 7 is too high, and age 4 is the lowest been involved in extensive research • Would a different format (grouping
age at which we can confidently permit concerning the impact of functional and order of sections, use of headings,
our field office employees to accept the limitations on rehabilitation outcomes. paragraphing) make the rules easier to
allegation in the proposed rule. Currently, we have an interagency understand?
These proposed rule changes apply agreement with the Clinical Research • Would more (but shorter) sections
only to our field office employees. State Center to explore the possibility of using be better?
agencies will still be able to authorize International Classification of • Could we improve clarity by adding
presumptive disability payments, in Functioning domains in predicting tables, lists, or diagrams?
appropriate cases, for children under disability. Modern concepts of disability • What else could we do to make the
age 4 and for children and adults who emphasize the gap between personal rules easier to understand?
do not have a complete inability to abilities and environmental demands.
When will we start to use these rules?
perform basic self-care activities. Under Therefore, it is crucial to characterize a
§ 416.933 of our regulations, which we claimant’s functional abilities, work- We will not use these rules until we
are not proposing to change, State related requirements, as well as key evaluate public comments and publish
agencies may authorize presumptive aspects of his or her workplace, home, final rules in the Federal Register. All
disability payments whenever they and community environments in order final rules we issue include an effective
determine that the evidence they to assess the potential for substantial date. We will continue to use our
already have reflects a high degree of gainful activity more comprehensively. current rules until that date. If we
probability that a person is disabled. What is our authority to make rules publish final rules, we will include a
and set procedures for determining summary of those relevant comments
What other projects are we doing to whether a person is disabled under the we received along with responses and
determine the requirements of work? statutory definition? an explanation of how we will apply the
new rules.
These proposed rules include criteria Under the Act, we have full power
that refer to the requirements of work. and authority to make rules and Regulatory Procedures
We are also conducting two long-term regulations, and to establish necessary Executive Order 12866
projects that we expect will help us to and appropriate procedures to carry out
better determine the requirements of such provisions. Sections 205(a), We have consulted with the Office of
work. While the outcome of these 702(a)(5), and 1631(d)(1). Management and Budget (OMB) and
projects may affect rules that we may determined that these proposed rules
How long would these proposed rules meet the requirements for a significant
propose in the future, we believe that be effective?
these long-term projects do not affect regulatory action under Executive Order
our decision to proceed with these If we publish these proposed rules as 12866. Thus, they were subject to OMB
proposed rules now. We would final rules, they will remain in effect for review.
welcome your comments regarding the 5 years after the date they become We believe these proposed rules are
proposed regulatory changes to the effective, unless we extend them or not economically significant within the
listing of mental impairments in light of revise and issue them again. meaning of Executive Order 12866;
the projects we have underway. Clarity of These Proposed Rules however, we invite public comment on
the cost impact of the rules.
• We are working to develop an Executive Order 12866, as amended,
occupational information system (OIS), requires each agency to write all rules Regulatory Flexibility Act
tailored to our disability programs, We certify that these proposed rules
which will replace our use of the 53 To provide independent advice and
would not have a significant economic
Dictionary of Occupational Titles. The recommendations on these plans and activities, we
convened a discretionary advisory committee, the impact on a substantial number of small
goal of the research and development Occupational Information Development Advisory entities because they would affect only
underway for the OIS Development Panel (Panel), which was established under the individuals. Thus, a regulatory
Project is to provide occupational Federal Advisory Committee Act of 1972, as
amended. This Panel began meeting in February flexibility analysis as provided in the
information that our adjudicators can 2009 and delivered its first report in September Regulatory Flexibility Act, as amended,
use to evaluate disability claims at steps 2009. Among other recommendations, this report is not required.
4 and 5 of the sequential evaluation recommends that we adopt specific domains of
process. The OIS Development Project mental-cognitive functioning that are critical to the Paperwork Reduction Act
evaluation of a claim for disability benefits. These
must conduct research regarding the domains are different than those contained in this These rules do not create any new, or
requirements of work in terms of proposed rule. The Panel’s report, in its entirety, affect any existing, collections and,
physical and mental-cognitive function can be accessed at http://www.ssa.gov/oidap/
therefore, do not require Office of
index.htm; the recommended mental-cognitive
that we consider in our residual domains and data elements are located on pages 41 Management and Budget approval
functional capacity assessments of and 42 of this report. under the Paperwork Reduction Act.
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American Association on Intellectual Academy Press (2002) (available at: Adolescent Psychiatry, 42:12, 1504–
and Developmental Disabilities, http://books.nap.edu/ 1512 (December 2003).
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Classification, and Systems of Supports, Parmenter, T.R. ‘‘Contributions of A New Synthesis,’’ American
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Retardation, press release dated President’s New Freedom Health and Human Services, Substance
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www.aaidd.org/content_1314.cfm. Achieving the Promise: Transforming Administration, Center for Mental
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Braddock, David L. and Robert L. Schalock, Robert, et al., ‘‘The Walker, Otis, Jr., and Chris Plauche
Schalock, eds., Adaptive Behavior and Renaming of Mental Retardation: Johnson, ‘‘Mental Retardation: Overview
Its Measurement: Implications for the Understanding the Change to the Term and Diagnosis,’’ Pediatrics in Review,
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Association on Intellectual and Vol. 45, No. 2, 116–124 (April 2007). Zeanah, Charles H., Jr., ed., Handbook
Developmental Disabilities (1999). Scheeringa, Michael, Chair, ‘‘Research of Infant Mental Health, Second Edition,
DeGangi, Georgia, Pediatric Disorders Diagnostic Criteria—Preschool Age Guilford Press, New York, NY, 2000.
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(2000). http://www.infantinstitute.org/WebRDC- Early Childhood, Revised Edition, ZERO
DelCarmen-Wiggins, Rebecca, and PA.pdf). TO THREE: National Center for Infants,
Alice Carter, eds., Handbook of Infant, Schroeder, Stephen R., Martin Gerry, Toddlers, and Families, Washington, DC
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Assessment, Oxford University Press, ‘‘Usage of the Term ‘Mental Retardation’: These references are included in the
New York (2004). Language, Image and Public Education,’’ rulemaking record for these proposed
Division of Mental Health and Center for the Study of Family, rules and are available for inspection by
Prevention of Substance Abuse, World Neighborhood and Community Policy, interested persons by making
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Mental Retardation (1996) (available at: (available at: http:// shown in this preamble.
http://www.who.int/mental_health/ www.socialsecurity.gov/disability/ (Catalog of Federal Domestic Assistance
media/en/69.pdf). MentalRetardationReport.pdf). Program Nos. 96.001, Social Security—
Division of Mental Health, World Shonkoff, Jack, and Deborah Phillips, Disability Insurance; 96.002, Social
Health Organization, Assessment of eds., From Neurons to Neighborhoods: Security—Retirement Insurance; 96.004,
People with Mental Retardation, (1992) The Science of Early Childhood Social Security—Survivors Insurance; and
(available at: Development, National Research 96.006, Supplemental Security Income).
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WHO_MNH_PSF_92.3.pdf). National Academy Press, Washington,
Eisenberg, Nancy, ed., Contemporary DC (2000) (available at: http:// 20 CFR Part 404
Topics in Developmental Psychology, www.nap.edu/books/0309069882/ Administrative practice and
John Wiley & Sons, New York (1987). html/). procedure, Blind, Disability benefits,
Jacobson, John W., and James A. Social Security Administration (SSA), Old-Age, Survivors, and Disability
Mulick, eds., Manual of Diagnosis and Childhood Disability Training, SSA Insurance, Reporting and recordkeeping
Professional Practice in Mental Office of Disability, Pub. No. 64–075, requirements, Social Security.
Retardation, American Psychological March 1997.
—Childhood Disability Evaluation 20 CFR Part 416
Association, Washington, DC (1996).
Lyon, G. Reid, David B. Gray, James Issues, SSA Office of Disability, Pub. Administrative practice and
F. Kavanagh, and Norman A. Krasnegor, No. 64–076, March 1998. procedure, Aged, Blind, Disability
eds., Better Understanding Learning Strain, Philip S., Michael J. Guralnick, benefits, Public assistance programs,
Disabilities, Paul H. Brookes Publishing and Hill M. Walker, eds., Children’s Reporting and recordkeeping
Company, Baltimore, MD (1983). Social Behavior: Development, requirements, Supplemental Security
Meisels, Samuel J. and Emily Assessment, and Modification, Income (SSI).

