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6414 Federal Register / Vol. 62, No. 28 / Tuesday, February 11, 1997 / Rules and Regulationsimpairment(s) is functionally equivalentto a listed impairment, we will use anymethod that is appropriate to, or bestdescribes, a child’s impairment(s) andfunctional limitations. However, weexplain that will consider all of themethods before we decide that animpairment(s) is not functionallyequivalent in severity to any listedimpairment and refer to final§ 416.924(g), which explains how wewill use the new Childhood DisabilityEvaluation Form, Form SSA–538, at theinitial and reconsideration levels.In (b)(1), we explain the first methodwe may use. An impairment(s) may befunctionally equivalent in severity to alisted impairment because of extremelimitations in one specific function,such as walking or talking, or based ona combination or more than one, butless medically severe, specificfunctional limitations, such as walkingand talking. In (b)(2), we explain that animpairment(s) may be functionallyequivalent to a listed impairment if itcauses functional limitations in broadareas of development or functioning(e.g., in motor or social functioning) thatare equivalent in severity to thedisabling functional limitations inlisting 112.12 or listing 112.02. (Theareas of functioning in which animpairment(s) may be evaluate arediscussed in paragraph (c), describedbelow.) In (b)(3), we explain that animpairment(s) may be functionallyequivalent to a listed impairment if it ischronic and characterized by frequentepisodes of illness or attacks, or byexacerbations and remissions. In suchcases, we may compare a child’sfunctional limitations to those in anylisting for a chronic impairment withsimilar episodic criteria. In (b)(4), weexplain that an impairment(s) may befunctionally equivalent to a listedimpairment if it requires treatment overa long period of time (at least a year)and the treatment itself (e.g., multiplesurgeries) causes marked and severefunctional limitations, or if thecombined effects of limitations causedby ongoing treatment and limitationscaused by the impairment(s) result inmarked and severe functionallimitations.In final paragraph (c), ‘‘Board areas ofdevelopment or functioning,’’ weexplain that listing 112.12, for infants(especially infants who are too young totest) and listing 112.02 are the listingswe will use for comparison when weuse this method of functionalequivalence. However, when wedetermine functional equivalence basedon broad functional limitations, we willevaluate the functional effects of animpairment(s) in several areas ofdevelopment or functioning specified inthis paragraph of § 416.926a instead ofreferring to the listings themselves. Wealso explain that we describe the areasof functioning in general terms in (c)(4)and in more detail for specific agegroups in (c)(5). If we find ‘‘markedlimitations’’ in two areas ofdevelopment or functioning, or‘‘extreme limitations’’ in one area, wewill find that an impairment(s) isfunctionally equivalent to listing 112.12or listing 112.02. Even though thelistings we use for reference are mentaldisorder listings, this evaluation may bedone for a physical impairment(s) or fora combination of physical and mentalimpairments. We define the terms‘‘marked limitations’’ and ‘‘extremelimitations’’ in (c)(3).In (c)(1), we explain how we use theareas of development or functioning: Weconsider the extent of functionallimitations in the areas affected by animpairment(s) and how limitations inone area affect development orfunctioning in other areas. Thus, whena physical impairment(s) producesglobal limitations (i.e., limitations in themotor area and at least one other area),those limitations must be evaluated inall relevant areas. We also makereference to new areas of motordevelopment and functioning we haveadded to ensure appropriateconsideration of physical impairments.In (c)(2), ‘‘Other considerations,’’ weexplain that we will consider allinformation in the case record that willhelp us determine the effect of animpairment(s) on a child’s physical andmental functioning. We will considerthe nature of the impairment(s), thechild’s age, the child’s ability to betested given his or her age, the child’sneed for help from others (and whethersuch need is age-appropriate), and otherrelevant factors.In (c)(3), we define the terms‘‘marked’’ and ‘‘extreme’’ limitations.The definitions are not new, but arebased on longstanding policy in theregulations and interpretations we haveused in our internal instructions andtraining. In (c)(4) and (c)(5), we describethe areas of development or functioningthat may be addressed in adetermination of functionalequivalence, including the new areas ofmotor development and motorfunctioning and the revised ‘‘personal’’area of functioning. The descriptions arebased on our prior descriptions andchanges mandated by Public Law 104–193, and contain several clarificationsbased on our experience evaluatingfunctional equivalence in children since1991.Final paragraph (d), ‘‘Examples ofimpairments that are functionallyequivalent in severity to a listedimpairment,’’ is substantively the sameas prior paragraph (d), ‘‘Examples ofimpairments of children that arefunctionally equivalent to the listings.’’We made minor editorial changes forclarity and, as throughout the rules, toconform the language to the changes inthe law. We also updated examples (1)and (11) to remove examples ofcardiovascular impairments that arenow listed impairments and, therefore,no longer examples of equivalence. Wechanged example (4) to delete referenceto a ‘‘marked inability to stand andwalk’’ because the limitation describedis actually ‘‘extreme.’’ We changedexample (5) to show how the area ofmotor functioning may be used. We alsoclarified the primary purpose ofexample (10), which is primarily forchildren who are too young to test andfor whom a diagnosis and other medicalfindings may be difficult to specify.Section 416.927 Evaluating MedicalOpinions About Your Impairment(s) orDisabilityWe have added a description of the‘‘marked and severe functionallimitations’’ standard for children toparagraph (a), ‘‘General,’’ which alreadyincluded a description of the disabilitystandard for adults.Section 416.929 How We EvaluateSymptoms, Including PainThroughout this section, we havereplaced references to a child’s ability to‘‘function independently, appropriately,and effectively in an age-appropriatemanner’’ with references to the child’s‘‘functioning.’’ The rules for evaluatinga child’s symptoms are otherwiseunchanged by the new law.Section 416.930 Need To FollowPrescribed TreatmentThis section explains that, in order toreceive benefits, an individual mustfollow treatment prescribed by his orher physician if the treatment canrestore his or her ability to work; i.e., ifthe treatment could end the individual’sdisability. We have added parallellanguage explaining that a child mustfollow prescribed treatment if thetreatment can reduce his or herfunctional limitations so that they areno longer ‘‘marked and severe.’’Section 416.987 DisabilityRedeterminations for Individuals WhoAttain Age 18This section is new. It provides rulesfor disability redeterminations