federal register - U.S. Government Printing Office

Federal Register / Vol. 62, No. 28 / Tuesday, February 11, 1997 / Rules and Regulations6425physical and mental functionallimitations, i.e., what a child cannot doas a result of an impairment, thatproduce marked and severe functionallimitations. If the functionallimitation(s) caused by yourimpairment(s) is the same as thedisabling functional limitation(s) causedby a listed impairment, we will find thatyour impairment(s) is equivalent inseverity to that listed impairment, evenif your impairment(s) is not medicallyrelated to the listed impairment. Whenwe make a determination or decisionusing this rule, the primary focus willbe on whether your functionallimitations are disabling, as long asthere is a direct, medically determinablecause for these limitations. As with anydisabling impairment, the durationrequirement must also be met (see§§ 416.909 and 416.924(a)).(b) How we determine functionalequivalence. We will compare anyfunctional limitations resulting fromyour impairment(s) with the disablingfunctional limitations of any listedimpairment in part A or part B of theListing that includes the samefunctional limitations. The listing weuse for comparison need not bemedically related to your impairment(s).In paragraphs (b)(1) through (b)(4) ofthis section we explain the methods wemay use to decide that yourimpairment(s) is functionally equivalentin severity to a listing. There is no setorder in which we must consider thesemethods and we may not consider themall if we find that your impairment(s) isfunctionally equivalent in severity to alisted impairment. We will use anymethod that is appropriate to, or bestdescribes, your impairment(s) andfunctional limitations. However, we willconsider all of the methods before wedetermine that your impairment(s) isnot functionally equivalent in severityto any listed impairment. At the initialand reconsideration levels (except whena disability hearing officer makes thereconsideration determination), we willalso complete a standard form, FormSSA–538, Childhood DisabilityEvaluation Form, to show how wedetermined whether your impairment(s)is functionally equivalent in severity toa listed impairment. (See § 416.924(g).)(1) Limitation of specific functions.We may find that your impairment(s) isfunctionally equivalent in severity to alisted impairment because of extremelimitation of one specific function, suchas walking or talking. (See paragraph (c)of this section for an explanation of theterm ‘‘extreme.’’) Some listings alsoinclude criteria requiring limitation ofmore than one specific function, such aslimitations in walking and talking; eachlimitation in itself is not enough toshow disability, but the combination oflimitations establishes marked andsevere functional limitations. If youhave a limitation of a combination ofspecific functions that are the same asthose in such a listed impairment, wewill find that your impairment(s) isfunctionally equivalent in severity tothat listing.(2) Broad areas of development orfunctioning. Instead of looking atlimitation of specific functions, we mayevaluate the effects of yourimpairment(s) in broad areas ofdevelopment or functioning, such associal functioning, motor functioning, orpersonal functioning (i.e., self-care) anddetermine if your functional limitationsare equivalent in severity to thedisabling functional limitations inlisting 112.12 or listing 112.02. If youhave extreme limitations in one area offunctioning or marked limitation in twoareas of functioning, we will find thatyour impairment(s) is functionallyequivalent in severity to a listedimpairment. We explain the broad areasof development or functioning weconsider and what the terms ‘‘extreme’’and ‘‘marked’’ mean in paragraph (c) ofthis section.(3) Episodic impairments. If you havea chronic impairment(s) that ischaracterized by frequent illnesses orattacks, or be exacerbations andremissions, we may evaluate yourfunctional limitations using themethods in paragraphs (b)(1) and (b)(2)of this section. However, yourfunctional limitations may vary and wemay not be able to use the methods inparagraphs (b)(1) and (b)(2) of thissection. Instead, we may compare yourfunctional limitation(s) to those in anylisting for a chronic impairment withsimilar episodic criteria to determine ifyour impairment(s) has such a seriousimpact on your functioning over timethat it is functionally equivalent inseverity to one of those listings.Limitations that are characteristic ofepisodic impairments are notnecessarily related to a single, specificfunction. Episodes of disablingfunctional limitations may occur withspecified frequency despite treatment. Ifyour episodic impairment(s) producesdisabling functional limitations that arethe same as the disabling functionallimitations of a listed impairment withsimilar episodic criteria, we will findthat you are disabled even though youmay be able to function adequatelybetween episodes.(4) Limitations related to treatment ormedication effects. Some impairmentsrequire treatment over a long period oftime (i.e., at least a year) and thetreatment itself (e.g., multiple surgeries)causes marked and severe functionallimitations. Marked and severefunctional limitations may also resultfrom the combined effects of limitationscaused by ongoing treatment andlimitations caused by an impairment(s).In many cases, we will be able toevaluate such limitations using themethods for evaluating specificfunctions or broad areas of developmentor functioning in paragraphs (b)(1) and(b)(2) of this section. But we may alsocompare your functional limitations(s)to criteria in listings based on treatment(including side effects of medication)that is itself disabling or that contributesto functional limitations. If treatment ofyour impairment(s) produces functionallimitations that are the same as thedisabling functional limitations of alisted impairment, we will find thatyour impairment(s) is functionallyequivalent in severity to that listing.(c) Broad areas of development orfunctioning. When we determinefunctional equivalence based on broadareas of development or functioning, wewill evaluate the functional effects ofyour impairment(s) in several areas ofdevelopment or functioning todetermine if your functional limitationsare equivalent in severity to thedisabling functional limitations oflisting 112.12 or listing 112.02.However, instead of referring to theareas of development or functioning inthose listings, we will refer to the areasof development or functioningdescribed in paragraphs (c)(4) and (c)(5)of this section. (We describe the areas ingeneral terms in paragraph (c)(4) andthen in detail as they apply to specificage groups in paragraph (c)(5).) If youhave marked limitations in two areas ofdevelopment or functioning, or extremelimitation in one area, we will find thatyour impairment(s) is functionallyequivalent in severity to listing 112.12or listing 112.02, even if yourimpairment(s) is a physicalimpairment(s) or a combination ofphysical and mental impairments. Weexplain the meaning of the terms‘‘marked limitation’’ and ‘‘extremelimitation’’ in paragraph (c)(3) of thissection.(1) How we use the areas ofdevelopment or functioning. (i) Whenwe make a finding about functionalequivalence, we will consider the extentof your functional limitations in theareas affected by your impairment(s).We will also consider how yourlimitation(s) in one area affects yourdevelopment or functioning in otherareas.(ii) In some children, some physicalimpairments will be evaluated most