Fenichel, eds., New Visions for the Academic Press, Inc., Orlando, FL
Michael J. Astrue,
Developmental Assessment of Infants (1986).
and Young Children, ZERO TO THREE, Task Force on Research Diagnostic Commissioner of Social Security.
National Center for Infants, Toddlers, Criteria: Infancy and Preschool, For the reasons set out in the
and Families, Washington, DC (1996). ‘‘Research Diagnostic Criteria for Infants preamble, we propose to amend
National Research Council, Mental and Preschool Children: The Process subparts J, P, and Q of part 404 and
Retardation: Determining Eligibility for and Empirical Support,’’ Journal of the subparts I, J, and N of part 416 of
chapter III of title 20 of the Code of The State agency disability examiner q. Remove the semicolon and the
Federal Regulations as set forth below: may assist in reviewing the claim and word ‘‘or’’ after section 114.04C2, add a
preparing documents that contain the period after section 114.04C2, and
PART 404—FEDERAL OLD-AGE, medical portion of the case review and remove section 114.04D of part B.
SURVIVORS AND DISABILITY any applicable residual functional r. Remove the word ‘‘or’’ after section
INSURANCE (1950–) capacity assessment. However, our 114.05D and remove section 114.05E of
medical or psychological consultant part B.
Subpart J—[Amended] must review and sign any document(s) s. Revise 114.06 of part B.
1. The authority citation for subpart J that includes the medical portion of the t. Remove the word ‘‘or’’ after section
of part 404 is revised to read as follows: case review and any applicable residual 114.07B and remove section 114.07C of
functional capacity assessment to attest part B.
Authority: Secs. 201(j), 204(f), 205(a)–(b), u. Remove the word ‘‘or’’ after section
(d)–(h), and (j), 221, 223(i), 225, and 702(a)(5)
that these documents are complete and
that he or she is responsible for the 114.08K and remove section 114.08L of
of the Social Security Act (42 U.S.C. 401(j), part B.
404(f), 405(a)–(b), (d)–(h), and (j), 421, 423(i), content, including the findings of fact
and any discussion of supporting v. Remove the word ‘‘or’’ after section
425, and 902(a)(5)); sec. 5, Pub. L. 97–455, 96
Stat. 2500 (42 U.S.C. 405 note); secs. 5, 6(c)– evidence. When a disability hearing 114.09C and remove section 114.09D of
(e), and 15, Pub. L. 98–460, 98 Stat. 1802 (42 officer makes a reconsideration part B.
U.S.C. 421 note); sec. 202, Pub. L. 108–203, w. Revise 114.10 of part B.
determination, the disability hearing
118 Stat. 509 (42 U.S.C. 902 note). officer has overall responsibility for The revisions read as follows:
2. Amend § 404.941 by revising assessing the medical severity of your Appendix 1 to Subpart P of Part 404—
paragraphs (b)(3) and (b)(4), and adding mental impairment(s). The Listing of Impairments
paragraph (b)(5) to read as follows: determination must document the
disability hearing officer’s pertinent * * * * *
§ 404.941 Prehearing case review. findings and conclusions regarding the 13. Mental Disorders (12.00 and 112.00):
(Insert date 5 years from the effective date of
* * * * * mental impairment(s). the final rules).
(b) * * * (ii) At the administrative law judge
(3) There is a change in the law or hearing and Appeals Council levels, the * * * * *
regulation; administrative law judge or, if the Part A
(4) There is an error in the file or Appeals Council makes a decision, the * * * * *
some other indication that the prior Appeals Council has overall
determination may be revised; or 3.00 Respiratory System
responsibility for assessing the medical
(5) An administrative law judge severity of your mental impairment(s). * * * * *
requires the services of a medical expert The written decision must incorporate H. Sleep-related breathing disorders. * * *
to assist in reviewing a mental Mental disorders affecting cognition that
the pertinent findings and conclusions result from sleep-related breathing disorders
disorder(s), but such services are of the administrative law judge or are evaluated under 12.02 (Dementia and
unavailable. Appeals Council. amnestic and other cognitive disorders).
* * * * * * * * * *
§ 404.1520a [Removed]
Subpart P—[Amended] 5. Remove § 404.1520a. 3.01 Category of Impairments, Respiratory
6. Amend appendix 1 to subpart P of System
3. The authority citation for subpart P part 404 as follows: * * * * *
of part 404 is revised to read as follows: a. Revise item 13 of the introductory 3.10 Sleep-related breathing disorders.
Authority: Secs. 202, 205(a)–(b), and (d)– text before part A. Evaluate under 3.09 (chronic cor pulmonale)
(h), 216(i), 221(a) and (i), 222(c), 223, 225, b. Revise the last sentence of section or 12.02 (Dementia and amnestic and other
and 702(a)(5) of the Social Security Act (42 3.00H of part A. cognitive disorders).
U.S.C. 402, 405(a)–(b), and (d)–(h), 416(i), c. Revise listing 3.10 of part A. * * * * *
421(a) and (i), 422(c), 423, 425, and d. Revise the fourth sentence of
902(a)(5)); sec. 211(b), Pub. L. 104–193, 110 10.00 Impairments That Affect Multiple
section 10.00A2 of part A. Body Systems
Stat. 2105, 2189, sec. 202, Pub. L. 108–203, e. Revise the third sentence in the first
118 Stat. 509 (42 U.S.C. 902 note). A. What impairment do we evaluate under
undesignated paragraph of section
4. Amend § 404.1503 by redesignating 11.00E of part A. this body system?
paragraph (e) as paragraph (e)(1) and f. Add a new undesignated sixth * * * * *
adding a new paragraph (e)(2), to read paragraph to section 11.00E of part A. 2. What is Down syndrome? * * * Down
as follows: g. Revise the introductory paragraph syndrome is characterized by a complex of
physical characteristics, delayed physical
of section 11.00F of part A of appendix
§ 404.1503 Who makes disability and development, and intellectual disability/
1. mental retardation (ID/MR). * * *
blindness determinations.
h. Revise 11.09 of part A.
* * * * * i. Revise 11.17 of part A. * * * * *
(e) * * * j. Revise 11.18 of part A. 11.00 Neurological
(2) Overall responsibility for k. Revise section 12.00 of part A. * * * * *
evaluating mental impairments. (i) In l. Revise the fourth sentence of E. Multiple sclerosis. * * * Paragraph B
any case at the initial and section 110.00A2 of part B. provides references to other listings for
reconsideration levels, except in cases m. Add section 111.00F to part B. evaluating visual disorders caused by
in which a disability hearing officer n. Revise section 112.00 of part B. multiple sclerosis. * * *
makes the reconsideration o. Revise the first sentence of section * * * * *
determination, our medical or 114.00D6e(ii), remove section 114.00I, We evaluate mental impairments
psychological consultant has overall and redesignate section 114.00J as associated with multiple sclerosis under
responsibility for assessing the medical section 114.00I in part B. 12.00.
severity of your mental impairment(s). p. Revise 114.02 and 114.03 of part B. * * * * *
F. Traumatic brain injury (TBI). We to evaluate the severity of mental disorders b. Symptoms and signs may include, but
evaluate neurological impairments that result except those under 12.05. To satisfy the are not limited to, inability to initiate and
from TBI under 11.02, 11.03, or 11.04, as paragraph C criteria, you must have a serious persist in goal-directed activities, social
applicable. We evaluate mental impairments and persistent mental disorder under one of withdrawal, flat or inappropriate affect,
that result from TBI under 12.02. those listings that satisfies the criteria in both poverty of thought and speech, loss of
* * * * * C1 and C2 (see 12.00E and F). interest or pleasure, disturbances of mood,
11.09 Multiple sclerosis. With: (ii) When we refer to ‘‘paragraph C’’ or ‘‘the odd beliefs and mannerisms, and paranoia.
paragraph C criteria’’ in the introductory text c. Examples of disorders in this category
* * * * * of this body system, we mean the criteria in include schizophrenia, schizoaffective
B. Visual disorder as described under the paragraph C of every mental disorders listing disorder, delusional disorder, and psychotic
criteria in 2.02, 2.03, or 2.04; or except 12.05. disorder due to a general medical condition.
* * * * * 3. To meet 12.05, your ID/MR must satisfy
3. Mood Disorders (12.04)
11.17 Degenerative disease not listed 12.05A, B, or D, or you must have a
elsewhere, such as Huntington’s disease, combination of ID/MR and another ‘‘severe’’ a. These disorders are characterized by an
Friedreich’s ataxia, and spino-cerebellar physical or mental impairment that satisfies irritable, depressed, elevated, or expansive
degeneration. With disorganization of motor 12.05C. mood, or by a loss of interest or pleasure in
function as described in 11.04B. B. How do we describe the mental all or almost all activities, causing a
disorders listing categories? In the following clinically significant decline in functioning.
* * * * * sections, we provide a brief description of the b. Symptoms and signs may include, but
11.18 Cerebral trauma. Evaluate under mental disorders included in each listing are not limited to, feelings of hopelessness or
11.02, 11.03, or 11.04, as applicable. category, followed by examples of symptoms guilt, suicidal ideation, a clinically
12.00 Mental Disorders and signs that persons with disorders in each significant change in body weight or appetite,
category may have. Except for 12.05, we also sleep disturbances, an increase or decrease in
A. What are the listings, and what do they energy, psychomotor abnormalities,
provide examples of common mental
require? disturbed concentration, pressured speech,
disorders diagnosed in each category; we do
1. The listings for mental disorders are grandiosity, reduced impulse control, rapidly
not provide examples for 12.05 because ID/
arranged in 10 categories: Dementia and alternating moods, sadness, euphoria, and
MR is the only disorder covered by that
amnestic and other cognitive disorders listing. Although the evidence must show social withdrawal.
(12.02); schizophrenia and other psychotic that you have a mental disorder in one of the c. Examples of disorders in this category
disorders (12.03); mood disorders (12.04); listing categories, your mental disorder does include major depressive disorder, the
intellectual disability/mental retardation (ID/ not have to match one of the examples in this various types of bipolar disorders,
MR) (12.05); anxiety disorders (12.06); section. We will find that any mental cyclothymic disorder, dysthymic disorder,
somatoform disorders (12.07); personality disorder meets one of these mental disorders and mood disorder due to a general medical
disorders (12.08); autism spectrum disorders listings when it can be included in one of the condition.
(12.10); other disorders usually first listing categories and satisfies the other
diagnosed in childhood or adolescence 4. Intellectual Disability/Mental Retardation
criteria of the appropriate listing. (ID/MR) (12.05)
(12.11); and eating disorders (12.13).
2. Each listing is divided into three 1. Dementia and Amnestic and Other a. This disorder is defined by significantly
paragraphs, designated A, B, and C. Except Cognitive Disorders (12.02) subaverage general intellectual functioning
for 12.05, the listing for ID/MR, your mental a. These disorders are characterized by a with significant deficits in adaptive
disorder must satisfy the requirements of clinically significant decline in cognitive functioning initially manifested before age
paragraphs A and B or paragraphs A and C functioning. 22.
in the listing for your mental disorder. See b. Symptoms and signs may include, but b. Signs may include, but are not limited
12.00A3 for the requirements for 12.05. are not limited to, disturbances in memory, to, poor conceptual, social, and practical
a. Paragraph A of each listing (except executive functioning (that is, higher-level skills, and a tendency to be passive, placid,
12.05) requires you to show that you have a cognitive processes; for example, regulating and dependent on others, or to be impulsive
medically determinable mental disorder in attention, planning, inhibiting responses, or easily frustrated. When we evaluate your
the listing category. For example, for 12.03A, decisionmaking), psychomotor activity, adaptive functioning, we also consider the
you must have evidence showing that you visual-spatial functioning, language and factors in 12.00F.
have schizophrenia or another medically speech, perception, insight, and judgment. c. ID/MR is often demonstrated by
determinable psychotic disorder. Paragraph c. Examples of disorders in this category evidence from the period before age 22.
A also includes a reference to the include the following. However, when we do not have evidence
corresponding section of 12.00B that (i) Dementia of the Alzheimer’s type; from that period, we will still find that you
describes the listing category; for example, (ii) Vascular dementia; have ID/MR if we have evidence about your
the reference in 12.03A is to 12.00B2, where (iii) Traumatic brain injury, or TBI (see also current functioning and the history of your
we provide a general description of 11.00F); and impairment that is consistent with the
schizophrenia and other psychotic disorders (iv) Dementia and amnestic or other diagnosis, and there is no evidence to
and give examples of disorders in the cognitive disorders due to medications, indicate an onset after age 22.
category. toxins, or a general medical condition, such d. We consider your IQ score to be ‘‘valid’’
b. (i) Paragraph B of each listing (except as human immunodeficiency virus infection, when it is supported by the other evidence,
12.05) provides the criteria we use to neurological disease (for example, multiple including objective clinical findings, other
evaluate the severity of your mental disorder. sclerosis, Parkinson’s disease, Huntington’s clinical observations, and evidence of your
These criteria are the mental abilities a disease), or metabolic disease (for example, day-to-day functioning that is consistent with
late-onset Tay-Sachs disease). the test score. If the IQ test provides more
person uses to function in a work setting, and
d. This category does not include mental
they apply to all of the listings. To satisfy the than one IQ score (for example, a verbal,
disorders that are included in the listing
paragraph B criteria, your mental disorder performance, and full scale IQ in a Wechsler
categories for ID/MR (12.05), autism
must result in ‘‘marked’’ limitations of two or series test), we use the lowest score. When
spectrum disorders (12.10), and other
‘‘extreme’’ limitation of one of the mental we consider your IQ score, we apply the
disorders usually first diagnosed in
abilities in paragraph B (see 12.00C, D, and childhood or adolescence (12.11). rules in 12.00D4.
F). e. In 12.05C, the term ‘‘severe’’ has the same
(ii) When we refer to ‘‘paragraph B’’ or ‘‘the 2. Schizophrenia and Other Psychotic meaning as in §§ 404.1520(c) and 416.920(c).
paragraph B criteria’’ in the introductory text Disorders (12.03) Your additional impairment(s) must cause
of this body system, we mean the criteria in a. These disorders are characterized by more than a slight or minimal physical or
paragraph B of every mental disorders listing delusions, hallucinations, disorganized mental functional limitation(s); it must
except 12.05. speech, or grossly disorganized or catatonic significantly limit your physical or mental
c. (i) Paragraph C provides an alternative behavior, causing a clinically significant ability to do basic work activities, as we
to the paragraph B criteria that we can use decline in functioning. explain in those sections of our regulations
and §§ 404.1521 and 416.921. The suspiciousness, and odd beliefs; social other cognitive disorders (12.02), ID/MR
limitation(s) must be separate from the detachment, discomfort, or avoidance; (12.05), and autism spectrum disorders
limitations caused by your ID/MR; for hypersensitivity to negative evaluation; an (12.10).
example, limitation in your ability to respond excessive need to be taken care of; difficulty 10. Eating Disorders (12.13)
appropriately to supervision and coworkers making independent decisions; a
that result from another mental disorder or in preoccupation with orderliness, a. These disorders are characterized by
your physical ability to walk, stand, or sit. If perfectionism, and control; grandiosity; disturbances in eating behavior and
your additional impairment(s) is not ‘‘severe’’ inappropriate and intense anger; self- preoccupation with, and excessive self-
as defined in our regulations, your ID/MR mutilating behaviors; and recurrent suicidal evaluation of, body weight and shape.
will not meet 12.05C even if your additional threats, gestures, or attempts. b. Symptoms and signs may include, but
impairment(s) prevents you from doing your c. Examples of disorders in this category are not limited to, refusal to maintain a
past work because of the unique features of include paranoid personality disorder, minimally normal weight or a minimally
that work. schizoid personality disorder, schizotypal normal body mass index (BMI); recurrent
f. Listing 12.05 is for ID/MR only. We personality disorder, dependent personality episodes of binge eating and behavior
evaluate other mental disorders that disorder, borderline personality disorder, and intended to prevent weight gain, such as self-
primarily affect cognition in the listing obsessive-compulsive personality disorder. induced vomiting, excessive exercise, or
categories for dementia and amnestic and misuse of laxatives; mood disturbances,
8. Autism Spectrum Disorders (12.10)
other cognitive disorders (12.02), autism social withdrawal, or irritability; amenorrhea;
spectrum disorders (12.10), or other disorders a. These disorders are characterized by
qualitative deficits in the development of dental problems; abnormal laboratory
usually first diagnosed in childhood or
reciprocal social interaction, verbal and findings; and cardiac abnormalities.
adolescence (12.11), as appropriate.
nonverbal communication skills, and c. Examples of disorders in this category
5. Anxiety Disorders (12.06) include anorexia nervosa and bulimia
symbolic or imaginative activity; restricted
a. These disorders are characterized by repetitive and stereotyped patterns of nervosa.
excessive anxiety, worry, apprehension, and behavior, interests, and activities; and a C. What are the paragraph B criteria? The
fear, or by avoidance of feelings, thoughts, history of early stagnation of skill acquisition paragraph B criteria are the mental abilities
activities, objects, places, or persons. or loss of previously acquired skills. a person uses to function in a work setting.
b. Symptoms and signs may include, but b. Symptoms and signs may include, but They are the abilities to: Understand,
are not limited to, restlessness, difficulty are not limited to, abnormalities and remember, and apply information (paragraph
concentrating, hyper-vigilance, muscle unevenness in the development of cognitive B1); interact with others (paragraph B2);
tension, sleep disturbance, fatigue, panic skills; unusual responses to sensory stimuli; concentrate, persist, and maintain pace
attacks, obsessions and compulsions, and behavioral difficulties, including (paragraph B3); and manage oneself
constant thoughts and fears about safety, and hyperactivity, short attention span, (paragraph B4). In this section, we provide
frequent somatic complaints. Symptoms and impulsivity, aggressiveness, or self-injurious basic definitions of the four paragraph B
signs associated with trauma may include actions. mental abilities and some examples of how
recurrent intrusive recollections of a c. Examples of disorders in this category a person may use these mental abilities to
traumatic event, and acting or feeling as if the include autistic disorder, Asperger’s function in a work setting. In 12.00D, we
traumatic event were recurring. disorder, and pervasive developmental explain how we rate the severity of
c. Examples of disorders in this category disorder (PDD). limitations in the paragraph B mental
include panic disorder, phobic disorder, d. This category does not include mental abilities under these listings.
obsessive-compulsive disorder, post- disorders that are included in the listing 1. Understand, remember, and apply
traumatic stress disorder (PTSD), generalized categories for dementia and amnestic and information (paragraph B1). This is the
anxiety disorder, and anxiety disorder due to other cognitive disorders (12.02), ID/MR
a general medical condition. ability to acquire, retain, integrate, access,
(12.05), and other disorders usually first and use information to perform work
6. Somatoform Disorders (12.07) diagnosed in childhood or adolescence activities. You use this mental ability when,
a. These disorders are characterized by (12.11). for example, you follow instructions, provide
physical symptoms or deficits that are not 9. Other Disorders Usually First Diagnosed in explanations, and identify and solve
intentionally produced or feigned, and that, Childhood or Adolescence (12.11) problems.
following clinical investigation, cannot be a. These disorders are characterized by 2. Interact with others (paragraph B2). This
fully explained by a general medical onset during childhood or adolescence, is the ability to relate to and work with
condition, another mental disorder, the direct although sometimes they are not diagnosed supervisors, co-workers, and the public. You
effects of a substance, or a culturally until adulthood. use this mental ability when, for example,
sanctioned behavior or experience. b. Symptoms and signs may include, but you cooperate, handle conflicts, and respond
b. Symptoms and signs may include, but are not limited to, underlying abnormalities to requests, suggestions, and criticism.
are not limited to, pain and other in cognitive processing (for example, deficits 3. Concentrate, persist, and maintain pace
abnormalities of sensation, gastrointestinal in learning and applying verbal or nonverbal (paragraph B3). This is the ability to focus
symptoms, fatigue, abnormal motor information, visual perception, memory, or a attention on work activities and to stay on
movement, pseudoseizures, and combination of these), deficits in attention or task at a sustained rate. You use this mental
pseudoneurological symptoms, such as ability when, for example, you concentrate,
impulse control, low frustration tolerance,
blindness or deafness. avoid distractions, initiate and complete
excessive or poorly planned motor activity,
c. Examples of disorders in this category activities, perform tasks at an appropriate
difficulty with organizing (time, space,
include somatization disorder, conversion and consistent speed, and sustain an
materials, or tasks), repeated accidental
disorder, body dysmorphic disorder, and ordinary routine.
injury, and deficits in social skills.
pain disorder associated with psychological 4. Manage oneself (paragraph B4). This is
Symptoms and signs specific to tic disorders
factors. the ability to regulate your emotions, control
include sudden, rapid, recurrent, non-
7. Personality Disorders (12.08) rhythmic, stereotyped motor movement or your behavior, and maintain your well-being
a. These disorders are characterized by an vocalization; mood lability; and obsessions in a work setting. You use this mental ability
enduring, inflexible, pervasive, and and compulsions. when, for example, you cope with your
maladaptive pattern of inner experience and c. Examples of disorders in this category frustration and stress, respond to demands
behavior that causes clinically significant include learning disorders, attention-deficit/ and changes in your environment, protect
distress or impairment in social, hyperactivity disorder, and tic disorders, yourself from harm and exploitation by
occupational, or other important areas of such as Tourette syndrome, chronic motor or others, inhibit inappropriate actions, take
functioning, and that has an onset in vocal tic disorder, and transient tic disorder. your medications, and maintain your
adolescence or early adulthood. d. This category does not include mental physical health, hygiene, and grooming.
b. Symptoms and signs may include, but disorders that are included in the listing D. How do we use the paragraph B mental
are not limited to, patterns of distrust, categories for dementia and amnestic and abilities to evaluate your mental disorder?
1. General b. Although we do not require E. What are the paragraph C criteria, and
a. When we rate your limitations using the standardized test scores to determine how do we use them to evaluate your mental
paragraph B mental abilities, we consider whether you have extreme limitations, we disorder?
only limitations you have because of your will generally find that you have extreme 1. General. We use the paragraph C criteria
limitation of a paragraph B mental ability as an alternative to paragraph B to evaluate
mental disorder.
when you have a valid score that is at least ‘‘serious and persistent mental disorders’’
b. To do most kinds of work, a person is
three standard deviations below the mean on under every mental disorders listing except
expected to use his or her mental abilities
an individually administered standardized 12.05. We can use the paragraph C criteria
independently, appropriately, effectively,
test designed to measure that ability and the without first considering whether your
and on a sustained basis.
evidence shows that your functioning over mental disorder satisfies the paragraph B
c. Marked or extreme limitation of a criteria.
paragraph B mental ability reflects the overall time is consistent with the score. (See also
12.00D4.) 2. Paragraph C criteria.
degree to which your mental disorder a. To meet the paragraph C criteria, you
interferes with your using that ability c. ‘‘Extreme’’ is the rating we give to the
must have a medically documented history,
independently, appropriately, effectively, worst limitations; however, it does not
over a period of at least 1 year, of the
and on a sustained basis in a work setting. necessarily mean a total lack or loss of ability
existence of a serious and persistent mental
It does not necessarily reflect a specific type to function. It is the equivalent of the level
disorder. Your mental disorder must also
or number of activities, including activities of of limitation we would expect to find on satisfy the criteria in C1 and C2.
daily living, that you have difficulty doing. standardized testing with scores that are at b. The criterion in C1 is satisfied when the
In addition, no single piece of information least three standard deviations below the evidence shows that continuing treatment,
(including test scores) can establish whether mean. psychosocial support(s), or a highly
you have marked or extreme limitation of a 4. How We Consider Your Test Results structured setting(s) diminishes the
paragraph B mental ability. (See 12.00D4.) symptoms and signs of your mental disorder.
d. Marked or extreme limitation of a a. We do not rely on any IQ score or other
test result alone. We consider your test scores (See 12.00F.)
paragraph B mental ability also reflects the c. The criterion in C2 is satisfied when the
kind and extent of supports you receive and together with the other information we have
evidence shows that you have achieved only
the characteristics of any highly structured about how you use the mental abilities
marginal adjustment despite your diminished
setting in which you spend your time that described in the paragraph B criteria in your
symptoms and signs. ‘‘Marginal adjustment’’
enable you to function as you do. The more day-to-day functioning.
means that your adaptation to the
