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Federal Register / Vol. 62, No. 28 / Tuesday, February 11, 1997 / Rules and Regulations6409or a combination of impairments on achild’s ability to functionindependently, appropriately, andeffectively in an age-appropriatemanner. The rules also provided thateach child whose impairment(s) did notmeet or medically or functionally equalthe requirements for any listing wouldhave an ‘‘individualized functionalassessment’’ (IFA), an evaluation of theimpact of the child’s impairment(s) onhis or her overall ability to functionindependently, appropriately, andeffectively in an age-appropriatemanner.In fact, the rules provided three stepsat which we would consider a child’sfunctioning. At each of these steps, weconsidered the impact of all of thechild’s medically determinableimpairments on his or her functioningand considered all relevant evidence,including the effects of the individual’ssymptoms and the side effects ofmedication. We considered the nature ofthe impairment(s), the child’s age, thechild’s ability to be tested given his orher age, the child’s ability to performage-appropriate daily activities, andother relevant factors.First, we added a ‘‘severeimpairment’’ step for children toparallel step 2 of the adult sequentialevaluation process. At this step, thethreshold for further evaluation waswhether a child had more than a slightabnormality or a combination of slightabnormalities that caused more thanminimal limitation in a child’s ability tofunction independently, appropriately,and effectively in an age-appropriatemanner.Second, at step 3 of the sequentialevaluation process, we expanded therules for determining equivalence to theListing. The new ‘‘functionalequivalence’’ rule was intended, amongother things, to address the SupremeCourt’s concerns about our use of theListing in childhood cases. Functionalequivalence provided that, if a child’simpairment(s) did not meet or medicallyequal the severity of any listedimpairment, we would assess the child’sfunctional limitations and comparethose limitations with the disablingfunctional consequences of any listedimpairment, without regard to whetherthe listed impairment chosen forcomparison was medically ‘‘related’’ tothe child’s impairment(s); for example,functional equivalence permitscomparison of the functional limitationscaused by a physical impairment withthe functional limitations establishingdisability in the mental disorderslistings.Last, for those children whoseimpairments were not of listing-levelseverity, the rules resulting from theZebley decision included an entirelynew fourth step in the sequentialevaluation process for children. At thisstep, we used the IFA to assess whethera child’s severe impairment(s), whilenot of listing-level severity, wasnonetheless of ‘‘comparable severity’’ toan impairment(s) that would disable anadult.The IFA addressed the functionalimpact of a child’s impairment(s) inbroad areas of functioning, which wecalled domains and behaviors, such ascognition, communication, and motorabilities. These domains and behaviorswere intended to encompass and reflectall the things that a child may do at anyparticular age, and were, therefore,intended to include all of a child’sfunctioning.If an IFA showed that a child’simpairment(s) substantially reduced hisor her ability to function independently,appropriately, and effectively in an ageappropriatemanner, and theimpairment(s) met the durationrequirement, we found theimpairment(s) to be of comparableseverity to an impairment that wouldresult in disability in an adult, and thechild would, therefore, be considereddisabled. If the impairment(s) did notsubstantially reduce the child’s abilityto function independently,appropriately, and effectively in an ageappropriatemanner, or if it did not meetthe duration requirement, we found thechild was not disabled. For mostchildren, the rules provided examples ofhow ‘‘marked’’ and ‘‘moderate’’limitations in the domains andbehaviors would indicate whether therewas a substantial reduction infunctioning; for example, ‘‘moderate’’limitations in three domains wouldgenerally, though not invariably, resultin a finding of disability.Summary of the Childhood DisabilityProvisions of Public Law 104–193Public Law 104–193 provides a newstatutory definition of disability forchildren claiming SSI benefits anddirects us to make significant changes inthe way we evaluate childhooddisability claims. Under the new law, achild’s impairment or combination ofimpairments must cause more seriousimpairment-related limitations than theold law and our prior regulationsrequired.Section 211(a) of Public Law 104–193amended section 1614(a)(3) of the Act toprovide a definition of disability forchildren separate from that for adults.The ‘‘comparable severity’’ criterion inthe Act was repealed and replaced withthe following definition:(C)(i) An individual under the age of 18shall be considered disabled for the purposesof this title if that individual has a medicallydeterminable physical or mental impairment,which results in marked and severefunctional limitations, and which can beexpected to result in death or which haslasted or can be expected to last for acontinuous period of not less than 12months.(ii) Notwithstanding clause (i), noindividual under the age of 18 who engagesin substantial gainful activity (determined inaccordance with regulations prescribedpursuant to subparagraph (E)) may beconsidered to be disabled.The conference report thataccompanied Public Law 104–193further explained:The conferees intend that only needychildren with severe disabilities be eligiblefor SSI, and the Listing of Impairments andother current disability determinationregulations as modified by these provisionsproperly reflect the severity of disabilitycontemplated by the new statutorydefinition. In those areas of the Listing thatinvolve domains of functioning, theconferees expect no less than two markedlimitations as the standard for qualification.The conferees are also aware that SSA usesthe term ‘‘severe’’ to often mean ‘‘other thanminor’’ in an initial screening procedure fordisability determination and in other places.The conferees, however, use the term‘‘severe’’ in its common sense meaning.H.R. Conf. Rep. No. 725, 104th Cong.,2d Sess. 328 (1996), reprinted in 1996U.S. Code, Cong. and Ad. News 2649,2716. The House report contains similarlanguage. See H.R. Rep. No. 651, 104thCong., 2d Sess. 1385 (1996), reprinted in1996 U.S. Code, Cong. and Ad. News2183, 2444.Further provisions concerningchildhood disability adjudication aresummarized below with references tothe relevant sections of Public Law 104–193.• The Commissioner was directed toremove references to maladaptivebehavior in the personal/behavioraldomain from listings 112.00C2 and112.02B2c(2) of the childhood mentaldisorders listings (Section 211(b) (1)).• The Commissioner was directed todiscontinue the IFA for children in 20CFR 416.924d and 416.924e (Section211(b) (2)).• Within 1 year after the date ofenactment, we must redetermine theeligibility of individuals under the ageof 18 who were eligible for SSI based ondisability as of August 22, 1996, andwhose eligibility may terminate byreason of the new law. The cases are tobe redetermined using the eligibilitycriteria for new applicants. The medicalimprovement review standard in section1614(a) (4) of the Act and 20 CFR416.994a, used in CDRs, shall not apply