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Federal Register / Vol. 62, No. 28 / Tuesday, February 11, 1997 / Rules and Regulations6413one such area. However, we also explainthat when we decide whether a child’simpairment(s) meets the requirementsfor any listed impairment, we willdecide that the impairment is of‘‘listing-level severity’’ even if it doesnot result in marked limitations in twobroad areas of functioning, or extremelimitations in one such area, if thelisting that we apply does not requiresuch limitations to establish that animpairment(s) is disabling. We alsoexplain that we define the terms‘‘marked’’ and ‘‘extreme’’ as they applyto children in § 416.926a.Section 416.926 Medical Equivalencefor Adults and ChildrenIn these interim final rules, we movedthe rules for deciding whether a child’simpairment(s) is medically equivalentin severity to any listing into the samesection as the rules for deciding medicalequivalence of impairments in adults,reserving § 416.926a for functionalequivalence. To make this clear, werevised the heading of final § 416.926 toreflect the inclusion of children. Wealso revised final paragraph (a), ‘‘Howmedical equivalence is determined,’’ byreplacing the explanation of how wedetermine medical equivalence withprovisions from prior § 416.926a. Wealso incorporated and revised the lastsentence of prior § 416.926a(a),explaining that we consider all relevantevidence in the case record when wedecide the issue of medical equivalencebecause it remains applicable to bothadults and children.We decided to use the provisions offormer § 416.926a(b) to explain our rulesfor determining medical equivalence forboth adults and children. This is not asubstantive change, but a clearerstatement of our longstanding policy onmedical equivalence than waspreviously included in prior§ 416.926(a), as it was clarified forchildren in prior § 416.926a(b). Thismerely allows us to address only oncein our regulations the policy of medicalequivalence, which is and always hasbeen the same for adults and children.(Although some of the text of§ 416.929(a) will differ from the text of§ 404.1526(a), both sections, which arein chapter III of title 20 of the Code ofFederal Regulations, will continue toprovide the same substantive rules.)We have also added a new paragraph(d), ‘‘Responsibility for determiningmedical equivalence,’’ to address ourlongstanding policy of who isresponsible for determining medicalequivalence for adults and children.Section 416.926a FunctionalEquivalence for ChildrenAlthough Public Law 104–193discontinued the use of the IFA, thelegislation nevertheless emphasized thatwe were still to continue evaluating thefunctioning of children in our disabilityassessments, as shown by the newsstatutory definition of disability,‘‘marked and severe functionallimitations.’’Moreover, in the legislative history,the conferees stated:* * * Where appropriate, the confereesremind SSA of the importance of the use offunctional equivalence disabilitydetermination procedures.* * * [T]he conferees do not intend tosuggest by this definition of childhooddisability that every child need be especiallyevaluated for functional limitations, or thatthis definition creates a supposition for anysuch examination. * * * Nonetheless, theconferees do not intend to limit the use offunctional information, if reflecting sufficientseverity and is otherwise appropriate.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 also containedsimilar language about the importanceof functional information. See H.R. Rep.No. 651, 104th Cong., 2d Sess. 1385–1386 (1996), reprinted in 1996 U.S.Code, Cong. and Ad. News 2183, 2444–2445.Thus, even though it eliminated theIFA, Congress directed us to continue toevaluate a child’s functional limitationswhere appropriate, albeit using a higherlevel of severity than under the formerIFA. Congress also explicitly endorsedour functional equivalence policy as ameans for evaluating impairments thatwould not meet or medically equal anyof our listings and without which someneedy children with severe disabilitieswould not be eligible.Therefore, we are retaining our priorpolicies on determining functionalequivalence. Because the changes madeby Public Law 104–193 make thefunctional equivalence provision thatlast point of adjudication in a child’sclaim and, therefore, critical to theoutcome of many cases, we are alsoclarifying these rules.When we published the prior rules inthe Federal Register on September 9,1993, we chose not to adopt a numberof public comments about our policy of‘‘functional equivalence.’’ Somecommenters on the 1993 rules thoughtthat, because the functional equivalencepolicy was unfamiliar, it was importantthat we provide as much detail aspossible in the regulations so that alladjudicators would understand andapply the new rules in the same way.Several commenters also said that§ 416.926a should explain the ‘‘thoughtprocesses’’ an adjudicator could employto make a finding of functionalequivalence; otherwise, the policy offunctional equivalence might be underutilized.One suggestion was that weincorporate into the rules the moredetailed instructions in our operatingmanuals and training guides. Onecommenter suggested that we provideseparate headings for medicalequivalence and functional equivalenceto highlight their differences and thenovelty of the functional equivalencepolicy.Although we did not adopt thecomments in 1993, we have madechanges in these rules that respond tosome of the earlier concerns of 1993 toreflect the increased importance of thefunctional equivalence policy under thenew law.First, as noted in the explanation of§ 416.926, we have separated thediscussion of medical equivalence forchildren from the discussion offunctional equivalence for children. Wehave also incorporated some of the moredetailed explanations from ouroperating manuals regarding theapplication of functional equivalence.Final paragraph (a), ‘‘General,’’ andfinal paragraph (b), ‘‘How we determinefunctional equivalence,’’ now include,in reorganized form, the rules forfunctional equivalence previously in§ 416.926a(a) and (b)(3). As alreadyindicated, we moved prior (b)(1) and(b)(2), which explained medicalequivalence, to § 416.926. Because ofthe reorganization, we deleted thesecond sentence from prior paragraph(b)(3) (‘‘If you have more than oneimpairment, we will consider thecombined effects of all yourimpairments on your overallfunctioning.’’) because it would havebeen redundant.In final paragraph (b), we alsoincluded some of the more detailedguidelines concerning functionalequivalence that commenters on the1993 childhood disability rulesrequested that we include in theregulations, and that we believe arenecessitated by the new definition ofdisability. This paragraph explains thatthere are several methods fordetermining functional equivalence, andthat we may use any one of them todetermine whether an impairment isfunctionally equivalent in severity to alisting. Subparagraphs then explain thevarious methods that we may employ todetermine functional equivalence. Weexplain that there is no set order inwhich we must apply these methodsand that, when we find that an