extensive the supports or the more structured b. We may find that you have ‘‘marked’’ or
requirements of daily living and your
the setting you need to function, the more ‘‘extreme’’ limitation when you have a test
environment is fragile; that is, you have
limited we will find you to be. (See 12.00F.) score that is slightly higher than the levels
minimal capacity to adapt to changes in your
we provide in 12.00D2 and D3 if other
2. What We Mean by ‘‘Marked’’ Limitation environment or to demands that are not
information in your case record shows that already part of your daily life. Changes or
a. Marked limitation of a paragraph B your functioning in day-to-day activities is
mental ability means that the symptoms and increased demands would likely lead to an
seriously or very seriously limited. We will exacerbation of your symptoms and signs and
signs of your mental disorder interfere not find that you have ‘‘marked’’ or ‘‘extreme’’
seriously with your using that mental ability to deterioration in your functioning; for
limitation in your ability to understand, example, you would be unable to function
independently, appropriately, effectively, remember, and apply information (or in any
and on a sustained basis to function in a outside a highly structured setting or outside
other ability measured by a standardized test) your home. Similarly, because of the nature
work setting. Although we do not require the unless you have evidence demonstrating that
use of such a scale, marked would be the of your mental disorder, you could
your functioning is consistent with such a experience episodes of deterioration that
fourth point on a five-point rating scale limitation.
consisting of no limitation, slight limitation, require you to be hospitalized or absent from
c. Generally, we will not find that a test work, making it difficult for you to sustain
moderate limitation, marked limitation, and result is valid for our purposes when the
extreme limitation. work activity over time.
information we have about your functioning F. How do we consider psychosocial
b. Although we do not require is of the kind typically used by medical
standardized test scores to determine supports, highly structured settings, and
professionals to determine that the test treatment when we evaluate your
whether you have marked limitations, we results are not the best measure of your day-
will generally find that you have marked functioning?
to-day functioning. If there is a material 1. Psychosocial supports and highly
limitation of a paragraph B mental ability inconsistency between your test results and
when you have a valid score that is at least structured settings may help you to function
other information in your case record, we by reducing the demands made on you.
two, but less than three, standard deviations will try to resolve it. We use the following
below the mean on an individually However, your ability to function in settings
guidelines when we consider your test (including your own home) that are less
administered standardized test designed to scores:
measure that ability and the evidence shows demanding, more structured, or more
(i) The interpretation of the test is supportive than those in which persons
that your functioning over time is consistent primarily the responsibility of the
with the score. (See also 12.00D4.) typically work does not necessarily show
professional who administered the test. The how you would function in a work setting
c. Marked limitation is also the equivalent
narrative report that accompanies the test under the stresses of a normal workday and
of the level of limitation we would expect to
results should specify whether the results are workweek on a sustained basis. Therefore,
find on standardized testing with scores that
deemed to be valid; that is, whether they are we will consider the kind and extent of
are at least two, but less than three, standard
consistent with your medical and supports you receive and the characteristics
deviations below the mean.
developmental history and information about of any structured setting in which you spend
3. What We Mean by ‘‘Extreme’’ Limitation your day-to-day functioning. your time when we evaluate the effect of
a. Extreme limitation of a paragraph B (ii) It is our responsibility to ensure that your mental disorder on your functioning
mental ability means that the symptoms and the evidence in your case record is complete and rate the limitation of your mental
signs of your mental disorder interfere very and to resolve any material inconsistencies in abilities (see 12.00D).
seriously with your using that mental ability the evidence. In some cases, we will be able 2. Examples of psychosocial supports and
independently, appropriately, effectively, to resolve an inconsistency with the highly structured settings.
and on a sustained basis to function in a information already in your case record. In a. You need family members or other
work setting. Although we do not require the others, we may need to request additional persons to monitor your daily activities and
use of such a scale, extreme would be the last information; for example, by recontacting to help you function; for example, you need
point on a five-point rating scale consisting your medical source(s), by purchasing a family members to remind you to eat, to shop
of no limitation, slight limitation, moderate consultative examination, or by questioning for you and pay your bills, to administer your
limitation, marked limitation, and extreme persons who are familiar with your day-to- medications, or to change their work hours
limitation. day functioning. so you are never home alone.
b. You participate in a special education c. The results of physical or mental status duties or work schedule, and any special
program that teaches you daily living and examinations or other clinical findings. supports or accommodations you have
vocational skills (see 12.00G4). d. Psychological testing, imaging studies, required or now require in order to work. If
c. You participate in a psychosocial or other laboratory findings. you have worked or are working through a
rehabilitation program, such as a day e. Your diagnosis. community mental health program, a
treatment or clubhouse program, in which f. The type, dosage, frequency, duration, sheltered work program, a supported work
you receive training in entry-level work skills and beneficial effects of medications you program, a rehabilitation program, or a
(see 12.00G4). receive. transitional employment program, we will
d. You participate in a sheltered, g. The type, frequency, duration, and consider the type and degree of support you
supported, or transitional work program, or beneficial effects of therapy or counseling have received or are receiving in order to
in a competitive employment setting with the you receive. work.
help of a job coach or an accommodating h. Any side effects of medication or other 5. Evidence from psychological and
supervisor (see 12.00G4). treatment that limit your ability to function psychiatric measures. We will consider the
e. You receive treatment in a day program (see 12.00F). results from psychological and psychiatric
at a hospital, community treatment program, i. Your clinical course, including changes measures together with all the other evidence
or other daily outpatient program. in your medication, therapy, or counseling in your case record. Results from these
f. You live in a group home, halfway and the time required for therapeutic measures are only part of the evidence we
house, or semi-independent living program effectiveness. use in our overall disability evaluation; we
with a counselor or resident supervisor who j. Observations and descriptions of how will not use these results alone to decide
is there 24 hours a day. you function. whether you are disabled. (See 12.00D4.)
g. You live in a hospital or other institution k. Any psychosocial support(s) you receive 6. Need for longitudinal evidence.
with 24-hour care. or highly structured setting(s) in which you a. Many persons with mental disorders
h. You live alone and do not receive any are involved (see 12.00F). experience periods of worsening of the
psychosocial support(s); however, you have l. Any sensory, motor, or speaking symptoms and signs of their mental disorders
created a highly structured environment by abnormalities or information about your (exacerbations) and periods of improvement
eliminating all but minimally necessary cultural background (for example, language of their symptoms and signs (remissions).
contact with the world outside your living differences, customs) that may affect an Exacerbations may make it difficult for you
space. evaluation of your mental disorder. to sustain employment. Therefore, we
3. Treatment. m. The expected duration of your generally will consider how you function
a. With treatment, such as medications and symptoms and signs and their effects on your longitudinally; that is, over time. We will not
psychotherapy, you may not only have your ability to function in a work setting over find that you are able to work solely because
symptoms and signs reduced, but may be time. you have a period(s) of remission, or that you
able to function well enough to work.
3. Evidence from you and persons who are disabled solely because you have an
b. Treatment may not resolve all of the
know you. We will ask you to describe your exacerbation(s) of your mental disorder. We
functional limitations that result from your
symptoms and your limitations if you are will consider how often you have remissions
mental disorder, and the medications you
able to do so, and we will use that and exacerbations and how long they last,
take or other treatment you receive for your
information to help us determine whether what causes your mental disorder to improve
disorder may cause side effects that affect
you are disabled. We will also consider or worsen, and any other information that is
your mental or physical functioning; for
information from persons who can describe relevant to our determination about how you
example, you may experience drowsiness,
blunted affect, or abnormal involuntary how you usually function from day to day function over time. We will consider
movements. when we need it to show the severity of your longitudinal evidence from relevant sources
c. We will consider the effect of any mental disorder and how it affects your over a sufficient period to establish the
treatment on your functioning when we ability to function. This information may severity of your mental disorder over time.
evaluate your mental disorder under these include, but is not limited to, information b. If you have a serious mental disorder,
listings. from your family, other caregivers, friends, you will probably have evidence of its effects
G. What evidence do we need to evaluate neighbors, or clergy. We will consider your on your functioning over time, even if you do
your mental disorder? statements and the statements of other not have an ongoing relationship with the
1. General. We need evidence to assess the persons to determine if they are consistent medical community. For example, family
existence and severity of your mental with the medical and other evidence we members, friends, adult day-care providers,
disorder and its effects on your ability to have. teachers, neighbors, former employers, social
function in a work setting. Although we 4. Evidence from school, vocational workers, peer specialists, mental health
always need evidence from an acceptable training, work, and work-related programs. clinics, emergency shelters, law enforcement,
medical source, the individual facts of your a. If you have recently attended or are still or government agencies may be familiar with
case will determine the extent of that attending school and have received or are your mental health history.
evidence and what evidence, if any, we need receiving special education services, we will c. You may function differently and appear
from other sources. For our basic rules on consider information from your school more or less limited in an unfamiliar or one-
evidence, see §§ 404.1512, 404.1513, 416.912, sources when we need it to show the severity time situation, such as a consultative
and 416.913. For our rules on evidence about of your mental disorder and how it affects examination, than is indicated by other
a person’s symptoms, see §§ 404.1529 and your ability to function. This information information about your functioning over
416.929. may include, but is not limited to, time. Your ability to function during a time-
2. Evidence from medical sources. We will Individualized Education Programs (IEPs), limited mental status examination or
consider all relevant medical evidence about education records, therapy progress notes, psychological testing, or in another
your mental disorder from your physician, and information from your teachers about unfamiliar or one-time situation, does not
psychologist, and other medical sources. how you function in their classrooms and necessarily show how you will be able to
Other medical sources include health care about any special services or function in a work setting under the stresses
providers, such as physician assistants, accommodations you receive at school. of a normal workday and workweek on a
nurses, licensed clinical social workers, and b. If you recently attended or are still sustained basis.
therapists. These other medical sources can attending vocational training classes or if you d. Working involves many factors and
be very helpful in providing evidence to have attempted to work or are working now, demands that can be stressful to persons with
assess the severity of your mental disorder we will consider information from your mental disorders; for example, the specific
and the resulting limitation in functioning, training program or employer when we need work activities involved, the physical work
especially if they see you regularly. Evidence it to show the severity of your mental environment, the work schedule or routine,
from medical sources may include: disorder and how it affects your ability to and the social interactions and relationships
a. Your reported symptoms. function. This information may include, but in the workplace. Stress may be caused, for
b. Your medical, psychiatric, and is not limited to, training or work example, by the demands of getting to work
psychological history. evaluations, modifications to your work regularly, having your performance
supervised, or remaining in the workplace for 12.01 Category of Impairments, Mental 2. Marginal adjustment, as described in
a full day. Disorders 12.00E2c.
(i) Your reaction to stress associated with 12.02 Dementia and Amnestic and Other 12.05 Intellectual Disability/Mental
the demands of work may be different from Cognitive Disorders, with both A and B or Retardation (ID/MR) satisfying A, B, C, or D.
another person’s; that is, the symptoms and both A and C. A. ID/MR as defined in 12.00B4, with
signs of your mental disorder may be more A. A medically determinable mental mental incapacity evidenced by dependence
or less affected by stress than those of disorder in this category (see 12.00B1). upon others for personal needs (for example,
another person with the same mental AND toileting, eating, dressing, or bathing) and an
disorder or another mental disorder. inability to follow directions, such that the
B. Marked limitations of two or extreme
(ii) We will consider evidence from all limitation of one of the following mental use of standardized measures of intellectual
sources about the effects of stress on your abilities: functioning is precluded.
mental abilities, including any evidence 1. Ability to understand, remember, and OR
pertinent to the effects of work-related stress. apply information (see 12.00C1). B. ID/MR as defined in 12.00B4, with a
We will also take into consideration what, if 2. Ability to interact with others (see valid IQ score of 59 or less (as defined in
any, psychosocial support(s) or structure you 12.00C2). 12.00B4d) on an individually administered
would need when you experience work- 3. Ability to concentrate, persist, and standardized test of general intelligence
maintain pace (see 12.00C3). having a mean of 100 and a standard
related stress (see 12.00F).
4. Ability to manage oneself (see 12.00C4). deviation of 15 (see 12.00D4).
H. How do we evaluate substance use
disorders? OR OR
If we find that you are disabled and there C. A serious and persistent mental disorder
C. ID/MR as defined in 12.00B4, with a
is medical evidence in your case record in this category (see 12.00E2) with both:
valid IQ score of 60 through 70 (as defined
establishing that you have a substance use 1. Continuing treatment, psychosocial
support(s), or a highly structured setting(s) in 12.00B4d) on an individually
disorder, we will determine whether your administered standardized test of general
that diminishes the symptoms and signs of
substance use disorder is a contributing your mental disorder, and intelligence having a mean of 100 and a
factor material to the determination of 2. Marginal adjustment, as described in standard deviation of 15 (see 12.00D4) and
disability. (See §§ 404.1535 and 416.935.) 12.00E2c. with another ‘‘severe’’ physical or mental
I. How do we evaluate mental disorders 12.03 Schizophrenia and Other Psychotic impairment (see 12.00B4e).
that do not meet one of the mental disorders Disorders, with both A and B or both A and OR
listings? C. D. ID/MR as defined in 12.00B4, with a
1. These listings include only examples of A. A medically determinable mental valid IQ score of 60 through 70 (as defined
mental disorders that we consider severe disorder in this category (see 12.00B2). in 12.00B4d) on an individually
enough to prevent you from doing any AND administered standardized test of general
gainful activity. If your severe mental B. Marked limitations of two or extreme intelligence having a mean of 100 and a
disorder does not meet the criteria of any of limitation of one of the following mental standard deviation of 15 (see 12.00D4),
these listings, we will also consider whether abilities: resulting in marked limitation of at least two
you have an impairment(s) that meets the 1. Ability to understand, remember, and of the following mental abilities:
criteria of a listing in another body system. apply information (see 12.00C1). 1. Ability to understand, remember, and
You may have a separate other impairment(s) 2. Ability to interact with others (see apply information (see 12.00C1).
or a physical impairment(s) that is secondary 12.00C2). 2. Ability to interact with others (see
to your mental disorder. For example, if you 3. Ability to concentrate, persist, and 12.00C2).
have an eating disorder and develop a maintain pace (see 12.00C3). 3. Ability to concentrate, persist, and
4. Ability to manage oneself (see 12.00C4). maintain pace (see 12.00C3).
cardiovascular impairment because of it, we
will evaluate your cardiovascular impairment OR 4. Ability to manage oneself (see 12.00C4).
under the listings for the cardiovascular body C. A serious and persistent mental disorder 12.06 Anxiety Disorders, with both A and
system. in this category (see 12.00E2) with both: B or both A and C.
2. If you have a severe medically 1. Continuing treatment, psychosocial A. A medically determinable mental
determinable impairment(s) that does not support(s), or a highly structured setting(s) disorder in this category (see 12.00B5).
that diminishes the symptoms and signs of AND
meet a listing, we will determine whether
your mental disorder, and
your impairment(s) medically equals a B. Marked limitations of two or extreme
2. Marginal adjustment, as described in
listing. (See §§ 404.1526 and 416.926.) 12.00E2c. limitation of one of the following mental
3. If your impairment(s) does not meet or 12.04 Mood Disorders, with both A and B abilities:
medically equal a listing, you may or may not or both A and C. 1. Ability to understand, remember, and
have the residual functional capacity to A. A medically determinable mental apply information (see 12.00C1).
engage in substantial gainful activity. (See disorder in this category (see 12.00B3). 2. Ability to interact with others (see
§§ 404.1545 and 416.945.) In that situation, AND 12.00C2).
we proceed to the fourth, and if necessary, 3. Ability to concentrate, persist, and
B. Marked limitations of two or extreme maintain pace (see 12.00C3).
the fifth steps of the sequential evaluation limitation of one of the following mental
process in §§ 404.1520 and 416.920. When 4. Ability to manage oneself (see 12.00C4).
abilities:
we assess your residual functional capacity, 1. Ability to understand, remember, and OR
we consider all of your physical and mental apply information (see 12.00C1). C. A serious and persistent mental disorder
limitations. If you have limitations in your 2. Ability to interact with others (see in this category (see 12.00E2) with both:
ability to perform work-related physical 12.00C2). 1. Continuing treatment, psychosocial
activities that are secondary to your mental 3. Ability to concentrate, persist, and support(s), or a highly structured setting(s)
disorder, we will consider them when we maintain pace (see 12.00C3). that diminishes the symptoms and signs of
assess your residual functional capacity. For 4. Ability to manage oneself (see 12.00C4). your mental disorder, and
example, limitations in walking or standing OR 2. Marginal adjustment, as described in
due to the side effects of medication you take C. A serious and persistent mental disorder 12.00E2c.
to treat your mental disorder may affect your in this category (see 12.00E2) with both: 12.07 Somatoform Disorders, with both A
residual functional capacity for work 1. Continuing treatment, psychosocial and B or both A and C.
requiring physical exertion. When we decide support(s), or a highly structured setting(s) A. A medically determinable mental
whether you continue to be disabled, we use that diminishes the symptoms and signs of disorder in this category (see 12.00B6).
the rules in §§ 404.1594 and 416.994. your mental disorder, and AND
B. Marked limitations of two or extreme 1. Ability to understand, remember, and or, conversely, may appear much worse
limitation of one of the following mental apply information (see 12.00C1). initially but improve after a few months.
abilities: 2. Ability to interact with others (see Therefore, the mental findings immediately
1. Ability to understand, remember, and 12.00C2). following TBI may not reflect the actual
apply information (see 12.00C1). 3. Ability to concentrate, persist, and severity of your mental impairment(s). The
2. Ability to interact with others (see maintain pace (see 12.00C3). actual severity of a mental impairment may
12.00C2). 4. Ability to manage oneself (see 12.00C4). not become apparent until 6 months post-
3. Ability to concentrate, persist, and OR injury.
maintain pace (see 12.00C3). C. A serious and persistent mental disorder 3. In some cases, evidence of a profound
4. Ability to manage oneself (see 12.00C4). in this category (see 12.00E2) with both: neurological impairment is sufficient to
OR 1. Continuing treatment, psychosocial permit a finding of disability within 3
C. A serious and persistent mental disorder support(s), or a highly structured setting(s) months post-injury. If a finding of disability
in this category (see 12.00E2) with both: that diminishes the symptoms and signs of within 3 months post-injury is not possible
1. Continuing treatment, psychosocial your mental disorder, and based on any neurological impairment(s), we
support(s), or a highly structured setting(s) 2. Marginal adjustment, as described in will defer adjudication of the claim until we
that diminishes the symptoms and signs of 12.00E2c. obtain evidence of your neurological or
your mental disorder, and 12.13 Eating Disorders, with both A and mental impairments at least 3 months post-
2. Marginal adjustment, as described in B or both A and C. injury. If a finding of disability still is not
12.00E2c. A. A medically determinable mental possible at that time, we will again defer
12.08 Personality Disorders, with both A disorder in this category (see 12.00B10). adjudication of the claim until we obtain
and B or both A and C. AND evidence at least 6 months post-injury. At
A. A medically determinable mental
B. Marked limitations of two or extreme that time, we will fully evaluate any
disorder in this category (see 12.00B7).
limitation of one of the following mental neurological and mental impairments and
AND abilities: adjudicate the claim.
B. Marked limitations of two or extreme 1. Ability to understand, remember, and
limitation of one of the following mental
* * * * *
apply information (see 12.00C1).
abilities: 2. Ability to interact with others (see 112.00 Mental Disorders
1. Ability to understand, remember, and 12.00C2).
apply information (see 12.00C1). A. What are the mental disorders listings
3. Ability to concentrate, persist, and for children age 3 to the attainment of age
2. Ability to interact with others (see maintain pace (see 12.00C3).
12.00C2). 18, and what do they require? (See 112.00I
3. Ability to concentrate, persist, and for the rules on developmental disorders in
OR children from birth to age 3.)
maintain pace (see 12.00C3).
4. Ability to manage oneself (see 12.00C4). C. A serious and persistent mental disorder 1. The listings for mental disorders are
in this category (see 12.00E2) with both: arranged in 10 categories: Dementia and
OR
1. Continuing treatment, psychosocial amnestic and other cognitive disorders
C. A serious and persistent mental disorder support(s), or a highly structured setting(s) (112.02); schizophrenia and other psychotic
in this category (see 12.00E2) with both: that diminishes the symptoms and signs of disorders (112.03); mood disorders (112.04);
1. Continuing treatment, psychosocial your mental disorder, and intellectual disability/mental retardation (ID/
support(s), or a highly structured setting(s) 2. Marginal adjustment, as described in MR) (112.05); anxiety disorders (112.06);
that diminishes the symptoms and signs of 12.00E2c.
your mental disorder, and somatoform disorders (112.07); personality
2. Marginal adjustment, as described in * * * * * disorders (112.08); autism spectrum
12.00E2c. disorders (112.10); other disorders usually
Part B first diagnosed in childhood or adolescence
12.10 Autism Spectrum Disorders, with
both A and B or both A and C. * * * * * (112.11); and eating disorders (112.13).
A. A medically determinable mental 2. Each listing is divided into three
110.00 Impairments That Affect Multiple
disorder in this category (see 12.00B8). paragraphs, designated A, B, and C. Except
Body Systems
for 112.05, the listing for ID/MR, your mental
AND
A. What kinds of impairments do we evaluate disorder must satisfy the requirements of
B. Marked limitations of two or extreme under this body system? paragraphs A and B or paragraphs A and C
limitation of one of the following mental in the listing for your mental disorder. See
abilities: * * * * *
2. What is Down syndrome? * * * Down 112.00A3 for the requirements for 112.05.
1. Ability to understand, remember, and a. Paragraph A of each listing (except
apply information (see 12.00C1). syndrome is characterized by a complex of
physical characteristics, delayed physical 112.05) requires you to show that you have
2. Ability to interact with others (see a medically determinable mental disorder in
12.00C2). development, and intellectual disability/
mental retardation (ID/MR). * * * the listing category. For example, for
3. Ability to concentrate, persist, and 112.06A, you must have evidence showing
maintain pace (see 12.00C3). * * * * * that you have an anxiety disorder, such as
