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The Social Security Administration has finalized a major revision to the medical criteria used to evaluate disorders of the immune system. The revision, which will not take effect until June 16, 2008, follows an extensive pre-revision analysis period in which the SSA published a notice of advance rulemaking and held two policy conferences on immune system disorders in the disability programs. The notice of proposed rulemaking was published more than a year and a half ago in August of 2006.
The criteria used to evaluate disorders of the immune system in adults and children appear in the Listing of Impairments (“Listings”) (20 CFR, Part 404, Subpart P, Appendix 1) at Listing §14.00 and §114.00, respectively.
Guidance expanded for evaluating immune system disorders
The revision expands guidance for evaluating immune system disorders. In general, the introductory text in §14.00 and §114.00 of the Listings is expanded and reorganized, and all reference listings are removed because of their redundancy. Reference listings are listings that are met by satisfying criteria of another listing. Instead, general guidance is either provided in the introductory text or new specific listing criteria replace the reference listings. Also added are functional criteria, similar to those in current HIV infection listings §14.08N and §114.080, for each of the other immune system disorders.
Introduction expands from four to 10 sections
The current four paragaraphs, A-D, in the introductory section have been expanded to 10 sections. The first section, §14.00A, provides a brief overview about this body system, including the disorders evaluated under the immune system listings. The next section, §14.00B, explains what information is needed to show the presence of an immune system disorder. Section 14.00C defines important terms used in the immune system listings. Each of the next three sections describes a particular category or type of immune system disorder: Autoimmune disorders (§14.00D); immune deficiency disorders, excluding HIV infection (§14.00E); and HIV infection (§14.00F). The next three sections explain how the SSA considers the effects of treatment (§14.00G), symptoms (§14.00H), and the functional limitations from an immune system disorder under these listings (§14.00I). The last section, §14.00J, explains how the SSA considers the effects of a claimant's immune system disorder when it does not meet the requirements of one of the immune system listings.
In a major change from the current listings, a requirement in §14.00B that there needed to be a longitudinal clinical record of at least three months demonstrating active disease in order to assess severity and duration of the impairment has been removed in an acknowledgment that this requirement is not always necessary.
Revision includes a number of new listings
As the SSA explained in the notice of proposed rulemaking, it has added a number of listings based on repeated manifestations accompanied by functional limitations and modeled after current listing §14.08N for each of the other immune system disorders. The new listings are
l §14.02B —systemic lupus erythematosus (SLE),
l §14.03B —systemic vasculitis,
l §14.04D —systemic sclerosis (scleroderma),
l §14.05E —polymyositis and dermatomyositis,
l §14.06B —undifferentiated and mixed connective tissue disease,
l §14.07C —immune deficiency disorders (other than HIV infection),
l §14.09D —inflammatory arthritis, and
l §14.10B —Sjögren's syndrome.
Each listing requires a claimant to have:
l The specified immune system disorder for that listing;
l Repeated manifestations that do not satisfy the requisite findings of another listing for the specified immune system disorder;
l At least two of the constitutional symptoms or signs, and “marked” limitation in one of three domains of functioning: activities of daily living, social functioning, or completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.
The SSA explains what it means by “repeated” in §14.00I3 and by “marked” in §14.00I4-5.
Changes from proposed regulations
In response to the 55 comments that were received, the final regulations reflect a number of changes from the regulations that appeared in the notice of proposed rulemaking. These changes, along with a review of the comments and the SSA's responses, together with the full text of the final regulations, were published in the March 18, 2008, Federal Register (73 Fed. Reg. 14570).
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