111.00 Neurological obsessive-compulsive disorder or generalized
OR anxiety disorder. Paragraph A also includes
* * * * *
C. A serious and persistent mental disorder a reference to the corresponding section of
F. Traumatic brain injury (TBI).
in this category (see 12.00E2) with both: 112.00B that describes the listing category;
1. We evaluate neurological impairments
1. Continuing treatment, psychosocial for example, the reference in 112.06A is to
that result from TBI under 111.02, 111.03,
support(s), or a highly structured setting(s) 112.00B5, where we provide a general
111.06, and 111.09, as applicable. We
that diminishes the symptoms and signs of description of anxiety disorders and give
evaluate mental impairments that result from
your mental disorder, and examples of disorders in the category.
TBI under 112.02.
2. Marginal adjustment, as described in b. (i) Paragraph B of each listing (except
2. TBI may result in neurological and
12.00E2c. 112.05) provides the criteria we use to
mental impairments with a wide variety of
12.11 Other Disorders Usually First
posttraumatic symptoms and signs. The rate evaluate the severity of your mental disorder.
Diagnosed in Childhood or Adolescence, These criteria are the mental abilities a child
and extent of recovery can be highly variable
with both A and B or both A and C. uses to do age-appropriate activities, and
and the long-term outcome may be difficult
A. A medically determinable mental they apply to all of the listings. To satisfy the
to predict in the first few months post-injury.
disorder in this category (see 12.00B9). paragraph B criteria, your mental disorder
Generally, the neurological impairment(s)
AND will stabilize more rapidly than any mental must result in ‘‘marked’’ limitations of two or
B. Marked limitations of two or extreme impairment. Sometimes, a mental ‘‘extreme’’ limitation of one of the mental
limitation of one of the following mental impairment may appear to improve abilities in paragraph B (see 112.00C, D, and
abilities: immediately following TBI and then worsen, F).
(ii) When we refer to ‘‘paragraph B’’ or ‘‘the 2. Schizophrenia and Other Psychotic be separate from the limitations caused by
paragraph B criteria’’ in the introductory text Disorders (112.03) your ID/MR.
of this body system, we mean the criteria in a. These disorders are characterized by e. Listing 112.05 is for ID/MR only. We
paragraph B of every mental disorders listing delusions, hallucinations, disorganized evaluate other mental disorders that
except 112.05. speech, or grossly disorganized or catatonic primarily affect cognition in the listing
c. (i) Paragraph C provides an alternative behavior, causing a clinically significant categories for dementia and amnestic and
to the paragraph B criteria that we can use other cognitive disorders (112.02); autism
decline in functioning.
to evaluate the severity of mental disorders spectrum disorders (112.10), or other
b. Symptoms and signs may include, but
except those under 112.05. To satisfy the disorders usually first diagnosed in
are not limited to, inability to initiate and
paragraph C criteria, you must have a serious childhood or adolescence (112.11), as
persist in goal-directed activities, social
and persistent mental disorder under one of appropriate.
withdrawal, flat or inappropriate affect,
those listings that satisfies the criteria in both poverty of thought and speech, loss of 5. Anxiety Disorders (112.06)
C1 and C2 (see 112.00E and F). interest or pleasure, disturbances of mood, a. These disorders are characterized by
(ii) When we refer to ‘‘paragraph C’’ or ‘‘the odd beliefs and mannerisms, and paranoia. excessive anxiety, worry, apprehension, and
paragraph C criteria’’ in the introductory text c. Examples of disorders in this category fear, or by avoidance of feelings, thoughts,
of this body system, we mean the criteria in include schizophrenia, schizoaffective activities, objects, places, or persons.
paragraph C of every mental disorders listing disorder, delusional disorder, and psychotic b. Symptoms and signs may include, but
except 112.05. disorder due to a general medical condition. are not limited to, restlessness, difficulty
3. To meet 112.05, your ID/MR must satisfy 3. Mood Disorders (112.04) concentrating, hyper-vigilance, muscle
112.05A, B, or D, or you must have a tension, sleep disturbance, fatigue, panic
a. These disorders are characterized by an attacks, obsessions and compulsions,
combination of ID/MR and another ‘‘severe’’
irritable, depressed, elevated, or expansive constant thoughts and fears about safety, and
physical or mental impairment that satisfies mood, or by a loss of interest or pleasure in
112.05C. frequent somatic complaints. Symptoms and
all or almost all activities, causing a signs associated with trauma may include
B. How do we describe the mental clinically significant decline in functioning.
disorders listing categories for children age 3 recurrent intrusive recollections of a
b. Symptoms and signs may include, but traumatic event, and acting or feeling as if the
to the attainment of age 18? In the following are not limited to, feelings of hopelessness or
sections, we provide a brief description of the traumatic event were recurring. Depending
guilt, suicidal ideation, a clinically on a child’s age and developmental stage,
mental disorders included in each listing significant change in body weight or appetite, other features may also include refusal to go
category, followed by examples of symptoms sleep disturbances, an increase or decrease in to school, academic failure, frequent
and signs that children with disorders in energy, psychomotor abnormalities, stomachaches and other physical complaints,
each category may have. Except for 112.05, disturbed concentration, pressured speech, extreme worries about sleeping away from
we also provide examples of mental grandiosity, reduced impulse control, rapidly home, being overly clinging, and exhibiting
disorders diagnosed in each category; we do alternating moods, sadness, euphoria, and tantrums at times of separation from
not provide examples for 112.05 because ID/ social withdrawal. Depending on a child’s caregivers.
MR is the only disorder covered by that age and developmental stage, certain c. Examples of disorders in this category
listing. Although the evidence must show features, such as somatic complaints, include panic disorder, phobic disorder,
that you have a mental disorder in one of the irritability, anger, aggression, and social obsessive-compulsive disorder, post-
listing categories, your mental disorder does withdrawal may be more commonly present traumatic stress disorder (PTSD), generalized
not have to match one of the examples in this than others. anxiety disorder, and anxiety disorder due to
section. We will find that any mental c. Examples of disorders in this category a general medical condition.
disorder meets one of these mental disorders include major depressive disorder, the
various types of bipolar disorders, 6. Somatoform Disorders (112.07)
listings when it can be included in one of the
listing categories and satisfies the other cyclothymic disorder, dysthymic disorder, a. These disorders are characterized by
criteria of the appropriate listing. and mood disorder due to a general medical physical symptoms or deficits that are not
condition. intentionally produced or feigned, and that,
1. Dementia and Amnestic and Other following clinical investigation, cannot be
Cognitive Disorders (112.02) 4. Intellectual Disability/Mental Retardation
(ID/MR) (112.05) fully explained by a general medical
a. These disorders are characterized by a condition, another mental disorder, the direct
clinically significant decline in cognitive a. This disorder is defined by significantly effects of a substance, or a culturally
subaverage general intellectual functioning sanctioned behavior or experience.
functioning.
with significant deficits in adaptive b. Symptoms and signs may include, but
b. Symptoms and signs may include, but
functioning. are not limited to, pain and other
are not limited to, disturbances in memory,
b. Signs may include, but are not limited abnormalities of sensation, gastrointestinal
executive functioning (that is, higher-level
to, poor conceptual, social, and practical symptoms, fatigue, abnormal motor
cognitive processes; for example, regulating skills, and a tendency to be passive, placid,
attention, planning, inhibiting responses, movement, pseudoseizures, and
and dependent on others, or to be impulsive pseudoneurological symptoms, such as
decisionmaking), psychomotor activity, or easily frustrated. When we evaluate your
visual-spatial functioning, language and blindness or deafness.
adaptive functioning, we also consider the c. Examples of disorders in this category
speech, perception, insight, and judgment. factors in 112.00F.
c. Examples of disorders in this category include somatization disorder, conversion
c. We consider your IQ score to be ‘‘valid’’ disorder, body dysmorphic disorder, and
include dementia and amnestic or other when it is supported by the other evidence,
cognitive disorders due to medications, pain disorder associated with psychological
including objective clinical findings, other factors.
toxins, or a general medical condition, such clinical observations, and evidence of your
as human immunodeficiency virus infection, day-to-day functioning that is consistent with 7. Personality Disorders (112.08)
neurological disease (for example, multiple the test score. If the IQ test provides more a. These disorders are characterized by an
sclerosis), or metabolic disease (for example, than one IQ score (for example, a verbal, enduring, inflexible, pervasive, and
lysosomal storage disease, late-onset Tay- performance, and full scale IQ in a Wechsler maladaptive pattern of inner experience and
Sachs disease); and traumatic brain injury, or series test), we use the lowest score. When behavior that causes clinically significant
TBI (see also 111.00F). we consider your IQ score, we apply the distress or impairment in social,
d. This category does not include mental rules in 112.00D4. occupational, or other important areas of
disorders that are included in the listing d. In 112.05C, the term ‘‘severe’’ has the functioning, and that has an onset in
categories for ID/MR (112.05), autism same meaning as in § 416.924(c). Your adolescence.
spectrum disorders (112.10), and other additional impairment(s) must cause more b. Symptoms and signs may include, but
disorders usually first diagnosed in than slight or minimal physical or mental are not limited to, patterns of distrust,
childhood or adolescence (112.11). functional limitations. The limitations must suspiciousness, and odd beliefs; social
detachment, discomfort, or avoidance; categories for dementia and amnestic and You use this mental ability when, for
hypersensitivity to negative evaluation; an other cognitive disorders (112.02), ID/MR example, you cope with your frustration and
excessive need to be taken care of; difficulty (112.05), and autism spectrum disorders stress, respond to demands and changes in
making independent decisions; a (112.10). your environment, protect yourself from
preoccupation with orderliness, 10. Eating Disorders (112.13) harm and exploitation by others, inhibit
perfectionism, and control; grandiosity; inappropriate actions, take your medications,
inappropriate and intense anger; self- a. These disorders are characterized by and maintain your physical health, hygiene,
mutilating behaviors; and recurrent suicidal persistent eating of nonnutritive substances and grooming.
threats, gestures, or attempts. or repeated episodes of regurgitation and re- D. How do we use the paragraph B mental
c. Examples of disorders in this category chewing of food, or by persistent failure to abilities to evaluate mental disorders in
include paranoid personality disorder, consume adequate nutrition by mouth. In children from age 3 to the attainment of age
schizoid personality disorder, schizotypal adolescence, these disorders are 18?
personality disorder, dependent personality characterized by disturbances in eating 1. General
disorder, borderline personality disorder, and behavior and preoccupation with, and a. When we rate your limitations using the
obsessive-compulsive personality disorder. excessive self-evaluation of, body weight and paragraph B mental abilities, we consider
shape. only limitations you have because of your
8. Autism Spectrum Disorders (112.10) b. Symptoms and signs may include, but mental disorder.
a. These disorders are characterized by are not limited to, failure to make expected b. We evaluate your limitations in the
qualitative deficits in the development of weight gains; refusal to maintain a minimally context of what is typically expected of
reciprocal social interaction, verbal and normal weight or a minimally normal body children your age without mental disorders.
nonverbal communication skills, and mass index (BMI); recurrent episodes of To do most age-appropriate activities, a child
symbolic or imaginative play; restricted binge eating and behavior intended to is expected to use his or her mental abilities
repetitive and stereotyped patterns of prevent weight gain, such as self-induced (given age-appropriate expectations)
behavior, interests, and activities; and early vomiting, excessive exercise, or misuse of independently, appropriately, effectively,
stagnation of skill acquisition or loss of laxatives; mood disturbances, social and on a sustained basis.
previously acquired skills. withdrawal, or irritability; amenorrhea; c. Marked or extreme limitation of a
b. Symptoms and signs may include, but dental problems; abnormal laboratory paragraph B mental ability reflects the overall
are not limited to, abnormalities and findings; and cardiac abnormalities. degree to which your mental disorder
unevenness in the development of cognitive c. Examples of disorders in this category interferes with your using that ability (given
skills; unusual responses to sensory stimuli; include pica, rumination disorder, and age-appropriate expectations) independently,
and behavioral difficulties, including feeding disorders of early childhood; appropriately, effectively, and on a sustained
hyperactivity, short attention span, anorexia nervosa; and bulimia nervosa. basis to do age-appropriate activities. It does
impulsivity, aggressiveness, or self-injurious C. What are the paragraph B criteria for not necessarily reflect a specific type or
actions. children age 3 to the attainment of age 18? number of activities, including activities of
c. Examples of disorders in this category The paragraph B criteria are the mental daily living, that you have difficulty doing.
include autistic disorder, Asperger’s abilities a child uses to do age-appropriate In addition, no single piece of information
disorder, and pervasive developmental activities. They are the abilities to: (including test scores) can establish whether
disorder (PDD). Understand, remember, and apply you have marked or extreme limitation of a
d. This category does not include mental information (paragraph B1); interact with paragraph B mental ability. (See 112.00D4.)
disorders that are included in the listing others (paragraph B2); concentrate, persist, d. Marked or extreme limitation of a
categories for dementia and amnestic and and maintain pace (paragraph B3); and paragraph B mental ability also reflects the
other cognitive disorders (112.02), ID/MR manage oneself (paragraph B4). In this kind and extent of supports you receive
(112.05), and other disorders usually first section, we provide basic definitions of the (beyond the supports that other children your
diagnosed in childhood or adolescence four paragraph B mental abilities and some age without mental disorders typically
(112.11). examples of how a child may use these receive) and the characteristics of any highly
9. Other Disorders Usually First Diagnosed in mental abilities to function. In 112.00D, we structured setting in which you spend your
Childhood or Adolescence (112.11) explain how we rate the severity of time that enable you to function as you do.
a. These disorders are characterized by limitations in the paragraph B mental The more extensive the supports or the more
onset during childhood or adolescence. abilities under these listings. structured the setting you need to function,
b. Symptoms and signs may include, but 1. Understand, remember, and apply the more limited we will find you to be. (See
are not limited to, underlying abnormalities information (paragraph B1). This is the 112.00F and § 416.924a.)
in cognitive processing (for example, deficits ability to acquire, retain, integrate, access, 2. What we mean by ‘‘marked’’ limitation
in learning and applying verbal or nonverbal and use information to perform age- a. Marked limitation of a paragraph B
information, visual perception, memory, or a appropriate activities. You use this mental mental ability means that the symptoms and
combination of these), deficits in attention or ability when, for example, you follow signs of your mental disorder interfere
impulse control, low frustration tolerance, instructions, provide explanations, and seriously with your using that mental ability
excessive or poorly planned motor activity, identify and solve problems. (given age-appropriate expectations)
difficulty with organizing (time, space, 2. Interact with others (paragraph B2). This independently, appropriately, effectively,
materials, or tasks), repeated accidental is the ability to relate to others at home, at and on a sustained basis to do age-
injury, and deficits in social skills. school, and in the community. You use this appropriate activities. Although we do not
Symptoms and signs specific to some mental ability when, for example, you require the use of such a scale, marked would
disorders in this category include fecal initiate and maintain friendships, cooperate, be the fourth point on a five-point rating
incontinence or urinary incontinence. handle conflicts, and respond to requests, scale consisting of no limitation, slight
Symptoms and signs specific to tic disorders suggestions, and criticism. limitation, moderate limitation, marked
include sudden, rapid, recurrent, non- 3. Concentrate, persist, and maintain pace limitation, and extreme limitation.
rhythmic, stereotyped motor movement or (paragraph B3). This is the ability to focus b. Although we do not require
vocalization; mood lability; and obsessions attention on age-appropriate activities and to standardized test scores to determine
and compulsions. stay on task at a sustained rate. You use this whether you have marked limitations, we
c. Examples of disorders in this category mental ability when, for example, you will generally find that you have marked
include learning disorders; attention-deficit/ concentrate, avoid distractions, initiate and limitation of a paragraph B mental ability
hyperactivity disorder; elimination disorders, complete activities, perform tasks at an when you have a valid score that is at least
such as developmentally inappropriate appropriate and consistent speed, and two, but less than three, standard deviations
encopresis and enuresis; and tic disorders, sustain an ordinary routine. below the mean on an individually
such as Tourette syndrome, chronic motor or 4. Manage oneself (paragraph B4). This is administered standardized test designed to
vocal tic disorder, and transient tic disorder. the ability to regulate your emotions, control measure that ability and the evidence shows
d. This category does not include mental your behavior, and maintain your well-being that your functioning over time is consistent
disorders that are included in the listing in age-appropriate activities and settings. with the score. (See also 112.00D4.)
c. Marked limitation is also the equivalent results should specify whether the results are age-appropriate settings on a sustained basis.
of the level of limitation we would expect to deemed to be valid; that is, whether they are Therefore, we will consider the kind and
find on standardized testing with scores that consistent with your medical and extent of supports you receive and the
are at least two, but less than three, standard developmental history and information about characteristics of any structured setting in
deviations below the mean for your age. your day-to-day functioning. which you spend your time (compared to
3. What we mean by ‘‘extreme’’ limitation (ii) It is our responsibility to ensure that children your age without mental disorders)
a. Extreme limitation of a paragraph B the evidence in your case record is complete when we evaluate the effect of your mental
mental ability means that the symptoms and and to resolve any material inconsistencies in disorder on your functioning and rate the
signs of your mental disorder interfere very the evidence. In some cases, we will be able limitation of your mental abilities (see
seriously with your using that mental ability to resolve an inconsistency with the 112.00D).
(given age-appropriate expectations) information already in your case record. In 2. Examples of psychosocial supports and
independently, appropriately, effectively, others, we may need to request additional highly structured settings
and on a sustained basis to do age- information; for example, by recontacting a. You need family members or other
appropriate activities. Although we do not your medical source(s), by purchasing a persons to help you in ways that children
require the use of such a scale, extreme consultative examination, or by questioning your age without mental disorders typically
would be the last point on a five-point rating persons who are familiar with your day-to- do not need to function age-appropriately; for
scale consisting of no limitation, slight day functioning. example, you need an aide to accompany you
limitation, moderate limitation, marked E. What are the paragraph C criteria, and on the school bus to help you control your
limitation, and extreme limitation. how do we use them to evaluate mental actions or to monitor you to be sure you are
b. Although we do not require disorders in children age 3 to the attainment not being self-injurious or injurious to others.
standardized test scores to determine of age 18? b. You receive one-on-one assistance in
whether you have extreme limitation, we will 1. General. We use the paragraph C criteria your classes every day, or you have a
generally find that you have extreme as an alternative to paragraph B to evaluate personal aide who helps you daily to
limitation of a paragraph B mental ability ‘‘serious and persistent mental disorders’’ function in your classroom.
when you have a valid score that is at least under every mental disorders listing except c. You are a student in a self-contained
three standard deviations below the mean for 112.05. We can use the paragraph C criteria classroom or attend a separate or alternative
your age on an individually administered without first considering whether your school where you receive special education
standardized test designed to measure that mental disorder satisfies the paragraph B services (see 112.00G4).
ability and the evidence shows that your criteria. d. You are a student in a special education
functioning over time is consistent with the 2. Paragraph C criteria setting that teaches you daily living skills,
score. (See also 112.00D4.) a. To meet the paragraph C criteria, you vocational skills, or entry-level work to help
c. ‘‘Extreme’’ is the rating we give to the must have a medically documented history, you be independent when you become an
worst limitations; however, it does not over a period of at least 1 year, of the adult (see 112.00G4).
necessarily mean a total lack or loss of ability existence of a serious and persistent mental e. You participate in a sheltered,
to function. It is the equivalent of the level disorder. Your mental disorder must also supported, or transitional work program or in
of limitation we would expect to find on satisfy the criteria in C1 and C2. a competitive employment setting with the
standardized testing with scores that are at b. The criterion in C1 is satisfied when the help of a job coach or an accommodating
least three standard deviations below the evidence shows that continuing treatment, supervisor (see 112.00G4).
mean for your age. psychosocial support(s), or a highly f. You receive treatment in a day program
4. How we consider your test results structured setting(s) diminishes the at a hospital, community treatment program,
a. We do not rely on any IQ score or other symptoms and signs of your mental disorder. or other daily outpatient program.
test result alone. We consider your test scores (See 112.00F.) g. You live in a group home, halfway
together with the other information we have c. The criterion in C2 is satisfied when the house, or semi-independent living program
about how you use the mental abilities evidence shows that you have achieved only with a counselor or resident supervisor who
described in the paragraph B criteria in your marginal adjustment despite your diminished is there 24 hours a day.
day-to-day functioning. symptoms and signs. ‘‘Marginal adjustment’’ h. You live in a residential school,
b. We may find that you have ‘‘marked’’ or means that your adaptation to the hospital, or other institution with 24-hour
‘‘extreme’’ limitation when you have a test requirements of daily living and your care.
score that is slightly higher than the levels environment is fragile; that is, you have 3. Treatment
we provide in 112.00D2 and D3 if other minimal capacity to adapt to changes in your a. With treatment, such as medications and
information in your case record shows that environment or to demands that are not social skills training, you may not only have
your functioning in day-to-day activities is already part of your daily life. Changes or your symptoms and signs reduced, but may
seriously or very seriously limited. We will increased demands would likely lead to an be able to function well enough to perform
not find that you have ‘‘marked’’ or ‘‘extreme’’ exacerbation of your symptoms and signs and age-appropriate activities.
limitation in your ability to understand, to deterioration in your functioning; for b. Treatment may not resolve all of the
remember, and apply information (or in any example, you would be unable to function functional limitations that result from your
other ability measured by a standardized test) outside a highly structured setting or outside mental disorder, and the medications you
unless you have evidence demonstrating that your home. Similarly, because of the nature take or other treatment you receive for your
your functioning is consistent with such a of your mental disorder, you could disorder may cause side effects that affect
limitation. experience episodes of deterioration that your mental or physical functioning; for
c. Generally, we will not find that a test require you to be hospitalized or absent from example, you may experience drowsiness,
result is valid for our purposes when the school, making it difficult for you to sustain blunted affect, or abnormal involuntary
information we have about your functioning age-appropriate activity over time. movements.
is of the kind typically used by medical F. How do we consider psychosocial c. We will consider the effect of any
professionals to determine that the test supports, highly structured settings, and treatment on your functioning when we
results are not the best measure of your day- treatment when we evaluate the functioning evaluate your mental disorder under these
to-day functioning. If there is a material of children age 3 to the attainment of age 18? listings.
inconsistency between your test results and 1. Psychosocial supports and highly G. What evidence do we need to evaluate
other information in your case record, we structured settings may help you to function your developmental or mental disorder?
will try to resolve it. We use the following by reducing the demands made on you. 1. General
guidelines when we consider your test However, your ability to function in settings a. If you have not attained age 3, we need
scores: (including your own home) that are less evidence to assess the existence and severity
(i) The interpretation of the test is demanding, more structured, or more of your developmental disorder and its
primarily the responsibility of the supportive than those in which children effects on your ability to acquire and
professional who administered the test. The typically function does not necessarily show maintain the skills needed to function age-
narrative report that accompanies the test how you would function in school or other appropriately. (See 112.00I for guidelines
about evaluating developmental disorders in ability to function. This information may basis. Therefore, we generally will consider
infants and toddlers under 112.14.) include, but is not limited to, information how you function longitudinally; that is, over
b. If you are age 3 to the attainment of age from your family, other caregivers, friends, time. We will not find that you are able to
18, we need evidence to assess the existence neighbors, or clergy. We will consider your function age-appropriately solely because
and severity of your mental disorder and its statements and the statements of other you have a period(s) of remission, or that you
effects on your ability to function age- persons to determine if they are consistent are disabled solely because you have an
appropriately. with the medical and other evidence we exacerbation(s) of your mental disorder. We
c. Although we always need evidence from have. will consider how often you have remissions
an acceptable medical source, the individual 4. Evidence from early intervention and exacerbations and how long they last,
facts of your case will determine the extent programs, school, vocational training, work, what causes your mental disorder to improve
of that evidence and what evidence, if any, and work-related programs. or worsen, and any other information that is
we need from other sources. For our basic a. If you receive services in an Early relevant to our determination about how you
rules on evidence, see §§ 416.912 and Intervention Program to help you with your function over time. We will consider
416.913. For our rules on evidence about a special developmental needs, we will longitudinal evidence from relevant sources
child’s symptoms, see § 416.929. consider information from your over a sufficient period to establish the
2. Evidence from medical sources. We will Individualized Family Service Plan (IFSP) severity of your mental disorder over time.
consider all relevant medical evidence about when we need it to show the severity of your b. If you have a serious mental disorder,
your mental disorder from your physician, developmental disorder. you will probably have evidence of its effects
psychologist, and your other medical b. If you receive special education or on your functioning over time, even if you do
sources. Other medical sources include related services at your preschool or school, not have an ongoing relationship with the
health care providers, such as physician we will consider the information in your medical community. For example, family
assistants, nurses, licensed clinical social Individualized Education Program (IEP) members, friends, day-care providers,
workers, and therapists. These other medical when we need it to show the severity of your teachers, neighbors, former employers, social
sources can be very helpful in providing mental disorder and how it affects your workers, mental health clinics, emergency
evidence to assess the severity of your mental ability to function. The information may shelters, law enforcement, or government
disorder and the resulting limitation in come from classroom teachers, special agencies may be familiar with your mental
functioning, especially if they see you educators, nurses, school psychologists, and health history.
regularly. Evidence from medical sources occupational, physical, and speech/language c. You may function differently and appear
may include: therapists. It may include, but is not limited more or less limited in an unfamiliar or one-
a. Your reported symptoms. to, comprehensive evaluation reports, IEPs, time situation, such as a consultative
education records, therapy progress notes, examination, than is indicated by other
b. Your medical, developmental,
information about your functioning over time
psychiatric, and psychological history. information from your teachers about how
(see § 416.924a(b)(6)). Your ability to
c. The results of physical or mental status you function in their classrooms, and
function during a time-limited mental status
examinations or other clinical findings. information about any special education
examination or psychological testing, or in
d. Psychological testing, developmental services or accommodations you receive at
another unfamiliar or one-time situation,
assessments, imaging studies, or other school. does not necessarily show how you will be
laboratory findings. c. If you have recently attended or are still able to function in a school or other age-
e. Your diagnosis. attending vocational training classes or if you appropriate setting on a sustained basis.
f. The type, dosage, frequency, duration, have attempted to work or are working now, d. Some of your day-to-day activities, or
and beneficial effects of medications you we will consider information from your some of the places where you spend time
receive. training program or your employer when we each day, can be stressful if you have a
g. The type, frequency, duration, and need it to show the severity of your mental mental disorder, making it difficult for you
beneficial effects of therapy, counseling, or disorder and how it affects your ability to to function as other children without mental
early intervention you receive. function. This information may include, but disorders typically do. For example, you may
h. Any side effects of medication or other is not limited to, training or work have to leave your home to go to daycare
treatment that limit your ability to function evaluations, modifications to your work where the level of activity and noise is
(see 112.00F). duties or work schedule, and any special stressful to you; or you may feel stressed
i. Your clinical course, including changes supports or accommodations you have when you move from elementary to middle
in your medication, therapy, or counseling required or now require in order to work. If school, where you have to change classrooms
and the time required for therapeutic you have worked or are working through a and settle yourself down to new situations
effectiveness. community mental health program, a and settings many times during each day.
j. Observations and descriptions of how sheltered work program, a supported work (i) Your reaction to stress associated with
you function. program, a rehabilitation program, or a the demands of your day-to-day activities
k. Any psychosocial support(s) you receive transitional employment program, we will may be different from another child’s; that is,
or highly structured setting(s) in which you consider the type and degree of support you the symptoms and signs of your mental
are involved (see 112.00F). have received or are receiving in order to disorder may be more or less affected by
l. Any sensory, motor, or speaking work. stress than those of another child with the
abnormalities or information about your 5. Evidence from developmental same mental disorder or another mental
cultural background (for example, language assessments or psychological and psychiatric disorder.
differences, customs) that may affect an measures. We will consider the results from (ii) We will consider evidence from all
evaluation of your developmental or mental developmental assessments or from sources about the effects of stress on your
disorder. psychological and psychiatric measures mental abilities. We will also take into
m. The expected duration of your together with all the other evidence in your consideration what, if any, psychosocial
symptoms and signs and their effects on your case record. Results from these measures are support(s) or structure you would need when
ability to function age-appropriately over only part of the evidence we use in our you experience stress (see 112.00F).
time. overall disability evaluation; we will not use H. How do we evaluate substance use
3. Evidence from you and persons who these results alone to decide whether you are disorders? If we find that you are disabled
know you. We will ask you to describe your disabled. (See 112.00D4.) and there is medical evidence in your case
symptoms and your limitations if you are 6. Need for longitudinal evidence. record establishing that you have a substance
able to do so, and we will use that a. Many children with mental disorders use disorder, we will determine whether
information to help us determine whether experience periods of worsening of the your substance use disorder is a contributing
you are disabled. We will also consider symptoms and signs of their mental disorders factor material to the determination of
information from persons who can describe (exacerbations) and periods of improvement disability. (See § 416.935.)
how you usually function from day to day of their symptoms and signs (remissions). I. How do we use 112.14 to evaluate
when we need it to show the severity of your Exacerbations may make it difficult for you developmental disorders of infants and
mental disorder and how it affects your to function age-appropriately on a sustained toddlers from birth to attainment of age 3?
1. General. If you are a child from birth to exploring the environment, engaging in trial- developmental abilities to achieve a
attainment of age 3 with a developmental and-error experimentation, putting things in recognized pattern of milestones, over a
disorder, we use 112.14 to evaluate your groups, understanding that words represent typical range of time, in order to acquire and
ability to acquire and maintain the motor, things, and participating in pretend play. maintain the skills needed to function age-
cognitive, social/communicative, and Using this ability develops the skills that appropriately.
emotional skills you need to function age- help you understand what things mean, how c. Marked or extreme limitation of a
appropriately. When we rate your things work, and how you can make things paragraph B developmental ability reflects
impairment-related limitations for this happen. You use this ability when, for the overall degree to which your
listing, we consider only limitations you example, you show interest in objects that are developmental disorder interferes with your
have because of your developmental new to you, imitate simple actions, name using that ability. It does not necessarily
disorder. If you have a somatic illness or body parts, understand simple cause-and- reflect a specific type or number of
physical abnormalities, we will evaluate effect relationships, remember simple developmental skills or activities that you
them under the affected body system; for directions, or figure out how to take have difficulty doing. In addition, no single
example, the musculoskeletal or neurological something apart. piece of information, including test scores,
system. (iii) Ability to interact with others can establish whether you have marked or
2. Description of 112.14 (paragraph B3). This is the ability to extreme limitation of a paragraph B
a. Developmental disorders are participate in reciprocal social interactions developmental ability. (See 112.00H4g.)
characterized by a delay or deficit in the and relationships by communicating your d. Marked or extreme limitation of a
development of age-appropriate skills or a feelings and intents through vocal and visual paragraph B developmental ability also
loss of previously acquired skills involving signals and exchanges; physical gestures, reflects the kind and extent of supports you
motor planning and control, learning, contact, and proximity; shared attention and receive (beyond the supports that infants or
relating socially and communicating, and affection; verbal turn-taking; and increasingly toddlers your age without developmental
self-regulating. complex messages. Using this ability disorders typically receive), and the
b. Examples of disorders in this category develops the social skills that make it characteristics of any highly structured
include feeding and eating disorders, sensory possible for you to influence others (for settings in which you spend your time, that
processing disorder, developmental example, by gesturing for a toy or saying ‘‘no’’ enable you to function as you do. The more
coordination disorder, autism and other to stop an action); invite someone to interact extensive the supports or the more structured
pervasive developmental disorders, with you (for example, by smiling or the setting you need to function, the more
separation anxiety disorder, and regulatory reaching); and draw someone’s attention to limited we will find you to be. (See 112.00I5
disorders. Some infants and toddlers may what interests you (for example, by pointing and § 416.924a.)
have a diagnosis of ‘‘developmental delay.’’ or taking your caregiver’s hand and leading e. What we mean by ‘‘marked’’ limitation
c. When we evaluate your developmental (i) Marked limitation of a paragraph B
that person). You use this ability when, for
disorder, we will consider the wide variation developmental ability means that the
example, you use vocalizations to initiate
in the range of normal or typical symptoms and signs of your developmental
and sustain a ‘‘conversation’’ with your
development in early childhood. Your disorder interfere seriously with your using
caregiver; respond to limits set by an adult
emerging skills at the end of an expected that ability to acquire and maintain the skills
with words, gestures, or facial expressions; you need to function age-appropriately.
milestone period may or may not indicate
play alongside another child; or participate Although we do not require the use of such
developmental delay or a delay that can be
in simple group activities with adult help. a scale, marked would be the fourth point on
expected to last for 12 months.
3. What are the paragraph B criteria for (iv) Ability to regulate physiological a five-point rating scale consisting of no
112.14? functions, attention, emotion, and behavior limitation, slight limitation, moderate
a. General. The paragraph B criteria are the (paragraph B4). This is the ability to stabilize limitation, marked limitation, and extreme
developmental abilities that infants and biological rhythms (for example, by acquiring limitation.
toddlers use to acquire and maintain the a sleep/wake cycle); control physiological (ii) Although we do not require
skills needed to function age-appropriately. functions (for example, by achieving regular standardized test scores to determine
They are the abilities to: Plan and control patterns of feeding); and attend, react, and whether you have marked limitations, we
motor movement (paragraph B1); learn and adapt to environmental stimuli, persons, will generally find that you have marked
remember (paragraph B2); interact with objects, and events (for example, by limitation of a paragraph B developmental
others (paragraph B3); and regulate becoming alert to things happening around ability when you have a valid score that is
physiological functions, attention, emotion, you and in relation to you, and responding at least two, but less than three, standard
and behavior (paragraph B4). We use these without overreacting or underreacting). Using deviations below the mean on a
criteria to evaluate limitations that result this ability develops the skills you need to comprehensive standardized developmental
from the developmental disorder. In regulate yourself and makes it possible for assessment designed to measure that ability
112.00I3b(i) through I3b(iv), we provide you to achieve and maintain a calm, alert, and the evidence shows that your
some examples of how infants and toddlers and organized physical and emotional state. functioning over time is consistent with the
use these developmental abilities to function You use this ability when, for example, you score.
age-appropriately. In 112.00I4, we explain recognize your body’s needs for food or (iii) Marked limitation is also the
how we rate the severity of limitations in the sleep, focus quickly and pay attention to equivalent of the level of limitation we
paragraph B mental abilities under 112.14. things that interest you, cry when you are would expect to find on standardized
b. Definitions of the paragraph B hurt but quiet when your caregiver holds developmental assessments with scores that
developmental abilities you, comfort yourself with your favorite toy are at least two, but less than three, standard
(i) Ability to plan and control motor when you are upset, ask for help when deviations below the mean for your age.
movement (paragraph B1). This is the ability something frustrates you, or refuse help from (iv) When there are no results from a
to plan, remember, and execute controlled your caregiver when trying to do something comprehensive standardized developmental
motor movements by integrating and for yourself. assessment in your case record, we can
coordinating perceptual and sensory input 4. How do we use the 112.14 criteria to evaluate your disorder based on a
with motor output. Using this ability evaluate your developmental disorder? comprehensive clinical developmental
develops gross and fine motor skills, and a. We will find that your developmental assessment; that is, an assessment of more
makes it possible for you to engage in age- disorder meets the requirements of 112.14 if than one or two isolated skills, with
appropriate symmetrical or alternating motor it results in marked limitations of two or abnormal findings noted on repeated
activities. You use this ability when, for extreme limitation of one of the paragraph B examinations. We will find marked
example, you walk, pull yourself up to stand, developmental abilities. limitation of a paragraph B developmental
grasp and hold objects with one or both b. We will evaluate your limitations in the ability if your skills and functioning on a
hands, and go up and down stairs with context of what is typically expected of clinical developmental assessment are at a
alternating feet. infants or toddlers your age without level that is typical of children who are more
(ii) Ability to learn and remember developmental disorders. An infant or than one-half, but not more than two-thirds,
(paragraph B2). This is the ability to learn by toddler is expected to use his or her your chronological age.
f. What we mean by ‘‘extreme’’ limitation 6. Deferral of determination If you have limitations in your ability to
(i) Extreme limitation of a paragraph B a. Full-term infants perform physical activities that are secondary
developmental ability means that the (i) In the first few months of life, full-term to your mental or developmental disorder,
symptoms and signs of your developmental infants typically display some irregularities we will consider them when we determine
disorder interfere very seriously with your in observable behaviors (for example, sleep whether your disorder functionally equals
ability to acquire and maintain the skills that cycles, feeding, responding to stimuli, the listings. For example, limitations in
you need to function age-appropriately. attending to faces, self-calming), making it walking or standing due to the side effects of
Although we do not require the use of such difficult to assess the presence, severity, and medication you take to treat your mental
a scale, extreme would be the last point on duration of a developmental disorder. disorder may affect your age-appropriate
a five-point rating scale consisting of no (ii) When the evidence indicates that you activities requiring physical exertion. When
limitation, slight limitation, moderate may have a significant developmental delay, we decide whether you continue to be
limitation, marked limitation, and extreme but there is insufficient evidence to make a disabled, we use the rules in §§ 416.994 and
limitation. determination, we will defer making a 416.994a.
(ii) Although we do not require disability determination under 112.14 until
112.01 Category of Impairments, Mental
standardized test scores to determine you are at least 6 months old. This will allow
Disorders
whether you have extreme limitation, we will us to obtain a longitudinal medical history so
generally find that you have extreme that we can more accurately evaluate your 112.02 Dementia and Amnestic and
limitation of a paragraph B developmental developmental patterns and functioning over Other Cognitive Disorders, with both A and
ability when you have a valid score that is time. When you are at least 6 months old, B or both A and C.
at least three standard deviations below the any developmental delay you may have can A. For children age 3 to attainment of age
mean on a comprehensive standardized be better assessed, and you can undergo 18, a medically determinable mental disorder
developmental assessment designed to standardized developmental testing, if in this category (see 112.00B1).
measure that ability and the evidence shows indicated. AND
that your functioning over time is consistent b. Premature infants. If you were born B. Marked limitations of two or extreme
with the score. prematurely, we will follow the rules in limitation of one of the following mental
(iii) ‘‘Extreme’’ is the rating we give to the § 416.924b(b) to determine your corrected abilities:
worst limitations; however, it does not chronological age; that is, the chronological 1. Ability to understand, remember, and
necessarily mean a total lack or loss of ability age adjusted by the period of gestational apply information (see 112.00C1).
to function. It is the equivalent of the level prematurity. When the evidence indicates 2. Ability to interact with others (see
of limitation we would expect to find on that you may have a significant 112.00C2).
standardized developmental assessments developmental delay, but there is insufficient 3. Ability to concentrate, persist, and
with scores that are at least three standard evidence to make a determination, we will maintain pace (see 112.00C3).
deviations below the mean for your age. defer your case until you attain a corrected 4. Ability to manage oneself (see
(iv) When there are no results from a chronological age of at least 6 months in 112.00C4).
comprehensive standardized developmental order to better evaluate your developmental
OR
assessment in your case record, we can delay.
c. When we will not defer a determination. C. A serious and persistent mental disorder
evaluate your disorder based on a
We will not defer our determination if we in this category (see 112.00E2) with both:
comprehensive clinical developmental
have sufficient evidence to determine that 1. Continuing treatment, psychosocial
assessment; that is, an assessment of more
you are disabled under 112.14 or any other support(s), or a highly structured setting(s)
than one or two isolated skills, with
listing, or that you have a combination of that diminishes the symptoms and signs of
abnormal findings noted on repeated
impairments that functionally equals the your mental disorder, and
examinations. We will find extreme 2. Marginal adjustment, as described in
limitation of a paragraph B developmental listings. In addition, we will not defer our
determination if the evidence demonstrates 112.00E2c.
ability if your skills and functioning on a 112.03 Schizophrenia and Other
clinical developmental assessment are at a that you are not disabled.
Psychotic Disorders, with both A and B or
level that is typical of children who are no J. How do we evaluate mental and both A and C.
more than one-half your chronological age. developmental disorders that do not meet A. For children age 3 to attainment of age
g. How we consider your test results. We one of the mental disorders listings? 18, a medically determinable mental disorder
use the rules in 112.00D4 to evaluate any test 1. These listings include only examples of in this category (see 112.00B2).
results in your case record. mental and developmental disorders that we
5. How do we consider supports when we AND
consider severe enough to result in marked
evaluate functioning under 112.14? B. Marked limitations of two or extreme
and severe functional limitations. If your
a. If you have a developmental delay or limitation of one of the following mental
severe mental or developmental disorder
your skills are qualitatively deficient, you abilities:
does not meet the criteria of any of these
may receive support in the form of early 1. Ability to understand, remember, and
listings, we will also consider whether you
intervention services to help you acquire apply information (see 112.00C1).
have an impairment(s) that meets the criteria
needed skills or to improve those that you 2. Ability to interact with others (see
of a listing in another body system. You may
have. 112.00C2).
have a separate other impairment(s) or a
b. You may receive therapeutic 3. Ability to concentrate, persist, and
physical impairment(s) that is secondary to
intervention, such as occupational therapy, maintain pace (see 112.00C3).
your mental disorder. For example, if you
from a visiting early childhood specialist or 4. Ability to manage oneself (see
have an eating disorder and develop a
therapist who sees you in your home or in 112.00C4).
cardiovascular impairment because of it, we
a structured clinical setting that is specially will evaluate your cardiovascular impairment OR
designed to enable you to develop specific under the listings for the cardiovascular body C. A serious and persistent mental disorder
skills. You may receive more direct help at system. in this category (see 112.00E2) with both:
home in acquiring skills than other children 2. If you have a severe medically 1. Continuing treatment, psychosocial
your age when, for example, your caregiver determinable impairment(s) that does not support(s), or a highly structured setting(s)
repeatedly models a sequence of physical meet a listing, we will determine whether that diminishes the symptoms and signs of
actions for you to imitate or spends large your impairment(s) medically equals a your mental disorder, and
amounts of time helping you to calm yourself listing. (See § 416.926.) If it does not, we will 2. Marginal adjustment, as described in
when you are upset. Generally, the more also consider whether you have an 112.00E2c.
direct help or therapeutic intervention you impairment(s) that functionally equals the 112.04 Mood Disorders, with both A and
need to develop skills compared to other listings. (See § 416.926a.) When we B or both A and C.
infants and toddlers your age without determine whether your impairment(s) A. For children age 3 to attainment of age
developmental disorders, the more limited functionally equals the listings, we consider 18, a medically determinable mental disorder
we will find you to be. all of your physical and mental limitations. in this category (see 112.00B3).
AND 1. Ability to understand, remember, and B. Marked limitations of two or extreme

B. Marked limitations of two or extreme apply information (see 112.00C1). limitation of one of the following mental
limitation of one of the following mental 2. Ability to interact with others (see abilities:
abilities: 112.00C1). 1. Ability to understand, remember, and
1. Ability to understand, remember, and 3. Ability to concentrate, persist, and apply information (see 112.00C1).
apply information (see 112.00C1). maintain pace (see 112.00C3). 2. Ability to interact with others (see
2. Ability to interact with others (see 4. Ability to manage oneself (see 112.00C2).
112.00C2). 112.00C4).
3. Ability to concentrate, persist, and
3. Ability to concentrate, persist, and OR maintain pace (see 112.00C3).
maintain pace (see 112.00C3). C. A serious and persistent mental disorder
4. Ability to manage oneself (see 4. Ability to manage oneself (see
in this category (see 112.00E2) with both: 112.00C4).
112.00C4). 1. Continuing treatment, psychosocial
OR OR
support(s), or a highly structured setting(s)
C. A serious and persistent mental disorder that diminishes the symptoms and signs of C. A serious and persistent mental disorder
in this category (see 112.00E2) with both: your mental disorder, and in this category (see 112.00E2) with both:
1. Continuing treatment, psychosocial 2. Marginal adjustment, as described in 1. Continuing treatment, psychosocial
support(s), or a highly structured setting(s) 112.00E2c. support(s), or a highly structured setting(s)
that diminishes the symptoms and signs of 112.07 Somatoform Disorders, with both that diminishes the symptoms and signs of
your mental disorder, and A and B or both A and C. your mental disorder, and
2. Marginal adjustment, as described in A. For children age 3 to attainment of age 2. Marginal adjustment, as described in
112.00E2c. 18, a medically determinable mental disorder 112.00E2c.
112.05 Intellectual Disability/Mental in this category (see 112.00B6). 112.11 Other Disorders Usually First
Retardation (ID/MR) satisfying A, B, C, or D. AND
A. For children age 3 to the attainment of Diagnosed in Childhood or Adolescence,
age 18, ID/MR as defined in 112.00B4, with B. Marked limitations of two or extreme with both A and B or both A and C.
mental incapacity evidenced by dependence limitation of one of the following mental A. For children age 3 to attainment of age
upon others for personal needs (grossly in abilities: 18, a medically determinable mental disorder
excess of age-appropriate dependence) and 1. Ability to understand, remember, and in this category (see 112.00B9).
an inability to follow directions, such that apply information (see 112.00C1).
AND
the use of standardized measures of 2. Ability to interact with others (see
112.00C2). B. Marked limitations of two or extreme
intellectual functioning is precluded.
3. Ability to concentrate, persist, and limitation of one of the following mental
OR abilities:
maintain pace (see 112.00C3).
B. For children age 3 to the attainment of 4. Ability to manage oneself (see 1. Ability to understand, remember, and
age 18, ID/MR as defined in 112.00B4, with 112.00C4). apply information (see 112.00C1).
a valid IQ score of 59 or less (as defined in 2. Ability to interact with others (see
OR
112.00B4d) on an individually administered 112.00C2).
standardized test of general intelligence C. A serious and persistent mental disorder
in this category (see 112.00E2) with both: 3. Ability to concentrate, persist, and
having a mean of 100 and a standard
deviation of 15 (see 112.00D4). 1. Continuing treatment, psychosocial maintain pace (see 112.00C3).
support(s), or a highly structured setting(s) 4. Ability to manage oneself (see
OR
that diminishes the symptoms and signs of 112.00C4).
C. For children age 3 to the attainment of your mental disorder, and
age 18, ID/MR as defined in 112.00B4, with OR
2. Marginal adjustment, as described in
a valid IQ score of 60 through 70 (as defined C. A serious and persistent mental disorder
112.00E2c.
in 112.00B4d) on an individually in this category (see 112.00E2) with both:
112.08 Personality Disorders, with both A
administered standardized test of general and B or both A and C. 1. Continuing treatment, psychosocial
intelligence having a mean of 100 and a A. For children age 3 to attainment of age support(s), or a highly structured setting(s)
standard deviation of 15 (see 112.00D4) and 18, a medically determinable mental disorder that diminishes the symptoms and signs of
with another ‘‘severe’’ physical or mental in this category (see 112.00B7). your mental disorder, and
impairment (see 112.00B4e). 2. Marginal adjustment, as described in
AND
OR 112.00E2c.
B. Marked limitations of two or extreme
D. For children from age 3 to the 112.13 Eating Disorders, with both A and
limitation of one of the following mental
attainment of age 18, ID/MR as defined in B or both A and C.
abilities:
112.00B4, with a valid IQ score of 60 through A. For children age 3 to attainment of age
1. Ability to understand, remember, and
70 (as defined in 112.00B4d) on an 18, a medically determinable mental disorder
apply information (see 112.00C1).
individually administered standardized test in this category (see 112.00B10).
2. Ability to interact with others (see
of general intelligence having a mean of 100
112.00C2). AND
and a standard deviation of 15 (see
112.00D4), resulting in marked limitation of 3. Ability to concentrate, persist, and B. Marked limitations of two or extreme
at least two of the following mental abilities: maintain pace (see 112.00C3). limitation of one of the following mental
1. Ability to understand, remember, and 4. Ability to manage oneself (see abilities:
apply information (see 112.00C1). 112.00C4). 1. Ability to understand, remember, and
2. Ability to interact with others (see OR apply information (see 112.00C1).
112.00C2). C. A serious and persistent mental disorder 2. Ability to interact with others (see
3. Ability to concentrate, persist, and in this category (see 112.00E2) with both: 112.00C2).
maintain pace (see 112.00C3). 1. Continuing treatment, psychosocial 3. Ability to concentrate, persist, and
4. Ability to manage oneself (see support(s), or a highly structured setting(s) maintain pace (see 112.00C3).
112.00C4). that diminishes the symptoms and signs of 4. Ability to manage oneself (see
112.06 Anxiety Disorders, with both A
your mental disorder, and 112.00C4).

and B or both A and C. 2. Marginal adjustment, as described in
A. For children age 3 to attainment of age 112.00E2c. OR
18, a medically determinable mental disorder 112.10 Autism Spectrum Disorders, with C. A serious and persistent mental disorder
in this category (see 112.00B5). both A and B or both A and C. in this category (see 112.00E2) with both:
AND A. For children age 3 to attainment of age 1. Continuing treatment, psychosocial
B. Marked limitations of two or extreme 18, a medically determinable mental disorder support(s), or a highly structured setting(s)
limitation of one of the following mental in this category (see 112.00B8). that diminishes the symptoms and signs of
abilities: AND your mental disorder, and
2. Marginal adjustment, as described in AND may assist in reviewing the claim and
112.00E2c. B. At least two of the constitutional preparing documents that contain the
112.14 Developmental Disorders of symptoms and signs (severe fatigue, fever, medical portion of the case review and
Infants and Toddlers, with both A and B. malaise, or involuntary weight loss).
A. For children from birth to attainment of
any applicable residual functional
age 3, a medically determinable * * * * * capacity assessment or determination
developmental disorder in this category (see 114.10 Sjögren’s syndrome, as described about functional equivalence. However,
112.00I2). in 114.00D7. With involvement of two or our medical or psychological consultant
more organs/body systems, and with: must review and sign any document(s)
AND A. One of the organs/body systems
B. Marked limitations of two or extreme involved to at least a moderate level of
that includes the medical portion of the
limitation of one of the following severity; case review and any applicable residual
developmental abilities: AND functional capacity assessment or
1. Ability to plan and control motor determination about functional
movement (see 112.00I3b(i)). B. At least two of the constitutional
symptoms and signs (severe fatigue, fever, equivalence to attest that they are
2. Ability to learn and remember (see complete and that he or she is
112.00I3b(ii)). malaise, or involuntary weight loss).
3. Ability to interact with others (see responsible for the content, including
112.00I3b(iii)). Subpart Q—[Amended] the findings of fact and any discussion
4. Ability to regulate physiological of supporting evidence. When a
7. The authority citation for subpart Q disability hearing officer makes a
functions, attention, emotion, and behavior
(see 112.00I3b(iv)). of part 404 continues to read as follows: reconsideration determination, the
* * * * * Authority: Secs. 205(a), 221, and 702(a)(5) disability hearing officer has overall
of the Social Security Act (42 U.S.C. 405(a), responsibility for assessing the medical
114.00 Immune System Disorders 421, and 902(a)(5)). severity of your mental impairment(s).
* * * * * 8. Amend § 404.1615 by adding a new The determination must document the
D. How do we document and evaluate the
fifth sentence at the end of paragraph (d) disability hearing officer’s pertinent
listed autoimmune disorders?
to read as follows: findings and conclusions regarding the
* * * * * mental impairment(s).
6. Inflammatory arthritis (114.09). § 404.1615 Making disability
* * * * * determinations. (ii) At the administrative law judge
e. How we evaluate inflammatory arthritis * * * * * hearing and Appeals Council levels, the
under the listings. (d) * * * See § 404.1503 regarding administrative law judge or, if the
* * * * * overall responsibility for reviewing Appeals Council makes a decision, the
(ii) Listing-level severity is shown in mental impairments in the State agency. Appeals Council has overall
114.09B and 114.09C2 by inflammatory * * * * * responsibility for assessing the medical
arthritis that involves various combinations severity of your mental impairment(s).
of complications of one or more major The written decision must incorporate
PART 416—SUPPLEMENTAL
peripheral joints or involves other joints, the pertinent findings and conclusions
such as inflammation or deformity, extra- SECURITY INCOME FOR THE AGED,
articular features, repeated manifestations, BLIND, AND DISABLED of the administrative law judge or
and constitutional symptoms and signs. Appeals Council.
* * * Subpart I—[Amended]
§ 416.920a [Removed]
* * * * * 9. The authority citation for subpart I
of part 416 is revised to read as follows: 11. Remove § 416.920a.
114.01 Category of Impairments, Immune
System Disorders Authority: Secs. 221(m), 702(a)(5), 1611, 12. Revise the heading of § 416.934
114.02 Systemic lupus erythematosus, as 1614, 1619, 1631(a), (c), (d)(1), and (p), and and paragraph (h) to read as follows:
described in 114.00D1. With involvement of 1633 of the Social Security Act (42 U.S.C.
421(m), 902(a)(5), 1382, 1382c, 1382h, § 416.934 Impairments that may warrant a
two or more organs/body systems, and with:
A. One of the organs/body systems 1383(a), (c), (d)(1), and (p), and 1383b); secs. finding of presumptive disability or
involved to at least a moderate level of 4(c) and 5, 6(c)–(e), 14(a), and 15, Pub. L. 98– presumptive blindness.
severity; 460, 98 Stat. 1794, 1801, 1802, and 1808 (42 * * * * *
AND U.S.C. 421 note, 423 note, and 1382h note).
(h) Allegation of intellectual
B. At least two of the constitutional 10. Amend § 416.903 by redesignating disability/mental retardation or another
symptoms and signs (severe fatigue, fever, paragraph (e) as paragraph (e)(1) and cognitive impairment (for example, an
malaise, or involuntary weight loss). adding a new paragraph (e)(2), to read autism spectrum disorder) with
114.03 Systemic vasculitis, as described as follows:
in 114.00D2. With involvement of two or complete inability to independently
more organs/body systems, and with: § 416.903 Who makes disability and perform basic self-care activities (such
A. One of the organs/body systems blindness determinations. as toileting, eating, dressing, or bathing)
involved to at least a moderate level of made by another person who files on
* * * * *
severity;
(e) * * * behalf of a claimant who is at least 4
AND (2) Overall responsibility for years old.
B. At least two of the constitutional evaluating mental impairments. (i) In * * * * *
symptoms and signs (severe fatigue, fever, any case at the initial and
malaise, or involuntary weight loss).
reconsideration levels, except in cases Subpart J—[Amended]

* * * * * in which a disability hearing officer
114.06 Undifferentiated and mixed makes the reconsideration 13. The authority citation for subpart
connective tissue disease, as described in J of part 416 continues to read as
114.00D5. With involvement of two or more
determination, our medical or
psychological consultant has overall follows:
organs/body systems, and with:
A. One of the organs/body systems responsibility for assessing the medical Authority: Secs. 702(a)(5), 1614, 1631, and
involved to at least a moderate level of severity of your mental impairment(s). 1633 of the Social Security Act (42 U.S.C.
severity; The State agency disability examiner 902(a)(5), 1382c, 1383, and 1383b).
14. Amend section 416.1015 by Subpart N—[Amended] (b) * * *

adding a new fifth sentence at the end (3) There is a change in the law or
15. The authority citation for subpart
of paragraph (d) to read as follows: regulation;
N of part 416 continues to read as
§ 416.1015 Making disability follows: (4) There is an error in the file or
determinations. Authority: Secs. 702(a)(5), 1631, and 1633 some other indication that the prior
* * * * * of the Social Security Act (42 U.S.C. determination may be revised; or
902(a)(5), 1383, and 1383b); sec. 202, Pub. L.
(d) * * * See § 416.903 regarding (5) An administrative law judge
108–203, 118 Stat. 509 (42 U.S.C. 902 note).
overall responsibility for reviewing requires the services of a medical expert
16. Amend § 416.1441 by revising to assist in reviewing a mental
mental impairments in the State agency.
paragraphs (b)(3) and (b)(4), and by disorder(s), but such services are
* * * * * adding a new paragraph (b)(5) to read as unavailable.
follows:
* * * * *
§ 416.1441 Prehearing case review. [FR Doc. 2010–20247 Filed 8–18–10; 8:45 am]
* * * * * BILLING CODE 4191–02–P

2010 20247

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Thursday,

August 19, 2010

8 68 FR at 12640. proposed rules now.

Current listing category Proposed listing category

evidence of current functioning demonstrate that

www.socialsecurity.gov/OP_Home/rulings/ssi/02/ and any clinical observations’’ that corroborate the

Current listing 12.05 Proposed listing 12.05

(SSA–2506–BK), to ensure that repeats the examples and summary guidance in

are primarily informational. As we explained earlier

2007), and the ‘‘Revised Medical Criteria for

References Social Security Benefits, National American Academy of Child and

Meisels, Samuel J. and Emily Assessment, and Modification, Income (SSI).

AND 1. Ability to understand, remember, and B. Marked limitations of two or extreme

your mental disorder, and 112.00C4).

reconsideration levels, except in cases Subpart J—[Amended]

14. Amend section 416.1015 by Subpart N—[Amended] (b) * * *

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